Child Care and Health in America: Today’s Challenges for Tomorrow’s Children


[MUSIC PLAYING] JOE NEEL: Hello and welcome. I’m Joe Neel. I edit health and health
policy at National Public Radio in Washington and
I’ll be your moderator today for our discussion
on child care and health in America. A few details to start
with– this event is presented in collaboration
with the Harvard T.H Chan School of Public Health,
the Robert Wood Johnson Foundation, and NPR. Both the Forum and NPR are
live streaming this event on their respective websites. The Forum is also streaming
this on their Facebook page. We’re going to have a
wide ranging discussion today of child care
and health and I hope it’ll be as informative to
the parents who are watching, who face many of the challenges
in child care that exist– cost, affordability, quality–
and also to the policymakers and other people who work in the
field of childhood development who may be watching. I’m going to get started
with some introductions. To my immediate right
is Gillian SteelFisher. Gillian is Senior Research
Scientist and Deputy Director of the Harvard Opinion Research
Program at the Harvard T.H. Chan School of Public Health. To her right is Susan Hibbard. She’s the Executive Director
of the BUILD Initiative, which we’ll be hearing a
little bit more about later. On her right is
Kristin Schubert, Managing Director at the
Robert Wood Johnson Foundation. And joining us remotely
is Rachel Schumacher. She’s Director of the Office
of Child Care at the US Department of Health and
Human Services in Washington. The program will include a
brief question and answer period near the end, and
you can email your questions to the forum at
hsph.harvard.edu. You can also participate
in a live chat that’s going on right
now at the Forum website. During our conversation
today, as I mentioned earlier, three words are going to be
mentioned many times– cost, quality, and affordability. We will try to sort out
what those words mean from various perspectives
of our panelists and I want to first
turn to Gillian. Gillian, the reason we’re here
today is NPR, the Foundation, and Harvard have just released
a poll on child care and health in America and you
know all about that. Give us some of the highlights. GILLIAN STEELFISHER:
Well, thank you so much. It’s great to be here today
with colleagues and others. So this poll is a nationally
representative snapshot of more than 1100 parents
across the country who have a child age 5 or
under who is in child care. And what I mean by
child care is any kind of care from someone other
than a parent that is regular. So that could be
another relative, it could be a nanny
or a babysitter, it could be in-home
child care center, or it could be a preschool. We try to capture the full
spectrum of experiences from parents so we could
give voice to their day to day experiences,
both in terms of the challenges of finding
affordable, high quality child care, and also the benefits
that that brings to them. So let me share with you a
couple of the key findings from that poll, and I’m going
start with a couple of slides, and start off with the first
of those three topics, which relates to quality. And I’m going to start by saying
that the results of the poll really show there may be a
gap between what parents see in terms of the quality
of their child care, and what expert
assessments have been about the state of child care
in the United States today. So here I’m going to show
you some data from the poll, tell you what
parents are saying. And in this particular
question, we asked parents to rate the
quality of the child care that their child receives. And we said, tell us what it’s
like from excellent to poor. And what we see is that
a majority, a full 59%, say excellent. That’s the highest
rating that can be. Now, we asked about
other particular features of childcare that might
contribute to quality. We asked about things like
safety, the experience and training of the providers,
preparation for later schooling, physical education. And again, large shares of
parents are saying excellent. Now, this is a
pretty rosy picture, and may seem like
good news at first. But when we contrast
this finding with the other kinds of reports
about the state of child care, we see there may be a gap that
parents are rating this as very high quality, but some
of the expert assessments would suggest that, in fact,
the state of child care today is not high quality. So for example, one
of the seminal reports from the National Institute
of Child Health and Human Development suggests that the
vast majority of child care is more in the
sort of fair realm. JOE NEEL: Something on the
order of about how much? GILLIAN STEELFISHER:
The vast majority. JOE NEEL: The vast majority. GILLIAN STEELFISHER: Yeah,
absolute, sort of in contrast to what we see in this poll. So this suggests that there
may be disconnect between what parents see and they may not
have all the information, they may not know all
the different aspects that an expert would have. They may benefit from
some of that information. So we’ve talked about the
first of your three, quality. So now let’s go to cost. And here what we see
is another highlight from the poll where you can
see that parents are really feeling the cost pinch. So in this slide, we
show the parents who are paying a fee for child
care, we said, which of you does the cost of child care
present a financial problem for your family? And we see that a
third, about 31%, say that it presents
a problem for them. That’s a pretty large share. But what makes it more
poignant is we actually focused on people who said their
financial situation was already strained, that it was not
really as strong, that now we have a majority, 61%,
saying that it’s presenting a financial challenge for them. That’s a really
large percentage. So, third point. We’ve now talked about
quality and cost, let’s talk about access. So what we see in–
to the next slide– is that a majority of
parents say that they face limited child care options. They may have only a few or
just even one realistic option for care. And again, we begin to see
in this part of the findings that these three issues
are really interrelated. That is that again,
these share of parents who are feeling more
financial strain, they’re also the ones who are
more likely to say that they don’t have as many options. So, these three factors are
kind of coming together. JOE NEEL: And when
it says people only have one option, typically
that would be what? Do we know? GILLIAN STEELFISHER: We don’t
know necessarily what it is. But the point is that
for them, they have this very limited resource. And they need it. And I think that’s a great
segue into the final point that I’ll share from the poll,
which is that child care is actually incredibly
important for parents, and it provides them
a great benefit. Now, we just said that they say
that the quality of their child care is excellent,
