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Policy Issues in Early Childhood Development

One of the distinctive features of the science of early childhood development is the extent to which research findings evolve under the anxious and eager eyes of millions of families, policy makers, and service providers who seek authoritative guidance as they address the challenges of promoting the health and well-being of young children. Moreover, as a public issue, questions about effective practices in the care and protection of children confront basic traditional values in areas that include personal responsibility, individual self-reliance, and the role of government involvement in people’s lives.

Many policies have changed at the federal and state level since the initial publication of From Neurons to Neighborhoods, some because of the scientific advances catalyzed by the report. More emphasis is placed upon early childhood education than it was a decade ago. State and federal maternal health legislation has expanded to include home visiting programs throughout the states. The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) has moved away from formulas toward packages for providing food for families. At the same time, socioeconomic and demographic trends have created new challenges, with a greater percentage of children growing up in poverty and to foreign-born mothers.

Three speakers at the workshop to commemorate the 10th anniversary of From Neurons to Neighborhoods examined public policy issues related to the report and raised questions about future directions that deserve attention. Joan Lombardi, Deputy Assistant Secretary and Interdepartmental Liaison for Early Childhood Development in the U.S. Department of Health and Human Services, described changes in federal policies affecting young



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3 Policy Issues in Early Childhood Development One of the distinctive features of the science of early childhood devel- opment is the extent to which research findings evolve under the anxious and eager eyes of millions of families, policy makers, and service providers who seek authoritative guidance as they address the challenges of promot- ing the health and well-being of young children. Moreover, as a public issue, questions about effective practices in the care and protection of children confront basic traditional values in areas that include personal responsi- bility, individual self-reliance, and the role of government involvement in people’s lives. Many policies have changed at the federal and state level since the initial publication of From Neurons to Neighborhoods, some because of the scientific advances catalyzed by the report. More emphasis is placed upon early childhood education than it was a decade ago. State and federal maternal health legislation has expanded to include home visiting programs throughout the states. The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) has moved away from formulas to- ward packages for providing food for families. At the same time, socioeco- nomic and demographic trends have created new challenges, with a greater percentage of children growing up in poverty and to foreign-born mothers. Three speakers at the workshop to commemorate the 10th anniversary of From Neurons to Neighborhoods examined public policy issues related to the report and raised questions about future directions that deserve at- tention. Joan Lombardi, Deputy Assistant Secretary and Interdepartmental Liaison for Early Childhood Development in the U.S. Department of Health and Human Services, described changes in federal policies affecting young 25

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26 FROM NEURONS TO NEIGHBORHOODS: AN UPDATE children and families over the past decade and the role of the science base in contributing to those changes. Mary Eming Young, Lead Child Devel- opment Specialist for the World Bank’s Human Development Network, spoke about how to mobilize science to promote policy innovation from an international perspective. Jack Shonkoff, Director of the Center on the Developing Child at Harvard University, presented a new framework in examining how the science of early childhood development can contribute to social change. THE FEDERAL POLICY ENVIRONMENT1 Joan Lombardi U.S. Department of Health and Human Services Before the workshop, Joan Lombardi, Deputy Assistant Secretary and Interdepartmental Liaison for Early Childhood Development in the U.S. Department of Health and Human Services, asked several people for their impression of the report From Neurons to Neighborhoods. One described it as a graduate school course condensed into a single book. Another said it was the embodiment of the importance of early childhood. A third ob- served that it affirmed the importance of the work they were doing. “We can’t underscore enough the importance of [this] report,” Lombardi said. In her talk, Lombardi described the evolution of the federal policy envi- ronment and its relation to the early childhood science base. From Neurons to Neighborhoods emphasized several key scientific concepts: • Biology and experience are both important in early childhood development. • Context shapes the developing child. • The growth of self-regulation is a cornerstone of early childhood development across domains of behavior. • Relationships are the building blocks of human development. • Vulnerability and resilience are key features of childhood and can be affected by both risk factors and protective factors. • The course of development can be altered in early childhood by effective interventions. These concepts have had great staying power and continue to influence federal policy today, Lombardi said. 1 This section of the chapter is based on the presentation by Joan Lombardi titled “The Federal Policy Perspective” at From Neurons to Neighborhoods Anniversary: Ten Years Later.

