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Early childhood wrap: Leandro proposals and racial differences in infant deaths

Policymakers concerned about the critical beginning years of children’s lives have been busy over the past two weeks exploring crucial questions: How can the persistent racial disparity in North Carolina’s infant mortality rate be reduced? How can the state ensure educational opportunity to every child? And how can the state collect and analyze data in a way that is more accessible and more connected to long-term outcomes?

Leandro report calls for program access, strength in the educator pipeline

A court-ordered report from consultant WestEd, released last week, recognized high-quality early childhood education to be critical for meeting the state’s constitutional obligation, defined by the decades-long Leandro lawsuit case, to provide every child with a sound, basic education. “However, access to early childhood education remains out of reach for many low-income families in North Carolina,” the report says.

The report focuses on NC Pre-K, the state’s public preschool program for at-risk 4-year-olds, and Smart Start, a network of local partnerships that coordinate early childhood education and health services for families. It recommends more funding for both programs, highlighting that the state’s NC Pre-K allotments cover only 60% of the cost and that Smart Start funding has been severely cut in the last 10 years.

But the findings and recommendations also address other issues that hinder access. For Smart Start, the report recommends covering startup costs for programs and tweaking “the funding and infrastructure” for infants and young children “to build and maintain a robust array of early childhood programs with a high-quality workforce.”

Citing findings from a 2018 study from the National Institute for Early Education Research (NIEER), the report summarizes other challenges to expanding NC Pre-K: “The necessary number of qualified teachers to fill teaching slots, enough eligible/high-quality private programs to meet the need, the ability to meet the local funding match requirement, [and] transportation that enables families and program staff to get to centers.”

To address these challenges, the report recommends increasing the reimbursement rate for centers that have NC Pre-K slots to cover high-quality services, administrative costs, and full-day, full-year programming, as well as covering transportation costs and construction of new facilities to provide the needed slots. The report also suggests offering financial incentives to centers in high-poverty communities that receive four and five starts on the state’s rating system to reach the higher quality standards required to receive state NC Pre-K funding. 

The report calls for the program to focus on the children who need it most rather than expanding to universal access. Currently, the program reaches about half of eligible children. Eligibility is based on family income but also is affected by such factors as special needs, limited English proficiency, and parental military status. 

The report recommends building the early educator workforce by increasing salaries to reach parity with early elementary teachers, ensuring private and public NC Pre-K teachers are paid equally, expanding programs like WAGE$ and Infant Toddler Educator AWARDS, recruiting new educators through loan forgiveness and home-grown programs, and providing statewide professional development to increase teacher quality.

The report also calls for alignment between early childhood and K-12 systems, suggesting that pre-K and kindergarten teachers should support families as they transition between the two, that principals should receive training on early childhood education, and that a system of formative assessments should be consistent across systems. Once students reach early grades, the report says, funding should increase for school support personnel such as school counselors, social workers, nurses, and psychologists, and teaching assistants should be provided in early grades.

Black babies are more than two times more likely to die than white babies

In 2018, North Carolina’s infant mortality rate decreased for the third year in a row, reaching an all-time low of 6.8%. That percentage has slowly decreased over the last two decades (in 1991, it was 9.1%), but the disparity between white and black rates has persisted. In 1999, the black infant mortality rate was 2.3 times higher than the white rate. In 2018, that ratio was 2.4.

“A ton of hard work has gone into getting North Carolina’s infant mortality rate the lowest it’s been historically,” Mandy Cohen, secretary of health and human services, said at a recent meeting of an early childhood advisory council that reports to Gov. Roy Cooper. “The disparity in infant mortality is still a black eye for North Carolina; I’ll just say that.”

Cohen added that, compared with other states, North Carolina’s overall rate is still one of the highest in the country.

The state’s Early Childhood Action Plan, released in February, aims to reduce the racial disparity ratio to 1.92 by 2020. But there is not one clear way to do that. Keisha Bentley-Edwards, assistant professor at Duke University’s School of Medicine and researcher on social equity, encouraged policymakers to think of the issue as one inextricably connected to race. 

“Often times, it’s more expedient to talk about these disparities in terms of poverty because there is an overrepresentation of African Americans specifically in those that are impoverished,” Bentley-Edwards said. “However, we see these numbers when you look at black women who haven’t graduated from high school all the way to those who have a bachelor’s degree and higher and even a Ph.D.”

Bentley-Edwards added that the disparity persists even when controlling for such risky behaviors as alcohol and drug use, as well as obesity. She said researchers and medical practitioners need to listen and learn from the experiences of black women before, during, and after pregnancy, as well as after the experience of miscarriage or infant death.

“We have to recognize that black women are an expert on their own bodies,” she said. 

Interactions between women of color and medical professionals do not build trust, Bentley-Edwards said. Even for celebrities such as Serena Williams, whose nurse dismissed her symptoms of pulmonary embolisms after her pregnancy, leading to a near-death experience, implicit bias causes practitioners not to take black women seriously as advocates for their own health or their children’s health. She said training is needed in schools of medicine to fight those biases.

“You’ll find that black women, their self-advocacy is often interpreted as being ignorant, histrionic or disrespectful,” she said. “Sometimes there’s communication issues, and sometimes there’s willful ignorance.”

Bentley-Edwards said access to quality care and contraception, home visits during and after pregnancy, housing stability during pregnancy, and holistic programs that support women’s physical and mental needs during pregnancy can lead to better outcomes for black mothers and babies.

Adam Searing, Georgetown University health care researcher and associate professor of public policy, shared research that found that states that have expanded Medicaid coverage have seen 50% greater reductions in infant mortality rates. Those declines were greatest among black infants, he said.

Another statistic Searing shared may get at a root of the issue. About 75% of black births happen at a quarter of hospitals across the country. Searing said this hospital segregation is a result of a “separate but equal” clause that Southern senators fought for in a 1947 health care funding bill.

“The disparity is simply built into the system,” Searing said.

Cohen echoed that. “What we’re actually trying to do is repair decades — maybe centuries — of broken trust,” she said.

Birth-to-workforce data

To make smart policy decisions, more transparent and connected data are needed. At last week’s meeting of the B-3 Interagency Council, which brings together experts, policymakers, and practitioners from both the early childhood and K-12 worlds, members heard updates from individuals working to link data across government agencies and across individuals’ lives. Eventually, a statewide education longitudinal data system, required by state statute, will track students from early childhood through K-12 through higher education through workforce entry.  

“If we say that we want to change outcomes for young children and their families from birth through third grade, then we need a strong set of data and information to really make those strategic decisions possible,” said Rebecca Planchard, senior early childhood policy advisor at the Department of Health and Human Services.

The North Carolina Government Data Analytics Center (GDAC) is working to link three systems now in use: the Early Childhood Integrated Data System (ECIDS), NC SchoolWorks, and the North Carolina Department of Commerce’s Common Follow-up System (CFS). 

Partners from all education levels and several government agencies are at the table defining exactly what this system will be, how it will be accessed, and how much money the system will need from the state. GDAC has finalized rules for who will contribute to the system and how data will be requested from it, and has asked a team from UNC-Chapel Hill to lead a data modernization effort. Much of this foundational work will be done in early 2020. 

For more on what these data systems include, how they’re connected, and why a longitudinal data system is important for the state’s students, check out this piece by EdNC’s Analisa Sorrells.

Liz Bell

Liz Bell is the early childhood reporter for EducationNC.