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This occasional paper is the ninth in a series on the National Quality Framework (NQF). The Education and Care Services National Law and National Regulations govern the minimum standards and requirements that all providers of NQF regulated services must meet, including health and safety requirements. Quality Area 2 of the National Quality Standard (NQS) upholds children's right to be protected and kept safe. The approved provider, nominated supervisors, coordinators and educators have responsibility for supporting the health, safety and wellbeing of all children. In exercising their responsibilities, they must take reasonable care to protect children from foreseeable risk of harm, injury and infection. This paper uses data from the National Quality Agenda Information Technology System (NQA ITS) to provide analysis of trends in serious incidents resulting in injury, trauma or illness in Australian children's education and care services between 1 April 2020 and 31 March 2022.

We provide the first causal evidence of the returns to maternal educational curricula on offspring's health at birth. Educational programs that aim to deliver more general knowledge may potentially improve women's earning potential and maternal prenatal investment by increasing the portability of skills across occupations and improving women's ability to make informed decisions about fertility options and health behavior. We study the impacts of a comprehensive educational reform that postponed students' curriculum choices and integrated more general education into the high school system on infant health outcomes. Using a dose-response difference-in-differences (DiD) model research design applied to linked population registries, we find that the reform led to a significant reduction in the incidence of very low birth weight (less than 1,500 grams) and very preterm birth (less than 33 gestation weeks). Overall, the reform's positive effects on infant health at birth seem to be driven by increased mothers' labor market opportunities and better family planning, rather than increased ability to avoid risky behaviours or increased women's earnings via different occupational choices or assortative mating. [This report received additional funding from Fundación Ramón Areces and the Spanish National Research Plan 2017-2020.]

The National Quality Framework (NQF) was established in 2012 to create a more efficient and cohesive approach to regulating early childhood education and care, and outside school hours care in Australia. The NQF provides a shared vision for governments and the children's education and care sector, and an agreed tool for measuring and monitoring service quality. It sets standards for safety and quality so that all children who attend services regulated under the NQF are supported to have the best start in life. This occasional paper discusses how and why the NQF came about, what has changed in the last 10 years, and future directions.

This report, from researchers at ChildObesity180, an initiative of the Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy at Tufts University, explores the impact of the Boston Foundation's investment in four nonprofits that provide structured physical activity to students. The report finds that investments in "Build Our Kids Success (BOKS)"; "Community Rowing, Inc."; "Playworks"; and "Sportsmen's Tennis and Enrichment Center" had a notable impact on the amount of physical activity students received in school. Once the pandemic forced a remote learning environment, the programs pivoted and innovated to take their work to the online space, with some success. However, the overall amount of physical activity students received in remote learning was, not surprisingly, significantly reduced.

In 2019, 135 million people in 55 countries were in food crises or worse, and 2 billion people did not have regular access to safe, nutritious and sufficient food. COVID-19 has exacerbated these hardships and may result in an additional 121 million people facing acute food insecurity by the end of 2020. Further, since the beginning of the pandemic, an estimated 1.6 billion learners in 199 countries worldwide were affected by school closures, with nearly 370 million children not receiving a school meal in 150 countries. The paper presents the evidence on the potential negative short-term and long-term effects of school meal scheme disruption during COVID-19 globally. It shows how vulnerable the children participating in these schemes are, how coping and mitigation measures are often only short-term solutions, and how prioritizing school re-opening is critical. For instance, it highlights how girls are at greater risk of not being in school or of being taken out of school early, which may lead to poor nutrition and health for themselves and their children. However, well-designed school feeding programmes have been shown to enable catch-up from early growth failure and other negative shocks. As such, once schools re-open, school meal schemes can help address the deprivation that children have experienced during the closures and provide an incentive for parents to send and keep their children, especially girls, in school.

This occasional paper is the seventh in a series on the National Quality Framework (NQF). It explores the quality of children's education and care services based on the socio-economic status of the area in which they are situated. The Socio-Economic Indexes for Areas (SEIFA) Index of Relative Socio-Economic Advantage and Disadvantage (IRSAD) is used by the Australian Bureau of Statistics (ABS) to classify services by the level of relative socio-economic advantage and disadvantage of their local area. This paper uses SEIFA as a proxy measure to identify services that are more or less likely to educate and care for children from disadvantaged backgrounds. This paper begins by highlighting contemporary research about the association between socio-economic status and developmental outcomes, and the impact of high quality education and care on children from more disadvantaged backgrounds. It then outlines the quality and availability of education and care in low socio-economic status areas, analysing service quality ratings and reassessment results. The paper also examines differences across service and provider management types, and remoteness classifications. The detailed analysis suggests that there are differences in the overall quality ratings of education and care services located in high and low socio-economic status areas. Services in relatively disadvantaged areas are slightly more likely to be rated Working Towards NQS and notably less likely to be rated Exceeding NQS than those in relatively advantaged areas.

The food stamp program (SNAP) is one of the most important elements of the social safety net and is the second largest anti-poverty program for children in the U.S. (only the EITC raises more children above poverty). The program varies little across states and over time, which creates challenges for quasi-experimental evaluation. Notably, SNAP benefit levels are fixed across 48 states; but local food prices vary widely, leading to substantial variation in the real value of SNAP benefits. In this study, we leverage time variation in the real value of the SNAP benefit across markets to examine the effects of SNAP on child health. We link panel data on regional food prices and the cost of the Thrifty Food Plan [TFP], as measured by the USDA's Quarterly Food at Home Price Database, to restricted-access geo-located National Health Interview Survey data on samples of SNAP-recipient and SNAP-eligible children. We estimate the relationship between the real value of SNAP benefits (i.e., the ratio of the SNAP maximum benefit to the TFP price faced by a household) and children's health and health care utilization, in a fixed effects framework that controls for a number of individual-level and region characteristics, including non-food prices. Our findings indicate that children in market regions with a lower real value of SNAP benefits utilize significantly less health care, and may utilize emergency room care at increased rates. Lower real SNAP benefits also lead to an increase in school absences but we find no effect on reported health status.