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27 POLICY ISSUES IN EARLY CHILDHOOD DEVELOPMENT The Policy Context In From Neurons to Neighborhoods, the Committee on Integrating the Science of Early Childhood Development pointed to five ongoing transfor- mations affecting families with young children: 1. Changes in the nature, schedule, and amount of work engaged in by parents of young children. 2. More children spending time in child care of varying quality start- ing at a young age. 3. Continuing high levels of economic hardships among families even in a strong economy. 4. Increasing cultural diversity and the persistence of disparities among subgroups. 5. Greater awareness of the effects of stress on young children. One of the most important points the report made is that the effects of these changes should not be viewed in isolation, Lombardi said. De- velopment is an integrated process. Similarly, federal policies that affect early childhood education should be seen as an integrated system. These policies encompass health, mental health, nutrition, child care, education, family support, and child protection (see Figure 3-1). Many federal poli- cies in these areas are long-standing and have had an important effect on the lives of families. “We do have things to celebrate in the policy arena,” said Lombardi. Policies that fall outside what is traditionally seen as early childhood concerns also have a substantial influence on children and families, includ- ing housing, economic, and transportation policies. “These are the things that I hear about when I travel across the country as having a profound effect on families,” said Lombardi. During the decade before the release of From Neurons to Neighbor- hoods, a robust set of early childhood policies emerged, including policies influencing child care, family and medical leave, Early Head Start, welfare reform, child support, the Children’s Health Insurance Program, and fam- ily preservation. It was not a perfect agenda, Lombardi noted. “We didn’t get it right in each one of those places. But we moved the needle, and we moved it in a bipartisan way.” In the decade since the report was released, the policy environment has shifted. At the federal level, policy changes have emphasized literacy, assess- ment, welfare reform, and family structure, although significant resources to back these changes have become available only in the past 2 years with the passage of the American Recovery and Reinvestment Act and the Patient Protection and Affordable Care Act. During this same period,

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28 FROM NEURONS TO NEIGHBORHOODS: AN UPDATE Early Care Education Health, Family Nutrition, Support and Mental and Child Health Protection Family and Community Well- Being FIGURE 3-1 Public policies that affect early childhood development collectively overlap. SOURCE: Lombardi, 2010. the states have been laboratories of innovation. For example, the expan- sion of prekindergarten programs at the state level was an enormous step forward, said Lombardi. However, the rate of children ages 0 to 5 living in poverty also has increased over the past decade, and the fraction of young children living in poverty is greater than the fraction of poor children ages 6 to 17. “Unfor- tunately the line is going in the wrong direction,” Lombardi said. “That is a concern for all of us.”

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29 POLICY ISSUES IN EARLY CHILDHOOD DEVELOPMENT New Policy Developments Recent federal policy changes have brought new attention to early childhood, with a particular emphasis on prenatal care to age 8. The Patient Protection and Affordable Care Act included authorization for the Mater- nal, Infant, and Early Childhood Home Visiting Program, which will make “an important difference to young children, particularly young children at risk,” according to Lombardi. New research initiatives include a study of the workforce for early childhood care conducted through the National Academies. Child Care, Head Start, and Early Head Start programs have all been expanded. In general, trends in the development of policy include emphases on evidence, place, and prevention. These changes reflect a gradual shift from a diverse set of programs to a more systematic approach, Lombardi observed. At the state level, advisory councils are coordinating programs. State and federal programs are moving toward more integrated standards. Common governance and professional development across programs are being emphasized. Families are being engaged in new ways, so that they can be more systematically involved in their children’s health, learning, and development. Data systems are being created at the individual and public health levels to track developmental measures across childhood and adolescence. Reflecting these changes, the U.S. Department of Health and Human Services has created new linkages with the U.S. Department of Education. An interagency policy board created by the two departments is beginning to align policies systematically. “It is an honor,” said Lombardi, “to be working for an administration and a President who understand that learn- ing begins at birth and that investments in health and education have a profound impact on development.” Implications for the Research Agenda As part of this new emphasis on early childhood development, a ro- bust agenda is emerging at the federal level and in partnership with states and communities, according to Lombardi. She posed four questions to the research community that have significant policy relevance: 1. What are the key elements that lead to improved child health and developmental outcomes in early childhood programs? 2. How can gains be sustained over time, and how does one program build on another? 3. How can the impact of community-wide strategies be evaluated? 4. What is the impact of media and technology on young children and family relationships?

