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									                                                                    Summer/Fall 2009 · Vol. 18, No. 1 · $14

Maine Policy
R               e                   v                   i                 e                     w
A Joint Publication of the Margaret Chase Smith Policy Center and the Margaret Chase Smith Library
                                                                                       Maine Policy
                                                                                       R     e      v      i     e     w

View current & previous issues of MPR at:   volume 18, number 1 · Maine Policy Review · 1

      Margaret Chase sMith PoliCy Center
                 Linda Silka, Interim Director

          Margaret Chase sMith library
                    Greg Gallant, Director

                   eDiTOriAl sTAFF

                      Ann Acheson
            Margaret Chase Smith Policy Center

            assistant Managing editor
                      Barbara Harrity
            Margaret Chase Smith Policy Center

                       Beth Goodnight
                      Goodnight Design

                   CirCulation &
                Web site MaintenanCe
                      Sharon LaBrie
            Margaret Chase Smith Policy Center

                     Eva McLaughlin
            Margaret Chase Smith Policy Center

                  Cover illustration
                       Robert Shetterly

                   J. S. McCarthy Printers

   Maine Policy Review (iSSn 1064-587) publishes independent analyses of public policy issues revelant to Maine.

   The journal is published two to three times per year by the Margaret chase Smith Policy center at the University of
   Maine and the Margaret chase Smith library in Skowhegan. The material published within does not necessarily reflect
   the views of the Margaret chase Smith library or University of Maine.

   The majority of articles appearing in Maine Policy Review are written by Maine citizens, many of whom are readers of
   the journal. The journal encourages the submission of manuscripts concerning relevant public policy issues of the day
   or in response to articles already published in the journal. Prospective authors are urged to contact the journal at the
   address below for a copy of the guidelines for submission or see our web site.

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   your letter to the editor to:

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                       07-581-1567 • fax: 07-581-166

 · Maine Policy Review · Summer/Fall 009                                                 View current & previous issues of MPR at:
       thanks to …
       Major Sponsor

       Margaret Chase Smith Library

       Maine Community Foundation                                  University of Maine Vice President for Research


       The Bingham Program                                  Maine Turnpike Authority                            and an Anonymous Benefactor

       Anthem Blue Cross and Blue Shield                    Maine Children’s Trust                              United Ways of Maine


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       volume eighteen of Maine Policy Review is funded, in part, by the supporters listed above. contributions to Maine Policy Review can be directed to the
       Margaret chase Smith Foundation, 10 Free Street, P.o. Box 4510, Portland, Me 0411. information regarding corporate, foundation, or individual
       support is available by contacting the Foundation.

View current & previous issues of MPR at:                         volume 18, number 1 · Maine Policy Review · 
TaBle oF conTenTS

    Introduction to the Early Childhood Issue                                                                 Family Economic Security
    Guest editors Leslie A. Forstadt and Sheryl Peavey introduce the articles                                 Family economic insecurity when children are very young can have
    in this special issue on early childhood by highlighting the myriad of                                    lifelong effects. Ann Acheson gives an overview of poverty and economic
    programs and policies affecting Maine’s young children and their families.                                insecurity in Maine, key benefits and programs to support families, and
                                                                                                              current and recommended policies to improve family economic security.
    by leslie a. Forstadt, Sheryl Peavey . . . . . . . . . . . . . . . . . . . . . . . . 10
                                                                                                              by ann acheson . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

                                                                                                              Early Childhood Health
investing early                                                                                               Dora Anne Mills presents a portrait of early childhood health in Maine.
                                                                                                              Among the many topics covered are prenatal care, early development,
    There is compelling evidence for the importance of early investment in                                    infectious diseases, oral, mental, and environmental health, and physical
    young children, for the children themselves, for the economy, and for                                     activity and nutrition. She notes policy successes and describes some of the
    society. Philip Trostel presents research on the economic and social value                                remaining challenges.
    of investing in early childhood development, noting that such investment
    is also the “right thing to do.” Dana F. Connors looks at investing early                                 by Dora anne Mills . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
    from a business point of view; he stresses that high-quality early care and
    education are vital for both individual and statewide economic security.                                  Maine’s High-Risk Infants and Maternal Health
    Judy Reidt-Parker discusses the need for improvement in Maine’s data
    collection systems to better understand the outcomes of investments in
                                                                                                              and Wellbeing: The Maine Infant Follow-Up Project
    early childhood.                                                                                          The authors describe the Maine Infant Follow-up Project, a research-
                                                                                                              based effort to accelerate early identification of developmental risk for
                                                                                                              infants whose mothers use drugs or alcohol. Early identification can
    The Dynamics of Investments in Young Children                                                             enable early targeted intervention for infants with a high risk of neuro-
    by Philip a. Trostel . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18         developmental disorders.
                                                                                                              by Beth a. logan, Marie J. Hayes, Mark S. Brown,
    Investing in Maine’s Youngest Children                                                                    Paul Tisher, Jonathan a. Paul, Ramesh Krishnan . . . . . . . . . . . . . . 60
    Has Great Returns for Business
    by Dana F. connors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

    Data Collection in Maine:
    Assessing the Return on Public Investment
    in Maine’s Early Childhood System
    by Judy Reidt-Parker. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0

                to our readers . . . . . . . . . .                                6

                the Margaret
                Chase sMith essay
                The Transforming Power of Literacy
                Barbara Bush. . . . . . . . . . . . . . . . . . . . . . . . . . 8

                thanks to reviewers . . . . .                                 1

4 · Maine Policy Review · Summer/Fall 009                                                         View current & previous issues of MPR at:
                                                                                                                                                                TaBle oF conTenTS

sPeCial PoPulations                                                                                    Parent Education:
    In Maine there are an increasing number of young children in special                              “Prepare the Child for the Path,
    populations. Alan B. Cobo-Lewis describes the state’s system of services                           Not the Path for the Child”
    for young children with disabilities and makes recommendations for
    improving interdepartmental coordination to better serve the children.                            Candace J. Eaton explains why parent education is so important and
    Helen D. Ward, Julie A. Atkins and Erin E. Oldham present their                                   describes a number of approaches and programs in Maine. She suggests
    research about the problems faced by parents of children with special                             that Maine needs to increase access to research-supported programs,
    needs in finding and keeping child care and in coordinating therapy                               parent-education classes, and support groups to all populations and all
    with child care programs. In another article, the same authors (Oldham,                           parts of the state.
    Atkins, Ward) discuss the needs of preschool English language learners                            by candace J. eaton . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116
    and describe an Early Reading First Program in Portland that enhanced
    school-readiness for this population.                                                             The Community Caring Collaborative:
    Interdepartmental Coordination for                                                                Case Study of a Grassroots Collaboration
    Maine’s Young Children with Disabilities                                                          to Create a System of Care for At-risk Infants,
    by alan B. cobo-lewis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68       Young Children, and Their Families
                                                                                                      in Washington County, Maine
    Child Care and Work Challenges for Maine’s                                                        Marjorie Withers presents a case study of a successful and innovative
    Parents of Children with Special Needs                                                            community-agency partnership, the Community Caring Collaborative, in
                                                                                                      Washington County, Maine, which is increasing services for community
    by Helen D. ward, Julie a. atkins, erin e. oldham . . . . . . . . . . . 8                        members and their children affected by exposure to drugs, alcohol, and
                                                                                                      other risk factors.
    English Language Learners in the State of Maine:                                                  by Marjorie withers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
    Early Education Policy That Can Make a Difference
    by erin e. oldham, Julie a. atkins, Helen D. ward . . . . . . . . . . . 88

Child Care
    Because early childhood experiences are so crucial to later-life success, the
    quality of child care is a critical policy concern. Michael Lahti, Rachel
    Connelly, Georgia N. Nigro and Rebecca Fraser-Thill report on findings
    from three studies on child care arrangements and quality in Maine and
    nationally. They describe the development of a new quality rating system
    in Maine for child care facilities, which can play a role in improving care
    and in helping parents choose quality care. Julie DellaMattera discusses
    current patterns of educational preparation and poor compensation for
    early educators and offers recommendations for improvement in this all-
    important profession.

    Working Parents and Child Care:
    Charting a New Course for Quality
    by Michel lahti, Rachel connelly, Georgia n. nigro,
    Rebecca Fraser-Thill . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94

    The Early Childhood Workforce
    by Julie DellaMattera . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106

View current & previous issues of MPR at:                                         volume 18, number 1 · Maine Policy Review · 5
leTTeR FRoM THe eDiToR

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6 · Maine Policy Review · Summer/Fall 009                                           View current & previous issues of MPR at:
            My Creed . . .
             is that public service must
             be more than doing a job
             efficiently and honestly.
             it must be a complete
             dedication to the people
             and to the nation with
             full recognition that every
             human being is entitled to
             courtesy and consideration,
             that constructive criticism
             is not only to be expected
             but sought, that smears are
             not only to be expected
             but fought, that honor is to
             be earned but not bought.
                           Margaret Chase Smith

View current & previous issues of MPR at:   volume 18, number 1 · Maine Policy Review · 7
THe MaRGaReT cHaSe SMiTH eSSay

                                         The Margaret Chase Smith Essay

                                              ever since i was a young girl i have      family literacy grants since 1996 totaling
                                        loved to read. From my childhood in             more than $ million.
                                        Rye, new york, to my life with George                Family literacy is an educational
     transforming                       Bush in Texas, china, washington, D.c.,
                                        and Kennebunkport (and many places in
                                                                                        approach that improves the reading,
                                                                                        writing, mathematics, english language

         Power of
                                        between), i have always had a book by my        proficiency, and life skills of parents along
                                        side and enjoyed countless hours reading.       with their children. These programs are
                                        Books have entertained me, comforted            based on evidence demonstrating that a
          literacy                      me, inspired me, and taught me a great
                                        deal about the world and its people.
                                                                                        mother’s educational level has a strong
                                                                                        influence on her child’s academic success
                                              while reading is an enriching and         and health and on the family’s economic
                    by barbara bush     fun hobby for me and many other people,         well-being. For example, parents who lack
                                        it is so much more than just a pastime.         basic literacy skills are not able to provide
                                        Good reading, writing, and thinking skills      their children with the necessary educa-
                                        are vital ingredients to functioning well in    tional support, and their son or daughter’s
                                        our complex society. These abilities are the    academic achievement can suffer. Their
                                        foundation of all other learning and help       family has restricted access to health care
                                        people to create brighter and more pros-        due to their inability to read and compre-
                                        perous futures for themselves and their         hend printed information. Their chil-
                                        families, as well as for our nation.            dren may not receive adequate nutrition
                                              i believe that if every man, woman,       because of their inability to understand the
                                        and child could read, write, and compre-        labels and nutrition content on food pack-
                                        hend, we would be much closer to solving        ages. and they may experience periods of
                                        many of the problems facing our country.        unemployment due to lack of education,
                                        That is why i became committed to               reducing their family’s annual income.
                                        promoting family literacy when George                The numbers for Maine are too
                                        was in office. i founded the Barbara Bush       frightening to ignore. according to the
                                        Foundation for Family literacy in 1989,         Maine Department of education, 5.4
                                        and today it continues to thrive. To date       percent of adults over age 5 do not have
                                        it has given more than $1 million to           more than an eighth grade education;
                                        704 family literacy programs in 50 states       14.6 percent of Mainers over age 5
                                        and the District of columbia. The Maine         have less than a high school diploma;
                                        Family literacy initiative, a statewide         7.8 percent speak a language other than
                                        initiative of my Foundation supporting          english at home; and almost 0,000 fami-
                                        the development and improvement of              lies with children under 18 live in poverty.
                                        family literacy in Maine, has awarded 18       i realize the problems of many of these

8 · Maine Policy Review · Summer/Fall 009               View current & previous issues of MPR at:
                                                                                                   THe MaRGaReT cHaSe SMiTH eSSay

people may be much deeper than their            Maine a more literate state. The best place    Former First
inability to read and write, but education      to start is in our own homes. as a parent      lady Barbara
can make a tremendous difference in the         our first responsibility is at home with       Bush has been
well-being and stability of families. Poor      our family because it is the most impor-
                                                                                               a champion
reading, writing, and math skills often         tant job we will ever have. Parents are
lead to poverty and then hopelessness.          the child’s first teacher and the home is      in promoting
      By offering comprehensive programs        their first school, so we must make it a       literacy for
that include adult literacy, early child-       peaceful, loving, and educational environ-     many years.
hood instruction, parenting education,          ment. one of the best ways to do that          in 1989 she
and intergenerational literacy activities       is to read together every day. Reading         founded the
to families most in need, parents and           to a pre-school child promotes language
                                                                                               barbara bush Foundation for Family literacy,
children participating in family literacy       acquisition and correlates with literacy
programs are reading and learning               development and future success in school.      which supports programs where parents and
together. and lives are improving.              By reading with our children or grand-         children can learn and read together. the
      Statistics compiled by the Maine          children, we will not only help to equip       Foundation works to bring literacy to every
Department of education show that pre-          them with the tools to succeed, we will        home by awarding money to build effective
school children who are enrolled in family      be spending quality time together and          family literacy projects. she is also author of
literacy programs with their parents do         creating many happy memories.
                                                                                               two children’s books, C. Fred’s Story and the
considerably better on developmental                  Family literacy programs in Maine, a
tests than children who do not partici-         state that George and i love and in which      best-selling Millie’s Book, whose profits bene-
pate in these programs. in Maine, 91            we have spent almost every summer for          fited literacy. she also wrote the best-selling
percent of school-aged children who have        the past 6 years, are making a wonderful      Barbara Bush: A Memoir and Reflections:
been enrolled in family literacy programs       difference in many lives. i’m so grateful to   Life After the White House.
showed significant progress of at least one     the teachers, volunteers, and all the people
grade level in reading on standardized          at these great programs for their dedica-
assessments. Research demonstrates that         tion to literacy and to building a better
children who participate are less likely        future for Maine.
to drop out of school down the road,                  To learn more about the work of the
breaking the cycle of low literacy, poverty,    Maine Family literacy initiative, please
and unemployment that may have existed          visit its web site at www.mainefamily
in their families for generations.     
      adult participants have significantly
improved their reading skills and are
better prepared to be good employees.
Many adults have obtained their GeDs as
a result of family literacy programs and are
now attending college. also, parents often
become much more involved in their
hildren’s school life. after nine months in
a program, 88 percent of parents served
by a family literacy program in Maine
attended all relevant parent conferences
and school meetings.
      literacy is everyone’s business, and
i encourage all Mainers to help to make

View current & previous issues of MPR at:            volume 18, number 1 · Maine Policy Review · 9

                           to the early                                   Guest editors Leslie Forstadt and Sheryl Peavey

                            childhood                                     introduce the articles in this special early child-

                                                                          hood issue of Maine Policy Review by highlighting

                                  issue                                   the myriad of programs and policies affecting

                                                                          Maine’s young children and their families. To illus-
                                              by leslie a. Forstadt
                                                                          trate the challenges faced by parents, they present
                                                    sheryl Peavey
                                                                          the fictional account of a young woman facing an

                                                                          unexpected pregnancy. The story illustrates the

                                                                          sometimes confusing array of services, programs,

                                                                          and funding for young children and their parents.

                                                                          The authors argue “it is time to make every door

                                                                          into the system of early childhood services the right

                                                                          door for every parent.”     

10 · Maine Policy Review · Summer/Fall 009              View current & previous issues of MPR at:

                                                                                                          new parents in

T    his issue of Maine Policy Review is focused on
     early childhood (children less than five years old).
it covers a diversity of topics that affect those in this
                                                                at a large retail store where
                                                                she works 0 hours a week at
                                                                minimum wage ($7.50/hour
                                                                                                                Maine face a

age group and their parents, from parenting education,          as of october 009), and her                    myriad of services,
to families learning english, to the policy implications        second job as a waitress at a
of financial investment in young children. These                restaurant on weekend nights.                   resources, and
articles reflect the current state of many of Maine’s           Between her two jobs, she
activities in early childhood and introduce the reader          makes $19,500 a year, which                     choices that have
to potential directions and possibilities to change             means she makes too much to
policies and norms.                                             qualify for state health insur-                 been built on years
     new parents in Maine face a myriad of services,            ance. Unfortunately, neither
resources, and choices that have been built on years            of her employers offers her                     of incongruent
of incongruent funding cycles, national trends, and             health insurance as a part-time
complex and confusing eligibility guidelines (see Table         employee. Fortunately for her,                  funding cycles,
1, pages 1–1). This patchwork of services has the             she is in good health.
capacity to confound even the most well informed                     Two months ago, Joanna                     national trends,
parent-to-be. over time, professionals have changed             reconnected at a Saturday
how they practice, responding to research findings and          night party with an old flame                   and complex and
the needs of those they serve. Policy and funding have          from high school. on Monday,
not always followed suit, and conflicting requirements,         he went back to graduate                        confusing eligibility
overlapping programs, and gaps in services have created         school in Pennsylvania, and
a great deal of confusion for new parents. it is time to        she went back to work. one                      guidelines.
make every door into the system of early childhood              month passed, and over that
services the right door for every parent.                       time they emailed several times,
     To illustrate the challenges faced by new parents          but decided not to see each
today, we present the fictional story of Joanna, a young        other again. also during that time, she missed
woman from Maine who is unexpectedly confronted                 her period, and was nauseous in the mornings.
with the decision to become a parent.                           at the urging of her friend lena, she purchased a
                                                                pregnancy test and got the affirmative answer to
                     PReGnancy                                  the test in the employee bathroom during her
                                                                afternoon break at work.

J  oanna is a 0-year-old high school graduate from
   Knox county. She lives in Rockland, which caters
to tourism during the summer season and is quieter
                                                                     with the emergence of the little plus sign on
                                                                the pregnancy test, Joanna realizes she is pregnant,
                                                                she has to decide what to do, and she has to go back
during the colder months of the year. as of June                to work. Her future beyond the next 10 minutes
009, the Maine state unemployment rate is 8.5                  becomes a blur before her eyes. During the remain-
percent, and Knox county has a 7.5 percent unem-                der of her shift, the realization of the pregnancy is
ployment rate, which makes it one of the better                 absorbed, and she can barely contain the flurry of
counties in terms of job security (Maine Department             questions and thoughts racing through her mind.
of labor 009). Joanna lives in a county that just              Keep the baby? yes. although it wasn’t something she
squeaks under the average poverty level in Maine                planned, she feels strongly that she wants to keep the
with a 1.1 percent poverty rate, compared with                 baby. lena had a baby when they were seniors in high
Maine’s 1.8 percent state rate (Maine Department               school, and she’s done fine. Joanna’s family lives close
of labor 009).                                                 by, and she knew she’d have a family some day. But
     Joanna pays the rent for her small one-bedroom             she’s pretty sure that if she calls the father, he’ll not
apartment with income from two jobs: one as a cashier           want to be involved.

View current & previous issues of MPR at:         volume 18, number 1 · Maine Policy Review · 11

TABLE 1:     early Childhood services in Maine

                                   Program                         Funding        age served                      eligibility
                                                                                                   age 4 by october 15
                                                               state, Federal,
                Pre-kindergarten                                                        4          no income eligibility unless a
                                                                                                   targeted program
                Child development services (Part C, idea)      state, Federal          0–3         diagnosis
                Child development services (Part b, idea)      state, Federal          3–5         diagnosis
                Children with special health Care needs        Federal                0–21         diagnosis
                                                                                                   universal prevention or identified
                Childhood lead Poisoning Prevention
                                                               Federal                 0–5         with positive screen through age
                screening and remediation support
health and                                                                                         required by statute (with exemp-
human           genetics/newborn screening                     Federal                birth
                                                                                  school entry–
(dhhs),         oral health (First tooth)                      Federal                             universal prevention/treatment
                                                                                   5th grade
Center for
disease         Public health nursing                          Federal, state    0–adolescence     identified health need
Control and
                                                                                                   income, pregnancy, breastfeeding;
Prevention      Women, infants and Children (WiC)              Federal           Perinatal; 0–5
                                                                                                   children to 5 years
                immunization (vaccines for Children;
                                                               Federal, state    0–school entry    income, no/underinsured
                seasonal vaccine)
                injury Prevention (Child Passenger safety)     Federal, state          0–5         universal prevention
                Partnership for tobacco Free Maine             Federal, state          life        Priority for pregnant women
                                                                                                               table continued on next page

                       at the end of her work day, Joanna talks with the                      DeciSion-MaKinG TiMe
                  pharmacist about who to call now that she’s pregnant.
                  She is handed a magnet for “11” to call if “pregnant
                  and need help,” among a variety of potential topics
                  that 11 can address. Joanna notes other topics, such as
                                                                                 M       any of the brochures Joanna collected seem
                                                                                         to make common sense—don’t smoke during
                                                                                 pregnancy, eat healthy foods, exercise—but some of
                  “need to find car seat,” and “parenting classes” in            the information is about things she has never had to
                  Maine. From 11, she is directed to a local family plan-       consider. Housing subsidy? eligibility for programs
                  ning clinic, where she gets a referral for a doctor and        based on different percentages of poverty levels?
                  a clinical confirmation of her pregnancy.                      Qualifying criteria based on income? is that before or
                       She heads home from the clinic with a recom-              after taxes are taken out of her paychecks? Forms for
                  mendation to start prenatal vitamins, a bag full of            various agencies and applications for different programs
                  pamphlets and information, and some uncertainty                litter the table. Joanna and lena start to sort the papers
                  about the future ahead of her because of the sudden            into piles and begin a “to-do” list for Joanna.
                  seeming gravity of every decision she makes. She invites
                  lena and her three-year-old daughter over for pizza                                 Health Care
                  after work. Together, they sit at her kitchen table to              The clinic Joanna went to provided her with
                  browse the pamphlets and start to consider Joanna’s            information about Mainecare, the Maine version of
                  options and find answers to some of her questions.             Medicaid, which is publicly funded health insurance.

1 · Maine Policy Review · Summer/Fall 009                    View current & previous issues of MPR at:

TABLE 1:    early Childhood services in Maine — Continued from previous page

                                   Program                           Funding        age served                    eligibility
                 Child Care                                       Federal, state       0–15         income
                 Child Care (Foster Children)                     Federal, state       0–15         Child welfare foster care status
                 Family Case Management                           Federal, state                    Child welfare services activity
                                                                  state (Fund
                 home visiting                                    for healthy      Prenatal–age 5   First time family; adolescent parent
                 a Family for Me (adoption services)              Federal              0–17         Child welfare services activity
                 Child abuse Prevention Councils                  state                0–21         universal prevention
 dhhs, office head start                                          Federal, state        3–5         income
 of Child
              early head start                                    Federal, state        0–3         income
 and Family
 services     alternate response                                  state                0–17         Child welfare services activity
 (oCFs)       Family reunification                                state                0–17         Child welfare services activity
                 Child Care resource and referral (rdCs)          Federal              0–15         universal
                 early intervention (Children’s behavioral
                                                                  Federal, state                    diagnosis
                 birth–5 Case Management (Children’s
                                                                  Federal, state                    diagnosis
                 behavioral health)
                 respite/Flex Funds for Children with
                                                                  state, Federal                    diagnosis
                 Cognitive disabilities
                 Child and adult Food Program                     Federal                           income
               temporary assistance for needy Families
 dhhs, office (tanF)                                              Federal, state                    income, household size
 of integrated
 access and    tanF Child Care vouchers                           Federal, state       0–15         income, employment
 support       Child support enforcement                          Federal, state       0–17         universal
               supplementary nutrition Program (snaP)             Federal, state                    income
 dhhs,          targeted Case Management                          Federal, state       0–17         income, diagnosis
 office of
                Psdt (early, Periodic, screening, diagnosis,
 MaineCare                                                        Federal, state       0–17         income
 (oMs)           habilitative services                            Federal, state                    income

as a single person with no dependents, she did not                   They look at the brochure for women, infants and
qualify. now that she’s pregnant, Mainecare eligibility         children (wic), a nutrition program for which Joanna
guidelines expand tremendously—up to 00 percent of             qualifies because she’s within 185 percent of poverty
poverty level (Maine equal Justice Partners 009). She          level (USDa 009). The family planning clinic put her
can get health insurance. But can she find a doctor who         name on a list to send over to wic and encouraged her
accepts Mainecare? Fortunately, Joanna will get into            to sign up right away. wic will help by giving vouchers
the one oB/Gyn who accepts Mainecare in her town.               for healthy foods starting during pregnancy and until

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                her child is five. She’s surprised to learn she can even          parents was over. often, her mom would yell at her,
                use the wic vouchers at the local farmer’s market.                too. How is Joanna supposed to know how to raise a
                                                                                  child differently? She can talk to lena, and she’s sure
                                        Housing                                   her mom and dad will have some advice, not that she
                     Joanna works hard to live on her own and wants               wants to take it. She knows she can do better than her
                to stay in her own place and not move back home if                parents did in being parents.
                that’s possible. She looks at the pamphlet for housing                  Joanna’s phone rings and it’s her brother, from
                and sees that she may elect to look for housing choice            whom she hasn’t heard in months. The last she knew,
                Section 8 subsidized housing if she qualifies, if a               he was living on a friend’s couch, jobless, and hitting
                voucher is available, and if she can find a place in a safe       up friends and family for beer money. when he was
                neighborhood. if she qualifies will depend on where               four, his dad was put in jail for serious drug addiction
                she wants to live. if she stays in Rockland, her income           and drug dealing. For the first four years of his young
                has to be below 50 percent of the median income. if               life, her brother witnessed serious violence, spent a
                she moves out of Knox county, her eligibility will                great deal of time in the house in front of the televi-
                be determined based on the median income of that                  sion, unattended to when he cried, and slightly
                county (Maine Department of Health and Human                      malnourished. when he was five, Joanna’s biological
                Services 008a). with a two-person family, she might              father starting dating their mom, and Joanna was born
                have a greater chance of qualifying. Her eligibility              when her brother was six.
                for a housing voucher is determined by the housing                      Joanna entered into early Head Start when she
                authority and is based on her total annual gross income           was three. at that point, her brother was nine and
                and family size. She is surprised to learn that a voucher         having a very difficult time in school, including
                can be used almost anywhere; she wonders if her land-             fighting and doing poorly in his academic subjects. By
                lord might accept it so she wouldn’t have to move, but            the time she was nine, Joanna was on a very different
                could save some money on rent, since she’ll have to               trajectory. She was developing well socially and
                spend more on diapers!                                            academically, and she graduated high school on time
                                                                                  and with aspirations of becoming a nurse. Her brother,
                                                                                  however, had dropped out when he was 15 and
      Where expectant parents stand now,                                          continued a cycle of violence and alcohol use. Their
                                                                                  parents tried to help her brother numerous times.
      they may have a sense that there is no                                      However, it eventually got to the point where he
                                                                                  wouldn’t talk with them about friends and activities,
      current coordinated, comprehensive                                          and they gave up and asked him to leave the house.
                                                                                  when Joanna graduated, she immediately began
      array of parenting information and                                          working full time so that she could move out to get
                                                                                  her own apartment. She talks with her brother for
      resources about healthy, effective child                                    a few minutes, but doesn’t share her news and quickly
                                                                                  gets off the phone to keep talking with lena.
      development and parenting.                                                        During her junior year of high school, Joanna had
                                                                                  a project in health class where she was in a group of
                                                                                  three students, and they had to take care of a “baby.” it
                            Knowing How to be a Parent                            wasn’t a real baby, but she had the responsibility of its
                     Joanna’s parents struggled as she grew up. Finances          care for one entire 4-hour period. overnight, it cried
                were always tight and the stresses on her parents were            incessantly, and she didn’t get any sleep. it also needed
                often released as shouting matches. She remembers                 to be fed or changed or burped what seemed like every
                hiding in her closet until the shouting between her               five minutes. She thought about the presentation her

14 · Maine Policy Review · Summer/Fall 009                      View current & previous issues of MPR at:

group did. They were so frustrated by how much the                (see lahti et al. this issue; Maine Department of Health
baby cried that they were sure they had a “broken”                and Human Services 008b). once Joanna learns that
baby or that they weren’t doing something right.                  the center has a long waiting list for infants, will
      Joanna’s educational experience was unusual,                quality drive her decision or will convenience make the
because most of Maine’s schools do not offer any type             choice for her? She will have to choose between driving
of family-related education, although it is offered as an         an additional hour each day to pick up and drop off
elective. There is nothing relating to family skills or           her child at a quality care center, or going just down
parenting included in Maine’s Learning Results. This              the street to the one with higher adult-child ratios.
may be changing, with the June 009 passage of a reso-                  But Joanna hasn’t even looked at the price tag.
lution on incorporating family and consumer science               once she realizes the cost of child care for her newborn
in Maine’s Learning Results (Maine legislature 009)              could be $150 dollars per week, which is nearly half
“Resolve to examine integrating Family and consumer               of her paycheck, Joanna may opt instead for asking a
Science into Maine’s High Schools as Part of the                  friend to care for her baby, or maybe her parents can
learning Results.”                                                help, as her mom only works two days a week. if she
      Joanna picks up a pamphlet for Maine’s home-                chooses center-based care, Joanna may be shocked to
visiting programs, which rings a bell because the                 realize that the experienced child care worker gets paid
assistant at the family planning clinic also mentioned            less than she does.
it. lena tells about her relationship with her own home                 will Joanna understand that this deceptively
visitor when her baby was born. in fact, says lena, her           simple decision of child care is incredibly important?
home visitor “still calls once a month to check in.” Her          if she goes back to work and puts her baby into child
home visitor told her about a parenting class where               care, will she take care to know what happens during
parents get together to learn about toddlers, and lena            those hours? caregivers who understand the impor-
decided to sign up, especially because her home visitor           tance of human interaction with babies provide a
told her that these classes aren’t offered all that often.        variety of stimulating activities, and support social
      Home visiting sounds interesting, because Joanna            interactions with other children will be pivotal to her
won’t have to go somewhere across town—a nice and                 baby’s healthy development (Maine Department of
knowledgeable person can come to her apartment and                Health and Human Services n.d.). will Joanna know
share information about her baby and how it grows and             that it’s not good to put an infant in front of the televi-
learns. Since she is embarking on being a single parent,          sion and that babies must have time to play on their
and since it’s her first child, she will definitely be eligible   bellies during the day? will she know to ask these
for the program. But the pamphlet says she has to sign            things of her care provider?
up before her baby turns three months old. She’s only
in her first trimester, so she still has some time. They                Information Cannot Replace Education
put the number on the to-do list for Joanna to call.                    at present, Joanna and lena talk about school.
                                                                  looking at lena’s daughter playing quietly with her
                 Child Care and Work                              toys, Joanna sighs and wonders if she can find the time
     Joanna draws another pamphlet from the pile.                 to go back to school, maybe starting before the baby is
This one is about choosing child care. assuming she               born. She would still like to go to nursing school, but
will still work, Joanna examines the material about               isn’t sure if she’ll be able to afford it. But she knows for
finding quality child care. little does she know, the             sure she’ll want her baby to go to college. one of the
closest child care center to her home is bursting at the          brochures on the table is for the alfond college
seams, with a high child-to-teacher ratio. Joanna isn’t           challenge, where her child (since it will be born after
well versed in quality standards for child care—doesn’t           January 009) can have a college account started with
know that “quality care” means a 4:1 ratio, and that              a $500 grant to start a nextGen account. lena adds
there is research evidence to support these numbers               this to the to-do list. Joanna already has aspirations for

View current & previous issues of MPR at:              volume 18, number 1 · Maine Policy Review · 15

                her child and will talk with the nextGen people about            session, as informed by federal guidelines and emerging
                how to start making a savings plan to make it a reality          research. These decisions affect the lives of all parents,
                (FaMe 008). She has no idea if she’ll be able to save           and are not limited to parents who may be single or
                enough, or even what is enough. will her small income            “at risk.” The articles in this issue of Maine Policy
                be able to support her finishing school, supporting two          Review explore many of these decisions, with a partic-
                people, and saving?                                              ular emphasis on why pregnancy through age five is
                                                                                 such a pivotal and important time.
                     iT TaKeS a villaGe To RaiSe a cHilD                               For anyone who has, will be, or knows someone in
                                                                                 the position of preparing to parent, it does not happen

                l    ena jokes with Joanna: “wouldn’t it be nice if there
                     was a way to just go and register as a parent?”
                They imagine the possibility that you could find out
                                                                                 in a vacuum. Parents need lots of help each step along
                                                                                 the way toward parenthood. This help will come in the
                                                                                 form of medical care, advice from friends and family,
                you’re pregnant and do some one-stop shopping to                 and information from professionals if it is accessible.
                get all the things you need—like a user’s manual, a              Then after some practice, parenting will get easier.
                wic voucher, a prenatal checkup, and a parenting                 Fortunately for Joanna and those considering parenting
                class. it is kind of like preparing to drive a car: you get      in Maine, policymakers, citizens, agency and private
                the manual, take the written and driving test, go the            professionals are considering the issues that arise as
                DMv, and off you go with your license as a qualified             future Maine citizens develop during their first five
                parent with all the answers.                                     years and over the rest of their lives.
                      looking at the state of Maine with a bird’s eye                  articles in this issue discuss why investments in
                view, Joanna and lena’s idea of a single place to one-           this age group have the potential to result in great
                stop shop for new parents is compelling. where                   outcomes and how Maine is developing an investment
                expectant parents stand now, they may have a sense               strategy. Table 1 at the beginning of this article details
                that there is no current coordinated, comprehensive              the types of services that are offered in this state, along
                array of parenting information and resources about               with their eligibility criteria and extent of services
                healthy, effective child development and parenting.              offered. The articles that follow address specific issues
                instead, each new parent must find for him or herself            faced by many of Maine’s families, such as financial
                what they need on the road to becoming parents.                  security, child care decisions, drug use during preg-
                Parents learn from word-of-mouth, internet searches,             nancy and infancy, and disability screening. we hope
                and family members. They can learn through home                  that this issue of the Maine Policy Review compels
                visitors, but this programming is in danger of not being         readers to speak up for young children, their parents,
                available to all parents. Perhaps the option of univer-          and their communities. Speak up and demand the
                sally available services could ease the stigma of partici-       social and political change that will prove true our state
                pation and create some income for these programs                 motto: i leaD. 
                beyond government support.
                      Most parents in Maine have no idea that they are
                part of a systematic effort within Maine and around
                the nation that is focused on young children and new               RefeRences
                families. Parents in Maine are lucky, because the term
                                                                                   Finance authority of Maine (FaMe). 2008. harold
                “wraparound” is becoming more familiar, and the idea
                                                                                       alfond College Challenge. FaMe, augusta. http://
                that one person who is involved in multiple state-            [accessed June 25, 2009]
                supported programs might have providers who talk to
                                                                                   Maine department of labor. 2009. County Profiles.
                one another is not a foreign concept.                                 Center for Workforce research and information,
                      Joanna, her brother, and lena are examples of                   Maine dol, augusta.
                young people who are betwixt and between the deci-                    lmis/countyProfiles.html. [accessed July 26, 2009]
                sions that are made by policymakers each legislative

16 · Maine Policy Review · Summer/Fall 009                     View current & previous issues of MPR at:

                                                                                               Leslie A. forstadt is child
                                                                                               and family development
  Maine department of health and human services.
     2008a. housing Choice vouchers Fact sheet. Maine                                          specialist with university of
     dhhs, augusta.                                              Maine Cooperative extension.
     housing/section-8/eligibility.html [accessed
     June 25, 2009]
                                                                                               since 2007, she has worked on
                                                                                               collaborative statewide proj-
  Maine department of health and human services.
     2008b. rules for the licensing of Child Care                                              ects including conferences and
     Facilities. Maine dhhs, augusta. http://www.maine.                                        work with the early Childhood
     gov/sos/cec/rules/10/148/148c032.doc [accessed
     July 8, 2009]                                                                             taskforce and now the Maine

  Maine department of health and human services. n.d.
                                                                Children’s growth Council, to support community and busi-
     steps to Choosing Child Care. Maine dhhs, early            ness investment in Maine’s young children and their families.
     Childhood division, augusta. http://www.maine.
     [accessed July 8, 2009]
                                                                                               sheryl Peavey is director
  Maine equal Justice Partners. 2009. MaineCare                                                of Maine’s early Childhood
     eligibility. Maine equal Justice Partners, augusta. [accessed                                                initiative, department
     september 10, 2009]                                                                       of health and human
  Maine legislature. 2009. resolve, to examine                                                 services. she staffs the
     Concepts and Competencies from Family and
                                                                                               Maine Children’s growth
     Consumer science for achieving educational
     goals. office of legislative information, 124th                                           Council and the governor’s
     Maine legislature, augusta. http://www.maine                                              business roundtable on
     resolve105.asp [accessed July 26, 2009]                                                   early Childhood investment.

  u.s. department of agriculture (usda). 2009. WiC
     income eligibility guidelines: 2008-2009. Food
     and nutrition service, usda, Washington, dC.
     guidelines08–09.htm [accessed september 10,

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DynaMicS oF inveSTMenTS in yoUnG cHilDRen

                   The Dynamics
                   of investments                                        Philip Trostel presents compelling evidence of the

                         in young                                        importance of early investment in young children,

                                                                         citing research demonstrating the economic and social

                         children                                        benefits of such investments. He suggests that the lack

                                                                         of understanding of the cause-and-effect relationship
                                              by Philip a. trostel
                                                                         between early childhood experiences and later-life

                                                                         consequences and a failure to conceptualize how

                                                                         things might be done in new ways are both obstacles.

                                                                         Trostel argues that investing in early childhood devel-

                                                                         opment benefits children for the rest of their lives,

                                                                         benefits government with reduced spending in other

                                                                         areas, and moreover is the “right thing to do.”     

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                                                                                    DynaMicS oF inveSTMenTS in yoUnG cHilDRen

                                                                                                           We simply cannot
                  inTRoDUcTion                                  Perry Preschool program was
                                                                estimated to be more than nine                afford not to make

i  n the mid 1960s, 1 three- and four-year-old
   african-american children living in poverty were
selected for a pioneering study on the long-term effects
                                                                times greater than the cost of the
                                                                     Rather than emphasize
                                                                                                              much greater invest-

of high-quality preschooling. almost half of those              the astounding payoff from the                ments in laying the
children (58 of the 1) were randomly chosen to                Perry Preschool experiment, one
participate in the High/Scope Perry Preschool program           could just as easily emphasize                groundwork for
in ypsilanti, Michigan. The other half served as a              the tragic unfairness for those
control group. Most (three-fourths) of those randomly           with the random misfortune                    successful lives for
selected into the program attended the Perry Preschool          of being in the control group.
for two academic years, with the rest only attending            The children excluded from                    our young children.
one year at age four. This preschool program consisted          the opportunity of a quality
of weekday .5-hour sessions taught in small groups             preschool experience generally
(there was an average of fewer than six children per            suffered the consequences for
teacher) by a certified teacher with at least a bachelor’s      the rest of their lives. and, as if that were not bad
degree, and 1.5-hour weekly home visits and curric-             enough, the rest of society experienced the higher costs
ulum interaction with mothers. The annual cost per              of crime, incarceration, and welfare spending, and
child was about $11,00 in 007 dollars. For further            lower tax revenues. Denying people opportunities to
information on the program and its consequences, see            create successful lives in the name of research is an
Schweinhart et al. (005).                                      inexplicable injustice.
     of the 1 children originally in the study, data               if only this inexplicable injustice were an isolated
from all 116 still alive were collected when they               incident. The real tragedy is that denying children
reached age 40 several years ago. The results are               opportunities for success occurs on a much wider scale
nothing short of remarkable. of the Perry Preschool             right now here in Maine. of course, the exclusion is not
attendees (the treatment group), 65 percent had gradu-          in the name of research. it occurs because early child-
ated from regular high school, compared to only 45              hood educational opportunities are perceived as being
percent of those in the control group. only 6 percent          too costly—especially now in these tight budgetary
of the control group was employed at age 40, compared           times. what is truly costly, however, is status quo. we
to 76 percent of the treatment group. Median annual             simply cannot afford not to make much greater invest-
earnings at age 40 were about 6 percent higher for the         ments in laying the groundwork for successful lives for
group participating in the enriched preschool program.          our young children.
Moreover, 17 percent of the group not participating in
the program was incarcerated at age 40, compared to                               THe PayoFF:
six percent of those with the good fortune of being                     a BRieF SURvey oF THe ReSeaRcH
selected into the high-quality preschool program. even
survival to age 40 was evidently positively affected by
preschool participation (97 percent for the treatment
group compared to 9 percent for the control group).
                                                                a    lthough the Perry Preschool study is the most
                                                                     widely celebrated research on the benefits of early
                                                                childhood programs, it is not alone in demonstrating
Similarly, fewer of the treatment group had received            astounding returns to early childhood programs. For
some form of social services by age 40, and fewer had           more in-depth reviews of the research briefly summa-
used illegal drugs and legal medications. even after            rized below, see currie (001), Karoly Kilburn and
taking the “time value of money” into account (i.e.,            cannon (005), cunha et al. (006), and Blau and
discounting the benefits that occur after the up-front          currie (006).
cost), the value of some of the various benefits to the              The abecedarian study is the other well-known
participants and to society from participation in the           small-scale randomized trial involving young children

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DynaMicS oF inveSTMenTS in yoUnG cHilDRen

                and the collection of long-term longitudinal data. This               The benefits of early childhood interventions were
                program provided full-day, year-round child care with           also shown in the Prenatal/early infancy project, a
                educational emphasis for 5 of 104 at-risk children             small-scale randomized trial of home visitation for low-
                born in chapel Hill, north carolina, in the mid-1970s           income, first-time, young and unmarried mothers in
                (the remaining 51 served as a control group). High-             elmira, new york. in the late 1970s and early 1980s,
                quality child care was provided for the treatment group         numerous and lengthy pre- and postnatal visits were
                from infancy until kindergarten at age five. The cumu-          made by specially trained nurses in a mostly white,
                lative five-year cost was approximately $77,000 per             rural area. The benefits have been estimated to be four
                child in 007 dollars (for further information on the           times the cost. However, the discounted benefit-cost
                cost and benefits of this program, see Barnett and              ratios of other home-visitation programs are generally
                Masse 007). Followed through to age 1, the treated            somewhat smaller than this, although they are still
                group had significantly lower costs in K-1 education           greater than one.
                (from less participation in special education and less                Because of their scientific designs, the results of
                grade repetition), less smoking and illegal drug use,           these programs represent the most highly regarded
                higher rates of high school completion and college              evidence on the effects of early childhood interventions.
                attendance, and greater earnings potential. after               ironically, the academic jury is still out on Head Start, by
                discounting the benefits occurring after participation          far the nation’s largest and best-known program for early
                in the program, the value of some of the benefits was           childhood education. This federally funded and locally
                estimated to be .5 times greater than the cost. The            administered program currently serves almost a million
                benefit-cost ratio for the abecedarian program is much          children (mostly four-year-olds) per year at an annual
                less than for the Perry Preschool program, primarily            cost of about $7 billion. Because of the lack of a control
                because it did not measure any benefits from reduced            group and the difficulties in constructing a comparison
                crime, which accounted for the majority of the                  group that is truly comparable, the evidence on the effec-
                measured benefits from the earlier experiment.                  tiveness of Head Start is mixed.
                                                                                      overall, the literature generally indicates tremen-
                                                                                dous returns from targeted efforts to lay early ground-
      like all other investments, the costs of                                  work for socially and economically successful lives.
                                                                                although more research on the topic narrowing the
      early childhood programs are borne up                                     precision of the estimates of the returns of early child-
                                                                                hood interventions would be useful, it is quite clear
      front, and the benefits accrue later.                                     that the returns can be substantial. Moreover, much
                                                                                of the return accrues to the general public (i.e., greater
                                                                                tax revenues and lower costs of crime, incarceration,
                     The chicago child-Parent center program begun              public health, and welfare). indeed, given the estimated
                in 1967 is a high-quality half-day preschool program            returns, if targeted investments in early childhood
                for at-risk three- and four-year-olds. The annual cost          development were private investment opportunities
                was about $7,500 per preschooler in 007 dollars.               capitalists would have scooped up those windfall-profit
                instead of a small-scale randomized trial, it is a large-       opportunities long ago.
                scale project that has been evaluated by comparing the
                outcomes of the participants to the outcomes of chil-                   $100 BillS lyinG on THe GRoUnD
                dren with comparable socioeconomic backgrounds.
                after discounting the post-preschool consequences,
                the estimated value of the increase in earnings and the
                decreases in the costs of crime, K-1 education, and
                                                                                i nvestments in early childhood education are analo-
                                                                                  gous to proverbial $100 bills lying on the ground
                                                                                waiting to be picked up. To illustrate the principle that
                social insurance was almost eight times greater than            investors seize clearly profitable private investment
                the cost of the program.                                        opportunities, economists often joke that we do not

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see $100 bills just lying around because people would                were only one hand, the choice would be clear.
obviously quickly scoop them up. For public invest-                  investing in disadvantaged young children is
ment opportunities, however, this principle often fails,             one policy where the choice is clear and the
and public investment in our most precious asset is a                two hands clap together…. The good news for
glaring example.                                                     policymakers is that there is strong evidence
      what makes this figurative $100-bills-left-on-the-             that early environments can be enriched and
ground instance particularly tragic is that not only is              that we can offset, in part, the powerful conse-
investment in early childhood development the finan-                 quences of the accident of birth.
cially sensible thing to do, it is also the moral impera-
tive. no reasonable argument can be made against                      it is thus particularly ironic that the typical argu-
improving and equalizing opportunities for successful           ment against devoting more resources to early child-
lives, all else the same. in most instances there is a          hood development is its cost, particularly now in such
severe tradeoff between equity and economic efficiency.         harsh budgetary times. But budgets are always tight.
That is, attempting to equalize incomes through                 if we cannot afford it now, then when? not now often
various social-insurance and public-welfare programs            means never. Moreover, if the debate comes down to
is typically extremely costly in terms of aggregate             just cost, then not making these investments is what is
prosperity. arthur okun famously described this harsh           really costly. The failure to pick up the figurative $100
tradeoff as a “leaky bucket” (okun 1975). a lot of              bills means greater costs in K-1 education, crime and
income is spilled in passing income from the rich to            crime prevention, incarceration, and welfare spending,
the poor. in the case of early childhood interventions,         as well as reduced opportunities for the success of our
though, the bucket is not only watertight, it actually          young people.
fills as greater opportunities are created for disadvan-
taged young children. Unlike perhaps any other egali-                         FailURe To concePTUaliZe
tarian policy, there is no tradeoff between strict fiscal
stewardship and promoting greater equality.
      The leading proponent of the idea above is James
Heckman, a nobel laureate in economics. He recently
                                                                l    ike all other investments, the costs of early child-
                                                                     hood programs are borne up front, and the benefits
                                                                accrue later. it is this initial cost that appears to be the
summarized the argument (Heckman 008):                         obstacle to ensuring quality early starts for the children
      a large body of research establishes that                 of Maine. in my opinion, though, the initial cost is not
      investing in disadvantaged young children                 really the primary obstacle to picking up the figurative
      improves the productivity of the economy and,             $100 bills lying around. no matter how tight budgets
      at the same time, reduces social and economic             get, we manage to fund other investments, such as K-1
      inequality. in the world of politics where                and higher education, and road maintenance, to name a
      “tradeoffs” are the rule, a policy of investing           few. i believe the problem is that we have a difficult time
      in disadvantaged young children is rare. For              imagining the counterfactual, that is, what would occur
      this policy, there is no tradeoff between equity          if we did things differently, or how things are different
      and efficiency, between fairness and economic             now as a consequence of our previous decisions.
      productivity. Sixty years ago, Harry Truman                     if we do not maintain our roads, we can still use
      said he would like to have a one-handed econ-             them for a long time, but we get visible reminders—big
      omist. asked why, he said that every econo-               potholes—that something needs to be done. The lack
      mist he met gave him a menu of choices and                of investment in early childhood education also creates
      not a preferred choice. They would tell him,              big potholes—more spending on special and remedial
      “on the one hand, if you adopt this policy                education, greater spending on police and corrections,
      you will get these benefits and costs; on the             more drug and crime problems, smaller tax base—but
      other hand, if you adopt another policy then              we are unaware that an important cause of these prob-
      there are these benefits and costs.” if there             lems is our insufficient investment in our youngest

