- Email: [email protected]
Meeting children's basic needs: Introduction
Children and Youth Services Review 32 (2010) 1133–1137
Contents lists available at ScienceDirect
Children and Youth Services Review j o u r n a l h o m e p a g e : w w w. e l s ev i e r. c o m / l o c a t e / c h i l d yo u t h
Introduction
Meeting children's basic needs: Introduction
Policies and programs that address children's well-being have been tremendously successful in helping to reduce teenage pregnancy rates, improve school readiness, and cut cigarette smoking by youth (Child Trends, 2010; Center for Disease Control & Prevention, 2009). Despite these successes, serious problems persist. Even the most innovative programs show promising but short-lived effects and are often not powerful enough to permanently improve children's life trajectories and break the intergenerational transmission of poverty (Schweinhart, 2006; Smedslund et al., 2006). Moreover, infant mortality rates remain stubbornly high (Dye & Johnson, 2009), children's mental health needs have gone unmet (Stagman & Cooper, 2010), the proportion of children in poverty has increased since 2000 (Moore, Redd, Burkhauser, Mbwana, & Collins, 2009), and almost 40% of children live in unaffordable housing, nearly double the rate in 1975 (Newman & Holupka, 2010). Such statistics bring into sharp relief the problems yet to be addressed. Moments of political change offer an opportunity to reflect on policies, take stock of what we have accomplished, assess how much more needs to be done, identify gaps in our knowledge, conduct the research needed to fill those gaps, and set our sights on policy directions that appear most fruitful. We conceived of this volume at the point of transition from the Bush to the Obama Administration, and devised it to critically assess how well low-income children's basic necessities of life are being met, with a focus on the unfinished business facing policymakers and researchers. The articles cover the major federal policies designed to meet children's basic needs including income (Gennetian, Castells, & Morris), health (Russ, Garro, & Halfon), food (Nord & Parker), housing (Leventhal & Newman), early care and education (Magnuson & Shager), and primary through secondary education (Pallas). Taken together, the six articles expertly survey the best thinking about children's fundamental needs and raise key questions that must be addressed if we are to make progress. While each topic has a unique history and body of knowledge, a valuable by-product of assembling a volume of papers on diverse aspects of children's basic needs is the cross-cutting themes that emerge. These themes gain added policy and research heft specifically because they apply to all, or nearly all, of the needs examined in this volume. They are, therefore, the focus of this introductory article. We start with a review of cross-cutting policy themes, followed by an overview of remaining research challenges. 1. Cross-cutting themes 1.1. Underutilization of programs Meeting children's basic needs is much harder if families do not sign up for relevant assistance programs or otherwise fail to claim the 0190-7409/$ – see front matter © 2010 Elsevier Ltd. All rights reserved. doi:10.1016/j.childyouth.2010.05.004
benefits these programs provide. The Office of the Assistant Secretary for Policy and Evaluation of the U.S. Department of Health and Human Services estimates that only 29% of the more than 8 million eligible children 0–12 years old received subsidized child care (Magnuson & Shager). Perhaps as few as 40% of children covered by health insurance had a preventive care visit within the last year; only about 20% of 2 to 5 year olds visited a dentist in the last year; and less than half of 2 year olds are fully immunized (Russ, Garro & Halfon). More than one-fifth of households with children were “food insecure” in 2008, despite the availability of multiple food assistance programs (Nord & Parker). Underutilization is pronounced among Latino and immigrant families, who may fail to understand their eligibility or be reluctant to participate because of distrust or language and cultural barriers. But lack of utilization is not necessarily the same as underutilization. In the case of early childhood education and care, as Magnuson and Shager note, some families may not need child care and others may rely on informal support. In those instances, we must ask to what extent such circumstances reduce the estimated underutilization, and what else accounts for the underutilization that remains. For health care, Russ, Garro and Halfon note that having health insurance is generally associated with fewer unmet health needs. A fundamental goal of the expansion of insurance for children under the Patient Protection and Affordable Care Act1 is to even further reduce unmet needs.2 But the authors point out that health insurance alone does not guarantee access to affordable, appropriate, and high quality care. Large gaps in the receipt of needed services are particularly likely for some types of care, such as developmental services, regardless of insurance coverage. For food assistance, some families – for example, those in which the parents are employed – may not realize they are eligible. Others may know they are, but the benefits for which they would qualify are too low to be worth the cost and hassle of applying.3 And, some may be discouraged from participating because of the stigma associated
1
PL 111–148, March 23, 2010. At this writing, health reform has just become law and experts are unclear about its effects on children's health insurance coverage and access to care. It is expected that more children will be covered, but children now covered by the Children's Health Insurance Program could experience a reduction in benefits. The provision to raise rates for Medicaid primary care physicians will likely assist children who are seriously ill and require specialists. How the health care exchanges will affect access is completely speculative at this point (Scanlon, 2010). 3 The “hassle factor” also contributed to households dropping off the Temporary Assistance for Needy Families rolls in states with requirements such as attending orientation sessions (e.g., Kalil et al., 2002). 2
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Introduction
with receiving “welfare.” There is also the possibility that participation is underreported (Nord, 2010a). Of greater concern is the estimated 80% of low-income households with food insecurity among children participating in one or more of the three largest nutrition assistance programs: the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), school lunch, and the Supplemental Nutrition Assistance Program (SNAP) (Nord, 2010b). The underutilization problem will be solved not by expanding current programs but by understanding these programs better and correcting impediments to access and participation. This may require a clearer understanding of the populations being served. It also may entail redesigning programs and how they are implemented. Gennetian, Castells and Morris, for example, write about the effectiveness of automatic enrollment in increasing take-up rates in social programs among eligible families. 1.2. Insufficient program coverage Another problem that is related to but distinct from program underutilization is inadequate program coverage. With the exception of primary education, where children's needs are met universally, most of children's basic needs are addressed on a means-tested basis. That is, family income – specifically poverty status or some variant of it – is used to determine eligibility for program assistance. Because food aid and health care are considered entitlements, eligibility guarantees access to program assistance. However, eligibility does not guarantee access to income assistance, housing subsidies, or early care and education. For example, as Magnuson and Shager report, just about half of poor preschool-age children were enrolled in Head Start in 2007. Although some of this discrepancy between children's needs and program coverage may be due to families' use of other sources of care and education such as state pre-K programs, this lack of coverage is primarily driven by families' needs outpacing program funding. Leventhal and Newman present an even more striking picture for housing: Only about one-quarter of eligible households receive federal housing assistance. Waiting lists in many jurisdictions are either closed or contain thousands of names, offering scant hope that most on the list will be served. Shortage of program coverage is likely to remain a persistent policy problem, although states may alleviate it by continuing to close federal gaps in program funding. For example, the past decade has witnessed great expansion in state pre-K programs to complement Head Start. For health care coverage, states have supplemented Medicaid with the State Children's Health Insurance Program (CHIP). Both of these programs have succeeded in expanding program coverage. Yet, inadequacies persist in areas such as housing assistance and those subject to underutilization. 1.3. Subgroup disparities Across all basic necessities of life, the degree to which children's needs are met varies systematically by socioeconomic status (SES). Children from lower SES families fare less well than children from higher SES families. This SES gradient underlies the means testing for benefits in every domain of a child's life reviewed in this volume with the sole exception of public education (a universal benefit). Virtually all authors report progress in reducing at least some SES disparities, including childhood mortality, physically inadequate housing, food insecurity, differential performance on some standardized tests of academic achievement, and even income itself as a specific result of the Earned Income Tax Credit.4 But all authors also report the 4
There is no solid evidence on whether there has been an improvement in lowincome children's participation in “quality” pre-K programs. While enrollments in preK and Head Start have increased, the variability in the quality of these programs means we cannot infer that quality has also increased (Magnuson, 2010).
