8

Key Conclusions and Recommendations

Existing disparities in opportunity have been shaped by historical contexts and continue to persist as a result of current policies and practices that create barriers to access, barriers that prevent many children—especially those from marginalized populations—from reaching their full potential. Throughout this report, the committee has described disparities that exist across multiple domains and family contexts and the ways in which these inequities create an opportunity gap that affects outcomes for young children not only from birth through age 8, but also across the life course. The committee was asked in its statement of task (see Box 1-1 in Chapter 1) to develop recommendations for education policy, practice, and research that could promote success for all students, as well as for steps that could be taken to improve conditions and promote success for children at home, in communities, and in schools. The committee’s evidence review informed the key conclusions and recommendations that follow, which highlight ways in which existing mechanisms across sectors could be used to promote greater equity and access to opportunity across all levels of the ecosystems in which children live.

KEY CONCLUSIONS

A number of common themes emerged during the committee’s evaluation of the literature related to the domains discussed in this report—education, physical health, and social-emotional health and well-being—and are reflected in the key conclusions that follow. These conclusions lay out what is known about the causes of the opportunity gap experienced by many

young children and areas in which changes to policies and social structures could help close this gap. These conclusions also informed the committee’s recommendations.

Conclusion 1: Differential experiences and access to resources in early childhood result in opportunity gaps, which can lead to long-term gaps in outcomes in education, physical health, and social-emotional development that are harmful to individuals, communities, and society.

There are a number of drivers of opportunity gaps in health and health outcomes in the early years and even before birth. The historical origins of many of these gaps—policies that intentionally segregated and limited access for various populations—can be seen in current policies and practices, which continue to perpetuate inequitable access to opportunity. Lack of accessible, high-quality health care can prevent parents from seeking care for both themselves and their children. Parents’ stress due to illness, unstable work schedules, and poverty can affect their ability to meet their children’s needs. Communities with fewer resources or unsafe and unhealthy neighborhood conditions can deprive children and families of opportunities to engage in activities that promote healthy development. In all these cases, both short- and long-term costs are borne not just by individuals but by society at large.

Conclusion 2: There is substantial evidence describing effective policies and practices that can increase opportunity across multiple domains. These domains range from health, such as increasing maternal access to prenatal care, access to health care, and insurance coverage to access to antipoverty programs and to early care and education. However, differential access as a matter of policy or practice, as well as inconsistent—and in some cases, uncoordinated—implementation and inadequate funding, has allowed barriers to accessing opportunities to persist, leaving the most vulnerable populations underserved. These barriers must be addressed for these promising policies and practices to be implemented equitably and effectively.

A positive finding in this report is the number of promising policies and practices with the potential to address opportunity gaps. However, their inconsistent—and in some cases uncoordinated—implementation has allowed these gaps to persist, leaving the most vulnerable populations underserved. For example, maternal access to prenatal care has been linked to better outcomes for both children and mothers, yet nearly 15% of women in the United States do not receive adequate prenatal care. Lack of access to health care and insurance coverage are key drivers of this disparity. Access

to adequate nutrition also plays an important role in children’s cognitive and physical development, as the consequences of poor nutrition can extend well beyond the early years into adolescence and even adulthood. Yet take-up of safety net nutrition programs is often low, in part because of administrative hurdles. Disparities in access to care and nutrition by race/ethnicity and socioeconomic status lead to disparities in outcomes that in turn can become and perpetuate opportunity gaps (see Conclusion 5). The policies and programs that can address these disparities are not equally accessible to all.

Conclusion 3: Restrictive eligibility criteria set at the federal and state levels and differences in state and local implementation of policies lead to vastly different experiences for children and families depending on who they are and where they live. Access to resources and services has been impeded by some state and federal policies, as well as service systems that create administrative barriers to access, barriers that disproportionately affect communities of color, immigrant families, and families with low income. These differences occur across all domains examined by the committee, from school funding and access, to quality schools and teachers, to access to health care and health insurance, to the neighborhood-level resources that shape the ability of parents to support and care for their children and provide the supports needed for healthy development.

Numerous systemic factors make variations in opportunities available to children and parents highly dependent on federal, state, and local policy choices; at the same time, however, the disparities that can result from these variations can be addressed through policy changes at all levels of government. In such efforts, federal guidance can help shape state and local policy to promote more equitable outcomes. As noted in Chapter 6 of this report, which examines the three most heavily studied social welfare programs—the Supplemental Nutrition Assistance Program (SNAP), Medicaid, and Head Start—the benefits of investing in these supports exceed the costs. Although the extent to which this is the case depends on the program, the committee’s analyses provide a conservative estimate of the potential returns on investing in targeted interventions to address the opportunity gap. For example, the committee found that every $1.00 spent on the SNAP program results in about $56.00 in benefits across the life course. Likewise, Medicaid and Medicaid expansion have high rates of return due to improved health and longevity, and a $1.00 investment in Head Start yields a return of about $1.86. These findings point to the potential for investments in targeted interventions that close the opportunity gap to yield benefits at the individual, family, and societal levels.

