INVESTING IN OUR CHILDREN’S FUTURE 23949 FROM Early Child DEVELOPMENT TO Human DEVELOPMENT THE WORLD BANK EDITED BY MARY EMING YOUNG From Early Child Development to Human Development Investing in Our Children’s Future Editor Mary Eming Young Education Sector Human Development Network THE WORLD BANK Washington, D.C. Proceedings of a World Bank Conference on Investing in Our Children’s Future Washington, D.C., April 10–11, 2000 © 2002 The International Bank for Reconstruction and Development / The World Bank 1818 H Street, NW Washington, D.C. 20433 All rights reserved. 1 2 3 4 05 04 03 02 The findings, interpretations, and conclusions expressed here are those of the author(s) and do not necessarily reflect the views of the Board of Executive Directors of the World Bank or the governments they represent. The World Bank cannot guarantee the accuracy of the data included in this work. 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All other queries on rights and licenses, including subsidiary rights, should be addressed to the Office of the Publisher, World Bank, 1818 H Street NW, Washington, D.C. 20433, USA, fax 202-522-2422, e-mail pubrights@worldbank.org. Library of Congress Cataloging-in-Publication Data has been applied for. Contents Foreword . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . v Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ix Chapter 1 Introduction and Overview . . . . . . . . . . . . . 1 Mary Eming Young I. The Benefits of Investing in Young Children Chapter 2 Early Child Development and the Brain—the Base for Health, Learning, and Behavior Throughout Life . . . . . . . . . . . . . . 23 J. Fraser Mustard Chapter 3 From Child Development to Human Development . . . . . . . . . . . . . . . . . . . . . 63 Jacques van der Gaag II. Measuring the Early Opportunity Gap Chapter 4 Standards of Care: Investments to Improve Children’s Educational Outcomes in Latin America . . . . . . . . . . . . . . . . . . . . . . . . . 81 J. Douglas Willms Chapter 5 Ensuring a Fair Start for All Children: The Case of Brazil . . . . . . . . . . . . . . . 123 Mary Eming Young III. Evaluating the Effectiveness of Early Childhood Programs Chapter 6 Investing in Effective Childcare and Education: Lessons from Research . . . . . . . 145 John M. Love, Peter Z. Schochet, and Alicia L. Meckstroth iii Chapter 7 Mapping and Documenting Effective Programming . . . . . . . . . . . . . . . . . . . 195 Judith L. Evans Chapter 8 Effective Early Childhood Programs: The U.S. Head Start Experience . . . . . . . . . . . . . 219 Louisa B. Tarullo Chapter 9 Elements of Quality in Home Visiting Programs: Three Jamaican Models . . . . . . . . . . 233 Kerida Scott-McDonald IV. The Private Sector’s Influence on the Public Sector Chapter 10 Role of the Private Sector in Early Child Development . . . . . . . . . . . . . . . . . . . . . . 257 Robert G. Myers Chapter 11 Communities Can Make a Difference: Five Cases Across Continents . . . . . . . . . . . . . . 293 Simone Kirpal V. Investing in the Future: Action and Policy Chapter 12 Narrowing the Gap for Poor Children . . . . . . . . . . . . . . . . . . . . . . . . . . 363 Enrique V. Iglesias and Donna E. Shalala Chapter 13 The Political Challenge: Commitment and Cooperation . . . . . . . . . . . . 375 Eduardo A. Doryan, Kul C. Gautam, and William H. Foege Authors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 393 Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 397 iv Foreword A child’s early years are critically important, for they provide the foundation for the rest of life, as an adolescent and as an adult. Children who are well nurtured can live well and create better soci- eties for all. Yes, children are our future and by investing in them at their earliest ages we invest in everyone’s human and economic development. In April 2000, the World Bank hosted a global conference which addressed the benefits and challenges of investing in early child de- velopment (ECD). This landmark conference brought together the world’s leading experts, academicians, practitioners, and policymak- ers to focus on various aspects of ECD. They represented nongovern- mental organizations and other private-sector groups, government agencies, and multilateral and bilateral organizations. This volume contains the proceedings of the conference. With its publication, the World Bank hopes to encourage countries to adopt policies that tar- get early child development, especially for children and families liv- ing in poverty, and to spark other groups and organizations to invest in ECD programs. The reasons for focusing on children are more than traditional and still pertinent humanitarian concerns for those least able to look after themselves. New insights from neuroscience and the behavioral and social sciences underscore the importance of giving children a better chance in life. Nurturing them in their early years is vital for attack- ing the worst effects of poverty and may be an effective way to break the relentless, vicious cycle of poverty that, too often, crosses genera- tions. Children who live in poverty cannot go to school, do not learn to read, will have difficulty finding a job, and will have little hope for their, and their children’s, future. Poverty diminishes people’s spiritu- al resources, peace of mind, dignity, and freedom to live fully. And, unfortunately, poverty is like a bad gene—it is inherited. v vi Foreword Studies repeatedly show that children who are born in poverty, live in unsanitary conditions, experience little mental stimulation or nur- turing, and have poor nutrition in their first years are far more likely than richer children to grow up stunted in both body and mind. Sci- ence tells us that early child development is critical and marks a child for life. The development of a young child’s brain affects physical and mental health, capacity to learn, and behavior throughout childhood and adult life. The wiring and sculpting of billions of neurons in the early years establish the base for developing competence and coping skills later. For nations, the first few years of a child’s life have a multi- plier effect. Young children who are well nurtured tend to do better in school and are more likely to develop the skills they will need to com- pete in a global economy. Investing in young children is an essential investment in human and economic development. During the past generation, we have seen greater progress than at any other time in history. Life expectancy has increased more during the past 40 years than during the past 4,000 years. In today’s world, the communications revolution holds out the promise of universal access to knowledge. In this world, 5.7 billion people participate and compete in a market economy, compared with 2.9 billion only 20 years ago. Yet, 100 million more people are living in poverty today than 10 years ago, and many of these are children. • Most children born into poverty are malnourished and neglect- ed and, hence, cannot attain their potential even before they enter primary school. • 125 million primary-school aged children are not in school, and most are girls. • Another 150 million children start primary school but drop out before they have completed 4 years of education. • Almost one-half of the children in the least developed countries of the world do not have access to primary education. • Nearly 1 billion people, or one-sixth of the world’s population, are illiterate, and most are women. • In the next 25 years, the world’s population is expected to in- crease by 2 billion people, and most of this increase will be in developing countries where poor families are already struggling. Foreword vii These statistics are discouraging, but they also indicate many op- portunities for taking action. Early child development is one way to reverse the trends. ECD interventions and programs fundamentally offer all children a fair chance to compete and succeed in life. They help ensure that the competition is fair for all children by providing the equipment and training they need to get ahead. Even by age 6, children who are malnourished and have never had a book read to them face a playing field that is already unfair. Education is a great equalizer if all children have an equal opportu- nity to take advantage of it. To reduce poverty and achieve universal access to primary education, organizations must come together in support of early child development. The World Bank has an impor- tant role to play, but the total effort is much larger than the World Bank’s investment alone. A strategy of cooperation, interaction, and partnership among many organizations, governments, multination- als, private-sector institutions, and civil groups offers the best possi- bility for launching and sustaining broad action in early child devel- opment. Simply acknowledging that early child development is important or simply increasing resources for primary education are not sufficient. Specific goals, policies, and actions are needed to en- sure that children can take full advantage of, and benefit fully from, the opportunities offered in primary school. The message communicated at this conference is the same as that conveyed 4 years ago at the World Bank’s first conference on early child development: “It is never too early to become involved but it can easily be too late.” This message is even more urgent today be- cause of the growing number of poor children and the accumulation of documented evidence showing that positive ECD interventions can make a difference. Across the globe, children offer us the promise of creating a better world, but we must act now to help them fulfill that promise. Mamphela Ramphele Managing Director, The World Bank Acknowledgments This proceedings of the World Bank conference, “Investing in Our Children’s Future,” was only feasible with the support and contribu- tions of many individuals. Thanks are first extended to the World Bank’s senior management, starting with James D. Wolfensohn, Pres- ident, and Eduardo A. Doryan, Vice President and Head, Human De- velopment Network, for their support of children’s issues and the ear- ly child development (ECD) program. Sincere thanks are given to Elaine Wolfensohn for her personal commitment and guidance at every stage in the planning of the conference and for her support of the Bank’s ECD initiative. Special thanks are due to Ruth Kagia, Direc- tor, Education Sector, Human Development Network, for her support and guidance in planning and organizing the conference. The conference brought together the world’s leading experts, aca- demicians, and practitioners from nongovernmental organizations and civil society, as well as policymakers from governments and mul- tilateral and bilateral organizations. They focused on the benefits, ef- fectiveness, and support of early child development—some of the same issues addressed at the World Bank’s first conference on early child development and at the “Children First Forum” organized by the Task Force for Child Survival and Development, both of which were held at The Carter Presidential Center, Atlanta, Georgia, in April 1996. The issues may be the same, but are even more urgent today. The conference benefited from the ongoing support of Bill Foege, Mark Rosenberg, John Gates, Conrad Ferrara, and Pamela Wuichet of the Collaborative Center for Child Wellbeing (formerly the Task Force for Child Survival and Development). The conference also benefited immensely from being embedded into the broader framework of the World Bank’s Children’s Week 2000, a week-long event organized in collaboration with the Child Labor and Street Children Teams of ix x Acknowledgments the Bank, which include Bona Kim, Zafiris Tzannatos, Catalina Vil- lamizar, and Kate Schecter and are coordinated by Stephen Com- mins. In this framework, the conference participants had the oppor- tunity to attend a series of events and workshops related to early child development, child labor, and street children. We also thank Vi- sion, Strength and Artistic (VSA) Expression and their affiliates, for organizing and showcasing its programs and artists and for an exhibi- tion of beautiful artwork created by disabled children from around the world, and Jennifer Dickson of Counterpart Canada, for facilitat- ing the participation of Raffi, child advocate and singer, who pre- miered his song “It Takes a Village to Raise a Child” and shared his vi- sion at the conference. Thank you, Raffi. Thanks are also extended to the Multilateral Development Department, Royal Ministry of Foreign Affairs, Norway, and the Ministry of Foreign Affairs, the Netherlands, for partially funding preparation of the conference background papers. In addition, many thanks are due to the team that helped organize the confer- ence: Simone R. Kirpal, Amber Surrency, Claudine Cobra, and Julie Wagshal in the Bank’s Education Sector, Human Development Net- work, and Ruth Hubbell-McKey and Bethany Chirico of Ellsworth Associates. A special note of appreciation goes to Francis James Dobbs, Christopher M. Walsh, and Peter Knight for liaison with the media and guidance on the design of media messages. Special thanks also to Gaby Fujimoto-Gómez and Carolina Gomez, from the Organization of American States (OAS), for coordinating the participation of ECD practitioners from Latin America; to Helen Keith, Early Childhood Services Planning and Development, for coordinating with participants from the Caribbean and providing guidance to develop the SERVOL case study; and to Marito Garcia and Susan Opper in the World Bank’s African Region, Venita Kaul and Ward Heneveld on the Bank’s India country team, and Antonio Lim in the Bank’s Europe and Central Asia Region, for supporting the participation of several delegates from the countries in their respective regions. Acknowledgments xi Thanks also to all 280 participants from forty-eight countries who made the conference happen and, in particular, to Joan Lombardi of the Bush Center in Child Development and Social Policy, Yale Uni- versity, for guiding the planning of the conference and facilitating the invitation to Secretary Donna E. Shalala of the U.S. Department of Health and Human Services, and to Ricardo Morán of the Inter- American Development Bank (IDB) for facilitating the invitation to Enrique V. Iglesias, President, IDB, who were the conference keynote speakers. Thanks also to Marjorie Newman-Williams and Waheed Hassan of the United Nation’s Children’s Fund (UNICEF) for facili- tating the participation of Kul C. Gautam, Deputy Executive Direc- tor, UNICEF. Special thanks to Robert Myers, Maris O’Rourke, and Heather Weiss, and to Margaret Marland, Minister for Children of Ontario, Canada, for their cooperation in chairing the confer- ence sessions. The conference featured presentations on the role of private initiatives in influencing public policy. The participants benefited from George Soros’ shared insights on his philanthropic activities and support of ECD programs worldwide. In addition, field practi- tioners from the private sector and civil society shared their experi- ences with their programs. Thanks in particular to Peter Hesse, who described his 10-year program in Haiti; Sister Ruth Montrichard, who spoke of her 25 years of dedication to the SERVOL program in Trinidad; Elizabeth Lorant, who described her work with the Soros Foundation beginning in the 1980s; and Kathy Bartlett, who described the Aga Khan Foundation’s Madrasa program in East Africa. Special acknowledgments are due to key partners in the support of early child development: UNICEF; the United Nations Educational, Scientific, and Cultural Organization (UNESCO); the World Health Organization (WHO); the Pan American Health Organization (PAHO); the U.S. Agency for International Development (USAID); IDB; the Asian Development Bank; OAS; and nongovernmental organizations, including Bernard van Leer Foundation, Aga Khan xii Acknowledgments Foundation, Save the Children USA, Christian Children’s Fund, World Organization for Early Child Education, Academy of Educa- tional Development (AED), World Vision, and the Consultative Group on Early Child Care and Development. Many, many thanks to Linda M. Richardson for the text editing; without her persistence, meticulous efforts, and superb skills, the timely preparation of this proceedings would not have been possible. Chapter 1 Introduction and Overview Mary Eming Young Early child development (ECD) programs that comprehensively address children’s basic needs—health, nutrition, and emotional and intellectual development—foster development of capable and productive adults. And, early interventions can alter the lifetime trajectories of children who are born poor or are deprived of the opportunities for growth and development available to those more fortunate. These facts are well known today and are founded on evidence from the neurobiological, behavioral, and social sciences and the evaluation of model interventions and large, publicly funded pro- grams. The short- and long-term benefits of ECD programs for chil- dren are enormous. By providing basic health care, adequate nutri- tion, and nurturing and stimulation in a caring environment, ECD interventions help ensure children’s progress in primary school, con- tinuation through secondary school, and successful entry into the work force. The economic returns to investing in young children are high. But, there is an even more compelling reason for underscoring the importance of the early years: Early interventions help children es- cape poverty. Among the world’s 6 billion people, 2.8 billion live on less than US$2 a day, and 1.2 billion live on less than $1 a day (World Bank 2000). Within every country, there is a massive imbalance be- tween rich and poor. 1 2 Mary Eming Young Disparities in children’s development mirror these economic disparities, and poverty is associated with poor social indicators, especially for poor children. Without the basic nutrition, health care, and stimulation needed to promote healthy growth, many poor chil- dren enter school not ready to learn. These children do poorly in class, repeat grades, and drop out at high rates. They are at a disad- vantage when they enter the workplace, earning the lowest wages, and, as parents, pass their poverty on to their children. Giving chil- dren a better chance is not only vital for attacking the worst effects of poverty, but also may be an effective way of breaking the relentless, vicious cycle of poverty transmitted across generations. Core aspects of poverty are targeted in the goals for international development recently set forth by the development community. The goals are: reducing by half the proportion of people living in extreme poverty by 2015; a two-thirds decline in infant and under-5 mortali- ty, and a three-fourths decline in maternal mortality; universal pri- mary education for all by 2015; gender equality in education by 2005; national strategies for sustainable development by 2005; and ensuring that the current loss of environmental resources is reversed globally and nationally by 2015. The goals in poverty, health, and education are mutually reinforc- ing. Higher school enrollment, especially for girls, reduces poverty. Reductions in mortality, gained through better basic health care, in- creases enrollment and performance in school, which reduces pover- ty. As a great equalizer, education diminishes the differences between rich and poor—but only if all children have an equal chance to take advantage of education. To meet the goal for universal primary education, poor children must be given a fair chance to benefit from school. In unequal soci- eties that have high levels of poverty, a level playing field even at age 6, or by the time a child enters school, may already be unfair for poor children. By intervening early, ECD programs offer all children the possibility to fully benefit from school and to succeed in the market- place. In this way, ECD interventions help reconcile countries’ goals for equity and efficiency (Birdsall 1999). Introduction and Overview 3 Early Child Development: Scientific Evidence The importance of early child development has been noted by econo- mists, behavioral scientists, educators, neuroscientists, and biologists. Fogel, the 1993 Nobelist in economics, states that the quality of early child development has a significant effect on the quality of popula- tions and influences health outcomes in adult life (Fogel 1999). In an analysis of factors contributing to inequality in health, conducted for the U.K. government, Acheson (1998) finds that, although remedia- ble risk factors affecting health occur throughout life, childhood is a critical and vulnerable state in which poor socioeconomic circum- stances have lasting effects. He notes that, because adverse outcomes (e.g., mental illness, short stature, obesity, delinquency, and unem- ployment) result from early adverse environments, policies that re- duce early adverse influences may have multiple benefits for a child’s entire life course and into the next generation. During early childhood, patterns of behavior, competency, and learning are initiated and established; socioenvironmental factors be- gin to modify genetic inheritance; brain cells grow in abundance; and biological pathways for handling stress arise. Increasing evidence from various sources (Rutter, Giller, and Hagell 1998; Tremblay 1999) documents that early-life conditions “have a long reach” for behav- ior, particularly antisocial behavior, delinquency, and crime. Longitu- dinal studies clearly show that most seriously antisocial adolescents and adults exhibit behavioral problems during childhood and that the origin of these problems traces back to fetal development and in- fancy (Karr-Morse and Wiley 1997). The early years also affect children’s learning, particularly their literacy and mathematics skills. Beginning at birth, most children are immersed in the language and literacy of their immediate family. As infants respond to their parents and siblings, speech emerges natu- rally and, by 12–18 months, toddlers usually begin to establish a recognizable vocabulary, which grows exponentially over the next few years as language structures emerge and speech and language continue to develop. These infant and toddler years are critical for 4 Mary Eming Young establishing the foundation for future literacy development (Willms 1999). In addition, recent research shows that children’s early mathe- matical capabilities are considerably differentiated by social class dur- ing these early years, when the neurological circuitry that underpins these capabilities also develops the most rapidly (Case, Griffin, and Kelly 1999). Commenting on gene–environment interactions, neuroscientists claim that individuals’ “skills, abilities, dreams, and prejudices” result from their genetic history and the particular physical and social envi- ronmental stimuli to which they are exposed. They note that inade- quate and inappropriate social and emotional experiences in the ear- ly environment can compromise higher-level neural systems that provide the information needed to bond, imitate, and generally re- spond in socially appropriate ways (Cynader and Frost 1999). Re- search shows that, during key developmental periods, the amount of gray matter in some brain areas can nearly double within as little as a year and that this process is followed by a drastic loss of tissue as un- needed cells are purged and the brain continues to organize itself. By the age of 3 years, the brains of children are 2.5 times more active than the brains of adults, and they remain this way throughout the first decade of life (Shore 1997). Extensive rewiring continues throughout childhood. Although growth spurts occur in the brain even beyond early childhood, the rule for brain development appears to be “use it or lose it” during the early critical periods (Giedd and others 1999). Stress also plays a role in early brain development. Studies of the biological pathways involved in reactions to stress show that the stresses to which individuals are exposed early in life may modify their ability to moderate and control responses to stress later in life (Cynader and Frost 1999); that the quality of sensory stimulation in early life helps shape the brain’s endocrine and immune pathways; and that adults who were poorly nurtured in early life tend to retain sustained levels of stress hormones long after situations that cause arousal. Studies also show that mothers’ handling of young animals can “set the program” for responses of the hypothalamus-pituitary- Introduction and Overview 5 adrenal pathway to stress throughout life and that the absence of ma- ternal care produces abnormal stress reactions later in life (McCain and Mustard 1999). Implications for ECD Brain development in the early years affects physical and mental health, learning, and behavior throughout life. What, how, and how much children learn later in school largely depends on the social and emotional competence and cognitive skills they develop in the first few years of life. The development of a young child’s brain depends on environmental stimulation, especially the quality of care and in- teraction the child receives. The quality of care received, including nutrition, health care, and stimulation, during the first few years can have a long-lasting effect on brain development. When these basic needs are met, children can gain improved critical thinking skills, self-confidence, problem-solving abilities, and capacity to cooperate with others. These skills will determine children’s overall school per- formance and possibly alter their developmental trajectory (Ramey and Ramey 1998). Solutions to meet the intellectual and social development needs of young children are available, but need to be adopted more broadly and intensively. The knowledge base to support large-scale invest- ments in ECD interventions is more than sufficient. These invest- ments will pave the way for improving individuals’ health, mental and physical performance, and productivity and, in a major way, help minimize or even prevent a host of related economic and social problems, including juvenile delinquency, teenage pregnancy, and social violence. Do ECD Interventions Work? ECD programs and interventions can improve children's chances in the world. Young children who participate in early interventions that include nutrition, health care, and nurturing have lower rates of school dropout, higher school enrollment, and higher achievement 6 Mary Eming Young from primary grades to adulthood. The examples of effective ECD in- terventions across the world’s regions are many, and some have been evaluated to measure their efficacy. Some of the best known examples include the Perry Preschool Project, the North Carolina Abecedarian Project, the Infant Health and Development Program, and the Head Start and Early Head Start programs in the United States; the Integrat- ed Child Development Service (ICDS) in India; and the Initial Educa- tion Project in Mexico. Studies of these interventions illuminate the particular benefits of ECD. For example, children who participated in ICDS scored higher on intellectual aptitude tests and had superior school attendance, academic performance, and general behavior than children who did not participate (Chaturvedi and others 1987). ICDS is the largest ECD program in the world, serving 32 million children. In Brazil, poor children who attended 1 year of preschool stayed in primary school 0.4 years longer than children who did not attend preschool (Barros and Mendonça 1999). For each year of preschool, children had a 7–12 percent increase in potential lifetime income, with the larger in- creases gained by children from families whose parents had the least amount of schooling (Barros and Mendonça 1999). The Abecedarian Project showed that the likelihood of children being held back in the same grade during primary school declined by almost 50 percent when children attended ECD programs (Ramey and others 2000). Studies also show that children from families with the least education derive the greatest cognitive and social benefits, and the effect of ear- ly interventions appears to be long-lasting. Gains such as these are real and verifiable, and they prove beyond a doubt that early inter- ventions work. The Next Step Science clearly identifies why and when ECD programs should be im- plemented. And, ECD researchers and practitioners have determined, in large part, what programs are effective and for which groups they are most needed. These considerations can all be further broadened Introduction and Overview 7 and refined, but the critical questions now for the global community are how to implement ECD interventions effectively and how to take these programs to scale. That is, how can governments utilize the knowledge gained from science to define policies that will benefit young children? How can existing scientific knowledge about early child development be trans- lated into interventions that benefit large numbers of young children deprived of their most basic needs from birth and, even, in utero? Which public policies are needed (e.g., specifically for poor and oth- erwise disadvantaged children)? What are the elements of program effectiveness? How can programs be brought to scale? What are the lessons learned in implementing these programs? And how can pub- lic-private partnerships be encouraged? The next step is to address these questions in global venues and to solicit continued, sustained investments in early child development for all nations. Continued efforts are needed to evaluate ECD programs and to promote, initiate, and implement effective ECD programs throughout the world and especially for impoverished children. Investing in Our Children’s Future To stimulate discussion of the questions posed above and invest- ments in early child development, the World Bank hosted an interna- tional conference, entitled “Investing in Our Children’s Future,” in Washington, D.C., on April 10–11, 2000. The conference participants reviewed the state of knowledge on the benefits and effectiveness of early interventions, addressed the role and influence of the private sector, emphasized the importance of narrowing the gap for poor children, and highlighted the potential political and economic gains from investing in ECD. This volume contains the proceedings of the conference. The chapters consist of papers developed for or subse- quent to the conference. The volume builds on and extends previous and similar efforts, in- cluding an earlier conference hosted by the Bank, entitled “Early 8 Mary Eming Young Child Development: Investing in the Future.” This conference was held at The Carter Presidential Center, Atlanta, Georgia, in April 1996, and the proceedings were published (Young 1997). Both con- ferences engaged representatives of governments, nongovernmental organizations, foundations, academia, and multilateral and bilateral agencies in interactive discussions and presentations on the impor- tance of investing in young children. The present volume is organized into five parts: The Benefits of In- vesting in Young Children, Measuring the Early Opportunity Gap, Evaluating the Effectiveness of Early Childhood Programs, The Pri- vate Sector’s Influence on the Public Sector, and Investing in the Fu- ture: Action and Policy. Twelve chapters are included. The authors de- scribe current understanding and suggest areas for future study and action. The contributions reflect their extensive research and practi- cal experience. The Benefits of Investing in Young Children Two chapters in part I summarize the individual and societal benefits of investing in young children. In “Early Child Development and the Brain: The Base for Health, Learning, and Behavior Throughout Life,” J. Fraser Mustard conveys current research and research findings on brain development. He notes historical evidence which suggests that the relationship between economic growth and improved health since the beginning of the industrial revolution is linked to improved outcomes for children associated with increased prosperity. He then reviews basic research on biological pathways; animal studies of de- velopment and function, gene–environment interactions, and im- mune effects; and population-based human studies of socioenviron- mental effects and educational experiences—all of which substantiate the importance of early childhood. Mustard describes the benefits of several intervention efforts and highlights the relevance of ECD pro- grams for developed countries, such as Canada, as well as developing countries. He emphasizes that good ECD programs should be avail- able for all population sectors and can improve the quality of society by reducing inequalities in health, competence, and coping skills. Introduction and Overview 9 In “From Child Development to Human Development,” Jacques van der Gaag defines the linkage between early child development and human development. He provides a brief history of development economics, commenting on the interests of Nobel laureates in eco- nomics to illustrate the historical shift from developing planning models to investing in people. Van der Gaag then describes four criti- cal pathways—education, health, social capital, and equality—link- ing early child development to human development, through eco- nomic growth. He summarizes in chart form the immediate and long-term benefits of ECD programs for children, adults, and society in each pathway, and he concludes that well-executed and well-tar- geted ECD programs are initiators of human development and in- vestments in the future of a nation. Measuring the Early Opportunity Gap Two chapters in part II address the need to measure inequalities in early child development and to target ECD programs effectively. In “Standards of Care: Investments to Improve Children’s Educational Outcomes in Latin America,” J. Douglas Willms summarizes the findings of the Primer Estudio Internacional Comparativo (PEIC), the first international study of school outcomes in Latin America which utilized common tests and questionnaires across (13) coun- tries. He describes the concept of socioeconomic gradients and re- views results which show that the gradients, school outcomes, and school achievement profiles vary widely among countries in the re- gion and that the gradients are related to inequalities in society and children’s developmental outcomes. Based on an analysis of the data, Willms presents a framework to help policymakers evaluate and monitor school outcomes. This framework includes a definition of “vulnerable” children and standards of care for superior school- ing; accounts for sector (private or public) and urbanicity; and incor- porates key considerations for low-income countries. Willms sug- gests that these countries could reduce the risk for children associated with low parental education by one-half if they achieved the standards set forth. 10 Mary Eming Young In “Ensuring a Fair Start for All Children: The Case of Brazil,” Mary Eming Young offers a special analysis of Brazil as an example of the potential implications of ECD policies to reduce inequality. She be- gins by summarizing the improved outcomes for vulnerable children in several ECD interventions in the United States as evidence to sup- port investments in comprehensive programs, to reduce poverty, build human capital, and strengthen overall development. Young then summarizes the results of a recent World Bank study conducted by the Institute of Applied Economic Research in Brazil. This study reinforces findings presented by Willms concerning inequalities of early education, and investments in this education, for children who are poor or reside in rural areas. The evaluation of the effects of preschool education in Brazil supports many other studies, which show that attendance in preschool correlates with increased school- ing overall, reduced grade repetition, and future earning capacity. Im- portantly, the gains of preschool education for children of illiterate parents appear to be higher than for children of educated parents. Overall, the calculation for Brazil yields a 2:1 benefit-cost ratio. Fur- ther, 1 year of preschool attendance results in a 7–12 percent increase in future earnings. Evaluating the Effectiveness of Early Childhood Programs Four chapters in part III address the question: What constitutes quali- ty? In “Investing in Effective Childcare and Education: Lessons from Research,” John M. Love, Peter Z. Schochet, and Alicia L. Meckstroth review research on the ingredients of quality. They identify two im- portant ingredients—classroom structure (e.g., child–staff ratio, sup- portive services, staff characteristics) and classroom dynamics (e.g., positive teacher and child behaviors, effective teacher–child interac- tions, stability and continuity). They also highlight eight supporting factors, which include teacher education, in-service training, experi- ence, continuity, and compensation; experienced and trained super- visors and directors; community partnerships; and safe and appropri- ate physical space. Studies of center- and family-based childcare, which are summarized in a useful chart at the end of the chapter, Introduction and Overview 11 indicate important modifying factors associated with positive out- comes. These factors include lower child–staff ratios, smaller group sizes, appropriate caregiving, developmentally appropriate practices, and caregiver responsiveness. Benefits associated with higher-quality childcare include improved language, enhanced social skills, reduced behavior problems, and increased cooperation. Based on this infor- mation, the authors highlight five types of investments as most im- portant for enhancing children’s early development: well-trained, motivated, and committed staff; safe, sanitary, and accessible facili- ties; child–staff ratios and group sizes that foster appropriate teacher–child interactions; consistent supervision; and staff develop- ment to ensure continuing and improving quality. They conclude by calling for additional quantitative studies of quality that utilize con- temporaneous, longitudinal, and pre-post designs. In “Mapping and Documenting Effective Programming,” Judith L. Evans describes the Effectiveness Initiative (EI), a 5-year, qualitative study of ten ECD programs. The aim is to better understand why pro- grams are effective for diverse participants, communities, and cul- tures. By examining the context of the ten programs in depth, the participants are “mapping” the dimensions of effectiveness and iden- tifying patterns of effectiveness across settings. Evans describes the ten programs; the organization, assumptions, and status of EI; the qualitative research tools that are being used (e.g., structured ques- tions, analogies, storytelling, interviews); and the qualitative research strategy adopted (i.e., embedded communications). She notes the ad- vantages of qualitative research for discerning and describing differ- ences, identifying patterns, gaining intuitive understanding, focusing on process, and validating programming decisions. Evans urges that qualitative reviews and evaluations be built into all ECD efforts to en- sure that scarce resources are invested wisely in effective programs. In the next chapter, Louisa B. Tarullo focuses on one U.S. program, Head Start. In “Effective Early Childhood Programs: The U.S. Head Start Experience,” Tarullo describes the program’s initiative of pro- gram performance measures, launched in 1995, and the Family and Child Experiences Survey (FACES), a central part of the initiative. 12 Mary Eming Young Data collected in the survey are being used to assess outcomes and re- fine the overall program. The conceptual framework for measuring program performance links process and outcome measures for Head Start children and families. Tarullo depicts the framework in pyramid form. The ultimate outcome measure is “child’s social competence,” and five objectives are identified to support this outcome. Multiple performance measures are defined for each objective. Tarullo also de- picts the study design for FACES and reports key findings from the 1997–98 follow-up. The data show that Head Start can enhance chil- dren’s growth and development; strengthen families as primary nur- turers of children; provide high-quality educational, health, and nu- tritional services to children; and improve children’s outcomes (e.g., higher vocabulary scores). These data have been used to document and communicate Head Start’s effects to the legislature and public and to improve the program further. Tarullo notes that the data are important evidence of the value of investments in early child development. In “Elements of Quality in Home Visiting Programs: Three Ja- maican Models,” Kerida Scott-McDonald notes the overwhelming disadvantages of neglect, abuse, and inappropriate care experienced by young children in poor Jamaican communities. She comments that, for the one in three children under age 4 who live in poverty in Jamaica, home-based early childhood programs offer perhaps the greatest hope of breaking the cycle of poverty. Scott-McDonald com- mends Jamaica for achieving 85 percent preschool coverage for all 4–5 year olds, but notes that day-care coverage for infants and chil- dren from birth to age 3 is only about 14 percent. She identifies and describes twelve elements of quality in three home visiting programs in Jamaica that are increasing poor families’ access to ECD interven- tions and, ultimately, building social capital. Scott-McDonald also comments on issues and concerns that still need to be addressed in Jamaica. She concludes that the greatest overall challenge for the home visiting programs is to ensure full institutionalization. Scott- McDonald argues that formal programs are too expensive for poor families and may be culturally irrelevant or insensitive to families’ Introduction and Overview 13 needs. She emphasizes that public-private partnerships are needed to take the home-based programs to scale and to integrate them into the nation’s delivery of social services. The Private Sector’s Influence on the Public Sector In part IV, two chapters consider the private sector’s involvement in early child development. In “Role of the Private Sector in Early Child Development,” Robert G. Myers illuminates the important and sig- nificant role that the private sector can have in improving children’s development. He clarifies the terminology used to refer to early child development, presents six arguments for societies to invest in ECD programs and the implications for the private sector, and defines and depicts the dimensions and components of the private sector as relat- ed to early childcare and education. The broad view of the private sector adopted by Myers includes small, medium, and large business organizations; the variety of social organizations (e.g., community groups, nongovernmental organizations and private voluntary orga- nizations, churches, philanthropies), and private individuals. These components can, and do, provide or support various ECD services, training, and materials. Myers goes on to review the reasons given for advocating private versus public care and education (e.g., availability of resources, cost-effectiveness, accountability, quality, equity) and suggests ways for increasing private-sector involvement in early childhood activities. He notes that the opportunities for becoming involved are many, and he encourages two components, business or- ganizations and adults without children, to become much more in- volved in early childcare and education. In “Communities Can Make a Difference: Five Case Studies,” Simone Kirpal highlights the role of communities in early child de- velopment. She presents five examples of ECD programs around the world that give priority to extensive involvement of the local com- munity, to create ownership and assure successful, cost-effective, and sustainable programs. The cases exemplify how effective ECD pro- grams can involve local communities to achieve sustainability and how private-public partnerships can enhance the potential for taking 14 Mary Eming Young the programs to scale. The five cases are the Montessori Preschool Project in Haiti; the Mother-Child Day Care Center Services in Uganda; SERVOL in Trinidad and Tobago; the Aga Khan Founda- tion’s efforts in Kenya, Uganda, and Zanzibar (the Madrasa Resource Centers) and in Pakistan (Improving Pre- and Primary Education); and the Step by Step program in Central and Eastern Europe, the Former Soviet Union, Haiti, Mongolia, and South Africa. In her in- troduction to the cases, Kirpal describes seven essential features of a successful ECD program. These include a child-centered approach, parental involvement and family support, community ownership, cultural and financial sustainability, training and capacity building, integration within a broader development framework, and private- public partnership. She notes that the goal of any community devel- opment program should be to enable a process that will be main- tained after outside funders leave. Involving communities from the outset and adopting a partnership approach that emphasizes the full participation of parents, families, and community members are nec- essary to begin this process. Investing in the Future: Action and Policy The two chapters in part V move the discussion to another level, from reviewing the data available to taking action and making policy. In the first chapter, Enrique V. Iglesias and Donna E. Shalala plead for a focus on children who are most vulnerable—the poor and disad- vantaged. Derived from their keynote addresses at the conference, “Narrowing the Gap for Poor Children” relates how poverty is trans- mitted between generations and the steps that can be taken to break the cycle. Iglesias and Shalala urge communities and government to work together and to combine their resources to intervene effectively. The U.S. Head Start and Early Head Start programs are cited as an ex- ample of programs that are providing important lessons about gov- ernment-sponsored, community-based early child development. Igle- sias and Shalala argue that even modest investments in programs that involve parents, schools, and local health organizations can have broad impact for society, by breaking the cycle of poverty and Introduction and Overview 15 lessening related effects such as violence, criminal behavior, and mental illness. They list six lessons from the Head Start experience: The earlier intervention begins, the better; quality counts; quality early childhood education begins with teacher training; parents must be involved and accommodated; early childhood education must be integrated with other needs; and government should make early childhood education a national laboratory and catalyst for change. Iglesias and Shalala conclude that the most important reason for in- vesting in programs such as Head Start or quality childcare is to “even up the odds” for poor children. They emphasize that the time has come to narrow the gap between what can be done and what is being done for poor children. In the final chapter, Eduardo A. Doryan, Kul C. Gautam, and William H. Foege address “The Political Challenge: Commitment and Cooperation.” Derived from their remarks on the political and policy aspects of early child development, made at the conference, this chapter considers the societal benefits and constraints to invest- ing in ECD programs and the political challenge for doing so. The authors emphasize that society can be transformed through ECD ef- forts that help realize the human potential, assure and protect hu- man rights, foster democracy, and reduce poverty. They note that political decisions favoring early child development may be thwart- ed by the immediate costs of ECD programs (in contrast with the long-term gains, well after politicians have left office) and difficulties in integrating ECD programs into other services provided by differ- ent government agencies or sectors. The distance and time between a decision and an effect are highlighted as two barriers to good deci- sionmaking. Doryan, Gautam, and Foege emphasize that, despite these constraints, government has an essential role to play in early child development and that policymakers must consider the power, position, and perception of all stakeholders when designing or im- plementing ECD programs. They cite six steps for effective govern- ment action and five “rules” for investing a nation’s resources in ear- ly child development. They agree that the time to act is now, and they urge the building of a global coalition to capture the enthusi- 16 Mary Eming Young asm of communities, the commitment of political leaders, and the passion of donors for early child development. Conclusion ECD programs are fundamentally about providing all children, who are born unknowingly into the game of life, a fair chance to succeed. Even by age 3 or 6, so many children are faced with so many obsta- cles. The field of play for them is not level and, for a lifetime, they will struggle uphill. Despite malnutrition, disease, neglect, and abuse, they strive to live and want to learn. Is this fair? Cannot the world of- fer them more? Most parents do their best to help their children have a fair chance in school and at work. But many parents themselves need help, for they are struggling too. Communities, governments, and societies can band together to give all children and families a fair chance—to provide the childcare and education programs needed for those with- out them, to provide assistance for families to benefit from them, and to make sure that all programs are of high quality and effective. As the world becomes more complex and the marketplace becomes even more global, nations need to ensure their survivability by looking af- ter their children so that both can participate and compete effectively in the world economy. How is equal opportunity created? In most countries, education is the great equalizer, but only if all children have equal opportunities to take advantage of education. Children who live in poverty in any country do not have equal access. If educational facilities are avail- able, they are of lesser quality than in more affluent areas, and poor children often have to forego education to work and bring income into the family. Many poor children do not even have family support and are on the streets earning their own way at very early ages. Market reforms make physical and human capital assets more valuable, which poor families all too often do not have. Govern- ments must be called upon to supplement these conventional reforms with more aggressive policies and programs to augment the Introduction and Overview 17 assets of the poor and to ensure that they too can exploit new market opportunities. Placing a premium on policies and programs targeting early childhood is an obvious first choice because these efforts engen- der a lifetime of improvement for the children and families benefit- ing from them. The poorer the families are, and the more unequal the society is, the greater need there is for governments to channel taxes and other public resources to ECD interventions that can stop the intergenerational transmission of poverty, which undermines the development of any nation (Birdsall 1999). Each country in the world needs to invest in the future of its chil- dren, and the private sector must participate in this investment. Pri- vate businesses and organizations have important roles to play and can influence government to take the right steps. Targeted invest- ments in early child development by private-public partnerships will help prepare all children to learn and succeed and to develop into healthier, more productive adults. Continued evaluation of the effectiveness of ECD programs will provide the guidance needed for making good investments. The monitoring and evaluation of programs for their efficacy, efficiency, and benefit-cost furnishes critical information for making policy de- cisions about which types of programs to support and which commu- nities or populations to target. As with any investment, financial costs will be weighed against potential benefits and feasibility of im- plementation. The challenge ahead is to fund ECD programs that can cost-effectively improve the lives of children and families at risk. In his closing remarks at the conference, Foege specifically chal- lenged the international community to deliberately plan a global coalition to fund ECD initiatives that would promote, measure, and improve children’s well-being. This coalition could be assembled similar to the new Global Alliance for Vaccines and Immunization and would include, in each country, a focal responsibility for child development. By placing children at the center of the global agenda to reduce poverty, we can “be the first generation to think both as nationals of our countries and as global citizens in an ever-shrinking and more 18 Mary Eming Young connected planet”—an opportunity and a challenge for us recently noted by James D. Wolfensohn (2001). As he eloquently states, “Our children will inherit the world we create. The issues are urgent. The future for our children will be shaped by the decisions we make and the courage and leadership we show today.” References Acheson, D. 1998. Independent Inquiry into Inequalities in Health: Report. London: The Stationery Office. Barros, R.P. de, and R. Mendonça. 1999. Costs and Benefits of Pre-school Education in Brazil. Background study commissioned to IPEA by the World Bank. Rio de Janeiro: Institute of Applied Economic Research. Birdsall, N. 1999. Investing in Children: The Role of the State in Unequal Societies. Remarks presented at a seminar on Breaking the Poverty Cycle: Investing in Early Childhood, Annual Meeting of the Boards of Governors of the Inter-American Development Bank and the Inter-American Investment Corporation, Paris, France, March 14, 1999. [www.iadb.org/sds/soc] Case, R., S. Griffin, and W.M. Kelly. 1999. Socioeconomic Gradients in Mathematical Ability and Their Responsiveness to Intervention during Early Childhood. In D.P. Keating and C. Hertzman, eds., Developmental Health and the Wealth of Nations. New York: Guilford Press. Chaturvedi, E., B.C. Srivastava, J.V. Singh, and M. Prasad. 1987. Impact of Six Years Exposure to ICDS Scheme on Psycho-social Development. Indian Pediatrics 24:153–60. Cynader, M.S., and B.J. Frost. 1999. Mechanisms of Brain Development: Neuronal Sculpting by the Physical and Social Environment. In D.P. Keating and C. Hertzman, eds., Developmental Health and the Wealth of Nations. New York: Guilford Press. Fogel, R.W. 1999. Catching Up With the Economy. American Economic Review 89(1):1–21. Introduction and Overview 19 Giedd, J.N., J. Blumenthal, N.D. Jeffries, F.X. Castellanos, H. Liu, and A. Zijdenbos. 1999. Brain Development during Childhood and Adolescence: A Longitudinal MRI Study. Nature Neuroscience 2(10):861–3. Karr-Morse, R., and M.S. Wiley. 1997. Ghosts from the Nursery: Tracing the Roots of Violence. New York: Atlantic Monthly Press. McCain, M.N., and J.F. Mustard. 1999. Early Years Study: Reversing the Real Brain Drain. Toronto: Publications Ontario. Ramey, C.T., F.A. Campbell, M. Burchinal, M.L. Skinner, D.M. Gardner, and S. L. Ramey. 2000. Persistent Effects of Early Childhood Education on High-Risk Children and Their Mothers. Applied Developmental Science 4(1):2–14. Ramey, C.T., and S.L. Ramey. 1998. Prevention of Intellectual Disabilities: Early Interventions to Improve Cognitive Development. Preventive Medicine 27:224–32. Rutter, M., H. Giller, and A. Hagell. 1998. Antisocial Behavior by Young People. Cambridge: Cambridge University Press. Shore, R. 1997. Rethinking the Brain — New Insights into Early Development. Families and Work Institute. New York, N.Y. Tremblay, R.E. 1999. When Children’s Social Development Fails. In D.P. Keating and C. Hertzman, eds., Developmental Health and the Wealth of Nations. New York: Guilford Press. Willms, D. 1999. Quality and Inequality in Children’s Literacy: The Effects of Families, Schools, and Communities. In D. P. Keating and C. Hertzman, eds., Developmental Health and the Wealth of Nations. New York: Guilford Press. Wolfensohn, J.D. 2001. The Challenges of Globalization. The Role of the World Bank. Address to the Bundestag. Berlin, Germany, April 2, 2001. World Bank. 2000. World Development Report 2000/2001, Attacking Poverty. New York: Oxford University Press. Young, M.E., ed. 1997. Early Child Development: Investing in our Children’s Future. International Congress Series 1137. Amsterdam: Elsevier Science B.V. Part I The Benefits of Investing in Young Children Chapter 2 Early Child Development and the Brain—the Base for Health, Learning, and Behavior Throughout Life J. Fraser Mustard For most mammals that have been studied in detail, the conditions influencing physical development and behavior in the early stage of life have a significant effect on the later stages. Although the impor- tance of the early years of life for the health and coping skills of many mammals has been recognized, the importance for human de- velopment and health is still controversial (Bruer 1999; Kagan 1998; Keating and Hertzman 1999). The emerging understanding of the in- fluence of the social and physical environment (water quality, secure physical environment, good nutrition, and excellent nurturing) in the early years of human development on risks for physical and men- tal health problems and competence and coping skills in adult life has led to proposals that investments in mothers and children will re- duce inequalities in development and health in adult life (Acheson 1998; Keating and Hertzman 1999; McCain and Mustard 1999). This knowledge, coupled with the increasing evidence that the early period of child development affects cognition, learning, and behavior in the later stages of life (Keating and Hertzman 1999; McCain and Mustard 1999; Wickelgren 1999), is creating a broader consensus about the fundamental importance of the early years of 23 24 J. Fraser Mustard development. Much of this evidence comes from research in the nat- ural and social sciences involving historical studies, neuroscience, ge- netics, longitudinal studies of birth cohorts, population epidemiolo- gy, cross-sectional studies, and randomized trials of the effects of improved support for early child development on later stages of life. One of the challenges is to combine the knowledge from the nat- ural sciences and the social sciences. In his book Consilience: The Uni- ty of Knowledge, Wilson (1998) sets out the difficulties of integrating knowledge about humans from the natural and social sciences when the interpretation involves the beliefs and values of a society and the different frameworks, beliefs, and cultures of intellectual disciplines. This chapter addresses early child development and health, compe- tence, and coping skills in adult life from the perspective of various disciplines in the natural and social sciences. The sections present historical evidence, research findings from biological and animal studies and from epidemiological and longitudinal studies in hu- mans, and a case example of a new early child development (ECD) initiative in Canada. Historical Evidence One of the striking changes in Western countries has been the effect of the industrial revolution on the prosperity and health of popula- tions in these countries. Fogel (1994), McKeown (1976), and others (Steckel and Floud 1997) have tried to assess the cause of the remark- able decline in mortality following the start of the industrial revolu- tion. In his study of Great Britain, McKeown (1976) estimates that direct public health measures account for about 25 percent of the reduction in mortality rate, and he concludes, by exclusion, that improved health was largely related to improved nutrition resulting from the gradual increase in prosperity and food production and distribution. His conclusion is controversial (Szreter 2000). However, Fogel (2000), in a broader and deeper assessment of a number of Western coun- tries, also concludes that better nutrition, largely resulting from the Early Child Development and the Brain 25 industrial revolution and improved prosperity, is the main factor causing the fall in mortality rates. In his analysis, Fogel (2000) finds that life expectancy improved as the mean heights of populations increased. Because nutrition during early childhood (including in utero) has a major effect on adult height (Floud, Wachter, and Gregory 1990), Fogel concludes that the increase in life expectancy is related to improved conditions for early childhood. He speculates that conditions during early childhood af- fected the risks for health problems in adult life. Obviously, other changes besides improved nutrition, such as reduction in family size, affected early child development during this period. Reduced family size could have led to reduced risk of childhood infections and, possi- bly, better nurturing of young children by parents (Reves 1985). This historical evidence shows a relationship between economic growth and improved health that is not due to health care and is only partially explained by conventional public health measures. The relationship, however, is linked to the improved outcomes for chil- dren associated with more prosperous societies. Being an economic historian, Fogel also considers the effect of a healthier, more competent population on economic growth. He con- cludes that much of the economic growth in developed countries in association with the industrial revolution was a consequence of the better quality of the population. He estimates that the improved quality of the population may have accounted for as much as 50 per- cent of the economic growth in the United Kingdom following the start of the industrial revolution (Fogel 2000). This evidence indicates a relationship between technological innovation, economic prosperi- ty, changes in the social environment and the health and well-being of populations and the effects of populations’ improved health and well-being on economic growth. In his recent book, Fogel (2000) dis- cusses the ways new knowledge and technological innovation are producing major economic and social changes in societies today and the potential effects of these changes on populations. The historical evidence leaves two unresolved questions: How does early life affect human development and the risk for physical and 26 J. Fraser Mustard mental health problems in adult life? And, what biological pathways are involved and how do the conditions of early child development affect these pathways? Research Findings Human and animal studies provide substantial evidence of the effects of nutrition and experience in the early years on brain development and competence, coping skills, behavior, and health later in life (Acheson 1998; Gunnar 1998; Hales 1997; Keating and Hertzman 1999; Lucas, Morley, and Cole 1998; McCain and Mustard 1999; McEwen 1998; Meaney and others 1996; Selye 1936, 1976; Suomi 1997). New knowledge about the development of the brain in early life and its effects on all aspects of body function, through pathways involving the endocrine systems, the immune system, and mental processes, is providing clues about other biological pathways (Francis and others 1999; Gunnar 1998; Keating and Hertzman 1999; McEwen 1998). The biological evidence supports the hypothesis that brain development in early childhood is a factor influencing health, learning, and behavior throughout the life cycle. Biological Pathways Biological studies provide intriguing evidence of the relationship be- tween brain development and experiences in early childhood. Clues about this relationship are found in pertinent studies of the brain/hormone pathways, sensory pathways (e.g., the visual cortex), and stages of brain development in humans. Brain/Hormone Pathways Understanding of the hypothalamus-pituitary-adrenal gland (HPA) system and the autonomic nervous system and stress has grown ex- ponentially since the work of Selye (1936). The development of these systems in early life and their effects on brain function and other im- portant pathways in the endocrine and immune systems are now bet- ter understood through studies of psychoneuroendocrinology and Early Child Development and the Brain 27 psychoneuroimmunology. Basically, external or internal sensory stimuli to the brain can, through the HPA system, lead to increased production of corticosteroids (sterols) and activation of the autonom- ic nervous system. Sterol levels and their duration in the blood affect all body systems and organs, including the brain. The brain regulates sterol levels in the blood through a feedback system involving the hypothalamus. Regulation of the release of corticotropin-releasing hormone (CRH) from the hypothalamus not only affects the HPA pathway, but also the hippocampus and other pathways involved in the limbic system (McEwen and Seeman 1999). A critical question is: How is the regulation of the CRH pathway set? The hippocampus and hypothalamus have steroid receptors that are important in a number of aspects of brain function influencing behavior, loss of cognitive function, memory loss with aging, sub- stance abuse, and suicide (Gunnar 1998; Francis and others 1999; McEwen and Seeman 1999; Selye 1936). Studies in newborn rat pups indicate that external and internal stimuli during early life can set the sensitivity and regulation of the CRH-HPA system (Francis and others 1999; Gunnar 1998; McEwen 1998; Meaney and others 1996). Some of the regulation appears to be mediated by the effects of stimuli, including sterols, in activating genetic components in the neurons in the hippocampus and hypothalamus that are part of the process for determining cell differentiation and function in early life. Sterols regulate gene expression by several pathways involving activa- tion of specific genes and via regulation of RNA transcription. Under- standing of the influence and sustained effects of variations in envi- ronmental conditions (experience) on the development of neural systems, at both the level of gene expression and synaptic develop- ment, is growing. Some investigators are exploring how changes at sites that regulate the transcription of genes may serve as a mecha- nism for long-term effects on neuron function. Stimulation of the CRH-HPA pathway can occur through at least three routes: by endogenous factors from the circulation such as those associated with illness; by direct stimulation from visceral sens- ing systems (e.g., pain and blood pressure); and by stimulation of the 28 J. Fraser Mustard hypothalamus through the brain’s external sensing systems (e.g., vi- sion, touch, sound, smell). The hippocampus is an important struc- ture because of its involvement with the limbic hypothalmic pitu- itary adrenal cortical (LHPA) system and the prefrontal cortex (Dettling and others 2000; Francis and others 1999; McEwen and See- man 1999). The hippocampus influences memory, learning, and be- havior. Chronic high levels of sterols can cause loss of neurons in the hippocampus, with effects on memory and behavior (McEwen 1999; Sapolsky 1992, 1997). Animal studies impressively demonstrate that early experiences (stimulation) influence the development of these brain pathways and affect the response of these pathways to internal or external stimulation later in life. McEwen and Schmeck (1994) summarize this dynamic interaction, the effects of early experiences, and the function of the CRH-HPA pathway as follows: “All this means that while the brain evokes hormones and their multi- tude of effects, the tide of hormone affects the brain too. The implica- tions are profound; individual differences in experience are translated into differences in brain function, even brain structure; that is what makes the situation so complex, so difficult to resolve into such tidy simplicities as nature versus nurture. Early life experiences and the hormone exposures that are determined by the brain’s reactions to those experiences provide cues that will change the way the brain re- sponds to new experiences in the future” (McEwen and Schmeck 1994, p. 178). Much of the evidence from both human and animal studies that now relates early experience to physical and mental health problems later in life points to the CRH-HPA pathway (Francis and others 1999; McEwen 1998, 1999; McEwen and Schmeck 1994; McEwen and See- man 1999; Sapolsky 1997). The exceptional work of Barker and col- leagues (Barker 1992, 1997; Phillips and others 1998) in relating birthweight and length of gestation to health in adult life shows the “long reach” of conditions in utero and early life to adult conditions such as coronary heart disease, high blood pressure, noninsulin- Early Child Development and the Brain 29 dependent diabetes, reduced immune function in later stages of life, and obesity. Experiments in a variety of animals confirm the link be- tween intrauterine growth retardation and hypertension and meta- bolic disorders. Recently, Barker’s group (Phillips and others 1998) found that plas- ma sterol levels in 64-year-old men were inversely related to their birthweight. The higher plasma sterol levels found in men with a low birthweight in relation to gestational age were significantly associat- ed with higher blood pressure, plasma glucose levels, and insulin re- sistance. Barker’s group concludes, as does Meaney’s group from stud- ies with rats, that the CRH-HPA axis can be programmed in utero (Phillips and others 1998; Smythe and others 1994). Thus, the development and regulation of the CRH-HPA pathway in early life, resulting from external and internal stimuli received in utero and shortly after birth, influence the regulation and function of this pathway throughout the life cycle. Because this pathway can af- fect memory, cognition, behavior, metabolic pathways, the immune system, and the cardiovascular system throughout life, the develop- ment of brain function in early life is very important. In addition, ev- idence indicates that the response of the autonomic nervous system, which is more difficult to study, is also influenced by conditions in early life, probably related, in part, to the development of the limbic HPA system (Francis and others 1999). Sensory Pathways Another set of brain pathways influenced by conditions in early life is the wiring and sculpting of the regions of the cortex that connect to the sensing systems (e.g., vision, touch, sound, smell). The neurons in the different sensing parts of the brain cortex that differentiate in response to signals received in early life influence how well individu- als recognize the world around them and respond to inputs from the sensing organs. Groundbreaking research on vision (Cynader and Frost 2000; Hubel and Weisel 1962) shows a sensitive period during the early stages of development when vision neurons in the occipital cortex of the brain are most sensitive to the wiring and sculpting of 30 J. Fraser Mustard neurons necessary for normal vision. As with the CRH-HPA system, during a sensitive period in early development, stimuli from the reti- na of the eye switch on the genetic machinery in the neurons in the occipital cortex to enable them to differentiate for their function in vision. In animal studies, if the sensitive period is missed, turning on the genetic mechanism is difficult. Despite different interpretations of this work by nonspecialists, one neuroscientist (Cynader 2000) in the vision field recently clearly stated the implications of this research: “Studies of the plasticity of the visual cortex during the critical period of postnatal development are particularly germane in light of recent controversies about the importance of early childhood experience in determining cortical competency in adults. These controversies— which have profound implications for early childhood education, par- enting, and childcare—have been characterized more by polemics than by neuroscience research. The visual cortex represents the best model that we have for understanding how sensory stimulation of the early brain influences brain circuitry and function throughout life. Its study should increase our knowledge of the ways in which early sen- sory inputs determine the long-term capabilities of the brain” (Cynad- er 2000, pp. 1943–44). The evidence from animal and human studies is consistent with the conclusion that the wiring and sculpting of the brain is most dy- namic during the early years of life and is substantially affected by the quality of nurturing or stimuli received during this period of de- velopment. These effects are not “all or nothing,” however, at least as indicated by the experimental results on vision. Still, the longer the period before signals from the eye reach the visual cortex in a young child, the poorer the individual’s visual acuity will be in adult life (Cynader and Frost 2000). That is, this component of the brain will not function as well as it could if normal signals from the eye had passed to the visual cortex during the sensitive period for the wiring and sculpting of neurons. Early Child Development and the Brain 31 The same relationship holds for other sensory pathways such as sound and touch (Cynader and Frost 2000; Hyman 1999). All of the research demonstrates that substantially improving the relevant wiring and sculpting for the sensing pathways is difficult later if the brain’s sensing system does not develop during the optimum period. Evidence is increasing for the interconnection of sensing path- ways, such as vision, with other key centers in the brain (Rauschecker 1999). Although relatively less is known about the development of neural pathways to other parts of the brain that affect arousal, emo- tions, behavior, language, and mathematical skills, some neuroscien- tists speculate that the wiring and sculpting of these pathways devel- op in a similar way to the sensory systems (Cynader and Frost 2000; Hubel 1994; Le Doux 1999). Recent evidence about the “cross-modal exchange” of different sensing systems with each other and other parts of the brain provides a framework for understanding the lasting effects of the development of these pathways in early life. Stages of Development Recent noninvasive studies of human brain development demon- strate that some structures develop earlier than others and that brain development is most active in the early years of life. By the second decade, this activity declines to approximately the values in adult life (Chugani, Phelps, and Mazziotta 1987; Huttenlocher 1994). Findings suggest that some developments occur early (e.g., sensing pathways such as vision, sound, touch; cross-modal connections; CRH-HPA pathways), whereas other pathways develop later (e.g., literacy, math- ematics) and are likely influenced by the earlier base (Case 1996; Cy- nader and Frost 2000; Hyman 1999). Some complex developments, such as behavior, emotion, and arousal, may be influenced at differ- ent stages. Fortunately, the hippocampus, a key structure for memo- ry, remains plastic throughout life and can generate new neurons (Kandel 1999; Kempermann and Gage 1999). However, evidence from studies of the effect of experiences in early life on the develop- ment and regulation of the CRH-HPA pathway and cortisol levels in- 32 J. Fraser Mustard dicates that a poor early environment can lead to poor regulation of cortisol, which can negatively affect the development, function, and regeneration of the hippocampus throughout life. Researchers are currently pursuing strategies to influence gene ex- pression at later stages of development to overcome, or at least par- tially overcome, the failure to establish appropriate gene expression in early stages of development (Cynader and Frost 2000; Smythe and others 1994). Animal Studies Much of the understanding of human physiology and disease and many of the technologies for diagnosis and treatment come from animal studies. Currently, scientists are experimenting with the transfer of animal tissue to humans to alleviate health problems, in- cluding some brain disorders. Because of cultural, philosophical, and other factors, many investigators resist attempts to apply knowledge from animal experiments to an understanding of brain function and development in humans. Some reservation about the relevance of animal studies to humans is sensible, but to ignore the core information is a mistake, partly because studies in animals can reveal how various organs of the body, such as the brain, develop and interact at cellular and organ levels throughout life. The perti- nent research for early child development includes studies of devel- opment and function, gene–environment interactions, and im- mune effects. Development and Function In a number of studies with mice, rats, and monkeys (Black and oth- ers 1998; Coe 1999; Greenough, Volkman, and Juraska 1973; Meaney and others 1988), researchers have examined the effects of early life events on brain development and brain characteristics and function later in life. The evidence from these and other studies in animals shows that the circumstances of early life influence brain develop- ment and that this early development affects behavior, learning, health, and memory in later life. Early Child Development and the Brain 33 Data from rats show a number of interesting observations relating developmental neurobiology to function. Rat pups given an enriched animal cage (toys to play with) and involved with their mother show clear benefits. In contrast to pups that are not given enriched housing, the animals, as adults, have more neurons and more neural connec- tions (an outcome of brain wiring and sculpting) and perform better on tests of rat competence. Greenough and colleagues note that adult rats exposed to a similar, enriched environment also exhibit new neu- rons and increased neural connections (Black and others 1998). How- ever, the changes occur faster and are greater in young rats. Other studies show that rat pups that are licked intensively by their mothers in early life develop a regulatory control for their CRH- HPA axis that provides a more balanced response to stimuli (i.e., low- er sterol levels and a faster return to lower baseline values) (Francis and others 1999; Meaney and others 1996, 1988). One of the striking features shown in these studies is that well-licked rat pups have better memories as they age. Also, the loss of hippocampus neurons was less in these rats as they aged, which is compatible with the observation that excess sterol levels can cause loss of neurons in the hippocampus (Sapolsky 1992, 1997). In sum, rat pups with much touch (licking from their mother) have a better regulated CRH-HPA pathway and re- tain better memory and cognitive function as they age. In one interesting study in rats, Francis and others (1999) crossed foster pups from mothers that groomed and licked intensely with pups from mothers that had low licking and grooming behavior. The results showed that, regardless of the biological mother, pups placed with “good” mothers developed CRH-HPA pathways similar to rats from, and reared by, these mothers. The female pups from “poor” mothers, reared by “good” mothers, had the same biological and mothering characteristics as the mothers that reared them. Gene–Environment Interactions The early life and development of monkeys have been studied exten- sively. In one set of experiments (Suomi 1997, 2000), rhesus monkeys were grouped into genetically vulnerable and resistant strains. The 34 J. Fraser Mustard genetically vulnerable strain was characterized as hyperreactors to stress or challenge. If not raised by a nurturing mother, these mon- keys have an overstimulated CRH-HPA system with exaggerated corti- sol responses and poor return to resting levels. These vulnerable ani- mals, poorly nurtured when young, show avoidance of novel stimuli as well as anxious and depressive reactions to maternal separation. As adults, they show increased anxiety and depressive behavior, exces- sive alcohol consumption when given access to alcohol, impulse ag- gression and violent behavior, and high circulating sterol levels. The females tend to be poor mothers. Researchers have studied in detail the biological pathways in these animals, which show high sterol levels in response to mild stress, high resting sterol levels, low brain serotonin levels, and a disrupted circadian rhythm for sterols. When offspring from “poor” mothers in the vulnerable strain are taken and reared by highly nurturing moth- ers (Suomi 1997, 2000), the high-risk infants become secure and pre- cocious in their exploratory patterns. As adults, they rise to the top of the social hierarchy; have a robust immune response, a better regulat- ed sterol pathway, and normal brain serotonin levels; and the females become very nurturing mothers. Researchers have found a genetic characteristic related to sero- tonin metabolism in the vulnerable monkeys (Bennett and others 2000; Suomi 2000). If poorly nurtured, the animals with the short al- lele have excess sterol responses to stimuli and low brain serotonin levels; if well nurtured, the animals do not show these adverse re- sponses (Suomi 2000). This finding exemplifies the effect of environ- ment on gene expression. Immune Effects One of the important effects of the HPA system is on the immune system. Excess activity of the CRH-HPA system with increased sterol levels in early life can produce permanent and marked reductions in immune competence (Coe 1999; Suomi 2000). The effect of sterols on the immune system is complex; for example, a strong CRH-HPA response can be beneficial in bringing an acute illness Early Child Development and the Brain 35 under control. Studies also show that infant monkeys reared in a deprived environment exhibit changes in antibody function that can increase their risk of autoimmune disorders and conditions such as asthma. Human Studies Epidemiological randomized social experiments, longitudinal stud- ies, and observational studies in populations indicate how early life experiences affect a child’s health, learning, and behavior. This expe- rience-dependent early development is influenced by nutrition, par- enting capability, and other factors that support early child develop- ment. The studies clearly demonstrate the value and benefit of good ECD programs involving parents. Environmental Effects Population-based, epidemiological studies in developed countries document the social partitioning of health, learning, and behavior. The studies show a gradient relationship between measures of health, cognition, and behavior and socioeconomic status (SES) (Bennett and others 2000; Case, Griffin, and Kelly 1999; Hertzman 1999; Macin- tyre 1994; Marmot and others 1995; Power and Hertzman 1999; Willms 1999). Individuals at the bottom of the SES index (levels IV and V) have the lowest scores, and those at the top of the index have the highest scores. Several points are of interest. First, the gradients for health, learning, and behavior in developed countries tend to be linear (i.e., there is no poverty threshold). Sec- ond, the gradient cannot be explained solely by genetics; the social environment clearly has an effect. Third, some countries have high performance and fairly flat gradients. Fourth, in developed countries, the greatest number of children in difficulty are in the large middle class. For example, Canadian data show that about 32 percent of chil- dren in poor families and more than 20 percent of children in afflu- ent families do not develop well in the early years (McCain and Mus- tard 1999). The cause of these gradients, or social partitioning, of populations is not just family income. 