Child care quality in different state policy contexts

Using data from the Child Care Supplement to the Fragile Families and Child Wellbeing Study, we test associations between the quality of child care and state child care policies. These data, which include observations of child care and interviews with care providers and mothers for 777 children across 14 states, allow for comparisons across a broader range of policy regimes and care settings than earlier research on this topic. Using multilevel linear and logistic models, we found that more generous subsidy policies (that is, greater investment, higher income eligibility) were positively associated with the quality of care in nonprofit child care centers, as well as with the use of center care. The stringency of regulations (that is, teacher education requirements, teacher‐child ratios/thresholds) was also associated with both quality and type of care, but in more complex ways. Higher teacher training requirements were positively associated with the quality of both family child care and nonprofit centers, while more stringent regulations decreased the number of children attending center care. No links were found between state policies and the quality of for‐profit center care. The implications for policy makers, advocates, and policy analysts are discussed. © 2007 by the Association for Public Policy Analysis and Management     

The Impact of Home‐Based Child Care Provider Unionization on the Cost,Type, and Availability of Subsidized Child Care in Illinois

In February 2005, Illinois became the first U.S. state to grant home‐based child care providers (HBCPs) the right to form a labor union in order to bargain collectively with the state government. This policy inspired similar efforts across the country and represents a potentially important direction for child care policy. To date, the implications of labor unions for the cost, type, and availability of subsidized child care have not been evaluated empirically. In this study, we examine the impact of granting Illinois HBCPs the right to form a labor union on (a) the type of child care (licensed vs. license‐exempt/home‐based vs. center‐based) used by subsidy‐receiving Illinois infants and toddlers; (b) the per‐child cost of subsidized child care for infants and toddlers; and (c) the percentage of Illinois infants and toddlers who use child care subsidies. To conduct these analyses, we combine data from the Current Population Survey with Child Care and Development Fund administrative records on U.S. infants and toddlers whose families received child care subsidies during the period from 2002 to 2008. We use both a traditional difference‐in‐differences as well as a comparative case study with a “synthetic” control group approach. The synthetic control group approach improves on traditional comparative case studies by providing a transparent, empirical approach for constructing the counterfactual, documenting comparison units’ contribution to the synthetically created control group and detailing the degree to which the synthetic control group is, or is not, similar to the treated unit on preintervention measures of the outcome as well as on other selected characteristics. We find that subsidy‐receiving Illinois infants and toddlers spent an average of between 6.4 and 7 percentage points more hours in licensed care settings, as compared to license‐exempt settings, in the three years following child care unionization. We also find that between 0.7 and 1.1 percentage points fewer Illinois infants and toddlers used child care subsidies following unionization.     

Are Parental Welfare Work Requirements Good for Disadvantaged Children? Evidence From Age‐of‐Youngest‐Child Exemptions

This paper assesses the impact of welfare reform's parental work requirements on low‐income children's cognitive and social‐emotional development. The identification strategy exploits an important feature of the work requirement rules—namely, age‐of‐youngest‐child exemptions—as a source of quasi‐experimental variation in first‐year maternal employment. The 1996 welfare reform law empowered states to exempt adult recipients from the work requirements until the youngest child reaches a certain age. This led to substantial variation in the amount of time that mothers can remain home with a newborn child. I use this variation to estimate the impact of work‐requirement‐induced increases in maternal employment. Using a sample of infants from the Birth cohort of the Early Childhood Longitudinal Study, the reduced form and instrumental variables estimates reveal sizable negative effects of maternal employment. An auxiliary analysis of mechanisms finds that working mothers experience an increase in depressive symptoms, and are less likely to breastfeed and read to their children. In addition, such children are exposed to nonparental child care arrangements at a younger age, and they spend more time in these settings throughout the first year of life.     

The long‐term effects on children and adolescents of a policy providing work supports for low‐income parents

New Hope, an employment‐based poverty‐reduction intervention for adults evaluated in a random‐assignment experimental design, had positive impacts on children's achievement and social behavior two and five years after random assignment. The question addressed in this paper was the following: Did the positive effects of New Hope on younger children diminish or even reverse when children reached the challenges of adolescence (eight years after random assignment)? Small positive impacts on school progress, school motivation, positive social behavior, child well‐being, and parent control endured, but impacts on school achievement and problem behavior were no longer evident. The most likely reasons for lasting impacts were that New Hope families were slightly less likely to be poor, and children had spent more time in center‐based child care and structured activities. New Hope represents a model policy that could produce modest improvements in the lives of low‐income adults and children. © 2011 by the Association for Public Policy Analysis and Management.     

