7

Research, Policy, and Practice: Contexts and Efforts to Address Opportunity Gaps

The committee’s overview of opportunity gaps and outcomes in education, physical health, and social-emotional health and well-being in previous chapters has highlighted the numerous ways in which policies, practices, and social contexts in each of these domains interact and often exacerbate opportunity gaps for young children. In this chapter, the committee discusses policies with the potential to improve outcomes for young children and their families. The chapter begins with a discussion of income augmentation programs and policies, and then turns to the effects of poor parental job quality on opportunity gaps for children, as well as policy interventions that address parents’ job quality. We then discuss policies, programs, and practices that address opportunity gaps and outcomes in these domains of interest. The chapter concludes with a discussion of human-centered design and policy development and the role of public–private partnerships.

INCOME AUGMENTATION PROGRAMS AND POLICIES

Programs that directly increase individual or family incomes are potential solutions to the opportunity gap for children. Several national and state programs with this focus have been implemented over the past 50 years, starting with those under the Great Society. This section describes three income augmentation programs and policies—minimum wage, the earned income tax credit (EITC), and paid family and medical leave—and the ways in which they may reduce opportunity gaps for young children. A fourth policy, the child tax credit (CTC), is briefly discussed in a later section.

Minimum Wage

Policies that enhance financial resources also impact birth outcomes. One prominent example is federal and state minimum wage increases, which raise the wage floor and boost the incomes of low-wage workers and their families. Higher family incomes can lead, in turn, to better social, economic, and health outcomes for parents and children (Wehby, Dave, & Kaestner, 2020). Greater access to resources such as housing, food, health care, and transportation can lower parental stress, improving a child’s caregiving environment and reducing the likelihood that a child will experience abuse, neglect, or other adverse experiences at home (Hill & Romich, 2018). Higher minimum wages also facilitate greater health care access, which can reduce the prevalence of low birthweight and increase use of prenatal care, all of which may positively impact children’s later health outcomes (Wehby, Dave, & Kaestner, 2020).

A 2016 study examined data on U.S. birth outcomes from 1980 to 2011 and found that state minimum wages that were higher than the federal floor were significantly linked to reduced prevalence of infant mortality and low birthweight. In particular, each dollar above the federal minimum wage led to a 4% decrease in infant mortality and a 1–2% decrease in the prevalence of low birthweight (Komro et al., 2016). A 2018 study using data from 1995 to 2013 found that a 10% increase in the minimum wage was associated with a 3.2% reduction in infant mortality among mothers with a high school degree or less (Jalali, 2018). A 2020 analysis examined 46 million births between 1989 and 2012 that occurred to women with a high school degree or less and found that a $1 minimum wage increase was linked to a significant 2 gram increase in birthweight and a significant, though small, increase in gestation length (0.01 weeks) and fetal growth (0.03 grams per week; Wehby, Dave, & Kaestner, 2020). Given the standard low birthweight threshold of 2,500 grams, these are very small effects that likely reached statistical significance as a result of the study’s large sample size. The $1 wage increase had small, insignificant effects on reducing the number of preterm births in the authors’ preferred specification.

A 2020 study assessed the impacts on birth outcomes of increasing “subminimum wages”—the wages that may be paid to tipped workers, which are often set much lower than the floor for nontipped workers. For example, the federal subminimum wage has been set at $2.13 per hour since 1991 (equivalent to about $4.63 in 2022 dollars, when adjusted for inflation), and the federal minimum wage was last increased to $7.25 per hour in 2009 (equivalent to about $12.00 per hour in 2022 dollars). The study found that when the tipped wage was set at the full federal minimum wage level, the birthweight of the smallest 5% of infants increased, and the birthweight of the largest 5% of infants decreased, leading to overall healthier

birthweights for gestational age (Andrea et al., 2020). A 2021 study using data from 2001 to 2018 examined the relationship between state preemption laws (which prevent cities, counties, and other local jurisdictions from adopting minimum wages higher than the state level) and infant mortality. The study found that each additional $1 increase in the minimum wage reduced the infant mortality rate by 1.3%, and as a result, state preemption laws that restricted local increases were linked to as many as 605 preventable infant deaths in 2018 (Wolf, Monnat, & Montez, 2021).

A 2019 study found that higher state minimum wages significantly reduced infant mortality among infants born to Black mothers (a 20% reduction among states at or above the 75th percentile of state minimum wage levels), whereas no significant impact was found for infants with White mothers (Rosenquist et al., 2020), suggesting that minimum wage policies may have the largest impact among those with the worst birth outcomes at baseline.

Earned Income Tax Credit

The EITC is a poverty-reducing and work-support policy that involves tax refunds disbursed annually to low-income working families. More than 25 million tax filers receive the benefit annually, and the average refund size is about $2,500 (National Conference of State Legislatures [NCSL], 2022). Beyond the federal EITC, more than half of states now have their own supplemental EITC programs of varying generosity. Through the increased income it provides, the EITC is expected to promote greater use of health care, greater ability to purchase food and other household resources, and reduced stress among low-income women, which may lead to better birth outcomes (Markowitz et al., 2017; Lenhart, 2019). While there have been mixed findings on the impacts of increased use of prenatal care in terms of healthier births, research has demonstrated that state EITCs have positive impacts on birth outcomes, although the effect sizes are generally small (Prenatal-to-3 Policy Impact Center, 2022). A study from 2017 found that higher local and state credits in New York City were associated with a small but statistically significant reduction in rates of low birthweight at the community level (Wicks-Lim & Arno, 2017).

Another study with a large sample of single mothers found that the state EITC was associated with a 0.5 ounce (16 grams) increase in birthweight (Strully, Rehkopf, & Xuan, 2010). Research on the District of Columbia’s credit expansions over time found beneficial effects on both birthweight and gestational age—of note, 1.9–4.7 fewer low-birthweight births per 100 live births and 48–104 gram increases in average birthweight (depending on the generosity of the credit, with the 104 gram increase being linked to a 40% EITC). The District of Columbia study also found an

increase in gestational age ranging from 0.12 to 0.43 weeks, depending on the generosity of the EITC (10–40%; Wagenaar et al., 2019). This finding has been replicated in a study of Montgomery County, Maryland, which found that the introduction of the EITC reduced the likelihood of low birthweight by 1.9–2.4 percentage points among likely eligible mothers. Moreover, the EITC significantly increased birthweights by 27.3 grams in states with generous, refundable credits (generosity being defined as 10% or more of the federal credit; Hill & Gurley-Calvez, 2019). While high credits yielded greater benefits in infant outcomes, even states with less generous or nonrefundable credits saw significant benefits in these measures compared with states with no EITC, but the benefits were smaller (Hill & Gurley-Calvez, 2019).

This research has further implications as we consider efforts to improve health equity, especially with respect to Black mother and infant dyads. A subsequent analysis by the same authors using the same data found that the improvements were greater in magnitude (37.2 grams and 0.15 gestation weeks) for Black mothers in states with generous, refundable credits compared with the effects for White and Hispanic mothers. This finding shows that the state credit has the potential to reduce racial disparities in birth outcomes and increase health equity for infants, as Black infants disproportionately experience low birthweight and preterm birth (Komro et al., 2019). The EITC has also been associated with improved child health beyond the perinatal period, including improvements in food security, test scores, and behavioral problems (Dahl & Lochner, 2012; Hamad & Rehkopf, 2016; Batra & Hamad, 2021).

Paid Family and Medical Leave

The United States lacks a national paid family and medical leave policy. Of the 34 Organisation for Economic Co-operation and Development countries, the United States is the only country that does not guarantee paid leave to mothers of infants, and one of only two countries that does not guarantee paid leave to both parents (Joshi et al., 2019; Raub et al., 2018). Yet as discussed in Chapter 5, while paid family leave policies and their effects can vary, their positive effects on maternal mental health are consistent across studies.

U.S. policy in family and medical leave is regulated by the Family and Medical Leave Act (FMLA), an unpaid job-protected leave program that covers about half of working parents (Joshi et al., 2020). Workers in 13 states and the District of Columbia receive paid family and medical leave benefits (or will have these benefits by 2024). These benefits are also available in a growing number of cities and counties (Joshi et al., 2019; A Better Balance, 2021). Some employers provide access to paid family leave, but

these benefits cover only 23% of civilian (private- and public-sector) workers and are available primarily to workers in higher-wage occupations (BLS, 2021); they are less available to Black, Hispanic, and immigrant workers (Bartel, Kim, & Nam, 2019) and working parents in lower-wage occupations (Adelstein & Peters, 2019).

California has the first and longest-running paid leave program, established in 2004. Quasi-experimental studies have provided strong evidence that the California program improved mental health and parent–infant interactions among parents participating in the program. These improvements include parents’ higher self-rated health, lower psychological distress, better coping with demands of parenthood, increased parental reading to infants, and higher ratings of infant health (Bullinger, 2019; Lee et al., 2020; Irish et al., 2021). Several cross-sectional studies have found that it is not just access to paid leave but also the duration of the leave that matters for mothers’ mental health. Longer paid leaves are associated with reduced maternal postpartum depression and major depressive disorder (Chatterji & Markowitz, 2012; Dagher, McGovern, & Dowd, 2014; Kornfeind & Sipsma, 2018; Mandal, 2018), and can buffer potential adverse effects of mothers’ depressive symptoms on their relationships with infants (Clark et al., 1997). Both parents in dual-earner families need access to paid family leave since only one working parent’s leave-taking was found to have negatively affected the other’s mental health. One study found that mothers’ longer paid maternity leave decreased fathers’ anxiety across the year after childbirth (Perry-Jenkins et al., 2017), while another found that fathers’ increased flexibility to take paternity leave in Sweden improved mothers’ mental health outcomes (Persson & Rossin-Slater, 2019).

Paid leave can have direct effects on children’s developmental outcomes, as well as indirect effects on children through changes in parents’ mental health or family income. Recent U.S. studies of infants with working mothers who took paid maternity leave found that their leave was associated with improved outcomes in infancy and toddlerhood, including higher infant brain function compared with infants of mothers taking unpaid leave. Higher physiological stress among mothers taking unpaid leave was identified as one pathway that may be associated with less mature patterns of infants’ brain activity (Brito et al., 2021). Taking paid leave also benefits children’s development over time. Infants whose mothers took paid leave were found to have better linguistic and social-emotional outcomes in toddlerhood compared with infants whose mothers took unpaid leave (Kozak et al., 2021).