36 J. Fraser Mustard Understanding the pathways for the social environment’s effect on health, learning, and behavior is a challenge. The evidence from lon- gitudinal studies supports brain development as being a contributing factor, which involves the establishment of pathways that influence learning, behavior, and physical and mental health throughout life. Power and Hertzman (1999) refer to this process as “biological em- bedding,” a concept that relates the environment of early life to the switching on of genetic mechanisms responsible for differentiation of the specific function of neurons in different regions of the brain. Longitudinal studies of cohorts of children from birth to adult life show similar effects of SES gradients for health, behavior, and learning (Case, Griffin, and Kelly 1999; Power and Matthews 1997; Power and Hertzman 1997, 1999; Power and others 1997; Tremblay 1999; Wadsworth 1991). Figure 1 depicts the gradients for academic achievement at age 23 in relation to social class at birth for children from the 1958 British birth cohort. Percentages Reprinted with permission of The Lancet from Power and Matthews (1997). Figure 1. Social Class at Birth and Percent With Education Qualifications (0 Level or Greater) at Age 23, 1958 British Birth Cohort Early Child Development and the Brain 37 with education qualifications improve with each step upward in social class at birth. The figure shows that the percentage of children with no educa- tional qualifications (below 0 level in the British system) at age 23 is highest for children born in the lowest social classes (IV and V) of British society, compared with only 5 percent of children born in the highest social classes (I and II). The percentage with educational qualifications increases at each higher level of social class at birth for both males and females. The gradient is obviously influenced by individuals’ circumstances at birth and their life courses to age 23. Figure 2 shows the gradients for health at age 33 among the same cohort. In the figure, “psychological distress” (as assessed by the twenty-four-item malaise inventory of psychological and so- matic symptoms) relates to future mental health problems, and “poor self-rated health” relates to chronic health problems in later life. The figure shows a gradient for health in relation to social class Reprinted with permission of The Lancet from Power and Matthews (1997). Figure 2. Social Class at Birth and Health at Age 33, 1958 British Birth Cohort 38 J. Fraser Mustard at birth. The gradient for future mental health problems at age 33 is most striking for females. Some aspects of both gradients (future mental health and chronic health problems) may reflect the effect of early life environment on the development of the CRH-HPA pathway, as discussed earlier. The data showing poor self-rated health in the early adult years as a predictor of chronic health problems later in life are compatible with Barker and colleagues’ findings that many chronic health prob- lems of individuals in adult life can be related to conditions during their mother’s pregnancy and the early years of life (Barker 1992, 1997; Phillips and others 1998). The data also agree with the conclu- sion of Acheson’s report (1998) on inequalities in health in the Unit- ed Kingdom—that early child development affects physical and men- tal health problems in adult life. The cohort data in figures 1 and 2 show that children in all social classes are subject to environmental factors that affect health, behav- ior, and learning in early life and that the proportion of children af- fected is greater in the lower social classes. These data, of course, do not take into account the effect of any events during life up to ages 23 and 33. Power, Hertzman, and colleagues have assessed such ef- fects and concluded that a poor early start compounded by a poor life course has the greatest effect on health, behavior, and learning (Pow- er and Hertzman 1997; Power and others 1997). Early Experience and Development Data from other longitudinal studies in other countries show a clear relationship between the early years and competence, coping skills, and health in later years. A Swedish study (Andersson 1992) of a sam- ple of children born in 1975 from low- and middle-income urban households shows that children who attended good ECD centers, which involved parents, before age 1, had the best social skills and cognitive abilities at age 13. Male children entering the school system in Sweden with poor verbal skills tended to be functionally illiterate as teenagers, and a significant number of them ended up in the jus- tice system (Stattin 1993). Early Child Development and the Brain 39 Studies of children in the French Ecoles Maternelle program (Bergmann 1996) show that this program enhances performance in the school system for children from all social classes and that the ear- lier the children entered the preschool program, the better their out- come. A study in the United Kingdom (Osburn and Milbank 1987) shows that children in good half-day preschool programs had better cognitive development and academic achievement than children who were not in these programs and that children from disadvan- taged backgrounds gained more than children from advantaged back- grounds. A striking observation from the longitudinal studies is that female children who are reared in dysfunctional families without external support in the early years are at increased risk for behavior and men- tal health problems in later life (Maughan and McCarthy 1997; Rodgers, Power, and Hope 1997; Rutter, Giller, and Hagell 1998). Many male children reared in dysfunctional families show clear evi- dence of antisocial behavior when they enter the school system, and about one-third of them will be delinquent in their teens (Tremblay 1999). Females show an increased risk for mental health problems, such as depression, in adult life (Maughan and McCarthy 1997; Rodgers, Power, and Hope 1997). These findings hold true for chil- dren in all social classes, and the proportion having difficulties in- creases for those at lower SES levels. Improving Early Child Development: The Effects A number of studies in developed and developing countries have ad- dressed the effects of programs for enhancing early child develop- ment on learning, behavior, and health later in life. Randomized tri- als of social interventions are far more difficult to conduct than randomized trials of medical drugs, and they tend to be small in size. The results of these studies, however, can be tested for consistency with the findings from biological and animal studies and from popu- lation-based epidemiological and longitudinal studies. A few studies demonstrate the effects of enhancing early child de- velopment for poor populations. In Jamaica, Grantham-McGregor 40 J. Fraser Mustard and others (1991, 1997) examined the effects of good nourishment and nurturing on the development of children stunted at birth, in comparison with a normal control group. The stunted children were randomized into four groups, receiving no enhanced nutrition and nurturing, improved nutrition, enhanced nurturing or stimulation, or improved nutrition and nurturing. After 2 years, the group given no support showed poor development; the groups given either im- proved nutrition or stimulation improved about equally and achieved about 50 percent of the development occurring in the con- trol group; and the group given both nurturing and nutrition equaled the development of the control group. This study highlights the val- ue of both nutrition and nurturing on early child development for infants who clearly were at a disadvantage at birth. The mothers of the stunted children in this study did not have a healthy pregnancy, and the children will carry some of the risks at birth identified by Barker (1992, 1997). The results from this study are compatible with those from animal and biological studies. The Carolina, or Abecedarian, project demonstrates the effect of an ECD initiative in a poor African-American population in the United States (Campbell and Ramey 1994; Ramey 1990; Ramey and others 2000). The children, whose mothers had a low intelligence quotient (IQ), were randomized into two groups. One group was placed in an ECD program which involved parents and home visits throughout the years beginning shortly after birth and continuing until the children entered school. The other group, the control, did not partic- ipate. The program was an intensive ECD initiative having one quali- fied early childhood educator for every three infants and toddlers until age 3 and one for every six children over age 3. The children participating in the ECD program showed gains in cognition (including IQ), educational performance, and improved behavior that were still evident at age 21, compared with the control group. The program’s effect on IQ is of particular interest because of a recent review (Wickelgren 1999) which concludes that circumstances during the first years of life appear to affect IQ. The children in the Carolina program also showed significant gains in mathematics Early Child Development and the Brain 41 performance during their school years. At age 21, more than four times as many children who had been in the preschool program were enrolled in 4-year degree programs, compared with children who had been in the control group. Special programs for the control group when they entered the school system did not have a significant effect on their development—further highlighting the importance of the preschool program. The well-known High/Scope Study (Berruta-Clement 1984; Schwein- hart 1993) provides evidence from a randomized study of the effects of an ECD initiative in the United States on children from families in poor socioeconomic circumstances. The children entered the pro- gram at age 3 and continued until they entered the school system at age 6. This program began after the Abecedarian project and operated only during the school year. It involved parents, one early childhood educator for six children, and home visits. At ages 18 to 20, the chil- dren who had attended the preschool program showed better school performance and employment and fewer behavior problems, such as teenage pregnancies and criminal activities. Their assessment at age 27 showed some striking effects. Compared with the control group, fewer females in the intervention were in programs for “educable mental impairment,” and the males in the intervention had far fewer criminal arrests. The results are compatible with (a) increasing evi- dence showing that females in poor early child development envi- ronments are at increased risk for mental health problems in adult life and (b) data showing that overcoming the disadvantages of poor brain development in the very early years is difficult later. The study did not show a sustained effect on IQ, perhaps because it enrolled children at age 3, after the very early years when IQ effects appear to be realized (Wickelgren 1999). Mathematical ability is an example of a development occurring in the immediate preschool period. Programs designed to enhance basic cognitive ability in mathematics at ages 4 to 5 years have an effect (Case, Griffin, and Kelly 1999; Griffin, Case, and Siegler 1994). Case and colleagues examined whether performance in mathematics in school years could be improved through an initiative called Right 42 J. Fraser Mustard Start in the United States. The strategy used, “the cognitive weight of numbers,” draws on multiple sensing pathways and, probably, is in- fluenced by the cross-modal information exchange that the sensing pathways develop in early life. In the study, children in a poor socio- economic neighborhood were randomized into an intervention group and a control group and compared with children in a middle- class school. At age 9, the children participating in the special preschool intervention program surpassed the children in the middle-class school, whereas the children in the control group performed less well than those in the middle-class school. Case spec- ulates that individuals who miss this sensitive period of development may have difficulty with complex mathematics later in life. Case’s findings are compatible with the conclusions of Fuchs and Reklis (1994), who studied the effects of early child development on mathematics performance of students in various U.S. states. Fuchs and Reklis found that a state’s mathematics performance in schools was high when children entered the school system with good early child development and low when early child development was low. They conclude that strong preschool programs are required to im- prove the mathematics performance of U.S. students overall. These results are compatible with the findings from the Abecedarian project and the concept that functions of the brain develop at different stages in the early years. Studies of ECD programs in other parts of the world are beginning to show similar effects. A study in India (Kaul and others 1991) also shows an effect of programs in the early years on subsequent ability in mathematics. A World Bank study (World Bank 2001) summarizes the results of ECD programs in Brazil as follows: increased comple- tion of primary school by one-third, lower grade repetition, and low- er drop-out rates. These results and others from Bolivia (Behrman, Cheng, and Todd 2000) further document that good ECD programs enhance outcomes in learning. Observational Studies. Observational studies also show the benefits of good support in the early years of life. One of the most recent stud- ies (Ames and others 1997) compares the outcome of children from Early Child Development and the Brain 43 Romania adopted into Canadian British Columbia families shortly after birth with children adopted after spending many months or years in Romanian orphanages. The description of these orphanages indicates that they were poor environments for good early child de- velopment. The children adopted shortly after birth exhibit similar development as Canadian-born children in middle-class families, but many of those adopted after spending many months or years in Romanian orphanages have significant behavioral problems, poor attachment to caregivers, and lower IQs than those adopted early. From a detailed analysis of Romanian orphanage studies, O’Connor and others (2000) conclude that children who spent more time in the orphanages before adoption showed persistently poor outcomes. Gunnar and colleagues studied the CRH-HPA axis in Romanian children adopted into British Columbia homes and found that those adopted late have higher sterol levels (Donzella and others 2000; Gunnar 1998; Gunnar and Donzella 1998). These sterol data agree with the results of animal studies showing that a poor nurturing en- vironment in early life can lead to an overactive and poorly regulated CRH-HPA system and elevated sterol levels, with effects on cognition, memory, and behavior. In reviewing the stress-sterol pathway and early childhood, Gunnar concludes that caregivers and parents have a very powerful effect on the development of this pathway in early life through the quality of their nurturing. The data from both ani- mal and human studies on the CRH-HPA axis and its development and effects are remarkably congruent. A study of orphans from Korea (Lien, Meyer, and Winick 1977) adopted into American homes also shows an effect of the quality of the early years on development and performance in later life. All the children adopted into American families early after birth had higher IQ scores than children who had spent considerable time in Korean orphanages before adoption. Those who were well nourished when adopted had the highest scores—again emphasizing the importance of nutrition in the early years. Despite the limitations of the orphanage studies and other possible explanations, all the findings are compatible with the results of 44 J. Fraser Mustard animal studies. The human data indicate the importance of the early years in establishing the base for competence and coping skills throughout life. Literacy A major observation from many studies is the relationship between verbal skills at about age 5 and literacy in later life. SES gradients in literacy may, in part, reflect early child development. Willms (1999) who has been involved in studies of literacy in developed countries, conducted by the Organization for Economic Cooperation and De- velopment (OECD) and Statistics Canada, emphasizes the impor- tance of early childhood, as well as school systems, for literacy. Recent OECD studies of three measures of literacy in OECD coun- tries show that, for all the countries, level of literacy is a gradient when plotted against SES measures such as parents’ level of education (OECD and Statistics Canada 2000; Willms 1999, in this volume). Some countries have a high performance and fairly flat gradient; oth- er countries have a fairly steep gradient. Literacy in later life is related to verbal skills or language development in early life (McKeough 1992; Stattin 1993; Willms in this volume). In the United States, population measures of verbal skills in early life show a fairly steep SES gradient (Brooks-Gunn, Duncan, and Brit- to 1999) compatible with the fairly steep literacy gradient found in the adult population (OECD and Statistics Canada 2000; Willms 1999). The greatest number of children not achieving their possible level of performance is in the middle class, a finding that strongly refutes the claim that few families in the middle class with young children do not have good early child development environments (Bruer 1999). Those who make this claim do not know or believe the findings from population-based, epidemiological studies. The United States has a significant problem because more than 45 percent of the population functions at low literacy (on the OECD scale). Included at this low level are persons with very poor skills who, for example, may not be able to determine from information printed on a package the correct amount of medicine to give a child, Early Child Development and the Brain 45 can only read simple and clearly presented material, and can only perform tasks that are not too complex. Improving early child devel- opment is a serious challenge for U.S. society if it wishes to reduce the inequalities in literacy. In developing countries, such as Chile, more than 85 percent of the population functions at levels 1 and 2 (on the OECD scale). To improve the socioeconomic circumstances of these countries, the World Bank and others must support efforts to improve literacy in written and cognitive performance and to encourage countries to invest in preschools [i.e., “tier 1,”] (McCain and Mustard 1999). Improving the literacy performance of populations will take at least 20 to 25 years if efforts are initiated now. Importantly, the tier 1 preschool initiatives must apply to all social classes (not only those in poverty) because of the evidence showing a gradient relationship be- tween literacy and SES. Interestingly, one country (Cuba) that has in- vested for decades in mothers and children in the early years has a high literacy performance for all of its population regardless of social class (Willms in this volume). A relevant observational study conducted for a number of U.S. states by the Stanford economist Fuchs (Fuchs and Reklis 1994) addressed the relationship between an index of early child develop- ment, readiness to learn at the time a child enters the school system, and the performance of children on a mathematics test at grade eight. The correlation was positive, with a correlation coefficient greater than +0.8. Math performance in the schools was clearly relat- ed to the level of early child development at the time the children entered the school system. Fuchs and Reklis (1994) conclude that investment in preschools for all children is at least equally important as investment in schools, to substantially improve mathematics out- comes in the United States. In addition to Case’s research and the data from population epidemiological studies and the OECD, this evidence refutes the naive assumption that only a small number of children could benefit from good ECD programs (Bruer 1999). The assessments of literacy in developed countries (OECD 2000) and Latin America yield some remarkable results (Willms in this 46 J. Fraser Mustard volume). Some countries show high performance in test areas and fairly flat gradients, and others show much poorer performance across all social classes. The countries with high performance and fairly flat gradients tend to have high-quality preschool programs for children which involve parents. Perhaps because literacy is a measure of brain development and function and brain development affects health, the correlation between estimates of a country’s literacy and life expectancy is strong (OECD 2000). This subject is covered more extensively in the chapter by Willms later in this volume. Early Child Development in Developed Countries: The Case of Canada Early child development is as important for developed countries as for developing countries. Canada is one example. Assessing the Needs In 1998, the Honorable Margaret McCain and the author were asked to chair a reference group and prepare a report on children’s early years in the province of Ontario (McCain and Mustard 1999). The report was addressed to the Premier, the Minister for Children, and the government of Ontario. In preparing the report, the reference group received many anecdotal accounts of children in difficulty in the wealthiest province in Canada and indications that the problem was increasing, but the group could not confirm this information because the government of Ontario did not have a relevant database. Fortunately, the National Longitudinal Survey of Children and Youth (NLSCY) had generated key data on children and youth in Ontario and Canada, from which the reference group could undertake a population assessment of the quality of early child development in Ontario. The survey included measures of verbal skills for children (an im- portant predictor of future development) at ages 4 and 5 years for all social classes. Figure 3 shows a clear gradient for this measure when plotted against families’ SES. Although the children in the poorest circumstances showed the poorest performance, 10 percent of the children from affluent families also did poorly. Also, the children in Early Child Development and the Brain 47 Ontario did not perform as well on the literacy test, at every SES level, as did children in the rest of Canada. The largest number of children not doing well, in comparison with the rest of Canada, were in the middle class. Verbal skill at ages 4 and 5 also is a predictor of subsequent behav- ioral and cognitive development. Not surprisingly, the literacy gradi- ent for youth and young adults in Ontario was steeper than for Cana- da’s three prairie provinces (Alberta, Saskatchewan, and Manitoba) and Quebec. Figure 4 shows the gradient in literacy performance for the popula- tion in Canadian provinces by socioeconomic status (McCain and Mustard 1999). The provinces fall into two groups—those with high performance and shallow gradients (Quebec and the three prairie provinces) and those with relatively steep gradients. The SES scale is similar to that in figure 3. Based on the Peabody Picture Vocabulary Test. Socioeconomic status is a composite measure of family income and mothers’ and fathers’ occupations and incomes; poor are on left, affluent on right. Figure 3. Socioeconomic Gradients of Children, Ages 4 and 5 Years, With Low-Receptive Vocabulary, Ontario and Canada, National Longitudinal Study of Children and Youth, 1994, Canada 48 J. Fraser Mustard An assessment of mathematics performance among Ontario’s chil- dren reveals a similar gradient (McCain and Mustard 1999). Impor- tantly, all these data indicate that a significant number of children from affluent families are not performing at desirable levels, while a higher portion of the children at the low end of the SES scale are also having difficulty. Assessment of the development of Ontario’s children in relation to family income shows that about 32 percent of the children in fami- lies at the bottom quartile of income, and more than 20 percent of the children in families at the top quartile of income, are not doing well. Complete analysis of the data shows that the greatest number of children in difficulty are in the middle class and that income is not the determining factor. Rather, the quality of parenting and care- giving is an important factor influencing the quality of a child’s early development. Based on these findings, the study recommended to SK, Saskatchewan; AB, Alberta; MN, Manitoba; QC, Quebec; ON, Ontario; NB, New Brunswick; NF, Newfoundland; PE, Prince Edward Island; NS, Nova Scotia; BC, British Columbia. Source: McCain and Mustard (1999). Figure 4. Literacy and SES Gradients for Canadian Youth, by Province, 1994 Early Child Development and the Brain 49 the government of Ontario that good ECD and parenting programs beginning early in life should be available for all families with young children in Ontario, if the province is to have a more competent, high-quality population in the future. The findings are additionally significant when related to the results of the literacy studies conducted by OECD and Statistics Canada (OECD 2000). The domains examined in these literacy studies are prose literacy, document literacy, and quantitative literacy. In Canada, more than 40 percent of the population functions at levels 1 and 2 (on the OECD scale) and about 22 percent at levels 4 and 5. In some developed countries, less than 25 percent are at levels 1 and 2 and more than 30 percent are at levels 4 and 5. To improve Canada’s per- formance in the knowledge-based economy, Canada and Ontario must invest in good ECD programs. The data show that developed countries such as Canada, as well as developing countries, need to im- prove their populations’ competence and coping skills for the future. Recommendation: Early Child Development and Parenting Centers The early-years study (McCain and Mustard 1999) recommended that the government of Ontario, in partnership with communities and in- volving the public and private sectors, establish early child develop- ment and parenting centers, to begin at conception and be sensitive to early child and brain development. Figure 5 depicts the framework for these centers. The study specifically proposes that the centers begin support for families before a child is born, because of the importance of the in utero period; include five essential components, or core functions, for young children and their parents, from conception until entry into school (at age 6); and measure their success in improving outcomes for children. The early child development and parenting centers will be guided by the following principles: 1. Available, accessible, affordable, and optional early child devel- opment and parenting centers for all young children and fami- lies in Ontario, from conception to entry into grade one in 50 J. Fraser Mustard the school system (parents may choose to bring their children or not) 2. Centers that are both parent-oriented and child-oriented 3. ECD programs that are environments for children to engage in play-based, problem-solving learning with other children and adults 4. Responsive relationships between adults (early child develop- ment staff and parents) and children that increase the potential of play-based learning 5. Quality programs that teach family literacy and numeracy to parents and other caregivers from diverse cultural, ethnic, and linguistic backgrounds 6. Parenting programs that support parents and other caregivers in all aspects of early child development Source: McCain and Mustard (1999). Figure 5. Proposed Framework for Early Child Development and Parenting Centers for the Province of Ontario Early Child Development and the Brain 51 7. Parent participation in ECD programs that enhance the child’s early learning and optimal development in the home environment 8. Appropriate supports and expertise that are available to allow all children to participate fully, regardless of physical, develop- mental, language, learning, or behavior difficulties 9. Ability to provide special efforts that may be necessary to en- gage some families and children whose circumstances make it difficult for them to be involved in the centers 10. Centers, regardless of location, that are linked to the local pri- mary school and with other institutions (e.g., libraries, recre- ation) and cultural activities in their communities 11. Centers that provide a flexible continuum of services to meet the needs of children and parents at home, work, and school 12. Monitoring of the effectiveness of the centers using a develop- mental readiness-to-learn measure of children when they enter the school system. A measure of early development (Early Development Index), simi- lar to that used by Fuchs and Reklis (1994), has been developed by the Canadian Institute for Advanced Research (CIAR), Human Devel- opment Program, the Founders’ Network of CIAR, and McMaster University (Janus and Offord 2000). Use of this measure in assess- ments of thousands of children as they enter the school system shows that school performance is related directly to the quality of early child development. This sensitive outcome measure can be used to assess the effectiveness of community programs to improve early child development. Ontario’s government and the Minister for Children understand the importance of programs such as these for the community, and they appreciate the enormous importance of early child develop- ment. The minister’s goal is to give the early years of human develop- ment the same importance as the later years (primary, secondary, and postsecondary education), and the government’s plans, which are be- ing introduced in Ontario, are community-based and involve both 52 J. Fraser Mustard the private and the public sectors. The minister is implementing the recommendations of the early-years study (McCain and Mustard 1999). Conclusion All the studies noted herein demonstrate that good ECD programs should be available for all population sectors and that these initia- tives will improve the overall quality of the population and reduce inequalities in health, competence, and coping skills. A key social consideration is that children who have a poor start are at increased risk of antisocial behavior, potentially resulting in increased crime and violence for society. High levels of social disruption impede de- velopment of competitive economies, whereas cohesive, stable soci- eties with reasonable equity in competence and coping skills are best able to adapt to economic and social changes associated with expo- nential growth in knowledge and new technology. The economic benefits of investing in early child development for society and individuals are very great. As economic historians have pointed out, improved health, competence, and coping skills were a significant factor in the economic growth of Western countries after the industrial revolution. Commenting on the value of early child development, van der Gaag concludes in the next chapter in this volume: “Well-executed and well-targeted ECD programs are initia- tors of [human development]. They stimulate improvements in edu- cation, health, social capital, and equality that have both immediate and long-term benefits for the children participating in the programs. Investments in ECD programs are in many ways investments in the future of a nation.” For the world regions to cope with the profound socioeconomic changes occurring, attention must be given to the competence and coping skills of all populations. Ontario has taken a major step in this direction with the establishment of early child development and par- enting centers. The recommendations stimulating this action (McCain and Mustard 1999) were strongly influenced by the work of Early Child Development and the Brain 53 the World Bank and the conclusion in its recent volume on early child development (Young 1997): “Because learning begins at birth, and even before, the starting point for involving families in ECD programs must be as early as possible.… Knowledge and understanding of ECD programs is no longer the con- straint facing early child development. 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These programs include interventions to improve the nutrition, health, cognitive development, and social interaction of children in the early years (Myers 1992; Young 1997). Human development refers to similar dimensions—education, health (including nutrition), social development, and growth—but at the scale of a nation. The multidimensional framework for HD used in this chapter is a variant of one first proposed by the United Na- tions Development Programme in 1990. (In)equality is included in the discussion, but an even broader concept of HD would include ad- ditional dimensions such as human rights (Sen 1999). Human development, broadly defined, is the overarching objec- tive of most international and multinational development programs. Because HD is so closely linked to ECD, investing in ECD is the natur- al starting point for these programs and for the public policy that frames these programs. Four critical “pathways” link ECD to HD. The first pathway runs through education. Interventions during the early years of a child have multiple benefits for subsequent investments in the child’s 63 64 Jacques van der Gaag education, ranging from on-time enrollment in elementary school to an increased probability of progressing to higher levels of education. The second pathway is through health. Like education, investments in health are an investment in human capital and have long-term benefits. The third pathway links the notion of improved social be- havior (as a result of being enrolled in an ECD program) with the for- mation of social capital. This linkage is more speculative, but is sug- gested by some interesting research results. In the fourth pathway, ECD is linked to HD by the potential of ECD programs to address in- equality in society. And, ultimately, education, health, social capital, and equality are linked to economic growth and, hence, to HD. All these linkages are discussed in this chapter, which concludes with suggestions for further research to close some of the gaps in knowledge identified. To provide context, the chapter opens with a brief history of development economics. Development Economics: A Brief History The history of development economics is well described in the Hand- book of Development Economics, volume 1 (Chenery and Srinivasan 1989), which is recommended for serious readers. A key point to note in this chapter is that early approaches to development, which were characterized by mathematical planning models, have been replaced gradually by development models which recognize that people are both the means and the ultimate cause of development. These more recent models underscore the importance of investing in (young) people as a central means to foster development. The shift from planning models to people is illustrated by the salient contributions of four Nobel laureates in economics, all of whom were re- warded for their work on development. The first Nobel laureate in eco- nomics was Jan Tinbergen, who shared the prize in 1969 with Ragna Frisch. Tinbergen’s influence on the field can still be felt around the world. Tinbergen initially studied physics and, later, applied mathe- matical planning models to the economies of developing countries, From Child Development to Human Development 65 mainly to determine optimal levels of investments. The planning, at least in concept, comprised three stages. First, at the macro level, a desired level of economic growth was chosen. Since labor was thought to be abundantly available, this desired growth rate deter- mined the optimal level of overall investment. At the middle stage, the optimal distribution of this investment by region and by industry was determined, and, at the third stage, individual investments for projects were evaluated and allocated. Apart from the abundance of labor (to be recruited from rural areas), no people were included in these planning models. It would be unfair to Tinbergen (who entered or, rather, invented the field of development economics because of concern for the living conditions of the world’s poor) to suggest that people were forgotten in the development process. On the contrary, people were seen as an important production factor. Consequently, education was an impor- tant element in these models. Investments in education needed to be planned, as were investments in roads or in machines. Indeed, skilled labor (the result of such investments) could also be allocated by re- gion or industry and, if needed, even imported. Omitted from these early models, however, was the (economic) be- havior of people. In 1979, the Nobel prize for economics was awarded to T.W. Schultz (and W.A. Lewis). Schultz’s major contribution to the field was in showing that the behavior of people in developing coun- tries is, like the people in developed countries, that of a rational homo economicus, reacting to incentives and opportunities. He stressed the importance of investing in human capital (skills and knowledge) to increase productivity (especially in agriculture) and entrepreneurship. A third Nobel laureate (in 1993), R.W. Fogel, emphasized the im- portance of “people development” in yet another way. Taking a his- torical view, Fogel underscores the importance of the contribution of technological change to physiological improvements. He concludes that the “technophysio” evolution (as termed by him) accounts for about half of British economic growth over the past two centuries. He states: “Much of this gain was due to the improvement in human thermodynamic efficiency. The rate of converting human energy in- 66 Jacques van der Gaag put into work output appears to have increased by about 50 percent since 1790” (Fogel 2000, pp.78–79). Fogel is also one of the few econ- omists who have recognized the importance of long-term health ef- fects from deprivation during early childhood. A. Sen, who received the Nobel prize in 1998, also recognized the central role of investing in people. The resulting higher income, from higher productivity, reduces poverty and increases economic well-being. However, Sen also underscores better health, higher edu- cation levels, and improved nutrition as separate goals which, in ad- dition to higher income, represent nonmonetary aspects of the quality of life (i.e., of “human development”) that are valuable in and of themselves. In his latest book (Sen 1999), he extends this concept, to emphasize that individual freedom is the ultimate goal of economic life. In this treatise, Sen uses a very broad definition of freedom, which includes freedom from hunger, disease, ignorance, all forms of deprivation, poverty, as well as political and economic freedom and civil rights. Linking ECD to HD: Four Pathways Education The first pathway, from ECD to HD, is through education. The impor- tance of ECD for subsequent educational performance, and the role of education in economic and human development, are well known and supported by extensive scientific evidence accumulated from neurophysics, pediatrics, the medical sciences, child development, education, sociology, and economics. Ample evidence documents the importance of the early months and years in life for a child’s physi- cal, mental, and social development (Cynader and Frost 1999; Mc- Cain and Mustard 1999; Myers 1992; Young 1997). The rapid devel- opment of the brain during the early months and years is crucial, and newborns who receive proper care and stimulation will be readier to enter school on time and to learn. Children participating in ECD programs receive psychosocial stimulation, nutritional supplementation, and health care, and their From Child Development to Human Development 67 parents receive training in effective childcare. Children who have participated in these programs show higher intelligence quotients and improvements in practical reasoning, eye and hand coordina- tion, hearing and speech, and reading readiness (Myers 1992). Grade repetition and dropout rates are lower, performance at school is higher, and the probability that a child will progress to higher levels of education increases (Barnett 1995; Barnett 1998; Grantham- McGregor and others 1997; Karoly and others 1998; Schweinhart and others 1993). Over the long term, these children benefit from earlier schooling, better schooling, and more schooling, making them more productive and more “successful”as adults. Being well educated is the best predic- tor of “success” as an adult, regardless of how success is defined. The definition of success, as a better job and higher income in the market- place or increased and improved production at home (e.g., childcare, nutritional practices, family health), can differ from case to case, but higher education is always associated with greater well-being, broadly defined (Haveman and Wolfe 1984; Psacharopoulos 1994). The public benefits of education are also well known. For society, they include greater ability to adopt new technologies, better func- tioning of democratic processes, lower fertility rates, and lower crime rates (Carnoy 1992; Rutter, Giller, and Hagell 1998). As firmly estab- lished in the economic literature on development, education is also important for economic growth (Barro 1997). The education pathway clearly demonstrates that the link between ECD and HD is straightforward, as abundantly documented by scien- tific evidence. Increased investments in ECD programs can be fully justified, and usually are, based on this evidence alone (van der Gaag and Tan 1998). Good education is a goal in itself and fosters econom- ic prosperity. Yet, three additional pathways deserve at least the same attention as education. Health For many decades, the leading development agencies, including the World Health Organization, the United Nations Children’s Fund (UNICEF), and the World Bank, have emphasized the importance of 68 Jacques van der Gaag providing good nutrition, immunization, and other basic health care services for young children. The health benefits of these services are immediately evident (Bundy 1997; PAHO 1998; Stephenson and oth- ers 1993), and the cost-effectiveness of interventions to improve these services is well established (Horton 1999). Despite this knowl- edge, and shamefully, millions of children in developing countries still die before they have lived 1 year, and those who survive suffer from a myriad of easily preventable diseases. ECD programs can make a dramatic difference. They are associated with decreased morbidity and mortality among children, fewer cases of malnutrition and stunting, improved personal hygiene and health care, and fewer instances of child abuse. Less well known are the strong links between trauma in the early years of life (e.g., from malnutrition, even in utero, and infectious diseases) and an individual’s health as an adult. Recent studies show that the links between health and nutrition in the early years of life and one’s health status as an adult are much more numerous and stronger than previously known. The range of adult health outcomes now known to be associated with growth in utero and early life de- velopment, or lack of, includes blood pressure, respiratory function, and schizophrenia. Childhood social and educational factors also are strongly associated with physical and mental health outcomes in adult life (Wadsworth and Kuh 1997). Scientific evidence of these links is also available in relation to the crucial period of brain development in utero and shortly after birth (Barker 1998; Ravelli 1999). Infant malnutrition has been associated with diabetes and reduced stature as an adult. Infection early in life has been related to the development of chronic bronchitis, acute appendicitis, asthma, Parkinson’s disease, and multiple sclerosis in adulthood. And, low birthweight has been correlated with subsequent increased blood pressure, chronic pulmonary disease, cardiovascular disease, coronary heart disease, and stroke. Thus, although an investment in basic health and nutritional services for young children can be justified by immedi- ate health and anthropometric outcomes for children, the linkage From Child Development to Human Development 69 to their health status as adults heightens the importance of the interventions, which are standard components of integrated ECD programs. The linkage to adults’ health status is also significant for HD ef- forts. Evidence indicates that the association between adults’ health status and economic well-being is at least as strong as the association between education and economic well-being (Hertzman 1999; Smith 1999). Adults with better health, higher life expectancy, and better weight and height measures tend to have higher productivity, less ab- senteeism from work, and higher incomes than their less fortunate counterparts. However, the causality in the relationship between health status and economic well-being remains in question. Does good health lead to higher productivity (income) or does a higher income enable one to buy better health? Both relationships—health as cause and as effect—have been proven true. When possible to establish that good or poor health came first, a subsequent economic effect could be determined (e.g., the reduced earning power of adults stunted by malnutrition as a child) (Bundy 1997; Thomas and Strauss 1997). The converse, higher income leading to better health, also is well docu- mented (Acheson 1998). Clearly, better health results in higher income in many instances, but additional research is needed to further unravel the dual relationship. To establish a definitive link between health and the HD of a na- tion, the health-and-income nexus must be aggregated across indi- viduals, for populations. Recent studies demonstrate this link. Like education, the health status of a population is related to the econom- ic growth of that population (Barro 1997; Pritchett and Summers 1996; WHO 1998). Key examples in Africa are the economic (growth- reducing) effects of malaria and the epidemic of Acquired Immuno- deficiency Syndrome (AIDS) (Bloom and Sachs 1998). Surprisingly, most of the studies of health and economic growth are recent, and additional research is needed to understand more ful- ly the many ways in which the health of a population, which is a good in itself, can influence the wealth of a nation. But, the fact that 70 Jacques van der Gaag the link is very important is no longer debatable. Like education, the health pathway from ECD to HD is clear. If increasing the wealth of a nation is an overall objective, beginning with the health of a new- born is a logical first step. Social Capital The “social” benefits of ECD programs are less well defined than the health and education benefits. Still, they do exist. Many studies of the effects of ECD programs note the change in children’s behavior (Kagitçibasi 1996; Karoly and others 1998). They are less aggressive and more cooperative, they behave better in groups, and they accept instructions (e.g., from parents) well. Overall the children have high- er self-concepts and are more socially adjusted. A few long-term (tracer) studies point to similar outcomes for the children’s adult life: improved self-esteem, social competence, motiva- tion, and acceptance of the culture’s norms and values. In particular, evidence suggests that participation in ECD programs leads to reduced criminal behavior and less delinquency as an adult (Schweinhart and others 1993; Yoshikawa 1995; Zigler, Taussig, and Black 1992). The link between improved social behavior and the formation and maintenance of “social capital” has yet to be established. Social capi- tal includes many distinct social phenomena. At the macro level, it refers to informal institutional arrangements, trust, ethnic social net- works, nonlegal market arrangements and other related phenomena (Coleman 1990; Putnam 1993). At the individual level, the term refers to a person’s ability to draw upon social networks to better pur- sue his or her own interests, a phenomenon that usually involves reciprocal arrangements similar to the exchange of “IOU” slips when obtaining financial credit (Coleman 1988, 1990; Lin 1999). Studies of the social benefits of ECD programs suggest that the ben- efits will continue later in life. As the brain needs to be wired properly for academic learning, so it needs to be prepared suitably for social learning. If studies can truly establish the link between the social ben- efits of ECD programs and improved skills of adults in creating and utilizing social capital, the link to HD can easily be made. From Child Development to Human Development 71 To do so only requires that the benefits to social capital at the indi- vidual level be aggregated to society as a whole. Although social capi- tal is an ill-defined concept that refers to many different social phe- nomena, this linkage has already been established firmly in the sociology and economic literature (Narayan 1997; Woolcock 1999). Much empirical evidence has been acquired recently, and although it does not directly make the link between children and adults as sug- gested above, it is convincing and growing. Interest in the link between culture, or values, and economic per- formance also is increasing. Recent studies suggest that “values” is an important concept for explaining differences in the growth of na- tions (Fukuyama 1995). If researchers determine that ECD programs can instill values that are reflected subsequently in adults’ behavior, the link between ECD and HD through the pathway of social capital may be even greater than suggested here. Equality The fourth pathway, “equality,” refers to a “level playing field.” It is inextricably linked to the previous three pathways. Equality may re- fer to a level playing field in education, health, or social capital. And, like education, health, and social capital, equality is a good in itself and contributes to the economic performance of a nation. If ECD programs can be shown to contribute to achieving a more equal soci- ety, the link between ECD and HD, through the pathway of equality, can be easily established. In fact, ECD programs can contribute great- ly to a leveling of the playing field if they are well targeted (Barros and Mendonça 1999). With a relatively small investment, ECD pro- grams can decrease the disadvantage of poor children, compared with their more fortunate counterparts, in nutritional status, cogni- tive and social development, and health. The benefits of greater equality begin right after birth. For adults, equality in education and health leads to equality of opportunity; better education and health lead to higher income. Sig- nificantly, data show that countries with a more equitable distribu- tion of income are also more healthy ( Deaton 1999; Hertzman 1999; 72 Jacques van der Gaag Wilkinson 1996). The evidence is undeniable, yet the reasons for the relationship are being debated. Nevertheless, the link between more equality of opportunity early in life and more equality in education, income, and health later in life appears to be strong, as does the ag- gregate link between greater equality in income and the health of so- ciety. And, again, the benefits begin with ECD. Finally, numerous studies show that greater equality leads to high- er sustainable growth (Aghion, Caroli, and García-Peñalosa 1999; Bar- ro 1997). The link between ECD and HD, through the pathway of equality, is complex, but strong. ECD: Benefits and Research Needs Table 1 summarizes the benefits of ECD—better education, improved health, increased social capital, and greater equality. All of these out- comes are of value themselves, and the benefits are immediately tangi- ble at the time of intervention (i.e., in a child’s early years). ECD pro- grams are most often justified by the immediate benefits to a child’s social and cognitive development and health and nutritional status. Yet, as discussed above, these outcomes have positive, long-term con- sequences for the children as they mature into adults and for their na- tions as a whole. Except for the pathway of education, these long-term benefits are usually ignored by government officials and policymakers. The link between ECD and HD through the pathway of education is clearly established and abundantly documented. New develop- ments in health research, particularly those addressing the relation- ship between child health and adult health, also provide ample evi- dence of a link between ECD and HD. As additional research findings become available, the pathway of health is likely to become as signif- icant to HD as is education. International organizations and govern- ments may need to fundamentally rethink health care efforts world- wide and to direct a much larger share of health care budgets to the health care of children, especially in their early years. The aim will be not only to address children’s immediate health problems, but also to reduce their future health risks as adults. Table 1. ECD Benefits for Children, Adults, and Society: Summary Pathways linking ECD to HD Benefits of ECD Education Health Social capital Equality For children Higher intelligence, improved practical Less morbidity, mortality, malnutrition, Higher self-concept; more Reduced disadvantages of poverty; (immediate) reasoning, eye and hand coordination, stunting, child abuse; better hygiene socially adjusted; less improved nutritional status, From Child Development to Human Development hearing and speech; reading readiness; and health care aggressive; more cooperative; cognitive and social development, improved school performance; less better behavior in groups; and health grade repetition and dropout; increased acceptance of increased schooling instructions For adults Higher productivity; increased Improved height and weight; Higher self-esteem; improved Equality of opportunity, education, (long-term) success (better jobs, higher enhanced cognitive development; social competence, motivation, health, and income incomes); improved childcare less infections and chronic acceptance of norms and and family health; greater diseases values; less delinquency and economic well-being criminal behavior For society Greater social cohesion; less Higher productivity; less Improved utilization of social Reduced poverty and crime; better poverty and crime; lower fertility absenteeism; higher incomes capital; enhanced social values societal health; increased social rates; increased adoption of new justice; higher sustainable technologies; improved democratic economic growth processes; higher economic growth ECD, Early child development; HD, human development. 73 74 Jacques van der Gaag The pathway of social capital is currently less clear, but suggestive. The link between social behavior as a child and as an adult needs to be confirmed, and the link between social behavior and social capital is still weak. The literature on social capital is relatively young, but current evidence indicates that this pathway for ECD to HD will be- come as firmly established as the pathways of education and health. The pathway of equality from ECD to HD is undeniable and, as noted, is linked to the other three pathways. The finding that income equality is related to the health of society is a recent and surprising one, which reinforces the importance of ECD and suggests far-reach- ing policy implications. Education, health, social capital, and equality are all important contributors to economic growth. Together with economic growth, they constitute the mutually reinforcing elements of a comprehen- sive framework for HD, as depicted in figure 1. This framework could be expanded easily, for example, to include gender issues or poverty (as it relates to equality). Well-executed and well-targeted ECD programs are initiators of HD. They stimulate improvements in education, health, social capi- tal, and equality that have both immediate and long-term benefits Figure 1. From Child Development to Human Development: A Comprehensive Framework From Child Development to Human Development 75 for the children participating in the programs. Investments in ECD programs are in many ways investments in the future of a nation. Acknowledgment The author thanks Wendy Janssens for excellent research assistance during the preparation of this chapter. References Acheson, D. 1998. Independent Inquiry into Inequalities in Health: Report. London: The Stationery Office. Aghion, P., E. Caroli, and C. García-Peñalosa. 1999. “Inequality and Economic Growth: The Perspective of the New Growth Theories.” Journal of Economic Literature 37 (December):1615–60. 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Part II Measuring the Early Opportunity Gap Chapter 4 Standards of Care: Investments to Improve Children’s Educational Outcomes in Latin America J. Douglas Willms At the 1990 World Conference on Education for All, held in Jomtien, Thailand, educators and policymakers recommended increased em- phasis on care and stimulation during early childhood, improve- ments in the quality of education provided, and universal access to completion of primary education by the end of the millennium. Dur- ing the 1980s, researchers showed that children in low-income coun- tries have lower levels of literacy than children in high-income coun- tries who receive similar amounts of schooling. Two plausible explanations for this finding are that children in poorer countries be- gin primary school without the developmental base to enable them to achieve their full potential and that the quality of schooling in low-income countries is lower than in high-income countries. During the 1980s, research conducted in several countries provid- ed compelling evidence that schools differ considerably in their out- comes, even after accounting for children’s family backgrounds (Bryk, Lee, and Smith 1990; Gray 1989; Raudenbush and Willms 1991; Willms 1992). The results of large-scale studies of schooling in low-income countries demonstrated the importance of human and 81 82 J. Douglas Willms material resources (e.g., school infrastructure, class size, teachers’ experience and qualifications, availability of instructional materials) for achieving better school outcomes (Fuller and Clarke 1994). Re- search by the World Bank showed that such factors have an even stronger relationship to academic achievement in low-income countries than to that in high-income countries (Heyneman and Loxley 1983). In 1996, a consortium of thirteen Latin American countries con- ducted the Primer Estudio Internacional Comparativo (PEIC), the first international study of school outcomes in Latin America to uti- lize common tests and questionnaires across several countries. The PEIC study entailed (a) testing more than 50,000 pupils in grades 3 and 4 for language and mathematics skills and (b) administering questionnaires to pupils, parents, teachers, and school administra- tors. The data included considerable information on early childhood outcomes, including parents’ home practices and whether the child attended day care. This comparative study is one of the first to assess the importance of these factors. The multinational study was funded by the Inter-American Development Bank; Convenio Andrés Bello; Ford Foundation; United Nations Educational, Scientific, and Cultural Organization (UNESCO); and the following participating countries: Argentina, Bolivia, Brazil, Colombia, Costa Rica, Chile, Cuba, Dominican Republic, Honduras, Mexico, Paraguay, Peru, and Républica Bolivariana de Venezuela. Two substantive reports of the study have been published. The first report (UNESCO 1998) provides technical information on PEIC and descriptive analyses by country. The second report, entitled Schooling Outcomes in Latin America, was coauthored by Willms and Somers (2000) and prepared in consultation with the Laboratorio Latino- americano de Evaluación de la Calidad de la Educación, which coor- dinated the study. The second report presents, for each country, detailed descriptions of the relationships between achievement out- comes and family socioeconomic status (SES), school sector (public, private), extent of urbanization (rural, urban, mega-city), material re- sources (e.g., class size, school infrastructure, teachers’ qualifications), Standards of Care 83 and school “culture” (e.g., parental involvement, teachers’ attitudes, principals’ autonomy, learning climate). The present chapter summarizes some findings of the Willms and Somers (2000) report and extends the analysis to assess the relative importance of family and school factors. Four aims are to: (a) portray the relationship between school outcomes and SES, giving attention to urbanicity and sector; (b) estimate the magnitude of effects associ- ated with risk factors relevant to childhood vulnerability in Latin America and discern the extent of these effects in mediating the rela- tionship between school outcomes and SES; (c) suggest a framework for using findings from international studies to prescribe “standards of care” based on the most important predictors of early childhood outcomes; and (d) suggest ways to improve the capability for moni- toring progress in early child development. The chapter demonstrates how the suggested framework could be applied across the relevant countries using PEIC findings and indi- cates the achievement of standards within each country. Drawing from the Willms and Somers (2000) report, the chapter presents data on twelve countries, referred to herein as the “Region” (data for the thirteenth country, Costa Rica, were not available because of a specific coding problem, and data for Peru are included only for Regional estimates because country-specific results for this country are embargoed). The chapter comprises five main sections, as follows: The Impor- tance of Understanding Socioeconomic Gradients; School Outcomes in Latin America: Gradients and School Profiles; Standards of Care: A Suggested Framework; Childhood Vulnerability: Analysis and Find- ings; and Next Steps: Strengthening the Basis for Monitoring and Re- form. A concluding section presents additional perspectives. Several caveats should be noted. Any analysis of this sort and any attempt to set standards can be easily criticized. A framework that links processes to outcomes is necessarily limited by the data avail- able and the difficulty of generalizing empirical findings which re- flect local social, political, and economic realities. Collaborations with school districts and governments grappling with the use of 84 J. Douglas Willms data for monitoring have demonstrated that the main value of mon- itoring is to stimulate dialogue on desired outcomes of schooling and critical examination of current policies and practices. Accord- ingly, the overarching goal of the chapter is to generate dialogue about standards of care. The Importance of Understanding Socioeconomic Gradients Perhaps the most pervasive finding of research on human develop- ment is that children’s developmental outcomes are related to the SES of their families. There is a “gradient”: Children whose parents have lower levels of education and income and are working in less prestigious jobs are less likely to succeed academically, more prone to behavioral disorders, and more vulnerable to poor health than are children living in affluent families. Virtually every important social outcome seems to be related to SES. This relationship has become so firmly entrenched in understanding human development that the terms “children with delayed development,” “children at risk,” and “children living in poverty” are used synonymously. Because this re- lationship has become accepted as nearly universal, one may ques- tion whether further study of socioeconomic gradients is worthwhile. Understanding socioeconomic gradients is essential for under- standing factors that contribute to the success of society. A “socioeco- nomic gradient” describes the relationship between some develop- mental outcome and SES. Researchers of early child development are typically interested in outcomes describing children’s cognitive, so- cial, and behavioral development. These outcomes, such as achieve- ment test scores, are usually measured on a continuous scale, but also can be measured dichotomously with indicators such as whether a child has a specific disease or behavior disorder or is particularly vul- nerable. SES refers to the relative position of a family or individual within a hierarchical social structure based on access to, or control over, wealth, prestige, and power (Dutton and Levine 1989; Mueller and Standards of Care 85 Parcel 1981). SES is usually operationalized as a composite measure comprising income, level of education, and occupational prestige. Gradients can be depicted as a line on a graph, with the developmen- tal outcome on the vertical axis and an SES measure on the horizon- tal axis (see figure 1). Implications of Socioeconomic Gradients Gradients can be used to indicate the translation of investments in material, social, and cultural resources into skills and competencies over time (e.g., between decades). For a society, they depict overall outcomes (e.g., levels of literacy) as well as inequalities among social classes. These inequalities have several implications for society—for its social cohesion, health and well-being, and social policy. Social Cohesion. Achieving equality of outcomes (i.e., “shallow gra- dients”) is essential for achieving social cohesion. Ritzen’s definition of social cohesion as “an inclusive civil society and responsive politi- cal institutions” (Ritzen 2000) is central to the World Bank’s ap- proach to policy and projects. Mounting evidence demonstrates that the economic success of societies depends on relationships among people within and among institutions, communities, and countries. Childhood Outcome Socioeconomic gradient Socioeconomic Status Figure 1. Socioeconomic Gradients, Defined 86 J. Douglas Willms Researchers have used the term social capital to characterize the nature of relationships among people and the relationships’ facilita- tion of collective action, social networks, and community norms and values (Coleman 1988). Research at the micro level has shown that the productivity of institutions and organizations depends on team- work, communication, sharing of knowledge and ideas, and workers’ embracing of organizations’ aims. Research at the macro level has been focused on the nature of social support and collective action and their effect on people’s trust and trustworthiness and sense of se- curity and well-being. Currently, the concept of social capital is being incorporated into the new growth models of economic development. Health and Well-Being. Inequalities in social outcomes appear to be a strong determinant of health and well-being. A number of studies show that health outcomes vary among neighborhoods, communi- ties, health authorities, states and provinces, and countries, even af- ter accounting for people’s socioeconomic backgrounds. Two findings are especially relevant to socioeconomic gradients. First, gradients for mortality and health status are nonlinear: They are steep at low levels of income and become shallower at higher levels of income (Epel- baum 1999; House and others 1990; Mirowsky and Hu 1996; Wolfson and others 1999; Wolfson, Rowe, Gentleman, and Tomiak 1993). Af- ter people meet their basic needs for food, clothing, and housing, fur- ther increases in income seem to contribute only marginally to their health. Second, health is not only related to overall levels of income and wealth, but also to levels of income inequality in a society (Wilkinson 1992, 1996; Kaplan and others 1996; Wolfson and others 1999). The predominating explanations relate to people feeling rela- tively deprived or excluded. Social Policy. Gradients can provide a focus for social policy, which is concerned mainly with achieving particular outcomes for society as a whole and, especially, for vulnerable groups. During the past few decades, governments have focused mainly on economic policies. Consequently, social policies have not changed at the same pace. Dis- cussions about social policy have mainly concerned the functions of state governments, particularly provision of services (e.g., public Standards of Care 87 education, health care, protective services) and redistribution of in- come by income transfers to targeted groups (Fellegi and Wolfson 1999). The roles of corporations, communities, and families in shap- ing social policy have received relatively little attention. Gradients are useful as a simple, straightforward device for shifting attention to- ward desired social outcomes and inequalities in outcomes. A simple display of gradients for a set of outcomes always begs the question, “Can we alter the gradients?” Socioeconomic Gradients for Childhood Vulnerability Socioeconomic gradients are pertinent to early childhood develop- ment and the vulnerability of children to society’s inequalities. In PEIC and other studies, researchers have demonstrated the complex relationships and interactions between these gradients and children’s vulnerability. Ten key questions for research have been elucidated by the Canadian Research Institute for Social Policy (Willms, forthcom- ing) and are summarized below. 1. At what age do socioeconomic gradients for children’s outcomes become evident? Do gradients become stronger as children become old- er? For example, are gradients evident for the prevalence of children with low birthweight or for children’s early develop- mental outcomes? Do gradients become stronger after children enter the formal school system? 2. Are gradients stronger for some outcomes than for others? For exam- ple, are gradients stronger for cognitive outcomes than for be- havioral outcomes? 3. Which SES components are related most strongly to children’s social and cognitive outcomes? Most recent research emphasizes the effects of poverty on children’s outcome, but other factors (e.g., par- ents’, and especially mothers’, level of education) have a signif- icant role. The relative importance of various SES components at different ages needs to be better understood. 4. Are gradients linear or curvilinear? A particular concern is whether gradients for children’s developmental outcomes weaken above 88 J. Douglas Willms a certain SES threshold and, if so, whether this threshold varies among communities. For example, the income threshold for health outcomes appears to be about $20,000: Below $20,000, the relationship between income and health is strong, and above $20,000, the relationship is weak (Epelbaum 1990; House and others 1990; Mirowsky and Hu 1996). Income gradi- ents may be curvilinear as well as linear. In Canada, the income gradient for health outcomes is curvilinear, but the change in slope is more gradual, making it difficult to identify a threshold accurately (Boyle and Willms 1998; Wolfson and others 1993, 1999). Determining whether gradients are linear or curvilinear is particularly relevant to the development of policies for in- vesting in early childhood by targeting resources to low-in- come families. 5. What factors mediate the relationships between childhood outcomes and SES? The term “mediating factors” describes the underlying processes for one variable influencing another (Baron and Ken- ny 1986) (e.g., income and achievement). For example, do parents in low-income families pursue a different approach to parenting which leads to poor developmental outcomes? If so, parenting styles could be a mediator of the socioeconomic gradient. 6. Are there groups within society whose children are particularly vulnera- ble? Special concerns are the outcomes for children in minority groups, single-parent families, and families with parents who were teenagers when they had their first child. 7. Do children’s outcomes vary by community? In relation to children’s development, “community” is defined as a group of citizens collectively concerned about the health and well-being of their children. Communities can be multiple and overlapping (e.g., neighborhoods, churches, municipalities, classrooms, schools, school districts). A concern is whether children’s outcomes vary among communities regardless of family background. 8. Do socioeconomic gradients vary among communities? For example, are some communities particularly successful in abating Standards of Care 89 inequalities in children’s outcomes? In many contexts, gradi- ents vary among communities, and communities that have particularly steep or shallow gradients can be identified. For school outcomes, gradients tend to converge for children at higher SES levels (Willms 2000). This convergence has impor- tant implications for social policy for it suggests that children from relatively affluent family backgrounds tend to do well in any community, whereas children from less affluent back- grounds can have substantially different outcomes in different communities. Successful communities are able to bolster the social outcomes of their least-advantaged citizens. 9. What are the effects of segregating children from lower socioeconomic backgrounds by, for example, residential segregation, private schooling, selective schooling, tracking or streaming, and ability grouping within classrooms or by other mechanisms that differentiate groups according to socioeconomic background? This question is especially relevant to low-income countries because their school systems are high- ly segregated owing to disparities in income between rural and urban families and to private schooling. This “hypothesis of double jeopardy” implies that a child in a poor family is even more vulnerable when educated in a poor setting. 10. If communities’ gradients vary, what factors are associated with high outcome levels and shallow gradients? If gradients for children’s developmental outcomes vary among communities, can a community’s achievement of superior or more equitably dis- tributed outcomes be explained by community factors? School Outcomes in Latin America: Gradients and School Profiles The target population for PEIC was all children attending grades 3 and 4 in the thirteen participating countries. For each country, the sample included approximately 100 schools, with twenty grade 3 pupils and twenty grade 4 pupils in each school, for a total of 3,000–4,000 pupils. The data collected included achievement test 90 J. Douglas Willms scores in language (Spanish) and mathematics and questionnaires ad- ministered to each pupil, one of the pupil’s parents, the teacher, prin- cipal, and school administrator. [See UNESCO (1998) and Willms and Somers (2000) for further details.] The findings for gradients and school profiles are depicted and summarized below. Gradients Figures 2–4 display the socioeconomic gradients, by country, for school outcomes (language scores, mathematics scores, and no grade repetition) in relation to parents’ education. Parents’ education (years of schooling) is averaged for a child’s two parents (the full regression models included a variable for single- or two-parent families). The gradients are calculated based on ordinary least-squares relationships, and, because most countries had a significant nonlinear component, the square of parental education is included. The test scores for lan- guage and mathematics are scaled using the Rasch method to obtain a mean score of 250 for the Region, with a standard deviation of 50. No grade repetition is included as a measure of whether a child has repeated at least one grade before completing grade three. In most analyses of schools’ effectiveness, grade repetition is treat- ed as a variable of school policy and is used in regression analyses as an independent variable to explain variation in academic test scores. In PEIC, grade repetition is treated as a dependent variable for three reasons: (a) progressing through school with one’s same-age peers is an important school outcome strongly related to self-esteem, sense of belonging, and general well-being (Shepard 1989; Shepard and Smith 1989); (b) grade failure early is one of the best predictors of complet- ing secondary school (Audas and Willms 2000; Rumberger 1995); and (c) reducing the rates of grade repetition is central to the long-term success of schooling in Latin America and is an outcome that can be improved easily through national and local policies. During the 1980s, a typical child in Latin America took 1.7 years to be promoted to the next grade (UNESCO-OREALC 1992). To simplify the discussion and be consistent with the “standard” of a “no-fail” policy, a dichotomous variable is used in this chapter to Standards of Care 91 indicate whether a child has repeated at least one grade. Willms and Somers (2000) used a “time to completion” measure to account for a child’s grade repetition. However, neither measure accounts for chil- dren who leave school before completing a grade and then reenter the same grade the following year. A more detailed analysis of this Figure 2. Socioeconomic Gradients for Language Scores, by Country 92 J. Douglas Willms issue is under way for a few countries, beginning with Brazil, by re- constructing each child’s educational history and applying a multi- level variant of event-history analysis. Figure 3. Socioeconomic Gradients for Mathematics Scores, by Country Standards of Care 93 Figure 4. Socioeconomic Gradients for No Grade Repetition, by Country 94 J. Douglas Willms The problem of grade repetition is acute in several Latin American countries. Some children report failing more than five times by the time they are in grade 3. However, the data for number of repetitions and children’s age are inconsistent. It seems that, in many schools, pupils leave school during the academic year and return the follow- ing year in the same grade, a situation that many parents would not usually consider grade repetition. Findings Several important findings are evident from the analyses. (1) Coun- tries vary dramatically in school outcomes and socioeconomic gradi- ents. (2) The hypothesis of converging gradients does not hold; that is, the results for children of parents with high levels of education vary as much as those for children of parents with low levels of edu- cation. (3) The gradients in some countries are nonlinear, but levels of achievement increase at higher SES levels. Previously, it seemed that “the success of a society, as gauged by these types of indicators, depends on the extent to which it is suc- cessful in reducing inequalities” (Willms 1999). The author’s current working hypothesis is that (a) societies progress from relatively flat gradients with low levels of social outcomes to steep gradients with average levels of outcomes and, finally, to shallow gradients with high levels of social outcomes, and (b) this progression depends on how social and human capital are invested (Willms 2000). Perhaps the most important point, however, is that the PEIC results for Cuba, similar to the results of the International Adult Lit- eracy Study (IALS) for Sweden, demonstrate that high levels of social outcomes and equality of social outcomes can be achieved among low- and high-status groups. The nonlinear relationship, which is most evident among the lowest-scoring countries, suggests that a “premium” is associated with completing secondary school, a find- ing that is not inconsistent with the current working hypothesis. The elite of a country may attain a higher standard of achievement first, and lower socioeconomic groups may then slowly rise to meet these levels. Standards of Care 95 Moreover, the results for Cuba and Chile, which, by Latin Ameri- can standards, have relatively low levels of grade repetition, demon- strate that high levels of achievement are possible without failing pupils. Brazil, which has a large percentage of children repeating grades, has achievement levels for language similar to those of Chile, and for mathematics, slightly higher. However, these results are based on grade cohorts, not age cohorts. The results for Brazil would be somewhat lower if, for example, the average scores of pupils ages 7 to 9 could be assessed in each country. This assessment will be one of the strengths of the Program of Indicators of Student Achievement (PISA) study, which targets all 15-year-olds in each country. If coun- tries adopt a no-repetition policy or take measures to dramatically re- duce repetition rates, many teachers will have to change their atti- tudes toward grade repetition and will need to be equipped with the necessary skills to teach in heterogeneous classrooms. School Profiles The analysis of school profiles offers additional detail on the varia- tion in school outcomes within each country and for the Region. Fig- ures 5–7 present these profiles for the Region. Hierarchical linear analysis yielded estimates of the average test scores for each school, with adjustment for measurement and sampling errors. The figures denote each school’s sector (public or private), urbanicity (rural, ur- ban, mega-city), and relative size. Similar plots for each country are given in the Willms and Somers (2000) report. Findings The school profiles show that schools in the Region vary widely in academic achievement even after accounting for parents’ education. In the full report (Willms and Somers 2000), the variation among schools within each country was examined in relation to certain fam- ily background variables, which included parents’ education, amount of time the parent was at home during work days, number of books in the home, and single- or two-parent family. Even with control for these variables, the schools’ academic achievement levels varied 96 J. Douglas Willms Figure 5. School Achievement Profile for Language, by Type of School, in the Region Standards of Care 97 Figure 6. School Achievement Profile for Mathematics, by Type of School, in the Region 98 J. Douglas Willms Figure 7. School Achievement Profile for No Grade Repetition, by Type of School, in the Region Standards of Care 99 substantially. At any SES level, the difference between the worst- and best-performing schools was about 1.5 standard deviations, which, for grades 3 and 4, amounts to about 1.5 years of schooling. The PEIC data also included several factors pertaining to a child’s early childhood experience (e.g., regular reading by parents to their child during preschool years, parental involvement in the child’s schooling). As expected, these factors were related positively to school outcomes, a finding that has been substantiated by many oth- er studies. The data also included an item for child’s attendance at day care, and the analysis showed small, but significant, effects associated with this variable. However, information was not collected on the nature or quality of day care or the period when the child attended day care. More detailed analyses of this variable within countries would likely indicate larger effects. A principal aim of the study was to discern which schooling factors contributed to high educational achievement. Analysis re- vealed that a number of factors were positively associated with high test scores and the time pupils took to complete the first three grades of primary school. Significantly, the important factors in- cluded variables pertaining to school resources and to school policy and practice. Standards of Care: A Suggested Framework The above data can be analyzed further to yield suggested standards of care for evaluating and monitoring school outcomes currently and over time. Establishing standards for reform is not easy, however, and the data and analyses to substantiate standards and reforms must be scrutinized carefully. For policymakers, a main concern is the com- plexity of interpreting statistical data from analyses of regression co- efficients and relative and attributable risks. In the PEIC study, the multilevel regression results are complex and not easily translated into policies for reform. Generally, the inter- pretation of regression coefficients is fairly straightforward—they 100 J. Douglas Willms represent the effect on the outcome of a one-unit increase in the co- variate when all other variables are held constant. For example, Willms and Somers (2000) estimate that the effect on language scores of teachers working another job is –11.2. That is, the language scores of children in schools where all teachers worked another job were 11.2 points less than those of children in schools where no teachers worked another job. However, the situation for PEIC and for similar studies is much more complex. Only about one-half of all pupils in the Region attended schools where no teachers worked another job, and less than 10 percent attended schools where all teachers worked another job; the remaining students (about 40 percent) attended schools where some teachers worked another job. A related problem is that the effect may be important in relative terms, but not in absolute terms. For example, within a country, a mi- nority group may have very low test scores, but the group comprises only 1 percent of the population. In regression analysis, the gap in test scores between minorities and nonminorities would be estimated as an unstandardized regression coefficient, and the difference would be expressed in the units of the test. The importance of the differ- ence, in this instance, would be judged in “relative” terms. However, the marginal contribution to R-squared (i.e., the propor- tion of the variance explained) would be quite small because the mi- nority group comprises only 1 percent of the population. Even if the scores of all minority pupils could be immediately boosted up to the Regional mean, this overall mean would not change dramatically. The importance of the difference, in this instance, would be judged in “absolute” terms. This distinction is important for policymakers as they choose between targeted interventions to improve scores and outcomes of particular groups (e.g., pupils in rural schools in low- socioeconomic areas) and universal interventions to improve scores and outcomes of all pupils (see Offord and others 1997). Relative risk and attributable risk are also commonly used by epi- demiologists. In this case, “relative risk” denotes the ratio of the pro- portion of vulnerable individuals among those exposed to a risk fac- tor to the proportion of vulnerable individuals among those not Standards of Care 101 exposed to the risk factor. As a multiplier, relative risk indicates the potential increased likelihood of a child being vulnerable if the child changes from not being exposed to being exposed. “Attributable risk” expresses in percent the total occurrence of vulnerability that could be attributed to a particular risk factor. To calculate these risks, the outcome variable must be dichoto- mous (i.e., vulnerable versus not vulnerable). For PEIC, the outcome variable is having low test scores versus not having low test scores, or repeating a grade versus not repeating a grade. The risk factors also must be dichotomous. For example, the PEIC risk factors include at- tending a school that has a poor library versus attending a school that has a good library, or attending a school that has low parental involvement versus attending a school that has high parental in- volvement. The technique of assigning relative and attributable risk is used in the analysis summarized below to elucidate possible standards for re- form. This technique is not as powerful as regression techniques, but the distinction between relative and absolute risk is more transparent. An Outcome Standard for Children The PEIC study defined a child as “vulnerable” if he or she had: • A language test score below 221 in grade 3 or below 240 in grade 4 (these cutoff scores correspond approximately to the lowest one-third of scores), or • A mathematics test score below 225 in grade 3 or below 239 in grade 4, or • Repeated a grade during the first 3 years of elementary school. This definition was based on several considerations. First, decid- ing on an outcome standard (cutoff score) for most achievement tests is arbitrary. In PEIC, one possibility was to use the results for Cuba as a standard for the Region. Another possibility was to use the mean or median test score as the standard and to denote those below the mean or median as vulnerable. Second, administrators in 102 J. Douglas Willms many countries voice concern about the “bottom third” of school- children. Third, experience shows that children who repeat a grade during the first few years of school are prone to leave school early. Based on the definition used, the PEIC data show that more than one-half (50.5 percent) of all children in the Region are vulnerable in one of these respects (15.5 percent of children, for example, repeated a grade during the first 3 years). The dichotomous variable in PEIC for vulnerable versus not vulnerable thus pertains to about one-half of the population studied. Standards for Superior Schooling For the analysis, standards also were established for each relevant co- variate in the PEIC study. Table 1 notes the standards for the most im- portant process variables identified by Willms and Somers (2000). Pupils’ Demographic and Early Childhood Characteristics To gauge the relative importance of the above standards, the princi- pal covariates in the analysis also were dichotomized. The following six characteristics were considered as demographic and early child- hood variables. Female. Of the children, 50.3 percent were girls and 49.7 percent were boys. High Parental Education. Children “at risk” were those whose parents had 8 years or less of formal schooling. Of all children in the Region, 52.3 percent had parents with more than 8 years of schooling. Two-Parent Family. Some 80 percent of the children in the Region lived in two-parent families. Parents Read Frequently. Some 36.3 percent of all children in the Region lived in families where parents reported reading frequently to their child. Standards of Care 103 Table 1. Standards for Process Variables and the Percentage of Children in the Region Who Attended Schools That Met With the Standard Percentage of children in the region who attended schools that met with Process variable Standard the standard Small classes Enrollments of 25 pupils or less 54.2 Adequate material More than 6.574 (the Regional mean) instructional 52.3 resources materials available in the school. (To determine the mean, school principals were asked whether they had certain materials from a list of twelve items.) Adequate library At least 1,000 books in the school library 32.1 Well-trained An average of more than 3.46 years (the Regional mean) 54.8 teachers of teacher training for all teachers in the sample Teachers working All teachers in the school work only one job 52.5 only one job Single-grade No multigrade classrooms in the school 12.6 classrooms Pupils tested All teachers use tests regularly 17.8 regularly No ability grouping No grouping of pupils by ability 38.7 Positive learning A learning climate higher than the Regional mean of 51.3 environment 0.600. [The index comprises the mean of three variables: whether some pupils in the classroom disturbed others (no=1, yes=0), fights happened often (no=1, yes=0), and pupils in the class were good friends (yes=1, no=0). Responses were obtained from pupils’ questionnaires, and a composite mean for discipline was aggregated by school.] Strong parental Parental involvement higher than the Regional mean of 53.8 involvement 2.535. [The index comprises the mean of three variables: whether the parent participates in school-related activities (seldom=1, sometimes=2, always=3), knows his or her child’s teacher (no=1, a little=2, a lot=3), and attends parent–teacher meetings (never or seldom=1, almost always=2, always=3). Responses were obtained from parents, and a composite mean for parental involvement was aggregated by school.] 