Donald TrumpDonald John TrumpRussian sanctions will boomerang States, cities rethink tax incentives after Amazon HQ2 backlash A Presidents Day perspective on the nature of a free press MORE has proposed making childcare payments fully tax deductible. This proposal would mainly benefit upper middle- and high-income families. Low- and lower middle-income families would benefit far less because most of them do not earn enough income to pay taxes and they rarely itemize their tax returns. 

In contrast, Hillary ClintonHillary Diane Rodham ClintonThe Democratic demolition derby Juan Williams: Don't count Biden out Candidates in Obama's orbit fail to capitalize on personal ties MORE’s early childhood proposals promise "no family would have to pay more than 10% of its income for affordable high-quality childcare." Families living in poverty currently spend over 30% of their monthly income on childcare, while those living just above the poverty line spend about 20%. Families of low- and middle-income levels would benefit greatly from Hillary's proposal. In addition to childcare, Hillary has proposed paid family leave for working families, an increase in home visiting services, dramatically improved access to early learning programs, a raise for early childhood educators, and universal preschool for every 4-year old child. 

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Whose plan is the better investment? What additional early childhood policies are needed?

We enthusiastically support Hillary’s current proposals. However, they do not go far enough. 

Current federal and state laws leave gaping policy holes in our nation’s safety net for at-risk children. America is treading water in a rising sea of young children with developmental delays, disabilities and mental health disorders who, without essential services, will become high-cost, low-achieving citizens.

Do Americans even know the dramatic statistics we are facing?

By 24 months, about 13% of children have developmentally delays. From 3 to 17 years, 15% to 17% possess a developmental disability, and from 9 to 17 years, 20% are diagnosed with a mental health disorder. Ultimately, at least one-fourth of our children will develop life-long conditions that lead to poor educational, health, social and economic outcomes.

Yet shockingly, only 2% to 3% of our nation’s children from birth to 36 months receive early intervention services under Part C of the Individuals with Disabilities Education Act.

Early identification and high-quality early intervention and learning programs substantially reduce rates of grade repetition, school dropouts, teenage pregnancy, criminal or antisocial behavior, substance abuse, suicidal ideation, suicide attempts, unemployment, and welfare dependency. Economists say for every dollar invested in a high-quality early childhood program, there's a 7% to 10% annual rate of return ―the younger the child, the wiser the investment.

We need a national policy framework bridging education, health and social sectors to help states fill gaps in essential children’s services. Specifically, for children 0 to 5 years, every state needs five “systemwide solutions” including:

1. Universal developmental-behavioral screening and wellness promotion. The American Academy of Pediatrics recommends that all children should be periodically screened for developmental delays, social-emotional problems, autism and family risk factors while simultaneously promoting early literacy and positive parenting skills. With parents' permission, screening results should be shared rapidly with agencies providing support to children and families, including medical, mental health, education, nutrition and social services. 

2. Systemwide care coordination. Referral data from multiple states reveal that only half of pediatrician-referred children become linked to early intervention agencies. For communities with care coordination services, linkage rates can soar to above 80%. Parents in all states deserve expert guidance in finding and securing effective community resources for their children.

3. Comprehensive and equitable eligibility assessments for all referred children. At present, 22 different state eligibility definitions exist for early intervention resulting in varying rates (1.5 to 7%) of service delivery and distressed parents. Most states have established overly restrictive criteria for eligibility. In many states, children with mild to moderate delays, that will become severe delays if left untreated, are excluded from early intervention services. Restrictive eligibility policies have become a major policy mistake causing later high costs to society.

4. A continuum of high-quality and well-coordinated care. A “continuum of care” includes:

a) prevention-based interventions such as parenting programs for all families and Early Head Start for all disadvantaged children.

b) targeted services for children and families needing more support.

c) intensive and individualized early intervention programs for children who require them.

5. Accountability for early identification and intervention. Parent-centered tracking systems are needed to assess rates of early identification, referrals, service enrollment, assessments, and child outcomes, including kindergarten readiness. Tracking systems would also help states plan and implement more effective early childhood services.

Establishing and implementing these policy initiatives would greatly improve the development of our nation’s children, and they would help the U.S. to become more productive and competitive in the future.

Kevin P Marks MD FAAP is a pediatrician at PeaceHealth Medical Group and clinical assistant professor at OHSU School of Medicine. Emily Vargas-Barón, Ph.D. is an early childhood policy planner and researcher and director of the RISE Institute.


The views expressed by authors are their own and not the views of The Hill.