stubborn persistence of other SES disparities. These include the rate of pre-term births, eighth-grade reading scores, enrollment in early education programs, and living in affordable housing. Differences by race and ethnicity also pervade children's needs, with racial and ethnic minority children faring less well than non-minority children. Yet there is surprising variation in the extent to which these differences are mitigated by SES. For example, disparities in SES account for only some of the gaps in children's health outcomes between race and ethnic groups, while they appear to account for a much greater share of food insecurity. As Gennetian et al. point out, high on the agenda for future policy research is an improved understanding of how money matters. This turns out to be a greater mystery than early models of the predictors of unmet needs recognized. A striking example is provided by Leventhal and Newman's discussion of the effects of housing affordability on children's well-being. The policy argument for making housing affordable is essentially an income issue; that is, making decent housing “affordable” gives a household more spendable income for other household needs, just as a direct income supplement would. Yet, statistical models using rich, longitudinal data find no beneficial cognitive, behavioral, or physical health effects on children as a result of affordable housing. Perhaps many low-income families living in affordable housing are not spending their added discretionary income on their children. There is also evidence that, as with poverty, the dynamics of housing unaffordability may play a role, because housing unaffordability is more of a temporary than a persistent status for most low-income families. Future research is needed to sort out these and other possible explanations. Since SES is not the only culprit, research is required to develop a deeper understanding of the causes of subgroup differences beyond socioeconomic disadvantage. Included here are differences by race and ethnicity, age, gender, and family composition. The question is not only why differences in child well-being exist, but also why differences exist in the effectiveness of programs to meet the needs of children in these different subgroups. Contributors to this volume point to a variety of policy mechanisms that could reduce SES disparities. One approach is to place a premium on the quality of programs and services provided by public programs. Both Magnuson and Shager and Pallas contend that ensuring classroom quality in the early and later year childhood years is a major program challenge. A similar concern is echoed by Russ, Garro and Halfon about the quality of health care for low-income children, and by Nord and Parker, who call for a greater focus on the quality and variety of children's food intake rather than the quantity. Quality is essential for moving beyond the mere satisfaction of minimum needs to the promotion of genuine child health and development. The private sector has become an increasingly salient player in the social safety net through the support of charter schools that seek to provide higher quality education than local public schools (see Pallas). A second approach involves minimizing disparities by targeting children and their families during the early periods of child development. Not only do young children appear to be especially vulnerable to deprivation, but lack of intervention or appropriate support may have life-long consequences. Growing research evidence in this area has helped fuel widespread support for early care and education (as reviewed by Magnuson and Shager), availability of medical care that begins prenatally (as described by Russ, Garro & Halfon), and food programs such as WIC. 1.4. An integrated approach to children's needs Bronfenbrenner's (1979) ecological model of human development formalized the conceptualization of the multiple contexts in which children are embedded and that influence their development. Every article in this volume sees its topic as only one of the many influences on children's lives. In their article on early education, for example,
Introduction
Magnuson and Shager note that even if children attend the highest quality pre-K program, what they gain could be undermined by a chaotic family environment or by subsequent inadequate schooling. Pallas reflects on primary and secondary schools as part of a “web of social institutions” including family, medicine, the economy and the criminal justice system. Russ, Garro and Halfon's life course health development model explicitly recognizes that health is the outcome of factors operating in multiple contexts including genetic, biologic, behavioral, social and economic influences. Gennetian, Castells and Morris call for a holistic theory of the role of income in children's lives to better understand the comparative importance of income, the family environment, parenting, and schools. The predictors of children's food insecurity presented by Nord and Parker also cover children's multiple contexts including housing, family, and economic resources. The one concrete example of an attempt at policy integration at the federal level in this volume appears in the housing article. Leventhal and Newman recount how, in the 1960s, the U.S. Department of Health, Education, and Welfare – the predecessor of Health and Human Services – took the lead in calling for an integrated approach to housing that would address tenants' wide ranging housing, social, and economic needs. Akin to others in this volume, Leventhal and Newman's conceptual framework, albeit parsimonious, nonetheless includes pathways to child development outcomes via multiple contexts that define a child's world. Although the ecological model has strongly influenced the way generations of researchers conceptualize the mechanisms through which children's contexts affect their well-being, a comprehensive model that encompasses all contexts has never been tested. One obstacle is sheer complexity. How these influences play out may be direct or indirect, linear or nonlinear, recursive or non-recursive, interactive or non-interactive, or some as yet unknown combination of these. Another impediment is the lack of data sufficient to the task. At a minimum, detailed measurement is required for each context and each child, following children and their families over time. As noted below in our discussion of research challenges, an additional barrier is the constraint on drawing causal inferences from observational data, on one hand, but the lack of clarity, at this stage of our understanding, about the most promising hypotheses to test experimentally, on the other. This combination of methodological and conceptual problems is an adaptation of what Pallas calls “weak technology”. Some direct policy implications follow from an integrated approach to children's needs. Like much of the existing research, basic needs policies focus mainly on a single domain. As a result, critics fault a lack of coordination across programs and even within individual programs. For example, are child care vouchers intended to support mothers' employment or promote children's development by providing quality early care and educational experiences? A related concern is that uncoordinated programs for children and their parents can compromise child well-being. For instance, Temporary Assistance for Needy Families, a major cash assistance program, requires parents to be employed as a prerequisite for assistance. At the same time, parents have no guaranteed access to child care assistance. Such inconsistencies among basic needs programs typically arise from their siloed funding streams. A well-noted exception is Head Start, which provides children with early education and physical, mental, and dental health services, and further provides parents with education and employment services. In addition, block grants, which give states funds to spend at their discretion within designated federal guidelines, are intended to improve coordination across assistance programs. One recommendation provided by several authors of this volume is to provide a menu of options or “cafeteria style” services (Gennetian, Castells & Morris) to meet the specific needs of both the family unit and its individual members. Gennetian, Castells and Morris offer an example of such an approach. The New Hope Program, launched as a demonstration prior to welfare reform, offered employment training for parents in addition to child care subsidies and support for family health care (Duncan, Huston, & Weisner, 2007).
