DOCUMENT RESUME

ED 352 171 PS 020 963

AUTHOR Szanton, Eleanor Stokes; And OthersTITLE Heart Start: The Emotional Foundations of School

Readiness.INSTITUTION National Center for Clinical Infant Programs,

Arlington, VA.SPONS AGENCY AT&T Foundation, New York, NY.; Metropolitan Life

Foundation.REPORT NO ISBN-0-943657-28-8PUB DATE 92NOTE 57p.; Foreword by Ernest L. Boyer. Preface by T.

Berry Brazelton. Separately printed four-page"Executive Summary" and eight-page "Five Vignettes"bound in. Funding also provided by Johnson ar''Johnson Consumer Products, Inc. and Pittway CorporateCharitable Foundation.

AVAILABLE FROM Zero to Three/National Center for Clinical InfantPrograms, 2000 14th Street North, Suite 380,Arlington, VA 22201-2500 ($13 plus $4 shipping andhandling). 964-965).

PUB TYPE Reports Evaluative/Feasibility (142)

EDRS PRICE MF01/PC03 Plus Postage.DESCRIPTORS Child Caregivers; Child Development; *Childhood

Needs; Child Rearing; Cognitive Development; DayCare; Emotional Adjustment; *Emotional Development;Environmental Influences; *Health Promotion; LearningReadiness; *Need Gratification; Preschool Education;*School Readiness; Security (Psychology); SelfConcept; *Young Children

IDENTIFIERS *Heart Start; Zero co Three

ABSTRACT

This publication is part of a package of threebooklets that synthesize current knowledge about the preconditionsfor learning in children and discuss ways of fostering theseconditions. (The other two booklets are an executive summary of thisreport and a collection of five vignettes on services for infants,toddlers, and families). This report is based on the prem'se thatchildren's expectations and attitudes are formed in the first monthsand years of their lives. Parents need to understand how they canpromote in their children certain characteristics that are related tolearning in school. These characteristics are: (1) confidence; (2)curiosity; (3) intentionality; (4) self-control; (5) relatedness; (6)capacity to communicate; and (7) cooperativeness. To develop thesecharacteristics, four kinds of needs must be met. First, the need forgood physical health is met by providing affordable and accessiblehealth care; tracking children through the health care system; andmaking child care a health resource. Second, children should beassured of time for unhurried caring from parents and family members,and stability of child care providers over time. Responsivecaregiving from parents and child care providers is a third need ofall children. Fourth, meeting children's need for safe and supportiveenvironments requires an adequate standard of living for children'sfamilies and adequate space in child care settings. In addition tothese needs, some children have special needs for themselves andtheir families that must be met. Recommendations for serving theseneeds of children are summarized in a chart that describes the

responsibility of federal, state, and local governments, and ofcorporate sources, in serving these needs. Numerous endnotes areincluded. (SLD)

U.S. DEPARTMENT OF EDUCATIONOffice of Educet:onal Research and Improvement

EDUCATIONAL RESOURCES INFORMATIONCENTER (ERIC)

This document has been reproduced asscorned from the person or organization

originating it0 Minor changes have been made to improve

reproduction Quality

Points of view or opinions stateo in this clocument do not necessarily represent officialOERI position or policy

HEART

SCOPE OF INTEREST NOTICE

The EPIC Facility has assignedthis document for processingto:

In our judgment, this documentis also of interest to the Clearinghouses noted to the rightIndexing should reflect theirspecial points of view.

START!11111111

The Emotional Foundations of School Readiness

'14 '

sic

4#0,14,Z=VI.,

BEST ESPY

a.

-...1.s.

. . - 4.,... ' '-.1.,,,,.'s..f.,;'.

;3:::...!.4...4::::::::4t11;:::::.

.,3,64.7.,, tf 1. ..e ,,:. ,'.... ,,.. .

, ...,,*.fr;'-,..;,41

,Ii.:/.. etect. .. ".

...i.li- ,. .,':til,41,-Af.

, - ;-e.p-4

.' liami,M>'' , .,'

c_

"PERMISSION TO REPRODUCE THISMATERIAL HAS BEEN GRANTED BY

V\

TO THE EDUCATIONAL RESOURCESINFORMATION CENTER (ERIC)."

Foreword byErnest L. Boyer, Ph.D.

Preface byT. Berry Brazelton, M.D.

ZEROTO

THREE, National Ccoldr lor Cluucal Infant Program,

This publication was made possible by generous grants from AT & T Foun-dation, JOHNSON & JOHNSON Consumer Products, Inc., Metropolitan LifeFoundation and Pitt-way Corporate Charitable Foundation.

******** ****N **********************************************************************************************

ZERO TO THREE/National Center for Clinical Infant Programs is the only national nonprofitorganization dedicated solely to improving the chances for healthy physical, cognitive andsocial develpment of infants, toddlers and their families.

Established in 1977, ZERO TO THREE is committed to:

exercising leadership in developing and communicating a national vision ofthe importance of the first three years of life and of the importance of early inter-vention and prevention to healthy growth and development;

developing a broader understanding of how services for infants and toddlersand their families are best provided; and

promoting training and practices in keeping with that understanding.

ZERO#4,0 TO

THREENational Center for Clinical Infant Programs

200014th Street North, Suite 380Arlington, VA 22201-2500

(703) 528-4300 FAX (703) 528-6848TDD (703) 528-0419

for ordering information and additional ZERO TO THREE publications, contact:ZERO TO THREE toll free: 1-800-544-0155.

***********************************************************************************************************

Copyright 1992ISBN #0- 943657 -28 -8

Library of Congress CatalogueCard Number: 92-82895

COST: $13.00 Heart Start$ 6.00 Executive Summary

Total Order Shipping/Handling FeeLess than $10 $2.50$10-559 $4.00$60 or more 10%

Same day service $8.00 additional

DEsiGN CREDIT: Melody SareckyL. Gar Botzum

EDITING CREDIT: Noelle Beatty

PHOTO CREDITS: Faith Bowlus (cover); Barbara Young, M.D. (pp. 2, 23);J. Brown /G. Simon (p. 9); Florence Sharp (p. 16); John Arms (p. 26)

Contents

Foreword by Ernest L. Boyer, Ph.D. iii

Preface by T. Berry Braze lton, M.D. v

L What Is at Stake 1

II. The "Heart Start" 7

III. What Is to Be Done? 15

1. Assuring Health 15

2. Assuring Time for UnhurriedCaring 17

3. Promoting Responsive Caregiving 20

4. Assuring Safe and SupportiveEnvironments 23

5. Providing Special Help for Familieswith Special Problems 24

Summary of Recommendations 29

Endnotes 35

Foreword byErnest L. Boyer

PresidentThe Carnegie Foundation for the Advancement of Teaching

The nation's schools are, in many respects,nothing short of miraculous. They open theirdoors and serve an unbelievable range ofstudents, against the most impossible odds.Undermined by poverty, violence, politicalcross-fire and the sharp sting of critics, theschools continue valiantly to carry on theirwork. In most communities, one can findteachers who are effective, even exemplary,and classrooms where lives are beingtransformed.

Still, there is another side to the equation. Evenin the best of our nation's schools, there arechildren who do not reach their full potential.The reasons for such failure are complex, but atleas, one primary problem is quite clear: manychildren come to school without the essentialsupport they need to learn effectively.

Nearly thirty years ago, policy-makers in thiscountry acknowledged the consequential rolethat preschool can play in improving children'sprospects for school learning. During thedecade of the sixties, they created Head Start togive early educational support to children whoare most at risk of school failure. As the firstgraduates of this program proceeded throughthe grades, it became clear that early interven-tion truly can make a difference.

Even in preschool, though, children varygreatly in their readiness to learn. Some aremore intellectually curious than others. Someread and speak well, while others have diffi-culty communicating. Some concentrate more

iii

readily than others. Some play and interactsuccessfully with their peers, while othersprefer to pick fights or remain alone at thefringe of classroom activity.

In the last two decades, our understanding ofchild development has grown at a dramaticpace. Above all, we now know that laterlearning depends heavily on what happens to achild in the first few years of life. We realizethat infants whose development has beencompromised during pregnancy are less likelyto succeed in school. We understand, too, thateven healthy children who are neglected,abused or subjected to significant instability intheir early years can be educationally impaired.

The conclusion is beyond dispute. If we careabout children, then we must ensure that everychildfrom no matter what socioeconomicclass, no matter what race, and no matter whatfamily circumstanceshas the support he orshe needs to become ready to learn.

This brief report is designed to help us reachthat important goal. Its purpose is to present, inthe clearest language available, a neededsynthesis of current knowledgeand it does soadmirably. The pages that follow show how thepreconditions of learning develop in childrenand describe how these conditions can befostered. There is essential information forparents and caregivers and for policy-makers,as well. The messages presented here deserve tobe widely read and the policies vigorouslypursued.

Preface byT. Berry Braze lton, M.D.

Children's Hospital Medical CenterBoston, Massachusetts

A child's experiences in the first months andyears of life determine whether he or she willenter school eager to learn or not. By schoolage, family and caregivers have alreadyprepared the child for success or failure. Thecommunity has already helped or hinderedthe family's capacity to nurture the child'sdevelopment.

In our diagnostic work at Children's Hospital inBoston we can tell by 8 months of age whethera baby expects to succeed or to fail by the wayhe or she approaches a task. We offer twoblocks to a seated 8-month old, and then wedemonstrate that we'd like her to place the twoblocks together. A baby who expects to succeed,and who is used to the approval and encour-agement of adults around her, will pick up oneblock, mouth it, rub it in her hair, drop it overthe side of the table, watching to see whethervou will retrieve it for her. When you do, shefinally completes the requested taskplace thetwo blocks together. Then she looks up at youwith a bright-eyed look of expectancy that says:"Tell me how great I am!"

But a baby who has an untreated learningdisability, or who comes from an environmenttoo chaotic or too hopeless to reinforce in him afeeling of success, will demonstrate an expecta-tion to fail. The baby will accept the offeredblocks, look dully at them, bring them closetogether dutifully as directed, but withoutexcitement or enthusiasm. He has demon-strated his cognitive understanding of the task,then he pushes them past each other, appar-

ently failing the task. Then comes the symptom:he looks up at you with the hangdog look thatsays, "Hit me, I'm no good. See! I've failed!"This child will expect to fail in school. He willexpect no encouragement from teachers, andmay shrink from encouragement if it is offered.He is likely to find school embarrassing andjoyless and may eventually drop out.

ihis report shows how we can produce manymore confident and achieving children, andmany fewer who expect to failwho comealmost to welcome failure as a retreat fromoverwhelming circumstances. It shows how achild's expectations and attitudes are formed inthe very first months and years of life, and whyencouragement and stimulation are the secondmost important gifts that parents can providetheir children. Love comes first. But parentsalso need to understand how their actions canhelp generate the confidence, the curiosity, thepleasure in learning and the understanding oflimits that will make their children expect tosucceed and help them do so. And policy-makers need to understand and support thesocial policies that can aid parents in achievingthose results.

I am proud that Heart Start was begun duringmy term as President of ZERO TO THREE/National Center for Clinical Infant Programs. Itcomes at a crucial time in this country's concernfor its children. I believe that parents, profes-sionals and policy-makers will all benefit fromit, and somost of allwill our youngestchildren.

I. WHAT IS AT STAKE

An American tragedy

any American children never reachtheir potential for learning. Somenever come close. In former times,

such undeveloped potential might have limitedthe pride that children took in themselves, thesatisfactions they experienced in school, theunderstanding they later brought to everydayproblems of life, and the stimulation they even-tually offered to their own children. Conse-quences enough. Yet now there is another evenmore damaging result: young men and womenwho do not have the characteristics they needto learn in school are in danger, all their lives, offinding only menial employment, or none.

The seasons are by now familiar. The produc-tion of goods is increasingly automated andtherefore provides steadily fewer low-skill jobs.Service jobs are growing in number but manyrequire greater verbal facility, higher technicalskills, better judgment, or more initiative thantraditional blue-collar tasks. Moreover, the paceof technological change now makes muchknowledge and most skills obsolete in littlemore than a decade. So employers seek to hire,even for entry-level jobs, men and women whocan readily be trained and later retrained forother jobs. American employers spend more onemployee training than the United Statesspends on all elementary and secondary educa-tion, public and private. In high-tech manufac-turing employees can expect to spend one-fifthof their work-lives in training. And they areexpected to learn. Learning and adaptation arenow lifelong challenges. How well people meetthose challenges will determine not only howknowledgeably they can participate in the civiclife of their communities but also whether ornot they advance in their own careers, whetherthey earn decent incomes, whether they arelikely to take pride in their work. It will also

affect how well our society competes in a worldm, rket.

So an interest in learning, and the capacity tobenefit from instruction, are not only important,they are probably more important now, formore people, than ever before in the history ofany society. And during the lives of today'schildren they will become more crucial still. Thefact that many of our children never approachtheir potential forformal learning isthus a triple trag-edya lifelong trag-edy for them, for theirfamilies and for oursociety as a whole.Since many of thesechildren are membersof minority groups,the consequences arenot only economic;they haunt our poli-tics and offend our sense of justice as well.

An interest inlearning, and the

capacity to benefitfrom instruction,

are not only impor-tant, they are prob-ably more impor-tant now, for morepeople, than everbefore in the his-

tory of any society.

Schools as much victims as villains

One-quarter of American teenagers don't finishhigh school. Many who do graduate havesimply gone through the motions. They maynot even read well: more than one out of eightof high-school juniors are functionally illiterate.The proportion unable to solve simple numer-ical problems is probably greater. SouthwesternBell Corporation tests applicants for entry-leveltelephone operator positions for reading com-prehension and simple mathematical skills. InSt. Louis in 1989, the company culled 15,000initial applicants in order to find 3,700 whoqualified to take the test. Of the 3,700 test-takers, only some 800fewer than one infouranswered 55 of the 85 questions correctly,and passed.

The frequency of similar stories has producedgrowing concern about the state of the nation'sschools. Education was once the concern onlyof parents, teachers and local school boards; ithas now become an urgent topic for business-men and politicians as well. The national [fed-eral, state and local] investment in education isgrowing. In 1991, it exceeded $410 billion. Some

small gains have been achieved, and perhapsmost importantly the disparity between minor-ity and nonminority achievement scores hassomewhat diminished. But the answer to the

2

IY

ultimate question remains the same: Are thegreat majority of U.S. students well preparedwhen they leave school for satisfying andsuccessful lives in a knowledge-basedeconomy? No, they are not.

In part, the problem is still one of resources.Some school systems, especially in areas where

the tax base and taxingauthority is limited, lackexperienced teachers, lackappropriate texts, andmay not provide evenphysical security. In othercommunities, the initia-tive of teachers and prin-cipals is deadened by theweight of an educationalbureaucracy. Nationalattitudes account foranother part of the prob-lem: much of the countrystill assumes that modestskills will earn goodwages, e.nd that low levelsof academic competenceare good enough. In arecent cross-nationalstudy of the mathematicalproficiency of 13-yearolds, South Korean stu-dents ranked first inmathematical skills, andU.S. students last. Butmore significant than thescores were the attitudestoward them: When askedwhether they regardthemselves as "good atmathematics," only 23percent of the Korean

students answered yes; 68 percent of the U.S.students answered yes.

8

But there is a fact which poor schools and lowexpectations do not explain. Many children arefailing to learn even the most basic skillsskillsthat schools are well-enough equipped to teach,and which most schools seriously attempt toteach. Why is that?

The source of the problem

From the time they leave the places of their birthuntil they arrive in preschool or kindergarten,children are largely invisible to society. No oneoutside a child's family may recognize difficul-ties likely to impede learning until they becomeevident in school. But professionals in childdevelopment know that the sources of thosedifficulties develop long before school begins.

The fact is that success in school depends oncharacteristics largely formed by th ..? age ofthree. And those characteristics are not a fundof factual knowledge, nor the ability to read orto recite the alphabet, nor familiarity withnumbers or colors. They are the characteristicsof children, of whatever background, who cometo school curious, confident, conscious of whatbehavior is expected of them, comfortable inseeking assistance, and able to get along withothersqualities largely developed, or notdeveloped, in the first three years of life. Thisholds true in good schools and poor schools, inlarge schools and small schools, in publicschools and private schools.

Almost all students who do poorly in schoollack some or all of those fund-mental character-istics. No matter what potential they are bornwith, children who have little confidence thatthey can figure things out, who have not beenencouraged to reach achievable goals, who lackthe capacity to express feelings, ideas andsimple concepts, or who feel no responsibilityto control their behavior (or are unable tocontrol it) are poorly equipped to learn inschool.