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                children. To paraphrase a famous line from the movie               and incarceration, for example, would not show up
                Cool Hand Luke (read this with a theatrical drawl),                in an accounting line labeled “returns to investment
                what we have here is a failure to conceptualize. it is             in early education.” But this does not make the
                this failure to conceptualize future counterfactual cost           returns any more hypothetical or any less real than
                savings that leads us to believe that the budget is too            if actual dollars were exchanged every time a child
                tight right now, and investment in our young children              is prevented from repeating a grade or spending time
                is not an urgent priority.                                         in detention. of course, more research quantifying
                     a fairly well known academic economist, lee                   these difficult-to-measure benefits would help us to
                Hansen at the University of wisconsin, joked to his                better visualize the counterfactual consequences, but
                graduate students that “if you can’t measure it, it might          the primary obstacle is the preoccupation with explicit
                as well not exist.” Unfortunately, there is too large a            monetary transactions. it is the preoccupation with
                grain of truth in this. we do not readily see the benefits         what is easily measurable that has led to all sorts of
                of early childhood education, so in policy discussions             economically inefficient policies, such as allowing
                they might as well not exist. consequently, too much               too much environmental degradation. we must hope
                of our spending goes to costly band-aids—remedial and              that this improves over time with improved ability
                special education, corrections, and welfare—rather than            to estimate values of things that do not involve market
                to relatively inexpensive prevention. Given the magni-             transactions.
                tudes of the costs of these band-aid programs (see Table                 also contributing to doubts about the payoff from
                1 for examples) prevention only needs to have small                early childhood interventions is the rather large range
                effects to lead to big savings.                                    of estimated benefit-cost ratios. The ratios in the case
                                                                                   studies noted above ranged from greater than nine to
                                                                                   less than three. This suggests uncertainty about the
                TABLE 1:    selected Maine state and                               value of the benefits of early education programs.
                            local Government spending
                            in FY 2005–06                                          actually, the benefit-cost ratios vary not because of
                                                                                   uncertainly about the values of the benefits, but rather
                                                                                   because of which benefits can be measured in each case.
                                              total           Per Capita           For example, some studies do not measure the value of
                 Public Welfare         $2,496,584,000          $1,903             the reduction in crime, other studies do not include the
                 special education        $282,763,474            $215             value of better health, some do not include the benefits
                                                                                   that accrue over entire lifetimes, and so on. The lower
                 Police Protection        $221,288,000            $169
                                                                                   range of cost-benefit ratios are mostly due to including
                 Corrections              $182,639,000            $139             the value of fewer benefits in the calculations. Hence,
                                                                                   the most complete estimates are generally in the upper
                source: special education expenditure is from the Maine            range of cost-benefit numbers.
                department of education. all other data are from the u.s.
                Census bureau.
                                                                                              wHy THe PayoFF iS So HiGH

                      The net benefits of early education are not readily
                seen for two reasons. First, the hazards of inadequate
                development in early childhood are latent, that is, not
                                                                                   P   erhaps another obstacle to making significantly
                                                                                       greater investment in early childhood develop-
                                                                                   ment is that the purported return is almost too high
                observed until much later. if the same hazards (proba-             to believe. it is like the joke about the two econo-
                bilities of incarceration, drug abuse) were immediate,             mists who walk past a $100 bill lying on the ground.
                such as providing alcohol to minors, they almost                   neither will pick it up because a real $100 bill lying
                certainly would be illegal. Second, there is no explicit           on the ground is just too good to be true. in the case
                exchange of dollars when the latent effects occur.                 of investment in the human capital of preschool chil-
                Thus, the subsequent costs savings in K-1 education               dren, though, there is a straightforward reason for

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the extraordinarily high returns. it has to do with the          keeping momentum from the start. if you start from a
nature of human capital accumulation.                            standing stop on the steepest part, you are unlikely to
      The more skills one learns, the easier it becomes          make it up the hill. Thus, it is the beginning that
to learn additional skills. as nobel Prize laureate James        generates the momentum for the hardest part that is
Heckman (000: 4) has written, “early learning begets            crucial. Having enough early momentum to get
later learning and early success breeds later success.”          through the inflection point (where the slope starts to
Human capital accumulation has a self-productive                 diminish) makes the rest of the hill relatively easy.
aspect. in other words, the production of human capital          Reaching academic, social, and economic summits is
is characterized by dynamic complementarity: the impact          like this biking example. The production profile of
of investment in human capital at a particular time in           human capital is shaped like a hill.
the life cycle affects, and is affected by, investments in
human capital at other times in the life cycle. This is
analogous to the “miracle of compound interest” with                           For far too many disadvantaged young
financial investments, but is considerably stronger in the
case of human capital accumulation, which is why                               children, our expensive investments in
investing early and often is so important and why the
payoff can be so high. it is also why later investments in                     their educations are largely ineffective
children’s human capital are also important. For far too
many disadvantaged young children, our expensive                               because of insufficient development
investments in their educations are largely ineffective
because of insufficient development in early childhood.                        in early childhood.
conversely, greater investments in early childhood invest-
ments would be largely ineffective if they come from
substantial cuts in investments in primary, secondary,                 There is also empirical evidence on the other side of
and tertiary education (although greater early childhood         the dynamic-complementarity issue. That is, the returns
investments will lead to later reductions in the costs of        to early investments in human capital depend
remedial education).                                             on the extent of later investments. The high returns to
      indeed, the first several years of education, and          early interventions are contingent on continued invest-
presumably preschool, have little direct economic                ment. To go back to the biking-up-a-hill analogy, although
payoff (for evidence on this, see Trostel 004;                  effort before the steepest part of the hill may be the most
Heckman, lochner and Todd 008). as common sense                 crucial, continued effort all the way up is needed to reach
would suggest, the payoff from the first years of                the summit. even past the inflection point where the slope
schooling is in preparing the student for later years            starts becoming less steep, coasting and losing momentum
of schooling, and those years have a direct economic             can still lead to failure. For example, some research has
return (for further discussion on this point, see cunha          found that the initial gains in academic achievement tests
et al. 006; cunha and Heckman 007). also, for                  from participation in Head Start “faded out” in elemen-
those falling behind initially it is difficult, even impos-      tary school because the former Head Start participants
sible, to catch up. adverse early childhood experiences          generally attended poorer schools (see currie and Thomas
can create a permanent barrier to success in life.               000). Thus, early and sustained investment creates the
      The empirical evidence on the nature of human              compounding effect.
capital accumulation suggests that achieving economic
success through education is analogous to climbing a                                     caveaTS
hill. imagine biking and being at the bottom of a big
hill. The crucial part of the effort up the hill is where
it starts to get steep. The key to getting through this
tough part where the road turns upward is having and
                                                                 T   wo important points should be stressed about esti-
                                                                     mates of the returns to investment in early child-
                                                                 hood development.

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                     First, because of the dynamic complementarity, the               The second, more well-known, caveat about esti-
                return to early childhood investments is contingent on          mated benefits of investment in early childhood devel-
                later human capital investments. consequently, the rate         opment is that almost all the estimates are from
                of return at various stages of investment in human              targeted interventions. That is, the estimates are for
                capital is not well defined. The rate of return to invest-      children the most at risk for low educational, social,
                ment at a specific stage of human capital accumulation          and economic outcomes. The benefit-cost ratios for
                depends on one’s perspective, that is, on the particular        such targeted interventions are surely higher than for
                thought experiment being considered. The return esti-           early childhood programs for the broader population.
                mated from a preschool intervention, for example,               a far higher proportion of non-at-risk children are
                implicitly holds all else constant, including the quantity      on their way to successful lives without new programs.
                and quality of later schooling. Similarly, the estimated        it is unclear, however, to what extent the benefit-cost
                return for high school or college graduation, for               ratio would be lower for a wide-reaching early child-
                instance, implicitly holds the quantity and quality of          hood program. Karoly and Bigelow (005), however,
                preschool and primary education constant. But these             calculated that the returns to a universal preschool
                stages of education are unlikely to be independent of           program would not be dramatically less than the
                each other. So, there is no clear cut way to unambigu-          returns to targeted programs. The benefit-cost ratio
                ously isolate the benefits of a specific stage of educa-        in their baseline case, after discounting the future bene-
                tional development. in other words, research studies            fits, was .6. Thus, as programs for early childhood
                examining different stages of preschool or school could         development reach a wider population, evidently the
                attribute the same benefits (higher earnings and tax            larger the net benefits for society. The policy goal
                revenues, lower costs of incarceration and welfare) to          should not be to achieve the higher benefit-cost ratio,
                different levels of human capital development.                  but rather to undertake all policies with benefit-cost
                                                                                ratios greater than one.

    it is rare that a public policy choice does                                                     conclUSion

    not present difficult tradeoffs, but greater
    investment in young children is such a case.
                                                                                T    he evidence is steadily mounting that investing
                                                                                     in early childhood development pays in a big way.
                                                                                it benefits the children for the rest of their lives. it
                                                                                also benefits society with reduced crime and reduced
                                                                                government spending in other areas. Moreover, it
                     This has important policy implications, but this           benefits society in terms of being the right thing to do
                point has been overlooked in the mushrooming litera-            (which clearly has value too). it is rare that a public
                ture on the returns to early childhood programs (as             policy choice does not present difficult tradeoffs, but
                well as in the literature on the returns to high school         greater investment in young children is such a case.
                and college graduation). The failure to account for the              as i see it, the real obstacle preventing us from
                dynamic complementarity between human capital                   taking advantage of the windfall-profit opportunities of
                investments can misguide policy. The estimated returns          investing in our young children is the lack of aware-
                from a specific preschool intervention, which implicitly        ness. The cause-and-effect relationships between early
                hold all else constant, do not generalize for a realloca-       childhood learning and later-life consequences are
                tion of preschool and school funding. The apparent              underappreciated, and our spending priorities lean too
                “fade out” of the benefits of Head Start serves as a good       far toward treating the symptoms rather than on low-
                lesson in this regard. it is important to keep in mind          cost prevention. in a 009 press release from the
                the specific experiment from which the estimated                Highscope educational Research Foundation, Sanford
                returns were derived.                                           newman, founder of Fight crime: invest in Kids, put a

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particularly eloquent point on this: “…we need to be
as willing to guarantee our kids space in a pre-kinder-
garten program as we are to guarantee a criminal a                 heckman, James J. 2008. “investing in disadvantaged
prison cell” (                              young Children is good economics and good
                                                                      Policy.” Presented at the american education
asp?contentid=8). indeed, we should be more                         Finance association annual Conference, denver,
willing to guarantee our kids quality early childhood                 Co.
education than later-life band-aids.
                                                                   heckman, James J., lance J. lochner and Petra e.
     whenever i think about the issue of early child-                 todd. “earnings Functions and rates of return.”
hood investments, i recall the old long-running ad                    Journal of human Capital 2(1): 113–125.
campaign of a well-known muffler business—where the                karoly, lynn a. and James h. bigelow. 2005. the
mechanic chuckles at the end “well, you can pay me                    economics of investing in universal Preschool
now, or you can pay me (a lot more) later.” Basic main-               education in California. rand, santa Monica, Ca.
tenance on a car is an obvious way to prevent expensive            karoly, lynn a., M. rebecca kilburn and Jill s. Cannon.
problems later. if only we could see early childhood                  2005. early Childhood interventions: Proven
development as an obvious way to prevent expensive,                   results, Future Promise. rand, santa Monica, Ca.
and inequitable, problems later.                                  okun, arthur M. 1975. equality and efficiency: the big
                                                                      tradeoff. brookings institution, Washington, dC.
                                                                   schweinhart, lawrence J., Jeanne Montie, Zongping
                                                                      Xiang, William s. barnett, Clive r. belfield and
                                                                      Milagros nores. 2005. lifetime effects: the high/
                                                                      scope Perry Preschool study through age 40.
                                                                      high/scope Press, ypsilanti, Mi.
  barnett, W.s. and leonard n. Masse. 2007.
                                                                   trostel, Philip a. 2004. “returns to scale in Producing
     “Comparative benefit-Cost analysis of the
                                                                      human Capital from schooling.” oxford economic
     abecedarian Program and its Policy implications.”
                                                                      Papers 56(3): 461–484.
     economics of education review 26(1): 113–25.
  blau, david and Janet Currie. 2006. “Pre-school, day
     Care, and after-school Care: Who’s Minding the
     kids?” handbook of the economics of education,
     vol. 2, ed. eric a. hanushek and Finis Welch.
     elsevier, amsterdam.
                                                                                                 Phillip Trostel is a professor
                                                                                                 of economics and public
  Cunha, Flavio and James heckman. 2007. “the
     technology of skill Formation.” american                                                    policy at the university of
     economic review 97(2): 31–47.                                                               Maine, where he holds a
  Cunha, Flavio, James J. heckman, lance lochner                                                 joint appointment in the
     and dimitriy v. Masterov. 2006. “interpreting the
     evidence on life Cycle skill Formation.” handbook
                                                                                                 Margaret Chase smith Policy
     of the economics of education, vol. 2, ed. eric a.                                          Center and the school of
     hanushek and Finis Welch. elsevier, amsterdam.                                              economics. he is an applied
  Currie, Janet. 2001. “early Childhood education                                                micro-economist special-
     Programs.” Journal of economic Perspectives
     15(2): 213–238.                                             izing in public finance, with a research focus on education

  Currie, Janet and duncan thomas. 2000. “school
                                                                 policy, human capital, and fiscal policy. a recent research
     Quality and the longer-term effects of head start.”         interest is the economics of early investments in human
     Journal of human resources 35(4): 755–774.                  capital. in 2007 he served as a member of the Maine legisla-
  heckman, James J. 2000. “Policies to Foster human              ture’s Commission to develop a strategic Priorities Plan for
     Capital.” research in economics 54(1): 3–56.
                                                                 Maine’s young Children.

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                         in Maine’s                                     Dana F. Connors describes how the business commu-

                          youngest                                      nity has become involved in the dialogue to help steer

                                                                        planning for investments in Maine’s youngest chil-

                      children Has                                      dren. He acknowledges that there are high costs in

                      Great Returns                                     failing to invest early and notes that creating skilled

                                                                        workers requires building the foundation in the first

                       for Business                                     few years of the worker’s life. He stresses that high-

                                                                        quality early education and care are vital for both
                                              by dana F. Connors
                                                                        individual and statewide economic security.       

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                                                                                                    create a skilled

i  n spite of rising unemployment, every day there
   are Maine businesses struggling to find qualified
workers for current jobs. employers are willing to
                                                                childhood. we had frank and
                                                                honest discussions about what
                                                                public policy is, and should be,
                                                                                                             worker at age 18

pay competitive wages with good benefits for skilled            for Maine’s youngest citizens—               or 22, we need to
workers. yet, workers with the knowledge, skills, and           our future workers.
abilities businesses need too often are so elusive that               we learned about amazing               start building the
jobs go unfilled.                                               new early brain science research.
     State government, higher education, and                    it gave us pause to consider our             foundation in the
employers have been grappling for decades with how              current public policies, which
to create a skilled workforce, so that Maine businesses         place the lowest priority on                 first few years of
have access to a pool of workers with knowledge,                spending public resources during
adaptability, innovative thinking, self-awareness, self-        the time when a person establishes           that worker’s life.
discipline, persistence, and empathy. what we are               the neurological connections that
beginning to learn is that to create a skilled worker at        lay the foundation for all intellec-
age 18 or , we need to start building the foundation          tual, emotional, social, moral, and
in the first few years of that worker’s life.                   physical development. in fact, when compared to every
     in recent years, some community and state leaders          dollar spent on school-aged children, Maine is investing
are redirecting their focus to early childhood. Using the       less than nine cents on our youngest children.
science of early brain research, these leaders promote                we talked about research by Dr. James Heckman,
the idea that investing in Maine’s youngest children            nobel laureate in economics, that confirms a child’s early
can result in more productive and contributing citizens         years provide the foundation for cognitive, linguistic,
who, in turn, strengthen our economy. among recent              social, and emotional healthy human development.
steps to smarter public policy is Governor Baldacci’s           Heckman (000: 7) helped us to focus our attention
decision to bring business leaders into this discussion         when he wrote:
by creating the Business Roundtable on early                         an important lesson to draw from the entire
childhood investment in 008. i am pleased to co-                    literature on successful early interventions is
chair this roundtable with Department of economics                   that it is the social skills and motivation of the
and community Development commissioner John                          child that are more easily altered—not iQ.
Richardson.                                                          These social and emotional skills affect perfor-
     The business community is now included as a                     mance in school and in the workplace. we too
voice in the Maine children’s Growth council, which                  often have a bias toward believing that only
will revise, prioritize, and help to steer Maine’s state             cognitive skills are of fundamental importance
plan for early investments in our youngest citizens.                 to success in life.
on the national front, there is a new organization of
business leaders, america’s edge, coming together to                 we also learned a great deal about the unmet need
begin a dialogue with federal and state officials about         of Maine’s youngest children and their families. as
the need to invest early in high-quality education and          discussed throughout this issue of Maine Policy
care for america’s future generations. i am pleased to          Review, there are approximately 67,000 Maine chil-
be a member of both the Maine children’s Growth                 dren under the age of five. Seventy percent of Maine’s
council and america’s edge.                                     current workforce is made up of those children’s
     in november 007, prior to the creation of the             parents. with 46,000 working parents with children
Business Roundtable on early childhood investment,              under the age of five, high-quality early care and educa-
dozens of Maine business leaders joined educators,              tion is good for Maine business. yet, in Maine there
social workers, scientists, law enforcement leaders,            are fewer than 4,000 licensed day care slots, only 17
medical professionals, policymakers, and other commu-           percent of which have been rated “high-quality” (see
nity leaders at a two-day summit to talk about early            lahti et al. this issue).

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TABLE 1:    Net savings per
            Child for investments
            in early Childhood
                                                      if parents know their chil-      demonstrated the life-long impact of high-quality
                                               dren are receiving the highest-         preschool programs. The chicago child-Parent center
 high/scope Perry            $244,811a         quality care while they work,           preschool program showed that similar gains were
 Preschool program                             we will have higher employee            possible for a preschool program serving over 100,000
 abecedarian Project         $ 94,802 b        morale, reduced absenteeism,            inner-city children. (See Trostel this issue for a full
 Chicago Child-Parent        $ 70,977c
                                               increased retention, and                discussion of these programs and their outcomes.)
 Centers                                       increased productivity. That                  Policymakers and business leaders have rarely
                                               translates into lower employee          viewed early childhood development as a growth or
anores et al. (2005).                          turnover and lower recruiting           competitiveness strategy. But the research is persuasive
bbarnett and Masse (2007).                     and training costs. in addition         that dollars invested in early childhood development
creynolds and temple (2006).                   to the benefits to today’s              provide extraordinary returns compared with most
                                               working parents and their               other types of investments. analysts have calculated
                                               employers, there are also future        the various savings from reduced crime, lower special
                   benefits. By providing the highest-quality care and educa-          education costs, increased productivity, and other
                   tion when our children are developing their critical                factors and concluded that the benefits to society far
                   learning platforms for later in life, we are making a wise          outweigh the costs of providing a good start in life to
                   investment in those who will become our future work-                kids who may not have it. Table 1 shows the per-child
                   force and our future business leaders.                              savings calculated for the three projects described here.
                        The measurable outcomes for young children who                       as business leaders increasingly realize the magni-
                   attend high-quality early care and education programs               tude of these benefits, they also are becoming stronger
                   are impressive. nationally, less than half of kinder-               advocates for these early investments. For example,
                   garten students have the skills needed to begin and                 according to a Zogby international Poll commissioned
                   succeed in their first year of school. in the lowest                by the committee for economic Development, 81
                   income kindergarten classrooms, just 5 percent of                  percent of business leaders believe that public funding
                   students are “school ready.” yet, achievement gaps                  of voluntary pre-kindergarten programs would improve
                   narrow considerably when high-risk children are                     america’s workforce.
                   provided high-quality early care and education.                           Failure to invest in high-quality early care and
                        Three long-term, carefully researched studies—                 education has been costly for Maine. currently, we
                   one begun in 196—have shown that children in high-                 spend more than $00 million annually in special
                   quality early learning programs have higher rates of                education costs and more than $800 million annually
                   high school graduation and college attendance, lower                on substance abuse along with exorbitant criminal
                   dropout rates, and earn higher incomes than the                     justice costs. Just one teen who becomes a criminal
                   study participants who did not receive the preschool                and stays in our criminal justice system as an adult
                   programs. The most persuasive data come from a 40-                  costs Maine $.5 million over the course of that life-
                   year study at the High/Scope Perry Preschool Project                time (cohen and Piquero 009).
                   in ypsilanti, Michigan. From 196 to 1967, preschool                      estimates of the return on investment for high-
                   teachers worked intensively with low-income african-                quality early education programs for low-income
                   american children aged three to four and then followed              children range from $4 to $17 for every $1 spent,
                   these children and a control group of like children                 depending on the program. in many cases, these early
                   throughout their lives. in another study, researchers               childhood investments produce greater returns than
                   at the University of north carolina set up a careful                most other economic development projects. what we
                   long-term test of the abecedarian Program, where low-               are finally starting to understand is that we need to
                   income children were randomly assigned either to a                  invest earlier in children’s lives to ensure that every
                   group that received early child development and educa-              child gets the right start in life.
                   tion services from birth through age four, or to a second                 as business leaders accustomed to analyzing
                   group that did not receive the program. Both projects               proposals based on cost-benefits and return on invest-

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ments, members of the Business Roundtable on
early childhood investment were asked to provide
leadership on this issue and recommend sound public                RefeRences
policy. we identified three priorities for investments             barnett, W. steven and leonard n. Masse. 2007.
for immediate action:                                                 “Comparative benefit-cost analysis of the
                                                                      abecedarian Program and its Policy implications.”
   1. Develop a network of public, private, and                       economics of education review 26:113–125.
      nonprofit partnerships to create and sustain
                                                                   Cohen, Mark a. and alex. r. Piquero. 2009. “new
      Maine’s comprehensive early childhood                           evidence on the Monetary value of saving a high
      system, and establish a nonprofit state-                        risk youth.” Journal of Quantitative Criminology
      level entity that accepts public and private                    25:25–49.
      funding, conducts ongoing resource devel-                    heckman, James. 2000. the real Question is how to
      opment, provides grant-making and service                       use the available Funds Wisely. the best evidence
      purchase activities, maintains a consistent                     supports the Policy Prescription: invest in the very
      bipartisan focus, and holds accountable                         young. university of Chicago and the ounce of
                                                                      Prevention Fund, Chicago.
      the myriad levels of Maine’s growing early
      childhood system.                                            lahti, Michel, rachel Connelly, georgia n. nigro and
                                                                      rebecca Fraser-thill. 2009. “Working Parents and
   . Develop a statewide “invest early”                              Child Care: Charting a new Course for Quality.”
      campaign about Maine’s moral and fiscal                         Maine Policy review 18(1): 94–104.
      responsibility and the value of investing in                 nores, Milagros, Clive r. belfield, W. steven barnett
      young children and encourage public and                         and lawrence schweinhart. 2005. “updating
      private investments that support Maine                          the economic impacts of the high/scope Perry
                                                                      Preschool Program.” educational evaluation and
      parents and primary caregivers in learning                      Policy analysis: 27(3): 245–261.
      and practicing healthy, effective child devel-
                                                                   reynolds, arthur J. and Judy a. temple. 2006.
                                                                      Prevention and Cost-effectiveness in early
   . Promote public and private investments                          intervention: a 20-year Follow-up of a Child-Parent
                                                                      Center Cohort. humphrey institute of Public affairs,
      that will increase the number of quali-
                                                                      university of Minnesota, Minneapolis.
      fied early childhood professionals and that
      improve the training, education, and quality                 trostel, Philip. 2009. “the dynamics of investments in
                                                                      young Children.” Maine Policy review 18(1): 18–25.
      of Maine’s early childhood professionals.

     in the fall of 009, the Business Roundtable
will be hosting six regional business leader summits                                            Dana f. connors is president of the
on early childhood. it is my hope that Maine busi-                                              Maine state Chamber of Commerce.
nesses, large and small, will join in this discussion
                                                                                                he is co-chair of the governor’s business
community by community, and help us to build the
high-quality early childhood system we all want and                                             roundtable on early Childhood initiatives,
all Maine children deserve. The costs of failing to act                                         and is a member of the Maine Children’s
are simply too great. High-quality early education                                              growth Council and of america’s edge.
and care is vital for our individual and statewide                                              he was a presenter at the 2007 governor’s
future economic security. Maine does not have a                                                 economic summit on early Childhood and
single potential worker to waste. 
                                                                                                also spoke at the national 2008 telluride
                                                                 economic summit on early Childhood investment.

View current & previous issues of MPR at:            volume 18, number 1 · Maine Policy Review · 9
DaTa collecTion in Maine

                Data collection
                     in Maine:                                            To better understand the outcomes of investments in

                                                                          early childhood, we need comprehensive data to
                     Assessing the Return
                                                                          measure benchmarks, according to Judy Reidt-
                     on Public Investment
                                                                          Parker. She describes the current state of data collec-
                          in Maine’s Early
                                                                          tion in Maine and discusses data that are needed
                       Childhood System                                   and where there are opportunities for improvement.
                                              by Judy reidt-Parker
                                                                          The greatest need is for the development of a common

                                                                          set of child and program outcomes that can be shared

                                                                          across departments and systems and for linking

                                                                          systems so that children’s progress can be followed

                                                                          longitudinally.   

0 · Maine Policy Review · Summer/Fall 009              View current & previous issues of MPR at:
                                                                                                         DaTa collecTion in Maine

                                                                                Maine children’s Growth council

a    s discussed throughout this issue of Maine Policy
     Review, early childhood experiences and learning
opportunities have a significant impact on a child’s
                                                                the Maine Children’s growth Council was created by state statute
                                                                to achieve sustainable social and financial investment in the healthy
future success in life. we understand that the posi-            development of Maine’s young children and their families. the group
tive impact of early childhood programs is directly             is comprised of two members of the senate, one from each of the
dependent on the level of program quality (national             two political parties having the greatest number of members in the
Scientific council 007). Moreover, as Trostel (this            senate, appointed by the president of the senate; two members of
issue) describes, economists have determined that               the house of representatives, one from each of the two political
investments in early childhood programs provide a               parties having the greatest number of members in the house,
more significant return on interventions than at any            appointed by the speaker of the house; the governor or the gover-
other stage in an individual’s life.                            nor’s designee and the attorney general or the attorney general’s
      To accurately evaluate the quality, affordability,        designee; three parents, at least one of whom has a young child, one
accessibility, and outcomes of Maine’s early childhood          each appointed by the governor, the president of the senate and the
systems, quantifiable and credible benchmarks are               speaker of the house; two persons with experience in public funding
essential. currently, comprehensive data to establish           and philanthropy, appointed by the president of the senate; one
and monitor these benchmarks are not readily avail-             person representing child abuse and neglect prevention, appointed
able, even though a substantial amount of information           by the speaker of the house; one person representing postsecondary
is being collected within and across the departments of         education, appointed by the governor; eight persons representing
state government.                                               statewide, membership or constituent organizations that advance
                                                                the well-being of young children and their families, nominated by
       DaTa we Have anD DaTa we neeD                            their organizations and appointed by the governor; one person
                                                                representing a statewide association of business and industry and
                                                                one person representing a business roundtable on early childhood
i  n 008, the children’s Growth council (cGc)
   began work to establish baseline standards for an
annual report on the status of children and early child-
                                                                investment, appointed by the governor; up to eight members of
                                                                the public, appointed by the governor; three ex-officio nonvoting
hood programs throughout Maine. (See sidebar for                members: the commissioner of education or the commissioner’s
description of the cGc.) This effort revealed signifi-          designee, a department of health and human services employee
cant gaps in data compilation and collation. child and          who works with early childhood programs including head start, and
program outcomes that can be consistently tracked               a person representing the office within the department of health and
over time must be developed and then objectively                human services that is the fiscal agent for the federal grant program
analyzed; however, much of the existing information             for comprehensive early childhood initiatives; and the director of the
is limited to a listing of numbers of families served,          head start collaboration project within the department of health and
or days attending a program. current data are not               human services, office of Child Care and head start.
representative of all aspects of early childhood. if
we are to truly assess the efficacy of investing in early       the Council reviews and addresses recommendations of legisla-
childhood, however, we need a data collection system            tive studies, advisory committees and the Children’s Cabinet and
that is designed to measure the impact of public policy.        is responsible for implementing the long-term plan for a unified,
an essential component of any future data systems               statewide early childhood services system, invest early in Maine.
planning is the development of a central clearinghouse          the council must coordinate state and community providers and
to collate the data from all the relevant departments           partners in this effort.
and provide an objective analysis. This system must be
comprehensive and include data encompassing prenatal            source: Maine state legislature. 2009. an act to amend the
care through adulthood, compiling data currently                laws governing the Maine Children’s growth Council. http://www.
housed in diverse information silos.                  
      evidence strongly indicates that early childhood          [accessed august 19, 2009]
health is directly related to later success or struggles in

View current & previous issues of MPR at:         volume 18, number 1 · Maine Policy Review · 1
DaTa collecTion in Maine

                adult life (Reynolds et al. 007). Therefore, the develop-       the efficacy of policies related to education, early inter-
                ment of a comprehensive data system should begin with            vention, child welfare, and behavioral health. it would
                the health data collected during prenatal care. linking          also allow for an analysis of data across systems, so, for
                the data collected by the Maine center for Disease               example, the impact of health interventions on educa-
                control (cDc) regarding prenatal health to early child-          tional outcomes can be explored.
                hood health, child care and education data would be a                 another significant gap in data for the early child-
                significant step toward the first part of a longitudinal         hood system is a common set of school-readiness indi-
                data approach. The early Periodic Screening Diagnosis            cators. The establishment of such indictors, aligned
                and Treatment (ePSDT) system, which follows the                  with the State of Maine Early Childhood Learning
                american Pediatrics Bright Futures standard, a system            Guidelines and reported statewide by all school depart-
                already established statewide, could be a key starting           ments, would provide data to inform public invest-
                point for child health data. Known to parents as the             ments and professional development priorities for the
                “well-child visits,” this process is implemented by              early childhood system. Reflecting the core elements of
                doctors statewide, for all children regardless of income         the Maine Learning Results (K-1), the purpose of
                or funding source. a variety of data are collected through       the Early Childhood Learning Guidelines is to help
                this method over an extended period of time, from the            early care and education practitioners improve practice
                first postnatal visit until a child reaches adulthood. a         and programs for young children ages three through
                first step will be to determine what currently collected         their entrance into kindergarten. The data related to
                data could be used longitudinally and to develop a               the proposed school-readiness indicators could be
                method for linking those data to child outcomes such             collated and analyzed in the context of clearly defined
                as obesity or mental health issues.                              outcome measurements, grounded in the already estab-
                                                                                 lished early learning guidelines, and linked to the K-1
                                                                                 learning results. These measurements would provide an
      the pressing charge for the CgC                                            assessment of the public policies designed to improve
                                                                                 child outcomes and should connect with longitudinal
      [Children’s growth Council] is to iden-                                    data to assure that the policies implemented provide
                                                                                 the greatest possible return on investment.
      tify a common set of child and program
                                                                                       oPPoRTUniTieS FoR iMPRoveMenT
      outcomes that can be shared across
      departments and systems, using                                             i  n 009, the Maine legislature passed a law requiring
                                                                                    schools to report Social Security numbers, thus
                                                                                 establishing a potential link for tracking non-identifi-
      compatible data collection practices.                                      able data about children across child-serving agen-
                                                                                 cies of state government.1 Most departments in state
                                                                                 government already use Social Security numbers as
                     assuring that child health data are then linked with        participant identifiers. a number of federal funding
                data from the Department of education is of paramount            opportunities are available to support the establishment
                importance. The basic understanding of early interven-           of an infrastructure that makes use of this new ability
                tion services is that the long-term impact of a disability       for a comprehensive assessment of early childhood
                or developmental or social or environmental challenge            systems. with many state departments in the process of
                can be reduced when treatment or intervention begins at          upgrading their database systems, Maine has a unique
                an early age. Developing a collection and analysis system        and immediate opportunity to develop a system to
                that provides longitudinal data on child outcomes from           track individual and program outcomes reflective of
                the early childhood system until graduation would                public investments and policies across all state child-
                provide policymakers with substantial information on             serving agencies.

 · Maine Policy Review · Summer/Fall 009                     View current & previous issues of MPR at:
                                                                                                                 DaTa collecTion in Maine

     Data collection within departments is often
limited in scope and frequently driven by federal
reporting requirements, rather than by the need for                enDnOTes
parallel data collection across programs, departments,             1. the state law also provides an opt-in provision
and systems. Developing cross-department, cross-                      for parents. if schools are required to provide
systems working agreements that allow for data to                     social security numbers, the numbers will not be
                                                                      provided to the department of education without
reflect individual and program outcomes must be
                                                                      written parental consent. in many states in the u.s.,
established. at the same time, assuring the right to                  data are linked across systems without relying
privacy for the birth to five-year-old population is                  exclusively on social security numbers, which can
essential and can be achieved. Maine has already devel-               be unreliable, and are not required to link child or
oped ethical data collection methods that have been                   public data.
reviewed and approved by the related federal funding
agencies. These methods provide an appropriate                     RefeRences
standard for assuring longitudinal data is collated
                                                                   national scientific Council on the developing Child.
and reported in a manner that provides sufficiently                   2007. the science of early Childhood development:
specific data without revealing an individual’s identity.             Closing the gap between What We know and
     Maine has the potential to track child and                       What We do.
program outcomes in a broad range of early childhood                  [accessed July, 2009]
domains, including child health, early care and educa-             reynolds, arthur J., Judy a. temple, suh-ruu ou,
tion programs, child welfare, and behavioral health                   dylan l. robertson, Joshua Mersky, James W.
provided that the relevant departments of state govern-               topitzes and Michael d. niles. 2007. “effects of a
                                                                      Preschool and school age intervention on adult
ment work collaboratively to share data. The develop-
                                                                      health and Well-being: evidence from a Chicago
ment of uniform statewide school-readiness indicators                 longitudinal study.” Paper presented at the bien-
is an essential element of these efforts.                             nial meeting of the society for research in Child
                                                                      development, March 30, 2007, boston, Ma. http://
                                                                      [accessed september 6, 2009]

T    he pressing charge for the cGc is to identify a
     common set of child and program outcomes that
can be shared across departments and systems, using
                                                                   trostel, Philip. 2009. “the dynamics of investments in
                                                                      young Children.” Maine Policy review 18(1): 18–25.

compatible data collection practices. next, the cGc
must develop and initiate a process that will establish
cross-system working agreements for the development
of a comprehensive, longitudinal assessment of the                                                Judy Reidt-Parker is a childhood specialist
early childhood system in Maine.                                                                  at the Maine Children’s alliance, with exten-
     Research supports the finding that programs deliv-                                           sive experience in the design and manage-
ering significant return on investment have four
                                                                                                  ment of early childhood programs. as a
common elements, regardless of design (national
Scientific council 007): targeted service populations,                                           member of the educare state leadership
integrated programming, quality standards, and                                                   team and the Children’s growth Council
outcome-based program evaluation. The cGc should                                                  (CgC), she is engaged in the review and
use those four elements as the basis for the develop-                                             assessment of the early childhood systems
ment of any data infrastructure and for all recommen-                                             in Maine and has been responsible for
dations related to early childhood public policy. 
                                                                 leading the effort to develop a baseline report for the CgC regarding data
                                                                 for children birth through five years.

View current & previous issues of MPR at:             volume 18, number 1 · Maine Policy Review · 
FaMily econoMic SecURiTy

                                 economic                            Research shows that family economic insecurity when

                                   Security                          children are very young can have lifelong effects. Ann

                                                                     Acheson gives an overview of patterns of poverty and

                                              by ann acheson         family economic insecurity in Maine, including the

                                                                     marked regional differences in poverty, income, and

                                                                     employment in the state. She describes some of the

                                                                     key benefits and programs to help support lower-

                                                                     income families and examines current policies and

                                                                     policy recommendations for addressing poverty and

                                                                     economic insecurity. Acheson notes that while Maine

                                                                     has been progressive in many of its policies that

                                                                     support family economic security, states can’t do it

                                                                     all, since much of the program and benefits funding,

                                                                     along with policies and eligibility requirements, are

                                                                     from federal sources.   

4 · Maine Policy Review · Summer/Fall 009         View current & previous issues of MPR at:
                                                                                                          FaMily econoMic SecURiTy

                                                                                                            …poverty or family
                                                                trative version of the measure,
                  inTRoDUcTion                                  are used in determining eligi-                 financial insecu-
                                                                bility for many government
                                                                                                               rity when children
M      aine’s young children need multiple kinds of
       supports to survive and thrive. Policies that
promote health, education, and strong families improve
                                                                and non-government programs.
                                                                Both thresholds and guidelines
                                                                are updated annually based                     are very young
the chances for healthy development, school readiness,          on changes in the consumer
and later life success (national center for children            price index1                                   can have lifelong
in Poverty 009a). This article focuses on the family                Maine’s individual poverty
domain, specifically, family economic security. Family          rate has increased since 000,                 effects….
economic security is defined as a “family’s ability to          when it was 9. percent, to 1.
meet its financial needs in a way that promotes the             percent in 007, the most recent
health and well-being of children and their parents             year for which both county and
in both the short and long term” (cauthen 007: 4).             state-level figures are available. Maine’s poverty rate
components include income (adequacy of amount                   has been somewhat below the national average for at
relative to expenses; stability; predictability); savings,      least the past eight years. However, there are marked
assets and other forms of wealth; and human and social          regional variations in poverty rates both from one
capital (e.g., education, skills, employment experi-            county to another and from one community to
ence). Research clearly demonstrates that poverty or            another. Some of Maine’s counties (aroostook,
family financial insecurity when children are very              Franklin, Piscataquis, Somerset and washington)
young can have lifelong effects, ranging from poor              have poverty rates considerably above both the state
health, emotional and behavioral problems, and school           and national average (see Figure 1, page 6) (acheson
difficulties, to lowered educational levels, lower earn-        006, 007). The poverty rate for children is even
ings, and even to higher rates of crime later in life           higher than for the population as a whole; in 007,
(wagmiller et al. 006).                                        in Maine 19.4 percent of children age birth to five
      This article gives an overview of poverty and             were living in below-poverty households. This was
family economic insecurity in Maine, followed by a              somewhat below the U.S. rate of 0.8 percent.
brief description of some of the benefits and programs
to help support lower-income Mainers. The concluding                                   Income
section examines current policies and policy recommen-               Maine’s median household income is below that
dations for addressing poverty and economic insecurity.         of the U.S., and Maine is in the lowest third of states
                                                                in this measure. (Median income is the mid-point of
            PoveRTy anD econoMic                                incomes in a given area, with half of households below
              inSecURiTy in Maine                               and half above this point.) as with poverty rates,
                                                                there is a great deal of variation in household income
                                                                between Maine’s counties. The lowest reported median
                        Poverty                                 household incomes in 007 were in washington
     The federal poverty measure is a standardized              ($,64) and Piscataquis ($,989) counties, and
income-based measure that sets a level for defining             the highest were in cumberland ($54,99), Sagadahoc
poverty. Poverty “thresholds” are the statistical version       ($5,75), and york ($5,65) counties, compared
of the poverty measure, used to calculate the number            with the state median of $45,8 and the national
of households and persons in poverty. (when we talk             median of $50,740 (Figure , page 6).
about poverty rates, it is this threshold measure to
which we refer.) Poverty status on the individual level                             Employment
is defined as any person living in a below-poverty                 in considering family economic security, employ-
household. Poverty guidelines, a simplified adminis-            ment is the key factor since earnings from work are the

View current & previous issues of MPR at:          volume 18, number 1 · Maine Policy Review · 5
FaMily econoMic SecURiTy

FIGURE 1: individual Poverty rates, u.s., Maine and Maine Counties, 2007


                                                                                                                                                                                               20.1%                  primary income source for most
                                                                                                                                                                                                                      Mainers and especially for lower-
                                           17.4%                                                                                                                        17.2%
                                                                   16.0%                                                                          16.5%                                                               income households. even before
   15%              14.1%                                                                                                  14.4%                                                    14.5%                             the current recession, which has
          13.0%                                                                          13.0%                                  13.5%                                                                                 increased unemployment rates, the
                                                                                                                                                                                                                      employment situation in Maine has
                                                        9.7%                   9.9%                                                                                                                                   been changing, with the loss of
   10%                                                                                                                                                        9.2%
                                                                                                                                                                                                           8.2%       better-paying manufacturing jobs
                                                                                                                                                                                                                      and an increase in lesser-paying
    5%                                                                                                                                                                                                                service jobs. Maine’s unemploy-
                                                                                                                                                                                                                      ment rate has tended to be slightly
                                                                                                                                                                                                                      lower than the national average in
    0%                                                                                                                                                                                                                recent years, but there continue to












                                                                                                                                                                                                                      be marked differences among the
















                                                                                                                                                                                                                      counties in unemployment rates.








                                                                                                                                                                                                                      in 008, the state’s unemployment

                                                                                                                                                                                                                      rate was 5.4 percent, and county
source: u.s. Census bureau, small area income and Poverty estimates (saiPe)                                                                                                                                           rates ranged from highs of 8.5
                                                                                                                                                                   percent in washington county
                                                                                                                                                                                                                      and 8.0 percent in Piscataquis
                                                                                                                                                                                                                      county to lows of 4.0 percent
                                                                                                                                                                                                                      in cumberland county and 4.6
FIGURE 2: Median household income, 2007                                                                                                                                                                               percent in Sagadahoc county. The
                                                                                                                                                                                                                      unemployment rate is a “lagging
                                                                                                                                                                                                                      indicator,” meaning that during
                                                                                                                                                                                                                      economic downturns such as the
                                                                                                                                                                                                                      current one, unemployment

$50,000                                                                                                                                                                                                               continues to rise even after the


                                                                                                                                                                                                                      economic situation starts to




                                                                                                                                                                                                                      improve, as employers do not start



                                                                                                                                                                                                                      hiring immediately. So far in 009,


$30,000                                                                                                                                                                                                               unemployment rates nationally and


                                                                                                                                                                                                                      in Maine are running well ahead
                                                                                                                                                                                                                      of 008 averages.
                                                                                                                                                                                                                           Maine’s employment pattern
                                                                                                                                                                                                                      is characterized by a rate of
                                                                                                                                                                                                                      multiple-job holding that is higher
                                                                                                                                                                                                                      than the national average. in 007,
    $0                                                                                                                                                                                                                8.1 percent of Mainers reported













                                                                                                                                                                                                                      holding more than one job over















                                                                                                                                                                                                                      the course of the year, compared










                                                                                                                                                                                                                      with 5. percent nationally. and

                                                                                                                                                                                                                      although the rate of multiple-job
source: u.s. Census bureau, small area income and Poverty estimates (saiPe)                                                                                                                                           holding has decreased nationally                                                                                                                                                                     since 1995, in Maine it has
                                                                                                                                                                                                                      increased (Maine SPo 009).

