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) and Utah (S100) 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.
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.