Title IX is a Beginning, Not a Destination: Programs for Pregnant and Parenting Youth

Sunday was the anniversary of Title IX, the Education Amendment that prohibits sex discrimination in public education, including discrimination against pregnant and parenting students. Many Americans primarily associate Title IX with its dramatic impact on young women’s opportunities to play sports; however, the spirit of Title IX is far more encompassing. While great progress has been made since the early 1970s to ensure that girls and women have equal opportunities to get a quality education, many barriers remain—especially for pregnant and parenting students.

According to a report by the National Women’s Law Center (NWLC), pregnant and parenting youth still often face discrimination at school that violates their legal rights under Title IX. Tremendous stigma surrounds teen pregnancy, and some teachers and school staff still assume that pregnant students will inevitably drop out. The report finds that these negative assumptions about pregnant and parenting youth often lead to overt discrimination such as the illegal expulsion of pregnant students, pressuring these students into enrolling in low-quality ‘alternative’ education programs, refusing to excuse absences for medical appointments or even childbirth, and not letting students make up work that they missed when absent due to pregnancy. Pregnant students are often denied the services available to other students with temporary medical conditions including home or hospital-based instruction. Although schools are required under the law to have Title IX coordinators to ensure that claims of sex discrimination are addressed, some schools either have a coordinator who does not know what his or her responsibilities are or have no coordinator at all.

The report emphasizes that rather than pregnancy being the end of the road for students, it can be a powerful motivating factor in encouraging formerly disengaged students to succeed in school and in their careers in order to provide their children with a better life. The report also argues that pregnancy is not the root cause of lack of educational achievement among students, but rather that factors like poverty, lack of access to health information and care, and a weak support system are the underlying factors that increase students’ risk of both teen pregnancy and low educational attainment. If students do not complete high school, it becomes far more difficult for them to go on to college or access jobs that pay a family-sustaining wage. With a young child to look after, it becomes even more critical for young parents to be able to earn a good living. Yet the child that may motivate a parenting student to succeed may be viewed by school staff as a liability and a reason to write the student off as ‘hopeless’.

Some states have enacted policies to support pregnant and parenting youth in continuing their education and developing the parenting and life skills they will need to raise a child. The District of Columbia’s New Heights program serves pregnant and parenting youth at 14 DC public schools using a youth development framework. The New Heights program provides supportive case management and educational workshops for expectant and parenting (male and female) students enrolled in DC public high schools. The program includes assistance with securing services such as child care vouchers, food assistance, job training opportunities, as well as workshops on topics such as pre-natal care, parenting, life skills, financial literacy, career planning, healthy relationships and other issues.

The California School Age Families Education (Cal-SAFE) program provides students with academic and support services to finish their education, build parenting skills and enroll their children in child care and development programs. According to a 2010 report to the California state legislature:

·         Over 73% of the students who left the Cal-SAFE Program had successfully completed their high school education (compared with the 40% completion rate for teen mothers nationally)

·         Only 8.47% of the babies born while their parents were enrolled in the program represented repeat pregnancies compared with the 20% national repeat birth rate in 2004

·         Only a 6.7% rate of low birth weight among children born to parents enrolled in Cal-SAFE, significantly lower than the national rate of 13.4% for mothers under 15, and 10% for mothers aged 15-19

·         Over 60% of the children of Cal-SAFE students attended a child care center funded by the Cal-SAFE Program and received services based on assessed developmental needs.

·         Over 94% of the children enrolled in the program were up-to-date on their immunizations, substantially higher than the rates for all children ages 19-35 months nationally (82%) and in California (81%)

Unfortunately, many programs to support pregnant and parenting youth face budget cuts. In California, for example, the Cal-SAFE program showed a major drop over three consecutive years in the number of youth served after its funding was changed to a block grant with more flexible requirements for school districts, allowing schools to move funding away from the program. Prior to the funding change, participation had grown for eight straight years since the program was introduced.  
 

One option for states looking to fund improved services for pregnant and parenting youth is the Pregnancy Assistance Fund (PAF). The Affordable Care Act created this $25 million competitive grant program to provide pregnant and parenting teens and women with a network of supportive services to help them continue their education and access critical supports such as health care, child care and family housing. The funds can also be used to improve services for pregnant women who are survivors of domestic violence, sexual assault and stalking. So far state and tribal entities in 16 states and the District of Columbia have received grants for up to three years to develop and implement programs.

Title IX is the minimum legal requirement for schools, but it is only a beginning. Federal law leaves a lot of room for state policymakers to develop strategies to promote the well-being of pregnant and parenting youth and their children. State policymakers may wish to consider reviewing how well schools in their state protect the rights of students to have equal access to education regardless of their gender. They may also want to consider what programs are currently in place to support pregnant and parenting youth and explore research-informed approaches that have produced positive results for young families.

 
For more information about how to reduce teen and unplanned pregnancies, as well as how to increase high school graduation rates, please visit PolicyforResults.org.  For CSSP resources on supporting pregnant and parenting youth who are also involved in the child welfare system click here.

Facilitating the Enrollment of Newly Eligible Families into the Exchanges

Beginning on October 1, 2013, individuals and small businesses will be able to purchase private health insurance through state-based competitive marketplaces called Affordable Insurance Exchanges (Exchanges), also known as the Health Insurance Marketplaces. Between the expansion of Medicaid and the subsidies that will become available to assist low-income families to purchase other types of insurance, these Exchanges are estimated to expand insurance coverage by the tens of millions. Health insurance is important for multiple reasons – and dramatically impacts outcomes for low-income families.  A study by the National Bureau of Economic Research found that having Medicaid corresponds with increases in hospital, outpatient, and drug utilization, increases in compliance with recommended preventive care, and declines in exposure to substantial out-of-pocket medical expenses and medical debts. There is also evidence of improvement in self-reported mental and physical health measures, perceived access to and quality of care, and overall wellbeing.

