Using Benefit-Cost Analysis to Scale Up Early Childhood Programs through Pay-for-Success Financing

Using Prevention Research to Reduce Racial Disparities in Health Through Innovative Funding Strategies: The Case of Doula Care

Racial disparities in maternal birth outcomes are substantial even when comparing women with similar levels of education. While racial differences in maternal death at birth or shortly afterward have attracted significant attention from researchers, non-fatal but potentially life-threatening pregnancy complications are 30-40 times more common than maternal deaths. Black women have the worst maternal health outcomes. Only recently have health researchers started to view structural racism rather than race as the critical factor underlying these persistent inequities. We discuss the economic framework that prevention scientists can use to convince policymakers to make sustainable investments in maternal health by expanding funding for doula care. While a few states allow Medicaid to fund doula services, most women at risk of poor maternal health outcomes arising from structural racism lack access to culturally sensitive caregivers during the pre-and post-partum periods as well as during birth. We provide a guide to how research in health services can be more readily translated to policy recommendations by describing two innovative ways that cost-benefit analysis can help direct private and public funding to support doula care for Black women and others at risk of poor birth outcomes.

"A win-win for all of us": COVID-19 sheds light on the essentialness of child care as key infrastructure

Child care centers in the United States allow many parents and caregivers to work in and outside of the home and support the growth and development of children. Child care closures and COVID-19 mitigation measures at the onset of the pandemic heightened the need for and awareness of the role of child care as core infrastructure. The purpose of our study was to examine the perceived role and benefits of child care based on the lived experiences of parents/caregivers and staff navigating child care during the pandemic. We conducted in-depth qualitative interviews with parents/caregivers (n = 20) of children who attended child care and staff (n = 12) who were working at child care programs in Ohio from September to November 2020. Qualitative data were coded and analyzed through the lens of four frameworks (i.e., capabilities, developmental, economics, and mutualism) related to child well-being. Our results highlight the perceived value of child care (a) for fostering capabilities and developmental growth in children; (b) for providing economic benefits for children, parents, and staff of child care programs; and (c) as an essential infrastructure that mutually benefits children, parents, families, staff, and the community. Findings support existing evidence regarding the broader impacts of child care and further investigation into the role of child care. We highlight the potential need for further investments in policies, resources, and supports for child care that reflects its essentialness and generative role.

Early Education and Adult Health: Age 37 Impacts and Economic Benefits of the Child-Parent Center Preschool Program

This paper evaluates the long-term impacts of the Chicago Child-Parent Center (CPC) program, a comprehensive early childhood program launched in the 1960s, on the physical and mental health outcomes. This study follows a cohort of 1539 participants born in 1979-1980 and surveyed most recently at age 35-37 by employing a matched study design created by including all students who were enrolled in kindergarten classrooms in CPC school sites as well as entire kindergarten classrooms in a matched set of similar high-poverty schools. Using propensity score weighting that addresses potential issues with differential attrition and nonrandom treatment assignment, results reveal that CPC preschool participation is associated with significantly lower rates of adverse health outcomes such as smoking and diabetes. Further, evaluating the economic impacts of the preschool component of the program, the study finds a benefit-cost ratio in the range of 1.35 to 3.66 (net benefit: $3,896) indicating that the health benefits of the program by themselves offset the costs of the program even without considering additional benefits arising from increased educational attainment and reduced involvement in crime reported in earlier cost-benefit analyses. The findings are robust to corrections for multiple hypothesis testing, sensitivity analysis using a range of discount rates, and Monte Carlo analysis to account for uncertainty in outcomes.

Use of social impact bonds in financing health systems responses to non-communicable diseases: scoping review

There is an interest to understand how social impact bonds (SIBs), a type of innovative financing instrument used in impact investment, can be used to finance the prevention of non-communicable diseases (NCDs). This is the first scoping review that explores the evidence of SIBs for NCDs and their key characteristics and performance. The review used both published and grey literature from eight databases (MEDLINE, NCBI, Elsevier, Cochrane Library, Google, Google Scholar, WHO publications and OECD iLibrary). A total of 83 studies and articles were eligible for inclusion, identifying 11 SIBs implemented in eight countries. The shared characteristics of the SIBs used for NCDs were impact investment companies as investors, local governments as outcome payers, not-for-profit service providers and an average US$2 015 456 private initial investment. The review revealed a lack of empirical evidence on SIBs for NCDs. Conflict of interest and lack of public disclosure were common issues in both the published and grey literature on SIBs. Furthermore, only three SIBs implemented for financing NCDs were meeting all their target outcomes. The common characteristics of the SIBs meeting their target outcomes were evidence-based interventions, multiple service providers and an intermediated structure. Overall, there is a need for more high-quality studies, particularly economic evaluations and qualitative studies on the benefits to target populations, and greater transparency from the private sector, in order to ensure improved SIBs for preventing NCDs.

