Category Archives: Public Policy

Incorporating Family Law into the Study of Nonmarital Families

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A guest post by Clare Huntington.

Thanks to the Fragile Families and Child Wellbeing Study as well as other research, we are developing a rich body of knowledge about child outcomes in nonmarital families. What is missing from this growing body of research, however, is a discussion of the role of law in influencing these outcomes.

As I have elaborated elsewhere, family law is designed for married families. The family law system is far from perfect, but the legal rules, institutions, and norms generally help divorcing families restructure their lives in a way that encourages co-parenting and recognizes the potential contributions of both parents, financially and socially, to the rearranged family.

It is a very different story for nonmarital families. Family law’s rules, institutions, and norms do not map well onto family life that is not defined by marriage and have the potential to undermine relationships in these fragile families.

Beginning with legal rules, states give considerable power to unmarried mothers (power that, for married mothers, is shared with a spouse). When a child is born to unmarried parents, for example, the mother automatically gains sole custody of the child under many state laws. Without rights to custody, fathers see their children only if they are able to stay on good terms with the mothers of their children. This legal structure can exacerbate the phenomenon of maternal gatekeeping, which is well documented.

Family law also exacerbates acrimony between unmarried parents. Child support laws, which are relatively effective for divorcing families, impose unrealistic obligations on unmarried fathers, many of whom have dismal economic prospects. The failure to satisfy child support requirements fuels animosity between unmarried parents, many of whom are already experiencing difficulty co-parenting.

The basic institutions of family law are designed for marital families and simply do not work for nonmarital families. A married couple needs to go to court to end their relationship. When there, the court will ensure there is a clear custody or visitation order, specifying when each parent will see the child. The family will also have access to the court-based resources that help divorcing couples adjust to post-divorce life, such as the development of a detailed parenting plan, access to co-parenting classes, and so on.

By contrast, unmarried parents do not need the state to dissolve their relationship, so there is no reason to go to court, and most do not. This means that unmarried parents ending a relationship are left without an institutional structure to help them adjust to post-separation life. They do not have the benefit of a custody or visitation agreement, which can guard against maternal gatekeeping and which sends the message that both parents can and should be involved in the child’s life. They do not have the benefit of a detailed parenting plan, which can forestall conflict and set out clear expectations. And they do not have the benefit of court-based co-parenting classes, which can teach parents how to work together. Of course there are many ways in which nonmarital families differ from marital families, and I do not mean to suggest that unmarried fathers are likely to take on the joint custody role that many divorced fathers do. But the lack of an institution to help nonmarital families transition into a co-parenting relationships is a serious problem.

Finally, family law’s norms still reinforce traditional gender norms, with fathers as breadwinners and mothers as caregivers. Anachronistic for many married couples, these norms are starkly at odds with the reality of nonmarital family life. Marital norms thus deem unmarried fathers failures because they are not providing for their children economically. This undermines the place of fathers in the family by telling mothers and children that fathers are not acting as they should, and it undermines the social contributions that fathers can make.

In all these ways, family law weakens the already tenuous bonds that tie nonmarital families together.

It is essential to develop a more inclusive family law, better suited to the needs of both marital and nonmarital families. I outline such an approach in my recent article, Postmarital Family Law: A Legal Structure for Nonmarital Families, but let me give one example here. To address the problem that nonmarital families do not have an effective institution to help forestall conflict and transition into co-parenting, the United States should learn from Australia’s creation of Family Relationship Centres (FRCs) in 2006. FRCs offer free, readily accessible mediation services in the community, not the courts, to help unmarried parents move into co-parenting relationships. Built in centrally located areas such as shopping malls, they help separating couples develop a short-term plan for the child. The plans are not legally binding, but the idea is that by forging an agreement for the first year or two after the romantic relationship ends, a couple will get in the habit of working together. Then, as their lives inevitably change, they will be better positioned to adapt and continue their co-parenting. It is too soon to evaluate the long-term impact of the FRCs, but an initial assessment found that the FRCs have reached families that would not otherwise have gone to court and that most clients are satisfied with the services they received.

It is hard to establish definitively as a causal matter that the mismatch between family law and nonmarital family life contributes to worse outcomes for nonmarital children, but there is reason to believe that family law’s failures exacerbate the rocky transitions that contribute to poor child outcomes. At a minimum, as we deepen our empirical understanding of nonmarital families, the role of the law should be in the conversation.

Child Health and Health Care Access

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Many celebrated outside the Supreme Court two weeks ago following SCOTUS’s decision to allow health care subsidies through the Affordable Care Act (ACA). I was among those who breathed a sigh of relief at home after reading that our coverage through the Marketplace would be continued. Now as life returns to normal and we no longer have to worry for the time being, let’s not forget the importance of health care access, especially for children, and the fact that there are still children who don’t have it. Exactly how important is health care access? Lindsey Leininger and Helen Levy joined forces in the latest Future of Children issue to tell us about the influence access has on child health.

Research on this question has had varying results, but Leininger and Levy argue that, overall, access to care does improve child health and that the influence is often more significant for those who are marginalized. The classic RAND Health Insurance Experiment, for instance, suggested that in the population as a whole, the generosity of insurance coverage did not significantly determine overall health. However for high-risk (meaning low-income) children, generosity of coverage did affect health.

Studies on Medicaid eligibility show further evidence: in the year after implementation, mortality fell among nonwhite infants, and this effect persisted for at least 10 years. Also, among children in low-income families, those who experienced more years of Medicaid eligibility were in better health. A variety of other studies have associated expansions of Medicaid eligibility with reductions in child mortality. With regard to Medicaid enrollment, positive effects have also been seen, such as increased enrollment leading to decreases in hospital admissions for conditions that could be well-managed by primary care.

Leininger’s own research has shown that lack of coverage can be a strong detriment to child health. Her study showed that each additional month without coverage was associated with a small, statistically significant decline in the probably of a child seeing a doctor for a well-visit or any other visit. A four-month spell of being uninsured, for example, resulted in a 4 percent decrease in the likelihood of any visit and a 9 percent decrease in the likelihood of a well-visit.

So insurance coverage is good for child health, especially for marginalized children. But according to our authors, although “the ACA builds on the earlier successes of Medicaid expansion and CHIP to promote children’s access to care… challenges remain.” Access to care improves child health, but it is not the only factor. For example one study cited by Leininger and Levy estimates that lack of access to medical care explains only about 10% of early mortality in the population as a whole; less than genetics (30%), social circumstances (15%), and behavioral factors (40%). To improve children’s health overall and consider policies that may do so, we must also consider the larger picture. To learn more about other factors that influence children’s health, read the full Future of Children issue on Child Health.

Child and Public Health in a Libertarian Legal Framework

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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.”

Evidence for Supporting Military Families

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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

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“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.

Food insecurity and child care for low-income families

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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

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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.

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 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.

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.