Affordable Insurance Exchanges will have a large impact on currently uninsured populations, especially young adults aged 18-34, who are the most likely to be uninsured. However, enrolling in health coverage is a significant obstacle for many Americans and their families. Many face challenges such as limited access to technology, low literacy skills, and language or cultural barriers. While the Affordable Care Act (ACA) simplifies the enrollment process and makes it much more consumer-friendly, many will need the assistance of trained and compassionate advisors in order to understand their coverage options and enroll in the most appropriate public program and/or health plan.

The Affordable Care Act (ACA) addressed the importance of in-person assistance by requiring all Exchanges to provide Navigator grants to entities for conducting public education activities to raise awareness about the new coverage options, helping people apply for, and enroll in, plans offered through the Exchanges, as well as providing referrals. It is the responsibility of Navigators to provide fair and impartial information to consumers about health insurance, the Exchange, Qualified Health Plans, and insurance affordability programs including premium tax credits, Medicaid and the Children’s Health Insurance Program (CHIP). Navigators will also provide referrals to consumer assistance programs and health insurance ombudsmen for enrollees with grievances, complaints, or questions about their health plan or coverage. Furthermore, Navigators are directed to provide information in a culturally and linguistically appropriate manner, including to persons with limited English proficiency; and to ensure accessibility and usability of Navigator tools and functions for persons with disabilities.

The U.S. Department of Health and Human Services submitted a related proposed rule for the Navigator Program on April 5^th and closed the comments period in May, with a final rule expected within the next few months. This proposed rule would establish conflict-of-interest and training standards, including standards for certification and recertification, for Navigators. States have the option of creating their own standards, as long as they meet the minimum requirements of the forthcoming final federal regulations.

As state policymakers design their Navigator Programs, important lessons from other consumer enrollment programs should be considered. According to an issue brief from the Georgetown Center for Children and Families, there are several components a Navigator Program should include in order to be responsive to people with low-income.

Target navigator resources to the most vulnerable. Research indicates that the lowest income and rural consumers prefer the kind of high-touch in-person services offered by community-based organizations while more moderate-income individuals may be comfortable with using a website or applying over the telephone with assistance from the Exchange’s call center. Given that resources are limited, it will be strategic to target navigator services through community-based groups that are best able to reach the most vulnerable, uninsured populations, focusing on those who are less likely to maneuver the eligibility and enrollment process on a self-service basis.

Integrate assistance for all insurance affordability programs. Two key factors drive the need for integrated navigator programs. First, many families will be covered through multiple programs (i.e. 75% of parents in the Exchange will have children in Medicaid or CHIP) and a significant number of people with fluctuating incomes will transition back and forth between Medicaid and the Exchange. Second, the ACA’s “no wrong door” approach requires that states provide access to all coverage options regardless of how and where consumers apply. Thus, consumers will best be served if navigators are highly trained and can provide assistance for all insurance affordability programs, while states will benefit from efficiency gains and economies of scale in consolidating navigator-type services.

Several enrollment strategies employed by Massachusetts were instrumental in the state’s success in reducing the uninsured population. Massachusetts’ enrollment gains under state health reform have been attributed to four key features of their implementation plan. These enrollment strategies help to explain why 97% of Massachusetts’ population is insured.

1. Massachusetts utilized data-driven eligibility and enrollment.
2. The state created a single, integrated eligibility system that offered information about various health coverage programs.
3. The state provided grants to community-based organizations for public education and enrollment support.
4. Massachusetts coordinated a strong public education campaign to inform consumers about coverage options and the individual mandate.

 In-person assistance will be critical to informing people that health coverage is available, to providing education about new coverage options, and to help with benefit utilization. Previous experiences with the creation of CHIP, and health insurance expansions in Oregon and Massachusetts show that an aggressive outreach and marketing campaign will achieve the result of markedly reducing the number of uninsured families - leading both to better health and economic security outcomes.

CSSP Resources for Health Reform Implementation

• Health Reform Implementation Opportunities for Place-Based Initiatives: Going Beyond Coverage to Improve Community Health - Issue Brief 1
• Health Reform Implementation Opportunities for Place-Based Initiatives: Consumer Protection and Patient's Bill of Rights - Issue Brief 2
• Health Reform Implementation Opportunities for Place-Based Initiatives: Community Roles in Assuring Coverage and Benefits - Issue Brief 3

For results-focused public policy strategies to ensure that children and families are healthy, visit Policyforresults.org. 

Combating Domestic Child Sex Trafficking: the Crucial Role of State Policy

Child sex trafficking is often viewed as a problem that only happens in other countries – such as Thailand or Cambodia. Many don’t realize that American children, often younger than 15, are coerced into prostitution in communities all over the US. According to the Bureau of Justice Statistics, 83% of the victims in confirmed cases of human trafficking are U.S. citizens.  There are also widespread misconceptions that trafficking victims ‘choose’ the prostitution ‘lifestyle’; in reality, many children who have been trafficked are only 10-14 years old when they are first victimized by pimps and well below the age of consent.

Last week the Senate Committee on Finance held a full committee hearing entitled Sex Trafficking and Exploitation in America: Child Welfare’s Role in Prevention and Intervention to explore the issue. Witness testimony highlighted:

·         the need to promote public awareness of the issue of domestic child sex trafficking, especially among youth at risk of exploitation;

·         the lack of housing and trauma-informed care for exploited children;

·         the potential role of the child welfare system in preventing child trafficking and helping survivors;

·         the importance of training for law enforcement, educators, social workers and others who work with children; and

·         the need for legal recognition of children who have been trafficked as survivors of child sexual abuse, not as juvenile offenders or ‘child prostitutes’.

