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EXECUTIVE OFFICE OF THE PRESIDENT
COUNCIL OF ECONOMIC ADVISERS
Elena Kagan
WASHINGTON, D.C. 20500
THE CHAIRMAN
April 3, 1997
MEMORANDUM FOR:
FRANK RAINES, DIRECTOR
OFFICE OF MANAGEMENT & BUDGET
DONNA SHALALA, SECRETARY
HEALTH & HUMAN SERVICES
GENE SPERLING, DIRECTOR
NATIONAL ECONOMIC COUNCIL
BRUCE REED, DIRECTOR
DOMESTIC POLICY COUNCIL
MAGGIE WILLIAMS, CHIEF OF STAFF
OFFICE OF THE FIRST LADY
FROM:
JANET YELLEN Jif
Attached is a draft of a CEA whitepaper on the benefits of programs targeted to very young
children. We are hoping to release it just prior to the White House Conference on Early Childhood
Development.
If you have any comments, please get them to me by COB on Monday, April 7.
Thank you for your help.
cc: Ten Klein
Pauline Alarnathy
Nicole Rabner
Attachment
+ return
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The First Three Years: Investments that Pay
Introduction
Experiences during early childhood can make a crucial difference for the rest of the
child's life. Health problems ranging from frequent colds to cerebral palsy can be prevented by
appropriate nutrition and care for pregnant and nursing mothers, and for their infants. Often very
small investments -- like immunization for polio or home-based smoking cessation programs --
yield large benefits.
The time from conception through early childhood does not just present a series of
avoidable health problems, but also opportunities to nurture a child's emotional and intellectual
development. Nurturing and stimulating a child in the first years of its life can promote
emotional health and prepare the young for the challenges posed by school and later life.
Ultimately, parents bear the responsibility for raising their children. The government
cannot require parents to spend time holding, feeding, and talking to their small children.
Through legislation like the Family and Medical Leave Act (FMLA), however, the government
helps provide the opportunity for parents to take time off from work to spend with their newborn
children. Similarly although the government does not forbid pregnant mothers from smoking, it
can take steps to reduce this behavior by providing information on the dangers smoking poses to
the development of their children. More broadly, government supported programs like the
Human Capital Initiative. (See Box 1.) leverage government resources into knowledge that can
be used by parents, educators, and doctors to help children flourish.
For many families, however, these policies are not enough. For example, without
government assistance, pregnant mothers in poverty and children growing up in poor families
lack the resources needed for appropriate nutrition and medical care. Programs like the Special
Supplemental Nutrition Program for Women, Infants, and Children (WIC) provide foods,
nutrition education, and access to health services for low-income women during and after
pregnancy and to their children through five years of age. The Vaccines for Children (VFC)
program is helping to ensure that 90 percent of all two-year-olds are fully vaccinated by the year
2000. These programs make an enormous difference in the future of children and may save
money, in the long-run, by permanently improving the health of children.
Why are the First Three Years So Important?
In recent years, researchers have made large strides towards understanding the process of
early development. Scientists investigating brain development have discovered biological
mechanisms that help to explain what psychologists and educators have long known: the first
three years are pivotal. Recent evidence suggests that the flurry of brain-building activity that
begins in the womb and continues at a rapid clip through a child's early years is affected more by
experience than was previously thought. This experience in turn is dependent not only on the
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Box 1. The Human Capital Initiative
An important building block of the Administration's efforts to support the well-being of
young children is the Human Capital Initiative, an ambitious research program examining the
effects of families, schools, communities, and the workplace on the formation of human
capital. The Initiative was launched by leading professional associations in the behavioral
sciences in the early 1990s and was endorsed by the Clinton Administration and Congress in
1994, with funding provided through the National Science Foundation. The goal of the
Initiative is to apply a growing multi-disciplinary knowledge base to the challenges confronted
by families and children so as to create an environment where all American children can grow
up to become healthy, educated, productive, and successful citizens.
Research funded through the Human Capital Initiative funds has the potential to inform
policy and support services for young children. For example, a psychologist at the University
of Pittsburgh is exploring the role of social relationships at home in promoting early academic
success among at-risk children; two economists at the University of California at Los Angeles
are examining the efficacy of early intervention programs in achieving long-term educational
and social benefits; a University of Michigan anthropologist is investigating the principles
used by young children to organize knowledge and the determinants of young children's social
stereotypes; a University of Iowa psychologist is studying conscience development in the first
four years of life with the goal of developing a general model of early conscience formation; a
University of California psychologist is examining the mathematical competencies that
children bring to their earliest preschool experiences.
The social and behavioral sciences have made important contributions to our
understanding of what makes our society successful in raising children to become healthy and
productive citizens. The Human Capital Initiative is a multi-disciplinary research effort to fill
gaps in our knowledge and to inform the actions taken on behalf of children.
physical health and emotional well-being of the child but also on the mother's health before
birth.
Links between brain activity and brain structure are becoming more and more evident to
scientists. When children are deprived of a stimulating environment early in life, their brains
may not develop to their full potential. More specifically, scientists have identified several
"windows" of time when different areas of the brain are developing and children are best able to
learn particular behaviors or skills. Of course, these windows do not open and close abruptly,
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and improvements are still possible after the window has passed. Still, understanding how and
when the brain develops helps adults target resources to children at the most effective times.
Early Interventions Have Big Payoffs
Family income is an important contributor to children's well-being. Low-income
children are at greater risk of virtually every adverse outcome: for example, they are more likely
to experience stunted growth, suffer learning disabilities, sustain injuries, have low educational
achievement, and exhibit extreme behavioral problems. Low-income children are 1.2 to 2.2 times
more likely than the average child to be low birthweight (less than 5 lb 8 oz), and they are 1.3
times more likely to die during infancy. They are about twice as likely to have physical or
mental disabilities and at least 3 times more likely to be hospitalized for injuries.¹ Family
income seems to be a significant contributor to the well-being of children primarily because of
the resources it makes available: medical care, nutrition, parental advice on child development,
quality child care, and preschool, for example.²
A growing body of research, much of it supported by the Federal government, from
sociologists, doctors, and educators, as well as economists has examined the effect of
investments -- goods or services like immunizations that are costly during childhood yet save
money in the future -- on children. In the language of economists such interventions contribute
to the stock of "human capital" -- which includes ideas, knowledge, education, training, and
problem-solving skills that make people productive contributors to economic activity. The
literature finds that investments in young children can have big payoffs for families, for
government, and for society. (See Box 2.) Investments can reduce the need for more-costly
measures later in life and lead to increased productivity.
'Children's Defense Fund, Wasting America's Future, Washington, DC., 1994: 62.
2 A recent study finds that income during the first five years of life has larger impacts on outcomes than
that during any other time of childhood (Greg Duncan, Wei-Jun Yeung, and Jeanne Brooks-Gunn, "Does Poverty
Affect the Life Chances of Children?", American Sociological Review, forthcoming).
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Box 2. Evaluating Investments in Children
Investments in children have the potential for substantial and lasting benefits.
However, not all interventions will be equally successful, so it is important to evaluate the
gains from specific programs. Ideally, such evaluations involve experimental designs whereby
individuals willing to participate in the intervention are randomly assigned to the "treatment"
group, who participate in the program, and the "control" group, who do not. The two groups
are then carefully monitored for a substantial period of time to see if individuals receiving the
treatment have superior outcomes.
Random assignment can be done by the toss of a coin, for example, or using
computerized randomization procedures. The treatment can be anything from receiving food
stamps to attending a pre-school program. The key advantage of random assignment is that
the treatment and control groups are likely to have similar characteristics, increasing the
confidence that any observed difference in outcomes is due to the intervention. In the absence
of such an experimental design, participants typically chose to enroll in the program while
nonparticipants choose not to. (In some cases, program administrators decide who is allowed
to enroll.) This nonrandom selection may result in difficult-to-observe differences between
participants and nonparticipants.
Unfortunately, randomized experiments are often expensive and have small sample
sizes, limiting their use in evaluating programs. Therefore, social scientists have developed a
variety of alternative methods of measuring the effects of interventions. Most importantly,
statistical techniques are used to account for observable differences between participants and
nonparticipants such as income, education, and family status. Researchers also increasing
attempt to obtain information from natural experiments, where participation in the
intervention is largely unrelated to individual characteristics or preferences. For instance,
cross-state differences in Medicaid eligibility have recently been used to examine how this
program affects the health of children.
Families Face Many Obstacles
Families face many challenges in making these important investments in young children.
For example,
The share of families with both parents working outside the home has risen rapidly.
In 1995, both parents were employed in more than 70 percent of married-couple families
with children, an increase from roughly 60 percent in 1980.³
3 Annual Demographic Files of the Current Population Survey (March), Department of Commerce, U.S.
Bureau of the Census
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Many families are single-parent households. In 1995, more than 20 percent of families
were single-parent households, compared to 13 percent in 1965.4
Some children are without health insurance. From 1989 to 1995, the percent of
children without private insurance increased over a quarter, from 26.4 percent to 33.9
percent.⁵ When including publicly provided insurance, a total of 9.8 million children are
uninsured (13.8 percent of all children), including 3.3 million under age 6.⁶ Surprisingly,
nearly nine out of ten uninsured children have at least one parent who works.⁷
Crime and instability are prevalent. Evidence suggests that many young children are
exposed to violence, particularly in large cities. In one survey, 47 percent of children
were reported to have heard gunshots in their neighborhood, and 1 in 10 children
witnessed a shooting or knifing before age 6.⁸
Many families with children live in poverty. About 16 percent of all families with
children under the age of 18 were in poverty in 1995, up from 12 percent in 1970. Of
female headed families with children, the poverty rate in 1995 was 42 percent.⁹
Because families are facing these obstacles, they often need help providing their young
children's needs. The Federal government has many programs that provide services to young
children (see Table 1 for important examples), some of which are discussed later. State and local
governments also have a variety of programs.
"Ibid.
'Ibid.
⁶Ibid.
'The State of America's Children Yearbook, Children's Defense Fund, 1997.
$ Taylor, L., B. Zuckerman, V. Harik, and B. Groves, "Witnessing Violence by Children and their
Mothers", Journal of Developmental and Behavioral Pediatrics cited in Starting Points, Carnegie Corporation of
New York: 17.
9 Annual Demographic Files of the Current Population Survey (March).
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Table 1. Selected Government Programs That Assist Children
Program
Year Of
Number Served
Annual Expenditure
Average Benefit
Enactment
Income Support Programs
Temporary Assistance for
1996
4.9 million families
$22 billion
$377 per family
Needy Families (TANF)
Earned Income Tax Credit
1975
18.9 million
$26.5 billion
$1,404 per return
(EITC)
tax returns
Child and Dependent Care
1954
6.2 million
$2.8 billion
$445 per tax return
Tax Credit
tax returns
Exclusion for Employer-
1981
$775 million
Provided Dependent Care
Health and Nutrition Programs
Medicaid
1965
17.2 million
$18.0 billion for
children
children
Food Stamp Program
1964
28.0 million
$25.7 billion for
$71 per month
(13.7 million
children and adults
per individual
children)
Special Supplemental
1972
6.9 million women
$3.5 billion in
$30 per month
Nutrition Program for
and children
federal payments
per family
Women, Infants, and
Children (WIC)
Early Childhood Programs
Child Care and
1996
$2.0 billion
Development Fund
Social Services Block
1975
$2.7 billion
Grant
Head Start
1964
750,696
$3.5 billion
$4,345 per child
Note: The year cited varies by program. Sources: TANF-based on 1995 FY AFDC numbers, 1996 Green Book,
EITC-estimated 1996 FY, Department of the Treasury; Child and Dependent Tax Credit-estimated 1996 FY, 1996
Green Book; Exclusion for Employer-Provided Dependent Care-1996 FY, President's Budget of the United States
Government, FY 98; Medicaid-1995, Annual Statistical Supplement, 1996, Social Security Bulletin; Food Stamp
Program-1995 FY, 1996 Green Book and U.S. Department of Agriculture; WIC-1995 FY, 1996 Green Book; Child
Care and Development Fund-1997 FY proposal, President's Budget of the United States Government, FY 98; Social
Services Block Grant-1996 FY, President's Budget of the United States Government, FY 98; Head Start-1995 FY,
1996 Green Book Devaney, Barbara et al.
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Improving Children's Physical Health
Physical health is essential to a child's growth and development and is influenced by the
interaction of a complex set of factors including nutrition, access to medical care, and the
environment. Investments in health are important throughout life, but some of the most
important and long-lasting of these occur before birth and during the first three years of life.
Maternal nutrition, lifestyle, and medical care during pregnancy have a serious impact on the
health and development of infants and children. Poor habits or deficient health care during
pregnancy can inhibit a child's development and may lead to "failure to thrive." Many of these
effects last a lifetime and some may even result in death. 10 For example, smoking during
pregnancy has been linked to 19 percent of low birthweight births. 11 Similarly, fetal alcohol
syndrome is associated with a variety of birth defects and health disorders. 12
In 1995, 7 percent of babies born in the United States were considered low birthweight.¹³
Low birthweight babies often require expensive medical attention early in life and may
subsequently suffer from a variety of physical, emotional, and intellectual problems.
Nearly two-thirds of neonatal deaths and about 60 percent of deaths in the first year of
life were low birthweight babies. 14
Health care costs in the first year of life for low birthweight infants are, on average,
$15,000 higher than those for normal weight babies, and elevated medical expenditures
continue throughout early childhood. 15
Cerebral palsy occurs 25 times more often in low birthweight children; and these children
also have higher incidences of deafness, blindness, epilepsy, chronic lung disease,
learning disabilities, and attention deficit disorder. 16
"The Future of Children Staff, "Analysis", The Future of Children, Vol. 2, No. 2, Winter 1992: 7-24.
11 J. Kleinman, and J.H. Madans, "The Effects of Maternal Smoking, Physical Stature, and Educational
Attainment on the Incidence of Low Birth Weight", American Journal of Epidemiology, Vol. 121, 1985: 832-55.
12 E.M. Ouellette, H.L. Rosett, N.P. Rosman, and L. Weiner, "Adverse Effects on Offspring of Maternal
Alcohol Abuse During Pregnancy", New England Journal of Medicine, Vol. 297, No. 10, 1977: 528-30.
13 Harry M. Rosenberg, et al. "Births and Deaths in the United States, 1995", Monthly Vital Statistics
Report, Vol. 45, No. 3 (S)2, October 4, 1996: 2.
14 S. Nigel Paneth, "The Problem of Low Birthweight", The Future of Children, Vol. 5, no. 1, Spring
1995.
IS Eugene M. Lewitt, Linda Schuurman Baker, Hope Cormon, and Patricia H. Shiono, "The Direct Cost of
Low Birth Weight", The Future of Children 5, No. 1, Spring 1995.
16 S. Nigel Paneth, "The Problem of Low Birth Rate".
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Children who were low birthweight babies are more likely to repeat a grade in school and
are about 50 percent more likely to be enrolled in some type of special education
program. 17
Prenatal care is believed to play a key role in the development of healthy children, largely
through the prevention of low birthweight. According to the recommendations of the American
College of Obstetricians, prenatal care should include three basic components: early and
continuous risk assessment, health promotion, and when necessary medical and/or psychological
intervention.
Adequate prenatal care is associated with reductions in low birthweight births and
lengthened duration of gestation, with some evidence that prenatal care is most effective
in reducing the probability of low birthweight among high-risk women. 18
One careful study finds that prenatal care is a particularly cost-effective method of
reducing neonatal mortality, when compared to alternative interventions such as the use
of neonatal intensive care. 19
We know less about which aspects of prenatal care are most beneficial. 20 Some experts
have concluded that standard prenatal care visits do little to reduce low birthweights but
that three specific areas of prenatal care are likely to have an impact: cessation of
smoking, nutrition of the malnourished, and medical care.²¹
The proportion of women receiving prenatal care in the first trimester of pregnancy rose
substantially during the 1970s, leveled off in the early 1980s, and then increased again during the
early 1990s (from 71 percent in 1990 to 86 percent in 1995). 22 Poor women and minorities are
significantly less likely to receive early and comprehensive prenatal care. The receipt of prenatal
services is closely linked to the availability and affordability of high-quality medical care, which
we turn to next.
17 Ibid,
18 Institute of Medicine, Preventing Low Birthweight, Ch. 6, Washington D.C.: National Academy Press,
1985.
19 T.J. Joyce, H. Corman, and M. Grossman, "A Cost-Benefit Analysis of Strategies to Reduce Infant
Mortality", Medical Care, Vol. 26, No. 4, April 1988: 348-60. Although not a full benefit-cost analysis, this
research finds that the costs of providing the prenatal care are more than offset by reductions first year hospital and
medical expenses resulting from averting low birthweights.
20 Institute of Medicine, Preventing Low Birthrate.
21 Greg R. Alexander, and Carol C. Korenbrot, "The Role of Prenatal Care in Preventing Low Birth
Weight", The Future of Children, Vol 5, No. 1, Spring 1995: 103-20.
22 Harry M. Rosenberg "Births and Deaths in the United States, 1995".
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Medical Care
Since 1965, the Medicaid program has provided health insurance for poor families. In
1995, nearly 30 percent of children under 6 were covered by Medicaid.²³ Eligibility used to be
closely tied to participation in the Aid to Families With Dependent Children (AFDC) program;
however, beginning in the middle 1980s, states were permitted and then subsequently required to
extend eligibility to other groups of children and pregnant women. All pregnant women and
children up to the age of 6 living in households with incomes up to 133 percent of the Federal
poverty line are now eligible for Medicaid. All children in poverty born after September 30,
1983 are also eligible, with the result that by 2002 all children (aged 18 and under) in poverty
will be eligible for the program.
Pregnant women receive special services under Medicaid including "enhanced" prenatal
programs that cover specialized services such as nutritional counseling and health education in
many states. Children covered by Medicaid are eligible for a wide variety of services including
inpatient and outpatient hospital services, physician services, x-ray services and many others. In
addition, under the Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) program,
States are required to provide screening, diagnosis, and treatment services to Medicaid-eligible
children (and are required to pay for treatment of conditions identified during EPSDT screens,
even if these services would not otherwise be covered). Since 1993, States have been entitled to
receive vaccines, free of charge, from the Federal government, for Medicaid-eligible and some
other categories of children. 24
A recent national study concluded that expanded Medicaid eligibility has reduced the
incidence of low birthweight babies and infant mortality.²
23 U.S. Bureau of the Census, Department of Commerce, Children's Health Care, Washington D.C.
24 The Federal government also provides funding for a variety of other programs serving women and young
children. These include matching funds for services delivered in public health settings and funds provided to
community and migrant health centers under the Community and Migrant Health Center Program. For a review of
these programs see Ian T. Hill, "The Role of Medicaid and Other Government Programs in Providing Medical Care
for Children and Pregnant Women" The Future of Children, Vol 2, No. 2, Winter 1992.
25 Janet Currie, and Jonathan Gruber, "Saving Babies: The Efficacy and Cost of Recent Changes in the
Medicaid Eligibility of Pregnant Women", Journal of Political Economy, Vol. 104, No. 6, December 1996: 1263-
96. However, the health effects of the Medicaid expansions are not unambiguous. Studies of Medicaid expansions
in Tennessee and Massachusetts failed to uncover improvements in prenatal care, birthweight, or neonatal mortality
(see J.S. Haas, et al., "The Effect of Providing Health Coverage to Poor Uninsured Pregnant Women in
Massachusetts" Journal of the American Medical Association, Vol. 269, No. 1, January 1993: 87-91 and J.M. Piper,
W.A. Ray, and M.R. Griffin, "Effects of Medicaid Eligibility Expansion on Prenatal Care and Pregnancy Outcome
in Tennessee", Journal of the American Medical Association, Vol. 264, No. 17, November 1990: 2219-23.
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The Medicaid expansions have significantly increased the probability that children have
at least one physician visit per year, as is recommended by pediatric guidelines. As a
result, child mortality rates have declined.²⁶
Nutrition
Adequate nutrition during pregnancy and the early years is another important investment
to ensure children's health. Poor nutrition during this important time can have profound and
lasting effects on a child's health.
