The U.S. Department of Health and Human Services (HHS) is home to several federal offices that set key policies for children and families. As President Biden’s nominee for HHS Secretary, Xavier Becerra, appears before the Senate Health, Education, Labor, and Pensions Committee on February 23, we hope he will keep the needs of children and families at the forefront of the agency’s ongoing work and its efforts to rebuild and recover amidst the COVID-19 pandemic.

Families, providers, and community and state systems leaders have spent this last year learning and innovating as the pandemic forced swift action and adaptation related to key issues of access, inclusion, and equity in early care and learning. Here are the lessons we hope new HHS leadership will heed from early childhood stakeholders as they take the agency’s helm:

1. For the Centers for Medicare and Medicaid Services: Enable and scale innovations related to home-visiting and early intervention services.

HHS’s Centers for Medicare and Medicaid Services (CMS) should explore new ways to leverage federal funding streams — like Medicaid — to expand access to evidence-based home visiting programs and doula services. By making access to MIECHV supported doula services a priority, HHS has the opportunity to address disparities in maternal health outcomes, improve engagement in home visiting, and strengthen the continuum of health-supportive interventions starting prenatally. Here in Illinois, Start Early has supported legislation to expand the Medicaid program to cover evidence-based home visiting and doula services, helping to ensure families have access to these high-quality supports that keep them and their children healthy. Expanding Medicaid to cover these important interventions will allow for state-wide expansion of home visiting and doula capacity and coordination of services and supports for children and families from before birth through early childhood. Under its new leadership, we encourage CMS to continue working with Illinois and other states who are working to remove barriers that prevent low-income women from accessing home visiting and doula services, provide guidance and support to states like Illinois that are looking to expand Medicaid coverage of these services, and replicate those efforts at the federal level. This includes timely approvals of flexibilities such as the 1115 waiver which extends postpartum coverage for women on Medicaid for up to 12 months.

Since the start of the COVID-19 pandemic, CMS has issued waivers and flexibilities that support the use of telehealth among Medicare beneficiaries. This has benefitted many underserved and priority populations, including children and families in rural areas and those receiving Early Intervention services. HHS has the opportunity to ensure that telehealth remains an option for delivery of all Early Intervention services beyond the current public health emergency. We strongly encourage CMS to use this unprecedented moment as an opportunity to learn from states and local communities where continuation of Medicaid-funded telehealth might benefit kids and families.

2. For the Administration for Children and Families: Promote cross-program collaboration and funding stream innovations that strengthen the U.S.’s child care infrastructure.

HHS’s Administration for Children and Families is home to the federal Office of Child Care and Office of Head Start, two entities that are positioned to continue making great strides in strengthening our nation’s child care infrastructure.

A key lesson from the pandemic is that simply stabilizing child care is not sufficient. We must also focus on improving, strengthening and redesigning our child care system to make it more equitable and accessible and supportive of the unique needs of home-based child care providers and family choice. We urge the Office of Child Care to explore how staffed family child care networks and shared services alliances can fulfill these goals, by increasing providers’ access to technical assistance and families’ access to embedded health, mental health and family engagement services. An investment in research is also essential, to determine the effectiveness of different types of networks for increasing supply, improving quality, enhancing child outcomes and to identify effective programs that support family, friend, and neighbor caregivers to maintain safe, stimulating home environments and earn livable wages.

We also encourage the Administration for Children and Families to explore how existing federal funding streams — including the Preschool Development B-5 funds, Head Start funds, and Child Care Development Block Grant — can be leveraged to ensure providers and networks of providers can partner effectively to best serve the children and families in their communities. While the pandemic has revealed the fragility of our under-resourced child care sector, it has also illuminated the importance of providers being able to braid or layer different funding sources to provide comprehensive services to families. Strong programs braid funding from various sources in order to ensure that the families they serve have access to a comprehensive, high-quality early childhood education experience. The Administration for Children and Families should work closely with state administrators to ensure providers at the local level can partner effectively by encouraging layered funding. This would go a long way toward improving the quality of experience for families with young children by increasing the opportunities for pre-k, head start, early head start and child care partnerships. Family child care networks and shared services alliances can be one of the vehicles for building those partnerships, as can the Early Head Start Child Care Partnerships model, which helps raise the bar on what quality infant and toddler care can and should be.