Although the Trafficking Victims Prevention Act of 2000  recognizes minors under 18 who have been induced to perform commercial sexual acts as human trafficking victims, child survivors of sex trafficking are still often arrested and put on probation or in juvenile detention. Some state policymakers have attempted to resolve this issue by passing legislation such as ‘Safe Harbor’ laws that protect child survivors of commercial sexual exploitation from being prosecuted for prostitution and require that agencies recognize them as survivors of sexual abuse rather than viewing them as criminals. States that have already passed such legislation include Connecticut, Florida, Illinois, Minnesota, New York, Vermont, and Washington State. A bill has been proposed and is currently being considered in the U.S. Senate which would extend such protections to child survivors nationwide.

In addition to concerns about the legal status of children who have been trafficked, witness testimony emphasized the need for effective, trauma-informed services to help children who have been trafficked and the role of the child welfare system in ensuring children get the services they need. In her witness testimony, Asia Graves, Maryland Outreach Services Coordinator and Survivor Advocate at FAIR Girls in Baltimore, stated that funding for emergency and transitional housing for homeless youth is urgently needed—in particular, dedicated beds for youth who have been exploited by sex traffickers. Homeless youth often have to choose either sleeping outside or returning to the pimps who have been exploiting them. Faced with the dangers of sleeping out on the streets, many children return to the adults who have been abusing and prostituting them. According to Graves, agencies and non-profits often have to ‘fight’ each other for beds so that the homeless and exploited youth they serve can have a safe place to sleep and sometimes resort to staying with sleeping children in hotel lobbies over night.

The testimony of all four witnesses emphasized that reform of the child welfare system is key. A large proportion of children who are trafficked have already been involved in the child welfare system and many are still legally in systems of care while being trafficked. According to the witness testimony of Susan Goldfarb, Executive Director of the Children’s Advocacy Center of Suffolk County, over 70% of trafficked children in the Boston area had a previous history of abuse and/or neglect and child welfare involvement. The Commissioner of the Connecticut Department of Children and Families, The Honorable Joette Katz, stated in her testimony that in Connecticut, 98% of children who are identified as survivors of sex trafficking had previous involvement with child welfare services, and many were legally in the care and custody of the Connecticut Department of Children and Families while they were being prostituted by traffickers. Ms. Goldfarb raised concerns that when children have been abused by someone who is not a caregiver, often the child welfare system does not intervene even when a report is made. Ms. Goldfarb stated that the child welfare system needs to view survivors of child sex trafficking as ‘their kids’ in order to ensure that children get the protection and services that they need. The witnesses highlighted the crucial importance of providing trafficked youth with the specialized foster care and trauma-informed services that they need to heal and stay safe once they have escaped their exploiters.

Some states have implemented policies to better protect children from sex trafficking and address the related issues in the child welfare system. Connecticut now accepts all cases of child sex trafficking through its Careline (the child welfare intake and information center) whether or not the alleged perpetrator is the ‘entrusted’ caregiver. The state has established an Interagency Human Anti-Trafficking Response Team (HART) led by the Connecticut Department of Children and Families which reviews and monitors Careline to ensure an appropriate response to children’s needs (including for victims with still unsubstantiated cases) and coordination with FBI and Homeland Security to ensure cases of child sex trafficking are prosecuted to fullest extent of state and federal law.

To help raise awareness, the Georgia Department of Education has partnered with Street Grace, a nonprofit dedicated to ending domestic minor sex trafficking, to launch an initiative to educate teachers and students throughout the state about the exploitation of children. The Georgia Attorney General has also launched a public awareness campaign around the issue. In Texas, H.B. 4009 created a Human Trafficking Prevention Task Force to address the issue statewide and mandated that all newly-licensed law enforcement officers receive training on human trafficking.

State policymakers may want to re-examine the legal framework to protect survivors of child sex trafficking in their state, the measures currently in place to prevent sex trafficking, and the programs and policies in place to address trauma and ensure that survivors get the help they need. They may also want to consider the training and education programs currently available to professionals that work with youth and to youth themselves to reduce their vulnerability to sex traffickers.

For more information about how policymakers can support the well-being of children and families and for policy strategies aimed at preventing abuse and neglect please visit PolicyforResults.org.  

Protecting Children from Toxic Stress

A new video from Frontiers of Innovation at Harvard’s Center on the Developing Child highlights the importance of promoting the well-being and skills of parents and caregivers to promote healthy child development. The 5-minute video, entitled Building Adult Capabilities to Improve Child Outcomes: A theory of change emphasizes the way that toxic stress can harm children’s development and argues that the best way to prevent children from being exposed to toxic stress is to strengthen the capabilities of their parents and other adults in their lives.  

Learning to manage daily life stress such as dealing with frustration, meeting new people or getting vaccinations is an important part of children’s growth and development. If, however, a child experiences long periods of intense, repeated stress or does not have a caregiver who is responsive to the child’s need for emotional support, the stress level becomes toxic. According to the American Academy of Pediatrics (AAP), severe toxic stress in childhood can weaken the architecture of a child’s brain and other growing systems. Over time, toxic stress will increase their risk of developmental delays, learning disabilities, and childhood behavior problems, as well as diabetes, heart disease, depression, drug abuse, alcoholism and other major health problems as adults. Risk factors for toxic stress in childhood include living in extreme poverty, experiencing abuse and neglect, exposure to family or neighborhood violence and the substance abuse or mental health issues of a caregiver.  

