Tuesday, May 3, 2016

Child PovertyWhat’s the Issue?

In the United States, there are wide gaps in the outcomes of children who grow up in impoverished circumstances compared to those who grow up with adequate resources. These gaps include both proximal and distal measures of health (including mental health), well-being, and productivity (Currie & Rossin-Slater, 2015). The effect of resource deprivation in early childhood grows increasingly larger over time, with initially small differences compounding and widening across the life course. The implications of these gaps transcend generations, setting a highly probable path for the futures of children and grandchildren before they are even born. They also transcend family lines: Impoverishment robs not only the individual but also society of these individual’s potential contributions. The good news is that there is substantial evidence that interventions can markedly improve the health and well-being of at-risk children. Many of these interventions are built on a platform of preschool, center-based care from birth through age 5 years old. Researchers, legislators, and policymakers understand that many children in this country are placed squarely on the road to continual struggle and hardship that will reach far beyond their own life. At the same time, there is an increasingly compelling and sophisticated understanding of how early childhood interventions can radically alter life-course trajectories, moving individuals toward a journey rich with potential. What remains is the question of what our society will do with this knowledge.

What’s the Background?

The literature on early childhood is extensive. Here we briefly describe the seminal model programs, the controversy surrounding the effectiveness of scaled-up programs, and the burgeoning research on universal programs. Though similar program structures exist internationally, we focus exclusively on those in the United States.

Two model programs implemented more than 40 years ago catalyzed the movement of early childhood intervention efforts that continues into the present day. These programs targeted the most vulnerable subsets of the population and demonstrated that with early intervention, the life course trajectory of individuals could be profoundly positively affected. The Perry Preschool Program (PPP) was started in 1962 in Ypsilanti, Michigan, a town plagued by poverty. One hundred and twenty-three impoverished African-American children with identified cognitive deficits were randomly assigned either to receive 3 hours of daily morning preschool and a weekly family visit by an educator throughout the school year or to act as controls. A decade later, the Abecedarian (ABC) project was implemented in North Carolina. This project targeted a group of 111 children (97% African American), who had been classified as “at risk” based on several factors that made the hope of social mobility all but nonexistent. ABC was designed to be more intense and comprehensive than PPP. Children randomly assigned to the control group were provided with health care and nutrition assistance. In addition to these services, children assigned to the experimental group were placed in center-based care for up to 9 hours a day, 5 days a week, for 50 weeks of the year from birth through age 5. These programs had substantial and well-documented effects on the health of those in the experimental groups, in addition to other positive impacts, including increased educational attainment, income, and quality of life measured in a variety of ways. These programs also reduced negative outcomes such as teen pregnancy, depression, and, in the case of PPP, incarceration.

The attention and recognition these programs still receive today begs the question why two studies with such small samples and from so long ago remain relevant. There are two main reasons. First, both programs continually followed participants through middle age. This longitudinal methodology is rare in the case of experimental early childhood studies and combined with the exceptionally low attrition rate makes the data extremely valuable. Second, these programs demonstrated that positively altering children’s environments and skills could forever change the course of their lives. Thus, they established the keystone evidence upon which all future intervention efforts in this area would build. For instance, HighScope, the curriculum developed in PPP, is still used in many Head Start centers. Beyond Head Start it is also widely purchased and implemented in a variety of private child care and preschool centers nationwide.

Scaled-up means-based programs are designed to improve the lives of children in similar ways as the model programs but aim to do so on a much larger scale. The most easily identifiable and longest running of these programs is Head Start, which provides federally funded center-based preschool to children growing up at or below the federal poverty level. More than 30 million children have participated in Head Start since its inception in 1965. Initial efforts to evaluate the effectiveness of Head Start focused almost exclusively on metrics of cognitive performance and produced discouraging results. These studies often lacked appropriate control comparisons, long-term follow-ups, and breadth and depth of meaningful outcomes (Elango, Garcia, Heckman, & Hojman, 2015). More recent research, employing a rigorous approach and capturing long-term effects by capitalizing on youth who participated both in Head Start and in nationally representative longitudinal studies, has unequivocally demonstrated the positive and enduring effects of the program. For instance, youth enrolled in Head Start showed increased health and healthy behaviors, reductions in obesity, higher rates of high-school completion, less grade repetition, and lower rates of incarceration compared to appropriately matched controls (Carneiro & Ginja, 2014). These effects remain even in the absence of long-term gains on cognitive performance measures.

