From the Day They Are Born Putting Science and the System to Work for Infants and Toddlers

A Report to Governor Deval Patrick The Birth to School Age Task Force Phase I: Supporting Infants and Toddlers, Their Families and Communities Massachusetts Department of Early Education and Care November 2010

1 Dear Governor Patrick,

I am pleased to present you with From the Day They Are Born, the final report of the Department of Early Education and Care Birth to School Age Task Force, in response to your call for the creation of a Task Force “to establish a statewide birth-to-school age strategy to ensure the healthy development of children, particularly those from low-income families.”

Herein, the Task Force articulates the rationale and urgency for considered and deliberate attention to the critical first three years of a child’s development. Equally important, the Task Force offers a framework for statewide policies, programs and practices that will put science and the system to work to ensure that all children have the best foundation for a lifetime of health, well-being and learning.

The Task Force shares your vision of a “21st century education system that is fully integrated, coherent and seamless — serving children from birth through higher education and beyond.” The Task Force also recognizes that the science of early development demands heightened attention to the years from birth to eight. Consequently, the Task Force has ensured that its first phase work is consistent with and complementary to the work of the Commonwealth Readiness Project and the Success for Life framework recently endorsed by your Readiness Cabinet.

Ever-cognizant of the challenges presented by the current and projected fiscal crisis the Task Force remained faithful to its charge to establish a statewide framework for action that addresses various service agencies, links multiple funding streams, and aligns preschool and school-age care. The Task Force calls for an unprecedented commitment to a shared vision and collaborative planning as well as for revolutionary partnerships across state agencies and between the public and private sectors.

On this foundation, and with the new set of common outcomes and indicators of progress presented in this report, the Task Force is confident that its recommendations will yield improvements in service. On behalf of the Department of Early Education and Care and the members of the Birth to School Age Task Force, thank you for your leadership. We stand ready to work with you, your Readiness Cabinet, and all those in the public and private sectors who share our commitment to the children and families of Massachusetts and who share our belief in a brighter future.

Sincerely,

Sherri Reneé Killins Commissioner, Department of Early Education and Care

2 TABLE OF CONTENTS

Introduction and Overview

Task Force Vision, Values and Beliefs

Toward a Better Future

Start with the Science  New Science Offers Insight and Opportunity  The Achievement Gap Opens as Early as Fifteen Months  Early Childhood Risk Factors Can Have Long Reaching Effects  Investing in Early Education Benefits All

Share Responsibility and Accountability: A Framework for Action  Target Beneficiaries o Children; o Families; and o Communities and Programs  Areas of Focus o Basic Needs o Health and Well Being o Development and Learning o Positive Relationships  Outcomes and Indicators of Progress  Goals and Strategies

Strengthen the System  Governance and Leadership  Family Support and Leadership  Standards and Regulations  Financing  Accountability and Evaluation

Acknowledgements

Appendices  Appendix A: Indicators of Progress  Appendix B: Strategies, Identified Actions and Lead Convener

3 THE BIRTH TO SCHOOL AGE TASK FORCE PHASE I: SUPPORTING INFANTS AND TODDLERS, THEIR FAMILIES AND COMMUNITIES Although the Task Force was established by and convened under the auspices of the Department of Early Education and Care, it is important to note that it represents the work of more than 50 practitioners, policymakers, educators and advocates from myriad disciplines and service sectors throughout the state. Based on the experience and expertise of this coalition, this report lays the foundation for an integrated system of early care and lifelong learning that begins on the day each individual is born. It also provides a blueprint for each individual’s success for life.

The Task Force would like to dedicate this report in memory of Dr. Libby Zimmerman* -- for her steadfast leadership in the field of early education and care and for her dedication and passion to ensure all children are provided the healthy foundation, they deserve, from the start. Her legacy as a champion for all babies and their families is the same spirit that inspired the work of this Task Force.

Task Force Membership: Dr. Robin Adair, University of Massachusetts Memorial Infant-Toddler and Preschool Clinics Dr. Charles Anderson, Caritas Christi Health Care Betty Bardige, A. L. Mailman Family Foundation Suzin Bartley, Children’s Trust Fund Lynson Moore Beaulieu, Former Member of the Board of Early Education and Care Ron Benham, Department of Public Health Ruth Bowman, Early Childhood Policy Coalition Emily Caille, Department of Elementary and Secondary Education Senator Gale Candaras, Massachusetts Senate Ann Capoccia, Department of Mental Health Marie Cassidy, Coordinator, Medford Family Network Sharon Scott-Chandler, Board of Early Education and Care / Action for Boston Community Development Representative Katherine Clark, Massachusetts House of Representatives Dr. Cassandra Clay, Boston University School of Social Work Kitt Cox, Birth to Three Family Center Richard DeRosa, Healthy Baby Healthy Child, Boston Public Health Commission Barbara Prindle-Eaton, Cape Cod Child Development Lei-Anne Ellis, City of Cambridge Department of Human Service Programs Dr. Meme English, Commonwealth Healthcare Group at Brightwood Marie Enochty, Cape Cod Children's Place Anne Marie Fitzgerald, Reach Out and Read Bob Gagne, Thom Westfield Infant Toddler Services Early Intervention Program Hanna Gebretensae, Urban College Melinda Green, Infants and Toddler Consultant Valerie Gumes, Haynes Early Education Center Darla Gundler, Department of Public Health Sue Heilman, Horizons for Homeless Children Lynn Hennigan, Together for Kids, Community Health Link Joan Kagan, Square One Sherri Killins, Department of Early Education and Care

4 Corky Klimczak, Hampshire County Family Network Betsy Leutz, Connected Beginnings Dr. John Lippit, Thrive in 5 Joan Louden-Black, Bristol Community College, New Bedford Early Literacy Consortium Mary Lu Love, University of Massachusetts, Boston, Institute Community Inclusion Jennifer McCracken, The Home for Little Wanderers Christine Haley Medina, Department of Early Education and Care Parent Advisory Council Neal Michaels, Department of Children and Families Heavenly Mitchell, Healthy Baby Healthy Child, Boston Public Health Commission Michele Norman, Consultant Amy O'Leary, Early Education for All Howard Ray, Department of Early Education and Care Eleanora Villegas-Reimers, Wheelock College Grace Richardson, Family Child Care Educator Yvette Rodriquez, Action for Boston Community Development Kate Roper, Department of Public Health Caroline Ross, United Way of Massachusetts Bay and Merrimack Valley Carol Rubin, Parent Child Home Program Linda Schaeffer, Board Member, Massachusetts Early Intervention Consortium Ronna Schaffer, Early Head Start Peg Sprague, United Way of Massachusetts Bay and Merrimack Valley Carl Sussman, Sussman Associates Sunday Taylor, Family Services of Greater Boston Lori Thames, Early Childhood Education Consultant Carole Thomson, Department of Elementary and Secondary Education Nancy Topping-Tailby, Massachusetts Head Start Association Victor Vasquez, Department of Transitional Assistance Representative Alice Wolf, Massachusetts House of Representatives Nida Wright, Tartt’s Day Care Center Dr. Libby Zimmerman, Connected Beginnings*

Staff Laura Beals, Connected Beginnings Claire Brady, Department of Early Education and Care Laurel Deacon, United Way of Massachusetts Bay and Merrimack Valley Gail DeRiggi, Department of Early Education and Care Nicole Lessard, Department of Early Education and Care Bryce McClamroch, Department of Public Health Larisa Mendez-Penate, Department of Early Education and Care Anita Moeller, Department of Early Education and Care Geetha Pai, United Way of Massachusetts Bay and Merrimack Valley Chris Pond, Department of Early Education and Care Pam Roux, Department of Early Education and Care Kelly Schaffer, Department of Early Education and Care Dr. Mallary Swartz, Connected Beginnings Jennifer Amaya-Thompson, Department of Early Education and Care Anitza Guadarrama-Tiernan, Children’s Trust Fund

5 INTRODUCTION & OVERVIEW

"It will be the goal of this administration to ensure that every child has access to a complete and competitive education – from the day they are born to the day they begin a career... President Barack Obama Address to Joint Session of Congress February 24, 2009

In states and communities throughout the country and around the world, dedicated champions of children, youth and families are working together to demonstrate the need for and potential of focused attention on the care and education of children. From the day they are born, a clear vision for and a commitment to facilitating and supporting healthy development and continuous learning of each and every child is not only a moral obligation but a sound economic strategy as well.

Massachusetts is no exception. Five years ago, with strong support from the state legislature, Massachusetts established the first state agency to combine the budgets and operations of its early education and early care agencies into a single Strengthening Families department – The Department of Early Education and Care. More recently, under the leadership of Research shows that there are five Governor Deval L. Patrick, Massachusetts has factors that strengthen families and embraced a vision for education that begins before thereby reduce the incidence of kindergarten and continues through higher education child abuse and neglect by providing and beyond. Based on the work of the Governor’s parents with what they need to unprecedented Readiness Project, the Governor’s parent effectively under stress: 1) Education Action Agenda set the goal that by 2020, Massachusetts will have a coordinated plan to Parental resilience; 2) Social provide high quality education and care for all connections; 3) Knowledge of children beginning at birth, which will smooth their parenting and child development; 4) transitions to school.i Calling for the use of science Concrete support in times of need; and an integrated system to revolutionize care, and 5) Children’s social and education, programs and services, the Department of emotional development. Early Education and Care’s Birth to School Age Task Force offers the following report as the next essential Strengthening Families step toward achieving that goal. www.strenghteningfamilies.net The following report, From the Day They Are Born, draws from and integrates key elements of the Department of Early Education and Care’s strategic planii. However, it also breaks new ground. In fact, it is the first-ever comprehensive Massachusetts framework for action on behalf of our youngest – and arguably most vulnerable residents – infants and toddlers.

6 Organization of the Task Force’s Work Profile of Children, Birth to Age The Zero to Three’s “Infant-Toddler Policy Agenda Three, in Massachusetts ______framework was adapted by the Task Force[1] . As a result, four committees were formed to focus on the following 224,973 Children Under the Age of 3 Live in Massachusetts areas: (National Infant and Toddler Child Care Initiative) 1. Good Health 2. Strong Families/Communities 12.5% Percent of Children 3. Positive Early Learning Experiences Below Poverty Level in 4. Strong Systems Massachusetts Under 18 Years (American Community Survey, 2004)

In addition the Task Force added a Diversity Subcommittee 26% of Massachusetts children as they felt diversity was an essential component of any under 6 experienced 1 or 2 framework given the current national and state risk factors for poor educational demographic trends. and health outcomes; 7% experienced at least 3 (National Good Health Center for Children in Poverty) Subcommittee Vision: All MA infants and toddlers, 8,571 Average number of children and their families, will have access to health care, 0–3 served per month by the nurturing relationships (including non-family care- Child Care and Development Fund giving settings) and physical and mental health (FY 2006 ACF-801 data, Child Care promotion, prevention, and intervention in order for Bureau) the infants and toddlers to grow into positive, caring 14,878 Children under 3 receiving and contributing adults. early intervention services under IDEA, Part C (U.S. Dept. of Children learn best when they are healthy physically, Education, Office of Special Ed. socially, and emotionally. The good health of infants, Programs, Data Analysis System, toddlers, and their families can be ensured by 2006) enacting policies which address the following issues 60% Percent of requests for child that this subcommittee focused on physical health, care resource and referral related mental health, family/parental physical and mental to infant and toddler care (Child health, developmental screening and environmental Care in America: 2008 State Facts, factors. NACCRRA)

Strong Families/Communities $9,630 - $14,591 Average cost for full-time child care for an infant in Subcommittee Vision: All MA infants and toddlers early edcuation and care program will live in strong families that raise resilient children (National Infant and Toddler Child in supportive, just and inclusive communities. Care Initiative) Families will be offered culturally and linguistically

[ 1] ZERO TO THREE is a national nonprofit organization that informs, trains, and supports professionals, policymakers and parents in their efforts to improve the lives of infants and toddlers. http://www.zerotothree.org/site/PageServer?pagename=ter_pub_infanttodller

7 appropriate information, education, and support to help them be effective caregivers as well as the opportunity to learn skills necessary to be engaged advocates for their children. Communities will invest in building strong families by having affordable, accessible, high quality programs and services available to all partnerships with families will be grounded in mutual respect, strengths-based practice, and parent/family empowerment.

Parents play the most active and significant role in their baby’s healthy development. Young children learn and grow in strong families where parents/families are able to successfully face the challenge of caring for their children, while, at the same time, meeting their work and other responsibilities. Strong families that allow babies and toddlers to thrive are supported by family –friendly state and federal policies with adequate funding for implementation. These policies should address the following issues: basic needs, income security, home visiting, child welfare, paid family leave, family/parental education, early education and care, and health and safety of environments and nurturing families.