Asthma is the leading chronic health condition among children in the United States and a major cause of childhood disability. It also disproportionately affects low-income and racial and ethnic minorities. Although a wide range of interventions have been implemented to improve asthma-related outcomes among socioeconomically disadvantaged and minority children, disparities persist. This paper, which was commissioned by the JPB Foundation and conducted by MDRC in partnership with the National Academy for State Health Policy, standardizes and compares effects from rigorous evaluations across three main types of interventions: those that focus on improving education and self-management, those that focus on addressing remediation of the conditions that trigger asthma in the home environment, and those that focus on improving health care provider practice. While prior reviews have summarized findings for each intervention type, this review systematically compares findings across a range of outcomes and a spectrum of different approaches to addressing childhood asthma, drawing from about 30 independent studies and earlier published reviews. In addition, the paper includes case studies of various local programs and state-level policy initiatives to illuminate current efforts to address childhood asthma in low-income communities and barriers faced in sustaining asthma programs. Key findings include: (1) Providing education on how to manage asthma is fundamental to improving outcomes, but it may not be enough to alleviate disparities in asthma management; (2) Some local programs are clearly bridging informational gaps among low-income families and are helping them maintain a safe home environment for their children with asthma; (3) The health care benefits of interventions that go beyond education are unclear; (4) Barriers to medication management are complex and medication adherence is difficult to influence; and (5) The role of the state, and the Medicaid program in particular, is relevant for the financing and sustainability of asthma programs for low-income children. Although the long-run sustainability of some of the programs highlighted in this report is uncertain, what is clear is that combating the disparities in the prevalence of asthma among different populations will require more than an agreement on standard asthma management practices within the medical community. The following are appended: (1) Methodology for Literature Review; (2) Summaries of Asthma Studies; (3) Detailed Case Studies of Local Asthma Programs; and (4) Detailed State-Based Case Studies. [This working paper was written with Felicia Heider, Carrie Hanlon, and Taylor Kniffin.]

ACECQA has published the second in its series of occasional papers, analysing one of the most challenging quality areas -- Children's Health and Safety. Quality Area 2 addresses one of the primary objectives of the National Quality Framework -- to ensure the health, safety and wellbeing of children attending education and care services. The paper examines performance across service types, socio economic and remoteness classifications, jurisdictions and management types. It also breaks down Quality Area 2 and highlights that standard 2.3 (each child is protected) and element 2.3.3 (incident and emergency planning) are the most challenging aspects of the Quality Area. One of the findings from the analysis is that services in remote and very remote areas may benefit from more support to understand and comply with the requirements of Quality Area 2. The paper also summarises recent state, territory and Commonwealth initiatives around child safe organisations, as well as some examples of the types of compliance and enforcement action that state and territory regulatory authorities have taken relating to children's health and safety.

Health and education are reciprocally related, and research indicates that unhealthy students are poorly positioned to learn. Providing services that prevent health problems or help students cope with existing health concerns is one way that schools intervene in the relationship between student background and educational outcomes. Providing health services on campus is theorized to promote educational goals by increasing access to services, improving health, and enhancing opportunities to learn. However, existing empirical tests of this relationship are rare and have important limitations. This paper uses data from Add Health, which identifies numerous services provided by schools across the U.S. Multilevel models test how availability of preventive or physical health services relates to adolescents' academic performance as well as implications for racial and socioeconomic educational inequality. Analyses consistently demonstrate that school provision of preventive/physical health services is positively related to youths' educational outcomes--including a higher GPA, lower odds of failing courses, and higher odds of graduating from high school--but also little evidence of differing associations across student subgroups. Additional results mitigate concerns that these relationships are biased by selection and offer evidence that increased opportunities to learn are one mechanism for the positive role of health services.

This paper exploits a source of variation in the eligibility for federal nutrition programs to identify the program effects on food insecurity. Children are eligible for the WIC [Women, Infants and Children] program until the day before they turn 61 months old. The result is an age discontinuity in program participation at the 61-month cutoff. Using the Early Childhood Longitudinal Study Birth-cohort dataset, we find strong evidence of a sizeable increase in household food insecurity at the 61-month cutoff. Our findings are robust to different model specifications, datasets, and various bandwidth choices using various non-parametric estimations. A section on data sources is appended.

In developed countries, obesity tends to be associated with worse labor market outcomes. One possible reason is that obesity leads to less human capital formation early in life. This paper investigates the association between obesity and the developmental functioning of children at younger ages (2-4 years) than ever previously examined. Data from the German Socio-Economic Panel Study are used to estimate models of developmental functioning in four critical areas (verbal skills, activities of daily living, motor skills, and social skills) as a function of various measures of weight (including BMI and obesity status) controlling for various child and family characteristics. The findings indicate that, among boys, obesity is a significant risk factor for lagged development in verbal skills, social skills, and activities of daily living. Among girls, weight generally does not have a statistically significant association with these developmental outcomes. Further investigations show that the correlations exist even for those preschool children who spend no time in day care, which implies that the correlation between obesity and developmental functioning cannot be due solely to discrimination by teachers, classmates, or day care providers. Full text (English translation) of the SOEP questions that were used to create the measures of developmental functioning used in this paper is appended. (Contains 4 tables and 1 footnote.)