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Several authors mention research initiatives that are attempting to build the knowledge base. Beyond these efforts are four noteworthy collaborations in process or soon to be launched. The first is the National Children's Study, which will follow more than 100,000 children from before birth until age 21 to determine how the different environments that are relevant to children's development interact to affect their health.5 Although the study currently focuses on the effects of environmental exposures on children's health, the ultimate goal is to add supplementary modules on other topics over time. Another recent research initiative, now in the design stage, is the MacArthur Foundation Network on Housing and Families with Children. Under this project, an interdisciplinary team will investigate how children's multiple social contexts affect child outcomes. The study uses a mixed-method approach that includes a longitudinal survey of 4000 families with children between the ages of 0 and 8; an experiment in which some families receive a housing voucher worth an average of about $7300 and others do not; and a qualitative study that conducts three rounds of in-depth interviews with a stratified sub-sample of 200 survey families. Two additional efforts focus on dissemination of scientific knowledge to an audience broader than researchers. The Future of Children, is a collaboration between the Woodrow Wilson School of Public and International Affairs at Princeton University and the Brookings Institution that solicits summaries of the latest research on a particular topic. A similar communications-focused project is the Society for Research on Child Development's Social Policy Reports. 1.5. Research challenges Advances in research on children's needs have simultaneously improved our understanding and revealed new questions. The housing affordability research described earlier offers a graphic example of how new findings can generate new puzzles and mysteries unanticipated by conventional theories.6 But identifying research gaps is much easier than developing successful conceptual and methodological strategies to fill them. Measurement remains a core challenge. Virtually every article raises concerns about conceptualizing and measuring quality. For example, Magnuson and Shager discuss structural versus process measures of the quality of early education; Pallas describes the difficulties in assessing teacher quality and what constitutes an “adequate” education; and Leventhal and Newman offer cases where “standard” measures of housing quality may be inappropriate when the goal is children's healthy development. Russ, Garro, and Halfon raise the same question of applicability for health quality measures, although there is cause for optimism that such health measures will be developed as they are required by the reauthorization of CHIP. Another challenge highlighted in several articles is the need for long-term studies to capture enduring and cumulative effects. Russ, Garro, and Halfon provide compelling examples of such long-term effects. They note that early childhood health has been suggested as a possible explanatory factor for the persistence of inequalities across generations; that childhood maltreatment is associated with multiple adolescent health risks including excess weight, depression, and substance use; and that childhood obesity is linked to adult health problems such as heart disease, hypertension, and diabetes. The Perry preschool and Abecedarian studies described in the early education article by Magnuson and Shager are highly regarded examples of the
5
See http://www.nationalchildrensstudy.gov/about/overview/Pages/default/aspx. In the case of housing affordability, finding no effect led researchers back to the conceptual drawing board. This generated new hypotheses about the size and nature of expenditures of increases in discretionary income on children and the temporal dynamics of housing affordability. 6
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Introduction
type of research needed to elucidate the long-term effects of programmatic interventions. It is not surprising that such studies are rare given the financial and implementation challenges they entail. The new National Children's Study is an exception. As noted, it plans to follow children from the pre-natal period until they are 21 years old. A final research challenge concerns research design, particularly the relative value of experimental versus non-experimental approaches. Here, we are between the proverbial rock and a hard place. On the one hand, because most of the research on children's needs is non-experimental, it strains to produce causal inferences. Observed impacts of basic needs programs may be not be causal at all, but a function of unmeasured differences among participants or of self-selection into programs. On the other hand, the “gold standard” of an experiment for studying impacts requires great clarity and specificity about the intervention to be tested. The simpler and more straightforward the intervention, the better. These criteria for designing a successful experiment defy the reality of children's needs and the depth of our knowledge about them. Research on children's needs is not exceptional in this regard: many experts question whether randomized experiments are the best approach for studying social policy issues because of their inherent complexity (e.g., Moffitt, 2003; Garfinkel, Manski, & Michalopoulos, 1992; Heckman, 1992) and lack of generalizability to different contexts and circumstances. For topics such as housing, which are only now developing insights into the most basic questions, it makes more sense to mine existing observational data and collect new survey and qualitative data specifically designed to explore the largely uncharted terrain of housing and child development rather than to invest in experiments. This should not be misinterpreted as a blanket criticism of experimental methods, but as a cautionary note. Before launching any studies, the critical prerequisite is a defensible conceptual framework that includes the mechanisms through which a basic needs program is likely to affect children, youth, and families. Most of the articles in this volume acknowledge the central importance of theory development. Pallas, for example, notes that advancing the development of a strong theory of teaching and learning to guide education policy requires a much greater emphasis on practice and context. Gennetian, Castells, and Morris propose a conceptual framework that incorporates the roles of family composition, family management, and the neighborhood and community contexts in which children grow up. The authors of the articles in this special issue surely subscribe to Kurt Lewin's maxim: “there is nothing more practical than a good theory” (Lewin, 1951). 2. Conclusions Many of the cross-cutting themes in this volume stem from the principles that gave rise to contemporary domestic social policy in the U.S.7 The triumphs of contemporary U.S. social policy are laudable. Most minimum standards for children are being met, except perhaps in areas of the U.S. where deep pockets of poverty remain hidden. Nearly all American children have sufficient food (Nord & Parker) and live in physically decent housing (Leventhal & Newman), although problems of diet quality, housing affordability, and neighborhood quality persist. Health is the most contentious need and one that often goes unmet, especially for parents, because insurance is largely a function of stable employment (Russ, Garro & Halfon). Questions remain about the human capital potential of the educational system
7 Several very good articles on the history of child policy in the U.S. include Hart (1991); Jacobs (1994); Kamerman and Kahn (2001); Yarrow (2009); Zaff and Smerdon (2009); and the role of government in family policymaking such as Bogenschneider (2006).
