The Brain Architects - Center on the Developing Child at Harvard University

**The Brain Architects Podcast: Extreme Heat & Early Childhood Development: A Discussion on Rising Temperatures and Strategies for Supporting Development and Lifelong Health** May 21, 2024

Contents

Podcast

Panelists

Additional Resources

Transcript

In April 2024, we hosted a webinar where we explored the science from our latest working paper, Extreme Heat Affects Early Childhood Development and Health. The Center’s Chief Science Officer, Dr. Lindsey Burghardt, joined by Dr. Kari Nadeau, Chair of the Department of Environmental Health at Harvard’s T.H. Chan School of Public Health, brought the latest research and insights from the field to discuss the intersection of heat, early childhood development, and health equity. They also discussed actionable solutions to benefit children, caregivers, and communities now and in the future. The webinar discussion has been adapted for this episode of the Brain Architects podcast.

Panelists

Lindsey Burghardt, MD, MPH, FAAP
Chief Science Officer, Center on the Developing Child at Harvard University

Kari Nadeau, MD, PhD
Chair of the Department of Environmental Health, Harvard’s T.H. Chan School of Public Health

Rebecca Hansen, MFA *(Webinar Host)*
Director of Communications, Center on the Developing Child at Harvard University

Cameron Seymour-Hawkins *(Podcast Host)*
Communications Coordinator, Center on the Developing Child at Harvard University

Additional Resources

Extreme Heat Affects Early Childhood Development and Health

Heat: An Action Guide for Policy

Webinar Recording: Extreme Heat and Early Childhood Development

Place Matters: The Environment We Create Shapes the Foundations of Healthy Development

Place Matters: What Surrounds Us Shapes Us

Transcript

Cameron Seymour-Hawkins: Welcome to The Brain Architects, a podcast from the Center on the Developing Child at Harvard University. I’m Cameron Seymour-Hawkins, the Center’s Communications Coordinator. Our Center believes that advances in the science of child development provide a powerful source of new ideas that can improve outcomes for children and their caregivers. By sharing the latest science from the field, we hope to help you make that science actionable and apply it in your work in ways that can increase your impact. 

In April, we hosted a webinar where we explored the science from our latest working paper, Extreme Heat Affects Early Childhood Development and Health.

The Center’s Chief Science Officer, Dr. Lindsey Burghardt, joined by Dr. Kari Nadeau, Chair of the Department of Environmental Health at Harvard’s T.H. Chan School of Public Health, brought the latest research and insights from the field to discuss the intersection of heat, early childhood development, and health equity. They also discussed actionable solutions to benefit children, caregivers, and communities now and in the future.

We’re excited to share this conversation on today’s episode of the Brain Architects.

Now, without further ado, here’s Rebecca Hansen, the Center’s Director of Communications, who will set the stage for our conversation. 

Rebecca Hansen: Hello, everyone, and welcome. We’re very happy to have you all with us for today’s webinar, Extreme Heat and Early Childhood Development: A discussion on rising temperatures and strategies for supporting development and lifelong health. Whether you’re joining us for the first time or have been a regular at our webinars here at the Center on the Developing Child, we are very happy to have you with us today.

So, today’s webinar is grounded in the first working paper from the Early Childhood Scientific Council on Equity and the Environment. The council is a multidisciplinary group that synthesizes and communicates about emerging science that can help to improve our understanding of how influences from the broader environment affect early childhood development and also lifelong health. The council’s first working paper, published earlier this year, focuses on the many ways that heat can affect development, including its impact on young children’s biological systems and how it can amplify the effects of systemic inequities.

The paper offers strategies to mitigate the impact of extreme temperatures and points toward actionable solutions for cooling the communities where children live, grow, learn, and play. And we look forward to diving into these strategies throughout today’s conversation.

So, without further ado, I am going to introduce our panel, starting with a note that while we had hoped to be joined today by Dr. Gaurab Basu, he was unfortunately unable to be here. We do have with us Dr. Lindsey Burghardt, who is Chief Science Officer at the Center on the Developing Child, where she develops and leads the center scientific agenda. She is also founding director of the Early Childhood Scientific Council for Equity and the Environment and leads their efforts to synthesize and communicate about the scientific mechanisms related to how children’s environments shape their development. Dr. Burghardt engages regularly with diverse stakeholders and audiences, with the aim of making the science both accessible and actionable. She is also a practicing primary care pediatrician in the community outside of Boston.

Dr. Burghardt is joined today by Dr. Kari Nadeau, who is chair of the Department of Environmental Health, and John Rock, professor of climate and population studies at the Harvard T.H. Chan School of Public Health. Dr. Nadeau is a practicing clinician specializing in allergy, asthma and immunology in children and adults, and she has published over 400 papers, many in the field of climate change and health, for more than 30 years. She has devoted herself to understanding how environmental and genetic factors affect the risk of developing allergies and asthma, especially wildfire induced air pollution. Her laboratory has been studying air pollution and wildfire effects on children and adults, including wildland firefighters. Dr. Nadeau is also a member of the Early Childhood Scientific Council on Equity and the Environment. And we are very happy to have her here with us today.

And with that, I will turn it over to Dr. Burghardt to begin our discussion.

Lindsey Burghardt: Thanks, Rebecca. I’m so excited for this conversation today. Thrilled to have Kari here with us. I’m just going to start by setting the stage a little bit for why this feels like such a timely and important conversation. And then we’ll dive right in. You know, I think many of us have recognized from our own experiences that temperatures are rising around the world. And, you know, science is confirming we’re having record setting heatwaves that are happening more often and they’re lasting longer than they have ever before. So I think with these increasing temperatures and with the increased frequency of these events, it makes this topic really timely and important because it’s something that’s already affecting kids and their caregivers today. And we know that excessive heat impacts kids development, both in the moment, but also potentially across their lifespan. And the good news is that there’s a lot of solutions that already exist and that communities are putting into effect already with really good results. So we’re going to talk today about how extreme heat affects development, the potential effects in pregnancy and throughout early childhood, and then get into some of those actionable solutions and thinking about how heat works to affect development. We really know that it starts with an understanding that environment influenced all children’s development by shaping the exposures and the experiences that they have. And this developmental environment is really the full range of exposures and experiences that they have in places where they live and learn and play and grow. And so what’s surrounding children is quite literally shaping their biology. But importantly, you know, these experiences and exposures can be positive or they can be negative. So environments can have exposures and experiences that fuel positive development, things like really strong foundational relationships with their caregivers and access to green space and breathing clean air. Or they can be more negative or potentially derail development. So things like extreme heat or breathing toxic air from wildfire smoke.

So climate change is coming in and it’s creating and shaping changes to this environment of exposures and experiences. And it’s really important to understand, too, that these effects are not only direct on their biology, like breathing in their toxic wildfire smoke, but they’re also indirect and that things like extreme weather events and flooding can cause displacement that then places enormous stress on caregivers, which then has an important effect on those foundational relationships. And when it comes to climate change, this is just the first in a series of conversation that we’re hoping to have about how climate change is shaping developmental environments. And today we’re going to talk about Heat and, Kari, it’s just so amazing and special to have you join this conversation as just really an expert and really thoughtful thought leader in this space. So thank you.

Kari Nadeau: Thank you. I’m so excited to be here. I’m a pediatrician. I’m a parent. I’ve lived and dealt with heat stress myself as well as climate change. So I’m really happy to be here. As the department chair of Environmental Health, we work a lot with climate change in the global environment, and so our health is inextricably related to earth cell and we need to really focus on early development of children.

And today, I’ll talk a little bit about how heat, specifically heat stress affects children, because now with climate change here on our planet, every child born today will suffer from at least one severe weather condition associate of climate change and most likely that will be heat. You, I’m sure, all heard on the news that last summer was the hottest summer on record for our earth and unfortunate it will likely be the coolest summer on record for our in the future.

So we not only have to talk about solutions today, but we absolutely must talk about how those solutions affect children and pregnant women and how it affects the early development of the child. So I’m excited, Lindsey, for your wonderful seminar today and happy to answer any questions from you as well as from the audience at the end.

Lindsey Burghardt: Yeah, Thanks, Kari. And actually, I am going to hopefully intersperse. We’ve got so many amazing questions that really helped to guide how we shaped the discussion today. And one question that I get a lot that came up quite frequently from the audience when it comes to heat is what do we mean? Like when we say extreme heat or excessive heat, What does that mean? How are people thinking about definitions and how do we kind of start from a common understanding?

Kari Nadeau: Yeah, that’s a great question. So when we talk about heat, especially in babies that tend to have a lot of extra tissue around, especially with children who are moving around and toddlers who are on the move, typically what we call heat that could affect them physically, mentally, in a in a way that’s not good for their bodies is 85 degrees Fahrenheit. So that’s what people think above, which if you’re exercising and moving a lot, it can actually be a problem for your health. So 85 degrees Fahrenheit is really where we keep the thresholds.

Lindsey Burghardt: Yeah, that’s super helpful. And I think, you know, the next question that usually follows is what about places where it’s been warm for quite a while? You know, how do we think about heat differently? You know, if you’re somebody listening in from someplace like Boston, that’s typically more cool and dry. How do we think about Heat and children’s the way that they’re going to experience is increasing temperatures differently or the same as a child who has always lived or whose family has always lived in a place that it’s typically more humid or hot.

Kari Nadeau: Right. So as we all know, we grow up in areas of the world with certain cultural habits. And we also make sure that our children are part of those cultural habits as a family. And those are good things. We’re part of that overall environment to take care of the next generation. And with that, for example, in Boston, we tend to have colder weather in New England.

But the problem with 85 degrees is if it’s in April versus July, where we’re prepared in July to have warmer weather, people already have their clothes out, their shorts are bathing, suits have pools open. But in April, not so much in the middle of Boston. And so people are used to having colder weather. So therefore, they’re going to dress their children and dress themselves up with warmer type layers of clothing and so that’s a problem because part of dealing with heat physiologically is to evaporate our sweat.

And if we can’t evaporate our sweat, especially for babies and toddlers, because they’re not just little adults, they have different ways of evaporating from their skin because they don’t have as much skin surface area. So it’s actually more dangerous for children not to be prepared for these high temperatures in areas of the world that they’re not used to.

That, for example, in Switzerland, there were places in the Alps that had absolutely no air conditioning ever. They just didn’t have it because they never thought they need it. And two years ago, they had summer conditions of greater than 100 degrees Fahrenheit and people were not ready. So the children had terrible heat, stress and exhaustion just because people aren’t ready.

And so we need to when you think about preparing the rest of the world, you’re right. There are places in the global majority and near the equator that are used to heat, but they’ve already adopted the methods to be able to deal with heat that I’ll talk about later on today, because those are methods that have been central to the ecological knowledge of that community that now we have to be humble and listen to so that we ourselves can take the same steps to protect our children.

Lindsey Burghardt: And that makes so much sense too. And thinking about like, you know, we’re used to something in July that we’re not prepared for in April or even in October. And I think in Boston in particular, we experienced this when it came to our schools and our early care and education settings, which by design were made to keep heat in, you know, and are not adapted then to kind of handle those higher temperatures at times of the year where children are more accustomed to spending time inside.

So I’m excited to get into that, you know, a little bit later on. So can you talk about, you know, under the skin, how does our body respond, you know, when temperatures increase and how is that different? How is the response different? As you mentioned, it really young children, especially infants who have different physiology.

Kari Nadeau: Yeah. So on one side, when we deal with stressors, our body handles stress in some similar ways.

So there’s just a certain pathway that when we deal with early life stressors, it’s similar with heat. There are and pathways that are very similar to other stress pathways. So what I like to think about is these types of life stressors that affect children, especially early on. So and the reason we know so much of this biology is because unfortunately animals out in animal husbandry and agriculture have dealt a lot with heat stress and so have their babies.

And so we know a lot about mammals and how babies have to deal with heat stress. And so biologically, what will happen, especially even after three exposures of heat waves of 85 to 100 degrees Fahrenheit, where you’re dealing with overheating for more than two days in a row. With that in mind, we’ve seen that these proteins called heat shock proteins, can get activated.

And the reason I don’t want you all to have to know the molecular mechanisms here, but the important thing is this it’s real, it’s documented. We’ve documented in animals, we’ve documented it in human babies. Key proteins get activated. And why is that important? Because these are stress or proteins that are meant to keep everything stable, to keep everything happy in our blood.

The minute that they get stressed, the minute that the heat goes up, then unfortunately, they start to activate a pathway that inflames our body. And inflammation is not good. I hope that none of you have to suffer through inflammation, but it can result in disease, it can result in autoimmunity, it results in allergies, it can result in gut problems and skin problems.

So when our immune system is not happy, it’s not good for a baby, good for a toddler. It’s also the heat itself. Those heat shock proteins are in the brain, so they can also affect cognition and mental health. So unfortunately, our human body is not meant for high amounts of heat. And you could say, well, we learned that the human body stays at an equal temperature and that when we have a fever, we have heat.

And when children have a fever, they deal with high amounts of heat. That’s true, but it’s not continual. It’s not for five days constantly, for example. And if you don’t hydrate, if you don’t have opportunities to try to decrease that heat, that’s what can lead to trouble. And what we’re finding is that that can be irreversible in babies and toddlers because they’re so sensitive to heat

Lindsey Burghardt: And those huge shock proteins themselves to have important functions.

Right. Like they protect your hemoglobin, like other things that are really important in making your other body systems again. And so it’s sort of this really interconnected series of effects, it seems like.

Kari Nadeau: Yeah, that’s right. So these heat shock proteins are kind of nannies and caretakers for other things in your blood and kind of they’re patrolling the universe to make sure everything else stays really stable and the proteins don’t turn into denatured proteins.

And what why do I say denatured? Well, if everyone has basically cooked an egg or made egg whites into a whip, they know that if you whip things up, that egg white can actually turn into a foam. And that’s what I mean. If you heat up the human body too much, especially in children, your other proteins start to turn into foam and that’s not good.

So these heat shock proteins are meant to take care of that. And when they’re disrupted, when they’re too hot, they can’t. So it leads to big problems.

Lindsey Burghardt: And it’s amazing that we understand that cellular level, you know, where when we think about heat, especially in these sensitive groups thinking about even before birth. Right. What are the effects of heat on pregnancy and pregnancy outcomes Because those of us who think about young children, you know, think about how early brain development really starts and how we can both understand the impacts and then think about protecting groups that might be especially sensitive to heat.

Kari Nadeau: Yeah, let’s talk about that. That’s really important because as we think about the ways that heat affects infants, toddlers, early development, it really does start a lot of the times in utero. And looking at maternal health is critical. When a woman is pregnant, her heat exchange is different. And for us that remember being pregnant, you get hot much faster because your metabolism is higher.

You’re pumping out much more blood than another typical person that’s not pregnant. And you’re also carrying a lot more weight. And so that’s hard to release heat as well as other people that aren’t pregnant. And you’re also taking care of another, you know, sort of whole organism. And so with that, in mind, people that are pregnant have much more sensitivities to heat.

So when I talk 85 degrees Fahrenheit, we actually don’t know the threshold for pregnant women. But we do know that pregnant women are exposed to heat waves, for example, a hundred degrees more than three days in a row. And if they haven’t been given or afforded the ability to get inside, to hydrate, to be in cool rooms, that can lead to prematurity of the child, that can lead to, unfortunately, sometimes premature deaths of the baby and can lead to health issues of the mother herself.

So with blood pressure changes and other aspects to her health, that needs to be taken care of right away. So heat has a direct effect on pregnant women. And importantly, we don’t know enough about how that affects the child that’s born after delivery. And so people are watching that. And we’re following a group now, for example, in the Central Valley in California.

But it is important to follow because we need to see to what extent that heat effect and as a woman who’s pregnant affects also her child.

Lindsey Burghardt: And I think, you know, many people may be familiar with this idea of heat stress or heat stroke in older people or in, you know, children who are athletes. And we kind of can conceptualize that. But there’s also really important effects of heat on our youngest children in terms of their behavior and sleep and their learning. Can you speak a little bit to that?

Kari Nadeau: Sure. It’s really important to know that our bodies were really meant to be at around 75 degrees Fahrenheit outside. We might be 98.6 degrees Fahrenheit inside our body, but that’s not what we like outside.

And so especially children, you know, they can get cranky. Adults sleep so well, it’s really hard because they’re metabolizing so fast. Infants also have that nice layer of fat. Typically, it’s hard for them to go to sleep and it’s hard for them to stay asleep because they’re constantly trying to cool themselves. So it’s really important to develop methods by which to make it more comfortable for early child development as well as infants and babies and toddlers.

So with that in mind, knowing that that age group is much more sensitive, there’s a lot of downstream issues that happen. If you’re cranky, if you can’t eat as well, you’re just don’t feel hungry. You also don’t want to play outside as much. Those are types of interactions that are really important for the cognitive development of any child in early development.

The other problem is that we know that in early child development, every degree Fahrenheit increase on the outside environment can actually lead to a 1% decrease in test scores. Now, we’re not scoring the average toddler. We know that in terms of tests, but it’s important to know that it affects the brain and affects how the brain is going to function.

And so, again, our body is not meant to be in greater areas than 75 degrees Fahrenheit to optimally. We don’t want to have to work in that type of temperature or develop in that type of temperature that’s higher than that. And when it does get higher, our brain literally does not function as well. And we have data on that for children.

Lindsey Burghardt: And I think, too, as a mother, I can remember having three small children and how sort of my own behavior and ability to regulate my own emotions changes in a room that’s, you know, 98 degrees and humid and how that affects the foundation. Our relationship, when I show up for those young children, you know, it’s stress on me that translates to my ability to be present and provide the things that are so important for child development.

And I’ve learned, too, that. Is it true that, you know, we all of us need a subtle drop in temperature to facilitate sleep onset? And so for you and when we don’t have that, you know, you mentioned trouble falling asleep and having more frequent waking is true of children. And then also the adults who are having more disrupted sleep who can then, you know, be available in a really different way the next day, you know, feels important. And we think about, you know, oh, sorry, go ahead.

Kari Nadeau: Now, you’re absolutely right. We’re trying to create the best environments, indirect and directly for our children. And adults don’t get good sleep, which oftentimes happens when it’s hot. You’re right. We use just the lower temperature to be able to just fall asleep for any of us on this earth.

But I do worry about this because indirectly, heat and living in high areas where there might be violence, the violence actually increases outside and inside the household. And children, unfortunately, are sometimes the victims of this violence or see it, and it’s very stressful to them. So it affects how we behave as adults and it also affects some other behaviors that are irreversibly damaging to children.

Lindsey Burghardt: And I think, you know, so many of the what we know about how heat changes behavior and leads to increase and in different types of violence, as you mentioned, is getting more measured and available in adults. I think it’s more difficult to measure. I think we haven’t yet, but it would be really interesting to understand how heat really affects the behavior of toddlers and young children, because I think it makes sense that their ability to regulate their own emotions is going to be maybe even more sensitive than ours.

And we know that this is something that’s affecting adults. So we can only assume that it’s going to affect kids, you know, as much, if not more. And, you know, our conversations about sleep and behavior got me thinking about like where children spend a lot of their time. And I think in particular, many infants spend much of their sleep time and they’re you know, they’re early learning time in early care and education settings, including those that happen in in-home settings.

So how do you think about what we need to be thinking about in terms of adapting to increasing temperatures both indoors and outdoors when it comes to those particular settings?

Kari Nadeau: Yeah, I think so many of our children, especially if they’re in nursery schools or in daycare settings, we need to make sure that on the whole we can create better structures to deal with this heat all throughout the world in the U.S..

So let’s talk about that because that’s important. We talked about climate change. We’ve talked about heat stress. There are ways to mitigate and adapt to climate change that include biodiversity, vacation, that have fantastic acts, children and how they’re growing. So part of those solutions in daycare centers, in schools, at our own homes can include bio vacation, could include green and real green.

And the reason that’s important is because part of the simple ways to help decrease heat exposure is to offer shade. So let’s just talk about what are some of the really typical things that one can use practically at home or at a nursery school or at a daycare center to just help to reduce heat? Number one, if it’s going to be hot outside, please make sure you monitor the NOA Web site websites that we can provide you links for.

There are also provided, I believe, Wendy, in the report, the report from the star. The developing child is fantastic, by the way, and I hope everyone will read it because it offers such great resources to citizens. And I’m really proud of it because there’s so much science in it that can really be tangibly used right now in real time.

So what does this mean? Let’s talk about solutions on the individual level for heat. First, go to shade. If you’re outside, seek a shaded place. If you’re inside, make sure that it’s shady, not in some sun exposed area. Seconds If there’s no air conditioner, there’s no central air feature that can cool the room, then get a fan, get a bowl of ice underneath that fan.

And that can reduce the temperatures up to five degrees Fahrenheit quickly in any given room. And so those are some low cost ways to really make sure that you can introduce a cooling system into an area, especially with children running around that want to play, that want to be interactive. The other thing is to get cool, wash clothes and make sure that any skin exposed take away as much clothes as you can, but just cool off the skin because that’ll help it evaporate.

Better humidity can also reduce the likelihood of evaporation, so anything that we can do to decrease humidity is good. So. So getting that skin cool will allow it to evaporate more as well. And then finally, making sure that the children are hydrated, the babies are hydrated and the people taking care of them are hydrated. So all of these things are simple, easy steps to do.

The first step, though, is monitor and monitor. Well, now, most cities, most places around our country, at least in the U.S. and many places around the world, have alert systems to let you know if there’s going to be a heat wave. And that’s important because then we can start getting ready. And so I give a list of things to prepare for on the individual basis.

But these are things that can also be done on the public scale to scale it up across any given area that’s affected by a heat wave.

Lindsey Burghardt: And I love the fan and bowl of ice tip. I can just like picture and almost feel how that will cool a room and it’s something that, you know, is potentially accessible to a lot of people.

Now. We’ve been learning a lot and I think there’s a big range of programs that are doing some incredible work. You know, places like the NC State Designs Natural Learning Initiative that are thinking about how to bring greenspace and outdoor environments to children for a number of reasons. And you and I have had conversations before, and I would love to kind of talk about it here about how these natural learning environments, particularly with really young children in these early care and education settings, have such cobenefits, both when it comes to our biology, sort of what happens underneath the skin and then what happens in a range of benefits for children’s development and learning and kind of social emotional health. So can you speak a little bit to those? And also the benefits that it has in terms of lowering temperature because it’s one of these when you start listing off all the great things that this does, it really just seems like a win win win win.

Kari Nadeau: It really is. And in all humility, we’re learning a lot more about the winds that seem to be exponential in value, especially to young children.

So let’s talk about that more. So then it’s important for the audience to know that a lot of people now are studying this concept of natural outdoor exposures, especially in children. And there’s a whole sort of system now, both adults and children called natural capital, the investment that we take in nature and how we can get exposed to it more purposefully so that we can help ourselves.

It also decreases heat when we’re in nature with trees and of course plants themselves. They can emit carbon, but they also sequester carbon. So there’s a lot of things about plants. Let’s talk first about the good things for our brain with plants and with greenery. So we know that one of the great benefits of being outdoors not on a screen that shows outdoors, actually being outdoors and walking and making mental pictures and photographs, wonderful things outside with our children and being able to make sure even in infants to get outdoors and inhale and be part of nature, that really helps cognitive development.

There are many studies now to show that that helps stimulate your brain. Children do better overall in tests once they get exposed to the outdoors, even for an hour in between recess, they go outside, get exposed to green, not cement tops, but green. In the case of this study that was done in Australia where children in nursery schools got exposed to green during an hour after during their school recess.

And they actually did better coming back in with such a similar controlled study. So with all that in mind, green is good for the brain, especially infants and developing bright green is also good for tactile learning. And when people have done studies on nursery schools that have green grass and dirt compared to a typical playground, that does not that just has rubberized mats, the children that are exposed to the dirt and play around in the grass, that only do they learn more and they’re more academically aware of things later in life.

But in addition, they get microbiome, they get good bacteria established in their gut that actually helps their immune system. So a study was done in Finland compared to a controlled group with all other measures controlled for, and they found that the children that were playing more in the dirt were exposed to grass and trees, that they had a different microbiome system in their gut and that that actually helped their immune system.

And they had and that was measured by how well they responded to vaccines. So this is really important. This is a win win, win, win win cognitive development, tactile development, good microbiome in the gut, good immune system, and then good protection against infections.

Lindsey Burghardt: Yeah, and it’s lowering temperatures at the same time. It’s amazing. And I love this space because it really feels like a place or whether you’re in philanthropy or policy or already in an early caring education setting like that feels like that’s something that we can do to kind of bring all of these cobenefits into these settings. So it feels like a real place for hope.

Kari Nadeau: Absolutely it is. It’s I am very hopeful and there are many more people doing work on here with rewilding environments, making sure that in that process of greening we green schools and green nursery schools first, that we prioritize that because we know how important that is for developing children.

Lindsey Burghardt: And so when we start to think about how we target some of these investments or our attention to make sure that we’re, you know, creating the greatest benefits for children, you know, through, you know, things that you’ve taught me and other members of the council are really kind of built in understanding that heat is not affecting all groups of children equally. And really, there’s so many factors like your socio economic status, your nutrition, living conditions, where you live geographically, what your stages in development. You know, these things all shape the way that children experience heat and the types of heat that a types of effects that he can have on their development. So can you talk a little bit about how heat, you know, sort of amplifies some of these other more systemic inequities and how heat, these effects of heat can be compounded in areas where air quality may already be more of a challenge?

Kari Nadeau: Right. I’m really glad that at the Center for the Developing Child, you know, you brought us all together in a council to talk about these difficult things and they’re complex, but that doesn’t mean we should step away from them. It means we need to really focus in and understand them better, understand how to prioritize solutions and I’m glad that your center you’ve exactly done that.

And so kudos to you for being able to have a webinar like this and being able to have systematic ways to approach difficult conversations. And one thing that we’re learning with climate change is it’s really been the x ray and to our soul of health inequities extra into the soul of a lot of communities, especially those including children of color, those including children that get displaced to do climate change.

We have over 200 million people displaced every year to climate change associated events, and about a 90% of those displaced are women and children. So we need to think about how this affects children on the long term scale and specifically heat, because it is so directly related to climate change. But like you said, when you have heat and you’re already incredibly exposed to things like air pollution, if you live in a community of color, unfortunately, you’re going to have a higher risk as a child to being exposed to toxins.

And that’s unfortunate because of something called red zoning and redlining that were part of our real estate practices. Now they’re not. But still we have communities that are highly exposed, inequitable. And so what happens is if you have heat stress, if you’re already exposed to air pollution or toxic chemicals, which happens a lot in our underserved, marginalized communities, people of color, people that necessarily have been discriminated against in our country and traditionally, unfortunately, Native Americans and original peoples across the world, those children really have some of the worst statistics for being able to deal with heat because they have underlying issues.

And unfortunately, we also have an issue around nutrition and good nutrition practices. And for many communities where they might not have access to healthy food, there’s a lot of obesity and that very much affects how people respond, especially children, to heat stress. So with all of that in mind, we need to really think about the most vulnerable, the most and actively exposed, because if we can’t help them as children, as toddlers, as babies, then who are we as a society?

Because it’s those children we should be focusing on first because they are going to need the most help. And so a lot of work is being done. And so I’m hopeful that the your report is coming out. You talk about these and exposed children and some of these vulnerable communities that we really need to make sure we understand and understand the multiplying effect of these exposures over time, not only in any given day could a child be exposed to heat, air pollution, drought, perhaps a vector borne disease or an under stress event in it for their mental health?

But in addition, it compounds over the course, like you said, over time. So they have a higher chance of having these issues. But I’m hopeful that their solutions now the EPA is putting out heat risk indices for children, especially those in what we call these communities that are in exposed environmental justice communities. Also, the CDC has a new heat, red heat risk index.

So you can go online as members of the public, search the Internet and go to the EPA, your Center for the Developing Child report, as well as the CDC, the center basically the Center for Disease Control. And of those information packets, you’re going to find a lot about heat stress and how to help communities. And I’m really grateful that our government has this systematic ways to help the public now.

Lindsey Burghardt: Yeah, it’s really amazing. I think the amount of attention that this topic is getting and how children are being brought into the conversation. I think even a couple of years ago there maybe weren’t this type of robust, you know, sources of information that they say with heat. And now I think the EPA resources and thank you for the kind words about our report, but just kind of getting these this information out to people who are taking care of young children everyday feels really important.

And I sort of have heard you kind of draw out our top name almost like three real levels of solutions, right? Sort of like we need to take some immediate actions to keep people safe when these heat waves happen. And but we also need to think about how are we adapting our systems, our services, our infrastructure, Because as you said, you know, this was the coolest summer and that we’ll see going forward.

So how do we, you know, adapt to that new reality? But then also, you know, and it got to this, I think, a little bit when it came to the early care and education settings, like how do we stop the reasons why the planet is warming so much in the first place by decreasing our reliance on fossil fuels and, you know, decrease our greenhouse gas emissions.

So, you know, thinking about those three levels of solutions, is there anything that you’ve learned from your work with workers in California or in other places about how we can think about solutions, particularly in urban heat islands where temperatures are much higher? And can we think about applying those solutions to children and to pregnant individuals?

Kari Nadeau: Yeah, I think there are a lot of solutions now and I’m really grateful.

So when we talk think about climate change, so many of our solutions have immediate effects on heat, and that’s great because we want to stop warming our planet. It’s not good. We see so many issues around that warming of the planet with drought, with wildfire smokes, with water insecurity, with food insecurity. Heat plants don’t like heat either. Yeah.

So we want to make sure we think about the whole Earth. This whole concept of one health, planetary health, animals, plants, everything. Heat especially affects them. And so there are ways to adapt to heat, like I talked about with on the individual levels, but on the on the other levels of adaptation and planting more tree canopy, for example, in cities, the urban heat islands are real.

Many people feel that when they’re in the inner city, Chicago or in a city Harlem or inner city, New York City, they’re going to have degrees up to five degrees Fahrenheit, more in some of the heat islands compared to, let’s say, rural areas. So that’s real. And so what’s happening now is people are realizing, again, thanks to that whole concept of natural capital, planting trees in cities, especially, and children are going to basically benefit from these tree planting exercises, plant trees up to increasing tree canopy by 30%, decreases premature deaths by 30%.

That’s incredible. And it reduces temperature by 1.3 degrees Fahrenheit. That’s great. That’s substantial. That helps maintain good health, that decreases the risks of heat stress and heat stroke for not just children, but also for everyone. So and that’s a 30% canopy increase. Could you imagine? 50%. So and then the trees will also help absorb carbon. And the most important thing for those of you have allergies to trees.

It’s actually not going to increase allergies. And that’s also if you plant mixed sex trees, you reduce allergies. And so it’s very cool that we see so many benefits of these systematic ways that cities and communities can actually push for these policy changes. They are happening around the country. In front of you on the phone, please talk to your town councils about increasing tree canopy and plant in the right trees.

And I’m happy to help in any way. I’ve done a lot of work with different towns and planting trees. The other thing that people are doing more and more is actually using cooling paint. So if you use white paint on roofs or even green roofing, having natural roofs like grass and other things that are happening more in cities like Paris or just planting sort of spruce up, that’s done very much in certain cultures that white roofs and sod roofs, solar panels also reflect light so that that rooftop does not absorb light.

So solar panels, white roofs, green, real green grass streams, for example, they all help a lot reduce the absorption of that heat. And then there’s new technologies coming out for cooling sidewalks. We’re doing that in Springfield, Massachusetts, for example. Now, there’s also examples of cooling pumps that you can install into your home and you don’t need to leave the home.

These are low cost methods. And importantly, is talked to your local council, talk to your state, because nowadays states actually give subsidies for air conditioning, for cooling pumps, for offering access to cooling rooms, for example. I know that’s maybe not as easy as having cooling places in your own backyard or your own home, but there are no public cooling rooms available, especially in areas of the country that deal with heat stress.

And then finally, public places are being offered as ways to cool, cool areas. Now, we are still missing a lot for schools. We need to do a lot more directed work for public schools and private schools for children and nursery school. So I think when we wrote our EPA report for the Children’s Protection Committee, we did say we have to systematically make sure that on the public side that we reduce temperatures in these key areas that are taking care of children.

So We’re on the road to these types of practices. But I’m really glad to see a lot of cities starting to adopt them now.

Lindsey Burghardt: Yeah, You talked a little bit about heat pumps. So if somebody is new to the concept of a heat pump, can you explain a little bit about kind of what that looks like, why it may or may not have advantages over air conditioning and then for both of those technologies, you know, one thing that people ask me about a lot is, you know, we have this very old building. It’s it would take a lot of investment to think about. You know, the EPA, I know, has done a lot of thinking about cost effectiveness and what that actually means in terms of investment versus benefits. Can you speak to that at all?

Kari Nadeau: Yeah, I’m not a heat pump expert. I mean, people think heat pump, they’re like, oh, well, you’re making heat for me.

That’s true. The same pump in the wintertime can make heat for you. In the summertime can make cool. So it’s I call it a pump and so they can install this in homes. I’ve seen them they are at the current time they can be very energy efficient so they don’t take as much energy as let’s, say, an air conditioner, which is good because we want to decrease the use of greenhouse gas energy components, increase the ability to use renewable energies and heating pumps are one of those systematic ways of being able to adapt to more renewable energy devices.

So overall, what, for example the city of Boston is doing, as well as other cities around the country, as well as communities, not just cities. They’re looking at these pumps because they’re more energy efficient. You can install them into your home now without a lot of issues and without disrupting normal living. And they don’t require as much energy, let’s say, as air conditioners do, because people probably no air conditioners use some toxins that then get emitted into the environment and they’re actually really bad for greenhouse gases.

And so we want to make sure that the very same solutions that we’re using for cooling do not turn into solutions that actually turn out to be worse for our environment and can start to increase change. So that’s where the pumps are actually really helpful. But if you have any other suggestions.

Lindsey Burghardt: No, no, no. I found it like so amazing when I first learned about it, because you hear a pump and you sort of think that it’s going to like, I don’t know, work off of some type of, you know, coolant like the air conditioners do.

But they actually in the winter, it’s kind of amazing dry heat out of the air even when temperatures are well below zero. I think the state of Maine has done this at scale and they actually warm many environments, you know, much more evenly in the traditional cooling methods. And then at the same time, you know, they’re able to draw in the summer months that energy and that heat out of the air and actually put it back into the earth in a way that it’s also, you know, cooling to the to the degree of air conditioning is without those negative effects of the greenhouse gas emissions.

I think, you know, many times when we learn that air conditioning may actually not be great for the environment, but, you know, if you had the ability to put some type of air conditioning in a place where children sleep or where children live and you can lower that temperature, I think we’ve learned that the effects on learning actually are really important when you lower those temperatures and that there’s significant costs associated with the learning losses in the days lost in school.

And that actually even though you have to invest it, put that money into air conditioning, you’re sort of regaining, you know, the losses that would have happened in so many other ways because of heat. And I think when it comes to young children, especially that ability to like, play and explore and just be curious and be able to move around your environment comfortably is so intangible and hard to measure.

But thinking about how to get these technologies into places where young children spend time feels, you know, so important. So I love that you Yeah. I mean, it’s great just to think about that. There’s solutions at so many levels that really, no matter where we sit, you know, we have to, you know, we can start to think about, you know, what we can do to make these make environments more comfortable for kids.

So, you know, if you had to think about if you were working in an early parent education setting, if you were in a school, you know, we’ve talked about a couple of different temperature numbers and ranges today. Is there you could wave a magic wand and say, I would love for these little infants to be able to play and live and sleep at this temperature in these toddlers. Is there a range that you think is helpful for the audience to know about?

Kari Nadeau: I think 70 to 75 is helpful. I think that that gives us leeway. But, you know, that’s where we’re coming down now. But obviously we want to know what’s harmful so that we don’t get to those temperatures. And that’s like 85 and above and all of this comes conditionally with making sure you’re hydrated, making sure that there’s humanity and dryness differences.

So with all that in mind, though, Lindsey, it is so important to try to be that change. Now with this information. I hope that your audience will take it forward on the individual level, but also to knock on the doors of your town council, to knock on the doors of your local government and say, hey, you know, can you give subsidies or cooling pumps for certain neighborhoods?

Can you make sure that they’re in schools? Can you make sure that we deal with good aeration? You know, just a little bit of wind will help with evaporation and will help reduce temperature a lot. So I hope that all of these things that we’ve talked about today will be helpful to your audience. But it’s important that we as a community really advocate for children, for infants, for toddlers, because we as adults, I think that is our a privilege to be able to make sure that we can take care of everyone on this planet, especially those that are early in life.

Lindsey Burghardt: Yeah thank you. And I learned so much every time I have a conversation with you about this. I wish that I could be like taking notes and talking so I can go back and learn more about all these great things. Is there anything that you would give us sort of a take away or, you know, a final recommendation for people who really want to bring this home?

I love the thought about coming to your lawmakers, coming to your local government. Is there anything that you would put forward as, you know, something that gets you up and into this work every day with hope and forward looking?

Kari Nadeau: Yeah. Thank you so much and thanks for everyone for joining. I am very hopeful that we can, through bio diversification, through getting access to more natural environments, actually help our children, especially in early development.

And I also am very hopeful that because there’s areas of the world that are dealing with extreme heat greater than 40 degrees centigrade, greater than 110 degrees Fahrenheit, this is happening more and more in the news. These are areas that I really do hope we can also think about. How are those children affected and what access can we make sure immediately we can provide to them for healthier lives.

Lindsey Burghardt: Yeah. Thank you, Kari. This is terrific. We’re so grateful for your time and your expertise and for everything that you’ve taught us today. So I’m going to turn it back over to our host. And thank you all for joining us. We hope to see you again at a future conversation.

Kari Nadeau: Thank you, Lindsey.

Rebecca Hansen: All right. Thank you so much, Dr. Burghardt and Dr. Nadeau for this wonderful conversation today.

I also just wanted to quickly note that we have several additional webinars in development for later this spring and summer where we’ll talk more about different aspects of the developmental environment and other topics related to early childhood development. So please be sure to follow us on social media and subscribe to our newsletter to receive updates and find registration information.

We’re so grateful to have you with us and we hope you enjoy the rest of your day.

Cameron Seymour-Hawkins: The Brain Architects is a product of the Center on the Developing Child at Harvard University. You can find us at developingchild.harvard.edu, where we’ll post any resources that were discussed in this episode. We’re also on Twitter @HarvardCenter, Facebook at Center Developing Child, and Instagram @DevelopingChildHarvard. Our music is Brain Power by Mela Collective.

Leah Anywanwu — **A Place to Play: Moving Towards Fairness of Place for All Children** May 02, 2024

Contents

Podcast

Panelists

Additional Resources

Transcript

In March 2024, we continued our Place Matters webinar series with our third installment: “A Place to Play: Moving Towards Fairness of Place for All Children.” During the webinar, we explored the power of play in supporting early childhood development, as well as the importance of ensuring that children and caregivers have access to safe green spaces, like parks and playgrounds. Our panel of experts discussed how access to safe, stimulating, and joyful play space is not equally distributed across communities, along with strategies to work toward building a future where all children have a safe place to play. The webinar discussion has been adapted for this episode of the Brain Architects podcast.

Panelists

Leah Anyanwu *(Moderator)*
Programme Specialist, Children on the Move, Children’s Learning and Development, The LEGO Foundation

Cynthia Briscoe Brown
Atlanta Board of Education Seat 8 At Large

Kathy Hirsh-Pasek
Professor of Psychology and Neuroscience, Temple University; Senior Fellow, Brookings Institute

Lysa Ratlif
Chief Executive Officer, KABOOM!

Le-Quyen Vu
Executive Director, Indochinese American Council

Melissa Rivard *(Webinar Host)*
Director of Engagement Strategies, Center on the Developing Child at Harvard University

Cameron Seymour-Hawkins *(Podcast Host)*
Communications Coordinator, Center on the Developing Child at Harvard University

Additional Resources

Place Matters: The Environment We Create Shapes the Foundations of Healthy Development

Presentation Slides

Playful Learning Landscapes

KABOOM!

Atlanta Community School Parks Initiative

LEGO Foundation

Indochinese American Council

Transcript

Cameron Seymour-Hawkins: Welcome to The Brain Architects, a podcast from the Center on the Developing Child at Harvard University. I’m Cameron Seymour-Hawkins, the Center’s Communications Coordinator. Our Center believes that advances in the science of child development provide a powerful source of new ideas that can improve outcomes for children and their caregivers. By sharing the latest science from the field, we hope to help you make that science actionable and apply it in your work in ways that can increase your impact.

In March, we continued our Place Matters webinar series with our third installment: “A Place to Play: Moving Towards Fairness of Place for All Children.” During the webinar, we explored how play and a family’s access to safe green spaces, like parks and playgrounds, support early development. Our panel of experts discussed how access to safe, stimulating, and joyful play space is not equally distributed along with strategies to work toward building a future where all children have a safe place to play. We’re excited to share part of this conversation on today’s episode of the Brain Architects podcast.

If you’re interested in in seeing some examples of community-led solutions to address gaps in play space equity presented by Lysa Ratliff of KABOOM and Kathy Hirsh-Pasek of Playful Learning Landscapes, we encourage you to head over to our YouTube channel to view the full webinar recording.

Now, without further ado, here’s Melissa Rivard, the Center’s Assistant Director of Innovation Strategies, who will set the stage for our conversation.

Melissa Rivard: Welcome and thank you all so much for joining us today. It’s really gratifying to have so many of you showing up for this really important topic. So thank you. I’m Melissa Rivard, Assistant Director of Innovation Strategies and I will be your host today. This webinar is part of a series of webinars that the Center on the Developing Child has hosted to examine the ways that a child’s broader environment, including the built and natural environments, as well as the systemic factors that shape them, play a role in shaping child development and health beginning before birth. Our focus today, the importance for all children to have access to stimulating joyful and safe places to play, is prompted by our focus on fairness of place as well as a desire to highlight a long standing collaboration between the Center on the Developing Child and the LEGO Foundation, and our shared belief in both the power of the early years and in the power of play to positively impact lifelong learning and health. Our moderator for the conversation is Leah Anyanwu. Leah is a program specialist at the LEGO Foundation, where she supports the Foundation’s early childhood portfolio with a focus on children displaced due to conflict and climate. Leah is a passionate educator and advocate with over a decade of experience working in education with a focus on early childhood and education systems reform. Along with Leah, we’ll be joined for this discussion by a phenomenal group of panelists who bring a wide range of expertise related to this topic. Kathy Hirsh-Pasek is a professor of psychology at Temple University and a senior fellow at the Brookings Institute. She served as president of the International Congress for Infant Studies, was on the Governing Board of the Society for Research in Child Development and is on the board of 0 to 3. In 2010, Dr. Hirsh-Pasek founded Playful Learning Landscapes with her colleagues, an initiative that reimagines cities and public squares as places with science infused designs that enhance academic and social learning opportunities for young children. And we have Lysa Ratliff, who is CEO of KABOOM!, a national nonprofit that works to end play space inequity. Lysa is a leading national advocate for equitable access to play spaces, has been invited to speak at several White House events and engages with members of federal, state and local public offices advocating for and creating opportunities for kids to play across the nation. We’re also joined by Le-Quyen Vu, who is Executive Director of the Indochinese American Council in Philadelphia, a nonprofit working to empower disadvantaged and minoritized groups and newly arrived refugees and immigrants in their community to achieve social, economic and educational advancement and mobility. And Cynthia Briscoe Brown, a member of the Atlanta Board of Education, Seat 8 at large who’s been instrumental in passing a number of policy initiatives, such as the historic Equity Policy, the Atlanta Community School Parks Initiative and the Atlanta Public Schools Center for Equity and Social Justice. Without further ado, I am so pleased to hand the baton to you, Leah.

Leah Anyanwu: Thank you and welcome, everyone. I am so excited to hear from each of our panelists about the critical work connected to play equity and for this conversation, which centers the power of play and the importance of safe and quality play spaces. Our aspiration at the LEGO Foundation is that children become creative, engaged, lifelong learners who thrive in a constantly changing world by experiencing the benefits of learning through play. The scientific evidence around the power of play is clear and growing. In short, play is essential, everyone. Not only is play the best way for children to learn and to thrive, but play builds the foundations of lifelong learning and fosters holistic development. We’re here today because there is so much opportunity for children, families and communities when it comes to play and creating spaces that invite and enhance it at the community level in policy development and in the work that brings each of us to this conversation today. Yet we have a long way to go towards ensuring that the opportunity for quality play is equally accessible to all children, families and communities. To quote the Place Matters paper that Melissa just mentioned, “just as dimensions of the built and natural environment have been designed over time, they can be redesigned to support healthy development.” Throughout our conversation today, we will share insights from research and the field about ways to redesign, to rethink and to rebuild in pursuit of creating environments that support all children’s copy development. Now, without further ado, let’s get started. And I really want to invite Kathy to really focus first on the why. So, Kathy, good to have you here. What does this science tell us about why play matters for children, particularly young children? And how is play connected to learning and what kinds of play and characteristics of play are particularly important?

Kathy Hirsch-Pasek: All right. You got it. And thank you so much, Leah. Well, we created Playful Learning Landscapes because we agreed with you Leah and we agreed with the work going on at Harvard that it was time to transform cities and villages and towns into family friendly spaces that were inclusive and that were infused with learning. So what I’m going to share with you today are not really just play spaces. It’s not like going to the playground. They are every day spaces that are infused with the science of learning and social learning that can be built right into the architecture. We build everything that we do on what we call our three part equation. The first thing is that when you go into a city, you need to know who your audience is. You need to be consistent with the cultural beliefs and the community values. So we start there. And then on top of that, we add a series of characteristics that define how human brains learn. And it just so happens that those same characteristics define play and playful learning. You have to be active, not passive, engaged, not distracted. It has to be meaningful. It has to not be disjointed. Has to be socially interactive. It has to change a little each time and be iterative. And finally, it should be joyful. That’s the how of learning how brains learn. And then the science of what children learn is the 6Cs. You know, in a world with AI we need to learn reading and writing and arithmetic, but we need to go beyond it. Can we collaborate and can we communicate well. Do we know our content? Do we have critical thinking? Do we have good–here you go–creative innovation, which is going to be very important. And then we want to know if you have the confidence to give it a try, which helps to feed grit and perseverance. There’s a whole lot of science to back this work up. And that you can use this equation for digital media, for places and for school building in ways that will help kids grow in a playful way.

Leah Anyanwu: Thank you, Kathy, for that framing, I want to bring Lysa into the conversation. Lysa, KABOOM!’s mission is to end play space inequity for good. Can you tell us how you define play space inequity and share what you’ve learned about the scope of the issue? And what are you and others doing at the policy level to try to address it?

Lysa Ratliff: Sure. The big question and I want to start by thanking Kathy for grounding us in such beautiful space, because what we see through those examples is that we have solutions. We are working against a solvable problem, and for Kaboom! we define play space inequity as a lack of access to and a sense of belonging and which is important. Quality play spaces due to the affect of systemic racism in communities across the country. And for anyone who’s been following the report, the play Place Matters report or the webinars, I would encourage you to go back to Dr. Lightsey-Joseph’s conversation where she laid out the historical policies that we are all trying to navigate today, and for Kaboom! Within that broader context, our focus is centered on kids. We care deeply about our children and we prioritize public space. And so we focus our efforts on play spaces and the surround sound that needs to happen so that kids have more access to and more quality time in play spaces so that they can benefit from all of the things that happen when kids go out and play on quality spaces. What we’ve learned about the scope. There’s just four really big categories that we’ve discovered through some work that we did that was funded by Colorado Health Foundation, and we worked with our partners at NC State and the College of Charleston, where we see those same patterns of inequities that Dr. Lightsey-Joseph was talking about and things like the achievement gap, the access to healthy food and health care coverage, all of those things. They also apply to play spaces. And so the four different areas are 1) distance matters and we hear a lot of conversation around the ten minute walk and the accessibility to play spaces and making sure that it is the easy option and that play spaces are within the communities that we need to work in. The challenge is that low income and communities of color and even rural rural communities are more likely to have limited access to play spaces where they live and learn. This is not just in their community, this is in their schools. There are schools without play spaces at scale and in parks just across the board. There is not easy access to play spaces and public spaces for kids and families to go. So that’s one critical piece. The quality of those spaces is also something that we’re concerned about. And so even when they do have access to places, it tends to be lower quality. It tends to be in communities of color, half the size as in communities that are predominantly white. So there’s less space to be able to play in and there’re worse physical conditions and lower play value. So we all know that kind of repetitive play is important and being able to not just go out there once and play, but time and time again to go out and discover new things is really important. That all has to do with quality. Neighborhood, again, you know, when we’re thinking about inequities, low income and BIPOC communities are more likely to have limited access to play spaces because of neighborhood factors like transportation and personal safety concerns. And so community cohesion and coming together and making sure that the community starts to really bind together as a community through public space will also help us address the barriers to kids going out and play. And then finally, history. You know, I’ll kind of end with this piece with where I started is that our communities are still shaped by racist historical practices like redlining. Our public spaces, our schools are a reminder that not so long ago they were segregated space. People are still alive that lived in segregated space. And I can’t share it here because I don’t have license to the photo. But I would encourage people to look at the Gordon Parks photo from 1956 called Outside Looking In, and it shows a group of young black kids looking through a fence into the most beautiful play space you can imagine. And yet they weren’t allowed to play in it. That residue is still what we’re dealing with today. Those kids in that photo are probably still alive. Some of them are probably still alive today. So we’re not talking about that long ago. So that history that we have inherited is also affecting how we work today . In the fifties, what we were also seeing is infrastructure being developed that went straight through thriving black communities like our highways and freeways, all of this backdrop is really the barriers that we have to make sure that we are acknowledging and problem solving around to make sure that we solve in a way that addresses the systemic issues, but also allows us to work in a systematic way so that our future is better than our past. You talked about policy, or asked about policy. And so to that part of the question, doing so much, so much and we’ve only really leaned into policy and advocacy and government affairs works since like 2019, 2020. And in that time we’ve moved in light years. You know, we think that our policy and advocacy work and the influence that we have there is as important as the spaces we build, because that’s where we’re going to stall and stop the perpetual issue of that historical racism has created in our public space and the allocation of resources. And so in the policy work, we see play space inequity as a historic challenge, which stems from an intersection of local and state and federal policies that were rooted in a racially biased ecosystem and decision making. And so we have to work at all of those levels. At a local level, we’re working with our partners on data. We are very committed over these past years to really understanding through data where play space inequity exists, and so a resource that we can bring to our local partners is giving, providing them with that data and letting them overlay it with their own data as a road map for the work and also as a tool to help prioritize. Oftentimes you see in local systems that they work against the pressure of who’s talking loudest and who’s asking loudest. And so by having that data as their baseline for prioritizing their budgets, which is also a little bit of a policy document, because budgets are saying where money and resources are going to go, it helps our state or our local partners prioritize historically, disinvested spaces. That state work links to our federal and That local work links to our federal and our state work. Because so often the resources that go into the local system come from the state or the federal government. And so we work a lot at the certainly at the federal level where we are in a couple of layers. So we are working across the board, not just specifically on play space issues, but advocacy efforts around things like the rural development and the farm bill and looking for greater flexibility in that CDBG program because we know those fundings, those funds are going into local budgets. And so making sure that we are a champion for prioritizing equity in those spaces and then even some of the work we’re doing with the administration is to support the implementation of the 40 initiatives. And then finally, two other points on the policy work at the state level. We’re also working to advocate for things like recess, mandatory recess. And I was horrified to learn that California is the 10th state, which is a state we just worked on with Governor Newsom to pass a mandatory recess bill, but it’s only the 10th state in our country that has mandatory recess. So we have work to do there. But it’s alarming to know that we’re not even mandating recess in the majority of our states. The last thing I’ll say about our policy and advocacy work is it’s not work we can do alone. And so we’re part of a lot of coalitions. We helped co-found Coalition called the Nonprofit Infrastructure Coalition. We did that during the pandemic when there was funding being decided around infrastructure and making sure that we were part of mobilizing the sector to advocate for equitable allocation of resources when a lot of money was going to come out from our federal government. And then two other notable coalitions we’re a part of is the Percefra Place Coalition, which advocates for greater investment by the federal government in civic infrastructure. And then finally, the Outdoor Alliance for Kids, which is really looking at promoting legislation and policies that make it easier for kids to access outdoor recreation and play. And so a lot there, but a lot of history and the partnerships that we’ve been able to build make it really easy for us to lock arms and make the kind of progress that we could have never made alone.

