Parents, Educators Call for “More Time, More Hours” to Improve Early Special Education Outcomes

by Helen Shum | Jan 29, 2019 | Benefits of Preschool, Educators and Workforce, EI/ECSE, School Readiness

The transition to kindergarten is tough for a lot of kids, but for those with developmental delays and disabilities, it can be especially challenging.

Tristan Davis, who was diagnosed with autism spectrum disorder through Early Intervention (EI) services offered by the Clackamas Educational Service District, was primarily non-verbal when he began preschool at Sunset Primary’s Early Childhood Special Education (ECSE) classroom.

His mom Tracey described preschool-aged Tristan as a happy boy who struggled with regulation and anxiety. Looking back, Tracey says she was nervous as Tristan began preparing for the transition to kindergarten as his ECSE preschool class met for only two and half hours each day, a few days a week.

She compared that to the experience of her older son, Anthony, who attended a traditional preschool program for five hours a day, 3–4 days a week.

“[Tristan’s] teacher, Eric, was amazing with him, but I noticed there was not a lot of consistency with the aides who were there. They seemed to have more children than help, sometimes. There were children all across the board developmentally.”

Tracey, who later became a special education paraeducator, is frank about the reality of EI/ECSE services given current funding levels, including the impact that pay and other workforce issues have on the special education field.

“Eric does it because he loves it and he’s great at it. But he was definitely not paid what he should have been.”

When asked what might have made more of a difference for Tristan as he transitioned to kindergarten, Tracey said, “More time, more hours.”

EI/ECSE Saves Taxpayer Dollars, But Is Still Underfunded

Tracey’s recollection of the stretched resources in her son’s classroom echoes reports from Children’s Institute and others that shows most children in EI/ECSE programs are not being served at recommended levels.

According to state data, only 28 percent of children enrolled in EI programming receive the recommended level of service. On average, children enrolled in ECSE with high needs only receive 8.7 hours of preschool per week, rather than the recommended 15 hours per week. EI service levels have actually decreased by an average of 70 percent from 2004 to 2016.

The governor’s latest budget proposal devotes $45.6 million to EI/ECSE, about $30 million less than what the Early Childhood Coalition and the Alliance for Early Intervention says is needed to adequately serve children. In the 2014–15 school year, more than 21 percent of children exiting EI had caught up with their peers and did not require ECSE services, saving the state nearly $4 million annually.

Those who work in the field see the need firsthand. Carla Moody Starr, a speech language pathologist on the EI/ECSE evaluation team at the Northwest Regional Educational Service District, says EI/ECSE evaluation staff are often the first point of contact for families who may be overwhelmed, in shock, or in a state of grief if their child is significantly delayed.

“We take into consideration family and child trauma, socio-economic differences, language, and cultural differences— being sensitive to parents, but also educating and advocating for their child is an art. More service is needed for kids with developmental or communication delays before kindergarten. More service is needed for family coaching and education as well. Without adequate EI/ECSE service, these children with disabilities may not develop the skills they need to be successful once they enter elementary school.”

Despite insufficient funding for EI/ECSE services, Tracey has high praise for the West Linn-Wilsonville school district’s ability to provide a wide array of resources to support her son’s learning and development.

In advance of his kindergarten school year, Tracey met with the staff at Trillium Creek Primary School to map out an Individualized Education Plan (IEP).

“Before school started, his kindergarten teacher left Tristan this long [voicemail] message saying, ‘I know you can’t talk to me, but I want you to know I’m so excited to see you.’ It meant so much to him and so much to me.

“I was so lucky with West Linn. My rent is outrageous and I’m a single mom, but I really felt there was never a question of—does he really need this? His teacher noticed he liked to jump and they got him an indoor trampoline, just in case he needed to jump it out. They just want him to be successful. That’s the community they foster there.”

EI/ECSE Supports Broader Inclusion Efforts

West-Linn Wilsonville is considered a full-inclusion district, meaning both neurotypical children and children with special education needs are taught in the same classroom. While the Oregon Department of Education sets a state target of 73 percent of special education students being served in a general education classroom, West-Linn Wilsonville far exceeds that standard, reporting that 85.7 percent of its special education students are served in that setting.

Tristan is now a third grader at Trillium Creek Primary and Tracey reports that he’s doing well. “He loves school and has many friends that he loves. He still has hard days and struggles with anxiety. Overall, school has been a positive experience for him. His team is always communicating with me, and I feel they are invested in his success and happiness.”

