An Infant-Toddler Agenda for the New Administration and Congress

The Science Behind Early Brain Development

Early Brain Development Lays the Foundation

A baby’s brain architecture forms as connections for important functions such as hearing, language, and cognition peak during the first three years. Early brain development occurs at lightning speed, creating more than one million new neural connections every second. Later, higher-level brain functions will be built on top of these foundational connections like a scaffold. Early experiences influence which connections are reinforced and which fall away unused, and thus whether this important foundation will be strong or fragile. Early childhood presents both a prime opportunity to positively influence the course of a young child’s life and a window of vulnerability for falling behind.

Relationships Are the Key to Strong Early Development

Relationships with trusted adults, primarily their parents, are central to helping babies navigate early experiences. Within these relationships, young children learn how they are valued and how the world works. With more than 5 million infants and toddlers spending time in the care of someone other than their parents, other caregivers also play a key role. Trusting relationships foster the social-emotional skills—confidence, persistence, self-regulation, attentiveness, and ability to form relationships—that set infants and toddlers on the path to being enthusiastic learners, productive workers, and emotionally competent adults. Emotions drive learning, as social-emotional and cognitive development intertwine to form the “bricks and mortar” of early brain architecture.

Not All Babies Have the Opportunity to Thrive

 

When families lack access to key ingredients for healthy, positive development, a child’s early years can become a time of vulnerability rather than potential. Chronic, unrelenting stress that children may experience from environmental factors such as unstable housing, deprivation, and parental stress or mental health issues can undermine brain development. It is often described as toxic stress because it unleashes hormones that constantly bathe the brain, weakening its architecture. Poverty and other stressors literally get under the skin: Early chronic stress becomes embedded, not just in neurological development, but in physical systems also developing rapidly in the early years.

• Too many children face adverse experiences in the earliest years: Almost half of all children under 3 years old live in low-income households, and more than one fifth live in poverty. Almost half of infants and toddlers in poverty have had at least one adverse experience that could undermine their development and future health.
• Disadvantaged children tend to fall behind before their second birthday: Children whose families lack economic and educational resources—those who are in the lowest socio-economic group, who live in poverty, whose parents have less education, or whose mothers are not employed—tend to lag behind their peers who have more of these resources in developing language skills, early math, and social-emotional indicators by age 2. Because children from racial or ethnic minorities disproportionately live in families with these characteristics, they are more likely to be behind, creating inequities of opportunity.
• Risk factors lead to developmental delays: Children with risk factors, such as living in low-income households, abuse or neglect, prenatal exposure to alcohol or other substances, and low parental education, have a higher incidence of developmental delays and disabilities than the general population. Disparities emerge as early as 9 months and widen by 24 months old.

Support the Parent-Child Connection: Enact National Paid Leave and Parent Support

 

Parents have a vital but daunting job on the front line of preparing the next generation of workers and citizens who will help shape our country’s future. The parent-child relationship is the most important ingredient in teaching children how they are valued and shaping who they will become. New research shows that parents want to be the best for their children, but they need support and a new roadmap. Taking a broader public health approach to parent support would provide parents that roadmap and the tools they need to follow it.

• Create a national Paid Family Leave program: The months after birth or adoption are a critical period for parents and children to become attuned to each other, helping attachment bloom and setting the stage for future social-emotional development. The time parents and babies have to bond should not be dependent on income, workplace, or zip code. The new Administration and Congress should create a national system to ensure all babies have the chance to form the connections with parents that will set them on a positive developmental path.
• Create a Parenting Edge initiative that provides broad support to new parents through a public health approach: Parents almost unanimously say that parenting is their greatest joy, but they feel judged, unsupported, and in need of a new roadmap. A bold effort would give all parents an edge with the know-how and confidence to nurture the future innovators, workers, and thinkers our nation needs for tomorrow. The Parenting Edge initiative would reach a broad range of parents through a comprehensive array of public-private approaches, including:
  • placing child development or IECMH specialists in pediatric practices, such as through the HealthySteps model, providing parents with quality information and support to nurture their child’s development;
  • seeding community partnerships to promote support for parents including approaches such as parent peer groups to help parents connect with and support each other, or communitywide efforts to highlight ways parents can support early development;
  • expanding the Maternal, Infant, and Early Childhood Home Visiting program to reach more families with intensive support and improving the program through innovations that put families at the center of services; and
  • ensuring child welfare programs provide research- and traumainformed services developed for these parents’ specific needs in nurturing their babies’ development.

