EMPath’s Disrupting the Poverty Cycle Conference
Introduction
Thanks, Beth, and thanks everybody; I’m very glad to be able to participate in this important conference. I’m happy to be here both because of the significant issues you’ll be discussing and to acknowledge the extraordinary work of Beth and her colleagues at EMPath.
I first heard about EMPath’s work 3 and 1/2 years ago. I had been intrigued about the emerging findings in brain science, and how they seemed to have important implications for human services, but there were lots of questions about what those implications were. I began asking colleagues who was doing the most interesting work to apply some of the new findings, and several colleagues encouraged me to talk with and learn about what was then the Crittenden Women’s Union in Boston. So, we had initial conversations, I visited with Beth and her staff, we invited Beth to come talk with colleagues at the Administration for Children and Families, and we’ve been in pretty regular communication ever since. I think you’ll hear in my remarks a number of ways in which the conversations have affected our thinking. But, in starting, I want to emphasize our, and my appreciation for EMPath’s commitment to actively engage with families in poverty, to listen to and learn from them, to draw from the best emerging research, to recognize that it often provides guidance but only rarely provides answers, and to be committed to trying new things, to measuring progress, and to adjusting and learning along the way.
As you heard in my bio, I’ve spent my career working to address poverty in the United States. I’ve been part of the Obama Administration since 2009, and Acting Assistant Secretary at ACF for the last three years. As you may know, ACF has federal responsibility for a wide range of programs principally affecting low income and vulnerable children, families and communities, including Head Start, child care, child welfare, child support, TANF, refugee resettlement, the Unaccompanied Children program, Native American programs, domestic violence, runaway and homeless youth, the Community Services Block Grant, and more.
ACF’s Commitment to Research
Historically, ACF has had a strong commitment to research and using evidence, and we’ve deepened that commitment during this Administration. Our research agenda includes work around supporting and promoting employment for low income families; marriage and family formation; early childhood; foster care, youth development; asset development and more. One key premise for us is that employment must be central to any strategy for addressing poverty in the US. But, prior research tells us that a narrow focus on just connecting individuals with the first available job raises short term employment rates but doesn’t lead to sustained employment or long run movement into better jobs. So, while our research agenda includes more effective ways to promote job search, we’ve also advanced efforts to evaluate career pathways, sectoral employment strategies, subsidized employment, better use of labor market information, and stronger linkages between human services and workforce agencies.
And recognizing the centrality of early childhood programs and experiences, our early childhood research addresses early learning standards, improving quality in care settings, strengthening parent-child relationships, innovative interventions, and supporting parental employment through access to high quality child care.
Behavioral Science Implications for Human Services
Early on in the Administration, we began asking about the potential relevance of work in behavioral science for human services programs. This ultimately led to the BIAS project — Behavioral Interventions to Advance Self Sufficiency, which seeks to use insights from behavioral science to improve the design and implementation of human services programs. BIAS has focused on very practical questions: how do you improve responses to a notice to prevent TANF sanctions; how do you get more incarcerated non-custodial parents to seek modifications of child support orders; how do you get more families to pursue child care recertifications in a timely way. Behavioral science suggests that removing the cognitive burden of complex forms and processes can assist adults in making more-informed decisions and facilitate desired choices, and BIAS aims to reduce barriers using behaviorally-informed program designs. The first round of BIAS found positive impacts in 11 of the 15 randomized controlled trials, using behavioral “nudges” like reminders or simplified, personalized letters, and we’ve launched the BIAS Next Generation project to continue and expand this work.
ACF’s Approach to the Work: Understanding the Role of Trauma
Several years back, we reached several conclusions that have contributed in important ways to our efforts. First, there had been increasing awareness to the role of trauma affecting children in the child welfare system and often their parents and that had spurred work on how child welfare systems can be more trauma-informed. We then came to recognize that program offices were increasingly focusing on trauma across ACF --- in work involving domestic violence victims and runaway and homeless youth; refugees and unaccompanied children; Native Americans; TANF recipients, participants in fatherhood programs, and more; and this strongly suggested to us the need for elevated attention to the role and significance of trauma across human services.