Positive Early Learning Experiences Subcommittee Vision: Every infant and toddler in MA has the optimal opportunity to experience caring, culturally and linguistically responsive and affirming relationships with parents/families, caregivers, peers and siblings within safe, stimulating, language- rich environments that promote exploratory learning.

Babies are born learning. Learning in very young children takes place through play, the active exploration of their environment, and, most importantly, through interactions with the significant adults in their lives. Positive early learning experiences can be provided that lay the foundation for future success by enacting policies which address the following issues that this subcommittee focused on access to quality affordable early education and care, early Head Start, Early Intervention and safe and nurturing environments.

Strong Systems Subcommittee Vision: All MA systems that serve infants and toddlers, especially those experiencing low income or other risk factors, will ensure that all families and young children have access to comprehensive, high quality early childhood and family support services that support healthy development of all children through affordable, inclusive and developmentally, culturally, and linguistically appropriate services. The goal shall be to promote family and community wellness so that all children, at 3 years of age, have the communication, cognitive, physical and social – emotional skills appropriate for their age level.

All infants and toddlers need access to high-quality, affordable early care and education, health and mental health, and family support services. Programs and services that

8 address these areas are critical; however, they are only as strong as the infrastructure that supports them. Comprehensive, coordinated systems of high-quality, prenatal-to- five services can be built by utilizing the following resources and tools: governance, leadership, quality improvement, accountability and evaluation, financing, public engagement and political will building, regulations and standards and professional development.

Diversity Subcommittee Vision: To systematically guide and incorporate cultural competence in all aspects of policy making, administration, practice, and service delivery, and to provide education and care that is equitable, family centered, child focused, and individualized care.

In order to be responsive to broad issues of diversity in the Commonwealth, this subcommittee focused on valuing diversity, cultural self–assessment, the "dynamics" inherent when cultures interact, institutionalized cultural knowledge and developing adaptations to service delivery reflecting an understanding of diversity between and within cultures.

Articulating a clear framework for action necessitates the integration of many components including the identification of target beneficiaries and areas of focus which frame the work. It is our shared responsibility to improve supports for these beneficiaries with a focus on the outcomes that all children, families and communities deserve.

Target Beneficiaries When we think about early education and care, particularly for infants and toddlers in the first three years of life, there are three primary target interconnected beneficiaries that policies, programs and services must reach:

1) Children (Infants and Toddlers) The outcomes delineated below recognize that infants and toddlers, within the context of their families, must have their fundamental needs met before they can progress toward a more sophisticated level of development that allows them to actualize their full capabilities.

2) Families Most children live within the context of a family structure and that system requires basic supports in order for each member to fully thrive and reach their full potential in all domains of life.

3) Communities and Programs Families and children live within communities and many are served by early education and family programs; both can provide supports to advance the abilities of infants and toddlers, and their families, to progress toward meeting their desired achievements.

9 Areas of Focus The Task Force identified four areas of focus – those areas in which the coordinated efforts of all segments of the system would have a significant impact:

1) Basic Needs Focuses on fundamental levels of safety, nutrition, economic security of families and professionals supporting children and families, adequate and affordable housing and health care.

2) Health and Well-Being Focuses on the desire that all Massachusetts infants and toddlers, and their families, will have access to health care, nurturing relationships (including non-family care-giving settings) and physical and mental health promotion, prevention, and intervention in order for the infants and toddlers to grow into positive, caring and contributing adults.

3) Positive Relationships Focuses on providing every infant and toddler in Massachusetts with optimal opportunities to experience caring, culturally and linguistically responsive and affirming relationships with parents/families, caregivers, peers and siblings within safe, stimulating, language-rich environments that promote exploratory learning.

4) Development and Learning Focuses on the optimal development of infants and toddlers through their family’s access to community support networks, high quality affordable early education and care programming, and communities with the capacity to strengthen families and support the healthy growth of all children.

10 OUR VISION, VALUES AND BELIEFS

We Envision… A Massachusetts in which every infant and toddler is emotionally and physically healthy with opportunities to experience consistent, nurturing early education and care in the context of strong families and supportive communities that provide comprehensive, high quality, culturally-competent programs and services that focus first on prevention and include responsive evaluation and informed intervention.

We Value…  All those who nurture, care and educate children.  A holistic approach to the care and education of children that integrates and leverages health, education and human services programs and support.  Continuity of education and care with seamless transitions between systems of support.  Programs and services that enable family choice and that meet the individual needs of children, parents and families.

We Believe…  All children can succeed.  Healthy development and learning begins before birth.  Parents/families and all those who support and care for young children have an obligation to work together as equals and to be positive forces in the lives of children.  Culturally appropriate services are essential to children, youth and families.  The MA system of early education and care must focus equally on promotion, prevention and intervention.  Communities must be active partners in ensuring access to high-quality education and care of children.  Disparities in access or quality of service to children, youth and families must be eliminated.  We believe our system should serve first those children and families with the greatest need.  We must all do more to ensure a diverse early education and care workforce that is compensated fairly and given the opportunity for ongoing professional development and career advancement.  Our system of early education and care should be flexible and responsive, adapting to meet changing times.  Accountability, evidenced-based programs and informed use of best practices are paramount.  Sustainability must always be a key consideration for any program, service or initiative.  Collaboration and coherent programming, services and advocacy based on shared data is essential to generate the best possible outcomes for children, youth and families.

11 TOWARD A BETTER FUTURE

Massachusetts has a unique opportunity to build our early education and care system. Together we can realign our work across sectors and focus on the needs of children and families. Specifically, early education and care policymakers, practitioners and providers can collaboratively:  Move from program focus to a results-driven focus that calls upon multiple programs and services to generate the outcomes that address family needs in comprehensive, integrated, and cost-effective ways;

 Direct resources to those most in need;  Track population-based outcomes to assure that our collective investments are effective.

New levels of flexibility will be required, along with an unprecedented coordination of the multiple state agencies that serve young children and their families. As we look toward the future, it seems compelling that improved coordination and efficiency will yield:

 High quality services that are accessible, affordable, and supportive of families;  Stable, long term relationships with highly qualified providers;  Supportive communities; and  Smooth transitions between early learning experiences and K-12 education.

Working together across systems, programs, roles, and funding sources, Massachusetts parents/families, providers, and policy-makers can help build sturdy foundations for all of our infants and toddlers to ensure long-term health, social- emotional well-being, and learning. Babies Can’t Wait. The longer we delay in addressing their Fathers, mothers and all guardians, are invaluable needs, the more difficult and expensive partners as a child’s first, most important and enduring it becomes to do so effectively. teachers and can benefit from the support of their From an economic standpoint, community. investments in our youngest children Enlightened state policies have a key role in supporting have an extraordinarily high rate of communities through regulations, resources, and return. coordinated data collection. Modest spending on effective programs in the early years is paid back more than Together, citizens and policymakers can build tenfold through savings in special communities that partner with families to promote education, reductions in grade retention healthy development for all children. If we meet families and school dropout rates, decreases in where they are, we can connect them to the community juvenile and adult crime and child abuse, around them. and increases in lifelong physical and emotional health, education, and productivity.

12 Responsible public investments are cost effective. Effective family programs and services connect early and stay in touch. At their best, health care, early education and care, and social services address the whole family’s needs.

Wise early investments can prevent a large part of the “proficiency gap” that opens at 18 months and continues to widen.

Community providers working together, driven by what families want and need, can deliver services at convenient times and locations, by those who speak their language, value their culture, and have Sources: Schweinhart et al. (2005) and Masse & Barnett earned their trust. For families, there (2002) as reported by the Center on the Developing Child, should be “no wrong door.” Harvard University

If we start with science, strengthen the system and truly share both responsibility and accountability for the outcomes every child deserves, we can ensure that all children get what they need -- strong, stable, nurturing families and communities, healthy physical and emotional development, and a steady diet of positive learning experiences from the day they are born.

13 START WITH THE SCIENCE

New Science Offers Insight and Opportunity Babies are born ready to learn. At an intuitive and experiential level, we all know this. However, in the last the last decade, scientists from multiple disciplines have joined forces to reveal new knowledge about the development of the human brain. With this new knowledge comes a transformational opportunity to change – to literally change – the course of an individual’s life.

In the first three years of life, the human brain develops more quickly than at any other time.iii Each second, a baby’s brain creates 700 neural connections. Neural connections evolve into the very architecture of the brain, building over time into complex circuits associated with a person’s specific cognitive and physical and iv abilities. A child’s brain is a fire to be ignited, not a pot to be filled. Brain research also reveals that the biological John Locke (1632-1704) reaction to sustained high stress levels for young children – brought about by violence, neglect or abuse, and by a lack of basic needs and stability – impedes brain development (such as memory) and thus the ability to learn. Such “toxic stress” also affects the immune system and a child’s overall ability to manage even basic levels of stress as a child grows.v Strong foundations are built through positive learning experiences in the first three years of life.

Consider language acquisition as an example. Virtually all children who can hear and speak (and most of those who cannot) learn at least one language, and come to rely upon it as their dominant mode of communication by the time they are three years old.

The Achievement Gap Opens as Early as 15 Months However, children do not learn equally well, and “meaningful differences”vi in their vocabularies and pragmatic (functional) language skills foreshadow differential success in school and in life. The gap opens at 15 – 18 months, is significant by age 3, and continues to widen. At school entry, some children are already two years behind in vocabulary size.vii And it matters for life.

 Vocabulary size at school entry is significantly correlated with 10th grade reading comprehension scores.viii  Children whose early language is weak are at serious risk for early reading failure, social- emotional difficulties, and school dropout.ix

Source: Hart, B., & Risley, T. (1995), found that young children from families experiencing poverty have about 70 percent of the vocabulary of the same aged child in a working-class family and about 45 percent of the vocabulary of a child from a professional family. This significant disparity is correlated to the number of words typically heard by children from each family structure.

According to Hart and Risley, virtually all of the variance in children’s vocabularies at age three (and their associated language and intellectual achievements at age 9) can be explained by early language input.x In their study, conducted in the early 1980’s, parental talkativeness to babies was the key; today, with many more children spending long hours in out-of-home early education and care, we also have to look at the quality of children’s interactions with non- parental educators and at the linguistic richness of early education and care environments. Children whose parents and caregivers talk with them more know more words as toddlers and continue learning at a faster rate.xi By kindergarten, children who have missed out on these playful, enriching conversations may be two years behind.xii They will likely have difficulty learning to read well, putting them at high risk for school failure.xiii

Early Childhood Risk Factors Can Have Long Reaching Effects Family risk factors such as poverty, low education, mental illness, substance abuse, domestic violence, as well as child factors such as maltreatment and biomedical vulnerabilities, have a cumulative impact. The more a child experiences such factors, the greater is his risk of intellectual, emotional, and physical delays.xiv

When a family lacks adequate income, safety, or stability, providing enriching experiences and protecting children from adversity is a challenge. The odds are three to one that someone who has had seven or more adverse experiences in early childhood will have cardiovascular disease as an adult.

Adverse experiences include: physical, emotional, or sexual abuse; emotional or physical neglect; family violence, mental illness or substance abuse; and parental Source: Barth et al. (2008) as reported by the Center on the Developing Child, Harvard University

15 separation, divorce, or incarceration. Stable, positive relationships with adults can mitigate the effects of stressful experiences.xv

Investing in Early Education Benefits All

If as a state we are serious about PUBLIC INVESTMENT IN EARLY CHILDHOOD eliminating the achievement gap, improving student performance, increasing student educational attainment and Brain Growth Compared to Public Expenditures boosting career and work readiness, then on Young Children we must begin at the beginning, with 100 90 infants from the day they are born, in a 80 system that addresses all aspects of 70

t 60 n e health development and education. c 50 r e

P 40 30 Sixty to eighty percent of the benefits from 20 investments in high quality programs for 10 0 poor children accrue to society. 1 3 5 7 9 11 13 15 17 19 Age of child (years)

Economists tell us that investments in high Sources: Public expenditures: RAND analysis of Table 1 in R. Haveman and B. quality early learning and family support Wolfe, “The Determinants of Children’s Attainments: A Review of Methods and Findings,” Journal of Economic Literature, Vol. 33, December 1995. Brain growth: programs for young children in poverty have Figure 2-0 in Purves, Body and Brain, Harvard University Press 1998, adopted a high “rate of return.” from D.W. Thompson, On Growth and Form.

Such programs benefit children in terms of educational success, long term health and mental health, and ultimately adult income and achievements. But their greatest monetary benefits accrue to society. We reap savings in special and remedial education, criminal justice, and family income supports, along with increased tax revenues.

