Positive Outcomes for At-Risk Children and Youth: Improving Lives through Practice and System Reform

Georgetown Public Policy Institute LEAD (Leadership, Evidence, Analysis, Debate) Conference
January 25, 2013
Deputy Assistant Secretary for Policy Mark Greenberg


Thanks very much, I greatly appreciate having the opportunity to join in this morning and, to talk about our work in the Administration for Children and Families and our contributions to the Administration’s efforts to promote positive outcomes for children and youth.

ACF is the part of HHS with responsibility at the federal level for a broad range of programs affecting low income individuals, families, and communities. Within our jurisdiction are Head Start, child care, child welfare and adoption assistance, child support, Temporary Assistance for Needy Families, and a number of other important programs. In almost all instances, the programs themselves are administered through States, Tribes, or other grantees; we have responsibilities to ensure that grantees comply with federal law; and, we seek to use our research, discretionary grants, and technical assistance efforts to advance the goals of the underlying laws.

In this Administration, ACF has been guided by a set of priority goals: to reduce child poverty and advance family economic security; to ensure child safety and well-being; to support child and adolescent development; to support vulnerable populations; and to upgrade ACF’s organizational capacity for families and communities and ensure program integrity. Our efforts are in support of a vision where all of America’s children, youth, families, individuals and communities are resilient, safe, healthy, and economically secure. And, we are guided by the President’s goal that a little girl – or boy who is born into the bleakest poverty should know that they have the same chance to succeed as anybody else.

We recognize that promoting the best outcomes for children necessitates addressing children’s needs throughout the life cycle. Moreover, recognizing that childrens’ success in life is shaped by their experiences in the home and in the community, an overall strategy must seek to ensure that children benefit from the financial and emotional support of both of their parents and grow up in healthy communities.

Our work is guided by a commitment to collaboration, integration, interoperability, and close coordination with other federal agencies. And, the Administration’s broad cross-program commitment to evidence-based policy guides our budget process, our approach to technical assistance, discretionary grantmaking and evaluation.
In the next few minutes, I want to highlight a set of areas in which our vision and commitment to evidence-based policy making is reflected. Necessarily, I’ll only touch on part of our efforts, and even for that part, I’ll just briefly highlight a range of areas and initiatives.

First, a robust body of research demonstrates that high-quality early learning and development programs and services improve young children’s health, social-emotional and cognitive outcomes, and school readiness. Young children with access to these high quality settings are more likely to enter kindergarten with the skills, knowledge, and dispositions they need to be successful. Yet, too many low income children do not have access to a high quality early learning program, either because the program is unavailable or unaffordable or because they are in a setting that is of mediocre quality or worse.

Improving access to high quality early learning settings is a key element of the Administration’s education agenda. And, whether a child is in child care or Head Start, children should have opportunities to be in engaging classrooms where program activities are not only fun and developmentally appropriate, but also promote increased vocabulary, early literacy, early math, problem solving, and healthy social interaction skills.

This Administration has had historically unprecedented coordination between Head Start and child care around training, technical assistance, professional development, health and safety, program integrity issues, and more. We’ve strengthened technical assistance to bring current research and the best available evidence-based strategies for early child development and education into the classroom. For the first time in program history, we’re requiring Head Start grantees that fall short on quality benchmarks compete for continued funding. We seek to improve child care quality within a framework of improved health and safety standards and monitoring, strong quality improvement systems, professional development and career advancement for the child care workforce; continuity of care for children; ensuring program integrity; and effective coordination.

Our early education work is done in close coordination with the Department of Education, including partnering to fund a Race to the Top – Early Learning Challenge grant competition. Fourteen states have received grants to support their efforts to increase the proportion of disadvantaged children enrolled in high-quality early learning programs, and to build comprehensive and integrated systems of services.

In our efforts, we seek to better understand and address the role that severe stress plays in the lives of young children. Researchers have found that “toxic stress”, intense adverse experiences sustained over a long period, can have detrimental effects on neurobiological development, which may account for a significant part of the gap in school performance between poor children and their more advantaged peers. Ultimately, strategies to reduce and prevent toxic stress must focus both on addressing the stressors that too often pervade the lives of poor children in poor communities, and efforts to help parents strengthen their parenting and become effective mediators in reducing the sustained impacts of stress. In 2011, we awarded six cooperative agreements for Early Head Start University Partnership Grants that seek to implement promising parenting interventions in Early Head Start settings to improve “toxic stress-related” outcomes for vulnerable infants and toddlers.

Ensuring child safety and well-being, one of our priority goals, is also addressed in the child welfare system. In the last fourteen years, the number of children in foster care has declined by over 25 percent. But, the children who remain in care face significant challenges stemming from the experience of maltreatment, and they typically have poor outcomes in the short and long terms, in the areas of health, mental health, relationships, education, and employment.

