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Low-income families' ability to sustain employment while ensuring the care and safety of their young children is profoundly affected by federal policies regarding access to subsidies and programs, such as Head Start. The current structure of these policies evolved during the decades following the 1990 enactment of the Child Care and Development Block Grant – a period that also witnessed expansion of the Head Start program and growth of state pre-K programs. Using data from two nationally representative surveys of child care providers conducted in 1990 and 2012, this paper examines trends in the supply, sponsorship, and funding structure of publicly-funded child care centers during this period of active policymaking in early care and education. These changes include major expansion in the number and share of child care centers receiving public funds, as well as in the number of children enrolled in these centers; relatively more rapid growth among for-profit vs. non-profit centers in the publicly-funded sector, but consistency in that the major share of publicly-funded centers remained non-profit; and substantial growth in publicly-funded centers receiving vouchers as a primary funding mechanism. These trends carry the potential to enhance the reach of quality improvement efforts tagged to public funds and may have increased low-income families' choice of centers with differing hours, in a range of locations, that serve a wider age range of children, as well as children supported with differing funding sources. Whether the growing supply of publicly-funded centers has actually kept pace with demand, let alone enhanced access of low-income families to care that supports their children's development, are critical, next-stage questions to address.

Preschool teachers are widely acknowledged as critical to supporting the school readiness of children, yet remain under-paid relative to their education levels and have high rates of turnover relative to the U.S. workforce as a whole. Federal and state policies affect preschool teachers through education and training requirements, as well as guidelines affecting subsidy reimbursement rates, for example. Because these policies are focused on low-income children, they disproportionately experience the impacts. The present study describes trends affecting the racial-ethnic composition, education and experience, and compensation and turnover of preschool teachers of 3–5-year olds in ECE programs receiving and not receiving public funds between 1990 and 2012 – two years when nationally representative data are available. Data sources are the Profile of Child Care Settings (1990) and the National Survey of Early Care and Education (2012). Results indicate that, while the experience and education levels of teachers have increased over this 22-year period, wages have remained flat. Access to health insurance, in contrast, has improved over time and turnover rates have declined. The race-ethnic composition of the preschool teaching workforce also shifted during this time period, revealing a notable loss of Black teachers. Comparisons of programs receiving and not receiving public funds, and among those receiving different sources of public funds – CCDBG/CCDF subsidies, Head Start funds, pre-K funds -- identified disparities within survey years, as well as differing trends over time. Results have implications for policies to support teachers and young children.

The current study compared patterns of service utilization reported by Early Head Start (EHS) families of children with and without disabilities by secondary analysis of data from the longitudinal investigation of the effectiveness of EHS. Findings reveal comparable positive trends for both groups of families for receipt of services corresponding to EHS performance standards promoting child and family development, family support, and health care. Service challenges remain in the low use of dental services overall and the higher use of acute health care services for children with disabilities. Future research should examine causes and outcomes of service use.

This study examines disparities in health status, health care utilization, insurance coverage and satisfaction in US low-income parents of infants and toddlers with disabilities compared to low-income parents of children without disabilities. The Early Head Start Research and Evaluation Project is a longitudinal study involving 2087 families in 17 communities across the United States. Families completed interviews at enrollment and at 7, 16, and 28 months after enrollment. Descriptive analyses were conducted to characterize children’s status in terms of health, health care use, and insurance coverage. Children with disabilities were more likely to experience poor health and to use more health care services. Parents of children with disabilities were more likely to report that medical care was inadequate. Hispanic children were less likely to experience excellent health. Hispanic parents were less likely to have health insurance or to report that their medical care was adequate. Low-income parents of young children with disabilities perceived their children as less healthy, more vulnerable and needing more health services. This study demonstrates the importance of providing accessible, culturally-competent services to this vulnerable population.

Early development is likely influenced by quality of early parenting and improvements or declines in quality over time. Little is known about how changes in different dimensions of parenting influence child outcomes, nor the relative sizes of associations when considering several aspects simultaneously. These questions are addressed in the Early Head Start Research and Evaluation Project (N = 1273). Assessments occurred when children were 1, 2, 3, and 5 years old. Parent supportiveness (videotaped play interactions), home learning environment (observed), and depressive symptoms and parenting stress (self-report) were assessed. Children's school readiness at age 5 was assessed via receptive vocabulary, letter–word knowledge, observed emotion regulation, approaches toward learning, and behavior problems. In this low-income sample, early parenting as well as change over time predicted school readiness. Associations mostly followed predictions from the family stress model and cognitive stimulation models; lea...

