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Policy Alternatives to Increase Access to Early Childhood Education and Care in Massachusetts

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University of Massachusetts - Amherst Amherst Masters Theses February 2014 Dissertations and Theses 2013 Policy Alternatives to Increase Access to Early Childhood Education and
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University of Massachusetts - Amherst Amherst Masters Theses February 2014 Dissertations and Theses 2013 Policy Alternatives to Increase Access to Early Childhood Education and Care in Massachusetts Meghan Lemay Follow this and additional works at: Lemay, Meghan, Policy Alternatives to Increase Access to Early Childhood Education and Care in Massachusetts (). Masters Theses February Paper This Open Access is brought to you for free and open access by the Dissertations and Theses at Amherst. It has been accepted for inclusion in Masters Theses February 2014 by an authorized administrator of Amherst. For more information, please contact POLICY ALTERNATIVES TO INCREASE ACCESS TO EARLY CHILDHOOD EDUCATION AND CARE IN MASSACHUSETTS A Thesis Presented by MEGHAN LEMAY Submitted to the Graduate School of the University of Massachusetts Amherst in partial fulfillment of the requirements for the degree of MASTER OF SCIENCE February 2013 Health Policy and Management POLICY ALTERNATIVES TO INCREASE ACCESS TO EARLY CHILDHOOD EDUCATION AND CARE IN MASSACHUSETTS A Thesis Presented by MEGHAN LEMAY Approved as to style and content by: Maria Bulzacchelli, Chair Paula Stamps, Member Edward Stanek, Department Head Public Health ABSTRACT POLICY ALTERNATIVES TO INCREASE ACCESS TO EARLY CHILDHOOD EDUCATION AND CARE IN MASSACHUSETTS FEBRUARY 2013 MEGHAN LEMAY, B.A., UNIVERSITY OF MASSACHUSETTS AMHERST M.S., UNIVERSITY OF MASSACHUSETTS AMHERST Access to early childhood education not only leads to improved social, academic, and health outcomes for children, but can also carry the same benefits into adulthood. Early education and care programs can work against some of the negative effects of social factors such as socioeconomic status, discrimination, social support, and work demands which have been linked to physical and mental health outcomes. Early education programs could intervene not only in the life of a child, but also impact parents, families, and populations. This thesis will review the research showing early childhood education leads to better social and health outcomes and that there is a lack of adequate access to early childhood education for low-income families in Massachusetts. This thesis presents three state-level policy options for making early childhood education more accessible to low-income families in Massachusetts: lengthen the certification period of child care vouchers; reduce the administrative burden on families including eliminating the need for double documentation; dissolve the child care subsidy waiting list by making child care services an entitlement for families at or below 50% State Median Income. These policy options are evaluated based on the criteria of political feasibility, equity and fairness, administrative ease, effectiveness, and cost. Based on this policy analysis, a recommendation is made for Massachusetts to lengthen the certification iii period of child care vouchers, as well as reduce the administrative burden on families including eliminating the need for double documentation. iv TABLE OF CONTENTS Page ABSTRACT... iii CHAPTER I. THE VALUE OF EARLY CHILDHOOD EDUCATION AND CURRENT MASSACHUSETTS POLICIES...1 A. Introduction and Objective...1 B. The Link Between Early Childhood Education and Health and Social Outcomes...2 C. The Link Between Early Childhood Education and the Health of Parents and Communities...7 D. The Implications of Early Childhood Education for Marginalized Populations and Inequality...12 E. Current Early Education and Care Programs in Massachusetts...20 II. METHODS...27 III. POLICY ALTERNATIVES...29 A. Extending the Length of Child Care Vouchers...29 B. Reduce the Administrative Burden on Families...31 C. Dissolve the Child Care Subsidy Waiting List...35 IV. COMPARISON OF POLICY ALTERNATIVES...39 V. RECOMMENDATIONS AND LIMITATIONS...47 REFERENCES...50 v CHAPTER 1 THE VALUE OF EARLY CHILDHOOD EDUCATION AND CURRENT MASSACHUSETTS POLICIES A. Introduction and Objective A connection has been made between early childhood education, family support services, and health outcomes for disadvantaged, low-income families with young children. A significant amount of research has been done over the past forty years suggesting the link between childhood poverty, reduced academic achievement, and subordinate health outcomes. In the public health discipline, social factors such as socioeconomic status, discrimination, social support, and work demands have been linked to physical and mental health outcomes. Early education and care programs have been suggested as a way to work against some of the negative effects of these social factors. Therefore early education could work to combat the ill health outcomes that are associated with negative social factors. This thesis will explore how early education programs could intervene not only in the life of a child, but also impact parents, families, and populations. This thesis will review the research showing early childhood education leads to better social and health outcomes and how access to early childhood education for low-income families is inadequate in Massachusetts. This thesis will present three state-level policy options for making early childhood education more accessible to low-income families in Massachusetts: lengthen the certification period of child care vouchers; reduce the administrative burden on families including eliminating the need for double documentation; dissolve the child care subsidy waiting list by making child care services vi an entitlement for families at or below 50% State Median Income. These policy options will be evaluated based on the criteria of political feasibility, equity and fairness, administrative ease, effectiveness, and cost. Based on this policy analysis, a policy option will be recommended for improving accessibility to early childhood education in Massachusetts. B. The Link Between Early Childhood Education and Health and Social Outcomes Studies show that healthy early childhood development and education can positively influence class-based health disparities, as well as success in school and life. The literature on poverty, child development, and education has documented how the early physical and sociolinguistic environment provided by average low-income families can sometimes lead to suboptimal child development (Campbell and Ramney, 1994). Research shows that 