Tag: Nurse Family Partnership

Reducing Generational Poverty – Some Thoughts

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During the last decade of my career we learned a lot about generational poverty and the various social problems that are associated with it. As a result of our hands-on experiences and what we have learned from others – including a lot of people in low income households, here are some of my conclusions:

  • We must greatly increase access to affordable, high quality early childhood development opportunities for children in low income households. Because of the way the brain develops, the years 0-3 are even more important than ages 3-5. Society will get an enormous return on its investments in such services.
  • We must remember that no child chooses the circumstances he/she was born into. And nearly every mom – regardless of income level – wants what is best for her children. Where there’s a lack of knowledge among young parents about ways to prevent problems and help young children develop, we need to try to help close the gap.
  • Where there’s enough good data, we should increase the use of pay-for-success financing mechanisms to scale high impact services and make more effective use of public resources. While few programs or services have enough solid data of long term impact and a high return on investment, Nurse-Family Partnership and a few other high quality early childhood development programs do.
  • We must continue working to improve education attainment levels, but we must do a lot more to ensure that at every step of the way we are doing a good job preparing students for the next step. In other words, every child who completes 3rd grade should be ready for 4th, etc. And there is simply no excuse for students who receive a high school diploma to require remedial work when they enroll in a community college.
  • We must do as much as possible to ensure that everyone earns some credential beyond a high school diploma that will enable them to be employable. It could be an industry-recognized certificate, an associate’s degree, or a four-year college degree. A high school diploma is not enough.
  • Young people in high poverty situations need to be exposed at an early age to career opportunities they might not even know exist. We need to broaden their horizons and help them raise their aspirations.
  • The non-cognitive is just as important as the cognitive. The more we do to help children develop good character, habits of persistence, social and emotional strengths, etc., the greater their likelihood of being successful in school, work, and life. The earlier we start, the better.
  • Every child needs a positive, long term relationship with at least one responsible adult.
  • There is sometimes a big disconnect between the ideas of many “thought leaders,” including some policy makers, and the realities of individuals living in high poverty situations. Too many well-meaning people do not have enough direct hands-on exposure to really understand the problems they are trying to solve. This is one reason a lot of their solutions don’t work as intended.
  • Fragmented and “silo” approaches will never solve our most serious social problems. Poverty, low education levels, crime rates, births to young unwed mothers in low income households, and a host of health issues are all inter-related. They reinforce and compound each other. But we don’t tend to treat them as if they were. The public sector operates through large bureaucratic silos, and the not-for-profit sector is incredibly fragmented. There are a lot of organizations doing a good job addressing some of the pieces, but we are not connecting the pieces well enough to solve the big problems. We must do much more to bring some of the good services and resources together – within and across the various sectors – in complementary, holistic, two-generation approaches that can be sustained over multiple years. This will work.
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More evidence of the importance of non-cognitive skill development in young children

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In a July 24, 2015 Opinionator piece published by the New York Times, David Borenstein reported on the findings of a major study by researchers from Penn State and Duke University that had been designed to understand how children develop healthy social skills.

The study tracked 753 children whose social and communication skills had been assessed by 50 kindergarten teachers across three geographic areas in the early 1990s to see what had happened to the students 13 to 19 years later.

As it turns out, the assessments in kindergarten predicted the likelihood of “whether the children would graduate from high school on time, get college degrees, have stable or full-time employment as young adults; whether they would live in public housing or receive public assistance; whether they would be held in juvenile detention or be arrested as adults. The kindergarten teacher’s scores also correlated with the number of arrests a young adult would have for severe offenses by age 25.”

“One major result: Children who scored high on social skills were four times as likely to graduate from college as those who scored low.”

Borenstein points out that “These studies suggest that if we want many more children to lead fulfilling and productive lives, it’s not enough for schools to focus exclusively on academics. Indeed, one of the most powerful and cost-effective interventions is to help children develop core social and emotional strengths like self-management, self-awareness and social awareness – strengths that are necessary for students to fully benefit from their education and succeed in many other areas of life.”

The findings of this study are consistent with those mentioned in a 2012 essay titled “Promoting Social Mobility” by James J. Heckman, published in the Sept./Oct. 2012 issue of Boston Review. Heckman writes, “An emerging literature confirms the common sense idea that success in life depends on much more than smarts. Non-cognitive abilities – including strength of motivation, an ability to act on long range plans, and the socio-emotional regulation needed to work with others – also have a large impact on earnings, employment, labor force experience, college attendance, teen pregnancy…and participation in crime.”

“….both cognitive and socio-emotional skills develop in early childhood, and their development depends on the family environment…..A growing fraction of our children are being born into disadvantaged families…..and that disadvantage tends to accumulate across generations.”