39

And there are many such children. In somestates close to one out of five children arerequired to repeat first grade. Many of them,unable to respond to any but the most idealteaching conditions, then fall further andfurther behind. Often they become more dis-couraged, more withdrawn, more resentful and,in some cases, more disruptive through eachgrade.

Does that mean that the quality of schoolingdoesn't matter, that the readiness of the studentis everything? No. The quality of schoolingmatters greatly. Schools can make a difference.Our schools must take children as they findthem and do their best for all. Moreover, evenpoorly prepared children can be helped by indi-vidualized attention from devoted and persis-tent teachers, especially if the children's fami-lies are also involved. But that kind of attentionis often not available. And, in any event, ineducation as in medicine, preventing problemsis far more effective than trying to cure them.All our children should arrive at school able tobenefit from the classroom.

Effective early childhood programs

High-quality programs clearly do advance chil-dren's development and help prepare them forschool. A recent study funded by the RobertWood Johnson Foundation compared the effectsof an intense, comprehensive child care pro-gram, as against medical care only, for almost1,000 low birthweight infants and their families.It found that at 3 years of age, those childrenreceiving medical care only were three times aslikely to have IQ scores classified as develop-mentally delayed, and a higher incidence ofbehavior problems.

Another well-documented study traced thelong-term consequences of an extensiveprogram that offered child care and familysupport to low-income families in Syracuse,

New York, over the first five years of their chil-dren's lives. A follow-up study ten years latercompared children who had been in the pro-gram with others of similar background whohad not. The program childrenespecially thegirlswere doing far better in school. Almosttwice as many of the program childrenexpected to remain in school for the followingfive years. And as young adolescents, the pro-gram boys had committed roughly one-fourththe number of offenses as the nonprogramb.)ys, and their offenses were far less severe.

A third study followed two sets of impover-ished Connecticut families with infants andtoddlers. One group received a coordinated setof health and social services; the other did not.A decade later, all but one of the children in thefirst group were doing well in school. Overall,more of the mothers were self-supporting, hadcompleted more schooling and had fewersubsequent children than those in the second.Fewer of the children in the families that hadreceived the services were in special education.Their school attendance was better, and theywere "liked more" by their teachers. The fami-lies that had not received services were costing,on average, almost $3,000 more per family eachyear, in welfare and special education, thanthose who had.

Not all early childhood programs produce sucheffects, but the characteristics of those that doare known. Effective programs are readilyaccessible. Their staffs are adequate in number;can offer a broad spectrum of services; crosstraditional, professional and bureaucraticboundaries; adapt to individual differences inchild and family needs; see the child in thecontext of the family and the family in thecontext of its surroundings; are perceived bytheir clients as being caring, respectful andtrustworthy; and provide services that arecoherent and easy to use.

Like high-quality early childhood programs,good preschools can also help children preparefor school. But preschools often face the sameproblem that schools do: they find themselveshaving to help 3- and 4-year olds overcomedelayed development and alter self-defeatingattitudes already deeply ingrained. Whenpreschools succeed at those tasks they performan immensely valuable service. But preventionis better still, and prevention must start earlier.It must start in the first weeks and months oflife, because it is then that children first try tounderstand and master their environment, andfind those efforts encouragedor not; firstattempt to concentrate and find it possibleor

not; first con-clude that theworld isorderly andpredictableor not; firstlearn thatothers arebasicallysupportiveand caringor not. It is inthose yearsthat the foun-dations forlater learningare laid down.Or are not.

[It is] in the first weeks andmonths of life that chil-dren first try to understandand master their environ-

ment, and find those effortsencouragedor not; first

attempt to concentrate andfind it pc, 'bleor not;first conciade that theworld is orderly and

predictableor not; firstlearn that others are basi-

cally supportive andcaringor not. It is in

those years that the foun-dations for later learningare laid down. Or are not.

The task

The next chapter suggests how the attributesessential to learning in school normallydevelop, and what may keep them from doingso. The happy and fundamental fact is that instable and supportive environments, virtuallyall healthy infants begin to develop those attrib-utes almost automatically. Healthy babies areborn curious. They are eager and able to learnright from the start. We know now that,

immediately after birth, infants can tell thedifference between their mother's voice and allother voices; they have learned to recognizethat most familiar voice even though it mustsound quite different outside the mother's bodythan it did in the womb. And infantsimmediately begin trying, from thatfirst squint-eyed peering out at theworld, to make sense of their sur-roundings and to communicate theirbasic needs. By 9 or 10 months, mostinfants recognize similarities anddifferencespictures of animalsagainst pictures of people, for exam-ple. They have begun to organizetheir observations of their world bycreating categories.

Anyone who has watched an infanttry and try again to reach an object, orto pile blocks on top of each other, or

become competent. That desire comes fromwithin; adults don't create it. But it is crucialthat adults encourage and not destroy it. Theinfant who finally pulls herself upright in her

is greeted by a parent's expression ofadmiration will have a qui' e differentattitude about herself, and about theimportance of curiosity and of persis-tence, than the child whose achieve-ment is ignoredor who is yelled atto lie down and go to sleep.

crib and

The infant who finallypulls herself upright inher crib and is greetedby a parent's expres-

sion of admiration willhave a quite differentattitude about herself,and about the impor-tance of curiosity andof persistence, than thechild whose achieve-ment is ignoredor

who is yelled at to liedown and go to sleep.

to walk, knows that infants seek notmerely to understand the world but to masterit. They want to be able to do thingsto

5

The task for parents and other care-givers is not to force development.Rather, it is to try to ensure that thepractices of daily life give the infantand toddler the emotional securityand encouragementthe "HeartStart"that are the foundations forlearning at home, in school andthroughout later life. It is to that taskthat we now turn.

II. THE "HEART START"

child arrives for her first day ofschool. She will be expected tolisten, to follow directions, to be

interested in toys and tasks, and to start andfinish small projects. She will be expected toexpress her needs, to respect those of others, tobe able to wait and to know when she needshelp. She will be expected, in short, to have the"Heart Start" capabilities she needs to learn inschool.

Characteristics that affectperformance in school

The specific characte.istics related to learning inschool are as follows:

1. ConfidenceA sense of control andmastery of one's body, behavior andworld; the child's sense that he is morelikely than not to succeed at what heundertakes, and that adults will behelpful.

2. CuriosityThe sense that finding outabout things is positive and leads to plea-sure.

3. IntentionalityThe wish and capacityto have an impact, and to act upon thatwith persistence. This is clearly related toa sense of competence, of being effective.

4. Self-ControlThe ability to modulateand control one's own actions in age-ap-propriate ways; a sense of inner control.

5. RelatednessThe ability to engagewith others based on the sense of beingunderstood by anti understanding others.

6. Capacity to CommunicateThe wishand ability to verbally exchange ideas,feelings and concepts with others. This isrelated to a sense of trust in others and ofpleasure in engaging with others,including adults.

7

7. CooperativenessThe ability tobalance one's own needs with those ofothers in a group activity.

These characteristics equip children with a"school literacy" more basic than knowledge ofnumbers and letters. It is the knowledge of howto learn.

Annie, one of twenty-fine first graders,is busily working at her desk. She smilesas the teacher walks by. With obviouspride, she is circling the letters that gowith the pictures (Z for zebra, etc.).Though she did not at first understandwhat to do, she had asked the teachers tohelp her, and she had watched the chil-dren around her.

Nearby, Bobby is sitting half on andhalf off his chair. A puzzled expression onhis face, he is looking around at the otherchildren. After scribbling different colorson his sheet of paper, he is getting rest-less. He grabs a friend's pencil and startstaunting him. The teacher scolds him andputs him in the "time out" chair in theback of the room. He looks relieved. Henow knows what he will be doing for thenext few minutes. And, even better; noone else knows that he was confused bythe assignment.

How is it that children develop any or all of heseven characteristics which allow them to becloser to Annie than Bobby when they reachschool age?

Infants differ; so do parents

All infants are born learners. They come intothe world eager to engage with it. But each

infant has unique physical, sensory and emo-tional capacities; each will put his or her ownstamp on everything that he or she encounters.Even identical events are different experiencesfor different babies. Sally hates to be swaddledand becomes severely distressed whenrestrained in that way. Barry loves it, calmsimmediately, and remains awake and alert.Darnell also calms but falls instantly asleep.Antricia is startled by the smalleet sounds butloves to watch movements. A soft touch startlesBilly but not a firm one. He enjoys being talkedto. Shatel rarely stops moving, reacts verystrongly to almost everything, eats hard, sleepshard, and puts all of herself into every activity.

Parents differ as well. Some parents will tune inquickly to a baby's unique characteristics;others will have little sense of what their childneeds. Some find the stress of caring for aninfant overwhelming and even infuriating attimes. Because of these infant and parent differ-ences, as well as the very different situations inwhich they find themselves, no two relation-ships that develop between babies and thosewho care for them are entirely alike.

Yet it is within those relationships that much ofthe baby's crucial learning will occur, and allbabies are learning about the same things. Theyare all learning about their bodies, aboutobjects, about who they are, how to feel aboutthemselves, and what they can expect of thosewho care for them. Such basic human capacitiesas the ability to feel trusting, to experience inti-

macy with others and to negotiate with othersbegin to develop from their earliest moments.

Two styles of parenting

A young mother hears a cry from her 5-week -old baby in the nearby crib. It is 3a.m. The mother's initial dismay quicklyturns to anticipation of the feeding thatwill now begin.

8

The baby senses the light turned on,feels the touches and cradling of her bodyand, though hungry, begins immediatelyto calm from the cues that tell her thather discomfort is about to end. For half-an-hour the baby nurses, pausingbetween bursts of sucking and gazing upinto her mother's eyes, woozily but withwhat the mother feels is pleasure andrecognition. During the pauses themother speaks softly to her new daugh-ter. The baby smiles, watching hermother's shifting expressions. "Hi,Emilysweet Emilyyou are verypretty. Were you hungry? Do you wantmore? Do you need a burp? I am glad tosee you even if it is 3 a.m." The babyslowly begins to drift off. Her motherputs her in the crib, kisses her, covers her,and says "Sweet dreams."

What is happening is utterly ordinary; a motheris feeding her baby. But what is happening tothe baby is extraordinary. Because while beingfed, she is learning about gentleness, about criesbeing answered, about her ability to makegiants come running. She is beginning to feeleffective and secure. She is beginning to sensethe subtle rhythm of exchange with her mother.It is the beginning of learning that she is worthresponding to, that she is important, and thatsomething or someone can be counted upon.

A young mother hears a cry from her 5-week -old baby in the crib nearby. It is 3a.m. The mother tenses. She has justfallen asleep after a fight with the baby'sfather. The baby's cries rapidly intensify."Oh be quiet," says the mother exhaust-edly. "I can't take one more thing." Thebaby cries more and more loudly.

"Shut that baby up" comes a shoutfrom beyond the thin wall"shut thatdamn baby up!" The mother slams her

fist against the wall and shouts, "Shutup yourself." She rolls out of bed andapproaches the crib. "I'm comingI'mcoming.Damn itshut up."She lifts thebaby up andhe quiets abit. "Al-ready thinkyou can justcry and getwhat youwant, don'tyou? Thatwon't lastlong, I can ,

tell you.Come onlet's get itover with."

As thebaby beginsto nurse, themotherstaresfixedlyahead, goingover therecent angryfight. Themothergrows moreagitated as she recalls the details. Thebaby responds to his mother's tension bysquirming restlessly. Finally, the babystiffens, arches, draws back from hismother's nipple and yelps. "You don'twant to eat? Fine, don't eat," says themother, and abruptly puts the stillhungry baby back into the crib. The babycries and the mother feels a surge ofanger. "Shut upjust shut up." The

4i.ir,

A

mother leaves the bedroom, shuts thedoor and in the kitchen turns up the radioloudly enough so that she cannot hear the

baby cry. Hecries until hefalls into anexhaustedsleep.

"Ik

'11"-

This baby is alsolearning. He islearning that to behandled and heldcan be uncomfort-able and distress-ing; that desperatecrying may leadonly to a sharp andangry voice; thathis needs andwants are notimportant and thatthere is no one tocount on.

Either of theseexperiences couldoccur to the samebaby at differenttimes, under differ-ent circumstances.But when eitherone of these experi-ences is typical, theeffects on that

baby's sense of self and of the world areprofound. The first baby's sense of security andof her feelings about others will be primarilypositive; the second baby's will be mainly nega-tive. Essential qualities and attitudes arealready beginning to be shaped.

This little boy is 8 months old. He hasbeen sitting in a jump seat for severalhours during the last of which he has

4BEST COPY MIKE E

slept. He awakens when the door slamsand he hears a deep voice. Immediatelyhe begins to bounce and crow. Every inchof him is excited. His father enters theroom, puts down his lunch bucket andwalks toward him. Now the baby nearlycatapults himself out of his jump chair ashis father smiles and reaches for him,saying, "And hello to youbig guycome and give your old man a hug." Thebaby grips his father's shirt and reachesfor his cheek and his father nuzzles thebaby's hand with his m-nith. The fatherasks if his son is ready to watch some ofthe ball game. The baby mirrors hisfather's happy feeling and responds witha chain of babbling. The father widenshis eyes and listens, then asks his son'sopinion of today's starting pitcher. Thebavy looks awaycalming himselfthefather waits and the baby turns back,locks eyes with his father and produces along string of syllables, ending in alaugh. His father grins and says, "Youmay be right." The baby's mother asksthe father if he'll change the baby'sdiaper. The father grimaces but agrees.Throughout the diaper change, the babyand his father continue a dialogue full ofbody movements, facial expressivenessand vocal exchanges.

This baby anticipates the pleasure he will havewith his father. He has already learned thatmost of the time his father feels very good withhim and he feels very good with his father. Hehas also learned to have "conversations" withhis fatherto initiate, be intentional, take turns,listen and respond. He feels respected, under-stood. He likes himself.

This little boy is 8 months old. He hasbeen sitting in a jump seat for severalhours, during the last of which he hasslept. He awakens when the door slams

10

and he hears a deep voice. Awake, hewiggles restlessly and looks in the seat'stray for something to handle. Everythingis on the floor. He makes a noise of frus-trationnot loudjust expressive of hisfeelings. He is trying to communicate.

The father comes in and tosses his coatover a chair. The baby grunts and bringshis hand to his mouth. The father glancesat him and then glances away. Themother calls to the father and says prob-ably the baby needs changing. Would hechange him while she finishes dinner?

The father says, sarcastically, "Thanksa lotis that a special present for me?"He disappears briefly and then suddenly,the baby is abruptly lifted out of the seatfrom the rear. The baby is surprised butonly stiffens and is quiet. "Ok stinko--let's clean up your load." The baby isplaced on his back to be changed. He liesstillchewing on his hand. Once, hetwists, extends his arm to grasp an objectand lifts his leg. The father pulls himback flat, lightly slaps his thigh and sayssharply, "Stay stillI'm almost done."The baby's eyes widen but he staysquietjust chewing on his hand. Thefather finishes quickly and returns him tohis jump chair.

This baby is also learning. He is learning to bewary in what he communicates to his father. Hehas learned to be passive and to curb his curi-osity. He has no sense that his father enjoyshim. He feels neither understood nor confident.He has learned nothing about turn taking, ormood sharing, or dialogue with his father.

A 2 -1/2- year -old girl approaches herbusy mother with some three-dimen-sional puzzle pieces that are not fittingtogether. She is distressed and a bit

whiny. Her mother glances down, smiles,and says"What has caused thatmisery?" The little girl says, "I can't doit." The mother continues sorting thepapers she's working on but leans over tostudy the pieces. "I think if you put thegreen one on top it will work." The littlegirl stops whining and tries it. Then shewhines again and says, "It doesn'titdoesn't work." "Well," her mother says,"I can't help until I finish thislater."She gets only this far when her 2-1/2 -year -old daughter hurls the pieces on thefloor and they all come apart. Her motherlooks at her ruefully and then says,"Come here." The little girl comes andleans against her. "Old dumb puzzlemade you madit's ok. We'll fix it later.Could you help me put away my work?"The 2 -1/2- year -old pulls herself together,smiles, and helps her put her papers away.

This little girl is learning about her importance,about help, about mutual respect and abouthow feeling bad can be followed by feelinggood. She is learning a lot about being under-stood and about cooperation. She expects to belistened to and she listens. Despite the frustra-tion of the puzzle, she feels basically competent,appreciated and responsible. She is now incontrol. Given experiences such as these, she islikely to enter school with enthusiasm andeagerness to take part.