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30 FROM NEURONS TO NEIGHBORHOODS: AN UPDATE Implications for the Policy Agenda The policy agenda remains unfinished. From Neurons to Neighbor- hoods began to fill the gap between what is known and what is being done, but the gap remains large. Lombardi suggested emphasizing the effects of policy on primary caregivers because of their significance to children. “They need time, information, and social networks of support,” she said. As a new grandmother, Lombardi added, she has been struck by how little time parents have with young children from the earliest ages and how little support they receive. Another important policy focus is to link child welfare more directly to early childhood, particularly with an increasing number of very young children in the foster care and child protection system. Quality early child- hood services can be an important respite for families and a supportive environment for the developing child. Early childhood mental health programs need to be taken to scale, according to Lombardi. The Substance Abuse and Mental Health Services Administration has launched several important demonstration projects, and these need to be expanded, she said. Child care should not be seen as creating deficits in children but as an opportunity to provide quality services to them. Much needs to be done to provide quality across child care and other early childhood programs. In particular, children from low-income families need access to quality services. “Federal child care assistance is still serving only 1 of 6 eligible children. That is not good enough.” Good policies also incorporate consideration of the life cycle. Early childhood development is linked to youth development, and both are linked to adult development. Finally, much can be learned from policies, research, programs, and experiences in other countries, and countries with proportionately greater needs require higher levels of attention and support. “Along with sharing research, we should be focusing much more attention on the millions and millions of children around the world who may be surviving but are not thriving because of malnutrition, violence, and poverty,” said Lombardi. “It is time for us to step up to the plate and continue to invest in those children.” Policy debates in recent years have tended to pit personal responsibility against public policies. From Neurons to Neighborhoods said that the time has come to move beyond such either/ors. Lombardi concluded her remarks by quoting from the report: “In the final analysis, healthy child develop- ment is dependent on a combination of individual responsibility, informal social supports, and formalized structures that evolve within a society.”

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31 POLICY ISSUES IN EARLY CHILDHOOD DEVELOPMENT Discussion A questioner asked Lombardi about the advantages of place-based policies compared with traditional health or human service systems, and Lombardi responded that she views the two as inseparable. “What you do in a community is pull all those pieces together.” For example, a major problem in the existing network of services is a lack of investment in the early childhood workforce, particularly for infants and toddlers. “It takes time and multiple service providers working together in a community to make that change. It is not a simple fix.” Only team efforts will be able to make changes of the necessary magnitude. There is a tremendous need, said Lombardi during the discussion pe- riod, to bridge the gap between the research community and what is going on in actual programs. Important innovations are occurring in early child- hood development. Programs serving very young children are reaching very different types of families even as the demographics of American families change rapidly. Practitioners have wisdom and evidence that will lead to better research questions and better policies, and both research results and policy decisions will be easier to communicate if researchers and policymak- ers interact directly with people who are doing the work. A GLOBAL PERSPECTIVE2 Mary Eming Young The World Bank Just as From Neurons to Neighborhoods led to major early childhood initiatives in the United States, the global community has been converging on the importance of early childhood development and the need for urgent action. These calls for action have several sources, said Mary Eming Young, Lead Child Development Specialist for the World Bank’s Human Develop- ment Network. International and regional agencies such as the World Bank, the United Nations, the Inter-American Development Bank, and the Asian Development Bank have been supporting early childhood development pro- grams through advocacy, funding, and technical assistance. For example, the recent report Closing the Gap in a Generation: Health Equity Through Action on the Social Determinants of Health from the World Health Or- ganization observes that the healthy development of young children is a powerful equalizer for all nations (Commission on Social Determinants 2 This section of the chapter is based on the presentation by Mary Eming Young titled “Lessons Learned from Global Perspective” at From Neurons to Neighborhoods Anniversary: Ten Years Later.