Roadmapping New Impact Bonds in a Post-COVID World: Insights from Case Studies in the Education Sector

In the last year, COVID-19 has tested both advanced and developing economies. Within such a context, the global learning crisis is expected to increase due to difficulties in accessing technology or in receiving learning support. Such a huge need, globally identified with the Sustainable Development Goal number 4 (hereafter SDG 4), implies the need for large-scale solutions from governments around the world, especially in terms of dedicated financial resources. In this context, the impact-investing sector offers an innovative financial tool, i.e., impact bonds (IBs), which are widely applied in the education sector, even if their limitations and potentials remain unexplored in academia. Based on these considerations, our work explores whether and how IBs can contribute to funding and improving educational outcomes, with a focus on their potentials in the post-COVID world. This study adopts a qualitative approach by performing a case study analysis of four IBs. Our pilot analysis is based on the following key dimensions: (i) partnerships and contractual arrangements; (ii) financial terms; and (iii) measurement and impact. The results offer interesting insights by deriving a preliminary model on the role of IBs in the post-COVID-19 world.

Reducing poverty and inequality through preschool-to-third-grade prevention services

The contributions of psychology to the development and evaluation of preschool-to-third-grade prevention programs are analyzed with an emphasis on poverty alleviation through implementation of effective services for a greater number of children. The need to alleviate poverty and increase economic success is high. Early childhood programs have been found to be an effective strategy for promoting educational success and economic well-being, but the availability of high quality programs that are aligned and integrated with schools across the learning continuum is limited. Psychology has made major contributions to knowledge and practice in (a) defining and evaluating educational enrichment and (b) understanding mechanisms of behavioral change. As an empirical illustration of these contributions for enhancing economic well-being, we report new midlife income data in the Child-Parent Centers, a preschool-to-third-grade program that integrates the two major contributions to improve life course outcomes. Based on a well-matched alternative-intervention design with high sample retention (86%; N = 1,329), findings indicate that participation was associated with a 25% increase in average annual income at age 34 years ($22,708 vs. $18,130; p < .01). Graduates were also more likely to be in the top income quartile (≥$27,500; 30.7% vs. 20.2%; p < .01). Most of the main effects were explained by cognitive, school, and family factors, though further corroboration is needed. Implications for strengthening the impacts of early childhood programs as an avenue for increasing well-being and reducing inequality emphasize redressing ecological barriers, improving continuity and alignment with other strategies, and implementing effectiveness elements widely. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Scaling up Evidence-Based Interventions in US Public Systems to Prevent Behavioral Health Problems: Challenges and Opportunities

A number of programs, policies, and practices have been tested using rigorous scientific methods and shown to prevent behavioral health problems (Catalano et al., Lancet 379:1653-1664, 2012; National Research Council and Institute of Medicine, 2009). Yet these evidence-based interventions (EBIs) are not widely used in public systems, and they have limited reach (Glasgow et al., American Journal of Public Health 102:1274-1281, 2012; National Research Council and Institute of Medicine 2009; Prinz and Sanders, Clinical Psychology Review 27:739-749, 2007). To address this challenge and improve public health and well-being at a population level, the Society for Prevention Research (SPR) formed the Mapping Advances in Prevention Science (MAPS) IV Translation Research Task Force, which considered ways to scale up EBIs in five public systems: behavioral health, child welfare, education, juvenile justice, and public health. After reviewing other efforts to scale up EBIs in public systems, a common set of factors were identified as affecting scale-up in all five systems. The most important factor was the degree to which these systems enacted public policies (i.e., statutes, regulations, and guidance) requiring or recommending EBIs and provided public funds for EBIs. Across systems, other facilitators of scale-up were creating EBIs that are ready for scale-up, public awareness of and support for EBIs, community engagement and capacity to implement EBIs, leadership support for EBIs, a skilled workforce capable of delivering EBIs, and data monitoring and evaluation capacity. It was concluded that the following actions are needed to significantly increase EBI scale-up in public systems: (1) provide more public policies and funding to support the creation, testing, and scaling up of EBIs; (2) develop and evaluate specific frameworks that address systems level barriers impeding EBI scale-up; and (3) promote public support for EBIs, community capacity to implement EBIs at scale, and partnerships between community stakeholders, policy makers, practitioners, and scientists within and across systems.