Using data from the Early Head Start Research and Evaluation Project, this study analyzed the similarities and differences of variables associated with child care services for low-income families with young children with disabilities and low-income families with typically developing children. Four major variables were analyzed: access to child care; maternal participation in self-sufficiency activities, such as work or education; quality of care; and parental satisfaction with care. Rates of child care utilization and maternal self sufficiency activities were similar for both groups. At age 3, however, children with disabilities received care of lower quality than their typically developing peers, and their parents were less satisfied with the child care arrangements. Policy and research implications, stressing the importance of improving child care quality for low-income children with disabilities across all types of settings, are presented.

One strand of home visiting research investigates efficacy while another investigates under what conditions programs achieve outcomes. The current study follows the latter approach. Using a within-program design in a sample of 11 home-based sites in the Early Head Start Research and Evaluation study, this study found that three components of home visits (quantity of involvement including number of home visits, duration in the program, length of visits and intensity of service; quality of engagement including global ratings of engagement by staff and ratings of engagement during each home visit; and the extent to which home visits were child focused) represented distinguishable aspects of home visit services. Demographic variables predicted components of involvement, and home visit involvement components were differentially related to outcomes at 36 months, after controlling for demographic/family factors and earlier functioning on the same measure. Only one quantity of involvement variable (duration) predicted improvements in home language and literacy environments at 36 months. Quality of involvement variables were negative predictors of maternal depressive symptoms at 36 months. Finally, the proportion of time during the visit devoted to child-focused activities predicted children's cognitive and language development scores, parent HOME scores, and parental support for language and learning when children were 36 months of age. Implications for home visiting programs and policies are discussed.

Early Head Start (EHS) is a comprehensive, two-generation program that provides services to low-income families with children under the age of 3 years. As part of their mandate, staff members of EHS programs collaborate with other service providers in their local communities, including Part C and childcare providers. The incidence of disabilities among low-income children was tracked as part of the EHS Research and Evaluation Project. The incidence of indicators of disabilities (or potential disabilities) was extremely high (87%) among these very young children living in poverty; however, only 99 participating families (4.7% of the sample) received Part C services. Receipt of Part C services was related negatively to specific family characteristics (e.g., mother less well educated, being of color, not speaking English). Participation in EHS had a positive impact on receipt of Part C services.

Three studies examined associations between early child care and child outcomes among families different from those in the National Institute of Child Health and Human Development (NICHD) Early Child Care Research Network study. Results suggest that quality is an important influence on children's development and may be an important moderator of the amount of time in care. Thus, the generalizability of the NICHD findings may hinge on the context in which those results were obtained. These studies, conducted in three national contexts, with different regulatory climates, ranges of child care quality, and a diversity of family characteristics, suggest a need for more complete estimates of how both quality and quantity of child care may influence a range of young children's developmental outcomes.

Le but principal du Projet de Recherche et d'Evaluation National Early Head Start (le Early Head Start est un programme de prevention et d'aide gouvernementale a la petite enfance defavorisee aux Etats-Unis d'Amerique) est d'evaluer l'application du programme et la qualite de service cles de developpement de l'enfant dans les 17 programmes de recherche de cette etude. L'equipe chargee de l'evaluation a developpe des echelles d'evaluation basees sur les Standards de Performance du Programme Head Start. Cette equipe a aussi developpe un procede d'evaluation des elements cles du programme, puis synthetise en quelques indices d'evaluation une grande quantite de renseignements sur l'application et la qualite du programme. Cette equipe a aussi utilise ces indices d'evaluation pour examiner les progres effectues par les programmes avec le temps, pour examiner egalement les impacts qu'a crees le programme et enfin pour offrir de l'aide aux programmes ainsi qu'une assistance technique pour l'application des strategies. Dans cet article, nous presentons les echelles d'evaluation et les methodes developpees pour evaluer l'application et la qualite. Nous decrivons les niveaux d'application et de qualite atteinte quatre ans apres le financement des programmes. Enfin, nous discutons les implications pour la politique a mener et la pratique.

This article draws on data from the ongoing federal Evaluation of Adolescent Pregnancy Prevention Approaches to discuss the early implementation experiences of two new and innovative programs intended to delay rapid repeat pregnancy among teen mothers: (1) AIM 4 Teen Moms, in Los Angeles County, California; and (2) Teen Options to Prevent Pregnancy (T.O.P.P.), in Columbus, Ohio. Program staff report common challenges in working with teen mothers, particularly concerning recruitment and retention, staff capacity and training, barriers to participation, and participants' overarching service needs. Lessons learned in addressing these challenges provide useful guidance to program developers, providers, policy makers, and stakeholders working with similar populations.

