Policy: Prevention and Early Childhood Development

Prevention of Child Abuse through Home Visiting

The development of home visiting services to avert child abuse has occurred only within the past four decades. The service which evolved into the Healthy Start program was initiated in Hawaii in 1975 under a federal grant and was based upon the work of the late Dr. Henry Kempe. (Another major home visiting program, the Nurse Family Partnership child health home visiting program was initiated around the same time.) In 1985, Healthy Start was initiated  through support of the Hawaii State Legislature; after the initial pilot program, services were expanded incrementally over the following decade as a distinct policy of investment in prevention of child abuse to avert the social and health problems related to early maltreatment.  Fortunately,  the Chair of the Hawaii State Senate Ways and Means Committee had become very interested in the potential of preventing child abuse as a strategy to  reduce crime and it’s costs.   He became  a strong champion for the initiative along with Dr. Calvin C. J. Sia, pediatrician.

In 1991, the U.S. Advisory Board on Child Abuse and Neglect published their second major national report  on child abuse and neglect. (futureofchildren.org/futureofchildren/publications/docs/03_03_10.pdf).  While there were many recommendations for improvement of the child welfare system,  their primary recommendation was to establish a universal home visiting program to prevent child abuse.  Hawaii Healthy Start was referred to  as the “star” of the home visitng programs to prevent child abuse.. In 1991, the Hawaii Family Support Center partnered with Prevent Child Abuse America to bring policy makers from a number of states together to attend a conference in Hawaii to learn about Healthy Start, and the Healthy Families America (HFA) initiative was launched. Within a few years, policy makers in many states embraced and expanded the program. The Association of State Legislators has supported  this approach to prevention of child abuse.

The Center for Disease Control has conducted research and reviewed evaluations of home visiting services to prevent child abuse and issued a statement in support of home visiting as a successful strategy in averting child maltreatment.

Most recently, home visiting services starting peri-natally, including the Healthy Families America model, were incorporated into the Health Care Affordability Act to improve the well-being and healthy development of young children and to promote school readiness. This has taken the form of a national level  peri-natal home visiting initiative, called Maternal Infant Early Childhood Home Visiting Program,  or MIECHV.  Many states are participating and establishing or expanding Healthy Families programs. Interestingly, the  program characteristics incorporated into the federal guidelines and requirements for this funding stream  are most similar to those of Healthy Start/HFA. All home visiting model programs are required to include a goal of child abuse prevention within programs established with this funding.

The Pew Foundation has conducted conferences and webinars on implementation of evidence based home visiting practice, and appears to be a continuing partner in the MIECHV initiative.

Policy on Early Childhood Development

Prevention of child abuse should be seen as part of a continuum of services aimed at averting poor outcomes for young children and promoting school readiness, which include efforts to enhance child health and development. The toxic stress of early abuse as well as the consequences of neglect are a major reason for lack of school readiness.

Several decades ago, the Hawaii Business Round Table developed their recommendations for education in Hawaii, which included the need for young children to be better prepared to succeed in school  as part of an overall goal of ensuring a skilled labor force.  This group has supported the Good Beginnings Alliance in their policy work in early childhood to enhance school readiness among young children. Over the past decade, local and national business leaders and economists have identified lack of a sufficient skilled labor force as a serious issue for the U.S. as economies evolve in an increasingly technically competitive environment, and are endorsing effective early childhood programs.

The Biggest Issue

The economics of child development was very well articulated publicly in an op-ed by David Brooks in the New York Times (NYT July 29, 2008, “The Biggest Issue”). This article first cited a major study which linked America’s historical technology edge and economic growth to educational attainment, which peaked by 1970 and has since declined. Brooks then linked this study conclusion with the work of Nobel Laureate Economist,  James Heckman, PhD. Heckman’s research concludes that the source of  the U.S. educational decline is less about poor schools than deteriorating home environments, with too many young children arriving at school without the basic skills needed to succeed. Heckman notes that while many young children are bathed in a family atmosphere which promotes a range of social and cognitive skills needed for  school readiness, increasingly too many children are not. He states that “it is possible by age five to predict with depressing accuracy which children will and will not succeed in school”. Poor educational attainment by too many young people is deeply affecting our labor workforce and economic edge. Brooks concludes by noting that while this issue was not a focus of the 2008 Presidential election, it is the biggest issue for the future of the U.S. economy.

