Minnesota’s five-year comprehensive needs assessment identified a significant area of need in ensuring Minnesota has inclusive systems that link young children and their families to all the support and services they need. It is Minnesota’s child health priority area.

Every family should have an equal opportunity to access health care, mental health services, early care and education, and local services and resources that are culturally honoring and support health, development, and safety. However, Minnesota faces significant challenges in implementing a coordinated, equitable, and efficient system of care for children and their families. The array of early childhood programs is complex and fragmented, due in part to differences in the way programs are funded and variations in their eligibility and other requirements.

Because so many families have reported difficulty in navigating the early childhood system, Minnesota has identified this as a priority need for our current five-year block grant cycle.

In Minnesota, public health and human services operate under local control with services delivered at the county- and Tribal-level in Minnesota’s 87 counties and 11 Tribal nations.  Similarly, early education intervention services for infants and toddlers with disabilities and their families operate in over 300 independent school districts. Tribal nations offer culturally-relevant services but are often unknown or ignored as potential referral resources by outside providers. Anecdotes from statewide providers consistently indicate that services are unavailable, unknown, or hard to access, but there is no statewide data that defines actual service gaps and barriers.

Health inequities start early in Minnesota, as demonstrated by the significantly higher infant mortality rates experienced by American Indian and African American families (12.7 and 10.4 per 1,000 live births respectively, compared to 3.8 for White infants). Screening rates for developmental and social-emotional health at well-child visits for Medicaid-eligible children in Minnesota are lower than recommended overall. The screening rates also vary by race, with American Indian and White children consistently having the lowest rates compared to other races. White and American Indian children are more heavily represented in rural areas, where rates of related screenings are lower. Early developmental screenings can help with identifying health conditions that can benefit from early intervention and treatment, such as language delays and autism.

Many projects and grants over the last ten years have started the work in improving comprehensive early childhood systems across government agencies. Formal recommendations in 2016 from local partners to the state, along with the results of an audit by the Office of Legislative Auditor in 2018, confirmed the need for a centralized system for resource navigation, referral and follow-through, and documentation of gaps and barriers in the system. During the recent Preschool Development Birth to Five Grant (PDG) needs assessment and strategic planning process, parents and providers shared their perspectives on the current assets and barriers that impact families who are experiencing racial, geographic, and economic inequities. Recommendations gathered through the Title V Needs Assessment confirmed the importance of this work and elevated this as a priority for MDH and stakeholders to focus on over the next five years.

Racial Equity

Children remain the poorest age group in Minnesota, with almost 150,000, 11.2% of all children, living in poverty in 2019.[1] Policies and practices rooted in structural racism have prevented Black, Indigenous, and People of Color (BIPOC) from having a fair start and this continues to be reflected in the disparities seen in today’s poverty rate – 37% of African American/Black and American Indian children are living in poverty comparted with only 6% of White children.

American Indian and children of color have fewer opportunities to succeed in school, and this starts with access to early childhood opportunities. In Minnesota, children are not guaranteed access to early childhood education, which means that this education is most often financed by parent’s tuition payments to private programs. With large income disparities by race, this further disadvantages BIPOC children. The median family income in Minnesota for American Indian, Black, and Hispanic families with children is $34,000 to $52,900, compared to $108,600 for White families with children.[2] We also know that early childhood education is associated with greater school readiness. Minnesota’s children experience racial disparities in school readiness as well with American Indian and Hispanic students having the lowest rates of school readiness at 62% and 68%, respectively.[3]

In 2018, American Indian children were 17 times more likely to experience out-of-home care than White children in the state.[4] Data from the Early Childhood Longitudinal Database (ECLDS) shows that, in 2019, 84.7% of African American/Black and 79.4% of American Indian/Alaska Native kindergarteners received economic assistance and/or food assistance, while only 23.3% of White kindergartners received assistance. Economic assistance through the Minnesota Family Investment Program (MFIP) or Diversionary Work Program (DWP), and Food Assistance through the Supplemental Nutrition Assistance Program (SNAP) and/or Free or Reduced Price lunch program are indicators of income and display the inequities in financial stability in Minnesota’s communities. Racism is embedded in our systems from the start.

Impacts of COVID-19 pandemic

COVID-19 has altered day-to-day life in many ways, both obvious and subtle, that affect child and family health. Families are experiencing additional stress due to school and childcare closures, work expectations, lack of statewide access to broadband/internet connections, access to supportive services, and negative impacts on small businesses in our local economies. This continued ambiguity and change in daily life can lead to tense parenting relationships, increased anxiety in both parents and children, and increased fear.