Leah Anyanwu: Yeah, Thank you, Lysa I mean, there’s so much to unpack here, but I’m going to ask you and you can maybe just in one minute, can you share KABOOM!’s general approach to design and creating play spaces and briefly summarize the project that can be will be speaking about this.

Lysa Ratliff: Yeah. Okay. This is a challenge. So data collection, I mentioned that data collection is recently we have we know that we cannot solve playspace inequity if we do not know where playspace inequity exists. So we’ve made deep investments in data. So that data piece, the partnering with others, what Kathy was talking about, community voice and making sure that we are responding to what the community identifies as their needs through the team that we have here, and more importantly, local partnerships that are connected to community on the ground. We work with Le-Quyen who will hear from. We recognized a couple of years ago that we cannot keep working one project at a time, but we’ve got to look at more system level partnerships and working with peer organizations. So in places like Atlanta, we’re locking arms where Children in Nature Network, Atlanta Public Schools, Transfer Public Land to utilize the data that we’ve collected to re-envision what a school yard can look like. Nature elements, sports elements, learning outdoor classrooms. you’re not just looking at a play infrastructure, but you’re looking holistically at that school campus as a place to grow food, as a place to have multiple activities and so the Oakland work that we’re doing as part of our partnership with the Learning Play Foundation in Oakland Unified School District, where we’re transforming 25 schoolyards throughout Oakland by the end of 2026.

Leah Anyanwu: Thanks, Lysa. I’m so sorry to interrupt that you have so much wisdom on this call and so many examples to share that I know we’ll share links to the theory of change and the project so folks can continue reading. I just really want to make sure we have time to pick up on one of the essential themes that you and Kathy spoke about, which is community involvement and leadership. And so I’d love to bring Le-Quyen in and Le-Quyen–can tell us what does community led look like in the Literacy Rich Neighborhood Initiative and the literacy tree installation, and how do you ensure that community members involvement is truly meaningful? How did involving the community make a difference in terms of design and the use of space? Le-Quyen, over to you.

Le-Quyen Vu: So just to be clear on the record, none of us knew that we were. Lysa probably didn’t know that we were funded by KABOOM!, and Kathy probably didn’t know that this project was her brain when I started picking her brain, before we responded to the Funder who was asking for us to submit our idea so that that just to put it out there. The Center did not invite us because we were linked together. It happened that way. So, so to me when we got this project, so we are the literacy agency, We work with adults, we work with children. Family literacy is part of what we do. We are not an architecture firm, so I am entering into a territory that is new, that is born to me. So the thing that I that I have to ask myself was how do we get the community to this space that we tried to transform? Who knew we who are the people who will be using it, and how do we get these folks to take ownership? We talk about that all the time, but how we go about doing it is different. So that was a question that would just make me lose sleep when I heard that I got the funding because that’s huge. So I realized, okay, we have to approach this, the community, as partners. We have a job to do and these are the folks that will help us finish the job. So I always said this we have to approach this as we have a product in that we’re not selling anything, but we have something to sell. So the people who are using the space are our customers. So we need to go do that. We need to involve them from the beginning. We need to do the research at that. Lysa did her work, Kathy did her work. So our job is to take that work and bring it to the community in a way that is going to create a result that everybody’s happy. So that’s basically it. So we came in with a blank piece of paper. We wrote the proposal with 20. There’s a goal, this thing that we achieved, but we didn’t have a definite picture of what that looked like. We said what it looked like would be from the community. But he has other goals. So we went in there from the beginning before we submitted the proposal, we went to the community and asked them, we are going to do this. Would you be partner with us? Would you be interested in us doing this? So even before we submit the proposal, we went and asked them. So everybody was asking us, Yes, yes, yes. And then when we got the funding, it was easy to go back and say, So we got the funding. You said you want us to do this, so let’s do it together. So that’s basically what it is. And then us in the process of working on this project, I realized there are a culture differences between institution between government and between the community who live in the neighborhood. And our job–everybody knows what they want the two and know what they want coming together and connecting those two things together. They don’t speak the same language. Good thing that English is my second language, so that come naturally for me to be like, okay, we’re going to have to connect these folks. So we along the way, we basically played the role of a mediator, the peacemaker, the coming okay, here’s what people said. Here’s not what people said. And then coming and bringing people together. And that’s how we started that project and that’s how we the people decide where they want the space, the kit, these know what it looks like and everything was from the people. We went back we invited the university students. We invite the people to take the classes, the design class together, the community committed to ten weeks of 3 hours of every hour, every week to work as a student to design this whole thing. So the first phase was we got the William Penn Foundation to do that tree. The second–there are more– they the community wants a lot. So we were able to get KABOOM! to fund the other piece that the community wanted. So it’s an ongoing project.

Leah Anyanwu: That’s what it sounds like Le-Quyen sounds like, you know, it’s very participatory and you’re always adapting and adjusting. And I mean, you touched on something that I would love to bring Cynthia in to kind of build on, and that’s, you know, a similar question, but from the policy perspective. So Cynthia, if you can just share briefly, you know, can you outline the work that you’ve done to make play more accessible for all children in Atlanta? And I know you’ve done a lot of work in this space, so perhaps you can just share, you know, a bit more broadly and then focus briefly on the Atlanta Community Schools Parks Initiative.

Cynthia B Brown: Absolutely. And thank you for asking. As Lysa said a few minutes ago, history matters. And in Atlanta in particular, where Atlanta public schools, it has a approximately four out of five of our students are on free or reduced lunch, and well over eight out of ten are students of color. We deal with racial and socioeconomic inequities that are baked in for centuries. We have schools which have no walk zones. It’s too unsafe for children to walk from their home to the school. We have schools where two thirds of our students are transient. Atlanta is a city of neighborhoods. And and so we still have neighborhood schools, attendance zones where we believe that schools really are the the beating heart of a community, the social center of a community, not just a place for children to go for instruction, but for wraparound services, for health centers, for food pantries, for clothes, closets. We have parent centers where parents can come and use wi fi and and computers to apply for social services and apply for jobs. We have parenting classes, so we really think of a school as the beating heart of the community. We want that entire school property to be a learning rich environment. And so when we had the opportunity to work with KABOOM! And the children and Nature Network Trust for Public Land, the city of Atlanta, we needed to find a way to to to build a structure for that kind of partnership. What we are really talking about here is a new kind of public private partnership where where we tackle big problems, problems that are h onestly too big for any one of us to solve and and we are able to do that because we don’t care who gets the credit. Our equity policy that the Board of Education passed in 2019 is the foundation of this. It’s the driver of everything else we’ve done. Because what it does is require the superintendent to eliminate inequities in every decision, every dollar, every program, every initiative, every thing we do in Atlanta, public schools coming out of that is our student outcomes focused governance work, which uses data to drive all of our decisions based on student outcomes. And so the data that we get from the Atlanta Community School Parks Initiative allows us to make the argument that student outcomes are affected by play spaces because we’re given that information that allows us to to to use the policy as a lever to drive direct action. Finally, we, we then use the policy. I never like to say we do anything top down in Atlanta Public Schools, but we can use this top down policy. The the this I believe statement that the board makes in a policy to drive bottom up engagement so we can put in a policy that the that the superintendent will consult with the community will develop an engagement plan and then fully and faithfully implement that plan before we before we make any major decision. That’s been an effective way for us to integrate this play space work to to build learning rich environments and to to get the community involved. Because like Le-Quyen’s project, this is very community based. Our children and their families, our employees design the projects that we then implement. I’ll also say that building relationships is critical. We have a mayor right now who declared this past year is the year of the Youth–an APS alum himself. He has declared that he wants Atlanta to be the best place in the country to raise a child. And so we’ve received additional assistance by building relationships with the mayor’s office, with the city council, with the Department of Parks and Recreation that have resulted in some very tangible results, including a joint use agreement between Atlanta Public schools, the city and this consortium that the Atlanta school, the Atlanta Community School Parks Initiative, so that we can open our school yards, our spaces in our schoolyards to the community to allow them to to enhance added rich, what we are doing at the school and also in the community. We have intergenerational spaces in those in those schoolyards. They are safe, they are clean, they are welcoming, and so they are enhancing and adding to what we do in the classrooms.

Leah Anyanwu: Thank you, Cynthia. So Le-Quyen I’d love to hear from you. What were your lessons learned about how community involvement can make a difference in the design and the use of the space?

Le-Quyen Vu: Community involvement would help us maintain the space, would help us advocate for funding. When we did this work, we were ambitious and we thought that little money we have can do three things. We ended up with able to do only two. The community. Engagement was able to make the case to the state and get the money from the state to do the other area. So that’s what community engagement and community engagement also mean that they will look out for this space is is it to maintain a lot of time, We built these places, we make it beautiful, but funding ended and then we don’t have a means to continue maintaining it. That is what what is meaning is meaning that this place will continue to be used. This place will continue to serve its purpose and they will continue to maintain.

Leah Anyanwu: Right. So really getting to the sustainability bit. And that’s really helpful. Lysa, can you also share your lessons learned about communicating the problem of play space inequity and what moves policy and decision makers can take if they want to make play more accessible for all children?

Lysa Ratliff: Yeah, I mean, I’ll just boil it down to at the end of the day, we are having human conversations about our most precious humans. And I, you know, when you use words like historical disinvestment, racial equity, racism, it can become emotionally charged. But for us, we’re talking about a human issue and we’re talking about a human issue as adults who have a responsibility to care for our kids. And that just crosses all walks of life. And so for us, particularly in our policy and advocacy work, we’ve been able to show up in a very nonpartisan way to problem solve. The work that we’re doing in Uvalde, Texas, where we have quite literally locked arms with the community there, we have gone to the Hill with them and advocated across You know, Democrats and Republicans who are really looking at space and equity as something that can be solved as an example to solve bigger issues. And so at the end of the day, just my my advice there is that we’re just talking about human issues and our responsibility as adults to care for our babies.

Leah Anyanwu: And this is a human issue, right? Like we can set aside our differences. At the end of the day, we are all set up for success when our children can thrive. Thank you for that. Kathy, a question we received is around examples or suggestions of ways to create opportunities for quality outdoor play in communities that might have fewer resources. Can you share for one or 2 minutes just any examples or suggestions that you might offer?

Kathy Hirsh-Pasek: Yeah, absolutely. The first thing I’ll say is that I totally agree with Lysa and Cynthia about the wonderful work that you guys are doing and how it’s really a team sport. And so there are a couple of things I’ll say about resources. The first is in the work that we do, bus stops have to be built, transit centers have to be built. There are budgets in cities and communities for these things to be built. So as I said, well, ours are play spaces. They aren’t really they’re just your average bus stop. They’re just your sidewalk. They just happen to be the library. And there is money for those amenities. So the cost to people in the community is zero. Okay. And we have found that if you go to the cities and you say, wow, the next time you put in this bus stop, the next time you put in this sidewalk, let us be a part of it and they will let us do it. And as Le-Quyen knows, Philly’s been really, really good about that. And even put a person who focuses on playful learning in the mayor’s office. So sometimes it takes that. And that also helps with the kind of coordination that Cynthia talked about. All right. One more piece to that is that, you know, you can do fancy things with the government or can do not fancy things. So I always talk about it as the champagne or the beer level. And all of those are available in the projects that we’ve done. And one that I did in the country of Colombia. And I have never, ever experienced poverty like I saw in the place that I was at in this one, this one school area in Colombia. And how did we put in place a learning landscape? We used cardboard, we painted it different colors, and we used chalk because with chalk I could draw on a floor, I could draw on a sidewalk. So sometimes it’s as easy as chalk. The examples I could show you that we went into, you know, supermarkets and change signage. The whole project cost us $65. So I wouldn’t worry about the cost. There are many ways to do it. I think the bigger issue is what you just talked about last time, that it really does involve listening and hearing as Le-Quyen told you so beautifully, so that the community has ownership you don’t and that you work with all the people who need to be around the table, which includes policy people and people from the Parks Department and people from the city, or it won’t get done.

Leah Anyanwu: Thank you, Kathy. And I love that charge that, you know, play can happen with nothing. I remember being a child and we were just playing outside. We would just make up stuff. So we don’t always need, you know, fancy playgrounds. Can we just have some creativity? Recycled cardboard, plastic bottles, rocks, tires. The sky is really the limit. So we are we are nearing the end of the hour, which is hard to believe. And thank you all for such a rich conversation. Before we close out, I’d love for each of you to share one positive note to leave our audience with. So perhaps that’s an outcome from your work, a development in your community, or finding from your research that we can take with us. So we’ll start with Le-Quyen then hand it over to Cynthia, Lysa and Kathy close us out.

Le-Quyen Vu: I would say persistence and partnerships. Those are the two things that I take away from this project.

Leah Anyanwu: Thank you Le-Quyen.

Cynthia B Brown: Mine is similar to that and that is never give up. Five years ago I would not have believed that we could be accomplishing what we are in Atlanta. And and the other word of advice I have is find champions, find a school board member who you can who you can rope in, who you can get excited about your project. Find a city council member, find a nonprofit CEO and and build those relationships so that together you can accomplish more. You can solve big problems in a way that none of you can do individually.

Leah Anyanwu: Thank you, Cynthia.

Lysa Ratliff: Hey. Ditto. There’s always a solution. And really, in looking at creating a better path in the future to, have a solutions mindset. And that’s how we’re getting stuff like this done. All of us work together in some way, shape or form on this panel. And so we’ve been committed to each other and to finding solutions to problems. And the more that we do that, the more results we’re going to see, like the ones Kathy shared with us at the beginning.

Kathy Hirsh-Pasek:: I’m going to end with, believe. If you can dream it, you can do it. If you really feel it in your heart. I have seen people from the community of Philadelphia, Santa Ana, Chicago, people who you would never believe could rise to the occasion and make dreams come true for their community. Make inclusive spaces where every child can grow and can thrive with their parents, with their grandparents, with their friends believe, If you can imagine it, it is possible.

Leah Anyanwu: Well, thank you for that. I think we have time for one last question before we close out. And that would be, you know, what advice do you have for folks about the best ways they can advocate for quality play spaces in their communities and what resources might you recommend? And anyone can take that one.

Kathy Hirsh-Pasek:: Well, I’m happy to jump in again. As I said, it depends what you want. You know, the resources can be beer or they can be champagne and they can come from parks departments or they can come from city government. There’s so many ways to do this. If you have a dream that you want to fulfill, write us and we’ll help you get there.

Cynthia B Brown: I’d second that and that is that that I think anyone working in this space is including myself, is happy to share what we’ve learned. In fact, the one of the most exciting things to me about the Atlanta Community School Parks Initiative is the chance to create a model which we can then replicate in communities across the country. So if if you are interested in this kind of initiative, if you want to hear more, please reach out to us and we would be excited for the opportunity to work with you in your community.

Lysa Ratliff: The last thing I’ll add is find your people. Find your people. There’s people everywhere. All you got to do is just look up and listen and gravitate towards the people who are ready to get things done. That’s certainly how all of us are making progress is just finding the problem solvers, right?

Leah Anyanwu: Oh, I was taking so many notes. Le-Quyen, Cynthia, Kathy, Lysa. Thank you. Thank you. Thank you for the work that you do each and every day to ensure that children can access safe and quality play spaces. Thank you all for the work you do and thank you to all of you who joined us in the audience today. I hope you are leaving with actionable insights that you can integrate into your work. Back to you, Melissa.

Melissa Rivard: Thank you so much, Leah, and to all of our panelists. What an incredible conversation. I just want to add my thanks to Leah’s for all of you and sharing your insights and your inspiring work today. And thanks to our audience for attending. Also, please stay connected to the Center’s work through our website and the newsletter for more on this topic. And of course, visit Playful Learning Landscapes and KABOOM!’s websites to learn more about their work, and have a playful day. Everyone, thanks so much for being with us.

Cameron Seymour-Hawkins: The Brain Architects is a product of the Center on the Developing Child at Harvard University. You can find us at developingchild.harvard.edu, where we’ll post any resources that were discussed in this episode. We’re also on Twitter @HarvardCenter, Facebook at Center Developing Child, and Instagram @DevelopingChildHarvard. Our music is Brain Power by Mela Collective.

**A Place to Play: Moving Towards Fairness of Place for All Children** May 02, 2024

Contents

Podcast

Panelists

Additional Resources

Transcript

In March 2024, we continued our Place Matters webinar series with our third installment: “A Place to Play: Moving Towards Fairness of Place for All Children.” During the webinar, we explored the power of play in supporting early childhood development, as well as the importance of ensuring that children and caregivers have access to safe green spaces, like parks and playgrounds. Our panel of experts discussed how access to safe, stimulating, and joyful play space is not equally distributed across communities, along with strategies to work toward building a future where all children have a safe place to play. The webinar discussion has been adapted for this episode of the Brain Architects podcast.

Panelists

Leah Anyanwu *(Moderator)*
Programme Specialist, Children on the Move, Children’s Learning and Development, The LEGO Foundation

Cynthia Briscoe Brown
Atlanta Board of Education Seat 8 At Large

Kathy Hirsh-Pasek
Professor of Psychology and Neuroscience, Temple University; Senior Fellow, Brookings Institute

Lysa Ratlif
Chief Executive Officer, KABOOM!

Le-Quyen Vu
Executive Director, Indochinese American Council

Melissa Rivard *(Webinar Host)*
Director of Engagement Strategies, Center on the Developing Child at Harvard University

Cameron Seymour-Hawkins *(Podcast Host)*
Communications Coordinator, Center on the Developing Child at Harvard University

Additional Resources

Place Matters: The Environment We Create Shapes the Foundations of Healthy Development

Presentation Slides

Playful Learning Landscapes

KABOOM!

Atlanta Community School Parks Initiative

LEGO Foundation

Indochinese American Council

Transcript

Cameron Seymour-Hawkins: Welcome to The Brain Architects, a podcast from the Center on the Developing Child at Harvard University. I’m Cameron Seymour-Hawkins, the Center’s Communications Coordinator. Our Center believes that advances in the science of child development provide a powerful source of new ideas that can improve outcomes for children and their caregivers. By sharing the latest science from the field, we hope to help you make that science actionable and apply it in your work in ways that can increase your impact.

In March, we continued our Place Matters webinar series with our third installment: “A Place to Play: Moving Towards Fairness of Place for All Children.” During the webinar, we explored how play and a family’s access to safe green spaces, like parks and playgrounds, support early development. Our panel of experts discussed how access to safe, stimulating, and joyful play space is not equally distributed along with strategies to work toward building a future where all children have a safe place to play. We’re excited to share part of this conversation on today’s episode of the Brain Architects podcast.

If you’re interested in in seeing some examples of community-led solutions to address gaps in play space equity presented by Lysa Ratliff of KABOOM and Kathy Hirsh-Pasek of Playful Learning Landscapes, we encourage you to head over to our YouTube channel to view the full webinar recording.

Now, without further ado, here’s Melissa Rivard, the Center’s Assistant Director of Innovation Strategies, who will set the stage for our conversation.

Melissa Rivard: Welcome and thank you all so much for joining us today. It’s really gratifying to have so many of you showing up for this really important topic. So thank you. I’m Melissa Rivard, Assistant Director of Innovation Strategies and I will be your host today. This webinar is part of a series of webinars that the Center on the Developing Child has hosted to examine the ways that a child’s broader environment, including the built and natural environments, as well as the systemic factors that shape them, play a role in shaping child development and health beginning before birth. Our focus today, the importance for all children to have access to stimulating joyful and safe places to play, is prompted by our focus on fairness of place as well as a desire to highlight a long standing collaboration between the Center on the Developing Child and the LEGO Foundation, and our shared belief in both the power of the early years and in the power of play to positively impact lifelong learning and health. Our moderator for the conversation is Leah Anyanwu. Leah is a program specialist at the LEGO Foundation, where she supports the Foundation’s early childhood portfolio with a focus on children displaced due to conflict and climate. Leah is a passionate educator and advocate with over a decade of experience working in education with a focus on early childhood and education systems reform. Along with Leah, we’ll be joined for this discussion by a phenomenal group of panelists who bring a wide range of expertise related to this topic. Kathy Hirsh-Pasek is a professor of psychology at Temple University and a senior fellow at the Brookings Institute. She served as president of the International Congress for Infant Studies, was on the Governing Board of the Society for Research in Child Development and is on the board of 0 to 3. In 2010, Dr. Hirsh-Pasek founded Playful Learning Landscapes with her colleagues, an initiative that reimagines cities and public squares as places with science infused designs that enhance academic and social learning opportunities for young children. And we have Lysa Ratliff, who is CEO of KABOOM!, a national nonprofit that works to end play space inequity. Lysa is a leading national advocate for equitable access to play spaces, has been invited to speak at several White House events and engages with members of federal, state and local public offices advocating for and creating opportunities for kids to play across the nation. We’re also joined by Le-Quyen Vu, who is Executive Director of the Indochinese American Council in Philadelphia, a nonprofit working to empower disadvantaged and minoritized groups and newly arrived refugees and immigrants in their community to achieve social, economic and educational advancement and mobility. And Cynthia Briscoe Brown, a member of the Atlanta Board of Education, Seat 8 at large who’s been instrumental in passing a number of policy initiatives, such as the historic Equity Policy, the Atlanta Community School Parks Initiative and the Atlanta Public Schools Center for Equity and Social Justice. Without further ado, I am so pleased to hand the baton to you, Leah.

Leah Anyanwu: Thank you and welcome, everyone. I am so excited to hear from each of our panelists about the critical work connected to play equity and for this conversation, which centers the power of play and the importance of safe and quality play spaces. Our aspiration at the LEGO Foundation is that children become creative, engaged, lifelong learners who thrive in a constantly changing world by experiencing the benefits of learning through play. The scientific evidence around the power of play is clear and growing. In short, play is essential, everyone. Not only is play the best way for children to learn and to thrive, but play builds the foundations of lifelong learning and fosters holistic development. We’re here today because there is so much opportunity for children, families and communities when it comes to play and creating spaces that invite and enhance it at the community level in policy development and in the work that brings each of us to this conversation today. Yet we have a long way to go towards ensuring that the opportunity for quality play is equally accessible to all children, families and communities. To quote the Place Matters paper that Melissa just mentioned, “just as dimensions of the built and natural environment have been designed over time, they can be redesigned to support healthy development.” Throughout our conversation today, we will share insights from research and the field about ways to redesign, to rethink and to rebuild in pursuit of creating environments that support all children’s copy development. Now, without further ado, let’s get started. And I really want to invite Kathy to really focus first on the why. So, Kathy, good to have you here. What does this science tell us about why play matters for children, particularly young children? And how is play connected to learning and what kinds of play and characteristics of play are particularly important?

Kathy Hirsch-Pasek: All right. You got it. And thank you so much, Leah. Well, we created Playful Learning Landscapes because we agreed with you Leah and we agreed with the work going on at Harvard that it was time to transform cities and villages and towns into family friendly spaces that were inclusive and that were infused with learning. So what I’m going to share with you today are not really just play spaces. It’s not like going to the playground. They are every day spaces that are infused with the science of learning and social learning that can be built right into the architecture. We build everything that we do on what we call our three part equation. The first thing is that when you go into a city, you need to know who your audience is. You need to be consistent with the cultural beliefs and the community values. So we start there. And then on top of that, we add a series of characteristics that define how human brains learn. And it just so happens that those same characteristics define play and playful learning. You have to be active, not passive, engaged, not distracted. It has to be meaningful. It has to not be disjointed. Has to be socially interactive. It has to change a little each time and be iterative. And finally, it should be joyful. That’s the how of learning how brains learn. And then the science of what children learn is the 6Cs. You know, in a world with AI we need to learn reading and writing and arithmetic, but we need to go beyond it. Can we collaborate and can we communicate well. Do we know our content? Do we have critical thinking? Do we have good–here you go–creative innovation, which is going to be very important. And then we want to know if you have the confidence to give it a try, which helps to feed grit and perseverance. There’s a whole lot of science to back this work up. And that you can use this equation for digital media, for places and for school building in ways that will help kids grow in a playful way.

Leah Anyanwu: Thank you, Kathy, for that framing, I want to bring Lysa into the conversation. Lysa, KABOOM!’s mission is to end play space inequity for good. Can you tell us how you define play space inequity and share what you’ve learned about the scope of the issue? And what are you and others doing at the policy level to try to address it?

Lysa Ratliff: Sure. The big question and I want to start by thanking Kathy for grounding us in such beautiful space, because what we see through those examples is that we have solutions. We are working against a solvable problem, and for Kaboom! we define play space inequity as a lack of access to and a sense of belonging and which is important. Quality play spaces due to the affect of systemic racism in communities across the country. And for anyone who’s been following the report, the play Place Matters report or the webinars, I would encourage you to go back to Dr. Lightsey-Joseph’s conversation where she laid out the historical policies that we are all trying to navigate today, and for Kaboom! Within that broader context, our focus is centered on kids. We care deeply about our children and we prioritize public space. And so we focus our efforts on play spaces and the surround sound that needs to happen so that kids have more access to and more quality time in play spaces so that they can benefit from all of the things that happen when kids go out and play on quality spaces. What we’ve learned about the scope. There’s just four really big categories that we’ve discovered through some work that we did that was funded by Colorado Health Foundation, and we worked with our partners at NC State and the College of Charleston, where we see those same patterns of inequities that Dr. Lightsey-Joseph was talking about and things like the achievement gap, the access to healthy food and health care coverage, all of those things. They also apply to play spaces. And so the four different areas are 1) distance matters and we hear a lot of conversation around the ten minute walk and the accessibility to play spaces and making sure that it is the easy option and that play spaces are within the communities that we need to work in. The challenge is that low income and communities of color and even rural rural communities are more likely to have limited access to play spaces where they live and learn. This is not just in their community, this is in their schools. There are schools without play spaces at scale and in parks just across the board. There is not easy access to play spaces and public spaces for kids and families to go. So that’s one critical piece. The quality of those spaces is also something that we’re concerned about. And so even when they do have access to places, it tends to be lower quality. It tends to be in communities of color, half the size as in communities that are predominantly white. So there’s less space to be able to play in and there’re worse physical conditions and lower play value. So we all know that kind of repetitive play is important and being able to not just go out there once and play, but time and time again to go out and discover new things is really important. That all has to do with quality. Neighborhood, again, you know, when we’re thinking about inequities, low income and BIPOC communities are more likely to have limited access to play spaces because of neighborhood factors like transportation and personal safety concerns. And so community cohesion and coming together and making sure that the community starts to really bind together as a community through public space will also help us address the barriers to kids going out and play. And then finally, history. You know, I’ll kind of end with this piece with where I started is that our communities are still shaped by racist historical practices like redlining. Our public spaces, our schools are a reminder that not so long ago they were segregated space. People are still alive that lived in segregated space. And I can’t share it here because I don’t have license to the photo. But I would encourage people to look at the Gordon Parks photo from 1956 called Outside Looking In, and it shows a group of young black kids looking through a fence into the most beautiful play space you can imagine. And yet they weren’t allowed to play in it. That residue is still what we’re dealing with today. Those kids in that photo are probably still alive. Some of them are probably still alive today. So we’re not talking about that long ago. So that history that we have inherited is also affecting how we work today . In the fifties, what we were also seeing is infrastructure being developed that went straight through thriving black communities like our highways and freeways, all of this backdrop is really the barriers that we have to make sure that we are acknowledging and problem solving around to make sure that we solve in a way that addresses the systemic issues, but also allows us to work in a systematic way so that our future is better than our past. You talked about policy, or asked about policy. And so to that part of the question, doing so much, so much and we’ve only really leaned into policy and advocacy and government affairs works since like 2019, 2020. And in that time we’ve moved in light years. You know, we think that our policy and advocacy work and the influence that we have there is as important as the spaces we build, because that’s where we’re going to stall and stop the perpetual issue of that historical racism has created in our public space and the allocation of resources. And so in the policy work, we see play space inequity as a historic challenge, which stems from an intersection of local and state and federal policies that were rooted in a racially biased ecosystem and decision making. And so we have to work at all of those levels. At a local level, we’re working with our partners on data. We are very committed over these past years to really understanding through data where play space inequity exists, and so a resource that we can bring to our local partners is giving, providing them with that data and letting them overlay it with their own data as a road map for the work and also as a tool to help prioritize. Oftentimes you see in local systems that they work against the pressure of who’s talking loudest and who’s asking loudest. And so by having that data as their baseline for prioritizing their budgets, which is also a little bit of a policy document, because budgets are saying where money and resources are going to go, it helps our state or our local partners prioritize historically, disinvested spaces. That state work links to our federal and That local work links to our federal and our state work. Because so often the resources that go into the local system come from the state or the federal government. And so we work a lot at the certainly at the federal level where we are in a couple of layers. So we are working across the board, not just specifically on play space issues, but advocacy efforts around things like the rural development and the farm bill and looking for greater flexibility in that CDBG program because we know those fundings, those funds are going into local budgets. And so making sure that we are a champion for prioritizing equity in those spaces and then even some of the work we’re doing with the administration is to support the implementation of the 40 initiatives. And then finally, two other points on the policy work at the state level. We’re also working to advocate for things like recess, mandatory recess. And I was horrified to learn that California is the 10th state, which is a state we just worked on with Governor Newsom to pass a mandatory recess bill, but it’s only the 10th state in our country that has mandatory recess. So we have work to do there. But it’s alarming to know that we’re not even mandating recess in the majority of our states. The last thing I’ll say about our policy and advocacy work is it’s not work we can do alone. And so we’re part of a lot of coalitions. We helped co-found Coalition called the Nonprofit Infrastructure Coalition. We did that during the pandemic when there was funding being decided around infrastructure and making sure that we were part of mobilizing the sector to advocate for equitable allocation of resources when a lot of money was going to come out from our federal government. And then two other notable coalitions we’re a part of is the Percefra Place Coalition, which advocates for greater investment by the federal government in civic infrastructure. And then finally, the Outdoor Alliance for Kids, which is really looking at promoting legislation and policies that make it easier for kids to access outdoor recreation and play. And so a lot there, but a lot of history and the partnerships that we’ve been able to build make it really easy for us to lock arms and make the kind of progress that we could have never made alone.

Leah Anyanwu: Yeah, Thank you, Lysa I mean, there’s so much to unpack here, but I’m going to ask you and you can maybe just in one minute, can you share KABOOM!’s general approach to design and creating play spaces and briefly summarize the project that can be will be speaking about this.

Lysa Ratliff: Yeah. Okay. This is a challenge. So data collection, I mentioned that data collection is recently we have we know that we cannot solve playspace inequity if we do not know where playspace inequity exists. So we’ve made deep investments in data. So that data piece, the partnering with others, what Kathy was talking about, community voice and making sure that we are responding to what the community identifies as their needs through the team that we have here, and more importantly, local partnerships that are connected to community on the ground. We work with Le-Quyen who will hear from. We recognized a couple of years ago that we cannot keep working one project at a time, but we’ve got to look at more system level partnerships and working with peer organizations. So in places like Atlanta, we’re locking arms where Children in Nature Network, Atlanta Public Schools, Transfer Public Land to utilize the data that we’ve collected to re-envision what a school yard can look like. Nature elements, sports elements, learning outdoor classrooms. you’re not just looking at a play infrastructure, but you’re looking holistically at that school campus as a place to grow food, as a place to have multiple activities and so the Oakland work that we’re doing as part of our partnership with the Learning Play Foundation in Oakland Unified School District, where we’re transforming 25 schoolyards throughout Oakland by the end of 2026.

Leah Anyanwu: Thanks, Lysa. I’m so sorry to interrupt that you have so much wisdom on this call and so many examples to share that I know we’ll share links to the theory of change and the project so folks can continue reading. I just really want to make sure we have time to pick up on one of the essential themes that you and Kathy spoke about, which is community involvement and leadership. And so I’d love to bring Le-Quyen in and Le-Quyen–can tell us what does community led look like in the Literacy Rich Neighborhood Initiative and the literacy tree installation, and how do you ensure that community members involvement is truly meaningful? How did involving the community make a difference in terms of design and the use of space? Le-Quyen, over to you.

Le-Quyen Vu: So just to be clear on the record, none of us knew that we were. Lysa probably didn’t know that we were funded by KABOOM!, and Kathy probably didn’t know that this project was her brain when I started picking her brain, before we responded to the Funder who was asking for us to submit our idea so that that just to put it out there. The Center did not invite us because we were linked together. It happened that way. So, so to me when we got this project, so we are the literacy agency, We work with adults, we work with children. Family literacy is part of what we do. We are not an architecture firm, so I am entering into a territory that is new, that is born to me. So the thing that I that I have to ask myself was how do we get the community to this space that we tried to transform? Who knew we who are the people who will be using it, and how do we get these folks to take ownership? We talk about that all the time, but how we go about doing it is different. So that was a question that would just make me lose sleep when I heard that I got the funding because that’s huge. So I realized, okay, we have to approach this, the community, as partners. We have a job to do and these are the folks that will help us finish the job. So I always said this we have to approach this as we have a product in that we’re not selling anything, but we have something to sell. So the people who are using the space are our customers. So we need to go do that. We need to involve them from the beginning. We need to do the research at that. Lysa did her work, Kathy did her work. So our job is to take that work and bring it to the community in a way that is going to create a result that everybody’s happy. So that’s basically it. So we came in with a blank piece of paper. We wrote the proposal with 20. There’s a goal, this thing that we achieved, but we didn’t have a definite picture of what that looked like. We said what it looked like would be from the community. But he has other goals. So we went in there from the beginning before we submitted the proposal, we went to the community and asked them, we are going to do this. Would you be partner with us? Would you be interested in us doing this? So even before we submit the proposal, we went and asked them. So everybody was asking us, Yes, yes, yes. And then when we got the funding, it was easy to go back and say, So we got the funding. You said you want us to do this, so let’s do it together. So that’s basically what it is. And then us in the process of working on this project, I realized there are a culture differences between institution between government and between the community who live in the neighborhood. And our job–everybody knows what they want the two and know what they want coming together and connecting those two things together. They don’t speak the same language. Good thing that English is my second language, so that come naturally for me to be like, okay, we’re going to have to connect these folks. So we along the way, we basically played the role of a mediator, the peacemaker, the coming okay, here’s what people said. Here’s not what people said. And then coming and bringing people together. And that’s how we started that project and that’s how we the people decide where they want the space, the kit, these know what it looks like and everything was from the people. We went back we invited the university students. We invite the people to take the classes, the design class together, the community committed to ten weeks of 3 hours of every hour, every week to work as a student to design this whole thing. So the first phase was we got the William Penn Foundation to do that tree. The second–there are more– they the community wants a lot. So we were able to get KABOOM! to fund the other piece that the community wanted. So it’s an ongoing project.

Leah Anyanwu: That’s what it sounds like Le-Quyen sounds like, you know, it’s very participatory and you’re always adapting and adjusting. And I mean, you touched on something that I would love to bring Cynthia in to kind of build on, and that’s, you know, a similar question, but from the policy perspective. So Cynthia, if you can just share briefly, you know, can you outline the work that you’ve done to make play more accessible for all children in Atlanta? And I know you’ve done a lot of work in this space, so perhaps you can just share, you know, a bit more broadly and then focus briefly on the Atlanta Community Schools Parks Initiative.

Cynthia B Brown: Absolutely. And thank you for asking. As Lysa said a few minutes ago, history matters. And in Atlanta in particular, where Atlanta public schools, it has a approximately four out of five of our students are on free or reduced lunch, and well over eight out of ten are students of color. We deal with racial and socioeconomic inequities that are baked in for centuries. We have schools which have no walk zones. It’s too unsafe for children to walk from their home to the school. We have schools where two thirds of our students are transient. Atlanta is a city of neighborhoods. And and so we still have neighborhood schools, attendance zones where we believe that schools really are the the beating heart of a community, the social center of a community, not just a place for children to go for instruction, but for wraparound services, for health centers, for food pantries, for clothes, closets. We have parent centers where parents can come and use wi fi and and computers to apply for social services and apply for jobs. We have parenting classes, so we really think of a school as the beating heart of the community. We want that entire school property to be a learning rich environment. And so when we had the opportunity to work with KABOOM! And the children and Nature Network Trust for Public Land, the city of Atlanta, we needed to find a way to to to build a structure for that kind of partnership. What we are really talking about here is a new kind of public private partnership where where we tackle big problems, problems that are h onestly too big for any one of us to solve and and we are able to do that because we don’t care who gets the credit. Our equity policy that the Board of Education passed in 2019 is the foundation of this. It’s the driver of everything else we’ve done. Because what it does is require the superintendent to eliminate inequities in every decision, every dollar, every program, every initiative, every thing we do in Atlanta, public schools coming out of that is our student outcomes focused governance work, which uses data to drive all of our decisions based on student outcomes. And so the data that we get from the Atlanta Community School Parks Initiative allows us to make the argument that student outcomes are affected by play spaces because we’re given that information that allows us to to to use the policy as a lever to drive direct action. Finally, we, we then use the policy. I never like to say we do anything top down in Atlanta Public Schools, but we can use this top down policy. The the this I believe statement that the board makes in a policy to drive bottom up engagement so we can put in a policy that the that the superintendent will consult with the community will develop an engagement plan and then fully and faithfully implement that plan before we before we make any major decision. That’s been an effective way for us to integrate this play space work to to build learning rich environments and to to get the community involved. Because like Le-Quyen’s project, this is very community based. Our children and their families, our employees design the projects that we then implement. I’ll also say that building relationships is critical. We have a mayor right now who declared this past year is the year of the Youth–an APS alum himself. He has declared that he wants Atlanta to be the best place in the country to raise a child. And so we’ve received additional assistance by building relationships with the mayor’s office, with the city council, with the Department of Parks and Recreation that have resulted in some very tangible results, including a joint use agreement between Atlanta Public schools, the city and this consortium that the Atlanta school, the Atlanta Community School Parks Initiative, so that we can open our school yards, our spaces in our schoolyards to the community to allow them to to enhance added rich, what we are doing at the school and also in the community. We have intergenerational spaces in those in those schoolyards. They are safe, they are clean, they are welcoming, and so they are enhancing and adding to what we do in the classrooms.

Leah Anyanwu: Thank you, Cynthia. So Le-Quyen I’d love to hear from you. What were your lessons learned about how community involvement can make a difference in the design and the use of the space?

Le-Quyen Vu: Community involvement would help us maintain the space, would help us advocate for funding. When we did this work, we were ambitious and we thought that little money we have can do three things. We ended up with able to do only two. The community. Engagement was able to make the case to the state and get the money from the state to do the other area. So that’s what community engagement and community engagement also mean that they will look out for this space is is it to maintain a lot of time, We built these places, we make it beautiful, but funding ended and then we don’t have a means to continue maintaining it. That is what what is meaning is meaning that this place will continue to be used. This place will continue to serve its purpose and they will continue to maintain.

Leah Anyanwu: Right. So really getting to the sustainability bit. And that’s really helpful. Lysa, can you also share your lessons learned about communicating the problem of play space inequity and what moves policy and decision makers can take if they want to make play more accessible for all children?

Lysa Ratliff: Yeah, I mean, I’ll just boil it down to at the end of the day, we are having human conversations about our most precious humans. And I, you know, when you use words like historical disinvestment, racial equity, racism, it can become emotionally charged. But for us, we’re talking about a human issue and we’re talking about a human issue as adults who have a responsibility to care for our kids. And that just crosses all walks of life. And so for us, particularly in our policy and advocacy work, we’ve been able to show up in a very nonpartisan way to problem solve. The work that we’re doing in Uvalde, Texas, where we have quite literally locked arms with the community there, we have gone to the Hill with them and advocated across You know, Democrats and Republicans who are really looking at space and equity as something that can be solved as an example to solve bigger issues. And so at the end of the day, just my my advice there is that we’re just talking about human issues and our responsibility as adults to care for our babies.

Leah Anyanwu: And this is a human issue, right? Like we can set aside our differences. At the end of the day, we are all set up for success when our children can thrive. Thank you for that. Kathy, a question we received is around examples or suggestions of ways to create opportunities for quality outdoor play in communities that might have fewer resources. Can you share for one or 2 minutes just any examples or suggestions that you might offer?

Kathy Hirsh-Pasek: Yeah, absolutely. The first thing I’ll say is that I totally agree with Lysa and Cynthia about the wonderful work that you guys are doing and how it’s really a team sport. And so there are a couple of things I’ll say about resources. The first is in the work that we do, bus stops have to be built, transit centers have to be built. There are budgets in cities and communities for these things to be built. So as I said, well, ours are play spaces. They aren’t really they’re just your average bus stop. They’re just your sidewalk. They just happen to be the library. And there is money for those amenities. So the cost to people in the community is zero. Okay. And we have found that if you go to the cities and you say, wow, the next time you put in this bus stop, the next time you put in this sidewalk, let us be a part of it and they will let us do it. And as Le-Quyen knows, Philly’s been really, really good about that. And even put a person who focuses on playful learning in the mayor’s office. So sometimes it takes that. And that also helps with the kind of coordination that Cynthia talked about. All right. One more piece to that is that, you know, you can do fancy things with the government or can do not fancy things. So I always talk about it as the champagne or the beer level. And all of those are available in the projects that we’ve done. And one that I did in the country of Colombia. And I have never, ever experienced poverty like I saw in the place that I was at in this one, this one school area in Colombia. And how did we put in place a learning landscape? We used cardboard, we painted it different colors, and we used chalk because with chalk I could draw on a floor, I could draw on a sidewalk. So sometimes it’s as easy as chalk. The examples I could show you that we went into, you know, supermarkets and change signage. The whole project cost us $65. So I wouldn’t worry about the cost. There are many ways to do it. I think the bigger issue is what you just talked about last time, that it really does involve listening and hearing as Le-Quyen told you so beautifully, so that the community has ownership you don’t and that you work with all the people who need to be around the table, which includes policy people and people from the Parks Department and people from the city, or it won’t get done.

Leah Anyanwu: Thank you, Kathy. And I love that charge that, you know, play can happen with nothing. I remember being a child and we were just playing outside. We would just make up stuff. So we don’t always need, you know, fancy playgrounds. Can we just have some creativity? Recycled cardboard, plastic bottles, rocks, tires. The sky is really the limit. So we are we are nearing the end of the hour, which is hard to believe. And thank you all for such a rich conversation. Before we close out, I’d love for each of you to share one positive note to leave our audience with. So perhaps that’s an outcome from your work, a development in your community, or finding from your research that we can take with us. So we’ll start with Le-Quyen then hand it over to Cynthia, Lysa and Kathy close us out.

Le-Quyen Vu: I would say persistence and partnerships. Those are the two things that I take away from this project.

Leah Anyanwu: Thank you Le-Quyen.

Cynthia B Brown: Mine is similar to that and that is never give up. Five years ago I would not have believed that we could be accomplishing what we are in Atlanta. And and the other word of advice I have is find champions, find a school board member who you can who you can rope in, who you can get excited about your project. Find a city council member, find a nonprofit CEO and and build those relationships so that together you can accomplish more. You can solve big problems in a way that none of you can do individually.

Leah Anyanwu: Thank you, Cynthia.

Lysa Ratliff: Hey. Ditto. There’s always a solution. And really, in looking at creating a better path in the future to, have a solutions mindset. And that’s how we’re getting stuff like this done. All of us work together in some way, shape or form on this panel. And so we’ve been committed to each other and to finding solutions to problems. And the more that we do that, the more results we’re going to see, like the ones Kathy shared with us at the beginning.

Kathy Hirsh-Pasek:: I’m going to end with, believe. If you can dream it, you can do it. If you really feel it in your heart. I have seen people from the community of Philadelphia, Santa Ana, Chicago, people who you would never believe could rise to the occasion and make dreams come true for their community. Make inclusive spaces where every child can grow and can thrive with their parents, with their grandparents, with their friends believe, If you can imagine it, it is possible.

Leah Anyanwu: Well, thank you for that. I think we have time for one last question before we close out. And that would be, you know, what advice do you have for folks about the best ways they can advocate for quality play spaces in their communities and what resources might you recommend? And anyone can take that one.

Kathy Hirsh-Pasek:: Well, I’m happy to jump in again. As I said, it depends what you want. You know, the resources can be beer or they can be champagne and they can come from parks departments or they can come from city government. There’s so many ways to do this. If you have a dream that you want to fulfill, write us and we’ll help you get there.

Cynthia B Brown: I’d second that and that is that that I think anyone working in this space is including myself, is happy to share what we’ve learned. In fact, the one of the most exciting things to me about the Atlanta Community School Parks Initiative is the chance to create a model which we can then replicate in communities across the country. So if if you are interested in this kind of initiative, if you want to hear more, please reach out to us and we would be excited for the opportunity to work with you in your community.

Lysa Ratliff: The last thing I’ll add is find your people. Find your people. There’s people everywhere. All you got to do is just look up and listen and gravitate towards the people who are ready to get things done. That’s certainly how all of us are making progress is just finding the problem solvers, right?

Leah Anyanwu: Oh, I was taking so many notes. Le-Quyen, Cynthia, Kathy, Lysa. Thank you. Thank you. Thank you for the work that you do each and every day to ensure that children can access safe and quality play spaces. Thank you all for the work you do and thank you to all of you who joined us in the audience today. I hope you are leaving with actionable insights that you can integrate into your work. Back to you, Melissa.

Melissa Rivard: Thank you so much, Leah, and to all of our panelists. What an incredible conversation. I just want to add my thanks to Leah’s for all of you and sharing your insights and your inspiring work today. And thanks to our audience for attending. Also, please stay connected to the Center’s work through our website and the newsletter for more on this topic. And of course, visit Playful Learning Landscapes and KABOOM!’s websites to learn more about their work, and have a playful day. Everyone, thanks so much for being with us.

Cameron Seymour-Hawkins: The Brain Architects is a product of the Center on the Developing Child at Harvard University. You can find us at developingchild.harvard.edu, where we’ll post any resources that were discussed in this episode. We’re also on Twitter @HarvardCenter, Facebook at Center Developing Child, and Instagram @DevelopingChildHarvard. Our music is Brain Power by Mela Collective.

Understanding Racism's Impact on Child Development: Working Towards Fairness of Place in the United States Feb 15, 2024

Contents

Podcast

Additional Resources

Transcript

In December 2023, we continued our Place Matters webinar series with our second installment: “Understanding Racism’s Impact on Child Development: Working Towards Fairness of Place in the United States.” During the webinar, Stephanie Curenton, PhD, Nathaniel Harnett, PhD, Mavis Sanders, PhD, and Natalie Slopen, ScD, discussed their latest research, exploring how racism gets “under the skin” to impact children’s development and how it contributes to unequal access to opportunity in the places where children live, grow, play, and learn. Together, they explored ways to dismantle systemic barriers and work toward solutions that promote healthy child development. The webinar discussion has been adapted for this episode of the Brain Architects podcast.

Additional Resources

Transcript

Cameron Seymour-Hawkins: Welcome to The Brain Architects, a podcast from the Center on the Developing Child at Harvard University. I’m Cameron Seymour-Hawkins, the Center’s Communications Coordinator.Our Center believes that advances in the science of child development provide a powerful source of new ideas that can improve outcomes for children and their caregivers. By sharing the latest science from the field, we hope to help you make that science actionable and apply it in your work in ways that can increase your impact.

In December, we continued our Place Matters webinar series with our second installment: “Understanding Racism’s Impact on Child Development: Working Towards Fairness of Place in the United States.” During the webinar, Doctors Stephanie Curenton, Nathaniel Harnett, Mavis Sanders, and Natalie Slopen, discussed their latest research, exploring how racism gets “under the skin” to impact children’s development and how it contributes to unequal access to opportunity in the places where children live, grow, play, and learn. Together, they explored ways to dismantle systemic barriers and work toward solutions that promote healthy child development. We’re excited to share this conversation on today’s episode of the Brain Architects podcast.

Now, without further ado, here’s Tassy Warren, the Center’s Deputy Director and Chief Strategy Officer, who will set the stage for our conversation.

Tassy Warren: Hello. Welcome to today’s webinar. Understanding Racism’s Impact on Child Development. Working towards fairness of place in the United States. We’re so excited to bring you into this conversation. Whether you’re joining us for the first time or are a regular to the Center on the Developing Child, thank you for being here today. This webinar is part of our Place Matters Webinar series. The series is designed to expand upon our Center’s recent work on how influences from our environments, particularly the built in natural environments, play a role in shaping early childhood development beginning before birth. Throughout this series, we’re highlighting scientific and community expertise and offering strategies to work towards fairness of place and to create the conditions that will allow all children to thrive. Today’s conversation will explore the intersection between policy, systemic inequalities, racial disparities, and children’s healthy development. We hope that you’ll gain insights that are helpful to you in the work you do in support of children and families. And thank you to everyone who submitted questions when registering for this event. We received hundreds of submitted questions, so we’ll be asking some of those questions in the second half of the conversation. Of course, we will not have time to address all the questions that are submitted or we would be here for days. But we were really intrigued going through all of the questions that were submitted. And we appreciate the thought-provoking ideas that you all brought to mind for us. So we will be thinking about how those questions can inform future conversations.

So I am really excited in just a second to hand it over to Dr. Stephanie Curenton, who we are incredibly lucky to have leading this conversation for us today. Dr. Curenton is a professor in the Education Leadership and Policy Studies department at Boston University. Wheelock College of Education and Human Development and is the Director of the Center on the Ecology of Early Development, or CEED.

CEED’S research and initiatives serve to inform policies that promote equity and justice for racially and ethnically minoritized children in the context of education, health and community. She is joined today by an outstanding panel of researchers Dr. Nathaniel Harnett, Dr. Mavis Sanders, and Dr. Natalie Slopen. Dr. Harnett is Director of the Neurobiology of Affective and Traumatic Experiences Laboratory at McLean Hospital and an Assistant Professor in Psychiatry at Harvard Medical School.