104 J. Douglas Willms Child Attended Day Care. Some 74 percent of all children in the Region attended some form of day care. Parents Involved in Child’s Schooling. Parents scoring 2.5 or higher on the parental involvement index were considered involved. Some 60.9 percent of the children in the Region lived in families where parents were involved in their schooling. Childhood Vulnerability: Analysis and Findings Using the established standards and the demographic and early childhood variables, the relative importance of each factor was as- sessed in a series of logistic regression models. The process variables (e.g., attending large classes instead of small classes) are considered risk factors. Odds Ratios for Risk Factors Table 2 presents the odds ratios derived from the logistic regression coefficients. Sex and Family Background This first set of variables presented in Table 2 includes sex, single-par- ent family, and low parental education. The results of the regression analysis indicate that the odds of being vulnerable for boys was 8 per- cent higher than for girls. Willms and Somers (2000) found that the differences associated with gender were relatively small: Girls aver- aged about 6 points higher on the language test, whereas boys aver- aged about 2 points higher on the mathematics test; and boys took slightly longer on average than girls to complete the first 3 years of schooling, but the difference was less than 1 month. The odds of being vulnerable for a child in a single-parent family was about 26 percent higher than the odds of being vulnerable in a two-parent family. And, the most striking effect is associated with having parents with a low level of education. The odds ratio for this risk factor is 3.26, indicating that children whose parents had Standards of Care 105 Table 2. Odds Ratios for Childhood Vulnerability Associated With Sex and Family Background, Urbanicity (Rural, Urban, Mega-city), Sector (Public, Private), Early Child Development, School Resources, and School Policy and Practice Regression model/coefficient Variable I II III IV V Sex and family background Male 1.08 1.08 1.06 1.11 1.10 Single-parent family 1.26 1.27 1.25 1.24 1.26 Low parental education 3.37 2.91 2.58 2.32 2.14 Sector and urbanicity Rural 2.29 2.48 1.30 1.60 Urban public 1.57 1.76 1.33 1.58 Mega-city public 1.18 1.33 (1.03) (1.07) Urban private 2.23 1.31 1.25 1.31 Mega-city private (base) (1.00) (1.00) (1.00) (1.00) Early child development No day care 1.39 1.15 1.11 Infrequently reads to child 1.79 1.60 1.50 Low parental involvement 1.39 1.32 1.16 School resources Large classes 1.62 1.54 Lacking classroom materials 1.72 1.68 Inadequate library 2.26 2.04 Low teacher training (1.04) (.94) School policy and practice Teachers working in other jobs 1.16 Multigrade classes 1.39 Infrequent testing 1.14 Ability grouping (1.06) Poor classroom climate 1.68 Low parental involvement at school 1.56 ( ) Not statistically significant. primary school education or less were more than three times as like- ly to be vulnerable as children whose parents had at least some sec- ondary schooling. This risk factor is by far the most important and outweighs the effects of gender and family structure. Sector and Urbanicity Figures 5–7 demonstrated that a marked “socioeconomic divide” is associated with school sector (public versus private) and urbanicity 106 J. Douglas Willms (rural, urban, mega-city). To relate this finding to childhood vulner- ability, the analysis included designation of mega-city private schools as the baseline category, and odds ratios were determined to indicate children’s risk associated with the other categories. The re- sults suggest that the odds of being vulnerable in urban private schools or mega-city public schools is about 20 percent higher than in mega-city private schools. This substantial effect is almost as large as that associated with living in a single-parent family, but it pales in comparison with the effects associated with attending urban public or rural schools. Compared with a child in mega-city private schools, the odds of a child being vulnerable in urban public schools was more than 1.5 times and, for a child in rural schools, more than 2.25 times. Notably, the effects associated with low parental education are mediated by sector and urbanicity. The odds ratio for a child with parents having low education decreased from 3.37 to 2.91 if the child attended a mega-city private school. Early Child Development The variables included in this analysis are no attendance at day care, infrequent parental reading to the child, and low parental in- volvement. The effects of all three factors are substantial, as indi- cated by the odds ratios of 1.39, 1.79, and 1.39, respectively. These effects are evident after controlling for the other variables. Again, the effects associated with low parental education are further medi- ated by effective early child development. The odds ratio for low parental education drops from 2.91 to 2.58 when the children at- tend day care and are read to by their parents and when their par- ent is involved in their schooling. These effects are especially strik- ing because the factors were measured cursorily and do not account for the amount of time in day care, the quality of day care, or par- enting style and parental involvement. These more specific vari- ables would be appropriate to capture and could be obtained in similar studies. Standards of Care 107 School Resources The next set of variables in Table 2 describes school resources. The only factor that is not statistically significant is teacher training. The other factors have odds ratios ranging from 1.62 to 2.26, which are surprisingly large, especially because these effects are attributable to resources after accounting for sex and family background and for sec- tor and urbanicity. These variables mediated the effects of low parental education only slightly, from 2.58 to 2.32 for a child in a school with good resources. However, these variables explained the effects associated with sector and urbanicity (see “Effects by Sector and Urbanicity” below). School Policy and Practice This set of factors is influenced more directly by school administra- tors and teachers than are those pertaining to school resources. The odds ratio for ability grouping was not statistically significant, and the odds ratios for the other factors ranged from 1.14 to 1.68. The effects of a poor classroom climate and low parental involvement at school are particularly striking, with odds ratios of 1.68 and 1.56, re- spectively. All the variables in this set further mediated the risk asso- ciated with low parental education, reducing it to 2.14 for a child in a school with good policies and practices. Relative and Attributable Risks Table 3 displays the relative and attributable risks for the variables as- sociated with sex and family background and school factors. Four variables would require large expenditures to improve the school sys- tem—to reduce class size, obtain more classroom materials, improve school libraries, and require that teachers be better trained. The rela- tive risk associated with these variables is 1.50, 1.74, 2.29, and 1.12, respectively. The data indicate, for example, that children who attend schools with large classes (i.e., more than 25 pupils) are 1.5 times as likely to be vulnerable as those who attend schools that meet the standard. Similarly, children in schools without adequate classroom 108 J. Douglas Willms Table 3. Relative and Attributable Risks for Childhood Vulnerability Associated With Sex and Family Background and School Factors Relative risk Attributable risk Variable (ratio) (percent) Sex and family background Male 1.05 2.6 Single-parent family 1.10 2.0 Low parental education 1.74 26.1 Early child development No day care 1.33 7.6 Infrequently reads to child 1.41 20.7 Low parental involvement 1.27 9.5 School resources Large classes 1.50 18.7 Lacking classroom materials 1.74 26.1 Inadequate library 2.29 46.5 Low teacher training 1.12 5.0 School policy and practice Teachers working in other jobs 1.23 10.1 Multigrade classes 1.22 2.8 Infrequent testing 1.11 8.6 Ability grouping 1.12 6.8 Poor classroom climate 1.49 19.5 Low parental involvement at school 1.53 20.0 materials are 1.74 times as likely to be vulnerable as those who attend schools with adequate classroom materials. The attributable risk associated with large classes is 18.7 percent. This finding suggests that childhood vulnerability could be reduced by 18.7 percent if all children could attend small classes. The entire story, no doubt, is much more complex, for these analyses are based on simple bivariate cross-tabulations. For example, the most effective teachers may be in schools with small classes, or the schools with the most classroom materials may tend to be those with smaller classes. Simply reducing class size may therefore not achieve the desired results. Also, the variables, as defined, may be “proxies” for other sig- nificant variables. For example, having an inadequate school library has an attributable risk of 46.5 percent. Yet, increasing the size of all school libraries will most likely not improve school outcomes accord- Standards of Care 109 ingly. These results, nevertheless, indicate the relative and absolute importance of the variables selected. The relative risks of the six factors pertaining to school policy and practice range from 1.11–1.12, for ability grouping and lack of test- ing, to 1.22–1.23, for multigrade classrooms and teachers working in other jobs, to 1.49–1.53, for poor classroom climate and low parental involvement at school. The attributable risks for the first four factors listed in the table range from less than 3 percent to slightly more than 10 percent, but the attributable risks associated with poor class- room climate and low parental involvement are considerable—about 20 percent. Also worth noting is that the relative and attributable risks of be- ing male or living in a single-parent family are very low. The relative risk of living in a family with parents having a low level of education is 1.74, and the attributable risk is 26.1 percent. These data suggest that if all children could live in families with parents educated be- yond primary schooling, childhood vulnerability could be reduced by more than 25 percent. Achieving this is, of course, impossible in the near future. Curiously, however, these relative and attributable risks are the same as those associated with lack of classroom materi- als, a factor that is not impossible to correct. The analysis also indicates that parents’ actions (i.e., what they do) are extremely important. The relative risk associated with parents who read infrequently to their child is 1.41, and the risk for low parental involvement in the child’s education is 1.27. These results suggest that childhood vulnerability could be reduced by more than 20 percent if all parents read regularly to their child, and by almost 10 percent if all parents were involved in their child’s schooling. Children who did not attend day care were 1.33 times more likely to be vulnerable than those who did attend day care, and the attribut- able risk is quite low—less than 8 percent. Effects by Sector and Urbanicity The above analyses provide a framework for assessing the relative im- portance of the factors by sector and urbanicity. Table 4 presents the 110 J. Douglas Willms percentages of vulnerable children in each sector and urban category. Based on the criteria used, 65.2 percent of the children in rural schools were vulnerable. In the private sector, 29.0 percent were vul- nerable in mega-city schools and 33.8 percent were vulnerable in ur- ban schools. In the public (nonrural) sector, 39.9 percent of the chil- dren were vulnerable in mega-city schools, and 49.6 percent were vulnerable in urban schools. Similar to the findings for the entire Region, about one-half of all children in urban public schools were vulnerable. The major question raised by this analysis is: “How would the sec- tors differ if all schools achieved the standards for school resources and school policy and practice?” To answer this question, the odds ratios were estimated for sector and urbanicity within a logistic re- gression model. Mega-city private schools served as the base for com- parison (1.0). The odds ratios for the other schools are greater than 1.0 because children were considered more likely to be vulnerable if they were in one of these four categories. To assess the effects associ- ated with the selected risk factors, the odds ratios were adjusted for family background, early child development, school resources, and school policy and practice, singly and in combination. Table 4 pre- sents the results. Table 4 shows that the odds of a child being vulnerable in a rural school are more than 4.5 times that in a mega-city private school. The odds ratios for a child in an urban public school is 2.41; in a mega-city public school, 1.62; and in an urban private school, 1.25. Some of the disparities are attributable to a child’s background. When adjusted for family background and early child development (FB/ECD), the odds ratios decrease considerably for a child in public school: from 4.57 to 2.48 in a rural school, 2.41 to 1.76 in an urban school, and 1.62 to 1.33 in a mega-city school. The odds ratio for a child in an urban private school increases slightly, from 1.25 to 1.31. When controlling for school resources (SR) only, the odds ratios also decrease considerably for a child in public school: from 4.57 to 1.70 in a rural school, 2.41 to 1.54 in an urban school, and 1.62 to 1.11 in a mega-city school. The odds ratio for a child in an urban Standards of Care 111 Table 4. Odds Ratios of Childhood Vulnerability by Sector and Urbanicity, Controlling for Family Background, Early Child Development, School Resources, and School Policy and Practice Sector/urbanicity Public Private Odds ratio/variable Rural Urban Mega-City Urban Mega-City Percentage of vulnerable children 65.2 49.6 39.9 33.8 29.0 Unadjusted 4.57 2.41 1.62 1.25 1.00 Adjusted for: Sex and family background and early child development (FB/ECD) 2.48 1.76 1.33 1.31 1.00 School resources (SR) 1.70 1.54 1.11 1.26 1.00 School policy and practice (SPP) 4.57 2.66 1.73 1.54 1.00 FB/ECD + SR 1.30 1.33 1.03 1.25 1.00 FB/ECD + SPP 3.16 2.14 1.52 1.52 1.00 FB/ECD, SR, + SPP 1.60 1.58 1.07 1.31 1.00 Note: The baseline for comparison is mega-city private schools. private school remains the same. Comparison of these results with those for FB/ECD reveals an extremely important finding: The dis- parities among sectors and urbanicity are related more strongly to school resources than to a pupil’s family background and early child development. When controlling for school policy and practice (SPP) only, the odds ratios do not change appreciably by sector or urbanicity. This result demonstrates clearly that disparities among sectors and urban- icity are not attributable to school policy and practice, even though these factors are extremely important within sectors and rural or urban settings. Even when accounting for family background and early child development, these two significant findings hold. Comparison of FB/ECD only with FB/ECD+SR reveals a large decrease in the odds ratios whereas comparison of FB/ECD only with FB/ECD+SPP reveals small decreases. When controlling for family background and early child develop- ment, school resources, and school policy and practice, the odds ratios do not change as dramatically as when not controlling for 112 J. Douglas Willms school policy and practice. This finding suggests that some of the me- diating effects of school resources on the differences among sectors and urbanicity are further mediated by school policy and practice. That is, maintaining a positive classroom climate and achieving high parental involvement at school are probably easier when class sizes are small, for example. In sum, the findings indicate that both school resources and school policy and practice are important determinants of school outcomes, but school resources (not school policy and prac- tice) distinguish the results for rural schools versus nonrural schools. Achieving High Standards in Latin America: Current Status The analyses demonstrate the importance of achieving high stan- dards for families and schools. Table 5 documents the percentage of children in each country of the Region who are in families and schools that meet these standards and the percentage of children who are not vulnerable (i.e., are above the threshold for vulnerability). A particularly interesting finding revealed in the table is that Cuba scores high on virtually every measure—the exceptions are frequent testing and no ability grouping. This finding suggests that Cuba’s very high test scores are not attributable solely to parents’ higher lev- el of education, but also are due to factors pertaining to early child development, school resources, and school policy and practice. When meeting with members of the Laboratorio, the Minister of Ed- ucation for Cuba explained Cuba’s remarkable success with school outcomes by first noting not the quality of Cuba’s schools, but the fact that almost every child attends a center for early child develop- ment. Other factors, such as high levels of teacher training, were cit- ed only secondarily. Next Steps: Strengthening the Basis for Monitoring and Reform The challenges in conducting international comparative studies of early child development are enormous, and these challenges are especially acute in low-income countries. In comparison with other Table 5. Percentage of Children in Families and Schools That Meet the Standards Selected Country/percent of children Variable AR BO BR CH CO CU HO ME PA RD VE All Family background Two-parent family 84 83 82 84 74 78 64 89 79 72 70 80 High parental education 59 50 23 67 47 89 18 49 36 44 61 52 Early child development Day care 87 70 78 70 67 94 59 84 50 67 86 75 Frequently reads to child 37 28 43 40 26 73 30 25 26 38 35 36 High parental involvement 51 48 65 66 69 84 57 53 62 49 70 61 School resources Small classes 84 80 57 33 36 88 2 — 29 11 27 54 Classroom materials 79 18 71 94 48 69 4 57 13 25 30 52 Adequate library 43 7 56 45 21 76 17 5 12 8 27 32 High teacher training 12 58 48 80 58 73 39 60 11 50 43 55 School policy and practice Teachers working one job 41 11 73 46 68 99 68 – 78 59 68 52 No multigrade classes 86 83 98 78 68 99 65 93 100 95 98 87 Frequent testing 41 53 31 86 24 39 57 72 27 14 45 46 No ability grouping 30 32 62 11 33 64 52 18 40 53 38 39 Standards of Care Good classroom climate 35 59 52 32 41 97 27 37 37 61 22 51 High parental involvement 29 10 56 73 76 98 32 33 55 26 87 54 Children not vulnerable 66 38 55 71 45 95 25 41 47 26 35 50 AR, Argentina; BO, Bolivia; BR, Brazil; CH, Chile; CO, Colombia; CU, Cuba; HO, Honduras; ME, Mexico; PA, Paraguay; RD, Dominican Republic; VE, R.B. de Venezuela. 113 114 J. Douglas Willms national and international studies, PEIC stands out as a remarkable achievement. The study provides a strong basis for monitoring early child development. The findings indicate that one can accurately estimate socioeconomic gradients, discern the importance of school resources, and identify the effect of investments in early childhood by families and schools. Perhaps more than any other study, PEIC in- dicates that parents’ and teachers’ actions (i.e., what they do with their resources) can have an effect comparable to improving the level of resources. If countries achieved the standards set forth in this chapter, they would reduce the risk associated with low parental education by nearly one-half. Flattening the gradients is possible, and some countries have already achieved many of the standards proposed. The framework for standards of care suggested in this chapter is founded on several key considerations for low-income countries. For these countries, the standards must: (a) be based on empirically de- rived findings about their effects on measurable outcomes; (b) be achievable through a coordinated effort by families, schools, and governments; (c) be inexpensive to measure regularly; and (d) pro- vide a means for gauging societal improvements over time. Additional studies in Latin America would benefit by including many of the measures developed in PEIC and suggested herein. The information gained from PEIC could be enhanced in several ways, as suggested below. The first suggestion would be costly to implement, but the others would be relatively inexpensive. 1. Develop a study comparable to PEIC, but with a target popula- tion of all 5-year-old children. A target population of even younger children is preferable, but reaching all 5-year-olds may be a sufficient challenge for the next study. This study would be conducted in conjunction with a study of all 9-year-old chil- dren. By repeating the monitoring effort every 4 years, one could assess the results for the 5-year-old cohort in the same schools when the majority of children are 9 years old. Standards of Care 115 2. Give preference to studies focused on age cohorts rather than grade cohorts. Although more complex administratively, a study of age cohorts would indicate the progression of children developmentally in school and control directly for any effects associated with grade repetition. 3. Track “communities,” however defined. For example, if a study first sampled communities, defined geographically, and then sampled schools and pupils, outcomes and socioeconomic gradi- ents for the community could be examined and the stability of the estimates could be discerned. By using multilevel models that extend PEIC’s analyses and incorporating time as an element (Willms and Raudenbush 1989), powerful information could be obtained about the effects of policies and practices for early childhood. Changes in intercepts and gradients could be related to changes in policy and practice within local communities. 4. Integrate geography better into the analyses. In almost all re- search on schools’ effectiveness, schools are treated as indepen- dent entities and not in relation to other schools in the commu- nity. Understanding of the roles of local communities could be improved dramatically if sufficient geographic data were avail- able to display findings on country maps. Importantly, the ef- fects of particular policies and practices could be documented “on the ground.” 5. Integrate small-sample, quantitative and qualitative studies of early child development into large-scale monitoring efforts. For example, the Willms and Somers (2000) report indicates schools that are particularly successful or unsuccessful in achieving high standards, based on the number of pupils and level of resources. Ethnographic studies are needed to understand why these schools are successful. Small-scale studies could be piggybacked onto large-scale studies to determine, for example, the results of the lowest-performing schools 4 years after a concerted effort is made to enhance their standards of school policy and practice, as suggested in PEIC. 116 J. Douglas Willms Two immediate opportunities for building on PEIC’s findings are in Brazil and Pakistan. The World Bank recently contracted to pro- vide technical assistance to Brazil’s National Institute for Educational Research (INEP). Brazil already has a sophisticated system for moni- toring schools, which includes a school census. Under the new con- tract, researchers could approach analysis of the monitoring data from a gradient perspective and give greater emphasis to standards of care, changes in community gradients over time, and geographic variations. INEP could then exploit historical records of achievement (e.g., over the past 10 years) to give educators and administrators findings based on more than a 1-year snapshot. The opportunity in Pakistan entails an operational research ap- proach to studying human development. The Aga Khan University (AKU) in Pakistan is developing an Institute of Human Development and has acknowledged the important role that this institute could play in research and training and in influencing policy formation in developing and Muslim countries. This research could demonstrate the importance of investments in human development in low-in- come countries. An immediate opportunity is the development of a study to examine the effects on children’s development (ages 0 to 6) of a training program to improve parenting skills and increase par- ents’ engagement in play and other literacy-related activities. This training program could be delivered through AKU’s network of pri- mary health care centers. Instruments and data collection procedures for conducting monitoring on a wide-scale basis for children during the early years could be developed as part of this research effort. Conclusion In recent years, low-income countries have increasingly participated in large-scale international studies such as the Third International Mathematics and Science Study (TIMSS) and the IALS, both con- ducted in 1994. During 2000, several low-income countries partici- pated in PISA, a study of academic achievement among 15-year-olds conducted by the Organization for Economic Cooperation and Standards of Care 117 Development. This bold and important move by these governments could yield long-term benefits for their systems of schooling. Too often, however, the findings of large-scale studies have little internal effect. Too much emphasis may be placed on “horse-race” compar- isons of average levels of achievement among countries, and few re- sources are usually available for data analyses within countries. Systems to monitor internal effects are needed. They could provide information on changes in achievement levels over time, inequities of achievement between males and females or among pupils of differ- ent socioeconomic backgrounds, varying achievement levels among jurisdictions, and the relationship between the quality of schools and their material and human resources or policies and practices. The PEIC study has provided invaluable information for analyzing children’s educational outcomes within and between countries. The standards of care derived from such analysis provide the basis for in- vestments to improve children’s school outcomes in Latin America and to monitor early child development. One of the most prominent findings noted in the first report on PEIC (UNESCO 1998) was the re- markable success of Cuba: Its average test scores, for both reading and mathematics, were about 2 standard deviations above the mean for the Region. Two other important findings across the Region and in most countries were that (a) the average test scores of pupils residing in mega-cities (having more than 1 million people) were somewhat higher than those of pupils in smaller cities and markedly higher than those of rural pupils and (b) pupils in private schools tended to have higher scores than those in public schools (UNESCO 1998). The second report (Willms and Somers 2000), on which this chapter is based, included among the outcomes a measure of the time needed for pupils to complete the first 3 years of primary schooling. Most Latin American countries still practice grade reten- tion and, in some cases, pupils may repeat a grade two or three times before advancing to the next grade. The data show that achievement test scores and grade repetition were strongly related to children’s family background, school sector, and extent of urban- ization. However, even after accounting for the pupils’ family back- 118 J. Douglas Willms grounds, the schools differed substantially in the academic achieve- ment of pupils and the time pupils took to complete the first 3 years of primary school. Some, but not all, of this variation was attribut- able to school resources, especially the availability of classroom in- structional materials, adequate school library, small classes, and well-trained teachers. Further analysis showed that school policies and practices have substantial effect. Test scores were higher and grade repetition was less in schools which had teachers who did not hold other jobs, no multigrade classes, frequent testing of pupils, and no grouping of pupils by ability. Two of the most important factors affecting outcomes were the learning climate of the classroom and the extent of parents’ involvement in children’s schooling, at home and at school. It is hoped that these findings will provoke focused discussions and dialogue about standards of care, as well as targeted investments to improve children’s educational outcomes in Latin America and elsewhere. Additional studies that build on the framework suggested in this chapter would strengthen the basis for monitoring outcomes and reforms. Notes This chapter extends the research for a report entitled Schooling Out- comes in Latin America, which was prepared by the author and Marie- Andrée Somers for UNESCO in cooperation with the Laboratorio Lati- noamericano de Evaluación de la Calidad de la Educación. Preparation of the report was supported by UNESCO, and this chapter, by the World Bank. The research was supported by the Canadian Institute for Advanced Research, which funds the New Brunswick/Canadian Imperial Bank of Commerce (NB/CIBC) Chair in Human Development at the University of New Brunswick, and by Human Resources Development Canada, Statistics Canada, and the U.S. Spencer Foundation. The opinions expressed in this chapter are solely the author’s. Standards of Care 119 References Audas, R., and J.D. Willms. 2000. Engagement and Dropping Out of School: A Life Course Perspective. Report prepared for Human Resources Development Canada. Ottawa. Baron, R.M., and D.A. Kenny. 1986. The Moderator-Mediator Variable Distinction in Social Psychological Research: Conceptual, Strategic, and Statistical Considerations. Journal of Personality and Social Psychology 51:1173–82. Boyle, M.H., and J.D. Willms. 1998. Place Effects for Areas Defined by Administrative Boundaries. American Journal of Epidemiology 149(6):577–85. Bryk, A.S., V.E. Lee, and J.B. Smith. 1990. 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Schooling Outcomes in Latin America. Fredericton, N.B.: Canadian Research Institute for Social Policy, University of New Brunswick. 122 J. Douglas Willms Wolfson, M., G. Kaplan, J. Lynch, N. Ross, E. Backlund, H. Gravelle, and R.G. Wilkinson. 1999. Relation between Income Inequality and Mortality: Empirical Demonstration. British Medical Journal 319:953–57. Wolfson, M., G. Rowe, J.F. Gentleman, and M. Tomiak. 1993. Career Earnings and Death: A Longitudinal Analysis of Older Canadian Men. Journal of Gerontology 48(4):S167–79. Chapter 5 Ensuring a Fair Start for All Children: The Case of Brazil Mary Eming Young Early childhood is a time of great vulnerability and opportunity. Rapid and dramatic changes in physical and mental development oc- cur during the first 3 years of human life. These developmental changes are currently viewed as the principal “building blocks” of adult cognitive and emotional functioning. Research on the brain shows that early experiences can shape individuals’ development (see the chapter by Mustard in this volume) and that early childhood of- fers a unique opportunity to change the life course of all children and, especially, those at risk. Many and various interventions have been undertaken worldwide to take advantage of this opportunity, for the benefit of children, families, and society. The interventions focus on children, parents, and families and often involve entire communities. The early child development (ECD) programs enhance children’s physical and intel- lectual growth during their early years through a range of services, which include childcare, preschool, home visits by trained profes- sionals, health and nutrition support, and parental education. The programs may be based in homes or childcare centers. Evaluation of these programs demonstrates clearly that early child- hood interventions are effective in improving children’s success in school and later life, especially for vulnerable, at-risk children who 123 124 Mary Eming Young live in poverty or in low-income families. These children often are born with low birthweights—a corollary of poverty and stunted de- velopment—and often have illiterate parents or mothers with low ed- ucation. The negative consequences for children of income poverty have been well documented. They span the life course, from birth (e.g., low birthweight) through toddlerhood and preschool years (e.g., poor social and emotional competence, reduced cognitive test scores) to adolescence (e.g., reduced completion of secondary school and low literacy, early childbearing). Interventions early in life are small investments that bring high returns for the physical, mental, and economic well-being of children and the adults they become. This chapter addresses the return on investments in early child de- velopment, especially for poor children. The benefits of preschool in- terventions for these children are summarized from several well- known U.S. interventions, and data from Brazil are shared as a case example of the opportunities available and the possibilities for ensur- ing a fair start for all children in the twenty-first century. Early Interventions for Vulnerable Children: U.S. Findings For all countries, ECD programs can promote learning readiness, in- crease school enrollment, reduce grade repetition and drop out from school, and increase individuals’ future earning capacity. Preschool education is an important component of early child development and results in children who are better prepared for primary school, who perform better in school overall, and who often benefit from im- proved health and nutrition. The benefits for vulnerable children are especially large and help redress the inequities of their birth. Research shows that early interventions particularly improve poor children’s performance and achievement in primary school (Karoly and others 1998). Most of the interventions in the United States re- porting positive results for these children are center-based programs for children ages 3–5 years (and some for children ages 0–3). Two no- table U.S. interventions which utilized a quasi-experimental design and targeted infants and young children beginning at birth are the Ensuring a Fair Start for All Children: The Case of Brazil 125 Abecedarian project in North Carolina and the Infant Health and De- velopment Program at various sites across the country. The outcomes of these efforts are summarized briefly below. Other types of early childhood interventions in other countries have also yielded positive results. Some effective alternatives (e.g., in Mexico, Turkey) emphasize education and enrichment of parents, es- pecially mothers. The return on investment can be significant, as de- termined for the Perry Preschool Project, a third successful U.S. inter- vention for low-income children summarized below. The Carolina Abecedarian Project The Carolina Abecedarian project was a single-site, randomized con- trolled trial that enrolled 111 children at birth who were biologically healthy but who came from very poor and undereducated families. The criterion for admission was a score indicating extreme risk on a thirteen-item high-risk index (Ramey and Ramey 1998). For example, the mean maternal intelligence quotient (IQ) was 85; the mean maternal education was 10 years; and approximately three-fourths of the mothers were unmarried. The families of the control group (n=54) received pediatric follow- up services, unlimited iron-fortified formula, social work services, and home visits. The intervention group (n=57) received the same services as the control group plus an early childhood education pro- gram, Partners for Learning, which was developed for the interven- tion and implemented in the participating child development cen- ters. Partners for Learning is an education program focusing on the first 36 months of life (Sparling, Lewis, and Ramey 1995) and consists of “games” that are incorporated into a child’s daily activities, which address social, emotional, and cognitive development and particular- ly emphasize language. The centers enrolled children after 6 weeks of age and maintained a low child-to-teacher ratio (3:1 for children age 1 year or less and 4:1 for children ages 1–3 years). Parents received home visits and attended parent group meetings. The results have been reported widely (Campbell and Ramey 1994, 1995; Ramey and Ramey 1998; Ramey and others 2000). By 36 126 Mary Eming Young months, the mean IQ scores were 101 and 84, respectively, for the in- tervention and control groups. The positive effects of the early inter- vention were greater for children of lesser-educated mothers than for those of more-educated mothers. Upon completion of the intervention at age 5, the children en- tered primary school. They were studied and tested again at ages 12 and 15, and a follow-up to determine long-term effects was conduct- ed at age 21. The children who received the early intervention per- formed better than the control group throughout the 20 years (figure 1). At age 21, they had higher mental test scores and higher reading scores, more were still in school (40 percent versus 20 percent), and more were in college or had graduated from college (35 percent versus 14 percent). They were, on average, 2 years older when their first child was born (19.1 years versus 17.1 years), and they had a higher employment rate (65 percent versus 50 percent). Infant Health and Development Program The Infant Health and Development Program (IHDP) was a longitudi- nal, eight-site, randomized trial of the effectiveness of an ECD pro- gram and family support services for approximately 1,000 low-birth- weight, premature infants from birth to age 3 (Berlin and others Source: Campbell and Pungello (1999), Frank Porter Graham Child Development Center, University of North Carolina, Chapel Hill. Figure 1. Abecedarian Project, Cognitive Test Scores, Ages 6.5–21 Years Ensuring a Fair Start for All Children: The Case of Brazil 127 1998). The study is unique in structuring a randomly assigned com- parison group. Eligible infants for the study had low birthweights (2,500 grams or less); were premature (37 weeks or less postconcep- tion); and were born between January 1985 and October 1985 in one of eight participating medical institutions. The eligible infants were stratified into two birthweight groups: lighter (< 2,001 grams) and heavier (2,001–2,500 grams) and then randomized into an interven- tion or comparison group. Two-thirds of the sample were in the lighter group and one-third was in the heavier group. One-third of the infants within each birthweight group was randomly assigned to the intervention group, and two-thirds were assigned to the compari- son group. Of the 1,302 eligible infants, 985 were randomized and were the principal sample. This sample came from racially and socioeconomi- cally diverse families, which included African-American families (52 percent), European-American families (37 percent), and Hispanic- American families (11 percent). The families’ incomes varied broadly. The intervention began immediately after the infants were dis- charged from the hospital and continued until the children were 3 years old (corrected age). All infants received a pediatric follow-up, including a medical and developmental assessment, and were re- ferred for other services as needed. In addition, the intervention group received (a) home visits on a weekly basis during the first year and then biweekly during the second and third years; (b) out-of- home education in child development centers beginning at 12 months and provided for 20 hours per week; and (c) parent group meetings at the child development centers every other month until the end of the program, to receive childrearing information and social support. The IHDP demonstrated positive outcomes and, as in the Abe- cedarian project, the children of the poorest and least-educated mothers gained the most benefit (Berlin and others 1998; Duncan, Brooks-Gunn, and Klebanov 1994; IHDP 1990; McCarton and others 1997). Compared with the comparison group, the children in the intervention group had higher cognitive development scores and 128 Mary Eming Young verbal scores at age 24 months and 36 months (figure 2). The positive effects were sustained through age 5 and age 8 (follow-ups). The chil- dren’s socioemotional development also showed positive effects. They had fewer behavioral problems (based on the Richman-Graham Behavior Checklist) at ages 24 and 36 months. Mothers reported fewer symptoms of depression and were more likely to be employed by the time their children were 36 months old. During the 3 years of the intervention, the mothers averaged more months of employment than the mothers in the comparison group (Berlin and others 1998). The Perry Preschool Project The Perry Preschool Project targeted low-income children ages 3–5 years. At initial testing, the children selected ranged from 70 to 85 in intellectual performance. The sample of 123 children was randomly assigned to one of two groups: a program group (n=58) enrolled in the preschool program, or a no-program group (n=65) not enrolled in Source: Berlin and others (1998). Figure 2. Infant Health and Development Program, Cognitive Development Over Time, Ages 12–36 Months Ensuring a Fair Start for All Children: The Case of Brazil 129 preschool. There were no differences in the children’s or parents’ abil- ities or disposition before the preschool program began. The program and no-program groups were matched in mean socioeconomic status, mean intellectual performance, and percentage of girls and boys. The intervention included a daily 2.5-hour classroom session every week- day and a weekly 90-minute home visit on weekday afternoons for 30 weeks per school year for 2 years. The teacher:student ratio was 1:6. At age 27, the students who had attended the program had an em- ployment rate twice as high, a high school completion rate one-third higher, 40 percent less crime, and 40 percent less teenage pregnancy than the students who had been in the no-program group (Schwein- hart, Barnes, and Weikart 1993). Importantly, the Perry Preschool Project shows a strong return on investment. The estimated benefit to cost of this project is US$7 (in savings) to US$1 (cost). This return is impressive and it highlights the very dramatic differences that can be made with early interventions for disadvantaged children. Indeed, much of the literature on international development con- cludes that a comprehensive program of early childhood services is a strong weapon against poverty, a builder of human capital, and one of the best investments a country can make in its overall develop- ment. Brazil is a case in point. Brazil: A Case Example Brazil is the ninth largest economy in the world, with a per capita gross national product of US$4,720. Although ranked as an upper- middle-income country, Brazil has a highly inequitable distribution of wealth resulting in a large gap between rich and poor. Poverty is associated with poor social indicators, especially for chil- dren. Currently, in Brazil, 6.3 million children under age 6 are in fam- ilies living in poverty. Children who are born poor, as correlated with their mother’s education, have higher mortality rates, lower immu- nization rates, and higher rates of malnutrition. They also have lower access to early childhood services. These children tend to do poorly in school, repeat grades, and eventually drop out of school. 130 Mary Eming Young In 1998–99, the World Bank undertook a study to review the edu- cational status of young children in Brazil and the policies and ser- vices targeted to preschool children. The findings of this study (World Bank 2001), summarized below, are important for all coun- tries and relevant to their ECD efforts. Early Childhood Services in Brazil Public services for children younger than age 7 in Brazil consist of day-care centers (crèches), for children up to age 3, and preschools (prèescolas), for children ages 4–6. In 1999, the official age for enter- ing primary school was 7; however, enrollment of 6-year-olds in pri- mary school is considered optimal. Since 1996, municipalities have been responsible for providing ele- mentary and early childhood education, and Brazil’s constitution re- quires that at least 25 percent of the budget be spent on maintaining and developing education. Public preschools are generally staffed by government employees, and they use a predetermined curriculum. Private institutions (including for-profit, nonprofit, and govern- ment-subsidized organizations) play a substantial role in providing preschool and day-care services and account for almost 44 percent of the enrollments in formal programs. To meet the significant demand for preschools and day care, an array of nonformal ECD services are also offered by community-based, nongovernmental, and religious organizations in the public and private sectors. These nonformal, low-cost alternatives to formal public preschools are estimated to serve more than 1 million children through home visits, day-care centers, and training and literacy centers. Preschool Enrollment In 1997, approximately 27 percent of Brazil’s 22 million children ages 0–6 years were enrolled in day-care and preschool programs. Approx- imately one-half attended public facilities, and one-half attended pri- vate facilities. Data from Brazil’s National Household Survey (IBGE 1997a) show that children in day care and preschool tend to be older and from Ensuring a Fair Start for All Children: The Case of Brazil 131 richer and urban families. Approximately 61 percent of Brazil’s chil- dren are enrolled in early childhood programs by age 6 (excluding primary school), compared with about 36 percent at age 4 and 55 percent at age 5. Enrollment for all children younger than age 3 aver- aged 6–8 percent across Brazil’s regions, and only 1 percent of chil- dren under age 1 attended day care. Regionally, enrollment was high- est in the Northeast and Southeast, averaging about 50 percent for children 4–6 years old. Enrollment in the Midwest, South, and North and in rural areas everywhere was low in comparison. Early education in Brazil is clearly an issue of rich versus poor. The 1997 household data show that the average rate of enrollment for children ages 0–6 in the richest 10 percent of the population is 56 percent, or more than twice the rate (24 percent) for children from the poorest 40 percent. Also, three-fourths of all preschool children in Brazil attend urban schools, and more urban than rural children participate in early education (32 percent versus 21 percent) at ages 0–6. The gap is largest in the Southeast region, followed by the Mid- west, South, and Northeast. Expenditures for Early Childhood Education In 1995, Brazil spent approximately US$1 billion in public funds on direct expenditures for early childhood education (Barros and Men- donça 1999; World Bank 2001). The expenditures ranged from US$37–$55 in the North and Northeast regions per child in preschool to US$173 in the South, US$324 in the Midwest, and more than US$660 in the Southeast. The state of São Paulo alone accounted for 75 percent of the nation’s total spending on early childhood services. Total public spending for preschool in Brazil primarily reflects the ECD budget of a single wealthy state, although almost two-thirds of the country’s poor live in a region (the Northeast) which, in 1995, re- ceived only 5 percent of these funds. Clearly, early childhood services means something far different for children in this region, and other poor or rural regions, than for children in São Paulo. Despite its relative wealth, São Paulo also receives a disproportion- ate share of social assistance for children ages 0–6. The state accounts 132 Mary Eming Young for only 6 percent of the poor children served by these programs, but receives almost 14 percent of the nation’s total budget for these pro- grams. In contrast, a poor state, such as Bahia, which has 17 percent of the poor children under age 7 served by social assistance programs, receives only 5 percent of the total budget for these programs (Barros and Mendonça 1999). Is Brazil investing its educational resources appropriately and effec- tively? Three findings are significant (Barros and Mendonça 1999): • Per-child spending at day-care and preschool levels is lower than at any other level of education. In 1995, total public ex- penditure for children ages 0–6 was approximately 17 times lower per student than the amount spent on tertiary education. • Municipalities are responsible for about 90 percent of the direct expenses for preschool and day-care facilities, as well as elemen- tary education, leaving few resources for ECD services. The ef- fects are serious. For example, although malnutrition is most dangerous during early childhood, only 13 percent of the bud- get for school feeding is targeted to children ages 0–6. • “Rich” children receive a disproportionate share of public ex- penditures. All Brazilian children, rich and poor, have the same constitutionally mandated access to preschool education; how- ever, most public expenditures are disproportionately concen- trated on educating nonpoor children. Benefits and Costs As part of the assessment of early childhood education in Brazil, the World Bank and the Institute of Applied Economic Research (IPEA) in Rio de Janeiro, Brazil, conducted an analysis to evaluate the effect of preschool education on children’s nutrition, years of schooling, and future earning capacity, for different age cohorts. The study utilized data collected in 1996–97 for Brazil’s survey of living standards (IBGE 1997b), which covered about 20,000 citizens between the ages of 25 and 64 in approximately 5,000 households in urban and rural areas Ensuring a Fair Start for All Children: The Case of Brazil 133 in the Northeast and Southeast regions of Brazil. The principal find- ings are as follows (Barros and Mendonça 1999): • Attendance in preschool has a positive and significant effect on the average years of schooling ultimately attained. One addi- tional year of preschool correlates with about a half-year in- crease in the schooling ultimately attained, and the gain may be higher for children of illiterate parents. • Preschooling also has a positive and statistically significant ef- fect on the probability of completing a certain level of educa- tion by a specific age. The rates for grade repetition are reduced by 3–5 percentage points for each additional year of preschool. The reduction in grade-repetition rates is especially important in Brazil, where children average 1.4 years to complete a grade. Reduced repetition increases the efficiency of schooling and de- creases the costs of schooling. • Attendance in preschool has both direct and indirect positive effects on future earnings. For males, 1 year of preschool educa- tion directly results in a 2–6 percent increase in future earnings. Future income also is indirectly affected by increases in overall schooling. In general, 1 year of primary school is estimated to in- crease future income by approximately 11 percent (Barros and Mendonça 1999). [The economic literature on education esti- mates that 1 extra year of primary education increases some- one’s future productivity by 10–30 percent (van der Gaag and Tan 1998).] Because one additional year of preschool correlates with a half-year increase in schooling, it produces an indirect gain in future income of about 5 percent. The combined direct and indirect effects of 1 year of preschool are, thus, a minimum 7 percent increase in potential lifetime income—for children whose parents have only 4 years of education (figure 3). Impor- tantly, the gains appear to be higher for children of illiterate parents. These children could gain a 12 percent increase in fu- ture earning capacity (figure 4). 134 Mary Eming Young This finding supports claims by other countries that the benefits of early childhood education are higher for children of low-income families than for children of middle- or high-income families. In the Brazil study, preschool education did not appear to significantly af- fect women’s earnings, probably because of their informal participa- tion in the workforce. Based on these gains, the benefit:cost ratio of investing in preschool education is 2:1, demonstrating that each year of preschool education yields a high return on investment. The benefits outweigh the costs and compare favorably with most benefit:cost ratios for in- dustrial and agricultural projects, which are less than 2:1 (van der Gaag and Tan 1998). Returns to Investment If education is considered an investment in human capital, the re- turns to this investment can be estimated. The benefit-cost analysis in the Brazil study shows a rate of return on preschool education of 7–12 percent. In other words, for each year of preschool education, participants can expect a 7–12 percent increase in future income. The Source: Derived from Barros and Mendonça (1999). Figure 3. Increase in Future Earning Capacity for Children Whose Parents Have 4 Years of Education Ensuring a Fair Start for All Children: The Case of Brazil 135 rate of return is 1.5 percent higher for the Southeast and tends to be higher among whites. Willingness to Pay for Preschool A calculation of the present value of the income derived from 1 year of attending preschool was compared with potential income without attending preschool. The calculation indicates that families would be willing to pay for preschool, especially those at higher-income levels. By charging fees for those who can afford to pay them, Brazil, and other countries, could extend preschool opportunities to more fami- lies and children at risk, thereby further enhancing the return on in- vestment. Policy Implications The benefit-cost analysis conducted by IPEA and the World Bank sug- gests that early intervention in the schooling of 4–6 year olds can make a difference by improving their chances of attaining higher levels of education, reducing grade repetition, and earning a higher income in the future. The main effect of preschool appears to be Source: Derived from Barros and Mendonça (1999). Figure 4. Increase in Future Earning Capacity for Children Whose Parents Are Illiterate 136 Mary Eming Young better preparedness for further schooling. Investing in good-quality preschools can be expected to improve attainment and efficiency of higher levels of future schooling. Because public preschools in Brazil are accessible to both rich and poor, the indication of willingness to pay is especially important. The benefits of preschool education sub- stantially outweigh the costs, which suggests that fees could be charged to families that can afford them. Preschool could then be subsidized or provided free to poor families that do not have access to this educational opportunity, but would benefit the most from it. These findings are supported by similar studies in Brazil and else- where. They imply three major policy actions: 1. Strengthen preschool financing to increase enrollment and efficiency. The research demonstrates an impressive willingness to pay for preschooling. The actual fees being charged, however, underval- ue the true demand. In Brazil’s Northeast, for example, not-so- poor households are charged only a small fee per year. Institut- ing a better fee structure would be an important measure for improving the financing of preschools without having to de- pend on additional budgetary outlays. 2. Increase access to preschool and early childcare for the poorest children. Increasing access to preschool for these children should be a na- tional priority in Brazil and elsewhere. Brazil’s guarantee of free preschool for every child is commendable, but targeting this commitment to poor children will greatly enhance its effect. This targeted strategy could be enhanced further by expanding nonformal programs, as low-cost alternatives to standard public services, and exploring public-private partnerships in early child development. 3. Combine preschool with other ECD services and support parents. Com- bining preschool with other ECD services is recommended. Children ages 0–3, who are mostly cared for at home, need to be connected with primary health programs. Parents should be given information, support, and assistance for their efforts to provide emotional support and stimulation for their children. Ensuring a Fair Start for All Children: The Case of Brazil 137 Brazil is taking major strides to improve its ECD services. The National Plan for Education (1998–2008) sets forth ambitious goals and objectives for day care (ages 0–3) and preschool (ages 4–6) (figure 5). Day Care (Ages 0–3) Access Goal: To expand day-care enrollments to at least a third of children 3 years or younger in the next 10 years. • Expand the provision of day care at least 5 percent per year. • Target poor children first. Quality Goal: To ensure that day-care programs provide a comprehensive package of health, nutrition, and education services to children (ages 0 to 3); are in formats flexible enough to meet families’ needs; and have higher-quality staff. [Specific objectives are set for 1, 2, 5, and 10 years.] Information, Monitoring, Quality Control Goal: To set national ECD standards and establish a municipal system for monitoring private, public, and community day-care centers. [Specific objectives are set for 1, 3, and 5 years.] Preschool (Ages 4–6) Access Goal: To achieve universal preschool enrollment. In 1 year: • Expand public preschool enrollments, focusing on poor children, by at least 5 percent per year. • Replace the classe de alfabetização program for disadvantaged 7-year-olds with preschool for children under age 6 and regular primary school for children 7 and older. In 5 years: • Set universal preschool enrollment for 6-year-olds as a Basic Education requirement. In 10 years: • Increase the enrollment of 4–6 year olds from the current 40 percent to 66 percent. Quality Goal: [Specific objectives are cited for 1, 3, 5, and 10 years to set and enforce national standards for preschool infrastructures, educational curricula and services, and professional training.] Information, Monitoring, Quality Control Goal: To set national ECD standards for preschools. [Specific objectives are set for 1, 3, and 5 years.] Source: Fujimoto-Gómez (1999). Figure 5. Brazil’s National Education Plan, 1998–2008: Day Care (Ages 0–3) and Preschool (Ages 4–6) 138 Mary Eming Young As elsewhere in the world, such lofty goals must be matched by commitment to funding. In its overall National Education Plan, Brazil gives first priority to elementary education for children ages 7–14, followed by education of adults deprived of basic learning during childhood, and, then, early childhood services. Brazil’s early child- hood services program requires adequate public support. Chronic underfunding and failure to target available resources to help poor families continue to undermine the efficacy of these services in Brazil. The first priority for any national ECD plan should be to ensure that poor children receive ECD services comparable with those pro- vided for more-fortunate children. Partnering with the private sector can be an effective way for government to achieve its goals by lever- aging its resources. The Advance Brazil (Avança Brazil) Program is an example of the promise of such public-private partnerships. It is a multiyear plan (Plano Plurianual, PPA) of all governmental programs. “Atençao à Criança” is one of the Advance Brazil programs targeting early child- hood, ages 0–6. The “Atenção à Criança” Program The “Atençao à Criança” Program for 2000–03 includes several key objectives to overcome poverty and social exclusion. An early childhood program is part of the framework. Overcoming poverty and exclusion in Brazil is a challenging task because Brazil has many inequities resulting from unequal income distri- bution and a long history of slavery. These inequities are com- pounded currently by budgetary crises, inability to respond to increasing social demands, and heightened unemployment and poverty resulting from globalization. The “Atençao à Criança” Program is targeting the next decade as the “Decade for Overcoming Poverty.” The program focuses on the family, including education of parents. One program, for children ages 0–6, has a 4-year budget of US$1 billion. The aim is to integrate all efforts toward the healthy growth and devel- opment of poor children, especially the poorest of the poor. The Ensuring a Fair Start for All Children: The Case of Brazil 139 basic strategy is to provide universal access to prenatal care for poor women, universal registration (of birth) for all children, early childhood education (formal and nonformal), and services to families. The educational programs include institutionalized day care and preschools, part- and full-time; noninstitutionalized home day care and “roving nurseries”; and alternative programs (e.g., by nongovernmental organizations) offering health, social develop- ment, education, nutrition, and family support. Services for fam- ilies include nutritional, social, health, socioeducational, and in- come-generating support for parents and their children. The monetary resources for these activities are substantial, but have previously been provided piecemeal. The “Atençao à Criança” Program will integrate and direct all the resources for children who truly need care. Additional efforts within the program target children ages 7–14, young adults ages 15–24, senior citizens over age 60, and peo- ple with disabilities. Schools, families, and communities are fo- cal points in all these efforts. The strategy for implementing them involves decentralization, capacity building in the public sector, monitoring and evaluation, and “driving” for results. This social agenda is based on the coordination of effort and a policy of inclusion. The savings to Brazil are sizeable. A child in preschool costs no more than US$100, but a child on the street costs US$200–$300, and a child in the penal system costs US$1,000 a month. The expenses of exclusion are high. Importantly, the “Atençao à Criança” Program includes the Minister of Finance and managers and presidents of companies, which have a stake in investing in children. All expenditures will be measured to assess them adequately and to understand the gains that are made through inclusion, not exclusion. Investing for children is a very positive human and economic strategy, and the greatest effects are seen among the poor. Source: W.E. Aduan, Federal Secretariat for Social Assistance, Brazil. 140 Mary Eming Young Conclusion To achieve greater equality in society, supportive efforts are needed beginning with children just after birth. Quality interventions from early infancy are clearly important and their positive effects have been documented in well-controlled prospective studies and large- scale retrospective studies, such as the Brazil study highlighted in this chapter. Early childhood interventions significantly improve the edu- cational attainment and success of poor children as they develop and mature. The needs are clear. Appropriate and cost-effective interven- tions are available. Governments can make a commitment to early child development and can coordinate targeted efforts to reach the poorest families and children. The opportunities are many for provid- ing children early learning experiences that will increase their chances for later success and their society’s overall productivity. Note The data presented in this chapter are derived from three documents: Brazil, Early Childhood Development: A Focus on the Impact of Preschools (World Bank 2001); “Costs and Benefits of Pre-School Education in Brazil,” by R. Paes de Barros and R. Mendonça, Institute of Applied Economic Research, Rio de Janeiro, Brazil, November 1999; and “Boosting Poor Children’s Chances,” by Gaby Fujimoto-Gómez, Or- ganization of American States, November 1999. The description of the Atenção à Criança Program is based on a presentation at the World Bank Conference on Investing in Our Children’s Future, April 10–11, 2000, Washington, D.C., by Wanda Engel Aduan, Director, Federal Secretariat for Social Assistance and State Secretary for Social Assis- tance, Brazil. References Barros, R.P. de, and R. Mendonça. 1999. Costs and Benefits of Pre- school Education in Brazil. Background study commissioned to Ensuring a Fair Start for All Children: The Case of Brazil 141 IPEA by the World Bank. Rio de Janeiro, Institute of Applied Economic Research. Berlin, L.J., J. Brooks-Gunn, C. McCarton, and M.C. McCormick. 1998. The Effectiveness of Early Intervention: Examining Risk Factors and Pathways to Enhanced Development. Preventive Medicine 27:238–45. Campbell, F.A., and E.P. Pungello. 1999. The Carolina Abecedarian Project. Website presentation on Long-Term Benefits of Intensive Early Education for Impoverished Children. Chapel Hill, N.C.: University of North Carolina, Frank Porter Graham Child Development Center. [www.fpg.unc.edu/~abc] Campbell, F.A., and C.T. Ramey. 1994. Effects of Early Intervention on Intellectual and Academic Achievement: A Follow-up Study of Children from Low-Income Families. Child Development 65:684–98. ———. 1995. Cognitive and School Outcomes for High-Risk African- American Students at Middle Adolescence: Positive Effects of Early Intervention. American Educational Research Journal 32:743–72. Duncan, G.J., J. Brooks-Gunn, and P.K. Klebanov. 1994. Economic Deprivation and Early Childhood Development. Child Development 65:296–318. Fujimoto-Gómez, G. 1999. Boosting Poor Children’s Chances. Background report commissioned to the Organization of American States. Washington, D.C.: World Bank, Human and Social Development Sector. IBGE (Instituto Brasileiro de Geografia e Estatística) [Brazilian Statistical Institute]. 1997a. Pesquisa National por Amostra de Domicílios (PNAD) [National Household Survey]. Rio de Janeiro. ———. 1997b. Pesquisa de Padrões de Vida (PPV) [Living Standard Measurement Survey]. Rio de Janeiro. IHDP (Infant Health and Development Program). 1990. Enhancing the Outcomes of Low-Birthweight, Premature Infants. Journal of the American Medical Association 263(22):3035–42. Karoly, L., P.W. Greenwood, S.S. Everingham, J. Houbé, M.R. Kilburn, C.P. Rydell, M. Sanders, and J. Chiesa, eds. 1998. Investing in Our 142 Mary Eming Young Children: What We Know and Don’t Know About the Costs and Benefits of Early Childhood Interventions. Santa Monica, Calif.:RAND. McCarton, C.M., J. Brooks-Gunn, I.F. Wallace, C.R. Bauer, F.C. Bennett, J.C. Bernbaum, R.S. Broyles, P.H. Casey, M.C. McCormick, D.T. Scott, J. Tyson, J. Tonascia, and C.L. Meinert. 1997. Results at Age 8 Years of Early Intervention for Low-Birth- Weight Premature Infants: The Infant Health and Development Program. Journal of the American Medical Association 277(2):126–32. Ramey, C.T., F.A. Campbell, M. Burchinal, M.L. Skinner, D.M. Gardner, and S.L. Ramey. 2000. Persistent Effects of Early Childhood Education on High-Risk Children and Their Mothers. Applied Developmental Science 4 (1):2–14. Ramey, C.T., and S.L. Ramey. 1998. Prevention of Intellectual Disabilities: Early Intervention to Improve Cognitive Development. Preventive Medicine 27:224–32. Schweinhart, L.J., H. Barnes, and D. Weikart. 1993. Significant Benefits: The High/Scope Perry Preschool Study Through Age 27. Monograph of the High/Scope Educational Research Foundation. No. 10. Ypsilanti, Mich.: High/Scope Educational Research Foundation. Sparling, J., I. Lewis, and C.T. Ramey. 1995. Partners for Learning: Birth to 36 Months. Lewisville, N.C.: Kaplan Press. van der Gaag, J., and J.P. Tan. 1998. The Benefits of Early Child Development Programs: An Economic Analysis. Washington, D.C.: World Bank, Human Development Network. World Bank. 2001. Brazil, Early Child Development: A Focus on the Impact of Preschools. Washington, D.C.: World Bank, Human Development Network. Part III Evaluating the Effectiveness of Early Childhood Programs Chapter 6 Investing in Effective Childcare and Education: Lessons from Research John M. Love, Peter Z. Schochet, and Alicia L. Meckstroth Childcare is becoming increasingly important in the United States and around the world as more and more parents are working and need care for their children. In addition, societies are increasingly in- terested in providing educational experiences and stimulation for all children to improve their chances of doing well in school and life. Often these experiences are provided in full-day settings referred to as childcare or in part-day programs such as preschool or prekinder- garten. As more children are placed in these childcare and education settings, understanding how the children are faring has become criti- cally important. Children’s safety is only one issue; other concerns re- late to children’s learning and development—while they are safe and free from danger. This chapter addresses four topics: the ingredients of quality child- care and education, the supports needed to achieve quality, relation- ships between quality and children’s development and well-being, and investments to enhance children’s development. The research and findings on these topics are described separately. Most of the re- search reviewed has been conducted in the United States, but the lessons learned may be relevant and pertinent to early child develop- ment (ECD) programs worldwide. Additional research is needed to 145 146 John M. Love, Peter Z. Schochet, and Alicia L. Meckstroth appreciate the applicability of the findings in other national contexts and with differing levels of resources. Ingredients of Quality Childcare and Education The Research Early research in childcare and the literature on preschool interven- tions provide a backdrop for understanding more recent studies of quality childcare and education. Quality is a concept typically used to describe features of program environments and children’s experi- ences in these environments that are presumed to be beneficial to the children’s well-being based on research and practice. Researchers have described empirical associations between features of childcare environments and aspects of children’s growth and development. The wisdom of practice has been captured by the National Associa- tion for the Education of Young Children (NAEYC) in its descriptions of “developmentally appropriate practice” (Bredekamp 1987; NAEYC 1996). A number of authors have attempted to define and measure quality childcare (Ferrar 1996; Ferrar, Harms, and Cryer 1996; Ferrar, McGinnis, and Sprachman 1992; Harms 1992; Howes 1992; Layzer, Goodson, and Moss 1993; Love, Ryer, and Faddis 1992; Phillips 1987; Phillips and Howes 1987). Two common features recur in these conceptualizations: a distinc- tion between the dynamic (interactional) and static (structural) fea- tures of a classroom, and an acknowledgment that the larger program context (outside the classroom) is an important determinant of the quality of children’s classroom experiences. Researchers have exam- ined the variables representing both the classroom environment and the larger program context. A review of this research suggests that much progress has been made since Lamb and Sternberg (1990) con- cluded that early research on childcare focused too much “on the ef- fects of daycare per se instead of recognizing that daycare has a myri- ad of incarnations and must always be viewed in the context of other events and experiences in the children’s lives.” Investing in Effective Childcare and Education: Lessons from Research 147 In the past 5 to 10 years, researchers have recognized the “myriad incarnations” of childcare by defining and measuring many quality variables, although they have not been as successful in understand- ing contextual variables. Tables 1 and 2 present an overview of stud- ies that have measured variations in childcare quality and outcomes for children in center-based childcare (table 1) and in family child- care (table 2). The Findings Researchers define the quality of early childcare and education in many ways, yet all the definitions reflect two main dimensions, or types of ingredients that correspond to the conceptual features just described: (a) the structure of a program or classroom (i.e., the basic setup that does not change much from hour to hour or day to day), and (b) the dynamics of the program or classroom (i.e., the behavior and interactions of the adults and children which change constantly and are interdependent). Classroom structure includes factors such as the size of the group and the ratio of number of children to adults, as well as the composi- tion of the group and safety factors. A classroom of twenty children and two adults has a group size of twenty and a ratio of 10 to 1. This structure is different from a classroom that has thirty children and two adults. Different numbers of children at different ages also alters the composition: A classroom of twenty 4-year-olds presents a differ- ent environment than one with ten 4-year-olds, five 3-year-olds, and five 2-year-olds. Classroom structure also includes the physical envi- ronment, which should be arranged to assure the safety of children, with electrical outlets covered, cleaning supplies locked up out of reach of children, and facilities for adults to wash after diapering or toileting. Staff characteristics, including education and training, as well as the program director or supervisor and the support she or he provides, are also part of the structure. Classroom dynamics includes four components: teacher’s behavior, children’s behavior, teacher–child interactions, and the stability and continuity of interactions. A teacher’s behavior may be positive and/or 148 John M. Love, Peter Z. Schochet, and Alicia L. Meckstroth negative. Positive behaviors include attentiveness, encouragement, en- gagement, sensitivity to children, and responsiveness to children’s changing needs. Negative behaviors include harshness and detach- ment. Other behaviors may occur, but these particularly positive and negative behaviors are especially important for children, as shown by research, and they can be measured by observation and recording. With respect to children’s behavior, one might ask, “What are the indicators of quality? Aren’t children just responding to the quality in the center or the home?” Of course, what children do while they are in a childcare setting at home or in a center is a good indicator of the quality of the environment. For example, a child’s crying may in- dicate hunger or a wet diaper or a teacher speaking harshly to, or ig- noring, the child. Teacher–child interactions are a special dimension for considera- tion. Recognition of these interactions acknowledges that adults’ behaviors affect children and often are a response to children’s behav- iors. In a quality childcare environment, teachers respond to chil- dren when the children talk and do things. Giving children interest- ing toys for play is not sufficient if a teacher does not respond when a child asks, “What is this?,” or if a teacher does not offer encourage- ment when a child builds a tower of blocks. Stability and continuity also are critical elements of classroom dy- namics. Children need caregivers who are constant in their lives, and teachers need to be consistent in the ways they respond to children. In sum, the important ingredients of quality childcare and educa- tion are: • Classroom (and program) structure – Appropriate and effective group size, child–staff ratio, com- position, safety – Supportive administration and services – Staff characteristics • Classroom dynamics – Positive teacher behaviors (e.g., attentiveness, encourage- ment, engagement, sensitivity, responsiveness) Investing in Effective Childcare and Education: Lessons from Research 149 – Positive child behaviors (e.g., interaction with materials, cooperation, joy) – Effective teacher–child interactions (e.g., teacher responsive- ness, verbal interaction) – Stability and continuity. Supports Needed to Achieve Quality The Research Research emphasizes the importance of childcare staff as supports for achieving quality outcomes. These studies record a variety of staff characteristics in relation to children’s outcomes. The variables in- clude staff’s level of formal education (Howes, Smith, and Galinsky 1995; Ruopp and others 1979); extent of experience in childcare (Kontos 1994; Ruopp and others 1979); specialized training in early childhood education and other certificates or credentials (Howes, Smith, and Galinsky 1995; Galinsky, Howes, and Kontos 1995); turnover and changes among teachers (Howes and Hamilton 1993); and experience of the center’s director (Phillips, McCartney, and Scarr 1987). Compared with research on the ingredients of quality, this re- search has been much less thorough and systematic in acknowl- edging that children’s childcare experience occurs in the context of other events and experiences in their lives. Some studies include such variables in their analyses, as Belsky (1990) notes, but the research overall does not yet yield firm conclusions about the effects of child- care quality when controlling for other factors. Some studies have examined variables describing child and family characteristics, such as family income (Studer 1992), mother’s educa- tion (Kontos 1991, 1994), mother’s employment (Kontos and others 1995), family structure (Kontos 1991; Schliecker, White, and Jacobs 1991), family socioeconomic status (Schliecker, White, and Jacobs 1991), child’s membership in a racial or ethnic group (Helburn and others 1995), child’s age when initially enrolled in out-of-home care 150 John M. Love, Peter Z. Schochet, and Alicia L. Meckstroth (Howes 1990; Kontos 1991), child’s gender (Howes 1988; Howes and Olenik 1986; Howes and Stewart 1987), duration of child’s day-care experience (Field 1991; Kontos 1991), child’s temperament (Hestenes, Kontos, and Bryan 1993), family social support (Howes and Stewart 1987; Lamb and others 1988), and family stress (Howes and Stewart 1987). These variables reflect the major advances that have been made in the richness of childcare research during the past decade, but additional, systematic research is needed to relate these variables to children’s childcare experiences. The Findings The research findings pertaining to staff characteristics point to eight factors that support quality childcare programs. These ingredients are: • Teacher education, especially specialized training in early child- hood • Inservice training beyond formal education • Teacher experience with children • Continuity of teaching staff—low turnover among the teaching staff • Adequate staff compensation—wages that allow staff to be com- fortable in their jobs and not worry about better-paying oppor- tunities elsewhere • A center director with experience and training who can super- vise and support staff • Community partnerships—linkages with other agencies that can provide health services and other supports • Safe and appropriate physical space. Relationship Between Quality and Children’s Development and Well-Being The relationship between childcare quality and children’s develop- ment and well-being has been assessed in studies conducted in child- Investing in Effective Childcare and Education: Lessons from Research 151 care centers and in family childcare settings. The findings indicate di- mensions of quality related to positive childcare outcomes, outcomes associated with higher quality, and factors modifying the relation- ship between childcare quality and outcomes. Research on preschool interventions supports these findings. Center-based Childcare: The Research The twenty-eight studies listed in table 1 demonstrate associations between various measures of childcare-center quality and one or more child outcome measures. Synthesizing the findings of these studies is complicated, however, because the studies differ in (a) de- sign (contemporaneous, longitudinal, and pre-post); (b) age of chil- dren (infant-toddler, preschool) during assessment and follow-up; (c) measures of childcare quality; (d) demographics of the sample; and (e) outcomes measured. In the table, the studies are grouped by type of design and listed alphabetically by author. The first nineteen stud- ies used one-time, nonexperimental, contemporaneous designs. The next seven studies used longitudinal designs, most with a one-time follow-up assessment. The last two studies used pre-post designs, assessing the program quality and child outcomes at the beginning and the end of specified periods. Center-based Childcare: The Findings Dimensions of Quality Linked With Positive Outcomes As suggested earlier, the ingredients of quality childcare typically are categorized into structural features, classroom dynamics, and staff characteristics. Hundreds of variables have been studied to elucidate these ingredients of quality. The most commonly measured structural variable is child–staff ra- tio. Considerable evidence shows that lower ratios (that is, fewer chil- dren per adult) are associated with a wide range of positive develop- mental indicators. The research also suggests that such structural features are associated with children’s well-being because they can provide the conditions that make possible more positive classroom dynamics. The National Day Care Study (Ruopp and others 1979) 152 John M. Love, Peter Z. Schochet, and Alicia L. Meckstroth shows that children’s social and cognitive development is enhanced in classrooms with a lower child–staff ratio and smaller group size. The Florida Child Care Quality Improvement Study (Howes, Smith, and Galinsky 1995) shows many significant improvements in chil- dren’s intellectual and emotional development after Florida institut- ed stricter requirements for ratios in infant and toddler centers. When the ratio was more favorable, children engaged in more cogni- tively complex play with objects; showed higher levels of linguistic narrative and discourse skills; were more securely attached to their teachers; and showed less evidence of aggression, anxiety, and hyper- activity. Improved ratios resulted in significant changes in the pro- gram environments. Teachers became more warm, sensitive, and nur- turing; showed greater responsiveness and encouragement; and were less negative in their disciplinary techniques. Many studies using contemporaneous designs have shown strong correlations between structural measures (such as ratio) and program dynamics. When classrooms have lower ratios, the amount of adult interaction with children is greater (Layzer, Goodson, and Moss 1993), and teachers and children interact in more beneficial ways (Whitebook, Howes, and Phillips 1989). When classrooms score high- er on structural dimensions such as safety and health, they are also rated as more developmentally appropriate (Love, Ryer, and Faddis 1992). The Florida study is especially useful in helping to disentangle the effects of different dimensions of quality. By using a pre-post design, Howes, Smith, and Galinsky (1995) demonstrate that changing one structural variable—which is readily regulatable—leads to inter- twined effects: overall (global) quality improves, teacher–child inter- actions improve, and children’s well-being is enhanced along a num- ber of dimensions. Howes and colleagues also note that the largest increases in some outcomes occur when classrooms add teachers with higher credentials and improve their child–staff ratios. Other studies support the conclusion that ratio, in and of itself, is not the most important determinant of children’s well-being. Dunn (1993) finds no significant relationship between ratio or group size Investing in Effective Childcare and Education: Lessons from Research 153 and children’s social and cognitive development. Using an experi- mental pre-post design, Love, Ryer, and Faddis (1992) find that changing ratios to less favorable conditions in California childcare centers does not significantly affect dynamic quality measures or se- lected aspects of children’s behavior in the classroom. Many studies have investigated the influence of a teacher’s (or, more generally, caregiver’s) qualifications on other indicators of pro- gram quality and child outcomes. The National Child Care Staffing Study (Whitebook, Howes, and Phillips 1989), the largest study to focus on staff characteristics, yields three pertinent conclusions: (a) teachers tend to provide higher-quality care and services to chil- dren, as measured through “appropriate and sensitive caregiving,” when they have had more formal education, more early childhood training at the college level, and earn higher wages and benefits; (b) children are more competent in social and language development when they attend centers with lower staff turnover; and (c) higher- quality centers have higher staff wages, a better adult work environ- ment, lower teacher turnover, and a more highly educated and trained staff. In summary, studies are showing important relationships between a number of the dynamic variables describing childcare-center quali- ty and measures of children’s development or well-being. Variables such as appropriate caregiving, developmentally appropriate prac- tices, and caregiver responsiveness describe caregiver–child interac- tions and the social environment in ways that directly affect chil- dren’s daily experiences. A number of studies have failed to show strong relationships between structural features of a program or class- room. Those that do (e.g., the Florida study) demonstrate that struc- tural/regulatable features do not operate in isolation but imply (and perhaps cause) positive changes in the classroom dynamics. Structur- al features seem to “set the stage,” or provide the necessary condi- tions, for positive dynamics to occur. By themselves, variables such as lower ratios, smaller group sizes, and safer physical equipment and space do not improve language development or enhance the cogni- tive complexity of children’s play. Nevertheless, they may be 154 John M. Love, Peter Z. Schochet, and Alicia L. Meckstroth extremely important as conditions that permit caregivers to be more responsive and to create developmentally appropriate experiences for children. Outcomes Associated With Higher Quality Although most studies have focused on associations between quality measures and children’s socioeconomic behavior and development, some studies have also measured children’s cognitive development, particularly language development. A few longitudinal studies have assessed children’s academic performance following their childcare experience. All of this research suggests that children are socially, emotionally, and cognitively better off when enrolled in higher-qual- ity childcare centers. When the quality of childcare is higher, peer interactions (includ- ing associative-cooperative levels of play) are “more optimal” (Field 1980); social development (including considerateness and sociability) is more positive (McCartney and others 1985; Phillips, McCartney, and Scarr 1987); affect is more positive (Howes 1990); and social skills (such as creativity, independence, extroversion, and interest in inter- acting with other children) are more advanced (Cost, Quality, and Child Outcomes Study Team 1995). Also, the complexity of play be- haviors with peers relates positively to indicators of quality (Dunn 1993; File and Kontos 1993; Howes, Smith, and Galinsky 1995), and higher levels of social problem-solving skills are apparent in higher- quality centers (Holloway and Reichart-Erickson 1988). When enrolled in higher-quality classrooms, children exhibit few- er or less serious behavior problems (Howes, Smith, and Galinsky 1995; Kontos 1991; Love, Ryer, and Faddis 1992) and better social ad- justment, including less socially deviant behavior (Dunn 1993; Kon- tos 1991). Children also comply more with, and are less resistant to, adult requests (Howes and Olenick 1986; Peterson and Peterson 1986); are more cooperative, responsive, and innovative (Ruopp and others 1979); are more securely attached to their teachers (Howes, Phillips, and Whitebook 1992); and are both adult- and peer-oriented (Howes, Phillips, and Whitebook 1992). Investing in Effective Childcare and Education: Lessons from Research 155 Studies also have demonstrated the negative social manifestations associated with lower levels of quality. For example, lower quality childcare is associated with children’s greater solitary play and aim- less wandering (Vandell and Powers 1983); uninvolvement in class- room activities (Love, Ryer, and Faddis 1992); more intense “negative affects,” such as frowning and crying accompanied by vocalizations and body movements (Hestenes, Kontos, and Bryan 1993); and less sustained verbal interactions (Peterson and Peterson 1986). Self-control, or the self-regulation of behavior, is considered an im- portant precursor to a successful school experience. The few studies that have measured this outcome show positive associations with program quality. For example, Howes and Olenick (1986) find that children in high-quality centers have higher levels of self-regulation than children in low-quality centers. Task orientation (another be- havioral characteristic valued by elementary schools) also is greater among children attending higher-quality centers (McCarthy and oth- ers 1985; Phillips, McCartney, and Scarr 1987). In addition, several studies show positive associations between re- ceptive language and center quality (Cost, Quality, and Child Out- comes Study Team 1995; McCartney and others 1985; Schliecker, White, and Jacobs 1991; Studer 1992). Others show that children in higher-quality care settings perform better on tests of premath skills, such as counting and making comparisons (Cost, Quality, and Child Outcomes Study Team 1995) and verbal intelligence (McCartney 1984). At younger ages, children in settings with less verbal commu- nication and less adult responsiveness show lower levels of language development (Melhuish and others 1990a). Longitudinal studies following children into kindergarten, first grade, and beyond show that children from higher-quality childcare centers are less distractible, more task-oriented, and more considerate (Howes 1988, for kindergarten); have fewer behavioral problems (Howes 1988, for first grade); and are happier, less shy, and more so- cially competent and have friendlier interactions with peers (Vandell, Henderson, and Wilson 1988, for age 8). Studies following children in the preschool years, after their participation in center-based care as 156 John M. Love, Peter Z. Schochet, and Alicia L. Meckstroth infants, show enduring associations with indicators of quality such as more positive and gregarious behavior with peers and less social withdrawal and aggression (Howes and Hamilton 1993) and greater personal maturity and social skills with peers and adults (Lamb and others 1988). Children who attended higher-quality childcare pro- grams make better academic progress and are rated higher on school- related skills, such as class participation, in the first grade (Howes 1988) and, by the sixth grade, are assigned to a gifted program at a higher rate (Field 1991) and receive higher math grades (Field 1991). Factors Modifying the Relationship Between Childcare Quality and Outcomes Researchers are increasingly recognizing the importance of control- ling for child and family background variables when analyzing rela- tionships between quality indicators and child outcome measures (Cost, Quality, and Child Outcomes Study Team 1995; Phillips, Mc- Cartney, and Scarr 1987). The research in this area has not been suffi- ciently systematic to make broad generalizations about these interac- tions, and the findings may differ between settings because the studies focused on different factors, measures, and contexts. The di- vergent analysis strategies used (some inappropriately) further com- plicate generalizations across studies. Several studies have examined differential effects depending on the age when children enter childcare. Howes (1990), for example, finds that teachers’ socialization practices better predict children’s outcomes when children enrolled as infants, but that families’ social- ization practices best predict outcomes for children who enrolled as toddlers. Kontos (1991), however, who studied 3–5 year olds, finds no differential effects. Other studies have attempted to determine whether quality indi- cators operate differently for girls and boys. Howes and Olenick (1986) find different patterns of relationships among childcare, fami- ly, and child and parent behaviors. In particular, childcare quality predicts self-regulation and task persistence in toddler boys but not in girls, leading the authors to conclude that boys are more sensitive to the quality of care. Howes (1988) analyzed the combined effects of Investing in Effective Childcare and Education: Lessons from Research 157 high quality and stable arrangements separately for boys and girls in the first grade and finds that academic skills are predicted by stability alone for girls, but that both stability and high quality predict acade- mic skills for boys. Family-based Childcare: The Research Less research has focused on family-based childcare than on center- based care. The research on family-based care shows extremely wide differences in definitions and measurements of quality, geographic settings, and families’ socioeconomic status and racial and ethnic compositions. Because family childcare more commonly serves in- fants and toddlers, the variation in ages is less than in center-based studies. Table 2 summarizes data from eight studies conducted be- tween 1981 and 1995. A multisite study, Quality in Family Child Care and Relative Care (Galinsky and others 1994; Kontos and oth- ers 1995), has contributed significantly to the understanding of the relationship between the quality of family childcare and children’s development. Family-based Childcare: The Findings Dimensions of Quality Linked With Positive Outcomes Important elements of quality associated with positive outcomes in family childcare include global quality (Goelman and Pence 1988; Howes and Stewart 1987; Kontos 1994; Kontos and others 1995); stability of care (Howes and Stewart 1987); caregiver’s training (Galinsky, Howes, and Kontos 1995); provider intentionality or pro- fessionalism and commitment to children (Kontos and others 1995); caregiver’s behaviors and characteristics, such as sensitivity and responsiveness (Kontos and others 1995); and structural fea- tures such as group size (Howes and Rubenstein 1981; Kontos and others 1995). “Intentionality,” identified by Kontos and others (1995), has not previously been articulated, but may be a key indica- tor of quality in family childcare (and perhaps center-based care). Kontos and colleagues argue that providers will give better-quality care if they are professionally prepared, seek opportunities to learn 158 John M. Love, Peter Z. Schochet, and Alicia L. Meckstroth about childcare and child development, actively plan for children’s experiences, and are actively involved in networks of other family childcare providers. The Quality in Family Child Care and Relative Care study identi- fies the relationship between providers and parents as potentially crucial. Relatives are often assumed to be in the best position to pro- vide needed childcare. However, in the study by Kontos and others (1995), the care provided by relatives (usually grandparents) was more likely to be rated as inadequate and the relatives were less sen- sitive and responsive in interacting with the target child. The au- thors note that, “when adults care for children under less than ideal circumstances (poverty, social isolation, not their chosen profession), the children are less likely to get the warmth and attention that par- ents rate as important attributes of quality childcare” (Kontos and others 1995, pp. 204–05). Outcomes Associated With Higher Quality As with the center-based studies, the outcomes measured in family daycare include cognitive and socioemotional development and focus especially on child–caregiver attachment. Goodman and Andrews (1981) find that adding a home-teaching educational program of 2 to 4 hours per week in a family day-care setting significantly improves children’s receptive language, readiness skills, and basic concepts. Howes and Stewart (1987) show the importance of childcare quality on children’s level of play with peers and objects, and Kontos and oth- ers (1995) measure children’s object play as a reflection of their level of cognitive development. Children in regulated care were more fre- quently engaged in high-level object play than were children in care provided by relatives. Other studies show that higher-quality care re- sults in improved development of social skills and personal maturity (Lamb and others 1988), less aimless wandering and more involve- ment in activities (Galinsky, Howes, and Kontos 1995), more vocaliza- tions to peers (Howes and Rubenstein 1981), and enhanced sociability (Kontos 1994). Kontos and colleagues (1995) find few behavior prob- lems in children in childcare provided by families and relatives. Investing in Effective Childcare and Education: Lessons from Research 159 The strength of a child’s attachment with a caregiver has been an important outcome in studies of infants and toddlers. The security and trust that accompany secure attachments enable children to use available resources and materials better. Studies show a greater securi- ty of attachment when caregivers are sensitive and responsive (Kon- tos and others 1995) and when they have received specialized train- ing (Galinsky, Howes, and Kontos 1995). The Quality in Family Child Care and Relative Care study shows no differences in security scores across different types of providers (Kontos and others 1995). Prelimi- nary findings from another multisite childcare study (NICHD Early Child Care Research Network 1996) suggest that secure infant–moth- er attachment (at 15 months of age) results from a complex interac- tion of quality of childcare and quality of mother–infant interactions at home. A preliminary report of this study indicates that attachment may be adversely affected by poor-quality childcare (i.e., where care- givers are inattentive). Research on language development shows that children benefit particularly in improved receptive vocabulary. Goelman and Pence (1987, 1988) and Goodman and Andrews (1981) find higher levels of language development among children attending higher-quality family childcare. However, Kontos and colleagues (1995) find that structural and process variables do not predict communicative com- petence (adaptive language); however, ratings by the providers may not have been a reliable method for assessing children’s language. Kontos and colleagues also report that the percentage of children en- gaged in high-level peer play and object play is less than expected given the children’s ages. They conclude that “children in family- based care are not experiencing caregiving environments likely to promote optimal development” (Kontos and others 1995, p. 163). Factors Modifying the Relationship Between Childcare Quality and Outcomes Several studies show differential effects of quality in relation to fac- tors such as a family’s socioeconomic status (Kontos 1994; Kontos and others 1995), maternal employment (Kontos and others 1995), and child’s gender (Howes and Stewart 1987). These findings are too 160 John M. Love, Peter Z. Schochet, and Alicia L. Meckstroth few, however, to warrant any firm conclusions about the most impor- tant factors moderating the relationship between family childcare and outcomes. The research does provide the foundation for future studies. In sum, the research summarized in tables 1 and 2 shows that the quality dimensions most commonly associated with positive out- comes are: • Lower child–staff ratios and smaller group sizes • Appropriate caregiving • Developmentally appropriate practices • Caregiver responsiveness. Child outcomes associated with higher-quality childcare are: • Improved language • Enhanced social skills • Reduced behavior problems • Increased cooperation. Lower child–staff ratios and smaller group sizes are important because they make possible more-positive dynamics. When teachers have to interact with fewer children, they can better respond to individual children, pay attention to each child, give appro- priate care, and create a developmentally appropriate classroom environment. However, although structural features such as good ratios and group sizes make positive dynamics possible, they do not guarantee quality in teacher–child interactions. Staff have to know how to make the best of good conditions. Staff supports, such as appropriate training and effective supervision, are essential. Investments in effective structures and supports yield positive dy- namics and outcomes. Children have better vocabulary and commu- nication skills, interact more positively with their peers and adults, and are less likely to be aggressive. Investing in Effective Childcare and Education: Lessons from Research 161 Preschool Interventions: Research on Quality Much of the research and evaluation of preschool programs and in- terventions supports these findings and reinforces the importance of quality care and education in early childhood. Although childcare and preschool settings are generally distinguished by the nature and extent of services provided, the classroom dynamics are similar in both settings and, in many countries, childcare and education are combined in integrated service programs. The literature on preschool interventions, however, does not allow for comparable reviews of the correlates or effects of quality, because researchers have only recently begun to emphasize descriptions of quality dimensions in their stud- ies. They have been more likely to contrast two or three treatment groups, or an intervention and a control group, rather than treating quality as a continuous variable for measuring child outcomes. The Perry Preschool study (Schweinhart, Barnes, and Weikart 1993), Abecedarian project (Campbell and Ramey 1994), and Syracuse Fami- ly Development Research Program (Lally, Mangione, and Honig 1987) are examples of these types of studies. Nevertheless, these stud- ies can legitimately be interpreted as evidence of the benefits of en- hanced program quality because the programs were designed as high- quality interventions. In each case, the children’s outcomes were contrasted with the outcomes for children who attended lower-quali- ty ECD programs or no ECD program. In the literature on preschool education, quality is most often as- sociated with the concept of developmentally appropriate practice. In a review of this literature, Bryant and colleagues (1994) identify several studies that illustrate the relationship between quality, de- fined as developmentally appropriate practice, and child outcomes. For example, the High/Scope study, conducted in the 1960s, shows that children who attend a developmentally appropriate, child-cen- tered program are better adjusted socially than similar children who attend a teacher-directed program implementing a direct-instruction curriculum (Schweinhart, Weikart, and Larner 1986). In a study of children attending state preschool programs in North Carolina, Bryant, Peisner-Feinberg, and Clifford (1993) found that children’s 162 John M. Love, Peter Z. Schochet, and Alicia L. Meckstroth communication abilities at the end of preschool are positively associ- ated with appropriate caregiving and that vocabulary development in kindergarten is positively associated with the quality of preschool. Burts and colleagues (Burts and others 1992; Hart and others 1995) show that children’s attendance in developmentally appropriate kindergartens is associated with fewer stress behaviors. Also, Bryant and colleagues (1994) show that children who attend higher-quality Head Start classes have better cognitive, although not social, out- comes at the end of the Head Start year (see also the chapter by Tarullo in this volume). Investments to Enhance Children’s Development The existing research demonstrates that the following five types of investment are most important for enhancing children’s early devel- opment: 1. Well-trained staff who are motivated and committed to their work with children 2. Facilities that are safe and sanitary and accessible to parents 3. Ratios and group sizes that allow staff to interact appropriately with children 4. Supervision that maintains consistency 5. Staff development that ensures continuing and improving quality. But, what if resources are scarce? What if a particular state or com- munity cannot afford to find or build good facilities or find enough staff? The research conducted thus far is not sufficiently precise to in- dicate which elements of quality are most important. Investing in ad- ditional ongoing research is essential. Ongoing Research and Evaluation To develop and improve effective childcare programs, information about existing programs must be collected and evaluated continu- Investing in Effective Childcare and Education: Lessons from Research 163 ously. Researchers have used a variety of statistical methods to assess the effects of childcare quality on children’s well-being. These in- clude nonexperimental designs (contemporaneous, longitudinal, and pre-post), to compare outcomes for children who attend classrooms or centers of different quality, and experimental studies, to compare outcomes for children who attend childcare classrooms randomly as- signed to different quality-of-care conditions. All methods have a role to play in improving the understanding of important ingredients of quality in ECD programs. Nonexperimental Designs Most studies have relied on nonexperimental designs, for observing a sample of children attending a representative set of classrooms or centers in particular locales. These studies measured the quality of care provided, as well as developmental outcomes, and compared outcomes for children attending higher- and lower-quality centers. Different statistical methods were used for contemporaneous, longi- tudinal, and pre-post designs. Studies employing a contemporaneous design measure childcare qual- ity and outcomes at approximately the same time. They assess the contemporaneous effects of childcare quality on outcomes by com- puting correlation coefficients between the outcome and quality mea- sures and determining the statistical significance of the correlation coefficients (see, for example, Howes, Phillips, and Whitebook 1992). Studies employing a longitudinal design assess the long-term effects of childcare experiences of varying quality on children’s outcomes. These studies obtain follow-up data for children who participate in good- and poor-quality childcare. The follow-up assessments are con- ducted at varying periods after the children’s childcare experience. The statistical models estimated in the studies using a longitudinal design are similar to those estimated in studies using a contempora- neous design. Researchers usually begin their analyses by calculating the correlation coefficients between a center’s quality and the out- come measures and then estimating regression models to control for child and family background variables. 