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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2018. Exploring Early Childhood Care and Education Levers to Improve Population Health: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25129.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2018. Exploring Early Childhood Care and Education Levers to Improve Population Health: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25129.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2018. Exploring Early Childhood Care and Education Levers to Improve Population Health: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25129.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2018. Exploring Early Childhood Care and Education Levers to Improve Population Health: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25129.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2018. Exploring Early Childhood Care and Education Levers to Improve Population Health: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25129.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2018. Exploring Early Childhood Care and Education Levers to Improve Population Health: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25129.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2018. Exploring Early Childhood Care and Education Levers to Improve Population Health: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25129.
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Page viii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2018. Exploring Early Childhood Care and Education Levers to Improve Population Health: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25129.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2018. Exploring Early Childhood Care and Education Levers to Improve Population Health: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25129.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2018. Exploring Early Childhood Care and Education Levers to Improve Population Health: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25129.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2018. Exploring Early Childhood Care and Education Levers to Improve Population Health: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25129.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2018. Exploring Early Childhood Care and Education Levers to Improve Population Health: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25129.
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Page xiii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2018. Exploring Early Childhood Care and Education Levers to Improve Population Health: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25129.
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Page R13
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2018. Exploring Early Childhood Care and Education Levers to Improve Population Health: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25129.
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Below is the uncorrected machine-read text of this chapter, intended to provide our own search engines and external engines with highly rich, chapter-representative searchable text of each book. Because it is UNCORRECTED material, please consider the following text as a useful but insufficient proxy for the authoritative book pages.

Exploring Early Childhood Care and Education Levers to Improve Population Health PROCEEDINGS OF A WORKSHOP Theresa M. Wizemann, Rapporteur Roundtable on Population Health Improvement Board on Population Health and Public Health Practice Health and Medicine Division PREPUBLICATION COPY: UNCORRECTED PROOFS

THE NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001 This activity was supported by contracts between the National Academy of Sciences and Aetna Foundation (#10002892), The California Endowment (#10003309), Dartmouth-Hitchcock Medical Center, Fannie E. Rippel Foundation, Health Resources and Services Administration (DHHS-10003351), Kaiser East Bay Community Foundation (#10002957), The Kresge Foundation (#10002910), Nemours, New York State Health Foundation (#10001272), New York University Langone Medical Center, Office of the Assistant Secretary for Health (#10003388), Robert Wood Johnson Foundation (#10001270), Samueli Institute, and Wake Forest Baptist Medical Center. Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project. International Standard Book Number-13: 978-0-309-XXXXX-X International Standard Book Number-10: 0-309-XXXXX-X Digital Object Identifier: https://doi.org/10.17226/25129 Additional copies of this publication are available for sale from the National Academies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334-3313; http://www.nap.edu. Copyright 2018 by the National Academy of Sciences. All rights reserved. Printed in the United States of America Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2018. Exploring early childhood care and education levers to improve population health: Proceedings of a workshop. Washington, DC: The National Academies Press. doi: https://doi.org/10.17226/25129. PREPUBLICATION COPY: UNCORRECTED PROOFS

The National Academy of Sciences was established in 1863 by an Act of Congress, signed by President Lincoln, as a private, nongovernmental institution to advise the nation on issues related to science and technology. Members are elected by their peers for outstanding contributions to research. Dr. Marcia McNutt is president. The National Academy of Engineering was established in 1964 under the charter of the National Academy of Sciences to bring the practices of engineering to advising the nation. Members are elected by their peers for extraordinary contributions to engineering. Dr. C. D. Mote, Jr., is president. The National Academy of Medicine (formerly the Institute of Medicine) was established in 1970 under the charter of the National Academy of Sciences to advise the nation on medical and health issues. Members are elected by their peers for distinguished contributions to medicine and health. Dr. Victor J. Dzau is president. The three Academies work together as the National Academies of Sciences, Engineering, and Medicine to provide independent, objective analysis and advice to the nation and conduct other activities to solve complex problems and inform public policy decisions. The National Academies also encourage education and research, recognize outstanding contributions to knowledge, and increase public understanding in matters of science, engineering, and medicine. Learn more about the National Academies of Sciences, Engineering, and Medicine at www.nationalacademies.org. PREPUBLICATION COPY: UNCORRECTED PROOFS

Consensus Study Reports published by the National Academies of Sciences, Engineering, and Medicine document the evidence-based consensus on the study’s statement of task by an authoring committee of experts. Reports typically include findings, conclusions, and recommendations based on information gathered by the committee and the committee’s deliberations. Each report has been subjected to a rigorous and independent peer-review process, and it represents the position of the National Academies on the statement of task. Proceedings published by the National Academies of Sciences, Engineering, and Medicine chronicle the presentations and discussions at a workshop, symposium, or other event convened by the National Academies. The statements and opinions contained in proceedings are those of the participants and are not endorsed by other participants, the planning committee, or the National Academies. For information about other products and activities of the National Academies, please visit www.nationalacademies.org/about/whatwedo. PREPUBLICATION COPY: UNCORRECTED PROOFS

