From Neurons to Neighborhoods The Science of Early Childhood Development (2000) / Chapter Skim
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Pages 338-381
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From page 338... ...
Much of its diversity is related to differences in target groups from the broad-based agendas of health promotion and disease prevention, early child care, and preschool education to the highly specialized challenges presented by developmental disabilities, economic hardship, family violence, and serious mental health problems, including child psychopathology, maternal depression, and parental substance abuse. Within this context, the diversity among and within subgroups is as great as that across the general population.
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From page 339... ...
As its knowledge base has matured, the field of early childhood intervention has evolved from its original focus on children to a growing appreciation of the extent to which family, community, and broader societal factors affect child health and development. A natural outgrowth of this evolution is a recognition that individual programs are always delivered within a multilayered context, and that their effects are always moderated by the influences of more pervasive social, economic, and political forces.
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From page 340... ...
for families of children with disabilities popularized by Dunst (1985~; the developmental contextual perspective proposed by Lerner (1991~; the biosocial mode! adopted for an intervention targeting low-birthweight, premature infants by Ramey and colleagues (1992~; the principles of developmental psychopathology formulated by Cicchetti and Cohen (1995~; the social context mode!
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From page 341... ...
The buffering function of protective factors and sources of support enhances it. · Early intervention programs are clesigneci to affect children directly (through the provision of structured experiences)
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From page 342... ...
. In contrast to its rich and widely endorsed conceptual foundation, the empirical knowledge base on the efficacy of early childhood intervention is relatively uneven.
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From page 343... ...
· Short-term IQ gains associated with high-quality preschool interventions for children living in poverty typically fade out during middle childhood, after the intervention has been completed; however, long-term benefits in higher academic achievement, lower rates of grade retention, and decreased referral for special education services have been replicated (Barrett, 1995; Karoly et al., 1998; Lazar et al., 1982) , with reported longterm effect sizes ranging from 0.1 to 0.4 standard deviation (Ramey and Campbell, 1984; Schweinhart et al., 1993~.
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From page 344... ...
For example, the largest initial IQ gains were documented in the Milwaukee Project, which targeted lowincome, black mothers with intellectual limitations and offered full-day infant and preschool child care for the first five years of life, as well as parent education and job training Barber, 1 YS ~ )
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From page 345... ...
of the effects of early childhood intervention programs found that all four of the programs that showed a long-term impact on chronic delinquency had influenced multiple family risk factors in early childhood, including parent-child interaction. Nevertheless, these findings are suggestive, not conclusive, and comparable information on a broader range of interventions is necessary before meaningful conclusions can be drawn about which program components, and in which combination, are successful in promoting positive long-term social outcomes.
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From page 346... ...
Finally, unlike interventions for low-income children, programs for children with special needs are required to provide access to a designated array of professional services in natural environments, including those offered by educators, physical and occupational therapists, and speech and language pathologists (Harbin et al., 2000~. Beyond both the prescriptions of the law and the evolving conceptual and empirical foundations of the field, much of the knowledge base that shapes the current practice of early childhood intervention is based on professional experience.
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From page 347... ...
Traditional Emphasis on IQ and Early Skill Acquisition From its earliest beginnings, the field of early childhood intervention has focused considerable attention on the promotion of intelligence. Although there is still widespread interest in this objective, there is also a great deal of concern about the way in which this elusive construct is conceptualized and measured.
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From page 348... ...
Growing Interest in Underlying Functional Capacities Increasing numbers of early childhood investigators and service providers criticize conventional intelligence testing that relies on the administration of single instruments in standardized settings. Central to this concern is a belief that traditional cognitive measures are unrelated to the everyday context of children's lives, that they impose a linear orientation on a process that is typically characterized by spurts, plateaus, and extensive variability, and that they are particularly inappropriate when used to evaluate the competence of children with disabilities or youngsters who are reared in families that reflect nonmajority cultures (Meisels, 1996~.
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From page 349... ...
Among those that are of greatest potential interest are new methods of measuring mastery motivation, problem-solving strategies, and the ability to generalize learning from one situation to another (see Chapter 5~. Medium-Term Impacts on Subsequent School Achievement The War on Poverty in the 1960s and the establishment of a federal entitlement to early intervention services for infants and toddlers with developmental disabilities in the 1980s were both motivated by a belief that preschool programs for vulnerable children in the early years could enhance
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From page 350... ...
For example, no differences in either special education or grade retention were found in follow-up investigations of the Houston Parent-Child Development Center to age 11 (Johnson and Walker, 1991) or for the Syracuse Family Development Research Program up to age 15 (tally et al., 1988~.
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From page 351... ...
Follow-up studies of children served by ParentChild Development Centers indicate positive trends in reading, vocabulary, and language on the Iowa Tests of Basic Skills, but the differences did not reach statistical significance (Johnson and Walker, 1991~. At age 8, there were no overall differences on the Woodcock-Tohnson Test between the intervention and follow-up groups from the Infant Health and Development Program, but the heavier of the low-birthweight intervention group had significantly higher mathematics scores than a matching subset of the control group (McCarton et al., 1997~.