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32 FROM NEURONS TO NEIGHBORHOODS: AN UPDATE of Health, 2008). In addition, such academic journals as the Lancet have published major articles on early childhood development (Engle et al., 2007; Grantham-McGregor et al., 2007; Jolly, 2007; Walker et al., 2007). And regional initiatives in such areas as Latin America have given highest priority to early childhood development programs as both a short-term and a long-term solution for addressing poverty. Three key messages have emerged from these calls for action, stated Young. First, start at the beginning—that is, integrate healthy childhood development into prenatal, early health, and parent education services. Second, get ready for success—that is, ensure children’s access to services before they enter school, beginning with the most vulnerable and disadvan- taged children. Third, include early childhood in all national policy plans across sectors. Closing the Gap Despite the recent global emphasis on early childhood development, much remains to be done to close the gap between understanding and ac- tion, said Young. Especially in developing countries, the science of early childhood development still needs to be translated into large-scale programs for young children. Young identified three obstacles to action. First, the time between mak- ing a change and realizing the benefits can be protracted. Policy makers must understand that they need to invest in early childhood education now for payoffs to occur later. Also, children, and especially the poor, do not have a political voice or representation to defend their interests. Second, the complexity of early childhood development demands an integrated approach that encompasses all levels and sectors of society. Today the health, education, and social protection sectors tend to work in silos. They do not work together to identify and pursue coordinated and practical approaches to child development. But no single sector can solve the problem on its own. Third, the necessary infrastructure for early childhood development needs to be built from the bottom up. Throughout the world, early child- hood development programs are uniquely dependent on a complex network of local, regional, and national institutions for financial management and implementation. Say that early childhood development programs consist of thousands of micro projects that serve 15 to 20 children each, Young observed. Clusters of 15 to 20 micro projects would form neighborhood clusters. These neighborhood clusters would depend on parent associations for organizational support, such as establishing contracts with local pro- viders, lobbying local authorities, or networking with volunteer organiza- tions. Neighborhood clusters in turn would depend on city- or district-wide

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33 POLICY ISSUES IN EARLY CHILDHOOD DEVELOPMENT support systems. The aim of all these networks would be to strengthen the basic unit of society—the family. But communities cannot take on this task successfully without strong public policies. As an indication of the scale of the challenge, Young cited the Head Start program’s coverage of about 1 million children in the United States, which is about half of the intended beneficiaries. Yet, approximately 200 million children worldwide are estimated to be at risk of poor development, and this figure is underestimated because it uses a poverty rate of less than $1 dollar a day of family income to determine if a child is at risk. An Agenda for the Next Decade Young identified four main tasks for the next decade. The first is to rigorously foster global understanding and awareness of the importance of early childhood development. Specifically, it is criti- cal to communicate the importance of healthy brain development in early childhood for the overall health, well-being, and competence of popula- tions. This knowledge needs to spread to all people at every level and especially to parents, caregivers, communities, government policy makers, financiers, and heads of states. The creation and strengthening of national policies affecting early childhood development depend on awareness of its importance, yet the tipping point for many necessary actions has not been reached. The second task is to promote a transdisciplinary science of human development that combines the natural and social sciences. New and devel- oping fields such as neuroscience and epigenetics could provide the basis for research and the application of that research across all disciplines, including the health sciences and the social sciences. The third task is to expand access to early childhood development programs and ensure the quality of these programs. Enhanced professional development and better understanding of the minimal requirements for quality will strengthen programs. Identifying what works and what does not work will lead to better design and scale-up of cost-effective options. The private sector needs incentives to invest in early childhood develop- ment. A particular need is for understanding governance at the macro level—what are the rules of the game, the laws, the attitudes, and the social structures that affect policies toward early childhood development? The fourth task is to assess the effects of early childhood development programs systematically and comparatively. Databases of child outcomes with and without programs are needed, and using the children’s outcomes could then be benchmarked using these databases. Useful databases would range far beyond small-scale research evaluations. Benchmarks are crucial for informing policy makers about where, how, and which programs to

