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Investing in Prenatal-to-Three (PN-3) System Change in Allegheny County, Pennsylvania

Research BriefEarly ChildhoodMay 21 2024

Since 2020, Child Trends has partnered with The Heinz Endowments to evaluate their efforts to build an equitable prenatal-to-three (PN-3) system in Allegheny County, Pennsylvania. This system should support strong communities, accessible services, and healthy families in which infants and toddlers thrive (see Figure 1, which depicts the components of the PN-3 Framework).

This brief details findings from a survey and interviews with local leaders and practitioners who are trying to build an equitable PN-3 system in Allegheny County. We begin by providing some background on The Heinz Endowments’ investments in PN-3 systems and then summarize our methods and findings from the work, including bright spots in the county’s PN-3 system as well as gaps or challenges yet to be addressed. Findings are organized into the following four sections:

  • Recent and expected shifts in building the PN-3 system, including what has changed in the past five years and what is expected to change in the next one to two years
  • System coordination and leadership, including the extent to which organizations and leaders from different PN-3 areas are collaborating around shared initiatives or goals
  • Families’ equitable access to PN-3 services, including organizations families trust, new or improved services, and gaps or disparities in access
  • The role of funding in building the PN-3 system, including things PN-3 organizations wish funders would do differently and opportunities for investments to meaningfully affect the system

The Heinz Endowments’ PN-3 initiative and grantmaking

The Heinz Endowments—along with a network of other foundations, nonprofit organizations, and public agencies focused on PN-3 work—have engaged in efforts to build an equitable PN-3 system and address existing disparities. The core mission of these efforts is to foster a coordinated PN-3 system that bridges sectors that traditionally operate independently (e.g., health care, child care, and family economic security). Another core component of the mission is to center equity in their approaches so that all families with young children in the county have access to the resources they need to thrive.

Importantly, the county has made great strides in recent years toward building a strong and equitable PN-3 system, and investments by The Heinz Endowments and others involved in the PN-3 space have been integral to this progress. For example, The Heinz Endowments:

  • Helped create the Department of Children’s Initiatives in Allegheny County, which has since expanded the number of infant and toddler child care slots in the county and expanded the number of families served by child care subsidies
  • Seeded the pilot of Hello Baby, a proactive network of support for all families in the county with newborns
  • Repeatedly shared their evaluation materials, including interactive service maps, policy analyses, data inventories, and literature reviews to inform other PN-3 initiatives in the county

Below, we highlight three of The Heinz Endowments’ recent investments in system-level tools and approaches to building an equitable PN-3 system: the PN-3 Framework, the Early Childhood Funders Collaborative, and the Investment Advisory Councils. Insights related to these investments and how they have influenced the PN-3 system in Allegheny County are discussed throughout the brief.

A framework for PN-3

First, Child Trends partnered with The Heinz Endowments to define the integrated set of supports that make up an equitable PN-3 system. Acknowledging that the system is broader than health care and early care and education alone, the PN-3 Framework includes three additional domains to capture other crucial markers of a strong system. These domains include: 1) families’ economic security, 2) community-level health and supportive services, and 3) coordinated system-level infrastructure at the levels of governance, data, and funding (see Figure 1). As systemic racism is pervasive in our society, it affects each domain through policies and practices that reduce opportunities for certain groups to thrive. The framework was created in collaboration with over 30 PN-3 leaders in the county, one of whom shared, “We can see ourselves in this,” when the framework was first developed. Our goal was that the framework could build awareness of the PN-3 system and inform a shared vision for more equitably supporting the needs of families.

Figure 1. A framework for PN-3

Figure 1. A framework for PN-3

Investment Advisory Councils (IACs)

Next, the Heinz Endowments provided funding for Grantmakers of Western Pennsylvania and their PN-3 Fellow to implement the Investment Advisory Councils (IACs)—an approach to community-driven grantmaking. The IACs convened three groups of PN-3 stakeholders from across disciplines and sectors to collaboratively develop a funding proposal related to one of three topic areas: 1) child care, 2) maternal and infant health, and 3) family economic security. The IACs intentionally centered the voices and perspectives of those belonging to and/or serving the historically marginalized Black communities in the county. All three groups have since been awarded two years of funding and begun implementing their projects. Findings from Child Trends’ evaluation of the IACs along with more information about the projects can be found in this brief: Investment Advisory Councils – A Community-Driven Grantmaking Pilot.  More recent updates on the IAC group’s work are provided throughout this brief as relevant.

