[Senate Hearing 111-1156]
[From the U.S. Government Publishing Office]
S. Hrg. 111-1156
THE STATE OF THE AMERICAN CHILD:
THE IMPACT OF FEDERAL POLICIES ON CHILDREN
=======================================================================
HEARING
BEFORE THE
SUBCOMMITTEE ON CHILDREN AND FAMILIES
OF THE
COMMITTEE ON HEALTH, EDUCATION,
LABOR, AND PENSIONS
UNITED STATES SENATE
ONE HUNDRED ELEVENTH CONGRESS
SECOND SESSION
ON
EXAMINING THE STATE OF THE AMERICAN CHILD, FOCUSING ON THE IMPACT OF
FEDERAL POLICIES ON CHILDREN
__________
JULY 29, 2010
__________
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COMMITTEE ON HEALTH, EDUCATION, LABOR, AND PENSIONS
TOM HARKIN, Iowa, Chairman
CHRISTOPHER J. DODD, Connecticut MICHAEL B. ENZI, Wyoming
BARBARA A. MIKULSKI, Maryland JUDD GREGG, New Hampshire
JEFF BINGAMAN, New Mexico LAMAR ALEXANDER, Tennessee
PATTY MURRAY, Washington RICHARD BURR, North Carolina
JACK REED, Rhode Island JOHNNY ISAKSON, Georgia
BERNARD SANDERS (I), Vermont JOHN McCAIN, Arizona
ROBERT P. CASEY, JR., Pennsylvania ORRIN G. HATCH, Utah
KAY R. HAGAN, North Carolina LISA MURKOWSKI, Alaska
JEFF MERKLEY, Oregon TOM COBURN, M.D., Oklahoma
AL FRANKEN, Minnesota PAT ROBERTS, Kansas
MICHAEL F. BENNET, Colorado
CARTE P. GOODWIN, West Virginia
Daniel E. Smith, Staff Director
Pamela Smith, Deputy Staff Director
Frank Macchiarola, Republican Staff Director and Chief Counsel
______
Subcommittee on Children and Families
CHRISTOPHER J. DODD, Connecticut, Chairman
JEFF BINGAMAN, New Mexico LAMAR ALEXANDER, Tennessee
PATTY MURRAY, Washington JUDD GREGG, New Hampshire
JACK REED, Rhode Island JOHN McCAIN, Arizona
BERNARD SANDERS (I), Vermont ORRIN G. HATCH, Utah
SHERROD BROWN, Ohio LISA MURKOWSKI, Alaska
ROBERT P. CASEY, JR., Pennsylvania TOM COBURN, M.D., Oklahoma
KAY R. HAGAN, North Carolina PAT ROBERTS, Kansas
JEFF MERKLEY, Oregon MICHAEL B. ENZI, Wyoming (ex
TOM HARKIN, Iowa (ex officio) officio)
Tamar MagarikHaro, Staff Director
David P. Cleary, Republican Staff Director
(ii)
?
C O N T E N T S
__________
STATEMENTS
THURSDAY, JULY 29, 2010
Page
Dodd, Hon. Christopher J., Chairman, Subcommittee on Children and
Families, opening statement.................................... 1
Merkley, Hon. Jeff, a U.S. Senator from the State of Oregon...... 5
Casey, Hon. Robert P., Jr., a U.S. Senator from the State of
Pennsylvania................................................... 5
Prepared statement........................................... 6
Rouse, Cecilia Elena, Ph.D., Member, Council of Economic
Advisers, Washington, DC....................................... 9
Prepared statement........................................... 11
Harris, Seth, Deputy Secretary, U.S. Department of Labor,
Washington, DC................................................. 22
Prepared statement........................................... 24
Hansell, David A., Acting Assistant Secretary, Administration for
Children and Families, U.S. Department of Health and Human
Services, Washington, DC....................................... 31
Prepared statement........................................... 32
Melendez de Santa Ana, Assistant Secretary, Office of Elementary
and Secondary Education, U.S. Department of Education,
Washington, DC................................................. 40
Prepared statement........................................... 42
Koh, Howard K., M.D., M.P.H., Assistant Secretary for Health,
U.S. Department of Health and Human Services, Washington, DC... 45
Prepared statement........................................... 47
ADDITIONAL MATERIAL
Statements, articles, publications, letters, etc.:
Senator Coburn............................................... 76
KellyAnn Day, MSW, Executive Director, New Haven Home
Recovery, Inc.............................................. 77
Beth Mattingly, Director, Research on Vulnerable Families,
The Carsey Institute....................................... 82
(iii)
THE STATE OF THE AMERICAN CHILD:
THE IMPACT OF FEDERAL POLICIES ON
CHILDREN
----------
THURSDAY, JULY 29, 2010
U.S. Senate,
Subcommittee on Children and Families,
Committee on Health, Education, Labor, and Pensions,
Washington, DC.
The subcommittee met, pursuant to notice, at 10:04 a.m. in
Room SD-430, Dirksen Senate Office Building, Hon. Christopher
J. Dodd, chairman of the subcommittee, presiding.
Present: Senators Dodd, Casey, and Merkley.
Opening Statement of Senator Dodd
Senator Dodd. The committee will come to order.
Let me welcome all of you here this morning. I will give
you a minute here to get settled. I thank our witnesses. I
thank our guests in the audience. And I see my colleague from
Oregon here as well. Senator Merkley, thank you for joining us
here this morning.
I have been told, before beginning with my opening
comments, that we will have a vote somewhere around 10:40-10:45
this morning. I believe there are several other members who
will be coming by this morning to participate in the hearing,
and so we will try and keep a continuum going and try and
stagger. So as soon as that vote occurs, Senator Merkley, I
might skip right out myself and make the vote and hand the
gavel to you for a few minutes and come right back and try to
work it in a way so we allow our witnesses to continue and the
questions to proceed.
What I will do this morning is make a few minutes of
opening remarks myself and then I will ask my colleague from
Oregon if he has any opening comments he would care to make.
Then we will turn to our very distinguished panel of witnesses
who are here this morning and we are very grateful to them and
their Departments for their willingness to participate in this,
the third, of our hearings on The State of the American Child:
The Impact of Federal Policies on Children. So again, brief
opening comments and then colleague comments and then turn to
our witnesses.
First of all, let me welcome everyone here this morning,
including our very distinguished panel, as I have said, to
this, the third, in a series of hearings on the State of the
American Child.
This subcommittee, Children and Families, is, I believe,
the Senate's only body specifically focused on addressing the
needs of children and their families in our Nation. This series
of hearings is historic in both its scope and its purpose. In
fact, I am not aware of any recent efforts in Congress to
explore so deeply the factors that underlie the well-being of
America's children.
As the parent of two young daughters, I understand the
weight of wanting to see your child reach his or her full
potential. Sometimes this weight is too heavy for a single
parent, as we all have learned, trying to maintain a job while
caring for an ill child. Sometimes the weight is too heavy for
a family, making the very difficult decision as to whether or
not to send that child who has done everything right over the
years off to college or to maintain those mortgage payments on
the house that you have lived in for a long time. And sometimes
this weight is far too heavy even for a school district,
striving to provide nutritious meals for children, but lacking
the resources because of the conditions economically in the
county or community in which they reside. Without support,
these weighty challenges, of course, I think as all of us
appreciate, in very many instances become absolutely
insurmountable both for children, for families, and for
communities.
Parents do the best they can. In fact, they want the very
best for their children. Almost without exception in this
country, that is a given. But what we have come to realize is
that a broad array of support systems at the local, State, and
Federal levels do exist to help families and children thrive.
And as I have said before, the most rewarding work that I have
ever done in my 35 years in the Congress of the United States
has been helping shape these family support systems at the
Federal level. In many ways, the success of our Nation can be
measured by, of course, the success of our own children, and we
have fought to improve the quality of life of every child. We
have made our society, I think, stronger, more productive, and
just.
Too many parents had to chose between the job they need,
and the children they love during a child's illness. For this
reason, of course, we fought for the Family and Medical Leave
Act. Since it was signed into law in February 1993, over 50
million Americans have taken up 12 weeks of job-protected,
unpaid leave in order to care for a child or a family member.
We have strengthened and expanded Head Start programs
across the Nation, helping some of the most vulnerable children
develop the cognitive and social and emotional skills required
to launch them on a path to maximizing their potential.
And we have strengthened child care and afterschool
programs as well.
We know that a child who lacks health insurance fares far
worse than a child who is insured when it comes to a host of
crucial medical services, including doctor visits, dental care,
vision care, and prescription drugs. And so we expanded health
insurance coverage through the CHIP program and Medicaid to
millions of uninsured children and passed health reform which
extends insurance coverage of proven preventative services like
routine immunizations and regular pediatric visits at no cost
to millions more.
And yet, our work is far from over, and the results
certainly have not demonstrated that we have taken care of
every child in this Nation.
This subcommittee held its first hearing in this series in
June. Our witnesses highlighted pressing issues affecting kids,
including their health, education, and family and community
lives. Not surprisingly our conversation turned to the impact
of the current economic crisis on our children and their
families. As Dr. Harry Holzer, an economist at Georgetown
University, outlined, the current economic crisis will have
long impacts on children even when the economy improves. Most
worrisome, even as unemployment is forecasted to fall over the
next several years, child poverty is expected to steadily rise
to nearly 25 percent by the year 2012.
But even though the current crisis has heightened our
awareness of the problems of children, many of these problems,
like poverty, were worsening before 2008, before this economic
crisis even hit us. This week, the Annie E. Casey Foundation
released their Kids Count Databook which showed--and I quote--
``overall improvements in child well-being that began in the
late 1990s stalled in the years before the current economic
crisis downturn.''
Therefore, I think it is imperative that we take a hard
look at what we need to do in order to help all American
children succeed and maximize their potential.
On Monday, the Subcommittee on Children and Families held
its second hearing in this series at the Yale Child Study
Center in New Haven, CT where we examined State and local
efforts aimed at addressing the changing needs of our families
before and during this economic crisis. Fortunately, the
individuals and organizations at the State and local level are
doing incredibly innovative work at a time when their own
organizations are making very difficult budgetary adjustments.
Many of these efforts are enhancing the very Federal programs
that we have built over the years. We have learned about unique
programs aimed at improving the social and health outcomes of
children enrolled in Head Start, such as collaboration of
dentists, providing oral health services and a training program
for fathers.
We learned about a successful pilot program called Help Me
Grow that began in Hartford, CT and has been expanded statewide
and replicated in seven other cities across the United States
to link families to a variety of health, developmental, and
community services.
We heard testimony on the successes of an afterschool
program in the low-income community in Bridgeport, CT. The
success of this program, the Bridgeport Lighthouse program,
which I have been involved with for a number of years, is
consistent with the studies that have shown that students
enrolled in afterschool programs perform better on tests
compared to other students in the same district who do not have
the advantage of afterschool programs.
The proven benefit to children who participate in
afterschool programs is well-studied and tremendously well-
documented, and as a result, I was deeply disappointed to see
the Senate appropriations bill change the 21st Century
Community Learning Center program in such a way that it will
split funding for afterschool programs with other costly
initiatives. Local and State initiatives can and are having a
tremendous impact like the afterschool program in Bridgeport,
but they need consistent support at the national level in order
to remain effective.
Today we are going to hear from our witnesses about the
impact and success of the programs they oversee while looking
at opportunities to expand or align them with the tremendous
work being done at the State and local level. History has shown
us that the Federal Government does play a critical role in
improving the lives of children and families. With more than
one in five children living in poverty in the early 1990s,
various policies enacted under the Clinton administration
helped reduce child poverty by a rate of more than 25 percent.
The same was true, I might add, in the 1960s where efforts
were made on the anti-poverty programs. We had staggering rates
of poverty, and yet, as a result of those efforts in the early
1960s, we reduced those numbers tremendously in those years.
And then when we backed away from them, we began to see those
numbers climb again.
In the 1980s, we did the studies on the commission looking
at the status of children. As a result of those studies, you
saw the child care tax credits, a lot of innovative programs,
and we reduced the numbers again. Then we backed away from it
again. Once again, we see the numbers beginning to rise.
The pattern is as clear as anything you can imagine. So
once again, as we enter this phase when I know there is a lot
of talk about cutting back on a lot of these programs,
understand what the cost will be, understand what the price
will be if we make the kind of decisions which deprive these
children and their families the support systems that they
absolutely must have if they are going to succeed at all.
So with more than one in five children living in poverty in
the early 1990s, as I said, various policies enacted under the
Clinton administration helped reduce the child poverty rate by
more than 25 percent. The rate is still too high, of course,
but no one could argue about the difference the child tax
credit, work incentives, and expanded health insurance for low-
income children made in the lives of millions of children. So
we must continue to improve and strengthen existing programs
that work and give us the kind of results that we have seen in
the past.
Before the committee today is a panel of experts from the
Departments of Labor, Health, Education, as well as an
economist from the White House. And I look forward to their
testimony.
Our work on behalf of children is never done at all, of
course. Over 20 years ago, as I mentioned a moment ago, the
National Commission on Children was established which laid out
a plan to address the needs of children. Out of that effort
came many vital programs such as the Earned Income Tax credit
and the Children's Health Insurance Program. Much has changed
in the field of children in the last 20 or 22 years, and for
this reason, I think it is time that we take another look at
the status of children and their families in our country and
outline promising new directions for policy and programs. More
importantly, this is not something we should do every 20 years.
It should be done every year, and I plan to introduce
legislation in the coming days which will do just that: provide
an annual, permanent basis by which we can judge the status and
the condition of the American child.
So I look forward to hearing from our witnesses today and
taking their lessons and learning from them as we move forward
in our fight to improve the condition of one out of four
Americans, those children who are under the age of 18 in our
country, and to see to it that we leave them in far better
shape than the presence circumstances would indicate.
With that, I want to turn to my colleagues briefly to see
if they have any opening comments. Senator Merkley arrived here
first, so you get the first arrived/first up opportunity, and
then I will turn to Senator Casey.
Statement of Senator Merkley
Senator Merkley. Mr. Chair, thank you very much and thank
you for your emphasis on the status of children and programs
that will improve their lives. What we all have come to learn
time and time again is that the issues faced in childhood very
much set a course for a person's life and disproportionately
so, so that they deserve a great deal of our attention.
And many of the issues about which you all will be
testifying are issues certainly of great concern to me and
great concern to my constituents back in Oregon. I look forward
to your comments this morning. Thank you.
Senator Dodd. Thank you, Senator.
Senator Casey.
Statement of Senator Casey
Senator Casey. Thanks so much, Mr. Chairman. I want to
thank our witnesses who are here. I will have a longer
statement for the record.
But I do want to say that often when you have a successful
program or public policy, a lot of people can stand up and
claim credit, as is often the case. But few, if any, of U.S.
Senators in the last 50 years have done more, have labored
longer in the vineyard of helping children and standing up for
their rights, for their well- being, and for their health and
safety and really their future--few have done more, and I
cannot think of any who have done more, than Senator Chris
Dodd. We are eternally grateful for that kind of leadership and
commitment. We need to draw inspiration from his example, all
of us, in the wake of his leaving in the early part of January
2011. So we are grateful for that leadership. We are especially
grateful he called this series of hearings to examine a set of
issues that candidly, even in the party I am a member of, we do
not spend enough time on. So I want to thank him for his
leadership and for his continuing efforts to put a spotlight on
a whole range of important issues as it relates to children.
I want to thank this committee for the work it has done,
and also President Obama and his administration, not just
because you are here today but because of what has been a
really focused and determined effort by President Obama to put
dollars and resources and focus and energy behind programs to
help our children. We are grateful for that, and I think we are
looking forward to this hearing today.
Thank you very much.
[The prepared statement of Senator Casey follows:]
Prepared Statement of Senator Casey
Thank you, Chairman Dodd, for calling this third in a
series of hearings on the state of the American Child--and
thank you for your continued outstanding leadership on
children's issues. I would also like to thank the panelists who
have taken time out of their busy days to share with us the
Administration's activities and programs that are improving the
lives of children.
This is a critically important time for us as a committee,
as a Congress and as a Nation to be assessing the state of the
American child. We've had a rough few years, with economic toil
and high levels of unemployment. Families are suffering, and
children cannot help but be affected. As we chart our way out
of the recession, it is essential that we reassess our
priorities as they relate to children.
While we have made many strides in the right direction--the
State Children's Health Insurance Program, investments in home
visitation and early education--children are still losing out.
As an overall share of the budget, our Federal investment in
children has been falling steadily. Though children make up a
quarter of our population, out of every dollar spent by the
Federal Government, less than a dime goes to children,
according to a report released earlier this month by First
Focus. And because children are also disproportionately helped
by programs that rely on Congress to act to fund them year
after year, they are more vulnerable to swings in politics,
economics, and public opinion.
Congress acted to help children through the American
Recovery and Reinvestment Act (ARRA). Federal spending on
children hit a record high of 2.3 percent of GDP in 2009,
largely as a result of the recession and increased investments
under ARRA. The children's share of ARRA was more than twice as
large as the children's share of the Federal budget as a whole.
But, much of the Recovery Act's spending substituted for or
cushioned spending cuts in States and localities, hard-hit by
the recession.
We cannot afford to let a generation get swept away in this
recession. The economic downturn has raised the child poverty
rate in this country to levels not seen in the last 20 years. A
new study by the Foundation for Child Development, which was
released in June, evaluated the well-being of children in the
United States and the impact of the recession. It found that
one in five children live in poverty. This rate of nearly 22
percent is up from 17 percent from before the recession began
in 2006. This rate places the United States the highest among
its peer nations.
We must act to ensure the extensions in early childhood
investment included in the Recovery Act are continued--and that
this support becomes the new baseline for children. I was
gratified by the Labor/Health/Education Subcommittee markup
earlier this week, which has set aside funding for critical
programs such as Head Start and Child Care Development Block
Grant at Recovery Act levels.
In Pennsylvania, the ARRA funding has helped to improve the
quality of child care and ensure more children have access to
care. Over the past year in the State's quality child care
program--a nationally recognized approach known as Keystone
STARS--nearly 30 percent of the child care programs in this
initiative moved up a STAR level. The child outcome data for
this program is showing exceptionally positive results, on par
with those obtained for the State's PA Pre-K Counts program as
well as its State investment in Head Start. The ARRA funding
has also helped to bring the waiting list for child care to
zero.
Quality must be a core focus of our investment in early
childhood programs. The research is irrefutable--investing in
quality programs for our children in their earliest years
greatly improves their life outcomes in so many areas.
Conservative estimates of early childhood education programs
put the savings to our economy at about $7 for every $1 we
invest. Analyses of other early childhood programs have
produced estimated benefits of up to $13 for every dollar
spent. If this were the stock market, we'd all be buying these
stocks.
Just in the last few weeks, several articles and reports
have appeared that further highlight the importance of
investing in children, especially when it comes to early
childhood education.
In May, an article in the journal Child
Development found that participating in high-quality child care
early in life can give children an academic leg up for years to
come. Researchers conducting this longitudinal study found that
the positive effects of high-quality child care can have
lasting effects on cognitive development and academic success.
Earlier this week, the College Board recently
issued a series of recommendations which they refer to as ``10
recommendations so important they cannot be ignored.'' It's a
part of their ``College Completion Agenda'' to provide a
roadmap to ensure that 55 percent of all adults ages 25 to 34
have an associate degree or higher by 2025. The first
recommendation: Make voluntary preschool education available to
all children in low-income families.
And only yesterday, the New York Times ran an
article called ``The Case for $320,000 Kindergarten Teachers,''
which discussed a study that was recently presented at a
conference, although it has not yet been reviewed. However,
this study found that high-quality kindergarten teachers are
worth about $320,000 a year; students who had learned more in
kindergarten were, as adults, more likely to go to college,
less likely to become single parents, more likely to be saving
for retirement, and were earning more than comparable peers.
Such investments speak to a philosophy rooted in the
fundamental principle of what it means to be an American--and
that is that every person, and every child, has the opportunity
to succeed. When America supports high quality child care, we
encourage children, families and our Nation to reach their full
potential.
I look forward to hearing from the witnesses today about
all the Federal programs that are making a difference for
children--and how we can strengthen those programs.
Senator Dodd. Thank you, Senator Casey. And if you have a
longer set of comments about my record, I would be pleased to
take it.
[Laughter.]
Thank you very much, Senator Casey.
I have said this before, by the way, and there will be
others I hope who will join us today. And as I do get ready to
leave after 30 years in the Senate, I cannot begin to tell you
what a sense of confidence and comfort it is to know that there
are people like Bob Casey and Jeff Merkley who are going to be
here, I hope, for a long time, who care deeply about the
issues, have brought, just in the short time they have been
here, tremendous interest and support for these efforts. So I
leave with a great sense of comfort knowing that there are
going to be people here who will continue the efforts, as there
were before I arrived in the Senate, people like Hubert
Humphrey and George McGovern. Bob Dole did a lot of work on
nutrition issues with children over the years. So this has been
a continuum over the years that people have made an effort. And
as I said a little while ago, nothing, no set of issues have
given me a greater sense of joy or pleasure to work on over the
past 3 decades than this cluster of issues, but I am very
comfortable knowing that there are some people sitting at this
very dais who are going to carry on the effort. So I thank both
of you very much for your efforts.
Let me introduce our witnesses, and then I will ask you to
try and keep your remarks, if you can, somewhere--I am not gong
to gavel people down. Obviously, this is important. But do not
filibuster like Senators are inclined to do, and we may get
through the hearing here this morning.
Dr. Cecilia Rouse currently serves as a member of the
Council of Economic Advisers, received her doctorate in
economics from Harvard, currently on leave from Princeton
University where she is a Theodore Wells Class of 1929, I guess
it is in the title of this thing, Professor of Economics and
Public Affairs. She has been a senior editor of the future of
children in the Journal of Labor Economics and served on the
National Economic Council under President Clinton from 1998 to
1999, and her research focuses on labor economics and the
economics of education. We thank you for being with us.
Seth Harris, whom I have known for a long time, is the
Deputy Secretary of Labor, the 11th person to hold this
position since it was created in 1986. Mr. Harris served as a
professor of law at the New York Law School and director of its
labor and employment law programs. During this time, he was the
senior fellow at the Life Without Limits Project of the United
Cerebral Palsy Association and a member of the National
Advisory Commission on Workplace Flexibility. He graduated from
NYU where he was editor-in-chief of the Law Review as well.
David Hansell is the Acting Assistant Secretary for the
Administration for Children and Families within the Department
of Health and Human Services. Prior to his work at HHS, he
served as the Principal Deputy Assistant Secretary at the
Administration for Children and Families. He also served as
commissioner of the New York State Office of Temporary and
Disability Assistance and as chief of staff of the New York
City Human Resources Administration. He is also a graduate of
Yale Law School in my hometown of Connecticut. You are very
familiar with Yale Child Study Center, I presume, as well.
Dr. Thelma Melendez is the Assistant Secretary for
Elementary and Secondary Education. In that capacity, she
serves as the principal advisor to the U.S. Secretary of
Education on all matters related to pre-K, elementary, and
secondary education. She earned her doctorate from the
University of Southern California where she was in the Rossier
School of Education program, specializing in language literacy
and learning. Prior to arriving at the Department of Education,
Dr. Melendez served as the superintendent of the Pomona Unified
School District in California.
And Dr. Howard Koh is the Assistant Secretary for Health at
the Department of Health and Human Services. In that role, Dr.
Koh oversees the HHS Office of Public Health and Science, the
commissioned corps of the U.S. Public Health Service in the
Office of the Surgeon General. He also serves as the senior
public health advisor to the Secretary. And in keeping with the
great tradition of the panel, Dr. Koh is also a graduate of
Yale College and the Yale School of Medicine. You are beginning
to think there is some pattern in all of this.
[Laughter.]
And I would be remiss if I did not point out that his
brother is a great friend of mine as well and is actively
involved with the State Department. So, Dr. Koh, we thank you
for joining us as well.
And with that, let me turn to our witnesses. Again, I
presume some of you may have supporting data for some of the
testimony you are going to provide for us this morning. I will
just make the unanimous consent that all supporting data and
information and materials that you think would help give us a
solid foundation on which to draw some conclusions in this
committee will be included in the record as well.
With that, Dr. Rouse, you are on.
STATEMENT OF CECILIA ELENA ROUSE, Ph.D., MEMBER, COUNCIL OF
ECONOMIC ADVISERS, WASHINGTON, DC
Ms. Rouse. Good morning, Chairman Dodd, Senators Merkley
and Casey. I am very pleased to represent the Council of
Economic Advisers this morning at this important hearing, and I
thank you very much for your strong commitment to improving the
lives of children and their families.
In my written testimony, I document the status of children
in America in three areas: economic status, health, and
education. To the extent possible, I assembled data that
reflect their status since the beginning of the recession,
although at this point such data are often unavailable.
Let me begin with trends in economic status. Between 1990
and 2007, expansions in the economy brought increases in family
income and with that decreases in the percentage of children
living below the poverty level. Along many dimensions, the
biggest gains over the past 20 years occurred during the
economic expansion of the 1990s. The bottom line is that a good
economy is good for everyone, especially children.
Unfortunately, the recent recession has had a negative
impact on this progress. The median income for families with
children has decreased, and as a result, the percentage of
children living in poverty has also increased. In 2008, the
most recent data available, 19 percent of children lived in
poverty and 8.5 percent, or over 6 million, lived in extreme
poverty.
As far as child health is concerned, there has been
progress in some dimensions such as rates of infant mortality,
exposure to environmental hazards, and health insurance
coverage largely due to the Children's Health Insurance
Program.
Unfortunately, trends in the area of childhood diseases
offer a more mixed picture. The percentage of children with
cavities, the most common chronic disease among children, has
declined, but the prevalence of asthma has increased.
Most importantly, the rate of childhood obesity has
increased significantly. In the late 1970s, 5.5 percent of
children were considered obese. Today that number has increased
to 17 percent. And unfortunately, childhood obesity has been
associated with a variety of immediate and future health
problems. Many of the future health problems stem from the fact
that these obese children are more likely to become obese
adults. A recent estimate suggests that overall obesity is
responsible for almost 10 percent of total annual medical
expenditures, or nearly $150 billion per year. The direct
medical costs of obesity have been estimated to be similar in
magnitude to those associated with smoking.
Finally, I document that along some dimensions, U.S.
student educational achievement has improved. However, the
level of achievement is not nearly as impressive. Proficiency
on national tests is low and our standings in international
comparisons have slipped.
So what has been and what will likely be the impact of the
recession on well-being of American children? A vast academic
literature has generally found that children from wealthier
families have higher educational attainment, are healthier, and
are more likely to go on to have successful labor market
outcomes than their poorer counterparts. Given this
relationship, the impact of the current recession on children
is of great concern. While it is too early to know for certain,
by all expectations it will set us back.
Recognizing that my colleagues will speak about many of the
Federal Government's efforts in several initiatives supported
by the administration, I would like to briefly underscore four
areas that I believe are important for improving the well-being
of children.
First, given the importance of family circumstances on
child well-being, an important short-run change is a solid and
timely economic recovery. This is why the HIRE Act and
extension of unemployment benefits were so important.
In addition, the President has continued to call for
additional support for small businesses, as well as for funding
to help retain teachers.
Second, with the alarming increase in childhood obesity, it
is important that we find a way to improve nutrition and
healthy lifestyles among American children. A notable step is
to expand and improve the Federal nutrition program. In
addition, the First Lady's Let's Move! campaign calls upon
everyone who has an effect on children's health to act together
to end the epidemic of childhood obesity within a generation.
Third, the competitiveness of the U.S. economy depends on
the productivity of its workers. The Federal Government's
investments in education and training have moved in the right
direction. Further, reauthorizations of the Elementary and
Secondary Education Act and the Workforce Investment Act, as
well as making the Early Learning Challenge Fund a reality,
will enable the Federal Government to continue these efforts.
Finally, one of the biggest changes that impacts the lives
of children is that an increased proportion are raised in
households in which all parents work in the labor market. While
many employers have adapted to the changing family
circumstances of U.S. workers by providing flexibility in the
workplace, too many do not. Wider adoption of such practices
may well benefit more firms' workers in the U.S. economy as a
whole, including children whose parents can more fully attend
to their health care, schooling, and other needs.
The Federal Family and Medical Leave Act was a historic
first step toward helping workers balance the responsibilities
to their families, as well as to their employers. As of 2007,
82 percent of all workers in the private sector had access to
unpaid family leave. We very much appreciate your leadership,
Senator Dodd, on the FMLA, and the Administration supports
further efforts in this area.
In sum, the well-being of children has improved along many
dimensions over the past 2 to 3 decades. While it has improved,
there is still work to be done especially in light of the
recent recession. The Federal Government has played and must
continue to play a significant role in maintaining and
accelerating progress. Such efforts include sound economic
strategies that enable parents to provide for their children,
improved access to quality health care, and high quality
education from cradle to career. These investments are critical
as our future prosperity depends on ensuring that American
children from all backgrounds have the opportunity to become
productive workers.
Thank you for your dedication to these issues and for
holding this important hearing. I would be happy to address any
questions that you may have.
[The prepared statement of Ms. Rouse follows:]
Prepared Statement of Cecilia Elena Rouse, Ph.D.
Good afternoon Chairman Dodd, Ranking Member Alexander, and
distinguished members of the subcommittee.
I am very pleased to represent the Council of Economic Advisers
(CEA) at this important hearing and thank you for your strong
commitment to improving the lives of children and their families. I
focus my remarks on documenting the status of children in America in
three areas: economic status, health, and education. To the extent
possible, I have assembled data that reflect their status since the
beginning of this recession although at this point such data are often
unavailable. I conclude by suggesting four areas in which it is
particularly important to bring change in order to improve the well-
being of children.
The bottom line is that a good economy is good for the well-being
of all, and especially children. Along many dimensions, the biggest
gains over the past 20 years occurred during the economic expansion of
the 1990s, as poverty rates in families with children dropped
dramatically as did some important measures of health, such as rates of
infant mortality. Given the link between the economy and child well-
being, we must remain vigilant to maintain these gains in the wake of
the recent recession, as investments in children are investments in the
future prosperity of America.
THE STATE OF CHILDREN IN AMERICA
Trends in Economic Status
Between 1990 and 2007, U.S.-real gross domestic product grew at an
average annual rate of 3.0 percent, and unemployment averaged 5.4
percent; growth was particularly strong during the 1990s. Not
surprisingly, the resources available to children improved during this
time as family incomes also rose. As evidence, the median income of
families with children increased by 12 percent during this period
fueled by an increase of 16 percent between 1990 and 2000. Consistent
with this economic growth, the percentage of children living below the
poverty level decreased from 21 percent to 18 percent between 1990 and
2007, as shown in Table 1.\1\
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\1\ The official poverty measure estimates poverty rates by
comparing a household's cash income to a threshold that accounts for
family size and inflation. Noncash benefits, such as food stamps, are
not included as income.
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Unfortunately, the recent recession has had a negative impact on
this progress. In 2008, the median income for families with children
decreased by 2.3 percent from the previous year and the percentage of
children living in poverty increased to 19 percent. Moreover, 8.5
percent of children (over 6 million) lived in extreme poverty (defined
as having family income less than 50 percent of the poverty threshold).
The percentage of children in food-insecure households jumped to 22.5
percent in 2008, up from 16.9 percent in 2007, and is the highest
percentage since data collection began in 1995.\2\ According to the
2010 KIDS COUNT Data Book recently released by the Annie E. Casey
Foundation, most experts expect the child poverty rate to increase
significantly over the next several years.\3\
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\2\ A household is defined as ``food-insecure'' if it was unable at
times to acquire adequate food for active, healthy living for all
household members due to insufficient money or other resources for
food.
\3\ Annie E. Casey Foundation. 2010 KIDS COUNT Data Book: State
Profiles of Child Well-Being. 2010.
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Trends in Child Health
Before the recession the United States had also witnessed
improvements in child health along many dimensions. For example, the
rate of infant mortality--which serves as an important indicator of the
health of a nation as it reflects a number of other measures, including
maternal health, quality of healthcare, and socioeconomic conditions--
decreased from 9.2 infant deaths per 1,000 live births in 1990 to 6.7
in 2007. Similarly, the proportion of children covered by health
insurance increased from 87 percent in 1990 to 89 percent in 2007 (see
Table 1).