Early Impacts of the Affordable Care Act on Health Insurance Coverage in Medicaid Expansion and Non‐Expansion States

The Affordable Care Act (ACA) aimed to achieve nearly universal health insurance coverage in the United States through a combination of insurance market reforms, mandates, subsidies, health insurance exchanges, and Medicaid expansions, most of which took effect in 2014. This paper estimates the causal effects of the ACA on health insurance coverage in 2014 using data from the American Community Survey. We utilize difference‐in‐difference‐in‐differences models that exploit cross‐sectional variation in the intensity of treatment arising from state participation in the Medicaid expansion and local area pre‐ACA uninsured rates. This strategy allows us to identify the effects of the ACA in both Medicaid expansion and non‐expansion states. Our preferred specification suggests that, at the average pre‐treatment uninsured rate, the full ACA increased the proportion of residents with insurance by 5.9 percentage points compared to 2.8 percentage points in states that did not expand Medicaid. Private insurance expansions from the ACA were due to increases in both employer‐provided and non‐group coverage. The coverage gains from the full ACA were largest for those without a college degree, non‐whites, young adults, unmarried individuals, and those without children in the home. We find no evidence that the Medicaid expansion crowded out private coverage.     

The nonprofit advantage: Producing quality in thick and thin child care markets

Nonprofit child care centers are frequently observed to produce child care which is, on average, of higher quality than care provided in commercial child care centers. In part, this nonprofit advantage is due to different input choices made by nonprofit centers—lower child‐staff ratios, better‐educated staff and directors, higher rates of professional development for staff. Nonprofit centers may have an additional productivity advantage, due to unmeasured staff motivation and abilities or to better management of the production of good‐quality child care. However, where nonprofit and for‐profit child care firms compete in the same local markets, we speculate that this extra advantage should only appear where demand is sufficiently “thick” to permit a quality differentiation strategy to be financially viable for nonprofits. We estimate the effect of nonprofit status on quality, controlling for differences in financial resources available to the center, differences in the clientele served, and differences in staff and center inputs. In this conventional examination, nonprofit status has a moderately positive impact on quality. However, when we account for the unobserved heterogeneity and separate markets into “thick” and “thin,” a particularly strong nonprofit advantage is found in thick markets, but no productivity advantage for nonprofits is found in thin markets. This finding suggests a clear role for nonprofit organizations in improving the cost‐quality trade‐off faced by parents, but also identifies the market conditions that affect the ability of nonprofit managers to employ this advantage. © 2009 by the Association for Public Policy Analysis and Management.     

Accountability via Performance Measurement: The Case of Child Protection Services

Since the 1980s child protection agencies have been subject to enormous scrutiny about perceived poor performance. Concerns are expressed about the capacity of services to cope with demand, the quality of practice, out‐of‐home care standards, and poor outcomes for children. Enter performance measurement. Using quantitative data to monitor effectiveness and efficiency, performance measurement promises improved resource management and accountability. This article discusses national, Victorian and Queensland child protection performance measurement regimes. It examines the extent to which performance measurement is used to promote accountability, as well as the indirect role of performance measurement in communicating policy intent. It suggests performance measurement is under‐utilised in child protection, but could be enhanced to contribute to better outcomes for children and families.     

Child Health in Elementary School Following California's Paid Family Leave Program

We evaluate changes in elementary school children health outcomes following the introduction of California's Paid Family Leave (PFL) program, which provided parents with paid time off following the birth of a child. Our health outcomes—overweight, ADHD, and hearing‐related problems—are characterized by diagnosis rates that only pick up during early elementary school. Moreover, our health outcomes have been found to be negatively linked with many potential implications of extended maternity leave—increased breastfeeding, prompt medical checkups at infancy, reduced prenatal stress, and reduced non‐parental care during infancy. Using the Early Childhood Longitudinal Studies (ECLS) within a difference‐in‐differences framework, our results suggest improvements in health outcomes among California elementary school children following PFL's introduction. Furthermore, the improvements are driven by children from less advantaged backgrounds, which is consistent with the notion that California's PFL had the greatest effect on leave‐taking duration after childbirth mostly for less advantaged mothers who previously could not afford to take unpaid leave.     

Can child care assistance in welfare and employment programs support the employment of low‐income families?

Policymakers have long recognized child care as a key ingredient in low‐income parents' employability. We examine the effects of expansions in child care policies that were bundled with a mix of employment‐related policies and implemented as part of several random assignment studies on families' child care access and cost. Almost all of these welfare and employment programs increased employment and led to concomitant increases in the use of child care, especially paid child care. Only the programs that also expanded access or affordability of child care consistently increased the use of child care subsidies and reduced out‐of‐pocket costs to parents, allowing parents to purchase center‐based care. With one exception, such programs had small effects on employment‐related child care problems, suggesting that broader and more generous targeting of child care assistance may be important for achieving the goal of enhancing the stability of employment among low‐income families. © 2004 by the Association for Public Policy Analysis and Management.     