Pregnant women with poor nutrition are more likely to have low birthweight babies and
children with poor nutrition often lack concentration and energy, experience dizziness,
headaches, ear infections and frequent colds.²⁷
Iron deficiency can impede the development of problem-solving skills, motor
coordination, attention, concentration, as well as long-term cognitive development.²⁸
Stunted growth, an indicator of poor nutrition, is associated with lower scores on tests of
academic ability, even after controlling for socioeconomic characteristics. 29
The Federal government has two programs that help to ensure good nutrition for low-
income pregnant women and young children: the Food Stamps Program and the Special
Supplemental Nutrition Program for Women, Infants, and Children (WIC). WIC is
targeted specifically to pregnant women, infants, and young children at nutritional risk. WIC
provides supplemental foods, nutrition education, and access to health services for low-income
women during and after pregnancy and to their children through five years of age. Almost 7.4
million women, infants, and children participated in WIC in FY 1997, and the program had a
budget of $3.9 billion. 30 WIC has had important benefits for women and young children (see
Box 3).
26 Currie, Janet and Jonathan Gruber, "Health Insurance Eligibility, Utilization of Medical Care and Child
Health", Quarterly Journal of Economics. Vol. 5, May 1996.
"Emesto Pollitt, "Developmental Impact of Nutrition on Pregnancy Infancy, and Childhood: Public Health
Issues in the United States" in Norman W. Bray (ed) International Review of Research in Mental Retardation, Vol.
15, Academic Press, 1988; Barbara H. Kehrer and Charles M. Wohlin, "Impact of Income Maintenance on Low
Birth Weight: Evidence from Gary Experiment," Journal of Human Resources Vol. 14, No. 4, 1979; and Food
Research and Action Center, Community Childhood Hunger Identification Project: A Survey of Childhood Hunger
in the United States, Washington, D.C. 1991, all cited in Wasting America's Future, Children's Defense Fund.
28 Children's Defense Fund, Wasting America's Future: 15.
29 Ibid.
30 Office of Management and Budget, Budget of the United States Government, Fiscal Year 1998:
Analytical Perspectives, Washington D.C.: U.S. Government Printing Office, 1997.
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Participation in WIC is associated with higher probabilities of receiving adequate prenatal
care, greater probabilities of receiving advice on nutrition, breast-feeding, and substance
use, higher average birthweights, and reduced incidence of low birthweight and
premature births.³¹
WIC participation is associated with lower rates of infant and neonatal mortality, even
after accounting for differences in the use of prenatal care, possibly due to improved
nutrition.
32
Participation in WIC reduces the incidence of iron-deficiency anemia among infants.³³
WIC participants are more likely to comply with nutritional guidelines for 4 to 6 month
old infants than are nonparticipants.³⁴
One widely cited study found that every dollar spent on WIC for pregnant women saves
$1.77 to $3.13 in Medicaid costs for new mothers and infants in the first 60 days of life. 35
31 Anne Gordon, and Lyle Nelson, "Characteristics and Outcomes of WIC participants and Nonparticipants:
Analysis of the 1988 National Maternal and Infant Health Survey", mimeo, Mathematica, March 1995.
32 Barbara Devaney, and Allen Schirm, "Infant Mortality Among Medicaid Newborns in Five States: The
Effects of Prenatal WIC Participation", mimeo, Mathematica Policy Research, Inc., May 1993.
33 Barbara Devaney, Marilyn Ellwood, and John Love, "Programs that Mitigate the Effects of Poverty On
Children", The Future of Children, Vol. 7, No. 2, Summer/Fall 1997, forthcoming.
34 Anne Gordon, and Lyle Nelson, "Characteristics and Outcomes of WIC participants and Nonparticipants:
Analysis of the 1988 National Maternal and Infant Health Survey". However, not all of the nutritional measures are
favorable. In particular, WIC participants are less likely to breast-feed their babies. This may occur partly because
infant formula is provided to WIC participants. In addition, some mothers may be referred to WIC because they are
feeding their infants improperly. The reduction in breast-feeding rates may be reversible, however, with some
evidence that WIC participants who are given advice to breast-feed do so more frequently than income-eligible non-
participants (U.S. Department of Agriculture, The WIC Breast-feeding Report: The Relationship of WIC Program
Participation to the Initiation and Duration of Breast-feeding, Alexandria VA, September 1992).
35 U.S. Department of Agriculture -- Food and Nutrition Service. A Study of the Savings in Medicaid and
Indigent Care for Newborns from Prenatal Participation in the WIC Program, Washington, D.C., 1990.
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Box 3. The Effects of Prenatal WIC Participation
In an effort to improve the health of newborns, WIC provides nutrition, health care, and
social service referrals to low-income pregnant women (and to children aged 5 and under).
Participants typically receive vouchers to purchase specific types of foods (milk, cheese, eggs,
infant formula, cereals, and fruit or vegetable juices) valued at an average of around $30 per
month, in addition to the services mentioned above.
To study the effect of this prenatal program on birth outcomes and Medicaid costs,
Mathematica Policy Research, Inc. undertook a study for the United States Department of
Agriculture in five States: Florida, Minnesota, North Carolina, South Carolina, and Texas.
Mothers included in the study participated in Medicaid and gave birth to around 105,000
infants in 1987 or 1988. To analyze the effect from WIC, birth outcomes and Medicaid costs
of WIC participants were compared to those of WIC nonparticipants. Statistical techniques
were used to control for observable differences between the WIC participants and
nonparticipants. (However, the two groups probably differ in ways which were not observed
by the researchers, which could explain some of the differences in observed outcomes
discussed below.)
WIC participants were only one-third to one-half as likely as nonparticipants to have
received inadequate prenatal care. Participation in the program was also associated with an
increase in birthweights (averaging between 51 and 117 grams), a lower incidence of pre-term
births, and a longer gestational age. Medicaid costs were also lower for WIC participants.
Every dollar spent on the prenatal WIC program was associated with savings in Medicaid
costs during the first 60 days after birth of $1.77 to $3.13 for newborns and mothers and from
$2.84 to $3.90 for newborns only. (These benefit-cost ratios are calculated assuming that the
two groups are identical, once the observable characteristics are controlled for.)
Smoking Cessation
In 1993, an estimated 16 percent of pregnant women in the United States smoked.³⁶ The
harmful effects of smoking on fetal development and child development are well-documented.
Programs designed to convince women to quit smoking during pregnancy may be an
exceptionally effective means of helping children.
36 Harry M. Rosenberg, et al. "Births and Deaths in the United States, 1995", p. 89.
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A pregnant women who smokes less than a pack a day is 53 percent more likely than a
nonsmoker to have a low birthweight baby; a woman smoking more than a pack a day is
130 percent more likely to do so.³⁷
The elimination of smoking during pregnancy could prevent about 10 percent of perinatal
deaths and about 35 percent of low birthweight births. 38
A baby born to a smoking mother is more likely to experience longer-term problems as
well, including higher risks of neurological abnormalities, poorer verbal skills (at age 48
months), and reduced fertility in women.³⁹
Smoking cessation programs for pregnant women, often administered through public
clinics or home-visiting programs (discussed below) are generally inexpensive and likely to be
especially cost-effective. Again, the cost-savings are most often associated with reductions in
low birthweight babies. Since these programs are inexpensive, they do not have to achieve
exceptionally high quit rates to recover costs.
The cost of providing smoking cessation programs to the 350,000 pregnant smokers seen
in public health clinics would be about $1.75 million. A quit rate of 12 percent (well
within the range of rates achieved by these programs) would save $12 for every $1
spent. 40 One study of a home-based smoking cessation program costing $11.75 per
patient found that for every $1 spent on the program, almost $3 were saved. 41
Smoking-cessation programs aimed specifically at pregnant women are more effective
and have a lower cost per quit than programs using generic material.⁴
"Select Committee on Children, Youth, and Family, "Opportunities for Success: Cost-Effective Programs
for Children, Update, 1990", 101st Congress, 2nd Session, Washington D.C.: U.S. Government Printing Office,
1990: 131.
38 Department of Health and Human Services, The Health Benefits of Smoking Cessation, A report of the
Surgeon General, 1990, cited in "Opportunities for Success: Cost-Effective Programs for Children, Update, 1990",
p. 132.
Select Committee on Children, Youth, and Family, Opportunities for Success: Cost-Effective Programs
for Children, Update, 1990".
40 J. Mayer, et al., "Health Promotion in Maternal and Child Health Care" in Universal Maternity Care: A
Description for Ensuring Access, edited by J. B. Kotch et al., Washington, D.C.: American Public Health
Association.
"Tbid.
4²R.A. Windsor, et al., "A Cost Effective Analysis of Self-Help Smoking Cessation Methods for Pregnant
Women," Public Health Reports, Vol. 103, 1988.
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Childhood Immunizations
Childhood immunizations play an important role in preventing diseases such as polio,
measles, rubella, diphtheria, and mumps. Prior to the approval of the measles vaccination in
1963, for example, about 500,000 cases of measles were reported each year, killing 400 to 500
people per year. By 1983, the number of cases of measles had dropped to a record low of 1,497.
The widespread use of vaccines has reduced the peak-level incidence of the disease in the United
States by at least 95 percent.43 In addition to securing the health of those immunized, vaccines
can indirectly protect those who do are not vaccinated (i.e., lower disease risk for all individuals).
Immunizations represent a particularly appropriate area for government involvement
since the provision of immunizations
Figure 1. Full Immunization of 2-Year-Olds
provides great health and economic
80
savings. In 1993, President Clinton signed
75
the Comprehensive Childhood
Immunization Initiative that created the
70
Vaccines for Children (VFC) program to
help uninsured, Medicaid-eligible children
Percent
65
get vaccinated. This initiative promoted the
Administration goal that 90 percent of all
60
two-year-olds should be fully vaccinated by
55
the year 2000. VFC provides all
recommended vaccines free of charge to
50
clinics and doctors in all 50 States who
1992
1993
1994
Jul94-Jun95
provide services to uninsured and
Medicaid-covered children. In response to
this initiative, the percent of all 2-year-olds who were fully immunized increased from 55 percent
in 1992 to 75 percent in 1994-1995. (See Figure 1.) This increase in immunization rates is
correlated with the 35 percent decrease in cases of preventable diseases per 100,000 children
under 5 from 1993 to 1996.44
The Centers for Disease Control and Prevention estimate that every $1 spent on the
Diphtheria vaccine saves nearly $30 in future direct and indirect savings -- which
includes savings from work loss, death, and disability; every $1 spent on the Measles,
Mumps, and Rubella vaccine saves over $20.45
43 Center for Disease Control and Prevention, CDC Immunization Information Document #240010, Centers
for Disease Control and Prevention, March 9, 1995.
"Children's Defense Fund, 1997. The State of America's Children, 1997.
⁴⁵U.S. Department of Health and Human Services, Center for Disease Control and Prevention, National
Immunization Program.
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Every $1 spent on polio vaccines is estimated to save $10.46
Home Visiting
Services are often particularly effective when provided to families in their own homes.
The goals of home visiting programs vary considerably. For example, some programs link
families with other social services while others assess the safety of the home. Many other
programs help parents set goals and make plans, encourage healthy habits, and answer questions
about pregnancy, childbirth, and child-rearing. Home visits are often made during pregnancy
and through the first 1 to 2 years after birth. The more successful programs typically continue
after the child is born and employ a comprehensive approach that addresses many of the goals
previously mentioned.⁴⁷
More than 4,000 programs in the United States use Home Visiting to provide health,
social, or educational services to families, sometimes in conjunction with organized child care
programs. Although the Federal government has no coordinated effort for home-visiting
programs, the Department of Health and Human Services and the Department of Education fund
various programs for families with young children. The Head Start program (discussed below)
administers one of the largest home-based programs, mostly to children in rural areas who would
have difficulty participating in center-based care. In 1990, 24 states used Medicaid funds to
provide prenatal care through home-visiting programs.⁴⁸ Because they are varied in both goals
and approach, evaluating home visiting programs as a whole is difficult.
Many studies have linked home visiting programs to reductions in the incidence of low
birthweight babies, to child abuse and neglect, and to improvements in prenatal care, IQ scores,
and child development. The studies differ widely, however, in their assessments of these
programs, in part due to immense heterogeneity in the intensity, scope, and focus of the
interventions. Understanding the differences in the effects of program specifics is necessary for
guiding policy.
Home visiting programs aimed at persuading pregnant women to stop smoking are found
to decrease the risk of low birthweight babies.⁴⁹
"U.S. Department of Health and Human Services, Centers for Disease Control and Prevention,
Justification of Appropriation Estimates for Committee on Appropriations, FY 1991 cited in "Opportunities for
Success: Cost-Effective Programs for Children, Update, 1990": 57.
"U.S. General Accounting Office, Home Visiting, HRD-90-83, July 1990: 3.
"Ibid.
"David Olds, and Harriet Kitzman, "Review of Research on Home Visiting for Pregnant Women and
Parents of Young Children", The Future of Children, Vol. 3, No. 3, Winter 1993: 86
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Studies of Philadelphia's and Baltimore's home visiting programs suggest that the
programs reduced medical costs associated with low birthweights by more than the cost
of the programs.⁵⁰
In a South Carolina study where "resource mothers" visited pregnant teens in rural areas,
program participants showed significant improvements in prenatal care attendance, WIC
enrollment, and well-child visits. 51
A study of home visiting programs for mothers of premature, low birthweight babies
showed that the intervention improved IQ scores at age 3.52
The Prenatal Early Intervention Program (PEIP) resulted in positive effects for children --
fewer emergency room visits and fewer reports of child abuse, for example -- as well as
for mothers who were more likely to complete schooling, gain employment, have fewer
subsequent children, and delay the birth of additional children. 53
A "randomized" experiment examining the effect of a home-visiting program in Elmira,
New York revealed substantial reductions in government expenditures during the first
four years of life for low-income families (see box 4).⁵⁴ The major sources of the cost-
savings included reduced transfer payments (from AFDC, Food Stamps, and Medicaid),
as well as reduced expenditures by Child Protective Services. Among low-income
participants, the cost savings during the first four years of life alone, modestly exceeded
program expenditures.
50 Mayer et al., "Health Promotion in Maternal and Child Health Care" in Universal Maternity Care: A
Description for Ensuring Access, edited by J. B. Kotch et al., American Public Health Association, Washington,
D.C. cited in "Opportunities for Success: Cost-Effective Programs for Children, Update, 1990": 145.
"Henry C. Heins, "Social Support in Improving Perinatal Outcome: The Resource Mothers Program",
Obstetrics and Gynecology, Vol. 70, No. 2, August 1987.
52 The Infant Health and Development Program, "Enhancing the Outcomes of Low Birth Weight,
Premature Infants", Journal of American Medical Association, Vol. 263, No. 22, June 1990 cited in "Opportunities
for Success: Cost-Effective Programs for Children, Update, 1990", pp. 143.
"Mayer et al., "Health Promotion in Maternal and Child Health Care": 145.
54 David L. Olds, Charles Henderson, Charles Phelps, Harriet Kitzman, and Carole Hanks, "Effect of
Prenatal and Infancy Nurse Home Visitation on Government Spending", Medical Care, Vol. 31, No. 2, 1993.
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Box 4. The Elmira, NY, Home Visitation Program
Home visiting is thought to improve pregnancy and early childhood outcomes. In the
late 1970s and early 1980s, a randomized experiment was conducted in Elmira, a semirural
county located in upstate New York, to study the effect of home visiting on health and social
outcomes. This study included 400 teenage, unmarried, or poor women who were pregnant
for the first time. The women were randomly assigned into four different groups-providing
some combination of health screenings, free transportation to health providers, and home visits
during pregnancy, or home visits from pregnancy through the child's second birthday. In the
most intensive intervention, nurses visited once every two weeks during pregnancy and then
once every two to six weeks thereafter (with decreasing frequency over time).
In the Elmira intervention, home visitation was found to decrease smoking and
improve diets and, for some groups, to reduce the frequency of low birthweight or pre-term
deliveries. Participants were also likely to make use of WIC and to attend childbirth education
classes. The home visits also increased the partner's interest in the pregnancy and his
attendance in the delivery room.
Program costs were compared with changes in government expenditures during the
first four years of the child's life. For low income families (but not for their higher income
counterparts) the measured benefits of frequent home visitation outweighed the costs -- costs
averaged around $6000 (1996 dollars), while the savings were over $6,300. The savings
resulted from decreased payments in AFDC, Food Stamps, Medicaid, and Child Protective
Services, and increased maternal employment. Almost one-third of the savings (among low-
income families) was due to the reductions in the number of subsequent pregnancies. This
study may underestimate the gains from the program since neither savings after age 4 nor
nonmonetary benefits in the earlier period are taken into account.⁵
Lead Abatement
Lead ingestion is hazardous to all people but is particularly dangerous for young children
because they absorb lead more readily than do adults and because the developing nervous
systems of children are more susceptible to the effects of lead. At high levels, lead can cause
coma, convulsions, and death. At lower levels, it is associated with reduced intelligence, reading
and learning disabilities, impaired hearing, and slowed growth. Many of the harmful effects of
elevated levels of lead in the blood are irreversible and result in substantial financial and human
costs.
55 David L. Olds, et al., "Effect of Prenatal and Infancy Home Visitation on Government Spending".
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Restrictions on the use of lead in gasoline, paint, and solder (used in making food cans
and water pipes) reduced blood lead levels for children under 6 by more than 75 percent during
the 1980s. 56
But progress in decreasing blood lead levels has slowed and high levels are frequently
found among low-income households, nonwhites, inner city residents, and persons living in older
homes. 57 Current efforts focus on reducing exposures to lead-based paint and lead-contaminated
dust, which are believed to be the main sources of excess blood lead levels in children. Although
few studies have estimated the costs and benefits for such programs, the evidence suggests that
the benefits of some abatement efforts may considerably exceed the costs.
The Department of Housing and Urban Development recently estimated that the costs of
proposed regulation requiring lead abatement in all federally-owned housing with lead
hazards above a certain level would be around $450 million and that the benefits would
be between $500 million and $1.5 billion. 58
Improving the Emotional Well-Being of Children
Emotional well-being in early childhood plays a critical role in allowing individuals to
develop their full potential. Emotionally healthy children enter school with the ability to
communicate with their peers and their teachers; confidence in their ability to make friends;
confidence in themselves; knowledge of socially acceptable behavior; motivation to learn; and
interest in activities. Because these children are prepared to enter school, their early educational
experience can be fruitful, enjoyable, and productive. Emotional health lays the foundation for
children to realize their talents and capabilities.
To ensure emotional health, children need daily nurturing and guidance from trustworthy
and caring adults. In the first years of life, children need love and care from adults who listen
and respond to their needs. Infants are dependent upon adults for touching, rocking, feeding, and
warming. In addition, stimulation through reading and talking is needed.⁵ This nurturing care
develops the basic trust that allows children to feel confident about entering the world. Without
nurturing care, infants grow up feeling helpless and scared, leading to problems later in life.
56 U.S. Department of Housing and Urban Development, "Regulatory Impact Analysis of the Proposed
Rule on Lead-Based Paint", July 7, 1996.
"Ibid.
"Ibid.
59 Carnegie Corporation of New York, Starting Points: Meeting the Needs of Our Youngest Children: 9.
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Parental Care During The First Months of Life
The experiences of the first months of life are critical for both emotional and physical
development. Substantial interactive parental contact during the earliest months is believed to
help babies form secure and loving attachments with adults, to ensure confidence and
competence, and to aid in establishing the basic trust necessary for psychological development
throughout life. 60 For this reason, as well as to allow ample time for mothers to recover from
childbirth and to permit parents to adapt to the changes surrounding the birth or adoption of a
child, many experts believe that several months of parental leave play an important role in
promoting healthy infant development.⁶¹
The desire to spend time at home in the earliest months of an infant's life has become
more difficult to fulfill, as a larger proportion of young children are raised by single parents and
as more women work. Even when employed, most new mothers typically take some time off
work to care for their babies.⁶ However, this often creates tensions between the demands of the
workplace and those of the home. To support families in their efforts to strike a workable
balance between these competing demands, President Clinton signed the Family and Medical
Leave Act (FMLA) into law in 1993. The FMLA grants 12 weeks of job-protected leave to new
parents with qualifying employment histories working for covered employers.63 By providing
employed parents with the time to nurture their newborn and to develop their parenting skills,
this legislation fosters good parenting skills and infant trust. The evidence suggests that the law
has played a positive role in helping parents balance work and home needs.
