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More than preschool: State strategies to improve child well-being are broadening, with greater emphasis on birth-to-3 years and help for parents

by Tim Anderson ~ June/July 2016 ~ Stateline Midwest »
One of the more notable trends in state policy over the past decade has been the increased legislative activity and investment around early childhood education.
In the Midwest, countless laws and programs (some new, some long-standing) are now in place, from “Preschool for All” in Illinois to “Gearing Up for Kindergarten” in North Dakota. (See below for details.)
While the region’s various prekindergarten initiatives vary in scope and design, they all reflect a belief among policymakers that a positive early learning experience can lessen achievement gaps, reduce the need for special supports as children get older, and produce better results for individuals and their communities.
But offering access to a good preschool is only one piece of a very complex policy puzzle.
To improve child well-being and long-term outcomes, states are looking to broaden their approach, in part by trying to reach more young people even earlier in life.
“What you begin to realize when you’re working with children who have already had three or four years of development is the importance of supporting early brain development — prenatal through age 3,” notes Virginia Knox, director of family well-being and children’s development for the MDRC, a nonpartisan education and social policy research organization.
That realization, for example, has led to a new campaign in Indiana to help expectant mothers make healthier lifestyle choices (for themselves and their babies) in order to reduce infant mortality and preterm birth rates.
In states such as Nebraska and Wisconsin, a greater emphasis is being placed on measuring and rewarding quality child care, while Minnesota has been a longtime leader in offering family education programs (through local school districts), including state-funded home visits to nurture positive parent-child interactions.
“Challenging home environments can lead to toxic effects on children’s early development,” Knox says. "When you know that, the more you see the importance of supporting the environment where the child is being raised. The goal is to mitigate what otherwise might be [home] environments that are so challenging that they really have long-term effects on children’s development.”
Addressing these myriad policy challenges (and opportunities) is now a focus of the Midwestern Legislative Conference, the nonpartisan group of all legislators from 11 states and four Canadian affiliate provinces. (CSG Midwest provides staff support to the MLC.) Wisconsin Rep. Joan Ballweg is chair of the MLC, and for her chair’s initiative, she has chosen to raise awareness about state programs that improve child well-being and lead to better long-term outcomes.
"Early investment translates to reduced costs and more productive citizens,” Ballweg says. (See below for the full interview about her chair’s initiative.)
Breaking harmful cycles
One goal of these early interventions is to reduce the prevalence of “adverse childhood experiences,” or ACEs: traumatic events such as child abuse or neglect that have negative, lasting effects on a person’s well-being and behavior.
A state invests in a home-visiting program for at-risk families, for example, with the idea that cases of child maltreatment can be prevented. Or it ensures access to behavioral and mental health care for parents, because this can improve a child’s home environment.
But addressing (and not just preventing) these ACEs should also be a part of state strategies, Ballweg says. She notes that in Wisconsin, there has been a concerted effort among state leaders to promote trauma-informed care, which employs scientific research to help reverse the negative consequences of ACEs.
In Ohio, meanwhile, a three-year-old Strong Families, Safe Communities program is spreading evidence-based practices centered on trauma-informed care, while also targeting improved treatment and care coordination for young people in crisis or suffering from a mental illness.
The name of Ohio’s program underscores the intent of many of these new state programs and laws on child well-being: fostering “strong families” as the way to help young people thrive.
“If you start thinking of it as a two-generation problem,” Knox says, “then some policies are going to be aimed at parents and their well-being, so that the whole family can have either economic security or a strong home environment for children.”
That “two-generation strategy” can take the form of income, housing or employment supports so that children grow up with more economic security, she adds, or it can mean providing parents with the trauma-informed care they need to cope with their own adverse childhood experiences.
Role of foster care in child well-being
Yet some children inevitably come to rely on a state’s child welfare system. In 2014, for example, more than 200,000 young people entered the nation’s foster care system — from 999 in North Dakota to 9,924 in Ohio. (That same year, more than 400,000 children were in the nation’s foster care system.)
“It is everything to these kids,” Michigan Rep. Jim Runestad, a longtime foster care parent, says about the system. “You listen to them talk, and even though they address concerns about this or that, you’ll also hear some of them — a significant portion of them — say the foster care system saved their lives.”
He has used his platform as a legislator to raise awareness about the system’s importance, along with some of its shortcomings. At “KidSpeak” events hosted by Runestad, children in foster care have told their stories — of being separated from their siblings, for example, or of being moved from school to school or home to home multiple times in a single year.
“Listen for 20 minutes to their stories,” he says, “and it will change your outlook.”
The personal stories of children, in fact, helped lead to the introduction of legislation this year in Michigan that would create a Foster Care Children’s Bill of Rights. At committee meetings a few years ago to create a Foster Parents Bill of Rights, legislators heard from the children as well, Rep. Marcia Hovey-Wright recalls. It became clear then, she adds, that young people’s rights should be codified as well.
“I view it as common-sense things that all kids should have a right to,” Hovey-Wright says.
Passed by the Michigan House earlier this year, the legislation (HB 4976-4978) would ensure access to behavioral health services, a plan to be placed in a permanent home and help with the transition to independent living. It also requires the state to place children with close relatives and friends and to keep siblings together whenever possible.
“If we as a state are going to take them out of the home, then we better provide the services they need,” Hovey-Wright says.
Hovey-Wright, a Democrat, and Runestad, a Republican, are co-sponsors of the legislative package — just one indication that there is plenty of room for bipartisan agreement on state policies to improve child well-being.


