Invest In Kids (IIK) knows—based on evidence and experience—that investing in young children and families is the best way to strengthen communities today and for future generations. As the bridge between research and practice, IIK leverages the power of evidence-based programs to make the largest possible difference for Colorado children and their families. Two programs implemented by IIK are of great interest to the Elsa & Peter Soderberg Charitable Foundation: Nurse-Family Partnership and Child First.

Nurse-Family Partnership® connects highly trained RNs with first-time pregnant people, caregivers' and their babies beginning in pregnancy. Through a relationship-based program, NFP empowers people to transform their lives and create better futures for themselves and their babies. With over four decades of research, NFP has consistently proven its effectiveness in meeting its goals: providing improved pregnancy outcomes, promotion of child health and development, and the encouragement of economic self-sufficiency for families.

Child First® is IIK’s newest evidence-based program. With a dearth of mental-health services available in Colorado, the Children’s Hospital Colorado announcing a Mental Health State of Emergency in May 2021, and the COVID-19 pandemic, the time seemed ripe to bring CF to Colorado. This two-generation model works with young children and families, providing intensive, home-based services that support families in building strong, nurturing relationships that heal and protect young children from the devastating impact of trauma and chronic stress. 

In 2021, the EPSCF provided a pilot grant to take the successful Referral Express and Central Hub (REACH) project state-wide. Tested in the Denver Metro area, the vision for REACH was to create a central hub where outreach and referrals could be handled with the goal of interrupting inefficient, inconsistent, and duplicative systems of case-building. At the time, activities such as outreach, partnership building, case finding, referral tracking, and program messaging were taking supervisors and nurse-home visitors away from their core duties serving children and families. At the same time REACH was expanding state-wide, IIK would build the awareness and recruitment for their new Child First program.

This work had an immediate impact on families in Colorado. Child First launched services in July 2021, and the program served 199 children and their caregivers in the 2021-22 program year. Child First in Colorado started with 32 staff members from four implementing agencies, consisting of two community mental health centers and two non-profit mental health agencies. The REACH program allowed IIK to build a strong and reliable referral base and to invest in key community partnerships and processes. IIK was able to increase the number of children served by 83% from our first to last quarters of the project.

Unfortunately, IIK was not immune to the nursing workforce crisis that worsened during the pandemic. IIK was forced to shift the focus of REACH to nurse recruitment. At the project midpoint, IIK reported an unprecedented 16% turnover rate between October 2021 and March 2022 which increased to 23% by the end of the one-year pilot project.

Addressing Workforce Challenges

The success of the REACH expansion made clear how dire the workforce issues are across the state. REACH’s success in increasing of the number of eligible families referred to IIK’s programs for critical support highlighted the urgent need to attract and retain first-rate professionals in the early childhood fields of public health nursing and mental health. Qualified workforce and the ability to serve clients are inexorably linked. REACH efforts combined with the impact of the pandemic on an already fragile safety net system has caused providers to experience unprecedented challenges in recruiting and retaining qualified professionals. Through partnership with local providers and broader collaboration with community partners, IIK decided to develop their first ever Workforce Initiative, FORRCE (Finding Opportunities in Recruitment and Retention for our Colorado Experts).

In 2023, EPSCF provided one year of funding support IIK, local providers, and community partners to investigate and address the issues that are impeding early childhood workforce. IIK hired a consultant, Prosono, to draft an implementation plan focused on workforce issues associated with pipeline and recruitment. Prosono and IIK used a phased approach: defining the problem, selecting priority pillars, conducting research, and developing recommendations. Engagement with stakeholders provided insights into opportunities and limitations, particularly for pipeline development in NFP and CF. For NFP, strategies focus on building partnerships with post-secondary institutions and increasing awareness among nursing students. For CF, strategies include advocating for Medicaid reimbursement, state agency ownership of Infant and Early Childhood Mental Health (IECMH), and integrating IECMH into postsecondary education.

In 2024, EPSCF committed one year of funding to support the rollout of recruitment and pipelines strategies as outlined in FORRCE. Highlights from the first six months include:

Nurse-Family Partnership (NFP):

• Gap Analysis Completed: IIK conducted workforce gap assessments across 21 NFP sites, identifying 7 that are eager to participate in the FORRCE Roll-Out.

• Education Partner Engagement: IIK has initiated relationships with Colorado University of Anschutz and Fort Lewis College to support BSN student pipelines.

• Training Resource Development: Information is being gathered to create sustainable partnership frameworks between education providers and NFP agencies.

• Agency Recruitment Phase: The formal invitation to participating agencies will begin following completion of foundational work.

Child First (CF):

• IECMH Coalition Building: IIK participated in 12+ statewide and national convenings, increasing visibility and policy influence. Their VP of Community Partnerships helped lead the development of the 2025–2030 IECMH strategic plan, which was endorsed by the state Early Childhood Leadership Commission.

• Medicaid Advocacy: IIK shifted advocacy strategies to align with a new state Medicaid System of Care, aiming to secure sustainable reimbursement for CF services.

• Policy Progress: Meetings with Medicaid consultants are underway; strategic adjustments are being made in response to shifting state health administration priorities.

State and Federal Policy Context:

• State Budget Victory: Despite over $1B in budget cuts, IIK successfully preserved funding for CF and NFP through targeted legislative advocacy.

• Federal Challenges: IIK is navigating instability caused by proposed Medicaid cuts, rollbacks on federal workforce programs, and a climate of political resistance to public health initiatives.

Strategic Partnerships and Opportunities:

IIK is in active conversation with the Colorado Equitable Economic Mobility Initiative (CEEMI) and Arnold Ventures about shaping the $20M “Colorado Partnership for Proven Programs” to include community health nursing and IECMH roles.