with No Child Left Behind (Pallas), although confidence is growing that early care and education are advancing toward this goal (Magnuson & Shager). While America lacks a singular comprehensive national vision to promote “healthy families and children,” the resulting fragmented domestic social policy agenda meets the most basic needs of impoverished children and has helped foster innovation. But tough challenges remain. These include maintaining high quality parenting and child care in the face of pressure to increase the labor force participation of parents; demographic shifts to non-native populations; underutilization of programs among eligible families; and persistent socioeconomic and racial/ethnic disparities in child outcomes, especially in health and education. The call for evidencebased policies and programs is now commonplace in federal legislation. We hope that the importance of a strong evidence base is reaffirmed by the findings presented in this volume. References Bogenschneider, K. (2006). Family policy matters: How policymaking affects families and what professionals can do, 2nd ed. Mahwah, New Jersey: Erlbaum. Bronfenbrenner, U. (1979). The ecology of human development. Cambridge, MA: Harvard University Press. Center for Disease Control & Prevention (2009). Trends in the Prevalence of Sexual Behaviors Accessed from http://www.cdc.gov/ HealthYouth/yrbs/pdf/yrbs/pdf/ yrbs07_us_sexual_behaviors_trend.pdf on October 1, 2009. Child Trends (2010). Early School Readiness Accessed from http://www.childtrendsdatabank. org/?q=node/104 and Daily Cigarette Use from http://www.childtrendsdatabank.org/ ?q=node/133 on May 1, 2010. Duncan, Greg J., Huston, Aletha C., & Weisner, Thomas S. (2007). Higher ground: New hope for the working poor and their children. New York: Russell Sage Foundation. Dye, J., & Johnson, T. (2009). A child's day: 2006: Selected indicators of child well-being. Washington, D.C.: U.S. Census Bureau. Garfinkel, I., Manski, C., & Michalopoulos, C. (1992). Are microexperiments always best? Randomization of individuals or sites. In C. Manski & I. Garfinkel (Eds.), Evaluating welfare and training programs (pp. 253−276). Cambridge, MA: Harvard University Press. Hart, Stuart N. (1991). From property to person status: Historical perspectives on children's rights. American Psychologist, 46, 53−59. Heckman, James (1992). Randomization and social policy evaluation. In C. Manski & I. Garfinkel (Eds.), Evaluating welfare and training programs (pp. 201−230). Cambridge, MA: Harvard University Press. Jacobs, Francine (1994). Child and family policy: Framing the issues. In F. Jacobs & M. Domes (Eds.), More than kissing babies: Current child and family policy in the United States. Westport, CT: Greenwood Publishing Corporation. Kamerman, Sheila B., & Kahn, Alfred J. (2001). Child and family policies in the United States at the opening of the twentieth century. Social Policy & Administration, 35, 69−84. Kalil, Ariel, Seefeldt, Kristin, & Wang, Hui-chen (2002). Sanctions and material hardship under TANF. Social Service Review, 643−662. Lewin, Kurt (1951). Selected theoretical papers. In D. Cartright (Ed.), Field theory in Social Science; Selected theoretical papers. New York: Harper & Row. Magnuson, Katherine (2010). Email communication to S. Newman, April 16. Moffitt, R. (2003). The role of randomized field trials in Social Science research: A Perspective from evaluations of reforms of social welfare programsInstitute for Research on Poverty Discussion Paper, no. 1264-03, Retrieved from http://www. irp.wisc.edu/publications/ dps/ pdfs/dp126403.pdf on March 20, 2006. Moore, Kristin, Redd, Z., Burkhauser, M., Mbwana, K., & Collins, A. (2009). Children in poverty: Trends, consequences, and policy options. Washington, D.C: Child Trends. Newman, Sandra and Scott Holupka (2010). The Housing and Neighborhood Conditions of America's Children: Patterns and Trends Over Four Decades. Paper presented at the annual research conference of the Association for Public Policy Analysis and Management, November. Nord, Mark (2010a). Email communication to S. Newman, April 5. Nord, Mark (2010b). Food Insecurity in Households with Children: Prevalence, Severity, and Household Characteristics. http://www/ers/usda.gov/publications/eib56 Scanlon, William (2010). Email communication to S. Newman, April 8. Schweinhart, Lawrence J. (2006). Preschool programs. Encyclopedia on early childhood development. : Center for Excellence for Early Childhood Development. Smedslund, Geir, Hagen, Kare Birger, Steiro, Asbjorn, Johme, Torill, Dalsbo, Therese Kristine, & Rud, Mons Georg (2006). Work programs for welfare recipients. The Campbell Collaboration. Stagman, Shannon, & Cooper, Janice L. (2010, April). Children's mental health: What every policymaker should know. New York: National Center for Children and Poverty. Yarrow, Andrew L. (2009). History of U.S. children's policy: 1900 to the present. First Focus. Zaff, Jonathan F., & Smerdon, Becky (2009). Putting children front and center: Building coordinated social policy for America's children. Applied Developmental Science, 13(3), 105−118.