The COVID-19 pandemic highlighted some of the structural shortcomings in many early childhood systems. For example, childcare systems and businesses were already struggling in Minnesota before the pandemic, and these struggles have been exacerbated as capacity limits have been imposed. As a result, many families are opting to keep their children home. Comprehensive early childhood systems, including quality childcare, are the backbone of our society – other vital sectors of society including healthcare, food, and utilities rely on it.[5]

Five-Year Strategies and Activities Moving Forward

Comprehensive services expand access to information, services, and supports families need to help their young children achieve their fullest potential. To make the best choices, families need access to information that educates them about what their child is learning and doing, how to optimally support early childhood development and child health, and what resources or programs are available in their community. Families, especially those who have young children with special health concerns, also need opportunities to connect with other families in their community. High-quality programs link families with supports in a comprehensive, collaborative, culturally and linguistically responsive manner that best meets the needs and preferences of families.

As with the other priority areas, a Strategy Team was assembled to identify a set of strategies for the Minnesota Title V program to focus on the development of a coordinated early childhood system. It is important to note the collaboration between the Comprehensive Early Childhood Systems and the CYSHN Strategy Teams to assure that the unique needs of families with CYSHN are highlighted and embedded within the broader early childhood system development.

A logic model has been developed to visualize our planned work and intended results (see Figure 1). A larger version of the logic model is included with the supporting documents for this application. This logic model, along with the five-year action plan table, provide a broad picture of Minnesota’s strategies aimed at improving our early childhood system.

Figure 1. Minnesota Comprehensive Early Childhood Systems Logic Model

Strategy A: Coordinate access to comprehensive, family-centered early childhood services

The first strategy focuses on the implementation of an electronic and human interfacing navigation system for families and early childhood providers to connect and coordinate referrals, service provision, and follow up communication. This will help families of young children to be able to better coordinate and access comprehensive, family-centered services.

Coordinate the Release, Evaluation, and Sustainability of the Minnesota Help Me Connect Online Navigator and Referral System

MDH, in partnership with MDE, DHS, and the Governor’s Children’s Cabinet, has led efforts to launch a new online navigator that will help pregnant and parenting families with young children (birth to 8 years of age) and providers learn about and access early childhood and prenatal supports and services. The demonstration site for Minnesota Help Me Connect (HMC) was built in 2019 and was tested with groups of early childhood providers across the state, such as primary health care providers, LPH, CPS, Head Start, early education programs, and the 11 Tribal Nations. Numerous technical and functional modifications have resulted based on the focus group findings and the live site launched in May 2021. The initial launch of the Minnesota HMC live site (www.helpmeconnectmn.org (see Figure 2)) included a phased release to prioritized groups of early childhood providers to allow for additional testing and community feedback through the summer of 2021, with a public launch scheduled for August 20, 2021.

Figure 2. Help Me Connect Live Site

A full-time HMC Coordinator was hired by MDH using PDG funds in August 2020 and that individual works with a cross-agency team of state and local staff to develop provider training and prioritize ongoing web site modifications.   HMC enhancements that will occur during FY2022 include:

• Collaboration with Tribal Nations and the PDG Tribal Consultant to revise and modify the Tribal Resources category and assure an inclusive list of American Indian programs and services are available in HMC.
• Development of a real-time referral mechanism – Resource Connector – for providers to select specific services found in HMC and automatically connect families through the completion of one referral form. The referral mechanism will allow providers to login to check on the status of their referrals and to receive follow-up information.
• Exploration and inclusion of culturally-specific services available to families that are currently missing from HMC.
• Creation of a new content category for Prenatal Services to assure that services for pregnant individuals are easily found.
• Translation of top-level webpages into Spanish, Somali, Hmong, and Karen.
• Development of provider and family evaluation measures, such as satisfaction surveys, referral outcome data, availability of resources, etc.
• Collaboration with the MDH CYSHN staff to review the relationship between the existing CYSHN Navigator (online resource directory) and HMC and identify potential next steps to consolidate resources or develop a crosswalk between the two navigators to make it easier for families who have children with special health needs to connect to a variety of appropriate services.
• Collaboration with the PDG community-level hubs to provide training, implementation, and evaluation measures (discussed in the next section).
• Implement electronic developmental and social-emotional screening access for providers and families with children birth to 72 months of age (discussed in Strategy B).
• Continued ongoing, periodic community engagement and testing of HMC, especially with providers serving families with young children that are experiencing racial, economic, and geographic disparities.