Early Childhood Funders Initiative (ECFA)

As a final example of The Heinz Endowments’ efforts to build an equitable PN-3 system in Allegheny County, they capitalized on the increased interest in supporting the child care industry during the COVID-19 pandemic and created the Early Childhood Funders Alliance (ECFA) of Southwestern Pennsylvania. The ECFA convenes local funders and supports collaborative efforts toward systemic change for the child care workforce in the county and the families they serve. With funding from The Heinz Endowments, sponsorship from Grantmakers of Western Pennsylvania, and facilitation support from Candor and Co. Consulting, the ECFA brought together more than 10 foundations on a quarterly basis in the past year to build connections, learn about challenges in the child care industry, and move toward jointly funding efforts to build a strong and equitable system.  The Child Trends team evaluated these efforts, and selected results are shared in this brief where relevant.

Methods of This Brief

Child Trends surveyed 25 individuals who work within local PN-3 organizations to learn more about the efforts building the PN-3 system in Allegheny County, what changed in the last five years, what opportunities exist for further improvements in the next two years, and the degree to which families have equitable access to PN-3 services. We also interviewed 10 of the individuals who completed the survey to get their reactions to the findings from the survey and hear more about their experiences working in PN-3 services in the county.  Our team used two systems evaluation frameworks[1],[2] to identify the indicators of systems change that were most relevant for The Heinz Endowments’ PN-3 initiative. Our survey and interview protocol were designed to measure which indicators of systems change respondents thought had already changed or anticipated would change in the near future. For more information about our methods, see Box 1.

Box 1. More about our methods and sample

Survey methods and sample
The PN-3 survey was available online from October through November 2023. Of the 86 individuals who we contacted about the survey, a total of 25 individuals participated (29% response rate). Among those eligible for the survey, 58 were staff PN-3 grantees of The Heinz Endowments. The other 28 respondents were individuals who participated in the Investment Advisory Councils.[3] Of the individuals who took the survey, eight were primarily in the early childhood education domain, nine were in family economic security, six were in maternal and child health, and two indicated that they work in a different system domain.

Interview methods and sample
Between January and February, our team also conducted follow-up interviews with a subset of those who completed the PN-3 survey. Of the 12 people who indicated in the survey that they were willing to speak with us again, nine responded to our request and chose to participate in an interview, and one interview contained two individuals for a total of 10 interviewees. Of the interviewees, four were primarily in the early childhood education domain, three in the maternal and child health domain, two in economic security, and one spanned all of these areas. Organizations our team spoke with spanned the gamut of providing direct services, leading advocacy work, and skill-building. Topics these organizations specialized in included pregnancy and delivery, child care, breastfeeding, and business development and economic wealth growth.


Recent & expected shifts in the PN-3 system

To begin, this section summarizes findings from two survey questions: how the PN-3 system has changed in the last five years, and how respondents expect it to change in the next one to two years. While later sections of this report dive deeper into specific components of the system, how they have changed, and what work is left to be done, these data provide an important snapshot into how the PN-3 system has changed in recent years and what those who work within the system expect to see in the future.

Most respondents see improvements in the county’s PN-3 system, though disagreed whether the capacity to meet families’ needs has improved.

To better understand if and how the PN-3 system in Allegheny County has changed in recent years, we first asked survey respondents about whether they have noticed shifts in various indicators of systems change over the last five years. As shown in Figure 2, respondents generally agreed they have seen positive changes in the county’s PN-3 system. Nearly all respondents noticed new advocates or champions for PN-3 (94%), and most noticed greater awareness of PN-3 among county leaders (78%), new or diversified funding (76%), new or improved services (71%), and increased political will or momentum for change (61%). Respondents were divided on whether they have seen programs with more capacity to meet the need and demand of families, with an equal number indicating that they had and had not seen this change (39% respectively).

Figure 2. In the last 5 Years of my work, I have noticed…

Figure 2. In the last 5 Years of my work, I have noticed...