16 SHARING RESPONSIBILITY AND ACCOUNTABILITY: A FRAMEWORK FOR ACTION

The work of the Task Force was built upon the underpinnings established by The Massachusetts Action Planning Team’s (APT) Ready for Lifelong Success: A Call for Collaborative Action On Behalf of Massachusetts’ Children and Youth report, which was submitted to Governor Patrick and the Patrick Administration Readiness Cabinet on June 29, 2009 and outlined “goals and strategies to improve the lifelong odds for all children and youth in our state” beginning at age 5.

The Task Force recognized that success in one’s life is dependent on the infrastructure built, and supports received, even before birth and through the following three critical years, and beyond. It was the goal and commitment of the Task Force to support and align its recommendations for the pre-birth to three year old population in the Commonwealth with those outlined in the Ready for Lifelong Success report. The next phase of the Task Force’s work will be to lay out recommendations for the population age three to age five to ensure that a cohesive and consistent continuum exists regarding the outcomes we want for all children pre- birth into their youth and beyond.

Outcomes and Indicators of Progress In order for the children, families and communities/programs in the Commonwealth to making comprehensive advancements, collective action must be guided by a united vision that outlines the results we want for these populations. For each of the target beneficiaries in each area of focus, the Task Force delineated the results -- the outcomes – to be achieved and identified the data points and indicators of progress (representative indictors are provided for each outcome; the full list of indicators is available in Appendix A) – that will enable policymakers, practitioners, program leaders and parents/families to see how well our collective efforts are working on behalf of our children, our communities and our state.

As the Massachusetts Action Planning Team (APT) keenly noted in the Ready for Lifelong Success report, “the statewide system of supports for children, youth and families is intricate and complex. It is important, therefore, to acknowledge that a broad range of actors, actions and initiatives—federal, state and local— can drive simultaneous progress toward multiple outcomes.” That report adopted the systems approach from the Forum for Youth Investment’s, which the Task Force also used to frame the demarcation of “outcomes, common goals, indicators of success and shared strategies” which allows for a collaborative and consistent focus. The outcomes outlined below will be evaluated for success by tracking the identified indicators of progress.

The following twelve outcomes provide a mechanism for outlining the achievements that the Task Force has identified as fundamental to making progress for infants and toddlers, and their families and communities in the Commonwealth.

17 BASIC NEEDS OUTCOME STATEMENTS

1. Infants and toddlers are safe from physical harm in their homes; safe in their early education and care and community settings. Representative Indicator:  Substantiated 51 A reports

2. Parents/families caring for infants and toddlers: have adequate, stable and affordable housing options; are economically secure and have stable work that generates a livable wage; and receive sufficient paid leave to care for sick children, newborn or adopted infants/ toddlers. Representative Indicator:  Number of homeless families as counted by US Census Bureau and Department of Elementary and Secondary Education

3. Infant and toddler caregivers/educators receive respect, support, and adequate compensation for their work. Representative Indicator:  Educators earning at least 100% of the median income level

HEALTH AND WELL BEING OUTCOME STATEMENTS

4. Infants and toddlers are born, and remain, physically and mentally healthy, have quality primary care (continuous, comprehensive, family-centered, coordinated, and culturally effective), and with their families have access to and are informed consumers of health care and receive consistent, coordinated health, dental and mental health services. Representative Indicator:  Rates of low birth weights

5. Pregnant women receive comprehensive pre and postnatal health care and support. Representative Indicator:  Births rates associated with late or no prenatal care

DEVELOPMENT AND LEARNING OUTCOME STATEMENTS

6. Infants and toddlers: a. are on track for their optimal development, receive adequate nutrition, have access to high- quality, affordable early education and care and have high-quality learning experiences with their families/ primary caregivers; and

b. enter school confident across all developmental domains ( physical, social, emotional, cognitive, language, and approaches to learning), and are performing well across those domains by the third grade. Representative Indicator:  Infants and toddlers with appropriate social-emotional developmental progress

18 7. Parents/families are competent in their role as their infant and toddler’s first teacher and have the knowledge and resources to support the optimal development of their infants and toddlers. Representative Indicator:  Adult/parental literacy rates

8. Parents/families have meaningful choices in services for infants and toddlers and are supported in accessing services and have informal and formal support networks. Representative Indicator:  Communities in the state where all families, regardless of income or special need, have access to more than one licensed early education option, including family child care

9. All communities have the capacity to strengthen families and support the healthy growth and development of its infant/ toddlers and have a coordinated network of high-quality, accessible services and resources. Representative Indicator:  Early education and care program accreditation rates (by The National Association for Family Child Care (NAFCC) or The National Association for the Education of Young Children NAEYC))

POSITIVE RELATIONSHIPS OUTCOME STATEMENTS

10. Infants/ toddlers have consistent, stable, responsive, nurturing & culturally responsive relationships in their out of home care settings and have predictable, responsive and nurturing relationships in their family settings. Representative Indicator:  Infants/toddlers in foster care with fewer than two out of home placements in 24 months

11. Families have access to community-based parent/family support groups that will include information on resources and supports for families with infants and toddlers, strategies are consistently promoted to strengthen maternal/paternal/familial- infant attachment and families have access to early, hands-on pre and post partum support for new caregivers/parents. Representative Indicator:  Access to and participation in parent/family support groups

12. Families of infants/ toddlers at risk for out of home placement have: 1) access to strength-based family support services that work together to prevent disruption, provide permanency if needed, 2) access to pre and post-permanency supports and 3) access to a coordinated system for visits between children, placement and families as appropriate. Representative Indicator:  Pre- and post-permanency supports offered/provided

19 Task Force Goals Based on the desired outcomes above, the Task Force developed the following thirteen goals for all infants/toddlers, families and community/programs in the Commonwealth:

Basic Needs 1. Ensure children’s homes and early education and care programs are safe. 2. Decrease the rate of poverty of young child and mitigate its pernicious impact on infants and toddlers.

Health and Well Being 3. Ensure pregnant women receive comprehensive pre and postnatal health care. 4. Provide infants and toddlers with quality primary care and ensure their families are informed consumers of health care.

Development and Learning 5. Continue efforts to build a diverse, stable, competent workforce to meet the needs of infants, toddlers, and their families. 6. Expand the number of high-quality child care slots for infants and toddlers, especially those impacted by poverty or other risk factors. 7. Support families in their role as their infant and toddler’s first teacher and encourage high quality learning experiences between infants and toddlers and their families/ primary caregivers. 8. Strengthen supports to ensure infants and toddlers are on track for optimal development and have access to high- quality, affordable early education and care and related resources to facilitate learning so that they enter school performing well across all developmental domains. 9. Build capacity to allow families with infants and toddlers to have meaningful early education and care choices and support in accessing informal and formal services/networks.

Positive Relationships 10. Support all communities in developing the capacity to strengthen families and support the healthy growth and development of its infants/ toddlers and have a coordinated network of high-quality, accessible services and resources. 11. Support consistent, stable, responsive, nurturing and culturally and linguistically responsive relationships in infant and toddler’s out of home settings, including early education and care and family service programs, and family settings. 12. Ensure access to community-based parent support groups and disseminate strategies to promote maternal/familial- infant attachment and hands-on pre and post partum support for new mothers/fathers/families. . 13. Provide families of infants/ toddlers at risk for out of home placement with access to: strength- based family support services, pre and post-permanency supports and to a coordinated system for visits.

20 The Task Force (TF) offered a series of strategies and identified actions for each goal above, as well as the “lead convener” for each strategy that is committed to enacting the work outlined below with other community and state partners. As noted for selected strategies, work is already underway to move the recommendations of this Report forward. The full list of strategies and identified actions to attain the successful implementation of each outcome can be found in Appendix B.

21 STRENGTHEN THE SYSTEM

With the creation of the Department of Early Education and Care, Massachusetts is off to a strong start in cultivating a coordinated, mixed-delivery system that is focused on, and provides programs, services and supports to address, the whole child. The work to strengthen the system and extend its reach into the earliest years of a child’s life will require aligning goals and coordinating actions across programs with different political cultures and requirements dictated by various funding streams. Through this work, we will not only be building on our foundation of service to children and families but tackling difficult deep-rooted problems such as gaps in services and outcomes based on race, income, culture, and language. Building out the system is a complex and challenging process that will take time and call upon many public and private individuals and organizations to approach their work in new ways.

Like any “system”, the education and care system is composed of a set of connected elements, forming a complex unit with some overall purpose, goal, or function that is achieved only through the actions and interactions of all the components. The early education and care system depends on an inter-play between the following components:

 Governance STANDARDS ASSESSMENT

 ACCOUNTABILITY Regulations FINANCE

 Workforce and Professional Development INFORMED

 FAMILIES & Early Education and Care and K-12 GOVERNANCE Linkages PUBLIC

 Standards, Assessment and Accountability

EARLY ED & REGULATIONS  Informed Families and Public CARE & K-12 WORKFORCE LINKAGES  Finance & PROF. DEV.

22 GOVERNANCE The evolving and responsive process of making decisions and implementing those decisions, with the foundational understanding that the inclusion and collaboration of stakeholder views, private and public, must be built into the front end of the process, decisions are made with transparency, and are inclusive and fair to all families and others affected.

OUTCOME STATEMENTS 1. An integrated strategic plan is in place for moving systems toward our vision. 2. Early childhood systems and providers are family centered: respectful of parents/families and work with them as partners. 3. An early childhood system of care exists through public and private service systems.

RECOMMENDATIONS Create integrated systems within, and across, agencies and access to coordinated and consistent information. o Integrate data system between agencies/systems. o Integrate case management across agencies (e.g. implement “One Family, One Plan”). o Develop clear lines of responsibility and accountability and identify next steps for action. o Develop a common vision, language and expectations. o Develop an accessible system to provide families with the education and information they want at locations they frequent (e.g. link with pediatricians).

REGULATIONS Implemented and mandated standards built on the strengths of the existing and diverse system that ensure a solid foundation that supports all children to learn and grow physically, socially, emotionally, and educationally as lifelong learners and contributing members of the community, and to support families in their essential work as parents and caregivers.

OUTCOME STATEMENT 1. Regulations are monitored and evolve to continually ensure they are supporting the diversity of the Commonwealth’s children and their families.

RECOMMENDATIONS  Ensure that assessment data informs continuous quality improvement efforts for programs serving children age birth to three years old.  Develop the regulation of educator salaries and compensation for those serving children age birth to three years old.  Expand enlightened state policies to support communities and community-based institutions through regulations, resources, and coordinated data collection.

23 WORKFORCE AND PROFESSIONAL DEVELOPMENT The early education and care workforce is the backbone of the systems and the services available to children and families. We value and support their skill development, diversity and fair compensation. The workforce system must maintain worker diversity and provide resources, support, expectation and core competencies that lead to the outcomes we want for all children.

OUTCOME STATEMENT 1. A professional development system that is well articulated and supports all members of the early childhood workforce is established and implemented.

RECOMMENDATIONS  Implement and gain full adoption of the MA Quality Rating and Improvement System (QRIS) to provide greater access to aligned resources.  Develop an Infant/Toddler Credential.  Address regulation of early childhood salaries and compensation.  Increase the number of Infant Toddler Specialists to support the career lattice for the birth to three population that is distinctive.  Create more opportunities for professional advancement for the population serving the birth to age three system.  Increase consistency of supervision of the professional development system across Departments.  Integrate the professional development system across education departments and align core competencies.  Develop a greater focus on the needs of infants and toddlers and their families.

EARLY EDUCATION AND CARE AND K-12 LINKAGES The education system in Massachusetts, under the leadership of the Governor and coordination of the Executive Office of Education, is committed to advancing actions and initiatives that will improve achievement for all students, close persistent achievement gaps, and to create a 21st century public education system that prepares students for higher education, work and life in a world economy and global society. Early education is one of the first steps on the educational path and children are most successful when linkages exist that encourage smooth transitions into the K-12 system and beyond. The system must continue to develop and support programmatic strategies that prepare children for readiness and ongoing success in school and life.

OUTCOME STATEMENT 1. An education system in Massachusetts that is comprehensive and cohesive from early education through higher education and advances the achievement of all students.

24 RECOMMENDATIONS  Begin assigning state identification numbers in early education to allow for children to be tracked earlier.  Develop a pre-K to age 20 database.  Provide interagency strategic initiatives to align the education system with the primary focus on promoting smooth transitions to advance the achievement of all children.

STANDARDS, ASSESSMENT AND ACCOUNTABILITY Together, standards, assessment and accountability provide a structure to facilitate employing an evaluative process to understand if current practice is effective and to constantly improve service to support the children and families of the Commonwealth.

