When parents have a question about enrolling their child in kindergarten, the first stop is usually their local school. Decades of policy have created a system of neighborhood schools that are easy to find and equipped to enroll any child of the right age who walks through their doors. Oregon parents who need help while they’re pregnant or have a newborn or toddler face a far more muddled path to getting help. “We don’t have anything like that for this really critical timeline for the first 1,000 days” of a child’s life, said Chelsea King, executive director of the Oregon Health and Education Collaborative. The Collaborative — a group of education and health care advocates, including a former governor — want to change that for Oregon’s next generation. They’ve launched an effort called the Upstream Initiative which is intended to bring health care and education providers together to support families during pregnancy and during the first three years of a child’s life. That could mean new in-home visit programs for parents after welcoming a new baby, help locating mental health or addiction treatment, emergency child care, early access to disability screenings or a variety of other help. “Families feel isolated, don’t know where to turn, don’t have those supports,” said Lisa Harnisch, executive director of the Marion Polk Early Learning Hub.  The Salem-based hub is one of five organizations in communities across Oregon that spent the past year creating a plan for “child success” focused on improving issues that currently stop families from getting help with stresses and health issues. King said currently, families with young children often turn to Facebook groups or other informal networks seeking emergency child care or information about disability screenings. “They are relying on social media and just talking to their neighbors because there isn’t a known infrastructure,” she said. In Salem, the hub identified key challenges they want to address: Aid for children with developmental delays or other disabilities is reactive, often only helping families with assessment and resources well after a child shows clear signs of needing help, ultimately increasing the cost of support. Outdated technology and poor information-sharing are a challenge across family and child services, which means workers spend more time completing administrative tasks than necessary and are able to help fewer families. Providers often lack the training needed to help families from different cultures or backgrounds than their own. Many health care providers don’t know how to refer families to other programs that might help them, leaving families on their own to juggle various appointments and visits. “This fragmentation not only inconveniences families but also poses serious health risks. Families often travel long distances between service providers or face long wait times for essential services, compounding their challenges and leading to delayed or missed care,” the report says. The hub’s plan calls for hiring community health workers who are trusted by the people they serve, developing new programs like extended home visiting after birth and postpartum mental health services, and creating one-stop locations where families can get a variety of services. Harnisch said they intend to begin chipping away at it in 2025, building partnerships with PacificSource and the Willamette Health Council and offering training for health care providers to begin addressing some of the issues. But making significant changes will take state investment, she said. Upstream focus Former Gov. John Kitzhaber is among the leaders of the Upstream Initiative, which he said builds on two key achievements from his time as governor. While in office, he spearheaded the creation of Early Learning Hubs, which were intended to connect and coordinate child care and preschool programs.  He was also the architect of the state’s coordinated care organizations — regional groups that manage care for Oregon Health Plan members and have a mandate to prevent disease and help people manage chronic illness. Now, he chairs the board for the Collaborative.  The idea is to make it easier for parents struggling with issues like poverty, addiction, limited access to food and mental health challenges to get support early, preventing costlier problems down the road. “My perspective comes partly from my career as an ER doc, where I began to see a lot of medical problems that were the result of social issues,” he said. “We treat the medical problems that send people back to the same community, same circumstances, and then we’re surprised to see them back in the ER again.” He said there’s a growing body of genetic research showing that stress, nutrition and other biological factors affecting parents even before conception can alter their children’s genetic expression, making them more susceptible to behavioral issues, addiction and chronic illness. “The evidence is really just overwhelming,” he said. That’s led to a growing awareness in both education and health care that helping families even before children get to preschool is crucial to children’s eventual success. “We’ve spent a lot of time and money and resources on trying to reunite kids in foster care, dealing with mental health issues … things that have their roots very, very early. And so the notion is to try to actually go as far up the stream as we can and actually try to prevent these problems from happening,” he said. An early model A southern Oregon program offers one model for a childhood success program. Southern Oregon Success has brought more than a dozen health care and social service agencies together in Jackson and Josephine counties.  Families who are expecting or have a young child can get referred through their doctor’s office or another health care provider, and work on developing a family success plan. From there, they’re able to get services from the network. That could be as simple as a few home visits after birth to check in on the family and help them find affordable child care, or a more intensive home visit schedule with a nurse, plus mental health treatment for parents. The program served 72 families last year and received about $100,000 from a mix of state and local agencies and health care providers. Most of that money was given directly to families to help them meet their goals. It’s led by former state Rep. Peter Buckley, who spent years helping craft budgets in the Legislature. “Every time you keep a child out of the child welfare system, you’re saving the state significant dollars and you’re getting a better outcome for that child,” Buckley said. In Salem, Harnisch, the Early Learning Hub director, wants her organization to play a similar role. “It’s not just about the hub but about us bringing people together to work on the perinatal system,” she said. Kitzhaber said he’s working with Sen. Lisa Reynolds, D-Portland — a pediatrician and longtime advocate for children — for money that could help implement child success plans in communities like Salem that have proposals. Reynolds has proposed a “Momnibus” bill that would provide money for treatment and support for new parents, particularly mothers. Harnisch is hopeful such money could help fund family navigators and new programs, as well as work to improve information-sharing. But Kitzhaber said the beauty of locally designed plans is that communities can work on what’s most important to them, and pursue private and philanthropic sponsorship to make changes.  “We’re trying to focus on what you can actually do at the community level,” he said. Contact reporter Rachel Alexander: [email protected] or 503-575-1241. A MOMENT MORE, PLEASE– If you found this story useful, consider subscribing to Salem Reporter if you don’t already. Work such as this, done by local professionals, depends on community support from subscribers. 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