Jonathan Wallace

December 1, 2008

Welcome to The Future of Children blog. In these blog posts, we highlight findings from our various volumes – making an effort to tie the research and policy recommendations to current affairs.

Please contribute your thoughts. We look forward to an interesting dialogue about the future of children and the various ways we can make that future promising and worthwhile.

Jonathan Wallace, Managing Editor

Child and Public Health in a Libertarian Legal Framework

Earlier this year the West Coast saw a measles outbreak, another recurrence in a string of previously eradicated childhood illnesses. Stories of parents’ various objections to vaccination quickly flooded the news, underscoring the main question: who is responsible for these public health crises, families or the state? While some people may have been surprised or confused to see such illnesses return, Clare Huntington and Elizabeth Scott’s explanation of children’s health in a legal framework for The Future of Children provides valuable context.

The U.S. legal system, say Huntington and Scott, “gives parents the authority and responsibility to make decisions about their children’s health care, and favors parental rights over society’s collective responsibility to provide for children’s welfare” or, in the case of vaccination, overall public health. They call this a libertarian legal framework as a way to describe the legal context in which parents are permitted to make their own decisions about child health. There are exceptions, such as when a child’s life is in danger or when a child is in juvenile justice custody; however, since parental rights are constitutionally protected, a high standard of harm must be met before intervention can occur.

In public health cases such as vaccination, where can the line of “harm” be drawn? Currently, all healthy children are required to receive vaccinations in order to attend school. However, almost all states offer exemptions for religious beliefs and many also offer them for other philosophical convictions. The balance between the libertarian argument and public health theoretically rests on the understanding that those with strong beliefs both deserve their right to decide and are a small enough segment of the population that the overall public interest of immunity is still met. However the return of some childhood illnesses shows that this balance is no longer being maintained.

Now many states are tightening their exemption policies. For example, California (origin of the measles outbreak) is on the verge of eliminating philosophical exemptions. For some states, making these adjustments may be more difficult. As Huntingdon and Scott put it, “without an affirmative legal obligation to promote children’s [or public] health, governmental investment is optional.” In this context, public health policy is often reactive rather than proactive or preventative.

Recent shifts in both cultural and legal views of vaccination deliver an immediate and crucial example of the libertarian legal context for child health policy and its limits. To read further on current issues in children’s health, see our latest issue of The Future of Children, Policies to Promote Child Health.”

Defragmenting Child Mental Health

If you’re ready for a crash course in mental health, read Alison Cuellar’s article in the new volume of Future of Children Policies to Promote Child Health.” She introduces us to internalizing and externalizing conditions that children experience, as well as the trajectories and outcomes that can accompany them. She also describes prevention programs, and interventions from academic, juvenile justice, and medical and social service angles.

Unfortunately, well intended programs and interventions often come with an unintended consequence. Cuellar argues that due, in part, to differing funding structures of schools, health care providers, and juvenile justice programs, there is an inherent lack of integration among treatment providers; thus, children sometimes fall through the cracks. For example, health insurance might not pay for anything beyond direct professional services provided to a child; whereas parent education or family treatment might be necessary but not be covered. Another example would be programs funded by the Substance Abuse and Mental Health Services Administration—while there might be more flexible funding available for intervention and prevention initiatives through this funder than health insurance, funding is limited to particular communities and settings; thus excluding children not found in these areas.

I’ll be frank in saying that there isn’t an easy method to defragment a complicated system of service delivery. Cuellar concludes that we need to identify ways to overcome fragmentation between services. Volume editors Currie and Reichman call on governments to follow the lead of businesses and make use of the vast amount of data available to them to “create an integrated portrait of child health or to target policies to those who have the most to gain from them.”

In a blog post last year, I wrote about how the Affordable Care Act was a step in the right direction to allow for a more integrated health care system and that there were existing initiatives, such as the patient-centered medical home model, that encourage coordination among providers. Perhaps future policies and practices will encourage coordination among mental health services, thereby improving child mental health.