164 John M. Love, Peter Z. Schochet, and Alicia L. Meckstroth Studies employing pre-post designs assess the effect of changes in center quality on children’s well-being. These studies compare the outcomes of separate cross-sections of children before and after a change in center quality (pre-post cross-section designs), or compare the outcomes of longitudinal samples of children who do, or do not, experience a change in center quality (pre-post longitudinal de- signs). The most important study using a pre-post cross-section de- sign is Howes, Smith, and Galinsky (1995), which assessed the effect of changes in Florida’s requirements for childcare facilities’ child–staff ratios on the quality of the children’s development. The study by Howes and Hamilton (1993) is an example of a pre-post longitudinal design. Experimental Designs Experimental, or randomized, designs are the most rigorous methodology for estimating internally valid effects of a center’s quality on children’s well-being. With this design, classrooms in a sample of childcare centers are randomly assigned to different qual- ity-of-care groups, and children requiring childcare are randomly assigned to the classrooms. Randomization ensures that there are no systematic observable or unobservable differences between chil- dren assigned to the different classrooms, except for the quality of care they receive, and that there are no systematic differences be- tween the quality of teachers assigned to the different quality-of- care groups. However, because parents or childcare staff may want to select spe- cific teachers for certain children, randomly assigning children to classrooms is seldom feasible. Therefore, a more realistic design is to allocate children to specific classrooms (either by parents’ or staff’s choice, or randomly) and then randomly assign classrooms to differ- ent quality-of-care conditions. This design, however, may produce less-precise estimates of the effects of childcare quality for a sample size than when all children are also randomly assigned to classrooms, because there is a greater chance that the average characteristics of children will differ across classrooms. Hence, the standard errors of Investing in Effective Childcare and Education: Lessons from Research 165 the estimated effects of childcare quality must take into account that a different allocation of classrooms to the quality-of-care groups could produce different results. Although not focusing on child out- comes, Love, Ryer, and Faddis (1992) conducted a study that illus- trates some of the strengths and problems of using an experimental design to assess the effects of structural variables on classroom dy- namics and children’s behavior. Randomized designs are, in theory, the most effective designs for obtaining reliable information on the effects of a policy intervention. Because these designs are often difficult to implement, however, they usually have practical limitations, and program staff are often unwill- ing to participate in randomized studies. Thus, many studies employ- ing randomized designs use only program sites that agree to partici- pate. The estimates of effect, based on experimental designs, must therefore be interpreted with caution. Research Needs The advantages and shortcomings of these nonexperimental and ex- perimental methods are discussed in detail in Love, Schochet, and Meckstroth (1996). Because nonexperimental designs are more prac- tical (less expensive and difficult than experimental designs), they are likely to prevail in future research. For future studies using nonexper- imental methods to estimate the effects of a center’s quality, two spe- cific recommendations are as follows: 1. For studies employing contemporaneous or longitudinal de- signs, estimate models using established statistical methods that correct and test for systematic, unobservable differences be- tween the characteristics of children who enroll in centers of different quality or in no centers. 2. Using pre-post designs, conduct additional studies to compare outcomes of a cross-section of children who attend childcare be- fore a change in the center’s quality with those of a separate cross-section of children who attend childcare after the change is made. 166 John M. Love, Peter Z. Schochet, and Alicia L. Meckstroth Conclusion Extensive research over the past 20 years has found strong, positive relationships between a variety of quality measures and various di- mensions of children’s development and well-being. Most of the re- search reviewed in this chapter addresses programs in the United States, and circumstances in the developing world likely could alter the specifics of particular relationships. Nevertheless, the research suggests that investments in five areas may have the greatest benefit: (1) well-trained staff who are motivated and committed to their work with children, (2) facilities that are safe and sanitary and accessible to parents, (3) ratios and group sizes that allow staff to interact appropri- ately with children, (4) supervision that maintains consistency, and (5) staff development that ensures continuing and improving quality. Consistent investments in the structures and supports for early child development can yield tremendous payoffs by improving the well-be- ing of children and their families and communities. Investments in research and evaluation will enable child development programs to continue to find ways to improve and increase their effectiveness. 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New York, N.Y.: Teachers College Press. Lally, J.R., P.L. Mangione, and A.S. Honig. 1987. Long-Range Impact of an Early Intervention with Low-Income Children and Their Families. San Francisco: Center for Child and Family Studies, Far West Laboratory for Educational Research and Development, September. Lamb, M.E., C.P. Hwang, A. Broberg, and F.L. Bookstein. 1988. The Effects of Out-of-Home Care on the Development of Social Competence in Swedish Preschoolers: A Longitudinal Study. Early Childhood Research Quarterly 3:379–402. Lamb, M.E., and K.J. Sternberg. 1990. Do We Really Know How Day Care Affects Children? Journal of Applied Developmental Psychology 11:351–79. Layzer, J.I., B.D. Goodson, and M. Moss. 1993. Observational Study of Early Childhood Programs, Final Report Volume 1: Life in Preschool. Washington, D.C.: U.S. Department of Education. Love, J.M., P. Ryer, and B. Faddis. 1992. Caring Environments— Program Quality in California’s Publicly Funded Child Development Programs: Report on the Legislatively Mandated 1990–91 Staff/Child Ratio Study. Portsmouth, N.H.: RMC Research Corporation. Love, J.M., P.Z. Schochet, and A.L. Meckstroth. 1996. Are They in Any Real Danger? What Research Does—and Doesn’t—Tell Us About Child Care Quality and Children’s Well-Being. Child Care Research and Policy Papers: Lessons from Child Care Research Funded by the Rockefeller Foundation. Princeton, N.J.: Mathematica Policy Research, Inc., May. McCartney, K. 1984. Effect of Day Care Environment on Children’s Language Development. Developmental Psychology 20(2):244–60. McCartney, K., S. Scarr, D. Phillips, and S. Grajek. 1985. Day Care as Intervention: Comparisons of Varying Quality Programs. Journal of Applied Developmental Psychology 6:247–60. Investing in Effective Childcare and Education: Lessons from Research 171 Melhuish, E.C., E. Lloyd, S. Martin, and A. Mooney. 1990a. Type of Child Care at 18 Months—II. Relations with Cognitive and Language Development. Journal of Child Psychology and Psychiatry 31(6):861–70. Melhuish, E.C., A. Mooney, S. Martin, and E. Lloyd. 1990b. Type of Child Care at 18 Months—I. Differences in Interactional Experience. Journal of Child Psychology and Psychiatry 31(6): 849–59. NAEYC (National Association for the Education of Young Children). 1996. Developmentally Appropriate Practice in Early Childhood Programs Serving Children From Birth Through Age 8: A Position Statement of the National Association for the Education of Young Children. Washington, D.C.: Author, July. NICHD (National Institute of Child Health and Human Development) Early Child Care Research Network. 1996. Infant Child Care and Attachment Security: Results of the NICHD Study of Early Child Care. Symposium presented at the meeting of the International Conference on Infant Studies, Providence, Rhode Island, April. Peterson, C., and R. Peterson. 1986. Parent-Child Interaction and Day Care: Does Quality of Day Care Matter? Journal of Applied Developmental Psychology 7:1–15. Phillips, D.A. 1987. Epilogue. In D.A. Phillips, ed., Quality in Child Care: What Does Research Tell Us? Washington, D.C.: National Association for the Education of Young Children. Phillips, D.A., and C. Howes. 1987. Indicators of Quality in Child Care: Review of Research. In D.A. Phillips, ed., Quality in Child Care: What Does Research Tell Us? Washington, D.C.: National Association for the Education of Young Children. Phillips, D., K. McCartney, and S. Scarr. 1987. Child-Care Quality and Children’s Social Development. Developmental Psychology 23(4):537–43. Ruopp, R.R., J. Travers, F. Glantz, and C. Coelen. 1979. Children at the Center: Final Results of the National Day Care Study. Cambridge, Mass.: Abt Books. 172 John M. Love, Peter Z. Schochet, and Alicia L. Meckstroth Schliecker, E., D.R. White, and E. Jacobs. 1991. The Role of Day Care Quality in the Prediction of Children’s Vocabulary. Canadian Journal of Behavioral Science 23(1):12–24. Schweinhart, L.J., H.V. Barnes, and D.P. Weikart. 1993. Significant Benefits: The High/Scope Perry Preschool Study Through Age 27. Monographs of the High/Scope Educational Research Foundation, no. 10. Ypsilanti, Mich.: High/Scope Educational Research Foundation. Schweinhart, L.J., D.P. Weikart, and M.B. Larner. 1986. A Report on the High/Scope Preschool Comparison Study: Consequences of Three Preschool Curriculum Models Through Age 15. Early Childhood Research Quarterly 1:15–45. Studer, M. 1992. Quality of Center Care and Preschool Cognitive Outcomes: Differences by Family Income. In P.A. Adler and P. Adler, eds., Sociological Studies of Child Development, vol 5. Greenwich, Conn.: JAI Press. Vandell, D.L., V.K. Henderson, and K.S. Wilson. 1988. A Longitudinal Study of Children with Day-Care Experiences of Varying Quality. Child Development 59:1286–92. Vandell, D., and C. Powers. 1983. Daycare Quality and Children’s Free Play Activities. American Journal of Orthopsychiatry 53:293–300. Whitebook, M., C. Howes, and D. Phillips. 1989. Who Cares? Child Care Teachers and the Quality of Care in America: Final Report: National Child Care Staffing Study. Berkeley, Calif.: Child Care Employee Project. Table 1. Center-based Childcare Studies That Examine Quality of Care and Child Outcomes Sample size/ages/ Relationships between quality Investing in Effective Childcare and Education: Lessons from Research Study (date) demographics Design and methodology Outcomes measured and child outcomes Studies using contemporaneous designs Cost, Quality, and • 826 children (age 4) • Contemporaneous design • Receptive language • Higher classroom quality index was associated with: Child Outcomes • 181 centers • Observational measures of class- • Prereading skills –Greater receptive language ability Study Team (1995) • 15% African American room quality • Premath skills –Higher premath skills 68% white • Direct assessments, teacher rat- • Self-perceptions of –More advanced social skills 6% Hispanic ings, and self-reports of child out- competence –More positive self-perceptions 4% Asian comes • Level of social play • Effect of quality on receptive language was greater 63% of mothers have • Attitudes toward for minority children. less than bachelor’s childcare degree • Social skills Dunn (1993) • 60 children (ages • Contemporaneous design • Sociability • Children with married parents and those attending 3 to 5) • Observational assessment, staff in- • Social adjustment centers that offered less variety and more guidance • 30 classrooms in terviews, and questionnaires to • Social play (or more “total limits”) were rated as better socially 24 centers measure classroom quality • Cognitive develop- adjusted; children attending centers that provided • 90% white • Direct assessment, teacher ratings, ment and intelligence more total limits had higher levels of complex social 10% African American and child achievement tests to • Cognitive play play. Middle socioeconomic measure child outcomes • Children attending classrooms with higher overall status quality and whose caregivers had a child-related col- 77% two-parent lege major and less experience in the center scored families higher on a test of intelligence. • Child–staff ratio and group size did not predict chil- dren’s social and cognitive development. 173 continued 174 Table 1 (continued). Center-based Childcare Studies That Examine Quality of Care and Child Outcomes John M. Love, Peter Z. Schochet, and Alicia L. Meckstroth Sample size/ages/ Relationships between quality Study (date) demographics Design and methodology Outcomes measured and child outcomes Field (1980) • 80 children (ages 3 • Contemporaneous design (observa- • Peer interactions • Children attending classrooms that had low to 4) tional and child data collection over • Play behaviors (fanta- teacher–child ratios and partitioned, special play ar- • Four center-based a 9-month period) sy play, associative- eas exhibited more optimal behaviors (including in- preschool classrooms • Observational assessment of quality cooperative play) teractions with peers, verbal interactions, fantasy • 100% white on two dimensions play, and associative-cooperative play). Middle socioeconomic • Direct assessment of child out- status comes File and Kontos • 28 children (ages 2.5 • Contemporaneous design (observa- • Cognitive play level • Positive teacher interactions with children, a charac- (1993) to 6) tional and child data collection over (functional, construc- teristic indicative of high-quality classrooms, were • 6 to 12 center class- a 2-week period) tive, and dramatic related to a higher level of children’s social play. rooms (exact number • Observational assessment of quality play) Less teacher involvement in routine activities, less not provided) • Direct assessment of child out- • Social play level (soli- watching, less support of cognitive play, and more • Demographic charac- comes tary, parallel, and in- overall teacher uninvolvement were also related to teristics not provided teractive play) higher levels of social play. 50% had mild or moder- • Children’s experiences with their teachers were not ate cognitive and/or related to their level of cognitive play. speech and language delays. Sample size/ages/ Relationships between quality Study (date) demographics Design and methodology Outcomes measured and child outcomes Investing in Effective Childcare and Education: Lessons from Research Goelman and Pence • 105 children (approxi- • Contemporaneous design (observa- • Language develop- • Among children attending center-based care, quality (1987 and 1988) mately 3 to 4 years of tional and child data collection over ment of care did not predict language development age, ages not provided) a 1-year period) • Peer interactions scores. • 53 centers • Observational assessment and par- • Play activities • Children in center-based care engaged in more high- • 52 family day-care ent ratings of classroom quality (solitary, cooperative) quality “information activities” than children in family providers • Direct assessment of child out- day care. However, for children in family childcare, • Predominantly white comes the amount of information activities was not related (Canadian) to quality. Range of socioeco- nomic status represented 50% two-parent families Hestenes, Kontos, • 60 children (ages 3 • Contemporaneous design (observa- • Emotional expression • Low levels of classroom engagement by teachers and Bryan (1993) to 5) tional and child data collection on (positive versus nega- predicted more intense negative affect among chil- • 26 centers two separate occasions) tive affect, intensity dren; children whose teachers showed high levels of 30 classrooms • Observational assessment of class- of affect, duration of classroom engagement displayed more intense posi- • Range of social classes room quality affect) tive affect, controlling for temperament and child de- represented • Direct assessment of child out- • Temperament mographics. Race/ethnicity of comes (approach, adapt- children not provided ability, intensity, mood, and rhythm) 175 continued 176 Table 1 (continued). Center-based Childcare Studies That Examine Quality of Care and Child Outcomes Sample size/ages/ Relationships between quality John M. Love, Peter Z. Schochet, and Alicia L. Meckstroth Study (date) demographics Design and methodology Outcomes measured and child outcomes Holloway and • 55 children (age 4) • Contemporaneous design (observa- • Free-play activities • Children engaging in high-quality interactions with Reichhart-Erickson • 15 centers tional and child data collection over • Social reasoning and teachers and children attending centers with lower (1988) • 4% African American a 3-week period) problem solving child-teacher ratios scored higher on a test of social 94% white • Observational measures of class- • Peer interactions reasoning skills. 2% Asian room quality • In centers that were better able to accommodate 91% two-parent • Direct assessment of child out- groups of varying sizes, had smaller classes, and of- families comes fered a variety of age-appropriate materials, children Predominantly middle scored higher on a test of social reasoning skills. socioeconomic status • In centers with a more spacious layout, children spent more time in focused, solitary play and less time observing. • Quality indicators were not significantly related to negative or positive social interactions with peers. Howes and Olenick • 89 children • Contemporaneous design • Compliance • Children attending high-quality centers were more (1986) (ages 1.5 to 3) • Observational assessment and • Resistance compliant and less resistant and were more likely to • Eight centers caregiver reporting of classroom • Self-regulation self-regulate (or refrain from touching food and for- • 10% African American quality measures bidden new toys). 70% white • Direct assessment (in home and • Quality of care predicted self-regulation and resis- 13% Hispanic center) and parent ratings of child tant behavior among boys but not girls. 7% Asian (based outcomes on race/ethnicity of father) 69% two-parent families Sample size/ages/ Relationships between quality Study (date) demographics Design and methodology Outcomes measured and child outcomes Investing in Effective Childcare and Education: Lessons from Research Howes, Phillips, and • 414 children • Contemporaneous design • Attachment with • Children in classrooms rated higher on “appropriate Whitebook (1992) (ages 1 to 4.5) • Observational assessment of quality teacher caregiving” were more likely to be classified as se- – 68 infants • Direct assessment of children • Social orientation cure (but not as avoidant or ambivalent). – 175 toddlers • Interaction with peers • Children in classrooms rated higher on “developmen- – 171 preschoolers tally appropriate activities” were more likely to be • 233 center classrooms both adult- and peer-oriented. • Full range of social classes represented 21% African American 73% white Howes and • 40 children (ages • Contemporaneous design • Peer social behaviors • The greater use of nonportable objects (indicative Rubenstein (1981) 1.5 to under 2) • Observational assessment of • Peer social interaction of a quality environment) in centers was positively • Eight centers classroom quality • Structure of peer play related to the level of interactive play. 16 family day-care • Direct assessment and observer • No overall differences in the frequency of socially homes ratings of child outcomes directed peer behaviors were present between • 33% African American, family day care and center care. Hispanic, or Asian 67% white Predominantly two-parent families Middle socioeconomic status 177 continued 178 Table 1 (continued). Center-based Childcare Studies That Examine Quality of Care and Child Outcomes Sample size/ages/ Relationships between quality John M. Love, Peter Z. Schochet, and Alicia L. Meckstroth Study (date) demographics Design and methodology Outcomes measured and child outcomes Kontos (1991) • 100 children • Contemporaneous design (observa- • Cognitive • Family background variables were significantly relat- (ages 3 to 5) tions and child assessments col- development ed to several measures of children’s cognitive and • 10 centers lected over a 1-day period) • Language language development. • Predominantly white • Observation and state licensing in- development • Overall quality (a measure of a minimum level of qual- Range of socioeco- struments used to assess quality • Social development ity) predicted better social adjustment scores and nomic status and • Caregiver ratings and child perfor- fewer behavior problems among children, controlling urban/rural families mance on standardized tests used for family background and childcare experience. represented to assess child outcomes • Age of entry into childcare and duration of the child- 57% two-parent care experience were not significant predictors of (married) families child development outcomes. Love, Ryer, and • Ages 3 to 5 (94% 3-4 • Pre-post design; contemporaneous • Behavior problems • In classrooms that were more developmentally Faddis (1992) year olds) • Classrooms randomly assigned • Stress behaviors appropriate, children showed less stress and less • 112 center classrooms to change ratio after fall data • Crying and fighting crying and fighting. 62 agencies collection • Involvement in • In classrooms that were more developmentally • 37% African American • Contemporaneous assessment activities inappropriate, children were more uninvolved in 19% white of classroom quality and child classroom activities and showed higher levels of 32% Hispanic outcomes stress. 13% Asian • Teacher ratings of behavior problems • When caregivers were attentive and encouraging, 23% limited English • Observer ratings of stress behaviors children showed less stress; when caregivers were proficient more harsh, critical, and detached, children showed Families eligible for higher levels of stress. childcare subsidy • In classrooms rated higher on scheduling, safety, (average of only 1.4 and health, there was less crying and fighting. children per agency paid full fee) Sample size/ages/ Relationships between quality Study (date) demographics Design and methodology Outcomes measured and child outcomes McCartney (1984) • 166 children • Contemporaneous design (obser- • Verbal intelligence • Children attending centers with higher overall quality Investing in Effective Childcare and Education: Lessons from Research (ages 3 to 5) vational and child data collection • Verbal interaction ratings were more likely to have greater verbal intel- • Nine centers over a 4-month period) with caregivers ligence and language development, controlling for • 80% black Bermudians • Observational measures of class- • Verbal interaction family background, age of entry in care, and number 20% white Bermudians room quality with peers of hours in care. 84% spent most of • Direct assessment of child outcomes • Language • Children who attended centers that allowed greater work week in day • Caregiver ratings of child outcomes development levels of child-initiated conversation, had many visi- care by age 2. tors, had less noise, and provided little free-play time scored higher on tests of language development. McCartney, Scarr, • 166 children (compari- • Contemporaneous, comparison group • Cognitive skills • Low-income children attending a high-quality day- Phillips, and Grajek son group: 72 children) design (observations and child data • Receptive language care intervention program had better language skills (1985) (ages 3 to 6) collection over a 4-month period) • Communication skills and were more considerate and sociable, compared • Nine centers • Observational assessment of class- • Sociability with children attending other center programs of • 78% black Bermudians room quality • Considerateness lower, but varying, quality. Findings hold when chil- 22% white Bermudians • Direct assessment of child perfor- • Dependency dren attending the high-quality program are com- Comparison group mance on standardized tests; parent • Intelligence pared with a group with similar family backgrounds. (100% black and caregiver ratings used to assess • Task orientation Bermudians) child outcomes Peterson and • 66 children (24 in home • Contemporaneous design • Parent-child • Children attending low-quality centers performed Peterson (1986) care) (ages 3 to 5) • Observational assessment of class- interaction worse on sustained verbal interactions and compli- • Four centers room quality • Verbal ance with task-oriented instructions than either chil- • Predominantly white • Direct assessment of child outcomes communication dren attending high-quality centers or children re- Predominantly middle • Compliance ceiving maternal care in the home; no differences socioeconomic status existed in these two outcomes for children receiving either high-quality center care or maternal care. 179 continued 180 Table 1 (continued). Center-based Childcare Studies That Examine Quality of Care and Child Outcomes Sample size/ages/ Relationships between quality John M. Love, Peter Z. Schochet, and Alicia L. Meckstroth Study (date) demographics Design and methodology Outcomes measured and child outcomes Phillips, McCartney, • 166 children • Contemporaneous design (observa- • Sociability • Children in centers with higher overall quality were and Scarr (1987) (ages 3 to 5.5) tional and child data collection over • Considerateness more socially developed in considerateness, socia- • Nine centers a 4-month period) • Dependence bility, intelligence, task orientation, and anxiety, con- • 78% black Bermudians • Observational assessment and staff • Intelligence trolling for age at entry, time in childcare, and family 22% white Bermudians reporting of quality • Task orientation background. 68% from two-parent • Teacher and parent ratings of child • Aggression • Children having greater levels of verbal interaction families outcomes • Hyperactivity with caregivers were more considerate, sociable, in- 85% spent most of • Anxiety telligent, and task-oriented. work week in day • In centers with directors who had greater levels of care by age 2. experience, children were less aggressive and anx- ious but also were less considerate and sociable. Schliecker, White, • 100 children (age 4) • Contemporaneous design (observa- • Language develop- • Day-care quality (measured dichotomously) and so- and Jacobs (1991) • 10 centers tional and child data collection over ment and compre- cioeconomic status (a combined measure of in- • Predominantly white a 2-week period) hension come, occupation, education, and family structure) Range of socioeco- • Observational assessment of class- both significantly predicted vocabulary comprehen- nomic status room quality sion; day-care quality may be particularly important represented • Direct assessment of child out- for single-parent, female-headed households. 63% two-parent comes families Sample size/ages/ Relationships between quality Study (date) demographics Design and methodology Outcomes measured and child outcomes Investing in Effective Childcare and Education: Lessons from Research Studer (1992) • 95 children in families • Contemporaneous design • Receptive language • Special training of caregiver, group size, and ratio currently using child- • Parental report of quality through were unrelated to receptive language ability. care center or nursery survey responses • Composite quality index was positively associated at time of the 1986 Na- • Direct assessment of child out- with receptive language ability only for low-income tional Longitudinal comes subsample. Study of Youth (ages • Composite quality index was negatively related to 3 to 4) receptive language ability for lower-middle-income • All two-parent families group. Vandell and Powers • 55 children • Contemporaneous design • Interaction with peers • Children attending centers rated as high quality (1983) (ages 3 to 4) • Observational assessment of class- • Interaction with were more likely to have positive interactions and • Six centers room quality adults vocalizations with adults. • White • Direct assessment of behavior • Vocalization with • Children attending low-quality centers were more Middle socioeconomic peers likely to engage in solitary play and aimless wander- status • Vocalization with ing. Two-parent families adults • No differences were found in peer-directed behav- Attended day care an • Solitary play iors and interactions in centers of varying quality. average of 2 years • Unoccupied behaviors 181 continued 182 Table 1 (continued). Center-based Childcare Studies That Examine Quality of Care and Child Outcomes Sample size/ages/ Relationships between quality John M. Love, Peter Z. Schochet, and Alicia L. Meckstroth Study (date) demographics Design and methodology Outcomes measured and child outcomes Studies using longitudinal designs Field (1991) • 56 children. Average • Longitudinal design (parent reports • School grades • Children who had spent more time in high-quality age 11.5 at follow-up. of child’s early care experience • Test scores day care were more likely to show more physical af- (Children began day used as baseline data) • Assignment to gifted fection during peer interactions, to be assigned to care when less than 2 • Caregiver reporting of classroom program the gifted program, and to receive higher math years old and contin- quality measures • Work/study habits grades. ued for average of 2.7 • Direct assessment and parent and • Leadership years.) teacher ratings of child outcomes • Emotional well-being • Six centers • Adult/child relations • Study 1: 28 children • Peer relations, attrac- Study 2: 56 children tiveness, assertive- • Heterogeneous sample ness, aggressivity, by race/ethnicity popularity (including African American, white, Hispanic; percent- ages not given) Middle socioeconomic status, highly edu- cated families Sample size/ages/ Relationships between quality Study (date) demographics Design and methodology Outcomes measured and child outcomes Howes (1990) • 80 children (same • Longitudinal design • Compliance, • Preschool children attending high-quality centers en- children examined in • Observational assessment and resistance gaged in more social pretend activities, displayed Howes and Olenick caregiver reporting of classroom • Self-regulation more “positive affect” relative to angry and dis- Investing in Effective Childcare and Education: Lessons from Research 1986) (ages 3 to 7 pri- quality measures • Social adjustment/ tressed behavior, and were rated by teachers as marily) • Direct assessment and parent and peer interactions having sociable relations with peers. • Began at ages 1.5 to 3 teacher ratings of child outcomes (social play, social • Kindergarten children who entered lower-quality (see Howes and pretend play, positive centers as infants were rated by teachers as more Olenick 1986) affect) distractible, less task-oriented, and less considerate, • Eight centers (estimate) compared with children who entered higher-quality • 9% African American centers as infants. 74% white • Among children enrolled as infants, childcare quality 13% Hispanic (measured through teacher socialization practices) 1% Asian best predicted child outcomes; among children en- 76% two-parent rolled as toddlers or preschoolers, family socializa- families tion practices best predicted child outcomes. Howes (1988) • 75 children enrolled in • Longitudinal design • Academic progress • For girls, stable childcare arrangements predicted laboratory elementary • Observational measures of class- • School skills (inde- academic skills, controlling for family characteristics. school. room quality pendence, group • For boys, stable arrangements and high-quality care • Childcare experience at • Teacher ratings of child outcomes skills, participation predicted academic skills, controlling for family char- age 4. Follow-up at first skills) acteristics. grade. • Behavior problems • For both boys and girls, high-quality care predicted • 12% African American enhanced school skills and low behavior problems. 69% white 12% Hispanic 6% Asian Mothers’ median edu- cation level: 14 years 70% two-parent families 183 continued 184 Table 1 (continued). Center-based Childcare Studies That Examine Quality of Care and Child Outcomes Sample size/ages/ Relationships between quality John M. Love, Peter Z. Schochet, and Alicia L. Meckstroth Study (date) demographics Design and methodology Outcomes measured and child outcomes Howes and • 72 children (48 at follow- • Longitudinal design • Social competence • Children having more changes in teachers were rat- Hamilton (1993) up) (ages 1 to 2). Follow- • Observational assessment of with peers (complex ed as lower in positive and gregarious behaviors and up at ages 4 to 5. quality play; prosocial, gre- higher in social withdrawal and aggression. • 5 centers (and one large • Direct assessment of child out- garious, aggressive, • Children who had secure teacher–child relationships family day-care home) at comes and withdrawn be- (or teacher–child relationships that changed in a start; 54 centers over haviors) positive direction) had more positive, gregarious, course of study and prosocial interactions with their peers and were • 14% African American less withdrawn and aggressive. 61% white • Changes in children’s childcare center or setting 25% Hispanic or Asian were not related to children’s social competence 67% middle socio- with peers. economic status Lamb, Hwang, • 140 children (ages 1 to 2). • Longitudinal design • Personal maturity • As measured at follow-up, children’s sociability Broberg, and Follow-up at ages 2 to 4. • Observational assessment of (independence, and personal maturity were not related to type of Bookstein (1988) • 53 centers caregiver quality and home ego resiliency, and childcare. 33 family day-care homes quality; parent ratings of social control) • The quality of care (regardless of type of provider) 54 maternal home care support • Sociability and family social support predicted personal mat- situations • Direct assessment of child • Adult–child urity and social skills with familiar peers and un- • 100% Swedish children outcomes interaction familiar adults. Range of socioeconomic • Peer play status represented • Activity level 100% two-parent families Older mothers (average age = 31) Sample size/ages/ Relationships between quality Study (date) demographics Design and methodology Outcomes measured and child outcomes Investing in Effective Childcare and Education: Lessons from Research Melhuish, Lloyd, • 193 children (age 1.5). • Longitudinal design • Language • Children in center-care settings that provided less Martin, and Mooney Assessments at 5 and • Observational measures of child- development verbal communication with and less responsiveness (1990a); Melhuish, 18 months. care quality • Cognitive to children scored lower on a measure of language Mooney, Martin, • Focus groups: • Direct assessment, observer rat- development development. and Lloyd (1990b) –Home care—57 ings, and parent reports of child –Relative care—30 outcomes –Family day care—74 –Center care—32 • 100% British Range of socioeco- nomic and educa- tional status Vandell, Henderson, • 20 children (age 4). • Longitudinal design • Interaction with peers • Children attending centers rated as high quality and Wilson (1988) Follow-up at age 8. • Observational assessment of class- • Interaction with tended to have more friendly interactions with • Six centers room quality adults peers, were assessed as happier and more socially • White • Direct and videotaped assessment • Solitary play competent, and were less likely to be viewed as Middle socioeconomic of children • Unoccupied behaviors “shy”; results were relatively consistent at ages status • Observer, parent, and peer ratings 4 and 8. of behavior • Having positive interactions with adults at age 4 was significantly correlated with ratings of empathy, social competence, and peer acceptance at age 8. 185 continued 186 Table 1 (continued). Center-based Childcare Studies That Examine Quality of Care and Child Outcomes Sample size/ages/ Relationships between quality John M. Love, Peter Z. Schochet, and Alicia L. Meckstroth Study (date) demographics Design and methodology Outcomes measured and child outcomes Studies using pre-post designs Howes, Smith, and • 880 children (ages 10 • Pre-post design • Peer play • Changing child–teacher ratio requirements for in- Galinsky (1995) months to 5 years). • Observational assessment of class- • Object play fants from 6:1 to 4:1 and for toddlers from 8:1 to 6:1 (Different children ex- room and teacher quality • Adaptive language resulted in more complex child play both with peers amined during baseline • Direct assessment and observer proficiency and objects, more secure attachment to caregivers, and follow-up data col- ratings of child outcomes • Behavior problems greater adaptive language proficiency, and fewer be- lection; second follow- • Attachment to havior problems (including aggression, anxiety, and up completed in spring caregiver hyperactivity). 1996) • Children in classrooms meeting professional stan- • 150 centers dards for child–teacher ratios engaged in more elab- • Range of socioeconom- orate peer play and had higher adaptive language ic status and urban/rur- scores, compared with children in classrooms with al families represented higher ratios. in the state of Florida • Children in classrooms that improved by shifting to (other demographic teachers with Child Development Associate (CDA) characteristics not re- credentials or CDA equivalency had the largest in- ported) crease in complexity of peer play and security of caregiver attachment. Children in classrooms with college-educated teachers who had early childhood training engaged in more complex peer play, had a more secure attachment with their caregiver, and had higher adaptive language scores. Sample size/ages/ Relationships between quality Study (date) demographics Design and methodology Outcomes measured and child outcomes Ruopp, Travers, • 1,600 children (ages 3 • Pre-post design (observational and • Cognitive • Preschool children attending centers with smaller Investing in Effective Childcare and Education: Lessons from Research Glantz, and Coelen to 5). (Infant/toddler child outcome data collection over a knowledge/school group sizes engaged in more adult–child social inter- (1979) substudy: ages 6 1-year period) readiness action, were more cooperative, responsive, and in- weeks to 3 years) • Observational measures of class- • Receptive language novative, and made greater gains in receptive lan- • 49 centers in three room quality ability guage ability; the effect of group size on receptive cities in quasi-experi- • Direct assessment of child out- • Adult–child interac- language ability was independent of child age, gen- ment; eight centers in comes tion der, race, family income, and other socioeconomic one public school dis- • Randomized experiment and quasi- • Social behaviors (co- background characteristics. trict in randomized ex- experiment operation, innovation, • Preschool children in centers that promoted reflec- periment • (Note: The findings for preschoolers apathy, distress) tive, innovative, and involved behavior showed • Infant/toddler sub- are from the 49-center quasi-exper- • Fine and gross motor greater gains in receptive language ability and cogni- study: 74 groups of iment and are generally supported skills tive knowledge. Children in centers where care- children and 54 centers by findings from the separate, ran- givers exhibited high levels of social and managerial • 65% African American domized experiment.) interaction with children showed more rapid gains 30% white in receptive language ability. The effects of these Range of socioeco- center and caregiver characteristics on receptive nomic status, with language ability and cognitive knowledge were low-income over- independent of child age, gender, race, family represented income, and other socioeconomic background Less than 50% characteristics. two-parent families • Preschool children attending centers with teachers better trained or educated in child-related fields had more social interactions with teachers, were more cooperative, compliant, and involved, and had greater gains in cognitive knowledge; neither years of teacher experience nor level of formal education showed a consistent relationship to child outcomes. 187 continued 188 Table 1 (continued). Center-based Childcare Studies That Examine Quality of Care and Child Outcomes Sample size/ages/ Relationships between quality John M. Love, Peter Z. Schochet, and Alicia L. Meckstroth Study (date) demographics Design and methodology Outcomes measured and child outcomes Ruopp, Travers, • Relationships between preschool child–caregiver Glantz, and Coelen ratios (5:1 to 10:1) and caregiver and child behavior (1979) were neither strong nor consistent; ratio was (continued) unrelated to gains in child test scores. • Toddlers attending centers with better child–staff ratios exhibited less overt distress; toddlers cared for by experienced staff exhibited more apathetic behavior; the degree of specialized staff training had no effect on child distress, child apathy, or exposure to potentially dangerous situations. • Infants attending centers with better child–staff ratios exhibited less overt distress, less apathetic behavior, and were exposed to fewer potentially dangerous situations; infants cared for by better educated but less experienced staff exhibited less apathy and were exposed to fewer potentially dangerous situations; infants cared for by staff with specialized training showed no significant behavioral differences. Note: The table includes only findings that the authors report as statistically significant. Source: Love, J.M., P.Z. Schochet, and A.L. Meckstroth. 1996. Are They in Any Real Danger? What Research Does—and Doesn’t—Tell Us About Child Care Quality and Children’s Well-Being. Child Care Research and Policy Papers: Lessons from Child Care Research Funded by the Rockefeller Foundation. Princeton, N.J.: Mathematica Policy Research, Inc., May. Table 2. Family-based Childcare Studies That Examine Quality of Care and Child Outcomes Sample size/ages/ Relationships between quality Study (date) demographics Design and methodology Outcomes measured and child outcomes Investing in Effective Childcare and Education: Lessons from Research Studies using contemporaneous designs Goelman and Pence • 105 children (ages 3 to • Contemporaneous design • Language develop- • Children attending high-quality family day-care (1987 and 1988) 4). Specific ages not (observational and child data ment homes had higher average scores for language provided. collection over a 1-year period) • Peer interactions development than children attending lower-quality • 53 centers • Observational assessment and • Play activities (soli- family day-care homes. • 52 family day-care parent ratings of classroom tary, cooperative) • Amount of “information activities” was not related providers quality to quality. Predominantly white • Direct assessment of child out- (Canadian) comes Range of socioeconom- ic status represented 50% two-parent families Goodman and • 52 children (ages 2.5 to 4) • Contemporaneous design • Cognitive • Children receiving an enhanced family day-care Andrews (1981) • 32 family day-care • An educational intervention was performance intervention showed greater improvement in providers (enhanced) used to assess quality (the inter- • Verbal intelligence cognitive performance on three standardized tests • (Control group receiving vention varied in intensity among than did either control group children in family nonenhanced family day three treatment groups but in day-care settings or comparison group children in care: 8 children) each case focused on the devel- professionally run group day-care centers. • (Comparison group opment of linguistic compe- receiving center-based tence). care: 68 children, three • Direct assessment and observer centers) ratings of child outcomes • 43% white 57% African American 189 continued 190 Table 2 (continued). Family-based Childcare Studies That Examine Quality of Care and Child Outcomes Sample size/ages/ Relationships between quality John M. Love, Peter Z. Schochet, and Alicia L. Meckstroth Study (date) demographics Design and methodology Outcomes measured and child outcomes Howes and • 40 children (20 in • Contemporaneous design • Peer social behaviors • Among family day-care homes, smaller group sizes Rubenstein (1981) family day care) • Observational assessment of class- • Peer social interaction and the presence of older peers in the group posi- (18 to 24 months) room quality • Structure of peer play tively influenced children’s vocalization to peers. • Eight centers • Direct assessment and observer • No overall significant differences in the frequency of 16 family day-care ratings of child outcomes socially directed peer behaviors were found be- homes tween family day care and center care. • 33% African American, Hispanic, or Asian 67% white Predominantly two- parent families Middle socioeconomic status Howes and Stewart • 55 children (ages 11 • Contemporaneous design • Play with peers • A greater number of changes in the family day-care (1987) to 30 months) • Observational assessment of family • Play with objects provider was associated with lower-level play with • 55 family day-care day-care quality • Play with adult care- objects and peers. homes • Direct assessment and observer givers • For boys, earlier childcare entry and fewer changes • Heterogeneous social ratings of child outcomes in provider were also associated with higher-level classes and parent play with objects. educational levels • Higher overall quality of care was related to higher (including 18% low levels of competent play with adults and with ob- socioeconomic jects; for girls, the relationship was also significant status) for higher-level play with peers. 82% two-parent families Sample size/ages/ Relationships between quality Study (date) demographics Design and methodology Outcomes measured and child outcomes Kontos (1994) • 57 children (ages 2.5 to • Contemporaneous design • Cognitive play • Children in family day-care homes that were rated at Investing in Effective Childcare and Education: Lessons from Research 4 years) • Observational assessment of family • Intelligence quotient a higher level of overall quality were significantly • 30 family day-care day-care quality • Language interaction less likely to engage in simple cognitive and social providers • Direct assessment and teacher rat- • Receptive vocabulary play, were rated as significantly more sociable, and • Middle socioeconomic ings of child outcomes • Social play and socia- scored higher in receptive vocabulary, controlling for status bility maternal education, caregiver experience, and con- 82% two-parent families ditions of caregiving. • Children in higher-quality family day-care homes who had mothers with more education and care- givers with less experience were rated as signifi- cantly more sociable. • Children in higher-quality family day-care homes who had mothers with a higher level of education scored significantly higher in receptive vocabulary. Kontos, Howes, • 226 children (ages 10 • Contemporaneous design • Peer play • Children with sensitive and responsive caregivers Shinn, and Galinsky months to 5 years) • Observational assessment of family • Attachment security were more likely to be securely attached to their (1995); Galinsky, • 226 family day-care day-care quality • Social adjustment/be- caregivers. Howes, Kontos, and providers • Direct assessment, observer rat- havior problems • Children who spent more time with their caregiver, Shinn (1994) • 42% white ings, and caregiver ratings of child • Object play were cared for in homes with more children per 23% African American outcomes • Use of language adult, and had caregivers who used more-respon- 31% Hispanic sive interactions engaged in a greater amount of Heterogeneous social play with objects; children with more-educated classes and maternal mothers and more-responsive caregivers engaged in educational levels more high-level object play. 81% two-parent families • Larger group sizes and child–staff ratios were relat- ed to more peer play. 191 continued 192 Table 2 (continued). Family-based Childcare Studies That Examine Quality of Care and Child Outcomes Sample size/ages/ Relationships between quality John M. Love, Peter Z. Schochet, and Alicia L. Meckstroth Study (date) demographics Design and methodology Outcomes measured and child outcomes Kontos, Howes, • Higher global quality was related to more object Shinn, and Galinsky play, more high-level object play, and better child at- (1995); Galinsky, tachment security; however, higher global quality Howes, Kontos, and was related to less high-level peer play. Shinn (1994) • Neither family background characteristics nor child- (continued) care characteristics (structural or process quality) predicted children’s language development or social adjustment. • Maternal working conditions and number of hours worked were unrelated to all aspects of children’s development. Studies using pre-post designs Galinsky, Howes, • 130 children (ages 1 to • Pre-post design • Peer play • Children with caregivers who had participated in a and Kontos (1995) 5, approximate; exact • Observational assessment of family • Attachment security 16-hour training course behaved in a manner indica- ages not given) day-care quality • Object play tive of a secure attachment with their caregiver, • 130 family day-care • Direct assessment and observer were more engaged in activities (such as listening providers ratings of child outcomes to stories), and spent less time wandering aimlessly, • Geographic diversity compared with children whose caregivers did not (other sample demo- receive the special training course. graphics not provided) Sample size/ages/ Relationships between quality Study (date) demographics Design and methodology Outcomes measured and child outcomes Investing in Effective Childcare and Education: Lessons from Research Studies using longitudinal designs Lamb, Hwang, • 140 children (ages 1 to • Longitudinal design • Personal maturity (in- • The quality of care (regardless of type of provider) Broberg, and 2). Follow-up at ages 2 • Observational assessment of care- dependence, ego re- and family social support predicted personal maturi- Bookstein (1988) to 4. giver quality and home quality; par- siliency, and control) ty and social skills with familiar peers and unfamiliar • 53 centers ent ratings of social support • Sociability adults. • 33 family day-care • Direct assessment of child out- • Adult-child interaction • As measured at follow-up, there was no significant homes comes • Peer play relationship between type of childcare and children’s 54 maternal home care • Activity level sociability or personal maturity. situations • 100% Swedish children Range of socioeco- nomic status repre- sented 100% two-parent families Older mothers (average age = 31) Note: The table includes only findings that the authors report as statistically significant. Source: Love, J.M., P.Z. Schochet, and A.L. Meckstroth. 1996. Are They in Any Real Danger? What Research Does—and Doesn’t—Tell Us About Child Care Quality and Children’s Well-Being. Child Care Research and Policy Papers: Lessons from Child Care Research Funded by the Rockefeller Foundation. Princeton, N.J.: Mathematica Policy Research, Inc., May. 193 Chapter 7 Mapping and Documenting Effective Programming Judith L. Evans Participants and professionals observing or engaged in early child- hood activities and programs tend to judge whether an activity or program is effective based on intuitive, overall impressions and, sometimes, mental checklists of “critical features.” The signs of an ef- fective early childhood program include a range of factors defined by professionals based on their individual experiences and goals, which may differ substantially. Figure 1 lists examples of the questions asked by early childhood professionals when evaluating the effectiveness of an early childhood program. To examine in greater depth the effectiveness of early childhood programs, the Bernard van Leer Foundation launched the Effective- ness Initiative (EI) in January 1999 in partnership with the Consulta- tive Group on Early Childhood Care and Development. The question being explored in this initiative is, “What makes early childhood pro- grams effective, in a variety of contexts, for diverse participants and stakeholders—from children, to parents, to community members and policymakers?” The emphasis in this initiative is on the effectiveness of the process of early child development (ECD) programming, rather than specific outcomes of ECD programs. This chapter describes the key features of the initiative, including the participating programs, the organization and underlying assumptions, and the qualitative re- search tools and strategies used to collect and analyze program data. 195 196 Judith L. Evans For the Program •Is the child central to what is going on? For example, when there are discussions about the program, is the focus on what is happening for children or on the facilities? •What is the nature of child-adult interactions? •Do the children stay “on task” when a stranger walks in? •Is there a predictable structure to each day (timetable) that includes unstructured time and space? •Are children and adults healthy and clean? What does “healthy and clean” mean, given the context? •What is the nature of parent (mother and father) involvement in the program? •Is there an acknowledgment of the value of individual differences and contributions? •Are people able to adapt to new situations? •Are the early childhood activities based on cultural characteristics? For example, are children allowed to look at adults directly? Are children allowed to ask questions of adults? •What evidence is there for the kind of training that caregivers, teachers, parents, and supervi- sors have received? •What kind of support (e.g., follow-up, advice) is provided to teachers, parents, and other par- ticipants by the organizers of the program? •Is the program comprehensive? Does it address children’s physical development (health and nutrition) and psychosocial development and the rights of children and families? •Are there opportunities for children and adults to express themselves verbally and creatively? •Does the curriculum include music and drama and other expressive opportunities? •What use is made of storytelling? •Is there fun, laughter, and joy (“a spring in the feet and a sparkle in the eye”) of the children and caregivers? For the Setting •Is the environment conducive to learning? For example, is children’s work displayed and are there materials and opportunities for exploration and problem solving? •Is there a high level of activity and constructive noise? •What is the child-to-adult ratio? Is it appropriate for the context? Does it vary based on the age of the children? •What kinds of “coverage” does the program provide? Is it inclusive or exclusive in enrolling children with disabilities? •Is there a monitoring and evaluation system in place? •Is provision made for children’s transition to primary school? •Are people (of all ages) asking interesting questions for which they may not necessarily have a “right” answer”? •Do people (of all ages) acknowledge they do not know all the answers, and are they willing to engage with others in seeking solutions? Source: Brainstorming session, 1999 Meeting of the Consultative Group on Early Childhood Care and Development. Figure 1. Early Childhood Programs: Possible Indicators of Effectiveness Mapping and Documenting Effective Programming 197 The EI is an in-depth, 5-year exploration to better understand in what ways programs are effective for diverse participants, com- munities, and cultures. The initiative involves a qualitative study of programs that have been in place for at least 10 years and the devel- opment of methods and “maps” for examining other programs in the future. The goals are twofold: • To gain deeper insight into the components of effective early childhood programs • To stimulate interagency and international dialogue on effec- tiveness, beyond the present scant measures and indicators of program success. The EI also is designed to test the use of qualitative research meth- ods, which are relatively well developed in other disciplines, in inter- national early childhood development. The initiative is not expected to yield a template for successful or ideal programs, but will “map” dimensions of effectiveness in specific programs and identify patterns of effectiveness across diverse settings. Available data, published during the past 5 years by the Consul- tative Group on Early Childhood Care and Development, the World Bank, the Inter-American Development Bank, and other organiza- tions, document the economic benefits of investments in early childhood. These data emphasize long-term economic outcomes benefiting individuals and industrialized societies, as measured by economic productivity. Although the ECD field has benefited great- ly from the research generating these data, the findings should not constrain the continued search for effective early childhood pro- grams. An economic emphasis narrows understanding of the full impact of effective early childhood programs on individual chil- dren, families, and communities. Also, current research findings emphasize preschool programs, and the potential benefits of home- based, parent support, and community development programs have not been explored in any depth. One of the challenges for the EI is to create a set of methods and data that are broader than, but as persuasive as, current economic 198 Judith L. Evans analyses of the benefits of early childhood programs. The aim is to understand the impact of a wide variety of early childhood strategies and to complement the quantitative research already conducted with qualitative research tools and methods. Key questions for the EI are: What makes an early childhood pro- gram “work”? What aspects of a program are working? What can we learn from programs that feel “right” in some ways but wrong in oth- er ways? How does a program change over time? Are effective pro- grams always effective? Are programs effective for only one set of stakeholders, or are they meeting the needs of different sets of stake- holders? Are they effective in the same ways for the various stake- holders? Can a program that is failing to make a difference in one di- mension nevertheless be effective in another? The Effectiveness Initiative The participants, organization, assumptions, and status of the EI are described below. A discussion of the tools and strategies being used follows. Participants The EI focuses on ten programs selected from more than forty pro- grams funded by a variety of organizations, foundations, donor agen- cies, and government. The ten programs are geographically diverse and illustrate a variety of approaches to ECD. Each program appears to meet the definition of an effective ECD program, that is, a program that meets the developmental and cultural needs of young children and their families in ways that enable them to thrive. Figure 2 briefly describes the programs. Organization Organization of the EI has involved selection and preparation of re- search teams, framing of meaningful questions, and development of processes to enhance individuals’ skills in listening, understanding, and interpreting people’s experiences and situations. Mapping and Documenting Effective Programming 199 1. Madrasa Resource Center (MRC) — Kenya The Madrasa Project was created to provide a preschool experience for young children (ages 3–6 years) to help prepare them for school and provide basic religious teachings. The program has been expanded to Zanzibar and Uganda. The MRC, which is based in Mombasa, provides training and support. Uniquely, the program: •Was developed by the Muslim community in response to its needs •Combines traditional Koranic teachings and more secular education •Prepares children to enroll and perform better in primary school •Is experimenting with a unique financing system (community-based endowments) •Provides a model for other Muslim countries. 2. Assoçiação de Criança Familia e Desenvolvimento (CFD) — Mozambique Since 1995, CFD (the Association for the Child, Family, and Development) has focused on a variety of community-based activities, which include enabling almost 500 community network groups to systematize spontaneous ECD activities. Uniquely, the CFD program: •Enlists community network groups as active development agents, which is crucial for the emerging Mozambique civil society •Stimulates daily recreational activities for children based on culturally appropriate methods •Restores traditional healing ceremonies to help children and families in psychosocial distress after Mozambique’s civil war •Shifted from Save the Children’s Children and War Project to effectively support community initiatives within a broader mission and a longer-term perspective. 3. Self-Employed Women’s Association (SEWA) — India Since 1972, SEWA has been committed to the empowerment of women and the creation of autonomous unions organized for women who work in the informal sector. Since 1989, SEWA has been organizing and operating crèches (for children ages birth–3 years) for women working in the tobacco industry in rural Kheda district and, more recently, in urban settings. Uniquely, the program: •Was the first trade union in India to begin childcare services •Was the first organization to address the needs of tobacco workers who had not been organized by the major central unions •Was the first organization to systematically establish crèches and create a financing mechanism for them •Works at the grassroots and policy level simultaneously. 4. Association for the Advancement of the Ethiopian Family and Child (ALMAYA) — Israel ALMAYA originated in 1985 as the Community and Educational Project for Beta Israel, an ancient Jewish community in Ethiopia which emigrated to Israel. The project became an independent, nonprofit association in 1990. The National ALMAYA Resource, Dissemination, and Training Center supervises programs in approximately twenty-five towns throughout Israel, continued Figure 2. Programs Included in the Effectiveness Initiative 200 Judith L. Evans trains paraprofessionals and professionals, develops educational materials to enhance the community’s Ethiopian heritage, and educates others about Beta-Israel’s Ethiopian origins and life in Israel. Uniquely, the program: •Exemplifies working with immigrant children and families in Israel •Effectively responds to large waves of immigration •Demonstrates how Ethiopian paraprofessionals can serve as agents of community change and role models, linking their community with the broader Israeli society •Provides a model for paraprofessional training that incorporates cultural sensitivity and on-the- job and regular in-service training. 5. Community-based Family Education (Mount Pinatubo) — Philippines This program was initiated with communities affected by the eruption of Mount Pinatubo. Based on an assessment of local culture, programs were developed with the community and include early childhood activities, parent education, and micro-enterprise projects. Income from the latter is shared equally by families, the cooperative, and the program. Uniquely, the program: •Works effectively within the community to define the community’s needs •Exemplifies how to respond in an emergency situation •Illustrates the synergies possible with an integrated, multipronged approach •Illustrates how nongovernmental organizations can work with government and communities to achieve sustainable programs •Provides an example of community-derived funding for an early childhood project. 6. Proyecto de Mejoramiento Educativo, de Salud y del Ambiente (PROMESA) — Colombia This integrated community-based early childhood education program was designed initially as an alternative participatory approach to ECD that could serve as a model of integrated social development and as a research and development project. Beginning in 1978 with 100 families in four small farming and fishing villages on the coast of Colombia, the program now serves approximately 7,000 families along the coast and in the interior, and variations of the approach are being implemented elsewhere in Colombia and in other countries. Uniquely, the program: •Relies on parents and community leaders as the main educational agents in the program •Uses project staff as facilitators in development and links to other institutions •Emphasizes interinstitutional coordination locally and regionally •Emphasizes the children’s program as the basis for integrated and sustainable social devel- opment •Integrates evaluation, monitoring, and research. 7. Programa No-formal de Educación Inicial (PRONOEI) — Peru This began as a nutrition program in the mid-1970s and evolved into a community-operated preschool. Later it became a model for nonformal education and was adopted by the Ministry of Education. Uniquely, the program: •Was developed in collaboration with the community and at its request •Adapted a proven curriculum model (the High/Scope curriculum) continued Figure 2 (continued). Programs Included in the Effectiveness Initiative Mapping and Documenting Effective Programming 201 •Used resources from the community for implementation •Used men from the community as teachers •Has been evaluated several times •Has been adopted officially as a national model program and is replicated in other parts of Latin America and elsewhere. 8. Samenspel (Playing Together/Joint Action) — Netherlands Samenspel was established in 1989 as a small-scale project to test strategies for reaching im- migrant families (primarily from Morocco and Turkey) and to explore ways to encourage mothers with young children to participate in play afternoons. Training programs for teams of multi-ethnic play leaders developed gradually. Samenspel groups can be found at play-group and communi- ty centers and within self-help and immigrant organizations. Uniquely, the program: •Provides an informal, low-key, and easily accessible mechanism for introducing immigrant women and children to the Dutch language and culture •Emphasizes capacity-building based on experiential learning that draws from people’s knowl- edge and experience •Uses a flexible and adaptable approach for working with people from different contexts who have similar needs. 9. Agueda Movement (Bela Vista) — Portugal The Agueda Movement began with creation of the Bela Vista preschool and is a conscious effort to provide for children who are socially marginalized. Outreach efforts to raise awareness led to community-based action and more inclusive activities to reduce duplication among Portugal’s various social services and to increase access for children and families that are not being served. Uniquely, the program: •Works within the infrastructure to make services more appropriate •Raises awareness at community and national levels •Develops additional services, as required, to meet identified needs •Has a nonhierarchical organizational structure and decisionmaking process. 10. Madres Guias (Guide Mothers) — Honduras This home- and center-based preschool program is designed to help children transition easily from home to preschool and then to primary school. The service providers, Guide Mothers, are local women trained to work with families in their homes and with children as they enter preschool. A radio program associated with the effort provides child development messages. Uniquely, the program: •Has a well-developed curriculum and training process •Plans to develop a training institute to train others in the country and elsewhere using their model •Has a well-developed social support network for responding quickly to emergencies (e.g., the devastation by Hurricane Mitch). Figure 2 (continued). Programs Included in the Effectiveness Initiative 202 Judith L. Evans Research Teams For each of the ten programs, teams of four or more persons (general- ly, two local and two nonlocal) have been organized and consist of the program staff and local consultants, staff from other EI programs and the Bernard van Leer Foundation, experts in relevant disciplines (e.g., statistics, data analysis, and cost-benefit studies), and staff from international organizations funding ECD programs. These teams de- velop the initial site-specific questions and processes for engaging di- verse stakeholders in “mapping” the details, evolution, and experi- ences of a program. The teams are supported by an advisory group of international early childhood professionals and foundation staff. They meet periodically to share their tools, methods, experiences, questions, concerns, and understanding. Meaningful Questions The framing of meaningful questions is key to generating under- standing. Too often, development workers and/or funders ask ques- tions that may limit people’s responses, may not be salient, and may not reveal the real meaning of people’s experiences. Getting beyond what we already know how to ask and hear is extremely difficult. In fact, Pearce (1971, p. 70) claims that, “We hear only the question to which we are capable of finding an answer.” For the EI, the challenge is: Can some new questions be developed? The EI is specifically exploring tools that help validate intuition (i.e., to better articulate or justify the sense that things are, or are not, working), which cannot be justified by a checklist or standardized in- strument. By creating additional methods for observing and making sense of the contexts of programs, the EI can enhance the develop- ment workers’ “toolkit” and help identify adequate language to vali- date “out-of-the-box” thinking. New Processes In addition to being able to ask new questions, listening better to better understand responses is an organizing feature of the EI. “Listening” does not denote a condescending, perfunctory, Mapping and Documenting Effective Programming 203 half-hearted effort of forming conclusions as information is pre- sented. Rather, listening means finding ways to receive people’s responses fully before trying to analyze, interpret, or categorize their meaning; it means “staying open” to hearing, seeing, and understanding. The EI also emphasizes use of an appropriate lens for obtaining and viewing data. This lens combines an objective (observer or out- sider’s) perspective (the “etic” approach) and a subjective (actor or in- sider’s) perspective (the “emic” approach) (Levi-Strauss 1966). The synthesis of these two approaches to listening will yield a fuller pic- ture of effective programming than otherwise possible. Assumptions The EI staff bring explicit and implicit assumptions to the initiative based on their own practices and experiences. They have an agenda for action and strive to offer something to help others change (im- prove) their lives, and they hold certain beliefs about the nature of effectiveness. These beliefs, which have been incorporated into the EI, are as follows: • Effectiveness cannot be defined in terms of a universally agreed-upon truth. No single dimension would make every early childhood program “effective.” Truths are multiple, and disagreement about the components of an effective program is part of the process of understanding. • Effectiveness is not a static concept. The effectiveness of an effort changes over time and with changing conditions. • Effectiveness cannot be placed on a linear scale that ranks programs from most effective to least effective. • Effectiveness resides in an organization and varies within an organiza- tion. Because some parts of an organization may be stronger than others, effectiveness is best represented as a profile. • Effectiveness takes time to identify and understand. The essence of ef- fective early childhood programming cannot be captured in a snapshot. Understanding effectiveness requires living with, and 204 Judith L. Evans experiencing, multiple, dynamic situations and time to recog- nize effectiveness in both process and outcomes. • Effectiveness is the result of experience and is a composite of many experiences. Current Status The EI is well under way, and the energy, enthusiasm, and commitment of the EI participants is stimulating, directly and indirectly, a wide range of activities. The EI is already experiencing the benefits of synergy among the different programs, team members, and methods. Multiple team meetings have been held at each site, members of all teams have met in a series of workshops, and both regional meetings and interna- tional conferences have been convened. These meetings have provided opportunities to create a shared vision, probe serious questions collec- tively and publicly, formulate questions more thoughtfully, share strategies and questions in teams’ working language (e.g., Spanish), pre- sent developments to audiences unfamiliar with the EI, and suggest possibilities for applying the process and results in other contexts. Qualitative Research Tools: Meaning in Language Qualitative research offers validated and tested tools that can be adapted for examining all the dimensions and complexity of ECD programs (Coffey and Atkinson 1996; Moustakas 1994). Utilizing data sources such as individual stories and anecdotes, interviews, field notes, recordings of natural interactions, documents, pictures, and other graphic representations, qualitative research can capture human experiences that are not approachable with quantitative methods (Geertz 1983). The EI aims to develop various analytical tools to reveal a layered understanding, and different facets, of meaning. This research avoids a reductionist summing up of data, recognizes and explores complex- ity as much as possible, and views people as analyzers of meaning even as they create meaning. People live their lives embedded in language, so why do researchers turn to numbers to define truth? Mapping and Documenting Effective Programming 205 Language is at the heart of meaning. As noted by Barritt and col- leagues (1979), qualitative research seeks data dominated by language and cultural understanding, not numbers. Numbers are important, but they should not be the only points of reference. By focusing on language, the EI can highlight aspects of experience that might other- wise go unmarked. Barritt and colleagues (1979, ch. 6, p. 83) note that, “Analysis of language requires rhetorical skill, the attention to meaning, and the struggle to say it right; we cannot escape the tradi- tion; we have to use it.” The EI offers an opportunity to validate an approach that allows people to tell their stories in their own language, without others’ im- mediate classification, censorship, or interpretation. Collectively, the teams interpret the stories together and broaden the basis for analysis in the hope of truly hearing what is being told. This approach will provide insight into a community’s values, beliefs, and practices and how to work within a culture to foster more equality—insights that are more difficult to obtain with other participatory techniques, such as Participatory Learning for Action (PLA). Robert Chambers’ (1997) reflections on the development of the PLA methods, which he has successfully promoted, reveal that he has realized the limits of such open methodologies to “get at” meaning. Using open methodologies for gathering data is not sufficient, and meaning can only be under- stood by working more skillfully with data that are generated in vari- ous ways. When data are reduced, knowledge and understanding are compromised. Most of the tools in the EI toolkit have been used previously by the EI participants and are being sharpened and used in different ways. The EI teams are expanding the use of questions, storytelling, and other narrative means and are learning and applying new methods of analysis and interpretation to better understand the effectiveness of early childhood programs. The tools being used include the develop- ment and organization of questions from different perspectives and the use of analogies to “map” program contexts, the gathering of sto- ries about effective programs from groups of participants, and inter- views with various stakeholders. 