Part II
In Part I of this blog post we explored and laid the foundation for Parts II and III by looking at the effects of ACEs including toxic stress, atypical brain development, and behavioral implications. In Part II we will be looking at different proactive strategies we can implement on a societal level to ensure that children’s needs are met in the early years, including implementation of paid maternity and paternity leave, continuation and improvement of home visit programs, and access to parenting and child development education. We will stop there, saving adolescence and adulthood for Part III.
In the final weeks of pregnancy and in the first few months of a child’s life, parental leave is an important component of setting the stage for the years ahead. Bonding in the first few months and years of life is linked with positive long-term socio-emotional, cognitive, and behavioral outcomes. Currently, the United States is the only developed country in the world that does not provide paid parental leave, instead providing twelve weeks unpaid with job security. Only six states have some form of paid leave, with varying lengths of duration, compensation, and possible job protection. The past few decades have seen quite a bit of research into this topic, and the findings are clear that paid leave is worth the cost.
Paid maternity leave has been shown to decrease stress, anxiety, and depressive symptoms in the mother while also reducing risk of rehospitalization by half. When mothers have more time off after giving birth, they are more likely to breastfeed for longer and to do so exclusively; the CDC’s official recommendation is to breastfeed exclusively for the first six months following childbirth. Health benefits to the child include strengthening the immune system, promoting positive brain development, lowering the risk of infection, and reduced risk of SIDS (Sudden Infant Death Syndrome). In fact, several studies have shown statistically significant reductions in both infant and child mortality when mothers have access to paid leave following childbirth. Though there is less data on paternity leave, evidence shows a positive impact on stress levels in the mother. Additionally, fathers who spent more time caring for their newborn showed increased connectivity between two areas of the brain that play a role in building empathy. Finally, one of the most well-documented and referenced studies addressing paid parental leave is a study from Norway that began in 1977 and continued into the early 2000s. After shifting their policy from 12 weeks of unpaid to 16 weeks of paid maternal leave, there was a decrease in the high school dropout rate and a 5% increase in earnings by age 30 for the children who were participants in the study.
An honest review of the evidence reveals there is a strong argument to be made for policy changes that provide families financial security and time to bond with their children in the months following birth. Maternity leave should be prioritized first as mothers need recovery time following pregnancy and to intimately bond with their baby. Paternity leave could be negotiated at a later time when maternity leave has become entrenched in our culture. While we pay an up-front cost with every new life that enters this world, the long-term outcomes cannot be understated as children are more likely to grow up healthy. This policy change would be the first step towards creating a better future for our children and society at large. Next, we will take a look at home visiting.
Home visiting, an opt-in service that seeks to support at-risk children and families in a variety of ways, has slowly become part of the social services fabric within the United States in the past fifteen years. The main goal of home visiting is to improve the overall well-being of children and families in the following domains:
- Prenatal, maternal, and newborn health
- Child health and development, including child maltreatment
- Parenting skills
- School readiness and child academic achievement
- Crime and domestic violence
- Family economic self-sufficiency
- Referrals and service coordination
A variety of service models are in existence that vary in focus, scope, visit frequency, and service duration. Some programs specialize in two of the above categories while others run the gamut. Funding for these programs has generally come from the US federal government, however, supplemental funding has been found in state programs such as Medicaid. In addition to federal funding, there has been ongoing data collection and analysis to ensure programs are effective and improve over time. The Mother and Home Visiting Program Evaluation (MIHOPE) has concluded that home visiting is an overall effective intervention to improve family life, to varying degrees in different categories and across service models. A few key findings include the following:
- The largest benefits from evidence-based early childhood home visiting come through reduced spending on government programs and increases in individual earnings
- Home visiting programs have had fairly consistent effects on family economic self-sufficiency
- In the area of children’s long-term health, studies of home visiting have found reductions in substance use among young adolescents and reductions in mortality by age 20
- Home visiting’s benefits generally exceed its costs over longer periods
While MIHOPE found home visiting to be an overall effective intervention, the report’s authors do acknowledge that “although effects have been found for many ages, outcome areas, and models, statistically significant findings are the exception rather than the rule”. This would suggest that all models are not created equal and that there is room for overall improvement in the world of home visiting. MIHOPE identified one area for improvement, stating that “parenting has been examined less often than other outcome areas in families with school-aged children, and there is little evidence of improved parenting in families with school-aged children.” Implementing more robust data collection and improving service delivery in this domain would appear to be essential goals moving forward. Additionally, increasing communication and collaboration across various service models to identify what works and what does not, and perhaps outlining standards, would also appear to be the keys to evolving and improving overall service delivery in the home visiting sphere. Next, we’ll take a closer look at the importance of parenting and child development education.