A 2 -1/2- year -old girl approaches herbusy mother with some three-dimen-sional puzzle pieces that are not fittingtogether. She is distressed and a bitwhiny. Without looking at her, hermother says, "Stop that blubbering I'vegot enough to do without listening tothat." The little girl tries to show hermother the puzzle. "Don't bother menowI've got to finish this." The littlegirl walks away and suddenly hurls file

pieces to the floor. Her mother turns toher and says, "You know better than tothrow things. If you're going to cry andcarry on, just go to your room and staythere or you'll get something to cryabout." The girl screams louder, runs toher room and slams the door.

This child is learningprobably she is contin-uing to learnthat her needs are not important,that she is not understood, that feeling badmeans more feeling bad and that you can'treally count on anyone when you need them.She is not respected nor does she respect, andshe feels out of control. If that exchange istypical of her relationship with her mother, sheis unlikely to enter school with enthusiasm orpossessing the complement of feelings whichwould help her succeed.

Each of these vignettes represents characteristicinterchanges in the lives of children, and ineach of them important feelings and abilitiesare being created or strengthened. Over time,the very different qualities of these contrastingrelationships will heavily influence the reper-toire of behaviors that are characteristic of aparticular child. Obviously, the child's owntemperament also matters greatly. But the chil-dren in these different relationships will arriveat kindergarten with markedly differing capaci-ties, feelings and expectations, and these willprofoundly influence how they enter into thegive and take of learning in school.

Sources of the problem

The main sources of the problem are clear. Theinfant may suffer from a physical problem, ormay have temperamental characteristics whichimpose heavy demands on his parents. Theparents themselves may be under great stress.Often now, in two-parent families, both parentswork; some even hold two jobs. They have littletime and less energy to devote to a small child,

though relaxed time is essential for parent andchild to learn the subtleties and interplay ofwhich each is capable. The parents may havelittle choice but to leave infants with anoverworked child care provider or a successionof caregivers; and these, in turn, may beuntrained, unaware of how powerfully theirbehavior will affect the child, or unmotivated todevelop a truly responsive relationship with thechild. The number of providers may itselfbecome a barrier to healthy development.Infants and toddlers may do very well whencared for by two primary caregivers but almostnever when cared for by three or more.

Or the parents may be nearly children them-selves. The parents may be immature or aimlessor depressed, angry or possibly abusing drugs.Such parents may scarcely be able to recognizetheir infant's or toddler's needs. Still less arethey likely to respond to them with consistentsympathy or understanding. Some parents havelearned, from difficult experiences in their ownchildhood, to be abusive or distantfrightenedof closeness or relentlessly critical.

Many parents simply don't understand howmuch the infant or toddler learns from how heis treated. The parent who correctly reads hisbaby's communications confirms his baby'sability to communicate and to achieve apositive result. The parent who seriouslymisreads such communications stifles expres-siveness and creates wariness and inhibition. Aparent may consider her baby's explorations asdeliberate misbehavior, and continuously sayno to the baby's activity. She may think that bysaying no she is training her baby in self-control, and not realize that the "no's" areconveying "don't be curious," inhibiting oneof the traits which needs treasuring andencouraging.

Equally important, many parents don't appre-ciate that pretend play is essential to a child's

12

ultimate intellectual and creative capacities.Such simple play is the beginning of problemsolving and logic. The parent who joins hischild in patting the baby doll and feeding thestuffed doggy or who extends the child's playby a comment ("I think little Minnie is lookingtired. Does she need a nap or a story?") isencouraging the creation of ideas and themastery of feelings through play. The child isbeing encouraged to be creative and activeinstead of depending on passive entertainment.This capacity for play also gradually enables achild to depend on herself as a source of feel-ings of interest and enjoyment.

However barriers to the infant's healthyemotional development may originate, they canreadily set off a self-reinforcing downwardspiral. Feeling rejected by a child's unrespon-siveness, or frustrated by a child's fussiness orirritability, a distracted or vulnerable mothermay avoid or punish her. Isolated and under-stimulated, or perhaps overstimulated, aninfant may become more withdrawn or moredifficult, making her m.)ther and others evenless willing to attend to her. Once such aproblem has developed, the 2-month-old mayrarely be picked up and held, or she may bepicked up mechanically by a parent or othercaretaker who goes on talking to someone elseor watching television. If caregivers habituallyhandle her roughly, or subject her to loudnoises and startling and unpredictablebehavior, the effect is worse. She may protectherself by tuning out or by becoming anxious,fearful or aggressive.

Thus, through simple, everyday actions, begin-ning in the first days and weeks of life, theinfant begins to develop the characteristics that,for good or ill, will strongly influence perfor-mance in school. The behavior of the infant'sprincipal caregivers creates in the infant's mindand heart capacities and patterns of expecta-tions that will deeply affect her functioning in

'/

all realms. The child who experiences attention,affection, mutual communication, respect andgenerosity will expect to continue to experiencesuch treatment and will feel that he or shedeserves it. And the child who receives thiscrucial "Heart Start" will tend, in turn, to beaffectionate, attentive, communicative,respectful and generous.

ailarly, a child who has been often ignored,or subjected to angry, unpredictable or violentbehaviorwhatever the initial causeis likelyto display the same behaviors in relations withothers. That is what she will regard as normal,not only as a child but as an adult as well.Experiences in infancy help form not only thecapacities, feelings and skills essential tosuccess in the educational setting but thedeepest patterns of behaviorpatterns likely tobe repeated when a child becomes a parent.

The most damaging possibilities

Some effects may be even more serious thanthat. We know that the effects of some forms ofearly deprivation on animals are not onlyprofound but enduring. Newborn rats kept inisolation fail to produce growth hormones or togain weight; instead they produce a proteinwhich appears to stunt growth. Newbornmonkeys raised for some months in a darkenedroom retain the capacity to see but never learnto distinguish simple shapes from one another.Monkeys raised normally can readily do so.Kittens blindfolded for the first six monthsnever fully learn to use their eyes.

We do not know from animal studies to whatextent various kinds of deprivation may perma-nently affect the human infant. But we knowthat the infant's brain reaches two-thirds of itsfull size by the age of 3, that in size and com-plexity it evolves, in those years, more rapidlythan it ever will again, and that certain kinds oflearning occur far more readily in infancy than

13

afterward. We also know that severe stress canaffect hormone production and produce phys-ical damage in the learning centers of the brain.So even if some kinds of learning and develop-ment can to some extent be made up in lateryears, the effects of early experience areprofound and likely to be long-lasting.

Thus, in the first four years of life, children areexperiencing their most fundamental lessons.They are learning to focus, to be intimate, tocontrol their behavior, to be imaginative, toseparate reality from fantasy, to have positiveself-esteem and to feel deeply connected to theadults in their lives. A child who cannot focushis attention, who is suspicious rather thantrusting, sad or angry rather than optimistic,destructive rather than respectful and one whois overcome with anxiety, preoccupied withfrightening fantasy and feels generallyunhappy about himselfsuch a child has littleopportunity at all, let alone equal opportunityto claim the possibilities of the world as hisown.

The consequences of neglect

Simple neglect may produce problems in schooleven more severe than those resulting fromphysical abuse. A recent and comprehensivesurvey studied the performance in school ofchildren suffering from maltreatment of manykinds. It concluded that neglected childrendemonstrated the most severe difficulties,performing more poorly than any other groupof maltreated youngsters. As a group, theneglected youngsters were more anxious, inat-tentive, and apathetic than other children. Theyrelied heavily on the teacher for encouragementand approval, and were both aggressive andwithdrawn in social situations. Sixty-fivepercent (65%) of these children were eitherretained in grade or had already been referredfor special services by the end of their first year.

School is only one setting in which the conse-quences of early maltreatment appear. Drug useoccurs most frequently among adolescentswhose early childhoods were spent in dis-tracted, disorganized and chaotic households.Juvenile delinquency is closely associated witha history of family violence or abuse. And forchildren growing up in communities marked byviolence, chaos and unpredictability the schoolculture and its expectations may seem soremote as to be wholly irrelevant.

So we know that the environment in which aninfant spends his first months and years willgreatly affect how he will later manage his lifein general and how readily he will be able toutilize opportunities for formal learning. Andwe know nowmuch more clearly than twenty

14

or even ten years agohow that effect isproduced. We know how positive kinds ofbehavior from caregivers, be they parents, otherfamily members or skilled child care providerscan help a child develop the emotional founda-tion for living a rewarding life. We know thatmany families lack the understanding, thecapacity or the support to provide such experi-ences and that many child care situations fail toprovide it. We know that children without thatfoundation have difficulty in school and so aresubjected to the additional stress of publicfailure. We know that whole grade levelsindeed whole schoolsare being swamped bythe early tragedies of these children.

Then what is to be done?

1 d

III. WHAT IS TO BE DONE?

hat needs to be done can beexpressed quite simply. It is to

... create the conditions which willgive all American children the opportunity todevelop, in the first years of their lives, thosecharacteristics--confidence, curiosity, persis-tence, a sense of responsibility, the capacity tounderstand the feelings of others and to coop-erate with themwhich are most important totheir later success in school.

Young children have four kinds of needs. Thefirst relates to the infant himself: it is simplygood physical health. The second and thirdneeds relate to him through his parents andother caregivers. One is time: sufficient time forcaregiver and child together so that an intimateand supportive relationship can develop. Theother is responsive caregiving: caregivingbased on an understanding of how childrendevelop, and how to encourage and respond tothat development. Finally, both infant and care-giver need a safe and supportive environment.

1. Assuring Health

Good physical health is obviously basic. Infantsexposed during pregnancy to drugs or alcohol,or born prematurely or with low birthweight,or exposed in infancy to high lead levels, orpoorly nourished, or who have contractedmeasles or polio for lack of routine immuniza-tion, may still develop the characteristics essen-tial to school readiness, but they begin withgrave disadvantages.

Those disadvantages are almost wholly avoid-able, but our healthcare system, as it now oper-ates, does not avoid them. Almost one-quarterof expectant mothers in the United Statesreceive no prenatal care, receive too little, orreceive it too late. In 1989, the U.S. infant

15

mortality rate was 9.8 per 1,000 live births, ahigher rate than virtually all other industrial-ized countries. (The rate for African-Americanbabies was more than twice that for whites.)More than one-quarter of fetuses are exposed todrugs. Almost 7 percent of our babies are bornat a low birthweight (defined as 2500 grams-5.5 lbs.or less), and 1.3 percent of our babiesare born at a very low birthweight, defined as1500 grams (3.5 lbs.) or less. Almost ten percent(10%) of school children have a known dis-abling condition, and many of these conditionscould have been found and treated muchearlier. But almost seventeen percent (17%) offamilies ha ve no access to a regular physician;thirty percent (30%) of children and their fami-lies are being seen only in emergencies, andthen by physicians with no prior knowledge ofthe family or the child.

What measures are needed to ensure goodhealth to a much higher proportion of Ameri-can children?

a. Providing affordableand accessible health care

The main reasons that avoidable health andnutrition problems develop in infants are thattheir families are unable to pay for routinehealth care, or do not have access to it.

Universal health care coverage isessential. It should be coupled with anexpansion of those programs (com-munity and migrant health centers,WIC programs, early intervention pro-grams for children with special needs,and health service corps, for example)that place prevention-oriented health-care facilities and personnel in other-wise underserved areas.

Though comprehensive coverage is critical, itsdesign involves many considerations beyondthe needs of infants. We therefore take no posi-

t

-4

,

tion as to the most appropriate form of acomprehensive system. But :wo other health-related measures, both more specificallyoriented toward young children, deservediscussion.

b. Welcoming, assessing and tracking

,e-

Even where affordable health care is available,it may not be fully utilized. A number ofEuropean countries deal with this problem bycreating strong financial incentives for parentsto participate in prenatal care and then to main-tain a schedule of continued preventive care.Some U.S. localities, similarly, are experiment-ing with programs in which the families of allnewborns are visited by health care personnel,given small presents for the infants, andinformed about and welcomed into their localhealth care system. Such visits demonstrate that

16

a friendly and caring health system is available,and effectively draw families into it. They alsoprovide occasions during which the home

visitor can assesswhether anyobvious physi-cal, financial orrelational prob-lems might putthe infant at risk.Some communi-

st are devel-oping computer-based systemsfor identifyinginfants withspecial healthcare needs andmaintainingcumulative andcontinuouslycurrent medicaltrecords on them,available to allhealth care pro-

viders. Some communities are combining suchwelcoming and follow-up systems.

Different systems will best fit differing places,but it is clear that, if well-administered, mostsuch systems do draw into regular health careinfants who might otherwise not receive it, orbetter inform health care providers of the rangeof conditions and treatments the infants haveexperienced, or both. Therefore:

The federal government should offerthe states funding for a range of iden-tification and follow-up systems. Itshould also provide advice as to bestcurrent practices in identification andfollow-up, and supply technical assis-tance in the design and establishmentof such systems.

U States and localities should assesstheir own needs, determine whatsystems would best meet those needs,and put them rapidly in place.

c. Making child care a health resource

Every week, child care providers--in centers orhomessee almost two-thirds of our nation'schildren under age 4. Understandably, thatcauses concern about hazards to health: groupsof very young children spend a great deal oftime together under the supervision of adults,many of whom are not fully trained in thehealth and safety requirements for children soyoung. But there is a reverse to this coin: a veryhigh proportion of the nation's youngest andmost vulnerable children are being seen everyday by persons whose calling is their care andwell-being. Those persons can be trained torecognize possible disabilities, developmentaldelay, and signs of abuse or other problems.They can be encouraged to raise health ques-tions with families. They can help refer familiesto the relevant health services. Where they canlink up with the appropriate medical profes-sionals their facilities may be appropriate sitesfor the provision of services, such as screeningand immunizations, or regular well-baby care.Child care providers, both in centers and infamily day care, are potentially a great resourcefor promoting infant health. We ought to makegood on that potential. Therefore:

States should require that all childcare providers be trained to recognizeapparent health and developmentalproblems, to encourage parents to seekappropriate treatment, and to identifythe appropriate services. Statelicensing and monitoring systemsshould support those practices.

Federal funding should be structuredto induce state agencies supervising

6617

health, child care and developmentaldisabilities to collaborate in makingscreening and follow-up referrals areality.

2. Assuring Time for UnhurriedCaring

a. Time with parents and familymembers

Health alone, of cola se, is not enough. There is atime requirement as well. Infants and toddlersneed unhurried time with those who are impor-tant to themlots of it. One reason is that thebetter a caregiver knows a child, the more read-ily she will recognize even the subtle cues thattell what that child needs. Infants and toddlersespecially need someone present steadilyenough to sense their temperaments, to learntheir rhythms and signs, and to respond in waysthat the infants can predict and understand.

A second reason why time is essentialtime tosimply be there, time to listenis that it signalsthe importance that beloved adults attach to therelationship. It tells infants they have value; arenot simply being fitted in.

Finally, time is necessary for parents as well.Parents need time to adjust emotionally toparenthood, to come to enjoy their babies, tolearn to feel competent as caregivers, to detectpossible difficulties, to get advice if necessary,and to arrange for child care if and when theyreturn to work.

Indeed, as the child moves to later infancy andtoddlerhood, he needs the time and attention ofmore than one adult. As Dr. Urie Bronfenbren-ner has noted:

Progressively more complex interaction andemotional attachment between caregiver andchild depend in substantial degree on the

availability and involvement of another adult,a third party who assists, encourages, spellsoff, gives status to, and expresses admiration

for the person caring for and engaging in

joint activity with the child.

Ideally, this is the child's other parent. It canalso be any other loving adult who is part of thehousehold. But whoever that third party maybe, whether in the family or not, he or she alsoneeds the time to play that supplementaryroleas well as some understanding of itsimportance.

But as already noted, the circumstances ofmany parents make such conditions excep-tional. Over one-quarter (27%) of Americaninfants are born to single parents, many ofwhom are teenagers. (By contrast, only 1.4% ofJapanese births are to teenagers.) Well over half(52.5%) of mothers of children under 3 are inthe labor force. Sixty-one percent (61%) of thesework full-time. Only about forty percent (40%)of working women in the United States are enti-tled to paid maternity, disability or parentalleave, and only another thirty percent (30%) tounpaid leave. In contrast, most European coun-tries provide a six-month paid leave; and sev-eralsuch as Austria, Finland and Germanyprovide two or three years of paid leave.

In short, many parents who may manage to seeto it that their children are healthy and well-fedand adequately clothed cannot do much morethan that. They cannot spend unhurried timewith their infants and toddlers, so too few ofthe enlivening interactions of adult and child soessential to learning occur. Where the child'stemperament is difficult, or her signals hard tointerpret, or where a mother has difficultymaking the emotional adjustment to parent-hood, or is slow to gain confidence, longperiods of time in which parent and child canbe together are especially neededand likely tobe especially lacking. We therefore propose that:

ILI The federal government should enactlegislation to require that employersprovide job-protected parental leavefor up to one year, but for at least sixmonths, following childbirth or adop-tion. Such leave could be paid forthrough a new contributory socialinsurance benefit, or an enhancedversion of the Temporary DisabilityInsurance benefits now provided infive of our larger states.