Evidence for Supporting Military Families

Following our discussion of the evidence-based movement, I would like to highlight the recent work of Future of Children contributor Col. Stephen Cozza (U.S. Army, retired) and the National Military Family Bereavement Study. In a recent interview, Cozza, who is a professor of psychiatry and associate director of the Center for the Study of Traumatic Stress at the Uniformed Services University of the Health Sciences, explained that the study aims to guide policy by creating a greater base of empirical data on how immediate family members are affected when a service member passes away.

In the interview, Cozza argued that basing policy on research is important for these families, whose needs vary based on relationship to the deceased, the type of death, geographic location, and other factors. By gathering data on these scenarios, Cozza hopes to better advise policy makers on how to help these families.

Even before the study began, Cozza established the importance of this research in his Future of Children article with Allison Holmes and Paula Rauch. A parent’s death in combat not only brings immediate grief, it can also mean that survivors lose their identity within the military community, especially if they have been living on base and need to leave. Additionally, sudden, violent deaths—such as suicides, accidents, and combat-related deaths—are more common among service members than in the general population, and such deaths have been shown to bring a greater risk of PTSD and other emotional issues for surviving loved ones.

Another Future of Children article suggested building communities of care for military families and pointed to a need for further research on how to best do so. In the article, communities of care are defined as complex systems that work across individual, parent/child, family, community, military, and national levels of organization to promote the health and development of military children and families. The authors highlighted the tensions that exist in creating these interdisciplinary care communities. When we attempt to create collaborative communities of care and run into conflicts between the training of clinicians and public health professionals, research evidence could create an objective common ground on which to base programs and policy. Cozza’s National Military Family Bereavement Study is an example of the evidence-based movement in action.

For more Future of Children articles on military families, see our Fall 2013 issue, Military Children and Families. For more on the evidence-based movement, check out this interview with Future of Children senior editor Ron Haskins.

The Evidence-Based Movement

“Despite decades of efforts and trillions of dollars in spending, rigorous evaluations typically find that around 75 percent of programs or practices that are intended to help people do better at school or at work have little or no effect,” says Future of Children senior editor Ron Haskins in a recent New York Times op-ed related to his new book.

Haskins isn’t arguing for massive budget cuts for federally funded social programs—instead, he’s hoping the new Congress won’t cut funding for evaluation research, which is a relatively new federal initiative. Evaluation research helps us know which programs work and don’t work; then we can expand what works and modify or eliminate what doesn’t work. Haskins concludes his op-ed by affirming that “social policy is too important to be left to guesswork.”

Research is one of the best tools to inform policy decisions because it’s more objective than political ideology. A lot is at stake when deciding which programs will be used to tackle social problems. This is especially true when considering child-related issues because what happens to people as children is likely to have lifelong effects. Regardless of what Congress decides to do, the Future of Children can be used as a nonpartisan resource to promote effective policies and programs for children and families based on the best available research.

For instance, when addressing childhood disability, begin with our volume “Children with Disabilities.” You’ll learn about the importance of policy measures that increase coordination between different types of services. Additionally, you’ll see how technology can improve outcomes but can also expand disparities unless access is provided equitably.

If you’re interested a multigenerational approach, read our volume “Helping Parents, Helping Children: Two Generation Mechanisms.” You’ll learn about what the most promising programs are doing for families. For example, you can read about how preschool and home-visiting programs can alleviate children’s stress, how increasing parent’s education levels can strengthen children’s healthy development, how improving parent’s health can improve children’s health, how carefully timed income support can promote children’s healthy development, and how helping poor families build assets can help children succeed.

For those interested in improving the literacy of young Americans, see “Literacy Challenges for the Twenty-First Century.” You’ll read of the breadth and complexity of literacy challenges, but also find policy implications such as the need to focus more attention on informational text and analytical writing in K-12 education, as well as arguments to increase access to strong preschool programs for children from low-income and non-English-speaking families.