3. For the Health Resources and Services Administration: Learn from families and home visitors about their COVID-related funding and flexibility needs.

HHS’s Health Resources and Services Administration is home to the Maternal, Infant, and Early Childhood Home-Visiting (MIECHV) Program. Nearly one year into the COVID-19 pandemic, home-visitors and their clients have learned a lot about the limitations of home-visiting funding sources and the additional flexibilities needed to deliver high-quality services during this time. Pending the inclusion of additional MIECHV funding in future COVID relief packages, HHS should continue to support the home visiting field and MIECHV program by offering the utmost flexibility to state grantees. Without losing sight of the goal to return to in-person home visiting when the pandemic subsides, HHS should capitalize on the opportunity to evaluate what the field has learned from the shift to virtual service delivery, from ways to creatively engage families to new sets of workforce supports. As the field works to understand the blend of service delivery strategies that will best serve families in the long-term, research should ensure key equity issues are investigated including access to and comfort with technology, and disparities in health risks and comfort with in-home services moving forward.

Racial inequities embedded in our current health care system make prenatal and maternal health care less accessible and less responsive to Black mothers regardless of their socio-economic status.

In a recent Block Club Chicago article exploring how doulas can help even the playing field in maternal health for women of color, Denise Cain — a mother in Start Early’s (formerly known as the Ounce) Healthy Parents & Babies program — spoke about how she benefitted from having a doula guide her through her second pregnancy and postpartum care.

“Support from a doula — who is trained to advise and offer emotional and physical support to mothers before and after birth — can make a big difference in the unequal health outcomes women of color face,” Diana McClarien, vice president of Start Early’s Early Head Start & Head Start Network shared in the piece.

In the piece, Start Early doula Patricia Ceja-Muhsen explains how doulas help inform women about all the different choices they can make, empowering them to have more control over their pregnancy and birthing process. She also adds that doulas can make sure doctors listen, address all of an expecting mom’s concerns and fully inform women about their options and the care they are receiving.

Start Early’s direct-service programs provide critical supports to young parents for building strong relationships with their baby and creating a safe and stimulating home environment. It is programs like these that can ensure all new moms and babies, including Black moms and babies, receive the quality physical and emotional care they need and deserve.

Read the full article at Block Club Chicago.

The second Starting Early Begins With… speaker series discussion painted a grim and preventable reality that exists for new Black mothers and their babies. The United States continues to report the highest rates of maternal mortality for birth parents when compared to 10 similarly wealthy countries.

Dr. Joia Adele Crear-Perry, MD, FACOG, a nationally recognized thought leader around racism as a root cause of health inequities, kicked off the event by sharing the background of the maternal and infant health crisis and its disproportionate effect on families of color.

“The United States was not built on a human rights framework… You should have the right to education, to housing, to food. Not to be a billionaire. But, for just a basic income – having a living wage,” Dr. Joia framed. “We don’t invest in things like paid leave, child care; the things we know that we desperately need right now, like free health insurance.”

Both systematic racial and gender racism generate chronic stressors for Black women that contribute to higher rates of maternal death. In addition, racial inequities are embedded in our current health care system, making care less accessible and less responsive to Black mothers and children as it should be, regardless of socio-economic status.

Later in the discussion, Start Early President Diana Rauner added how, “the COVID-19 pandemic has exasperated the stressors that exist for Black women and health care providers in under-resourced communities.”

Fortunately, Dr. Joia and Diana shared many solutions for overcoming this avoidable and tragic reality – services, such as doulas and home visiting, and programs that offer universal newborn supports, which are proven to ultimately reach more under-resourced families. In addition, Dr. Joia noted that, “… we [need to] stop racializing things like Medicaid. We all need health care, not just Black people.”