206 Judith L. Evans The Initial Questions For the EI, an advisory committee of early childhood programmers, policymakers, and practitioners initially met to develop a set of ques- tions about the nature of effective organizations. These questions, which were organized into different “cuts,” or “maps,” of a program’s history, were shared during initial site visits to encourage the EI par- ticipants to reflect on their organization’s history and the evolution of the program in the future. All programs adopted this initial set of questions, which consists of a set of overlapping “maps” for describ- ing a project over time, beginning with the project’s origin. The time- line and questions for each program relate to key events, change points, and crucial moments in the program’s evolution. The specific dimensions of these “cuts” are as follows: • Influences. This cut consists of a description of everything that has influenced the program over time (e.g., economic, political, and cultural effects and changes; participants’ perception of changes). Two aims are to capture the effect of serendipity and personal choices on the program and to understand the effects of available financial and physical resources. • Attitudes and Values. This cut is to identify and explore the under- lying implicit and explicit assumptions of program participants (e.g., the values and beliefs about children’s development and the way children learn, the value of intervening and the types of intervention thought to be appropriate). Attitudes and values affect the types of activities undertaken in a program. • Organizational Structure. This cut involves creating an organiza- tional chart and describing changes over time (e.g., in the pro- gram’s leadership). • Organizational Culture. This cut is to identify processes within the organization for addressing problems, overcoming obsta- cles, making decisions, recruiting, hiring and training staff, and other concerns. This cut also provides information on who participates in the program at different times and in dif- ferent ways. Mapping and Documenting Effective Programming 207 • Linkages. This cut charts the types of linkages formed with other organizations, individuals, donors, and government, as well as the organization’s networks and its roles in these networks. • Outcomes. This cut highlights the influences of the organization (e.g., on children and families, staff, community, other organi- zations) from the perspectives of various stakeholders and places the organization in a broader context (e.g., in relation to government policy). • Mapping the Future. Speculative mapping is used to identify how key stakeholders envisage the future and the development of the program over time with respect to its underlying philoso- phy; assumptions, goals, and activities; organization; decision- making processes; linkages; and outcomes. A River Analogy The course of an ECD program can be compared to the life of a riv- er, developing from a small spring or stream with a certain course or direction and influenced by many things as it flows from small beginnings into a lake or ocean. The depth and breadth of rivers, and projects, are determined by multiple contextual factors. Some flow in a predictable path, but most are diverted in some way from their natural course; at times, they are fed by tributaries and widen to cover more ground, and other times they shrink from drought; sometimes, dams impede their progress or cause them to flood and destroy fertile ground; some rivers flow into lakes and maintain their identity, while others flow into the ocean to become part of a broader sea, losing their uniqueness. Programs, too, progress in distinctive ways, and their courses and contours can be traced and mapped. This type of analogy has been, and can be, used to spark creativity and help program teams tell and share their story with others. For the EI, the river analogy has helped participants visualize their projects; encouraged staff to share their experiences differently; stimulated lively discussions about key events, influences, and outcomes; and helped participants gain a deeper understanding about the dynamics 208 Judith L. Evans of their program. Such discussions would not have arisen with the application of more standardized instruments, such as interviews and questionnaires. Storytelling Telling one’s story is not always easy or natural, and it may be cen- sored or “cut short” by others. Telling a program’s story is compound- ed by two additional factors. First, the program implementers or ben- eficiaries do not necessarily know what outsiders want to know about their story, and, second, listeners may not hear the story as experi- enced by the teller. Outsiders’ retelling of a program’s story may not be recognizable to the program participants, and outsiders may not be able to identify aspects that make the program effective or are perceived by others as being effective. Eliciting the full richness of a story is a challenge for the EI and other initiatives. Storytelling is used to access different sources, data, and ways of processing data. By gathering and analyzing stories, a better under- standing can be gained of effective early childhood settings. The EI participants are asked to think of a moment in any ECD setting when they said, “This is really working.” They are asked to describe this moment in writing in as much detail as possible. The stories are then shared among the group, and the group “codes” their meaning by identifying all words that have meaning and combining these later to identify themes. By analyzing and interpreting their stories in this way, the participants gain a better understanding of their shared con- cepts, attitudes, and practices and become aware of different views about the relevant features of a successful program. This storytelling method enables researchers to: • Focus on the meaning of effectiveness in a particular ECD set- ting (i.e., understanding the participants’ understanding of ef- fective ECD programming) • Generate a data set without requiring participants to agonize over writing long essays • Give participants the tools to analyze their own stories Mapping and Documenting Effective Programming 209 • Use stories to identify common and shared themes • Use themes as a basis for more informed dialogue with those who are “living the experience.” Interviews In the EI, program teams are conducting individual interviews with a wide variety of stakeholders (i.e., people at the site), who may include those currently involved in the program (parents, community mem- bers, staff, direct beneficiaries), past participants, local and national government officials, representatives of nongovernmental organiza- tions, and funders. Summarizing data collected for PROMESA, figure 3 indicates some of the important themes and issues that may emerge about a program’s effectiveness from these interviews. The successes and failures identified can then be explored further with the participants. Individual interviews can enhance understanding of how organi- zations have evolved and their effects over time. Individuals have many stories to tell and will have unique and different perceptions of a program’s evolution, for they have entered the program at different times and come from diverse backgrounds. Combining their stories with the perceptions and experiences of persons outside the program is another challenge in constructing a good, sound story of a pro- gram’s effectiveness. Qualitative Research Strategies: Embedded Communications Each of the tools described above serves a specific function in gather- ing and analyzing data. Together, they offer a beginning, integrated set of activities to help determine effective ECD programming. The tools are not discrete activities, but are interwoven and form the toolkit for the EI. Creating the tools and instruments is part of the strategy to engage EI participants in qualitative research. Teams are developing and testing tools while also developing strategies for data analysis. Designing a communication strategy that helps to convey the EI process as well as outcomes is a related and essential effort. The 210 Judith L. Evans 1. Continuity and stability in an organization (which may lead to solid performance and/or sedentarianism) vs. change and turnover (which might undercut actions or provide dynamism) 2. The importance of “tolerance of ambiguity” vs. an imposing structure 3. The personal growth and development of participants at various program levels, as both means and end 4. The process of recognizing one’s capacities (at community and institutional levels) 5. The need to construct credibility with communities and funders and the process for doing so 6. Building and maintaining local confidence when operating at a distance 7. Forms of reinforcing internal and intrinsic motivation among program participants 8. The importance of a play approach to learning 9. The timing of separation by project “outsiders” and the effects of separation 10. Voluntarism vs. payment 11. Forms of integration and their implications for functioning; constructing a “transdisciplinary” view 12. Achieving sustainability; solving immediate problems vs. taking a longer view 13. Respecting local values and cultures and strengthening local customs while introducing new customs and values; defining the custodian of knowledge 14. The role of “connections” in the success of a program 15. Forms (and effects) of program dissemination 16. Building a workable system for registering and using program information which is not over- burdening 17. Discretion, tact, and diplomacy as styles of functioning internal to an organization and in relation to others outside 18. Organizations as families and the rule of families in organizations, particularly in relation to handling differences without “breaking apart” 19. The importance of different forms of communication 20. Converting adversity and crisis into opportunity and advantage 21. The place of (or need for) welfare aid (“asistencialismo”) within a program that empha- sizes empowerment 22. The centrality of people within organizations vs. the centrality of organizations 23. Delegating responsibility 24. Strategies that allow communities and staff members to appropriate (“buy into”) a particu- lar program philosophy 25. Combining disparate interests in joint actions for the common good; becoming “profes- sional” without succumbing to difficulties associated with professional organizations, forms of training, and organizational attitudes. Source: Myers 1999. Figure 3. Themes and Issues Emerging About PROMESA in Colombia Mapping and Documenting Effective Programming 211 EI is enhancing the ability of all participants to engage openly in a re- view process that shares results as it proceeds. Traditional social science research uses a linear communications model. Researchers (sometimes with funders) choose the research focus, determine the research questions, and design the research activities, which usually include data gathering, sorting, analyzing, and interpreting and the writing up of results. Each step of this process is accomplished separately in sequence. The goal of this traditional method is to maintain objectivity in the research, exter- nal to the person conducting the research. Information is gleaned as the research moves from one activity to the next, and partici- pants (respondents) at one stage are usually excluded from the next stages. Rarely is information gathered, sorted, and reflected back to the respondents, giving them a chance to generate other ques- tions, reshape the study, and dialogue with researchers about the nature of their experience and knowledge. They are not asked to help interpret their experience and are frequently not given the results of the research. Data technicians also are uninvolved after they have provided the data. Researchers analyze, write, and report the research results to an audience, which frequently does not include the groups with whom or for whom the research was conducted. The qualitative research approach used in the EI requires a differ- ent communication model which may be termed embedded commu- nication (Ilfeld 2000). Ideally, such research allows information to flow in all directions, through dialogue between diverse stakehold- ers and through collective design and implementation of the pro- ject. Three distinct, but interrelated, communication activities with- in this model are: (1) collecting and gathering raw data and information, (2) working with and analyzing the information and data, and (3) communicating the new understandings and knowl- edge to diverse audiences. Each activity embodies all the steps in a traditional research de- sign: framing questions; gathering data, sorting data, analyzing data, and interpreting data; and writing up or representing these data. The 212 Judith L. Evans levels of activity represent increasing levels of refinement and polish, with level 1 focused on manipulating raw data and gathering infor- mation broadly, level 2 focused on shaping “first drafts” and first con- clusions that are discussed with participants in a consultative process, and level 3 focused on shaping more formalized communications for audiences within and outside of the participants. The three levels can be viewed as a spiral, with each level influencing the others. For example, a decision to create a web site (level 3) may trigger a deci- sion to collect new data and reexamine certain issues (level 1); and a sorting of information (level 2) from a series of interviews (level 1) may suggest a new direction for questioning (level 1), a new way to understand the experience (level 2), or the outline for a potential video (level 3). Figures 4 and 5 depict and describe the activities in this embedded communications model for qualitative research. Figure 4. Embedded Communications Model for Qualitative Research Mapping and Documenting Effective Programming 213 Ideally, all participants in a qualitative research activity are viewed as communicators. Mechanisms will be needed to capture each par- ticipant’s and group’s collective ideas, thoughts, experiences, and concerns. Participants should identify how they will record their thought processes. To record private thoughts and insights consis- tently across a group, the individuals can be asked to keep “books of 1. Getting it Down: 2. Working with the Data: 3. Making Products: Collecting, capturing, Applying lenses; sorting, Formatting knowledge and generating raw analyzing, and framing for communications with data knowledge diverse audiences Activities: Activities: Activities: •Keep personal scrapbooks •Sort materials, often using •Write professional, scien- and journals—take notes, a particular focus or “lens” tific, popular nonfiction, jot down thoughts and (e.g., all materials having to and creative and dramatic experiences regularly do with turning points, or descriptions •Conduct meetings, dis- all topics of interest to par- •Develop audiovisual ma- cussions, and e-mail ents and parent educators) terials (e.g., videos, photo exchanges among parti- •Analyze themes and high- documentaries, graphic cipants light key elements, con- illustrations, PowerPoint™ •Capture and write up spe- cepts, and information presentations, slide shows, cific experiences of ideas •Create a framework for plays, television and radio (focused documentation) organizing findings (usually shows) •Generate understanding suggested by the themes •Develop meeting and work- or insights through work- and insights that emerge) shop activities shops, observations, site •Shape documents and •Conduct public and profes- visits, etc. materials into a logical and sional awareness and edu- •Collect program data, intuitively meaningful order cation campaigns using including anecdotes and •Embellish frameworks with supportive materials (e.g., stories, quotes, statistics, details, examples, and illus- booklets and brochures, interviews, etc. trations taken from the raw websites, CD-ROMs, media •Brainstorm and collectively data spots) problem-solve, recall, •Develop proposals and explore, and question research designs for further •Review existing documen- work tation and records to select •Design program activities those relevant to the effort and plans for future pro- •Record (photograph, video- gram actions tape, and audiotape) Figure 5. The Embedded Communications Model: Description of Activities 214 Judith L. Evans shadows,” or notebooks, where they jot notes, make sketches, paste quotations, and otherwise capture the “shadows” of ideas, thoughts, and experiences in one place. Group devices for collating informa- tion (see figure 6) could include “the wall” (a wall or bulletin board where people can place representations of the various kinds of knowl- edge they are gathering). Other group devices, such as an electronic Site What are How did Questions we learning? we learn it? raised/implications Build bridges among By doing it, sharing and How to ensure that what we the different actors; building by using new are doing is also a relevant learn from and get methodologies, develop- process for the program and children involved ing participatory tools its actors; how to promote regardless of age; and instruments, creat- changes within the program; listen to all the ing space for discussion how to safeguard the demands Peru voices; strengthen and reflection, using the generated by the process; self-concept within flexibility of the program. learn more about childrearing Latin America; value patterns and find ways to have our experience. them taken into account by policymakers. Philippines Learning to ask the Through daily recording, Organize and analyze informa- right questions at the observing, regular meet- tion; apply what we have right time, and to ings, focus group discus- learned from other teams and simplify and modify sions, home visiting, in- partners; documentation?; ulti- information for pro- terviewing. mate aim — self-sustaining gram partners, need communities that can address for more in-depth their own situation. look at program. continued Figure 6. Matrix of Learning at Program Sites: Questions and Issues Mapping and Documenting Effective Programming 215 bulletin board, a shared filing system, a group Intranet site, or book- shelves and tables for arraying materials, also could be used. Figure 6 presents a matrix used in the EI to collate information gathered within and between sites. These types of matrices are use- ful for identifying issues to address and sharing information and experiences. Questions that Questions that we Experience that we ask ourselves ask other programs we like to share Issues How do we estab- Charts from commu- Return of information Limits of data gath- lish limits for data nities, work on pro- and capacity to build ering, insights into gathering; how can files and attitudes, knowledge from ex- other programs’ we get to know organizing data, good perience; recognize strengths, the El’s more about other ideas for improving the changes that ex- way of exploration, teams’ work, and communications. perience generates. impact on different learn from them; stakeholders. how to contribute to generate effec- tiveness within the program, even when the El ends; what impact are we going to have on different stakeholders. Interrelatedness of What did they learn Share work in prog- Application of the tools, capacity build- from passing on ress (specifically, learning to strength- ing, techniques, and leadership to locals; training of govern- en our program; inte- strategies. livelihood projects; ment day-care work- gration of program advocacy; training ers) and how these content and ap- and capacity build- maximize benefits; proach with tools ing; migrants and generate more infor- and methods; form displaced families; mation with commu- of documentation. child-to-child ex- nities; encourage ad- changes; communi- vocacy to influence cations; workshops policymakers. with everyone. Figure 6 (continued). Matrix of Learning at Program Sites: Questions and Issues 216 Judith L. Evans In any group, each individual will offer different communications skills, interests, and aptitudes—as an articulator of ideas and thoughts, notetaker, interviewer, organizer of material, systems thinker, analyst, or tracker of details. Some individuals are more comfortable writing, whereas others prefer speaking, listening, pho- tographing, taping, or devising actions. The group should embrace the contributions of all the individuals and enable them to partici- pate fully in the documentation and communication effort. The exchange of knowledge is both enriched and distilled by the codifying of it. A collating committee can sort through and track the information collected from individuals and the group. Codifying the knowledge improves the chances that knowledge will be exchanged effectively. For this reason, communications and documentation are integral parts of every activity and should be embedded throughout the qualitative research project. Conclusion The EI effort is pursuing the development and use of a variety of tools for gathering and processing data to achieve a better understanding of the observations made and to learn from the process. Whereas quantitative research begins with a blueprint of fixed and prescribed methods and procedures that are used with conformity across all sites, qualitative research consciously avoids having a normative blue- print and seeks to identify patterns and individual differences in case studies that would not become evident in research based on fixed as- sumptions. The qualitative research approach adopted for the EI en- ables researchers to obtain both information and insights on process. The research outcomes may confirm intuitive understandings and validate programming decisions that are made based on these under- standings. Beyond outcomes, however, the EI effort is equally or even more valuable because of the process undertaken. More than fifty people from around the world have embarked on a journey together and are actively engaged in a dialogue to generate questions and methodologies to address these questions which will contribute far Mapping and Documenting Effective Programming 217 beyond the EI. The cross-site exchanges, periodic meetings of all team members, and frequent sharing of information and activities foster joint ownership of qualitative research tools and strategies that can be used to assess ECD programs in a wide variety of early childhood settings. This type of ongoing evaluation is needed to support contin- ued learning and improvement in ECD programming. Qualitative re- views and evaluation should be built into all programs as an impor- tant measure for ensuring that the scarce resources for ECD are invested wisely in effective programs. Overall, the EI promises to pro- vide the ECD field a better understanding of the requirements for cre- ating effective ECD programs in diverse settings and contexts, using diverse programming approaches. Note This chapter is adapted from “When ECD Works: Mapping the Con- tours of Effective Programming,” by G. Salole and J. L. Evans in Early Childhood Matters #93, a publication of the Bernard van Leer Founda- tion, and the Coordinators’ Notebook #23, a publication of the Consul- tative Group on Early Childhood Care and Development. References Barritt, L. S., A. J. Beekman, H. Bleeker, and K. Mulderij. 1979. Science Not Method. University of Michigan, Ann Arbor. Chambers, R. 1997. Whose Reality Counts? Putting the First Last. London: Intermediate Technology Publications. Coffey, A., and P. Atkinson. 1996. Making Sense of Qualitative Data: Complementary Research Strategies. London: Sage Publications. Geertz, C. 1983. Local Knowledge: Further Essays in Interpretive Anthropology. New York: Basic Books. Ilfeld, E.M. 2000. Embedded Research. Bernard van Leer Foundation, The Hague, Netherlands. Levi-Strauss, C. 1966. The Savage Mind. London: Weidenfeld and Nicolson. 218 Judith L. Evans Moustakas, C. 1994. Phenomenological Research Methods. London: Sage Publications. Myers, R. 1999. Effectiveness Initiative: An Evaluation of PROMESA: Report on a Visit to Colombia, August 27 to September 1, 1999. The Consultative Group on Early Childhood Care and Development. Tlalcoligia, Mexico. Pearce, J.C. 1971. The Crack in the Cosmic Egg. New York: Washington Square Press. Chapter 8 Effective Early Childhood Programs: The U.S. Head Start Experience Louisa B. Tarullo In 2000, the U.S. Head Start program marked its fifth year of develop- ment and implementation of program performance measures. As the United States’ premier early childhood education program, Head Start is leading the way in developing and reporting on accountabili- ty of services, which Head Start provides each year to more than 800,000 children and their families. From the initial planning of this accountability system in 1995 to publication of the third progress re- port (Administration on Children, Youth, and Families 2001), Head Start has made dramatic progress in establishing outcome-oriented accountability. The system combines the best attributes of scientific research with program-level reporting and monitoring. It is based on consensus-driven criteria for program accountability. This chapter describes Head Start’s initiative of program perfor- mance measures and the Family and Child Experiences Survey, a cen- tral part of this initiative. Data collected in the survey are being used to assess Head Start’s outcomes and to refine the overall program. The Program Performance Measures Initiative The Head Start Act (42 U.S.C. 9831 et seq. 1994) defines program per- formance measures as “methods and procedures for measuring, 219 220 Louisa B. Tarullo annually and over longer periods, the quality and effectiveness of programs operated by Head Start agencies” that will be used to identi- fy strengths and weaknesses in the Head Start program—both nation- ally and by region—and to pinpoint areas requiring additional train- ing and technical assistance. Specifically, the program performance measures were developed in accordance with the recommendations of the Advisory Committee on Head Start Quality and Expansion; the mandate of section 641A(b) of the Head Start Act, as reauthorized in 1994; and the Government Performance and Results Act (Public Law 103–62 of 1993). In 1995, Head Start undertook a consensus-building process to de- velop the program performance measures. The process included dis- cussions with staff and parents in the Head Start program; representa- tives of early childhood organizations; researchers; experts in education, child development, and early intervention; and officials in the Head Start bureau of the U.S. Department of Health and Human Services. Conceptual Framework In 1996–97, Head Start developed a conceptual framework for the program performance measures and revised and condensed the ini- tial measures. The conceptual framework unifies and organizes the measures and shows the linkages between process and outcome mea- sures for Head Start children and families (see figure 1). The conceptual framework is based on the ultimate goal of Head Start: to promote the social competence of children. Social compe- tence is defined as a child’s every-day effectiveness in dealing with the present environment and later responsibilities in school and life. For a 5-year-old child who is ending preschool and entering primary school, an important life challenge and key test of social competence is school readiness (i.e., whether the child has acquired the skills, un- derstandings, and behaviors that help ensure successful functioning in the new environment). Effective Early Childhood Programs: The U.S. Head Start Experience 221 Head Start has adopted the “whole child” view of school readiness recommended by the Goal One Technical Planning Group of the U.S. National Education Goals Panel (Goal One Technical Planning Group 1991, 1993). In this view, school readiness is a multifaceted phenom- enon comprising five developmental domains important to a child’s readiness for school: physical well-being and motor development, so- cial and emotional development, approaches to learning, language usage and emerging literacy, and cognition and general knowledge. Each domain is represented in the battery of measures used to assess the performance of Head Start programs. The performance measures account for the interrelatedness of cognitive, emotional, and social development; physical and mental health; and nutritional needs. Figure 1. Head Start’s Program Performance Measures: Conceptual Framework 222 Louisa B. Tarullo A child’s social competence is at the top of the conceptual frame- work, depicted as a pyramid. Five objectives support this outcome: • Objective 1. Enhance children’s healthy growth and develop- ment. • Objective 2. Strengthen families as the primary nurturers of their children. • Objective 3. Provide children with educational, health, and nu- tritional services. • Objective 4. Link children and families to needed community services. • Objective 5. Ensure well-managed programs that involve par- ents in decisionmaking. Each objective is critical for helping children of low-income fami- lies attain their full potential. The objectives represent key corner- stones of the Head Start program. Objectives 1 and 2 represent out- comes or results that the program is designed to produce. Achieving both objectives is critical to the ultimate success of Head Start. Be- cause parent involvement and family support are key tenets of Head Start, both child and family-oriented outcome measures are included. Objectives 3, 4, and 5 are on the lower tiers of the pyramid and con- tain key process measures for attaining objectives 1 and 2 and the ul- timate goal of enhancing children’s social competence. An important aspect of the pyramid is the strong empirical connection between the provision of quality services (process measures) and improvements in child development (outcome measures). Program Performance Measures Head Start has set forth twenty-four program performance measures grouped under the five program objectives (see figure 2). For each program performance measure, performance indicators specify how the measure will be assessed. Figure 3 shows a section of Head Start’s program performance measures matrix, which includes the objective, performance measure, performance indicator, data Effective Early Childhood Programs: The U.S. Head Start Experience 223 OBJECTIVE 1: Enhance Children’s Healthy Growth and Development. 1. Head Start children demonstrate improved emergent literacy, numeracy, and language skills. 2. Head Start children demonstrate improved general cognitive skills. 3. Head Start children demonstrate improved gross and fine motor skills. 4. Head Start children demonstrate improved positive attitudes toward learning. 5. Head Start children demonstrate improved social behavior and emotional well-being. 6. Head Start children demonstrate improved physical health. OBJECTIVE 2: Strengthen Families as the Primary Nurturers of Their Children. 7. Head Start parents demonstrate improved parenting skills. 8. Head Start parents improve their self-concept and emotional well-being. 9. Head Start parents make progress toward their educational, literacy, and employment goals. OBJECTIVE 3: Provide Children With Educational, Health, and Nutritional Services. 10. Head Start programs provide developmentally appropriate educational environments. 11. Head Start staff interact with children in a skilled and sensitive manner. 12. Head Start programs support and respect children’s cultures. 13. Head Start assures children receive needed medical, dental, and mental health services. 14. Head Start children receive meals and snacks that meet their daily nutritional needs. 15. Head Start programs provide individualized services for children with disabilities. OBJECTIVE 4: Link Children and Families to Needed Community Services. 16. Head Start parents link with social service agencies to obtain needed services. 17. Head Start parents link with educational agencies to obtain needed services. 18. Head Start parents link with health care services to obtain needed care. 19. Head Start parents secure childcare in order to work, go to school, or gain employment training. OBJECTIVE 5: Ensure Well-Managed Programs that Involve Parents in Decisionmaking. 20. Head Start programs are well-managed. 21. Head Start parents are involved actively in decisions about program operations. 22. Head Start programs employ qualified staff. 23. Head Start programs support staff development and training. 24. Head Start programs comply with Head Start regulations. Figure 2. Head Start’s Program Performance Measures, by Objective 224 Louisa B. Tarullo source, and 1997–98 data. The performance indicator for the first per- formance measure under objective 1, “Head Start children demon- strate improved emergent literacy, numeracy, and language skills,” is a change in the children’s emergent literacy, as measured by assess- ments of the children. A more process-oriented measure (not shown) for objective 3 (Pro- vide children with educational, health, and nutritional services) is “Head Start assures children receive needed medical, dental, and mental health services.” The performance indicator for this measure is the number and percent of Head Start children who received need- ed medical services as reported by the program. Progress on the indicators supporting each objective is being docu- mented in periodic reports. Data are obtained from agency resources such as Head Start’s program information report (PIR), regional office reports, and outcomes for classrooms, teachers, families, and children reported in Head Start’s Family and Child Experiences Survey. OBJECTIVE 1: Enhance Children’s Healthy Growth and Development Performance Performance measure indicator Data source 1997–98 Data 1. Head Start (HS) HS children’s Child Assessment 4-year-old HS children children demonstrate emergent literacy. (Woodcock-Johnson finishing the program had improved emergent Letter-Wood median standard scores of literacy, numeracy, Identification). 89.8 (compared with the and language skills. national mean of 100). HS children gained 1.6 points from fall to spring (no gain compared with norms). Woodcock-Johnson 4-year-old HS children Dictation. finishing the program had median standard scores of 88.1 (compared with the national mean of 100). In HS, children gained 1.5 points. In kindergarten, children gained 4.6 points. Figure 3. Sample of Head Start’s Program Performance Measures Matrix Effective Early Childhood Programs: The U.S. Head Start Experience 225 Head Start’s Family and Child Experiences Survey Head Start’s Family and Child Experiences Survey (FACES) is a central part of the program performance measures initiative. Through FACES, researchers are gathering comprehensive data on the cognitive, social, emotional, and physical development of chil- dren participating in Head Start; the characteristics, well-being, and accomplishments of families; the quality of Head Start classrooms; and the characteristics, needs, and opinions of teachers and other staff in Head Start. The survey provides data on a nationally representative sample of Head Start programs, centers, classrooms, children, and parents. The sample is stratified by three variables: region of the country (north- east, midwest, south, or west); urbanicity (urban versus rural); and percentage of minority families in the program (50 percent or more versus less than 50 percent). FACES includes six phases of data collection. The first phase (spring 1997) consisted of a field test of approximately 2,400 children and parents from a nationally stratified random sample of forty Head Start programs. The field test established the feasibility of large-scale interviewing of parents and assessment of children using selected in- struments. The test also provided valuable information on the status of Head Start programs, children, and families. The second and third phases (fall 1997 and spring 1998) consisted of data collection on a sample of 3,200 children and families in the same forty Head Start programs. The spring 1998 phase included assessments of children completing the Head Start program and of Head Start graduates completing kindergarten (a kindergarten field test). Data also were collected from interviews with parents and ratings by kindergarten teachers. The kindergarten cohort was subse- quently followed into first grade. The fourth phase (spring 1999) consisted of data collection in the forty Head Start programs and a follow-up of former Head Start chil- dren into kindergarten. The fifth phase (spring 2000) concluded the kindergarten follow-up of children who completed Head Start in 226 Louisa B. Tarullo spring 1999 and of first graders who completed Head Start in 1998. The sixth phase in spring 2001 completed the first-grade follow-up of children who completed Head Start in spring 1999. Continuing Head Start’s commitment to ongoing assessments using performance mea- sures, a new nationally representative cohort was selected for data collection beginning in fall 2000. Sampling 2,800 children and their families from forty-three new Head Start programs across the nation, FACES continues to examine child outcomes, program quality, and family well-being and achievements. Figure 4 presents the study design of FACES. Through the six phases, researchers have been able to assess the effects of Head Start by comparing children and their parents before (pre-Head Start) and after (post-Head Start) exposure to the program. Because of the full cooperation of the Head Start programs studied and the diligent fieldwork conducted by the research teams, the completion rates for FACES are high, averaging more than 80 percent on all survey measures. FACES: Findings The FACES data collected during fall 1997 and spring 1998 offer im- portant findings on the change in children’s growth and develop- ment, the consistency of classroom quality, and the characteristics and accomplishments of Head Start families throughout the 1997–98 year. Follow-up into kindergarten reveals important information on Head Start graduates’ performance in school. Key findings from 1997–98 are presented below. Does Head Start Enhance Children’s Healthy Growth and Development? Participation in Head Start can enhance a child’s growth and devel- opment. The data show the following: • The typical child completing Head Start possessed the early lit- eracy and numeracy knowledge and skills, as well as the social skills, that indicate a readiness to learn when the child reaches kindergarten and first grade. Effective Early Childhood Programs: The U.S. Head Start Experience 227 Figure 4. FACES Study Design: Samples and Data Collection 228 Louisa B. Tarullo • Head Start children showed significant gains in vocabulary and writing skills and in social skills during the Head Start year. The children showed little progress, however, in letter recognition and book knowledge. • During the year, the children’s play became more complex, and they became more involved in interactive play with peers—an indicator of social development. • Children who complete Head Start are “ready to learn,” as shown by the extent of their learning by the end of kinder- garten. By the end of kindergarten, Head Start graduates made substantial gains in word knowledge, letter recognition, math skills, writing skills, and phonemic awareness. Does Head Start Strengthen Families as the Primary Nurturers of Their Children? Participation in Head Start can strengthen families as primary nurtur- ers. The data indicate the following: • Primary caregivers (usually parents) were equally likely to be married or single. The typical caregiver was young (between 20 and 30 years of age), had at least a high school diploma or a graduate-equivalent degree (GED), and was employed. Despite the high proportion of caregivers in the workforce, 85 percent of the households participating in Head Start received supple- mental sources of income. • More than two-thirds of Head Start parents reported that they read to their children at least three to five times a week. Impor- tantly, the frequency of parents’ reading was linked to a child’s vocabulary scores, and children who were read to more often showed greater word knowledge at the end of the year. • Head Start parents cited significant accomplishments during the year. More primary caregivers were employed (an increase of 2 percent from fall to spring); 9 percent obtained a license, certifi- cate, or degree; and fewer received welfare assistance (a decline of 3.5 percent from fall to spring). Effective Early Childhood Programs: The U.S. Head Start Experience 229 • Head Start parents cited Head Start as an important source of support in rearing their child. They also reported a greater sense of control over their own lives at the end of Head Start than at the beginning. • Fathers appeared to play an important and positive role in the lives of children. When the father was not present in the home, the resources available to the family, both socially and financial- ly, were reduced. Families without fathers in the household were more likely to be exposed to violent crime or domestic violence. • Most parents were active in their Head Start program, and ap- proximately 80 percent had visited with Head Start staff in their home, attended a parent-teacher conference, and observed a classroom. • More than 85 percent of parents were very satisfied with the ser- vices their child received to help the child grow and develop, prepare the child for kindergarten, and identify and provide other services for the child. Does Head Start Provide Children With High-Quality Educational, Health, and Nutritional Services? The quality of Head Start services is good. Key indicators include the following: • The quality in Head Start classrooms has been consistently rated as good over three points of measurement by trained observers. In fall 1997, the average Early Childhood Environment Rating Scale (ECERS) score across Head Start’s 518 classrooms was good. Nearly one-fifth of the classrooms were rated as very good or ex- cellent, and no classroom was rated inadequate. These ratings compare favorably with those reported for other preschool and childcare programs. • The average numbers for both class size and child:adult ratios were far better than those required by Head Start’s program per- formance standards and the accreditation standards of the Na- tional Association for the Education of Young Children (NAEYC). 230 Louisa B. Tarullo • Most Head Start teachers have good teaching qualifications. Nearly one-third of all teachers had a bachelor’s or graduate degree, and teachers averaged nearly 12 years of teaching expe- rience. The educational level of teachers correlated with the quality of classrooms; that is, the higher a teacher’s educational level was, the better the classroom quality was. What Is the Link Between Classroom Quality and Child Outcomes? The observed quality of Head Start classrooms is linked to children’s outcomes. The data show the following: • Children in Head Start classrooms that had richer teacher–child interaction and more language learning opportunities had high- er vocabulary scores. Also, children in classrooms that had low- er child:adult ratios showed greater gains in vocabulary scores during the year. • Children in classrooms rated higher for their learning environ- ment materials spent more time in simple interactive play or pretend play and less time in noninteractive play. Conclusion The Head Start program performance measures initiative was launched in 1995. By 1999, Head Start had collected extensive infor- mation on its program’s performance. Through FACES, Head Start has accumulated data on the change in children’s performance dur- ing one or more years of participating in Head Start, the kindergarten progress of Head Start graduates, the quality and characteristics of Head Start programs, and the well-being and achievements of Head Start families. The data show that Head Start can enhance children’s growth and development; strengthen families as primary nurturers of children; provide high-quality educational, health, and nutritional services to children; and improve children’s outcomes. The performance data have proved useful for documenting the accountability of Head Start externally and for improving the Effective Early Childhood Programs: The U.S. Head Start Experience 231 program internally. During Head Start’s 1998 reauthorization, offi- cials were able to report to the U.S. Congress on the quality of Head Start programs and the knowledge and skills of children who com- pleted these programs. In addition, FACES data were presented to the Advisory Committee on Head Start Research and Evaluation, which was mandated and charged by the U.S. Congress to provide recom- mendations on the design of a study or studies to determine the na- tional impact of Head Start. FACES data also have been disseminated widely within Head Start. The data are used in continuing efforts to improve Head Start and to refine training and technical assistance. Researchers have presented FACES findings at national conferences of researchers and practitioners, including Head Start’s National Re- search Conference and meetings of the Society for Research in Child Development and the National Head Start Association. The data and findings reported are important evidence of the value of investments in early child development. Notes This chapter is derived from the third progress report on Head Start’s program performance measures initiative. The full report, referenced below, can be accessed at the following website: http://www.acf.dhhs.gov/programs/core. The FACES study is being conducted by Westat, Inc., Abt Associates, Inc., Ellsworth Associates, Inc., and The CDM Group, Inc. It is directed by the Commissioner’s Office of Research and Evaluation, Administration on Children, Youth, and Families, U.S. Department of Health and Human Ser- vices. The author represents a team of researchers who prepared this report, including: Nicholas Zill, Gary Resnick, Ruth Hubbell McKey, David Connell, Robert O’Brien, Mary Ann D’Elio, and Cheryl Clark. References Administration on Children, Youth, and Families. 2001. Head Start FACES: Longitudinal Findings on Program Performance. Third Progress 232 Louisa B. Tarullo Report. Washington, D.C.: U.S. Department of Health and Human Services. Goal One Technical Planning Group. 1991. The Goal One Technical Planning Subgroup Report on School Readiness. In National Education Goals Panel, ed., Potential Strategies for Long- term Indicator Development: Reports of the Technical Planning Subgroups. Report No. 91–0, pp. 1–18. Washington, D.C.: National Education Goals Panel. ———. 1993. Reconsidering Children’s Early Development and Learning: Toward Shared Beliefs and Vocabulary. Draft Report to the National Education Goals Panel. Washington, D.C.: National Education Goals Panel. Government Performance and Results Act (Public Law 103–62). 1993. Head Start Act, Section 641A(b), 42 U.S.C. 9831 et seq. 1994. Chapter 9 Elements of Quality in Home Visiting Programs: Three Jamaican Models Kerida Scott-McDonald Young children in poor Jamaican communities face overwhelming disadvantages of neglect, abuse, and inappropriate care owing to par- ents’ lack of knowledge, time, and resources as well as high emotion- al stress. The children are placed further at risk because the tradition- al supports of extended families have weakened and affordable programs offering compensatory benefits to parents and children are not available or are of poor quality. The outcomes of these two fac- tors, interacting cyclically over time, are dysfunctional families and new generations of children who become economically and develop- mentally deprived parents. In Jamaica, approximately one in every three children under the age of 4 (i.e., approximately 70,000 children) lives in poverty. Home- based early childhood programs represent perhaps the greatest hope for breaking the cycle of poverty in this country. International re- search confirms that high-quality early childhood services can make a vast difference in the lives of children and that these services have the most significant effect on those who are economically deprived. Jamaica has achieved commendable preschool coverage, reaching 85 percent of all 4–5 year olds, but opportunities for infants and chil- dren from birth to age 3 are extremely limited. Day-care coverage for this age group is currently low (approximately 14 percent), and most 233 234 Kerida Scott-McDonald programs are offered by private operators at rates far exceeding the capability of poor families. The government, which is faced with a crippling burden of debt and competing demands from the social sector, cannot be expected to support wide-scale expansion of center-based childcare. Also, for- mal day-care services can be considered inappropriate and irrelevant in rural areas having the greatest incidence of poverty and where mothers are most often unemployed or earning their living in and around their homes. Home visiting programs offer an important alternative in Jamaica for increasing the access of poor families to early childhood interven- tions and, ultimately, for building social capital. This chapter exam- ines elements of quality that may be useful benchmarks in delivering such programs. Three home visiting models currently operating in Ja- maica are reviewed to identify practices that appear to have con- tributed significantly to the success of the interventions. The three models offer the same basic ingredients of psychosocial stimulation for children as well as counseling, education, and parental support. The programs all serve children living in poverty, but each program serves distinctly different populations. The three programs are the: • Roving Caregivers Program, which serves the needs of children of teenage mothers and families • Community-Based Rehabilitation Program, which assists young children with disabilities • Malnourished Children’s Program, which addresses the nutri- tional and psychosocial needs of children admitted to the hos- pital for malnutrition. Together, these programs address the three main principles under- lying the Convention on the Rights of the Child (CRC)—survival, protection, and development. Any home visiting program considered for implementation on a national scale must give sufficient emphasis to each of these rights and goals for children. A brief overview of the three programs follows. Elements of Quality in Home Visiting Programs: Three Jamaican Models 235 Overview Roving Caregivers Program The Roving Caregivers Program (RCP) is a core initiative implement- ed under the Community and Home-Based Learning component of the government of Jamaica/United Nations Children’s Fund (UNICEF) Basic Education and Early Childhood Development Pro- gram. The objective of the initiative is to ensure development and expansion of effective and low-cost delivery of early childhood ser- vices to meet developmental needs of children ages birth to 3 years. RCP is a nonformal, multidimensional, integrated program of child development and parenting education. The basic ingredients in- clude childcare, environmental education, referral information, per- sonal development, skills training, and income generation. RCP is implemented by the Rural Family Support Organization (RuFamSo) in two rural parishes in central Jamaica. These parishes were identified as the pilot region for implementation of the govern- ment’s new policy on integration of early childhood education. Ru- FamSo, which has strong linkages with several development and in- ternational agencies, provides integrated services for families. Besides RCP, these services include the Teenage Mothers Project, Male Adoles- cent Program, Uplifting Adolescents Program, and Home-Based Nurs- ery Program. All programs, including RCP, are a spinoff of the initial Teenage Mothers Project. Initiated in 1992 as a joint effort with the Bernard van Leer Foun- dation, RCP is designed to assist high-risk families. Community child health clinics help target beneficiaries. RCP deploys a cadre of child development promoters to model stimulation activities in homes and to deliver parenting education messages. The caregivers (or rovers), who carry out their tasks on foot, are young secondary school gradu- ates recruited from the communities in which they live. Rovers are selected based on the recommendations of their former school princi- pals or guidance counselors. Depending on the proximity of the homes, interventions are organized for individuals and groups. 236 Kerida Scott-McDonald RCP has a strong training component. Rovers receive 1 week of preservice training and regular inservice training consisting of 1-day workshops every 2 weeks and 1-week courses every 3 months. The workshops are held to discuss issues and concerns related to visits, to review weekly plans, and to make play materials for stimulation ac- tivities. Home visits are monitored closely by project officers who conduct onsite supervisory visits every 2 weeks. Within approximately 6 years, RCP has expanded from fifteen to twenty-five districts and currently benefits 3,500 children ages birth to 3 years and 700 homes in approximately sixty communities. In 1998, under a government poverty eradication initiative, the roving caregivers model was successfully tested in an urban setting, in eleven depressed inner-city communities for the benefit of 1,300 children. Community-Based Rehabilitation Program The Community-Based Rehabilitation Program is part of the Dedicat- ed to the Development of the Disabled (3D) organization, which was established in 1985. 3D is committed to rehabilitation and integra- tion of persons with disabilities into their communities by teaching and assisting caregivers to help persons with disabilities function at their highest potential. The community program offers a range of ser- vices, including early stimulation for children at risk of developing slowly, early identification of disabilities, assessment of abilities, de- velopment of individual home plans to enhance a child’s abilities, group and individual parental counseling, psychoeducational assess- ments for school-aged children, and referrals to other agencies. The home-based program was initiated in one of Jamaica’s fourteen parishes and now operates in four parishes, serving approximately 1,000 families. The children benefiting from the program are from birth to 6 years old who exhibit significantly slow or delayed devel- opment in one or more areas of self-help, speech and language, and motor or cognitive behavior. Children are referred to 3D’s community program by parents, doc- tors, nurses, day-care centers, social workers, and school teachers. Elements of Quality in Home Visiting Programs: Three Jamaican Models 237 After referral, a complete assessment is conducted of the child using the Denver Developmental Screening Test. The child receives a com- plete medical examination and, after diagnosis, is placed in an inter- vention program administered by a child development aide. Based on the assessment, interviews with parents and community mem- bers, and observations in the home setting, the aide develops an indi- vidual child and home plan. When this groundwork is completed, the aide begins to guide parents in strategies for stimulation. Aides usually visit each child at least twice each month, beginning with weekly visits and then less frequently as the program progresses. Problems requiring an assessment by a specialist or a specific inter- vention are referred to other agencies. Each aide visits between twelve and twenty children each week and attends weekly case con- ferences with the project’s supervisor to discuss child program and teaching methods. Initial training received by the aides is reinforced in continuous in-service training. Malnourished Children’s Program The Malnourished Children’s Program was established in 1994 by the Child Development Research Group of the Tropical Metabolism Re- search Unit (now renamed the Tropical Medicine Research Institute, TMRI) of the University Hospital of the West Indies to address early deficiencies of children hospitalized for malnutrition. Before initia- tion of this outreach program, hospital personnel observed that many children who recovered and were sent home from the TMRI had to be readmitted for the same condition after a short time. To ad- dress this problem, TMRI pioneered intervention strategies to reduce the high readmission rate by conducting follow-up home visits to monitor children discharged from the TMRI. During each home visit, staff focus on stimulation, environ- mental factors potentially detrimental to the child’s health, and the child’s nutritional status and possible need for food supple- mentation. Parents of children admitted to the TMRI participate in an ongoing weekly program consisting of parenting education and a social welfare project. TMRI helps parents develop income- 238 Kerida Scott-McDonald generating skills, begin self-help projects, and find jobs or shelter. TMRI also provides food packages, bedding, and clothing for needy, unemployed parents. The parents are required to attend at least twelve workshops and, on completion, are awarded a certifi- cate of participation. In addition to individual home visits, TMRI operates a community outreach program at three locations in poor communities within the Kingston metropolitan area, which has a high prevalence of malnu- trition. This program includes regular psychosocial stimulation of children ages 3 and less, supported with a mobile toy-lending library. TMRI also has extended its parenting and child stimulation services to Jamaica’s only exclusive hospital for children, through a weekly program at the nutrition clinic. Home Visiting Programs: Elements of Quality Twelve elements of quality can be noted in the practices of the three model programs described above. These elements, which have con- tributed significantly to the success of the programs, are: 1. Linkage of childcare supports with family supports 2. Recognition of women’s multiple roles as mothers, homemak- ers, and income earners 3. Transfer of skills to the clients and households 4. Flexibility in service delivery 5. Acknowledgment of family configurations and building on ex- isting networks for children 6. Sustainability of the program play materials 7. Strong referral systems and access support 8. High staff retention 9. Documentation 10. Strong feedback and monitoring mechanisms 11. Research orientation leading to action 12. Proactive measures to ensure sustainability and institutional- ization. Elements of Quality in Home Visiting Programs: Three Jamaican Models 239 The findings and impressions presented below for each element are based on interviews with program directors, staff members, and recipients as well as observations of meetings, training sessions, and other interventions. For analysis, the author assumed that the stan- dards for program inputs were strongly related to the desired program outcomes, but made no attempt to establish direct connections be- tween inputs and outcomes. Linkage of Childcare Supports With Family Supports All three programs described above are based on the primary princi- ple that children cannot be assisted in isolation. The programs approach interventions on behalf of children from a holistic perspec- tive, by providing support to families while giving direct supports to children. As noted previously, RCP is a spinoff of the Teenage Mothers Proj- ect, which was established initially to address the problem of teen pregnancy (Jamaica’s rate of teenage pregnancies is 108 per 1,000, the highest in the Caribbean). The project was expanded to include other services when it was realized that the problem of teen mothers could not be addressed in isolation. RCP, the home visiting program, was initiated to overcome the limited effects of intervening with only the teenage mother and her baby. A demonstration nursery provides day care for children while teenage mothers attend academic and skill- training classes, as well as counseling and self-esteem-building ses- sions. Sessions for fathers of the babies and for grandmothers (the mothers of the teenage girls) are also available. This multilayered strategy involves the entire family network, and the program has had an almost 100 percent success rate in preventing second pregnancies among the teenagers. In the 3D program, both parents are required to participate in the intervention for their child with a disability. The roles of each family member are articulated in the home plan to encourage total support for the child. Also, in recognition of the importance of the wider community in influencing the development of the child, the aides work to build supportive relationships between families. 240 Kerida Scott-McDonald In the Malnourished Children’s Program, staff strive to increase the economic stability of families by identifying employment oppor- tunities and making job referrals for fathers. For each case, home vis- its facilitate ongoing identification of specific and interconnected so- cial, environmental, and economic needs of children and their families. Recognition of Women’s Multiple Roles as Mothers, Homemakers, and Income Earners A significant proportion of the households in Jamaica (45 percent) are headed by females. In addition, the participation of females in the labor force is low, amounting to only 10 percent of women, com- pared with 20 percent of males. Because of this double disadvantage, each program closely links childcare strategies to maternal care and support. In group parenting sessions, the following pertinent topics are addressed: referrals to antenatal clinics; promotion of breastfeed- ing, nutrition education, reproductive health, and environmental hy- giene and safety; and training and support for income-generating ac- tivities. In the 3D program, the sessions on reproductive health cover pre- natal and genetic counseling. Parenting sessions include emphasis on time management, to help mothers cope with the additional de- mands of children with disabilities. The Malnourished Children’s Program, which targets children whose survival and growth are par- ticularly at risk, places significant emphasis on income-generation opportunities for mothers. Staff attempt to match the interests and abilities of each mother with marketable skills. The program sponsors mothers to take advantage of skill-training opportunities in areas such as childcare, geriatric care, dressmaking, and hairdressing. Mothers with very low literacy levels receive practical in-house train- ing in areas such as setting tables, making beds, and relating to em- ployers, to prepare them for domestic work. The program also pro- vides tangible support to mothers who wish to buy and sell food or goods, buying these items in bulk and offering them to mothers at significantly reduced prices. Elements of Quality in Home Visiting Programs: Three Jamaican Models 241 Transfer of Skills to Clients and Households The three home visiting programs emphasize the empowerment of parents and the transfer of skills to their households through trained and monitored outreach workers. In RCP, parents are selected as par- ent group leaders for income-generating projects, thus building lead- ership skills, confidence, and self-esteem. Roving caregivers model stimulation activities for children with the expectation that parents will continue these activities between visits. Involving parents direct- ly is a significant challenge initially because the rovers’ visits are fre- quently viewed by parents or caregivers as opportunities to gain child supervision so that they can attend to household chores. However, the program emphasizes the guiding of parents in strategies for in- cluding stimulation-type activities in routine household tasks. In the Malnourished Children’s Program, parents are selected as play leaders for group stimulation sessions, and outreach workers ob- serve and guide these activities. Parents also are asked to lead food- preparation demonstrations using cooking equipment traditionally found in their homes. In the 3D program, clients who demonstrate particular coping skills are selected and trained to become communi- ty rehabilitation workers. This strategy, which relies on the total transfer of skills, helps sustain and strengthen the gains of the overall program. Flexibility in Service Delivery A positive characteristic common to all the programs is flexibility in implementation. For example, RCP implemented stimulation activi- ties initially in individual homes, but subsequently modified this ap- proach for homes in close proximity (e.g., communal dwelling units consisting of several homes) to conduct activities in shared spaces within yards. This adaptation yielded an additional benefit because messages about child development reached many other adults in ad- dition to those officially participating in the program. The children are grouped by age, and they benefit from social interaction during stimulation activities. When homes are more distant, RCP continues with individual home visits. 242 Kerida Scott-McDonald In the 3D program, homes are far apart and clients convene in health centers. In the Malnourished Children’s Program, visits are conducted in high-density areas in suitable and available spaces (e.g., community centers, basic schools, under trees). Basic schools are community-operated and government-subsidized preschools catering to children ages 4–5 and providing a high level of coverage (approxi- mately 95 percent) of the age cohort. Maintaining flexibility in the organization of programs helps en- sure that they are adapted to local conditions and meet the needs of staff and the circumstances of parents and communities. The pro- grams also demonstrate flexibility in the type of assistance provided to families (i.e., the content of service delivery). All the programs ac- knowledge that families and children differ in their needs and stage of development and that the delivery of services and the types of sup- port must be customized to accommodate these differences. For example, the Malnourished Children’s Program supports a va- riety of income-generating activities, based on the particular strengths or circumstances of the adults, rather than a predetermined group activity for all. In the 3D program, each home plan, which guides the interventions provided, is designed based on an assess- ment of that family’s circumstances. Acknowledgment of Family Configurations and Building on Existing Networks for Children Child-shifting and alternate caregiving are commonplace in Jamaica. Rural-to-urban migration is common, and approximately 20,000 in- dividuals emigrate from Jamaica each year. As a result, the variety of family configurations is myriad and the support networks for chil- dren are complex. All three programs make a strong effort to identify primary and secondary caregivers and to work with these persons interchangeably. RCP regularly involves significant others in its stimulation and par- ent education activities. The 3D program’s strategy incorporates a child-to-child approach, particularly when mothers work outside their homes and the intervention depends on the participation of Elements of Quality in Home Visiting Programs: Three Jamaican Models 243 siblings. In the Malnourished Children’s Program, parents are asked to bring neighbors to the TMRI for training so that these individuals can sustain the children’s activities when the parents are absent. Sustainability of the Program Play Materials The application of child development knowledge in a program’s prac- tices is a major determinant of quality for any early childhood inter- vention. For example, the fact that young children learn most effec- tively through experiential play is now firmly established. To grasp basic concepts and to develop sensory and motor systems, young children need a variety of concrete, hands-on materials. However, providing a continuing and adequate supply of learning materials is a major challenge for early childhood programs in devel- oping countries such as Jamaica. Although many early childhood ac- tivities can be done with items from the natural environment, some learning materials must be specially made. When there is no source of these materials locally, center-based programs must import items at great expense and then replenish them frequently as stocks dwin- dle or become worn. A positive characteristic of all three home visiting programs is their emphasis on strategies for sustaining stimulation and other program materials. In RCP, outreach workers encourage use of household items and construction of stimulation materials. They spend part of their biweekly sessions making toys for upcoming vis- its, and parents are taught to make toys in parent group sessions. Still, maintaining a sufficient supply of materials for the number of households visited is difficult. In addition, some of the materials that are made are not durable, and the costs to replace them are high. Also, certain materials, to support children’s manipulative skills, cannot be made easily by the rovers. To resolve this problem, RCP is establishing a small-scale production facility for materials de- velopment, linking the production of toys to the training of out-of- school youth in marketable skills. The Malnourished Children’s Program hires a person to make toys for the mobile toy-lending library. Students from a national technical 244 Kerida Scott-McDonald and vocational training program and parents also help make toys. In a continuing collection drive, community-based factories and entre- preneurs are asked to donate “trashables” (e.g., cardboard, tins, cloth scraps, wood ends). In the 3D program, parents are taught to make toys as well as adaptive aids, which can be prohibitively costly for poor families. Strong Referral Systems and Access Support Another common strength of the programs is their use of available community and other resources and infrastructure to support opti- mal child development. Recognizing their respective advantages and limited capacities, they draw heavily on other services (e.g., child health clinics, the public health department, the Food-for-the-Poor organization, the women’s crisis center, the Jamaica adult literacy program) to meet multiple needs of families. The programs enhance the awareness of clients about these services and provide practical support to facilitate access to them. For example, the Malnourished Children’s Program will pay for a multiparous woman to receive tubal ligation, if desired, at the family planning unit. The 3D organization will provide transportation for clients to access alternative services, and parent leaders will accompa- ny clients on their first visit to these services. The organization also acts as a referee to enable clients to access benefits offered by credit unions or insurance programs. Building on existing social systems is a key strategy for all three programs. Their experience demonstrates that information, by itself, is not sufficient and that active referrals are needed. Families living in poverty with children at risk need help to seek help. High Staff Retention Stability of staffing is another element of quality observed in the three home visiting programs. The administrators of these programs recognize that job satisfaction helps ensure staff stability which, in turn, is a prerequisite for staff growth and development. In RCP, out- reach workers matriculate into the program directly from secondary Elements of Quality in Home Visiting Programs: Three Jamaican Models 245 schools and generally stay for approximately 3 years, leaving to ex- plore new career opportunities. Their average 3-year tenure enables the program to benefit from their accumulated knowledge and expe- rience, in the delivery of home visits and the modeling of program delivery for new recruits. In the 3D program, outreach workers most often begin as benefi- ciaries and stay in the program for an average of 10 years. The fact that the employee’s own children benefit from the program is a main incentive for staying. Other incentives include opportunities for pro- fessional and self-development, as well as guaranteed benefits of em- ployment, such as health insurance. Documentation Each home visiting program strongly emphasizes documentation of processes and materials utilized in the program. This documentation is an effective strategy for ensuring continuity. In RCP, weekly activi- ty guides are prepared to guide rovers in child stimulation and par- enting education during home visits. These guides are placed in an activity “bank” that is drawn from and built on over time. In addi- tion, a video documentary that describes the program has proven useful for training new caregivers and informing potential donors about the scope and nature of RCP. The 3D program has established an entire documentation unit that includes cameras and video-editing facilities. This unit has documented the 3D training program in twelve videos with accom- panying written material. Leaflets describing the program have been produced for distribution, and assessment tools have been developed to determine and record the children’s developmental levels. The Malnourished Children’s Program has published book- lets to reinforce workshop topics and has compiled manuals on making toys. To build on and strengthen the documentation of each of these programs, UNICEF is supporting development of a home-visiting manual. The hope is that this manual could be used as a national guide for home visiting early childhood programs. 246 Kerida Scott-McDonald Strong Feedback and Monitoring Mechanisms Closely related to maintaining standards in any program is having a well-organized and meaningful system of feedback and monitor- ing. Such a system is well-established in each of the three programs and deserves to be highlighted as an important element of quality. In RCP, full-day feedback sessions are held every 2 weeks to review progress in the home visits, discuss strategies for overcoming emerging problems, and highlight and reinforce positive experi- ences. In addition, project officers accompany rovers at specific intervals to provide supervision and guidance onsite. The Malnour- ished Children’s Program’s monitoring component is similar ex- cept that feedback and planning sessions are held weekly and progress is recorded in a written logbook. In the 3D program, a case file is established for each child and the cases are reviewed weekly to discuss each child’s progress. In addition, all staff are required to contribute to an evaluation meeting, held quarterly. Monitoring in this program is based on the “manpower model,” which consists of a community-based rehabilitation coordinator who oversees the work of supervisors who, in turn, oversee community rehabilita- tion workers. Research Orientation Leading to Action All three home visiting programs are experimental or extensions and improvements of innovative programs that are testing new methods and materials for accomplishing their missions more effectively. Sig- nificantly, each program places heavy emphasis on research as part of its agenda. This research has helped to validate the programs and to justify further funding, as well as providing useful information for guiding practice. In two programs, the research is being used to sub- stantiate the government’s taking the programs to scale. In RCP, the development of the children has been assessed using an internationally recognized instrument, and a tracer study was con- ducted on children in primary school 12 years after the RCP interven- tion. The effect of training on the knowledge of roving caregivers also has been evaluated. Elements of Quality in Home Visiting Programs: Three Jamaican Models 247 Research conducted in the 3D program to validate an identifica- tion and assessment instrument (The Ten Question Screening Tool) has led to utilization of this tool by paraprofessionals in several devel- oping countries. Recent research on community attitudes, which showed that neighbors are more likely to respond supportively if a family demonstrates strong acceptance of a child with a disability, stimulated revision of the program’s strategies. Internationally recognized research on the effects of food supple- mentation and stimulation (Grantham-McGregor and others 1991), conducted in the Malnourished Children’s Program, supports the concept that psychosocial intervention can compensate for deficits associated with early malnutrition. Researchers in the program have conducted a longitudinal study of children from the program who are now 20 years old. More recently, research on the reasons for hos- pital readmission of children with malnutrition has led to a refining of program strategies, which has resulted in the end of readmissions for children participating in the program. Proactive Measures to Ensure Sustainability and Institutionalization Sustainability is a critical and most-sought-after component of in- tervention. A strong element of quality in the programs has been their proactive orientation toward securing sustainability and insti- tutionalization. In particular, two of the three programs have as- sumed a role in mainstreaming their innovations. These programs planned strategically for various phases of their life cycle. From suc- cessful, small pilot projects operating on a trial-and-error basis, they moved through expansion and replication, during which services increased in scope and coverage. In this second phase, much net- working was undertaken to increase the awareness of stakeholders about the programs’ products and processes and to secure partner- ships for sustainability. For example, RCP established linkages with Jamaica’s Social Devel- opment Commission, the national coordinating agency for com- munity development and the government’s poverty eradication 248 Kerida Scott-McDonald program. RCP also asked the public health department to help with education and training of parents; various church groups to provide leadership; and other organizations and private entities to provide fi- nancial or in-kind contributions. In some cases, this networking was informal and one-to-one. In addition, RCP’s advisory board held sev- eral consultation workshops with stakeholders and circulated the proceedings widely. In a third phase, programs are attempting to transfer their mod- els beyond the previous controlled conditions and to test their strategies in more realistic operating venues in existing programs and services. Through strong advocacy, RCP has secured govern- ment support to extend its coverage by using National Youth Ser- vice workers to implement the program in one of seventeen early childhood resource centers. Similarly, in one parish, the 3D pro- gram is conducting a pilot project utilizing government workers to deliver its services. The Challenges Remaining Figure 1 provides an overview of the three home visiting programs re- viewed in this chapter. Although these programs exhibit twelve criti- cal elements of quality for early childhood interventions, many ques- tions, challenges, and concerns remain and need to be addressed thoughtfully. Key issues include: • Avoiding a “hand-out mentality” which measures a program’s worth by the food or other tangible benefits distributed • Ensuring sustainability of food contributions • Addressing the power and status of women and men • Balancing the tension between promoting children’s rights and respecting cultural beliefs and practices • Ensuring provision of reinforcing public educational messages • Devising strategies for increasing a program’s coverage while maintaining quality. Elements of Quality in Home Visiting Programs: Three Jamaican Models 249 Program Roving 3D Community-Based Malnourished Description Caregivers Program Rehabilitation Program Children’s Program Implementing Rural Family Support Dedicated to the Tropical Medicine agency Organization (RuFamSo) Development of the Research Institute, Disabled (3D) Organization University Hospital of the West Indies Start Date 1995 1985 1994 Population Poor families: Families of children with 60 admitted per year 250 Homes disabilities (~1,000) Children 3 months to 750 Children 3 years Children birth to 3 years Services Psychosocial stimulation, Training of families to Psychosocial stimulation, counseling, parental stimulate/teach life skills counseling, parental education and supports, Early identification/ assess- education and supports income generation ment of ability/disability Group stimulation and Teenage Mothers Project Individual home plan parent sessions in Male Adolescent Program Individual/group parent communities counseling Mobile toy-lending library Medical clinics Linkage of Childcare Supports With Family Supports Demonstration nursery for Both parents required to Assistance with income children attend clinic generation and job Academic and skill training Family roles defined to referrals classes for teen mothers support child Recognition of Women’s Multiple Roles as Mothers, Homemakers, and Income Earners Promotion of reproductive Fertility management Matching mothers and health and family planning Prenatal and genetic skills Home hygiene and safety counseling Supporting mothers via Training and support for Time management sponsored attendance income generation at other programs and in-house training Transfer of Skills to Clients and Households Parents selected as parent Majority of community Parents selected as play group leaders rehabilitation workers leaders are parents Parents lead food demonstrations Flexibility in Service Delivery Distant homes: one-to-one Distant homes: clients High-density areas: Close homes: group visit convene in health centers visits conducted in community centers, basic schools, and under trees continued Figure 1. Overview of Three Home Visiting Programs in Jamaica 250 Kerida Scott-McDonald Program Roving 3D Community-Based Malnourished Description Caregivers Program Rehabilitation Program Children’s Program Acknowledgment of Family Configurations and Building on Existing Networks for Children Involvement of grand- Involvement of siblings and Working mothers bring in mothers schoolchildren caregivers and neigh- Child-to-child bors for training Sustainability of the Program Play Materials Parents taught to make Parents taught to make and Person hired to make toys simple toys in parent use adaptive aids for mobile toy-lending group sessions library Youths in Male Adolescent Parents and technical and Program make toys vocational students help make toys Collection drive Strong Referral Systems and Access Support Child health clinics Psychological assessments Women’s crisis center Housing trust Jamaica adult literacy National insurance program program Food-for-the-Poor Family planning unit Credit union High Staff Retention Rovers remain 3 years, Community rehabilitation on average workers remain 10 years, on average Incentives and professional development opportunities Documentation Weekly stimulation guides Documentation unit Booklets to reinforce Video documentary Training program docu- workshop topics Home-visiting manual mented in twelve videos and written packages Leaflets and assessment tools Strong Feedback and Monitoring Mechanisms Workshops biweekly Case file for each child Logbook Supervision onsite Weekly case review Timetable for visiting Quarterly evaluation of discharged children child’s progress Weekly feedback and “Manpower model” planning sessions Supervision onsite continued Figure 1 (continued). Overview of Three Home Visiting Programs in Jamaica Elements of Quality in Home Visiting Programs: Three Jamaican Models 251 Program Roving 3D Community-Based Malnourished Description Caregivers Program Rehabilitation Program Children’s Program Research Orientation Leading to Action Developmental assessments Research to validate identifi- Longitudinal studies Tracer studies of children cation and assessment Research to determine Evaluation of impact of tool reasons for readmis- training on rover’s Research on community sions knowledge attitudes Mix of interventions for greatest effect Proactive Measures to Ensure Sustainability and Institutionalization Advocacy by advisory Pilot project in one parish board to train government Consultations with stake- workers to deliver program holders Figure 1 (continued). Overview of Three Home Visiting Programs in Jamaica The greatest overall challenge for the home visiting programs is to ensure full institutionalization. As part of its new policy on the inte- gration of early childhood (day-care and preschool) services, the Ja- maican government is grappling with whether and how it should take an early childhood home visiting program to scale. In light of the new policy, UNICEF is supporting an in-depth, strategic review of Jamaica’s national early childhood program. This assessment in- cludes a study of the feasibility of taking the home visiting model(s) to scale. UNICEF will be examining financial projections, targets and strategies, and existing structures, as well as the possibility of ex- panding the role of community health aides, deployed by the Min- istry of Health, to include child development and early stimulation activities with health and nutrition services currently delivered to families. To introduce a home visiting program on a national scale, regard- less of the model or combination of models used, and to ensure that the economic returns on scarce resources are maximized, a well- structured system for targeting children, families, and communities 252 Kerida Scott-McDonald needs to be developed. Information will be needed for determining the status of children, families, and communities in order to identify areas of greatest need and areas least likely to meet the needs without intervention. Clearly, general improvements in child survival, growth, and development depend on improvements in the home and in the community that shelters, nourishes, socializes, and protects a young child. Linking early childhood home visiting programs with more general community-based initiatives and social investments, which involve attention to community conditions and development of social infrastructure (e.g., supports for breastfeeding, nutrition, safe water, shelter) is critical. Some might argue that social institutions in developing countries such as Jamaica do not have the capacity to incorporate such inter- ventions, but accepting this notion would be fatalistic. High-quality programs for young children living in poverty have demonstrated, more than any other innovation, the ability to narrow the gap be- tween rich and poor and to break the intergenerational cycle of poverty. However, formal programs in childcare centers and professional interventions have proven to be too expensive for poor families and, in many cases, culturally irrelevant or insensitive to family needs. As signatories to the CRC, national governments are bound to the examination of alternative strategies for assisting families in childrearing. Article 18 of the CRC outlines the state’s respon- sibility as follows: to “render appropriate assistance to parents/ guardians for childrearing and develop institutions, facilities, and services for childcare.” Home visiting programs such as those de- scribed in this chapter must be included among the social services provided for poor families. The link between early child develop- ment and poverty is well understood, and the maximum effective- ness and sustainability of efforts on behalf of children depend on direct parental involvement. Elements of Quality in Home Visiting Programs: Three Jamaican Models 253 Conclusion The home visiting programs reviewed in this chapter combine deliv- ery of services to children, caregivers, and communities by providing stimulation and play activities, education and support of parents, promotion and organization of community involvement, and refer- ral to agencies that offer educational, health care, economic, and oth- er opportunities and support for children and adults. The approaches supporting early child development, particularly for children ages birth to 3 years, are comprehensive, holistic, and complementary. They incorporate, as noted, twelve essential elements of quality that should be part of any home visiting early childhood program. The great challenge remaining for these three programs and con- cerned stakeholders is the mainstreaming of the programs within the nation’s delivery of social services by the governmental sector, the nongovernmental sector, or a combination of both through creative partnerships. Because of competing social demands and limited re- sources, the home visiting programs will need to be examined care- fully for their fit with the range of family needs and the intervention strategies, services, and personnel available. References Grantham-McGregor, S.M., C.A. Powell, S.P. Walker, and J.H. Himes. 1991. Nutritional Supplementation, Psychosocial Stimulation, and Mental Development of Stunted Children: The Jamaica Study. Lancet 338:1–5. Part IV The Private Sector’s Influence on the Public Sector Chapter 10 Role of the Private Sector in Early Child Development Robert G. Myers The private sector has an important and significant role to play in improving the development of young children. This chapter pre- sents a framework for discussing the private sector’s potential con- tributions and highlights specific ways for this sector to contribute. The chapter is organized into four sections: clarification of the con- cept of early child development (ECD) and reasons for supporting ECD; definitions of the private sector; review of the sometimes- conflicting reasons for advocating private versus public care and education; and suggested ways of increasing the involvement of the private sector, especially companies and individuals, in sup- porting early childhood activities. Key points are summarized in the conclusion. Early Child Development The concept of ECD includes terms such as early childhood, child de- velopment, childcare, and early education. Although often used in distinct ways, these terms, together, convey the essence of ECD. Ap- preciating the substance of ECD is important when considering the reasons for supporting ECD and the implications for private-sector involvement. 257 258 Robert G. Myers Definitions In this chapter and volume, early childhood encompasses the period from conception until entry into school at about age 6 or 7. The peri- od may be extended through ages 7 and 8 when designing ECD pro- grams, to include the articulation between preschool programs and grades 1 or 2 of primary school. Early childhood is the period when the brain develops almost to its fullest and when humans learn to walk and talk, begin to establish moral foundations, gain self-confi- dence, and develop a general world view. This early period provides the foundation for later living and learning. Child development is a multifaceted, integral, and continual process of change as children become able to handle ever-more-complex lev- els of moving, thinking, feeling, and relating to others. Physical, mental, social, and emotional development occurs as a child interacts with his or her surrounding environments—the family, community, and broader society. Childcare consists of the actions taken by caregivers in the home or a nondomestic setting to ensure children’s survival and to promote their growth and development. Good care responds to children’s ba- sic physical, mental, social, and emotional needs, determined biolog- ically and by the cultural and socioeconomic context and environ- ment. Too often, childcare is considered narrowly as custodial care that provides only protection and the fulfillment of biological needs, without regard for children’s mental, social, and emotional develop- ment. Also, the needs of caregivers, as well as children, are important considerations when discussing forms of care. For example, some- times, parents’ needs take precedence over children’s needs when choosing among childcare options. Early education, or early learning, is the process of acquiring knowl- edge, skills, habits, and values through experience, experimentation, reflection, observation, and/or study and instruction during early childhood. Education is a crucial part of child development and in- volves a gradual unfolding of biologically determined characteristics. Unfortunately, early education is often associated narrowly with Role of the Private Sector in Early Child Development 259 mental development occurring in preschool centers which, as their name implies, are designed to prepare children for success in school, giving little attention to broader developmental needs or care. Although often labeled and organized separately, childcare and early education programs should offer the same basic program ele- ments to help children develop their maximum potential. Childcare programs must meet parents’ as well as children’s needs, and there- fore may have different hours of operation than early education pro- grams; however, the basic attention given to the children should be the same. In the discussion below, the terms “early childcare and development,” “early childhood education and care,” and “ECD” are used interchangeably. Why Support ECD Programs? Common sense and scientific findings suggest that the early years of childhood are critical for formation of intelligence, personality, and social behavior and that a child who develops well during these years will have greater opportunities in life, be more productive, and, very likely, be a better citizen. The reasons why societies should want to invest in ECD have been elaborated elsewhere (e.g., Myers 1995). Some of these reasons may resonate more than others in particular groups and settings. Six arguments for ECD are, in brief: 1. Human Rights. Children have a right to live and develop to their full potential. The United Nations Children’s Fund (UNICEF) and other international organizations supported by local hu- man rights organizations have vigorously promoted this posi- tion, based on the near-universal signing of the Convention on the Rights of the Child, which includes the right to healthy de- velopment. However, some governments do not find this argu- ment for supporting early childhood programs particularly compelling. 2. Moral and Social Values. Humanity transmits its values through children, beginning in infancy. This argument will be forceful for those who believe that core values are being lost and/or that 260 Robert G. Myers the particular values of their cultural group are not represented adequately in a homogeneous system of childcare and educa- tion supported by government. 3. Economic Productivity. Society benefits economically from im- proved early development by greater productivity in later life. This argument may be attractive to governments and business- es concerned about economic growth and competing in a world economy. However, as suggested later in this chapter, the general economic benefit and the chain of effects from ear- ly childhood through schooling to greater economic produc- tivity may not convince private companies to invest in ECD (versus, for example, investing in secondary or technical edu- cation). Potentially more convincing for many employers is the notion that childcare programs may free up women to work and thereby increase the immediate availability of an im- portant source of labor. 4. Cost-Savings. Investments in ECD are preventive and can reduce later needs for, and costs of, social welfare programs, remedial school programs, healthcare, and judicial and criminal services (Schweinhart and others 1993). This argument should be par- ticularly attractive to governments, but may not be to private businesses or individuals because the immediate private (versus social) benefit to the firm or person may not be great or evident. Private decisions do not usually incorporate social externalities. 5. Program Efficacy. The efficacy of health, nutrition, education, and women’s programs can be improved by combining these pro- grams with ECD. Combined efforts result in enhanced interac- tive effects among health, nutrition, and early stimulation. From the perspective of industry and commerce, childcare pro- grams may be good investments because workers (especially women) will lose less worktime due to child-related concerns. 