Landscape analysis for a community-designed intervention to enhance early childhood development in San Francisco.

To determine the appropriate components for a community-based intervention for early childhood development, a broad series of stakeholder interviews was completed in a three-month period (January-March 2019) and a systematic review of their responses was performed. Additionally, 11 citywide assessment reports for child equity were reviewed and added to the information matrix. We performed this population-based assessment in San Francisco, a dense urban environment with roughly 43,000 children under the age of 5. The city has high rates of income inequity, with roughly half of the children considered to be living in low-income or poverty conditions. Interviews were conducted with 34 stakeholders representing various sectors, including community organizations, government, healthcare, and academia. Nine main concerns surrounding low-income families and children (LIFC) living in San Francisco were extracted from stakeholder interviews. The concerns were divided into subcategories based on a socioecological health model. City-funded, community-based, family resource centers were an identified space for performing an early childhood health intervention supporting LIFC. Furthermore, any proposed intervention to support LIFC must be implemented with a culturally tailored focus, as a one-size-fits-all, clinic-based model is not desired. Community-engaged and culturally specific activities are requested and required for effectively promoting early childhood development in an urban environment. In this article we propose that additional work towards implementing community-based interventions with support from the clinic are needed.