Closing the Opportunity Gap for Young Children (2023)

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C l o si n g t h e O p p o r t u ni t y G a p f o r Y o u n g C hil d r e n L a R u e All e n a n d R e b e k a h H u t t o n, E di t o r s C o m mi t t e e o n E x pl o ri n g t h e O p p o r t u ni t y G a p f o r Y o u n g C hil d r e n f r o m Bi r t h t o A g e Ei g h t B o a r d o n C hil d r e n, Y o u t h, a n d F a mili e s Di vi si o n of B e h a vi o r al a n d S o ci al S ci e n c e s a n d E d u c a ti o n C o n s e n s u s St u d y R e p o rt P R E P U B L I C A T I O N C O P Y, U N C O R R E C T E D P R O O F S 

NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001 This activity was supported by contracts between the National Academy of Sciences and the Administration for Children and Families (HHSP233201400020B/75P00120F37106), Bainum Family Foundation (6186), Bill and Melinda Gates Foundation (INV-001632), Brady Education Foundation (unnumbered), Foundation for Child Development (NAS 06-2020), Heising-Simons Foundation (2020-1415), and W.K. Kellogg Foundation (P0132304). Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project. International Standard Book Number-13: 978-0-309-XXXXX-X International Standard Book Number-10: 0-309-XXXXX-X Digital Object Identifier: https://doi.org/10.17226/26743 This publication is available from the National Academies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334-3313; http://www.nap.edu. Copyright 2023 by the National Academy of Sciences. National Academies of Sciences, Engineering, and Medicine and National Academies Press and the graphical logos for each are all trademarks of the National Academy of Sciences. All rights reserved. Printed in the United States of America. Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2023. Closing the Opportunity Gap for Young Children. Washington, DC: The National Academies Press. https://doi.org/10.17226/26743. i PREPUBLICATION COPY, UNCORRECTED PROOFS 

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COMMITTEE ON EXPLORING THE OPPORTUNITY GAP FOR YOUNG CHILDREN FROM BIRTH TO AGE EIGHT LARUE ALLEN (Chair), Vice Dean for Faculty Affairs, Steinhardt School of Culture, Education and Human Development, New York University RANDALL AKEE, Associate Professor, University of California, Los Angeles ALFREDO J. ARTILES, Lee L. Jacks Professor of Education, Stanford University RENÉE BOYNTON-JARRETT, Associate Professor of Pediatrics, Boston Medical Center Vital Village Networks, Boston University School of Medicine KENNETH A. DODGE, William McDougall Professor of Public Policy, Sanford School of Public Policy, Duke University BRENDA JONES HARDEN, Ruth Ottman Professor of Child and Family Welfare, Columbia School of Social Work PAMELA K. JOSHI, Senior Scientist and Associate Director, Institute for Children, Youth and Family Policy, The Heller School for Social Policy and Management, Brandeis University SHANTEL E. MEEK, Professor of Practice and Founding Director, The Children’s Equity Project, Arizona State University BELA MOTÉ, President and Chief Executive Officer, Carole Robertson Center for Learning MILAGROS NORES, Codirector for Research, Associate Research Professor National Institute for Early Education Research, Rutgers, The State University of New Jersey CYNTHIA OSBORNE, Professor of Early Childhood Education and Policy, Executive Director, Prenatal- to-3 Policy Impact Center, Peabody College of Education and Human Development, Vanderbilt University ALBERT WAT, Senior Policy Director, Alliance for Early Success Study Staff REBEKAH HUTTON, Study Director PAMELLA ATAYI, Program Coordinator IVORY DEAN, Program Officer (until October 2021) SARAH PERUMATTAM, Research Assistant (from October 2021 until May 2022) MEREDITH YOUNG, Associate Program Officer (from May 2022) 2020–2022 James C. Puffer, MD/American Board of Family Medicine Fellow RITA HAMAD, Associate Professor in Residence, Director, Social Policies for Health Equity Research (SPHERE) Program, Department of Family & Community Medicine, Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco 2020–2021 National Academy of Medicine Distinguished Nurse Scholar-in-Residence and Consultant to the Committee ASHLEY DARCY-MAHONEY, Professor, Director of Infant Research, Autism & Neurodevelopmental Disorders Institute; Chair, Community of Policy, Populations and Systems, George Washington University School of Nursing iv PREPUBLICATION COPY, UNCORRECTED PROOFS 

