Healthy Universal Preschool Collaborative Framework: Using Co-Design to Expand Early Identification in Early Childhood Systems
- coloradoabcd
- Jul 27
- 4 min read
Updated: Aug 5
This summer, Colorado Universal Preschool (UPK) programs will begin implementing new Healthy Development Quality Standards, which include supporting children’s vision, hearing, oral health, and social-behavioral development. While these standards create exciting opportunities to support young children’s healthy development, many preschool programs face limited capacity, resources, and community connections needed to implement them effectively.
To help address this challenge, Assuring Better Child Health & Development (ABCD), in partnership with Healthy Child Care Colorado, recently completed a two-year initiative focused on integrating oral health education, screening and referral practices into Universal Preschool settings. Supported by funding from the Delta Dental of Colorado Foundation (DDCOF), the project served as a demonstration of how the Healthy Universal Preschool Collaborative (HUPC) framework can help communities translate statewide standards into locally driven action.
At the heart of HUPC is co-design, an approach that brings families, educators, health professionals, Child Care Health Consultants (CCHCs), community organizations, and other partners together as equal contributors to identify challenges, design solutions, and strengthen systems that reflect each community's unique strengths and needs.
Why Start with Oral Health? Healthy development includes more than learning to walk, talk, and build social and motor skills. Oral health is closely connected to children’s overall health, learning and wellbeing, yet dental concerns often go unnoticed in infants and toddlers. Tooth pain and untreated decay can affect nutrition, sleep, speech, attendance, and a child’s ability to learn and thrive.
Addressing oral health in preschools is just one more developmental area that can set up children for healthy success as they grow. Oral health provided an ideal opportunity to test the HUPC Framework while helping communities build partnerships, referral pathways, and sustainable practices that can eventually be expanded to other areas of healthy development.
In this project, five organizations championed the work across Colorado:
Each lead organization convened a local co-design team that included preschool providers, Child Care Health Consultants (CCHCs), oral health professionals, and community partners to design policies and procedures for conducting screenings and referrals in preschool settings.
Through the HUPC framework and co-design process, each lead organization was able to support their community in developing a unique solution that would work best for them. In Denver, coaches came in to help support children with tooth brushing during preschool hours. In the San Luis Valley, where the nearest dental provider for the community may be an hour’s drive away, preventative care was a crucial focus. Joint Initiatives for Children in El Paso even had their very own tooth fairy come to school!
Although each approach looked different, all communities shared the same goal: ensuring young children receive the support they need for healthy development.
The project also highlighted the critical role of Child Care Health Consultants (CCHCs). CCHCs are licensed medical professionals who support child care programs with health and safety practices, chronic health needs, medication administration, and developmental concerns. While Colorado child care programs are required to have access to a CCHC, these professionals are often underfunded and have limited capacity to meet growing needs. Many child care centers pay for their own CCHC.
Beyond being a requirement, CCHCs are necessary to ensure that children receive necessary medical care while in a child program - through support as simple as administering medication or as complex as assisting with a child’s feeding tube. Through this project, CCHCs conducted oral screenings, something that had never been done before, demonstrating how they can help bridge early childhood education and health care systems. Their role is not only important; it’s vital. Without CCHCs, the children who received oral screenings that ended up in a subsequent referral (nearly ¼ of preschoolers in this project), may have an underlying dental issue that would never be addressed.
“There's so much more that we can do … when visiting the classrooms and doing health education … that's what impacts these children's lives.”
- Participating CCHC
Over the course of the 18-month project, lead organizations worked with 77 Universal Preschool Programs in mixed settings, serving over 2500 preschoolers to implement oral education, screening, and referrals. Over 900 children received oral health screenings, and over 800 children are now brushing their teeth regularly while at preschool. Nearly 25% of children screened were referred for additional dental care.
Beyond these outcomes, communities strengthened partnerships, created new referral pathways, increased local capacity, and demonstrated how co-design can help translate statewide policy into sustainable local practice.
“[This project] really expanded our relationships, particularly with CCHCs.”
-Lead Organization
While this project focused on oral health, the Healthy Universal Preschool Collaborative was designed as a framework that can support all of the Healthy Development Quality Standards. ABCD Colorado and Healthy Child Care Colorado look forward to expanding the HUPC framework to address additional areas, including vision, hearing, and social-behavioral health, so that more children and families across Colorado can benefit from coordinated, community-driven systems of support.
The Healthy Universal Preschool Collaborative demonstrates that when communities are trusted to design solutions together, they create approaches that are practical, sustainable, and uniquely suited to the children and families they serve.
Learn more in our Healthy Universal Preschool Collaborative Impact Report.
This project was made possible through generous funding from the Delta Dental Foundation of Colorado.
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