Introduction
S. Newman Policy Studies, Institute for Policy Studies, Johns Hopkins University, Baltimore, Maryland 21210, USA Corresponding author. E-mail address: [email protected](S. Newman). T. Leventhal Eliot-Pearson Department of Child Development, Tufts University, 105 College Avenue, Medford, MA 02155, USA
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L. Gennetian Economic Studies, Brookings Institution, 1775 Massachusetts Avenue, Washington, DC 20036, USA
Contents lists available at ScienceDirect
Children and Youth Services Review j o u r n a l h o m e p a g e : w w w. e l s ev i e r. c o m / l o c a t e / c h i l d yo u t h
Introduction
Meeting children's basic needs: Introduction
Policies and programs that address children's well-being have been tremendously successful in helping to reduce teenage pregnancy rates, improve school readiness, and cut cigarette smoking by youth (Child Trends, 2010; Center for Disease Control & Prevention, 2009). Despite these successes, serious problems persist. Even the most innovative programs show promising but short-lived effects and are often not powerful enough to permanently improve children's life trajectories and break the intergenerational transmission of poverty (Schweinhart, 2006; Smedslund et al., 2006). Moreover, infant mortality rates remain stubbornly high (Dye & Johnson, 2009), children's mental health needs have gone unmet (Stagman & Cooper, 2010), the proportion of children in poverty has increased since 2000 (Moore, Redd, Burkhauser, Mbwana, & Collins, 2009), and almost 40% of children live in unaffordable housing, nearly double the rate in 1975 (Newman & Holupka, 2010). Such statistics bring into sharp relief the problems yet to be addressed. Moments of political change offer an opportunity to reflect on policies, take stock of what we have accomplished, assess how much more needs to be done, identify gaps in our knowledge, conduct the research needed to fill those gaps, and set our sights on policy directions that appear most fruitful. We conceived of this volume at the point of transition from the Bush to the Obama Administration, and devised it to critically assess how well low-income children's basic necessities of life are being met, with a focus on the unfinished business facing policymakers and researchers. The articles cover the major federal policies designed to meet children's basic needs including income (Gennetian, Castells, & Morris), health (Russ, Garro, & Halfon), food (Nord & Parker), housing (Leventhal & Newman), early care and education (Magnuson & Shager), and primary through secondary education (Pallas). Taken together, the six articles expertly survey the best thinking about children's fundamental needs and raise key questions that must be addressed if we are to make progress. While each topic has a unique history and body of knowledge, a valuable by-product of assembling a volume of papers on diverse aspects of children's basic needs is the cross-cutting themes that emerge. These themes gain added policy and research heft specifically because they apply to all, or nearly all, of the needs examined in this volume. They are, therefore, the focus of this introductory article. We start with a review of cross-cutting policy themes, followed by an overview of remaining research challenges. 1. Cross-cutting themes 1.1. Underutilization of programs Meeting children's basic needs is much harder if families do not sign up for relevant assistance programs or otherwise fail to claim the 0190-7409/$ – see front matter © 2010 Elsevier Ltd. All rights reserved. doi:10.1016/j.childyouth.2010.05.004
benefits these programs provide. The Office of the Assistant Secretary for Policy and Evaluation of the U.S. Department of Health and Human Services estimates that only 29% of the more than 8 million eligible children 0–12 years old received subsidized child care (Magnuson & Shager). Perhaps as few as 40% of children covered by health insurance had a preventive care visit within the last year; only about 20% of 2 to 5 year olds visited a dentist in the last year; and less than half of 2 year olds are fully immunized (Russ, Garro & Halfon). More than one-fifth of households with children were “food insecure” in 2008, despite the availability of multiple food assistance programs (Nord & Parker). Underutilization is pronounced among Latino and immigrant families, who may fail to understand their eligibility or be reluctant to participate because of distrust or language and cultural barriers. But lack of utilization is not necessarily the same as underutilization. In the case of early childhood education and care, as Magnuson and Shager note, some families may not need child care and others may rely on informal support. In those instances, we must ask to what extent such circumstances reduce the estimated underutilization, and what else accounts for the underutilization that remains. For health care, Russ, Garro and Halfon note that having health insurance is generally associated with fewer unmet health needs. A fundamental goal of the expansion of insurance for children under the Patient Protection and Affordable Care Act1 is to even further reduce unmet needs.2 But the authors point out that health insurance alone does not guarantee access to affordable, appropriate, and high quality care. Large gaps in the receipt of needed services are particularly likely for some types of care, such as developmental services, regardless of insurance coverage. For food assistance, some families – for example, those in which the parents are employed – may not realize they are eligible. Others may know they are, but the benefits for which they would qualify are too low to be worth the cost and hassle of applying.3 And, some may be discouraged from participating because of the stigma associated
1
PL 111–148, March 23, 2010. At this writing, health reform has just become law and experts are unclear about its effects on children's health insurance coverage and access to care. It is expected that more children will be covered, but children now covered by the Children's Health Insurance Program could experience a reduction in benefits. The provision to raise rates for Medicaid primary care physicians will likely assist children who are seriously ill and require specialists. How the health care exchanges will affect access is completely speculative at this point (Scanlon, 2010). 3 The “hassle factor” also contributed to households dropping off the Temporary Assistance for Needy Families rolls in states with requirements such as attending orientation sessions (e.g., Kalil et al., 2002). 2
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with receiving “welfare.” There is also the possibility that participation is underreported (Nord, 2010a). Of greater concern is the estimated 80% of low-income households with food insecurity among children participating in one or more of the three largest nutrition assistance programs: the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), school lunch, and the Supplemental Nutrition Assistance Program (SNAP) (Nord, 2010b). The underutilization problem will be solved not by expanding current programs but by understanding these programs better and correcting impediments to access and participation. This may require a clearer understanding of the populations being served. It also may entail redesigning programs and how they are implemented. Gennetian, Castells and Morris, for example, write about the effectiveness of automatic enrollment in increasing take-up rates in social programs among eligible families. 1.2. Insufficient program coverage Another problem that is related to but distinct from program underutilization is inadequate program coverage. With the exception of primary education, where children's needs are met universally, most of children's basic needs are addressed on a means-tested basis. That is, family income – specifically poverty status or some variant of it – is used to determine eligibility for program assistance. Because food aid and health care are considered entitlements, eligibility guarantees access to program assistance. However, eligibility does not guarantee access to income assistance, housing subsidies, or early care and education. For example, as Magnuson and Shager report, just about half of poor preschool-age children were enrolled in Head Start in 2007. Although some of this discrepancy between children's needs and program coverage may be due to families' use of other sources of care and education such as state pre-K programs, this lack of coverage is primarily driven by families' needs outpacing program funding. Leventhal and Newman present an even more striking picture for housing: Only about one-quarter of eligible households receive federal housing assistance. Waiting lists in many jurisdictions are either closed or contain thousands of names, offering scant hope that most on the list will be served. Shortage of program coverage is likely to remain a persistent policy problem, although states may alleviate it by continuing to close federal gaps in program funding. For example, the past decade has witnessed great expansion in state pre-K programs to complement Head Start. For health care coverage, states have supplemented Medicaid with the State Children's Health Insurance Program (CHIP). Both of these programs have succeeded in expanding program coverage. Yet, inadequacies persist in areas such as housing assistance and those subject to underutilization. 1.3. Subgroup disparities Across all basic necessities of life, the degree to which children's needs are met varies systematically by socioeconomic status (SES). Children from lower SES families fare less well than children from higher SES families. This SES gradient underlies the means testing for benefits in every domain of a child's life reviewed in this volume with the sole exception of public education (a universal benefit). Virtually all authors report progress in reducing at least some SES disparities, including childhood mortality, physically inadequate housing, food insecurity, differential performance on some standardized tests of academic achievement, and even income itself as a specific result of the Earned Income Tax Credit.4 But all authors also report the 4
There is no solid evidence on whether there has been an improvement in lowincome children's participation in “quality” pre-K programs. While enrollments in preK and Head Start have increased, the variability in the quality of these programs means we cannot infer that quality has also increased (Magnuson, 2010).
