Pregnant woman holding stomach
Maternal & Infant Health Summit logo

Thank you for attending Mayor Muriel Bowser’s
National Maternal & Infant Health Summit

Woman kissing baby small
Woman smiling and holding baby
Woman holding stomach in blue dress
Pregnant woman holding stomach
Maternal & Infant Health Summit logo

Thank you for attending Mayor Muriel Bowser’s
National Maternal & Infant Health Summit

Mayor Muriel Bowser with children

About the Summit

Thank you to the DC residents, elected officials, health and education officials and community-based partners who made the 2019 National Maternal & Infant Health Summit a success. Together, we strengthened the connection between maternal and infant health and early childhood development; explored innovations and emerging issues in perinatal healthcare; and connected residents to local healthcare and early education service providers and resources.

To keep attendees connected to the topics of maternal and infant health, childhood development, and early education, Thrive by Five and the Mayor’s Office on Women’s Policy and Initiatives have worked with community-based partners to co-host a series of yearlong events until next year’s Summit. For more information, visit the “Stay Connected” tab.

 

Agenda

Featuring a lunchtime conversation with Mayor Muriel Bowser, moderated by Lesli Foster. 

Moderator: Lesli Foster

Journalist, WUSA9
website

Honorable Muriel Bowser

Mayor, Washington, DC
website

Alyssa Milano

Actress & Activist
website

Charles Johnson

Founder, 4Kira4Moms
website

Valerie Hollingsworth-Baker

25th International President,
Zeta Phi Beta Sorority, Inc.
website

Featuring a lunchtime conversation with Mayor Muriel Bowser, moderated by Lesli Foster. 

Moderator: Lesli Foster

Journalist, WUSA9
website

Honorable Muriel Bowser

Mayor, Washington, DC
website

Alyssa Milano

Actress & Activist
website

Charles Johnson

Founder, 4Kira4Moms
website

Valerie Hollingsworth-Baker

25th International President, Zeta Phi Beta Sorority, Inc.
website

9:00 AM

3rd Floor

Registration/Light Breakfast

 

9:00 AM – 3:00 PM 

3rd Floor

Summit Health and Early Education Expo

9:30 AM

Ballroom B

Welcome & Remarks

The Honorable Muriel Bowser, Mayor, District of Columbia

Dr. Faith Gibson Hubbard, Executive Director, Thrive By Five DC

Mayor Bowser will offer remarks and her own reflections on last year’s Summit. She will speak to investments and innovation happening in the District around maternal and infant health.

Dr. Faith Gibson Hubbard, Executive Director of Thrive by Five, will welcome Summit attendees by offering reflections from last year’s Summit, discussing investments that DC has made in perinatal health and education since last year, (including the expansion of Thrive by Five), and outline the day’s agenda. This will be done with support from Office of the State Superintendent of Education’s Division of Early Learning.

 

9:45 AM – 10:25 AM

Ballroom B

Panel #1

Centering the Narratives of Moms: A Discussion on Policy & Practice

Through the voices and narratives of moms, this panel will focus on local and national investments being made to improve outcomes for maternal and infant health. This discussion will provide greater context and set the tone for the Summit. 

Moderator: Dr. Faith Gibson Hubbard
Executive Director, Thrive By Five DC

Moderator: Jennifer Porter
Executive Director, Mayor’s Office on Women’s Policy and Initiatives

Kimberly Churches
CEO, American Association of University Women

Pati Jinich
Chef, TV Personality, Author

Dr. Esther Gamuchirai Madzivire
Obstetrics and Gynecology (OB/GYN), Atrium Health

10:25 AM – 10:30 AM

Ballroom B

Remarks

David A. Hinson
President, Congressional Black Caucus Foundation

10:30 AM – 11:05 AM

Ballroom B

Panel #2

Early Exposures in Life: Understanding Risk and Resilience to Improve Health and Education

This panel will discuss the concepts of trust and trauma-informed care. The conversation will be oriented to topics related to access to quality and responsive healthcare, early education, and family strengthening programmatic models, as it relates to health and education outcomes. 

