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Child Care Project

Early Childhood Initiatives in the States: Translating Research into Policy

State Legislative Report--Vol. 23, No. 14--June 1998

By Scott Groginsky, Senior Policy Specialist
Steve Christian, Policy Specialist
Laurie McConnell, Research Analyst

 New insights on how and when the human brain develops are affecting public policy relating to young children and their families at the federal, state and local levels. The discovery that babies' brains develop more rapidly and earlier than previously understood has far reaching implications for education, health care, child care, and parenting.

Scientists, philanthropies, child advocates and celebrities have joined to spread the word about new brain research and what it means for lawmakers, community leaders and human service providers. They have used various strategies to raise awareness and encourage state legislators to translate the brain research into policies. Such strategies include:

• Forums, conferences and tours for policymakers on brain development;
• Testimony before legislative committees;
• Dissemination of written materials, such as recent Newsweek and Time magazines' special editions on early brain development;
• Invitations to businesses, law enforcement, faith communities and others to become involved in children's issues; and
• Public service announcements and media campaigns.

Increasing numbers of state legislators and governors are responding to the public awareness campaign. Many legislators participate in outreach efforts through sponsoring and carrying legislation, speaking at and helping plan events for the public and other policymakers, serv ing on task forces or committees, seeking out information to translate into public policy, and sharing knowledge with colleagues. In addition, governors from several states, including California, Colorado, Florida, Georgia, Idaho, Indiana, Iowa, North Carolina, Ohio, Rhode Island, South Dakota and Vermont mentioned the brain research in appeals to state lawmakers to support early childhood development programs during the 1998 sessions.

Legislators have responded to these appeals. Iowa legislation enacted this year (SF 2406) to provide grants for school readiness, for example, states: "The General Assembly recognizes the significant findings of brain research indicating that early stimulation of the brain increases the learning ability of a child." A California bill (AB 1210) passed by both houses of the Legislature in 1997 to give information to parents and maternity care workers about child development, stated, "Neuroscience researchers now know that brain neuron connections occur rapidly after birth and are dependent on the experiences and stimuli of infants and children." The governor vetoed the legislation, promising to introduce his own early childhood initiative. Early in 1998, he proposed several budget increases. (This initiative is discussed more fully on pages 6 and 11). A proposed Rhode Island bill (H 8350) that would increase child care access for low-income families, improve quality and expand health care coverage to center providers also draws on the information. It asserts, "Recent research in neuroscience and early brain development supports the critical importance of the early childhood years and their life long effects on a child's development."

Although the highly publicized brain research has had a tremendous impact on policy for young children and their families, other developments in recent years have also contributed to increased attention to early childhood issues. Over the past two decades, child development researchers have been confirming the importance of good quality early care and education for the nation's youngest children. The last 20 years have also seen a dramatic increase in the number of working mothers, a major demographic shift that will escalate with work requirements under welfare reform. These two factors made child care a critical public policy issue even before the latest neuroscience discoveries.

Nurturing and responsive relationships during the first years of life are crucial to the brain's development. As a child interacts with the world, the number of neural connections within his or her brain soars. A child who lacks appropriate relationships and stimulation during this period will be less able to learn, cope with stress and emotions, and form relationships. A large body of research has correlated early childhood experiences with outcomes later in life.

• Throughout the entire process of development, beginning before birth, the brain is exquisitely sensitive to environmental conditions, including nourishment, care, surroundings and stimulation. These conditions influence the intricate circuitry of the human brain.
• The first three years of life are when the vast majority of connections, or synapses, is produced. The number of synapses increases rapidly until about age three and then holds steady throughout the first decade of life. After age 10, many of the synapses that are not used are eliminated.
• As babies gain more experience, positive or negative, the brain's wiring becomes more defined. Nurturing, responsive caregiving plays a vital role in healthy development, directly affecting the formation of neural pathways.
• For most of the first decade of life, children's brains are twice as active as adults'. Brain cell connections formed in the first year of life will remain largely in place for the rest of a child's life.
• Early exposure to adverse conditions (in utero and in the postnatal environment) has more harmful and long-lasting effects on young children than was previously suspected (1, pp. 7, 10-12,16).

