- Voluntary home visiting and other forms of parent training and education.
- Family economic supports.
- Streamlined access to services and resources.
Research underscores the importance of strong, stable and positive relationships between parents and other caregivers and the infants and toddlers in their care. While parents are their children’s first and best teacher, all parents need help now and then, and many don’t have adequate support through family and friends. Providing guidance and support for families with infants and toddlers leads to better social and emotional outcomes.
Poor socioeconomic status is closely linked to negative indicators of child and maternal well-being, including low birth weight, which correlates to negative health issues throughout life. This is not good news for the 1-in-5 infants and toddlers living in poverty in 2017 or for the 50% of new families living below, at or near poverty thresholds.
Reducing prolonged economic stress is one of three principles for improving outcomes for families and their children, according to the Center on the Developing Child at Harvard University. Economic supports such as Temporary Assistance to Needy Families (TANF), Medicaid and child care assistance help parents of infants and toddlers work or attend job-training programs. The Earned Income Tax Credit (EITC), Supplemental Nutrition Assistance Program (SNAP) and other two-generation approaches can simultaneously address the needs of parents and children to improve outcomes for the whole family. States are expanding on these federal programs and creating their own unique initiatives. In addition, some states are trying to ensure parents are aware of services and resources through mobile apps, child care centers, medical offices, job sites, businesses and religious establishments.
Eligibilty for these services is determined by the federal poverty threshold—a family’s measure of need, determined mostly by family size and composition. All family members have the same poverty threshold. If a family’s income is below the threshold, they are considered to live “in poverty.” According to the Congressional Research Service, 39.7 million people in the United States (12.3% of the population) live in poverty and another 49.3 million live within 200% of poverty thresholds.
Training and Education to Equip Parents
Parents want help supporting their child’s social and emotional development. Parent training and support through home visiting, mobile apps or educational tools can help. South Dakota’s Bright Start Initiative is a comprehensive family engagement and early childhood initiative that provides home visitation, newborn hearing and early intervention screenings, immunizations, online information resources, parent and infant welcome boxes, and responsive parenting seminars. The Read to Grow program in Connecticut is a literacy program that aims to get books into the hands of families with infants and toddlers. It provides free books to families, beginning with the birth of their child.
Voluntary home visiting is a parent-support and prevention strategy used to help pregnant women and new parents meet the social-emotional, cognitive and health needs of their young children. Cost-benefit analyses show that high-quality home visiting programs offer returns on investment ranging from $1.75 to $5.70 for every dollar spent on child protection, K-12 special education, grade retention and criminal justice expenses. Program lengths vary, with some targeting the first year of a child’s life. Some programs, such as Parents as Teachers or Nurse-Family Partnership are targeted to families meeting certain criteria. Others are universally available within defined geographic areas. Family Connects is a communitywide universal nurse home visiting program for parents of newborns. It is based on the Family Connects Durham model piloted in Durham County, N.C. Family Connects operates in five states.
Home visiting is an increasingly common strategy for promoting infant and child health, fostering healthy social-emotional development and school readiness, and preventing child abuse and neglect. Across the country, high-quality home visiting programs offer vital support to mothers, and in some cases fathers, as they handle challenges of parenting babies and young children. Most publicly funded home visiting programs require or emphasize use of evidence-based models, of which at least 18 are federally recognized, with even more showing promising results.
Family Economic Supports
Federal programs, such as SNAP, WIC and the EITC, support the well-being of infants and toddlers and their families. EITC, for example, is a tax credit policy the federal government, 29 states, the District of Columbia, Guam, Puerto Rico and some municipalities have implemented to support the financial stability of low-income working families, especially those with children. EITCs reduce income tax liability for qualifying taxpayers in an amount determined mostly by their income level, marital status and number of dependent children. State EITC policies are mostly modeled after the federal credit, but they vary somewhat on eligibility standards, methods for calculating the credit amount and refundability.
The federal EITC is the largest and most successful anti-poverty means-tested program and research has shown it benefits the health and well-being of mothers, infants and children.19 State EITCs provide an additional benefit to the federal credit. For example, in 2017, 1.4 million families in California shared a total of $325 million in state credits, bolstering the $6.8 billion they received in federal credits.
EITCs can free up family resources for child care expenses by decreasing the amount of taxes owed. Research finds that single mothers, especially those with low wages, are more likely to be employed and experience an increase in earnings when they receive a credit. Low-income mothers receiving a credit are more capable of paying for child care and, thus, are more apt to be employed.
SNAP is a federal nutrition program for the approximately 40% of poor families that may be experiencing food insecurity. According to the American Academy of Pediatrics, good nutrition in the first 1,000 days between a woman’s pregnancy and her child’s second birthday lays the groundwork for success later in life. The Government Accountability Office finds that families with young children miss out on benefits they are eligible for due to varied and complex requirements between federal programs. For example, states could reduce barriers to WIC by combining WIC applications with other social programs, such as TANF, SNAP or Medicaid.
Early Head Start Provides Comprehensive Supports for Infants and Toddlers
Early Head Start is a federal program focused on the early education experiences of low-income babies and toddlers. Early Head Start programs, which can be center- or home-based, offer an array of child and family development services, including health and developmental screenings; nutritious food; parenting resources and support; and access to health, mental health and social services. Minnesota, Missouri and Oregon supplement with state funding. Early Head Start-Child Care Partnerships are collaborations between Early Head Start and local infant and toddler child care programs. These partnerships increase access, enhance services and provide opportunities to raise program quality at both child care centers and Early Head Start programs.