Respondents are optimistic that improvements will continue to happen in the county’s PN-3 system.

We also asked survey respondents what changes they expect to see within the PN-3 system in the next one to two years.  As shown in Figure 3, nearly all respondents expect to see greater or improved coordination (94%), most expect to see more joint planning and vision setting (78%) and improved referral systems (67%), and half expect to see more case management coordination (50%) and new or more robust data sharing agreements (50%). Expectations of relevant new laws, regulations, or policies to facilitate greater collaboration and information sharing varied, with 33 percent indicating they expected to see this change and 22 percent indicating they do not expect to see this change.

Figure 3. In the next 1-2 years of my work, I expect to see…

Figure 3. In the next 1-2 years of my work, I expect to see...

System coordination & leadership

In this section, we highlight findings and takeaways related to coordination and leadership within the county’s PN-3 system. This includes the extent to which organizations and leaders from different parts of the system are coordinating, collaborating, and aligning their missions and strategies related to PN-3 issues. Leadership within the PN-3 system is also discussed.

Although more joint planning and vision setting are happening, some partners may be missing.

Across both the survey and interviews, most respondents reported that joint planning and vision setting are happening in the county. They emphasized the importance of this collaborative work to build awareness of the various services, projects, and opportunities available to families in the county. Both County and nonprofit grantees highlighted that they and others in the PN-3 field understand that their individual entities cannot do all the work in isolation and are instead having conversations and are working to collaborate more effectively. This seems to be happening among county-level departments, but one interviewee highlighted how she sees vision planning happening when in discussions around supporting the child care field through business development. Most respondents shared that they’ve seen more joint vision planning happening in the last five years and that they expect this change to continue.

However, we also heard from respondents that joint planning and vision setting are complex processes. These processes require not only a multitude of stakeholder voices, but also a holistic view of PN-3 that considers the whole life course of families and children beyond the PN-3 years. A holistic perspective also requires understanding of the complex network of system, community, and individual factors that impact families’ well-being and access to services. As noted in the introduction, inequitable access to maternal and child health care, child care, and economic support exists in Pittsburgh, and making improvements in each area requires a concerted effort.  Engaging in this kind of collaborative vision setting requires that those involved have a strong understanding of the PN-3 system and can see where they and their work fit into the system. During interviews, several respondents noted potential challenges in this area. One interviewee shared a feeling that other system leaders in the county might not be totally sure what PN-3 entails, which could potentially make it more difficult to bring those individuals into conversations about PN-3 issues. Another interviewee noted that although she felt that more joint planning and vision setting were happening among PN-3 organizations, she and her colleagues are rarely included in those conversations.

“I think the PN3 orgs are doing more joint planning and vision setting together… We just don’t get pulled into these conversations very often.” – Interviewee

This interviewee’s organization was notably most aligned with the “Strong and Secure Families” area of the PN-3 framework (see Figure 1), a topic not always included in the PN-3 system as clearly as child care, for example. Though anecdotal, this experience further underscores the importance of establishing a shared understanding of the PN-3 system and all that it entails to ensure diverse stakeholders are included in improvement efforts.

There is more awareness, political will, diversified funding, and data sharing, though some worry the positive funding trends won’t continue.

In reflecting on changes to the PN-3 system in the last five years, most survey respondents agreed that they had seen greater awareness of PN-3 issues among county leaders (78%), and more than half agreed that they had seen greater political will and momentum for change (61%). When we asked interviewees for their reactions to these findings from the survey, the factors they attributed those changes to varied. Some interviewees discussed the accomplishments of their organizations that have increased political will and momentum for change. Others cited the election of the new County Executive, Sarah Innamorato, as an indicator that there is greater awareness of PN-3 issues among county leaders. One interviewee noted that the COVID-19 pandemic caused a different level of awareness of societal and systemic issues, which resulted in additional advocacy around PN-3 issues as well as diversified funding:

“I do think that while the pandemic was very difficult for us to bear, there are some positive things that have come out of that…I would agree because a different level of awareness resulted in some additional advocacy, which resulted in some diversified funding… I think that was a big driver that opened up eyes and doors and conversations for people to talk more about how do we help…This is what people are experiencing.” – Interviewee

Importantly, while increases in funding for providers and families during the pandemic were beneficial, many respondents felt uncertain if more of that funding would come, even though it is still needed. Another interviewee mentioned that it does seem that PN-3 funding in the county is being diversified, even if more money is not coming in.  When asked where they think the diversified funding is going, interviewees mentioned that they’ve seen funding going toward community services, advocacy, the early learning system, and the early childhood workforce.