6 · Maine Policy Review · Summer/Fall 009                                                                                                  View current & previous issues of MPR at:
                                                                                                               FaMily econoMic SecURiTy

                                                                FIGURE 3: employment status of Parents of low-income
                                                                              Children, 2007

      Multiple-job holding is related to two primary
factors in Maine: seasonal employment and low wages.                            17%                   19%
Maine has a high number of seasonal jobs, especially in
the tourism and natural-resource-based industries. Data
from the U.S. Bureau of economic analysis clearly                               38%
                                                                                                                           Not employed
show that more Mainers are employed in the summer
                                                                                                                           Part-time or part-year
months than in the winter months (Maine SPo 009).
although some seasonal employment pays well while                                                                          Full-time, year-round
it lasts, the income is generally not enough to sustain
families year-round. Moreover, seasonal employment                              47%
earnings in Maine are also unpredictable, dependent
in part on factors such as weather, the state of the
national economy, and even the world economy (as
                                                                               Maine                 U.S.
demonstrated by the impact of increased fuel prices
on economic sectors ranging from tourism to lobster
                                                                          source: national Center for Children in Poverty (2009b)
fishing). additionally, lower-wage workers will often
work several jobs at the same time just to get by.
      Figure  shows the employment situation for
parents of low-income children in Maine and the U.S.
in 007, highlighting the fact that fewer of these Maine        However, several programs of particular importance to
parents have full-time, year round jobs (47 percent)            working families with young children warrant further
compared with 55 percent of parents nationally                  discussion. “work-support” benefits and programs
(national center for children in Poverty 009b).                of federal and state government aim to close the gap
                                                                between earnings and basic expenses for lower-income
     BeneFiTS anD SUPPoRTS PRoMoTinG                            workers. These benefits either supplement low earnings
        FaMily econoMic SecURiTy                                or reduce expenses by subsidizing the costs of needed
                                                                goods or services (cauthen 007). Because certain

T     here are a myriad of benefits and programs to
      assist lower-income individuals and families, many
of which are aimed at those below the poverty level.
                                                                household expenses (e.g., housing, child care, energy,
                                                                medical costs, and transportation) represent a larger
                                                                proportion of the budgets of lower-income households
Some programs provide direct cash assistance (e.g.,             than of higher-income households, benefits aimed at
Temporary assistance to needy Families [TanF],                  these categories of expense can be particularly impor-
unemployment benefits). others provide assistance in            tant. lower-income households also are more sensitive
the form of vouchers or credits for goods or services           to price increases in these essential items, as was evident
(e.g., the supplemental nutrition assistance program            when energy costs increased so sharply in 008. Table 1
[food stamps], child care) or subsidies that are paid           (pages 9–40) provides details on some of the key work
on behalf of the individual or family (e.g., housing,           and income supports benefits, and some of the
energy). Still others provide education, training, or           strengths and weaknesses of each.
other employment-related programs to assist individ-
uals to achieve better-paying, more stable employment                          Earned Income Tax Credit
and to thereby gain greater self-sufficiency (e.g., the               The earned income tax credit (eiTc) is a tax
Parents as Scholars [PaS] program; Job corps). The              benefit designed to encourage work and to assist fami-
sidebar (page 8) lists a number of the more important          lies to become independent. This benefit for low- and
of these programs and benefits.                                 moderate-income workers helps reduce the impact of
      a detailed description of these and other pro-            payroll and income taxes and also supplements earnings
grams and benefits is beyond the scope of this article.         for very low-wage workers. Begun in 1975 and refined

View current & previous issues of MPR at:            volume 18, number 1 · Maine Policy Review · 7
FaMily econoMic SecURiTy

                PROGRAMs TO ADDRess POVeRTY AnD
                    fAMILY ecOnOMIc secURITY

                      Selected direct (caSh) PaymentS
   Temporary Assistance to needy families (TAnf)—u.s. department                    several times since then, the eiTc had become
   of health and human services (u.s. dhhs) and Maine department of                 the federal government’s largest anti-poverty
   health and human services (Maine dhhs) office of integrated access
                                                                                    program for those under age 65 by the mid-
   and support
                                                                                    1990s (Beamer 007). Twenty-four states and
   General Assistance—short-term emergency funds administered through               the District of columbia have also instituted
   municipalities to allow purchase of basic necessities for those without          state earned income tax credits. The amount of
   means to pay
                                                                                    the state tax credit is set as a percentage of the
   supplemental security Income (ssI)—Federal, administered by social               federal credit, ranging from .5 percent
   security administration, designed to help aged, blind, and disabled              (louisiana) to as much as 4 percent
   people who have little or no income                                              (wisconsin) (
   earned Income Tax credit (eITc)—Federal and state, administered                  asp). Maine is on the lower end of states in its
   through the internal revenue service and Maine revenue services,                 earned income tax credit of five percent.
   aimed at working families                                                              The size of the federal tax credit depends
   Unemployment Insurance Benefits—u.s. department of labor and                     on household income from work and on family
   employers, administered by Maine department of labor                             size. Unlike the minimum wage, the amounts
                                                                                    are indexed to inflation each year. working
                                                                                    families with children with annual incomes
                        Selected SubSidieS/VoucherS
                                                                                    below about $4,000 to $41,000 (depending
   supplemental nutrition Assistance Program (snAP; formerly food                   on marital status and number of children)
   stamps)—u.s. department of agriculture (usda) and Maine dhhs
   office of integrated access and support
                                                                                    generally are eligible for the eiTc. (workers
                                                                                    without children who have very low incomes,
   free and Reduced school Lunch—usda, administered by Maine                        below about $1,000, or $16,000 for a married
   department of education                                                          couple, can receive a very small credit.)
   special supplemental nutrition Program for Women, Infants and children           according to the center on Budget and Policy
   (WIc)—usda and Maine dhhs office of integrated access and support                Priorities web site, among families with chil-
   child care Vouchers—Federal Child Care development Fund and                      dren, the average size of the federal credit in the
   Maine dhhs office of Child and Family services                                   U.S. in 006 was $,75 (
   Low Income Home energy Assistance Program (LIHeAP)—u.s. dhhs,
   administered by Maine Community action agencies
                                                                                          The federal tax credit, and the tax credit
                                                                                    in most states, is refundable. Refundable credits
   Weatherization Assistance—u.s. department of energy, administered                provide a payment even if no taxes are owed,
   by Maine Community action agencies                                               i.e., if the amount of the credit is greater than
   Housing (Rental) subsidies—u.s. department of housing and urban                  the tax liability, the government pays the differ-
   renewal (hud) and Mainehousing. Programs include housing Choice                  ence to the worker as a cash rebate. The federal
   vouchers (section 8), rental assistance Coupons Plus (aimed at the               credit was made refundable because policy-
   homeless), subsidized apartments.                                                makers recognized that the income tax is not
                                                                                    the only federal tax paid by low- and middle-
          Selected emPloyment, training and education ProgramS                      income workers, who usually pay much more
   Pell Grants, subsidized Loans—u.s. department of education, for
                                                                                    in payroll taxes than in income taxes.
   higher education                                                                       Maine until this year was one of only a
                                                                                    handful of states whose credit was not refund-
   Parents as scholars (Pas)—u.s. dhhs and Maine dhhs office of                     able. However, in 009 the legislature passed a
   integrated access and support (student aid program to help low-
   income parents enrolled in two- or four-year college programs)
                                                                                    tax-overhaul package, which included making
                                                                                    the state eiTc partially refundable: up to $150
   Job corps—u.s. department of labor                                               for joint filers and $15 for single filers. The
                                                                                    changes will go into effect in tax year 010.4

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                                                                                                             FaMily econoMic SecURiTy

TABLE 1:      Characteristics of Work support Programs

                   description        target       relationship
     Policy                                                                       strengths                          Weaknesses
                    of benefit      Population     (funding and

                                                                       Federally funded entitlement:       • typically received as a lump
                                                                       all eligible families and indi-       sum at the end of the year
                                                  Federal entitle-     viduals who apply are entitled        so cannot be used to offset
                                    low- to       ment; several        to benefits                           expenses as incurred
 Federal          refundable
                                    moderate-     states and some                                          • Many married-couple families
 earned           tax credit that                                      • relatively high participation
                                    income        localities supple-                                         face marriage “penalty”
 income tax       reduces tax                                            rates
                                    working       ment the federal                                         • large families receive same
 Credit (eitC)    liability                                            • low stigma because admin-
                                    families      credit with a                                              benefit level as those with
                                                  state credit           istered through the income          two children
                                                                         tax system and not associated     • low benefits for workers
                                                                         with welfare                        without (resident) children
                                                                                                           • inadequate funding: federal
                                                  block grant with
                                                                                                             block grant with state
                  subsidizes                      matching funds       • Makes child care more afford-
                                                                                                             matching requirements
                  child care                      for states that        able and facilitates employ-
                                                                                                           • only 1 in 7 eligible families
 Child            expenses,         low- to       meet mainte-           ment
                                                                                                             served (national average); few
 Care and         enabling          moderate-     nance of effort      • reduces child care expenses
                                                                                                             subsidies available to non-
 development      parents           income        requirement;           as they are incurred
                                                                                                             welfare families
 Fund (CCdF)      to work or        working       federal law sets     • has the potential to make
                                                                                                           • low provider payment rates
 subsidies        engage in         families      broad guide-           higher-quality early care and
                                                                                                             jeopardize quality of care in
                  work-related                    lines; states          learning experiences available
                                                                                                             many states families face a
                  activities                      administer             to low-income children
                                                                                                             steep benefit “cliff” when
                                                                                                             they lose a subsidy
                  non-refund-                     Federal entitle-
                  able child and                  ment; several
                  dependent                       states build on      • Federally funded entitlement:
                                                                                                           • not refundable so helps few
                  care tax credit                 federal credit         all eligible families and indi-
 Federal                            Families at                                                              low-income families
                  reduces the                     and offer state        viduals who apply are entitled
 Child and                          all income                                                             • benefits are low relative to the
                  amount of                       credits or tax         to benefits
 dependent                          levels with                                                              cost of high-quality child care
                  taxes working                   deductions           • low stigma because admin-
 Care tax                           child care                                                             • offset to tax liability so cannot
                  families with                   to offset state        istered through the income
 Credit                             expenses                                                                 be used to pay for expenses
                  child care                      income tax             tax system and not associated
                                                                                                             as incurred
                  expenses are                    liability              with welfare
                  required to
                                                  Federal entitle-
                                                                       • Medicaid is a joint federal/
                  Family health                   ment with                                                • increases in Medicaid
                                                                         state entitlement: all eligible
                  insurance         low-          required state                                             spending are stressing state
                                                                         families and individuals who
                  coverage for      income        match; admin-                                              budgets
 Medicaid                                                                apply are entitled to benefits
                  parents and       adults and    istered by the                                           • Working-age adults have
                                                                       • Medicaid and sChiP provide
                  children with     children      states with                                                limited access to public health
                                                                         health insurance access to a
                  low incomes                     broad federal                                              coverage
                                                                         substantial portion of children

                                                                                                                   table continues on next page

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FaMily econoMic SecURiTy

TABLE 1:      Characteristics of Work support Programs — continued from previous page

                    description       target         relationship
     Policy                                                                          strengths                          Weaknesses
                     of benefit     Population       (funding and
                                                   block grant with
 state                                             state mainte-
                  children and
 Children’s                                        nance of effort
                  some parents      low-                                  • Medicaid & sChiP provide          • inadequate funding: sChiP
 health                                            requirement;
                  with family       income                                  health insurance access to a        is a federal block grant with
 insurance                                         administered
                  income above      children                                substantial portion of children     state matching requirements
 Program                                           by states with
                  the Medicaid
 (sChiP)                                           broad federal
                  income limit
                  housing                          Federal program
                                    low-                                                                      • need for housing assistance
                  vouchers                         with local
 housing                            income                                • Federally funded                    far exceeds available funding
                  allowing                         housing authori-
 Choice                             families                              • Makes housing more afford-        • some families with vouchers
                  recipients to                    ties responsible
 vouchers                           and indi-                               able for those with access          have difficulty finding land-
                  rent privately                   for adminis-
                                    viduals                                                                     lords who will accept them
                  owned units                      tering benefits
                                                                                                              • Participation rates could be
 supplemental                                      Federal entitle-       • Federally funded entitlement
                   Food assis-      low-                                                                      • high stigma because of asso-
 nutrition                                         ment program             (states pay only a portion
                   tance for        income                                                                      ciation with welfare
 Program                                           with states              of administrative costs): all
                   low-income       families                                                                  • strict asset eligibility limits
 (snaP;                                            responsible for          eligible families and indi-
                   families and     and indi-                                                                 • Families can face a significant
 formerly food                                     administering            viduals who apply are entitled
                   individuals      viduals                                                                     benefit “cliff” when their
 stamps)                                           benefits                 to benefits
                                                                                                                income reaches the gross
                                                                                                                income limit

source: Modified from Cauthen (2007: 25–27), tables a1 and a2.

                                            Housing                                    kept up with the rate of cost increase and the demand
                         The cost of housing in Maine has increased at a               for subsidized housing and housing vouchers. For rental
                   much faster rate than the increase in Maine’s median                housing, the Section 8 housing voucher program in
                   income. MaineHousing’s “affordability index” indicates              Maine currently has 11,500 eligible families on the wait
                   that both rental and home purchase are beyond the                   list, and the wait list has been closed to new applicants
                   means of many working families. The affordability                   (Maine DHHS 008).
                   index is the ratio of the home or rent cost considered to
                   be affordable at median income; a cost of 8 percent or                                    Child Care
                   less of median income is considered affordable (Maine                    as is the case for housing, the availability of child
                   SPo 009). even in counties such as cumberland and                  care and child care assistance has not kept up with the
                   york, where indicators such as poverty, unemployment,               demand. There are an estimated 46,000 children under
                   and income are better, housing and rental prices are                five needing child care, but only 7,600 spaces in
                   very high, leading to an unfavorable housing afford-                licensed care; although Maine serves 78 percent of
                   ability index. Half of Maine’s low-income working                   eligible three- and four-year olds in Head Start, only
                   families are defined as being “housing burdened,”                   eight percent of families can be served annually in
                   meaning they spend more than one-third of their                     early Head Start (Maine DHHS 008). child care is
                   income on housing (Maine DHHS 008). at the same                    costly and can consume a disproportionate share of
                   time, benefits to provide housing assistance have not               income for lower-wage workers. although families

40 · Maine Policy Review · Summer/Fall 009                           View current & previous issues of MPR at:
                                                                                                             FaMily econoMic SecURiTy

                                                                        RecOMMenDeD sTATe POLIcIes fOR PARenTInG
whose incomes are below 75 percent of the state’s med-                          AnD ecOnOMIc sUPPORTs
ian income are eligible for government child care subsi-                (nATIOnAL cenTeR fOR cHILDRen In POVeRTY)
dies, many eligible families are not receiving subsidies,
in large part due to insufficient funding. From 00                State choiceS to Promote effectiVe Parenting
through 007, there was an 11 percent decrease in                   • Provide paid medical/maternity leave. [2008] (Maine—no)
the number of families receiving child care vouchers,
and information from the office of early care and                   • have a Medicaid family planning waiver to extend coverage
                                                                      to low-income women to increase the interval between
education indicates that subsidies now reach only 8                  pregnancies. [2008] (Maine—no)
percent of eligible children (lahti et al. this issue).
                                                                    • exempt single parents on tanF from work requirements until
                     Health Care                                      the youngest child reaches age one. [2006] (Maine—Partial)
                                                                           The exemption is limited to 12 months in the
      a substantial contribution to support family                         recipient’s lifetime.
income also is provided by government medical bene-                 • reduce the tanF work requirement for single parents with
fits paid for lower-income and disabled people, espe-                 children under age six. [2006] (Maine—yes)
cially the children’s health insurance program (ScHiP),
                                                                    • allow parents in school to qualify for child care subsidies.
Medicaid (Mainecare), and parts of Medicare (for the                  [2005] (Maine—yes)
disabled). (For information about additional programs
                                                                    • operate a statewide home-visiting program. [2007]
and services for Maine’s youngest residents, see Forstadt
and Peavey [this issue]; for more details about health                    Two statewide programs
insurance see Mills [this issue]).
                                                                    • Formally link home-visiting programs to supports for early
                                                                      childhood development (e.g., Medicaid/sChiP, early interven-
             Policy conSiDeRaTionS                                    tion, and early childhood mental health). [2007] (Maine—yes)

M       aine and other states are able to enact a number
        of kinds of policies that can help families with
young children to have greater economic security.
                                                                    State choiceS to SuPPort family economic Security
                                                                    • establish a state minimum wage that exceeds the federal
The national center for children in Poverty (009a)                   minimum wage. [october 2009] (Maine—yes)
                                                                           Maine $7.50 (federal is $7.25 as of July 2009)
suggests a series of policies in the areas of health and
nutrition, early care and education, and parenting and              • exempt a single-parent family of three below the poverty level
economic supports. The sidebar shows their recom-                     from personal income tax. [2007] (Maine—yes)
                                                                          Up to 143 percent federal poverty limit
mended policies in the area of parenting and economic
supports. Maine already has a majority of these policies            • offer a refundable state earned income tax credit. [2010]
in place and more can be done.                                        (Maine—enacted 2009)
                                                                           State credit will be partially refundable
      However, there is only so much states can do alone
to try to address family economic security. Funding for             • offer a refundable state dependent care tax credit. [2007]
the vast majority of programs and benefits is provided
by the federal government, and many policies and eligi-             • keep co-payments for child care subsidies below 10 percent
bility requirements are likewise the purview of the                   of family income for most families. [2008] (Maine—yes)
federal government. Some programs, such as TanF, the                • allow families on tanF to receive some or all of their child
federal eiTc and Medicaid, are entitlements, meaning                  support payment without reducing tanF cash assistance.
that as the number of eligible people increases, all those            [2007] (Maine—Partial)
                                                                           Up to $50 passed through. Amount disregarded for
eligible will receive benefits in the amount to which                      purposes of eligibility and benefits. State also uses
they are entitled. Many other programs and benefits are                    fill-the-gap budgeting.
funded through block grants to the states or through
                                                                    source: adapted from national Center for Children in Poverty (2009a: 4)
annual fixed-amount federal appropriations. if need
increases, states have no way to provide additional

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FaMily econoMic SecURiTy

                funding and must try to “ration” the available                 However, even recent increases in the minimum wage
                resources. Unlike the federal government, Maine and            will not solve the problem of income inadequacy for
                other states cannot operate with a budget deficit.             low-wages workers. Minimum wages (even if two people
                                                                               in a household are working full-time, year round) will
                                                                               not support a family basic-needs budget in Maine.
        there are multiple kinds of policies                                        Invest Early in Maine, 2008 notes that “the
                                                                               most direct intervention to support working families
        and programs that can help promote                                     struggling to meet their basic needs is to increase their
                                                                               wages” (Maine DHHS 008: 8). Many have recom-
        family economic security….                                             mended increasing the minimum wage and working
                                                                               toward having employers pay a living wage. Both can
                                                                               be done at the state level, but national actions also are
                       Basic-Needs Budgets, Livable Wages,                     needed. along with being increased, the minimum
                             and the Minimum Wage                              wage should be indexed to inflation, as is the eiTc
                      Basic-needs budgets have been proposed as an             and other tax credits. Goal 1.B.7 of the “invest early”
                alternative to federal poverty guidelines. This model          report suggests for Maine: “Be a model employer—
                uses a market-basket approach to identify budget items         ensure that all projects and programs funded with state
                necessary for a household to maintain an adequate              dollars pay a living wage” (Maine DHHS 008: 8).
                standard of living, taking into account differences in
                expenses depending on work status, household compo-                       Expanding and Promoting the
                sition, and the region where the household is located.                     Earned Income Tax Credit
                Most basic-needs budgets include the same categories                Maine has progressed in its state eiTc by making
                used by the U.S. Department of labor Statistics:               it partially refundable, beginning in 010. However,
                food, housing, transportation, child care, clothing            Maine’s eiTc amount is low compared with many
                and personal care; most also include taxes, and some           other states (only five percent of the federal credit).
                include an allowance for savings. The hourly rate for          increasing the amount of the Maine eiTc and making
                a “livable wage” (sometimes called “living wage”) for a        the state credit fully, instead of partially, refundable
                given area, household size and household composition           would provide additional support for working families.
                can be calculated by dividing total expenses of the basic      Maine also can help working families by encouraging
                needs budget by the number of hours in a year of full          more eligible workers to apply for the federal eiTc,
                time work. Recent calculations show that the annual            which is done as part of filing federal income taxes. This
                livable wage average in Maine in 008 for a single             could be accomplished through education campaigns
                adult with two children was $41,605, which would               and by promoting additional opportunities for free tax
                be $0/hour (             preparation for low-income workers, working through
                html). The poverty guideline for a three-person house-         advocacy and social service organizations (Beamer 007:
                hold in 008 was $17,600, which is 4 percent of the           51). improving Maine’s eiTc and having more workers
                state’s average livable wage. (There are regional differ-      receive the federal eiTc could also benefit areas of the
                ences in livable wages within the state, ranging from          state whose economies are struggling. in counties with
                $1.70/ hour in aroostook county to $.1/hour                higher poverty rates, proportionally more families
                in the york-Kittery-South Berwick metropolitan area            benefit from the federal eiTc, so any improvements
                for a single parent with two children in 008.)                in eiTc receipt can give a boost to the economies in
                      Maine is ahead of the nation in its minimum wage,        those areas (Beamer 007: 50).
                which went up to $7.50/hour as of october 1, 009.
                The federal minimum wage, which had remained at                      Improving Other Programs and Benefits
                $5.15/hour from 1997 to 006, went up in a series of               access, affordability, and quality of child care have
                steps from 007 to 009 to $7.5/hour in July 009.            important policy and fiscal implications that are

4 · Maine Policy Review · Summer/Fall 009                   View current & previous issues of MPR at:
                                                                                                             FaMily econoMic SecURiTy

discussed in a number of articles in this issue (lahti et       encourage more students to continue education beyond
al.; ward, oldham and atkins). From the perspective             high school are an important component in developing
of family economic security the two critical aspects of         human capital. in Maine, these include programs such
child care that need to be addressed are access (demand         as Gear-Up, Upward Bound, and Maine educational
for child care exceeds supply) and cost (most families          opportunity centers (Meoc).
pay as much as 5 percent of their income for just one                For higher education, the recent increase in federal
child) (Maine DHHS 008: 16). improving both                    Pell grants is a good start, but critics point out that the
education and pay for child care workers could help             federal government’s support for lower-income students
improve access (as more workers would be attracted to           is still not keeping up with rising costs and increasing
the field) and quality of care. on the family expense           demand. The recent recession, which has reduced the
side, increased federal funding for child care subsidies        incomes of many families, has also led to increased
is needed, since many eligible families currently are           need for scholarship, grant and loan support from all
unable to receive the assistance to which they are enti-        sources for students in higher education.
tled. employer-provided or employer-subsidized child                  Maine has been a leader in providing assistance
care is an option that could be encouraged and                  for low-income adults (primarily single mothers) to
expanded.                                                       move from welfare to work by supporting them to get
      Housing assistance is another area where demand           post-secondary degrees through the Parents as Scholars
far exceeds the availability of resources, especially for       (PaS) program. Maine also has recently instituted a
rental housing where funding for subsidies and for              loan forgiveness program through opportunity Maine,
low-income housing is largely from the federal govern-          whereby students attending college in Maine and
ment. Greatly increasing the federal subsidy funds for          living and working in the state after graduation can
renters would be of major benefit for Maine’s working           claim a state tax credit equal to the amount of student
families. For low- and moderate-income home owners,             loan payments.
MaineHousing has a number of programs that can                        on the down side, state support for higher educa-
provide assistance in the form of low or no down                tion in Maine has decreased since 199, and Maine’s
payments and low-interest loans for home purchase.              grant aid for undergraduates ($41 per full time equiv-
MaineHousing also recently instituted an innovative             alent student) in 006 was well below the national
loan program to assist those of low and moderate                average of $61. For Maine students graduating from
means with home weatherization to improve energy                college in 007 the average student loan burden was
efficiency and thereby reduce annual costs (Mccormick           $,948, the eight highest in the country (Plimpton,
and van Hook 008). increasing the level, and predict-          Tsai and Dupee 009). increasing support both for
ability, of federal funding for the low income Home             institutions that provide education and training and
energy assistance Program (liHeaP) and for weather-             for those who attend them is important, given the role
ization is another important action that could be taken         of post-secondary education and training in helping
to reduce housing costs for lower-income families.              increase the human capital component of family
      Finally, policies and programs to address human           economic security
capital improvement are important to help parents
of young children achieve greater economic security.                                conclUSion
There is a well-documented correlation between educa-
tion and skills and lifetime earnings. Moreover, the
kinds of jobs that require higher levels of education
and skills are also more likely to be stable, be full time
                                                                T     here are multiple kinds of policies and programs
                                                                      that can help promote family economic secu-
                                                                rity, which have only been touched on in this article.
and year-round, and to provide benefits such as health          economic development strategies can indirectly
and life insurance and access to pension plans.                 impact family economic security through increasing
      Programs to improve the quality of K-1 educa-            the number and quality of jobs. in terms of existing
tion, to reduce high school drop-out rates, and to              programs, Maine is in a difficult position as severe

View current & previous issues of MPR at:           volume 18, number 1 · Maine Policy Review · 4
FaMily econoMic SecURiTy

                short-term budget crises threaten to erode funding and
                support for key programs and benefits that help support
                families. Federal, state, local and private efforts are all           4. as of this writing (september 2009) opponents
                needed to expand opportunities for jobs with adequate                    of the tax reform legislation have gathered signa-
                                                                                         tures to try to place a referendum repealing the
                wages; to assist lower-income families by providing                      tax reform on Maine’s June 2010 ballot. if enough
                necessary assistance to help pay for high-cost budget                    signatures are certified, the tax reform package,
                items such as child care, housing and energy; to increase                including the changes in Maine’s eitC, will have to
                support for those pursuing post-secondary education                      be put on hold, pending results of the referendum.
                and job skills training/re-training; and to engage in
                education and information outreach activities so that                 RefeRences
                more eligible families take advantage of the benefits to
                                                                                      acheson, ann. 2006. Poverty in Maine, 2006. Margaret
                which they are entitled such as the eiTc, child care,
                                                                                         Chase smith Center for Public Policy, university of
                and nutrition benefits, among many others.                              Maine, orono.
                                                                                      acheson, ann. 2007. “Poverty in Maine.” Maine Policy
                                                                                         review 16(1): 12–29.
                                                                                      beamer, glenn. 2007. “state earned income tax
                                                                                         Credits and ‘Making Work Pay:’ how Maine Might
                  enDnOTes                                                               help Workers.” Maine Policy review 16(1): 46–53.
                  1. the federal poverty measure has long been                        bernstein, Jared. 2001. let the War on the Poverty line
                     considered inadequate in that it uses outdated                      Commence. Foundation for Child development,
                     family budget assumptions; does not take regional                   new york.
                     differences in costs into account; and does not
                                                                                      Cauthen, nancy k. 2007. improving Work supports:
                     take household composition into account, only
                                                                                         Closing the Financial gap for low-wage Workers
                     size. nonetheless, it remains as the standard
                                                                                         and their Families. economic Policy institute,
                     statistical measure used in defining poverty in the
                                                                                         Washington, dC.
                     u.s. For further critical analysis of problems with
                     the measure, see, for example, Corbett (1999) and                Corbett, thomas P. 1999. “Poverty: improving the
                     bernstein (2001).                                                   Measure after thirty years: a Conference.” Focus
                                                                                         20(2): 51–55.
                  2. since Census income is self-reported, economists
                     say that a more comprehensive measure of income                  Forstadt, leslie and sheryl Peavey. 2009. “introduction
                     in a given area is personal income. the national                    to the early Childhood issue.” Maine Policy review
                     bureau of economic analysis state and county                        18(1): 10–17.
                     estimates of total and per capita income include
                                                                                      lahti, Michel, rachel Connelly, georgia n. nigro and
                      net earnings from wages and self employment,
                                                                                         rebecca Fraser-thill. 2009. “Working Parents and
                      income from investments (dividends, interest, and
                                                                                         Child Care: Charting a new Course for Quality.”
                      rent), and income from transfer payments (e.g.,
                                                                                         Maine Policy review 18(1): 94–104.
                      government retirement and disability benefits,
                      Medicare, unemployment insurance benefits).                     Maine department of health and human services
                      see acheson (2006, 2007) and Maine sPo (2009)                      (dhhs). 2008. invest early in Maine: a Working
                      for more detailed analyses of personal income in                   Plan for humane early Childhood systems. Maine
                      Maine.                                                             dhhs, augusta.
                  3. because the methodology used in determining                      Maine state Planning office (sPo). 2009. 2009 report
                     the federal poverty guidelines is so problematic,                   on Poverty in Maine. Maine sPo, augusta.
                     a number of federal and state programs use a
                                                                                      McCormick, dale and lucy van hook. 2008.
                     percentage multiple in determining eligibility, for
                                                                                        “Connecting residential energy efficiency and
                     example, household income that is 125 percent,
                                                                                        Carbon emissions reductions: Mainehousing’s
                     150 percent, or 200 percent of the poverty guide-
                                                                                        Carbon Market Project.” Maine Policy review 17(2):
                     line. in 2008, the poverty guideline for a family of
                     four was $24,380.

44 · Maine Policy Review · Summer/Fall 009                        View current & previous issues of MPR at:
                                                                                                FaMily econoMic SecURiTy

  Mills, dora anne. 2009. “early Childhood health.”
      Maine Policy review 18(1): 46–59.
  national Center for Children in Poverty. 2009a. Maine
     early Childhood Profile. national Center for
     Children in Poverty, Mailman school of Public
     health, Columbia university, new york. http://www.
     Me.pdf [accessed september 12, 2009]
  national Center for Children in Poverty. 2009b. Maine
     Family economic security Profile. national Center
     for Children in Poverty, Mailman school of Public
     health, Columbia university, new york. http://www. [accessed
     september 12, 2009]
  Plimpton, lisa, elaine tsai and lauren dupee. 2009.
      indicators of higher education achievement in
      Maine: College as a right and responsibility for all
      Maine People. College for Me, Maine Compact for
      higher education, augusta.
  Wagmiller, robert, Mary Clare lennon, li kuang, Philip
    alberti and J. lawrence aber. 2006. “dynamics of
    Family economic disadvantage and Children’s life
    Chances.” american sociological review 71(5):

                                Ann Acheson is a research
                                associate and editor of
                                Maine Policy Review at
                                the Margaret Chase smith
                                Policy Center, university
                                of Maine, and a faculty
                                associate in the department
                                of anthropology. she has
                                more than 30 years experi-
ence in applied qualitative and quantitative social/behav-
ioral science research and evaluation in both academic and
non-academic settings. her recent work focuses on health
and social policy, particularly substance abuse, mental
health, and poverty.

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                               childhood                                Dora Anne Mills presents a panoramic portrait of

                                  Health                                early childhood health in Maine, describing the

                                                                        ways in which poverty, health insurance, preg-

                                              by dora anne Mills        nancy, early growth and development, infectious

                                                                        and chronic diseases, oral health, environmental

                                                                        health, injury, mental health and physical activity

                                                                        and nutrition affect children. She notes policy

                                                                        successes in these areas and describes some of the

                                                                        challenges that remain and the new challenges that

                                                                        are arising.   

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                                                                                                             Poverty is perhaps
                  inTRoDUcTion                                  doubles the chances of low birth
                                                                weight, doubles the chances of               the most wide-

T     he prenatal and early childhood period are consid-
      ered the most vulnerable chapter in a person’s life.
early childhood is the only time in our lives when we
                                                                being hospitalized, triples the
                                                                chances of lead poisoning, and
                                                                almost doubles the chances of
                                                                                                             spread factor in

are completely dependent on another person, and it              dying in the first year of life.             Maine with the
is also the period when the brain and other organs are          Poverty during early childhood
most intensely developing.                                      correlates more strongly with                biggest impact on
      This article reviews factors affecting the health of      dropping out of high school
our infants and young children, with a focus on those           than poverty in later childhood              the health of our
especially relevant to policymaking. it is a “picture” of       (Brooks-Gunn and Duncan
early childhood health—where Maine is and where                 1997). and for the approximate               youngest residents.
Maine needs to go. Readers should keep in mind that             15,000 Maine children ages
even within Maine’s successes in early childhood, there         birth to five years old living
are children who are left behind. numerous studies              below the federal poverty level
indicate that the presence of health disparities in the         (in 008, an annual income of $17,600 for a family of
prenatal and early childhood period has long-term costs         three), there is inadequate income to pay for clothing,
not only for the individuals involved, but for society          food, and housing. Poverty is truly a major public
at large. (Several articles in this issue of Maine Policy       health threat.
Review discuss some of these costs, e.g., Trostel,
connors.) This article first considers two broad areas                          HealTH inSURance
affecting early childhood health: poverty and health
insurance. Then, it discusses specific factors related to
early childhood health, beginning with the prenatal
period, and then considering the topics of growth and
                                                                T    hrough Dirigo Health Reform, the wise use of
                                                                     ScHiP (the federal government’s State children’s
                                                                Health insurance Program), and numerous outreach
development, infectious diseases, chronic disease, oral         efforts, Maine has done an excellent job expanding
health, environmental health, injury, mental health, and        health insurance for children, resulting in one of
physical activity and nutrition. The concluding section         the highest rates of children’s health insurance in
addresses where we go from here in terms of policy.             the country. ScHiP expansions using Mainecare
                                                                (Medicaid) to insure children and their parents living
                       PoveRTy                                  in households earning up to 00 percent of the federal
                                                                poverty level have resulted in about one-third of

P   overty is perhaps the most widespread factor in
    Maine with the biggest impact on the health of our
youngest residents. in Maine there are approximately
                                                                young children and their parents now being enrolled
                                                                in Mainecare.
                                                                     although we have one of the lowest rates of
71,000 children under the age of five; of these, about          uninsurance among children, seven percent of Maine
one in five live in families that are below the official        children under five years of age still lack health insur-
poverty level. Poverty can result in poor physical              ance, translating to nearly 5,000 young children and
health throughout an individual’s lifetime, lower               infants. For all Maine children under 18 years old, the
school achievement, poor cognitive abilities, reduced           uninsurance rates are higher (10 percent) among low-
emotional and behavioral outcomes, and high chances             income families (those with income under 00 percent
of teenage childbearing. (For further detail about              of the federal poverty level), even though they are
poverty in Maine, see acheson this issue.)                      eligible for Mainecare. Uninsurance makes children
     in terms of childhood health outcomes, poverty,            vulnerable to a myriad of health problems as a result of
even when other factors are adjusted for, doubles a             late detection of illness and a lack of routine periodic
child’s chances of being in fair or poor health, almost         well child care checks.

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                   PReGnancy anD THe PeRinaTal PeRioD                            death syndrome, and child abuse and neglect. while
                                                                                 Maine had one of the highest teen pregnancy rates in

                T    he health of infants and young children begins
                     long before birth. increasingly we recognize that
                the health of babies is influenced heavily by the health
                                                                                 the country in the early-mid 1980s, the state saw the
                                                                                 steepest decline of this rate in the nation in the 1990s,
                                                                                 and the rate has continued to decline over the last 10
                of mothers and fathers in the prenatal and even pre-             years. Maine now has one of the lowest teen pregnancy
                conception time periods. Moreover, the perinatal                 rates in the country, although these rates are still
                period is a critical one. (The perinatal period is defined       higher than seen in many developed countries. Maine’s
                variously as starting at the 0th to 8th week of gesta-         success is attributable to the two-pronged strategy of
                tion and ending one to four weeks after birth).                  broadening access to effective education and family
                                                                                 planning services.
                       Prevention of Unintended Pregnancy                              ongoing federal and state policies are critical to
                      assuring the ability for people to determine the           assuring access to family planning, which is effective
                number and spacing of their children, and therefore              at reducing unintended and teenage pregnancy rates.
                to decrease the proportion of unintended pregnancies,            Recent federal policies increased support for absti-
                results in healthier infants and young children.                 nence-only-until-heterosexual-marriage programs,
                intended pregnancies are associated with improved                which are found overall to be ineffective. in fact,
                prenatal care and infant health, increases in educa-             federal funds for abstinence-only educational efforts
                tional and employment opportunities for both                     grew by a factor of 0, from $9 million in 1997 to
                parents, and reductions in welfare dependency, child             $176 million in 007, almost to the level of funding
                abuse, and neglect. Two effective strategies to reduce           for federal family planning efforts. Despite these and
                unintended pregnancies include assuring access to                other challenges from federal policies, Maine has main-
                family planning services and comprehensive family                tained a strong track record of supporting effective
                life education in our schools and communities. Family            family planning strategies. For instance, Maine was one
                planning in this context means the access to and use             of the first and is currently one of 17 states that have
                of preventive reproductive health care, including                rejected abstinence-only federal funds (though they are
                contraception. comprehensive family life education               granted directly from the federal government to one
                gives the knowledge and skills to make healthy deci-             private organization in Maine). as of 00 Maine law
                sions about sexual activity and about accessing family           defines comprehensive family life education as the stan-
                planning services.                                               dard to be taught in public schools (MRSa Title ,
                      in Maine about 40 percent of pregnancies are               chapter 406, Sections 190 and 1910). and Maine
                unintended, a percentage that has increased over the             is fortunate to have a network of 45 family planning
                last six years, though it is still lower than in other           clinics offering family planning services statewide to all
                states. Maine unintended pregnancy rates are higher              people living in Maine, regardless of income, sexual
                among those with low income (58 percent for those                orientation, or gender identification.
                earning <$15,000), young parents (75 percent for
                those under 0), and those with lower education                              Substance Abuse and Tobacco
                attainment (65 percent for those with less than a                     alcohol and illicit drug use during pregnancy,
                high school education).                                          even in small amounts, can be harmful to the baby.
                      a key component of reducing unintended preg-               Substance use is associated with child abuse and neglect,
                nancies is the prevention of teenage pregnancies since           domestic violence, and many other secondary effects on
                the vast majority of teenage pregnancies are unin-               children. in Maine, about one in four post-partum
                tended. Teenage pregnancy is associated with lower               women report they participated in binge drinking more
                levels of educational attainment, higher levels of public        than three times during pregnancy. anecdotal reports
                assistance, higher rates of poverty, and higher rates of         from some physicians in Maine indicate that newborn
                low birth weight babies, neonatal death, sudden infant           admissions for narcotic abstinence syndrome due to

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maternal drug addiction have increased over the last            percent in the Downeast, Penquis, and central Maine
several years. The office of Substance abuse’s treatment        districts. national data show that a lack of access to
data confirm large increases over this decade in preg-          adequate prenatal care is associated with poverty, lack
nant women being admitted in Maine for opiate addic-            of health insurance, transportation difficulties, and
tion, from a total of 16 in 000 to 164 in 008. (See           family support.
article by logan et al. this issue for further discussion of
maternal drug addiction and its impact on infants.)                           Prematurity/Low Birth Weight
      Tobacco use during pregnancy is associated with                 about 11 percent of infants born in Maine are
low birth weight. Tobacco exposure in infants and               considered premature (birth less than 7 weeks of preg-
young children is associated with sudden infant death           nancy). although this is lower than the national rate of
syndrome (SiDS), asthma, ear infections, and pneu-              1 percent, it increased more than 17 percent between
monia. in Maine, about one in five new mothers                  1995 and 005. approximately three-quarters of
smoke throughout pregnancy. This rate is six times              preterm births occur spontaneously and are associated
higher ( percent) for low-income women than for               with such factors as previous preterm births, multiple
higher-income women (five percent). about 40 percent            fetal pregnancy (twins, triplets), and uterine or cervical
of low-income new mothers are smoking in the post-              abnormalities.
partum period. one in 0 Maine newborns is exposed
every day to cigarette smoke.
      Policies and programs to prevent and treat the use                          the health of infants and young
of these substances in families of child-bearing age are
important. Maine’s share of the national Tobacco                                  children begins long before birth.
Settlement (Fund for a Healthy Maine) provides free
counseling and access to medications for those who
want to quit smoking through the Maine Tobacco Help                  about seven percent of infants in Maine are born
line, along with substance abuse treatment. Maine’s             with low birth weight, less than ,500 grams (5.5
Healthy Maine Partnerships work on tobacco and                  pounds), compared with a national rate of about eight
substance abuse prevention initiatives that especially          percent. Rates of low birth weight in Maine, a major
focus on those at high risk. Maine’s smoke-free laws            contributing factor to infant mortality and morbidity,
directly protect our young children and help smokers            have steadily risen since the 1990s, increasing more
to cut down or quit. currently, Maine’s smoke-free laws         than 11 percent between 1995 and 005. Major risk
include virtually all indoor public places and automo-          factors for low birth weight include multiple fetal preg-
biles in which children under age 16 are present. Home          nancy, prematurity, maternal smoking, inadequate
visiting and public health nursing offer important              maternal nutrition, and extremes of maternal age.
education and referrals for substance abuse and tobacco              infant mortality, the rate of death among infants
treatment to families of infants and young children.            between birth and one year of age, is a barometer of
                                                                the overall health of infants and mothers. Maine expe-
                     Prenatal Care                              rienced lower rates of infant mortality than the U.S. as
     Besides assuring that women of child-bearing age           a whole. of about 1,000 to 14,000 babies born each
and fathers are as healthy as possible, one direct inter-       year in Maine, an average of 80 will not live to see
vention to assure early detection of health problems is         their first birthday. This translates to a five-year infant
ongoing prenatal care. Maine’s rate of 87 percent of            mortality rate of 5.6 per 1,000 live births. Three-
women receiving prenatal care starting in the first             quarters of these deaths occurred during the neonatal
trimester is high relative to other states. although this       period (first 8 days of life). while Maine’s five-year
rate has stayed fairly steady the past few years, there are     infant mortality rates declined during the 1990s, infant
some variations within Maine from about 90 percent              mortality has risen since 000, mainly from an increase
in cumberland county and the Midcoast to about 8               in the neonatal rates.

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                     The most common causes for infant mortality in              between exposure to tobacco smoke and infant
                Maine are congenital anomalies (about one-third), pre-           stomach sleeping position with SiDS. Resulting aware-
                maturity (about one-quarter), and SiDS (sudden infant            ness campaigns about both contributing factors (such
                death syndrome) (about one-tenth), with the remainder            as the “Back to Sleep” campaign) have helped to reduce
                mostly due to pregnancy and labor complications. SiDS            the number of infant deaths due to SiDS.
                is the most common reason for infant death outside of                  State and federal policies led to the development
                the neonatal period (first 8 days). Deaths due to con-          of a system of newborn screening for disorders that if
                genital anomalies have also increased in recent years.           left untreated, would result in cognitive delays, signifi-
                                                                                 cant health problems, or early death. Maine consis-
                                                                                 tently screens 99 percent of infants born for 
       …it is especially important to detect                                     treatable, congenital, metabolic, and other genetic
                                                                                 conditions detectable in the newborn period. The
       abnormalities with growth and develop-                                    Maine center for Disease control’s (cDc) genetics
                                                                                 program coordinates specialty consultation and treat-
       ment during [gestation and the first five                                 ment within 48 hours of the test results for the infants
                                                                                 who are found to have a disorder.
       years of life] since early intervention can
                                                                                           GRowTH anD DeveloPMenT
       successfully address many problems.

                            Policies and Perinatal Health
                                                                                 T    he human brain and other organs develop during
                                                                                      gestation and the first five years of life more
                                                                                 rapidly than any other time. Therefore, it is especially
                     Many policies and programs have had a significant           important to detect abnormalities with growth and
                impact on perinatal health. Public health nursing in             development during this period since early intervention
                Maine began in 190 to address the state’s high infant           can successfully address many problems.
                and maternal mortality rates. The program continues
                to address these issues by providing nursing visits and                           Vision and Hearing
                other services to high-risk mothers and babies. Maine’s               Because an infant and toddler’s development is
                system of home visiting provides voluntary pre- and              dependent on adequate vision and hearing, early detec-
                post-natal home visits to all first time parents and             tion of problems with these two senses is important.
                ongoing visits for those at high risk to educate parents         about 150 to 400 infants in Maine do not pass a
                about factors that contribute to a family’s overall health       newborn hearing test, and about four of them are
                and link them to needed services.                                identified with severe hearing impairment every year.
                     although a broad range of federal and state poli-           one in 0 preschoolers has vision problems. with
                cies affect perinatal health, including most of those            early screening and interventions, these children can
                mentioned throughout this article, a few are worth               develop normally.
                special mention. For instance, federal and state policies             State and federal policies are important to address
                have led to comprehensive data collection systems that           early detection of vision and hearing problems. in 000
                include the extensive health information contained               the legislature passed the Maine newborn Hearing law
                in vital records (abortion, miscarriage, birth, fetal            that ensures all parents of children born in hospitals
                death, death, and marriage certificates), and PRaMS              and birthing centers are offered newborn hearing
                (Pregnancy Risk assessment Monitoring System), a                 screenings before returning home. Maine statute and
                voluntary survey of about 10 percent of post-partum              rules also require hearing and distant vision screenings
                women. one example of the success of these systems               in kindergarten and grade one and near vision and
                is that analyses of them showed the strong association           binocular vision screening in grade one.

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              Developmental Disorders                           until 190 that the Maine Board of Health (prede-
     autism is emerging as one of the most common               cessor to the Maine cDc) gained the legislative
developmental disorders, occurring in about one in              authority to regulate public drinking water in Maine.
150 children. a neurological disorder that affects              over the ensuing years Maine’s public water supply
the ability of a person to communicate and interact             gradually improved in safety, and as a result, water-
with others, autism is normally identifiable within             borne infections decreased, especially among the most
the first three years of life. autism can and should            vulnerable—infants and young children. Third, immu-
be screened for in all young children since early               nizations are one of the top public health successes of
diagnosis and intervention have been shown to help              the 0th century, resulting in millions of lives saved.
children to develop. Some other common develop-                 childhood immunizations have eliminated many of
mental disorders that can be detected and treated in            the top killers of young children from early in the last
the early childhood period include nervous system               century—smallpox, tetanus, diphtheria, polio, several
disabilities such as Down and Fragile X syndromes,              types of bacterial meningitis, measles, influenza, and
metabolic disorders such as phenylketonuria (PKU)               others. adult vaccinations such as those against tetanus
and hypothyroidism, and degenerative disorders                  and influenza have also reduced perinatal disease and
such as Rett syndrome.                                          deaths among mothers and newborns.
     child Development Services (cDS) offers compre-                 Public health successes—safe drinking water,
hensive developmental screening, early intervention,            sanitary conditions, and immunizations—are all the
and special education for children ages birth through           result of policies that set standards, provided regula-
age five with a variety of developmental challenges that        tory authority, and funded programs to make these
may otherwise impede their school readiness. Head Start         successes possible.
also offers comprehensive services for children living in
poverty or with a disability. (See cobo-lewis this issue                           cHRonic DiSeaSe
for further discussion of the service system for young
children with disabilities.)

               inFecTioUS DiSeaSeS
                                                                n     early three-quarters of Maine people die from
                                                                      one of four chronic diseases: cancer, cardiovas-
                                                                cular disease, diabetes, and chronic lung disease, which
                                                                are also the major causes of disability and premature

o     ne hundred years ago one in five babies born
      in Maine did not live to see their fifth birthday.
Today, this number is about one in 800. The main
                                                                death. although the burden of most of them is seen
                                                                primarily in adulthood, the disease process can start
                                                                early in life and reach across the lifespan. it is therefore
reason for this enormous success is the decrease of             important to examine policies that have their impact
infectious diseases affecting mothers and infants. The          in early childhood to prevent these diseases. Policies
top causes of infectious disease-related deaths among           related to the behavioral risk factors of tobacco,
young children in Maine 100 years ago were diarrhea             physical activity, and nutrition hold some of the most
(most common), influenza and other causes of pneu-              direct preventive impact.
monia and bronchitis, diphtheria, pertussis (whooping
cough), tuberculosis, and meningitis.                                         Screening for Chronic Diseases
     Several major factors are responsible for these                               in Early Childhood
dramatic declines in lethal infectious diseases. First,              increasingly we recognize that some chronic
improved sanitary conditions in the birthing and                diseases have biological risk factors that are identifiable
perinatal period and throughout our society have less-          in early childhood, including high cholesterol, hyper-
ened the transmission of infectious diseases. Second,           tension, and obesity. current recommendations are
the availability of safe drinking water has led to the          for children to be screened starting at age two with
decline in water-borne infectious diseases. it wasn’t           a fasting lipid profile blood test if they have a family

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                history of early cardiovascular disease or of significant                           oRal HealTH
                risk factors (such as high cholesterol, smoking, obesity)
                or have an unknown family history. Blood pressure
                screening is also recommended in early childhood.
                obesity screening (which can include determining
                                                                                M       aine has one of the highest edentulous rates
                                                                                        (loss of teeth) in the country among adults.
                                                                                Given that the foundation for adult oral health starts
                parental obesity and/or the child’s body mass index             in early childhood, one can consider this adult health
                with percentile determinations by age and gender)               indicator to also be a measurement of childhood poor
                should start early in childhood also.                           oral health. although there is a scarcity of oral health
                                                                                measurements among young children, one survey in
                                       Diabetes                                 004 showed that one in seven Maine kindergarteners
                     The recent upsurge in diabetes associated with             had untreated tooth decay (Governor’s economic
                the obesity epidemic is clearly already having an               Summit on early childhood. 007). Poor oral health
                impact on infant health. in 007, 5. percent of births         in early childhood is found much more commonly
                (744 births) were to mothers with gestational or                among families living in poverty, and its impact is seen
                existing diabetes. This is up from 1.7 percent (97             throughout an individual’s lifetime.
                births) just 0 years ago, with a steady increase seen                There are two major policy-related strategies
                in the years between. eleven percent of post-partum             that improve the oral health of young children. First,
                Maine women report having diabetes during preg-                 obtaining regular preventive dental health care at an
                nancy (gestational and pre-existing diabetes). Policies         early age is important both for detecting early oral
                related to reducing obesity are discussed elsewhere             health problems and for preventing them, since these
                in this article, but have potential for significantly           visits are an opportunity for oral hygiene education
                impacting the diabetes epidemic that is affecting the           and preventive cleanings. in Maine about half of all
                health of our young children.                                   children between the ages of one and five years of
                                                                                age have never been to a dentist (cDc 00). Many
                                        Asthma                                  policy-related factors affect this strategy, including
                      asthma is the only major chronic disease with a           shortages of oral health care providers, lack of dental
                higher prevalence in children than adults, and Maine            insurance, and low dental care reimbursements. Some
                has among the highest asthma rates in the country.              current initiatives to improve access to early oral health
                approximately 45,000 Maine children have asthma                 care include Fund for a Healthy Maine dollars that are
                (15 percent), including approximately 5,000 children            used for reimbursing dental care for some uninsured
                ages birth to age five (6.5 percent). Those under age           low-income people and for building community dental
                five have the highest rates of emergency department             capacity; the training of pediatricians for some basic
                visits and hospitalizations. asthma rates are higher in         preventive oral health care; and the ability for dental
                families living in poverty and in some racial minorities        hygienists to practice in public health settings.
                such as in african americans (Maine cDc 008a).                       Second, community water fluoridation is an
                      a number of policies affect the impact of asthma          important and successful population-based interven-
                in early childhood. Federal policies that control air           tion that improves the oral health of young children.
                pollution (including ozone production) are especially           although about 80 percent of Maine’s public drinking
                important to states in the northeastern United States           water supplies are fluoridated (all of which were voted
                since the jet stream carries asthma-inducing air pollut-        by the community, as required by state law), more than
                ants here from elsewhere in the country. other federal          half of Mainers, mostly in rural areas, obtain their
                and state policies that assure clean outdoor and indoor         home drinking water from a private well, which may
                air are also important, including those that increase use       not have naturally occurring fluoride. it is important
                of public transportation, decrease exposure to second-          for the health of our young children to assure fluorida-
                hand smoke, and improve the efficiency of wood-                 tion of public water supplies and access to supple-
                burning and other sources of heat and energy.                   mental fluoride when indicated.

