Rethinking Business as Usual. Are We Even Starting in the Right Place?

Center on the Developing Child at Harvard University’s Hannah Barber challenges us to rethink how we improve child and family outcomes.

Photo by Larry Crayton on Unsplash

by Hannah Barber

Never in living memory has the importance of independent, rigorous scientific thinking been so apparent. As we face some of modern society’s greatest challenges, from the COVID-19 pandemic to our ever-changing climate, the need to draw upon the latest scientific thinking for solutions is clear.

As any number of Albert Einstein quotes will tell you, identifying the right question is a critical step toward finding the right solution. And for those seeking greater impacts for children and families, this may just be the big idea we have been looking for. That is, instead of asking “Which program should we invest in?”, perhaps we should be asking a different set of questions altogether.

Since the dawn of public schools, societies have recognized the value in public investments to help all children thrive. More recently, science has shown us that the best time to influence lifelong learning, health, and behavioral outcomes is in the earliest years of a child’s life—including during the prenatal period. While the science continues to evolve, and our understanding continues to deepen (including some of the latest insights about the development of critical feedback loops between the brain and the body early in life), we have known for decades that the early years are a time of incredible opportunity.

We have been drawing on this powerful insight to help narrow societal disparities, even as far back as President Johnson’s War on Poverty in the 1960s. Many will recognize this period as the time of the famous Perry Preschool and Abecedarian studies, both of which demonstrated our ability to improve life outcomes for children through high-quality preschool programs.

As Duncan and Magnuson’s 2013 study tells us, half a century of program evaluation research has demonstrated repeatedly that effective early childhood services can improve life outcomes for children facing adversity, produce important benefits for society, and generate positive returns on investments. And, policymakers and practitioners often invoke this evidence base to build support for existing programs.

But, here’s the thing: in reality, the average magnitude of intervention effects has not increased substantially in 50 years.

This stagnation has occurred even while our understanding has deepened of precisely how the experiences children have early in life “get inside” the body and affect their learning, health, and behavioral outcomes. Somewhat ironically, we now have more information than ever with which to design and strengthen the impact of our work and yet, we are not moving forward in the leaps and bounds that this depth of knowledge should allow.

Why then, with the power of this knowledge, have we made such little progress in improving child and family outcomes over the past 50 years?

By their very nature, complex social challenges have many wide and varied stakeholders, all of whom come with unique goals, objectives, and languages. For example, those who are focused on early learning have different funding streams, delivery systems, and accountability measures than those focused on child welfare or public health—yet they often serve the same “customers” whose varied challenges make progress more difficult. This is complicated work, and anyone who suggests that there is a silver bullet, frankly, shouldn’t be trusted.

There is, however, a short list of challenges that we know may contribute to a lack of progression toward more substantial impact. Among many others, these include:

  • An overreliance on “evidence-based” programs that have shown a statistically significant difference on any outcome on average when compared to a control group, which lacks precision and replicability;

  • The slow, opaque, and often convoluted nature of program evaluation that doesn’t allow for improved understanding of what works for whom in what context and why, which would allow for rapid-cycle improvements on the pathway to scalability;

  • A lack of appropriate measures and an overreliance on “close enough” substitute or proxy measures; and,  

  • Difficulties on the journey to scale, whereby programs (if they can scale) often lose impact.

The science of early childhood development can point us in the right direction by bringing us back to the very first principles of strong, healthy development—of the brain and the body together. It can provide a common language across multiple stakeholders and help to shape a universal definition of success.

Addressing these challenges is no small feat. It cannot be done in one fell swoop. We will make progress, however, if we are strategic and focus on finding the right place to start.

At the Center on the Developing Child, we have found that one of the most powerful first steps you can take is to go back to the beginning—as Einstein suggests—and find out if you are asking the right question.

So, how do we find the right question?

The science of early childhood development can point us in the right direction by bringing us back to the very first principles of strong, healthy development—of the brain and the body together. It can provide a common language across multiple stakeholders and help to shape a universal definition of success.

Here’s how the science gets us there.

At the core of human development, we understand that genes and environments interact and influence lifelong outcomes across learning, health, and behavior.  This has been illustrated clearly in the current context of the COVID-19 pandemic, where the very health disparities that have roots in early adversity—cardiovascular disease, diabetes, and metabolic conditions, amongst others—are the same co-morbidities that increase the risk of serious illness, or even death, from COVID-19 later in life.

This leads us to conclude that there are two key levers for improving outcomes: genes and the environment. Broadly speaking, we don’t have control over the genes; however, we do have the ability to design environments.