Conclusion 4: Research shows that income from full-time employment does not cover the cost of basic needs for many working families. In addition, many employers do not provide benefits such as paid leave or child care. Limited access to paid family leave creates an opportunity gap for young children by limiting parents’ and infants’ bonding time, decreasing the time available to take care of serious health issues, elevating family stress, and exposing children to financial uncertainty. Limited access to high-quality child care can create opportunity gaps by limiting parents’ employment, earnings, and job stability, ultimately leading to family economic insecurity.

Multiple studies have found parents’ precarious job conditions to be related to children’s mental health outcomes, including emotional and behavioral difficulties and decreased opportunities for social-emotional connections with parents. Of concern as well is the lack of employer-provided paid family leave, since access to paid leave has been shown to promote healthy developmental outcomes and to allow parents to see to their own and their children’s health. Research suggests that paid family leave is an effective policy that benefits the well-being of young children and parents and reduces financial uncertainty.

Conclusion 5: Differential experiences and access to resources are associated with factors such as race/ethnicity, income, social class, gender, national origin, language background, and disability; however, the intersections of these factors with social determinants can result in interdependent systems of disadvantage that multiply negative effects. Thus, opportunity gaps for one age group can persist and compound, becoming the cause of future opportunity gaps.

This report identifies numerous opportunity gaps that the committee refers to collectively as “the opportunity gap.” However, the outcomes of many opportunity gaps for the youngest children can themselves become future opportunity gaps. Differential experiences are associated with such factors as race/ethnicity, social class, gender, national origin, language background and disability, and the intersections of these social determinants can result in interdependent systems of disadvantage that multiply negative effects. An intersectional approach is therefore necessary to fully understand how opportunity gaps are perpetuated and how they can be eliminated.

Conclusion 6: Structural racism and discrimination perpetuate opportunity gaps and the achievement gap. Systematic exclusion, structural racism, racial and ethnic discrimination, poverty, unequal allocation of resources and services, labor market inequalities, biases in access to and

experiences in services, and policies that create administrative burden for families all affect the ways in which families experience opportunity. While many of these structures have their origins in the past, they persist, and their effects—now compounded—continue to affect outcomes and the well-being of children and families.

A number of social and structural factors have created and continue to perpetuate a confluence of disparities in opportunity for young children. The National Institutes of Health defines structural racism and discrimination as “macro-level conditions (e.g., residential segregation and institutional policies) that limit opportunities, resources, power, and well-being of individuals and populations based on race/ethnicity and other statuses, including but not limited to: gender, sexual orientation, gender identity, disability status, social class or socioeconomic status, religion, national origin, immigration status, limited English proficiency, or physical characteristics or health conditions” (National Institutes of Health, 2023). Systematic exclusion, structural racism, unequal allocation of resources and services, labor market inequalities, biases in access to services, and policies that create administrative burden for families all affect the ways in which families experience opportunity, and in turn are associated with a variety of outcomes. Disparities in outcomes across education and wellness are deeply rooted in hundreds of years of policies and practices (e.g., segregation, discriminatory housing policies, employment policies, insufficient social safety nets) that have caused some communities of color to have fewer and/or differential access to resources. While many of these structures have their origins in the past, they persist, and their effects, now compounded, continue to affect the well-being of children and families.

RECOMMENDATIONS

The committee’s recommendations draw on evidence-based conclusions presented throughout the report to identify actions that can be taken by policy makers, practitioners, community organizations, philanthropic organizations, and other stakeholders. These recommendations are designed to address opportunity gaps, improve data collection, and identify future research needs.

Recommendation 1: Federal entities and agencies and private philanthropic organizations that collect data and fund research related to child health and development should create and adequately support an effective equity-focused policy- and services-monitoring data infrastructure (collection of both quantitative and qualitative data, data analysis, and program evaluation) to guide federal, state, and local

policy decisions aimed at closing the opportunity gap across income, race/ethnicity, disability, gender, language background, and immigrant status. This data infrastructure should also be made available for research and learning.

To further a research agenda addressing the opportunity gap, actions such as the following could be taken by federal entities and private philanthropic organizations:

• All federal data (and data reported to the federal government by states and local communities) could be disaggregated for groups listed in Executive Order 13985, On Advancing Racial Equity and Support for Underserved Communities through the Federal Government.
• Data could be shared across agencies that are responsible for individual safety net and social insurance programs (e.g., the Department of Health and Human Services/Centers for Medicare & Medicaid Services for Medicaid, the Internal Revenue Service for the earned income tax credit/child tax credit, the Department of Labor for unemployment insurance) and linked when possible to create merged data sets. These data could be used by each agency to monitor program access, quality, and outcomes across groups known to experience gaps in opportunity through internal and external research studies.
• The Office of Management and Budget (OMB), with input from the Office of Science and Technology Policy, could direct all federal agencies to conduct audits and examine disparate treatment and administrative burden in state and local service systems responsible for serving families and children.
• OMB could direct each federal agency with significant federal expenditures on young children to create an equity research, evaluation, and technical assistance center.
• OMB could direct federal statistical agencies to assess current data collection on families and young children and make recommendations on improvements aimed at addressing opportunity and outcome gaps that can be evaluated and prioritized for investment.
• The Department of Labor could use its existing data to monitor differential trends in job quality, including wages, employer-provided benefits, schedules, and health and safety standards for all workers and working families with young children. With input from the relevant offices of the Executive Office of the President (e.g. the

