Brief Prenatal-to-3 Policies

Overview

Scientific research has confirmed and clarified what is known about the effects of prenatal health and early experiences on a child’s development and is informing policymaking in many state legislatures.

Simply put, babies require responsive and caring relationships with adults in nurturing and stimulating environments. The implications for school readiness and success later in life can be profound.

Moreover, the economic return on investment from high-quality infant and toddler programs can be significant. Nobel laureate economist James Heckman asserts that nurturing, positive early development experiences are as important to a child’s future as a good education. His research shows that investing early in young children’s lives improves health outcomes, supports greater upward mobility and reduces social costs. Heckman found a financial return on investment of up to 13 percent for investments in programs beginning at birth, high-quality child care and health services for infants and toddlers in low-income families. The RAND Corporation found a return of $2 to $4 for every dollar spent on well-designed and implemented high-quality early childhood programs.

Learn more about home visiting, high-quality early childhood programs and financing options states can take to promote better outcomes for infants and toddlers.

Paid Leave

The type and quality of interactions children have with their parents and other caregivers is one of the most important factors in building the brain’s foundation. Many parents are stretched thin, particularly new or young parents and parents who are economically disadvantaged, lack stable housing or are food insecure.

Because the bond between parent and child is so critical, some states are considering paid family leave as a policy option to enable parents to spend more time with their babies. Eleven states—California, Colorado, Connecticut, Delaware, Maryland, Massachusetts, New Jersey, New York, Oregon, Rhode Island and Washington—and the District of Columbia—have paid family leave laws on the books. Each year about 25 states debate similar legislation. In some cases— Hawaii and Maine, for example—they establish study commissions to inform decision-making about paid family leave programs in their states.

In 2022, Delaware (S 1) and Maryland (S 275) enacted legislation to create paid family and medical leave programs. Paid leave benefits will begin in Maryland in 2025 and the following year in Delaware.

Virginia took a different approach with S 15. As of July 2022 insurance companies will be authorized to offer policies employers can purchase to provide paid leave benefits for their workers. This new law includes neither an employer mandate nor a payroll tax.

Georgia (H 146), South Carolina (S 11) and Utah (S 100) passed narrower focus limiting who qualifies, how long paid leave can be taken and what life events make an employee eligible to receive the benefit.

Rhode Island’s paid leave program, enacted in 2013, provides employees with four weeks of leave. In 2021, with the signing of H 6090, legislators increased the benefit amount to five weeks beginning in 2022 and then to six weeks in 2023.

Colorado voters overwhelmingly approved creating a state paid family and medical leave program through a 2020 ballot initiative. Benefits will begin in 2024. Oregon enacted legislation in 2019 to establish a paid family and medical leave system; however, during the 2022 session they passed H 3398 delaying implementation. Under the updated law, employers will begin making contributions to the state's paid family and medical leave insurance on Jan. 1, 2023, one year later than originally scheduled. Employees can begin collecting benefits on Sept. 1, 2023. All other states with paid leave policies are collecting and paying benefits.

Home Visiting

Infants and toddlers require supportive and positively engaged parents to feel secure and thrive. Home visiting is an approach policymakers are promoting in some states and considering in others to link expectant mothers with prenatal care, encourage strong parent-child attachment and foster positive child health and development. Home visiting is a voluntary, parent-support and prevention strategy used to help pregnant mothers, first-time and teen parents. Services are most often delivered by trained nurses, social workers or child development specialists.

State lawmakers play an important role in establishing effective home visiting policies in their states and determining how state and federal funding sources are used to sustain and improve the quality of home visiting systems. The primary source of federal funding for home visiting is the Maternal, Infant and Early Childhood Home Visiting (MIECHV) program, which began in 2010. Congress has invested billions of dollars through MIECHV to help states begin and expand evidence-based home visiting. Current funding provides $400 million per year through federal fiscal year 2022. Funds can be used for evidence-based programs, innovation, statewide needs assessments, training and technical assistance, and evaluation.

According to NCSL’s early care and education budget actions FY 2017 report, states used a variety of sources to pay for home visiting programs: state general funds, federal MIECHV funds, tobacco settlement funds and taxes, TANF, Medicaid, federal child welfare funds, federal Project Launch and private funds. Twenty-six states reported investing state or dedicated funds in home visiting programs.