BOARD ON CHILDREN, YOUTH, AND FAMILIES JONATHAN TODRES (Chair), Georgia State University College of Law RICHARD F. CATALANO, JR., University of Washington School of Social Work TAMMY CHANG, University of Michigan ANDREA GONZALEZ, McMaster University NANCY E. HILL, Harvard University CHARLES HOMER, Economic Mobility Pathways MARGARET KUKLINSKI, University of Washington MICHAEL C. LU, University of California, Berkeley, School of Public Health STEPHANIE J. MONROE, Wrenwood Group STEPHEN RUSSELL, The University of Texas at Austin NISHA SACHDEV, Premnas Partners, Washington, DC JANE WALDFOGEL, Columbia University School of Social Work JOANNA L. WILLIAMS, Rutgers University Staff NATACHA BLAIN, Senior Board Director EMILY P. BACKES, Deputy Board Director v PREPUBLICATION COPY, UNCORRECTED PROOFS 

Acknowledgments This report would not have been possible without the contributions of many people. First, we thank the sponsors of this study without whom this work would not have been possible: the Administration for Children and Families at the U.S. Department of Health and Human Services, the Bainum Family Foundation, the Bill and Melinda Gates Foundation, the Brady Education Foundation, the Foundation for Child Development, the Heising-Simons Foundation, and the W.K. Kellogg Foundation. The committee and project staff would also like to express their gratitude to the numerous experts and consultants who contributed to the development report. We would like to extend our deep gratitude to Ashley Darcy-Mahoney and Rita Hamad for their valuable insights, research and writing support, and contributions to the committee’s work. We thank Marianne Bitler and Seojung “Cate” Oh for their work on a commissioned paper for the committee on the economic costs of the opportunity gap. Thanks are also due to the numerous experts who volunteered significant time and effort to address the committee during our public information-gathering and listening sessions: Carolyn Barnes, Ajay Chaudry, Janet Currie, Lisa Gennetian, Pamela Herd, Rucker Johnson, Ariel Kalil, Kimberly Noble, Sean Reardon, and Hirokazu Yoshikawa. The insights and perspectives shared with the committee played an essential role in informing the committees discussions, deliberations, and recommendations. We thank Nancy McArdle of diversitydatakids.org for preparing the summary tables of the population of children ages 0–8. Finally, we thank Rona Briere for her editing of the report. We would also like to thank the many staff members of the National Academies of Sciences, Engineering, and Medicine who provided invaluable support throughout this process: Natacha Blain for her oversight as director of the Board on Children, Youth, and Families; Anne Marie Houppert, Christopher Lao-Scott, and Rebecca Morgan for their research support and fact checking; Faye Hillman, Javed Khan, and Micah Winograd for their financial management assistance; Christopher King and Sandra McDermin for their insights and guidance; Doug Sprunger and Meredith Fender for their assistance with communications and dissemination of the report; Natalie Nielsen, Patricia Morison, Maryjo Oster, Bea Porter, Kirsten Sampson Snyder, and Amy Stephens for their guidance throughout the report review process; and Clair Woolley for her assistance with the final production of the report. We would like to extend gratitude to the members of the project staff who worked directly with the committee over the course of the project—Rebekah Hutton, Pamella Atayi, Ivory Dean, Sarah Perumattam, and Meredith Young—for their significant contributions to supporting the committee’s work. Finally, the committee wishes to thank our chair, LaRue Allen, for her dedication to this work and the exceptional leadership and guidance that she has provided throughout this process. This Consensus Study Report was reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the National Academies of Sciences, Engineering, and Medicine in making each published report as sound as possible and to ensure that it meets the institutional standards for quality, objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We thank the following individuals for their review of this report: vi PREPUBLICATION COPY, UNCORRECTED PROOFS 