Sometimes implementing evaluation designs that involve random assignment or strong nonrandomized comparison group designs is not feasible. When this is the case, several other types of comparisons may offer credible, though not conclusive, evidence on program effects. This article describes three approaches—comparisons of the outcomes of the treatment group with a national sample, comparisons of the outcomes of program participants and nonparticipants, and dose-response analyses—and illustrates their use in the evaluation of the School-Based Adolescent Health Care Program. The findings suggest that if outcomes are measured before and after the intervention, comparisons of the treatment group outcomes to outcomes for a national sample may provide valid estimates of program effects. The other two types of comparisons produced implausible and unstable estimates of program effects. Because of the selection bias inherent in these two methods, researchers cannot count on being able to produce plausible estimates of program effects with such comparisons.

The Early Head Start Research and Evaluation project launches an intense study of the new Early Head Start program and simultaneously begins a far-reaching longitudinal study of infants and toddlers in low-income families. The Early Head Start study will include approximately 3,000 families living in 17 diverse communities that reflect the socioeconomic and political context of low-income families in the United States in the late 1990s. We will measure a broad range of outcomes, collect extensive information about the programs and the individual families' expenses with them, and conduct state-of-the-art analyses to link experiences with outcomes. The findings from this national evaluation and longitudinal study will have the potential to influence policies affecting the lives of low-income American families with young children.

At the beginning of 1990, 80 000 day-care centers in the US were serving about 4 million preschool children.1 This represents threefold increase since 1976 to 1977 in the number of centers and a fourfold increase in enrollments. Approximately 118 000 regulated family day-care providers were serving about 700 000 children. There were between 550 000 and 1.1 million nonregulated family day-care homes that were serving an unknown number of children. The number of regulated family day-care homes and the number of children enrolled in those homes increased since the mid-1970s, though not as much as the number enrolled in centers. About 17% of the children enrolled in center-based programs and 5% of those enrolled in regulated family day-care homes came from families receiving public assistance. Low-income families are overrepresented in Head Start and other sponsored non-profit programs. The fact that increasing numbers of children are enrolled in early education and care programs presents an opportunity to serve the needs of disadvantaged children who may not necessarily receive nutritious meals, environmental stimulation, developmental screening, and adequate preventive health care at home. Programs such as Head Start, for example, are required to provide a comprehensive set of services in addition to a developmentally appropriate curriculum. In the first part of this paper we examine the general health and safety procedures followed by center staff and family day-care providers for sick children ill providers. The extent to which providers conform to health and safety provisions will be examined. For example, do providers maintain records, obtain medical releases, have the phone number of a physician, have an emergency medical plan, have a list of persons to whom the child may be released, and conduct fire drills?

Data from a nationally representative survey of child care centers and a 5-site, observational study of centers were used to examine the quality of care provided to children from low-income families. Comparisons were made to a national sample of centers; among Head Start, public school-sponsored, and other community-based subsidized centers; and among centers that served families from differing socioeconomic groups. The quality of care in centers that served predominantly low-income children was adequate, but highly variable, with structural indices exhibiting higher quality than observations of global quality and of staff-child interactions. When compared to Head Start and public school-sponsored centers, the community-based centers had smaller groups and fewer children per teacher for preschoolers, but also had less well educated and compensated staff. Centers that predominantly served children from upper-income families provided the highest quality of care across multiple indices, and those that predominantly served children from middle-income families almost uniformly provided the poorest quality of care. The centers that served children from low-income families did not differ significantly in quality from the upper-income centers on most indices. However, the teachers in these programs were observed to be less sensitive and more harsh than teachers in the centers that served more advantaged families. The implications of the findings for research and policy are discussed.

This report estimates Early Head Start impacts on children and families when children were in fifth grade. It includes additional nonexperimental analyses to inform program practice and guide future research. Impacts on the full sample of children and families in the grade 5 followup suggest that for the overall sample, Early Head Start did not continue to have the broad pattern of impacts for child and family outcomes seen at earlier ages; however, there were interesting patterns of impacts for some subgroups.

This paper presents findings from a survey of child care use by teenage parent Aid to Families with Dependent Children recipients in three low-income metropolitan areas. The teenage mothers surveyed were participants and control group members in demonstration programs that provided access to a range of services similar to those being implemented under the Family Support Act of 1988—employment training, education, and supportive services including child care assistance. The results focus on the need for care, the extent to which child care is a barrier to participation in employment-related activities, the types of child care used, the cost of care, and mothers' satisfaction and problems with their arrangements. The child care arrangements made by the teenage mothers are also compared to those made by other mothers of young children in the local areas.