Paths to better long-term outcomes for children and families: Examples of recent state legislation, new laws and noteworthy programs in Midwest

Preschool for All in IllinoisThis initiative was created by the state General Assembly in 2006 with the intention of offering preschool education to every 3- and 4-year-old in the state. Family child care homes, public schools, Head Start programs, and private child care and faith-based centers are all eligible to apply for competitive grants offered by the state. The program is available in every county, but funding limitations do not allow the program to cover every child whose family seeks to enroll in early learning. As a result, children deemed “at risk” receive the first funding priority. More than 75,000 children were enrolled through the initiative in 2015.
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Indiana’s Focus on Healthy Babies — The state Department of Health has made reducing infant mortality its No. 1 priority, and has launched a campaign to raise awareness about receiving prenatal care and preventing behaviors that can lead to preterm births (smoking, for example). These births are the greatest contributor to infant deaths. Preterm babies also are more likely to have long-term health problems and neurological disorders. And in 2014, Indiana legislators passed a bill to begin addressing the problem of newborns being exposed to addictive drugs or alcohol while in the mother’s womb. SB 408 requires better identification and data collection of cases involving Neonatal Abstinence Syndrome.
Helping Hand for Iowa Children, Families in Crisis — One year after the Iowa Legislature established a special working group to look at ways to improve services for children and families in crisis (SF 505), it included funding in the 2016 state budget for two of that group’s recommendations. Lawmakers appropriated $300,000 for planning grants (HF 2460) as the first step in a plan to improve access to mental health crisis services — intensive, face-to-face interventions provided to children and/or their families in inpatient or outpatient settings. Secondly, the state will fund the creation of three to five “children’s well-being labs” with the goal of finding strategies that help young people with “complex needs.”
Kansas Endowment for Youth — A decision made by the Kansas Legislature 17 years ago continues to support programs that promote the health and welfare of young children. Lawmakers at the time chose to dedicate money from the settlement with tobacco companies to the Kansas Endowment for Youth. Today, that endowment is used to fund programs focused on early learning, health and child welfare. For example, early-childhood block grants go to local providers that offer services for expectant parents, at-risk infants, toddlers, preschool students and young families. A Kansas Children’s Cabinet (also created by the Legislature) reviews and evaluates endowment-funded programs.
Foster Care Advances in Michigan — Improving services for young people in foster care has been a focal point in Michigan, where system-wide problems led to a 2006 lawsuit and subsequent court settlement. Three years ago, the Legislature began moving the state to a “performance-based” model, where funding for providers is based on desired outcomes rather than per diem rates. A new legislative package (HB 4976-HB 4978) approved by the House in May would create a “Bill of Rights for Foster Children” — for example, ensuring access to behavioral health services; a plan to be placed in a permanent home; and help with the transition to independent living. The state also has a college scholarship for foster care children.
Help for Young Families in Minnesota — Created as a statewide initiative in 1984, the Early Childhood Family Education program was the first of its kind in the country. Today, it continues to offer low- or no-cost services (via the state’s local school districts) to all Minnesota families with children ages birth to 4, regardless of income. The program offers everything from parent discussion groups and learning workshops for children, to home visits and health and child-development screenings. Approximately 128,062 parents and 122,123 children participated in the program’s various activities in 2010. The state requires parent educators and early-childhood educators in the program to be licensed.
Nebraska’s New School Readiness Tax Credit — Starting in 2017, the state of Nebraska will begin offering tiered tax credits to early childhood programs and their employees. Up to $5 million in tax credits will be provided. LB 889 (passed earlier this year) is also linked to a quality rating system created three years ago by the Unicameral Legislature. Under this system, providers receive incentives for being evaluated by the state and making improvements in child care. The size of the tax credit for providers will be based on their quality rating, and for individual employees, it will depend on factors such as level of education, training and work history.
Gearing Up for Kindergarten in North Dakota — Deeper investments in recent years by the North Dakota Legislative Assembly have allowed the state-funded, research-based Gearing Up for Kindergarten program to expand to more school districts and reach more people. Administered by North Dakota State University (it partners with local school districts), Gearing Up offers its services for the families of children one year away from entering kindergarten. Combining preschool learning activities for children with educational opportunities for their parents, Gearing Up classes are taught by kindergarten teachers.
Implementation of Trauma-Informed Care in Ohio — Launched three years ago, Ohio’s Strong Families, Safe Communities program helps young people in crisis. Grants are awarded to projects that provide treatment and improved care coordination for youths at risk of self-harm or aggression due to a mental illness or developmental disability. The state is also raising awareness about trauma-informed care, a framework for treatment that recognizes the consequences of trauma and how to help people recover from it. Ohio’s Trauma-Informed Care Initiative spreads evidence-based practices among behavioral health providers, child welfare agencies, the courts, and local schools and law enforcement.
South Dakota’s Bill of Rights for Foster Parents — In an effort to increase support for foster parents, South Dakota’s Division of Child Protection Services created a special work group composed of foster parents, legislators, state agency staff and others. That group then developed a handbook with a 17-point “Foster Parent Bill of Rights” — for example, the right to receive the training and support needed to provide quality services to a child and the right to receive timely financial reimbursement. The handbook also provides foster and adoptive parents with a broad range of information on a number of topics, from legal advice to tips and advice from fellow parents.
Fostering Futures, Improving Mental Health Care in WisconsinWisconsin’s Fostering Futures Initiative aims to help individuals move beyond the cycles of harm caused by adverse childhood experiences, or ACEs, such as physical, emotional or sexual abuse. Part of its goal is to raise awareness about how and why to provide trauma-informed care to individuals affected by an ACE. Laws enacted in 2014, meanwhile, have sought to strengthen the state’s entire mental health system. AB 452 provides state guidance to pediatricians on how to treat children with mental health needs, while AB 458 increases children’s access to mental health in rural areas by allowing these services to be provided via “telehealth.”