State lawmakers have focused on at least five specific policy areas as a result of the new early brain development research.

This report examines different state policy responses to the recent brain development findings, particularly within the legislative context. Because state legislators create and amend laws, appropriate money, and monitor policies, they are central to translating the new information into support systems for young children and their families. The role of state policymakers in health and human services issues is more important than ever because of new block grants or other programs for welfare reform, health care and child care. This report discusses legislative initiatives that have been enacted, were pending or that had been defeated as of May 1998.

 Sixteen states and cities received grants, including Baltimore, Boston, Colorado, Florida, Georgia/Atlanta, Hawaii, Minnesota/Minneapolis, North Carolina, Ohio, Pittsburgh, Rhode Island, San Francisco, Vermont and West Virginia. This report discusses many of these efforts.

Brain research has highlighted the importance of good child care, especially for infants and toddlers. Child care no longer is considered separate from learning-children learn in all settings. High-quality programs address two policy objectives. They provide safe environments that allow parents to work without worrying about their children. And they provide stimulating and nurturing settings that foster healthy child development, prepare children to succeed in school and give them the tools they need to develop into productive adults (2, p. 3).

 State legislators have developed an array of laws and policies to improve the quality of child care. They have also addressed the issues of expanding access for low-income families, building the supply of care and encouraging the involvement of businesses. The brain development research has, in some cases, bolstered these efforts.

Several recent studies have raised concerns about the existing child care system. The research has found that good programs lead to positive development, but that good programs are more the exception than the rule. Other studies have found that despite child care's effectiveness at helping low-income families work, most families lack access to the care they need. Selected studies are detailed in appendix A.

Citing the findings on early brain development, Rhode Island lawmakers have focused on supporting child care providers. Last year, the legislature increased reimbursement rates for subsidized providers to reach the 75th percentile of market rates by 2000, a level that is specified in proposed federal regulations. A pending bill, the Early Education and Care Act (H 8350), would accelerate that process by a year. The bill recognizes that "children who receive warm and sensitive caregiving are more likely to trust caregivers, to enter school ready to learn, and to get along with other children" and that "reimbursement rates to child care providers help them to direct resources for training and retaining staff." With increased reimbursement, it is also more likely that child care providers will be willing to accept subsidized children into their programs.

 To promote good low-income child care, Rhode Island legislators in 1997 also expanded the state funded health insurance program to include family child care providers who care for subsidized children. This year's bill would further expand the insurance program by offering coverage to subsidized center-based providers. By requiring coverage to caregivers, the policy serves as an incentive for job retention and turnover reduction, leading to greater continuity of care, which is associated with high quality child care.

The 1998 Rhode Island bill would also establish a fund to target low-income children for enhanced and comprehensive services, including an increase in the number of Head Start spots. The bill provides funding for mentoring, training and technical assistance to providers, and help for programs seeking accreditation. The bill maintains that "it is further evident that the child who enters school ready to learn in all relevant respects-socially, emotionally, medically and academically-is more likely to perform well in school and ultimately become a productive member of society."

State legislators are also addressing the high number of low-income working mothers with children under age 6, which in many states has contributed to long waiting lists for child care. A year after the federal government eliminated separate child care funding categories based on a family's welfare status, some states established similar coordinated structures. In 1997, at least nine states, including Rhode Island, directed funds to all families below a certain income level, whether or not they were on welfare. Rhode Island's proposed legislation would also fund an increase in the availability of child care in the state, boosting eligibility from 185 percent to 250 percent of the federal poverty level (FPL).

Illinois also increased child care coverage for poor families in 1997 by increasing state appropriations by $100 million ($30 million more than the governor requested). The legislature's bipartisan, landmark action guaranteed child care services to all low-income families earning $21,819 gross per year for a family of three, whether or not they are on welfare. One tradeoff of this approach is that the state increased its maximum parent fee to about 13 percent of income for a family of three, or $54 per week. Fees had been as low as 25 cents per week. The new funding will serve nearly 60,000 more eligible children (3, pp. 57-58). In February 1997, Representative Carol Ronen, chair of the Illinois House Children and Youth Committee, held up a copy of Newsweek magazine featuring a report on brain research and asked committee members to consider expanding child care coverage.

