Inside Texas Children’s Hospital, there’s a quiet kind of ambition going on that doesn’t make news until years later, when the numbers eventually support the concept. It began in 2016 with a single, seemingly straightforward finding: by the time they enter kindergarten, children from lower-income families hear up to 30 million fewer words than their more affluent peers. Once baked in, that gap seldom closes. Therefore, a small group at the hospital’s West Campus made the decision to attempt to shut it down before it ever started.
Their creation, known as upSTART, was short-lived. It started with upWORDS, a program that taught parents about “serve and return” interactions—the back-and-forth babbling and responding that forms the foundation of a baby’s early brain. The program’s assistant director, Maura Dugan, refers to the gadget parents wear as a “language Fitbit” and calls it LENA. It counts conversations, counts words, and gives parents a score they can genuinely raise. That simplicity, which turns brain science into something a weary new mother can do at two in the morning, has an almost radical quality.
The more intriguing aspect of this tale is probably that the program didn’t end there. Families continued to arrive with needs unrelated to vocabulary, such as unstable housing, postpartum depression, or the silent anxiety of not knowing how to pay for dinner. Instead of remaining narrowly focused, the team broadened their focus to include upWORDS Bridges for developmental delays, upLIFT for perinatal mental health, and a Community Connections arm that addresses the social pressures that families typically don’t speak about. The hospital’s Director of Population Health, Nancy Correa, put it simply: worrying about dinner makes it difficult to concentrate on bonding with your baby.
The staff behind this program is what sets it apart from the typical hospital outreach initiative. A large number of community health workers were former participants. As a young mother with a six-month-old daughter, Rosa Paredes joined, became engrossed in the work, and eventually received training to become a certified community health worker. Santy Guel, who had little herself but grew up watching her mother feed neighbors, once declared as she left a benefits office that she would one day work behind that desk. She now helps mothers deal with depression and anxiety in their own homes and in their native tongue. It’s a small detail that can be easily missed, but it could be the real source of the program’s credibility. People who have experienced the same fear are trusted by families.
Over 14,000 Welcome Baby Bags have been distributed throughout Greater Houston, and over 1,100 families have participated in upWORDS over the course of two years, with hundreds more participating in related programs. It has been sustained by sixteen grants totaling fourteen million dollars, including state funding that indicates Texas itself recognizes its worth. It remains to be seen if other states will examine it closely enough to duplicate it. It can be challenging to scale programs linked to individual hospitals or grant cycles, and what works in Houston’s unique combination of nonprofits, hospitals, and county funding might not translate well elsewhere.
Nevertheless, it’s difficult to ignore how unglamorous the entire strategy is and how that may be precisely the point. Just regular home visits, a wearable word counter, and people who can recall what it was like to be in need of assistance—no ostentatious technology, no broad policy mandate. Washington’s early childhood policy discussions frequently focus on abstract concepts like funding formulas, access metrics, and theoretical results that are decades away. One conversation, one crib, one anxious new parent at a time, upSTART works in the opposite register. That patience is uncommon, and it might be the most difficult aspect of the model for any other state to replicate.