Collaborate with the Preschool Development Grant Implementation of Community Resource Hubs

While MDH is working in partnership with others to lead the HMC activities described above, additional PDG efforts are being coordinated by DHS to administer grant funding to community-based partnerships to create community resource hubs. The hubs offer an opportunity for families (experiencing racial, geographic, and economic disparities) to talk with another person to receive one-on-one navigation assistance and coordination of services. The hubs have the following goals:

• Make it easier for families to get what they need. Develop universal access points for families, coupled with culturally appropriate, relationship-based navigation of programs and systems.
• Increase access to services. Partner with state agencies to test and evaluate Help Me Connect coupled with culturally appropriate, relationship-based navigation.
• Grow community engagement and support community-developed solutions. A community-based, whole family approach so families have what they need to thrive. This will look and feel different in every community.

The Request for Proposals for community-based partnerships to apply for hubs grant funding was released during the summer of 2020, and final selection of organizations occurred in September/October 2020.  The grant is supporting 12 primary applicant organizations and their service partners throughout Minnesota to build capacity at the local level to provide support services to pregnant and parenting families. The selected hubs include Tribal Nations and Urban American Indian organizations, schools, counties, community partners, communities of color, and greater Minnesota (rural) and urban communities.

Various staff from MDH, including the HMC Coordinator and PDG Lead, will collaborate with DHS staff and the selected community resource hubs on implementation.  During FY 2022, Hub grantees will:

• Participate in a Community of Practice
• Receive ongoing training on Help Me Connect and Minnesota’s Bridge to Benefits portal, which screens low-income families for potential eligibility in Minnesota’s work support and tax credit programs and completes the application process
• Co-design a closed loop referral mechanism for Help Me Connect
• Receive ongoing training and consultation from Early Childhood Mental Health regional staff
• Collect data on families and activities to support program evaluation and quality improvement efforts

Participate with the MDH Center for Health Equity Staff to Implement the Community Solutions for Healthy Child Development Grant Program

Through the Title V and PDG needs assessments, state agencies learned that many of the strategies implemented to help communities, families, and children of color and American Indian children do not leverage existing community and family strengths – which under-utilizes many assets communities already possess. Strengthening community capacity and supporting community-sourced solutions are key strategies in achieving health and racial equity. 

In 2019, the Minnesota Legislature directed MDH to establish the Community Solutions for Healthy Child Development grant program, with the purposes of: improving child development outcomes related to the well-being of children of color and American Indian children from prenatal to third grade and their families; reducing racial disparities in children’s health and development; and promoting racial and geographic equity. Staff from the MDH Center for Health Equity (CHE) oversee the Community Solutions grants, in collaboration with the Community Solutions Advisory Council, which is comprised of 12 members representing diverse Minnesota communities, areas of expertise and geographic locations.

The similarity of goals between the Community Solutions grant program and the PDG Renewal Grant led to an exciting collaboration to support additional Community Solutions grants beginning in FY2021. PDG Renewal Grant funding was used to supplement the Community Solutions state funding and double the number of grantees.

The Community Solutions grants will amplify the work of communities of color and American Indian communities and support them to create their own solutions through investments in their infrastructure, staff, and resources. Grantees will be connected to a network of statewide leaders doing similar work in their own cultural communities and to resources, skills, and knowledge within MDH and partners across the state. Title V staff and MDH PDG staff will collaborate with CHE staff to provide community outreach, technical assistance, and evaluation consultation to the grantees as appropriate. Biannual grantee meetings will be held in FY2022 focusing on program evaluation and other technical assistance needs. We will learn from grantees about what works best within their communities as an avenue to better support these efforts in the future. At the direction of the advisory council, there will also be efforts to sustain funding once PDG and state appropriated funds expire.