Progress has also been made in reducing the impact of environmental
hazards, such as lead poisoning and unsafe drinking water, on child
health over the past two decades. Lead poisoning can cause a multitude
of health problems from learning disabilities and behavioral problems
to seizures, coma, and death. Young children and children living below
the poverty line in older housing are particularly at risk.
Fortunately, blood lead levels have decreased in recent decades; for
example, the percentage of young children (ages 1-5) with more than 10
micrograms of lead per deciliter of blood dropped from 8.6 percent
between 1988 and 1991 to 1.4 percent between 1999 and 2004.\4\ Access
to safe drinking water is another important environmental measure of
health since children are especially sensitive to certain contaminants
in drinking water, which have the potential to cause illness,
developmental disorders, and cancer. The positive news is that the
percentage of children served by community water systems that did not
meet all applicable health-based drinking water standards has dropped
from 18 percent in 1993 to 6 percent in 2008, although estimates have
fluctuated during that time period.
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\4\ Jones, Robert L., et al. ``Trends in Blood Lead Levels and
Blood Lead Testing Among U.S. Children Aged 1 to 5 Years, 1988-2004.''
Pediatrics (March 2009): E376-85.
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While there has been some progress in terms of child health over
the past 20 years, trends in the area of childhood diseases offer a
more mixed picture. The most common chronic disease among children is
dental caries (cavities). And, the percentage of children (ages 5-17)
with untreated cavities has declined from 24.3 percent in the late
1980s and early 1990s to 16.3 percent in more recent years. In
contrast, the prevalence of asthma, another very common chronic
childhood disease, increased in past decades (1980s and 1990s). More
recent data show that in 2008, 9.5 percent of children (under 18) had
asthma, an increase from 8.8 percent in 2001.
Asthma is a major cause of childhood disability and can be very
burdensome in terms of both medical and indirect costs. For example, in
2003, 12.8 million school days were missed due to asthma among those
who reported at least one asthma attack in the previous year.\5\ In
addition, even after controlling for higher asthma prevalence, minority
children have much greater rates of adverse outcomes, which include
emergency department visits, hospitalizations, and death.\6\
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\5\ Akinbami, Lara J. ``The State of Childhood Asthma, United
States, 1980-2005.'' Advance Data from Vital and Health Statistics, no.
381 (2006). Hyattsville, MD: National Center for Health Statistics.
\6\ Akinbami, Lara J., et al. ``Status of Childhood Asthma in the
United States, 1980-2007.'' Pediatrics, American Academy of Pediatrics
(March 2009): S131-45.
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Depression is another important medical condition with 8.3 percent
of youth (ages 12-17) reporting at least one ``major depressive
episode'' in the past year in 2008. Depression negatively impacts
development and well-being of adolescents; however, not all youth are
affected equally.\7\ For example, in 2008, female adolescents were
almost three times as likely as males to have had a major depressive
episode in the past year. The prevalence of this condition among all
youth has not changed in recent years.
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\7\ Federal Interagency Forum on Child and Family Statistics.
America's Children in Brief: Key National Indicators of Well-Being,
2010. Washington, DC: U.S. Government Printing Office. July 2010.
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Most importantly, the rate of childhood obesity has increased
significantly from the past. Child obesity is defined as a body mass
index (BMI) at or above the 95th percentile for children of the same
age and sex. In the second half of the 1970s, 5.5 percent of children
(ages 2-19) were considered obese. This proportion increased to 17
percent of children in the most recent data available (2007-8). When
including overweight children (with a BMI between the 85th and 94th
percentiles), this number nearly doubles to 32 percent.\8\ Childhood
obesity has been associated with a variety of immediate and future
health problems including high cholesterol and high blood pressure,
both risk factors for cardiovascular disease, as well as asthma,
diabetes, and psychological stress such as low self-esteem.
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\8\ Ogden, Cynthia L., et al. ``Prevalence of High Body Mass Index
in U.S. Children and Adolescents, 2007-8.'' Journal of American Medical
Association 303, no. 3 (2010): 242-49.
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Researchers estimate that direct medical costs for children with
elevated BMI are estimated to be $3 billion per year.\9\ In addition,
many of the future health problems stem from the fact that obese
children are more likely to become obese adults. And, obesity across
all age groups is costly in terms of both direct medical costs and
indirect costs that arise from losses in productivity, absenteeism, and
premature death. Estimates suggest that obesity is responsible for
almost 10 percent of total annual medical expenditures, or about $147
billion per year in 2008.\10\ Another study found that between 1987 and
2001, increases in the proportion of, and spending on, obese people
relative to people of normal weight account for 27 percent of the rise
in inflation-adjusted per capita spending.\11\ Conservative estimates
find that the direct medical costs of obesity are similar in magnitude
to those associated with smoking.\12\
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\9\ Trasande, Leonardo, and Samprit Chatterjee. ``Corrigendum: The
Impact of Obesity on Health Service Utilization and Costs in
Childhood.'' Obesity 17, no. 9 (2009): 1473.
\10\ Finkelstein, Eric A., et al. ``Annual Medical Spending
Attributable to Obesity: Payer- and Service-Specific Estimates.''
Health Affairs (2009): W822-31.
\11\ Thorpe, Kenneth E., et al. ``Trends: The Impact of Obesity on
Rising Medical Spending.'' Health Affairs (2004): W4-480-6.
\12\ Stein, Cynthia J., and Graham A. Colditz. ``The Epidemic of
Obesity.'' Journal of Clinical Endocrinology & Metabolism (2004): 2522-
25.
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TRENDS IN EDUCATION
Along some dimensions U.S.-student achievement has improved over
the past 30 years, particularly as measured by the National Assessment
of Education Progress (NAEP), the Nation's Report Card. For example, as
shown in Figure 1, the performance of 9-year-olds (who are typically
enrolled in 4th grade) and 13-year-olds (typically 8th grade) improved
in mathematics between 1978 and 2008. Nearly three-quarters of 13-year-
olds in 2008 scored above the 1978 median, with similar gains
throughout the distribution. The performance of 17-year-olds (typically
12th graders) has also improved, although the gain was smaller.
Despite this progress, the level of achievement is not nearly as
impressive. In the most recent tests, only 32 percent of 8th graders
were proficient in reading and only 34 percent in math, where a student
is deemed ``proficient'' if he or she demonstrates age- or grade-
appropriate competency over challenging subject matter and shows an
ability to apply knowledge to real-world situations.\13\
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\13\ National Assessment of Educational Progress. ``The Nation's
Report Card: Grade 8 National Math and Reading Achievement Levels.''
2009.
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This low level of attainment, which is observed at both the
secondary and post-secondary levels, is underscored in international
comparisons. Among the cohort born between 1943 and 1952 (that largely
completed its education by the late 1970s), the United States has the
highest percentage with at least a bachelor's degree (or the
equivalent) compared to other developed nations. However, that
percentage has not grown in the United States while increasing
substantially in other countries. The OECD data suggest that only 40
percent of Americans born between 1973 and 1982 have completed
associate's degrees or better which is lower than that in 11 other
countries (led by Canada and Korea, where up to 56 percent completed
some post-secondary degree or extended certificate program).\14\ High
school graduation rates show a similar pattern as the United States has
slipped from the top to the middle in recent cohorts.
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\14\ Organisation for Economic and Co-operation and Development.
``Education at a Glance.'' 2009.
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These relatively low rates of educational attainment have costs to
both the individual and to society. As one example, individuals who
have not graduated from high school earn less than those with a high
school degree and are significantly less likely to be employed at a
stable full-time job or one that pays benefits much less at all. As a
result of their relatively poorer labor market prospects, these workers
contribute less in taxes and are more likely to draw on public
assistance. By one estimate, high school dropouts earn approximately
$300,000 less over their lifetime than high school graduates (with no
further education and in present discounted value terms) and contribute
about $70,000 less in taxes.\15\
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\15\ The figures in the text have been inflated to 2009 dollars.
Rouse, Cecilia E. ``Consequences for the Labor Market.'' In The Price
We Pay: Economic and Social Consequences of Inadequate Education,
edited by Clive Belfield & Henry M. Levin, pp. 99-124. Washington, DC:
Brookings Institution Press, 2007.
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And so there is work to be done to strengthen the education and
training of American workers and as we do so, it is important to
emphasize that the task of improving later educational outcomes begins
before elementary school. School readiness which involves both
cognitive skills--as measured by vocabulary size, complexity of spoken
language, and basic counting--and social and emotional skills--such as
the ability to follow directions and self-regulate--is critical to
later educational and labor market success. Children who arrive at
kindergarten without these skills lack the foundation on which later
learning will build. And yet relatively recent research indicates that
as many as 45 percent of entering kindergartners are ill-prepared to
succeed in school.\16\ Because investments in the youngest members of
U.S. society generate better-prepared students and healthier workers
that earn higher wages, economists have estimated that the long-run
benefits outweigh the costs of a high-quality pre-school. Steven W.
Barnett and Leonard N. Masse estimate that a dollar investment in one
program produced $2.50 in long-run savings for taxpayers.\17\ James
Heckman, Nobel Laureate in Economics, and his colleagues estimated even
higher savings of $7 from another program.\18\
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\16\ Hair, Elizabeth, et al. ``Children's School Readiness in the
ECLS-K: Predictions to Academic, Health, and Social Outcomes in First
Grade.'' Early Childhood Research Quarterly 21, no. 4 (2006): 431-54.
\17\ Barnett, W. Steven, and Leonard N. Masse. ``Comparative
Benefit-Cost Analysis of the Abecedarian Program and Its Policy
Implications.'' Economics of Education Review 26, no. 1 (2007): 113-25.
\18\ Heckman, James J., et al. ``The Rate of Return to the High/
Scope Perry Preschool Program.'' Mimeo, University of Chicago. April
2009.
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THE IMPACT OF FAMILY CIRCUMSTANCES ON CHILD WELL-BEING AND IMPLICATIONS
FOR THE IMPACT OF THE RECESSION ON CHILDREN
A vast academic literature has attempted to explain the role of
family economic resources on child well-being and has generally found
that children from more advantaged families have better outcomes than
those from less advantaged backgrounds. Children from wealthier
families have higher educational attainment, are healthier, and are
more likely to go on to have successful labor market outcomes than
their poorer counterparts.
More specifically, studies have found that income is associated
with a number of education-related outcomes such as a child's cognitive
abilities and school achievement. One study found that children in
families with incomes below 50 percent of the poverty line scored
significantly lower on a set of cognitive tests than children in
families with incomes at 150-200 percent of the poverty line.\19\
Another study estimated that on average, children who had experienced
poverty during some or all of their adolescence completed between 1.0
and 1.75 fewer years of schooling than children who had not.\20\
Similarly, proficiency rates on the NAEP assessments are much lower for
those whose family incomes make them eligible for a free or reduced-
price lunch, as shown in Figure 2. The low achievement in these
subgroups is also reflected in low attainment as measured by high
school completion, college enrollment, and college completion.
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\19\ Smith, Judith R., Jeanne Brooks-Gunn, and Pamela K. Klebanov.
``The Consequences of Living in Poverty for Young Children's Cognitive
and Verbal Ability and Early School Achievement.'' In Consequences of
Growing Up Poor, edited by Greg J. Duncan and Jeanne Brooks-Gunn, pp.
132-39. New York: Russell Sage Foundation, 1997.
\20\ Teachman, J.D., et al. ``Poverty during Adolescence and
Subsequent Educational Attainment.'' In Consequences of Growing Up
Poor, edited by Greg J. Duncan and Jeanne Brooks-Gunn, pp. 382-418. New
York: Russell Sage Foundation, 1997.
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There is a similar relationship between family circumstances and
health outcomes. For example, researchers in one study that controlled
for maternal education and family structure found that children in
families facing long-term poverty had more behavioral problems than
children who had never dealt with poverty.\21\ In another, average
blood lead levels were found to be 60 percent higher for children (ages
1-5) in lower-income families than for those in higher-income
families.\22\ Similarly, poverty remains a significant factor in the
prevalence of cavities with 26 percent of children in poverty having
untreated cavities compared to just 11.8 percent of children with
family incomes at or above 200 percent of the poverty threshold.
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\21\ Duncan, Greg. J., Jeanne Brooks-Gunn, and Pamela K. Klebanov.
``Economic Deprivation and Early-Childhood Development.'' Child
Development 65 (1994): 296-318.
\22\ Jones (2009).
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Given the relationship between family circumstances and child well-
being, of great concern is the impact of the current recession on
children. Since December 2007, total private employment decreased by
7.9 million, and the current unemployment rate remains unacceptably
high at 9.5 percent. Children have also been adversely affected as the
percentage of children living in a household with at least one
unemployed parent more than doubled between 2007 and 2009 such that now
1 in 10 children live in a household with at least one unemployed adult
(see Figure 3). Further, over 2 million homes were foreclosed in 2008
and the number of people in families that were homeless rose by 9
percent that year. According to one study, more than 450 school
districts had an increase of at least 25 percent in the number of
homeless students between the 2006-7 and 2007-8 school year \23\ In the
2008-9 school year, the U.S. Department of Education reported a 20
percent increase in the number of homeless students.\24\
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\23\ Duffield, Barbara and Phillip Lovell. ``The Economic Crisis
Hits Home: The Unfolding Increase in Child & Youth Homelessness.''
National Association for the Education of Homeless Children and Youth
(December 2008).
\24\ United States Interagency Council on Homelessness. ``Opening
Doors: Federal Strategic Plan to Prevent and End Homelessness.'' 2010.
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While it is too early to know for certain the impact of this
recession on children, by all expectations, it will set us back.
Homeless children are, generally speaking, more likely to suffer from
health and mental health problems and to perform poorly in school, than
children in stable housing.\25\ Job loss not only affects the workers
who lost their jobs, but also has a lasting impact on their children.
In one important study, economists followed the lives of children whose
fathers lost their jobs due to plant closings and those whose fathers
had not been displaced. The researchers found that, as adults, the
annual earnings of children whose fathers had been displaced were 9
percent lower than those whose fathers had not been displaced; they
were also 3 percentage points more likely to ever receive public
assistance.\26\
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\25\ Duffield and Lovell (2008).
\26\ Oreopolous, Philip, Marianne Page, and Ann H. Stevens. ``The
Intergenerational Effects of Worker Displacement.'' Working Paper
11587. Cambridge, MA: National Bureau of Economic Research (August
2005).
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The recession also has had a negative impact on older youth: the
unemployment rate for youth (ages 16-24) was 18.2 percent last month,
nearly double the national unemployment rate. This weak labor market
will likely adversely impact their future labor market outcomes as
well. One study found that students who graduated during a recession
experienced persistent lower wages than those who graduated during
better times.\27\ Specifically, a 1 percentage point increase in the
national unemployment rate decreased initial wages by 6 percent. Even
10 years after graduation, the wage loss was still present at 4
percent. I note that this difficulty that young adults are having
gaining exposure to the world of work, is one reason that the President
has joined with Members of Congress to support funding for summer youth
employment.
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\27\ Kahn, Lisa. ``The Long-Term Labor Market Consequences of
Graduating from College in a Bad Economy.'' Mimeo, Yale University.
August 2009.
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Given the current length of this recession, it is important to look
not only at impacts of transitory poverty but also at the impact of
longer-term poverty on child well-being. Persistent poverty status
affects a plethora of outcomes, ranging from adult earnings to criminal
behavior to health. Researchers estimate that the total difference in
lifetime earnings between children who lived in persistent poverty and
children who did not amounts to about 1.3 percent of 2008 GDP.\28\
Children living in poverty are more likely to be involved in criminal
activity, which will cost society at least $170 billion annually. And
due to the incidence of poor health in poorer children, direct
expenditures on health care are estimated to cost an additional $22
billion a year.
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\28\ Holzer, Harry J., et al. ``The Economic Costs of Childhood
Poverty in the United States.'' Journal of Children and Poverty 14, no.
1 (2008): 41-61.
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While family income plays a big role in these adverse outcomes,
there are also indirect channels through which the recession will
affect children. For example, one study found that job loss is
associated with increased divorce rates.\29\ Children in unstable
families have poorer school performance and increased behavioral
problems, and unemployment can also cause stress for parents, which can
affect their behavior with their children.\30\ This, in turn, can
affect children's emotional adjustment.\31\
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\29\ Charles, Kerwin K., and Melvin Stephens, Jr. ``Job
Displacement, Disability, and Divorce.'' Working Paper 8578. Cambridge,
MA: National Bureau of Economic Research (November 2001).
\30\ Cavanagh, Shannon, and Aletha C. Huston. ``Family Instability
and Children's Early Problem Behavior.'' Social Forces 85, no. 1
(2006): 551-81; Morris, Pamela, Greg J. Duncan, and Christopher
Rodrigues.``Does Money Really Matter? Estimating Impacts of Family
Income on Children's Achievement with Data from Random-Assignment
Experiments.'' Unpublished manuscript, Northwestern University
(February 2004).
\31\ Kalil, Ariel. ``Unemployment and job displacement: The impact
on families and children.'' Ivey Business Journal (July/August 2005).
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Finally, it is important to highlight one indicator of child well-
being that, thanks to the Federal Government, has not suffered during
the recession--health insurance coverage for children. Given that over
one-half of Americans obtain their health insurance through their
employer, hard economic times can bring increases in the numbers of
children without health insurance coverage. Not surprisingly, the
proportion of children covered by private health insurance has
continued to decrease since the start of the recession. Fortunately,
the increase in the proportion of children covered by public health
insurance more than compensated for the decline in private insurance.
According to the Census Bureau, about 10 percent of children were
without health insurance in 2008. A more recent estimate from the
National Health Interview Survey suggests that in 2009, 8.2 percent of
children were without health insurance, the lowest level on record.
These positive developments will continue as a result of the historic
expansion of the Children's Health Insurance Program, which extended
coverage to 2.6 million additional children in fiscal year 2009, and
the Patient Protection and Affordable Care Act of 2010, which will end
limits on pre-existing conditions, extend the period of time during
which children can stay on their parents' health insurance, and make
health insurance more affordable for all.
WHAT HAS TO CHANGE FOR CHILDREN TO DO BETTER?
Recognizing that my colleagues will speak about many of the Federal
Government's efforts and several initiatives supported by the
Administration, I would like to underscore four general areas that I
believe are important for improving the well-being of children.
A Speedy Economic Recovery
First, given the importance of family circumstances on child well-
being, an important short-run change is a solid and timely economic
recovery. The CEA estimates that by the middle of the second quarter of
2010, the American Recovery and Reinvestment Act of 2009 (ARRA) had
raised the level of real GDP by 2.7 to 3.2 percent and the level of
employment by 2.5 to 3.6 million relative to what they would have been
without it.\32\ However, unemployment remains at 9.5 percent, and
recent economic data indicate that while a recovery is starting to take
place, much stronger job gains are needed to put the millions of
Americans who have lost their jobs since the start of this recession
back to work. This is why the HIRE Act, the jobs tax credit that
provides an incentive for small businesses to hire unemployed workers,
is so important to this economy, as is extension of unemployment
benefits. In addition, the President has continued to call for
additional support for small businesses as well as for additional
funding to help retain teachers as we head into the next school year.
When parents have jobs that provide the resources to put nutritious
food on the table and a safe and stable place to live, it is reflected
in the well-being of their children.
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\32\ Council of Economic Advisers. ``The Economic Impact of the
American Recovery and Reinvestment Act of 2009, Fourth Quarterly
Report.'' July 2010.
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A Commitment to Healthy Children
Second, with the alarming increase in childhood obesity and the
associated health and economic consequences that ensue, it is important
that we find a way to improve nutrition and healthy lifestyles among
American children. A notable step is to expand and improve the Federal
nutrition program. Two bills currently awaiting floor votes--the
Healthy, Hunger-Free Kids Act in the Senate and the Improving Nutrition
for America's Children Act in the House--aim to increase children's
access to healthier meals by providing additional funds to child
nutrition programs, including the National School Lunch Program. The
improved child nutrition program will not only assist schools in
meeting meal requirements and enrolling eligible children but also
support nutrition education in schools to promote healthy eating
habits. In addition, the First Lady's Let's Move! campaign calls upon
everyone who has an effect on children's health (from parents to
teachers to political leaders) to act together to end the epidemic of
childhood obesity within a generation. To assist in achieving this
goal, a White House Task Force on Childhood Obesity was established by
the President and is implementing a series of 70 recommendations.
A Commitment to a World-Class Education
Third, the competitiveness of the U.S. economy depends on the
productivity of its workers. A growing share of jobs requires workers
with greater analytical and interactive skills, which are typically
acquired with some post-secondary education. And yet students cannot
succeed in post-secondary education and training programs if they are
ill-prepared. While the current U.S. education and training system has
been shown to provide valuable labor market skills to participants, it
could be more effective at encouraging completion and responding to the
needs of the labor market. As detailed in the CEA report, ``Preparing
the Workers of Today for the Jobs of Tomorrow,'' a comprehensive
strategy must include a solid early childhood, elementary, and
secondary system that ensures students have strong basic skills;
institutions and programs that have goals that are aligned and
curricula that are cumulative; close collaboration between training
providers and employers to ensure that curricula are aligned with
workforce needs; flexible scheduling, appropriate curricula, and
financial aid designed to meet the needs of students; and incentives
for institutions and programs to continually improve and innovate; and
accountability for results.\33\
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\33\ Council of Economic Advisers. ``Preparing the Workers of Today
for the Jobs of Tomorrow.'' (July 2009).
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The Federal Government's investments in these areas have moved in
the right direction particularly with some of the innovative
investments in the ARRA and the Health Care and Education
Reconciliation Act of 2010. The Reauthorizations of the Elementary and
Secondary Education Act of 1965 and the Workforce Investment Act will
enable the Federal Government to continue these efforts so that the
U.S. education and training system can once again be first in the
world. The Administration also remains committed to working with
Congress to make the Early Learning Challenge Fund a reality. This
proposal, if enacted, would challenge States to establish model systems
of early learning and ensure that more children enter school ready to
learn and succeed.
Workplaces That Recognize Changes in Family Economic Structure
Finally, as documented in the CEA report, ``Work-Life Balance and
the Economics of Workplace Flexibility,'' one of the biggest changes
that impacts the lives of children is the growing participation of
women in the labor force. For example, while in 1968, 48 percent of
children were raised in households where the father worked full-time,
the mother was not in the labor force, and the parents were married; by
2008, only 20 percent of children lived in such households. As a
result, an increased proportion of children are raised in households in
which all parents work in the labor market (for single-parent
households, this means that the one parent works; for two-parent
households, both parents work). In 1968, 25 percent of children lived
in households in which all parents were working full-time; 40 years
later, that percentage had nearly doubled.\34\
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\34\ Council of Economic Advisers. ``Work-Life Balance and the
Economics of Workplace Flexibility.'' (March 2010).
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In addition, compared with 1965, in 2003 women spent more time on
market work and significantly less time on non-market work such as food
preparation, kitchen cleanup, and washing clothes. For men, the
patterns were reversed as they spent substantially fewer hours on
market work and somewhat more hours on non-market work.\35\ With men
and women both performing non-market and market work, often one or both
of them need the ability to attend to family responsibilities such as
taking children to doctors' appointments. And while many employers have
adapted to the changing family circumstances of U.S. workers by
providing flexibility in the work place (most commonly by allowing
workers to periodically change when they work), many do not.
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\35\ See Table II in Aguiar, Mark, and Erik Hurst. ``Measuring
Trends in Leisure: The Allocation of Time Over Five Decades.''
Quarterly Journal of Economics 122, no. 3 (2007): 969-1006.
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While the costs and benefits of adopting flexible work arrangements
vary by employer, the benefits of adopting such management practices
can outweigh the costs by reducing absenteeism, lowering turnover,
improving the health of workers, and increasing productivity. As such,
to the extent employers may not have accurate information about the
costs and benefits of these practices and because benefits may extend
beyond the individual employer and its workers, wider adoption of such
policies and practices may well benefit firms, workers, and the U.S.
economy as a whole, including children whose parents can more fully
attend to their health care, schooling, and other needs.
CONCLUSION
While the well-being of children has improved along many dimensions
over the past two to three decades, there is still work to be done
especially in light of the recent economic recession. The Federal
Government has played, and must continue to play, a significant role in
maintaining and accelerating progress through improved access to sound
economic strategies that enable parents to provide for their children,
quality health care, and high quality education from cradle to career.
These investments are critical as our future prosperity depends on
ensuring that American children from all backgrounds have the
opportunity to become productive workers.
Thank you for your dedication to these issues and for holding this
important hearing. I would be happy to address any questions that you
may have.
Senator Dodd. Thank you very much, Dr. Rouse. It was very
helpful.
Mr. Harris, welcome.
STATEMENT OF SETH D. HARRIS, DEPUTY SECRETARY,
U.S. DEPARTMENT OF LABOR, WASHINGTON, DC
Mr. Harris. Mr. Chairman, Senators Casey and Merkley, thank
you so much for inviting me to testify about the Labor
Department's efforts to improve the lives of children in
America.
Mr. Chairman, it is a special honor and a distinct pleasure
to reflect on your 30-year career as one of this Nation's
leading advocates for America's workers and children. Because
of your service, working parents and their children are more
prosperous, they are healthier, and they live in a fairer
world. You were motivated by a simple but fundamental
principle: Workers do not merely work. They are people, whole
people. And our workplace policies must value their
contributions in the workplace while respecting the realities
of their everyday lives. Workers' families need both their
economic support and their loving care. Your dedication to this
vision has helped to humanize the American workplace so that
millions of workers can satisfy both of these needs.
Mr. Chairman, your departure at the end of this Congress
will mark the end of an era and a great loss for America. At
the Labor Department, we share your values and we are committed
to carrying on your work.
Secretary Solis has laid out a simple and straightforward
vision for the Labor Department: good jobs for everyone. Good
jobs are found in safe and healthy workplaces. They provide
opportunities to acquire the skills workers need for the jobs
of the future and to ensure workplace flexibility for family
and personal caregiving.
Mr. Chairman, we believe this vision nicely reflects your
life's work on behalf of working families. The Family and
Medical Leave Act, which the Labor Department administers, has
helped more than 50 million Americans balance the demands of
work with the needs of their families and their own health. In
doing so, the FMLA promoted the economic security of American
working families. Mr. Chairman, without your hard work, as Dr.
Rouse said, the FMLA would not have become the law of the land.
While the FMLA is essential to workplace flexibility, you
know well, Mr. Chairman, that the FMLA provides eligible
workers only with unpaid job-protected leave, and many families
simply cannot afford to miss a paycheck. The Obama
administration has endorsed your Healthy Families Act to assure
workers get at least 7 days of paid sick leave. This
fundamental workplace standard will assure that workers can
stay home if they or their children are sick and do so without
fear of losing their job or income.
As important as the rights protected by the FMLA are, they
can be frustrated when a family cannot afford good quality
health care. The Patient Protection and Affordable Care Act
will completely change the quality of life for the millions of
American families who live in fear of doctors' bills or a
notice from the insurance company canceling their policy.
Again, Mr. Chairman, your leadership was essential in getting
this landmark health insurance reform law passed.
Again, workers are pillars of our economy and their
families. This is especially true for nearly 9 million working
women who are also heads of household. Simply the financial
health of families increasingly depends upon women. Both women
and men must be able to secure their families' places in the
middle class and this means that all workers must earn wages
that can support a family. However, gender wage inequality
stubbornly persists. For this reason, we thank you, Mr.
Chairman, for championing the Paycheck Fairness Act.
Good jobs for everyone includes assuring that young people
have the skills they need to compete in the rapidly changing
global economy. The Department administers several programs
that benefit young adults entering the workforce. Under the
Workforce Investment Act, the Department administers youth
activities funds with our State and local partners that deliver
job training, work experience, and job placement services to
low-income youth who experience barriers to employment. Many
eligible young people do not have basic skills and the
population we serve frequently includes homeless youth,
runaways, pregnant or parenting teens, ex-offenders, school
dropouts, or foster children. These young people are, indeed,
fortunate that you and your colleagues in the Senate fought to
ensure that the Recovery Act included $1.2 billion or the WIA
youth funds. This funding enabled more than 325,000 youth
across the United States to experience employment during the
summer of 2009.
The Labor Department also prepares older children and young
adults to become productive contributors to our economy through
programs like Job Corps and Youth Build. By taking low-income
youth and placing them on a career pathway with job training
and support, the Department helps them lay the foundation for
lifetime income security and, when they start families, a
better future for their children.
Mr. Chairman, I have only skated over the surface of the
Labor Department's work on behalf of children. We enforce the
FLSA's child labor protections. We support transitional jobs as
part of the President's Fatherhood Initiative, among many other
activities I would be delighted to talk about during Q&A.
Let me close by saying, Mr. Chairman, your absence from the
Senate will be a great loss for America's working families and
children. In tribute to your legacy and in full recognition of
the work yet to be done, we will fight to ensure that your
vision of a humanized labor market and compassionate workplaces
continues to guide the work of the Department of Labor.
Thank you again for inviting me to testify today, and I
look forward to our questions.
[The prepared statement of Mr. Harris follows:]
Prepared Statement of Seth D. Harris
Good morning Chairman Dodd, Ranking Member Alexander, and members
of the subcommittee. Thank you for inviting me to testify about the
Labor Department's role in improving the state of America's children.
Mr. Chairman, it is my great honor and distinct pleasure to have
this opportunity to reflect on your 30-year career as one of this
Nation's leading advocates for America's workers and children. Because
of your service, the lives of working parents and their children are
more prosperous, healthier, and more fair. You have fought for the
rights of women, minorities, children, and those whose voices are not
always heard. These Americans may not know your name. But they know the
products of your endeavors. And your efforts, very simply, have made
their lives immeasurably better.
Your impressive accomplishments in the House of Representatives and
in the U.S. Senate were motivated by a simple but fundamental
principle: workers don't merely work. They are more than economic
inputs into America's economy or costs on an employer's ledger. They
are people--whole people--and our workplace policies must value their
contributions in the workplace while respecting the realities of their
everyday lives. Workers are also parents, spouses, and adult children
of aging parents. Their families need both their economic support and
their loving care. Your dedication to this vision has helped to
humanize the American labor market and American workplaces so that
millions of workers can satisfy both of these needs. As you reminded
your colleagues just a few years ago,
``When we talk about a more compassionate America, nowhere is
that more evident than in our caregiving leave policies. No one
should have to choose between work and family.''
To that, Mr. Chairman, we would add only a resounding ``Amen.''
Your departure at the end of this Congress will mark the end of an
era and a great loss for America, but your work will live on. At the
Labor Department, we share your values and we are committed to carrying
on your work. We also fully expect that we will hear from you, even
after your retirement, if we stray from the path you have laid out.
On behalf of Secretary Solis, the 17,000 men and women of the U.S.
Labor Department, and the millions of working Americans whom we serve,
thank you for your outstanding leadership and service.
SECRETARY SOLIS' VISION AND GOOD JOBS FOR EVERYONE
Secretary Solis has laid out a simple and straightforward vision
for the Labor Department: Good Jobs for Everyone. We are the Department
of Good Jobs for Everyone. Good jobs can be found in safe and healthy
workplaces, and in fair and diverse workplaces. Good jobs support a
family by increasing incomes and narrowing the wage gap, while
providing opportunities to acquire the skills and knowledge that
workers will need for the jobs of the future, particularly in high-
growth and emerging industry sectors like ``green'' jobs. Good jobs
help middle-class families remain in the middle class. They also
provide upward mobility and a pathway to the middle-class for low-wage
workers and those disenfranchised from the labor market. Good jobs
facilitate the return to work for those individuals who experienced
workplace injuries or illnesses and are able to work, while providing
sufficient income and medical care for those who are unable to do so.
Good jobs ensure that workers have a voice in their workplaces, and
provide health care coverage and retirement security. And finally, good
jobs provide workplace flexibility for family and personal care-giving.
Mr. Chairman, we believe that this vision nicely reflects your life's
work on behalf of working families.