• Council of Economic Advisers), the data could be used to formulate policy recommendations and set goals for improving job quality.
• The National Institutes of Health, National Science Foundation, and Institute of Education Sciences could prioritize studies that fill gaps in knowledge about policies, programs, and practices that reduce opportunity gaps for subgroups of young children that are underrepresented in the existing evidence base.
• The Internal Revenue Service and the Census Bureau could create a linked data system for use in analyzing all families’ access to and take-up of tax credits—the most robust antipoverty programs, including the earned income tax credit and the child tax credit—in support of the development of a systematic outreach approach to reduce the burden associated with and increase take-up.
• The Department of Education could require the “What Works Clearinghouse” to report the evidence for subgroups of children and results from rigorous quasi-experimental studies.
• The Interagency Forum on Child and Family Statistics could evaluate each agency’s existing systems for collecting data on young children and whether and how these systems could be linked. This assessment would lead to recommendations for improving these data systems so they could be used to evaluate and monitor developmental outcomes of young children, including disparities among groups in access, take-up, and outcomes across multiple programs.
• The philanthropic community could prioritize investments in further developing state and local data systems that include linked data on children’s health and education outcomes, as well as measures of opportunity gaps by race/ethnicity, income, nativity, language, and disability, at a minimum. To monitor child opportunity across communities and target funding to communities with lower resources, a consistent set of state/local measures from these systems could be added to the Child Opportunity Index. Investments are also needed to bolster the evaluation efforts of community-based organizations aimed at identifying, piloting, and expanding evidence-based practices that make families’ access to systems more equitable and user friendly and their experiences within systems positive and promotive.

Monitoring and accountability are a key issue for the successful implementation of all of the committee’s recommendations. Given the complexities surrounding the opportunity gap for young children, a system of metrics is needed to track disparities in opportunities and resources, such as access to qualified educators, rigorous and inclusive curricula, school funding, school ecologies that support learning, quality health care, and

resources that promote healthy social and emotional well-being and development. In addition to tracking of these metrics, systematic cataloging of evidence-based, effective, and equitable policies and program interventions across domains in a centralized database/registry would provide a significant resource to communities, policy makers, researchers, and philanthropic organizations working to reduce disparities in opportunity for children. While there is evidence that policies and programs reduce opportunity gaps on average, information often is lacking as to whether policies are effective in reducing gaps for different subgroups of children.

This recommendation cuts across all chapters of the report, in which a range of evidence and a variety of innovative approaches are highlighted. Chapter 1 outlines the racialized distribution of resources in the United States (e.g., Parolin et al., 2021) that contributes to gaps in opportunity and achievement, as well as the historical and current drivers of inequities in education (e.g., Reardon, 2015), physical health, and social and emotional well-being. This introductory chapter also details the administrative burden associated with benefit programs and their state-by-state shortcomings, and includes a robust discussion of how poverty perpetuates the opportunity gap (National Academies, 2019a). The following five chapters detail gaps in data collection, funding, and administrative coordination that impact early care and education (ECE), early elementary education, child health, and social-emotional development. Chapter 6 then provides an estimation of the economic costs of the opportunity gap, and illustrates how it can be reduced using the examples of SNAP (Hoynes, Schanzenbach, & Almond, 2016; Bitler & Figinski, 2019), Medicaid (Miller & Wherry, 2019; Goodman-Bacon, 2021), and the Head Start program (Ludwig & Miller, 2007; Johnson & Jackson, 2019; Bailey et al., 2021). Chapter 7 summarizes evidence on two approaches for reducing opportunity gaps related to job quality and resulting positive impacts on employment, earnings, and health and well-being (e.g., Miller et al., 2008; Duncan et al., 2009; Katz et al., 2021; Roder & Elliot, 2021; Sabol et al., 2021). In addition, the effect of the earned income tax credit on improved child health and educational outcomes demonstrate the importance of coordinated and sustained efforts to increase uptake of such programs (Dahl & Lochner, 2012; Markowitz et al., 2017; Komro et al., 2019; Lenhart, 2019; Batra & Hamad, 2021).

Recommendation 2: The federal government and states should establish early learning opportunities—accompanied by both legal accountability guaranteeing access and inclusive, intentional quality standards that are aligned with scientific evidence—as a right afforded to all children and families who need and want services.

A robust body of research demonstrates the benefits of ECE and its power as a strategy for reducing opportunity gaps. Ironically, however,

policies that impose rigorous eligibility criteria and enrollment processes create access barriers for those who stand to benefit the most from ECE programs. One promising approach for reducing opportunity gaps in ECE would be to reenvision it as a public good, like K–12 education, that all children and families have the choice to claim (Sawhill, 1999; Barnett, Schulman, & Shore, 2004; Ladd, 2017; DeAngelis, Holmes Erickson, & Ritter, 2020; Bailey, Shuqiao, & Timpe, 2022).