The Power of P-3 School Reform

Arthur Reynolds describes the significance, development, and effects of preschool to 3rd grade approaches. This school reform strategy integrates services and supports transitions, thereby increasing achievement, sustaining gains, and realistically reducing achievement gaps. Evidence from the Child-Parent Center (CPC) program is reviewed to illustrate key principles, strategies, and elements. Data from the Chicago Longitudinal Study and the more recent Midwest CPC expansion show that the program is effective in enhancing the transition to school and promoting longer-term well-being.

Scaling and Sustaining Effective Early Childhood Programs Through School-Family-University Collaboration

We describe the development, implementation, and evaluation of a comprehensive preschool to third grade prevention program for the goals of sustaining services at a large scale. The Midwest Child–Parent Center (CPC) Expansion is a multilevel collaborative school reform model designed to improve school achievement and parental involvement from ages 3 to 9. By increasing the dosage, coordination, and comprehensiveness of services, the program is expected to enhance the transition to school and promote more enduring effects on well‐being in multiple domains. We review and evaluate evidence from two longitudinal studies (Midwest CPC, 2012 to present; Chicago Longitudinal Study, 1983 to present) and four implementation examples of how the guiding principles of shared ownership, committed resources, and progress monitoring for improvement can promote effectiveness. The implementation system of partners and further expansion using “Pay for Success” financing shows the feasibility of scaling the program while continuing to improve effectiveness.

The title for this Special Section is Bringing Developmental Science into the World, edited by Roberta Michnick Golinkoff, Kathy Hirsh‐Pasek, Rachel Grob, and Mark Schlesinger

School Readiness in the Midwest Child-Parent Center Expansion: A Propensity Score Analysis of Year 1 Impacts

In this paper, we evaluate the effectiveness of the first year of a federally-funded, evidence-based preschool through third grade intervention in Chicago. We use inverse probability weighting with regression adjustment to estimate the impacts of the Child-Parent Center (CPC) program on teacher assessments of school readiness for 1,289 low-income preschool and 591 comparison-group participants. Results indicated significant positive impacts of the program for all domains, including literacy, math, socio-emotional development, science and total score. The percentage of CPC children who met national norms in school readiness exceeded the comparison group by 12 to 18.5 percentage points. Full-day participants experienced greater school readiness gains while program impacts were similar by family income and home language. Compared to the original CPC evaluation of children born in 1980 in which few comparison group children attended preschool, we find evidence that the contemporary implementation performs at least as well even though the current comparison group participants had alternative preschool experience.

Using social impact borrowing to expand preschool through third grade programs in urban public schools

Budget constraints and difficulty raising taxes limit school districts from expanding education programming even when research shows that additional expenditures would generate economic benefits that are greater than costs. Recently, coalitions of private investors, philanthropists, education practitioners, and government finance analysts have emerged to create opportunities to expand education services that promise high rates of social net benefits without raising taxes or reducing other expenditures. These collaborators have a strong interest in obtaining careful estimates of educational program effectiveness. We describe the use of social-impact borrowing to increase access to the Child-Parent Center preschool-through-third-grade intervention for at-risk students in the Chicago Public School District. The partners include the city, school district, investors, nonprofit organizations, and a university. The key to the feasibility of social-impact borrowing is the ability to document that early intervention can reduce the need for later special-education services. With the help of private investors and nonprofit organizations, it is possible for public school districts to finance services with funds from private sources and use future cost savings to repay this debt. We discuss how social-impact borrowing is being used in Chicago and in Salt Lake County as the nation's first two instances of using pay-for-performance social-impact borrowing to support early education.