Benefits For Typically Developing Peers

Ginny Scelza is a parent of two children who attended the Multnomah Early Childhood Program (MECP), operated by the David Douglas School District. The program runs preschool classes at 11 locations across six school districts and offers an inclusive environment where children with special education needs learn alongside typically developing children.

Ginny, whose son and daughter are typically developing admits that her interest in the program was due to the affordable cost and convenient location, initially just a few minutes from her home. MECP tuition costs $32 a month for a twice-a-week program, much less than private preschool programs in the area. Free and reduced tuition is available for qualifying families.

“The fact that the preschool was in the same building that [my son] would be in for kindergarten was a big draw—that made so much sense.”

Ginny also valued the program’s emphasis on social emotional development.

“I saw [preschool] as a transition from the home environment to a classroom community. How do you share? How do you develop friendships? How do you work as part of a team? Having my kids in the program helped strengthen their empathy for other people and that was more important to me than academics.”

Ginny credits the program for creating a smooth transition to kindergarten for both her children. She also notes that the benefits of such programs have a positive effect that goes beyond just those children who have disabilities and delays.

“At age 3 or 4, [my daughter] was learning that kids who were in wheelchairs or needed extra help—they were also a part of her school community. It was normal. How does that not become part of who you are?”

Learn More and Support Increased Funding for EI/ECSE Services

EI/ECSE 2019 Fact Sheet

Oregon Must Invest More in Young Children With Disabilities: A Conversation With FACT Oregon’s Executive Director

Join us and a growing coalition of Early Childhood advocates in requesting an addition $75 million investment to increase service levels for children with disabilities and delays.

A brief explanation of ACEs – Adverse Childhood Experiences

by Helen Shum | Jan 29, 2019 | National Research, Health and Development, Successful Students

Reporting contributed by Niki Reading

The idea that early childhood experiences help shape the trajectory of a person’s life—in both positive and negative ways—makes intuitive sense to most. But thanks to pioneering research and advocacy in the field of childhood trauma, our understanding of the connection between adverse childhood experiences (ACEs) and lifelong health outcomes has grown exponentially in the last two decades.

A Foundational Study: ACEs

The Adverse Childhood Experiences study, or ACE Study, was conducted by researchers at Kaiser Permanente and the Centers for Disease Control and Prevention (CDC) in the late 1990s. They sought to examine the impact of specific negative childhood experiences and conditions on long-term health. ACEs fall into three categories: abuse, neglect, and family/household challenges. The categories capture experiences like mental illness experienced by family members, physical and substance abuse, divorce, and physical and emotional neglect.

In the study of more than 17,000 adults, researchers found that those with a high number of ACEs were at much greater risk for negative health outcomes like obesity, depression, sexually transmitted diseases, heart disease, broken bones, stroke, and even cancer. Those risks remained even when lifestyle choices like smoking and drinking were factored in. A high number of ACEs also affected life potential such as lowering academic achievement and increasing the amount of sick time taken off from work.

The study also found that the impact of ACEs was cumulative: the more ACEs a person had, the more likely that person was to suffer from negative health outcomes.

A Growing Movement

A movement to recognize, treat, and prevent ACEs has now bloomed, led by pioneers in the field like Dr. Nadine Burke Harris, a pediatrician and founder of the Center for Youth Wellness in San Francisco. In her book and related TED Talk, Burke Harris chronicles efforts to bring greater awareness of and treatment for ACEs into clinical practice.

A key strategy to fighting the effects of ACEs, according to Burke Harris and other experts, is to take a multidisciplinary approach—integrating physical and mental health, research, policy, education, and family supports.

What We Can Do to Fight ACEs

The effects of ACEs can be mitigated and treated, and recognizing this is an important first step in improving outcomes for children and families. In children who experience a high number of ACEs, having close relationships with stable adults—like teachers or grandparents—can help build resilience and make a big difference in lifelong health and wellness.

In Oregon, recognition and awareness of ACEs is increasingly widespread in education and public health circles, but funding and support for effective intervention and preventive programs remains challenging.

That’s why Children’s Institute and others continue to advocate for evidence-based programs like voluntary home visiting for pregnant mothers, parent training classes, high-quality child care, mental illness, and substance abuse treatment. These programs can change the trajectory of long-term health outcomes for families and children.

Stay tuned for our upcoming story on ACEs which features the Gladstone School District’s approach to recognizing the impact of ACEs on students and to providing safe, structured learning environments for their students.

