Investing in the first 1,000 days of a child’s life, a key formative period of brain development, can improve that child’s health and well-being over his or her entire lifetime.

This compelling fact spurred New York State to launch the First 1,000 Days on Medicaid initiative, a host of new cross-sector programs for children up to age three. New York’s Medicaid program, which spearheads the initiative, covers about 60 percent of the state’s very young children.

United Hospital Fund is a lead partner in this effort, which is bringing together a variety of child-serving sectors to collaborate with the State’s Medicaid program and promote child health and development in a variety of settings. UHF staff guided the development of the initiative’s proposals, soliciting ideas from 200 participating experts in child development, child welfare, pediatrics, mental health, and education—and developing a ranking and voting process to create the final Ten-Point Action Plan. It was adopted in 2018 and fully funded by the state legislature for implementation. UHF staff is continuing to support the State by advising on project implementation, re-convening stakeholders as necessary, and sharing lessons from its Children’s Health Initiative.


The First 1,000 Days Ten-Point Action Plan

Braided funding for early childhood mental health consultations—to unite several state agencies to co-fund training for early childhood teachers on how to support healthy development and identify behavioral problems;
Statewide home visiting—to expand home visiting programs that have demonstrated improved outcomes;
Preventive pediatric care clinical advisory group—to guide pediatricians on prevention, health promotion, and addressing poverty-related risks;
Expansion of “Centering Pregnancy”—to spread this successful model of group prenatal care for mothers in communities with the poorest birth outcomes;
Early literacy through local strategies—to improve early language development by expanding “Reach Out and Read” to pediatric primary care;
Requiring managed care plans to have a child-specific quality agenda—to develop quality improvement programs on common child-health quality measures;
Developmental inventory upon kindergarten entry—to create a standard measurement tool for use at that milestone;
Peer family navigators in multiple settings—to launch nine pilot projects, in homeless shelters, drug treatment programs, and other settings, to help hard-to-reach families connect to resources;
Parent/caregiver diagnosis as eligibility criterion for dyadic therapy—to allow children’s Medicaid enrollment to cover a proven parent/child therapy model based solely on a parent’s mood, anxiety, or substance abuse disorder diagnosis;
Data system development for cross-sector referrals—to develop a screening and referral data system that connects families to nearby health and social services.

UHF's First 1,000 Days Team

Chad Shearer is the Senior Vice President for Policy and Program at United Hospital Fund, overseeing work across the coverage and access, quality and efficiency, and clinical-community partnerships focus areas, as well as UHF conferences and grantmaking. Previously, Mr. Shearer was at the Princeton School of Public & International Affairs, where he served as deputy director of the Robert Wood Johnson Foundation’s State Health Reform Assistance Network, a project coordinating technical assistance to 11 states on the implementation of the Affordable Care Act’s coverage expansion provisions. He was also a lecturer in public affairs at the university, teaching a capstone policy workshop.

Mr. Shearer also was senior program officer at the Center for Health Care Strategies, where he helped shape its Medicaid Leadership Institute, an intensive training program for selected state Medicaid directors. Before that, he served as legislative director for Congressman Pete Stark, who was Chairman of the Ways and Means Subcommittee on Health, in the United States House of Representatives.

Mr. Shearer holds both a law degree and a master’s of health administration from the University of Iowa.