This paper describes important issues in the promotion of the development of children 0 to 6 years of age in Brazil, particularly in education, health, children's rights and public policy. Brazil exhibits tremendous disparities and some of the worst welfare indicators in Latin America. Much of the population faces poverty, limited educational opportunities, and inequitable access to services and basic protections. The youngest children are disproportionately affected. Indicators of malnutrition remain high. Despite the efforts of dedicated teachers and officials, the public education system is not providing an adequate foundation so that children from low-income families may one day rise out of poverty. Education has been a key area of public policy under several government administrations, but early childhood development has not been underscored. Nonetheless, there are reasons for optimism. This paper includes numerous examples of good practice in early childhood education in Brazil, including children's participation, progressive pedagogies that build on local cultures and well-designed, publicly funded early childhood education strategies. (Contains 4 figures and 26 footnotes.)

This paper discusses routes by which HIV/AIDS money is dispersed and received. It notes that capturing accurate data on actual spending patterns of large donors can be difficult, as there is no uniform tracking or reporting system and much HIV/AIDS money is spent under the broader category of sexual and reproductive health. Most of the information contained in the first two sections is based on main reports that assess the general manner in which HIV/AIDS money as a whole is being distributed. Moving on from who is providing funds for HIV/AIDS initiatives at global level, it tracks sources and flows from governments, through bilateral and multilateral channels. It does not include estimates of household spending on care and treatment, which cannot be realistically quantified. Information follows on top US and European donors, the international business community and pharmaceutical companies. Later sections look into ways HIV/AIDS funding is being spent, with the proviso, as before, that detailed breakdowns of actual spending are rare. The broadest categories are prevention, care and treatment, orphan support and research. Within the field of ECD vis-a-vis HIV/AIDS, funds are being directed through two main areas of concern--prevention of mother-to-child transmission and the care of orphans and vulnerable children. This paper describes major players in these arenas, showing that efforts are being made by a few agencies through the amount of funding directed along these channels is minimal in contrast to other target areas. Fundamental questions are raised about current donor priorities and there follows some discussion touching areas where new or reallocated HIV/AIDS funding could be directed. Obvious gaps in the provision of money for ECD and HIV/AIDS support are then identified along with opportunities to carry out work fill such gaps. The final section examines what it would take to direct more money to support young children living in the shadow of HIV/AIDS. Including very young children in HIV/AIDS response strategies will ultimately depend on individual communities devising their own solutions. A further section highlights the critical importance of sharing knowledge through networks that communicate and disseminate evidence-based research findings and project evaluations. In conclusion, this paper calls for advocacy to urge that more funding should go to ECD-HIV/AIDS needs and that current funding approaches to dealing with the crisis need, in addition, to be tracked and evaluated, with a view to promoting more and better ways of meeting the unfulfilled needs of very young children affected by HIV/AIDS. (Contains 2 figures.)

The National Assembly on School-Based Health Care (NASBHC) convened a meeting of 23 stakeholders representing a national cross-section of experts in the fields of health and education on April 30, 2004. Among the participants were school health practitioners, educators, researchers, and funders. The meeting's purpose was to clarify and document the relationship between school-based health centers (SBHCs) and student academic performance. The diverse backgrounds, experiences, and viewpoints among participants contributed to a vigorous discussion of pertinent issues. The meeting included a discussion of the educational policy context that is increasing pressures on SBHCs to document the impact of their services on academic performance. This paper aims to: (1) summarize the meeting proceedings and recommendations; (2) provide a stimulus for further discussion and research on the connection between SBHCs and academic performance; and (3) provide guidance to those currently working with SBHCs, including staff, researchers, evaluators, advocates and their educational partners on strategies to document and enhance the collaboration between SBHCs and educators to improve student success and sustain the viability of the SBHC initiative. (Contains 4 figures and 1 footnote.) [Funding for this paper was provided by The Health Foundation of Greater Cincinnati.]

This paper provides a background and discussion regarding tobacco-free schools. The paper is intended to enhance discussion about the health benefits to children who attend schools that have a comprehensive tobacco-free school policy. The benefits to the personal health of students are both direct and environmental. Direct health benefits from a tobacco-free school policy are achieved via effective and appropriate health instruction that informs students of the health consequences of tobacco use, thus helping to reduce or eliminate tobacco use behaviors among youth. Environmental health benefits from a tobacco-free school policy are achieved via the elimination of second-hand smoke, a known risk factor for tobacco-related health problems. [Report prepared for the Montana Board of Public Education by the Montana Healthy Schools Network and the Office of Public Instruction's Division of Health Enhancement and Safety.]

This paper examines conflicting evidence regarding the impacts of welfare reform on children's wellbeing. Research shows that poverty rates, teen crime and fertility, and child maltreatment are down. Lack of appropriate state-level data on indicators of child wellbeing precludes serious analysis of the role of welfare reform for most indicators. Good data come from welfare reform experiments from the 1990s, which indicate the impacts of welfare reform packages under evaluation relative to the old AFDC system. For elementary students, evidence strongly indicates that welfare reform can powerfully enhance achievement and positive behavior, with little evidence of harm. The beneficial impacts appear strongest for children in families with longer histories of welfare receipt. More limited evidence suggests that welfare reforms may cause detrimental increases in teens' school problems and risky behaviors. Reforms with work mandates but few supports for working mothers are significantly less beneficial for elementary students than programs with work supports. Reforms with positive impacts on children operate more through changes outside the family. Poverty, maternal depression, domestic violence, and children's developmental problems are very common. Policy recommendations include providing after-school and community programs for older children and encouraging fathers' involvement with children. (Contains 57 bibliographic references.) (SM)

The research reviewed and the current responses identified in this paper show that at local, national and international levels there are gaps in programming and policy to engage ideas and mobilise resources to address the needs and experiences of very young children infected/affected by HIV and AIDS. Chapter one identifies some key areas where the lives of very young children are affected by the pandemic. Chapter two reveals that HIV and AIDS and early childhood development (ECD) programming has shown a limited response so far. Finally, in Chapter three, conclusions are drawn that indicate that services are required urgently to support very young children both directly and through the families and communities in which they live. (Lists 9 resources and 11 online resources.)