Paid family leave also has been shown to increase breastfeeding, which has been linked with improvements in bonding and later child and maternal health. One of two rigorous quasi-experimental studies of mothers in California (Hamad et al., 2019) found that the ability to spend the first

few weeks with a newborn significantly increased the ability to breastfeed and facilitated its continuation. The other of these studies (Huang & Yang, 2015) found that paid leave increased breastfeeding during the first 3, 6, and 9 months postpartum. Other studies in the United States as well as other high-income countries have found that maternity leave lasting at least 8 weeks results in increased probability of establishing breastfeeding (National Academies, 2019b). Paid parental leave may also increase attachment between mothers and children and give parents more time to develop skills and establish social supports that can allow the continuation of breastfeeding after return to work (National Academies, 2016).

Other studies have shown that maternity leave leads to lower infant and child mortality (National Academies, 2019b). Research has also found that paid maternity leave could lead to a reduction in low birthweight and early births, with larger effects for unmarried and Black women (Stearns, 2015).

While there is a robust literature on paid family leave, there have been few studies of medical leave. However, evidence from paid sick leave (which is shorter in duration than medical leave) indicates positive effects on workers’ take-up of preventive health care for themselves and their children (Shepherd-Banigan et al., 2017). Paid sick leave can help workers with moderate mental health issues stay employed (Goorin, Frank, & Glied, 2021) and can lessen stress related to missing a paid day of work (Hill, 2013). One study found that access to sick leave was associated with less psychological distress and helped prevent negative spillover effects into other aspects of life and day-to-day activities (Stoddard-Dare et al., 2018).

In addition to the strong evidence showing that paid family and medical leave positively impacts children’s health outcomes, these programs also have been found to improve women’s employment outcomes (Baum & Ruhm, 2013; Byker, 2016), with no negative effects on employers (Bartel, Kim, & Nam, 2019). Across studies, however, there is evidence of limited access to both unpaid leave under the FMLA and paid leave for all workers. Access is disproportionately lower for low-income, Black, Hispanic, and immigrant workers, resulting in their children’s greater exposure to opportunity gaps. Reasons for this lower access include the unaffordability of taking unpaid or partially paid leave, restrictive eligibility criteria, administratively burdensome systems, and lack of knowledge about programs.

Unpaid leave guaranteed by the FMLA is out of reach for many working parents, but especially for low-income and Black and Hispanic working families because of issues of affordability and restrictive eligibility criteria. A nationally representative employee survey found that workers earning hourly wages under $15 and Black and Hispanic workers were less likely to take FMLA leave even when they needed it for a qualifying health reason (Brown et al., 2020). Workers who had experienced an unmet need for leave

cited the inability to afford leave as their main reason for not taking it. The result for these workers’ own or another family member’s health was postponing (44%) or forgoing (39%) medical treatment (Brown et al., 2020).

Beyond affordability, the FMLA’s strict eligibility requirements, such as the number of hours and weeks worked and firm size, limit access for women (Heymann et al., 2021) and Hispanic and immigrant workers (Joshi et al., 2020). For example, Hispanic and immigrant workers have lower access because they disproportionately work for small businesses that do not meet the FMLA’s eligibility criteria. More Black workers are eligible because they have higher rates of employment in the public sector, which provides automatic eligibility for the FMLA (Joshi et al., 2020).

To address the limitations of the FMLA, a growing number of states and cities have developed their own paid family and medical leave programs that address affordability issues and increase take-up rates. Research has found that paid leave programs increase the use of leave among Black and Hispanic working mothers who previously had low leave take-up rates (Rossin-Slater, Ruhm, & Waldfogel, 2013). One study estimates that if national policy changed from unpaid to paid leave, Black workers would benefit more relative to White workers since by taking unpaid leave, they stand to lose more wages relative to total family income (Joshi et al., 2019). Newer state and local paid leave programs target higher wage replacement for low-wage workers. Such programs can help reduce racial/ethnic disparities, but no research is available on their impact as yet.

Administratively burdensome application and benefit systems can decrease access to family and medical leave (Grant et al., 2019). One qualitative study found that the application process was cumbersome for some low-income parents, and that some qualifying families abandoned the application because of the lack of information and guidance regarding the submission process. There were also delays in employers and health care providers completing their portions of the application (Setty, Skinner, & Wilson-Simmons, 2016). Since each employer designs its own process for employees to take unpaid leave through the FMLA, and similarly, each state agency designs its own administrative system for paid leave, the application processes, required documentation, outreach, and assistance offered will vary. Most leave programs require medical certification and documentation of family relationships, which creates administrative complexity without a straightforward process for use by workers to request and transfer forms from the health care system and vital records to employers.

Both surveys and qualitative studies have found that gaps in knowledge about programs limit access to and use of family and medical leave programs among low-income workers. Surveys conducted in California (statewide) and in greater San Francisco suggest that lower-income mothers had limited program knowledge (Goodman, Elser, & Dow, 2020) and

that immigrant and Hispanic workers who had a qualifying event also had lower awareness (Appelbaum & Milkman, 2011).

The evidence base on family and medical leave has some limitations that could be improved with new and better data collection. First, most national surveys do not include comprehensive measures of employment, access to and take-up of employer-provided or publicly available paid leave, and adult and child health outcomes. Similarly, administrative databases that track paid leave applications and usage do not always collect data on race/ethnicity and generally are not linked to health databases, making it difficult to estimate the impact of having access to leave on health or health disparities. The implementation of unpaid leave under the FMLA and paid family and medical leave programs is not tracked systematically, so it is difficult to document FMLA enforcement and the access and outreach issues in paid family and medical leave programs. More information is needed on implementation to inform the design of practices that improve knowledge and take-up of programs.

PARENTS’ POOR JOB QUALITY AND OPPORTUNITY GAPS FOR CHILDREN

Parents’ job characteristics are a social determinant of their children’s health. The quality of parents’ jobs is an important but overlooked component of the resources available to children that affect their healthy development (Heinrich, 2014). As highlighted in Figure 7-1, parents’ jobs have direct and indirect pathways to children’s health and development. Parents’ jobs present opportunity gaps for children if they do not provide enough resources, wages, and benefits, or if they entail unpredictable work schedules, or require working at night or on weekends, making it difficult to arrange child care and producing family stress. The role of parents’ jobs in creating opportunity gaps is important to consider since most families with children (89%) include at least one working parent (Department of Labor, 2022), and earnings make up more than 75% of household income (Shrider et al., 2021).

While parents’ employment provides the main source of family resources to invest in children, there are trade-offs between the resources gained and potentially less parental time with children, as well as the quality of care arrangements to which children are exposed when parents are working (Becker, 1981; Peters, 1995). Moreover, parents’ positive or negative experiences at work can spill over to affect their psychological well-being, family interactions, and children’s social-emotional development (Repetti & Wang, 2014). While research shows that unemployment has a consistent negative effect on mental health, studies of employment have found both

positive and negative effects depending on job quality, including wages, hours, schedules, and stability (Antonisse & Garfield, 2018).

Beyond employment status, the quality of parents’ jobs affects children’s healthy development. While there is no standard definition of job quality, both economic and noneconomic dimensions affect parents’ health, family dynamics, and resources available to invest in children. These dimensions include compensation, such as earnings and benefits (health insurance, pensions, paid leave); working conditions (hours, predictability of schedules, job security, safety); business culture and job design (mission and autonomy); and opportunities for skill development and advancement (Howell & Kalleberg, 2019; Congdon et al., 2020).

Studies show that some characteristics of parents’ jobs directly affect financial and health resources available for their children, whereas other characteristics, such as work schedules, hours, tasks, and relationships affect children indirectly through their parents (Menaghan & Parcel, 1995). Heinrich (2014) posits that exposure to lower wages and benefits and unpredictable hours and schedules can increase family stress, which negatively affects both parents’ and children’s mental health (Heinrich, 2014). Conversely, higher-wage jobs that provide work–family support and the opportunity to engage in creative work have been linked to improved mental health (Burgard & Lin, 2013).

A growing nonexperimental evidence base confirms that parents’ job characteristics are associated with outcomes for both parents and children in the predicted directions. Indices of poor-quality job characteristics are associated with children’s grade repetition and behavior issues (Kalil & Ziol-Guest, 2005; Strazdins et al., 2010) and mothers’ worse postpartum mental health (Cooklin et al., 2011). Several studies establish a negative association between nonstandard schedules (Joshi & Bogen, 2007; Li et al., 2014) or unpredictable schedules (Carrillo et al., 2017; Schneider and Harknett, 2019a,b; Ananat et al., 2022) and parents’ well-being and children’s behavioral health and quality care arrangements. Evidence suggests that precarious work schedules may also make it more difficult for individuals and families to meet work requirements for safety net programs (Karpman, Hahn, & Gangopadhyaya, 2019). In contrast, higher-quality jobs are associated with children’s improved reading and math scores and behavioral outcomes (Lombardi & Coley, 2013) and help improve new parents’ mental health in dual-earner couples (Perry-Jenkins et al., 2017). In addition, more consistent work schedules and higher-quality jobs can increase options for many families to access higher-quality schools through school choice programs when their neighborhood school is underperforming, especially when those programs require families to provide transportation and child care (Sandstrom, 2015; Chingos & Blagg, 2017; McShane & Shaw, 2020; Collier, 2021). Although the preponderance of evidence

suggests that lower job quality has negative implications for families, a causal relationship cannot be determined because of potential selection bias.

Over the past 40 years, wages have failed to keep up with inflation, and employers have offered fewer benefits, making it difficult for the average working family with children to cover a basic family budget that includes the costs of housing, food, child care, and health insurance (Howell & Kalleberg, 2019). At the same time, wage growth at the upper end of the labor market has significantly increased wage inequality (Howell & Kalleberg, 2019). Other dimensions of poor job quality discussed above have increased as well, including nonstandard work hours (in the evening, at night, or on weekends) and unpredictable scheduling practices, such as last-minute scheduling changes (Henly, Lambert, & Dresser, 2021). Growing wage inequality and declining job quality mean lower access to resources for lower- and middle-income families, in turn widening parental job–related opportunity gaps for children.