“…Early interventions can improve cognitive as well as socio-emotional skills. They promote schooling, reduce crime, foster workforce productivity, and reduce teenage pregnancy…”

Heckman notes that programs that target the early years seem to have the greatest promise. These include Nurse-Family Partnership (which Goodwill is implementing in parts of Indiana). “Programs with home visits (like NFP) affect the lives of the parents and create a permanent change in the home environment that supports the child after center-based interventions end.”

One randomized controlled trial of families that participated in Nurse-Family Partnership showed that NFP children had 67% fewer behavioral and cognitive problems at age 6 than children in a control group.

The two-generation approach practiced by Nurse-Family Partnership benefits the entire family in numerous demonstrable ways. For example, Goodwill’s implementation of NFP is resulting in an increase in earned income in 33% of participating households. In addition, among parents with less than 12 years of education at enrollment, 59% have increased their education attainment level as measured one year post-enrollment in NFP.

There’s a growing amount of solid evidence that investments in high quality early childhood development programs generate substantial benefits to society as well as to the participating children. Those programs, such as NFP, that also include wraparound services for other family members yield even greater benefits and, if scaled sufficiently, can go a long way toward reducing generational poverty and a lot of the social problems that accompany it.

On Character Development

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In my September 2, 2014 post to this blog, I described how, over the past 20 or more years, my colleagues at Goodwill and I have been working to build a strong, dynamic, serving institution. Such institutions are vitally important to the development and ongoing improvement of a decent, stable society.

But, as emphasized by Richard Reeves in a wonderful essay, “The New Politics of Character,” in National Affairs, that’s not enough. Reeves states that “if we want a better, freer, fairer society, we will have to complement the 20th-century focus on strong institutions with a new (if also ancient) concern for strong individuals. The quality of our policies is a vital concern. But so is the quality of our people.”

According to Reeves, “The development of character is perhaps the central task of any civilized society and every individual within it…..Gaps in character development correlate to gaps in income, family functioning, education, and employment. The character gap fuels the opportunity gap, and vice versa.”

Lest we think there are simple solutions, though, Reeves provides a dose of reality. For example, he points out that, while rates of teen parenthood have declined, rates have proved stubbornly high among the least-educated, lowest-income groups. It may appear that poor teenagers who become parents are irrationally discounting the future and so failing to demonstrate the virtue of prudence. But there’s an important factor in the equation that we might not realize: “Teen pregnancy appears to have a limited impact on life chances for this group (poor teenagers) because their life chances were so truncated in the first place. Broadly speaking, they are not sacrificing opportunities for wealth and security in the long term for short-term pleasures; their opportunities for future pleasures are few, so as a matter of calculation it makes more sense to pursue the short-term pleasures than it would for a teen from a wealthier family.”

Reeves suggested approach? “The key insight for policymakers is that the task is not simply to teach prudence, but to improve the future prospects of these young adults so they have brighter possible futures to measure the present against…The opportunity agenda is a character agenda, and vice versa.”

Of course, without good role models, it is harder for a child to learn to defer gratification. There is also a growing body of evidence from neuroscientists showing “that growing up in a poor, stressful environment slows the development of the pre-frontal cortex, the part of the brain responsible for self-regulation.”

Reeves emphasizes, though, that “The most important influence on character development is not poverty – it is parenting. Good parenting – close, attentive, nurturing – can often compensate for material poverty.”

This is reassuring for those of us at Goodwill in central Indiana. We’ve now been implementing Nurse-Family Partnership for nearly three years, and well over 600 babies have been born to the moms who have enrolled. All of those moms want to do what’s best for their babies. But when our nurses first meet them, few know how to be good parents or to provide the kind of environment in the home that is conducive to the proper health and development of their children. That’s a lot of what our nurses emphasize during their 2-1/2 year relationship with these families. And that’s a big part of why NFP nationally has shown such remarkably strong results reducing the incidence of a lot of negative social indicators among children whose parents participated in NFP.

Of course, NFP is only part of a long term solution to a lot of major social problems. But thirty years of solid evidence illustrates why it should be scaled as much as possible. We intend to do our part.

The War on Poverty

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In January 1964, President Johnson declared war on poverty. During the days leading up to and immediately following the 50-year observation of that declaration, many have commented on the progress, lack of progress, or outright failure of that “war.”

In the January 7, 2014 Wall Street Journal, Robert Rector of the Heritage Foundation noted that in the U.S., living standards among the poor are much improved over those of 50 years ago. He also pointed out that the “collapse of marriage in low income communities has played a substantial role in the declining capacity for self support.”

In the January 5, 2014 New York Times, Ron Haskins of the Brookings Institution also emphasized that “Children in single-parent families are more likely to be poor, fail in school, have mental health issues and be idle as young adults, all of which reduce self-sufficiency.” Haskins concluded his piece by stating that “we don’t need another war on poverty as much as we need to improve the programs we already have and create the conditions for more personal responsibility regarding education, work, marriage, and child bearing.”