stubborn persistence of other SES disparities. These include the rate of pre-term births, eighth-grade reading scores, enrollment in early education programs, and living in affordable housing. Differences by race and ethnicity also pervade children's needs, with racial and ethnic minority children faring less well than non-minority children. Yet there is surprising variation in the extent to which these differences are mitigated by SES. For example, disparities in SES account for only some of the gaps in children's health outcomes between race and ethnic groups, while they appear to account for a much greater share of food insecurity. As Gennetian et al. point out, high on the agenda for future policy research is an improved understanding of how money matters. This turns out to be a greater mystery than early models of the predictors of unmet needs recognized. A striking example is provided by Leventhal and Newman's discussion of the effects of housing affordability on children's well-being. The policy argument for making housing affordable is essentially an income issue; that is, making decent housing “affordable” gives a household more spendable income for other household needs, just as a direct income supplement would. Yet, statistical models using rich, longitudinal data find no beneficial cognitive, behavioral, or physical health effects on children as a result of affordable housing. Perhaps many low-income families living in affordable housing are not spending their added discretionary income on their children. There is also evidence that, as with poverty, the dynamics of housing unaffordability may play a role, because housing unaffordability is more of a temporary than a persistent status for most low-income families. Future research is needed to sort out these and other possible explanations. Since SES is not the only culprit, research is required to develop a deeper understanding of the causes of subgroup differences beyond socioeconomic disadvantage. Included here are differences by race and ethnicity, age, gender, and family composition. The question is not only why differences in child well-being exist, but also why differences exist in the effectiveness of programs to meet the needs of children in these different subgroups. Contributors to this volume point to a variety of policy mechanisms that could reduce SES disparities. One approach is to place a premium on the quality of programs and services provided by public programs. Both Magnuson and Shager and Pallas contend that ensuring classroom quality in the early and later year childhood years is a major program challenge. A similar concern is echoed by Russ, Garro and Halfon about the quality of health care for low-income children, and by Nord and Parker, who call for a greater focus on the quality and variety of children's food intake rather than the quantity. Quality is essential for moving beyond the mere satisfaction of minimum needs to the promotion of genuine child health and development. The private sector has become an increasingly salient player in the social safety net through the support of charter schools that seek to provide higher quality education than local public schools (see Pallas). A second approach involves minimizing disparities by targeting children and their families during the early periods of child development. Not only do young children appear to be especially vulnerable to deprivation, but lack of intervention or appropriate support may have life-long consequences. Growing research evidence in this area has helped fuel widespread support for early care and education (as reviewed by Magnuson and Shager), availability of medical care that begins prenatally (as described by Russ, Garro & Halfon), and food programs such as WIC. 1.4. An integrated approach to children's needs Bronfenbrenner's (1979) ecological model of human development formalized the conceptualization of the multiple contexts in which children are embedded and that influence their development. Every article in this volume sees its topic as only one of the many influences on children's lives. In their article on early education, for example,
Introduction
Magnuson and Shager note that even if children attend the highest quality pre-K program, what they gain could be undermined by a chaotic family environment or by subsequent inadequate schooling. Pallas reflects on primary and secondary schools as part of a “web of social institutions” including family, medicine, the economy and the criminal justice system. Russ, Garro and Halfon's life course health development model explicitly recognizes that health is the outcome of factors operating in multiple contexts including genetic, biologic, behavioral, social and economic influences. Gennetian, Castells and Morris call for a holistic theory of the role of income in children's lives to better understand the comparative importance of income, the family environment, parenting, and schools. The predictors of children's food insecurity presented by Nord and Parker also cover children's multiple contexts including housing, family, and economic resources. The one concrete example of an attempt at policy integration at the federal level in this volume appears in the housing article. Leventhal and Newman recount how, in the 1960s, the U.S. Department of Health, Education, and Welfare – the predecessor of Health and Human Services – took the lead in calling for an integrated approach to housing that would address tenants' wide ranging housing, social, and economic needs. Akin to others in this volume, Leventhal and Newman's conceptual framework, albeit parsimonious, nonetheless includes pathways to child development outcomes via multiple contexts that define a child's world. Although the ecological model has strongly influenced the way generations of researchers conceptualize the mechanisms through which children's contexts affect their well-being, a comprehensive model that encompasses all contexts has never been tested. One obstacle is sheer complexity. How these influences play out may be direct or indirect, linear or nonlinear, recursive or non-recursive, interactive or non-interactive, or some as yet unknown combination of these. Another impediment is the lack of data sufficient to the task. At a minimum, detailed measurement is required for each context and each child, following children and their families over time. As noted below in our discussion of research challenges, an additional barrier is the constraint on drawing causal inferences from observational data, on one hand, but the lack of clarity, at this stage of our understanding, about the most promising hypotheses to test experimentally, on the other. This combination of methodological and conceptual problems is an adaptation of what Pallas calls “weak technology”. Some direct policy implications follow from an integrated approach to children's needs. Like much of the existing research, basic needs policies focus mainly on a single domain. As a result, critics fault a lack of coordination across programs and even within individual programs. For example, are child care vouchers intended to support mothers' employment or promote children's development by providing quality early care and educational experiences? A related concern is that uncoordinated programs for children and their parents can compromise child well-being. For instance, Temporary Assistance for Needy Families, a major cash assistance program, requires parents to be employed as a prerequisite for assistance. At the same time, parents have no guaranteed access to child care assistance. Such inconsistencies among basic needs programs typically arise from their siloed funding streams. A well-noted exception is Head Start, which provides children with early education and physical, mental, and dental health services, and further provides parents with education and employment services. In addition, block grants, which give states funds to spend at their discretion within designated federal guidelines, are intended to improve coordination across assistance programs. One recommendation provided by several authors of this volume is to provide a menu of options or “cafeteria style” services (Gennetian, Castells & Morris) to meet the specific needs of both the family unit and its individual members. Gennetian, Castells and Morris offer an example of such an approach. The New Hope Program, launched as a demonstration prior to welfare reform, offered employment training for parents in addition to child care subsidies and support for family health care (Duncan, Huston, & Weisner, 2007).