Half of those who responded to the survey expect to see new or more robust data sharing agreements in the county over the next 1-2 years. A couple interviewees highlighted how there is more trust between departments and organizations, which in some cases had has already led to new or more robust data sharing agreements. For example, interviewees shared instances of data sharing agreements between school districts and the county, between different county departments, and with Early Head Start. One interviewee shared that it seems larger funders are increasingly interested in making data-informed decisions, speculating that this priority could be driving the move toward more, or more robust, agreements.

“I think there’s more trust than we have [had] five years ago to enter into those data sharing agreements.” – Interviewee

Efforts to strengthen the PN-3 system need a strong, central voice to guide the work and strategic messaging.

Although respondents noted many positive changes within the county’s PN-3 system with respect to collaboration, they also shared some challenges. One interviewee, for example, discussed how currently, there are no centralized goals guiding PN-3 work in the county. Rather, there are initiatives of various sizes happening—each with their funding mechanism, mission, and strategy to achieve that mission. While the strong nonprofit and philanthropic presence around PN-3 issues in the county certainly helps to expand and improve the services available to families, some interviewees noted that it can also create confusion or dilute the effectiveness of their efforts. One interviewee touched on how system leaders cannot always come to agreement on how to best tackle an issue, or variety of issues, so there isn’t a cohesive effort to address them.

“I think that one organization or one agency can’t be all things to all people, but if we have a [way] that affords us all to receive funding for the particular part of the developmental cycle or process that we’re focused on, but requires us to work together because it’s really focused on outcomes…if you’re gonna do work in the prenatal to three space, what does success look like there? And then what are the [ways] that require people to move toward the success, not just check a box?” – Interviewee

Additionally, though most survey respondents and interviewees agreed that more collaboration is happening in the county, a few noted that occasionally, some in PN-3 still want to gatekeep information or try to do all the work themselves. Because the PN-3 field spans many topics and areas of expertise, diverse perspectives are needed to meaningfully change the system. However, it can be difficult to bring these voices together and move toward an agreed upon vision. As one interviewee put it, “there’s a lack of clarity of purpose, because everybody can’t be in charge.”

Some respondents also felt that challenges gaining traction on PN-3 topics are in part due to issues with messaging and differing perspectives on how to gain wide public support for PN-3 issues. For example, respondents described challenges in securing funding for essential PN-3 services because of opinions about what types of services should be made available for families.  Another interviewee described how racism influences perceptions of what families deserve and that there is a sense that the services Black and Latino families need for their children are perceived negatively. Finally, another interviewee noted that they have observed variation in public opinion about different areas of the PN-3 system. For example, she felt that there is more awareness in the county about the importance of child care and its impacts on workforce and economic issues, compared to other PN-3 topics such as maternal and child health.

Families’ equitable access to PN-3 services

In trying to build an equitable PN-3 system in Allegheny County, it’s critical to get a sense of how families in the county are experiencing the system. To better understand the extent to which families have equitable access to PN-3 services in Pittsburgh, we asked survey respondents and interviewees about organizations they believe families trust, whether the supply of services is sufficient to meet the needs of families, gaps in available services, and the extent to which families can equitably access the services they need to thrive.

Although there are many trusted organizations in the county and some new or improved services, more capacity is needed to meet families’ needs.

Interviewees shared about multiple services they believe families value, highlighting a variety of services they have heard families mention. These included grassroots organizations that provide free, tangible goods that help meet basic needs, such as food and diaper banks; as well as individualized services aimed to meet the specific needs of each family including Head Start/Early Head Start services, Family Support Centers, home visiting, early intervention, and Healthy Start. Other trusted services that interviewees mentioned include the Trade Institute of Pittsburgh (which offers holistic workforce development programs), Footbridge (which provides immediate financial assistance to families facing a short-term financial crisis), and the free doula program offered by University of Pittsburgh Medical Center (UPMC).

