[II. Early Childhood Development and Learning: Ten Key Lessons ]
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[IV. Building On Success]
Researchers and policymakers still have a great deal to learn about how children grow and learn, but we know enough now to begin to promote their healthy early development. Research and practice in many fields—including not only brain science but also medicine, psychology, education, cognitive science, and organizational development—have produced a vast body of knowledge, leading to better, more informed approaches to helping young children and their families. This knowledge rests on thousands of studies and evaluations of hundreds of programs—far too many to summarize in a single report. But we can distill from them fundamental lessons about effective strategies.
We Americans take pride in having created a truly advanced society. In the realm of science and technology, we have few rivals. People from around the globe seek information and treatment from our health professionals. Given our resources and the value we place on life, liberty, and the pursuit of happiness, we should have a very low rate of infant mortality. And we do—but only in our more affluent communities. The infant mortality rate for African-American infants is 2.4 times higher than for white infants. When the nation is considered as a whole, we lag behind more than a dozen other countries in ensuring infant survival. About two-thirds of infant deaths occur in the first months of life, and are due mainly to health problems, such as birth defects or early delivery. The other third of infant deaths occur after the first months and are influenced greatly by social or environmental factors, such as inadequate health care or exposure to cigarette smoke.21 In general, children born to teenage parents, especially those living with their mothers alone, appear to be more likely than other children to have continuing health problems.
We can do better—if we take a preventive approach to health care and make adequate prenatal care available to more expectant mothers. The facts are clear: good prenatal care dramatically boost women?s chances of giving birth to healthy babies. It is also a sound investment. Prenatal care reduces the number of low-birth weight infants, saving the health care system up to $30,000 each time.22
Prenatal care also leads to better nutrition for expectant mothers and infants, a key factor in children?s healthy development. The government provides critical nutritional support by means of the Women, Infants, and Children Supplement Nutrition Program (WIC) program, which provides nutrition to pregnant women and infants, and food stamps for low-income families. But expectant parents need information and guidance about the kinds of foods and food supplements that engender good health. Ideally, prospective parents should receive information and support even before they conceive a child. This is sometimes called "preconception care" and it can boost the health of mothers and babies, as well as fathers? knowledge and confidence.
Health care is unquestionably important in the early months of pregnancy. And yet, many women still do not get adequate prenatal care. The percentage of expectant women who receive late or no prenatal care is 8.2 percent for African-American women, 7.6 percent for Hispanic women, and 3.6 percent for white women. Very young mothers—those age 15 or under—are twice as likely as older teens and five times more likely than women over age 19 to receive late prenatal care or none at all.23 Some expectant women lack health coverage that would pay for early visits. Others don?t know where to go, or how to get there, or why a doctor would want to see them when they are not even "showing." Efforts are needed to ensure that the public is better informed, that prenatal care is accessible and affordable, and that care is not delayed while eligibility is established. Aggressive outreach could encourage more prospective parents to seek early care. And preconception and prenatal care should encompass not only health care and risk assessments, but also solid information and services such as screening and treatment for depression, smoking cessation, and alcohol abuse. While maternal health is the main focus of prenatal care, children benefit when fathers are brought into the process from the outset.
Prenatal care is a good start—but only a start—for a lifetime of good health. Infants and toddlers need regular well-child care, the full set of recommended immunizations, and swift attention when they show signs of illness or developmental delays. That is why health coverage is so important. We have made significant progress in this area. In 1997, the federal government implemented the largest expansion in health care in more than 3 decades, providing $24 billion to provide health coverage to millions of uninsured children and their parents through the Children?s Health Insurance Program (CHIP)—a federal-state partnership.
Despite this program, nearly 11 million children still lack health insurance. At least half of these children are eligible for federal-state programs, but too often their parents don?t know or don?t believe that they qualify. A national campaign called "Insure Kids Now" has been launched to educate the public about the importance and availability of coverage.24
Once parents have access to health care for their children, it must be family-centered. Many parents want more information, reassurance, and resources during well-baby visits than traditional pediatric practices can provide. When health care providers (and insurers) restructure their policies and practices to provide services that meet parents? needs and emphasize prevention, children benefit.
Writing about the importance of parent education, an American physician asserted that parents too often undertake their new roles "without previous instruction, or without forethought; they undertake it as though it could be learned either by intuition, by instinct, or by affection. The consequence is, that frequently they are in a sea of trouble and uncertainty, tossing about without experience or compass."25
This statement was written nearly a century ago by one of our nation?s first women physicians. Despite having advanced light years in medical and scientific knowledge, the need for family support and parent education remains as strong as ever—perhaps stronger, since today Americans are far more mobile and less reliant on extended family living in their households or around the block.