A recent study found that one-third of families working full-time year-round do not earn enough to cover a basic family budget, and more than three-quarters of low-income full-time working families do not have enough income to cover basic costs, including child care, transportation, housing, food, and other expenses (Joshi et al., 2022). Figure 7-2 shows the significant proportions of working families (14%) and low-income families (31%) that do not earn enough wages from full-time work to cover basic expenses or have any access to health insurance or pensions through their employers. These jobs are the most concerning in terms of providing adequate resources for families with children.

It is well known that racial inequities in wages and employer-provided benefits are an enduring feature of the U.S. labor market (Kristal, Cohen, & Navot, 2018; Howell & Kalleberg, 2019). Black, Hispanic, and foreign-born working parents disproportionately experience low job quality (Earle et al., 2014). Figure 7-2 shows significant racial/ethnic and nativity differences in the quality of jobs held by full-time year-round working families. Approximately 30% of Hispanic families have full-time jobs that do not provide enough wages to cover basic expenses and do not offer health insurance or pension benefits. While many families need access to income assistance to make up for these shortfalls in job resources, low-income Hispanic (43%) and immigrant (41%) families are in particular need because they disproportionately have earnings that do not cover family expenses or work for employers that do not offer benefits. In addition to lower wages and less access to employer-provided benefits, Black and Hispanic workers are more likely than workers from other racial/ethnic groups to work in jobs that require nonstandard work schedules during the evening, at night, and on weekends (Presser & Ward, 2011); to work part-time hours involuntarily (e.g., they would like to work full-time; Golden & Kim, 2020); and to

have last-minute shift changes (Storer, Schneider, & Harknett, 2020). Thus, Black, Hispanic, immigrant, and low-income children have higher exposure to opportunity gaps stemming from their parents’ lower-quality jobs.

These racial/ethnic and nativity differences in job quality are driven by structural factors such as occupational segregation, racial/ethnic discrimination in hiring and promotion, policy choices such as exclusion from laws that provide worker protections, and differences in access to educational opportunities and attainment (Derenoncourt & Montialoux, 2020; Shakesprere, Katz, & Loprest, 2021). To the extent that Black, Hispanic, and immigrant families have higher exposure to poor job quality, they experience greater opportunity gaps in resources to invest in children, which in turn contributes to racial/ethnic disparities in children’s health (Burgard & Lin, 2013). Studies of the effects of parents’ job quality on children do not

disaggregate the effects of job quality on families by income, race/ethnicity, or nativity, mainly because of low sample sizes.

POLICY INTERVENTIONS AND PROGRAMS THAT ADDRESS PARENTS’ JOB QUALITY

Research has established a clear need for public policies to address the child opportunity gaps created by parents’ low job quality. Federal policies set minimum wages; protect family income in the event of job loss; and supplement low earnings to help offset the high costs of everyday expenses such as food, rent, and child care. Income supplements, provided by means-tested programs and tax credits, are targeted primarily to families and children with the greatest need. Limited employer-provided benefits are supplemented through public health insurance. Some social insurance programs, such as unemployment insurance, replace a portion of lost wages when workers lose their jobs. Other programs provide education and training to enable access to higher-quality jobs. Since many of these policies were established long ago, adjustments are needed to better address economic changes that affect families’ economic outcomes and social-emotional health. As discussed previously, structural changes in the economy that create opportunity gaps for children include persistently low wage growth, nonstandard work schedules demanded by a 24/7 economy, and employers’ unstable scheduling practices. The disparate negative effects of the economic crises associated with the COVID-19 pandemic on Black, Hispanic, and immigrant working families highlighted the need for more comprehensive policy interventions.

The United States, however, lacks a comprehensive approach to addressing structural economic changes. A complex set of policies and programs addresses low earnings, and limited benefits are available through employers, but these measures do not fully address all aspects of poor job quality, do not serve all children, and can be difficult to know about or access. These limitations translate to persistent resource gaps that elevate family stress and are tied to children’s social-emotional health. Higher exposure to poor job quality and uneven access to policies that alleviate it for low-income, Black, Hispanic, and immigrant families exacerbate child opportunity gaps that can lead to disparate outcomes.

This section reviews the evidence on the effectiveness of policies for promoting economic security and social-emotional health for all families with children, with attention to whether they effectively reduce gaps in family job quality experienced by low-income Black, Hispanic, and immigrant working families with children. The discussion concludes with promising practices for improving programs to better address family economic security, promote child development, and reduce racial/ethnic and nativity gaps

in jobs that provide adequate compensation and schedules amenable to raising children.

Federal Labor Standards and Social Protection Policies

Federal laws enacted in the 1930s establish basic national labor standards, including minimum wages, overtime provisions, restrictions on child labor, unpaid job-protected leave, and unemployment insurance. These laws were enacted at a time when the economy and families looked very different from the way they are today. While labor standards have been updated over time, for example, to provide break times for nursing mothers or to cover previously excluded occupations that employed a high proportion of Black and Hispanic workers (Dixon, 2021), policies are antiquated, particularly for working women, who do the lion’s share of caregiving (Ansel & Boushey, 2017). Compared with other countries, the United States has robust child labor laws but lower labor standards to protect families from economic insecurity and limited policies to address caregiving for children (e.g., child care, paid sick leave, and paid family and medical leave; WORLD Policy Analysis Center, 2022).

Burgeoning evidence shows that labor standards establishing minimum wages and unemployment insurance help families with children by reducing downward mobility and family stress and improving social-emotional health. Whereas the federal minimum wage is low ($7.25 per hour) and has not kept pace with inflation, there is evidence that an increase in the minimum wage throughout childhood is associated with improvements in child health, particularly from birth to age 5, and with small to no decreases in employment (Wehby, Dave, & Kaestner, 2020). Although the evidence on the effect of minimum wages on adult health is mixed, a recent review of rigorously designed studies found that raising minimum wages led to a decrease in the prevalence of low birthweight, a decrease in smoking prevalence among adult women, and reduced absences from work due to illness among employed adults (Leigh & Du, 2018). Moreover, improving minimum wage coverage over time by bringing in more sectors that employ Black workers significantly reduced Black–White earnings gaps (Derenoncourt & Montialoux, 2020), and correlational evidence shows reduced poverty for Black children (Spriggs, 2019). This evidence suggests that expansion of minimum wage provisions could improve parents’ job quality, increase the resources available to children, and reduce racial/ethnic child opportunity gaps. However, the minimum wage would need to be greatly increased (to more than $10.25 per hour) to have a significant impact on reducing child poverty (National Academies, 2019a).

In addition to minimum wages, social insurance systems such as unemployment insurance protect working families with children from downward

economic mobility and prevent declines in families’ health due to parents’ job loss. Unemployment insurance provides temporary partial replacement of earnings for unemployed workers who lost their jobs through no fault of their own but because of structural factors such as downsizing. Rules and benefit coverage under the joint federal–state program vary by state, but most programs replace up to half of wages up to a maximum of 26 weeks (Congressional Research Service, 2019).

Parents’ job loss negatively affects families and children through reduced financial resources, greater income instability, and elevated stress (Kalil, 2013). An extensive literature establishes that involuntary job loss is associated with worse adult physical and mental health (Catalano et al., 2011), including increased risk of men’s premature death (Sullivan & von Watcher, 2009) and infants’ lower birth weight (Lindo, 2011). Both correlational and causal studies show that unemployment and job loss have negative consequences for children’s outcomes as well, particularly in low-income families. Job loss is associated with both short- and long-term education outcomes for children, such as a greater likelihood of grade repetition (Kalil & Ziol-Guest, 2008; Stevens & Schaller, 2011), lower math and reading scores (Ananat et al., 2011), more challenges with classroom behavior (Johnson, Kalil, & Dunifon, 2010; Hill et al., 2011), and greater psychological strain (McLoyd et al., 1994; Coelli, 2011). Some evidence indicates that unemployment has particularly large long-term negative effects on Black children’s educational attainment (Kalil & Wightman, 2011).

Unemployment insurance is an essential support for children whose parents lose their jobs. Using a variety of modeling techniques that minimize selection bias, research has established that unemployed workers receiving unemployment insurance benefits have better self-rated health and mental health compared with workers who do not receive these benefits (O’Campo et al., 2015; Cylus & Avendano, 2017). A growing body of rigorous research shows that the generosity of unemployment benefits, especially during recessions, reduces suicide rates (Sullivan & von Wachter, 2009; Cylus, Glymour, & Avendano, 2014), significantly improves adults’ self-rated health, and is not associated with increases in health risks such as alcohol consumption (Kuka, 2020). During the early years of the COVID-19 pandemic, expanded unemployment insurance benefits were associated with reduced risk of depression and anxiety (Berkowitz & Basu, 2021). Although there have been few studies of unemployment insurance focused on children, there is some evidence that the generosity of these benefits is positively associated with academic achievement (Kukla-Acevedo & Heflin, 2014; Regmi, 2019). An extensive body of evidence shows that extensions of unemployment insurance during the Great Recession (Rothstein, 2011; Farber, Rothstein, & Valletta, 2015; Chodorow-Reich, Coglianese, & Karabarbounis, 2019) and the COVID-19 pandemic had negligible effects

on unemployment rates (Altonji et al., 2020; Bartik et al., 2020; Petrosky-Nadeu & Valletta, 2021) and reduced poverty (Chen & Shrider, 2021). These studies do not focus on racial/ethnic differences in outcomes.