DOLORES ACEVEDO-GARCIA, Institute for Child, Youth and Family Policy, The Heller School for Social Policy and Management, Brandeis University ERICA FRANKENBERG, Education Policy Studies, The Pennsylvania State University VIVIAN L. GADSDEN, National Center on Fathers and Families, Graduate School of Education, University of Pennsylvania BETH GRAUE, Center for Research on Early Childhood Education, University of Wisconsin–Madison SANDRA G. HASSINK, Nemours Pediatric Obesity Initiative, Nemours Children’s Health System IHEOMA U. IRUKA, Department of Public Policy and Equity Research Action Coalition, University of North Carolina at Chapel Hill DANIELLE LARAQUE-ARENA, New York Academy of Medicine STEPHEN W. RAUDENBUSH, Department of Sociology, The University of Chicago ARTHUR J. REYNOLDS, Institute of Child Development, University of Minnesota Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations of this report, nor did they see the final draft before its release. The review of this report was overseen by Claire D. Brindis, University of California, San Francisco, and Elaine L. Larson, Columbia University. They were responsible for making certain that an independent examination of this report was carried out in accordance with the standards of the National Academies and that all review comments were carefully considered. Responsibility for the final content rests entirely with the authoring committee and the National Academies. vii PREPUBLICATION COPY, UNCORRECTED PROOFS 

Preface The committee that produced this report was tasked with authoring a consensus report focused on identifying and describing causes, costs, and effects of the opportunity gap in children. We define the opportunity gap as the unequal and inequitable distribution of resources and experiences on the basis of race, ethnicity, socioeconomic status, English proficiency, disability, immigration status, community wealth, familial situations, geography, or other factors that contribute to or perpetuate inequities in well-being across groups of young children in outcomes including health, social-emotional development, and education. Our statement of task specifies that the committee focus on children from birth to age 8 and make recommendations on how to improve conditions and promote success for children—at home, in communities, and in schools. Our work began with addressing the relationship between the opportunity gap and the persistent achievement gaps that disadvantage children from marginalized groups. In our view, opportunity gaps fuel achievement gaps as a result of various missed opportunities. Thus we reviewed evidence and consulted experts on family, school, economic, and community factors that promote, mitigate, or diminish opportunities for achievement. Reviewing and synthesizing this literature also made it clear that it would be naïve to approach fulfilling our task of recommending ways to improve outcomes and promote child success without focusing beyond academic achievement to encompass two other important developmental outcomes that greatly influence a child’s ability to profit from available opportunities—physical health, and social and emotional well-being. Complementing our scientific review of the opportunity gaps in these three major areas of development, we were tasked with summarizing the economic justification for addressing the opportunity gap—both the costs of the existing failures and the potential economic benefits of addressing them. Our review of evidence on promising federal and state policy interventions and practices that have addressed the opportunity gap is intended to move us forward in closing the gap through interventions based on practices and policies that have already shown some promise. Finally, while every sector of our society has a role to play in addressing the opportunity gap, the committee was also asked to pay particular attention to identifying the potential roles and actions appropriate for our sponsors from philanthropy in supporting federal, state, and local governments in working to address the opportunity gap. In taking on the commitment to address a complex statement of task, the committee was aware of the many existing bodies of evidence documenting the ways in which disparities in early life opportunities have an impact on children’s development. In fact, the National Academies has played a significant role in providing expert analysis of the need for better distribution of existing resources for young children in areas as diverse as health, access to quality early education, and the opportunity to participate in summertime programs that help children maintain and build on the gains of the prior school year. What was needed, in our opinion, was a broader lens on the problems with the persistent achievement gap among children. In addition to examining opportunity gaps that children face in unequally resourced academic settings (from preschool to second grade), we showed the gaps in resources that make children less able to benefit from their academic setting. Thus, as suggested above, our approach to addressing the committee’s statement of task includes documenting the interconnection of education, physical health, and social and emotional development to a child’s readiness to benefit from available educational opportunities. Any chance of creating equity for all young children depends on understanding how viii PREPUBLICATION COPY, UNCORRECTED PROOFS 