During the 18-month period ending in the summer of 1995, approximately 17 percent of
workers took time off work for a reason covered by the legislation.64
The FMLA provided these benefits without imposing large costs on employers. Over 90
percent of covered establishments reported that the FMLA had no noticeable effect on
their business performance or growth and larger percentages of these employers indicated
60 Ibid.
61 E.F. Zigler and M. Frank (eds.), The Parental Leave Crisis: Toward A National Policy. New Haven:
Yale University Press, 1988.
62 Jacob A. Klerman and Arleen Leibowitz, "The Work-Employment Decision Among New Mothers",
Journal of Human Resources, Vol. 29, Spring 1994: 277-303, show that 73 percent of employed women with one
month old infants and 41 percent of employed women with two month olds were on leave from their jobs, rather
than working, during the 1986-1988 period.
63 For further details on the FMLA, see Ruhm, Christopher J., "Policy Watch: The Family and Medical
Leave Act", Journal of Economic Perspectives, forthcoming, Spring 1997.
64 U.S. Department of Labor, Commission on Family and Medical Leave, A Workable Balance: Report to
Congress on Family and Medical Leave Policies, Washington, D.C. U.S. Department of Labor 1996.
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positive rather than negative effects on employee productivity, turnover, and career
advancement.65
Quality Child Care for Infants and Toddlers
The emotional well-being of infants and toddlers is promoted by their having close and
stable relationships with a small number of adults in safe and intimate settings. Traditionally,
these have been provided by parents, particularly mothers, who stayed at home with their
children. However, as women increasingly work outside the home and more children grow up in
single parent households, full-time parental care is becoming less and less typical.
Accompanying this trend is the increased use of child-care outside the home. In 1993, about 30
percent of children under 5 in employed-
Figure 2. Child Care Arrangements for Children Under 5
in Families With Employed Mothers, 1993
mother families were cared for in organized
Mother
facilities, only 13 percent in 1977. (See
Grandparent
6.2%
16.5%
Figure 2.) Children in poor families with
employed mothers were only two-thirds as
Father
15.9%
likely to receive care in organized facilities
Family Day Care
16.6%
as were children in non-poor families.
Another option for care outside the home is
family day care -- care by nonrelatives in
Other
another home -- which accounts for an
14.9%
additional 17 percent of the care received
Day Care/Nursury School
by children under 5 with working
29.9%
mothers. 66 Among these child care
Source: Table C1, U.S. Department of Commerce, Bureau of the Census,
facilities, a bewildering array of options
exist with respect to environment, cost, hours spent per week and per day, and services, along
with considerable uncertainty regarding the quality of the services provided. Nonetheless, this
care received outside the home can be rewarding for children. 67
65 David Cantor, et al., "The Impact of the Family and Medical Leave Act: A Survey of Employers",
mimeo, Westat Inc., Rockville, MD, October 1995.
66 Tabulations from the Survey of Income and Program Participation, U.S. Bureau of Census, Department
of Commerce.
67 Early childhood programs can affect children positively or negatively, depending on the quality of the
care. Quality care is best measured by the warmth and interaction between the provider and the child, but assessing
these dimensions is necessarily a subjective, timely, and expensive exercise. As a result, researchers and regulators
tend to focus on more easily observable specific structural measures, such as child-teacher ratios, group sizes, and
staff training, which may also play a role. The available evidence suggests that changes in these structural factors
have the potential to improve the quality of child care if they are accompanied by broader changes in the way child
care is delivered, with smaller benefits if they occur in isolation.
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Children who receive care in quality centers tend to be less distracted, and more
task-oriented, considerate, happy, and socially competent in elementary school. They are
also more likely to be assigned to gifted programs and make better academic progress.68
Children enrolled in high-quality programs are more self-confident, proficient in
language, and advanced in cognitive development. Poor quality childcare programs risk
the development of poor school skills and may lead to heightened aggression.69
The Syracuse University Family Development Research Program provided extensive
childcare, in addition to home visiting, health and nutrition resources. The program,
which served 108 low-income families with children aged 0 to 5, decreased the number,
severity, and chronicity of juvenile justice problems.⁷⁰
Participation in Project CARE, an intensive combination of center-based and home-based
intervention and health care, which serves children beginning at birth, is associated with
significant increases in measured intelligence.⁷¹
Quality child care has important payoffs in terms of increasing emotional well-being and
school readiness but the care received by many children is inadequate. For example, more than
one-third of classrooms surveyed in the National Child Care Staffing study were rated less than
"minimally adequate" and only 12 percent received a score which met or exceeded the standard
associated with "good" classroom practices.⁷² Scattered evidence from several studies suggests
that disadvantaged families, as well as those who are more psychologically or economically
68 See Love, John M., Peter Z. Schochet, Alicia Meckstroth, "Are They In Any Real Danger? What
Research Does -- And Doesn't -- Tell Us About Child Care Quality and Children's Well-Being", mimeo,
Mathematica Policy Research, May 1996.
69Suzanne W. Helburn and Carollee Howes, "Child Care Cost and Quality", Future of Children, Vol. 6,
No. 2, Summer/Fall 1996: 62-63. However, these studies frequently do not fully control for differences in family
background characteristics, which could affect the outcomes analyzed.
70 Hirokazu Yoshikawa, "Long-Term Effects of Early Childhood Programs on Social Outcomes and
Delinquency", Future of Children, Vol. 5, No.3, Winter 1995: 59.
"Donna Bryant, and Kelly Maxwell, "The Effectiveness of Early Intervention for Disadvantaged
Children", The Effectiveness of Early Intervention, 1997.
"First name Whitebook, et al. Who Cares? Child Care Teachers and the Quality of Care in America: A
Final Report: National Child Care Staffing Study, Berkeley, CA: Child Care Employee Project, 1989, as cited in
John Love et. al. "Are They In Any Real Danger? What Research Does -- And Doesn't -- Tell Us About Child Care
Quality and Children's Well-Being".
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stressed, are more likely to enroll their children in child care arrangements that are of relatively
low quality.⁷³
For many families, cost represents a substantial barrier to obtaining quality child care.⁷⁴
The Federal government plays an important role in alleviating this financial burden. In 1994, the
GAO identified over 90 child care and early childhood development programs administered by
11 federal agencies.⁷⁵ Since 1980, federal support has doubled, and for low-income families,
support has almost tripled.⁷⁶
One of the largest Federal child care assistance programs is the Child and Dependent
Care Tax Credit. This program, which began in 1954 and cost an estimated $2.7 billion
in FY 1997, provides a tax credit to taxpayers who work or are seeking work and have a
qualifying dependent (e.g. a child under the age of 13). Parents can receive a credit of up
to $2,400 per year for one qualifying dependent and $4,800 for two or more qualifying
dependents.⁷
Under the newly established Child Care and Development Fund, the Federal
government has made $2.8 billion available to States for FY 1997. This program,
authorized by the Personal Responsibility and Work Opportunity Reconciliation Act of
1996, will assist low-income families and those transitioning on and off welfare to obtain
child care so that they can work or attend training/education. This program brings
together four Federal child care subsidy programs and allows States to design a
comprehensive, integrated service delivery system to meet the needs of low-income
working families. This program represents an increase in child care funding of nearly
$600 million for States over FY 1996. 78
73 Love, John M., Peter Z. Schochet, Alicia Meckstroth, "Are They In Any Real Danger? What Research
Does -- And Doesn't - Tell Us About Child Care Quality and Children's Well-Being".
74 Average weekly child care costs were $74 in 1993 for families that purchased care, with substantially
higher expenditures for wealthy than poor households. (L. Casper, "What Does It Cost To Mind Our Pre-
schoolers?", Current Population Reports, Series 70-52, Washington, D.C., The U.S. Bureau of Census.
75 U.S. General Accounting Office, Early Childhood Programs: Multiple Programs and Overlapping
Target Groups, HEHS-95-4FS, Washington, D.C. October 1994.
"D.S. Phillips, ed. Child Care for Low-Income Families: Summary of Two Workshops, Washington, D.C.:
National Academy Press, 1995.
"House Committee on Ways and Means, The 1996 Green Book, 104th Congress, 2nd session: 199; Office
of Management and Budget, Analytical Perspectives, Budget of the United States Government, Fiscal Year 1998,
643.
"Department of Health and Human Services, Administration for Children and Families.
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One of the main purposes of the Social Services Block Grant is preventing neglect,
abuse, or exploitation of children and adults. Some of this funding goes to child care
services in almost all states.⁷⁹
Since 1981, employees have generally been allowed to receive an Exclusion For
Employer-Provided Dependent Care from their gross income on their tax return. The
exclusion is limited to $5,000 per year with an exception for a married taxpayer filing
separately who is limited to $2,500. The cost of this provision is an estimated $830
million in FY 1997 80
The 1994 expansions to the Head Start program (discussed below) included a set-aside
for establishing Early Head Start, which is targeted at low-income families with
children under 3 and pregnant women. Early Head Start employs a "two-generation"
approach that is designed to serve parents and children simultaneously. The program
provides intensive health and nutrition services during the prenatal period and for the first
three years of the child's life. In fiscal year 1996, 4 percent of the Head Start Grant ($143
million) was set-aside for Early Head Start and, during the 1996 calendar year, Early
Head Start grants were awarded to 74 localities across the nation. These programs will
serve 7,100 infants and toddlers and their families, many of whom live in public housing
developments. 81 Randomized experiments are being conducted to allow accurate
evaluation of the success of Early Head Start.
Early Education
Children need stimulation and interaction to develop motivation, inquisitiveness,
acceptable social behavior, and self-confidence. Early education programs for children aged 3 to
5 help children develop these positive traits, and preschool enrollment has risen substantially.
(See Figure 3.) The programs vary dramatically on many dimensions -- hours per day and days
per week, the type of curriculum, services included, and cost. Some programs incorporate health
care by encouraging immunizations, hearing and vision screenings, and home visiting.
Much of the literature on the effects of compensatory preschool finds that the programs
initially increase IQ scores but that the effect fades over time. 82 Consequently, it is frequently
asserted that pre-school has no permanent effect on cognitive outcomes. However, research
"House Committee on Ways and Means, The 1996 Green Book, pp. 651.
80 House Committee on Ways and Means, The 1996 Green Book; Office of Management and Budget,
Analytical Perspectives, Budget of the United States Government, Fiscal Year 1998.
"Department of Health and Human Services, Fact Sheet, "Improving Head Start: A Success Story",
November 5, 1996.
82For a review of the literature see W. Stephen Barnett, "Benefits of Compensatory Preschool Education",
Journal of Human Resources, Vol 27, No.2.
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examining effects on other outcomes such as educational attainment, behavior, and health status
continues to find benefits of preschool. These long-term benefits are believed to be the result of
Figure 3. Preschool Enrollment of 3-4 Year-Olds
entering elementary school with more
40
experiences and advantages. School
learning is viewed by many as a
35
"cumulative process" where these early
advantages foster later performance. 83
30
Percent
A comprehensive review of
25
compensatory preschool education
found significant favorable effects
20
on long-term school performance,
as measured by grade retention,
15
special education enrollment, and
1973
1975
1977
1979
1981
1983
1985
1967
1989
1991
1993
Source: U.S. Department of Commerce, Bureau of the Census,
high school graduation. 84
Early education programs, in combination with family support programs, have been
found to reduce antisocial behavior and delinquency.85
Preschool participants also more likely to receive immunizations.86
Particularly noteworthy evidence has been obtained from the Perry Pre-School Study.
(See Box 5.) This intervention, which was begun in 1962, randomly assigned 128 3- and 4-year-
old children into a treatment or control group. The treatment group received an intensive pre-
school program and home visits to the parents. 87 No services were provided to the control group.
The study had follow-ups annually from age 3 to 11 and at ages 14, 15, 19, and 27. Favorable
outcomes have been observed for the treatment group, relative to the controls, over a variety of
dimensions including
"Ibid.
"Tbid. The author notes that some of these studies may not have sufficient control groups since they were
self-selected or drawn from different populations.
"Hirokazu Yoshikawa, "Long-Term Effects of Early Childhood Programs on Social Outcomes and
Delinquency", Future of Children, Vol. 5, No. 3, Winter 1995.
86 Janet Currie and Duncan Thomas, "Can Early Childhood Education Lead to Long Term Gains in
Cognition?", Policy Options, forthcoming; R. L. McKey, H. Condelli, H. Ganson, et al., The Impact of Head Start
on Children, Families, and Communities: Final Report of the Head Start Evaluation, Synthesis and Utilization
Project, Washington, D.C.: CSR, Inc, June 1985.
87 The results of the Perry Pre-School study may not be generalizable to other preschool programs, which
generally do not provide the same level of services or monetary investment.
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a significantly higher level of IQ at age 7, school achievement at age 14, schooling,
general literacy at age 19, monthly earnings and home ownership at age 27 and
significantly lower levels of social service receipt from age 17 to 27 and arrests by age
27.8⁸
These estimated benefits translate into savings from $4.75 to $8.75 in future expenditure
on special education, public assistance, and crime from every dollar spent on Perry Pre-
school.
89
As with child care for infants and toddler, financial constraints make it difficult for many
families, especially those with low incomes, to send their children to pre-school programs. In
1990, only 35 percent of children from poor families attended pre-school versus the 60 percent of
children in affluent families.⁹⁰ Through the Head Start program, the Federal government plays
a key role in assuring that low-income children between the ages of 3 and 5 can receive pre-
school education and access to social services which will improve their social competence,
learning skills, health and nutrition.
88 Lawrence Schweinhart et al., Significant Benefits, High/Scope Press, 1993.
"Isabel V. Sawhill, "Young Children and Families" in Henry J. Aaron and Charles L. Schultze, editors,
Setting Domestic Priorities, Washington D.C.: Brookings, 1992, pp. 168; Lawrence Schweinhart et al., Significant
Benefits: 167.
⁹Deanna Gombry, Mary Larner, Donna Terman, Nora Krantzler, Carol Stevenson, and Richard Berman,
"Financing Child Care: Analysis and Recommendations", Future of Children, Vol. 6, No. 2, Summer/Fall 1990.
25
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Box 5. The High/Scope Perry Preschool Project
In the 1960s, concern for the intellectual development of young children living in
poverty spurred research on the ability of early education programs to break the link between
poor school performance and family poverty. The hypothesis was that good preschool would
help young children move from the home into the classroom, and thus raise these children's
educational ability and attainment.
The High/Scope Perry Preschool Project, which began in 1962, is one of the most
notable results of this research. It stands out from other studies because of its design and its
longevity. Children living in the predominantly black neighborhood on the South Side of
Ypsilanti, Michigan were randomly assigned to either the treatment group, who then attended
preschool, or the control group, who then did not attend preschool. A total of 128 African-
American children entered the project and 123 completed the preschool years.
The 58 children in the treatment group received a daily 2 ½ hour classroom session
during the school year. This program employed roughly 4 teachers for every 5 children. In
addition to the classroom session, the children and their mothers received a weekly 1 ½ hour
visit in the home from the child's teacher. Over three-quarters of these children attended the
classroom session for two years, with the rest attending one year. This intensive preschool
program that cost roughly $7,350 per child per year (1996 dollars). For comparison, Head
Start costs roughly $3,900 per child.9¹
The 123 children completing the program were interviewed annually from age 3 to 11,
and at ages 14, 15, 19, and 27. The longevity of this study allows analysis of many long-term
effects of the preschool intervention. Overall, the benefits from $1 spent on the program are
dramatic, varying from $4 to $8, depending on the economic assumptions. These benefits take
the form of decreased future costs of education, crime, and welfare dependence, as well as
increased labor market earnings.
"Berrueta-Clement, J.R., Schweinhart, L.J., and Weikart, David, "Lasting School Effects of Preschool
Education on Children from Low-Income Families in the United States", Preventing School Failure: The
Relationship Between Preschool and Primary Education, International Development Research Centre, 1984 cited
in Lawrence Schweinhart et al., Significant Benefits.
26
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Since Head Start's formation, the program has served over 15 million children and their
families. Of the 750,000 children enrolled in fiscal year 1995, two-thirds were 4 year olds and
about 13 percent had disabilities.⁹² Most programs are center-based but vary in number of days
per week and hours per day. However, Head Start currently has slots for only about 40 percent
of eligible children. The low participation rates represent a lost opportunity to invest in our
children, given the favorable effects of Head Start on future outcomes, and the President has
stated the goal of serving one million children by 2002.
A survey of 72 studies of Head Start concluded that the program had sizable favorable
effects on children's cognitive development at the end of the program year.93
A randomized study in four counties revealed that Head Start raised access to health care,
the receipt of basic health services, improved diets, and led to better health status.⁹⁴ The
Head Start participants also had more fully developed and coordinated motor skills.
An influential study that compared the results for siblings where some participated in
Head Start and others did not found that program participation increased test scores
significantly for some children and also reduced the probability of being retained in
grade.⁹⁵
Parenting skills have also been found to be positively affected by Head Start in some
studies.⁹
Conclusions
Scientists and educators have identified the first three years of life (and pregnancy) as a
time when children have "fertile minds": efforts by parents, care-givers, educators, and
government programs to help children during these years are especially fruitful, often for years to
come. Because of the long-lasting effects of early investments -- such as the provision of health
"Barbara Devaney, Marilyn Ellwood, and John Love, "Programs That Mitigate the Effects of Poverty on
Children".
"Barbara Devaney, Marilyn Ellwood, and John Love, "Programs That Mitigate the Effects of Poverty on
Children".
94 Abt Associates Inc, The Effects of Head Start Health Services: Report of the Head Start Health
Evaluation, Cambridge, MA, 1984.
95 Janet Currie and Duncan Thomas, "Does Head Start Make A Difference?", American Economic Review,
June 1995: 359; Currie, Janet and Duncan Thomas, "Can Early Childhood Education Lead to Long Term Gains in
Cognition?": 4 and 7.
⁹R.L. McKey, H. Ganson Condelli, et al., The Impact of Head Start on Children, Families, and
Communities: Final Report of the Head Start Evaluation, Synthesis and Utilization Project. Washington, D.C. CSR,
Inc, June 1985.
27
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care and quality child care -- they tend to have big payoffs. They avert the need for more-costly
interventions -- such as special education or incarceration -- and contribute to generally happier,
healthier, and more productive children, adolescents, and adults.
Parents, of course, play the largest role in meeting the needs of their children. Broad
social trends -- such as dual-worker families, single-parent families, crime, and poverty -- make it
difficult for many families to provide for these needs. The government can help by providing
parents with the opportunity to spend more time with their children and supply information on
-
how to raise physically healthy and emotionally secure children. Some families also require
more assistance from the government, including various types of financial support, in order to
have the resources necessary to give their children a good start in life.
Families, communities, and the government are making innumerable investments in
young children. These investments are important because our youngest children are, in a very
real sense, the future of America.
28
UNITED STATES.
UNITED STATES ENVIRONMENTAL PROTECTION AGENCY
PROTECTION AGENCY
WASHINGTON, D.C. 20460
cc: Ten Klein
F
Elizabeth Drye
April 3, 1997
+veturn
OFFICE OF
THE ADMINISTRATOR
MEMORANDUM FOR ELENA KAGAN, DOMESTIC POLICY COUNCIL
Eliz- could you look
FROM:
Gary Counselor S. Guzy to the Day 1. Administrator
into second-hend
smoke projects in PP 2-3?
Thanks.
SUBJECT: EPA POLICIES TARGETED TO CHILDREN IN THEIR EARLIEST E.
YEARS
In response to the President's February 24 Memorandum, attached please find a list of
EPA's existing and planned efforts to enhance the development of children during their earliest
years of life. Our compilation builds upon EPA's September 1996 report Environmental Health
Threats to Children and will be expanded through the work of EPA's new Office of Children's
Health Protection.
Because so many of our efforts are directly linked to communities across the country, we
also have collected information about programs taking place at EPA's ten regional offices. We
will forward this list to you shortly.