Many young children are not getting what they need to grow, learn, and develop optimally. Developmental science long ago established that children are born learning, and neuroscience has demonstrated for decades that the early years are among the most sensitive periods in the life course for brain development. High-quality ECE is indeed a public good with social and economic returns that benefit all, and is recognized as a fundamental right in many countries around the world. Despite this fact, ECE is available only to some and exists as a patchwork system of varying quality. As a result, many families, disproportionately those from marginalized backgrounds, are left in difficult positions, balancing the safety, care, and education of their children and their employment.

Considering the wealth of evidence, the federal government and states should establish early learning opportunities—accompanied by legal accountability guaranteeing access and inclusive, intentional quality standards that are aligned with scientific evidence—as a right afforded to all children and families who need and want these services. To this end, federal and state actors should consider codifying ECE as both a civil and a human right of all young children. This could be achieved at the federal level by ratifying the United Nations Convention on the Rights of the Child, which would build on existing precedent established at the federal level through, for example, the right to preschool services for young children with disabilities under the Individuals with Disabilities Education Act (IDEA).

Chapter 1 of this report describes the historical and structural drivers of gaps in early learning opportunities (e.g., segregation, poverty, and economic opportunity), and provides evidence supporting the assertion that ECE investments have been inadequate to bridge opportunity gaps for historically marginalized groups (Institute of Medicine [IOM] & National Research Council [NRC], 2015; Lombardi et al., 2016; Malik et al., 2018; National Academies, 2018; Ullrich & Schmit, 2019; Keating, Cole, & Schaffner, 2020; Meek et al., 2020; Friedman-Krauss et al., 2022a, 2022b). Chapter 2 explores the short- and long-term benefits of ECE for a child’s long-term trajectory (e.g., schooling and labor market outcomes; see Gormley, 2017; Bai et al., 2020; Bailey, Sun, & Timpe, 2021; Gray-Lobe, Pathak, & Walters, 2021; Jung & Barnett, 2021). That chapter also describes the uncoordinated current policies, systems, and funding streams whose shortcomings impede efforts to advance early learning goals for all children. Evidence related to disparities in access, gaps in availability, and administrative

barriers demonstrate clear differential experiences in learning settings and the need for coordinated quality standards (National Academies, 2018).

Recommendation 3: The federal government—in partnership with states—should fully implement a voluntary universal high-quality public early care and education system using a targeted universal approach (i.e., setting universal goals that are pursued using processes and strategies targeted to the needs of different groups). Such programs should be responsive to community needs, reflect the true cost of quality, and have strong monitoring and accountability systems that specifically address gaps in opportunity.

Such a unified system would:

• ensure that children and families from communities listed in Executive Order 13985, Advancing Racial Equity and Support for Underserved Communities through the Federal Government, are prioritized;
• allocate greater resources to historically marginalized communities to compensate for historical and current inequities in resources, experiences, and opportunities;
• allocate greater resources for parts of the ECE system that have traditionally received fewer resources;
• require evidence-based program standards that improve population outcomes and explicitly remedy opportunity gaps;
• build a corps of diverse, competent, well-trained, well-supported, and appropriately compensated early childhood educators and program leaders, across all age groups and program settings; and
• require disaggregated data collection that can be linked with other relevant data sources, as well as continuous quality improvement aimed at bridging opportunity and outcome gaps.

Underinvestment in high-quality ECE disproportionately affects children from low-income families, children of color, children who speak languages other than English at home, and children with disabilities. This underinvestment is the result of a complex array of factors, starting with the racialized¹ origins of ECE work and the perspective that ECE is an individual family’s responsibility. This underinvestment in ECE persists today despite the well-documented benefits—individual and societal—of

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¹ Racialization is defined as the act of giving a racial character to someone or something or the process of categorizing, marginalizing, or regarding according to race (Merriam-Webster, 2022).

high-quality ECE. Underinvestment has hit the ECE workforce particularly hard, resulting in high rates of poverty and economic insecurity among those who care for and teach young children. Efforts to target ECE investments to children from households with low income have not ensured high-quality experiences or been sufficient in scope to serve all eligible children.

Quality frameworks adopted by the field may not, in many instances, include indicators that have a particularly salient effect on opportunity gaps and the experiences of children from historically marginalized communities, such as issues related to bias, language of instruction, and inclusion of children with disabilities. Underfunded and fragmented programs, underpaid workers, inconsistent access to high-quality programming, and inadequate quality frameworks contribute to opportunity gaps. Wide-scale implementation of such a system should take into account the challenges that can occur during scale-up, such as insufficient capacity to implement programs, lack of sustained funding, a mismatch between demand for and supply of programs, lack of demand for programs, or barriers to access for targeted populations. A systematic approach to scaling up should be used to ensure that goals are clear and measurable, that progress is assessed regularly, and that challenges and opportunities are identified as they occur to inform iterative improvements in implementation. Two prior consensus studies of the National Academies—Transforming the Workforce for Children Birth through Age 8 (IOM & NRC, 2015) and Transforming the Financing of Early Care and Education (2018)—offer additional comprehensive recommendations that provide guidance to support improvements in the quality of professional practice for ECE professionals, as well as in the funding of ECE in a way that makes high-quality programs accessible and affordable for families.