Most survey respondents agreed they have seen new or improved services. In the survey, almost three-quarters of respondents agreed that they have seen new or improved services (71%). A few interviewees noted that while there are still child care deserts in the county, they have nonetheless seen some improvements in recent years. Two interviewees shared examples of new child care centers, and one highlighted how efforts to relax zoning requirements for home-based child care were in discussion (and recently passed). Another interviewee observed that hospitals seem to be offering more services such as free transportation and doula services.[4] Finally, one interviewee highlighted that in regard to new or improved services, they questioned whether organizations are truly connecting with families to meet them where they are and provide new or improved services based on what they hear.

However, respondents were divided on whether they have seen programs with more capacity to meet the demand from families (39% said they had seen this change, and 39% said they had not), with some attributing capacity shortages for certain services to workforce issues. The child care field is still struggling to recruit and retain staff, leaving many facilities without the capacity to serve their maximum number of children. Similarly, another interviewee shared how they are struggling to recruit home visiting nurses despite the demand for services. Several interviewees also mentioned a shortage of mental health care providers in the county, and particularly those who accept insurance. Families also need more options for crisis child care (when their usual provider is closed or when something urgent comes up) and nontraditional care hours (e.g., evening, weekends).

Families need more services and direct assistance to meet their basic needs, particularly in under-resourced neighborhoods.

There are still gaps in families’ access to PN-3 services, with many struggling to meet their basic needs and make ends meet. Over half of survey respondents disagreed that programs and services were affordable for families. In interviews, it was consistently highlighted that families seek out organizations that provide free tangible goods such as diapers or food banks. While one interviewee shared that there seem to be more grassroots efforts within the county to provide these tangible goods, many others noted that existing programs are insufficient to meet the needs of families. Certain goods often run out quickly, particularly more expensive items such as infant formula and diapers. Likewise, programs that provide direct financial assistance to families with immediate needs (e.g., car repairs, overdue bills) often experience long waitlists, meaning few families who need support can access these programs.

“Meeting a family’s basic needs is an area that continues to be underinvested in, even after the pandemic. Waiting lists are long and the workforce is underinvested in, or not even thought of as a workforce. Families are unable to feed their families, unable to buy diapers, and unable to pay rent.” – Survey respondent

Geographic disparities also remain a challenge to connecting families with needed services. The geography of Pittsburgh, with rolling hills and several river crossings, means communities can be segmented. To access services, families either need proximity to services or access to robust public transportation. Black families are less likely to live in close proximity to services  due to racist housing policies such as forced relocation, racial restrictive deed covenants, and redlining. These policies have had lasting impacts on the ability to build home equity and generational wealth which prevents families from having greater choice in where they live. For example, while mortgage denials to anyone not of the White or Caucasian race were previously more explicit, today Black families are still disproportionately more likely to be denied a mortgage. As for public transportation, Pittsburgh’s system has been facing budget challenges for years.

When asked which areas or neighborhoods consistently have inequitable access to services, survey respondents mentioned Northside and the Hill District as well as communities that are further out from the city center such as Natrona Heights and communities in the Monongahela (Mon) Valley, such as McKeesport. A few interviewees touched on how accessing services is harder for these communities, stressing that the physical distance between services and communities makes it challenging to build trusting relationships and tailor services to community needs. A couple interviewees highlighted that all these areas experience low incomes and while they vary in race and ethnicity demographics, they noted these areas are predominantly neighborhoods with Black families. For example, the Hill District is predominately Black (72%) and 60 percent of Black households make less than $25,000 per year, significantly lower than the county median income of $60k per year.  Both survey and interview participants connected the geographic patterns to historical and systemic racism. One survey respondent said that “all the areas where Black and Brown people live” are underserved.

Interviewees similarly mentioned a need for more flexible health care options, such as telehealth or mobile units, to meet families where they are. Families face a lot of barriers to receiving care, and travelling to an appointment may mean they have to find a babysitter, dog walker, or someone to cover their shift at work. It would be great if service providers could bring the care to them and adjust their hours to align with families’ scheduling needs (e.g., more hours in the evening).