A third type of program is deemed “universal” because, as the name implies, admittance is open to all children regardless of parental socioeconomic means. Universal preschool, unlike Head Start, has not been adopted on the national level and thus suffers from a lack of representative data. The limited amount of work that has been done in this area largely points to the ineffectiveness of these types of programs. A more textured look, however, has revealed that children from disadvantaged backgrounds do benefit from enrollment in the programs (Cascio & Schanzenbach, 2013). These children have few if any alternative quality child care arrangements. Advantaged children on the other hand, who are likely to have better quality preschool alternatives show little benefits in the few areas that have been measured. Research in this field is nascent. Currently, there are several constraints that limit the interpretation and generalizability of the findings, including a narrow set of outcomes and a lack of longitudinal data.

What’s the Debate?

Much of the debate surrounding early childhood interventions has centered on the effectiveness of the programs for improving children’s lives in significant and long-term ways. Indeed, when cognitive skills as measured by standardized tests have been the focus of the debate, nearly all of the interventions can be accurately assessed as having failed. In the cases where initial cognitive gains have been documented, they tend to fade relatively quickly after the intervention ceases. Those who believe efforts to improve the outcomes of impoverished children are misguided or fruitless often point to these results as support for their position. Yet, as discussed earlier, when the scope of success reaches beyond cognitive metrics and into tangible adult outcomes such as smoking, obesity, depression, education, lifetime earnings, and incarceration, these same programs that have produced little effect on test scores show a tremendous impact.

Researchers within the last decade have made a concerted effort to understand how movement on standardized test scores is not more clearly associated with outcomes that seem intimately related to intellectual ability. To this end, a large body of evidence is accumulating that demonstrates social skills such as emotion regulation, executive functioning, and empathy to be equally, if not more, important for health and well-being in adulthood (Heckman, Stixrud, & Urzua, 2006). This has been demonstrated both in cases where these “soft” skills were directly manipulated and in cases where they may have been indirectly imparted through means such as smaller class size, better teacher quality, one-on-one academic tutoring, and general modeling of social competence by caring and competent adults (Chetty, et al., 2011; Sorenson & Dodge, 2015).

Assuming the malleability of skills that will allow children to be healthy and productive adults, the debate has moved to the economic efficacy of investing in early childhood interventions. The intensity, duration, and comprehensiveness of programs have been hallmarks of their success, and thus the cost of deploying such high-quality programs is not cheap. When adolescent and adult outcomes beyond standardized test scores are considered, however, examinations have shown that these programs offer a significant return on investment (Belfield, Nores, & Barnett, 2004). These returns accrue to the individual who received the treatment, the family, and society, in terms of both economic productivity and reductions in crime. Furthermore, they compound over the entire life course, with benefits amplifying across multiple stakeholders.

Another aspect of the debate is the role that government should play in these interventions. This is a highly politicized topic, as rooted within it is how far the government’s reach should go into the lives of individuals. Though people from many camps agree that action should be taken, it is hotly debated what that action should be. Should preschool be made part of a compulsory public education? Should a voucher system be put into place that allows impoverished families to pay tuition at the most elite preschools? Should a voucher system be put into place where all families, regardless of income, are subsidized so their children can attend any preschool? Further complicating this is that these solutions and many others may be viable in theory but may play out differently when put into practice.

More of an empirical question than a debate stems from the evidence that the most successful programs (model programs) tend to be multicomponent, complementing center-based care with parental home visits. Though their platform was education, these programs targeted other critical elements, including the home environment, health, and nutrition. These programs were wildly successful, but it is difficult to tease out which component provided the most impact. It may also be that the whole of comprehensive programs is greater than the sum of its parts and that all the components must be present because they interact, work together, and feed off one another. Thus, a challenge going forward will be designing programs that include all the essential elements for improving the lives of children but maintaining a balance, not extending to superfluous extras that provide little benefit but come at a high cost.