In the remainder of my testimony, I will discuss how Secretary
Solis' vision of Good Jobs for Everyone seeks to address the concerns
of working families and children from birth through the beginnings of
adulthood. The Labor Department administers programs that help ensure
good jobs for parents and, in doing so, provides access to a better
childhood for their offspring. Simply put: children have the greatest
opportunities when their parents can provide them with economic
security and family stability. But the Labor Department also assures
that children have the opportunity to acquire the education and develop
the skills they need to become productive contributors in the new
American economy and, in turn, the economic bulwarks for their
families. Just as you have advised, Mr. Chairman, our goal and the goal
of our partners in the agencies testifying here today is to help
workers succeed as whole people, in the workplace and in the home.
WORKPLACE FLEXIBILITY AND LEAVE: FAMILIES BALANCING LIFE'S DEMANDS
The right to take job-protected leave to care for a child who is
sick is absolutely essential to the concept of a ``good job.'' It
recognizes the dual role that working parents play. The seemingly
never-ending juggling act that parents face in trying to balance work
life and family life begins as soon as a baby arrives, continues beyond
that first call home a school nurse makes when a child has a fever or a
broken bone, and remains when a call comes from a nursing home to
resolve a health issue for an ailing parent. That is why one of the
tenets of Secretary Solis' definition of Good Jobs for Everyone is that
a good job ``provides workplace flexibility for family and personal
care-giving.''
You know better than anyone, Mr. Chairman, that the Family and
Medical Leave Act (FMLA) provides this necessary flexibility. The
passage of the FMLA was the most important legislative event of its
time for the lives of working families. This landmark law gave working
Americans the right to take unpaid leave to be there for their families
when it counts: when a child, parent, or spouse has a serious illness,
or when a baby is born or adopted. The FMLA has helped more than 50
million Americans balance the demands of the workplace with the needs
of their family and their own health, and in doing so promoted the
financial stability and economic security of American working families.
As President Clinton noted when he made FMLA the first legislation he
signed into law, your bill set a long overdue standard of fairness in
the workplace. Mr. Chairman, there can be no doubt that without your
hard work and persistence, the FMLA would not have become the law of
the land, and countless American workplaces would be void of the basic
standard of fairness it mandates.
The impact that the FMLA has on the health and well-being of our
Nation's children cannot be overstated. More mothers and fathers have
the opportunity to bond with their newborns. Employees recuperate more
quickly and completely from illness resulting in greater productivity
upon their return. Children are healthier, infection rates in childcare
facilities decrease, and parents are less likely to postpone or skip
their children's vaccination schedules all because their parents are
provided job-protected sick leave.\1\
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\1\ Vicky Lovell, Ph.D., ``No Time To Be Sick: Why Everyone Suffers
When Workers Don't Have Paid Sick Leave,'' Institute for Women's Policy
Research, 2004.
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Guided by Secretary Solis, the Department of Labor has recommitted
itself to the enforcement of the FMLA. The Department's Wage and Hour
Division (WHD) ensures that workers' FMLA rights are protected. In one
instance, WHD was able to successfully assist a working mother who was
a manager at a Dollar General store near Houston, TX. She needed to
leave from work for the birth of her child and notified her employer 2
months before she was to give birth. The employer, however, failed to
properly notify the employee of her rights and responsibilities under
the FMLA, and subsequently terminated her employment while she was on
leave for the birth of her child. Fortunately, a WHD investigator was
able to recover several thousand dollars in back wages for this new
mother. Such gross violations of the law are inexcusable and will not
be tolerated.
As you know, Mr. Chairman, family life is constantly changing, and
the rules and regulations that govern workplace flexibility must keep
pace. The Department is committed to ensuring that all working parents
have the tools they need to balance work and family life--even if their
families do not fit the ``traditional'' definition. The Department
recently updated FMLA guidance to respond to the ever-increasing
diversity in modern American families. Seventeen years after the
enactment of the FMLA, the Wage and Hour Division published a new
Administrator's Interpretation clarifying that the definition of a
``son or daughter'' includes the concept of in loco parentis--that is,
the person who has day-to-day responsibility for a child is entitled to
take job-protected leave to care for that child who is seriously ill.
Under this interpretation, the brother who receives a call in the
middle of the night that his sister and her infant daughter have been
in a serious car wreck; the woman who is awaiting the birth of her
same-sex partner's biological child; or the grandmother who is the sole
guardian of a grandchild forced to stay home from school because of an
asthma attack, are entitled to take the necessary leave because they
have assumed the role of a parent.
More than 100,000 children growing up with same-sex parents can
benefit from this important interpretation of the FMLA, while countless
children being parented by grandparents, domestic partners, and other
extended family members will also benefit. The specific make-up of a
family should have no effect on the life of a child, nor does it change
the pivotal role a caregiver plays in that child's development. The
Labor Department's updated FMLA guidance is yet another small step
towards ensuring that all children, regardless of the family they come
from, are properly cared for.
While the FMLA is essential to the workplace flexibility needed by
today's working families, Mr. Chairman, you have acknowledged that it
has its limitations. As it stands, the FMLA provides eligible workers
only with unpaid leave, and many families simply cannot afford to miss
a paycheck. In 2008, the Department's Bureau of Labor Statistics (BLS)
found that only 61 percent of private-sector employees are offered paid
sick leave for their own illness or injury. Only 23 percent of the
lowest 10 percent of wage earners had access to paid sick leave, and
only 17 percent of that group had access to personal leave. The
Administration supports your efforts to secure more access to paid
leave for American workers. As you know, the President's budget
included an initiative to encourage States to set up paid leave funds.
In addition, at a hearing about the H1N1 flu pandemic you chaired
last year, I was proud to announce the Administration's strong
endorsement of your Healthy Families Act. Your great friend Senator
Edward M. Kennedy introduced this important legislation, and I applaud
you for continuing to champion this bill. The Healthy Families Act
would provide workers with 7 days of paid sick leave. This fundamental
workplace benefit will assure that workers can stay home if they or
their children are sick, and do so without fear of losing their job or
critical income. We look forward to continuing your fight to get this
important legislation enacted.
HEALTH CARE
For decades, as health care costs rose astronomically, insurance
companies imposed more and more restrictions on health insurance
policies, and fewer employers offered health benefits, American workers
found it harder and harder to provide for their families' most basic
need for health care. As important as the rights protected by FMLA are,
they can be substantially frustrated when a parent who takes FMLA-
protected leave to care for a sick child cannot afford to take that
child to a doctor. The Patient Protection and Affordable Care Act
(Affordable Care Act) will completely change the quality of life for
the millions of American families who live in fear of doctors' bills or
a notice from the insurance company that their policy had been
canceled.
Mr. Chairman, you have been a true leader in the fight for
guaranteed health care for children and were instrumental in the
passage of health care reform. Throughout your career, you have fought
for health care reform based on your deep belief that quality,
affordable and accessible health care for every single American should
be a right, not a privilege. Passage and enactment of the Affordable
Care Act has secured your place in history as a champion for the
ordinary working Americans, all of whom will benefit from this new law.
The benefits this law will provide for working families are
immense. Even low-income workers will have the peace of mind that comes
with having quality health care coverage for the whole family. Workers
will decide what job works best for their families based on relevant
factors, like pay, location, career advancement opportunities, and job
satisfaction. No longer will workers be held hostage to a job simply
because they cannot afford to lose the health care benefits that come
with it. Now, all workers will have access to quality affordable
coverage. Simply removing the pre-existing condition limitation will
have a profound effect on American workers. Workers with chronic
medical conditions will not be tied to one job for the rest of their
lives. As workers find jobs that better match their skills, employers
will benefit as well.
At the Department of Labor, we are proud to be one of the lead
agencies implementing the Affordable Care Act. The Department has
worked with the Departments of Health and Human Services and Treasury
to issue regulations on coverage of preventive services, pre-existing
condition exclusions, lifetime and annual limits, rescissions, patient
protections, grandfathered health plans, and most relevant to this
hearing, the extension of coverage for adult children. I will talk more
later about how the Department helps ease young adults' transition into
the workplace, but I would like to note that the Affordable Care Act's
requirement that health plans and insurance companies extend coverage
for adult children up to the age of 26 significantly helps young adults
make good decisions about their first jobs, instead of being driven
into a job just for health care coverage or risking living without care
while they job hunt.
INCOME SECURITY
As I mentioned earlier, the Department of Labor views workers as
pillars of the economy and their families. To support a structure, a
pillar must be strong and grounded on a solid foundation. In human
terms, workers must earn wages that allow them to support their
families and have the necessary skills to keep those jobs. Poverty is
antithetical to a safe and secure family. My former colleague Dr. Harry
Holzer testified at the first hearing of this series on the ``State of
the American Child'' about how unemployed parents and childhood poverty
are linked to negative long-term consequences for the future employment
and earnings of children. When parents struggle to provide for their
children's needs, children suffer in both the short- and long-term, and
recognition of this link magnifies the implications of the current
economic crisis. As witnesses at that first hearing discussed, the
recent recession and continuing unemployment crisis will have lasting
impacts on today's American children.
That is why the Labor Department helps families by fighting for
wage earners to get the pay that they are entitled to and providing
them with a solid foundation of training so they can secure the jobs
that will help them secure or find their place in the middle class.
ENSURING FAIR PAY
The growing number of female breadwinners in this country means
that the financial health of families increasingly depends on women.
With nearly 9 million working women who are also heads-of-household,
the Labor Department is committed to making sure that pathways out of
poverty are open to women as much as they are to men. Often, however,
the mere opportunity is not enough. As the Chairman knows well, gender
wage inequalities stubbornly persist, and women of color often bear a
disproportionate share of this burden.
For this reason, Mr. Chairman, thank you for championing the
Paycheck Fairness Act for the last seven Congresses. You have been at
the very forefront of this fight, and it is a fight this Administration
has pledged to continue. Enacting this important legislation would
enhance the Equal Pay Act and bring economic justice to America's
working women; in doing so, this country would take another step
towards ensuring that many fewer mothers would have to choose between
paying the bills and caring for their loved ones.
Though President Obama affirmed his commitment to equal pay for
women by signing the Lilly Ledbetter Fair Pay Act into law, Secretary
Solis, this Administration, and you, Mr. Chairman, all agree that more
must be done. As a result, the President established the National Equal
Pay Enforcement Task Force. The Department's Office of Federal Contract
Compliance Programs is working with other agencies across the
government to ensure that the promise of equal pay for women is
fulfilled.
FATHERS AND TRANSITIONAL JOBS
Responsible fathers are also crucial to the economic security of
families. The President is firmly committed to promoting and supporting
responsible fatherhood. As part of this commitment, the Labor
Department's Employment and Training Administration (ETA) is working
closely with the Department of Health and Human Services' (HHS)
Administration for Children and Families (ACF) to launch a new
initiative to test and evaluate transitional jobs. Transitional jobs
typically provide subsidized employment, supportive services and job
placement assistance to participants with little work history. These
opportunities help vulnerable workers overcome substantial barriers to
work, build a resume, and move into long-term, unsubsidized employment.
ACF has provided technical assistance on how child support enforcement
would affect program approaches in the Labor Department's Transitional
Jobs demonstration projects for low-income non-custodial parents. We
believe that stable employment for fathers will have long-term
beneficial effects for their children.
JOB TRAINING FOR THE YOUTH OF TODAY, PARENTS OF TOMORROW
The Department of Labor invests in job training for all workers. It
is another tenet of Good Jobs for Everyone that a good job provides
opportunities to acquire the skills and knowledge for the jobs of the
future. Secretary Solis and Assistant Secretary for Employment and
Training Jane Oates have testified before the HELP Committee numerous
times on the Department's full array of job training programs and how
they support the economic security of America's families through
lifelong job training, knowledge, and skills acquisition. I will not
take the committee's time to go over these programs again. As I
mentioned earlier, however, these programs are critical to helping
families reach and remain in the middle class in a 21st century
economy.
Instead, I would like to focus on the Department's job training
programs that benefit young adults who are just leaving childhood and
entering the world of work. The Secretary's vision of Good Jobs for
Everyone includes ensuring that young people have access to careers in
high-growth industries and the skills they need to compete in the
global economy. This vision aligns with your determination, Mr.
Chairman, to improve life opportunities for our children and youth. In
due time, children become adults and have their own children. Putting
these young adults on a track to gainful, skilled employment early in
life is the best way to ensure not only their own success, but the
future success of their children. Research suggests paid work
experience may improve educational and employment outcomes for at-risk
youth.\2\
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\2\ Edwards, K., and A. Hertel-Fernandez. 2010. ``The Kids Aren't
Alright: A Labor Market Analysis of Young Workers.'' EPI Briefing Paper
#258, Economic Policy Institute.
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Under the Workforce Investment Act of 1998 (WIA), the Department
administers Youth Activities funds allocated to State and local areas
to deliver a comprehensive array of youth workforce investment
activities. These activities help ensure that youth obtain the skills
and knowledge needed to succeed in a knowledge-based economy, and
emerging industry sectors such as healthcare and ``green'' jobs. WIA
authorizes services to low-income youth, ages 14 to 21, who experience
barriers to employment. Many eligible young people are deficient in
basic skills, and are frequently homeless, runaways, pregnant or
parenting, criminal offenders, school dropouts, or foster children.
As you know, Mr. Chairman, WIA programs serve both in-school and
out-of-school youth, including youth with disabilities and other youth
who may require additional assistance to complete an educational
program or to secure and hold employment. By providing them with access
to tutoring, alternative secondary school services, summer employment,
occupational training, work experience, supportive services, leadership
development opportunities, mentoring, counseling, and follow-up
services, participants are prepared for both post-secondary education
and ultimate employment. The WIA Youth program typically serves between
250,000 and 300,000 youth per year.
These young people are indeed fortunate that you and your
colleagues in the Senate fought to ensure that the American Recovery
and Reinvestment Act (Recovery Act) included increased funding for WIA
programs. The Recovery Act provided an additional $1.2 billion in WIA
Youth funds, with an emphasis on summer employment. The Recovery Act
also allowed the Department to increase the age of eligibility for
youth services to 24 years of age. DOL's ETA is encouraging summer
youth programs to develop work experiences that would expose young
people to jobs in the emerging ``green'' economy. For example, in
Philadelphia, PA, many youth received a combination of post-secondary
training with worksite experiences in green jobs. Some of these youth
participated in a partnership with Temple University, which provided
them with Environmental Research Internships and experience working
with researchers in the field. The summer work experiences described
above are especially critical for low-income youth. This Recovery Act
funding enabled more than 325,000 diverse youth to experience
employment during the summer of 2009. Of these youth, approximately
159,000 were African-American, 7,000 were American Indian or Alaska
Native, 6,000 were Asian, and 87,000 were Latino.\3\
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\3\ Mathematica Policy Research, Inc., ``Reinvesting in America's
Youth: Lessons from the 2009 Recovery Act Summer Youth Employment
Initiative.'' Contract Number DOLU091A20968. February 26, 2010.
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Recovery Act funding also enabled ETA and ACF to promote subsidized
summer employment opportunities for similar low-income youth. To date,
we are aware of at least 15 States that will be using the Temporary
Assistance for Needy Families (TANF) Emergency Contingency funding
provided in the Recovery Act for summer employment programming, giving
youth access to a multitude of support services and occupational skills
training.
Unfortunately, the summer youth programs have not yet been funded
this summer. Funding these programs is essential, even at this late
date. We hope that Congress will still act so we can help students this
summer and into the fall.
In addition to the WIA services described above for low-income
students enrolled in high school, the Labor Department also provides
alternative pathways to successful employment for disconnected youth
and those who do not graduate from high school. One such initiative is
the Department's YouthBuild program, which provides job training and
educational opportunities for low-income or at-risk out-of-school youth
ages 16 to 24. By providing these youth with the opportunity to acquire
academic and work-related credentials while constructing or
rehabilitating affordable housing for low-income or homeless families
in poor communities, the YouthBuild program creates opportunities to
re-engage out-of-school youth in education, skills training, and
leadership development while serving their community. Many YouthBuild
program graduates continue on in community or 4-year colleges to gain
the education and skills that they need to be productive in the 21st
Century economy.
Recently, YouthBuild programs have begun providing training in
green construction techniques, which will help youth compete for jobs
in a changing construction sector. The Lake County YouthBuild program
in northern Chicago trains its young people in green construction and
has begun installing solar water heating and solar electricity in the
low-income housing that it builds in its community. In addition, the
Department has introduced a new Apprenticeship Training Program,
designed specifically for YouthBuild, to support the transition of our
young people into apprenticeship opportunities in high-growth, emerging
sectors of the economy. In Portland, OR, YouthBuild created a
registered apprenticeship program with the Laborers Union to train its
students in weatherization skills, and created green career tracks in
several fields for its YouthBuild graduates in partnership with
Portland Community College.
The Labor Department's most intensive program that assists youth
with employment is Job Corps. Established 46 years ago to help fight
the War on Poverty, Job Corps helps at-risk youth with education and
job training in an effort to halt the perpetual cycle of poverty that
claims the livelihood and future success of far too many American
children. By providing a foothold for graduates to ascend beyond low-
wage jobs through training and education, Job Corps gives many of its
graduates a pathway to the middle-class. Job Corps students and
graduates earn academic credentials, such as a High School Diploma or
GED, and industry-recognized certifications, State licensures, or
apprenticeships in their career technical training area. These
credentials ensure that graduates have attained the skills and
knowledge necessary to compete in today's labor market, including
emerging industries, like green jobs. By operating 123 centers in 48
States, Puerto Rico, and the District of Columbia, Job Corps provides
training and education opportunities to young men and women nationwide.
Additionally, on-site daycare services at 28 of these centers, allow
students who may be parents to fully participate in the program
We have heard numerous success stories from impressive Job Corps
alumni. Some years ago, James Sollome thought he was on the verge of
starvation. His father was in prison and he was an unemployed high
school dropout who had been living out of his car for 4 months. While
job-hunting at a local unemployment office, James was informed of the
opportunities available at the Excelsior Springs Job Corps Center. In a
little more than a year after joining Job Corps, James graduated with
his GED and earned his certificate of completion in painting. He went
on to college, and in the coming year, he is expecting to graduate with
a Ph.D. in pharmacology and toxicology from the University of Arizona.
Another success story comes from a woman in the Chairman's home
State of Connecticut. Roccina Blash, a native of Waterbury, graduated
at the top of her class in the Emergency Medical Training (EMT) program
at New Haven Job Corps Center. In May 2010, Roccina accepted a full-
time position with American Medical Response Ambulance Service. She is
not alone in her success. There are thousands of Job Corps students who
have launched thriving careers with the assistance of the Department of
Labor.
It is programs like these that typify the Department of Labor's
role in maintaining and promoting the state of the American child. By
taking often disenfranchised, low-income youth and placing them on a
career pathway with job-training and support, the Department of Labor
helps them on the path to lifelong income security and economic
stability and a better future for their children.
MAKING SURE FIRST JOBS ARE SAFE AND SUCCESSFUL
While the Department helps youth transition into the working world,
it is also part of our mission to ensure that youth are employed only
in jobs that are safe and age appropriate. Part of building a long-
lasting and productive relationship between young people and work is
making sure their early experiences are positive ones. An unsafe or age
inappropriate job is unlikely to be a successful job. A good job is a
safe job--no matter how old or young you are.
Towards this end, the Department vigorously enforces the child
labor provisions of the Fair Labor Standards Act. The Department
recently published new child labor rules governing the employment of
youth in nonagricultural industries, which became effective on July 19,
2010. These changes, which represent the most sweeping revisions to our
child labor rules in over 30 years, are crafted to improve the
occupational safety and health of the workplaces of the 21st Century
and the realties faced by working youth and their employers. These
rules reflect the hard work and commitment of the Labor Department's
Wage and Hour Division and Occupational Safety and Health
Administration, along with our partners at the Department of Health and
Human Services' National Institute for Occupational Safety and Health.
The new regulations give employers clear notice that there are certain
jobs children are simply not allowed to perform. They also expand
opportunities for young workers to gain safe, positive work experience
in fields such as advertising, teaching, banking and information
technology, as well as through school-supervised work-study programs.
With the completion of these rules, DOL staff have turned their
attention to strengthening the regulatory protections for children
working in agriculture.
These strategies work. Last year, Wage and Hour investigators found
children working in the blueberry fields of North Carolina. While we
assessed civil money penalties against those farmers and farm labor
contractors for the violations, our staff also engaged the local
community, local departments of social services, and State migrant
education consultants, to provide alternatives to children whose
parents are in the fields and to provide education on child safety.
This year, when we sent investigators back into the fields unannounced,
we found no children working in the blueberry fields of North Carolina.
We strongly believe that our efforts to prevent young workers from
being employed in unsafe occupations and industries will lead to fewer
injuries and fewer deaths.
CONCLUSION
Mr. Chairman, your absence from the Senate will be a great loss for
America's working families and children. As President Obama said on the
announcement of your retirement, ``You have worked tirelessly to
improve the lives of children and families, but your work is not
done.'' In tribute to your legacy and in full recognition of the work
yet to be done, we will fight to ensure that your vision of a humanized
labor market and compassionate workplaces lives on at the Department of
Labor.
My testimony illustrates the ways that the Labor Department enables
America's children to succeed and thrive across various life-stages. We
are hard at work to realize Good Jobs for Everyone--for today's workers
and their families, as well as the workers of the future. Thank you for
inviting me to testify today. I would be happy to answer any questions
the committee may have.
Senator Dodd. Well, thank you very, very much, Mr. Harris.
It is very helpful. I am anxious to ask you some questions
about the Department of Labor. So we thank you for being here
today.
Yes, Mr. Hansell. How are you?
STATEMENT OF DAVID A. HANSELL, ACTING ASSISTANT SECRETARY,
ADMINISTRATION FOR CHILDREN AND FAMILIES, U.S. DEPARTMENT OF
HEALTH AND HUMAN SERVICES, WASHINGTON, DC
Mr. Hansell. Good morning. Chairman Dodd, Senator Casey,
Senator Merkley, I am pleased to appear before you to discuss
the state of children in America.
But I would first like to join my administration colleagues
in taking this opportunity to express our appreciation to you,
Mr. Chairman, for your longstanding commitment to improving the
lives of our Nation's children. From expanding child care and
strengthening Head Start, to addressing child abuse and
domestic violence, this subcommittee, under your leadership has
made enormous contributions to children across the country.
While many children in our Nation are thriving, as you
indicated, statistics show that far too many children are
growing up in poverty without adequate family support and
without access to quality care and education. The President and
Secretary Sebelius have established a number of priority
initiatives to address these challenges.
Recognizing that children's early experiences are critical
in shaping the foundation for long-term growth and development,
one of the Secretary's highest priorities is early childhood
development. The early childhood programs administered by the
Administration for Children and Families both provide enriching
experiences that promote the long-term success of disadvantaged
children and assist low-income working parents with the
availability and cost of child care. Child care subsidies are
provided to 1.6 million children nationally, and Head Start
funds 1,600 grantees in our poorest neighborhoods to serve
nearly 1 million children in poverty.
The Recovery Act included a $2 billion increase in child
care funding, allowing providers to serve 200,000 more children
than would otherwise have been possible and make quality
improvements to the program. The President's fiscal year 2011
budget requests another $1.6 billion to sustain this Recovery
Act investment and outlines a set of principles for child care
reauthorization, focusing on serving more low-income children
in safe, healthy, nurturing child care settings that will
promote learning, child development, and school readiness.
The Recovery Act also invested $2.1 billion in expansions
to Head Start and Early Head Start programs, expansions that
the President's budget would sustain in fiscal year 2011.
We also continue to improve Head Start using the tools
provided by Head Start reauthorization. We will be
significantly increasing the expectations for what Head Start
programs should achieve by strengthening Head Start program
performance standards. We will be providing the necessary
supports to meet those expectations by reinventing the training
and technical assistance system, and we will be strengthening
accountability by implementing a system that injects
competition into the Head Start program for poor performing
grantees as envisioned by this subcommittee in the Head Start
reauthorization.
The administration is committed to working with States to
reduce the incidence of child abuse and neglect and provide
safe and permanent homes for all of America's children. Our
efforts to prevent the maltreatment of children, to mediate
children's exposure to violence, to find permanent placements
for those children who cannot safely return to their homes, and
to provide transitional services for older youth are all
critical to ensuring that America's children grow into healthy,
stable adults.
We have been working closely with the subcommittee on
reauthorization of two programs offering critical support for
these children and young adults: the Child Abuse Prevention and
Treatment Act and the Family Violence Prevention and Services
Act.
We are also committed to investing in proven programs and
strategies to positively impact children's safety, permanence,
and well-being or in programs that show significant promise in
that regard. A new $20 million grant program will be funded
shortly to support innovative strategies for moving to
permanent homes children who have been in foster care the
longest.
There is no question that families should be the core
support for children. Children's well-being depends on
financial and emotional support from both parents, and parental
employment is the key to long-term economic security for
families. Bolstered by the $5 billion provided in the Recovery
Act, our new TANF emergency fund is helping families during the
economic downturn, including significant investments in
subsidized employment. States have plans to create more than
200,000 jobs for needy adults and youth by September. Given the
difficult fiscal choices that States are facing in an economy
that still has high unemployment, we strongly urge the Congress
to take action now so that all States can continue to access
the emergency fund in fiscal year 2011.
Research suggests that the most stable families consist of
two parents who are involved and invested in their children's
success. The President is committed to promoting responsible
fatherhood and helping fathers meet their obligations by
ensuring that they have the broad range of services, including
job, relationship, and parenting skills training that they need
to be successful. The vision of the President's Fatherhood
Initiative, in conjunction with services offered through our
child support enforcement, child care, and TANF programs, offer
an integrated set of strategies to bolster the economic
security of especially vulnerable families and their children.
Under your committed leadership, Mr. Chairman, significant
strides have been made in understanding where we are most
challenged in improving the state of American children and
targeting funding and attention to policies that seek to
address these challenges. We look forward to continued efforts
to ensure that legislative changes and key investments are made
to further improve the lives of America's children. I look
forward to answering questions after their testimony.
[The prepared statement of Mr. Hansell follows:]
Prepared Statement of David A. Hansell
Chairman Dodd, Ranking Member Alexander, and members of the
subcommittee, I am pleased to appear before you today to discuss the
state of Children in America. I would first like to take this
opportunity to express my thanks to you, Mr. Chairman, for your long-
standing commitment to improving the lives of our Nation's children and
your tireless efforts on their behalf.
From expanding child care and strengthening Head Start to
addressing child abuse and domestic violence, this subcommittee has
made enormous contributions to children across the Nation, and we are
grateful for your steadfast dedication and efforts. You have been
influential in targeting funding for services to improve the lives of
children through these and a wide range of other programs in the
Administration for Children and Families (ACF), including the Community
Services Block Grant, the Low Income Home Energy Assistance Program,
the Assets for Independence Program and the Developmental Disabilities
Program.
For purposes of today's hearing, I will limit the focus of my
testimony to early childhood development; the safety, permanence, and
well-being of our most vulnerable children; and, fatherhood and
economic security (which play a major role in the lives of children and
their families) and how ACF programs are contributing to these efforts.
I would like to begin by sharing some significant statistics
regarding the state of many children in this country.
STATE OF CHILDREN IN AMERICA
While in many respects American children are doing well, ACF has
particular stewardship of programs for children and families most at
risk for negative outcomes. As you are keenly aware, there are far too
many in need of our services.
Poverty--Between 1993 and 2000, the child poverty rate
declined from 22.7 percent to 16.2 percent due in substantial part to a
near full-employment economy and rising employment among single
mothers.\1\ Unfortunately, since 2000 these positive trends have not
been sustained. By 2008, nearly 1 in 5 children lived in poverty and 8
percent of children (5.9 million) lived in extreme poverty, defined as
living in a family with income less than one-half of the poverty
threshold. These are the highest percentages of children living in
poverty since 1998. About 22 percent of children lived in households
that were food insecure at times in 2008, an increase from 17 percent
in 2007 and the highest percentage recorded since monitoring began in
1995.\2\
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\1\ U.S. Census Bureau, ``Table 3. Poverty Status of People, by
Age, Race, and Hispanic Origin: 1959 to 2008,'' available at: http://
www.census.gov/hhes/www/poverty/data/historical/hstpov3
.xls.
\2\ Federal Interagency Forum on Child and Family Statistics.
America's Children in Brief: Key National Indicators of Well-Being,
2010. Washington, DC: U.S. Government Printing Office.
---------------------------------------------------------------------------
Family Structure--In 2008, 67 percent of children ages 0-
17 lived with two married parents, down from 77 percent in 1980. Among
the 2.8 million children (4 percent) not living with either parent in
2008, 54 percent (1.5 million) lived with grandparents, 25 percent
lived with other relatives, and 21 percent lived with non-relatives. Of
children in non-relative homes, 38 percent (228,000) lived with foster
parents.\3\ The percentage of children exiting foster care to a
permanent home through adoption or guardianship has been increasing.
Over 40 percent of births in the United States were outside marriage in
2008.\4\
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\3\ Federal Interagency Forum on Child and Family Statistics.
America's Children in Brief Key National Indicators of Well-Being,
2010. Washington, DC: U.S. Government Printing Office.
\4\ Ibid.
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Child Care--Many children spend time with a caregiver
other than their parents. The majority of children (61 percent) ages 0-
6 received some form of non-
parental care on a regular basis in 2009.\5\ At the same time, the
parents of more than 28 million school-age children work outside the
home.\6\ For both young children and those in school, the cost of care
and the lack of support too often do not allow families the ability to
access high quality care, particularly for very young children. The
average annual price of care for an infant in a center ranged from
$4,560 in the least expensive State to $15,895 in the highest. A recent
report from the Carsey Institute found that, among working families who
made child care payments for their young children, families living in
poverty paid 32 percent of their monthly family income for child care--
nearly five times more than families at 200 percent of poverty or
higher.
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\5\ America's Children in Brief: Key National Indicators of Well-
Being, 2010 (Childstats.gov).
\6\ U.S. Department of Labor, 1998 (www.afterschoolalliance.org).
---------------------------------------------------------------------------
Child Maltreatment--In 2008, the rate of substantiated
reports of child maltreatment was approximately 10 per 1,000 children
ages 0-17. Younger children are more frequently victims of child
maltreatment than older children. Neglect is the predominant form of
maltreatment for all children and the youngest children are most at
risk. In 2008, there were 22 substantiated child maltreatment reports
per 1,000 children under age 1, compared with 12 for children ages 1-3,
11 for children ages 4-7, 9 for children ages 8-11, 8 for children ages
12-15, and 5.5 for adolescents ages 16-17.\7\
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\7\ Federal Interagency Forum on Child and Family Statistics.
America's Children in Brief Key National Indicators of Well-Being,
2010. Washington, DC: U.S. Government Printing Office.
---------------------------------------------------------------------------
ADMINISTRATION PRIORITIES
While many children across the country are thriving, these
statistics show that far too many children today are growing up in
poverty, without adequate family support, and without access to quality
care and education. The President and the Secretary have established a
number of priority initiatives to address these challenges. The first I
would like to discuss focuses on early learning and school readiness.
EARLY CHILDHOOD DEVELOPMENT
Recognizing that children's early experiences are critical in
shaping the foundation for their long-term learning, development and
growth, one of the Secretary's highest priorities is early childhood
development. We know that with nurturing and responsive relationships
with parents and caregivers and with engaging learning environments in
early care and education settings, young children are capable of
tremendous growth and resilience in the face of adversity. That is why
we are focused both on raising the bar on quality in early childhood
programs--including child care and Head Start--and on expanding access
to high quality programs so more children can participate in them.
Early childhood programs are critical to breaking the cycle of
poverty in the United States, and are vital to the country's workforce
development, economic security, and global competitiveness. The early
childhood programs administered by ACF are designed both to assist low-
income working parents with the cost of child care, and to fund
programs that provide enriching early childhood experiences that
promote the long-term success of disadvantaged children.
Child care subsidies are provided to 1.6 million children
nationally through the Child Care and Development Fund to reduce the
burden of high child care costs for low-income working families.
Additionally, Head Start funds over 1,600 grantees in our poorest
neighborhoods to provide enriching early childhood experiences and
health services to nearly 1 million children in poverty.
Evidence continues to mount regarding the profound influence
children's earliest experiences have on their later success. Because of
the strong relationship between early experience and later success,
investments in high quality early childhood programs can pay large
dividends.