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            enviRonMenTal HealTH                                vast majority of lead-poisoned children in Maine are
                                                                found to have been exposed to lead from household

y    oung children are particularly vulnerable to
     environmental toxins. They breathe air and
consume food and fluids several times more per
                                                                paint, mostly paint found in pre-1950 homes. low-
                                                                income and racial minority children are also at higher
                                                                risk for lead poisoning, mainly because they are more
body weight than adults. young children are also                likely to live in pre-1950s housing with deferred
more susceptible to the harmful effects of many                 maintenance.
toxicants, especially those that exert their damage
disproportionately on developing organs. yet, of the
significantly produced commercial chemicals, nearly                              young children are particularly
three-quarters have undergone little or no toxicity
testing. what little testing has been done has focused                           vulnerable to environmental toxins.
on adult animals, whose kinetics are different from
young, developing animals (Physicians for Social
Responsibility 008).                                                 Federal and state policies play an especially impor-
                                                                tant role in preventing and detecting lead poisoning.
                         Lead                                   For instance, federal laws that banned lead in residen-
      lead poisoning remains one of the major environ-          tial paint (1978) and greatly reduced its presence in
mental hazards threatening young children in Maine.             gasoline (1970s-1990s) resulted in large reductions in
Given that the paint found in homes built before 1950           the overall blood lead levels among american children.
accounts for the very vast majority of lead poisoning in        Federal Medicaid regulations requiring all young chil-
U.S. children and that Maine has one of the highest             dren with Medicaid insurance (Mainecare) to be
proportions of pre-1950 housing stock, lead poisoning           blood tested for lead (199) along with subsequent
is likely to be a major public health threat to Maine’s         Maine state laws that require screening and appropriate
young children for years to come.                               follow up blood testing are associated with increased
      children under six years of age are at the greatest       screening rates among Maine children over the last 15
risk for lead poisoning because lead has a bigger               years. Maine law that requires all blood lead tests to be
impact on developing nervous systems. its effects can           reported to the Maine cDc assures that all children
lead to lifelong physical and developmental disabili-           identified with high levels will have appropriate follow-
ties. By state law, all Maine children at ages one and          up, such as medical treatment, home inspection and
again at two years old are required to have a blood             testing, along with public health nursing visits to help
test for lead unless a child does not have Mainecare            the family mitigate the presence of lead at home. in the
insurance and if the child is determined by their               future, federal and state policies and resources that
health care provider’s screening to not have any risk           assure all high-risk housing is tested and mitigated are
factors for lead poisoning. over the last several years,        our best hope for primary prevention of this ongoing
half of Maine’s one-year-olds and one-quarter of                100+ year old environmental public health threat
Maine’s two-year-olds have had such a blood test.               (Maine cDc 008b).
although the annual number of young children iden-
tified with elevated blood lead levels has declined over                      Other Environmental Toxins
the last five years, there are an estimated 1,000 chil-              other environmental toxins have emerged that
dren under six years of age with lead poisoning. lead-          also appear to disproportionately affect young chil-
poisoned children are found throughout the state;               dren. For instance, because of their developing nervous
however, about 40 percent are in five metropolitan              systems, young children are more affected by forms of
areas (lewiston/auburn, Portland/westbrook, Bangor,             mercury, a heavy metal with similarities to lead. in
Biddeford/Saco, and Sanford), which also have higher            1999 it was determined that a common preservative
rates of lead poisoning among those screened. The               found in vaccines, thimerosal, contained ethylmercury,

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                and was contributing significantly to the mercury                              Motor Vehicle Crashes
                exposure in young children. During the subsequent                   Motor vehicle crashes are the single biggest cause
                years thimerosal was virtually eliminated from the early       of death in Mainers ages one through five years (and
                childhood vaccine supply. young children continue to           to age 5). These deaths have decreased over the years,
                be exposed to methymercury found in certain fish such          from a rate of six per 100,000 for Maine children less
                as tuna and swordfish. This mercury’s origins are              than five years old in the early 1980s to 1.4 in the last
                thought to be primarily from sources of air pollution          three years. This dramatic reduction in crash deaths is
                (such as coal-fired industrial plants) that produce            directly related to policies that assure the safe transport
                mercury, which is then carried by prevailing winds             of young children. Federal policies and programs have
                and precipitates in cold climates to be taken up in            improved the safety of automobiles and provided
                the environment.                                               funding for states to provide free infant car seats to
                     Bisphenol-a (BPa), a chemical and endocrine               low-income families. State laws requiring appropriate
                disrupter with possible long-term health effects, is           vehicle restraints for all children (car seats and booster
                commonly found in some hard plastic food and                   seats), backseat placement for all children under 1
                beverage containers and liners, including that of some         years of age, and primary seat belt laws for adults along
                baby bottles. young children appear to have some the           with speed and alcohol laws all have improved the safe
                highest exposures to BPa because of its use in baby            transport of our children.
                bottles and pre-mixed infant formula liners.                        The success of these policies is seen in the data.
                     Decabromodiphenyl ether (decaBDe), a bromi-               in 1995, one in six Maine children ages birth to
                nated flame retardant, is another chemical of concern          four years old was not restrained in a child passenger
                for young children. Based on animal studies, it is             seat. in a 007 Maine study, 100 percent of infants
                classified as a possible carcinogen (cancer-causing            (birth to age one), 96 percent of children ages one
                chemical), a likely endocrine disrupter, and as                to four, and 87 percent of four- to seven-year-olds
                possibly having neurological and reproductive effects.         were restrained.
                DecaBDe has been detected in human breast milk
                and urine. one dilemma has been to assure that                       Intentional Injuries and Domestic Abuse
                there are safe alternatives that can provide life-                  among infants, the second leading cause of injury
                saving fire retardation properties to products such            hospitalization is assault. in 007, an astonishing 5,07
                as mattresses and furniture. Several possible alterna-         children in Maine ages birth to 17 were found to be
                tives have been identified. as a result, some countries        victims of substantiated abuse or neglect. Forty percent
                and states such as Maine are moving toward phasing             of these, ,150, were children under five years old.
                out the use of decaBDe.                                        The effects of child abuse can be lifelong and have
                                                                               an impact on many aspects of a person’s life. Policies
                                        inJURy                                 related to the reporting of these crimes, enforcement
                                                                               of laws against perpetrators, treatment of victims, and

                a    review of the major causes of injury in young
                     children gives us three stunning examples. The
                dramatic successes of motor vehicle policies give us a
                                                                               prevention strategies can have a positive effect on these
                                                                               devastating statistics.
                                                                                    Domestic violence of any sort can affect the health
                road map to approach policies and programs that can            of Maine’s young people. every year more than 7,000
                reduce injuries and deaths. on the other hand, the             Maine women are physically or sexually assaulted by
                data on child abuse and neglect indicate an ongoing            an intimate partner. one in 0 new mothers in Maine
                tragedy that our country and state have not adequately         reports experiencing physical abuse around the time
                addressed. Finally, falls are an interesting example           of pregnancy. Those mothers reporting abuse are three
                because of a silent acceptance that can also be affected       times as likely to be diagnosed with post-partum
                by effective policies.                                         depression.

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     These kinds of stressors in early childhood can            member. about one in seven post-partum women in
affect children through their lifespan, even if they            Maine has been diagnosed with depression by a health
themselves are not victims of abuse. For instance, the          care provider, and this rate rises to one in five for low-
adverse childhood experiences (ace) Study (Felitti et           income women.
al. 1998) showed an association of stressful childhood                Several sources of health data on Maine children
experiences (such as witnessing or being victimized by          indicate high rates of behavioral health issues relative
abuse, violence, and substance abuse) with adult risk           to other states. For instance, according to the national
behaviors and health outcomes such as alcoholism,               Survey of children with Special Health needs, Maine
drug abuse, depression, attempted suicide, smoking,             has high rates of children with special health needs
high-risk sexual behaviors, and obesity.                        (18 percent) relative to the country (14 percent), which
                                                                appear to be due to high rates of behavioral health
                          Falls                                 diagnoses such as attention deficit disorder and high
      Falls are the leading cause of injury hospitalization     rates of asthma (
and emergency department visits for children under age          StatePrevalence005.aspx?geo=Maine). Medicaid
five. in the five-year period between 00 and 006,            (Mainecare) claims data in Maine also indicate high
more than 16,000 children in Maine were treated in              claims related to behavioral health diagnoses among
emergency departments due to falls, and an additional           Maine children.
00 were hospitalized. Policies related to safe play-                 Fortunately, effective early interventions to
grounds and other places where young children spend             promote healthy social and emotional development and
time, along with educational efforts about children’s           to prevent and treat mental health problems can have
developmental stages (what children are capable of at           lifelong positive effects. Such programs and policies
different ages) can help reduce these falls.                    include public education and awareness campaigns that
                                                                promote healthy social and emotional development in
                  MenTal HealTH                                 early childhood, family leave policies, safety net finan-
                                                                cial programs that protect families with young children

M       ental health of young children is defined as
        the healthy social and emotional development
of young children. infants and very young children
                                                                from extreme poverty, home visiting programs, early
                                                                Head Start, foster care and treatments to address the
                                                                stressors foster children have encountered, interventions
are especially affected by the relationships with their         to prevent and treat parental behavioral health prob-
parents and caregivers, including the adults’ mental            lems, and laws that protect children from abuse.
health problems, along with the impact of their envi-
ronment and any genetic or other biological effects.                  PHySical acTiviTy anD nUTRiTion
      in Maine, the annual PRaMS (
dhhs/bohodr/prams.htm) survey of post-partum
women shows the prevalence of a variety of issues
that can affect the mental health of infants and young
                                                                n     utrition and physical activity habits seen in early
                                                                      childhood set the stage for related successes and
                                                                challenges throughout the lifetime, and therefore
children. For instance, about one in four Maine                 warrant special attention by policymakers.
women report binge drinking at least three times                     Growth retardation and malnutrition were once
during pregnancy. of post-partum women with                     the major nutritional challenges facing our young chil-
Mainecare insurance, about one in six report at least           dren. although food insecurity with resulting hunger
five major stressors during pregnancy, such as inability        and malnutrition continue to challenge too many fami-
to pay some bills, inability to buy enough food, job            lies with young children, often food insecurity today
loss, physical abuse by a partner, moving to a new              results in poor nutrition with fatty and sugary foods
address, homelessness, drug or drinking problems in             and sugary beverages, with resulting obesity. The heavy
the household, and death of or major illness in a family        marketing of relatively unhealthy foods to young chil-

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                dren and families, the lower costs of many relatively             percent vs. 87 percent). The most common reasons
                unhealthy foods and beverages over healthier choices,             for stopping breastfeeding include the belief that
                and the time investments it takes for overly busy fami-           breastfeeding is insufficiently feeding the baby and
                lies to cook are all factors that contribute to the uphill        difficulties with breastfeeding (
                battle families with young children face when trying to           dhhs/bohodr/prams.htm).
                make healthy food-purchasing decisions.                                 Programs and policies to address nutritional needs
                      Physical activity, the other side of the calorie equa-      of pregnant women and young children include wic
                tion (calories expended versus calories ingested), also           (women, infants and children), a public health
                poses challenges to families with young children. with            program that provides food, nutrition counseling,
                most parents of young children working and with our               health screenings, and access to health services to low-
                environments no longer making it easy to exercise, it is          income women and young children and young children
                increasingly challenging for parents and children to get          (birth to age five) with nutrition risks. originally
                adequate exercise.                                                created to address malnutrition, the program is under-
                                                                                  going changes in its food package to also address
                                                                                  obesity-related poor nutrition that disproportionately
         thirty-six percent of Maine kinder-                                      affects low-income families. Studies show that wic
                                                                                  reduces medical costs and improves a number of impor-
         gartners are obese, a higher rate                                        tant health outcomes in infants and young children.
                                                                                        other programs and policies to address the phys-
         than seen in older children.                                             ical activity and nutritional needs of young children
                                                                                  include those that change the built environment (such
                                                                                  as adding sidewalks, especially in low-income neighbor-
                     Maine data show the results of these physical                hoods); educate young families on how to make
                activity and nutritional challenges. Thirty-six percent           healthy nutrition and physical activity choices; make
                of Maine kindergarteners are overweight or obese, a               healthy foods and beverages and physical activity
                higher rate than seen in older children. (and about               options less expensive for low-income families; and
                60 percent of Maine adults are overweight or obese.)              encourage breastfeeding. The long-standing federal
                Some of the factors associated with childhood obesity             policies that resulted in the addition of folic acid and
                are poverty and obesity in one or both parents. obesity           iodine to the food supply are other examples of
                rates among Maine young adults (18-4), i.e., those               ongoing successes that positively affect the health
                who are most commonly becoming parents, have more                 of pregnant women and infants.
                than doubled in just 10 years. More than one-third
                (7 percent) of pregnant women in Maine are over-                                 DiScUSSion:
                weight or obese, and this rate is higher (4 percent)                      wHeRe Do we Go FRoM HeRe?
                among low-income pregnant women (
                     Breastfeeding in infancy is one of the best
                nutritional strategies for the health of infants and
                                                                                  M     aine and the nation have been successful in many
                                                                                        aspects of children’s health, but challenges remain
                                                                                  in a number of areas, and new challenges are arising.
                young children, including helping to prevent obesity
                and to boost infant immune systems. Breastfeeding                                    Infant Mortality
                in Maine ranks about average in the U.S., though                       Despite the U.S. being considered the wealthiest
                we have slightly lower rates of ever breastfeeding                country and a world leader in many areas, in early
                and of breastfeeding at six months of age (www.cdc.               childhood health, we lag behind. our infant mortality
                gov/BReaSTFeeDinG/DaTa/report_card.htm).                         ranks rd, after countries in almost every corner of
                low-income Maine women are less likely to have                    the world—australia, canada, the european Union,
                ever breast fed than higher income women (69                      Singapore, and Japan (United nations 007). our

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                                                                                                             eaRly cHilDHooD HealTH

mortality rate for children birth to age five similarly         and birth defects surveillance programs (cobo-lewis
ranks 6th. These countries also give us a road map             this issue).
to improve the health of our young children, and
ironically, it’s the same road map the U.S. helped to                             Infectious Diseases
develop early in the last century, with investments in               Sanitation and clean drinking water had a
maternal and child health and support for families              dramatic impact in reducing mortality among infants
with young children.                                            and young children, along with the general population.
     in response to the state’s rising infant mortality         Today, however, many of our public drinking water
rates, about two years ago the Maine infant Maternal            supplies are more than 100 years old and need repairs
Mortality Review Panel was formed to do in-depth                to maintain safe water for a growing population.
reviews of infant deaths in order to identify common            adequate funding from state, federal and local sources
and preventable contributory factors. it is modeled             is needed for these repairs and upgrades.
after the long-standing Maine child Review Death                     Successes in immunizations face many policy-
Panel. analysis of their first reviews is expected in           related challenges. The U.S. is one of the few developed
the coming year.                                                countries without sufficient federal oversight to ensure
                                                                adequate manufacturing and distribution of vaccina-
  Growth and Development, Early Intervention                    tions. vaccine availability is dependent on each state’s
     a number of issues need to be addressed in the             policy and funding abilities. in a number of states,
areas of growth and development and early identifica-           costs are a barrier for many patients. Misinformation
tion of children with developmental disorders.                  about the risks of vaccines, with resulting parental fears
Policies are important for tracking, research, early            about them, has grown these past few years. Because
detection, and intervention of developmental issues.            of the success of vaccines, the diseases they prevent are
as noted previously, Maine law enables the Maine                often rare or nonexistent in the U.S. concerns about
cDc to offer bloodspot testing and to provide refer-            the vaccines, however, are far more common than the
rals and follow up on all newborns for  metabolic             deadly diseases they prevent. The number of shots
and genetic conditions. There are also policies                 given to young children is also a barrier for some
providing for hearing screening for newborns and                parents. The pandemic with the new H1n1 (“swine
hearing and vision screening for children in kinder-            flu”) is disproportionately affecting children, young
garten and first grade. a gap that needs to be reme-            adults, and pregnant women. challenges with miti-
died is the lack of any policy or program supporting            gating and delivering vaccine to address this pandemic
pre-school vision and hearing screening. Screening              are pointing out the weaknesses in our policies on
and early intervention for autism is another process            infectious diseases. one can hope that the experiences
that needs improvement. although developmental                  of this pandemic will result in improved policies.
screening is a standard part of a well child check, the
screening for autism has not yet been fully adopted.                               Chronic Diseases
Maine is working to integrate this screening into the                Some chronic diseases have biological risk factors
policies of payers and into the education of physicians         that are identifiable in early childhood (e.g., high
and other health care providers.                                cholesterol, hypertension, and obesity). However,
     cobo-lewis (this issue) notes that there can be            screening for these risk factors is not fully incorporated
a lack of coordination between various systems serving          into the health care system. To assure such screenings
young children with disabilities. Recommendations               are done more routinely, it is important that there be
from a recent report of the Subcommittee to Study               effective policies within health settings and related
early childhood Special education resulted in changes           government agencies, such as policies that all children
to Maine law that mandate referrals to children’s               should be screened and inclusion of the screening on
Development Services based on the cDc’s screening               well child care forms, and adequate health care provider
results in their bloodspot testing, newborn hearing,            reimbursement for the services. effective prevention

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eaRly cHilDHooD HealTH

                of chronic diseases also starts in childhood and is the          Maine cDc District Public Health Units within
                result of federal, state, and community policies                 DHHS offices that include field epidemiologists and
                resulting in easier access to healthy nutrition, physical        public health nurses; community health nursing; child
                activity, and tobacco-free life at school, at home, and          abuse and neglect councils; communities for children
                throughout a child’s community.                                  and youth; wic; Maine’s Department of Health and
                                                                                 Human Services (DHHS) social services Future Search
                                                                                 councils, and community Service networks.
      some of the most remarkable progress                                             To maintain past successes and address current
                                                                                 challenges, a concerted, coordinated, and ongoing
      in health over the past 100 years includes                                 effort is needed to work with such a myriad of systems
                                                                                 and factors affecting the health of infants and young
      measures that affect early childhood.                                      children. one strategy to strengthen Maine’s public
                                                                                 health and some social service systems has been the
                                                                                 creation of and improved coordination in the eight
                                Environmental Health                             DHHS districts. with emerging coordinating bodies
                     lead, mercury, BPa, and decaBDe all provide                 such as the co-location of Maine cDc regional staff in
                examples of the importance of federal and state policies         District Public Health Units, the District coordinating
                for protecting young children from environmental                 councils for Public Health, the child-focused Future
                toxins. Policies have been instrumental in providing             Search District initiatives, and the mental health-
                the necessary research, in regulating or banning the             focused community Service networks, there have been
                use of these chemicals, or in mitigating their effects.          recent improvements in and are ongoing opportunities
                a number of environmental health experts, however,               to improve coordination, efficiency, and effectiveness
                believe the U.S. should adopt the precautionary prin-            of all the systems.
                ciple as a policy approach to commercial chemicals, as                 Because disparities are common, even in some of
                is being done in some other countries including the              our successful outcomes and areas of the state, it is
                european Union. This precautionary principle would               also important that all our systems address populations
                assure that research is done up front so that the                at risk or already facing disparities, along with the
                proposed use of a chemical will not result in significant        overall indicators.
                harm or that potential harm is minimized. Proponents
                say that this approach assures the health of our entire                              conclUSion
                population better than the current approach of deter-
                mining if harm has occurred only after perhaps years of
                exposure. Some argue that the precautionary principle
                will help avoid another tragic legacy like lead poisoning.
                                                                                 S   ome of the most remarkable progress in health over
                                                                                     the past 100 years includes measures that affect
                                                                                 early childhood. These successes were primarily the
                                                                                 result of coordinated, focused, and evidence-based
                                Networks and Systems                             investment in maternal and child health, yet the entire
                     Maine is fortunate to have several strong statewide         population reaped the benefits. we know from these
                networks that work on issues affecting the health of             successes that it is possible for all children in Maine
                infants and young children. These include: the state-            to begin with a healthy start. with a focused invest-
                wide systems of family planning clinics and community            ment on early childhood and coordination of existing
                outreach; home-visiting programs; Healthy Maine                  programs, we can assure that all babies born are wanted
                Partnerships (our statewide system of comprehensive              and born to families who are able to feed, house, and
                community health coalitions); child Development                  clothe them. and, each of these children will have the
                Services (cDS); a network of health centers, pediatric           support of their family, community and health system.
                practices, hospitals and health systems; dental clinics;         This is how our village of Maine can assure that all are

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                                                                                                                eaRly cHilDHooD HealTH

born equal, free, and with a chance to pursue their full
measure of happiness. This is how our village of Maine
can touch the future.                                             logan, beth a., Marie J. hayes, Mark s. brown, Paul
                                                                      tisher, Jonathan a. Paul and ramesh krishnan.
                                                                      2009. “Maine’s high risk infants and Maternal
                                                                      health and Wellbeing: the Maine infant Follow-up
                                                                      Project.” Maine Policy review 18(1): 60–67.

  AcknOWLeDGMenTs                                                  Maine Center for disease Control and Prevention
                                                                      (CdC). 2008a. burden of asthma in Maine, 2008.
  special thanks to erika lichter and brenda Corkum                   Maine CdC, augusta.
  from the Maine CdC for compiling many of the data                   bohdcfh/mat/information%20and%20Publications/
  used in this article.                                               2008%20asthma%20burden%20report.pdf
                                                                      [accessed september 19, 2009]

  RefeRences                                                       Maine Center for disease Control and Prevention
                                                                      (CdC). 2008b. Childhood lead Poisoning in Maine,
  acheson, ann. 2009. “Family economic security.”                     2008 update. Maine CdC, augusta. http://www.
     Maine Policy review 18(1): 34–45.                      
  brooks-gunn, Jeanne and greg J. duncan. 1997.                       pdf [accessed september 20, 2008]
     “the effects of Poverty on Children.” the Future              Physicians for social responsibilitiy. 2008. Pediatric
     of Children 7(2): 55–71.                                         environmental health toolkit: key Concepts in
  Centers for disease Control. 2003. 2003 national                    Pediatric environmental health. Physicians for
     survey of Children’s health. CdC, atlanta. http://               social responsibility, Washington, dC. http://www. (accessed             
     december 2, 2008)                                                [accessed september 19, 2008]

  Cobo-lewis, alan b. 2009. “interdepartmental                     trostel, Philip. 2009. “the dynamics of investments in
     Coordination for Maine’s young Children with                     young Children.” Maine Policy review 18(1): 18–25.
     disabilities.” Maine Policy review 18(1): 68–81.              united nations. 2007. World Population Prospects:
  Connors, dana F. 2009. “investing in Maine’s youngest               the 2006 revision. united nations, new york.
     Children has great returns for business.” Maine        
     Policy review 18(1): 26–29.                                      wpp2006/WPP2006_highlights_rev.pdf [accessed
                                                                      september 20, 2009]
  Felitti, vincent J, robert F. anda, dale nordenberg,
      david F. Williamson, alison M. spitz, valerie
      edwards, Mary P. koss and James s. Marks.
      1998. “relationship of Childhood abuse and
      household dysfunction to Many of the leading
      Causes of death in adults, the adverse Childhood                                          Dora Anne Mills is the public health
      experiences (aCe) study.” american Journal of
                                                                                                director for Maine and serves as
      Preventive Medicine 14(4): 245–258.
                                                                                                the director of the Maine Center
  governor’s economic summit on early Childhood.
     2007. early Childhood in Maine: a Compilation of                                           for disease Control and Prevention
     statewide data. governor’s economic summit on                                              (Maine CdC) in the department of
     early Childhood , augusta, Me. http://www.maine.
                                                                                                health and human services. before
     early%20Childhood%20in%20Maine.%20a%20                                                     taking this position in 1996, she did
     Compilation%20of%20statewide%20data.pdf                                                    her medical pediatric training and
     [accessed september 20, 2009]
                                                                                                worked in los angeles, did volun-
                                                                 teer work in tanzania, and practiced medicine in her hometown of
                                                                 Farmington. she is also the mother of two young children.

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Maine’S HiGH-RiSK inFanTS

                     Maine’s High-
                      Risk infants                                    The Maine Infant Follow-Up Project is a research-

                     and Maternal                                     based effort to accelerate early identification of devel-

                                                                      opmental risk for infants whose mothers use drugs or

                       Health and                                     alcohol. These infants are at high risk for neurodevel-

                       wellbeing:                                     opmental disorders, and early identification will

                                                                      enable early-early intervention. Targeted interven-

                             The Maine Infant                         tions will increase the chance for children to catch up

                            Follow-Up Project                         developmentally during the period of most rapid

                                              by beth a. logan        brain growth in the first three years of life.   

                                                Marie J. hayes

                                                Mark s. brown

                                                   Paul tisher

                                              Jonathan a. Paul

                                              ramesh krishnan

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                                                                                                        Maine’S HiGH-RiSK inFanTS

                                                                                                       Maine’s spiraling

M       aternal and child health is profoundly affected
        by Maine’s regional landscape of intergenera-
tional rural poverty and limited health care access.
                                                                cognitive and motor deficits
                                                                associated with oxygen depriva-
                                                                tion), leading to developmental
                                                                                                       need for services

economic and social disadvantage is all too common in           disabilities later in childhood.       for developmental
Maine families and can derail the path to normal child
development. Maine’s rate of infant mortality in the               PReScRiPTion oPiaTe                 disabilities and
first year is high, but similar to U.S. rural states, with        ePiDeMic anD PRenaTal
leading causes being congenital anomalies, prematurity,                 eXPoSUReS                      special educa-
sudden infant death syndrome (SiDS), and pregnancy
and delivery complications.                                                                            tion poses a crisis
       according to the web-based injury Statistics
Query and Reporting System (wiSQaRS) of the U.S.
centers for Disease control and Prevention (www.cdc.
                                                                a    n increasingly large group
                                                                     of Maine infants are being
                                                                exposed to prescription opiates
                                                                                                            of care for early

gov/injury/wisqars/), SiDS in Maine represents 10               as addiction reaches epidemic               identification of
percent of all infant deaths compared to only 5.4               proportions statewide. Hospital
percent in the northeast region. Because of the known           admissions for prescription drug            developmental
association of SiDS and prenatal alcohol and drug               abuse increased 06 percent
addiction (Hunt and Hauck 006), Maine’s elevated               between 004 and 008 (Maine                and behavioral
SiDS rate may reflect an acquired brain injury that is          Department of Health and
driven largely by poor maternal health, lifestyle, and          Human Services 009). in the                disorders related to
economic adversity.                                             most recent national Survey
      although Maine has implemented policy changes             on Drug Use and Health in                   maternal addiction.
to address the leading cause of infant death (i.e.,             Maine (006–007), 4.6 percent
congenital anomalies) with mandated statewide                   of those 1 or older (5,000
screening for a host of genetic and metabolic disorders         people) reported having used
at the time of birth, at present there is no public policy      pain relievers nonmedically in the past year (Hughes,
that mandates screening for long-term consequences of           Sathe and Spagnola 009). young adults of childbearing
prenatal poverty-related risk factors (e.g., alcohol,           age constitute the largest group of opiate-addicted
tobacco, abuse of opiates and other substances, lack of         patients, with 9 percent of the 500 women in treat-
prenatal care, malnutrition, and domestic abuse).               ment in acadia Hospital’s narcotics Treatment Program
Maine’s spiraling need for services for developmental           (nTP) in Bangor being of childbearing age, and approx-
disabilities and special education (Maine Department            imately 15 percent being pregnant at any given time.
of education 007) poses a crisis of care for early iden-            The standard of care for pregnant women with
tification of developmental and behavioral disorders            opiate addiction is methadone maintenance through
related to maternal addiction.                                  enrollment in a narcotics treatment program. careful
      Regionally, northeastern Maine families show              dosing of methadone matches the increasing metabolic
exceptionally low socioeconomic status (e.g., poor              demands of the growing fetus. in contrast, untreated
employment and education achievement; receipt of                opiate abuse (typically in a background of co-occurring
public assistance and Medicaid) that is correlated with         maternal tobacco and alcohol abuse) exposes the fetus
alcohol, tobacco, and drug addiction (Hayes et al.              to repeated binge and withdrawal episodes responsible
00; Troese et al. 008). During pregnancy and                 for high rates of in utero fetal death (oei and lui
immediately after birth, unregulated drug and alcohol           007). after birth, opiate-dependent infants are at high
exposure of the developing child is probabilistically           risk for numerous adverse effects, including a
(dependent on genetic susceptibility, dose, and timing)         protracted withdrawal process. The severity of with-
related to neurological damage (e.g., poor respiratory          drawal is compounded by maternal psychiatric diag-
and cardiac function associated with prematurity, and           nosis requiring antidepressant and anti-anxiety

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Maine’S HiGH-RiSK inFanTS

                medications such as Prozac and benzodiazepines, which                The second study was conducted in a cohort of
                have their own withdrawal syndromes.                           families enrolled in the narcotics treatment program
                                                                               (nTP) at the acadia Hospital in Bangor. The nTP
                   THe Maine inFanT Follow-UP PRoJecT:                         serves primarily low-income, white families (97
                    evalUaTinG RiSK STaTUS in cHilDRen                         percent caucasian), ages 1 to 65, 47 percent female,
                                                                               from northeastern Maine. Mothers in this cohort were

                T     he Maine infant Follow-up Project is an effort to
                      provide a longitudinal framework to accelerate the
                early identification of developmental risk to include
                                                                               in recovery treatment for opiate addiction at acadia
                                                                               nTP and were maintained on methadone during
                                                                               their pregnancies.
                the prenatal and early infancy period so that early-early            The groups did not differ statistically in tobacco
                intervention can be initiated. To date, our work has           use or pre-pregnancy or pregnancy estimates of alcohol
                included more than 00 alcohol- and opiate-exposed             use. Rates of tobacco and alcohol use in both samples
                infants and involves an interdisciplinary team with            were high, but similar to those of women of the same
                leadership from Dr. Mark Brown, chief of pediatrics at         social class (SaMHSa 008). The two study groups
                eastern Maine Medical center; Dr. Paul Tisher, former          differed primarily in opiate and other illicit drug use
                chief of psychiatry at eastern Maine Medical center            pre-pregnancy, with the acadia nTP group differing
                and chief medical officer at acadia Hospital; and the          statistically in the use of opiates and other illicit drugs
                Maine institute for Human Genetics and Health and              pre-pregnancy (opiates, marijuana, cocaine, and inhal-
                University of Maine infant development team led by             ants) from the FPc group. Hence, this comparison,
                Marie Hayes. as part of our joint efforts to identify          allows us to study differences in outcomes for these
                high-risk infants, we have characterized both prenatal         infants that are unique to opiate and other polydrug
                substance exposure and environmental risk factors in           exposure, given the samples are similar in alcohol,
                different samples of northeastern Maine families. in the       tobacco, and environmental risk factors.
                first study, disadvantaged women and their infants were              women had structured interviews during the
                studied from pregnancy onward with the goal of under-          third trimester with questions about their psycholog-
                standing the complex relationship between infant brain         ical health and the quantity, frequency, and timing
                development, demographic risk, and prenatal exposure           of tobacco, alcohol and other substances both pre-
                to alcohol and tobacco. in the second study, we again          pregnancy and during pregnancy, along with ques-
                evaluated demographic and alcohol/tobacco risk in the          tions about tolerance and addiction to alcohol. These
                context of opiate addiction, with an expanded suite of         measures assess problem drinking and have been
                markers of brain development.                                  demonstrated in the literature to be valid indicators
                      These two study cohorts were similarly exposed to        of the amount and severity of prenatal exposure
                rural poverty, as evidenced by their demographic char-         (Jacobson and Jacobson 1996). alcohol has well-
                acteristics. Groups were also similar on measures of           established detrimental effects on brain development
                psychological wellbeing, as indicated by scores on the         known as fetal alcohol syndrome/alcohol-related
                Beck Depression inventory, second edition (BDi-ii), a          neurodevelopmental disorder (FaS/aRnD) (May
                screen for maternal depression.                                and Gossage 001). additionally, data from routine
                      in the first cohort, women were recruited from           random urine analyses (Ua), which screen for mari-
                the Family Practice clinic (FPc) of eastern Maine              juana, methadone, oxycodone, other opiates, benzodi-
                Medical center (eMMc), which serves low-income                 azepines, cocaine, and stimulant medications were
                families from primarily washington, Hancock, and               collected. The most commonly detected illicit drug
                Penobscot counties. Pregnant women were caucasian              detected in Ua screens was marijuana, followed by
                (9 percent), single (64.7 percent), young (<6 years =        benzodiazepines and other opiates.
                70. percent), unemployed (48 percent), and depen-                   The first study found that infants whose mothers
                dent on Medicaid (Mainecare) or had no health insur-           had high alcohol use patterns before and during preg-
                ance (81.6 percent).                                           nancy exhibited fragmented and unstable sleep along

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                                                     FIGURE 1: Treatment rate for Neonatal Abstinence syndrome,
                                                                   by Prenatal exposure (November 2007–November 2008)

with fewer normal sleep movements.
infants were sleep deprived, indicated               100%

by decreased alertness and increased irri-                                                 No Treatment               Phenobarb Only            DTO/Methadone
tability during the day. Tobacco
smoking during pregnancy, present in                  80%
54 percent of the mothers, was associ-
ated with increased infant drowsiness                 70%
associated with difficult transitions

                                                  Treatment Rate
                                                      60%                                                                                               57.1%
between sleeping and waking. Sleep
deprivation represents an enormous                    50%
risk to the developing infant; sleep                                                                                            44.4%
integrity is critical in brain maturation             40%
and plasticity, but more importantly,
                                                      30%                                           27.8%                                                        28.6%
sleep deprivation is associated with
                                                                                                                       22.2%            22.2%
SiDS (for a more complete discussion,                 20%          18.2%
see Hayes et al. 007).                                                                                                                         14.3%
      in the second study, led by Dr.                 10%
Brown, an interdisciplinary team of
doctors, nurses and researchers evalu-                   0
                                                                      Methadone              Buprenorphine                 Prescription                 Street
ated the effects of different drug
regimens on length of hospital stay,                                                                        Prenatal Exposure
withdrawal severity, and infant irrita-
bility. Between 60 and 80 percent of
opiate-exposed infants develop a condition called                               The differences seen in infant outcome based on
neonatal abstinence syndrome (naS), a life-threaten-                       treatment history highlight the importance of charac-
ing collection of physiological symptoms of withdrawal                     terizing both the exposure history and the withdrawal
(e.g., irritability, poor sleep and feeding, gastrointestinal              profile of these high-risk infants. Managing and
distress, sweating and respiratory dysfunction) between                    reducing the severity of naS through new drug regi-
48 and 7 hours after birth. Sixty-six percent of infants                  mens have been implemented and have improved
in the study group experienced severe withdrawal                           treatment and reduced the length of stay in the
symptoms that met criteria for naS.                                        hospital. in the neonatal nursery at eMMc, mothers
      Figure 1 shows differences in withdrawal treatment                   are strongly encouraged to breastfeed because of the
based on type of addiction treatment during pregnancy.                     demonstrated advantages for the high-risk infant’s
infant outcome is measured in number of infants                            developing brain and the evidence from our group and
requiring no treatment, phenobarbitol, or opiate                           others that withdrawal may be ameliorated by the trace
replacement, e.g., DTo (titrated dose of tincture of                       amounts of opiates present in the breast milk (abdel-
opium) or methadone. Mothers were treated with                             latif et al. 006).
either methadone, bupenorphine (Subutex), prescrip-                             as part of the opiate study, the University of
tion opiates, or no treatment (self-medication or using                    Maine team in collaboration with Dr. Krishnan has
street drugs). while it appears that infants of mothers                    been examining opiate-exposed infants and matched
maintained on methadone were more likely to need                           controls for early cognitive function. over the last
more aggressive treatment for naS (higher rates of                         decade, the behavioral and neural biomarkers to screen
DTo/methadone), it should be noted that methadone-                         for cognitive developmental risk in the newborn using
treated mothers generally have more complex and                            electroencephalography (eeG) cognitive testing have
longer-standing opiate addiction and other sociodemo-                      emerged (Molfese 000). we found that newborn brain
graphic challenges than those on buprenorphine.                            waves are predicted by prenatal exposure profiles:

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                women entering opiate-replacement treatment earlier             area have required tremendous focused adaptation from
                have infants with better eeG associated with attention          our existing health care infrastructure. The cutting-edge
                and memory function. in addition, withdrawal severity           intervention system at acadia Hospital is continuing to
                and drug replacement clearly impair the brain eeG               develop innovative care of the pregnant patient and her
                response acutely, and perhaps for the long term, adding         family in preparation for the birth of the opiate-
                new urgency for improved pharmacological regimens               exposed infant. There are prenatal parenting groups
                for withdrawal treatment and prenatal maternal opiate           along with joint pediatric and nTP prenatal meetings
                management (Krishnan et al. 008).                              with health care providers to prepare for hospitalization
                     Because the population of opiate-addicted mothers          withdrawal complications. additionally, the psycholog-
                is characterized as having poor access to health care           ical adjustment to the birth of an infant, and often to
                resources, integrating child screens into narcotics treat-      first parenthood, is difficult for any mother, but is
                ment programs can activate mechanisms for early inter-          particularly difficult for a mother struggling with
                vention. Under the leadership of Dr. Tisher, and in             addiction recovery and economic stress. in addition to
                conjunction with the well child clinic at acadia                the typical challenges encountered by new parents,
                Hospital, the study team has established a follow-up            these families are also presented with the challenge of
                clinic to evaluate long-term developmental conse-               caring for a “temperamental” infant who suffers symp-
                quences of naS. children are assessed at seven months           toms of withdrawal.
                using the Bayley Scales of infant Development, which
                assesses motor, cognitive, and language development                     FUTURe DiRecTionS anD Policy
                along with social and emotional functioning. in our                             iMPlicaTionS
                current cohort, 50 percent of the children screened
                exhibit significant delays in motor function, an infancy
                marker of developmental delay. The relationship to
                withdrawal severity, prenatal methadone dose, and
                other prenatal and postnatal risk factors are suggestive
                                                                                a    lthough modern medicine and intensive care
                                                                                     interventions for newborns have revolutionized
                                                                                pediatric medicine, more efforts are needed to rehabili-
                but not yet clear.                                              tate children suffering neurodevelopmental compro-
                                                                                mise. a large proportion of these complications are
                                                                                related to poor maternal prenatal health and substance
      Pushing back the window of child                                          abuse, often leading to aRnD and in rare cases, FaS
                                                                                and naS related to opiate withdrawal. Brain injury
      identification to the perinatal and early                                 learning disabilities related to alcohol exposure show up
                                                                                in the child as social and cognitive processing deficits
      infancy period allows interventionists                                    and attention-deficit hyperactivity disorder. in Maine,
                                                                                prescription opiate addiction has been added to the
      to take best advantage of the explosion                                   problem of alcohol abuse as a risk factor in early devel-
                                                                                opment. The brain developmental injury from these
      of brain growth in the first three years.                                 prenatal exposures conspires with environmental risk
                                                                                due to poverty to create more Maine children each year
                                                                                in need of special care, which if delayed until school-
                                       Discussion                               age, may lead to a lifetime of developmental disability.
                     clearly, early-early assessment is needed to                    High-risk infants are born to high-risk families
                improve pharmacological methods of prenatal metha-              living in high-risk environments. often, developmental
                done maintenance and safe withdrawal after birth, and           consequences show “sleeper” effects that emerge later in
                to inform standards of care for these children who are          the toddler and childhood years; that is, apparently
                at high risk of brain injury as they age. These current         healthy infants may emerge as impaired at later points
                efforts to address the opiate crisis in the eastern Maine       in their lives. Hence, environmental risk factors may

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                                                                                                                Maine’S HiGH-RiSK inFanTS

exacerbate preexisting prenatal risk factors when the
child returns home.
      The Maine infant Follow-up Project is now                    RefeRences
working in collaboration with the national effort of the           abdel-latif, Mohamed e., Jason Pinner, sara Clews,
Sarah Jane Foundation called the “Pediatric acquired                  Fiona Cooke, kei lui and Julee oei. 2006. “effects
Brain injury [PaBi] Plan” of intervention for brain                   of breast Milk on the severity and outcome of
                                                                      neonatal abstinence syndrome among infants
injury during the early years (
                                                                      of drug-dependent Mothers.” Pediatrics 117(6):
Using cutting-edge assessment and treatment methods,                  1163–1169.
we can identify at-risk children earlier. Pushing back the
                                                                   als, heidelise, Frank h. duffy, gloria b. Mcanulty,
window of child identification to the perinatal and early              Michael J. rivkin, sridhar vajapeyam, robert
infancy period allows interventionists to take best advan-             v. Mulkern, simon k. Warfield, Petra s. huppi,
tage of the explosion of brain growth in the first three               samantha C. butler, nikk Conneman, Christine
years (als et al. 004).                                               Fischer and eric C. eichenwald. 2004. “early
      it is well known that stimulating experiences and                experience alters brain Function and structure.”
                                                                       Pediatrics 113(4): 846–857.
opportunities to practice new abilities in all develop-
mental domains (e.g., cognitive, language, social, and             hayes, Marie J., eric brown, Patricia a. hofmaster,
                                                                      aditi a. davare, kelly g. Parker and James a.
motor) optimize brain development. Targeted early envi-
                                                                      raczek. 2002. “Prenatal alcohol intake in a rural,
ronmental enrichment that is maternal and family based                Caucasian Clinic.” Family Medicine 34(2): 120–125.
is being implemented to increase the chance of develop-
                                                                   hayes, Marie J., M.r. akiles, a.a. gilles, M. Fukumizu,
mental catch-up and recovery, led through an expansion                b.J. sallinen and M. troese. 2007. “arousal
of existing developmental care systems. This dynamic                  deficits in apneic Premature infants treated
intervention model is based on new research in pediat-                with theophylline and Caffeine.” Journal of
rics, developmental psychology/psychiatry, and clinical               Perinatology 27:782–789.
neuroscience tied to the PaBi national program for                 hughes, a., n. sathe and k. spagnola. 2009. state
child brain injury. a statewide effort to improve early-              estimates of substance use from the 2006-2007
early assessment and intervention promises a larger net               national surveys on drug use and health.
                                                                      office of applied studies, substance abuse
for developmental catch-up, along with improved family
                                                                      and Mental health services administration,
and school support for caregivers working with children               nsduh series h–35, hhs Publication no. sMa
with brain injury.                                                   09-4362). rockville, Md.
                                                                   hunt, Carl e. and Fern r. hauck. 2006. “sudden infant
                                                                      death syndrome.” Canadian Medical association
                                                                      Journal 174(13): 1861–1869.

  AcknOWLeDGMenTs                                                  Jacobson, Joseph l. and sandra W. Jacobson.
                                                                      1996. “Prospective, longitudinal assessment of
  the authors would like to thank all of the families who             developmental neurotoxicity.” environmental
  participated in our study, all of the wonderful staff at            health Perspectives supplements 104(2): 275–283.
  eastern Maine Medical Center and acadia hospital,
  and our funding sources: university of Maine’s                   krishnan, ramesh k.M., Marcia troese, Jonathan a.
  academic Prominence initiative, national institutes of               Paul, beth Matano, Mark s. brown, Paul W. tisher
  health/national institute on drug abuse, and the tufts               and Marie J. hayes. 2008. “auditory event related
  university school of Medicine Faculty grant Program.                 Potentials in neonates Prenatally exposed to
                                                                       Methadone.” Presented at the Pediatric academic
                                                                       society annual Meeting, honolulu, hi.