Raising children is challenging for all parents; it is certainly stressful for the nation?s large number of very young parents. The nation has made progress in this area. After rising in the late 1980s, the teen pregnancy rate has been declining steadily in the 1990s. The birth rate for teen mothers (aged 15 to 17) fell by 16 percent between 1991 and 1997. During the same period, there was a marked decline (21 percent) in the rate of second births to teens.26
But the problem remains serious. The teen birth rate in 1997 was higher than it had been in the mid-1980s, when it was at a low point. Most were not married: in 1996, one out of every three births in the U.S. was to an unmarried mother. And while the birth rate for young African-American and Hispanic women fell substantially (by 23 percent and 8 percent respectively), it continues to be higher than for other groups.27 These concerns have led to the establishment of the National Strategy to Prevent Teen Pregnancy.
Teen mothers have a particular need for parent education and support. They are less likely to seek prenatal care, more likely to smoke during pregnancy, and more likely to give birth to low-weight babies. Compared with children born to older mothers, the children of teen mothers are less likely to have the emotional support and intellectual stimulation they need for healthy development.28
Today, 3.3 million children live with adolescent mothers. These young mothers have a particular need for parent education and support. They are much less likely than other mothers to take advantage of prenatal care, and those who are 16 or younger are more likely to have low-birth weight children—with all of the health and developmental problems associated with that condition. In general, children born to teenage parents, especially those living with their mothers alone, appear to be more likely than other children to have continuing health problems.29
But all parents can benefit from family support and parent education. Most say they have a pretty good idea of what to look for in terms of their babies? physical development, but need more help recognizing social and emotional milestones. They are perplexed by recent findings about the importance of the early years. They know they need to stimulate their children, but how and how much? And how can they be sure that the other adults who care for their children will give them what they need?
Parents want to do a good job. Many go to bed at night convinced that they haven?t spent enough quality time with their children. More than half of today?s parents believe they are not doing as good a job at child rearing as their own parents did.30 The survey conducted by Zero to Three, a conference participant, confirms that few first-time parents feel fully prepared for their new role. The youngest and least financially secure feel particularly unprepared. They also want more information, including the findings about early brain development that were presented at the Conference. The Zero to Three survey found that 60 percent of parents are "extremely" or "very" interested in this subject, and another 21 are "fairly" interested.
But surveys are not the only indications that people who have responsibility for young children want help. Existing family support and parent education services are at full capacity; books and magazines on childcare are widely read. Corporations and community organizations that have set up 800 telephone help lines for parents have been flooded with calls. And online parent resources are expanding. Pediatricians say they are frustrated that they have so little time to respond to the long lists of questions and concerns that parents raise; and some are restructuring their practices to meet this need.
Family support and parent education programs are often aimed at new mothers, but can also help fathers adapt successfully to their new roles. We know that many fathers are having difficulty finding a place for themselves in the family setting, and that divorce rates are rising. By focusing on fathers? needs and roles, family support and parent education programs can help to support men who are struggling to adjust to new roles and responsibilities. The best programs address not only child rearing issues, but the challenges fathers and mothers meet as they raise their families, such as getting and keeping jobs, resolving conflict, and managing their time.
A number of well established family support programs have been subjected to rigorous evaluation. For example, an evaluation of Avance, a family support program featured at the Conference that has served low-income, predominantly Hispanic families over more than 2 decades, has demonstrated an improved ability by families to provide an emotionally nurturing and stimulating home for their young children, enhanced mothers? child-rearing knowledge, attitudes, and practices, and increased mothers? use of community resources.31 In general, research evidence on comprehensive family support programs is promising but not conclusive. Comprehensive, multifaceted programs are difficult to evaluate because they encompass so many activities, and tailor services to the needs of different families. Different programs serve children of different ages and target different kinds of families, so it is hard to make comparisons of their impact or cost-effectiveness.