PLANNING COMMITTEE ON EXPLORING EARLY CHILDHOOD CARE AND EDUCATION LEVERS TO IMPROVE POPULATION HEALTH1 MORTON SWARTZ (Chair), Chief, Jackson Firm of Medical Service and Infectious Disease Unit, Massachusetts General Hospital DEBBIE I. CHANG, Senior Vice President, Policy and Prevention, Nemours MARQUITA F. DAVIS, Deputy Director, Early Childhood Learning, Bill & Melinda Gates Foundation JENNIFER FREY, Assistant Professor, Graduate School of Education and Human Development, The George Washington University JACQUELINE JONES, President and Chief Executive Officer, Foundation for Child Development PAULA M. LANTZ, Professor and Associate Dean for Research and Public Policy, Gerald R. Ford School of Public Policy, University of Michigan PHYLLIS MEADOWS, Senior Fellow, Health Program, The Kresge Foundation LARRY PASTI, Senior Director, Big Picture Approach Consulting, Forum for Youth Investment VALORA WASHINGTON, Chief Executive Officer, Council for Professional Recognition 1 The National Academies of Sciences, Engineering, and Medicine’s planning committees are solely responsible for organizing the workshop, identifying topics, and choosing speakers. The responsibility for the published Proceedings of a Workshop rests with the workshop rapporteur and the institution. v PREPUBLICATION COPY: UNCORRECTED PROOFS

ROUNDTABLE ON POPULATION HEALTH IMPROVEMENT1 GEORGE J. ISHAM (Co-Chair), Senior Advisor, HealthPartners; Senior Fellow, HealthPartners Institute for Education and Research SANNE MAGNAN (Co-Chair), Adjunct Assistant Professor, University of Minnesota PHILIP M. ALBERTI, Senior Director, Health Equity Research and Policy, Association of American Medical Colleges TERRY ALLAN, Health Commissioner, Cuyahoga County Board of Health JOHN AUERBACH, Executive Director, Trust for America’s Health CATHY BAASE, Chair, Board of Directors, Michigan Health Improvement Alliance, Consultant for Health Strategy, The Dow Chemical Company DEBBIE I. CHANG, Senior Vice President, Policy and Prevention, Nemours CHARLES J. FAZIO, Senior Vice President and Medical Director, HealthPartners, Inc. GEORGE R. FLORES, Senior Program Officer, The California Endowment KATHY GERWIG, Vice President, Employee Safety, Health, and Wellness, and Environmental Stewardship Officer, Kaiser Permanente ALAN GILBERT, Director of Global Government and NGO Strategies, GE Healthymagination MARY LOU GOEKE, Executive Director, United Way of Santa Cruz County MARTHE GOLD, Senior Scholar in Residence, The New York Academy of Medicine MARC N. GOUREVITCH, Professor and Chair, Department of Population Health; Professor, Department of Medicine; Professor, Department of Psychiatry; New York University School of Medicine GARTH GRAHAM, President, Aetna Foundation GARY R. GUNDERSON, Vice President, Faith Health, Wake Forest University WAYNE JONAS, Executive Director, H&S Ventures ROBERT M. KAPLAN, Professor, Stanford University DAVID A. KINDIG, Professor Emeritus of Population Health Sciences; Emeritus Vice Chancellor for Health Sciences, University of Wisconsin–Madison PAULA M. LANTZ, Professor and Associate Dean for Research and Public Policy, Gerald R. Ford School of Public Policy, University of Michigan MICHELLE LARKIN, Associate Vice President, Associate Chief of Staff, Robert Wood Johnson Foundation THOMAS A. LAVEIST, Professor and Chair, Department of Health Policy, Milken Institute School of Public Health, The George Washington University JEFFREY LEVI, Professor, Milken Institute School of Public Health, The George Washington University SHARRIE MCINTOSH, Vice President for Programs, New York State Health Foundation ROBERT MCLELLAN, Chief, Section of Occupational and Environmental Medicine; Medical Director, Live Well/Work Well, Professor, Medicine, Community and Family Medicine and Dartmouth Geisel School of Medicine, Dartmouth-Hitchcock Medical Center PHYLLIS D. MEADOWS, Senior Fellow, Health Program, The Kresge Foundation BOBBY MILSTEIN, Director, ReThink Health 1 The National Academies of Sciences, Engineering, and Medicine’s forums and roundtables do not issue, review, or approve individual documents. The responsibility for the published Proceedings of a Workshop rests with the workshop rapporteur and the institution. vii PREPUBLICATION COPY: UNCORRECTED PROOFS

