Earlier this week, the Census Bureau released its official statistics on poverty, income and health insurance coverage in 2016. Following last year’s trend, the data show improvements across all three measures. The average household’s income rose more from 2014 to 2016 than in any other two-year period, and the share of Americans without health insurance fell to a record low of 8.8 percent – or 28.1 million people – in 2016, demonstrating the positive impact of major health coverage expansions under the Affordable Care Act (ACA).
The 2016 American Community Survey (ACS), released yesterday, offers a closer look at the economic conditions facing families in cities and counties across the nation and provides greater insight into the experiences of children and families in these communities. Poverty negatively impacts the health and well-being of all individuals, but for a young child, its consequences can shape their entire life trajectory. Early childhood is a critical period for physical, cognitive and social-emotional growth, and creates the foundation for healthy development, academic success and well-being well into adolescence and adulthood.
CSSP recognizes that public policy can play a significant role in improving the health and well-being of children and families, in particular, families facing the most significant barriers – including living in poverty. To consider the 2016 ACS data in the context of some innovative policy efforts underway across the country, we took a closer look at the data in 3 of CSSP’s EC-LINC network communities and highlighted some of the important work happening in these communities to ensure the health and well-being of young children and their families.
These EC-LINC communities - Los Angeles, CA, Boston, MA and Kent County, MI - are investing in and scaling up effective and innovative strategies for meeting the needs of young children and families. It is important to note that all three of these communities are in states that have expanded Medicaid coverage to adults in poverty – many of them parents. Coverage for parents means that more eligible children will enroll, stay enrolled and receive needed health care, including preventive care. Health coverage provides access to a range of essential health care services and supports that promote health and social and emotional development for children and youth. Children with insurance are more likely to have a usual source of care, health care services they need, access to preventive care, and as a result, be better prepared to do well academically and in other aspects of life.
Los Angeles, California is home to First 5 LA. In LA County, 10.4 percent of people living in poverty in 2016 were children age 6 and under. Among these children, 75.8 percent were Hispanic or Latino compared to 5.6 percent of their White peers. In LA, 95.3 percent of children age 18 and below living at 138 percent or below of the poverty threshold were covered by some form of health insurance in 2016. 86.5 percent of these children were covered by some form of public insurance.
There are several efforts underway in Los Angeles to advance the health and well-being of young children in the community. First 5 LA is working to increase family and community protective factors including strengthening families’ capacities, building social connections and concrete supports, promoting family-supporting communities through coordinated services and supports, and creating a common vision and social networks through various investments, including a place-based approach called Best Start in 14 communities. Best Start focuses on building supportive communities where children and families can thrive by bringing together parents and caregivers, residents, businesses and other stakeholders to collectively improve a community’s policies, resources and services to better support residents, and create communities where families can thrive.
Welcome Baby, a free, voluntary home visiting program that supports pregnant women and new moms through pregnancy and early parenthood is a component of Best Start and is funded by First 5 LA. Welcome Baby started in 2009 as a pilot program and has since expanded to 13 LA County hospitals, serving approximately 60 percent of all families within Best Start communities and over a third of the births countywide. Pregnant women and new moms who deliver or plan to deliver in one of the participating Welcome Baby hospitals are paired with a personal Parental Coach who provides them with information and support during pregnancy and following birth, and if needed, referrals to community resources that help families receive health care coverage or other supportive services. Families enrolled in the program have demonstrated lower parental stress, higher levels of maternal responsiveness and greater communication skills, social competence and engagement compared to non-participating families.
Boston, Massachusetts is home to the United Way of Massachusetts Bay and Merrimack Valley. In Boston, 9.3 percent of people living in poverty in 2016 were children age 6 and under. Among these children, 51 percent were Black and 36.3 percent were Hispanic or Latino compared to 5.4 percent of White children. In Boston, 98.9 percent of children age 18 and below living at 138 percent or below of the poverty threshold were covered by some form of health insurance. 93.2 percent of these children were covered by some form of public insurance.