Systems must implement standards to ensure children are provided the tools they need to thrive physically, socially, emotionally, and educationally. Accountability for meeting those standards is vital at all levels and collaboration is foundational to measuring, recognizing needs and developing the assets of the field. Assessment allows for the evolution of more effective program practice and policies.

OUTCOME STATEMENTS 1. Early identification and effective response for the full range of developmental issues and risk factors for infants and toddlers and their families are in place. 2. Strong quality standards (including pre-natal to age 3) are in place for all early childhood systems and providers, and they are monitored and enforced. 3. Early learning experiences for infants and toddlers enrolled in early childhood programs are designed to promote positive, supportive and responsive interactions with a consistent, primary caregiver(s). 4. Data systems are in place across systems to capture data to monitor and inform policies and programs effectively.

RECOMMENDATIONS  Require standardized screening for developmental delays or mental health concerns in early education and care programs.  Institute a system for providing follow-up services in early education and care programs based on screening results.  Ensure staff is effectively trained to administer the standardized assessments.  Gather consensus on desired data and outcomes to capture for children birth to three.  Create linkages of data across systems to support: - more effectively and efficiently serving individual children and families; - better identification of needs and whether needs are being met; - determination of whether desired outcomes are being achieved; and identification of resources needed to achieve positive outcomes for children.

25  Address and navigate privacy constraints (FERPA, HIPPA, etc.) which limit the ability to assign individual identifiers to allow tracking data longitudinally across service delivery systems.

INFORMED FAMILIES AND PUBLIC Children develop in the context of their families, with research documenting that the quality and consistency of their primary relationships actually affects the wiring of the brain. What happens at home is paramount to a child’s development and school readiness, even for children in full- time early care and education. Understanding this, and respecting the culture, language(s), strengths and assets of families, including those at highest risk, is crucial to any and all interventions.

OUTCOME STATEMENT 1. Parents/Families with infants and toddlers have meaningful early education and care choices and support in accessing informal and formal services/networks. 2. All early childhood programs actively encourage family engagement reflecting the research that has demonstrated that for young children, especially those from families experiencing significant adversity, programs that support parents’ and families’ ability to provide responsive care increases the likelihood of positive child outcomes.

RECOMMENDATIONS  Address the challenges families may face in maintaining continuity of early education and care, and other services, due to eligibility issues and categorical funding for different types of funding streams (TANF, income eligible financial assistance, Early Head Start/Head Start; Early Intervention, Special Education, etc.).  Create statewide policies to offer paid family leave or financial support for parents/families to stay home with infants in their first months of life.  Increase the statewide access to evidence based home visiting, family support, & parent education (promotion and prevention levels).  Support statewide access to a range of services for families facing difficult challenges (e.g., substance abuse, mental health issues, domestic violence, homelessness, etc) (prevention-intervention levels).  Increase awareness of new communication resources and strategies for families (e.g. Massachusetts 2-1-1).  Increase coordination of family engagement across programs and service systems.  Establish, disseminate and implement best practices for family engagement.

FINANCE A dedicated funding stream that supports the growth and development of our youngest children is foundation to achieving positive outcomes across domains for all children.

26 OUTCOME STATEMENT 1. A dedicated funding stream for Early Care and Education provides adequate, consistent, and coordinated funding for quality infant-toddler services, particularly for infant and toddlers and families experiencing risk and must also include fair compensation for the early childhood workforce, private industry support and maximization of public and private insurance coverage/resources.

RECOMMENDATIONS  Create a dedicated revenue stream, like many other states including Illinois, for early childhood education and care.  Bridge the projected $600 million funding gap for universally accessible quality Early Childhood Education and Care. o Understand the private commitment and how it could expand.

27 APPENDIX A: INDICATORS OF PROGRESS

BASIC NEEDS OUTCOME STATEMENTS

Infants and toddlers are safe from physical harm in their homes; safe in their early education and care and community settings.

Indicators:

 Early education and care facilities, including family child care programs, with smoke and carbon monoxide detectors 11,655 Early Education and Care Programs are licensed (September 2010) The Department of Early Education and Care (EEC) Licensing Standards require that approved carbon monoxide detectors be located and maintained in the program in accordance with the provisions of the state fire safety code and guidelines. Additionally, every program not located in a residence must submit evidence of compliance with applicable fire codes and family child care homes must have approved smoke detectors in operable condition on each floor level of the home and outside of each separate sleeping area. http://www.mass.gov/Eoedu/docs/EEC/regs_policies/20100122_606_cmr.pdf

 Substantiated 51 A reports 3% of Massachusetts’ children, age zero to five, are involved in substantiated cases (2008) Upon receipt of a report filed under section 51A, the Department of Children and Families shall investigate the suspected child abuse or neglect, provide a written evaluation of the household of the child, including the parents and home environment and make a written determination relative to the safety of and risk posed to the child and whether the suspected child abuse or neglect is substantiated.

 Sudden Infant Death Syndrome death rates  31 infants (2007) Massachusetts Department of Public Health Registry of Vital Records and Statistics 2007. Boston, MA: Division of Violence and Injury Prevention, Bureau of Community Health Access and Promotion. Massachusetts Department of Public Health. July 2007.

 Shaken Baby Syndrome Rates (waiting for DPH data)

Parents/families caring for infants and toddlers: have adequate, stable and affordable housing options; are economically secure and have stable work that generates a livable wage; and receive sufficient paid leave to care for sick children, newborn or adopted infants/ toddlers.

28 Indicators:

 Percentage of families spending more than 30% of annual income on housing 47% Kids Count Data Center http://datacenter.kidscount.org/data/bystate/StateLanding.aspx? state=MA

 Number/percentage of families receiving economic security support (including cash assistance and tax credits) 49,673 families (2009) MA Department of Transitional Assistance http://www.mass.gov/? pageID=eohhs2agencylanding&L=4&L0=Home&L1=Government&L2=Departments+and+Division s&L3=Department+of+Transitional+Assistance&sid=Eeohhs2

 Number of units of adequate, safe, affordable non-toxic housing 2,621,989 2000 US Census, DTA (is this US or MA?) CITE

 Number/percentage of families at or below 200% of the Federal Poverty Level in MA 318,000 families (March 2009 Report) NACCRRA and Massachusetts CCR&R Network http://www.mass.gov/? pageID=eohhs2agencylanding&L=4&L0=Home&L1=Government&L2=Departments+and+Division s&L3=Department+of+Transitional+Assistance&sid=Eeohhs5

 Number of families living in poverty (<185% of what) 242,404 families 2000 US Census

 MA Unemployment Rate 8.3% MA Executive Office of Labor and Workforce Development (August 2010) http://lmi2.detma.org/lmi/Newsrelease/NewsLMI20100921.htm

 Homeless families were living in emergency shelter funded by MA Department of Transitional Assistance (DTA) 2,472 families including 4,413 children and youth (October 2008) MA Department of Transitional Assistance

Infant and toddler caregivers/educators receive respect, support, and adequate compensation for their work. No indicator currently available for this outcome.

29 HEALTH AND WELL BEING OUTCOME STATEMENTS

Infants and toddlers are born, and remain, physically and mentally healthy, have quality primary care (continuous, comprehensive, family-centered, coordinated, and culturally effective), and with their families have access to and are informed consumers of health care and receive consistent, coordinated health, dental and mental health services. Indicators:  Low birth weight rate 5,955 (2008) Massachusetts Department of Public Health Statistics report Massachusetts Births 2008. Boston, MA: Division of Research and Epidemiology, Bureau of Health Information, Statistics, Research, and Evaluation. Massachusetts Department of Public Health. March 2010

 Infants and toddlers (9 to 48 months) receiving lead screenings 191,276 (72%) (July 1, 2008 - June 30, 2009) Massachusetts Department of Public Health Screening and Incidence Statistics. 2009. Boston, MA: Childhood Lead Poisoning Prevention Program, Bureau of Environmental Health. Massachusetts Department of Public Health. July 2009.

 Teen birth rate 20.1 births per 1,000 females ages 15-19 (2008) MASSChip http://www.mass.gov/? pageID=eohhs2subtopic&L=4&L0=Home&L1=Researcher&L2=Community+Health+and+Safety&L 3=MassCHIP&sid=Eeohhs2

 Health care coverage 98.8% of 0-18 year olds (2008) The Connector, MassHealth http://www.mass.gov/? pageID=eohhs2agencylanding&L=4&L0=Home&L1=Government&L2=Departments+and+Division s&L3=MassHealth&sid=Eeohhs2

 Availability of Early Childhood Mental Health consultation to programs EEC supports a statewide mental health consultation services model for the early education and care field (July 2010) Department of Early Education and Care http://www.mass.gov/?pageID=eduterminal&L=7&L0=Home&L1=Pre+K+- +Grade+12&L2=Early+Education+and+Care&L3=Financial+Assistance&L4=For+Providers&L5=Gr ant+Opportunities&L6=Competitive+Grant+Opportunities&sid=Eoedu&b=terminalcontent&f=EE C_finanasst_grants_grants_fy11_mhgrant&csid=Eoedu

Waiting for DPH data for the following indicators:  Immunization Rates CAROL SMITH DPH

30  Newborn hearing screenings and resulting referrals Rashmi Dayalu  Newborn metabolic screening and referrals Janet Farrell  Number of children diagnosed with Autism Spectrum Disorder Tracy Osbahr  Dental exams by 12 months Lynn Bethel  Screenings for behavioral/mental health and referrals EOHHS / CBHI  Number of mental health experts trained to work with Infants and Toddlers  Hospitalization rates Sylvia Hobbs  Emergency room visits for non-emergency health needs Sylvia Hobbs  Trauma exposures Sylvia Hobbs  Fetal Alcohol Syndrome and/or drug addiction Drew Hanchett DPH- MAYBE  Multiple and/or sustained trauma exposures MASS Health  Post Traumatic Stress Disorder diagnosis MASS Health  Medical/dental homes SANDRA Broughton – DPH- MAYBE  Well-child screenings MASS Health  Infants and toddlers covered for dental health coverage Lynn Bethel - DPH- MAYBE  Pediatricians screening for maternal and paternal depression, substance abuse, and other mental health concerns not DPH

Pregnant women receive comprehensive pre and postnatal health care and support. Indicators:  Women receiving adequate prenatal care 82% (2008) Massachusetts Births 2008. Boston, MA: Division of Research and Epidemiology, Bureau of Health Information, Statistics, Research, and Evaluation. Massachusetts Department of Public Health. March 2010

 Breastfeeding initiation rates 81% of mothers breastfed or intended to breastfeed (2008) Massachusetts Department of Public Health Massachusetts Births 2008. Boston, MA: Division of Research and Epidemiology, Bureau of Health Information, Statistics, Research, and Evaluation. Massachusetts Department of Public Health. March 2010

 Cesarean delivery rate 34.4% of all births (2008) Massachusetts Department of Public Health Massachusetts Births 2008. Boston, MA: Division of Research and Epidemiology, Bureau of Health Information, Statistics, Research, and Evaluation. Massachusetts Department of Public Health. March 2010

 Mothers indicating smoking and/or drinking while pregnant 6.9% (2008) Massachusetts Department of Public Health Massachusetts Births 2008. Boston, MA: Division of Research and Epidemiology, Bureau of Health Information, Statistics, Research, and Evaluation. Massachusetts Department of Public Health. March 2010

31  Births with late, or no, prenatal care 1,724 births (2.3%) MassChip http://www.mass.gov/? pageID=eohhs2subtopic&L=4&L0=Home&L1=Researcher&L2=Community+Health+and+Safety&L 3=MassCHIP&sid=Eeohhs2

Waiting for DPH data for the following indicators:  Receipt of OB/GYN services Angela Nannini  Preeclampsia/diabetes rates during pregnancy Hafsatou Diop for diabetes

DEVELOPMENT AND LEARNING OUTCOME STATEMENTS

Infants and toddlers: c. are on track for their optimal development, receive adequate nutrition, have access to high- quality, affordable early education and care and have high-quality learning experiences with their families/ primary caregivers; and

d. enter school confident across all developmental domains ( physical, social, emotional, cognitive, language, and approaches to learning), and are performing well across those domains by the third grade.

Indicators:  Children without food security 3% (2004-2006) USDA Household Food Security study CITE

 Early Intervention Referrals 6,851 (2008-2009) Massachusetts Department of Public Health

 Early Intervention : Successful outcomes across domains no DPH data Waiting for DPH data for the following indicator Massachusetts Department of Public Health CITE

 Infants and toddlers on the waiting list for financial assistance for early education and care programming 8,580 infants and toddlers (August 2010) MA Department of Early Education and Care Waiting List

Parents/families are competent in their role as their infant and toddler’s first teacher and have the knowledge and resources to support the optimal development of their infants and toddlers.

