A Roadmap to Rebuilding an Early Childhood System of Care

The prenatal period to age three is when the brain and body develop the most rapidly, as such it is the most sensitive and critical in a child's development. Our brain is the only organ that is not fully formed at birth; it requires input from those around us to shape it. The science of the developing child is clear: children exposed to stimulating, warm and secure environments in those first three years are set on a path of healthy brain development and life-long health and well-being, whereas children exposed to early and chronic adversity will struggle throughout the course of their lives.

Increasingly, state policy leaders recognize that investments in this early period yield substantial savings to education, health systems and other social services over time. They are also aware that the failure to ensure that children get off to a strong start levies serious short- and long-term costs to children, families and society.

Although the need to invest in this early period is clear, policy leaders lack clear, evidence-driven guidance as to what the smartest investments are to ensure that infants and toddlers thrive. The Covid-19 crisis makes these policy choices even more crucial: families with young children are struggling to maintain employment and care for their little ones. Huge increases in food insecurity, housing instability and parental stress have devastating consequences for the developing child. Communities of color have borne the brunt of the crisis, exacerbating already deep and persistent racial and ethnic inequities in child and family well-being.

The pandemic has exposed the need for a system of care to support families—no one institution can do it alone. Health, education, employment, social services, families, communities—each of these institutions must work together to ensure that healthy children are born to healthy parents and that parents have the skills, resources and institutional supports they need to work and care for their children's health and wellbeing and be the parents their children deserve.

The Prenatal-to-3 Policy Impact Center at the LBJ School of Public Affairs developed a State Policy Roadmap to help decision-makers as they seek to craft policies that enhance the wellbeing of infants, toddlers and their parents. It identifies five effective state-level policies and six strategies. Rigorous reviews of the research confirm that each positively impacts prenatal-to-3 outcomes and most reduce racial and ethnic disparities in outcomes and promote equity.

The five policies are broad and promote greater health and economic resources within households. These are:

• Expansion of income eligibility for health insurance. Expanding income eligibility for health insurance allows childless adults as well as parents access to health care. This is especially important for lower-income women because it provides them with access to medical care prior to conception and prenatal care when they need it.
• Reduction of administrative burdens surrounding benefits and services. The reduction of administrative burdens ensures that people who are eligible for benefits and services receive them. This is the most straightforward policy that states can implement. Although adequate safeguards against fraud are required, it is costly to require in person recertification for benefits at short intervals. States have made several modifications to their processes in response to COVID-19 and they should consider making them permanent so all families who are eligible for services receive them.
• Paid family leave. Now is also the time for states to implement a paid family leave policy, allowing parents to receive at least a portion of their incomes for at least six weeks while they stay at home with their newborns. Paid family leave not only allows time for parents to bond with their infants in the critical first months of life, but increases the likelihood that they will return to their pre-birth employer, increasing employment over the long run.
• Increasing state minimum wage and creating a state version of the Earned Income Tax Credit (EITC). Increasing the state minimum wage to at least $10 per hour and offering a refundable state version of the Earned Income Tax Credit (EITC) that is at least 10 percent of the federal EITC are two additional policies that not only substantially increase household resources but reduce adverse birth outcomes and promote health and wellbeing across early childhood.

The six strategies we recommend are also backed up by rigorous research, but we cannot provide clear guidance as to what states should do through policy or regulatory action to ensure the results found in the causal studies. These strategies include:

• Implementing comprehensive screening and referral programs to identify developmental delays in children and connect families with the resources they need to help them support their children
• Setting child care subsidy reimbursement rates at levels that allow families to afford high quality care
• Funding group prenatal care programs to enhance birth outcomes and improve the emotional well-being of mothers
• Offering home visiting programs to enhance parenting skills
• Funding Early Head Start programs to increase the number of eligible children participating in this effective two-generation program
• Setting broad eligibility criteria for intervention services that identify and address early developmental delays in infants and toddlers.

No state is currently implementing all 11 of these solutions, but there are wide variations across states in the benefits and services that children and families have access to, which lead to huge variations in outcomes. As states attempt to rebuild their health, economic, child care, education and social service systems, this roadmap can help them implement the policies that have the biggest impacts, benefiting families in the short-term and leading to long-term gains for society as a whole.

This piece was first published in "Resiliency in the Age of COVID-19: A Policy Toolkit," a report by the LBJ School. It is republished here with permission.