Start Early’s direct-service programs provide critical supports to young parents for building strong relationships with their baby and creating a safe and stimulating home environment. It is programs like these that can ensure all new moms and babies, including Black moms and babies, receive the quality physical and emotional care they need and deserve.

In the last three decades, scientific research has demonstrated how deeply adversity in childhood becomes embedded into biology, behavior, and risk, and how these can be passed on to future generations. This body of science — Neuroscience, Epigenetics, Adverse Childhood Experiences (ACE), and Resilience research, or NEAR — is one of the largest public health discoveries of our time.

Home visitors knowledgeable about the NEAR sciences and research are interested in bringing this information to families but worry about causing harm. The NEAR@Home toolkit addresses these concerns and provides strategies for engaging parents in discussing NEAR sciences and using the ACEs questionnaire in a safe, respectful and effective way for both home visitor and family.

Home visitors are uniquely positioned to help families mitigate the effects of past, present, and future adversity through supporting protective, responsive parenting and safe attachment relationships. The NEAR@Home process gives parents choice, offering information, assuring safety, being respectful, allowing time and space for reflection, and by always closing with hope and resilience.

The NEAR@Home toolkit was created, tested, and revised by home visitors, mental health providers, and other experts in the field of NEAR and home visiting in Alaska, Idaho, Oregon, and Washington. The NEAR@Home toolkit is designed as a training manual with guided processes to help you learn and practice language and strategies to safely and effectively talk about the trauma of ACEs. We emphasize safety and reflective support for the home visitor as a critical element in this process.

The NEAR @Home toolkit was developed as a self-study process and is being shared without cost because we believe that all home visitors deserve to have access to this guidance. Many home visitors discovered that while self-study of the NEAR@Home toolkit was useful, they preferred a supported learning experience and have informed the development of NEAR@Home Facilitated Learning. Learning how to be safe, respectful, and effective while talking about the NEAR sciences with parents is a complex process that requires and deserves time and support.

The NEAR@Home Facilitated Learning process is very different from most training programs. Thinking about, talking about childhood trauma stirs feelings in all of us, whether ACEs are part of our life story or not. Our learning process is guided by Facilitators who are relationship focused, trauma sensitive, and fluent in infant mental health concepts and processes. The Facilitators model self-regulation, co-regulation, spacious listening, and reflective processes to walk with home visitors and supervisors through learning how to do a NEAR home visit. Implementation Science guides the structure of the learning process from a mutual exploration of fit and feasibility to follow up reflective consultation to support home visitors as they integrate these new skills.

From a child’s first soccer team to recreational softball leagues to rooting for your favorite team, sports hold an iconic place in our lives. And they play an equally important role in helping children’s development in the early years.

It’s easy to see how sports can help with children’s gross and fine motor skills development. Less obvious, but just as critical, is the role that sports and play-based learning activities have in social-emotional development and speech and language development.

Be a Good Sport

As babies grow into toddlers, they gradually start to regulate their emotions. Playing sports with others gives them the opportunity to experience feelings such as joy, frustration, pride and patience in a non-threatening situation. To help them develop social-emotional skills, try:

1. Naming emotions as they play. “Suzy, great job catching that ball – you must be so proud of yourself!”
2. Help your child regulate his emotions when he is upset by talking about their feelings. “Tyler, I can see that you’re upset about missing the goal – let’s talk about why you’re upset.”

As children continue to grow and begin to play on teams, they develop teamwork skills that will be invaluable on and off the field. Team sports also provide a great opportunity to encourage empathy while learning new skills and celebrating successes. Try these tips to make sure your child will win the sportsmanship award:

1. Model the behavior you want to see – cheer as loudly for all the children on the team as you do for your child. Encourage your child to be a “cheerleader” for their team.
2. Reinforce the importance of taking turns at shooting the basket or practicing on the balance beam.

Hat Tricks, Fartleks and Setter

Every sport comes with a vocabulary of its own. Which means more and more opportunities to expose your children to new and varied language! From silly to repetitious to obscure, how do you make the most of this treasure trove?