6. Social Equity. Providing a “fair start” may help modify distressing socioeconomic and gender-related inequities. This argument will appeal particularly to governments and nongovernmental Role of the Private Sector in Early Child Development 261 organizations concerned with creating a more equitable society and to groups that have not had equal access to services. For in- dustry, this argument may have to be linked to the notion of achieving greater social stability (a climate in which companies can operate with greater security) and to the altruistic values of company managers (which may also have an economic payoff because a company will be viewed as socially responsible). Backed by scientific studies, this combination of social arguments should be compelling to governments and social organizations. How- ever, the arguments may not be convincing to private firms or indi- viduals because of the lack of a direct, private payoff. If governments do not act, the potential social benefits offered by ECD programs to the general population (e.g., crime reduction and related judicial costs) would be lost. Implications for the Private Sector Much discussion of private-sector involvement in education has been focused on higher and secondary education, with only some atten- tion given to primary schools. Although parts of this broad discus- sion are pertinent to ECD, discussion of private-sector involvement in early childhood programs must differ for several reasons in addi- tion to the obvious difference in children’s ages. Four characteristics of ECD are particularly pertinent to discussion of private-sector in- volvement in this arena. These are the evolution of the field of early childhood education, the breadth and the selective nature of educa- tional systems, and the “tension” between ECD and women’s work. Evolution of the Field Early childhood education is at a different stage in financing, opera- tion, and public-private control than other educational levels. Prima- ry school education, for example, has become largely a public re- sponsibility throughout the world, although this has not always been the case. Until the late nineteenth century in Europe, for exam- ple, religious organizations dominated in the provision of primary 262 Robert G. Myers schooling, a trend that seems to be mirrored currently for early childcare and education in many countries. In contrast, childcare and early education for healthy develop- ment of young children is essentially a private-sector responsibility, particularly in the developing world and especially for children under age 4. Mangenheim (1999) shows that the private-sector bias in early childcare and education also is characteristic of the United States. In many parts of the developing world, care and education during a child’s early years continue to be almost exclusively the responsibil- ity of the family, with relatively little financial support from govern- ment. And, a large proportion of formal and informal childcare and early education programs are operated by nongovernmental, and of- ten religious, organizations. In most countries, preschool education is not obligatory or universal, and governments therefore are not con- cerned legally with educational support at this level. This situation is similar to that for upper secondary and higher education, although the tradition of public involvement at these levels is much longer than for ECD. There are, of course, important exceptions to the dominance of the private sector, broadly defined, in attending to young children. Preschool for children during the year immediately preceding entry into primary school has become obligatory in some countries. And, Latin America has a growing number of governmental educational programs for young children, reaching down to age 4 and some- times age 3. In Europe, the public sector is deeply involved in supporting childcare and early education by a variety of strategies. In socialist countries, an intense governmental effort was made previously to fund and operate programs for young children, but much of this work has been undone with the shift of political and economic policies during the 1990s. In India, a very large num- ber of children benefit from the public Integrated Child Develop- ment Service. In countries where the private sector is already dominant in ECD and early education, “privatization” may not be the main issue. In- stead, the task may be to identify ways that the private sector can Role of the Private Sector in Early Child Development 263 help parents to educate their children, can improve existing child- hood programs operated within the private sector, and can partner with government to improve access to, and quality of, ECD programs financed and administered by government. In some countries, the concern may be how to make early childhood programs more public and how to involve governments in a field they have been reluctant to enter. Breadth Most discussions of private-sector education have focused on chil- dren’s participation in schools and what they learn there. However, early development and learning mostly occur outside schools in oth- er educational and learning environments such as the family and community. Because development occurs as children interact with their environment(s), programs to improve early child development must encompass complementary strategies linked to the different en- vironments that surround a child (Bronfenbrenner 1979). These strategies (Myers 1995) include: • Attending to children in centers outside the home (creating an alternative environment for care and education) • Educating and supporting parents, focusing on the home envi- ronment • Supporting child-centered community development programs, focusing on changing the general conditions that affect child development in communities • Strengthening the capacity of social institutions created to attend to children and families (in centers, homes, or com- munities) • Advocating and legislating creation of a better policy and legal environment for programs. The private sector can be involved in many more ways of improv- ing early child development than by operating early childhood cen- ters or providing resources to organizations that operate centers. 264 Robert G. Myers Selectivity As children ascend in the educational system, they grow older and become a more select group socially and economically, particularly in the developing world. As they age, they also approach and then pass the legal age for entering the formal labor force. Through selection, the families of children who remain in the educational system are more likely to be able to pay for their child’s education. Children from low-income families are more likely to be selected out of the system, and children who remain come from families with more re- sources. Also, children who remain are usually more able and more qualified than others for a position that will pay well after they com- plete school, making loans for education a feasible option. From the perspective of the corporate sector, investing in these more-select children may make sense because companies will need a well-qualified workforce, especially in this time of globalization. These same conditions of selectivity, linked to age and labor-market availability, are less applicable to discussions of children during their first 5 or 6 years of life, even though many young children in the de- veloping world work at a very early age. Tension Between ECD and Women’s Work Early childhood programming is at the intersection of education and care, and it relates directly to a tension in allocating women’s time between children’s development and women’s work. Although, in theory, this tension applies to both parents, most societies continue to assign women the almost exclusive role of caregiver, hence, the phrase “women’s work.” Because care is part of ECD, the discussion of ECD extends well beyond the boundaries of educational institu- tions and budgets to include other parts of public bureaucracies and home care by parents or others. Discussion of ECD programs also in- cludes not only their effects on children’s performance and produc- tivity in school and later life and work, but also the family members’ (especially mothers’ and older sisters’) earning and learning power as potential contributors to the labor force. This potential tradeoff be- Role of the Private Sector in Early Child Development 265 tween care and participation in the labor force recedes in importance as children mature and enter higher levels of education. The Private Sector Different meanings applied to the term “private sector” color and sometimes derail discussions of ECD. Failing to clarify the meaning of private sector can compromise discussions, because different orga- nizations and individuals have different vested interests in the out- comes of early care and development, the types of resources they can offer, and their organizational ways. Definitions At a very general level, “private” connotes that which belongs to spe- cific and separate individuals or groups, whereas “public” refers to goods and concerns held in common. Presently, “public” is usually equated with a government’s statements and roles as representative of a people’s common concerns. Hence, a contrast is often made be- tween the private sector and the governmental sector. The tendency to equate “public” with “governmental,” however, may contradict the original meaning of the word public. When a government truly represents a people’s concerns, it may accurately be termed a “public” institution. However, in a dictatorship, the concerns of the govern- ment may or may not be public concerns and the people have no ownership or control of the government. During the twentieth century, the role of governments in provid- ing education increased rapidly, particularly at the elementary school level. Education (and schooling) came to be viewed as a public good that should be provided free of charge, often within the framework of a welfare state. During the past two decades, however, the welfare state has been challenged and initiatives to “privatize” social services, including education, have arisen. Figure 1 presents the various dimensions of the private sector as re- lated to early childcare and education. In many discussions, these di- mensions are combined to represent the private sector, which is 266 Robert G. Myers viewed as everything that is not governmental or everything “outside government” (van der Gaag 1995). The figure demonstrates that a broad definition which contrasts the private and governmental sec- tors encompasses organizations established explicitly to provide ser- vices and products that may or may not be educational. The private sector broadly includes profit and nonprofit institutions, religious and nonreligious institutions, nongovernmental organizations (NGOs), community groups, and private voluntary organizations (PVOs). Both organizations and individuals are included. In some discussions, the definition of private sector as related to early childcare and education is limited to private care and education services provided directly by businesses or social groups (column 2, rows A and B). In others, the definition is focused on all activities (row A, columns 1 and 2) conducted for private profit by only the business community. The distinction between organizations that are directly involved in care and education (column 2) and those that are not (column 1) helps clarify discussions about “privatization” versus “involving the Noncare/noneducation Care/education products Dimension purposes and products (services, training, materials) (column 1) (column 2) A. Business organizations Large organizations Steel company, bank Kindercare Medium or small organizations Shoe repair shop Home daycare center B. Social organizations Community groups Local women’s group Women’s group care center NGOs/PVOs Churches Religious group Religious preschool Philanthropies General foundation Childcare foundation C. Private individuals Adults without children Mother in home, tutor NGOs, Nongovernmental organizations; PVOs, private voluntary organizations. Figure 1. Dimensions of the Private Sector as Related to Early Childcare and Education Role of the Private Sector in Early Child Development 267 private sector.” Whereas privatization involves the shifting of owner- ship and operation (and sometimes financing) from governmental to nongovernmental organizations or individuals (that is, into column 2), “involving the private sector” suggests a broader search for ways to involve private institutions and individuals that are not already di- rectly involved in programs of care and education; emphasis is placed on column 1, but the concept pertains to all parts of the figure. In- volving the private sector may consist of finding ways to: • Shift institutions and individuals from column 1 to column 2 as owners, operators, or caregivers (i.e., privatizing), or • Capture resources from all parts of the private sector that could be used by public or private institutions for care and education to improve child development. The advantages and disadvantages of privatization have been much debated and are not specifically addressed in this chapter. Rather, the focus is on the broader theme of “involving the private sector” in care and education. Private-Sector Involvement: Statistics Statistics on the involvement of the private sector in childcare and education mostly report enrollments of children in formal institu- tions owned and operated by business or social organizations (col- umn 2, rows A and B). The data include enrollments in for-profit and nonprofit educational institutions, religious and nonreligious institutions, and community groups and PVOs directly involved in education. The statistics omit the educational contributions of busi- ness or social organizations not established explicitly for education- al purposes, and they do not reflect individual or informal home care and education. The statistical and administrative definition of private-sector in- volvement rarely, if ever, distinguishes explicitly among ownership, operation, or control of organizations and sources of financing. The dominating criterion almost always seems to be ownership. As noted 268 Robert G. Myers by Bray (1998), this definition of “private” is problematic because of organizations’ different combinations of financing, operation, and control. For example, financing may be provided by the government, but operation and control may be nongovernmental, as for the bur- geoning “charter” schools in the United States. Or, institutions creat- ed and operated by the government may be financed largely by non- governmental sources, as are many community-based centers that are officially sanctioned and supervised by the government, but support- ed by community volunteers. In the recent reviews prepared for the Year 2000 Evaluation of Edu- cation for All, most countries reported that a certain percentage of students enrolled in early childhood programs are enrolled in private (i.e., nongovernmental) programs. This percentage varies widely among the countries. For example, in Cuba, early childhood educa- tion and development is considered the responsibility of the govern- ment, and the percentage of private institutions is reported as zero. In various African countries and parts of the Middle East, however, the government places heavy responsibility for early care and education on families and local community organizations, and enrollment in these “private” initiatives is reported as 100 percent. The data for these countries do not indicate the extent of governmental support to subsidize the programs. Nevertheless, for educational statistics in general (and data on ear- ly education and care in particular), the nongovernmental, adminis- trative definition of private appears to be the definition of choice or of least resistance. Because most statistics do not include the contri- butions of private, unregistered institutions that are providing care and education, the estimates of private-sector activity may be signifi- cantly underreported. Involving Institutions Figure 1 distinguishes between business and social organizations, a distinction that corresponds approximately, and respectively, to “for- profit” and “not-for-profit.” When using this distinction, discussion of the private sector could be limited to organizations created to Role of the Private Sector in Early Child Development 269 make a profit for those who own and operate the institution (i.e., to row A). This definition is derived from an economic decisionmaking framework which relates efficiency and effectiveness to an organiza- tion’s desire to maximize profits. The definition can be applied to a firm that produces and sells an educational service or product (col- umn 2, row A) and/or to a business that operates in another market (column 1, row A). Applied narrowly, this economic definition excludes all not-for- profit institutions such as churches, community groups, or voluntary organizations, even if they operate a school or childcare center and charge fees. In figure 1, these not-for-profit organizations are grouped together in a separate, “social” category because their motivation is supposedly social and altruistic (i.e., serving the public good, rather than seeking private gain). Distinguishing a business sector from a social sector in relation to profit-seeking behavior is problematic because the behavior of profit- seeking and nonprofit organizations may be similar. Many “nonprof- it” organizations operate as profit-making, seeking new markets and trying to perform cost-effectively. A not-for-profit educational organi- zation often charges fees and may actually earn profits, but may (or may be required to) distribute or disguise its profits by paying higher salaries or reinvesting them in the organization. In addition, not-for- profit organizations may seek to maximize nonmonetary benefits (such as socialization to a particular religious orientation) that are more private than social. Conversely, a for-profit, noneducational business organization may use its profits (at least partially) altruisti- cally to support nonprofit and public undertakings, including child- care and education programs. Or, for-profit educational institutions may utilize “sliding” fee scales to allow subsidies for some students, an action that is not aimed at maximizing profits. If private sector is defined only in economic terms, then “privatiza- tion” becomes a narrow concept of privately owned and operated or- ganizations seeking greater control of a defined market and motivat- ed by a desire to maximize profits. Social organizations would be excluded. 270 Robert G. Myers Although the distinctions between profit and nonprofit blur, the difference is sufficient enough for societies to continue to distinguish them legally. Also, social organizations are expected to more closely represent the public interest, compared with profit-driven businesses, and to have certain operational advantages over government bureau- cracies and corporations. These advantages relate, for example, to their organizational structure and their ability to interact with local populations and adjust to cultural differences. Figure 1 further segregates large organizations from small and medium organizations [e.g., “mom and pop” (mostly “mom” in this case) operations]. When discussing privatization or the role of the private sector, emphasis is usually given to large firms, in the hope of identifying large-scale, rapid, and efficient ways to improve systems. In the developing world, however, most nongovernmental childcare and education programs are operated by small groups, communities, or individuals, with larger social, but usually not business, organiza- tions (e.g., religious groups or international NGOs) sometimes in- volved. The combination of small, as well as large, enterprises (and particularly, small enterprises delivering a service) constitutes a major category of private-sector organizations involved in the operation of early childcare and education programs. Figure 1 also segregates social organizations as community groups, NGOs and PVOs, churches, and philanthropies. These cate- gories may overlap (e.g., a community group may be rooted in reli- gious beliefs), and the groups may differ substantially in motiva- tion, ways of becoming involved in care and education, and persons to convince about involvement (e.g., the local priest, mayor, or women’s leader). Except for philanthropies, which have funds to provide, many of the other groups, including NGOs and PVOs, must seek funds and/or operate with donations of time and in-kind contributions. Size, again, is an issue. Although not conveyed in figure 1, involv- ing an international NGO or philanthropy that has an annual budget of US$100 million is different than inviting a local women’s group to donate time and money to organize a service. Role of the Private Sector in Early Child Development 271 Involving Individuals and Families A different perspective of “private” is needed for discussions of in- volving individuals and families. Their private role may be as imme- diate providers of childcare and education or as users of, and payers for, these services (see figure 1, column 2). Or, individuals and fami- lies may be considered potential sources of support for care and edu- cation programs (if they do not have children) (see column 2). In ei- ther case, the discussion shifts from the power of private and public producers to the power of private consumers, who may choose to be at-home providers of care and education. Families and individuals have their own criteria for choosing whether to (or how much and how to) invest in early childcare and education in or outside the home. Their incentive to invest may be a child’s development in a center or work-related childcare needs. Their information about options and their knowledge of the possible bene- fits for the child may be extensive or limited. Their choices will be af- fected by the characteristics of available services [e.g., cost (in relation to ability to pay), distance, flexibility of hours, quality, and confi- dence in the program]. Understanding how families make their decisions to invest time and money in early childhood programs, including care and educa- tion at home versus nongovernmental or governmental settings out- side the home, is important. Their decisions may be affected, for ex- ample, by: • Offering private education at different prices and of different quality • Offering public subsidies as direct payments, scholarships, tax credits, or vouchers for use in private or public programs as the user chooses • Extending parental work leaves • Providing additional information about available programs. From the perspective of families and individuals, the concept of privatizing education is associated more with increasing the choices 272 Robert G. Myers for potential users to meet particular needs than with shifting the op- erational base from governmental to nongovernmental institutions. Choice is viewed as good in and of itself and is linked to a market- based orientation of knowledgeable consumers, high competition, and availability of many options (see Plank and Sykes 1999). These conditions are not currently present in most developing countries. In the recent dispute at the National Autonomous University of Mexico, a public institution, students demonstrated against privatiza- tion, defined as the introduction of modest fees for some students ac- cording to their ability to pay. It did not involve a change in the op- eration and control of the university, which would continue to be a public institution. Although the students won their 9-month fight against privatization, the demand for entrance into higher education shifted, interestingly, toward private institutions, which increased their enrollments and thereby increased privatization of higher edu- cation in Mexico. Along with the notion of improving private choices, the idea of in- creasing parents’ share of the cost of care and education (i.e., making a greater private investment) has also become more popular in recent years. Governments have begun to introduce fees for public pro- grams, a form of privatizing, and to encourage development of pri- vately operated schools for families who can pay for them, leaving the government to serve others. These ways of capturing private funds from families for care and education programs may increase the choices for some families but reduce those for others, and they may create greater inequities if not accompanied by subsidies. These considerations are relevant to discussions of private versus public care and education. Private Versus Public Care and Education At least six general concerns “drive” discussions of public versus pri- vate financing, operation, and control of social programs, including early care and education. These concerns are: Role of the Private Sector in Early Child Development 273 • Availability of resources and educational opportunity • Efficiency and cost-effectiveness • Accountability • Quality • Equity • Diversity and choice. The relative weight given to each of these concerns, as they are converted into criteria for judging the effects, will set the tone and af- fect viewpoints of private-sector involvement. Availability of Resources and Educational Opportunity The concern that governments simply cannot find sufficient money for adequately financing education programs, including early child- hood programs, is widespread. Competing demands for governmen- tal funds lead to underfinancing and “a need to restrain expenditures so as to reduce deficits and debts” (Tooley 1999). This concern is usu- ally linked to the expressed desire to improve access and coverage of programs for children who are “left out” because governmental funds are scarce. Regardless of whether governments have the ability to increase funds for early childhood programs, the proportion of a govern- ment’s budget allocated for these programs is minimal—often less than 1 percent of the total education budget in most developing countries, an amount that is virtually invisible in their gross domestic product. Even when health expenditures are included, the allocation is small, and transfers from planned expenditures for defense, security, or even other educational levels are not deemed feasible. Accordingly, businesses, communities, and other social organiza- tions and individuals are considered the first “alternative” sources of funding to supplement limited government capacity (or willingness to spend) for early childhood (or other care and education) programs. The search for private funding: 274 Robert G. Myers • Motivates exploration of additional ways for the corporate and business world (i.e., the noneducational, profit-making part of the private sector) to be convinced to use its resources for the public good by supporting programs • Provokes interest in programs operated by community groups and voluntary organizations, which can capture new funds or involve individuals in giving their time to provide early child- care and education • Leads to initiatives that require or entice parents to pay for ser- vices offered through private, and sometimes public, programs. Seeking alternative financing broadly in the private sector may, or may not, reduce the public role in operating and controlling pro- grams. While recognizing that obtaining additional funds from the private sector may be desirable, some critics continue to view the state’s role of protector as important and necessary, and they suggest that the search for alternative funding can have undesirable results. For example, the costs of private programs may thwart the participa- tion of low-income families in care and education programs unless the public continues to provide free services or help defray the costs of private services. Private-sector involvement could thus adversely affect equity (see “Equity” below). Additionally, governments may have an “excuse” not to allocate funds to these programs, leaving their support to the whims of vari- ous private groups. One suggested alternative is that governments should strengthen their position by increasing taxes for families that can afford to pay and using these revenues to expand early care and education programs. Efficiency and Cost-Effectiveness Another concern is the common complaint that public programs are administered inefficiently and use the scarce resources they can ob- tain poorly. The bureaucracy is viewed as large and lethargic, and possibly corrupt, not directly accountable to the users of its services, subject to political influence, and having little incentive to improve Role of the Private Sector in Early Child Development 275 the administration of its programs. Presumably, programs that are privately operated within a competitive system would need to be ac- countable to users and therefore seek the most efficient and cost-ef- fective ways of providing early care and education. The emphasis here is more on operation and control than on direct funding, which could come from public sources via vouchers or from users’ direct payments. In a review of a private secondary education, Bray (1998) suggests that more research is needed to confirm the already considerable evi- dence that private schools are more efficient than public ones. Clear- ly, circumstances vary widely among different settings depending on the populations served by private or public systems. While acknowledging that the search for efficiency is legitimate and even necessary, some critics are concerned that the cult of effi- ciency can distort educational goals and distract operators from their primary task of educating and caring for children. These critics sug- gest that an organization can be efficient but ineffective, or, perhaps, have a limited standard of effectiveness (e.g., children finish school without repeating grades), while disregarding whether children learn and develop in an integrated way. These critics are concerned about the increasingly common view of children as “products.” Also, in the ECD field, using funds for half-day programs focused on 5-year-olds may be efficient if the primary purpose is to prepare children for school, but this focus de-emphasizes other purposes, for example, meeting the needs of parents who must work longer hours and seek full-day programs for younger, as well as older, preschool children. Similarly, having large numbers of children per caregiver or teacher may be efficient, but the children are then likely to be “herd- ed” rather than helped to learn. Efficiency must be viewed in terms of outcomes and not simply mechanistic accomplishments (e.g., timely delivery of “inputs,” meeting payrolls for teachers, reducing grade repetition). A central question with regard to private versus public funding and operation of programs is whether the definition of outcomes is narrowly orga- nizational and monetary or broader and more humanitarian. 276 Robert G. Myers Accountability Accountability is closely related to efficiency. In this case, it refers more to the delivery of results than to forms used in delivering them. Accountability is the meeting of standards and the responding to users’ articulated personal and social desires. Although national governments spend public monies on educa- tion, they are only generally accountable to the public. Bureaucracies are entrenched and most public servants cannot be voted out or re- placed by the public. Locally, where school boards and committees interface directly with their constituents, the administrators and teachers in public schools may be held directly accountable for the services delivered. Yet, for the most part, little attention is given to early childcare and education. Moreover, criticizing those who are viewed as experts (in childhood education) is not considered appro- priate in many parts of the developing world. One may assume that accountability will improve if private insti- tutions operate childcare and education centers and/or if parents have to pay fees for a service. However, this assumption may not be accurate in cultures where market values do not dominate and lines of authority and forms of relationships differ from those in the mar- ket-oriented developed world. Bray (1998) provides examples of both situations. Quality As with accountability, advocates of private-sector education pro- grams argue that these programs, which charge fees, will be of higher quality than public-sector education because the programs have to be responsive to clients within a competitive environment. This argu- ment is not linked primarily to lack of funding, although this issue may be relevant, but to features of private education, such as the abil- ity to clearly define outcomes and expectations, the selection and re- tention of good teachers (Rothstein, Carnoy, and Benveniste 1999), the use of evaluation, and a greater propensity to innovate (Finn, Manno, and Vanourek 2000). The argument depends on the assump- tion that users will be able to define, recognize, and monitor quality Role of the Private Sector in Early Child Development 277 and that quality will be a primary consideration when they choose among programs. A contrasting argument suggests that allowing private organiza- tions to operate programs could reduce quality because tangential, but related, factors (market imperfections) may influence users’ deci- sions, interfere with competition, and diminish an organization’s re- sponsibility for accountability. For example: • Low-income parents who must work may need childcare, but they may have little choice among programs because they can- not pay for expensive programs and must avail themselves of low-cost, potentially low-quality private alternatives if higher- quality public programs are not available or accessible or oper- ate during their work hours. In this instance, distance, hours, and cost take precedence over quality. • Parents may not be aware that they qualify for programs that would provide quality care and education and/or they may not be informed of the potential benefits of a quality program that offers services beyond simple custodial care. Knowledge is not uniformly distributed. These “imperfections” in the system may allow operators to “cut corners” and reduce quality, for example, by hiring inexperienced caregivers and teachers at low salaries. Operators may offer users ac- ceptable tradeoffs (e.g., longer hours, but reduced quality). In a study of selected public and private schools in California, Rothstein, Carnoy, and Benveniste (1999) suggested that the location of schools in high- or low-income areas was more important to the clarity of a schools’ goals and the teachers attracted to a school than whether the school was public or private. The results of a recent comparative study in Latin America (Casassus and others 1998) showed that the test scores for children in Cuba (an entirely public system) were clearly superior to those for children in Colombia (which has mostly private elementary and secondary schools). 278 Robert G. Myers In a recent survey (Myers 2000a) conducted for the Year 2000 Eval- uation of Education for All, at least three ECD professionals from dif- ferent developing world settings mentioned that the number of pri- vate organizations providing very-low-quality early childcare and education was expanding rapidly, and they urged institution of gov- ernment controls. In sum, the availability of private organizations for early childcare and education does not guarantee higher-quality pro- grams and may even result in lower-quality programs, depending on the circumstances. Equity Discussions of the role of the private sector become more negative when focusing on equity. In this instance, the private sector is often cast as a villain, a possible source of inequity, rather than social cor- rection. Most private offerings are assumed to be available only to those who can pay for them, a situation that can create (or reinforce) a divided social system. In this case, the elite have access to quality private schooling, while the poor “make do” with an inferior public system, and urban children are favored over rural children. Tooley (1999) suggests that this assumption may be misconceived because (a) the public provision of services can be inequitable and has hidden costs, and (b) innovative private programs for disadvan- taged populations can be identified. Tooley (1999) presents eighteen examples of privately operated programs which demonstrate the po- tential benefits of private education, mainly at secondary and higher education levels. He highlights operators that established “tutoring” programs which became large-scale, alternative education programs characterized by low fees and results comparable with, if not better than, those of public institutions. However, Tooley does not clarify the meaning of “low cost” or the benefit of these programs to the poor, as distinguished from the lower-middle-class or middle-class population. Some argue (Sancho 1999) that tapping alternative sources will en- able governments to target public subsidies better and to increase the Role of the Private Sector in Early Child Development 279 flow of funds to programs for the poor. The unstated assumption is that this flow of funds will reduce inequities because the poor will have greater access to programs. However, if private programs tend to be of better quality than public programs, as is also argued, a two- tiered system will be created, and inequity will be related to quality rather than to access. That is, the public system will provide “second- rate” programs for the poor, and the private system will provide qual- ity programs for those who can pay. Lack of access to quality pro- grams is seldom considered an indicator of continuing inequity. This view may be exaggerated because, as already noted, high- quality public programs exist, as well as poor-quality private pro- grams. Nevertheless, there are sufficient examples of inequitable, bi- furcated systems related to quality. Equating increased access directly with improvements in equity should be questioned. Diversity and Choice Discussions of private education also involve questions related to the choices among diverse approaches. The offerings of public education tend to be homogeneous, and large-scale public programs have diffi- culty responding to parents’ demands for specific attention during the school years to cultural and religious differences. Public school systems also have difficulty entertaining alternative curricula, which has led to the growth of private schools operated by religious or cul- tural groups that are in the minority or are attracted to specific curric- ula (e.g., Montessori, creative arts) not sanctioned by educational au- thorities. These tendencies within public schools may be moderated by de- centralized systems with local control of curricula and the hiring of teachers. However, there will still be groups whose desires are not ad- equately represented in the public school system, and these groups have, historically, developed their own schools as a preferable alter- native. The desire to respond to parental desires and to marginalized social groups can be applauded as a celebration of diversity, but may also reinforce social disjunctions and separateness. 280 Robert G. Myers Involving the Private Sector The broad view of the private sector, adopted in this chapter, includes business and social organizations and individuals that are not direct- ly involved in providing early childcare or education, but have re- sources that could be tapped to benefit young children. Two of the components depicted in figure 1—business organizations and adults without children (column 1, rows A and C)—could become much more involved in early care and education. Potential ways of involv- ing these businesses and individuals are suggested below. Involving Private Enterprise Noncare, noneducation businesses may desire to invest in, or sup- port, early childhood programs because of enlightened self-interest, social responsibility, and/or altruism. With regard to their self-inter- est, businesses may wish to consider three pertinent findings: • Research suggests that company employees who do not have to worry about the care of their children will be better workers and have less absenteeism. • The good publicity gained from participating in social programs can help sell products. • Some forms of contributions can result in tax exemptions. Improving the quality and productivity of the labor force is advan- tageous to private companies, for their own self-interest and the gen- eral public interest. The growing research literature on ECD links in- vestments in early childhood to better performance in school and enhanced productivity later. Although the fact that healthier, more intelligent children will be more productive workers later in life is in- tuitively obvious, employers sometimes have difficulty accepting this long chain of causality because it is hard to envision and such invest- ments do not yield immediate payoffs. The connection between edu- cation and productivity is more obvious and convincing for pro- grams at secondary and university levels, when the children and Role of the Private Sector in Early Child Development 281 youth are older and the direct relationship between training and work can be visualized more easily. Support can be provided, or is already being provided, to ECD pro- grams by private businesses in several general ways—within compa- nies, outside companies in the broader social arena, and collectively. Possible ways to contribute are suggested below. Within Companies One way of supporting early care and education is “at home,” focus- ing on company employees. When government does not require companies to provide childcare or maternity benefits, some firms have taken the initiative to provide these benefits to their own em- ployees. The benefits may include: • Instituting flexible work hours so that parents can better attend to childcare at home. • Establishing a childcare or early education center onsite, operat- ed by the firm or under contract with a separate service pro- vider. Whether onsite services will be useful and successful depends somewhat on the distance employees have to travel to work. This approach has not been particularly effective in many developing countries because working mothers do not want their children to endure long trips twice a day on crowded pub- lic transportation. • Providing parents with a cash benefit or voucher to be used for a program that meets certain standards. • Providing parental education programs for employees. • Asking employees to contribute to general social programs (e.g., the United Fund in the United States, which usually includes some support for early childhood programs) or to more-specific early childhood programs sponsored by the company or con- ducted by others. The suggestions above entail “extra” expenses for a business, which many companies in the developing world are not willing to 282 Robert G. Myers entertain, particularly when their comparative advantage in the world market depends on maintaining low production costs. Com- panies are not likely to take these actions unless they see direct ben- efits to productivity or have a large social conscience. An example is the noncompliance with laws in many developing countries which require businesses with more than a certain number of female em- ployees to provide a childcare center onsite. Even in these situa- tions, most firms do not provide day care, and most governments do not enforce the law. In some settings, the result may be institu- tion of a “cap” on hiring female labor (to keep the numbers low and avoid providing childcare), or female laborers are hired temporarily and rehired periodically (or let go) so that the firm can avoid paying a benefit. Partly because businesses are reluctant to provide employees with childcare and early education benefits, many governments have in- cluded childcare within mandated social security benefits. Other ways governments have helped companies afford these benefits for their employees include allowing companies an exemption from tax- es or from paying child-related social security benefits if the compa- nies provide their own services or other benefits. Outside Companies, the Broader Social Arena Another approach, which can generate even wider support for ECD, is for firms to provide support for new or ongoing programs operated by governments, private educational firms, organizations in the so- cial sector, or individuals. The business community does, and can, support these efforts in many ways—by paying taxes, supporting philanthropies, contributing to social trust funds, “adopting” schools, and donating products or services. Taxes and philanthropic programs are the two most prominent indirect forms of contribu- tions by private enterprise to ECD for the public good. These forms of contribution are addressed below, as are the other, more direct, ways to contribute to ECD. Paying Taxes. Tax contributions by private enterprise to support so- cial programs, including programs for young children, are sometimes Role of the Private Sector in Early Child Development 283 overlooked, perhaps because they are not always visible to the public and do not involve direct, easily credited actions by companies. Con- tributions to ECD that are made through general taxation and budget allocations are likely to be small for individual companies and for the entire private sector because tax rates are relatively low, ways may be found not to pay taxes, and a very small proportion of general bud- getary allocations are spent on young children. Sometimes, however, taxes are earmarked. Paying into a social se- curity fund used, in part, to support childcare programs operated by the public sector or an approved agent is one form of earmarking. Mexico and Sweden are two countries that earmark taxes in this way, whereas the United States does not (Myers 2000b). These funding arrangements, which tap private-sector funds, are usually shared with employees, who pay a portion of their salary into the fund, and gov- ernment, which contributes from general revenues. The earmarked funds also may be used to support maternity and job-leave benefits for parents. Liberal arrangements for maternity support are available in Sweden and most socialist countries. In the developing world, however, they are seldom available or are honored only in special cir- cumstances. And, unless companies are monitored, earmarked taxes may deter some from hiring female employees, because these em- ployees will increase a company’s costs. In Colombia, one variant of this form of contribution is the re- quirement that each organization, private or public, pay a 3 percent payroll tax designated for early childhood activities of the Colombian Institute for Family Welfare. The program supported is organized and controlled by the government and operated by communities, as is usually the case when private-sector contributions are made through taxes to the government. Establishing a Philanthropy. Philanthropic giving has expanded great- ly across the developed world, but is still in its infancy in most coun- tries of the developing world. Nevertheless, foundations established by major companies operating in the developing world are beginning to gain social importance. A philanthropy established by a business to donate all or part of its funds to ECD may continue to be linked 284 Robert G. Myers closely to the company or may become totally independent, operat- ing as part of the not-for-profit social sector. Funds from a philanthropy can be used to support many possible initiatives to improve early child development. For example, they can support centers operated privately or publicly, and they can be used for the full range of complementary strategies in ECD (e.g., cen- ters, parental education, child-centered community programs, train- ing and other forms of capacity building, advocacy). Recent history indicates a relatively low level of involvement of philanthropies in ECD, although specific data are not available. How- ever, the trend appears to be changing slowly as increased contribu- tions are spurred perhaps by the search for new activities to support, new knowledge about the importance of early childhood, changing social and economic conditions, human rights considerations, and other reasons. The cases described in the next chapter (e.g., the Abrinq Foundation for Children’s Rights, the Aga Khan Foundation) illustrate the growing philanthropic involvement of the private sec- tor. However, despite these pioneer and continuing efforts, the shift toward greater support for ECD does not appear to apply yet to the developing world in a significant way. Establishing and Helping to Operate a Social Trust Fund. Businesses could become more directly involved in ECD by establishing and helping to operate a social trust fund. As a demand-responsive form of in- volvement, the fund would support programs proposed by care and educational institutions, rather than preset packages of activities. Businesses could operate the fund like a philanthropy or have a much more active and protagonistic role (e.g., providing direct technical or legal support to early childcare and educational institutions, offering loans, becoming involved in advocacy efforts). A social trust fund is an excellent opportunity for building partner- ships across sectors to support ECD, involving governments, private enterprises, and international organizations in contributing to a com- mon fund. All contributors and potential users could be represented on an oversight, governing committee, and an NGO could be estab- lished to operate the programs using the fund’s resources. The fund Role of the Private Sector in Early Child Development 285 could operate nationally, internationally, or within countries in par- ticular geographic or political areas. A major purpose of the fund would be to help create and strength- en ECD programs. Activities would be focused on helping communi- ties, NGOs, and small entrepreneurs establish and improve programs, and the fund could provide additional support to institutions fi- nanced and/or operated by government. Emphasis could be placed on developing strategies of self-sufficiency for institutions serving lower-income groups that cannot afford to pay the full costs of ser- vices. Technical assistance could be provided to help eligible institu- tions develop proposals for funding. “Adopting” a School. Programs for companies to adopt a school have been established in Costa Rica and Paraguay. The companies offer the school a range of assistance, such as helping with construction; pur- chasing or donating materials; and providing management advice, scholarships, and food. One example is the Arauco Company in Chile which provides support to various local community schools (UNICEF and Fundación Andes 1994). For privately operated schools, companies may help support a capital fund, sometimes on a match- ing basis, to provide a guaranteed, ongoing source of financial sup- port from the earnings of the fund. Donating Products or Services. In the past, private enterprise often has provided in-kind assistance to various parts of the educational sys- tem. The most notable example of this assistance is the large-scale do- nation of new computers. In the United States, for example, a mecha- nism has been created to recycle computers replaced by businesses. A similar mechanism could be created in developing countries to help communities and NGOs administer and provide early childcare and education. Other in-kind contributions by private enterprise have been mostly for elementary schools and include donations of school supplies (e.g., paper, crayons, books), construction materials, and sometimes food. Other opportunities for involvement that are less related to imme- diate needs or expenditures are also available. For example, for com- munity or private schools, industry could donate products that can 286 Robert G. Myers be resold, and donations could be used to build sustainability by helping local institutions develop their own capital funds. Or, indus- try could offer management assistance to schools, for most institu- tions of early education are administered by individuals who have no management experience. Courses could be developed to help direc- tors of early childhood centers, operated by community organiza- tions or NGOs, perform self-diagnoses of the centers’ organizational and financial condition. Some larger private businesses will be able to offer specialized assis- tance, such as computer support or other examples suggested below: • Book publishers could provide courses for entrepreneurs in early childcare and education using books and materials they already sell. • Banks could offer small loans, possibly on favorable terms, to small entrepreneurs in education. Or, credit card arrangements could be made, similar to those used to accumulate “frequent travel” miles, to assign a small percentage of one’s purchases to a fund for care and education. • Communications organizations can help publicize educational options and offer expertise and “air time” to support campaigns for early distance education and to sensitize and inform parents (e.g., CNN’s current agreement with UNICEF, the World Health Organization, and others to inform the public about children’s rights). Telephone companies could allow messages to be print- ed on their telephone bills to reach a large number of families. Collective Involvement Besides the possibilities for individual companies’ involvement in ECD, collective contributions from the private sector are also possible and perhaps more feasible. Examples of collective involvement in ed- ucation include the Coffee Growers Association in Colombia and the Sugar Growers Association in Guatemala. Establishing a committee to help monitor whether particular firms are providing the benefits or services that should be provided under Role of the Private Sector in Early Child Development 287 law in relation to young children could be one form of collective in- volvement. A “seal” could be created to identify companies consid- ered to be “child friendly.” Involving Private Citizens Private citizens who are not parents can play a role as individual phil- anthropists in support of ECD. Other opportunities have been ad- dressed elsewhere, such as use of vouchers, which privatize education and increase parents’ choices for their children’s education, and indi- viduals’ donation of time to help care for or educate young children, a phenomenon often found in many settings of the developing world, but not the developed world. Individual Philanthropy In the developed world, churches, charities, hospitals, and other or- ganizations have long recognized the value of soliciting funds from private individuals, a tradition of microphilanthropy that has devel- oped and perhaps been abused. Large international NGOs (e.g., Save the Children, Christian Children’s Fund, Plan International, World Vision) are among the institutions that have used this approach to support programs to improve the condition of children in the devel- oping world. These organizations have been very successful in ob- taining funds by establishing programs for individual donors to “sponsor” a child or family in the developing world, drawing their funds mostly from individuals in the developed world. Although some of this philanthropic tradition also exists in the developing world, individual philanthropy is not as strong as in the developed world, partly because the number of middle- and upper-income peo- ple who can individually donate funds is much smaller. Nevertheless, individual involvement in childrearing by nonpar- ents in communities of the developing world may be very high be- cause of extended family and kinship arrangements and traditions of community work. In addition, similar to the developed world, a new approach to involvement is arising as individuals are asked to make financial contributions to social programs. For example, in 288 Robert G. Myers Bangladesh, GrameenPhone appeals directly to individuals for fi- nancial assistance, and, in Colombia, the Center for International Development and Education is experimenting with an appeal for donations from Colombians living outside Colombia. The explosion of the Internet greatly expands possibilities for mi- crophilanthropy to a new level. For example, a small European group used the Internet to appeal for assistance after Hurricane Mitch, rais- ing US$200,000 almost overnight. Because of this success, the group is considering developing a mechanism for similar appeals that would include, for potential donors, a “menu” of NGOs in the devel- oping world and short presentations of their programs. The organiza- tions (and appeals) would be screened independently to validate their authenticity, experience, and need. One technology is already avail- able to facilitate such an effort. As reported in TIME magazine (Schenker 2000), “… technology industry executives spoke to some of the world’s largest banks at the [recent] Davos meeting about using digital certificates so that small amounts of money can be transferred between individuals.” Undoubtedly, there are many examples of sim- ilar potentially fruitful efforts in the developing world, and docu- menting them and learning from their successes and failures would be useful. Conclusion This chapter has explored possible opportunities for involving com- ponents of the private sector in early child development. The main observations are summarized as follows. 1. Involving the private sector is different from privatizing. “Priva- tization” is a much narrower concept that refers to the shifting of ownership and operation, and sometimes financing, from governmental organizations to nongovernmental organizations or individuals. “Involving the private sector” is a broad notion that refers to the wide participation of all components of the private sector in a full range of activities. Role of the Private Sector in Early Child Development 289 2. For early child development in the developing world, privatiza- tion may not be the main issue, as suggested by the very high proportion of private-sector support for early childcare and edu- cation programs and the high proportion of early childhood programs operated privately. Rather, the task may be to identify ways for various parts of the private sector to help parents with their child’s education, to improve existing childhood programs operated by the private sector, and to partner with government to improve access to, and quality of, programs financed and ad- ministered by the government. Attention may need to be given to making early childhood programs more public and involving governments in a field they have been reluctant to enter. 3. The arguments for investing in ECD may be compelling to gov- ernments and different social organizations, but may not be convincing to private businesses or individuals that may expect direct, private payoffs, or returns, from their investments, par- ticularly if the businesses or individuals are not already involved in early childcare or education. If the private sector does not as- sume some responsibility in this area, and governments do not act, ECD programs will be underinvested (i.e., the level of pri- vate-sector benefits will not match the level of social benefits ECD programs can provide). 4. The assumption that there are knowledgeable consumers and competitive markets in many settings of the developing world is doubtful. The lack of these ingredients in many settings under- cuts existing arguments for privatization, which postulate im- proved quality, accountability, and efficiency by offering incen- tives to private providers or funds to consumers for choosing among options. 5. The criteria for evaluating the effects of increased involvement by the private sector or privatization of early childcare and edu- cation include changes in levels of funding, access, accountabil- ity, efficiency, quality, diversity and choice, and equity. Apply- ing these criteria may lead to contradictory conclusions. For example, the tendency to use the criteria of funding and access 290 Robert G. Myers often leads to neglect of equity and differences in quality, or in- equity. Shifting the balance between public and private support affects these criteria in different settings, and researchers have yet to accumulate all the evidence about these effects. 6. The opportunities for involving noneducation and noncare businesses in early childcare and education are many. One promising approach is their participation in establishing and operating social trust funds. 7. Individual microphilanthropy is another promising approach for tapping private-sector resources that has not been promoted or examined widely within the developing world. Note In writing this chapter, the author benefited from papers or thoughts by Jeffrey Puryear, Miriam Waiser, Claudio Castro, Henry Levin, Stephen Heyneman, Mark Bray, and Ellen Mangenheim. The respon- sibility for the contents is solely the author’s. References Bray, M. 1998. Privatization of Secondary Education: Issues and Policy Implications. In J. Delors, ed., Education for the Twenty-First Century: Issues and Prospects. Paris: UNESCO. Bronfenbrenner, U. 1979. The Ecology of Human Development. Cambridge, Mass.: Harvard University Press. Casassus, J., J.E. Froemel, J.C. Palafox, and S. Cusato. 1998. Primer Estudio Internacional Comparativo Sobre Lenguaje, Matemática y Factores Asociados en Tercero y Cuarto Grado. Santiago, Chile: UNESCO, Regional Office for Education in Latin America and the Caribbean (Chile), Latin American Laboratory for Evaluation and Quality of Education. Finn, C.E., B. Manno, and G. Vanourek. 2000. Charter Schools in Action: Renewing Public Education. Princeton: Princeton University Press. Role of the Private Sector in Early Child Development 291 Mangenheim, E. 1999. Preschools and Privatization. Paper presented at the conference on Setting the Agenda for the Center of the Study of Privatization in Education. Columbia University, Teachers’ College. Mimeo [Forthcoming from Westview Press in a volume edited by H.M. Levin.] Myers, R. 1995. The Twelve Who Survive: Strengthening Programs of Early Childhood Development in the Third World. Ypsilanti, Mich.: High/Scope Press. ———. 2000a. Early Childhood Care and Development, A Global Review: 1990–1999. Paper for UNICEF and The Education for All Forum, contributed to the Year 2000 Evaluation of Education for All. Paris: The Education For All Forum. [Available on http://www.unesco.org/education/efa] ———. 2000b. Financing Early Childhood Care and Education Services. In M. Neuman, ed., International Journal of Educational Research 33:75–93. Plank, D., and G. Sykes. 1999. How Choice Changes the Education System: A Michigan Case Study. In C. Soudien and P. Kallaway, eds., Education, Equity and Transformation. Dordrecht, The Netherlands: Kluwer Academic Publishers, in cooperation with UNESCO Institute for Education. Rothstein, R., M. Carnoy, and G. Benveniste. 1999. What Public Schools Can Learn from Private Schools. Aspen, Col.: Economic Policy Institute. Sancho, A. 1999. Sintesis del la Conferencia sobre Oportunidades de Inversión en Educación Privada en Países en Desarrollo. Washington, D.C.: International Finance Corporation. Schenker, J.L. 2000. Plans to Dotcom the World. TIME Europe, Feb. 14, 40. Schweinhart, L., H. Barnes, and D. Weikart (with W.S. Barnett and A. Epstein). 1993. Significant Benefits. The High/Scope Perry Pre-school Study Through Age 27. Ypsilanti, Mich.: High/Scope Press. Tooley, J. 1999. The Global Education Industry. Lessons from Private Education in Developing Countries. London: Institute of Economic Affairs, in conjunction with International Finance Corporation. 292 Robert G. Myers UNICEF (United Nations Children’s Fund) and Fundación Andes. 1994. Aportes de la Empresa Privada al Mejoramiento de la Educación en Chile. Santiago: UNICEF. Van der Gaag, J. 1995. Private and Public Initiatives. Working Together for Health and Education. Washington, D.C.: The World Bank. Chapter 11 Communities Can Make a Difference: Five Cases Across Continents Simone Kirpal This chapter presents five case studies of community-based early child development (ECD) programs. The cases are examples of good practice, which gives priority to extensive involvement of the local community to create ownership and establish successful, cost-effec- tive, and sustainable programs. The case studies highlight ways the private sector can influence public policy and provide insight on two key issues: • How do effective ECD programs involve local communities to become culturally and financially sustainable? • Can private-public partnerships enhance the potential for tak- ing ECD programs to scale? Both questions are closely related. Knowing how high-quality ECD programs can reach the most vulnerable and poorest children and enhance their life chances without being prohibitively costly is im- portant for providing technical support to governments, advocating for ECD programs, facilitating decisionmaking about these programs, and justifying investments in them. Moving programs to scale and increasing their accessibility by lowering unit costs is one way of reaching out to poor children and to rural areas. Yet, if programs are 293 294 Simone Kirpal meant to have a lasting effect on changing and improving the condi- tion of children and society, they must be culturally sustainable and respond to local needs and demands. Only if local communities are involved in programs and take ownership of them will ECD programs persist and continue to have the same positive effects when outside donors cease their funding. Five Case Studies: Overview The five cases presented in this chapter share certain commonalities. They all provide direct ECD preschool or center-based services to poor communities. In addition, all programs have developed a train- ing component to train teachers and/or caregivers. They all rely on some form of community support and are struggling with the issue of scaling up to reach more children. The cases, all examples of effective programs, are summarized briefly below and described separately in greater detail later in the chapter. The Montessori Preschool Project in Haiti offers a 9-month teacher training course for scholarship students from poor communities who have relatively low education levels, enabling them to become certi- fied Montessori preschool teachers. On graduation, the teachers are given financial support to return to their community to establish preschools, mostly in poor and rural areas, if the local communities provide the necessary resources for the schools to become financially sustainable after a few years. Since its inception in 1986, the project has trained more than 450 teachers and has supported forty-three preschools spread throughout Haiti, serving approximately 2,000 children each year. Recently, two additional centers for training teachers have been established to increase local capacity for early childhood education. The Mother-Child Day Care Center Services (MCDCCS) in Uganda provides low-cost, high-quality childcare for children ages 0–10 years to help poor working mothers living in slums and rural trading areas become economically self-reliant. The program aims to improve the condition of young children by empowering mothers and supporting Communities Can Make a Difference: Five Cases Across Continents 295 their development so that they can better provide for their children. In addition to providing a safe and stimulating environment for chil- dren and reliable childcare services, which enables mothers to work, the three MCDCCS centers offer a variety of integrated programs, which include counseling on child health and breastfeeding, family planning, parenting skills, and literacy. Approximately 6,600 chil- dren have benefited from the program since the first center opened in 1987. SERVOL is a nongovernmental organization (NGO) in Trinidad and Tobago that has developed and administers several education programs in disadvantaged and poor areas of the country. The pro- grams include an early childhood care and education (ECCE) effort, a parent outreach program, an alternative school enrichment initiative for secondary school students, a skill training program for adoles- cents, and a high-technology course for young people ages 20–25 years. All programs, including content and monitoring, are operated entirely by individuals in the community. Initiated in 1971, SER- VOL’s programs have gradually become sustainable financially and, in 1987, the government of Trinidad and Tobago, through the Min- istry of Education, established SERVOL as its agent for nonformal ed- ucation and assumed payment of salaries for teachers and instructors. Currently, SERVOL administers, manages, and closely monitors 160 public ECCE centers in Trinidad and Tobago. The Aga Khan Foundation supports two efforts, the Madrasa Re- source Centers (MRC) in Kenya, Uganda, and Zanzibar, which work with disadvantaged Muslim communities to help establish commu- nity-owned and community-managed preschools, and Improving Pre- and Primary Education (IPPS) in rural Sindh, Pakistan, which helps lo- cal communities establish and manage their own preschools and pri- mary schools. These efforts emphasize the strengthening of local ca- pacity to improve the quality of basic education and often involve partnerships with NGOs and local governments. The IPPS and MRC project teams conduct community awareness and mobilization activ- ities; help develop curricula and leadership skills; identify partners’ roles and responsibilities; and train and support communities and 296 Simone Kirpal school management committees in organizing, establishing, manag- ing, and financing their own ECD activities or primary schools. Spe- cial emphasis is given to the education of girls and the empowerment of women by, for example, ensuring that girls constitute at least 50 percent of the total enrollment and selecting and training local women as teachers, heads of schools, and members of school man- agement committees. By early 2000, the MRCs were working with approximately 130 communities across East Africa, and the IPPS project, which began in 1996, was working with 12 communities to establish preschools and primary schools. IPPS plans to expand to another six to eight communities in rural Sindh and to work with mothers and other caregivers, focusing on children under 3 years old and on childrearing practices in the home. The Step by Step program differs from the other four cases in not originating from within a local community in a developing country. Instead, the program was designed originally for former communist countries and implemented initially in Central and Eastern Europe and the Former Soviet Union. Gradually, the program has spread to other parts of the world, including Haiti, Mongolia, and South Africa. Step by Step provides a teaching methodology to guide and support education reform. It includes materials, courses, and training pro- grams, for teachers and caregivers, which introduce child-centered teaching methods and support community and family involvement in preschool and primary education. The aim is to engender demo- cratic ideas and principles within young children and their families by encouraging children to make choices, take responsibility, express their ideas with creativity, and develop critical thinking skills. The institutional reform process is reinforced by training teachers and administrators at preschool and primary school levels, introducing new course content and interactive teaching methods at universities and pedagogical institutes, encouraging cooperation on educational content and policies among different government ministries, and establishing national associations for parents and teachers. In 2000, its sixth year of operation, Step by Step was training 40,000 teachers Communities Can Make a Difference: Five Cases Across Continents 297 annually in twenty-eight countries and serving more than 500,000 families and children in preschools and primary schools. The pro- gram cooperates with more than 300 institutions which train, and re- train, teachers to implement new practices. Table 1 summarizes the activities and types and forms of partner- ships in the five cases. Following on the framework suggested by Myers in the preceding chapter, the table identifies involvement of the public and/or private sectors; includes community within the private sector; and indicates the role of the community in initiating, contributing to, or participating in the programs. Table 1. Five Successful ECD Programs: Overview Projects Montessori MCDCCS SERVOL MRC/IPPS Step by Step Childcare, ECCE centers, Preschools, Preschools, Preschools, training, teacher training, training, teacher teacher parent parent capacity training, Type of program training education education building methodology Community involvement Community initiative no ✓ ✓ ✓ no Community contribution ✓ ✓ ✓ ✓ ✓ Private sector Community participation no no ✓ ✓ ✓ Support from international donors or foundations ✓ ✓ ✓ ✓ ✓ Government support or involvement no ✓ ✓ ✓ ✓ Financial Preschools: ✓ Preschools: ✓ ✓ (At sustainability Training: no no ✓ Training: no country level) ECD, Early child development; ECCE, early childhood care and education. ✓, Yes. 298 Simone Kirpal Features of a Successful ECD Program Comparison of the five examples of good practice in this chapter suggests several common features that account for their success. The programs give priority to the following essential elements: • Child-centered approach • Parental involvement and family support • Community ownership • Cultural and financial sustainability • Training and capacity building • Integration within a broader framework of development • Private-public partnerships. Child-centered Approach Each of the five programs has adopted a child-centered approach that supports the integral development of each child through services ad- dressing a child’s cognitive, motor, psychosocial, and emotional de- velopment simultaneously. The teaching methods give priority to the development of individual attributes and social skills, such as self-es- teem, confidence, responsibility, problem solving, and critical think- ing. This approach distinguishes these programs from the countries’ traditional, mainstream educational programs, which feature large classes; rote learning and memorization; a purely academic, no-play orientation; no group activities; and preschools conceived as an ex- tension of primary schools, without accounting for the specific devel- opmental needs of 3–5 year olds. The underlying values of the child- centered approach are particularly important when targeting poor and vulnerable children to enhance their life chances, because these children are often marginalized, stigmatized, and suffer from low self- esteem. Parental Involvement and Family Support A variety of adults and family members are integral to a child’s daily life. One of the most effective ways of supporting a child’s develop- ment is to build on the knowledge and skills that these individuals Communities Can Make a Difference: Five Cases Across Continents 299 already have and to give them additional resources to enhance their roles as caregivers. Both SERVOL and the MCDCCS programs are sup- porting families and working directly with parents, particularly mothers. By working with adults and family members, the programs are extending their benefits to caregivers, as well as children. ECD programs have a much greater effect when activities and pat- terns of communication and interaction are reinforced consistently between the program setting and the home environment. Also, a child’s positive development is more likely to be sustained when ECD activities are integrated into the child’s daily life than when provided for only a few hours a day. The effect of any ECD program will be lim- ited if the program is conducted in isolation. When ECD-related ac- tivities are replicated at home, by working with parents and modify- ing their behaviors and parent-child interactions, the program’s outreach is extended and benefits other siblings and children in the household. This extension is particularly important for children from poor households because financial constraints often allow families to send only a very limited number of young children from the same household to educational programs such as preschools. By working with parents and achieving these spill-over effects, and thus benefit- ing children who do not attend any form of early stimulation pro- gram, the programs attain a broad outreach at relatively low cost. Par- ents acquire a better understanding of their child’s developmental needs and are encouraged to support their child’s educational devel- opment later on, thus increasing the chances that a child will contin- ue schooling beyond pre-primary education. Parents’ interest in their child’s educational achievement is an important factor that affects a child’s future school performance positively (Young 1996). Involving parents in school and classroom activities familiarizes them with the teaching environment and the (child-centered) teach- ing method used and ultimately increases their acceptance of the en- tire formal education system. This acceptance is important, because a considerable number of poor families are reluctant to give priority to investing in formal education for their children. In addition, unedu- cated individuals and members of socially excluded and marginalized 300 Simone Kirpal groups often have difficulty understanding the education system and interacting with formal institutions. They may be unfamiliar with ad- ministrative procedures, feel uncomfortable and discouraged when having to communicate with administrators, and avoid interacting with teachers and school officials. In turn, the education systems in developing countries often tend to discourage parental participation (e.g., in Haiti, parents are not permitted in the classrooms). Nonfor- mal or semiformal ECD programs can bridge this gap by providing a point of entry for parents to participate in children’s development and, ultimately, support them in their educational achievements later on. Community Ownership In this chapter, “community” refers to the (local) community where an ECD program is anchored. It includes all formal and informal structures, social groups, and individuals. Formal institutionalized structures may include those mentioned by Myers in the preceding chapter (social organizations, community groups, NGOs, private vol- untary organizations, religious organizations, business organizations, as well as local government). Generally, community involvement ex- tends across private (for-profit, not-for-profit) and public sectors. Except for the Montessori Preschool Project (in which all pre- schools are privately owned by individuals), the cases highlighted in this chapter are founded on extensive community involvement in financially supporting, implementing, and managing ECD programs. The programs have established partnerships with the communities and rely on the communities as local resources for reducing a pro- gram’s costs and improving a program’s quality. Community involvement and ownership are crucial to a program’s effectiveness. However, the dynamics of community mobilization, contribution, empowerment, and participation affect programs differently and may, or may not, foster desired outcomes. Community involvement is a complex process implying a wide range of activities and commitments. “Community contribution” and “community participation” are referred to herein as two different Communities Can Make a Difference: Five Cases Across Continents 301 dimensions of community involvement. A local community may be- come involved in an ECD program by providing different types of contribution, including labor and in-kind support (e.g., to help con- struct a school building, operate a food canteen, or organize fundrais- ing activities). Parents may also contribute to a program’s content and quality by, for example, assisting in the classroom or creating teaching materials. Some authors refer to this type of community in- volvement, providing “inputs,” as “passive participation.” Evans, Myers, and Ilfeld (2000, p. 35) describe this participation as “the con- tribution of each individual to a common endeavor—a contribution of time, or labor, or money, or knowledge, or of several of these.” In passive participation, parents and communities have little control or say over what actually happens for their children. A stronger form of community involvement is the active partici- pation of a local community, beyond mere consultations with com- munity groups and parents to obtain input. Active participation in- cludes shared responsibility by the groups for decisions that are made. Although passive participation is useful and may be neces- sary (e.g., the presence of parents or community leaders at meet- ings), a program is more likely to be sustainable if this participation is complemented by a community’s active participation in making decisions about the program and sharing responsibilities for imple- menting it. Active participation requires, and results in, community decisionmaking and community management. When a program is controlled by a community, the community is much more likely to take ownership of it. Experience shows that community involvement, in general, is ef- fective for reducing a program’s costs and creating at least minimal ownership by the community. However, the active participation of a community substantially increases potential effectiveness and long- term sustainability by fostering an extension of services, building lo- cal capacity, and empowering communities. The challenge for all ECD programs is to nurture this approach over time and to acknowl- edge communities as equal, full-fledged partners, rather than mere re- sources (Rugh and Bossert 1998). Among the cases in this chapter, 302 Simone Kirpal SERVOL and the MRC and IPPS projects are two examples that are pursuing this type of partnership approach most effectively. Cultural and Financial Sustainability In poor countries where resources and capacities of the public sector are limited, parental and community involvement are prerequisites for achieving long-term sustainability of ECD programs after outside funding has ceased. Long-term sustainability is a key issue for each of the cases presented in this chapter. All of the programs began as small-scale initiatives and have expanded gradually in response to de- mands from their local communities. Sustainability has two different aspects: cultural and financial. Cul- tural sustainability refers to program content and teaching methods that reflect the local community’s knowledge and practices of child development and socialization. In general, an ECD program is more likely to be culturally appropriate when initiated from within the lo- cal community through a participatory process, from the beginning, for program development and implementation. The SERVOL and MRC and IPPS projects exemplify how long-term sustainability can be achieved through active participation and establishment of a cul- turally responsive program. An alternative approach to achieving cultural sustainability is to adapt training and teaching methods to respond to the educational and cultural context of the community and society. The Montessori Preschool Project and Step by Step program have adopted this ap- proach. They offer a relatively flexible didactical framework (Montes- sori) or a teaching and classroom methodology (Step by Step) that can be adapted and modified to incorporate a community’s local lan- guage, educational background, and cultural context. Financial sustainability refers to continued funding and support to maintain and ensure the viability of a program after outside funding has ended. ECD programs designed to serve the poorest and most dis- advantaged children in a community cannot exist solely on the con- tributions of these children’s parents. As demonstrated by the cases in this chapter, additional financial or in-kind support from local com- Communities Can Make a Difference: Five Cases Across Continents 303 munities and/or governments is needed to maintain these ECD pro- grams over time. Each program is pursuing a different strategy for achieving financial sustainability, but all rely on local community structures and individuals for cofunding their activities. For example, SERVOL partners with the government which is re- sponsible for paying the salaries of teachers and instructors. The MRC and IPPS projects, Step by Step, and the Montessori Preschool Project rely on community contributions and support from local groups (e.g., churches, government, foundations), which provide buildings, matching grants, and even long-term subsidies. For both Step by Step and the MRC and IPPS projects, fundraising is important for support- ing and promoting the programs. Both programs also have intro- duced microcredit schemes and use of endowment funds to increase their communities’ financial resources, for the benefit of all partici- pants. The MCDCCS program in Uganda has innovatively combined microcredit schemes and income-generating activities to support children and mothers through the ECD centers. The program specif- ically aims to increase household incomes, in the belief that all chil- dren in a household will benefit if mothers are empowered and sup- ported financially to better provide for them. The MCDCCS centers directly provide childcare services for working mothers; childcare and employment opportunities in small-scale, income-generating projects for unemployed mothers; and microcredit opportunities for all mothers. Throughout the program, the women’s ability to pay childcare and health services fees has increased constantly over the years and the children’s health and nutritional status has improved significantly. Training and Capacity Building In all the cases, the mere provision of childcare or preschool services is complemented by high-quality training for childcare providers or preschool teachers. All the programs have been supplemented gradu- ally by significant capacity-building activities, to increase their local community’s capacity to maintain and expand the program over 304 Simone Kirpal time. Although these training efforts were conceived initially as a tool to facilitate small-scale, local capacity building for the programs, the training components have, in all five cases, evolved into separate, independent entities advocating holistic training approaches or methodologies for ECD. Typically, these training components are ac- companied by a series of training manuals and materials. The teach- ing methodologies used by SERVOL, the MRC and IPPS projects, and Step by Step have expanded far beyond their initial contexts to be adopted, adapted, and further refined by other programs in other countries. This expansion demonstrates that an ECD training pro- gram can, in itself, be an important tool for scaling up successful ECD initiatives beyond their country of origin. Integration Within a Broader Framework of Development Integrating early interventions within the broader framework of de- velopment reinforces and helps sustain ECD programs in the long term. Several of the cases in this chapter have embedded ECD inter- ventions in other projects designed to support parents and local com- munities. For example, the core ECD programs in the MRC and IPPS projects, MCDCCS, and SERVOL are sustained by a range of comple- mentary programs addressing human, social, and economic develop- ment more broadly. Among the cases, the MRC and IPPS projects ap- ply the most structured strategy and approach for mentoring communities, to strengthen local capacity, develop leadership skills, raise awareness, and mobilize the community. Two key principles pervade their activities: (a) empowering local women through sup- port and training and ensuring that women are represented on all management committees, and (b) enabling communities to manage and finance their own schools. The MCDCCS program is centered on the needs of poor working mothers and empowerment of them by providing childcare and related services. MCDCCS’ integrated approach combines childcare services and training of childcare providers with parent education and other services for mothers (e.g., health education and literacy; counseling on breastfeeding, family planning, parenting skills, and Communities Can Make a Difference: Five Cases Across Continents 305 HIV/AIDS; gender equality) and income-generating opportunities for unemployed mothers. All these activities and services are integrated within each center. SERVOL has taken a different approach, to establish gradually a se- ries of stand-alone, but complementary, programs which include ECCE services, parenting programs, programs for secondary school dropouts and adolescents, and higher training for young men and women. With a life-cycle approach and programs for different age groups, SERVOL aims to break the intergenerational cycle of poverty. Private-Public Partnerships Most of the programs highlighted in this chapter began as demand- driven, small-scale projects, with one preschool or center, in response to a community’s immediate needs. As the community’s demand for ECD services increased, the local initiatives began to seek outside funding from international donors (e.g., private foundations, bilater- al and multilateral organizations) to be able to serve more children and improve the quality of the programs. For example, both the Montessori Preschool Project and the MCDCCS program were established and maintained on a small scale for about 15 years, receiving extensive community support and small grants from international donors. Both programs were well received by their communities, helped mothers and caregivers, benefited the children enrolled, and were financially sustainable locally. However, major investments are now needed to expand the programs to other communities and to broaden the scope of the programs. To secure its viability, the MCDCCS program is seeking to establish new centers and to invest in additional small-scale, income-generating projects. The Montessori Preschool Project is seeking to expand its teacher training program by establishing more training centers and offering continuing professional development for school teachers from all educational levels (preschool to secondary education), particularly primary school teachers. Although such major investments will help to consolidate a pro- gram, expand its outreach, and maintain or even improve its quality, 306 Simone Kirpal most donors will not continue to fund a program substantially over a long term. Innovative models for private-public partnerships within countries are needed to take ECD programs to scale and to sustain them over time. In general, international donors cease or reduce their funding after 10–15 years. SERVOL is one example. Outside donors are often willing to support local educational initiatives, but are also interested in actively supporting or creating incentives to establish a structure that will enable programs to become viable and self-sustain- ing over time. Having such a supportive structure is a prerequisite for moving programs to scale and should be developed at different lev- els—within the community, through capacity building and commu- nity support, and regionally and nationally, through generating an enabling environment and legal guidance. The MRC and IPPS projects have focused on developing this sup- portive structure at the community level by strengthening the capac- ities of local project teams to enable communities to develop, imple- ment, and monitor the MRC preschool program on a larger scale and to manage the IPPS preschools and primary schools. The projects also encourage local NGOs to partner with local governments. The Step by Step program is working locally as well as regionally and nationally, but is giving priority to initiating an institutional reform process that will ultimately be accepted and supported by government institutions. SERVOL is a unique case of a nonformal ECD program moving to scale and becoming financially sustain- able through private-public partnership. Although now fully sup- ported by the government, legally and financially, SERVOL has been able to remain truly community-based and community-man- aged and, yet, is the government’s formal agent for delivering non- formal education services and administering 160 public ECCE cen- ters. SERVOL is truly a success story, but the process has taken more than 20 years. Conclusion The goal of any community development program should be to en- able a process that will be maintained after outside funders leave. Communities Can Make a Difference: Five Cases Across Continents 307 One way to begin this process is to have those who will ultimately be responsible for the program take ownership of it from the beginning. A partnership approach to planning, funding, and implementing a program enables parents and community members to gain the knowledge and skills they will need to continue the initial program (sustainability) and to create additional programs on their own (replicability). In early child development, parental and community involvement is a particular strength and resource for achieving highly effective programs that are culturally appropriate. In addition, parental in- volvement will increase the potential that elements of the programs are replicated at home and integrated into children’s daily life, there- by also extending the program’s benefits to other children in the household. Because resources at the household level are extremely limited in poor countries, communities become crucial partners in providing financial and in-kind support for ECD