According to a 2012 policy statement by the AAP, parents and other caregivers play a crucial role in buffering such sources of stress by responding to the child’s distress with love and support. Absent this type of caring support, children are less equipped to learn how to manage stress and emotions in times of difficulty. Empowering parents with the skills to meet children’s emotional needs and deal with difficult problems such as poverty and family violence is therefore essential to children’s well-being. A parent cannot prevent violent crimes or natural disasters from occurring in their neighborhood, but they can develop skills to protect the emotional well-being of their children when these sources of stress occur.  

In a commentary for Spotlight on Poverty and Opportunity, Jack P. Shonkoff, director of the Center on the Developing Child at Harvard University, highlighted the importance of ‘executive function’ skills for parents and caregivers, which include ‘the ability to focus and sustain attention, set goals and make plans, follow rules, solve problems, monitor actions, delay gratification, and control impulses’.According to Shonkoff, these are skills that are learned most rapidly between the ages of three and five, with a second window of accelerated development in adolescence and early adulthood. The part of the brain that controls executive function skills remains plastic until age 25 or even 30. Shonkoff argues that this second period of growth provides an opportunity to help young parents whose own development was undermined by early-life adversity to strengthen these skills, which he calls ‘the building blocks of resilience’. Shonkoff recommends that early childhood providers and workforce development agencies incorporate the development of executive function skills into their programming to strengthen the capacity of parents and other caregivers in order to build strong, healthy families and reduce children’s risk of toxic stress.  

In the video, Building Adult Capabilities to Improve Child Outcomes, they argue that strengthening the capacity of everyone who interacts with children is one of the best ways to promote healthy early development and prevent children from being exposed to toxic stress. The video also emphasizes the importance of the wider community in reinforcing these efforts and the need for effective policy that helps families overcome barriers to well-being such as poverty, family and neighborhood violence, child maltreatment and parental mental health or substance abuse issues. While skill-building for parents and caregivers is described as a bridge to help children overcome obstacles, the video highlights the role of policy in removing these obstacles from their path altogether. Mitigating the harmful effects of stress can improve child well-being, but the ideal would be to prevent children from being exposed to risk factors such as violence and poverty altogether.  

The US Department of Health and Human Services, Administration for Children and Families (ACF) said in an information memorandum that many state and county child welfare systems are investing significant funds in providing services intended to improve well-being outcomes for children and their families such as counseling, parenting classes, and life skills training, but that ‘a number of studies suggest that some of these services are not grounded in the best available evidence and may be provided to children without sufficient attention to their specific maltreatment and trauma histories’. It is important to consider outcome-focused and research-informed solutions to ensuring the needs of children and their families are being appropriately addressed. To that end, policymakers may wish to explore evidence-based approaches to services to help children who have suffered maltreatment in their healing process. They may also wish to consider incorporating evidence-based or research-informed programs for families that reduce the risk of child abuse and neglect as well as the risk of toxic stress that can result from maltreatment. 

In addition to broader policy efforts to promote the well-being of families and address gaps in child mental health care, new state and local-level policies and programs are attempting to incorporate executive function skills into early learning and parent education programs. Frontiers of Innovation has begun working with organizations in sites across the United States to establish working groups and develop neighborhood-level efforts to strengthen the capacity of parents and create opportunities to develop executive function skills. Washington State is the first state to participate in Frontiers of Innovation - with the aim of creating state-level policy change that benefits young children and families statewide by reducing barriers to learning and positive health outcomes. In particular, early learning policies in Washington State aim to promote the development of ‘executive function’ skills. Washington State has incorporated executive function skills into their 2012 Early Learning and Development guidelines by including an introductory text on executive function, as well as expanding their developmental indicators and strategies for parents and caregivers with a focus on these skills. The state has developed an online training module for teachers, caregivers, trainers of early education professionals and Quality Rating and Improvement System coaches.  

However, while skill-building can help parents cope with the challenges that threaten their family’s well-being and reduce the likelihood of toxic stress in children, it is essential that their efforts are supported by policy change to address the social issues such as poverty and violence that put their children at risk in the first place. Neighborhoods with high rates of poverty and violent crime expose entire communities of young children to an increased risk of toxic stress. Policies that promote family economic stability to reduce childhood poverty and policy approaches that prevent children from being exposed to violent crime in their neighborhoods can therefore have a major impact on reducing toxic stress for young children throughout the community. 

Effective policy approaches to family violence are also important for the prevention of toxic stress in children; according to the Bureau of Justice Statistics, between 2001-2005 there were children under the age of 12 living in 35.2% of households where intimate partner violence was occurring. Seeing a parent being abused has serious emotional consequences for children. The availability of mental health care and substance abuse treatment programs for parents is also critical. Policies that promote access to appropriate care can have a big impact on reducing the risk of toxic stress for children whose parents do struggle with mental illness or substance dependency. At the state level, policies to provide parents with mental health and substance abuse treatment supports can be incorporated into programs such as workforce development.

State policymakers may wish to consider expansion of poverty-reduction policies and efforts to prevent children from being exposed to violence in their communities, as well as re-examining the mental health and substance abuse programs that are available to parents in their state.  

Policymakers could also consider ways that active skill building could be incorporated into early childhood education, workforce development and parenting education programs – and could consider implementing protective and promotive factor frame works into those settings. They may wish to partner with health care and human service professionals in their state to promote screening for toxic stress risk factors in well-child visits or through expanding home visiting programs and find ways to support parents in reducing their children’s exposure to toxic stress.
 
For more information about reducing child poverty and promoting children’s social, emotional and behavioral health, please visit PolicyForResults.org. To learn about CSSP’s Strengthening Families Initiative aimed at reducing child abuse and neglect by building protective and promotive factors visit cssp.org.