If you have questions or would like further information, please call me or Courtney
Manning at (202) 260-7960.
cc:
Pauline Abernathy
Nicole Rabner
Recycled/Recyclable
Printed with Soy/Canola Ink on paper that
contains at least 50% recycled fiber
EPA POLICIES TARGETED TO CHILDREN IN THEIR EARLIEST YEARS
Existing and Planned Projects and Programs
April 3, 1997
THE EPA OFFICE OF CHILDREN'S HEALTH PROTECTION AND CHILDREN'S
ENVIRONMENTAL HEALTH INITIATIVE
In February, 1997 Administrator Browner established a new Office of Children's Health
Protection to carry out the Agency's National Agenda announced in September 1996 to address
the wide array of complex environmental threats to children's health, from asthma-exacerbating
air pollution to toxic chemicals that can lead to serious health problems. This new office will be
located within EPA's Office of the Administrator. It will:
Review EPA health standards to make sure they are protective of children,
beginning with selecting five of the most significant current EPA standards, and
establishing procedures for reviewing new standards as they are developed.
Coordinate children's health issues across the Agency, by chairing a new EPA
Board on Children's Environmental Health that will assure integration of EPA
activities affecting children; and by working with the Agency's Science Policy
Council, Regulatory Policy Council and program and regional offices to coordinate
regulatory and other actions that affect children's health.
Research and set new policies on children's susceptibility and exposure to
pollutants. To ensure that all EPA efforts use the best information in developing
protections for children, the new Office will work with researchers at EPA, other
federal agencies and academic institutions to identify and expand research on
children's health. The new Office will also develop new, comprehensive policies
that address children's cumulative and simultaneous exposures to environmental
health threats, and will work with other offices within EPA to develop a research
agenda on children's environmental health issues.
Expand community right-to-know and education on children's health, The
new Office will carry out a Family Right-to-Know Initiative to expand access to
vital information about children's environmental health, so that families can make
informed choices concerning environmental exposures to their children. The new
Office also will lead Agency efforts to provide parents, teachers, and health
professionals with education and information about protecting children from
environmental health threats in their homes, schools, and communities.
Funding: $7.5 million in FY97
New Policy on Evaluating Health Risks to Children
New Program
In October 1995, EPA established a new Agency-wide policy that, for the first time, will
ensure that we consistently and explicitly evaluate environmental health risks of infants
and children in all of the risk assessments, risk characterizations, and environmental and
public health standards that we set for the nation.
This is not a new idea to the many programs throughout the Agency that currently
consider children's health issues in assessing overall risk. This is, however, a major step
forward in establishing a consistent nationwide children's environmental health policy. We
know that children have a greater potential for exposure to environmental hazards and our
assessments of health risks do not always fully take into account the potential effects on
this vulnerable population. The National Academy of Sciences has called for policy
changes to reflect children's health factors in evaluating environmental risks.
EPA's new policy will allow the Agency to make better public health decisions that reflect
not just data on adults, but on children, whenever possible. By making children a health
priority, we expect that this policy will encourage new, much-needed research to provide
the child-specific data we need to thoroughly evaluate the health risks children and infants
face from pollution in our air, land and water. (A description of EPA's other science-
related activities is listed in the last section.)
SECOND-HAND SMOKE
Infants and young children whose parents smoke are among the most seriously affected by
exposure to environmental tobacco smoke, or second hand smoke, which is a carcinogen and
presents significant health risks to children. Children are at increased risk of lower respiratory
tract infections such as pneumonia and bronchitis. A 1992 EPA risk assessment found that
second hand smoke is responsible for between 150,000 and 300,000 lower respiratory tract
infections in infants and children under 18 months of age annually and results in 7,500 to
15,000 hospitalizations each year. EPA is taking or planning to take the following actions to
address the health risks of second-hand smoke:
Second-hand Smoke -- Public Service Campaign
Planned Project
EPA will partner with the American Medical Association (AMA) to conduct a national
TV, radio, print and transit public service advertising campaign to educate parents about
how second-hand smoke contributes to early childhood ear infections and respiratory
problems. Campaign materials will be produced in both English and Spanish. The
promotion will be targeted to low income, urban populations where second-hand smoke
exposure is believed to be highest. Materials distribution would take place through AMA,
the Centers for Disease Control and Prevention and EPA.
Impact and Funding: In 1996, 29% of U.S. households still exposed young children to
second-hand smoke. The funding level is $350,000 in FY97. A similar amount is
planned in FY98 for another version of the campaign.
2
Daycare Outreach regarding Indoor Air Quality
Current Project
Building on the success of a pilot project underway in the State of Pennsylvania, EPA is
working with the National Resource Center for Health and Safety in Childcare to expand a
project that is reducing childhood exposure to second-hand smoke.
This pilot, which will be expanded to 5-8 more states this year, provides a self-learning
program for childcare center staff to assist them in educating parents about reducing
childhood exposure to second-hand smoke. After successfully completing the program's
test and committing to implement risk-reducing actions, childcare staff members are
awarded continuing education credits in the state's licensing system.
Approximately 100 providers have implemented the program, reaching more than 1000
young children in Pennsylvania. Exportation to additional states will take place during
FY 1997 and FY 1998, and, in the future, include other indoor air problems which
children face.
Impact and Funding: It is anticipated that 50-200 facilities per state will be served. The
funding level in FY97 is $30,000.
Second-hand Smoke -- Pediatrician Speaker Kits
Planned Project
Working with EPA, the American Academy of Pediatrics (AAP) is promoting community-
based action to reduce the risks, particularly to young children, from second-hand smoke
and other indoor air pollutants. The AAP will use its existing child health care network
and membership outreach systems to develop and market a kit for pediatricians to use
when addressing public groups in their community on second-hand smoke and other
indoor air quality issues. EPA estimates that exposure to second-hand smoke annually
causes up to 300,000 cases of childhood respiratory infection and causes as many as 1
million asthmatic children to have additional episodes and increased severity of
symptoms.
Funding: $37,000 for FY1997.
INDOOR AIR QUALITY
Indoor Air Quality in Schools
Current Project
It is estimated that between 550,000 and 1.8 million pre-school aged children can be
found in school buildings every day. Healthy indoor air, among other factors,
contributes to a healthy and favorable learning environment for children. To address this
issue, EPA, in conjunction with the National PTA, National Education Association,
Association of School Business Officials, Council for American Private Education,
American Federation of Teachers, and the American Lung Association, has developed an
easy-to-use kit called IAQ Tools for Schools. The kit empowers schools to carry out a
practical plan of action to prevent and resolve indoor air quality problems at little or no
cost using simple activities and in-house staff.
3
The IAQ Tools for Schools Kit has repeatedly been called the best guidance for schools to
use in preventing and resolving indoor air problems. It is endorsed by many of the major
national school organizations, and whole school districts and major urban school systems
have adopted the Kit. Many national advocacy organizations are promoting the Kit as an
easy and effective program for minimizing adverse health and learning impacts for
children. Strong support for the Kit has been voiced by State departments of education
and departments of health, and State legislatures are using the Kit as a guide to develop
indoor air quality standards in schools.
Funding: Funding for IAQ Tools for Schools outreach and implementation is $1.3 million
for FY1997 (this is for all elementary and secondary schools, regardless of whether
preschool children are found in the school). An equivalent amount is targeted for FY98.
PROTECTION FROM UV RAYS
Children's Sun Protection Campaign
Current Project
In order to address overexposure to the sun's harmful ultraviolet light, which can
seriously damage a young child's skin, EPA will develop and launch a Children's Sun
Protection Campaign during this year and next.
The Campaign, which includes targeting pre-school children, will educate parents and
teachers about the risks of overexposure to the sun, especially the harmful UV radiation
that is most intense between 11:00 am and 2:00 pm. It will encourage parents and
teachers to take sun protective actions to reduce a child's lifetime risk of developing skin
cancer. EPA will promote the program through partnerships with Broadcast
Meteorologists and major educational associations such as the National Parent Teachers
Association and the National Education Association.
Funding: The funding level in FY97 is $50,000 for planning; $250,000 in FY98 for
implementation.
PROTECTING YOUNG CHILDREN FROM LEAD POISONING
Lead poisoning is a top environmental health hazard for young children, affecting nearly
1 million children age five and under, according to Centers for Disease Control and Prevention
(CDC) data. Lead poisoning causes IQ deficiencies, reading and learning disabilities, impaired
hearing, reduced attention spans, hyperactivity, antisocial behavior, and other problems in young
children. Pregnant women poisoned by lead can transfer lead to a developing fetus, resulting in
adverse developmental effects.
Although lead-based house paint has long since been taken off the market, children living
in older homes are threatened by chipping or peeling lead paint, and excessive amounts of lead-
contaminated dust. More than 80 percent of U.S. homes built before 1978 -- some 64 million --
contain lead paint.
4
To address this most pressing remaining need in lead poisoning prevention, EPA's lead
initiatives will continue to be a central piece of EPA's strategy for protecting children. EPA has
identified children under the age of six as the population of highest concern in the development
of its lead risk reduction program and has placed significant emphasis on the specialized exposure
concerns related to children. EPA has, and will continue to assure that all standards are especially
protective of children and have a continued focus on the exposure situations which are most
relevant to this sensitive sub-population.
Real Estate Disclosure Rule
Current Program
As part of the Administration's community right-to-know efforts, EPA and HUD took
action in March 1996 to require sellers and landlords to disclose any known lead-based
paint to home buyers, allowing them the option of conducting a lead hazard assessment.
Approximately 64 million dwellings -- all built before 1978 -- contain some lead-based
paint, although much of it can be managed and maintained safely by using simple, low-cost
common sense procedures. Particularly at risk are families renovating older structures and
low-income families living in dilapidated housing. Parents can unknowingly poison their
children when they disrupt lead-based painted surfaces during renovations, for example.
Funding: $32,000 for FY1997
Residential Lead Exposure
Current Project
EPA is currently in the process of identifying what specific levels of lead contamination in
residential dust and soil present hazards to children, as well as identifying what conditions
of paint present hazards. As part of this project, EPA is developing a comprehensive
assessment of residential lead risks to children. This project will result in clear, identifiable
standards for what constitutes a lead hazard to children in paint, dust and soil.
Funding: $1 million for FY1997
Lead Hazards During Renovation and Remodeling
Planned Program
Renovation and remodeling activities are often forgotten when thinking about lead
hazards, but these activities can actually exacerbate existing situations by disturbing lead
paint and creating lead dust, often where it is least expected. Parents can unknowingly
poison their young children when they disrupt lead-based painted surfaces during
renovations, for example.
EPA will develop a rule to ensure that high-risk renovation and remodeling activities are
done safely, by requiring training and safe practices. EPA is currently developing a
regulation to require that renovation and remodeling contractors educate their customers
about lead by distributing a brochure previously developed by EPA.
Funding: $759,000 in FY1997
5
Rulemaking on Do-It-Yourself Debris From
Removal of Lead Based Paint
Planned Project
EPA is considering various options to facilitate accelerated removal of lead based paints
from households. EPA plans to clarify the regulations for disposal of the debris generated
from renovations and remodeling -- to encourage homeowners and contractors to
accelerate the safe removal of lead from children's home environments.
This activity is specifically aimed at protecting young children, because they are most at
risk from lead based paint in households.
Funding: $50,000 for FY1997
Educating Parents About Childhood Risks from Lead Exposure
New Program
EPA has launched a childhood lead poisoning outreach program directed at parents and
other caregivers or service providers (e.g., pediatricians) of children under 6 years old in
high risk target areas. This lead poisoning prevention and lead hazard awareness effort is
one of the ways EPA is increasing lead-based paint hazard awareness and promoting lead
poisoning prevention in high risk target populations such as young children.
Funding: $592,000 for FY1997
Clean up of Lead-contaminated Waste Sites
Current Project
EPA is expanding its efforts to address exposure and cleanup of lead through such actions
as conducting consistent, comprehensive assessments to evaluate the impact on children of
lead-contaminated hazardous waste sites. EPA is working closely with the Agency for
Toxic Substances and Disease Registry (ATSDR) and the Department of Housing and
Urban Development to examine blood lead levels in children and to develop guidance on
addressing the impacts of environmental lead on children in urban environments.
Funding: $4 million in FY 1997
PROTECTING YOUNG CHILDREN FROM PESTICIDES
Improving Scientific Knowledge About Children's Exposure to Pesticides Planned Project
A 1993 National Academy of Sciences (NAS) report, Pesticides in the Diets of Infants
and Children, concluded that then-current scientific and regulatory approaches did not
adequately protect infants and children from pesticide residues in food. The Academy
called on EPA to make significant changes in assessing exposure to pesticides, analyzing
the potential for harmful or toxic effects, and using these data to characterize actual risks.
Thus, the Academy report provided a major challenge to EPA to improve the safety of our
food supply and provide greater assurance that our children are protected.
Building on the recommendations from the NAS report, the 1996 Food Quality Protection
Act (FQPA) requires a reassessment of all existing pesticide tolerances (i.e., the amount of
pesticide residue allowed by law in or on a harvested crop) to ensure that they meet the
new safety standard, including the additional protections for children. EPA will review
6
more than 9,000 tolerances within the next ten years under this program. In August of
1997, EPA will publish a schedule for review of existing tolerances. Pesticide tolerances
that pose the greatest risks, particularly to children, will be given the highest priority. In
order to meet the new FQPA standard, EPA will make an explicit determination whether
pesticide tolerances are safe for children, including consideration of aggregate risks from
all sources of exposure and common mechanisms of toxicity.
Funding: $9 million in FY1998
Science Issues Raised by the Food Quality Protection Act
New Project
EPA is developing science policies and procedures for incorporating the new child
protective standards required by the 1996 Food Quality Protection Act (FQPA) into all
pesticide risk assessments. Among other provisions, FQPA requires (1) use of an
additional safety factor to account for potential pre- and post-natal toxicity and the
completeness of data with respect to exposure and toxicity to infants and children; (2)
consideration of in utero exposure to pesticide chemicals; (3) consideration of aggregate
exposure to pesticides (i.e., from all sources including dietary, drinking water and
residential); and (4) consideration of the available information concerning the cumulative
effects of pesticide residues and other substances with a common mechanism of toxicity.
As these policies are refined, through the EPA's Scientific Advisory Panel and other peer
review processes, they will be incorporated into the Agency's pesticide risk assessments to
ensure the adequate protection of infants and children.
Funding: $2.215 million in FY1997
Improvement in the Food Consumption Survey
Current Program
Reliable and comprehensive food consumption data is essential for accurate risk
assessments, particularly when assessing risks to children, who often have very different
food consumption patterns than adults. Because children eat proportionately more food
and drink more fluids than adults do, they are more exposed to environmental threats.
Children eat far larger amounts of certain foods for their body weight than adults and thus
may ingest more pollutants per pound of body weight.
These differing consumption patterns can be easily underestimated in an incomplete
survey. EPA uses the United States Department of Agriculture's (USDA) Continuing
Surveys of Food Intakes by Individuals and the Department of Health and Human
Service's National Health and Nutrition Examination Survey to estimate food
consumption for the U.S. population, including children.
EPA is working with USDA to identify weaknesses in the existing data and recommend
improvements, including increases in the sampling size for the infant and children
population subgroups to better assess children's food consumption patterns.
Funding: $75,000 for FY1997 (in addition to the base costs for running the program,
which are found in USDA's budget). Children Impacted: 51 million
7
Improvements in the Dietary Risk Evaluation System
New Program
In response to the 1993 National Academy of Sciences Report Pesticides in the Diets of
Infants and Children, EPA initiated efforts to improve its Dietary Risk Evaluation System
that will help to provide more realistic pesticide exposure and risk estimates for children.
These efforts also respond directly to new requirements in the 1996 Food Quality
Protection Act to improve protections for infants and children.
Funding: $200,000 FY1997
National Pesticide Residue Database
Planned Project
Children in their earliest years consume much more of certain foods per pound of
body weight than adults do, particularly fruits, vegetables and juices, making them
especially vulnerable to pesticide residues. To address this and other issues raised in the
Pesticides in the Diets of Infants and Children report, an interagency working group
composed of staff from EPA, FDA and USDA has developed a National Pesticide Residue
Database. When implemented, such a database will enhance the Agency's risk assessment
capability by improving the availability and quality of data on actual pesticide residues in
food, including those foods commonly consumed by children.
Funding: $0.5-1 million for start up and $1 million annually
Outdoor Residential Exposure Task Force
New Program
Young children are often disproportionately exposed to lawn chemicals because of their
unique behavior, such as crawling in the grass. To assess those risks, EPA has organized
an Outdoor Residential Exposure Task Force in order to develop data on exposure on
pesticides that have been applied to lawns.
Funding: $75,000 in FY1997
NAFTA Research Program
New Program
As part of the NAFTA research program, EPA will develop and implement an approach to
examine the cumulative risks and adverse health effects in young children resulting from
persistent exposures to pesticides. Research will be conducted in communities along the
U.S.-Mexican border.
Funding: $2.2 million for FY1997
SETTING STRONG STANDARDS AND TAKING TOUGH ACTIONS TO PROTECT
CHILDREN'S HEALTH
Protecting Young Children Living Near Toxic Waste Sites
Current Project
EPA has been extensively involved in a project with the Agency For Toxic Substances and
Disease Registry (ATSDR) called the "ATSDR Child Health Initiative." The Child Health
Initiative is a program which places special emphasis on identifying and preventing the
adverse effects of chemical hazards at toxic waste sites, on the health of the fetus, infants,
children and youth.
8
This program was specifically launched to address the unique vulnerabilities of children
who are often placed at greater risk of adverse health effects when exposed to toxic
substances. These unique characteristics have been confirmed by more than ten years of
public health assessments, toxicological investigations, and epidemiologic studies. As a
result of this work, when two recent ATSDR health advisories led to relocation of
hundreds of families and children from homes contaminated with mercury or with highly
toxic pesticide, special attention was focused on the children's medical and psychological
status. EPA participates on an ATSDR expert panel which makes recommendations to
the ATSDR Board of Science Councilors on ATSDR efforts to protect children at
Superfund toxic waste sites.
Funding: Approximately $60-80 million for FY1997
Combustion Rulemaking to Reduce Dioxin, Furan, Lead
and Mercury Pollution
Current Project
EPA's ongoing combustion rulemakings will help reduce the amount of lead, mercury,
dioxin, and furan, and other heavy metals emitted into the air by hazardous waste
combustion units in this country.
The goal of these regulations is to reduce, by 2005, emissions of dioxins and furans by
90%, particulate matter by 50%, and acid gases by 50% from levels emitted in 1994.
Reductions in mercury are also expected to be significant. These pollutants are a particular
danger to children, who may suffer from brain and central nervous system damage or
adverse developmental effects such as delayed walking and talking, as a result of
exposure. For example, exposure to high doses of mercury during pregnancy and the
first few months of life may pose particular threats to a child's developing nervous
system.
EPA is also examining alternative technologies for the treatment and disposal of mercury-
bearing wastes.
Funding: N/A
Protecting Young Children from toxic PCBs
Current Program
PCBs, or polychlorinated biphenyls, were banned by EPA in 1976 because they cause
cancer; some 20 years later, however, this toxic chemical continues to persist in the
environment, often in contaminated fish. Children whose mothers have high levels of
PCBs when pregnant may develop learning disabilities and experience delayed
development.
EPA continues the development and implementation of programs that will improve
measures designed to ensure safe remediation and incineration of toxic PCBs. New rules
to streamline procedures will speed the clean up of PCBs, providing a particular benefit to
children, who are uniquely vulnerable.
Funding: $500,000 for FY1997
9
Existing Chemicals
Planned Program
EPA will develop and incorporate a child-centered focus for the review of existing
chemicals. Testing actions will be developed to prioritize evaluation of chemicals with
high exposure potential to children and chemicals suspected of being health hazards to
children.
Funding: $100,000 for FY1997
New Chemical Assessment
Planned Program
EPA will develop an individual assessment component for new chemicals that may be used
in products designed for use by or for children. By FY1998, EPA will have
methodologies and criteria in place to assure that new chemicals entering the marketplace
have been assessed for exposures related to children, and standards set through the new
chemical process to assure that exposures are acceptable. Among uses of particular
concern could include paints, fabrics, dyes and plastics.