What’s Next?

With compelling evidence that early childhood educational interventions have short- and long-term effects on the health and well-being of participants, there are ample reasons to increase investment in the development and execution of these programs on a national level. Though universal preschool is a noble goal and may be the right direction to move toward, there are a number of initial steps that would increase the chances that such a large-scale structural change would produce systematic benefits. This can be accomplished through the dual efforts of broadening the scope and scale of subsidized center-based care and preschool availability while implementing interventions designed specifically to reach children in the most at-risk situations. Furthermore, a strong evaluation component needs to be put into place so that the processes underlying programs’ successes and shortcomings can be understood and the program can be refined accordingly. This not only will enable the improved design of interventions but also may eliminate unnecessary costs.

Given that the infrastructure for Head Start is in place, it is a natural starting point for the expansion of early childhood interventions. Though the mission of Head Start does not vary among centers, the quality varies greatly. Efforts should be instituted to maintain consistently high levels of teaching, adhere to a core set of curriculum principles, and employ the whole child approach regardless of which community a Head Start program serves. This can be done at the same time that centers are allowed to adapt based on the needs of the children they serve. Head Start funding should be continued and expanded. Though there are no data available showing the number of children who are eligible for Head Start but are not enrolled due to centers being at capacity, we know from important examples that the need is greater than the demand. For a recent example, when Head Start funds were increased in response to the Flint water crisis, it was reported that 800 children in that city alone were waiting to receive Head Start services. Furthermore, Head Start should be extended beyond the current income guidelines. A wide swath of families neither qualifies for subsidized child care nor has the means to pay the exorbitant rates associated with full-time private preschool. Children in these families are left to fall through the cracks as they are placed in suboptimal care settings.

A Head Start expansion will have impacts far beyond the lives of individuals. Providing child care that is high quality, affordable, and easily accessible stabilizes families. When parents have safe and reliable child care, it increases their ability to maintain employment. Not only are they able to hold a job, but they are also able to build a reputation as reliable employees. In turn, when parents’ pool of expendable income grows, more resources are often devoted to children in the form of educational opportunities, extracurricular activities, and the consistent provision of a nutritious diet. Furthermore, the increased scaling up of Head Start will provide the opportunity to develop and test curricula that are applicable to children from a range of socioeconomic backgrounds and family structures, thus aiding the move toward universal preschool. Finally, more centers and more oversight of these centers means more jobs for skilled and unskilled workers alike—for instance, educators, nutritionists, dieticians, facilities workers, and navigators. These centers will feed the economy in multiple ways, allowing parents to work, creating job opportunities within depressed communities, and preparing a new generation to succeed and prosper.

Though scaling up Head Start would be an important and extremely productive move, it is not the only necessary step. Another is increased funding toward high-quality, intensive, comprehensive education interventions aimed at groups who are at risk based on a variety of factors. The most at-risk children need exposure to services across so many domains that Head Start or similar programs simply cannot address all their needs. These children and their parents and guardians need more direct attention that involves not only training in strengthening relationships and creating a positive and constructive family environment but also help navigating the complex system of benefits and supports for which they may be eligible. Model programs emulating PPP and ABC need to be designed and deployed to contemporary children and families. At the same time, a clearinghouse should be developed to classify and categorize interventions to guide researchers and policymakers as they adapt programs for the unique needs and circumstances of a given subsample of the population. This can be modeled after the U.S. Department of Health and Human Services Teen Pregnancy Prevention Review.