L) Until federal legislation is enacted, allstates should require employers toprovide parental leave for at least sixmonths at the time of childbirth oradoption.

IJ Federal incentives should encouragestates to put parental leave legislationquickly in place.

In advance of legal requirements,employers who have not already doneso should provide family leave atchildbirth, adoption or illness, as aninvestment in their work force,present and future.

b. Stability of child care providersover time

The care of children is changing. More and morechildren are moving into child care, at youngerages, and for longer periods of time. What theyneed is a special kind of care. It's not babysittingand it's not school. It is a continuing relationshipwith a few caring people in an intimate setting.Just as they need parents who read and respondto their signals with ease and who give them thesense of being important, so infants need thisfrom one or two particular child care providers.And continuity of care is essential. When infantslose a caregiver, they really lose a sense of them-selves and of the way things work.

Yet the economics of child care militate againstboth intimacy and continuity of care. Child careworkers in the United States average $5.35 perhour, lower than the average wages of thosewho work in kennels or who park cars. The payis so poor that they tend to leave for other jobsas soon as possible; the turnover rate for childcare workers in centers in 1988 was forty-onepercent (41%)! And in order to make ends meet,centers and family day care homes are temptedto place children in groups too large and super-vised by too few adults. As of 1992, only threestates set standards that meet the ratios wepropose below. Nine states have ratios that arehigher than 6:1 for infants. Nineteen states haveratios that are higher than 8:1 for coddlers.Fifteen states set no standards whatsoever forgroup size for infants. The result is a doubleconcern for many parents: having too little timeto be with their infants, they are forced to seekchild care where no one else has much time forthem either. "Parental choice" between lowquality programs is no choice. We thereforepropose:

(1) Stronger state standards and federalleadership

The states should set timetables forbringing infant and toddler child carestandards regarding group size andadult/child ratios up to at least mini-mally adequate levels. For childrennot yet mobile, group sizes should beno larger than six; ratios should be nomore than 1:3. For children crawlingand up to 18 months, the group sizeshould be no more than nine; ratios nomore than 1:3. For children 18 monthsto 3 years, group sizes should be nomore than twelve; ratios 1:4. Centersand group homes with mixed agegroupings should never have morethan two children under 2 years of agein a single group. Family day care

19

providers caring for mixed age group-ings should never have more than twochildren under 2 years of age.

U Federal child care legislation shouldbe amended to provide incentives forstates to rapidly implement such stan-dards.

LL1 A federal entity should regularlysurvey the progress of states, andidentify and promote promising stateinitiatives.

Li States and localities should increaseguidance to families on how to choosequality child care for their infants andtoddlers.

(2) Higher minimum child care wages

State legislation should set the wagesof infant and toddler care providers ata level substantially above theminimum wage, with mandated bene-fits. Infant and toddler child careproviders with substantial trainingshould have minimum salaries set bystate law equivalent to the state'sprimary school teachers.

Through refundable child care taxbenefits or other cash subsidies tolow-income parents and/or child careproviders, the federal governmentshould begin to bridge the gapbetween what families can afford topay and what child care really costs ifstaff are paid appropriately.

(3) Continuity of caregivers: best practice forchild care programs

State guidance should promote conti-nuity of care. Child care centers

should be strongly encouraged to haveproviders move up the age range, sothat they care for the same childrenfrom infancy to preschool.

U Child care programs should assign aparticular caregiver for each child.

U Federal child care legislation andcorresponding federal regulationsshould eliminate conflicting regula-tions, eligibility standards andfunding mechanisms so that familiesare not forced to change child caresituations in order to receive child caresubsidies. States should move quicklyto implement these changes.

3. Promoting Responsive Caregiving

In addition to good physical health and unhur-ried time with their caregivers, infants needcaregivers who understand how childrendevelop, and understand that responsive andencouraging relationships with caregivers arecrucial in fostering that development.

a. The responsive understandingof parents

Almost all parents understand instinctively thatan infant's development will depend, in somedegree, on whether their relationship with thechild is supportive, loving and stimulating. Forparents to form such relationships, they requirethe support which enhances their own feelingsof competence and confidence. All parentsrequire the social networks of family, friendsand community which provide the concrete andemotional assistance essential to family well-being. They also require access to resources,and information on children's growth anddevelopment.

Some parents need special assistance. How

20

much assistance a parent needs is highly vari-able. Some may need only the interest andsupport of their family health care providers,their extended family and a circle of friends. Ifthey need additional advice, they may find it inthe many helpful publications available, orfrom educational television programs.

But other parents are not in such a happy posi-tion. Young parents of first children may havehad no previous experience with infants. Evenexperienced parents may be uncertain as tohow to respond to a difficult or unusually sensi-tive child. And many parents are simply notaware of just how critical it is that the infantexperience responsive, nurturing and stablerelationships. Nor may they fully understandhow caregiver and child affect each other.

In extreme cases, the result is neglect or abuse.In 1990, there were 2.5 million reports of childabuse in the United States, exactly double therate of 1980. Almost ninety percent (90%) ofthose children who died as a result of abuse orneglect were under age 5; fifty-three percent(53%) were under age 1. But reported abuse orneglect is only a fraction of a much largerphenomenon. For every reported case of actualabuse, there are clearly many cases of parentsunable to give their infants or toddlers the fullmeasure of support and encouragement thatconstitute a "Heart Start."

The following three policies, each already par-tially in place, should be applied nationwide:

(1) Parenting education before and afterchildbirth. All students in elementary, middleand high school should learn about with thestages of infant development and the effects oninfants of differing kinds of caregiver behavior.By the time these students become parents thedetails may be forgotten, but the central mes-sages of such courses are likely to endure: thatprenatal care, attention and responsiveness to

infant behavior are essential. Conveying thosemessages in elementary, secondary and highschools has the additional benefit that futurefathers as well as mothers will be exposed tothem.

Similarly, prospective parents of both sexesshould be strongly encouraged to participate inthe actual care of their child as well as in child-birth discussions or classes. Therefore:

States should fund and local educa-tion agencies should organize earlyand widespread expansion of parenteducation courses in elementary,middle and high schools.

U A variety of institutionsclinics,community l'ealth centers, groupmedical practices, schools andjunior colleg,:should, amongthemselves, create comprehensivenetworks of parenting classes anddiscussion groups. Health care andchild care practitioners shouldroutinely urge both present andprospective parents to participate insuch classes or groups. Where needed,incentives should be offered to induceparticipation.

It is absolutely essential, of course, that suchcourses be sensitive to the cultural, educational,ethnic and class backgrounds of the differentparticipants. They must be as respectful of theparticipants as we want the participants to be oftheir infants.

(2) Family resource programs. In many com-munities, professionals, parents and advocateshave formed networks and established pro-grams to assist parents in child-rearing. Theseefforts, generally referred to as family supportor family resource programs, differ widely inform, scale and emphasis. But they typically

21

provide some combination of parent education,parent support groups, drop-in centers whereparents can meet with program staff and otherfamilies on an informal basis, information andreferral to child care, health care, counselingand health screening for infants. As pre\ entionprograms, they have the important function ofidentifying troubled families early on, assuringthat they receive necessary services in time toavoid the need for more intensive remedialmeasures. And they share a number of funda-mentals: they are community-based, preven-tion-oriented, concerned about the whole rangeof issues that parents may face, and skillful atbuilding on strengths rather than emphasizingdeficits. They should become an essential pieceof the fabric of community services. Yet verylittle public money ha,, so far been available tothem. Therefore:

Li Federal, state and local governments,in partnership with private commu-nity organizations, should developand expand community-based familysupport programs to provide parentswith the knowledge, skills and sup-port they need to raise their children.

(3) Child care and health care providers ascolleagues of parents. Both child care andhealth care providers can and should play amuch larger role than they presently do inenlarging parents' understanding of the needsof their infants and toddlers. So should relatedprofessionals, such as WIC program personnel.They should be brought to think of themselvesas colleagues of each child's parents in sharinginformation about the child, pointing out devel-opmental milestones and individual differ-ences, and discussing various approaches toparticular problems. One useful and i.creas-ingly common practice is for pediatricians tohave child development specialists work withthem to discuss these issues with parents. Allpediatricians and other health care providers

should either work with such colleagues or beprepared to spend significan;: amounts of timethemselves on these issues with parents.Accordingly, supervised training in infant andtoddler development and in the principles ofeffective interaction with families should berequired for all child care and health careproviders and related personnel. [PreparingPractitioners to Work with Infants, Toddlers andTheir Families, a set of reports for the profes-sions, for educators, for parents and for policy-makers published by ZERO TO THREE, formsa strong foundation upon which to design suchtraining.] And child care providers should bebacked by organizations able to provide inser-vice training, developmental assessment, refer-rals to more intensive services, and directservices for infants and their families withspecial needs.

Therefore:

(a) Recommendations for health carepersonnel

Preservice and inservice training forhealth care providers and nutritionistsshould be broadened to emphasize theimportance of establishing a relation-ship with parents in which discus-sions of the child's development, andof the parents' role in it, can naturallyoccur.

The protocols of health clinics andWIC programs should require thattime be taken to attempt to build suchrelationships and that discussions ofdevelopment and parenting concernsare regularly initiated.

Pediatricians and other health careproviders should either take on thesefunctions or hire child developmentspecialists to do so.

22

National standards for the certificationof physicians, public health nurses,nurse practitioners and nutritionistsshould include competence in theessentials of parenting and of infantdevelopment.

(b) Recommendations for child carepersonnel

All preservice and inservice trainingfor infant care providers should bebroadened to emphasize the impor-tance of establishing a relationshipwith parents in which discussions ofthe child's development, and of theparents' role in it, can naturally occur.

State and local regulations shouldrequire that child care providersattempt to establish such relationshipsand that they regularly initiate discus-sions of developmental and parentingconcerns with families.

b. The responsive understanding ofchild care providers

A number of the proposals above assume thatchild care providers are themselves well-trainedand sensitive to the importance of their role.Fortunately many are, and their number isincreasing. But even of the child care providersworking in centers, only some sixty percent(60%) have any training in child development.A much lower percentage have training ininfant and toddler development. In family daycare homes, the percentages are lower still. Thisis not surprising. Only twenty five statesrequire training in child development for childcare providers. Only fifteen state licensing of-fices require specialized training for infant andtoddler care. Only three states require familyday care providers to have specialized trainingin infant/toddler care. Furthermore, thirteen

; ;

states allow exemptions if the child care issponsored by a church or by the schoolsystem.

Therefore:

States and communities shouldrequire that child care providers havetraining specifically in infant develop-ment and family-centered infant caresufficient to meet the Child Develop-ment Associate Credel itial or similarstandards. There should be no exemp-tions to this policy for schools orreligious organizations.

Federal funds should provide incen-tives for the early enactment of infantand toddler training requirements bystates.

The federal government should act asa clearinghouse for the promulgationof best practice and technical assis-tance in infant and toddler child care.

4. Assuring Safe and SupportiveEnvironments

An adequate standard of living

In addition to good health care, and to lovingadults with enough time to develop strongbonds, infants and toddlers also require safeand supportive environments. Evidenceabounds that many small children exposed toactual violence or accounts of violence sufferirreparable harm as they try to make sense ofthese seemingly random acts. The violenceprevalent in some impoverished environmentscan permanently damage the emotional andintellectual development of young children.

Decent safe housing is also highly important; itaffects children's health and families' ability toparent.

Infants and toddlers and their families needenough income to support an adequate stan-dard of living. At present, one out of every fourchildren under age 3 lives in a family whose in-come is below the poverty threshold. Children

under age 3 areeconomicallymore vulner-able than anyother agegroup in theUnited Statesand dispropor-tionately recip-ients of Aid toFamilies withDependentChildren(AFDC).The followingmeasures arethe minimumthat should beenacted:

:47

83 BEST COPY AVAILABLE

U A Refundable Child Tax Credit of$1,000, indexed to the cost of living,and provided for each child in afamily under the age of 18. Recom-mended by the National Commissionon Children, such a tax credit wouldsupplement family income whenearnings are low, help to defraysome of the economic costs of childrearing, and reduce the child povertyrate.

O Until such a credit is enacted, theEarned Income Tax Credit (EITC)should be expanded and made moreresponsive to family size.

At least on an experimental basis,enact a child support assurance bene-fit, as described in the report of theNational Commission on Children,which would provide a guaranteedminimum child support benefit forchildren in one-parent families whenthe absent parent fails to pay support,or pays it irregularly or at an inade-quate level.

b. Adequate space in child caresettings

Small children cared for in groups need enoughspace to move about freely, explore and try outnew challenges. Adequate space also reducesnoise, the communication of disease, conflictover toys and physical intrusion of one child onanother. And space is important for caregiversas well. Research has shown that in morespacious environments caregivers are moreinclined to smile at children, and less inclinedto say no.

States should require as usable playspace in center-based group care:

24

0-8 months [for a group no largerthan six] -350 square feet per group

8-18 months [for a group no largerthan nine]-500 square feet pergroup

18-36 months [for a group no largerthen twelve] -600 square feet pergroup

in family child care: [for a mixed agegroup with no more than two childrenunder age 2]-600 square feet per group

5. Providing Special Help forFamilies with Special Problems

One of the thorniest problems for policy-makers and service providers alike arises fromthe fact that some of the families whose infantsmost desperately need better health and moreunderstanding caregivers are those that do notreadily reach out for support or easily accept it.Perhaps the family has had no experience withsupportive service relationships and fears thatprofessionals will be too nosy or bossy. Perhapsa parent has an alcohol or drug abuse problem,lives in an isolated rural location, or believesthat asking for help is a sign of failure. Thefamily may not at first realize their child has aphysical problem. Or the mother may be clini-cally depressed, unable to make a decision toseek help. The family may be homeless, or themother may be a teenage single parent, rejectedby her family, or alone in a new town. Themother may be housebound because she fearsviolence in the neighborhood. Or a family maybe worried that signs of physical abuse willmean their child will be taken away from them.

There are many circumstances, in short, underwhich a family in need of help may not reachout for it. Yet every community should find and

connect with all families in need, not simplythose that show up for services. Outreach andfollow-up systems, such as those mentionedabove, are one way to begin to address thisproblem. Family resource and home visitingprograms are another. But communities mustalso meet the needs of those parents with moreserious mental health or early interventionneeds. Mental health and child abuse treatmentprograms which focus on the troubled relation-ships of parents and their infants and toddlersin particular should be expanded, with addi-tional funds made available for training theirproviders.

Therefore:

D Every community should develop aplan for identifying and coordinatingcare for all families of infants andtoddlers in need of intensive services.

Every community should work todevelop an array of integrated servicesfor families with more severe needs.

2 U

Foundations and state and federalgovernments should provide fundingfor high-quality specialized mentalhealth, child abuse treatment, fostercare, and/or early intervention ser-vices. Those services should be acces-sible in all communities to families ofchildren with complex medical needs,and to parents who are teenagers, orwho have mental health problems, aredrug-addicted or are otherwise notfully functional.

17)., Foundations and state and federalgovernments should provide funds forspecialized family-centered trainingfor those who work with parents andfoster parents and their infants andtoddlers. [ZERO TO THREE'S ownTASK materials provide a strong foun-dation for such training.]

A NEW PERSPECTIVE

To summarize: health, and unhurried, respon-sive caregiving in a safe, supportive environ-ment are what all babies need. The variousrecommendations for services here proposedseem to us essential if the United States is tohelp families give their children the "HeartStart"the emotional foundations for schoolreadinessprovidedby so many othernations.

Those services that doexist are often noworganized and man-aged in ways that areconvenient for theirproviders, but daunt-ing or inaccessible ordemeaning to theintended beneficiaries.That is understand-able, especially when iiiilproviders are over-stretched and in shortsupply. But the endresults are often poor.Services that are diffi-cult to reach, or imper-sonally provided, orpoorly explained willoften not be used. Orthey may need to beoffered repeatedlybefore they areaccepted. That leavesproviders spread z __.1

thinner, recipientsmore discouraged, and society inclined toblame the victims.

n

Thus, something beyond the simple establish-ment of services or funding of programs isrequired. What is needed is a commitment tosupport parents across the board in their mostimportant work. It is a determination to makeservices not only available but attractive,understandable and fully useful to the persons

they are intended tohelpto provideservices in thecontext of continuingand respectful rela-tionships betweenprovider and parent,and in settings asfamiliar and conve-nient as possible.