Long‐term care reform and the role of housing finance

Abstract

The Clinton administration's recently announced home and community‐based care proposals have potentially important implications not only for long‐term care policy, but also for housing policy in the United States. This article attempts to draw out some of those implications. The first section examines problems inherent in the current “medical/welfare” system of financing long‐term care, which constrains consumer choice by limiting the supply of providers to control costs and by increasing medical professionals’ control over the types of services provided in the name of quality control. The medical/welfare dominance of long‐term care policy has resulted in an overreliance on nursing homes as providers, resulting in both escalating costs and continued consumer dissatisfaction.

The second half of the article looks at recent market and policy developments in response to consumer demand for lower cost alternatives to nursing homes. These alternatives promote more consumer autonomy and control in supportive housing arrangements. A more comprehensive services and housing policy could promote these developments in an approach that combines the security of public financing of supportive services with the benefits of consumer choice, market competition, and legal protections that characterize housing markets. In such a scenario, housing finance institutions—including government agencies, lenders, developers, and investors—could play a pivotal role in the long‐term care debate not only by unlocking substantial financial resources but, equally important, by transforming the provision of long‐term care services to promote consumer choice and autonomy.     

The Effects of Tulsa's Pre‐K Program on Middle School Student Performance

As states have upgraded their commitment to pre‐K education over the past two decades, questions have arisen. Critics argue that program effects are likely to fade out or disappear over time, while supporters contend that program effects are likely to persist under certain conditions. Using data from Tulsa Public Schools, three neighboring school districts, and the state of Oklahoma, and propensity score weighting, we estimate the effects of Tulsa's universal, school‐based pre‐K program on multiple measures of academic progress for middle school students. We find enduring effects on math achievement test scores, enrollment in honors courses, and grade retention for students as a whole, and similar effects for certain subgroups. We conclude that some positive effects of a high‐quality pre‐K program are discernible as late as middle school.     

Welfare reforms,family resources,and child maltreatment

This paper examines the impact of welfare reforms on several measures of child maltreatment. The authors use state‐level data from 1990 to 1998 to examine whether recent welfare reforms have increased or reduced the incidence of reported and substantiated cases of maltreatment, the incidence of specific types of substantiated maltreatment—physical abuse and neglect—and the number of children living in out‐of‐home care. The welfare reforms considered are the imposition of: family caps, lifetime limits, work requirements, sanctions for non‐compliance, and the restriction of welfare benefits to immigrants. How welfare benefit levels and changes in state Earned Income Tax Credit programs affect reports and substantiated cases of maltreatment are also considered. Evidence strongly indicates that reductions in states' welfare benefit levels increase the number of children in out‐of‐home care, and some evidence indicates that strict lifetime welfare limits and tougher sanctions for noncompliance are related to higher levels of substantiated maltreatment. The evidence on family caps is mixed: family caps appear to be associated with fewer instances of substantiated maltreatment, but more children in out‐of‐home care. Because most of the welfare reforms examined have been in effect for only a short time, these results should be considered preliminary. Overall, however, they provide some evidence that the recent welfare reforms in the United States may have increased child maltreatment. © 2003 by the Association for Public Policy and Analysis and Management.     

The Impact of Child‐Care Subsidies on Child Development: Evidence from Geographic Variation in the Distance to Social Service Agencies

In this paper, we examine the impact of U.S. child‐care subsidies on the cognitive and behavioral development of children in low‐income female‐headed families. We identify the effect of subsidy receipt by exploiting geographic variation in the distance that families must travel from home to reach the nearest social service agency that administers the subsidy application process. Using data from the Kindergarten cohort of the Early Childhood Longitudinal Study, our instrumental variables estimates suggest that children receiving subsidized child care in the year before kindergarten score lower on tests of cognitive ability and reveal more behavior problems throughout kindergarten. An auxiliary analysis of longer‐run outcomes shows that these negative effects largely disappear by the time children finish first grade.     

From Birth to School: Early Childhood Initiatives and Third‐Grade Outcomes in North Carolina

This study examines the community‐wide effects of two statewide early childhood policy initiatives in North Carolina. One initiative provides funding to improve the quality of child care services at the county level for all children between the ages of 0 to 5, and the other provides funding for preschool slots for disadvantaged four‐year‐olds. Differences across counties in the timing of the rollout and in the magnitude of the state financial investments per child provide the variation in programs needed to estimate their effects on schooling outcomes in third grade. We find robust positive effects of each program on third‐grade test scores in both reading and math. These effects can best be explained by a combination of direct benefits for participants and spillover benefits for others. Our preferred models suggest that the combined average effects on test scores of investments in both programs at 2009 funding levels are equivalent to two to four months of instruction in grade 3.     

