The number of interventions focused on early language development in young children has increased over the past decade. There is a paucity of research on the adoption and implementation of these programs in real-world community settings. This study presents findings from qualitative interviews with leadership, staff, and past participants of a community-based early language development intervention. Themes related to program implementation challenges and solutions are presented. Previous program participants (n=16) identified facilitators and barriers to successful program implementation and provided specific recommendations for program improvements. Interviews with the program leadership and staff (n=6) revealed two main themes: Servant leadership and implementation facilitators. Servant leadership, perseverance and dedication to the families and community, was the premise on which the majority of the program successes could be attributed. The curriculum and structure of the program are important, but based upon the leadership and staff interviews, it is apparent that beyond the content and curriculum, relationships and addressing needs of participants are critical to achieving the goals of the program. Implementation in real-world contexts may require adaptations and enhancements of community-based programs, while maintaining fidelity to core program components, to successfully reach the targeted population and achieve program related outcomes.

Key Take Away Points

  • Challenges encountered during program startup and program growth and dissemination phases were different.
  • The servant leadership philosophy and dedication that flowed from it informed almost every aspect of the program from start-up through growth and dissemination.
  • In real-world contexts, program adaptations and enhancements may be needed to successfully implement community-based programs.

Author Biography

Cary M. Cain, PhD, MPH, RN Cary Cain is an Assistant Professor in the Department of Pediatrics at Baylor College of Medicine and a Robert Wood Johnson Foundation Future of Nursing Scholar Alumni. Dr. Cain conducts the evaluation of the Texas Children's Hospital upWORDS program. She also analyzes data to understand and address gaps resulting from familial, educational, and societal systems that fail to create conditions that promote healthy development for young children. Her research interests are in the prevention of childhood adversity through addressing shared risk and protective factors such as social determinants of health, early brain development, and parental support. Kimberly Kay Lopez, DrPH Dr. Kimberly Kay Lopez earned a Bachelor of Arts in Anthropology from the University of Houston, a Master's in Public Health in Community Health Practice and a Doctorate in Public Health in Management, Policy and Community Health from The University of Texas School of Public Health-Houston. Dr. Lopez's research interests include the effects of adversities on children, families, and communities. Her areas of expertise include maternal/child health, community assessment, and qualitative research methods. Dr. Lopez works with communities and vulnerable populations to identify health issues of concern and to develop solutions from within the community. She has more than twenty-five years experience engaging community and vulnerable populations in research and advocacy and developing strategic partnerships and action-oriented collaboratives to address health disparities and improve outcomes for children and families. Currently, Dr. Lopez is leading a research initiative designed to evaluate maternal support programs for mothers of newborns and infants; conducting an assessment of the health and medical needs of children in foster care, and bringing to scale a community-based early brain/language development program in underserved communities. As Director Public Health and the Center for the Study of Adversity, Resilience, and Education, Dr. Lopez leads the application of a public health framework to inward and outward facing research and program initiatives designed to improve maternal child health outcomes. Dr. Lopez and her team design, implement and evaluate innovative strategies, programs, policies, and practices to mitigate childhood and community adversities and to promote resilience. Dr. Lopez is an Assistant Professor of Pediatrics, Section of Public Health Pediatrics at Baylor College of Medicine. She also serves as adjunct faculty at The University of Texas School of Public Health-Division of Health Promotion and Prevention, and is a Faculty Affiliate with the Kinder Institute for Urban Research, Rice University. Lynda Chima Aririguzo, MD, MPH Lynda Chima Aririguzo is a fellow in Academic General Pediatrics, with an emphasis in global health, at Baylor College of Medicine. She obtained a bachelor’s in science at Tulane University in New Orleans, Louisiana. She received her medical degree and master’s degree in public health from The University of Texas – Houston and completed a global child health pediatrics residency at Baylor College of Medicine. As a budding clinician-educator, she provides primary care children and adolescents while teaching residents and medical students. Her academic interests include improving social determinants of health, particularly early childhood literacy, and addressing issues that overlap local and global underserved populations. She has experienced addressing pediatric outcomes in Central America and Eastern and Western Africa. As a native Houstonian, she is also dedicated to community work servicing inner city child welfare. Angela Cummings, DrPH Angie Cummings received her DrPH in Community Health Practice from The University of Texas School of Public Health. Currently, she is an assistant professor at Baylor College of Medicine in the Section of Public Health Pediatrics. Her current work includes evaluation of integrated behavioral health in primary care and research related to health care utilization for behavioral health issues.