activities in support of children’s development, whether at the family and community levels, or at the levels of local, state, and federal government, are often misaligned and sometimes even in conflict. Though entities at each level may be committed to promoting positive outcomes for children, we perceived the need to document how historical practices of less favorable treatment of children with differing social class, immigration, racial, ethnic, linguistic, and ability backgrounds reinforce the existing opportunity gaps and undermine efforts to eliminate them. Our task, then, was to (1) summarize the evidence that has shown the many negative effects on children of being on the wrong side of the opportunity gap; (2) highlight actions for change that have been recommended by several expert groups, including more than a half dozen National Academies panels; and (3) develop a coherent picture of the many conflicting, underimplemented, or inequitably implemented policies at the federal and state levels. All of this was intended to make the case that, more than creating new tools to close this pernicious gap, we as a nation need to mobilize what we already have and know, or what we could know if we compared notes and collaborated across policy and practice silos. We recognize that creating momentum for a shared national commitment to closing the opportunity gap will not happen overnight, so our recommendations include actions that can be addressed in the shorter term along with recommendations that will require changes at the state and federal levels—changes that may take longer to put in place. On behalf of the committee, I would like to thank our sponsors from the world of philanthropy and government for requesting the creation of this important synthesis of research, practices, and policies aimed at creating a forceful and systematic attack on the gaps in access to resources that leave so many children behind. We could not have done this work without the incredible skill and diligence of the National Academies staff, led by Rebekah Hutton. I am deeply grateful to them all for their support—past, present, and future. My fellow committee members and I formed what I know, from chairing two earlier National Academies committees, to be an unusually strong bond and unwavering commitment to fully addressing our statement of task. Colleagues were unstinting in sharing their talents, resources, views, and time to achieve our shared goals on this very important project. My warmest regards and thanks to each and every one of you. As large as is the accomplishment we feel upon completing this report, we know that we have much work ahead of us to disseminate our recommendations to a wide range of audiences, including our sponsors who, in their wisdom, tasked the committee with identifying roles they could play in closing the gap. LaRue Allen, Chair Committee on Exploring the Opportunity Gap for Young Children from Birth to Age Eight t ix PREPUBLICATION COPY, UNCORRECTED PROOFS 

Contents PREFACE, viii ACRONYMS AND ABBREVIATIONS, xix SUMMARY, SUMMARY-1 1 INTRODUCTION, 1-1 About This Study, 1-1 Study Approach, 1-2 The Report Conceptual Framework, 1-4 Understanding the Historical and Structural Drivers of the Opportunity Gap, 1-8 Historical Precedents in Education, 1-8 Segregation as a Structural Driver of the Opportunity Gap, 1-11 Demographic and Structural Change Affecting Children and Families, 1-16 The Changing Demography of Children from Birth to Age 8: Implications for the Opportunity Gap, 1-16 Structural Changes in the Economy and Labor Markets, 1-21 Poverty, 1-22 Geography, 1-23 Access to Resources, Supports, and Opportunities, 1-27 Administrative Burden, 1-27 Implementation of Programs, 1-28 Overview of the Report, 1-29 2 OPPORTUNITY GAPS IN EARLY CHILD CARE AND EDUCATION EXPERIENCED BY CHILDREN FROM BIRTH TO PRE-K, 2-1 Why Early Care and Education Matters, 2-1 Current Policy, Funding, and Systems, 2-6 Access to Early Care and Education Systems, 2-12 Disparities in Access, 2-14 Gaps in ECE Capacity, 2-18 Cost as a Barrier to Access, 2-19 x PREPUBLICATION COPY, UNCORRECTED PROOFS 