so probably not surprising that they think
it benefits their child. What may not be as
obvious from the beginning is that it actually
benefits them as well. JOE NEEL: And we have
another slide coming. GILLIAN STEELFISHER: Let’s
turn to the next slide. Last one. So parents believe
that the child care is good for their families on
an array of characteristics. And it’s not just
their job, although we see that more than 40% say it
is a benefit for their job. It’s not just their job. It’s also their overall
well-being and perhaps most importantly, their
relationship with their child. So this is a dimension that may
be not as talked about as much from the perspective
of child care. So pulling this together, we see
that cost, quality, and access are key issues. They may not be where
they need to be today, and yet this is a resource that
is so critical for families. JOE NEEL: I should
just say that we’ve started a series of reports
on NPR on the radio and online that we’ll be rolling out
over the next several weeks, looking at each specific issue
that Jillian’s talked about and other things that the
poll revealed that we’ll also be talking about here. But I want to go on
next to a video clip that we have from
a 2015 documentary called The Raising of America:
Early Childhood and the Future of Our Nation, and we chose
it because it documents how parents can find
themselves in such a tough spot like Gillian was
talking about, trying to balance the care
of their children and the other demands on them. And I should note
that in addition to the story of one family
that’s presented here, the family is Erica
Burks-Cummings and Leroy Campbell, we’ll also be hearing
from a pediatrician, Renee Boynton-Jarrett at
Boston Medical Center, if we can have that clip. ERICA BURKS-CUMMINGS:
I work 40 hours a week. Leroy works sometimes
60 hours a week. He works a split shift. So like, 2:00 in the
afternoon to about– LEROY CAMPBELL: When I’m done. ERICA BURKS-CUMMINGS:
1:00, 2:00 in the morning. NARRATOR: Leroy is a driver
and mechanic; Erica, a nurse. Combined, they work more
than 100 hours a week. In fact, Americans work more
hours annually than most all of our peer nations. LEROY CAMPBELL: In today’s
date, we all gotta work. I can remember back in
like, my grandfather’s days, and all the men worked. The ladies, the woman stay
home and take care of the house and family things like that. In today’s date, it
surely can’t happen. Everybody got to go
and work and– you know what I’m saying– bring it in. NARRATOR: A growing
percentage of Americans work unreliable,
precarious schedules which can change from
week to week depending on employer’s demands. ERICA BURKS-CUMMINGS:
Here, and that’s something that we have to work on. I do rotating nights, so
I’m on nights this week. And so the next week
then, I’ll be on days. So it kind of
balances out that way. RENEE BOYNTON-JARRETT: Parents
are juggling, shifting, trying to balance a variety
of competing demands that there just don’t
seem like there are easy or reasonable solutions. It leads to a level
of tension and stress. Is this what we’ve
decided as a society, that this degree of tension,
these complex tradeoffs, are the norm, to be expected,
just a part of raising a child? JOE NEEL: Rachel Schumacher,
I want to turn to you now. That clip showed
the juggling act that many parents need to
do every day and every week. Talk if you would
for a few minutes about the many
challenges parents are facing in trying
to secure the health and the child care
their children need. RACHEL SCHUMACHER: Sure, thank
you, and thank you so much for having me here today. I think that this
clip and this survey show something that really shows
the incredible shift in America that we are starting
to recognize that child care is essential
really for two generations. It’s not just a work
support, although it’s desperately needed. It really promotes
child development. And these parents in this survey
are recognizing how important that experience is for their
children’s future, their school readiness, and their development
for the rest of their lives. They’re right. Research has shown for over
a decade how important child care is to really promoting
those early trusting relationships that help children
learn, help children trust and learn how to
work in a group, learn how to be successful in
life and persist in challenges. And at the same
time, the parents are, as you said,
very stretched. They have a hard time
finding what they can afford. The average cost of care in
this country for an infant, it actually rivals the cost
of a year at a public college, for a year of college education. And that’s something
that a lot of parents aren’t prepared for when they
do have their first child. They’re surprised to
find out that they need to get on a waiting list to
find that child care that they really want down the street,
that it might take longer than they have as leave to be
able to get into that program. And that it’s going
to eat up a huge chunk of their take-home pay. And that’s something a
lot of young families are not prepared for. At the same time, we know that
the folks that are actually providing the care, the
teachers and the caregivers, are not making very high wages. In fact in every
state in this country, according to some
analysis we’ve done, the median take-home salary, the
median income for these folks, would make them eligible
for the SNAP program, which is the food stamps program in
every state in this country. And yet, these folks
are charged with really helping educate young
children, supporting parents. I love that the survey showed
how much parents appreciate that connection they have with
their child care provider. These folks are doing
incredible work, and they need the skills
and the qualifications to do it and the salaries and
they’re currently not getting it yet in this country. JOE NEEL: And talk for
a moment, if you would, about why the quality of
child care is so important. RACHEL SCHUMACHER: Oh yes,
that’s a great question. When children experience this
early learning environment, they’re in care on
average for working parents, 35 hours a week. So we often think about learning
and preschool and starting at the K to 12 age,
but that’s not true. Early childhood brain
development in the first three years lays a foundation for
what these children are going to be able to do, their
attitudes toward learning, their ability to form a
trusting relationship. They need continuity
with that caregiver, they need that
caregiver to provide a lot of language
and stimulation and help them understand
their feelings. If that’s not going on in
that early environment, it really is a
missed opportunity for these young children
that will affect them as they go forward
in their school and later on in the rest
of their working career. JOE NEEL: And of course, it also
reverberates through the family too, as the poll showed. Parents benefit from child care