One of the benefits of home visiting is that each model is connected to at least one of the protective factors, while some of them are connected to all five. Since not all home visiting models provide support around child development education or parenting, it is important to ensure parents have access to parenting education in their community, whether that is through a non-profit, family success center, or other agencies and institutions that provide resources and support.
An ideal place to start when educating first-time parents is the five protective factors. These five concepts, which include the importance of social connections, having concrete support in times of need, parental resilience, knowledge of child development, and social-emotional competence in children, are essential when considering the health of a child and the environment they grow up in. This knowledge lays the foundation for understanding the essential ingredients that contribute to successful parenting.
One of the five protective factors, knowledge of parenting and child development, provides a level of expectation and a chance to prepare for what is to come. One study states, “…because parents are the main caregivers of young children, the extent and quality of their parenting knowledge is vital to children’s wholesome development”. Despite the importance of this parenting feature, 75% of mothers who were surveyed reported they could use more education in at least one area of parenting, while half reported they could use more education in three or more.
One area that parents seem to be less prepared for is infancy. Research has shown that “…parents are less tolerant of infantile than mature behaviors and prone to abuse children they perceive as lagging in expected development”. A normal behavior observed in infants is long stretches of inconsolable crying. This behavior can be extremely challenging for new parents and is the number one trigger for what is known as shaken baby syndrome (SBS), a form of abuse in which the parent is overwhelmed with frustration and anger, subsequently shaking the baby violently and causing severe brain injury. The Shaken Baby Alliance, an organization that educates people about SBS, has rolled out “…a structured educational program regarding infant crying patterns, the dangers of violent shaking, and ways to cope with infant crying, including a crying plan…” While crying is the number one SBS trigger, there are others on the list such as feeding issues, potty training, and interrupting an activity the caregiver is engaging in. SBA’s educational program, as well as others, can help parents navigate the challenges of infancy and childhood.
Early research into the efficacy of parenting education has shown that it has benefits for both parents and children. Covering topics such as learning and play, rules and routines, and managing relationships, parents in a UK study self-reported that their parenting skills had improved after more than two sessions of instruction. In another study looking at the long-term effectiveness of parenting education, researchers found that “…child behavior problems and parental mental well-being were significantly maintained during sustained implementation…” (of the concepts and skills learned in the classroom). Formal instruction, however, is not the only method of learning how to improve parenting skills. Some parents attend parenting support groups, and in one study of a peer-to-peer group of adults with developmentally disabled children, the parents reported learning from one another and felt that they could go to the group with a problem they were unable to solve at home, get the necessary support, and effectively tend to their child. Although research on the topic of parenting education outcomes needs more exploration, existing research indicates there are benefits to these types of programs.
As a society, there are policy changes and cultural shifts we can make to help benefit our children and improve developmental outcomes. Providing support to and educating parents is one, while providing paid time off after childbirth is another. By implementing, improving, and evolving these interventions, we are taking a proactive approach to promoting healthy development rather than reacting to the fallout years down the road. While we try to do what we can to improve outcomes, there will always be those who we are unable to reach and who grow up in less-than-ideal circumstances that wind up facing challenges as teens and adults. In Part III we will be exploring ways to address those challenges by giving people a chance at redemption.
Sources:
https://www.ncbi.nlm.nih.gov/p...20parents%20%5B11%5D.
https://www.apa.org/monitor/20...ature-parental-leave
https://www.journals.uchicago....i/abs/10.1086/679627
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4934583/
https://www.americanactionforu...mily-leave-policies/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7367791/
https://shakenbaby.org/what-is-shaken-baby-syndrome/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7040847/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6232939/
https://www.sciencedirect.com/...399119302964#bib0095
The Mother Infant Home Visiting Program Evaluation
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