Vibrant and Healthy Kids Aligning Science, Practice, and Policy to Advance Health Equity (2019) / Chapter Skim
Currently Skimming:
7 Promoting Health Equity Through Early Care and Education
7 Promoting Health Equity Through Early Care and Education
Pages 473-544
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 473... ...
, the early care and education (ECE) platform is a significant opportunity for health promotion and advancing health equity (see the committee's conceptual model, Figure 1-9, in Chapter 1)
|
From page 474... ...
Chapter conclusions in brief: •• For ECE programs to contribute significantly to a health promotion and eq uity strategy, there is a need to intentionally, cohesively, and simultaneously address adequate funding that supports comprehensive, evidence-based standards and practices that promote health equity in the ECE system, an adequately compensated and competent workforce, a connection to community resources and support, continuous quality improvement, and a systematic examination of effectiveness at multiple levels. •• Policies and systems that prepare and support early childhood educators and program leaders, including those in public schools, need to incorpo rate the latest evidence about how educators can better support children's school readiness and success by fostering their health and well-being.
|
From page 475... ...
Currently, eligibility for ECE programs is limited, and among eligible families, access is low due to lack of funding and availability of programs and services. Therefore, even if existing publicly funded programs have the resources to provide robust supports that improve young children's health and well-being, they will not reach most children, especially those who live in low-income households or experience adverse experiences and toxic stressors.
|
From page 476... ...
476 FIGURE 7-1 Conceptual framework: How ECE is linked to health promotion and health equity. SOURCE: Informed by Hahn et al., 2016.
|
From page 477... ...
. DIRECT LINKS BETWEEN ECE AND HEALTH EQUITY Health, social-emotional, and other health-related behavioral outcomes are some of the most commonly reported from evaluations of ECE programs, aside from the often-cited cognitive outcomes (Cannon et al., 2017; Carney et al., 2015; Fisher et al., 2014; Rossin-Slater, 2015)
|
From page 478... ...
In sum, there was consistent evidence that centerbased ECE programs improved educational and health-related outcomes for low-income and ethnic minority preschool-age children, with some indication of long-term outcomes.
|
From page 479... ...
−0.02) Assignment to 15.5 −0.28 (−0.49 to Yes Yes special education −0.08)
|
From page 480... ...
. Foundational Research in ECE The foundational studies of the HighScope PPP and Carolina ABC project provide the most robust findings regarding the link between ECE and health equity throughout the life course.
|
From page 481... ...
The HighScope PPP started in 1962 with a focus on serving 3- and 4-year-olds (it was 1–2 years long) with a home visiting component.
|
From page 482... ...
. This also had persistent effects when children were in their 20s, with children in the treatment group having better intellectual test performance and reading and mathematics test scores, more years of education, and a greater likelihood of being enrolled in college (Campbell et al., 2012; Frank Porter Graham Child Development Institute, 2012)
|
From page 483... ...
The effect seems to be more pronounced for boys and African American children. One reason that Head Start stands out among ECE programs with respect to impact on physical health outcomes may be that the program design includes a robust health component (such as requiring programs to provide diverse nutrition and health services, helping families receive physical examinations by scheduling screening appointments or offering screenings directly onsite, assisting families in applying for ageappropriate health care services, providing health promotion activities directly onsite, and tracking each child's health progress)
|
From page 484... ...
In 2016, the federal government released updated standards for Head Start (previously not updated since the authorization of the Improving Head Start for School Readiness Act of 2007) to reflect the latest research on child development and program quality.
|
From page 485... ...
Still, the promising results from large-scale, publicly funded pre-K programs, in light of the impacts that Head Start and New York City's UPK program have on young children's health outcomes, suggest that ECE programs that serve significant proportions of young children can be a platform for interventions that promote health equity. Home-Based Child Care Programs Home-based child care is regulated family child care and family, friend, and neighbor care (Porter et al., 2010b)
|
From page 486... ...
. Home-based child care also serves as a primary nonparental care arrangement for infants and toddlers (Corcoran et al., 2019)
|
From page 487... ...
, and internalizing and externalizing problem behaviors. However, mostly correlational data indicate that children in centers compared to family child care homes had higher cognitive, language, and school readiness scores but increased likelihood of contracting communicable illnesses and otitis media (ear infection)
|
From page 488... ...
Moreover, without a strategy such as a QRIS, ECE programs could have inequitable resources for improvement, exacerbating the variance of quality among programs and leading to inequitable outcomes for children, families, and communities. When funded adequately and supported as a unifying strategy for ECE, QRISs can raise the overall quality of the ECE system and create more equity across communities.
|
From page 489... ...
found specific standards, including a focus on nutrition (including standards) , physical activity and screen time limits, professional development for staff and teachers, and sharing information about nutrition and physical activity with families.
|
From page 490... ...