COMMUNITY RIGHT TO KNOW AND EDUCATION
Consumer Pesticide Right-to-Know Brochure
Planned Project
In response to a 1996 Food Quality and Protection Act requirement, EPA is developing a
brochure to provide to large retail grocers that discusses the risks and benefits of
pesticides and provides information to consumers on how they can reduce their exposure
to pesticide residues on food. This brochure, which will be published annually, will allow
parents to make more informed choices for their families.
Funding: $100,000 in FY1997
Consumer Labeling Initiative
Current Project
In 1995, EPA began its Consumer Labeling Initiative to develop labeling for products that
is clear, easy to understand, and that allows parents to make more informed choices for
their families. EPA has initiated a pilot project focused on indoor insecticides, outdoor
pesticides and household antimicrobial products, all products that may pose special risks
for young children.
Funding: $370,000 in FY 1997
Design for the Environment for Kids
Planned Program
Building on its successful Design for the Environment (DfE) voluntary program, EPA is
developing a DfE for Kids program for products used in the home or in schools. DfE is a
voluntary program with individual industries, professional organizations, state and local
governments, other federal agencies and the public to promote safer substitutes,
technologies and chemical processes. A DfE program targeted specifically at products
used in children's environments will help give families new ways to reduce their exposure
to hazardous chemicals at home and in schools.
Funding: $400,000 for FY1997
10
Poison Prevention
Current Project
Accidental poisoning from pesticide chemicals around the household remains a serious
threat to children. EPA is an active member of the Poison Prevention Council, and
annually distributes thousands of fact sheets on pesticides and child safety to medical
establishments and the general public. As a result of the Poison Prevention Week
outreach in 1995, EPA was able to send a poison prevention message to 3.5 million
television viewers.
Funding: $5,000 for FY1997
Providing Parents with Easy to Access and Easy To
Read Environmental Health Information
Current Program
The EPA Home Page on the Internet provides information directly targeted to parents and
teachers about how to protect children's health, including particular risks to young
children such as lead poisoning, second hand smoke, asbestos, insect repellents and sun
exposure.
EPA estimates that the number of hits to the specific Protecting Children's Health page
has been increasing at a rate of four times the previous month's number. This page went
live at the end of October 1996.
Funding: We have not targeted specific funding to this page -- it is part of the whole
effort to redesign the Home Page to make the information more accessible to the public.
PROTECTING MOTHERS AND INFANTS FROM CONTAMINATED FISH AND
POLLUTED WATERS
Polluted waters not only affect children when they swim in our lakes and streams, but
also when they eat certain freshwater fish. Hundreds of beaches are closed each summer due to
raw sewage and other contamination. All over America, warning signs are posted near thousands
of rivers, lakes and streams, raising special concerns that pregnant women, children, and others
with sensitive or compromised immune systems should not eat fish caught in the water because of
contamination. During 1995, over 1,700 fish advisories were posted -- with 73 percent of them
related to mercury contamination. Exposure during pregnancy and the first few months of life
to high doses of some chemicals commonly found in fish tissue, such as methyl mercury and
PCBs, may pose particular threats to a child's developing nervous system.
Providing Parents with more information about contaminated fish
Current Program
EPA has developed a database of fish consumption advisories which is available to the
public. The National Listing of Fish and Wildlife Consumption Advisories includes all
available information describing state-issued fish consumption advisories in the United
States. Included in the database is information on the geographic location of the advisory,
species of fish concern, chemicals, and segments of the population that are affected.
11
EPA is working with state health and environmental departments to improve the
effectiveness of fish consumption advisories. The Agency is incorporating new risk
assessment methods into national guidance for states and tribes. EPA is also developing
methods for assessing fish consumption rates in sensitive subpopulations, including
children and women of childbearing age.
Funding: $475,000 in FY1997
Great Lakes Water Quality Initiative
Current Program
EPA is also working to protect the nation's largest body of fresh water through the Great
Lakes Water Quality Initiative. By addressing the long-term toxic pollution that persists in
the Great Lakes, this initiative is protecting children and families by decreasing their
exposure to toxic pollutants which can pose particular health effects on reproduction, and
children's development and immune systems.
Beach Health Protection
New Program
Children's health may be at an increased risk from contaminated beaches. Various
illnesses can result from the disease-causing pathogens in sewage-contaminated waters;
these illnesses range from hepatitis, dysentery, and gastrointestinal illnesses to fever, ear
infections, and other health problems. Children tend to be at increased risk because of
greater exposure due to longer periods of playing in the water and accidentally
swallowing water, more extensive cuts and abrasions, and a still-developing immune
system.
EPA recently established a Beach Health Protection Program to improve the effectiveness
of beach contamination advisories and monitoring. EPA will work with states, tribes,
local agencies, environmental groups, and others to reduce microbiological contamination
at the Nation's bathing beaches and other recreational water bodies. The 1997 program
includes development of a prototype national database of beach health information,
convening a national beach health conference to refine our strategic approach, and starting
appropriate water quality models for microbiological contaminants.
The Program will also establish an information network to raise the awareness of local
authorities, health professionals and the public of health risks and methods of prevention.
Funding and Impact: $420,000 for FY1997.
PROTECTING INFANTS FROM MICROBIAL CONTAMINANTS IN DRINKING
WATER
Drinking water contaminants pose a risk to children, particularly to infants, who drink
more fluids per pound of body weight -- and who may be more vulnerable to the effects of
microbial contaminants such as Cryptosporidium, Eicoli, Giardia or the Norwalk virus. EPA
estimates that last year, a total of 30 million Americans drank water from systems that violated
one or more public health standards -- and roughly 13 million of them are served by systems that
12
do not filter their water and thus may not adequately protect against microbial contaminants.
In August 1996, Congress passed new drinking water legislation that provides
strengthened protections to ensure that American families have clean, safe tap water --
improvements that the Clinton Administration has called for since 1993 -- including provisions to
improve consumer information about local tap water. The new legislation gives Americans access
to direct, simple information about local water quality, water sources, contaminants, and whether
the water poses a risk to health.
To ensure that drinking water is safe for children, our immediate priority is control of
microbial contaminants. EPA has taken a number of steps to reduce health risks from microbial
contaminants in drinking water systems across the nation:
EPA has targeted safety standard development and available resources to focus on
contaminants in drinking water that pose the greatest threats to public health, such as
microbial contaminants, including Cryptosporidium, and on special populations such as the
elderly, children, people with HIV/AIDS, and others who are most at risk from unsafe
drinking water.
EPA requires that large water systems test source water -- and, in some cases, treated
water -- for Cryptosporidium. Data from this 18-month test, along with information
collected by EPA, will help develop new safety rules and standards to protect further
against Cryptosporidium and other microbial agents.
EPA launched the Partnership for Safe Water with the nation's water suppliers in March
1995, to achieve voluntary improvements in surface water filtration plants around the
nation. Filtration substantially reduces -- but may not entirely eliminate --
Cryptosporidium contamination.
While EPA has historically developed shorter- and longer-term drinking water Health
Advisory criteria for children to protect them against potential exposure to drinking water
contaminants, limited information is available to characterize the actual risks to infants and
children. The 1997 program will assure that developmental studies are designed to
evaluate lifetime effects on infants and children resulting from the short sporadic nature of
exposures to contaminated drinking water supplies during their formative years.
Funding: $300,000 for FY1997
Safe Drinking Water for Children living in Rural Areas
Planned Program
EPA is also working with the U.S. Department of Agriculture to bring clean running water
to the children and families who live in the 1.4 million rural households across this
country. With its Water 2000 initiative, the Administration is working with states,
companies, banks, and non-profit groups to bring safe, affordable drinking water to
America's most remote and needy corners by the end of the century.
13
Funding: N/A
APPLYING THE BEST SCIENCE TO PROTECT OUR CHILDREN'S FUTURE
EPA has worked conscientiously to ensure the sound scientific underpinnings for its policy
initiatives on protecting children. It is critical that the best science be applied to these problems;
that the research be of the absolute highest integrity and caliber; that it be on the cutting-edge in
sophistication, allowing for consideration of the special mechanisms that affect children as well as
differences in susceptibility, and not just whether an effect to the general population occurs; and
that it focus on the issues of greatest risk and concern.
Focusing Toxic Air Pollution Research
Current Program
Asthma -- both individual episodes and asthma-related deaths -- is increasingly on the rise
in children. Ongoing research is expected to provide new information critical to
understanding how air pollution affects the development of asthma in children. A special
effort funds research that focuses on the link between health effects and exposure to toxic'
urban air pollution. EPA is funding studies that identify whether special subpopulations --
such as infants and children -- are at increased health risks due to higher exposure to toxic
urban air pollution, or due to their inherent biological sensitivities. These community-
based efforts will examine the pattern, frequency, and magnitude of exposures in specific
communities.
Proposed New Air Quality Standards: EPA's research into the health effects of
particulate matter (soot) and ozone (smog) led EPA to propose strengthening air
quality standards for these air pollutants last year. These proposals are designed to
protect children, including children with respiratory diseases such as asthma.
Improving Scientific Knowledge About Fine Particle Air Pollution
In FY97, EPA will significantly expand its research program on particulate matter
air pollution. Research will be conducted to identify the way in which particles
affect human health, the critical exposure concentrations, and the sizes, chemical
compositions, and sources of particles responsible for health effects. Research also
will begin to investigate technologies and control practices to reduce fine particles.
In addition to research at our laboratories, EPA has awarded a grant to the
Harvard University School of Public Health to examine fine particles in urban air
and the respiratory health of children.
Funding: $43.9 million for FY1997
Researching Potential Effects on the Endocrine System from
Pesticides and Industrial Chemicals
Current Program
In recent years, increasing scientific and public attention has been focused on the potential
effects of synthetic chemicals on the hormone system. These chemicals -- which have
been labeled "endocrine disruptors" -- may pose a major health concern for children.
14
Although there is considerable scientific uncertainty, it is clear that a number of chemicals,
including organochlorine pesticides such as DDT and chemicals such as PCBs, can cause
endocrine disruption in wildlife and laboratory animals. Because very low levels of
chemicals that block or mimic reproductive and thyroid hormones can determine the
course of prenatal development, concern exists about the potential for birth defects and
alterations of normal growth and development in children. Endocrine disruptors may
also play an important role in reproductive cancers.
In recent years, increasing scientific and public attention has been focused on the potential
effects of synthetic chemicals on the hormone system. EPA has acted to ban many of these
chemicals -- including DDT and PCBs -- and has already taken many steps to regulate
over 95% of known sources of dioxin in the U.S.
In addition, EPA is involved in important research to try to better understand increasing
reports of reproductive, developmental and other problems linked to some chemicals,
including processes that may uniquely affect children. EPA has developed a national
research strategy -- with the involvement of stakeholders -- for areas like pesticide and
chemical screening, testing and controls. EPA's research in FY97 is focusing on important
questions to determine: classes of chemicals that may affect the endocrine system; how
much exposure produces adverse effects; how humans and wildlife are exposed; effects
actually occurring in humans and wildlife; and the combined effects of exposure to
multiple endocrine disruptor chemicals.
Funding: $10.8 million for FY1997
Improved Risk Assessment Procedures For Pesticides
Planned Project
EPA is developing a new application of an existing technique for probable risk
assessments, known as the Monte-Carlo method, to better reflect actual exposure to
pesticide chemical residues. Application of this technique will greatly enhance our ability
to identify and mitigate pesticide risks to young children. The development of this new
procedure will require improvements in food consumption data and upgrading of
computer systems.
Funding: $500,000 in FY1997
Exposure Research
In addition to looking at health effects, EPA is studying how children are exposed to
pesticides and other toxic chemicals. If we understood more about which pathways of
exposure are of greatest concern, we could better focus preventive measures.
EPA's strategy for studying residential exposure to chemicals focuses on children
as the most highly exposed subpopulation of concern. The residential exposure
research program is an intensive study of how residues of pesticides and other
chemicals are transported into and around homes, how residues are
transferred/dislodged from surfaces in and around the home onto children, an
assessment of the behaviors of children (such as crawling on the floor or putting
their hands in their mouth) that bring them into contact with these residues, and
what happens to the residues after they are transferred to the children's skin.
15
The National Human Exposure Assessment Survey is an important research tool.
It is an ambitious study to evaluate total human exposure to multiple chemicals on
a community and regional scale. In collaboration with the Minnesota Department
of Health, EPA is carrying out a special children's exposure module of the survey.
Children will be screened for exposure to certain pesticides, with a goal of
identifying "highly exposed" children and their sources of exposure. Researchers
will measure the levels of pesticides in the air children breathe; in food and
drinking water; and in the soil and dust around their homes. If successful, this
screening phase will be used to supplement other Survey studies.
EPA also will develop models of children's total exposure to several major
chemical classes. The research will consider key physiological and behavioral
differences between adults and children. This effort will take advantage of data
from other efforts in which children's exposure is being measured.
Funding: $700,000 for FY1997
Cumulative Exposure Project
Current Project
The Cumulative Exposure Project is EPA's most comprehensive effort to develop
estimates of pollutant exposures to children in the near term. The project uses existing
data and methods to estimate exposures to the general population through air, food, and
drinking water, and focuses on identifying pollutants and sources with the greatest impacts
on children. Data from the Cumulative Exposure Project will be used to:
Identify air toxics that pose the greatest public health threat to children nationally.
The analysis of air toxics will provide estimates of the levels of toxics in the
outdoor air where children live and will compare these levels to health benchmarks
to identify locations of greatest concern.
Address the differential exposure of young children to food and drinking water
contaminants, by incorporating children's intake rates and body weights into the
analysis. Levels of toxic pollutants in food and air will be compared with health
benchmarks to identify exposures of greatest concern.
Impact and Funding: The expected result of the program is the generation of a wealth
of data on young children's cumulative exposures to environmental pollutants.
General release of the project's results will support efforts by citizens to understand and
improve the environmental health of the children in their communities. Over the past three
years, EPA has spent approximately $1.5 million on the project. Funding in FY97 is
$400,000, with another $400,000 anticipated in FY98.
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04/02/81
U.S. Department of Justice
2
Office of Justice Programs
Office of Juvenile Justice and
Delinquency Prevention
Office of the Administrator
Washington. DC 20531
April 1, 1997
MEMORANDUM
To:
Elena Kagan, Deputy Assistant to the President for Domestic Policy
From:
Shay Bilchik, Administrator(Al for S.B.
Re:
Department of Justice Activities for Children Ages 0-3: REVISED
cc:
The Attorney General
As the Attorney General's designee on the Interagency Working Group on Early
Childhood Development, I am responding to the President's Executive Memorandum for an
assessment of and information on Department of Justice existing and proposed activities targeted
to children in their earliest years.
Attached is a comprehensive response to the first bullet in the President's Memorandum.
Many of the projects described do not include specific information on number of clients served
or impact of the program, either because the project is new, does not lend itself to that
assessment, or has not yet gathered that type of information. However, where possible, I have
included that information. In response to the second bullet of the President's Memorandum,
planned projects and programs have been articulated where they exist under "Proposed
Improvements" for each existing project.
In the limited time available, however, I have only been able to sketch out in general
terms a response to the third bullet: proposals for additional projects and programs which could
be implemented by various Department of Justice bureaus and offices in collaboration with other
Federal agencies. Some of these proposals were presented to you on a conceptual level by the
Attorney General as a possible challenge emanating from the White House Conference on Early
Childhood Development and Learning. They have not been discussed with other agencies and so
I do not know the level of interest or capacity for other agencies to participate. The exchange of
information you have facilitated between agencies on existing and proposed activities will clearly
assist in this matter. The Attorney General and I had an opportunity to discuss this memorandum
and she asked me to emphasize that we are excited about the prospects of using this inventory of
projects as an opportunity for planning FY 98 and FY 99 zero-to-three projects with other
Departments and creating a sustained national focus on this important topic.
If there is interest from the Domestic Policy Council in pursuing these proposals, the
Department of Justice and the Office of Juvenile Justice and Delinquency Prevention are willing
to be active participants in their development and implementation. My preliminary thinking on
the proposals and how they might be put into operation is attached and precedes a list of possible
announcements at the White House Conference, a list of documents for inclusion in a resource
list for conference participants, and the inventory of existing Department activities.
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Proposed Initiatives
Respond to Child Victims of Violence
Through a partnership between the Departments of Education, Health and Human Services and
Justice (including the Violence Against Women Grants Office, the Office for Victims of Crime,
Community Oriented Policing Services and the Office of Juvenile Justice and Delinquency
Prevention), and other appropriate federal agencies, the proposed Child Victims of Violence
Initiative could support the development of a system in up to ten communities which assures that
every child exposed to violence has a rapid and appropriate intervention initiated by teachers,
cops, health care providers and others.
Specifically, the Child Victims of Violence Initiative could:
identify up to ten sites that show readiness to engage a broad range of individuals in
effectively intervening with children who are the victims of violence, including exposure
to family and community violence as well as abuse and neglect;
build upon the concept of Child Development - Community Policing and provide
intensive training and technical assistance to the ten sites using existing federal contracts
to train prosecutors, law enforcement, family judges (DOJ); teachers and school
personnel (ED); child protective service providers and social workers (HHS); and other
community-level individuals that may be reached by various federal agencies, in early
child development and identification and response to child abuse, neglect and exposure to
violence;
provide limited seed money (grants less than $100,000 each) which would be pooled
from each of the participating agencies' existing funds to assist in the development of
unified family courts that comprehensively respond to child abuse, neglect, and violence;
coordinate victims assistance and victims compensation for these children; and
disseminate information research, effective practices, and promising programs to these
sites and others via bulletins, fact sheets and a national satellite teleconference.
Ensure an Adult Presence in Children's Lives
Through a similar effort of combining existing technical assistance contracts and pooling funds,
the federal agencies could work with courts, non-profits, social service workers and other
community members to assure that every child has a nurturing, stable, reliable adult presence
throughout the 0-3 stage of life.
Establish Community-Wide Planning Around 0-3
04/02/97 WED 10:33 ГАД 202 JUI
Again, through a similar effort as described above, the federal agencies could work with state and
locals to establish a sustainable comprehensive, community-based planning process involving
public, private, and non-profit players in the community to focus explicit attention on the needs
of those aged 0-3 in their community.
Support Research and Program Interventions on the Impact of Alcohol and Other Drug
Abuse on Child Development
The Department of Justice could work with other Federal agencies to support research on the
impact of alcohol and other drug:abuse on child development; and interventions, such as drug
courts that comprehensively focus on family issues and on pregnant women.
Increase Family Strengthening in Safe Havens
With the likelihood of increased funding for the Department of Justice's Community Prevention
Grants and the increased public support for prevention for children ages 0-3, there are a number
of opportunities for the Department to collaborate with other agencies to increase family
strengthening programs in safe havens, multi-service after school programs or community
centers.
04/02/97 WED 10:34 ГАД 606
Possible Announcements
On March 10, 1997 the Department of Justice announced Safe Streets/Safe Kids:
Community Approaches to Reducing Abuse and Neglect and Preventing Delinquency.
This grant program will fund five communities at between $125,000 and $925,000, with
a total investment of $2.7 million per fiscal year for five years beginning with FY96.
This program is designed to improve community responses to child and adolescent abuse
and neglect to break the cycle of early childhood victimization and later delinquency
and/or criminality. The five selected communities are: Huntsville, Alabama; the Sault
Sainte Marie Tribe of Chippewa Indians in Michigan; Kansas City, Missouri; Toledo,
Ohio; and Chittenden County, Vermont.