At the end of 2018, 18 home visiting models met federal criteria to be considered evidence-based. States and localities have the flexibility to determine which model to use and which is likely to best address specific community needs. Evaluations of evidence-based home visiting models show positive outcomes for babies and toddlers and their families while creating long-term savings for states. The return on investment for every dollar spent on these efforts ranges from $1.75 to $5.70. Programs can be targeted to provide visits to families with infants meeting certain criteria or can be universal. Family Connects is a communitywide nurse home visiting program for parents of newborns residing in a given geographic area and is based on the Durham Connects model piloted in Durham County, N.C. Illinois is planning an expansion of Family Connects using federal Title V Maternal and Child Health funds.

Child Care

Promoting Access to High-Quality Settings for Infants and Toddlers

High-quality child care provides a safe, nurturing and developmentally appropriate environment for infants and toddlers, while also enabling their parents to work outside the home or pursue education and training opportunities. Nearly four million infants and toddlers are in a family child care setting, which includes home-based and friend, neighbor and relative care. This care is often not regulated or licensed and can be lower quality. A literature review by Mathematica outlines the characteristics of home-based care and options to consider to boost the quality of care. In addition, the Center on American Progress’ 2018 report found that child care shortages for infants and toddlers exist across the country but are more prevalent in rural areas and counties with families with lower incomes.

Family child care providers often have limited access to information and training on quality child care or quality improvement opportunities. The use of family child care networks is a research-informed strategy to promote higher quality in family child care settings.

A 2019 report by Ready Nation, a national advocacy organization, highlights the challenges parents face finding child care for children under two years of age and the impact it has on their employment. The study revealed that for 86 percent of parents, lack of child care hindered their ability to work consistently. The study found that the economic impact of the lack of child care to working parents, employers and taxpayers is $57 billion per year in lost earnings, productivity and revenue.

States are working on approaches to improve the supply and quality of infant and toddler child care. A 2015 federal report by the Administration for Children and Families addressed infant and toddler teacher workforce compensation. States are looking to their quality rating and improvement systems (QRIS) to measure or assess the quality of early care programs, including the standards for care for infants and toddlers.

Well-being and Developmental Screenings

Developmental and well-being screenings help ensure that infants’ and toddlers’ growth and development are on track. The American Academy of Pediatrics recommends developmental screenings for infants and toddlers at 9, 18 and 30 months and whenever additional attention is needed. These can be conducted by a trained health provider, early childhood teacher or another qualified provider. Bright Futures are guidelines recommended for physicians, child care providers and home visitors to follow as they administer social, behavioral and developmental screenings.

Millions of children receive health care coverage through their state’s Medicaid or Children’s Health Insurance Program (CHIP). Well-child visits and developmental screenings provided through these programs can save states money through early identification and treatment of health and development issues. Additionally, states are required to provide children enrolled in Medicaid with the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit. This includes comprehensive preventive, dental, mental health, developmental and specialty services. From 2016 to 2018, at least 11 states included funding in their appropriations bills to increase reimbursement rates for health care providers administering EPSDT screenings.

Funding

Some states have targeted funding for infant and toddler programs. For example, Kansas uses tobacco settlement funds for infant and toddler state initiatives. Illinois provides a 20 percent birth-to-three funding set-aside by statute, and Nebraska’s Six Pence fund was legislatively established in 2006.

Federal funds also can be used to increase access to high-quality child care for infants and toddlers. In 2014, the federal government reauthorized the Child Care and Development Block Grant (CCDBG), the program through which the federal child care subsidy program is administered. The federal Child Care and Development Fund final rule set forth changes to improve infant and toddler child care, including an increased 3 percent set-aside for quality. Some states have used the funding opportunity to create a system of infant and toddler specialists and to increase reimbursement rates for infant and toddler care providers.

The Preschool Development Birth through Five Grant (PDG B-5) is a federal one-year planning grant opportunity for states to support infants and toddlers. Forty-four states, the District of Columbia and the Virgin Islands received awards to work on a birth-to-five needs assessment and strategic planning with an emphasis on parental choice, expanding access and improving quality and strengthening the workforce.

Early Head Start is a federal program focused on the early education experiences of low-income babies and toddlers. Early Head Start-Child Care Partnerships (EHS-CCP) is a strategy that states are using to enhance services to infants and toddlers in low-income families. EHS-CCP partnerships increase access, enhance services and provide opportunities to raise program quality at both child care centers that serve infants and toddlers and Early Head Start programs.