Connect Neurons to Neighborhoods: Expand Quality Infant-Toddler Child Care, Early Head Start, and Developmental Child Welfare Services

 

The seminal work From Neurons to Neighborhoods documented the community’s role in helping parents support their children’s early brain development. Now, our policies must better address this vital connection. Some families face significant challenges, such as living in poverty, substance abuse or mental health problems, housing instability, or even maltreatment, that lead to chronic, unrelenting stress often toxic to a baby’s developing brain. These families need the most comprehensive support, yet too many children often do not receive the quality developmental support they need to thrive. Neighborhoods—how communities connect with babies and families—play a critical role in supporting babies’ strong brain connections and development. The new Administration and Congress should:

• Ensure all families can access quality, affordable child care: Work is a fact of life for the majority of parents of very young children, yet child care costs, particularly for infants, take an outsize bite from their budgets. At the same time, child care helps shape brain development, yet quality care for infants and toddlers is in very short supply. The new Administration and Congress should make a major investment to recognize child care as both a work support and a critical early learning setting where development unfolds for babies:
  • Address our country’s pressing needs by fully covering the cost of the 2014 reauthorization of the Child Care and Development Block Grant, including boosting quality.
  • Include a significant investment of mandatory funds to ensure quality care by well-trained and well-compensated providers is accessible and affordable for all families that need it.
  • Invest intentionally in building quality care specifically for infants and toddlers. This means: increasing the qualifications of the workforce to include expertise in infant and toddler development; working with institutions of Higher Education to instill more infant-toddler content in degree programs; and ensuring that babies living in families with a severe lack of resources, including those on Temporary Assistance for Needy Families, have access to quality care commensurate with Early Head Start.
• Extend Early Head Start to half of all eligible infants and toddlers by 2021: Early Head Start’s expansive vision offers a crucial two-generation approach to support both babies and parents with comprehensive services. Yet, it only reaches 5 percent of eligible pregnant women, babies, and toddlers. We need to realize the program’s potential for promoting positive development by providing:
  • a down payment on expansion of Early Head Start in a “first hundred days” measure to address our country’s pressing needs, and
  • a major commitment of funds to expand Early Head Start so that it reaches at least 50 percent of eligible children and pregnant women by the year 2021.
• Reorient the child welfare system to ensure stable relationships and sound development for infants and toddlers experiencing maltreatment: Young children have the highest incidence of abuse and neglect, are the most likely to be placed in foster care, and tend to stay longer in care. The hidden cost of their experiences is developmental and social-emotional harm. Their parents’ needs, often including their own early trauma, go unaddressed. Child welfare policy and practice needs to be reoriented toward a systematic framework, implemented at the community level, that breaks cycles and embraces families with the goal of supporting the healthy development of children.
  • Enact legislation to allow Title IV-E foster care maintenance funding to be used for preventive and reunification services and the infrastructure to ensure effective use of those funds.
  • Promote states’ adoption of child welfare policies and practices oriented around supporting the positive development of infants and toddlers.
  • Through the Child Abuse Prevention and Treatment Act, expand Safe Babies Court Teams, a research-based systems-change approach grounded in developmental science. The expansion would create statewide networks of community-level, judicially led teams of child welfare staff, families, and service providers that provide families with tailored interventions to meet their specific needs.

Invest in the Bedrock of Brain Connections: Promote Strong Infant-Early Childhood Mental Health

A baby agenda must start with the bedrock of brain development: social-emotional development, synonymous with IECMH. Babies can and do experience mental health problems that can undermine their development, especially when exposed to chronic, unrelenting stress and trauma from situations such as living in poverty, experiencing abuse or neglect, or witnessing domestic or community violence. The first years are a unique opportunity to vigorously promote positive mental health, prevent or identify early problems when early intervention can be effective, and identify and treat disorders. A national mental health policy must start with babies, requiring a comprehensive IECMH Strategy to:

Make Services More Available and Accessible

• Fund models to integrate IECMH clinicians into primary pediatric health care. Nearly all infants and young children are seen in pediatric care in their first years of life, making it a prime place to reach their families with support for social-emotional and other development. Federal health care funding streams should include opportunities to support IECMH clinicians in pediatric offices to:
  • integrate support for social-emotional development of infants and young children, including screening, assessment, and referral strategies;
  • provide parents and caregivers with information on how they can support the early social-emotional development of their children; and
  • offer mental health services that address the needs of young children exposed to adverse life experiences and trauma.
• Ensure that all early childhood development programs, including Head Start, Early Head Start, licensed child care, preschool special education, Part C Early Intervention, and home visiting programs have access to an IECMH consultant. IECMH consultants work collaboratively with early childhood programs to improve both their understanding of how to promote positive social-emotional development as well as their ability to prevent and identify mental health issues among children in their care, therefore helping reduce problem behaviors in young children. Access to IECMH consultants would:
  • infuse competencies for supporting social-emotional development into early childhood programs to help address the needs of children and families they serve,
  • increase access to mental health resources and referral mechanisms available in the community, and
  • reduce suspensions and expulsions by preventing or addressing challenging behaviors.
• Create an IECMH-in-Child Welfare initiative to work with states and communities to develop a continuum of IECMH services for young children and their parents in the child welfare system. Families in the child welfare system are affected by the most adverse circumstances which can span generations. In addition, infants and toddlers who have experienced maltreatment are vulnerable to mental health challenges. The Administration and Congress should create a joint effort among mental health and child welfare agencies to:
  • develop a continuum of IECMH services integrated into child welfare practice that includes assessments of the parent-child relationship, effective parenting education, visit coaching, and multigenerational therapies such as Child-Parent Psychotherapy; and
  • infuse a knowledge of IECMH and the impacts of intergenerational trauma into child welfare and judicial personnel training.