and high quality child care. RACHEL SCHUMACHER:
Oh, absolutely. I think that’s one of the
things I was particularly struck by in looking
at the survey results, is that a really high quality
caregiver is partnering with those parents. They’re talking to them about
what they’re seeing at home and telling them what they’re
seeing in the caregiving situation. They’re puzzling through how
to help with stranger anxiety and how to help the child learn
how to deal with new situations and how to get along
with their peers. And those exchanges
are incredibly important for young
parents to get, especially first-time parents. If they have that
partnership, they can really be shored
up in their own work and feel confident when they go
on to their work or education, whatever it is they need
to do that their child is in a safe environment,
that they’re getting the stimulation that
they need to learn, and that they
really can come back and know that that child
will be happy to see them, but also have a really
wonderful learning experience in their child care setting. JOE NEEL: Thank you. All of that, of course,
speaks to quality, which we’re going to continue
talking about here a lot today. Let me turn now
to Susan Hibbard. You had an organization
called the BUILD Initiative that helps state leaders
develop early childhood systems. As a part of that, you’re
helping states and others develop quality rating systems. I’d like to hear
more about that. But first off, can you tell
us what people in the field mean when they talk
about high quality and tell us how that
might be changing? SUSAN HIBBARD: Sure. I too thank you
for having me here. And just great points
that people have raised. The definition of quality
has really changed over time, especially when you
think about what I’m going to address, quality
rating and improvement systems. When people started looking
at the level of quality in child care, they
were really looking at a disconnect between the
licensing requirements and what they knew to be safe,
healthy, nurturing environments for children, for
young children. And so quality rating
and improvement systems and the focus on quality
were raising the floor. Now, when we talk about quality
in a child care setting, our expectations for that
setting are much, much higher. As Rachel talked about, we’re
talking about the development of relationships and
attachment between the adult and the child. We’re talking
about play and play as learning and really
intentionally organizing the day so that the child
can explore their interests, expand their language,
gain confidence, gain in peer relationships. It’s a much more demanding
set of criteria for quality. And quality rating and
improvement systems are really a constantly changing
but still in their infancy set of strategies
that are looking at defining quality, measuring
it, helping to communicate with family members and with the
folks who pay, which could be the private payers, could
be the accountability to the government,
communicating what quality is and then improving that quality. And in many ways, it’s a
continuous quality improvement set of strategies so that you
reach a level of one or two stars, and it’s
defined what it would take to get to a higher
level of quality. It’s a strategy that’s emerged
with enormous potential. Each of the QRIS in
the country, and now there are QRIS in 49 states,
in many of the territories, and now– JOE NEEL: And it’s QRIS? SUSAN HIBBARD: Quality Rating
and Improvement Systems. JOE NEEL: OK, thank you. SUSAN HIBBARD: We
like the I the most, but some people focus
on the R, the rating. All QRIS have tiered quality
standards, and ratings that go with those
standards so that one star, two star, or whatever
the symbol is, each one has a higher
set of standards and then supports for quality
improvement, a communication mechanism, and then
some kind of financing. But after that,
states really differ in what a QRIS is or can do. And initially, communication
was the idea, sort of related to the poll, that
if a parent saw that this was a higher
quality center by the rating, the parent would
choose that center. So it was a way of
educating the parent, creating demand for quality,
giving an incentive because of the increased demand for
the programs to increase their quality. So it was sort of a win-win
communication mechanism. Well, that’s a
great idea and it’s beautiful to communicate like
that about the idea of QRIS. But as Gillian pointed
out, so many parents don’t have multiple options. And the options in
the community or that are affordable may not
be of high quality. And I think it’s human
nature that we all need to feel that our
children are in a good setting when we go off to
work, or we wouldn’t be able to survive the day. So there’s just a level of
human nature kicking in there. So now I think QRIS
are sort of at a stage of recognizing
that they’re a push to help keep promoting quality. The field recognizes that
cost availability and location are going to keep
being key issues, especially when
transportation is such a challenge
for poor families, and that therefore we need
to invest in the quality and increase the number
of quality programs, not just communicate which ones
are quality but actually create quality so that all
families with young children can have that
positive experience and know that the children
really are not just safe, but that their brain
development is engaged, that those first 1000 days
are being put to good use and the child is able
to just naturally expand their curiosity and learning. JOE NEEL: I have one question
that I don’t want to put anyone on the spot right
now, but I want you to be thinking
about it because when we have the question and
answer session later, I will raise it again. It’s 2016, why are we only
now thinking or getting started with quality rating
systems that parents can use? We have quality ratings for
just about everything else in our life, including
restaurants etc. So why can’t we get something
more basic than this? But I’ll come back
to that in a minute. The Q&A, I want to go next to
Kristin Schubert of the Robert Wood Johnson Foundation. To put this in a broader
societal perspective, the Foundation for
several years now has been talking about
a culture of health, emphasizing this idea that
it’s not just health care, it’s a whole societal
effort to improve health. Help us understand,
if you would, how these poll findings
are fitting into the bigger picture. KRISTIN SCHUBERT:
I’m happy to, Joe. I’ll go into your question
for a second, though. I think Renee
Boyton-Jarrett said it best. Is this what we’ve
decided is the best we can do for our children
in this country? So I’d love to pick
that back up with you. I’m so pleased to be here. This is a critical issue for
us as a health and health care foundation and for our society. I am very blessed. I get to work for an amazing
organization, the Robert Wood Johnson Foundation. Our vision is to build