Resources

“Take the ACE Quiz — And Learn What It Does And Doesn’t Mean,” NPR

More than ABCs and 123s: Health and Kindergarten Readiness

by Helen Shum | Jan 8, 2019 | Health and Kindergarten Readiness, Health and Development, School Readiness

Preparing a child for kindergarten—and school readiness in general—is one of the most important goals of early childhood care and education.

While most educators and childhood development experts would agree that physical and behavioral health plays a major role in a child’s readiness for kindergarten, Oregon and other states have struggled to determine how to measure and track progress in these areas.

A workgroup convened by Children’s Institute and Oregon Health Authority (OHA), with support from Oregon Pediatric Improvement Partnership (OPIP) has now issued a set of recommendations which could bring the health sector closer to that goal.

The Health Aspects of Kindergarten Readiness (HAKR) Technical Workgroup prioritized four measures across multiple areas of children’s health and development. The goal is to drive system-level changes and improvements to kindergarten readiness, especially for children served by the Oregon Health Plan (Medicaid).

The complete package of recommended metrics was endorsed by Oregon’s Metrics and Scoring Committee last month, a milestone moment in a year-long process incorporating input and expertise from a diverse set of stakeholders.

“This has exciting implications for more deeply connecting our health and education systems, in Oregon and nationally,” said Dr. Dana Hargunani, chief medical officer at OHA.

Proposal Builds on Earlier Work, Includes Incentive Strategy

Oregon introduced a statewide kindergarten assessment in 2013, requiring educators to collect information about students’ early literacy and math skills, as well as interpersonal and self-regulation skills. Data from those assessments highlighted the wide variability in readiness, often driven by factors such as family income and access to high-quality early care and education.

Researchers, data analysts, and advocates have since called for a closer look at the health aspects of kindergarten readiness, including greater attention to social-emotional factors. The HAKR workgroup met over nine months in 2018 to research and develop recommended metrics for adoption by Coordinated Care Organizations (CCOs), networks of health care providers serving people on Medicaid.

The measurement strategy proposed by the HAKR workgroup includes incentivizing the metrics, meaning that CCOs that demonstrate progress on them could receive bonus payments.

Closer Look at Social-Emotional Factors

The four priority measures included in the final proposal cover familiar areas of children’s health, including dental visits, well-child visits, and follow-ups to developmental screenings. It also includes a new ask—the development of a measure that can help CCOs address social-emotional health.

“The workgroup heard from families, pediatricians, and early learning partners time and time again about challenges related to children’s social-emotional and behavioral health, so it was clear that our recommendations would need to have a strong focus on addressing social-emotional health if we wanted to impact the outcome of kindergarten readiness,” said Elena Rivera, senior health policy and program advisor at Children’s Institute.

The measures pull from multiple data sources and track whether children receive essential preventive care as well as follow-up services to meet additional needs. According to an analysis from OPIP, only 40 percent of children identified at risk of developmental delay received follow-up care, with large variations across providers.

Understanding how many children were flagged for a developmental follow-up and whether they actually received a follow-up can offer a more complete understanding of a child’s health history and inform larger efforts to improve health practice and policy, including connections to early learning and family support programs.

“We really felt an urgency to recommend metrics that were feasible in the near-term, while also driving toward a more comprehensive set of measures that will cross multiple domains of kindergarten readiness.

We recognize that this is truly a multi-faceted, complex, multi-generational interaction that will take time to implement,” said Rivera.

Workgroup members believe that implementation of the metrics could begin in 2020 and provide a foundation for further metrics over time.

Hargunani and Rivera presenting to the Oregon Metrics and Scoring Committee in November.

View Full Presentation to the Metrics and Scoring Committee (PDF)

Oregon’s Infant-Toddler Care Dilemma: Providing Quality Care at an Affordable Cost

by Helen Shum | Jan 4, 2019 | Research and Evaluation, Child Care, Oregon Research

Imagine you’re an Oregonian earning a median-level household income of $78,683 a year. Let’s also imagine you’ve just become a new parent and are researching infant-toddler care options in advance of your planned return to work.

Do you choose a child care option that costs 11 percent of your total household income? Twenty percent? Thirty-nine percent?

What if those cost differences also reflected the relative quality of those care options? How much are you willing to pay for high-quality care?