Whatever your political persuasion, the best research can bring people together to solve social problems. Whenever possible, let’s leave guesswork behind and follow the evidence. To read our research publications, visit futureofchildren.org.

Childhood Food Insecurity: Especially Vulnerable Populations

If you’ve read our recent posts, you now know that a number of factors besides household income influence childhood food insecurity, including caretakers’ mental and physical health, parents’ marital status, and childcare arrangements. However, even when these factors are taken into account, children of immigrant parents and children of incarcerated parents remain especially at risk for childhood food insecurity, according to the Future of Children‘s Fall 2014 research report.

For example, writes John Cook, after controlling for other risk factors, “children of foreign-born mothers were three times as likely to experience very low food security as were children of U.S.-born mothers.” And a study by Kelly Balistreri found that 40 percent of children experiencing very low food security are children of immigrants, even though they constitute less than 25 percent of all children in the US.

When children have one or more parents incarcerated, this factor also decreases food security, however the reasons for the effect of incarceration are unclear. The research report highlights several theoretical explanations, but none have been thoroughly investigated. For example, incarcerating a parent might theoretically improve a household’s food security because of decreased demands on resources or by removing a negative influence in the household. On the other hand, incarceration might reduce food security because that parent’s financial, child care, and other contributions are removed. Given these conflicting theories, you might think that other factors correlated with incarceration, such as drug use or mental illness (which I discussed in a previous blog), are causing the effects we see. However, Wallace and Cox found that children with an incarcerated parent are more likely to be food insecure even after controlling for correlated factors.

We need to better understand exactly how these populations are affected, but it’s clear from the research report that children of immigrant or incarcerated parents may need additional support to obtain stable nutrition. Given that these are often two difficult-to-reach populations, policy makers should consider how to best serve these children within existing programs or with new possibilities. For more information about these vulnerable populations, see the Future of Children‘s Fall 2014 research report. For more about children of immigrants in the U.S., see Volume 21 on Immigrant Children.

Food Insecurity and Marital Status

So far, in our blog series on the Gunderson and Ziliak Future of Children research report, we’ve outlined how 1 in 5 children in America are food insecure and how there are more reasons for this besides low household income. For example, caregivers’ mental and physical health, as well as child care arrangements, are contributing factors. Another piece of the puzzle is family structure.

I’ll start with some basic statistics. This table from childstats.gov shows the differences in the percentage of food-insecure households with children by family structure in 2011. Without taking any other contributing factors into account, female-headed households with no spouse present are more than twice as likely to be food-insecure than households headed by married couples (40 vs. 15 percent). Households headed by a father with no spouse present have a 28% prevalence of food insecurity, in between married couples and single mothers.

These differences aren’t surprising. But there’s more to the story.

Gunderson and Ziliak summarize several studies that give us clues about how marital status is related to food insecurity. For example, Balistreri found that children living with a single parent or with an unmarried parent in a more complex family (such as when the mother is cohabiting with a partner and there’s also a grandparent in the household) are at greater risk of food insecurity than children living with two biological parents or in a stepfamily. Also, Neeraj Kaushal and colleagues found that children living with their biological parents, whether married or cohabiting, have a lower risk of food insecurity. In contrast, Miller and colleagues found no substantive differences across family types after controlling for socioeconomic status and demographic characteristics. Regarding unmarried families, Nepomnyaschy and colleagues have shown that nonresident fathers’ consistent support, whether in cash or in kind, is associated with lower food insecurity; interestingly, inconsistent support was worse than no support at all.

Based on these findings, it’s important not to jump to conclusions about marital status and food insecurity. While married-couple households seem to be at least risk, this doesn’t mean a marriage certificate solves food insecurity, and that we should rush people into marriage. Family complexity, socioeconomic status, and nonresident fathers’ support also play a contributing role.