a culture of health for everyone living here. And really central
to that is ensuring that all of our children get
off on the best foot possible. I’m also though, blessed because
I have an amazing family. And I’m telling you
this because I remember too well about
nine years ago when I was having my first child, I
was ready to go back to work. And Rachel, I was
unprepared, for sure. I really struggled to
find him the right care. We bounced around from
a neighborhood setting, then I pulled him out of that
and we did some in-home care. That didn’t work
out, and we finally landed on a center-based
setting for him. That year was
enormously stressful. And I was a really
well-resourced person, and I was able to
piece it together. I worked for a great place
that allowed me the flexibility to manage through all of that. And I had an incredible
family who could see me through those ups and downs. So many people don’t have that. And what this poll shows us
is that too many parents, too many families
face huge barriers to access and care
for their kids. And yes, it’s
about their ability to be able to
engage in their jobs and support their families. But there are so many
other benefits too, that this poll highlights. In 2/3 of US families,
both parents work. And so many of our kids
are also being raised now by single-parent
households as well. So it really is
incumbent that we do a much better
job in this country in helping them find the right
care that fits their needs, and care that’s affordable. So there’s a number of
things we need to do to improve this situation. I know we’ll get into some
of those in the conversation. Yes, we need to close
this information gap. Too many of us have no idea
what quality looks like, but we also need to
create the demand to build more opportunities
and more options for people. You heard from Leroy and
Erica, that’s a common story. For so many of our
families, we need to make sure that they
have options that are flexible to fit their needs. That is much more common of a
story than not in this country. And the last thing I’ll say
is that we just frankly need greater investment in all of our
children, all of our families. I really enjoy listening
to John Pepper, he’s the former CEO
of Procter & Gamble. And he says that
90% of brain growth happens in the first
five years of life. And during this
time, we as a society invest 5% in high
quality child care. What a disparity. So I’d love to get into
a conversation about that and how we can
create a shared norm, a shared value for all of
our kids and families here. Thanks. JOE NEEL: All right. Thank you. The second part of the
Forum, we’ll turn to now. This is where we
address the issues and talk about
possible solutions and answer some of the
questions that have been raised. I want to turn back to Gillian
first and start with you. How can the poll
results– we’ve heard a little bit about how they’re
informing the conversation. But tell us more about
how you think that they can help guide policies. GILLIAN STEELFISHER: Sure. Well, I think the poll
findings really support a lot of the pieces
that I and my colleagues have been talking about. First and foremost,
they really do suggest in terms of
the gap in information, that we need to be
able to fill that gap. We need to be able to find them
information that’s relevant that supports them, not just in
selecting a child care center, as we said, because
they may not have multiple options to select. But in providing
them information about what it is they
need to look for, what do they need to do
to elevate and to have that conversation with
their provider about what high quality care means
for them in that context. So that certainly
speaks then, and I think my colleagues
will be able to talk about some particular
strategies for doing that. And then of course, the other
two dimensions here in terms of access and accessing
affordable high quality is really central. And the findings speak to
all these three intertwining dimensions of the issue. JOE NEEL: Great. I have another clip. I want to turn to that now. It shows an example of
an innovative program in my home state, Oklahoma. Oklahoma was the
second state in the US to offer free preschool
for all four-year-olds. And this video was
produced by my colleagues on the education team at NPR. GROUP: My eyes are
facing forward. I’m standing straight and tall. My hands are behind my back. I’m ready for the hall. Five, four, three,
two, one, zero, zip. PRESCHOOL INSTRUCTOR: This
is their first experience in school for the most part. A lot of them have been
in daycare or some sort of child care setting. But then when they
come to public school, it’s just different. GIRL 1: Can you take
me to the party? GIRL 2: Sure. Can you drive? GIRL 1: Yes. PRESCHOOL INSTRUCTOR:
In my classroom, I use a project
approach to learning, and I let the kids
guide the curriculum. What do you think of that idea? ALL: Good! PRESCHOOL INSTRUCTOR: Yeah? I think that it’s more
important for the children to determine what the curriculum
is so that they stay engaged. If they’re not engaged, then I
spend my day managing behavior versus letting them be able
to discover and explore and construct their own
knowledge of something. BOY: How do I put
this paint shirt on? PRESCHOOL INSTRUCTOR:
We spend a lot of time learning what patience
is and waiting, because life is full of waiting. And so I draw their stick
with their name on it and then I ask them to tell me
where they’re going to play. Sean, where would
you like to play? SEAN: I don’t know, [INAUDIBLE]. PRESCHOOL INSTRUCTOR: Where
would you like to play? With these? OK. That holds them accountable. That is them saying, I’m
going to go play in the dough. So they know they’re going
to go to the sensory table and play in the dough
that they claimed that spot, they’re going
there, they claimed their play. JOE NEEL: I think it’s
great that patience is being taught in preschool. [LAUGHTER] I think we could teach it
throughout life and adult learning, too. Anyway, enough of my comments. Of course, making child care
affordable through programs like free preschool
for four-year-olds is really on the leading edge
of trying to improve child care. But all these things
are intertwined, as Gillian said– affordability,
access, and quality. But let’s go through
and talk to each of you about various aspects
of this, and I’ll start with affordability
and turn to Susan. And let’s talk about
tax strategies. Can tax credits and
other things help? What needs to be done? SUSAN HIBBARD: Yeah, tax credits
are an important financing strategy related to
child care tax credits for parents, make
quality more affordable. Tax credits for providers,
caregivers, teachers are like a wage supplement. And tax credits for
businesses are an incentive to support quality child care. So tax credits could be, and
they are right now, important, but they could be a
significant player in improving quality and
supporting access to quality. Right now, a lot of