Access to Early Intervention and Early Special Education for Children with Disabilities, 2-20 Administrative Barriers to Access, 2-24 Differential Experiences in Learning Settings, 2-25 The Importance of Structural Quality Standards, 2-29 Physical Infrastructure, 2-30 Ratios and Class Sizes, 2-30 Language of Instruction, 2-31 Harsh and Exclusionary Discipline Policies, 2-33 The Early Care and Education Workforce, 2-35 Education and Professional Preparation, 2-36 Compensation, 2-38 Access to Professional Development and Supportive Working Conditions, 2-40 Professional Beliefs and Practices, 2-41 Process and Interactional Quality, 2-42 Pedagogy, Instruction, and Access to Enrichment, 2-42 Strong Family Engagement, 2-44 The Impact of COVID-19 on Children’s Opportunity Gaps, 2-46 Conclusions, 2-47 3 OPPORTUNITY GAPS IN THE EDUCATION EXPERIENCED BY CHILDREN IN GRADES K-3, 3-1 Current Policy, Funding, and Systems for Early Elementary Education, 3-2 Access to and Funding for Out-of-School Time, 3-5 Special Education, 3-6 Absenteeism, 3-15 Differential Experiences in Early Elementary Learning Settings, 3-17 Physical Infrastructure, 3-17 Ratios and Class Sizes, 3-18 Language of Instruction, 3-18 Harsh and Exclusionary Discipline Policies, 3-19 The Education Workforce in Grades K-3, 3-24 xi PREPUBLICATION COPY, UNCORRECTED PROOFS 

Supportive, Enriching, and Warm Teacher-Child Relationships and Interactions, 3-24 Teacher Expectations and Perceptions of Behavior, 3-26 Pedagogy, Instruction, and Access to Enrichment, 3-27 The Impact of COVID-19, 3-29 Conclusions, 3-31 4 OPPORTUNITY GAPS IN THE PHYSICAL HEALTH AND HEALTH CARE EXPERIENCED BY YOUNG CHILDREN AND THEIR PARENTS, 4-1 Drivers of Opportunity Gaps in Health and Health Outcomes, 4-2 Conditions Prior to Birth and Pregnancy, 4-2 Maternal Access to Health Insurance, 4-3 Maternal Access to Adequate Prenatal Care, 4-4 The Medical Home and Developmental Screening, 4-7 Poverty and Health Care, 4-8 Racism and Culturally Responsive Care, 4-9 Relational Health, 4-11 Adultification, 4-11 Antiracism and Dismantling Race-based Medicine, 4-12 Nutrition, 4-16 Food Insecurity for Households with Children, 4-17 Safe and Healthy Environments, 4-18 Addressing Opportunity Gaps in Physical Health and Health Care, 4-28 Poverty Reduction, 4-28 Access to Pediatric and Family Health Care, 4-28 Antiracism and Dismantling of Race-based Medicine, 4-29 Screening for Social Influences of Health, 4-29 Alternative Models for Delivering Health Care, 4-29 Safe and Violence-Free Environments, 4-30 xii PREPUBLICATION COPY, UNCORRECTED PROOFS 

Conclusions, 4-31 5 OPPORTUNITY GAPS IN THE SOCIAL EMOTIONAL DEVELOPMENT, WELL-BEING, AND MENTAL HEALTH EXPERIENCED BY YOUNG CHILDREN, 5-1 Contemporary Child Development Science, 5-2 How Disparities in Child Outcomes Develop, 5-3 Historical and Current Inequities in Families’ Access to Community Resources, 5-4 Disparities and Opportunity Gaps in Mental Health in Early Childhood, 5-4 Positive Socialization and Identify Formation, 5-9 Reducing Opportunity Gaps in Mental Health in Early Childhood, 5-10 Screening and Assessment Strategies to Reduce Opportunity Gaps, 5-11 Parent Beliefs about Child Development, Behavior, and Use of Mental Health Services, 5-15 Strengthening Families Work Supports to Reduce Opportunity Gaps, 5-15 Home Visiting Strategies to Reduce Opportunity Gaps, 5-17 Program Strategies to Reduce Opportunity Gaps in Early Childhood Mental Health, 5-20 School Nursing to Reduce Opportunity Gaps in School, 5-21 Conclusions, 5-23 6 THE ECONOMIC COSTS OF THE OPPORTUNITY GAP, 6-1 The Opportunity Gap: Cost Estimates, 6-2 Share of Opportunity Gaps and Their Costs That Can Be Affected by Policy, 6-3 Approaches to Evaluating the Net Benefits of Investment in Mitigating the Opportunity Gap, 6-4 Evidence for Whether Implementation Makes Sense: Representative Examples of Effective Policies in Three Arenas, 6-6 Reducing the Opportunity Gap due to Income Differences through Cash and Near-Cash Means-Tested Assistance, 6-6 xiii PREPUBLICATION COPY, UNCORRECTED PROOFS 