The research is prompting action on child care in another large state, California. In 1997 legislators increased child care funds by nearly $400 million; about half were state funds and about half were federal funds. The increase will serve all families on welfare and some working poor families who were on waiting lists. Even with this increase, the state serves less than half the eligible children whose parents want subsidized care. To address some of this unmet need and to provide sufficient child care funds for the growing state welfare-to-work program, Governor Pete Wilson has proposed to increase the child care assistance budget by $742 million, including a $10 million special set-aside for infant and toddler child care. This proposal also includes $3.7 million for voluntary caregiver training, a key element of a good child care system. The governor's fact sheet cites recent studies, including those that cover early childhood brain research and Carnegie's Starting Points report.

Vermont's child care quality improvements are also fueled by the new research, according to the state's Agency of Human Services fiscal year 1999 Report to the Legislature. The report contains the Time magazine articles on brain development and discusses the brain research. It declares that with the increases in child care demand, "high-quality child care and early education are essential"(4, p. 9). To promote child development, Vermont is developing child care as an early-education system and will help cover the costs by increasing the community and business partnerships began after the governor's Early Childhood Summit and continued by the Child Care Fund of Vermont. Advocates and state agencies are also developing training programs throughout the state based on the brain development research and are starting a tiered reimbursement system for providers based on their experience or accreditation.

Missouri Governor Mel Carnahan created the governor's Commission on Early Childhood Care and Education and hosted a conference in November 1997 on brain development and its impact on early childhood development. The commission, which included four state legislators and was chaired by a former state senator, reviewed Missouri's early childhood services and issued a report recommending measures to ensure that all Missouri's children enter school ready to learn. The report recommended creation of a cohesive early childhood education system, expansion of local early care and education initiatives, promotion of high standards for early childhood care and education services, better caregiver training, creation of school-linked programs for 3- and 4-year-olds and adequate funding. Following issuance of the commission's report, the governor submitted and the legislature approved a bill that creates an Early Childhood Development Education and Care Fund, with approximately $2.2 million of the revenues generated from riverboat gaming admission fees. The bill requires that most of the fund be used for grants for voluntary prekindergarten programs. The fund will also be used to provide child care and education certificates to low-income families, provide assistance to low-income families caring for their children under age 3 at home and to increase reimbursements to accredited child care facilities for low-income children.

Early childhood advocates have engaged legislators on child care issues by including them in tours of child care centers. In Oklahoma, a tour of child care centers succeeded in educating legislators about the lack of good care. By witnessing three centers with three levels of quality-low, medium and high-legislators and legislative staff recognized the impact of factors such as regulations and provider reimbursement. This educational activity coincided with Oklahoma legislative funding that authorized a higher reimbursement rate for child care providers with stronger teacher qualifications, better provider compensation and more parent involvement. A May 1998 meeting in North Carolina included visits to publicly-funded child care centers by legislators and legislative staff and other policy leaders. These centers are part of the state's widely recognized child care initiative, Smart Start, which gives counties funds to develop programs for families with young children. It allows counties to choose from a range of comprehensive support services to enhance child care.

State legislatures are also providing incentives for businesses to support child care and early education. Concerned about a large child care waiting list for eligible low-income families and using a research study to identify industries that employ families who use publicly funded care, Florida's Legislature enacted a partnership act to secure business funds for low-income child care (3, pp. 54-55). Business participation in the partnership has encouraged the Legislature to expand a match from $2 million in 1996 to $6 million in 1998. Led by the state Starting Points Brain Power initiative, lawmakers considered the brain development research during legislative deliberations on early childhood policies (5, p. 109). Pittsburgh's Early Childhood Initiative has used the brain research to raise funds from businesses for early care and education. The private sector has committed to raising $59 million from 450 businesses, foundations and wealthy individuals over five years to benefit 7,600 children. So far, $25 million has been pledged, with the expectation that by 2002, when the private sector involvement phases out, state government will allocate $28 million to run the program. (6, p. 45).