How welfare reform affects young children: Experimental findings from Connecticut—A research note

As welfare‐to‐work reforms increase women's labor market attachment, the lives of their young children are likely to change. This note draws on a random‐assignment experiment in Connecticut to ask whether mothers' rising employment levels and program participation are associated with changes in young children's early learning and cognitive growth. Children of mothers who entered Connecticut's Jobs First program, an initiative with strict 21‐month time limits and work incentives, displayed moderate advantages in their early learning, compared with those in a control group. A number of potential mechanisms for this effect are explored, including maternal employment and income, home environment, and child care. Mothers in the new welfare program are more likely to be employed, have higher income, are less likely to be married, have more children's books in their home, and take their children to libraries and museums more frequently. However, these effects explain little of the observed gain in child outcomes. Other parenting practices and the home's social environment do explain early learning, but these remained unaffected by welfare reform. © 2003 by the Association for Public Policy Analysis and Management     

Government Assistance Protects Low‐Income Families from Eviction

A lack of affordable housing is a pressing issue for many low‐income American families and can lead to eviction from their homes. Housing assistance programs to address this problem include public housing and other assistance, including vouchers, through which a government agency offsets the cost of private market housing. This paper assesses whether the receipt of either category of assistance reduces the probability that a family will be evicted from their home in the subsequent six years. Because no randomized trial has assessed these effects, we use observational data and formalize the conditions under which a causal interpretation is warranted. Families living in public housing experience less eviction conditional on pre‐treatment variables. We argue that this evidence points toward a causal conclusion that assistance, particularly public housing, protects families from eviction.     

Presidents and Patronage

To what extent do presidents select appointees based upon campaign experience and connections? The answer to this question has important implications for our understanding of presidential management and political leadership. This article presents a theory explaining where presidents place different types of appointees and why, focusing on differences in ideology, competence, and non‐policy patronage benefits among potential appointees. We develop a formal model and test its implications with new data on 1,307 persons appointed in the first six months of the Obama administration. The empirical results broadly support the theory, suggesting that President Obama was more likely to place appointees selected for non‐policy patronage reasons in agencies off his agenda, in agencies that shared his policy views, and where appointees are least able to affect agency performance. We conclude that patronage continues to play an important role in American politics, with important consequences for campaigns, presidential politics, and governance.     

An effectiveness‐based evaluation of five state pre‐kindergarten programs

Since 1980, the number of state pre‐kindergarten (pre‐K) programs has more than doubled, with 38 states enrolling more than one million children in 2006 alone. This study evaluates how five state pre‐K programs affected children's receptive vocabulary, math, and print awareness skills. Taking advantage of states' strict enrollment policies determined by a child's date of birth, a regression‐discontinuity design was used to estimate effects in Michigan, New Jersey, Oklahoma, South Carolina, and West Virginia. For receptive vocabulary, only New Jersey and Oklahoma yielded significant standardized impacts, though two of the three other coefficients were in a direction indicating positive effects. For math, all the coefficients were positive but only Michigan and New Jersey yielded reliable results. The largest impacts were for print awareness, where all five coefficients were positive and four were reliable in Michigan, New Jersey, South Carolina, and West Virginia. The five states were not randomly selected and, on average, have higher quality program standards than non‐studied states, precluding formal extrapolation to the nation at large. However, our sample of states differed in many other ways, permitting the conclusion that state pre‐K programs can have positive effects on children's cognitive skills, though the magnitude of these effects varies by state and outcome. © 2008 by the Association for Public Policy Analysis and Management.     

Rating and Evaluating Health Systems: The Value of the Life Expectancy Approach

ABSTRACT

Cross-national ranking and rating of public services does not always provide the conditions for effective cross-national learning, because such learning requires causal understanding of the mechanisms underlying ranking scores. That causal understanding means grappling with the production functions involved in public services, and it is particularly difficult for organizations or policy domains where processes are more readily measurable than outcomes relative to goals. Health is to a large extent a policy domain of that type, which makes effective ranking and comparison difficult and also presents a particular challenge for cross-national learning. Numerous attempts have been made to compare the efficiency of different health care systems, and though there is a certain logic about such approaches to ranking and rating, this paper argues that much can be learnt for health policy using life expectancy as the basis for ranking and comparison.