the tax provisions that we have related
to child care benefit higher income
working families rather than the lowest income
working families, which limits their usefulness. Part of the reason
for that is if you look at the federal child
independent care tax credit, it’s the model. The benefit isn’t
refundable, which means if you don’t owe
taxes, you don’t get it. The amount is capped at an
unreasonable amount that doesn’t relate to the college
education costs of childcare for infants that
Rachel pointed out. It’s unrealistic, and you
can only get to 20% to 35% of that cap. And then the credit
isn’t playing a role in terms of quality. It isn’t linked to the
quality of the center. And most of the states
follow the federal example and mirror those provisions. But some states are
giving a double credit for quality centers,
for opting for quality. And some other states
are really paving the way for what may be part
of the financing sort of answer to some of the dilemmas. Louisiana has a school
readiness tax credit, and they’ve had it since 2007. And it’s a package of
refundable income tax credits that are connected to their
Quality Rating and Improvement System. The parents get credits for
selecting a higher quality center that’s in the
Quality Rating System. The child care
provider gets credits. And the range is $750
to $1,500 per child, who’s in subsidized, funded
child care, foster care. The directors and the staff in
centers in the Quality Rating System get credits for
educational qualifications. And then businesses
can get credits for supporting centers that are
in the Quality Rating System. So other states have
been looking at that. And what we do at BUILD is
create a learning community where state leaders can
share their strategies across borders. It is sort of sad that in
2016, we are this rudimentary. But the field related
to women and children is underfunded in every way. And so having a learning
community and a way for innovations like Louisiana’s
to be shared across state borders and to help people
problem-solve together to sort of diffuse
promising strategies and to put researchers and
implementers together, both so that we all know the latest
research and the findings, but also so that the researchers
have some reality testing and recognize that
there are things going on out in the world that
need to be looked at and maybe in a different
way than they were before. So I think we’re seeing a lot
of potential for tax credits. And I hope that we’ll see
the federal administration look at how they
could be something that when the states
emulate, it actually will help the lowest income
families who need the most support. JOE NEEL: Well, it
occurs to me while I’m listening to what you’re
saying that yes, it’s a noble goal and a desired goal
to increase the affordability to low income families. But I hear a lot of people in
middle class and upper middle class families complain
about this too. So are you saying that we
should restrict tax credits just to families who need subsidies
and perhaps don’t need a– where do you draw the
line, because we can’t give– SUSAN HIBBARD: No, I love my
double tax credit in Maine for choosing a quality
center, and needed it. It’s a huge cost, but the way
it’s structured right now, it’s not that we’re
supporting everyone. There’s actually a lack of
support for the lowest income families. So we’re sort of doing
the exact reverse of what we should be doing. I think families of all kinds
of incomes need support, because the cost of
quality is very high. And we need to create not
just tax systems, but funding streams of all
kinds so that we’re investing in the success
of families and families with young children,
and young children. They’re our country’s
greatest capital resource, our greatest human resource. And we’re investing
in remediation, and we’re investing
in treatment. We’re not investing
in prevention, and we’re not investing
in opportunity. So it’s a tremendous loss,
and I think financially, economically, and then obviously
in terms of just humanity, we’re doing a disservice to
our children and our society. JOE NEEL: Rachel, I
want to turn to you because a couple
of years ago, there was bipartisan support for
reauthorizing the Child Care and Development Fund. Can you tell us
a little bit more about where things
stand with that? RACHEL SCHUMACHER: Sure. I’d really love to jump
in here, because I think what Susan said is so true. Parents can’t afford
the cost of quality all the way up and down
the income spectrum. It’s especially an issue for
our lowest income families. And those are the children
that research show may benefit the most from having
the opportunity to participate in a high quality program. So it’s really an
important thing for our society to take on. The Child Care and
Development Fund is the largest source
of federal funding. It goes to states, and
states put their money in and partner to help pay
for childcare assistance for low income
families, families that are earning less
than around– the maximum is up to $50,000 for
a family of four. But currently, we’re
only serving about 15% of the eligible children
around the country. And this program has a
lot more it could do. And the good news is that
as you mentioned, in 2014, Congress took up this
legislation and reauthorized, reformed the child care
program in a bipartisan manner with overwhelming support. And the reason
was in part, a lot of this brain research
we’ve been talking about, and a recognition that
child care makes a really big difference not
just as a work support, but also to help
child development. And what Congress
did is really set new foundational
basic requirements across the country for health
and safety for child care. And it may surprise you to know
that those didn’t exist before, that we didn’t have a national
standard for what basic health and safety training
providers should have, or criminal background
checks to occur. That was not the
law of the land. It is now, and states have been
working for the last couple years to come into
compliance with that law. It’s very exciting, we
just released in September a final rule implementing
this new law. And we really see
it as an opportunity to raise the bar, not just for
that basic foundation, right, you can’t have quality if
health and safety isn’t there in these programs. So that is an
amazing first step. But it also includes
new, set aside funds for investing
and improving high quality in child
care around the country that states can use. They can use it to improve the
care for infants and toddlers. They can use it to
help child care staff, teachers get scholarships
so they can go to school and get degrees. We don’t have
national standards now for what type of
education and training in terms of child development
and things like that that teachers need to have. This law and rule will
require a basic level in health and safety
understanding, things like CPR, first aid, medication