Cost vs. Quality Amid a Scarcity of Choice

For many Oregonians, this hypothetical calculus is all too real. A new analysis by the Center for American Progress (CAP) highlights the uncomfortable reality parents face when seeking infant-toddler child care. CAP analyzed data from all 50 states to come up with average costs for care, distinguishing between child care options that meet minimal standards for care and those that offer “high-quality” care.

High-quality care includes settings where caregivers have received more advanced training in child development and where staff ratios surpass minimum legal requirements.

For your hypothetical family, home-based child care meeting the most minimal of licensing standards will cost approximately $8,655 per year, or 11 percent of an Oregonian’s median household income. Center-based child care serving infants will cost you $15,736 per year, or 20 percent of the median household income. And high-quality, center-based child care will cost you a jaw-dropping, $30,686 per year, or about 39 percent of the median household income.

Even for those earning more than Oregon’s median income, an $8,655 per year child care bill is no bargain. But for those who can afford to pay it, securing a child care spot for an infant or toddler, comes with another layer of challenge: lack of availability.

CAP analysis shows that In Multnomah County, there are five children for every available infant-toddler child care slot. In Harney county, there are 31 children for every available slot. In Lake County, there are 62 children for every available slot.

Infant-Toddler Care Offers Little Financial Incentive to Providers

Much of the scarcity is due to the fact that there just aren’t a lot of financial incentives to care for infants and toddlers. A certified, center-based child care provider must staff infant rooms at a 1:4 staff to child ratio; 24–35-month-olds at a 1:5 ratio; and 36-month to kindergarten-age children at a 1:10 ratio. But centers know that charging the parents of infants more than twice as much as the parents of a 3-year-old is not practical, so they effectively subsidize the cost of younger children with the rates charged to older kids.

Registered home-based providers in Oregon generally care for fewer children across a broader age range. Their licensing requirements call for a 1:10 staff to child ratio. However, only two out of 10 children can be under 24 months old, which also limits availability to parents seeking care for children under 2.

Another quirk in the child care picture is that efforts to offer public preschool opportunities to more children in Oregon could exacerbate the problem of cost and scarcity in infant-toddler child care. As child care providers often subsidize the higher cost of infant-toddler care with the relative lower cost of care for 3- and 4-year-olds, broader access to public preschool in Oregon could actually put more pressure on the operational cost of providing child care as preschool-aged kids would likely leave for (free) public options.

DIY Child Care

CAP has created an interactive tool which allows users to modify various elements of child care to better understand the cost of providing quality care in Oregon and other states. Click the image to try it yourself.

Source: Center for American Progress.

Low-Income Families Struggle to Cover Affordability Gap

Given that 19 percent of Oregon’s children ages 0–5 live at or below the poverty line, how do parents earning low-income wages work if they need child care?

Oregon offers child care subsidies funded primarily by a federal block grant to low-income working families. However, the CAP analysis also demonstrates that in Oregon, there is an $83 per month difference between the cost of center-based care for an infant and what the state offers in child care subsidy assistance.

Governor Kate Brown’s latest budget proposal calls for a $10 million investment in Baby Promise, a program that seeks to increase access to child care in a variety of settings. Recognizing the need for a significant public investment in child care is a step toward creating an early care and support system for children and families that works.

Learn more about CI’s legislative recommendations for early childhood, including child care.

Learn more about the early child care landscape in Oregon.

Get Involved: Share your story with us about the child care struggle and tell lawmakers you support family-friendly policies and funding for child care.

Oregon’s Child Care Crisis

by Helen Shum | Dec 5, 2018 | National Research, Child Care

Oregon is in a child care crisis. As many working parents know, finding reliable and affordable child care from a trusted provider is not easy. According to a study by the Center for American Progress, Oregon is a child care desert, defined as a place where there are more than three children per licensed, available child care slot. Infant-toddler care in Oregon is even scarcer, with 6.8 children per slot. These findings, in addition to Oregon’s ranking as the third-least affordable state for licensed, center-based care adds to mounting evidence that Oregon’s child care system is in dire straits. Our state’s inability to build a supply of quality child care options for working families threatens the safe and healthy development of our most vulnerable young children.

Every day across Oregon, thousands of young children are cared for by people other than their parents. Parents need this child care to be safe and reliable. At the same time, young children need responsive and nurturing relationships with caregivers to stimulate their growing brains. Babies are born learners and what happens in early childhood largely shapes their later life experiences.