programs. In countries that have weak institutional capacities, communities are the greatest as- set. But, communities alone cannot establish and maintain large- scale programs. They need support from other stakeholders, includ- ing governmental and nongovernmental agencies, local funders, and the private sector. Long-term financial sustainability of ECD programs can only be ensured when both the private and public sectors become equally involved in supporting an ECD initiative and creating an enabling environment for developing the program further. Ultimately, these partners will complement parents’ and families’ contributions to fund and maintain a program in the long term. The case studies in this chapter demonstrate that new forms of private-public partnership need to be developed and institution- alized to reinforce these processes because support from interna- tional donors is usually temporary and limited in taking ECD pro- grams to scale. Community mobilization and parental participation are relative- ly easy to achieve in early intervention programs, compared with other educational services, because preschool education and other 308 Simone Kirpal ECD services for children ages 0–6 years benefit children, parents, and other household members directly. Although Lokshin and Tan (2000) refer to improvements in child outcomes through ECD in- terventions as “direct” benefits, and Myers (1995) refers to the pos- itive effects of ECD programs on household income levels and well- being as “indirect” (or immediate) benefits, this distinction may not be necessary. “Freeing up” family members for economic activ- ities or attendance at school by providing childcare services can also be interpreted as a direct benefit of ECD programs, and en- hanced parenting skills benefit parents, children, and younger sib- lings equally. These benefits accrue from all ECD services that provide some form of childcare. The services benefit parents, and particularly mothers, by providing increased opportunity for income-generating activities. They also benefit other family members, especially older siblings, by liberating them from childcare responsibilities, in many cases enabling, especially, girls to continue their education. Programs that also provide counseling on the broader aspects of child develop- ment (e.g., health, nutrition, breastfeeding) support parents in their roles as caregivers, enhance their parenting skills, and educate and empower them. Another factor resulting in a high level of parental support for ECD programs, compared with, for example, sending children to pri- mary or secondary school, may be the relatively low opportunity costs for families as preschool-age children are not expected, in most societies, to help in the household or on the farm and generally are not yet, or only randomly, involved in economic activities. The unique combination of these features in ECD programs offers great promise for mobilizing families and communities with limited resources in developing countries to invest in young children at an early stage. As exemplified by the five case studies in this chapter, ECD programs that combine these features are most likely to be effec- tive and sustainable and to have the greatest impact on children, families, and communities. Each of the five cases is described in de- tail below. Communities Can Make a Difference: Five Cases Across Continents 309 1. Haiti: Montessori-Based Teacher Training and Preschools The Montessori Preschool Project provides high-quality, internation- ally recognized teacher training. Through a scholarship scheme, in- dividuals with limited economic resources are financially supported to become certified preschool teachers and to open their own preschools. The project was created and is supported by the Peter- Hesse Foundation, Solidarity in Partnership for One World, a non- profit organization registered in Germany and Haiti. Peter Hesse started the foundation in 1981 for the purpose of sustaining small self-help projects for poor people in Haiti. Initially, the foundation focused on 2-day seminars on project management for self-help groups and on alleviation of small financial bottlenecks, mostly for rural initiatives. In 1984, the foundation changed its emphasis to early childhood care and development, which led to creation of the foundation’s first teacher training center (in 1986), the Centre Montessori d’Haiti. Mission The Montessori Preschool Project aims to influence Haiti’s education sector, at public and private levels, by demonstrating that high-quali- ty early childhood education is possible—even with limited re- sources—if the quality and length of teacher training are adequate. The mission of the Montessori program is to give poor children a bet- ter chance to develop themselves early enough through quality teacher training and creation of community-based preschools. The training of qualified teachers translates directly into increased local capacity to provide early stimulation and education programs of good quality to children ages 2.5–5 years. Cultural Context Haiti’s culture is based heavily on oral communication. Teachers are accustomed to memorizing and reciting teaching material, but have difficulty applying this knowledge in the classroom. To improve application, most of the Montessori training course is presented 310 Simone Kirpal through oral instruction in Creole, the local language. In addition, the project adapted the curriculum to the needs of student teachers in Haiti, adding substantial practice time to help them transfer theo- ry into practice. The student teachers must complete supervised in- ternships, create didactical material, and be able to adapt everyday objects as teaching tools. Haitian teachers compensate for a shortage of books and materials by developing their own lessons, teaching ma- terials, and visual aids. Methodology and Approach Montessori education embraces a child-centered philosophy that em- phasizes individuals’ learning paths and the capabilities of each child. Children can access different kinds of materials freely and are encouraged to learn at their own pace. The freedom for purposeful activity allows children to develop not only their intellectual facul- ties, but also their powers of deliberation, intuition, independence, and self-discipline, as well as the social awareness and behavior need- ed to function in the world. Teachers and children are taught mutual respect and nonaggressive behavior; competition is strictly avoided. In the Montessori approach, didactical materials present knowl- edge to children in an orderly way so that their intellect can classify the information into an organized system of thought. This process of working with the material exercises a child’s intellect constantly and expands the child’s mental abilities. The effectiveness of the material derives from the thoughtfully planned manner of its presentation, which flows from: • Concepts presented in isolation (which reduces the confusion of receiving too many ideas at once), to • Appreciation of various difficulties in isolation, from easiest to most difficult (for young children, from concrete to abstract), to • Use of a graduated series of self-teaching materials suited to the various stages of a child’s development, to • Incorporation of body movement (occupation) for specific pur- poses (i.e., combining movement and mental concentration). Communities Can Make a Difference: Five Cases Across Continents 311 More than 50 percent of the didactical material for Montessori preschools, including most reading material, is produced locally. Teachers make most of the material at the beginning of the academic year. In addition, one basic set of imported Montessori teaching ma- terials, which costs approximately US$1,000, is provided to each new preschool. Because the Montessori teaching material benefits the child’s cognitive development even when a teacher does not fully un- derstand the didactical background, teachers who do not completely comprehend the Montessori pedagogy can become effective teachers. From training in the Montessori teaching method, people from poor communities and with relatively low levels of education have be- come certified teachers. Children attending Montessori preschools range in age from 2.5–5 years and, in exceptional cases, 6 years. Classes are not divided by age groups, and children are invited to learn from each other and to in- teract across ages. Older children learn to take pride in helping weak- er and smaller children and, thereby, enhance their social skills. Implementation Montessori student teachers complete a 9-month training course, a final examination, and two 6-week internships in an affiliated Montessori school. They can receive three types of diplomas: assis- tant’s diploma, national teacher diploma, and international Montessori directress/director diploma. All student teachers are examined and given their diploma by the Centre Montessori d’Haiti. To obtain the international diploma, students must pass all parts (written, oral demonstration, practical) of the national examination conducted by the Centre Montessori d’Haiti, dem- onstrate a complete understanding of the Montessori philosophy, and pass a second examination conducted by an outside, inter- nationally recognized specialist. About 20 percent of all Montes- sori-trained student teachers have obtained the international Montessori directress/director diploma, which certifies them as Montessori teachers entitled to teach and open schools in Haiti and around the world. After teaching for 1 year, they can also 312 Simone Kirpal become assistant student teacher trainers in one of Haiti’s Montes- sori training centers. About 50 percent of all Montessori student teachers are scholar- ship students who sign a contract with the Centre Montessori d’Haiti which obliges them to teach for 3 years in a poor community after they complete their training. Most teachers return to their own locale to establish a school, and most extend their commitment beyond the initial 3-year agreement. All Montessori project preschools throughout Haiti are strongly linked by their common structures, teaching philosophy, and admin- istrative organization. Each summer break, the teachers gather for a 3-week workshop to share experiences and enrich their teaching skills. During 1996–97, the Centre Montessori d’Haiti interrupted its teacher training courses to strengthen the Montessori preschool structure across Haiti and to conduct evaluations. Also in 1996, sev- enty-five Haitian Montessori teachers established the Association Montessori d’Haiti (AMOH), a professional teachers group. Evolution The Montessori Preschool Project in Haiti began in 1986. Since then, forty-three Montessori preschools have been established, and forty- one are still operating, having persisted in Haiti’s turbulent years of political instability. They provide services, in sixty preschool classes, for about 2,000 children each year from poor communities. Sustainability and increasing local teaching capacity are essential aspects of the project. When it began, one Montessori training cen- ter, with a preschool class of twenty-five children, trained twenty teachers in the first 9-month course. Both the center and the class were directed by expatriates. Under the leadership of a London- trained Montessori specialist from Trinidad, the capacity of the center soon grew to an annual average of forty students, mostly women. Re- cently, two additional training centers were established with financial support from the Peter-Hesse Foundation and are linked closely to the original center. With all three centers, the Montessori project cur- rently has the capacity to train sixty teachers each year. Communities Can Make a Difference: Five Cases Across Continents 313 The forty-one operating Montessori preschools include one for children with human immunodeficiency virus infection, one for deaf children, and two attached to an orphanage. Since the project began, an average of three new preschools open each year. Over the years, only one preschool has ceased operation, and one has returned to Haiti’s traditional system of rote learning. Classes remain “small” (thirty children per class), compared with the traditional Haitian classrooms of sixty children. To date, 450 teachers have been trained; 297 have received national teacher diplomas, and 83 have received international teaching diplomas. The increase in local capacity to train qualified teachers translates directly into increased capacity to provide high-quality stimulation and education programs for preschool-aged children. The children stay in the Montessori schools an average of 2 to 3 years. Of the 2,000 children enrolled each year, only about 10 percent drop out. About 660 children graduate each year, and more than 80 percent continue on to primary school. Par- ents do not seem to favor enrollment of boys over girls at the preschool level, which helps to increase the number of girls going on to primary school. Financial Support The average annual financial support for the Montessori Preschool Project has been US$100,000 or less. Often far less has been available, but funding has always been sufficient to support the project. Financ- ing is secured privately by the founder and approximately fifty indi- vidual donors per year. The German government occasionally assists with small grants to cover exceptional needs. The United Nations De- velopment Programme (UNDP) and the German Development Ser- vice (DED) have financed a U.N. volunteer in past years. The foundation’s funding supports overall project coordination and supervision and scholarship students who later teach in schools for disadvantaged children in poor communities. In addition, each new preschool receives US$3,000–$4,000 in startup funds which are used to purchase a basic set of Montessori teaching material, help with school construction and administrative organization, and 314 Simone Kirpal procure technical advice. Montessori graduates are encouraged, and financially supported, to open Montessori preschools for children at risk if the local community provides support to enable the school to become sustainable in the long term. Other financial resources are limited, but sufficient to sustain the preschools and are secured through school fees and community in-kind contributions (e.g., providing a building). The Montessori training centers raise financial contributions from the regular fees paid by student teachers who are not on scholarship. The two re- cently established training centers are paying back startup funds to the project by providing scholarships for a number of student teachers each year. Principles of Success The success of the Montessori Preschool Project can be attributed to the following characteristics. • Driven by Demand. The Montessori Preschool Project started small and has expanded in a sustainable manner. • Community-based. Schools are opened only when requested by a community and when community involvement proves to be re- liable. • Teacher Ownership. Teachers privately own the schools and are ac- countable for financing, student performance, and school repu- tation. • Financially Sustainable. Schools and training centers become fi- nancially independent after approximately 1 year. • Culturally Relevant. The project builds on indigenous cultural patterns, and the teaching methods are adapted to the local language (Creole) and oral culture. • Well-defined Selection Criteria. Selection criteria for student teachers are clearly defined, and scholarship students are screened carefully to ensure their future commitment to rural communities. Communities Can Make a Difference: Five Cases Across Continents 315 • Low-income Employment Opportunities. The project provides em- ployment opportunities for low-income individuals. Poor stu- dents who have completed secondary education can become qualified and certified teachers and are supported to open their own preschools. • Economically Inclusive. The program brings together teachers and children from different economic backgrounds. The combina- tion of poor and rich students helps the schools become finan- cially sustainable and achieve a good reputation. • Successful Teaching Method. The Montessori approach builds self- esteem, confidence, problem-solving skills, and positive life attitudes. Outlook The Montessori Preschool Project is making strides in going to scale, program evaluation, and advocacy and visibility. Going to Scale Haiti continues to have a great unsatisfied demand for high-quality preschools. With the two new Montessori training centers, training capacity has increased from twenty to sixty teachers per academic year. This increase is expected to have long-term spill-over effects as new teachers open new preschools in poor communities. To improve the educational standard in Haiti, better teacher train- ing is needed at all school levels. The Peter-Hesse Foundation pro- poses to establish a resource center to provide assistance and profes- sional development for teachers of preschool and primary school. To improve their skills in teaching and curriculum development, teach- ers using the center would be able to participate in continuing edu- cation and special-topic seminars with professional education ex- perts. They would have professional assistance to access print and electronic media materials, do research, and review didactical materi- als for specific classroom needs. To reach working teachers, the center would be available to any teacher from the public or private 316 Simone Kirpal sector and would remain open during off-work times (e.g., Saturdays, vacation periods). Program Evaluation In addition to its own 1996–97 evaluation, the Centre Montessori d’Haiti is pursuing an independent external evaluation of the proj- ect’s effect on the educational outcomes of poor children and the professional development of proficient preschool teachers. Advocacy and Visibility Promoting high-quality early child development and education as a priority in development politics, in Germany and internationally, is an important part of the foundation’s activities. For broader visibility, the foundation registered as an NGO and is represented in several childcare networks and at international early child development and U.N. conferences. The foundation’s “Three Suggestions for One World Development” was selected as input from NGOs to the U.N. World Summit for Social Development, held in March 1995. The Montessori Preschool Project was also internationally selected for presentation at EXPO 2000 in Hannover, Germany. 2. Uganda: Community-Based Mother-Child Day Care Center Services Community-Based Mother-Child Day Care Center Services (MCDCCS) provides modern, affordable childcare for working mothers living in the slums and rural trading areas of Uganda. The target group is poor, disheartened, and homeless mothers who cannot afford to pay for regular childcare services and who are not reached, permanently, by national and international programs addressing the needs of women and girls. Using an integrated approach, MCDCCS offers a variety of pro- grams to help these women, including formal and nonformal educa- tion (e.g., literacy courses), counseling on breastfeeding and family planning, promotion of safe motherhood, public health education Communities Can Make a Difference: Five Cases Across Continents 317 (e.g., hygiene and nutrition) for children and mothers, assistance with health issues and immunization, promotion of gender equality and girl’s education, enforcement of positive childrearing practices, training of childcare workers to the certificate level, and creation of employment opportunities for mothers through income-generating projects and microcredit facilities. The microcredit facilities from the centers’ revolving funds are MCDCCS’ most important services. For many women, these facilities offer the only way to borrow money to cover their social, domestic, and business-expansion needs and to pay school fees for their chil- dren. Loans are most often used to pay for prompt medical treatment for sick children. Mission MCDCCS has adopted the philosophy that “women empowered are children liberated.” Its mission is to improve the conditions of young children and end the cycle of poverty, illiteracy, and ignorance, be- ginning with their mothers. The belief is that, once poor women are freed from constant childcare and are given the chance to become economically active, the future of children will be ensured. Cultural Context In many African countries, including Uganda, men strive to show their worth by fathering as many children as possible. This practice is particularly true for unemployed, low-income, working-class men. Uganda’s illiteracy rate is high, and studies reveal that the number of educated and self-sufficient women is low, compared with other countries. The majority of women carry the burden of childbearing and childrearing, often with little or no financial support. High illit- eracy and birthrates remain a problem that stalls the productivity and potential of many women. In 1997, the Uganda government introduced Universal Primary Education (UPE), for four children per family initially and with plans to include all Uganda’s children in the near future. This proposal was intended to benefit girls; however, their traditional role at home and 318 Simone Kirpal in the workplace makes their attending school from early ages on, without interruption, almost impossible. Several other government- launched programs directly related to the advancement of women in Uganda do not reach the poorest and most marginalized women and mothers because they are not able to take advantage of these programs. Methodology and Approach The MCDCCS program aims to improve the condition of young children by empowering mothers to become economically produc- tive and less ignorant. When women are liberated from constant childcare and become involved in financial activities, the future of their children is safer, healthier, and more productive, and girls are freed from their roles as surrogate mothers caring for younger siblings. A breakthrough can be made only if women and family issues are addressed together and the specific needs of targeted women are tak- en into account. When low-cost, high-quality childcare services are provided for infants from a few days old to children more than 10 years old, mothers can become self-reliant economically and provide better for their children’s basic needs. In contrast with traditional Ugandan childcare centers, which are expensive and provide services for children aged 3 and older, the MCDCCS centers focus on children from ages 0–8+ years. MCDCCS’ general approach is integrated and holistic, and the program address- es issues such as child health, family planning, gender concerns, and special needs of girls. Besides providing a safe environment for chil- dren and educating their mothers, the centers train caregivers and teachers and generate employment opportunities for women through small-scale, income-generating projects and microcredit schemes. MCDCCS is an important step toward increasing women’s inde- pendence and helping them attain a position to negotiate greater control over family planning and birthrates, safe motherhood, and the curbing of sexually transmitted diseases, especially HIV/AIDS. An integrated approach also fosters education of women at the grass- Communities Can Make a Difference: Five Cases Across Continents 319 roots level and supports health initiatives (e.g., immunization cam- paigns) and the practice of positive public health habits (e.g., proper use of latrines). Implementation Three MCDCCS centers are currently operating. Oriented wholly to- ward serving mothers’ needs, they are located near the workplace (i.e., markets) so that mothers can conveniently drop off and pick up their children. The centers operate from 6:30 a.m. to 6:30 p.m. If a child is less than 1 year old, the mother is required to come in period- ically to breastfeed. The centers offer hourly drop-off arrangements and after-school care for older children. They also help mothers ac- quire immunization cards, which are required for all children, and keep track of immunization records. Over time, the centers have become special places for both moth- ers and children. They have become focal points for learning, teach- ing, and relaxing—places where women can openly discuss their major concerns of daily life. The centers also are vital safe havens where battered women and children in crisis can find shelter and counseling. More than 90 percent of battered women who seek refuge come with their children. Trust and understanding, which are nurtured in the centers, build a foundation for broader health and education programs, particularly family planning services. These services are open as well to women who do not have children in the centers. Basic data on the centers are monitored carefully and regularly. Some important findings are as follows: • Between 1987 and 1999, more than 900 mothers used MCDCCS services and approximately 6,600 children benefited from the program. • Children who attend the centers beginning at an early age (i.e., from a few days to 1 year old) perform much better in all aspects of child development and skill learning than children who be- gin coming to the centers at age 3 or later. 320 Simone Kirpal • Infant mortality among MCDCCS children is extremely low (3 out of 6,600 children compared with Uganda’s average of 83 per 1,000 live births) . • The growing demand for family planning services has led to a decreased number of very young children (less than 1 year old) in the centers, from a daily average of twenty-five in 1987 to four in 1999. As women are liberated from childcare duties, they can engage in economic activities to better provide for their family. A mother’s ability to pay the monthly fees for childcare services promptly can be interpreted as a direct indicator of a reduction in poverty. Between 1987 and 1999, the number of MCDCCS mothers who paid promptly increased from 20 percent to 50 percent despite a tenfold increase in fees. Mothers who attend the centers’ programs soon become agents of positive change within their homes, communities, and workplaces. Community-level indicators for evaluating and monitoring the effect of the MCDCCS centers include: • Increased number of women requesting family planning ser- vices • Improved weight and overall health status of children attending the centers • Decreased infant and child mortality rates • Increased immunization coverage • Increased school readiness and, thus, school attendance, espe- cially for girls • Increased literacy rate among girls • Decreased population growth rates • Decreased rate of sexually transmitted diseases, especially HIV/AIDS • Improved living conditions for center children diagnosed with HIV/AIDS, as a result of receiving proper care, adequate feeding, and prompt medical treatment Communities Can Make a Difference: Five Cases Across Continents 321 • Better opportunities for center mothers diagnosed with HIV/AIDS, to continue working if they can • Reduced violations of children’s rights (e.g., sexual abuse, child marriage, child mothers) • Improved parenting skills of women. Evolution In 1994, a group of Ugandan women, who were members of the Uganda National Council of Women (now known as the National As- sociation of Women Organizations in Uganda, or NAWOU), initiated a project for underprivileged women. The aim was to give poor women struggling in Ugandan slum areas a chance to become more productive economically, more confident, and better able to care for their children properly. This group identified the burden of continual childbirth and child- rearing as the greatest handicap to economic productivity of women and increased school enrollment rates for girls. Affordable, high-qual- ity, mother-child day-care centers were proposed as a practical solu- tion to enhance poor children’s chances by providing a safe, healthy, and stimulating environment. In addition, these centers provided a setting for gradually introducing related educational and health pro- grams. After the project was initiated, the mothers began to view the day- care centers as special places where they could ask for advice on al- most everything concerned with daily life. Related educational and health programs were introduced gradually and, in time, the centers evolved into sanctuaries where local women and children could learn, teach, and relax. Financial Support The MCDCCS strategy combines income-generating efforts with fi- nancial support from international donors and assistance from na- tional governmental and nongovernmental agencies. The program generates money by collecting small fees from the mothers for child- care services (as mothers’ potential for economic productivity 322 Simone Kirpal increases, they are expected to pay higher fees for services); engaging in income-generating activities, such as poultry (selling eggs and hens) and pig farms; operating small farms and gardens for subsis- tence-level production of local fruits and vegetables; charging fees for training services; and renting out the main hall of the centers for spe- cial events. MCDCCS offers employment possibilities for unemployed moth- ers who use the centers’ childcare services. An average of sixty work- ers per month, mostly mothers, are employed in the three centers and for the income-generating projects. The Ministry of Education provides technical assistance to main- tain the legal and professional status of the centers and a training school. Family planning materials are supplied by the City Council of Kampala, Department of Health. The program also receives major technical and financial support from NAWOU, which promotes MCDCCS locally and helps establish international contacts. In the past, the Swedish International Development Cooperation Agency (SIDA) provided a grant of US$15,000, and the United Nations Educa- tional, Scientific, and Cultural Organization (UNESCO) provided a grant of US$25,000. At the Development Marketplace 2000, held February 8–9, 2000, in Washington, D.C., MCDCCS received US$90,000. The Develop- ment Marketplace provides a forum to identify and nurture innova- tive ideas in the development community. In a competition open to NGOs, businesses, academia, foundations, and bilateral and multilat- eral agencies, the Development Marketplace awarded approximately US$5 million in startup funds for project proposals to reduce poverty. MCDCCS committed the new funds to improve and update the three existing centers; expand services by starting three new centers; in- crease its income-generating potential by producing children’s books and teaching material and expanding farm production; increase local capacity—through training, supervision, improved teaching material, performance assessments, and evaluation—to provide high-quality childcare services; introduce new elements, such as music and com- puter equipment and skills; and launch a major marketing campaign Communities Can Make a Difference: Five Cases Across Continents 323 (e.g., using posters, radio, newspaper, and TV announcements) to cre- ate awareness of child development issues related to health and edu- cation in the early years and the positive role of the family. Principles of Success The success of the MCDCCS program can be attributed to the follow- ing characteristics. • Holistic Approach. Creatively, MCDCCS combines early child de- velopment, parent education, and family planning with job cre- ation and income-generating activities. • Targeted Needs. The program is designed to meet the specific needs of one of the poorest and most marginalized groups in Uganda—illiterate and excluded women in slum areas. • Community-based. The centers are community-based and adjust their programs to meet mothers’ needs. • Flexible. The program is flexible in providing education and health programs on demand. • Monitoring. The centers carefully monitor the children’s growth and their motor and cognitive development. • Linkages. MCDCCS has wide and various spill-over effects be- cause the centers establish linkages between nonformal educa- tion for women, health education, and family planning with other national health and immunization campaigns. • Empowerment. MCDCCS alleviates poverty at the grassroots level through empowerment. Outlook The MCDCCS program is planning for long-term sustainability, influ- encing public policy, and improving literacy among Ugandan women. Sustainability With six centers, MCDCCS plans to become financially sustainable by expanding its income-generating activities, providing professional 324 Simone Kirpal training for teachers and caregivers, and enhancing the ability of mothers to pay higher fees for childcare. Advocacy MCDCCS envisions having a broader influence on public policy by raising awareness of the need for mother-child services in communi- ties and eventually achieving a nationwide effect. Literacy One center program that has not reached most MCDCCS women is literacy. The mothers’ key objective is survival and, beyond that, they rely on the centers to enable them to increase profits from their busi- nesses. They cannot imagine spending precious time studying. The mothers also note that, because they are now able to educate their children, the children can read and write for them if needed. As long as women are poor and struggling to survive, they will not consider literacy a priority. Only by establishing day-care centers on a massive scale will girls be able to begin their education early and in large numbers. These centers, in the long term, will dramatically help re- duce the number of illiterate women in Uganda. 3. Trinidad and Tobago: Integrated Education and Early Childhood Program SERVOL (Service Volunteered for All) is an NGO in Trinidad and To- bago that administers high-quality education programs in disadvan- taged areas. The programs include a parent outreach program for par- ents ages 17–30, an early childhood program for children ages 2.5–5, a nonformal secondary school program for children ages 13–16, a hu- man development and skill training program for adolescents ages 16–20, and a high technology program for young men and women ages 20–25. All programs are operated entirely, both in content and monitor- ing, by people from the community. Each of the 160 early childhood centers and 40 adolescent centers operate under the auspices of a Communities Can Make a Difference: Five Cases Across Continents 325 village board of education, which hires and fires teachers in consulta- tion with SERVOL. These boards convene monthly meetings to ob- tain input from parents, and they regularly canvas 4,500 adolescents to obtain their views on the effectiveness of the programs and sugges- tions for improvement, which are then implemented. Mission SERVOL is “igniting the fires of hope.” It is an organization of weak, frail, ordinary, imperfect, and yet hope-filled and committed people seeking to help weak, frail, ordinary, imperfect, and hope-drained people become agents of attitudinal and social change in a journey that leads to total human development. Cultural Context The Black Power riots, which took place in Trinidad and Tobago in 1970, were interpreted by Fr. Pantin, the founder of SERVOL, as a “cry for help” from the ghetto. As he walked up the hill of Laventille to try to respond, he was confronted by the social problems of the area and its people: unemployment, poverty, and low self-esteem. Fr. Pantin observed that the main cause of these problems was a total breakdown of family life, coupled with inappropriate parenting prac- tices. Not knowing how to respond to the situation, he decided to begin by listening to the people and helping them start their own small projects. The people first asked SERVOL to establish early childhood pro- grams (focused on day care, not education), and they subsequently challenged SERVOL to give their children access to quality educa- tion, computers, and advanced electronics. SERVOL became a peo- ple’s organization committed to the building of bridges between the ghetto and the world of commerce and industry by offering high- quality programs to low-income families. To ensure that these pro- grams meet international standards, SERVOL’s Early Childhood Teachers’ Certificate is validated by Oxford University, and its Hi- Technology programs are examined by the firm of Cambridge Infor- mation Technology. 326 Simone Kirpal Methodology and Approach SERVOL’s pioneers believed that previous efforts to help poor people had been largely unsuccessful because well-meaning “do-gooders” assumed, with cultural arrogance, that they could organize interven- tion programs without consulting the beneficiaries. SERVOL insists on beginning by asking, “How can we help you?”, and then by listen- ing attentively to the response, before attempting to organize any projects. SERVOL calls this type of intervening in the lives of people “respectful intervention.” SERVOL’s pioneers also observed that many poverty programs at- tempted to address one or more problems in isolation but that pover- ty reaches every aspect of life and demands an integrated approach. Although lack of financial resources is clearly an important factor, it is not the most debilitating affliction of poor people. More perni- cious is the sense of powerlessness and hopelessness that, for most poor people, makes climbing out of “the pit of poverty” virtually im- possible. To meet this challenge, SERVOL embraces the empower- ment of individuals, families, and communities through integrated educational programs designed to revive hope. SERVOL’s guiding principle is to use people from the community to develop the community. Ninety percent of the 600 teachers, train- ers, and administrative staff are grassroots community members. All programs are truly community-based and parent-oriented. The com- munity boards of education manage the SERVOL centers; employ the teachers and instructors; pay their salaries and their National Insur- ance and Health Surcharge contributions (from government funds transferred to their accounts by SERVOL); monitor teachers’ atten- dance, punctuality, and performance; and dismiss delinquent teach- ers in consultation with SERVOL. Implementation The aims of SERVOL are implemented through a variety of programs to reach across a range of age groups in the community. Five major programs are described below. These programs have stood the test of Communities Can Make a Difference: Five Cases Across Continents 327 time and their current success reflects a sometimes long and difficult development effort. Parent Outreach Program Guided by latest research findings in neuroscience and the social sci- ences, SERVOL established the Parent Outreach Program (POP) to give poor children a good start. Evidence shows that children’s growth and development between 0 and 3 years largely determine how they will develop and learn subsequently and that, by the time they reach age 6, they are resistant to change. Waiting for children to enter primary school is too late to begin to attack the effects of pover- ty. Efforts must begin with pregnant mothers, many of whom are sin- gle parents who, because of financial and psychological stress, may neglect or batter their children. To reach these families, SERVOL has trained twenty-five POP facili- tators who visit the remote villages and ghettos of Trinidad and Toba- go each day, going from house to house, making friends with parents, and helping them deal with their problems with small children and life in general. The facilitators praise the parents for their accomplish- ments and counsel them on the importance of proper nutrition, breastfeeding, and alternatives to physical punishment. In subse- quent meetings, small groups of parents share common problems and possible solutions. The facilitators also teach the parents income- generating crafts enabling them to earn money while staying home with their children. An extension of the POP program is Parent Partners. Under this ac- tivity, one parent from the village agrees to be trained to work with the POP facilitator, and small day-care facilities, for three or four chil- dren, are established in the houses of selected parents who are willing to be trained in day-care skills. POP facilitators do not project the conventional image of profes- sionals who have all the answers, an approach that may intimidate parents; rather, the facilitators praise the parents for their accom- plishments in difficult situations and convince them that they are the primary educators of their children and can solve their own 328 Simone Kirpal problems with a little help. The POP program has been received en- thusiastically by thousands of parents, acknowledging their growth in parenting skills and self-confidence. Many have become successful entrepreneurs in making crafts and other products while staying home to care for their children. ECCE Program SERVOL has established and supervises a national ECCE program that involves 160 centers and more than 300 teachers serving almost 5,000 children ages 2.5–5 years. All teachers have been carefully trained, and most have received an Early Childhood Teachers’ Certifi- cate validated by Oxford University. Like POP, this program is guided by SERVOL’s belief that “what goes on in the home is more important than what goes on in the school.” A high-quality early childhood education that is commu- nity-based, parent-oriented, and administered by trained teachers is one of the most important ways to bring about desirable, funda- mental change in poverty situations. The ECCE program extends empowerment from the child and parents (emphasized in the POP program) to the community and, importantly, encourages and permits teachers to influence parents’ childrearing practices. The program is intended to have a cumulative effect on parental practices over time. The community actively participates in the operation of the centers, which are managed by the village board of education. Junior Life Center Program With few exceptions, all children enter primary school in Trinidad and Tobago (ages 5–12). However, only 80 percent of the 30,000 chil- dren who attend and complete primary school enter secondary school. The vast majority of this large number of children who drop out come from poverty areas and are so “turned off” by the tradition- al educational system that special approaches are needed to rekindle their hope. SERVOL’s Junior Life Center (JLC) program offers more than 6,000 children ages 13–16 an innovative curriculum designed to Communities Can Make a Difference: Five Cases Across Continents 329 restore self-esteem and enable them to rejoin the mainstream educa- tional system. In this program, classes are small (one teacher for twenty-five stu- dents), and each corner of the classroom has a special function, serv- ing as a miniature bank, post office, department store, or supermar- ket. These “props” are used to teach literacy and mathematics and to demonstrate that learning can be fun. Data show that 70 percent of these children perform very well in the post-primary examination and are able to return to traditional secondary schools. Adolescent Development Program Another feature of the educational system is the high number of 16–19 year olds who do not complete school or complete school functionally illiterate and with limited knowledge. Reasons include poverty (resulting in chronic absenteeism), substance abuse, and an overly academic approach to education that is unsuitable for young people seeking vocational training. SERVOL’s Adolescent Develop- ment Program (ADP) is designed to serve these young people and has graduated more than 40,000 adolescents over the past 30 years. ADP is a four-stage program. It begins with a 3-month intensive attitudinal component, which transforms hostile adolescents who have battered egos into confident young adults who learn to un- derstand themselves through a variety of courses in, for example, self-awareness, spirituality, literacy, emotional understanding, rap sessions, public speaking, and art analysis—all administered by trained staff. Most importantly, both young men and women are exposed to an Adolescent Parent Program in which they learn about the needs of their future children and interact with babies and toddlers in reinforcing practical sessions held in the centers’ day-care units. In the second, 9-month, stage, the young adults pursue technical training in a skill of their choice from fourteen vocational courses of- fered. They are then placed with private companies for job training, which is evaluated by the company. At the end of this training peri- od, they graduate from SERVOL and seek employment or apply to 330 Simone Kirpal SERVOL’s sister organization, FUND-AID, for a small loan to purchase equipment and become micro-entrepreneurs. SERVOL graduates have a reputation as reliable and hardworking employees, most of whom find a job within a year. A number of sur- veys reveal that 78 percent of all companies interviewed would give preference to SERVOL graduates because they display a more positive work attitude and a good work ethic, a result that was confirmed in a 1998–99 study. Evaluation studies also show that SERVOL’s female graduates tend to postpone childbearing until their mid-20s—a sig- nificantly higher age than the norm of 16–18 years. So far, SERVOL has not had any problem with any “delinquent” students taken in at the request of the Ministry of Education. Each year, the Ministry asks SERVOL to accept thirty to forty adolescents who are deemed un- manageable by their school principals; at the end of the 3-month ADP, these young people can return to their original school or pursue a vocational course with SERVOL. Hi-Tech Program Five years ago, SERVOL assessed its accomplishments after 25 years. Despite its documented success, dissatisfaction arose with its gradu- ates’ lack of access to technology careers. Although SERVOL had suc- cessfully trained thousands of carpenters, practical nurses, electri- cians, and other skilled experts, most of whom had secured employment, SERVOL’s graduates had no access to the world of high technology that was sweeping over Trinidad and Tobago. As a conse- quence, SERVOL explored funding possibilities to provide opportuni- ties for technology careers. Recently, the Inter-American Development Bank (IDB) agreed to fund SERVOL’s Hi-Tech project, offering postgraduate courses in computer technology, digital electronics, and computer control elec- tronics in one of SERVOL’s three Hi-Tech centers, which graduate 400 students yearly. Local industry hires many of these graduates im- mediately. Among the 1998–99 class, 53.0 percent were placed in jobs immediately and 20.7 percent opted for further education. Only 26.3 percent of all graduates could not be placed or contracted. Communities Can Make a Difference: Five Cases Across Continents 331 Evolution Three months after Fr. Pantin walked into the ghetto of Laventille in 1970, he confessed to a resident, Chaca, that he was “getting nowhere” and was thinking of returning to his teaching post at St. Mary’s College. Chaca was vehement in his protest: “You cannot do that! It is true that you have done nothing more than get jobs for a few dozen kids, but what you have really done is to bring hope to the area. Every morning you walk up the hill, those watching you think, maybe tomorrow it will be my turn to get a job. And once people have hope, they will continue the struggle.” Initiated in 1971, SERVOL achieved sustainability in 1987 when the government of Trinidad and Tobago, through the Ministry of Ed- ucation, established SERVOL as its agent for nonformal education and assumed payment of the salaries of teachers and instructors, which were formerly paid through grants from overseas foundations. In 1992, based on a very special private-public partnership agree- ment, the Ministry of Education assumed full financial responsibility for SERVOL’s programs. SERVOL still “walks up the hill” every day, but Fr. Pantin and Cha- ca have been replaced by thousands of adolescents, hundreds of ear- ly childhood educators, and scores of outreach workers who visit parents. This growing number of trainees, instructors, and preschool children proclaim silently to people throughout Trinidad and Toba- go: “We are SERVOL and we bring with us a message of hope.” Financial Support 1971–86 In this initial period, SERVOL depended heavily on the financial sup- port of overseas foundations. The main contributors were the Bernard van Leer Foundation, The Netherlands (for the ECCE Pro- gram); Misereor, Germany (for ADP); Helvetas, Switzerland (for infra- structure development); the Inter-American Foundation, United States (for rural agricultural and development programs); Save the Children, Canada; and Development and Peace, Canada (for training and equipment). 332 Simone Kirpal Although SERVOL’s programs clearly provided a valuable service to Trinidad and Tobago, the government provided no support initially, except for two contributions for the construction of two adolescent centers. However, the business community and the public provided significant support. Eventually, SERVOL was able to derive some 15 percent of its total income from the production of its adolescent training departments, which accepted construction and maintenance contracts from customers. 1987–91 The new government in 1986 asked SERVOL to expand the ECCE Program and the ADP across Trinidad and Tobago. Unfortunately, the new government had inherited an almost bankrupt economy and had few funds available to support expansion. With support from three foundations that had been providing significant fund- ing over the previous years (the Bernard van Leer Foundation, Mis- ereor, and the Inter-American Foundation), SERVOL was able to ne- gotiate a 5-year contract with the Ministry of Education. Under this contract, SERVOL secured foundation support for the expanded program over the next 5 years (1987–91) on a declining basis, beginning with total funding for 1987 and dwindling to zero fund- ing in 1992; the Ministry of Education provided minimal funding in 1987 and gradually increased its contribution to total support in 1992. 1993–2000 In 1992, the Bernard van Leer Foundation indicated that it would cease funding for SERVOL. This announcement posed a financial challenge because the Ministry of Education funded only salaries of teachers and instructors and SERVOL depended entirely on the foun- dation for support of administrative and infrastructure expenses. SERVOL proposed that the foundation help establish an endow- ment fund to eventually make SERVOL independent of overseas fi- nancial support. SERVOL launched a vigorous fundraising campaign, focusing on banks and local business conglomerates, and the founda- Communities Can Make a Difference: Five Cases Across Continents 333 tion matched every dollar SERVOL collected. SERVOL’s endowment fund currently has approximately US$3.5 million and SERVOL is al- most self-sufficient. SERVOL and the Ministry of Education currently have a tacit agreement whereby the Ministry officially recognizes SERVOL as its agent for the development and dissemination of early childhood and adolescent programs in Trinidad and Tobago. Since 1990, the govern- ment budget includes an annual subvention to SERVOL. SERVOL op- erates relatively autonomously in implementing its nonformal educa- tion programs, with the stipulation that it submit regular reports and annual audited accounts to the Ministry. The government has entrusted the entire ECCE program to SER- VOL, and SERVOL plays an active role in influencing public policy and the funding of ECCE programs. When SERVOL began to devel- op its own ECCE program in the 1970s, the government of Trinidad and Tobago was not interested in early intervention programs. The only public program consisted of fifty preschools based in commu- nity centers and managed and staffed by young women with little or no training. SERVOL embarked on a public education program to alert the population to the importance of the early years of child- hood. By 1981, SERVOL had become known throughout the Caribbean as the agency that offered high-quality training for early childhood educators. Over the past 20 years, SERVOL has trained approximately 600 teachers from all over the Caribbean region to certificate level, as validated by Oxford University. As a net effect, the SPICES curriculum developed by SERVOL is now used widely throughout the Caribbean and has been adopted for teacher train- ing programs at the School of Continuing Studies of the University of the West Indies. Four recent, significant events highlight SERVOL’s importance and positive effect on ECCE in Trinidad and Tobago: • Maintaining Government Support. When the new government in 1992 slashed the ECCE budget by 40 percent, SERVOL mobi- lized the 150 communities operating parent-supported ECCE 334 Simone Kirpal centers. As a result, the Senate postponed discussion of the na- tional budget until the government guaranteed restoration of the ECCE budget. • Securing IDB Funding. SERVOL had campaigned to increase the salaries paid to the training staff and teachers of its 150 centers. In 1996, the IDB, Ministry of Planning and Development, and SERVOL signed a grant agreement which effectively doubled the salaries and significantly improved the status of teachers. This agreement implies that the Ministry of Education will assume this financial commitment when the IDB grant expires. • Expanding POP into the Ministry of Education. In 1993, the govern- ment commissioned a task force to review the entire education system of Trinidad and Tobago, and SERVOL’s executive director was asked to chair the ECCE subcommittee. One of the subcom- mittee’s resolutions suggested application for a loan to build and staff fifty new preschools and to augment POP by paying for twenty-five additional parent outreach facilitators. This reso- lution signaled a breakthrough in educational policy. • Establishing an Association for ECCE. By 1999, enthusiasm for ECCE had increased remarkably, fueled largely by the growing number of trained personnel emerging from SERVOL. A number of these graduates formed an association for ECCE in Trinidad and Toba- go which included ECCE personnel from the private and public sectors. Principles of Success The success of SERVOL can be attributed to the following charac- teristics. • Idealism. Idealism permeates the organization, empowering peo- ple to transform their own lives every day. SERVOL shows how a person, in contact with small children, adolescents, mentally challenged individuals, parents, and communities, can become a change agent. The SERVOL staff complete each day exhausted, but electrified, because by helping others change, they are themselves transformed in rewarding and satisfying ways. Communities Can Make a Difference: Five Cases Across Continents 335 • Decentralization. SERVOL is a decentralized organization and all participants have enough room and autonomy to be creative. As the organization expands, bureaucracy is avoided as much as possible. • Constant Training and Retraining of Staff. As a relatively small orga- nization, SERVOL invests much time and money in continual training of staff and building sustainable capacity in order to be able to rely on its own human resources and to promote staff within the organization. Staff members have risen from instruc- tors and coordinators to the highest levels of administration, and approximately 25 percent of the staff were formerly trainees in the ADP or ECCE program. • Tight Fiscal Control. All of SERVOL’s finances are carefully con- trolled. Vouchers and receipts are required for even minor fi- nancial transactions. • Fulfillment and Satisfaction. Most significantly, SERVOL offers everyone an opportunity to contribute to a noble, righteous cause outside of themselves. Many of SERVOL’s dedicated staff stay at SERVOL even when apprentices they have trained return and say they are making more money than their instructors. Outlook SERVOL is striving to reach out to more children, extend ECCE pro- grams to children ages 0–2.5, and engage private childcare centers in ensuring high-quality standards. SERVOL has also successfully ex- panded its programs to other countries worldwide. Going to Scale SERVOL has established the groundwork for high-quality ECCE in Trinidad and Tobago and seeks to build on this accomplishment by expanding the program so that every child ages 2.5–5 years has access to high-quality services. To reach out to the majority of the poorest children, the number of the current 160 public ECCE centers must be doubled or even tripled. 336 Simone Kirpal Extended ECCE By the time a child enters an ECCE center, inappropriate parenting practices during the first years may have already caused consider- able damage. One aim is to extend the current ECCE programs to children between the ages of 0 and 2.5 years to complement the efforts of the POP program. Support of preventive programs is far easier and less expensive than repairing damage that has already occurred. Improved Private ECCE In addition to the 160 public ECCE centers that SERVOL closely monitors and regularly evaluates, Trinidad and Tobago has approx- imately 600 privately operated ECCE centers, most of them lacking supervision and adequate quality standards. More support for pri- vate childcare centers and monitoring is needed to improve their operations, train teachers, and ensure that the center structures are adequate. Expansion to Other Countries SERVOL has expanded its ADP and ECCE program to almost every country in the English-speaking Caribbean and as far afield as South Africa and Ireland. Expansion to a country begins with an invitation from SERVOL to interested persons to visit a SERVOL project. If the individuals decide that the project is applicable to their country, they are invited to send a senior person to spend time (from 3 months to 1 year) to be trained as a teacher trainer and then return to the home country to initiate the project. 4. East Africa and South Asia: Capacity Building and Innovations in Early Child Development The Aga Khan Foundation (AKF) is a private, nondenominational development agency created under Swiss law in 1967. It operates in fourteen countries through field offices located in Kenya, Uganda, Communities Can Make a Difference: Five Cases Across Continents 337 Tanzania, India, Bangladesh, Tajikistan, Pakistan, and Mozam- bique. AKF focuses on four main areas: rural development; health; education and enhancement of NGOs, organizations, and related concerns including community participation; and women and the environment. AKF currently supports more than 100 projects and programs. Twenty-five of these are related to education, approximately half to the Young Children and the Family (YCF) program and half to the School Improvement Program (SIP). The overall goals of these two programs are to: (a) increase the quality of formal and nonformal ed- ucational settings and of early childhood care and development (ECCD) programs, and (b) increase access, completion, and learning achievement rates for disadvantaged groups, especially girls, isolated rural children, and poor urban children. AKF is part of the wider Aga Khan Development Network, a group of institutions interested in social and economic development and in promoting and supporting culture. The foundation collaborates with governments (e.g., Canada, United States, Switzerland), other donor agencies (e.g., European Commission, World Bank), and foundations (e.g., Ford Foundation, Bernard van Leer Foundation). Over the past 15 years, AKF has helped to create and strengthen lo- cal NGOs and selected government resource bases. Many of the NGOs partner with local governments to improve the quality of basic education. Others primarily help communities and community- based organizations establish, manage, and finance their own ECD activities or primary schools. This assistance usually occurs where al- ternative education models facilitate increased access to education for disadvantaged communities (e.g., rural areas, ethnic minorities) or for girls. Two AKF-supported projects are described below: the community preschool program linked to the Madrasa Resource Centers (MRCs) in East Africa, and the preschool and primary community schools proj- ect in Sindh, Pakistan, led by Aga Khan Education Services, Pakistan (AKES, P). 338 Simone Kirpal Mission The mission of AKF is to promote creative and effective solutions to problems that impede social development in specific regions of the developing world. Cultural Context The MRCs in Kenya, Uganda, and Zanzibar help disadvantaged ur- ban, peri-urban, and rural Muslim communities establish communi- ty-owned and community-managed preschools. The curricula and overall ethos of the centers reflect each country’s national ECD framework and/or curricula, language, and culture (e.g., the Swahili culture on the coast of Kenya and the Zanzibar islands, the Luganda culture in Uganda) and values and beliefs drawn from Islam. The project in Sindh, Pakistan, Improving Pre- and Primary Educa- tion (IPPS), operates in rural Sindh. The AKES,P team leading the project helps communities establish community-owned and commu- nity-managed preschools and primary schools. The team helped develop a preschool curriculum that encourages the integral develop- ment of children, drawing on their parents’ and communities’ cul- tural backgrounds and values. Methodology and Approach Both the MRC and IPPS programs focus especially on: (a) ensuring that girls constitute at least 50 percent of the total enrollment; (b) se- lecting and training local women (who may not have completed grade 10) to serve as school teachers and administrators; and (c) pro- moting and ensuring that women are represented on management committees. Many girls and women in the participating communi- ties have limited opportunities outside the home. The directors of the three MRCs and the director of IPPS are women. The two programs adapt their similar approaches to their particu- lar contexts. Both programs: • Work closely with communities to build trust and partnership and to encourage dialogue and full participation Communities Can Make a Difference: Five Cases Across Continents 339 • Provide intensive and regular training and mentoring for com- munities to strengthen local capacity, develop leadership skills, raise awareness, and mobilize the communities • Promote development and use of low-cost teaching and learn- ing materials • Introduce activity-based learning and develop appropriate cur- ricula • Support local women and promote girls’ education • Pursue financial sustainability by strengthening the local com- munities’ capacities to manage and finance their own schools. Implementation Various activities are undertaken in the MRC and IPPS programs to build trust and encourage dialogue; train, mentor, and provide support; and monitor and assess progress. Key activities are de- scribed below. Initial Community Work and Establishment of Schools To build trust and encourage dialogue, the MRC and IPPS teams con- duct initial community awareness and mobilization activities for 3 to 12 months, holding discussions with community members on key program components, including partners’ roles and responsibilities. The IPPS teams conduct an initial survey of potential school-age chil- dren. The MRC teams collaborate with community development offi- cers, who lead the mobilization and train and support school man- agement committees for 2 years. The AKES,P and the MRCs sign a contract with interested commu- nities outlining the terms and conditions of the partnership and re- sponsibilities, and the communities open bank accounts for their schools. The communities then find suitable premises for the schools. In the MRC program, existing madrasas (traditional Islamic schools usually devoted exclusively to religious education) are used when possible because they are usually vacant during the mornings; otherwise, the communities build their own preschools. In the IPPS project, the communities rent buildings, obtain donations of 340 Simone Kirpal buildings, or build new schools. The communities also identify local women candidates to be trained by the project teams, and they elect the management committee. In IPPS, local Community-Based Edu- cation Societies (CBES), which include parents and community lead- ers, are formed and registered. The MRCs work with their communi- ties to register their preschools. Training, Mentoring, and Support The MRC and IPPS teams provide ongoing training, mentoring, and support for trainees, who will serve as teachers and administrators in communities and schools. MRCs. The MRCs provide initial orientation training of 1 month to introduce basic concepts of active learning, organization of appropri- ate learning environments, and ways to develop low-cost classroom materials. Thereafter, teachers receive in-school support once a week for 78 weeks during the 1.5 years of the contract and then two or three times a month for the duration. Teachers also meet weekly in small groups at the MRCs throughout the 2 years for planning and problem solving with MRC trainers. IPPS. Teacher development consists of an initial 5–6 months of in- tensive, holistic training provided in Karachi and focused on the women trainees’ personal, moral, and professional development, as trainees will have multiple roles on their return to the community (as teachers, women, and extended family and community members). Training emphasizes self-development, responsibility, mutual respect, collegiality, and teamwork. The IPPS team provides additional in-ser- vice training and biweekly follow-up support in schools throughout the first 2 years. Training also is provided to the MRC’s school man- agement committees and the IPPS’ CBES on community mobiliza- tion, fundraising, basic accounting skills, and school management and planning. Most of this training occurs in the communities. Monitoring and Assessment of Progress Progress is monitored and assessed continually to assure quality, good management, and financial sustainability. Communities Can Make a Difference: Five Cases Across Continents 341 MRCs. Trainers and community development officers visit schools weekly to work with teachers, management committees, and the community. A Madrasa Evaluation Instrument (MEI) is completed by MRC staff and shared with the school management communities every 6 months. The results of this evaluation are discussed and used to plan for the next 6 months. The MEI is adapted from the High/Scope Program Implementation Plan and addresses the proj- ects’ main components: quality of teaching and learning, adult-child and child-child interactions, parent and community participation, school management, and appropriate use of local cultural and reli- gious values. The MEI is an important part of the criteria for the school and community’s “graduation” from the program, with ex- pected levels of achievement outlined. IPPS. The IPPS team meets monthly with each CBES to provide training and perform regular audits. IPPS field supervisors offer bi- weekly support to teachers. In addition, three AKES,P board mem- bers, IPPS professional staff, and all CBES chairpersons meet quar- terly in workshops to improve management, administrative, and fundraising skills and to share experiences and solve problems across communities. Evolution The MRC and IPPS programs began separately and at different times, but have influenced each other as they have developed. MRCs The MRC program began in Kenya in the mid-1980s to address com- munities’ concerns about strengthening children’s understanding of their local culture and religion and increasing their chances for access to, and success in, formal education. A local, well-respected Muslim woman, trained as a primary teacher, began working with a few com- munities to develop the curriculum and approach. Over time, inter- est grew and the AKF helped to establish the first MRC in Mombasa, Kenya, in 1986. AKF established the MRC in Zanzibar in 1990 and the MRC in Uganda in 1993. 342 Simone Kirpal In the mid-1990s, AKF staff undertook an internal review of the MRCs and their preschools, which numbered three in Uganda, fifteen in Kenya, and about twenty in Zanzibar. The main issues facing the program at that time included (a) strengthening the MRCs’ capacities to develop, implement, and monitor the preschool program on a larger scale; (b) addressing the financial sustainability of the preschools and ensuring that they were com- munity-owned and community-managed and that they provided quality early learning experiences; and (c) achieving sustainability for the MRCs. By early 2000, the MRCs were working with more than 130 com- munities across East Africa, each with its own preschool. The MRCs have strengthened their organizational and technical capacity and have improved their community skills. For the future, they are con- sidering continued work with disadvantaged Muslim communities, provision of selected training of trainers and short courses for preschool teachers from a broader range of communities, and “piloting” new activities (e.g., working with parents and other caregivers). IPPS The IPPS project began in 1996 and currently involves twelve com- munities that are establishing preschools and primary schools. The schools begin with preschool classes and add on additional grades each year as the children progress. During initial development, the MRC program shared lessons with its IPPS colleagues in Pakistan. Currently in its second phase, IPPS plans to expand to another six to eight communities in rural Sindh. Additional work with mothers and other caregivers, focusing on children under 3 and childrearing prac- tices at home, is also planned. IPPS hopes to extend its effects by mainstreaming its key lessons and approach to other NGOs working with community schools around Sindh through training trainers and, possibly, attaching these organizations’ staff to IPPS for certain periods of time. Communities Can Make a Difference: Five Cases Across Continents 343 Financial Structure MRCs The MRCs receive cofunding from AKF and one or more of the fol- lowing: the Canadian International Development Agency, European Commission, Ford Foundation, Bernard van Leer Foundation, gov- ernment of Kenya, World Bank, and Rahimtullah Trust (a local phil- anthropy). Each community receives the equivalent of US$1,000 as an initial seed grant for learning and teaching materials and basic school equipment (e.g., low shelves, mats, outside play equipment). This money is also used as “top-up” funds for refurbishment and low- cost construction of the building. In general, the seed grant is given in small disbursements according to an agreed-upon plan and costs estimated by the community. To address the continuing vulnerability of the preschools, especial- ly in poorer communities, the AKF and MRCs are piloting the use of community-level mini-endowments pooled within countries and re- gions. A portion of the returns (5 percent) on the investment would be returned regularly as dividends to the communities to contribute to (but not fully pay) the operating costs of their preschools (includ- ing teachers’ salaries, a main cost). Communities are expected to con- tinue to ensure that the mutually agreed-upon school fees are paid (or subsidized from elsewhere) and to conduct other fundraising ac- tivities to cover any deficits or increase their endowment. Each mini-endowment consists of a “graduation grant” of US$2,500 given to schools that meet agreed-upon criteria for gradua- tion, which include a quality learning and teaching environment, regular and active participation of the school management commit- tee, and regular payment of teachers’ salaries for the previous 6 months. Communities also can add funds to their endowment, and up to US$2,500 would be matched by the program. With this match- ing program, the community could accumulate an endowment fund of US$7,500. As of April 2000, the average endowment capital per graduated school was $4,701 in Kenya, $3,640 in Zanzibar, and $2,932 in Uganda. 344 Simone Kirpal An initial group of thirty-eight schools have “graduated” across the three countries. AKF has held lengthy discussions with the com- munities about types of investment mechanisms (e.g., mutual funds, treasury bills, fixed income accounts) and with local banks, MRCs, and the national boards about management of the endowments. During 2000, the thirty-eight schools will participate in a piloting of the mini-endowment concept. This pilot effort will be monitored to assess whether the endowment is an effective mechanism for en- abling schools to become self-sustaining and to determine factors that enable schools to use the endowment dividends effectively. IPPS The IPPS project is funded by AKF and the U.S. Agency for Interna- tional Development (USAID). Since the beginning of the program, AKES,P has tried to help build long-term sustainability of the com- munity schools and to ensure the quality and relevance of the teach- ing and learning process. Financially, the IPPS project has adopted a similar approach to the MRCs’ mini-endowments. The goal for the community schools is to become financially self-sufficient within 2 years. Approximately ten of the twelve schools initiated during the first 3–4 year phase are currently self-sustaining financially. The fol- lowing steps are taken to achieve self-sufficiency: • Each IPPS project covers all operational funds for its schools, in- cluding teachers’ salaries and operating expenses. • During the first 2 years, the CBESs collect fees from students and additional donations from local sponsors, which are often used to off-set fees for the poorest students. These funds are deposit- ed into a “collection account” managed jointly by IPPS and the respective CBES. IPPS does not release funds for teachers’ salaries until the monthly fees have been obtained, and the CBES account only increases if the fees and donations collected adequately cover the salaries and other operating expenses. • Money deposited into the account is allowed to grow, in accor- dance with banking regulations of Pakistan, for 2 years and Communities Can Make a Difference: Five Cases Across Continents 345 then the account becomes an investment fund invested on be- half of the CBES. When the CBES achieves adequate local capacity to manage the securities, the money is transferred entirely to the CBES. • On transfer of the funds, an account is opened for the CBES to cover the schools’ operating expenses. For most CBESs, the fee level is sufficient to cover operating costs and they do not need to draw on their investment funds. • The IPPS team has developed alternative options to assist poorer communities that have not been able to fully cover their schools’ operating expenses. These CBESs are organizing fundraising activities and seeking donations to cover student costs (e.g., for girls from poorer households). Principles of Success The success of the MRC and IPPS programs can be attributed to the following characteristics. • High Levels of Trust. Both programs have built high levels of trust with the participating communities. Staff listen and work with the communities on their concerns and ideas for helping their children. The roles and responsibilities of each partner are de- fined clearly. • Community Mobilization and Organization. An intensive process of mobilization and organization is incorporated within each pro- gram. The process includes regular support and monitoring of local management committees, especially during the first 2–3 years, to continually reinforce community ownership and the community’s ability to manage ECD activities. • Spill-over Effects. Success with one community can help replicate success and build trust with other communities that observe their neighbors’ involvement and the positive effect of the pro- grams on children’s learning experiences. • Use and Development of Local Resources. The projects rely on the local material, financial, and in-kind resources available to build 346 Simone Kirpal ECD centers. Major investments to develop local human capac- ity, focusing on women, are a priority. • Quality Learning. The MRC and IPPS programs emphasize quality learning that both builds on local cultural and religious values and uses lessons and knowledge from other ECD efforts. • Mentoring and Follow-up. Both programs provide continual, sys- tematic mentoring and support. The teachers, community lead- ers, and school management committees benefit by implemen- tation and absorption of ideas that are facilitated and shared through large- and small-group training exercises and continual in-school support. • Flexibility. The programs are flexible and able to address and incorporate needs and issues that emerge as the programs evolve. For example, the MRCs introduced community develop- ment officers to strengthen community development efforts; the MRCs established literacy classes for mothers and in- laws; and IPPS organized nonformal classes for older, out-of- school girls. • Financial Sustainability. Sustainability over the long term is the programs’ major goal. Both programs achieve sustainability of schools by focusing on capacity building, testing and sharing different strategies on a regular basis, and involving all partners and stakeholders, including donors, from the beginning. Outlook Through the MRCs and IPPS project, the AKF is fostering demand for ECD programs; strategies of sustainability; sharing of skills and knowledge; selected research studies and evaluations; and network- ing among institutions. Increased Demand The demand from other communities for community-owned schools and teacher training programs for both programs continues to grow. The MRC and IPPS teams have to assess whether this demand will shorten the time needed to raise awareness and mobilize communi- Communities Can Make a Difference: Five Cases Across Continents 347 ties, and thus increase efficiency and reduce costs. They also need to develop new strategies and training programs (e.g., short, “alterna- tive” training courses for interested preschool teachers). Sustaining Quality and Organizational Inputs Innovative strategies are needed to sustain the programs after com- pletion of the initial intervention. Communities that have successful- ly completed the MRC program are developing graduate preschool associations to provide continual support and to foster interaction between schools and quality of learning and teaching. The MRCs also are training lead teachers and local community mobilizers for each school to assume the mentoring and leadership development roles formerly provided by the MRCs. The IPPS is convening regular meet- ings for head teachers and CBES members and is training locally based supervisors to provide technical advice for small clusters of schools. Sharing of Skills and Knowledge A continuing challenge for the programs is to creatively and realisti- cally plan for disseminating the skills, knowledge, and lessons (e.g., through technical assistance, training, mentoring, or dissemination of materials) to help others adapt or replicate their work. The IPPS team does not extend the scale of its operations significantly, but fo- cuses on training teachers and trainers from other community-based organizations instead. The MRCs are responding to other countries (e.g., in West Africa) that are expressing interest in learning about replicating and adapting the MRC program. Research Studies and Evaluations In-depth research and evaluation of the impact, effectiveness, and costs of the MRC and IPPS programs are necessary for internal reflec- tion, effective program implementation at the community level, and growth. The studies are also essential to improve assessment and un- derstanding of the effect of community-based ECD programs on chil- dren, families, and the broad community. 348 Simone Kirpal Capacity Building and Networking Identifying ways to build and strengthen a variety of institutions and to encourage networking among them is essential for achieving ac- cess to quality and culturally appropriate and affordable ECD services for poor children. Nongovernmental and community-based organi- zations (e.g., women’s groups, religious groups, preschool commit- tees) and the private and public sectors are all potential collaborators and partners that need to be able to access expertise on technical is- sues, organizational development, fundraising, and financial man- agement for long-term sustainability of ECD programs. Their efforts need to be supported by governments, local and international donors, foundations, and others. 5. Central and Eastern Europe, the Former Soviet Union, Mongolia, Haiti, and South Africa: Step by Step—Early Childhood Education Reform Step by Step is an education reform program for infants and children, 0–10 years, that introduces child-centered teaching methods and sup- ports community and family involvement in preschools and primary schools. The aim of the program is to engender democratic ideas and principles within young children and their families. The methods used encourage children to make choices, take responsibility for their decisions, express their ideas with creativity, help each other, develop critical thinking skills, and practice independent thinking. The pro- gram promotes the rights of all children to a quality education, and special teaching materials and training programs are designed to en- hance equal access for children of ethnic minorities (e.g., Roma), refugees, children with disabilities, and families living in poverty. Step by Step offers an innovative and comprehensive approach to institutional reform of early childhood education programs at all lev- els, by training teachers and administrators at preschool and primary school levels through ongoing professional development; training faculties at universities and pedagogical institutes on the application of new course content and interactive teaching methods; cooperating Communities Can Make a Difference: Five Cases Across Continents 349 with education and health ministries on educational content and policies; establishing national associations for parents, teachers, and faculties; and creating an international forum (the International Step by Step Association, or ISSA) for parents, teachers, and faculties to promote open society values in education. The Open Society Institute (OSI), a private grant-making founda- tion, launched the Step by Step program in 1994 to address the de- cline in services for young children in regions affected by the eco- nomic upheaval after the fall of communism. OSI seeks to promote the development of open societies by supporting a range of programs dealing with educational, social, and legal reform. Created by George Soros, OSI forms part of the network of Soros foundations, a group of autonomous NGOs operating in 30 countries around the world, in- cluding the countries in Central and Eastern Europe and the former Soviet Union, Burma, Haiti, South Africa, Guatemala, and the United States. The foundations support initiatives in education; civil society; independent media; Internet and e-mail communications; publish- ing; human rights; arts and culture; and social, legal, and economic reform. Children’s Resources International (CRI), a nonprofit organization based in Washington, D.C., serves as OSI’s partner and provides inter- national technical assistance to Step by Step. CRI has developed the program’s philosophy and core written materials, which include methodologies, courses, and training programs for teachers and care- givers of infants and toddlers and for preschools, early primary grades, and institutions of higher education. CRI works with a net- work of trainers to provide ongoing support to each country team. The goals of all technical assistance to the program are to transfer expertise to each country and to enable country teams to continue the program in the future using their own resources. Mission The mission of the Step by Step program is to create an educational experience that promotes democratic thinking and action. The cul- ture of democracy is taught and modeled day by day. By starting this 350 Simone Kirpal process with the youngest citizens, the children, the principles of open societies are instilled in the next generation. Child-centered classrooms promote democratic principles and inspire life-long learn- ers who are able to succeed in open societies (Hansen, Kaufmann, and Saifer 1997). Cultural Context Step by Step emphasizes change and democratic transformation, based on the experience of countries in transition, and addresses the continuing challenge for all democracies to provide the kinds of edu- cational experiences that ensure continuation of open and free soci- eties. Step by Step’s child-centered philosophy is based on the work of international theorists in early childhood education (Erikson, Piaget, Vygotsky, Dewey) and is universally applicable when adapted to local cultural circumstances. The core program components are family and community partner- ship, individualization of the learning process, active learning, self- initiative, self-efficacy and empowerment, shared control, freedom of thought and speech, and respect for differences and similarities. These components are especially relevant for the countries where the program is being implemented initially (in Central and Eastern Eu- rope and the former Soviet Union, Mongolia, Haiti, and South Africa). These countries have strong traditions of teacher-centered ed- ucation and are struggling to make the transition to democratic soci- eties during a time of enthusiasm for educational reforms, tempered by harsh realities. The realities include sharp economic declines re- gionally; decreased social services (including early childhood pro- grams); reduced state services for training teachers; professional isola- tion from Western pedagogical trends; closing of preschool facilities, due to lack of financing; and reduced funding for the remaining preschools, resulting in a reduction in national nutrition and health programs, inadequate education materials, a crumbling infrastruc- ture, and delays in paying staff salaries. Step by Step has sought to build on the strength of previously ex- isting systems by “opening up” their structures to community and Communities Can Make a Difference: Five Cases Across Continents 351 family involvement; developing ministry-approved retraining pro- grams within established teacher training systems; and, initially, making contributions to rebuild the preschool infrastructure. The program has focused on developing, in each country, a professionally based (rather than politically, state-based) NGO that can contribute to a plurality of approaches in education and the development of civ- il society. Methodology and Approach As described by OSI and CRI (1998), the Step by Step program: • Is a program of teaching methods that need to be adapted local- ly in each country to fit with national educational standards and needs • Offers an alternative teaching approach to the official curricu- lum, to give parents choices, but seeks official recognition and support from the ministry of education • Emphasizes long-term replicability, sustainability, and growth by partnering with the ministry of education and institutions that train and retrain teachers and caregivers • Collaborates with existing publicly funded institutions (kinder- gartens, preschools, primary schools, pedagogical institutes, universities, training centers) to create long-lasting change and systemic effect • Is a child-centered model that emphasizes meeting the individ- ual educational needs of each child in a classroom • Builds on the principle that parents are the primary educators of their children and should be invited to participate in the schools • Encourages community involvement from local government and businesses • Promotes equal opportunities, nondiscrimination, and inclu- siveness to integrate into regular classrooms children from di- verse backgrounds, ethnic minorities, and those with special needs 352 Simone Kirpal • Seeks to produce and purchase all educational furniture and materials in the region, wherever possible, to boost local economies. Implementation Each country team has primary responsibility for adapting (translat- ing, publishing) the core written training materials developed by CRI and for refining the implementation strategy to meet the country’s specific needs and concerns. Step by Step follows a 5-year develop- mental cycle in each country. In collaboration with an international network of trainers, CRI, OSI, and ISSA support each country team by: • Training core project members in child-centered methods, adult training techniques, and educational reform • Developing educational and training materials • Providing in-country training and ongoing technical assistance • Mentoring teams as they develop implementation strategies and plans. In each country, intensive methodology training is given initially to a team of early childhood experts responsible for adapting the pro- gram to the country’s context and needs. Model classrooms are im- plemented in preschools and primary schools and then expanded to new classrooms at low cost, relying on matching funds from commu- nities. Training is also provided for faculties from higher education institutions to ensure inclusion of child-centered methodologies in professional training and retraining programs for teachers. In addi- tion, the country team cooperates with the ministry of education to introduce child-centered policies and programs and establishes an in- dependent Step by Step NGO or association in the country. This orga- nization: • Provides ongoing professional development for early childhood educators by offering training and sharing experience through professional journals and conferences Communities Can Make a Difference: Five Cases Across Continents 353 • Monitors the quality of the Step by Step program in preschools, primary schools, and teacher training programs • Advocates greater parental involvement in education and devel- opmentally appropriate education methods nationally • Promotes child-centered methodologies to schools and commu- nities • Develops quality programs for marginalized groups, such as Roma and other ethnic minorities and children with disabilities • Develops standards and evaluates good practice in early child- hood education as an independent, nongovernmental voice in the educational community. By the end of the 5-year developmental period, Step by Step hopes to have established high-quality, self-sustaining training programs that are officially accredited by the ministry of education and are available and affordable to all teachers and schools seeking to learn child-centered methods. The program also aims to be financially sus- tainable and replicable within each country. (Sustainability refers to the ability of participating schools to continue the Step by Step pro- gram after OSI funding ends. Replicability refers to the ability of preschools and primary schools to receive training and implement the program without OSI funding.) Evolution George Soros established his first foundation, the Open Society Fund, in New York in 1979 and his first Eastern European foundation in Hungary in 1984. He now funds a network of foundations operating in more than thirty countries throughout the world dedicated to building and maintaining the infrastructure and institutions of an open society. The Step-by-Step program was initiated originally to address the decline in services for young children in Central and Eastern Europe and the former Soviet Union, caused by the economic upheaval after the fall of communism. In its first year in 1994, the program was es- tablished in 200 preschool classrooms in fifteen countries. In its sixth 354 Simone Kirpal year of operation, the program trained 40,000 teachers annually in twenty-eight countries and territories, serving more than 500,000 families and children in preschools and primary schools. The pro- gram cooperates with more than 300 institutions that train and re- train teachers to implement new practices. Countries have joined the program at different times, and the program is at different stages of development in the participating countries and territories. Currently, these are: Albania, Armenia, Azerbaijan, Belarus, Bosnia-Herzegovina, Bulgaria, Croatia, Czech Republic, Estonia, Georgia, Haiti, Hungary, Kazakhstan, Kosovo, Kyrgyzstan, Latvia, Lithuania, Macedonia, Moldova, Mongolia, Montenegro, Romania, Russia, Slovakia, Slovenia, South Africa, Ukraine, Yugoslavia. In early 1999, the program formally established ISSA, which is reg- istered in the Netherlands as a nongovernmental membership orga- nization. ISSA serves as an international Step by Step forum for na- tional associations of teachers, parents, and faculties. Among its goals and objectives, ISSA aims to promote the Step by Step program and philosophy internationally; facilitate information sharing among member organizations; provide opportunities for professional devel- opment; encourage and disseminate research on child-centered learn- ing; develop international initiatives in early childhood education in partnership with interested organizations; and assist members in fundraising and building partnerships. Financial Support OSI provides the initial investment for Step by Step in each partici- pating country. To initiate financial sustainability, the country team undertakes a grassroots effort by approaching potential funding part- ners after the first year of the program to secure partnership funding to support expansion of the preschool model classrooms. The pro- gram provides a catalyst for cofunding by offering matching funds for training and educational materials (to cover capital costs) for preschools that expand their staff by funding additional salaries or creating a volunteer program. Communities Can Make a Difference: Five Cases Across Continents 355 The grassroots effort is targeted to local governments and par- ents. The team promotes connections with local authorities and communities by inviting them to training sessions and school festi- vals and by keeping them informed and involved in the develop- ment of the program. Despite severe constraints for financial sup- port, local authorities have been able to sustain and replicate Step by Step locally. Parents volunteer as classroom assistants, partici- pate in fundraising to support schools, provide labor to renovate classrooms and playgrounds or to make furniture, and donate equipment or books. The program also encourages partnerships with businesses and other foundations and international organiza- tions, and cofunding and donations have been obtained in several countries. Principles of Success The success of the Step by Step program can be attributed to the fol- lowing characteristics. • Private-Public Partnership. By collaborating with existing publicly funded institutions, Step by Step creates long-lasting change and long-term commitment among all its stakeholders. • Culturally Appropriate Methods. Step by Step accounts for each country’s cultural background by encouraging adaptation and modification of the teaching methods and methodology to meet local needs, language, and educational standards. • Child-centered Teaching. The program promotes a child-centered approach and interactive learning method to meet the individ- ual educational needs of each child in a classroom. • Community and Parental Involvement. Step by Step encourages ex- tensive involvement of communities and parents, and parents are invited to participate actively in school activities. • Financial Sustainability. Long-term replicability, sustainability, and growth of the program are achieved in partnership with min- istries of education and institutions that train and retrain teach- ers and caregivers. 