ACF’s Approach to the Work: Learnings from the Toxic Stress Research
Second, like many of you, we were struck by the work around toxic stress by Jack Shonkoff and his colleagues at the Harvard Center for the Developing Child. This work tells us that when children experience strong, frequent, or prolonged adversity without adequate adult support, the prolonged stress can disrupt the development of brain architecture and other organ systems, and have lifelong negative consequences. We drew two principal conclusions: that public policy should seek to reduce the stressors that too often characterize the lives of poor children, families and communities, and at the same time, should seek to strengthen the capacities of caregivers to cope with both current stressors and the continuing effects of past ones. I want to emphasize both points, because I’m concerned that sometimes, we just focus on the part about strengthening the capacities of parents and caretakers. While that’s fundamental, it’s also true that when families live in conditions in which they’re unable to meet basic needs, are at continued risk of utility shut-offs, eviction and homelessness, and face sustained violence in their home or community, the answers can’t be just about strengthening coping skills. Rather, the combined attention to reducing stressors and strengthening skills seems key.
We understand that attention to the impacts of child poverty and to toxic stress are related but not identical. In a powerful statement of the research (PDF), the American Academy of Pediatrics has concluded that children who experience poverty, particularly during early life or for an extended period, are at risk of a host of adverse health and developmental outcomes through their life course, with impacts on birth weight, infant mortality, language development, chronic illness, environmental exposure, nutrition, and injury. Child poverty raises the risk of experiencing toxic stress and of difficulties with self-regulation and executive function. So, there’s much reason to believe that reducing the number of children living in sustained poverty would reduce risks of experiencing toxic stress, and could improve child and adult outcomes.
ACF’s Approach to the Work: Connecting Multiple Concepts
Third, we began to recognize that we were having a set of conversations, often separately, about what seemed to be a closely related set of issues, including the work relating to trauma, stress, adverse childhood experiences, executive function, self-regulation, non-cognitive skills, resilience, strengths and risk factors, the research about scarcity, the 30 million word gap, parenting, our behavioral science work, and the emerging interest in two generational efforts. That spurred us to begin to ask how these related to each other, is there a common core, and what should be the implications for research and practice in human services programs.
Contextualizing the Work
So, in the next few minutes, I’ll say more about the directions we’ve been pursuing, and some implications for human services. But, I want to emphasize two points before doing so.
First, much of the research is research in progress. We’ll know more in a year, and in five years, and in ten. But, that’s always true, and an overall challenge for our work is that at any given point, the research only answers a small fraction of the questions that programs and practitioners face each day. I think that necessarily means that being evidence-based means being committed to using the best available research and to building the research base, while also recognizing that a large share of the status quo isn’t evidence-based, and that the need for more and better research should never prevent us from trying new things and innovating.
Second, I want to be clear that this body of work and its potential implications for improving the effectiveness of human services programs does not purport to be an analysis of why the United States has sustained persistent high levels of poverty and inequality. Structural factors in our economy and public policy, not deficiencies in executive functioning or the impacts of trauma, are central in understanding why the United States has a child poverty rate exceeding virtually all other developed nations, and how the severity of inequality constrains opportunity and mobility in the United States.
I do think the work I’ll be discussing holds enormous promise for improving our effectiveness in helping parents succeed in employment and improving family functioning and child outcomes. But, it’s no substitute for the broader set of issues about the need for a full employment economy; raising the quality of jobs and supports for work; shrinking the racial wealth gap and addressing other racial disparities; universal access to child care and early education; health care for all; immigration reform; decarceration; a fairer tax code and other key efforts that I’m not covering today.
With these caveats, let me highlight a set of initiatives we’re engaged in and talk about their broader implications.
ACF’s Efforts to Address Self-Regulation
First, we’ve commissioned a set of four reports to describe key research relating to self-regulation and its relevance to human services. These reports lay out an applied framework for self-regulation development, describe how toxic stress can affect the development of self-regulation, and identify a variety of interventions that result in meaningful positive effects on cognitive, emotional, and behavioral self-regulation as well as broader outcomes like mental health and academic achievement. A forthcoming report seeks to identify practical implications. This series, along with shorter practice-focused briefs, seek to help practitioners and others understand what self-regulation is, how it connects to what they already know and are doing, and how they might enhance current practices.