Without access to unemployment insurance to mitigate the economic and health effects of job loss, particularly during recessions, the risk of downward family economic mobility increases, potentially widening child opportunity gaps. One study found that only one-third of children with an unemployed parent lived in families that received unemployment insurance (Issacs, 2013). Yet several studies document challenges with the design of the unemployment insurance program (von Wachter, 2019) and access to benefits (U.S. Bureau of Labor Statistics [BLS], 2019). More than half of unemployed workers do not apply for unemployment insurance benefits; a much higher proportion of these workers indicated that their reason for not applying was thinking they were not eligible rather than having to deal with administrative hassles (Gould-Werth & Schaefer, 2012). These issues disproportionately affect unemployed workers without college degrees and Hispanic workers (Gould-Werth and Schaefer, 2012). Moreover, low-income workers, those arguably in most need of assistance, have a lower proportion of their earnings replaced compared with middle- and higher-income workers (East and Simon, 2020). The unemployment insurance program appears to better serve workers with higher education and income, thus exacerbating opportunity gaps.

Studies have found that Black and Hispanic children are more exposed to unemployment compared with their White peers (Parolin, 2020), since Black and Hispanic versus White workers have higher unemployment rates and longer duration of unemployment, even in tight labor markets (Aaronson, Barnes, & Edelberg, 2021; BLS, 2021). Structural factors such as hiring discrimination (Neumark, 2018), mass incarceration (Pager, 2003), and increased likelihood of being the first fired as the business cycle weakens (Couch & Fairlie, 2010) contribute to the persistent racial unemployment gap. Yet Black and Hispanic versus White workers were less likely to receive unemployment benefits prior to and during the COVID-19 pandemic (Nichols & Simms, 2012; U.S. Government Accountability Office [GAO], 2021). Many states, especially those in the South that have larger shares of Black and Hispanic residents, have made it increasingly difficult to access unemployment benefits and offer lower amounts and fewer weeks of benefits (Kofman & Fresques, 2020). Based on the evidence base, it has been recommended that the effectiveness of the unemployment insurance program could be improved by modernizing eligibility and administrative processes; making benefits more generous, particularly during recessions; and resolving budget shortfalls (Gould-Werth & Schaefer, 2012; Isaacs, 2013; von Wachter, 2019). To improve the effectiveness of unemployment insurance specifically for families, states could institute or expand a dependent

allowance targeting increased benefits to support for children during times of economic instability and heighted family stress (von Wachter, 2019). Given the greater barriers to access to unemployment insurance faced by Black, Hispanic, and immigrant workers, these policy improvements have the potential to help close racial/ethnic and income-based opportunity gaps.

Social Protection Policies

Federally funded social protection programs designed to supplement low job wages and limited employer-provided benefits have positive effects on both parents’ employment and children’s developmental outcomes (Boushey & Mitukiewicz, 2014). These programs provide direct income support in the form of tax credits to working families (e.g., the EITC and CTC), in-kind benefits to pay for food (the Supplemental Nutrition Assistance Program [SNAP]), and subsidies to help pay for child care (the Child Care and Development Fund), as well as programs such as Medicaid, which supplement the lack of health insurance in many low-wage jobs. The CTC is designed to provide income support to children, which also helps families make up for wages that have not kept pace with inflation, while programs such as the EITC and child care subsidies are associated with increases in employment and earnings among low-income workers (Ha, 2009; Ha & Miller, 2015; Hoynes & Patel, 2018) as well as reduced poverty (National Academies, 2019a). Yet despite these benefits, differential access to these programs can cause opportunity gaps. The CTC, for example, is contingent on employment and provides benefits largely to middle-income families, offering minimal or no benefits for the lowest-income families. Research on the recent expansion of the CTC, however, found that the revised program reduced poverty, food insecurity, and material hardship (Parolin et al., 2021) and did not reduce employment (Roll, Hamilton, & Chun, 2021).

Many social policies benefit the health of both adults and children (Osypuk et al., 2014), benefits that persist for children into adulthood (East & Page, 2020). An extensive literature review documented in two other reports of the National Academies established that the EITC generates significant improvements in child health (National Academies, 2019a,b; see also Braga, Balvin, & Gangopadhyaya, 2020). And studies of SNAP show that making eligibility criteria more inclusive for immigrants improves child health for this population over time (East, 2020). There has been less research on the CTC, but early evidence indicates that it has positive effects on reducing injuries and behavior problems when the tax credit is refundable and extended to families with low incomes (Rostad et al., 2020).

One of the above-referenced National Academies studies shows that a significant expansion of the safety net could reduce poverty overall by half and significantly reduce poverty among Black and Hispanic families

(National Academies, 2019a). However, children in immigrant families, who are largely Hispanic, are exposed to particularly large income-based opportunity gaps due to their exclusion from safety net programs; thus children in noncitizen families have much higher poverty rates compared with other children, yet they are excluded from the EITC even when they are U.S. citizens (Acevedo-Garcia et al., 2021a). Children in noncitizen families face not only the standard set of complex rules and administrative systems that all families face, but also additional barriers, such as categorical eligibility based on immigration status, stricter income eligibility, and reduced benefit levels (Heinrich, 2018; Acevedo-Garcia et al., 2021b).

State and Local Paid Family and Medical Leave and Scheduling Laws

As discussed earlier, since there is no federal guarantee of paid family and medical leave or sick leave, and no federal laws address employers’ unpredictable scheduling practices, some states and localities have passed laws to fill these gaps. With respect to paid leave, although rigorous research demonstrates that it positively impacts child and maternal health outcomes, women’s employment outcomes, and economic returns to employers, there is some evidence of small decreases in employment for one subgroup of younger women (out of multiple groups tested; Das & Polachek, 2015) and for women who used paid leave right after it was implemented in California in 2004 (Bailey et al., 2019). The positive impacts of paid leave detailed in this chapter largely outweigh concerns about lower women’s employment. However, more research is needed on the long-term impacts on women’s employment to identify any resulting gender discrimination by employers due to women’s potential need for maternity leave (Mathur et al., 2017).

With respect to unpredictable scheduling, a growing number of cities and one state have implemented laws designed to improve the predictability and stability of work schedules, mainly in the service sector. These laws bar employers from using irregular and unpredictable scheduling practices, including little or no advance notice of scheduling and inconsistent scheduling from week to week—practices that can increase income instability and make it difficult for parents to plan ahead for child care, take classes, or work second jobs. Oregon is the only state with a law on predictable scheduling. Six cities—San Francisco and Emeryville in California, Chicago, New York City, Philadelphia, and Seattle—have implemented ordinances barring such practices (Harknett & Schneider, 2020), and more than 12 cities have ongoing initiatives to pass such laws (Lambert, 2020). Typically, however, these ordinances apply only to large employers (e.g., in Seattle, establishments with >500 employees; Wolfe, Jones, & Cooper, 2018).

Since mid-2017, Seattle’s Secure Schedule Ordinance has required employers to post schedules at least 14 days in advance and pay employees additional compensation (called “predictability pay”) for each employer-requested schedule change that occurs after the original schedule posting (Harknett, Schneider, & Irwin, 2021b). Two years after the ordinance was implemented, a rigorous evaluation found an increase in the predictability of scheduling, predictability-related pay, job satisfaction, and employees’ overall happiness, and a decrease in employees’ material hardship (Harknett, Schneider, & Irwin, 2021a). No significant effect on psychological distress among employees was found.

Evidence is also emerging from Emeryville’s 2017 Fair Workweek Ordinance (FWO), which required two weeks’ advance scheduling notice and allowed workers to decline unscheduled hours without retaliation. Research using a difference-in-difference design found that the FWO significantly reduced scheduling unpredictability mainly by reducing surprise shifts and last-minute scheduling (Ananat, Gassman-Pines, & Fitz-Henley, 2022). The ordinance had some effects on labor market outcomes, including a decrease in the likelihood of working on any given day and an increase in the length of shifts that may have potential implications for earnings (Ananat, Gassman-Pines, & Fitz-Henley, 2022). The ordinance also had significant and positive effects on workers’ sleep quality, but no effects on parenting behaviors (e.g., losing temper) or child’s behavior (e.g., uncooperative, worrying).

State-level laws on paid family and medical leave and scheduling address the lack of federal policies focused on improving job quality. While there is strong evidence of the health impacts of paid family and medical leave, scheduling laws are more recent. Emerging research evidence on scheduling laws shows some effects on workers’ health but no spillover effects on parenting or child health. Both paid leave and scheduling laws require workers to negotiate time with supervisors, whether time away from or at work. Studies highlight that the nuts and bolts of scheduling laws can be complex; thus both supervisors and employees must know and understand the laws well enough to ensure that they are implemented correctly (Mitchell, Baumle, & Cloud, 2021). Since these laws are relatively new and localities may not be in full compliance, stronger health effects may emerge over time (Lambert, 2020). Moreover, since low wages and supervisor discretion are common in the retail sector, significant impacts of these laws on child health may be seen in that sector only with improvements in labor laws and the social safety net and even more advance scheduling notices (e.g., retail stores in Germany provide 6 months’ advance notice; Carré & Tilly, 2017).

Programs Designed to Supplement Low Wages and Limited Benefits and Promote Career Advancement

Funded by federal agencies and private foundations, a number of innovative community-based programs are designed to improve job quality by providing some combination of earnings supplements, access to subsidized benefits, career-specific job training, job placement, and support services. Some programs target low-income families with children, sometimes using a dual-generation approach (serving parents and their children), while other programs target workers without a high school degree. A recent review identified 52 programs targeting family economic security, low-wage employment, and child well-being, but many of these programs were pilots or in the early stages of development and have not been rigorously evaluated (Sama-Miller & Baumgartner, 2017). Since the committee’s focus is on identifying opportunity gaps in job quality that affect children’s resources and well-being, we summarize two approaches that have been evaluated using experimental or quasi-experimental designs and that showed positive impacts on employment and earnings, as well as health and well-being.¹

The first approach to improving parents’ job quality is based on supplementing low-wage full-time jobs and providing parents with support to help maintain their employment. The New Hope program, one of the earliest comprehensive programs designed to supplement poor job quality, operated in Milwaukee during the welfare reform era from 1994 to 1998. The program offered a combination of wage subsidies, income supplements (child allowance), work supportive benefits (subsidized child care and health insurance), a community service job if needed, and case management. The program’s design was premised on the idea that full-time work (defined as 30 hours per week) should not result in family incomes under the federal poverty threshold and that access to support services should not be administratively burdensome. New Hope supplemented wages from full-time jobs with a menu of benefits from which families could choose. More than half of New Hope parents were Black (55%), more than one-quarter were Hispanic (29%), and the majority were mothers (90%) (Huston et al., 2005). The program was evaluated using a randomized controlled design, and the

___________________

¹ During the 1990s, there were several rigorous evaluations of welfare-to-work programs that included some combination of education, job training, and support services. These studies found mixed impacts on parents’ employment and children’s outcomes (National Academies, 2019b). Given the significant decline in families’ participation in the welfare program (Temporary Assistance to Needy Families), the results of these evaluations are less relevant today since they are focused on the impact of imposing work requirements to receive public benefits rather than on a comprehensive and intentional strategy for improving job quality and children’s outcomes. The negative outcomes found by the evaluations of welfare-to-work programs led the National Academies’ Committee on Vibrant and Healthy Kids to recommend eliminating those work requirements (National Academies, 2019b).

evaluation identified short-term positive impacts during the program and longer-term impacts three and five years after the program had ended.