1. As your child plays, name actions and items that are involved in their sport. Kick, run, pass, racquet, ball, tee, somersault…..the list is endless.
2. Have your child put the game into their own words – ask them to tell you how the game works.

We can’t guarantee that your child will become the next Serena Williams, David Beckham, Simone Biles or Derek Jeter, but we do know that time spent playing sports in the early years will pay off in many other ways!

Recommended for Infants

Materials Needed:

• Several small, interesting toys (rattles, teethers, colorful blocks, shakers)
• Soft blanket

Developmental Goals:

• Promote gross and fine motor development that encourages them to move, reach and stretch.
• Purposeful movement of own bodies.

In the Future:

• Infants need plenty of opportunities to increase their strength and motor development to eventually be able to crawl and then walk.
• Reaching for objects is goal directed behavior; as infants become successful at obtaining objects, it will encourage them to continue to act with purpose.

Activity:

1. This activity is appropriate only for infants who are able to support their body weight enough for tummy-time activities.
2. Spread the blanket on the floor in an area where he will be protected from other activity in the room.
3. Place him on his tummy on the blanket. Show him a toy and describe it to him. Look, (Child’s Name), I have a blue and white rattle.
4. Put the toy on the blanket just at arm’s reach from your child so that he has to stretch his arm out to grab it.
5. Give him time to shake, mouth and touch the toy.
6. When he shows you he is ready for a new experience, place another toy just at arm’s reach for him to grab.
7. Encourage him to use the opposite arm by placing the toy within closer reach of the arm he did not previously use.
8. Repeat the interaction for as long as your child is interested. Pay particular attention to his activity level. It is hard work for your child to lie on his tummy and reach for toys. You may notice that he is beginning to have a hard time supporting his head and neck, he is no longer reaching for objects, or he has an unhappy look on his face. When your child shows you that he is finished or that his body is getting tired, help him change position so he can rest his muscles.

As you are playing with your baby, consider how he moves his arms and the rest of his body to reach the toy, in what ways does he grasp and manipulate the toy, and how long is he able to attend to his experience.

Don’t underestimate the incredible thinking skills that young children have. Through this activity, your toddler will compare objects and ask questions to help understand their differences in quantity.

Recommended for Preschoolers

Materials Needed:

• Not a Box by Antoinette Portis
• Cardboard boxes, cardboard tubes, other recycled materials
• Bedsheets or blankets

Developmental Goals:

• Using language to share ideas.
• Using imagination in play.

In the Future:

• Being able to express ideas through language gives young children the opportunity to strengthen their vocabulary and develop their conversational skills.
• Imaginative thinking provides children with opportunities to develop flexible thinking, strengthening their ability to problem solve, which is important when attempting later math and reading problems.

Activity:

1. Introduce the book to your child.  As with any new book, take time to allow your child to explore the book’s pictures on his own before sitting down to read it out loud.
2. As you read the book together, invite him to talk about the different things that the rabbit makes with his cardboard box.
3. After reading the story, show your child the recycled materials you have collected.  Working together, decide what you will build.
4. Allow your child to take the lead, but don’t be afraid to join in and share ideas!
5. After the play space is built, ask him to describe what he built.

For older preschoolers: have them use writing tools to record a blue print of what they want to build prior to building. This provides them with the opportunity to analyze, plan and follow through on their ideas.

While much attention and effort has been directed at addressing the widening opportunity gap in the United States, children growing up in communities that are under-resourced from decades of historical and institutional racism face an equally pervasive and related health gap. By and large, they have markedly worse health than their peers from more advantaged communities. This gap appears early in life and builds over time. Science suggests that adverse early life experiences and environments — prenatally and in a child’s first years — can contribute to the health gap, leaving biological imprints on the child’s developing body and brain that can have strong and lasting effects.

Fortunately, new and current research points us to a critical strategy in narrowing the health gap and giving all children a chance at good health over their lifetime: We can ensure that every child has access to high-quality early childhood programs, including early education and home visiting.