We do know, however, that programs emphasizing home visitation can produce impressive results, particularly when they begin with prenatal care and include follow-up into the elementary school years. Programs that include regular home visits appear to be particularly effective in meeting new parents? informational needs and allaying their anxieties.32
New parents have a lot to learn. Twenty-five years ago, when hospital stays for new mothers tended to be longer, there was more time for advice and instruction. Nursing an infant is certainly a natural process, but the know-how to begin successfully does not come naturally. The same is true for diapering or bathing a newborn, dealing with cradle cap, or establishing daily (and nightly) routines. Even a minimum hospital stay of 48 hours is not always enough time for parents to adjust to their new responsibilities before they bring their newborns home. Follow-up is helpful, but today, only a small minority of families receives follow-up visits by nurses. As the months pass, most parents gain confidence and competence, but they can still benefit from advice about how to keep track of a baby?s development, recognize and deal with illnesses and emergencies, baby-proof their homes, choose toys for their children, and play and chat with children at different ages. Some home visitors make videotapes which help parents learn what to look for as they watch their children grow, and spur important discussions about children?s development in the context of family dynamics.
Today, more than half of all mothers go back to work before their babies? first birthdays. Many choose to continue their careers while raising a family; others prefer to stay home, but cannot afford to financially. Fifty-five percent of working women contribute half or more of family income.33 Other mothers must work or attend training to meet new welfare requirements.
As a result, the great majority of infants and toddlers are in nonmaternal care for some stretch of time. This is a potential opportunity. Studies that have followed children?s progress over decades, such as the Perry/High Scope Preschool Study, have shown that high quality early care and education programs produce long-term benefits, especially for children from low-income families. Programs with well trained staffs and strong curricula (geared to children?s needs at each stage of development) have been shown to promote cognitive, social, and emotional development in young children. Children who attend such programs fare better in elementary school, especially if they receive ongoing support as they move through the grades. They are less likely to be held back and less likely to be referred for special education.34
The trouble is that high quality, affordable childcare is hard to come by. Researchers who have observed and rated childcare programs (including both childcare centers and family day care settings) say that many are poor to barely adequate. They may have unqualified or poorly trained staff; too many children for each staff member; inadequate facilities; or other shortcomings. Programs for infants and toddlers appear to be the worst of all.35 Moreover, childcare schedules often do not mesh with parents? work schedules. Many parents resort to makeshift arrangements; their children may be in several locations or programs during a single day.
Given the realities of today?s families, the need for affordable, high-quality childcare has been hoisted high on the national agenda. This is an issue that affects not only children?s healthy development, but also parents? ability to work outside the home with the concentration and peace of mind needed to succeed in today?s workplaces. Many businesses are beginning to realize that providing childcare to their workers makes good business sense, enabling the employees to work to the best of their abilities.
Researchers and practitioners are shaping many proposals to define and improve quality in early care and education, addressing ways to upgrade the training, qualifications, and working conditions of childcare providers; mechanisms for assuring safe environments for young children; and the content of early childhood curricula. Some take a broad view, arguing that changes must be made not only in programs, but also in the policies, financing strategies, and accreditation practices that underlie the nation?s childcare services.36 These efforts provide a broad framework for improving childcare so that children can thrive and parents can work and learn with peace of mind.
Today, childcare is at a crossroads. Ideas abound for improving services, but states and localities need the time and resources to plan and coordinate reform efforts. Otherwise, efforts to improve childcare may lead to further fragmentation. To ensure safe and healthy care for children of all ages, welfare reform legislation passed in 1996 created a Child Care and Development Fund—$3.7 billion dollars in 1998. These funds go to states to help families make the transition from welfare to job training and work; they help low-income working families pay for the childcare they need in order to stay in the workforce.37 In addition, 39 states spend nearly $1.8 billion each year to fund their own prekindergarten programs, mainly for 3- and 4-year-olds, and/or to support Head Start.38
We can base tomorrow?s early care and education programs on the experience of today?s successful programs. Much can be learned from the experience of the military, which has instituted excellent childcare programs by requiring substantial basic training for caregivers, offering them a career ladder, and providing sufficient wages and benefits to reduce staff turnover.
Finally, to meet the many needs of our youngest children, we need a comprehensive approach. This is the toughest challenge of all. It is difficult, in part, because Americans tend to resist "systems." When it comes to young children, however, we pay systematically when we do not provide coherent, well-coordinated services. When services are fragmented, too many children, and too much promise, fall through the cracks.
If all of the core institutions discussed in the following chapter were to work together, and take concrete steps to coordinate their approaches, our communities could begin to move toward better results for children. But this effort challenges many people and many institutions to examine their policies and practices, and to make changes. It means reordering priorities. This is not easy, nor can it be quickly accomplished. It will take sustained attention and work.
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[II. Early Childhood Development and Learning: Ten Key Lessons ] |
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[IV. Building On Success] |