The New Hope evaluation found significant impacts on employment, earnings, and poverty reduction during the three years of program operation that lasted beyond program participation for families with low to moderate barriers to work (Miller et al., 2008). The program also reduced adults’ depression and improved their physical well-being (Miller et al., 2008). Positive effects were observed on children’s academic performance (reading), positive behavior, and enrollment in child care and structured activities, and these effects lasted three years after the program ended (Huston et al., 2005). Five years after the program ended, new findings for children emerged. Children were less likely to repeat a grade, receive poor grades, or be placed in special education (Miller et al., 2008). Generally, the effects were stronger for boys than girls. For example, boys in program group families, particularly Black boys, had positive future work orientation and employment experiences compared with the control group (McLoyd et al., 2011).

Other studies of employment programs that provided earnings supplements found similar positive effects on employment and children’s achievement (Duncan et al., 2009). Taken together, the findings for New Hope and programs that subsidized low wages suggest that ensuring earnings for full-time work that are above the federal poverty threshold is effective at helping to improve job quality and children’s health in low-income families. For families at the lowest end of the income gradient, studies found that employment-focused programs not providing comprehensive support had negative impacts on parents’ mental health and resulted in less use of formal child care (Alderson et al., 2008). An employment-focused approach that does not provide child care and other benefits and supports for parents’ emotional and psychological well-being may therefore be insufficient to improve parents’ job quality and will not address opportunity gaps, particularly for children living in families with the lowest incomes.

The second approach to improving job quality uses a sectoral strategy that provides training and connects workers to jobs in specific high-demand industries. Sectoral job training programs generally target workers (who may or may not be parents) who are younger (aged 18–24) and do not have education beyond high school, or they target low-income parents while simultaneously providing services to their children (a two-generation approach). These job training programs have been implemented in the health care, information technology, and manufacturing sectors.

There have been several experimental evaluations of sectoral job training programs that include screening, placement, and wraparound services for workers who met preenrollment criteria (ranging from minimum educational attainment to drug screening). Not all of these programs target parents. A recent review of the evidence found that four multisite programs

(WorkAdvance, Project Quest, Year Up, and sites included in the Sectoral Employment Impact Study) have significant impacts on gains in earnings (12–34%) that are sustained long after program participation (Katz et al., 2022). More than 75% of participants have been Black and Hispanic workers, suggesting that these programs can help improve racial/ethnic disparities in job quality.

One of the above sectoral training programs, Project Quest, is particularly relevant to reducing opportunity gaps associated with parents’ jobs, since more than 70% of participants had children at program entry. This program’s impact on annual earnings was found to be much higher for participants who had at least one child under 18 compared with those who had no children (Roder & Elliot, 2019). Although the program does not track impacts on children, these findings highlight significant increases in resources available to children. Earnings gains far exceed the costs of the program and participants’ college attendance (Roder & Elliot, 2021).

In contrast to sectoral training targeted to adults, dual-generation programs target parents and children. CareerAdvance targets education and training services to parents with children enrolled in Head Start programs run by community action organizations in Tulsa, Oklahoma. Using a sectoral training approach targeting jobs in the health care sector, the program offers intensive services to support parents’ participation, such as tuition coverage, as well as in-kind services, such as after-school care or transportation, to offset wages lost while attending school. The program also coordinates parents’ and children’s schedules, and the same support staff work with both parents and children. The program’s goals are to improve economic outcomes, family dynamics, and children’s educational and health outcomes (Sabol et al., 2021).

While there have been fewer evaluations of dual-generation versus other sectoral programs, a quasi-experimental evaluation of CareerAdvance—a two-generation program that provides postsecondary credentialing and career training for parents of children enrolled in Head Start—found that parents were employed more in health care than in other sectors and had improved psychological well-being after one year of participation. After two years, parents had higher incomes and improved psychological wellbeing and physical health, and children had higher school attendance and lower chronic absenteeism (Sommer et al., 2020). Since children in both the treatment and comparison groups are enrolled in high-quality Head Start centers, the lack of significant differences in children’s educational and behavioral outcomes on average is not unexpected. Positive effects of CareerAdvance were found both among children who were less school ready as well as among children whose parents were more college ready (Sabol et al., 2019).

Employer Policies and Practices

There have been relatively few rigorous studies of employer practices that improve job quality and reduce employee stress, thereby improving parents’ mental health and work–family outcomes. The Work, Family, and Health Study and the Stable Scheduling Study are two group randomized controlled trials of interventions designed to improve employer practices. Both interventions were designed to improve health outcomes by reducing work–family conflicts, but they varied in approach and by sector.

Designed to promote employees’ control over work schedules and increase supervisors’ support for employees’ family and personal life, the Work, Family, and Health intervention targeted two different occupations and industries: professionals in the information technology (IT) sector and hourly service workers in nursing homes. Through facilitated discussions and supervisor training, the intervention aimed to redesign work to modify practices that cause stress in families and do not benefit productivity. For IT professionals, the intervention reduced turnover and had several beneficial impacts on social-emotional health, including lower levels of employee burnout, perceived stress, and psychological stress (Moen et al., 2016) and improvements in the functioning of parents’ biological stress systems (Almeida et al., 2018). Improved outcomes for working parents and children included more daily shared time for parents and children (Davis et al., 2015), increased positive affect among youth (Lawson et al., 2016), and modifications of adolescents’ negative sleep patterns (McHale et al., 2015). This example points to the potential for work quality interventions to address systemic issues in other sectors that impede family and child health. In contrast, for hourly workers in the long-term care sector who are paid lower wages than IT professionals and engage in hands-on work with patients, the intervention lowered cardiometabolic risk, but results across other health outcomes were mixed (Lovejoy et al., 2021). Psychosocial stress did improve, but only among employees who had significant elder care responsibilities (Kossek et al., 2019).

Designed to increase the stability and predictability of work schedules, the Stable Scheduling Study included two group-randomized controlled trials conducted in the retail sector (clothing stores). The first trial focused on changing one work practice—requiring managers to post the full month’s schedule at least seven days before the start of the month. The study found that this intervention did significantly increase the number of weeks and days schedules were posted in advance but had no effects on perceived stress, work–family conflict, or turnover (Lambert, Henly, & Kim, 2019). The second trial went further by giving workers two weeks’ advance notice of scheduling and eliminating all on-call shift work. At some stores in the intervention group, employees received a mobile application that enabled

them to easily swap shifts and a guaranteed minimum number of work hours. The intervention significantly improved productivity and employees’ sleep quality and physical health (symptoms of headaches, muscle pain, and stomachaches), but there were no significant differences in perceived stress and work–family conflict (Williams et al., 2018, 2019).

ADDRESSING OPPORTUNITY GAPS AND OUTCOMES IN EDUCATION

It is clear from the literature that expanding access to high-quality early care and education (ECE), followed by well-resourced, high-quality elementary experiences, has the potential to bridge opportunity gaps associated with children’s academic and learning outcomes in both the short and long terms (Pearman et al., 2019; Cascio, 2021; Bailey, Sun, & Timpe, 2022). Yet ECE programs remain insufficiently funded, and unable to serve all eligible children and families, to ensure equitable access to quality programs, and to support the competency and well-being of the ECE workforce (National Academies, 2018). The limited public investment in ECE has disproportionately impacted children of color and those from immigrant families, especially those from low-income communities. These shortfalls have been shaped in part by societal attitudes toward safety net spending and aid for people living in poverty, which in turn are entangled with racism, class bias, and a meritocratic ethos (DeParle, 2022). Contrary to such attitudes, however, the research evidence shows that strengthening safety net supports (income supplements) is associated with later average higher earnings, better health, and reduced criminal arrests (National Academies, 2019a).

Full Funding

Although adequate funding of education programs and policies is essential, it has never been realized in the United States in the early years or the early grades. As a result of funding shortfalls, existing programs never reach all eligible children, and for those that they do reach, quality is inadequate and uneven. Research has found that increased investments in Head Start and in K–12 education are positively associated with educational attainment and earnings, and negatively associated with the likelihood of poverty and incarceration (Johnson & Jackson, 2019). Research in the K–12 system similarly has found that school spending and school funding reform, the latter typically stemming from court mandates, are both associated with increased achievement, educational attainment, and even wages in adulthood (Candelaria & Shores, 2015, 2017; Hyman, 2017; Lafortune, Rothstein, & Schanzenbach, 2018). Importantly, Johnson and Jackson (2019) found that the effects of Head Start increase when participation is followed by

well-funded K–12 education, and that the effects on children of investments in K–12 education are magnified when children first participate in Head Start, pointing to the importance of the interconnectedness of these systems to children’s outcomes and of continuity in funding and quality experiences.

Remedying the many opportunity gaps caused by these inadequacies in funding will require significant new resources across the birth to age 8 continuum, and encompassing ECE, general education, and education for children with disabilities under the Individuals with Disabilities Education Act (IDEA). As discussed in Chapters 2 and 3, an essential component of a fully funded education system is a significant investment in the workforce, across age groups and settings, that guarantees compensation and benefits commensurate with credentials and experience. The current lack of full funding for education for children aged 0–8 points to the lack of a strategic national plan for supporting these young children. Considering the powerful role of adult–child interactions and relationships in children’s early learning experiences, it is clear that without this piece of the puzzle, quality in young children’s education will be unattainable, and opportunity gaps will remain.