 

No New Promise Neighborhoods Grants for FY2013

On May 17, the U.S. Department of Education Office of Innovation and Improvement announced there would be no new Promise Neighborhoods grants for Fiscal Year (FY) 2013 (ending September 30, 2013). Existing grants awarded in previous fiscal years will continue to be funded according to the terms of the existing grant agreements, allowing communities to continue building and implementing strategies that will improve outcomes for children and families. There are several other place-based initiatives that will continue to be funded, including the Building Neighborhood Capacity Program and Choice Neighborhoods. Furthermore, in President Obama’s FY2014 budget he requested funds for both Promise Neighborhoods and a new program under the Neighborhood Revitalization Initiative: Promise Zones. Located in high poverty neighborhoods throughout the nation, federal agencies will engage directly with local leaders within “Promise Zones” in an effort to break down barriers and help them access and coordinate the resources and expertise neighborhoods need to create jobs, leverage private investment, increase economic activity, reduce violence and improve educational opportunities.

Place-based initiatives, like Promise Neighborhoods, Choice Neighborhoods and the Building Neighborhood Capacity Program, are important investments in community change because they allow for innovative practices that are responsive to the unique context of each community. The traditional model for delivering services to high-poverty communities has been siloed and fragmented, with implementation of evidence-based practices that do not always fit the needs of the community.  The community contexts in which local initiatives are implemented will have a significant effect on their ability to achieve the desired results. For example, residential mobility, student mobility within and among schools, community safety, unemployment, degree of concentrated poverty, housing insecurity—all these factors directly affect child/family well-being and thus are likely to affect the success of any local initiative. Although these factors may not themselves be core results that the local initiative seeks to change, these factors must be known and taken into account when designing place-based strategies.  

Although new Promise Neighborhoods will not be funded in FY2013, there are many ways policymakers can continue to combat intergenerational poverty in their states by following the theory of change that is the foundation of Promise Neighborhoods.  For example, the California Assembly is discussing legislation modeled after the federal Promise Neighborhoods program.

Regardless of whether or not your state is in a position to create legislation funding Promise Neighborhoods, utilizing a results framework is an effective strategy in bringing about community change. Identifying results can serve as a “pathway” to achieving children’s healthy development and academic success. And, these four overarching results communicate simply and clearly what Promise Neighborhoods strives to achieve—assuring that;

• Children are healthy and prepared for school entry
• Children and youth are healthy and succeed in school
• Youth graduate from high school and college, and
• Families and neighborhoods support the healthy development, academic success and well-being of their children.

Promise Neighborhoods’ theory of change is rooted in the importance of gathering information from the community about their needs and desired outcomes.  This can inform the way governments direct funds to target those specific needs, thereby ensuring that communities have the resources they need to effectively serve the children and families in these community. This increased capacity along with building accountable community partnerships will help to ensure fidelity to financial investments and more effectively lead to improved outcomes for children and families. Though the Promise Neighborhoods program is a major investment of federal dollars, a combination of public and private funding has also been shown to support place-based efforts.  In practice, the best outcomes are built on sustainable financing strategies which often include a mixture of funds that local partners have aligned with their results framework.

State policymakers can take steps to transform high-poverty neighborhoods beginning with engaging community members and bringing multiple stakeholders together, such as human service organizations, schools, child welfare agencies, and businesses. These entities can then work together to come up with a shared set of priority results—policymakers can encourage innovation in achieving these results by allowing for flexibility while at the same time requiring evidence of a strategy’s effectiveness. For more on achieving results through public policy strategies, visit Policyforresults.org.  To learn more about the continuing work of Promise Neighborhoods visit the Promise Neighborhoods Institute at PolicyLink and for information and tools that are useful for undergoing place-based efforts in your community visit CSSP’s Investing in Community blog.  

The President’s Early Childhood Initiative: Quality Preschool’s Role in Closing the Opportunity Gap

Public education is often seen as a great equalizer, giving students from low-income families the chance to develop their talents and reach their full potential. In reality, American public education is far from a level playing field and many students start school already at a disadvantage due in part to a lack of quality early learning opportunities. Increasing access to high-quality preschool programs could potentially narrow the opportunity gap that helps to perpetuate poverty and weaken the economy.

 According to  Early Warning!: Why Reading by the End of Third Grade Matters, a special report from Kids Count, children from low-income families and members of racial and ethnic minorities are at significantly higher risk of low educational attainment, ranging from lower reading proficiency in elementary school to lower high school graduation rates. This opportunity gap not only adversely impacts these students, their families and communities but has far-reaching economic consequences for the United States. An analysis by McKinsey and Company found that the opportunity gap between students of different socioeconomic, racial and ethnic groups amounts to “the economic equivalent of a permanent national recession” and that if the gap between low-income students and those from higher-income families had been closed, the Unites States’ “GDP in 2008 would have been $400 billion to $670 billion higher, or 3 to 5 percent of GDP”. The Kids Count report identifies quality preschool education as one way to ensure that children are ready to learn at their full potential in kindergarten and first grade and an important aspect of narrowing this opportunity gap.

To address the disparity in school readiness and educational outcomes, President Obama’s 2013 State of the Union address called for the introduction of universal preschool to ensure that all children have access to early childhood education. The President’s proposed budget includes an early education initiative that would expand provision to all children whose families live at or below 200% of the poverty level. Current programs such as Head Start and Early Head Start serve only children from households with income below the poverty level or who are eligible for public assistance. Many working poor families are not eligible for Head Start but may still find it difficult or impossible to afford private preschool tuition.

Quality preschool programs have long-term benefits for children including gains on cognitive tests, improvements in social and emotional development, improvements in school success including less grade repetition, less special needs education placement and increased high school graduation. According to a report from the National Institute for Early Education Research (NIEER), the benefits children gain from quality preschool education are associated with long-term outcomes like greater school success, reduced crime and delinquency, and increased earnings over a lifetime.