Chapter 1 of this report details segregation by socioeconomic status, disability status, and language, which structures the ECE system to benefit wealthier families and widen the educational achievement gap by limiting equitable access to quality educational opportunities for all children (Owens, Reardon, & Jencks, 2016; Gormley, 2017; Gándara, 2020; Meek et al., 2020; Cascio, 2021; Gillispie, 2021). Chapter 2 presents evidence from individual studies on the short- and long-term benefits of both targeted and universal preschool programs, and these studies report positive outcomes for children in low-income households, as well as those from marginalized communities (Bartik, Gormley, & Adelstein, 2012; Cascio & Schanzenbach, 2013; Phillips et al., 2017; Jung and Barnett, 2021). In addition, findings from meta-analyses support the substantial positive effects of high-quality pre-K on child learning and development across a range of domains (Camili et al., 2010; Duncan & Magnuson, 2013; Kay & Pennucci, 2014; Schindler et al., 2015; Joo et al., 2020). Because compulsory public education does not extend to ECE except for children with disabilities (under IDEA), many

children and their families have no legal recourse to challenge inequitable access to quality education.

Recommendation 4: The federal government, states, local communities, and districts should adequately and equitably support elementary school education and out-of-school programs. Elementary school education should operate under a common quality framework, with quality benchmarks aligned with those in the early care and education system and based on evidence-based policies and practices.

Such a system would:

• address structural drivers of education opportunity, including segregation in learning settings by language, disability, race, and income; and
• be adequately funded to support the implementation of high-quality benchmarks aligned with those in the ECE system, including
  • high-quality instruction and asset-driven pedagogies, assessments, and curricula;
  • social-emotional and mental health supports and policies to explicitly reduce exclusionary and harsh discipline and eliminate disparities in such practices;
  • full inclusion of children with disabilities in general education settings, with high-quality and individualized services and supports;
  • bilingual learning opportunities for children who are English learners and dual language learners;
  • structurally sound, safe, healthy, and engaging learning environments;
  • a well-qualified, fairly compensated, and supported workforce;
  • data-driven continuous quality improvement efforts targeted at identifying and addressing opportunity and outcome gaps;
  • authentic and meaningful family engagement and partnerships;
  • strong partnerships with ECE systems that promote seamless transitions from ECE to the early grades; and
  • community partnerships and engagement to promote holistic family wellness.

Increasing funding for education, particularly for low-income students, has significant effects (e.g., improving achievement and graduation rates, employment, and wages and reducing poverty rates). Thus, resource allocation would need to prioritize underserved populations, including high-poverty and minoritized communities and children with unique needs, such

as English learners and students with disabilities. Increased resources could be used in a targeted way to meet quality benchmarks, close opportunity gaps, and meet the holistic and academic needs of students. ECE and the early grades would also need to be aligned so that what was attained in the early years would be built upon and expanded in the later grades rather than repeated or dropped altogether. Families and communities must be a part of these systems to ensure that children are immersed in the environments and conditions they need to thrive across settings.

Chapter 3 of this report catalogs evidence related to differential experiences in early elementary learning settings, and includes a discussion of the common features of quality elementary school (e.g., structural factors, school- and district-level factors, teacher-level factors, and child-level outcomes; Paro et al., 2009; Lowenstein et al., 2015; Ansari & Pianta, 2019; Buttaro & Catsambis, 2019; Darling-Hammond, 2019). Poor physical infrastructure, large class sizes, singular language of instruction, and harsh and exclusionary discipline practices can further widen these gaps for children from marginalized communities. Evidence supporting the importance of warm, supportive, and enriching teacher–child relationships is presented in the context of the systems, policies, and funding that influence those relationships, as well as the child and teacher demographic characteristics that may mediate them (IOM & NRC, 2015).

Recommendation 5: The Department of Education should fully integrate Individuals with Disabilities Education Act programming with general early childhood and K–12 education. As part of achieving this goal, the Department of Education, states, and districts should undertake specific reforms explicitly addressing opportunity gaps identified in this report, including

1. uneven access to early intervention and preschool special education;
2. uneven quality and dosage of early intervention and preschool special education;
3. inclusion of children with disabilities across age groups, especially preschoolers, who are the most likely to be served in separate settings;
4. nonbiased, accurate identification, specifically addressing over- and underidentification of specific groups of children, such as children of color, English learners, and others; and
5. prohibition of harsh forms of discipline, including suspensions, expulsions, all forms of corporal punishment, seclusion, and inappropriate restraint for all students with disabilities, with special attention to students of color, who are disproportionately subject to these practices.

