The State Early Childhood Policy

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The State Early Childhood Policy Technical
Assistance Network (SECPTAN)
Investing in Early Childhood and School Readiness
Plenary Using Limited Health Dollars Wisely
Conference Naples, FL October 7-9, 2005
Charles Bruner, SECPTAN Director
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SECPTANs Mission

• To provide help to state policy makers to move
  forward early learning/school readiness agendas
• Evidenced-based
• Timely
• Customized
• Nonpartisan
• To produce resources for the field based upon
  technical assistance requests and experiences

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From Indicators to Policy Most Frequently
Raised TA Questions

• How can we describe our work to get attention?
• How can we mobilize support to produce action?
• How can we organize our work to fit together and
  achieve results?
• Whos doing something we should look to for ideas?

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Message Box SECPTANs Interconnected Answers

• Focus on results. (We have a problem.)
• Show ways to achieve them. (We have solutions.)
• Identify the investment gap. (We know where and
  how to invest.)
• Develop allies and mobilize support. (We all need
  to step forward.)
• chorus, not cacophony

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Answering the Questions A Checklist Approach

• Focus on Results. The SRII Foundation.
• What all children need to start school ready to
  learn Equation
• Current status of children on starting school
  "ready Indicators
• Family and societal consequences of not starting
  ready Indicators
• Shows Ways to Achieve Them.
• Effective programs, services, and practices to
  improve school readiness Evidenced-Based
  Strategies
• Identify the Investment Gap and How to Address
  It.
• Investment opportunities to develop system Gap
  Analysis
• Implementation design to efficiently and
  effectively develop system Governance/Management
  
• Identify Allies and Mobilize Support.
• Education and mobilization strategy to secure
  resources Political Will-Building

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Results and Evidenced-Based Strategies

• Equation Elements
• Ready Families.
• Ready Communities
• Ready Services (Health).
• Ready Services
• (Early Childhood Education)...............
• Ready Schools.

Strategies Selected home visiting, family support
programs, developmental child welfare
services Toxin removal, public awareness/action
campaigns Health insurance, medical homes and
developmental health services, early intervention
(Part C) Quality, affordable child care, supports
for FFN providers, pre-school enriched
pre-school for low-income/vulnerable
children Transition plans, community schools
Red Lead Health Role Light Blue Health Role
in Referral and Consultation
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Returns on Investment fromExemplary Early
Childhood Programs
Many Happy Returns Three Economic Models that
Make the Case for School Readiness
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Identifying the Investment Gap (1)Composite
Nine-State DC Average Per Child Investment by
Age
7,889
4,113
1,683
709
Early Learning Left Out Closing the Investment
Gap for Americas Youngest Children
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Identifying the Investment Gap (2) Potential
Investments in School Readiness Equation
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Implementation DesignA System of Systems
Building an Early Learning System The ABCs of
Planning and Governance Structures
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Developing Allies and Mobilizing Support
Strategies for Different Champion Groups
Beyond the Usual Suspects Developing New Allies
to Invest in School Readiness
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The Completed Checklist

• Focus on Results.
• What all children need to start school ready to
  learn
• Current status of children on starting school
  "ready
• Family and societal consequences of not starting
  ready
• Shows Ways to Achieve Them.
• Effective programs, services, and strategies to
  improve school readiness
• Identify the Investment Gap.
• Investment opportunities to develop system
• Implementation design to efficiently and
  effectively develop system
• Identify Allies and Mobilize Support.
• Education and mobilization strategy to secure
  resources

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The Special Role for Health in Ensuring School
Readiness

• Medical home and well-child care
• Health consultation to child care facilities and
  home care providers, schools, and home visiting
  programs

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Health Care and School Readiness

• Simple Thinking
• Health Insurance Medical Care Child Health
• Expanded/Reframed Thinking
• Medical care content as well as insurance
  coverage important for ensuring child health.
• Transmedical services, including those focused
  upon family pediatrics, needed to ensure child
  health.
• Health includes developmental (social, emotional,
  cognitive) as well as physical health services.
• Implications of Reframed Thinking
• Expanded Use of EPSDT under Medicaid
• Incentives for broadened practice
• Health consultation with child care and other
  early childhood providers

Health Care and School Readiness The Health
Communitys Role in Supporting Child Development
New Approaches and Model Legislation
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Five Reasons for Enhancing Well-Child Care

• Opportunity Near universal contact with young
  children
• Expectation Ultimate goals for well-child care
• Impact Healths potential contribution to
  closing the gap in kindergarten readiness
• Interconnectedness Relationship of health and
  social/emotional development to cognitive
  development
• Potential Existence of exemplary and
  implementable practices and programs

