The Scale-Up Effect in Early Childhood and Public Policy

Why Interventions Lose Impact at Scale and What We Can Do About It

John List, Dana Suskind, Lauren Supplee, John List, Dana Suskind, Lauren Supplee, John A List, Lauren H Supplee, John A List, Dana Suskind, Lauren H Supplee

• Publisher: Routledge
• Year: 2021
• Print ISBN: 9780367360443
• eBook ISBN: 9781000384314
• Edition: 1
• Topic: Business
• Subtopic: Formazione aziendale
• Index: Business

This critical volume combines theoretical and empirical work across disciplines to explore what threatens scalability—and what enables it—in the early childhood field. Authors and editors provide specific recommendations to help professionals refine and apply the science of scaling in their programs, research, and decision making.

Written by leading experts in early childhood, economics, psychology, public health, philanthropy, and more, chapters and commentaries shine light on how to effectively use experimental insights for policy purposes. The result is a comprehensive and forward-thinking guide to the challenges and possibilities of effective scaling in early childhood and beyond.

Essential reading for researchers, practitioners, funders, and policy makers alike, this book raises vital questions and provides a vision for the long-term journey to scalable evidence.

1 Failed to Scale

Embracing the Challenge of Scaling in Early Childhood

DOI: 10.4324/9780367822972-1

Snigdha Gupta

UNIVERSITY OF CHICAGO

Lauren H. Supplee

CHILD TRENDS

Dana Suskind

UNIVERSITY OF CHICAGO

John A. List

UNIVERSITY OF CHICAGO; AUSTRALIAN NATIONAL UNIVERSITY; NBER

Author Note

Lauren H. Supplee is now at the William T. Grant Foundation.

Science of Scaling and Early Childhood: Two of the Greatest Public Policy Issues of Our Time

In recent years, citizens and law makers have become increasingly enthusiastic about adopting evidence-based policies and programs. Social scientists have delivered evidence of countless interventions that positively impact people’s lives. And yet, most programs, when expanded, have not delivered the dramatic societal impacts promised.

This is especially true in the field of early childhood. Research suggests that high-quality early childhood programs (those serving children from birth through age 5) have the potential to reduce the inequities that plague our nation and rob too many children of opportunity—and that they can deliver a 13% return on investment in the process. Despite the research and evidence, however, few programs have followed through and delivered on this promise. In order to reap the individual and economic benefits of early childhood programs, researchers and practitioners must figure out how to take these programs from small-scale experiments and implement them at scale in a way that enables population-level impacts.

This book—at its heart an exploration of threats to and facilitators of scaling—uses the lens of early childhood to examine the topic for two key reasons: a) early childhood is a critical period that lays the foundation for an individual’s life course, a period in which successful interventions have the power to allow children to reach their full potential; and b) early childhood programs are implemented through a complex and notoriously fragmented system that makes it particularly challenging to study, implement, and scale programs in the field. We’ve chosen early childhood in hopes that focusing on disentangling challenges in a particularly vexing domain will lead to conclusions that resonate in all public policy domains that experience similar scaling challenges, including health, education, energy, climate, and employment.

This book will examine some of the most critical questions of our time related to scaling evidence-based programs: Why have we failed to bring evidence-based programs found to be effective in small-scale experiments to the population level? How can we scale such programs effectively? Perhaps more importantly, we hope the book stimulates dialogue between researchers, practitioners, funders, and policy makers, paving the path toward stronger partnerships that bring fundamental changes in research and program design. Ultimately, we hope it elevates the burgeoning field of evidence-based policy making.

Why is Early Childhood So Important?

The first few years of a child’s life are critically important and provide a unique window of opportunity to positively impact their physical, emotional, and cognitive growth. During these years, a child’s brain develops rapidly—at the rate of 1 million neural connections per second, a rate never matched in later life. Healthy brain development during this period provides children with the foundation necessary for developing to their full potential, setting them up for success in school and the workforce, and allowing them to lead a healthy and stable life.

Research has shown that access to nutrition, strong and nurturing relationships with caregivers, and exposure to environmental stress and adversity have profound impacts on a child’s early brain development. Tragically, millions of children around the world may lack access to nutrition, the nurturing relationships needed for healthy brain development, or both. Lack of nutrition and early stimulation has tremendous negative consequences on a child’s physical, cognitive, and socioemotional development, as does exposure to stress. These factors put a child at risk of not reaping benefits of later education, leading to lower rates of employment in adult-life, and making it more challenging to achieve economic stability.