ACF’s Efforts to Better Understand and Mitigate Toxic Stress and Trauma
Second, we’ve funded six grantees in a Buffering Toxic Stress Consortium, to test promising parenting interventions in Early Head Start settings seeking to reduce the risk of toxic stress among children. The interventions differ in emphasis, style, and training requirements. Some rely on using videotaped interactions to provide coaching and feedback to parents, some are implemented by home visiting staff and others are implemented by outside master-level consultants. Most are implemented at home with individual families, but one is implemented with groups of families at the Early Head Start site. The Consortium and our staff have identified common measures at baseline and for measuring impacts. I’ve visited a number of the sites, and have seen and heard their excitement; if we do see impacts, this will have significant implications for Early Head Start and other early childhood programs. Along with these efforts, Head Start has developed and implemented training on trauma, toxic stress and resiliency. In child welfare, we’ve funded three cohorts of demonstration grants which focus on integrating trauma-informed and trauma-focused practice in child protective service delivery; improving access to needs-driven, evidence-based and evidence-informed mental and behavioral health services in child welfare and; promoting well-being and adoption after trauma. Our Runaway and Homeless Youth program has provided extensive technical to its grantees on trauma and implementing a trauma-informed culture. We are the primary funder for the National Center on Domestic Violence, Trauma & Mental Health, which offers resources, training, and technical assistance related to the intersection of trauma, domestic violence, mental health, and substance abuse for domestic violence programs. We’ve worked with HHS colleagues to support States in developing sustainable funding strategies for services to children who have experienced trauma. And, we’re working closely with HHS colleagues to develop a toolkit on trauma-informed approaches in human services, which we plan to release later this year. We hope it’ll provide practical guidance across multiple settings.
ACF’s Efforts to Better Understand and Encourage Two-Generation Approaches
In another demonstration effort, four grantees in our Head Start University Partnership Grants for Dual-Generation Approaches, are targeting a range of adult outcomes, including education and career advancement, employment and financial security, self-regulation, and mental health. One is enrolling Head Start parents in education activities, such as English language classes that are aligned with their preschool children’s education. Another is implementing a depression intervention for mothers of children participating in Head Start. One is implementing a social-emotional development curriculum for Head Start children in conjunction with an aligned coping strategies intervention for their parents. A fourth is testing an intervention aimed at improving brain function for attention, cognition, and behavior in Head Start children, as well as improving communication skills and reducing stress in parents. Again, we’ll eventually have experimental findings that will help us better understand the effectiveness of this range of approaches and implications for Head Start programs.
Like many of you, ACF has been actively supporting two-generation strategies. We’ve done so because it seems fundamental that we cannot get good outcomes for children without recognizing that children grow up in families, that strong and supportive families will promote better outcomes, and that when family life is disrupted, chaotic, or worse, it is far more difficult to get good outcomes for children. And, in efforts to work with adults, particularly to promote success in employment, it’s essential that strategies are mindful of the roles, responsibilities, and challenges faced when workers are also parents. To promote two-generational strategies, we’ve put out guidance to TANF agencies and community services block grant grantees, we’ve written to all human services commissioners, our regional offices are actively communicating with states and other grantees, and we’re supporting a ten site demonstration project, Rural IMPACT, that focuses on two-generational efforts to address rural child poverty.
We’re mindful, though, that there’s a limited research base, and many questions about what to do and how to do it. So, we launched the Two-Generation Approaches to Improving Family Self-Sufficiency project. Based on field work, stakeholder engagement, and a literature review, the final report will describe program models, assess how well-defined the models are, whether they can be evaluated, potential research questions and potential evaluation designs.
ACF’s Efforts to Better Understand and Support Executive Functioning skills, Cognitive Resources and Coaching Models
Like many of you, we are intrigued by the hypothesis that strengthening executive function skills could contribute to both better success in the workforce and improved parenting skills. Several states are pursuing work along these lines in our Systems to Family Stability Policy Academy for TANF programs. We’re helping and encouraging this work, but we also appreciate there are questions about how to define executive function, how to measure it, how to measure improvements, do improvements in research settings translate to improvements in daily performance, and how do we determine if measured improvements contribute to success in employment, parenting, or both. We’ve initiated the Goal-Oriented Adult Learning in Self-Sufficiency (GOALS) project to explore how emerging insights from psychology on self-regulation, executive functioning, and related cognitive and emotional skills can inform adult workforce development programs. The project will synthesize existing research and is engaged in field work to learn from promising programs integrating brain science-informed frameworks.
We also recognize that environments play an important role in our ability to set and achieve goals. One of the key premises guiding BIAS is that getting better results can’t just be about trying to strengthen participant skills. It also must involve efforts to understand and address unproductive cognitive burdens that programs inadvertently place on clients and that’s a strong focus of our next set of BIAS efforts. We also want to better understand the role of physical environment and underlying office culture shape. To address this, we recently launched the Understanding Poverty: Childhood and Family Experiences and TANF Office Culture. One part of this project will explore how organizational culture, office design, and office procedures contribute to shaping clients’ experiences with TANF, the services provided to them, and potentially their outcomes.