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Opportunity

• More than any other service providers, pediatric
  health practitioners see young children and their
  parents and can identify developmental concerns.
• 99 of children 0-5 visit a health practitioner
  at least once during the year
• 31 of children 0-5 have a well-child visit/EPSDT
  screen funded by Medicaid

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EPSDTs Major Role in Serving Young Children
Note 69.8 of all 0-5 year-olds as proportion of
those below 200 of poverty have EPSDT screens,
compared with 21.4 of all 6-17 year-olds.
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While the majority of the Medicaid population,
children represent only a small percentage of
Medicaid spending.
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Expectation

• Physical Health and Development Well-Child
  Visit Goals
• No undetected hearing or vision problems
• No chronic health problems without a treatment
  plan
• Immunizations complete for age
• No untreated dental caries
• No undetected congenital abnormalities
• Good nutritional habits and no obesity
• No exposure to tobacco smoke
• Emotional, Social, and Cognitive Development
  Well-Child Visit Goals
• No unrecognized or untreated developmental delays
  (social, cognitive, communication)
• No unrecognized maternal depression, family
  violence, or family substance abuse
• Parents knowledgeable and skilled to anticipate
  and meet childs developmental needs
• Parents linked to all appropriate community
  services

source Dr. Ed Schor, Commonwealth Fund
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Impact

• Up to half of achievement gap in later grades is
  already evident in the readiness gap at
  kindergarten entry.
• - Rouse, Brooks-Gunn, and McClanahan
• As much as one-quarter of the readiness gap may
  be attributable to health conditions or health
  behaviors of both mothers and children
• - Currie
• Parents play the most important role in preparing
  their children for school (at least one-half of
  all impacts on kindergarten readiness), and
  health services can assist in supporting parents
  in fulfilling that role.

source School Readiness Closing Racial and
Ethnic Gaps, Future of Children (Spring, 2005)
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Interconnectedness

• Three in four children who start school behind
  cognitively also have physical or social and
  emotional delays as issues.
• Children starting behind in more than one area
  have the most difficulty catching up.
• Kindergarten teachers report greatest challenge
  in helping children learn is in dealing with
  social and emotional issues, not cognitive ones.

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ECLS-K Data and Percent of ChildrenLagging on
One or More DimensionsInterconnectnessness of
Dimensions
Health
15.5
7.6
While 24.1 of children lag in cognitive
development, only 6.4 lag only in cognitive
development!
8.1
13.2
5.0
Social and Emotional
5.0
6.4
Cognitive
source Child Trends analysis of ECLS-K, base
year public-use data for 1998-1999
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Potential

• Exemplary programs and practices exist that
• Increase pediatric practitioners use of
  developmental screening, provision of
  anticipatory guidance, and identification of
  developmental health concerns during well-child
  visits
• Strengthen pediatric referrals to Part C early
  intervention and other community-based services
  to address developmental, behavioral, and
  parenting needs
• Link back to pediatric practitioner for
  monitoring and follow-up at next well-child visit
• These programs and practices work because they
• Make sense to practitioners, patients, and
  referring agencies
• Have enlisted pediatric practitioner support and
  leadership and are implementable in office
  settings
• Do not involve major new costs and often are
  eligible for Medicaid funding support

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Promising Practices in Well-Child Care A
Beginning List

• Achieving Better Child Development (ABCD
  Initiative supported by Commonwealth Fund)
• Help Me Grow (Connecticut)
• Reach Out and Read
• Healthy Steps for Young Children
• Bright Futures and Bright Futures MH
• Touchpoints
• DSM-PC and DC0-3

source and resource Commonwealth Fund
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From Indicators to Policy Overall Implications
for State/National Policy

• Medicaid, SCHIP, and EPSDT/Developmental Health
  Services Sustained and Promoted
• Health Systems Linked to Other Early Childhood
  Systems for Health Consultation and Referrals

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Federal/State Partnership and Child Health
Coverage

• Childrens health coverage would be in a crisis
  without Medicaid and SCHIP.
• While the majority of the Medicaid population,
  children represent only a small percentage of
  Medicaid spending.
• Medicaid and SCHIP play a vital role in providing
  child health coverage for a large share of the
  working population.
• Children covered by federal programs (Medicaid
  and SCHIP) represent those most likely to have
  significant health needs and require preventive
  and early intervention services.
• Providing preventive and early intervention
  health services to young children is
  cost-effective and needed to achieve societal
  goals (including closing the achievement gap).