These benefits could potentially result in significant cost savings over time if high-quality preschool education becomes more widely available. A University of Chicago longitudinal study of a preschool program implemented by Chicago public schools found in its cost-benefit analysis that for every dollar spent on providing children with a quality preschool education, $10.83 may be saved over time due to reduced burdens on the criminal justice system, higher incomes and higher tax revenues.

The Center for American Progress says that in addition to the cognitive and social benefits of quality early education, preschool programs are also important for working families, who often face tremendous difficulties in finding affordable, quality child care programs. Well-run preschool programs provide children with the enriching learning environment that too many child care settings lack. This has the potential to positively impact families and the economy in two ways – by serving to close the opportunity gap and in better supporting parents in the workforce – leading to better outcomes for children and their families as well as dual-generation increased economic productivity.

According to NIEER, several states have already implemented some form of universal access to preschool, including Georgia, Oklahoma, Florida, West Virginia, Illinois and the District of Columbia. However, in other states few children participate in state-funded preschool programs and in ten states there are currently no state-funded preschool programs whatsoever.

Following President Obama’s February unveiling of his plan to greatly expand access to pre-school, the Administration has been setting in motion the policy to implement this plan. At a Brookings Institution panel last Wednesday, Secretary of Education Arne Duncan gave a keynote address on President Obama’s proposed Preschool for All Initiative. A number of experts in the field and policymakers dedicated to this work participated in the event including:  Congresswoman Nancy Johnson; Roberto Rodriguez the Special Assistant to the President for Education Policy; W. Steven Barnett the Director of the National Institute for Early Education Research at Rutgers University and Grover J. Whitehurst the Director of the Brown Center on Education Policy. Secretary Duncan outlined the administration’s plan to expand access to preschool and Congresswoman Johnson discussed the challenges that states currently face in providing high-quality preschool programs.

State policymakers may wish to consider examining the early learning provision currently available in their state as well as the percentage of children currently enrolled in early childhood education programs to look for ways that access to quality programs could be improved. Expanding access to high-quality preschool is an effective strategy for ensuring better outcomes for children. In doing so, and closing the opportunity gap, policymakers begin to better meet the needs of their constituency, work toward equity and boost their economies.

For more information on improving educational outcomes and the economy, please visit PolicyforResults.org for a fact sheet on building a 21st century workforce to strengthen state economies.  

Prioritizing the Mental Health Needs of Children and Youth in the Child Welfare System

As the month of May draws to a close, we are reminded that mental health is integral to whole health - and children who have been removed from their homes need a system that will do the utmost to see to their safety and wellbeing. In recognition of the tens of millions of Americans living with mental health problems, on April 30^th President Obama declared May as National Mental Health Awareness Month. He also declared May as National Foster Care Month, in recognition of the children and youth awaiting permanency and the families, professionals and foster parents who care for them. These are two issues of critical importance to all families and, while important to spotlight in May, must remain a policy focus year round.

The link between mental health and involvement in the child welfare system is notable. Although most children with mental health challenges do not become involved with the child welfare system, and children in foster care do not necessarily have mental health disorders—children in foster care do have disproportionately high rates of social, emotional or behavioral health concerns. Child welfare systems that prioritize mental health and focus on protective factors can deliver better results for children and youth in foster care or for those children in families where there is a risk of removal.

Research in child welfare suggests that children do best in their own families and should remain home with their parents whenever possible. When that is not possible, children should be returned to their families or moved to another permanent home as quickly as possible consistent with safety concerns. There are many circumstances in which family strengthening attempts can prevent removal of a child from the home. These interventions can include home visits, housing assistance and family counseling among other options. Lack of access to these family strengthening services can prove disastrous for families. For example, in extreme cases some families have been forced to relinquish custody of their child to the child welfare system in order to gain treatment for their children who were experiencing serious mental, emotional or behavioral health challenges. Separation from the family is traumatic for children, and should be a last resort if effective attempts at family strengthening have not been productive.

Child maltreatment, including abuse and neglect can have negative impacts on children and youth—particularly if their developmental milestones are not nurtured and supported. Without proper support, these problems can linger throughout a child’s development, causing further physical, mental, emotional or behavioral issues later in their childhood or adolescence. Infants and toddlers who have been removed from their parents can miss developing a sense of trust gained from attachment to their parents. This sense of trust is essential in order for them to develop relationships with adults and peers as they mature. At later ages, children must: develop the physical skills necessary to gain a sense of autonomy, be able to exert some control over their environment in order to develop a sense of purpose, deal with new academic demands and navigate social relationships. Attention to a child or adolescent’s socio-emotional wellbeing is essential to ensuring their successful transition to adulthood.

Children and youth who experience trauma stemming from abuse and neglect can also face disrupted attachment and delayed development of capacities required for building relationships. Among children and youth who are reported for abuse:

• 32% of children from birth to five years old have developmental problems;
• Among school-aged children and adolescents, 10% are at risk of cognitive problems or low academic achievement, 43% have emotional or behavioral problems, and 13% have both;
• Adolescents engage in more risky behaviors than their same-aged normative peers—almost 50% have used alcohol at some time during their lives and over 20% have used other substances.

Research has shown that caregivers can buffer the impact of trauma and promote better outcomes for children even under stressful circumstances when the following Strengthening Families Protective Factors are present:

• Parental resilience
• Social connections
• Knowledge of parenting and child development
• Concrete support in times of need
• Social and emotional competence of children

To achieve the goals of safety, well-being and permanency for youth in the foster care system, policymakers can adopt policies that strengthen reunification, adoption and guardianship. Requiring family involvement in decision-making can aid in reunification, establishing state adoption credits can encourage more adoptions, and setting adequate subsidy and benefit levels can support guardianship.