Dr. Harnett’s research is focused on understanding the neurobiological mechanisms that mediate susceptibility to trauma and stress related disorders. Dr. Sanders is a Senior Research Scholar of Black Children and Families at Child Trends, where she leads in applied research agenda that advances racial equity and social justice. Before joining Child Trends in 2021, Dr. Sanders served as a professor of education and affiliate professor in the doctoral program in Language, Literacy and Culture at the University of Maryland, Baltimore County.

Dr. Slopen is an Assistant Professor of Social and Behavioral Sciences at Harvard T.H. Chan School of Public Health. Dr. Slopen is a social epidemiologist, and her research focuses on social and contextual factors that shape childhood development and inequities in health. Now, I’ll let Dr. Curenton share more about herself and kick off our conversation.

Stephanie Curenton: Hello, everyone. I am honored to be here to moderate this conversation and to represent CEED as well as Boston University. As Tassy was saying, our work at CEED specifically focuses on understanding how racism impacts Black children’s growth and development and ways in which families use their cultural assets and social capital to protect themselves from the harm of racism.

And we know that this conversation we’re having today is critically important because racism operates on multiple levels and it impacts young children throughout all levels of their biology, their social development and other ecological systems. And in the prenatal phase and the first years of life, they are the most sensitive developmental period. So it’s really critical to understand how racism exerts its impact on the health and growth of prenatal children and infants and toddlers.

As a scholar myself, I’ve been investigating and doing work on the topic of racism in young children’s learning for decades. By the fall of 2024, CEED, along with our partners at Equity Research Action Coalition, will be publishing a special issue for Early Childhood Research Quarterly on this topic, featuring researchers from a variety of disciplines and highlighting the work of several junior scholars.

So the scientific evidence is clear, and it’s growing that racism imposes unique and substantial stressors on the daily lives of families and caregivers. And understanding how these stressors affect child health and development provides a compelling framework for understanding and protecting young children. Such frameworks are the Rise Three Model, for which I’m a coauthor with Dr. Iheoma Iruka.

It presents new ideas about how communities, policies, programs and funding streams might confront and dismantle inequalities and build a stronger future for all of us. But we’re here today because there is so much opportunity ahead of us at the community level, at the policy level, and in all the work that brings each of us to this conversation today, as the Center on the Developing Child wrote in Their Place Matters paper that was published earlier this year.

It says just as dimensions of the built and natural environment have been designed over time, they can be redesigned to support healthy development. So throughout our discussion today, we will share ways to redesign, rethink and advance forward in pursuit of creating environments that are anti-racist and can support all children’s healthy development. And with that, I’m so excited to be moderating this conversation with Nate and Natalie and Mavis.

And I’m going to start the conversation with Nate. So, Nate, can you share what you’ve observed in your recent research in early childhood emotional health? Specifically, how have you observed the effects of racism on children’s brain development and how. And how were you able to expose a direct relationship to structural racism in your findings?

Nathaniel Harnett: Yes. Thank you so much, Dr. Curenton. And thank you very much for having me. Just to set the stage for answering that question, you know, my lab is really interested in understanding how we identify and prevent the development of things like trauma and stress related disorders. And we know that the stress that people experience during childhood really plays a role in the development of those disorders.

And we know that there are these really strong racial disparities between the amount of stress that people are exposed to where Black and other racially, ethically marginalized individuals are exposed to a disproportionate amount of stress. And so what we’ve been trying to do is to understand how the places in which children are growing up is related to the developments in brain structure and function and how that might play a role in later development of PTSD.

And so one of the more recent things that we’ve done is we looked at data from this large scale longitudinal study of child development called the Adolescent Brain and Cognitive Development Study. This is a study in about 10 to 12000 kids that started when they were about 9 to 10 years old. We were looking at the volume of gray matter of different brain regions that we know are really important for emotion, learning and memory.

These include things like the prefrontal cortex, really important for attention and top down regulation of people’s emotional responses. And then regions like the amygdala and hippocampus, which are really important for expressing that emotional response, that fear response to something stressful. And what we found was that if you look at the brain volume of white children compared to Black children, you see that Black talent show, this decrements in gray matter volume of these different brain regions.

But what’s really important is if you look at the environments that they’re growing up in, if you look at the amount of income that Black children have or their parents have, if you look at this thing called the area deprivation index, it’s way of looking at the amount of resources available in these different environments. If you look at the amount of conflict that’s happening in the homes, there really strong racial disparities in all these different areas where Black children are really living in these areas that have much more deprivation, There’s much more conflict in the homes, there’s much lower income across those in all of those things are related to gray matter volume in the study. And so once we go through to address your question of how do we actually expose this direct link, once we go through, we try to normalize these mathematically, when we try to account for all of those, you really don’t see strong racial differences in gray matter volume anymore. This is really important because we also look to see how are the volumes of these regions tied to PTSD symptoms even at nine and ten years old.

And so you wouldn’t expect large symptoms of PTSD. You wouldn’t expect many people to reach the level of the disorder. And you don’t see that. But you really still see even at nine and ten differences in the severity of PTSD symptoms, differences in the levels of trauma, exposure at nine, ten years old between white and Black individuals. And once you sort of normalize when you sort of equalize the environment, the places that they’re growing up in, you really see these sort of normalizations of brain volume, too.

And so we’re really thinking about how do we address this question that the webinar is about this sort of aspect of place and how that’s really toward kids are growing up so that we can help to alleviate some of these brain differences that we see that are going to have a role in how these individuals develop into the future.

Stephanie Curenton: So this is just absolutely fascinating. I was taking copious notes here, and I can’t wait until we get to the question and answer session to talk more. But at this point, though, I want to give Natalie a chance to talk about some of her recent work that is centered on racial disparities in the physical and mental health of young children.

So, Natalie, can you tell us about your research and how you’re finding links to inequitable experiences and opportunities, particularly as it relates to inequalities in the places where caregivers are raising their young children?

Natalie Slopen: Yes. Thank you so much for having me here and for the opportunity to share the work that I’m doing along with my students. So my research is focused on understanding how inequitable experiences of opportunity for healthy development that are shaped by our systems and structures affect healthy development and contribute to inequities that we see across socioeconomic position as well as across racial and ethnic groups with marginalized, racial and ethnic children from marginalized groups, often displaying worse outcomes early in the life course.

And we know that these differences emerge over time. So, you know, health is rooted in childhood. And so it’s really important to understand the systems and structures that are in place very early on affecting children in their families so that we can identify where and how we can intervene. And so I have been working on research across a variety of topics, thinking about what are different systems and structures that children interact with that are relevant to their health in the earliest years of life.

And one of the areas very relevant to today’s topic is housing. And one of the areas that I’m interested in is also in neighborhoods. And so I thought I could give an example of a study that I published this past year related to neighborhoods that connects to the topic for today. So this was a study that we published in Pediatrics, and we drew on a large national data source called the Mortality Disparities in American Communities.

And what we did is we connected information about over a million children in the United States coming from the American community surveys, linking it to information about the neighborhoods that they were living in. So here we were using a neighborhood measure called the Child Opportunity Index. And then we followed the children were followed with death record data for 11 years.

And so what our study found was that residing in neighborhoods with lower opportunity based on this measure of the Child Opportunity Index was associated with increased risk for mortality for children as well as for their parents. And so we felt as though it was important to document the intergenerational consequences of neighborhood settings and the importance of implementing place based policies to reduce the inequities that children experience that will have consequences as time goes on.

And so that particular study that I’m talking about was focused on outcome of mortality. But there’s a huge literature documenting the role that inequitable neighborhood environments, how across many dimensions of social, emotional, behavioral development in children and then health outcomes that we see as individuals age over over the life course. So that’s an interesting area of work. And one of the topics that I’m very interested in is how we best measure neighborhood context for health.

So there’s a lot of leading, you know, a lot of popular measures of neighborhood environment. And I think there’s a lot of open questions about which is going to be most useful for us and in which context. So some measures may be best when we’re thinking about how to decide where to implement certain programs or policies, whereas other may be useful, you know, for research purposes.

And so I think there’s a lot of open questions that we can answer using science about the best ways to conceptualize what the characteristics of neighborhoods matter most for children. And then finally, another topic that I’m interested in has to do with heterogeneity or variation in the way children respond and to their environments, thinking that that can help us to understand how to develop interventions that can close gaps in outcomes to lead to more equitable health and development for all children.

Stephanie Curenton: Well, again, just some really compelling research and just really, really, really interesting and compelling, somewhat a little sad too. So I will turn it over to Mavis. And Mavis, you and your team of researchers recently developed an interactive tool that allows users to such as users, such as policymakers, practitioners or researchers, to browse a decade of literature on the effects of protective community resources, and with the aim to explore how these resources can mitigate the impacts of risks faced by children and youth, including racism, as one of those risks.

So during your review of this extensive body of work, can you share more about some of your key discoveries?

Mavis Sanders: Absolutely. Thank you so much, Stephanie. Thank you for the invitation to this conversation. Just to provide a bit of context. My coauthors and I, including Jennifer Winston, Shana Rochester and Dominique Martinez, that I definitely want to give a shout out. We have been engaged in a process since I arrived at Child Friends to develop a research agenda which we sort of collectively throughout the organization decided would acknowledge the diversity in the Black community be strengths-based, be systems-focused and solutions-based as well. And we went through a three step process, and I believe that there will be a brief in the chat box to identify what went through this three step process to identify the research priorities. So you can imagine it was a large option, a large number of options that we could have pursued.

And so what we decided through this three step process is to focus on Black family, cultural assets and community protected resources. My colleague, Chrishana Lloyd, will be focused on Black family cultural assets and I am focused on protective community resources as part of that process. We are engaged in a systematic review of protective community resources and how they relate to child and youth development.

We had 3000 studies. Initially we were able to reduce those to about 300, and so of studies that went before a review, and then we reduced further to 172 settings. So your bibliographic tool that you reference includes information for those 172 studies that users can filter based on either the risk of participants or the age of the participants, or the type the type of protected community resource people are interested in.

And so for this discussion, because we’re talking a lot about mental well-being and cognitive development and so forth, when we look at those outcomes and this also feel terrible about things like community cohesion and support. Rise to the top is being consistently significant across this very diverse body of literature. So I want to put that out there. This is really hard to come to, drawn any absolutes.But there is a preponderance of evidence that suggests that community role models and mentors positive peer support, school connectedness and engagement in community based activities as well as neighborhood amenities, all contribute to the positive mental health of young people and that they can mitigate some of the risk. And I think that’s what Natalie was talking about. That’s in communities and what that suggests to me is that relationships matter, but also the spaces for people to gather and build those kinds of relationships that were so important to young people’s development. So I’d be happy to talk about that further as this conversation unfolds.

Stephanie Curenton: Yes. I’m going to ask you another question, Mavis, about your work. Your team released a brief in November that was called Black Children and Youth can Benefit from focused research on protective community Resources. And in that brief, you stated several neighborhood amenities and services that were associated with that health and safety. Can you name some more of those specifically?

Mavis Sanders: Yeah, absolutely. When we and Natalie talked about this as well, the constraints that we have as researchers by the measures that we have. Right. But we are improving in those areas. Neighborhood amenities specifically, which is one of the areas that we found to have a significant and positive relationship and association with Black children’s flourishing and development. One of those, you can think of those amenities as parks, recreation centers, libraries, sidewalks. So people who are familiar with the National Survey of Children’s Health are familiar with that sort of neighborhood amenities measure that includes those. There are also some studies that are really interesting around walkability of a city. So how is the city sitting out to promote walking as a mode of transportation? So you look at, you know, public transit location as how buildings are laid out, the lighting that is available. All of those things. And so we also published one brief where we looked at flourishing and flourishing was just looking at individuals’ ability to stick to a particular topic or a particular task and to have their ability to control their emotions and those kinds of things. And we found that young people who had access to all four of those neighborhood amenities, sidewalks, green spaces and parks, libraries and rec center were more likely to flourish or to have those sort of mental health indicators of flourishing than children who did not have access to those amenities. We also found out another study suggested that young men who work in cities with walkability so young Black, male, adolescent were less likely to report being involved in physical violence of any sort when they lived in cities or neighborhoods with higher walkability skills. So those are two of the sort of space-based or, you know, built environment elements that would seem to make a difference in the outcomes that we’re interested in for Black children.

Stephanie Curenton: Yeah. Again, this is just so the research that all of you are talking about is just really, really emphasizing the importance of place and the importance of relationships within the context of spaces and places. So it’s just fascinating to me. I’m going to circle back to Natalie now and ask you, Natalie, about the Child Opportunity Index and how you use that in your work. So specifically, can you share with us more about this tool and how that tool in particular might help us better understand health disparities in places where children live and grow?

Natalie Slopen: Okay, so the Child Opportunity Index is a measurement tool that was developed by Dolores Acevedo-Garcia and her colleagues, notably Clements, know IQ is a major contributor there as well. They’re based at Brandeis University, and they developed this measure as a way to think about the opportunities that are available to children in various communities across the United States. So it’s an example of a police station measure that’s aiming to evaluate or quantify resources and opportunities, specifically as related to children’s well-being and future prospects. So there are other place based composite measures of advantages or disadvantage that exists. And yet we mentioned the area deprivation index as an example. There’s the social vulnerability index. There’s really a host, there’s an environmental justice index.

But this is the only one that I’m aware of that I’ve seen in the literature that’s really tailored and designed to think about those aspects of the environment that matter for child development specifically. So it’s thinking about quality of education and health care, neighborhood characteristics of the built environment such as those that Mavis had just mentioned, like walkability and safety and other essential elements of neighborhoods and communities.

And so this measure is used by many different types of individuals and organizations. It’s very well designed to highlight disparities in access to opportunities across different demographic groups and across geographic areas. So this can help people to think about, you know, which contexts really require certain types of investments or interventions and where we may see the greatest impacts of investments for improving outcomes among them, perhaps underserved communities. And so the data is, you know, we have this data nationally across the United States, and it’s been being used by researchers as well as a lot of different public health departments at this time.

Stephanie Curenton: Great, great. So happy to learn, too, that that was built here in Massachusetts. That’s very great. I’m going to switch to talking about the implications for you all’s work and I’m going to open it up to each of you. So I know that it’s hard for researchers to come up with policy recommendations or community strategies specifically because we are scientists and researchers by training. But can you think about your research and how it informs strategies to support child development at either that community level or that larger systems level? And I’m going to circle back to Nate and let him start.

Nathaniel Harnett: You chose the one that it’s hard to answer. So I think that, you know, for us in the brain imaging field, it’s sometimes hard to think about how does showing picture pictures of the brain to people really help with this type of thing and how do we address policy? But I think that one of the benefits of the work that we do is that we really can show these effects very strongly. It’s one thing when you ask people, you know, do you think that discrimination has an impact on well-being? And you can get in this argument of, oh, is it perceived as the best thing? And we can actually look at the brain. We can actually look at what happens when you keep people in these impoverished environments. I think that’s really powerful.

We’ve done a bit in terms of reaching out, both to talking with individuals at the Center For and Behavior with Transition and thinking about how do we actually talk to people in positions of power, people who are making laws, people are making policy and actually showing them the data to just say, look, this is a real thing. We can really see it in the people that we’re looking at.

It’s not something you can really get away from, you know, And I think that there are other things that we thought about in terms of what are the actual policies that we can do. And I think, you know, one thing that I’ve said in the past is like, well, we know that even though there’s heterogeneity, the results, even things like cash transfers are associated with changes in brain, they vary reliably in some ways associated with changes in mental health and behavior.

And I think that part of the reason you see these heterogeneity is in some of the findings is for the exact reason that we’re talking about here. Right. And that the place that people are growing up and the actual structures themselves also need to change to help to facilitate this bettering of child development and ultimately sort of healthy adult functioning in the future.

Stephanie Curenton: What about Natalie or Mavis? Do you want to follow up on that?

Mavis Sanders: Sure, I’ll jump in. I think it really speaks to the need for researchers not to conduct their research in silos, to think about these research policy practice kinds of partnerships and being intentional about building those. Also, I’ve I feel lucky to be a part of an applied research center where we really are thinking about solutions, but also working in tandem to evaluate interventions like Nate just mentioned, to be able to show effects both short term as well as long term.

And I think it also speaks to the need for funding to support that kind of work and not only those short term evaluations, but those long term evaluations. And so really helping folks be present to seeing over a period of time and also to support the establishment of databases that allow this research. All of that is so important.

And we see how this research can also translate into positive practice. I love the sort of rebuild effort that’s going on in Philadelphia. We can talk a lot about that. But it is the sort of outgoing mayor, and I guess they’re part of their legacy to rebuild the libraries and the parks and the rec centers that are in Philadelphia.

Hundreds of billions of dollars have been invested, has been very community center, where the community has a say in the type of amenities that are provided to communities and the importance of those spaces not just for what we think about, but for afterschool programing, for family reunions, for all of these things that we know sort of benefit both children and families.

And I believe that there’s a video clip that will be there to talk about rebuild to a certain extent. But these are the kinds of large scale initiatives, policy initiatives that can take place when policymakers and practitioners and advocates, as well as researchers are in conversation to say this matters, this type of investment is absolutely necessary to address the disinvestment that has occurred in Black communities and other underserved communities.

And I think sometimes when we question the importance of our voices, but I think it absolutely is necessary in tandem with advocates and practitioners.

Stephanie Curenton: And I think that’s very, very well said. Did you have anything you wanted to add to that question? Natalie?

Natalie Slopen: No, please feel free to move on. I think that was really comprehensive and I appreciate Mavis bringing in this notion of collaboration with with Cost Communities, because that’s really what we need to be doing to have tailored and effective approaches. And I think also being like recognizing that evaluation for some of the types of programs that we’re talking about is really hard and may may not be able to follow a randomized trial. But we need to to think broadly and creatively about how to build the evidence about what works.

Stephanie Curenton: So I’m going to start this next question with you, Natalie. And this question is about mindset shifts. So we’ve been talking about changes to spaces in the built environment, but can you talk to us and share your ideas about what mindset shifts or adjustments we really need to consider in the early childhood field and which mindset shifts would be informed by your research?

Natalie Slopen: That’s a hard question. So I think that, you know, there’s been so much change and progress in the field of early childhood over the past several decades, and I think that there is now tremendous appreciation and focus on inequities, which is wonderful and a lot of attention to how we can take an anti-racist approach to understanding and addressing inequities in a way that we haven’t seen in the past. And that’s thanks to a lot of people’s work across a lot of different disciplines. I think we see changes in psychology and social work and public health, but it’s really coming from a lot of people focused on early child development, which is great. I think we have a long way to go to understand how to situate everything that we understand about an eco bio developmental model of child development within our thinking about upstream causes. And so while personal relationships matter, personal relationships are situated in an ecosystem and we we want to take a structural approach so that we can be as effective for as many people as possible. So I think that might be somewhat of a mindset shift. It’s not saying that relationships don’t matter because of course they do. But if we can shift our mind to think about what can we do at the higher upstream policy level to allow for the types of relationships we typically study, you know, are helpful to children to play themselves out.

So what can we do upstream to create opportunities in for children to have the healthiest context possible would be the mindset shift that that comes to my mind is continuing to push to think about upstream determinants.

Stephanie Curenton: Yeah, so I love what you just added here. You just articulated it that this is what we’re talking about now. This research is really about space and place. It’s upstream, right? It’s it’s a really good example of how to think about the work that’s important and upstream. So it’s fascinating. I’m just learning so much here with you all today.

I know that at this point we have a good amount of time for some questions from the community and we have some here that Tassy and her team have already curated. And I’m going to start with one and I’ll just open the floor. And whoever is interested can just respond to it. So one question is, what does the research show us about the different types of impacts that racism has in early childhood education and poverty, what they have in early childhood development? What similarities do we see and what differences do we see about the different how the different types of racism affect young children? And I’m assuming by types of racism, they’re talking about structural, interpersonal, internalized, etc..

Mavis Sanders: I’ll jump in and say from our systematic review of the literature on protective community resources, what we found was that even though we looked at a decade of research, right, so from 2012 until 2022, so research that was published within that sort of last decade went nowhere in 2023, ended in 2020. And I think one thing we identified some gaps in is in that report that you referenced earlier, Stephanie, that we need more in group for group specific types of studies because right now so much of the research and I understand researchers who are trying to be published in the top journals of their particular field, they actually will rely on a lot of survey data or data that includes diverse population of participants so that they can sort of draw and generalize the findings. Right. But when we do that, we give up something, right? So there’s no perfect study. You know, there are pros and cons to all kinds of approaches, and that’s reason we need a mix of studies, because at this particular point, we don’t have a lot of specific studies, and it’s hard for us to sort of talk about what this means, like the impact of racism, for example, the impact of anti-Black racism on young people, how that differs across, you know, region of the country, across socioeconomic status. There are so many very specific questions that we don’t know the answer to because we haven’t had that type of research. And then by the same token, we can say what supports, you know, youth versus young children’s development. And when we start talking about youth, we look at sexual and gender identity and how that has different effects and affects the experiences of young people differently.

All of these become questions that show that even though there is an abundance of research, that we have been constrained by measures a lot of it we’re using quantitative survey designs that can limit the kinds of questions that we can ask and the measures that we’ve had in the past. I mean, just thinking about the different types of racism, that’s a fairly current conversation. And so people are just beginning. So I wish that we could say more. But I think one thing that we can say is in this literature, there are large gaps and so we need to embrace the importance of those very group specific questions and encourage researchers to go ahead and do it. And I don’t think that there’s been the same level of permission to do those kinds of studies in the past. But we know their importance and we need to give each other and ourselves and various researchers who are coming into the pipeline permission to conduct those kinds of research.

Stephanie Curenton: Yeah. So I echo and support everything you’re saying and just this idea of how we need to expand and diversify our research and just in terms of measures, in terms of samples, in terms of quality data versus quantitative, I think that that is a really good, thoughtful and big agenda for how we move forward and in a way that can answer these questions.

So it’s great. I’m going to ask this question from an audience member, which I think is really interesting, is which one point about racism’s impact on early child development? Do you do you wish that we as researchers or the public policy makers practitioners that we understood more? So let’s think about one point.

Natalie Slopen: The one point that comes to my mind is I think that there is could be often a misconception that the consequences of experience. Well, first of all, I think people hear the word racism, and very often the default thought is interpersonal experiences of racism and not thinking across different levels. So, number one, but I think that there’s a conventional thought that the damage would be psychological or emotional without thinking about the broader span of consequences. There are implications of the range of types of racist experiences that people have interpersonally and within their day to day experiences in systems and in structural environments that affect cognitive development and social development and how the physical health is impacted. As Nate talked about, sleep, the whole range of developmental outcomes that we study are beginning to be studied in relation to a variety of forms of racism and we shouldn’t underestimate that the pervasive impacts that it can have.

Mavis Sanders: That is a hard question because we know how pervasive the effects have been, right? So I would cheat and I would, you know, try to at least two come to mind, top of mind. And one is the relationship between racism and economic violence. Or when I talk about economic violence, again, drawing from the domestic violence definitions of obstructions to economic mobility and opportunity, because in that way we see the interface between racism and poverty and economic disinvestment in communities and all that means for children’s well-being, their health and the environment. So that’s one thing. But I think also importantly, how racism and this pervasiveness of American society leading to representation in education, the effect that that has had on one’s identity development and young children’s identity development, what we see that in terms of youth and what we’re seeing in terms of research, where young Black and young adults, Black youths feel less tied to Black identity than previous generations.

And what does that mean for young Black children as they develop in the society that is still characterized by anti-Black racism? When young Black children do not have a sort of positive racial identity? And how do they then begin to understand the system that they’re in and how do they navigate the this? So the effects of racism not only on racial identity, no children and their whole identity, their personhood, but also is the association with economic deprivation and violence in the United States. So those would be two things.

Nathaniel Harnett: Yeah. So I’m also going to cheat in answering this question because I think that the question itself really dovetails nicely with both Dr. Slopen’s and Dr. Sanders answers to what is the mindset shift We’re going to we need to have this sort of field, and especially for those of us in neuroscience, I think it’s really important to recognize that we really haven’t done that much in terms of trying to understand this sort of intersection of racialization, socioeconomic deprivation and violence that children are exposed to.

We spent a lot of time thinking about how environmental deprivation or exposure to different threats the environment might affect children in general. We’ve done two decades of work looking at all of this, but in terms of acknowledging or accepting that the experiences that say, Black or white children might have are different as a result of this sort of socio historical or cultural pressures that’s been placed on the environments that people now grow up in.

There’s been very limited to do with that. And also going back to Dr. Sanders point, and it’s something that our work is trying to move to, We haven’t done a good job of it. We’ve focused a lot on group differences and potential contributors to that, but we haven’t explored or begun to scratch the surface of what’s happening within groups. What might be different for individuals who are still exposed to these high levels of racism that come from less socioeconomically disadvantaged areas. What’s the sort of impact on the brain? And again, we know again, it’s been almost 100 years, maybe more, figuring out these regions are really important for emotion, really important for different psychiatric disorders. And if we really want to have a full understanding of what the consequences of stress are, what the consequences of racism are, and what the sort of brain basis for disorders are, so we can make these generalizable, actionable treatments for the entire system in the United States. We really need to figure out what’s happening there, especially in child and how this sort of intersection between racialization and these threat and deprivation, other aspects of thinking about childhood development are intersecting to achieve those goals.

Stephanie Curenton: So I have a quick follow up question for Mavis. When you were talking, did you say that children nowadays have a less of a attachment to their Black identity than in prior years decades? Can you talk more about that?

Mavis Sanders: I have to send you the poll. And so I don’t want to share the source, but I’m almost sure what the source is about. But as I said, it’s documented now and so I will soon that link. But yes, they were just looking at across generations in terms of identification with one sort of racial identity. And we know that young people, I think younger than 30, have a different level attach of attachment than previous generations.

And I will make sure that I send that study so that it can be added as a resource for participants moving forward.

Stephanie Curenton: Yeah, that’s really interesting. Compelling. I see a lot of little shocked emojis floating up the, you know, with that. So yes, please. Sure. That we all get that. I have another question that I’m going to go to here. Okay. And I again, I’ll throw this out to anyone. How do you think we can ensure that future research contributes to this dismantling of racial inequalities and of building those conditions for a success? How do you think future research what do you think future research needs to do? And for everyone, as a field, not just you.

Mavis Sanders: I would say that Nate has, you know, sort of laid it out and that Natalie has also laid it out in terms of, you know, group specific studies, in terms of new questions and the development of new measures, the actual full use of the existing measures that are out there around economic opportunity and the opportunity index scale that Natalie was talking about using a variety of approaches, engaging with community to see about community questions. What is important in those communities. We talk about research, policy, practice partnerships and research. So I think all of those, you know, those are at least four areas in terms of the approach to who has a say in the types of questions that we’re asking and answering. You know, what type of supports and funding are available for us to do these specific kinds of studies and vehicles for publication. And then for those who are in higher ed and academia, whether or not institutions of higher education are also valuing these that our promotion and tenure ratings are also valuing them. And so that as people do this type of research, they’re not fearful that they will be able to advance in their chosen field in academia. It really means that we have to start bringing all of these insights into the conversations because we know this research is important, that there are so many institutions and systems that are in place that may limit people’s opportunity to engage with this.

Stephanie Curenton: What I really love about you all as panelists is that you are all coming from different perspectives, right? So it’s sort of really interdisciplinary and I think that’s a strength. When I talked about the ECRQ. special issue, also, it’s interdisciplinary. And I’m wondering when we think about research for the future, I’m wondering if there could be some way in which instead of approaching these questions as individual scientists, can we approach things as a collaborative right so that we can go deeper?

And I just think that that is such a good, proactive way to allow the science to advance. And I’m hoping that people can hear funders, federal agencies, I’m hoping that they can hear this as well, and really see the power of what we can learn when we have an interdisciplinary group working on issues. We have about 5 minutes. I’m going to give you all each some time to do a take away message. And so the takeaway message is please share a positive outcome or a development in your work related to communities, policies and research that we can take with us. So an idea that we can leave with us that will help us sort of fill and empower to learn and grow, continue this work. So what’s a positive you want to leave with us?

Mavis Sanders: Well, one positive that I have is that it seems to be a convergence that I’ve seen around advocacy groups, policy groups, researchers that understand the importance of disentangling the effects or highlighting the effects of systemic the way systems organization affect outcomes and not just reporting outcomes, but really trying to help people understand the context in which those outcomes are produced. And so that’s moving us forward in the conversation. So we’re not reporting just, oh, there’s a gap in academic achievement between Black children and white children, and we’re talking about the institutional aspects of of underfunding education and relying on text, you know, property, poverty, tax based or whatever. And they have long term effects of economic inequity, of educational and economic inequities to lead to these outcomes. So the importance of contextualizing these findings so that we take our research gains for the systems that produce them rather than the individual, I think is really important. And it seems as though I feel as though there’s much more support for that and and almost an expectation of that. And so we can hold on to that and push that that I think that that helps us to to change or create those kinds of environments that all children deserve and to thrive.

Stephanie Curenton: I love that. What about Natalie and Nate? What are what is your takeaway or positive takeaway you want to leave us with?

Natalie Slopen: Well, I feel very encouraged about the attention that we see across the different disciplines. Thinking about early childhood to context, I think there has been this shift that we’ve all observed over the past decade that has made it almost an expectation to be thinking about across topics and I think that our data sources are catching up and we have more and more opportunities, let’s say, where researchers who rely on large federally funded cohort studies, for example, they are collecting more information that allows us to study both risk factors, but also protect of factors, which is an incredibly important future direction as well. And so I think that we have increasing opportunities to take a very comprehensive look at social environments that shape child development, both positive and negative. And also to take a multi-level perspective, which we know is going to be really important for figuring out upstream strategies for intervention.

Stephanie Curenton: Yeah, okay, great, great. What about you, Nate?

Nathaniel Harnett: I think you are. Both of these are great. I wish I could just answer that, but I’ll try to come up with something unique very quickly. You know, I think for me, I’m not unaware of the sort of story that neuroscience has played and the way in which people will use biology to justify a lot of, let’s say, racist behavior. And the way that sort of structuralism, the institutions that we have, it’s been very, very encouraging to see more people pay attention to this. And you know, really get the data to show that it’s not this sort of ingrained brain thing. It’s the systems that we develop as the structures that are in place that are contributing to altered development and playing a role. That is true. And I think this sort of increased recognition, having the data to really emphasize this is just been really positive for me. Yeah.

Stephanie Curenton: I tell you, I am so filled up with knowledge and encouraged as a scientist by, this conversation with you all, I really feel as though we need more conversations like this. We just scratched the surface here and I it’s been so lovely meeting you all. And I want to say that I hope we can continue this conversation in meaningful ways.

And I want to thank you for being part of this panel and bringing your knowledge here in this space. And I thank you on behalf of Harvard and the Center on the Developing Child. I thank you on behalf of Boston University and and CEED. And I look forward to continuing these conversations with you all.

Cameron Seymour-Hawkins: The Brain Architects is a product of the Center on the Developing Child at Harvard University. You can find us at developingchild.harvard.edu, where we will post any resources that were discussed in this episode. The next webinar in our Place Matters webinar series is on March 5th at 12pm EST—stay tuned to our social channels for more details. You can find us on Twitter @HarvardCenter, Facebook at Center Developing Child, and Instagram @DevelopingChildHarvard. Our music is Brain Power by Mela Collective.

Dr Mona Hanna-Attisha — **A New Lens on Poverty: Working Towards Fairness of Place in the United States** Jan 24, 2024

Contents

Podcast

Panelists

Additional Resources

Transcript

In the fall of 2023, we kicked off our three-part Place Matters webinar series with our first installment: “A New Lens on Poverty: Working Towards Fairness of Place in the United States.” The webinar discussion featured the work of Mona Hanna-Attisha, MD, MPH, FAAP, whose research uncovered the water crisis in Flint, H. Luke Shaefer, PhD, co-author of the new book *The Injustice of Place: Uncovering the Legacy of Poverty in America*, and their groundbreaking new program, RxKids, an innovative effort to address child poverty and improve health equity. This conversation, moderated by our Chief Science Officer, Lindsey Burghardt, MD, MPH, FAAP, has been adapted for the Brain Architects podcast.

Panelists

*Mona Hanna-Attisha, MD, MPH, FAAP*
Founding Director, Pediatric Public Health Initiative

H. Luke Shaefer, PhD
Professor of Public Policy and Director of Policy Solutions, University of Michigan

Lindsey C. Burghardt, MD, MPH, FAAP *(Moderator)*
Chief Science Officer, Center on the Developing Child at Harvard University

Rebecca Hansen, MFA *(Webinar Host)*
Director of Communications, Center on the Developing Child at Harvard University

Amelia Johnson *(Podcast Host)*
Communications Specialist, Center on the Developing Child at Harvard University

Additional Resources

Place Matters: The Environment We Create Shapes the Foundations of Healthy Development

RxKids

The Injustice of Place: Uncovering the Legacy of Poverty in America

What the Eyes Don’t See: A Story of Crisis, Resistance, and Hope in an American City

Transcript

Amelia Johnson: Welcome to The Brain Architects, a podcast from the Center on the Developing Child at Harvard University. I’m Amelia Johnson, the Center’s Communications Specialist. Our Center believes that advances in the science of child development provide a powerful source of new ideas that can improve outcomes for children and their caregivers. By sharing the latest science from the field, we hope to help you make that science actionable and apply it in your work in ways that can increase your impact.

In October, we kicked off our three-part Place Matters webinar series with our first installment: “A New Lens on Poverty: Working Towards Fairness of Place in the United States.” During the webinar, Dr. Lindsey Burghardt, our Chief Science Officer, moderated a discussion between Dr. Mona Hanna-Attisha, whose research uncovered the water crisis in Flint, and H. Luke Shaefer, co-author of the new book The Injustice of Place: Uncovering the Legacy of Poverty in America. The resulting explores how the qualities of the places where people live are shaped by historic and current policies, which have created deep disadvantage across many communities with important implications for the health and development of the children who live there. We’re happy to share these insights with you all on today’s episode.

Now, without further ado, here’s Rebecca Hansen, the Center’s Director of Communications, who will set the stage with a brief overview of the webinar series.

Rebecca Hansen: Alright, hello, everyone. My name is Rebecca Hansen, and I’m the Director of Communications here at the Center on the Developing Child. And I’m very excited to welcome you all to today’s webinar, A New Lens on Poverty: Working Toward Fairness of Place in the United States. This webinar is the first in an ongoing series designed to examine the many ways that a child’s broader environment, including the built and natural environments, as well as the systemic factors that shape those environments, all play a role in shaping early childhood development beginning before birth. In this series, we will explore various environment tool influences from both scientific and community-based perspectives, including strategies to work toward fairness of place and improve existing conditions to allow all children to thrive. I want to thank everyone who submitted questions for our panelists today. We received hundreds of questions, and we will turn to some of those in the second half of the conversation. And with that, I am excited now to hand it over to Dr. Lindsey Burghardt, who is the Chief Science Officer at the Center on the Developing Child and a practicing pediatrician in the community outside of Boston. Lindsey, I will pass it over to you to introduce our panelists and get the conversation started.

Lindsey Burghardt: Thanks, Rebecca. And thanks to everybody who took time out of their day to join us here. And before I introduce our fantastic panelists, I’m just going to start by giving some context and some background for our conversation, and then we’ll jump right in. And I think we’ll have a great conversation together today. So earlier this year, the National Scientific Council on the Developing Child published their 16th working paper and they called it Place Matters: The Environment We Create Shapes the Foundation of Healthy Development. And that working paper laid out a framework for how the child-caregiver relationship is critically important and just as important as it’s ever been. But in shaping early childhood development. But that relationship doesn’t exist in isolation. And the places where people live affect what they’re exposed to. And that in turn affects maturing biological systems. And those effects can be positive or they can be negative. And that’s what we mean when we say that Place Matters. So the physical environment that surrounds children, their built environment, their natural environment. Both of those are shaped by human actions, including very intentional decisions around policies that shape the environments where kids live and the quality and the conditions in the environment where children live. They’re not evenly or randomly distributed. They’re shaped by and they’re deeply rooted in public policies and social history that we’ll talk about today. So for many families, both these historical roots, as well as present day policies and decisions being made, are resulting in really an uneven distribution of risk and opportunity in neighborhoods and in the places where families are raising young children. So I am thrilled just completely thrilled to introduce two really special guests who are going to talk more about this today and who are really deeply committed to reshaping children’s environments to support their healthy development. Dr. Mona Hanna-Attisha is a fellow pediatrician. She’s an activist and author. Just an amazing person who leads an innovative program called Rx Kids, which aims to address child poverty and health equity. And it does it through unconditional direct cash payments to residents of Flint, Michigan, during pregnancy and throughout the first year of their child’s life. Our other panelists, Dr. Luke Schafer. among many things, is the Hermann Amalie Kohn Professor of Social Justice and Social Policy at the University of Michigan’s Gerald R Ford School of Public Policy and the inaugural Director of Poverty Solutions. And he’s partnering with Mona to launch Rx Kids. Luke has a new book that came out this summer, The Injustice of Place, and it provides what I think is a really sweeping understanding of extreme poverty in the United States. And it puts a new lens on poverty, I think, because of the unique multidimensional measures, Luke, that you used in the book, as well as the way that you engage the communities when you are conducting research for the book. So Mona and Luke, welcome. I’m really excited to have you here.

Mona Hanna-Attisha: Thank you so much for having us.

Lindsey Burghardt: So the two of you are working in really close collaboration with the community in Flint to address poverty in really actionable ways. And what I’m hoping today and what we talked about before when we prepared for this webinar was really focusing on the innovative approach to solutions that you guys have taken and so that those who are listening can apply anything that resonates in their own contexts. Sound good? Awesome. All right, let’s do it. So first question for Mona. We have some international listeners and some who may not be as familiar with maybe how your really specific engagement in this area got kicked off and your work related to the Flint water crisis and you really helped to shine a spotlight on a key example of how community disadvantage and underinvestment influence exposures that shape children’s developing systems. Can you talk a little bit about how you became involved in the water crisis in Flint, what you learned and kind of where things stand today? Awesome.

Mona Hanna-Attisha: Thank you for that question and thank you for having us. We’re so excited to be here with all of you, almost 500 people to talk about solutions. And in order for us to really move forward and to make a better world for our kiddos, I think we so often have to start by looking back. So I can share a little bit what happened in Flint and my role. And it’s really it really starts by looking even further back. And I think that’s where kind of Luke is an expert in terms of kind of a history that got us to where we are today in terms of disadvantage. But Flint was at one point like a place of prosperity and opportunity. The birth of the UAW, which is in the news right now, that there’s a historic strike in the 1930s that really put Flint on the map. And autoworkers were demanding prosperity, very similar to what they’re demanding right now. And there was Flint kids striking alongside their parents. And there’s a Flint kid that was holding a sign in the 1930s. It said, give us a chance for better food and a better life. And that advocacy, that resistance that enabled really the beginning of the UAW and the birth of the middle class in America. And that started in Flint. And things happened in the environment and investment and public health and education and community schools and, you know, infrastructure, all this stuff that made Flint a place of prosperity, that translated into improved opportunity and improved health for the people that lived there. The history that followed in Flint is not unique to the communities across the nation. It’s a history of disinvestment. Automation. Globalization. Plants closed. Jobs were lost. Exploitation of workers. Systemic racism that made certain neighborhoods specific to African-Americans because of redlining and blockbusting and chronic disinvestment from, you know, state and federal government, which made Flint kind of this a bleeding city with the loss of population. And really every disparity that you can think of. And even before the water crisis that made growing up in Flint toxic like in so many of our communities, a kid in Flint, you know, their life expectancy is, you know, 15 to 20 years less. And a kid in another part of our county, this is once again not unique to Flint, but the census tract that you grow in the place, the environment, the conditions, the history, the geography, the hierarchy all predict how you end up. Flint was near bankrupt, lost democracy was taken over by emergency management. Like so many cities in our state at that time, anti-democratic law pushed through by our gerrymandered legislature, and that took away democracy, accountability and the decision was made to change our water source. It was from the Great Lakes to Flint River water without proper treatment, and that caused corrosive water to flow through our drinking water infrastructure and that corroded our pipes, which had lead in them for a year and a half. The people of Flint, a predominantly poor minority community, were drinking lead laced water. That’s how I got involved as a practicing pediatrician in Flint to do the research to uncover what was happening to our kids and really since then have been on this path to recovery. But it is an emblematic story of what happens when you live in a place that has been chronically disinvested, that does not prioritize the health and development of our children. Literally, the address of our children predicted whether or not they were going to drink poisoned water. So maybe an extreme example of what happens, a consequence of growing up in a certain place, but once again, not unlike so many communities across this nation.

Lindsey Burghardt: And, you know, I think for Luke, Flint really represents this example, as Mona articulated so beautifully, of a community that has been disadvantaged in so many ways and the sort of that theme of underinvestment. And Luke, in the book, I was really fascinated when you wrote about this concept and developed this index of deep disadvantage, which is something that I had not heard about before in the context of understanding poverty. So I’m wondering if you can kind of describe the index and share more about how it can deepen our understanding about the circumstances of a community, especially as it pertains to young children.

Luke Shaefer: I think that the index really tries to pick up on the themes that both of you have already started describing. One is that when we think about something like poverty, it really is often a matter when we’re really thinking about it’s a matter of compounded disadvantage. So in my field, we often think of poverty as a lack of income, not having enough to meet your basic needs. But I think when we all think about it, we think about income. And that’s clearly really important. But we also think about health. and those vast disparities that Mona was describing, you know, huge differences in life expectancy in fairly small levels of geography. And I think we think about social mobility. So we think about the possibility if you grow up or what are your chances of rising to the middle class. And so the index, the first thing the index really did was try to bring income, poverty, income, health and social mobility into conversation with each other. And it turns out we can learn more about a community. We can actually find communities where poverty is very high, but social mobility is also pretty good. Or communities that have longer or shorter life expectancy than we think. And it just really enriches our understanding and I think gets us closer to what we’re talking about. The second thing that the index does is say it tries to shift the focus from the individual to the community. So Mona described like huge, like decade plus long differences in life expectancy and like small geographic spaces and like, how can we how can we explain that the same is true with social mobility. So there are places in the United States where if you grow up poor, you are just as likely as anyone else to rise to the middle class. And then there are places where if you grew up poor, you’re likely to be poor as an adult as well. So how do we understand those geographic differences? So we brought all of those factors together and put them into a Machine Learning technique called principal component analysis. And we’re able to rank all the counties in the United States in the 500 largest cities on a continuum of disadvantage based on income, health and social mobility and it created a map for us and just to reiterate the evidence from this that support is exactly what both of you were saying. Once we had that map, we started comparing it to other maps and we could see like huge parallels. The most stark one was a map of enslavement in the United States from 1860, where we compared our map of deep disadvantage, a concentration of deep disadvantage to a map of the concentration of enslavement from 1860 and could see not just some correlation, but like really just a high level of correlation between the very gradation of those maps. So that really takes the onus off the individual. How can it be an individual’s fault when communities have been bifurcated and divided in these ways, not just for a decade, not just for a few decades, but well over a century? I think we have to start thinking about solutions in a very different way.

Lindsey Burghardt: Thanks for bringing the solutions early. So, Mona, from your experience, like how does this disadvantage, you know, and it’s so deep as you’ve described and kind of through these generations. How does it show up in children’s environment and how does it impact their health? Because, you know, we know that this starts before birth and it can show very early in life and things like low, low birth weight, which Luke talks about in the book, too, is a marker of, you know, disadvantage early in life. So how do you observe that in practice? How is it showing up in your work?

Mona Hanna-Attisha: Yeah. Lindsey That’s a great question. And as a fellow practicing pediatrician, you know, we see it in our patients, we see it in their bodies and we see it in their blunted potentials. One of my favorite quotes, someone said as a pediatrician, we are the ultimate witnesses to failed social policies. You know, it’s these inaction and policy or certain actions that that make our kids sick. And, you know, and once again, implicate their entire life course. I’m going to share one quick story. The last time I testified before Congress, you always have to tell stories. They don’t listen to science and facts as much as long stories. And I and I told them a story about a patient, a kiddo who and who had seizures and developmental disorders and all these problems because he had drunk, you know, from the leadline in his house during the water crisis. But then I didn’t just talk about the kid. I traced it back to his family history. So his grandparents moved to Flint in the 1950s as part of the Great Migration North. So look at the policy because of Jim Crow racist, you know, laws and lynching and oppression, his family, you know, fled the South and came to Flint like, you know, Chicago, Detroit, all these other places for a chance at equality for them and their children. And they stayed in Flint. The ups and downs and their grandkid, their great grandson, was now sick because of policies not just the acute policy of our water switch, but also these historic policies that have made it hard for people to be healthy. And that’s just an example of how it’s kind of the multigenerational impact.

Lindsey Burghardt: Yeah, absolutely. And can you talk for those who may not be specifically familiar with exposures like related to water in particular, and like, how does that show up? I mean, can you explain like how that can matter even before birth?

Mona Hanna-Attisha: Yeah. So important. Yeah. Like most environmental exposures, they often don’t show up acutely. So lead is known as a kind of a silent epidemic. We we don’t see acutely the consequences of lead exposure like like many environmental exposures. Yet we see their manifestations, their, you know, their impact years, if not decades later. So my book is called What the Eyes Don’t See, and it’s because of that we don’t see lead in water. We don’t see a lot of the contaminants in there yet Once again, they manifest later causing things like cognition issues, behavioral problems, early exposure to things like lead and other neurotoxins cause things like hypertension, high blood pressure that’s been linked to, you know, early dementia and gout and kidney disease and a whole slew of lifelong consequences because of an exposure in early childhood. And also, like you said, also prenatally, a lot of these toxins in our water and in our in the rest of our environment also cross the placenta and affect the developing child. So we know that exposure in this kind of critical, you know, prenatal infancy window as these, you know, hazardous kind of life course altering impact.

Lindsey Burghardt: Yeah, I really appreciate how well you articulated that because I think that’s especially what’s frustrating in practice is that some of these implications and effects of environmental exposures that we see, they are like invisible and they’re delayed. So the implications of being, like you said, exposed to lead in utero or as Luke describes in his book, the implications of being born with a lower birth weight, we tie that I think, sometimes to these very individual actions when really there’s things that are surrounding us and shaping our biological systems from the earliest days of development that are very much not based on individual actions. People’s systems can be shaped for better or for worse by what surrounds them as they’re developing. And so I think I heard you say once, and it has stuck with me on such a deep level. I wish I could prescribe away poverty. And I think that’s one of the times that I knew that you were going to be like a force in this field, is that that connection is so important. And I think that getting that message out about how poverty impacts and how the impacts of things like systemic racism affect not only, you know, how well children do in school, but their health throughout their life, cause it’s so important. So thank you both for being the spokes people that you are and for kind of getting these messages out in the articulate way that you do. And I want to pivot to Luke now and talk about, you know, your team found that some of these places of deepest disadvantage were actually dominated by rural communities. And I think there’s often this counterpoint or kind of counter assumption that poverty can be worse in cities because of things like high cost of living and high concentration of people. And we sometimes, I think, erroneously assume that rural communities might have lower levels of inequality which you actually found is not the case. So can you kind of talk about why these assumptions were wrong and how you kind of found poverty to exist in different contexts and how that played out?

Luke Shaefer: So I think borrowing from Bryan Stevenson I’ll mention that I think we’re best at understanding the problems that we’re most proximate to. And so most scholars and folks who are thinking about poverty are, you know, more clustered in urban areas. And so I myself had been, you know, all of my time that was working in the field in places like Chicago and, you know, in in urban areas in Michigan. And so it’s easier to just see, you know, certain challenges, high cost of living being one of them. Right. We can see sort of how much housing is costing. We can see that public transportation systems maybe don’t work as well as they should. And so we can follow our nose there. In this book, we tried to take a data driven approach to zero in, and we wanted to go to the most disadvantaged places in the country based on income, health and social mobility. And as you mentioned, I when we looked at that top 100 places in the United States, we loaded in every county, in every city. You know, the 500 largest cities gets you down to cities of maybe 50,000 people. It was disproportionately rural. There actually only nine cities in that hundred most disadvantaged places. And in a place like Chicago, it wasn’t even in the 600 most disadvantaged places. And then we went to these places and really got to know a subset of them, the ones that we write about in the book, but also spent time getting to know other communities. And it looked right to us. Right? We felt like this sort of visual audit validated that. So the thing is that like when you are more proximate, the problems, you can understand their downsides, but you also don’t understand some of the signals of those things. So we have a high cost of living in some parts of the United States in urban centers, is often connected to the fact that there are better services in those places. So maybe the health care system doesn’t work as well as it should, but it’s there and people have access to a health care system. Maybe public transportation doesn’t work like it should, but there is some public transportation in the rural communities, which also, you know, I think surprises some folks. Many of these rural communities are predominately communities of Black Americans or Latin Americans, of course, out West and Native American lands. And there might not be any hospital at all or no health care system to speak of. And there certainly is no public transportation. And so there’s cost of living differences, which we’re used to. Thinking of them as a challenge also represent things which are differentiated in terms of private philanthropy. We see, you know, hugely more dollars go into low income Americans in urban centers than in rural areas because that’s where the money is and people like to give to their communities. And then so much of the what’s available, the federal government to work on these community problems is actually driven by contracts or grants. And what does that require? That requires very talented folks who can write those grants, which you often don’t have, in very, very poor rural communities that you might have in an urban community. So once again, I think when we sort of delve deeper, when we really try to understand places and we, you know, we can come away sort of with a deeper understanding of what’s going on, what are the challenges that different communities are facing that that we might not have any connection to at the start?

Lindsey Burghardt: Well, thanks. Luke, let’s shift a little bit and talk about Rx Kids because I think this can feel very overwhelming. And when I heard about Rx Kids and I saw the potential for this solution, I got so excited because here’s a chance for like public policy to really influence child health and development in an incredibly positive way. So this is the first prenatal and infant cash allowance program in the country, is that right?

Mona Hanna-Attisha:: The first universal one. First universal–okay. All right.

Lindsey Burghardt: So, Mona, can you talk about how your experience has kind of led you to this program, like how it works? How did you come to Rx Kids? Yeah.