In Boston, there are a number of initiatives underway to help prepare children to enter school ready to learn and develop critical social and academic skills. The United Way is working to ensure all of Boston’s children enter kindergarten ready for success and life through various initiatives including Thrive in 5, a partnership with the City of Boston. Recognizing that developmental screenings, coupled with strong linkages to early intervention services and consistent follow-up can promote well-being and healthy development and help ensure that all young children enter school ready and able to learn, the United Way is incubating the Data & Resources Investing in Vital Early Education (DRIVE), an effort to identify infants, toddlers and preschoolers who are most-at-risk of falling behind and connect them to early intervention services. Data from DRIVE are then used to ensure receipt of timely referrals and early intervention and parent have opportunities to increase their understanding, expectations and involvement in healthy child development. This model has the potential to scale to other cities in Massachusetts.
Kent County, Michigan is home to First Steps Kent County and the Great Start Collaborative which are focused on ensuring that all children birth to age eight, especially those in highest need, have access to high-quality early learning and development programs and enter kindergarten prepared for success. In Kent County, 11 percent of people living in poverty in 2016 were children age 6 and under. Among these children, 15.9 percent were Black and 49.8 percent were Hispanic or Latino compared to 30.9 percent of White children. 94.1 percent of children age 18 and below living at 138 percent or below of the poverty threshold were covered by some form of health insurance. 89.1 percent of these children were covered by some form of public insurance.
Committed to ensuring that every young child in Kent County will enter kindergarten healthy and ready to succeed in school and beyond, First Steps Kent County has taken a number of steps to promote positive outcomes for children in the community. These actions include creating the first Kent County Community Plan for Early Childhood, serving as a key player in Michigan's recent 'historic' expansion of the Great Start Readiness Program – a publicly funded preschool program for 4 year olds with factors which may place them at risk of educational failure, and launching multiple demonstration projects including the Children's Healthcare Access Program (CHAP), Early Learning Communities and Welcome Home Baby.
CHAP is an evidence-based model that improves the quality of care and health outcomes for children with Medicaid while reducing the cost of care. While originally launched by First Steps, CHAP has since been scaled state-wide to demonstrate that by reallocating resources to focus on prevention and early intervention, the result will be improved health outcomes, higher quality of care and reduced healthcare costs for Michigan’s children. MI-CHAP transforms medical care delivery to the families, providing services throughout the state by utilizing Virtual CHAP (expertly trained CHAP Specialists who are available by calling Michigan 2-1-1 and provide assistance in areas including Medicaid Benefits) and local multidisciplinary teams to increase access to medical homes for children on Medicaid and decrease costs associated with emergency room visits, inpatient hospitalizations and inappropriate asthma management.
As these examples demonstrate, communities across the country are investing in promising approaches to support families with young children, including home visiting programs, place-based initiatives that help to build communities where children can thrive, and innovations in pediatric care and early learning that focus on early identification and intervention to ensure that children are linked with necessary services and supports and enter school ready and able to learn. While these programs have reached many families, truly scaling such efforts – and better meeting the needs of the millions of children that are experiencing poverty across the country - necessitates policy change.
The ACS data released yesterday make a compelling case for why policy matters and the opportunity policymakers have to improve services and supports for young children and families across the nation. Local data provide important insight into the experiences of children and families living in poverty and highlight how existing supports and services can better meet the needs of every family. To ensure that policies are responsive to the needs of families, policymakers must look at what is happening at the local level and the ACS data provide an opportunity to do that. A look at innovations taking place in these three EC-LINC communities provides promising examples of programs with potential to scale.
Policymakers should use these data to inform action that can be taken now to ensure that children and families have the supports needed to thrive including access to health care, prevention and early learning opportunities. Failure to invest in children and families during early childhood results in inequities that can produce poor and costly outcomes later in life. Policymakers must embrace the challenge of continuing efforts to tackle poverty, inequities and uninsured rates and not leave children and families worse off. In doing so, they should build on our progress in recent years by expanding the innovative efforts underway in communities across the country so that every young child has the opportunities needed to truly thrive.
Shadi Houshyar is a senior associate at CSSP.