Moderator: Dr. LaQuandra Nesbitt
Director, DC Health

Dr. Myra Jones-Taylor
ZERO TO THREE

Linda Goler Blount
Black Women’s Health Imperative

Dr. Nefertiti Poyner
Devereux Center for Resilient Children

Dr. Joia Crear-Perry
National Birth Equity Collaborative

Dr. Neena McConnico
Child Witness to Violence Project – Boston Medical Center

11:05 AM – 11:10 AM

Ballroom B

Remarks

Stacey D. Stewart
President, March of Dimes

11:10 AM – 11:15 AM

Ballroom B

Remarks

Oliver M. Johnson, II
Executive Vice President and General
Counsel, MedStar Health

11:15 AM – 12:00 PM

Ballroom B

Panel #3

The Role of Food Policy, Access, and Nutrition in Supporting Positive Outcomes for Families

This panel will highlight national and local efforts focused on healthy food access for families, breastfeeding, and babies’ first foods. 

Moderator: Ona Balkus
Food Policy Directors, DC Office of Planning

Ward 1 Councilmember Brianne Nadeau
Council of the District of Columbia

Dr. Kofi Essel
The George Washington University
School of Medicine & Health Sciences

Dr. Sahira Long
Children’s National Health System

Lauren Biel
DC Greens

Beverly Wheeler
DC Hunger Solutions

12:15 PM – 1:20 PM

Ballroom C

Luncheon

Remarks

Monty Robinson
Vice President – Mid-Atlantic Region, Aetna

The panel will allow our guests to discuss their experiences with motherhood and parenthood and underscore the importance of centering the narratives of moms and babies in perinatal health care.

Moderator: Lesli Foster
Journalist, WUSA9

The Honorable Muriel Bowser
Mayor, Washington, DC

Alyssa Milano
Actress & Activist

Charles Johnson
Founder, 4Kira4Moms

Valerie Hollingsworth Baker
25th International President,
Zeta Phi Beta Sorority, Inc.

1:25 PM – 1:30 PM

Ballroom C

Remarks

Elizabeth Groginsky
Assistant Superintendent of Early Learning,
Office of the State Superintendent of Education

1:30 PM – 2:15 PM

Ballroom C

Panel #4

Our Fathers Speak: “A Place for Dads in Perinatal Health and Early Education”

The panel will highlight the importance of fatherhood involvement in building stronger families and communities. The discussion will include the role of males in perinatal care, maternal health, and early education.

Moderator: Jason Wallace
Director, Mayor’s Office on
Fathers, Men and Boys

The Honorable Cedric Richmond
US House of Representatives,
Democrat – Louisiana, 2nd District

Kenneth Braswell
CEO, Fathers Incorporated

Dr. Roger Mitchell
Chief Medical Examiner, DC Office
of the Chief Medical Examiner

Antoine Robinson
DC Dad, Bright Beginnings

Jonathan Webb
CEO, Association of Maternal
& Child Health Programs

2:20 PM – 2:30 PM

Ballroom C

Summary & Next Steps

Dr. Faith Gibson Hubbard
Executive Director, Thrive By Five DC

Second Floor, Small Rooms

Breakout Sessions: Round #1

Giving Voice to Mothers: Black Women Speak Out on Maternal Health Care in the District – Room #202A
Facilitator: DC Primary Care Association

Black mothers with experience of the District’s maternal health system will share their perspectives on what providers and policymakers need to know about maternal health care across the continuum of care. Panelists will share their stories of joy, frustration, connection, and fragmentation, and how listening to women is key to improvement. Participants will leave with a greater understanding of how systems-level challenges impact individuals and identify opportunities within their sphere of influence to better support black women and their families.

 

Midwifery in DC an Evidence Based Solution – Room#202B
Facilitator: American College of Nurse Midwives (DC Affiliate)

Midwives provide a range of services to women and families across the District. This session will highlight settings practices certified nurse midwives currently work in DC. By the end of the session, attendees will be able to describe the scope of practice of certified nurse midwives, how midwives can provide “low cost, high impact” and evidence based care, and how midwives collaborate with other health care professionals to address health disparities and maternal mortality in D.C.

 

Food for Thought: Eating Right for Two – Room #207A
Facilitator: Educare DC

This session will showcase our Pregnant & Lactating Mom Circle, a group that provides educational information to pregnant moms regarding healthy eating during pregnancy. Workshop participants will leave with a deeper understanding of the importance of good nutrition at the onset of pregnancy, during pregnancy, and after giving birth. We will also discuss the benefits of breastfeeding, how to build healthy eating habits for infants, and best practices for nutrition in early childhood centers.