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34 FROM NEURONS TO NEIGHBORHOODS: AN UPDATE scale up and for attaining universality, accountability, and comparability within and among countries. Young observed that, in public health systems, children’s health and well-being are largely measured by negative outcomes such as pathology, mortality, or low birth weight instead of positive outcomes such as well- being or competence. In education, measures focus on children’s access to school, enrollment rates, or educational failures. Measurement of learning outcomes often comes near the end of compulsory education, which is too late, Young said. Such assessments fail to recognize the issues in the early years that set the trajectory for later learning and performance. Assessment tools and measures need to encompass the whole child and be multidimen- sional reflections of cognitive, social, or emotional development. They also need to be applicable to groups of children, not just to individual children, Young said. By speaking in a common language about the transdisciplinary dimen- sions of early human development and by gathering best practices from countries that have implemented coherent and comprehensive sets of so- cial policies toward early childhood development, the machinery of public policy can be leveraged to improve the lives of children around the world. Discussion In response to a question about the key skills needed by the early child- hood workforce in developing countries, Young observed that caregivers and providers need an understanding of developmentally appropriate prac- tices. An area that cuts across all ages is the importance of relationships in providing quality care. In the past, considerable attention has focused on the curriculum provided in early childhood education. But a more impor- tant bottom line is quality. From home-based programs to formal educa- tion, the quality of the interactions between adults and children fosters learning and development. Young also was asked whether experiences in developing countries have lessons for the United States, and she observed that a great deal can be learned from developing countries. For example, Brazil, Cuba, Mexico, and other Latin American countries have made great progress establish- ing a continuum of programs beginning with prenatal care and extending through primary school. They are harnessing new understandings from sci- ence to build parenting and early childhood programs. And political leaders are recognizing that early childhood development needs to be part of their political platforms to be elected. In response to a question about how best to build capacity for early childhood development, Young emphasized transdisciplinary training for

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35 POLICY ISSUES IN EARLY CHILDHOOD DEVELOPMENT everyone involved with the field, from parents and care providers to re- searchers and policy makers. One questioner pointed out that political conflict and violence pose huge barriers to healthy child development, which caused Young to reiter- ate the need to start early. Children in conflict-burdened states have an even greater need of nurturing, nutrition, and stimulation. “For us to have tolerant, pluralistic societies, we need to start earlier,” she observed. Young quoted a former minister of education who was also a pediatrician who told her that investing in early childhood development is a matter of national security; her comment: “he could not have said it better.” In response to a question about gender disparities, Young agreed that the issue needs to be addressed with families and with policy makers. Gender bias in a society can interact with child development programs in harmful ways—as when families pull their daughters from school because they believe that an early education program has taught their daughters all they need to know. Early childhood programs can send children along trajectories toward more equity, she said. A questioner asked whether place-based programs can reach transient populations like the homeless or highly mobile children, and Young agreed that it is possible for such children to be left behind. She mentioned children in China left behind when their parents go to cities to work. In those cases, care providers need to work with governments to support these vulnerable population groups. CREATING THE FUTURE OF EARLY CHILDHOOD POLICY AND PRACTICE3 Jack P. Shonkoff Harvard University On the basis of a conceptual model developed by Julius Richmond, social change requires three things, said Jack P. Shonkoff, Director of the Center on the Developing Child at Harvard University. The first is a knowl- edge base, which From Neurons to Neighborhoods helped articulate 10 years ago and which has been growing ever since. The second is political will, which Shonkoff judged to be even stronger now than it was a decade ago, “notwithstanding all the constraints.” The third is a social strategy, which constitutes the major challenge facing those who seek to chart the future of early childhood policy and practice. 3 This section of the chapter is based on the presentation by Jack Shonkoff titled “Creating the Future of Early Childhood Policy and Practice” at From Neurons to Neighborhoods An- niversary: Ten Years Later.