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Several authors mention research initiatives that are attempting to build the knowledge base. Beyond these efforts are four noteworthy collaborations in process or soon to be launched. The first is the National Children's Study, which will follow more than 100,000 children from before birth until age 21 to determine how the different environments that are relevant to children's development interact to affect their health.5 Although the study currently focuses on the effects of environmental exposures on children's health, the ultimate goal is to add supplementary modules on other topics over time. Another recent research initiative, now in the design stage, is the MacArthur Foundation Network on Housing and Families with Children. Under this project, an interdisciplinary team will investigate how children's multiple social contexts affect child outcomes. The study uses a mixed-method approach that includes a longitudinal survey of 4000 families with children between the ages of 0 and 8; an experiment in which some families receive a housing voucher worth an average of about $7300 and others do not; and a qualitative study that conducts three rounds of in-depth interviews with a stratified sub-sample of 200 survey families. Two additional efforts focus on dissemination of scientific knowledge to an audience broader than researchers. The Future of Children, is a collaboration between the Woodrow Wilson School of Public and International Affairs at Princeton University and the Brookings Institution that solicits summaries of the latest research on a particular topic. A similar communications-focused project is the Society for Research on Child Development's Social Policy Reports. 1.5. Research challenges Advances in research on children's needs have simultaneously improved our understanding and revealed new questions. The housing affordability research described earlier offers a graphic example of how new findings can generate new puzzles and mysteries unanticipated by conventional theories.6 But identifying research gaps is much easier than developing successful conceptual and methodological strategies to fill them. Measurement remains a core challenge. Virtually every article raises concerns about conceptualizing and measuring quality. For example, Magnuson and Shager discuss structural versus process measures of the quality of early education; Pallas describes the difficulties in assessing teacher quality and what constitutes an “adequate” education; and Leventhal and Newman offer cases where “standard” measures of housing quality may be inappropriate when the goal is children's healthy development. Russ, Garro, and Halfon raise the same question of applicability for health quality measures, although there is cause for optimism that such health measures will be developed as they are required by the reauthorization of CHIP. Another challenge highlighted in several articles is the need for long-term studies to capture enduring and cumulative effects. Russ, Garro, and Halfon provide compelling examples of such long-term effects. They note that early childhood health has been suggested as a possible explanatory factor for the persistence of inequalities across generations; that childhood maltreatment is associated with multiple adolescent health risks including excess weight, depression, and substance use; and that childhood obesity is linked to adult health problems such as heart disease, hypertension, and diabetes. The Perry preschool and Abecedarian studies described in the early education article by Magnuson and Shager are highly regarded examples of the
5
See http://www.nationalchildrensstudy.gov/about/overview/Pages/default/aspx. In the case of housing affordability, finding no effect led researchers back to the conceptual drawing board. This generated new hypotheses about the size and nature of expenditures of increases in discretionary income on children and the temporal dynamics of housing affordability. 6
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type of research needed to elucidate the long-term effects of programmatic interventions. It is not surprising that such studies are rare given the financial and implementation challenges they entail. The new National Children's Study is an exception. As noted, it plans to follow children from the pre-natal period until they are 21 years old. A final research challenge concerns research design, particularly the relative value of experimental versus non-experimental approaches. Here, we are between the proverbial rock and a hard place. On the one hand, because most of the research on children's needs is non-experimental, it strains to produce causal inferences. Observed impacts of basic needs programs may be not be causal at all, but a function of unmeasured differences among participants or of self-selection into programs. On the other hand, the “gold standard” of an experiment for studying impacts requires great clarity and specificity about the intervention to be tested. The simpler and more straightforward the intervention, the better. These criteria for designing a successful experiment defy the reality of children's needs and the depth of our knowledge about them. Research on children's needs is not exceptional in this regard: many experts question whether randomized experiments are the best approach for studying social policy issues because of their inherent complexity (e.g., Moffitt, 2003; Garfinkel, Manski, & Michalopoulos, 1992; Heckman, 1992) and lack of generalizability to different contexts and circumstances. For topics such as housing, which are only now developing insights into the most basic questions, it makes more sense to mine existing observational data and collect new survey and qualitative data specifically designed to explore the largely uncharted terrain of housing and child development rather than to invest in experiments. This should not be misinterpreted as a blanket criticism of experimental methods, but as a cautionary note. Before launching any studies, the critical prerequisite is a defensible conceptual framework that includes the mechanisms through which a basic needs program is likely to affect children, youth, and families. Most of the articles in this volume acknowledge the central importance of theory development. Pallas, for example, notes that advancing the development of a strong theory of teaching and learning to guide education policy requires a much greater emphasis on practice and context. Gennetian, Castells, and Morris propose a conceptual framework that incorporates the roles of family composition, family management, and the neighborhood and community contexts in which children grow up. The authors of the articles in this special issue surely subscribe to Kurt Lewin's maxim: “there is nothing more practical than a good theory” (Lewin, 1951). 2. Conclusions Many of the cross-cutting themes in this volume stem from the principles that gave rise to contemporary domestic social policy in the U.S.7 The triumphs of contemporary U.S. social policy are laudable. Most minimum standards for children are being met, except perhaps in areas of the U.S. where deep pockets of poverty remain hidden. Nearly all American children have sufficient food (Nord & Parker) and live in physically decent housing (Leventhal & Newman), although problems of diet quality, housing affordability, and neighborhood quality persist. Health is the most contentious need and one that often goes unmet, especially for parents, because insurance is largely a function of stable employment (Russ, Garro & Halfon). Questions remain about the human capital potential of the educational system
7 Several very good articles on the history of child policy in the U.S. include Hart (1991); Jacobs (1994); Kamerman and Kahn (2001); Yarrow (2009); Zaff and Smerdon (2009); and the role of government in family policymaking such as Bogenschneider (2006).