32 Indicators:  Adult literacy rates (among parents) 10% of 5,096,670 parents lack basic prose literacy skills (2003) U.S. Department of Education, Institute of Education Sciences, National Center for Education Statistics, 2003 National Assessment of Adult Literacy http://nces.ed.gov/naal (NCES)

Parents/families have meaningful choices in services for infants and toddlers and are supported in accessing services and have informal and formal support networks. No indicator currently available for this outcome.

All communities have the capacity to strengthen families and support the healthy growth and development of its infant/ toddlers and have a coordinated network of high-quality, accessible services and resources.

Indicators:  Early education and care programs accredited by The National Association for the Education of Young Children 897 programs, serving 69,146 children (September 2010) The National Association for the Education of Young Children http://www.naeyc.org/academy/accreditation/summary

 Early education and care programs accredited by The National Association for Family Child Care 92 programs (September 2010) The National Association for Family Child Care http://www.nafcc.org/accreditation/acclist5db.asp

POSITIVE RELATIONSHIPS OUTCOME STATEMENTS

Infants/ toddlers have consistent, stable, responsive, nurturing & culturally responsive relationships in their out of home care settings and have predictable, responsive and nurturing relationships in their family settings. No indicator currently available for this outcome.

Families have access to community-based parent/family support groups that will include information on resources and supports for families with infants and toddlers, strategies are consistently promoted to strengthen maternal/paternal/familial- infant attachment and families have access to early, hands-on pre and post partum support for new caregivers/parents.

Waiting for DPH data for the following indicators: not DPH  Rates of pre- and post-partum support for new mothers/parents  Use of Newborn Behavioral Assessment System or Newborn Behavioral Observation to promote parent/child attachment and help parents understand their baby’s strengths, needs, temperament, and style of relating and learning

33 Families of infants/ toddlers at risk for out of home placement have: 1) access to strength-based family support services that work together to prevent disruption, provide permanency if needed, 2) access to pre and post-permanency supports and 3) access to a coordinated system for visits between children, placement and families as appropriate. No indicator currently available for this outcome.

INDICATORS THAT REQUIRE ADDITIONAL RESEARCH The Task Force recognized that while the Indicator data below does not currently exist, they would be interested in future work to develop and collect data on the following components:

 Housing that meets appropriate lead standards  Outdoor play spaces available in the community and indoor play spaces available through local family engagement programs that are developmentally appropriate for infants and toddlers  Family support services provided the families of infant/toddlers at risk for out of home placement  Pre- and post-permanency supports offered/provided  Access to a coordinated system for visits offered/provided  Number of affordable housing vouchers available from state and federal sources  Number of homeless families as counted by US Census Bureau and Department of Elementary and Secondary Education  Number of families earning minimum wage versus livable wage in MA  Infant/toddler educators who receive compensation commensurate with education attained, experience, and responsibility  Educators earning at least 100% of the median income level  Infants and toddlers with appropriate social-emotional developmental progress  Special Education referrals at preschool or kindergarten entry  Vocabulary in native language(s) at kindergarten entry  Developmental assessments by age 3  Number of infant and toddler educators with access to professional development  Facilities built specifically for early education  Families participating in local family engagement programming  Families offered at least one home visit· Beth Buxton-Carter (partial)  Families with positive or improved parent-child interaction as reported by home visiting and early education program providers Beth Buxton-Carter and Karin Downs  Low income children enrolled in Early Head Start or similar comprehensive program  Families accessing food resources (e.g. SNAP, WIC, food pantries etc.), versus the eligible population Stella Uzogara  Infants/ toddlers treated for obesity and for malnutrition Diana Hoek for malnutrition  Communities in the state where all families, regardless of income or special need, have access to more than one licensed early education option, including family child care  Communities in the state where all families have access to at least one primary health care option that includes developmental pediatric services and supports for families  Infant/toddler educator turnover rates  Licensed and license-exempt programs with quality group size, ratios, and continuity of care  Scores on observations tool for use with preschool aged children) for an understanding of relationship-based care-giving(e.g. The CSEFEL Pyramid Infant Toddler Observation Scale (TPITOS)

34 specific to supporting the social emotional development of infants and toddlers and Teaching Pyramid Observation Tool (TPOT))  Expulsion rates (and ways to measure with clear definitions of “expulsion”)  Access to supports/treatment/parenting support for parents with mental health or substance abuse issues  Average length of time in foster care  Infants/toddlers in foster care with fewer than two out of home placements in 24 months  Infants/ toddlers achieving permanency  Families experiencing reunification; families receiving pre/post-permanency supports  Lead educators in licensed infant/toddler programs who have at least a Child Development Associate (CDA) with infant/toddler or family child care endorsement or equivalent educational credentials  Amount of quality, need--based, evidence-based professional development that individual infant/toddler educators receive per year  Programs meeting quality standards for learning and environments ((ITERS, FCCERS, or other observational scales)  Number of programs achieving a Quality Rating and Improvement System Level 3 or above (future)  Percentage of eligible families receiving requested services/supports  Number of providers within communities that have regular coordination meetings regarding the families they jointly serve  Access to and participation in parent/family support groups  Programs making special efforts to involve fathers as well as mothers, at birth or earlier  Fathers involved in family support programs  Fathers attending well-child visits and receiving anticipatory guidance

35 APPENDIX B: STRATEGIES, IDENTIFIED ACTIONS AND LEAD CONVENER

The Task Force (TF) offered a series of strategies and identified actions for each goal. Where a “lead convener” could be identified, that is noted, and that entity is committed to enacting that piece of the work outlined below with their community and state partners. For selected strategies, work is already underway to move the recommendations of this Report forward.

GOAL # 1: Ensure children’s homes and early education and care programs are safe. A safe home and early education and care programs is a basic right every infant and toddler deserves. These environments must be free from hazards that act as barriers to our children learning and growing -- physically, socially, emotionally and educationally.

Strategy 1: Increase monitoring of infant and toddler early education and care programs and provide technical assistance to help providers with compliance. Enhance safety of Family Friend and Neighbor (FFN) care settings by distributing safety checklist to informal caregivers.

TF Identified Actions: Determine process for building on EEC’s existing licensing and monitoring function; Identify key access points for FFN caregivers for dissemination of information; Research existing tools to determine appropriate checklist for FFN caregivers; Request a monthly checklist on health and safety with payment invoice from informal caregivers receiving payment through state agencies.

Lead Convener: Department of Early Education and Care

Strategy 2: Provide information and resources to prevent children from experiencing abuse and neglect.

TF Identified Actions: Inventory prevention resources for families experiencing stress and crisis; Identify systems capacity to provide information and referrals to services for young children and their families; Utilize geo-mapping to identify gaps in accessing family support services; Identify and invest in effective, existing models that can be brought to scale; Ensure coordination of existing services for young children and families requiring multiple system involvement, provide data sharing and coordinated case management and improve cross system outcome development; Develop cross disciplinary training on family support principles and approaches; Conduct community based information sessions for families with young children; Embed Strengthening Families Initiative in early care and education system.

Lead Convener: TBD Action Taken: The Department of Public Health (DPH) has received funding (June 2010) from the Health Resources and Service Administration (HRSA) and Administration for Children and Families (ACF) to implement the Home Visiting Grant Program. This grant focuses on strengthening and improving

36 programs and activities carried out under Title V (the MA DPH is the state Title V agency); improving coordination of services for at risk communities; and identifying and providing comprehensive service to improve outcome for families living in high risk communities. This new grant program is part of the Department of Health and Human Services’ (HHS) national effort to establish a comprehensive continuum of services for pregnant women and parenting families including children from birth to 8 years old.

With this grant funding, a federally funded Home Visiting Collaborative Task Force has been established in Massachusetts with the aim of expanding evidence based home visiting services in the state (Lead by DPH and Co-Chaired by EEC Commissioner Killins and Lauren Smith, DPH Medical Director.) In Massachusetts, this provides the opportunity to develop a comprehensive home-visiting program aligned with the goals of this federal legislation to improve maternal/paternal, infant and child health and development; parenting skills; school readiness; family economic self-sufficiency and decrease juvenile delinquency.

EEC has also worked with the Children’s Trust Fund on training Coordinated Family and Community Engagement grantees on the Strengthening Families model and embedded the model within that grant.

GOAL # 2: Decrease the rate of poverty of young child and mitigate its pernicious impact on infants and toddlers. The global and state economy can affect the vitality of the family as the ripple effect of strained resources emanates throughout the family structure and can be detrimental to the early experiences of infants and toddlers.

Strategy 1: Ensure that housing placement, subsidy and production responses are adequate to meet demand for stable, permanent housing options.

TF Identified Actions: Develop common definition of ‘homeless’ across state agencies using the broadest definition; Increase shelter space to meet current demand; Determine demand based on new common definition; Connect non- Department of Housing and Community Development (DHCD) funded shelters to permanent housing resources more effectively; Assess success of current DHCD pilot initiative for rapid re-housing and prevention to inform expansion.

Lead Convener: TBD

Strategy 2: Increase inclusion of asset development supports that enhance the economic stability of individuals and families who are currently experiencing or have experienced homelessness.

TF Identified Actions: Identify effective models for integration of asset development supports and scale up in MA; Increase affordable housing to meet demand.

Lead Convener: TBD

Strategy 3: Expand the Earned Income Tax Credit (EITC) and the Dependent Care Tax Credit and make it deductible.

TF Identified Actions: Undertake an in-depth analysis of federal and state tax policy, including eligibility and benefit levels, indicating areas in which changes would benefit family economic security.

37 Lead Convener: TBD

Strategy 4: Expand financial assistance to early education and care for families by increasing income eligibility levels and reducing parental copayments.

TF Identified Actions: Research the effectiveness of utilizing the United Way Financial Stability Framework, an initiative designed to help low-to-moderate-income individuals and families achieve financial stability.

Strategy 5: Increase asset development supports that enhance the economic stability of individuals and families and expand opportunities for education and workforce training.

TF Identified Actions: Provide community-based access to financial counseling to help families manage finances and grow assets; Provide support for Community-Development Financial Institutions (CDIFIs) to bring low-cost financial services to low-income neighborhoods; Identify promising practices for community building efforts; Provide community-based access to work supports; Engage families in sustained collaborative efforts to strengthen communities conditions for families and children; Establish Family Service Centers in all MA communities; Create jobs creation programs to deal with high rates of unemployment and changing job markets.

Lead Convener: TBD

Strategy 6: Expand the number of high-quality child care slots for infants and toddlers, especially those impacted by poverty or other risk factors.

TF Identified Actions: Prioritize available financial assistance funding for children impacted by poverty or with other risk factors for educational failure.

Strategy 7: Advance the Interagency Council on Housing and Homelessness’ Housing First initiative.

TF Identified Actions: Seek opportunities to link to the emerging model.

Lead Convener: TBD

GOAL # 3: Ensure pregnant women receive comprehensive pre and postnatal health care.

Before and during pregnancy women, and their children, benefit from prenatal care which can identify impending obstructions to their child’s healthy development which impede them in the early years and beyond. After pregnancy a mother’s physical and mental health are paramount to the ability for a child to develop an understanding of responsive interpersonal connections. Intervening when impairments exist in a mother’s physical and mental health before and after the birth of a child can contribute to long lasting improvements in the child and family’s success.

38 Strategy 1: Identify pregnant and post partum women with or at risk for perinatal depression through screening and provide interventions.

TF Identified Actions: Pilot and evaluate use of evidence based screening tools in OB/GYN, midwifery and well child settings; Promote Universal Screening for Maternal Depression in prenatal, postpartum and pediatric settings as well as early childhood settings; Support home-visiting and group services for communities with high rates of perinatal depression; Ensure provision of adequate training for providers who provide screening, identification and treating women with depression in pregnancy and the postpartum period, including trauma informed best practice and support for women who experience reproductive loss; Ensure access to effective treatment such as: In-home Cognitive Behavioral Therapy (IH-CBT), and Multi-Systemic Family Therapy (etc. SAMHSA); Ensure availability of post-partum supports around trauma with access to a trained provider in early education settings, medical home and community resource centers and/or other community based settings (increase capacity for assessment, referral and treatment); Establish statewide advisory council to provide profession guidance on establishing a statewide system of care and developing best practices; Develop social marketing message to decrease stigma and increase awareness of the impact of maternal depression on families and communities.

Lead Convener: Department of Public Health / Executive Office of Health and Human Services grants, LAUNCH/MYCHILD, will pilot screening for maternal depression in well child visits and follow up referrals and support.

Strategy 11: Implement model of change and integrating system of services for women with co-occurring disorders (substance abuse and mental health) and histories of trauma.