Among the many things that should be taken into consideration when taking the actions described above is that all intervention efforts must be both optimally designed and optimally evaluated. The robust literature in this area can serve as a roadmap, guiding people along the most desirable routes. We do not have the space here to give comprehensive recommendations but will offer a few. First, intervene early. Abundant research suggests that preventative efforts are more effective and more efficient than curative ones. Problems of impoverished children tend to cascade as they progress through childhood and adolescence. In this vein, “skills beget skills” (Cunha & Heckman, 2007). Laying a solid early foundation sets the stage for later development. Second, intervene comprehensively. Engaging parents and involving them will help to extend and reinforce any intervention efforts that happen within a center-based context. Furthermore, research indicates that interventions that include both center-based care and home visits are particularly effective for imparting noncognitive skills that, as discussed earlier, are paramount to an individual’s getting and staying on a productive life course. Third and related, emphasize noncognitive and cognitive skills. Less is known about measuring noncognitive skills, and given their importance, this should be a high-priority research area. Fourth, choose well-trained and high-quality educators to implement the intervention. Research suggests that this actually matters a great deal for obtaining positive outcomes from interventions (St. Pierre & Layzer, 2006).

A constant and concerted effort should also be made to refine and strengthen intervention efforts. This requires rigorous evaluations that are carefully planned before the intervention is deployed and implemented with the same degree of effort as the intervention itself. Early childhood interventions have been plagued by naysayers whose arguments have been fueled by research suggesting that programs such as Head Start cost a lot of money and produce few if any results. Though recent research tends to refute this, new interventions will be put under a microscope. Thus, measures of fidelity (i.e., comparing the actual to the intended implementation, outcomes across a variety of domains, and prioritization of collecting longitudinal data) are all necessary to continue to prove the utility and efficacy of these programs. This also calls for flexibility. Swift and continuous evaluation may reveal insights into things that need to be revised, changed, or scrapped, and those in charge need to be willing to investigate and adjust as much and as often as necessary.

The United States lags behind other developing nations on a number of crucial metrics, including teen pregnancy, infant death, obesity, and incarceration rates. These outcomes disproportionately plague those who have grown up in poverty. With an expansion of our current early childhood intervention efforts, we can change the trajectory of lives, setting a new course wherein potential, productivity, and fulfillment are within the reach of all people. Policies aimed at addressing the needs of our most vulnerable members are an investment in all of our futures.

Paul Hughes-Cromwick and George Miller also contributed to this report.

References

Belfield, C. R., Milagros, N., & Barnett, W. S. (2005). The HighScope Perry Preschool Program: Cost-benefit analysis from the age-40 follow-up. Ypsilanti, MI: HighScope Press.

Carneiro, P., & Ginja, R. (2014). Long-term impacts of compensatory preschool on health and behavior: Evidence from Head Start. American Economic Journal: Economic Policy, 6(4), 135–173.

Cascio, E., & Schanzenbach, D. (2013, fall). The impacts of expanding access to high-quality preschool education. Brookings Papers on Economic Activity, 127–179.

Chetty, R., Friedman, J. N., Hilger, N., Saez, E., Schanzenbach, D. W., & Yagan, D. (2011). How does your kindergarten classroom affect your earnings? Evidence from Project Star. Quarterly Journal of Economics, 126(4), 1593–1660.

Cunha, F., & Heckman, J. (2007, January). The technology of skill formation. Cambridge, MA: National Bureau of Economic Research, Working Paper 12840.

Currie, J., & Rossin-Slater, M. (2015). Early life origins of life cycle well-being: Research and policy implications. Journal of Policy Analysis and Management, 34, 208–242.

Elango, S., García, J. L., Heckman, J. J., and Hojman, A. (2015, November). Early childhood education. Cambridge, MA: National Bureau of Economic Research, Working Paper 21766.

Heckman, J. J., Stixrud, J., & Urzua, S. (2006, February). The effects of cognitive and noncognitive abilities on labor market outcomes and social behavior. Cambridge, MA: National Bureau of Economic Research, Working Paper 12006.

Sorensen, L. C., & Dodge, K. A. (2015, December). How does the fast track intervention prevent adverse outcomes in young adulthood?. Child Development, 87(2), 429–445.

St. Pierre, R. G., & Layzer, J. I. (1999). Using home visits for multiple purposes: The Comprehensive Child Development Program. Future of Children, 9, 134–151.


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