administration. Things you would
want your child care provider to know how
to do for your child will now be the case. And that’s a really
important step forward. Where we still need
to look is fully funding what this program could
do and what it’s set up to do. The president put forward a
proposal for the last two years in his budget to expand access
to child care assistance and really provide a
guarantee for families with children who are
infants and toddlers up to the age of four and for them
to access higher quality care. And that means
paying more per child for care so that those families
who are part of this program can access more of the
care in their community. And it will make
a huge difference if parents have more ability
to choose across the spectrum, if they can afford
higher levels. There is some demand out there,
we can tell from this survey. Parents want high quality. They want to be able to find
and afford that type of care. We as a society and
as a country need to take some steps
to really help parents do what they know
is right for their children and not make it so
hard for them to do it. Make it easier using these
quality rating systems, but also making it so that in
low income communities where perhaps none of the
parents can really pay the true cost
of high quality, that’s not what’s driving
the child care market. That there’s other supports
that are through this program and through other means that
could make that care exist in that community, because
quality should be the same for all children no
matter what income, no matter the name over the
door– preschool, Head Start, child care, we’ve been throwing
around some different terms. Our vision is that all
children have access to a similar level
of high quality care. And we’re working very hard
toward that vision here. JOE NEEL: But I assume like
with all funding issues, it will have to now wait
until the next administration and the next Congress
to get that through. But there has been some
significant bipartisan support. RACHEL SCHUMACHER:
Yes, and that’s what’s so exciting about it. That’s the good news. I think that we have seen
some really strong support on both sides of the
aisle for this issue. People get that it
supports local economies in their districts. It supports their families,
their constituents. It supports so many of
the children and families that people meet every day
that our policymakers talk to. And they’re hearing it, and
they want to do something better for our children and families. I believe that’s true. JOE NEEL: All right. I want to move on, we need to
hit on a couple of other topics before we turn to
your questions. I want to talk about
access for a few minutes and turn to Kristin. From our poll, we know
that not all families have options in
terms of location, care costs, other options. Talk to us more about that. KRISTIN SCHUBERT:
Yeah, I’ll pick up on some of Rachel’s points and
try to hit three main ones. We know that there are child
care deserts in this country. You’ve heard of food deserts,
same thing with child care options. That’s what we’re
talking about here. Frankly, very few
options, or none. We’ve heard from the
business community that they’ve moved
into locations and actually have
had to build that in to their relocation plans. The second big theme that
Rachel’s highlighting is there are many more kids eligible for
Head Start and Early Head Start in this country that aren’t
actually accessing it. There are more families
eligible for subsidies and other mechanisms to pay
for care or help pay for care that aren’t accessing it, why? Why is that? What are the difficulties
and challenges with people even being aware
of what they’re entitled to? We know that there
are communities, and I think Susan will
hit on some of this, where the private
sector has come together with the public sector and
said, we’re going to do better, and we’re going to pull on
yes, the federal mechanisms that we have, the
state mechanisms, and we’re going to put our
own dollars into making sure we’re building better
options for families at the local level. So we have some examples of
that and we need more of that. The last point I’ll make,
and we haven’t hit on it yet, is the workforce. The workforce in child
care is among the lowest paid in this country. It’s outrageous. Many of them qualify for
public assistance themselves. We need to talk about that, we
need to talk about how yes, we need greater investment
at the federal level, but we also need greater
investment from the community on up. So I hope we get to that, too. JOE NEEL: I want to talk a
little bit about quality. All of you can address this. Research has shown that
investing in child care does pay off, and we’ve
heard some of the things today, especially the
brain science benefits that Rachel was talking about. But really, what our poll
found, and maybe Gillian, you can address this, that
parents really thought that child care had a very
positive impact on both the child and themselves. GILLIAN STEELFISHER: Absolutely. So first, exactly
what you said, which is that the poll finds that
parents think that childcare is good for the child, for
their overall well-being, for their educational attainment
and cognitive development, for their emotional well-being,
their physical development. But it’s actually
not just today. And I didn’t have
a slide of this, but let me just have you imagine
some of this really rich data, which is to say that when
we talk about the long term benefits of being in a high
quality child care setting, parents are really in
agreement that it has benefits for the child in terms
of their later schooling, in terms of their overall
health and development. This research that’s
been out there is making its way into the
public sphere and is known. And so there is a demand
for quality from parents. And so we see for
example, that it’s one of the differentiating
factors when they’re looking at one
provider versus another where they have a choice. They want high quality. And so I think that a key
takeaway is that really, there is demand there. Right now they think
they’re getting it too, which is the trick from
the public perspective. But there is a demand
there that we hopefully can tap into and engage the
public more meaningfully in this dialogue. JOE NEEL: All right, I want
to turn to your questions now. Let’s go first to
our online questions. And Lisa Mirowitz
is here to give us our first online question. LISA MIROWITZ: Great,
thank you everyone. We have a lot of questions
coming in, a lot of people joining our live chat. Let’s start out with this
question from Singapore. “What can we learn
from other countries with successful childcare policy
programs and happy populations? Northern European countries
like Denmark, Sweden, Finland, Singapore, Japan, any other
country not on this list, to improve our childcare?” JOE NEEL: Who wants to go first? I think you all would
like to say something. KRISTIN SCHUBERT: I can