Policymakers at all levels of government have realized that without proper care, nurturing and support during the early years, children have difficulty learning when they enter school. State legislators are addressing barriers to school readiness with a number of efforts, including early literacy, parent education, good early childhood education programs, systems collaboration, and coordination with health services.

This section describes school readiness policy that focuses on early learning, which includes state preschool programs, Head Start and early literacy programs. Other initiatives also affect school readiness but are considered in other sections of this report. Parent education efforts are discussed in the family support section on pages 10 to 12, child health efforts on pages 12 and 13, and collaborative efforts in the early childhood infrastructure section on page 14.

Preschool programs tend to be half-day and are typically aimed at 3-and 4-year-olds, funded at various levels and with a range of requirements. In addition, 13 states and the District of Columbia provide supplemental funding for Head Start, a comprehensive early childhood education program for children ages 3 to 5 who are poor or who have disabilities. Another federal program, Title I, supports high-poverty school districts by helping children learn at an early age. The program requires schools to address the needs of children, particularly as they move from preschool to school.

The recent brain research has shed light on the importance of learning before a child is old enough to participate in these programs. Early literacy programs are an example of this change in emphasis. The U.S. Department of Education has published a guide to encourage people to become involved in early literacy programs for children from birth to age 5. Early Head Start, a federally funded program, also focuses on infants and toddlers, and is discussed in the family support section. A number of studies have shown that good preschool programs generate savings and increase the likelihood that young children will benefit later. Selected studies are referenced in the bibliography in appendix B.

The Connecticut General Assembly enacted a comprehensive $80 million school readiness grant program in June 1997 (1997 Conn. Acts, P.A. 259) with extensive input from early childhood organizations on the latest brain development findings. The bill funds preschool for 3- and 4-year-olds, pools state resources, coordinates local service delivery, and establishes local School Readiness Councils in selected towns and school districts. In addition, it supports training and career development for early childhood care and education providers and establishes an accreditation process.

Building on the success of the school readiness legislation, Connecticut enacted in 1998 an early literacy bill to improve the reading skills of young children in kindergarten through third grade (1998 Conn. Acts, P.A. 243). The legislation provides for full-day kindergarten, reduces class sizes, establishes summer and after-school programs for poor readers and requires training and continuing education that incorporate the brain development research findings.

To foster reading and language skills, Florida legislators from both houses have proposed bills (SB 660 and HB 3909) to require state-funded care and education programs for children from birth to age 5 to provide 30 minutes of reading and classical music each day. The bills discuss several aspects of the brain research, stating "there is no other time in a child's life as productive for brain development as the first year." During his annual budget address to the legislature in January 1998, Georgia Governor Zell Miller cited the new brain research in requesting that lawmakers appropriate funds to purchase and distribute classical music tapes and CDs for newborns. The governor stated that "no one doubts that listening to music, especially at a very early age, affects the spatial-temporal reasoning that underlies math, engineering and chess." It now appears that state funding will not be necessary because a number of private interests have agreed to provide financial support. Missouri's Governor Carnahan initiated a similar policy.

The early brain research led Georgia's Office of School Readiness to launch the "Standards of Care" initiative in April 1998. Although it was created by the state legislature in 1996 to administer the state's prekindergarten program for 4-year-olds, the office has expanded its focus to include care and learning for children from birth to age 3. The Standards of Care initiative is a voluntary program that has three primary components, formal recognition of exemplary child care centers, quality enhancement grants and enhanced caregiver training. It concentrates on appropriate music, reading, nurturing and activities that help very young children learn.

In 1998, Iowa legislators enacted a school ready children's grant program, which will offer block grants to communities to fund a variety of programs for the under age 5 population. This bill (SF 2406) has been a high priority for many state groups, and Iowa's epidemiologist made several presentations to the legislature on the topic of brain research and early childhood development. Communities will have flexibility to spend grants, which would combine federal, state, local, public and private funding. Money can be used to fund preschool programs for at-risk 4-year-olds, parent education classes that build on the new brain research and child development information, full-day Head Start programs or other programs that would help prepare Iowa's youngest children to learn. This statewide grant program is intended to encourage communities to be innovative and sensitive to the needs of their neighbors, and facilitate the formation of public-private partnerships to further support programming.