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Maine’S HiGH-RiSK inFanTS

                                                                                                                  Beth A. Logan is a Ph.d.
                                                                                                                  student in the develop-
                 Maine department of education. 2007. students with
                    disabilities Maine Child Count data ages 3–21,                                                mental-clinical psychology
                    1986-2007. Maine doe, augusta. http://www.                                                    program at the university
                                                                                                                  of Maine. her research
                    [accessed september 11, 2009]
                                                                                                                  examines the effects of
                 Maine department of health and human services.
                    2009. admissions by Primary drug. Maine Maine                                                 methadone exposure on
                    dhhs, office of substance abuse, augusta. http://                                             cognitive development.
                                                                                                                  she is currently leading
                    [accessed september 11, 2009]                                 the Maine infant Follow-up Project’s early assessment and
                 May, Philip a. and J. Phillip gossage. 2001. estimating          intervention program using psychology and clinical neuro-
                   the Prevalence of Fetal alcohol syndrome: a                    science methods in collaboration with the acadia hospital.
                   summary. national institute on alcohol abuse and
                   alcoholism, bethseda, Md. http://pubs.niaaa.nih.
                   gov/publications/arh25-3/159-167.htm [accessed
                   september 11, 2009]                                                                             Marie J. Hayes is professor
                 Molfese, dennis l. 2000. “Predicting dyslexia at 8                                               of psychology in the
                    years of age using neonatal brain responses.”                                                 department of Psychology
                    brain and language 72:238–245.
                                                                                                                  and graduate school of
                 oei, Julee and kei lui. 2007. “Management of the                                                 biomedical sciences at
                    newborn infant affected by Maternal opiates
                    and other drugs of dependency.” Journal of                                                     the university of Maine
                    Paediatrics and Child health 43(1–2): 9–18.                                                   and senior scientist at the
                 office of applied studies, substance abuse and                                                   Maine institute for human
                     Mental health services administration (saMhsa).
                                                                                                                  genetics and health. her
                     2008. “alcohol use among Pregnant Women and
                     recent Mothers: 2002 to 2007.” the nsduh report              research funded by the national institutes of health exam-
                     (september): 1–6.                                            ines prenatal determinants of brain injury in high-risk infants
                 troese, Marcia, Michio Fukumizu, bethany J. sallinen,            and the application of biotechnology to detect early markers.
                    allyson a. gilles, Joseph d. Wellman, Jonathan
                    a. Paul, eric r. brown and Marie J. hayes. 2008.
                                                                                  she is interested in research that addresses maternal-child
                    “sleep Fragmentation and evidence for sleep                   health in disadvantaged families.
                    debt in alcohol-exposed infants.” early human
                    development 84:577–585.
                                                                                                                   Mark s. Brown, M.D.,
                                                                                                                  is chief of pediatrics and
                                                                                                                  director of the neonatal
                                                                                                                  intensive Care unit and
                                                                                                                  nurseries at eastern Maine
                                                                                                                  Medical Center in bangor,
                                                                                                                  Maine. his commitment to
                                                                                                                  continuous improvement to
                                                                                                                  care has led to the hoMe
                                                                                  noW study, which was designed to ask whether there is a
                                                                                  more effective treatment for infants with narcotic withdrawal.

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                                 Paul Tisher, M.D., held                                          Ramesh krishnan, M.D.,
                                 the position of vice presi-                                      is a neonatologist in
                                 dent of medical affairs at                                       the Pediatric service at
                                 acadia hospital and chief of                                     eastern Maine Medical
                                 psychiatry at eastern Maine                                      Center in bangor, Maine,
                                 Medical Center, bangor,                                          with a special interest in
                                 Maine, from 1994 to May                                          mechanical ventilation of
                                 2009. his earlier academic                                       the newborn lung and lung
                                 appointments included asso-                                      injury mechanisms. his other
ciate clinical professor in the department of Psychiatry at      research interests include the neurocognitive and develop-
tufts university school of Medicine. he is currently working     mental effects on infants exposed to opiates in utero using
as a private consultant.                                         event-related potential studies. he is the recipient of a tufts
                                                                 university Charlton grant award, which supports research
                                                                 projects likely to lead to funding from extramural sources,
                                 Jonathan A. Paul is a Ph.d.
                                                                 such as the national institutes of health and the national
                                 student in the university
                                                                 science Foundation.
                                 of Maine graduate school
                                 of biomedical sciences, with
                                 a concentration in neurosci-
                                 ence. he is studying prenatal
                                 exposures and brain devel-
                                 opment, in particular the
                                 effects of prenatal metha-
done exposure. he has been using electroencephalography
(eeg) methods to evaluate newborn cognitive deficits, along
with sleep integrity and brain function in high-risk infants.

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Maine’S yoUnG cHilDRen wiTH DiSaBiliTieS

           coordination for                                            Alan B. Cobo-Lewis describes Maine’s system of

             Maine’s young                                             services for young children with disabilities. He notes

                                                                       that families of young children with disabilities face

              children with                                            challenges in navigating Maine’s service structure.

                 Disabilities                                          There can be delays before children get appropriate

                                                                       evaluation, and there are sometimes problems with

                                          by alan b. Cobo-lewis        interagency referrals. Cobo-Lewis makes a number of

                                                                       recommendations regarding data linkage; coordina-

                                                                       tion of eligibility determination from different fund-

                                                                       ing streams; updating interagency agreements; and

                                                                       creation of a more efficient state departmental struc-

                                                                       ture for services to children with disabilities.   

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                                                                                      Maine’S yoUnG cHilDRen wiTH DiSaBiliTieS

                                                                                                          Families of young
                   inTRoDUcTion                                 parent education and family
                                                                supports for first-time families                children with

T     here is evidence that services provided early in life
      to children with a range of disabilities are effective
(Guralnick 1997). yet, states vary considerably in how
                                                                with children prenatal through
                                                                age five), and children’s
                                                                Behavioral Health Services
                                                                                                                disabilities face

services are actually provided (Hebbeler et al. 007),          (cBHS; for children through                     significant
and there is only limited knowledge on outcomes of              age 0 who have developmental
this early intervention as actually practiced, as opposed       disabilities or delays, intellectual            challenges in
to early intervention in model programs (Hebbeler               disabilities, pervasive develop-
et al. 009). Families of young children with disabili-         mental disorders or autism,                     navigating
ties face significant challenges in navigating Maine’s          and mental health issues). The
structure for services. although Maine has attempted            Maine centers for Disease                       Maine’s structure
significant reform of its system for serving infants,           control and Prevention (Maine
toddlers, and preschoolers with disabilities in the past        cDc) in the DHHS is respon-                     for services.
three years, delays and barriers still exist. Maine has         sible for, among other programs,
been slow to address problems with interdepartmental            the newborn bloodspot
coordination, including those that result in under-refer-       screening program, the newborn
rals. Maine must work to fix the aspects of the system          hearing program, and the birth
that lead to underperformance while retaining those             defects surveillance program. The office of integrated
that have led to good performance. This article reviews         access and Support in the DHHS is responsible for
patterns of good performance and underperformance               determining eligibility for several programs, including
and concludes with specific suggestions, especially on          Temporary assistance for needy Families (TanF), the
the need for greater interdepartmental coordination.            food supplement program (formerly food stamps), and
                                                                Mainecare (Maine’s Medicaid system). in particular,
   Maine’S SySTeM FoR SeRviceS To yoUnG                         a child can qualify for Mainecare either through low
       cHilDRen wiTH DiSaBiliTieS                               family income or through significant disability.
                                                                      when a family suspects its child has a disability,

T     he Maine Department of education (Doe) and
      the Department of Health and Human Services
(DHHS) are the two primary state agencies that
                                                                it can face a cumbersome process for identifying the
                                                                disability and qualifying for adequate services. The
                                                                family can also face a cumbersome process even under-
ensure the delivery of services for infants, toddlers, and      standing what services are appropriate and available
preschoolers with disabilities. Some programs within            and how to navigate the system. The system is
these two departments pertain specifically to children          complex, with many entry points, different eligibility
with disabilities, and others serve a broader constitu-         criteria for different programs, and different points
ency. child Development Services (cDS) in the Doe               of contact. There are caseworkers available to help—
is responsible for early intervention for infants and           though there are even eligibility criteria for case
toddlers with disabilities and for early childhood special      management, and caseworkers may not always have a
education for preschoolers with disabilities. cDS is            sufficiently broad perspective to help families with
organized into regional sites that correspond roughly to        all their needs. in addition, there are nonprofit organi-
Maine’s 16 counties, plus a state cDS unit in the Doe           zations and public instrumentalities of the state that
for administration and general supervision. The Doe is          can help families of children with disabilities. For
also responsible for public pre-kindergarten programs.          example, under the federal Developmental Disabilities
      The office of child and Family Services in the            assistance and Bill of Rights act, each state has a
DHHS oversees child care, Head Start, child welfare             systems change organization (Maine Developmental
(including adoption, foster care, and prevention of             Disabilities council), a protection and advocacy orga-
child abuse and neglect), home visiting (voluntary              nization (Disability Rights center of Maine), and a

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Maine’S yoUnG cHilDRen wiTH DiSaBiliTieS

                   What Is IDeA?
                                                                                         inDiviDUalS wiTH DiSaBiliTieS
  the federal individuals with disabilities education                                  eDUcaTion iMPRoveMenT acT (iDea)
  improvement act (idea) defines early interven-

  tion and special education services for infants,                                      he federal individuals with Disabilities education
  toddlers, preschoolers, and school-age children:                                      improvement act (iDea) is administered by the
                                                                                  U.S. Department of education (U.S. Doe). iDea
  1. under Part C of idea states provide early inter-                             provides for “early intervention” (Part c of iDea,
     vention to infants and toddlers with disabilities.                           for infants and toddlers with disabilities) and “special
     states may also choose to provide services                                   education” (Part B of iDea, for children with disabili-
     to children at risk. (Maine does not.) eligibility                           ties from age three). iDea also provides for targeted
     criteria can be broad, moderate, or narrow.                                  funds and appropriate activities for preschoolers with
     (Maine’s are narrow.) Part C federal funds are                               disabilities (Section 619 of iDea Part B). (See sidebar
     used for children with disabilities from birth                               for a summary.)
     through age two. states can also participate in                                    early intervention (Part c) is administered at the
     a new “Part C option” that allows families to                                state level through state “lead agencies.” Special educa-
     receive early intervention until they choose to                              tion (Part B) is administered at the state level by state
     enter the school system at a later age. (to date                             educational agencies. Part c of iDea requires that a
     no state has taken the Part C option.)                                       state have an interagency coordinating council for early
  2. under Part b of idea states provide special                                  intervention, and Part B of iDea requires that a state
     education and related services to students with                              have a state advisory panel for special education. in
     disabilities. under Part b states must ensure                                Maine, the Maine advisory council on the education
     that children receive “free appropriate public                               of children with Disabilities (MacecD—pronounced
     education.”                                                                  “maist”) serves as both the Part c interagency coordi-
                                                                                  nating council and the Part B state advisory panel.
  Part b section 611 federal funds are for special                                      There are many models for ensuring the provision
  education from age three. Maine chooses to use                                  of services to infants, toddlers, and preschoolers with
  section 611 funds only for school-age children                                  disabilities. according to the national early childhood
  (age five to graduation or age 20, whichever                                    Technical assistance center’s web site (www.nectac.
  comes first).                                                                   org/partc/ptclead.asp), non-educational agencies serve
                                                                                  as sole lead agency for early intervention in 8 states.
  Part b section 619 federal funds are for early                                  in 10 states plus washington, D.c., educational agen-
  childhood special education for preschoolers (age                               cies serve as sole lead agency for early intervention.
  three to five). For preschoolers’ education, special                            Some states have innovative collaborations. in vermont
  education includes participating in “appropriate                                and nebraska, the Department of education serves as
  activities.”                                                                    co-lead agency for early intervention with a human
                                                                                  services or health agency. wyoming’s Department of
                                                                                  Health serves as lead agency for early intervention
                                                                                  under Part c and also provides early childhood special
                                                                                  education services to preschoolers with disabilities
                                                                                  under Part B. This allows the wyoming Department
                 university center for excellence in developmental                of Health to provide birth-to-five early intervention
                 disabilities (University of Maine center for                     and early childhood special education services through
                 community inclusion and Disability Studies).                     a unique arrangement where the wyoming Department
                 There are also nonprofit organizations focusing on               of education exercises general oversight over special
                 children’s issues, legal issues, advocacy, and issues            education (wyoming Doe 007), but passes federal
                 specific to particular disabilities.                             special education funds to the Department of Health

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                                                                                         Maine’S yoUnG cHilDRen wiTH DiSaBiliTieS

and ensures proper administration of the preschool              an evaluation. Participants in the PDD systems change
special education program through an interagency                initiative made 6 specific recommendations (cronin
agreement. in Pennsylvania, the office of child                 008). among them were recommendations about how
Development and early learning is jointly overseen by           to develop a standardized screening and referral process
the Department of Public welfare and the Department             and how to ensure delivery of evaluation results in a
of education (                             timely manner. Participants recommended that the
     in Maine, the Doe serves as both the lead                  Maine Doe and the DHHS convene a joint work-
agency for early intervention (Part c) and the state            group for appropriately broad approaches for diagnosis
educational agency for special education (Part B).              and treatment, braiding funding streams, rationalizing
child Development Services in the Doe specializes               case management to improve coordination, designating
in early intervention and early childhood special educa-        a single point of contact during the screening/evalua-
tion for children with disabilities from birth until            tion process, and creating an integrated system centered
school entry (roughly birth to five years old).                 on the child’s needs from initial concern through evalu-
                                                                ation. Participants also made specific recommendations
  DelayS BeFoRe aPPRoPRiaTe evalUaTion                          on standardization of assessment, tracking, and evalua-
                                                                tions and assessments, and on materials explaining the
                                                                process to families. Most of these recommendations
           Systems Change Initiative for                        would pertain just as much to improving Maine’s
        Pervasive Developmental Disorders                       approach to families of children with other disabilities.
      The Maine Developmental Disabilities council
is coordinating a systems change initiative to address                   Compliance with IDEA Timelines
the need for increased capacity and effectiveness in                  iDea requires that no more than 45 days elapse
public services and supports for persons who have               from referral to cDS of an infant or toddler for early
pervasive developmental disorders (PDDs, sometimes              intervention to completion of evaluation and initial
called the “autism spectrum”). while this article’s focus       assessment and meeting of the family’s individualized
is broader than autism, some issues identified in the           family service plan (iFSP) team to determine eligibility
PDD systems change initiative pertain more broadly              and write a service plan if the child is determined
than just to autism. in particular, the systems change          eligible (code of Federal Regulations, Title 4
initiative sought to understand and make recommen-              Sections 0.1(e)(), 0.(e)(1), July 1, 008).
dations about shortening the wait for diagnosis and             nationally, however, only about 60 percent of children
determination of eligibility. only about half of chil-          get an iFSP within 45 days of referral (Hebbeler et al.
dren on the autism spectrum in Maine are diagnosed              007). although Maine falls short of the requirement
before kindergarten (Maine DHHS 007) even though               for 100 percent compliance, it has reported to U.S.
there is evidence that autism can be diagnosed at least         Doe that compliance in recent years has been more
as young as 18 months. Thus, children in Maine who              than 90 percent (Knudsen 008; Maine Doe 009).
have autism are not being diagnosed early enough to             However, the Doe has instituted detailed on-site
receive the full benefit of early intervention (Maine           monitoring visits at the 16 regional cDS sites, and
DHHS 009).                                                     on-site reviews of individual children’s files suggest a
      Families in the PDD systems change initiative             median compliance rate of 75 percent (www.maine.
identified several points in their history where time was       gov/education/speced/cds/monitoring/index.html). The
wasted in getting their children appropriately evaluated        statewide figure of 90 percent derives from computer-
and diagnosed. These included discounting of legiti-            ized records of all children referred to early intervention
mate parental concerns by pediatricians in well child           (roughly 1,600 children per year), whereas the site-
visits, delays of months before a cDS team referred             specific data of 75 percent derive from chart review
to an appropriate assessment, and months spent on               (intensive review of at least 10 percent of charts at each
waiting lists between referrals and the performance of          site). This discrepancy suggests that on-site monitoring

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       subcommittee to study early childhood special
                        education                                                passed a series of three bills to implement 17 of the
                                                                                 subcommittee’s 1 recommendations: Public law 007
  the subcommittee had a diverse membership of 28 stakeholders,                  chapter 450, Public law 007 chapter 07, and Public
  including disability advocates (an adult with a disability and                 law 007 chapter 50. The major themes of these
  four parents of children with disabilities), Cds members (two                  recommendations were (1) to build on the good aspects
  contracted service providers, two service providers employed                   of Maine’s existing structure for birth-to-five services,
  directly by a Cds site, a regional board member, and a regional                () to increase interagency collaboration among the
  site director), a head start program director, a child care program            Doe, the DHHS, public schools, and other commu-
  director, public school members (a pre-kindergarten teacher, an                nity resources, and () to increase accountability of
  elementary school principal, two special education directors, a                system components (Subcommittee to Study early
  superintendent, and a school board member), a delegate from                    childhood Special education 007).
  MaCeCd, four legislators, two delegates from doe, and two
  delegates from the dhhs.                                                         Maine’S eaRly iDenTiFicaTion iS SliPPinG

                 and technical assistance may be a valuable training
                                                                                 i Dea requires that states have a system for iden-
                                                                                   tifying children with disabilities. This is called
                                                                                 “child find.” The subcommittee examined Maine’s
                 opportunity for cDS site staff, and that it would help          performance at early identification and for the most
                 improve the validity of Maine’s data collection system.         part, found success. where the subcommittee found
                 (in addition to being good policy, ensuring the validity        Maine to have fallen short, it recommended specific
                 of data is a requirement of iDea.) The on-site moni-            actions to address it. Unfortunately, in the years that
                 toring data are consistent with the concern expressed in        have followed, Maine has slipped on a key area of early
                 the PDD systems change initiative about delays before           identification, and where it needed to improve in early
                 diagnosis and appropriate evaluation. However, exam-            identification, action has been slow, and the state has
                 ining specific family stories in the PDD systems change         not yet shown improvement. Recent actions, however,
                 initiative indicates that some children were given an           suggest that improvement is within reach if interdepart-
                 initial evaluation in a timely fashion, but experienced         mental issues can be resolved.
                 substantial delays before obtaining an appropriate eval-
                 uation. This suggests that cDS and cBHS should give                      “Mind the Gap”: Identification of
                 attention to ensuring that all referred children be evalu-                 Preschoolers with Disabilities
                 ated comprehensively enough to determine what                         The subcommittee considered a proposal from the
                 services would meet their needs.                                Doe to move early childhood special education for
                                                                                 preschoolers to the K-1 public school system. one
                 SUBcoMMiTee To STUDy eaRly cHilDHooD                            reason was that since education through at least part of
                          SPecial eDUcaTion                                      K-1 is essentially universal, it could improve Maine’s
                                                                                 success at identifying preschool children with disabili-

                 i  n 006 Maine created the Subcommittee to Study
                    early childhood Special education to make
                 recommendations about early intervention and early
                                                                                 ties. The data, however, did not bear out that hypoth-
                                                                                 esis. as it turns out, Maine’s cDS system is quite
                                                                                 successful at identifying preschoolers with disabilities,
                 childhood special education. The subcommittee                   thus fulfilling the federal mandate for child find, at
                 was authorized to introduce a bill to implement its             least for preschoolers.
                 recommendations. (See sidebar for information on                      Figure 1 shows Maine’s special education rate for
                 the membership of the subcommittee.) The subcom-                preschoolers (three- to five-year-olds) and older chil-
                 mittee was co-chaired by a parent (myself ) and a cDS           dren (six- to 17-year-olds) from 004 through 007,
                 contracted service provider and produced eight find-            along with data from the other states and District of
                 ings and 1 recommendations. The 1rd legislature              columbia. Maine’s identification rate is high in both

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                                                 FIGURE 1: iDeA Part b: state-by-state Trends in special education
                                                                                       identification rates for Preschoolers and school-age Children

categories (the blue lines for Maine are                                                                                              2004   2005      2006   2007
above most of the gray lines for the other
                                                                                                    3–5-year-olds                            6–17-year-olds
states). Maine’s identification has fallen in
both categories, but while it has fallen only
slightly for six- to 17-year-olds, it has fallen                                                     = Maine
                                                                                                     = other states and D.C.
dramatically for three- to five-year-olds.
     what does this mean for success at                 15%                                                                                                          15%
early identification? with all the variation
between states and across time in special
education identification in each age group,
                                                 (Percentage of General Population)
how can we assess success at early identifi-
cation? Because states differ on special
                                                         Special Ed ID Rate

education rates, to fairly compare states
on success of preschool identification, one             10%                                                                                                          10%
should examine the ratio of identification
rates among three- to five-year-olds to
identification rates among six- to 17-year-
olds. whatever a specific state’s baseline
rate of children in special education, this
ratio would be close to 100 percent (no
gap between preschoolers and older                       5%                                                                                                          5%
students) for states that are successful at
early identification and much less than 100
percent (large gap between preschoolers
and older students) for states that are less
successful at early identification. Data
                                                                                       2004         2005         2006          2007
examined by the subcommittee (the 004
data in Figure 1) indicated that under the
cDS system at the time, Maine’s ratio was
                                                                                      source: all data are from
better than more than 90 percent of states.
Unfortunately in the years since, Maine has
slipped. although Maine outscored 9
percent of other states and washington, D.c., in 004                                         identifying infants and toddlers overall (children under
(ratio of 76 percent), the ratio has slipped steadily since                                   age three). The subcommittee noted that Maine was
then. in 007 Maine outscored only 8 percent of                                              close to the middle compared to other states in identi-
other states and washington, D.c (ratio of 60 percent).                                       fying birth to two-year-olds who need early inter-
Thus, Maine’s gap between preschool identification and                                        vention. Figure  (page 74) shows Maine’s early
school-age identification is growing.1                                                        identification rate for infants, one-year-old toddlers,
                                                                                              and two-year-old toddlers from 004 through 007,
                                                                                              along with data from the other states and washington,
       Identification of Infants and Toddlers                                                 D.c. as the middle and right panels of Figure 
                  with Disabilities                                                           indicate, Maine has slipped in identifying toddlers.
     The U.S. Doe has highlighted very early identifi-                                        considering birth to two-year-olds overall, Maine has
cation as a priority: it requires every state to report on                                    slipped from ranking better than 68 percent of states
success at identifying infants (children under age one)                                       in 004 to ranking near the median in 007, though
needing early intervention and to report on success at                                        in 007 Maine did still identify a higher proportion of

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   FIGURE 2: iDeA Part C: state-by-state Trends in early intervention
                                             identification rates

                                                                        2004    2005   2006    2007                                       not discretionary—the U.S. Doe
                                                                                                                                          responded by reminding Maine of the
                                                        Infants                  1-year-olds                 2-year-olds
                                                                                                                                          state’s obligation to identify all eligible
                                                                                                                                          children (Maine Doe 009).
                                                                                                                                                in spite of Maine’s success at identi-
                                        10%                                                                                    10%
                                                                  = Maine                                                                 fying preschoolers with disabilities and
                                                                  = other states and D.C.
                                                                                                                                          its mid-range performance at identifying
                                                                                                                                          toddlers with disabilities, the subcom-
Children Receiving Early Intervention

                                                                                                                                          mittee found that Maine did not do well
 (Percentage of General Population)

                                         8%                                                                                     8%
                                                                                                                                          at identifying infants. The left panel of
                                                                                                                                          Figure  shows the percentage of infants
                                                                                                                                          in each state receiving early identifica-
                                         6%                                                                                     6%        tion. in 004 Maine outscored only 0
                                                                                                                                          percent of other states and washington,
                                                                                                                                          D.c., identifying only 0.69 percent of
                                                                                                                                          infants for early intervention. This was
                                         4%                                                                                     4%        well below the median and Maine’s long-
                                                                                                                                          range federal target, which was near one
                                                                                                                                          percent. By 007 Maine’s performance
                                                                                                                                          on this federal benchmark had barely
                                         2%                                                                                     2%        budged, with Maine outscoring 6
                                                                                                                                          percent of other states and washington,
                                                                                                                                          D.c., identifying only 0.71 percent of
                                                                                                                                          infants for early intervention and falling
                                         0                                                                                      0         short of the 0.85 percent that Maine had
                                                                                                                                          identified as its target for that year
                                             2004    2005    2006    2007                          2004     2005   2006   2007
                                                                                                                                          (Maine Doe 009).
                                                                                                                                                Maine’s performance on infant iden-
                                                                                                                                          tification has consistently fallen well
                                            source: early intervention data from; population from u.s. Census
                                                                                                                                          short of targets and national norms. The
                                                                                                                                          Maine Doe has indicated to the U.S.
                                                                                                                                          Doe that “the state does not expect large
                                                     birth to two-year-olds than 80 percent of the 15 other              increases” and has requested that its short-term targets
                                                     states with narrow eligibility criteria (www.ideainfant             for identifying infants be recalibrated downward (Maine
                                                                  Doe 009: 5). This would not solve the problem.
                                                     pdf ). This may have reflected a state effort to reduce
                                                     identification rates: the Maine Doe’s most recent                            inTeRDePaRTMenTal ReFeRRalS
                                                     annual submission of these data to the U.S. Doe
                                                     notes that “the original targets were set anticipating
                                                     efforts to reduce the number of children identified                     Referrals from Health and Human Services
                                                     so that Maine’s percent of children identified would                                         to Education
                                                     be more closely aligned with the overall percent of                       Under federal law, infants and toddlers can be elig-
                                                     children identified for the 50 states and D.c. and                  ible for early intervention either because they are experi-
                                                     more importantly within the ability of the state’s                  encing developmental delays or because they have a
                                                     economic climate to adequately serve the children                   diagnosed physical or mental condition with a high pro-
                                                     identified” (Maine Doe 009: 8). But child find is                 bability of resulting in such a delay. The identification

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process is different for children with delays versus those      activities” for identifying infants with disabilities
with diagnosed conditions; children with a diagnosed            (Maine Doe 009). Some addressed the subcommit-
condition can typically be identified younger—poten-            tee’s recommendation to update the interagency agree-
tially at birth (Hebbeler et al. 007). The anomalously         ment to ensure that children are referred from Maine
low identification of infants with disabilities in cDS          cDc to cDS, but in my opinion, most of these
may be related to the referral process for young chil-          improvement activities do little to address the funda-
dren who may already have diagnosed conditions. The             mental requirement for these interagency referrals.
state’s first contact with infants with disabilities is often   Recently, however, Maine cDc and cDS have estab-
not through cDS, but through the DHHS. For                      lished a process for centralized referrals to cDS
example, the Maine cDc operates the newborn                     from the Maine cDc’s newborn hearing program
hearing program (for universal screening of newborns            (Stockford and Hannigan 009). Processes have not
for hearing loss and follow-up when necessary), the             yet been established for referrals to cDS from the
newborn bloodspot program (for universal laboratory             Maine cDc’s newborn bloodspot program or the
testing of infant blood samples for metabolic or genetic        birth defects surveillance program. it is important for
abnormalities that can result in disability), and the           the departments to establish those processes, however,
birth defects surveillance program (for identification          and also to report data on the success of the processes
and investigation of birth defects in children and to           for referral to cDS from all three of these programs
maintain a central registry of cases of birth defects).         in Maine cDc.
Referral of children from Maine cDc to cDS is
neither universal nor automatic. This lack of consistent                      Referrals from Education to
referrals from Maine cDc to cDS may be in large                               Health and Human Services
part responsible for Maine’s low identification rate of              The Maine DHHS is not just a potential referral
infants who need early intervention. Better referral            source for cDS; it also ensures provision of some
from Maine cDc to cDS could move Maine’s early                  services. about half the children served by cDS are
intervention identification for infants from the bottom         eligible for Mainecare, either based on low family
third to at least the median or even the top third of           income or on their disability. while the eligibility
states (cobo-lewis and Hatch 007).                             criteria for children’s Behavioral Services (cBHS) in
      Based largely on this information, the subcom-            the DHHS are different from eligibility criteria in
mittee made a specific recommendation for the state to          cDS, there is substantial overlap in children served
mandate referrals to cDS from these three programs in           by the two programs. Some services in cBHS (such as
Maine cDc. This recommendation was ultimately                   respite care) do not require a child to have Mainecare,
incorporated into state law. To facilitate these mandated       but most services in the program do require the child
referrals, and to address a host of other interagency           to have Mainecare.
issues, the subcommittee also made a recommendation                  with family consent, cDS is able to bill
that the Doe and DHHS update their “interagency                 Mainecare for many services it provides to enrolled
agreement,” which had not been updated for more than            children. Because about two-thirds of Mainecare
a decade. although the Doe and the DHHS have                    expenditures are paid with federal funds, this is highly
agreed upon an outline and have drafted some sections,          cost-effective for the state. in accessing Mainecare,
the updated agreement has not yet been executed at the          however, cDS must abide by the regulations governing
time of this writing (September 009). in testimony to          it. For example, federal Medicaid regulations require
the Joint Standing committee on education and                   that persons receiving services have a choice of service
cultural affairs on March , 009, however, the                provider. This has the potential to contrast with typical
departments indicated that their intention is to update         cDS practice. cDS may consult with the family about
the interagency agreement by october 009.                      providers, but the choice of provider can be at the
      in its annual report to U.S. Doe, the Maine               discretion of cDS, subject to the family’s right to chal-
Doe cited 19 accomplishments in “improvement                    lenge a decision in dispute resolution procedures.

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                     More generally, when a child is deemed eligible for        a lawsuit in federal court against DHHS (K.S. v.
                cDS services, there is sometimes disagreement between           Harvey) to require the DHHS to ensure provision of
                cDS and the family over the intensity or nature of              medically necessary services to children in cDS who
                the service. cDS is required by iDea to ensure that             are covered by Mainecare. The lawsuit was settled in
                preschoolers with disabilities receive a “free appropriate      fall 008, and the terms of the settlement require cDS
                public education,” but children sometimes need                  to give notice to families of Mainecare-eligible chil-
                services that go beyond what cDS considers a free               dren in cDS of the processes for seeking approval for
                appropriate public education. one example might be              services, including services that may go beyond what is
                that a family or other members of the child’s team              provided in the child’s individualized cDS plan. This
                might conclude that a child needs services during the           means that families in Mainecare can choose to access
                summer that could be considered part of free appro-             cBHS for services denied by cDS. in addition, state
                priate public education, but cDS can interpret the              law since 007 has required that cDS make appro-
                Doe rules as imposing a more stringent requirement              priate referrals to public and private resources, regard-
                before agreeing to provide services beyond the school           less of a child’s eligibility for cDS services.
                year. alternatively, cDS may agree to the provision of                although the settlement agreement was important
                summer services at a reduced frequency or intensity.            to ensure that Maine comply with federal Medicaid
                                                                                regulations, it means that there is now additional dupli-
                                                                                cation of process between cBHS and cDS. Maine
      Maine should consider administrative                                      should consider administrative coordination—and even
                                                                                an administrative merger—of cDS and cBHS to
      coordination—and even an administra-                                      simplify the process for families and to avoid adminis-
                                                                                trative duplication. a coordinated or merged unit could
      tive merger—of Cds [Child development                                     assess the child’s needs and braid funding to meet those
                                                                                needs. a model worth looking at is wyoming’s, noted
      services] and Cbhs [Children’s                                            earlier, where the state education department monitors
                                                                                early childhood special education, but essentially
      behaviorial health services] to simplify                                  subcontracts its coordination to a unit of the state
                                                                                health department.
      the process for families and to avoid
                                                                                                    DaTa linKaGe
      administrative duplication.

                     Under federal Medicaid regulations, children
                                                                                a    nother consequence of services for children with
                                                                                     disabilities being spread between the Doe and
                                                                                the DHHS is data fragmentation. To make good
                covered by Mainecare must receive services that are             policy decisions, it can be helpful to be able to link
                medically necessary, including medically necessary              individual-level records between state agencies. This
                services to treat or ameliorate a child’s physical and          can be done in a way that keeps individual-level data
                mental health condition. Under state rules, cDS has             anonymous to protect privacy. Such linkage can address
                typically been the gatekeeper for some Mainecare                important issues such as how effective is early interven-
                services (notably developmental therapy). as an educa-          tion as measured by outcomes years later in school, or
                tional agency operating under iDea, cDS has under-              how many children are receiving services from both
                standably applied an eligibility criterion of free              departments and what are their eligibility categories
                appropriate public education rather than applying a             in each data system. These questions are important
                medically necessary criterion. This conflict between            in monitoring disabilities; for example, to determine
                Medicaid’s medically necessary criterion and iDea’s             autism prevalence, it is important to count persons
                free appropriate public education criterion triggered           with autism identified in the health system and in the

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                                                                 FIGURE 3:	 How	the	Funding	Pieces	Fit	Together:	“Mosaic		
                                                                 	            Plot”	Showing	Rough	Breakdown	of	Major		
                                                                 	            Funding	Sources	in	Child	Development	Services
education system, but not to double-count those iden-
tified in both systems. Data linkage is also necessary to
                                                                                              Total                             Total
address specific policy questions about referrals from                                        Federal                           State
Maine cDc to cDS. For example, what proportion                                                50%                                50%
of children in the Maine cDc programs were in cDS                                             $19.3M                          $19.7M
before referrals were required by state law, and at what
ages did these children enter the cDS system?                                  Total           Federal                State
      “Protected health information,” such as is often                         DOE               DOE                  DOE
found in the data systems of the DHHS, is governed                             41%               12%                  29%
by privacy provisions issued under the federal Health                         $16.0M            $4.7M                $11.2M
insurance Portability and accountability act (HiPaa)
( educational records, as
often found in the data systems of the Doe, are
                                                                               Total                  Federal               State
governed by the privacy provisions of the federal                              DHHS                    DHHS                 DHHS
Family educational Rights and Privacy act (FeRPa)                               59%                     37%                  22%
( in exer-                             $23.0M                  $14.6M                $8.4M
cising caution about compliance with HiPaa and
FeRPa, state agencies can be reluctant to share data
even when there are protocols for sharing that are
compliant with both HiPaa and FeRPa. This issue
was studied by the Maine education Policy Research               Note: Area of each of the mosaic’s four cells reflects the contribution of
                                                                 corresponding funding stream. Data derive from analysis of commissioner
institute and the completed report (Mason 2008)                  of education’s testimony on proposed FY 2007 CDS budget (Maine DOE 2005)
outlines methods for encrypted data linkage that have            and FY 2007 Federal Medical Assistance Percentage (U.S. DHHS 2005). DHHS
been implemented by Maine researchers working with               total is based on commissioner of education’s estimate of $23 million in total
sensitive health, education, and juvenile justice data in        MaineCare charges for CDS, and calculations of state and federal share are
other states. Maine needs to take advantage of these             based on published Federal Medical Assistance Percentage of 63.27 percent.
                                                                 DOE detail is based on commissioner’s estimates of $2,194,384 in early
encrypted linkage methodologies to address inter-                intervention IDEA funds, $2,553,622 in preschool IDEA funds, and $11,235,307
agency data issues.                                              in requested state appropriation to CDS.
      Reidt-Parker (this issue) has further discussion
of the importance of data linkage, pointing out that
quantifiable and credible benchmarks are essential for
evaluating the quality, affordability, accessibility, and            The state appropriates money from the general
outcomes of Maine’s early childhood systems more                fund to the Doe, and the federal government awards
generally, not just in the area of children with disabili-      money to the state Doe under Part c of iDea for
ties. She also notes that “comprehensive data to estab-         early intervention services (infants and toddlers) and
lish and monitor these benchmarks are not readily               Part B Section 619 of iDea for early childhood special
available, even though a substantial amount of informa-         education (preschoolers). (The federal government also
tion is being collected within and across the depart-           awards money under Part B Section 611 of iDea for
ments of state government” (Reidt-Parker this issue: 31)        special education for children age three to 20, but the
                                                                Maine Doe uses its discretion to allocate all of the
                       FUNDiNG                                  Section 611 money to K-12 special education.) in
                                                                addition, under Part c of iDea, some money is recov-

T     he major funding sources for cDS reflect the
      need for interdepartmental coordination. Figure
3 summarizes how the major funding pieces for cDS
                                                                erable from “family cost participation” (the term in
                                                                iDea that includes family fees and private insurance),
                                                                but this is not a major source of funding in Maine, so
fit together.                                                   is not included in Figure 3.

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                     Many states use Medicaid to help to fund services          $.6 million in preschool Part B Section 619 iDea
                such as cDS. in Maine, the federal government                   funds (, and also
                matches state Mainecare dollars on roughly a :1                by temporarily raising the Federal Medical assistance
                basis under the Federal Medical assistance Percentage,          Percentage to 7.7 percent as of the time of this
                so services that cDS is able to bill Mainecare leverage         writing (
                substantial federal funds. The figure clearly shows that        oms-fmap.shtml). if the additional federal iDea
                cDS is funded roughly half by the federal government            money for infants, toddlers, and preschoolers is spent
                and half by state government. it also shows that almost         over two years and is spent entirely on cDS, then the
                60 percent of state and federal funding for cDS passes          net effect of the stimulus package might be up to
                through the DHHS, even though cDS is located                    roughly a six percent temporary increment to the
                in the Doe. This requires substantial coordination              annual cDS budget. But even such an influx would
                between the departments to ensure that both depart-             not raise the total cDS annual budget to its 005 level.
                ments comply with all relevant regulations.                     in addition, stimulus package money is one-time, and
                                                                                the intention is to make wise investments that empha-
                                                                                size reform and minimize a “funding cliff ” (U.S. Doe
      although the doe has found savings in                                     009), not to plug holes in existing budgets. an
                                                                                example of a good use of stimulus package money
      administrative reorganization, the pres-                                  would be to create a referral system to cDS from
                                                                                Maine cDc’s newborn bloodspot and birth defects
      sure on the system that delivers services                                 programs (Debra Hannigan personal communication,
                                                                                June 1, 009).
      to children with disabilities is obvious.                                       Part c of iDea allows family fees for early inter-
                                                                                vention, including a sliding fee scale, for some early
                                                                                intervention services. within the past five years,
                      The 007 budget for cDS represented a cut of              connecticut instituted a sliding fee scale that is
                roughly one-third in state appropriation to the Doe,            substantially more aggressive than Maine’s. in fiscal
                amounting to roughly 16 percent of cDS’s total                  year 008, connecticut netted $697,744 from its
                budget (Maine Doe 005). Since then the state                   sliding fees (connecticut Birth to Three System 008).
                appropriation to cDS has been flat-funded. accord-              Scaled down to Maine’s lower early intervention enroll-
                ing to the legislature’s office of Fiscal Program Review,       ment and taking into account Maine’s lower median
                educating a child with a disability in cDS is, on               income, family fees would yield only modest income.
                average, less expensive to the state than educating a                 one feature of a sliding fee scale is that it can be
                child with a disability in the K-1 public school system        structured to give families with private insurance an
                (        incentive to allow cDS to access their private health
                notes/Fn0170.htm). although the Doe has found                 insurance. connecticut halves the fees if families con-
                savings in administrative reorganization, the pressure          sent to the use of private health insurance to help fund
                on the system that delivers services to children with           early intervention services (
                disabilities is obvious. This is reflected in the Maine         %0participation%0adjustment%0letter.pdf ), and
                Doe’s annual filings with the U.S. Doe, which cite              Maine eliminates fees with consent to access insurance
                economic challenges and budgetary constraints in                (Debra Hannigan personal communication, august 5,
                explaining Maine’s performance at identifying infants           009). Thus, while sliding fees yield only modest
                and toddlers with disabilities (Maine Doe 009).                amounts, they may be helpful at raising money from
                      The american Recovery and Reinvestment act                private insurance. in connecticut, private insurance
                of 009 (the “stimulus package”) has ameliorated the            contributed $.4 million to early intervention in fiscal
                fiscal situation by delivering an additional $.1 million       year 008 (connecticut Birth to Three System 008).
                in iDea early intervention funds and an additional              Since 71.4 percent of children in connecticut are

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                                                                                          Maine’S yoUnG cHilDRen wiTH DiSaBiliTieS

covered by private health insurance, versus 51.9 percent             and cDS. Maine should consider a streamlined
in Maine (cohen and Makuc 008), a realistic estimate                system where cBHS and cDS could work
for Maine would be $59,955 (1.5 percent of the total                together so that families could find out in
estimated cDS birth-five budget in Figure , page 77),               “one-stop shopping” what services their child is
less whatever funds Maine is currently recovering from               eligible for. children birth to age five should be
private health insurance for early intervention.                     able to get a unified individualized service plan
     The Maine legislature is currently considering a                that includes all services and that coordinates
requirement that private insurance cover early interven-             the determination of which funding stream to
tion for birth to two-year-olds up to an annual cap,                 tap for each service.
along with covering autism treatment for persons under
                                                                   •	 Update	the	interagency	agreement. The existing
age 1 up to a cap. Bills in the 14th legislature to
                                                                      interagency agreement is outdated. To achieve all
address these possibilities (lD 45 and lD 1198,
                                                                      the goals above, Maine should finally execute a
respectively) have been referred to the state Bureau
                                                                      detailed interagency agreement to clearly define
of insurance for assessment of their effects on health
                                                                      roles and responsibilities.
insurance premiums.
                                                                   •	 Birth	to	age	five	services. Given Maine’s good
   conclUSion anD RecoMMenDaTionS                                     identification of preschoolers with disabili-
                                                                      ties, especially compared with states that serve

c     DS is more cost-effective than K-1 public
      schools, but interdepartmental issues continue to
hamper Maine’s ability to address issues of early iden-
                                                                      preschoolers with disabilities in the K-1 system,
                                                                      Maine should continue operating a birth to
                                                                      age five system for early intervention and early
tification, service coordination, and data analysis. and              childhood special education.
funding remains an ongoing concern. Following are
                                                                   •	 Consider	a	more	efficient	structure. Given the
specific recommendations to address these issues:
                                                                      slow implementation of needed interagency
  •	 Data	linkage. improved data linkage among                        policies betwen Maine cDc and cDS, and
     departments would help to address questions                      given the duplication of effort between cBHS
     about how resources are allocated and how effec-                 and cDS, Maine should consider a more aggres-
     tive programming is. Maine should take advan-                    sive approach to streamlining services between
     tage of encrypted linkage methodologies.                         the two major departments. a model such as
                                                                      Pennsylvania’s would create an office of child
  •	 Interagency	referrals. as required by law but not
                                                                      development and early learning to coordinate
     yet fully implemented, the Maine DHHS and
                                                                      activities between departments. a model such as
     the Maine Doe must automatically refer chil-
                                                                      wyoming’s would reduce duplication of effort
     dren as appropriate to cDS from Maine cDc’s
                                                                      by consolidating cDS and cBHS.
     surveillance programs. intervention for children
     with disabilities should begin as early as possible.
                                                                   •	 Early	intervention	insurance	mandate. a more
  •	 Coordinate	eligibility	determination	from	                       aggressive family fee structure for early interven-
     different	funding	streams. Under the settle-                     tion would yield modest revenue by itself, but
     ment agreement in K.S. v. Harvey, children’s                     coupling Maine’s existing family fee structure
     Behavioral Services is determining eligibility                   that with a requirement for private health insur-
     for medically necessary services for Mainecare-                  ance to cover a portion of early intervention
     eligible children birth to age five. This process                could yield revenue of around 1.5 percent of
     was necessary to ensure compliance with                          the total cDS budget—more if an insurance
     Medicaid regulations, but it does mean that                      mandate included developmental therapy. 
     there is duplication of effort between cBHS
                                                                                              Please turn the page for article references & author bio.

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Maine’S yoUnG cHilDRen wiTH DiSaBiliTieS

                  enDnOTes                                                             Connecticut birth to three system. 2008.
                                                                                          exploring new Ways of learning. Connecticut
                  1. an anonymous reviewer of this article asked to
                                                                                          department of developmental services,
                     what extent the drop in three- to five-year-old iden-
                     tification might be attributed to ongoing attempts
                                                                                          2008%20annual%20Final2.pdf [accessed June 2,
                     by the state to impose better uniformity across
                     the regional Cds sites via statewide assessment
                     procedures. there is indeed variability among the                 Cronin, nancy. 2008. supportive document to the
                     regional Cds sites in identification, but Cds vari-                  report of the early identification Workgroup:
                     ability in special education identification is roughly               screening and evaluating infants, toddlers, and
                     the same as variability among k-12 school districts                  young Children for Pdd. Maine developmental
                     when measured on a relative scale, though Cds is                     disabilities Council, augusta. http://www.maineddc.
                     actually less variable on an absolute scale (Meteer                  org/documents/pdd-early-identification-workgroup.
                     et al. 2006). analysis by the author of site-by-site                 doc [accessed May 27, 2009]
                     changes in Cds identification since 2004 have so
                                                                                       guralnick, Michael J. (ed.). 1997. the effectiveness of
                     far not revealed any obvious correlation between
                                                                                          early intervention. brookes, baltimore, Md.
                     overall identification rate and changes in variability.
                                                                                       hebbeler, kathleen., Jesse levin, Maria Perez, irene
                  2. an anonymous reviewer correctly noted that under
                                                                                          lam and Jay g. Chambers. 2009. “expenditures
                     Part C of idea some jurisdictions (about one-eighth
                                                                                          for early intervention services.” infants & young
                     of states and territories) serve infants and toddlers
                                                                                          Children 22(2): 76–86.
                     at risk along with serving infants and toddlers with
                     disabilities. if jurisdictions that also serve infants            hebbeler, kathleen, donna spiker, don bailey, anita
                     and toddlers at risk are excluded from the analysis                  scarborough, sangeeta Mallik, rune simeonsson,
                     then the 2007 figures in this paragraph barely                       Marnie singer and lauren nelson. 2007. Final
                     change (Maine still ranks near the median among                      report of the national early intervention
                     states and territories that do not serve infants and                 longitudinal study (neils). sri international,
                     toddlers at risk, and Maine still ranks higher than 80               Menlo Park, Ca.
                     percent of such states and territories with narrow                   neils_report_02_07_Final2.pdf [accessed May 26,
                     eligibility criteria.)                                               2009]
                                                                                       knudsen, William W. 2008. Maine Part C FFy 2006
                  RefeRences                                                              sPP/aPr response table. u.s. department of
                                                                                          education, office of special education Programs,
                  Cobo-lewis, alan and rob hatch. 2007. Presentation                      Washington, dC.
                     to Joint standing Committee on education and                         report/idea/partcspap/2008/me-4response-2008c.pdf
                     Cultural affairs and Joint standing Committee on                     [accessed May 26, 2009]
                     health & human services on Final report of the
                     subcommittee to study early Childhood special                     Maine department of education (doe). 2005.
                     education and ld 1850.                                               testimony of Commissioner of education to
                                                                                          Joint standing Committee on appropriations and
                  Cohen, robin a. and diane M. Makuc. 2008. “state,                       Financial affairs and Joint standing Committee on
                     regional, and national estimates of health                           education and Cultural affairs for ld 468. February
                     insurance Coverage for People under 65 years of                      14, 2005, augusta.
                     age: national health interview survey, 2004–2006.”
                     national health statistics reports, number 1, June                Maine department of education (doe). 2009. annual
                     19, 2008. u.s. Centers for disease Control and                       Performance report—Part C. Fiscal year July 1,
                     Prevention, atlanta.                   2007 through June 30, 2008. resubmission april
                     nhsr/nhsr001.pdf [accessed June 2, 2009]                             7, 2009. Maine doe, augusta. http://www.maine.
                                                                                          07-2009.pdf [accessed May 26, 2009]

80 · Maine Policy Review · Summer/Fall 009                        View current & previous issues of MPR at:
                                                                                           Maine’S yoUnG cHilDRen wiTH DiSaBiliTieS

  Maine department of health and human services                    u.s. department of education (doe). 2009. american
     (dhhs). 2007. autistic spectrum disorders report.                recovery and reinvestment act of 2009: idea
     report submitted to Joint standing Committee on                  recovery Funds for services to Children and
     health and human services, Maine legislature.                    youths with disabilities. u.s. doe, Washington,
     Maine dhhs, augusta.                       dC.
     dhhs/2007_autism_report.pdf [accessed May 27,                    factsheet/idea.html [accessed June 1, 2009]
                                                                   u.s. department of health and human services
  Maine department of health and human services                       (dhhs). 2005. “Federal Financial Participation
     (dhhs). 2009. autistic spectrum disorders report.                in state assistance expenditures, Fy 2007.” 70
     report submitted to Joint standing Committee on                  Federal register 71856, 71857.
     health and human services, Maine legislature.                    health/fmap07.htm [accessed May 29, 2009]
     Maine dhhs, augusta.
                                                                   Wyoming department of education (doe). 2007.
     reports/autism_act_report.pdf [accessed May 27,
                                                                     Wyoming state Performance Plan for special
                                                                     education FFy 2005–2010. Wyoming department
  Mason, Craig. 2008. linkage of early Childhood health              of education special Programs unit, riverton.
    and education data. Maine education Policy             
    research institute, university of Maine, orono.                  peform_plan.pdf [accessed May 31, 2009]
    linkageofearlychildhoodrpt.pdf [accessed May 28,
  Meteer, dewey, Jean bridges, Jean youde, ellen
     Whitcomb and alan Cobo-lewis. 2006. second
                                                                                                 Alan B. cobo-Lewis is
     report from data group to subcommittee to study
     early Childhood special education: efficiency, Cost,                                        an associate professor of
     and variability. Maine department of education,                                             psychology at the university
     cds/103106datagroup.pdf [accessed august 21,                                                of Maine. his research
     2009]                                                                                       has focused on vision and
  reidt-Parker, Judy. 2009. “data Collection in Maine:                                           hearing, language and educa-
     assessing the return on Public investment in                                                tion in bilingual children,
     Maine’s early Childhood system.” Maine Policy
     review 18(1): 30–33.                                                                        communicative develop-
  stockford, david and debra hannigan. 2009. Child                                               ment in young children with
     development services administrative letter 18.             disabilities, and computerized testing for early identification
     Cds, augusta, Maine.
                                                                of language delay. he has two children, one of whom has a
     [accessed June 1, 2009]                                    disability. in 2006-2007, he co-chaired Maine’s subcommittee
  subcommittee to study early Childhood special                 to study early Childhood special education. he serves as
     education. 2007. Final report of the subcommittee          a member of the Maine Children’s growth Council and as
     to study early Childhood special education. Maine
     doe, augusta.
                                                                treasurer of the Maine developmental disabilities Council.
     speced/cds/committee/finalreport.pdf [accessed             in 2007 he won the autism society of Maine service award
     May 22, 2009]                                              and a Maine Children’s alliance giraffe award (for people
                                                                who “stick their neck out” for kids), and in 2008 received the
                                                                university of Maine Presidential Public service award.