Recognizing this, the Congress significantly increased funding for
both the Child Care and Head Start programs through the American
Recovery and Reinvestment Act (Recovery Act). The Recovery Act included
$2.1 billion to fund expansions in Head Start, Early Head Start,
investments in teachers, classroom materials, and services and supports
for State Advisory Councils on Early Childhood Development and
Education. The program will be serving nearly 50,000 additional
children in Early Head Start and over 13,000 additional children in
Head Start. Child Care funding increased by $2 billion in the Recovery
Act, and the providers will serve an estimated 200,000 more children
than would otherwise have been supported by the program.
While this is important progress, far too many children still do
not have access to high quality early childhood services. Head Start
serves just over half of poor children, Early Head Start serves less
than 5 percent, and the Child Care and Development Fund serves only one
in six eligible children. Further, for those receiving services, the
quality of their experiences has not received adequate attention to
produce the benefits that all children need and deserve.
As we move forward, we have a number of goals for our early
childhood programs including, improving the quality of child care and
Head Start programs, fostering the integration of ACF's early childhood
programs with other early learning programs and social services,
vertically aligning programs with the elementary and secondary
education system, and strengthening program integrity.
Using the Child Care and Development Block Grant's (CCDBG)
mandatory 4 percent quality set-aside, we are helping States build a
systematic framework for quality investments. This effort includes
taking actions to strengthen the quality of child care programs by
expanding the number of States with Quality Rating and Improvement
Systems (QRIS). The QRIS includes a set of standards that define each
level of quality, an incentive and support system to help programs meet
higher standards, and outreach to inform parents of what the ratings
mean.
There is much more that can and should be done to raise the quality
of child care for America's children. We look forward to working with
Congress to craft a child care reauthorization framework, including
needed reforms to ensure that children receive high quality care that
fosters healthy child development and meets the diverse needs of
families. The President's fiscal year 2011 budget request proposed an
increased investment of $1.6 billion for child care and outlined a set
of principles for reauthorization focusing on serving more low-income
children in safe, healthy, nurturing child care settings that are
optimally effective in promoting learning, child development and school
readiness. The Early Learning Challenge Fund (ELCF) also remains a
priority of the Administration and we look forward to working with
Congress to make the ELCF a reality.
In addition, because high quality early childhood education spans
the ages of birth to age 8 and involves the transition of children from
early childhood programs into our Nation's schools, continued
collaboration between the Department of Health and Human Services and
the Department of Education is essential. Secretary Sebelius and
Secretary Duncan have been working very closely, and the two
Departments have a number of joint efforts currently underway. We have
formed working groups consisting of the best minds in both Departments
to address the most pressing issues in the early childhood field,
including creating a more educated, better trained early childhood
workforce; better connecting the early education and health systems;
and improving the way data are collected and used to improve early
childhood systems at the State level. The two Departments also co-
hosted listening sessions across the country to hear from the foremost
experts and early childhood practitioners concerning these issues. The
Departments consult regularly on the early childhood initiatives
underway in each Department and will continue to collaborate on future
initiatives and legislation that are vital to the development and
education of our Nation's youngest children, especially efforts to
improve the quality of these programs and services with the goal of
improving child outcomes.
We also continue to improve Head Start using the tools provided to
us by the Improving Head Start for School Readiness Act of 2007. As you
may recall, in January of this year ACF released the findings of the
Head Start Impact Study which showed that at the end of 1 program year,
access to Head Start positively influenced children's school readiness.
When measured again at the end of kindergarten and first grade, some of
these benefits persisted, but the Head Start children and the control
group children were at the same level on many of the measures studied.
While the Head Start program has significantly changed since the study
was conducted in 2002, we are using the findings of the Head Start
Impact Study and that of other studies to improve the program.
We have developed a set of initiatives outlined in a planning
document entitled, The Head Start Roadmap to Excellence. These
initiatives will strengthen Head Start programs in preparing poor
children for success in school and life. The initiatives in the Roadmap
significantly increase the expectations for what Head Start programs
should achieve, provide the necessary supports to meet those
expectations, and strengthen the accountability provisions for programs
that do not meet expectations. Specifically:
To increase what we expect from Head Start programs, we
are strengthening the Head Start Program Performance Standards. These
standards provide a standard definition of quality services for all
Head Start grantees. The revised program performance standards will
institute best practices in the field of early education and child
development and ensure that Head Start programs meet the educational,
health and nutritional needs of the children and families they serve,
along with improving program integrity and fiscal management.
To provide additional support to programs, we are
reinventing the training and technical assistance system. The new
system will provide ``cascading levels of support'' for Head Start
programs with National Centers providing information about best
practices to State Centers, and mentor coaches helping programs to
implement these best practices at the program level.
Finally, to strengthen accountability, we will implement a
system that injects competition into Head Start by requiring low
performing programs to compete for continued funding as required by
this subcommittee in the Head Start reauthorization. This recompetition
process is absolutely central to raising the bar on quality not only by
getting rid of poor performers but in providing significant new
incentives for programs to improve their performance and offer quality
services. We are working hard to craft a system that is fair and
transparent and that will result in a significant improvement in
program quality. We anticipate publishing the proposed rules later this
year.
Program integrity is one of HHS's key priorities and applies to all
programs administered by HHS. The President has charged each Federal
agency with launching rigorous audits and conducting ``annual
assessments to determine which of their programs are at risk of making
improper payments . . .'' In response, Secretary Sebelius recently
established the Council on Program Integrity, which will look at all
areas within the Department--from Medicare and Medicaid, to Head Start
and Child Care, to LIHEAP--to conduct risk assessments of programs or
operations most vulnerable to fraud or abuse; enhance existing program
integrity initiatives or create new ones; share best practices on
program integrity throughout HHS; and measure the results of our
efforts.
ACF already has taken steps to enhance program integrity in all of
our programs, including our early childhood programs. For example, the
Office of Head Start has created a fraud hotline that will allow
information on inappropriate behavior to be reported directly to the
Assistant Secretary. It also initiated unannounced visits of Head Start
programs and is developing new regulations to strengthen program
integrity at the grantee level.
I would like to turn now to our priority goals for ensuring the
safety, permanence and well-being of children.
SAFETY, PERMANENCY, AND WELL-BEING OF VULNERABLE CHILDREN
The Administration is committed to working with States to reduce
the incidence of child abuse and neglect and provide safe and permanent
homes for all of America's children. The children facing challenges to
safety and permanency are among the most vulnerable children in our
country. Our efforts to prevent the maltreatment of children, mediate
children's exposure to violence, find permanent placements for those
children who cannot safely return to their homes, and provide temporary
or transitional placements and services for older youth are critical to
ensuring that America's children grow into healthy, stable adults.
The impact of not addressing the needs of these vulnerable children
is far-reaching. Maltreatment in general is associated with a number of
negative outcomes for children, including lower school achievement,
juvenile delinquency, substance abuse, and mental health problems.\8\
Certain types of maltreatment can result in long-term physical, social,
and emotional problems, and even deaths.\9\ Children who witness
domestic violence are at a greater risk of developing behavioral and
emotional problems, cognitive and attitudinal issues, and long term
problems.\10\ Children who witness domestic violence in their homes are
more likely to justify their own use of violence in their
relationships.\11\ It is imperative that we seek solutions that build
on promising practices to address the needs of these children.
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\8\ Administration for Children and Families, Office of Planning,
Research and Evaluation. (2004b). Children ages 3 to 5 in the child
welfare system. NSCAW Research Brief No. 5. Washington, DC: Author.
English, D.J., Widom, C.S., & Brandford, C. (2004). Another look at
the effects of child abuse. NU journal, 251,23-24.
\9\ Fellit, V.J. (2002). The relationship of adverse childhood
experiences to adult health: Turning gold into lead. Zeitschrift fur
Psychosomatische Medizin and Psychotherapie 48(4), 359-69. Retrieved
June 18, 2007, from www.acestudy.org/docs/GoldintoLead.pdf.
Flaherty, E.G., et al. (2006). Effect of early childhood adversity
on health. Archives of Pediatrics and Adolescent Medicine, 160, 1232-
38.
\10\ Stapleton, J.G., Phillips, K.G., Moynihan, M.M., Wiesen-
Martin, D.R., Beulieu, A.L. (2010) New Hampshire endowment for health
planning grant final report: The mental health needs of children
exposed to violence in their homes. Retrieved July 26, 2010 from http:/
/www.nhcadsv.org/Maureen/EFHReportFINAL.pdf.
\11\ Singer, M.L., Miller, D.B., Guo, S., Slovak, K and Frieson, T.
(1998) The Mental Health Consequences of Children's Exposure to
Violence. Mandel School of Applied Social Sciences, Community Health
Research Institute, Case Western Reserve University, Cleveland, OH:
Cuyahoga County.
Jaffe, P.G., & Geffner, R. (1998). Child custody disputes and
domestic violence: Critical issues for mental health, social service,
and legal professionals. In G. Holden, R. Geffner, & E. Jouriles
(Eds.), Children exposed to marital violence: Theory, research, and
applied issues (pp. 371-408). Washington, DC: American Psychological
Association.
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We have been working closely with this subcommittee on
reauthorization of two programs offering support for these
populations--the Child Abuse Prevention and Treatment Act and the
Family Violence Prevention and Services Act. We look forward to
continuing these efforts and finalizing enactment of these key pieces
of legislation.
At the same time, this Administration has placed a significant
priority on the development and implementation of evidence-based and
evidence-informed research and practice. We are committed to investing
in programs and strategies that have proven effective through rigorous
evaluation, building on promising practices, and promoting innovation
to expand the body of knowledge all of which increase the portfolio of
interventions proven to positively impact children's safety, permanence
and well-being. Proven strategies are particularly important in the
child welfare and well-being arenas because the stakes for children are
so high.
The Administration recently demonstrated its commitment to
identifying and replicating best practices for children who stay in
foster care the longest by proposing a $20 million grant program to
fund innovative strategies for moving these children to permanent
homes. The first year of funds for these grants will be awarded in
September and the President's Budget proposes continued funding for
these grants to identify effective practices for our most vulnerable
children. The goals of the innovative approaches to foster care program
are to: implement innovative intervention strategies that are informed
by the relevant literature; reduce long-term foster care stays and
improve child outcomes; and rigorously evaluate these efforts to
provide substantial information about the effectiveness of the
programs, interventions, and practices in reducing long-term foster
care. State projects that meet negotiated targets will be eligible for
incentive payments that will be awarded above and beyond the base award
amount and will be given flexibility in using the incentive payments to
enhance project-related activities. This initiative to reduce long-term
foster care is a significant step toward improving services and
outcomes for vulnerable children who pass through, and often remain in,
the child welfare system.
Another example of the President's commitment to targeting funds
towards evidence-based approaches and testing innovation is the new
Home Visiting program created in the Affordable Care Act. Just last
week, HHS released $88 million for development and implementation of
high-quality, evidence-based statewide home visiting programs, to
assure effective coordination and delivery of critical health,
development, early learning, child abuse and neglect prevention, and
family support services to young children and families.
Additionally, the President's fiscal year 2011 budget requests a
$10 million increase in child abuse discretionary activities. These
funds will be used to establish a new competitive grant program for
States to support increased use, and high quality implementation, of
evidence-based and evidence-informed child maltreatment prevention
programs and activities. The competitive grant program is intended to
encourage States to use existing funding streams to support community-
based prevention activities rooted in a strong evidence base. Funds
also will be used to insure that child maltreatment prevention and
family support is integrated with other State systems for children and
youth.
With the current condition of the economy putting additional stress
on families, States are seeing an increase in child abuse and neglect
and domestic violence. At a time of increasing pressure on State
budgets it is imperative that funding is targeted to evidence-based and
evidence-informed approaches to maximize every dollar spent protecting
and supporting children and families. Further, the cost of addressing
the consequences of abuse and neglect after maltreatment has happened
far exceeds the cost of investing in evidence-based interventions that
prevent abuse from occurring or effectively mitigate the consequences
of the abuse.\12\
---------------------------------------------------------------------------
\12\ Pew/PCA, ``Time for Reform: Investing in Prevention, Keeping
Children Safe at Home.'' See http://www.pewtrusts.org/uploadedFiles/
wwwpewtrustsorg/Reports/Foster_care_reform/time
_for_reform.pdf.
---------------------------------------------------------------------------
The last priority area impacting the state of our Nation's children
that I would like to discuss is advancing economic security and
fatherhood.
ECONOMIC SECURITY AND RESPONSIBLE FATHERHOOD
There is no question that families are the core support for
children. Children's well-being depends on financial and emotional
support from both parents, and parental employment is the key to long-
term economic security for families. To help families succeed in the
workforce, we seek to connect parents not only with work, but also with
educational opportunities and other supports to help them move into
better jobs, child care to help meet the costs of work and basic needs,
and with services to address the barriers that sometimes make work
difficult for some individuals.
The Temporary Assistance for Needy Families Program (TANF) provides
assistance and work opportunities to needy families and is one of the
Nation's primary safety net programs for low-income families with
children. Under this $16.5 billion block grant program, States have
broad flexibility to design programs that strengthen families and
promote work, personal responsibility, and self-sufficiency. Within
certain Federal requirements, States can determine their own
eligibility criteria, benefit levels, and the type of services and
benefits available to TANF recipients.
As with child care, Head Start, and Child Support, the Recovery Act
included significant investments to bolster the safety net for low-
income children and families. This legislation affected the TANF
program in several key ways, including the establishment of a new $5
billion Emergency Contingency Fund for States, Territories, and Tribes
for fiscal year 2009 and fiscal year 2010. This Emergency Fund was
structured with the recognition that there are multiple ways to help
families during an economic downturn by expressly providing additional
funding for basic assistance, short-term needs, and subsidized
employment. To date, ACF has awarded over $4 billion in TANF Emergency
Funds to 47 States, 17 Tribes, the District of Columbia, and the
Territories of the Virgin Islands and Puerto Rico.
The TANF Emergency Fund has played a crucial role in allowing TANF
jurisdictions to respond to the needs of vulnerable children and
families during this economic downturn. TANF jurisdictions have taken
advantage of the opportunities provided by the Emergency Fund to
implement programs and provide benefits that specifically target
children. For example, ACF has awarded Emergency Fund dollars for
benefits such as back-to-school clothing allowances, scholarships for
summer camps, and services provided through partnerships with local
agencies that operate Summer Food Service Programs, and community
organizations, such as The Boys and Girls Club.
Further, as of July 25, 34 States, the District of Columbia and the
Virgin Islands have established subsidized employment programs using $1
billion in Emergency Funds. These States have plans to create nearly
200,000 jobs by September. This is an unprecedented use of funds for
subsidized employment programs. In January, the Department of Labor and
HHS issued a joint letter encouraging workforce and human services
agencies to work together to explore all funds available for the
creation and expansion of subsidized summer employment programs for
low-income youth. Taking advantage of this opportunity, and in the
absence of additional Workforce Investment Act (WIA) funding for this
purpose, 21 States and the District of Columbia are using emergency
funds to expand and develop programs specifically designed for youth;
some have even partnered with their local WIA One Stop Centers in order
to maximize recruitment and implement effective practices. Since youth
employment is at a 60-year low, this is a crucial investment in
supporting a robust economic recovery.
Given the difficult fiscal choices States are facing in an economy
that still has high unemployment, and the recent extremely positive
activity by States, we strongly urge Congress to take action so that
all States can access the Emergency Fund in 2011 when, unfortunately,
unemployment and poverty are likely to remain elevated in the aftermath
of the recession. By extending the Emergency Fund through fiscal year
2011 and providing additional funding, Congress can help States
continue their innovative efforts to expand employment and strengthen
the safety net so desperately needed by many low-income children and
families. In addition, the Department of Labor's fiscal year 2011
request includes second-year funding for their Transitional Jobs
Program to demonstrate and evaluate program models, which combine
short-term subsidized or supported employment with a well-designed
suite of supportive services and job search assistance during and after
the transitional job to help individuals with significant barriers to
obtain the skills they need to secure unsubsidized jobs. Fiscal year
2010 funding will be used to support and rigorously test transitional
jobs programs targeting non-custodial parents, a group whose employment
outcomes are likely to have an important effect on children.
While employment is a key element of providing support to children,
research suggests that the most stable families consist of two parents
who also are involved and invested in their children's success.
Children who have a quality relationship with their father are more
likely to stay in school and pursue higher education and are less
likely to be sexually active, or give birth out of wedlock at a young
age.\13\ Unfortunately, too many fathers today are not engaged and
participating in their children's lives. They are not making the
emotional and financial contributions they could and are, therefore,
not having the kind of impact that promotes family and child well-
being.
---------------------------------------------------------------------------
\13\ The Effects of Father Involvement: A Summary of the Research
Evidence. Sarah Allen, MSc and Kerry Daly, Ph.D., University of Guelph
(2002) (http://www.ecdtp.org/docs/pdf/IF%20
Father%20Res%20Summary%20(KD) pdf.)
---------------------------------------------------------------------------
Responsible fatherhood programs can help fathers find work and stay
engaged in their children's lives, allowing fathers to provide the
emotional and financial support every child needs. The President is
committed to promoting responsible fatherhood and helping fathers meet
their obligations by ensuring that they have the broad range of
services (including job, relationship, and parenting skills training)
that they need to be successful. On Father's Day this year President
Obama said,
``Now, I can't legislate fatherhood--I can't force anybody to
love a child. . . . What we can do is come together and support
fathers who are willing to step up and be good partners and
parents and providers. . . .''
The vision of the President's fatherhood initiative in conjunction
with services offered through Child Support Enforcement, Child Care and
TANF offers an integrated set of strategies to bolster the economic
security of especially vulnerable families and their children. Our
fiscal year 2011 budget request to create a new Fatherhood, Marriage
and Family Innovation Fund would build a strong evidence base around
what service intervention models work to remove barriers to employment
and increase family functioning and parenting capacity, and identify
best practices that could be replicated within TANF, Child Support
Enforcement, and other State and community-based programs. The
Innovation Fund will provide for comprehensive programs that can meet
the multiple needs that fathers and their families face.
A guiding premise for us is that children need and deserve the
financial and emotional support of both of their parents. Accordingly,
we have placed a high priority on the effective operation of the Child
Support Enforcement program. Child Support Enforcement is integral to
family economic security and, of course, is an important aspect of our
responsible fatherhood efforts. This program serves 17 million children
overall, and half of all poor children. Most families in the program
are low-income working families and the majority of children are born
outside of marriage. Forty-five percent of these families formerly
received TANF and 13 percent are currently in the TANF program.
In fiscal year 2008, the Child Support Enforcement Program
collected $26.6 billion in child support, while the total Federal
contribution to costs was $4.1 billion. By securing support from non-
custodial parents, the Child Support Enforcement Program lifts a
million people out of poverty every year and helps families avoid the
need for public assistance. Child support provides about 30 percent of
income for the poor families who receive it, and over 90 percent of the
child support money collected by the program is distributed directly to
children and families. This represents a shift in programmatic mission
that began with welfare reform, to move the program from one that
sought to reimburse the Federal and State Governments for public
assistance paid to families. Distributing more of the support collected
to families increases and stabilizes family income and strengthens
positive outcomes for families. The emerging mission of the child
support program is to improve child well-being by working with both
parents to improve parental capacity to support their children.
The Recovery Act temporarily restored Federal matching funds for
State expenditures made with child support incentive payments--a long-
standing policy that was ended by the Deficit Reduction Act of 2005. In
the past, State programs relied heavily on this authority to fund
operations, and we estimate that program expenditures would be cut by
over 10 percent without the continued matching funds, since it is
unlikely that States could afford to make up the reduction in Federal
funding. The President's fiscal year 2011 budget requests a total of
$4.3 billion for the Child Support Enforcement Program and includes
several legislative proposals, the most significant being a 1-year
continuation of the Recovery Act provision.
CONCLUSION
With the work of this subcommittee, and under your committed
leadership, Mr. Chairman, significant strides have been made in
understanding where we are most challenged in improving the state of
American children and targeting funding and attention to policies that
seek to address these challenges. As I have discussed in my testimony,
the Administration has developed an integrated set of strategies to
bolster ongoing efforts. Where we can, we are making policy changes and
targeting resources to effect the change that is needed, but as I have
outlined there are a number of key areas where we need your help. We
look forward to working with the Congress to ensure that legislative
changes and key investments are made to continue to improve the lives
of children in America.
Thank you for the opportunity to address the subcommittee today. I
would be happy to answer any questions.
Senator Dodd. Thank you very, very much, Mr. Hansell. I
appreciate your testimony.
Dr. Melendez, welcome and welcome to the committee.
STATEMENT OF THELMA MELENDEZ DE SANTA ANA, ASSISTANT SECRETARY,
OFFICE OF ELEMENTARY AND SECONDARY EDUCATION, U.S. DEPARTMENT
OF EDUCATION, WASHINGTON, DC
Ms. Melendez de Santa Ana. Thank you very much, Chairman
Dodd, and thank you, Senator Casey and Senator Merkley. It is a
wonderful opportunity, actually my first, to testify on behalf
of the U.S. Department of Education. Mr. Chairman, I especially
want to thank you, as others have done, for the decades of
leadership in Congress as a champion for our country's most
vulnerable children and families and the founder of the
Senate's first Children's Caucus.
As you know, I am the Assistant Secretary of Elementary and
Secondary Education, and I come to this position with
experiences as a superintendent, as a principal, and as a
classroom teacher, and most recently, as you mentioned, as
superintendent of the Pomona Unified School District.
I appreciate your leadership in convening these hearings on
the State of the American Child. It is critical that we are all
aware of the challenges facing the Nation's children and
families, particularly in these tough economic times.
Many of us believe that education is the one true way out
of poverty for disadvantaged students. In fact, education is
critical, not just for the success of the individual child, but
also for the success of this country. There is no doubt that an
educated workforce is the key to remaining competitive in a
global economy and necessary to ensuring the prosperity of our
communities.
While we have made great strides as a Nation, we still have
a lot of work to do. The achievement gap between economically
disadvantaged students and their more affluent peers is far too
wide and it starts before kindergarten. In 2005, only 59
percent of poor 4-year-olds participated in preschool education
compared to 72 percent of nonpoor 4-year-olds. This gap
continues as children get older.
When we look at NAPE scores of both 4th and 8th graders, we
continue to see very significant gaps between low-income
students and their more affluent peers, as well as minority and
nonminority students.
Additionally, far too many young people fail to graduate
from high school on time, especially young African-American,
Latino, and Native American students. Nationally about 70
percent of students graduate from high school on time with a
regular diploma, but just over half of African-American and
Latino and American Indian students earn diplomas within 4
years of entering high school. And only 13 percent of Latinos
and 17.5 percent of African-Americans hold a bachelors degree.
We must do better.
That is why the President and Secretary Duncan announced
the Administration's program to reduce America's high school
dropout rate with General Colin Powell and Alma Powell, the
chair of the America's Promise Alliance, who testified at your
first in this series of hearings. Mr. Chairman, the President
has set an ambitious goal that by 2020 we will once again have
the highest proportion of college graduates in the world.
This goal is the basis of this Administration's cradle-to-
career strategy for education reform. Our plan begins with
stronger early learning programs and services and continues
with rigor and high expectations to ensure that more students
enter high school on the path to graduate, prepared for college
and a career. And finally, we must work to make sure that more
students earn a college degree that prepares them for a
meaningful career.
The reauthorization of the Elementary and Secondary
Education Act is an essential means to an end. Our proposal for
reauthorization, the Blueprint for Reform, includes a focus on
high-quality teaching and learning, improving equity and
excellence, and building capacity at the State and local
levels. The Blueprint is focused on closing the achievement
gap, raising the bar for all students, and as you know, this is
a moral and an economic imperative. Early learning from birth
through 3rd grade is an essential part of our strategy for
meeting the President's 2020 goal. Research demonstrates that
learning begins at birth and that high-quality early learning
programs help children, especially high-needs children, arrive
in kindergarten ready to succeed in school and life, as Mr.
Hansell mentioned.
That is why the Administration's fiscal year 2011 budget
request included $9.3 billion over 10 years for the Early
Learning Challenge Fund to support States in strengthening
their early learning settings. We recognize the difficult
fiscal challenges and appreciate the work of the Senate
Appropriations Subcommittee on Labor, Health and Human
Services, Education, and Related Services for including $300
million for this important priority in the fiscal 2011 mark. We
remain committed to working with Congress to advance funding
for this initiative and continuing our work on early learning
with the Department of Health and Human Services.
We are also setting high expectations and improving
teaching and learning in our K-12 schools. Our approach builds
on the efforts of the Nation's Governors and the State chief
school officers by supporting State-developed college- and
career-ready standards. But improving teaching and learning
does not end with standards. It only begins there. We have got
to support high-quality assessments, State and locally
developed curricula, and professional development for teachers
and principals that are aligned to these standards.
Research tells us that teachers are the most important in-
school factor in student success, but access to effective
teachers is not equal. High-poverty, high-minority schools and
students get short-changed. We need to make sure that the best
teachers teach where they are needed the most. Our proposal
provides funds to spur the creation of more effective teacher
preparation pathways, meaningful career ladders, and stronger
supports to retain great teachers and programs to reward them
for all that they do.
To address the greatest achievement gaps and the lowest
graduation rates, our proposal drives resources to our lowest
performing schools. We have all set a goal of turning around
5,000 of our lowest performing schools, the bottom 5 percent in
each State in the country. There are schools where achievement
has been low for years and is not improving. In fact, 2,000 of
our high schools produce a majority of our Nation's dropouts
and approximately 75 percent of our Latino and our African-
American dropouts.
Thanks to the Recovery Act and annual appropriations, we
have already committed $4 billion in school improvement grants
to support local turnaround efforts. Through our Blueprint and
our annual budget request, we will continue to seek resources
and support to turn around these lowest performing schools.
Our plan recognizes that diverse learners, including
English learners, migrant, rural, and homeless students and
students with disabilities, have specific needs that must be
addressed through additional support.
Further, thanks to your efforts, we are increasing college
access and opportunities for more students, providing $40
billion in increased Pell Grants to help more students go to
college. And the Department has undertaken, over the past 2
years, to simplify the student aid application process so that
all students can get the aid for which they are eligible.
And finally, our proposal strives to build capacity at the
State and local levels through our initiatives like Race to the
Top which includes grants to States for systemic reforms,
Investing in Innovation, or i3, which provides grants to
districts and nonprofits to develop and scale up promising
practices. We need to make great improvements and pioneer new
models. Our proposal also supports a comprehensive approach to
student needs through Safe and Healthy Students and support for
afterschool programs.
We also want to increase support for strong family and
community engagement in education. So we propose to double
title I funding for family engagement and require districts and
schools to implement strong family and community engagement
efforts.
Through his fiscal year 2011 budget request, the President
has demonstrated that he is absolutely committed to children
and to improving their education. He has proposed historic
increases for education, the largest increase ever requested
for ESEA, to ensure that students can succeed and that our
country can maintain its place as a global leader.
I think we can all agree that the current state of
education is not good enough, especially when our most
vulnerable children and families continue to struggle. We must
all do better. We must continue to work together in a
bipartisan way to reauthorize and improve ESEA as soon as
possible. Our children simply cannot afford to wait.
Once again, thank you, Chairman Dodd. Thanks to the
committee for this opportunity to testify, and I look forward
to answering any questions that you may have.
[The prepared statement of Ms. Melendez de Santa Ana
follows:]
Prepared Statement of Thelma Melendez de Santa Ana
Thank you, Chairman Dodd, Ranking Member Alexander, and members of
the subcommittee for this opportunity to testify on behalf of the U.S.
Department of Education. Mr. Chairman, I especially want to thank you
for your decades of leadership in Congress, as a champion for our
country's most vulnerable children and families, and the founder of the
Senate's first Children's Caucus.
My name is Thelma Melendez de Santa Ana, and I currently serve as
the Assistant Secretary for Elementary and Secondary Education. I come
to this position with experiences as a superintendent, a principal, and
a classroom teacher, most recently as the superintendent of the Pomona
School District in California. In each position I've held, I have been
focused on what will improve teaching and learning, to help ensure the
success of all of our children.
I appreciate your leadership in convening these hearings on the
``State of the American Child.'' It's critical that we all be aware of
the challenges facing the Nation's children and families, particularly
in these tough economic times. We have to see the roadblocks in order
to overcome them.
Many of us believe that education is the one true way out of
poverty for disadvantaged children. In fact, education is critical not
just to the success of an individual child, but also to the success of
the country. There's no doubt that an educated workforce is the key to
remaining competitive in a global economy and that an educated
citizenry is necessary to ensure national prosperity and the common
good.
While we have made great strides as a nation, we have a lot of work
to do. The achievement gap between economically disadvantaged students
and their more affluent peers is far too wide. And far too many young
people fail to graduate from high school on time--especially young
African-American, Latino, and Native American students.
Nationally, about 70 percent of students graduate from high school
on time with a regular diploma, but just over half of African-American
and Latino and American Indian students earn diplomas within 4 years of
entering high school. In many States, the graduation gap between white
and minority students is stunning; in several, it is as much as 40 or
50 percentage points. And, only 13 percent of Latinos and 17.5 percent
of African-Americans hold a bachelor's degree. We must do better. That
is why the President and I announced the Administration's program to
reduce America's high school dropout rate, which we announced with
General Colin Powell and Alma Powell, the chair of the America's
Promise Alliance--who testified at your first in this series of
hearings. Our goal is that by 2020, we will once again have the highest
proportion of college graduates in the world--and reaching that goal
will require focusing attention not only on high school dropouts, but
all along the educational continuum.
This goal is the basis of this Administration's cradle-to-college-
and-career strategy for education reform. Our plan begins with stronger
early learning programs and services, making sure children enter school
ready to learn. Further, we must ensure that more students enter high
school with strong grounding based on high standards and effective
teaching in elementary and middle school, so they are on a path to
graduate from high school ready to succeed in college and a career.
And, finally, we must work to make sure that more students earn a
college degree that prepares them for a meaningful career.
The reauthorization of the Elementary and Secondary Education Act
(ESEA) is an essential means to this end. Our reauthorization Blueprint
for Reform includes a focus on high-quality teaching and learning,
improving equity and excellence, and building capacity at the State and
local levels. We've centered the goals of the Blueprint on closing the
achievement gap and raising the bar for all students. This is a moral
and economic imperative.
The years prior to kindergarten are critical in shaping a child's
foundation for later school success. Research demonstrates that
learning begins at birth and that high-quality early learning programs
help children, especially high-need children, arrive in kindergarten
ready to succeed in school and in life. Early learning is an essential
part of our strategy for meeting the President's 2020 goal. As the
Secretary says, we have to get schools out of the catch-up business.
The Department's early learning agenda focuses on children from
birth through third grade, with seamless transitions between preschool
and elementary school. Our proposal for reauthorizing ESEA supports a
continuum of learning that will help to close the achievement gap and
ensure that every student graduates from high school ready to succeed
in college and a career.
Our approach builds on the great efforts of the Nation's governors
and the chief State school officers by supporting implementation of
State-developed college- and career-ready standards. But improving
teaching and learning doesn't end with standards--it only begins there.
We've got to support high-quality assessments, State and locally
developed curricula, and professional development and communities of
collaborative support for teachers and principals that are aligned to
those standards. And we need to ensure fair and rigorous
accountability, measuring every student's growth towards college and
career readiness, as growth and progress are critical elements of any
picture of how our schools are doing.
In order to close the achievement gap between economically
disadvantaged students and their more affluent peers, we must provide
better educational opportunities for all students.
High quality early learning programs and services are so important
to ensuring equity and excellence for a child's educational future.
Studies show that at least half of the achievement gap between poor and
more affluent children already exists when they enter kindergarten. The
larger the gap, the harder it is to close later on. That is why the
Administration's fiscal year 2011 budget request included $9.3 billion
over 10 years for the Early Learning Challenge Fund, to support and
encourage States to reform and raise the bar across their early
learning settings. Many in Congress worked to include the Early
Learning Challenge Fund in the Healthcare and Education Reconciliation
Act earlier this year. We remain committed to working with Congress to
advance funding for this important initiative in fiscal year 2011.
Research also tells us that teachers are the most important in-
school factor in student success, but access to effective teachers is
not equal. We all know that high-poverty and high-minority schools are
being short-changed--often being taught by less experienced, less well-
prepared, and less-effective teachers. We need to make sure that the
best teachers teach where they are needed the most. We want to spur the
creation of more effective pathways for preparation of teachers,
meaningful career ladders and stronger efforts to retain great
teachers, and we want to support educators in their instructional
practice and reward them for all they do. Our proposal will provide
funds to develop and support effective teachers and leaders and make
sure that every child has the opportunity to learn from excellent
teachers.