The final report to Congress presents complete findings from our seven-year national evaluation of Early Head Start. The findings show that the program promotes learning and the parenting that supports it within the first three years of life. Participating children perform significantly better in cognitive, language, and social-emotional development than their peers who do not participate. The program also has important impacts on many aspects of parenting and the home environment, and it supports parents’ progress toward economic self-sufficiency.

This publication, the first major report on the Early Head Start national evaluation, focuses on early implementation experiences and tells the story of the 17 programs that helped launch the first nationwide program for low-income infants and toddlers.

This publication, the first major report on the Early Head Start national evaluation, focuses on early implementation experiences and tells the story of the 17 programs that helped launch the first nationwide program for low-income infants and toddlers.

Examines partnerships developing between early childhood and welfare agencies; describes their strategies for meeting the challenges of welfare reform; and addresses their concerns, including frustration of early childhood staff in trying to help families with severe barriers to work, confusion about supports and benefits available to those who are working, and ongoing concern about quality and availability of child care as well as general concern about whether families will be able to make it over the longer term.

Purpose: The purpose of this investigation was to assess the School-Based Adolescent Health Care Program, which provided comprehensive health-related services in 24 school-based health centers. Methods: The outcomes evaluation compared a cohort of students attending 19 participating schools and a national sample of urban youths, using logit models to control for observed differences between the two groups of youths. Outcome measures included self-reports concerning health center utilization, use of other health care providers, knowledge of key health facts, substance use, sexual activity, contraceptive use, pregnancies and births, and health status. Results: The health centers increased students' access to health care and improved their health knowledge. However, the estimated impacts on health status and risky behaviors were inconsistent, and most were small and not statistically significant. Conclusions: School-based health centers can increase students' health knowledge and access to health-related services, but more intensive or different services are needed if they are to significantly reduce risk-taking behaviors.

More than half of the children in families supported by welfare are under age six, and another third are in grade school. The mothers of these children cannot leave welfare for employment unless they can find and pay for child care. Yet, as this article points out, the child care needs of these families are not easily met: Many require care for infants and toddlers, care at odd hours, and care in poor neighborhoods-all of which are scarce. Evidence reviewed by the authors indicates that problems with child care affordability, availability, and quality impede mothers from participating in the labor force and in job training programs. Recent public finding for child care subsidies has helped families leaving welfare to afford the child care they need, although the demand for financial assistance outstrips available funding. This article urges that policymakers work to facilitate access to subsidies, increase the supply of care that can meet the needs of poor working families, and guard against exposure to poor-quality care that can jeopardize both children's well-being and parents' employment.

It has been argued in the literature that the observed mortality crossover among older black Americans relative to the white population is a result of ‘differential early mortality which selects the least robust persons from the disadvantaged population at relatively earlier ages so that, at advanced ages, the disadvantaged population has proportionately more robust persons’ (Kenneth G. Manton). The authors examine the plausibility of the observed black mortality crossover and the heterogeneity argument supporting its existence. In addition to citing evidence from the literature, they use life tables from various countries known to have good mortality data to explore the relation between mortality in childhood and at younger adult ages and mortality in old age for cohorts and periods. Analysis suggests that the association between childhood and old-age mortality for cohorts is positive, implying that observed mortality crossovers are produced by deficient data rather than population heterogeneity.

It has long been observed that married persons experience more favorable mortality than unmarried persons. Hypotheses about possible explanations for mortality differentials by marital status fall into three general categories: (1) hypotheses regarding errors in the data, (2) hypotheses related to the selection of persons into and out of marital states, and (3) hypotheses regarding environmental and behavioral factors associated with various marital states. In this paper the authors investigate the extent to which mortality differences by marital status are similar across populations and assess the importance of selection factors in producing the excess mortality of the single populations.

Tells the story of program development in the early years, examining the nature and extent of implementation in key program areas and the quality of child development services for the 17 programs participating in the national evaluation.

Early Head Start, a federal program begun in 1995 for low-income pregnant women and families with infants and toddlers, was evaluated through a randomized trial of 3,001 families in 17 programs. Interviews with primary caregivers, child assessments, and observations of parent-child interactions were completed when children were 3 years old. Caregivers were diverse in race-ethnicity, language, and other characteristics. Regression-adjusted impact analyses showed that 3-year-old program children performed better than did control children in cognitive and language development, displayed higher emotional engagement of the parent and sustained attention with play objects, and were lower in aggressive behavior. Compared with controls, Early Head Start parents were more emotionally supportive, provided more language and learning stimulation, read to their children more, and spanked less. The strongest and most numerous impacts were for programs that offered a mix of home-visiting and center-based services and that fully implemented the performance standards early.