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cHilD caRe FoR cHilDRen wiTH SPecial neeDS

                   child care
                    and work                                          Research by the authors with parents, child care

                 challenges for                                       providers, and other service providers found that

                                                                      parents of children with special needs face particular

               Maine’s Parents                                        challenges trying to maintain stable employment

              of children with                                        while balancing work and family. These parents

                                                                      have more difficulty finding and keeping child care

                 Special needs                                        for children with special needs, and there is a lack of

                                                                      coordination of therapy with child care programs.
                                              by helen d. Ward
                                                                      Since the study was completed, Maine has taken
                                                Julie a. atkins
                                                                      several steps to begin to address these issues.   
                                                erin e. oldham

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                                                                                        cHilD caRe FoR cHilDRen wiTH SPecial neeDS

    carol lives in Maine and is the mother of                   nosed conditions that present real challenges for parents
    Jason, a four-year-old boy with autism spec-                in finding and keeping child care arrangements, main-
    trum disorder. Until recently, the only child               taining stable employment, and meeting the special
    care arrangements carol could find for her son              needs of their children. according to staff at child
    did not offer special services such as speech and           care Plus Me, a program designed to prevent child
    occupational therapy (oT) on-site. as a result,             care expulsions, an estimated 70 percent of the calls
    carol lost several jobs because her employers               received from child care providers involve children with
    were not willing to accommodate her hectic                  undiagnosed behavioral problems (ward et al. 006).
    schedule driving Jason to these services three                   low-income families are especially vulnerable to the
    times a week. eventually, carol was able to                 work and financial challenges of caring for a child with
    find a job with a more understanding employer               special needs because they are twice as likely to have a
    although she still faced challenges at work. in             child with special needs as are higher income families
    carol’s words, “i was working full-time and i               (ward et al. 006). These low-wage earners are also less
    would have to tell my boss that i have to leave             likely to have the workplace flexibility that allows them
    for a little while. She is like okay, ‘Do what you          to attend to their child’s special needs without jeopar-
    got to do and come back.’ i was bringing him                dizing their employment (Ross Phillips 00).
    to oT here, preschool, plus speech and after i                   This article presents research we conducted in Maine
    bring him to all of those, i had to go back to              to examine the complex relationships between child care
    work and stay overtime because i had to make                and work issues for parents of children with special needs.
    up the hours i lost.” For a time, carol was                 elsewhere in this issue, alan cobo-lewis writes about the
    able to manage this arrangement because her                 bewildering array of programs and funding streams that
    mother was in the area to care for Jason while              families of children with special needs must navigate to
    carol worked overtime. eventually, however,                 access services for their children. while we focus on the
    her mother moved away. although carol                       child care and work challenges of parents in this popula-
    enjoyed her job immensely, she was forced to                tion, we echo his call for better coordination of services,
    leave the position because no one was avail-                specifically as it relates to the difficulties this lack of coor-
    able to care for Jason. after suffering a period            dination poses for parents who are attempting to main-
    of financial hardship, carol was able to enroll             tain stable employment while meeting the special needs
    Jason in a half-day comprehensive preschool                 of their child.
    program in her community. expressing the                         we used focus groups and interviews with parents
    relief she felt, carol said, “it is a place where           of children with special needs and interviews with child
    they are going to have all of the services on site,         care providers, professionals delivering therapeutic
    at one location.” There would no longer be any              services (e.g., occupational therapists, speech thera-
    need for carol to leave work to take Jason to               pists), DHHS caseworkers, and others who serve this
    his appointments. She felt free to begin looking            population. we also conducted a statewide survey of
    for a new job, at least for the limited hours that          189 child care providers and 441 parents of children
    the new preschool is open.                                  with special needs, and analyzed data from the
                                                                national Survey of america’s Families (nSaF).
                                                                     our findings indicate that thousands of parents
     carol’s difficulties balancing the economic needs          of children with special needs across Maine face signifi-
of her family with the special needs of her son are not         cant challenges maintaining stable employment and
unique. in Maine, almost one in ten (9.4 percent) indi-         balancing work and family. Most of the difficulties
viduals ages five to 0 has a diagnosed disability, the         these parents face will seem familiar to any parent.
second highest rate in the country (U.S. census Bureau          yet our research indicates that for parents of children
007). Many more children in Maine have undiag-                 with special needs, the intensity and frequency of these

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cHilD caRe FoR cHilDRen wiTH SPecial neeDS

                difficulties and the impact they have on their employ-          child care providers we surveyed said they found it
                ment is heightened because of the particular demands            more difficult to care for children with behavioral
                of their children. Research conducted elsewhere in the          problems than children with physical/medical special
                country echoes our findings, especially with regard to          needs. interestingly, both parents and providers
                the particular difficulties faced by parents of children        reported that parents whose children don’t appear on
                with behavioral special needs (Rosenzweig et al. 008).         first impression to have special needs will enroll their
                                                                                children without telling the provider just to “get their
                   DiFFicUlTieS FinDinG cHilD caRe FoR                          foot in the door.” Then when the child has difficulties,
                      cHilDRen wiTH SPecial neeDS                               the parents feign surprise. Staff from child care Plus
                                                                                Me liken children with behavioral difficulties to

                P  arents of children with special needs face great diffi-
                   culty finding child care. one parent told us,
                                                                                “canaries in a coal mine” who are the first to show the
                                                                                negative effects of more global issues of quality in a
                                                                                child care setting. yet with improvements in overall
                                                                                quality, appropriate training and on-site consultation
                    i found a job immediately when i moved up
                                                                                from mental health experts, children with special needs
                    here…. i couldn’t find child care because it was
                                                                                can be integrated successfully into child care programs.
                    too hard, because nobody wanted to take a child
                    with special needs. But i brought him to a day
                                                                                         eXPUlSion oF cHilDRen wiTH
                    care and i had called every other place and went
                                                                                        SPecial neeDS FRoM cHilD caRe
                    and drove by it to see what it is like before i
                    brought him. about the tenth one i called, she
                    said, “Sure, bring him over.” So i bring him
                    over and she called me two days later and i was
                                                                                a     lthough Maine is making inclusion efforts for
                                                                                      children with special needs, our study found that
                                                                                expulsion from child care is a significant problem.
                    supposed to start work on Monday and it was
                                                                                More than one-third of the providers we surveyed (5.
                    Saturday and she said, “i can’t watch your son
                                                                                percent) reported asking a child with special needs to
                    because it is going to be too difficult for me.”
                                                                                leave their program. asked what challenges they face
                                                                                in caring for a child with special needs, providers cited
                                                                                lack of staff for necessary supervision (58.5 percent);
       …job stability among parents                                             concerns about disruptions to other children (51.7
                                                                                percent); lack of training (44. percent); and difficul-
       of children with special needs…                                          ties including children with special needs in program
                                                                                activities (.9 percent).
       is significantly lower than for parents                                        Parents reflected many of these concerns. For
       of children without special needs.
                                                                                   • almost one in five (18.9 percent) were asked
                                                                                     by a child care provider to remove their child
                                                                                     from the program.
                     Parents whose children have behavioral difficulties
                face more challenges finding and maintaining child care            • almost one-quarter (.5 percent) reported
                arrangements than do parents of children with solely                 a lack of inclusion of their child with special
                physical disabilities or speech/language difficulties.               needs in the activities of the program.
                DHHS caseworkers reported that it was easier to find
                                                                                   • almost one-third (0. percent) reported a
                and maintain child care for a child with physical
                                                                                     lack of support from the provider regarding
                disabilities than for a child with behavioral problems.
                                                                                     their child’s special needs.
                Similarly, about three-quarters (74.8 percent) of the

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                                                                                      cHilD caRe FoR cHilDRen wiTH SPecial neeDS

     lacK oF cooRDinaTion oF THeRaPy                            intervention/preschool special education services can
        wiTH cHilD caRe PRoGRaMS                                cause transportation problems, work disruptions, and
                                                                difficult transitions for children and families. in some

e    ven when stable, satisfactory child care is found,
     our findings demonstrated that the ability of
parents of children with special needs to balance work
                                                                cases, as carol’s story illustrates, despite a desire to work,
                                                                parents are unable to stay employed. But for many
                                                                more, employment remains an economic necessity.
and family is often affected by a lack of coordina-
tion between the child care system and the services                    eMPloyMenT cHaRacTeRiSTicS
their children need (e.g., speech therapy, occupational               oF woRKinG PaRenTS oF cHilDRen
therapy, developmental therapy). The individuals with                       wiTH SPecial neeDS
Disabilities education act (iDea) provides for early
intervention and preschool special education services
for children ages zero to five, as well as school-aged
children. iDea contains requirements that emphasize
                                                                P   arents of children with special needs do work, but
                                                                    their employment is unstable, and they find it diffi-
                                                                cult to move up the career ladder. our analysis of data
the importance of children receiving these services at          from the national Survey of america’s Families revealed
home or in a setting where the child interacts with             that a substantial proportion of parents of children
nondisabled peers, rather than in a specialist’s office.        with special needs work, and among those who are
if services are delivered in the child’s natural environ-       employed, they are as likely to work full-time as parents
ment, communication can occur between the specialist            of children without special needs. This may be due to
and the parent and/or child care provider so that               economic necessity, the need for the health insurance,
between sessions all of the adults interacting with the         and/or the desire for a respite from caring for their
child are “on the same page.” The child is able to apply        child with special needs.
what is learned in his or her normal environment                     Parents in Maine reported some of the difficult
instead of having to transfer what is learned in the            work choices they made related to the demands of
artificial setting of the specialist’s office to those more     meeting the special needs of their children. These
normal settings. in addition, as carol’s story illustrates,     included reducing (57. percent) or changing (44.
when services are delivered on site, parents have fewer         percent) their work hours, refusing a job offer or
transportation issues during the work day.                      promotion (9.4 percent), or quitting their job alto-
      However, funding and other constraints, along             gether (0. percent).
with the transportation issues inherent in a rural state             Given these work difficulties, it’s not surprising
such as Maine, have hindered full implementation of             that despite higher than expected labor force participa-
that model, which is reflected in our findings. ninety-         tion rates, job stability among parents of children with
three percent of children of the parents in our survey          special needs, as measured by number of months in the
were reportedly receiving early intervention or preschool       parent’s current job, is significantly lower than for
special education and related services under iDea.              parents of children without special needs. nationally,
nearly half (4.4 percent of children ages zero to two          parents of children with no special needs reported
and 46.8 percent of children ages three to five) were           they had been in their current job on average for 79
receiving some or all of their services in specialists’         months; for parents of a child with a behavioral
offices. Parents indicated all of the settings where their      disability it was 70 months; and for those whose child
child received services, so some children may have been         had a health condition, it was 59 months. in part due
receiving services only at child care or both at home and       to this job instability, parents of these children experi-
at a specialist’s office. However, only .5 percent of         ence more financial insecurity than do parents of chil-
child care providers in our provider survey reported that       dren without special needs.
services were provided at their child care program. This             even after we controlled for other factors (mother’s
lack of coordination between child care and iDea early          age, race, education, marital status, number of dependent

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cHilD caRe FoR cHilDRen wiTH SPecial neeDS

     FIGURE 1: Percentage of u.s. Families experiencing indicators
                                                      of Financial insecurity, by Type of Disability of Child

                                                80%                                                                                                   early childhood Division and children’s
                                                                                                                                                      Behavioral Health and the center for
Families with Financial Insecurity Indicators

                                                70%        Poor        Food Poverty         Rent Poverty          Parent Lacks Health Insurance
                                                                                                                                                      community inclusion and Disabilities
                                                60%                                                                                                   Studies (cciDS) at the University of
                                                                           53%                                                                        Maine. The initiative provides information,
                                                50%                                                                                                   resources, training, and technical assistance
                                                                                                                                                      to child care providers to increase access,
                                                      36% 35%
                                                               34%              34%       36%        34%                                              participation, and retention of children
                                                                                                                                                      with special needs in child care, to prevent
                                                                                                          23%   25%         25%                       expulsion, and to improve the quality of
                                                20%                                                                 18%                17% 16%        early care and education.
                                                                                                                                                           in 007, a new program built upon
                                                10%                                                                                                   the early childhood mental health consul-
                                                                                                                                                      tation to child care provided by child
                                                         Behavioral              Health                   Disabled              No Special            care Plus Me—an initiative designed to
                                                                                Condition                                         Needs               train community early childhood mental
                                                                                    Type of Disability of Child                                       health clinicians to provide child-specific
                                                                                                                                                      and programmatic consultation to child
                                                                                                                                                      care programs. Maine also participates in
                                                                                                                                                      expanding inclusive opportunities, a
                                                             children) that can influence economic status, financial                   federally funded initiative to enable states to receive
                                                             security for these families remained more precarious than                 technical assistance in undertaking state team/systems-
                                                             for parents of children without special needs.                            level collaborative planning to expand inclusive oppor-
                                                                                                                                       tunities for young children and their families. This
                                                               incReaSinG PaRenTal Financial STaBiliTy                                 interagency planning process includes the key stake-
                                                                      AND MeeTinG cHilDRenS’ neeDS                                     holders from the early care and education system, the
                                                                                                                                       early intervention/preschool special education programs

                                                              a   ddressing the challenges faced by parents of
                                                                  children with special needs is important both to
                                                             provide a more stable workforce for Maine’s economy
                                                                                                                                       under iDea, the cciDS, and parents of children with
                                                                                                                                       special needs.
                                                                                                                                            These efforts are in line with many of the broad
                                                             and to enhance the long-term outcomes for children                        recommendations included in our final report from the
                                                             with special needs. if parents experience child care and                  006 study:
                                                             work problems, their ability to access services for their
                                                                                                                                          • Providing greater interagency coordination to
                                                             child at an early age (when intervention is most effec-
                                                                                                                                            meet the complex needs of families of children
                                                             tive) can be diminished.
                                                                                                                                            with special needs.
                                                                   Meeting the complex needs of these families will
                                                             require greater public investment and closer collaboration                   • Strengthening the capacity to provide inclu-
                                                             between agencies in order to strengthen the capacity of                        sive, high-quality child care to children with
                                                             the early care and education system to serve these chil-                       special needs.
                                                             dren, address gaps in services, and resolve programmatic
                                                                                                                                          • Delivering services under iDea (e.g., speech
                                                             and policy conflicts. Since we completed our study in
                                                                                                                                            therapy, occupational therapy, physical
                                                             006, Maine has taken significant steps to address these
                                                                                                                                            therapy, developmental therapy, specialized
                                                             issues. The state continues to support child care Plus
                                                                                                                                            instruction) in a way that supports inclusion
                                                             Me, a state-university partnership project of the Maine
                                                                                                                                            and the need of parents to work.
                                                             Department of Health and Human Services (DHHS)

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                                                                                       cHilD caRe FoR cHilDRen wiTH SPecial neeDS

  • Making welfare to work policies flexible                                                     Helen D. Ward is a research
    enough to meet the individual circumstances                                                  associate at the Cutler
    of families of children with special needs.
                                                                                                 institute for health and
  • Providing greater flexibility in the workplace                                               social Policy, Muskie school
    to allow parents to maintain employment                                                      of Public service, university
    while still meeting the special needs of their
                                                                                                 of southern Maine. her
                                                                                                 work at Cutler has focused
      Specific strategies under each of the recommenda-                                          on examining cross-systems
tions listed above are suggested in the final report                                             issues and their effect on
which can be downloaded from our project web site               special populations of young children and their families, with
( we are                 a particular focus on children with special needs, early inter-
encouraged that the voices of parents like carol are
                                                                vention services, early care and education and child welfare.
being heard by Maine policymakers, and we hope the
difficult interagency work that has begun at the state
and local level will ultimately relieve parents’ child care     Julie A. Atkins is a research associate at the Cutler institute
and work challenges and help children to gain access to         for health and social Policy, Muskie school of Public service,
the early intervention services they need to reach their
                                                                university of southern Maine. her primary focus is on the
full potential. 
                                                                accessibility and coordination of early care and educa-
                                                                tion and early intervention services for low-income special
                                                                populations, including children with special needs, english
                                                                language learners, and children in the child welfare system.
  Cobo-lewis, alan b. 2009. “streamlining services for
     young Mainers with disabilities.” Maine Policy
     review 18(1): 68–81.                                                                        erin e. Oldham is the
  rosenzweig, Julie M., eileen M. brennan, katherine                                             owner of oldham innovative
     huffstutter and Jennifer r. bradley. 2008. “Child                                           research, a new england
     Care and employed Parents of Children with
     emotional or behavioral disorders.” Journal of                                              research and evaluation
     emotional and behavioral disorders 16(2): 78–89.                                            company. her speciality is
  ross Phillips, katherin. 2002. “Working for all Families?                                      educational research. she is
     Family leave Policies in the united states.” the
                                                                                                 currently directing the evalu-
     economics of Work and Family, ed. Jean kimmel
     and emily P. hoffman W.e. upjohn institute for                                              ation of an early reading
     employment research, kalamazoo, Mi. pp 159–180.                                             First project in Maine and
  u.s. Census bureau. 2007. american Community                  conducting research on the use of early education and care
     survey, r1801: Percent of People 5 to 20
                                                                among somali, sudanese, and Cambodian immigrants in
     years old with a disability universe: Civilian
     noninstitutionalized Population 5 to 20 years. http://     Maine and Mexican refugees in Colorado. [accessed July 15, 2009]
  Ward, helen, lisa Morris, Julie atkins, erin oldham
    and angela herrick. 2006. Child Care and Children
    with special needs: Challenges for low-income
    Families, Final report. Muskie school of Public
    service, university of southern Maine, Portland.

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enGliSH lanGUaGe leaRneRS

                        language                                       Erin Oldham, Julie Atkins and Helen Ward discuss

                  learners in the                                      the increasing number of Maine children who are

                                                                       English language learners (ELL) or who are limited-

                  State of Maine:                                      English proficient (LEP), noting that insufficient

                                                                       attention has been paid to the preschool education
                             Early Education
                                                                       of this group. The authors describe lessons learned
                             Policy That Can
                                                                       from an Early Reading First Program in Portland,
                            Make a Difference                          which enhanced the school-readiness of preschool
                                              by erin e. oldham
                                                                       ELL children.     
                                                 Julie a. atkins

                                                 helen d. Ward

88 · Maine Policy Review · Summer/Fall 009           View current & previous issues of MPR at:
                                                                                                            enGliSH lanGUaGe leaRneRS

                                                                                                             in large part, the

M      aine has experienced a large increase in english
       language learners (ell) or limited english
proficient (leP) students over the last 15 years. From
                                                                     than children who are profi-
                                                                     cient (collier and Thomas
                                                                                                             ability to learn in

1995 to 006, there was a 5.6 percent increase in                                                           school depends on
                                                                   • native language instruction
leP students (U.S. Department of education 008),                    boosts the academic success
which amounts to ,146 children in Maine schools in                                                          english proficiency
                                                                     of english language learners
the 006 school year. Portland public schools currently              (august and Hakuta 1997).
have more than 1,800 ell students, making up 5                                                              and literacy skills.
percent of their enrollment. in Maine, the increase in               common characteristics of
immigration trends is distinguished from many other             successful programs for ell
states by the sheer diversity of nations from which new         include
american families are arriving. This diversity is clearly
reflected in the more than 50 languages spoken in                  • Some native language instruction, especially
the Portland schools system (Marguerite MacDonald                    initially.
personal communication). in the last five to 10 years,             • early phasing in of english instruction.
the diversity seen in Portland is moving to other parts
of the state, increasing the need for statewide attention          • Teachers specially trained in instructing ell.
to the educational needs of ell students. Because of               • Family involvement to build supportive
the potential impact of preschool education on these                 environments at home and home-school
children’s long-term outcomes, the preschool educa-                  connections (august and Hakuta 1997).
tional needs of ell students are critically important.
Thus, this brief article describes crucial elements in
ensuring that ell children arrive in school ready for           wHaT can Maine Do To enSURe SUcceSSFUl
school, along with ideas for what Maine can do to                     leaRninG FoR ell cHilDRen?
ensure successful long-term learning for this popula-
tion of young Mainers. we provide an example of a
successful program currently being implemented for
preschool-age ell children and end with recommen-
                                                                T    o build the connections between families and
                                                                     schools that will enable us to serve ell children’s
                                                                needs, we must understand the viewpoint of refugee
dations for policymakers and practitioners.                     families. a project being conducted by the Muskie
                                                                School of Public Service at the University of Southern
      KeyS To ScHool ReaDineSS anD                              Maine and oldham innovative Research (new
    acaDeMic SUcceSS FoR ell cHilDRen                           americans: child care choices for Parents of english
                                                                language learners) is seeking to understand how to

i  n large part, the ability to learn in school depends
   on english proficiency and literacy skills. There are
a number of key research findings that can inform our
                                                                build bridges between refugee families and schools. This
                                                                project is funded from 007 through 010 through
                                                                the U.S. Department of Health and Human Services.
efforts to effectively address the needs of children with       The study explores the perspectives of parents (using
limited english proficiency.                                    cultural brokers), child care providers, K- teachers, and
                                                                state-level administrators on the topics of parents’ beliefs
  • The amount of time it takes to learn english                about child rearing, early education, and school readi-
    varies widely from person to person.                        ness and how teachers (preschool through second grade)
  • Students with strong proficiency in their                   are prepared for and experience teaching ell children.
    native language are more likely to develop                  Preliminary findings from the study offer insight into
    greater proficiency in english. ell children                potential strategies for more effectively serving this
    who are not proficient in their first language              population. one notable finding is that parents’ reli-
    take longer to reach proficiency in english                 gious and cultural beliefs affect whether they enroll their

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enGliSH lanGUaGe leaRneRS

                children in any type of preschooling. Teachers at Reiche          can be of particular benefit to refugee children and
                elementary in Portland (who were involved in inter-               their parents. Research demonstrates that preschool
                views conducted through the study) report that there              attendance significantly raises the english-language
                is a significant difference between children who attend           proficiency of ell and increases reading and math
                preschool and those who do not in terms of developing             scores for these children (Magnuson et al. 006).
                the skills necessary for success in school. as a first grade      ece programs also can link immigrant parents to
                teacher in Portland noted, “there is a lack of scissors,          employment, health and other social services, and help
                pencils, and crayons in some homes. The children                  with parenting, eSl, and literacy skills. Good-quality
                haven’t had exposure and a chance to play with these              ece programs also provide a way to track children’s
                things. Their parents don’t understand the need to have           development and emotional well-being and connect
                these things. So i have to do ‘hand-over-hand’ practice           them, if needed, with early intervention services.
                with the child. it would be great if they got this exposure       This may be of particular benefit to children of refugee
                in preschool.” another teacher noted that “their vocabu-          families who may have experienced violence or trauma
                lary is low—their exposure to different things outside            in their native country. while the ece system in
                the home is lacking. They don’t have people to practice           Maine contains many high-quality programs and some
                their english with. The classroom is where they practice          programs with experience and expertise in providing
                their english (and it is hard to get them to stop talking         early education to refugee families, too few ece
                during class time!).”                                             providers have training in or knowledge of how to
                                                                                  serve these families well.

      early reading First programs are inten-                                         eaRly ReaDinG FiRST: an eXaMPle oF a
                                                                                     PRoGRaM SUcceSSFUlly woRKinG wiTH
      sive early literacy programs intended to                                      PReScHool enGliSH lanGUaGe leaRneRS

      provide research-based instruction to
      preschool-age children, especially ell.
                                                                                  e    arly Reading First programs are intensive early
                                                                                       literacy programs intended to provide research-
                                                                                  based instruction to preschool-age children, especially
                                                                                  ell. The University of Southern Maine was funded
                                                                                  by the U.S. Department of education from 005 to
                      an article by Patty Fisher on the Mercurynews.              008 to implement an early literacy initiative referred
                com web site (                             to as the “Portland early literacy collaborative.” The
                1798780?source=most_emailed&nclick_check=1)                      program involved a high-quality curriculum (“opening
                describes a program in San Jose, california, that may             worlds of learning”) that provided research-based
                hold promise for Maine. it is a Stretch to Kindergarten           activities for the classroom, research-based intensive
                program in which children who have had no exposure                professional development for teachers (i.e., monthly
                to preschool spend the three weeks before kindergarten            training), coaching for teachers, and used data to
                in a classroom experiencing the classroom routine                 inform instruction. approximately 15 three- to five-
                and practicing skills such as cutting with scissors and           year-old children in nine classrooms in five centers were
                coloring with crayons.                                            served each year in Portland, Maine.
                      The early care and education (ece) system, made                   This program enhanced the school-readiness skills
                up of preschool, Head Start, and family child care                of preschool ell children. an evaluation, conducted by
                homes, is both enriched by this diversity and faces               oldham innovative Research, found that ell children
                many challenges in serving these children. it is well             began the preschool program with a much lower level of
                established that high-quality ece programs can help               pre-reading and writing skills than english-speaking chil-
                at-risk children gain the skills they need to be ready for        dren. importantly, these same ell children made huge
                school. However, enrollment in a quality ece program              strides by the end of the program. For instance, before the

90 · Maine Policy Review · Summer/Fall 009                      View current & previous issues of MPR at:
                                                                                                                 enGliSH lanGUaGe leaRneRS

                                                                 FIGURE 1: Percentage of ell Children ready for school as
                                                                                a result of early reading First (erF)

006–007 school year, only 0 percent of ell children           100%

knew enough uppercase letters to be considered ready for
school. However, after two years of early Reading First                                                                 Spring 2006, Before ERF
implementation, more than 60 percent of children met                                                                    Spring 2008, After ERF
this standard for school readiness. another important
message from the results (illustrated in Figure 1) is that        70%
ell children have a harder time learning certain skills                             62%
and need more practice in those areas. one area in which                                          55%
ell children need more help is “print word awareness,”            50%                                                              50%
that is, in knowing how books work (you read them left
to right) and how words and sentences work (there is a            40%                                                                                 39%

space between words, punctuation separates sentences).
name writing is another area for extra attention. Many of
the children from refugee families have not had much or           20%
                                                                              20%                                 19%
any exposure to writing tools in the home and are behind                                                                    14%
                                                                                            11%                                               11%
in these skills. There are many such practical lessons to be      10%
learned from the early Reading First projects.                                                              2%
      The University of Southern Maine received a                   0
                                                                              Uppercase     Beginning       Print Word         Rhyme              Name
second early Reading First grant in 008 (funded by                            Letters       Sounds         Awareness         Awareness           Writing
the U.S. Department of education through 011).
                                                                                                   School Readiness Skill
This grant will serve almost 00 children through
Head Start and child care centers in Biddeford,
lewiston, and Portland and promises to provide critical         second language and what can be done to enhance their
information about teaching ell children what they               literacy, math, and social skills, () continue Maine’s
need to know prior to kindergarten.                             tradition of applying for and receiving federal and foun-
                                                                dation grants to improve our ability to serve ell chil-
                     wHaT neXT?                                 dren in multiple ways, and () use forums where
                                                                researchers, policymakers, professionals, and practitioners

R    esearchers and practitioners in Maine are working
     hard to better understand and address the needs of
ell children and their families. Training on multicul-
                                                                focused on preschool education can review the findings
                                                                from ongoing studies in Maine and identify important
                                                                lessons, policy implications, and action steps. 
turalism, diversity, and strategies for teaching kinder-
garten through 1th grade ell students are offered
and funded through the Department of education
(however, these courses do not focus specifically on
preschool and early childhood). The Multilingual and
Multicultural center of the Portland public schools has            the authors would like to thank susan reed, director
                                                                   of an early reading First project, for her review of and
a Robert wood Johnson grant to develop a program to                contributions to this article.
deliver mental health services for children and youth
that recognizes the cultural norms and values of the
target communities.                                                RefeRences
     our suggestions for moving forward are the                    august, diane and kenji hakuta (eds). 1998. educating
following: (1) increase training and higher education                 language Minority Children. national academy
opportunities, focused on preschool education in                      Press, Washington dC.
particular, as most preschool teachers have no training
                                                                                              Please turn the page for more references and author bios.
and little understanding of how children develop a

View current & previous issues of MPR at:               volume 18, number 1 · Maine Policy Review · 91
enGliSH lanGUaGe leaRneRS

                                                                                                                      Helen D. Ward is a research
                                                                                                                      associate at the Cutler
                  Collier, virginia P. and Wayne P. thomas. 2004.
                      “the astounding effectiveness of dual-language
                                                                                                                      institute for health and
                      education for all.” nabe Journal of research and                                                social Policy, Muskie school
                      Practice 2(1): 1–20.                                            of Public service, university
                      Collier.pdf [accessed July 13, 2009]
                                                                                                                      of southern Maine. her
                  Magnuson, katherine, Claudia lahaie and Jane
                    Waldfogel. 2006. “Preschool and school readiness                                                  work at Cutler has focused
                    of Children of immigrants.” social science                                                        on examining cross-systems
                    Quarterly 87(5): 1241–1262.
                                                                                                                      issues and their effect on
                  u.s. department of education. 2008. Maine: rate of                 special populations of young children and their families, with
                     leP growth 1995/1996–2005/2006. http://www.
                               a particular focus on children with special needs, early inter-
                     [accessed July 12, 2009]                                        vention services, early care and education and child welfare.

                                                 erin e. Oldham is the
                                                 owner of oldham innovative
                                                 research, a new england
                                                 research and evaluation
                                                 company. her speciality is
                                                 educational research. she is
                                                 currently directing the evalu-
                                                 ation of an early reading
                                                 First project in Maine and
                conducting research on the use of early education and care
                among somali, sudanese, and Cambodian immigrants in
                Maine and Mexican refugees in Colorado.

                Julie A. Atkins is a research associate at the Cutler institute
                for health and social Policy, Muskie school of Public
                service, university of southern Maine. her primary focus
                is on the accessibility and coordination of early care and
                education and early intervention services for low-income
                special populations, including children with special needs,
                english language learners, and children in the child welfare

9 · Maine Policy Review · Summer/Fall 009                         View current & previous issues of MPR at:
                                                                                               enGliSH lanGUaGe leaRneRS

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woRKinG PaRenTS anD cHilD caRe

                             Parents and                                  Close to two-thirds of children in Maine under the

                             child care:                                  age of five need child care while their parents work.

                                                                          The quality of child care is a critical policy concern,

                 Charting a New Course                                    since research tells us that early childhood experience

                             for Quality                                  plays a major role in later-life success for individuals.

                                                  by Michel lahti         The authors report on findings from three studies

                                                 rachel Connelly          regarding child care arrangements in Maine and the

                                                georgia n. nigro          quality of child care in the state and nationally. They

                                              rebecca Fraser-thill
                                                                          describe the development and implementation of

                                                                          Maine’s new Quality Rating System (QRS) for child

                                                                          care facilities, Quality for ME, and the role that it

                                                                          can play both in improving child care and in helping

                                                                          parents chose quality care.   

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                                                                                                     woRKinG PaRenTS anD cHilD caRe

                                                                                                                …the quality of
                   inTRoDUcTion                                 tion, the total approved licensed
                                                                capacity for child care served                   the care children

n      ationally and in Maine, the majority of preschool
       and school-aged children in the U.S. live in families
in which all parents work. according to a 007 report to
                                                                approximately 48,450 children.
                                                                center-based care settings have
                                                                the most approved licensed
                                                                                                                 receive when cared

the state legislature from the Maine child care advisory        capacity (6 percent), compared                  for by someone
council, 65 percent of children under the age of five           to family child care homes (
in Maine need child care while their parents work. as           percent) or nursery schools (five                other than their
research has demonstrated, and as several articles in this      percent). Finally, there is care
issue discuss, the quality of early childhood experience        that is informal—family, friend,                 parent is a critical
has a major influence on later success for individuals.         and neighbor care that parents
“investing early” can also pay big returns for society (see     arrange themselves, where the                    public policy
articles by Trostel and connors this issue). Therefore the      caregiver does not receive any
quality of the care children receive when cared for by          sort of government support                       concern.
someone other than their parent is a critical public policy     (Maine child care advisory
concern. This article identifies what research from three       council 007).
studies tells us about child care arrangements in Maine and           The focus for policymakers
the quality of child care. it describes a new Maine effort to   is often on the child care services that are government
improve the quality of care in licensed child care settings.1   funded or otherwise government supported. Families are
                                                                eligible for government subsidy if their income is at or
               cHilD caRe in Maine                              below 75 percent of the Maine state median income.
                                                                They can continue to receive or be eligible for subsidy as

M      aine is geographically and financially diverse,
       supporting a variety of child care options for
working parents. The out-of-home option most often
                                                                long as they are working or in school and their income
                                                                does not exceed 85 percent of the state median income.
                                                                However, where funds are short, the state policy is that
associated with child care in people’s minds is licensed,       families of very low income and families with children
regulated child care centers. in Maine, these centers           with special needs are given priority for receiving a
serve at least three children, and the average size of a        government subsidy. according to information from
licensed, regulated center is 5 children. However, there       the state office of early care and education, Maine
are many alternatives to this form of care. There are           provides child care subsidies to more than 8,81 families
licensed, regulated family child care homes, in which as        annually and was projected to spend a total of more than
many as 1 children under the age of 1 are cared for in        $6 million dollars during the 008 federal fiscal year
an individual’s home. There are licensed nursery schools        for child care subsidies and related activities. For the
and part-time programs, which offer care to children            time period of 00 through 007, there was an 11
ages three to seven for up to three and one-half hours          percent decrease in the total number of families receiving
per day. There are Head Start and early Head Start              this type of support. Reports from the state office of
programs that are family focused and have eligibility           early care and education indicate that subsidies now
requirements for enrollment and services. There are             reach only 8 percent of the children who are eligible.
public school preschool programs that are administered
by local education agencies. There is also a form of legal,                    wHo USeS wHaT TyPe
unregulated child care called caRe for Me, where only                         oF cHilD caRe in Maine?
one or two children are cared for in someone’s home.
This type of care is considered “legal” in that these
care providers can receive government reimbursement
for care if they pass a background check. according to
                                                                w      hen choosing child care, parents in Maine, like
                                                                       parents throughout the United States, have a
                                                                menu of choices available in terms of type and cost
007 state office of early care and education informa-          of care. yet not all types of care or all levels of quality

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woRKinG PaRenTS anD cHilD caRe

                or costs are available to every parent. availability                                Type of Child Care Used
                depends on where one lives, what time of day the care                    in the studies discussed here, we identified five
                is needed, the age of the child, and if the child has               main categories of child care arrangements: relative
                special needs.                                                      care, friend or neighbor care, a family day care home,
                      To understand the choices parents make about                  a child care center or preschool, and a catchall “other”
                child care, a statewide random telephone survey was                 category, which includes in-home babysitting. Table 1
                conducted in 004–005. This effort yielded 800                     shows the primary child care arrangements reported for
                surveys of parents whose youngest child was under the               the youngest child in Maine families with a child under
                age of five. in addition, similar mail surveys were sent            the age of five.
                to a random sample of 1,571 parents who received
                governmental support for child care. of these parents,
                91 responded, for a 5 percent response rate.                      TABLE 1:    Type of Child Care used by Maine
                      in reporting these results, we concentrate on the type                    Families using More than Five
                of care chosen, the cost of the care, and parents’ percep-                      hours of Child Care per Week (2004)
                tions of availability. we are particularly interested in
                whether receiving a government subsidy, a “voucher,” or a            Center-based Care                                39%
                “slot,” changes the access, costs, and perception of avail-
                                                                                     relative Care                                    25%
                ability. child care in this context is defined as care that is
                provided by someone other than a parent.                             Family Child Care home                           21%
                                                                                     Friends Care                                     11%
                             Amount of Child Care Used
                                                                                     other                                             4%
                     Thirty-two percent of Maine households with a
                child under age five reported using no child care, and              note: data from telephone survey, weighted to reflect the
                another 1 percent used less than six hours of care a               true urban/rural distribution in the state.
                week. The hours of child care used varied substantially
                for Maine families even among those who used six or
                more hours of per week, henceforth known as child                        child care arrangements varied by employment
                care users. Just under half of the user families used               status. center-based care, which is often thought to
                0 or more hours of child care a week. as one would                 enhance school readiness, was most often used by
                expect, employed mothers used significantly more                    non-employed mothers (45 percent) and by mothers
                hours of child care than non-employed mothers. For                  employed full time (44 percent). center slots are often
                the mothers employed full time (5 or more hours                    offered only by the week or by the full day, and are
                per week), their children were in care on average for               thus less often the choice of families when the mother
                7 hours per week. in comparison, children were in                  is employed part-time. For those mothers who were
                care on average for 1 hours per week for mothers                   employed part-time, relative care was chosen 5
                employed part time, and 17 hours for mothers who                    percent of the time. it may be that relatives are willing
                were not employed.                                                  to provide part-time care, but are more reluctant to
                     Those Maine families who received child care                   provide full-time care, or it may be that parents feel
                subsidies were substantially more likely to use six or              that relative care is acceptable for part-time care, but
                more hours of child care, which is to be expected since             lacks the educational component they are looking for
                receipt of the subsidy is largely predicated on parental            in full-time care. an alternative explanation is that
                employment. ninety-seven percent of the subsidy                     much of the part-time employment occurs when
                recipients used six or more hours of child care a week              centers are closed and when relatives, who may also be
                compared to 57 percent of the non-subsidy recipients.               employed, are more likely to be available.

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      national data available to compare with Maine               TABLE 3:     Parent Perceptions of Choice of
includes only employed mothers. Table  shows that                             Availability of Good-Quality Care
Mainers make more use of formal arrangements such                              Near My home (2004)
as center care and family day care and substantially less
use of relative care. This may reflect a difference in the                                                       Percentage—
percentage of mothers working part time in Maine                                                                  “no good
compared to national data, the lack of grandparents                                                                Choices”
available in Maine to act as caregivers, or a greater avail-       by subsidy status
ability of formal slots in Maine due to the relatively               no receipt of government subsidy                 20%
lower average wage levels in the state.                              “voucher” government                             16%
                                                                      subsidy recipients
TABLE 2:     Primary Child Care Arrangements                         “slot” government subsidy                        14%
             used by employed Mothers (2004)                          recipients
                                                                   by residence
                                    Maine            u.s.            urban location of residence                      16%
 only With Parents                    26%            27%             rural location of residence                      24%
 relative Care                        18%            30%           by employment status
 Friend Care                            8%           10%             Mother employed Full time                        19%
 Family Child Care home               16%            11%             Mother employed Part time                        17%
 Center-based Child Care              29%            26%             Mother not employed                              32%
 other                                  3%            n/a
                                                                  note: data by subsidy status comes from all three surveys,
note: both columns include data for families with employed        weighted to reflect the true urban/rural distribution in the
mother of children under age five only. Maine data are            state. data by urban/rural residents comes from all three
from the telephone survey only, weighted to reflect the true      surveys, weighted to reflect the population of the state.
urban/rural distribution in the state. national data come         data by mothers’ employment status comes from telephone
from spring 1999 siPP Who’s Minding the Kids? Child               survey only, weighted to reflect the true urban/rural distribu-
Care Arrangements: Spring 1999 detailed tables (PPl-168),         tion in the state. the reason for using only the telephone
table 2b. it is always difficult to compare data from different   survey is that part-time employment of the mother cannot be
sources. in this case we made the following compromises. in       ascertained from the two mailed surveys.
national siPP data, the friend/informal category also includes
nannies and in-home babysitters. in Maine these arrange-
ments are listed as “other.” also siPP data include the                on average, close to 0 percent of Maine families
arrangements of all young children, while the Maine figures       answered “no,” meaning they felt that there were no
include only the youngest child.                                  good choices for child care near their homes. a sense of
                                                                  choice related to the mother’s employment status, but
                                                                  the relationship is not simple. Mothers working part
Parents’ Perceptions of Availability of Child Care                time were the most likely to respond “yes,” that they
     in all three study samples, parents were asked               have good choices, followed by mothers who were
whether there were good choices for child care where              employed full time. This is consistent with part-time
they lived. This is a critical issue in a rural state such as     employed mothers making more use of relatives and
Maine where many families live long distances from the            friends than those employed full time. But the most
types of urban centers that are more likely to offer a            likely to respond “no” to having good choices for child
variety of child care options.                                    care were non-employed mothers.

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                                                                                 quality, this national study involves multiple investiga-
                      Conclusions from Parent Survey Results                     tors at multiple sites. Given its depth and breadth, it
                     Results from the 004–005 study, the most                  has advanced knowledge in unprecedented ways. we
                recent of its kind in Maine, indicated that most fami-           present a brief review of this important research to help
                lies with young children, even those that include a stay-        Maine readers appreciate the national context within
                at-home parent, use some form of child care. Use of              which our own child care dilemmas take place.
                child care varies by type of employment. access to
                good, high-quality child care seems to be a concern,                   Goals and Design of the NICHD Study
                especially for those families living in the more rural                 The major goal of the nicHD study is to examine
                areas of Maine, where one-quarter of the rural respon-           how variations in child care relate to children’s social-
                dents said that they did not have good choices for care.         emotional adjustment, cognitive and linguistic develop-
                                                                                 ment, and physical growth and health. The children in
                                                                                 the study were born in 1991 in 4 hospitals at 10 sites
        ...higher quality child care can                                         across the country. The researchers recruited mothers
                                                                                 who were over 18 years old, spoke english, were not
        buffer young children from the                                           ill or abusing substances, lived within an hour of the
                                                                                 university lab, and had delivered a single, healthy child.
        negative effects of low income.                                          each site enrolled at least 10 percent single-parent
                                                                                 households, 10 percent mothers with less than a high
                                                                                 school education, and 10 percent ethnic minority
                     we also found differences and similarities between          mothers. There were 1,64 families enrolled in the study
                those families receiving child care subsidies from the           at the beginning; when the children finished first grade,
                state and those who do not. Subsidy recipient families           1,100 of these families were still participating. although
                were more likely to use licensable care, family day care,        the families in the study represent a range of socio-
                and center-based care, which may enhance school read-            economic and sociocultural backgrounds, the sample
                iness. Families receiving child care subsidies did not feel      is not nationally representative. Household income
                they had less choice in providers than the rest of the           and mother’s educational level are higher than the
                population. But only a portion of those families who             national average, yet sample families are also more likely
                are eligible for a subsidy receive one, and we found that        to receive public assistance than families in general.
                low-income families who were not recipients were                 Despite the sampling efforts noted above, ethnic
                much more likely to use relative and friend care. Many           minority children are still somewhat underrepresented.
                of the respondents to the mailed survey questions                      assessments of the children and their care environ-
                about slots and vouchers reported frustration at being           ments occurred when the children were six months, 15
                on the waiting list for a subsidy and uncertainty about          months, 4 months, 6 months, and 54 months, and
                what help they might receive.                                    when they were in first grade. Both the child care and
                                                                                 the home environment were assessed through a combi-
                  eFFecTS oF QUaliTy caRe on cHilDRen:                           nation of observations, phone interviews, face-to-face
                           wHaT Do we Know?                                      interviews, and questionnaires. Trained assessors
                                                                                 observed children in their homes, in their child care

                T    he question of how child care affects children
                     has long interested researchers, policymakers,
                families, and journalists. one important source
                                                                                 settings, in laboratory playrooms, and later, in class-
                                                                                 rooms. child outcomes were assessed in three domains:
                                                                                 social-emotional functioning, cognitive development,
                of research about child care effects is the ongoing              and health and physical development. Despite some
                national institute of child Health and Development               limitations, the nicHD study comprises the most
                (nicHD) early child care Study (nicHD 005).                     comprehensive corpus of child care data focused on
                Unlike other research on the effects of child care               quality and child outcomes currently available.