In order to address the greatest achievement gaps and the lowest
graduation rates, our proposal drives efforts and resources to our
lowest performing schools.
We have set a goal of turning around 5,000 of our lowest performing
schools--the bottom 5 percent in each State in the country. These are
schools where achievement has been low for years and isn't improving.
Many of these schools produce a disproportionate percentage of our high
school dropouts. In fact, fewer than 15 percent of all high schools,
about 2,000 schools, produce a majority of our Nation's dropouts and
approximately two-thirds of Latino and African-American dropouts.
Thanks to the Recovery Act and annual appropriations, we have
already committed $4 billion to support local efforts to turn around
these lowest performing schools through School Improvement Grants--up
to $6 million to help each of these schools. Through our Blueprint and
our annual budget request, we will continue to seek resources and
support to turn around our lowest-performing schools.
Our plan also recognizes that diverse learners, including English
Learners, migrant, rural, and homeless students, students with
disabilities, and other vulnerable populations have specific needs that
must be addressed through additional support. For example, to better
support English Learners (EL), we are encouraging states to develop
English language proficiency standards and high-quality assessments
that prepare EL students to succeed. We also expect schools to
understand the diversity of their EL populations and better
differentiate their supports for subgroups of EL students.
Further, thanks to SAFRA, we are increasing college access and
opportunities for more students, providing $40 billion in increased
Pell Grants to help more students go to college. And, the Department
has undertaken efforts over the past 2 years to simplify the Federal
student aid application process so that all students can get the aid
for which they are eligible.
Finally, our proposal strives to help build capacity at the State
and local levels for making the reforms necessary to close the
achievement gaps. Our plan recognizes that capacity is a critical
element as States, districts, non-profit organizations, and communities
undertake major changes to improve education for all their students.
Through our initiatives, like Race to the Top, which provides grants to
States for systemic reforms, and Investing in Innovation, or i3, which
provides grants to districts and non-profits to develop and scale up
promising instructional practices, strategies and supports, we can make
great improvements and pioneer new models. Our proposal supports a
comprehensive approach to students' needs, including through Safe and
Healthy Students and support for afterschool programs. We maintain
important formula funding, and structure competitive programs to target
the areas that most need those funds.
We also propose to increase support for strong family and community
engagement and efforts to create open, welcoming avenues for parents to
engage with teachers, schools, and programs. We believe that family and
community engagement should be a requirement for schools and districts,
especially as they seek to improve. And that's why we propose to double
title I funding for family engagement. In addition, through Promise
Neighborhood grants, we will support the development and implementation
of a continuum of effective community services, strong family supports,
and comprehensive education reforms in high-need communities, to
improve children's education and life outcomes.
Through his fiscal year 2011 budget request, the President has
demonstrated that he is absolutely committed to children and to
improving their education--he has proposed historic increases for
education programs--the largest increase ever requested for ESEA--to
ensure that students can succeed and that our country can maintain its
place as a global power.
I think we can all agree that the current state of education is not
good enough, especially when certain segments of our population, our
most vulnerable children and families, continue to struggle. We must
all do better. And that's why we must continue to work together in a
bipartisan way to reauthorize and improve ESEA as soon as possible. Our
children simply can't afford to wait.
Once again, thank you Chairman Dodd, and thanks to the committee
for this opportunity to testify. I look forward to answering any
questions you may have.
Senator Dodd. Doctor, thank you very, very much. I
appreciate your testimony.
Dr. Koh, welcome.
STATEMENT OF HOWARD K. KOH, M.D., M.P.H., ASSISTANT SECRETARY
FOR HEALTH, U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES,
WASHINGTON, DC
Dr. Koh. Thank you very much, Chairman Dodd, Senator Casey,
Senator Merkley. It is a great honor to be here today to
address the state of children's health and to review the
activities of the Department of Health and Human Services to
advance the health and well-being of America's children.
The youth of today are tomorrow's workers, parents, and
leaders, and we must provide them with every opportunity to
reach their full potential for health. So this hearing is of
great importance to the Nation and to me personally as the
Assistant Secretary for Health, as a physician who has cared
for patients for over 30 years, and as a father of three.
First, Mr. Chairman, thank you for your extraordinary
service to our Nation's children and families. Over the past 3
decades, you have demonstrated an outstanding commitment to
promoting the health of children and guaranteeing essential
health services. You have led so many efforts to build a
foundation for health for the youngest and most vulnerable in
our society. Most importantly perhaps, you have long recognized
that children's health is shaped by a constellation of
interconnected factors outside of the realm of individual
biology of disease, including education, economics, family
environment, policy change, and many other dimensions. Our
Department views health through the same broad lens, and we
share your commitment to a broad societal interconnected
approach to health to respond to these needs.
And on a personal note, Mr. Chairman, since I grew up in
New Haven, CT, attended college and medical school there, and
have felt your personal support of me and my brother, Legal
Advisor Harold Koh of the State Department, as we both entered
public service on the Federal level, I want to thank you for
everything you have done not just for my family but for so many
families across this country.
The public health future of our children rests on more
culturally competent health care and a major focus on
prevention and wellness. And we are very proud to be in an
administration where those priorities are upheld by the
President and Secretary Sebelius.
We know that there will be major demographic shifts over
the coming decades. By 2050, we have projected 107 million will
live in the United States, 25 million more than today, and also
diversity will expand, as you have heard from my fellow
speakers. So in these and many other ways, the population of
children will grow and change and we must be ready to address
these challenges with new opportunities.
In that spirit, the definition of children's health has
expanded and is now viewed broadly. In fact, in 2004, an
Institute of Medicine report proposed a new definition saying,
``Children's health should be defined as the extent
to which an individual child or groups of children are
able or enabled to develop and realize their potential,
satisfy their needs, and develop the capacities that
allow them to interact successfully with their
biological, physical, and social environments.''
So we embrace this broader definition, and it highlights
not just the physical health aspects but also mental health and
social well-being dimensions of true health or, as the World
Health Organization has stated, ``Health is a state of complete
physical, mental and social well-being and not merely the
absence of disease or infirmity.''
I am very pleased to tell you, Mr. Chairman and
subcommittee members, that the health status of children as a
whole has improved in many ways over the last several
generations. When we look at Healthy People 2010, the Nation
has either progressed toward or met many targets that were set
a decade ago. For example, let me cite a few.
For childhood immunizations, we are at near record high
levels, including those related to diphtheria, polio,
hepatitis, meningitis, pneumococcal infections, and
meningococcal disease.
For Sudden Infant Death Syndrome, we have clear reductions
in that category.
For perinatally acquired AIDS, we have had a decreasing
number of new cases.
Breastfeeding rates have increased.
We have an increase in health insurance coverage rates for
children, although we need much more.
We have a decline in adolescent birth rates after a 2-year
increase and a decline in percentage of preterm births for the
second straight year.
However, we at the Department and so many others across the
country are aware of the many, many health challenges that
remain. For example, childhood obesity. You have already heard
that theme from my fellow speakers. Preterm births, infant
mortality with the recent stall in the decline of rates and
striking disparities. Injury and violence remain leading causes
of death for adolescents. Conditions such as asthma, autism,
and other developmental disorders impact quality of life.
Tobacco, alcohol, and other drugs remain major challenges for
our children. Early sexual activity leads to sexually
transmitted disease and unintended pregnancy. And mental health
disorders deserve special attention.
So at Health and Human Services, we are committed to
working with you and so many others across the country to
address these challenges. And there are many, many
opportunities and let me just cite a few.
With your great leadership, Mr. Chairman, we have
reauthorized the Children's Health Insurance Program and also
the Affordable Care Act will have such far-reaching
implications for generations to come. And we are delighted that
through these two efforts, coverage will be expanded,
prevention will be highlighted, and kids will be healthier for
the future.
We are particularly pleased that in the Affordable Care
Act, there are $15 billion dedicated over the next 10 years in
a new Public Health and Prevention Fund and also a dedicated
effort for a new public health and prevention strategy that is
going to emphasize reaching full potential for adults and
children.
Allow me to comment further on three areas: tobacco,
obesity, and emotional well-being.
On June 22, 2009, we entered a new era of prevention and
tobacco control when the President signed the Family Smoking
Prevention and Tobacco Control Act into law. Mr. Chairman, I
remember very fondly being in the Rose Garden with you and
thanking you for your leadership then, and I want to thank the
subcommittee members who have all been so supportive on tobacco
control and launching the country to a new era in public health
due to the passage of this law.
As you have heard, we are also partnering with the First
Lady on the Let's Move! campaign to solve childhood obesity in
the next generation, and we have many activities in the
Department to support that work, new dietary guidelines coming
out for Americans in the very near future, and the Affordable
Care Act promotes many activities about prevention that will
focus on obesity.
And then finally, on emotional and mental health for our
kids moving forward, last year a very important Institute of
Medicine report entitled, Preventing Mental, Emotional, and
Behavioral Disorders in Young People, articulated the issues
and offered broad strategies for moving forward with respect to
treatment, recovery and prevention, and we are embracing those
approaches at the Department.
So in summary, Mr. Chairman and subcommittee members, thank
you for the opportunity for this brief presentation. By
expanding opportunities for our kids, building the right
infrastructure, focusing on prevention and wellness, we have
many, many opportunities for the future, and we look forward to
broadening and strengthening our partnerships with you and so
many others across the country. Thank you very much.
[The prepared statement of Dr. Koh follows:]
Prepared Statement of Howard K. Koh, M.D., M.P.H.
INTRODUCTION
Good morning Chairman Dodd, Ranking Member Alexander and members of
the subcommittee. It is my honor to be here today to review the state
of children's health and to present the activities of the Department of
Health and Human Services (HHS) to advance the health and well-being of
America's 74.5 million children. The young people of today are
tomorrow's workers, parents and leaders. We must provide them with
every opportunity to reach their full potential, which, in turn,
requires good health.
First, Mr. Chairman, thank you for your extraordinary service to
our Nation's children and families. Over the last 36 years, you have
demonstrated an outstanding commitment to developing policies that
promote children's healthy development and guarantee essential health
resources. Your leadership has helped millions of poor children receive
the care they deserve. You have led so many efforts to build the
foundation for health for the youngest and most vulnerable among us.
More importantly perhaps, you have long recognized that children's
health is shaped by a constellation of interconnected factors outside
of the traditional health realm, including education, family
environment and community settings. HHS views ``health'' through the
same broad lens. We share your commitment to ensuring that values of
interconnectedness and shared responsibility are part of all of our
continuing efforts to respond to the health needs of infants, children,
adolescents and their families.
I am pleased to say that the health status of children as a whole
has improved significantly over the last few generations. Expanded
access to health care and increased commitment to the development of
comprehensive and coordinated child health initiatives across life
stages have led to this improvement. We at HHS are acutely aware of the
many challenges that remain such as childhood obesity prevention,
tobacco control and the onset of mental health disorders, and we are
working with our Federal, State and local partners to address them.
That's why one of the first things President Obama did was sign into
law a reauthorization of the Children's Health Insurance Program
(CHIP)--a down payment on comprehensive health insurance reform. And in
March of this year, the President signed the Affordable Care Act,
putting in place comprehensive reforms that will hold insurance
companies more accountable, lower health care costs, guarantee more
health care choices, and enhance the quality of health care for all
Americans. These new laws will have far reaching positive impacts on
our healthcare system and on children's health and lives for
generations to come.
EXPANDING ACCESS AND IMPROVING QUALITY: CHILDREN'S HEALTH INSURANCE
PROGRAM REAUTHORIZATION ACT (CHIPRA) AND THE AFFORDABLE CARE ACT
Expanding Access to Private and Public Coverage
CHIPRA and the Affordable Care Act greatly expand resources and
coverage for CHIP and seek to improve the quality of care, including
shifting toward a greater focus on prevention. CHIPRA and the
Affordable Care Act combine to provide an additional $69 billion in
Federal CHIP allotments through fiscal year 2015. The Centers for
Medicare and Medicaid Services (CMS) shows that in fiscal year 2009, 8
million children were enrolled in CHIP, and the funding increases in
CHIPRA and the Affordable Care Act will allow States to cover millions
more children in both Medicaid and CHIP.
Additionally, Secretary Sebelius has initiated the Secretary's
Challenge: Connecting Kids to Coverage, a 5-year campaign that will
challenge Federal officials, governors, mayors, community
organizations, tribal leaders and faith-based organizations to enroll
the nearly 5 million uninsured children who are eligible for Medicaid
or CHIP but are not currently enrolled.
The Affordable Care Act builds on these commitments. Children will
benefit from new rules of the road that insurance companies have to
follow, comprehensive reforms that expand access to health coverage, a
new emphasis on the quality of children's care, and important new
policies and programs that will put prevention first.
Beginning this year, health insurance companies will be prohibited
from excluding children from coverage because of pre-existing
conditions. Additionally, insurance companies will no longer be allowed
to impose lifetime dollar limits on essential benefits, nor will they
be permitted to cancel coverage when an individual gets sick just
because of a mistake in her paperwork.
To move toward a system where all children have access to health
insurance, the new law not only extends CHIP through Fiscal Year 2015
and provides additional funding, but also strengthens both Medicaid and
CHIP by raising Medicaid's Federal income eligibility floor to 133
percent of the Federal poverty level in 2014 and maintaining existing
levels of coverage for children in CHIP. Furthermore, in 2014, families
who are not eligible for other affordable coverage will be able to use
State insurance exchanges to obtain coverage for themselves and their
children.
Improving Quality of Health Care
To address quality improvement in children's health care, the
Affordable Care Act creates quality priorities and promotes quality
measurement for children, as well as reporting requirements for care
children receive. The act outlines provisions to ensure there are an
adequate number of medical providers to meet increased future needs.
And, coverage in the new State-based insurance exchanges will include
children's dental and vision coverage--two critical forms of coverage
that are often not included in coverage packages for children.
Children will also benefit from unprecedented investments in
prevention at both the individual and community levels, as essential
prevention services are more fully integrated between the clinic and
community. At the individual level, new health plans are required to
cover recommended preventive services with no cost-sharing for the
enrollee. These recommended services include regular well-baby and
well-child visits, routine immunizations, and other screenings that are
important to keep kids healthy. Additionally, the Affordable Care Act
makes a major investment--$1.5 billion over 5 years--in evidence-based
home visitation programs designed to improve outcomes--including
maternal and child health and development outcomes--for pregnant women
and families with young children.
To ensure quality and safety of pediatric medications, the Best
Pharmaceuticals for Children Act and the Pediatric Research Equity Act
have stimulated pediatric studies of therapies intended for the
pediatric populations. As a result, labeling has been changed for
almost 400 medications to include information to guide safe use in
children. Before 1997, a majority of medications (approximately 80
percent) that were prescribed to pediatric patients were not studied in
children.
At the community level, the Affordable Care Act invests $15 billion
over the next 10 years in public health and prevention programs through
the creation of the Public Health and Prevention Fund to promote
improved health outcomes. Its activities will complement the work of
the first-ever National Prevention and Health Promotion Strategy, which
will emphasize prevention and well-being--identifying and prioritizing
actions across government and between sectors to benefit Americans of
all ages.
By expanding and sustaining the necessary infrastructure to prevent
disease, detect it early, and manage conditions before they become
severe, HHS is working to transform our health care system to keep
children healthy and reduce the likelihood that children will develop
chronic disease later in life. As part of this historic commitment, the
Department has leveraged the Communities Putting Prevention to Work
(CPPW) program, funded through the American Recovery and Reinvestment
Act (ARRA). This program expands the use of evidence-based strategies
and programs, mobilizes local resources at the community-level, and
strengthens the capacity of States. Through its four distinct but
unified initiatives, CPPW will: increase levels of physical activity;
improve nutrition; decrease obesity rates; and decrease smoking
prevalence, teen smoking initiation, and exposure to second-hand smoke.
The initiative's strong emphasis on policy and environmental change at
both the State and local levels supports an expanding definition of
``health'' for the public.
DEFINING ``HEALTH'' AND HEALTHY CHILDREN
The definition of ``health'' in childhood has evolved significantly
over time. A century ago, when infectious diseases posed the greatest
threat, ``health'' was viewed as the absence of disease or premature
mortality. Today, ``health'' in general, and children's health in
particular, is now viewed in a broader developmental context. A 2004
Institute of Medicine (IOM) report, Children's Health, The Nation's
Wealth, proposed a new definition to reflect these new realities:
Children's health should be defined as the extent to which an
individual child or groups of children are able or enabled to:
(a) develop and realize their potential; (b) satisfy their
needs; and (c) develop the capacities that allow them to
interact successfully with their biological, physical, and
social environments.
This broader definition incorporates not only the physical absence
of disease, but also highlights healthy development throughout life
stages which recognizes the critical roles of mental and social well-
being. As shown in the Centers for Disease Control and Prevention's
(CDC) Adverse Childhood Experiences study, psychologically difficult
events in childhood are linked with a range of later physical and
behavioral health problems, including smoking, suicide, heart and lung
disease, physical injury, diabetes, obesity, unintended pregnancy,
sexually transmitted diseases, and alcoholism (Felitti, et al. 2002).
Indeed, as noted by the World Health Organization (WHO), ``Health is a
state of complete physical, mental and social well-being and not merely
the absence of disease or infirmity.''
This ``social determinants'' approach to health is the vision
behind the Department's Healthy People initiative--a national health-
promotion and disease-prevention agenda that, for the last three
decades, has articulated overarching goals, emerging public health
priorities and tracked movement toward specific targets. In the coming
decade, Healthy People 2020 proposes four overarching goals: (1)
achieve health equity, eliminate disparities and improve health for all
groups; (2) eliminate preventable disease, disability, injury and
premature death; (3) promote healthy development and healthy behaviors
across every life stage; and (4) create social and physical
environments that promote good health for all. As we prepare for the
next decade, implement the Affordable Care Act, and enter a new era of
prevention, HHS will continue using the Healthy People framework as a
public health roadmap to unify our national dialogue about health,
including children's health, motivate action, and encourage new
directions in health promotion.
Wrapping up Healthy People 2010 activities permits an assessment of
the status of children's health in relation to targets set a decade
ago. Preliminary analyses indicate that the Nation has either
progressed toward or met the target on a number of objectives for
children. These figures, detailed below, reflect movement on a host of
diseases, conditions, risk factors, and behaviors for the growing
population of U.S. children.
STATE OF CHILDREN'S HEALTH: DATA SNAPSHOT AND PROGRESS TOWARD HEALTHY
PEOPLE 2010 TARGETS
The number of children in the United States is increasing. In 2009,
there were 74.5 million children in the United States, 2 million more
than in 2000. This number is projected to increase to 101.6 million by
2050. In 2009, the population of children was evenly divided over three
age groups: 0-5 years (25.5 million), 6-11 years (24.3 million), and
12-17 years (24.8 million). Children's racial and ethnic diversity is
projected to grow in the decades to come: by 2023; less than half of
all children are projected to be White, non-Hispanic. By 2050, 39
percent of U.S. children are projected to be Hispanic (up from 22
percent in 2009), and 38 percent are projected to be White, non-
Hispanic (down from 55 percent in 2009).
Similar to the Healthy People framework which is used to motivate
action on children's health activities and improve health outcomes, the
Forum on Child and Family Statistics releases an annual report using
statistical data from 22 Federal agencies on the well-being of U.S.
children and families. This year's report demonstrates a number of key
positive trends including: a decline in the percentage of pre-term
births (for the second straight year); an increase in health insurance
coverage rates for children; a decline in the adolescent birth rate
after a 2-year increase; and teen smoking rates at their lowest levels
since data collection began for the report.
Maternal, Infant and Child Health and Early and Middle Childhood
Perhaps the most notable development is that following years of
increases, the Nation's pre-term birth rate declined for the second
straight year, from 12.8 percent in 2006 to 12.7 percent in 2007 to
12.3 percent in 2008. Decreases in pre-term birth rates between 2007
and 2008 were seen for each of the three largest race and ethnicity
groups: White, non-Hispanic; Black, non-Hispanic; and Hispanic women.
Still, one out of every eight babies in the United States are born pre-
term, and the U.S. pre-term birth rate is higher than in most developed
countries.
After decades of decline, the recent stagnation in the U.S. infant
mortality rate has generated concern among researchers and
policymakers. The U.S. infant mortality rate did not decline
significantly from 2000 to 2005, showed a slight decline from 2005 to
2006, and a non-significant increase from 2006 to 2007. In 2007, a
total of 29,138 infant deaths occurred in the United States, and the
U.S. infant mortality rate was 6.75 infant deaths per 1,000 live
births, compared with 6.89 in 2000. Furthermore, there persist
significant disparities in infant mortality rates among racial and
ethnic minorities.
Maintaining and enhancing the success of childhood vaccination is
crucial to ensuring children's long-term health and public health.
Increased immunization rates over the last century have improved
children's health and increased life expectancy. Today, childhood
vaccination rates are at near record high levels but they can still
improve.
Autism is more prevalent than previously believed, affecting 1 out
of every 110 American children.
Chronic diseases continue to affect a large percentage of children.
For example, nearly 1 in 10 children (9 percent) have asthma, which
includes children with active asthma symptoms and children with well-
controlled asthma. The percentage of children with current asthma
increased slightly from 2001 to 2008.
Childhood obesity is another major public health challenge: 1 in 3
U.S. children are over-weight or obese. Additionally, a third of
children born in 2000 are expected to develop weight-related diabetes
in their lifetime. Combined data for the years 2005-8 indicate that
Mexican-American and Black, non-Hispanic children were more likely to
be obese than White, non-Hispanic children. Obesity impacts children in
almost every facet of their life, not just health. According to the
White House Task Force on Childhood Obesity's Report to the President,
severely obese children have a level of health-related quality of life
(a measure of their physical, emotional, educational and social well-
being) well below their peers that are not overweight. Obesity rates
are related to poor eating patterns: in 2003-4, on average, children's
diets were out of balance, with too much added sugar and solid fat and
not enough nutrient-dense foods, especially fruits, vegetables, and
whole grains. The average diet for all age groups met the standards for
total grains, but only children ages 2-5 met the standards for total
fruit and milk.
Unintentional injuries--such as those caused by burns, drowning,
falls, poisoning and road traffic--also remain the leading cause of
morbidity and mortality among children in the United States. Each year,
among those 0 to 19 years of age, more than 12,000 people die from
unintentional injuries, and more than 9.2 million are treated in
emergency departments for nonfatal injuries.
Adolescent Health
Injury and violence are the leading causes of death for
adolescents. For example, motor vehicle crashes are the leading cause
of death for U.S. teens, accounting for more than one in three deaths
in this age group. In 2008, 9 teens ages 16 to 19 died every day from
motor vehicle injuries. Per mile driven, teen drivers ages 16 to 19 are
four times more likely than older drivers to crash. Fortunately, teen
motor vehicle crashes are preventable, and proven strategies can
improve the safety of young drivers on the road. In 2008, about 3,500
teens in the United States aged 15-19 were killed, and more than
350,000 were treated in emergency departments for injuries suffered in
motor vehicle crashes. Young people ages 15-24 represent only 14
percent of the U.S. population; however, they account for 30 percent
($19 billion) of the total costs of motor vehicle injuries among males
and 28 percent ($7 billion) of the total costs of motor vehicle
injuries among females.
Today's adolescents face a variety of challenges and stresses. By
far, the largest challenges to this age group are the dangers of drugs
and alcohol, and the onset of mental health disorders. Illicit drug use
among youth remained unchanged from 2008 to 2009. In 2009, 8 percent of
8th graders, 18 percent of 10th graders, and 23 percent of 12th graders
reported illicit drug use in the past 30 days. These statistics
represent declines from peaks of 15 percent for 8th graders and 23
percent for 10th graders in 1996 and 26 percent for 12th graders in
1997. However, the proportion of 8th graders who disapprove of trying
marijuana or hashish once or twice increased from 69 percent in 1998 to
76 percent in 2004, exceeding the Healthy People target of 72 percent.
An emerging substance use issue of concern is the non-medical use of
prescription drugs among teens. Past-year nonmedical use of substances
such as Vicodin and OxyContin increased during the last 5 years among
10th graders and remained unchanged among 8th and 12th graders. Nearly
1 in 10 high school seniors reported non-medical use of Vicodin; 1 in
20 reported abuse of OxyContin.
Alcohol use is an ongoing public health concern. Between 1999 and
2009, heavy drinking declined from 13 percent to 8 percent among 8th
graders, from 24 percent to 18 percent among 10th graders, and from 31
percent to 25 percent among 12th graders. For students in grades 9
through 12, riding with a driver who has been drinking achieved its
Healthy People target. In addition, a nationwide legal standard of .08
percent blood alcohol concentration (BAC) maximum levels for driving
while intoxicated (DWI) enforcement and prosecution was achieved. This
standard represents an effective tool in the effort to combat drunk
driving. Research has found that passage of a 0.08 percent BAC per se
law (which makes it an offense in and of itself to drive with a BAC
measured at or above .08, whether or not the driver or operator
exhibits visible signs of intoxication), particularly when accompanied
by publicity, results in a 6 percent to 8 percent reduction in alcohol-
related fatalities. In spite of these gains, underage drinking remains
a serious threat to the health and safety of adolescents. On average,
28 percent of youth aged 12 to 20 drank alcohol in the past month.
These underage drinkers consumed, on average, more drinks per day (4.9)
on the days they drank than persons aged 21 or older (2.8).
Also, despite progress in reducing tobacco use, nearly 3,900 kids
try their first cigarette each day, and 1,000 of those children become
daily smokers. Tobacco dependence is recognized as a pediatric disease
because 90 percent of tobacco users begin using before 18 years of age.
Recent Morbidity and Mortality Weekly Report data from CDC on tobacco
found that for three measures of cigarette use (ever smoked cigarettes,
current cigarette use, and current frequent use), rates among high
school students began to decline in the late 1990s, but the rate of
decline slowed during 2003-9. However, indicators of exposure to
second-hand smoke in children have decreased from 88 percent in the
years between 1998 and 1994 to approximately 53 percent in 2007-8. But
this still represents a significant risk because routine exposure to
second-hand smoke increases the probability of lower respiratory tract
infections, asthma, and sudden infant death syndrome.
Mental health disorders also often have their onset during the teen
years. In 2008, 8.5 percent of youth aged 12-17 years old had a major
depressive episode in the past year. In fact, half of all lifetime
cases of mental illness begin by age 14 and by age 24. In this sense,
adolescence is a particularly vulnerable period for the onset of mental
disorders.
Early sexual activity is also associated with emotional and
physical health risks. Youth who engage in sexual activity are at risk
of contracting sexually transmitted infections (STIs) and becoming
pregnant. In 2007, 48 percent of high school students reported ever
having had sexual intercourse. In the same year, among those reporting
having had sexual intercourse during the past 3 months, 16 percent
reported the use of birth control pills to prevent pregnancy before the
last sexual intercourse, and 62 percent reported use of a condom during
the last sexual intercourse.
The Healthy People Midcourse Review
At the Healthy People 2010 midcourse review, progress was made
toward achieving or exceeding targets for the Nation's maternal,
infant, and child health objectives. We can cite achievements
throughout the life course of the young child through to young
adulthood, including:
Preconception care--Folic acid intake: The proportion of
women of child-bearing age consuming the recommended daily intake of
folate increased. Median red blood cell (RBC) folate levels for non-
pregnant females aged 15 to 44 years exceeded the Healthy People target
of 220ng/ml.
Preconception care--Smoking cessation: The proportion of
women who have abstained from smoking during pregnancy increased,
moving toward the target of 99 percent.
Perinatally acquired HIV: The target for the number of new
cases of perinatally acquired AIDS was exceeded: new cases declined
from a baseline of 82 new cases in 2002 to 57 cases in 2003, surpassing
the target of 75 cases. Prevention of perinatal HIV transmission
requires routine HIV screening of all pregnant women and the use of
appropriate antiretroviral and obstetrical interventions that begin
during the pregnancy and continue through the first few months of the
infant's life. Together, these actions can reduce the rate for mother-
to-child HIV transmission to 2 percent or lower.
Breastfeeding: Rates increased for immediate and 6- and
12-months post partum.
Immunizations: A number of Healthy People vaccination
objectives reached their targets, including those related to
diphtheria, polio, hepatitis, bacterial meningitis, pneumococcal
infections, and meningococcal disease (for adolescents). Perinatal
hepatitis B prevention programs and the routine hepatitis B vaccination
of children have also resulted in a decline of cases of chronic
hepatitis B virus infections in infants and children aged 2 years and
under--achieving 63 percent of the targeted change. Additionally, just
as the objectives related to the vaccinations themselves are important,
so are the objectives related to evidence-based strategies for raising
vaccination coverage rates. The proportion of public and private health
care providers who have measured childhood vaccination coverage levels
and the proportion of children participating in population-based
immunization registries moved toward their targets.
Sudden infant death syndrome (SIDS): Despite significant
declines in rates since 1990, SIDS remains the third leading cause of
infant death. Clear reductions occurred in infant deaths and deaths
attributed to sudden infant death syndrome. Reported rates for SIDS
declined by 15 percent between 1999 and 2002. From its original
baseline of 35 percent, the proportion of infants being put to sleep on
their backs met the Healthy People target of 70 percent.
HHS ACTIVITIES TO IMPROVE CHILD HEALTH OUTCOMES
Multiple agencies within HHS are working to maximize the impact of
available resources to respond to the current and emerging physical,
mental and social health needs of children and their families. In the
rest of the testimony, we use the life-span framework to review the
current status of these activities:
Maternal, Infant, and Child Health and Early to Middle Childhood
Current Program Activities and Accomplishments
Infant mortality: HHS is analyzing reasons for the recent
stagnation in infant mortality rates, possible causes of pre-term
birth, issues in the coding and reporting of sudden and unexplained
infant deaths, and strategies for preventing maternal illness and
death. Given the high pre-term birth rate, and the lack of substantial
decline in the infant mortality rate in the United States, a
comprehensive public health research agenda that investigates the
social, genetic, and biomedical factors contributing to pre-term birth
and existing racial and ethnic disparities would inform policies and
activities. A National Summit on Preconception Care was convened by CDC
and its partners in June 2005, and there have been subsequent
conferences focused on preconception care in 2008 and preconception
health in 2010. National recommendations to coordinate services are
forthcoming and are expected to lead to improved pregnancy outcomes and
reduce costs associated with adverse perinatal outcomes.
SIDS: The national ``Back to Sleep'' campaign is educating
physicians and caregivers about the risks associated with prone
sleeping (sleeping with stomach facing down). As a result of the
campaign and other SIDS prevention education, the proportion of infants
being put to sleep on their backs has doubled since the baseline in
1996, but the rate has leveled off in recent years.
Prenatal care: HHS is a partner for Text4Baby, a free mobile
information service designed to promote maternal and child health. An
educational program of the National Healthy Mothers, Healthy Babies
Coalition (HMHB), Text4Baby provides pregnant women and new moms with
information to help them care for their health and give their babies
the best possible start in life. Women who sign up for the service by
texting BABY to 511411 (or BEBE in Spanish) will receive free text
messages each week, timed to their due date or baby's date of birth.
CDC is also promoting the Baby-Friendly Hospital Initiative, a global
program sponsored by the WHO and the United Nations Children's Fund
(UNICEF), to encourage and recognize hospitals and birthing centers
that offer an optimal level of care of lactation according to the WHO/
UNICEF Ten Steps to Successful Breastfeeding for Hospitals.
Folic acid intake: Consumption of folic acid by women of
childbearing age has been shown to reduce the rate for neural tube
defects (NTD). HHS, through the Food and Drug Administration (FDA) and
CDC, has emphasized food fortification with folic acid to help prevent
NTDs. In addition to food fortification, CDC has several ongoing folic
acid education projects designed to reach affected populations.
Smoking cessation: Federal partnership activities aimed at reducing
tobacco use among pregnant women are under way, including efforts to
strengthen States' capacities to develop, implement, and evaluate
tobacco prevention and cessation programs for women of reproductive
age.