The important role parents and caregivers play in caring for and providing a rich and nurturing environment to children during these critical early years cannot be overstated. A myriad of studies have shown that parent and caregiver investment in a child’s development leads to better physical, emotional, and cognitive growth. What was once based on inference has now been scientifically investigated through neuroscience research. Advances in brain imaging techniques have filled the gap in understanding how parent or caregiver input impacts the brain, and ultimately a child’s skill formation. The evidence generated suggests the single most important component to healthy brain development is the relationship between a child and their caregiver, with warm and responsive interactions at the heart of that relationship.

Research from economics reveals that investment in the care and development of children during the early years makes economic sense, too. It not only leads to better outcomes for individual children and their families but impacts the society as a whole. In a series of groundbreaking studies, economist James Heckman has shown that investing in early childhood development, particularly for at-risk children, can significantly reduce social and economic costs to society in the long run and help break the cycle of intergenerational poverty. Investments in early childhood lead to long-term positive impacts on a child’s education, health, social behaviors, and employment outcomes, thus reducing societal spending on remedial education, social services, health care expenses, and criminal justice. Further, his analyses suggest that high-quality early childhood programs, as we mentioned previously, can have a 13% return on investment for every dollar spent. A failure to invest in the care and well-being of our children has significant social and economic costs.

In short, early childhood development is a public health issue—one that merits a robust population-level health response targeting parent and caregiver investment in child development, beginning at birth.

The Vast Landscape of Early Childhood Programs in Developed and Developing Countries

The growing body of literature on the importance of early childhood has led to increased support for early childhood programs and policies worldwide. The United States established the Administration for Children & Families (ACF) in 1991 to promote the resilience, health, safety, and economic security of children, youth, families, and communities through the implementation of educational and supportive programs in collaboration with organizations at the state and local levels. In 2015, the United Nations General Assembly included early childhood as a target within the goal on education in its Sustainable Development Goals (SDGs), a set of 17 interconnected goals designed to achieve a more sustainable future for all. Furthermore, one of the world’s oldest and most-respected medical journals, The Lancet, published special issues devoted to early childhood in 2007, 2011, and 2017. As momentum among policy makers, researchers, and practitioners has accelerated, both developed and developing countries have made significant strides in strengthening their early childhood care and education programming.

Of course, that programming differs from country to country. Many developed countries, having already eradicated issues of chronic malnutrition, are now heavily focused on supporting children’s cognitive and socioemotional development. Developing countries are enhancing their programs to address all three simultaneously in response to research that shows strengthening the early childhood landscape requires an integrated, multi-dimensional approach focused on developing children’s physical, cognitive, and socioemotional development.

Reviewing the progress that all countries have made to improve child outcomes across all three dimensions tells one story: It is complex and challenging, even when resources are abundant. If we, as a society, want to improve outcomes for all children, it is imperative that we better understand the threats to scalability so that resources can be used strategically on interventions that will actually lead to desired outcomes. This is particularly true in countries with scarce resources and little to no infrastructure. In this book, we draw upon evidence and lessons from early childhood programs in the United States and across the world to help develop a shared understanding of the challenges to scaling and advance the thinking of researchers, practitioners, and policy makers trying to improve outcomes for millions of children across the world.

How Early Childhood Programs Reach Children and Families

Irrespective of their location, early childhood programs around the world generally reach children through one of two delivery channels: (a) through services provided directly to children in the form of child care programs (center-based or home-based) and preschool programs; or (b) through parent-focused interventions delivered in homes or in community or health-care settings.

Let us take the example of the United States to review the incredible diversity of early childhood care and education (ECE) programs¹ that cater to children under age 5. Of the nation’s roughly 20 million children in this age group, a majority spend time in multiple care settings during a week—for example, children may spend time at a child care center on some days and be watched by a relative or neighbor on other days. The programs that serve them differ greatly in terms of the ages of participating children, the setting, funding mechanisms, and hours of operation, as well as quality. The National Survey of Early Care and Education (NSECE) 2014 Report estimates there are approximately 129,000 center-based programs in the United States that serve roughly 7 million children between birth and age 5. In its classification, NSECE includes many types of ECE programs including child care centers, Head Start, preschools, and pre-kindergarten classrooms in public schools. Per their estimates, 30% of centers exclusively serve children ages 3 to 5, 25% serve children birth to age 5, and another 27% serve children from birth to school-age. If we examine this further, it is apparent that there are more centers that serve the 3–5-year-old population than birth to 3; furthermore, there are more centers that serve 2-year-olds than those that serve children younger than 1 year. In terms of the organizational structure, as many as 52% of these centers are not-for-profit, whereas 32% are for-profit and only 16% are run by government entities. Sixty-eight percent of centers generate revenues though tuition and fees from parents and a majority of the programs (roughly 72%) receive some revenue from government sources.

