Leading Early Childhood Expert Seeks Missing Breakthroughs
Image by Harald Groven via Flickr
If programs focusing on early childhood were given credit ratings, the Nurse Family Partnership (NFP) would be certified AAA. The program, built around nurses visiting low-income mothers at home from pregnancy until their children reach age 2, is among the most widely-touted, well-respected interventions in existence. It boasts a long track record of improving health outcomes and reducing problems among poorer moms and kids.
NFP has also been exceptionally diligent when it comes to scientifically evaluating its own effectiveness while staying open to improvement. Program founder Dr. David Olds and his research team have amassed more than three decades of research in New York, Tennessee and Colorado that has shown the program delivers a host of benefits to both mom and child.
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The improvements documented in controlled trials include huge reductions in the number of child injuries, lower child mortality rates, healthier eating habits during pregnancy, fewer closely spaced pregnancies, higher rates of economic self-sufficiency, improved language development, lower arrest rates as the kids grow-up – the list goes on.
One obvious reaction to all this from a policy perspective would be to heap praise on the life-changing potential of such interventions, urge other home-visiting programs toward similarly rigorous standards, and work on scaling up to reach as many low-income kids as possible. The Affordable Care Act will fund at total of $1.5 billion in state grants to expand just such early childhood home-visiting programs.
At the same time, it’s worth pointing out that despite the program’s well-documented successes, it isn’t a cure-all for the problems darkening the prospects of low-income, at-risk children.
Consider the newest study from Dr. Olds’ team, posted online on JAMA Pediatrics last week. The researchers, following up with NFP children at the ages of 6 and 9, found that the children from families who received nurse home visits did no better on measures of intellectual functioning and academic achievement than peers in a control group.
Overall, the study did find some improvements in behavior, language and attention in nurse-visited kids, while children visited by paraprofessionals showed little benefit overall.
Dr. Jack Shonkoff, a leading early childhood researcher who heads Harvard’s Center on the Developing Child, used the latest study on the Nurse Family Partnership as a jumping off point to argue that the early childhood field as a whole must foster more bold, innovative new ideas that can deliver bigger breakthroughs in the realms of academic achievement and health disparities. The latest findings paint a “sober picture” for leaders in search of programs that offer lower-income children a better shot at academic success, Shonkoff writes in an editorial accompanying the study in JAMA Pediatrics.
That doesn’t mean the lack of academic gains at ages 6 and 9 in the latest NFP study is an indictment of the program itself. As Shonkoff was careful to point out in an online conversation with Olds, “That’s not a problem with the Nurse Family Partnership because maybe it’s not designed to produce those improvements in school achievement.”
But academic success among low-income children is a particularly pressing issue at the moment, as mounting evidence shows that kids from wealthier families are pulling ahead of their lower-income peers both academically and linguistically at a very early age. As Stanford sociologist Sean Reardon has argued, rich kids’ academic edge translates into economic advantage, creating “a worrisome mutual reinforcement of trends that is making our society more socially and economically immobile.”
Over the past two decades, a wealth of new evidence has shown that the more maltreatment and family dysfunction a child encounters early in life, the more negative health effects (chronic disease, substance abuse problems, shorter lifespans) he or she will likely experience later in life. But this knowledge of how serious adversity compromises body and mind over time hasn’t led to big new breakthroughs in unwinding or even preventing these effects. Shonkoff, comparing advances achieved in diseases such as cancer or cystic fibrosis to those made in combatting early-childhood adversity, calls the difference an “indefensible contrast.”
The idea here is that while new scientific breakthroughs in neuroscience and epigenetics are changing our understanding of young brains, these insights have yet to be applied at the level of new interventions aimed at combatting conditions such as toxic stress as well as the academic achievement gap.
The lack of big new breakthroughs and laser-guided interventions prompts Shonkoff to call for a new spirit of innovation in search of meaningful improvements in the health and well-being of at-risk, low-income kids. His conclusion reads like an urgent new mission statement:
The marching orders are clear – we must embrace a spirit of constructive dissatisfaction with best practices, continually design and test new ideas, learn from things that do not work, and settle for nothing less than breakthrough impacts on important outcomes.
Peer-reviewed academic research often proceeds at a stately pace. Innovation tends to thrive in dynamic, quickly changing environments where information flows freely, new ideas are constantly tweaked and tested, and failure can be as illuminating as success. If Shonkoff is right, perhaps the early childhood field could use a little start-up energy of its own.
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