Inclusive, Quality Standards

Most quality frameworks fail to include factors that uniquely affect the learning experiences of children from historically marginalized communities. But while these factors are rarely examined in the broader context of quality, they have an outsized impact on the experiences of children of color, those who are dual language learners, and those with disabilities (Meek et al., 2020). This gap can be filled by expanding quality frameworks to go beyond the traditional markers of quality, such as small class sizes and credentialed teachers. Research suggests that a new system, based in a core set of standards informed and driven by closing opportunity gaps, might include structurally safe and healthy learning spaces; low teacher:student ratios and small class sizes; inclusion of children with disabilities with fully funded and appropriate services and supports; culturally affirming and research-based pedagogy and instruction; bilingual learning (i.e., learning both in English and in the home language) for dual language learners; a supported, competent, and fairly compensated workforce; and attention to bias and racism in adult–child relationships and interactions. This reenvisioning of quality frameworks is relevant from the early years to the early grades and is critical if significant resources are to be dedicated to improving the quality of early education.

A Supported, Fairly Compensated, Competent Workforce

A previous study of the National Academies on transforming the ECE workforce notes that an inclusive model of ECE quality would expand on the conception of what constitutes an effective and competent early childhood educator. The ECE field has spent decades defining what such an educator should know and be able to do (Institute of Medicine [IOM] & National Research Council [NRC], 2015). A more inclusive definition of workforce quality could be applied to all early childhood educators, including home child care workers, regardless of what age group they serve, what funding streams support them, or what setting they work in while allowing for specialized skills needed for different program types (IOM & NRC, 2015). Research shows that early childhood educators need access to professional preparation and ongoing supports to meet this standard, and this is especially so for those with limited financial resources and those from communities of color, who experience systemic barriers to higher education and other career pathways (IOM & NRC, 2015).

Data, Monitoring, and Accountability

Accountability measures, including quality standards and use of enforcement mechanisms—such as federal offices for civil rights—together with technical assistance systems, can be used to close opportunity gaps. Indeed, the opportunity gaps discussed in this report will be closed only if states, districts, and programs identify and monitor existing gaps, adequately fund interventions to close those gaps, and implement accountability standards to track progress.

The federal government has traditionally funded services, although incompletely and imperfectly, for historically marginalized groups, such as through supplemental education funding (e.g., Titles I and III), Head Start, or IDEA. But accountability for failing to bridge opportunity gaps has been weak. Indeed, a lack of accountability for reducing disparities in outcomes across publicly funded programs is common and serves as a significant hindrance to progress (Meek et al., 2020). This lack of accountability manifests in program standards that do not address the unique experiences of children from historically marginalized communities, monitoring systems that do not look for inequities in experiences, and accountability systems that impose no consequences for failing to address and therefore maintaining inequities.

A well-documented example of this lack of accountability is school segregation. After Brown v. Board of Education was decided, the government issued desegregation orders, and as a result, integration, albeit flawed and incomplete, increased sharply. Yet several court cases in the past 40

years have reversed oversight and requirements first implemented in the period after the Brown decision, and different administrations over time have failed to prioritize civil rights enforcement, including on the issue of segregation. Today, schools are more segregated than they were in 1970 (Orfield & Frankenberg, 2014).

ADDRESSING OPPORTUNITY GAPS AND OUTCOMES IN PHYSICAL HEALTH

Disparities in health outcomes often begin in early childhood as the result of a number of factors previously described in this report. Addressing these factors can not only improve health outcomes for parents and young children in the short term but also promote more positive health outcomes across the lifespan. Variations in access to health care and healthy environments from state to state and within communities create substantial differences in how—and the extent to which—these factors negatively impact different groups of children to create opportunity gaps. This section highlights a number of policies, programs, and approaches that can be implemented to promote positive and equitable health outcomes for children and their families.

Improving Maternal Health and Birth Outcomes

California has successfully reversed trends in maternal mortality. Between 2006 and 2013, during a period of collaboration among the California Department of Public Health, the California Maternal Quality Care Collaborative, and the California Hospital Association, the state’s rate of maternal mortality dropped by 50%, even as the national rate continued to rise (Main, 2018). Research shows, however, that this decline did not include an overall reduction in racial disparities in maternal mortality and morbidity. Since that time, the California Maternal Quality Care Collaborative has launched the California Birth Equity Collaborative, and an evaluation of this collaborative is ongoing.

State policies have also begun focusing on ways to reduce adverse birth outcomes. One approach to this end is illustrated by Perinatal Quality Collaboratives (PQCs) and Maternal Mortality Review Committees (MMRCs). These statewide, multidisciplinary networks promote evidence-based clinical practices by bringing key stakeholders together, produce issue briefs and strategic plans, and convene symposia and other events. MMRCs operate at the state level to identify and analyze maternal deaths, disseminate findings, and develop recommendations. PQCs often serve as the “action arm” of MMRCs, translating MMRC findings into clinical reforms (Bellazaire & Skinner, 2019). Together, MMRCs and PQCs are thought to improve birth

outcomes through systemwide changes across a state. Involvement of state governments in these efforts includes participation of key leaders in PQCs; states can also use legislation to mandate and fund MMRCs. In addition, federal grants provide funding to establish and support existing MMRCs in states. Currently, most states have active PQCs and MMRCs (Prenatal-to-3 Policy Impact Center, 2020).

Another state-level approach to improving birth outcomes is participation in the Alliance for Innovation on Maternal Health (AIM), which works to bring efforts to improve maternal health at the national, state, and hospital levels into alignment (Mahoney, 2018). For example, AIM provides hospitals with toolkits and bundles of medical information—generally articles, guidelines, and educational documents—regarding evidence-based practices for improving specific patient outcomes. A bundle, for example, might address a particular medical cause of maternal mortality and morbidity (such as preeclampsia or obstetric hemorrhage). In contrast to a PQC, a toolkit or bundle is thought to improve birth outcomes not through systemwide changes but through adjustments to practices in particular hospital settings. To date, research on this approach is limited to observational studies; although research suggests that toolkits and bundles can help reduce maternal morbidity, more rigorous studies would help in drawing firm conclusions about causality.

Improved access to information and best practices in clinical and prenatal care for mothers has been shown to improve health outcomes for infants across U.S. states. The sharing and transmission of data, information, and research is an important foundation for healthy infant and newborn outcomes. Additionally, there is evidence that increased income for parents results in a reduction in adverse health outcomes and birth experiences. Studies looking at raising minimum wages and expanding the EITC have shown that these policies produce significant reductions in infant mortality and increased birthweights.

Medicaid

Numerous policies and programs can improve the health of birthing people during the prenatal period, birth outcomes, and well-being during the perinatal period, which in turn can have lifelong positive impacts on children’s health. One such policy is expanding income eligibility for health insurance, which research shows may improve birth outcomes (Prenatal-to-3 Policy Impact Center, 2021). Before Medicaid expansion, low-income women without children had more limited access to family planning services, preventive care before conception, and prenatal care in the earliest stages of pregnancy (Bhatt & Beck-Sagué, 2018). The ability of women and

birthing persons to access care during the preconception and interconception periods gives clinicians a window of opportunity to assess and treat health conditions prior to pregnancy, which can lead to safer and healthier pregnancies and births and thus reduce maternal and infant mortality, low birthweights, and preterm births (Bhatt & Beck-Sagué, 2018).

Although the income limit to qualify for Medicaid is higher for pregnant versus nonpregnant people, these differing income eligibility guidelines can cause interruptions in health insurance coverage around childbirth known as perinatal churn. As a result, access to care is often restricted during the postpartum period, which can exacerbate health disparities and negatively impact maternal health. There has been some effort through state Medicaid expansion to decrease the gap in Medicaid eligibility between nonpregnancy and pregnancy, thus reducing the numbers of individuals susceptible to perinatal insurance churn compared with the numbers in nonexpansion states (Daw, Backes Kozhimannil, & Admon, 2019; Searing & Ross, 2019).

Evidence shows that although state Medicaid expansions are not significantly associated with improved birth outcomes in the overall population, the expansions do help reduce racial disparities in preterm birth and infant mortality, as well as both overall rates of and racial disparities in maternal mortality (Prenatal-to-3 Policy Impact Center, 2021). One study found that state Medicaid expansion was significantly associated with a 0.1 percentage point reduction in the incidence of very low birthweight and a 0.4 percentage point reduction in preterm birth rates among non-Hispanic Black infants compared with White infants. A second study found 52.6 fewer infant deaths per 1,000 live births among Hispanic infants in Medicaid expansion versus nonexpansion states. A 2020 quasi-experimental study also found that Medicaid expansion was associated with 6.7 fewer maternal deaths overall per 100,000 live births; when disaggregated by race, the findings showed 16.3 fewer deaths among Black mothers, six fewer deaths among Hispanic mothers, and no significant impacts among White mothers. Thus, while the Medicaid expansion may not have observable impacts at the population level, it may have significant impacts for particularly vulnerable populations.

Nutrition Assistance Programs

Three programs—SNAP, the National School Breakfast and Lunch Programs, and the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)—provide nutritional assistance and improve outcomes for vulnerable children and families.

Supplemental Nutrition Assistance Program (SNAP)

Hoynes, Schanzenbach, and Almond (2016) found that every $100 in SNAP benefits saved families $70 of their own income that they would otherwise have had to spend on food but could now spend on additional resources for their children. About $30 of this amount went to additional food purchases, thus increasing total spending on food by 30%. The remaining money saved by receiving SNAP benefits was available for other household expenditures.

Receiving SNAP benefits also translated into improvements in child outcomes beyond nutrition. Children from households with SNAP benefits had observed improvements in attendance at school and at medical checkups (National Academies, 2019a). Other research found that receipt of food aid led to a significantly reduced incidence of low birthweight and improvements in infant health (Almond, Hoynes, & Schanzenbach, 2011). More recent research has shown that the loss of SNAP benefits for those who exceed the income threshold results in worse caregiver and child health, and also increases the incidence of food insecurity (Ettinger de Cuba et al., 2019).