Az

Each of the proposalswe have made isimportant, andtogether their impactwould be profound.They add up to adeep and compre-hensive commitmentto our nation'syoungest and mostvulnerable citizens.But the fundamentalneed is not for acollection of partic-ular measures, butfor a perspective.And it should beapplied to all in thisareapublic and

private. All policy initiativesin addition to theother ways in which they must be assessedshould be viewed in terms of their effects on

26 REST COPY AVililiBLE

infants and toddlers. At all levels of govern-ment, and in private institutions as well, weshould learn to ask ourselves: what are theconsequences for infants and their families?

Will this policy improve infant health? Will it

give infants and toddlers more time, or less,

with parents or other trusted caregivers? Will it

tend to enlarge what parents and other care-givers understand about the needs of veryyoung children, or not? Does it tend to confirmparents' importance in the lives of their chil-dren, or to diminish that importance? Can it be

revised to serve its other purposes and stillimproveor at least not worsenthe situationof the nation's youngest children? Does itaccord with our nation's professed belief in the

crucial importance of the family?

We have made many recommendations, and

over the short run some will be expensive. Butthe net result will not be costly. For one thing,

J

27

most of the needed policies and servicesalready exist in part, or in some locations. Foranother, the services we recommend willresolve problems rather than simply processingthem: they thus reduce needs for further ser-vice. And the costs will be broadly shared; anumber of our proposals require federal or statefunding, but many relate to employers and toprivate agencies and foundations.

The deepest economy of these proposals is thatof the long run. Over the long run, of course,they are not a cost but an investment. They arean investment in our most precious resources.And that investment will pay back quitequickly, as virtually all of our 5- and 6-year-oldchildren begin to arrive at school confident,curious, persistent, able to communicate and to

get along with othersready, in short, to thrive

in school.

SUMMARY OF RECOMMENDATIONS

1. Assuring Healtha. Providing affordable and accessible health care

Universal health care coverage is essential. It should be coupled with anexpansion of those programs (community and migrant health centers, WICprograms, early intervention programs for children with special needs, and healthservice corps, for example) that place prevention-oriented health care facilities andpersonnel in otherwise underserved areas.

b. Welcoming, assessing and tracking

The federal government should offer the states funding for a range of identifi-cation and follow-up systems. It should also provide advice as to best current prac-tices in identification and follow-up, and supply technical assistance in the designand establishment of such systems.

C.] States and localities should assess their own needs, determine what systemswould best meet those needs, and put them rapidly in place.

c. Making child care a health resource

States should require that all child care providers be trained to recognizeapparent health and developmental problems, to encourage parents to seek appro-priate treatment, and to identify the appropriate services. State licensing and moni-toring systems should support those practices.

Federal funding should be structured to induce state agencies supervisinghealth, child care and developmental disabilities to collaborate in making screeningand follow-up referrals a reality.

2. Assuring Time for Unhurried Caring

a. Time with parents and family members

The federal government should enact legislation to require that employersprovide job-protected parental leave for up to one year, but for at least six months,following childbirth or adoption. Such leave could be paid for through a newcontributory social insurance benefit, or an enhanced version of the TemporaryDisability Insurance benefits now provided in five of our larger states.

Until federal legislation is enacted, all states should require employers toprovide parental leave for at least six months at the time of childbirth or adoption.

Federal incentives should encourage states to put parental leave legislationquickly in place.

In advance of legal requirements, employers who have not already done soshould provide family leave at childbirth, adoption or illness, as an investment intheir work force, present and future.

29 0'

SUMMARY OF RECOMMENDATIONS

b. Stability of child care providers over time

(1) Stronger state standards and federal leadership

The states should set timetables for bringing infant and toddler child carestandards regarding group size and adult/child ratios up to at least minimallyadequate levels. For children not yet mobile, group sizes should be no larger thansix; ratios should be no more than 1:3. For children crawling and up to 18 months,the group size should be no more than nine; ratios no more than 1:3. For children18 months to 3 years, group sizes should be no more than twelve; ratios 1:4. Cen-ters and group homes with mixed age groupings should never have more than twochildren under 2 years of age in a single group. Family day care providers caringfor mixed age groupings should never have more than two children under 2 yearsof age.

Federal child care legislation should be amended to provide incentives forstates to rapidly implement such standards.

A federal entity should regularly survey the progress of states, and identifyand promote promising state initiatives.

C:1 States and localities should increase guidance to families on how to choosequality child care for their infants and toddlers.

(2) Higher minimum child care wages

State legislation should set the wages of infant and toddler care providers at alevel substantially above the minimum wage, with mandated benefits. Infant andtoddler child care providers with substantial training should have minimumsalaries set by state law equivalent to the state's primary school teachers.

Through refundable child care tax benefits or other cash subsidies to low-income parents and/or child care providers, the federal government should beginto bridge the gap between what families can afford to pay and what child carereally costs if staff are paid appropriately.

(3) Continuity of caregivers: best practice for child care programs

State guidance should promote continuity Of care. Child care centers shouldbe strongly encouraged to have providers move up the age range, so that they carefor the same children from infancy to preschool.

Child care programs should assign a particular caregiver for each child.

Federal child care legislation and corresponding federal regulations shouldeliminate conflicting regulations, eligibility standards and funding mechanisms sothat families are not forced to change child care situations in order to receive childcare subsidies. States should move quickly to implement these changes.

30

Responsibility

v

v

v

v

v

SUMMARY OF RECOMMENDATIONS

3. Promoting Responsive Caregivinga. The responsive understanding of parents

(1) Parenting education before and after childbirth

States should fund and local education agencies should organize early andwidespread expansion of parent education courses in elementary, middle andhigh-schools.

A variety of institutions - clinics, community health centers, group medicalpractices, schools and junior colleges should, among themselves, create com-prehensive networks of parenting classes and discussion groups. Health careand child care practitioners should routinely urge both present and prospectiveparents to participate in such classes or groups. Where needed, incentivesshould be offered to induce participation.

(2) Family resource programs

Federal, state and local governments, in partnership with private commu-nity organizations, should develop ana expand community-based familysupport programs to provide parents with the knowledge, skills and supportthey need to raise their children.

(3) Child care and health care providers as colleagues of parents

(a) Recommendations for health care personnel

Preservice and inservice training for health care providers and nutritionistsshould be broadened to emphasize the importance of establishing a relationshipwith parents in which discussions of the child's development, and of theparents' role in it, can naturally occur.

The protocols of health clinics and WIC programs should require that timebe taken to attempt to build such relationships and that discussions of develop-ment and parenting concerns are regularly initiated.

Pediatricians and other health care providers should either take on thesefunctions or hire child development specialists to do so.

National standards for the certification of physicians, public health nurses,nurse practitioners and nutritionists should include competence in the essentialsof parenting and of infant development.

(b) Recommendations for child care personnel

All preservice and inservice training for infant care providers should bebroadened to emphasize the importance of establishing a relationship withparents in which discussions of the child's development, and of the parents' rolein it, can naturally occur.

State and local regulations should require that child care providers attemptto establish such relationships and that they regularly initiate discussions ofdevelopmental and parenting concerns with families.

31 t; ,7)

Responsibility

SUMMARY OF RECOMMENDATIONS

b. The responsive understanding of child care providers

Q States and communities should require that child care providers havetraining specifically in infant development and family-centered infant care suffi-cient to meet the Child Development Associate Credential or similar standards.There should be no exemptions to this policy for schools or religious organiza-tions.

Federal funds should provide incentives for the early enactment of infantand toddler training requirements by states.

The federal government should act as a clearinghouse for the promulga-tion of best practice and technical assistance in infant and toddler child care.

4. Assuring Safe and Supportive Environments

a. An adequate standard of living

A Refundable Child Tax Credit of $1,000, indexed to the cost of living, andprovided for each child in a family under the age of eighteen. Recommended bythe National Commission on Children, such a tax credit would supplement familyincome when earnings are low, help to defray some of the economic costs of childrearing, and reduce the child poverty rate.

Until such a credit is enacted, the Earned Income Tax Credit (EITC) should beexpanded and made more responsive to family size.

At least on an experimental basis, enact a child support assurance benefit, asdescribed in the report of the National Commission on Children, which wouldprovide a guaranteed minimum child support benefit for children in one-parentfamilies when the absent parent fails to pay support, or pays it irregularly or at aninadequate level.

b. Adequate space in child care settings

States should require as usable play space in center-based group care:

0-8 months [for a group no larger than six]350 square feet per group

8-18 months [for a group no larger than nine]500 square feet per group

18-36 months [for a group no larger than twelve]600 square feet per group

in family child care: [for a mixed age group with no more than two childrenunder age 2]

600 square feet per group

32

6 b

1./

4/

V

v

tr

SUMMARY OF RECOMMENDATIONS

5. Providing Special Help for Families with Special Problems

Every community should develop a plan for identifying and coordinatingcare for all families of infants and toddlers in need of intensive services.

Every community should work to develop an array of integrated services forfamilies with more severe needs. Such services should be delivered through theestablishment of a meaningful, continuous relationship between family andprofessional.

Foundations and state and federal governments should provide funding forhigh-quality specialized mental health, child abuse treatment, foster care, and/orearly intervention services. Those services should be accessible in all communitiesto families of children with complex medical needs, and to parents who are teen-agers, or who have mental health problems, are drug addicted or are otherwise notfully functional.

Foundations and state and federal governments should provide funds forspecialized family-centered training for those who work with parents and fosterparents and their infants and toddlers. [ZERO TO THREE'S own TASK materialsprovide a strong foundation for such training.]

Endnotes

I. WHAT IS AT STAKE?

Pages 1-3

Corporate testing for entry-level skills, the amount employers spend on training, and the change in the workforce:

The following articles are taken from an insert dated February 9, 1990, entitled, "Smarter Jobs, Dumber Workers. Is thatAmerica's Future? The Knowledge Gap."

DeVenuta, K. (2/9/90). "Education Openers." Wall Street Journal. R5.

Richards, B. (2/9/90). "Wanting Workers." Wall Street Journal. R10-11,

Swasy, A., and Hymowitz, C. (2/9/90). "The Workplace Revolution." Wall Street Journal. R6-8.

Concern about education:

National Commission of the States. (1990). "International Assessment of Educational Progress." Denver, CO:National Commission of the States.

Stevenson, H., and Lee, S. (1990). Contexts of Achievement: A Study of American, Chinese, and JapaneseChildren. Monographs of the Society for Research in Child Development. Serial No. 221, Vol. 55, Nos. 1-2.

Stevenson, H., and Stigler, J. (1992). The Learning Gap. New York: Simon & Schuster (Summit Books).

Our nation's expenditures on education:

President's Budget Message, FY '92/'93. (1/92). GAO Report #041-001-00366-5.

Stewart, A. et al., Congressional Research Service. (1991). "Head Start: Percentage of Eligible Children Served andRecent Expansions." CRS Report for Congress. Washington, DC: CRS, pp. 1-6.

Comparison of American and foreign students:

Laosa, L.M. (1984). "Social Policies toward Children of Diverse Ethnic, Racial and Language Groups in the UnitedStates." In Stevenson, H.VI , & A.E. Siegel (Eds.) Child Development Research and Social Policy: Volume One.Chicago, IL: The University .f Chicago Press. (Prepared under the auspices of the Society for Research in ChildDevelopment.)

Stevenson, H., and Stigler, J. (1992). The Learning Gap. New York: Simon & Schuster (Summit Books).

Those children who are required to repeat first grade:

Shepard, L. (1989). Flunking Grades: Research and Policies on Retention. London, England: Falmer Press.

The experience of children in their early school years:

Meisels, S.J. (April, 1989). "High Stakes Testing in Kindergarten." Educational Leadership. 46, 16-22.

Meisels, S.J. (1992). "Doing Harm by Doing Good: Iatrogenic Effects of Early Childhood Enrollment andPromotion Policies." Early Childhood Research Ouarterly. (In press).

Need for children to arrive in school ready to learn:

Boyer, E.L. (1991). Ready to Learn: A Mandate for the Nation. Princeton, NJ: The Carnegie Foundation for theAdvancement of Teaching.

National Association of State Boards of Education (NASBE). (1991). Caring Communities: Supporting YoungChildren and Families. (The Report of the National Task Force on School Readiness) Alexandria, VA: NASBE.

35

National Governor's Association (NGA). (1990). Consensus Pr Chanxe, Educating America: State Strategies forAchieving the National Education Goals. (The Report of the Task Force on Education) Washington, DC: NGA.

Pages 3-5

Studies of the effectiveness of early prevention and intervention:

Berrueta-Clement, J.R., Schweinhart, L.J., Barnett, W.S., Epstein, A.S., & Weikart, D.P. (1984). Changed Lives: TheEffects of the Perry Preschool Program on Youths throughAge J9. (Monographs of the High/Scope EducationalResearch Foundation, No.8). Ypsilanti, MI: High/Scope.

Darlington, R.B., Royce, J.M., Snipper, A.S., Murray, H.W., & Lazar, 1. (1980). "Preschool Programs and LaterCompetence of Children from Low-Income Families." Science. 208, 202.204.

Gross, R.T., and Hayes, C. (1991). "Implementing a Multi-site, Multidisciplinary Clinical Trial: The Infant Healthand Development Program." Zero to Three. XI: 4, 1-7. Funded by the Robert Wood Johnson Foundation.

Infant Health & Development Program. (1990). "Enhancing the Outcomes of Low-Birth- Weight, PrematureInfants" Jayrnal of the American Medical Association. 263, 3035- 3042.

Lally, J.R., arid Honig, A.S. (1977). "The Family Development Research Program: A Program for Prenatal, Infant,& Early Childhood Enrichment. Final Report." Syracuse, NY: Syracuse University.

Lally, J.R., Mangione, P.L., Honig, A.S., & Wittner, D.S. (1988). "More Pride, Less Delinquency: Findings from theTen-Year Follow-up Study of the Syracuse University Family Development Research Program." Zero to Three.VIII: 4, 13-18.

Meisels, S.J. (1992). "Early Intervention: A Matter of Context." Zero to Three. XII: 3, 1- 6.

Olds, D.L., Henderson, C.R., Chamberlin, R., & Tatelbaum, R. (1986). "Preventing Child Abuse and Neglect: ARandomized Trial of Nurse Home Visitation." Pediatrics. 78, 65- 78.

Price, R., Cowen, E., Lorton, R., & Ramos-McKay, J. (1988). Fourteen Ounces of Prevention. Washington, DC:American Psychological Association.

Provence, S., and Naylor, A. (1983). Working with Disadvantaged Parents and Their Children. New Haven, CT:Yale University Press. This is the study of the Connecticut families.

Ramey, C.T., and Ramey, S.L. (1992). At Risk Does Not Mean Doomed. Birmingham, AL: NationalHealth/Education Consortium.

Seitz, V , Rosenbaum, L.K., & Apfel, N.H. (1985). "Effects of Family Support Intervention: A Ten-Year Follow-up." Child Development. 56, 376-391. A follow-up on the study of Connecticut families.

Zigler, E. (1988). "The IQ Pendulum." [Review of H. Spitz, The Raising of Intelligence.] Readings. 3:2, 4-9.

II. THE "HEART START"

Page 7

Annie and Bobby:

Greenspan, S.I., and Lodish, R. (December, 1991). "School Literacy: The Real ABC's." Phi Delta Kappan. 300-308.

Pages 7-13

Publications that describe early social and emotional development and/or suggest a relationship between earlydevelopment or experience and later characteristics, in alphabetical order:

Achenbach, T.M., Howell, C.T., Quay, H.C., & Conners, C.K. (1991). "National Survey of Problems andCompetencies Among 4-to 16-year-olds: Parents Reports for Normative and Clinical Samples." Monographs ofthe Society for Research in Child Development. 225: 3.

36

Arend, R., Cove, F., & Sroufe, L.A. (1979). "Continuity of Individual Adaptation from Infancy to Kindergarten: APredictive Study of Ego-Resiliency and Curiosity in Preschoolers." Cni Id Development. 50, 950-959.

Bar-Tal, D., Raviv. A., & Leiser, T. (1980). "The Development of Altruistic Behavior: Empirical Evidence.-Developmental Psychology. 16, 516-524.

Belsky, J., and Nezworski, T. (Eds.) (1988). Clinical Implications of Attachment. Hillsdale, NJ: Lawrence ErlbaumAssociates, Inc.

Block, J., Block, J. H., & Keyes, S. (1988) "Logitudinally Foretelling Drug Usage in Adolescence Early ChildhoodPersonality and Environmental Precursors." Child Development. 59: 2, 336-355.