Recognizing the linkage between child maltreatment and later delinquency, the
Department of Justice's Office of Juvenile Justice and Delinquency Prevention and
Executive Office for Weed and Seed has joined with the Department of Health and
Human Services recently awarded grants of $25,000, training and technical assistance,
and AFDC waivers to select Weed and Seed and SafeFutures communities to
implement a nurse home visitation program for low-income first-time mothers. This
model nurse home visitation program has improved outcomes for first time mothers and
their infants, with outcomes that include:
25% reduction in cigarette smoking during pregnancy among women who
smoked cigarettes at registration (4.17 cigarettes/day difference)
25% reduction in the rates of hypertensive disorders of pregnancy and less severe
cases among those with the condition (215 versus 16%)
80% reduction in rates of child maltrcatment among at-risk families from birth
through child's second year (19% versus 4%)
56% reduction in the rates of children's health-care encounters for injuries and
ingestions from birth through child's second birthday (.34 versus .15 visits)
43% reduction in subsequent pregnancy among low-income, unmarried women
by first child's fourth birthday (1.02 versus .58 pregnancies)
83% increase in the rates of labor force participation by first child's fourth
birthday (8.59 versus 5.66 months employed)
45-month reductionlin AFDC utilization among low-income, unmarried women
by first child's 15th birthday (92 versus 47 months of AFDC -- preliminary
finding from 15-year follow-up in Elmira).
The Department of Justice's Office for Victims of Crime and Violence Against Women
Grants Office are working together with the South Carolina U.S. Attorney's Office and
the South Carolina Department of Public Safety to develop a national teleconference
targeting law enforcement professionals and addressing the needs of and issues
surrounding child witnesses of domestic violence. The teleconference will air on June
19th and is a follow up on the national teleconference on domestic violence held in
04/02/97 WED 10:34 PAA " JUI 2000
May 1996.
In an effort to share the information generated from a review of state and local
statutory rape initiatives and prosecutorial practices, the Department of Justice will
sponsor a symposium for prosecutors and law enforcement officers on the benefits and
limitations of current statutory rape prosecutorial practices in June 1997.
The Department of Justice's office of Juvenile Justice and Delinquency Prevention will
publish fact sheets and bulletins for community leaders, law enforcement, teachers, social
workers, and others on Permanency Planning for Abused and Neglected Children" (Fact
Sheet to be completed mid May), "The Epidemiology of Serious Violence" and "In the
Wake of Child Maltreatment" (Bulletins completed by end of May).
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Documents to list in Conference Resource Packet
The following documents can be accessed on the internet at: http://www.ncjrs.org
or by calling toll free 800-638-8736.
Family Strengthening for High-Risk Youth. FS-9408
Violent Families and Youth Violence. FS-9421
VOCA: Helping Victims of Child Abuse. FS-9526
National Center for Missing and Exploited Children. FS-9532
Parental Kidnaping. FS-9534
Adolescent Motherhood: Implications for the Juvenile Justice System. FS-9750
The Missing and Exploited Children's Program. FS-9761
Child Development-Community, Policing: Partnership in a Climate of Violence. NCJ 164380
Court Appointed Special Advocates: A Voice for Abused and Neglected Children in Court.
NCJ 1645
Family Life, Delinquency, and Crime: A Policymaker's Guide. NCJ 140517
Bridging the Child Welfare and Juvenile Justice Systems. NCJ 152155
National Center for Missing and Exploited Children. FS-9532
Project on Human Development in Chicago Neighborhoods: A Research Update. NIJ Research
in Brief. NCJ 163603
Assessing the Exposure of Urban Youth to Violence. NIJ Research Preview. November 1996.
Department of Justice Activities for Children Ages 0-3
1) CHILD ABUSE AND NEGLECT
Research on children's exposure to abuse and neglect and its impact. both immediate and
in the long term on delinquency. drug use, teen pregnancy, school failure and violent
behavior.
Causes and Correlates of Delinquency Studies
Funding Level: $600,000 per year ($10 million for 11 years).
Number of Clients Served: The needs and concerns of 4,500 inner city youth are being
analyzed.
Description: Since 1986 the Department has funded the Causes and Correlates of
Delinquency Studies to obtain a comprehensive understanding of the development and
course of delinquent careers. Through a series of coordinated longitudinal research
projects studying 4,500 inner-city youth, the Department is obtaining information on a
variety of risk and causalifactors associated with delinquent behavior, including the
higher risk of delinquency (and the increased likelihood of committing serious delinquent
acts) among youth who have a maltreatment history. The Studies are also examining the
correlation between maltreatment and drug use, teen pregnancy and school problems.
Evidence of Success: More than 400 journal articles, dozens of reports, and several
bulletins have been published. Key findings include:
children exposed to multiple forms of family violence report twice the rate of
violence and delinquency than children not exposed to such environments (39%
vs. 78%);
the risk of using drugs is about one-third higher among youth who have a
maltreatment history;
the prevalence of violence among drug-using youth is more than double its
prevalence in the nonusing group;
maltreated boys do not report higher rates of impregnating girls than non-
maltreated boys, but maltreated girls experience pregnancy more than non-
maltreated girls (52% to 34%); and
by the time maltreated children are in high school, their school achievement is
significantly lowerthan that of youth who do not have a history of maltreatment.
Proposed Improvements: Expansion of the analysis to the children of these 4,500 youth
and an ongoing series of bulletins which will include as its next two topics: "The
Epidemiology of Serious Wolence" and "In the Wake of Child Maltreatment."
1
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307
Childhood Victimization and Adult Violence: Using Multiple Measures To Better
Estimate Offending
Funding Level: $199,420
Projected Clients Served: Children and their families who have come to the attention of
the justice system.
Description: This award, which extends funding for research on childhood victimization
and adult violence, focuses on the use of multiple measures to better estimate offending.
Evidence of Success: Report due Summer, 1997.
Proposed Improvements Not applicable, project still ongoing.
Examples of child abuse interventions. judges and lawyers who understand child
development issues and court-appointed special advocates (volunteers) who are improving
the dependency court system (protective services. foster care and custody).
Safe Streets/Safe Kids: Community Approaches to Reducing Abuse and Neglect and
Preventing Delinquency
Funding Level: $2.7 million per fiscal year for five years beginning with FY96.
Number of Clients Served: The Safe Kids/Safe Streets funds five communities of varying
size populations,
Description: Five communities have been selected for funding under Safe Kids/Safe
Streets. (In response to the solicitation, 178 applications were received, reflecting an
encouraging number of communities that are composing coordinated, multi faceted
responses to abuse and neglect, as well as strong competition for funding). This program
is designed to improve community response to child and adolescent abuse and neglect to
break the cycle of early childhood victimization and later delinquency and/or criminality.
The five selected communities are: Huntsville, Alabama; the Sault Sainte Marie Tribe of
Chippewa Indians in Michigan; Kansas City, Missouri; Toledo, Ohio; and Chittenden
County, Vermont. Each community will receive between $125,000 and $925,000
through a cooperative agreement for an initial 18-month budget period in a 66-month
project period
Program goals are to: (1) encourage localities to restructure and strengthen the criminal
and juvenile justice systems to be more comprehensive and proactive in helping children
and adolescents and their families who have been or are at risk of being abused and
neglected; (2) implement or strengthen coordinated management of abuse and neglect
cases by improving policy and practice of the criminal and juvenile justice systems and
the child welfare, family services, and related systems; and (3) develop comprehensive
community wide, cross-agency strategies to reduce child and adolescent abuse and
neglect and resulting child fatalities.
Evidence of Success: Not applicable as awards have not yet been made.
Proposed Improvements: Not applicable; project work not yet begun.
2
Training and Technical Assistance to Improve Court Practice in Abuse and Neglect
Cases
Program: This project of the National Council of Juvenile and Family Court Judges, is
known variously as the Child Victims Project, the Model Court Project: and as the
Hamilton County Juven le Court Model.
Funding Level: In FY97 funding level is $941,100.
Number of Clients served: The project serves multiple juvenile and family courts
nationwide. Currently the project is working with 10 "model" or "core" courts on an
intensive basis and five fobserver" courts on a less intensive basis. Training and
technical assistance, however, is provided to many other courts through national and state
training programs and presentations and through dissemination of project resource
material.
Description: This program provides training and technical assistance to dependency
courts nationwide to help them cope with increased demands for expanded and increased
hearings on increasingly complex child abuse and neglect matters. The Hamilton County
demonstration court experience showed that dependency court practice can be improved
to the benefit of the children in court care. This project continue to transfer the lessons
and knowledge gained from the demonstration court to interested jurisdictions through
training, dissemination of resource materials and technical support.
Evidence of Success: The number of jurisdictions implementing one or more improved
court practices has increased since 1996 from four to 15.;
Proposed Improvements: ONDP has published seven Portable Guides to Investigating
Child Abuse, and will be producing four more to assist|law enforcement, medical
practitioners, and child protective service providers in investigations of child abuse; in
addition, OJJDP will be sublishing a bulletin on "Permanency Planning for Abused and
Neglected Children" and will expand its outreach efforts in order to train additional
communities.
Action Partnerships with Professional Organizations
Funding Level: $15,000
Projected Clients Served: Attorneys representing child victims and child victims.
Description: The American Professional Society on the Abuse of Children (APSAC) will
collaborate with the National Association of Counsel for Children (NACC) to offer a
training track for civil attorneys representing children at APSAC's Fifth National
Colloquium. The goals of the project are to assist attorneys representing children in civil
court to acquire skills necessary to advocate effectively for their clients, and to build the
ability of APSAC and NA CC to collaborate to meet the needs of attorneys working with
maltreated children in civil courts. Three seminars of at least three hours in length will
provide skills-based training in critical practice issues, and at least two of the seminars
will build skills in interdise iplimary collaboration. Products include audiotapes of the
seminars, handout packets and sections of the Colloquium program.
Evidence of Success: Training evaluations, better legal representation and services for
child victims.
3
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2093
Children's Advocacy Center Program. (Includes efforts of four Regional Children's
Advocacy Centers and the National Network of Children's Advocacy Centers)
Funding Level: In FY96 funding was $3,250,000 of which $3 million was provided by
OJJDP and $250,000 by O.V.C.
Number of Clients Served: The more than 300 communities with established or
developing Children's Advocacy Center programs and any other community interested in
establishing a children's advocacy center or multi disciplinary approach to abuse and
neglect case investigation, prosecution and treatment.
Description: This program provides training, technical assistance and funding to local
commonties seeking to establish or strengthen children's advocacy centers or multi
disciplinary teams. Two million in funding is administered by the National Network.
The National Network and the four Regional Children's Advocacy Centers provide
training and technical assistance and share information to assist communities through a
variety of means. Support and information are provided through national and regional
conferences, through telephone and on-site consultation, through community-specific
trainings, through mentoring programs pairing established CAC programs with
communities developing such programs and through dissemination of resource materials
and information. $50,000 of the OVC funds are being used to assist a tribal community
develop a CAC under a phiot program. The Western RCAC is administering those funds
will provide training and technical assistance to that community.
Evidence of Success: A measure of success is the growth in communities having
established children's ad tocacy center since inception of this program in 1995. During
that time, communities with established or developing children's advocacy centers have
increased from under 200 to more than 360.
Proposed Improvements: OJDP will be considering the proposed development of
additional publications produced by this project which will assist communities with
replication of model children's advocacy centers.
Mentoring Program for Children's Advocacy Centers
Funding Level: $50,000
Projected Clients Served: Communities wishing to establish Children's Advocacy
Centers or improve their current Children's Advocacy Center.
Description: Teams of those who work with children in alcommunity will be able to
receive on-site training regarding how to utilize a multidisciplinary approach in
identifying, investigating, and handling child abuse. The teams will attend a well
functioning, established center that serves a similar population and receive first-hand
information as well as guidance and program materials that will help them set up centers
in their own communities. Experienced staff of established centers are available for
telephone or other consultation
Evidence of Success: Customer satisfaction, the availability of more children's advocacy
centers for children across the country.
Proposed Improvements: Projects are being individually evaluated.
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Child Advocate Demonstration Program
Funding Level: $56,533
Projected Clients Serve Children and their families within the District of Columbia
Description: A Child Interview Specialist for the District of Columbia United States
Attorneys' Office, Viction- Witness Assistance Programihas been funded to work with the
Children's Advocacy Center in D.C. and improve the treatment of child victims in the
criminal justice process She has also conducted training for law enforcement officers,
prosecutors, judges, and D.C. school nurses on recognizing and responding to abused
children.
Evidence of Success: Customer satisfaction, better trained staff
Proposed Improvements Services are increasing and expanding for victims of child
abuse in the District of Columbia because of this program which will be funded through
the District of Columbials budget in future years.
Examples of Child Sexual Abuse Prevention and Intervention
Forensic Medical Exam Video
Funding Level: $45,000
Projected Clients Served The film will be distributed through the National Network for
Children's Advocacy Centers and OJP agencies to hospitals, child protective services
units, possibly medical and aursing associations, children's advocacy centers, and law
enforcement agencies wanting to learn the best, most supportive techniques for
conducting a forensic medical exam on a child who has been sexually abused.
Description: A video will be produced that illustrates how to complete a forensic medical
examination so that the illohas a safe, supportive environment that promotes healing.
The latest scientific technology, as well as distance learning that makes it possible for
remote facilities that may not have trained and experienced staff to conduct a sensitive
and effective pediatric forensic medical examination will be part of this project.
Evidence of Success: The first draft of film will be available by the end of May. The
demand for the film as well ES improved practice will be evidence of success.
Proposed Improvements: Comments and requests for more information and training will
be considered.
Use of Close-Circuit Television and Videotaped Testimony in Child Sexual Abuse
Trials: An Evaluation of the Bureau of Justice Assistance's Funding Program
Funding Level: $74,796
Projected Clients Served: This research has relevance to all jurisdictions.
Description: This project documents how 28 jurisdictions are using Bureau of Justice
Assistance funding to implement close-circuit televised and videotaped testimony in child
sexual abuse cases, includi how often the technologies are successfully introduced into
the prosecution and adjudication process.
Evidence of Success: Produced a report assessing the usefulness of close circuit television
and video taping technology as applied to child sexual abuse trials. This resource is now
5
available to the field.
Proposed Improvement The report provides a series of recommendations for the use of
this technology with ch Id sexual abuse cases.
Safe Kids/Safe Streets Training and Technical Assistance
Funding Level: $100,000
Projected Clients Serve Medical professionals and victims of child sexual abuse.
Description: The office or Victims of Crime is funding training and technical assistance
to the sites selected in the Safe Kids/Safe Streets program to develop and enhance the
medical component of the system's response in child sexual abuse cases.
Evidence of Success: Improved services.
Proposed Improvements None at this time.
Child Abuse and Neglect Field Test
Funding Level: TBD
Projected Clients Served Children and their families who have come to the attention of
the justice system.
Description: This research demonstration will test the effectiveness of an intervention
with abused and/or negleo ctcll children in reducing negative consequences of child abuse
and neglect, including an isocial behavior, mental illness, drug use, and delinquency, in
one or more sites. This project is in development; field implementation is expected FY
1999.
Evidence of Success: No applicable as awards have not yet been made.
Proposed Improvements: Not applicable; project work not yet begun.
Justice System Processing of Child Abuse Cases American Bar Association
Funding Level: $499,988
Projected Clients Served: This research has relevance to all jurisdictions.
Description: This project 00 inbines the resources of the American Bar Association's
Center on Children and the Law; Westat, Inc; and James Bell Associates to track cases,
victims, and perpetrators through the justice system.
Evidence of Success: Reportudue Spring, 1997.
Proposed Improvements: No applicable, project still ongoing.
Interventions with Drug Abusin Parents
Drug Courts
Funding Level: In FY 95 the entire Drug Courts, Program Office appropriation was
$11.9 million, in FY 96, $15 million and in FY 97, $30 million. The budget request
for FY 98 is $75 million.
Number of Clients Served Since 1995, the Drug Courts Program Office has funded
131 Planning Grants, approximately 50 Implementation Grants, and over 20
Enhancement Grants.
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OJJDP
Description: The Drug Courts Program Office funds adult and juvenile drug courts.
Adult drug courts often in! thude parents whose substance abuse affects their children in
a variety of ways. Drug court treatment for adults & juveniles may include family
members. The drug court program for adults may produce drug free babies and more
responsible parents for and other children of the family.
Evidence of Success: The Drug Courts Program Office (DCPO) has a cooperative
agreement with the American University-Justice Programs Office for the purpose of
operating the Drug Court clearinghouse. The Clearinghouse collects data on the drug
free babies born to drug court participants, as one of their functions.
Based on the data collected by the clearinghouse a total of 254 drug free babies have
been born to participant o drug court programs funded by DCPO. It is important to
note that several of the grants listed were awarded on 2/25/97 and therefore their totals
are not a reflection of their federal funding. These jurisdictions will, however, be able
to continue to report this information under their new federal funding. The following
is a breakdown of this imformation:
Number of
Type of Grant/
City, State
Bables Horn
Year Awarded
Drug-Free
Bakersfield, CA
124
Enhancement Grant - 1997
Butte County, CA
6
Planning Grant 1995
San Bernardino. CA
30
Enhancement Grant 1997
San Jose, CA
6
Enhancement Grant - 1997
Santa Barbara, CA
2
Implementation Grant - 1995
Wilmington, DE
5
Enhancement Grant - 1995
Kalamazoo, MI
18
Enhancement Grant - 1996
Rochester. NY
1
Enhancement Grant 1997
Portland. OR
61
Enhancement Grant - 1995
Total
254
Proposed Improvements: The DCPO will continue to support in FY 1998 drug court
programs that produce healther families. The DCPO will continue to support the Drug
Court Clearinghouse that collects data on family involvement in drug courts.
Parental Drug Testing in Child Abuse and Neglect Cases
Funding Level: $89,996
Projected Clients Served: This research has relevance to all jurisdictions.
Description: This study examines the use of parental drug testing to aid judicial and
social service system collaboration in preventing further maltreatment in child abuse and
neglect cases.
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Evidence of Success: Prod ced a case study on Washington, D.C. court handling of
parental drug testing in child abuse and neglect cases. This report provides a model for
other jurisdictions. Currently, this resource is available at NCJRS.
Proposed Improvement Not applicable, this is an evaluation of an existing program.
***
The area of child abuse and neglect is one that would be particularly amenable to a Department
of Justice initiative with other a dencies. One area we would be particularly interested in
pursuing is research and programming on the impact of alcohol and other drug abuse on child
development and interventions, such as drug courts that focus on family issues. Another area to
explore is conflict resolution training for teen parents, to engage them in teaching their new borns
empathy, the concept of reward and punishment and how to resolve issues peacefully.
Additionally, we are interested idhow Department of Justice's training of prosecutors on child
abuse issues can become part of larger effort that engages law enforcement and protective
service investigators. This training could include issues related to child development, domestic
violence, and appropriate system esponses.
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OJJDP
2) FAMILY STRENGTHEN INCAND SAFE HAVENS
Examples of home visitation and family strengthening programs designed to support the
functioning of high risk families.
The Prenatal and Earl Ghildhood Nurse Home Visitation Program
Funding Level: $820,00 over three years.
Number of Clients Served: 600 first time mothers and their newborn babies.
Description: The Department is currently implementing, jointly with the Department
of Health and Human Services, a nurse home visitation program for low-income first-
time mothers, some of which were drug addicts. In the program, nurse home visitors
will work intensively with funilies in six sites to improve key aspects of health and early
child development.
Evidence of Success: Thisprogram has been proven effective in reducing child abuse
and neglect, Specifically is expected to: (a) help first-time mothers improve their
health-related behaviors during pregnancy improves birth outcomes, which in turn
diminish the likelihood incurological impairment in the child, (b) enhance empathy and
emotional availability in the parent-child relationship during the first two years of life
reduces the likelihood of child abuse and neglect, and (c) improve parents' participation in
the work force and reduc unintended subsequent pregnancies contributes to economic
self-sufficiency and family subility. The positive results this program will achieve in
the health and social functioning of low-income mothers in the Weed and Seed and
SafeFutures' sites in which is being implemented, offer significant potential as a
means of reducing violene and criminality in young adults.