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                                                                     at several points in time the nicHD researchers
          Selected NICHD Study Findings                         have examined the link between child care quality and
     although the nicHD study is ongoing, the                   child outcomes. They showed that quality of care influ-
research has generated many findings already. we begin          ences children’s cognitive performance (e.g., analysis of
with the findings on quality of child care, because this        practical problems, memory for simple words, identifica-
issue, more than any other about child care, garners            tion of letter forms, and language skills). They also found
widespread attention from both the scientific commu-            that greater language stimulation by caregivers is related
nity and the popular press.                                     to higher scores on the cognitive measures. But when
                                                                children’s earlier abilities are taken into account, quality
Quality	of	Child	Care	                                          of care is not related to most child outcomes; individual
      in the nicHD study, the researchers assessed              differences in ability are driving the child outcomes. in
many characteristics of the child care environment to           other words, children’s language comprehension at age 54
measure quality. “Structural” characteristics include such      months is best predicted by their language comprehen-
features as child-staff ratios and group size; “process”        sion at 6 months and not by the quality of child care
characteristics include such features as caregiver-child        experienced in between. But what about the quality of
interaction and emotional climate. in one set of analyses,      child care experienced up until 6 months?
they looked at whether classrooms met the guidelines                 in a careful look at how quality of child care
for child-staff ratio, group size, caregiver training, and      supports the achievement of low-income children in
caregiver higher education set by the american Public           particular, some of the nicHD researchers
Health association and the american academy of                  (Mccartney et al. 007) have used the sample to test
Pediatrics. in the researchers’ words, “most classes            whether child care quality has a direct effect on child
observed in the study did not meet all four of these            outcomes at 6 months and an indirect effect through
guidelines” (nicHD 005: 1). in another set of                 improvements in the home environment. They found
analyses, the nicHD researchers created the variable            evidence for both pathways, suggesting that higher-
“positive caregiving,” which consisted of responsiveness        quality child care can buffer young children from the
to communication, stimulation of cognitive develop-             negative effects of low income. it is particularly inter-
ment, attachment, facial expressiveness, and positive           esting that evidence for the indirect pathway through
regard for the infants. Using this variable, the majority       improved home environments was found. This finding
of infants (70–80 percent) were judged to be receiving          suggests that child care settings are important sites of
care that was moderately or highly sensitive or moder-          parent education.
ately or highly positive, whereas toddlers’ and
preschoolers’ care was judged to be “not at all character-      Other	Findings		
istic” or “somewhat uncharacteristic” of positive care-              The nicHD researchers also investigated the
giving more than 50 percent of the time. when the               quantity of time in care. They found that more time in
researchers extrapolated the figures to the nation as a         child care through 54 months of age predicted more
whole, the results suggested that positive caregiving was       problem behaviors, such as aggression and disobedi-
“somewhat characteristic” or “highly characteristic” for        ence, as observed by teachers at 54 months and in
fewer than 40 percent of children. in other words, many         kindergarten. even when child temperament, maternal
children are spending long hours in child care that is          sensitivity, and other family background factors were
neither stimulating nor responsive.                             taken into account, these associations held, indicating
      The strongest and most consistent predictor of            that time spent in child care was related to the obser-
overall quality involves the kinds of language caregivers       vation of problem behaviors.
direct to children. caregivers who respond to children’s             one of the most galvanizing findings from the
vocalizations, ask questions, praise, teach, and talk to        nicHD study is that regardless of the number of
children in positive ways tend to be in child care              hours that a child spent in care over the early years,
centers that receive high overall ratings of quality.           or the type of care experienced (e.g., center, child care

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                home, relative care), parenting mattered. Parenting              has made great strides in supporting the training of
                measures, such as maternal childrearing beliefs, infant          child care professionals, but with only ,841 providers
                attachment security, and maternal sensitivity were               registered with the project (as of December 008) of
                statistically significant predictors of a host of develop-       the estimated 6,77 regulated child care providers in
                mental outcomes, such as language production and                 Maine, there is clearly a long way to go.
                comprehension, social competence, and problem                         Finally, the nicHD study and data from Maine
                behavior. So, for example, this finding suggests that            suggest that some children will spend a significant
                a large portion of the variability in language ability           portion of their early childhoods in child care. with
                of same-aged children is due to the quality of the               longer time in care associated with more problem
                parenting the children receive. The skills that are              behaviors later, policymakers, researchers, teachers, and
                precursors to those needed for school were, in fact,             families must tackle this issue now. we need a better
                more strongly linked with the parenting measures                 understanding of the reasons behind the association
                than they were with child care quality, hours in care,           so we can take steps to diminish the negative effects
                or type of care. Thus, the nicHD findings imply that             for those children who must spend substantial time in
                children benefit from positive parenting, whether the            child care. Too often parents have few options to find
                children experience extensive child care or are exclu-           high-quality care for their children.
                sively reared by parents.
                                                                                            iMPRovinG THe QUaliTy oF
                         What Does the National Research                                       cHilD caRe in Maine
                               Mean for Maine?
                     The nicHD study clearly demonstrated that
                positive, responsive parenting is key to improving child
                outcomes. Poverty compromises the capacity of parents
                                                                                 c    oncerns about the quality of child care throughout
                                                                                      the U.S. have led for a call to establish system-
                                                                                 atic monitoring or rating systems at the state level. a
                to respond sensitively to children, but high-quality             publication from the U.S. Department of Health and
                child care can offset some of the negative outcomes for          Human Services child care Bureau (U.S. DHHS
                children. The recent summary of research by the U.S.             007) reported that since 1998, 14 states have imple-
                Department of Health and Human Services office of                mented statewide quality rating systems (QRS). a
                Planning, Research and evaluation (Burchinal et al.              QRS is defined as a systematic approach to assess,
                009) indicates that good-quality child care can influ-          improve, and communicate the levels of quality in
                ence positive outcomes for children. High-quality child          early care and education programs. The idea behind a
                care makes sense because it can positively affect two            QRS is that as parents learn more about ratings, they
                generations: children and parents.                               will use them in making child care choices, selecting
                     another good reason to heed the nicHD study is              the highest-quality care they can afford. as the ratings
                to compare its findings on quality to the research done          are used, more programs will volunteer for ratings
                in Maine child care settings on the same topic. Two              so they are not excluded from parents’ ratings-based
                studies about the cost and quality of child care in              choices. Ultimately, parents will have more higher-
                Maine, one on preschool classrooms (Marshall et al.              quality choices, and then more children will receive
                004a) and the other on family child care settings               high-quality care. in addition, a QRS creates an
                (Marshall et al. 004b), revealed that many children             accountability mechanism for funders and enhances the
                spend time in settings that deliver care of fairly low           professionalization of early care and education workers.
                quality. although the state studies did not evaluate                  Quality rating systems have program standards based
                different options for improving quality, the nicHD               on state-licensing regulations and include levels beyond
                study suggests many avenues. Quality of care can be              licensing standards, defined by each state. accountability
                improved, for example, by increasing staff education             measures are built into these systems to determine how
                and training, especially in engaging children verbally           well programs meet standards, and some form of nota-
                (see DellaMattera this issue). Maine Roads to Quality            tion is provided—stars or steps, for example. These

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approaches usually include support to providers to assist       care settings meeting a “good” level of quality.
them in enrolling in the program and/or to increase their            The design of Maine’s QRS involved the use of
levels of quality to meet higher standards over time. Some      information gathered from parents and providers. The
states include financial incentives linked to program stan-     statewide parent survey discussed earlier was also used, as
dards. Finally, most systems have some form of parent           were recommendations from stakeholder groups advising
education component to help parents understand the              the state agency. in addition, other state rating systems
system and standards.                                           were studied, and a review of the literature on QRS to
                                                                date was conducted. Finally, a study was conducted that
                Quality for ME:                                 was similar in approach to ceglowski (004), which
    Maine’s New Tiered Quality Rating System                    developed a set of definitions of child care quality
      Quality for Me was piloted during 007 and                through focus group methodology in order to explore
implemented in March 008. while all child care                 directly how parents and providers defined quality.
programs in Maine are required to be licensed to
ensure that basic levels of health and safety are met,
participation in the Quality for Me program is volun-                         Concerns about the quality of child
tary, with one exception. Beginning in october 009,
all programs receiving government subsidies will be                           care throughout the u.s. have led for
required to enroll. Participating child care programs
complete a self-assessment, and after a review by state                       a call to establish systematic monitoring
officials, receive a step level ranking of one, two, three,
or four. The ranking is based on eight components of                          or rating systems at the state level.
quality: licensing compliance history, learning environ-
ment, program evaluation, staff development, adminis-
trative policies/procedures, family involvement,                     The study design used in Maine was a qualitative
community resources, and child observation. each of             approach using focus group interviews combined with
the four steps includes requirements based on these             concept-mapping methodology. in early 005, six
eight components, but the requirements vary from step           regional focus groups were held with 44 people, both
to step and by type of setting. all requirements of one         providers and parents, attending. each focus group
step must be met before a program can move to the               discussed the general question: What would you see
next step, with the fourth step representing the highest        or hear that would make you think that this was
level of quality in this system.                                a high-quality child care setting? The most common
                                                                responses were positive interactions between caregivers
     Designing Maine’s Quality Rating System                    and children, and between caregivers and adults; age
     Maine’s QRS was developed based on research and            appropriate activities, space and materials; caregivers
planning efforts over the last eight years. First, in early     who understand developmental issues for children;
000, the Maine Department of Health and Human                  and safe, clean environment, healthy foods/snacks.
Services (MDHHS) commissioned a set of studies, The                  next, 80 statements about quality were selected
Cost and Quality of Full-Day, Year Round Early                  verbatim from the focus group transcripts. The state-
Care and Education in Maine (Marshall et al.                    ments were considered to be descriptors of quality and
004a) and The Cost and Quality of Family Child                 non-duplicative in nature. More than 00 early care
Care Homes in Maine (Marshall et al. 004b), that               and education specialists, parents, researchers, and
involved direct observation of licensed center class-           providers were contacted to review and rate the state-
rooms and family child care homes representing every            ments through a concept-mapping process. Forty-seven
county in the state of Maine. These 004 findings indi-         people responded, and the results of the concept-mapping
cated that quality was a substantial concern in Maine,          process provided the following quality domains to be
with less than a third of all the licensed Maine child          considered most important to measure in a quality rating

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                system: (1) parent–provider relations; () child’s social/         made available to completely meet demand for child
                emotional needs; () quality of staff/health and safety            care by 01.
                issues/staff–child interactions. These domains are quite                 although research on the components of high-
                similar to the elements identified by ceglowski (004).            quality child care, such as the nicHD study, is
                central in both studies is the importance placed on the            ongoing, there are emerging findings that can guide
                interactions between parents and providers.                        policymakers. Positive parenting is the most important
                                                                                   predictor of good child outcomes, regardless of the
                                                                                   kind of child care arrangement for most children. in
      …the majority of families report using                                       addition, for those children from lower socioeconomic
                                                                                   backgrounds, high-quality child care settings can influ-
      some type of child care, many for a                                          ence positive child outcomes. Many families who
                                                                                   qualify for state subsidies, more than a third in Maine,
      substantial number of hours a week. it is                                    however, do not receive support. Many are on waiting
                                                                                   lists. one finding in our studies was that families
      clear that families in Maine need afford-                                    receiving subsidies felt they did have good choices of
                                                                                   child care available to them, which was similar to the
      able, high-quality child care services.                                      responses of higher-income parents. However, more
                                                                                   than a quarter of parents living in rural Maine reported
                                                                                   not having good choices for quality care. low-income
                                                                                   families not receiving subsidies are the most likely to
                              Getting Started with a                               use relatives and friends as caregivers, settings that are
                          Quality Rating System in Maine                           the least likely to have a school readiness curriculum.
                     The QRS began with enrollments in March of                          in addition, the overall quality of child care
                008, and as of april 009 there were 401 center-based             settings is in question, as Maine studies echo many
                and family child care home settings enrolled. This                 national studies and indicate that more than a third of
                represents approximately 16 percent of all licensed                the licensed settings are rated as less than good quality.
                child care settings in Maine. The majority of these                Using the most recent estimates, this may mean that
                settings (60 percent) is self-rated at a step two or lower.        more than 9,000 Maine children from birth to age five
                as mentioned earlier, all settings receiving government            are served in low-quality settings.
                subsidy, approximately 780 settings statewide, will have                 The Quality for Me program provides parents
                to enroll by october of 009.                                      four tiers of quality rankings of participating child care
                                                                                   facilities. it is hoped that the new required participa-
                 DiScUSSion anD iMPlicaTionS FoR Policy                            tion of settings that receive government subsidy money
                                                                                   will encourage other centers to participate. The ranking

                a    ccording to Maine State Planning office estimates,
                     there are 68,944 children from birth to age four
                in 008, and that number is expected to increase by
                                                                                   scheme was thoughtfully created, based on careful
                                                                                   research gathered from both parents and caregivers.
                                                                                   Built into the system are limited financial incentives
                about 0.4 percent to 69,8 by 01. Based on the                  for providers who are serving children with government
                only scientifically designed household telephone survey            subsidies. in addition, parents whose children are
                conducted, the results of which are now more than five             served in the step four highest-quality settings are
                years old, the majority of families report using some              eligible to claim a deduction in their taxes. However,
                type of child care, many for a substantial number of               these incentives are minimal at best considering the
                hours a week. it is clear that families in Maine need              various structural barriers child care providers face in
                affordable, high-quality child care services. estimates            trying to improve the quality of the care.
                from Schilder and Digital River, inc., (006) indicate                   we hope that this article also illustrates the need
                that there will need to be an additional 6,95 slots               for better information about this important aspect of

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                                                                                                        woRKinG PaRenTS anD cHilD caRe

public policy for Maine families. The household survey
information discussed here is more than five years old,
and not enough is known about the experiences of                  RefeRences
families seeking and/or using government subsidies for            burchinal, Margaret, kirsten kainz, karen Cai,
child care. in 008, more than $4 million taxpayer                  kathryn tout, ivelisse Martinez-beck and Colleen
dollars were spent in direct support of child care                   rathgeb. 2009. early Care and education Quality
services. as recommended by the national early                       and Child outcomes. Publication no. 2009-15,
                                                                     oPre research-to-Policy brief no. 1. Childtrends,
childhood accountability Task Force (007), invest-
                                                                     Washington, dC.
ments are needed to support state level data infrastruc-
ture that moves decision-making from best guesses to              Ceglowski, deborah. 2004. “how stake holder groups
                                                                     define Quality in Child Care.” early Childhood
policies founded on solid evidence. Parents and citizens             educational Journal 32(2): 101–111.
deserve rich and continually updated information on
                                                                  Connelly, rachel and Michel lahti. 2006. “a Portrait of
the status of young children and early learning
                                                                     Child Care Choice for Maine Families with Children
programs.                                                            under the age of Five.” Working Paper, Feb. 2006.
     enhancing the quality of child care settings that     
serve Maine’s working families is a critical policy                  maineccarrangements.pdf [accessed august 31,
concern. Getting more accurate and timely information                2009]
about this aspect of Maine’s social services and                  Connors, dana F. 2009. “investing in Maine’s youngest
economic sector is necessary for informed decision                   Children has great returns for business.” Maine
making. Maine’s working parents who need affordable,                 Policy review 18(1): 26–29.
high-quality services deserve no less.                           dellaMattera, Julie. 2009. “the early Childhood
                                                                      Workforce.” Maine Policy review 18(1): 106–115.
                                                                  lahti Michel, rachel Connelly, alex hildebrand, sue
AcknOWLeDGMenTs                                                      ebersten and guinevere twitchell. 2006. “a Focus
                                                                     on the Quality of Child Care settings,” Working
  AcknOWLeDGMenTs                                                    Paper, Feb. 2006,
  support for this research was provided to the authors              connelly/pdf/maineccquality.pdf [accessed august
  through the state of Maine department of health and                31, 2009]
  human services, division of early Care and education.           Maine Child Care advisory Council. 2007. Child Care
  special thanks to Carolyn drugge, whose leadership                 in Maine. a report to the 123rd Maine legislature.
  and dedication made this work possible.                            Maine Child Care advisory Council, augusta. http://
                                                                     advisorycouncilreporttolegislature.pdf [accessed
                                                                     august 30, 2009]
  1. For the full report of findings from the parent child
                                                                  Marshall, nancy l., Cindy l. Creps, nancy burstein,
     care services survey, see Connelly and lahti (2006);
                                                                     Joanne e. roberts, Julie dennehy, Wendy W.
     the research done to assist in the development of
                                                                     robeson and Frederic b. glantz. 2004a. the Cost
     the Maine quality rating system is found in lahti et
                                                                     and Quality of Full day, year-round early Care
     al. (2006).
                                                                     and education in Maine: Preschool Classrooms.
  2. it should be noted that the families in the niChd               Wellesley Centers for Women, Muskie school
     study selected the type of care in which they placed            of the university of southern Maine, and abt
     their children. as the study was designed, any                  associates, inc.
     differences in child outcomes could be the result of
                                                                  Marshall, nancy l., Cindy l Creps, nancy r. burstein,
     the different child care experienced by children
                                                                     betsy squib, Joanne roberts, Julie dennehy,
     or the result of the children’s differing family back-
                                                                     Wendy W. robeson and sue y. Wang. 2004b. the
     grounds. the niChd researchers address the issue
                                                                     Cost and Quality of Family Child Care homes in
     of selection with complex statistical techniques,
                                                                     Maine. Wellesley Centers for Women, university of
     but these techniques can only go so far toward
                                                                     Maine, Farmington, and abt associates, inc.
     handling the problem.
                                                                                       Please turn the page for more article references & author bios.

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woRKinG PaRenTS anD cHilD caRe

                                                                                                                 Rachel connelly is the
                                                                                                                 bion r. Cram Professor
                  McCartney, kathleen, eric dearing, beck a. taylor
                    and kristen l bub. 2007. “Quality of Child Care                                             of economics at bowdoin
                    supports the achievement of low-income                                                       College. she has published
                    Children: direct and indirect Pathways through
                                                                                                                 widely on the economics of
                    Caregiving and home environment.” Journal of
                    applied developmental Psychology 28:411–426.                                                 child care, modeling both
                  national early Childhood education task Force. 2007.                                           the demand and supply
                     taking stock: assessing and improving early                                                 side of the child care market.
                     Childhood learning and Program Quality. Per
                     Charitable trusts, Philadelphia.
                                                                                                                 she is the author, along with
                                                                                  deborah degraff and rachel Willis, of Kids at Work: The
                  national instititute of Child health and development
                     (niChd) early Child Care research network. 2005.             Value of Employer-Sponsored On-Site Child Care Centers
                     Child Care and Child development. the guilford               (2004, W. e. upjohn institute for employment research).
                     Press, new york.
                  schilder, diane and digital research, inc. 2006. Maine
                     Child Care Workforce Climate report and Market                                              Georgia n. nigro is
                     rate analysis. report to early Care and education
                     unit, Maine department of health and human                                                  professor of psychology at
                     services, augusta.                                                                          bates College, where she
                  trostel, Philip. 2009. “the dynamics of investments in                                         teaches courses in devel-
                     young Children.” Maine Policy review 18(1): 18–25.
                                                                                                                opmental psychology and
                  u.s. department of health and human services (u.s.                                             community-based research
                     dhhs). 2007. Child Care bulletin 32. u.s. dhhs,
                     Child Care bureau, Washington, dC. http://www.                                              methods. she is a member
            [accessed august 30,                                             of Maine’s infant toddler
                                                                                                                 initiative team.

                                               Michel Lahti is a research                                        Rebecca fraser-Thill served
                                               faculty member at the                                             for six years as a lecturer in
                                               university of southern                                            psychology at bates College.
                                               Maine. he is a principal                                          she is the co-author of
                                               investigator on the evalu-                                        the forthcoming textbook
                                               ation of Maine’s child care                                      Visualizing the Lifespan
                                               Quality rating system and                                        (2010, Wiley) and was a
                                               teaches in the Public Policy                                      member of the workgroup
                                               and Management graduate                                           that drafted Supporting
                Program, Muskie school of Public service.                         Maine’s Infants and Toddlers: Guidelines for Learning and
                                                                                  Development, a companion to Maine’s Early Childhood
                                                                                  Learning Guidelines.

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eaRly cHilDHooD woRKFoRce

                                The early
                               childhood                                    Julie DellaMattera describes how the strongest predic-

                               workforce                                    tors of high-quality care and early education are the

                                                                            educational preparation of early educators, their

                                               by Julie dellaMattera        continued training, compensation, and recognition

                                                                            of their professionalism. She presents information on

                                                                            the current patterns of educational preparation and

                                                                            poor compensation of early educators and offers

                                                                            recommendations to improve training and compen-

                                                                            sation. DellaMattera notes the need to also change

                                                                            public perceptions of those who work in the field of

                                                                            early care and education so that they are respected for

                                                                            their specialized knowledge.    

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                                                                                                        eaRly cHilDHooD woRKFoRce

           eaRly caRe anD eDUcaTion                             dren between the ages of birth
               acRoSS THe naTion                                and five in the U.S. (U.S. census           needs to be done
                                                                Bureau 008). across the nation,
                                                                                                            to entice quali-
T     here is growing public awareness of how quality
      early childhood experiences influence later success
in education, employment, citizenship, and personal
                                                                approximately 55 percent of chil-
                                                                dren under three, 68 percent of
                                                                three-year-olds, 78 percent of              fied early care and
satisfaction. President Barack obama is proposing to            four-year-olds, and 84 percent of
spend $10 billion on preschool programs to help states          five-year-olds are enrolled in some         education profes-
to provide voluntary, universal preschool for all chil-         type of early care and education
dren. He also plans to increase spending for Head Start         program on a regular basis, which           sionals to enter and
and quadruple support for early Head Start.                     translates to more than 1 million
      children who have high-quality early care and             children ( 009;              stay in the field.
education experiences are nearly 0 percent more likely         Johnson 005). This current
to graduate from high school, about 40 percent less             preschool population is the most
likely to repeat a grade, and  percent less likely to be      culturally diverse age group in
arrested as juveniles. every $1 invested in high-quality        our country and includes an increasing number of chil-
early childhood programming produces $7 to $16 in               dren with developmental delays, disabilities, and english
savings for local and national governments, mostly              language learners (lee and Burkam 00.)
from avoiding special education and welfare costs later              Government economists are projecting that jobs
in life (Schweinhart et. al. 005). (See Trostel this issue,    for early care and education professionals will grow
for further discussion of the economics of “investing           much faster than the average for all careers (U.S.
early.”) young children exposed to high-quality settings        Bureau of labor Statistics 008a). To best serve this
with educated and knowledgeable staff exhibit better            rapidly growing and diverse population, early child-
language and mathematics skills, better cognitive and           hood professionals must have a solid knowledge base
social skills, better relationships with classmates, and        of appropriate early childhood development, teaching
fewer behavioral problems, all of which have lasting            methods, and an understanding of a wide variety of
effects into adulthood (Kauerz 001).                           cultural norms. Further, something needs to be done
      currently, there are about .5 million people             to entice qualified early care and education profes-
working in early care and education programs across             sionals to enter and stay in the field.
the country and of these, 97 percent are women.
center-based early care and education programs                       eaRly caRe anD eDUcaTion in Maine
employ about 90,000 workers; 75,000 people are
self-employed early care and education professionals,
and an additional 15,000 work in other types of early
care and education programs. about 41,000 early care
                                                                T    here are approximately 70,700 preschool-age
                                                                     children (birth to age five) living in Maine,
                                                                approximately 5.4 percent of Maine’s population
and education professionals are working specifically in         (Governor’s economic Summit 007). More than
preschool programs with three- to five-year-olds                48,000 preschool-age children in Maine have parents
(Herzenberg, Price and Bradley 005). additionally,             who work. Quality early care and education services
there are hundreds of thousands of specialists and ther-        are essential for these working parents. There are about
apists who work with young children and their fami-             51,600 licensed early care and education spots. These
lies, offering counseling, developmental therapies,             numbers may suggest that early care and education
health and wellness assistance, and dozens of other             needs are being met across the state. These numbers
early childhood support services.                               are deceiving, however, because it is not only parents of
      ensuring that young children have quality early           preschool-age children who need child care. currently
childhood experiences has become a priority of U.S.             there are an additional 9,000 children ages six to
society. There are nearly 1 million preschool-age chil-        1 who also need care while their parents work. That

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TABLE 1:   Children in licensed early Care and education

                   early Care
                                         early education Programs
                   Programs                                                        physically and emotionally healthy, have higher self-
                Center-   home-       Public school- nursery        head           esteem, and achieve higher levels of academic and social
                based     based        based Pre-k   school         start          success. in a profession where people work long hours,
 number of                                                                         make little money, have minimal or no health benefits,
 licensed        778       1,830           125              212      208           and suffer from a lack of recognition, how can we
 programs                                                                          assure that all of Maine’s preschool-age children receive
 number of                                                                         a quality early care and education experience?
 children       22,300    19,600          2,100         3,900       4,000                lahti et al. (this issue) discuss in detail what
 served                                                                            research has to say about the quality of child care, and
 number                                                                            they describe a new Maine effort to improve quality in
                                140,000 (birth to age 12)
 needing care                                                                      licensed child care settings. This article focuses on the
                                                                                   critical component of the child care workforce. The
                                                                                   strongest predictors of high-quality early care and
                                                                                   education programming are the educational prepara-
                                                                                   tion of the early educators, continued training,
                means that there is a total of 140,000 children birth to           compensation, and recognition of professionalism and
                age 1 vying for 51,600 licensed early care and educa-             quality in the early care and education field. Better-
                tion spots (see Table 1) (Maine child care advisory                educated early care and education professionals are
                council 007).                                                     more responsive, positive, and sensitive to individual
                     Maine’s licensed early care and education accounts            needs; they offer richer language and cognitive experi-
                for only one-third of all child care needed. The                   ences, and are less punitive and more egalitarian with
                remaining two-thirds of all children are in unregulated            children (early et al. 006).
                care. State numbers reveal that about  percent of the
                children are taken care of by another family member                 eDUcaTional PRePaRaTion FoR eaRly caRe
                such as a grandparent or aunt, or by a family friend,                   anD eDUcaTion PRoFeSSionalS
                what is known in the field as “family friend and
                neighbor” care. an additional 44 percent of Maine’s
                children are being cared for by ever-changing babysitters
                and nannies, older siblings, illegal early care and educa-
                                                                                   T     he defining feature of a profession is the existence
                                                                                         of a common core of knowledge. in the U.S.,
                                                                                   early care and education professionals do not share
                tion providers who have not passed basic state require-            this common core of knowledge. The recent federal
                ments, or perhaps they are receiving no care at all.               legislation set forth in No Child Left Behind calls
                     while some of Maine’s largest industries are                  for “highly qualified” teachers. The eager to learn
                having trouble finding skilled workers, lack of acces-             committee defines a highly qualified early care and
                sible and affordable early care and education programs             education professional as someone with a four-year
                for their children creates an obstacle for people hoping           bachelor’s degree and specialized education in early
                to enter the state’s workforce. women, in particular,              childhood. Recent reports found that less than half of
                find it difficult to get the occupational training and             early educators have a four-year degree and, of those
                education they need to join the workforce. Many                    professionals with a four-year degree, less than half
                mothers are forced to make less than optimal career                have a four-year degree specifically in early childhood
                choices because they cannot find care for their children.          development (Mims et al. 008). Recent policies on
                     we know who Maine’s youngest children are and                 improving school readiness cite studies showing that
                we know where they are, or are not, being cared for.               quality early care and education is strongly influenced
                But who is caring for and educating Maine’s preschool-             by the educational level of the early educator. yet, 0
                age children? children who have high-quality early                 states have no educational requirements for beginning
                care and education experiences are more likely to be               professionals in early care and education programs.

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in most states a high school diploma and little or no           while those hired earlier with high school degrees are
experience is sufficient for many early care and educa-         “grandfathered.” This program offers information and
tion jobs (Barnett et al. 008).                                support to first-time parents of all ages and income
      if universal public preschool were made available to      levels anywhere in the state. other state-supported
all ,610,000 four-year-olds currently living in the U.S.,      agencies, such as child Development Service (cDS)
we would need more than 00,500 early educators with            and the Department of Health and Human Services
four-year degrees in early childhood. estimates put the         (DHHS), have various educational requirements
number of highly qualified early care and education             depending on the specific job. case managers and
professionals currently working in preschool classrooms         educational technicians may need as little as a high
at about 7,780. This number is far from the hundreds           school diploma and training; social workers and child
of thousands that will be needed to offer quality               protective workers need a minimum of a bachelor’s
preschool programming for all four-year-olds.                   degree; therapists need a degree and specific Maine
      in Maine, as in other states, educational require-        licensure; and mental health counselors are required
ments for early care and education professionals vary           to have a master’s degree.
widely depending on the job. in private early care and                These varied educational requirements have
education programs, where young children can spend              implications for early care and education professionals,
up to 50 hours per week, state licensing requirements           programs, and more importantly, for Maine’s preschool-
demand only a high school diploma. one-half of all              age children. a select number of early care and educa-
center-based early educators have only a high school            tion professionals are required to meet high educational
diploma and only one-third have a bachelor’s degree.            standards, but this requirement is for the minority of
in home-based programs approximately two-thirds                 early care and education professionals and therefore has
of early educators have only a high school diploma              an impact on only a select group of preschool-age chil-
and a little over one-tenth have a bachelor’s degree            dren. Prior to kindergarten, where educators must have
(Governor’s economic Summit 007). Further, bache-              a minimum of a four-year college degree in education,
lor’s degrees are not necessarily in education or even a        early educators are typically far less prepared, with
related early childhood field.                                  fewer than half having a bachelor’s degree. However,
      interestingly, in public early care and education         despite the considerable research evidence (e.g., early
programs such as school-based pre-K programs and                et al. 006), public policy has yet to fully acknowledge
kindergartens, early educators are required to hold a           the value of well-educated, professional early educators.
bachelor’s degree and certifications or licenses specific       if a four-year degree is the standard for a highly quali-
to their field. For example, in school-based pre-K              fied early educator, then here in Maine we have a long
programs, early educators must have a bachelor’s degree         way yet to go before all children in early care and
in early childhood, a state of Maine teaching certificate,      education programs have highly qualified teachers.
and an additional early childhood teacher endorsement,
the endorsement 081.                                                    coMMon coRe oF KnowleDGe:
      in addition, Maine has numerous statewide early                    eaRly caRe anD eDUcaTional
care and education programs designed to provide                             PRoFeSSional TRaininG
support services to young children and their families.
educational requirements for these professional posi-
tions vary, but many require only a high school diploma
(see Table , page 110). one such program, the Maine
                                                                T    he state of Maine, in an effort to improve early
                                                                     care and education experiences for young chil-
                                                                dren, has invested much money and time in creating a
Home visiting Program, serves approximately 5,000               comprehensive statewide system. This system addresses
families and until 007 required only a high school             the important process of creating a common core of
diploma and training. newly hired home visitors since           knowledge for all of Maine’s early care and education
007 are now required to have a bachelor’s degree,              professionals and offers cohesive early childhood

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TABLE 2:    Who is Working with Maine’s Youngest Children?

                                                                   number        starting
                            Job title                                of        annual Mean           Minimum educational requirement
                                                                   Workers        Wage
 early care and education
 early educator: home-based                                         1,830          $15,700      high school diploma
 early educator: Center-based, nursery schools and head
                                                                    9,570          $16,075      high school diploma
 start Programs
 Public schools
 teacher assistants and Classroom ed techs
                                                                    8,510          $20,630      high school diploma
 in Public schools
                                                                                                bachelor’s degree, teaching certificate, and
 Public Pre-k teachers,                                               125          $32,350
                                                                                                endorsement 081
 kindergarten teachers                                                940          $32,350      bachelor’s degree and teaching certificate
 Professions supporting early childhood Development
 social and human service assistants (i.e., case manage-
 ment aide, social work assistant, mental health aide,
                                                                    4,800          $18,200      high school diploma
 community outreach worker, home visitor [hired pre-
 2007], life skills counselor, or gerontology aide)

 Child, Family, and school social Workers (i.e., child
 welfare worker, family services, child protective services,       17,480          $25,650      bachelor’s degree and appropriate licensure
 occupational social worker, or gerontology social worker)
 Mental health Counselors                                             850          $26,690      Master’s degree and appropriate licensure

source: u.s. bureau of labor statistics 2008b.

                    guidelines, training opportunities, and specialized                Services 005). The 006 infant and toddler guidelines,
                    credentials. These statewide opportunities have been               Supporting Maine’s Infants & Toddlers, was designed
                    put in place by various agencies such as the Muskie                to help individuals understand what to look for as a baby
                    School at the University of Southern Maine, Maine                  grows and develops and how natural learning can take
                    Department of Health and Human Services (DHHS),                    place during everyday activities in homes or early care and
                    and the office of child care and Head Start to                     education settings (Maine Department of Health and
                    support early care and education professionals as they             Human Services 006). Both of these guidelines offer
                    advance along a career path.                                       suggestions for parents, early educators, and other child
                          in the last four years, the state of Maine has created       development professionals on ways to interact with young
                    two sets of guidelines to improve early care and education         children, organize their environment so it supports
                    practice and enrich programs for preschool-age children,           learning, and respond to individual differences.
                    birth through their entrance into kindergarten. The                     To help early educators to better use the Maine
                    Maine Early Childhood Learning Guidelines, created                 guidelines and support preschool-age children’s
                    in 005, are intended to result in greater collaboration           learning, Maine has yearly minimal training require-
                    and consistency across systems by aligning practice across         ments for all people working in early care and educa-
                    all early care and education settings and the early grades         tion programs. Both center-based and nursery school
                    of public education (Maine Department of education                 early educators must have 0 hours of annual training;
                    and the Maine Department of Health and Human                       home-based early educators must have 1 hours;

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and Head Start early educators must have at least 15.           who complete specialized training that supports the
Public pre-K and kindergarten teachers must meet                development of children under the age of three. at
Department of education recertification requirements.           the press conference announcing the new initiative,
      To help address the annual training needs of early        attorney General Rowe pointed out that 85 percent
care and education professionals, the Muskie School,            of brain development happens in the first three years.
in collaboration with the office of child and Family            Rowe said, “This new credential serves as a seal of
Services and Maine DHHS, created a 180-hour state-              approval of sorts. it tells parents that their providers
wide training program: Maine Roads to Quality                   have taken that extra step by completing formalized
(MRTQ). MRTQ is designed to promote and support                 education, based on best-practices in education and
professionalism in the early care and education field           child care today” (
and to advance the quality of early care and education.
This core knowledge training can be used to meet                     coMPenSaTion oF eaRly cHilDHooD
national child Development associate (cDa) require-                     eDUcaTion PRoFeSSionalS:
ments, articulate into an associate’s degree program,                    TRyinG To MaKe a livinG
renew state licensing, or for ongoing professional
development training. another, more advanced training
program, is offered by the University of Maine’s center
for community inclusion and Disability Studies
                                                                e    arly care and education is the fourth largest
                                                                     industry in Maine, generating $180.6 million
                                                                annually (Governor’s economic Summit 007).
and college of education and Human Development                  approximately 44,000 people are employed in jobs
in collaboration with the Maine Department of                   that support Maine’s youngest children: 1,000 in early
education. This graduate study, Training opportunities          care, 9,500 in public schools, and ,000 in profes-
for Personnel (ToP): Birth to Five, offers flexible             sions that support childhood development. There are
training opportunities and emphasizes interdisciplinary,        a wide variety of early care and education careers, each
inclusive, family-centered, culturally competent                with different education preparation and continuing
approaches, and developmentally-appropriate and                 training requirements, and with an even wider range
evidence-based practices.                                       of possible salaries.
      in addition to supporting early educators, the                  Research clearly documents the correlation
state has tried to address the needs of parents, public         between recruitment and retention of well-qualified
schools, and community members by creating several              early care and education professionals and adequate
new specialized credentials. These credentials will help        compensation. Professionals who are more satisfacto-
to ensure that early educators have specialized training        rily compensated in terms of pay, benefits, and
specific to the developmental levels of the children with       working conditions are more likely to stay in their jobs
whom they work. The first credential, the endorsement           and to provide higher quality educational experiences
081: early childhood Teacher (Birth to School age),             for young children. additionally, poor pay and little or
is for pre-K educators. endorsement 081 is intended             no benefits make it difficult to hire and recruit highly
to support appropriate early education learning experi-         qualified early educators (whitebook et al. 001).
ences by ensuring that all educators working in public                Jobs supporting early childhood development are
school pre-K programs have specialized knowledge                varied. However, the one thing all early care and educa-
of early childhood development. in 011, all public             tion jobs have in common is relatively low pay. in 004,
school pre-K programs will be required to have a lead           the median hourly earning of an early care and education
teacher who has both a valid Maine state teaching               educator was a dismal $7.90, with the lowest 10 percent
certificate and the new endorsement 081.                        earning less than $5.90, and the highest 10 percent
      in January 008 another state credential was              earning more than $1.4. Preschool teachers were aver-
unveiled, the Maine infant Toddler credential. This             aging $9.5 per hour (U.S. Bureau of labor Statistics
credential, earned through the MRTQ professional                008c). cashiers at Starbucks make more money than
development system, will be awarded to early educators          many early care and education professionals.

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                     in Maine, the highest paying jobs are in manage-                    RecoGniTion oF eaRly caRe
                ment, averaging more than $79,000 annually. The food                    anD eDUcaTion PRoFeSSionalS
                preparation and serving-related occupations group                           FoR a JoB well Done
                was the lowest paid, with an average annual salary of
                $0,700 (U.S. Bureau of labor Statistics 008b). The
                average center-based early educator makes $18,860
                per year (Governor’s economic Summit 007). Home-
                                                                                e    arly care and education professionals often get started
                                                                                     in the field when they have their own children and
                                                                                are either unable to find quality care or unable to afford
                based early educators make about $4,00 annually.              early care. Further, as there are little to no educational
                However, after subtracting the estimated cost of using          requirements to enter many of these jobs, early educators
                their home and out-of-pocket expenses such as food,             often have no more than a high school diploma. it is no
                toys, materials, equipment, and household supplies, the         wonder, therefore, that public perception is that anyone
                annual salary for home-based early educators is closer          who has raised children is adequately qualified to care
                to $15,700 per year (Marshall et al. 004). For kinder-         for and educate groups of young children. Both those
                garten teachers, the mean salary in Maine is $44,90            working in the profession and many of those who create
                with a range of $9,000 to $59,000 depending upon               regulations governing the profession support this myth.
                location, educational level, and years in the field.            This view that parental knowledge is enough is a major
                Mental health counselors, with a required master’s              barrier to overcome.
                degree, make between $6,600 and $59,00 annually                     at the national level, two early childhood organiza-
                (see Table , page 110).                                        tions are honoring the hard work and dedication to
                                                                                quality that is needed to ensure that preschool-age
                                                                                children are receiving quality early childhood experi-
    …low pay, high staff turnover, and a dead-                                  ences. Both the national association of Family child
                                                                                care (naFcc) and the national association for the
    end career path are what most early care                                    education of young children (naeyc) award program
                                                                                accreditation to early care and education programs that
    and education professionals face.                                           complete an extensive and comprehensive self-study.
                                                                                Maine has only 49 naFcc-accredited home-based
                                                                                facilities and 76 naeyc-accredited center-based early
                      as a workforce, early educators’ wages rank 596           care and education programs, or a total of 15 programs.
                out of a list of 647 for occupations. early educators                 The state of Maine, in an effort to evaluate and
                in Maine make less than manicurists and dog trainers            recognize quality early care and education programming
                (Governor’s economic Summit 007). These low wages              has created several quality rating systems. The data gath-
                contribute to high turnover rates, which can impede             ered by these rating systems may be used by parents to
                educational effectiveness and waste resources spent on          help them choose quality early care and education
                early education preparation and continuing education.           programs. one quality rating system, the voluntary
                Recent studies place the national annual turnover rate          Quality for Me (QRS) rating scale, is a tiered rating scale
                for preschool teachers at 0 percent, compared to 16            intended to increase awareness of the basic standards of
                percent for parking lot attendants. Turnover in early care      early care and education, to recognize early educators who
                and education programs is second only to the turnover           provide quality care, and to educate the community about
                rate in the fast food industry (Jacobson 005). in Maine        the benefits of higher-quality care. additionally, early care
                nearly half of home-based early educators have been             and education programs that receive a top-level rating are
                licensed for less than five years (Marshall et al. 004).       eligible for a higher percentage of state voucher reimburse-
                This constant shifting of early educators disadvantages         ment money (see lahti et al. this issue, for further discus-
                preschool-age children by making it difficult for them          sion of the QRS).
                to form attachments and feel comfortable taking the                   The second quality rating system is a Quality
                risks necessary to grow.                                        certificate awarded by the office of child care and

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Head Start to early care and education programs that            there is already a deficit in available early care and then
meet state-approved quality criteria. The Maine legisla-        argue that increasing educational requirements would
ture passed a law that allows Maine taxpayers who               further tax an already under staffed field.
enroll their children in a child care center or home                  Second, we must recognize that one of the most
with a Quality certificate to receive a double child            effective ways of ensuring high-quality early care and
care tax credit on their state income tax return. The           education experiences for young children and their
new law may result in a tax refund of up to $500.               families is to provide high-quality training programs
     additionally, MRTQ has created a career lattice            and ongoing opportunities for personal and profes-
and registry, a system that tracks employment, educa-           sional development for those involved in the early care
tion, and training. The registry uses work and training         and education field. in any profession, when one feels
histories to assign a level, one to eight, on the appro-        bored, overloaded, or unappreciated, burnout can
priate career lattice. This allows early educators to track     result. Burnout reduces productivity and is the leading
ongoing training and educational accomplishments.               cause of turnover in the field of early care and educa-
     Unfortunately, 67 percent of Maine’s home-based            tion (Decker, Bailey and westergaard 00). For more
and  percent of center-based early care and education         than 10 years in Maine the Muskie School has designed
programs have no quality determination. currently,              and delivered a variety of training opportunities for
only about 15 early care and education programs                early educators. However, many early educators are still
would qualify for the highest rating level on the QRS           not taking advantage of the training they need to keep
scale and only 6,400 children attend early care and             them updated and rejuvenated. new training delivery
education programs with a Quality certificate. Studies          systems must be designed: more on-line courses, more
have shown that 70 percent of Maine preschool class-            self-studies, more face-to-face locations. and, as with
rooms were rated “less than good” and 70 percent of             educational requirements, yearly training requirements
home-based programs failed to meet minimal bench-               should be increased.
marks in basic care, such as always washing their                     Third, early educators must be compensated; their
hands after diapering or toileting a child (Governor’s          pay should reflect the vital and complex work that they
economic Summit 007).                                          do. a new kindergarten teacher, working 10 months,
                                                                makes almost double what a new center-based early
                     DiScUSSion                                 educator makes working for a full year. and, most early
                                                                educators not working in a public school system have

T     he most effective predictors of high-quality early
      care and education programming are the prepara-
tion and compensation of early care and education
                                                                no benefits. Unfortunately, in Maine and across the
                                                                nation, low pay, high staff turnover, and a dead-end
                                                                career path are what most early care and education
professionals and their responsiveness and sensitivity          professionals face. Discouraged and disheartened early
to the children they support. To assure that all chil-          educators are not going to be performing at their best,
dren can receive a quality experience, we need to find          and young children will pay the price in apathetic
ways to encourage more highly qualified people to               teaching. we stand to lose far more in educational
enter the field, and we need to find ways to support            benefits than we save by underpaying early educators.
those already in the field to increase retention. To do               one way to perhaps increase early educators’
this, we must first increase the minimum educational            wages is to unionize the field of early care and educa-
requirements for all early care and education profes-           tion. in 007, following a statewide vote of 790 in
sionals. early childhood is an amazing time of growth           favor to 15 opposed, nearly ,00 home-based early
and development and early educators with specialized            care and education professionals decided to pursue
education create high-quality environments that engage          their case for joining the Maine State employees
young children in the learning process. in Maine, as            association. The reasons for unionizing are clear: to
in other states, an increase in educational requirements        have more influence in the regulatory process, to have
has been slow to materialize. States often point out that       a greater say in rules, regulations and training, and to

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eaRly cHilDHooD woRKFoRce

                obtain better health and liability insurance. Until this
                time, early educators have had little to no say in their
                highly regulated privately run businesses.                           early, diane, donna bryant, robert Pianta, richard
                     Finally, early care and education must be acknowl-                  Clifford, Margaret burchinal, sharon ritchie,
                                                                                         Carollee howes and oscar barbarin. 2006. “are
                edged as an important profession, a profession that is                   teachers’ education, Major, and Credentials related
                making a vital contribution to our nation’s future. only                 to Classroom Quality and Children’s academic
                then will the professionals who work in early care and                   gains in Pre-kindergarten?” early Childhood
                education get the support, recognition, and pay that                     research Quarterly 21:174–195.
                they deserve. we need to change the public perception                governor’s economic summit on early Childhood.
                of those who work in the field of early care and educa-                 2007. economics of early Care and education in
                tion. The current view that “anyone can do that” must                   Maine. governor’s economic summit on early
                                                                                        Childhood, augusta, Me.
                be replaced; those working with young children need
                to be respected as professionals with specific and                   herzenberg, stephen, Mark Price and david bradley.
                specialized knowledge.                                                  2005. losing ground in early Childhood education:
                                                                                        declining Workforce Qualifications in an expanding
                     Maine is working hard to address and respond to                    industry, 1979–2004. economic Policy institute,
                each of these issues. There are numerous new initia-                    Washington, dC.
                tives, and many early educators are still trying to figure              entry/study_ece_summary/ [accessed July 20,
                out how to make the best use of all that Maine has                      2009]
                to offer. with early care and education professionals,               Jacobson, linda. 2005. “More governors Want to
                experts in child development, and state agencies and                    rate early-Childhood Programs.” education Week
                organizations working together, we can make the                         24(17).
                                                                                        09/22rating.h24.html [accessed July 15, 2009]
                changes that will support Maine’s youngest children
                and ensure that they all have access to exceptional early            Johnson, Julia. 2005. Who’s Minding the kids? Child
                care and education experiences.                                        Care arrangements: Winter 2002. u.s. department
                                                                                        of Commerce, economics and statistics
                                                                                        administration, Washington, dC. http://www.
                                                                              –101.pdf [accessed
                                                                                        July 20, 2009]
                                                                                     kauerz, kristie. 2001. starting early, starting now: a
                                                                                        Policymakers guide to early Care and education
                  barnett, William s., Jason hustedt, allison Friedman,                 and school success. education Commission of the
                     Judi boyd and dale epstein. 2008. the state                        states, denver.
                     of Preschool: 2008 state Preschool yearbook.
                                                                                     lahti, Michel, rachel Connelly, georgia n. nigro and
                     national institute of early education research,
                                                                                        rebecca Fraser-thill. 2009. “Working Parents and
                     rutgers university, new brunswick, nJ. http://nieer.
                                                                                        Child Care: Charting a new Course for Quality.”
                     org/yearbook/pdf/yearbook.pdf [accessed July 15,
                                                                                        Maine Policy review 18(1): 94–104.
                                                                                     lee, valerie and david burkam. 2002. inequality at the
         Forum on Child and Family statistics.
                                                                                        starting gate: social background differences in
                      2009. america’s Children: key national indicators
                                                                                        achievement as Children begin school. economic
                      of Well-being, 2009.
                                                                                        Policy institute, Washington, dC.
                      americaschildren/famsoc3.asp [accessed July 15,
                      2009]                                                          Maine department of education and the Maine
                                                                                        department of health and human services. 2005.
                  decker, James, tammy lynn bailey and nikki
                                                                                        Maine early Childhood learning guidelines. Maine
                     Westergaard. 2002. “burnout among Childcare
                                                                                        doe and dhhs, augusta.
                     Workers.” residential treatment for Children &
                     youth 19(4): 61–77.