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From page 352... ...
Very few early childhood intervention programs have followed their sample into the adolescent and adult years. The most extensive data have been collected for graduates of the High/Scope Perry Preschool Program, which reveal statistically significant differences at age 27 favoring the intervention group over the controls in income and in rates of high school graduation, criminal arrests, and welfare participation, but no differences in teen pregnancy (Schweinhart et al., 1993~.
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From page 353... ...
Caregiver characteristics that promote healthy child development include warmth, nurturance, stability, predictability, and contingent responsiveness. Children's characteristics that influence the nature of their interactions with their caregivers include predictability of behavior, social responsiveness, readability of cues, activity level, and mood.
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From page 354... ...
reported that at least one-third of the families of children with a developmental disability are living at or below the poverty line. Notwithstanding the strong predictive validity of demographic markers, they have relatively limited utility as guides for designing effective interventions because they tell us relatively little about the causal mechanisms that explain their impacts on child development.
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From page 355... ...
as a measure of the caregiving milieu, and 8 of the 11 demonstrated at least some positive program influence. In addition, impacts on the quality of the home environment were assessed in four programs that combined home-based and center-based components, two of which (the Infant Health and Development Program and the Houston Parent-Child Development Center)
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From page 356... ...
Threats to Social and Educational Opportunity Beyond their threats to children's physical health and safety, certain characteristics of communities add further disadvantage by undermining a sense of opportunity or individual possibility, beginning in infancy and extending throughout childhood. Aspects of this burden include the adverse consequences of limited recreational facilities, inadequate child care, and substandard schools.
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From page 357... ...
Historical examples include institutions for young children with Down syndrome and cerebral palsy; contemporary models are best exemplified by Romanian orphanages and children living in extremely abusive homes dominated by severe mental illness and substance abuse. In both circumstances, research has demonstrated the devastating impacts of early and severe deprivation, as well as the remarkable capacity of children, both with and without biologically based disabilities, to recover from extraordinary developmental assaults if an alternative environment is provided as early as possible (Benoit et al., 1996; Provence and Lipton, Chapter 9~.
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From page 358... ...
Social Policies that Affect Families with Young Children Social policies often have considerable impact on the well-being of young children and their families, directly or indirectly, and by either commission or omission (Shonkoff et al., 2000~. Some, such as federally mandated early intervention and special education services under the Individuals with Disabilities Education Act and state-mandated child care regulations, are recognizable components of the early intervention arena.
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From page 359... ...
LESSONS LEARNED AND FUTURE CHALLENGES Essential Features of Effective Interventions Despite the methodological limitations of the existing science base and the marked diversity of disciplinary perspectives and program models that are represented in the research literature, a common set of essential features has emerged across a broad spectrum of early childhood intervention systems. These include a mix of both well-documented empirical findings and state-of-the-art guidelines based on professional consensus.
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From page 360... ...
of early childhood intervention. Consequently, there is little justification for an approach to program evaluation that asks generic questions about whether services are effective, in contrast to an assessment strategy that investigates the extent to which specific kinds of interventions have differential impacts on specific kinds of children in specific types of families.
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From page 361... ...
One year after program termination, child developmental gains persisted for 67 percent of the center-based programs and 44 percent of the home-based interventions. Research demonstrating differential effectiveness for specific subgroups of children and families further supports the need for individualization of services to ensure maximum impact.
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From page 362... ...
The research literature on child care provides abundant evidence of the positive correlation between quality of care and developmental outcomes for children (see reviews by Lamb, 1998; Love et al., 1996; Scarr and Eisenberg, 1993; and Smith, 1998~. Moreover, in the absence of subsidies, children from low-income families who are at greater developmental risk are more likely to receive lower-quality care (NICHD Early Child Care Research Network, 1997c; Phillips et al., 1987b)
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From page 363... ...
The nonrandom nature of the differences in program participation, however, precludes definitive interpretation of intensity effects. In two studies of a home visiting program for poor families with infants in Jamaica, one of which used a random assignment design, weekly visits were associated with higher child developmental test scores than biweekly visits, and children who were visited biweekly scored higher than those who received services at monthly intervals (Powell and Grantham-McGregor, 1989~.
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From page 364... ...
Moreover, it is most important to recognize that the only way to provide definitive answers to questions about the relative impacts of the timing, intensity, and duration of service delivery is to conduct randomized experimental studies on specific populations.
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From page 365... ...
Examples include infants with significant developmental disabilities with or without complex medical concerns, preschoolers with severe behavioral disorders, mothers with clinical depression, and families dealing with the stresses of poverty, marital discord, substance abuse, and recurrent domestic violence. Each of these types of problems typically requires a level of professional expertise that exceeds the generic skills of a child care provider, early childhood educator, child protective services worker, or nonprofessional home visitor.