Families with children under age 3 who qualify for early intervention receive an Individualized Family Service Plan that defines goals and the types of services that will support the family and child. Children older than age 3 who are eligible for special education services under IDEA meet with school professionals to develop an Individualized Education Program to support their educational goals.
|
From page 491... ...
They matched pairs of dyads using propensity-score matching to reduce selection bias and estimate the effect of early intervention services on cognitive function trajectories. They found that service receipt was positively associated with children's cognitive functioning and trajectory and more maternal supports (e.g., mothers' report of emotional, informational, child care, financial, respite, and other support)
|
From page 492... ...
are used to gauge the impact of special education services on children's outcomes. In one study using propensity-score matching with data from the Early Childhood Longitudinal Study-Kindergarten Class (ECLS-K)
|
From page 493... ...
Analyses of ECLS-K data of multiyear longitudinal observations and extensive covariate adjustment for potential child-, family-, and state-level confounds showed that minority children were consistently less likely than similar white, English-speaking children to be identified as having a disability and so to receive special education services. From kindergarten entry to the end of middle school, racial and ethnic minority children were less likely to be identified as having learning disabilities, speech or language impairments, intellectual disabilities, health impairments, or emotional disturbances.
|
From page 494... ...
. Many reasons likely account for the mixed findings, including cross-sectional versus longitudinal data, national compared to state or local data, child- versus school-level data, special education category, and trying to equate white and ethnic minority children when the latter are more likely to experience larger risk factors for developmental delay (e.g., poverty)
|
From page 495... ...
. Food insecurity increases during the summer months, when children do not have access to NSLP, and the Summer Food Service Program could alleviate this problem.
|
From page 496... ...
They also inspired the design and implementation of large-scale, publicly funded ECE programs that the field continues to evaluate, improve, and refine over time -- many of which are discussed in this chapter. The evidence linking health equity to ECE programs and services, including Head Start, pre-K, early intervention, special education, and nutrition programs, is mixed.
|
From page 497... ...
How effective are ECE programs in providing such environments? Some reviews of ECE programs have found adverse effects on children's social behaviors, especially externalizing behaviors (D'Onise et al., 2010)
|
From page 498... ...
However, studies that examined different kinds of ECE or specific interventions in these programs reveal that ECE and public education can be vehicles for cultivating social-emotional skills and reducing bullying behaviors for older children through effective professional development, coaching, and use of evidence-based curricula. For example, an evaluation of the Chicago School Readiness Program shows that the combination of training in classroom management and job-embedded coaching helped Head Start teachers create more "emotionally and behaviorally supportive classroom environments" and reduced children's emotional and behavioral challenges and improved their EF skills (Raver, 2012, p.
|
From page 499... ...
The Early Childhood Consultation Partnership provides mental health consultation to ECE programs that serve children from birth through age 5 in Connecticut. Consultants work with early childhood educators for 8 weeks, at 4–6 hours per week, to improve the socialemotional environment of the classroom, behavior management strategies, and interactions and support for specific children with social-behavioral challenges.
|
From page 500... ...
programs showed that "students demonstrated enhanced SEL skills, attitudes, and positive social behaviors following intervention, and also demonstrated fewer conduct problems and
|
From page 501... ...
(2015) found that ECE programs that implemented "enhancements" or interventions that target specific social-emotional competencies were more effective at improving children's behaviors than those that relied on a "global" curriculum that addressed children's learning and developmental domains comprehensively.
|
From page 502... ...
In a qualitative analysis of six statewide or local early childhood mental health consultation programs, Duran et al.
|
From page 503... ...
The evidence described above suggests that early childhood educators are more effective at promoting social-emotional development when they have access to effective training and consultation and evidence-based curricula. But even with those supports, ECE programs and educators may lack the capacity to fully provide what children and families need, especially recipients who have experienced trauma, chronic stress, or adverse experiences.
|
From page 504... ...
. The Comer SDP was developed by James Comer and the Child Study Center at Yale University in 1968 to improve the educational experiences of low-income ethnic minority children.
|
From page 505... ...
. These examples all apply developmental science and aim to advance health equity during the preconception through early childhood periods.
|
From page 506... ...