Reducing the Opportunity Gap due to Inequitable Access to Health Care and Health Insurance through Medicaid, 6-7 Reducing the Opportunity Gap due to Unequal Access to Early Education through the Head Start Program, 6-8 Conclusions, 6-9 7 RESEARCH, POLICY, AND PRACTICE: CONTEXTS AND EFFORTS TO ADDRESS OPPORTUNITY GAPS, 7-1 Income Augmentation Programs and Policies, 7-1 Minimum Wage, 7-1 Earned Income Tax Credit, 7-2 Paid Family and Medical Leave, 7-3 Parents’ Poor Job Quality and Opportunity Gaps for Children, 7-6 Policy Interventions and Programs that Address Parents’ Job Quality, 7-10 Federal Labor Standards and Social Protection Policies, 7-11 Safety Net Programs, 7-13 State and Local Paid Family and Medical Leave and Scheduling Laws, 7-14 Programs Designed to Supplement Low Wages and Limited Benefits and Promote Career Advancement, 7-15 Employer Policies and Practices, 7-17 Addressing Opportunity Gaps and Outcomes in Education, 7-18 Full Funding, 7-19 Inclusive, Quality Standards, 7-19 A Supported, Fairly Compensated, Competent Workforce, 7-20 Data, Monitoring, and Accountability, 7-20 Addressing Opportunity Gaps and Outcomes in Physical Health, 7-21 Improving Maternal Health and Birth Outcomes, 7-21 Medicaid, 7-22 Nutrition Assistance Programs, 7-23 Reduction of Environmental Contaminants, 7-25 xiv PREPUBLICATION COPY, UNCORRECTED PROOFS 

Human-Centered Design and Policy Development, 7-27 Public-Private Partnerships, 7-29 Conclusions, 7-30 8 KEY CONCLUSIONS AND RECOMMENDATIONS, 8-1 Key Conclusions, 8-1 Recommendations, 8-4 APPENDIXES A TOTAL POPULATION OF CHILDREN AGES 0-8 BY RACE/ETHNICITY AND NATIVITY, 2020 A-1 B PERCENTAGE OF CHILDREN FROM BIRTH THROUGH AGE 5 AND NOT YET IN KINDERGARTEN PARTICIPATING IN VARIOUS WEEKLY NONPARENTAL CARE ARRANGEMENTS, BY CHILD AND FAMILY CHARACTERISTICS, 2019 B-1 C COMMITTEE MEMBER AND STAFF BIOSKETCHES C-1 xv PREPUBLICATION COPY, UNCORRECTED PROOFS 