TF Identified Actions: Promote universal screening and identification of women with co-occurring disorders and with histories of trauma – by a trained provider in a variety of settings including community based settings; Develop a system for reimbursement for screening for maternal substance use in prenatal, postpartum or pediatric settings; Promote use of the NICU Network Neurobehavioral Scale, a comprehensive instrument to assess substance- exposed and high-risk infants; Develop policies that are supportive of mothers in, or transitioning into, recovery (e.g. care for children while mother is in treatment); Support home-visiting and group services for communities with high rates of substance use; Ensure provision of adequate training for providers in the practice of trauma informed care and in screening, identification and treating women with co-occurring disorders in pregnancy and the postpartum period; Strengthen the Family Recovery Collaborative statewide advisory council in providing professional guidance on establishing a statewide system of care and developing best practices; Expand the number of residential shelter, and treatment beds for pregnant and post partum women with substance use disorders and/or experiencing interpersonal violence.

Lead Convener: TBD

Strategy 3: Use Life Course* model to promote Preconception and Interconception education and care.

TF Identified Actions: Promote Individual responsibility across the lifespan, including “reproductive awareness” by developing, evaluating and disseminating reproductive life planning tools; Raise Consumer Awareness by developing, evaluating and disseminating age-appropriate educational curricula and modules for use in school health education programs. Integrate reproductive health messages into existing health promotion campaigns. Design and conduct social marketing campaigns to develop messages for promoting preconception health knowledge and attitudes, and behaviors; Support Interventions for Identified Risks by increasing

39 health/education provider awareness concerning the importance of ongoing care for chronic conditions and interventions for identified risk factors; Support Interventions for Identified Risks by increasing health/education provider awareness concerning the importance of ongoing care for chronic conditions and interventions for identified risk factors; Promote Public Health Programs and Strategies by developing and supporting public health practice collaborative groups to promote shared learning and dissemination of approaches for increasing preconception health. Incorporate preconception care efforts into existing public health and education programs

*Closing the Black-White Gap in Birth Outcomes: A Life Course Approach , Michael Lu, MD, MPH (Department of Community Health Sciences, UCLA School of Public Health,) [email protected]

Lead Convener: Department of Public Health

GOAL # 4: Provide infants and toddlers with quality primary care (physical health, mental health and dental health) and ensure their families are informed consumers of health care. Health problems that arise in the earliest years, if not resolved, can have lasting effects on a child’s overall development. Children are dependent on their families and caregivers to ensure their health needs are identified and treated in order to minimize any impact on overall future health.

Strategy 1: Emphasize a dyadic approach as a guiding principle.

TF Identified Actions: Work toward a long term commitment to skill building regarding the dyadic approach and making connections with families; Seek buy-in and resources from state agencies to support this approach; Collaborate with other programs with these expertise; Collaborate around models; Train early childhood staff in observation, assessment and supportive interventions; Ensure that a key component of engagement is an ongoing process of self reflection, training, and evaluation of effectiveness in serving diverse and isolated communities; Ensure alignment with EEC to support dissemination of dyadic approach.

Lead Convener: TBD

Strategy 2: Support all early education and after school program educators with training in the best practice model of Mental Health Consultation: promotion, prevention and intervention.

TF Identified Actions: Train all early childhood education staff in social emotional development and the need for mental health consultation (e.g. statewide roll-out of CSEFEL pyramid training and model); Make mental health consultation accessible through individual practitioners, agencies or hubs/networks; Increase access to treatment modalities such as Parent Child Interactive Psychotherapy.

Action Taken: The Center on the Social and Emotional Foundations for Early Learning (CSEFEL) is a national center focused on promoting the social emotional development and school readiness of young children birth to age 5. EEC prioritized up to $300,000 of American Recovery and Reinvestment Act (ARRA) funding to invest in the augmentation of the Massachusetts CSEFEL initiative by seeking to purchase new high quality intensive CSEFEL training opportunities that will train up to 2000 early education and care staff in the Pyramid Model who work directly with children across the Commonwealth to enhance knowledge and skills, support the implementation and sustainability of evidence-based practices; and

40 increase the size of the workforce skilled in supporting the social emotional development of young children (July 1, 2010 through August 31, 2011).

Strategy 3: Assess behavioral health needs on a systemic level (i.e. family, school, culture, considerations of dyadic relationship) including the Child and Adolescent Needs and Strengths instrument (CANS), the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood, DC 0-3R observation in natural environment, input of parents/families and multiple caregivers by supporting the work of the Young Children’s Interagency Council, now the LAUNCH/MYCHILD grant projects.

TF Identified Actions: Support the Young Children’s Interagency Council, now the LAUNCH/MYCHILD grant projects , as they pilot, and implement use of a developmentally appropriate diagnostic and billing tool to complement the Diagnostic and Statistical Manual of Mental Disorders (DSM IV), the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood, Revised (DC 0-3R).

Lead Convener: The Executive Office of Health and Human Services and the Department of Public Health are partnering on two grants on early childhood mental health with funding from the Substance Abuse and Mental Health Services Administration (SAMHSA). The Executive Office for Health and Human Services is the lead on a Systems of Care grant entitled Mass Young Children’s Health Initiative for Learning and Development (MYCHILD) and Department of Public Health (DPH) on a promotion and prevention initiative called Mass LAUNCH. A key goal of the projects is to develop a strategy for developmentally appropriate diagnosis and billing for young children, including training on use of the CANS B-4 and the DC 0-3R. EOHHS and DPH are working closely with Mass Health and the Children’s Behavioral Health Initiative (CBHI) which developed the Massachusetts CANS and the CANS B-4 and are supporting use of the CANS tools across Mass Health services providers and other state agencies.

Strategy 4: Examine the use of Early Intervention (EI) reimbursement mechanisms to support infant mental health services.

TF Identified Actions: Support Infant Mental Health training for EI practitioners, such as IN-TIME training; Bring in consultative expertise in infant mental health in both training and direct service; Evaluate impact of EI/Children's Behavioral Health Initiative (CBHI) Protocol for collaboration on service provision for children B-3.

Lead Convener: TBD

Strategy 5: Enhance comprehensive transition planning for children leaving Early Intervention (EI) and moving on to Part B and other community providers (especially for mental health services).

TF Identified Actions: Early Childhood and Mental Health providers, including CBHI Community Service Agencies, reach out to EI programs to talk about services (if children don’t meet criteria for Special Education services, a specific plan should link to other supports in the community); Develop a cross-system mechanism for payment to support collaboration in creating transition plan; Ensure transition process includes culturally appropriate services and supports that the family may want and identify; assist families with the transition to Part B Services and use the MOU Concerning Early Childhood Programs as a model for local coordination.

Lead Convener: TBD

Strategy 6: Implement the medical home model.

41 TF Identified Actions: Provide the Governor with recommendations to support the inclusion of young children’s needs in the Commonwealth Fund and the Mass League of Community Health Centers / MassHealth Medical Home Initiative (Patient Centered Medical Home Project).

Lead Convener: LAUNCH/MYCHILD grants are initiating demonstration sites on pediatric medical homes, using a learning collaborative model. The learning collaborative will develop a toolkit to promote replication. Lessons learned will be shared with the EOHHS and the Commonwealth Fund projects.(check this with Kathy Betts, EOHHS)

Strategy 7: Develop a simple payment/eligibility system for promotion, prevention and intervention services for physical and mental health (ensure clear and easy access to behavioral health coverage and promote preventive care as a strategy.

TF Identified Actions: Examine gaps relative to access to physical, dental and mental health; Support leadership at EEC and the Department of Public Health, and other relevant agencies, to have an ongoing dialogue regarding health related issues; Support regular meetings between EEC Commissioner and Department of Public Health Medical Director; Develop potential hybrid model of public and private insurance and state support. Convene medical and other stakeholders to develop strategic plan for meeting health needs of young children and their families; Conduct focus groups of families with young children regarding their concerns for their young child’s health and their connections to the health care system.

Lead Convener: TBD

Strategy 8: Implement dental home model and facilitate more dental providers with pediatric training to accept MassHealth.

TF Identified Actions: Engage with Mass Dental Society and the League (CHCs) regarding appropriate strategies related to oral health for young children; Support healthier food and snack choices in early education settings; Support appropriate rates to ensure access for young children; Encourage documentation of first dental visit in early childhood settings; Promote use of evidence-based curricula in early childhood programs such as Cavity Free Kids; Ensure pediatricians and family physicians look in children’s mouths and incorporate questions around preventive care and first dental visit(s) .

Lead Convener: Consortium

Strategy 9: Develop an infrastructure to ensure that families and providers have access to current, culturally and linguistically accessible information and support in accessing children’s health resources.

TF Identified Actions: Elicit expertise of diverse community members to ensure families are informed consumers and solution- focused participants; Support paid local cultural brokers/community health workers; Pilot and evaluate the Help Me Grow model of child development with enhanced case management; Ensure an ongoing process of self reflection, training, and evaluation of effectiveness in serving diverse and isolated communities.

Lead Convener: TBD

42 GOAL # 5: Continue efforts to build a diverse, stable, competent workforce to meet the needs of infants, toddlers, and their families. As recognized by the Massachusetts Early Education and Care and Out–of-School-Time Workforce Development Task Force, compensation must be integral to any professional development system, offering resources for implementation and staff training as well as compensation for staff that recognize achievements.

Strategy 1: Strengthen the EEC workforce through intentional strategies that provide meaningful increases in compensation, linked to education and competency.

TF Identified Actions: Implement quality improvement, recruitment, and retention strategies including accreditation incentives, apprenticeship and mentoring programs, communities of practice or models that link compensation to education and other recommendations of Workforce Development Task Force Report; Assure that vouchers for infants and toddlers support the real cost of high quality care; Mandate that Orientation training and annual required training for early education and care providers include promotion of social/emotional well- being and growth, language, literacy and numeracy, partnering with diverse families and awareness of local resources for infants, toddlers, families, and educators.

Lead Convener: TBD Action Taken: EEC is launching the new 5 hour pre-service Orientation for Family Child Care Educators, which should be available by fall 2010. Additionally, a new 5 hour post service Family Child Care Educator Orientation, will be required within 6 months of receiving a Family Child Care license.

Strategy 2: Provide evidence-based training and mentorship/reflective supervision for early care and education educators on caring for infants and toddlers. TF Identified Actions: Expand current training initiatives; Set aside a significant portion of Early Childhood Educator’s scholarship and training funds to support infant/toddler educators; Involve Early Intervention personnel as mentors for infant/toddler educators and as practicum supervisors for trainees; Develop Infant/Toddler Early Learning Guidelines to inform professional development and family outreach activities; Expand need-based provision of evidence-based and research-informed educational sequences and align them with degree/credential opportunities and Early Learning Guidelines; Create and offer educational sequences and apprenticeship opportunities that are accessible for diverse educators with varying levels of English proficiency and literacy; Partner with higher education to assure that appropriate Child Development Associate (CDA)/Associate’s Degree coursework with infant/toddler or family child care focus is available, affordable, and accessible in all communities and that programs meet National Association for the Education of Young Children (NAEYC) certification standards; Create standards and credentials for family support workers.

Action Taken: EEC prioritized up to $50,000 of American Recovery and Reinvestment Act (ARRA) funding to invest in the design and development of Infant and Toddler Early Childhood Program Standards and Guidelines for Learning Experiences (March – December 2010).

Strategy 3: Strengthen family child care educators and reach out to Family Friend and Neighbor (FFN) caregivers, especially those caring for children eligible for financial assistance.

43 TF Identified Actions: Provide quality support to providers through staffed networks/systems; Support providers through home visiting programs early literacy outreach efforts and other partnerships; Increase required annual training hours for family child care educators to match center-based program requirements; Give family child care educators “a place at the table” in emerging policies, especially related to licensing and workforce development, to assure that educational offerings and strategies meet their needs; Take advantage of supports available through Child and Adult Care Food Program agencies, Early Head Start training, and other federal or privately-funded programs; Support family child care accreditation, using tools and benchmarks developed by NAFCC; Raise the educational level of the family child care workforce by requiring new entrants to have high school diplomas or GEDs; Provide safety kits, child development information, links to community resources, and other supports through Resource and Referral Agencies and community organizations.

Action Taken: EEC prioritized up to $150,000 of American Recovery and Reinvestment Act (ARRA) funding to invest in specialized training and ongoing technical assistance for all family child care educators statewide focusing on relationship-based care, early literacy development in the first three years of life, creating literacy rich child care environments, and promoting parental involvement in book sharing, reading aloud and storytelling. Upon the completion of the training, the providers will receive developmentally and culturally appropriate children's books and resources for their programs (May 1, 2010 - March 31, 2011).

GOAL # 7: Support families in their role as their infant and toddler’s first teacher and encourage high- quality learning experiences with infants and toddlers and their families/ primary caregivers.