Perinatally acquired HIV: The Health Resources and Services
Administration (HRSA) continually monitors the number and proportion of
babies tested who are born to HIV-positive mothers enrolled in programs
funded under Title XXVI (HIV Health Care Services Program) of the
Public Health Service Act, the number of children receiving care and
treatment, the number of pregnant HIV-positive women in care, and the
number of pregnant women on prophylaxis. The reduction of babies born
infected with HIV is also apparent in programs authorized under title
XXVI. This decline is attributable, in part, to the emphasis placed on
testing high-risk women of child-bearing age, enrolling those women
testing positive into primary care, and ensuring that pregnant women
are provided with appropriate primary care for therapy and prenatal
care through providers under title XXVI.
Breastfeeding: Multiple initiatives support breastfeeding, from the
Federal level down to the community level. Among Federal initiatives
that encourage breastfeeding are the ``National Breastfeeding Awareness
Campaign,'' the Healthy Start Initiative, and HRSA's Title V Maternal
and Child Health Block Grant Program. Additionally, the Affordable Care
Act requires employers to provide a reasonable break time and place for
breastfeeding mothers to express milk for 1 year after their child's
birth. HHS is working with other Federal departments and public and
private employers to help mothers receive the support they need to
breastfeed in the workplace.
Immunizations: HHS, led by CDC, supports State-based immunization
efforts that make vaccines available to financially vulnerable children
and adolescents, as well as adults when funds are available.
Additionally, a significant investment $300 million was made through
ARRA in supporting State- and local-based programs to ensure
vaccination efforts reached underserved groups. Funds will also support
programs to increase public awareness and knowledge about the benefits
of vaccination, as well as the risks of vaccine-preventable diseases.
Additional funds were also allocated to assess the impact and
effectiveness of newly recommended vaccines and monitor vaccine safety.
HRSA's Title V Block Grants for maternal and child health: HRSA's
Maternal and Child Health (MCH) Block Grant program is a key Federal
effort that focuses solely on improving the health of all mothers and
children. The partnership between the Federal Government and States
ensures that the needs of mothers and children, including children with
special health care needs, are addressed. Specifically, the program
seeks to: (1) assure access to quality care, especially for those with
low-incomes or limited availability of care; (2) reduce infant mortality;
(3) provide and ensure access to comprehensive prenatal and postnatal
care to women (especially low-income and at-risk pregnant women); (4)
increase the number of children receiving health assessments and
follow-up diagnostic and treatment services; (5) provide and ensure
access to preventive and child care services as well as rehabilitative
services for certain children; (6) implement family-centered,
community-based, systems of coordinated care for children with special
healthcare needs; and (7) provide toll-free hotlines and assistance in
applying for services to pregnant women with infants and children who
are eligible for Medicaid. The program's wide range of activities
include support for MCH research, training of MCH providers, genetic
services and newborn screening and follow-up, sickle cell disease,
hemophilia, universal newborn hearing screening, and early childhood
systems of services that bring together health, education and social
services.
In working to improve access to healthcare, the MCH Block program
has been able to increase both the number of children served by the
States under title V (to 35 million in fiscal year 2008) and the number
of children receiving services under Title V of the Social Security Act
who have Medicaid and CHIP coverage. Increased coverage under Medicaid
and CHIP for children receiving title V services better assures access,
availability, and continuity of care to a wide range of preventive and
acute care services.
Childhood Obesity: HHS is partnering with the First Lady in
promoting the ``Let's Move!'' campaign to end the epidemic of childhood
obesity in the next generation. Based on four pillars of helping
parents make healthy choices, creating healthy schools, providing
access to healthy and affordable food, and promoting physical activity,
the initiative is helping schools, communities and families address the
epidemic.
HHS's early actions to implement elements of the White House
Childhood Obesity Task Force Plan include efforts to prevent childhood
obesity in child care settings--a pivotal phase in children's lives.
While each State creates and enforces its own child care licensing
standards, HHS, through the Administration on Children and Families,
plans to roll out guidance and suggested standards for physical
activity and nutrition for child care later this summer. Also, as part
of the Head Start Body program, HHS will provide individual grants to
Head Start programs to improve or construct playgrounds and outdoor
play spaces under the Head Start Body Start National Center for
Physical Development and Outdoor Play. HHS is also empowering parents
and caregivers with nutritional knowledge, tools and resources to make
healthy choices. Over the next year, HHS will: in partnership with the
Department of Agriculture, release the new Dietary Guidelines for
Americans that provides science-based advice about making food choices
to promote health; develop a new Front of Pack labeling system to make
it easier for consumers, with a quick glance, to make healthy and
informed food choices; and oversee the implementation of menu labeling
provisions authorized by the Affordable Care Act. The Affordable Care
Act requires owners of retail chain restaurants and vending machines
(with more than 20 locations) to post caloric information, which will
empower consumers to make healthier choices.
HHS is also implementing community demonstration projects
authorized by CHIPRA; the Department will award $25 million in grants
to select communities for health care providers to work with schools,
community programs, recreation centers and other groups to build
seamless community-clinical systems to reduce and prevent obesity among
child residents. Additionally, since the White House Task Force
established a goal of 100 percent of primary care physicians assessing
body mass index (BMI) at well-child and adolescent visits by 2012, HHS
will outreach to State Medicaid Directors to help them better
understand the scope of prevention services they should provide to
children and encourage BMI assessment and follow-up. Also, HRSA has
launched a learning collaborative to significantly increase the health
of children and families. Over the next year (through July 2011),
faculty experts are helping to design, implement and test information
that communities, including grantee community health centers, can use
to help children achieve and maintain a healthy weight.
Additionally, HHS is updating the President's Challenge program to
ensure consistency with the Physical Activity Guidelines and make it
easier for schools to implement the program. The First Lady has set a
goal of doubling the number of children in the 2010-11 school year who
earn a President's Active Lifestyle Award (PALA). HHS will lead our
Nation toward achieving this goal. The modernization of the President's
Challenge Youth Fitness Test will begin this year, and HHS will double
the number of children in the 2010-11 school year who earn a PALA
award.
Obesity research also continues across the Department. For example,
the National Institutes of Health's (NIH) National Collaborative of
Childhood Obesity Research (NCCOR), launched in 2009 in partnership
with the CDC and the Robert Wood Johnson Foundation, is accelerating
research progress and translating findings into effective solutions at
the societal level. NCCOR is designed to coordinate funding efforts,
pooling members' resources for large projects that might not be
feasible otherwise. NCCOR recently launched the Envision project ($15
million), which aims to help us understand the complexity of childhood
obesity and virtually test environmental and policy interventions
through sophisticated computational, systems models. During Fiscal Year
2010, NCCOR also will begin funding a nationwide study to determine the
effectiveness of existing community-based strategies and programs.
Childhood Injury Prevention: Through public health surveillance
efforts, research and implementation of effective strategies, CDC is
working to protect young Americans from the threat of injury and
violence. CDC prioritizes its work for children and adolescents by
focusing on: (1) child maltreatment prevention and (2) prevention of
child/adolescent motor vehicle related injuries.
Motor Vehicle Injury Prevention: CDC's research and prevention
efforts are focused on improving seat belt use and reducing impaired
driving, and helping groups at risk: child passengers and teen.
Examples include raising parents' awareness about the leading causes of
childhood injury in the United States and how they can be prevented.
For example, CDC launched the initiative titled, Protect the Ones You
Love: Child Injuries Are Preventable. CDC is also supporting States in
the implementation of optimal graduated licensing laws (GDL). CDC's
research and prevention efforts are focused on improving seat belt use
and reducing impaired driving, and helping groups at risk: child
passengers and teens.
Autism and Developmental Disabilities: Through ARRA, funding for
autism research increased from $118 million in Fiscal Year 2008 to $196
million in Fiscal Year 2009. Several HHS agencies and offices are
addressing autism spectrum disorders through research, surveillance,
public education, and service delivery. HHS and the White House co-
hosted a meeting with external stakeholders in recognition of World
Autism Awareness Day on April 2, 2010, to learn more about the gaps in
addressing the needs of people with autism. The Interagency Autism
Coordinating Committee (IACC), a Federal advisory committee established
in 2006 through the Combating Autism Act, advises the HHS Secretary and
coordinates all efforts within the Department concerning autism. The
IACC released the second edition of the Strategic Plan for Autism
Spectrum Disorder Research in January 2010. The 2010 Plan adds 32 new
research objectives and more fully addresses the needs of people with
autism spectrum disorder across the spectrum, from young children to
adults, and places new emphasis on both non-verbal and cognitively-
impaired people with autism spectrum disorder. On April 30, 2010,
Secretary Sebelius announced appointment of five new members to the
IACC who add a breadth of expertise and perspectives to the committee.
In an effort to better understand risk factors and potential causes
of ASD, CDC is currently conducting one of the largest studies in the
United States to help identify factors that may put children at risk
for ASD and other developmental disabilities. This study, being
conducted across a six site network known as the Centers for Autism and
Developmental Disabilities Research and Epidemiology (CADDRE), is
called SEED, the Study to Explore Early Development. SEED is now
nearing the close of the enrollment phase and first publications will
be in Fiscal Year 2011.
Asthma Control Programs: CDC's National Asthma Control Program is
reducing the number of deaths, hospitalizations, emergency department
visits, school or work days missed, and limitations on activities due
to asthma. Funding for health departments in 34 States, the District of
Columbia, and Puerto Rico to conduct asthma surveillance, maintain and
expand partnerships, implement statewide comprehensive asthma plans
with their partners, implement interventions to reduce the burden of
asthma, and develop and implement an evaluation plan. CDC also funds
the State health departments in California, Michigan, Minnesota,
Mississippi, Missouri, New York, Oregon, Rhode Island and Washington to
conduct in-depth surveillance projects (three of them using Medicaid
data), disparities assessments, and interventions, implementation and
evaluation.
Surveillance efforts continue: In 2005, CDC implemented its
National Asthma Survey (NAS) data collection effort as a call-back
survey subsequent to the Behavioral Risk Factor Surveillance Survey
(BRFSS). By 2009, participation in the Asthma Call-back Survey (ACBS)
had expanded to 35 States, the District of Columbia and Puerto Rico. In
2010, 40 States will use the ACBS to collect data. Before CDC initiated
the NAS and ACBS, none of this information was available at the State
level. The ACBS data are used by the States to track Healthy People
goals, evaluate programs, and plan future activities at the State
level.
Early Hearing Detection and Intervention: Prior to the
authorization of the Early Hearing Detection and Intervention (EHDI)
program in 2000 (under the Children's Health Act), less than half of
the infants in the United States were being screened for hearing loss.
CDC's EHDI program provides support on the development and
implementation of State-level tracking and surveillance systems to
ensure that infants and children with hearing loss are identified early
and receive services as soon as possible. Collaborative work with State
EHDI programs and other partners to ensure infants receive recommended
follow-up diagnostic and intervention services in a timely manner to
realize the benefits of newborn hearing screening.
Food allergy: Food allergy is an emerging major health problem that
affects approximately 4 percent of U.S. adults and 5 percent of
children under 5 years old, and its prevalence seems to be increasing.
Despite the risk of severe allergic reactions to food, and even death,
there is no current treatment other than allergen avoidance and
treating the symptoms associated with severe reactions. NIH's National
Institute of Allergy and Infectious Diseases (NIAID) remains committed
to basic research and clinical studies to advance our understanding of
food allergy. NIAID-supported clinical trials continue to demonstrate
the potential for immunotherapy to prevent or reverse established food
allergies, such as peanut allergy, in children. NIAID also is leading
an effort to develop ``best practice'' clinical guidelines for
healthcare professionals for the diagnosis, management, and treatment
of food allergies. The guidelines are expected to be published before
the end of 2010.
National Children's Study (NCS): Efforts to promote health and
prevent disease are predicated on understanding the causes and timing
of, and triggers for, events that affect children's health. The NIH,
joined by a consortium of Federal partners, has begun to pilot test
recruitment strategies for the NCS, a large, multi-year research study
with the goal of discovering and exploring the relationships between
the environment (broadly defined), genetics, growth, development and
health on 100,000 children from before birth through age 21. Complex
environmental interactions and their relationships with critical growth
and development periods will be studied, and it is expected that the
data gathered will be utilized by researchers for many decades to come,
providing insight into what constitutes children's health, but also
childhood precursors of many adult chronic conditions.
Additional research and healthcare quality improvement projects for
children: HHS's Agency for Healthcare Research and Quality (AHRQ)
current projects include: testing approaches to deliver effective
treatments for children with mental health problems; making medication
management child-centered; implementing evidence-based care processes
for infants with fever; using computers to automate developmental
surveillance and screening; preventing adverse effects of medications
during pregnancy; comparative safety and effectiveness of stimulant
medication for children with ADHD; and effectiveness of ADHD treatment
in at-risk preschoolers. In addition, AHRQ is working collaboratively
with CMS to implement CHIPRA through the identification of evidence-
based healthcare quality measures for use by public and private
programs, and other activities related to improving quality.
Adolescent Health
Current Program Activities and Accomplishments
Tobacco control: On June 22, 2009, the President signed the Family
Smoking Prevention and Tobacco Control Act (Tobacco Control Act)
(Public Law 111-31) into law. The Tobacco Control Act grants the FDA
important new authority to regulate the manufacture, marketing and
distribution of tobacco products to protect the public health generally
and to reduce tobacco use by children and adolescents. HHS is directly
supporting FDA's regulation of tobacco products and is promulgating
regulations that limit the sale, distribution, and marketing of
cigarettes and smokeless tobacco to protect the health of children and
adolescents. FDA has also implemented provisions that prohibit the use
of certain characterizing flavors in cigarettes, and prohibit
manufacturing tobacco products with the descriptors ``light,''
``mild,'' or ``low'' or similar descriptors.
CDC provides national leadership for a comprehensive, broad-based
approach to reducing tobacco use. Essential elements of this approach
include State-based, community-based, and health system-based
interventions; cessation services; counter-advertising; policy
development and implementation; tobacco product research; surveillance;
and evaluation. A key goal of CDC's tobacco control program is to
reduce the initiation of tobacco use among children, adolescents, and
young adults. CDC will continue to encourage effective, evidence-based
efforts to reduce youth smoking rates in the United States. These
include strategies such as counter-advertising mass media campaigns;
higher prices for tobacco products through increases in excise taxes;
tobacco-free environments; programs that promote changes in social
norms; comprehensive community-wide and school-based tobacco-use
prevention policies to help reduce smoking; reductions in tobacco
advertising, promotions, and commercial availability of tobacco
products through implementation of FDA's regulatory authority; and
effectively countering tobacco industry marketing influences.
Division of Adolescent School Health: CDC's Division of Adolescent
and School Health addresses six critical types of adolescent health
behavior that research shows contribute to the leading causes of death
and disability among adults and youth. These behaviors usually are
established during childhood, persist into adulthood, are interrelated,
and are preventable. The Division focuses on collecting data to better
understand the risks and challenges facing the adolescents of today, as
well as develop strategies to prevent disease and promote overall well-
being wherever possible.
Office of Adolescent Health: Consistent with the directive
contained in the Fiscal Year 2010 Consolidated Appropriations Act
(Act), a new Office of Adolescent Health (OAH) has been established
within the Office of Public Health and Science of the HHS Office of the
Secretary. The President's budget for Fiscal Year 2010 proposed a new
Teenage Pregnancy Prevention initiative to address high teen pregnancy
rates by replicating evidence-based models and testing innovative
strategies. The Act provides $110 million to support the TPP Program
with not less than $75 million for funding the replication of programs
that have been proven effective through rigorous evaluation and not
less than $25 million for funding demonstration programs to develop and
test additional models and innovative strategies.
In the short term, OAH will focus primarily on the implementation
of the Teen Pregnancy Prevention program. However, HHS envisions that
the Office of Adolescent Health will also address many of the
interrelated health needs of adolescents such as mental health, injury
and violence prevention, substance abuse, sexual behavior, pregnancy
prevention, nutrition, physical activity, and tobacco use, as
authorized. The OAH is planning to work with other HHS agencies,
including the Substance Abuse and Mental Health Services Administration
(SAMHSA), to coordinate adolescent activities within the Department and
address the recommendations contained in recent IOM reports on the
health needs of adolescents.
Addressing onset of mental health problems: A 2009 IOM report
Preventing Mental, Emotional and Behavioral Disorders in Young People,
clearly articulated that we have many programs that can prevent
problems including substance use and mental disorders. Current SAMHSA
programs focusing on prevention, treatment and recovery for youth
include:
The Drug-Free Communities Program and Sober Truth on
Preventing Underage Drinking (STOP Act): Fund communities to develop
coalitions across different sectors of the community--schools, law
enforcement, businesses and merchants, health and behavioral healthcare
providers, media, faith-based, community leaders--to prevent and reduce
substance abuse among youth using a strategic prevention framework and
evidence-based population prevention practices.
Safe Schools Healthy Students Program: Addresses the
common risk factors associated with substance use and school violence
while strengthening factors that promote good mental health. These
grants, jointly funded by the Departments of HHS, Education, and
Justice, enable local educational agencies to partner with their local
mental health, law enforcement, and juvenile justice agencies to
support a comprehensive, coordinated plan of activities, programs, and
services. Local comprehensive strategies must address five elements,
including early childhood social and emotional learning programs.
Results from this program indicate a 15 percent decrease in number of
students involved in violent incidents (17,800 in Year 1 of grant to
15,163 in Year 3); decreases in number of students experiencing or
witnessing violence, and improved overall sense of safety in the
school.
Community Mental Health Services for Children and their
Families Program (Children's Mental Health Initiative): This treatment
program for youth with serious emotional disorders has had an impact in
nearly 22 percent of the 3,177 counties in the United States and has
served over 88,000 children with disabling mental health conditions.
The program is based on a system of care approach which provides
individualized, comprehensive and coordinated, community-based wrap-
around services to maintain children in their homes and communities and
to prevent more costly and restrictive institutional care. Key outcomes
from this program include reductions in negative symptoms, improved
functioning in school, less involvement with the juvenile justice
system, and reduced family stress.
CLOSING
Thank you Mr. Chairman for the opportunity to present this overview
about the state of children's health and well-being in the United
States. HHS is committed to expanding access to health care and
increasing our coordination of child health initiatives with our
Federal, State and local partners to devise, test and implement
solutions to the challenges and opportunities ahead. I would be glad to
answer any questions you may have.
Senator Dodd. Thank you very much, Doctor, and I thank all
of you for your work, your dedication to these issues, and the
efforts you are making today to improve the quality of life for
these kids and their families.
Let me begin. Some of you have suggested this already, but
it is something that is so important. It can get dizzying,
obviously, when we start listening to all the various programs
and ideas at the local level, State level, obviously, the
national level as well. And the question that comes to mind,
obviously, is the ability to coordinate.
I am particularly grateful to the Administration, as chair
of the Banking Committee. Jeff Merkley and I serve together on
that committee. Bob Casey, in fact, was on that committee with
us. And looking at the issue of how do we bring efforts
together on the issue of livable communities. To the
Administration's great credit, they have now formed an
interagency task force with the Department of Energy, the
Department of Housing, and the Department of Transportation. So
they begin to coordinate efforts in that regard.
It occurs to me, obviously, this is a similar set of cases
we are talking about here, the ability to have some sort of an
interagency involvement so that there is the debate about whose
jurisdiction. I mean, there has been an age-old debate since
1965. Does Head Start belong in the Department of Education or
the Department of Health and Human Services? In fact, we had
yesterday a conversation. Bob Casey and I spent an hour or so
together talking about these issues with Tom Harkin, the
chairman of the committee, and we spent about 20 minutes just
talking about that very point, about jurisdiction when it comes
to these questions.
So it seems to me it is important, without resolving the
issues and getting into the internecine battles that can occur
over who has jurisdiction over which programs, if you can sort
of leapfrog over all of that and end up with that sort of
coordinated effort, then the fact that it exists in one
Department or another becomes less significant in my view if,
in fact, there is a highly coordinated way of dealing with
these questions.
And as you point out, Dr. Koh, there is so much of this,
that each of these Departments represented here today--and I
will include the Council of Economic Advisers as well. The
ability to coordinate those efforts and looking holistically at
how this child or the children are developing on a social, on a
health, on an educational basis--and I wonder if any of you
want to pick up on that point and let me know what is going on
in terms of our ability to coordinate these activities.
Who would like to start? We will start with you, Mr.
Hansell.
Mr. Hansell. Well, Mr. Chairman, you are raising a very
important issue, and it is one I am happy to say I think has
been a hallmark of this Administration. I have to say, having
served previously in State and local government, I have never
seen a level of interdepartmental collaboration as I have seen
in the Obama administration. And it is for exactly the reasons
you say, which is that while we have multiple siloed programs
and funding streams, the goals, the outcomes we want to achieve
are common to them, and we have to make sure that they are
working together and not at cross purposes.
Actually I can give two examples that relate to the
colleagues on my left and my right which I think are wonderful
illustrations of this.
Dr. Melendez and I both talked in our testimony about how
we are working very closely between ACF and the Department of
Education to create a real birth to 8 continuum of early
childhood programs, and we have a number of initiatives
underway to do that. The Early Learning Challenge Fund, which
we proposed, we think would be important in bringing States to
the table to really partner with us on that, but the work is
already going on. We very strongly believe and I know that Dr.
Melendez and her colleagues do as well that all of the
programs, those we administer, the child care and Head Start
programs, as well as the K-12 programs that the Department of
Education administers, must have a common set of outcomes, a
common framework, a common set of data elements so that we can
make sure that as we achieve gains early on for children, those
gains are sustained as they move into the educational system
and onward into adulthood. So that is one example.
Another has to do with our work with the Department of
Labor and the Employment and Training Administration. We have
focused very heavily this year on the summer youth employment
program which has traditionally been funded through the
Workforce Investment Act funding. But many States were
challenged this year because their Recovery Act funding for
that purpose had been largely exhausted. So we worked with
Assistant Secretary Oates in the Employment and Training
Administration to issue guidance to States very early this year
on how they could use the new TANF emergency funds to bolster
their WIA funding to make sure that they could sustain and, in
many cases, even expand their summer youth employment programs
because, again, that is a key to helping youth get sort of on
the right track so that they can develop the kind of workplace
skills that they are going to need as they move into adulthood.
And I am delighted to say that States have taken this up
with gusto. We now have 21 States and the District of Columbia
that are using the TANF funds to supplement their WIA funds to
support summer youth programs this summer. Tens of thousands of
slots have been created.
So those are, I think, from our perspective very important
but only very early examples of the kinds of collaboration that
we hope to accomplish. But I think they are illustrative of the
work that is going on in this Administration.
Senator Dodd. Do either of you, Mr. Harris or Dr. Melendez,
want to comment on that at all? Do you have any other thoughts
you might share?
Mr. Harris. I can only agree. What we have found in this
Administration is that collaboration rises up organically
between the Departments. It is not imposed from above. As a
result, I think it is much, much more effective.
We could talk also about a collaboration we have with ACF
with respect to transitional jobs. We are in cooperation with
the Education Department in creating a K through work data
quality initiative that will include job training initiatives
and postsecondary education. So I think it has worked very
well.
There are areas, I think, where we could do more with
respect to, for example, data sharing. When we, for example,
regulate in the child labor area, we work very closely with the
National Institute of Occupational Safety and Health, but
building a larger database and building integrated databases of
information on what is going on in child health both in the
workplace and outside I think would be a helpful step. But that
is something I think that will grow up organically as we
continue to address these issues together. So I agree
completely with Assistant Secretary Hansell.
Senator Dodd. That is very good.
Yes, Dr. Koh.
Dr. Koh. Mr. Chairman, I can cite another example. We have
a health promotion target-setting process, Healthy People that
I alluded to, and this is a very important year. Healthy People
2010 is concluding this year, and we are about to launch
Healthy People 2020, so targets for the country for the next
decade. In that target-setting process, we have a Federal
interagency work group that reaches across Government and it
sets targets for the whole country to shoot for and involves so
many partners across the Federal Government and across every
community in the country. So that is one proactive way of
aligning a lot of resources and mobilizing resources.
Senator Dodd. That is good to hear.
My lead-off witness in Connecticut the other day at the
Yale Child Study Center was Ed Zigler. I can see the smiles
occurring on all the faces. The audience cannot see it, but for
those of you not familiar with the name Ed Zigler, he is sort
of the high priest of early childhood development issues, the
author and the founder of the Head Start program back in 1965
and has written extensively and been engaged now for so many
years in the subject matter.
He cites the four touchstones for him in dealing with these
issues. Parental involvement, direct health issues, education
issues, and child care are the four touchstones he uses.
I would like to pick up on the parental involvement issue.
This to me is one of the more perplexing set of issues. When
you look at the children in Head Start programs and even at my
State level the amount of afterschool programs, obviously, they
do not reach everyone. To a large extent, the parents who are
aware of the existence of programs, who make an effort, have a
substantial lead on others who are not aware or are so stressed
out trying to cope every day just to put food on the table,
where they live. It makes it harder and harder to engage these
families in providing for the needs of their children. They
care no less about their children in my view. They still have
the same desires that their children get the best they can
possibly give them. But it is overwhelming. It is just
overwhelming.
It perplexes me to a great deal on almost every level we
talk about of how do we engage parents more. It obviously
begins there. From the very moment of conception, obviously at
child birth, all of these efforts, if you can just engage at
the earliest possible stage of a child's development, then the
results just dramatically improve proportionately to the extent
you are involved early.
I wonder, Dr. Melendez--because one of the difficulties is
how do we get parents involved--Head Start requires that
parents be involved. So that is one of the conditions of the
Head Start program. We get participation by parents in Head
Start. It drops significantly by the 1st grade and beyond--
parental involvement--generally speaking. I think it goes back
to the point, Dr. Rouse, you made earlier. When you have
children who come from affluent or relatively secure economic
means, those numbers are vastly better in terms of parental
involvement, and as the economics worsen, then the parental
involvement, engagement declines substantially.
I wonder what thoughts are being given on how we can do a
better job of reaching out to parents of children. Any thoughts
you might have on this at all I would be interested in. Let me
begin with you, Dr. Melendez.
Ms. Melendez de Santa Ana. Absolutely. And if I may say
just to add a little bit to a conversation earlier, part of the
work that we are engaged in with HHS is to really build on that
transition between early learning programs and kindergarten.
That is a critical transition period. As it plays out when it
comes to parental engagement, that is critical.
Having been in the classroom, having been a principal and
worked in different levels, you are absolutely right. At the
elementary level, you see the parents around. Having worked in
middle school, you see less of them. In high school, you see
even less.
What we are trying to do in the Department through our use
of title I funds in our proposal is to say, look, let us double
the amount of money and put in, in terms of our proposal,
opportunities for parents, for schools to take responsibility
for being welcoming environments for parents, ensuring that
parents are welcomed, ensuring that they have a voice in the
decisions that are being made.
We are also asking in our proposal for a set-aside of 1
percent so we can find those innovative programs so that States
can compete out funds for nonprofits and school districts to
identify them. You know, it is very difficult for school
districts to think about ways in which they can do that, but
there are many examples across the country where that is
happening, where there are ways in which parents are brought
in. There are training programs. There are ways in which they
can be engaged.
And so we look forward to further conversation in which we
can work together across our agencies and work together with
Congress to be able to identify because that is critical. If a
parent is not there, if a parent is not supportive, it is very,
very difficult, yet not impossible.
Senator Dodd. Home visiting. I think a lot of times too--
particularly in poorer families, it is not uncommon that their
parents themselves had their own--the school environment was
not the most welcoming. Therefore, to engage them to come to a
place which was in some cases seen as almost a hostile
environment, it makes it even harder.
Ms. Melendez de Santa Ana. Absolutely, or language, whether
they have access to that.
We had a program in which we asked teachers to go out to
the homes of the students, and the teachers were absolutely
amazed. They had no idea how they lived, the type of
environment they had. And it really helped in terms of
understanding the types of strategies and ways in which they
can interact with the students and their parents.
Senator Dodd. Have there been any national programs you are
aware of? I mean, you talked about it with Pomona, I gather, as
superintendent.
Ms. Melendez de Santa Ana. Yes.
Senator Dodd. But I wonder if there have been any unique
examples where a community or a county has been successful in
these home visiting programs because I could not agree more. I
think if a teacher can see where a child lives and the
circumstances in which they live, that is a very different
relationship the following morning in terms of looking at that
child and how that child learns and what that child is
grappling with. I just think the dynamic is fundamentally
different as a result of that experience.
But I am wondering if there has been any examples at a
State or local level where this has worked particularly well.
Yes, Doctor.
Dr. Koh. Mr. Chairman, you probably know that in the
Affordable Care Act there are new resources for HRSA, the
Health Resources and Services Administration, to promote home
visiting programs. That just got unveiled in the last several
weeks. I think it is $1.5 billion over the next 5 years. So
these programs are evidence-based. There is a scientific
database to show that they are effective and it is targeted
particularly for young parents. So we could not agree with you
more that the home visiting theme is effective for education
but also for health as well.
Senator Dodd. Yes, Dr. Rouse.
Ms. Rouse. If I may, I would just add that certainly while
there is an important role for encouraging parental involvement
at the earliest stages and at a fundamental level, I think the
lack of workplace flexibility for many workers makes it--even
for those workers that want to be able to go to the school and
meet with the teacher, but are not able to get time off from
work--and that is especially true for low-skilled workers who
have the least flexibility.
Senator Dodd. Well, we have tried. We have authored some
legislation over the years to try and provide leave from work
for parents. Everyone sort of gets the notion of FMLA now. It
took forever, but on family and medical leave where you have an
illness. And everyone bought into the illness ultimately. It
took 7 years, but they got to the point where they understood
that an illness warranted having a parent be able to spend some
time with a child. We have had a much more difficult time
convincing my colleagues that the ability to be able to make
that school visit, to take that hour or 2 is a harder sell.
I have to ask you too, Dr. Melendez, because I mentioned in
my opening comments about my concerns over what happened in the
appropriations committee with afterschool programs. The
extended day issue I also like. It is very important. You get 7
hours for that. I get 15 hours with the afterschool programs.
And the extended day is a very expensive program. What I do not
like is the idea of taking money out of afterschool programs to
pay for that. There are other means, and afterschool is just
very critical.
Again, you talk about adolescents. The statistics and data
of the problems that children get into during that period
between 2 p.m. and 6 p.m. in the afternoon is stunning.
Can you share with me any thoughts on whether or not the
Administration is going to be supportive of at least trying to
maintain some static funding, or are we going to start having
competition between extended day and afterschool?
Ms. Melendez de Santa Ana. Well, first of all, I just want
to say thank you because as the superintendent, we had an
afterschool program funded by the Federal Government, and it
was a wonderful program at a middle school and with a
nonprofit. So I know how important it is to have programs that
support students especially in impoverished areas and the
important role that they play.
We are looking at how we can extend the day and give school
districts the opportunity to figure out how they can embed
afterschool programs and extend the day as a coherent program.
That is part of what we are thinking through and would be more
than happy to work with you as we move toward reauthorization
and have conversations with you about this topic.
Senator Dodd. Well, yesterday the Appropriations Committee
cut the funding, and now they are going to go to full committee
today. To the extent you can weigh in at all between now and
this afternoon--you know, this is not down the road. This is
now happening as we are talking here. So to the extent someone
can weigh in--again, I do not like to see us competing because
I think the extended day idea has a great value. Just at the
same time, I am looking at what families struggle with. You go
back to that working family and the conditions and having good
afterschool programs make a huge difference. And they also
support. I mean, it is not just a place for child care, but the
idea that it becomes an educational place, all sets of skill
sets and so forth are developed during that time. So I just
raise the issue. I cannot resist raising the issue since you
are here.
Ms. Melendez de Santa Ana. Of course.
Senator Dodd. Dr. Rouse, I want to go back, if I can,
because these economic statistics are troubling to me. A recent
report issued at the end of June by the Congressional Budget
Office highlighted the fact that income inequality has tripled
in the last 30 years to levels not seen since 1928 in our
country. Given your expertise as an economist, what is the
impact of this growing income gap on the well-being of
children? And what are the roots of the growing inequality? And
have there been economic policies which have increased the
inequality in the United States in your view?
The Urban Institute--Brookings Institution Tax Policy
Center considers only the impact of tax policy changes and have
provided data that indicate that the tax cuts enacted in 2001
and 2003 have widened income inequality in the country.