JOSÉ T. MONTERO, Director, Office for State, Tribal, Local and Territorial Support; Deputy Director, Centers for Disease Control and Prevention MARY PITTMAN, President and Chief Executive Officer,, Public Health Institute PAMELA RUSSO, Senior Program Officer, Robert Wood Johnson Foundation Health and Medicine Division Staff ALINA BACIU, Study Director KIMANI HAMILTON-WRAY, Senior Program Assistant DARLA THOMPSON, Program Officer (until August 2017) ROSE MARIE MARTINEZ, Senior Board Director, Board on Population Health and Public Health Practice viii PREPUBLICATION COPY: UNCORRECTED PROOFS

Reviewers This Proceedings of a Workshop was reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the National Academies of Sciences, Engineering, and Medicine in making each published proceedings as sound as possible and to ensure that it meets the institutional standards for quality, objectivity, evidence, and responsiveness to the charge. The review comments and draft manuscript remain confidential to protect the integrity of the process. We thank the following individuals for their review of this proceedings: JENNIFER R. FREY, The George Washington University ELIZABETH GROGINSKY, Government of the District of Columbia CODY KORNACK, National Head Start Association Alan L. Mendelsohn, NYU School of Medicine MYETA MOON, United Way Worldwide Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the content of the proceedings, nor did they see the final draft before its release. The review of this proceedings was overseen by HUGH TILSON, University of North Carolina at Chapel Hill. He was responsible for making certain that an independent examination of this proceedings was carried out in accordance with standards of the National Academies and that all review comments were carefully considered. Responsibility for the final content rests entirely with the rapporteur and the National Academies. ix PREPUBLICATION COPY: UNCORRECTED PROOFS

Contents ACRONYMS AND ABBREVIATIONS 1 INTRODUCTION 1 Focusing on Children, 1 Workshop Objectives, 2 Organization of the Workshop and Proceedings, 3 2 EXPLORING THE EVIDENCE AT THE INTERSECTION OF EARLY CARE AND EDUCATION WITH HEALTH 5 Closing the Word Gap, 6 Family-Centered Early Childhood Education, 9 Learning Collaboratives, 11 The Proven Power of Early Connections, 13 Discussion, 14 Gallery Walk Reflections, 16 3 CROSS-SECTOR COLLABORATION 19 The New York City Department of Health and Mental Hygiene, 20 Head Start as a Lever to Improve Population Health, 24 Health, Access, and Affordability in Child Care, 26 Prosper Lincoln, 28 Discussion, 30 Gallery Walk Reflections, 31 4 POTENTIAL POLICY CHALLENGES AND OPPORTUNITIES 34 Policy Highlights at the Intersection of Health and Early Care and Education, 35 Embedding Social-Emotional Learning into State Policies, 40 Partnering with the Business Community, 41 Health Care/Child care Integration, 43 Changing Institutions and Their Cultures, 44 Discussion, 46 Gallery Walk Reflections, 48 5 CLOSING REMARKS AND REFLECTIONS ON THE DAY 51 Discussion, 52 APPENDIXES A REFERENCES 55 B WORKSHOP AGENDA 57 xi PREPUBLICATION COPY: UNCORRECTED PROOFS

C GALLERY WALK QUESTIONS AND INPUT 61 D BIOGRAPHICAL SKETCHES OF WORKSHOP SPEAKERS AND MODERATORS 71 xii PREPUBLICATION COPY: UNCORRECTED PROOFS

Acronyms and Abbreviations CCSSOO Council of Chief State School Officers CDC Centers for Disease Control and Prevention DOHMH Department of Health and Mental Hygiene (New York City) ECELC Early Care and Education Learning Collaborative EPIC Executives Partnering to Invest in Children ESSA Every Student Succeeds Act IOM Institute of Medicine MTSS multi-tiered support systems OACAC Ozarks Area Community Action Corporation PBIS Positive Behavioral Interventions and Supports SEL social-emotional learning xiii PREPUBLICATION COPY: UNCORRECTED PROOFS

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On September 14, 2017, the Roundtable on Population Health Improvement of the National Academies of Sciences, Engineering, and Medicine convened a workshop to explore the intersection of health and early childhood care and education, two key social determinants of health. This workshop follows a 2014 roundtable workshop that considered the interface between the education and health sectors broadly, from research and metrics to cross-sectoral partnerships and financing. The 2017 workshop continued that discussion, with a deeper focus on early childhood (birth through age 5) as a critical period in human development and an important opportunity for educational and related interventions. This publication summarizes the presentations and discussions from the 2017 workshop.

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