Bloom, B. (1964). Stability and Change in Human Characteristics. New York: Wiley.

Bradley, R. H., Caldwell, B.M., Rock, S. L., Barnard, K. E., Gray, C., Hammond, M.A., Mitchell, S., Siegel, I..,Ramey, C.T., Gottfried, A.W., & Johnson, D. L. (1990) "Home Environment and Cognitive Development in theFirst 3 Years of Life: A Collaborative Study Involving Six Sites and Three Ethnic Groups in North America."Developmental Psychology. 2: 5, 217-235.

Brazelton, T.B., and Cramer, B.G. (1990). The Earliest Relationship. Reading, MA: Addison-Wesley PublishingCompany, p. 199.

Bronfenbrenner, U. (1979). The Ecology of Human Development: Experiments by Nature and Design. Cambridge.MA: Harvard University Press.

California Department of Education & Far West Laboratory. (1990-1992). The Program for Infant. 1 oddierCaregivers. Infant/Toddler Caregiving: Curriculum Guide Series. (A Guide to Culturally Sensitive Care. A (;tiiile toRoutines, A Guide to Setting Up the Environment, A Guide to Social-Emotional Growth and Socialization, A Guide toLanguage Development and Communication, A Guide to Creating Partnerships and Parents, and A Guide to IntellectualDevelopment and Creativity) Sacramento, CA and Sausalito, CA.

Campos, J.J., Barrett, K.C., Lamb, M.E., Goldsmith, H.H., & Stenberg, C. (1983). "Socioemotional DevelopmentIn M. Haith, & J.J. Campos (Eds.) Handbook of Child Psychology: Vol. 2, Infancy and Developmental

ys chobiolo. New York: Wiley, pp. 783- 916.

Cicchetti, D., Toth, S. L., & Hennessy, K. (1989). "Research on the Consequences of Child Maltreatment and 1kApplication to Educational Settings." Topics in Early Childhood Special Education. 9:2, 43.

Cohn, D. A. (1990). "Child-Mother Attachment of Six-Year Olds and Social Competence at School." ChildDevelopment. 61, 152-162.

Doge, K. A., Bates, J. E., & Pettit, G. S. (1990). "Mechanisms in the Cycle of Violence." Science. 250, 1682.

Emde, R.N. (1989). "The Infant's Relationship Experience: Developmental and Affective Aspects." In A.J.Sameroff, & R.N. Emde (Eds.) Relationship Disturbances ir. Early Childhood. New York: Basic Books, Inc.

Emde, R., Johnson, W.F., & Easterbrooks, M.A. (1988). "The Do's and Don'ts of Early Moral Development:Psychoanalytic Tradition and Current Research." In J. Kagan, & S. Lamb (Eds.) The Emergence of Morality.Chicago: University of Chicago Press.

Erode, R., and Sameroff, A.(1989). "Understanding Early Relationship Disturbances." In A.J. Sameroff, & R.N.Emde (Eds.) Relationship Disturbances in Early Childhood. New York: Basic Books.

Erickson, M.F., and Pianta, R.C. (1989). "New Lunchbox, Old Feelings: What Kids Bring to School." EarlyEducation and Development. 1:1, 40.

Erickson, M.F., Sroufe, L.A., & Egeland, B. (1985). "The Relationship Between Quality of Attachment andBehavior Problc-ns in Preschool in a High Risk Sample." In I. Betherton & E. Waters (Eds.) "Growing Points inAttachment Theory and Research." Monographs of the Society of Research in Child Development. 50, 1-2. SeriesNo. 209.

Escalona, S. (1987). Critical Issues in the Early Development of Premature Infants. Newhaven, CT: Yale UniversityPress.

37

Fish, M., Stifter, C.A., & Belsky, J. (1991). "Conditions of Continuity and Discontinuity in Infant NegativeEmotionality: Newborn to Five Months." Child Development. 62, 1525- 1537.

Fonagv, P., Steele, H., & Steele, M. (1991). "Maternal Representations of Attachment During Pregnancy Predictthe Organization of Infant-Mother Attachment at One-Year of Age." Child Development. 62, 891-905.

Fraiberg, S., Adelson, E., & Shapiro, V. (1980). "Ghosts in the Nursery: A Psychoanalytic Approach to theProblems of Impaired Mother-Infant Relationships." In S. Fraiberg (Ed.) Clinical Studies in Infant Mental Health:The First Year of Life. New York: Basic Books. 164-196.

George, C., and Main, M. (1979). "Social Interactions of Young Abused Children: Approach, Avoidance, andAggression." Child Development. 50, 306-318.

Greenspan, S.I. (1992). Infancy and Early Childhood: the Practice of Clinical Assessment and Intervention withEmotional and Developmental Challenges. Madison, CT: International Universities Press.

Greenspan, S.I., and Lodish, R. (December, 1991). "School Literacy: The Real ABC's." Phi Delta Kappan. 300-308.

Greenspan, S.I., and Greenspan, N.T. (1985). First Feelings: Milestones in the Emotional Development of YourInfant and Child from Birth to Age 4. New York: Viking Press.

Greenspan, S.I. (1989). "Equal Opportunity for Infants and Young Children: Preventive Services for Childre in aMulti-Risk Enviionment." In G. Miller (Ed.) Giving Children a Chance: The Case for More Effective Nation .Policies. Washington, DC: Center for National Policy Press.

Halpern, R. "Poverty and Infant Development." In C. Zeanah (Ed.) Handbook of Infant Mental Health. GuilfordPress. (In press).

Hamburg, D.A. (1987). "Early Intervention to Prevent Lifelong Damage: Lessons From Current Research." Testi-mom/ for the Senate Committee on Labor and Human Resources and the House Committee on Education and Labor. 9/9, 10.

Hamburg, D.A. (1987). "Fundamental Building Blocks of Early Life." Report of the President, CarnegieCorporation. New Ye..k: Carnegie Corporation.

Hamburg, D.A. (1992). Today's Children: Creating a Future for a Generation in Crisis. New York: RandonHouse.

Hoffman-Plotkin, D., and Twentyman, C.T. (1984). "A Multimodal Assessment of Behavioral ana CognitiveDeficits in Abused and Neglected Preschoolers." Child Development. 55, 794-802.

Howes, C., and Eldredge, R. (1985). "Responses of Abused, Neglected, and Nonmaltreated Children to theBehaviors of their Peers." Journal of Applied Developmental Psychology. 6, 261-270.

Hunt, 1. McV. (1961). Intelligence and Experience. New York: Ronald Press.

bard, C.E., Haynes, 0.M., Chisholm, G., & Baak, K. (1991). "Emotional Determinants of Infant-MotherAttachment." Child Development. 62, 906-917.

Jacobson, S.W., and Frye, K.F. (1991). "Effect of Maternal Social Support on Attachment: Experimental Evidence."Child Development. 62, 572-582.

Kagan, J. (1981). The Second Year: The Emergence of Self-Awareness. Cambridge, MA: Harvard University Press.

Kagan, J. (1984). The Nature of the Child. New York: Basic Books, Inc.

Kaufman, J., and Cicchetti, D. (1989). "Effects of Maltreatment on School-aged Children's Socio-emotionalDevelopment: Assessments in a Day-Camp Setting." Developmental Psychology. 25, 516-524.

Lal-reniere, P.J., and Sroufe, L.A. (1985). "Profiles of Peer Competence in the Preschool: Interrelations among Mea-sures, Influence of Social Ecology, and Relation to Attachment History." Developmental Psychology. 21, 56-69.

Lally, I.R. (1984). "Three Views of Child Neglect: Expanding Visions of Preventive Intervention." Child Abuseand Neglect. S, 243-254.

38 <

Lally, J.R (1990). Infant Toddler Caregiving: A Guide to Social-Emotional Growth and Socialization. Sacramento,CA: California Department of Education and Far West Laboratory, Center for Child and Family Studies,Sausalito, CA, p. 50.

Lewis, M. (1992). Shame: The Exposed Self. New York: Free Press.

Lewis, M., Feiring, C., McGuffog, C., & Jaskir, J. (1984). "Predicting Psychopathology in Six-Year Olds from EarlySocial Relations." Child Development. 55, 123-136.

Lieberman, A.F. (1991). "Attachment and Exploration: The Toddler's Dilemma." Zero to Three. XI: 3, 6-11.

Luthar, S.S., and Zigler, E. (1991). "Vulnerability and Competence: A Review of Research on Resilience inChildhood." American journal of Orthopsychiatry. 61, 6-22.

Lyons-Ruth, K. "Maternal Depressive Symptoms, Disorganized Infant-Mother Attachment Relationships andHostile-Aggressive Behavior in the Preschool Classroom: A Prospective Longitudinal View from Infancy to AgeFive." In D. Cicchetti, & S. Toth (Eds.) Rochester Symposium on Developmental Psychopathology, Vol. 4: ADevelopmental Approach to Affective Disorders. Rochester, NY: University of Rochester. (In press).

Lyons-Ruth, K., Alpern, L., & Repacholi, B. (1991). "Disorganized Infant Attachment Classification and MaternalPsychosocial Problems as Predictors of Hostile-Aggressive Behavior in the Preschool Classroom." In K. Lyons-Ruth (chair), Disorganized Attachment Behavior from Infancy to Age Six: Maternal Context, RepresentationalProcesses and Child Maladaptation. Symposium presented at the biennial meeting of the Society for Research in ChildDevelopment, April, 1991, Seattle, WA.

Mayes, L.C., and Carter, A.S. (1990). "Emerging Social Re.'illatory Capacities as Seen in the Still-Face Situation."Child Development. 6, 754-763.

Meisels, S.J., and Provence, S. with the Task Force on Screening and Assessment of the National Early ChildhoodTechnical Assistance System (NEC*TAS) (1989). Screening and Assessment: Guidelines for Identi inn Younl;Disabled and Developmentally Vulnerable Children and their Families. Washington, DC: National Center forClinical Infant Programs.

Meisels, S.J., and Shonkoff, J.P. (Eds.) (1990). Handbook of Early Childhood Intervention. New York: CambridgeUniversity Press.

Morisset, C.E., Barnard, K.E., Greenberg, M.T., Booth, C.L., & Spieker, S.J. (1990). "Environmental Influences onEarly Language Development: The Context of Social Risk." Development and Psychopathology. 2: 2, 127-149.

Nugent, J.K., and Brazelton, T.B. (1989). "Preventive Intervention with Infants and Families: The NBAS Model."Infant Mental Health Journal. 10, 2.

Piaget, J. (1974). The Origins of Intelligence in Children. New York: International Universities Press.Pianta, R.C., Sroufe, L.A., & Egeland, B. (1989). "Continuity and Discontinuity in Maternal Sensitivity at 6, 24, and42 Months in a High-Risk Sample." Child Development. 60, 481-487.

Provence, S. (1990). "Interactional Issues: Infants, Parents, Professionals." Infants and Young Children. 3:1, 1-7.

Provence, S., and Lipton, R.C. (1962). Infants in Institutions. New York: International Universities Press.

Provence, S., and Naylor, A. (1983). Working with Disadvantaged Parents and Children: Scientific Issues andPractice. New Haven, CT: Yale University Press.

Radke-Yarrow, M., Cummings, E.M., Kuczynski, L., & Chapman, M. (1985). "Patterns of Attachment in Two- andThree- Year-Olds in Normal Families and Families with Parental Depression." Child Development. 56, 884-893.

Rubin, K.1-1., Both, L., Zahn-Waxler, C., Cummings, E.M., & Wilkinson, M. (1991). "Dyadic Play Behaviors ofChildren of Well and Depressed Mothers." Development and Psychopathology. 3, 243-251.

Sameroff, A. J. (1986). "Environmental Context of Child Development." Journal of Pediatrics. 109, 192-200.

Sameroff, A.J. (1989). "Principles of Development and Psychopathology." In A.J. Sameroff, & R.N. Emde (Eds.)Relationship Disturbances in Early Childhood. New York: Basic Books, Inc.

39

Sameroff, A. J. (1990). "Prevention of Developmental Psychopathology Using the Transactional Model:Perspectives on Host, Risk Agent, and Environmental Interactions." Paper presented at the Conference on thePresent Status and Future Needs of Research on Prevention of Mental Disorders, Washington, DC: NationalInstitutes on Mental Health, Department of Health and Human Services.

Sameroff, A. J., Seifer, R., Barocas, R., Zax, M., & Greenspan, S. (1987). "Intelligence Quotient Scores of 4-Year OldChildren: Soc. i1- Emotional Risk Factors." Pediatrics. 79: 3, 343-350.

Schorr, L.B., with Schorr, D. (1988). Within our Reach: Breaking the Cycle of Disadvantage. New York: AnchorPress/Doubleday.

Seitz, V., Rosenbaum, L.K., & Apfel, N.H. (1985). "Effects of Family Support Intervention: A Ten-Year Follow-up." Child Development. 56, 376-391.

Spangler, G. (1990). "Mother, Child, and Situational Correlates of Toddlers' Social Competence." Infant Behaviorand Development. 13, 405-419.

Sroufe, L.A. (1979). "The Coherence of Individual Development: Early Care, Attachment, and SubsequentDevelopmental Issues." American Psychologist. 34:10, 834-841.

Sroufe, L.A. (1983). "Infant-Caregiver Attachment and Patterns of Adaptation and Competence: Roots ofMaladaptation and Competence." In M. Perlmutter (Ed.) Minnesota Symi- nsia in Child Development. Hillsdale,NJ: Erlbaum. 16, 41-81.

Stattin, H., and Klackenberg-Larsson, I. (1990). "The Relationship Between Maternal Attributes in the Early Life ofthe Child's Future Criminal Behavior." Development and Psychopathology. 2:2, 99-111.

Stern, D.N. (1985). The Interpersonal World of the Infant: A View from Psychoanalysis and DevelopmentalPsychology. New York: Basic Books, Inc.

Teti, D.M., and Gelfand, D.M. (1991). "Behavioral Competence among Mothers of Infants in the First Year: TheMediational Role of Maternal Self-Efficacy." Child Development. 62, 918-929.

Waters, E., Wippman, J., & Sroufe, L.A. (1979). "Attachment, Positive Affect, and Competence in the Peer Group:TWO Studies in Construct Validation." Child Development. 50, 821-829.

Winnicott, D. W. (1987). The Child, the Family and the Outside World. Reading, MA: Addison-Wesley.

Yarrow, L.J. (1981). "Beyond Cognition: The Development of Mastery Motivation." Zero to Three. 1:3, 1-5.

Zahn-Waxler, C., Cummings, M., McKnew, D., & Radke-Yarrow, M. (1984). "Altruism, Aggression and SocialInteractions in Young Children with a Manic-Depressive Parent." Child Development. 55, 112-122.

Zahn-Waxler, C., and Radke-Yarrow, M. "The Development of Altruism: Alternative Research Strategies." In N.Eisenberg (Ed.) The Development of Prosocial Behavior. In Eisenberg, N. (1992) The Caring Child. Cambridge,MA: Harvard University Press. p. 153.

Zigler, E., and Hall, N. (1989). "Physical Child Abuse in America: Past, Present and Future." In D. Cicchetti, & V.Carlson (Eds.) Child Maltreatment. New York: Cambridge University Press. pp. 38-75.

Pages 13-14

Effects of deprivation on animals:

Harlow, H.R., and Harlow, M.H. (1966). "Learning to Love." American Scientist. 54, 244-272.

Hunt, J. McV. (1961). Intelligence and Experience. New York: Ronald Press.

Rosenblum, L.A., and Harlow, H.R. (1963). "Approach-Avoidance Conflict in the Mother-Surrogate Situation."Psychological Reports. 12, 83-85.

40

Infant brain development:

Greenough, W., Black, J. & Wallace, C. (1987). "Experience and Brain Development." Child Development. 58, 539-559.

Gregory, R. (1987). "Brain Development." The Oxford Companion to the Mind. Oxford, England: OxfordUniversity Press.

National Health/ Education Consortium (NH /EC). (1991). "Healthy Brain Development: Precursor to Learning."Washington, DC: NH/EC.

Younger, B. (1990). "Infants Detection of Correlations among Feature Categories." Child Development. 61: 3, 614-620.

Children's most fundamental lessons:

Greenspan, S.1. (1989). "Equal Opportunity for Infants and Young Children: Preventive Services for Children in aMulti-Risk Environment." In G. Miller (Ed.) Giving Children a Chance: The Case for More Effective NationalPolicies. Washington, DC: Center for National Policy Press, p. 134.