Governor Phil Batt of Idaho encouraged the Legislature "to spend some time this session on what, if any, effort the state should make to capitalize on the latest brain development research." The Legislature debated, but ultimately rejected, supplementing the Head Start program with $1.5 million in state funds this year. Although the measure failed this session, a strong coalition of support developed around the issue and on related early childhood development policies. Legislative interest in early childhood brain development also led to a full-day session at the Idaho capital this session on the significance and policy implications of the research.

In its 1998 session, the Colorado General Assembly recognized the connection between early childhood cognitive development and later school performance. Responding to the poor showing of the state's fourth graders on standardized reading and writing tests, the legislature created an Education and School Readiness Program (HB 1296) to provide grants to local jurisdictions that promote school readiness for at-risk children. The grants, which are subject to available appropriations, are required to be used for age-appropriate reading readiness tutoring, the purchase of age-appropriate reading readiness materials, and early childhood accreditation and professional development. The General Assembly recognized "that it is in the state's best interest to promote school readiness for at-risk children by supporting language skills and cognitive development before children start kindergarten."

A growing body of research continues to find that parents are the most important factor in a young child's development. Yet more two-parent families are working than ever before, many at night or during the weekend. The number of working mothers of children under age 3 is increasing, and about 65 percent of mothers with a child under age 6 works. The national poverty rate for children under age 6 was 22.7 percent in 1996, compared with 15.3 percent in 1970. More than one in seven children, or 11.3 million, lacked health insurance in 1996 (7, pp. 38, 103, 117). This struggle to make ends meet and limited access to health care place greater stress on many families.

In many communities, the existing system of family support services is complex, uncoordinated and addresses specific symptoms or only targeted groups, rather than offering a full range of supports to all families with young children. To improve the existing system, policymakers are increasingly incorporating early care and education services into a system that provides families with comprehensive, flexible and concrete assistance. These family support services include parent education, counseling, home visits, job training and placement, peer support, education, health and social services, housing, literacy tutoring and transportation assistance. Early Head Start and Even Start are examples of federal family support programs. Most state family support programs include an early childhood component while maintaining a focus on the entire family. These programs are often housed in community-based family resource centers located in public schools or neighborhood agencies. School-based programs can be an effective way to reach parents, particularly teen parents who are completing high school. Libraries, hospitals and home visitation programs are also means of reaching out to parents of young children. Although these family support efforts require coordination of funding and regulations with multiple service providers, they represent a comprehensive approach that has been shown to improve the impact of early childhood initiatives. Some employers offer parenting classes and are becoming increasingly involved in community efforts to improve early childhood services.

Numerous studies have found that well-designed, carefully targeted family support services can generate savings and improve academic success, reduce aggressive child behavior, improve parents' awareness of their child's development and reduce child abuse. Selected studies are detailed in appendix A.

Because of the research showing reductions in child abuse and neglect, many states have established and funded home visiting programs. Legislators in Ohio set aside $7.2 million of the state's Temporary Assistance to Needy Families allocation to expand the state's Early Start home visiting program for welfare parents, including teen parents, with children under age 3. A brain development expert presented facts on early childhood development to the state's Republican Senate caucus during budget deliberations in 1997. In Maryland, child advocates testified about the importance of early childhood brain research, and along with state agencies, hosted forums on brain research as legislators proposed to establish a home visiting program in 1998. The Massachusetts legislature approved new funds for a universal home visiting program for adolescent parents as the Children's Trust Fund, United Way's Success by Six and other Starting Points partners provided informational outreach to lawmakers.

Vermont is expanding its Success by Six home visiting and parent education program, based on an estimated savings of more than $7 for every $1 spent on comprehensive and coordinated family support programs. Early childhood issues were highlighted in the legislature this session with the dissemination of personalized booklets of information to each legislator that contained stories and descriptions of available early childhood and family support resources in their communities. After a wide-ranging effort by state child advocacy groups, the Michigan Legislature approved funds for community-based family resource centers targeted primarily to children under age 3. As part of these efforts, advocates provided lawmakers with copies of the Time magazine issue focusing on early childhood brain development.