with No Child Left Behind (Pallas), although confidence is growing that early care and education are advancing toward this goal (Magnuson & Shager). While America lacks a singular comprehensive national vision to promote “healthy families and children,” the resulting fragmented domestic social policy agenda meets the most basic needs of impoverished children and has helped foster innovation. But tough challenges remain. These include maintaining high quality parenting and child care in the face of pressure to increase the labor force participation of parents; demographic shifts to non-native populations; underutilization of programs among eligible families; and persistent socioeconomic and racial/ethnic disparities in child outcomes, especially in health and education. The call for evidencebased policies and programs is now commonplace in federal legislation. We hope that the importance of a strong evidence base is reaffirmed by the findings presented in this volume. References Bogenschneider, K. (2006). Family policy matters: How policymaking affects families and what professionals can do, 2nd ed. Mahwah, New Jersey: Erlbaum. Bronfenbrenner, U. (1979). The ecology of human development. Cambridge, MA: Harvard University Press. Center for Disease Control & Prevention (2009). Trends in the Prevalence of Sexual Behaviors Accessed from http://www.cdc.gov/ HealthYouth/yrbs/pdf/yrbs/pdf/ yrbs07_us_sexual_behaviors_trend.pdf on October 1, 2009. Child Trends (2010). Early School Readiness Accessed from http://www.childtrendsdatabank. org/?q=node/104 and Daily Cigarette Use from http://www.childtrendsdatabank.org/ ?q=node/133 on May 1, 2010. Duncan, Greg J., Huston, Aletha C., & Weisner, Thomas S. (2007). Higher ground: New hope for the working poor and their children. New York: Russell Sage Foundation. Dye, J., & Johnson, T. (2009). A child's day: 2006: Selected indicators of child well-being. Washington, D.C.: U.S. Census Bureau. Garfinkel, I., Manski, C., & Michalopoulos, C. (1992). Are microexperiments always best? Randomization of individuals or sites. In C. Manski & I. Garfinkel (Eds.), Evaluating welfare and training programs (pp. 253−276). Cambridge, MA: Harvard University Press. Hart, Stuart N. (1991). From property to person status: Historical perspectives on children's rights. American Psychologist, 46, 53−59. Heckman, James (1992). Randomization and social policy evaluation. In C. Manski & I. Garfinkel (Eds.), Evaluating welfare and training programs (pp. 201−230). Cambridge, MA: Harvard University Press. Jacobs, Francine (1994). Child and family policy: Framing the issues. In F. Jacobs & M. Domes (Eds.), More than kissing babies: Current child and family policy in the United States. Westport, CT: Greenwood Publishing Corporation. Kamerman, Sheila B., & Kahn, Alfred J. (2001). Child and family policies in the United States at the opening of the twentieth century. Social Policy & Administration, 35, 69−84. Kalil, Ariel, Seefeldt, Kristin, & Wang, Hui-chen (2002). Sanctions and material hardship under TANF. Social Service Review, 643−662. Lewin, Kurt (1951). Selected theoretical papers. In D. Cartright (Ed.), Field theory in Social Science; Selected theoretical papers. New York: Harper & Row. Magnuson, Katherine (2010). Email communication to S. Newman, April 16. Moffitt, R. (2003). The role of randomized field trials in Social Science research: A Perspective from evaluations of reforms of social welfare programsInstitute for Research on Poverty Discussion Paper, no. 1264-03, Retrieved from http://www. irp.wisc.edu/publications/ dps/ pdfs/dp126403.pdf on March 20, 2006. Moore, Kristin, Redd, Z., Burkhauser, M., Mbwana, K., & Collins, A. (2009). Children in poverty: Trends, consequences, and policy options. Washington, D.C: Child Trends. Newman, Sandra and Scott Holupka (2010). The Housing and Neighborhood Conditions of America's Children: Patterns and Trends Over Four Decades. Paper presented at the annual research conference of the Association for Public Policy Analysis and Management, November. Nord, Mark (2010a). Email communication to S. Newman, April 5. Nord, Mark (2010b). Food Insecurity in Households with Children: Prevalence, Severity, and Household Characteristics. http://www/ers/usda.gov/publications/eib56 Scanlon, William (2010). Email communication to S. Newman, April 8. Schweinhart, Lawrence J. (2006). Preschool programs. Encyclopedia on early childhood development. : Center for Excellence for Early Childhood Development. Smedslund, Geir, Hagen, Kare Birger, Steiro, Asbjorn, Johme, Torill, Dalsbo, Therese Kristine, & Rud, Mons Georg (2006). Work programs for welfare recipients. The Campbell Collaboration. Stagman, Shannon, & Cooper, Janice L. (2010, April). Children's mental health: What every policymaker should know. New York: National Center for Children and Poverty. Yarrow, Andrew L. (2009). History of U.S. children's policy: 1900 to the present. First Focus. Zaff, Jonathan F., & Smerdon, Becky (2009). Putting children front and center: Building coordinated social policy for America's children. Applied Developmental Science, 13(3), 105−118.
Introduction
S. Newman Policy Studies, Institute for Policy Studies, Johns Hopkins University, Baltimore, Maryland 21210, USA Corresponding author. E-mail address: [email protected](S. Newman). T. Leventhal Eliot-Pearson Department of Child Development, Tufts University, 105 College Avenue, Medford, MA 02155, USA
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L. Gennetian Economic Studies, Brookings Institution, 1775 Massachusetts Avenue, Washington, DC 20036, USA