jump in with a headline. I think what you see in those
countries is a common shared value for all kids,
right from the beginning. They understand implicitly how
much early childhood matters to lifelong health and
longevity and prosperity and productivity. They understand the benefits
to their country as a whole. And it really starts there. So right from the
get-go, the conversation has a different tenor, and
investment across the board looks very different than it
does here in the United States. And that’s where we need to go. JOE NEEL: Rachel, can I
pose that question to you? RACHEL SCHUMACHER: Yeah,
that’s a really good question. And I think there’s lots
of reasons why countries have different policies. But one of the things
that I am struck by when I look at
these other countries is their emphasis
also on the importance of women having an opportunity
to participate in the labor force and not have to
pull back on their careers or not enter the labor force
at all when they have children, and to make sure that the system
isn’t hindering those choices, and is actually
enabling a full choice. And they often offer
paternity leave as well. So there is a very
important focus on helping parents keep their
career focus without having to choose their career,
or just the ability to put food on the table,
over their child’s well-being and to make sure that
that isn’t a choice, it shouldn’t be a choice
any parent has to make. And I do think that’s one of
the motivating factors when you look at these other countries. And we do see when you
look at the survey results also, that when the child
is sick who stays home, it’s often the mom
who has to stay home. It’s really challenging
to have young children and to stay committed and
fully involved in your career when you don’t have
reliable child care. It’s stressful. And that’s what
our survey told us, and that’s what that
first clip told us. And I think the Oklahoma example
and what other countries tell us is that when a
country makes a choice to put their resources on the
line, you can fix this problem. This can be something that
we fix in our lifetimes. It’s going to take a little
bit of figuring and jiggering with our budget,
but we could do it, and we could make children
and families’ lives a lot less stressful
around this country. JOE NEEL: All right, we
have a lot of questions. Let’s go to the next one. LISA MIROWITZ: OK,
let’s do another one. This is from a viewer
in South Carolina. “There are many children
with no disability who have working parents
with income levels above financial
eligibility for Head Start. However, quality child
care not including basic needs, clothes, private
health insurance costs, et cetera, would be over 50%
of one parent’s monthly salary, especially in my state
of South Carolina. What are ideas,
plans, or programs do you think should be
in place for families with children in the gap?” JOE NEEL: Susan? SUSAN HIBBARD: I think this
is exactly what we were trying to address, that
this cost issue is an issue that affects not just
the poorest working families, but a whole wide array. And right now, we
have some strategies that meet some segments
of some populations. And we need to I think,
make the commitment and then find the
dollars to actually pay for the costs of quality for all
those who can’t on their own. I think that’s part of
the tax credit push, but we need actual
funding, massive support at the federal and state
level to make it happen. JOE NEEL: And I would just note
that both the Clinton campaign, the Trump campaign,
and the Stein campaign have child care plans. I wrote about this in a blog
post yesterday on npr.org, and I would refer
people to that if you wanted to learn
more about what’s being proposed this year. We didn’t have time to go
through all of the details here. Lisa? LISA MIROWITZ: Thanks
for pointing that out in this election
year, definitely. I’ll do one more
here, because we’ve had a number of questions
about how to get subsidies and things like that. “Is there a process for applying
for subsidized child care? I work overnight. Can I get support for
childcare so that I can get rest during the day? SUSAN HIBBARD: That’s
a Rachel question. RACHEL SCHUMACHER: Yes. Yes, you can. So the program
that we administer, it’s funding that
goes to the states. And the states actually operate
the child care subsidy programs that we’ve been talking about. So every state provides
their own system for accessing these types
of services, usually in the Department
of Human Services or in the Department of
Education in the state. But there are also
very often something called child care resource and
referral agencies in states. And they provide a
wealth of information on how to find child
care, and can link you up with these other
types of resources that we’re talking about. You can also go to our website,
the ACF Office of Child Care website, and get links to
information in different places around the country. I think also there is a
national website you should look at called Child Care Aware of
America, which can help you find your child care
resource and referral agency in your state. JOE NEEL: And that website
is, the ACF website is, do you know the address? RACHEL SCHUMACHER: I don’t
know it off the top of my head, I’m sorry. It’s ACF Office of Child Care. If you Google those
things, you will end up coming to our website. But the Child Care
Aware of America site will help you link to
the resource and referral agencies, which I think is
a good first step for anyone looking for child care. JOE NEEL: Sorry I put
you on the spot there. RACHEL SCHUMACHER: It’s okay. JOE NEEL: Lisa,
do we want to take a question from the audience? Does anyone have
a question here? RACHEL SCHUMACHER: Nope. Anyone? Oh, I see someone back there. Here, can we– JOE NEEL: Go ahead. AUDIENCE: I have a
couple of questions. First of all, how, when
parents are asked about quality and they express
wanting high quality care, how are they
defining that? And then secondly, when we’re
talking about child care, is there an age range
that we’re talking about? And how does that mesh with
issues about parental leave? JOE NEEL: Right. We talked a little bit
about that in the beginning, but Gillian? GILLIAN STEELFISHER: Sure. So in terms of the poll
findings themselves, we asked about quality from
multiple different facets. So in some cases, we
asked them how would you assess the quality of childcare,
and I showed you those results. One thing I didn’t show you
was when we asked about, why are you choosing one
provider over another, or why are you choosing
one center over another? And there we saw that
about 70% of parents cited something to
do with quality. Now there we have some
insight about what they meant by quality. And they talk about things
like the nurturing relationship with the provider,
their ability to provide fostering environment to
support children’s curiosity, to help them learn. A lot of the core dimensions