Mona Hanna-Attisha:: So, so the water crisis happened in Flint, and, you know, we had this population wide exposure to a neurotoxin also just kind of the trauma of the injustice. So we have been working around the clock to mitigate the impact of the water crisis and really promote the health and development of kids. And our work has really kind of focused on that early childhood window. We have two brand new childcare centers, huge expansion of early literacy, Imagination Library, Reach Out and Read nutrition, prescriptions, home visiting programs, trauma informed care, the expanded Medicaid, early intervention. The list goes on and on of the awesome that we have been able to put into place in Flint. But caveat, these are things that should have been there already and these are things that all kids need. They need food, they need education, and they need health care as a basics. But we didn’t have them before and we’re still kind of struggling to maintain them. And a lot of that what we have been able to put in place really relies on families to do more, you know, sign up for this program, go to this class, read to your kids, you know, feed them healthy, come to see me as a clinician. And that’s all good. But it makes me feel guilty like I am. I have been tired of asking the oppressed to do more. We talk about the kind of this concept of resilience, like why should my patients have to be more resilient? Because we as a society fail to build resilient communities. And when you understand what it means to grow up, be born into and grow up in poverty, like Lindsey, you said, I’ve wished so many times the ability to prescribe away poverty, like when I’m holding a little newborn in my hands and doing all the things I’m doing, the vaccines and the growth and development and the back to sleep and feeding and all this up, I wish I could change their zip code so that they do not have to grow up in poverty. And I was kind of sick of shrugging my shoulders and I’m like, Well, hold on, let’s do something. We can do something. We do big, hard things. Let’s do something. So I called Professor Shaefer over here, who is a child poverty expert, helped bring forth the expanded child tax credit for the nation. And I’m like, Do you want to work with me on a child allowance for Flint? He didn’t say no. And, you know, since then, we have been developing this program, which has become Rx Kids. It is a prescription for health, hope and opportunity. And starting in 2024, we will be prescribing every pregnant mom unconditional universal cash allowance and mid pregnancy, and then every baby an unconditional universal monthly cash allowance from birth to 12 months of age. This has never been done before. It’s city-wide scale. It’s launching. I see all the hearts and I’m so excited because now I’m. Sure the loving is hard and. Perfect because this is launching on Valentine’s Day. Because as much as we are trying to alleviate poverty and address economic instability, we are sending a strong message of love. This is how we are supposed to care for each other. This is about loving our moms and babies, seeing them and hearing them and walking alongside them during this really critical mom infant period, which not only is so important developmentally, but turns out to be the most economically vulnerable. Families are the most poor perinatally. So we’re launching in February. We’ve raised a lot of money. We still have about $15 million to raise. So anybody feel free to contact me if you want to give us money or, you know, anybody really rich here wants to support us, go to RxKids.com But we are launching in January and our hope is to do this for five years of moms and babies. And, and maybe I could pivot to Luke and who can tell us more about kind of the science of child allowances globally and domestically, if that’s okay, Lindsey.

Lindsey Burghardt: Please, yes!

Luke Shaefer: So in prior work that I had done, I had focused on very, very poor families in the United States. And actually this increase in families without any money. So in the United States, families might have access to food assistance through like food stamps or maybe even work that can provide for that. But what does it mean that they have money to be able to buy toothbrushes or toilet paper or diapers or pay the rent if you’re facing eviction or food? And so as we were thinking about what to do about it being policy scholars and wanting to get to solutions, we also knew that the old casual birth system that we had in this in the United States was a very stigmatized program. It was a program that just made families answer many, many stigmatizing, invasive questions. It has a long history of it being administered in structurally racist ways in the United States. So we wanted to look for a different model. But luckily you don’t have to start from scratch. There is this incredible movement across the world for child allowances or sometimes they’re called child benefits. And the logic starts from a very different place, which is raising kids is expensive and society has a reason to come alongside parents and support parents in that work. And one way to do that that empowers families is to provide cash to pay the utility bill or to buy diapers or buy the crib. And so we’ve seen this over and over again in country after country, provide a small amount of money. Sometimes that’s $250 per kid, maybe $300 per young kid and every time countries adopt this, child poverty plummets and food hardship plummet, and kids do better on so many different metrics. So in the United States, this seemed like pie in the sky a number of years ago, and my colleagues and I started talking about it, but it became a reality in 2021, where we did this through the expanded child tax credit. And families for six months, really received a monthly amount to support their kids in a way that they saw was best. And we saw child poverty fall to an all-time low. Millions of children lifted out of poverty. We saw food hardship fall to an all-time low. We saw improvements, research papers, finding improvements in the mental health of parents. We saw one of the things I thought was most interesting was credit scores actually hit their all-time high. At the end of 2021, the number of Americans with bad credit fell to an all-time low. So, so many markers of financial health and it wasn’t extended. There still is a lot of support in Washington for it, but it did not become a permanent reality. And we just saw new child poverty numbers where child poverty more than doubled. And we have millions and millions of kids back in poverty after having been out of it. But there is still interest. And I think it showed what was possible for as a country that we could follow other countries on this. And so when I got Mona’s call, I couldn’t have imagined a call I would want to have gotten more to try to keep this in the public imagination and be a part of Flint actually leading the nation and saying like, this is how we should care for our families with kids, because we would have loved to done it for every kid of every age. But those numbers got really, really big, really quickly. So as I learned from my pediatrician and new pediatrician colleagues, like how important that first year of life is, and before that, babies brains doubled in size. And so much of what happens in that first year affects the life course. There’s a new paper in the quarterly Journal of Economics that finds an extra thousand dollars during that first year of life, has a substantively increase in earnings like relationship with people’s earnings in their thirties. So we’re talking about decades later and that it pays for itself. So this program is going to be laser focused on that first year of life in that prenatal period. And another thing that I really love about it is linking health care providers. So, you know, there’ll be lots of ways into the program but the primary way is for poor families to, you know, expecting moms to go to their prenatal doctor’s appointment and be prescribed cash along with all of the other advice that they’re receiving. And so we, you know, think and believe that it’s going to deepen the relationship between provider and family. So we’ll have the positive impacts of money that can help with your core expenses that families have, as well as a deepening of relationship with providers. And we hope maybe a re-envisioning of the social contract since this is so different from really any other type of program that we have in the social safety net.

Lindsey Burghardt: I love that and I love that tying it to your prenatal care and your prenatal provider and thinking about that model of a program like Reach Out and Read where parents don’t need to go to another different place and answer another set of questions and make a new relationship. When they already have one that for many they hold dear and as a trusted source of information. So I just think that deepening of that relationship is an incredible part of this program. And I think you talked about this a little bit with some of the effects that maybe we wouldn’t anticipate it with the program. Right. Like credit scores increasing, are there things that you’re thinking about looking at as outcomes that might not necessarily be tied immediately in our conscious, like thinking about implications for parents or children’s mental health in childhood or other kind of downstream implications of not having to feel this kind of burden of poverty.

Mona Hanna-Attisha: Maybe I’ll talk about some of the wellbeing ones and talk about some of the community measures that we’re excited about. So we’re going to look at wellbeing, so we’re looking at measures of happiness and hope for themselves and their children, looking at the measures of dignity and trust, agency and empowerment. So I’m in addition to, you know, lots of health outcomes and, you know, prematurity and low birth rate, maternal morbidity and mortality, mortality and NICU admissions and well-child visits and health care utilization and postpartum depression. So there’s a lot of health stuff, but through surveys, we’re going to look at these well-being measures, which I’m excited about. And then this is a universal program. So in addition to kind of self-report, we’re going to also be leaning on administrative population level data. So maybe Luke can talk about some of the exciting things that a community level which is really novel for this, for this kind of project that we’re going to look up.

Luke Shaefer:Yeah, I’m super excited about the sort of deepening of the relationships and seeing, you know, one thing we often see in my field is, well, you know, an organizational start, a new program that they think is really great and nobody will show up in. You know, they’ll think, Oh, we need to market it more. We need to make sure people know about it. Somehow with cash transfers, people show up. It is something that they value. So it’s a way to sort of build that relationship. So I’m excited to see if the cash transfers increases, you know, prenatal visits, does it increase things like nurse home visits after the fact because it’s building the relationship, sort of welcoming us into a conversation. And I’m really excited about child welfare outcomes. So that very first year of life is like a shock. I think it’s the biggest shock in terms of child maltreatment and kids being placed out of home. And so there is a new study out about the Alaska Permanent Fund and what it means to get benefits from that. That’s really a basic income that Alaskan residents have. And so this new paper looks at families that got that during that infant period and sees huge reduction in child welfare reports and out of home placements. Pretty incredible. And there’s yeah, there’s another you know, one thing that people are often interested in is around like alcohol and tobacco or drug use, you know, worrying that maybe folks will use cash in the ways that society deems wrong. And the research has been really interesting on that. So all of the places where we studied that there’s never an increase in substance uses. In some places there’s actually a decrease in those things. So the cash transfers are related to reduced alcohol, and tobacco, for example, maybe as a result of reducing stress, means that families are less likely to feel like they need to rely on substances. And then what we can do with this that we can’t do with any study that, you know, a pilot for a couple hundred is what Mona was alluding to of looking at the community level factors like does this help to rebuild trust in government and just money circulating through the community. So we’re talking about 9 million extra dollars that is going into the hands of Flint residents. And all of the research suggests most, if not all of that is going to be spent locally. And maybe this is going to be a more effective economic development strategy than some of the top down type approaches that we’re more often using.

Mona Hanna-Attisha: The rebuilding of the social contract work, I see this also as a way to restore democracy and more trust and faith in government. And I think we might see that in improved voting rates and civic engagement. So that’s something else that we’re looking at.

Lindsey Burghardt: So I can imagine that like people who are listening would really like to kind of look into your play book and get an idea of how you’re able to do this. I can’t wait to be able to share some specifics about how you kind of got the program to life. How did you get it written into the state’s budget? So, you know, can you share kind of any tips for people that might be listening and interested in applying this to their own contexts?

Mona Hanna-Attisha: Absolutely. So from the onset, our intention was to start this in Flint, but really to share this. That’s why we’re so excited to be here today. So this is expensive. So we need about $11 million a year to do this. 9 million are the direct cash transfers. And once again, we want to do this for five birth cohorts, five years of moms of babies. So our goal has been to raise $55 million. We received a very, very generous grant from philanthropy from the CS Mott Foundation, a $15 million match grant very early. Other foundations also came in, a mix of family and local and state and national foundations. But our most exciting funding has come from the state of Michigan, and this is our pathway towards sustainability and scalability. And it has come as a redirection of TANF, which is the Temporary Assistance for Needy Families. This is the cash welfare system, and I’m going to send it back to Luke because he’s an expert here. But this is super exciting. This enables other communities to do this. This is what’s really kind of getting the attention nationally and is the playbook.

Luke Shaefer: And the United States in 1996, we thought that we reformed welfare to be a work first and time limited cash welfare program. But it turns out what we did was create a very flexible block grant. So this is a chunk of money that’s 16.5 million at the federal level that goes down to states. In Michigan, we get about 750 million of that in this TANF funding. And all the states can choose to use this for cash assistance where they provide a small amount of money to families every single month. And if they do that, they have to do a lot of reporting. There’s lots of requirements. They can actually get into trouble if they don’t do things right. Or if they want to they can not provide cash assistance and use the money for any number of other things as long as they can justify on paper that it fits one of the core purposes of TANF that includes, you know, taking care of kids in their own home, but also things like promoting marriage or reducing out of marriage births. So what states have figured out over time is that they can actually use the money in ways that they were probably already spending otherwise. And so we’ve shifted the money to all sorts of things. Lots of states pay for their child welfare, their foster care system out of it, Lots of, sort of, using the money to deal with administrative costs. And in Michigan is not out of line with where a lot of other states are. Of their 750 million that the federal government spends then and the state puts in another 100 million or so, only about 55 million actually goes to cash assistance to families. So that’s 6% of the total amount to a much bigger chunk goes to things like the child welfare system or in the case of Michigan college scholarships, that mostly go to higher income families because we were short on our college scholarship budget. So Rx Kids what it does is say, let’s bring some of that money back to, you know, what was really the intention of the original program as 6% is not an appropriate amount of this block grant to be spending on cash aid. But let’s do it in a fundamentally different way. Let’s do it with dignity. So, you know, cash welfare programs of TANF always require like an income test, and families have to apply. They have to really prove that they’re not just poor, but they’re really, really poor. In this case, we’re going to use TANF to support families who are low income, but all families are going to be eligible because by making every family in Flint eligible, we actually cut off the stigma that having that income tax can have on families who don’t have enough. Right. We’re no longer saying you get this money because you can’t handle, you know, your own needs. We’re saying raising kids is expensive and society wants to come along and support you in that work. It turns out people that are well above the poverty line, have trouble paying for diapers or trouble paying the rent or paying for child care. So it makes a lot of sense. So we’ve just been so excited to see the level of interest that this has driven from other states. We’re hearing from people in all sorts of other states that want to talk about this. I think in part by focusing on this first year, we sidestep some of the general, you know, the typical questions about, you know, does this become a life cycle? Is this a dependency? Is it going to impact, you know, our work in the long run? We’re talking about really focusing on this first year of life when families are the poorest, when kids are developing at like breakneck speed and using this money in a dignified way, not just to help families meet their basic needs, but also to try to send them a very clear message that you are cared for and we want to be a part of helping you do this job that you think is, you know, the most important thing that you are doing.

Mona Hanna-Attisha: I can just add you have Luke and I, but this this work, like all good work is done, has been done in a humble partnership with our community. And that we have a group of moms and dads and kids that have been really driving this work and where this kind of originated and that that’s part of Flint’s story. If you remember Flint’s a story that lost democracy so central to our recovery and our path forward is the role of participatory democracy and self-determination. So from the logo design to how much money to our Valentine’s Day party and who’s going to perform it, maybe Beyonce, maybe so all of this has been driven by our parents, by moms and dads in this work, which I think is, you know, which is kind of central to all public health work and working communities.

Lindsey Burghardt: And that’s amazing. It’s actually the perfect segue to our questions. We got over 100 questions from the webinar registrants from all around the world. And one of my favorites, because I’ve heard you talk about this is really how you were incorporating that lived experience and community perspective in the in your work. And I just think to hear you talking about bringing back like the joy and the dignity and centering those in this process just I think is amazing. And we’re going to jump into a couple of questions. We have a few minutes here to just hear from what our registrants wanted to know more about. And there are several questions that kind of got into the education and early education space and thinking about applying, Luke, like what you kind of learned on the road about schools in the education context, to think about how we can think about solutions to funding to support these places, you know, schools and early childhood centers to address issues related to poverty and kind of what strategies and recommendations would you both give school districts to help center the importance of place? Sorry, there’s a couple questions in one.

Luke Shaefer:Actually I’ve just been writing about this, so the very first thing that I mentioned is it’s worth it to look at the history of places and figure out why schools are so unequal. So one of the favorite parts for me of my book is a passage about segregation as academies that cropped up in a lot of the communities that we’ve studied over time where, when Brown v Board came down, communities were able to ignore it for a while, and then finally they weren’t. And they had to integrate public schools and the research is very powerful that integrating public schools had a huge positive impact for Black American schoolchildren and no negative impact for white schoolchildren. But communities going in the opposite direction and the segregation academy sometimes pulled over like all of the resources from the public schools and basically replicated in many ways the system we had before. So looking at that history, I think is really critical. I think it can help us understand like what are the solutions that would actually work, how could they be circumvented? So what do you do with that? One strategy that I have actually become very interested in is just raising the pay of starting teachers. So this has a really nice evidence base around. We just we paid teachers who do incredibly hard work almost nothing. And so, you know, to keep that up–again, it’s not just the money and being able to survive, but it’s the signal that we send to people who want to go into the teaching profession about how we value it. So the evidence is sort of in that first few years of teaching: if we could raise those salaries, we would attract more people, we would keep them for longer. And if you can have mandates across systems that, like everybody is raising their teacher salaries, it’ll impact the poorest schools the most.

Mona Hanna-Attisha: But we need to raise early childcare teacher salaries even more. They are paid so little. And if we respect the science that we all understand that this is the most critical time in a child’s life, we know these are brain builders We need to be paying them Ph.D. level salaries. I mean, it just it needs to follow the science and they are absolutely undervalued. So, I mean, that would be one of my recommendations. But also really thinking about the education system a lot earlier, you know, why is a school, you know, grade K-12? Well, why doesn’t it start at age three or, you know, age one? So really respecting the science and thinking about the importance of the–prioritize the importance of early education.

Lindsey Burghardt: Yeah, I couldn’t agree more. And I think, you know, Luke, you mentioned that there’s like economic perspective now looking at kind of the cost benefit analysis, even like focusing on young children very early when they need it most. And I think to us as pediatricians and for people who are deeply immersed in this work, it just makes total sense. But I, I hope that we can continue to build the kind of arguments for what really feels like science that our grandmothers told us that makes the most sense: if you take care of young kids when they’re very small, you can get them off to a good start and sometimes better to get it right the first time, I think, although it’s never too late, of course.

Mona Hanna-Attisha: So I know you have a bazillion questions, but I’m going to I can’t not share my favorite quote, so

Luke Shaefer:I know you’re going to.

Mona Hanna-Attisha: So, we’re launching on Valentine’s Day, remember, because this is about love, and it’s Black History Month. And it’s also Frederick Douglas’s, self-proclaimed birthday. And he his quote about prevention is my favorite quote and really kind of what I live by. And he has said: It is easier to build strong children than to repair broken men. And that is the work that we are all doing every day. It is building strong children, our health care system, our education system, our criminal justice system, you name the system. It’s reactive. We fail to prevent we fail to invest in our kids and we go on and Band-Aid and pay the consequences. So it is easier to build strong children than to repair a broken man.

Lindsey Burghardt: Yeah, it’s beautiful and I think to your point, we can hold up each of these systems and look at how they are considering or not considering very young children’s welfare and their impact on the youngest citizens. And I don’t think that we do that in a universal enough way. And thinking about bringing in folks to the table in zoning and urban planning and environmental protection who do not consider themselves early childhood advocates or people whose work influences early childhood, when in fact it has a profound influence on children and families. And I think you both are just doing such important work and connecting the dots. And you know, the last question that I’ll raise that came from audience that I loved, and I swear it was not planted: if science is so clear about how exposures like pesticides in lead and water affect brain development, you know, how have these things become so partisan in their communications? And how do you address that in your work to achieve the kind of mindset shift that allowed you to get something like Rx Kids off the ground? Like, how do we kind of approach these conversations to demonstrate to a variety of audiences what science tells us about supporting young kids?

Mona Hanna-Attisha: There’s a lot in there, and I’m just going to, you know, I think we have to keep sharing the science. And as we’ve done a little bit today, we have to continue sharing the stories about why this is important. I think very often we share a lot of bad news and we share we catastrophize, especially with all the issues facing children and climate change. And, you know, the list goes on–gun violence. And I think like you have done today, I think it’s important to share the solutions and to share kind of the community driven, you know, hope and the practical way that we can do this. We are at a place right now, this science denial place, not by accident. And we have to look at the history. Special interests and corporations have made it be this way. They have purposefully weakened regulations, disinvested in public health. Everybody, you know, go read about one of my heroes, Harvard’s first woman, professor Alice Hamilton, who fought against these industries and, you know, against the lead industry and General Motors and all these special interests and was silenced. And that really kind of set forth this paradigm that we work with today that has allowed for the unchecked use of so many bad things that hurt kids because the upper hand is always industry and corporations and profits and it’s not kids. So we have to learn that history and then we have to kind of, you know, keep electing people who understand that and respect that and will fight for kids.

Lindsey Burghardt: Beautifully said. So closing thoughts from the two of you. So if you had to give advice for listeners, people who want to pursue public policy changes like what the two of you have worked so hard for in their own communities, what advice would you give?

Luke Shaefer:I guess I would encourage people to start with listening. You know, I have found that my book that we talked some about today, all of the chapters were not things that I really expected to write about going in. But as we got to know communities, we really started to talk to families that drove our research agenda. That really drives the agenda of my research center here. And so we have to be willing to look at things like in our book, we have a chapter on government corruption, we have a chapter on community violence, and then tie it to the history and really be mindful that the challenges that face us today did not appear out of thin air. And if we really understand where they came from, we can do better at figuring out where to move forward and then come to positive, concrete solutions and celebrate them when things happen. You know, positive change can happen in the incredible distance that we’ve come on lead pipes being replaced all over the country is really remarkable. And so we have to understand our challenges and celebrate solutions.

Lindsey Burghardt: Love it. Mona?

Mona Hanna-Attisha: I would just say you make all kinds of friends, those of us who live in who do this work often hang out with folks that are very similar to us. And I never thought I’d hang out with a social scientist policy guy to be able to do this. But we need to make all kinds of different friends. The tent of folks that care about kids is broad, and I think if that tent– as big as we can make that tent–the more likely that we will be able to achieve the outcomes that we hope to see.

Lindsey Burghardt: I love it. Every time I talk to the two of you, I feel so inspired and buoyed to go out and think about this more. And you gave me so much to think about and reflect on and consider in our work at the Center. We partner with other organizations as well but everybody who’s listening feels the same way is that thank you so much for making the time, for being here, for being the advocates that you are for young children, for all the work you’re doing in Flint and beyond.

Mona Hanna-Attisha: Thank you for having us.

Lindsey Burghardt: So I’m going to turn it right back over to Rebecca Hansen from the Center to close us out.

Rebecca Hansen: Alright, Thank you, Lindsey. And thank you again to our panelists for a really wonderful conversation. As Lindsey said, this has given us so much to think about and great ideas to apply to our work, and we’re really grateful for your willingness to share your expertise with our community. And lastly, I just want to say that there is so much more to come in this webinar series. We are working to bring more conversations like this one to you in the coming months. we’ll be sharing more about the next webinars in our series, including a conversation examining the impact of racism on child development. So please stay tuned on our social media channels and subscribe to our newsletter so you can stay up to date on additional activity in the series. So thank you again to you, all of you, for coming and I hope you have a great day.

Amelia Johnson: The Brain Architects is a product of the Center on the Developing Child at Harvard University. You can find us at developingchild.harvard.edu, where we will post any resources that were discussed in this episode. The next webinar in our three-part Place Matters webinar series is on December 11th at 12pm EST—stay tuned to our social channels for more details. You can find us on Twitter @HarvardCenter, Facebook at Center Developing Child, and Instagram @DevelopingChildHarvard. Our music is Brain Power by Mela Collective.

H Luke Shaefer — **A New Lens on Poverty: Working Towards Fairness of Place in the United States** Jan 24, 2024

Contents

Podcast

Panelists

Additional Resources

Transcript

In the fall of 2023, we kicked off our three-part Place Matters webinar series with our first installment: “A New Lens on Poverty: Working Towards Fairness of Place in the United States.” The webinar discussion featured the work of Mona Hanna-Attisha, MD, MPH, FAAP, whose research uncovered the water crisis in Flint, H. Luke Shaefer, PhD, co-author of the new book *The Injustice of Place: Uncovering the Legacy of Poverty in America*, and their groundbreaking new program, RxKids, an innovative effort to address child poverty and improve health equity. This conversation, moderated by our Chief Science Officer, Lindsey Burghardt, MD, MPH, FAAP, has been adapted for the Brain Architects podcast.

Panelists

*Mona Hanna-Attisha, MD, MPH, FAAP*
Founding Director, Pediatric Public Health Initiative

H. Luke Shaefer, PhD
Professor of Public Policy and Director of Policy Solutions, University of Michigan

Lindsey C. Burghardt, MD, MPH, FAAP *(Moderator)*
Chief Science Officer, Center on the Developing Child at Harvard University

Rebecca Hansen, MFA *(Webinar Host)*
Director of Communications, Center on the Developing Child at Harvard University

Amelia Johnson *(Podcast Host)*
Communications Specialist, Center on the Developing Child at Harvard University

Additional Resources

Place Matters: The Environment We Create Shapes the Foundations of Healthy Development

RxKids

The Injustice of Place: Uncovering the Legacy of Poverty in America

What the Eyes Don’t See: A Story of Crisis, Resistance, and Hope in an American City

Transcript

Amelia Johnson: Welcome to The Brain Architects, a podcast from the Center on the Developing Child at Harvard University. I’m Amelia Johnson, the Center’s Communications Specialist. Our Center believes that advances in the science of child development provide a powerful source of new ideas that can improve outcomes for children and their caregivers. By sharing the latest science from the field, we hope to help you make that science actionable and apply it in your work in ways that can increase your impact.

In October, we kicked off our three-part Place Matters webinar series with our first installment: “A New Lens on Poverty: Working Towards Fairness of Place in the United States.” During the webinar, Dr. Lindsey Burghardt, our Chief Science Officer, moderated a discussion between Dr. Mona Hanna-Attisha, whose research uncovered the water crisis in Flint, and H. Luke Shaefer, co-author of the new book The Injustice of Place: Uncovering the Legacy of Poverty in America. The resulting explores how the qualities of the places where people live are shaped by historic and current policies, which have created deep disadvantage across many communities with important implications for the health and development of the children who live there. We’re happy to share these insights with you all on today’s episode.

Now, without further ado, here’s Rebecca Hansen, the Center’s Director of Communications, who will set the stage with a brief overview of the webinar series.

Rebecca Hansen: Alright, hello, everyone. My name is Rebecca Hansen, and I’m the Director of Communications here at the Center on the Developing Child. And I’m very excited to welcome you all to today’s webinar, A New Lens on Poverty: Working Toward Fairness of Place in the United States. This webinar is the first in an ongoing series designed to examine the many ways that a child’s broader environment, including the built and natural environments, as well as the systemic factors that shape those environments, all play a role in shaping early childhood development beginning before birth. In this series, we will explore various environment tool influences from both scientific and community-based perspectives, including strategies to work toward fairness of place and improve existing conditions to allow all children to thrive. I want to thank everyone who submitted questions for our panelists today. We received hundreds of questions, and we will turn to some of those in the second half of the conversation. And with that, I am excited now to hand it over to Dr. Lindsey Burghardt, who is the Chief Science Officer at the Center on the Developing Child and a practicing pediatrician in the community outside of Boston. Lindsey, I will pass it over to you to introduce our panelists and get the conversation started.

Lindsey Burghardt: Thanks, Rebecca. And thanks to everybody who took time out of their day to join us here. And before I introduce our fantastic panelists, I’m just going to start by giving some context and some background for our conversation, and then we’ll jump right in. And I think we’ll have a great conversation together today. So earlier this year, the National Scientific Council on the Developing Child published their 16th working paper and they called it Place Matters: The Environment We Create Shapes the Foundation of Healthy Development. And that working paper laid out a framework for how the child-caregiver relationship is critically important and just as important as it’s ever been. But in shaping early childhood development. But that relationship doesn’t exist in isolation. And the places where people live affect what they’re exposed to. And that in turn affects maturing biological systems. And those effects can be positive or they can be negative. And that’s what we mean when we say that Place Matters. So the physical environment that surrounds children, their built environment, their natural environment. Both of those are shaped by human actions, including very intentional decisions around policies that shape the environments where kids live and the quality and the conditions in the environment where children live. They’re not evenly or randomly distributed. They’re shaped by and they’re deeply rooted in public policies and social history that we’ll talk about today. So for many families, both these historical roots, as well as present day policies and decisions being made, are resulting in really an uneven distribution of risk and opportunity in neighborhoods and in the places where families are raising young children. So I am thrilled just completely thrilled to introduce two really special guests who are going to talk more about this today and who are really deeply committed to reshaping children’s environments to support their healthy development. Dr. Mona Hanna-Attisha is a fellow pediatrician. She’s an activist and author. Just an amazing person who leads an innovative program called Rx Kids, which aims to address child poverty and health equity. And it does it through unconditional direct cash payments to residents of Flint, Michigan, during pregnancy and throughout the first year of their child’s life. Our other panelists, Dr. Luke Schafer. among many things, is the Hermann Amalie Kohn Professor of Social Justice and Social Policy at the University of Michigan’s Gerald R Ford School of Public Policy and the inaugural Director of Poverty Solutions. And he’s partnering with Mona to launch Rx Kids. Luke has a new book that came out this summer, The Injustice of Place, and it provides what I think is a really sweeping understanding of extreme poverty in the United States. And it puts a new lens on poverty, I think, because of the unique multidimensional measures, Luke, that you used in the book, as well as the way that you engage the communities when you are conducting research for the book. So Mona and Luke, welcome. I’m really excited to have you here.

Mona Hanna-Attisha: Thank you so much for having us.

Lindsey Burghardt: So the two of you are working in really close collaboration with the community in Flint to address poverty in really actionable ways. And what I’m hoping today and what we talked about before when we prepared for this webinar was really focusing on the innovative approach to solutions that you guys have taken and so that those who are listening can apply anything that resonates in their own contexts. Sound good? Awesome. All right, let’s do it. So first question for Mona. We have some international listeners and some who may not be as familiar with maybe how your really specific engagement in this area got kicked off and your work related to the Flint water crisis and you really helped to shine a spotlight on a key example of how community disadvantage and underinvestment influence exposures that shape children’s developing systems. Can you talk a little bit about how you became involved in the water crisis in Flint, what you learned and kind of where things stand today? Awesome.

Mona Hanna-Attisha: Thank you for that question and thank you for having us. We’re so excited to be here with all of you, almost 500 people to talk about solutions. And in order for us to really move forward and to make a better world for our kiddos, I think we so often have to start by looking back. So I can share a little bit what happened in Flint and my role. And it’s really it really starts by looking even further back. And I think that’s where kind of Luke is an expert in terms of kind of a history that got us to where we are today in terms of disadvantage. But Flint was at one point like a place of prosperity and opportunity. The birth of the UAW, which is in the news right now, that there’s a historic strike in the 1930s that really put Flint on the map. And autoworkers were demanding prosperity, very similar to what they’re demanding right now. And there was Flint kids striking alongside their parents. And there’s a Flint kid that was holding a sign in the 1930s. It said, give us a chance for better food and a better life. And that advocacy, that resistance that enabled really the beginning of the UAW and the birth of the middle class in America. And that started in Flint. And things happened in the environment and investment and public health and education and community schools and, you know, infrastructure, all this stuff that made Flint a place of prosperity, that translated into improved opportunity and improved health for the people that lived there. The history that followed in Flint is not unique to the communities across the nation. It’s a history of disinvestment. Automation. Globalization. Plants closed. Jobs were lost. Exploitation of workers. Systemic racism that made certain neighborhoods specific to African-Americans because of redlining and blockbusting and chronic disinvestment from, you know, state and federal government, which made Flint kind of this a bleeding city with the loss of population. And really every disparity that you can think of. And even before the water crisis that made growing up in Flint toxic like in so many of our communities, a kid in Flint, you know, their life expectancy is, you know, 15 to 20 years less. And a kid in another part of our county, this is once again not unique to Flint, but the census tract that you grow in the place, the environment, the conditions, the history, the geography, the hierarchy all predict how you end up. Flint was near bankrupt, lost democracy was taken over by emergency management. Like so many cities in our state at that time, anti-democratic law pushed through by our gerrymandered legislature, and that took away democracy, accountability and the decision was made to change our water source. It was from the Great Lakes to Flint River water without proper treatment, and that caused corrosive water to flow through our drinking water infrastructure and that corroded our pipes, which had lead in them for a year and a half. The people of Flint, a predominantly poor minority community, were drinking lead laced water. That’s how I got involved as a practicing pediatrician in Flint to do the research to uncover what was happening to our kids and really since then have been on this path to recovery. But it is an emblematic story of what happens when you live in a place that has been chronically disinvested, that does not prioritize the health and development of our children. Literally, the address of our children predicted whether or not they were going to drink poisoned water. So maybe an extreme example of what happens, a consequence of growing up in a certain place, but once again, not unlike so many communities across this nation.

Lindsey Burghardt: And, you know, I think for Luke, Flint really represents this example, as Mona articulated so beautifully, of a community that has been disadvantaged in so many ways and the sort of that theme of underinvestment. And Luke, in the book, I was really fascinated when you wrote about this concept and developed this index of deep disadvantage, which is something that I had not heard about before in the context of understanding poverty. So I’m wondering if you can kind of describe the index and share more about how it can deepen our understanding about the circumstances of a community, especially as it pertains to young children.

Luke Shaefer: I think that the index really tries to pick up on the themes that both of you have already started describing. One is that when we think about something like poverty, it really is often a matter when we’re really thinking about it’s a matter of compounded disadvantage. So in my field, we often think of poverty as a lack of income, not having enough to meet your basic needs. But I think when we all think about it, we think about income. And that’s clearly really important. But we also think about health. and those vast disparities that Mona was describing, you know, huge differences in life expectancy in fairly small levels of geography. And I think we think about social mobility. So we think about the possibility if you grow up or what are your chances of rising to the middle class. And so the index, the first thing the index really did was try to bring income, poverty, income, health and social mobility into conversation with each other. And it turns out we can learn more about a community. We can actually find communities where poverty is very high, but social mobility is also pretty good. Or communities that have longer or shorter life expectancy than we think. And it just really enriches our understanding and I think gets us closer to what we’re talking about. The second thing that the index does is say it tries to shift the focus from the individual to the community. So Mona described like huge, like decade plus long differences in life expectancy and like small geographic spaces and like, how can we how can we explain that the same is true with social mobility. So there are places in the United States where if you grow up poor, you are just as likely as anyone else to rise to the middle class. And then there are places where if you grew up poor, you’re likely to be poor as an adult as well. So how do we understand those geographic differences? So we brought all of those factors together and put them into a Machine Learning technique called principal component analysis. And we’re able to rank all the counties in the United States in the 500 largest cities on a continuum of disadvantage based on income, health and social mobility and it created a map for us and just to reiterate the evidence from this that support is exactly what both of you were saying. Once we had that map, we started comparing it to other maps and we could see like huge parallels. The most stark one was a map of enslavement in the United States from 1860, where we compared our map of deep disadvantage, a concentration of deep disadvantage to a map of the concentration of enslavement from 1860 and could see not just some correlation, but like really just a high level of correlation between the very gradation of those maps. So that really takes the onus off the individual. How can it be an individual’s fault when communities have been bifurcated and divided in these ways, not just for a decade, not just for a few decades, but well over a century? I think we have to start thinking about solutions in a very different way.

Lindsey Burghardt: Thanks for bringing the solutions early. So, Mona, from your experience, like how does this disadvantage, you know, and it’s so deep as you’ve described and kind of through these generations. How does it show up in children’s environment and how does it impact their health? Because, you know, we know that this starts before birth and it can show very early in life and things like low, low birth weight, which Luke talks about in the book, too, is a marker of, you know, disadvantage early in life. So how do you observe that in practice? How is it showing up in your work?

Mona Hanna-Attisha: Yeah. Lindsey That’s a great question. And as a fellow practicing pediatrician, you know, we see it in our patients, we see it in their bodies and we see it in their blunted potentials. One of my favorite quotes, someone said as a pediatrician, we are the ultimate witnesses to failed social policies. You know, it’s these inaction and policy or certain actions that that make our kids sick. And, you know, and once again, implicate their entire life course. I’m going to share one quick story. The last time I testified before Congress, you always have to tell stories. They don’t listen to science and facts as much as long stories. And I and I told them a story about a patient, a kiddo who and who had seizures and developmental disorders and all these problems because he had drunk, you know, from the leadline in his house during the water crisis. But then I didn’t just talk about the kid. I traced it back to his family history. So his grandparents moved to Flint in the 1950s as part of the Great Migration North. So look at the policy because of Jim Crow racist, you know, laws and lynching and oppression, his family, you know, fled the South and came to Flint like, you know, Chicago, Detroit, all these other places for a chance at equality for them and their children. And they stayed in Flint. The ups and downs and their grandkid, their great grandson, was now sick because of policies not just the acute policy of our water switch, but also these historic policies that have made it hard for people to be healthy. And that’s just an example of how it’s kind of the multigenerational impact.

Lindsey Burghardt: Yeah, absolutely. And can you talk for those who may not be specifically familiar with exposures like related to water in particular, and like, how does that show up? I mean, can you explain like how that can matter even before birth?

Mona Hanna-Attisha: Yeah. So important. Yeah. Like most environmental exposures, they often don’t show up acutely. So lead is known as a kind of a silent epidemic. We we don’t see acutely the consequences of lead exposure like like many environmental exposures. Yet we see their manifestations, their, you know, their impact years, if not decades later. So my book is called What the Eyes Don’t See, and it’s because of that we don’t see lead in water. We don’t see a lot of the contaminants in there yet Once again, they manifest later causing things like cognition issues, behavioral problems, early exposure to things like lead and other neurotoxins cause things like hypertension, high blood pressure that’s been linked to, you know, early dementia and gout and kidney disease and a whole slew of lifelong consequences because of an exposure in early childhood. And also, like you said, also prenatally, a lot of these toxins in our water and in our in the rest of our environment also cross the placenta and affect the developing child. So we know that exposure in this kind of critical, you know, prenatal infancy window as these, you know, hazardous kind of life course altering impact.

Lindsey Burghardt: Yeah, I really appreciate how well you articulated that because I think that’s especially what’s frustrating in practice is that some of these implications and effects of environmental exposures that we see, they are like invisible and they’re delayed. So the implications of being, like you said, exposed to lead in utero or as Luke describes in his book, the implications of being born with a lower birth weight, we tie that I think, sometimes to these very individual actions when really there’s things that are surrounding us and shaping our biological systems from the earliest days of development that are very much not based on individual actions. People’s systems can be shaped for better or for worse by what surrounds them as they’re developing. And so I think I heard you say once, and it has stuck with me on such a deep level. I wish I could prescribe away poverty. And I think that’s one of the times that I knew that you were going to be like a force in this field, is that that connection is so important. And I think that getting that message out about how poverty impacts and how the impacts of things like systemic racism affect not only, you know, how well children do in school, but their health throughout their life, cause it’s so important. So thank you both for being the spokes people that you are and for kind of getting these messages out in the articulate way that you do. And I want to pivot to Luke now and talk about, you know, your team found that some of these places of deepest disadvantage were actually dominated by rural communities. And I think there’s often this counterpoint or kind of counter assumption that poverty can be worse in cities because of things like high cost of living and high concentration of people. And we sometimes, I think, erroneously assume that rural communities might have lower levels of inequality which you actually found is not the case. So can you kind of talk about why these assumptions were wrong and how you kind of found poverty to exist in different contexts and how that played out?

Luke Shaefer: So I think borrowing from Bryan Stevenson I’ll mention that I think we’re best at understanding the problems that we’re most proximate to. And so most scholars and folks who are thinking about poverty are, you know, more clustered in urban areas. And so I myself had been, you know, all of my time that was working in the field in places like Chicago and, you know, in in urban areas in Michigan. And so it’s easier to just see, you know, certain challenges, high cost of living being one of them. Right. We can see sort of how much housing is costing. We can see that public transportation systems maybe don’t work as well as they should. And so we can follow our nose there. In this book, we tried to take a data driven approach to zero in, and we wanted to go to the most disadvantaged places in the country based on income, health and social mobility. And as you mentioned, I when we looked at that top 100 places in the United States, we loaded in every county, in every city. You know, the 500 largest cities gets you down to cities of maybe 50,000 people. It was disproportionately rural. There actually only nine cities in that hundred most disadvantaged places. And in a place like Chicago, it wasn’t even in the 600 most disadvantaged places. And then we went to these places and really got to know a subset of them, the ones that we write about in the book, but also spent time getting to know other communities. And it looked right to us. Right? We felt like this sort of visual audit validated that. So the thing is that like when you are more proximate, the problems, you can understand their downsides, but you also don’t understand some of the signals of those things. So we have a high cost of living in some parts of the United States in urban centers, is often connected to the fact that there are better services in those places. So maybe the health care system doesn’t work as well as it should, but it’s there and people have access to a health care system. Maybe public transportation doesn’t work like it should, but there is some public transportation in the rural communities, which also, you know, I think surprises some folks. Many of these rural communities are predominately communities of Black Americans or Latin Americans, of course, out West and Native American lands. And there might not be any hospital at all or no health care system to speak of. And there certainly is no public transportation. And so there’s cost of living differences, which we’re used to. Thinking of them as a challenge also represent things which are differentiated in terms of private philanthropy. We see, you know, hugely more dollars go into low income Americans in urban centers than in rural areas because that’s where the money is and people like to give to their communities. And then so much of the what’s available, the federal government to work on these community problems is actually driven by contracts or grants. And what does that require? That requires very talented folks who can write those grants, which you often don’t have, in very, very poor rural communities that you might have in an urban community. So once again, I think when we sort of delve deeper, when we really try to understand places and we, you know, we can come away sort of with a deeper understanding of what’s going on, what are the challenges that different communities are facing that that we might not have any connection to at the start?

Lindsey Burghardt: Well, thanks. Luke, let’s shift a little bit and talk about Rx Kids because I think this can feel very overwhelming. And when I heard about Rx Kids and I saw the potential for this solution, I got so excited because here’s a chance for like public policy to really influence child health and development in an incredibly positive way. So this is the first prenatal and infant cash allowance program in the country, is that right?

Mona Hanna-Attisha:: The first universal one. First universal–okay. All right.

Lindsey Burghardt: So, Mona, can you talk about how your experience has kind of led you to this program, like how it works? How did you come to Rx Kids? Yeah.

Mona Hanna-Attisha:: So, so the water crisis happened in Flint, and, you know, we had this population wide exposure to a neurotoxin also just kind of the trauma of the injustice. So we have been working around the clock to mitigate the impact of the water crisis and really promote the health and development of kids. And our work has really kind of focused on that early childhood window. We have two brand new childcare centers, huge expansion of early literacy, Imagination Library, Reach Out and Read nutrition, prescriptions, home visiting programs, trauma informed care, the expanded Medicaid, early intervention. The list goes on and on of the awesome that we have been able to put into place in Flint. But caveat, these are things that should have been there already and these are things that all kids need. They need food, they need education, and they need health care as a basics. But we didn’t have them before and we’re still kind of struggling to maintain them. And a lot of that what we have been able to put in place really relies on families to do more, you know, sign up for this program, go to this class, read to your kids, you know, feed them healthy, come to see me as a clinician. And that’s all good. But it makes me feel guilty like I am. I have been tired of asking the oppressed to do more. We talk about the kind of this concept of resilience, like why should my patients have to be more resilient? Because we as a society fail to build resilient communities. And when you understand what it means to grow up, be born into and grow up in poverty, like Lindsey, you said, I’ve wished so many times the ability to prescribe away poverty, like when I’m holding a little newborn in my hands and doing all the things I’m doing, the vaccines and the growth and development and the back to sleep and feeding and all this up, I wish I could change their zip code so that they do not have to grow up in poverty. And I was kind of sick of shrugging my shoulders and I’m like, Well, hold on, let’s do something. We can do something. We do big, hard things. Let’s do something. So I called Professor Shaefer over here, who is a child poverty expert, helped bring forth the expanded child tax credit for the nation. And I’m like, Do you want to work with me on a child allowance for Flint? He didn’t say no. And, you know, since then, we have been developing this program, which has become Rx Kids. It is a prescription for health, hope and opportunity. And starting in 2024, we will be prescribing every pregnant mom unconditional universal cash allowance and mid pregnancy, and then every baby an unconditional universal monthly cash allowance from birth to 12 months of age. This has never been done before. It’s city-wide scale. It’s launching. I see all the hearts and I’m so excited because now I’m. Sure the loving is hard and. Perfect because this is launching on Valentine’s Day. Because as much as we are trying to alleviate poverty and address economic instability, we are sending a strong message of love. This is how we are supposed to care for each other. This is about loving our moms and babies, seeing them and hearing them and walking alongside them during this really critical mom infant period, which not only is so important developmentally, but turns out to be the most economically vulnerable. Families are the most poor perinatally. So we’re launching in February. We’ve raised a lot of money. We still have about $15 million to raise. So anybody feel free to contact me if you want to give us money or, you know, anybody really rich here wants to support us, go to RxKids.com But we are launching in January and our hope is to do this for five years of moms and babies. And, and maybe I could pivot to Luke and who can tell us more about kind of the science of child allowances globally and domestically, if that’s okay, Lindsey.

Lindsey Burghardt: Please, yes!

Luke Shaefer: So in prior work that I had done, I had focused on very, very poor families in the United States. And actually this increase in families without any money. So in the United States, families might have access to food assistance through like food stamps or maybe even work that can provide for that. But what does it mean that they have money to be able to buy toothbrushes or toilet paper or diapers or pay the rent if you’re facing eviction or food? And so as we were thinking about what to do about it being policy scholars and wanting to get to solutions, we also knew that the old casual birth system that we had in this in the United States was a very stigmatized program. It was a program that just made families answer many, many stigmatizing, invasive questions. It has a long history of it being administered in structurally racist ways in the United States. So we wanted to look for a different model. But luckily you don’t have to start from scratch. There is this incredible movement across the world for child allowances or sometimes they’re called child benefits. And the logic starts from a very different place, which is raising kids is expensive and society has a reason to come alongside parents and support parents in that work. And one way to do that that empowers families is to provide cash to pay the utility bill or to buy diapers or buy the crib. And so we’ve seen this over and over again in country after country, provide a small amount of money. Sometimes that’s $250 per kid, maybe $300 per young kid and every time countries adopt this, child poverty plummets and food hardship plummet, and kids do better on so many different metrics. So in the United States, this seemed like pie in the sky a number of years ago, and my colleagues and I started talking about it, but it became a reality in 2021, where we did this through the expanded child tax credit. And families for six months, really received a monthly amount to support their kids in a way that they saw was best. And we saw child poverty fall to an all-time low. Millions of children lifted out of poverty. We saw food hardship fall to an all-time low. We saw improvements, research papers, finding improvements in the mental health of parents. We saw one of the things I thought was most interesting was credit scores actually hit their all-time high. At the end of 2021, the number of Americans with bad credit fell to an all-time low. So, so many markers of financial health and it wasn’t extended. There still is a lot of support in Washington for it, but it did not become a permanent reality. And we just saw new child poverty numbers where child poverty more than doubled. And we have millions and millions of kids back in poverty after having been out of it. But there is still interest. And I think it showed what was possible for as a country that we could follow other countries on this. And so when I got Mona’s call, I couldn’t have imagined a call I would want to have gotten more to try to keep this in the public imagination and be a part of Flint actually leading the nation and saying like, this is how we should care for our families with kids, because we would have loved to done it for every kid of every age. But those numbers got really, really big, really quickly. So as I learned from my pediatrician and new pediatrician colleagues, like how important that first year of life is, and before that, babies brains doubled in size. And so much of what happens in that first year affects the life course. There’s a new paper in the quarterly Journal of Economics that finds an extra thousand dollars during that first year of life, has a substantively increase in earnings like relationship with people’s earnings in their thirties. So we’re talking about decades later and that it pays for itself. So this program is going to be laser focused on that first year of life in that prenatal period. And another thing that I really love about it is linking health care providers. So, you know, there’ll be lots of ways into the program but the primary way is for poor families to, you know, expecting moms to go to their prenatal doctor’s appointment and be prescribed cash along with all of the other advice that they’re receiving. And so we, you know, think and believe that it’s going to deepen the relationship between provider and family. So we’ll have the positive impacts of money that can help with your core expenses that families have, as well as a deepening of relationship with providers. And we hope maybe a re-envisioning of the social contract since this is so different from really any other type of program that we have in the social safety net.

Lindsey Burghardt: I love that and I love that tying it to your prenatal care and your prenatal provider and thinking about that model of a program like Reach Out and Read where parents don’t need to go to another different place and answer another set of questions and make a new relationship. When they already have one that for many they hold dear and as a trusted source of information. So I just think that deepening of that relationship is an incredible part of this program. And I think you talked about this a little bit with some of the effects that maybe we wouldn’t anticipate it with the program. Right. Like credit scores increasing, are there things that you’re thinking about looking at as outcomes that might not necessarily be tied immediately in our conscious, like thinking about implications for parents or children’s mental health in childhood or other kind of downstream implications of not having to feel this kind of burden of poverty.

Mona Hanna-Attisha: Maybe I’ll talk about some of the wellbeing ones and talk about some of the community measures that we’re excited about. So we’re going to look at wellbeing, so we’re looking at measures of happiness and hope for themselves and their children, looking at the measures of dignity and trust, agency and empowerment. So I’m in addition to, you know, lots of health outcomes and, you know, prematurity and low birth rate, maternal morbidity and mortality, mortality and NICU admissions and well-child visits and health care utilization and postpartum depression. So there’s a lot of health stuff, but through surveys, we’re going to look at these well-being measures, which I’m excited about. And then this is a universal program. So in addition to kind of self-report, we’re going to also be leaning on administrative population level data. So maybe Luke can talk about some of the exciting things that a community level which is really novel for this, for this kind of project that we’re going to look up.

Luke Shaefer:Yeah, I’m super excited about the sort of deepening of the relationships and seeing, you know, one thing we often see in my field is, well, you know, an organizational start, a new program that they think is really great and nobody will show up in. You know, they’ll think, Oh, we need to market it more. We need to make sure people know about it. Somehow with cash transfers, people show up. It is something that they value. So it’s a way to sort of build that relationship. So I’m excited to see if the cash transfers increases, you know, prenatal visits, does it increase things like nurse home visits after the fact because it’s building the relationship, sort of welcoming us into a conversation. And I’m really excited about child welfare outcomes. So that very first year of life is like a shock. I think it’s the biggest shock in terms of child maltreatment and kids being placed out of home. And so there is a new study out about the Alaska Permanent Fund and what it means to get benefits from that. That’s really a basic income that Alaskan residents have. And so this new paper looks at families that got that during that infant period and sees huge reduction in child welfare reports and out of home placements. Pretty incredible. And there’s yeah, there’s another you know, one thing that people are often interested in is around like alcohol and tobacco or drug use, you know, worrying that maybe folks will use cash in the ways that society deems wrong. And the research has been really interesting on that. So all of the places where we studied that there’s never an increase in substance uses. In some places there’s actually a decrease in those things. So the cash transfers are related to reduced alcohol, and tobacco, for example, maybe as a result of reducing stress, means that families are less likely to feel like they need to rely on substances. And then what we can do with this that we can’t do with any study that, you know, a pilot for a couple hundred is what Mona was alluding to of looking at the community level factors like does this help to rebuild trust in government and just money circulating through the community. So we’re talking about 9 million extra dollars that is going into the hands of Flint residents. And all of the research suggests most, if not all of that is going to be spent locally. And maybe this is going to be a more effective economic development strategy than some of the top down type approaches that we’re more often using.

Mona Hanna-Attisha: The rebuilding of the social contract work, I see this also as a way to restore democracy and more trust and faith in government. And I think we might see that in improved voting rates and civic engagement. So that’s something else that we’re looking at.

Lindsey Burghardt: So I can imagine that like people who are listening would really like to kind of look into your play book and get an idea of how you’re able to do this. I can’t wait to be able to share some specifics about how you kind of got the program to life. How did you get it written into the state’s budget? So, you know, can you share kind of any tips for people that might be listening and interested in applying this to their own contexts?

Mona Hanna-Attisha: Absolutely. So from the onset, our intention was to start this in Flint, but really to share this. That’s why we’re so excited to be here today. So this is expensive. So we need about $11 million a year to do this. 9 million are the direct cash transfers. And once again, we want to do this for five birth cohorts, five years of moms of babies. So our goal has been to raise $55 million. We received a very, very generous grant from philanthropy from the CS Mott Foundation, a $15 million match grant very early. Other foundations also came in, a mix of family and local and state and national foundations. But our most exciting funding has come from the state of Michigan, and this is our pathway towards sustainability and scalability. And it has come as a redirection of TANF, which is the Temporary Assistance for Needy Families. This is the cash welfare system, and I’m going to send it back to Luke because he’s an expert here. But this is super exciting. This enables other communities to do this. This is what’s really kind of getting the attention nationally and is the playbook.