There is growing acknowledgement that optimal early childhood development is crucial not only for health, well-being, and competence but also for society at large. This second paper in a series focuses on the period from birth to age 6 and draws on research from Canada and other countries to address several questions of children's development, including the following: (1) What are the known threats to young children's optimal development?; (2) Which types of targeted programs promote the development of vulnerable children and under what circumstances?; and (3) To what extend is the current approach to targeting early childhood programs consistent with what we know about what is required to promote young children's development? The paper discusses research evidence from evaluations of three categories of programs intended to promote development of at-risk children: child-focused programs, parent-focused programs, and two-generation programs. The research evidence examined clearly demonstrates that the most effective way of enhancing the development of at-risk children is through center-based, group programs. The research evidence shows that the development of at-risk children is not promoted by programs that are solely parent-focused or by two-generation programs. Following an executive summary, the paper's chapters are: (1) "Supporting the Development of Canada's Children; (2) "Identification of Vulnerable Children"; (3) "Targeted Child-Focused Programs"; (4) "Targeted Parent-Focused Programs"; (5) "Two-Generation Programs"; (6) "Universal Programs"; and (7) "Policy Implications." (Contains 232 references.) (HTH)

"Can You Hear Me? The Right of Young Children to Participate in Decisions Affecting Them" emphasises that participation enhances children's self-esteem and confidence, promotes their overall capacities, produces better outcomes, strengthens understanding of and commitment to democratic processes and protects children more effectively. Participation provides the opportunity for developing a sense of autonomy, independence, heightened social competence and resilience. The benefits are therefore significant, and adults with both direct and indirect responsibility for children need to acquire a greater humility in recognising that they have a great deal to learn from children. But the case for listening to young children goes beyond the beneficial outcomes. It is also a matter of social injustice and human rights. All people, however young, are entitled to be participants in their own lives, to influence what happens to them, to be involved in creating their own environments, to exercise choices and to have their views respected and valued. (Contains 4 footnotes.)

The experience of long-term poverty affects many child outcomes, in part through a family stress process in which poverty is considered to be one of the major factors causing family dysfunction, depression among caregivers and inadequate parenting. Recent scholarship extends the classical Family Stress Model by researching the ways in which neighbourhood contexts might mediate or modify these relationships. Neighbourhoods vary from the affluent to the economically deprived and since the long-term poor rarely live in well-off neighbourhoods, measures of neighbourhood disadvantage add little to family poverty in the prediction of child health and behaviour problems. But neighbourhoods also differ in the degree to which they are socially organized, cohesive and supportive to the enterprise of raising children. Sociologists refer to this as the "social capital" of neighbourhoods and propose that such social capital may ameliorate the effects of poverty and help parents raise children to achieve their full potential. This study reports the construction of measures related to social capital (Collective Efficacy and Social Support) at the neighbourhood, rather than the individual level, and the use of these along with a battery of census characteristics and other explanatory variables in the prediction of outcomes for longitudinal children aged 4 to 15 in the NLSCY [National Longitudinal Survey of Children and Youth]. The authors used statistical modeling to study the impact of higher or lower amounts of social capital in a national sample and in a smaller sample of some 200 neighbourhoods (as defined by census enumeration areas). The results support some aspects of an expanded family stress theory in that the effects of long-term poverty upon child outcomes are mediated, but also moderated by neighbourhood social capital, and by family "burnout" (dysfunction and parental depression). The study confirms previous research showing that certain parenting styles are strongly associated with children's health and behaviour problems, and that neighbourhoods account for small but significant proportions of the variation in child outcomes. An innovative result is that the degree to which long-term poverty impacts child outcomes varies according to the characteristics of neighbourhoods. The authors caution that their study cannot provide national estimates of the impact of neighbourhood social capital on child outcomes. A bibliography is included. (Contains 3 figures, 12 tables, and 30 footnotes.) [This paper is available in French under the title: "La pauvrete, le capital social, les competences parentales et les resultats des enfants au Canada."

The advent of schooling, the cash economy, and new political systems have brought about many situations providing challenges to the Samburu and the Turkana nomadic pastoralists in northern Kenya. This report details the experiences of the staff of the El-barta project in working with communities within a situation of isolation, harsh climatic conditions, and few economic resources. Chapter 1 of the paper introduces the organization and describes the scope of their work in enabling groups and individuals to take responsibility for building the capacity of their communities in order to enhance young children's development. El-barta works closely with community organizations through its six departments--health, education, food security, communications, finance, and administration--and links its interventions to the communities through three main community groups: focus groups, function committees, and opinion leaders. Chapters 2 through 5 examine different aspects of the El-barta project, showing how they are tied together in an integrated program: (1) early childhood development program, building on positive traditional child-rearing practices and facilitating the development of community day care centers; (2) health interventions, including medical care, maternal-child health, nutrition, personal hygiene, and safe home environment; (3) food security interventions, including drought preparedness, improved food practices, and income generating activities; and (4) further education interventions, including out-of-school programming and adult literacy training. Chapter 6 details some of the obstacles to program implementation and identifies potential goals for further enhancing early childhood development. The report concludes by asserting that it is critical to have an integrated program when working in a harsh environment and imperative to keep as many good traditional practices as possible for a society in transition from traditional to modern ways of life. (KB)