As noted in the EEC Families Learn & Grow Together Guide, families are a child’s first and most important teachers and it is in their everyday routines that great learning opportunities happen. Each child and family is different. Children learn and grow at their own pace and in their own unique and wonderful way. Families also have their own special and unique traditions. There are many ways families can learn and grow together.

Strategy 1: Assure that infants and toddlers get a large and steady supply of rich, responsive language experience in their homes, early education settings, and communities that support their curiosity and concept development.

TF Identified Actions: Educate families on the value of speaking their primary language with their children, especially if they are not fully fluent and comfortable in English; Ensure a focus on language (as well as literacy and numeracy) through expansion of effective programs such as Reach Out and Read and the Parent-Child Home Program and supports for increased capacity to serve families for whom English is not a primary language.

Lead Convener: TBD

Strategy 2: Support families and caregivers in providing positive learning experiences for infants and toddlers by supporting paid family leave and through normative systems (pediatric clinics, early education and Early Intervention programs, child care resource and referral agencies, family network sites, libraries, etc.).

TF Identified Actions: Protect and strengthen existing programs and help them to document results; Adopt national and locally- developed models that have proven most effective, considering culture, language, family structure, involvement of all parents and primary caregivers, parent/family preference, level of need, family literacy,

44 geography, and other contextual factors; Expand use of effective, intensive models..

Lead Convener: TBD

Strategy 3: Build on and ensure availability of Parent/Family Information Networks in all communities across the State that are focused on the development of infants and toddlers.

TF Identified Actions: Develop a statewide advisory committee on this topic; Identify existing Family Networks across the state and assess for focus on infants and toddlers; Collaborate with existing family networks and local and state agencies to ensure families have access to knowledge and resources; Ensure availability of Information and Resource Specialists with expertise in infant and toddler optimal development; Expand models that locate child development specialist in primary care; Develop infant/toddler focus in existing networks and create new networks across the state; Create an outreach strategy that includes involvement of culturally and linguistically relevant population groups; Develop a family-friendly web-based strategy that includes supports for optimal development in infants and toddlers.

Lead Convener: TBD

Strategy 4: Reach out to families/primary caregivers in high need communities or with identified risk factors.

TF Identified Actions: Expand effective programs that focus on providing a rich array of positive learning experiences as part of daily routines; Extend home-visiting and other family supportive services to family, friend, and neighbor care providers, foster families, and others caring for infants and toddlers on a regular basis outside of regulated early education programs; Make ABE and ESL programs available to families and caregivers.

Lead Convener: TBD

GOAL # 8: Strengthen supports to ensure infants and toddlers are on track for optimal development and have access to high- quality, affordable early education and care and related resources to facilitate that they enter school performing well across all developmental domains.

From the start, once infants trust that their environments are consistently safe and they are engaged by trusted nurturing adults they immediately begin to explore their world. The first years of life are critical to the development of motor skills, language and literacy, and overall brain development. High quality learning experiences offer both structured and unstructured opportunities for these children to investigate and learn across multiple domains to prepare a strong foundation for lifelong learning.

Strategy 1: Launch an accessible public awareness communications campaign with, multilingual dissemination of information via diverse media formats that emphasizes basic needs, family relationships, health care (physical, mental and dental), risk reduction, and the critical nature of safe homes, the value of early intervention and quality early learning environments. . BB: The identified actions go well beyond safety; this section seems misplaced. It is important that public messaging include positive learning experiences, especially language, positive relationships, and interactive play, and that it stress the importance of assuring that all child care provide these and that caregivers have the needed expertise and support to care for infants and toddlers in groups.

TF Identified Actions:

45 Integrate and customize information and resources developed by state agencies; Expand community awareness and appreciation activities such as Provider Appreciation Day and Week of the Young Child that highlight the importance of the early years; Inventory and communicate resources (e.g. health care and insurance options etc) for families with young children; Use multiple strategies and media to distribute information; Deliver in multiple languages to multiple audiences, including minority populations; Build the case for promotion prevention, intervention; Align with and build community-wide partnerships and messages; Build community coalitions that include parents/families and providers; Build public support for policy action that focuses on child poverty.

Lead Convener: Department of Early Education and Care in partnership with the United Way of Massachusetts Bay and Merrimack Valley and the FrameWorks Institute. Action Taken: EEC, along with strategic state and private partners, has prioritized up to $298,500 of American Recovery and Reinvestment Act (ARRA) funding to invest in a multi-pronged communications campaign to raise awareness around the importance of the earliest years (including quality early education and care experiences) that serves as an overarching infrastructure that local community efforts/messages can align with and connect to (July 2010 - September 2011).

Strategy 2: In supportive partnership with families, screen children for developmental delays, disabilities, major family risk factors (e.g. violence, depression), and chronic conditions as a routine part of well-child visits and assure thorough follow-up.

Note: Not all aspects of the screening need to be conducted by the pediatrician/family physician; infant- toddler specialists might handle part of the screening and also provide follow-up services or link families with appropriate services in the community (which may need to be expanded in some areas, better coordinated, or reimbursed through health insurance when prescribed by a medical professional).

TF Identified Actions: Design a screening protocol for working with physicians and health insurance providers; Provide training for pediatricians, nurses, and other health professionals serving low-income families or those with multiple risk factors in areas of the state where “anticipatory guidance” and “developmental pediatrics” are not currently the norm; Create and disseminate local infant/toddler/family resource guides; Make developmental specialist and physician-referred family support services reimbursable by Medicaid and Mass Health; Strengthen infrastructure for service referral, provision, and coordination in each community. Ensure that the MA Child Psychiatry Access Project (MCPAP) and CBHI clinicians have expertise in infant toddler mental health.

Lead Convener: Department of Public Health /EOHHS LAUNCH/MYCHILD grants are initiating demonstration sites on pediatric medical homes, using a learning collaborative model. The demonstration sites will include a team of an ECMH clinician and a Family Partner/Care Coordinator, who will provide enhanced screening and assessment, family support and parenting education, linkages to services and follow up on referrals. The learning collaborative provides training to this team along with a pediatric champion and administration from each site. The Learning Collaborative will develop a toolkit to promote replication and sustainability, including billing strategies. Lessons learned will be shared with the EOHHS and the Commonwealth Fund projects

Strategy 3: Expand the ability of Early Intervention, infant/toddler development and mental health consultants and home visitors to work with all infant/toddler educators. Create a network of infant/toddler/family specialists who can provide consultation, technical assistance, outreach, and support to programs and providers serving children, under age 3, and their families.

TF Identified Actions:

46 Create blended funding streams; Provide joint training opportunities; Sustain and build upon current initiatives (e.g. mental health consultant and expulsion-prevention initiatives, Children’s Behavioral Health Initiative, etc.); Ensure programs serving infants and toddlers are included in these efforts as appropriate; Identify training needs and supply needed training for specialists who can serve in this capacity; Build incentives for partnerships and formal Memoranda of Understanding into system-building efforts; Formally link all licensed early education and care and family support programs serving infants and toddlers to a specialist or agency team who makes regular visits and provides support or referrals as needed for the classroom, home, or program as a whole and (with parent/family involvement); Provide a mechanism for funding these services.

Lead Convener: Department of Early Education and Care in partnership with the Department of Public Health, the Head Start Training and Technical Assistance Program Action Taken: EEC is partnering with the Department of Public Health, the Head Start Training and Technical Assistance Program, and representatives from higher education and other training vendors to create a statewide leadership network for infant and toddler programs specialists/mentors using modules developed in Region 1 with Zero to Three’s National Infant and Toddler Child Care Initiative. The model will train teams from communities with identified underperforming schools and form an ongoing Learning Community.

Strategy 4: Assure affordability through an expanded voucher program and direct financial supports to providers and programs.

TF Identified Actions: Eliminate the current waiting list, giving priority to children with multiple or severe risk factors who are entering settings with demonstrated high quality or specialized supports and expertise; Serve families at 200% of poverty.

Lead Convener: TBD

Strategy 5: Invest in facility improvement and expansion.

TF Identified Actions: Assure that existing early education and care facilities, family child care programs, and indoor and outdoor play spaces have adequate space, natural light, and ability to modulate sensory stimulation (including protected areas for infants and toddlers) and meet health and safety guidelines; Build or expand early education and care facilities to serve infants and toddlers; Provide credit and other supports to enable new family child care educators and Family Friend and Neighbor providers to create appropriate spaces for infant toddler care.

Lead Convener: TBD Action Taken: EEC has prioritized up to $500,000 of American Recovery and Reinvestment Act (ARRA) funding to fund a two part model focusing on early education and care programs serving infants and toddlers. Participants will receive a minimum of two professional development opportunities regarding making quality enhancements to their early education and care programs’ physical environments and will be eligible to apply for grant funds to implement improvements in their program (July 30, 2010 - August 1, 2011).

Strategy 6: Expand programs (such as Early Head Start and similar comprehensive programs) for infants and toddlers. Note: Most effective programs offer both early education and care and home visits, prioritize family involvement, and support families both in their role as “first teachers” and in meeting self-sufficiency, health,

47 and mental health goals. Best results are obtained when programs begin in the prenatal period.

TF Identified Actions: Document Early Head Start child outcomes and plan for continuation of effective sites and review unfunded proposals; Expand program with additional state funds to qualified programs or promising proposals if federal funds prove insufficient.

Lead Convener: TBD

Strategy 7: Decrease the number of families with young children who are food insecure and improve access to healthy food options.

TF Identified Actions: Increase utilization of entitlement programs (e.g. Women, Infants and Children (WIC)) to reduce nutritional insecurity; Promote awareness of new WIC food package; Create new promotion campaign for WIC based on findings; Launch targeted statewide breastfeeding promotion campaign based on 1) research regarding barriers for particular populations and 2) similar successful campaigns (e.g. “Back to Sleep”); Develop process for integration of nutrition information into standard prenatal and well-baby visits; Increase regulation of unhealthy food advertisements during children’s programming; Encourage development of new program focusing on group meal preparation with healthy and culturally appropriate food choices.

Lead Convener: Department of Public Health

Goal # 9: Build capacity to allow families meaningful choices in services for infants and toddlers and support in accessing informal and formal services/networks.

Choosing programs or informal services, particularly for an infant or toddler, is a very personal choice for each family. Programs should be available that are compatible with different family’s cultural expectations, philosophies and schedule, and should provide a safe environment that is educational, engaging and nurturing.

Strategy 1: Improve knowledge about resources that are available in a family’s community and help all families identify opportunities for their children (including eligibility).

TF Identified Actions: Complete inventory of family engagement and support programming available in MA; Conduct focus groups of families across the state as consumers to determine education and support needs; Expand warm lines with language capacity; Increase required parent/family councils and ensure representation; Explore viability of existing resources to support services for children prenatal to three and their families; Replicate or adapt effective models (e.g. Harlem Children’s Zone Baby College) for high risk families.

Lead Convener: Department of Early Education and Care through support for the Coordinated Family and Community Engagement Grantees.

Strategy 2: Eliminate barriers to accessing resources (language, culture, geographic and traditional hours).

TF Identified Actions: Develop system to monitor capacity, utilization and demand for resources; Identify redundancies and gaps, build on best practices/current programs, develop a plan for working as a comprehensive system; Promote co-location/co-mingling of funding for family support, determine common outcomes and centralize reporting; Explore viability of existing resources to support services for children prenatal to three and their

48 families.

Lead Convener: TBD

Strategy 3: Families are actively involved in leadership, advocacy, and governance.

TF Identified Actions: Conduct focus groups of parents/families across the state as consumers to determine education and support needs. Build partnership with families into the MA Quality Rating and Improvement System, with a mechanism for strengthening this component based on experience in the field and input from a wide range of families.

GOAL # 10: Support all communities in developing the capacity to strengthen families and support the healthy growth and development of its infants/ toddlers and have a coordinated network of high- quality, accessible services and resources.

The “Strengthening Families” approach refers to five foundational Protective Factors; when these factors are present and robust in a family, the likelihood of child abuse and neglect diminish. One factor includes the importance of social connection which is described as “friends, family members, neighbors, and other members of a community who provide emotional support and concrete assistance to parents.” Supportive communities can provide multiple supports to families to reduce their isolation and increase the likelihood that they access appropriate resources and services.

Strategy 1: Communities support trauma-informed practice and have supports to identify trauma-related concerns.

TF Identified Actions: Promote use of trauma-informed strategies (e.g. Mass Advocates for Children Trauma and Learning Policy Initiative); Collaborate with public health departments to expand community building activities such as the “Steps” Program (community walking groups); Complete community needs assessments collaboratively with other state agencies; Make trauma identification and response training available to early education educators; Review Adverse Childhood Experiences (ACE) research to inform training development.