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Additional SECPTAN Resources

• Seven Things Policy Makers Need to Know About
  School Readiness (basic arguments)
• Up and Running (description of multi-site
  initiatives)
• On the Path to School Readiness (discussion of
  universal pre-k)
• Many Happy Returns (ROI analyses)
• Child Welfare and School Readiness
• Measuring Childrens School Readiness (assessment
  options)
• Community Building and School Readiness

www.finebynine.org
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Additional Resource Basic Talking Points About
School Readiness

• 1. Learning begins at birth.
• 2. Nurture, as well as nature, matters.
• 3. School readiness is more than just what
  children know.
• 4. School unreadiness is costly.
• 5. Parents work.
• 6. Quality matters.
• 7. Investments pay off.

Seven Things Policy Makers Need to Know about
School Readiness
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Additional Resource Description of Multi-Site
Early Childhood Initiatives

• Initiatives in health, family support, early
  childhood education, economic self-sufficiency,
  child abuse prevention, pre-school, and
  comprehensive early learning initiatives
• Description, state/community locations,
• and contact information

Up and Running A Compendium of Multi-Site Early
Childhood Initiatives
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Additional Resource Considerations Regarding
Universal Pre-School

• Expected contribution to school success (part of
  answer, but not silver bullet
• Parental desires and needs (culture and
  time/space needs)
• Features of effective programs (high quality, but
  different responses for different children and
  enriched pre-school for low-income/disadvantaged
  children)
• Workforce development considerations
• (importance of diversity)
• Pre-school as part of larger early learning
  system
• (integrated to other approaches and needs)
• Avoiding unintended consequences (limit
• disruptions of current early childhood programs)
• Financing (free vs. sliding scale, phase-ins,
• public/private roles)

On the Path to School Readiness Key Questions
to Consider Before Establishing Universal
Pre-Kindergarten
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Additional Resource Three Economic Development
Cases for Early Childhood Education

• Child Human Capital Development Four Seminal
  ROI Studies
• Community Capital Development Economic Modeling
  of Contribution of Early Care to Local Economy
• Adult Human Capital Development Economic
  Development in Poor Neighborhoods

Many Happy Returns Three Economic Models that
Make the Case for School Readiness
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Additional Resource Child Welfare and School
Readiness

• Opportunities for Action - Best Practices
• Identifying developmental needs during
  investigation and assessment
• Providing developmental services and service
  referrals as part of in-home services
• Addressing developmental needs during placement
• Addressing developmental needs in adoption
• Role of judicial leadership

Child Welfare and School Readiness Making the
Link for Vulnerable Children
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Additional Resource Measuring Childrens School
Readiness

• Discussion of value of kindergarten assessment of
  what children know and can do for benchmarking
  purposes
• Description of issues in ensuring appropriate use
• Highlight and comparison of three state
  approaches in providing comprehensive assessment
• Annotated bibliography of resources on
  kindergarten assessment

Measuring Childrens School Readiness Options
for Developing State Baselines and Benchmarks
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Additional Resource Community-Building and
School Readiness Focus on Vulnerable
Neighborhoods

• Rich in young children (50 more young children
  as percent of population)
• Significant in size (8 of all children, but
  one-quarter of school unreadiness population,
  with 2-5 times the rate of single parenting,
  child poverty, low education, lack of savings and
  home ownership)
• Diverse in ethnicity (83 children of color, and
  where 23 all African American and Hispanic
  children live)

Census Tracts and Child Raising Place-Based
Implications for Child and Family Policy
Investments and Reforms
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Poor Neighborhoods Wealthy in Young Children
Very Young Children (0-4) as Percentage of
Population by Child-Raising Vulnerability
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A Snapshot of America
Differences Across Census Tracts by Child Raising
Vulnerabilities (school, education, economic,
wealth indicators)
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Place and Race Sharp Distinctions
Racial Composition of Census Tracts by
Child-Raising Vulnerability
Note 1.7 of all White Non-Hispanics, but 20.3
of Blacks, and 25.3 of Hispanics live in census
tracts with six or more vulnerability factors.
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Implications of Place for Policy and Practice

• Place matters, particularly for closing the
  countrys achievement gap
• Color blind approaches (bringing credentialed
  White, non-Hispanic teachers from suburbs in to
  teach preschool) wont solve, and could compound,
  problem
• Place-based strategies can improve school
  readiness, while building community and economic
  opportunity
• staff and career development for people in
  neighborhood
• community building around school readiness
• re-entry and re-integration around fatherhood and
  school readiness

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Useful Web Sites
Commonwealth Fund www.cmwf.org National
Academy for State Health Policy
www.nashp.org National Center for Children in
Poverty www.nccp.org