that we subsequently then asked about in that. So parents really are talking
about the heart of some of this dimension of quality. JOE NEEL: Great. And then another question
from the audience? LISA MIROWITZ: OK, here we go. AUDIENCE: Hi, thank
you very much. So besides voting
in November, how can we put pressure
on our legislatures, or just in our communities,
to invest in early child care? JOE NEEL: Susan? Kristin? SUSAN HIBBARD: I
think for a long time, we’ve been afraid as
a field, and maybe as women, predominantly, to ask
for the cost for what we really need. Paid parental leave would
be a huge assistance to the infant
child care problem. I think that that’s a
policy that many countries and some states in
our country find makes sense, and not just for
the woman, but for the father, if there is a father,
for any parent, any caring adult for that child. So we have to demand, I think,
the investment– investment in the early childhood
workforce, investment in children. The least amount of investment
goes even in our education, just looking from an
education perspective, the lowest investment is
made in the years that have the highest impact in
terms of brain development and learning. And we can do this
through policy change. Legislators need to understand
we’ve done it before. Senior citizens used to be the
poorest segment of our society in the United States. Now young children are
the poorest age group in our society. So a policy shift like Social
Security can change things. We can change all that. And a lot has changed in the
last five to seven years. Now there are 20
states on the path to having deep infrastructure
related to quality. And I think if we
can keep pushing for the next federal
administration, the next state administrations, and
our local officials too, to think about
all of the options to actually improve quality
and serve young children and families, that we can do it. So I think it’s really speaking
up and demanding what we need. JOE NEEL: Kristin? KRISTIN SCHUBERT: Start talking
about it at your dinner table. Tell your parents and your
friends over Thanksgiving about what you heard today. Start educating
yourself, because we have a huge gap still. We’re in an audience, I think,
of like-minded folks who do understand the science. Not many people do yet. We still look at
babies in this country from a certain vantage point. It’s not well-known yet. We need to start
talking to one another about this incredible
time of life and just how important it
is because the science is exploding. And we haven’t caught up yet. So I would just say, adding
to Susan’s, just get educated and start talking about it. AUDIENCE: Right, start at home. KRISTIN SCHUBERT: Yep. JOE NEEL: All right,
I wanted to wrap up by asking each of our panelists
to identify or recommend a policy takeaway,
and it’s a key message for people who will watch
this now and in the future. I think we kind of touched
a little bit on that, but I’ll start
with you, Gillian. Do you have a policy
takeaway for us? GILLIAN STEELFISHER: Sure. Well, my focus is, of
course, on the public, on parents themselves and
what they have to say. And this poll tells us that they
see the benefits of child care, of high quality, accessible,
affordable childcare for themselves, for their
child, for their families, for their jobs. They see those benefits. And they’re beginning to
see a bit of that science in terms of the long term
benefits and the investment that you can make in
very young children. And so the sort
of policy takeaway is, we have to now
leverage that public demand through meaningful policy,
keeping in mind that parents feel like right now, for their
immediate need, it’s okay. But it’s fragile, right? So their immediate
care is high quality. But what’s the broader system? And how we can bring them
into that conversation with that sort of dual
edge of their involvement. JOE NEEL: All right, great. Susan? SUSAN HIBBARD: I’ve already
mentioned some policy suggestions, so I’m
going to take one little second to say, I think we
can’t leave racial disparities and income disparities and
disparities between people whose home language
isn’t English and those who it is, we
can’t leave those out of the conversation. Some people have different
definitions of quality than the research
currently says. And we need to learn and
grow and understand that, because quality in part
might be seeing people who look like you, who
share culture with you, and who understand
your language, or at least who understand
how to teach a dual language learner. So I think we have to
raise the questions of, what are these
racial disparities about in which
children are thriving, and who are being left behind? And we need to figure
out how to place our resources in
ways that maximize the opportunities for all. But I think our most
important policies going forward are the needed
investments, the investments in the programs, getting
the programs into a quality framework, a Quality
Rating and Improvement System, and investments
in the workforce so that we know that the adults
who are caring for our children and educating our children
aren’t stressed out and barely surviving,
but are actually able to thrive themselves and
share that joy of learning with the children. JOE NEEL: Kristin? KRISTIN SCHUBERT:
Ditto and ditto. Would add to this a liveable
wage in this country. That’s an important part of this
conversation, and on equal pay. Because so many single
moms are struggling to support their kids. We really need to
close that gap as well. So I would add to that. JOE NEEL: And Rachel,
you get the final word. RACHEL SCHUMACHER: Wow, and
everyone has been so eloquent. I would just say two things. One is, we’ve been
all saying it. The true cost of high
quality care cannot be borne by parents. We have to recognize as
a society, as a country, that that’s something we
have to solve together. And the second one, I’m going
to use that term you use so nicely, child care deserts. We have to really
shore up the choices, particularly for our low income
communities in rural areas. We need to provide
the types of supports to make that high
quality happen no matter where you are in this
country so parents really do have equal access
to high quality care for their children. JOE NEEL: Thank you. And I want to thank the Forum
for presenting this today. It was very stimulating
conversation as usual. I want to thank the staff,
Lisa, Christina Roache, and all the people behind the scenes. And I particularly want to
thank our panelists, who came here and also joined
us from Washington. The conversation is not over. You can continue the
conversation on the Forum website at forumhsph.org. And note that the next
Forum in this series is on domestic violence. It’s called “The
Domestic Violence Crisis: Mobilizing the
Public and Private Sectors.” And that’s on October 24,
again, at 12:30 PM eastern time. So thank you very much. [APPLAUSE] [MUSIC PLAYING]