Lead Convener: TBD

Strategy 2: Support resilience/protective factors and mental health promotion for families

TF Identified Actions: EEC to implement Strengthening Families self-assessment tool in early care and education settings; Support use of Bright Futures in Practice (especially mental health promotion) tools in pediatric settings; Adopt an asset based model/s (make available to early education and care providers, mandate for early educators); Mandate ongoing self reflective anti-bias training in state funded programs and support services for staff working with young children and their families; Promote both parent/family and adult activity/support groups; Build capacity in the field by expanding the definition of “providers”, to include committed social service workers, parent/family volunteers, etc. and provide opportunities for higher education to these providers to build career lattices; Develop social marketing message to decrease stigma and increase awareness of the impact of maternal/paternal depression on families and communities (e.g., Department of Public Health Massachusetts New Parents Initiative).

49 Lead Convener: Department of Public Health (LAUNCH/MYCHILD)

Strategy 3: By filling gaps in existing systems, create a sequence of supports, beginning prenatally or at birth, and a system of promotion (for everyone), prevention (efforts to strengthen protective factors for children and families who may have economic, social, or biological risk factors, including newcomer families), and early intervention (services for children or child/parent dyads with identified difficulties, delays, or challenges) that provides services tailored to child and family needs.

Note: Use universal efforts (such as Welcome, Baby bags and visits and use of family-supportive tools such as the NBO) to engage families, connect them to available resources, and begin to identify unmet needs.

TF Identified Actions: Identify strengths, gaps, and under-utilized resources in each community. Maintain supports for current promotion and prevention programs and collaborative efforts to reach and support families before birth and during the first three years; Through an RFP process, sustain, expand, reinstate, or introduce programs such as First Link, prenatal support groups, Boot Camp for Dads, and Baby College to fill gaps in promotion and prevention services in each community.

Lead Convener: TBD

Strategy 4: Support evidence-based or research-informed programming for infants, toddlers, and families by providing adequate and predictable funding.

TF Identified Actions: Tap Mass Health, private insurance, public/private partnerships, Title I funds; ARRA, and other public funding streams; Set aside significant portions of appropriate funding streams (e.g. Title 1); Appoint an Infant/Toddler “Czar” to coordinate efforts of government agencies and develop an Infant/Toddler Budget; Make the case for investments in programs to serve infants, toddlers, and families; Develop a “Baby Caucus” or Birth through Age Five Caucus in the MA state legislature, similar to the Congressional Baby Caucus.

Strategy 5: Ensure infrastructure for coordination at local level.

TF Identified Actions: Assess existing or potential collaborative entities; Determine best mechanism to support effective collaboration so that services are seamless for families. Identify funding for selected pilots and replicate successful pilots.

Strategy 6: Support a network that will be responsive to diverse family populations (e.g. same-sex parenting, single parents, linguistically diverse populations, recently immigrated, multi-generational, foster, adoptive, and blended families etc.).

TF Identified Actions: Include funding that allows for professional development/career lattice for vocational opportunities for cultural community brokers; Implement best practice guidelines regarding blended families in consultation with local expertise; Standardize core competencies and develop training modules on cross cultural work; Build capacity of assessment and intervention for families with special needs.

50 Lead Convener: TBD

Strategy 7: Implement a universal data system for young children and their families accessing services across systems.

TF Identified Actions: Provide a state investment in development of a system of care; Develop Memoranda of Understanding across state agencies on enhanced data collection and sharing.

Strategy 8: Galvanize the business sector to support early childhood efforts.

TF Identified Actions: Build strategic private-public partnerships to engage the business community at all levels; Gauge the business community’s current knowledge and interest through focus groups; Invite business partners to round table discussions to share compelling data and impact of early childhood on current and future workforce; Include business aimed at parents/families of young children in campaigns, etc.

Lead Convener: United Way of Massachusetts Bay and Merrimack Valley

Strategy 9: Build effective coalitions at the community level through cross-training, events for providers and families, shared outreach, warm lines and resource guides, local coordinating councils, and/or joint education and advocacy efforts.

TF Identified Actions: Encourage community-wide efforts at least twice a year to encourage mutual awareness and coordination of efforts to promote positive learning experiences and overall health and well-being for infants, toddlers, and families; Make continued efforts to get “everyone at the table,” including families; Precede and follow-up with strategic planning summits and priority-setting activities; Publish local training calendars and encourage collaboration and cross-training.

Lead Convener: Department of Early Education and Care , United Way, Children’s Trust Fund and Connected Beginnings

Connected Beginnings Training Institute (CBTI) is committed to building effective coalitions at the community level through the organization of "cross-training" events for providers and families. CBTI, an initiative of the United Way of Mass. Bay & Merrimack Valley, will partner with EEC, the Children's Trust Fund and other state and private entities to achieve this strategic goal.

GOAL #11: Support consistent, stable, responsive, nurturing and culturally and linguistically responsive relationships in infant and toddler’s out of home settings, including early education and care and family service programs, and family settings.

Through warm nurturing social exchanges infants and toddlers learn to trust their caregivers and the larger world and are then free to develop and learn. It is in the context of these trusting relationships that the earliest skills emerge, such as literacy and social skills.

Strategy 1: Review and revise state policies and implementation strategies so as to promote continuity of care (across the day, year, entire infant/toddler period, and beyond as well as cultural continuity and positive

51 home/ early education and care relationships).

TF Identified Actions: Review policies and requirements and make any revisions that do not require legislative or federal approval; Assure that policies and requirements support the involvement of fathers as well as mothers, of both parents in same-sex families, and of grandparents, foster parents, and others playing a parenting role; Continue to issue vouchers that are good for one year, regardless of changing family circumstances, if child remains in same setting or with same provider; Issue 2-year vouchers and/or increase reimbursement rate for high quality settings that have implemented primary care giving arrangements and continuity of care policies as recommended by Zero to Three.

Strategy 2: Improve the dissemination of best practices regarding parenting/nurturing.

TF Identified Actions: Conduct focus groups of parents/families across the state as consumers to determine education and support needs; Expand warm lines with language capacity; Increase required parent/family councils and ensure representation, including provision of training/tools for parents/families to do so.

Lead Convener: Children’s Trust Fund; Department of Public Health (DPH) (as part of the Massachusetts New Parents Initiative, DPH conducted nine focus groups with new parents in two communities to determine their priorities for community, social and family supports for new parents. The results of these focus groups can help inform this action.

GOAL # 12: Ensure access to community-based parent/family support groups and disseminate strategies to promote maternal/paternal and infant attachment and hands-on pre and post partum support for new mothers/fathers.

Research indicates that a “mothers’ sensitivity to the behavior and emotions of their infants and toddlers has been shown to be important for the development of secure attachment. In turn, secure attachment predicts a less stressful transition to out-of-home care, and better social-emotional adjustment in later childhood, adolescence, and adulthood.xvi” Providing mothers’ and family members with social supports is one effective strategy in promoting the positive development of infants and toddlers and facilitates increased successes throughout the child’s life.

Strategy 1: Promote strategies that will strengthen maternal and infant attachment.

TF Identified Actions: Support initiation and duration of exclusive breastfeeding with access to nursing mothers in hospitals, pediatrician offices, and integration into home-based services; Support practices in birth hospitals that promote early attachment (e.g. no separation of mother and baby, skin-to-skin contact, rooming in for infants, etc.); Support groups focused on effective and nurturing early parenting (e.g. Mayan Wraps, understanding infant cues, physical responses, etc.); Promote effective infant soothing techniques (eg. swaddling, shushing, swinging, baby massage etc.); Promote insurance coverage of specially trained Community Health Workers (Doulas) for pre and postpartum support; Train providers who interface with mothers of young infants in strategies that promote early attachment.

52 Lead Convener: Department of Public Health (emotional-based messages developed through the Mass New Parents Initiative; Shaken Baby Syndrome public awareness training)

Strategy 2: Create community-based Family Support Groups that will include information on resources and supports for families with infants and toddlers and enhance access to early, hands-on pre- and post partum support for new mothers.

TF Identified Actions: Establish a yearly calendar of meetings and events for attendance by families of infants and toddlers; Determine specialty areas of interest to parents/families and create a speakers bureau on a range of topics for typically developing and special populations that can include experts on topics such as sibling rivalry, temper tantrums, Attention Deficit Hyperactivity Disorder (ADHD) , Autism, Aspergers, etc; Expand access to home visiting services, especially to communities with poor perinatal outcomes (e.g. Healthy Families, Early Intervention Partnerships Programs (EIPP), Early Head Start, Healthy Baby Healthy Child, Community Health Workers (Doulas), Boston and Worcester Healthy Start Initiatives); Promote insurance coverage of specially trained Community Health Workers for pre and postpartum support.

Lead Convener: Department of Public Health (Home Visiting grant)

GOAL # 13: Provide families of infants/ toddlers at risk for out of home placement with access to: strength-based family support services, pre and post-permanency supports and a coordinated system for visits.

All children deserve a safe environment with nurturing adults to allow them to develop to their full potential across all domains. The preservation of each child’s family is the goal of providing strength-based family support services, pre and post-permanency supports and a coordinated system for visits. Without these interventions children are more likely to experience negative short and long term outcomes pertaining to their educational, health and societal status. With family supports, many children can remain in their homes as their family engages in opportunities that connect them with community services and resources and begin to be empowered as they promote their own skills.

Strategy 1: Improve coordination among existing resources (include continuity of information across service providers).

TF Identified Actions: Convene relevant programs/agencies to ensure collaboration, identify redundancies and gaps, build on best practices and develop a plan for working as a comprehensive system; Promote co-location/co-mingling of funding for family support, determine common outcomes and centralize reporting; Identify evaluation components to determine impact of education and supports and to inform future programming; Review existing community models (e.g. Thrive in 5, Early Childhood System of Care) to assess transferability to statewide system; Create standards and credentials for family support workers (on-going education/professional development system); Identify new funding options to support services for children birth to three and their families and increase advocacy efforts to shift funding to focus on prenatal to three.

Lead Convener: TBD

Strategy 2: Ensure capacity meets demand across communities and populations.

53 TF Identified Actions: Complete inventory of family engagement and support programming available in MA; Conduct focus groups of parents/families across the state as consumers to determine education and support needs; Develop system to monitor capacity, utilization and demand; Explore viability of existing resources to support services for children prenatal to three and their families; Identify evaluation components to determine impact of education and supports and to inform future programming; Identify new funding options to support services for children birth to three and their families and increase advocacy efforts to shift funding to focus on prenatal to three.

Lead Convener: Department of Public Health (Home Visiting grant)

Strategy 3: Improve the dissemination of best practices regarding parenting/nurturing.

TF Identified Actions: Campaign for high impact, high priority dissemination of information (including training of resource providers for consistent messaging); Create standards and credentials for family support workers (ongoing education/professional development system).

Lead Convener: Children’s Trust Fund; Departments of Public Health and Early Education and Care

54 55 i Need to Adjust Cites –numbering is now out of order Ready for Lifelong Success, The Patrick Administration Education Action Agenda, June 2008, http://www.mass.gov/? pageID=eoeterminal&L=3&L0=Home&L1=Commonwealth+Readiness+Project&L2=Readiness+Reports&sid=Ee oe&b=terminalcontent&f=readiness_project_readiness_final_report&csid=Eeoe ii Putting Children and Families First, The Department of Early Education and Care’s Strategic Plan, February 2009 iii ADD CITE iv http://developingchild.harvard.edu/library/multimedia/interactive_features/five-numbers/ v ADD CITE vi vii

xi Hart, B., & Risley, T. (1995). Meaningful differences in the everyday experiences of young American children. Baltimore, MD: Brookes. xii Biemiller, A. & Slonin, N. (2001). Estimating root vocabulary growth in advantaged and disadvantaged populations: Evidence for a common sequence of vocabulary acquisition. Journal of Educational Psychology, 93, 498-520. xiii Snow, C.E., Porche, M.V., Tabors, P.O., & Harris, S.R. (2007). Is literacy enough? Pathways to academic success for adolescents. Baltimore: Paul H. Brookes Publishing Co. xiv Barth, et al. (2008) xv Middlebrooks J.S.& Audage N.C. (2008). The Effects of Childhood Stress on Health Across the Lifespan. Atlanta (GA): Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. xvi Ahnert, L., Gunnar, M. R., Lamb, M. E., & Barthel, M. (2004), as cited by FSU Center for Prevention and Early Intervention Policy (“Enhancing Maternal Sensitivity to Infants and Young Children, http://www.cpeip.fsu.edu/resourceFiles/resourceFile_104.pdf), Transition to child care: Associations with infant- mother attachment, infant negative emotion, and cortisol elevations. Child Development, 75, 639-650.