 

Share your thoughts about the District of Columbia’s development of a five-year strategic plan for children, and families with children, birth to five! – Room #201
Facilitator: Office of the State Superintendent of Education

The District of Columbia’s Office of the State Superintendent of Education is leading the development of strategic plan as part of the District’s Preschool Development Grant, Birth through Five. Workshop participants will have the opportunity to provide feedback on the current draft of the strategic plan’s goals, strategies and actions to affect change in the District. The final strategic plan will impact the District’s entire early childhood system—encompassing all of the public and private entities, programs, services and environments (such as child development facilities, pre-K, Early Intervention, home visiting, etc.) that impact children’s lives.

Second Floor, Small Rooms

Breakout Sessions: Round #2

Maternal & Infant Mental Health Landscape Taking Steps to Improve Practice & Policy
Room #202A

Facilitator: Children’s National Health System

Discussing the landscape of infant and early childhood mental health in the District. Identifying potential resources and opportunities for policy change. Looking at a model of collaboration for evaluation and treatment of perinatal mental health in a pediatric primary care office.

 

Culturally Aware Prenatal Care with a Reproductive Justice Framework in a Community
Health Setting – Room# 202B

Facilitator: Community of Hope

Community of Hope has developed a unique model of care which incorporates leadership by Midwives of color, group education, care coordination, reproductive health counseling, emotional wellness services, home visiting, lactation promotion, parenting support and a birth center. This model brings life to the reproductive justice framework through approaches that are practical, meaningful and impactful for the families we serve. This session will discuss systemic barriers which deepen the disparities in maternal aligns with nationally recognized best practices, and reflects the core principles identified to decrease perinatal health disparities and improve maternal and child health outcomes for families in Wards 5, 7 and 8 and practical ideas for how to change this trajectory.

 

Home Visiting for Expecting and Parenting Families – Room #207B
Facilitator: The DC Home Visiting Council

Come hear home visitors from programs across the District discuss the needs of families from the prenatal period through the earliest years of the child’s life, including maternal health and mental health, parent-child relationship building, child health and development. We will discuss how home visiting approaches are supporting them during this important period, through 1:1 service, group support, and connections to service. The session will include significant opportunities for participant interaction and storytelling.

 

A Bright Start: Supporting Healthy Pregnancies through Home-Delivered Meals – Room #207A
Facilitators: Food & Friends, in partnership with AmeriHealth Caritas DC

Good nutrition is vital for a healthy pregnancy. A new partnership between Food & Friends and AmeriHealth Caritas DC aims to change that by providing free home-delivered meals for pregnant women and new moms throughout the District. In the year since the launch of the program, results have shown positive effects on maternal health and wellbeing. This session will share background on the development of this program, provide an overview of initial results, and highlight gaps for future research.

 

Perinatal and Early Childhood Behavioral Health and Policy—Creating Change Together – Room #201
Facilitator: The Pritzker Children’s Initiative DC – The Early Childhood Innovation Network

The Pritzker Children’s Initiative-DC (PCI-DC) is a city-wide, multi-disciplinary collaboration formed to develop a policy and action agenda with four key areas of focus that will increase the number of children ages 0-3 who receive high quality social-emotional and developmental support services. This workshop will discuss the PCI-DC and engage participants in collaborative discussion to give feedback on the draft action plan and generate new and innovative ideas for collaboration.

Agenda

9:00 AM
3rd Floor

Registration/Light Breakfast

 

9:00 AM – 3:00 PM 

3rd Floor

Summit Health and Early Education Expo

9:30 AM

Ballroom B

Welcome & Remarks

The Honorable Muriel Bowser, Mayor, District of Columbia

Dr. Faith Gibson Hubbard, Executive Director, Thrive By Five DC

Mayor Bowser will offer remarks and her own reflections on last year’s Summit. She will speak to investments and innovation happening in the District around maternal and infant health.

Dr. Faith Gibson Hubbard, Executive Director of Thrive by Five, will welcome Summit attendees by offering reflections from last year’s Summit, discussing investments that DC has made in perinatal health and education since last year, (including the expansion of Thrive by Five), and outline the day’s agenda. This will be done with support from Office of the State Superintendent of Education’s Division of Early Learning.