Ben Bernanke, who appeared before me the other day in his
capacity as the Chairman of the Federal Reserve Board in coming
before us on their annual report to Congress on the Humphrey-
Hawkins issue--and Ben Bernanke is a rather unique and
fascinating choice that was made by President Bush I do not
think in anticipation of what was going to occur shortly after
he gets the job. But he wrote his doctoral dissertation, and
his real expertise is the depression era and what happened in
it.
I asked him the other day to comment, if he would, based on
his expertise and his own doctoral studies, about the impacts
of long-term unemployment on people. He was very direct. Once
you get people back to work, which obviously we all want to see
happen, there are implications beyond that that affect that
child, affect those families, and there are long-term effects
as well.
I wonder if you might just expand on that a bit in your
capacity on the Council of Economic Advisers.
Ms. Rouse. Sure, I am happy to.
In terms of the impacts of increasing inequality, I
certainly know of no studies that suggested increasing
inequality is helpful to the well-being of children, and
especially when it is that the wealthier families are becoming
wealthier and the struggling families are even struggling more,
it would be inconceivable really that it is going to be helpful
to the well-being of children.
The prospects of long-term unemployment are certainly of
concern in terms of the impacts on children. One of the most
interesting and compelling studies on this is evidence from
Canada, but it is evidence that looks at plant closures. And
what the researchers found is that children whose fathers had
been displaced earned 9 percent lower earnings as adults--so
this is the impact on the children for when they are adults--
than the children whose fathers had not been displaced. They
were 3 percentage points more likely to ever be on public
assistance as well. So we certainly do anticipate that there
will be long-term impacts on the children from this recession.
So I think it is something to be quite concerned about.
Senator Dodd. Senator Merkley, you are back with us and
thank you.
Senator Merkley. Thank you very much, Mr. Chair.
I appreciate the point that you are making, Dr. Rouse, and
the loss of manufacturing jobs may well be one of the most
profound impacts upon the well-being of our children.
I was very struck when I went into a food bank a few months
ago and the director immediately said to me the biggest
positive change we have seen is that we used to have a stream
of families coming in who had essentially been driven into
desperation or poverty by payday loans, 500 percent interest
rates, and that reforming those had ended that. They did not
see families coming in in that situation. Then she proceeded to
say, however, the unfortunate news is the unemployment now is
driving a similar stream of folks to the food banks.
One of the things that I wanted to raise specifically,
because it is an issue that came up last year and I want to
keep raising it, in relation to children's health is tobacco
and specifically the tobacco industry's interest in pursuit of
new products to drive addiction. Folks are well aware that when
people take up tobacco in their 20's, they rarely become
addicted to it. So to continue a customer base, if you will,
that you need to drive addiction in children.
So there is a series of new products that have come out.
This is one that is being test-marketed in Portland and a
couple other cities around the country called Orbs. It is in a
little package like this, shaped like a cell phone so that when
it is in a child's pocket, it will look like a cell phone
rather than look like tobacco. It makes it very hard for
teachers to know what is there. It has a very fancy little
dispenser that pops out one tablet at a time kind of like a Pez
dispenser. So it is a lot of fun. And they come in two flavors
which are mint and caramel. To me this represents a huge threat
to the future of our children.
There are also two other similar products being tested. One
are dissolvable breath strips. You have seen all these
dissolvable breath strips that you put on your tongue. Well,
these are finely ground tobacco dissolvable breath strips. And
the third are toothpicks. So these are experiments in reaching
children.
We were able to get in a 2-year accelerated review by the
FDA and the FDA controls tobacco of these products. But
particularly for those of you who deal in health, I wanted to
make a little of a pitch to focus on trying to stop these types
of products because they will lead to a new generation of
tobacco addiction and tobacco health issues. And I would just
see if anyone has any comments about it.
Dr. Koh. Senator, first of all, I want to thank you for
your leadership on this issue, and I have seen many
announcements of your passion on this issue and your leadership
and press coverage of your attention to this emerging public
health challenge. So thank you very, very much.
As I alluded to in my comments, with the leadership of
Chairman Dodd and yourself and so many others, we are
revitalizing our efforts on tobacco control at the Department
and across the country. As you aptly point out, as more and
more States go smoke-free in this country--about 24 of the 50
States have gone smoke-free in public places--the tobacco
industry is creating more and more new, innovative products to
put before adults and also young people. You have placed great
attention to that, and we want to thank you for that.
We do have a situation around the world where several dozen
countries have completely smoke-free nations, and the tobacco
industry is aware of that and they are trying to plan for the
future. So these new products have hit the market. So with the
new authority granted to the FDA and a new commitment to
preventing addiction for kids, we need to track these trends
very, very carefully.
So thank you for your leadership on that.
Senator Merkley. Thank you and thank you for your efforts,
and I hope the Administration will continue to pursue this,
especially after we get the results of this study from the FDA
of these products.
A second thing I wanted to address in the context of
childhood obesity is that clearly children's play habits have
changed dramatically. Having a 12-year-old and a 14-year-old, I
see this firsthand. Video games have replaced everyone throwing
their books in the door and running out to the neighborhood
afterschool gathering.
In that sense, a troubling thing to me is that a lot of
school athletic extracurricular activities that were free--so
whether I played basketball or tennis or ran cross country, it
was free. There are now activity fees throughout our Nation,
maybe not all schools, but certainly my impression is most
schools try to make ends meet. That means children in poverty
are less likely to participate. Not only are they less likely
to participate in the neighborhood activities because the
neighborhood gathering does not occur anymore, but then they
are less likely to participate in organized athletic programs
at the school because of the school activity fees.
I wonder if any of you have insights on studies that have
been done on this or things that we need to do to try to change
that dynamic.
Dr. Koh. I can comment again, Senator, if you wish. You are
absolutely right that we need greater attention to policies to
help promote exercise and prevent obesity in the next
generation. This is a tremendous initiative that has been led
by the First Lady, as a number of us have noted.
Recently through the Affordable Care Act, the CDC has
funded over 40 communities to look at policy changes in
communities called Communities Putting Prevention to Work. It
is focused on policy change for adults and kids to prevent
tobacco addiction and to prevent obesity. So some of those
policy changes that you are alluding to are being addressed by
some of the communities being funded by this new initiative and
we are eagerly awaiting some of those results in future years.
Ms. Melendez de Santa Ana. Part of our proposal in the
Blueprint is to expand the content areas to include physical
education as competitive grants where States and local school
districts can request grants around physical education in ways
that they can ensure that students have programs that will
support them, along with music and arts, environmental
literacy, different areas like that, financial literacy.
Mr. Hansell. And I might add, Senator, relating this to
your earlier point, obviously we want to start kids out as
early as possible with good health habits and not bad health
habits. So we, in both our Head Start and our child care
programs, are very involved with the First Lady's Let's Move!
initiative, are working with providers to integrate both good
nutrition and physical activity into those programs, and are
working with them providing guidance, and providing technical
assistance on how they can get the kids started with those
kinds of good health habits as early as possible.
Senator Merkley. Thank you very much, Mr. Chair.
Senator Dodd. Thank you very much, Senator. I appreciate
your emphasis on the tobacco issues. This was a great cause of
Senator Kennedy, of course, who chaired the committee here for
years, and with his illness, prior to his death, I was acting
chairman of the committee with the help of Senator Merkley and
others. I do not know, Bob, if you were involved with the
committee at that juncture or not. But we went through a rather
contentious markup of the bill and it passed overwhelmingly on
the floor of the Senate. The House, obviously, had passed the
legislation earlier.
But the numbers are just breathtaking. I will turn to
Senator Casey in a minute. I think we had 3,000 a day--3,500
children under the age of 18 start smoking for the first time
every day. So today before the day ends, keep that number in
your mind, if you would. Just before today ends, somewhere
between 3,000 and 4,000 children will pick up the habit. And we
know, of that number, about 1,000--it is a lifetime habit. The
good news is that some of them drop it, obviously, with the
tremendous efforts being made today.
Of course, the economic model is perfect because we lose
about 3,500 to 4,000 people a day in the country as a result of
smoking. So the business model is, as Senator Merkley has
pointed out, if you do not get those kids starting every day,
obviously if you lose 4,000 smokers a day, you would be out of
business pretty quickly if you did not attract a new audience
and a new constituency.
I am terribly disappointed, by the way, with the industry
because a major part of that bill was designed, obviously, to
promote stopping the advertising and putting better labels and
so forth. The industry has gone out and hired a bunch of first
amendment lawyers to be able to kill all of the provisions of
that part of the bill. I will just say editorially that I look
at the U.S. Supreme Court and who is on it today, and some of
the people in the past who represented other industries in the
past when it came on first amendment arguments. I do not
minimize first amendment arguments, but when you consider the
damage being done.
And if you want to talk to someone, talk to a parent who
smokes about whether or not they want their children to smoke.
So I appreciate your raising the issue. It is an important
one.
Senator Casey.
Senator Casey. Thank you, Chairman Dodd. And I want to
thank our witnesses. Sorry. After your testimony, I had to run
and I did not hear the full measure of Senator Dodd's questions
and Senator Merkley's, but I got a brief summary. So I do not
want to plow the same ground.
But I did want to say first that the substance of your
testimony today individually and cumulatively is very helpful
because too often what happens in Washington is that you have a
lot of bills, even bills that deal with substantial subject
matters, that pass and they fade away before anyone knows they
passed, and we do not have a chance to really concentrate on
what happened. The Recovery Act was a good example of that. It
was so substantial in its impact in a very positive way, and
yet, we up here have not done a very good job of telling people
that.
The same is true, I think, as it relates to children. When
you went through, each of your testimonies pointed out the
impact of programs and policies and new strategies employed
since the early part of 2009 that are having a positive impact.
One of the challenges we have is figuring out better ways
to assemble all of these and put them into one narrative, one
set of reporting for the American people, because sometimes
they hear about this program or that program, and they are not
sure that it is working.
So what Senator Dodd has not only talked about, but worked
on for years, is making sure that we are not just cataloging
programs, we are trying to put them in an organized fashion.
That is why having a report annually is so critical because it
is not just the American people who do not get enough exposure
to some of the achievements or some of the ways programs are
actually working and getting results year after year, but even
U.S. Senators do not pay enough attention sometimes to how
programs are working or not and the results we are getting.
So that is not a question. That is really a concern that I
raise--that we have got to figure out better ways to let people
know and to let all of us know the success of some of these
programs.
It leads me to a broader question which is very much
related to what Senator Dodd started with in his questioning.
It is not the same issue but it is related. This question about
coordination and, frankly, strategy. I think if there is one
thing missing now it is that we do not have nationally enough
of a strategy. We have a lot of programs that are working. We
are getting good results. But we need to have a strategy that
we are all clear about.
Then, of course, what is missing too is the political will.
One report recently said that we are spending basically a dime
out of a dollar on kids, roughly. That is not nearly good
enough.
So I wanted to ask you about whether--and this is really
for anyone. I know you have a particular line of responsibility
within your Department or within your jurisdiction, but how do
we get to the point--and I think the Administration has tried
with the Early Learning Challenge Fund to coordinate and have a
more systemic approach--but how do we get to the point where we
have an actual strategy in place which will dictate what we do,
and if we do not have a strategy in place, we cannot really
make the kind of progress we need to make? Does anybody have
any thoughts on that in terms of the strategy?
Mr. Harris. Well, I will begin, Senator. I think that your
emphasis on outcomes is absolutely critical. For us to spend
less time talking about programs and more time talking about
how those programs change and improve people's lives in the way
we have with some of the bills that Senator Dodd has driven
through Congress, I know that has been a focus both for
Secretary Sebelius and for Secretary Duncan. It has also been a
focus for Secretary Solis at the Labor Department where we are
working very hard to not only do a better job of articulating
how our programs improve the lives of working people and their
children, but also to use the information about how our
programs achieve outcomes to improve the programs themselves.
So in the focus that you hear from Secretary Duncan in
particular, but also in the Labor Department, on innovation
where we are data-driven in our decisionmaking, that is a
critical part of assembling any strategy. And understanding how
each element of what we do in our Department drives to the
ultimate goal of improving the lives of working families,
improving the lives of children is critical to that.
I think unique, at least in modern history, among
presidential administrations, this administration is deeply
committed to social science research and to data-driven
decisionmaking. So I have a lot of confidence that the building
blocks of a national strategy, not just with respect to
children, but with respect to working families--one of the
themes I think you have heard today from everybody on the panel
is how parents are critical to the stable economic support of
their families and how their economic condition is going to
drive outcomes for their children for decades to come. So I
think as we focus on that more and focus on outcomes more, I
think we are going to be more successful in building the kind
of strategy that you are articulating.
Senator Casey. Anybody else on this question? Doctor.
Dr. Koh. First of all, Senator, it is good to see you
again. I remember about a year ago joining you in rural
Pennsylvania for an event on health reform and the Affordable
Care Act.
Senator Casey. That is right.
Dr. Koh. So it is great to see you again.
Because of your hard work in the passage of the act, there
are several deliverables on national strategies that I think
you will be very proud of.
First, there is a requirement in the act to create a
national prevention strategy to be submitted to you and other
Members of Congress by next March. A baseline report on
prevention was submitted July 1, but the follow-up report on a
national prevention strategy is due next March. After this
hearing I will go back and reemphasize to my colleagues that
there should be a special part of that dedicated to prevention
for kids and well-being for kids.
Also, in the Affordable Care Act, there is the directive
for a national health care quality strategy. So again in that
report, there should be a dedicated part that is focused on
health care in kids and quality.
So I think those are two strategies, Senator, that you
might want to track as we move forward with implementing the
Affordable Care Act.
Senator Casey. Well, I know in our discussions yesterday,
Senator Dodd and Senator Harkin and I were wrestling with,
among others, these kinds of questions. That is why having an
annual report is I think vitally important.
The good news is--and this is not recent, but I think the
intensity or the commitment by CEOs and business leaders I
think has been there, you could argue, for a while. I know in
Pennsylvania, for example, in the late 1990s a lot more CEOs,
including the State's business roundtables, were talking about
early education as being a real focus. So I think there is
support there, but I think all the more reason why we need some
of those folks to support a strategy, just as they do in any
kind of business planning or strategic planning.
I was noting that along this line, we got a report
yesterday. I want to talk about results and legislation. Dr.
Rouse, you mentioned a couple of them today. You have all
referred to the Recovery Act. You talked about the HIRE Act and
a whole series of bills that were passed, but we just had a
report yesterday from Mark Sandy and Dr. Alan Blinder from
Princeton projecting and analyzing economic performance. And it
said without any Government action, the downturn would have
continued in 2011, and they give a report on what happened with
the Government action. Real GDP would have fallen 7.4 percent
in 2009 and another 3.7 percent in 2010. Now, it is hard to
prove a negative. It is hard to prove that things would have
been worse when the economic conditions are bad for a lot of
people.
The same is true, I think, when it comes to children. We
have to figure out more and better ways to let people know
about results, and the only way to get the kind of results we
need is to have a strategy. So we did not solve that problem
today, but I think we are informed about it more than we were.
I know I am over, but Senator Dodd is willing to give us a
lot more time today.
Senator Dodd. Thanks, Senator, very, very much.
By the way, let me correct myself. Earlier I mentioned the
afterschool programs, and my staff very properly reminded me
here that, first of all, they increased the funding for the
21st Century Community Learning Centers. But what they did do--
and the point I was trying to make--is they are now allowing
some of those resources to fund the extended learning time out
of that program, which means you are going to add pressure in
terms of the afterschools. So by adding a new program without
the kind of increases we would all like to see because of the
obvious restraints we are going through, you put pressure on
the afterschool programs and therefore reduce it.
So I should express my gratitude. They did increase some
funding. By the way, they did it for Head Start as well and the
child care development block grants as well, close to $1
billion in either case, and in this environment I appreciate
very much Senator Harkin's leadership on that as well.
Let me get into the health issues with you too. I know, Dr.
Koh, you talked a lot about this. Oral health is such a
critical issue. It just amazed me the other day listening to a
doctor in Connecticut. We have now 40 dentists that are
beginning to work on oral health in our schools. And I was
amazed at how 30 to 35 percent of 3-year-olds have tooth decay.
I just found that stunning. I do not know. Maybe I should not
be as surprised, given the poverty levels, but the idea that a
3-year-old is already suffering from tooth decay seemed to me
just a glaring statistic.
The obesity issue we have talked about and I think properly
talking about the First Lady's efforts in that regard are
tremendous.
I listened this morning to our colleague, Blanche Lincoln,
who chairs the Agriculture Committee of the U.S. Senate, and
she has proposed legislation now dealing with better nutrition
and the standards being set for these various food programs
that children depend upon. So many do.
The exercise issue. Senator Murphy talked about the lack of
exercise. We have had hearings on this. I have had hearings on
the obesity issue. Senator Harkin has been a champion in
talking about the quality of food and nutrition and the
importance of those issues.
And health has so much to do--we have talked about the
parental issues. We talked about the education issues. But the
health aspects, a child that does not get that good, healthy
start and then maintain that healthy involvement, obviously you
can put all of the other efforts and they begin to stumble if
you do not get that kind of an effort.
I mentioned this program in Connecticut called Help Me
Grow, which has been replicated now throughout the State of
Connecticut, in fact, being used in the southern States as
well, where we link a variety of health, developmental, and
community services together. You have got a one-stop. This is
really the great advantage.
I am going to turn to Dr. Koh because I think he is
familiar with this.
But I wonder if there are any other similar efforts at the
national level or other States that are doing something like
that because it seems so essential to me, given the array of
services that are out there and how daunting that can be, going
to Senator Casey's point, from a parental standpoint. So having
a place where you can go and have the access of that
information seems so critically important.
So, Dr. Koh, I wonder if you might share some thoughts on
that.
Dr. Koh. Sure, I can start, Mr. Chairman. I am sure my
colleagues can add.
I think you have hit a very important theme, and as I
mentioned in my remarks, what we value about your vision is
taking the broadest possible view of health. And that is what
you are alluding, I think, in your question. We need to view
health broadly, look at not just causes of death in certain
populations, but also impact on quality of life, emphasize
prevention, try to eliminate disparities, talk about the
emotional aspects of health, as well as the physical aspects of
health. So I think your question is alluding to much of that.
Senator Dodd. In fact, my staff reminded me that in the
Affordable Health Care bill--and Bob Casey was involved in this
as well, The National Quality Strategy--we fought very, very
hard that children be a part of that.
Dr. Koh. Great. That is wonderful.
Senator Dodd. So that is now part of that examination. The
good news is most children are doing pretty well. So it is not
a huge audience, but it is an important one.
So I apologize for interrupting.
Dr. Koh. I can answer also broadly that the Affordable Care
Act really tries to build better systems of care and prevention
and link prevention to care and build a way to link clinic and
community in many of the ways that you have alluded to.
I will give you one example. For the community health
centers, which really serve many of the underserved in this
country, there has been tremendous investment in those
community health centers, investment in a stronger primary care
workforce, more investments in prevention, as I have mentioned
before. Some of those will focus on oral health. There is
language in the Affordable Care Act for greater emphasis on
oral health. I think in general building better systems of
prevention and treatment, especially in underserved
communities, is a big theme from the Affordable Care Act moving
forward.
Senator Dodd. Does anybody else want to comment on that
issue of the--and Healthy People 2010, by the way, I think is a
terrific program. In fact, Lamar Alexander and I wrote the
Preemie Act in 2006 to combat the increasing rates of preterm
and low-birth weight children. That is up for reauthorization
next year, and I will not be here, but I am looking at you,
Bob, and others who are not here. I got a bucket list I am
putting together here of things you are going to have to keep
an eye on as we move along.
Senator Casey. Can we consult you, though, for free?
Senator Dodd. For free, absolutely.
But again, the low-birth rate among nonHispanic African-
Americans over the past 15 years has remained about twice that
of nonHispanic Caucasian women. Again, I wonder if you have any
thoughts on this. I do not want to get that specific, but can
you share with us any thoughts at all at the Federal level on
the premature birth rate issue?
Dr. Koh. Well, as I mentioned, the good news was that the
rate has dropped this year, but we still have one out of eight
children who are born prematurely. So that number is way too
high. So, again, we are going to need more attention to a
comprehensive approach for moms even before they become
pregnant, making sure that they are getting coverage with
health insurance, making sure they have good nutrition, making
sure they have a health care provider to consult, and then
taking good care of that child from the instant he or she is
born, and making sure that wellness and prevention is
emphasized from literally the first day of life.
Senator Dodd. I am jumping around on you quickly because
the vote just started, and I am not going to try and have you
hang around for a half an hour or an hour until we come back
again. So I will rush along and maybe leave the record open for
some additional questions we have.
But on the Family and Medical Leave Act, the Department of
Labor--and I had a question in here regarding data. There has
not been any updated information about how this is working
right, if that is correct, in the last few years. When was the
last time--2000? Was it that long ago?
Mr. Harris. Yes, that is right, Senator.
Senator Dodd. So the question then is I wonder if there is
any effort being made here to bring us up to date on how this
is going.
Mr. Harris. Yes.
Senator Dodd. I am trying to make a case, and I am not
getting very far with it. But, obviously, look, I would have
had a paid program if I could have. You have to stagger it a
bit for all the obvious reasons we have thought about. But I
cannot really get to that point unless I get more data on how
we are doing with the present law.
Mr. Harris. And that is precisely what we are intending to
do. In 2011, we are going to be doing a study on Family and
Medical Leave usage.
But I do not want you to give up hope on paid leave. Let me
just say you have been a critical leader on this, and when you
talked about learning lessons from the States' experience, you
know that before there was a Family and Medical Leave Act, a
number of States had State family and medical leave acts that
gave us the evidence that showed that not only would it work
effectively for families, but it would be very low-cost for
employers. The study we did in 2000 ratified that, and my
expectation is that the study that we are going to do in 2011
will show that it is a tremendous benefit to families at a
fairly low cost to employers.
But we are now seeing States or we have seen States over
the last decade developing State-paid leave policies of varying
sorts, temporary disability policies. In California, paid leave
policies.
So the President in his fiscal 2011 budget proposed a $50
million fund to incentivize States or to pay for States'
administrative costs in the creation of paid leave programs in
those States. Earlier this week, the subcommittee on
appropriations, the Labor Appropriations Subcommittee, included
$10 million of those $50 million to get us started in
incentivizing States to create State-paid leave programs.
So we agree with you that that is the right direction to go
in right now, that there are too many particularly low-wage
workers who are unable to take the family and medical leave
that they need because they simply cannot afford to go without
a paycheck. We think the way to do that is to allow States to
innovate in this space and for us to provide them with
incentives to do that.
Senator Dodd. Let me jump to another issue that I am
interested in. While conducting these hearings, we learned a
great deal about both State and local groups, and the Federal
Government obviously measures. We talked about having this
annual report. The National Longitudinal Surveys of Youth run
by the Department of Labor Statistics is critical, obviously,
for many of us up here. The most recent survey follows a group
of children through adulthood to examine critical childhood
well-being. The Bureau of Labor Statistics has not started
collecting data on a new group of children since 1997. I wonder
if you could share with us whether or not you intend to start
surveying a new group of children. If so, when? And how would
this type of data aid the Department in your view in
understanding the efficacy of these programs?
Mr. Harris. We do not yet have funding to create a new
cohort for the National Longitudinal Survey, and that is part
of the discussion for--we are just beginning our discussions
about the fiscal 2012 budget, and it is part of that
discussion. There will, however, be a new data release on the
NLS cohort from 1997 that will come out in June 2011 that will
provide us with more information about adolescents, young
adults, and slightly older adults that are in that 1997 cohort.
So we will have some more information, but we are taking a look
at whether or not we can propose a budget that will fund an
additional cohort.
Senator Dodd. Terrific.
Bob, do you have any additional quick questions? They will
hold the vote for us.
[Laughter.]
Senator Casey. Nice to have a senior member who can hold
votes.
I had a couple more. One was one of the ways I try to think
about these issues in a broad way--and those who know a lot
more would frame this a little differently, but if we do four
things well, I think we are getting close to a strategy. One is
children's health insurance. Two is early learning. Three is
nutrition and anti-hunger strategies, and fourth is just basic
safety.
I was reading--and this is in my prepared statement, but
the college completion agenda--a recent report came out about
25- to 34-year-olds who have an associates degree or higher. We
are not doing so well across the world. But the first
recommendation they made to improve the number of 25- to 34-
year-olds who have an associates degree or higher--
recommendation No. 1 was to make preschool education available
to all. So we are finally linking what happens down the road to
what happens in the dawn of a child's life.
We have talked a good bit today about children's health,
about early education, and Senator Dodd covered a lot of those
topics, as well as the nutrition, which is part of what
Chairman Lincoln is doing on our committee on the Child
Nutrition Act, and we hope to get that done soon.
But let me go to that fourth matter, which a number of you
have touched on, which is just the protection element, abuse
and all of the horrific stories we hear on a regular basis
about children being abused or neglected. Anything that anyone
wants to say about that issue, and then I think we have to go.
Mr. Hansell. Well, that is one of our responsibilities, one
we take very seriously, and we work with and fund States to
implement programs to reduce child abuse and maltreatment. I
guess what I would say in terms of the directions in which we
are moving--a couple of comments. Through the formula funding
we distribute to States under the CAPTA program, what we are
trying to do is to work with States to move in the direction of
using those funds--again, it is consistent with some of the
things we have talked about this morning--to support evidence-
based and evidence-informed interventions. The things that we
have documented, is evidence that will really make a difference
in ideally, of course, preventing child abuse and maltreatment,
by addressing the issues otherwise. And so that is what we are
trying to focus States on with their core funding.
But we also have added a discretionary component to the
CAPTA program through which we are using $10 million to expand
the evidence base, essentially to expand the compendium of
interventions that we know will make a difference in preventing
child abuse, child neglect, and child maltreatment. As we do
that, we can then encourage States to draw from that evidence
base in using the base resources, Federal and State, that they
have to address these very, very important issues.
Senator Casey. Thanks. We will submit some more questions
for the record, but I do want to thank Chairman Dodd for this
opportunity. Thank you.
Senator Dodd. Well, thank you.
That is obviously up for reauthorization. We are trying to
get that done now in the next few weeks before we adjourn. I
appreciate that as well.
I would be remiss if I did not point out, by the way, that
you always take great pride in your sort of official family,
and Lloyd Horowitz who is sitting right behind you, Dr.
Melendez, used to sit back up here behind me in this committee.
It is a pleasure to see you, Lloyd, and thank you for all your
service when you were on this side of the dais and now working
on that side of the table. So I would be remiss if I did not
thank you personally for the tremendous efforts you have made
and what a great advocate in the educational field you have
been. So thank you very, very much for that.
To all of you, I thank you. I wish we could spend all day
with you on these matters. You are so knowledgeable and
thoughtful about all of this. We are very blessed to have
quality people who care so deeply and bring a wealth of
experience to these debates and discussions.
It is a subject matter that historically some of my
strongest--when I wrote the first child care development block
grant program back in the early 1980s, my cosponsor was Orrin
Hatch of Utah. When we did Family and Medical Leave, it was Kit
Bond and Dan Coates of Indiana. Senator Alexander and I have
done a lot of work on these issues of premature birth and
infant screening. A former opponent of Bob Casey, Rick
Santorum, and I worked on autism together. He had issues in
Pennsylvania.
On these issues we were able to build bipartisan support. I
really worry in a way that we are losing that. It worries me.
These were not issues that should divide people. We are talking
about children in the country and how we do a better job and
give them a decent start in life. My hope is again, as I get
ready to leave town, that they get back to that spirit again
when it comes to these issues. There are a lot of other reasons
in which you can have ideological debates. This ought not to be
a set of them. We are all aiming for exactly the same thing. We
know how difficult it is for parents, for communities today to
meet these challenges. We work on the assumption that every
parent--every parent--wants to do the very best they can for
their child. If you begin with that notion that we ought to be
doing everything we can to make that a reality, as close to a
reality as possible.
So I am very grateful to all of you for years and years of
your involvement in these issues and your knowledge and
expertise. It would be tremendously helpful. So we look forward
to your continuing work with us up here on this side and with
people like Bob Casey who will be carrying on the challenges
here and doing a great job at it as well.
So the committee will stand adjourned and I thank you.
[Additional material follows.]
ADDITIONAL MATERIAL
Prepared Statement of Senator Coburn
Mr. Chairman, I appreciate the subcommittee engaging in a
timely discussion on the state of the American child and the
impact of Federal policies on children. It is critical that we
understand how the decisions we make here in Congress impact
the futures of our children and grandchildren.
Regrettably, the outlook of the American child is bleak.
The current state of the American child is a $13.2 trillion
national debt that is a direct result of Federal policies. The
state of the American child is generational theft perpetrated
by the hands of a Federal Government devoid of fiscal
discipline. It is a theft carried out by members of both
political parties.
The witnesses testifying before the subcommittee offered
compelling information and statistics concerning the challenges
facing today's youth, but none of the formal testimony raised
concerns about the impact that our national debt will have on
our Nation's youth. Quite to the contrary, testimony submitted
to the subcommittee largely advocated for more and bigger
government programs which, of course, require yet more Federal
spending.
This is not to discount the real challenges pointed out by
those who took the time to testify before the subcommittee, but
it is a gross oversight that must be addressed.
A few months ago I met a 3-year-old girl from Maryland
named Madeline. I first came to know this precious little girl
through a photograph. She was dressed head-to-toe in pink, had
a little blond ponytail, a pacifier in her mouth and a sign
weighing heavily around her neck that read: ``I'm already
$38,000 in debt and I only own a dollhouse.''
When Madeline was photographed, she was already $38,000 in
debt. Nearly 7 months later, the national debt is now over
$42,000 per man, woman and child in this country.
If one were to extrapolate that rate of increase--from
$38,000 to $42,000--to cover every 6-month period for the next
20 years, it becomes clear that the future of today's youth is
one saddled by debt. If you include unfunded liabilities--
Madeline will owe $1,113,000 when she turns 24.
If you had a 6-percent interest rate on $1,113,000,
Madeline is going to have to pay $66,000 a year in interest on
the debt. She will pay that before she pays any taxes to run
the government, defend the country, and pay for Medicare for my
generation. These costs will impact her ability to continue her
education, to own a home and to start and provide for her own
family.
We should not be proud of Federal policies that steal from
our children. There is no more important question before the
country today than whether or not we will continue stealing
opportunity and freedom from the next generation.
Sadly, Congress has repeatedly demonstrated that it is
unwilling to prioritize spending. On multiple occasions this
year the U.S. Senate rejected amendments to cut spending.
Instead of trimming the fat for the benefit of future
generations, Congress chose to raise the debt ceiling by $1.9
trillion to $14.3 trillion. Instead of working to pay for
programs by eliminating fractions of the hundreds of billions
this country loses to waste, fraud and abuse in the government,
Congress chose to instead violate PAYGO rules and add $266
billion to the deficit this year alone.
These choices have consequences on America's children.
What has made this country great has been the heritage of
sacrifice demonstrated by the generations that have come before
us. We are now denying that heritage, but it is not too late to
reverse course. Congress must reverse course and rein in
spending. We must restore a bright and hopeful future for all
of the Madeline's of this country.
Prepared Statement of Kellyann Day, MSW, Executive Director,
New Haven Home Recovery, Inc.
Good morning Senator Dodd and distinguished guests it's an honor to
be here. Thank you for inviting me to speak and thank you for great
work on family and children's issues.
Contrary to the stereotype of men sleeping in doorways or pushing
overloaded shopping carts stuffed with their worldly belongings,
families now comprise 40 percent of the homeless population in the
United States. The percentage is closer to 50 percent in the State of
Connecticut.
Just 30 years ago, child and family homelessness did not exist as
it does today. The numbers of homeless families in the United States
are increasing at a rapid rate. According to the National Alliance to
End Homelessness' Web site, ``Approximately 3.5 million individuals
experience homelessness each year--about 600,000 families and 1.5
million children. An additional 3.8 million adults and children are
residing in doubled-up, overcrowded, or otherwise precarious housing
situations.''
Connecticut faces a significant and growing challenge of family
homelessness, with a steadily increasing number of homeless families
with children. We saw a 13 percent increase in homeless families from
2007 vs. 2008 and a 33 percent increase between 2008 and 2009!
