Prenatal to Three - A Study Overview

Charlotte is one of the fastest growing cities in
the U.S. but ranked as the least economically
mobile, with 41% of all young children living in
low-income households. The goal of this project was
to provide a comprehensive, baseline inventory of
family services and supports in Mecklenburg County
for families expecting a child or with a child under the
age of 3. Through this research, we sought to identify
gaps and opportunities in service access and referral
processes, provide recommendations for improving
family utilization of relevant services, and support
Mecklenburg County efforts to address the needs of
families with young children, particularly those from
underserved and marginalized communities.
Families need a village of support to promote
healthy child development for their young children.
For low-income and racial/ethnic minority families,
in particular, multiple unmet health needs are
apparent from children’s conception through their
development. For example, within Mecklenburg
County, access to prenatal care has been declining
over the past decade, with only 64% of expectant
mothers receiving adequate prenatal care.
To optimally support infant and young children’s
health and development, families require a
comprehensive and well-coordinated prenatal to
age 3 (PN-3) system of care that reflects the multiple
contexts within which they are embedded. Yet
families face considerable barriers in navigating a
complicated and often disparate set of family and
early childhood services to address the physical
and social-emotional needs of their young children,
which in turn reduces their capacity to utilize
individual services.
Children aged 0 to 3 make up a sizable share of
Mecklenburg County’s total population. According to
the most recent micro-level U.S. Census estimates,
5.4% of Mecklenburg County’s total population
is age 3 or younger; this translates to 58,867
children. Moreover, young children are changing
the face of Mecklenburg County, given that they are
more racially/ethnically diverse than the population
as a whole.
“That statement – ‘it
takes a village’ – it
really does, if you
want a successful
child and not just a
statistic.”
– Charlotte parent and focus group
participant
Mecklenburg County’s Racial and Ethnic Composition
Non-Hispanic White
Non-Hispanic Black
Hispanic
Other Race/Ethnicity
50%
40%
30%
20%
10%
42%
31%
14% 13%
37%
29%
21%
13%
38%
31%
22%
9%
0%
Total Population Age 0-3 Population All New Births
Source: American Community Survey/IPUMS 2018; NC Vital Statistics 2019

Raising young children requires financial
resources to invest in and support child
development. However, 41% of children
ages 0-3 in Mecklenburg County live in households
where economic resources are highly strained.
Approximately 24,136 young children live in families
where the household income is at or below 200%
of the federal poverty level (FPL), which means for
a family of four, the family makes $53,000 a year
or less. Furthermore, 21% (approximately 12,362
young children in Mecklenburg County), face even
greater financial strain as they live in families in
which the household income is at or below 100% of
the FPL, or $26,500 or less for a family of four.
Although Mecklenburg County’s young child
population is racially/ethnically diverse, those in
need are not. Non-Hispanic Black and Hispanic/
Latino children make up nearly 80% of young
children living in households with financial need.
41% of children ages
0-3 in Mecklenburg
County live in
households where
economic resources
are highly strained.
Mecklenburg County’s Child Age 3-0 Population
Economic & Racial/Ethnic Composition
Non-Hispanic White
Non-Hispanic Black
Hispanic
Other Race/Ethnicity
60%
50%
40%
30%
55%
43%
36%
20%
10%
20%
11% 15%
12%
41% 37%
11% 12%
9%
0%
Above 200% FPL
Low Income
(

Service Inventory
The Landscape Analysis reflects three key domains of services for young children,
their parents, and their families:
1 2 3
Health
Services
Early Care
and Education
Services
Food &
Tangible
Supports
Health Services Overview
The health services that children are likely
to need between birth and 3 years of age
are pediatric care, early intervention and
behavioral health support.
• Pediatric care was defined as services that focus
on the child’s physical health and well-being,
including preventive care as well as the diagnosis
and treatment of infections, injuries and diseases.
Pediatric Care Landscape Map – Density
• Early intervention (EI) services are services and
supports available to children aged 3 years and
younger who have a documented developmental
delay or disability.
• Child behavioral health primarily focuses on
strengthening the parent-child relationship,
fostering positive family interactions and shaping
parenting practices and behavior so that parents
can help their children better manage their
emotions, form close relationships and explore
the environment and learn.
Behavioral Health Landscape Map – Density