 

9:45 AM – 10:25 AM

Ballroom B

Panel #1

Centering the Narratives of Moms: A Discussion on Policy & Practice

Through the voices and narratives of moms, this panel will focus on local and national investments being made to improve outcomes for maternal and infant health. This discussion will provide greater context and set the tone for the Summit. 

Moderator: Dr. Faith Gibson Hubbard
Executive Director Thrive By Five

Jennifer Porter
Executive Director, Mayor’s Office on Women’s Policy and Initiatives

Kimberly Churches
CEO, American Association of University Women

Pati Jinich
Chef, TV Personality, Author

Dr. Esther Gamuchirai Madzivire
Obstetrics and Gynecology (OB/GYN), Atrium Health

10:25 – 10:30

Ballroom B

Remarks

David A. Hinson
President, Congressional Black Caucus Foundation

10:30 – 11:05

Ballroom B

Panel #2

Early Exposures in Life: Understanding Risk and Resilience to Improve Health and Education

This panel will discuss the concepts of trust and trauma-informed care. The conversation will be oriented to topics related to access to quality and responsive healthcare, early education, and family strengthening programmatic models, as it relates to health and education outcomes. 

Moderator: Dr. LaQuandra Nesbitt
Director, DC Health

Dr. Myra Jones-Taylor
ZERO TO THREE

Linda Goler Blount
Black Women’s Health Imperative

Dr. Nefertiti Poyner
Devereux Center for Resilient Children

Dr. Joia Crear-Perry
National Birth Equity Collaborative

Dr. Neena McConnico
Child Witness to Violence Project – Boston Medical Center

11:05 AM – 11:10 AM

Ballroom B

 

Remarks

Stacey D. Stewart
President, March of Dimes

11:10 AM – 11:15 AM

Ballroom B

Remarks

Oliver M. Johnson, II
Executive Vice President and General
Counsel, MedStar Health

11:15 AM – 12:00 PM

Ballroom B

Panel #3

The Role of Food Policy, Access, and Nutrition in Supporting Positive Outcomes for Families

This panel will highlight national and local efforts focused on healthy food access for families, breastfeeding, and babies’ first foods. 

Moderator: Ona Balkus
Food Policy Directors, DC Office of Planning

Ward 1 Councilmember Brianne Nadeau
Council of the District of Columbia

Dr. Kofi Essel
The George Washington University
School of Medicine & Health Sciences

Dr. Sahira Long
Children’s National Health System

Lauren Biel
DC Greens

Beverly Wheeler
DC Hunger Solutions

12:15 Pm – 1:20 PM

Ballroom C

Luncheon

Remarks

Monty Robinson
Vice President – Mid-Atlantic Region, Aetna

The panel will allow our guests to discuss their experiences with motherhood and parenthood and underscore the importance of centering the narratives of moms and babies in perinatal health care.

Moderator: Lesli Foster
Journalist, WUSA9

The Honorable Muriel Bowser
Mayor, Washington, DC

Alyssa Milano
Actress & Activist

Charles Johnson
Founder, 4Kira4Moms

Valerie Hollingsworth Baker
25th International President,
Zeta Phi Beta Sorority, Inc.

1:25 PM – 1:30 PM

Ballroom C

Remarks

Elizabeth Groginsky
Assistant Superintendent of Early Learning,
Office of the State Superintendent of Education

1:30 PM – 2:15 PM

Ballroom C

Panel #4

Our Fathers Speak: “A Place for Dads in Perinatal Health and Early Education”

The panel will highlight the importance of fatherhood involvement in building stronger families and communities. The discussion will include the role of males in perinatal care, maternal health, and early education.

Moderator: Jason Wallace
Director, Mayor’s Office on
Fathers, Men and Boys

The Honorable Cedric Richmond
US House of Representatives,
Democrat – Louisiana, 2nd District

Kenneth Braswell
CEO, Fathers Incorporated

Dr. Roger Mitchell
Chief Medical Examiner, DC Office
of the Chief Medical Examiner

Antoine Robinson
DC Dad, Bright Beginnings

Jonathan Webb
CEO, Association of Maternal
& Child Health Programs

2:20 PM – 2:30 PM

Ballroom C

Summary & Next Steps

Dr. Faith Gibson Hubbard
Executive Director, Thrive By Five DC

Second Floor, Small Rooms

Breakout Sessions: Round #1

Giving Voice to Mothers: Black Women Speak Out on Maternal Health Care in the District – Room #202A

Facilitator: DC Primary Care Association

Black mothers with experience of the District’s maternal health system will share their perspectives on what providers and policymakers need to know about maternal health care across the continuum of care. Panelists will share their stories of joy, frustration, connection, and fragmentation, and how listening to women is key to improvement. Participants will leave with a greater understanding of how systems-level challenges impact individuals and identify opportunities within their sphere of influence to better support black women and their families.