The maximum federal share of funding for IDEA determined by Congress is 40% of the national average per pupil expenditure. Unfortunately, Congress has never met this goal, and today funds only about 18% of what it costs to educate children with disabilities. Indeed, the inadequate funding of these services has resulted in states restricting eligibility criteria, lowering the dosage of services, or stretching wait times for the evaluation and service delivery process to the upper limits of what is allowable by law.

IDEA policy reforms, through reauthorization, regulation, technical assistance, and monitoring and accountability systems, must intentionally address gaps in access, particularly for children of color; accuracy in identification; inclusion in general ECE settings; and the harsh discipline to which children with disabilities are disproportionately subject. Unaddressed, these funding and policy issues will continue to perpetuate opportunity and outcome gaps between children with disabilities and their peers.

Chapter 1 of this report details the current shortcomings of IDEA in meeting the need for sufficient quantity and dosage of high-quality services for children who access special education, as well as issues with accurate identification of and provision of services to children of color who may experience disproportionately high rates of harsh discipline (Meek et al., 2020; National Center for Learning Disabilities, 2020; Smith et al., 2020; Department of Education, 2021; Gillispie, 2021; Hinds, Newby, & Korman, 2022). Chapter 2 presents a detailed comparison of child care, Head Start, and state pre-K programs and their coverage by IDEA (e.g., Table 2-1), and provides a lengthy discussion of the benefit of inclusive special education services for academic and social outcomes for children with disabilities, as well as the barriers that preclude access for many children.

Recommendation 6: The Department of Health and Human Services (HHS) should create, lead, and be accountable for coordinating an interagency group focused on children’s mental health and social-emotional well-being that includes the several HHS operating divisions, including the Administration for Children and Families, the Health Resources and Services Administration, the Substance Abuse and Mental Health Services Administration, the Centers for Disease Control and Prevention, and the Centers for Medicare & Medicaid Services, among others, as well as the Department of Education, the Department of Justice, the Department of Housing and Urban Development, and other relevant agencies, for the purpose of designing, implementing, and evaluating a comprehensive system of primary psychosocial care for young children and their families.

Such a comprehensive system of primary psychosocial care for young children and their families would include:

• universal support from the prenatal period through third grade, consisting of regular screening and identification of needs in mental health and social-emotional development for both families and children, followed by facilitated access that community resources to address those needs;
• sufficient community capacity to address young children’s needs through a comprehensive array of well-funded evidence-based intervention programs and resources;
• an integrated data system, much like a child’s electronic medical record, that charts a child’s needs and interventions across the life course, to facilitate cross-agency communication and program and policy evaluation, and serve as a resource for future providers; and
• an evaluation plan and support for research to understand systemic and structural drivers (e.g., racism) that create or worsen physical and mental health challenges among young children from historically marginalized communities.

For families with children, no universal system provides care to support the social and emotional development, mental health, and well-being of their child from birth until age 5 when they enter the K–12 system with continuity of supports and services through the early school-age years. Chapter 5 of this report describes how families are faced with the burden of identifying the needs of their children, as well as accessing the resources to address those needs. During these early years, disparities in opportunity can grow as more advantaged families are able to use their resources to support the social-emotional needs of their children. Families from minoritized groups (both parents and children) are disproportionately exposed to hardships and stress across the life course, including stress related to racism and discrimination; are less likely to have their mental health needs met; and are more likely to have treatment prematurely terminated (e.g., Reiss, 2013; Cree et al., 2018; Jones Harden & Slopen, 2022). In addition, children from minoritized groups are less likely to have access to mental health services in schools and in the child welfare system (IOM, 2003; McGuire et al., 2006). For many families, especially those experiencing poverty, health issues, and precarious jobs, uncoordinated public systems that are charged with providing support for the well-being of children create barriers to access and burden these families in their efforts to access services and supports (Aber, Jones, & Cohen, 2000; Yoshikawa, Aber, & Beardslee, 2012; Alegría et al., 2015; Mazza et al., 2017; Schenck-Fontaine & Panico, 2019; Ridley et al., 2020).

Given the complexity of the system proposed in Recommendation 6, an interagency working group offers the potential to ensure that the design of this system is informed by the work of agencies whose policies have

an impact on children’s mental health and social-emotional well-being, and that the system’s implementation is consistent and coordinated. A centralized system for identifying and cataloging effective, evidence-based intervention programs, policies, and resources that exist within a particular community should be part of the development of this system of primary psychosocial care. That system would support local community efforts to select appropriate evidence-based interventions, which could then be evaluated and used to understand drivers of challenges affecting specific communities.

Recommendation 7: The Department of Labor and the Department of Health and Human Services, in partnership with other relevant federal agencies, should review, update, and enforce existing labor standards and employment policies to address disparities that disproportionately affect working families with young children.