Investments in higher wages and other supports for the PN-3 workforce could help address shortages in the supply of PN-3 services, improve services for families, and decrease the need for basic needs support.

Investments in the Family Economic Security: Spotlight on the IACs

The family economic security IAC group is led by Catapult and is piloting a guaranteed basic income program for mothers with young children in the county. Participants are reporting better savings and debt management and nearly 60% report feeling better off now than they did a year ago.

Investments in the Child Care Workforce: Spotlight on the IACs

The child care IAC group’s proposal included plans for a region-wide public relations campaign focused on the importance of a strong and supported child care workforce to support the region’s children, families, and economy. This work is being led by Trying Together and the Early Excellence Project, who anticipate launching the campaign with Motor Mouth Media in spring 2024.

Workforce shortages are a driving factor in restricting families’ access to needed services. Both child care (particularly, infant and toddler slots) and home visiting were mentioned as programs where workforce shortages are the primary challenge to meeting the needs of families. And, while the demand for services in the county has increased, staffing capacity has decreased. Several interviewees mentioned that many child care providers, home visitors, and others in caretaking professions, occupied primarily by women and particularly women of color, left their jobs during the COVID-19 pandemic. Research indicates stagnating wages, the high cost of child care, and a lack of benefits were driving factors. Further contributing to this issue is the fact that many of these individuals require child care themselves, but with low compensation, many find it makes more sense to stay at home with their children rather than work just to pay for care. In this way, workforce and child care shortages are inextricably linked.

“…our problems about staffing are multi, but not because we don’t have programs that exist for families, it’s because we can’t staff the programs and keep people compensated [well] enough that they don’t have to worry about child care or school or cars or housing. They’re flooded with those other challenges.” – Interviewee

Interviewees also shared that there is an urgent need for more mental health care services in the county. Families who need mental health care often need support immediately and cannot wait six months for an appointment, but there are not currently enough mental health providers to meet the need. Additionally, families sometimes cannot receive services because of where they live.

“People who need care need it right now. I think the government needs to make it a priority. They can pay for education so people can get the education they need to help people. We are in a crisis.  We need incentives to get more mental health care workers.” – Interviewee

The role of funders in the PN-3 system

In both the survey and in our follow-up interviews, we also asked respondents questions about what they would like PN-3 funders to do differently to support the creation of an equitable PN-3 system. In this section, we mean funders to include philanthropic and private funders as well as public officials allocating federal, state, and local dollars.

Funders might need to rethink how they invest in the PN-3 system and how they work with their grantees.

When asked about the top three things that funders could do to better support PN-3 grantees, survey respondents most often selected offering longer grant periods (68%), higher grant amounts (52%), and more flexible reporting requirements (52%; see Figure 4). Nearly a third of survey respondents (32%) also wrote in their own suggestions for what funders could do,[5] with a few recommending funders provide operating funds for grantees, support advocacy, and allow for projects to change over time based on community needs.

Figure 4. From the list below, what do you see as the top three things that funders could do to better support their grantees?

Figure 4. From the list below, what do you see as the top three things that funders could do to better support their grantees?

Interviewees echoed many of these same themes, including flexible application processes. They described how having longer grant periods and relaxed reporting requirements would allow organizations more time to focus on their missions and implementation of services and require less time filling out reporting paperwork. Longer funding periods would also allow for more grant onboarding time (e.g., hiring and onboarding staff, getting a program up and running) and for organizations to plan further ahead rather than one year at a time. Flexible or informal grant reporting could help build funding/grantee relationships, especially if it was in addition to technical assistance. One interviewee shared that through trust-building, intentional conversations could be had around what success might look like with funds. Further, if both parties understand what work is going into meeting that vision of success, funders might be more willing to offer longer grant periods.