356 Simone Kirpal • Nongovernmental Support. Step by Step supports the continuous development of child-centered early childhood programs and professionals and the development of civil societies by estab- lishing, in each country, an independent, nonpolitical national association or NGO that contributes to plurality in education. Outlook Step by Step builds effectively on its program evaluations and is striv- ing for a new teaching approach that is socially inclusive and cultur- ally and financially sustainable. Studies and Program Evaluation Multiple evaluations, at national and international levels, have shown that the same or even better educational results can be achieved by using Step by Step’s child-centered teaching methods, compared with traditional teacher-centered methods. National stud- ies conducted in cooperation with pedagogical institutes, universi- ties, and ministries have been essential in the acceptance of the pro- gram’s preschool and primary school methodologies by the ministries of education in the twenty-eight participating countries and territories. Most interestingly, several studies have shown that the Step by Step program supports children’s social and emotional development more strongly than traditional programs and that the participating children average higher scores on tests that measure their cooperation, leadership, self-esteem, problem solving, and per- severance. An independent evaluation of the Step by Step preschool program in four countries (Bulgaria, Kyrgyzstan, Romania, Ukraine) by USAID in 1999 confirmed that Step by Step supports children’s democratic behaviors and values, as related to their mak- ing choices, taking initiatives, valuing individual expression, and contributing as members of a learning community. Classroom ob- servations showed that these values are embodied in Step by Step classrooms in staff-child interactions and the curriculum and phys- ical environment. Communities Can Make a Difference: Five Cases Across Continents 357 Social Inclusion There is strong evidence that child-centered approaches enable teach- ers to respond more effectively to children’s individual needs. The USAID evaluation suggests that the Step by Step program is particu- larly beneficial to children with low academic skills and to disadvan- taged children from ethnic minorities. For example, data collected over 3 years on Roma children who attended Step by Step preschools in Yugoslavia show that, in comparison with Roma children who did not attend the preschools, the children had a much higher profi- ciency level in Serbian, attended primary school more regularly, com- pleted the first grade (100 percent), and scored higher on math and reading tests at the end of first grade. Data also show that participa- tion in Step by Step preschool more than doubles educational out- comes for severely disadvantaged children, supporting the claim that adequate preschool education is an important means of ensuring eq- uity among children. Step by Step is conducting a pilot project to assess the effect of us- ing Step by Step methods to educate the large number of Roma chil- dren placed in schools serving predominantly children who are men- tally retarded. In the Czech Republic, for example, as many as 80 percent of Roma children are currently labeled “mentally deficient” and placed in these special schools. The aim of the pilot project is to reintegrate Roma children from these schools by grade 3 or 4. Early results confirm that most of the Roma children are misdiagnosed as having mental deficiencies, unnecessarily reducing their educational potentials. Special Education Step by Step hopes to contribute to development of anti-biased adult education programs, objective tests and procedures for child assessments, and educational approaches to meet the specific needs of these children to address this basic human rights issue in the re- gion. Step by Step also is pursuing activities to include children with special needs into regular preschools and primary schools, 358 Simone Kirpal through teacher training projects and university courses that pre- pare teachers. Sustainability Between 2003–05, the twenty-eight countries and territories initially participating in Step by Step will become fully independent of OSI. Initial studies in four countries indicate that the Step by Step NGOs established in these countries have the capacity to continue all pro- gram activities in the future without outside financial assistance. The responsibility for regional and international activities and coordina- tion of programs in new countries is shifting to ISSA. Note The five case studies have been developed in close collaboration with the respective projects. The author would like to thank, in particular, the following individuals for providing valuable information, contri- butions, and comments: Carol Guy-James Barratt and Peter Hesse Peter-Hesse Foundation Römerstr. 1A D–41564 Kaarst-Büttgen Germany Tel: 49-2131-756.830 Fax: 49-2131-756.831 website: http://www.solidarity.org Alice Byangwa Mujunga Mother-Child Day Care Center Services P.O. Box 1663 Kampala Uganda Tel: 256-41-346.597 Fax: 256-41-345.293 Communities Can Make a Difference: Five Cases Across Continents 359 Ruth Montrichard SERVOL Ltd. 91 Frederick Street Port of Spain Republic of Trinidad and Tobago West Indies Tel: 1-868-623.7009 and 1-868-627.9360 Fax: 1-868-624.1619 and 1-868-622.1043 website: http://community.wow.net/servol Kathy Bartlett Aga Khan Foundation 1–3 Ave de la Paix 1202 Geneva Switzerland Tel: 41-22-909.7200 Fax: 41-22-909.7291 website: http://www.partnershipwalk.com/akf/index.htm Elizabeth Lorant and Sarah Klaus Open Society Institute International Step by Step Association 400 West 59th Street New York, NY 10019 U.S.A. Tel: 1-212-547.6918 Fax: 1-212-548.4610 website: http://www.issa.nl; http://www.soros.org References Evans, J.L., R.G. Myers, and E.M. Ilfeld. 2000. Early Childhood Counts. A Programming Guide on Early Childhood Care for Development. Washington, D.C.: World Bank. 360 Simone Kirpal Hansen, K.A., R.K. Kaufmann, and S. Saifer. 1997. Education and the Culture of Democracy: Early Childhood Practice. Washington, D.C.: Children’s Resources International, Inc., in Partnership with the Open Society Institute. Lokshin, M., and T.L. Tan. 2000. Different Countries–Similar Problems: The Effect of Costs of Early Child Development Programs on Household Behavior. Abstract. Preliminary Draft. Washington, D.C.: World Bank. Myers, R. 1995. The Twelve Who Survive: Strengthening Programs of Early Child Development in the Third World. 2nd ed. Ypsilanti, Mich.: High/Scope Press. OSI (The Open Society Institute) and CRI (Children’s Resources International, Inc.). 1998. Step by Step: A Program for Children from Birth to Ten Years and Their Families. 1998 Country Report. Washington, D.C. Rugh, A., and H. Bossert. 1998. Involving Communities. Participation in the Delivery of Education Programs. Washington, D.C.: U.S. Agency for International Development. Young, M.E. 1996. Early Child Development: Investing in the Future. Washington, D.C.: World Bank. Part V Investing in the Future: Action and Policy Chapter 12 Narrowing the Gap for Poor Children Enrique V. Iglesias and Donna E. Shalala The reasons for investing in early child development are many. Per- haps the most important is ethical, for so many children lack the es- sential care needed to develop their full human potential. As noted by Amartya Sen (1999), the core of human development is really a question of choice and freedom—which millions of children in the world today still do not have. Gross underinvestment in children, and their mothers, especially those in the poorest households and with the least education, is one of the most potent “engines” driving the growing inequality within and between nations. Investing in early childhood is essential for na- tions and regions trying to eradicate mass poverty. Latin America is only one example of a worldwide problem. The issues are the same everywhere. This chapter addresses the underlying basis for the in- creasing problem of inequality and ways to combat this problem through action and policy. Intergenerational Poverty Two of the most dramatic concerns for the global community are the growing number of children in poverty and the vicious circle of poverty—reproduction of poverty and intergenerational poverty. In Latin America, for example, more than four out of ten children 363 364 Enrique V. Iglesias and Donna E. Shalala under age 9 (or about 43 million children) live on less than US$2.00 per day. These children account for almost 10 percent of the total population (500 million) in Latin America currently. Since 1980, the number of children in poverty has increased by almost two-thirds (from about 26 million) (IDB 1999). Not only are many of the region’s children poor, however; they also face multiple, difficult obstacles related to poverty. Many have not completed primary education, and most live in poverty that is both material and educational. Many suffer from malnutrition, dis- ease, abuse, and neglect, which begins during the critical period from conception through early childhood and impairs their ability and ca- pacity to learn. In Chile, for example, a study of children’s psychomotor develop- ment by age 18 months and thereafter showed that 40 percent of the children from poor families were developmentally delayed by age 5, 50 percent were delayed in language development, 30 percent in vi- sual and motor development, and 17 percent in gross motor develop- ment (Seguel, Izquierdo, and Edwards 1992). Poor children, such as these, are condemned unnecessarily to illiteracy, low earnings, and few opportunities for a better life. As adults, children of poverty pass their poverty on to their own children. This “reproduction” of poverty, or intergenerational pover- ty, is one of the major causes for the persistent poverty, income mal- distribution, street children, and increased violence and crime throughout Latin America and other world regions. This tragic interlinkage develops as follows. Poor parents have many children and larger families, but do not have the means or par- enting skills to provide for them or meet their developmental needs. Intellectually and emotionally stunted, the children are less able to learn and often fail in school, repeating grades and eventually drop- ping out. As unskilled youth with scarce market skills, most have to work in poorly paid “dead-end” jobs and some engage in better-paid illicit activities. When they have children, they replenish, and renew, the vicious circle of poverty. Narrowing the Gap for Poor Children 365 The new age of information technology will offer many opportu- nities for Latin Americans born today, but the children of poverty will be left even further behind, unable to effectively acquire the skills needed to participate fully in modern life. Even more so than previously, schooling will determine future job options and earn- ings. Between 1980 and 1997, the earnings ratio of office workers to manual laborers in Latin America increased 30 percent, from 1:3 to 1:7. Children who do not complete secondary school are increasingly disadvantaged. Those who are most vulnerable are children in pover- ty, from indigenous social groups, living in urban shantytowns or rural areas, and malnourished. Any one of these factors decreases their chances of completing secondary school. And, the lives of many of the 43 million children already in poverty in Latin America are af- fected by more than one of these factors, which is often the case. The overall impact for development in the region is, and will remain, strongly negative until this poverty cycle can be broken. Breaking the Cycle Fortunately, the knowledge and the means exist for greatly improving the lives and economic potential of poor children and families. Recent research in Latin America and elsewhere suggests effective ways for breaking the linkages in the cycle of poverty. Six methods are clear: • Life education and counseling for older children and adoles- cents, and quality reproductive health services for young women • Prenatal care and nutrition for mothers, and good nutrition and health care for children in their early years • Education and training in parenting skills • Community-based education and training in safety, health, and nutrition • Childcare to keep children safe and to provide adequate stimu- lation to foster development and readiness to learn 366 Enrique V. Iglesias and Donna E. Shalala • Academic and psychological support for disadvantaged children during the initial school years, to increase their chances of suc- cess in school and society. Communities and nations can break the cycle of poverty by inter- vening in these ways in an urgent and decisive manner. The technical and economic opportunities are available to confront the problem, but tremendous political will and commitment are needed to solve the problem. Government cannot act alone. The resources and tal- ents of government must be matched by other sectors. By joining hands and sharing responsibility, the civil society, private sector (including nongovernmental organizations), and government, sup- ported by international agencies such as the World Bank, the Inter- American Development Bank (IDB), and other regional development banks, can meet this great social challenge of the new millennium and make a difference in many lives. The IDB, for example, funds and supports many efforts through- out the Americas to improve the lives of disadvantaged children and youth. Some of these efforts are stand-alone projects, and more are part of multifaceted antipoverty programs. The motivation for many activities is the highly visible and troubling problem of street chil- dren in large urban areas—a key link in the poverty cycle. In partner- ship with the World Bank and other organizations, the IDB sponsors seminars and other events to increase and disseminate relevant knowledge and produces policy and program materials related to ear- ly child development. Yet, no institution in government, the private sector, or interna- tional development can say today that it is doing enough. Inter- national agencies such as the IDB, which would like to do much more, are often constrained by the availability of subsidized funding and the reluctance of some countries to borrow at prevailing terms for child development programs. Every dollar that is invested in poor children (e.g., in improving childcare, training teachers, building schools, and supporting parents) is a dollar well spent, now and for the future. Even in the Narrowing the Gap for Poor Children 367 United States, where there is broad consensus that investing in poor and at-risk children early in their lives pays dividends, more can be done. From a business perspective, investment in early child develop- ment “works.” Building brainpower builds economic power, and building healthy bodies builds healthy nations. The world cannot af- ford to waste a single future worker. Intervening Effectively Even modest investments in community-based child development programs that involve parents, schools, and local health organiza- tions can have broad impact for society, by reducing the reproduc- tion of poverty between generations and lessening related effects (e.g., violence, abuse, criminal behavior, mental illness). Recent data from the United States, for example, demonstrate the effectiveness of prevention programs for children: the number of children who are victims of abuse and neglect declined in this country for the fifth year in a row, and the incidence of maltreatment decreased to 12.9 cases per 1,000 children, the lowest rate in 10 years (United States 2000). Much more information about early child development is known today than even a decade ago. And, every child, in every corner of the globe, deserves to benefit from this knowledge and from the progress that has been made through programs such as Head Start. Head Start In the United States, some of the most important lessons about early child development have come from the Head Start program, which celebrated its thirty-fifth anniversary in 2000. This government pro- gram of comprehensive early intervention for low-income preschool children, and their parents, enjoys remarkable political support. The reason is simple: Head Start “works,” it is cost effective, and it bene- fits the country. Head Start began as part of President Lyndon Johnson’s War on Poverty and in response to literature and media coverage during the 368 Enrique V. Iglesias and Donna E. Shalala early 1960s on the extent, and depth, of poverty (e.g., among mi- grant workers) in the United States. In the face of America’s growing wealth at this time, millions of low- and very-low-income families were suffering alone and in the shadows, unprepared to help their preschool children and passing on a life of poverty from one genera- tion to the next. Child development experts in government and academia soon recognized that poor children needed “a hand up” very early in life. Waiting until a poor child entered kindergarten was often too late, and the public schools were incapable of overcoming the losses suffered by poor children in the first years of life. The time for making a national investment in poor children had arrived, and Head Start was created. Head Start was never intended to focus only on education, but, rather, to help develop socially, emotionally, and physically healthy children. A typical Head Start class has seventeen children, one teacher, one assistant, and one other adult—usually a parent. At least 10 percent of the enrollment opportunities must be available to chil- dren with disabilities. The curriculum is of high quality, comprehen- sive, age-appropriate, and standard across the United States. Much at- tention is given to cognition and language. But that is only the beginning. Head Start children also receive comprehensive health services, in- cluding immunizations, physical and dental examinations, and nu- trition support. They are helped to overcome their fears and they learn to share, cooperate, listen, and take turns. They receive lunch and a snack, and some children receive breakfast. The typical day is a mixture of instruction, creative play inside and outside, and balanced meals. Head Start also focuses on building families. Parental involvement and learning are extensive, and parents progress toward their own ed- ucational, literacy, and employment goals by training and working in Head Start. Although funding and enrollment have increased dramatically since 1965, Head Start maintains its core mission of developing the whole child and enabling each child to reach his or her full potential. Narrowing the Gap for Poor Children 369 Head Start has accomplished a great deal. Research on the program shows that children leave Head Start with a wide range of specific skills and knowledge, which they need to succeed in kindergarten. The practical, common-sense achievements that they make lay the groundwork for their future learning and emotional development. Yet, improvements continue to be made in the program. During the past 7 years, administrators have expanded Head Start, strengthened parental involvement and learning, improved quality, and demanded more accountability. Currently, almost 900,000 children are enrolled in Head Start, and another 45,000 are enrolled in Early Head Start, a complementary program that was created to meet the special needs of children ages 0–3. Recently, Head Start received its largest budget increase ever, and additional funding is being sought. Although most countries do not have the resources to fund early childhood education at this level, the investment is worth far more than the cost, because every child who enters Head Start is one less child that is on the road to poverty with no “off-ramp.” Enrollment in Head Start will not break the cycle of intergenerational poverty for every child, but it does increase the possibility of escaping poverty. As noted earlier, more resources are better than less, and some are better than none. Lessons Learned After 3.5 decades of experience with Head Start, six lessons have be- come clear for maximizing investments in early child development. These could be considered “six lessons for children to grow by.” They are as follows. 1. The earlier intervention begins, the better. This lesson is perhaps the most important. Research shows that development of the brain in the early years is a pathway that affects physical and mental health, learning, and behavior throughout the life cycle (Carnegie Corporation of New York 1994; Karr-Morse and Wiley 1997; Keating and Hertzmann 1999; Shore 1997). The research 370 Enrique V. Iglesias and Donna E. Shalala findings, which were presented at the United States’ White House Conference on Early Childhood Development and Learn- ing, in April 1997, and elsewhere, provided the impetus for ini- tiating the Early Head Start program. 2. Quality counts. In a long-term study of poor children (Campbell and Ramey 1994), one-half of the children were assigned to high-quality day care from infancy to age 5, and the other half received only nutritional supplements and visits from social workers. The group assigned to the high-quality day care were more successful later in life in almost every measurable way. Money alone is never the answer, however. For this reason, Head Start is imposing new performance standards for all its centers and has allocated 25 percent of all new funding to sup- port higher standards and investments in quality. The perfor- mance standards are rigorous, clearly stated, and mandatory. They are being used to evaluate all aspects of the Head Start pro- gram, from children’s readiness to read and their social develop- ment, to the effectiveness of program management. (Tarullo de- scribes the performance standard initiative in an earlier chapter in this volume.) Excellence has to be the goal. Since 1995, 150 Head Start grantees have been terminated or have relinquished their grants for lack of quality. The program’s consistent demand for high quality benefits parents and children. Recently, Head Start re- ceived the highest score in customer satisfaction of any govern- ment agency or private company in the United States. 3. Quality early childhood education begins with training. The turnover rate for Head Start staff is very low—less than 11 percent a year. And, 80 percent of Head Start teachers have 5 or more years of experience. A qualified and committed staff is one of the bene- fits of providing and supporting professional training. All Head Start teachers are currently required to have a special child de- velopment certificate. By 2002, the aim is to achieve a majority Narrowing the Gap for Poor Children 371 of Head Start teachers with a 2- to 4-year degree in early child- hood education. The government is helping to expand the ca- pacity of colleges and universities to teach early childhood edu- cation and to train childcare staff to work with infants and toddlers. Head Start also is increasing staff salaries and investing in the health and safety of its facilities. 4. Parents must be involved and accommodated. One of the reasons that parents express such a high level of satisfaction with Head Start is that Head Start “listens” to them. The program learns from parents and encourages them to remain involved. This emphasis has continued since the earliest days of the program and is the key to its success. In fact, many Head Start parents be- come Head Start teachers. Keeping parents engaged and involved is not sufficient, how- ever. Programs also must accommodate their changing needs. For example, when Head Start began, the number of women in the work force and of single-parent families was far fewer than today. As work patterns changed, Head Start had to change. Currently, Head Start is expanding its hours, increasing the flex- ibility of its hours, taking early childhood education programs into the workplace, and encouraging Head Start centers to part- ner with quality programs that provide childcare after Head Start and until parents return home from work. Head Start also has learned the importance of keeping par- ents connected to the communities where they live. Programs must be culturally sensitive, involve community leaders, and keep decisionmaking at the local level as much as possible. 5. Early childhood education must be integrated with other needs. Poor children do not need one strategy. They need a comprehensive strategy that extends beyond early childhood stimulation and education. Integrated services, especially for infants and tod- dlers, are a prerequisite for success. For example, in Head Start, childhood immunizations were an early priority. Today, at least 372 Enrique V. Iglesias and Donna E. Shalala 90 percent of U.S. children receive the most critical immuniza- tion doses by age 2. Immunizations save not only lives, but also resources, by preventing disease before it strikes. This under- standing is important even for countries that do not have uni- versal health care coverage (e.g., the United States) or have only limited resources to purchase and distribute vaccines. For the same reason, the U.S. government is expanding access to health insurance for poor children. Three years ago, the State Children’s Health Insurance Program was initiated with the states to ensure that millions more children from low- income working families have health insurance. Programs such as Head Start and childcare centers are effective ways of identi- fying children who are eligible for health insurance. Integrated services help ensure that nurses talk to teachers, teachers talk to nutritionists, nutritionists talk to staff, and everyone talks to parents. 6. Government should make early childhood education a national labora- tory and catalyst for change. “If you build it, they will come” is a now-famous phrase from a recent U.S. movie, Field of Dreams. An adaptation of this phrase conveys an imperative for early child development: Build it and change will come. Head Start has been a national laboratory and catalyst for change. Since its creation in 1965, Head Start has transformed how people think about, educate, and care for young children in the United States and how quality is measured in all child- care settings. The Early Head Start program is doing the same for infants and toddlers. When investing in early childhood education, maintaining an active research agenda is important. Because “one size never fits all,” continuing efforts are needed to determine which pro- grams are effective for which children under which circum- stances and to use this knowledge to build better programs, in- tegrating the best research as quickly as possible. Narrowing the Gap for Poor Children 373 Conclusion The most important reason for investing in programs such as Head Start or quality childcare is to “even up the odds” for poor children. The economic benefits are significant, as noted by van der Gaag in this volume. Yet, there is also a profound moral purpose for investing in early child development. This is a new millennium, a time of high techno- logical achievement when almost no scientific advancement seems impossible. But, millions of children on every continent are strug- gling to survive. This “disconnect”—between two real, but inconsis- tent, concepts—is unconscionable for the world today. The time has come to connect, to narrow the gap for poor children, between what can be done and what is being done. Much has been learned about how to help very young children grow to be smart and healthy. The important step, however, is the next step—to engage families, communities, universities, religious and oth- er organizations, as well as government, to invest in the first and most lasting hope of the new century, the world’s children. A 2-year-old in the barrios of Peru, a baby crying for milk in Lagos, a little girl not yet 4 years old in the slums of Calcutta, and a 3-year-old in Head Start in rural North Dakota—these children, all children, are the future. Note This chapter is derived from the authors’ keynote addresses at the World Bank Conference on Investing in Our Children’s Future, held April 10–11, 2000, at the World Bank, Washington, D.C. References Campbell, F.A., and C.T. Ramey. 1994. Effects of Early Intervention on Intellectual and Academic Achievement: A Follow-up Study of Children from Low-Income Families. Child Development 65:684–98. 374 Enrique V. Iglesias and Donna E. Shalala Carnegie Corporation of New York. 1994. Starting Points: Meeting the Needs of Our Youngest Children. New York. IDB (Inter-American Development Bank). 1999. Breaking the Poverty Cycle: Investing in Early Childhood. Washington, D.C. [www.iadb.org/sds/soc] Karr-Morse, R., and M.S. Wiley. 1997. Ghosts from the Nursery: Tracing the Roots of Violence. New York: Atlantic Monthly Press. Keating, D.P., and C. Hertzman, eds., 1999. Developmental Health and the Wealth of Nations: Social, Biological, and Educational Dynamics. New York: The Guilford Press. Seguel, X., T. Izquierdo, and M. Edwards. 1992. Diagnostico Nacional y Elaboración del Plan de Acción para el Decenio en el Area del Desarrollo Infantil y Familiar. Santiago, Chile: United Nations Children’s Fund (UNICEF). Sen, A.K. 1999. Investing in Early Childhood: Its Role in Development. Keynote address presented at a seminar on Breaking the Poverty Cycle: Investing in Early Childhood, Annual Meeting of the Boards of Governors of the Inter-American Development Bank and the Inter-American Investment Corporation, Paris, France, March 14, 1999. [www.iadb.org/sds/soc] Shore, R. 1997. Rethinking the Brain — New Insights into Early Development. Families and Work Institute. New York, N.Y. United States. Department of Health and Human Services. Administration on Children, Youth and Families. 2000. Child Maltreatment 1998: Reports from the States to the National Child Abuse and Neglect Data System. Washington, D.C.: U.S. Government Printing Office. Chapter 13 The Political Challenge: Commitment and Cooperation Eduardo A. Doryan, Kul C. Gautam, and William H. Foege The final question for this volume, and perhaps the first question in early child development, is: Why intervene in the lives of young children? In the previous chapter, Iglesias and Shalala highlight the ethical and moral impetus for early child development (ECD) programs to “narrow the gap” for poor children. Earlier, van der Gaag connects early child development to human development overall. For children and families, the benefits are clear, as communicated throughout this volume. But, the benefits also must be obvious to the larger society and government because their support is essential for maintaining and sustaining effective programs. To reap the full bene- fits of the many community-based efforts under way, programs must be taken to scale nationwide. The final challenge, then, is political— to obtain the necessary commitment and cooperation, from all sec- tors, to realize the full potential of early child development, national- ly and globally. This chapter considers the societal benefits and constraints to in- vesting in early child development and the political challenge for doing so. Some factors, steps, and “rules” are suggested for in- vesting in policies of action that would help bring ECD programs to scale. 375 376 Eduardo A. Doryan, Kul C. Gautam, and William H. Foege Transforming Society Through ECD Much progress has been made over the past 15 years in bringing early child development to the attention of society and government. Today, nations (e.g., Brazil, Philippines, Namibia, Ghana) are adopting na- tional plans for accelerating early child development, and multina- tional organizations [e.g., the United Children’s Fund (UNICEF), the World Bank) are promoting the well-being of children, women, and vulnerable populations in development efforts that include ECD inter- ventions. These efforts are complemented by, and in some cases, coor- dinated with, the interests and actions of organizations in the private sector [e.g., foundations, nongovernmental organizations (NGOs)]. In- creasingly, early child development is viewed as the best proxy or con- tributor to economic development and national development. All these participants deserve to be congratulated for the transfor- mations in society that they have stimulated and underwritten. Their continued support and commitment can be the launching pad for achieving even greater transformations over the next 15 years to ful- fill the hopes and expectations of many more children and their fam- ilies. The long-term benefits of investing in early child development are extraordinary. The consequences of not investing or of neglecting children are equally far-reaching—lifelong deprivation and deficits for many children and major cumulative losses for their families, communities, and nations. What are society’s aspirations for children, and what can ECD pro- grams offer? From a global perspective, four aspirations would be that children grow up to reach their full human potential and that they live in a society where human rights are respected, democracy flour- ishes, and poverty is not an insurmountable barrier to human progress. Investing in early child development significantly helps to achieve these hopes. Human Potential ECD programs are instrumental for achieving human potential— through, for example, the lifelong effects of improved intrauterine The Political Challenge: Commitment and Cooperation 377 growth (resulting from better maternal health and nutrition), psy- chosocial stimulation in early infancy, and preparedness for school. These and other benefits for enhancing the human potential are well summarized by the other chapters in this volume. Human Rights Human rights are often equated with civil and political rights, free- dom of speech, freedom of religion, and rule of law. But, human rights also include social and economic rights. The Universal Declara- tion on Human Rights and the Convention on the Rights of the Child, as well as other human rights covenants, recognize the right to life, survival, health, nutrition, education, and protection. A society that honors these rights must begin with the rights of the youngest children. The very essence of human rights is to protect the weak and vulnerable from the tyranny of the strong and powerful. Protecting the rights of children who cannot defend themselves, to ensure their survival, growth, and development, is the obligation of all adults and all countries that signed or ratified these human rights instruments. In a very fundamental sense, human rights begin with the rights of children, and a society that does not invest its re- sources, to the maximum extent possible, for the survival, protection, and development of children fails to honor its human rights obliga- tions, especially those set forth in the Convention on the Rights of the Child. Participation Because children do not vote and have no voice in society, some might say they have no stake in democracy. But, the way children are reared and the type of physical and psychosocial environments they grow in have lifelong effects on the development of their val- ues and personality traits. Nurturing children in an atmosphere of mutual respect and compassion and inculcating them, from the ear- liest stages of life, with the values of sharing and taking responsibil- ity contribute to the creation of caring societies that espouse demo- cratic values. 378 Eduardo A. Doryan, Kul C. Gautam, and William H. Foege From an adult’s perspective, democracy requires that political and civic leaders be responsive to the protection of rights of all their con- stituents and that public resources be utilized in the most effective manner to help their constituencies. Democratically oriented leaders and electorates should find that investing in children is the most en- lightened and visionary public policy they can promote. Reduction of Poverty Poverty has many faces, which include malnutrition, childhood dis- ease, lack of learning and play opportunities, and violence against women and children. These and other facets of poverty undermine the optimal development of young children and diminish their po- tential for breaking out of the cycle of poverty. As suggested by Igle- sias and Shalala in the preceding chapter, early child development is the shortest route of breaking the intergenerational cycle of poverty. Children who are born healthy, fed well, stimulated in infancy, protected from childhood illnesses, and nurtured in stimulating and affectionate environments will grow up to become healthy adults, in- volved parents, and productive citizens. Successful child develop- ment results from adequate care at home facilitated by basic commu- nity services and supportive national and international policies. Women’s role is critical. Research shows that children survive and thrive better in communities where women have dignity, access to re- sources, and political influence. These elements are all essential for reducing poverty and promoting early child development. Constraints to Investment For society, knowing the well-established benefits of early child devel- opment may not be sufficient for making the decision to invest in ECD programs and to support them fully. Policymakers may ask why there is not more investment in these programs globally if investing in early child development is so important. What are the constraints to investing in ECD? Common constraints for society and govern- ment are: The Political Challenge: Commitment and Cooperation 379 • Immediate costs versus long-term gains. The costs of intervening ear- ly are immediate, but the investment is long term. Because the observable benefits do not accrue until long after a government or administration has left office, ECD programs tend not to be popular among politicians, who desire more immediate recogni- tion for their achievements. The benefits of constructing a school or clinic or distributing textbooks may not be obvious for years, but they contribute over time to the building of social capital and, hence, economic development. • Difficulty delivering integrated services. Early interventions that ad- dress integral needs of young children and families are difficult for society and government to deliver in a coherent and coordi- nated manner. Government (and donor agencies) tend to be ori- ented sectorally, and government departments or ministries tend to be organized vertically. Because the needs of children and families (e.g., health, education, social assistance) cross these artificial partitions, they are not easily addressed within the bureaucracies. Comprehensive development frameworks are needed to integrate the vision of policymakers and to coordi- nate action “on the ground.” In addition, two barriers to good decisionmaking in global health and development are: • The distance between a decision and an effect • The time between a decision and an effect. The greater the distance, or the time, between a decision and an ef- fect, the more difficult it is to make good decisions. The most difficult decisions to make are those that involve both distance and time (e.g., decisions about nuclear or toxic wastes, which have incubation times of hundreds of years and may be disposed of in other countries). De- cisions to invest in positive early child development are similar, be- cause society’s effects are realized over generations, even centuries, and may be broadly dispersed. 380 Eduardo A. Doryan, Kul C. Gautam, and William H. Foege Believing that society can change and that children’s future and destiny can be improved is a first step. Once a nation adopts this positive perspective, determining what can be changed and what cannot be changed becomes easier to address. These decisions de- pend on the science. The Challenges Conferences on early child development, such as those held by the World Bank and other multinational organizations, are an important step in publicizing the benefits of early child development and over- coming the constraints expressed by governments and policymakers. These meetings enable researchers, administrators, and politicians to share and interpret research findings, celebrate the creativity and in- novation of ECD programs, better understand the role of healthy child development in economic development, and appreciate the im- portance of investing in early child development for both human and global development. The chapters in this volume, which emanate from one conference, highlight four challenges for the field of early child development: • Promoting a balanced view of development that includes ECD programs • Making explicit the link between the needs of poor children and families and the concerns of politicians • Developing improved methods for measuring and evaluating the effectiveness of programs • Achieving sustainable, national programs. One way to achieve sustainability is to change social norms. Measles, for example, used to be an expected childhood disease, but now a single case in developed countries is newsworthy and causes the public to question the activities of the local health department. The public relates to cause and effect. As Hawkins notes in his book A Brief History of Time, the history of science is the gradual realiza- The Political Challenge: Commitment and Cooperation 381 tion that things do not happen in an arbitrary fashion (Hawkins 1988). Or, as noted in a New York subway booth and reported in the New York Times, “Lots of people confuse bad management with des- tiny” (Nemy 1999, sec. B, p. 2). The challenge now for early child development is to create better destiny through better manage- ment, to apply the science and invest in a better future for every child in every country. Cause and Effect History tells us that everything that now exists has a past and that everything that is done now will have ripples in the future. Knowl- edge about the brain’s development—the windows of opportunity in the early years, the effects of learning on later years—supports this concept. But, some effects are more permanent and some losses can never be recouped. Society cannot, for example, reverse the retardation caused by insufficient iodine intake during a child’s first months and years, or return function to the legs of a child crippled by polio, or eliminate a child’s trauma from experiencing war. Other causes, such as toxins (e.g., alcohol, tobacco smoke) and abuse, also have lifelong effects. Recently, the U.S. Centers for Disease Control and Prevention (Felliti and others 1998) published the first scientific study of the health of adults who were abused as children. The study docu- mented, for the first time, that smoking, drinking, drug use, de- pression, suicide attempts, and overweight all were elevated in adults who had experienced, during childhood, physical, psycho- logical, or sexual abuse; a mother being beaten; or a family member using drugs or going to jail. In 1962, Kempe coined the phrase “the battered child syndrome” (Kempe and others 1962). The causes may be both genetic and environmental. Influences in a child’s up- bringing have a role in the mental health of the child and, later, the adult. The battered child syndrome causes a battered adult syn- drome, and an accumulation of battered adults causes a battered society syndrome, which, in turn, continues to foster battered 382 Eduardo A. Doryan, Kul C. Gautam, and William H. Foege children. This intergenerational cycle complements, and enhances, the effects of a cycle of poverty. Inefficiencies Many of the current approaches to social issues are inefficient. For ex- ample, mothers often bear children whom they may feed, nurture, and love for 9 or more months, only to lose them then to measles— this is inefficient. If the child survives measles and continues on to primary school but drops out in the early grades, or thrives in school but then contracts an HIV infection and subsequently develops AIDS in the early 20s—this, again, is inefficient. Rearing children while be- ing depressed and addicted because of being abused as a child also is inefficient. And, allowing children to be retarded because of pre- ventable deficiencies in micronutrient intake is inefficient. Similarly, not providing health and educational benefits to all chil- dren is inefficient, and building prisons to house troubled youth and adults because society “saved” money by not supporting community programs of health and education is inefficient. These approaches are not only inefficient, however, they also have heartrending and soci- ety-rending effects. Obviously, these inefficiencies are not rational and do not contribute to acceptable societies. Nevertheless, inefficiencies persist, partly because of human ten- dencies to procrastinate, but also because of longstanding and un- challenged social norms. Societies may verbalize the need for pre- vention, but hesitate to take preventive action. For example, many countries have historically placed greater value on treating lung cancer, rather than helping people stop smoking. This emphasis is only now beginning to change, with the support and action of global organizations, including the World Health Organization (WHO), the World Bank, and UNICEF. And, despite professed inter- est in children and investments in Head Start, U.S. support for chil- dren is far less than that for older persons. In his book The Virtues of Aging, President Carter notes that for every US$12 spent on people over age 65, the U.S. Government spends only US$1 for children and youth under age 18 (Carter 1998). These are only The Political Challenge: Commitment and Cooperation 383 two examples of the mismatch between rhetoric and action on prevention. In the United States, a major change in perspective occurred when the rhetoric of disease prevention was modified to include health promotion. While disease prevention focuses on pathology and re- ducing the extent of a problem (e.g., mortality and morbidity), health promotion focuses on positive changes in scale. The philoso- phy, objective, and expectations are different and, when communi- cated to the public, can help change social norms and values. Societies’ thinking about children has heretofore reflected the pathological approach of waiting until a “disease” is evident before reacting. Leadership is desperately needed, to ask questions such as “what is good for the future?” and “what is good for the world?” Effi- cient, positive approaches must be promulgated and fostered, for the vast majority of the public that government serves has not yet been born and may be of different nationalities. Policies for Action The decision to invest in early child development must be matched by efficient and effective policies to stimulate ECD efforts. Whereas the decision may appear to be noncontroversial, especially with re- gard to narrowing the gap for poor children, the policies which allo- cate, or reallocate, resources to health, education, and nutrition for young children are not. Some individuals and groups may support such policies, but many may not. Merely making “pro-poor” policies to focus on more vulnerable segments of a society or improve condi- tions in a particularly poor region does not guarantee that the poli- cies will be adopted or implemented effectively. The political impli- cations of a policy, including the support or opposition of key stakeholders, often influence adoption of the policy. Four Considerations Policymakers who are, or will be, designing and implementing ECD programs will need to address four factors: the stakeholders, or 384 Eduardo A. Doryan, Kul C. Gautam, and William H. Foege “players,” in early child development; the relative power of each stakeholder; the position of each stakeholder; and public perception. • Players. The stakeholders include all individuals and groups who will be affected by the change in policy and who may become involved in influencing its outcome. The players may include government ministries (e.g., health, finance, agriculture, educa- tion) and local government; professional groups (e.g., physi- cians, nurses, preschool teachers); business organizations; religious organizations; consumers of health and education ser- vices (e.g., urban and rural, poor and middle-class individuals, families, and communities); and international organizations (e.g., the International Monetary Fund, World Bank, WHO, donors). Each group and subgroup will understand and act on the policies from a different perspective. • Power. Poor people are often poorly organized and politically weak, particularly in rural areas. Children, particularly in their early years, do not have a representative association, and adults are usually more influential, although not necessarily well orga- nized. Additionally, power and influence are exercised differ- ently depending on the political system and the traditions of a country and culture. • Position. The position taken by each stakeholder will reflect their support of, or opposition to, the policy and the intensity of their commitment. When multiple reforms are proposed, each stakeholder may support some policies and oppose others. The various positions taken serve as a basis for negotiation. • Perception. The public’s perception and understanding of the is- sue and the proposed policy may affect which groups become mobilized and their positions on the policy. For “pro-poor” policies, a coalition of stakeholders (both domestic and international) needs to be developed to achieve sufficient adop- tion and implementation of the policies to sustain a positive change. As Hsiao and others (2001) suggest, development of this coalition The Political Challenge: Commitment and Cooperation 385 depends, in turn, on the skill and commitment of those who support the policies, the nature of the proposed changes, and the overall country context. Successful implementation of any policy depends on the political skill of its advocates, and not simply political will. This skill must be technically based. Six Steps for Government Government has an essential role to play in early child develop- ment. By blending good politics (i.e., well-founded proposals) and good techniques (i.e., political skill), government can stimulate public support for ECD policies and programs which will strength- en its position and power to implement the policies and programs and foster cooperation and coordination with other stakeholders and potential funders. Six effective steps for government action are as follows: 1. Create a political constituency for children. Include the constituency in a strategic communications plan, which would be a compo- nent of the design of ECD programs. Build early child develop- ment into a holistic, integrated, comprehensive development framework designed to overcome the cycle of poverty and to foster a balanced view of economic, financial, human, gover- nance, and institutional issues across government sectors. Hav- ing a political constituency for ECD programs can strengthen the power of the various stakeholders and change the public’s perception of early child development. 2. Earmark public resources. This action will ensure the availability of resources for ECD programs, protect the investment in chil- dren in times of crisis, and guard against changing political in- terests. Government should monitor children’s growth and de- velopment as closely as, or more closely than, it monitors the growth in gross domestic product. Examples of successful ECD efforts that have been sustained by earmarked tax revenues in- clude Colombia’s use of a 3 percent payroll tax to support sta- ble financing of day-care programs, even in times of financial 386 Eduardo A. Doryan, Kul C. Gautam, and William H. Foege adjustment or political upheaval. Earmarked revenues can serve to create a strong power base for ECD. 3. Provide incentives for community support of ECD. Government should encourage initiatives by small community groups, civil society, and local government. The U.S. Head Start program is one example of a federally funded effort founded on communi- ty initiatives. By supporting such efforts, government can help create community-based productive and small business sectors, with new stakeholders, that can promote early child develop- ment with one voice. Having a “voice” is the first step toward empowerment. 4. Create demanding consumers. Government can allow and even en- courage private-sector providers (not-for-profit and for-profit) of ECD programs. Government also can provide public subsi- dies for poor families, to help them access ECD services and make them effective consumers. These actions will further in- crease the number of stakeholders who are interested in, and supportive of, ECD programs. 5. Provide information on the choices available. Government has a role in developing and disseminating information, standards, train- ing materials, and program evaluations to enable consumers to make informed choices about early child development and al- ternative providers of ECD programs. Government can leverage improvements in the quality of ECD programs based on this in- formation and on pilot studies of funding alternatives. One al- ternative, for example, is New Zealand’s mixed funding model of block grants and subsidies. By enhancing public informa- tion, government would foster transparency of ECD programs and potentially enhance the public’s perception of these efforts. 6. Create new providers. Mothers can be effective ECD providers in home-based programs, such as in Colombia and Bolivia. The women receive training and minimum assistance, on credit, to meet facility standards. They are “accredited” as eligible to pro- vide day-care services. Such efforts enable providers to benefit from public subsidies while also participating in a competitive, The Political Challenge: Commitment and Cooperation 387 choice-based system of ECD programs. In addition, they benefit parents by increasing the number and type of care options to choose from (e.g., based on convenience, proximity, flexibility of hours). By helping to create new providers locally, govern- ment helps consolidate the players, power, position, and per- ception of early child development, primarily at the local level. By taking these six steps, government can achieve a “golden trian- gle” of civil-society participation, market-driven mechanism, and a clear role for government. Government also can launch the neces- sary political action to foster sustainable ECD programs that can be moved to scale. As noted by Papert (1980, p. 29), “What is happen- ing now is an empirical question. What can happen is a technical question, but what will happen is a political question, depending on social choices.” Clearly, early child development is, first and fore- most, a political, or social, choice. It is no longer an empirical ques- tion, but, rather, an issue for action. Five Rules for Investing Before committing a nation’s resources to early child development, policymakers should have appropriate guidance from the ECD community. This guidance should be evidence-based and timely. Five general rules for investing in early child development are of- fered below: 1. Invest early and invest wisely. Often, there are no second chances for child development. Each child has only one opportunity, to grow and develop, and this opportunity should not be squan- dered. 2. Identify opportunities to contribute to early child development in every development project. Children are everyone’s business and not the exclusive concern of one department, ministry, or sector. Every development project has a place for ECD initiatives. Early child development is integral to human development, as well described by van der Gaag earlier in this volume. 388 Eduardo A. Doryan, Kul C. Gautam, and William H. Foege 3. Ensure that all governments and donor agencies honor the 2020 com- mitment, that all developing countries will allocate 20 percent of their budgets for basic social services, and that all donors will allocate 20 percent of their official development assistance for these services. This commitment was made at several United Nations conferences and is vital for early childcare and devel- opment, a basic social service. 4. Empower women. The well-being of children is inextricably linked to the well-being of women. 5. Make the commitment to children, beginning with early childcare and development, the foundation for peace, democracy, and human rights in families, communities, nations, and the world. The love and care for children, and the imperative to invest in early child development, can be the basis for uniting a divided world. Building a Global Coalition “Build it and change will come,” is an imperative for early child de- velopment introduced previously in this volume by Iglesias and Sha- lala. The time is ripe now for building a global coalition for early child development that will stimulate actions and policies for invest- ing in the future. Similar to the remarkable Global Alliance for Vac- cines and Immunization, which was recently organized and funded by a generous gift from the Bill and Melinda Gates Foundation, the coalition for early child development would combine good science with good policies and involve all stakeholders, including local and national groups, governmental agencies, multinational organiza- tions, NGOs, foundations, religious groups, industry, and other pub- lic- or private-sector interests. A deliberate plan to build and fund a coalition would capture local and community enthusiasm for early child development, the politi- cal commitment to ECD programs that has already been made by many countries, and the passion of donors who recognize the global The Political Challenge: Commitment and Cooperation 389 need for efforts targeted to children worldwide. The coalition would represent a conscious decision to combine resources, experiences, scientific findings, ingenuity, a sense of community, and new ap- proaches to education for the benefit of generations to come. Build- ing a coalition will make change happen, including perhaps, the designation of ministers of child development. Conclusion More information is not needed to act now to support early child de- velopment. If appropriate action is taken, future generations will know and be grateful that politicians and economists, based on sci- entists’ teachings, invested adequately in their children. The concept of the “tipping point” applies. That is, there is a drop that causes the glass to finally overflow, there is a moment when a friendship be- comes permanent, there is a minute when a vaccine provides protec- tion, and there is a day when the world finally “does right” by its children. For children to have the positive core elements that offer them a successful life, they need parents who have a capacity to nurture, good mental health, and a network of positive social support. These parents are more likely to be found in societies that are committed to parenthood, equity, economic stability, appropriate childcare, and effective education. Yet, to raise a child takes more than a village—it takes the whole world—and society and government need to identify how to do a better job. Focusing on averages is no longer sufficient; the important measures now are standard deviations, and the chil- dren and families represented by these deviations. The ECD community is an assemblage of individuals with di- verse interests, expertise, and talents who are bound together by a shared goal to create a world that honors children by enhancing their positive development. The next step is to build a coalition, an alliance, that will promote, measure, and improve the well-being of children, beginning in the early years. This is now the “tipping point” for early child development, the day when the investment 390 Eduardo A. Doryan, Kul C. Gautam, and William H. Foege in early childhood moves to a new stage, so that all children hence- forth will benefit and progress cannot be reversed. The beliefs and commitments of others can serve to guide those who continue the effort. As James P. Grant, former head of UNICEF, said in his last speech to the United Nations’ General Assembly, “The vital vulnerable years of childhood should be given a first call on so- cieties concerns and capacities….There will always be something more immediate; there will never be anything more important. If we believe that, lets organize to do it. Lets combine authority, resources, and responsibility in a person in every country” (Grant 1994). Gandhi observed that people often become what they believe themselves to be, and children often become what their parents and society believe them to be. And, Jonas Salk noted that evolution will be what we want it to be. The message is: if we can envision it, we can achieve it. Creating the future starts with the ability to envision the future, and that day is today. Note This chapter is derived from two presentations on “What Policymak- ers Need to Know,” by Eduardo Doryan and Kul Gautam, and on William Foege’s closing address, “The Political Economy of Investing in Young Children’s Early Development,” at the World Bank Confer- ence on Investing in Our Children’s Future, held April 10–11, 2000, at the World Bank, Washington, D.C. References Carter, J. 1998. The Virtues of Aging. New York: Ballantine Books, Random House. Felitti, V.J., R.F. Anda, D.F. Nordenberg, D.F. Williamson, A.M. Spitz, V. Edwards, M.P. Koss, and J.S. Marks. 1998. Relationship of Childhood Abuse and Household Dysfunction to Many of the The Political Challenge: Commitment and Cooperation 391 Leading Causes of Death in Adults: The Adverse Childhood Experiences (ACE) Study. American Journal of Preventive Medicine 14(4):245–58. Grant, J.P. 1994. Child Rights: A Central Moral Imperative of Our Time. Statement by the Executive Director of UNICEF to the Third Committee of the 49th General Assembly of the United Nations. New York, November 11. Hawkins, S. 1988. A Brief History of Time. New York: Bantam Books. Hsiao, W., M. Roberts, P. Berman, and M. Reich. 2001. Political Analysis and Political Strategies. In Getting Health Sector Reform Right. Background paper for World Bank Institute flagship course on Health Reform and Sustainable Financing. Washington, D.C.: World Bank. Kempe, C.H., F.N. Silverman, B.F. Steele, W. Droegemueller, and H.K. Silver. 1962. The Battered-Child Syndrome. Journal of the American Medical Association 181:17–24. Nemy, E. 1999. Metropolitan Diary. The New York Times, sec. B, p. 2, May 3. Papert, S. 1980. Mindstorms. New York: Basic Books, p. 29. Authors Eduardo A. Doryan, Ph.D. Vice President and Head Human Development Network The World Bank Washington, D.C., U.S.A. Currently: Special Representative to the United Nations, New York for The World Bank Office of the Special Representative to the United Nations New York, New York, U.S.A. Judith L. Evans, Ed.D. Director Department of Programme Documentation and Communication Bernard van Leer Foundation The Hague, The Netherlands William H. Foege, M.D., M.P.H. Presidential Distinguished Professor Rollins School of Public Health Emory University Atlanta, Georgia, U.S.A. Kul C. Gautam, M.P.A. Deputy Executive Director United Nations Children’s Fund (UNICEF) New York, New York, U.S.A. 393 394 Authors Enrique V. Iglesias, Ph.D. President Inter-American Development Bank Washington, D.C., U.S.A. Simone Kirpal, M.A. Social Scientist Early Child Development Team Education Sector Human Development Network The World Bank Washington, D.C., U.S.A. Currently: Staff Institute of Technology and Education (ITB) Bremen, Germany John M. Love, Ph.D. Senior Fellow Mathematica Policy Research, Inc. Princeton, New Jersey, U.S.A. Alicia L. Meckstroth, M.A. Researcher Mathematica Policy Research, Inc. Princeton, New Jersey, U.S.A. J. Fraser Mustard, M.D., Ph.D. Founding President Canadian Institute for Advanced Research, The Founders’ Network Toronto, Ontario, Canada Authors 395 Robert G. Myers, Ph.D. Independent Consultant Tlalcoligia, D.F., Mexico Peter Z. Schochet, Ph.D. Senior Economist Mathematica Policy Research, Inc. Princeton, New Jersey, U.S.A. Kerida Scott-McDonald, Ph.D. Early Childhood Development Officer United Nations Children’s Fund (UNICEF), Jamaica Kingston, Jamaica, West Indies Donna E. Shalala, Ph.D. Secretary U.S. Department of Health and Human Services Washington, D.C., U.S.A. Currently: President University of Miami Coral Gables, Florida, U.S.A. Louisa B. Tarullo, Ed.D. Senior Social Science Research Analyst Administration on Children,Youth, and Families U.S. Department of Health and Human Services Washington, D.C., U.S.A. Jacques van der Gaag, Ph.D. Dean Faculty of Economics and Econometrics University of Amsterdam The Netherlands 396 Authors J. Douglas Willms, Ph.D. Director Canadian Research Institute for Social Policy University of New Brunswick Fredericton, New Brunswick, Canada Mary Eming Young, M.D., Dr.P.H. Lead Specialist Education Sector Human Development Network The World Bank Washington, D.C., U.S.A. Index A 42, 52, 60, 63–64, 67–68, 70–75, Abecedarian (Carolina) project, U.S. 77–78, 124, 132–135, 136, 140– 6, 40–42, 125–126, 141, 161 142, 161, 172, 277–278, 291, 299, Abrinq Foundation for Children’s 307–308, 311, 367, 370, 373 Rights 284 Bernard van Leer Foundation xi, Accountability 13, 219, 230, 273, 195, 202, 217, 235, 331, 332, 337, 276, 289, 369 343 Administration on Children, Youth, Biological pathways 3, 4, 8, 24, and Families, U.S. 219, 231 26–32, 34, 59 Advance Brazil Program 138 Bolivia 42, 82, 91–93, 113, 386 Advocacy 215, 248, 251, 284, Brain development, function 4–5, 8, 315–316, 324 18–19, 26, 31, 32–33, 36, 41, 46, Aga Khan Foundation (AKF) xi, 14, 49, 54–55, 68, 76 284, 295, 336–338, 341–344, 346, Brain/hormone pathways 26–29 359 Brazil 6, 10, 82, 91–93, 95, 113, 116, Aga Khan University 116 123–124, 129–142, 376 Agueda Movement, Portugal 201 Animal studies 8, 24, 26, 28, 30, C 32–35, 39, 43–44 California 153, 168, 170, 277 Argentina 82, 91–93, 113 Canada x, xi, 8, 24, 44, 46–52, 59, Assoçiação de Criança Familia e 88, 118–121, 331, 337 Desenvolvimento, Mozambique Canadian Institute for Advanced 199 Research (CIAR) 51, 54, 118, 120 Association for the Advancement of Canadian International Development the Ethiopian Family and Child, Agency 343 Israel 199 Canadian Research Institute for Social Atençao à Criança Program, Brazil Policy 87, 121 138–140 Capacity building 14, 140, 214–215, Attributable risk(s) 99–101, 107–109 284, 298, 303–304, 306, 336, 346, 348 B Caregivers 43, 50, 148, 154, 159, Bangladesh 288, 337 173, 178–180, 186–187, 191–192, Barriers to good decisionmaking 15, 196, 228, 234–236, 241–242, 379 245–246, 249–251, 253, 258, 267, Benefit-cost analysis, benefit:cost ratio 276, 294, 296, 299, 308, 318, 324, 10, 17, 134–136 342, 349, 351, 355 Benefits and costs 132–135 Caribbean x, 121, 239, 290, 332–333, Benefits, of early child development. 336 See also Economic benefits, Societal Carolina project. See Abecedarian benefits v, 1, 3, 6–9, 11, 15, 33, project 397 398 Index Case studies, community programs 353, 355–356, 359, 365, 367, 371, 13, 216, 293–294, 307–308, 358 375, 378, 382, 386 Catalyst for change 15, 372 Community-based Family Education, Center-based childcare 151–157, 172, Philippines 200 173–188 Community-based (programs) 14, 51, Central and Eastern Europe 14, 296, 130, 199–200, 234, 236, 244, 246, 348–350, 353 249–252, 268, 293, 306, 309, 314, Childcare 10, 12, 15–16, 30, 55, 67, 316, 323, 326, 328, 337, 340, 73, 123, 136, 145, 258–259 347–348, 365, 367, 375, 386 Child-centered approach 14, 298, Community-based Rehabilitation 356, 358 Program, Jamaica. See also Childhood vulnerability 83, 87, Dedicated to the Development 104–106, 108–109, 111 of the Disabled (3D) Organization, Children at risk. See also Vulnerable Jamaica 234, 236–237 children 84, 135, 367 Community development 14, 197, Children’s Resources International 263, 306, 339, 341, 346 (CRI) 349, 351–352, 360 Community involvement 253, 296, Child–staff ratio 10, 148, 151–152, 300–302, 307, 314, 351 160, 164, 173, 191 Community mobilization 300, 307, Chile 5, 82, 91–93, 95, 113, 121, 340, 345 284, 290, 292, 364, 374 Community ownership 14, 298, Christian Children’s Fund xi, 287 300–302, 345 Civil society(ies) ix, xi, 85, 199, 349, Community services 222, 223, 378 351, 356, 366, 386 Community support 294, 305–306, Classroom dynamics 10, 147–148, 386 151–153, 160–161, 165 Companies, involvement in early Classroom quality 226, 230, 172, childhood development 139, 257, 174, 176–183, 185, 187 260–261, 264, 280–283, 285–287, Classroom structure 10, 147–148, 160 329–330 Cognitive development 19, 39, 47, Complementary approaches, 53, 63, 72–73, 125, 127–128, 142, programs, strategies 253, 263, 152–154, 158, 168, 173, 311, 323 284, 304–305, 369 Collective involvement 286–287 Comprehensive approaches, programs, Colombia 82, 91–93, 113, 200, 210, strategies 10, 74, 129, 137, 196, 218, 276, 282–283, 286, 288, 384, 253, 348, 367–368, 371, 379, 385 386 Consultative Group on Early Child- Community 10, 13–14, 51, 86, hood Care and Development xii, 88–89, 115–116, 121, 130, 137, 195–197, 217–218 150, 162, 195, 197, 199–201, 205, Continuity 10, 147–150, 210, 245 207, 209–210, 222–223, 234–238, Convention on the Rights of the Child 241–242, 244, 246–247, 249–253, (CRC) 234, 252, 259, 377 258, 262–263, 266–270, 274, 282, Corticotropin-releasing hormone 284–286, 293–298, 300–307, 309, (CRH) 27–31, 33–34, 38, 43 312, 314, 316, 320, 322–324, 326, Costa Rica 82–83, 285 328, 332–333, 337–348, 350–351, Cost-effectiveness 13, 68, 273–275 Index 399 Cuba 45, 82, 91–93, 94–95, 100, Effectiveness Initiative 11, 195, 112–113, 117, 268, 277, 379 197–218 Cultural sustainability 212, 214, 294, Effective programming 11, 195–218 302, 305, 317, 365–366, 378, 382, Elements of quality. See also Dimen- 385 sions of quality, Quality 12, 157, Cycle of poverty. See also Intergenera- 162, 233–253 tional poverty v, 2, 12, 14, 233, Embedded communications, model 252, 365–367 209–213 Empowerment 199, 210, 241, 296, D 300, 304, 323, 326, 328, 350, 386 Environmental effects 8, 35–38 Dedicated to the Development of the Equality. See also Inequality 2, 9, 52, Disabled (3D) Organization, 63–64, 71–74, 85, 94, 138, 205, Jamaica. See also Community-based 305, 317 Rehabilitation Program, Jamaica Equity 2, 13, 52, 260, 262, 278–279, 236–237, 239–242, 244–251 291, 296, 348–350, 353 Definitions, early child development Europe x, 14, 261–262, 291, 296, 257–259 348–350, 353 Development and Peace, Canada 331 European Commission 337, 343 Development economics 9, 64–66 Evaluation 1, 10–12, 17, 53, 123, Dimensions of quality. See also 161–167, 196, 200, 217–218, 231, Elements of quality, Quality 246, 250–251, 268, 276, 278, 151–154, 157–158 290–291, 312, 315–316, 322, 330, Dominican Republic 82, 91–93, 113 341, 346–347, 356–357, 386 Examples of good practice 293, 298 E Expenditures for early childhood edu- Early childhood care and education cation, Brazil 131–132 (ECCE) 291, 295, 297, 305–306, Experimental designs 163–165 328, 331–336 Early Development Index 51 F Early Head Start program, U.S. 6, 14, Family and Child Experiences Survey 369–370, 372 (FACES), Head Start program, East Africa xi, 296, 336–337, 342 U.S. 11–12, 219, 224–231 Economic benefits. See also Benefits Family background 88, 95, 104–105, 52, 197, 260, 373 107–108, 110–111, 113, 117, 156, Economic development v, vi, 86, 163, 169, 178–180, 192 304, 337, 376, 379–380 Family-based childcare 10, 157–161, Economic productivity 197, 260, 321 189–193 Economic returns. See also Return(s) to Family involvement 296, 348, 351 (on) investment 1, 251 Family support 14, 16, 126, 139, 222, Education for All 2, 81, 268, 278, 291 235, 238–239, 249, 298–300 Education pathway 9, 63–64, 66–67, Features of a successful program. 72–74 See also Principles of success 14, Effective childcare and education 10, 298–308 145–193 400 Index Financial sustainability 14, 298, 278, 281, 283, 285, 288–289, 295– 302–303, 307, 339–340, 342, 346, 296, 300, 303, 306, 313, 317–318, 354–355 326, 330, 332–334, 337, 343, 351, Financing, of early child development 366–368, 369–373, 378–379, 136, 199, 261, 267–268, 272–274, 382–390 288, 291, 296, 313–314, 350, 385, Great Britain 24 391 Guatemala 286, 346 Flexibility, of programs 214, 238, 241–242, 248, 271, 346, 371, 387 H Florida Child Care Quality Improve- Haiti xi, 14, 294, 296, 300, 308–316, ment study 152, 169 348–350, 354 Fogel, R.W. 3, 24–25, 65–66 Head Start program, U.S. 6, 14, Ford Foundation 82, 337, 343 219–226, 229–331, 367–373, 386 Formal programs 12, 130, 136, 252 Health and well-being 25, 85–86, 320 Former Soviet Union 14, 296, Health pathway 9, 64, 67–70, 72–74 349–350, 353 Health status 68–69, 86, 320 For-profit organizations 130, Helvetas, Switzerland 331 267–269, 284, 300, 386 High/Scope Study, U.S. See also Perry Foundation support 14, 195, 198, Preschool Project (study), U.S. 41, 235, 283–284, 295, 297, 303, 305, 54, 60, 78, 142, 161, 172, 200, 332, 336–337, 343–345, 349, 290–291, 340, 360 353–355, 376, 388 Hippocampus 27–28, 31–33, 58 Future earning capacity 10, 124, Historical evidence, for prosperity, 132–135 health, and child development 8, 24–26 G Home-based program(s) 12–13, 197, Gene-environment interactions 4, 8, 233, 235–236, 386 32, 33–34 Home visiting models 234–253 Genetics 24, 35 Home visiting program(s) 233–253 German Development Service 313 Honduras 82, 91–93, 113, 201 Germany 19, 309, 313, 316, 331, 358 Human development ix, x, 9, 23, 25, Ghana 376 51–52, 56, 61, 63–78, 84, 116, 118, Global coalition, for ECD initiatives 142, 171, 290, 324–325, 363, 375, 15, 17, 388–389 387 Goals for international development Human potential 15, 363, 376–377 2 Hypothalamus-pituitary-adrenal (HPA) Going to scale. See also Taking the pathway 4–5, 26, 27–29, 31, programs to scale 315–316, 335, 33–34, 38, 43 375 Government, role and support. See I also National government, role of Immune system, effects 26, 29, 34–35 14–15, 16–17, 46, 49, 51, 72, 130, Improving Pre- and Primary Education 138, 198, 200, 207, 209, 215, 234– (IPPS), Pakistan 14, 295–297, 236, 242, 246–248, 250–251, 260, 302–304, 306, 338–348 262–263, 265–268, 270, 272–273, Index 401 India x, 6, 18, 42, 199, 262, 337 K Indicators of effectiveness 196 Kenya 14, 78, 199, 295, 336, 338, Individual involvement in ECD efforts 340–342 266–267, 271–274, 282, 287–290, Korea 43, 57 300–302 Inefficiencies, in society 382–383 L Inequality. See also Equality 3, 10, 19, 61, 64, 75, 77–78, 86, 120–122, 363 Laboratorio Latinoamericano de Eval- Infant Health and Development uación de la Calidad de la Edu- Program (IHDP) 6, 125–128, 142 cación 82, 118 Initial Education Project, Mexico 6 Language, development of. See also In-kind assistance, contribution 248, Literacy, Verbal skills 3, 11, 31, 44, 270, 285, 301–302, 307, 314, 345 51, 60, 82, 90–91 95–96, 100–101, Institute of Applied Economic 125, 153–155, 158–160, 168, 170– Research (IPEA) 10, 18, 75, 132, 171, 221, 224, 230, 236, 364, 368 135, 140–141 Latin America x, 9, 45, 81–122, 201, Institutionalization 12, 238, 214, 262, 277, 290, 363–365 246–247, 251 Lessons from research 10, 145–193 Integrated approach, programs, Lessons learned, to maximize invest- services 63, 235, 295, 304, 316, ments in ECD 7, 15, 369–373 318, 326, 371, 379 Level playing field 2, 16, 71 Integrated Child Development Service Lewis, W.A. 65 (ICDS), India 6, 18, 262 Literacy. See also Language, Verbal Inter-American Development Bank skills 3–4, 19, 31, 44–50, 59, 61, (IDB) xi, 18, 82, 197, 330, 334, 81, 85, 94, 116, 121, 124, 130, 139, 364, 366, 374 221, 223–224, 226, 240, 244, 250, Inter-American Foundation 331–332 295, 304, 316–317, 320, 323–324, Intergenerational poverty v, 14, 17, 329, 346, 364, 368 252, 363–365, 369 Longitudinal designs 151, 163–165, International Adult Literacy Study 182–185, 193 (IALS) 94, 116 Longitudinal studies 3, 24, 35–36, International Monetary Fund 384 38–39, 251 International Step by Step Association (ISSA) 349, 359 M Investing in early child development Madrasa Resource Center (MRC), v, 52, 363, 367, 373, 375–376, 378, Kenya, Uganda, Zanzibar 14, 199, 380, 387–388 295–297, 302–304, 306, 337–348 Ireland 336 Madres Guias, Honduras 201 Israel 199 Malnourished Children’s Program, Jamaica 234, 237–238, 240–247, J 249–251 Jamaica, and government of 12, 39, Mathematical ability (performance), 56, 76, 233–253 mathematics 3–4, 18, 41–42, 48, 54, 90, 92, 95, 97, 101, 104, 117 402 Index Measuring the early opportunity gap O 8, 9, 79–142 Ontario xi, 19, 46–52, 58, 77 Mexico 6, 82, 91–93, 113, 125, 218, Open Society Institute 349, 359–360 272, 283 Organization for Economic Coopera- Microphilanthropy 287–288, 290 tion and Development (OECD) Mongolia 14, 296, 348, 350, 354 44, 59, 120–121 Montessori Preschool Project, Haiti Orphanages, children in 43 14, 294, 297, 300, 302–303, 305, Outcomes 3, 8–12, 25, 42–43, 45, 49, 309–316 68, 70, 72, 75, 78, 81–122, 125, Moral purpose 373 127, 141–142, 147, 149, 151–166, Moral values 259 168, 172–195, 197, 204, 206–207, Mother-Child Day Care Center Ser- 209, 216, 219, 222, 224, 226, 230, vices (MCDCCS), Uganda 14, 233, 238, 265, 275–276, 300, 308, 294–295, 297, 299, 303–305, 316, 357 316–324, 358 Outcome standard(s) 101–102 Mozambique 199, 337 P N Pakistan 14, 116, 295, 337–338, 342, Namibia 376 344 Narrowing the gap for poor children Paraguay 82, 91–93, 113, 285 7, 14, 363–374, 383 Parental involvement 14, 83, 99, National Day Care Study, U.S. 151, 101–104, 106–109, 112–113, 252, 171 298–300, 307, 353, 355, 368, 371 National Education Plan, Brazil Partners for Learning 125, 142 137–138 Partnerships 7, 10, 13, 17, 136, 138, National government, role of. See also 150, 247, 252, 284, 293–294, Government, role and support 297–298, 300, 305–306, 354–355 209, 252, 276, 321 Pathways, to human development 9, National Institute for Educational 63–78 Research, Brazil 116 Perry Preschool Project (study), U.S. National Longitudinal Survey of Chil- See also High/Scope Study, U.S. 6, dren and Youth, Canada 46–47 60, 78, 125, 128–129, 142, 160, 172 Netherlands 201, 331 Peru 82–83, 91–93, 200, 214, 373 New Zealand 386 Peter-Hesse Foundation 309, 312, Nonexperimental designs 163, 165 315, 358 Nonformal program(s) 130, 136, 139, Philanthropy(ies) 13, 266, 270, 282, 200, 235, 295, 300, 306, 316, 283–284, 287–288, 290, 343 323–324, 331, 333, 337, 346 Philippines 200, 214, 376 Nongovernmental organizations Plan International 287 (NGOs) v, ix, xi, 8, 13, 139, 200, Play materials 236, 238, 243–244, 209, 260, 266–267, 270, 284, 288, 250 295, 316, 324, 351–352, 356, 366, Policies for action 383–389 376 Political challenge 15, 375–391 Not-for-profit organizations 268–269, Portugal 201 284, 300, 386 Index 403 Poverty v, vi, 1–2, 10, 12, 14–18, 35, Public-private partnership. See also 44, 54, 66, 73–75, 77, 84, 86, 124, Private-public partnership 7, 13, 129, 139, 158, 233–234, 236, 244, 136, 138 247, 252, 305, 317, 320, 322–323, 325–328, 348, 363–366, 368–369, Q 374, 376, 378, 382, 385 Qualitative research tools, strategies Pre-post design 11, 151–153, 11, 195, 198, 204–217 163–165, 178, 186, 192 Quality 3–5, 8, 10–13, 15–16, 19, 23, Preschool interventions, education, 25, 30, 43, 46, 48–52, 55, 61, 66, effects of 10, 124–129 81, 85–86, 94, 99, 106, 112, 117, Primer Estudio Internacional Compar- 120–122, 136–138, 145–195, 205, ativo (PEIC) 9, 82–83, 89–90, 94, 220, 222, 225–226, 229–231, 99–102, 114–117 233–253, 263, 271, 273, 276–280, Principles of success. See also Features 289–290, 293–295, 300–301, 303, of a successful program 314–315, 305, 309, 313, 315–318, 321–322, 323, 334–335, 345–346, 355–356 324–325, 328, 333, 335–337, Private sector, definitions and dimen- 340–344, 346–348, 353, 363, 365, sions 265–270 368–373, 386 Private sector, role of x-xi, 7–8, Quality in Family Child Care and Rela- 13–14, 17, 49, 53, 110, 130, 138, tive Care study 158–159 255, 257–292, 293, 296–297, 307, 315, 366, 376 R Private citizens, involvement in early child development 287–288 Rahimtullah Trust 343 Private-public partnership. See also Relative risk(s) 100–101, 107–109 Public-private partnership 13–14, Research and evaluation 161–162, 17, 293, 298, 305–307, 331, 355 166, 231, 347 Private versus public care and educa- Resources v, vi, 2, 11, 13–15, 17, 57, tion 13, 257, 272 76–77, 82, 85, 88, 99, 103, 105, Private voluntary organizations 107–108, 110–115, 117–121, 132, (PVOs) 13, 266, 300 138–139, 146, 159, 162, 201, 206, Privatization 262, 266–267, 269–270, 217, 224, 229, 233, 244, 251, 253, 272, 288–291 263–265, 267, 273–274, 280, 284, Program efficacy 260 290, 294, 299–303, 307–309, 314, Program of Indicators of Student 326, 335, 345, 349, 360, 366, 369, Achievement (PISA) study 95 372, 377–378, 383, 385, 387, Program performance measures, Head 389–390 Start program, U.S. 11, 219–225, Return(s) to (on) investment, See also 230–231 Economic returns 77, 124–125, Programa No-formal de Educación Ini- 129, 134–135 cial (PRONOEI), Peru 200 Right Start, U.S. 41–42 Proyecto de Mejoramiento Educativo, Roma children 357 de Salud y del Ambiente Romania 43, 53, 59, 354, 356 (PROMESA), Colombia 200, Roving Caregivers Program (RCP), 209–210 Jamaica 234–236, 239, 241–251 404 Index Rural Family Support Organization Soros, George xi, 349, 353, 359 (RuFamSo), Jamaica 235, 249 South Africa 14, 296, 336, 348–350, 354 S South Asia 336 Staff characteristics 10, 147–151, 153 Samenspel, Netherlands 201 Staff retention 238, 244, 250 Save the Children xii, 199, 287, 331 Stages of (brain) development 29, School policy and practice 99, 31–32 105–107, 110–114, 118, 105 Stakeholders 15, 195, 198, 202, School profiles 83, 89–90, 95–99 205–208, 211, 214–215, 247–248, School resources 99, 105–107, 252, 307, 346, 355, 382–386, 388 110–114, 118 Standards for superior schooling Schultz, T.W. 65 102–104 Scientific evidence, of links between Standards of care 9, 81–122 early child development and State Children’s Health Insurance human development 3–5, 66–68 Program, U.S. 372 Self-Employed Women’s Association, Step by Step program 14, 296–297, India 199 302–304, 306, 348–360 Self-regulation, of behavior 155–156, Steroid receptors 27 176, 183 Stress 3–5, 26, 34, 37, 43, 55–56, 58, Sen, A. 63, 66, 78, 363, 374 60, 65, 150, 162, 167–168, 178, Sensory pathways 26, 29–31 182, 188, 199, 232, 260, 327 Serotonin 34, 54 Supports 10, 26, 36, 51, 134, 145, Service Volunteered for All (SERVOL), 149–151, 160, 166, 232, 238–239, Trinidad and Tobago x, xi, 14, 242, 247, 249, 252, 295, 298, 313, 295, 297, 299, 302–306, 324–336, 319, 337, 348, 356, 366, 381 358–359 Sustainability. See also Cultural Social capital 9, 12, 52, 64, 70–74, sustainability, Financial sustain- 76–78, 86, 119, 121, 234, 379 ability 13–14, 210, 238, 242, Social class 4, 36–39, 45–46, 85, 175 247–248, 251–252, 286, 297–298, Social cohesion 73, 85–86, 120 300, 302–303, 307, 312, 323, 331, Social competence 12, 70, 73, 339–340, 342, 344, 346, 348, 351, 169–170, 184–185, 220, 222 353–355, 359, 380 Social equity. See also Equity 260 Sweden 38, 94, 283 Social policy xi, 85–87, 89, 121 Swedish International Development Social trust fund 282, 284, 290 Cooperation Agency (SIDA) 322 Social values 73, 259 Syracuse Family Development Re- Societal (social) benefits, effects. See search Program 161 also Benefits 2, 15, 67, 70–75, 259–261, 289, 367, 375–378, 381–383 T Socioeconomic gradients 9, 18, 47, Tajikistan 337 54, 83–95, 114–115 Taking the programs to scale. See also Socioeconomic status (SES) 35–36, Going to scale 7, 13–14, 246, 293 39, 44–48, 55, 58, 82–84, 86–88, Tanzania 77, 337 94, 99, 120, 129, 149, 157, 159, Taxes, earmarked for social programs 176, 179, 180, 186 252–253, 385 Index 405 Teacher-child interactions 147–149, United Nations Educational, Scientific, 152, 160 and Cultural Organization Teacher’s qualifications 153 (UNESCO) xi, 82, 90, 117–118, Teacher training. See also Training 15, 121, 290–291, 322 103, 105, 107–108, 294, 297, 305, United States 6, 10, 40–42, 44–45, 54, 309, 313, 315, 333, 346, 351, 353, 120–121, 124, 145, 166, 219, 262, 358 268, 281, 283, 285, 331, 337, 349, Technology, role of 288, 324, 330, 367–368, 370, 372, 374, 383 365 Universal Declaration on Human Teenage Mothers Project, Jamaica Rights 377 235, 249 University Hospital of the West Indies Third International Mathematics and 237 Science Study (TIMSS) 116 U.S. Agency for International Develop- Tinbergen, Jan 64–65 ment (USAID) xi, 344, 356–357, Training vii, 10, 12, 14–15, 67, 103, 360 105, 107–108, 112–113, 116, 130, U.S. National Education Goals Panel 137, 147, 149–150, 153, 157, 221, 232 159–160, 168, 181, 186, 188, 192, 196, 199–201, 206, 220, 223, 231, V 235–237, 239–240, 243–246, Venezuela, Républica Bolivariana de 248–251, 266, 281, 284, 294–298, 82, 91–93, 113 302–305, 309, 311–312, 314–315, Verbal skills. See also Language, 317, 322, 324, 329, 331–335, Literacy 38, 44, 46 338–342, 346–335, 358, 365–366, Vulnerable children. See also Children 368, 370, 386 at risk 9–10, 110–111, 121, Trinidad and Tobago xi, 14, 295, 124–129, 298, 365 324–325, 327–328, 330–336, 359 Tropical Medicine Research Institute W (TMRI), Jamaica 237–238, 243 Turkey 125, 201 West Africa 347 2020 Commitment 388 White House Conference on Early Childhood Development and U Learning, U.S. 370 Willingness to pay 135–136 Uganda 14, 199, 294–295, 303, Women’s multiple roles 238, 240, 316–318, 321, 323–324, 336, 338, 249 341–343, 358 World Bank v, vii, ix–x, 1, 7, 10, United Fund, U.S. 281 18–19, 42, 44, 52–53, 60–61, 68, United Kingdom 25, 38–39, 55 77–78, 82, 85, 116, 118, 130–132, United Nations Children’s Fund 135, 140–142, 197, 292, 337, (UNICEF) xi, 67–68, 76, 235, 245, 343,359–360, 366, 372–373, 376, 251, 259, 285–286, 291–292, 374, 380, 382, 384, 390–391 376, 382, 390–391 World Conference on Education for United Nations Development All 81 Programme (UNDP) 63, 313 406 Index World Health Organization (WHO) xi, 67, 69, 78, 286, 382, 384 World Vision xii, 287 Y Year 2000 Evaluation of Education for All 268, 278, 291 Z Zanzibar 199, 295, 338, 341–343 C hildren are our future. Investing in every child at an early age is an investment in human and economic development for all. Children born in poverty are far more likely to grow up stunted in both body and mind. Science tells us that early child development is critical and marks a child for life. Young children who are well nurtured do better in school and can develop the skills to compete in a global economy. Recently, the World Bank hosted a conference to review the state of knowledge on brain development, the link between early child develop- ment (ECD) and human development, standards of care to improve chil- dren’s educational outcomes, qualitative and quantitative measures of effective programs, and elements of quality in ECD programs. The world’s leading experts from nongovernmental, governmental, multilateral, and bilateral organizations urged the public and private sectors to enhance and coordinate activities and to formulate policies to advance the development of all children and to “narrow the gap” for poor children. This book contains essential resource information that includes descrip- tions and case studies of successful ECD programs throughout the world. Written in an accessible style, it is invaluable for all policymakers and practitioners concerned about human development and education of children worldwide. THE WORLD BANK 1818 H Street, NW 15050 Washington, DC 20043 USA Telephone: 202 477-1234 Facsimile: 202 477-6391 Internet: www.worldbank.org E-mail: feedback@worldbank.org 9 780821 350508 ISBN 0-8213-5050-1