To implement this recommendation, the federal government could:

• build on the current job protections offered under the unpaid Family Medical Leave Act to create a paid social insurance program, administered by the Social Security Administration, to support parents needing time away from work to care for infants and newly adopted children and attend to their own and their family members’ serious health issues;
• address documented issues in access to paid family and medical leave for low-income families and families from marginalized communities by implementing progressive wage replacement rates, making coverage more inclusive by eliminating firm-size requirements, and using existing hours and duration criteria for Social Security Disability Insurance or Medicare Hospital Insurance;
• develop recommendations on the definition of good-quality jobs for families with children, an effort that should include setting standards for family-sustaining wages and family-friendly employer practices;
• update existing labor standards and policies, raise the minimum wage floor, make work schedules more predictable, budget more resources for enforcement, and incentivize employers to provide training and career ladders; and
• partner with philanthropic organizations to conduct research on job quality standards and metrics to guide policy and employer-based interventions.

Research shows that many working families do not earn enough from full-time employment to cover basic needs, and that many employers do

not provide benefits such as paid sick or medical leave, parental leave, or child care. Lack of access to paid leave creates an opportunity gap for young children by limiting bonding time for parents and infants, decreasing the time available to attend to serious health issues, elevating family stress, and exposing children to financial uncertainty. Overall, this body of research suggests that paid family and medical leave is an effective policy that improves the social-emotional well-being of parents and the health of their young children. Moreover, making the program nearly universal would lower per worker costs. The policy could be further improved by reducing racial/ethnic and income disparities in take-up of leave through less restrictive eligibility criteria, higher wage replacement rates, targeted outreach, and improved administrative systems.

Chapter 5 of this report describes the evidence on paid family leave and its positive effects on mental health outcomes for both children and caregivers (e.g., Bullinger, 2019; Irish et al., 2021; Kozak et al., 2021). Chapter 7 further reports on the benefits of lengthy, accessible paid leave for caregivers’ mental health outcomes (Chatterji & Markowitz, 2012; Dagher, McGovern, & Dowd, 2014; Kornfeind & Sipsma, 2018; Mandal, 2018), as well as infants’ physical health and attachment (National Academies, 2016, 2019b; Hamad, Modrek, & White, 2019). In addition, that chapter presents research on the current limitations of the Family and Medical Leave Act and paid leave for all workers (e.g., Joshi et al., 2019, 2020), as well as the role of parental job quality as a social determinant of a child’s health (e.g., Burgard & Lin, 2013; Repetti & Wang, 2014; Antonisse & Garfield, 2018; Congdon et al., 2020).

Recommendation 8: The federal government, in partnership with state and local governments, philanthropy, and relevant public and private organizations, should support policies and interventions targeting social determinants of health that create and perpetuate opportunity gaps at the community level.

To further the development of targeted policies and interventions for addressing the opportunity gap at the community level, the following actions should be taken by federal, state, and local entities and private philanthropic organizations:

• Federal and state governments should expand existing safety net programs that have been shown to address poverty and food insecurity as social determinants of health, including the special Supplemental Nutrition Program for Women, Infants, and Children, SNAP, and the earned income tax credit, as well as the 2021 expanded child tax credit. Eligibility applications for these programs

• could be unified and streamlined to reduce administrative hurdles to take-up.
• As with other programs such as child care subsidies, to reduce disruptions in insurance and health care access, the federal government should ensure continuous coverage with Medicaid for a minimum 12-month period even if families experience temporary changes in income during the year that make them ineligible, and Medicaid should be provided to women for at least 12 months postpartum.
• Federal, state, and local governments should increase the supply of affordable high-quality housing, which would include access to green spaces, playgrounds, and parks.
• Local governments should engage in urban planning improvements to enhance traffic safety and eliminate road hazards (e.g., legislate speed limits), especially in marginalized communities.
• Governments at the federal, state, and local levels and philanthropy should prioritize support for communities with a level of high need and low resources, as measured by the Child Opportunity Index, program administrative data, and historical budget data.
• Early learning, education, and health care systems should act as anchor institutions and be coordinated through shared data systems and integrated service delivery to promote family wellness and community development by offering onsite or providing connections to health, mental health, after-school, nutritional support, and economic wellness services. The federal government should build on and expand existing programming that can facilitate this anchor organization approach, such as full-service community schools, Head Start, and federally qualified health centers.
• Community organizations, philanthropy, and local governments should support evidence-based programs for young people, such as those that include tutoring or mentoring; sports; and early childhood mental health programs, including parent–child interaction and cognitive-behavioral therapeutic approaches.

Children living in poverty and those from other marginalized populations are subject to inequities in experiences with and access to resources related to health care, child care, school quality, safe and healthy home environments and neighborhood contexts, along with access to supportive programs. These inequities in access to resources and programs that strongly influence developmental outcomes lead to persistent opportunity gaps for young children. Creation of a centralized resource cataloguing effective, evidence-based practices across domains that eliminate disparities in opportunity among young children—similar to the What Works

Clearinghouse, for example—could allow communities to share and learn from experiences with promising and effective intervention programs and policies. In addition, state and local governments could examine existing policies that have demonstrated promising outcomes for young children, and leverage resources and partnerships with the private sector to invest in interventions with the potential to close opportunity gaps for young children and support their healthy development.