An important extension of this analysis has been additional research following up on long-run outcomes for children affected by SNAP/Food Stamp benefits during their childhood. In one study, researchers found that the children had improved health outcomes as adults as well (Hoynes, Schanzenbach, & Almond, 2016), which suggests that improvements in household resources that enable improved nutrition translate into better long-term health for affected children. In fact, a recent National Academies study (National Academies, 2019a) found that SNAP improves birth outcomes as well as many child and health outcomes. And research has shown that the pandemic electronic benefit transfer (EBT) program reduced food insecurity by more than seven percentage points in at-risk households (Bauer et al., 2020).

National School Breakfast and Lunch Programs

While there are a number of nutrition-focused programs in the United States, research on their short- and long-term impacts is not abundant. One study (Gundersen, Kreider, & Pepper, 2012) used data from the National Health and Nutrition Examination Survey to investigate the National School Lunch Program (NSLP) which provides free and reduced-price lunches for children in pre-K and grades K–12—approximately 4.9 billion lunches were provided in fiscal year 2019 (pre-COVID-19; National Academies, 2016; USDA, 2022a). Gunderson and colleagues (2012) estimate that the NSLP reduced food insecurity by at least 3.8%, reduced poor health

in children by at least 29%, and reduced rates of obesity in children by at least 17%. Bhattacharya and colleagues (2006) found that the School Breakfast Program (SBP) improved healthy eating habits, increased the quality of calories consumed, reduced vitamin and mineral deficiencies, and improved the quality of diets for both children and their families, all of which could lead to better health and well-being for households with children who utilize the program. And recent research has shown that the pandemic EBT program, which provided food vouchers to cover the cost of meals for students while school was not in session, reduced food insecurity by more than 7 percentage points in at-risk households (Bauer et al., 2020).

For many students, there is well-documented stigma associated with using the NSLP and SBP; however, the program’s Community Eligibility Provision (CEP) may be a promising strategy for reducing this stigma (Radsky et al., 2022). Currently, a students’ family income is used to determine their eligibility to receive free or reduced-price meals at school. The CEP allows schools to offer free meals to all students, eliminating processes that differentiate between those who do and do not pay full price. Research suggests that universal provision of school meals—through the CEP or other universal meal programs—can increase student achievement (Kitchen et al., 2013; Gordanier et al., 2020; Ruffini, 2020; Schwartz & Rothbart, 2020; Radsky et al., 2022). A 2022 study of the implementation of the CEP in Oregon found that the program improved student nutrition, reduced administrative burden, and had a statistically significant effect on reducing student suspension rates by the third year of implementation. The protective effect on suspension was particularly pronounced for students from low-income families. The use of this program to reduce stigma highlights its potential value not only in providing meals but also in promoting equity in other domains (Radsky et al., 2022).

Special Supplemental Nutrition Program for Women, Infants, and Children

WIC provides healthy food packages, nutrition education, and breastfeeding support for low-income pregnant and postpartum women and children under age 5. In 2019, nearly 11 million people were eligible for the WIC program (USDA, 2022b). A review of the research on WIC (Carlson & Neuberger, 2021) found that women who participate in WIC have healthier babies compared with those who do not participate. The WIC program allows women to access more nutritious foods and improves infant feeding; specifically, WIC participants consume more high-quality, nutrient-dense foods. Mental development among children whose mothers participated in WIC was found to be higher than that among children whose mothers did not participate. Revisions to WIC in 2009 that improved the nutritional

content of the food package and added a fruit and vegetable voucher were shown to have improved dietary quality, birth outcomes, and child health (Tester, Leung, & Crawford, 2016; Hamad et al., 2019; Guan et al., 2021; Pulvera, Collin, & Hamad, 2022). During the COVID-19 pandemic, the value of the fruit and vegetable voucher was increased, although as of this writing, these benefits are set to expire.

The National Academies report Vibrant and Healthy Kids (National Academies, 2019b, p. 15) includes a recommendation that various levels of governmental agencies strive to remove barriers to participation for both WIC and SNAP. In particular, the report states that these benefits should not be conditioned on parental employment in families with young children or pregnant women—conditions that could reduce eligibility for these programs among the poorest families with the greatest need. At present, WIC take-up is high for infants (nearly 100%) but only 50% for women and 25% as children reach age 4. Moreover, WIC benefits expire when children turn 5, leaving many children without nutrition benefits and with worsening household food insecurity until they start school and qualify for reduced-price lunch (Bitler et al., 2022; USDA, 2022b).

Reduction of Environmental Contaminants

Multilevel approaches are required to address inequities in the distribution of environmental contaminants, including actions at the government, industry, community/clinic, and household levels (Schulz et al., 2016). A recent National Academies report (National Academies, 2019b) summarizes current regulatory approaches to addressing environmental factors and children’s health via existing government bodies, including the Centers for Disease Control and Prevention, Environmental Protection Agency (EPA), U.S. Food and Drug Administration, and U.S. Consumer Product Safety Commission. Several states have also asserted regulatory authority over particular environmental toxicants, including bisphenol A, cleaning agents in schools, and flame retardants (NCSL, 2017). The President’s Task Force on Environmental Health Risks and Safety Risks to Children has made recommendations in three domains: (1) strengthen environmental protection in ECE settings through expanded workforce training, program monitoring, and regulations; (2) support expanded or innovative models for training prenatal and childhood health care providers on screening, counseling, and interventions to prevent or mitigate toxic environmental exposures; and (3) encourage relevant federal agencies to continue to support and enforce efforts to prevent and mitigate the impact of environmental toxicants during preconception through early childhood (National Academies, 2019b).

In all three of these domains, it is important to incorporate civil rights approaches that promote racial equity in environmental justice. Such approaches can mitigate inequitable burdens, lower or remove barriers to community participation in decision making, and improve access to health and environmental benefits (USDA, 2012; National Academies, 2017). Such might include, for example, describing proposals in terms that are understandable to all, analyzing the benefits and burdens for high-risk subgroups and not just the population at large, and including low-income people and people of color in all steps of the process (National Academies, 2019b). In addition to these policy changes, there are downstream interventions for each of these three domains, as detailed below.

Allergens/Pollutants and Asthma

Interventions focused at the family/household level have the potential to reduce allergen- and pollutant-driven asthma triggers. These interventions are focused on improving indoor air quality and reducing allergens by, for example, providing mattress and pillow covers, high-efficiency particulate air vacuum cleaners and air filters, and cleaning; controlling cockroaches; and eliminating leaks and removing moldy items (Krieger et al., 2010). Such interventions have been found to reduce asthma symptoms and school absenteeism among children in both rural and urban areas, and are often carried out by home visitors or community health workers (Crain et al., 2002; Chew et al., 2003; Morgan et al., 2004; Levy et al., 2006; Crocker et al., 2011). Moreover, these interventions have been found to reduce disparities in asthma-related outcomes based on race/ethnicity and income (Postma, Karr, & Kieckhefer, 2009).

Lead

A report by the Health Impact Project (2017, pp. 3–4) includes the following recommendations for promoting community interventions to reduce lead exposure and disparities in exposure:

• Reduce lead in drinking water in homes built before 1986 and other places children frequent. Removing leaded drinking water service lines from the homes of children born in 2018 would protect more than 350,000 children and yield $2.7 billion in future benefits, or about $1.33 per dollar invested.
• Remove lead paint hazards from low-income housing built before 1960 and other places children spend time. Eradicating lead paint hazards from older homes of children from low-income families

• would provide $3.5 billion in future benefits, or approximately $1.39 per dollar invested, and protect more than 311,000 children.
• Increase enforcement of the federal renovation, repair, and painting rule. Ensuring that contractors comply with the EPA rule that requires lead-safe renovation, repair, and painting practices would protect about 211,000 children born in 2018 and provide future benefits of $4.5 billion, or about $3.10 per dollar spent.
• Reduce air lead emissions. Eliminating lead from airplane fuel would protect more than 226,000 children born in 2018 who live near airports, generate $262 million in future benefits, and remove roughly 450 tons of lead from the environment every year.
• Clean up contaminated soil.
• Improve blood lead testing among children at high risk of exposure, and find and remediate the sources of their exposure.
• Ensure access to developmental and neuropsychological assessments and appropriate high-quality programs for children with elevated blood lead levels.

It is important to note that, to support many of these initiatives, Medicaid can cover home investigations of lead exposures; case management for exposed children; and support to states for implementing education, screening, and outreach efforts in areas at high risk of lead exposure, although such programs would have to be applied at the local level (Tong, Artiga, & Rudowitz, 2022). In addition, greater collaboration with tribal nations is needed to improve state screening and registry efforts (President’s Task Force on Environmental Health Risks and Safety Risks to Children, 2016).

With more than 13 million preschoolers in child care every day, including six million infants and toddlers, child care settings are also critical sites with the potential for lead exposure (Amoah et al., 2016). These highly heterogeneous settings include individual homes, community centers, and office buildings, and licensing guidelines also vary greatly at the local level. Interventions addressing these settings could involve regulations and policies, as well as requirements for training child care workers in environmental risk assessment, which prior studies have shown to be effective for both lead and other contaminants (Amoah et al., 2016).

Other Environmental Contaminants

Multilevel approaches are also required to address inequities in the distribution of other environmental contaminants. These approaches could include improving manufacturing and industrial processes to minimize pollution, evaluating construction and urban development plans to reduce

dependence on automobile transportation, and involving communities in assessment processes to effect broader policy change (Schulz et al., 2016).

The only environmental exposure screening that receives Medicaid support is that for lead because of the magnitude, frequency, and duration of exposure; the significance of health impacts; and the potential for prevention (Honsberger, McCaman, & VanLandeghem, 2018). This could be an avenue of policy change for other environmental toxicants.

In summary, pollutants and environmental contaminants have potentially significant impacts on child health outcomes. These pollutants may also play a role in school achievement and attendance in the case of asthma or other chronic disease, and there are racial/ethnic and socioeconomic disparities in exposure and risk for children from vulnerable communities. Depending on the type of contaminant, potential solutions range from local community development and environmental cleaning efforts to local, state, and federal policies to legislate change.