Environments are made up of experiences (the direct interactions that children and families partake in) and conditions (the circumstances under which those experiences occur). Designing environments involves improving and strengthening both experiences and conditions at the same time.

This means that, to give each child the best start in life, we must:

  • Provide experiences (and strengthen caregivers’ own skills to provide experiences) that are full of the most active ingredients in healthy child development—including responsive “serve and return” interactions; and

  • Ensure these experiences take place under conditions in the ecosystem (for example, within organizations and public policy) that work with and actively support parents, caregivers, and frontline services to provide these experiences.

Both of these levers must be considered in relation to timing. To maximize our scarce resources in outcomes relating to economic return, as well as impact upon development, we must reconceptualize what we mean by “early.” Whilst the door of childhood development does not suddenly close at the age of three, the importance of focusing our efforts on the prenatal to age three period has never been more clear.

So, rather than ask, What pre-K program should I invest in or Which home visiting program is the best?, the science guides us instead to ask :

How might we sustainably design conditions and experiences to promote strong, healthy development to ensure that children and families thrive?

Reframing the question results in some important implications:

  • An invitation to innovate both at the practice level (that is, the location of the direct child and family experience) and further upstream in the ecosystem. Often, innovation focuses on what is happening on the ground, but a reframe such as this highlights the role that those at organizational management and policymaking levels can play in laying sturdy foundations for development.

  • An opportunity to widen the scope of those identified as making decisions that impact children and families. This lies not only with those who are traditionally tasked with providing children’s services, but also stretches out to those who influence a family’s conditions as well. For example, housing, urban design, employment, and infrastructure all affect a caregiver’s capacity to be responsive to a child. Consider for a moment: the duration of a parent’s commute, the quality of family housing available, or the accessibility of green space. These are all components of the environment that affect child development. Rather than sitting on the shoulders of a few underfunded service systems, supporting children’s development should, very reasonably, be spread across the shoulders of many.

  • A relentless focus on the end goal of promoting strong, healthy development to ensure that children and families thrive—rather than on proxy indicators that can sometimes serve as distractions or the pursuit of “easier fixes.” For example, a focus on the challenge of lifting third grade reading scores often leads to the implementation of reading programs in the early years of elementary school. Instead, we should be focused on addressing the disparities that affect a child’s ability to read and learn in the first place. A reframe toward building strong foundations will address these and other indicators in a more substantive, holistic, and sustainable way.

  • An opportunity for truly representative communities (service providers, policy makers, families, children, and others) to work together on an agenda that is based on the science of child development. As Jack Shonkoff, M.D., Director of the Center on the Developing Child, notes: “Drawing upon science-informed insights combined with the lived experiences of families and communities, the expertise of service providers, and a diversity of political perspectives … can catalyze fresh thinking and more effective action.”  

Reframing the question does not mean that our collective past efforts have gone to waste. Rather, persistent attempts to increase access to services, reduce their fragmentation, build integrated delivery systems, and secure sustainable funding remain important objectives. These, however, cannot be the end goal and must always be in service of achieving greater outcomes for children and families.

How can we keep children and families front and center in this work?

The science of early childhood development, adversity, and resilience provides both a place to identify a powerful program frame and a set of insights to keep our work on track toward real, tangible change as we design solutions.

The Center on the Developing Child has identified a set of three design principles that are at the very core of supporting the development of strong brain architecture and biological systems. The principles are:

Grounded in science, these design principles can guide decision makers to think at all levels about the forces that could result in better outcomes for children. They can serve as a lens for seeing our programs, services, and policies differently, for rethinking how we deliver them, and for identifying areas where they are truly aligned with these principles and areas where they either don’t support the principles or actively work against them. Identifying these gaps or areas of improvement is where the real innovation can happen.

By using the science as a lens to reframe the challenge and monitor our progress, organizations, policy makers, and service providers from a range of sectors can begin to move toward breakthrough outcomes for children and families.

Now that is a problem frame that Einstein would be proud of.

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Hannah Barber joined the Center on the Developing Child in 2017. As Project Manager, Hannah leads strategy and content development for the Center’s Science X Design offering, a suite of strategies to support the design, evaluation, and scale of sustainable policies and practices using the latest insights from the science of early childhood development, adversity, and resilience. She works with a range of national and international innovators, including policy makers, system leaders, practitioners, and social entrepreneurs. Hannah brings extensive international experience in child development and adult learning.

She holds a BA in Politics and International Studies, a Master of Teaching from the University of Melbourne, and a Master of Education from the Harvard Graduate School of Education.

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To find out more about the Center on the Developing Child and how you can use the science in your work, please visit their website.