Boxes, Figures, and Tables BOXES 1-1 Statement of Task: Committee on Exploring the Opportunity Gap for Young Children from Birth to Age Eight, 1-2 1-2 Relevant Reports of the National Academies of Sciences, Engineering, and Medicine, 1-4 1-3 The Child Opportunity Index, 1-25 4-1 The Effect of Preterm Birth on Opportunity Gaps, 4-5 4-2 Policy Lessons: Lead Exposure and Academic Performance, 4-21 5-1 The COVID-19 Pandemic Has Worsened the Opportunity Gap, 5-22 FIGURES 1-1 A conceptual framework for understanding the opportunity gap, 1-7 1-2 Changing racial/ethnic composition of the U.S. child population 0 to 18 (percent), 1-17 1-3 Racial/ethnic composition of children aged 0-8 in the United States, 2020, 1-18 1-4 Racial/ethnic composition of children aged 0-8 by family immigration status, 2020 (thousands), 1-19 1-5 Racial/ethnic composition of children aged 0-8 by family immigrant status, 2020 (percent), 1-20 2-1 Percent of children aged 3-4 enrolled in ECE, 2020, 2-16 2-2 Percentage of low-income children served by Head Start, by state, 2-17 2-3 Percentage of U.S. 3- and 4-year olds enrolled in state-funded preschool, 2-18 xvi PREPUBLICATION COPY, UNCORRECTED PROOFS 

2-4 Current enrollment in head start and state-funded preschool and the number of additional slots needed for universal pre-k, 2-19 2-5 Weekly child care costs as a percentage of household income for low-income households that pay out of pocket, by race/ethnicity and nativity status, 2-20 2-6 Percentage of states’ populations of 3- and 4-year olds enrolled in state preschool programs by number of national institute for early education research (NIEER) quality benchmarks, 2-27 3-1 Percentage of students aged 5-21 served under the Individuals with Disabilities Education Act (IDEA) part B within race/ethnicity, by educational environment, fall 2019, 3-9 4-1 Leading causes of death among children and adolescents in the United States, 1999- 2020, 4-27 7-1 Hypothesized pathways between parents’ job quality and children’s health and development, 7-7 7-2 Share of full-time working families with jobs without adequate family-supporting wages or benefits by race/ethnicity and foreign-born status, 7-9 TABLES 1-1 Historical Precents in Education in the United States across Systems and Settings for Children from Birth through Age 8, 1-8 2-1 Comparison of Child Care, Head Start, and State Pre-K Programs and Programs Covered by the Individual with Disabilities Education Act (IDEA) Part C and Part B Section 619, 2-8 2-2 Median Hourly Wages (in Dollars) of Center-Based Teachers and Caregivers by Age of Children Served and Sponsorship and Funding of Center-Based Program or Employment, 2-39 3-1 Risk Ratios for Students with Disabilities Ages 5-21 (Individuals with Disabilities Education Act [IDEA], Part B) by Racial/Ethnic Group and Disability Category, Fall 2019, 3-7 xvii PREPUBLICATION COPY, UNCORRECTED PROOFS 

3-2 Odds Ratio for Special Education Identification by Grade Level and Student Group, 3-12 3-3 Behaviors Associated With Learning Disabilities and Second Language Acquisition, 3-14 3-4 Racial Disparities for Students With Disabilities In Days Of Lost Instruction Due To Disciplinary Removal: Top 10 States (Including the District of Columbia), 3- 20 4-1 Misrepresentation of Race in Preclinical Curricula, 4-14 4-2 Food Insecurity by Selected Household Characteristics, 2021, 4-17 5-1 Racial and Ethnic Differences in Diagnosis Rates for Attention Deficit/Hyperactivity Disorder (ADHD) and Autism Spectrum Disorder (ASD), 5-12 5-2 Outcomes of Interest for Home Visiting Programs at the Primary Prevention Level, 5-17 5-3 Outcomes of Interest for Secondary Level Home Visiting Programs, 5-18 xviii PREPUBLICATION COPY, UNCORRECTED PROOFS 

Acronyms and Abbreviations AAP American Academy of Pediatrics ABC Attachment and Biobehavioral Catch-up ACE adverse childhood experience ACOG American College of Obstetricians and Gynecologists ADHD attention deficit/hyperactivity disorder AFDC Aid to Families with Dependent Children AI/AN American Indian/Alaska Native APHA American Public Health Association ASD autism spectrum disorder BIE Bureau of Indian Education BLL blood lead level BPA bisphenol A CCAP Child Care Assistance Program CCDBG Child Care Development Block Grant CCDF Child Care Development Fund CDA child development associate CDC Centers for Disease Control and Prevention CEP Community Eligibility Provision xix PREPUBLICATION COPY, UNCORRECTED PROOFS 