HUMAN-CENTERED DESIGN AND POLICY DEVELOPMENT

In recent years, the application of human-centered design (HCD) principles and approaches has expanded at all levels of the social services domain. Service providers from different systems can adopt an HCD approach to establishing an effective family engagement framework as a way to improve their services. Policy makers, advocates, and agency staff with roles in designing and implementing policies can use HCD to ensure that their work centers on the needs and experiences of the user or consumer from the beginning so the policies will have the intended impact for children, families, and communities.

First applied to the development of consumer goods and online applications and websites, HCD is based on the premise that working with the stakeholders most directly affected by a particular issue is critical to develop the most effective solutions. The approach entails three phases: inspiration, ideation, and implementation (IDEO.org, 2015). In general, HCD turns on its head the notion that only trained “experts” should lead the design process, whether its intended outcome is a commercial product, a website, or the development or implementation of a policy.

Exploring how an HCD approach can be operationalized in a school, community, or policy context can inform the planning and implementation of authentic family engagement within processes, systems, and day-to-day practices. In the context of policy development and implementation, an HCD approach will incorporate the following principles:

• The approach goes beyond getting feedback from end users, instead collaborating with them as codesigners with equal decision-making power (Pahlka, 2018; Weeby, 2018). “In short, community voice without community leadership is significantly less effective” (Weeby, 2018, p. 10).
• The design process intentionally dismantles barriers to access to publicly funded services and benefits so policies can lead to equitable outcomes across race and ethnicity, linguistic group, socioeconomic status, gender, geography, and other social factors associated with unequal opportunities and outcomes (Pahlka, 2018).
• The design process involves multidisciplinary teams that include not only policy makers but also stakeholders such as design professionals, subject matter experts, policy implementers, and procurement and compliance professionals (Pahlka, 2019).
• Iterative processes and feedback loops are incorporated to improve policy design and implementation, driven by real-time, actionable data from user experience, allowing for “experimentation that can inform policy development with the knowledge of what’s actually working towards the original intent” (Pahlka, 2019, p. 6).

Applying an HCD approach to policy requires that policy leaders take additional steps to ensure that equity is at the center of the process. Otherwise, the work will exclude critical voices and result in policies and implementation processes that continue to create barriers for certain communities to access publicly funded services to which they are entitled. First, the definition of “end users” in HCD includes those whose voices are often not at the table and who face the greatest barriers to accessing services and benefits. Participation in HCD processes takes time, and involving users who happen to be able to engage will likely perpetuate the inequities in current systems (Weeby, 2018). Also, HCD processes need to “take into consideration the historical and social contexts within which many social ‘problems’ exist” (Weeby, 2018, p. 11). As discussed earlier, barriers to accessing publicly funded programs that can reduce opportunity gaps are as much a result of historical disinvestment and disenfranchisement of low-income communities and communities of color as of poorly designed or implemented policies. Neglecting this history will only lead to incomplete solutions, even when the “end users” are at the center of the process (Weeby, 2018).

To date, HCD approaches have been used to good effect in a number of public policy areas. Examples include designing the Centers for Medicare & Medicaid Services’ strategy for transferring health care delivery from a procedure-based to a value-based system (Sinai, Leftwich, & McGuire, 2020); creating prototypes of tools that school districts can test and adapt

to implement public school funding reform in California (Knudson, 2019); identifying key lessons and developing outreach materials to improve the implementation of paid family leave in New Jersey (Schulte, 2021; Zucker, 2021) and increasing participation in EITC programs in New York (Rodriguez et al., 2021).

Taken together, the experience thus far in applying HCD to the policy arena shows that the approach holds great promise for creating more equitable policies and implementation processes that address many of the causes of the opportunity gaps discussed in this report. A fundamental overhaul of the systems that have contributed to these opportunity gaps for children and their families is needed, and providers and policy makers alike need to bring families to the table as authentic partners in informing policies and systems. Only then will the shared responsibility for the learning and development of children translate to deep and sustainable impact.

PUBLIC–PRIVATE PARTNERSHIPS

Public–private partnerships are an increasingly effective approach for fostering multisectoral collaboration and leveraging the strengths of stakeholders from a wide variety of disciplines and sectors. Opportunity gaps exist across a number of domains. Many of the factors that drive opportunity gaps in education, physical health, and social-emotional development and well-being cut across these domains; a multisectoral approach will be required to reduce, mitigate, and eliminate them. Through public–private partnerships, the public sector, philanthropic organizations, private-sector businesses, and other stakeholders can combine and sustain efforts to address opportunity gaps more efficiently.

A number of states already use public–private partnerships to support programs, interventions, and services aimed at addressing disparities in outcomes in a variety of health, education, and developmental domains. For example, some of these partnerships have focused on increasing school readiness; funding the development of community-level early care, health, and education systems; increasing access to health services; providing parent education and family support to promote health and social-emotional health; and facilitating the alignment of foundation funding in such areas as school attendance, home visiting, and policy advocacy to promote improvements in outcomes for children (U.S. Department of Health and Human Services, 2014; NCSL, 2012).

Part of the committee’s task was to identify the potential roles, actions, and supports that would enable the philanthropic community to assist in addressing the opportunity gap. Public–private partnerships are one way in which philanthropic organizations can engage with other stakeholders to this end. Philanthropic organizations are well positioned to engage

communities at the national, state, and local levels to help deliver community-driven solutions for promoting equity across a variety of sectors. The 2017 National Academies report Communities in Action: Pathways to Health Equity highlighted a number of ways in which the philanthropic community could promote health equity—for example, supporting community organizing, building capacity, supporting enforcement of civil rights laws to target injustice, and prioritizing equity in the social determinants of health by investing in minoritized and low-income communities (National Academies, 2017). While the focus of that report was on health equity, many of these concepts and actions can be applied more broadly to promoting equity in education and social-emotional health and well-being as well.

Philanthropic organizations can take on a number of roles in efforts to reduce the opportunity gap. They can serve as conveners to bring together members of government, community organizations, and individuals to identify community needs; work within to communities to develop and fund grants to address local needs; create opportunities to develop leaders who can help sustain efforts and build capacity; develop, fund, implement, test, and scale promising interventions to promote equity; and fund research that focuses on the needs of groups experiencing the greatest disparities and builds the knowledge base needed to address the numerous opportunity gaps that exist across sectors. It is important to note, however, that philanthropic organizations cannot meet the demand for programs, services, and infrastructure alone. It is through partnership with other stakeholders—community members, employers, government, and other community institutions—that they can play a key role in addressing and responding to the needs of the communities and populations they serve and fostering and sustaining innovative approaches to promoting equity.

CONCLUSIONS

There is strong evidence that the social safety net reduces child poverty. Safety net programs are crucial for providing the resources needed to address the opportunity gaps discussed in this report, improving economic security, and countering structural racism. These programs include the EITC, WIC, SNAP, Medicaid, minimum wages, and paid family leave. Increased investment for support of these programs is associated with improved outcomes across a variety of domains. However, differences in state policies can create geographic disparities in the supports available through these programs, and administrative burden can limit access and exacerbate inequities. The complexity of programs and uncertainties related to eligibility, continued participation, and benefit levels create stress and insecurity within households. In addition, eligibility restrictions significantly limit the

ability of safety net programs to reduce opportunity gaps for children in Hispanic and immigrant families that could be mitigated by more inclusive eligibility rules and reduced administrative burden.

Because of the lack of comprehensive surveys, limitations of program administrative data, and the lack of program implementation studies, a number of equity-focused research questions about paid family and medical leave remain unanswered. A growing nonexperimental evidence base shows that parents’ poor job quality is associated with greater social-emotional issues for young children by raising parents’ stress levels. Black, Hispanic, immigrant, and low-income children have higher exposure to opportunity gaps associated with parents’ low-quality jobs. More comprehensive data sets that include measures of parents’ jobs and children’s outcomes are needed to understand how differential exposure to opportunity gaps in parents’ job quality affects differences in children’s health and education outcomes by income, race/ethnicity, and immigrant status.

Parental job characteristics are an often overlooked social determinant of health for young children. Recent rigorous studies demonstrate that the implementation of scheduling laws in the lower-wage retail sector leads to improved scheduling practices. Studies have found that scheduling laws have positive impacts on job satisfaction, overall happiness, and sleep quality, but null impacts on social-emotional health for adults or children. However, evidence suggests that inconsistent or unreliable work schedules can make it difficult for some families to meet the work requirements necessary for them to access safety net programs. Earnings subsidies, sectoral job training, and wraparound service approaches help improve parents’ job quality and can open doors for Black and Hispanic workers to enter higher-wage sectors; however, none of these approaches addresses structural issues such as racial discrimination in hiring, wages, or advancement. Thus, programs can potentially help reduce racial/ethnic opportunity gaps in parents’ job quality and psychological stress that influence children’s development, but more research is needed to test rigorously whether these strategies reduce gaps in children’s social-emotional outcomes.

Taken together, results from these interventions show that proactively changing employer practices with the goal of reducing stress from work–family conflicts can be effective in improving the social-emotional and physical health of working parents, which in turn positively affects children’s health. These studies also show that, to improve social-emotional outcomes, interventions need to be improved and tailored for parents who work in lower-wage occupations and in the service sector. These are challenging to redesign because of narrow profit margins and lean staffing (Kelly & Moen, 2020). Since Black, Hispanic, low-income, and immigrant working parents work disproportionately in the service sector and are underrepresented in professional occupations (Earle et al., 2014), opportunity gaps in job

quality by income and race/ethnicity will remain unless employer scheduling practices are improved.

Despite the number of programs and policies in the United States with the potential to close the opportunity gap, the complex system of these programs and policies is not equally accessible to all children and families—especially those who are in greatest need of services. Both state-to-state and intrastate variations in the implementation and funding of various programs and policies (e.g., Medicaid expansion, minimum wages, the EITC) lead to persistent inequities in outcomes for children.

REFERENCES

This page intentionally left blank.