The consequences of neglect:

Erickson, M., Sroufe, L.A., & Egeland, B. (1985). "The Relationship Between Quality of Attachment and BehaviorProblems in Preschool in a High Risk Sample." In I. Betherton & E. Waters (Eds.) "Growing Points in AttachmentTheory and Research." Monographs of the Society of Research in Child Development. 50, 1-2. Series No. 209.

III. WHAT Is To BE DONE?

Page 15

Percentage of women who receive delayed or late prenatal care:

Singh, S., Darroch Forrest, J., & Torres, A. (1989). Prenatal Care in the United States: A State and CountyInventory. Washington, DC: The Alan Guttmacher Institute. 1, 20.

Infant mortality statistics:

The Annie E. Casey Foundation, and The Center for the Study of Social Policy. (1992). Kids Count Data Book:State Profiles of Child Well-Being. Greenwich, CT & Washington, DC.

National Center for Health Statistics. (1992). "Advance Report of Final Mortality Statistics, 1989." Monthly VitalStatistics Report. 40:8. (Supplement 2: Tables 25 & 26).

United Nations Children's Fund (UNICEF). (1992). "The State of the World's Children: 1992." Oxford, England:Oxford University Press.

Percentage of children exposed in utero to drugs:

National Institute on Drug Abuse, Rockville, MD. (1991). National Household Survey on Drug Abuse: PopulationEstimates 1990. Washington, DC: Government Printing Office. (DHHS Publication No. (ADM) 91-1732). Note: Thispercentage was derived from the babies born exposed in utero to cocaine, marijuana, and other illegal substances. It does notinclude babies who are born exposed in utero to cigarettes and alcohol, which are 38% and 73% respectively.

Percentage of low birthweight babies: (defined as less than 2500 grams or 5 pounds, 8 ounces)

National Center for Health Statistics. (1991). Vital Statistics of the United States, 1988. Vol. I: Natality.Washington, DC: Public Health Service.

Percentage of very low birthweight babies: (defined as less than 1500 grams or .3.5 pounds)

National Center for Health Statistics. (1991). Vital Statistics of the United States, i 8. Vol. I: Natality.Washington, DC: Public Health Service.

41

Percentage of children entering school who have a disabling condition:

Department of Education. (1991). 13th Annual Report to Congress of the Implementation of IDEA. Washington,DC: Government Printing Office. Prepared by the Division of Innovation and Development, Office of Special EducationPrograms, Office of Special Education and Rehabilitative Services.

Percentage of children with no access to a regular physician, no health insurance:

Children's Defense Fund. (1991). The State of America's Children, 1991. Washington, DC: Children's DefenseFund, p. 56.

Department of Health and Human Services. (1991). National Health Interview Survey. Washington, DC:Government Printing Office.

National Association of Children's Hospital and Related Institutions. (1989). Profile of Child Health in the UnitedStates. Alexandria, VA: National Association of Children's Hospitals and Related Institutions, p. 19.

A comparison 1,1th other countries:

Miller, C.A. (1987). Maternal Health and Infant Survival. Arlington, VA: ZERO TO THREE/National Center forClinical Infant Programs.

Organization for Economic Cooperation and Development. (1990). "Figures: Statistics on the Member Countries."Paris: OECD.

Williams, B.C., and Miller, C.A.. (1991). Preventive Health Care for Young Children: Findings From a 10-CountryStudy and Directions for United States Policy. Arlington, VA: National Center for Clinical Infant Programs, pp.75-76.

Page 17

Percentage of infants and toddlers seen by child care providers:

Haves, C.D., Palmer, J.L., & Zaslow, M.J. (Eds.) (1990). Who Cares for America's Children? Child Care Policy forthe 1990's. Washington, DC: National Academy Press.

The importance of unhurried time:

Pawl, J. (1991). "Relationships from an Infant Mental Health Perspective." Plenary Address to the Michigan Asso-ciation for Infant Mental Health, Fifteenth Annual Conference.

Toddlers need the time and attention of more than one adult:

Bronfenbrenner, U. (1991). "What Do Families Do?" Family Affairs. 4: I. (Family Affairs is published the Institutefor American Values, New York City.)

Page 18

Our parental workforce:

Kamerman, S. B., and Kahn, A. J. (Eds.). (1991). Child Care, Parental Leave, and the Under 3's: Policy Innovationin Europe. Westport, CT: Auburn House.

Sorrentino, C. (1990). "The Changing Family in International Perspective." Monthly Labor Review. 53. Publisheddata from United States, Canadian, and Swedish labor force surveys; unpublished data for other countries provided by theStatistical Office of the European Communities from the European Community labor force surveys.

Department of Labor, Bureau of Labor Statistics. (1989). Handbook of Labor Statistics. Washington, DC:Government Printing Office. (Bulletin #2340, Table 56).

Parental leave in the United Statespaid and unpaid:

Department of Labor, Bureau of Labor Statistics. (1989). Employee Benefits in Medium and Large Firms, 1989.

4:j42

Washington, DC: Government Printing Office. (Bulletin ?:;2363. Stock #029-001-03056-8).

Women's Legal Defense Fund. (1991). "Family and Medical Leave." Washington, DC: Women's Legal DefenseFund.

Parental leave statistics for selected countries:

Kamerman, S.B., and Kahn, A.J. (Eds.). (1991). Child Care, Parental Leave, and the Under 3's: Policy Innovation inEurope. Westport, CT: Auburn House.

Zig ler, E.F. & Frank, M. (Eds.) (1988). The Parental Leave Crisis: Toward a National Policy. New Haven, CT: YaleUniversity Press.

A medical and social science basis for parental leave:

Hopper, P., and Zig ler, E. (1988). "The Medical and Social Science Basis for a National Infant Care Leave Policy.American Journal of Orthopsychiatry. 58, 324-338.

Percentage of infants born to single parents:

National Center for Health Statistics. (1991). Vital Statistics of the United States, 1988. Vol. I: Natality.Washington, DC: Public Health Service.

Percentage of families headed by single parents:

Department of Commerce, Bureau of the Census. (1990). "Household and Family Characteristics: March 1990 and1989." Current Population Reports. Washington, DC: Government Printing Office. (Series P-20, #447).

Percentage of total births by teenagers:

National Center for Health Statistics. (1991). Vital Statistics of the United States, 1988. Vol. I: Natality.Washington, DC: Public Health Service.

Total Japanese births by teenagers:

Statistical Bureau of the Management and Coordination Agency. (1991). The Japanese Statistical Yearbook. Tokyo,Japan: Japanese Government Printing Office. Statistics from 1989.

Importance of continuity of care for children:

Howes, C., and Hamilton, C.E. "Children's Relationships With Child Care Teachers: Stability and ConcordanceWith Parental Attachments." Child Development, (In press).

Lally, J. R. (1990). Infant Toddler Caregiving: A Guide to Social-Emotional Growth and Socialization. Sacramento,CA: California Department of Education and Far West Laboratories, Center for Child and Family Studies, p. 50.

Lally, J.R. (1992). "Together in Care: Meeting the Intimacy Needs of Infants and Toddlers in Groups [video]." FarWest Laboratories, Center for Child and Family Studies, Sacramento, CA.

Pawl, J. (1991). "Relationships from an Infant Mental Health Perspective." Plenary Address to the MichiganAssociation for Infant Mental Health, Fifteenth Annual Conference.

Page 19

Policies relating to quality of child care:

Meisels, S.J., and Sternberg, L.S. (1989). "Quality Sacrificed in Proprietary Child Care." Education Week. (June 7).

Zigler, E., and Finn-Stevenson, M. (1989). "Child Care in America: From Problem to Solution." Educational Policy.3, 313-329.

Zigler, E. (1990). "Shaping Child Care Policies and Programs in America." American Journal of CommunityPsychology . 18, 183-193.

E46

Comparison of child care wages to those of parking lot attendants and kennel workers:

Modigliani, K. (1986). "But Who Will Take Care of the Children? Child Care, Women and Devalued Labor."Journal of Education. 168: 3, 46-69.

Caregivers' salaries and turnover rates:

Howes, C. (1992). "Changes in Teachers and Shifts in Teacher-Child Relationships and Children's SocialCompetence. A presentation at the "8th International Conference on Infant Studies (ICIS). Miami Beach, FL, May 7-10.

Whitebook, M., Howes, C., & Phillips, D. (1989). Who Cares? Child Care Teachers and the Quality of Care inAmerica. Oakland, CA: Child Care Employee Project.

State policies on infant care:

Adams, G. (1990). Who Knows How Safe? The Status ( ,( State Efforts to Ensure Quality Child Care. Washington,DC: Children's Defense Fund.

Adams, G., and Sandfort, J.R. (1992). State Investments in Child Care and Early Childhood Education.Washington, DC: Children's Defense Fund.

Morgan, G. (1992). National State of Child Care Regulation (Chapter on Ratios). Washington, DC: NationalAssociation for the Education of Young Children. (In press).

Page 20

Child abuse statistics:

Daro, D., and McCurdy, K. (1990). "Current Trends in Child Abuse Reporting and Fatalities: The Results of the1990 Annual Fifty-State Survey." Chicago, IL: National Committee for Prevention of Child Abuse.

Page 21

Family resource programs:

Kagan, J., Powell, Weissbourd, B., & Zigler, E. (1987). America's Family Support Programs: Perspective andProspects. New Haven, CT: Yale University Press.

Page 22

Training recommendations:

Fenichel, E. S., and Eggbeer, L. in collaboration with the TASK Advisory Board. (1990). Preparing Practitioners toWork with Infants, Toddlers and Their Families: Issues and Recommendations for Policymakers. (Also, Issues andRecommendations for the Professions, Issues and Recommendations for Educators and Trainers, and Issues and Recom-mendations for Parents.) Arlington, VA: ZERO TO THREE/National Center for Clinical Infant Programs.

Percentage of caregivers with infant development training:

Whitebook, M., Howes, C., & Phillips, D. (1989). Who Cares? Child Care Teachers and the Quality of Care inAmerica. Oakland, CA: Child Care Employee Project.

States requiring training in child development:

Morgan, G. (1991). "National Child Care Policy: The Importance of Consumer Protection." Keynote Address atNational Licensing Conference, San Francisco, CA.

States requiring specialized training for infant and toddler care:

Morgan, G. (1992). State of the States Report. Wheelock College: Center for Career Development in EarlyChildhood and Education. (In press). Data from May 1991.

44

States allowing exemptions for church and school-based child care centers:

Morgan, G. (1990). "How the States Administer Their Licensing Programs." National State of Child CareRegulation: 1990. Watertown, MA: Work/Family Directions.

Page 23

Children at the poverty level:

Johnson, C.M., Sum, A.M., & Weill, J.D. (1992). Vanishing Dreams: The Economic Plight of America's YoungFamilies. Washington, DC: Children's Defense Fund & Northeastern University's Center for Labor MarketStudies.

Department of Commerce, Bureau of the Census. (1990). "Money Income and Poverty Status in the United States,1989." Current Population Reports. Washington, DC: Government Printing Office. (Series P-60, #168. 7).

Page 24

Refundable child tax credit:

National Commission on Children. (1991). Beyond Rhetoric A New American Agenda for Children and Families:Final Report of the National Commission on Children. Washington, DC: National Commission on Children,Chapter XXI.

Tax credits for children and selected country comparisons: (for additional information)

Kamerman, S. B., and Kahn, A. J. (Eds.). (1991). Child Care, Parental Leave, and the Under 3's: Policy Innovationin Europe. Westport, CT: Auburn House.

Adequate space in child care settings:

Lally, J.R., & Stewart, J. (1990). "Infant/Toddler Caregiving: A Guide to Setting Up Environments." The Programfor Infant/Toddler Caregivers. Sacramento, CA: California Department of Education & Far West Laboratories.

The Program for Infant/Toddler Caregivers. (1992). "Together In Care: The Child Care Video Magazine." [accom-panies Video} Sacramento, CA: California Department of Education and Far West Laboratories. (Contains the recom-

mendations of Louis Torelli.)

Though more stringent in some respects, our recommendations are consistent with:

American Public Health Association (APHA) and American Academy of Pediatrics (AAP). (1992). Caring for OurChildren. National Health and Safety Standards: Guidelines for Out of Home Child Care Programs. Washington,DC & Elk Grove, IL.

National Association for the Education of Young Children (NAEYC). (1991). Accreditation Criteria andProcedures of the National Academy of Early Childhood Programs. Washington, DC: NAEYC.

4O45

Heart Start: The Emotional Foundations of School Readiness was drafted byEleanor Stokes Szanton, Peter L. Szanton, Jeree H. Pawl, Kathryn E.Barnard, Stanley I. Greenspan, J. Ronald Lally, and Bernice Weissbourd.Its Endnotes were compiled by Joan Melner.

Office support was provided by Simone Bielsker and Gail Shirar.

The paper's recommendations were developed and its text approved bythe Committee on Public Policy/Public Education of ZERO TO THREE/National Center for Clinical Infant Programs (Bernice Weissbourd, Chair;T. Berry Braze lton; Irving B. Harris; Asa Grant Hilliard, III; BeverlyRoberson Jackson; Sheila B. Kamerman; J. Ronald Lally; Bernard Levy;Peggy Daly Pizzo; Arnold J. Sameroff; Marilyn M. Segal; RebeccaShahmoon Shanok; Lynn G. Straus; and Edward Zig ler).

In addition, the drafters are grateful to Deane Argenta, Carol Berman,Emily Fenichel, Abbey Griffin, Samuel J. Meisels, and Judith Viorst, eachof whom reviewed and helped shape the document at key stages in itsdevelopment.

;)

Five Vignettes:How Services Can Change

The Lives of Infants, Toddlers and Their Families

Heart Start: The Emotional Foundations of SchoolReadiness makes a number of recommendationsthat, implemented together, would make a pro-found difference in the readiness for school ofour nation's children. To illustrate the ways inwhich high-quality, family-centered servicescan make a crucial difference to young familiesand ultimately to their children, we offer thefollowing vignettes. The vignettes, while fic-tional, are based on the experiences of many ofus in our work with families and providers ofservice in a range of circumstances. Empha-sized in each vignette are the qualities of therelationships offered, whether to a youngmother and father and their baby, to a teenagesingle parent, to a toddler entering child care, toa foster parent or to a new mother who is wor-ried that something is wrong with her baby. Thevarious kinds of expertise which a nurse, a doc-tor, an infant mental health expert or a day careprovider possess are diverse, but they must allbe informed by an awareness of the importanceof the relationship of parent and child, and ofprofessional (or para-professional) and parentand child.

The same awareness informs the recommenda-tions that are the heart of "Heart Start."

Vignette #1:The Community Health Nurse:

A baby "welcomed" and followed;a family supported

The way it shouldn't be:

At the very last minute Suzanne hadgiven in and called her mother to see if

;.)

she could come to the hospital and takeher and little Danny home. Every timeGreg came to the hospital they foughtand then Greg stormed off. No job, nomoneyhow could they manage? What amess! She should have been more careful.This baby was going to really mess upher life. Now her mother was there withher nasty mouth saying, "I told you so.Better get in the wheel chair, Suz, it's thelast free ride you and your little bundle ofjoy are going to get. You'll pay the pipernow. "The nurse muttered somethingabout "a fine boy" as she handed Dannyto Suzanne but Suzanne felt so sick andangry she could barely hear her and shedidn't reply. She just took him, held himand wished she could be anywhere else inthe world. She wished Greg were here.She wished her mother would go away.She wished she were dead.

Unless they receive help, Suzanne, Greg andDanny all seem headed for conflict, unhappi-ness and failure. But policies such as those rec-ommended under "Welcoming, assessing andtracking" and "Health care providers as col-leagues of parents" can ensure that a profes-sional can come to know them over time, andprovide substantial help.

The way it should be:

Suzanne and Greg were sitting in fac-ing chairs next to the hospital bed.Suzanne was holding Danny, just one-day-old. Greg was leaning forward, talk-ing agitatedly, "That's the only place Icould find. It's not so bad." Suzanne tried

to picture the three of them in a tinyroom in a transient hotel. She felt scaredand sick and angry. What did she evenknow about taking care of a baby? Shestared at Danny. Oh God, if only he'djust go away. A woman walked in justthen and introduced herself "Hi, sorry tointerrupt, but I wanted to get a chance totalk to you before tomorrow when you'llbe leaving the hospital. My name is JaneSummers and I'm a nurse with the HealthDepartment. I wanted to see if I could beof help to you." Greg sneered, "Howabout a job." Suzanne said, "Yeah, andhow about an apartment?" Jane Summersasked, "You two and your baby are all onyour own? "You got it," answered Greg."Well," said Jane, "then we've got a lotof getting acquainted to do. I can reallyhelp you think about both of those thingsand about this little fellow as well.Whoam I talking to anyway?" "I'm Suzanne,this is Greg, and this is Danny". "It's niceto meet you all," said Jane Summers."Your son looks like a very healthy boy.Who does he look like?" SimultaneouslyGreg and Suzanne both said, "Me" andthen they both laughed. This seemed tofree Greg up to move and he went and gotanother chair so that Jane Summerscould sit down. They began to getacquainted.