Over recent years, there has been an explosion in the collection of state and local level child and youth indicator data by federal statistical agencies and in the dissemination of those data through agency Web sites. This paper reviews these resources and provides information needed to access the data. Data sources are presented in five topical areas: economics and demographics (e.g., decennial Census and Census 2000 Supplementary Survey); health (vital statistics, disease surveillance systems, and health surveys); education (e.g., Common Core of Data and Schools and Staffing Survey); crime and juvenile justice (e.g., Easy Access System and Census of Juveniles in Residential Placement Databook); and child welfare (National Child Abuse and Neglect Data System and Adoption and Foster Care Analysis and Reporting System). Each section begins with an overview of what is available, including descriptions of data portholes that agencies have developed to facilitate access to data, and descriptions of individual data resources, including surveys, administrative data sets, and publications available on agency Web sites. Internet addresses to those resources are provided. Selected nonfederal sources are also briefly covered. An appendix presents a summary listing of federal Web sites containing indicator data on children and youth. (SM)

Dental disease is one of the most prevalent illnesses facing children in the United States today. Eighty percent of untreated dental disease in permanent teeth is found in roughly 25 percent of 5- to 17-year old children, most of whom come from low-income and other vulnerable populations. The State Children's Health Insurance Program (SCHIP) offers states an opportunity to expand health insurance and, by extension, financial access to dental care. This paper analyzes whether and how the coverage and delivery of dental services is changing under SCHIP, examining key differences between new separate SCHIP initiatives and traditional and expanded Medicaid programs. Data from telephone interviews and site visits with 18 states indicated that states did not focus particular attention on dental issues during SCHIP program development, though dental health coverage constituted a fundamentally important component of child health programs. All but one state elected to cover dental benefits. The extent of dental coverage under SCHIP was quite broad, although not as comprehensive as Medicaid dental coverage. Copayments on dental services were nominal in most separate SCHIP programs. Under separate SCHIP programs, some states raised dental payment levels above Medicaid's in an effort to raise dental provider participation, while other states paid about the same for dental services. In two states, early SCHIP dental program successes hastened reform efforts under Medicaid dental programs. Results suggest that improvements in access may be occurring under separate SCHIP programs that are paying dental providers at market rates when compared with Medicaid. (Contains 15 references.) (SM)

An Australian national task force examined a number of areas related to achieving educational equality for Australia's Indigenous peoples. This paper looks at health issues, particularly during ages 0-8, that may affect the educational outcomes of Aboriginal and Torres Strait Islander children. Chapter 1 discusses the importance of the early years of life in terms of brain development and future potential; the low educational attainment of Indigenous students and low Indigenous participation in early childhood services; population statistics; and the national policy context on Indigenous education, including national efforts to accelerate Indigenous progress and recommendations on interagency cooperation between the health and education sectors. Chapter 2 summarizes findings on nine health issues of concern: the lower life expectancy at birth and higher mortality rates at all ages for Indigenous Australians; low birth weight and failure to thrive; malnutrition and poor quality diet; high rates of infectious diseases and high incidence of educationally significant hearing impairment due to otitis media; social and emotional well-being; substance abuse; adolescent pregnancy; childhood trauma, including that related to family violence and child abuse; and childhood injuries. Chapter 3 describes Indigenous conceptions of health and well-being as encompassing family and community, and current initiatives that link community development and capacity building to childhood health issues. The appendix presents the Adelaide Declaration on National Goals for Schooling in the 21st Century. (Contains 43 references.) (SV)

This paper examines trends in federal spending on children, assessing changes in spending between 1960-97 and classifying federal programs within eight budget categories: tax credits and exemptions (including the Earned Income Tax Credit and dependent exemption); income security (including Aid to Families with Dependent Children); nutrition (including Food Stamps); health (including Medicaid); education; housing; social services; and training. Federal spending on children grew 246 percent, from $48.6 billion to $168.5 billion, while the number of children grew just 9.7 percent. In terms of gross domestic product, this growth in spending is just 11 percent. Federal spending on poor children increased 23-fold. Until recently, programs that put money into parents' pockets lost ground to targeted, in-kind spending. The dependent exemption declined from 65 percent of all federal spending on children to 16 percent. Three new programs account for half of the increase in total spending on children (Earned Income Credit, Medicaid, and Food Stamps). Nutrition and health programs rank third and fourth among categories of spending on children. Federal education funds shifted from targeting children of military or government personnel toward targeting disadvantaged children. Spending on children increasingly shifted from broad-based middle class relief to programs designed for the poor. (SM)

This study examined the enrollment process for the State Childrens Health Insurance Program (SCHIP) and the outcomes of that process. Data were collected during spring and summer of 2000 through telephone interviews with state program officials from eight states selected based on a variety of demographic and programmatic variables; the states were Alabama, California, Colorado, Florida, Michigan, Missouri, New York, and North Carolina. States had a difficult time producing outcome data and varied considerably in data collection and reporting practices. The major findings include the following: (1) states have implemented many similar strategies for simplifying the SCHIP enrollment process, but simplifications to Medicaid policies and procedures are less extensive; (2) inconsistencies between SCHIP and Medicaid eligibility rules and requirements made enrollment more difficult and confusing for families; (3) in most states, less than half of applicants were approved for SCHIP eligibility, with a large proportion referred to Medicaid; (4) large proportions of SCHIP applications were denied for procedural reasons; (5) SCHIP programs ask families about existing health insurance coverage as part of the application process, and deny coverage to families covered by other insurance; and (6) state SCHIP and Medicaid data systems are highly variable in their capacity to report eligibility outcome data. Implications of these findings for future policy include the need to ensure that appropriate referrals for Medicaid translate into approvals for Medicaid, to consider available alternatives for reducing the number of children denied coverage for procedural reasons or incomplete submissions, to monitor the relationships between public and private health coverage, and to improve states administrative data systems. (A discussion of the limitations of state data systems is appended. Contains 13 references.) (KB)