 

Midwifery in DC an Evidence Based Solution – Room#202B

Facilitator: American College of Nurse Midwives (DC Affiliate)

Midwives provide a range of services to women and families across the District. This session will highlight settings
practices certified nurse midwives currently work in DC. By the end of the session, attendees will be able to
describe the scope of practice of certified nurse midwives, how midwives can provide “low cost, high impact” and evidence based care, and how midwives collaborate with other health care professionals to address health disparities and maternal mortality in D.C.

 

Food for Thought: Eating Right for Two – Room #207A

Facilitator: Educare DC

This session will showcase our Pregnant & Lactating Mom Circle, a group that provides educational information to pregnant moms regarding healthy eating during pregnancy. Workshop participants will leave with a deeper understanding of the importance of good nutrition at the onset of pregnancy, during pregnancy, and after giving birth. We will also discuss the benefits of breastfeeding, how to build healthy eating habits for infants, and best practices for nutrition in early childhood centers.

 

Share your thoughts about the District of Columbia’s development of a five-year strategic plan for children, and families with children, birth to five! – Room #201

Facilitator: Office of the State Superintendent of Education

The District of Columbia’s Office of the State Superintendent of Education is leading the development of strategic plan as part of the District’s Preschool Development Grant, Birth through Five. Workshop participants will have the opportunity to provide feedback on the current draft of the strategic plan’s goals, strategies and actions to affect change in the District. The final strategic plan will impact the District’s entire early childhood system—encompassing all of the public and private entities, programs, services and environments (such as child development facilities, pre-K, Early Intervention, home visiting, etc.) that impact children’s lives.

Second Floor, Small Rooms

Breakout Sessions: Round #2

Maternal & Infant Mental Health Landscape Taking Steps to Improve Practice & Policy
Room #202A

Facilitator: Children’s National Health System

Discussing the landscape of infant and early childhood mental health in the District. Identifying potential resources and opportunities for policy change. Looking at a model of collaboration for evaluation and treatment of perinatal mental health in a pediatric primary care office.

 

Culturally Aware Prenatal Care with a Reproductive Justice Framework in a Community
Health Setting – Room# 202B

Facilitator: Community of Hope

Community of Hope has developed a unique model of care which incorporates leadership by Midwives of color, group education, care coordination, reproductive health counseling, emotional wellness services, home visiting, lactation promotion, parenting support and a birth center. This model brings life to the reproductive justice framework through approaches that are practical, meaningful and impactful for the families we serve. This session will discuss systemic barriers which deepen the disparities in maternal aligns with nationally recognized best practices, and reflects the core principles identified to decrease perinatal health disparities and improve maternal and child health outcomes for families in Wards 5, 7 and 8 and practical ideas for how to change this trajectory.

 

Home Visiting for Expecting and Parenting Families – Room #207B

Facilitator: The DC Home Visiting Council

Come hear home visitors from programs across the District discuss the needs of families from the prenatal period through the earliest years of the child’s life, including maternal health and mental health, parent-child relationship building, child health and development. We will discuss how home visiting approaches are supporting them during this important period, through 1:1 service, group support, and connections to service. The session will include significant opportunities for participant interaction and storytelling.

 

A Bright Start: Supporting Healthy Pregnancies through Home-Delivered Meals – Room #207A

Facilitators: Food & Friends, in partnership with AmeriHealth Caritas DC

Good nutrition is vital for a healthy pregnancy. A new partnership between Food & Friends and AmeriHealth Caritas DC aims to change that by providing free home-delivered meals for pregnant women and new moms throughout the District. In the year since the launch of the program, results have shown positive effects on maternal health and wellbeing. This session will share background on the development of this program, provide an overview of initial results, and highlight gaps for future research.