The Fragile Families Study and the work of Sara McLanahan, editor-in-chief of the Future of Children offer potential policy implications. In a recent article about unmarried parents, McLanahan and Jencks concluded that to prevent the negative outcomes associated with having children outside of marriage, women with lower socioeconomic status can be encouraged to postpone having children, giving them time to mature and increase their education and earnings. By extension, since women aren’t likely to marry men with poor earning capacity, men need to increase their capacity to provide for a family. Initiatives such as the promotion of effective birth control and education access seem promising. For currently unmarried families, Nepomnyaschy’s article underscores the importance of consistent child support in reducing the risk of childhood food insecurity.

Food insecurity and child care for low-income families

So far, we’ve written several blogs about how characteristics of children’s parents can influence food security. As the authors of our Fall 2014 research report remind us, however, three-quarters of children spend some portion of their preschool years in the care of people other than their parents, so we need to look at how child-care arrangements may also influence food insecurity among children. This is especially important given that children in center-based care may receive a majority of their nutritional needs at their center rather than in the home.

The research report highlights a study by Heflin, Arteaga, and Gable that compared child care by parents to child care by someone else, among low-income families. Specifically, they examined five types of child-care arrangements: child-care by parents, by a relative, by someone unrelated to the child in a home care setting, in a child-care center, and in Head Start. They found that compared with children cared for exclusively by their parents, low-income preschoolers attending a child-care center had lower levels of both food insecurity in general and of very low food security. Children cared for by a relative were less likely to experience food insecurity in general but equally likely to experience very low food security and children cared for by an unrelated adult were more likely to experience very low food security.

The finding that low-income preschoolers attending child-care centers had lower levels of food insecurity and very low food security compared to those cared for by their parents has several theoretical explanations. First, parents of these children may be better able to work while their children attend the center, which increases household income. Second, these children may receive some of their nutritional needs directly through the child-care center.

While school-based nutrition programs have proven to help alleviate food insecurity for some children, this research reminds us that preschool children must also be considered in policy discussions. Improving access to child-care services for low-income parents of preschool children may improve food security within this age group.

Rising from a Culture of Violence to a Culture of Health

Sara McLanahan, Editor-in-Chief of Future of Children, along with several colleagues, recently prepared a policy report published by the Robert Wood Johnson Foundation (RWJF) that describes children’s exposure to violence in the Fragile Families Study (see the Future of Children Fall 2010 volume to learn more about Fragile Families). The report examines neighborhood violence, intimate partner violence, and harsh parenting, and finds that these types of violence are endemic and interrelated. An implication of these findings is that we need to tackle all these kinds of violence simultaneously, rather than in isolation. The authors point out, for instance, that reducing harsh parenting practices of mothers who experience domestic violence and are worried about their child’s safety won’t be as effective as reducing harsh parenting while also taking on the other problems.

What’s preventing us from achieving this vision?

Part of the problem, as the policy report points out, is that our efforts to combat violence could be more holistic. In other words, there might be a number of specialized programs working on different types of violence within the same community, and yet there can be a disconnect in communication and coordination between these well-meaning efforts. This disconnect warrants consideration.

To gather ideas from stakeholders on how to “break down the silos” between specialized efforts, RWJF has provided a discussion forum led by Senior Program Officer Martha Davis, along with a dialogue on RWJF’s LinkedIn Leadership Network. In the discussion threads, a common theme I noticed from several community leaders was that we should use common needs as a way to build relationships that cross program boundaries. The proposition that all stakeholders–such as prevention, intervention, community services and government–should come together, trust one another, share information and resources, and work together on objectives seems promising.