Champion Minnesota’s Integrated Care for Early Childhood Initiative

Minnesota received notice we received a Health Resource and Services Administration’s Early Childhood Comprehensive Systems: Health Integration Prenatal-to-Three Program grant. Minnesota’s project, titled the Minnesota Integrated Care for Early Childhood Initiative, is a community-led, collective effort to engage families, professionals, and other community partners to build the infrastructure for an equitable, family-centered, integrated model for conducting early childhood screening, referral, and follow-up in health settings. Minnesota will accomplish this by accomplishing the following goals:   

• Community-Driven Leadership: Cultivate and support a community-driven leadership structure where problems and solutions are defined by, and decision-making power is shared with the community.  
• Shared Understanding and Vision: Build a shared understanding and vision of gaps, assets, and opportunities in achieving an equitable early childhood system that is inclusive of the health system.  
• Health System Capacity: Increase health system capacity to serve Minnesota’s prenatal-to-three populations most at risk for adverse outcomes.  
• Financial and Policy Strategies: Identify and carry out innovative financial and policy strategies to support implementation and sustainability of efforts.  
• Advance Equity: Increase Minnesota’s capacity to advance equitable access to services and supports for underserved prenatal-to-three populations.

Minnesota’s project will focus on the populations that are typically under identified in health care settings and under served through our early childhood system. These children (for whatever reason – including provider bias, systemic racism, etc.) are not being identified and linked with early intervention services. Finally, we will be working with a community-based facilitator to bring together a representative Advisory Council to develop a model to better identify children and link them with needed services. While MDH will champion the initiative, we are looking to the community (through the Advisory Council) to identify and define the problem and solutions, and drive improvements needed to form a more equitable early childhood system.

Strategy B: Maximize and Increase Funding to Support Statewide Programs that Serve Families who are Pregnant and Parenting Young Children

The second strategy focuses on increasing the capacity of existing early childhood programs and maximizing new opportunities to test and expand services that will increase coordination and access to services for families with young children.

Implement Minnesota’s Follow Along Program

The Follow Along Program (FAP) is an early childhood developmental and social-emotional screening system delivered through LPH agencies for families with children birth to 3 years of age. The program offers families periodic guidance on early childhood developmental and social emotional milestones, access to age-appropriate ASQ®-3 and ASQ®:SE-2 intervals, timely referral to assessment/evaluation and community services, and follow up to assure connections have been made.

The FAP is partially funded via an Interagency Agreement between MDE and MDH, which is funded by Minnesota’s Part C Infants and Toddlers with Disabilities Program. MDE serves as Minnesota’s Part C agency and provides funding to MDH to assist in implementing a comprehensive system that looks for, finds, and evaluates children who need special education. MDH uses the funding from the agreement to provide grants to LPH agencies to coordinate the FAP at the county level. MDH also provides training and technical support to the LPH agencies and manages the FAP data system.

During FY2022, MDH will continue to work with LPH agencies to implement the FAP – ensuring they adhere to program standards and helping support coordination between the FAP, primary care providers, and early intervention providers.

Implement Electronic Access to Developmental and Social-Emotional Screening through LPH agencies and Support Collaboration with Community Partners

Electronic Developmental Screening Access

Minnesota convenes an Interagency Developmental Screening Task Force comprised of Department of Health, Human Services, and Education staff that oversee various early childhood screening programs, including the Title V-supported programs – FAP and FHV. Providing electronic access to developmental and social-emotional screening to families has been a priority among state and local early childhood partners for the past several years in efforts to identify strategies to assure all children are receiving recommended screening guidelines. A wide array of early childhood providers are currently providing periodic or one-time screening to families with young children – there are currently seven state-administered programs across state agencies that use the ASQ®-3 and ASQ®:SE-2 instruments. In most situations, there is no communication between screening providers to share screening information that may help avoid duplication, but more importantly, to identify which children have not been screened.

Electronic screening priorities for MDH include:

• Promoting access to the Ages and Stages Questionnaires ASQ®-3 and ASQ®:SE-2,
• Having the technical ability to integrate (share) screening information between the electronic screening system and various public health reporting data systems, and
• Ensuring functionality that will allow LPH agencies to collaborate with other community-level screening agencies to share screening data and coordinate referrals for children experiencing concerns.

MDH finalized an agreement with the Brookes Publishing team in early 2020, which allows MDH to partner with LPH agencies to test the ASQ® Online system. In April 2020, MDH offered the system to counties to use for their FHV, FAP, and CPS screening programs to help remedy challenges the programs were having in providing timely screenings to families during the COVID-19 pandemic.

Moving forward and through FY2022, MDH will provide leadership and technical assistance to the counties with active screening accounts under the MDH-sponsored ASQ® online screening system. Braided funding from Minnesota’s PDG project, the Title V MCH Block Grant; the state’s Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Program, and the Part C program will be used to sustain ongoing subscription and screening costs so local agencies will be able to use the system at no cost.