Young parents need a relationship with some-one who takes an interest in the medical andsocial well-being of all of the members of theirfamily. The county health nurse can make homevisits, observe and discuss their baby andbabies in general with the parents, findresources and provide information. She can besure the baby gets regular preventive healthcare and screening, since this family wouldqualify for Medicaid or maternal and childhealth services. She can enlarge their knowl-edge and understanding of their baby. And she

2

can do this through a supportive relationshipthat tries to take account of all of this vulnerablefamily's many needs. And though she can't sin-gle handedly solve their housing and employ-ment problems, she can connect them to infor-mation about job training and housing re-sources and help them think about the best wayto make use of them.

Vignette #2:The Talbotsa special baby

Joan Talbot closed the door of Dr.Gould's office with a certain sense ofexcitement. It had taken her a long time,a lot of courage and persistence to gethere. She felt, finally, as though someoneunderstood that Jonathan had a problemand that she had a problem with Jona-than. She also felt hope that she andJonathan could find a way to really likeeach othermaybe even enjoy each other.

She had been worried about Jonathansince his birth. He came somewhat earlyand was low in birthweight. Even in thehospital he seemed to Joan to cry morethan the other babies, working himself upinto a red fury. She worried that some-thing was zvrongthat she was too oldto be having this child even though,aftertwo daughters, her husband so muchwanted a "Jonathan Talbot, III." Joan'smother didn't seem to have enjoyed help-ing to care for Jonathan the first ten daysat home, as she had Letty and Silvie."Poor little thing," her mother had saidover and over as together they had rockedhim to try and soothe him. Her motherhad seemed almost relieved to leave, justas Jon had seemed glad to escape to arguea case halfway across the country. Anddear old Dr. Lord hadn't seen anything toworry about. "It's just colic. He'll grow

out of it. "Alont/z by month Jonathan wasretreating further into his own zvorld,looking away or squirming wheneverJoan picked hint up and often screamingwhen she held him. In addition hisweight was not good. He seemed to fightgrowing, just as he fought everything elseabout being alive. She had found herselfsometimes wishing they had stoppedwith two children; he was ruining every -thing. And now Sylvia was wetting herbed at night again and throwing tempertantrums. Joan didn't know whether shewould ever get back to her own free lanceart work. She felt size zvas losing her gripand becoming more furious withJonathan everyday.

This situation is quite a common one. It is tragicfor infants who experience discomfort and trau-ma over their first weeks and months of life. Itis tragic for parents even experienced parentswith lots of resources, such as the Talbotswhofeel inadequate and resentful. Finally, it is tragicfor this child's future in school and beyondone in which Jonathan may well be labeledlearning disabled, hyperactive or autistic, as hissituation, unchecked, grows worse.

Then one day in desperation she calleda hotline for people with parenting prob-lems. The person on the phone told herabout Dr. Gould, a specialist withinfants and young children who had sen-sory processing problems. Joan soughthim out and she and Jonathan had beenworking with him for several weeks. Dr.Gould reassured her that she was right,that Jonathan did indeed have problemsand that he was very easily over stimu-lated. Dr. Gould explained that the thingsany good ordinary mother like Joanwould be inclined to do were things thatdidn't work at all well with Jonathan.Joan was now learning to react to

3 L.,'

Jonathan in ways that really helpedhimto hold him in a particu ,zr way, forinstance and she was learning toaccept her original resentment. Dr. Gouldworked with her to invent ways to cap-ture Jonathan's attention and get him tolook at what she was doing, slowly andgently bringing him into more contactwith the zvorld.

As they rode down the elevator, Joanspoke to Jonathan in the quiet voice thatDr. Gould had suggested she use. Shecaptured his gaze, and Jonathan beganto sinile. He looked away quickly, butJoan didn't try to force him to look ather. She understood he was resting. In amoment he looked back and smiledagain. She returned his smile and saidsoftly, "You and I are going to be goodbuddies, I. Talbot the IIIreally goodbuddies."

Resources such as Dr. Gould are rare at themoment. As recommended in "Providing spe-cial help for families with special problems,"the federal and state governments, as well asfoundations, should be funding the training, ofpeople qualified to provide this kind of help.

Vignette #3:Foster mothers need advice, too

The way it shouldn't be:

Mrs. Brown realized size couldn't bearit one more minute. It had seemed theright thing to do in response to the epi-demic she read about in the papers. Thosepoor babiesexposed to drugs beforethey even had a chance to be in the world.With her experience she had been sure shecould handle any baby. Lit /le Rodneyhad been finethe first drug-exposed

baby she had cared fora mite more jit-tery than some but a little special atten-tion and he settled in fine. She had seenno reason to hesitate to take another. Butthat was before she met Holly twomonths ago. Fifteen years of being a fos-ter mother, and suddenly she felt helpless.She and her husband lake had triedeverything. Jake was tired of thescreaming, and he made that vent clear.So now things were very tense betweenthem.

Just now, when Holly had startedscreaming and throwing everything inreach, Mrs. Brown jerked her up hard byher arm and all but threw her in her crib.Holly was still howling when Mrs.Brown shakily dialed the social servicesnumber. Without telling them what hadhappened she said Holly was disruptiveand too difficult and they would need toarrange to pick her up as soon as possi-ble. No, she didn't want to discuss it. Lether know when they could come andshe'd have Holly's things ready. She hungup feeling like a failure; "But, at leastknowing Holly is leaving, I won't hurther. I've never hurt a child and I don'twant to start now.... I wonder what willhappen to her."

The way it should be:

Mrs. Brown was very moved by thestories in the papers about the babiesexposed to crack, cocaine and otherdrugs. She had cared for a lot of babies inher fifteen years as a foster mother andshe felt moved to help some of these chil-dren. On impulse, she called the place-ment worker and volunteered. Ms.Childres said she was delighted that Mrs.Brown had called and they would behappy to include her. They would want

4

to help her with the special care such achild might need, and they had specialtraining for that, she explained.

Mrs. Brown bristled a bit, saying shehad handled some humdingers in her dayand had never needed any special train-ing. Mrs. Childres replied that it wasbecause of that skill that she thoughtMrs. Brown would be perfect, but therewere things that might come up whichexperts on children exposed to drugscould help with. Such children didn'talways respond like most kids"Somedo, but some don't. We have to be veryselective about the homes that they go toand we want to prepare those who quali-fy in a general way and then meet regu-larly about the particular child whocomes to your home." Mrs. Brown saidthat she was always interested in learn-ing things and that it sounded as if itwould be interesting and worthwhile.They discussed the schedule of trainingand other details such as the need forrespite care if the child she cared for wasparticularly difficult. Mrs. Brown saidshe would discuss it all with her hus-band, and get back to Ms. Childres.

Prevention is always preferable to intervention.Frequently, preventive efforts keep damagingdisruptions from occurring. Trainin foster par-ents and providing consultation regarding thechildren for whom they care protects both thefoster parents and the child. Drug-exposedinfants are a special case, but abused andneglected children and any children separatedfrom their familiar surroundings and parentsare in need of special care and understanding.Helping foster parents to better understand theneeds of such children,and to learn more effec-tive ways of responding to them are importantaspects of successful child welfare efforts. Asrecommended in "Providing special help for

families with special problems," federal, stateand private funding should support this kind ofassistance.

Vignette #4:A community health center: Treating

more than a cold for a newAmerican family

Supportive relationships can develop at a doc-tor's office or health center. Often a child isbrought in because of a particular health prob-lem, but the need for broader counseling isobvious. Recommendations relating to "Familyresource programs" arid "Child care and healthproviders aF colleagues of parents" suggesthow these needs could be met.

For the third time in as many visits tothe Community Health Center where shehad been treated for a very bad cold andcough, 2-year-old liana's screaming andkicking made it almost impossible for Dr.Randal to examine her. Mrs. Carrero, themother of liana and 6-month-old Jose,seemed helpless in this situation, embar-rassed by Ilana's behavior yet unable tochange it. Feeling that the Carrero's need-ed more than her limited Spanish andbrief experience in counseling parentscould offer, Dr. Randal sought advicefrom Mrs. Valesquez, a bilingual mentalhealth consultant attached to the center.At the Carrero's next visit, Dr. Randalintroduced Mrs. Valesquez as someonewho might be able to help them under-stand why clinic appointments were sodifficult for liana.

Mrs. Valesquez learned that Ilana'sbehavior had been as difficult at home asin the clinic. She also discovered that theCarrero's had lived in almost a dozen dif-ferent single rooms in the apariments of

5

other new inn during the threeyears they had been in this country. Mr.Carrero worked long and irregular hours.In recent months he had spent severalweeks at a time away from home work-ing on construction projects.

Mrs. Valesquez found times when sizecould talk with Mr. and Mrs. Carrero,both in their room and at the health cen-ter. She set up weekly appointments. Shehelped them to think about what lianamight have been feeling as the familychanged living arrangenzetzts, her belovedfather seemed to disappear from her lifeand her new baby brother preoccupied hermother. As the Carrero's began to taketime to explain planned events, includingclinic visits, to Rana in advance, lianafelt more in control of her world, includ-ing her own behavior. Proud of theirdaughter's intelligence, the Carrero'sstarted to include their "big girl" in theirdiscussions of the apartment they hopedto find for their family alone. Oz,er time,the Carrero's explored with Mrs. Vale-squez aspects of their histories thatmight be affecting relationships in theentire family. They also discussed morehonestly their feelings about their immi-gration and the loss of so many iznor-taut people. As their trust in Mrs.Valesquez grew, they were both morewilling to discuss other possibilitiesavailablesuch as English classes andjob training.

After several months, the Carrero'sfelt that Ilana was far more cooperativeand happy. Both parents felt more opti-mistic. They and Mrs. Valesquez agreedthat they didn't need to continue to meet,thought they always looked her up wizenthey came to the clinic. No longer a placeof embarrassment and discomfort, the

clinic had become a safe haven. The sameis beginning to be true of their adoptedhome.

Vignette #5:Child care: A secure placeand a special relationship

The way it shouldn't be:

Tim stood just inside the entrance tothe big playroom. He was sturdy for 2 -1/2but short. The noise was jarring and helooked around for the woman his mothertalked to when they came in. She hadsaid to his mother, "He'll be fineI'll gethim started" and she had taken his hand.But now, just as fast, she was gone. Itscared him as much as the other time.This was not a good place to be. Hewanted his mother and he wanted to gohome. A boy running past bumped himhard and Tim nearly fell, but lie caughthimself and made his way to the cornerof the room. He still couldn't see that bigperson or the other one--just lots andlots of small kids. He sat down and fin-gered some colored blocks on the floor. Abig boy came and grabbed one andstepped on his hand. Tim yelped and criedand looked around. He held his hurt handin the other and the tears ran down hischeeks. No one saw.

2 weeks later:

Tim stood just inside the entrance tothe big playroom. It was very noisy. Aboy ran past him and bumped him. Timlunged for him and pushed him down.The boy cried, and Tim walked °ye_ tothe blocks. He picked some up, and a big-ger boy came and grabbed them. Tim gavethem up quickly and then turned and saw

6

a smaller boy who had some. He pulledthem away from him. The boy cried. Timlooked at the blocks. He couldn't remem-ber what he'd been going to do withthem, so lie threw them down. They madea very satisfying sound. He picked upseveral other toys nearby and threwthem. Suddenly one of the women wasthere yelling at him and holding his armvery hard. She was saying lots of thingsto him and now she said, "time out" andscrunched him on a stool. He tried to getup, but she wouldn't let him. She waved afinger in his face. He thought about bitingit. She went away. He didn't like thisplace. He wanted his mother. He wantedto go home.

What Tim is learning in this child "care" center,is almost everything we would not want him to.He is important to no one here and must fendfor himself, as must others. For some it's likehomefor others it's newly terrible. For all it isa potentially damaging experience. Clear poli-cies which support quality child care can go farto ensure that very young children are treatedin ways that teach them to cooperate, to care forothers and to learn.

The way it should be:

Tim and his mother had visited thecenter twice in the last week. They hadspent time with Mindy who told themshe would be Tim's primary caregiver.Both Tin: and his mother felt comfortablewith Mindy. Site was interested in them,wanted to talk regularly about Tim'sprogress and seemed to understand howTim's mother felt about leaving Tim to goto work. To Tim today felt much thesame, but his mother knew she was goingto leave him for several hours and hadtold him so. Mindy met them at the doom;squatted down to speak to Tim who

smiled shyly, remembering her, and thenwalked with mother and child to thesmall rocking horse that Tim had soenjoyed the last time. A small boy rushedby and bumped Tim quite hard. Mindycaught the little boy and talked quietlyto himintroduced him to Tim and senthim on his zvay. Tim got on the horse andMindy sat nearby where a somewhat big-ger girl was building with blocks and aboy was working with large puzzlepieces. Mindy attended to all of them inturn as they wanted her attention orhelp. These were her three and she alwayskept a special eye on them. When it wastime for her to go, Tim's mother remindedhim she was leaving today. He lookedsurprised and climbed off the horse.Mindy picked him up and said, "Let's goto the door and say good-bye to yourmother." Tim wanted to go with hismother. But his mother really seemed tobe going to leave him, so he clung closerto Mindy who cuddled him and talkedquietly. Then his mother was gone. It waslike everyone in the world was holdingtheir breath at the same time but Mindyheld him and patted him and talked qui-etly and then everyone began to breatheagain. He could see the toys and children,but mostly lie liked hearing Mindy'svoice. Ten minutes later Tint was on hishorse. He wasn't as wholly confident astwenty minutes before; but lie could stillride, and Mindy was close by and alwaysnoticed when he looked at her.

2 weeks later:

After his mother kissed him, Tintwaved good-bye and then he said, "Hi"again to Mindy who ruffled his hair. Timmade a line for the block area but whenlie got there Wong Chen had corralled all

7

of the red ones Tim wanted. Tint squatteddown and watched Wong Chen. In aminute, Mindy came over and squatteddown too and they both watched him.Then Mindy said, "Tim is very interestedin those blocks too, Wong Chen, wouldyou let hint have a few?" Wong Chenlooked at the floor and then lie looked upand frowned at Mindy and then at Tint.Mindy said, "OK, Wong Chen, if youwant them right now, Tint can use themlater." And then to Tint, "Maybe you'dlike bristle blocks? I don't think anyonehas those." As Tim started to walk away,Wong Chen handed hint one red block andMindy said, "Thank you Wong Chen,we'll use that. Suddenly Tim decided toride his horse instead, but first he tookthe block from Mindy and fed his horse."Spotty is hungry," said Tint, "breakfastfood." Molly, 3-1/2, stuck a clothes pintoward Spotty's mouth. "He's very hun-gry," said Molly, "All the animals arehungry." Tim said, "they're all very, veryhungry." Wong Chen, who had beenwatching, got the basket, put all theblocks in it and brought it to Tim andMolly. They all fed all the animals -every one they could find. Some of theother six children joined them. Mollyannounced that it was time for all theanimals to sleep. Tim and Wong Chen,Molly and one of the other children gotcloth squares and covered them. WongChen woke up Spotty and climbed up toride him. Tim started building with thered blocks. He would build a big carared car like his mother's car. His motherwas working. She would come later"Mother comes later," Tim said. Mindyheard hint. "Shc will, Tint," said Mindy."She'll come after lunch, and after yournap and after stories." "Lunch and

stories," said Tim and then he said, "Seemy car? I made it myself."

Tim is learning a lot in this center, mostly verygood things. He feels important. He feels heardand understood. He feels protected, and his pri-mary caregiver helps him negotia 2 the difficultthings with other children. He is learning tocooperate and to pay attention to what otherchildren need and want. There is enough space,

there are enough providers, just enough chil-dren and abundant affection for everyone.

Far too often in our nation child care is "theway it shouldn't be." Heart Start's recommenda-tions about child care ratios and group size,continuity of care, and the training and com-pensation of child care providers all can help tomake it "the way it should be." E

#1 TOTHREE

ZERO

National Center for Clinical Infant Programs2000 14th Street North, Suite 380

Arlington, VA 22201-2500(703) 528-4300 FAX (703) 528-6848

TDD (703) 528-0419

for ordering information and additional ZERO TO THREE publications, contact:ZERO TO THREE to// free: 1-800-544-0155.

8