Luke Shaefer: And the United States in 1996, we thought that we reformed welfare to be a work first and time limited cash welfare program. But it turns out what we did was create a very flexible block grant. So this is a chunk of money that’s 16.5 million at the federal level that goes down to states. In Michigan, we get about 750 million of that in this TANF funding. And all the states can choose to use this for cash assistance where they provide a small amount of money to families every single month. And if they do that, they have to do a lot of reporting. There’s lots of requirements. They can actually get into trouble if they don’t do things right. Or if they want to they can not provide cash assistance and use the money for any number of other things as long as they can justify on paper that it fits one of the core purposes of TANF that includes, you know, taking care of kids in their own home, but also things like promoting marriage or reducing out of marriage births. So what states have figured out over time is that they can actually use the money in ways that they were probably already spending otherwise. And so we’ve shifted the money to all sorts of things. Lots of states pay for their child welfare, their foster care system out of it, Lots of, sort of, using the money to deal with administrative costs. And in Michigan is not out of line with where a lot of other states are. Of their 750 million that the federal government spends then and the state puts in another 100 million or so, only about 55 million actually goes to cash assistance to families. So that’s 6% of the total amount to a much bigger chunk goes to things like the child welfare system or in the case of Michigan college scholarships, that mostly go to higher income families because we were short on our college scholarship budget. So Rx Kids what it does is say, let’s bring some of that money back to, you know, what was really the intention of the original program as 6% is not an appropriate amount of this block grant to be spending on cash aid. But let’s do it in a fundamentally different way. Let’s do it with dignity. So, you know, cash welfare programs of TANF always require like an income test, and families have to apply. They have to really prove that they’re not just poor, but they’re really, really poor. In this case, we’re going to use TANF to support families who are low income, but all families are going to be eligible because by making every family in Flint eligible, we actually cut off the stigma that having that income tax can have on families who don’t have enough. Right. We’re no longer saying you get this money because you can’t handle, you know, your own needs. We’re saying raising kids is expensive and society wants to come along and support you in that work. It turns out people that are well above the poverty line, have trouble paying for diapers or trouble paying the rent or paying for child care. So it makes a lot of sense. So we’ve just been so excited to see the level of interest that this has driven from other states. We’re hearing from people in all sorts of other states that want to talk about this. I think in part by focusing on this first year, we sidestep some of the general, you know, the typical questions about, you know, does this become a life cycle? Is this a dependency? Is it going to impact, you know, our work in the long run? We’re talking about really focusing on this first year of life when families are the poorest, when kids are developing at like breakneck speed and using this money in a dignified way, not just to help families meet their basic needs, but also to try to send them a very clear message that you are cared for and we want to be a part of helping you do this job that you think is, you know, the most important thing that you are doing.

Mona Hanna-Attisha: I can just add you have Luke and I, but this this work, like all good work is done, has been done in a humble partnership with our community. And that we have a group of moms and dads and kids that have been really driving this work and where this kind of originated and that that’s part of Flint’s story. If you remember Flint’s a story that lost democracy so central to our recovery and our path forward is the role of participatory democracy and self-determination. So from the logo design to how much money to our Valentine’s Day party and who’s going to perform it, maybe Beyonce, maybe so all of this has been driven by our parents, by moms and dads in this work, which I think is, you know, which is kind of central to all public health work and working communities.

Lindsey Burghardt: And that’s amazing. It’s actually the perfect segue to our questions. We got over 100 questions from the webinar registrants from all around the world. And one of my favorites, because I’ve heard you talk about this is really how you were incorporating that lived experience and community perspective in the in your work. And I just think to hear you talking about bringing back like the joy and the dignity and centering those in this process just I think is amazing. And we’re going to jump into a couple of questions. We have a few minutes here to just hear from what our registrants wanted to know more about. And there are several questions that kind of got into the education and early education space and thinking about applying, Luke, like what you kind of learned on the road about schools in the education context, to think about how we can think about solutions to funding to support these places, you know, schools and early childhood centers to address issues related to poverty and kind of what strategies and recommendations would you both give school districts to help center the importance of place? Sorry, there’s a couple questions in one.

Luke Shaefer:Actually I’ve just been writing about this, so the very first thing that I mentioned is it’s worth it to look at the history of places and figure out why schools are so unequal. So one of the favorite parts for me of my book is a passage about segregation as academies that cropped up in a lot of the communities that we’ve studied over time where, when Brown v Board came down, communities were able to ignore it for a while, and then finally they weren’t. And they had to integrate public schools and the research is very powerful that integrating public schools had a huge positive impact for Black American schoolchildren and no negative impact for white schoolchildren. But communities going in the opposite direction and the segregation academy sometimes pulled over like all of the resources from the public schools and basically replicated in many ways the system we had before. So looking at that history, I think is really critical. I think it can help us understand like what are the solutions that would actually work, how could they be circumvented? So what do you do with that? One strategy that I have actually become very interested in is just raising the pay of starting teachers. So this has a really nice evidence base around. We just we paid teachers who do incredibly hard work almost nothing. And so, you know, to keep that up–again, it’s not just the money and being able to survive, but it’s the signal that we send to people who want to go into the teaching profession about how we value it. So the evidence is sort of in that first few years of teaching: if we could raise those salaries, we would attract more people, we would keep them for longer. And if you can have mandates across systems that, like everybody is raising their teacher salaries, it’ll impact the poorest schools the most.

Mona Hanna-Attisha: But we need to raise early childcare teacher salaries even more. They are paid so little. And if we respect the science that we all understand that this is the most critical time in a child’s life, we know these are brain builders We need to be paying them Ph.D. level salaries. I mean, it just it needs to follow the science and they are absolutely undervalued. So, I mean, that would be one of my recommendations. But also really thinking about the education system a lot earlier, you know, why is a school, you know, grade K-12? Well, why doesn’t it start at age three or, you know, age one? So really respecting the science and thinking about the importance of the–prioritize the importance of early education.

Lindsey Burghardt: Yeah, I couldn’t agree more. And I think, you know, Luke, you mentioned that there’s like economic perspective now looking at kind of the cost benefit analysis, even like focusing on young children very early when they need it most. And I think to us as pediatricians and for people who are deeply immersed in this work, it just makes total sense. But I, I hope that we can continue to build the kind of arguments for what really feels like science that our grandmothers told us that makes the most sense: if you take care of young kids when they’re very small, you can get them off to a good start and sometimes better to get it right the first time, I think, although it’s never too late, of course.

Mona Hanna-Attisha: So I know you have a bazillion questions, but I’m going to I can’t not share my favorite quote, so

Luke Shaefer:I know you’re going to.

Mona Hanna-Attisha: So, we’re launching on Valentine’s Day, remember, because this is about love, and it’s Black History Month. And it’s also Frederick Douglas’s, self-proclaimed birthday. And he his quote about prevention is my favorite quote and really kind of what I live by. And he has said: It is easier to build strong children than to repair broken men. And that is the work that we are all doing every day. It is building strong children, our health care system, our education system, our criminal justice system, you name the system. It’s reactive. We fail to prevent we fail to invest in our kids and we go on and Band-Aid and pay the consequences. So it is easier to build strong children than to repair a broken man.

Lindsey Burghardt: Yeah, it’s beautiful and I think to your point, we can hold up each of these systems and look at how they are considering or not considering very young children’s welfare and their impact on the youngest citizens. And I don’t think that we do that in a universal enough way. And thinking about bringing in folks to the table in zoning and urban planning and environmental protection who do not consider themselves early childhood advocates or people whose work influences early childhood, when in fact it has a profound influence on children and families. And I think you both are just doing such important work and connecting the dots. And you know, the last question that I’ll raise that came from audience that I loved, and I swear it was not planted: if science is so clear about how exposures like pesticides in lead and water affect brain development, you know, how have these things become so partisan in their communications? And how do you address that in your work to achieve the kind of mindset shift that allowed you to get something like Rx Kids off the ground? Like, how do we kind of approach these conversations to demonstrate to a variety of audiences what science tells us about supporting young kids?

Mona Hanna-Attisha: There’s a lot in there, and I’m just going to, you know, I think we have to keep sharing the science. And as we’ve done a little bit today, we have to continue sharing the stories about why this is important. I think very often we share a lot of bad news and we share we catastrophize, especially with all the issues facing children and climate change. And, you know, the list goes on–gun violence. And I think like you have done today, I think it’s important to share the solutions and to share kind of the community driven, you know, hope and the practical way that we can do this. We are at a place right now, this science denial place, not by accident. And we have to look at the history. Special interests and corporations have made it be this way. They have purposefully weakened regulations, disinvested in public health. Everybody, you know, go read about one of my heroes, Harvard’s first woman, professor Alice Hamilton, who fought against these industries and, you know, against the lead industry and General Motors and all these special interests and was silenced. And that really kind of set forth this paradigm that we work with today that has allowed for the unchecked use of so many bad things that hurt kids because the upper hand is always industry and corporations and profits and it’s not kids. So we have to learn that history and then we have to kind of, you know, keep electing people who understand that and respect that and will fight for kids.

Lindsey Burghardt: Beautifully said. So closing thoughts from the two of you. So if you had to give advice for listeners, people who want to pursue public policy changes like what the two of you have worked so hard for in their own communities, what advice would you give?

Luke Shaefer:I guess I would encourage people to start with listening. You know, I have found that my book that we talked some about today, all of the chapters were not things that I really expected to write about going in. But as we got to know communities, we really started to talk to families that drove our research agenda. That really drives the agenda of my research center here. And so we have to be willing to look at things like in our book, we have a chapter on government corruption, we have a chapter on community violence, and then tie it to the history and really be mindful that the challenges that face us today did not appear out of thin air. And if we really understand where they came from, we can do better at figuring out where to move forward and then come to positive, concrete solutions and celebrate them when things happen. You know, positive change can happen in the incredible distance that we’ve come on lead pipes being replaced all over the country is really remarkable. And so we have to understand our challenges and celebrate solutions.

Lindsey Burghardt: Love it. Mona?

Mona Hanna-Attisha: I would just say you make all kinds of friends, those of us who live in who do this work often hang out with folks that are very similar to us. And I never thought I’d hang out with a social scientist policy guy to be able to do this. But we need to make all kinds of different friends. The tent of folks that care about kids is broad, and I think if that tent– as big as we can make that tent–the more likely that we will be able to achieve the outcomes that we hope to see.

Lindsey Burghardt: I love it. Every time I talk to the two of you, I feel so inspired and buoyed to go out and think about this more. And you gave me so much to think about and reflect on and consider in our work at the Center. We partner with other organizations as well but everybody who’s listening feels the same way is that thank you so much for making the time, for being here, for being the advocates that you are for young children, for all the work you’re doing in Flint and beyond.

Mona Hanna-Attisha: Thank you for having us.

Lindsey Burghardt: So I’m going to turn it right back over to Rebecca Hansen from the Center to close us out.

Rebecca Hansen: Alright, Thank you, Lindsey. And thank you again to our panelists for a really wonderful conversation. As Lindsey said, this has given us so much to think about and great ideas to apply to our work, and we’re really grateful for your willingness to share your expertise with our community. And lastly, I just want to say that there is so much more to come in this webinar series. We are working to bring more conversations like this one to you in the coming months. we’ll be sharing more about the next webinars in our series, including a conversation examining the impact of racism on child development. So please stay tuned on our social media channels and subscribe to our newsletter so you can stay up to date on additional activity in the series. So thank you again to you, all of you, for coming and I hope you have a great day.

Amelia Johnson: The Brain Architects is a product of the Center on the Developing Child at Harvard University. You can find us at developingchild.harvard.edu, where we will post any resources that were discussed in this episode. The next webinar in our three-part Place Matters webinar series is on December 11th at 12pm EST—stay tuned to our social channels for more details. You can find us on Twitter @HarvardCenter, Facebook at Center Developing Child, and Instagram @DevelopingChildHarvard. Our music is Brain Power by Mela Collective.

**Place Matters** Sep 20, 2023

Contents

Podcast

Panelists

Additional Resources

Transcript

In June, we hosted a webinar about our latest Working Paper, Place Matters: The Environment We Create Shapes the Foundations of Healthy Development, which examines how a wide range of conditions in the places where children live, grow, play, and learn can shape how children develop. The paper examines the many ways in which the built and natural environment surrounding a child can affect their development, emphasizes how the latest science can help deepen our understanding, and points towards promising opportunities to re-design environments so that all children can grow up in homes and neighborhoods free of hazards and rich with opportunity. Corey Zimmerman, our Chief Program Officer, moderated a discussion around these themes between Dr. Lindsey Burghardt (Chief Science Officer) and Dr. Dominique Lightsey-Joseph (Director of Equity, Diversity, Inclusion and Belonging Strategy) which has been adapted for this episode of the Brain Architects podcast.

Panelists

Tassy Warren, EdM *(Podcast Host)*
Deputy Director and Chief Strategy Officer, Center on the Developing Child at Harvard University

*Corey Zimmerman, EdM (Moderator)*
Chief Program Officer, Center on the Developing Child at Harvard University

Lindsey C. Burghardt, MD, MPH, FAAP
Chief Science Officer, Center on the Developing Child at Harvard University

Dominique Lightsey-Joseph, EdD, EdM
Director of Equity, Diversity, Inclusion and Belonging (EDIB) Strategy, Center on the Developing Child at Harvard University

Additional Resources

Place Matters: The Environment We Create Shapes the Foundations of Healthy Development

Place Matters: An Action Guide for Policy

Place Matters: What Surrounds Us Shapes Us

Child Opportunity Index (COI)

Healthy School Environments – US Environmental Protection Agency

Transcript

**Tassy Warren:** Welcome to The Brain Architects, a podcast from the Center on the Developing Child at Harvard University. I’m Tassy Warren, the Center’s Deputy Director and Chief Strategy Officer. Our Center believes that advances in the science of child development provide a powerful source of new ideas that can improve outcomes for children and their caregivers. By sharing the latest science from the field, we hope to help you make that science actionable and apply it in your work in ways that can increase your impact.

In June, we hosted a webinar about our latest Working Paper, *Place Matters: The Environment We Create Shapes the Foundations of Healthy Development*, which examines how a wide range of conditions in the places where children live, grow, play, and learn can shape how childre

During the webinar, Corey Zimmerman, our Chief Program Officer, moderated a discussion around these themes between Dr. Lindsey Burghardt (Chief Science Officer) and Dr. Dominique Lightsey-Joseph (Director of Equity, Diversity, Inclusion and Belonging Strategy) which we’re happy to share with you all on today’s episode. To access the full Working Paper and related publications, please visit our website at developingchild.harvard.edu.

Now, without further ado, here’s Corey Zimmerman.

**Corey Zimmerman:** Hi, everybody. Welcome. I’m Corey Zimmerman. I’m the Chief Program Officer here at the Center on the Developing Child, and today we’re going to be discussing a paper, the name of it is *Place Matters: The Environment We Create Shapes the Foundation of Healthy Development*. This paper was written by our National Scientific Council on Developing Child and was released earlier this year in March.

We see this webinar as an opportunity to begin to understand a broader frame for thinking about what influences early childhood development, the role that inequity plays in influencing the environment children are in, and third, some early thoughts on new actors or sectors that might be called upon given this broader frame, to be able to join us in our collective effort to improve outcomes for all children and their families.

Okay. With that, let’s get started. It is my pleasure to introduce you to my two colleagues, Dr. Lindsey Burghardt, who is the Chief Science Officer here at the Center on the Developing Child. And then second, Dr. Dominique Lightsey-Joseph, who is our Director of Equity, Diversity, Inclusion and Belonging Strategy here at the Center. Okay. So we’re going to start with a brief overview of the Working Paper, Place Matters from Dr. Burghardt.

**Lindsey Burghardt:** Thank you again, Corey, for that introduction. And thanks to all of you today who took time out of your day to join us and to hear about this new working paper from the National Scientific Council. So the overall focus of this paper is really to broaden the frame of how we’re talking about early childhood development and health. And we’re going to look upstream today and consider all the different factors that influence how kids develop.

So we all experience this continuous influx and flow of influences from our environments, and they begin before birth right in the earliest days of the prenatal period, and they continue throughout our lives. And these influences include the environments of relationships and those environments–that environment of relationships–is just as important as it’s ever been. And children also experience exposures and influences from the physical environment that surrounds them and their caregivers.

So particularly the built and natural environments. And there are a really wide range of conditions in places where children live, learn, play and grow, and all these conditions have the ability to get under the skin and affect the developing brain and also other biological systems. So the immune system, the microbiome and the metabolic system, among others. And beginning before birth, these environmental conditions are shaping how children develop and that, in turn, has the ability to shape their lifelong physical and mental health.

So the built and natural environments and the systemic factors that shape them, like policies that influence where people are able to live and how resources are distributed, interact with each other and they interact with a child’s social environment in really deeply interconnected ways. So this is really what we mean when we say that *place matters*. So every environment is infused with a combination of influences, and these influences can have positive or negative effects on health and development.

And it’s also really important to recognize that level of exposure to risk and access to opportunity for children are not distributed equally. So in 2004, the National Scientific Council on the Developing Child described the effects of early life experiences on the developing brain and its first working paper called *Young Children Develop in an Environment of Relationships*. And over the two decades that followed, this concept really helped to make the case for caregiver-child relationships is sort of the active ingredient in how environments can influence the architecture of the developing brain. So the environment of relationships includes the presence of responsive relationships, the presence of significant stress and adversity, caregiver well-being, social connectedness, community support, faith and cultural traditions. And so more recently as our understanding of how early the early origins of health and disease have advanced, we’ve also really started to understand how early experiences affect multiple developing biological systems beyond the brain. So thinking about the immune system, the metabolic system, the respiratory system, and actually how these systems are interacting with each other and shaping each other as well as the brain. So the environment of relationships again, is just as important as it’s ever been, but these environments–that environment or relationship–it doesn’t exist in isolation; it exists in the context of is much broader environments that include the built and natural environments that surround children.

Exposures from the natural and the built environments also directly shape the development of biological systems inside the body, and they interact with adult-child relationships in a really deeply interconnected way. And these exposures can be positive or negative, and they can include things like air quality and temperature that children breathe, the purity and availability of their water supply, their ability to access safe green space and healthy housing and whether or not they’re exposed to things like environmental toxicants.

So we can take the example of lead is one that many people are familiar with. So lead is one factor in the built environment that connects to safe and healthy housing, connects to clean water supply and to exposure to toxicants. And we’ve known now for a really long time that lead is harmful to children’s development, particularly in the prenatal period and in the earliest years. And lead is still a challenge for a lot of families that today that are still dealing with this and the ongoing situations in Flint and in Jackson speak really clearly to this issue. So the presence of lead in children’s drinking water directly influences and affects their development, and it also shapes the environment that their caregivers are in with the burden and stress that it puts on them. So if there’s lead in the water supply, caregivers often have to seek out alternatives, and it’s typically at a cost, they may need to find in time for additional doctor’s visits and follow up. And all this can cause stress on them, and that can impact their ability to be in a caregiving relationship. So when we look at an environment, one that provides lots of positive influences is more likely to support children’s healthy development, and just as an environment that provides or imposes more negative influences is going to be more likely to result in disease and in poor health outcomes.

So let’s widen the frame one level further, because there’s also these really broad systemic influences that play quite a powerful role in shaping the environments our children live. So these systemic influences are going to shape children’s development directly and they’re going to shape them indirectly through their influence on a child’s environment of relationships and their built and natural environments. And these influences include things like current and historic public policies, systemic racism and intergenerational poverty, among others. So it’s really important to acknowledge that conditions in our built and natural environments are not experienced equally among children. They vary widely and the adverse effects of systemic racism in particular have deep historical roots whose impacts continue to the present day and many present-day policies continue to perpetuate these inequities and their ongoing effects. So there’s an example that we’re going to dive deeper into a little bit later on in redlining. And redlining strongly influences where many children of color live today. And although this practice is now illegal, it has modern day implications like the home appraisal process that continues to shape the environment where young children grow. So increasingly, data that has been provided that shows deep analysis of these differences at the community level. And there’s one that’s provided by the Childhood Opportunity Index, or COI, that’s cited in the working paper. And then we’ll again talk in more detail later on. But the COI demonstrates that in the United States, neighborhood opportunity is highly segregated by race with black and Hispanic children having access to significantly less neighborhood opportunity than white children.

So let’s shift a little bit now to talk about the timing, which is so important. Well, it’s really clear now that it’s not just our genetics and it’s not just our environment, that influence health and development. It’s both. And the influence that our genes and our environment have on our health is also really depends on the time during which we have certain experiences or exposures. And people differ in their sensitivity to influences from their environment at different points throughout their life course. And children’s biological systems in particular have different periods when they’re really sensitive and more sensitive to various environmental exposures and influences, even within the same biological system. So one example is the developing microbiome in our gut, which is very sensitive to influence from the built and natural environments around the time of birth and in the first few years of life.

So in general, the sensitivity of the brain and the other biological systems that we’ve talked about is typically greater in the prenatal period than it is in early childhood. And in general, young children are more sensitive to influences from their environment than older children who are in turn more sensitive than adolescents. And in general, adolescence will be more sensitive than adults to many environmental exposures, and this is really important when we consider the importance and the impact of environmental exposures because of a greater sensitivity in early childhood.

When an exposure happens during a fetal development or in early childhood, it’s going to have a very different impact and potential effects than if that same exposure happened later in life. So when we think about it, actually the first place where a child’s development is affected by place is the intrauterine environment during pregnancy. And during fetal development,immature biological systems are developing a very, extremely fast pace and their development is powerfully shaped by the environment around them. And these systems read the conditions in the womb as predictors of what they’re going to encounter after birth, and they sort of adapt accordingly. And so because these systems are still differentiating, they’re still becoming specialized and figuring out what they’re going to be, the exposures can result in really different outcomes depending on the time during development when they occur.

And we can take a look here at the example of air pollution. So air pollutants can be absorbed in a variety of ways and can cause problems in developing organs and entire organ systems. But the nature and the severity of any potential effects will be different depending on the time during childhood and during development when the exposure occurs.

So, for example, in the prenatal period, exposure to air pollution is associated with things like adverse birth outcomes in prematurity and in low birth weight. And in early childhood exposure to air pollution is a known risk factor for a variety of health effects, including asthma and children who are exposed to higher rates of outdoor air pollution during the first year of life may have diminished functional lung capacity as teenagers. So this is only one example of how the nature and the extent of an exposure that occurs very early in life may not even be fully apparent for years or even decades later.

So let’s talk a little bit about climate. So climate and our changing climate is a really important factor in how children experience place. So we’ve talk today about how environment shape development and health, and we’ve discussed that what surrounds us quite literally shapes us.

So let’s go back to thinking really broadly about what’s surrounding and shaping children in their environment. We talked about the quality and the temperature of the air that they breathe, the purity and availability of their water supply, their ability to access safe and healthy housing, their ability to access nutritious foods and the quality and density of the buildings in their neighborhoods. So climate is modifying the environment where these kids are living in a number of ways, it’s increasing the temperature of the air that’s surrounding them and making that air less pure. And it’s altering the availability and purity of the water supply, and that’s making housing less predictable through displaced men and through increasing energy costs. And it’s making nutritious foods for many children around the world even more scarce.

So climate is changing children’s environment and it’s doing it unequally across groups. Let’s just take a moment to look at heat as an example. So higher temperatures actually lead to a really wide variety of negative outcomes on development and health, including adverse birth outcomes like prematurity and low birth weight. It can have impacts when it’s experienced even in early childhood on academic achievement that can persist for many years later and heat increases the effect of air pollutants which are known to worsen conditions like asthma. So more heat will intensify the effects of air pollution and we’ll see more problems with asthma as a result. And heat is increasing in all children’s environments all over the world, but it’s not increasing equally among communities. So urban areas that already have a higher density of buildings, already are experiencing higher temperatures and have less green space, are going to be more impacted than suburban or rural areas. And the disparities then, in exposure to heat and the intensified effects of air pollution are going to be different depending on where you live and how you’re experiencing our changing climate. And as a result, we’re going to see a disparate impact in the contribution to disparities in rates of diseases like asthma that are already based on where children live.

So we feel that the implications of this really rapidly growing science on this front are clear. Understanding the really powerful effects that the natural and built environments have on the early foundations of health and development is calling for increased attention to really important influences that fall well beyond what we all consider the traditional boundaries of the early childhood field. So this demands that we have to incorporate a more intentional early childhood perspective within the current concerns of things like urban planning, rural development, environmental protection, climate change, anti-discrimination policies, many others. And doing this requires that a much broader range of policy domains must work together to address racist and other discriminatory policies, and we have to achieve greater equity.

All communities have aspects of their built and natural environments that have been designed through intentional decisions made over time, and they can be redesigned to support healthy development. And supporting healthy development is still very much about encouraging and supporting caregiver-child relationships, and it’s also about bringing communities, businesses and governments to work together to assure a supportive and healthy environment for all young children with particular attention to the built and natural environments that are currently falling far short of that goal.

So working together across various policy domains beyond the early childhood field and sector, we can reshape environmental influences with a science informed lens and a shared goal of achieving fairness of place so that all children can grow up in homes and neighborhood that are free of hazards and rich with opportunity.

**Corey Zimmerman:** All right. Thank you, Dr. Burghardt, for that overview of the paper. So many rich insights. I’m actually really excited to dive into this more now with you and Dr. Lightsey-Joseph. Thank you. All right. That was a great overview. And now we’re going to shift into the panel part. So, Dr. Burghardt, this first question is going to be for you.

You mentioned that every environment is infused with a combination of influences and that those influences can impact children in positive and negative ways. And I was wondering, can you give us an example of an environmental influence that has an important impact on children and families? But maybe that’s not something that we typically think of as related to early childhood development.

Like, help us dimensionalize a little bit. What would be an example?

**Lindsey Burghardt:** Yeah, thanks for the question, Corey. So one of my favorite examples here is green space. So our knowledge of the health effects of green space is really increasing as we’re learning more and more of the science behind how green space exposure affects health and development in children. And we have a growing body of science that’s demonstrating that the benefits of access to safe green space around the prenatal period has a variety of benefits and a variety of health outcomes in children.

So later on, benefits to the immune system and benefits really on children’s mental health in a number of ways. And there’s also a really growing and exciting deepening knowledge about how green space can offset some of the more negative environmental exposures that I spoke about, like heat and air pollution. So, you know, as we talked about earlier, children are experiencing the built and natural environment really differently based on where they live. And right now, children’s opportunity to access green space is not equal. But I think that given the robustness and the rapidly growing science in this area, around the really wide range of benefits, this kind of disparity of place is one that really demands greater attention. And in particular when when it pertains to green space. There’s also, I think, really interesting and significant what we call co-benefits when we think about bringing together in conversation and action children’s health and their environments.

So, for example, if we’re decreasing concentrations of air pollution, including through ways like increasing green space, then we can improve the air quality that children are breathing and potentially make problems like asthma less likely to occur. And these types of interventions, as we spoke about earlier, they’re really needed most in communities that have the lowest concentrations of green space right now and also the highest rates of asthma.

**Corey Zimmerman:** So many thoughts. That’ sparking so many different ideas, and that’s an example that’s close to my heart as well. So I really appreciate that one. Dr. Lightsey-Joseph, I want to bring you in. I want to ask about this concept of fairness of place that Dr. Burghardt mentioned. And I was curious if you could tell us a little bit more about the social history that’s led to this unequal distribution of environmental influences.

**Dominique Lightsey-Joseph:** Sure. Thank you for having me today, Corey. And good to see you, Dr. Burghardt. Yeah, sure. I can answer that question for you. I think in understanding the unequal distribution of environmental influences, we have to name the historical practice of redlining in the U.S., which is a policy in the thirties by the Federal Home Owners loan Corporation, in which neighborhoods, particularly those that were populated by Black residents, were color-coded based on perceived financial risks or real estate investments. And those areas that were color coded red were seen as the riskiest and the most undesirable neighborhoods. And this process resulted in these communities being systematically denied vital services and opportunities for economic advancement in this country. And despite the Civil Rights Act of 1964, the Fair Housing Act of 1968, which officially outlawed redlining, the economic disparities that resulted from these discriminatory practices persist.

An example of this would be, there was a 2020 report that was conducted by the National Community Reinvestment Coalition, which found that 74% of neighborhoods initially redlined in the ‘30s remain economically disadvantaged today. And this is characterized by lowered home values, higher rates of poverty and things of that nature. And I’d be remiss if I didn’t say that the impact of redlining, it doesn’t just end at financial implications. They stretch deep into the health and environmental qualities, too. And as Dr. Burghardt mentioned earlier, we can take Flint, Michigan, for instance, which is discussed in the paper, and the city’s water crisis, which subjected a predominantly Black community to dangerous levels of lead exposure has roots in the long term consequences of redlining. It was that facilitated segregation of that city all of those years ago that resulted in this higher concentration of poverty and exposure to these environmental hazards.

In comparison to, you know, other neighbor of neighboring areas in the state. So to really answer that question, Corey, I think the influence of redlining has pervasively shaped the socioeconomic and environmental contours of our neighborhoods, and consequently, it has defined the environments where kids are raised and the opportunities or lack thereof, they have to grow up healthy.

**Corey Zimmerman:** Thank you for sharing that. And I want to pull it forward now and ask you a follow up question, Dr. Lightsey-Joseph, around the Child Opportunity Index that Dr. Burghardt mentioned earlier and is in the paper, I think that’s a way of kind of quantifying also some of the ongoing pieces that you’re talking about. So, the Index lays bare the many ways in which disparity of place continue to exist across communities today. And I was curious about what this powerful dataset has to offer us as we think about how to create health promoting environments for all children. So I was curious your thoughts about that.

**Dominique Lightsey-Joseph:** Yes, the Child Opportunity Index, or the COI, it really does lay bare the fact that these disparities across communities exist. And I think it quantifies it to your point in a way that there’s that felt anecdotal knowledge of it, but to see it in the form of the COI, I think is invaluable. So it’s a tool that really does help us to understand these disparities across communities. And it uses a range of indicators, as Dr. Burghardt said earlier, within the educational, health and environmental domains, that really examines the conditions that are vital for children’s healthy development across neighborhoods in the U.S. And one of the most significant insights by the COI is that the substantial disparities in child opportunity are often racialized in nature between different neighborhoods, cities and regions. And for example, in the 100 largest U.S. metropolitan areas , a turn of the decade analysis of the COI, found that Black children are 7.6 times more likely than white children to live in neighborhoods with substantially lower opportunity to grow up healthy. And Latine children are about 5.3 times more likely to live in neighborhoods with lower opportunity. And so the COI beyond that, right, it allows us to identify these environmental disparities across neighborhoods within the same city as well.

So as you both know, I’m a transplant from California, has deep roots out there. And there’s a neighborhood in West Fresno that has consistently been ranked as one of the neighborhoods most burdened by population in the state of California. And subsequently it ranks really low on the COI as well, due to the high air pollution and the limited green spaces. But in contrast to that, neighborhoods with a higher ranking within the same city, literally across the tracks, right, often have less pollution and more parks and playgrounds. And I think the data that is offered by the COI is really this powerful resource, right? That not only allows us to identify these spaces, but it also allows us to address these disparities so that they can inform where these targeted interventions and resource allocations in neighborhoods that require more attention to infrastructure and investment is necessary.

And I would say that it’s important to note that neighborhoods in Flint, like we mentioned a few times and Fresno, are still impacted by being redlined all those years ago, the environments in which our kids live, grow, play and learn, they were not fixed, and these outcomes are not inevitable. They are the products of decisions that have been made over time and they can be reimagined and restructured.

And so I think it’s the responsibility of us, like researchers, government officials, advocacy groups, policymakers, just to name a few. But it’s our responsibility to really work collectively with community leaders to invest and restructure these built environments. I think we have to work together. That’s the only way that we’re going to be able to support healthy development for kids, regardless of their race, their ethnicity, or their socioeconomic status.

**Corey Zimmerman:** I love that. This is a product of decisions that have been made over time and we have an opportunity to redesign. And I find such power in that. There’s such agency actually in that this is changeable. We can do this differently. And so, Dr. Burghardt, I want to actually ask you, with that lens in mind, there is an opportunity to redesign neighborhoods in communities to support healthy development. And I was curious, can you say more about your you had a last point in your presentation that was around the extended role for actors in other sectors outside the traditional early childhood field. So I wondered if you could expand on that a bit.

**Lindsey Burghardt:** Yes, absolutely. Thanks, Corey. And I think I’m going to +1 what Dr. Lightsey-Joseph just said. And that I think for me, like the thing about the COI that really stands out is her point that she made about the geographic proximity and the starkness of difference. Like I feel that we can’t emphasize that point enough. If you look at cities like Milwaukee, I think is a good example of one where literally adjacent to each other some of the highest levels of opportunity in the state and the lowest opportunities in the country right next to each other. And I think that it just highlights that that intentional decision making of where to allocate and distribute resources is a really stark example. And if you check out the, if anyone’s interested, you can go to the website actually and learn a lot about the COI in your particular area. And you can it kind of translates, I think, to what we experience and know from our own experiences. So I’m not adding anything more eloquent than what Dr. Lightsey-Joseph said, but I think just a really, really valuable tool when we’re thinking about where we can invest and where we can focus on health promoting environments.

So, to get back to your question, Corey you know, in the beginning of our time together, I talked about broadening this list of policies that we’re thinking about as affecting the foundations of early childhood development and lifelong physical health and mental health. And the list I gave is by no means exclusive. But I think that looking at things like environmental protection, climate change policies, in particular, mitigation, housing, urban planning, zoning requirements, which helps to redress things like redlining, economic development, criminal legal reform and the criminal justice system and anti-discrimination policies. We can bring decision makers from all these different sectors to the table, even though they haven’t traditionally considered their work perhaps as impacting childhood development and lifelong health. We can again think about how all of the decisions we’re making–literally, every one–is affecting childhood health and development, and I think many people who are here today are already doing that in their work. But it’s thinking about who else can we bring in and who else can we share this messaging with, because we can make a child assessment, you know, impact assessment in every policy and program that we do. We should be looking at every single decision we make, even the ones that on the surface you think, well, there’s no way that that could affect children. Most people here could explain how it, in fact, would. So everything from minimum wage laws to zoning laws, they will affect children’s development, they will shape those environments and those environments will shape children’s health and development. And we really need to demand that kids are considered and that the impact on them is considered when all of these decisions are made.

**Corey Zimmerman:** Okay, so we have reached the point in the session, I feel like I should readjust my chair somehow, like we’re going to switch into the Q&A session now. So we’re going to switch over from the questions that we have sort of prepared and now respond to questions that have come in through the through our social media channels, through registration links. So a big thank you to Dr. Lightsey-Joseph and Dr. Burghardt for your responses so far and for your upcoming now next set of thoughtful responses also. Alright, the first one I’m going to start with is this one. It’s for you, Dr. Lightsey-Joseph, given what we’ve been talking about. And the question is, can you talk more about how and connect this to how does this align with protective factors and resiliency? Curious your thoughts about that.

**Dominique Lightsey-Joseph:** I love that question. So in these neighborhoods, right, there, there are these strong community-based organizations and social support structures that already exist, and they have long been providing emotional support, the practical help, the collective strength and resilience, which in turn nurtures the well-being and empowerment for the kids and families residing in these respective communities. And I think acknowledging these protective factors is important because they are invaluable for sure. I also think it doesn’t negate the need to confront and address the systemic injustices that have resulted in such disparities and made resilience so necessary in the first place. So these protective factors are present and they, to me, serve as a really good starting point from which we might begin to foster a healthier and more equitable environments for these kids. And so I think, to Dr. Burghardt’s point earlier about, you know, approaching this from a holistic perspective and looking at all of these other sectors, that we have to come together and work collectively to restructure these environments, but the approach in how we do that should be guided by the insights and the experiences of those within the communities and not merely outside speculations, assumptions or perceptions of the challenges.

So while we might use data to help us identify where these areas are, I think pairing that information with an approach to the wider systemic challenges and keeping it community-led and community-guided can really give us a real shot at transforming these opportunities that are available to kids on a national scale.

**Corey Zimmerman:** All right. I’m going to keep this going. Dr. Burghardt, this next question is for you. And you touched on this a bit earlier, but I think this is an opportunity for us to go deeper. And this is a topic that I care a lot about, and I swear I didn’t plant this question. Somebody else actually submitted it. And so the question is, how does the impact of climate change on the built in natural environments shape the foundations of development? And I’m excited to see this question, too, because I think there’s a lot of energy in this space right now. So I’m curious for you to add a little more thoughts from what you did earlier.

**Lindsey Burghardt:** Yeah, thanks, Corey. I appreciate the chance to come back to this topic and to talk more about it. You know that I share this passion with you, but I also think it’s a real opportunity for those of us in the early childhood field who kind of understand how there’s all these different influences, how they affect children’s health and development, to bring to conversations into the same space that maybe aren’t happening as much as they could right now. So climate change and children’s health are two things that I think once we can kind of explain the connections between the two make a lot of sense, but aren’t necessarily intuitive, especially for some of those sectors that I mentioned before, that kind of sit outside of what we consider the traditional scope of the early childhood field. So when we think about how we can tell the story, we’ve discussed today how children’s environments shape their development and health, and we know that environments affect development and that climate change affects each of the environments that we talked about today and that it does so unevenly across these different groups. So climate change, again, is modifying in many, many ways, both the built and the natural environments where children are living. And heat is one example that we discussed, but there are many others. So if we think about the availability of a pure water supply and access to nutritious foods as other examples of things that are impacted by climate change. So if nutritious foods are less available, for example, this can directly affect children’s developing biological systems, especially in the prenatal period and early childhood. So when we take what science has already demonstrated and what we already know about the importance of nutrition or lack thereof in the prenatal period in early childhood, and then we think about how that’s modified and changed by climate, it becomes a really clear and compelling story about why this is a really important issue that’s going to affect–and is affecting today–children’s development and health. And then things like natural disasters and flooding are going to increase the number of families who are displaced from where they live, and that’s going to significantly alter the physical environment that surrounds those children and it’s going to directly affect their developing biological systems as well. And so while climate change is an urgent issue that’s affecting how children are experiencing place, there’s also in this space a really wide solutions space that’s already available to us now at every level from high, broad, reaching goals also to more immediate things that many of us may have a potential to act on fairly quickly. And there’s actually a really big, what we call co-benefit that exist when we look at climate change and early children’s development and health in the same space. Because many of the solutions that we all know about that promote early childhood development, healthy development, are also climate promoting policies and programs like access to green space and decreasing air pollution by decreasing fossil fuel combustion. All of these things are really good for children and they’re really good for our climate. There’s a strong financial case that we can make here too, so there’s good research that’s demonstrated that for every dollar we put into decreasing greenhouse gas emissions, for example, we see up to almost at least $6 gained in child related outcomes. So that’s pretty compelling and maybe something we can take out into the field when we have these conversations.

**Corey Zimmerman:** So much richness there. I really love the like as we think about place matters and then how climate modifies place and why that is such are and see and attention and this idea of co-benefits that there are solutions that are good for the planet and good for helping us reduce the effects as well as are good for children and their outcomes.

So we can spend another hour there. But that’s not what this webinar is for. Okay, let me keep going in questions. Dr. Lightsey-Joseph, this one is for you. This is a theme we’ve been touching on throughout and it’s sort of expanding beyond early childhood. But this one is particularly about how can government agencies and nonprofits reach influential leaders like business to advocate for young children?

**Dominique Lightsey-Joseph:** So I think this in the same vein as Dr. Burghardt’s presentation earlier, at the time of our start together, I think the key to reaching influential leaders like those in business is to first recognize that there is this intersectionality of children’s lives, and so the environments that they are growing up in are influenced by so many sectors outside of just the early childhood arena. So really anybody, everybody can contribute from their respective domains and it’s going to take that kind of a holistic approach—there’s that term again–to you know, to make this change happen. And I think to answer this question more directly, I might use what we do at the Center as an example. So we have the knowledgebase on early child development as it relates to the brain, and we do the work to turn that scientific information into practical action, and we develop partnerships to engage with leaders–some within ECD and some outside–and we address what we bring to the table to their respective contexts. And then that enables those leaders to go out and advocate for and restructure programs and policies that favor children and families within their own unique contexts.

And so from my perspective, I see advocacy being more about more than just persuading others to act. It’s equally about investing that time into empowering one another to act. And I think the aim of government agencies and nonprofits should be to provide open access to our insights and our resources, develop outreach tactics that are content-specific and relevant. And I think we need to partner with leaders with respect for their unique contexts. And when we approach these leaders, we need to make sure we’re not approaching them merely as benefactors of our resources. They are our partners in doing this important work.

**Corey Zimmerman:** I love that, there’s so much–like it’s a two way interaction here—like, what do we bring and how do we engage together in this world. There’s so much. I think it connects actually in some ways to this next question that we have. The next question is for you, Dr. Burghardt, and it’s asking about what are possible changes that schools can make? So now coming at it from kind of a different lens and different set of partners. What are possible changes that schools can make to have a positive impact on healthy development? And maybe there are some particular calling out of early care and education centers to within that. But the question asked first about schools.

**Lindsey Burghardt:** Yeah, it’s a good question and it’s tough because, you know, most schools are already taking on like really substantial, really difficult efforts to meet the basic needs of a lot of students and teachers. So how we think about talking about adding in and layering in things like place-based support in those spaces, I think really has to be done in alignment with the needs and the priorities of people who have been working and are working in that space for a really long time to make schools the health promoting environments that they are. And I think, as in any program or policy domain, it’s really important to call out what Dr. Lightsey-Joseph said, and involving and working with the community who is there and affected and in those schools to understand what the needs are and what their priorities are, whether it’s related to air quality in schools, to high temperatures in classrooms, or to access to clean drinking water. And one resource that I do refer to that I think is useful for some concrete tools is the Environmental Protection Agency has a website they created with Office of Children’s Health Protection and it has really specific recommendations about how to pursue, and different options for pursuing, health promoting environments and specific categories within schools. It even has a list, I think it’s called *Top Ten Ways to Make Your Schools Healthier*, and it has a really specific breakdown of each item in the list that contains action steps and kind of a guide for how to approach these things that can seem very kind of large and overwhelming to tackle on an individual level. And the list has things like, you know, items that are indoor and outdoor air quality, radon, you know, lead in drinking water and how to approach–if you’re interested–you know, each of these different factors. I think we can also think about on green space the issues that we talked about earlier and thinking about if there’s local context or opportunity to bring green space to children’s learning environments even, and especially the early care and education environments too. You know, we know that there’s benefits to having children access green space. And if they’re able to do that locally in their school environment, I think that’s really potentially powerful.

**Corey Zimmerman:** Thank you. And I think there’s so many creative solutions out there right now, too, around how to schools and that outdoor learning environments and what they’re being able to do and it’s a great resource. Thanks for sharing about the EPA one. I think we have time, I think for two, maybe three questions we’ll see here. So the next question, Dr. Lightsey-Joseph, is kind of touching a little bit on what we’ve talked about earlier, but how might we use data better to identify neighborhoods for higher investment and what needs are most prevalent so we know where? I’m curious on your thoughts.

**Dominique Lightsey-Joseph:** One: yes, data critical. It’s a critical role in informing policy decisions and identifying neighborhoods in need for that higher investment. And we’ve been talking about it, as you said, with the COI being one example, which we’ve been discussing. But I want to pick up too on what Dr. Burghardt was saying, in terms of looking at the data on environmental conditions of neighborhoods, I think that has a really rich–it’s a really rich data source that we can tap into as well. And that could include looking at the data on pollution levels, access to green spaces, quality of housing, just to name a few. And we know from these studies, right, that children growing up in these areas with high levels of pollution or limited access to green spaces are more likely to suffer from health related issues like asthma and have lower levels of physical activity. We can also look at access to health resources such as primary care providers, nutritious food options, because those are critical to children’s physical development and overall well-being. And I think there’s also data out there on social determinants of health, such as poverty rates or employment opportunities, that that can also be critical in understanding the challenges faced by neighborhoods. And I think cross-referencing all of these data points on top of one another might be the way that we can identify those neighborhoods that are most in need of investment. A neighborhood that might run low all of those indicators I mentioned would be a prime candidate for some form of or community-based participatory intervention. And I know that’s a mouthful: *community-based participatory intervention*. But I say that because it goes back to what I said earlier. It’s not just about identifying where these neighborhoods are. Any interventions would need to involve and partner with the communities and the local organizations who are already doing this work to really understand those specific needs and strengths within the context of the neighborhood.

**Corey Zimmerman:** I love that. So many pieces that are connecting to what we’ve been talking about. I want to draw out–this question’s for you, Dr. Burghardt–and just one particular dimension actually, of what we’ve been talking about, about where there’s inequity and actually and there’s a lot of data. I was wondering if you could talk about–So this is a question that had come in and it was curious about can you address the unequal exposure to air pollution and talk some more about that?

**Lindsey Burghardt:** Yeah, I think it does. It’s a nice question too. I think it ties together some of the points that Dr. Lightsey-Joseph was just making. I’ll put out there first, you know, we use the term air pollution a lot. Air pollution really means a bunch of different things that are put out into the environment that are harmful for human health and development. But it’s generally a mixture that comes largely from fossil fuel combustion. So we can think about things like cars, busses like manufacturing sites and the amount of air pollution that a child is exposed to depends on where they live. So children who live closer to highways or roadways, closer to transportation depots or near manufacturing or combustion facilities are going to be exposed to higher rates of air pollution than children who live further from these sources. And we’ve discussed throughout the hour that where children live is impacted by historical policies like redlining and modern-day policies that kind of perpetuate where people are able to live and what type of neighborhood opportunity they’re able to access. But in neighborhoods that were previously redlined, and Dr. Lightsey-Joseph explained this very well earlier, there was an inability of the residents who live there to accumulate wealth by getting favorable mortgages or access to high paying jobs. And through that inability to accumulate wealth, they were therefore unable to gain as much political power to oppose the building of things like highways and transportation hubs, manufacturing sites in their neighborhoods. And so many of these air pollution producing factors are more commonly situated in neighborhoods that were previously redlined. And so, as a result, children who live in these areas are exposed to more air pollution than children who live farther from highways, manufacturing sites, transportation terminals. And that translates to a difference in the rates of things like asthma and other diseases that are caused by–or can be influenced by–exposure to air pollution. And we see higher rates of asthma in children who live and previously redlined neighborhoods than children who have access to neighborhoods with lower rates of air pollution. So it’s very clearly influenced by where you live.

**Corey Zimmerman:** There’s some sobering facts in there, just sort of pieces you were sharing and lots of reactions. All right. So last question. I’m going to squeeze one last one in here. This one’s for you, Dr. Lightsey-Joseph. It’s a question around how do you–how do we think about promoting change and do that in a way that keeps in mind people’s cultural norms, whether those are regional or local, but just thinking about how to promote change while keeping in mind those cultural norms.

**Dominique Lightsey-Joseph:** That is such an important question, Corey, for so many reasons. I think was sticking out for me is is important is an important question because there are so many well-meaning institutions that do run the risk of perpetuating a savior complex if their solutions aren’t representative of the communities that we’re trying to serve. And so what is being asked speaks to that importance of respect and understanding that change should never mean dismissing the ways people have lived for generations, but rather promoting change should involve working within those cultural frameworks to improve conditions in ways that really do resonate within the community.

And I think for sustainable change we’ve been talking about, you know, throughout our time today, we need to first understand and respect the context of these communities we’re engaging with. And this can be achieved in a number of ways, whether it’s active listening, engaging in learning opportunities of community-building relationships, collaborating with our communities, our members across different events. It’s really about amplifying those voices and insights rather than imposing our own. I think we also need to recognize that there is not a one-size fits-all approach to problem-solving solutions that work in one context or in one neighborhood might not work in another. So we have to really develop these framework targeted strategies that align with the specific realities of a respective community. And then I think the last thing I would say is it’s really about building capacity and empowering communities too, by providing access to the knowledge that we have. So the goal is to make sure we’re respectful of the cultural aspects in these communities while promoting and supporting programs, conditions. And I think to achieve this, our approach has to be rooted in empathy, respect and most importantly, not most importantly, but also very important is partnership.

**Corey Zimmerman:** What a great note to end on. All right, I’m pulling forward the theme that there are these universal concerns and ways we can use data that really having an approach that’s rooted in empathy and respect and partnership. And with that, thank you. A nd we wish you the best in your continued work supporting children and families.

Thank you for all that you’re doing. I’m really thrilled to be on this journey with you. Thank you.

**Tassy Warren:** The Brain Architects is a product of the Center on the Developing Child at Harvard University. You can find us at developingchild.harvard.edu, where we will post any resources that were discussed in this episode. You can find us on Twitter @HarvardCenter, Facebook at Center Developing Child, and Instagram @DevelopingChildHarvard. Our music is from freemusicarchive.org.

Corey Zimmerman, Chief Program Officer, HCDC — **Place Matters** Sep 20, 2023

Contents

Podcast

Panelists

Additional Resources

Transcript

In June, we hosted a webinar about our latest Working Paper, Place Matters: The Environment We Create Shapes the Foundations of Healthy Development, which examines how a wide range of conditions in the places where children live, grow, play, and learn can shape how children develop. The paper examines the many ways in which the built and natural environment surrounding a child can affect their development, emphasizes how the latest science can help deepen our understanding, and points towards promising opportunities to re-design environments so that all children can grow up in homes and neighborhoods free of hazards and rich with opportunity. Corey Zimmerman, our Chief Program Officer, moderated a discussion around these themes between Dr. Lindsey Burghardt (Chief Science Officer) and Dr. Dominique Lightsey-Joseph (Director of Equity, Diversity, Inclusion and Belonging Strategy) which has been adapted for this episode of the Brain Architects podcast.

Panelists

Tassy Warren, EdM *(Podcast Host)*
Deputy Director and Chief Strategy Officer, Center on the Developing Child at Harvard University

*Corey Zimmerman, EdM (Moderator)*
Chief Program Officer, Center on the Developing Child at Harvard University

Lindsey C. Burghardt, MD, MPH, FAAP
Chief Science Officer, Center on the Developing Child at Harvard University

Dominique Lightsey-Joseph, EdD, EdM
Director of Equity, Diversity, Inclusion and Belonging (EDIB) Strategy, Center on the Developing Child at Harvard University

Additional Resources

Place Matters: The Environment We Create Shapes the Foundations of Healthy Development

Place Matters: An Action Guide for Policy

Place Matters: What Surrounds Us Shapes Us

Child Opportunity Index (COI)

Healthy School Environments – US Environmental Protection Agency

Transcript

**Tassy Warren:** Welcome to The Brain Architects, a podcast from the Center on the Developing Child at Harvard University. I’m Tassy Warren, the Center’s Deputy Director and Chief Strategy Officer. Our Center believes that advances in the science of child development provide a powerful source of new ideas that can improve outcomes for children and their caregivers. By sharing the latest science from the field, we hope to help you make that science actionable and apply it in your work in ways that can increase your impact.

In June, we hosted a webinar about our latest Working Paper, *Place Matters: The Environment We Create Shapes the Foundations of Healthy Development*, which examines how a wide range of conditions in the places where children live, grow, play, and learn can shape how childre

During the webinar, Corey Zimmerman, our Chief Program Officer, moderated a discussion around these themes between Dr. Lindsey Burghardt (Chief Science Officer) and Dr. Dominique Lightsey-Joseph (Director of Equity, Diversity, Inclusion and Belonging Strategy) which we’re happy to share with you all on today’s episode. To access the full Working Paper and related publications, please visit our website at developingchild.harvard.edu.

Now, without further ado, here’s Corey Zimmerman.

**Corey Zimmerman:** Hi, everybody. Welcome. I’m Corey Zimmerman. I’m the Chief Program Officer here at the Center on the Developing Child, and today we’re going to be discussing a paper, the name of it is *Place Matters: The Environment We Create Shapes the Foundation of Healthy Development*. This paper was written by our National Scientific Council on Developing Child and was released earlier this year in March.