MDH will lead monthly virtual Community of Practice sessions for participating agencies to share strategies, address barriers, and provide evaluation data to MDH and partnering agencies. Feedback from the Community of Practice will be used to generate recommendations for the implementation of a statewide screening portal that may be used to coordinate early childhood developmental and social-emotional screening across all sectors of Minnesota screening providers. Title V staff will work closely with the HMC Coordinator to include electronic screening access within the new HMC Navigator. This will also provide the PDG community-level Hubs (discussed in Strategy A) access to real-time screening options, as they are working to connect children and their families to appropriate community services.

Collaborative Pilot Projects

During FY2022, MDH will also be facilitating 8-10 pilot project grants to encourage more collaboration between local agencies around developmental screening and actively test the electronic screening system in partnership with other early childhood providers.

Child Protective Services (CPS)

One area of focus for these collaborative pilot projects will be between LPH agencies and CPS. Referrals to Part C from CPS are often made automatically (due to mandates), this can result in families not knowing that they were even referred and/or can mean that many children do not meet the eligibility requirements for early intervention services. These specific pilots will be charged with reviewing whether LPH can assist in ensuring that children referred to CPS receive mandated early childhood screening and Part C referrals – and test whether electronic developmental screening could be used as an appropriate mechanism to support and connect families involved in CPS to a variety of services, while still meeting all regulations and mandates. Grantees of the pilot projects will be asked to review local screening and referral procedures and partner with CPS staff to test an electronic screening protocol for children (birth to three years old) that are entering CPS. While all children who have screening concerns and/or current developmental/social-emotional delays will be referred immediately for a Part C evaluation, recommendations will be made for how to assure the remaining families are connected to the FAP for periodic developmental and social-emotional screening through the ASQ Online system and ongoing LPH support as needed.

Primary Care Providers and Other Community-Level Screening Providers

Another focus of the electronic screening pilot projects will be on the connection between LPH agencies and primary care providers. Agencies will partner with other community-level screening providers to encourage the development of a coordinated screening system that is able to track a child’s completed screening activities and share results and potential referrals with other providers who are serving the same child. The intent of a coordinated electronic screening system is not only to increase access for families to complete their child’s recommended developmental screening intervals, but to assure that the various providers mutually serving families are able to see which children have completed screens, whether there were any concerns or referrals, and to document any related follow-up actions to ensure families are receiving coordinated care. The electronic screening system will also serve as an alert to providers when families have missed completing a recommended screening interval and allow them to open a new, age-appropriate screening interval for families to complete right away at their next visit.

Primary care providers in pediatric and family practice clinics have expressed a strong desire to collaborate with LPH agencies who are typically screening the same children. Primary care providers who are completing a C&TC visit with young children are often aware that the family has completed a recent screening instrument through LPH or Early Head Start, but do not have the capacity to request screening results in a timely manner that will benefit the current well-child visit. Therefore, most primary care providers are expected to conduct a new developmental screen during the child’s appointment to receive full reimbursement. Families, having to complete screens multiple times, are confused and frustrated that their child’s screening results aren’t shared between screening providers. Several LPH agencies that will be using the ASQ® Online system are very interested in collaborating with local health care providers or have already connected with primary care clinics to begin discussions about next steps. As noted earlier, MDH will host monthly virtual Community of Practice opportunities for LPH agencies using the MDH-sponsored ASQ® Online system and be able to facilitate connections between public health and primary care. The Community of Practice will provide an opportunity for local agencies to share strategies for a successful partnership with primary care that can be replicated by others across the state, and aggregate data obtained through the ASQ® Online system will provide MDH with evaluation information.

Evidence-Based Strategy Measure

Minnesota will use the implementation of ASQ Online electronic screening system as our evidence-based strategy measure (ESM) for the next five-year block grant cycle. More specifically, we will measure the percent of screens completed in the county’s FAP that utilized an electronic screening system (versus the paper version). More information on the measure, data sources, and potential limitations is included on the ESM detail sheet.