Chapter 1 provides examples of federal, state, and local influences on the opportunity gap and associated racial/ethnic disparities, as well as effects on marginalized communities, including differences in achievement and inequitable access to mental and physical supports for health and well-being (e.g., Bell, 1965; Vogtman, 2017; Minoff, 2020; Derenoncourt & Montialoux, 2021; Parolin et al., 2021). These examples extend to discriminatory housing policies and urban planning and community development that can contribute to increased injuries and environmental exposure to toxins (Morency et al., 2012; Rothstein, 2017; National Academies, 2019b). Chapter 4 provides a brief history of Medicaid, including the role of states in determining income and eligibility thresholds (Nolen, Beckman, & Sandoe, 2020); Chapter 6 describes the implications of expanding Medicaid coverage for pregnant people and families (e.g., reducing infant deaths by 50%), and Chapter 7 presents evidence on the positive effects of exposure to Medicaid on educational outcomes and adult health (Meyer & Wherry, 2012; Miller & Wherry, 2019; Brown, Kowalski, & Lurie, 2020; Goodman-Bacon, 2021). In addition, Chapter 4 expands on the opportunity for anchor institutions to support neighborhood development, reduce housing insecurity and crime, and increase community safety (Sharkey, Torrats-Espinosa, & Takyar, 2017; Kelleher, Reece, & Sandel, 2018; National Academies, 2019a). This coordinated approach can leverage political will and private and public funding at a variety of levels to support sustained and synergistic interventions with the potential to remediate the opportunity gap.

Recommendation 9: Early learning and K–12 education systems, health care systems, and employers should test and institute policies and protocols for identifying and addressing manifestations of institutional racism to reduce inequities in access to resources and quality services in education, health care, and public health.

To identify and address manifestations of institutional racism that create and perpetuate the opportunity gap, the following specific actions should be taken to reduce inequities in access to resources and quality services in education, health care, and public health:

• Systems leaders and administrators across all levels of government (federal, state, local) should work to address institutional racism and increase culturally and linguistically appropriate health care, public health, early care and education, and early grade education.
• Policy makers should take into account historical inequities in resource distribution and current manifestations of racism and marginalization in developing policy and making budgetary decisions.
• Federal research agencies (e.g., the National Institutes of Health, the National Science Foundation) and philanthropic organizations should support and prioritize historically marginalized communities and groups to improve their access to professional development programs, apprenticeships, and scholarships and diversify the pipeline of health care professionals, public health practitioners, teachers, early educators, and early childhood researchers.
• National professional organizations and accreditors should improve curriculum training and require minimum competencies in antiracist approaches; social determinants of health inequities; and culturally competent, trauma-informed, and resilience-building health care, early care and education, and early grade education.

A consistent finding across issue areas (e.g., early education, health, social-emotional development) is that opportunity is associated with race, and that race intersects with multiple other identities to result in compounded gaps in opportunity and outcomes. Many gaps in opportunity and outcomes are the products of centuries of systemic racism across numerous domains of life, including financial/wealth, health, and education. Any attempt to address unequal opportunity requires understanding and remedying historical inequities and their manifestations today.

Chapter 1 of this report describes the historical precedents of the opportunity gap in educational systems, the role of segregation in widening this gap, and structural and economic policies that further widen these inequities. Chapters 2 and 3 explore the evidence on the intersection of institutional racism with ECE and elementary education, and highlight how program funding, early special education intervention, differential learning settings, and the training of the education workforce are heavily influenced by manifestations of structural racism (e.g., poorly funded programs, under- and overidentification of children of color for special education, harsh disciplinary practices aimed at marginalized children, and poorly paid and trained educators). Chapter 5 connects racialized drivers of opportunity gaps to child and parental health, with evidence demonstrating clear disparities in health care delivery, relational health, and safe and healthy neighborhoods. Chapter 6 extends this discussion to include the

impact of institutional racism on opportunity gaps in child mental health, and highlights strategies for reducing these gaps.

FINAL THOUGHTS

Many of the findings and challenges presented in this report are not new; however, the committee’s recommendations highlight ways in which changes to the status quo hold the potential to improve the quality of care and education children receive from birth through age 8. Differential access to high-quality experiences, services, programs, and other resources is the result of a diverse array of factors, both historical and current, which have led to disparities in educational outcomes, physical health, mental health, and healthy social-emotional development and well-being that persist and compound. Indeed, these disparities will continue to persist in the absence of investments in increasing equitable access to opportunity. It is important to stress that the question of quality is central to all efforts to close the opportunity gap; the expansion of access to resources and experiences alone is insufficient in the absence of high quality.

Promising approaches highlighted in this report offer the opportunity to reduce disparities in ways that promote healthy development and learning for all children. The committee hopes that implementation of its recommendations, which cut across the systems that serve young children and their families, will guide leaders in federal, state, and local governments; the private sector; and the philanthropic community in developing multifaceted, cross-sectoral approaches that can shape policies, programs, and services to foster the well-being of and improve outcomes for young children, their families, and their communities.

REFERENCES

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