Under the State Childrens Health Insurance Program (SCHIP), states have the option to subsidize employer premiums for low-income workers with children. Given the potential for subsidized employer-sponsored insurance (ESI) programs to reduce the number of uninsured children, this study examined SCHIPs regulations and state experiences with premium assistance programs. In addition to a literature review, three states, Massachusetts, Mississippi, and Wisconsin, were selected for in-depth examination. Data were collected through telephone interviews with officials from each state and from the Centers for Medicare and Medicaid Services regarding the impact of SCHIP regulations, state implementation experiences, and lessons learned. Findings revealed that although state officials viewed premium assistance as a worthwhile means of expanding health coverage, the experiences of Massachusetts and Wisconsin suggest that subsidizing ESI programs is administratively complex due to federal requirements addressing concerns about crowd out--the potential that SCHIP might displace private insurance coverage. These states found that outreach efforts had to be augmented with specific efforts targeting employers. Enrollment procedures were complex, time-consuming, and challenging, especially the requirements to compare employee benefit packages to the state-selected SCHIP benchmark. Massachusetts and Wisconsin officials cautioned other states from being overly optimistic about initial enrollment, with Wisconsins enrollment currently at 47 families. Mississippi had yet to implement its program, but state officials were optimistic that it is a worthwhile strategy within the broader context of expanding health coverage. It was concluded that it is reasonable for states to question the efficiency of this strategy for reducing the number of uninsured among low-income children, given the limited target population and the small likelihood that federal regulations for premium assistance under SCHIP will be relaxed. (Contains 25 endnotes and 24 references.) (KB)

This study examined states efforts to retain children in their State Childrens Health Insurance Program (SCHIP). Data were obtained during spring and summer of 2000 through telephone interviews with state program officials from eight states selected based on a variety of demographic and programmatic variables; the states were Alabama, California, Colorado, Florida, Michigan, Missouri, New York, and North Carolina. The major findings include the following: (1) states procedures for conducting SCHIP eligibility redetermination were quite similar to one another, but had not been simplified to the same level as initial enrollment processes; (2) less than half of enrolled children retained SCHIP eligibility at redetermination; (3) high rates of parents who do not respond to renewal notices nor submit renewal applications for their children may be cause for concern; (4) denial of eligibility for failure to pay premiums did not provide information on premium affordability because the denial code reflected several possible outcomes; and (5) state SCHIP and Medicaid data systems were highly variable in their capacity to report eligibility and redetermination outcome data. Implications of findings for future policy include the need to simplify eligibility redetermination procedures, to monitor the dynamics of families with children enrolled in SCHIP, to make renewal notices more user-friendly, and to improve states administrative data systems. It was concluded that if states are to make informed improvements in their eligibility renewal policies, they need either to invest in improving administrative data systems, or to periodically conduct research to understand better what happens to children once they lose their SCHIP eligibility. (Contains 11 endnotes and 9 references.) (KB)

Immigrant status carries considerable challenges to survival and mobility in U.S. society. As an emerging dimension of social stratification, legal status influences not only immigrants but also their children. Using data collected in Houston and San Diego, this study examines the intergenerational health consequences of undocumented status for child well-being. Results support the argument that children with undocumented immigrant parents suffer higher risks of poverty and poor health than children in legal households, and children in mixed-status households are equally disadvantaged despite having a legal parent. Children in legal households are wealthier and have more food, better living quarters, and better health insurance and health status. Drawbacks to being raised in families with one or more unauthorized residents offer further evidence of a growing policy dilemma about access to health care and the general well-being of children. Addressing these needs carries particular significance for the future of a growing Chicano/a population, among whom research documents an observable health deficit. This deficit, which may also exist among other Latino groups experiencing high rates of undocumented migration and uncertain legal status outcomes, contributes to existing health disparities and racial and ethnic inequality in the United States. (Contains 62 references.) (Author/SM)

Drawing on 1998-99 survey and ethnographic data from research on the implementation and effects of welfare reform in four large cities, this paper describes the food security of mother-headed families in highly disadvantaged urban neighborhoods who had received or currently receive cash welfare benefits. The families of four groups of women were compared: those who worked and no longer received welfare; those who combined welfare and work; nonworking welfare recipients; and those who neither worked nor received welfare. Food insecurity in the prior year was high in all groups. About half the families were food insecure. There was hunger in over 15 percent of families. Nearly one-third of the families had food hardships affecting children's diets. Food insecurity was highest among families where mothers had neither employment income nor welfare benefits and lowest among families where mothers worked and no longer received welfare, though even in this group, 44.5 percent were food insecure, and 15 percent had experienced hunger. Interview data indicate that, in this population, women who are food secure expend considerable energy piecing together strategies to ensure an adequate amount of food available for themselves and their children. (Contains 58 references.) (SM)

In June 1999, Making the Grade and the National Assembly on School-Based Health Care sponsored a workshop to examine the best political and financial strategies for fostering the growth and stability of school-based health centers (SBHCs). State and local elected officials offered detailed accounts of how public support for a growing network of centers has been built in their localities. Public officials as well as private representatives from several hospital and health care systems discussed their successes and failures in designing funding strategies to sustain centers for the long term. This paper, inspired by and based in large part on the workshop proceedings, examines the political and funding strategies that have laid a foundation for continued expansion of the centers. (Author/EV)