When it Comes to Child Care, Quality Matters

Quality child care is provided by well-trained caregivers who understand and can support a young child’s brain development. This level of care supports early education, teaching young children foundational reading, writing, and math skills that stimulate their rapidly growing brains and strengthens their natural love of learning. Well-trained and skilled child care providers may also be the first adult in a young child’s life to recognize an emerging developmental delay or disability.

Providers know, and brain research conducted over decades tells us, that the early years from birth to 5 are a time of profound brain development, when the opportunity to positively influence children’s social-emotional and decision-making skills is greatest. Children who receive quality care in their early years are more likely to be ready for kindergarten, read proficiently at third grade, graduate from high school, and attend college. As adults, they are healthier, earn higher incomes, and are less likely to have interactions with the criminal justice system.

Quality Care Comes at a Price

Licensed and regulated care for babies and toddlers is extremely expensive to provide. Child care is labor-intensive work and licensed settings are required to follow safety and staffing ratios. This makes it difficult to economize on the largest share of their overhead costs, which are devoted to payroll. Oregon recently earned the undesirable distinction of being the third-least affordable state in the country for center-based care. According to the Economic Policy Institute, one year of infant and toddler day care in Oregon is more expensive than public college tuition.

Child care subsidy programs like Employment Related Day Care (ERDC) have not been able to sufficiently address child care costs for low-income Oregonians, who also pay some of the highest co-pays in the nation for care.

This means that many parents, whether they are paying the full cost of child care or are eligible for subsidies, find quality child care extremely difficult—if not impossible—to afford.

Despite High Costs, Providers are Still Paid Far Too Little

Adding to the economic complexity of child care is the fact that we just don’t pay early childhood workers enough for the important work we expect them to do. In Oregon, wages in 2017 for child care workers averaged $11.47 per hour—on par with the earnings of office receptionists, janitors, and general laborers. Not surprisingly, the early childhood profession suffers from high turnover.

Given the high costs of child care that parents already pay, it is not feasible to expect them to pay even more to increase wages for child care providers. In countries with economies similar to the United States, child care costs are heavily subsidized by governments or employers. Solving the problem in a comprehensive or sustainable way will be difficult without a major commitment from Congress, along with increased state and private investment. If we continue to leave families to solve the issue of child care on their own, our entire state will suffer.

What Happens When There is No Care?

After analyzing data from 22 states, the Center for American Progress found that more than half of Americans are now living in “child care deserts”—neighborhoods or communities where there are more than three children for every licensed child care slot.

In 2016, the Center for American Progress borrowed terminology from the frequently studied issue of food deserts to create a working definition of child care deserts.

Not surprisingly, finding high-quality child care is especially difficult for families who:

earn low-income wages
need infant or toddler care
live in rural areas
have children with developmental delays or disabilities
need “off-hours” or weekend care due to non-traditional work schedules

Immigrant and refugee communities, and communities of color are also disproportionately impacted by the lack of access to affordable quality care.

In a follow-up analysis of infant-toddler care across nine states and the District of Columbia, CAP compiled child care supply data from every county in Oregon. Notably, a greater percentage of families living in more remote areas suffered from an under supply of infant-toddler compared to those in urban centers.

A Closer Look at the Child Care Crisis in Oregon

Click tables to enlarge.

An Opportunity for Oregon

Very simply, the child care crisis affects all of us, not just those with young children. As a nation, we lose an estimated $8.3 billion a year in wages from parents who miss work due to a lack of child care. If Oregon continues to be a child care desert, businesses across the state will continue to lose workers.

Our failure to invest in child care systems has longer-term effects, too. Nobel Prize-winning economist James Heckman found that early childhood programs don’t just positively impact educational, health, and economic outcomes for children, but increase the work productivity of their parents, reduce crime, and improve property values, among other community benefits. Overall, Heckman estimates that investments in early childhood programs generate a 7–13 percent economic return rate.

“High-quality, reliable child care pays for the entire program before the child enters kindergarten. The economic gains of freeing mothers to enter the workforce, build skills and earn income pays for the cost of the program in the short-term while long-term benefits for children accrue into adulthood.”

— James Heckman, Nobel Laureate Economist

Strengthening the Child Care System

Children’s Institute believes Oregon can make progress on the child care crisis by strengthening and stabilizing existing programs that work, focusing on the areas of highest need, and increasing the numbers of qualified workers. Oregon’s child care landscape is incredibly complex, but one thing is clear—access to high-quality child care is a critical part of the support young children need to stay safe, be healthy, and grow into successful adults. Learn more about our specific recommendations to help Oregon fund a child care system that works for all of us.