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36 FROM NEURONS TO NEIGHBORHOODS: AN UPDATE Existing Social Strategies Researchers, policy makers, and practitioners in the field of early child- hood development currently employ a variety of social strategies, said Shonkoff. The question is how to design and implement new strategies that produce a higher magnitude of impact. He discussed three strategies in particular. The first is to enhance the quality of the policies and programs that are in place and increase access to services. A tremendous amount of creative energy is directed toward this strategy. For example, the field no longer hesitates to address variability in the quality of programs, whereas when the political will was not as strong, it was dangerous to talk about poor-quality programs. “Now it is danger- ous not to talk about the variability in quality,” he observed. The second strategy is to expand effective models. Taking good pro- grams to scale requires creative thinking and effort. “This is a real chal- lenge,” Shonkoff said. “We need better strategies to take things to scale.” The third strategy, on which Shonkoff focused, is to build, test, and promote enhanced theories of change. This strategy was implicit in the original work on From Neurons to Neighborhoods, and it can be more explicit today, given that the science base is an even greater potential source of innovative ideas. One benefit of this strategy is that it offers a way to examine and im- prove current approaches in early childhood intervention. For example, the most common current approach was established with the Great Society programs and has largely stood the test of time. It provides enriched op- portunities for learning to children who may have limited access to such opportunities. It is also a two-generational approach, in that it provides ed- ucation to parents about child development and parenting support. “With very few exceptions, everything that we do is a variation on that theme, and it continues to stand on a very solid scientific foundation,” Shonkoff said. A strategy of developing and testing new theories of change asks how the current approach can be strengthened. For example, research on the biology of adversity suggests a compelling new theory to enhance both learning and health (see Figure 3-2). Excessive activation of the body’s stress response systems can lead to long-term disruptions in brain architecture, immune status, metabolic regulation, and cardiovascular function. Decreas- ing the number and severity of adverse early experiences and strengthening the relationships that protect young children from the harmful effects of toxic stress would therefore be expected to build stronger foundations for both learning and health. “Developing and testing new approaches does not mean that enriched learning experiences are unimportant,” Shonkoff said. “They are tremen-

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37 POLICY ISSUES IN EARLY CHILDHOOD DEVELOPMENT Health- Cumulative Effects Related Over Time Behaviors Environment of Relationships Educational Gene- Achievement Physiological Physical, Environment & Economic Adaptations & Chemical, & Built Interaction Productivity Disruptions Environments Nutrition Physical & Mental Health Biological Embedding During Sensitive Periods FIGURE 3-2 A biodevelopmental framework can relate the multiple influences dur- ing development to lifelong outcomes. SOURCE: Center on the Developing Child at Harvard University, 2010b. Reprinted with permission. Copyright 2010 Center3-2 the Developing Child at Harvard Figure on University. dously important. But new thinking is needed to build on the best of current efforts and design new interventions that achieve greater impacts.” In pursuing innovative strategies, the business community can also be seen as a potential partner, rather than an antagonist, Shonkoff observed. In business, the most successful organizations know they are not going to stay at the top of their fields if they do not figure out how to be the first ones to do the next new thing. Actively pursuing innovation is not a sign of weakness but of strength. A Partnership for Innovation One way to translate a science base into more effective programs is to bring together people with diverse expertise. For example, the Center on the Developing Child, which Shonkoff directs, has been developing a joint initiative with the National Conference of State Legislatures and the National Governors Association Center for Best Practices. Those partners in turn brought in the TruePoint Center for High Performance and High Commitment to provide expertise in organizational system change, innova - tion, and the processes needed to move an innovation agenda. The result has been the Early Childhood Innovation Partnership, which is leveraging the science base to develop an innovation agenda that goes beyond current practices and policies.