As a social worker, I often wonder how ideas and research can make a meaningful difference in people’s lives. With this in mind, I recently connected with Martha and discussed the bigger picture. What I learned from our conversation was that we can all catch RWJF’s vision of a culture of health in our communities–part of which is that all children will be able to grow up in safe and nurturing environments at home, in the neighborhood, and at school. And that all children will have a real chance from the very beginning to develop to their full potential as individuals. Risa Lavizzo-Mourey, the President of RWJF, describes this vision in her 2014 President’s Message. I’m excited by the challenge to promote a culture of health.

I would like to invite you to join the conversation. Read the policy report and comment below to share your ideas. Tell us about any programs or policies you believe are making a difference that we can learn from, how you think we can move from a culture of violence to a culture of health, or anything else you think can be part of the solution for improving environments for children and their families.

Health of Caregivers and Childhood Food Insecurity

We often assume that low household income causes children’s food insecurity. But the Future of Children’s recent research report highlights a number of additional factors that contribute to food insecurity. One notable risk factor is a caregiver who faces mental or physical health problems.

The latest research shows that even when we account for income level, caregivers’ health is still central to children’s food security. For example, a recent paper in the Journal of Children and Poverty found that mothers in food-secure families had better overall health and were less likely to report substance use compared with mothers in food-insecure households. Craig Gunderson and James Ziliak‘s Future of Children report cites a number of health factors that can contribute to children’s food insecurity, including parental depression, parental drug use, or living with an adult with a disability.

What can we do to help children in these situations? The authors point out that the effect of caregiver’s mental and physical health on family food security raises concerns about families’ ability to navigate the welfare system. A caregiver’s health problems may also be exacerbated by lack of access to services. While the authors argue that improved access to services could improve food security, they also state that we need further research on how policy makers can create more accessible systems. The authors offer one suggestion to address the risk factor of substance use: ensuring that mothers who seek substance use treatment are enrolled in SNAP and WIC, if they are eligible. Perhaps a similar idea could be implemented in other contexts where caregivers receive medical or mental health treatment.

As more researchers explore the relationship between food security and health, new policy possibilities may come to light. However, the research highlighted in the Future of Children report makes us aware that health contributes to food security, and low income is not the only indicator of risk. In following blog posts, we will explore additional factors that influence food security. To learn more about health and food insecurity, see the Future of Children‘s Fall 2014 research report.

Childhood Food Insecurity in America

This past year, lighthearted quizzes have been popular to share and discuss on social media. They’ve allowed to me to find out everything from what U.S. state I actually belong in to which Disney princess I would be if I existed in the cartoon realm, simply by answering odd and seemingly unrelated questions about my personality and preferences. The researcher in me feels a little annoyed at how unscientific these assessments are, but at the same time they are sometimes too fun to pass up–and somehow the results can feel so valid. I’m definitely not opposed to the idea of living in New York as Mulan.

As fun as it can be to spend free time taking and sharing these quizzes, one quiz that ought to go viral is the Hunger Quiz from the Feeding America charity. While it won’t tell you which vegetable you are, it will inform you of some of the surprising facts about hunger in America, and possibly some of your misconceptions about food insecurity. A take-home message is that hunger is a significant problem in America that can alleviated. But what can we do about it?

In a new Future of Children research report, professors Craig Gunderson of the University of Illinois and James Ziliak of the University of Kentucky use the latest research to describe childhood food insecurity in the U.S. They write that the government defines food insecurity as “a household-level economic and social condition of limited access to food” and surprisingly, in 2012, over 1 in 5 children met this criterion. This is disheartening, especially since the government spent over $100 billion in fiscal year 2012 on federal food-assistance programs.

The authors argue that one reason food insecurity rates remain stubbornly high is that we don’t fully understand what causes food insecurity or how programs help alleviate it. The research in the report helps fill this gap and can contribute to policy initiatives that could result in powerful improvements in the health and wellbeing of children.

In upcoming blog posts, we’ll be exploring factors that contribute to food insecurity and what policies are worth consideration in light of these factors. To learn more about food insecurity in America, see the Fall 2014 research report in the Future of Children.