There are a number of resources for policymakers, advocates and families on supporting the mental health needs of children involved with the child welfare system, including:

• Results-based policies to aid children and youth in foster care
• Results-based policies to promote children’s social, emotional and behavioral health
• Promoting Children’s Social, Emotional and Behavioral Health (report)
• National Child Traumatic Stress Network

Ensuring access to quality child care is a smart investment

Affordable, high-quality child care is of tremendous importance for working families. In most families, all of the adults work outside the home and 32.9% of children under five receive regular child care from non-relatives. Early childhood is a critical phase for a child’s brain development; a stimulating, supportive environment is important for all children, and quality child care is important for children’s health, well-being and readiness for school. Research shows that high-quality child care can have positive impacts on a child’s life in a number of ways - including higher educational attainment and lower rates of social problems.  Further, the benefits of high-quality child care extend beyond childhood well into adulthood.  

With so many working families relying on care outside the home, access to affordable, high-quality child care is not only important for children’s well-being, it is important for national economic productivity. Research  suggests that access to quality child care has a positive impact on parents’ productivity by reducing absenteeism, tardiness and lack of concentration at work. Through reforming child care assistance programs and establishing thorough regulation of child care facilities, policymakers can play an important role in ensuring that more children in working families have a healthy start. 

However, despite the importance of high-quality child care, finding care at an affordable cost is often very difficult for working parents. According to the Center for American Progress, child care for an infant costs more than tuition at a public college in most states; many low-income families spend about half of their income on child care. Even once parents find an affordable child care provider, the quality of care may be very low. Not all states require that child care providers be trained or have background checks. Even licensed providers are not monitored in some states. The lack of quality childcare is a problem that is widespread.  According to Child Care Aware of America, child care programs provided by the Department of Defense for military families scored the highest in their 2013 Child Care Aware rankings of state program requirements and oversight, receiving a ‘B’ grade. 10 states received ‘C’ grades in the rankings, while 21 state programs received a grade of ‘D’ and a shocking 20 states received failing grades. 
 

Proposed regulations to improve the quality of child care

To address the issue of the low quality and high cost of child care for working families, the Department of Health and Human Services (DHHS) released proposed regulations on Monday for child care providers receiving Child Care and Development Fund (CCDF) program subsidies. The proposed regulations include changes in four key areas:

            “(1) improving health and safety in child care;

             (2) improving the quality of child care;

             (3) establishing family-friendly policies; and

             (4) strengthening program integrity.”

The new regulations would add requirements for child care providers to:

o   undergo background checks;

o   have their facilities inspected for compliance with state and local health, fire and building codes;

o   receive health and safety training on topics such as first aid and CPR; and

o   be monitored by the states through unannounced, on-site visits.

Under these new regulations, states would still have the option of exempting relatives and caregivers in the child’s home from some or all of the CCDF requirements so that caregivers such as a child’s grandparent or in-home babysitter are not required to meet the same requirements as a child care center or other professional provider.
 

Many parents assume that child care providers are already required to meet basic standards similar to those outlined in the proposed regulations.  According to a 2010 survey conducted by Child Care Aware of America (formerly the National Association of Child Care Resource and Referral Agencies), most parents believed that some or most child care providers were already required by law to be trained, licensed, background checked and monitored by the state.  However, in reality regulation of child care providers varies greatly state-to-state; some states already have some requirements similar to the proposed regulations in place, while others have far fewer requirements. Parents may find it difficult to get reliable information about the quality of their child care options. To remedy this, the new regulations aim to provide parents with more information about child care providers’ track record on health, safety and licensing as well as the qualifications of the caregivers. States would develop child care information websites and maintain a hotline for parent complaints about child care providers.
 

Many eligible families not receiving child care assistance

One notable provision in the proposal is the establishment of a 12-month period for re-determining a family’s eligibility for assistance and allowing parents who lose their job to remain eligible for a period of time while searching for work. Under the current regulations, parents in some states immediately lose eligibility if they lose their jobs, making it difficult for parents to schedule interviews or follow up on potential job opportunities as they arise. Under the proposed regulations, states would have more flexibility to minimize requirements in order to help eligible families benefit from the program.

Currently, most low and middle-income families have to pay all their child care expenses out of pocket, including most of those who are eligible for CCDF benefits.  While estimates of participation have increased in recent years, most families who are income-eligible for child care assistance do not receive the benefit and those that do typically receive it for less than a year.  The Department of Health and Human Services estimated that in 2009 only 18% of potentially eligible children received subsidized child care. According to the proposed regulations, “[c]urrently, most families receiving CCDF-assistance participate in the program for only 3 to 7 months, and many are still eligible when they leave the program. Parents often find it difficult to navigate administrative processes and paperwork required to maintain their eligibility and State policies can be inflexible to changes in a family's circumstances.” The proposal includes coordination with other programs serving low-income families, which would be used in an effort to reduce the administrative work involved for both parents and state agencies so that a larger number of eligible families receive needed child care assistance.

With research drawing the link between quality child care and healthy outcomes for children, parent productivity and national economic productivity, supporting quality child care is a good investment for states. State policymakers may wish to consider how current regulations in their state compare with the regulations proposed by DHHS and ways that they might advance their work to make child care safer, healthier and more enriching. State policymakers could also consider how to streamline access to child care assistance to ensure that eligible families are able to benefit.

For more information on ways that policymakers can promote the well-being of children and families, please visit PolicyforResults.org and watch for our upcoming results-based policy report on state strategies to support early healthy development.  Check-out CSSP’s Strengthening Families work and our Protective and Promotive Factors Framework to learn more about research-based, cost-effective strategies to in­crease family strengths, enhance child development and reduce child abuse and neglect.