Available shelter and housing for homeless families is decreasing.
There is a rising demand for shelter and housing at a time when State
and local government are unable to support the operations of shelters
and are cutting budgets. The development of affordable and supportive
housing has slowed significantly. Public housing authority lists are
long and rarely open for new names.
In 2007, the nationwide average shelter stay for a homeless family
was 5 months. With the economy worsening in 2008 and 2009, the length
of stay has been increasing. At NHHR we have seen a 17 percent increase
in the number of days a family is living at the shelter.
In a nationwide survey, 87 percent of homeless families cited a
lack of affordable housing as the primary cause of their homelessness.
Although most homeless families are headed by a single parent, families
in 36 of the 50 States must work at least two full-time jobs in order
to afford Fair Market Rent for a two-bedroom unit.
Overcoming homelessness is almost impossible without
steady employment.
Over two-thirds of homeless parents are unemployed.
53 percent of homeless mothers do not have a high school
diploma.
In 17 of 50 States, households must earn over $16/hour to afford
the Fair Market Rent for a two-bedroom unit. According to the National
Center on Family Homelessness' Stat Report Card, the minimum wage in
Connecticut is $8.25. The average wage for renters is $16.53, but the
hourly wage needed to afford a two-bedroom apartment is $21.11. That
means someone working full-time at minimum wage earns only 39 percent
of what is needed to afford the average two-bedroom apartment.
Homeless children have less of a chance of succeeding in school.
This year 35 percent of the 130 children sheltered in NHHR shelters
were between 6 and 12 years old and attending school.
Homeless children are more likely than housed children to
be held back a grade.
Homeless children have higher rates of school mobility and
grade retention than low-income housed children.
Frequent school transfers are the most significant barrier
to the academic success of homeless students.
Homeless families are more vulnerable to serious health issues.
While homeless, children experience high rates of acute and chronic
health problems. The constant barrage of stressful and traumatic
experiences also has profound effects on their development and ability
to learn.
Children experiencing homelessness are:
Four times more likely to show delayed development.
Twice as likely to have learning disabilities as non-
homeless children.
Sick four times more often than other children.
Have four times as many respiratory infections.
Have twice as many ear infections.
Five times more gastrointestinal problems.
Four times more likely to have asthma.
Go hungry at twice the rate of other children.
Have high rates of obesity due to nutritional
deficiencies.
Have three times the rate of emotional and behavioral
problems compared to non-homeless children.
Violence plays a major role in the lives of homeless children.
By age 12, 83 percent had been exposed to at least one
serious violent event.
Almost 25 percent have witnessed acts of violence within
their families.
Homeless parents and their children are more likely to
have experienced violence.
Domestic violence is the second most frequently stated
cause of homelessness for families.
One out of three homeless teens have witnessed a stabbing,
shooting, rape, or murder in their communities.
Among youth aging out of foster care, those who subsequently
experience homelessness are more likely to be uninsured and have worse
health care access than those who maintain housing.
Over 50 percent of all homeless mothers have a lifelong mental
health problem.
Homeless adults in family shelters, when compared to the general
adult population, have three times the rate of tuberculosis and eight
times more HIV diagnoses.
Homeless parents and their children are more likely to be separated
from each other.
Homelessness is the most important predictor of the separation of
mothers from their children.
34 percent of school-aged homeless children have lived
apart from their families.
37 percent of children involved with child welfare
services have mothers who have been homeless at least once.
62 percent of children placed in foster care come from
formerly homeless families.
The deck is clearly stacked against homeless and the unstably
housed. How do we focus on education when we don't have a stable place
to sleep? Forty-five percent of the homeless children sheltered at NHHR
shelters were under 6 years old. We have new born babies at the
shelter, often!
Of the 15 programs that NHHR operates I'd like to highlight two.
The first is the Family School Connection (FSC) program, funded by
the Connecticut Children's Trust Fund. It operates out of the Fair
Haven K-8 School, which has the highest number of homeless families in
the city. FSC is an intensive home visiting program that provides
parent education and student advocacy. Children who are ``at risk'' of
neglect because of excessive tardiness or truancy and/or academic or
behavior challenges are referred to the program.
Young children who are frequently tardy, absent, and disconnected
from school are likely to be living in circumstances where family
issues are interfering with their participation and opportunity to
learn and achieve.
Outcomes:
Significant drop in DCF referrals by the School
(comparable to last year).
an increase in parental involvement.
15 percent increase in grades for students enrolled in the
program.
On a cold morning in March, during the CMT's the FSC staff received
a call from the school requesting assistance. When staff arrived, they
found that a 3d grade boy was selling his Christmas toys to classmates
to help his Dad pay for rent and food. A back pack full of food, a Stop
and Shop gift card, toiletry items and warm clothing were provided to
the child to bring home that day. Subsequently the family was informed
about the program and enrolled. As of today, Dad is employed, engaged
with the school and accessing community resources. The child is
excelling socially and academically. This is a highly successful
program and we have many families on the wait list.
The Family School Connection program conducts universal screening
of all its families. The program is prevention-based, and therefore,
screens clients to make sure the State Department of Children and
Families (DCF) is not involved with the family. The program also
screens children for social and emotional development and refers those
at risk for help.
The vision of Family School Connection is that every child will be
raised within a nurturing environment that will ensure positive growth
and development.
The mission of the Family School Connection (FSC) program is to
work in partnership with parents of children ages 5 to 12 years old who
are frequently tardy, absent or disconnected from school in order to
strengthen the parent-child relationship, home-school relationship and
the parent's role in their child's schooling.
GUIDING PRINCIPLES
Young children who are frequently tardy, absent, and
disconnected from school are likely to be living in circumstances where
family issues are interfering with the child's participation and
opportunity to learn and achieve.
Developing a trusting and productive relationship between
the program staff and the family is the foundation for strengthening a
vulnerable family.
Consistent and reliable contacts are the most effective
way of establishing a supportive and helpful relationship between the
program staff and the family.
The goals of the Family School Connection program are to:
Enhance nurturing parenting practices.
Reduce stress related to parenting.
Increase parental involvement in the child's education.
The program works to achieve these goals by meeting the following
objectives:
Increase primary caregiver's parenting skills, attitudes,
and behavior.
Increase primary caregiver's ability to use community
resources.
Increase communication between primary caregivers and
school personnel.
Increase primary caregiver's involvement in the child's
education and presence in the school.
A growing body of intervention evaluations demonstrates that family
involvement can be strengthened with positive results for children and
their school success. To achieve these results, it is necessary to
match the child's developmental needs, the parent's attitudes and
practices, and the school's expectations and support of family
involvement. Three family involvement processes for creating this match
emerge from the evidence base:
Parenting consists of the attitudes, values, and practices
of parents in raising young children.
Home-School Relationships are the formal and informal
connections between the family and educational setting.
Responsibility for Learning Outcomes is the aspect of
parenting that places emphasis on activities in the home and community
that promote learning skills in the young child.
The Family School Connection Program encompasses these processes in
the design and structure of the program through three components aimed
at reducing the risk of child abuse and neglect and increasing positive
results for children and their school success:
HOME VISITATION
Home visiting based on the concept of ``family-centered'' practice
is the foundation of the Family School Connection program. This
practice is designed to engage families as partners and is essential to
the success of the program. Research has found that parents enrolled in
the home visiting component experienced less stress, developed
healthier interactions with their children, and became more involved in
their children's academic lives during the time they participated. The
program results also suggest that this home visiting is a promising way
to decrease child abuse and neglect in families with school-aged
children.
Program participants are offered weekly home visits for as long as
the family feels the visits are beneficial or until the child ages out
of the program. At any time the frequency of the visits can be changed
based on the family's needs and preferences. The first objective of the
home visitor is to establish a relationship with the family. Often this
is accomplished by addressing immediate and concrete needs identified
by the family such as employment, child care, transportation, basic
necessities, and other issues that might be making it difficult for the
parent to attend to the child's need to be in school.
The second objective is to establish a plan for assisting the
family. The home visitor works with the family to create and implement
a Family Action Plan that draws on the family's strengths, community
resources, and the skills of the home visitor to:
strengthen parent-child relationships;
create linkages for the family to community resources;
support the parent in meeting their family's basic needs;
support the parent in attaining their own aspirations and
needs; and
support the overall social-emotional needs of the parent
and child.
The clinical supervisor works with the home visitor to assess the
family's needs and support the home visitor and parent in the creation
and implementation of the family action plan. The clinical supervisor
can also provide clinical intervention for the family if the need
arises.
HOME-SCHOOL TEAM
The program supports families by helping both the parent and child
make a positive connection with the child's school. Program staff help
the family connect with a host of school and community services.
Program staff also work with school personnel to help the school better
understand and support the needs of the family. Parent school
involvement is an essential piece of the program and is encouraged by
program staff at every opportunity.
FAMILY LEARNING
Traditionally, school officials have found it challenging to get
parents involved, especially in areas that have a large non-English
speaking, immigrant population. This has been due, in large part, to
language and cultural barriers experienced by non-English speaking
parents. In order to accommodate this population, parent engagement
strategies are modeled after those used by Brein McMahon High School in
Norwalk, CT, where there is also a large immigrant population.
Communication is also crucial to getting parents involved. Parents may
not get involved because they lack direct and helpful information.
Information needs to be provided consistently and in different formats
to ensure the information is delivered in a clear and supportive style.
Resources should be provided to parents who want to learn more about
their children's education and activities. The FSC staff aid school
staff trying to increase involvement by implementing these strategies.
Program staff work with families help them understand and take
responsibility for their children's learning outcomes. This is the
aspect of parenting that places emphasis on activities in the home and
community that promote learning skills for children. Responsibility for
learning outcomes in the elementary school years falls into four main
areas: supporting literacy, helping with homework, managing children's
education, and maintaining high expectations.
Program staff work in partnership with the school, community
organizations, and arts and cultural institutions to engage families in
family learning opportunities. Family learning opportunities can range
scope and service but are all intended to extend to help the parent
understand and under-take their role as the child's first and most
important teacher. The home visitor works with the family to enroll
them in family literacy programs, before and afterschool programs,
tutoring services or parent workshops on topics that support and extend
a child's learning to the home and community.
Highlights this year:
316 books were read between Oct 2009 to May 2010 by FSC
enrolled students.
The FSC program was able to purchase school uniforms for
children within the FSC program. FSC has become an active investor of
Fair Haven School's ``uniform is unity'' policy.
FSC families participated in New Haven Home Recovery's
holiday program, Adopt a Family, where 32 FSC families were adopted and
given Christmas gifts this holiday season.
The FSC program co-sponsors the RIF program with The
Fairhaven School to promote reading as well as connect families with
the school. FSC staff and families participate in this school-wide
presentation.
The FSC program participated in the Fair Haven School
Advisory Program (Grades 7-8). The advisory program is an arrangement
whereby one adult and a small group of students have an opportunity to
interact on a scheduled basis in order to provide a caring environment
for guidance and support, everyday administrative details, recognition
and activities to promote citizenship. The purposes of advisory are to
ensure that each student is known well at school by at least one adult
who is that student's advocate (the advisor), to guarantee that every
student belongs to a peer group, to help every student find ways to be
successful, and promote coordination between home and school.
The FSC program had six target children graduate from the
Fairhaven K-8 and all are registered to attend high school in the fall.
In addition, as result of FSC involvement, parents reported school
successes with their children.
All FSC families participated in the Homework Contract
campaign. This assists families with becoming involved in their
children's academics and build on parent-child school relationships.
During the fiscal year ending, June 30, 2009, FSC families
participated in a series of family field trips with transportation and
admission sponsored by NHHR. The field trips include: Duckpin bowling,
Movie night Lake Compounce, Roller Magic Rink, Beauty and the Beast at
the Chevrolet Theatre, Lighthouse Park, Norwalk Aquarium and Beardsley
Zoo.
FSC annual data:
107 Families have been referred.
53 Families were enrolled.
85 Children participated.
211 People total.
The Second Program is the The Homeless Prevention and Rapid Re-
housing program, funded through the American Recovery and Reinvestment
Act provides funding and services to families and individuals. NHHR
serves families who are at imminent risk of homelessness, or who are
literally homeless. Examples of assistance that may be provided
include:
Financial Assistance
Rental assistance, including back rent.
Security and utility deposits.
Assistance with utility payments, including utility
arrearages.
Moving cost assistance (not furnishings).
General Assistance
Referrals to other agencies/shelters when appropriate.
Legal services to assist appropriate person's to stay in
their housing (not assistance with mortgages)
Populations to be Served
Programs will target people who would be homeless ``but for this
assistance.''
Rapid Re-Housing:
Includes people who are literally homeless (ex: living in a
shelter, a motel, a car, etc.) who require more permanent housing.
Prevention with Re-location:
Includes people who are at imminent risk of becoming homeless (ex:
notice to quit, in the process of an eviction, institutional discharge,
housing has been condemned, etc.), who are unable to repair their
current housing situation and will need to relocate.
Prevention In Place:
This includes people who are at risk of becoming homeless (ex:
behind on rent, temporary loss of income, etc.), but who intend to stay
in their current housing situation.
The following is the program breakdown of those served through
HPRP:
HPRP
------------------------------------------------------------------------
Total in
Households Household
------------------------------------------------------------------------
Admitted......................................... 15 56
Discharged....................................... 40 41
In progress...................................... 183 569
----------------------
Total.......................................... 238 766
Denied........................................... 138 438
------------------------------------------------------------------------
For example, Jack and Diane were evicted from their home of 5
years. Jack is a self-employed contractor. Diane is a stay at home
mother of 6 children. Upon eviction, the family moved into a local
homeless shelter, but one of their children's asthma became so severe
they were forced to move to a motel. After two apartments fell through,
the family finally found a house to rent. Unfortunately the timing was
off and they had reached their limit on the credit card at the motel
and were being put out on the street. Their only choice was to sleep in
their car. HPRP prevented this from happening by providing funding for
the motel and ultimately relocating them into a home.
Mike and Gina were being evicted on the day they came to NHHR for
help. Gina is pregnant and was recently laid off from her job. The
couple has 3 young boys and Gina's elderly, disabled mother living with
them. Dad was working and Gina had found an apartment to rent but they
did not have the security deposit. The Connecticut Department of Social
Services has closed the security deposit guarantee program. NHHR's HPRP
program was able to pay the security deposit and part of the first
month's rent in order to avoid this family moving into a shelter.
Lastly, Juan and Julia, both college graduates, moved to NH from
Puerto Rico in order to seek medication care for their son. Their 1-
year-old was ill and had recently undergone open heart surgery at Yale
New Haven Hospital. In addition the boy was recovering from liver
disease and other infections. The family was living in the Ronald
McDonald House during the baby's hospitalization, but had no place to
live upon discharge. A stay at a shelter, would have comprised the
boy's fragile health. They considered going back to Puerto Rico, but
funding was limited and they needed to remain close to necessary
medical care. HPRP was able to assist them in finding housing, paying
for security deposit and rental assistance. The family is stably housed
and Juan and Julia are currently looking for work.
These two programs are examples of excellent programs that need to
and should continue.
Please feel free to contact me with any questions or concerns
regarding this testimony.
Prepared Statement of Beth Mattingly, Director, Research on Vulnerable
Families, The Carsey Institute
Subcommittee Chairman Senator Dodd, Ranking Member Senator
Alexander, and all the subcommittee members, thank you for the
opportunity to submit testimony on The State of the American Child: The
Impact of Federal Policies on Children.
My name is Beth Mattingly and I am the director of research on
vulnerable families at the Carsey Institute at the University of New
Hampshire. The Carsey Institute examines child poverty, how different
family policies influence rural, suburban, and urban families and how
families adjust their labor force behavior during times of economic
strain.
The Carsey Institute at the University of New Hampshire has
conducted extensive policy-relevant research on the differences between
rural, suburban, and central city families and children in order to
better understand trends in child poverty and the implications of
different policies. This document summarizes the findings of the Carsey
Institute and some of the Federal policy recommendations that have
emerged from this research.
Research shows that poverty has negative impacts on the life
outcomes of children through decreased access to quality health care,
nutrition, child care, education, and other opportunities.\1\ Exposure
to poverty in America is not uniform, but rather varies by region,
State, and place type. Our research consistently shows that rural
places have poverty rates that are about as high as those found in
central cities, yet many continue to view poverty as primarily an inner
city problem.\2\
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\1\ See Bradley, Robert H., Case, Anne, Angela Fertig, and
Christina Paxson. 2005. ``The lasting impact of childhood health and
circumstance.'' Journal of Health Economics 24:365-89, who examined the
impact of prenatal conditions and child health at age 7 on various
outcomes; Corwyn, Robert F., McAdoo, H. P., & Garcia Coll, C. G.
(2001). The home environments of children in the United States part I:
Variations by age, ethnicity, and poverty status. Child Development,
72, 1844-86; Brooks-Gunn, Jeanne. and Greg. J. Duncan. 1997. ``The
effects of poverty on children.'' The Future Of Children/Center For The
Future Of Children, The David And Lucile Packard Foundation 7:55-71;
Korenman, Sanders, Jane E. Miller, and John E. Sjaastad. 1995. ``Long-
term poverty and child development in the United States: Results from
the NLSY.'' Children and Youth Services Review 17:127-55; McLoyd,
Vonnie. C. (1998). Socioeconomic disadvantages and child development.
American Psychologist, 53, 185-204.
\2\ See Weber, Bruce, Leif Jensen, Kathleen Miller, Jane Mosley and
Monica Fisher. 2005. ``A critical Review of Rural Poverty Literature:
Is There Truly a Rural Effect?'' International Regional Science Review
28:381; O'Hare, William P. 2009. ``The Forgotten Fifth: Child Poverty
in Rural America.'' The Carsey Institute, Durham, NH.
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Recent estimates from the Carsey Institute suggest that more than
one in five American children under age of 6 lived in poverty in
2008.\3\ According to data from the American Community Survey (ACS),
this rate is significantly higher in the rural South, where
approximately one-third of children live in poverty.\4\ In no region
across the United States did child poverty significantly decline from
2007 to 2008, and in some places, including the Midwest, the rates
increased.\5\ Some factors that increase the risk for poverty are:
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\3\ Mattingly, Marybeth J. 2009. ``Regional Young Child Poverty in
2008: Rural Midwest Sees Increased Poverty, While Urban Northeast Rates
Decrease.'' The Carsey Institute, Durham, NH.
\4\ Ibid.
\5\ Ibid.
Education, Wages and Work Hours. Both parental employment
status and parental education influence children's risk of being poor.
Non-metropolitan mothers of children under the age of 6 maintain higher
rates of employment than their urban counterparts (69 percent and 63
percent, respectively).\6\ Yet, despite these higher rates of work,
rural mothers earn lower wages, have lower overall family incomes, and
experience poverty rates nearly 4 percent higher than their urban
counterparts (24 percent vs. 20 percent, respectively).\7\ Also, while
non-metropolitan mothers appear to have higher rates of employment than
urban mothers, on the whole, individuals living in non-metropolitan
areas are more likely to be working part-time than those in
metropolitan areas (21 percent vs. 18 percent respectively).\8\
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\6\ Smith, Kristin. 2007. ``Employment Rates Higher Among Rural
Mothers Than Urban Mothers.'' Carsey Institute, Durham, NH.
\7\ Ibid.
\8\ Shattuck, Anne. 2009. ``Rural Workers Would Benefit from
Unemployment Insurance Modernization.'' Carsey Institute, Durham, NH.
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Fragile Family Structures. Data show that American family
structures have been shifting since the 1990s, particularly in rural
America.\9\ By 2008, only 68 percent of rural children were living in
married couple families, down from the 1990 estimate of 73 percent.\10\
This shift has major implications for child poverty, as only 9 percent
of married couple families are in poverty, compared with 21 percent of
single father homes, and 43 percent of single mother homes.\11\ Family
structure is part of the story behind extremely high child poverty
rates in the rural South: there are high rates of divorce, out-of-
wedlock childbirth, and female-headed households,\12\ all of which are
associated with higher risks of poverty.\13\
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\9\ O'Hare, William and Allison Churilla. 2008. ``Rural Children
Now Less Likely to Live in Married-Couple Families.'' Carsey Institute,
Durham, NH.
\10\ Ibid.
\11\ Ibid.
\12\ Mattingly, Marybeth J. and Catherine Turcotte-Seabury. 2010.
``Understanding Very High Rates of Young Child Poverty in the South.''
The Carsey Institute, Durham, NH.
\13\ O'Hare, William, Wendy Manning, Meredith Porter, and Heidi
Lyons. 2009. ``Rural Children Are More Likely to Live in Cohabiting-
Couple Households.'' Carsey Institute, Durham, NH.
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Racial Composition. Rural, non-white children lived in
low-income families at nearly twice the rate of white children, and
nearly 2.5 times the rate of white children in central cities.\14\
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\14\ Churilla, Allison. 2008. ``Urban and Rural Children Experience
Similar Rates of Low-Income and Poverty.'' Carsey Institute, Durham,
NH.
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challenges for rural poverty and federal policy implications
Tax Credits and Income Needed for Basic Needs
Poverty may be reduced by allowing families better and continued
access to tax credits, including the Earned Income Tax Credit (EITC)
and the 2009 Recovery Act's Child Tax Credit. The Child Tax Credit in
particular is threatened by an approaching expiration date, a change
that would have a detrimental effect on working rural families, with
the loss of income affecting up to 3.3 million low-income rural
children.\15\ Similarly important, the EITC is disproportionately
accessed by rural families, representing 16 percent of tax filers, but
20 percent of EITC claimants, translating into an average credit of
$1,850 per family.\16\ These direct infusions of money into rural
families can improve child outcomes by allowing parents to afford
better quality food, child care, and educational materials.
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\15\ Sherman, Arloc and Marybeth J. Mattingly. 2010. ``Over 3
Million Low-Income Children in Rural Areas Face Cut in Child Tax Credit
if Recovery Act Improvement Expires.'' Carsey Institute and Center on
Budget and Policy Priorities, Durham, NH/Washington, DC.
\16\ O'Hare, William and Elizabeth Kneebone. 2007. ``EITC is Vital
for Working-Poor Families in Rural America.'' Carsey Institute, Durham,
NH.
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Research also suggests that the poverty threshold does not
adequately reflect the incomes needed to provide for families' basic
needs,\17\ \18\ and that a revision of the threshold would expand the
eligibility guidelines for participation in assistance programs, such
as supplemental nutrition plans,\19\ tax credits, health insurance, and
child care subsidies.\20\
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\17\ Churilla, Allison. 2008. ``Urban and Rural Children Experience
Similar Rates of Low-Income and Poverty.'' Carsey Institute, Durham,
NH.
\18\ Mattingly, Marybeth J. and Catherine Turcotte-Seabury. 2010.
``Understanding Very High Rates of Young Child Poverty in the South.''
The Carsey Institute, Durham, NH.
\19\ Wauchope, Barbara and Nena Stracuzzi. 2010. ``Challenges in
Serving Rural American Children.
\20\ Smith, Kristin and Kristi Gozjolko. 2010. ``Low Income and
Impoverished Families Pay More Disproportionately for Child Care.'' The
Carsey Institute, Durham, NH.
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Limited Access to Childcare
Higher employment rates among rural mothers means an increased
demand for quality child care for the working day hours. Despite
demand, however, rural mothers have fewer quality care providers
available than their urban counterparts,\21\ and more obstacles to
accessing it, such as a lack of transportation. Though urban families
pay more for child care,\22\ perhaps due to the higher quality of
available care, in the poorest families across regions, a staggering
percentage of yearly income is spent on child care.\23\ Families below
the poverty line dedicate 32 percent of their monthly income to child
care, nearly twice what those just above the poverty line pay, and
nearly five times the percentage that families 200 percent above the
poverty line pay.\24\ As such, rural families tend to turn to informal
non-relative care (e.g., a babysitter) at higher rates than their non-
rural counterparts (25 percent usage versus 20 percent usage,
respectively),\25\ which may be of poorer quality, and may result in
decreased child development.\26\ Far more families are in need of child
care assistance than receive it, so additional funding for assistance
through the Child Care Development Block Grant would be beneficial.\27\
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\21\ Smith, Kristin. 2006. ``Rural Families Choose Home-Based Child
Care for their Preschool-Aged Children.'' Carsey Institute, Durham, NH.
\22\ Ibid.
\23\ Smith, Kristin and Kristi Gozjolko. 2010. ``Low Income and
Impoverished Families Pay More Disproportionately for Child Care.'' The
Carsey Institute, Durham, NH.
\24\ Ibid.
\25\ Smith, Kristin. 2006. ``Rural Families Choose Home-Based Child
Care for their Preschool-Aged Children.'' Carsey Institute, Durham, NH.
\26\ Smith, Kristin. 2007. ``Employment Rates Higher Among Rural
Mothers Than Urban Mothers.'' Carsey Institute, Durham, NH.
\27\ See Smith, Kristin and Kristi Gozjolko. 2010. ``Low Income and
Impoverished Families Pay More Disproportionately for Child Care.'' The
Carsey Institute, Durham, NH.
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Poor Educational Outcomes
Research suggests that rural children may have greater difficulty
in the school system than urban students, beginning with things like
letter and sound recognition in kindergarten.\28\ This disadvantage may
be rooted in the poorer quality of rural children's pre-school
childcare, as discussed above. Older rural students have fewer upper-
level mathematics courses available to them, as compared to urban
students (one to three classes versus seven classes available,
respectively).\29\ This limited availability translates into lower
scores on standardized exams among rural students, which can limit
students' capability and interest in related (and profitable) college
majors and careers.\30\ In addition, experiencing poverty as a child,
as many rural students do, is correlated with completing fewer years of
school altogether than a student who hadn't experienced childhood
poverty.\31\ \32\
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\28\ Smith, Kristin. 2006. ``Rural Families Choose Home-Based Child
Care for their Preschool-Aged Children.'' Carsey Institute, Durham, NH.
\29\ Graham, Suzanne E. 2009. ``Students in Rural Schools Have
Limited Access to Advance Mathematics Courses.'' Carsey Institute.
\30\ Ibid.
\31\ Case, Anne, Angela Fertig, and Christina Paxson. 2005. ``The
lasting impact of childhood health and circumstance'' Journal of Health
Economics 24:365-89.
\32\ McLoyd, Vonnie. C. 1998. Socioeconomic Disadvantages and Child
Development. American Psychologist, 53, 185-204.
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Increased Food Insecurity
While food security is defined as regular, dependable access to
enough quality food to sustain a healthy lifestyle,\33\ food insecurity
means that ``access to adequate food is limited by a lack of money and
other resources.'' \34\ Nearly 15 percent of American households were
food insecure in 2008,\35\ with a disproportionate number of these
families living in rural America.\36\ Many households in rural America
are dependent upon Federal nutrition programs to reduce food
insecurity,\37\ with higher rates of use of programs like food
stamps,\38\ summer lunch programs,\39\ and the Women, Infants, and
Children program \40\ than among their urban counterparts.
Participation in most of these programs is highest in the South,
particularly among families who are headed by a single, non-white
female.\41\ Though these programs are key to maintaining the well-being
of many poor families, anywhere from 92 percent to 55 percent of
eligible people do not participate depending on the program in
question,\42\ likely due to a lack of access to information about
eligibility or the geographic isolation of their residence.
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\33\ Stracuzzi, Nena and Sally Ward. 2010. ``What's for Dinner?
Finding and Affording Healthy Foods in New Hampshire Communities.''
Carsey Institute, Durham, NH.
\34\ Ibid: 1.
\35\ Ibid.
\36\ Wauchope, Barbara and Nena Stracuzzi. 2010. ``Challenges in
Serving Rural American Children through the Summer Food Service
Program.'' Carsey Institute, Durham, NH.
\37\ Smith, Kristin and Sarah Savage. 2007. ``Food Stamp and School
Lunch Programs Alleviate Food Insecurity in Rural America.'' Carsey
Institute, Durham, NH.
\38\ Ibid.
\39\ Wauchope, Barbara and Nena Stracuzzi. 2010. ``Challenges in
Serving Rural American Children through the Summer Food Service
Program.'' Carsey Institute, Durham, NH.
\40\ Wauchope, Barbara and Anne Shattuck. 2010. ``Federal Child
Nutrition Programs are Important to Rural Households.'' Carsey
Institute, Durham, NH.
\41\ Ibid.
\42\ Ibid.
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Many rural families who are eligible to take part in child
nutrition programs do not participate (43 percent).\43\ Policies
wishing to address increased food insecurity should focus on obstacles
that keep rural families from participating in governmental nutrition
programs. For instance, rural families might have a more difficult time
accessing child nutrition programs because of their increased
remoteness from and lack of transportation to facilities that are able
to help.\44\ Governmental programs have attempted to remedy some of the
problems with transportation by creating programs where food is
delivered to rural children in need. However, many of these programs
suffer financially because of the same problem they are meant to
alleviate; the remoteness of rural families in need.\45\
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\43\ Wauchope, Barbara and Anne Shattuck. 2010. ``Federal Child
Nutrition Programs are Important to Rural Households.'' Carsey
Institute, Durham, NH.
\44\ Ibid.
\45\ Wauchope, Barbara and Nena Stracuzzi. 2010. ``Challenges in
Serving Rural American Children through the Summer Food Service
Program.'' Carsey Institute, Durham, NH.
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Access to Healthcare
Nearly 10 percent of American children are without health
insurance, with the highest numbers of uninsured in rural regions and
southern cities.\46\ Of all children who are covered, 28 percent are
covered by a public insurance plan, such as Medicaid or the State Child
Health Insurance Plan (SCHIP).\47\ In addition to lower rates of
insurance holdings among rural children, they are also more likely to
be covered by these public plans than their suburban counterparts,
highlighting the important role of public health insurance in rural
America.\48\
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\46\ Mattingly, Marybeth J. and Michelle Stransky. 2009. ``Rural
and Urban Children Have Lower Rates of Health Insurance Coverage and
are More Often Covered by Public Plans.'' Carsey Institute, Durham, NH.
\47\ Ibid.
\48\ Ibid.
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The enactment of health care reform undoubtedly will change the
picture of rural access to health care. The implementation should be
monitored carefully to ensure that rural health care needs are met.
Risk for Child Maltreatment
Research shows that there were nearly 2 million counts of alleged
child maltreatment in the United States in 2007, mostly regarding
suspected neglect.\49\ The types of maltreatment in rural areas are
quite similar to those in urban areas, with families experiencing
various stressors, such as alcohol abuse or mental health problems,
which exacerbate the circumstances of family violence. However, rural
families who have been reported to Child Protective Services are more
likely to be facing additional stressors than urban families, including
difficulty paying for basic needs, and high levels of family
stress.\50\ In addition, rural families are more likely to have their
children relocated into out-of-home placements than urban families.\51\
Higher rates of poverty, less access to additional resources, and
higher populations of non-white residents are all common in rural
areas, and are all independently related to higher risks of out-of-home
placement.\52\
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\49\ Mattingly, Marybeth J. and Wendy A. Walsh. 2010. ``Rural
Families with a Child Abuse Report are More Likely Headed by a Single
Parent and Endure Economic and Family Stress.'' The Carsey Institute.
\50\ Ibid.
\51\ Mattingly, Marybeth J., Melissa Wells, and Michael Dineen.
2010. ``Out-of-Home Care by State and Place: Higher Placement Rates for
Children in Some Remote Rural Places.'' The Carsey Institute.
\52\ Ibid.
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Reducing the risk for child maltreatment is complicated; however,
some promising ideas include increasing family supports, particularly
for those experiencing financial strains and family stressors that
could manifest in poor outcomes like child maltreatment. Additionally,
further understanding the stressors for unmarried couples,\53\
immigrants,\54\ or those experiencing multi-generational poverty could
result in more appropriate responses to rural poverty, and help to
close the persistent rural-urban gap.
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\53\ O'Hare, William, Wendy Manning, Meredith Porter, and Heidi
Lyons. 2009. ``Rural Children Are More Likely to Live in Cohabiting-
Couple Households.'' Carsey Institute, Durham, NH.
\54\ Johnson, Kenneth. 2006. ``Demographic Trends in Rural and
Small Town America.'' Carsey Institute, Durham, NH.
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Thank you for the opportunity to identify some of the implications
of Federal policy for rural children and families.
[Whereupon, at 11:52 a.m., the hearing was adjourned.]