This study estimates the effect of maternal education on birth outcomes using data from the Vital Statistics Natality files for 1970 to 1999. It also assesses the importance of four potential channels through which maternal education may improve birth outcomes: use of prenatal care, smoking behavior, marriage, and fertility. In an effort to account for unobserved characteristics of women that could induce spurious correlation, the study pursues two distinct empirical strategies. First, it constructs panel data by linking women in different years of the Vital Statistics records and examines the effects of changes in education on changes in birth outcomes. Second, it compiles a new data set on openings of two and four year colleges between 1940 and 1990. The study uses data about the availability of colleges in the woman's county in her 17th year as an instrument for maternal education. Findings using the two approaches are similar. Higher maternal education improves infant health, as measured by birthweight and gestational age. It also increases the probability that a new mother is unmarried, reduces fertility, increases use of prenatal care, and reduces smoking, suggesting that these are important pathways for the ultimate effect on health. (Contains 43 references.) (SM)

Case, Lubotsky, and Paxson (2001) show that the well-known relationship between socioeconomic status (SES) and health exists in childhood and grows more pronounced with age. However, in cross-sectional data, it is difficult to distinguish between two possible explanations. The first is that low-SES children are less able to respond to a given health shock. The second is that low-SES children experience more shocks. This study shows, using panel data on Canadian children, that: (1) the gradient researchers estimate in the cross section is very similar to that estimated previously using U.S. children; (2) both high- and low-SES children recover from past health shocks to about the same degree; and (3) the relationship between SES and health grows stronger over time mainly because low-SES children receive more negative health shocks. In addition, researchers examine the effect of health shocks on math and reading scores. They find that health shocks affect test scores and future health in very similar ways. The results suggest that public policy aimed at reducing SES-related health differentials in children should focus on reducing the incidence of health shocks as well as on reducing disparities in access to palliative care. (Contains 17 references.) (Author/SM)

Noting that North Carolina is a leader in the integration of family support into services for families with young children, this brochure provides practical information and guidelines for family supportive early care and education programs, early intervention, parenting programs, and health services for families with young children. The brochure notes that family support is a change strategy cutting across all social strata, family types, and professional disciplines. The brochure defines family support and details the mandate for such support in federal and state legislation and regulations for many child and family service programs. The benefits of family involvement are delineated for families; for providers, staff, and trainers; and for communities, programs or agencies, policymakers, and government bodies. Guidelines for supportive early childhood care and education include parents participating in decisions about their child's care and education, and programs linking families with a range of services. Guidelines for family supportive early intervention include providing a formal orientation for families and giving parents needed information for their meaningful involvement. Guidelines for supportive parenting education programs include enhancing the cultural values of parents and families, and affirming and building on parents' strengths and knowledge. Guidelines for supportive health services include using a two-generation approach and connecting parents to other parents. The brochure also notes supportive program evaluation practices, including the inclusion of program participant representatives on the evaluation team and working explicitly to overcome possible barriers. A list of organizations that have helped develop family support practice information and assessment procedures completes the brochure. (KB)

Noting that health benefits for children should be one of the principal goals of comprehensive early childhood initiatives, this Smart Start brochure provides information on "medical homes" and their importance to the overall health of children; the brochure also describes community strategies to help promote a medical home for all children. The medical home, the practice of enhancing access to a regular source of health care, with coordinated referrals to specialized care when needed, is one of three major practices considered necessary to enhance children's health. Among the benefits of a medical home are minimized delay of needed medical or dental care, and decreased visits to the emergency room. The medical home approach to care is described as accessible, family-centered, continuous, comprehensive, coordinated, compassionate, and culturally competent. Because the medical home has been formally adopted by the American Academy of Pediatrics and the Federal Maternal and Child Health Bureau, the concept is receiving greater awareness in the medical community. Progress in improving children's access to a medical home in North Carolina is being made. Local Smart Start initiatives, as are other community-based early childhood initiatives, are well-positioned to promote the medical home concept. Community efforts in promoting a medical home may use numerous strategies, among them gathering data to measure young children's access to a medical home in their community, contacting active health care providers to determine the progress of young children's access to a medical home, assisting with outreach efforts for publicly funded child health insurance programs, and assisting families in building their capacity to promote the medical home. (KB)

The Early Childhood Longitudinal Study, Birth Cohort 2000 (ECLS-B) is a study that will assess children's health status and their growth and development in domains that are critical for later school readiness and academic achievement. This paper is one of several that have been prepared in support of ECLS-B design efforts. It is anticipated that three waves of data will be collected from families of children born between January and December 2000, with supplementary data collected from child care providers. Several options remaining to be decided are addressed, including identifying the primary respondent and other respondents, the assessments to be used, and how to collect data on variables such as other children in the family. The following eight major domains have been identified for the study: (1) demographic background; (2) family organization, composition, history, and turbulence; (3) family processes; (4) child care; (5) child characteristics; (6) child outcomes; (7) early health care, feeding patterns, nutrition, and insurance; and (8) distal constructs, such as neighborhood characteristics. Each of these domains is discussed. (Contains 485 references.) (SLD)