Both the GOALS and BIAS projects recognize that individuals have finite cognitive capacity to cope with the stresses of poverty, trauma, and the day-to-day problems around economic security, all of which consume cognitive resources. Coaching-based interventions and motivational interviewing have been proposed as a way by which case managers can facilitate goal achievement and help individuals overcome traditional barriers to employment. More broadly, in multiple areas of human services and employment program efforts and work around financial capability, we’re seeing what is sometimes being described as a paradigm shift from case management to coaching, guided by the premise that a coaching model better reflects how adults learn and progress.
This fall, we launched an Evaluation of Coaching-Focused Interventions for Hard-to-Employ TANF clients and Other Low-Income Populations to rigorously test employment and life skills coaching interventions targeting hard-to-serve adults. And, we recently launched a Study of Coaching Practices in Early Care and Education Settings to explore how coaching practices are implemented and vary in early care and education (ECE) classrooms serving children supported by Child Care and Development Fund (CCDF) subsidies or Head Start grants.
ACF’s Efforts to Address Implicit Bias
We’re also strengthening our attention to implicit bias. Research shows we all have implicit biases which are pervasive and are engrained from early ages. Research by the Yale Child Study Center (PDF) finds that many preschool teachers’ implicit biases can impact their expectations for and punishment of disruptive student behavior. Together with HHS colleagues, we’ve launched a National Center of Excellence in Infant and Early Childhood Mental Health Consultation. This new TA center has developed a toolkit to support states and tribal communities in building new mental health consultation systems. The toolkit explicitly states that implicit bias should be included in the competencies of mental health consultants. We want to ensure that consultants have the resources and training they need to identify their own implicit biases and work with administrators and other staff to address implicit biases in the classroom, particularly as they relate to adult-child interactions and exclusionary discipline. Going forward, we believe there could be broader implications across human services delivery.
Implications for ACF’s Workforce
Finally, I want to flag one more thing we’re taking on in our own internal training. During my time as Acting Assistant Secretary, I’ve spent a lot of time working on issues relating to productivity, satisfaction, retention and promoting voice and engagement for our own workforce. Among other things, this led me to ask how much of the work I’ve been talking about has relevance not just to service delivery but also to the operation of human services agencies, and perhaps other parts of government. Wouldn’t we all benefit from being more goal-directed, from having greater voice in articulating what we want to accomplish and more purposively mapping out plans to get there? Might the workplace function better if we all had stronger self-regulation skills? Might supervisors be more effective with greater understanding of principles of coaching and motivational interviewing?
We’re taking a first set of steps to find out. At ACF, we’re planning to enhance our overall staff training with what we’re calling ACF University, in which we will focus on what are the core things that all ACF employees should benefit from knowing more about --- that includes a deeper understanding of poverty, and family structure, and early childhood and human development, and the roles of trauma and stress. We’re also planning to offer, on a voluntary basis, staff training in strengthening executive function skills. Our premise is that it’ll help for participating staff to better understand what’s involved in the executive functioning work, to appreciate this isn’t just about poor people, and we’ll gain further insight into its effectiveness.
Key Principles for Human Services Delivery
So, having laid out a number of things that we’re doing, I want to close by suggesting that while we’ve got a lot of ongoing research, it’s also time for us to work together to best articulate the principles that seem broadly applicable to human services delivery. We should do this with a recognition that we’ll have a more refined version in five years, or maybe next year. But I do think the work suggests a set of overarching principles to better incorporate into our work. Among them — that because persistent childhood poverty hurts children's development, helping families move out of poverty needs to be a central focus of our efforts; that human services programs need to be trauma-informed, but with the recognition that trauma will be central in the experiences of some but not all individuals and families seeking services; that we need to structure programs and policies so that they reduce, not add to the stressors facing needy families; that we need to better apply what we know about how adults learn and progress, and apply this not just in education and training programs, but across human services programs; that program designs and demands should be structured to avoid increasing the burdens on cognition and self-regulation; and that whole family approaches have the potential to improve both adult and child impacts, both because they’re more responsive to the factors motivating adults, and because of the close connections between strengthening adult capacities and promoting child outcomes.
Conclusion
To close, I want to return to a point I made earlier in the talk. The research provides important guidance, but doesn’t really give us answers; we’ll know more later, but that’s always true. So, I think the challenge for all of us now is to ask ourselves what the research suggests is potentially promising; to be willing to test and innovate; to integrate evaluation in pilot programs where possible so that we can obtain real-time feedback; and to recognize that the potentials for brain-science informed human services can make an important contribution to the efforts to reduce the extent, severity and consequences of poverty in the United States.
Thanks, all, and I very much look forward to our continuing to learn from each other.