Closing the Opportunity Gap for Young Children (2023) / Chapter Skim
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Pages 284-330
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. Tertiary-level home visiting programs are typically therapeutic and are targeted at children and families that display mental health challenges.
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. Other home visiting programs may have a parent management orientation and coach parents to alter negative interaction patterns with their children.
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Program Strategies for Reducing Opportunity Gaps in Early Childhood Mental Health Mental health programs are another set of interventions designed to reduce the opportunity gaps and disparate mental health outcomes experienced by children and families from racially/ethnically and socioeconomically marginalized populations. The goal of infant and early childhood mental health programs is to foster the optimal social-emotional functioning of young children, specifically regarding the development of positive relationships with adults and peers, the expression and regulation of emotions, and the creation of a solid sense of identity and autonomy.
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IECMHC consultants may also collaborate with teachers and parents to create supports for children already showing challenging behavior, which may result in fewer child suspensions and expulsions. A growing evidence base is documenting the effectiveness of IECMHC at the child, teacher, school, and family levels (Brennan et al., 2008; Perry et al., 2010; Hepburn et al., 2013; Substance Abuse and Mental Health Services Administration, 2014; Center of Excellence for Infant & Early Childhood Mental Health Consultation [IECMHC]
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. School Nursing to Reduce Opportunity Gaps in School Strengthening school-based mental health systems and supports could help in addressing the growing mental and social-emotional health challenges seen in young children (Johnson, 2017; Kodzis, 2021)
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Prior to the pandemic, about one-third of student health visits to school nurses were related to mental health. As previously noted, students from minoritized populations face more barriers to accessing mental health treatment relative to other groups, and structural racism can exacerbate these conditions.
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. This unequal impact has likely increased the opportunity gap for young children, exacerbating disparities in their long-run outcomes.
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Active policies and support for accessing proven programs is necessary to help all children thrive socially and emotionally and to eliminate centuries-old inequities in opportunities that are responsible for disparities in outcomes in this realm. Although there are many promising practices that can help close this opportunity gap, unequal access to services and resources that promote positive social-emotional development and well-being remains a barrier to promoting equitable outcomes for young children.
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. Inequalities in use of specialty mental health services among Latinos, African Americans, and non-Latino whites.
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Early Childhood Research & Practice, 12(1)
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. The effect of paid family leave on infant and parental health in the United States.
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. Early Head Start and infant mental health.
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: Does home visiting prevent child maltreatment? National Institute of Justice.
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. Child–teacher relationship training as a Head Start early mental health intervention for children exhibiting disruptive behavior.
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. Maternal, Infant, and Early Childhood Home Visiting (MIECHV)
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. Mental health consultation in child care: Transforming relationships among directors, staff, and families.
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. Randomized trial of the healthy families Arizona home visiting program.
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Child Development, 82(1)
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. Impacts on family outcomes of evidence-based early childhood home visiting: Results from the mother and infant home visiting program evaluation.
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Available: https://www.schoolmentalhealth.org/ media/SOM/Microsites/NCSMH/Documents/Bainum/Advancing-CSMHS_September 2019.pdf National Home Visiting Resource Center.
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. Prevalence of autism spectrum disorders in Hispanic and non-Hispanic white children.
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. The role of infant and early childhood mental health consultation in reducing racial and gender relational and discipline dis parities between black and white preschoolers.
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. Expert convening on in fant and early childhood mental health consultation.
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. Social and emotional learning services and child outcomes in third grade: Evidence from a cohort of Head Start participants.
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6 The Economic Costs of the Opportunity Gap1 This chapter presents the committee's estimation of the economic costs posed by the opportunity gap, using traditional approaches from costbenefit analysis. These numbers, appropriately discounted, mark the upper bound of, or the maximum of, the benefit side of a calculation of the value of "investing in strategies, interventions, and policies to address opportunity gap concerns for children from birth to age 8," which was part of the committee's statement of task (Box 1-1 in Chapter 1)
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, provide representative calculations from the literature for three interventions, and present the conclusions that can be drawn from these findings. THE OPPORTUNITY GAP: COST ESTIMATES This section provides rough estimates of the economic costs of the opportunity gap that are due to mortality and morbidity as a percentage of gross domestic product (GDP)
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We note further that these different groups have different levels of low birthweight and preterm birth, which represent additional risks, so eliminating these
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If averting low birthweight, low gestational age, and other health differences at birth affects later adult earnings, one should count either the properly measured present discounted value of the lower birthweight or lower gestational age and other health differences or the positive carry-on effects of these improved outcomes, but not both. SHARE OF OPPORTUNITY GAPS AND THEIR COSTS THAT CAN BE AFFECTED BY POLICY The previous section presented some examples of calculations of the net savings to society from closing opportunity gaps, detailed some of the mortality differences across groups that would be eliminated, and described challenges with making even rough estimates for valuing benefits of these changes.
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But any program that will eliminate disparities must either leave advantaged children unaffected or have greater impacts on the disadvantaged groups. APPROACHES TO EVALUATING THE NET BENEFITS OF INVESTMENT IN MITIGATING THE OPPORTUNITY GAP Even though a specific policy intervention might prove to be highly effective in mitigating the opportunity gap, it may not be feasible if it incurs tremendous costs relative to benefits.
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For instance, studies on early childhood education programs such as Head Start report costs and benefits using the internal rate of return or the ratio of benefit to cost of a program (Heckman et al., 2010; Carneiro & Ginja, 2014)
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This section summarizes findings about the effectiveness of such programs in closing the opportunity gap. In addition, we provide findings from previous research about whether a certain welfare program generates a larger benefit than its cost based on MVPF estimates.
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A large body of literature on the effects of the SNAP/Food Stamp program provides valuable information about its effects in closing many aspects of the opportunity gap. SNAP currently provides a voucher that can be used to purchase food by low-income families that have gross incomes below 130% of the federal poverty threshold or otherwise satisfy gross income limits and have net incomes below 100% of the federal poverty threshold.
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Reducing the Opportunity Gap Due to Inequitable Access to Health Care and Health Insurance through Medicaid Since being established in 1965 and gradually adopted by states, Medicaid has provided basic health insurance to low-income individuals. Medicaid coverage was closely tied to AFDC participation until the early 1980s, but eligibility dramatically expanded to a broader population (Hoynes & Schanzenbach, 2018)
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. The above findings imply that the early-life intervention of the Head Start program has been effective in mitigating opportunity gaps in education, earnings, and health across income and racial groups.
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Focusing on gains in the accumulation of human capital and improvement in economic selfsufficiency, they estimate that the Head Start program generates positive fiscal externalities by reducing public assistance expenditures and increasing tax revenue (from approximately $576 to $2,331 annually per program participant) as a result of the additional wages earned by the exposed children.
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. [Economic costs of the Opportunity Gap]
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. Reducing inequality through dynamic complementar ity: Evidence from Head Start and public school spending.
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. Third grade follow-up to the Head Start impact study: Final report.
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, 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)
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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)
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. 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)
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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)
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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.
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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.
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. 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.
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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%)
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