CHIP Children’s Health Insurance Program CLASS Classroom Assessment Scoring System CMS Centers for Medicare & Medicaid Services CPP Child Parent Psychotherapy CPS Current Population Survey CPC Chicago Child–Parent Center CPSC Consumer Product Safety Commission CRDC Civil Rights Data Collection CTC Child Tax Credit DB Developmental and Behavioral DOL U.S. Department of Labor EBT electronic benefit transfer ECE early care and education ECERS-R Early Childhood Environmental Rating Scale-Revised ECPP-NHES Early Childhood Program Participation Survey of the National Household Education Surveys Program EITC Earned Income Tax Credit ELA English Language Arts EPA Environmental Protection Agency xx PREPUBLICATION COPY, UNCORRECTED PROOFS 

ESSA Elementary and Secondary Education Act ESSA Every Student Succeeds Act FLSA Fair Labor Standards Act FMLA Family Medical Leave Act FPL Federal Poverty Level FWO Fair Workweek Ordinance GAO Government Accountability Office GDP gross domestic product HCD human-centered design HHS U.S. Department of Health and Human Services HMD Health and Medicine Division HomVEE Home Visiting Evaluation and Effectiveness HSIS Head Start Impact Study HSPPS Head Start Program Performance Standards IDEA Individuals with Disabilities Education Act IECMHC Infant and Early Childhood Mental Health Consultation programs IES Institute of Education Sciences IOM Institute of Medicine IRS Internal Revenue Service xxi PREPUBLICATION COPY, UNCORRECTED PROOFS 

L1 first language L2 second language LAUNCH Linking Actions for Unmet Needs in Children’s Health MIECHV Maternal, Infant, and Early Childhood Home Visiting Program MIHOPE Maternal Infant Home Visiting Program Evaluation MMRC Maternal Mortality Review Committee MMWR Morbidity and Mortality Weekly Report MVPF marginal value of public funds NAEP National Assessment of Educational Progress NAEYC National Association for the Education of Young Children NCHS National Center for Health Statistics NCSER National Center for Special Education Research NFP Nurse-Family Partnership NHANES National Health and Nutrition Examination Survey NHVY National Home Visiting Yearbook NICHD Eunice Kennedy Shriver National Institute of Child Health and Human Development NIEER National Institute for Early Education Research NIH National Institutes of Health xxii PREPUBLICATION COPY, UNCORRECTED PROOFS 

NRC National Research Council NSECE National Survey of Early Care and Education NSF National Science Foundation NSLP National School Lunch Program OECD Organisation for Economic Co-operation and Development OMB Office of Management and Budget OST out of school time PCE positive child experiences PEELS Pre-Elementary Education Longitudinal Study PPP public–private partnership pre-K prekindergarten PQC Perinatal Quality Collaborative PTFCEH President’s Task Force on Children’s Environmental Health QALY Quality-Adjusted Additional Life Year QRIS Quality Rating and Improvement System RCT randomized controlled trial SAMHSA Substance Abuse and Mental Health Services Administration SES socioeconomic Status SNAP Supplemental Nutrition Assistance Program SSI Supplemental Security Income xxiii PREPUBLICATION COPY, UNCORRECTED PROOFS 

STEM science, technology, engineering, and mathematics SWD students with disabilities TANF Temporary Assistance for Needy Families UI unemployment insurance UNICEF United Nations Children’s Fund USDA U.S. Department of Agriculture VBAC vaginal birth after cesarean VSL value of a statistical life VSLY value of a statistical life year WIC Special Supplemental Nutrition Program for Women, Infants, and Children WONDER Wide-ranging ONline Data for Epidemiologic Research i PREPUBLICATION COPY, UNCORRECTED PROOFS