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38 FROM NEURONS TO NEIGHBORHOODS: AN UPDATE The partnership has spent considerable time establishing priorities and has focused on three domains designed to reduce adversity and not just provide enrichment. The first is to reduce developmental barriers to learn- ing. These are aspects of social and emotional development and executive functioning that interfere with children’s ability to achieve full benefit from enriched learning opportunities. “We cannot simply provide enrichment; we also have to reduce barriers to healthy development,” said Shonkoff. The second focus area is to transform the lives of parents as a way of changing the lives of their children. Violence, mental health problems, sub- stance abuse, and other factors are placing tremendous burdens on the lives of young children, particularly for the most vulnerable. Changing the life prospects of highly disadvantaged children requires more than parenting education, because simply providing information does not automatically change the circumstances of people who are dealing with significant stress- inducing circumstances. The third area of focus is to reconceptualize the health dimension of early childhood policy and practice. Current policy for early childhood development remains centered on education—it is designed to prepare children to be ready to succeed in school. Current policy also has a health dimension, but it is largely focused on ensuring access to a regular source of medical care. Are the child’s immunizations up to date? Have vision and hearing been screened? Has a child been examined for developmental problems or health impairments? Speaking as a pediatrician, Shonkoff observed that education-centered interventions are obviously important, but early childhood does not just lay the foundation for learning. It also has long-term health consequences and can be a time in which the origins of lifelong health problems are estab- lished, including the precursors of cardiovascular disease, diabetes, hyper- tension, stroke, and other common chronic diseases. “The health dimension of early childhood is not just about medical care. It is about addressing the early roots of lifelong health and disease,” he noted. An Ecology of Innovation One way to organize thinking about innovation in the field of early childhood development is through analogy with an ecological system, Shonkoff observed. At the first level, innovations occur in a particular “climate.” For early childhood development, the climate for innovation is determined by public discourse in the policy arena and, more broadly, by public understanding of the field. It is important for people in positions of power, said Shonkoff, to understand why the early childhood period is so important and to establish priorities for the allocation of resources. In that respect, today’s climate is promising. “The policy climate for

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39 POLICY ISSUES IN EARLY CHILDHOOD DEVELOPMENT early childhood right now is very different from what it was 10 years ago. People get it—in a general sense—that early experience affects the develop- ing architecture of the brain.” However, the climate could be improved, Shonkoff pointed out. If policy makers understood the impact of behavior, emotion, and executive functioning on learning, there would no longer be a policy debate about whether early childhood programs should focus on cognitive skills or social and emotional development. Similarly, policy mak- ers need to understand that the early childhood policy agenda is as much about health as it is about education. Such an understanding would make it possible to consider early childhood investments as relevant for both health and education budgets. The second dimension of an ecology of innovation is “seeds.” These are the breakthrough ideas currently being cultivated in “hot house” laborato- ries, whether those laboratories are in the university or in the community, that go beyond interventions currently being done, tested, or taken to scale. For example, the idea of improving child outcomes by transforming the economic and psychological capacities of their parents is one such seed. A lot of work has already been done in this area—particularly in services fo- cused primarily on low-income women—but this work is not yet ready for replication in early childhood programs. “These intervention strategies are not yet ready to be tested in a randomized controlled trial,” said Shonkoff. “We need further incubation of creative, new ideas before we conduct these kinds of trials.” Another innovation seed in the domain of health is the use of biomark- ers to assess relative resilience and vulnerability, individualize services, and measure the effects of interventions. Such biomarkers include stress hor- mones, inflammatory proteins, cardiovascular reactivity, epigenetic mark- ers, and neuroimaging, among others. Much work still needs to be done to develop these biomarkers before they can be used in community-based settings, as the use of measures without knowing their full meaning raises ethical as well as scientific questions. But research on biomarkers is gener- ating considerable interest and excitement. For example, could biomarkers measure the impacts of toxic stress on young children or differentiate those who are in trouble from those who are not? This work is definitely not ready for programmatic application, but it certainly is important to pursue in a responsible manner, Shonkoff said. The third aspect of an ecology is “soil”—the people and places who constitute a receptive environment to try a new idea. “If we are using sci- ence to incubate seeds, then we need places that provide rich soil where you can plant some of these seeds and evaluate whether they grow.” If the soil is not receptive, the failure of a program may be blamed on the program itself and not on the conditions under which it was implemented. Communities and states that want to try new things provide promising soil for innova-