Prenatal-to-three strategies often involve a complex mix of federal, state, local and private-sector funding, and because state legislatures make fiscal decisions regarding their state budgets, legislators play a critical role in determining funding approaches for prenatal-to-three programs. A 2018 report from the Center for the Study of Social Policy examined public-sector spending for pregnant women, infants and toddlers and funding strategies for improving health and developmental trajectories for infants and toddlers. The report found that current funding investments provide an insufficient base of support for vulnerable families with young children.
Funding streams that support healthy beginnings, family supports and early learning, development and care include:
- Federal Funding – Maternal and Child Health (Title V), Maternal, Infant and Early Childhood Home Visiting (MIECHV), Medicaid, Early Head Start, Child Care and Development Block Grant (CCDBG).
- State Funding – Maintenance of Effort (MOE), state match, general fund, dedicated funds, set-aside.
- Other Funding – Public-private partnerships, local tax earmarks, philanthropic.
How can states make these federal and state dollars work better? Consider the following funding strategies:
- Blending funds combines funding sources for one purpose. For example, Early Head Start and CCDBG can be blended to support early care for infants and toddlers.
- Braiding funds coordinates multiple sources of funding to support the total service cost. Braided funding often leads to coordinating eligibility requirements or co-location of services.
- Public-private partnerships are partnerships between government agencies and businesses, philanthropies or other nonprofit organizations with common goals.
Home Visiting Funding
According to NCSL’s fiscal year 2019 early care and education budget actions report, states use a variety of sources to pay for home visiting programs: state general funds, federal Maternal, Infant and Early Childhood Home Visiting program (MIECHV), Title V Maternal and Child Health (MCH) Block Grant, tobacco settlements 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. Despite federal and state funding, home visiting programs reach only a small fraction of those who could benefit from them.
MIECHV is the primary source of federal funding for home visiting. Since 2010, Congress has invested billions of dollars through MIECHV to help states begin and expand evidence-based home visiting. For states, tribes and territories, 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.
In 2016, the Virginia General Assembly directed a review by the Joint Legislative Audit and Review Commission of early childhood development programs in the state. The review found that Virginia’s voluntary home visiting programs are generally effective, but funding for home visiting is unstable and “hinders the ability of the programs to operate consistently and strategically over time.
Streamlined Access to Services and Resources
Programs and services for infants and toddlers and their families span a multitude of providers, agencies, levels of government and funding streams. And while the needs of families and young children often are complex and interrelated, most programs (e.g., child care assistance, early intervention, health and mental health services, home visiting and nutrition) are siloed. Bureaucratic and burdensome requirements often stand in the way of families accessing the services they need and are eligible to receive. Coordinated communication, enrollment, outreach and service delivery in places that parents and families naturally visit increase the chances that families will reap the intended benefits of programs.
A 2016 Urban Institute report examined state policies in six states to streamline access to Medicaid, SNAP and child care assistance. States implementing universal enrollment or categorical eligibility offer an opportunity for state agencies to break down siloes, which sometimes require state legislative and administrative rule changes. Three states—Colorado, Idaho and North Carolina—passed legislation to align eligibility rules for child care assistance programs and SNAP. These states also examined the use of technology to help low-income families get and keep services for which they are eligible.
Many states are beginning to break down bureaucratic siloes and improve service delivery by adopting a two-generation approach, also known as intergenerational, multi-generational or whole-family strategies. This approach simultaneously addresses the needs of parents and children to improve outcomes for the whole family. Two-generation approaches draw from findings that the well-being of parents is crucial to their young children’s social and emotional, physical and economic well-being. At the same time, parents’ ability to succeed in school and the workplace is substantially affected by how well their children are doing.
Oklahoma and Colorado offer examples of two-generation strategies at work. CAP-Tulsa, the community action agency in Tulsa, Okla., provides education and job training opportunities to parents while, at the same time, providing high-quality early childhood education programs for their children, newborns through 4-years-olds. In 2017, Colorado Governor John Hickenlooper created a two-generation program coordinator position within the governor’s office to help state agencies develop and implement programs, policy and goals. Colorado’s Department of Human Services also uses a two-generation approach to guide its delivery of TANF services and child support programs.
Connecting Families to Resources
Help Me Grow connects at-risk children with early childhood health services to improve health outcomes and control health care costs. The program was started 1997 by a Connecticut physician and later funded by the state legislature in 2002. Since then, 27 states have replicated it. Through state-specific approaches, Help Me Grow helps health care and child care professionals identify developmental and behavioral issues in children and direct their parents to local resources and services through a call center. The initiative has connected thousands of families to parent education, programs for children with developmental disabilities, mental health services and other resources. It also has saved states millions of dollars in sometimes unnecessary medical services. The Help Me Grow system in South Carolina has access to primary care physicians, and Delaware’s Help Me Grow is augmenting home visiting services and developmental screening referrals to promote optimal child development.
More than 20 states are funding Reach Out and Read, an evidence-based nonprofit organization of medical providers who promote early literacy and school readiness through their pediatric offices. Focusing mostly on low-income families, children between 6 months and 5 years of age receive a new book to take home as part of their well-child visits. At each visit, pediatricians and other medical providers support healthy child and parent interactions and talk to parents about the importance of reading to their children and advise parents on how to engage with their children when reading.
Three Early Steps
Five Questions to Ask
- What are the most pressing unmet needs of families with infants and toddlers in my state?
- Does my state have the capacity to collect data and measure home visiting program outcomes?
- How can my state use state or federal funding to serve more eligible infants and toddlers and their families with evidenced-based home visiting services?
- To what extent are agencies and programs in my state working together to remove enrollment barriers and support the needs of whole families beginning from the prenatal period?
- Does my state have its own EITC? Find out at NCSL’s Tax Credits for Working Families: Earned Income Tax Credit webpage.