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From page 366... ...
This tension between intervention models that view parents as the ultimate authority with respect to their children's interests and those that view them as requiring significant assistance demands highly skilled staff and creates a complex challenge for the early childhood field. Family-Centered, Community-Based, Coordinated Orientation The concepts of family-centered, community-based, coordinated services are firmly embedded in the professional experience and philosophies that guide all early childhood programs, from the generic child care facility to the most highly specialized intervention for young children with complex developmental disabilities or severely compromised living arrangements.
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From page 367... ...
Beyond the failure of existing policies and programs to ensure the identification and enrollment of all children and families who could benefit from available services, many early childhood intervention efforts experience significant participant attrition. For example, in one study of ParentChild Development centers, ~ / percent of the treatment group dropped out in the first year of the program (Walker et al., 1995~.
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From page 368... ...
Between 20 and 67 percent of all the families who enrolled in the home visiting programs reviewed left the program before it was scheduled to end (Gomby et al., 1999~. Significant dropout rates present problems for both service delivery and for the evaluation of intervention impacts.
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From page 369... ...
The importance of examining the design and implementation of early childhood policies and practices through a cultural lens cannot be overstated. All early childhood intervention initiatives, as described earlier in this chapter, are generally predicated on both a presumption of vulnerability (in the child or the family or both)
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From page 370... ...
For children, the presence of a biologically based disability, such as cerebral palsy or a sensory loss, requires an intervention strategy that incorporates knowledge about both normative child development and adaptation to a specific physical impairment. For mothers, the diagnosis of depression or a substance abuse problem adds an enormous burden to the normative stresses of parenting, and necessitates services that go beyond the provision of simple advice and support.
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From page 371... ...
Influencing and Assessing the Impacts of Postintervention Environments The demands of policy makers for evidence of long-term impacts as a result of investments in early childhood programs have put service providers and program evaluators in a difficult bind. Central to this dilemma is the widely endorsed assertion that effective early intervention services do not serve as inoculations that confer a lifetime of immunity against the adverse effects of later experiences.
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From page 372... ...
Moreover, the medium-term benefits of reduced grade retention and special education referrals can be quite large economically and could justify the initial costs of early intervention, even in the absence of longer-term impacts. Strengthening the Service Infrastructure Services to promote the health and well-being of all young children, as well as early intervention efforts for those who are developmentally vuinerable, cover a diverse and highly fragmented array of policies, programs, and funding sources.
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From page 373... ...
This shift has been embedded in a changing political climate characterized by reductions in taxes and appropriations for government social programs, Revolution of authority from the federal to state and local levels, and an increasing reliance on market solutions to address health and human services needs. In this context, early childhood intervention programs face a less forgiving environment that demands evidence of both measurable impacts and more efficient service delivery.
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From page 374... ...
, the Comprehensive Child Development Program ($8,600 per year for 5 years) , and the Infant Health and Development Program ($10,000 per year for three years)
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From page 375... ...
Advocates often ask how one can assign a dollar value to the lives that are saved by child care safety regulations, or to a boost in self-esteem for a child who avoids the stigma of assignment to a special education program. In contrast to the questions asked of cost-benefit analyses, some investigators conduct cost-effectiveness studies to avoid the problem of benefit valuation by simply comparing the relative costs of programs designed to meet similar goals (Barrett, 2000~.
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From page 376... ...
Details on procedures for the cost and benefit accounting method are provided by Schweinhart and his colleagues (1993~. Despite the value of the economic analyses that have been conducted on the Perry Preschool Program, several features of the intervention make it difficult to generalize from the findings.
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From page 377... ...
Thus, while a complete cost/benefit accounting considers all sources of benefits, it is important to identify to what extent the participants themselves are receiving the benefits. The long-term analyses of the High/Scope Perry Preschool Program clearly demonstrate that a very intensive early intervention program can produce benefits far in excess of its costs.
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From page 378... ...
CONCLUSIONS Early childhood interventions are provided under the auspices of a wide variety of policies and programs. These include high-prevalence services, such as child care and early childhood education, as well as targeted interventions for a range of vuinerabilities, including economic hardship, childhood disabilities, parental substance abuse, and child maltreatment, among others.
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From page 379... ...
The measurable effects of parent-focused interventions on standardized child development scores in economically disadvantaged families, however, are less conclusive, and there is little empirical documentation that nonspecific, general family support models for high-risk families, which typically are less expensive to deliver, have significant impacts on either parent behavior or assessed child performance. In the final analysis, there is considerable evidence to support the notion that mode!
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From page 380... ...
Nevertheless, there currently are few systematic data on the costs and benefits of intensive early childhood interventions, and almost none on the less intensive, real-worId services that are more likely to be implemented on a large scale. Practitioners and policy makers need careful evaluations of a broad portfolio of intervention programs, including both modest and intensive models, as programs with the largest impacts on children are not always the most practical to implement.
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From page 381... ...
IV Knowledge into Action
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