Social-Emotional Learning, Trauma-Informed Care, and Suspensions and Expulsions Suspensions and expulsions in ECE or K–12 settings are often used as a deterrent for misbehavior, which could be due to many factors, including learning disabilities and social-emotional needs in response to trauma, chronic stress, and adverse experiences. "Suspension" is either out-of-school or in-school suspension, which often lasts from 1 to 10 days but varies across states and localities.
|
From page 507... ...
In child care centers, expulsion rates are 13 times what they are in kindergarten through 12th grade. These rates are particularly pernicious for black children, who are suspended and expelled at much higher rates than their peers.
|
From page 508... ...
and implicit bias training (see the section on supports for the ECE professional for an overview of both approaches to help address suspension and expulsion issues)
|
From page 509... ...
(2016) , ECE programs support a positive, enriching, and stable home environment through parents' participation in educational, social, health, and job training opportunities.
|
From page 510... ...
. As reviewed in the Parenting Matters report, some ECE programs "provide full- or parttime classroom-based services (center or family child care)
|
From page 511... ...
Participation in the CPC preschool intervention relative to the usual enrichment program was associated with significantly higher rates of school com pletion by age 24, significantly lower rates of juvenile arrest for both violent and nonviolent offenses, lower rates of school remedial services, stable employment, health insurance coverage, and lower likelihood of depressive symptoms (Temple and Reynolds, 2007)
|
From page 512... ...
(Pears et al., 2007, 2012, 2013) Two-generational model programs, such as Head Start, Project Redirection, New Chance demonstration, Ohio's Learning and Earning Program, Teen Parent Demonstration, and the Comprehensive Child Development Program from the 1980s and 1990s, offered mothers a wide range of services, including parenting classes, job training, mandatory schooling, and child care (Granger and Cytron, 1999; NASEM, 2016a; Polit, 1989)
|
From page 513... ...
Priorities include affirming parents' competence, increasing their access to information on child development, and reinforcing positive parenting practices" (Knoche et al., 2012; NASEM, 2016a, pp.
|
From page 514... ...
. These examples all apply developmental science and aim to advance health equity during the preconception through early childhood periods.
|
From page 515... ...
Home Visiting Evidence of Effectiveness identified many effective models that impact various outcomes, including positive parenting practices, family economic self-sufficiency, child health, child development and school readiness, and reductions in child maltreatment. Regarding positive parent practices, the review shows that while many individual evaluations of home visiting programs have shown impacts on parenting practices tied to positive developmental outcomes, the average impacts of home visiting on parenting practices are not large.
|
From page 516... ...
With new approaches to family engagement and support, such as the Two Gen 2.0 models, more actionable evidence is emerging about how best to support children and their families in the early years. LINKAGES BETWEEN ECE AND HEALTH EQUITY THROUGH SUPPORTS FOR THE ECE PROFESSIONAL The salutary effects that ECE can have on the physical, mental, and social-emotional health of children -- whether through the inclusion of comprehensive services, evidence-based curriculum, high-quality professional development and supports, or effective family engagement -- an be c disrupted if the ECE professionals themselves are not trained or supported to implement best practices or navigate systems of services for children and families outside the ECE sector.
|
From page 517... ...
Some of these areas are especially relevant to promoting young children's health and well-being, such as knowledge and skills related to working effectively with children who have experienced chronic stress, trauma, and adversity; collaboration with professionals in ECE or the education sector; promotion of self-regulation and related EFs; and support for DLLs. Incorporating these issues into efforts to improve policies, systems, and programs that prepare and support early childhood educators is critical to maximizing the potential of ECE programs to improve health outcomes and equity.
|
From page 518... ...
SOURCE: Child Welfare Committee, The National Child Traumatic Stress Network, 2013.
|
From page 519... ...
Evidence is emerging on the impact of implicit bias training, mostly from the public health and nursing sectors. One core feature of implicit bias training is cultural competence, which "is the process and ability of an individual or organization to function effectively within different cultural situations" (Betancourt et al., 2003; Cross et al., 1989; Gallagher and Polanin, 2015, p.
|
From page 520... ...
. These examples all apply developmental science and aim to advance health equity during the preconception through early childhood periods.
|
From page 521... ...
policies and practices to make progress on health equity. Chapter 4 discusses the role of culture as a contextual determinant of development.
|
From page 522... ...
. Devine's prejudice habit-breaking framework argues that implicit biases are deeply entrenched habits developed through socialization experiences (Devine et al., 2012)
|
From page 523... ...
There is also emerging evidence (Borntrager et al., 2012; Hydon et al., 2015) that when educators work with children who experience trauma and significant adverse experiences, whether in ECE programs or public schools, they can experience "secondary traumatic stress" (STS)
|
From page 524... ...