Child advocacy groups in Minnesota heightened legislators' awareness of brain development research over the past two years. The Legislature created a number of new early childhood programs:

In 1997, the California Legislature passed a bill to provide information on infant brain development to all health facilities for dissemination to parents. Lawmakers directed federal funds to acute care hospitals and special hospitals providing maternity care so parents could immediately begin learning about their children's brain development. Although he vetoed the bill, Governor Pete Wilson proposed $3.1 million in 1998 to give new parents information about good child development practices. This allocation would fund grants to local organizations that support parents, a 24-hour hotline of child development information, and brochures, posters and public service announcements. Another piece of the governor's proposal is to earmark $2 million to expand a school-based program to include parental education and outreach for low-income families. Such services would address multiple risk factors, such as poor health, family dysfunction, substance abuse and inadequate nutrition.

Another vehicle for parent outreach, the library, was discussed at a recent legislative forum in Connecticut. A library coordinator spoke about an initiative that makes community libraries a focal point for early literacy by encouraging parents to be involved with their children in library activities. Libraries send literacy packets to parents of newborns, which include an application for a library card, information about age-appropriate reading and information about libraries' location and access. The program addresses the state's significant Spanish-speaking population by promoting the use of books in native languages, which has shown to facilitate children's reading development. A related program for low-income families provides a bookmobile to housing projects.

The 1997 West Virginia Legislature required a comprehensive study on programs for children under age 5. The state's Study Commission on Services for Young Children identified three steps that would have a positive effect on the state's youngest children: expansion of parent education, expansion of preschool for 3- and 4-year-olds and replication of "Starting Points" centers throughout the state. In its 1998 session, the West Virginia Legislature appropriated $1.2 million to fund a new line item for Starting Points centers and early parent education.

The 1997 Maine Legislature, recognizing that "research has demonstrated that the early years of childhood are critical to learning," established the Task Force to Study Strategies to Support Parents as Children's First Teachers. The resulting report identified three key components of a statewide strategy: home visits for all new parents, parenting education and support, and community-based family support services, including enriched child care (8, p. xi). In response to the report, the Maine Legislature directed the state Children's Cabinet to develop a fiscal plan for expansion of existing state-funded child and family support initiatives, to develop a core curriculum for caregivers and families, and to support parenting education in public schools.

The new neuroscience research underscores the need for young children and pregnant women to receive adequate health care. Much of a child's basic neurological as well as physical development occurs in utero. Although the human brain continues to grow at a rapid rate during the two years following birth, important aspects of neural development take place many months before a child is born. Use of alcohol, tobacco and drugs by pregnant women increases the risk that a newborn will be underweight or have developmental abnormalities. Children under 3 are more vulnerable to physical injury than at any other time in childhood and without preventive health care, including immunizations, they are susceptible to diseases and disabilities (9, p. 22).

National interest in the health of children and pregnant women has increased over the past few years. Federal policy changes to increase children's health insurance coverage and access to care so that children can obtain health care that is appropriate to their developmental needs were created in the 1997 Balanced Budget Act. This established the State Children's Health Insurance Program (SCHIP), which will provide $20 billion in federal funds over five years to assist states in covering uninsured children. Nearly all state legislatures across the country have established state-sponsored insurance programs or Medicaid program eligibility expansions for children to take advantage of this new federal funding. Many acted prior to SCHIP.

State legislatures have also enacted laws to improve immunization rates, prevent injuries to children, and enhance oral health and access to dental care for children. Recognizing that prenatal care and low-birthweight prevention can improve child health, state lawmakers have enacted laws to increase access to appropriate health care and expand Medicaid eligibility for pregnant women. Recent state laws also address the problem of substance abusing pregnant women. For example, states have enacted laws to give substance abusing pregnant women priority for state-funded treatment facilities. In addition, state laws consider medical advances that improve early identification of conditions that can cause health problems and disabilities. Many states have required enhanced newborn screening, created mechanisms to maintain screening information to improve public health outreach and have funded screenings.