Center-based child care programs are just one of many entities that deliver services directly to children in early childhood. There are also many entities that focus on parents. For example, there are a number of home visiting programs that support and empower pregnant women and families with young children—particularly those living in at-risk communities—with the knowledge, resources, and skills they need to thrive. Twenty-one home visiting programs in the United States meet the Department of Health and Human Services’ criteria for an “evidence-based early childhood home visiting service delivery model” (Sama-Miller et al., 2019). These programs, which we know have positive impacts for vulnerable children and families, unfortunately reach only a tiny percentage of families. Estimates suggest that only 1.6% of families that stand to benefit from evidence-based home visiting were served by such programs in 2018 (Meisch & Isaacs, 2019). In other words, more than 17.5 million families with a child under age 6 are not receiving this essential service.

These numbers tell a story that is far too common: An unacceptably high number of children and families across the world do not receive the support they need to foster healthy brain development during the early years.

Why is Early Childhood So Susceptible to the Challenges of Scaling?

Despite the science that highlights the importance of nurturing relationships for children’s development, why have we failed to provide most families with access to high-quality early childhood programs that offer or bolster such relationships? Why have these programs, which have demonstrated evidence of effectiveness, not been scaled to the point where they serve the intended population? Of course, funding (or the lack thereof) is one of the biggest challenges. While the discussion on funding mechanisms and how best to allocate funds is outside the scope of this book, we hope that a deeper understanding of threats to scalability will go a long way toward not only developing programs that have evidence of effectiveness at scale, but will also help catalyze funding to further support such programs.

Funding aside, let’s consider some of the challenges that pose a challenge to scaling in the early childhood field in the United States.

Early Childhood Programs are Implemented by a Complex, Fragmented System

During the first years of a child’s life, children and families interact with multiple, fragmented systems that span the fields of health, family support and engagement, and early learning and development. There is no one universal system that exists for early childhood development, like the K-12 public school system, which children don’t enter until age 5 or 6. Consequently, families have to work through multiple systems to secure appointments and visit multiple offices to meet their children’s needs. Besides being inefficient and an added burden on families, it puts the most vulnerable families and children at risk of falling through the cracks.

In addition to the challenges posed by the number of programs available, differences in governance structure, infrastructure, and resources available across states makes it incredibly difficult to effectively replicate a program across geographies and maintain results. Researchers and practitioners can design a highly effective intervention, but unless there is an equally robust infrastructure and governance structure to uptake the intervention, population-level impacts will remain an aspirational goal.

Lack of Universal Data System and Scalable Measures of Quality Leaves Many Flying Blind

Access to reliable and accurate data is critical to any scaling effort. But individual early childhood programs differ significantly in the kind of data and quality measures they collect or are required to collect. Almost all programs have some administrative data available (demographic information on participating children and families, program attendance, staff qualification, caseload, etc.), however, the depth and breadth of this administrative data varies significantly across programs and states. While there has been movement in states toward integrating data across early childhood programs to reflect all the services families may access and to measure long-term outcomes, many of these efforts are still in the early stages.

While administrative data can provide valuable insight into a program, it doesn’t paint a complete picture. The quality of an early childhood program depends on both structural quality (child–staff ratio, group size, training, etc.) as well as process quality (i.e., the day-to-day interactions a child has with parents and caregivers). In fact, process quality is at the heart of a high-quality early childhood program and drives outcomes that are distal and appear years later. Measuring process quality isn’t easy and is particularly challenging at scale. Measures used to study process quality, especially those used in research studi...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Table of Contents
• List of Illustrations
• Editor Biographies
• List of Contributors
• Acknowledgements
• 1. Failed to Scale: Embracing the Challenge of Scaling in Early Childhood
• PART I: The Science of Early Childhood and Complexities of Scaling
• PART II: The Scale-up Effect: Understanding the Threats to Scalability
• PART III: Charting a Path Forward
• Index