Explore the Implementation of Universal, Evidence-Based Family Home Visiting Models to Support all Families with Newborns

The Strategy Team for the Comprehensive Early Childhood Systems priority need acknowledged the positive outcomes and successes of Minnesota’s FHV Program numerous times during the strategic planning sessions and expressed a strong desire to explore ways to offer all families with children birth to five years of age an opportunity to receive home visiting services. Many partners fondly remember when local agencies had the capacity to offer universal home visits to all families after the birth of a child but recognize that the capacity and funding has not been sustainable. MDH FHV staff routinely connect with LPH agencies to discuss family home visiting models which recently resulted in 3 additional counties adding an evidence-based HV model to the services offered to families. During FY2022, MDH will engage local home visiting partners to review family home visiting models, explore options to maximize funding opportunities, focus efforts to assure that evidence-based home visiting services are available in every county in Minnesota and promote access to a broader population of families with young children.

National Performance Measure and Five-Year Objective

The strategies outlined in this priority area are focused on enhancing coordination and connections between families and services across a multitude of early childhood settings. Several activities are targeted at improving access to developmental and social-emotional screening, specifically for children birth to kindergarten entrance. Minnesota has chosen National Performance Measure (NPM) 6 as our focus for the current five-year block grant cycle, which started in FY2021. This NPM measures the percent of children, ages 9-35 months, receiving a developmental screening using a parent-completed screening tool.

The 2017-2018 National Survey of Children’s Health found that 58.5% of children, ages 9-35 months, received parent-completed developmental screening. By 2025, Minnesota aims to increase the percentage of children receiving developmental screening by 10% (i.e., approximately 64.4% of children will receive developmental screening by 2025). Our target for FY2022 is 61.6% of children.

Ongoing Efforts Related to Child Health Domain

Promote best practices in developmental screening through Child & Teen Checkups (C&TC)

MDH provides consultation to DHS on policy to help drive improvements in developmental and mental health screening and referral for Minnesota’s Child and Teen Checkups (C&TC) program, which is Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit. DHS, Minnesota’s Medicaid agency, has an interagency agreement with the MCH program to provide consultation, training, and technical assistance to DHS, C&TC providers, and others across the state who provide child preventive health screenings and referral.

To drive improvements in screening and referral for C&TC, Minnesota will continue to emphasize developmental and mental health screening as recommended components for C&TC visits (birth through age 20 years), and for postpartum screening during infant well visits. C&TC staff will utilize Medicaid billing data to help guide training prioritization to clinic systems that are either seeing large numbers of Medicaid enrolled children, or higher risk enrolled children, which are not currently billing for developmental or social-emotional screening. MDH and DHS will continue to participate in the Interagency Developmental Screening Task Force which sets developmental screening tool standards, which provides the guidance for C&TC evidence based developmental screening procedure recommendations.

Promote Connections Between Family Home Visiting and Early Childhood System Collaboration

Family Home Visiting requires all grantees to include an objective on developing a plan with community partners to improve integration within the early childhood system. Local agencies often address this by participating in local community inter-agency groups and meetings that focus on young children and their families. Grantees report on progress in their narrative reports and it is discussed at site visits and regularly scheduled check-in calls. Family Home Visiting Nurse Consultants also provide ASQ & ASQ:SE training at least quarterly to enhance home visitors capacity to provide screening and subsequent referrals and connections to the early childhood services that benefit families.

[1] U.S. Census Bureau; American Community Survey, 2019 American Community Survey 1-Year Estimates, Table DP03; generated by Molly Meyer; using data.census.gov; <https://data.census.gov/cedsci/>; (26 March 2021).

[2] Minnesota’s education system shows persistent opportunity gaps by race. (2021). Federal Reserve Bank of Minneapolis. Retrieved from: https://www.minneapolisfed.org/article/2021/minnesotas-education-system-shows-persistent-opportunity-gaps-by-race

[3] Minnesota’s education system shows persistent opportunity gaps by race. (2021). Federal Reserve Bank of Minneapolis. Retrieved from: https://www.minneapolisfed.org/article/2021/minnesotas-education-system-shows-persistent-opportunity-gaps-by-race

[4] Foster care: Temporary out-of-home care for children (2018). Minnesota Department of Human Services https://edocs.dhs.state.mn.us/lfserver/Public/DHS-4760-ENG.

[5] COVID-19 pandemic worsening state’s child care crisis (2020). Rachel Kats, Session Daily. Retrieved from: https://www.house.leg.state.mn.us/sessiondaily/Story/15234?fbclid=IwAR3WFBgx2DEbLEULK8kid5lCxV0Vukgef9KVbcC2KojeK1a9XwHLVc1n2ps.