Expand the Workforce

• Prioritize funds in mental health training programs to graduate more child psychiatrists, child psychologists, and other mental health clinicians who specialize in IECMH. Clinicians trained and experienced in IECMH are in extremely short supply.
• Create and fund a National IECMH Service Corps to dramatically increase the availability of well-trained mental health clinicians specializing in the diagnosis and treatment of IECMH disorders. The IECMH Service Corps program would support IECMH-specific graduate education, loan repayment, and placement and supervision of IECMH clinicians in health professional shortage areas.

Ensure IECMH Services Are Adequately Funded

• Create guidance for Medicaid to ensure coverage for IECMH screening, diagnosis, and treatment through public and commercial health insurance. Systemic reimbursement issues hinder the ability to pay for IECMH services. The new Administration and Congress should convene Medicaid and commercial health insurers to create IECMH benefit packages that ensure coverage for:
  • IECMH prevention and treatment in diverse settings (e.g., pediatric primary care, home visiting, early education);
  • mental health services to prevent or treat IECMH disorders provided to families and children both together and separately (two-generational treatment);
  • multiple screenings for parent and child (e.g., depression and developmental screens, respectively) in the same setting and/or on the same day; and
  • developmentally appropriate assessment and diagnosis.
• Fund initiatives that help improve the capacity of the mental health system to address the needs of young children and their families, such as the Infant-Early Childhood Mental Health Promotion, Intervention, and Treatment grants included in the mental health reform bills in the 114th Congress. Such grants will help to expand the ability to appropriately diagnose young children and will expand and promote treatments appropriate for very young children together with their parents.

Investing in Early Development is Critical to Our Nation’s Future

Program evaluation research highlights effective strategies to create the conditions in which children and their families thrive, even in the face of adverse circumstances. Such strategies promote strong relationships that can help buffer children from the toxic stress that can undermine healthy brain development and provide positive early learning experiences. Starting in the prenatal period, proven approaches can promote stronger social-emotional foundations. Congress and the Administration can build on what we know to:

• Arm parents with information about child development to help promote healthy outcomes. Ensuring strong parental support is an important intervention to prevent detrimental impacts to brain development associated with living in poverty at an early age. Broad-based models of parent support based in pediatric settings have been shown to improve parenting practices and increase knowledge of early development.
• Plant the seeds of strong early mental health, laying the cornerstone of healthy, lifelong development. IECMH can be positively affected through a continuum of strategies focused on promotion (e.g. supporting strong parent-child relationships), prevention (more intensive services aimed at identifying and mitigating risk factors that threaten healthy development, as well as supporting caregivers in better addressing children’s needs), and treatment to directly address mental health disorders (e.g. Child Parent Psychotherapy and Attachment and Behavioral Catch-Up.)
• Promote quality early care and learning to ready babies for success. The Early Head Start evaluation found positive effects on children’s development, as well as on parents’ support for development and more positive discipline techniques. When services began with pregnant women, their children showed some of the strongest impacts on social-emotional and cognitive development. Early Head Start also significantly improved how fathers interacted with and related to their children. Children in the Abecedarian Project had long-lasting positive impacts that led to higher IQ and achievement test scores, fewer grade retentions and placements in special education, higher levels of college graduation and job-holding, and healthier outcomes as adults.
• Act early for better outcomes. A prekindergarten follow-up of children and families in the Early Head Start evaluation found that those who had participated in Early Head Start, followed by a formal program for ages 3 to 5, had the most positive outcomes. Research on Educare, a high-quality early care and learning program serving children birth-to-5 found children who entered the program earlier had better scores on school readiness assessments than children who entered the program later.

Economists estimate that when we invest in quality early development for disadvantaged children, the rate of return is between 7 and 10 percent a year. Moreover, Nobel laureate James Heckman’s models show that optimal investments in the birth-to-3 year range can boost the return on investment for prekindergarten.