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

Rising from a Culture of Violence to a Culture of Health

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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

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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

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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.

A Two-Generation Solution to Education Disparity

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Education tends to pay off.  Higher educational attainment is associated with higher earnings, lower unemployment and better health. In the Future of Children, Neeraj Kaushal explains that education also influences important lifestyle decisions such as marriage, sex, childbearing, and substance use.

Importantly, parents' education not only affects themselves, but also affects the wellbeing of their children. Better-educated parents often pass down the tradition of education to their children along with its benefits. The intergenerational payoffs of education are persistent and perhaps even underestimated.

While some families benefit immensely from education, other families face structural obstacles to advancing their socioeconomic status via further educational attainment. Racial and ethnic disparities are apparent by education, and children with less-educated parents are less likely to succeed in school. Furthermore, Kaushal points out, the U.S. education system reinforces socioeconomic inequality across generations by spending more money on educating richer children than poorer children.

These challenges lend support to the idea of targeting education-related interventions toward less-educated parents and their children. This might be done via a two-generation approach in which parents and children are served simultaneously. While the theoretical basis for these programs is strong, the empirical evidence is only emerging. What we do know is that investing in parents is likely to have a lasting effect on children's health and development, which in turn increases their wellbeing as adults. There is also evidence that adult offspring's educational attainment influences the health and life expectancy of the parents, even after accounting for parents' socioeconomic resources. This may be due to children's knowledge of health and technology they share with their parents and having more financial means to support them.  It's arguable that investing in programs that aim to increase parents' education and skills at the same time as they invest in children's development could go a long way to reduce intergenerational inequality.

For more information about two-generation programs, see the Future of Children volume Helping Parents, Helping Children: Two-Generation Mechanisms.

Policy Prescriptions to Prevent Teen Pregnancy

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Most teens would probably say they don't want to become pregnant--in fact 87% of teen pregnancies in 2001 were reportedly unintended (see Figure 1). Even though there have been tens of thousands of teen pregnancies in recent years, teen births in the US have actually declined over the last 20 years, from 61.8 live births per 1,000 females aged 15-19 years in 1991 to 29.4 in 2012. This trend, which is due to factors that include teens making more informed decisions regarding their sexual health, is encouraging and suggests we can continue to make progress in preventing teen pregnancies.

First, we need to understand what makes teens more likely to get pregnant. Isabel Sawhill, Adam Thomas, and Emily Monea, in the Future of Children, outline several plausible explanations including cultural norms of increased acceptance of premarital sex and having children outside of marriage, a lack of positive alternatives to single motherhood, an attitude of fatalism, the high cost and limited availability of contraception, lack of knowledge about contraception and reproductive health, and inconsistent or incorrect use of contraception. The authors point out that these explanations generally fall into the categories of motivation, knowledge, and access.

Next, we can examine possible solutions. The Centers for Disease Control and Prevention recently released a Vital Signs brief outlining what the federal government, health care professionals, parents/caregivers, and teens can do to prevent teen pregnancy. What I like about the CDC's suggestions is that they start where the teen is and show how adults can support teens' healthy development. For example, professionals can encourage teens to delay sexual activity but should also encourage sexually active teens to consider the most effective methods of birth control. Parents can know where their teens are and what they are doing (isn't there an app for that?), especially after school, and talk with their teens about sex.

Finally, are programs that promote these types of solutions worth the cost? Sawhill and colleagues, in their Future of Children article, conducted simulations of the costs and effects of policy initiatives that encouraged men to use condoms (motivation), discouraged teen sexual activity and educated participants about proper contraceptive use (knowledge), and expanding access to Medicaid-subsidized contraception (access). All three had good benefit-cost ratios, suggesting they are excellent social investments that can actually save taxpayer dollars. For more information on how to prevent teen pregnancy and unintended pregnancies in general, see the Fragile Families volume of Future of Children.

A Holistic Approach to Healthcare

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The health of parents and children are closely intertwined, yet the health-care system generally does not take an integrated approach to family health treatment. For instance, pediatricians who treat children with asthmatic symptoms often do not ask about parents' smoking and rarely intervene to help change the parents' smoking behavior. It's probably not considered within the scope of their practice and they aren't able to bill the treatment to the child's insurance. This situation is problematic since a primary cause of the symptoms is likely the secondhand smoke in the child's environment. Pediatricians don't necessarily need to abandon their specialization and start treating parents and children in the same practice, but the solution likely lies in reforming the health care system to be more holistic and interconnected.

Sherry Glied and Don Oellerich write in the Two-Generation issue of Future of Children that few programs aim to treat parents and children together due to structural barriers in the U.S. health-care system. They argue that the Affordable Care Act, which expands coverage to millions of lower-income parents, is a necessary step to help establish a policy environment to allow for two-generation approaches to health.

Importantly, it's up to the states to take two further steps. First, they need to ensure that parents and children can be treated in the same programs despite Medicaid eligibility. Second, they should give providers incentives to generate meaningful changes in their practices, such as embracing the patient-centered medical home model which makes additional payments to providers who coordinate their services with other medical and social service providers.

Glied and Oellerich conclude that the rationale for two-generation programs that target both children's and parents' health problems is strong, and there are new opportunities ahead to develop and implement these programs.

Expanding the Two-Generation Approach to Combat Stress

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Stress can make or break a child. Manageable stress is necessary to help a child develop self-regulation and coping skills; yet, toxic stress can contribute to long-term mental and physical health problems. With this in mind, what can be done to help children in potentially stressful environments such as poverty or the foster care system?