54 percent of homeless preschoolers had a major language, gross motor, fine motor, or social developmental delay, compared to only 16 percent of their housed peers (McCoy-Roth, Mackintosh, and Murphey, 2012, p. 3). Early childhood intervention is necessary to avoid these and other serious issues correlated with problematic early environments. It is necessary to integrate early education and care with family support services as family needs are often interconnected, for example, over 80 percent of mothers with children experiencing homelessness have previously experienced domestic violence, and their children are more likely to have emotional and behavioral problems (McCoy-Roth, Mackintosh, and Murphey, 2012, p. 5). The High/Scope Perry Preschool Project was a landmark study conducted in Michigan in 1962 that produced results which sparked major interest in the issue and led 2 to decades of further research. The study followed two groups of at-risk children from the age of 3 until they were 27 and was able to show that the group that went through an active learning preschool program out-performed the control group that did not attend a preschool program, in a variety of ways. The program group on average had completed a significantly higher level of schooling than the no-program group had the program group significantly outscored on various tests of school achievement and intellectual performance (Schweinhart and Weikart, 1993, p. 56). In addition, the study showed that more students who did not go through the program had criminal records as adults compared with those who did go through the program. Those who had a preschool education also had a higher monthly income as adults, and a higher percentage of home ownership. This study was able to clearly make the connection between early education and an improved overall quality of life. When young children develop in a healthy early environment, they are more likely to grow into successful adults who can potentially break the cycle of poverty and positively impact communities as a whole. Follow-up studies have been conducted in recent years to make further conclusions about early intervention programs of the 1960s and 1970s. In 2003 researchers followed up with participants from the Brookline Early Education Project in Massachusetts, an innovative, community-based program that provided health and developmental services for children and their families from 3 months before birth until entry into kindergarten (Palfrey et al, 2005, p. 145). This was the first study to focus heavily on the correlation between health-related outcomes and an early education intervention. Participants in this follow-up study were adults who had been enrolled in the Brookline Early Education Project from 1973 to The program was initially 3 evaluated by monitoring the children from birth through second grade. Then, decades later, a quasi-experimental causal-comparative study used a survey to gather information on the health, educational, and employment status of the adult participants in the Brookline Early Education Project and compared it to the status of control group members. The survey had a 47 percent response rate. The results of the Brookline Early Education follow-up study showed that participants in the program had on average attained more years of schooling, had higher incomes, and were more likely to have private health insurance, compared with the control group. Sixty-four percent of the participants in the urban early education program reported being in very good or excellent health, while only percent of the urban control group reported this level of health (Palfrey et al, 2005, p. 150). The study showed that there was a dramatic difference between the urban group and the suburban group regardless of participation in the early education program, meaning that on average children who grew up in suburban neighborhoods were better off in adulthood compared with those who grew up in an urban environment, regardless of participation in the early education program. Despite this, overall participation in the early education program was associated with higher levels of health efficacy, more positive health behaviors, and less depression than their peers (Palfrey et al, 2005, p. 150). A 2010 study used statistics on childhood height to provide evidence that childhood health influences health and economic status throughout adulthood (Case and Paxson, 2010, p. 65). With data collected from early to late adulthood on cohort members in five longitudinal data sets, height was found to be uniformly associated with level of employment, income, physical health and cognitive ability. A 2011 retrospective 4 cohort study examined the link between preschool attendance and adult cardiovascular disease risk. After controlling for potential confounders, the study found that adults with a preschool education were more likely to engage in rigorous physical activity and refrain from smoking. This study discusses the potential health benefit of interventions outside of the health sector to prevent cardiovascular diseases, which are strongly associated with lifelong social disadvantage (D Onise et al, 2011, p. 278). An older systematic review of randomized control trials that examined the health effects of day care discussed how day care leads to increased employment, lower teenage pregnancy rates, higher socioeconomic status and decreased criminal behavior yet points out that there was little evidence proving an increase of health outcomes across the spectrum, but that there must be further research (Zoritch, Roberts, and Oakley, 1998, p. 317). There has been increasing acknowledgement in the scientific, as well as public policy literature that children from vulnerable families, where there is social disadvantage, parental mental health problems, substance abuse or domestic violence, are at risk of attention, language, learning and behavior problems because of poor attachment and lack of stimulation in the first 5 years (Gwynne, Blick, and Duffy, 2009, p. 119). In the 2000 book, From Neurons to Neighborhoods: The Science of Early Child Development, Jack Shonkoff and Deborah Phillips present evidence on early brain development and the importance of children s early environment and initial experiences. Children are born ready to learn and need nurturing relationships in order to develop in the optimal way. Children who develop in a stressful environment are more likely to experience emotional disorders, behavior problems, and school failure later (Shonkoff and Phillips, 2000). Infants and children who experience trauma are most significantly 5 at-risk because of the effects of cortisol and the early cementing of the Limbic- Hypothalamus-Pituitary-Adrenal axis and autonomic nervous system pathways (Bolger and Patterson, 2001, p. 549). Early education programs can serve to teach coping skills and reinforce self-esteem for all children, not just those who have experienced trauma (Marmot and Wilkinson, Eds. 2006, p. 46). Many scientific developments have also furthered the understanding of the lifecourse perspective on health, which sees a person s biological status as a marker of their past social position and, through the structured nature of social processes, as liable to selective accumulation of future advantage or disadvantage, a person s past social experiences become written into the physiology and pathology of their body (Blane, 2006, p. 54). This perspective is important for understanding how experiences in early life are connected to health and well-being later in life. Social context tends to structure life chances so that advantages and disadvantages tend to cluster cross-sectionally and accumulate longitudinally (Blane, 2006, p. 55). Cross-sectionally accumulated advantage could mean, for example, that a person who lives in an environmental hazardfree home is likely to have a higher income and therefore be able to afford a healthier diet, whereas, longitudinally accumulated advantage could mean, for example, if a child attends a high-quality early education program, they are more likely to go to college, become financially stable as an adult, and then retire with a pension. Importantly, interventions can occur throughout the course of one s life that may alter the trajectory of health and well-being. Early education and care can intercede in the dynamic of the ongoing process of social accumulation in the continuity of social circumstances from 6 parental social class to social conditions during childhood and adolescence, and eventually, to adult socioeconomic position (Blane, 2006, p. 56). There is ample evidence exposing the link between early childhood education and improved health and social outcomes over the lifespan. Multiple studies have compared the health and well-being of adults who attended an early childhood education program as children, with adults that did not, and the results are clear: early childhood education interventions work to improve health and social outcomes in childhood, adolescence, and adulthood. Studies show that a healthy, educational environment in the first five years of life is crucial to optimal brain development. Early childhood education is vital for all children, but it is especially important for children who are already disadvantaged by poverty or a history of trauma. Early education can improve the educational, social, economic, and health outcomes of the children who receive it. The evidence exists to support the implementation of early childhood education programs as educational, social, and health policy. C. The Link Between Early Childhood Education and the Health of Parents and Communities One important way in which early education programs can influence the health of parents, families, and communities is by providing a social network or support system. Access to early education and day care programs can serve to connect parents with social networks and support that they may not have in other aspects of their life. A great deal of theoretical sociological research exists explaining the importance of social integration and social support in how individuals connect to the community. The level of 7 connectedness to one s community is vital to an individual s health and well-being as well as to the health and vitality of entire populations (Berkman and Kawachi, Eds. 2000, p. 137). Health and social support are interrelated in crucial ways, as anthropologists of the 1950s pointed out, the structural arrangement of social institutions shapes the resources available to the individual and hence that person s behavioral and emotional responses (Berkman and Kawachi, Eds. 2000, p. 141). In the 1970s a series of studies consistently showed that a shortage of social networks was correlated with higher rates of mortality. Since then, the intricacies of how social integration and networks influence population health have been further explored. The generally accepted conceptual model argues that networks operate at the behavioral level through four primary pathways: provision of social support, social influence, on social engagement and attachment, and access to resources and material goods (Berkman and Kawachi, Eds. 2000, p. 144). Parents of children who are enrolled in early care programs may gain greater access to these pathways compared to parents whose young children stay at home until kindergarten. This may be especially important for socially disadvantaged or lowincome families who already are at a higher risk for lacking material resources. Families may further their social networks, and therefore health, by being involved in early education programs. Early education facilities may serve as institutional liaisons. For example, they may connect families with health care or adult education opportunities. Early care programs may also strive to intentionally work on changing the health behaviors of families as, shared norms around health behaviors are powerful sources of social influence with direct consequences for the behaviors of network members the social influence which extends from the network s values and norms 8 constitutes an important and underappreciated pathway through which networks impact health (Marsden and Friedkin, 1994, p. 5). Within early education institutions, for example, when dental hygiene is enforced in school, parents and children may be taking that health behavior home with them. In addition, social network size is inversely related to unhealthy behaviors. Multiple studies have shown that there is a steady gradient between increasing social disconnection and the cumulative prevalence of healthdamaging behaviors such as tobacco and alcohol consumption, physical inactivity, and consequent obesity (Berkman and Kawachi, Eds. 2000, p. 149). Social scientists also point out that socially engaging in a community may allow people to feel as though life acquires a sense of coherence, meaningfulness and interdependence (Berkman and Kawachi, Eds. 2000, p. 146). This could have a major positive effect on low-income families and communities. Social capital can be viewed as a subset of social networks or social cohesion and is defined as features of social structures such as levels of interpersonal trust and norms of reciprocity and mutual aid- which act as resources for individuals and facilitate collective action (Coleman, 1990, p. 101). Similar to the effects of social networks, significant social capital can positively impact health. Social capital is specifically important
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