Early Care and Education
Services Overview
The Early Care and Education domain
includes resources and supports associated
with keeping young children healthy and
safe, nurturing secure attachment relationships
between children and caregivers, promoting
children’s cognitive, language, and social-emotional
development and fostering family well-being. Early
care and education services that children PN-3 are
likely to need were categorized as literacy support,
childcare and Early Head Start.
• Literacy support was defined as any program
that encourages parents to read with their
young children. Most of the literacy programs in
Mecklenburg County are national programs that
partner with local sites.
• Childcare sites included center- and familybased
care available for children between birth
and age 3. In total, there are 449 childcare sites
that serve this group, and 63% are 4- and 5-star
sites.
• Early Head Start is a federal program for
families from low-income households designed
to promote the development of infants and
toddlers as well as help parents meet goals for
housing, employment, education and financial
stability.
Nutrition/Food & Tangible
Support Services
The Nutrition/Food and Tangible Support includes
services that can benefit the whole family. For
Nutrition/Food, we included lactation supports,
the WIC program and a number of faith-based and
nonprofit organizations that help provide food
to families with young children. We identified 66
such programs. For Tangible Support, we included
organizations that provide items relevant for
families with young children, including baby clothes
and furniture, diapers and other supplies. There are
33 of these services in Mecklenburg County.

Key Lessons and Takeaways
As part of the landscape study, focus groups were held with parents/caregivers and service providers
were interviewed. Here are some of the key takeaways from those conversations.
Family Strengths
Multiple strengths were identified that help
families raise young children in Charlotte.
Those strengths include:
• Tenacity – Across focus groups, parents
described how they had to fight through red
tape and barriers to get their children services.
• Willingness to invest in children – Parents
investment in their children was evidenced in
various ways, including spending quality time
with their children, being present for school and
other events, and fighting for their children’s
rights and equal treatment.
• Supporting one another – Families who are
especially skilled at accessing and providing
support fared better than those who were more
isolated.
“I’ve learned you
have to stay on top
of it until you get an
answer, and even
then, when you get an
answer, if that’s not
accommodating you
and your child, you
keep pushing through
until you get what you
need because they’re
not just going to hand
it to you.”
– Focus Group Participant

Needs & Challenges
There are multiple factors and conditions
that can influence and interfere with service
utilization for families with young children in
Mecklenburg County.
• Financial strain – Economic instability and
financial stress emerged as the biggest challenge
facing parents with young children.
• Inadequate play spaces for children – Across
focus groups, parents discussed the lack of safe
and well-kept spaces for the children to play.
• Uncertainty about child health and
development – Parents and service providers
discussed the need for greater parent education
in effective caregiving techniques.
• Unmet mental health needs among parents –
Throughout the focus groups, parents discussed
their own difficulties with mental health.
“Parents have to work
multiple jobs to survive
and afford housing. Child
development is at the bottom
of the list.”
– Focus group participant
“One thing happens and
financially, they get behind.
It could be a car issue or
they’re sick for a week, and
so they lose a week’s worth
of wages. I think it’s those
little gaps that keep parents
barely above survival.”
– Service Provider
Factors Influencing
Family Service Access
Parents and service providers described several
factors that more directly impact parents’ ability
to access services, supports and resources.
• Communication and logistical concerns –
Participants reported that word of mouth was
the primary way by which they learned about
resources. While this can be an effective way of
locating services for some families, it compounds
the disadvantages faced by low-income families
or those who do not have a local network.
• Service policies and procedures – Parents
often said the eligibility requirements for
accessing services to be too stringent or unclear.
Misunderstandings regarding eligibility are of
particular concern for Hispanic/Latino immigrant
families due to inconsistencies between local and
federal policies as well as fear of deportation.
• Family experiences when accessing services –
Parents stated they are more likely to access
services when they perceive the organization to
be helpful in meeting the need identified by the
family. This includes providing services that are
culturally sensitive and relevant. This is especially
important for Hispanic/Latino families.

Stakeholder Generated
Recommendations:
Strengthening Systems of Care for Families with Young Children
Recommendations generated by participant
stakeholders reflected 3 main categories:
(1) Implement collaborative and
comprehensive PN-3 service models
for meeting the diverse needs of
families
a. Improve inter-agency communication and
collaboration.
b. Address basic needs and build a social and
economic safety net for families.
c. Increase access to affordable childcare options.
d. Utilize a multigenerational, whole family
approach to quality care that is responsive to
parent needs and preferences.
“Let’s not reinvent the wheel,
let’s reinforce the wheel that
already exists”
–Service Provider
(2) Strengthen efforts at outreach
and access to quality services.
a. Enhance outreach.
b. Develop a community presence.
c. Investigate the feasibility of creating and
sustaining a searchable community database of
PN-3 services for parents and providers to use.
d. Build evaluation capacity.
e. Increase home visiting services.
f. Invest in quality behavioral health support for
children and families.
(3) Foster culturally sensitive and
responsive care
a. Build a workforce that mirrors the cultural
backgrounds of the families served.
b. Develop trusted partners to help families
navigate the systems and prepare for the future.
c. Build community trust and strengthen
relationships with families.