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40 FROM NEURONS TO NEIGHBORHOODS: AN UPDATE tion. “We can’t try new things everywhere, and we can’t try new things in places that don’t want to take risks, so we have to utilize those settings that want to be the pioneers.” The Benefits of Programmatic Focus The priorities selected by the Early Childhood Innovation Partnership are a subset of the many new ideas worth trying that could have concrete benefits for multiple constituencies. Shonkoff identified four potential ben- efits of pursuing these priorities. First, policy makers want evidence of interventions that produce im- pacts on school readiness and on educational achievement. They are look- ing for new ways to promote health and prevent disease, not just pay for expensive care for people who are sick. Second, the people who work in early childhood programs on a day-to- day basis are eager for new things to try. Many are trying new interventions themselves, but they have few ways of disseminating ideas that work well. Also, some people may try new things, but the ability of science to explain why these things work can be the crucial impetus to change. “If people are trying things that seem to have significant impacts, it would be great for scientists to be in there to figure out the explanation as to why they are working,” Shonkoff said. Third, trying out new ideas will make it possible to leverage the sci- ence of early childhood development across a wide range of sectors and outcomes. “It is not just about learning, it is not just about behavior, it is not just about health. We can deal with all these domains simultaneously,” he noted. Finally, and more speculatively, if researchers can figure out how to use technology to measure the biological impacts of an intervention, they could transform the evaluation of alternative approaches to promoting early childhood development. For example, science would “not have to wait for a 50-year follow-up study to show that we have the capacity to reduce the risk of heart disease,” Shonkoff observed. “That would be a tremendous new contribution to the field.” Discussion Shonkoff was asked what the United States can learn from other coun- tries in establishing programs and policies that affect early childhood devel- opment, and he pointed out that many countries have established promising early childhood initiatives that are worthy of examination. However, the United States has a more individualistic political culture than do many other countries and therefore does not necessarily look abroad for policy

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41 POLICY ISSUES IN EARLY CHILDHOOD DEVELOPMENT guidance. “That is just the reality,” he said, “without passing a judgment on it one way or the other.” The challenge is to develop a strategy that reflects the political culture of the United States. It is also important to remember that in early childhood development, much of the action in the United States occurs at the state rather than fed- eral level. Federal policy and funding certainly have tremendous influence, but most important decisions are made by state officials, and it can be more manageable to work with leaders at that level. In addition, by working at the state level, new ideas can be instituted in places that are more hospi- table to them. For example, the Early Childhood Innovation Partnership is currently working with a state to connect its child welfare system to a larger health agenda, in part using funds and guidelines provided through the new federal health care law. Shonkoff stated, “This is simply a matter of building relationships with people who want to try new things—and then rolling up our sleeves and getting to work. We don’t have illusions about sending people scientific papers and expecting things to change. . . . Our strategy is to find places that want to exhibit leadership through innovation, explore what is possible, and then use successful achievements as examples for other places.” A logic model for the development of effective policy needs to em- phasize both people and programs. Governments do not make children healthier. It is what the government does to strengthen the capacity of caregivers in a child’s life or a community in which a child lives that has an effect on health. This emphasizes causal mechanisms while also providing an opportunity for more politically persuasive, broadly based, and bipar- tisan arguments. Shonkoff also commented on the potential for conflicts among the needs of young children and adolescents across different age groups. He said it is a mistake to talk about any one period as being more important than any other period. Brain development proceeds continually through- out the early years of life, into adolescence, and through adulthood. Thus, investing only in a single period can result in gains lost when that period is over. At the moment, early childhood receives fewer societal investments than do other periods of life, which makes it harder to build a strong foundation for later development. But that does not mean that one period is more important than another. From Neurons to Neighborhoods, in fo- cusing on the first few years of life, made this point by saying that from a developmental perspective, a policy focus on the period from birth to age 3 is starting too late and ending too early. Focusing on a single age period also can send the mistaken message that irreversible damage can be done if interventions are lacking at that age. There is plasticity in the brain throughout life, so children should not be stigmatized by saying that an irreplaceable opportunity has been missed.

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