Key highlights of the indings on maternal and child outcomes come from two
randomized clinical trialskturing the past 20 years in Elimira, NY and Memphis, TN
funded in large part by th Department of Health and Human Services. They include:
25% reduction in siggrette smoking during pregnancy among women who
smoked cigarettes registration (4.17 cigarettes/day difference)
25% reduction in the rates of hypertensive disorders of pregnancy and less severe
cases among those with the condition (215 versus 16%)
80% reduction in nate of child maltreatment among at-risk families from birth
through child's section year (19% versus 4%)
56% reduction in the lates of children's health-care encounters for injuries and
ingestions from through child's second birthday (.34 versus .15 visits)
43% reduction in subsequent pregnancy among low-income, unmarried women
by first child's found birthday (1.02 versus .58 pregnancies)
83% increase in therates of labor force participation by first child's fourth
birthday (8.59 versus 5.66 months employed)
45-month reduction in AFDC utilization among low-income, unmarried women
by first child's 15th birthday (92 versus 47 months of AFDC -- preliminary
finding from 15-ye follow-up in Elmira).
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Proposed Improvement CUJDP will publish a bulletin on the Nurse Home Visitation
Program with Dr. Old's Slyear research results, as soon as they are published in the
Journal of the American Medical Association.
Strengthening Americ stamilies Project
Funding Level: In FY9 funding level is a $250,000 award to the University of Utah's
Department of Health and Education.
Number of Clients Served: The project serves communities nationwide. Through its
national conferences, it basairectly trained practitioners and program administrators from
200 communities, including Weed and Seed and SafeFutures sites. As the information
dissemination effort condnues, agencies in numerous other communities will receive
information, training and support.
Program Description: This program provides training and technical assistance to family
services agencies and strators to enable them to improve or establish effective
family strengthening programs nationwide by disseminating information on model family
strengthening approaches providing training and technical assistance on implementation
barriers and issues, and helping communities to select and evaluate family programs.
Evidence of Success: Theorogram is just concluding the national conferences, which are
the core of its outreach and support efforts. It is too early to judge success. This
initiative has produced a document entitled Effective Purenting Strategies for Families of
High-Risk Youth (December 993), which identifies a representative group of 25
promising programs.
Proposed Improvements: InFY 1997, the following activities are planned: a 2nd
regional training confere CB 16 be held from March 23-25, 1997 in Washington, D.C.,
delivery of ten regional ram-specific workshops, production of user and training-
of-trainers guides, distribution of family strengthening workshop videos, and technical
assistance to individual jurisdictions to implement effective programs.
Parents Anonymous (PAi.Inc.
Funding Level:
Number of Clients Served
Description: Recognizing that minority children are over represented in the dependency
system, this initiative provides funds to support the national PA organizations'
comprehensive model of bighborhood-based shared leadership to families in low-
income, high crime areas. This national initiative is being implemented in 11 States by
PA organizations whose trained staff are dedicated to serving the needs of minority and
ethnic families, including Native Americans, African Americans, Asians, Latinos, and
Appalachians. Parents are gi en the opportunity to observe, practice, and learn skills in
parenting, communication conflict resolution, and other related life skills. These skills
are taught in the context of family life, the worksite, and personal friendships. They are
practiced in weekly group ressions as concerns are aired on various parenting, family,
personal, and employment ssucs.
Evidence of Success:
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OJJDP
Safe Havens
Funding Level: Approximately $4 million in FY 1997.
Number of Clients Served: Over 10,000
Description: Operation Wood and Seed targets children of all ages who may be at risk.
Early childhood health piol lems are frequently addressed through the Safe Havens, such
as the clinic provided by Safe Haven in Savannah, Ga. This Safe Haven also provides
a day care center for local addren whose parents must work. Other sites, such as New
Orleans, Dallas, and Richmond, have immunization pfograms for infants and young
children. A number of Weed and Seed Safe Havens have programs serving the needs of
expectant mothers to helpfensure their health and the health of their children 0-3.
Evidence of Success: A rec trevaluation of the Weed and Seed Safe Havens in Madison,
Wisconsin, concluded tha the program successfully targeted at-risk children and that
Safe Haven programs were of good quality.
Proposed Improvements: Improving connections between Safe Havens and the Home
Visitation program in six Meed and Seed sites: Oklahoma City, OK; Los Angeles, CA;
Fresno, CA; Clearwater, RU San Diego, and St. Louis, MO.
Community Prevention Grants-Title V
Funding Level: The Community Prevention Grants Program was initially funded at $13
million in FY 94, and in FYRS- FY 97 the funding increased to $20 million.
Number of Clients Served FY 96 over 100,000 youth were served in over 300
communities through this inquency prevention program.
Description: In the 1992 thorization of the JJDP Act of 1974, Congress established
Title
V
:
Incentive
Grants Local Delinquency Prevention Program (Community
Prevention Grants). Congress found that (1) it is more effective in human and fiscal terms
to prevent delinquency than attempt to control or change it; (2) half or more of all
States were unable to spend my juvenile justice formula grant funds on delinquency
prevention because of other liorities; and (3) Federal incentives were needed to assist
States and local communities mobilizing delinquency prevention policies and
programs. The scope of the pingrams being implemented by each community varies
greatly because each community develops a three yeardelinquency prevention plan
targeting risk factors determined by their own community. They include:
Counseling and inter services involving parents, families, and juveniles in
managing stress, conflict resolution, and reducing violent behavior.
Programs, for parents that improve their parenting skills, provide support groups,
increase parent-child steractions, and reduce child abuse and neglect.
Health services such as prenatal care and education, health education classes for
new parents, co-located health and community centers, etc.
School-based programs which target truancy, school failure, violence, teen
pregnancy, anti-soch behavior, and drug and alcohol abuse.
Economic developmer and training programs such as job readiness and skill
development, neighboobood/family business, and neighborhood rehabilitation.
Law-enforcement sparmored programs such as community policing, police
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liaisons to commun schools, arbitration/mediation programs supervised by law
enforcement repres atatives, and gang and gun prevention and intervention.
Comprehensive munity mobilization that ineet the needs of youth through
streamlining available services:so that efficient unduplicated services are provided
by local youth/farming service systems, community forums, and educational
activities for the community
The 1996 GAO Report to ongress on the implementation of Title V indicated that 68%
of
the
276
projects fundenti FY 1994 and 95 addressed problems in the family domain.
Fifty-three projects provided activities to intervene with the zero to three age group
specifically.
Evidence of Success: The level of community ownership and investment in these
programs has been impressive, as evidenced by the match exceeding 90 percent when
only 50 percent of the Federal share is required by the program. Communities have
leveraged resources and counded other grants based upon their promising results from the
program. Evaluation effo underway at a local, State and national level. While it is
too soon to declare succe the increased level of coordination, the comprehensive
service delivery systems
sing established, and the targeted efforts to reduce risk factors
by increasing protective factors, based on data, have forced communities to respond to
what the data reveals. The immunities themselves have developed delinquency
prevention plans and have ored their prevention programming to respond to their
specific needs and report! this strategic approach is beginning to show promising
results.
Proposed Improvements:
h the reauthorization of the Juvenile Justice and
Delinquency Prevention Act process the Administration has introduced a bill that
would create an At-Risk Children Grant program that would replace the Community
Prevention Grants Program increase the funding level to $75 million. OJJDP has
proposed program refinements in response to input from the States and based on its
experience managing the irogram. Program improvements include allowing units of
local government to receive he funding so that the funds would be available to the
communities faster, to dropite need forithe local jurisdictions to meet the core
requirements of the JJDP and to assist rural communities in accessing funds by
dropping the in-kind or cash natch requirement for non-metropolitan statistical areas. An
additional improvement is increase the funding for the program so that other
communities will be able comparticipate in delinquency prevention programming.
With the likelihood of increased funding for OJJDP' Community Prevention Grants and the
increased public support for prevention for children ages 0-3, there would be a number of
opportunities for a new initiative on the issue of family strengthening and safe havens.
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3) DOMESTIC VIOLENCE
Illustrations of teachers. law ircement. criminal justice professionals, and advocates
engaged in identifying and
addressing child victimization in family conflict.
Rural Domestic Violer
and Child Victimization Enforcement Grant Program
Funding Level: FY 199
$7 million; FY 1997 - $8 million; FY 1999 (authorized) - $15
million. In September
20 grants totaling $5.6 million were awarded to 7 States, 4
local governments in rull states, 5 private entities in rural States, and 4 Indian tribal
governments. In March
26 additional grants totaling $5.6 million to 10 States, 6
local governments, 3 India tribal governments, and 7 private entities in rural States were
announced.
Number of Clients Server
Description: This grant trogram encourages law. enforcement, criminal justice
professionals, and advocants to address child victimization especially in rural areas.
The Rural Domestic Victor and Child Victimization Enforcement Grant Program (42
U.S.C. § 13971 implement certain provisions of the Violence Against Women Act,
which was enacted in September 1994 as Title IV of the Violent Crime Control and Law
Enforcement Act of 199
The program provides a unique opportunity for law
enforcement and prosecupt agencies, the courts, non-governmental victim services
agencies, community or rations, and businesses in rural communities and Indian
Nations to collaborate in
sting protocols and strategies tailored specifically to meet the
needs of rural population
ie goals of the program are to:
Develop and imp
policies, protocols, and services designed to promote the
early identification
tervention, and prevention of domestic violence and child
victimization;
Increase victims'
and accessito treatment and counseling;
Enhance the inves tion and prosecution of domestic violence and child abuse
cases; and
Develop and implement innovative, comprehensive strategies that draw on a rural
jurisdiction's unio haracteristics and resources to enhance community
members'
underst
ng of the phenomenon of domestic violence and child
victimization
and
together to prevent such violence.
Evidence of Success: Enhancia
access to services for battered women and abused
children
in
rural
communitie
and States, availability of a wider range of services, and
increases in the investigat and prosecution of domestic violence and child abuse cases.
Proposed Improvements:
reposed improvements will be based on program results.
Dependency Court Inter Program for Family Violence
Metropolitan Dade Cour Circuit Court
Funding Level: $615,000
Projected Clients Served:
Description: The overall grap of the project are to:|1) centralize and coordinate judicial
13
and social service responsi pility for domestic violence in dependency court; 2)
coordinate tracking of cases between dependency and domestic violence divisions of the
court; 3) educate the Countand child protective staff on the complex dynamics of
domestic violence, the courrence of domestic violence and child abuse and the impact
of domestic violence dren who witness; 4) strengthen advocacy and other services
for women and children D are victims of domestic violence; and 5) refer perpetrators
of domestic violence to erer intervention programs.
In addition, the project document the co-occurrence of domestic violence and child
abuse; cross-reference all dependency filings to determine whether there is a previous or
concurrent case in the violence or criminal division of the court; place full-time
advocates for victims of ornestic violence in dependency court; conduct lethality
assessments for child abuse und domestic violence and provide the court with
information regarding ris actors for the mother and her children; work with the mother
to plan for her safety and ine safety of her children; facilitate the filing of protection
orders when it is appropriate and when it would not further jeopardize the safety of
women and children; dinate services and treatment for women and children; monitor
perpetrators' compliance th court orders, and develop the framework for a curriculum
for judges on how to handle dependency cases when domestic violence is a factor.
Evidence of Success: Thelproject was initiated March 1, 1997.
Proposed Improvements The project directors will consult on a regular basis with
members of a national advisory group composed of experts in domestic violence, the co-
occurrence of domestic violence and child abuse and in the treatment of children who
witness violence. Project activities may be adjusted and enhanced in response to the
advise of advisory group nembers.
National Teleconference on the Impact of Domestic Violence on Children
Funding Level: $50,000
Number of Clients Served aw enforcement professionals)
Description: OVC and VARGO are working together with the South Carolina U.S.
Attorney's Office and the rth Carolina Department of Public Safety to develop a
national teleconference targeting law enforcement professionals and addressing the needs
of and issues surfounding Id witnesses of domestic violence. The teleconference will
air on June 19th and is a ow up on the national teleconference on domestic violence
held in May 1996.
Evidence of Success: Part ants will complete evaluations on-site. Within six to 12
months, the South Carolina partment of Public Safety will conduct a follow-up
evaluation with participan determine the effectiveness of the teleconference and the
actual implementation of concepts learned during the teleconference.
Proposed Improvements: Hans are in development to fund a program that will use
focus groups of adult survivers to explore the longer term effects of domestic violence.
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OJJDP
Hospital-based Emergency Shelter for Women and Children Victimized by
Domestic Violence, University of Southern California School of Medicine
Funding Level: $100,000
Projected Clients Served: Women who are abused and their children in the Southern
California area as well asidommunities wishing to replicate this program.
Description: This project 400 develop a hospital-based emergency shelter for victims of
spouse abuse and their children. It will serve as a laboratory and training site for other
communities. This project will develop protocols and procedures for replication, and a
detailed report documenting program effectiveness. It breaks new ground by showing
how a secure shelter in a hospital environment can be set up, tied into community
services, and funded--using nsurance company or other third party payer resources.
Evidence of Success: Customer satisfaction, quality of printed materials and training
provided, more resources for children and battered spouses through insurance and
Medicaid programs.
Proposed Improvements Will be based on project success.
Domestic Violence and its Impact on Children (with VAWGO)
Funding Level: $50,000
Projected Clients Served: Adults who witnessed domestic violence in their homes as
children, practitioners in the ields of domestic violence and child abuse, child victims of
abuse, law enforcement professionals.
Description: This is a focus group that will identify the unique needs of child witnesses
and victims of domestic violence, and will explore ways to meet these needs in a
collaborative manner.
Evidence of Success: The focus group will develop a victim-centered approach to
meeting the needs of child winesses of domestic violence.
Proposed Improvements: None planned at this time.
State Victims of Crime Act VOCA) Assistance Programs
Funding Level: Formula Grant Programs, varies by state
Projected Clients Served State subgrantees that provide services to victims of child
physical and sexual abuse and families affected by domestic violence.
Description: OVC awards formula grants to each of the states for victim assistance
programs. Under OVC Guidelines, each state is required to give priority to programs that
serve victims of sexual assault. spousal abuse and child abuse, by allocating a minimum
of 10% of federal VOCA funds to subgrants to such programs.
Evidence of Success: OvCand NU are conducting an evaluation of state level VOCA
programs to determine their ffectiveness.
Proposed Improvements: MILL be developed from the evaluation.
When Domestic Violence and Custody Disputes Coincide
Funding Level: $70,556
Projected Clients Served: This research has elevance to all jurisdictions.
IS
Description: This project, funded by NIJ and the State Justice Institute, examines
effective court responses to domestic violence cases involving custody disputes.
Evidence of Success: Report due Summer, 1997.
Proposed Improvements: Not applicable, project still ongoing.
Children of Battered Women
Funding Level: $249,982.
Projected Clients Served: This research has relevance to all jurisdictions.
Description: This study seeks to clarify understanding of the needs of the children of
battered women. Investiga fors gather data on mothers who apply for temporary
restraining orders over a 6-month period and, through telephone contacts with the
mothers, follow a sample fleases that proceed to criminal prosecution.
Evidence of Success: Report due Summer, 997.
Proposed Improvements: Notapplicable, project still ongoing.
Assessing the Feasibility of Creating Centralized State Data Bases on the Incidence
of Sexual and Domestic Violence
Funding Level: $62,268
Projected Clients Served: This research has relevance to all jurisdictions.
Description: A group of experts will study and reportion how to create centralized State
data bases on the incidence of sexual and domestic violence.
Evidence of Success: This study produced a previously nonexistent document of use to
the field.
Proposed Improvements The report suggests improvements by comparing states. A
follow up study will identify several passible models.
Children's Out-of-Court Statements Regents of the University of California
Funding Level: $253,914
Projected Clients Served: This research has relevance to all jurisdictions.
Description: Researchers conducting three interrelated studies are investigating effective
ways to introduce children's testimony in domestic violence cases and juror decision
making regarding the reliabi ity of hearsay versus live trial testimony
Evidence of Success: Report due Summer, 1997.
Proposed Improvements: Not applicable, project still ongoing.
Assessment of Family Violence Interventions
Funding Level: $299,665
Projected Clients Served: This research has relevance to all jurisdictions.
Description: A committee of experts is developing a synthesis of the relevant research
and expert opinions regarding the strengths and limitations of existing program
interventions in the area of family violence
Evidence of Success: Report due Fall, 1997
Proposed Improvements: Not upplicable, project still ongoing.
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OJJDP
Domestic violence and family court models.
Kentucky Full Faith and Credit Domestic Violence Initiative
Funding Level: The project is funded through a cooperative agreement between the
Justice Cabinet of the Commonwealth of Kentucky and the DOJ's Office of Community
Oriented policing (COPS), and the Office for Victims of Crime (OVC). Total project
cost is $220,000. Originally funded for one year in February 1996, the program has been
granted a one year no-cost intension.
Number of Clients Served: his projectinvolves police officers, victim advocates,
judges, court personnel, prosecutors and private attorneys.
Description: Section 2265 b1 the Violence Against Women Act (Title IV of the Violence
Control Enforcement Act of 1994) P.L. 103-322 requires that civil and criminal
protection orders (CPO's) issued by any court or Indian Tribe be given full faith and
credit by other states and tribes. The act further requires that so long as the original court
had personal and subject matter jurisdiction and the respondent reasonable notice and an
opportunity to be heard, that the CPO be enforced as if issued by a court in the second
state or tribe. The new law means that a victim need not wait until a new violent
incident occurs before seeking the protection of a court in the new state.
Through the Kentucky Domestic Violence Project, the Kentucky Cabinet is to develop
and test methods and instruments for intra and interstate civil and criminal protection
orders relating to domestic violence. Kentucky was chosen for this project because it
boarders seven other states and already has established a state-wide, centralized
restraining order file. Through this grant Kentucky has already provided training to
judges, clerks, advocates and police officers throughout the state on the Kentucky's' new
full faith and credit legislation (passed in early 1996) as well as the provisions of the
Federal law.
Evidence of Success: This project will result in better methods of enforcing inter- as well
as intra-state protection orders through a four-pronged approach: integration of the courts,
state police, local law enfordement and the advocacy community in the enforcement of
protection orders; construction of model interim procedures for exchanging information
with surrounding jurisdictions the production and dissemination of training and technical
assistance materials; and the development of training modules. The pervasive goal of the
project is the increased safety of victims, pregnant mothers and children through the
thorough and timely enforcement of CPO's by all sectors of the criminal justice system.
Proposed Improvements: OP is discussing with the American Bar Association the
possibility of providing partal support to develop and implement unified family courts in
three jurisdictions to respond to families experiencing domestic violence, child abuse and
neglect, substance abuse, divorce, and juvenile delinquency.
On a related note, the Kentucky project has revealed a situation which may well impact
children ages 0-3 years: that is child custody provisions of CPO's may not be
enforceable under the Federa full faith and credit provisions.
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OJJDP
Prosecutions Under the Violence Against Women Act
Funding Level: Not applicable
Number of Clients Served Notapplicable
Description: Every United States Attorney's office has established a Point of Contact
(POC) for Violence Against Women Act (VAWA) cases. The Executive Office for U.S.
Attorneys (EOUSA), in unction with other components of the Department of Justice,
held a conference on January 10, 1997 for all of the VAWA POCs. The conference was
an opportunity to train the POCs, educate them on the new federal provisions, and
encourage them to pursue prosecutions of these crimes.
The Office of Legal Education in EOUSA, recently sponsored a Violence Against
Women and Children Seminar which was held in Albuquerque, New Mexico, March 12-
14, 1997. The course was a tended by approximately 60 Assistant United States
Attorneys and Department of Justice Trial Attorneys. The seminar included segments on
current statutory issues (including the Violence Against Women Act and the recent
revisions to the child exploitation statutes), the investigation, pretrial and trial of cases
involving women and children victims victim-witness issues (including legal issues, the
rights of victim-witnesses and special interview techniques), profiling and presenting
forensic evidence, using expert witnesses, and penalty issues. The seminar also devoted a
segment to computer/Internet issues which covered child pornography and cases in which
children are lured to travel across statellines for illegal purposes.
Support to children involved in cases handled by United States Attorneys' offices is
offered through the Victim-Mitness Program. Each United States Attorney has a Victim-
Witness Coordinator, whose purpose is to assist victims and witnesses through the
criminal justice process. Services include referrals to appropriate organizations for
medical and financial losses. In cases involving children, many innovative approaches
have been utilized to support children. Some examples include: child victim impact
statements in which children particularly younger ones, draw pictures for the court to
understand the impact of the crime on the child; courtroom orientation programs with
court activity books and videos describing the trial process; and the use of child
attendants for those children too frightened to testify alone.