In the same issue of the New York Times, Scott Winship of the Manhattan Institute emphasized that “expanding opportunity for poor kids will require that we ‘incentivize’ the right behaviors, attitudes, and values, through economic carrots and sticks. Culture, not just economics, must be a front in the war on immobility.”

And in the January 9 New York Times, Nicholas Kristoff emphasized the importance of early interventions including parent coaching to get pregnant women to drink and smoke less and to encourage at-risk moms to talk to their children more. Among the successful programs he mentioned is Nurse-Family Partnership, which Goodwill is implementing in Indianapolis.

Kristoff also emphasized the importance of programs that encourage jobs for the most at-risk groups, and both he and Rector mentioned the earned income tax credit as a benefit to the working poor and for society. On a related note, Harvard’s Gregory Mankiw wrote in the January 5 New York Times that in efforts to help those struggling at the bottom of the economic ladder, the most effective solution would be to increase the skills of those low-wage workers.

While there is general agreement that more needs to be done to reduce poverty, there is certainly no consensus on what should be added, increased, modified, or eliminated. Bringing this closer to home, though, reading these and numerous other commentaries has reinforced my belief that the directions we have taken at Goodwill are on target. The older youth and adults who enroll in our Excel Centers represent “low hanging fruit” in efforts to raise education attainment levels. In addition, our emphasis on continuing to support our graduates until they earn post-secondary credentials and become established in the workforce is likely to play a major role not only in helping our graduates become economically self-sufficient, but also in ensuring a quick economic return to society for its investment in our schools.

Nurse-Family Partnership is part of a long-term solution to generational poverty that also has a strongly positive economic return to society. In addition to improving pregnancy outcomes, NFP helps parents learn how to provide competent care that will enhance the health and development of their children. NFP also helps parents improve their economic self-sufficiency by developing plans for their future, continuing their education, and finding work.

Everything we do at Goodwill ultimately plays a part in helping individuals and families increase their economic self-sufficiency. Cumulatively, these efforts can – at least in our small corner of the world – begin to reduce generational poverty and the various social problems that accompany it.

Big societal investments with big returns

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In 1944 Congress passed what became known as the G.I. Bill, which provided a number of benefits for returning World War II veterans. From the time the bill passed till 1956, 2.2 million veterans used the G. I. Bill’s education benefits to attend colleges or universities. Most of those veterans would not have been able to afford college otherwise. My dad was one of those, and he became the first person in his family to graduate from college.
The G. I. Bill was a massive public investment that made possible a huge increase in the number of Americans with post-secondary degrees. The country has benefited from that initial post-war investment ever since.

In 1956, thanks largely to the efforts of President Eisenhower, Congress passed legislation that enabled the creation of the Interstate Highway System. We continue to benefit from that massive public investment in physical infrastructure that greatly reduced travel time in the U.S. and made possible substantial increases in productivity.

In 1961, President Kennedy issued a challenge to NASA to land a man on the moon and return him safely to earth before the end of the decade. The massive public investment that followed President Kennedy’s challenge resulted in Neil Armstrong’s “one small step for a man, one giant leap for mankind” in July 1969. The new or improved technologies that resulted from the research and development needed to accomplish that goal led to numerous other developments that continue to provide benefits to our society.

Contrast those large public investments in higher education, physical infrastructure, and research and development focused on a specific goal with similarly huge amounts that have been spent since the 1960s on a wide array of social programs and supports to alleviate poverty. Despite the enormous expenditures, the official poverty rate is higher today than it was in the late 1960s.

Is there anything we can do that might enable us to start reducing poverty? While there are no quick fixes or panaceas, we have become increasingly convinced that, given the current situation, an important piece of a long term solution would be a sustained, substantial investment in high quality early childhood development opportunities for children in low income households.

According to Ready Nation, a business partnership for early childhood and economic success that is part of America’s Promise Alliance:

  • “Disadvantaged children can be 18 months behind their peers by the time they start kindergarten.
  • Children not ready for kindergarten are half as likely to read well by third grade.
  • Children not reading proficiently by third grade are four times more likely to drop out.”

In a September 14, 2013 Opinionator piece on NYTimes.com, Professor James Heckman, a Nobel Laureate economist at the University of Chicago who has studied this issue for decades, wrote, “Quality early childhood programs for disadvantaged children more than pay for themselves in better education, health, and economic outcomes.” There is an enormous amount of data supporting that statement.

We see the need for such opportunities every day in our work with low income moms in the Excel Centers and Nurse-Family Partnership. If we made a large enough commitment in the U.S. over an extended period of time to expand the availability of high quality early childhood development programs for kids in low income households, there is a strong probability we would substantially reduce generational poverty and a lot of the social problems associated with it. And, as with the investments in higher education, infrastructure, and research and development in the 1940s, ’50s, and ’60s, our country would benefit from those investments for decades.