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  Maine department of health and human services.                   u.s. bureau of labor statistics. 2008c. state
     2006. supporting Maine’s infants & toddlers:                     occupational employment and Wages, May
     guidelines for learning & development. Maine                     2008: 39-9011 Child Care Workers. division of
     dhhs, augusta.                                                   occupational employment statistics, Washington,
  Maine Child Care advisory Council. 2007. early Care
                                                                      [accessed July 15, 2009]
     and education in Maine, 2007 and beyond. report
     to the 123rd Maine legislature, augusta. http://              Whitebook, Marcy, laura sakai, edna gerber and                    Carollee howes. 2001. then & now: Changes in
     hood_education.pdf [accessed July 3, 2009]                      Child Care staffing, 1994–2000. Center for the Child
                                                                     Care Workforce, Washington, dC.
  Marshall, nancy, Cindy Creps, nancy burstein, betsy
     squibb, Joanne roberts, Julie dennehy, Wendy
     robeson and sue Wang. 2004. the Cost and
     Quality of Family Child Care homes in Maine. a
     report on the Findings from the Maine Cost and
     Quality study, Maine office of Child Care and head                                        Julie DellaMattera is a
     start, augusta.
                                                                                               professor of early childhood
  Mims, sharon, Catherine scott-little, Joanna lower,                                          education at the university
     deborah Cassidy and linda hestenes. 2008.
     “education level and stability as it relates to                                           of Maine in the College
     early Childhood Classroom Quality: a survey of                                            of education and human
     early Childhood Program directors and teachers”
                                                                                               development. she is a former
     Journal of research in Childhood education 23(2):
     227–237.                                                                                  preschool owner, educa-
  saluja, gitanjali, diane early and richard Clifford. 2001.                                   tion specialist, and a trainer
     “Public school Pre-kindergarten: does it Make a                                           for Maine roads to Quality.
     difference?” Principal 80(5): 18–21.
                                                                her research focus is the underlying views of preschoolers’
  schweinhart, lawrence, Jeanne Montie, Zongping
                                                                cognitive development found in current standards-based
     Xiang, William s. barnett, Clive belfield and
     Milagros nores. 2005. lifetime effects: the high/          preschool polices and the influence these policies and stan-
     scope Perry Preschool study through age 40.                dards may have on educators’ teaching practices.
     high/scope Press, yipsilanti, Mi.
  trostel, Philip. 2009. “the dynamics of investments in
     young Children.” Maine Policy review 18(1): 18–25.
  u.s. Census bureau. 2008. state and County Quick
     html [accessed July 15, 2009]
  u.s. bureau of labor statistics. 2008a. occupational
     outlook handbook, 2008-09 edition. office
     of occupational statistics and employment
     Projections, Washington, dC.
     oco/ [accessed July 15, 2009]
  u.s. bureau of labor statistics. 2008b. May 2008 state
     occupational employment and Wage estimates
     me.htm#b00-0000 [accessed July 15, 2009]

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                               education:                                 Candace J. Eaton describes why parent education is

                                                                          important and discusses a number of parent-educa-
                    “Prepare the Child for
                                                                          tion approaches and programs that currently exist in
                        the Path, Not the
                                                                          Maine. She argues that we need to increase access
                       Path for the Child”
                                                                          to research-supported programs, parent-education
                                               by Candace J. eaton
                                                                          classes, and support groups to all geographic areas of

                                                                          the state and all populations. In this era of reduced

                                                                          funding, Eaton recommends continuous evaluation

                                                                          of program outcomes and the limitation of funding

                                                                          to programs and approaches that show positive

                                                                          improvements.     

116 · Maine Policy Review · Summer/Fall 009             View current & previous issues of MPR at:
                                                                                                                   PaRenT eDUcaTion

                                                                                                          effective programs

T     he phone rings and the caller asks, “i need to
      take a parenting course, do you have any coming
right up?” as a provider, you ask yourself: what type
                                                                  nearly every home in suburban
                                                                  america. Today you may find
                                                                  What to Expect or Drs. Sears
                                                                                                                work with parents

of parenting class are they looking to attend? How old            and Sears.                                    and caregivers
are their children? where do they live? what is their                   Many of us would like to
family composition? is the caller self-motivated or               think we turned out just fine                 to increase the
mandated to attend a class or series of classes? These are        from the parenting we received
just pieces of the information you must learn so you              as children. But in the past                  problem-solving
can make the best recommendation for this parent or               decade, research has shown that
caregiver. Being able to refer this caller also hinges on         there are many factors in healthy             and parenting
the local availability of appropriate parent education            parenting and healthy children.
opportunities—another issue altogether.                           we have learned that 80 percent               skills necessary to
      Parenting education is a continuum of learning for          of the child’s brain development
all adults involved in the family. it also can refer to classes   occurs in the first three years of            nurture a healthy
that teach young people the skills they will need as they         life. we have also learned that
think about becoming parents. in this article, “parent”           what happens at home during                   family.
refers to any guardian or primary caregiver of a child or         the first three years of life can
adolescent. effective programs work with parents and              profoundly influence the later
caregivers to increase the problem-solving and parenting          physical health or illness of an
skills necessary to nurture a healthy family. Research            adolescent or adult. Strengthening parent-child rela-
shows that effective parent training and family interven-         tionships and honing parenting skills are of critical
tions promote protective factors for both parents and             importance to support healthy growth and develop-
children (lundahl and Harris 006). Protective factors            ment in those early years of a child’s life.
include nurturing and attachment, knowledge of                          one important influence on parenting is the
parenting and of child and youth development, parental            fundamental change in the institution of marriage and
resilience, social connections, and concrete supports for         its effect on the structure of families and child births
parents (child welfare information Gateway 009). This            since 1960. Today, nearly 5 percent of all children are
article reviews the need for parent education and describes       born outside of marriage, and the percentage of single-
some of the effective parent education approaches being           parent households has more than tripled in the past 50
applied in Maine.                                                 years. within the context of changing and blending
                                                                  family arrangements, it is more imperative to ensure
   wHy iS PaRenT eDUcaTion iMPoRTanT?                             that children have safe, dependable, and nurturing

S   ometimes parenting can be frustrating and the
    skills of parenting are not often intuitive. child-
rearing patterns are influenced by a personal sense of
                                                                        where we once were born, grew up, and
                                                                  continued to live in our familiar communities, we
                                                                  are now increasingly mobile, moving away from
competence, an understanding of child development                 our extended families to continue schooling or find
combined with each child’s unique temperament, and                employment. at the same time, since much of our
the cultural traditions of the community. For better or           state is rural, those families who do stay often live in
worse, most adults learned their approach to parenting            isolation from neighbors and community activities.
from their own parents, who learned from their                    although the internet connects us in many ways,
parents, who learned from their parents. Some readers             providing access to family and parenting resources,
of a certain age remember that Dr. Benjamin Spock’s               some rural markets are still not served well and remain
parenting guidance book was in the bookcase of                    disconnected from help and support.

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                               wHaT MaKeS PaRenT                                 members—adults, children, and youth. Skilled practi-
                              eDUcaTion eFFecTive?                               tioners work with families to help them engage formal
                                                                                 and informal resources to support healthy family devel-

                e    ffective parent education strengthens and builds
                     on the relationship between parent and child.
                Quality family-strengthening programs nurture existing
                                                                                 opment—a marker of a program’s efficacy.

                                                                                             wHen Do FaMilieS acceSS
                parenting skills, recognizing that parents want to do                          PaRenT eDUcaTion?
                the best possible job at preparing their children for the
                future. Grounded in research and using well-trained
                instructors, these formal programs encourage parents
                to be effective role models. They provide child develop-
                                                                                 P    arents seek guidance throughout their child’s life
                                                                                      from many places. Physicians provide prenatal care
                                                                                 and education for parents about the developing fetus
                ment information, seize opportunities for parents to             and health-related questions. The information provided
                practice new skills, and create supportive communities           during optional hospital-based childbirth classes
                and positive relationships within families. in my role           prepares them for childbirth and the early days after
                as an educator, i have found that most parents who               the baby comes home. Some local hospitals include
                seek parenting classes are motivated, humble, willing            “Boot camp for new Dads” as a component of their
                to try new things, persistent, grateful for the guidance,        childbirth series.
                and are willing to laugh at themselves throughout                      in Maine, first-time parents may participate in a
                the process. By making parenting education a formal,             home-based educational program that is universally
                statewide offering, we have the potential to serve all           available to families enrolled during the prenatal period
                families, from all walks of life. learning together helps        or within the first three months of the infant’s life.
                caregivers to enhance their skills and improve parent/           Healthy Families, Parents are Teachers Too, and
                child communication. This, in turn, can foster positive          Parents as Teachers are three model programs available
                childhood experiences and often prevent child abuse              for these new parents to gain confidence and learn
                and neglect.                                                     about child development from pregnancy through age
                                                                                 five. Some public health and community health nurses
                                                                                 are available to make home visits to assist families with
      by making parenting education a formal,                                    infants facing various medical challenges. all of the
                                                                                 home-visiting programs offer periodic child develop-
      statewide offering, we have the potential                                  ment assessments, parent support and education,
                                                                                 and connections to other community programs and
      to serve all families, from all walks of life.                             resources. These community-based home-visiting
                                                                                 programs are not an arm of government interfering
                                                                                 in the private lives of families. Program services
                     it is important to note that effective parent educa-        are designed to support family functioning through
                tion depends on the quality of the educator, the educa-          trusting relationships, developing or increasing
                tional materials, the setting in which it is provided, and       problem-solving skills, and working with the family’s
                the timing and flexibility to meet the parent’s needs.           natural support systems.
                instructors need to be culturally sensitive to the specific            Parents may seek assistance in dealing with new
                population learning new skills. Qualified instructors            ages and stages of development, such a child who is
                may be social workers, counselors, public school educa-          teething or sibling rivalry when a second child is born.
                tors, nurses, family and consumer science teachers, and          They may look for help when confronted with biting
                trained facilitators and paraprofessionals. a well-trained       or temper tantrums. They may want someone to talk
                instructor will enhance each family’s capacity to                to about how little sleep they’ve gotten. They compare
                support the growth and development of all family                 notes and look for help with toilet training and

118 · Maine Policy Review · Summer/Fall 009                    View current & previous issues of MPR at:
                                                                                                                        PaRenT eDUcaTion

sleeping through the night. new parents seek informa-           examples provide opportunities for learning on the
tion for new circumstances. They seek information               go and in the everyday world.
about their infant, their school-age child, and they seek             Many parents are seeking resources—a quick tip
guidance about setting limits with their adolescent.            sheet, a book or video, that they can read or watch, to
     Parents seek parenting education at multiple points        learn how to “fix the problem.” community and family
in their own lives as well as those of their children.          resource center libraries have a wealth of resources on
changes in family dynamics may send adults scurrying            parenting education, which are enhanced when a parent
to find solutions to new problems created by death,             educator is available for drop-in advice. Drop-in hours
divorce, remarriage, adoption, military deployment,             give families the opportunity to access the knowledge of
mental illness, or allegations of child abuse. Grand            a trained educator on specific behavioral issues and seek
families and other kinship families may struggle with           referrals and connections to other social services. online
new responsibilities in raising grand-children, nieces,         resources offer classes on topics like anger management,
and nephews. Family court judges and child welfare              sibling rivalry, and self-esteem. Today’s families are
officials may mandate or “strongly recommend” that              addressing tough issues, and many are looking for
families in transition participate in structured parent         support; all can benefit from connections to trained
educational opportunities. counselors may suggest a             professionals either in person or on the internet.
parenting class to help with the stresses parents are
experiencing in communicating with their child.                         coMPonenTS anD eXaMPleS oF
                                                                          coMMUniTy-BaSeD PaRenT
        SelF-STUDy oPPoRTUniTieS FoR                                        eDUcaTion PRoGRaMS
           FaMilieS anD caReGiveRS

M      aine families may access resources for self-study,
       including curricula, books, magazines, media,
                                                                i  n some communities, parents may access parenting
                                                                   classes in a weekly series, offered through the local
                                                                adult education program or through a community
and the internet. one avenue for support includes               social service agency. Self-motivated participants may
the educational materials and self-study opportunities          seek this information and support on their own, while
provided through national universities. More locally,           others are referred through the courts or local child
the University of Maine cooperative extension offers            welfare office. community-based education is best
The Growing Years (                  provided in non-threatening environments that are
center/parents/tgy.htm), fact sheets that provide guid-         comfortable and convenient. These programs are also
ance on topical issues related to the ages and stages of        best offered with a “public face,” that is, in a place
infants and young children through the age of five.             that is acceptable to all—such as at home, a school,
These materials are mailed directly to the home to              a library, or at a place of worship. community-based
provide anticipatory guidance to parents and caregivers         family resource centers are ideal because they provide
on the developmental progress of their child. each fact         an array of services and activities that are integrated,
sheet arrives “just in time” with suggestions designed          comprehensive, flexible, and responsive to community
for the baby’s age and developmental milestones.                identified needs. Research shows that high-quality,
     another example of parent resources is Born                effective family resource centers will include all of the
learning™ (, a partnership                 following: parent education, child development activi-
of civitas, the ad council, american academy                    ties, resource and referral, drop-in availability, peer-to-
of Pediatrics, and United way of america. Born                  peer supports, life skills coaching, and advocacy. Right
learning™ helps parents, caregivers and communities             now, there are less than a handful of these comprehen-
create quality early learning opportunities for children        sive family resource centers in Maine.
birth to age five with online tools and educational                   Parent educators may choose from several different
information for the various ages and stages. Many               models of parenting education. The development

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PaRenT eDUcaTion

                content model provides topics of interest to parents            options, and an important part of these classes is the
                of a specific age range. The issues model may include           peer support families receive in addition to mini-
                specific topics, such as sibling rivalry or stepfamilies,       lessons provided by the facilitator.
                which do not tie specifically a child’s age to the devel-
                opmental stage within the issue. Communication                                 evalUaTinG FaMily
                models seek to enhance communication between                               STRenGTHeninG PRoGRaMS
                parents and children, or communication among all of
                the adults in a child’s life. an experiential model, such
                as using Realcare™ computerized infants for students
                learning infant care, provide students with a realistic
                                                                                F    requently, grant funding sources require parent
                                                                                     education programs to include evaluation tools
                                                                                that measure outcomes and changes in behavior.
                simulated parenting experience.                                 a large body of research supports the emphasis on
                      each education model has a role in providing a full       parent education that focuses on family strengths and
                range of educational opportunities to meet the needs of         resilience rather than risk factors. This approach rein-
                today’s families. Successful programs understand that           forces existing protective factors instead of dwelling on
                knowledge of lifespan development is as essential as            family weaknesses. Strength-based programs include
                knowledge of child development in order to understand           family-skills training and activities to help children and
                the needs of a new parent. adults attending a series of         parents communicate effectively and develop culturally
                classes indicate learning is enhanced when all of the           appropriate strategies consistent with family beliefs. in
                participants have common needs or similar characteristics       addition to being well planned in their development
                (colosi and Dunifon 00).                                      and administration, parent education programs need to
                      Parent coaching or parent mentoring may be                have solid evaluation plans that go beyond measuring
                available on a limited, cost-per-hour basis, in person,         clients’ satisfaction to directly measure program goals
                by phone, or online. a relatively new response to               and objectives and changes in parents’ behaviors.
                meeting the needs and challenges of today’s families,                 evidence-based and evidence-informed are terms
                parent coaching, offers skilled guidance to promote             awarded to programs that are grounded in research
                communication and safety within the family’s own                and have undergone rigorous testing. Registries of
                environment. one example in the Portland area is                evidence-informed programs, including Blueprints
                offered by youth alternatives ingraham; Parenting and           for violence Prevention, the national Registry of
                Family education: Professional coaching for Parents is          evidenced-based Programs and Practices (nRePP),
                offered by one-hour sessions for a modest fee. Parents          and the office of Juvenile Justice and Delinquency
                decide how many or few sessions they will need.                 Prevention (oJJDP) evaluate programs and designate
                Families will find other coaching opportunities online.         successful parenting programs as exemplary or model
                      Facilitated family support groups are historically        programs, effective programs, and/or promising
                the most common opportunity to learn new parenting              programs. each program focuses on specific risk and
                skills. as noted earlier, family composition is varied and      protective factors. These curricula vary, and some
                can change rapidly. we have traditional families—               programs require specific training for group facilitators.
                biological mom and dad. we have single-parent fami-                   Families that have many stressors may benefit from
                lies, same sex families, blended families—his and/or            a combination of individual and group parent training
                hers and maybe ours. Foster and adoptive families step          that develops skills that emphasize social connections
                in to care for children whose families are unable to do         and the parents’ ability to access community supports.
                so safely. an increasing number of children are living in       allowing parents to practice new skills with their
                families caring for children of relatives, referred to as       children during parent-training sessions is consistently
                “grandfamilies” or “kinship families.” Facilitated              associated with greater effectiveness. This type of
                support groups with a trained parent educator provide           training may be more effective when serving families
                these families with access to increased problem-solving         in need of specific services and skill development.

10 · Maine Policy Review · Summer/Fall 009                   View current & previous issues of MPR at:
                                                                                                                      PaRenT eDUcaTion

  wHaT iS cURRenTly availaBle in Maine?                         as an evidenced-based approach for enhancing the
                                                                competence of parents and strengthening the parent-

F   rom too little information to too much information,
    families are bombarded with media sound bites:
“read my book,” “play my video,” “do this,” and “don’t
                                                                child relationship. currently, all of the home visitors in
                                                                Maine have been trained in Touchpoints™, using a
                                                                team of well-respected Maine trainers. Based on 60 years
do that.” what’s a parent to do? The state of Maine is          of infant research and practice by Dr. T. Berry Brazelton,
working to provide a common message, in a consistent            this approach has reached more than 1,000 providers in
manner, using common models that are research-                  more than 80 communities, and more than one million
informed.                                                       families since 1996. Families can supplement this guid-
                                                                ance with self-study through books and videos authored
                    Touchpoints™                                by T. Berry Brazelton and the Brazelton Touchpoints
     The first approach is a comprehensive team                 center, available in several family resource centers and
approach based on a core set of principles. Many home           municipal libraries.
visitors, public health nurses, maternal and child health
nurses, pediatricians and early care educators are
trained in the Touchpoints™ (                             in addition to being well planned in
approach to help Maine parents reaffirm their priorities
and strengths as parents. Touchpoints™, developed by                          their development and administration,
T. Berry Brazelton, noted pediatrician and author,
provides parents with many teachable moments based                            parent education programs need to have
on the cues of their infant and toddler. This approach
empowers parents to discover their effectiveness as                           solid evaluation plans that go beyond
parents, guiding them through their children’s predict-
able developmental events (touchpoints) to support                            measuring clients’ satisfaction to directly
healthy child development.
     children develop their skills in many different                          measure program goals and objectives
areas at the same time. when children show a sudden
burst in one area of development, they often backslide                        and changes in parents’ behaviors.
or regress in another area of development. while this is
a positive sign of development, parents and providers
might find themselves disagreeing with each other.                            Period of Purple Crying®
     The essence of Touchpoints™ training is to                      The second model adopted by Maine is the Period
provide anticipatory guidance with a focus on the               of Purple crying® (
common interest in the child by both parents and                iD=4&subnaviD=), which was developed by the
providers. This approach focuses on helping parents to          national center on Shaken Baby Syndrome based on 5
learn what to do, rather than telling parents what not          years of research on normal infant crying conducted by
to do. it is an approach that trains providers to listen        Ronald G. Barr and others. This program helps parents
to what families need and to support parents’ discovery         and caregivers to understand the natural, yet frustrating
of what is best for their children. The Touchpoints™            features of normal crying in infants that can lead to
approach enhances the competence of parents and                 shaking or abuse. This evidenced-based shaken-baby-
builds strong family-child relationships, laying the            syndrome prevention program includes a 10-minute
foundation for their child’s healthy development.               DvD and full-color 11-page booklet intended to be
     Maine is emphasizing the development of a sustain-         given to parents of new infants in the hospital. The
able training infrastructure for service providers and          message is clear, memorable, and meaningful, and is
recommends adoption of the Brazelton Touchpoints™               designed to be interesting and relevant to both men and

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PaRenT eDUcaTion

                women. This program approaches the prevention of                a computerized infant simulator that requires realistic
                shaken-baby syndrome through education about normal             care of an infant and reports on exactly how it
                infant development, specifically, about crying in normal        was cared for. when used in child development or
                infants, rather than being limited to warnings of the           parenting education, a Realcare® baby helps future
                negative consequences of shaking.                               parents become more confident, capable, and attentive
                     Thirty-one of Maine’s  hospitals have been               caregivers. By teaching proper infant care skills and
                trained in this abusive head-trauma prevention                  providing an around-the-clock interactive experience
                program and will provide educational information to             with a lifelike simulator, the program can be success-
                all parents after the birth of their new infant. a nurse        fully applied to babysitter education and teen preg-
                will watch the DvD with the family and answer any               nancy prevention efforts. we often hear that babies do
                questions. The family will then be given a copy of the          not come with a manual, yet in this program, they do.
                DvD to take home, to review at their convenience,               educators teach child development education prior to
                and to share with all future caregivers of their child.         students participating in the parenting simulation.
                                                                                     in addition to the core child development infor-
                                                                                mation provided, specialized demonstration infants
      universal access to parent education                                      teach students about the effects of fetal alcohol
                                                                                syndrome, the effect of drugs, and why shaken-baby
      and family support is an investment                                       syndrome (abusive head trauma) should be prevented.
                                                                                other lessons incorporate the financial responsibility
      priority for the state of Maine.                                          of parenthood, infant health needs, and readiness for
                                                                                parenthood. Many communities partner with their
                                                                                local child abuse prevention council to provide this
                     as families are frequently overwhelmed by the              educational experience in their schools as a supplement
                amount of information provided during their brief               to their Maine Learning Results curriculum. This is
                hospital stay when the baby is born, trained home visi-         an ideal way to integrate the community-based presen-
                tors and public health/maternal health nurses will              tation of the Period of Purple crying® with the
                review this material during a later home visit. Maine’s         Realcare® Parenting program.
                16 countywide child abuse prevention councils will
                provide public education and training to the commu-                            Co-Parenting Programs
                nity, so that all adults will understand that some babies             The fourth major approach in Maine provides
                will experience periods of inconsolable crying. The             parents who are separating or divorcing an opportunity
                Maine children’s Trust, Maine children’s alliance, and          to learn how to successfully co-parent their children,
                the Barbara Bush center have begun a public service             by putting the needs of their children at the fore. “Kids
                educational campaign on local radio stations to inform          First,” “For Kids Sake,” “Parent works,” or “Moving
                the general public about the prevention of shaken-baby          Forward” are titles of a four-hour workshop held in 15
                syndrome. The Maine children’s Trust is collaborating           cities throughout Maine to assist parents with the tran-
                with the national center on Shaken Baby Syndrome                sition through a family separation. Parents learn that
                to evaluate this broad-based community education                family disruption due to divorce is not a single event,
                approach to reduce abusive infant head trauma.                  but a series of events. it may involve trial separation,
                                                                                divorce, life in a single-parent family, life with a parent
                          RealCare® Parenting Program                           and live-in lover(s), the remarriage of one or both
                      The third model, Realcare® Parenting Program              parents, life in a blended family, the breakup of one
                (formerly known as Baby Think it over®) (www.                   or both step-parent families, and so on. Parents will
       was developed by                     learn how divorce affects children, how they can work
                Realityworks, inc., using a hands-on approach with              together to make things easier for their children, and

1 · Maine Policy Review · Summer/Fall 009                   View current & previous issues of MPR at:
                                                                                                                        PaRenT eDUcaTion

how other parents have coped in similar situations.             benefits—from higher tax revenues, reduced crime
They will learn how to deal with conflict without               costs, reductions in special education and grade reten-
involving the children, make decisions about parenting          tion (see Trostel and connors this issue).
arrangements, and help children adjust to differences                The Invest Early Plan for Maine (Maine
between households. Parents with new partners are               Department of Health and Human Services 008: 10)
encouraged to attend the same workshop.                         outlines a primary goal that “all Maine families will
      The annual calendar of classes and locations are          have access to programs that deliver comprehensive,
posted to the state of Maine web site (www.courts.              family-centered, culturally sensitive, linguistically             competent and collaborative prevention services.” This
edu.html). in addition, Maine’s judicial system has             report is the culmination of years of study by Maine’s
published a booklet on their web site, A Guide to               experts in child development. Universal access to
Making Child-Focused Parenting Time Decisions,                  parent education and family support is an investment
available for free download.                                    priority for the state of Maine.
      in all 50 states (plus the District of columbia,               in 006–007, Maine’s 16 countywide child abuse
Guam, Puerto Rico, and the virgin islands), the judi-           and neglect prevention councils presented their recom-
cial system has taken a leadership role in requiring            mendations for strengthening Maine’s families through
families to learn more about the dynamics of parenting          family resource centers to the Governor’s children’s
education and family relationships. Funded through              cabinet Task Force on early childhood. They reported
the Department of Health and Human Services access              that most prevention programs, even those that are
and visitation Grant Program since 1998, states deter-          intense and comprehensive, are relatively less expensive
mine the type of service(s) to be provided. The services        than programs that intervene or treat children who
must be related to the overall goal of the program,             have been abused. However, state funding and support
which, according to their web site, is to “support and          for child abuse prevention has dwindled in recent
facilitate non-custodial parents’ access to and visitation      years, with less than $140,000 allocated to be shared
of their children” (          among the child abuse prevention councils in each of
005/reports/prelim_access_visitation_grants/).                 Maine’s counties.

    coST-BeneFiTS oF PaRenT eDUcaTion                                              call To acTion
     To STRenGTHen Maine’S FaMilieS

a    cost-benefit analysis by Heckman, Grunewald
     and Reynolds (006) can be used to translate
                                                                S   o, how do parents find out what parent education
                                                                    and support is available in their neighborhood?
                                                                How can we support families in raising children in our
the impact of early care into the language of busi-             community? what is our call to action?
ness and economics. Some impacts appear relatively                    in 1998, Maine convened the Task Force to Study
quickly, positively affect parenting, and lead to fewer         Strategies to Support Parents as children’s First Teachers
substantiated cases of abuse and neglect than would             (Maine Department of Human Services 1998). The task
have been expected. other impacts, seen in children             force identified three key strategies to ensure healthy
as they develop and grow older, take more time to               development and school readiness, including (1) home-
materialize, such as increased graduation rates, reduc-         visiting services for all new parents, () support for
tions in juvenile and adult crime, and higher earn-             parents as children’s first teachers, and () family-support
ings in the workforce. cost-benefit analysis not only           services. The task force recommended specific characteris-
demonstrates the relative size of benefits to costs, it also    tics of effective home-visiting programs, recommended
shows who benefits. although the children and parents           the development of a core curriculum for parents and
participating in prevention programs benefit through            caregivers, and identified ways to improve current and
improved outcomes, the nonparticipating public also             community-based services.

View current & previous issues of MPR at:          volume 18, number 1 · Maine Policy Review · 1
PaRenT eDUcaTion

                      in December 007, the 1rd legislature in their         for this program has been provided by private founda-
                “executive Summary of the commission to Develop                tions and community donations. we need to increase
                a Strategic Priorities Plan for Maine’s young children,”       capacity to reach all counties and expand access to
                recommended investments in strengthening families              every public middle school and high school, as desired
                through comprehensive family support services (Maine           by the local community.
                office of Policy and legal analysis 007). The state                 The Maine children’s Trust, the 10 United ways of
                of Maine supports universal home-visiting services             Maine, and various other private foundations support
                for first-time families through the Fund for Healthy           additional community-based parent education opportuni-
                Maine, using tobacco settlement funds. in fiscal year          ties sporadically available throughout the state. This may
                008, local home-visiting programs served ,800 first-         be our most complex challenge. Today, there is an awak-
                time families (Johnson 009). level funding and                ened realization of the importance of parent education.
                budget cuts have limited the program. it is clear that         we have reduced the stigma of parent education as being
                we need to increase capacity to reach all geographic           for only at-risk families and recognize that families volun-
                areas and expand access to parent education through            tarily want access to education and support year-round.
                home-visiting programs for the families of all 1,000          However, many of our state policies ignore this growing
                new infants born each year.                                    body of information.
                      Funded through the U.S. Department of Health                   Parents and caregivers indicate that they want help
                and Human Services, access and visitation Grant                to develop a long-range view of their actions. They will
                Program, co-parenting classes are available in only 15         be better able to focus their sights on the future if their
                communities. But in the period of april 009 through           long-term perspective is not lost in the day-to-day
                april 010, some communities will only offer the               issues of today’s family challenges. we need to increase
                program twice. co-parenting education provides an              access to parent-education classes and support groups
                affordable, cost-effective form of intervention that           to reach all geographic areas. at a minimum, we should
                not only complements and supports court-connected              provide access to programs in every county, and this
                mediation and visitation supervision programs, but             minimum is not currently being met. in this current
                also reduces expenses to the legal system by preventing        economic climate, we must require continuous evalua-
                costly re-litigation by parents in conflict (Supreme           tion of program outcomes, and fund only those oppor-
                court of virginia 000). we must increase capacity for         tunities that show positive improvements.
                families in transition to access monthly co-parenting                all of this returns me to the sub-title of this article.
                classes in every county in Maine.                              “Prepare the child for the path, not the path for the
                      a partnership of the Maine children’s Trust and          child” was printed on a paperweight tile given to me by
                Maine’s community hospitals, the Period of Purple              my husband. i frequently remember this motto when
                crying® is a new program introduced in april 009.             challenged to protect children from the fast-paced life
                Using only private contributions, we were able to              they encounter after they leave the womb. our collective
                launch this evidence-based model. it would be a                job is to teach our children the skills they need to make
                nominal gesture for the state to actively support the          good choices every day. as i write this final paragraph,
                costs of distributing copies of the DvD to parents at          i hear the laughter and engaged conversation of five
                the time of delivery to share with other caregivers of         parents participating in our Positive Parenting class for
                their newborn child, particularly in light of the public       families with young children down the hall. These are
                dollars saved when children do not experience abusive          all families seeking additional tools for their parenting
                head trauma.                                                   toolbox. Two of the parents live in a traditional family
                      only eleven of Maine’s 16 child abuse prevention         with their biological children, one has guardianship of
                councils currently have the capacity to provide the            her grandchild, one grandparent lives in a multi-genera-
                Realcare® Parenting Program in their local communi-            tional household, and one non-custodial parent was
                ties. over the past 10 years, sporadic funding support         “strongly encouraged” to attend. These parents will help

14 · Maine Policy Review · Summer/Fall 009                  View current & previous issues of MPR at:
                                                                                                                            PaRenT eDUcaTion

their children to “stop, think, and make a good choice.”
That is good advice for us all. it is time for Maine to
stop, think, and make the good choice to invest in                 Maine department of human services. 1998. report
supporting families.                                                 of the task Force to study strategies to support
                                                                      Parents as Children’s First teachers. Maine dhs,
                                                                      ee/71.pdf [accessed august 28, 2009]
                                                                   Maine office of Policy and legal analysis. 2007.
  RefeRences                                                          executive summary of the Commission to develop
  Child Welfare information gateway. 2009.                            a strategic Priorities Plan for Maine’s young
      strengthening Families and Communities: 2009                    Children. report to the 123rd legislature. Maine
      resource guide. Child Welfare information                       oPla, augusta.
      gateway, Children’s bureau/aCyF, Washington, dC.                youngchildexecsum.pdf [accessed august 28,                2009]
      [accessed august 27, 2009]                                   supreme Court of virginia. 2000. Model Parent
  Colosi, laura and rachel dunifon. 2003. effective                   education Curriculum and a study of related
     Parent education Programs. Cornell university                    Custody and visitation issues. report to the
     Cooperative extension, ithaca, ny. http://www.                   governor and general assembly of virginia,                  richmond.
     education%20Programs.pdf [accessed august 27,                    by+year/hd262000/$file/hd26_2000.pdf [accessed
     2009]                                                            august 28, 2009]

  Connors, dana. 2009. “investing in Maine’s youngest              trostel, Philip. 2009. “the dynamics of investments in
     Children has great returns for business.” Maine                  young Children.” Maine Policy review 18(1): 18–25.
     Policy review 18(1): 26–29.
  heckman, James, rob grunewald and arthur
     reynolds. 2006. “the dollars and Cents of
     investing early: Cost-benefit analysis in early Care
     and education.” Zero to three 26(6): 10–17.
                                                                                               candace J. eaton serves
  Johnson, kay. 2009. state-based home visiting:
                                                                                               downeast health services
     strengthening Programs through state leadership.
     national Center for Children in Poverty, Columbia                                         as the program director
     university, new york.                                                for the hancock County
     publications/pdf/text_862.pdf [accessed august 28,
     2009]                                                                                     Children’s Council and
                                                                                               served previously as
  lundahl, brad W. and n. harris. 2006. “delivering
     Parent training to Families at risk to abuse:                                             finance director and interim
     lessons from three Meta-analyses.” american                                               executive director. she is
     Professional society on the abuse of Children
     18:7–11.                                                                                  on the board of directors
  Maine department of health and human services.                for the Maine Children’s trust, united Way of eastern
     2008. invest early in Maine: a Working Plan for            Maine’s Community impact Council for Families and
     humane early Childhood systems. Maine dhhs,
                                                                Children, statewide advisory Committee for Communities
     early%20in%20Maine%202008.pdf [accessed                    for Children and youth, is a member of the Maine Child
     august 28, 2009]                                           abuse Prevention Councils, and formerly served on the
                                                                governor’s task Force on early Childhood.

View current & previous issues of MPR at:          volume 18, number 1 · Maine Policy Review · 15
coMMUniTy caRinG collaBoRaTive

    community caring                                                      Marjorie Withers presents a case study of rural

       collaborative:                                                     Washington County, where community-agency part-

                                                                          nerships are increasing services for community

                     Case Study of a                                      members and their children affected by exposure to

            Grassroots Collaboration                                      drugs, alcohol, and other risk factors. The

          to Create a System of Care                                      Community Caring Collaborative (CCC) is an

                   for At-risk Infants,                                   effective model in part because of its structure. But

                     Young Children,                                      most important, according to Withers, is the creation

                and Their Families in                                     of hope and new energy in an area of the state char-

                                                                          acterized by longstanding feelings of hopelessness
          Washington County, Maine
                                                                          and powerlessness.    
                                               by Marjorie Withers

16 · Maine Policy Review · Summer/Fall 009             View current & previous issues of MPR at:
                                                                                                 coMMUniTy caRinG collaBoRaTive

                                                                                                          …the CCC
                  inTRoDUcTion                                  washington county has been hit
                                                                hard by many storms of nature             [Community Caring

T    his article is a case study on the evolution of the
     community caring collaborative (ccc) in
washington county. The ccc is a new model of
                                                                and the ravages of social change.
                                                                none have been more devastating
                                                                than the opiate crisis of the past
                                                                                                          Collaborative] is

collaboration for rural areas and has been selected as an       10 years. no family has been left         dedicated to creating
example of collaboration under a grant funded by the            untouched by the epidemic
Robert wood Johnson Foundation. it is an example of             misuse of prescription drugs.             training opportunities,
innovative community investment by agencies to create                The devastation left in the
partnerships that increase services and opportunities           wake of this widespread addic-            to building profes-
for community members and their children who are                tion has led to a slew of new
affected by substance exposure and other risk factors.          grave statistics for very young           sional infrastructure
Specifically, the ccc is dedicated to creating training         children in washington county,
opportunities, to building professional infrastructure          including:                                and capacity in a
and capacity in a vast and economically challenged
                                                                   • one out of three infants             vast and economi-
rural area, and to creating a continuum of best-practice
                                                                     is born at risk due to
services for its diverse community members.
                                                                     substance exposure (tobacco,         cally challenged rural
                                                                     alcohol, opiates, or combi-
                                                                     nations), low birth weight,          area, and to creating
                                                                     exposure to trauma, pre-
w      ashington county is larger geographically
       than the combined states of Rhode island and
connecticut, with a sparse population of ,000. it is
                                                                     term delivery, or birth to
                                                                     teen parents.
                                                                                                          a continuum of best-

home to ,000 Passamaquoddy Tribal members, ,000                  • Highest percentage in                practice services for
of whom live on two separate tribal reservations 48                  Maine of infants in child
miles apart within the county. washington county is                  protective custody.                  its diverse community
the poorest county in the state, with the highest rate
                                                                   • Highest percentage in                members.
of unemployment; its economic profile is bleak. The
                                                                     Maine of terminated
majority of work is both seasonal and natural-resource-
                                                                     parental rights.
dependent, including fishing, clamming, lobstering,
tipping and wreath making, wild blueberry harvesting               • Highest percentage in
and processing, timber harvesting, and the production                Maine of children in special education.
of pulp and paper (when the mill is running). Health
                                                                   • Highest percentage in Maine of children under
disparities abound, with washington county being
                                                                     the age of four dismissed from child care due
the only new england location where the life expec-
                                                                     to behavioral acting out.
tancy for women has decreased rather than increased
in the last 10 years. Tribal members’ health profiles are
bleaker, with an average life expectancy of 49 years.                               wHo we aRe
     washington county is a place where neighbors
matter and communities know their members intimately.
Professionals who stay are devoted to the rugged terrain
and resilient community members. The line between
                                                                T    hese alarming statistics brought together a group
                                                                     of concerned community members who both
                                                                lived in washington county and worked in agencies or
“helpers” and “helped” is often blurred by the lack of          who had a family member affected by substance use or
degrees of separation characteristic of places where            had a high-risk infant/child. we began with the core
everyone has multiple overlapping roles. over the years,        assumption that creating trust and safe communication

View current & previous issues of MPR at:         volume 18, number 1 · Maine Policy Review · 17
coMMUniTy caRinG collaBoRaTive

                is essential for true collaboration and systems change.                               Work Group
                The ccc chose to partner with an existing non-profit                  The work group includes front-line workers, supervi-
                organization in washington county serving adults with           sors, and family members. it focuses on communication
                special needs. By not creating a new separate entity, the       across agencies about programming, concerns and prob-
                ccc modeled partnership and investment in existing              lem solving. it includes specific committees on training,
                agencies to achieve new goals. our story offers an              curriculum development, and shared programming.
                alternative way of organizing collaboration that empha-
                sizes investment in programming and training, using                                Executive Council
                existing staff to achieve new goals.                                 The executive council includes directors of
                      Rural areas often have difficulty creating effective      agencies and family members who develop policy and
                collaboration because of distance and differences in            make decisions on an advisory basis for the ccc.
                regions and communities and because of historical               it focuses on financial planning opportunities and
                memories of broken promises or political rivalry that           creating shared policy that allows the ccc to establish
                do not dissipate across time. The grassroots nature of          non-redundant seamless services and create new
                the ccc and our willingness to address historical               programs across agencies.
                issues broke down those barriers and fostered a collab-
                orative that is dedicated and flexible in meeting                               State Agency Partners
                community and agency needs.                                          our third group includes state agency partners.
                                                                                we partnered with state agencies, specifically, the state
                                                                                of Maine centers for Disease control, Family Health
   our story offers an alternative way of                                       Division to apply for (and receive) one of the first six
                                                                                nationally awarded “Project linking actions for
   organizing collaboration that emphasizes                                     Unmet needs in children’s Health” (laUncH) five-
                                                                                year grants through the Substance abuse and Mental
   investment in programming and training,                                      Health Services administration (SaMHSa).
                                                                                laUncH stipulates that the state be an active partner
   using existing staff to achieve new goals.                                   in developing state policy that supports change for the
                                                                                unmet public health/mental health needs of infants
                                                                                and young children.
                     originally, the group convened to consider writing
                        riginally,                                                   other distant partners include state leadership
                a grant. instead, the group formally became the ccc             participants from different parts of the Department
                and decided to ask community members and to                     of Health and Human Services. our state liaison
                conduct focus groups to discover what were perceived            coordinates the state agency partners group, which
                to be the greatest needs for children and families.             includes the Division of Family Health, the office of
                The ccc represents the first time that leaders of the           Minority Health, Division of children’s Mental
                Passamaquoddy Tribe were included as primary players            Health, the early childhood services director, office of
                from the inception, along with front-line workers,              child care and Head Start director, medical director
                agency directors from the private and public sectors,           of the Family Health Division, representation from the
                and family members. Members of the ccc include                  Department of education and the director of early
                representatives from our two higher educational institu-        Periodic Screening Diagnosis Treatment program
                tions that play a key role in our mission to increase           within Maine care. This powerful, dynamic group
                professional standards and create a well-trained work-          meets every other month to support and address
                force. Through this core group, several separate                barriers that affect new programming and services.
                subgroups have developed that meet on a monthly
                basis, along with other partnerships.

18 · Maine Policy Review · Summer/Fall 009                   View current & previous issues of MPR at:
                                                                                                 coMMUniTy caRinG collaBoRaTive

                    wHaT we Do                                         infants and children regardless of whether it is
                                                                       a first-time parent or not. Family educators use

T   hrough focus groups and meetings our mission
    developed to include the following activities:
                                                                       TouchpointsTM (Brazelton, best practice).
                                                                      • DC 0-3R, diagnostic process that is develop-
  1. creating learning/training opportunities to                        mentally and relationship-based that is now
     support a workforce that offers best-practice                      offered by 18 trained clinicians in washington
     services to our community.                                         county (Dc 0-R recognized best-practice
                                                                        diagnostic process).
  . creating a system of care that is not redun-
     dant, is family-driven, and is responsible to the                • Development of mental health consultation
     individual needs of infants, children and their                    services available to all washington county
     families across systems using a single, shared-                    child care services, Head Start, preschool and
     case plan.                                                         elementary schools up to grade three.
  . creating partnerships that generate new                          • Peer-to-peer program for parents helping
     opportunities for services using existing                          parents done in conjunction with Maine Parent
     agencies to ensure a complete continuum of                         Federation (best-practice recognition from
     services in washington county.                                     SaMHSa).
  4. creating a learning environment that supports                    • Support groups for parents with high-risk
     innovative practice and is responsive to the                       infants and children.
     changing needs of our community.
                                                                      • implementation of parenting group designed
  5. including equally all partners representing                        by two local practitioners for parents who are
     different areas, populations, and services                         receiving methadone maintenance.
     within washington county in a culturally
     competent, respectful, and historically aware
                                                                              wHaT we Have leaRneD
  6. Providing training and supervision for all best-
     practice models introduced.                                o     ur belief is that collaboration is a necessity.
                                                                      collaboration requires time and the development
                                                                of trust that occurs when partners feel validated and
  7. creating new best-practice services including:
                                                                supported. it is a process that assumes there will be
     • Integrated services: integrates early intervention       differences and history that must be acknowledged and
       services in primary care and in treatment centers        dealt with before coming to new understandings. as
       allowing earlier intervention and assessment of          dollars dwindle and needs increase, it is essential that
       at-risk infants and young children and offering          agencies in rural areas work together to
       support in a local, safe environment that encour-
                                                                   • create safe harbors for problem solving.
       ages holistic planning and provision of services.
                                                                   • Share agendas.
     • Bridging program: Uses the wraparound
       High Fidelity Model to meet the needs of                    • eliminate redundant services and paperwork.
       high-risk infants and children across systems
                                                                   • Be informed by the population it seeks
       (wraparound best practice).
                                                                     to serve.
     • Family/parenting support home visiting:
                                                                   • Find ways to partner and apply for new
       increases home visiting to include all high-risk
                                                                     initiatives in a united way.

View current & previous issues of MPR at:           volume 18, number 1 · Maine Policy Review · 19
coMMUniTy caRinG collaBoRaTive

                  • lend strengths and share concerns.                           others about the implications of being rural and remote
                                                                                 and the best methods for planning and providing
                  • create learning communities and opportuni-
                    ties to guarantee best practice across systems.
                                                                                      Perhaps the most serious implication and lesson
                  • address issues of burnout and isolation for                  for prospective collaborators to learn from the ccc is
                    both staff and consumers.                                    the generation of hope that occurs when people and
                                                                                 agencies feel empowered. washington county’s true
                  • Respect and learn the cultures of the
                                                                                 albatross has not been its economic or rural issues. it
                    community and of the providers.
                                                                                 has been the feelings of hopelessness and powerlessness
                  • Be committed to development of a work-                       that have affected our families, agencies, and institu-
                    force by involving higher education in the                   tions. collaboration and the creation of new and inno-
                    collaborative.                                               vative responsive programming are empowering our
                                                                                 community to dream and envision change. it is
                  • Be transparent about issues and funding.
                                                                                 creating hope. Hope generates new energy and a new
                                                                                 understanding of the strengths in our families, our
                     we have also learned that change has a domino
                                                                                 agencies, our communities, and our future. 
                effect. as we have opened the door to collaboration and
                provided a venue for true communication and problem
                solving, the answers have appeared. The ccc has
                achieved many unanticipated secondary gains. it has              Marjorie Withers is the director of the Community Caring
                been a healing process for historical divisions and misas-       Collaborative and director of the launCh project in
                sumptions. it has been a place of reaffirming shared             Washington County, one of six national sites working on
                values to develop shared visions and has generated               integrating services for infants and young children and
                respect and genuine caring for programs and individuals.
                                                                                 their families and expanding the scope of public health
                                    iMPlicaTionS                                 to include early intervention. she has been designing
                                                                                 programs and offering services in substance abuse and

                T    he community caring collaborative is an effective
                     model of collaboration because of our structure.
                our work group serves as the grassroots of the organi-
                                                                                 mental health for more than 30 years.

                zation and the source of many ideas, concerns, issues,
                and solutions. our executive counsel is necessary to
                ensure buy-in at the director level of local agencies and
                to ensure that there are mechanisms to accommodate
                change and collaboration. our state agency partners are
                essential to all that we do.
                     at our first summer institute in June 009, we
                took 40 people on a bus ride across washington
                county with presenters telling their agency’s story and
                two tribal presenters explaining history and culture as
                we went on reservation land. People from away were
                stunned. Understanding the layers of complexity that
                our rural roads and isolated communities make is
                essential to funding and responding to our community
                effectively. The ccc takes seriously its role to educate

10 · Maine Policy Review · Summer/Fall 009                    View current & previous issues of MPR at:
View current & previous issues of MPR at:   volume 18, number 1 · Maine Policy Review · 11
Thanks	to	Our	Reviewers…                                                      We would like to extend our sincere
                                                                              thanks and appreciation to all those
                                                                              who took time to review articles
                                                                              submitted for consideration for
                                                                              volume 18 of Maine Policy Review.
                                                                              their insights and recommendations
                                                                              assist us in our editorial decision-
                                                                              making, and provide valuable feed-
                                                                              back to authors in revising their
                                                                              articles to be suitable for publication
                                                                              in the journal.

                                                                              the following individuals reviewed
                                                                              articles, and in some cases several
                                                                              articles, for volume 18:

                                                                              James acheson            James McConnon
                                                                              dolores J. appl           Charles Morris
                                                                              glenn beamer              sheryl Peavey
                                                                              alan Cobo-lewis           loraine spenciner
                                                                              Mary davis                betsy squibb
                                                                              leslie Forstadt           alison terry
                                                                              gisela                    helen Ward
                                                                                                        Wendy Wolf

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