We see this webinar as an opportunity to begin to understand a broader frame for thinking about what influences early childhood development, the role that inequity plays in influencing the environment children are in, and third, some early thoughts on new actors or sectors that might be called upon given this broader frame, to be able to join us in our collective effort to improve outcomes for all children and their families.

Okay. With that, let’s get started. It is my pleasure to introduce you to my two colleagues, Dr. Lindsey Burghardt, who is the Chief Science Officer here at the Center on the Developing Child. And then second, Dr. Dominique Lightsey-Joseph, who is our Director of Equity, Diversity, Inclusion and Belonging Strategy here at the Center. Okay. So we’re going to start with a brief overview of the Working Paper, Place Matters from Dr. Burghardt.

**Lindsey Burghardt:** Thank you again, Corey, for that introduction. And thanks to all of you today who took time out of your day to join us and to hear about this new working paper from the National Scientific Council. So the overall focus of this paper is really to broaden the frame of how we’re talking about early childhood development and health. And we’re going to look upstream today and consider all the different factors that influence how kids develop.

So we all experience this continuous influx and flow of influences from our environments, and they begin before birth right in the earliest days of the prenatal period, and they continue throughout our lives. And these influences include the environments of relationships and those environments–that environment of relationships–is just as important as it’s ever been. And children also experience exposures and influences from the physical environment that surrounds them and their caregivers.

So particularly the built and natural environments. And there are a really wide range of conditions in places where children live, learn, play and grow, and all these conditions have the ability to get under the skin and affect the developing brain and also other biological systems. So the immune system, the microbiome and the metabolic system, among others. And beginning before birth, these environmental conditions are shaping how children develop and that, in turn, has the ability to shape their lifelong physical and mental health.

So the built and natural environments and the systemic factors that shape them, like policies that influence where people are able to live and how resources are distributed, interact with each other and they interact with a child’s social environment in really deeply interconnected ways. So this is really what we mean when we say that *place matters*. So every environment is infused with a combination of influences, and these influences can have positive or negative effects on health and development.

And it’s also really important to recognize that level of exposure to risk and access to opportunity for children are not distributed equally. So in 2004, the National Scientific Council on the Developing Child described the effects of early life experiences on the developing brain and its first working paper called *Young Children Develop in an Environment of Relationships*. And over the two decades that followed, this concept really helped to make the case for caregiver-child relationships is sort of the active ingredient in how environments can influence the architecture of the developing brain. So the environment of relationships includes the presence of responsive relationships, the presence of significant stress and adversity, caregiver well-being, social connectedness, community support, faith and cultural traditions. And so more recently as our understanding of how early the early origins of health and disease have advanced, we’ve also really started to understand how early experiences affect multiple developing biological systems beyond the brain. So thinking about the immune system, the metabolic system, the respiratory system, and actually how these systems are interacting with each other and shaping each other as well as the brain. So the environment of relationships again, is just as important as it’s ever been, but these environments–that environment or relationship–it doesn’t exist in isolation; it exists in the context of is much broader environments that include the built and natural environments that surround children.

Exposures from the natural and the built environments also directly shape the development of biological systems inside the body, and they interact with adult-child relationships in a really deeply interconnected way. And these exposures can be positive or negative, and they can include things like air quality and temperature that children breathe, the purity and availability of their water supply, their ability to access safe green space and healthy housing and whether or not they’re exposed to things like environmental toxicants.

So we can take the example of lead is one that many people are familiar with. So lead is one factor in the built environment that connects to safe and healthy housing, connects to clean water supply and to exposure to toxicants. And we’ve known now for a really long time that lead is harmful to children’s development, particularly in the prenatal period and in the earliest years. And lead is still a challenge for a lot of families that today that are still dealing with this and the ongoing situations in Flint and in Jackson speak really clearly to this issue. So the presence of lead in children’s drinking water directly influences and affects their development, and it also shapes the environment that their caregivers are in with the burden and stress that it puts on them. So if there’s lead in the water supply, caregivers often have to seek out alternatives, and it’s typically at a cost, they may need to find in time for additional doctor’s visits and follow up. And all this can cause stress on them, and that can impact their ability to be in a caregiving relationship. So when we look at an environment, one that provides lots of positive influences is more likely to support children’s healthy development, and just as an environment that provides or imposes more negative influences is going to be more likely to result in disease and in poor health outcomes.

So let’s widen the frame one level further, because there’s also these really broad systemic influences that play quite a powerful role in shaping the environments our children live. So these systemic influences are going to shape children’s development directly and they’re going to shape them indirectly through their influence on a child’s environment of relationships and their built and natural environments. And these influences include things like current and historic public policies, systemic racism and intergenerational poverty, among others. So it’s really important to acknowledge that conditions in our built and natural environments are not experienced equally among children. They vary widely and the adverse effects of systemic racism in particular have deep historical roots whose impacts continue to the present day and many present-day policies continue to perpetuate these inequities and their ongoing effects. So there’s an example that we’re going to dive deeper into a little bit later on in redlining. And redlining strongly influences where many children of color live today. And although this practice is now illegal, it has modern day implications like the home appraisal process that continues to shape the environment where young children grow. So increasingly, data that has been provided that shows deep analysis of these differences at the community level. And there’s one that’s provided by the Childhood Opportunity Index, or COI, that’s cited in the working paper. And then we’ll again talk in more detail later on. But the COI demonstrates that in the United States, neighborhood opportunity is highly segregated by race with black and Hispanic children having access to significantly less neighborhood opportunity than white children.

So let’s shift a little bit now to talk about the timing, which is so important. Well, it’s really clear now that it’s not just our genetics and it’s not just our environment, that influence health and development. It’s both. And the influence that our genes and our environment have on our health is also really depends on the time during which we have certain experiences or exposures. And people differ in their sensitivity to influences from their environment at different points throughout their life course. And children’s biological systems in particular have different periods when they’re really sensitive and more sensitive to various environmental exposures and influences, even within the same biological system. So one example is the developing microbiome in our gut, which is very sensitive to influence from the built and natural environments around the time of birth and in the first few years of life.

So in general, the sensitivity of the brain and the other biological systems that we’ve talked about is typically greater in the prenatal period than it is in early childhood. And in general, young children are more sensitive to influences from their environment than older children who are in turn more sensitive than adolescents. And in general, adolescence will be more sensitive than adults to many environmental exposures, and this is really important when we consider the importance and the impact of environmental exposures because of a greater sensitivity in early childhood.

When an exposure happens during a fetal development or in early childhood, it’s going to have a very different impact and potential effects than if that same exposure happened later in life. So when we think about it, actually the first place where a child’s development is affected by place is the intrauterine environment during pregnancy. And during fetal development,immature biological systems are developing a very, extremely fast pace and their development is powerfully shaped by the environment around them. And these systems read the conditions in the womb as predictors of what they’re going to encounter after birth, and they sort of adapt accordingly. And so because these systems are still differentiating, they’re still becoming specialized and figuring out what they’re going to be, the exposures can result in really different outcomes depending on the time during development when they occur.

And we can take a look here at the example of air pollution. So air pollutants can be absorbed in a variety of ways and can cause problems in developing organs and entire organ systems. But the nature and the severity of any potential effects will be different depending on the time during childhood and during development when the exposure occurs.

So, for example, in the prenatal period, exposure to air pollution is associated with things like adverse birth outcomes in prematurity and in low birth weight. And in early childhood exposure to air pollution is a known risk factor for a variety of health effects, including asthma and children who are exposed to higher rates of outdoor air pollution during the first year of life may have diminished functional lung capacity as teenagers. So this is only one example of how the nature and the extent of an exposure that occurs very early in life may not even be fully apparent for years or even decades later.

So let’s talk a little bit about climate. So climate and our changing climate is a really important factor in how children experience place. So we’ve talk today about how environment shape development and health, and we’ve discussed that what surrounds us quite literally shapes us.

So let’s go back to thinking really broadly about what’s surrounding and shaping children in their environment. We talked about the quality and the temperature of the air that they breathe, the purity and availability of their water supply, their ability to access safe and healthy housing, their ability to access nutritious foods and the quality and density of the buildings in their neighborhoods. So climate is modifying the environment where these kids are living in a number of ways, it’s increasing the temperature of the air that’s surrounding them and making that air less pure. And it’s altering the availability and purity of the water supply, and that’s making housing less predictable through displaced men and through increasing energy costs. And it’s making nutritious foods for many children around the world even more scarce.

So climate is changing children’s environment and it’s doing it unequally across groups. Let’s just take a moment to look at heat as an example. So higher temperatures actually lead to a really wide variety of negative outcomes on development and health, including adverse birth outcomes like prematurity and low birth weight. It can have impacts when it’s experienced even in early childhood on academic achievement that can persist for many years later and heat increases the effect of air pollutants which are known to worsen conditions like asthma. So more heat will intensify the effects of air pollution and we’ll see more problems with asthma as a result. And heat is increasing in all children’s environments all over the world, but it’s not increasing equally among communities. So urban areas that already have a higher density of buildings, already are experiencing higher temperatures and have less green space, are going to be more impacted than suburban or rural areas. And the disparities then, in exposure to heat and the intensified effects of air pollution are going to be different depending on where you live and how you’re experiencing our changing climate. And as a result, we’re going to see a disparate impact in the contribution to disparities in rates of diseases like asthma that are already based on where children live.

So we feel that the implications of this really rapidly growing science on this front are clear. Understanding the really powerful effects that the natural and built environments have on the early foundations of health and development is calling for increased attention to really important influences that fall well beyond what we all consider the traditional boundaries of the early childhood field. So this demands that we have to incorporate a more intentional early childhood perspective within the current concerns of things like urban planning, rural development, environmental protection, climate change, anti-discrimination policies, many others. And doing this requires that a much broader range of policy domains must work together to address racist and other discriminatory policies, and we have to achieve greater equity.

All communities have aspects of their built and natural environments that have been designed through intentional decisions made over time, and they can be redesigned to support healthy development. And supporting healthy development is still very much about encouraging and supporting caregiver-child relationships, and it’s also about bringing communities, businesses and governments to work together to assure a supportive and healthy environment for all young children with particular attention to the built and natural environments that are currently falling far short of that goal.

So working together across various policy domains beyond the early childhood field and sector, we can reshape environmental influences with a science informed lens and a shared goal of achieving fairness of place so that all children can grow up in homes and neighborhood that are free of hazards and rich with opportunity.

**Corey Zimmerman:** All right. Thank you, Dr. Burghardt, for that overview of the paper. So many rich insights. I’m actually really excited to dive into this more now with you and Dr. Lightsey-Joseph. Thank you. All right. That was a great overview. And now we’re going to shift into the panel part. So, Dr. Burghardt, this first question is going to be for you.

You mentioned that every environment is infused with a combination of influences and that those influences can impact children in positive and negative ways. And I was wondering, can you give us an example of an environmental influence that has an important impact on children and families? But maybe that’s not something that we typically think of as related to early childhood development.

Like, help us dimensionalize a little bit. What would be an example?

**Lindsey Burghardt:** Yeah, thanks for the question, Corey. So one of my favorite examples here is green space. So our knowledge of the health effects of green space is really increasing as we’re learning more and more of the science behind how green space exposure affects health and development in children. And we have a growing body of science that’s demonstrating that the benefits of access to safe green space around the prenatal period has a variety of benefits and a variety of health outcomes in children.

So later on, benefits to the immune system and benefits really on children’s mental health in a number of ways. And there’s also a really growing and exciting deepening knowledge about how green space can offset some of the more negative environmental exposures that I spoke about, like heat and air pollution. So, you know, as we talked about earlier, children are experiencing the built and natural environment really differently based on where they live. And right now, children’s opportunity to access green space is not equal. But I think that given the robustness and the rapidly growing science in this area, around the really wide range of benefits, this kind of disparity of place is one that really demands greater attention. And in particular when when it pertains to green space. There’s also, I think, really interesting and significant what we call co-benefits when we think about bringing together in conversation and action children’s health and their environments.

So, for example, if we’re decreasing concentrations of air pollution, including through ways like increasing green space, then we can improve the air quality that children are breathing and potentially make problems like asthma less likely to occur. And these types of interventions, as we spoke about earlier, they’re really needed most in communities that have the lowest concentrations of green space right now and also the highest rates of asthma.

**Corey Zimmerman:** So many thoughts. That’ sparking so many different ideas, and that’s an example that’s close to my heart as well. So I really appreciate that one. Dr. Lightsey-Joseph, I want to bring you in. I want to ask about this concept of fairness of place that Dr. Burghardt mentioned. And I was curious if you could tell us a little bit more about the social history that’s led to this unequal distribution of environmental influences.

**Dominique Lightsey-Joseph:** Sure. Thank you for having me today, Corey. And good to see you, Dr. Burghardt. Yeah, sure. I can answer that question for you. I think in understanding the unequal distribution of environmental influences, we have to name the historical practice of redlining in the U.S., which is a policy in the thirties by the Federal Home Owners loan Corporation, in which neighborhoods, particularly those that were populated by Black residents, were color-coded based on perceived financial risks or real estate investments. And those areas that were color coded red were seen as the riskiest and the most undesirable neighborhoods. And this process resulted in these communities being systematically denied vital services and opportunities for economic advancement in this country. And despite the Civil Rights Act of 1964, the Fair Housing Act of 1968, which officially outlawed redlining, the economic disparities that resulted from these discriminatory practices persist.

An example of this would be, there was a 2020 report that was conducted by the National Community Reinvestment Coalition, which found that 74% of neighborhoods initially redlined in the ‘30s remain economically disadvantaged today. And this is characterized by lowered home values, higher rates of poverty and things of that nature. And I’d be remiss if I didn’t say that the impact of redlining, it doesn’t just end at financial implications. They stretch deep into the health and environmental qualities, too. And as Dr. Burghardt mentioned earlier, we can take Flint, Michigan, for instance, which is discussed in the paper, and the city’s water crisis, which subjected a predominantly Black community to dangerous levels of lead exposure has roots in the long term consequences of redlining. It was that facilitated segregation of that city all of those years ago that resulted in this higher concentration of poverty and exposure to these environmental hazards.

In comparison to, you know, other neighbor of neighboring areas in the state. So to really answer that question, Corey, I think the influence of redlining has pervasively shaped the socioeconomic and environmental contours of our neighborhoods, and consequently, it has defined the environments where kids are raised and the opportunities or lack thereof, they have to grow up healthy.

**Corey Zimmerman:** Thank you for sharing that. And I want to pull it forward now and ask you a follow up question, Dr. Lightsey-Joseph, around the Child Opportunity Index that Dr. Burghardt mentioned earlier and is in the paper, I think that’s a way of kind of quantifying also some of the ongoing pieces that you’re talking about. So, the Index lays bare the many ways in which disparity of place continue to exist across communities today. And I was curious about what this powerful dataset has to offer us as we think about how to create health promoting environments for all children. So I was curious your thoughts about that.

**Dominique Lightsey-Joseph:** Yes, the Child Opportunity Index, or the COI, it really does lay bare the fact that these disparities across communities exist. And I think it quantifies it to your point in a way that there’s that felt anecdotal knowledge of it, but to see it in the form of the COI, I think is invaluable. So it’s a tool that really does help us to understand these disparities across communities. And it uses a range of indicators, as Dr. Burghardt said earlier, within the educational, health and environmental domains, that really examines the conditions that are vital for children’s healthy development across neighborhoods in the U.S. And one of the most significant insights by the COI is that the substantial disparities in child opportunity are often racialized in nature between different neighborhoods, cities and regions. And for example, in the 100 largest U.S. metropolitan areas , a turn of the decade analysis of the COI, found that Black children are 7.6 times more likely than white children to live in neighborhoods with substantially lower opportunity to grow up healthy. And Latine children are about 5.3 times more likely to live in neighborhoods with lower opportunity. And so the COI beyond that, right, it allows us to identify these environmental disparities across neighborhoods within the same city as well.

So as you both know, I’m a transplant from California, has deep roots out there. And there’s a neighborhood in West Fresno that has consistently been ranked as one of the neighborhoods most burdened by population in the state of California. And subsequently it ranks really low on the COI as well, due to the high air pollution and the limited green spaces. But in contrast to that, neighborhoods with a higher ranking within the same city, literally across the tracks, right, often have less pollution and more parks and playgrounds. And I think the data that is offered by the COI is really this powerful resource, right? That not only allows us to identify these spaces, but it also allows us to address these disparities so that they can inform where these targeted interventions and resource allocations in neighborhoods that require more attention to infrastructure and investment is necessary.

And I would say that it’s important to note that neighborhoods in Flint, like we mentioned a few times and Fresno, are still impacted by being redlined all those years ago, the environments in which our kids live, grow, play and learn, they were not fixed, and these outcomes are not inevitable. They are the products of decisions that have been made over time and they can be reimagined and restructured.

And so I think it’s the responsibility of us, like researchers, government officials, advocacy groups, policymakers, just to name a few. But it’s our responsibility to really work collectively with community leaders to invest and restructure these built environments. I think we have to work together. That’s the only way that we’re going to be able to support healthy development for kids, regardless of their race, their ethnicity, or their socioeconomic status.

**Corey Zimmerman:** I love that. This is a product of decisions that have been made over time and we have an opportunity to redesign. And I find such power in that. There’s such agency actually in that this is changeable. We can do this differently. And so, Dr. Burghardt, I want to actually ask you, with that lens in mind, there is an opportunity to redesign neighborhoods in communities to support healthy development. And I was curious, can you say more about your you had a last point in your presentation that was around the extended role for actors in other sectors outside the traditional early childhood field. So I wondered if you could expand on that a bit.

**Lindsey Burghardt:** Yes, absolutely. Thanks, Corey. And I think I’m going to +1 what Dr. Lightsey-Joseph just said. And that I think for me, like the thing about the COI that really stands out is her point that she made about the geographic proximity and the starkness of difference. Like I feel that we can’t emphasize that point enough. If you look at cities like Milwaukee, I think is a good example of one where literally adjacent to each other some of the highest levels of opportunity in the state and the lowest opportunities in the country right next to each other. And I think that it just highlights that that intentional decision making of where to allocate and distribute resources is a really stark example. And if you check out the, if anyone’s interested, you can go to the website actually and learn a lot about the COI in your particular area. And you can it kind of translates, I think, to what we experience and know from our own experiences. So I’m not adding anything more eloquent than what Dr. Lightsey-Joseph said, but I think just a really, really valuable tool when we’re thinking about where we can invest and where we can focus on health promoting environments.

So, to get back to your question, Corey you know, in the beginning of our time together, I talked about broadening this list of policies that we’re thinking about as affecting the foundations of early childhood development and lifelong physical health and mental health. And the list I gave is by no means exclusive. But I think that looking at things like environmental protection, climate change policies, in particular, mitigation, housing, urban planning, zoning requirements, which helps to redress things like redlining, economic development, criminal legal reform and the criminal justice system and anti-discrimination policies. We can bring decision makers from all these different sectors to the table, even though they haven’t traditionally considered their work perhaps as impacting childhood development and lifelong health. We can again think about how all of the decisions we’re making–literally, every one–is affecting childhood health and development, and I think many people who are here today are already doing that in their work. But it’s thinking about who else can we bring in and who else can we share this messaging with, because we can make a child assessment, you know, impact assessment in every policy and program that we do. We should be looking at every single decision we make, even the ones that on the surface you think, well, there’s no way that that could affect children. Most people here could explain how it, in fact, would. So everything from minimum wage laws to zoning laws, they will affect children’s development, they will shape those environments and those environments will shape children’s health and development. And we really need to demand that kids are considered and that the impact on them is considered when all of these decisions are made.

**Corey Zimmerman:** Okay, so we have reached the point in the session, I feel like I should readjust my chair somehow, like we’re going to switch into the Q&A session now. So we’re going to switch over from the questions that we have sort of prepared and now respond to questions that have come in through the through our social media channels, through registration links. So a big thank you to Dr. Lightsey-Joseph and Dr. Burghardt for your responses so far and for your upcoming now next set of thoughtful responses also. Alright, the first one I’m going to start with is this one. It’s for you, Dr. Lightsey-Joseph, given what we’ve been talking about. And the question is, can you talk more about how and connect this to how does this align with protective factors and resiliency? Curious your thoughts about that.

**Dominique Lightsey-Joseph:** I love that question. So in these neighborhoods, right, there, there are these strong community-based organizations and social support structures that already exist, and they have long been providing emotional support, the practical help, the collective strength and resilience, which in turn nurtures the well-being and empowerment for the kids and families residing in these respective communities. And I think acknowledging these protective factors is important because they are invaluable for sure. I also think it doesn’t negate the need to confront and address the systemic injustices that have resulted in such disparities and made resilience so necessary in the first place. So these protective factors are present and they, to me, serve as a really good starting point from which we might begin to foster a healthier and more equitable environments for these kids. And so I think, to Dr. Burghardt’s point earlier about, you know, approaching this from a holistic perspective and looking at all of these other sectors, that we have to come together and work collectively to restructure these environments, but the approach in how we do that should be guided by the insights and the experiences of those within the communities and not merely outside speculations, assumptions or perceptions of the challenges.

So while we might use data to help us identify where these areas are, I think pairing that information with an approach to the wider systemic challenges and keeping it community-led and community-guided can really give us a real shot at transforming these opportunities that are available to kids on a national scale.

**Corey Zimmerman:** All right. I’m going to keep this going. Dr. Burghardt, this next question is for you. And you touched on this a bit earlier, but I think this is an opportunity for us to go deeper. And this is a topic that I care a lot about, and I swear I didn’t plant this question. Somebody else actually submitted it. And so the question is, how does the impact of climate change on the built in natural environments shape the foundations of development? And I’m excited to see this question, too, because I think there’s a lot of energy in this space right now. So I’m curious for you to add a little more thoughts from what you did earlier.

**Lindsey Burghardt:** Yeah, thanks, Corey. I appreciate the chance to come back to this topic and to talk more about it. You know that I share this passion with you, but I also think it’s a real opportunity for those of us in the early childhood field who kind of understand how there’s all these different influences, how they affect children’s health and development, to bring to conversations into the same space that maybe aren’t happening as much as they could right now. So climate change and children’s health are two things that I think once we can kind of explain the connections between the two make a lot of sense, but aren’t necessarily intuitive, especially for some of those sectors that I mentioned before, that kind of sit outside of what we consider the traditional scope of the early childhood field. So when we think about how we can tell the story, we’ve discussed today how children’s environments shape their development and health, and we know that environments affect development and that climate change affects each of the environments that we talked about today and that it does so unevenly across these different groups. So climate change, again, is modifying in many, many ways, both the built and the natural environments where children are living. And heat is one example that we discussed, but there are many others. So if we think about the availability of a pure water supply and access to nutritious foods as other examples of things that are impacted by climate change. So if nutritious foods are less available, for example, this can directly affect children’s developing biological systems, especially in the prenatal period and early childhood. So when we take what science has already demonstrated and what we already know about the importance of nutrition or lack thereof in the prenatal period in early childhood, and then we think about how that’s modified and changed by climate, it becomes a really clear and compelling story about why this is a really important issue that’s going to affect–and is affecting today–children’s development and health. And then things like natural disasters and flooding are going to increase the number of families who are displaced from where they live, and that’s going to significantly alter the physical environment that surrounds those children and it’s going to directly affect their developing biological systems as well. And so while climate change is an urgent issue that’s affecting how children are experiencing place, there’s also in this space a really wide solutions space that’s already available to us now at every level from high, broad, reaching goals also to more immediate things that many of us may have a potential to act on fairly quickly. And there’s actually a really big, what we call co-benefit that exist when we look at climate change and early children’s development and health in the same space. Because many of the solutions that we all know about that promote early childhood development, healthy development, are also climate promoting policies and programs like access to green space and decreasing air pollution by decreasing fossil fuel combustion. All of these things are really good for children and they’re really good for our climate. There’s a strong financial case that we can make here too, so there’s good research that’s demonstrated that for every dollar we put into decreasing greenhouse gas emissions, for example, we see up to almost at least $6 gained in child related outcomes. So that’s pretty compelling and maybe something we can take out into the field when we have these conversations.

**Corey Zimmerman:** So much richness there. I really love the like as we think about place matters and then how climate modifies place and why that is such are and see and attention and this idea of co-benefits that there are solutions that are good for the planet and good for helping us reduce the effects as well as are good for children and their outcomes.

So we can spend another hour there. But that’s not what this webinar is for. Okay, let me keep going in questions. Dr. Lightsey-Joseph, this one is for you. This is a theme we’ve been touching on throughout and it’s sort of expanding beyond early childhood. But this one is particularly about how can government agencies and nonprofits reach influential leaders like business to advocate for young children?

**Dominique Lightsey-Joseph:** So I think this in the same vein as Dr. Burghardt’s presentation earlier, at the time of our start together, I think the key to reaching influential leaders like those in business is to first recognize that there is this intersectionality of children’s lives, and so the environments that they are growing up in are influenced by so many sectors outside of just the early childhood arena. So really anybody, everybody can contribute from their respective domains and it’s going to take that kind of a holistic approach—there’s that term again–to you know, to make this change happen. And I think to answer this question more directly, I might use what we do at the Center as an example. So we have the knowledgebase on early child development as it relates to the brain, and we do the work to turn that scientific information into practical action, and we develop partnerships to engage with leaders–some within ECD and some outside–and we address what we bring to the table to their respective contexts. And then that enables those leaders to go out and advocate for and restructure programs and policies that favor children and families within their own unique contexts.

And so from my perspective, I see advocacy being more about more than just persuading others to act. It’s equally about investing that time into empowering one another to act. And I think the aim of government agencies and nonprofits should be to provide open access to our insights and our resources, develop outreach tactics that are content-specific and relevant. And I think we need to partner with leaders with respect for their unique contexts. And when we approach these leaders, we need to make sure we’re not approaching them merely as benefactors of our resources. They are our partners in doing this important work.

**Corey Zimmerman:** I love that, there’s so much–like it’s a two way interaction here—like, what do we bring and how do we engage together in this world. There’s so much. I think it connects actually in some ways to this next question that we have. The next question is for you, Dr. Burghardt, and it’s asking about what are possible changes that schools can make? So now coming at it from kind of a different lens and different set of partners. What are possible changes that schools can make to have a positive impact on healthy development? And maybe there are some particular calling out of early care and education centers to within that. But the question asked first about schools.

**Lindsey Burghardt:** Yeah, it’s a good question and it’s tough because, you know, most schools are already taking on like really substantial, really difficult efforts to meet the basic needs of a lot of students and teachers. So how we think about talking about adding in and layering in things like place-based support in those spaces, I think really has to be done in alignment with the needs and the priorities of people who have been working and are working in that space for a really long time to make schools the health promoting environments that they are. And I think, as in any program or policy domain, it’s really important to call out what Dr. Lightsey-Joseph said, and involving and working with the community who is there and affected and in those schools to understand what the needs are and what their priorities are, whether it’s related to air quality in schools, to high temperatures in classrooms, or to access to clean drinking water. And one resource that I do refer to that I think is useful for some concrete tools is the Environmental Protection Agency has a website they created with Office of Children’s Health Protection and it has really specific recommendations about how to pursue, and different options for pursuing, health promoting environments and specific categories within schools. It even has a list, I think it’s called *Top Ten Ways to Make Your Schools Healthier*, and it has a really specific breakdown of each item in the list that contains action steps and kind of a guide for how to approach these things that can seem very kind of large and overwhelming to tackle on an individual level. And the list has things like, you know, items that are indoor and outdoor air quality, radon, you know, lead in drinking water and how to approach–if you’re interested–you know, each of these different factors. I think we can also think about on green space the issues that we talked about earlier and thinking about if there’s local context or opportunity to bring green space to children’s learning environments even, and especially the early care and education environments too. You know, we know that there’s benefits to having children access green space. And if they’re able to do that locally in their school environment, I think that’s really potentially powerful.

**Corey Zimmerman:** Thank you. And I think there’s so many creative solutions out there right now, too, around how to schools and that outdoor learning environments and what they’re being able to do and it’s a great resource. Thanks for sharing about the EPA one. I think we have time, I think for two, maybe three questions we’ll see here. So the next question, Dr. Lightsey-Joseph, is kind of touching a little bit on what we’ve talked about earlier, but how might we use data better to identify neighborhoods for higher investment and what needs are most prevalent so we know where? I’m curious on your thoughts.

**Dominique Lightsey-Joseph:** One: yes, data critical. It’s a critical role in informing policy decisions and identifying neighborhoods in need for that higher investment. And we’ve been talking about it, as you said, with the COI being one example, which we’ve been discussing. But I want to pick up too on what Dr. Burghardt was saying, in terms of looking at the data on environmental conditions of neighborhoods, I think that has a really rich–it’s a really rich data source that we can tap into as well. And that could include looking at the data on pollution levels, access to green spaces, quality of housing, just to name a few. And we know from these studies, right, that children growing up in these areas with high levels of pollution or limited access to green spaces are more likely to suffer from health related issues like asthma and have lower levels of physical activity. We can also look at access to health resources such as primary care providers, nutritious food options, because those are critical to children’s physical development and overall well-being. And I think there’s also data out there on social determinants of health, such as poverty rates or employment opportunities, that that can also be critical in understanding the challenges faced by neighborhoods. And I think cross-referencing all of these data points on top of one another might be the way that we can identify those neighborhoods that are most in need of investment. A neighborhood that might run low all of those indicators I mentioned would be a prime candidate for some form of or community-based participatory intervention. And I know that’s a mouthful: *community-based participatory intervention*. But I say that because it goes back to what I said earlier. It’s not just about identifying where these neighborhoods are. Any interventions would need to involve and partner with the communities and the local organizations who are already doing this work to really understand those specific needs and strengths within the context of the neighborhood.

**Corey Zimmerman:** I love that. So many pieces that are connecting to what we’ve been talking about. I want to draw out–this question’s for you, Dr. Burghardt–and just one particular dimension actually, of what we’ve been talking about, about where there’s inequity and actually and there’s a lot of data. I was wondering if you could talk about–So this is a question that had come in and it was curious about can you address the unequal exposure to air pollution and talk some more about that?

**Lindsey Burghardt:** Yeah, I think it does. It’s a nice question too. I think it ties together some of the points that Dr. Lightsey-Joseph was just making. I’ll put out there first, you know, we use the term air pollution a lot. Air pollution really means a bunch of different things that are put out into the environment that are harmful for human health and development. But it’s generally a mixture that comes largely from fossil fuel combustion. So we can think about things like cars, busses like manufacturing sites and the amount of air pollution that a child is exposed to depends on where they live. So children who live closer to highways or roadways, closer to transportation depots or near manufacturing or combustion facilities are going to be exposed to higher rates of air pollution than children who live further from these sources. And we’ve discussed throughout the hour that where children live is impacted by historical policies like redlining and modern-day policies that kind of perpetuate where people are able to live and what type of neighborhood opportunity they’re able to access. But in neighborhoods that were previously redlined, and Dr. Lightsey-Joseph explained this very well earlier, there was an inability of the residents who live there to accumulate wealth by getting favorable mortgages or access to high paying jobs. And through that inability to accumulate wealth, they were therefore unable to gain as much political power to oppose the building of things like highways and transportation hubs, manufacturing sites in their neighborhoods. And so many of these air pollution producing factors are more commonly situated in neighborhoods that were previously redlined. And so, as a result, children who live in these areas are exposed to more air pollution than children who live farther from highways, manufacturing sites, transportation terminals. And that translates to a difference in the rates of things like asthma and other diseases that are caused by–or can be influenced by–exposure to air pollution. And we see higher rates of asthma in children who live and previously redlined neighborhoods than children who have access to neighborhoods with lower rates of air pollution. So it’s very clearly influenced by where you live.

**Corey Zimmerman:** There’s some sobering facts in there, just sort of pieces you were sharing and lots of reactions. All right. So last question. I’m going to squeeze one last one in here. This one’s for you, Dr. Lightsey-Joseph. It’s a question around how do you–how do we think about promoting change and do that in a way that keeps in mind people’s cultural norms, whether those are regional or local, but just thinking about how to promote change while keeping in mind those cultural norms.

**Dominique Lightsey-Joseph:** That is such an important question, Corey, for so many reasons. I think was sticking out for me is is important is an important question because there are so many well-meaning institutions that do run the risk of perpetuating a savior complex if their solutions aren’t representative of the communities that we’re trying to serve. And so what is being asked speaks to that importance of respect and understanding that change should never mean dismissing the ways people have lived for generations, but rather promoting change should involve working within those cultural frameworks to improve conditions in ways that really do resonate within the community.

And I think for sustainable change we’ve been talking about, you know, throughout our time today, we need to first understand and respect the context of these communities we’re engaging with. And this can be achieved in a number of ways, whether it’s active listening, engaging in learning opportunities of community-building relationships, collaborating with our communities, our members across different events. It’s really about amplifying those voices and insights rather than imposing our own. I think we also need to recognize that there is not a one-size fits-all approach to problem-solving solutions that work in one context or in one neighborhood might not work in another. So we have to really develop these framework targeted strategies that align with the specific realities of a respective community. And then I think the last thing I would say is it’s really about building capacity and empowering communities too, by providing access to the knowledge that we have. So the goal is to make sure we’re respectful of the cultural aspects in these communities while promoting and supporting programs, conditions. And I think to achieve this, our approach has to be rooted in empathy, respect and most importantly, not most importantly, but also very important is partnership.

**Corey Zimmerman:** What a great note to end on. All right, I’m pulling forward the theme that there are these universal concerns and ways we can use data that really having an approach that’s rooted in empathy and respect and partnership. And with that, thank you. A nd we wish you the best in your continued work supporting children and families.

Thank you for all that you’re doing. I’m really thrilled to be on this journey with you. Thank you.

**Tassy Warren:** The Brain Architects is a product of the Center on the Developing Child at Harvard University. You can find us at developingchild.harvard.edu, where we will post any resources that were discussed in this episode. You can find us on Twitter @HarvardCenter, Facebook at Center Developing Child, and Instagram @DevelopingChildHarvard. Our music is from freemusicarchive.org.

**IDEAS Framework Toolkit** Jul 11, 2023

Contents

Podcast

Panelists

Additional Resources

Transcript

In April, we hosted a webinar about the recently released IDEAS Impact Framework Toolkit—a free online resource designed to help innovators in the field of early childhood build improved programs and products that are positioned to achieve greater impact in their communities. During the webinar, we provided an overview of the site and had the opportunity to hear from two organizations in the field about how they leveraged the toolkit and its resources to shape their work: Valley Settlement and Raising a Reader. This episode of the Brain Architects podcast features highlights from the webinar. If you’re interested in hearing a full walk through of the toolkit by the Director of our Pediatric Innovation Initiative, Dr. Melanie Berry, please head over to our YouTube channel to view the full webinar recording.

Panelists

Aeshna Badruzzaman, PhD *(Moderator)*
Senior Project Manager for Instructional Design, Center on the Developing Child at Harvard University

Melanie Berry, PsyD
Director of the Pediatric Innovation Initiative, Center on the Developing Child at Harvard University

Sally Boughton, MNM
Director of Development & Communications at Valley Settlement

Andres Garcia Lopez, EdM, MBA
Senior Project Manager, Center on the Developing Child at Harvard University

Karla Reyes
Program Manager of El Busesito Mobile Preschool Program at Valley Settlement

Michelle Sioson Hyman
Senior Vice President, Programs and Partnerships at Raising a Reader

Corey Zimmerman, EdM *(Podcast Host)*
Chief Program Officer, Center on the Developing Child at Harvard University

Additional Resources

IDEAS Framework Toolkit

Valley Settlement

Raising a Reader

Transcript

**Corey Zimmerman:** Welcome to the Brain Architects, a podcast from the Center on the Developing Child at Harvard University. I’m Corey Zimmerman, the Center’s Chief Program Officer. Our Center believes that advances in the science of child development provide a powerful source of new ideas that can improve outcomes for children and their caregivers. By sharing the latest science from the field, we hope to help you make that science actionable, and apply it in your work in ways that can increase your impact.

With that goal in mind, the Center recently released the IDEAS Impact Framework Toolkit—a free online resource designed to help innovators in the field of early childhood build improved programs and products that are positioned to achieve greater impact in their communities. The Toolkit is self-guided, self-paced, and provides a structured and flexible approach that facilitates program development, evaluation, and fast-cycle iteration, including resources to help teams develop and investigate a clear and precise Theory of Change.

In April, we hosted a webinar about the toolkit, where we provided an overview of the site and had the opportunity to hear from teams at several organizations in the field about how they leveraged the toolkit and its resources to shape their work. We’re excited to share those discussions with you here on this episode of the Brain Architects podcast. If you’re interested in hearing a full walk through of the toolkit, by the Director of our Pediatric Innovation Initiative, Dr. Melanie Berry, please head over to our YouTube channel to view the full webinar recording. You’ll also hear from Dr. Melanie Berry during the Q&A portion.

The full IDEAS toolkit we’ll be talking about today can be found at ideas.developingchild.harvard.edu. And now, without further ado, here’s Dr. Aeshna Badruzzaman, the Center’s Senior Project Manager for Instructional Design and the moderator for our panel discussion.

**Aeshna Badruzzaman:** Hello, everyone. Welcome. My name is Dr. Aeshna Badruzzaman. I am a Senior Project Manager for Instructional Design at the Center on the Developing Child at Harvard University or HCDC, and I’m part of the development team of the IDEAS Impact Framework Toolkit. And today, I’ll be your host. So, you may hear me come off mute, and help guide presenters, and I’ll be facilitating our question and answer period. So, we are so pleased to be talking to you today about this resource. The IDEAS Impact Framework was born out of more than a decade of the Frontiers of Innovation Initiative or FOI. And some of you may have been partners in that effort. So, while our team no longer offers live training on the framework, we are so excited to be introducing it to you as a free open access resource. And we really hope that this format is going to help make IDEAS accessible to innovators in the field of early childhood development moving forward. The framework was developed in partnership with the University of Washington College of Education, and the University of Oregon Center for Translational Neuroscience. With support from the Gates Foundation, The Lego Foundation, Porticus and the Hemera Foundation. I encourage you to check out our history and acknowledgments page of the toolkit for more information about our various collaborations and supporters throughout time as well.

Now I’ll go ahead and introduce our first set of speakers from folks at Valley Settlement. We have with us Karla Reyes, who is the program manager of the El Busesito mobile preschool program at Valley Settlement, which is a nonprofit that works to create opportunities for the Latino community in the Aspen to Parachute region of Colorado. Karla joined Valley Settlement in March 2015, as a preschool teacher for El Busesito until June 2021 when she took on a leadership role. And we also have Sally Boughton who is the Director of Development and Communications at Valley Settlement, a nonprofit again, serving the rural Aspen to Parachute region Colorado with six to generation programs designed by and for local Latina immigrant families. And Sally has been with Valley Settlement for over five years and began managing the organization’s evaluation function in 2021. Thank you so much Karla and Sally look forward to hearing from you.

**Karla Reyes:** Good afternoon, everyone. Thank you for inviting us to share our work with you all and how we have used the framework. I’m going to talk a little bit about it, we’ll see the program and how I kind of started. The idea that it will succeed though began in 2011. We had two bilingual and bicultural community organizers, who met one on one with about 300 families from the Aspen to Parachute region of Colorado. And they learned about their lives and the barriers that they faced within our community. One of the findings from the initial listening tour was that only 1% of Latino children in our community were enrolled in preschool. We also learned that three of the biggest barriers for families to participate in preschool programs were language, cost and transportation resulting in lack of access. Now we have all this information. And we started thinking creatively of different ways that we could bring more access to preschool education to our community. I have also seen those one of the first two generation programs that we launched in Valley Settlement to address the needs of preschool education. And throughout the years Valley Settlement has continued to learn, evolve and co-design programming to respond to community needs. Now, our program has four mobile preschool buses that have been retrofitted into small preschool classrooms. We have two teachers on the bus, and we serve eight children at a time, we provide families with about five to 10 hours of free preschool education. We have about 96 children that we serve annually between 40 to 50 children graduating at the end of the school year and moving on to kindergarten. And currently right now we serve different five different neighborhoods within our community. And we strive to build close relationships with families. So, our program really is designed to meet families at where they are, are at and start breaking down those barriers. We host family nights; we have home visits with our families. We have parent teacher conferences; we have different ways that families can volunteer within our program. We provide a lot of materials for families to use that home so that they can do home activities and homework packets with their students. And we really try to engage with the families. So, each one of our teachers speak Spanish, is bilingual and bicultural. So, this really allows that bond and that relationship to build with each one of our families. I’m going to hand it off to Sally Boughton, and she’s going to talk a little bit more about how we’ve used the framework.

**Sally Boughton:** Thanks, Karla. So, several years ago, we started working with the team at Frontiers of Innovation to refine and evolve our evaluation practices. This work included creating theories of change for each of our programs, researching and recommending observational assessments to measure participant progress towards our program targets and outcomes, and creating implementation guides for our programs to detail the critical components of our work and ensure that future staff can implement programs with fidelity, while still continuing to listen to and evolve alongside families. Since the early days of our programming, Valley Settlement has invested in evaluation to measure understand and strengthen the changes that children and families create in their lives through our programming. Working with the team at FOI really brought this to the next level. Over the last few years, we’ve been working to be more inclusive and participatory in our evaluation process. So now our entire staff gathers for three days every summer, in what I call an evaluation retreat, where we review our annual program data as a team and then try to answer those questions ¿qué? ¿por qué? ¿Y ahora qué? or as the toolkit outlines: What does the data say? Why? Why might the data say this? Or what does that mean? And finally, now what do we do to tweak or change in our evaluation approach or in our programming, based on what we see in the data? Our teams then create action plans to outline those changes that they want to make. We’re usually tweaking one or more program components for the upcoming year. On day two of the retreat, teams then go in and refine and evolve their theories of change. So, we really see that theory of change as a living document that breathes and grows alongside our programming. They identify what targets and outcomes they’re interested in measuring for the coming program year. And then after that evaluation retreat, we work together with our evaluation consultant to refine our measurement tools. And then I always try to call out and highlight that I am in the minority of Valley Settlements. Our staff are largely of the community that we work with. Most of our staff are immigrants or children of immigrants, many have grown up in this community, or immigrated to the community as adults with young children. And so, they have those shared lived experiences with the participants in our programs. And many of our staff have actually been former participants in our programs. Having the entire team participate in this process is incredibly valuable. It really places the experts in the work our staff in the evaluator seat, and we gained so much more by having that inclusive, participatory process. And we’re really so grateful to have our work shared in the online toolkit because, you know, I am not an expert in the IDEAS framework by any means. And that’s kind of the whole point is that it’s very usable, you can go in, you can click through this toolkit, you can see how it all is structured and works. And it just makes for a really kind of manageable, useful process that you can engage in. Thanks so much.

**Aeshna:** Thank you, Karla, and Sally, really appreciate you taking the time to share your experiences with us. Now we’ll hear from folks from Raising a Reader. So Raising A Reader supports families to build, practice and grow reading routines at home. Their award-winning evidence-based program helps caring adults set their children up for success by creating shared reading routines, fostering social emotional learning, healthy family relationships and learning skills needed to thrive in school and beyond. And first, we’ll hear from Michelle Sioson Hyman, who is Senior Vice President, program and partnerships. And in her role, Michelle is responsible for overseeing program development, growth and impact. And then we’ll hear from Andres Garcia Lopez, who is a Senior Project Manager at the Center on the Developing Child. And in his role, he’s coached many early childhood development entrepreneurs, including Raising a Reader in developing strategies to maintain their science-based impact, while scaling their ventures. Welcome Michelle and Andreas.

**Michelle Sioson Hyman:** Thank you so much for having me. I’ll start with a brief overview of Raising a Reader and how we’ve used the framework and then fundraising, engaging some conversation. So Raising a Reader is a national family engagement and early literacy organization through our network of affiliates and partners across 34 states and both rural and urban communities. We engage and support parents and the other caring adults in children’s lives help strengthen the bonds with their children, while building critical early reading and social emotional skills. So along with our award winning multicultural and multilingual book collection, we provide easy to use materials and guides that are really designed to make the most of that shared reading time in the home. So our work really does begin though, with partnering with local agencies who become members of our affiliate network, a community of practice in which we can share best practices and build connections. And we provide professional development, technical assistance and capacity building support to this network of affiliates and partners, who really work across the intersection of systems, supporting children and families at the various points throughout their educational and developmental journey. So that’s, you know, in ECD, K, 12, Health and Human Services. And we’re really able to meet families in the spaces and places where they are involved in how the framework has really impacted our work was that we were introduced to Andres. And the framework is a really critical inflection point in our history. So we’re over 23 years old and Raising a Reader had 39 independent evaluation that prove the success of our Classic Red Bookbag Program and its impact on improving and sustaining home literacy environments. But one thing that we realized through our work with Andres was that there were critical aspects to our work that we weren’t capturing in our theory of change. And just maybe I’ll stop there, and then we can chat. Does that work?

**Andres Garcia Lopez:** Sounds good. That works. Michelle. Thanks so much for that overview. And I’m so excited to be part of this panel, and it’s an honor to share it with you, Michelle, and with the Valley Settlement team. So I’ll just add a few things. I was working with Michelle as part of a fellowship that the Center partners with the Promise Venture Studio. And as was mentioned before, the theory of change on the IDEAS framework really helps you think about what are the key ingredients that my organization in my program works on or provides to families and

or maybe two partners that get to the targets that that move the needle towards my outcomes. One thing that was different about Raising a Reader was that they weren’t with partners. So I wanted to mention that sometimes the IDEAS framework can be, and the theory of change could be flexible, and adaptable to meet your needs. Originally, there are three columns in the theory of change. But we’re working with Michelle, we thought we should have an extra column because they wanted to look at how working with partners and affiliate organizations, what their strategy is that was doing racing, a reader was getting into the targets in partners and affiliates and how that was getting to the outcomes with families. And that was a key component on identifying precisely the actions that get to the targets and the outcomes. And I’ll pause there so that Michelle can share more about the specifics of what some of those strategies were and how that helped the organization.

**Michelle:** Thanks, Andres. Yeah, so one of the things including that additional column that Andres was talking about, it really helped us think through, how are we really building that educator capacity? And how are we really providing professional development around early childhood development. And another aspect to it is that we knew we did it all the time. And we had stories about how we did it all the time. But using the theory of change, the framework to really make it much more precise, is really helping us think through how we are doing it. And so, it also helped us think about how our program is impacting early relational health through strengthening healthy family bonds. And so, it really has made us to be better poised to effectively test and evaluate how we are doing this work and what isn’t what is not working.

**Andres:** Thank you, Michelle. And one comment that I add, as we have about 90% of the participants that are now in the webinar are new to the to the framework, sometimes you may use the framework as a program developer, or somebody who’s implementing a program like your shell, but you could also use it to help other organizations like the way I have used it as part of the center in the developing child, or as promised venture studio has also used it with social entrepreneurs in their organization, the framework is really helpful in helping you think through your impact strategy. I mentioned a brief comment, if you’re familiar with other frameworks that innovators use, like the lean startup or business model canvas or other ones, it these helps you think through in a very clear way, in a simplified way, what are your strategies and how I am I get into the outcomes. And because of its it’s simple, and it can fit in one page, it also facilitates communication, communicating internally and externally, with the families you work with, with their funders, potential funders and with potential partners. But I’ll pause there.

**Michelle:** One more thing I just wanted to add about the framework is how it really helped us think about our innovations and new programming to into our theory of change and help facilitate that fast cycle iteration. Because it’s over the last few years, we’ve developed to new programs and explored how we were success and exploring how we can integrate technology into our programming. And we didn’t have that we didn’t have that in our previous theory of change. And so being able to build that into a using the framework to build that into our theory of change, thinking about the evaluation, how do we get that feedback loop? It was really beneficial and helpful for us as we’re continuing to innovate and develop new programs to

**Andres:** Thank you, Michelle.

**Aeshna:** Thank you so much for sharing your experiences. And we’re going to go ahead and pull some questions from the chat. And we will start with kind of a somewhat broad question. And that came from Aaron Soto. Is that are there any prerequisites for an organization to implement the ideas framework? And it was Melanie, you might want to speak to this?

**Melanie Berry:** Sure. I would say there aren’t necessarily any standard prerequisites. But I do think having worked with a lot of different organizations around this framework, there are some conditions that set you up to be more or less successful or effective using the framework. One thing I would say is it’s important to have all the right people at the table. So, I mentioned that one of the principles of the framework is co creation and this idea that, you know, bringing together a group of people who have multiple perspectives on the program can be really valuable and that might include leadership, people who are responsible for developing or implementing the program, people who will lead on the evaluation or research efforts, but equally, importantly, you might invite people to contribute who have a role in actually delivering the service working directly with kids, families and caregivers. And better yet invite a representative from the community that you serve to be part of this process. So that’s the first piece is just having the right people at the table. And then the second thing I would say is timing can be important. So this framework is really designed to help you prepare for a fast cycle iteration process. So to prepare for a round of collecting data, reviewing that data, interpreting and analyzing it and making sense of it, and putting what you learn into practice. So the timing there can be important, you know, are you set up and prepared to actually put this plan into action? Do you have the resources you need? Is everyone bought in? Etc? Yeah, and having the authority to put what you learn into practice. So if you’re implementing a program that was developed by someone else, do you have sort of the leeway to make changes to how you’re implementing that program based on what you learned? Or are there kind of more strict parameters around how you implement that program?

**Aeshna:** Thanks, Melanie. The next question we have came from Nicolas, and it says a question for Miss Reyes from El Busesito. Were there any outcomes or benefits that happened unexpectedly from developing this program? i.e. unintended consequences that happened, which you did not expect, yet?

**Karla:** Yes. So there, it’s that’s definitely been a learning curve, we’ve definitely had to modify and just evolve the program. One of the biggest changes that we’ve made just recently is changing the program from a five-hour week model, where children receive two and a half hours of preschool twice a week, to offering five hours of preschool twice a week. So in total, they’re receiving 10 hours a week. And this really came from listening and taking the time to listen to parents and hear what their needs were, for years, or parents had been asking for more time on the bus, we’re really trying to make an impact on how many children we served. And like I said, we have, we have the capacity to serve 96 children in our valley. So that’s 96 children that otherwise wouldn’t be receiving preschool, you know, in a traditional preschool setting. And we’ve noticed recently, we’ve had a decrease in our enrollment. So it’s been a little bit harder to enroll children into our shorter classes. And I think that has now impacted our school district and our other centers that have grown their capacity in their centers, which was the ultimate goal to get more children into preschool and enrolled. So we’ve now looked at how we can because we’re mobile, we can now take our program and start serving communities that don’t have that access. So it’s, it’s been playing out lately, that we’ve noticed these trends.

**Aeshna:** Thank you. And actually, I just realized that this question is, the way it got segmented in the question answer section, I didn’t realize that the Nicholas who asked the question has the same question for folks at Raising a Reader. So were there any outcomes or benefits that happened unexpectedly from developing the program?