While the child welfare system has gotten better at ensuring safety and permanency, we believe states can and should do more to help children heal and recover from the trauma of abuse and neglect. The first step is getting better at identifying mental health or trauma-related symptoms, through valid and reliable screening, assessment, and ongoing monitoring. The second step is connecting children and youth with interventions to effectively address the effects of maltreatment and build the skills and capacities that are needed to overcome trauma, and we are working to help the field build the capacity to deliver evidence-based interventions with fidelity. Involving families - birth, foster, kin, or adoptive - in promoting social and emotional well-being is critical, and most evidence-based interventions that improve outcomes for children have a strong caregiver involvement component.

We are committing grant funding to projects including ones to support cross-sector collaboration to serve high-need families involved with child welfare and at risk of homelessness; to help child welfare systems assemble evidence-based interventions matched to the needs of their populations; to support collaborative initiatives between child welfare and education systems to reduce barriers to school success; and to incorporate an emphasis on children’s social and emotional well-being in substance abuse treatment programs for caregivers.
This work reinforces the directions of recent legislation. The 2011 Child and Family Services Improvement and Innovation Act requires States to describe how they will monitor and treat emotional trauma associated with child maltreatment and removal from home and describe their activities to address developmental needs of children under 5. And, the law directs states to develop protocols that ensure the appropriate use and monitoring of psychotropic medications. The Administration has placed a major emphasis on providing technical assistance and guidance to States as they look at and strengthen their practices relating to use and monitoring of psychotropic drugs for children in foster care.
The 2011 legislation also authorized HHS to grant up to 10 Title IV-E child welfare waivers a year over three years for state child welfare reform and improvement efforts. We’ve granted the first nine of those waivers, and nearly all of them expressly seek to address trauma and measurably improve child well-being. Many are focused on better screening, assessment, and trauma-informed treatment for children in or at risk of entering foster care.

In addition, the Fostering Connections to Success and Increasing Adoptions Act of 2008 included a focus on increasing supports and services to older youth aging out of foster care
because we know they have a unique set of challenges that systems need to build their capacity to address more effectively. And, we’re working with other federal agencies in a systematic effort to identify barriers and challenges under federal law to more effective strategies for addressing successful transitions to adulthood for disconnected youth.

Our commitment to evidence-based programming characterizes other work that I can only brief touch on this talk. In the areas of both home visiting and teen pregnancy prevention, new funding provided in the Affordable Care Act was tied to a requirement that most of the funds support replication of programs that have shown positive impacts through rigorous studies, identified by cyclical reviews of the evidence base, while still allowing a portion of the funding for innovation. Rigorous evaluations of the replicated and innovative programs are being conducted.

In any effort to improve outcomes for children, work to help promote economic stability for families and the healthy engagement of parents in the lives of their children is crucial. We have launched a major experimental evaluation of career pathways strategies to help less-skilled adults move to family-supporting employment; we are implementing and evaluating Health Professions Opportunity Grants to spur sector-based strategies to help TANF recipients and other low income adults attain good jobs in health care; we have initiated evaluations of subsidized employment efforts, building off the success of TANF agencies during the Recovery Act when they created the largest subsidized employment effort in the United States since the 1970s; and we are initiating new research to learn about the most effective job search strategies.

We recognize that children who don’t live with their biological parents are, on average, at greater risk of living in poverty and experiencing health, academic, and behavioral problems than are children raised by their married biological parents. Each year, Congress provides $150 million for funding programs and research relating to promoting healthy marriages and responsible fatherhood. These programs give parents training and support along with practical coping skills. To date, research has indicated that providing relationship skills training and case management for unmarried couples has had disappointing impact --- across eight sites, we found essentially no impacts three years after enrollment. For married couples, we have found small positive impacts at the twelve month point, but it’s too soon to tell if there will be sustained long term impacts that translate in ways that affect child well-being. Based on the research to date, we have encouraged grantees to develop more comprehensive approaches, including attention to economic stability. And, we are conducting a new round of evaluations, including responsible fatherhood grants that expressly focus on services to noncustodial parents returning from prison.

We have also worked to bring about an evolution in the child support program from a narrow focus on enforcement and collection to a program guided by the principle that children need the financial and emotional support of both parents, and grounded in the recognition that not all fathers have the means to make significant child support payments. Across the country, local child support offices are partnering with fatherhood programs, workforce programs and community colleges, going into prisons to reduce orders, and working with returning veterans. And, last year, we awarded five grants to child support agencies for parenting time strategies and eight grants to child support agencies for programs that provide employment services to noncustodial parents.

I’ve only had time to touch on some of our initiatives, and I’ll look forward to further exchange later in the panel. I’ll close by emphasizing our commitment to promoting the best outcomes for children, to implementing evidence-based and evidence-informed programs where possible, and to continous efforts to build evidence for the future.

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