How Family Food Security Supports the Economy and Children's Health

By supporting children’s healthy development policymakers help to provide the foundation needed for children to grow into thriving adults.  A critical aspect of child health is food security.  Several federal and state programs are aimed at ensuring children and families have access to adequate nutrition.  These investments often also have benefits for the economy. Programs like WIC, Healthy Food Financing, School Nutrition Programs and SNAP are all aimed at ensuring food security for poor and low-income families.

The Supplemental Nutrition Assistance Program (SNAP) is a vital lifeline for families; about 75% of households receiving SNAP benefits include at least one child, senior or person with a disability. Over 25% of all US children received SNAP benefits in 2011 according to USDA data.

On November 1, 2013, every U.S. family receiving SNAP benefits will have those benefits cut, making it more difficult for over 47 million people to buy food. On that day the 2009 increase to SNAP that occurred through the American Recovery and Reinvestment Act (ARRA) will expire, and additional cuts will likely be included in the new farm bill. On Tuesday the Senate Agriculture Committee passed a $4.1 billion cut to SNAP benefits over the next 10 years as part of its version of the bill, which would likely result in an average cut of $90 per month for nearly 500,000 households. The House Agriculture Committee passed its version of the farm bill on Wednesday, making even more drastic cuts totaling $20.5 billion over the next decade.

 Prior to the 2009 increase through ARRA, the level of SNAP benefits per family was so low that receipt of the benefits had ‘no detectable impact on child health’ according to a study by Children’s Health Watch. Following the increase, the study found that children in families receiving SNAP benefits were significantly more likely to be ‘well’ -- not overweight or underweight, in good health, developing normally for their age, and having never been hospitalized, compared to children whose families were eligible but did not receive the benefit. Another study by Children’s Health Watch found that when families’ SNAP benefits are reduced, young children are more likely to ‘be food insecure (a known child health risk), be in poor health and have developmental delays than young children in families whose benefits do not decrease’. The study also found that families whose SNAP benefits were reduced were more likely to forego needed health care due to inability to afford care, be food insecure and struggle to pay for heat and utilities than families whose benefits do not decrease.

In addition to the important impact SNAP benefits can have on child health, SNAP also has important economic stimulus effects. Research by the USDA indicates that every dollar of federally-funded SNAP benefits generates between $1.73 and $1.79 in economic activity in industries such as agriculture, retail, wholesale-transportation and food processing. SNAP benefits play an important role in sustaining demand for groceries and preventing job losses in these industries. A study by the Center for American Progress found that for every $1 billion cut from SNAP, 13,718 jobs would be lost. 

Another change in the House version of the farm bill is the elimination of 'broad-based categorical eligibility', which gives states the option of allowing recipients of certain other public benefits to qualify automatically for SNAP. Broad-based categorical eligibility prevents recipients who have already met financial eligibility requirements from needlessly going through the financial need determination process again. Since 2009, the USDA Food and Nutrition Service has strongly recommended that states adopt broad-based categorical eligibility to reduce state workloads, more efficiently helping families in need. Eliminating this option will increase barriers to receiving SNAP for eligible families, placing young children at greater risk for being significantly underweight for their age and living in households that are food and housing insecure. 

The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) addresses this critical issue by providing additional support for nutrition and food security among women and young children; nearly 9 million women and children are served by this highly successful program. However, uncertainty about the future of WIC funding presents a challenge for states in ensuring that all eligible applicants are able to participate. Research conducted by the National WIC Association found that many state and local agencies have consolidated or closed clinics, laid-off staff or reduced their service hours in preparation for expected funding reductions due to sequestration. The research findings indicate that this ‘streamlining’ has negatively impacted service delivery resulting in eligible women and children being placed on waiting lists and ‘negatively affecting nutrition education and breastfeeding support’ for participants. The Center for Budget and Policy Priorities estimates that the President’s budget request of $7.142 billion for WIC would be sufficient to serve all eligible applicants, but that a lower level of funding might prevent eligible women and children from benefitting from the program.

School nutrition programs provide an additional boost to food security for children from low-income households. In 2011, the National School Lunch program provided low-cost or free lunches to over 31 million children and breakfast to over 12 million children every school day.   However, if broad-based categorical eligibility is eliminated, many children who currently received free school meals based on their family’s SNAP eligibility would be affected.  According to the Center for Budget and Policy Priorities, an estimated 210,000 children would lose access to free school lunches and breakfasts if broad-based categorical eligibility were eliminated.

Even if families have the benefits they need to provide their children with good nutrition, many low-income families still live in ‘food deserts’ where access to grocery stores and farmers markets selling fresh, nutritious food is very difficult. The Healthy Food Financing Initiative promotes good nutrition and economic development in under-served communities based on a model pioneered by the Pennsylvania Fresh Food Initiative, a public-private partnership that opened or improved 88 grocery stores and increased access to healthy food for 400,000 residents in just five years. The initiative also helped to retain or create 5,000 jobs in such communities throughout the state. For a case study of the Pennsylvania Fresh Food Initiative please visit www.cssp.org. 

In light of these impending cuts, state policymakers may want to consider planning for how to provide SNAP recipients with information about the changes and how to manage an increase in client inquiries about the reduction in benefits. If the option of broad-based categorical eligibility is also eliminated, states may be faced with an increase in workloads involved in completing financial need determination separately for each program.

State policymakers may also want to explore expansion of state and local-level initiatives to promote childhood nutrition and health such as increased state funding for farmers’ markets, school nutrition education and Farm to School initiatives as well as fresh food initiatives inspired by the Pennsylvania model.

Access to healthy, affordable food is fundamental element to ensuring children are healthy and thrive.  For state-based policy strategies to ensure that children are healthy please visit PolicyforResults for strategies to improve access to affordable healthy food and to support healthy school initiatives.   For more on collaborating around results and results-based policy strategies, visit Policyforresults.org.