“The capacity to continually write applications and then follow up reports can be a never-ending time consumption that leaves less service provision time”. – Grantee Interviewee

Interviewees also stressed that funders need to talk with their grantees to understand the true cost of services. Interviewees shared that nonprofits often get used to doing their work with less money. During the COVID-19 pandemic, there was an influx of funds to help organizations, and for some, this meant having extra funds to cover operating costs that typically are not covered by grants. While the influx of pandemic relief funding has since gone away, operating costs still exist and are in fact greater due to the general rise in costs for staffing and services. Interviewees said funders can advance equity by investing in grantee capacity building that provides resources for leadership development, organizational sustainability, and infrastructure improvements which remain large gaps in grantee organizations. Unless funders work with their grantees to understand these gaps and adjust funding to account for inflation or changes in demand, nonprofits have no choice but to decrease their scope to ensure they remain sustainable.

“…it’s kind of odd when [funders] ask, ‘What’s your sustainability plan?’ But as nonprofits, it 100% depends on funding… and donations are great, but they’re not at the level that covers operations.” – Grantee interviewee

Interviewees also asked that funders incorporate technical assistance to help organizations write proposals and reports. PN-3 organizations, and particularly those that are smaller or new to grant writing, can find the process of applying for funding very intimidating. This can create inequities in that smaller organizations, who may be more connected to the communities they are serving, have diminished access to funding. Technical assistance from funders could be an opportunity for grantees to learn about what it means to assess outcomes and why it is important, and likewise for funders to ensure quality data are collected and reported back. If funds are limited, technical assistance could also help build capacity within the grantee organization to seek additional funding:

“[Funder] brought the small organizations along over the course of time, building them up around reporting, what is good data to collect, what is reporting look like, how do you do this in alignment with your work? …I think we help position organizations who are getting a small amount of money so [if the funder cannot give as much as they’d like], how can [they still] support them?” – Grantee interviewee

To support collaboration in the PN-3 systems, funders need to designate appropriate and sustained funding and help bring employers and government stakeholders together.

In addition to how they can better support their grantees, interviewees raised that funders should also invest in relationship building and collaboration among PN-3 organizations. PN-3 organizations see the value of collaborating with other organizations and parts of the PN-3 system to engage in joint planning, improve systems of referrals, share data, and think about new strategies or opportunities. However, many interviewees also noted that this work is very time and resource intensive. Collaboration requires capacity that organizations don’t always have, particularly because few have a dedicated or sufficient budget and staff to support collaboration. Relatedly, some interviewees mentioned that existing funding opportunities in the county can create a feeling of competition; particularly among nonprofit organizations that are often competing for available funding, in which case collaboration or data sharing can feel counterintuitive. Interviewees cautioned funders against requiring their grantees to engage in collaboration without providing sufficient funding and support to do so in a meaningful and sustained way.

“I do think that there should be a more coordinated effort to bring our different sectors together. But, realistically, all of us are so overwhelmed and so busy and already doing way more than we can really do that [funders] saying ‘we’re going to add another layer of something that you have to do’ [just is not realistic].” – Interviewee

“I don’t think any of us are going to just organically do it [collaboration], being realistic, because we just don’t have the time or capacity. It’s typically not because people don’t want to. It’s because where are we going to find the time? Who’s going to coordinate it?” – Interviewee

Interviewees also noted the importance of bringing other key stakeholders—namely, employers and the public sector—together for discussions about PN-3 topics. While philanthropy provides much needed investments in the county’s PN-3 system, the impact of these investments is limited without partnership from employers and public leaders. Creating space for these stakeholders to come together with philanthropy could help pave the way for more scaled and more sustainable funding in the future.

To build capacity within the PN-3 system, funders need to meet communities (and their trusted organizations) where they are.

Investments in Collaboration & Joint Funding: Spotlight on the ECFA

The Early Childhood Funders Alliance (ECFA) of Southwestern Pennsylvania was created to convene local funders and support collaborative efforts toward assisting children and families in Allegheny County. Nearly two years in, funders are forming new collaborations and jointly funding a shared initiative to support business stabilization for family child care providers. They recently supported the region winning a national grant to improve the quality of child care jobs.

Investments in the Maternal and Child Health: Spotlight on the IACs

The maternal health IAC group is being led by Healthy Start and they are using the funds to implement their community-driven plan for maternal health equity in the county.