The Heckman Equation: Economics of Human Potential

As noted above, James Heckman (University of Chicago, 2009) has also investigated the issues of early childhood development and economic development. To summarize his findings, Heckman provides an equation on investment in young children.  “Investing in early childhood resources for disadvantaged families with young children = development of cognitive and social skills by age 5 = GAIN in capable, productive citizens who pay dividends for generations to come”.   Heckman and other economists show that the costs of such policy will be far less than current costs of social problems and lost productivity.  More about the Heckman Equation.

The Science of Early Childhood: Closing the Gap Between What We Know and What We Do“  (Harvard Center on the Developing Child, 2007) Pediatrician Jack Shonkoff, MD, Director of the Harvard Center on the Developing Child, is a major leader in the effort to establish rational public policy on early childhood. This document summarizes key findings of recent neuroscience research on early brain development and outlines specific policies for promoting positive child development and school readiness. Other relevant documents are located on their website. See documents from the Harvard Center on the Developing Child.

The Federal Reserve

Art Rolnick and Rob Grunewald, research economists with the Federal Reserve Bank of Minneapolis, have researched, published and presented extensively on the economics of early childhood development. They note that, in addition to monetary policy and banking issues, research at the “Fed” looks at how economies grow and conditions that affect growth. A key ingredient of economic growth is the quality of the workforce, and public investments in human capital can have a positive effect. They note that traditionally government leaders at the state and local levels have invested in economic development schemes with public dollars, which the Fed research has shown not to be effective. They cite the long tradition of investing in public education, i.e. K-12 as a human capital strategy. However, after studying the early brain research and successful early childhood programs, they recognize that the foundations for learning are established in the years prior to kindergarten. They conclude that the return on early childhood development programs that focus on young children of families at risk far exceeds the return on other economic investment projects. They now argue that “research shows that reaching children with multiple risk factors, even by age 3 may be too late.” They recommend “parent mentoring programs that start as early as pre-natally.” They state that “compared with the billions of dollars spent each year on high-risk economic development schemes, this type of investment in early childhood programs is a far better and far more secure economic development tool.” They have presented this information in a document titled “Development of the Economic Argument for Investing in Birth to Five”. See the document.

The Telluride Principles

The Pew Foundation has partnered with the Telluride Foundation to bring business leaders together to discuss the economics of early childhood. As a result, business leaders are partnering with other organizations to promote state and national policies on school readiness. The group has published “The Telluride Principles for Investing in Young Children” (2008). This policy document was the product of the second annual Economic Summit on Early Childhood Education (2008). The 5 “Telluride Principles” are driven by participants’ agreement that investing in children is a vital economic growth strategy and a priority of business, government and philanthropy. See the Telluride Principle documents.

The Pew Foundation

Further information on the Telluride Summits and early childhood policy is available on the   Pew Foundation website.    Other documents are also available, including “The Costs of Disinvestment: Why States Can’t Afford to Cut Smart Early Childhood Programs” (2010). By cutting good programs, states pay increasing costs for child welfare, low weight births, special education, corrections, productivity of parents in the workforce and increased parental reliance on public assistance.

In Hawaii

In addition to the advocacy work of the Hawaii Family Support Center in regard to prevention of child abuse and neglect, the Good Beginnings Alliance has provided leadership on broader early childhood policy over the past decade. A recent policy document “Early Childhood Issues for Hawaii,” (2010, pdf, not  now available on their website) noted that Hawaii has been a leader in developing effective early childhood programs and services over the past two decades. This document summarizes the lost resources in early childhood programs over the past two years and examines needs related to early learning.

The Hawaii Early Learning Council was established in state statute by the legislature in 2009. More recently,  the Council became an Advisory Board for the Office of Early Childhood Development and Learning in the Office of the Governor.  This Office has worked with community partners to develop an early childhood plan under  the leadership of a recently established position of an Early Childhood Coordinator; the plan was completed in 2012.

In summary, policy makers in Hawaii and across the country are clear that providing support early to ensure that children arrive at kindergarten safe, healthy and ready to learn is not only humane but is a cost effective approach in the best interest of all citizens as tax-payers and beneficiaries of a strong economy and nation.

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