Evidence of Success: There are currently 34 VAWA cases pending in the United States
Attorneys' offices. In addition to those cases, the United States Attorneys have obtained
guilty pleas from six defendants. In at least 8 of these cases, children were involved
either as victims themselvi or as witnesses to the violence.
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OJJDP
4) COMMUNITY VIOLENCE
Recent research on the impact of community violence on child development (temperament,
cognition. and language development).
The Project on Human Development in Chicago Neighborhoods
Funding Level: $2 million mer fiscal year from 1993 to 1999.
Number of Clients Served 7000 children and youth.
Program Description: This inprecedented longitudinal study of 7000 children and youth
aims to study the development of criminal behavior from birth to young adulthood with a
particular focus on the effects of community and neighborhood contexts on individual
behavior. In 1995-96, 350 infants aged approximately 6 months were enrolled in the
Project to study the earliest manifestations ofjsocial and cognitive development.
Findings from this aspect of the study will inform early interventions designed to reduce
antisocial behayior, criminality, and violence. The Project is studying infant temperament
(e.g., activity level, negativity, frustration fear, impulsivity, soothability), cognition
(memory, information processing speed), and language development. These constructs
have been shown to predict conduct disorder, delinquency, criminal behavior, and even
school performance, in older children and young adults. The Project is also studying
child and parent exposure to violence in urban/neighborhoods.
Evidence of Success: Preliminary analyses from information provided by the child's
primary care giver indicated that
Fifty percent of pregitincies were unwanted.
Forty percent of the atants are in some kind of day care, over half of which takes
place outside the home and for more than 20 hours per week.
About 1 in 4 caregivers report clinical levels of depression or other mental health/
behavioral difficulties
Proposed Improvements: The Departmentof Education has recently provided funds for
the Project to reassess the infantsiat age|2 with the explicit objective being to
systematically and directly assess both home and child care environments. These data
will be examined for their impact on cognitive, emotional, and behavioral outcomes in
the children.
Practices in child development community policing.
The Child Development Community Policing (CD-CP) Program
Funding Level: In fiscal year 1997, $300,000 was awarded to document and replicate the
child-centered, community or oriented politing model.
Number of Clients Served During the first three years of the CD-CP program's operation,
more than 450 children were eferred to the consultation service by officers in the field.
Description: Many of ourchildren live incommunities where violence, fear, and despair
are commonplace. OJJDR's Child Deve opment-Community Policing Program (CD-CP),
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is a project in which the New Haven, Connecticut Police Department and the Yale
University Child Study Center developed a collaborative effort between law enforcement
and mental health profess onals in order to help these children and their families. CD-
CP, initiated in 1991, is an innovative partnership between police and mental health
professionals in New Haven, Connecticut which aims to address the psychological
burdens on children, families and the broader community of increasing levels of
community violence. In the CD-CP programs four years of operation in New Haven, it
has developed an approach in which child developmental principles are applied to the
day-to-day practice of community policing and clinical practice is informed by an
understanding of crime, violence and the community derived from contact with the
police. The project includes a 10-week training course in child development for all new
police officers and child dove opment fellowships forfcommunity-based district
commanders who direct eighborhood police teams. The fellowships provide 4 to 6
hours of training each week over a 3-month period at Yale's Child Study Center. A 3-
pronged system of support services is also provided 10 help maintain communication
among community members, police and related services personnel, and Child Study
Center staff. Fiscal Year 995 OJJDP funds supported program replication efforts in
Buffalo, NY; Charlotte, NO: Nashville, TN: and Portland, OR. Fiscal Year 1996 funds
supported the implementat on of the 5-phase replication protocol in the 4 selected sites.
Evidence of Success: The CD-CP program has provided a wide range of coordinated
police and clinical responses, including: round the clock availability of consultation with
a clinical professional and a police supervisor to patrol officers who assist children
exposed to violence; weekly case conferences with police officers, educators, and child
study center staff; open police stations located in neighborhoods and accessible to
residents for police and related services community liaison and coordination of
community response; crisi response; clinical referral; interagency collaboration; home-
based follow-up; and officer support andineighborhood foot patrols. Police officers in the
field are referring hundreds of children to the consultation service. The first calls,
involving children exposed to some form of violence, were made by officers who had
participated in the child development seminar, or worked in neighborhoods supervised by
the clinical fellows, or by the police supervisors themselves. As a result of the program's
work, significant institutional changes have taken place in both the police department and
the Child Study Center, such as established protocols for training officers in principles of
child development and training clinicians in principles of policing and criminal justice,
protocols for referral and consultation, regular collaborative meetings, and changes in
approach to traditional policing and clinical problems. In fiscal year 1996, 40 trainers
participated in 4-day replicati on training Additional presentations were made to over
1,000 practitioners in law enforcement, mental health, education and social service.
Proposed Improvements: Fiscal Year 1997 will support replication site data collection
and analysis activities, and evelopment of a detailed casebook about the model and
program. In addition, it will begin a partnership between the VAWA office, the Office
for Victims of Crime and OUDP to expand the project to additional sites, introduce a
more intensive domestic violence component, and add alschool component.
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OJJDP
Strategies for providing services 10 Native American and rural communities.
Children's Justice Act Discretionary Grant Program for Native Americans
Funding Level: $1,330,000
Projected Clients Served Victims of child physical and sexual abuse in Indian country,
professionals that work within the justice system on child abuse issues, child advocates.
Description: OVC is funding 17 Native American tribes or tribal organizations to
continue projects designed 10 improve investigation and prosecution of child physical
abuse and sexual abuse cases in a manner that lessens trauma to child victims. This
includes establishment and training of tidisciplinary teams, and specialized training
for prosecutors, investigators and other professionals who handle child sexual abuse
cases.
Evidence of Success: Client satisfaction and establishment and maintenance of
comprehensive programs
Proposed Improvements: Ongoing evaluat on of programs identify sitc-specific
improvements.
Children's Advocacy Centers in Indian Country
Funding Level: $50,000
Projected Clients Served Child victims of crime in Indian country.
Description: OVC is funding two tribes to establish or strengthen Children's Advocacy
Centers in Indian country. These Centers are child-focused, multidisciplinary settings
that provide a coordinated strategy to meet the needs of child victims in the criminal
justice system.
Evidence of Success: Client satisfaction and the establishment and maintenance of
Centers.
Proposed Improvements: Proposals to improve this program will be based on project
results.
Tribal Court Appointed Special Advocate Programs (CASA) (with OJJDP)
Funding Level: $60,000
Projected Clients Served: Children in Indian country in the tribal justice system.
Description: OVC is supporting the continuation of two CASA programs in Indian
country, which enable trial court systems to assign advocates to represent the best
interests of Native American children.
Evidence of Success: Client Sati staction and utilization of advocates.
Proposed Improvements: None
Interagency Agreement with Indian Health Service
Funding Level: $25,000
Projected Clients Served: Child protection and/or multidisciplinary teams in the Phoenix,
Arizona area, and their child clients.
Description: OVC is providing funding to the Indian Health Service (IHS) to develop and
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OJJDP
7
conduct two training seminars for child protection and/or multidisciplinary teams in the
IHS Phoenix, Arizona area. The seminars will focus on child sexual abuse issues and the
development of strategies to resolve these issues.
Evidence of Success: Seminar evaluations
Proposed Improvements: Will be developed from evaluations.
* *
In the areas of domestic violence and community violence, an appropriate and impactful
Department of Justice initiative would focus on expanding the Child Development Community
Policing program and Unified Family Courts, bui ding on community building efforts and the
current energy in the field around community justice.
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5) MISSING AND EXPLOITED CHILDREN AND CHILD SUPPORT ENFORCEMENT
Research on the impact of parental abduction on child development.
Second National Incidence Studies of Missing, Abducted, Runaway and
Thrownaway Children (NISMART II)
Funding level: In FY 95, OUNDR funded Temple University's Institute for Survey
Research to conduct NISMARTII The initial $1.5 million cooperative agreement
included survey design and development, pilot testing new instruments and partial data
collection.
Number of Clients served The research consists of multiple study components. The
Household Survey will select and interview an estimated 23,000 eligible households
concerning 40,000 children via random digit dialing survey methods. Studies of police
records in approximately 600 law enforcement agencies will be conducted to study
stereotypical kidnapings and stranger abductions. An estimated 90 such cases are
expected to be identified for study.
Program Description: The goals of NISMART II are to update the 1988 NISMART I
study, providing the publiciand policy makers with valid estimates of the numbers and
characteristics of children who were missing, abducted runaway or thrownaway during a
one year period compared to results ten years ago, the number of missing children
incidents reported to the and/or known to be missing and the number who were
recovered. The purpose of this research is to: better understand the extent and nature of
these problems for America's children, the risks associated with these episodes, and the
law enforcement's response Ultimately the aims of the study are providing study results
for the prevention of child victimization and effective intervention by law enforcement.
Evidence of Success: The 1988 INISMART study was the first commissioned research to
carefully define and count the number of children missing for a wide variety of reasons. It
was the first to provide scientific evidence of the extent of parental abductions of
children, the circumstances of the abduction, the duration, harm to the child, etc. The
research helped to better focus policies on target populations at risk.
Proposed Improvements: A number of methodological improvements are planned.
NISMART II will be conducting interviews with a much larger sample of children in
order to capture sufficient numbers of rare abduction cases. In addition, all children ages
10 years and older will be interviewed directly about their "missing" experiences as well
as other types of victimization, primarily sexual assault Parents and guardians will
continue to be interviewed regarding the experiences of their children under the age of 10.
In addition, OJJDP will release a report on Child Abduction and Juvenile Sex
Offending."
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Examples of local, state and international support in reducing parental kidnaping and
reuniting families.
Reducing Parental Kidnaping and Reuniting Families: National Center for Missing
and Exploited Children NOMEC)
Funding Level: $3,444,968
Number of Clients Served NCMEC has played a role in the recovery of 34,000 missing
children since 1984.
Description: As authorized by Gangress in the Missing Children's Assistance Act,
NCMEC serves as a national resource center and clearinghouse dedicated to missing and
exploited children's issues including a 24-hour hotline.
Evidence of Success: NOMEC has distributed thousands of publications with practical
advice for law enforcement, parents, prosecutors, and other professionals working on
missing children's issues. Through an online network linking 49 States' missing
children clearinghouses, the center is able 10 transmit case information and photographs
of missing children instantaneously.
Proposed Improvements Through the Jimmy Ryce Law Enforcement Training Center,
OJJDP, NCMEC and the FBI are working to improve the national response to missing
children's cases through a training and technical assistance program for law enforcement.
In addition, the FBI and Criminal Division participate in the Hardiman Task Force, along
with five other federal agencies. The Task Force was created to make available the
combined resources and expertise of these federal law enforcement agencies to assist
state and local governments in the most difficult cases of missing and exploited children
nationwide, as identified by theidhief of the Task Force. in consultation with the National
Center for Missing and Exploited Children The Task Force recently sent two members
to Belgium to assist that country) effort to combat its problem of child exploitation.
Police Training in Identification and Response
Funding Level: Approximately $750,000 per year.
Number of Clients Served: Approximately 4,000 law enforcement officers, prosecutors,
child protective services personnel and medical personnel are trained every year.
Description: Title IV Training and Technical Assistance focuses on providing
information that highlights the most recent research and trends in investigative techniques
for all types of missing and exploited children cases These courses contain modules
pertaining to interview and interrogation techniques, investigative strategies, lead and
development. case management, media relations, liability concerns, and comprehensive response plan
Evidence of Success: Success of the training can be gauged by the increased usage of the
FBI's National Crime Information Center to document missing children and the fact that
99% of America's missing children are recovered.
Proposed Improvements: The Department will continue to monitor and research emerging
criminal trends in the victim zation of children and disseminate proactive investigative
techniques and methodologies to reduce threats to America's children.
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Office of Crimes Against Children
Funding Level:
Number of Clients:
Description: The Department of Justice has established a new office of Crimes Against
Children in its Violent Crimes and Major Offenders Section, Criminal Investigation
Division, FBI Headquarters. The creation of OCAC was in response to governmental and
public awareness of the significant crime problems that exist with respect to the
victimization of children of tender years. In addition to addressing sexual assaults and
sexual exploitation of children, which includes Sex Tourism violations, the OCAC will
be responsible for international parental kidnaping matters as well as Unlawful Flight to
Avoid Prosecution-Parental Kidnaping and child Support recovery Act investigations.
Evidence of Success:
Proposed Improvements:
Strategies for ensuring child support.
Criminal Child Support Enforcement
Funding Level:
Number of Clients Served:
Description: While states hear primary responsibility for criminal prosecutions, DOJ
has a much narrower bur equally significant responsibility in bringing federal criminal
prosecutions under the Child Support Recovery Act ("CSRA") in the appropriate
interstate cases. While criminal prosecution is not a practical or appropriate primary
mechanism for collecting child support, in appropriate cases, criminal prosecution will
punish egregious offenders, obtain support and deter wrongdoing. DOJ has taken
numerous steps to strengthen criminal child support enforcement, including compliance
with President Clinton's July 21. 1996 Directive to the Attorney General: 1) convened
a task force on criminal child support enforcement, comprised of federal, state and
local prosecutors, FBI, HHS, Internal Revenue Service, and state IV-D agencies; 2)
drafted legislation to amend the CSRA to create two new felony offenses for egregious
failures to meet child support obligations; 3) sent written guidance on best practices on
referrals, investigations and prosecutions to every U.S. Attorney's Office and FBI
office; 4) increased federal child support investigators by granting HHS Office of
Inspector General Special Agents authority as Special Deputy United States Marshals to
conduct investigations and initiate arrests for these offenses; 5) launched a
comprehensive employee education and awareness program in full compliance with
Executive Order 12953, which targets employees entitled to child support and those
who owe child support; and 6) revised Attorney General Guidelines for Enforcement of
CSRA.
Evidence of Success: These recent efforts have resulted in a substantial increase in the
number of federal child support prosecutions. From October 1994 to October 1996,
the Department prosecuted over 230 CSRA cases.
Proposed Improvements: 1) Expansion of the DOJ employee program.
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OJJDP
Child Support Training of State Judges on Full Faith and Credit Issues
Funding Level: NA
Number of Clients Served: NA
Description: In an effort to ensure that children receive from their noncustodial parents
the court-ordered financial support to which they are entitled, the Department has
embarked on a "campaign" to educate state court judges about the existence of the
Federal Full Faith and Credit for Child Support Orders Act of 1994. We have also sought
to encourage states to adopt the Uniform Interstate Family Support Act (UIFSA). Both
statutes are designed to foster the concept of full faith and credit as it relates to
enforcement of child support orders. The Department has sought to raise awareness of the
need for reforming outdated child support legislation with state legislatures, with state
court chief justices and at conferences
To foster the goal of increasing the number of children receiving the child support to
which they are legally enti led last fall the Department, along with the Department of
Health and Human Services and the State Justice Institute, funded the creation of several
types of educational materials for state judges on UIFSA and the federal statute, including
computer-based training and a benchbook (cost of approximately $32 thousand to the
Department).
Evidence of Success: NA
Proposed Improvements: NA
Child Support Training of Federal Prosecutors
Funding Level:
Number of Clients Served: SI
Description: On February 25 and 26, 1997 eighty-one federal prosecutors attended a
seminar, sponsored by the Office of Legal Education, on prosecution of child support
cases. Instructors from the Criminal Division and other Department of Justice
components lectured on ethical and legal issues and Department policies regarding CSRA
prosecutions.
Evidence of Success:
Proposed Improvements: The Department proposes conduction such training every two or
three years, as funding is made available.
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6) TEEN PREGNANCY AND STATUTORY RAPE
Strategies for police and prosecuto enforcement of statutory rape laws as a means for
reducing both statutory rape and teen pregnancy
Statutory Rape and Teen Pregnancy Study
Funding level:
Number of Clients Serverl:
Description: Laws pertaining to statutory rape Mary from state to state. To date there is no
Administration policy this issue However, the recently enacted Welfare Reform
legislation stipulates that by no later than January 1 1997, the Attorney General will
establish a program that studies the linkage between statutory rape and teen pregnancy,
and that educates law enforcement officials on the prevention and prosecution of statutory
rape. Research being conducted by the American Bar Association and Progressive
Foundation will be very helpful in fulfi ling this obligation.
Pursuant to a directive in the Personal Responsibility and Work Opportunity
Reconciliation Act of 1996, the Department is establishing a program to study the link
between statutory rape and teenage pregnancy, with particular focus on repeat offenses
committed by predatory older men.
Evidence of Success:
Proposed Improvements: In an effort 10 share the information generated from a review
of state and local statutory rape initiatives and prosecutorial practices, the Department
will sponsor a symposium for prosecutors and law enforcement officers on the benefits
and limitations of current statutory rape prosecutorial practices in June 1997.
Programs for Young Women
Practical and Cultural Education Center for Girls, Inc., (P.A.C.E.)
Funding Level: $300,000 for August 1994 to July 1996
Number of Clients Served:
Description: PACE seeks o improve the quality of life for at-risk girls between the ages
of twelve and eighteen in Pensacola, Tallahassee, Jacksonville, Orlando, Bradenton, Ft.
Lauderdale and Miami, Florida PACE focuses on 1) providing accredited high school
completion and basic skills education; 2) developing and implementing a career
placement plan; 3) preventing substance abuse through education and counseling; 4)
preventing teenage pregnancies; 5) teaching cultural awareness; 6) enabling young
women to choose a safe environment free from violence and abuse; 7) teaching
responsible health choices and 8) encourag involvement and volunteerism in the
community.
Evidence of Success:
Proposed Improvements:
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Challenge Activity E Gender-Specific Programming for Youth
Funding Level: The Challenge Grants Program was initially funded at $10 million in FY
95 and this amount has remained constant through FY 97. Challenge Activity E is one of
10 Challenge Activities that can be selected and 23 States have chosen Activity E in FY
95 and FY 96. States are able 70 spend the equivalent up to 10% of their Formula Grant
allocation on each Challenge Activity. The amount of Challenge funds budgeted for
Activity E by States is approximately $1.6 million
Number of Clients Served:
Description: The Challenge Grant Program was designed to provide States with seed
funding to promote juvenile justice systems change and improvement efforts. Funds can
be used for ten specific program areas. Through Challenge Activity E, Gender-Specific
Programming for Youth, States are developing and adopting policies to prohibit gender
bias in placement and treatment Programs are being established to ensure that female
youth have access to the full tange of health and mental health services, treatment for
physical or sexual assaul and abuse, self-defense instruction, education in general, and
other training and vocational services. By providing appropriate services and skills
training to girls, their very young children, and future children, will benefit too because
health, sexuality, and psycho-social development education and assistance is provided
through this Activity.
Evidence of Success: Challenge Activity E has been the program activity that has been
selected more than any other Challenge Activity which indicates the great amount of
interest and need. Twenty-four states selected Challenge Activity E and have found that
these seed grant funds have assisted them in their efforts to develop appropriate
interventions to address chromoc status offender-type behaviors, develop vehicles to work
towards developing the full potential of female youth, and to provide training to juvenile
justice professionals so that they are able to respond to the needs of female youth more
effectively.
Proposed Improvements: One unprovement for consideration would be to require that the
interventions pursued be evaluated for effect iveness and impact.
Trafficked Women and Children in Transition: A Protocol for Community Service
and Support
Funding Level: $70,000
Projected Clients Served: Women and children generally immigrants, who have been
enslaved in the garment onsex slave industry
Description: OVC is funding the Hilipind American Service Group (FASG), a private,
nonprofit service organization in Los Angeles, California, to provide victim serves to
women and children who have been enslaved in the garment or sex slave industry.
FASG will also develop a protocol for the INS and Administrative Office of the U.S.
Courts to use when releasing these victims into community care.
Evidence of Success: Funding is beginning. Success will be measured by client
satisfaction, quality of materials produced
Proposed Improvements: None this time.
28
Obviously, with the Administration emphasis on making Welfare Reform work, program
development and collaboration with other agencies in this area would be of interest to the
Department of Justice.
29