Ross A. Thompson explains in the Future of Children that the early plasticity (capacity to change) of the brain and other biological systems offers hope to those who aspire to help at-risk children. "We may be able to intervene early in children's lives with experiences that help reorganize biological systems constructively." He advises, however, that plasticity declines over time so early screening and intervention is ideal. For instance, one study found that children who spent eight or more months in a Romanian orphanage, while being profoundly deprived of normal human relationships, before being adopted fared worse in terms of health consequences than similar children who only spent four months or less in the that environment.

Thompson emphasizes that a key point of intervention to ease the consequences of chronic stress is improving the quality of relationships between children and adults. "Whether two-generation programs target parents, preschool teachers, foster parents, or ... [grandparents], focusing on relationships is likely to enhance their success." This shows promise in helping strengthen families so children can experience a manageable amount of stress in their lives that contribute to healthy development.

To learn more about this approach to combating stress, see the Two-Generation issue of the Future of Children.

The Implications of Parents' Employment for their Children

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Parent's (and especially mother's) work is not always beneficial for their children.

In the Future of Children, Carolyn J. Heinrich explains that working parents can be positive role models for their children, and the income they earn can improve their children's lives. However, work can impair the developing bond between parents and young children (especially when parents work long hours or evening and night shifts); and stress that parents bring home can have a negative effect on parenting and the quality of the home environment, and thereby induce stress into children's lives.

It seems that the balance between work and family ought to be of utmost concern to policy makers, especially in relation to low-income parents who are most likely to work in stressful jobs with few or no benefits, but what is the solution?

Heinrich points to two-generation interventions as a possibility to maximize the benefits and minimize the detriments of parents' work.  She mentions the Career Advance program, which was recently highlighted by National Public Radio, as an example of a two-generation intervention that targets parents with children in Head Start for workforce development services.  This and similar programs focus on high-quality childhood education, job training that helps parents upgrade their workforce skills as well as family and peer support services. She explains that if these programs help parents secure better jobs that improve how they feel about their work and the role models and encouragement they offer to their children, then their children may reap benefits beyond those from just the education and stronger financial supports families realize from program participation.

To learn more about how two-generation programs can help families, see the latest issue of Future of Children, Helping Parents, Helping Children: Two-Generation Mechanisms.

The Promise of Two-Generation Programs

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This week, the Future of Children released a new issue titled Helping Parents, Helping Children: Two-Generation Mechanisms. As the executive summary says, "because the home environment is so important for children's development, many people think that 'two-generation' programs, which serve parents and children simultaneously with high-quality interventions, can be more effective (and perhaps more efficient) than programs that serve them individually." These programs generally entail parents enrolling in education or job training at the same time they enroll their children in high-quality child care. The issue explores six mechanisms, or pathways, through which parents and the home environment may influence children's development--stress, education, health, income, employment, and assets--to discover how we might best use these mechanisms to bolster two-generation programs.

A recent story in the Washington Post, which highlights findings from our issue, describes the two-generation approach, especially as it relates to alleviating poverty. It features Future of Children Senior Editor Ron Haskins, who remarks that although it is too early to tell whether the two-generation approach is effective in alleviating poverty, it certainly shows promise. P. Lindsay Chase-Lansdale, co-author of one paper in the issue, describes in the story how it is unreasonable for the child to be the only point of intervention when a family is going through difficult times: "Those gains [from childhood intervention alone] may not be enough if a child is coming home to a family with great hopes, but is stressed by making ends meet, working multiple jobs, looking for work or facing food insecurity." To lift a child out of poverty, the family likely needs help as well.

The quality of the home environment and parent-child relationships are crucial for children's development because they have lasting effects into adulthood and carry intergenerational implications. We invite you to explore the two-generation mechanisms and programs found in this issue of the Future of Children.

Higher Autism Rates: What Can Be done?

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The newest data on Autism Spectrum Disorder (ASD) from the Centers for Disease Control and Prevention (CDC) offer an alarming picture of childhood disability in America. Approximately 1 in 68 children who were 8 years old in the 11 participating states in 2010 were identified with ASD. This new estimate is more than twice as high as the earliest estimates from 2000 and 2002. The CDC states that "we don't know what is causing this increase. Some of it may be due to the way children are identified, diagnosed, and served in their local communities, but exactly how much is unknown."

People with ASD can have numerous strengths, but the challenges associated with ASD and other disabilities can be persistent and costly for individuals, families, and society. In the Future of Children issue on Children with Disabilities, Stabile and Allin calculated that the average annual cost (in 2011 dollars) to families of children with disabilities was approximately $10,800, and approximately $19,700 to social programs such as Medicaid and special education.

Even though there might be extra costs early on, Aron and Loprest note that early detection and intervention is crucial, and both sets of authors point out that early detection can provide long-term cost savings. However, some families are not screening their children due to barriers such as limited access and the belief that it's unnecessary. Stabile and Allin emphasize that mental health problems, as opposed to physical disabilities, appear to be particularly associated with negative effects on future wellbeing in adulthood.

Having previously practiced social work in a treatment program for adults with ASD, ADHD, and learning disabilities, I've seen first-hand the difficulties that such adults can experience. These include difficulty developing and maintaining relationships (especially romantic relationships), finding and keeping gainful employment, and having healthy self-esteem after years of being bullied by peers.

With the increased prevalence of ASD among children, policy makers should remember that this is not simply a childhood disability, but a lifelong disorder with potentially significant long-term costs and challenges. Clearly, we need more research to understand the causes of ASD, but the funding and evaluation of expensive interventions to prevent and reduce the negative aspects associated with ASD, and other disabilities, during childhood and early adulthood might be justified given the research found in this Future of Children issue.

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