Because financial, technical, and geographic constraints often limit the ability of health care providers to reach all children in need of care, especially in developing nations, some governments, donor agencies, and other development organizations are exploring the use of interagency collaboration to deliver health care services in schools. This paper examines the need for health and education agencies to work together to ensure that school-aged children have adequate health care. The paper identifies factors critical to the successful implementation of integrated and interagency programs, analyzes the organizational and institutional barriers to such collaborations, proposes ways to overcome such barriers, and provides a brief inventory of school-health programs undertaken in developing countries. The first part of the paper discusses the rising concern for school-aged children in developing countries regarding their health and nutrition, and the link between children's health and educational achievement. This part makes a case for interagency collaboration for school-based health programs, and examines elements of successful programs, barriers to such collaboration, and ways governments and schools can overcome the constraints. A table summarizes key strategies discussed in the section, objectives for the strategies, possible outcomes, and some implementation issues. The second part of the paper describes programs and activities targeting school-aged children, with a school-based health component, and currently in operation and involving interagency collaboration in developing nations. The following information is provided for each program: (1) project sponsor; (2) other participating organizations); (3) dates of operation; (4) interventions available; and (5) program strengths. (Contains a 39-item bibliography.) (KB)

This study examined the association between food insecurity, participation in the National School Lunch Program (NSLP), and child well-being. Participants were children age 6-12 years in families in which at least one child participated in the NSLP. Data came from the 1997 Child Development Supplement to the Panel Study of Income Dynamics. Food insecurity was measured using a scale developed by the U.S. Department of Agriculture. Child outcomes were measured in the areas of health, behavioral adjustment, and achievement. Data analysis indicated that while food insecurity itself was mostly a product of financial constraints, marginal food insecurity was possibly more attributable to a broader range of socioeconomic and cultural factors. Measures of families' economic status were highly related to children's participation in the NSLP. There was a dramatically increased likelihood of participation in the NSLP among black children. Food insecurity was associated with behavioral problems, increased odds of health limitations, and decreased math scores. After adjusting for selection, participation in the NSLP did not significantly impact child outcomes. The exception was for children in families experiencing child hunger, for whom participation was associated with reduced behavior problems. (Contains 26 references.) (SM)

Prior to the enactment of the State Children's Health Insurance Program (SCHIP), policymakers examined the need to safeguard the private insurance market from "crowd out," the substitution of public health insurance coverage for private health insurance coverage. This qualitative study examined how 18 states are addressing crowd out, the degree to which state officials perceive crowd out to be occurring, and the implications of crowd-out prevention strategies on enrollment. Data were collected through site visits and telephone interviews with a broad range of key informants in the 18 states (Alabama, California, Colorado, Connecticut, Florida, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, New Jersey, New York, North Carolina, Ohio, Pennsylvania, Texas, Washington, and Wisconsin). Findings indicate that 17 states adopted policies to address crowd out. Seven types of crowd-out strategies were identified: (1) waiting periods; (2) monitoring/application questions regarding children's health insurance status; (3) verifying insurance status against databases of private coverage; (4) cost sharing; (5) subsidizing employer-based coverage; and (6) imposing obligations on employers or insurers. SCHIP and Medicaid officials, as well as other key informants, consistently reported little to no concern over crowd out. However, the pressures to increase enrollment have begun to outweigh concerns about crowd out at the state and local levels. It was concluded that although it is difficult to predict the direction that SCHIP will take, clearly the issues surrounding crowd out will continue to influence the discussion, particularly as the program reaches higher income families. (Two appendices delineate the types of policies to deter crowd out in 50 states and the District of Columbia, and list key SCHIP and Medicaid contacts in the study states. Contains 16 references.) (KB)

To understand the impact of high poverty neighborhoods on families, researchers collected data from participants at the Boston site of the Department of Housing and Urban Development's Moving To Opportunity (MTO) program, which randomly assigned housing vouchers to applicants living in high poverty public housing projects. This allowed families to move to private apartments, typically in lower poverty neighborhoods. The qualitative fieldwork included observation of Boston's MTO and participant interviews. This work caused researchers to refocus their quantitative data collection on substantially different outcomes, primarily related to safety and health. In subsequent quantitative work, researchers found the largest program effects in the domains suggested by qualitative interviews. The qualitative work led researchers to develop an overall conceptual framework for considering the impacts of impoverished neighborhoods on families and how moves to lower poverty neighborhoods might affect them. They observed that fear of random violence caused parents in inner city neighborhoods to focus significant daily effort on keeping their children safe. Later quantitative research confirmed that the intensity of parental monitoring was reduced among families offered housing vouchers. By listening to MTO families, researchers learned lessons with important implications for housing policy. (Contains 18 references.) (SM)

With the aim of tailoring future programming decisions to local conditions and concerns, an ethnographic study was commissioned to examine childrearing practices in a small middle income village in Hebei Province, China. The research was designed to learn about the concerns and goals of child care providers, and about the strategic thinking and activities that derived from these goals and concerns. This report details the study of 10 children between the ages 1 and 3 and their caregivers, typically parents or grandparents, who were observed over a 12-month period as they went about their everyday routines. Additional information was obtained through conversations with caregivers. The research was conducted in three stages, each stage during a different agricultural season. Section 1 of the report summarizes the child care arrangements for each of the children studied, showing that arrangements varied by family, and frequently changed throughout the year to accommodate parental employment and other circumstances. Section 2 of the report describes adults' practices and expectations with respect to children's health and hygiene, the various activities comprising a child's day, what adults endeavor to teach children, and children's relationships with adults. The topics covered in this section of the report address the key areas of concern articulated by childcare providers in the course of the research: (1) child health, hygiene, and the body; (2) children's activities, including toys, books, television, drawing and writing, visiting friends, and visiting relatives; (3) purposeful teaching, including names, personal information, songs and poems, counting, and teaching styles; and (4) behavior toward adults, including obedience, addressing adults, and hosting adult guests. (KB)