(2018) found that more formal professional supports, such as small group size and access to professional development or coaching, were not related to early childhood educators' experience of stress.
|
From page 525... ...
ECE CONCLUSIONS AND RECOMMENDATIONS Below, the committee provides conclusions and recommendations, based on the information reviewed in this chapter, to ensure adequate resources for ECE programs and educators, support and improve competencies for the ECE workforce, and improve access to ECE for eligible children. The goal of these recommendations is to advance the ECE system to promote health equity during the early childhood period to set the course for good health and well-being into adulthood.
|
From page 526... ...
It is also critical to consider the cost of funding programs to ensure that they reach all eligible children. Until that has been remedied, our nation will not maximize the potential of ECE programs to promote the health and school readiness of young children, especially those who tend to fall on the wrong side of the health equity equation (e.g., low-income children and children of color)
|
From page 527... ...
systems and programs, including home visiting, adopt a comprehensive approach to school readiness. This approach should explicitly incorporate health promotion and health equity as core goals.
|
From page 528... ...
• The Office of Child Care and the Office of Head Start at the federal level, along with state, local, tribal, and territorial early care and other education agencies, should assess the full cost of implementing standards that promote health outcomes and equity as described above, including support ing educators' own health and well-being, and work with Congress to align funding levels of the major federal ECE programs -- child care subsidy and Head Start -- accordingly. • Health and human service entities, the federal Early L earning Interagency Policy Board, state Early Childhood Advisory Councils, and federal, state, local, tribal, and territorial agencies that oversee home visiting and ECE programs should ensure greater programmatic coordina tion and policy alignment to ensure effective allocation of resources.
|
From page 529... ...
Recommendation 7-2: Building off the 2015 Institute of Medi cine and the National Research Council report Transforming the Workforce for Children Birth Through Age 8, the committee rec ommends that degree granting institutions, professional prepa ration programs, and providers of ongoing professional learning opportunities develop or strengthen coursework or practicums that focus on competencies of educators, principals, and early care and education program directors that are critical to chil dren's health, school readiness, and life success. Specific areas include • Strengthening professionals' understanding of and capacity to collaborate with professionals from other sectors, such as health and social work (interprofessional learnings)
|
From page 530... ...
Currently, eligibility for ECE programs is limited, and among eligible families, access is low due to lack of funding and avail ability of programs and services. Therefore, even if existing publicly funded programs have the resources to provide robust supports that improve young children's health and well-being, they will not reach most children, especially those who live in low-income households or experience adverse experiences and toxic stressors.
|
From page 531... ...
State pre-K programs are highly variable, and some will be better positioned to serve as a platform for promoting health equity than others. In the final analysis, the committee believes that among the major publicly funded ECE programs, Head Start's history, program design, quality standards, targeted populations, and evidence base make a useful platform from which to build expanded access to comprehensive high-quality ECE programs.
|
From page 532... ...
Based on its review of the evidence and committee expertise, the committee applies the evidence to provide recommendations in the areas of allocating adequate resources to support ECE programs and educators, supporting and training the workforce, and improving access to quality ECE for eligible children. By targeting these key areas that are instrumental to an effective and equitable system, the committee identifies a comprehensive approach to leveraging and enhancing the current ECE system to promote health equity.
|
From page 533... ...
2007. Child care and the well-being of children.
|
From page 534... ...
Chapel Hill, NC: The University of North Carolina, Frank Porter Graham Child Development Institute, Center for Early Care and Education -- Dual Language Learners. CBITS (Cognitive Behavioral Intervention for Trauma in Schools)
|
From page 535... ...
. Child Welfare Committee, National Child Traumatic Stress Network.
|
From page 536... ...
2013. Predictors of quality and child outcomes in family child care settings.
|
From page 537... ...
2016. Early childhood education to promote health equity: A community guide systematic review.
|
From page 538... ...
2011. Child care subsidies and childhood obesity.
|
From page 539... ...
2016. Expulsion and suspension in early education as mat ters of social justice and health equity.
|
From page 540... ...
2017a. Communities in action: Pathways to health equity.
|
From page 541... ...
2010b. A review of the literature on home-based child care: Implications for future directions.
|
From page 542... ...
2010. Parent engagement and school readiness: Effects of the Getting Ready intervention on preschool children's social-emotional competencies.
|
From page 543... ...
Berkeley, CA: Center for the Study of Child Care Employment, University of California, Berkeley. Whitehurst, G
|
From page 544... ...
Washington, DC, and New York: Society for Research in Development and Foundation for Child Development. Zakszeski, B
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.