Q&A with Rep. Joan Ballweg on her MLC chair’s initiative: State policies to promote child well-being and improve long-term outcomes

Every year, the leader of CSG Midwest’s Midwestern Legislative Conference chooses a policy issue as her MLC chair’s initiative. That decision helps guide the session topics for the MLC Annual Meeting and the research done by CSG Midwest on behalf of the region’s state legislators. Rep. Ballweg explains here why her MLC chair’s initiative is focusing on policies that strengthen families, improve child well-being and lead to better long-term outcomes.

Q: How did you first get involved in these issues that center on child well-being and long-term outcomes?
A: I was first invited by Wisconsin First Lady Tonette Walker, along with three other legislators, to join the Fostering Futures Policy Advisory Committee. Her Fostering Futures Initiative began in 2011 with the support of the Annie E. Casey Foundation. Mrs. Walker started work with state and national experts to spread the understanding of Adverse Childhood Experiences (ACEs) and to promote a trauma-informed culture throughout Wisconsin. Today, we see a visible change with both statewide understanding of ACEs and their importance, and the presence of Trauma Informed Care (TIC) in both policy and practice across Wisconsin. A network of TIC trainers is now available. Both agencies and organizations throughout the state have taken advantage of this free program.


Q: What do you see as the role of states, in particular, in trying to promote strong families and to create better long-term outcomes for children?
A: As we know, states make the rules and hold the purse strings in areas like education, protecting children at risk, foster care, income maintenance, Medicaid, law enforcement and corrections. Science shows us that a child’s brain development is greatly impacted from birth to 3, before most children are in formal educational programs. Encouraging early, high-quality child care, along with parental support when necessary, will have positive results down the road for those children. We can see that in terms of school success, reduced law enforcement/corrections interactions and more positive life outcomes. Early investment translates to reduced costs and more productive citizens. It’s a smart investment for the state and an important investment for Wisconsin’s children.


Q: What are some of the policy areas that you think warrant more attention from states?
A: Home visiting is an important policy area that states can continue to invest in. Wisconsin currently funds 14 evidence-based home visiting programs that operate in 15 counties and tribal communities. Our program is voluntary, serving at-risk families living in high-risk communities. The goal is to serve pregnant women, children from birth to 8, and their families. Home visiting has been found to improve parenting, school readiness and health. It can also help prevent child abuse and neglect.


Q: Are there promising new programs, initiatives or laws in Wisconsin that you’ve seen?
A: This year, we embarked on an exciting and important new initiative — the Wisconsin Legislative Children’s Caucus. Our first program was held in April; it featured experts in the field of early brain development and covered the benefits of investing in early childhood education as well as different programs dedicated to improving childhood outcomes. Our agenda included presentations from a bio-related psychologist, a social scientist and an economist. I believe the diversity of these experts speaks volumes about how far the field of early childhood has come. We are cutting across disciplines, landing at the same point — a point of great focus and concern on early childhood.
Another promising Wisconsin initiative is the YoungStar Program, which was implemented in 2010 and is run by the Department of Children and Families. It’s a five-star quality rating system for child care providers based on education, learning environment, business methods, and practices around child health and well-being. Through YoungStar, the state is addressing several key issues in Wisconsin’s child care system. Over the past two years, Wisconsin has seen an increase in the number of children served by high-quality programs. It’s a positive move for Wisconsin’s children and their families.