The final report to Congress presents complete findings from our seven-year national evaluation of Early Head Start. The findings show that the program promotes learning and the parenting that supports it within the first three years of life.

Finds that, a year or more after enrolling in the program, 2-year-olds perform significantly better on a range of measures of cognitive, language, and social-emotional development, when compared with a randomly assigned control group. EHS families are also more likely to attend school or job training and have less parenting stress and family conflict. The program produced significant impacts for important groups, including welfare families, working families, and families headed by teenage mothers. For these families, EHS programs appear to have provided a foundation of support for parenting and child development while families coped with new work requirements and time limits on TANF cash assistance, balanced the demands of work and family, or attended to their own developmental needs.

Data from surveys conducted by the Alan Guttmacher Institute (AGI) in 1981 have been used to create 3 indicators of the effectiveness of family planning clinics serving teenagers: the mean delay between 1st intercourse and 1st clinic visit (which for teenage clinic patients is 13.2 months); teenage patient retention (67%); and the average excess of patient satisfaction over dissatisfaction with clinic policies and services (33%). Clinics run by Planned Parenthood are more effective than other types of facility according to the mean delay indicator whereas other clinics such as those associated with community action programs and neighborhood health centers rank highest in levels of patient satisfaction and patient retention. All 3 measures indicate that clinics serving 1000-2499 family planning patients per year are more effective in serving teenagers than either smaller of larger clinics and that nonmetropolitan clinics are more effective in providing services than those in cities. Regression analysis shows that clinic administrators might take a number of actions to shorten the mean delay among teenagers between 1st intercourse and 1st clinic visit. These include offering community education programs for teenagers enlisting the support of local churches developing relationships with local youth groups opening the clinic curing evenings and weekends accepting more teenagers as walk-in patients and locating a clinic in or near neighborhoods where many teenagers live. 2 of the same factors--developing an active relationship with youth groups and opening the clinic to teenagers on evenings and weekends--were also found to be particularly effective in keeping teenagers as clinic patients. The range of services offered at the clinic and the socioeconomic conditions in the county served by the clinic have an impact as well. The satisfaction of the teenage patients with clinic policies and services appears to be determined primarily by the patients own characteristics. For example satisfaction with the clinic is lower when a larger proportion of teenage patients are nonwhite and satisfaction is higher when a larger proportion are students. In addition teenagers in counties where there are several different clinics to choose from are more satisfied with their selection. These results suggest that making an effort to reach teenagers and inform them may help clinics serve teenagers more effectively by shortening the length of time that teenagers delay their 1st clinic visit inducing more of them to return regularly and increasing their satisfaction with the clinics. (authors modified)

To investigate the reasons behind the high levels of nonuse or inconsistent use of contraceptives among sexually active adolescents in the US the Alan Guttmacher Institute (AGI) undertook a 1983 study using 10 focus group discussions with teenagers from 5 US cities. Focus groups are small groups of 6 to 12 participants and 1 trained moderator; the informal setting is believed to encourage more detailed behavioral responses and provides a qualitative understanding of the topics addressed. The groups were segregated according to sex and age with the ages from 16 to 17 and 18 to 19. The groups were composed of single sexually active teenagers overwhelmingly from middle or lower middle class white families. After taping and analyzing the sessions the researchers found some common reasons given for nonuse. Included were the belief they were not at risk at the time of their intercourse lack of preparation for a sexual encounter partners objections lack of information about birth control methods or where to access them and the belief that contraceptives were complicated or unpleasant to use. The authors suggest that conflicting societal messages may be in part responsible. For example 1st sexual encounters are often unprepared for and may signify the "bad" label offered by society for sex at a young age or before marriage. Yet this is coupled with advertisements promoting the excitement of sexual adventure. Embarrassment and confusion result from such ambivalence creating a need for contraceptive service providers to recognize and become sensitive to the needs of these young consumers. The authors offer several suggestions to help diminish this ambivalence: elevating the content and quality of sex education in secondary schools; informing young men of their legal responsibilities to the mothers of their offspring; selecting and training groups of students to serve as peer sources of family planning information; and instituting programs that encourage parent and child communication on sexual matters. Their hope is to reduce the negative feelings and to incease effective contraceptive practice among adolescents.