Pennsylvania legislators are now considering expanding of the state's child health insurance program. Starting Points representatives at the Office of Child Development, University of Pittsburgh, have conducted extensive outreach to policymakers and provided research briefs on child health issues. In addition, the Pittsburgh Starting Points project and the Heinz Endowment sponsored a public forum in Pittsburgh titled, "Nurturing Neurons and the Early Childhood Connection." Key state legislators and legislative staff participated in the conference, which featured presentations by neuroscientists and child development experts.

California legislators are responding to the governor's proposal to add $6.1 million to provide newborns with hearing screenings. Emphasizing the brain's ability to learn language by age two, the governor's fact sheet describes long-term problems resulting from hearing impairment, such as serious limitations on language and communication, which can hurt a child's school performance. Using $2.6 million in federal funds and about $3.5 million in state funds, the proposed screenings would serve 116,000 children in the first year and 392,000 children in the second year.

The Massachusetts legislature also has been studying how to improve access to health care for young children. The Boston Starting Points coalition leaders sponsored a briefing for legislators and legislative staff about brain development, which attracted at least 30 participants. The briefing, along with legislative testimony, contributed to a better understanding of the issue among legislators, who continue to give support and priority consideration to bills that provide greater health care access to children.

An early childhood infrastructure is a coordinated, cohesive early care and education system, including funding, a range of appropriate choices for parents, consumer protection elements, such as well-enforced health and safety standards, professional development, ongoing dissemination of program information and evaluation. Several states that have focused on expanding the infrastructure have experienced successes in developing resources for young children and their families (10, p. 6).

Citing the brain research, Kentucky Governor Paul Patton this year moved to create an Office for Early Childhood Development within the governor's office. The new office will study the current status of child care and parenting programs in the state and recommend ways to strengthen the system, identify service gaps and eliminate duplication of services for children up to age 5. The legislature approved the initiative through the FY 1999 budget, which will fund staff and, tentatively, an advisory committee that will likely include legislators.

Ohio provides five specific models for programs to follow in coordinating Head Start, child care, preschool programs and public schools. A recent legislative oversight report found that the collaboration resulted in more families and children receiving services (11, pp. 20-21). Tennessee's Joint Select Committee on Children and Youth, which includes legislative leaders and key committee chairs, has drafted successful legislation on child care facilities, family resource centers and early intervention for young children with disabilities (2, p. 85). The Colorado Children's Campaign formed an hoc committee that includes state legislators and other stakeholders that has been effective at engaging and educating legislators on the need for a more coordinated system of early care and education.

Other state legislatures have emphasized early childhood coordination in recent initiatives. For example, the West Virginia Legislature gave the state's children's cabinet unique authority to coordinate important early childhood services. Cabinet officials have used this authority to negotiate interagency agreements, transfer funds between and within departments, establish local family resource networks and waive impeding regulations (12, p. 150). In Hawaii, the Legislature and governor established the state's Early Childhood Education and Care Coordinating Committee to create new funding options during an economic downturn. The 1996 report cited the brain research and in 1997, the Legislature enacted the Good Beginnings Alliance (1997 Hawaii Acts, Act 77), a new public-private partnership to help plan, coordinate and finance early childhood services for children up to age 6 (13).

1. Rima Shore, Rethinking the Brain: New Insights into Early Development Executive Summary (New York, N.Y.: Families and Work Institute, 1997).

2. Shelley Smith, Mary Fairchild and Scott Groginsky, Early Childhood Care and Education: An Investment That Works, 2nd ed. (Denver, Colo.: National Conference of State Legislatures, 1997).

3. Mary L. Culkin, Scott Groginsky, and Steve Christian. Building Blocks: A Legislator's Guide to Child Care Policy (Denver, Colo.: National Conference of State Legislatures, December 1997).

4. Vermont Agency of Human Services, Wise Investments...Improving Outcomes: Investments Made in Earlier Years Are Reducing Demand For Services Today. FY99 Budget and Program Overview and Recommendations, January 12, 1998.