 

Perinatal and Early Childhood Behavioral Health and Policy—Creating Change Together – Room #201

Facilitator: The Pritzker Children’s Initiative DC – The Early Childhood Innovation Network

The Pritzker Children’s Initiative-DC (PCI-DC) is a city-wide, multi-disciplinary collaboration formed to develop a policy and action agenda with four key areas of focus that will increase the number of children ages 0-3 who receive high quality social-emotional and developmental support services. This workshop will discuss the PCI-DC and engage participants in collaborative discussion to give feedback on the draft action plan and generate new and innovative ideas for collaboration.

Thank you to all of our 2019 partners for contributing to this year’s summit!

2019 Planning Committee

Thrive by Five led the planning of Mayor Muriel Bowser’s National Maternal & Infant Health Summit with the support of the following agencies.

2019 Planning Committee

Thrive by Five led the planning of Mayor Muriel Bowser’s National Maternal & Infant Health Summit with the support of the following agencies.

Amerigroup, Maternal & Infant Health Summit Sponsor
Carefirst, Maternal & Infant Health Summit Sponsor
Logo for Johns Hopkins University, Sibley Memorial Hospital
Children's National Hospital, Maternal & Infant Health Summit Sponsor
Amerihealth DC, Maternal & Infant Health Summit Sponsor
Amerigroup, Maternal & Infant Health Summit Sponsor
Carefirst, Maternal & Infant Health Summit Sponsor
Logo for Johns Hopkins University, Sibley Memorial Hospital
Children's National Hospital, Maternal & Infant Health Summit Sponsor
Amerihealth DC, Maternal & Infant Health Summit Sponsor
Amerigroup, Maternal & Infant Health Summit Sponsor
Logo for Johns Hopkins University, Sibley Memorial Hospital
Amerigroup, Maternal & Infant Health Summit Sponsor
Carefirst, Maternal & Infant Health Summit Sponsor
Logo for Johns Hopkins University, Sibley Memorial Hospital
Children's National Hospital, Maternal & Infant Health Summit Sponsor
Amerihealth DC, Maternal & Infant Health Summit Sponsor
Amerigroup, Maternal & Infant Health Summit Sponsor
Carefirst, Maternal & Infant Health Summit Sponsor
Logo for Johns Hopkins University, Sibley Memorial Hospital
Children's National Hospital, Maternal & Infant Health Summit Sponsor
Amerihealth DC, Maternal & Infant Health Summit Sponsor
Amerigroup, Maternal & Infant Health Summit Sponsor
Amerigroup, Maternal & Infant Health Summit Sponsor
Carefirst, Maternal & Infant Health Summit Sponsor
Logo for Johns Hopkins University, Sibley Memorial Hospital

Twitter

@momhealthdc

- October 16, 2019, 9:18 pm

Where are the soon-to-be moms out there? 🤰 You may find this trimester by trimester guide to prenatal health especi… https://t.co/xgwqsa66tP
h J R
@momhealthdc

- October 16, 2019, 6:47 pm

It's about time policy reflected the nation's rising concern around maternal mortality and morbidity rates... espec… https://t.co/UXuvyMzQZf
h J R
@momhealthdc

- October 16, 2019, 6:10 pm

We're 4 weeks away from an event that's just what the doc ordered! Join us on Nov. 13 for a session on hypertensive… https://t.co/sXmvNhgr8P
h J R
@momhealthdc

- October 16, 2019, 12:15 am

Good news! Even though the 2nd annual #DCMaternalHealth Summit is over, you don't have to wait an entire year to be… https://t.co/w1XrVW9dlN
h J R
@momhealthdc

- October 15, 2019, 10:35 pm

"Resilience requires relationships" 👪 and 7 other facts about early childhood development from @HarvardCenter. Rese… https://t.co/dqKtyjSDvs
h J R
Mayor's association logo
DC Health logo
Mayor's office logo

This project was supported by the Preschool Development Grant Birth through Five Initiative (PDG B-5), Grant Number 90TP0045, from the Office of Child Care, Administration for Children and Families, U.S. Department of Health and Human Services. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Office of Child Care, the Administration for Children and Families, or the U.S. Department of Health and Human Services.

Mayor's association logo
DC Health logo
Mayor's office logo

This project was supported by the Preschool Development Grant Birth through Five Initiative (PDG B-5), Grant Number 90TP0045, from the Office of Child Care, Administration for Children and Families, U.S. Department of Health and Human Services. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Office of Child Care, the Administration for Children and Families, or the U.S. Department of Health and Human Services.