Interviewees further highlighted the need for a more global shift in how funders and philanthropic organizations in particular approach PN-3 funding in the county, particularly noting the need for funders to meet communities where they are rather than where they wish they were. In deciding where to target investments, interviewees stressed that funders should not assume they know what is needed but instead ask members of the community directly, including both families and the on-the-ground staff providing services. Importantly, meaningful community engagement to identify these priorities would require a concerted effort from funders to build relationships and trust. One strategy for accomplishing this could be to lean on the networks and expertise of trusted community-based organizations who have established rapport with families. Leveraging the knowledge and lived experiences of those rooted in the community, funders should aim to broaden inclusion so that members of the community can come together around PN-3 topics, brainstorm solutions to meet the diverse needs of families, and address existing inequities. Interviewees also emphasized that in deciding where to invest, funders should first look to the resources, services, and strengths that already exist within communities and consider ways to lift up and expand those assets. One interviewee also suggested funders consider communities’ existing resources and demographic characteristics to assess the level of funding needed to support a community and establish equality with other more well-resourced communities.

“There should be at a part in the grant [application] that talks about the communities’ demographic [characteristics] from a social and economic standpoint. [Funders should ask] am I giving resources to an already well-resourced community, or am I giving resources to a community that is already significantly under-resourced, and therefore I should be evaluate how much I’m giving to them [and whether it is] enough to be impactful? If [funders are] giving you funds and you’re already starting below the starting point, how effective will [that] be in moving the needle?” – Interviewee  


Building an equitable PN-3 system is complex. The sectors that make up the system are broad, spanning health care, early education, and social services. The sectors and their organizations vary widely in the extent to which they are interconnected. Further, system-building efforts are operating in a context shaped by historical inequities, systemic racism, and economic disparities. Building a strong and equitable PN-3 system will take a significant investment over the long term.

An equitable PN-3 system is taking shape in Allegheny County, though. The efforts of the Heinz Endowments, working with other partners over the past five years, have resulted in increased cross-sector discussions, data sharing, and joint planning and vision setting. In January 2024, the Department of Children Initiatives and the newly elected County Executive announced a $500 thousand expansion to the Allegheny County Child Care Matters pilot program, which will clear the wait list for child care subsidy in the county and further expand the number of families who can access high-quality and affordable care. The Investment Advisory Council funding is supporting a guaranteed basic income pilot for mothers with young children, a public relations campaign to recruit child care workers in the county, and the implementation of a community-driven plan to support maternal health equity. The Early Childhood Funders Alliance is jointly funding efforts to support family child care providers and to improve the quality of child care jobs.

We hope that the findings from this evaluation showcase the important work happening in Allegheny County toward building an equitable PN-3 system. Still, more work is needed—with contributions from funders, public officials, PN-3 professionals, researchers, and parents—to ensure that all families and young children in the county have what they need to thrive.


None of these exciting shifts, nor the research capturing it, would have been possible without the tireless efforts, passion, and generosity of the PN-3 workforce in Allegheny County. To the service providers, funders, public officials, and other PN-3 system leaders who took time out of their busy schedules to share their insights and expertise with our team—repeatedly and over several years—we cannot thank you enough. Thank you for teaching us so very much.

We would like to thank our colleagues Kathryn Tout (Child Trends), Kristine Andrews (Ideas to Impact Consulting), and the team at The Heinz Endowments for their partnership and contributions to this work. We also want to thank Catherine Schaefer (Child Trends) for their review of this brief.


[1] Coffman, J. (2007). A framework for evaluating systems initiatives. Build.

[2] Latham, N. (2014). A practical guide to evaluating systems change in a human services system context. Center for Evaluation Innovation, Learning for Action.

[3] Nine of the 58 grantee staff who responded to the survey also participated in the Investment Advisory Councils.

[4] It’s plausible that survey respondents were thinking of a recent policy or new political leaders now in positions that could lead to new or different services.

[5] Other things that respondents mentioned funders could do better to support grantees included: providing operating funds (n=3), supporting advocacy (n=2), and creating more flexibility in grantmaking overall (n=3; for example, one respondent said “[funders should] be open to the project changing to match community needs.”).

Suggested citation

Ulmen, K., Koushik, P., Hilty, R., & Wilkinson, A. (2024). Investing in Prenatal-to-Three (PN-3) Systems Change in Allegheny County, Pennsylvania: Case Study Brief. Child Trends. DOI: 10.56417/9487s4563q