**Michelle:** Sure. So I’ll say that we have had 39 independent evaluation that showed, then we knew that Raising Reader helped improve home literacy environments, and which is like increased shared reading time, increased duration, and frequency, improve the number of books in the home. But one thing that we were hearing from folks was, oh, well, it’s helping me build confidence and supporting my child’s early learning in the home. It’s really providing a sense of comfort and support for our families, this daily really reading routine. And so creating a new theory of change, with coaching support from Andres, to really make a much more precise, we were able to build those kinds of things into our theory of change, which then led us to improving our measurement tools, so asking specific questions so that we could actually get some more data around, While their stories are great,it’s also helpful to have our surveys also reflect some of that more quantitatively as well.

**Aeshna:** Thank you, Michelle. And we have one question here. This asks if someone could speak to how this theory of change framework can inform logic model use and development, ensuring that the information is complimentary and not duplicative for programs who choose to create both types of resources.

**Melanie:** I’m happy to field that; I get asked that question a lot. From what I understand. Those two terms theory of change and logic model are often used actually interchangeably in the field. And there really isn’t solid consensus on how the two are similar and different. The best guidance on that that I’ve found is that logic models tend to be more standardized, they often include inputs, activities, outputs, and then short term and long-term outcomes are variations on that theme. And they’re really, their descriptive theories of change, are a bit less standardized. So if you Google the term theory of change, you’ll find many, many, many different approaches to theory of change. But in general, they’re intended to be causal models that really explain how and why the expected changes come about. That’s one way of thinking about that, then logic models are more descriptive and theories of change are really intended to be explanatory causal models. Honestly, in practice, I find that they’re, you know, when someone asks you for a logic model or a theory of change, you really have to follow up to ask what they mean, specifically what they’re looking for there. Because I think expectations vary widely. Our approach to theory of change is really, it zooms in on the point of service delivery, or the point of contact with kids, families, caregivers, and follows that through to the ultimate outcomes that you’re hoping to see, which are typically child level in the field of early childhood. And it can be really helpful to set you up to make a plan for gathering data to better understand whether you’re having the impact that you’re hoping to achieve. I hope that’s helpful. Sally, do you want to add to that?

**Sally:** Yeah, so I actually have a real-life example of how we’ve used both at the same time. So we recently worked with the team at Mathematica to create a Two Gen logic model, they did a project with different to join organizations across the country. And so we have been using theories of change for years in our programs and our six different programs to really identify, you know, what is the what are our strategies? What are the targets? What are the outcomes we’re trying to have in each of our programs, so it’s kind of granular, and then we worked with the team at Mathematica to create this, like, what is our whole organization do? And what is the whole change we’re trying to make in the community in in children and families. And so having that overarching logic model, that our theories of change then kind of feed up into, you can see how they, how they interact, how they’re incorporated in that larger logic model has been just really interesting, but we’re not duplicating. So we don’t have like a logic model and a theory of change for each of our programs.

**Aeshna:** Does anybody else want to speak to that before I move to the next question? Okay. So we have a question here from Eric Marlowe and asks, In your experience, I think this could be open to anyone here. How long are the typical iteration cycles? How long do you recommend evaluating and adapting elements of a given program so that changes are made neither too soon? nor too late?

**Melanie:** I can take a first pass that then I’d be curious to hear from our colleagues at Raising a Reader and Valley Settlement, if I understood correctly. So that was the question. Like, how often or how long does it take? Or maybe a little bit of both?

**Aeshna:** My interpretation was a little bit of both.

**Melanie:** Okay. I think so the way this question gets asked to us often is how fast is fast cycle? Like, are we talking something you can do in days, weeks, months, years? And the answer there, I think is unfortunately, it depends. It really depends on the nature of the program, or service or product that you’re looking to evaluate and improve. If it’s, let’s say, a 10 week parenting group, then a single cycle could take, you know, you’d want a couple of months to plan and prepare, to identify to develop your theory of change to identify your questions to figure out your study design, figure out the tools you want to use prepare for data collection, then obviously, you need the 10 weeks to go by where you’re actually delivering the program to kids and families. And then you’ll need some time afterwards to analyze interpret and make sense of that data.

But that timeframe is obviously going to be really different if it’s a program that’s implemented on a school year calendar, for instance, or if you develop something like an app or a website that families can engage with, as they choose, and maybe dosage and engagement looks really different from parents or parents. So there’s no right answer for how long a cycle can take, you really just need to be thoughtful about what you’re hoping to learn. And then in terms of how often, I think that really varies, again, from organization to organization, and what the appetite and bandwidth is to engage in this kind of iterative learning. I know that valley settlement, for instance, has really built this into your kind of culture and your routines as an organization. And it seems like you’ve developed a really nice kind of annual rhythm. So maybe I could pass the baton to Sally and, Karla, to talk more about that.

**Sally:** Yeah, so as you say, Melanie, we really do our evaluation on an annual basis. So we most of our programs happen during the school year. We do pre and post surveys, we also do pre mid and post TS GOLD assessments for Busesito preschool. And then we really we do the bulk of data analysis in June and July. And then every July, we gather and do that evaluation retreat with our entire team. And then in August, we’re kind of refining our evaluation and planning the next evaluation cycle. But what I will say is that when we’re piloting new initiatives, we are trying to be a little more like eyes on as the as the initiative is happening. So for example, we worked a few years ago to implement a Child Development Associate course, for family, friends and neighbors, providers, and also for high school students who are Spanish speaking. And we were we were doing little pre and post assessments throughout at the beginning and end of kind of each section of the quarter module. Just to understand like, was our approach working? How could we pivot and adjust. So as we’re piloting new things, we do try to be a little more rapid, if you will, I would just echo the same thing that we do have an annual, like an annual cycle, I guess, where we do an annual evaluation, annual check in with our affiliates is what we call it. And then we do have a couple of pilots right now where we are calling them mini learning phases. After each learning phase, then we’ll take a look at the feedback and then see what tweaks or what modifications we need to do to improve the program. And then we have our second learning phase, and things like that.

**Aeshna:** A quick follow up from Nicolas to this question was so does that mean that the theory of change is different with each iteration?

**Sally:** So we definitely like we can evolve our theory of change every year, we go in as a team and look at the strategies and say like, you know, are you are you still doing these things? How are you doing them? You know, we definitely change and evolve in our programming, we’re not doing the same thing every year, because programs, neighborhoods, communities change and evolve. And we learn new things every year. So we do go in and tweak our theory of change every year.

**Michelle:** And I’ll say we just revised ours so we haven’t changed it. But one thing I think it is helping us think about though, as we are developing our program, how to stay focused on what it is that we really want to do. Because there are so many needs, and we serve so many different communities that have different needs. How do we stay true to this theory of change that for our mission, and things like that, so it really helps us identify are clearly like, where is our most unique impact and helps us stay there and not kind of stray just because there might be a funding source over there or something like that.

**Melanie:** I’ll just add that. It’s a great question. And it gives us the chance to underscore that. Absolutely. A Theory of Change can and should evolve over time, as you learn. So we call them living documents, right? It’s not a one-time exercise that you do, and you make a PDF of it. And it’s done. It’s a living document that you come back to after every round of learning. And you say, you know, what did we learn? How can we refine our theory of change? How can we refine our actual program or product or service? And how could we refine how we’re gathering data and learning going forward?

**Aeshna:** Thank you. So now we have a question from Megan Crystal, asking if we have any examples if we know of any state level policy or programs that have used this framework.

**Melanie:** I have a couple that come to mind. So a while back as part of the Frontiers of Innovation Initiative that Aeshna mentioned, there was a project team who implemented a video coaching program to support childcare and early learning professionals. And that project was done in partnership with the State Department of Early Learning. And this framework was used to sort of articulate theory of change for that approach, and to actually work with partners at the University of Washington to craft the evaluation plan. So that’s one example. And then another more recent example that comes to mind is our Center worked with partners at the Massachusetts Department of Early Education and Care to create an initiative wide theory of change, actually, similarly for an effort underway to bring early care and support organizations to build the capacity of actually childcare directors across the state. So we worked with them to create an initiative wide theory of change. And then each organization who was providing that service, use that initiative, wide theory of change as a template and kind of tailored it for their particular approach. And I think that’s still being used right now, as the initiative continues to kind of facilitate learning and improvement over time. There might be other examples, but those are two that come to mind.

**Aeshna:** Thanks, Melanie. Does anybody else-

**Melanie:** Can I squeeze in one more just in case folks are looking for examples. We worked with an organization called TOPS, which is based in the Netherlands. And they provide if I’m remembering correctly, services to families with newborn children. And I think that’s actually like a nationwide program that’s used ideas to drive towards greater impact. And there are resources or references about the tops program in the resources section of the toolkit. I think there’s a research article there that talks about their experience.

**Aeshna:** Alright. Great. Thanks, everyone. I was hoping we might have time for one more question, but actually see that we’re pretty close to the end there. So I just wanted to thank you all for joining us. thank our panelists for sharing your experiences and your learning, we really appreciate it. And thank you all so much for joining, we really, really hope that this resource is useful for you all, and we wish you the best in your continued work, supporting kids and families.

**Corey:** The Brain Architects is a product of the Center on the Developing Child at Harvard University. You can find us at developingchild.harvard.edu, where we’ll post any resources that were discussed in this episode. We’re also on Twitter @HarvardCenter, Facebook at Center Developing Child, and Instagram @DevelopingChildHarvard. Our music is Brain Power by Mela from freemusicarchive.org.

**IDEAS Framework Toolkit** Jul 11, 2023

Contents

Podcast

Panelists

Additional Resources

Transcript

In April, we hosted a webinar about the recently released IDEAS Impact Framework Toolkit—a free online resource designed to help innovators in the field of early childhood build improved programs and products that are positioned to achieve greater impact in their communities. During the webinar, we provided an overview of the site and had the opportunity to hear from two organizations in the field about how they leveraged the toolkit and its resources to shape their work: Valley Settlement and Raising a Reader. This episode of the Brain Architects podcast features highlights from the webinar. If you’re interested in hearing a full walk through of the toolkit by the Director of our Pediatric Innovation Initiative, Dr. Melanie Berry, please head over to our YouTube channel to view the full webinar recording.

Panelists

Aeshna Badruzzaman, PhD *(Moderator)*
Senior Project Manager for Instructional Design, Center on the Developing Child at Harvard University

Melanie Berry, PsyD
Director of the Pediatric Innovation Initiative, Center on the Developing Child at Harvard University

Sally Boughton, MNM
Director of Development & Communications at Valley Settlement

Andres Garcia Lopez, EdM, MBA
Senior Project Manager, Center on the Developing Child at Harvard University

Karla Reyes
Program Manager of El Busesito Mobile Preschool Program at Valley Settlement

Michelle Sioson Hyman
Senior Vice President, Programs and Partnerships at Raising a Reader

Corey Zimmerman, EdM *(Podcast Host)*
Chief Program Officer, Center on the Developing Child at Harvard University

Additional Resources

IDEAS Framework Toolkit

Valley Settlement

Raising a Reader

Transcript

**Corey Zimmerman:** Welcome to the Brain Architects, a podcast from the Center on the Developing Child at Harvard University. I’m Corey Zimmerman, the Center’s Chief Program Officer. Our Center believes that advances in the science of child development provide a powerful source of new ideas that can improve outcomes for children and their caregivers. By sharing the latest science from the field, we hope to help you make that science actionable, and apply it in your work in ways that can increase your impact.

With that goal in mind, the Center recently released the IDEAS Impact Framework Toolkit—a free online resource designed to help innovators in the field of early childhood build improved programs and products that are positioned to achieve greater impact in their communities. The Toolkit is self-guided, self-paced, and provides a structured and flexible approach that facilitates program development, evaluation, and fast-cycle iteration, including resources to help teams develop and investigate a clear and precise Theory of Change.

In April, we hosted a webinar about the toolkit, where we provided an overview of the site and had the opportunity to hear from teams at several organizations in the field about how they leveraged the toolkit and its resources to shape their work. We’re excited to share those discussions with you here on this episode of the Brain Architects podcast. If you’re interested in hearing a full walk through of the toolkit, by the Director of our Pediatric Innovation Initiative, Dr. Melanie Berry, please head over to our YouTube channel to view the full webinar recording. You’ll also hear from Dr. Melanie Berry during the Q&A portion.

The full IDEAS toolkit we’ll be talking about today can be found at ideas.developingchild.harvard.edu. And now, without further ado, here’s Dr. Aeshna Badruzzaman, the Center’s Senior Project Manager for Instructional Design and the moderator for our panel discussion.

**Aeshna Badruzzaman:** Hello, everyone. Welcome. My name is Dr. Aeshna Badruzzaman. I am a Senior Project Manager for Instructional Design at the Center on the Developing Child at Harvard University or HCDC, and I’m part of the development team of the IDEAS Impact Framework Toolkit. And today, I’ll be your host. So, you may hear me come off mute, and help guide presenters, and I’ll be facilitating our question and answer period. So, we are so pleased to be talking to you today about this resource. The IDEAS Impact Framework was born out of more than a decade of the Frontiers of Innovation Initiative or FOI. And some of you may have been partners in that effort. So, while our team no longer offers live training on the framework, we are so excited to be introducing it to you as a free open access resource. And we really hope that this format is going to help make IDEAS accessible to innovators in the field of early childhood development moving forward. The framework was developed in partnership with the University of Washington College of Education, and the University of Oregon Center for Translational Neuroscience. With support from the Gates Foundation, The Lego Foundation, Porticus and the Hemera Foundation. I encourage you to check out our history and acknowledgments page of the toolkit for more information about our various collaborations and supporters throughout time as well.

Now I’ll go ahead and introduce our first set of speakers from folks at Valley Settlement. We have with us Karla Reyes, who is the program manager of the El Busesito mobile preschool program at Valley Settlement, which is a nonprofit that works to create opportunities for the Latino community in the Aspen to Parachute region of Colorado. Karla joined Valley Settlement in March 2015, as a preschool teacher for El Busesito until June 2021 when she took on a leadership role. And we also have Sally Boughton who is the Director of Development and Communications at Valley Settlement, a nonprofit again, serving the rural Aspen to Parachute region Colorado with six to generation programs designed by and for local Latina immigrant families. And Sally has been with Valley Settlement for over five years and began managing the organization’s evaluation function in 2021. Thank you so much Karla and Sally look forward to hearing from you.

**Karla Reyes:** Good afternoon, everyone. Thank you for inviting us to share our work with you all and how we have used the framework. I’m going to talk a little bit about it, we’ll see the program and how I kind of started. The idea that it will succeed though began in 2011. We had two bilingual and bicultural community organizers, who met one on one with about 300 families from the Aspen to Parachute region of Colorado. And they learned about their lives and the barriers that they faced within our community. One of the findings from the initial listening tour was that only 1% of Latino children in our community were enrolled in preschool. We also learned that three of the biggest barriers for families to participate in preschool programs were language, cost and transportation resulting in lack of access. Now we have all this information. And we started thinking creatively of different ways that we could bring more access to preschool education to our community. I have also seen those one of the first two generation programs that we launched in Valley Settlement to address the needs of preschool education. And throughout the years Valley Settlement has continued to learn, evolve and co-design programming to respond to community needs. Now, our program has four mobile preschool buses that have been retrofitted into small preschool classrooms. We have two teachers on the bus, and we serve eight children at a time, we provide families with about five to 10 hours of free preschool education. We have about 96 children that we serve annually between 40 to 50 children graduating at the end of the school year and moving on to kindergarten. And currently right now we serve different five different neighborhoods within our community. And we strive to build close relationships with families. So, our program really is designed to meet families at where they are, are at and start breaking down those barriers. We host family nights; we have home visits with our families. We have parent teacher conferences; we have different ways that families can volunteer within our program. We provide a lot of materials for families to use that home so that they can do home activities and homework packets with their students. And we really try to engage with the families. So, each one of our teachers speak Spanish, is bilingual and bicultural. So, this really allows that bond and that relationship to build with each one of our families. I’m going to hand it off to Sally Boughton, and she’s going to talk a little bit more about how we’ve used the framework.

**Sally Boughton:** Thanks, Karla. So, several years ago, we started working with the team at Frontiers of Innovation to refine and evolve our evaluation practices. This work included creating theories of change for each of our programs, researching and recommending observational assessments to measure participant progress towards our program targets and outcomes, and creating implementation guides for our programs to detail the critical components of our work and ensure that future staff can implement programs with fidelity, while still continuing to listen to and evolve alongside families. Since the early days of our programming, Valley Settlement has invested in evaluation to measure understand and strengthen the changes that children and families create in their lives through our programming. Working with the team at FOI really brought this to the next level. Over the last few years, we’ve been working to be more inclusive and participatory in our evaluation process. So now our entire staff gathers for three days every summer, in what I call an evaluation retreat, where we review our annual program data as a team and then try to answer those questions ¿qué? ¿por qué? ¿Y ahora qué? or as the toolkit outlines: What does the data say? Why? Why might the data say this? Or what does that mean? And finally, now what do we do to tweak or change in our evaluation approach or in our programming, based on what we see in the data? Our teams then create action plans to outline those changes that they want to make. We’re usually tweaking one or more program components for the upcoming year. On day two of the retreat, teams then go in and refine and evolve their theories of change. So, we really see that theory of change as a living document that breathes and grows alongside our programming. They identify what targets and outcomes they’re interested in measuring for the coming program year. And then after that evaluation retreat, we work together with our evaluation consultant to refine our measurement tools. And then I always try to call out and highlight that I am in the minority of Valley Settlements. Our staff are largely of the community that we work with. Most of our staff are immigrants or children of immigrants, many have grown up in this community, or immigrated to the community as adults with young children. And so, they have those shared lived experiences with the participants in our programs. And many of our staff have actually been former participants in our programs. Having the entire team participate in this process is incredibly valuable. It really places the experts in the work our staff in the evaluator seat, and we gained so much more by having that inclusive, participatory process. And we’re really so grateful to have our work shared in the online toolkit because, you know, I am not an expert in the IDEAS framework by any means. And that’s kind of the whole point is that it’s very usable, you can go in, you can click through this toolkit, you can see how it all is structured and works. And it just makes for a really kind of manageable, useful process that you can engage in. Thanks so much.

**Aeshna:** Thank you, Karla, and Sally, really appreciate you taking the time to share your experiences with us. Now we’ll hear from folks from Raising a Reader. So Raising A Reader supports families to build, practice and grow reading routines at home. Their award-winning evidence-based program helps caring adults set their children up for success by creating shared reading routines, fostering social emotional learning, healthy family relationships and learning skills needed to thrive in school and beyond. And first, we’ll hear from Michelle Sioson Hyman, who is Senior Vice President, program and partnerships. And in her role, Michelle is responsible for overseeing program development, growth and impact. And then we’ll hear from Andres Garcia Lopez, who is a Senior Project Manager at the Center on the Developing Child. And in his role, he’s coached many early childhood development entrepreneurs, including Raising a Reader in developing strategies to maintain their science-based impact, while scaling their ventures. Welcome Michelle and Andreas.

**Michelle Sioson Hyman:** Thank you so much for having me. I’ll start with a brief overview of Raising a Reader and how we’ve used the framework and then fundraising, engaging some conversation. So Raising a Reader is a national family engagement and early literacy organization through our network of affiliates and partners across 34 states and both rural and urban communities. We engage and support parents and the other caring adults in children’s lives help strengthen the bonds with their children, while building critical early reading and social emotional skills. So along with our award winning multicultural and multilingual book collection, we provide easy to use materials and guides that are really designed to make the most of that shared reading time in the home. So our work really does begin though, with partnering with local agencies who become members of our affiliate network, a community of practice in which we can share best practices and build connections. And we provide professional development, technical assistance and capacity building support to this network of affiliates and partners, who really work across the intersection of systems, supporting children and families at the various points throughout their educational and developmental journey. So that’s, you know, in ECD, K, 12, Health and Human Services. And we’re really able to meet families in the spaces and places where they are involved in how the framework has really impacted our work was that we were introduced to Andres. And the framework is a really critical inflection point in our history. So we’re over 23 years old and Raising a Reader had 39 independent evaluation that prove the success of our Classic Red Bookbag Program and its impact on improving and sustaining home literacy environments. But one thing that we realized through our work with Andres was that there were critical aspects to our work that we weren’t capturing in our theory of change. And just maybe I’ll stop there, and then we can chat. Does that work?

**Andres Garcia Lopez:** Sounds good. That works. Michelle. Thanks so much for that overview. And I’m so excited to be part of this panel, and it’s an honor to share it with you, Michelle, and with the Valley Settlement team. So I’ll just add a few things. I was working with Michelle as part of a fellowship that the Center partners with the Promise Venture Studio. And as was mentioned before, the theory of change on the IDEAS framework really helps you think about what are the key ingredients that my organization in my program works on or provides to families and

or maybe two partners that get to the targets that that move the needle towards my outcomes. One thing that was different about Raising a Reader was that they weren’t with partners. So I wanted to mention that sometimes the IDEAS framework can be, and the theory of change could be flexible, and adaptable to meet your needs. Originally, there are three columns in the theory of change. But we’re working with Michelle, we thought we should have an extra column because they wanted to look at how working with partners and affiliate organizations, what their strategy is that was doing racing, a reader was getting into the targets in partners and affiliates and how that was getting to the outcomes with families. And that was a key component on identifying precisely the actions that get to the targets and the outcomes. And I’ll pause there so that Michelle can share more about the specifics of what some of those strategies were and how that helped the organization.

**Michelle:** Thanks, Andres. Yeah, so one of the things including that additional column that Andres was talking about, it really helped us think through, how are we really building that educator capacity? And how are we really providing professional development around early childhood development. And another aspect to it is that we knew we did it all the time. And we had stories about how we did it all the time. But using the theory of change, the framework to really make it much more precise, is really helping us think through how we are doing it. And so, it also helped us think about how our program is impacting early relational health through strengthening healthy family bonds. And so, it really has made us to be better poised to effectively test and evaluate how we are doing this work and what isn’t what is not working.

**Andres:** Thank you, Michelle. And one comment that I add, as we have about 90% of the participants that are now in the webinar are new to the to the framework, sometimes you may use the framework as a program developer, or somebody who’s implementing a program like your shell, but you could also use it to help other organizations like the way I have used it as part of the center in the developing child, or as promised venture studio has also used it with social entrepreneurs in their organization, the framework is really helpful in helping you think through your impact strategy. I mentioned a brief comment, if you’re familiar with other frameworks that innovators use, like the lean startup or business model canvas or other ones, it these helps you think through in a very clear way, in a simplified way, what are your strategies and how I am I get into the outcomes. And because of its it’s simple, and it can fit in one page, it also facilitates communication, communicating internally and externally, with the families you work with, with their funders, potential funders and with potential partners. But I’ll pause there.

**Michelle:** One more thing I just wanted to add about the framework is how it really helped us think about our innovations and new programming to into our theory of change and help facilitate that fast cycle iteration. Because it’s over the last few years, we’ve developed to new programs and explored how we were success and exploring how we can integrate technology into our programming. And we didn’t have that we didn’t have that in our previous theory of change. And so being able to build that into a using the framework to build that into our theory of change, thinking about the evaluation, how do we get that feedback loop? It was really beneficial and helpful for us as we’re continuing to innovate and develop new programs to

**Andres:** Thank you, Michelle.

**Aeshna:** Thank you so much for sharing your experiences. And we’re going to go ahead and pull some questions from the chat. And we will start with kind of a somewhat broad question. And that came from Aaron Soto. Is that are there any prerequisites for an organization to implement the ideas framework? And it was Melanie, you might want to speak to this?

**Melanie Berry:** Sure. I would say there aren’t necessarily any standard prerequisites. But I do think having worked with a lot of different organizations around this framework, there are some conditions that set you up to be more or less successful or effective using the framework. One thing I would say is it’s important to have all the right people at the table. So, I mentioned that one of the principles of the framework is co creation and this idea that, you know, bringing together a group of people who have multiple perspectives on the program can be really valuable and that might include leadership, people who are responsible for developing or implementing the program, people who will lead on the evaluation or research efforts, but equally, importantly, you might invite people to contribute who have a role in actually delivering the service working directly with kids, families and caregivers. And better yet invite a representative from the community that you serve to be part of this process. So that’s the first piece is just having the right people at the table. And then the second thing I would say is timing can be important. So this framework is really designed to help you prepare for a fast cycle iteration process. So to prepare for a round of collecting data, reviewing that data, interpreting and analyzing it and making sense of it, and putting what you learn into practice. So the timing there can be important, you know, are you set up and prepared to actually put this plan into action? Do you have the resources you need? Is everyone bought in? Etc? Yeah, and having the authority to put what you learn into practice. So if you’re implementing a program that was developed by someone else, do you have sort of the leeway to make changes to how you’re implementing that program based on what you learned? Or are there kind of more strict parameters around how you implement that program?

**Aeshna:** Thanks, Melanie. The next question we have came from Nicolas, and it says a question for Miss Reyes from El Busesito. Were there any outcomes or benefits that happened unexpectedly from developing this program? i.e. unintended consequences that happened, which you did not expect, yet?

**Karla:** Yes. So there, it’s that’s definitely been a learning curve, we’ve definitely had to modify and just evolve the program. One of the biggest changes that we’ve made just recently is changing the program from a five-hour week model, where children receive two and a half hours of preschool twice a week, to offering five hours of preschool twice a week. So in total, they’re receiving 10 hours a week. And this really came from listening and taking the time to listen to parents and hear what their needs were, for years, or parents had been asking for more time on the bus, we’re really trying to make an impact on how many children we served. And like I said, we have, we have the capacity to serve 96 children in our valley. So that’s 96 children that otherwise wouldn’t be receiving preschool, you know, in a traditional preschool setting. And we’ve noticed recently, we’ve had a decrease in our enrollment. So it’s been a little bit harder to enroll children into our shorter classes. And I think that has now impacted our school district and our other centers that have grown their capacity in their centers, which was the ultimate goal to get more children into preschool and enrolled. So we’ve now looked at how we can because we’re mobile, we can now take our program and start serving communities that don’t have that access. So it’s, it’s been playing out lately, that we’ve noticed these trends.

**Aeshna:** Thank you. And actually, I just realized that this question is, the way it got segmented in the question answer section, I didn’t realize that the Nicholas who asked the question has the same question for folks at Raising a Reader. So were there any outcomes or benefits that happened unexpectedly from developing the program?

**Michelle:** Sure. So I’ll say that we have had 39 independent evaluation that showed, then we knew that Raising Reader helped improve home literacy environments, and which is like increased shared reading time, increased duration, and frequency, improve the number of books in the home. But one thing that we were hearing from folks was, oh, well, it’s helping me build confidence and supporting my child’s early learning in the home. It’s really providing a sense of comfort and support for our families, this daily really reading routine. And so creating a new theory of change, with coaching support from Andres, to really make a much more precise, we were able to build those kinds of things into our theory of change, which then led us to improving our measurement tools, so asking specific questions so that we could actually get some more data around, While their stories are great,it’s also helpful to have our surveys also reflect some of that more quantitatively as well.

**Aeshna:** Thank you, Michelle. And we have one question here. This asks if someone could speak to how this theory of change framework can inform logic model use and development, ensuring that the information is complimentary and not duplicative for programs who choose to create both types of resources.

**Melanie:** I’m happy to field that; I get asked that question a lot. From what I understand. Those two terms theory of change and logic model are often used actually interchangeably in the field. And there really isn’t solid consensus on how the two are similar and different. The best guidance on that that I’ve found is that logic models tend to be more standardized, they often include inputs, activities, outputs, and then short term and long-term outcomes are variations on that theme. And they’re really, their descriptive theories of change, are a bit less standardized. So if you Google the term theory of change, you’ll find many, many, many different approaches to theory of change. But in general, they’re intended to be causal models that really explain how and why the expected changes come about. That’s one way of thinking about that, then logic models are more descriptive and theories of change are really intended to be explanatory causal models. Honestly, in practice, I find that they’re, you know, when someone asks you for a logic model or a theory of change, you really have to follow up to ask what they mean, specifically what they’re looking for there. Because I think expectations vary widely. Our approach to theory of change is really, it zooms in on the point of service delivery, or the point of contact with kids, families, caregivers, and follows that through to the ultimate outcomes that you’re hoping to see, which are typically child level in the field of early childhood. And it can be really helpful to set you up to make a plan for gathering data to better understand whether you’re having the impact that you’re hoping to achieve. I hope that’s helpful. Sally, do you want to add to that?

**Sally:** Yeah, so I actually have a real-life example of how we’ve used both at the same time. So we recently worked with the team at Mathematica to create a Two Gen logic model, they did a project with different to join organizations across the country. And so we have been using theories of change for years in our programs and our six different programs to really identify, you know, what is the what are our strategies? What are the targets? What are the outcomes we’re trying to have in each of our programs, so it’s kind of granular, and then we worked with the team at Mathematica to create this, like, what is our whole organization do? And what is the whole change we’re trying to make in the community in in children and families. And so having that overarching logic model, that our theories of change then kind of feed up into, you can see how they, how they interact, how they’re incorporated in that larger logic model has been just really interesting, but we’re not duplicating. So we don’t have like a logic model and a theory of change for each of our programs.

**Aeshna:** Does anybody else want to speak to that before I move to the next question? Okay. So we have a question here from Eric Marlowe and asks, In your experience, I think this could be open to anyone here. How long are the typical iteration cycles? How long do you recommend evaluating and adapting elements of a given program so that changes are made neither too soon? nor too late?

**Melanie:** I can take a first pass that then I’d be curious to hear from our colleagues at Raising a Reader and Valley Settlement, if I understood correctly. So that was the question. Like, how often or how long does it take? Or maybe a little bit of both?

**Aeshna:** My interpretation was a little bit of both.

**Melanie:** Okay. I think so the way this question gets asked to us often is how fast is fast cycle? Like, are we talking something you can do in days, weeks, months, years? And the answer there, I think is unfortunately, it depends. It really depends on the nature of the program, or service or product that you’re looking to evaluate and improve. If it’s, let’s say, a 10 week parenting group, then a single cycle could take, you know, you’d want a couple of months to plan and prepare, to identify to develop your theory of change to identify your questions to figure out your study design, figure out the tools you want to use prepare for data collection, then obviously, you need the 10 weeks to go by where you’re actually delivering the program to kids and families. And then you’ll need some time afterwards to analyze interpret and make sense of that data.

But that timeframe is obviously going to be really different if it’s a program that’s implemented on a school year calendar, for instance, or if you develop something like an app or a website that families can engage with, as they choose, and maybe dosage and engagement looks really different from parents or parents. So there’s no right answer for how long a cycle can take, you really just need to be thoughtful about what you’re hoping to learn. And then in terms of how often, I think that really varies, again, from organization to organization, and what the appetite and bandwidth is to engage in this kind of iterative learning. I know that valley settlement, for instance, has really built this into your kind of culture and your routines as an organization. And it seems like you’ve developed a really nice kind of annual rhythm. So maybe I could pass the baton to Sally and, Karla, to talk more about that.

**Sally:** Yeah, so as you say, Melanie, we really do our evaluation on an annual basis. So we most of our programs happen during the school year. We do pre and post surveys, we also do pre mid and post TS GOLD assessments for Busesito preschool. And then we really we do the bulk of data analysis in June and July. And then every July, we gather and do that evaluation retreat with our entire team. And then in August, we’re kind of refining our evaluation and planning the next evaluation cycle. But what I will say is that when we’re piloting new initiatives, we are trying to be a little more like eyes on as the as the initiative is happening. So for example, we worked a few years ago to implement a Child Development Associate course, for family, friends and neighbors, providers, and also for high school students who are Spanish speaking. And we were we were doing little pre and post assessments throughout at the beginning and end of kind of each section of the quarter module. Just to understand like, was our approach working? How could we pivot and adjust. So as we’re piloting new things, we do try to be a little more rapid, if you will, I would just echo the same thing that we do have an annual, like an annual cycle, I guess, where we do an annual evaluation, annual check in with our affiliates is what we call it. And then we do have a couple of pilots right now where we are calling them mini learning phases. After each learning phase, then we’ll take a look at the feedback and then see what tweaks or what modifications we need to do to improve the program. And then we have our second learning phase, and things like that.

**Aeshna:** A quick follow up from Nicolas to this question was so does that mean that the theory of change is different with each iteration?

**Sally:** So we definitely like we can evolve our theory of change every year, we go in as a team and look at the strategies and say like, you know, are you are you still doing these things? How are you doing them? You know, we definitely change and evolve in our programming, we’re not doing the same thing every year, because programs, neighborhoods, communities change and evolve. And we learn new things every year. So we do go in and tweak our theory of change every year.

**Michelle:** And I’ll say we just revised ours so we haven’t changed it. But one thing I think it is helping us think about though, as we are developing our program, how to stay focused on what it is that we really want to do. Because there are so many needs, and we serve so many different communities that have different needs. How do we stay true to this theory of change that for our mission, and things like that, so it really helps us identify are clearly like, where is our most unique impact and helps us stay there and not kind of stray just because there might be a funding source over there or something like that.

**Melanie:** I’ll just add that. It’s a great question. And it gives us the chance to underscore that. Absolutely. A Theory of Change can and should evolve over time, as you learn. So we call them living documents, right? It’s not a one-time exercise that you do, and you make a PDF of it. And it’s done. It’s a living document that you come back to after every round of learning. And you say, you know, what did we learn? How can we refine our theory of change? How can we refine our actual program or product or service? And how could we refine how we’re gathering data and learning going forward?

**Aeshna:** Thank you. So now we have a question from Megan Crystal, asking if we have any examples if we know of any state level policy or programs that have used this framework.

**Melanie:** I have a couple that come to mind. So a while back as part of the Frontiers of Innovation Initiative that Aeshna mentioned, there was a project team who implemented a video coaching program to support childcare and early learning professionals. And that project was done in partnership with the State Department of Early Learning. And this framework was used to sort of articulate theory of change for that approach, and to actually work with partners at the University of Washington to craft the evaluation plan. So that’s one example. And then another more recent example that comes to mind is our Center worked with partners at the Massachusetts Department of Early Education and Care to create an initiative wide theory of change, actually, similarly for an effort underway to bring early care and support organizations to build the capacity of actually childcare directors across the state. So we worked with them to create an initiative wide theory of change. And then each organization who was providing that service, use that initiative, wide theory of change as a template and kind of tailored it for their particular approach. And I think that’s still being used right now, as the initiative continues to kind of facilitate learning and improvement over time. There might be other examples, but those are two that come to mind.

**Aeshna:** Thanks, Melanie. Does anybody else-

**Melanie:** Can I squeeze in one more just in case folks are looking for examples. We worked with an organization called TOPS, which is based in the Netherlands. And they provide if I’m remembering correctly, services to families with newborn children. And I think that’s actually like a nationwide program that’s used ideas to drive towards greater impact. And there are resources or references about the tops program in the resources section of the toolkit. I think there’s a research article there that talks about their experience.

**Aeshna:** Alright. Great. Thanks, everyone. I was hoping we might have time for one more question, but actually see that we’re pretty close to the end there. So I just wanted to thank you all for joining us. thank our panelists for sharing your experiences and your learning, we really appreciate it. And thank you all so much for joining, we really, really hope that this resource is useful for you all, and we wish you the best in your continued work, supporting kids and families.

**Corey:** The Brain Architects is a product of the Center on the Developing Child at Harvard University. You can find us at developingchild.harvard.edu, where we’ll post any resources that were discussed in this episode. We’re also on Twitter @HarvardCenter, Facebook at Center Developing Child, and Instagram @DevelopingChildHarvard. Our music is Brain Power by Mela from freemusicarchive.org.

Building Resilience Through Play Feb 22, 2022

Contents

Podcast

Panelists

Additional Resources

Transcript

These days, resilience is needed more than ever, and one simple, underrecognized way of supporting healthy and resilient child development is as old as humanity itself: play. Far from frivolous, play contributes to sturdy brain architecture, the foundations of lifelong health, and the building blocks of resilience, yet its importance is often overlooked. In this podcast, Dr. Jack Shonkoff explains the role of play in supporting resilience and five experts share their ideas and personal stories about applying the science of play in homes, communities, and crisis environments around the world.

Panelists

Andres Bustamante, Assistant Professor, University of California Irvine School of Education

Laura Huerta Migus, Deputy Director, Office of Museum Services at Institute for Museum and Library Services

Lynneth Solis, Researcher and lecturer at the Harvard Graduate School of Education

Erum Mariam, Executive Director, BRAC Institute of Educational Development, BRAC University

Michael Yogman, Pediatrician, Harvard Medical School, Cambridge Hospital

Additional Resources

Resources from the Center on the Developing Child

Resources from Our Guests

Panel

Play in Humanitarian Settings

Prescription for Play

- The Power of Play: A Pediatric Role in Enhancing Development in Young Children
- Preventing Childhood Toxic Stress: Partnering with Families and Communities to Promote Relational Health

Transcript

Sally Pfitzer, host: Welcome to the Brain Architects, a podcast from the Center on the Developing Child at Harvard University. I’m your host, Sally Pfitzer. Our Center believes that advances in science can provide a powerful source of new ideas that can improve outcomes for children and families. We want to help you apply the science of early childhood development to your everyday interactions with children and take what you’re hearing from our experts and panels and apply it to your everyday work.

So in today’s episode, we’re going to get serious about the topic of play. For children, play is a fundamental building block of child development, but its role in supporting resilience is often overlooked. And after the past few years, we surely need resilience now more than ever! For me, as a former preschool teacher, I’m especially excited about this episode and speaking with today’s experts, because I’ve seen first-hand how important play is for young children’s development. But what can science tell us about it? And what can be done to support more play in everyday life, even in crisis contexts? In this podcast, we’ll dive into the science of play and resilience, and then we’ll explore how people are using that knowledge to support child development around the world. To explain the science, we’ll start with Dr. Jack Shonkoff, Professor of Child Health and Development and the Director of the Center on the Developing Child at Harvard University. So Jack, what do we mean by resilience and what do we know about how people develop it?

Jack Shonkoff: What we mean by resilience is that we’re talking about the ability to do well, the ability to cope, the ability to overcome hardship, or adversity, or threat to your well-being. So the key about resilience is it doesn’t occur in a vacuum.

Resilience is something that you actively build, and you build it in the context of relationships in an environment that helps you learn how to cope with challenges, cope with stress, cope with hardships. And it starts very early. It starts in infancy. And infants need to have some sense of participation in that.

But also, you don’t do it totally on your own. You need the support and the security, when you’re a baby, of adults who basically help provide a manageable environment in which you can learn resilience. So, if stresses and threats are overwhelming, they can overwhelm the system. And you don’t really get a chance to build resilience. If every time something happens that challenges you, somebody jumps in to protect you, that’s not good for you either because you have to build that yourself.

So the environment has a lot to do with how you develop resilience and skills, but so does your own activity on the environment, your own sense of being a player rather than just a receiver.

But no two children are the same, even children in the same family, growing up in the same environment. From birth, children differ in how adaptable they are. If you go into a newborn nursery in a hospital, the nurses who work there can tell you about how those babies are all different from each other. Some kids are just more easygoing, constitutionally. Some kids roll with the flow, a little bit easier than others. So in a sense, we don’t all start off with the same way of reacting to stress or hardship.

Sally: That’s great. And thinking about how resilience is built, are there specific building blocks that you need to think about? In this case, could you talk a little bit more about how play might support those building blocks?

Jack: Play, by definition, is an interactive process or a kind of self-directed process. It’s not by chance that all children, regardless of where they live in the history of the species, use play as a way to develop skills. It’s the way children learn to master their environment. And they learn to try things out. They test things. They test limits. It’s driven by curiosity, and it’s driven by an inborn drive to master the environment.

And if you think about what resilience is all about, resilience is mastering your environment. It’s building the skills to be able to cope, building the skills to have strategies, to deal with your own reactions, be able to have some control over what’s going on around you. And none of that would develop as well as it does if you depended on just being taught how to be resilient. No. Your ability, your natural ability to play, is one of the most important strategies that we have developmentally to build resilience in the face of adversity.

Sally: So, what is the science that underlines this connection between healthy development and how play supports it?

Jack: God, there are mountains of science that help us to understand the process of development. And three principles, three concepts, just continue to stand out among all of the research, evidence, and knowledge we have about development. And they are the keys to healthy development.

The first is the importance of supportive relationships. Children develop in an environment of relationships. So, supportive relationships are critically important for healthy development. The second is the need to reduce significant sources of stress—not eliminate stress, but reduce stress, so it’s manageable. And then the third is building core skills, the kinds of skills that are needed for just about anything that we’re expected to do at any point in our life. So these are the core skills that are the building blocks of learning, and behavior, and good health.

And if we put those three things together—supportive relationships, reducing sources of stress, and building core skills—they are essential for us to understand not only how resilience develops over time, but also what an important role play occupies in that process. Particularly in a young child, there is this sense of trying to figure out what the world is all about. So core skill development, which is essential for building resilience, is very much tied into the ability to learn actively through play and through interaction with others.

There has been so much research done on resilience in a variety of circumstances, trying to understand what is it that explains how some children overcome adversity and do well in spite of hardship and threats. The one thing that comes out in just about every single study is whenever there’s evidence of resilience, you can always identify at least one very important relationship that was critical to the development of resilience. Very often, it’s a parent. It doesn’t have to be a parent. It can be another member of the family. It doesn’t have to be a family member. It could be a neighbor. It could be a preschool teacher. It could be a child care provider. It could be a coach. It doesn’t really matter who it is. It certainly doesn’t have to be a blood relative, but there has to be at least one relationship that basically provides a scaffold in which children develop the skills to be able to cope themselves.

That’s the ultimate answer to the question of, can you build your own resilience? The answer is for all the studies that have ever been done, no, you can’t. You can’t become resilient yourself. You can’t will yourself to be resilient. You have to be able to be supported by at least one nurturing relationship.

If we look across the incredible range of experiences and conditions that children grow up in, the principles remain the same. Children are all busy actively mastering their environment, regardless of what that environment is. The challenge is to understand what’s individually different about each child and what is the nature of the environment in which the child is living. And everything else is just figuring that out based on basic principles of what science tells us about development.

Sally: So Jack, you spoke earlier about how play helps build resilience. I’m wondering if you could you give us an example of what that might look like at different ages—for example, what would it look like for an infant?

Jack: What play is about is early on, beginning in the earliest of infancy, really, shortly after birth, is if you think about what babies do, and once babies become attuned to the people who are caring for them, it’s the kind of thing that gets everybody all excited—the eye contact, the beginning of a smile, the cooing, and the vocalizations, and all that stuff that elicits back and forth, serve and return interaction between very young infants and adults. The vocalizing back and forth, the smiling, the looking around and then looking at the same thing, and then handing something, and grabbing it, and giving it back. And, all of those very simple interactions early on are playful interactions.

And then, as you move out of the very earliest of infancy and get into the second half of the first year, when babies become more mobile, and they’re rolling over, and then they’re crawling, being able to reach for things, and grab things. You find the right balance between allowing the child some room to do things in a protected environment and also initiating some things with you. So you initiate interactions. You respond to interactions. You let a child move around. You put stuff out on the floor for a child to play with. And sometimes, hopefully, you leave the child alone in a safe place and let the child explore.

All of this, a lot of people may not think of that as play. They may think of play as more organized kinds of activities. But that is the beginning of play. It’s the beginning of active learning, discovery, curiosity, trying things, learning from what happens when you do something, action and reaction, all that stuff. And then, as you get older and you start to play more organized games, play peekaboo, play Simon Says with a child that’s a little bit older, play all these kinds of games that have rules attached to them, rules about taking turns, rules about following instructions, all of this, board games as kids get older, and then as they get into the school age years, organized games, sports, more challenging board games, again, now most people would say, oh, yeah, that’s like play. That’s what play is all about. But it started much earlier, and it started with the foundation that was all about discovery, creativity, exploration, learning.

In the best of all worlds, play doesn’t end until you die, because play is a way of thinking and engaging with the world. Play is one of the most important vehicles for having some sense of mastery and control over the world that you live in, which is getting us very close to the definition of what resilience is all about. It’s not being able to just deal with predictable things that you’re expecting and you’re prepared to cope with, but being able to deal with anything that life sends your way.

Sally: Could you talk a little bit more about how play might actually support health? What are we learning from our current research?

Jack: This is a really important question and a really important expansion of how we think about play. It’s easy to understand that most of the conversation and most of the thinking about play for the last, let’s say, last 20 years as we’ve been learning more and more about the science of early development is it naturally connects to learning and behavior. It was very brain-focused.

But it’s not just the brain that’s developing. It’s the immune system and metabolic systems. Just like the brain is experience-dependent, the immune system is experience-dependent. It’s learning about different bacteria and viruses that are out there and it’s exposed to. And as a result of that, the immune system is building resistance to those infections early on and preparing you for better physical health. And the same thing with metabolic systems. A well-regulated environment every day is affecting all of these systems. And a dysregulated environment or a highly stressed environment, as it affects the immune system, can cause increased inflammation, which is part of the stress response.

And early behavioral regulation, it leads to more health-promoting adult behaviors, less likely to engage in risk-taking behaviors, less likely to engage in addictive behaviors, problems with smoking, problems with alcohol, problems with risky physical activities that get you into trouble.

So the link with play—there’s no question that somewhere down the road over the next 10 to 20 years, we will all have an understanding that playful learning and the role of play in building resilience is as much about physical and mental health as it is about early learning and school achievement.

Sally: You’ve given us so much to think about, as always, Jack! Thanks so much for your time and being here with us today. When we come back, our panel is going to give us some examples of how they’re putting that science into action.

Musical interlude

Sally: Okay, so we’ve learned a bit about how play affects our biology. Let’s bring it out of the lab now, and into our daily lives. Most of us think about play happening in child care and on playgrounds, but play can honestly happen anywhere! In our next segment, I’m so excited to talk to our panel members, who have lots of examples to share. Joining us on today’s podcast, we have Andres Bustamante, who is an assistant professor in human development in context at the University of California Irvine. Thanks for being here today.

Andres Bustamente: Thank you, Sally. It’s such a pleasure to be here.

Sally: Also on today’s podcast, we have Lynneth Solis, who’s a researcher and lecturer at the Harvard Graduate School of Education. It’s so nice to talk to you today, Lynneth.

Lynneth Solis: Thank you, Sally. It’s a pleasure to be here.

Sally: And also on today’s podcast, we have Laura Huerta Migus, who is the deputy director of the Office of Museum Services at the Institute of Museum and Library Services. Nice to see you today.

Laura Huerta Migus: So happy to be here, Sally.

Sally: Lynneth, I know you’ve looked at research on play and how it helps to build resilience in a lot of different places and contexts. How might opportunities for play look different in some of these different contexts?

Lynneth: The interesting thing is that we see play supporting children’s coping with stress and developing resilience in all kinds of contexts. So you may find it in a simple drop-off at preschool. So that can be really stressful for a child. What we have seen is that children that are allowed a few minutes between drop-off and the start of the day to play on their own or with peers, depending on their choice, actually show reduced levels of stress, both behaviorally and biologically.

But we also can think about other settings with children being exposed to prolonged adversity, like war or being in a refugee setting, where having the opportunity to play, for example, in play groups with caregivers or with other children gives the children an opportunity to create bonds with their caregivers and with other children. And it gives them opportunities to practice some of the coping skills to deal with the difficult emotions and effects of prolonged stress.

We’ve also seen it in situations where children have hospital stays or hospital interventions, which, again, can be very foreign for children, can be very stress-producing. And when health care staff use play to introduce to children what the procedures might be, to give them some space between the introduction of these procedures and the actual medical intervention, what we see is that children show reduced levels of stress prior to the medical intervention but also post the medical intervention.

So their ability to reduce the stress after coming out of that experience also seems to allow them to regulate their stress levels more quickly and more effectively. And so what we see is that both cross-culturally but also in different types of settings, play can be very beneficial for children and for the adults and caregivers in their lives.

Sally: That was the perfect tee-up, Lynneth. Thank you. Laura, what are some examples you’ve seen that encourage play that were created by museums and libraries? I think that’s a really interesting place to be thinking about how play is happening.

Laura: Yeah. Thanks for that, Sally. So it actually builds quite a lot on what Lynneth was telling us about the evidence. So the practice of children’s libraries and children’s areas being interactive, sometimes looking like mini children’s museums for example, having “making spaces” or craft spaces is a relatively new pursuit that is now pretty mainstream practice in library design.

You’ll see the same in museums. Obviously, we have children’s galleries. We have children’s programming, even children’s tours in mainstream museums. And, of course, we take it to the extreme in museums. We actually have children’s museums, right, the entire museum that’s designed with the child’s needs and development in mind.

We also think about playful experiences, like story times. And story times that are starting for the youngest families and the youngest children to help build that sense of playfulness but also helping parents build great relationships with their babies from day one in enriched environments. And then we’re helping to be part of really a public education effort in helping to teach caregivers—so not just parents, but any adult caregiver, which could also include educators—about the value of play as learning and how important it is for child development.

Sally: Laura, I was really struck by that phrase, you said it was a public education effort. And that was making me think, Andres, of your work, thinking about engaging community. And I was wondering if you could tell us a bit more about how you engage community members authentically to help devise playful learning opportunities.

Andres: Yeah, absolutely. So I’m part of a larger project called the Playful Learning Landscapes Initiative, which was started by Kathy Hirsh-Pasek and Roberta Golinkoff—who are my mentors and close collaborators. And that project is all about designing everyday spaces, spaces where children and families naturally go and naturally spend time. You can think bus stops, parks, grocery stores, doctors’ offices, laundromats, anywhere where families go in their everyday routine, and trying to enrich those spaces with play and learning value. Because, like our other guests Lynneth and Laura have shared with us, that has so much value. Those interactions and that play time is so enriching for kids.

We are partnering with a local community organization called SAELI. SAELI stands for the Santa Ana Early Learning Initiative. And we’re partnering with SAELI in order to design public spaces so not only that they have the learning value and stay true to what developmental science tells us about what creates high-quality learning situations, but also so that they reflect the community’s values and goals and strength and culture.

And this is really important because it can have a big impact on the way that families interact and engage with the sites and really build a sense of ownership, which can really increase learning value and also longevity and usability of these sites in the community. And so SAELI has over 200 members, and it’s local parents, it’s teachers, it’s school administrators, it’s local politicians, it’s community organizing and nonprofit organizations.

And so all people coming together to promote enrichment activities and supports for families with kids 0 to 9. And so through this partnership with SAELI, we’ve held design sessions where we have about 40 mothers from Santa Ana come in and just share their vision for their community. So we have them tell stories about their childhood and their experiences growing up, sometimes in other countries or sometimes here in Santa Ana, and what they did in those spaces. What did they do at the bus stop? Or what did they do at the park? Or how was it going to the market or the grocery store? And then from those stories, we’re able to distill themes and commonalities across families’ experiences and then try to represent those experiences in the designs that we create. And then we actually have families build stuff, so we’ll bring arts and crafts kits and have them actually build out a bus stop or a game for the park.

And so families end up sharing these really special stories and games that they played as kids and that now they want to play with their kids and show other people in their community. And these games are so rich with learning value. And so it becomes this situation where we accomplish all the goals that we wanted to from a science perspective about making learning situations that create these high-quality caregiver-child interactions, but are deeply embedded in the community’s lived experiences.

