What’s Early Childhood Got to Do with Health Care Reform?

August 2, 2010

One of the provisions I particularly like in the Affordable Care Act is the section that provides $1.5 billion over five years to states for home visiting programs for new mothers.

Under the Maternal, Infant, and Early Childhood Home Visiting Program, nurses, social workers, or other professionals are expected to meet with at-risk families in their homes, evaluate the families’ circumstances, and connect families with help related to health care, developmental services for children, early education, parenting skills, child abuse prevention, and nutrition education or assistance.

On July 21, HHS announced that it had awarded the first $88 million in funding for this initiative. Forty-nine states, the District of Columbia, and five territories applied for and were awarded these funds (principally distributed based on the relative proportion of children in poverty in the states). The first step in this initiative will focus on a needs assessment with additional funding coming later for programming based on the results of that needs assessment.

This provision is modeled on the David Olds’ Nurse Family Partnership program and underlines decades of research into the value of investing in our youngest children and their families. Indeed, this past week, David Leonhardt of the New York Times (I seem to quote him a lot in these blogs: he has a great perspective – or maybe, we just agree!) wrote a piece reporting on some recent research about how valuable it is to invest in young children. These researchers from Harvard looked at adult success based on the quality of kindergarten experience. One of the economists who conducted the research noted that a stand-out kindergarten teacher is worth $320,000, because that is what the success of children from their classes translated to in improved lifetime earnings and the like.

This research echoes the research on a cohort of children that attended the Perry Preschool program from 1962-1967 in our own backyard in Ypsilanti, Michigan. Larry Schweinhart and colleagues at the Highscope Research Foundation have been looking at cohort data for the Perry Preschool Program (a high quality early childhood program for three and four year olds) for four decades and found that benefits from high quality programs grow over time. The 40-year cohort study showed a return of $16 for every tax dollar invested in the Perry early care and education initiative.  Most of that return was the result of a combination of higher earnings and fewer crimes committed among this population as compared to the control group.

The Nurse Family Partnership Program, which was a foundation for the provision in the Affordable Care Act, is also a research-based program based on the theory that new, low income mothers can benefit from the ongoing involvement of a nurse in helping them to become better mothers. The nurse engagement starts prenatally and continues through the first two years of the child’s life. Nurses were selected for this work because the research showed that they are most trusted of practitioners and were able to build strong relationships with the women they were helping. The nurse family partnership program has documented a solid return on investment of at least 2:1 and as much as 5:1 in reduced child behavioral problems, crimes, and child abuse/neglect.

It is very significant that the Maternal, Infant, and Early Childhood Home Visiting Program is a provision of the health reform law that is not only authorized but also appropriated and was one of the earliest components of health reform to be implemented. $1.5 billion is a big commitment to an effort that is not as directly related to insurance coverage and medical care as the rest of the law. But, this is one effort that is truly at the core of what know can improve the lives of our children and reduce unneeded costs to society. This initiative is pure prevention at its best: research-based, public health-oriented and targeted to those it can help the most.