5. National Governors' Association, The First Three Years: A Governor's Guide to Early Childhood. Washington, D.C.: National Governors' Association, 1997.

6. Caren Marcus, "Baby Talk," Pittsburgh Magazine -reprint- (Pittsburgh, Pa.: Pittsburgh Magazine, August 1997).

7. Children's Defense Fund, The State of America's Children: Yearbook 1998 (Washington, D.C., Children's Defense Fund, 1998).

8. Report of the Task Force to Study Strategies to Support Parents as Children's First Teachers, 1998 (Maine).

9. National Commission on Children, Beyond Rhetoric: A New American Agenda for Children and Families (Washington, D.C.: U.S. Government Printing Office, 1991).

10. Sharon L. Kagan and Nancy E. Cohen, Not By Chance: Creating an Early Care and Education System for America's Children-Abridged Report (New Haven, Conn.: Bush Center in Child Development and Social Policy at Yale University, 1997).

11. Ohio Legislative Office of Education Oversight, Implementation of Head Start in Ohio (Columbus, Ohio: LOEO, April 1997).

12. Amy Laura Dombro, Nina Sazer O'Donnell, Ellen Galinsky, et al., Community Mobilization: Strategies to Support Young Children and Their Families (New York, N.Y.: Families and Work Institute, 1996).

13. Hawaii Early Childhood Education and Care Coordinating Committee, The Good Beginnings Initiative Master Plan (Honolulu, Hawaii: Governor's Office of Children and Youth, January 1996).

(See the Bibliography on page 19 for references.)

Good quality child care programs can improve the language and cognitive skills of children. The vast majority of child care centers, however, provide mediocre to poor care and most family child care homes provide only custodial or poor care, according to two multi-state studies. Another multi-state study found that three out of four poor children have unsafe and unresponsive family child care. Better training and education for providers, lower child to staff ratios, and better compensation have improved child care quality. Nine out of 10 children from low-income working families lack the child care they need because of inadequate federal and state funding, according to a 1998 survey.

A 1998 RAND report found that early intervention, such as preschool, generate long-term savings to the government through increased tax revenues, decreased welfare outlays, reduced spending on health, education and social services, and lower criminal justice costs. The longitudinal High/Scope Perry Preschool Project study found that good early education programs for low-income children lead to academic success, better job achievement and half as many arrests later in life. The RAND study found that this high-quality preschool program saved more than $13,000 per participant. A variety of studies and evaluations of children in early childhood education programs have found long-term, statistically significant positive effects on standardized reading and math achievement tests, as well as antisocial behavior and delinquency. Despite a limited amount of research on Head Start, several studies indicate that the program has improved many child and family outcomes, including school success, parent employment, better access to services and improved abilities of children and parents to cope with violence. Several state preschool evaluations reveal that participants rated higher in academic progress, school attendance and positive behaviors than children who did not receive these services.

Reviews of many family support programs that include early childhood components found long-term effects on reducing crime, antisocial behavior and aggression. The RAND study found that the Elmira home visiting program saved the government more than $18,000 for each high-risk family, which is four times the cost of the program. Various state studies of family support programs have found that low-income participating parents had improved understanding of child development, parent-child interaction and awareness of their child. Other findings included improved parent participation, academic proficiency and outcomes, school readiness, dropout rates, involvement of school officials and connections with community agencies. A recent evaluation of Hawaii's home visiting program, Healthy Start, found that participating families had fewer instances of child maltreatment and displayed much greater maternal involvement and sensitivity to their children than nonparticipants.

Although most American children get off to a healthy start, babies weighing less than 5.5 pounds at birth have a high probability of experiencing developmental problems. In 1994, 7.3 percent of all babies were born with a low birthweight, an increase of 7 percent over the 1985-94 period. Children are more likely to be born healthy and to thrive when their parents plan and prepare for pregnancy. When pregnancies are too closely spaced and when they are unwanted, the risk of low birthweight and other maternal and infant health problems is dramatically increased.

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© 1998 by the National Conference of State Legislatures.