Many of our families are from Mexico, and they talked about how the abacus was a really common tool for them to learn math. And so we’re going to make a bus stop that has a giant abacus. And so kids can count things and engage in math conversation while they wait for the bus. And it’s a way that we’re really building on families’ strengths and experiences of like, this is how they learned math, and so they’re really equipped to communicate math and engage in this activity with their kids.

Another game, another bus stop idea was a Loteria bus stop. So Loteria is a really popular local game. It’s kind of like bingo. You spin a wheel and then you get a symbol. And then we’re going to make a bus stop that has a big version of Loteria. And then when you get a symbol, you flip it, and there’s different activities that kids and families can engage in that are play-oriented but have a learning value. I think that there’s going to be a real deep sense of ownership, because the families are the ones who really created these designs.

Laura: I just wanted to respond, Andres, to something really important about those examples that you gave. And that often when we’re talking about children and children’s learning and play, we talk about children as if they are isolated and they’re experiencing these activities on their own or in a child-only environment.

And we know how important play can be for strengthening or building really positive adult-child relationships and what you’re talking about here in terms of identity development and cultural identity building and generational transmission of knowledge. And I just think that that’s really important, at least also think about play as not just for the child but for the child and everything around and everyone around the child. It’s good for everybody.

Sally: Very true, and it seems to me that we all need play now more than ever, especially given the past couple of years!

Laura: Families have gone through trauma on a large scale over the last two years. And I think there’s a really important moment right now where, as a country, we have the opportunity to say we know what is important for our children’s well-being and for their recovery.

Lynneth: Play allows children to deal with uncertainty. So what it allows children to do is to pivot, to adapt, to follow different paths, depending on what’s happening right in front of them. So it’s an iterative process. And those skills that are developed over time are the building blocks of those coping mechanisms that are important when children are exposed to uncertain situations, like a pandemic, et cetera. And the interesting thing is that this is also true for adults.

Laura: Some of the most impacted families and children in the pandemic were our youngest children, so pre-academic years, children 0 to 4 or 5 years old, whose parents and caregivers were essential workers, and who tended to also be in our lower socioeconomic strata. Those families and children lost access to most of their learning and care supports and were very isolated in their homes. So many of us were, but you think about a restaurant or service worker with a two-year-old and what that first year of the pandemic looked like. Virtual learning doesn’t work for a three-year-old.

One of the innovations that we saw, in the children’s museum world in particular, was the development of learning kits—very simple sets of materials, tangible materials, that were focused around fun and playful activities. Quite often, they were just small prompts to elicit pretend play and guided play between adult and child.

What we heard from hundreds and thousands of parents was that they wanted these kits. They needed materials to engage their children away from screen time and in ways that were meaningful and that gave the parents confidence and power to engage their children in something joyful in a time of incredible stress. Hundreds of thousands of these kits have been disseminated by hundreds of libraries and museums. And the need is still there, and the want is still there. And so I think that tells us something about how families feel like play is a critical part of their toolkit, their resilience toolkit.

Sally: Thank you for those thoughts; they’re so important. We’ve talked a lot about the connection between resilience and play as it relates to learning. I’m wondering, though, are there also connections between play and other kinds of development? For example, we’ve been thinking a lot about health and social-emotional skills..

Lynneth: Something that is important to understand about the connections between play and all sorts of developmental outcomes for children is that not every single play experience leads to all the outcomes. So what do I mean? That there are certain types of play that are particularly supportive of health outcomes, for example. So you might think about more physically active play that might have children practicing both fine and gross motor skills or games that might have them be, again, physically active, may help reduce stress, which is also associated to biological responses to stress that can be harmful to the body.

On the other hand, if you think about social-emotional skills, dramatic play, pretend play, storytelling are types of play that can be associated with outcomes that are about understanding emotions, knowing how to name emotions, knowing how to respond to others and their emotions, regulating how to interact with others in a positive way.

So it’s not that children should only be engaging with object play and building and learning mathematical skills or that they should only be engaged in dramatic play and developing language and social-emotional skills. But that, actually, it’s sort of the toolbox of opportunities for children to engage in different types of playful interactions with peers, with friends, but also adults, as we’ve heard from the other panelists.

Laura: I really would like to “yes, and” what Lynneth said about the different kinds of play. Especially as you’re thinking about yourself as a parent or an educator or a policymaker, there’s often wanting the answer of, what kind of play is the best? And so I think emphasizing the notion that all kinds of play is the best is so important.

And also acknowledging why different communities are going to take different approaches, because the needs are going to be different. The affordances, what’s available, what matters is going to be different from family to family, community to community. And that’s a kind of diversity and flexibility I think it’s important for us to also embrace.

Lynneth: A question we often hear is, should this be free play or guided play? Which one is the most beneficial? And I think going along with this idea of all kinds of play for different types of outcomes is the idea that free play, children being able to play uninterrupted, being able to focus, being able to set up their own challenges and figure out problem-solving strategies is incredibly important for children.

And, as we’ve also discussed in the podcast, that the interaction with others—so the added support, the added scaffolding from educators, from parents, from other adults in children’s lives—can also help expand the types of opportunities that children have to learn and to develop skills through their play. So it’s important to know that adults helping to shape play is not necessarily a negative thing.

And it’s always in relationship to what is the interaction, how are we making these interactions with children the most valuable to both allow them to take risks and build autonomy and independence while also feeling supported in their environment?

Andres: I absolutely love this conversation about different kinds of play. And I really appreciated something that Laura said, which is that in each community, this might look different. And I think that’s the beauty in this idea of designing with the people who are going to be, at the end, using the space.

And so, for example, in our work in Santa Ana, a huge theme that came through from all of our families is this idea of transmission of culture intergenerationally. You know, whether it’s their language or their culture or their customs or their childhood games, they feel like their kids are not always getting their full experience of their community.

That might not actually be a top priority for every community. But I think that’s why if you design with the people who are going to be in the space, it’s so powerful. And you end up tapping into these really valuable ideas that are really going to motivate people to use these play spaces and create the kind of rich learning that we really want to see between kids and families.

Lynneth: I love what Andres and Laura have shared about working with communities. When I think about involving communities and creating playful experiences for children, there’s three questions that I like to think about. One is, what is working here? What’s already good? And what’s most meaningful?

Both Andres and Laura have shared examples of this. How do we work with communities to say, when we think about play, we don’t want to impose an already packaged program or set of activities. What we want to learn is, what’s already working for you? What’s already meaningful for you? And how does this continue to celebrate your history, your family relationships, community relationships, and the values that you have for the children in your community? So I really, really appreciate this conversation.

Sally: Thank you all so much, this was honestly such a treat – I love hearing all of your perspectives. So thank you!

Musical interlude

Sally: So next up, we have an expert on one really important kind of setting that’s all too often overlooked: humanitarian settings for refugees. There are millions of children in these settings worldwide and they need playful experiences as much as any child. Well, fortunately, there are some very committed people working on just that, and today I’m delighted to have a chance to speak with one of them. Her name is Erum Mariam and she’s with the BRAC Institute of Educational Development. I’m so looking forward to our conversation today, Erum.

Erum Mariam: Thank you, Sally. Looking forward to this conversation with you today.

Sally: So I know that you and the BRAC Institute, as well as your partners from Sesame Workshop and other organizations, have done a lot of work bringing play to humanitarian or refugee settings. Could you tell me a little bit more about what you mean by humanitarian settings?

Erum: Sure. I’ll be speaking from my experience of the Rohingya context today. Rohingya started coming in in 2017. There were thousands and thousands of Rohingya who were coming over from Myanmar and coming to Bangladesh to a place named Cox’s Bazaar. It’s the largest refugee camp in the world, and with about almost a million people.

So I will be talking about people who have been displaced from their own country. And in this case, it’s really very, very sad because they came away after the genocide in Myanmar. And there were women with infants and toddlers. They came with the most essential belongings, their families. And then they went into shelters, which were absolutely very temporary, with bamboo and then plastic sheets on top. And then after that, they moved more into what looked like housing. But these houses are of two, three rooms and made of bamboo as well as sheets. And that’s the humanitarian setting.

Sally: Wow. Could you give me a sense of how many children in particular are in this kind of setting worldwide, and maybe give us a glimpse into what that situation might look like for a child in particular?

Erum: I think, worldwide, the amount of displaced population is somewhere around 82 million. And out of that, believe it or not, it’s thought that about 42% are children. That’s around 34 million children we are talking about. It’s a really big number of children.

And what it’s like for children, I mean, one day, I saw this, I observed this, and it has really stayed with me. That there was a child who was about two years old, and she was with the mother. And the mother was given some—they were getting relief materials, and the mother got biscuits. And I saw that the mother took a piece of stone and the packet, and she was crushing the biscuits. As she crushed the biscuits, and it became powder, and she took the powder, and she was feeding the child. And then she was taking some for herself. Because you know, there were days that they wouldn’t get meals. And so even in the extremely difficult situation, I saw that mothers and parents tried their best for the children.

After that, when I observed that they got some kind of housing, we could see parents trying so hard to get a sense of normalcy, to give a sense of normalcy to their children in a very, very difficult situation. So I would see moms and dads getting water, moms cooking, dads getting bamboo to make the house stronger, parents drying their chilis and other things on the rooftop. And so just to give that sense of normalcy to everyday life in a very, very difficult situation.

Sally: I can imagine in these moments, where people are struggling to have access to food and water, that play might be something that’s lost. And in some cases, rightfully so, right? You need to make sure you’re treating these more immediate needs. Could you tell us a little bit more about why play should still be considered important in these settings?

Erum: Sure. Play does have this power of creating a very nurturing environment. And play of course has so much to do with relationships, because when children play, there is a relationship there. There is a caregiver or even their older siblings also in that space. When there are these situations of real deprivation, of so much of trauma, and if we can have these situations where there is nurturing and there is stimulation, I think that’s really fantastic for the children, that there are these opportunities for child development.

Sally: Erum, I love that you highlighted that responsive relationship with an adult or sibling. I think that’s really critical in terms of developing resilience. Could you give me an example of how these playful approaches might be integrated into these settings?

Erum: Yes, absolutely. In 2017, when we were there in the camp, and one day we were at a center. It was a child-friendly space, and the children were there. And we went in and we said, what do you want to show us? Show us anything that you really want to show and you’re proud of. And the children all got up and they were chanting a rhyme.

And believe it or not, Sally, when the children were chanting, we found that community members, they came and they surrounded the center. And they surrounded the center because with the chanting and with the children clapping and chanting, there was a connection with the community.

So we started exploring the Rohingya culture. We asked the children, what did you do when you were in Myanmar? And they showed us the most fascinating physical play. We asked the children, what do you like drawing? And they showed us motifs which were different. Children even as young as age two were able to hold the crayon. And they had really good fine motor skills. And so they were showing us the motifs of art.

We explored, we were exploring with the caregivers. We asked what is it that they had that belongs to the Rohingya culture. They showed us designs of cloth that they used to have in every household that would hang under the ceiling. The caregivers, the community members, they told us stories which were very much about the Rohingya culture and history.

As we developed this content, we spoke to child therapists. And the child therapists, they told us that, don’t you see what you have done. What you have done is you’ve been working on learning through play, but what you have really done here is healing through play.

And so they said that the two elements that you have been able to bring out is you have given so much emphasis on the children’s voices that they could say—they could tell you that this is what we did, this is what we like, this is what we play, and things like that. And the second was that we respected the Rohingya culture. And the Rohingya have beautiful play. And their play is really about coordination and balance. And they were bringing that to us and to the world.

Sally: Incredible. I really loved it when you were talking about both respect for the culture and how they play, as well as respect for children as autonomous and humans that have their own beliefs and ideas and creative thinking, too. I think that’s a really powerful mix. I’m wondering if you could tell us a little bit more about how this pandemic that we’re experiencing has affected your work with the Rohingya?

Erum: Once there was the lockdown and there was restricted mobility, parents of course had to step up. And that meant that every child’s home had to be, had to have an environment which was so very stimulating for the child.

So every week we would call the mother for 20 minutes. For the first 10 minutes, we would speak about her mental health issues. Was she having any kind of difficulty? How were the days? Is there anything that she wanted to speak to us about? And the next 10 minutes was about the playful approaches with the child. And so the child and the mom and the facilitator who was calling on the phone. And so this was, the next 10 minutes was about the chanting, the rhymes that the children love doing, and also some physical play that would be possible under those circumstances.

This was something that was totally emerged from COVID. And what we have found is when we looked at all the data and the results of the 20-minute phone call, we found that this has shown so much of improvement in the children’s communication and language, in children’s social-emotional development and cognitive development. So those are results that we’re extremely excited about. And so we look forward to much more.

Sally: That’s thrilling. And I feel like this thread that’s gone throughout this interview is around listening and how important that’s been for you and your organization, and how that’s meant that the resources you provide are so much more targeted. And that’s beautiful.

I have one last question for you. The needs for international refugees seem really huge and daunting. And we were wondering if you could share a little bit more around how might listeners of the podcast take action, or any feelings you have around hope that you’d like us to end on.

Erum: Yeah. My experiences with working with the refugees have shown that those who are displaced, their experiences are so hard. And so they live under such harsh realities. But what I have found is that their spirit is so—they have so much resilience. And there’s so much spirit for them to go on.

Because at the end of the day, we go back to our lives. But the people who are living in these conditions, they go on, and they find normalcy. They find aspirations. They find dreams. They find—under the most difficult of conditions. So the best we can do is just keep on supporting. Whatever opportunity we get. Whenever there’s a chance for any kind of resources, contribute there. So any opportunity to be there to amplify the cause and be a part of the solutions for the humanitarian settings.

Sally: Thank you so much for your time, Erum, I really enjoyed our conversation. And for listeners, we’ll post resources and information relating to the support for children in humanitarian settings on our website, which is developingchild.harvard.edu. When we come back, we’ll wrap up with a pediatrician’s important prescription for parents.

Musical interlude

Sally: And we’re back! After so much emphasis on what societies and communities can do, we wanted to close with something really practical that everyone could do. Joining us on today’s podcast, we have Dr. Michael Yogman who’s a pediatrician and faculty at Harvard Medical School and Cambridge Hospital. It’s so nice to talk to you today, Dr. Yogman.

Michael Yogman: Thank you so much for inviting me.

Sally: One thing I didn’t say in my introduction is that you are actually the founder and driver of an initiative of the American Academy of Pediatrics; it’s called Prescription for Play. The idea is to encourage pediatricians to actively prescribe play for children to support their healthy development, and then to give them some tools and resources for the kinds of playful interactions they might suggest to parents. Could you tell me a little bit more about what the Prescription for Play initiative is, and where did it come from?

Michael: I spent about six years as chairman of the board of the Boston Children’s Museum. I was also chairing a committee of the American Academy of Pediatrics and had agreed to write a clinical report on play in early childhood. It occurred to me that pediatricians often considered play frivolous, parents often considered play frivolous. And there had been an increasing movement about taking the focus on learning standards, and third grade, and literacy, and moving that kind of No Child Left Behind testing standard back into preschool and early child care. And I interviewed a teacher who was weeping because her director said that she should remove the blocks from her child care center. And I said, you know what? That’s nuts!

It started a notion that we could point out to pediatricians that just like any other medicine, they could write a “prescription for play” at all well visits, and that it would convey a message that play was not frivolous, that it was brain-building. We realized the role that play could play in promoting safe, stable, nurturing relationships, which were critical to resilience. And pediatricians could play an important role in incentivizing parents to value play.

I think the pandemic and its ensuing stresses, this child mental health emergency that we’re now seeing, never has it been more important for kids to be able to play. The notion that we’re going to make up for the learning loss through remote learning, by hammering kids with more stressful academic pressure is only compounding the stresses of child mental health. Play has a really important role in buffering the stress that is really preventive.

Sally: Do you have any sense of how many pediatricians are participating in this?

Michael: So it’s an uphill battle. I think just as I think we really were making headway, lo and behold, the pandemic hit. Pediatricians are very supportive of this concept. I think that any changes have been a little bit put on the back burner as they’ve just tried to get kids immunized, move away from virtual visits toward in-person visits. And I think we’ll get back to an emphasis on play. So I think it’s been picked up actually in hospitals in Denmark, and in Salt Lake City, and by the LEGO Foundation. I’ve gotten lots of inquiries on trying to transform pediatric waiting rooms, hospital waiting rooms to really promulgate a lot of these ideas. And part of the purpose is to enable parents to realize the value in observing what their kids are doing during play rather than sitting on their iPhones during the waiting room.

Sally: It’s exciting to hear, and I can only imagine how frustrating that was to feel like you were getting traction and then have this pandemic hit.

Michael: Unbelievable.

Sally: So could you give our listeners three ideas or maybe three tips that represent how pediatricians might guide parents to support healthy child development through play?

Michael: I think that acknowledging when really young infants have that brief period of quiet alertness and they’re cooing, to realize those are meaningful moments, and parents want to be responsive and engaged. Even if it’s brief. It’s important. So that’s number one. When they coo and you coo back at them, they’re really learning about turn-taking. That’s an important skill for the pragmatics of language development, which evolves later on.

Number two, the power of letting kids explore. There’s some wonderful research by Alison Gopnik that if parents were too pushy, you gave them a toy with multiple aspects of it, if parents were too pushy at demonstrating all the things, the kids weren’t interested. If you let the children explore it on their own, they did much more active exploration and were much more joyful about discovering things on their own.

And the third one is just to emphasize the importance of reading, and singing, and letting kids even play. You don’t need to buy expensive toys, playing with wooden spoons and plastic Tupperware that are just around the house. Since parents are using those objects, kids are really excited to pretend that they’re adults and exploring those objects just as the adults are using them.

Sally: It’s funny, they’re all ready to grow up and turn into adults, and here we are as adults sometimes wishing we could be kids again, right?

Michael: Exactly. And I think for parents to, the final advice is as adults, I love George Bernard Shaw’s quote: “We don’t stop playing because we grow old, we grow old because we stop playing.” Probably a good note to end on.

Sally: Perfect. I really have enjoyed talking with you.

Musical interlude

Sally: So that concludes our look at how play builds resilience and what we can do to support it. I’d like to thank all of our guests, those conversations were so much fun, I really learned so much on today’s episode. And thank you for sharing your personal experiences and your stories. I’m your host, Sally Pfitzer, and we hope you’ll join us next time!

The Brain Architects is a product of the Center on the Developing Child at Harvard University. Harold Shawn of Levelsoundz Productions was our audio editor for this episode and Lauren Osgood was our production assistant. Our music is “Brain Power” by Mela from freemusicarchive.org. You can find much more on the science of child development at developingchild.harvard.edu, where we’ll post any resources that were discussed in this episode. We’re also on Twitter (@HarvardCenter), Facebook (@centerdevelopingchild), Instagram (@developingchildharvard), and LinkedIn (Center on the Developing Child at Harvard University).

**COVID-19 Special Edition: Mental Health Vital Signs** Jun 16, 2021
The devastating toll of the pandemic has underscored the critical importance of connecting what science is telling us to the lived experiences of people and communities. In March of 2020, we recorded episodes exploring the impact the coronavirus pandemic could have on child development. Now, a year later, we wanted to continue these conversations and discuss what we’ve learned, what needs to change, and where we go from here.

Contents

Podcast

Speakers

Additional Resources

Transcript

In the final episode in this special series, host Sally Pfitzer speaks with Dr. Nancy Rotter, a pediatric psychologist and the Director of Psychology in Child and Adolescent Psychiatry, Ambulatory Care Division at Massachusetts General Hospital. They discuss how the pandemic changed conversations around mental health, why we need to integrate mental health into the context of overall health, and what caregivers can do to help children prepare for the lessening of restrictions and the return to school.

Subscribe below via your podcast platform of choice to receive all new episodes as soon as they’re released.

Speakers

Sally Pfitzer, Podcast Host

Dr. Nancy Rotter, Pediatric Psychologist and Director of Psychology, Child and Adolescent Psychiatry, Ambulatory Care Division at Massachusetts General Hospital; Assistant Professor, Harvard Medical School

Additional Resources

Resources from the Center on the Developing Child

The Brain Architects Podcast: COVID-19 Special Edition: Mental Health in a Locked-Down World

Q&A: The Coronavirus Pandemic: Mental Health One Year Later

Re-Envisioning, Not Just Rebuilding: Looking Ahead to a Post-COVID-19 World

Working Paper 15: Connecting the Brain to the Rest of the Body: Early Childhood Development and Lifelong Health Are Deeply Intertwined

InBrief: Connecting the Brain to the Rest of the Body

A Guide to COVID-19 and Early Childhood Development Resources

Resources recommended by Dr. Nancy Rotter

Interim Guidance on Supporting the Emotional and Behavioral Health Needs of Children, Adolescents and Families During the COVID-19 Pandemic

Mothers—and fathers—report mental, physical health declines

Mental Health Impact of the COVID-19 Pandemic: An Update

Depression and anxiety in pregnancy during COVID-19: A rapid review and meta-analysis

COVID-19’s Disproportionate Effects on Children of Color Will Challenge the Next Generation

A Guide to Mental Health Resources for COVID-19

How to Talk to Your Children About the Coronavirus (COVID-19)

Preparing Children for When Their Parents Return to Work

National Alliance on Mental Health: Mental Health By the Numbers

Transcript

**Sally:** Welcome to *The Brain Architects*, a podcast from the Center on the Developing Child at Harvard University. I’m your host Sally Pfitzer. In March of 2020, we recorded episodes exploring the impact the coronavirus pandemic could have on child development. You may remember we discussed the importance of self-care for caregivers, and the importance of physical distancing, not social distancing.  And now a year later, we wanted to continue those conversations and discuss what we’ve learned, what needs to change, and where we go from here.

Joining us on today’s podcast, we have Dr. Nancy Rotter. She’s a pediatric psychologist and the Director of Psychology in Child and Adolescent Psychiatry, Ambulatory Care Division, at Mass General Hospital. Thanks so much for being with us today, Nancy.

**Dr. Rotter:** Thanks for having me, Sally.

**Sally:** So, the pandemic has made conversations about mental health more common and perhaps even less stigmatized. How do we make sure that this perspective and these conversations continue even as vaccines become available and restrictions are lessened?

**Dr. Rotter:** You know, I agree that there has been some shifting over time in terms of awareness and acknowledgement about mental health and specifically children’s mental health. I think the pandemic has really raised these conversations to a higher level. I think that there’s certainly been comfort in talking about heightened distress that people have experienced due to the pandemic secondary to the many stressors that families have experienced. I think about things like loss of typical childcare support, like daycare, in-person school, or even grandparents caring for children, unemployment or shifts to having to work at home, social isolation. And I think all of these things are widely understood as contributing to how people are coping and to mental health. I think sometimes people find it easier to describe experiences of anxiety and depression in the context of stress and the stress perhaps experienced by the pandemic. You might not hear those words as much. You might hear things that sound less stigmatizing—that people might talk a lot about stress or isolation or fatigue, rather than referring to specific mental health conditions themselves.

I do think that it might be a good direction to go in to think about how we can acknowledge mental health conditions as an aspect of overall health so that we can increasingly talk about things like depression or anxiety or substance use disorders in the same way that we speak about diabetes or heart disease. Shifting towards a more specific and accurate language for mental health conditions can really make a difference. because I think if we do so we can really add clarity for diagnoses, which then result in leading to more effective evidence-based treatments to treat these illnesses. Again, thinking about these like we do other health conditions.

I think the continued progress, to kind of get to the other part of your question, towards the de-stigmatization of mental health conditions will really require increased and ongoing discussions about emotional health, and to have this happen in schools, in the media, within families, and certainly when children go to see their pediatrician. I think that pediatricians more and more are providing mental health screenings at routine exams, asking developmentally based questions to both parents and children or adolescents to screen for things that are concerning—anxiety, depression, suicidality, substance use disorders. And I kind of like the idea of thinking of that type of screening as mental health vital signs. And for me, that fits with the concept that when you go to your pediatrician or you go to your doctor, there’s always vital signs. They take your heart rate and your blood pressure, and it seems to me that using that kind of language really is helpful and is something that’s understandable to everyone and can help to really de-stigmatize the concept of mental health. And I do hope that we continue to work in the direction of integration of mental health into the context of overall health.

**Sally:** Yeah, absolutely. So many important points, and I especially love that idea of the vital signs. Nancy, from your perspective, has the pandemic exposed any weaknesses in our mental health care systems, particularly for young children? And how should we take those into consideration as we move forward?

**Dr. Rotter:** I would describe the primary challenges in our mental health care system for young children as twofold. The first relates to access to mental health care and the second is for increased need for prevention and early intervention services. While thinking about the importance of mental health care for children, I think it’s really important to be aware of some of the prevalence rates. For example, 50% of all life-time mental illness begins by age 14 and 75% begins by age 24. So, it’s very clear that making sure that we are keeping an eye on and assessing children and adolescents is key.

I have to say that the pandemic has impacted access to mental health care in somewhat of a complicated way. On the one hand, unfortunately, there’s been an increased need for mental health services for everyone, and specifically for children, and the need has really outstripped the availability of services. This has occurred in the setting of overall improved ability to access care via telehealth. Telehealth, through both the use of video and telephone visits has improved access in many ways. Families who struggle with transportation, that don’t have the time, that have financial limitations—it’s allowed them to access behavioral health care more readily. However, this is further complicated as telehealth access has not been equitable. Black, Latino, and non-English speaking patients, and patients living in communities hardest hit by the pandemic demonstrate consistently lower rates of use and access to video-enabled technology.

And while overall access to care has been a problem during the pandemic and it’s not easily solved, there’s been some hopeful news in Massachusetts. Effective January 1st of this year, the state legislature passed a bill requiring insurers to pay for services conducted by either telephone or by video technology at the same rate of reimbursement that they cover in-person visits. And I do think that’s really going to make a difference. That isn’t going to solve our immediate problem of access during the pandemic, but hopefully that knowing that that’s going to be an option down the road that that will allow for additional ways that we can help people.

In terms of prevention and early intervention, I think addressing the mental health needs of young children when they present with mild symptoms—like sleep or feeding, or toileting, anxiety or behavioral issues—sometimes might not get identified until they reach a level that really requires urgent intervention. However, preventative and early intervention when the initial or the mild symptom becomes apparent can be extremely useful, and my thinking is that it can be improved by having mental health professionals in the clinic, with the pediatricians so that there’s behavioral health care integration. And that way, making services available in the context of the yearly pediatric checkup, which families typically come to, that there would be screening and opportunity for intervention when families are coming every year or even for other visits.

In my work at MGH, in pediatric behavioral medicine, we’ve been very successful at embedding psychologists in specialty medical clinics like gastroenterology and diabetes and food allergy, which is where I work. Sometimes, for example in food allergy, I will meet with a family where a child is very anxious about having a blood test. And so, I can—at a minimum—meet with the child then and if they’re not ready to do a blood test that day with intervention, that now they know me and they can come back a couple of times to see me and I can help prepare them for that. And so, catching families where they’re going to get their medical care and being able to help them in that context is really important and really useful. This is something that has been established in many primary care clinics and hospitals across the country. The idea is to really think about a variety of services that might best meet the needs of the family by offering some in-clinic consultation, some brief treatment, access to parenting groups, and potentially digital health interventions in addition to the more traditional therapy and medication treatments that we all know about.

**Sally:** I really love this idea of integration. In particular, at the Center, we talk a lot about the need for responsive relationships and I hear a lot of what you’re saying there is that if you’re able to build those responsive relationships early with kids, you have a better chance at allowing them to benefit from your services if they know you better.

**Dr. Rotter:** Absolutely. And you know, one of the other statistics that I think is so powerful is that when referrals are made by anyone—by physicians or pediatricians—to a mental health professional, approximately 50% of those do not follow through. And so, by having someone actually live in the clinic to meet the family—sometimes even what we call as a warm hand-off—where they just are introduced, they get to see a face and a name, and there’s a connection that can really reduce the gap we have sometimes when they’re referrals that don’t make it to the referral source.

**Sally:** So, in a Q&A for Mass General Hospital on preparing children for when their parents return to work, you said, and I’ll quote you here, “Parents may experience their own anxiety about having children return to daycare due to the worries about COVID and may inadvertently send signals to children about their own anxiety.” Could you give us some ideas on how we can support caregivers during this adjustment period?

**Dr. Rotter:** Absolutely, in supporting parents and caregivers, it’s important to be aware that they may have their own mental health needs and perhaps had mental health issues prior to the pandemic. The toll that the pandemic has had on caregivers and parents has been tremendous. Caregivers have been required to step into roles that they were neither trained to do nor prepared for, such as becoming teachers to their children, providing full-time childcare while at the same time working a full-time job or perhaps coping with stress of unemployment or the loss of loved ones.

Self-care strategies can range from taking a few minutes to read an email from a friend, a section of the paper. Additionally, self-care can come in the form of family activities, creating scavenger hunts or obstacle courses for children, or even coming up with healthy cooking projects can combine self-care with family time. And I think that sometimes there are things that we might do that are really self-care that we may not consider self-care. They might be small, or they might be small and done every day and even that sense of routine can provide a break, can provide some comfort, and can provide some predictability. I think we’ve all been dealing with the lack of predictability in quite a profound way during the pandemic. And I’m not sure that’s going to change quickly as things open up in different pieces and in different ways.

**Sally:** I really appreciate that lens on the caregiver, and I wonder if you could talk a little bit more about how caregivers can ease their children back into normal life, while at the same time remaining cognizant of the stressors of this past year. And if you could speak specifically to infants and toddlers, I think their fears are sometimes a little less obvious to us.

**Dr. Rotter:** Absolutely, young children may exhibit distress through behavioral changes or shifts in their typical functioning, which can include sleep, eating, toileting, anxiety, tantrums, or increased irritability. And it’s hard to know when that happens what that could be a function of. It’s really important that if there are changes—abrupt changes or unusual changes in a child’s functioning—it’s really important to seek out consultation from your child’s pediatrician in order to rule out any underlying medical issues as a first step. And if at that point in conversation with the pediatrician, the belief is that perhaps what is being experienced by the child are indicators of stress or anxiety, that’s a time where a referral to a mental health professional from your pediatrician can be very helpful.

Many children and families are currently adjusting to the increased amount of time children are spending in-school and/or activities that were not happening during the pandemic restrictions. It’s typical and expected for infants and toddlers to experience discomfort when separating from their parents or caregivers, and this may in fact be exacerbated by the extended period of time they spent at home during the pandemic with parents or caregivers. So, it’s helpful to have a plan in mind. For older children, maybe toddlers, talking with them about familiar school activities that they may remember from when they were in school in the past, such as things that they played with or listening to stories, can help them prepare for their new schedules. But it’s also useful to think about what might be different, like the teacher will be wearing a mask, and there might be new hand-washing rules. They might tell their child, “we’ll wake up in the morning and have breakfast together and then you’ll go off to school, where you’re playing with your friends and you’ll be with your teachers and have lunch with them. And then you’ll return when it’s about time for dinner, we’ll all have dinner together.”

Additionally, for older children, sometimes the process of rehearsing going to school through play with dolls or figures can help reduce the stress. Reading books about returning to school can be useful as well. When possible, even for very young children, doing a short visit to school or daycare to acquaint or reacquaint the child with the classroom and the teacher can ease the transition as well. Even starting back in a more gradual manner can be helpful if that’s an option—going for a couple of hours the first few days and then working up to longer periods of time at the daycare center or preschool. Parents might also find talking with their children in the direct, but simple way about the coronavirus and how their child’s school or daycare has rules to make sure everyone is safe and healthy. For example, they may tell their children that their school is listening to the things that the doctors and the scientists are saying about going to school safely, and those are the things that they’re doing at school.

**Sally:** I know a lot of kids have been really isolated the last year, some maybe have only one friend or no younger children that they see. So, could you talk a little bit more about that social isolation or maybe potential anxiety that might be resulting from that?

**Dr. Rotter:** Yeah, I think social anxiety is a concern that many caregivers and parents have and some children have. I think for children who are naturally slightly more shy or anxious, particularly in new situations, that reentering social environments can be quite challenging. I would think a lot with the family about ideas such as previewing what to expect. Sometimes for young children looking at pictures of someone they maybe haven’t seen in a while, thinking about things they did before with that child that might have been fun or interesting when we’re thinking of young children.

Another thing that I talk a lot about with families when children have some anxiety about social situations is the structured play date. I think the idea of having a very specific plan in mind for an activity that’s really time based, so it’s not a long unstructured period of time, but it might be that a child comes over for lawn bowling and cookies and lemonade. And then that’s the end of that particular playdate. Or a specific arts or crafts activity or something along those lines, but that everyone knows what the expectation it, that there’s it’s something else to focus on, and sometimes that really helps to sort of build things. And often, what we’ll find is in those situations, that once children are comfortable with each other or reconnect in the case of they haven’t seen each other in a while that they can sort of take it from there. But some children need more, more structured play dates to help build in that comfort in a social setting.

**Sally:** There’s so many people, who I think will be comforted by your examples, because you gave really clear ideas on how to move things forward. So really, we’re really delighted.

I’m your host, Sally Pfitzer. The Brain Architects is a product of the Center on the Developing Child at Harvard University. You can find us at developingchild.harvard.edu. We’re also on Twitter @HarvardCenter, Facebook @CenterDevelopingChild, Instagram @DevelopingChildHarvard and LinkedIn, Center on the Developing Child at Harvard University. Brandi Thomas is our producer. Dominic Mathurin is our audio editor. Our music is Brain Power by Mela from freemusicarchive.org. This podcast was recorded at my dining room table.

**COVID-19 Special Edition: Mental Health Vital Signs** Jun 16, 2021
The devastating toll of the pandemic has underscored the critical importance of connecting what science is telling us to the lived experiences of people and communities. In March of 2020, we recorded episodes exploring the impact the coronavirus pandemic could have on child development. Now, a year later, we wanted to continue these conversations and discuss what we’ve learned, what needs to change, and where we go from here.

Contents

Podcast

Speakers

Additional Resources

Transcript

In the final episode in this special series, host Sally Pfitzer speaks with Dr. Nancy Rotter, a pediatric psychologist and the Director of Psychology in Child and Adolescent Psychiatry, Ambulatory Care Division at Massachusetts General Hospital. They discuss how the pandemic changed conversations around mental health, why we need to integrate mental health into the context of overall health, and what caregivers can do to help children prepare for the lessening of restrictions and the return to school.

Subscribe below via your podcast platform of choice to receive all new episodes as soon as they’re released.

Speakers

Sally Pfitzer, Podcast Host

Dr. Nancy Rotter, Pediatric Psychologist and Director of Psychology, Child and Adolescent Psychiatry, Ambulatory Care Division at Massachusetts General Hospital; Assistant Professor, Harvard Medical School

Additional Resources

Resources from the Center on the Developing Child

The Brain Architects Podcast: COVID-19 Special Edition: Mental Health in a Locked-Down World

Q&A: The Coronavirus Pandemic: Mental Health One Year Later

Re-Envisioning, Not Just Rebuilding: Looking Ahead to a Post-COVID-19 World

Working Paper 15: Connecting the Brain to the Rest of the Body: Early Childhood Development and Lifelong Health Are Deeply Intertwined

InBrief: Connecting the Brain to the Rest of the Body

A Guide to COVID-19 and Early Childhood Development Resources

Resources recommended by Dr. Nancy Rotter

Interim Guidance on Supporting the Emotional and Behavioral Health Needs of Children, Adolescents and Families During the COVID-19 Pandemic

Mothers—and fathers—report mental, physical health declines

Mental Health Impact of the COVID-19 Pandemic: An Update

Depression and anxiety in pregnancy during COVID-19: A rapid review and meta-analysis

COVID-19’s Disproportionate Effects on Children of Color Will Challenge the Next Generation

A Guide to Mental Health Resources for COVID-19

How to Talk to Your Children About the Coronavirus (COVID-19)

Preparing Children for When Their Parents Return to Work

National Alliance on Mental Health: Mental Health By the Numbers

Transcript

**Sally:** Welcome to *The Brain Architects*, a podcast from the Center on the Developing Child at Harvard University. I’m your host Sally Pfitzer. In March of 2020, we recorded episodes exploring the impact the coronavirus pandemic could have on child development. You may remember we discussed the importance of self-care for caregivers, and the importance of physical distancing, not social distancing.  And now a year later, we wanted to continue those conversations and discuss what we’ve learned, what needs to change, and where we go from here.

Joining us on today’s podcast, we have Dr. Nancy Rotter. She’s a pediatric psychologist and the Director of Psychology in Child and Adolescent Psychiatry, Ambulatory Care Division, at Mass General Hospital. Thanks so much for being with us today, Nancy.

**Dr. Rotter:** Thanks for having me, Sally.

**Sally:** So, the pandemic has made conversations about mental health more common and perhaps even less stigmatized. How do we make sure that this perspective and these conversations continue even as vaccines become available and restrictions are lessened?

**Dr. Rotter:** You know, I agree that there has been some shifting over time in terms of awareness and acknowledgement about mental health and specifically children’s mental health. I think the pandemic has really raised these conversations to a higher level. I think that there’s certainly been comfort in talking about heightened distress that people have experienced due to the pandemic secondary to the many stressors that families have experienced. I think about things like loss of typical childcare support, like daycare, in-person school, or even grandparents caring for children, unemployment or shifts to having to work at home, social isolation. And I think all of these things are widely understood as contributing to how people are coping and to mental health. I think sometimes people find it easier to describe experiences of anxiety and depression in the context of stress and the stress perhaps experienced by the pandemic. You might not hear those words as much. You might hear things that sound less stigmatizing—that people might talk a lot about stress or isolation or fatigue, rather than referring to specific mental health conditions themselves.

I do think that it might be a good direction to go in to think about how we can acknowledge mental health conditions as an aspect of overall health so that we can increasingly talk about things like depression or anxiety or substance use disorders in the same way that we speak about diabetes or heart disease. Shifting towards a more specific and accurate language for mental health conditions can really make a difference. because I think if we do so we can really add clarity for diagnoses, which then result in leading to more effective evidence-based treatments to treat these illnesses. Again, thinking about these like we do other health conditions.

I think the continued progress, to kind of get to the other part of your question, towards the de-stigmatization of mental health conditions will really require increased and ongoing discussions about emotional health, and to have this happen in schools, in the media, within families, and certainly when children go to see their pediatrician. I think that pediatricians more and more are providing mental health screenings at routine exams, asking developmentally based questions to both parents and children or adolescents to screen for things that are concerning—anxiety, depression, suicidality, substance use disorders. And I kind of like the idea of thinking of that type of screening as mental health vital signs. And for me, that fits with the concept that when you go to your pediatrician or you go to your doctor, there’s always vital signs. They take your heart rate and your blood pressure, and it seems to me that using that kind of language really is helpful and is something that’s understandable to everyone and can help to really de-stigmatize the concept of mental health. And I do hope that we continue to work in the direction of integration of mental health into the context of overall health.

**Sally:** Yeah, absolutely. So many important points, and I especially love that idea of the vital signs. Nancy, from your perspective, has the pandemic exposed any weaknesses in our mental health care systems, particularly for young children? And how should we take those into consideration as we move forward?

**Dr. Rotter:** I would describe the primary challenges in our mental health care system for young children as twofold. The first relates to access to mental health care and the second is for increased need for prevention and early intervention services. While thinking about the importance of mental health care for children, I think it’s really important to be aware of some of the prevalence rates. For example, 50% of all life-time mental illness begins by age 14 and 75% begins by age 24. So, it’s very clear that making sure that we are keeping an eye on and assessing children and adolescents is key.

I have to say that the pandemic has impacted access to mental health care in somewhat of a complicated way. On the one hand, unfortunately, there’s been an increased need for mental health services for everyone, and specifically for children, and the need has really outstripped the availability of services. This has occurred in the setting of overall improved ability to access care via telehealth. Telehealth, through both the use of video and telephone visits has improved access in many ways. Families who struggle with transportation, that don’t have the time, that have financial limitations—it’s allowed them to access behavioral health care more readily. However, this is further complicated as telehealth access has not been equitable. Black, Latino, and non-English speaking patients, and patients living in communities hardest hit by the pandemic demonstrate consistently lower rates of use and access to video-enabled technology.

And while overall access to care has been a problem during the pandemic and it’s not easily solved, there’s been some hopeful news in Massachusetts. Effective January 1st of this year, the state legislature passed a bill requiring insurers to pay for services conducted by either telephone or by video technology at the same rate of reimbursement that they cover in-person visits. And I do think that’s really going to make a difference. That isn’t going to solve our immediate problem of access during the pandemic, but hopefully that knowing that that’s going to be an option down the road that that will allow for additional ways that we can help people.

In terms of prevention and early intervention, I think addressing the mental health needs of young children when they present with mild symptoms—like sleep or feeding, or toileting, anxiety or behavioral issues—sometimes might not get identified until they reach a level that really requires urgent intervention. However, preventative and early intervention when the initial or the mild symptom becomes apparent can be extremely useful, and my thinking is that it can be improved by having mental health professionals in the clinic, with the pediatricians so that there’s behavioral health care integration. And that way, making services available in the context of the yearly pediatric checkup, which families typically come to, that there would be screening and opportunity for intervention when families are coming every year or even for other visits.

In my work at MGH, in pediatric behavioral medicine, we’ve been very successful at embedding psychologists in specialty medical clinics like gastroenterology and diabetes and food allergy, which is where I work. Sometimes, for example in food allergy, I will meet with a family where a child is very anxious about having a blood test. And so, I can—at a minimum—meet with the child then and if they’re not ready to do a blood test that day with intervention, that now they know me and they can come back a couple of times to see me and I can help prepare them for that. And so, catching families where they’re going to get their medical care and being able to help them in that context is really important and really useful. This is something that has been established in many primary care clinics and hospitals across the country. The idea is to really think about a variety of services that might best meet the needs of the family by offering some in-clinic consultation, some brief treatment, access to parenting groups, and potentially digital health interventions in addition to the more traditional therapy and medication treatments that we all know about.

**Sally:** I really love this idea of integration. In particular, at the Center, we talk a lot about the need for responsive relationships and I hear a lot of what you’re saying there is that if you’re able to build those responsive relationships early with kids, you have a better chance at allowing them to benefit from your services if they know you better.

**Dr. Rotter:** Absolutely. And you know, one of the other statistics that I think is so powerful is that when referrals are made by anyone—by physicians or pediatricians—to a mental health professional, approximately 50% of those do not follow through. And so, by having someone actually live in the clinic to meet the family—sometimes even what we call as a warm hand-off—where they just are introduced, they get to see a face and a name, and there’s a connection that can really reduce the gap we have sometimes when they’re referrals that don’t make it to the referral source.

**Sally:** So, in a Q&A for Mass General Hospital on preparing children for when their parents return to work, you said, and I’ll quote you here, “Parents may experience their own anxiety about having children return to daycare due to the worries about COVID and may inadvertently send signals to children about their own anxiety.” Could you give us some ideas on how we can support caregivers during this adjustment period?

**Dr. Rotter:** Absolutely, in supporting parents and caregivers, it’s important to be aware that they may have their own mental health needs and perhaps had mental health issues prior to the pandemic. The toll that the pandemic has had on caregivers and parents has been tremendous. Caregivers have been required to step into roles that they were neither trained to do nor prepared for, such as becoming teachers to their children, providing full-time childcare while at the same time working a full-time job or perhaps coping with stress of unemployment or the loss of loved ones.

Self-care strategies can range from taking a few minutes to read an email from a friend, a section of the paper. Additionally, self-care can come in the form of family activities, creating scavenger hunts or obstacle courses for children, or even coming up with healthy cooking projects can combine self-care with family time. And I think that sometimes there are things that we might do that are really self-care that we may not consider self-care. They might be small, or they might be small and done every day and even that sense of routine can provide a break, can provide some comfort, and can provide some predictability. I think we’ve all been dealing with the lack of predictability in quite a profound way during the pandemic. And I’m not sure that’s going to change quickly as things open up in different pieces and in different ways.

**Sally:** I really appreciate that lens on the caregiver, and I wonder if you could talk a little bit more about how caregivers can ease their children back into normal life, while at the same time remaining cognizant of the stressors of this past year. And if you could speak specifically to infants and toddlers, I think their fears are sometimes a little less obvious to us.

**Dr. Rotter:** Absolutely, young children may exhibit distress through behavioral changes or shifts in their typical functioning, which can include sleep, eating, toileting, anxiety, tantrums, or increased irritability. And it’s hard to know when that happens what that could be a function of. It’s really important that if there are changes—abrupt changes or unusual changes in a child’s functioning—it’s really important to seek out consultation from your child’s pediatrician in order to rule out any underlying medical issues as a first step. And if at that point in conversation with the pediatrician, the belief is that perhaps what is being experienced by the child are indicators of stress or anxiety, that’s a time where a referral to a mental health professional from your pediatrician can be very helpful.

Many children and families are currently adjusting to the increased amount of time children are spending in-school and/or activities that were not happening during the pandemic restrictions. It’s typical and expected for infants and toddlers to experience discomfort when separating from their parents or caregivers, and this may in fact be exacerbated by the extended period of time they spent at home during the pandemic with parents or caregivers. So, it’s helpful to have a plan in mind. For older children, maybe toddlers, talking with them about familiar school activities that they may remember from when they were in school in the past, such as things that they played with or listening to stories, can help them prepare for their new schedules. But it’s also useful to think about what might be different, like the teacher will be wearing a mask, and there might be new hand-washing rules. They might tell their child, “we’ll wake up in the morning and have breakfast together and then you’ll go off to school, where you’re playing with your friends and you’ll be with your teachers and have lunch with them. And then you’ll return when it’s about time for dinner, we’ll all have dinner together.”

Additionally, for older children, sometimes the process of rehearsing going to school through play with dolls or figures can help reduce the stress. Reading books about returning to school can be useful as well. When possible, even for very young children, doing a short visit to school or daycare to acquaint or reacquaint the child with the classroom and the teacher can ease the transition as well. Even starting back in a more gradual manner can be helpful if that’s an option—going for a couple of hours the first few days and then working up to longer periods of time at the daycare center or preschool. Parents might also find talking with their children in the direct, but simple way about the coronavirus and how their child’s school or daycare has rules to make sure everyone is safe and healthy. For example, they may tell their children that their school is listening to the things that the doctors and the scientists are saying about going to school safely, and those are the things that they’re doing at school.

**Sally:** I know a lot of kids have been really isolated the last year, some maybe have only one friend or no younger children that they see. So, could you talk a little bit more about that social isolation or maybe potential anxiety that might be resulting from that?

**Dr. Rotter:** Yeah, I think social anxiety is a concern that many caregivers and parents have and some children have. I think for children who are naturally slightly more shy or anxious, particularly in new situations, that reentering social environments can be quite challenging. I would think a lot with the family about ideas such as previewing what to expect. Sometimes for young children looking at pictures of someone they maybe haven’t seen in a while, thinking about things they did before with that child that might have been fun or interesting when we’re thinking of young children.

Another thing that I talk a lot about with families when children have some anxiety about social situations is the structured play date. I think the idea of having a very specific plan in mind for an activity that’s really time based, so it’s not a long unstructured period of time, but it might be that a child comes over for lawn bowling and cookies and lemonade. And then that’s the end of that particular playdate. Or a specific arts or crafts activity or something along those lines, but that everyone knows what the expectation it, that there’s it’s something else to focus on, and sometimes that really helps to sort of build things. And often, what we’ll find is in those situations, that once children are comfortable with each other or reconnect in the case of they haven’t seen each other in a while that they can sort of take it from there. But some children need more, more structured play dates to help build in that comfort in a social setting.

**Sally:** There’s so many people, who I think will be comforted by your examples, because you gave really clear ideas on how to move things forward. So really, we’re really delighted.

I’m your host, Sally Pfitzer. The Brain Architects is a product of the Center on the Developing Child at Harvard University. You can find us at developingchild.harvard.edu. We’re also on Twitter @HarvardCenter, Facebook @CenterDevelopingChild, Instagram @DevelopingChildHarvard and LinkedIn, Center on the Developing Child at Harvard University. Brandi Thomas is our producer. Dominic Mathurin is our audio editor. Our music is Brain Power by Mela from freemusicarchive.org. This podcast was recorded at my dining room table.

**COVID-19 Special Edition: Building from Strengths: Post-Pandemic Partnerships in Health Care** Jun 10, 2021
The devastating toll of the pandemic has underscored the critical importance of connecting what science is telling us to the lived experiences of people and communities. In March of 2020, we recorded episodes exploring the impact the coronavirus pandemic could have on child development. Now, a year later, we wanted to continue these conversations and discuss what we’ve learned, what needs to change, and where we go from here.

Contents

Podcast

Speakers

Additional Resources

Transcript

In the third episode in this 4-part special series, host Sally Pfitzer speaks with Dr. Renée Boynton-Jarrett, the founding Director of Vital Village Networks at Boston Medical Center and an Associate Professor of Pediatrics at Boston University School of Medicine. They discuss the cost of failing to address structural inequities with sustainable and comprehensive policy changes, the vital role community leaders played during the pandemic, and why health care systems need to demonstrate trustworthiness.

The next and final episode of this special podcast series will focus on the pandemic’s impact on the mental health system.

Subscribe below via your podcast platform of choice to receive all new episodes as soon as they’re released.

Speakers

Sally Pfitzer, Podcast Host

Dr. Renée Boynton-Jarrett, Founding Director of Vital Village Networks at Boston Medical Center and Associate Professor of Pediatrics at Boston University School of Medicine

Additional Resources

Vital Village Networks

The Brain Architects Podcast: COVID-19 Special Edition: Creating Communities of Opportunity

Thinking About Racial Disparities in COVID-19 Impacts Through a Science-Informed, Early Childhood Lens

Early Childhood Adversity, Toxic Stress, and the Impacts of Racism on the Foundations of Health

Brief: Moving Upstream: Confronting Racism to Open Up Children’s Potential

Infographic: How Racism Can Affect Child Development

Re-Envisioning, Not Just Rebuilding: Looking Ahead to a Post-COVID-19 World

Working Paper 15: Connecting the Brain to the Rest of the Body: Early Childhood Development and Lifelong Health Are Deeply Intertwined

InBrief: Connecting the Brain to the Rest of the Body

A Guide to COVID-19 and Early Childhood Development

Transcript

**Sally:** Welcome to *The Brain Architects*, a podcast from the Center on the Developing Child at Harvard University. I’m your host Sally Pfitzer. In March of 2020, we recorded episodes exploring the impact the coronavirus pandemic could have on child development. You may remember we discussed the importance of self-care for caregivers, and the importance of physical distancing, not social distancing.  And now a year later, we wanted to continue those conversations and discuss what we’ve learned, what needs to change, and where we go from here.

On today’s podcast, we have Dr. Renée Boynton-Jarrett, who is the founding Director of Vital Village Networks at Boston Medical Center and an Associate Professor of Pediatrics at Boston University School of Medicine. So good to have you with us, Renée.

**Dr. Boynton-Jarrett:** Delighted to be here. Thank you, Sally.

**Sally:** Renée, in March of 2020, we spoke with Dr. David Williams, who explained that many of the disparities that we saw in the early stages of the pandemic were predictable and the result of longstanding social policies and systemic racism. From your perspective, as an expert in the field, in the past year, what have we learned about these disparities?

**Dr. Boynton-Jarrett:** I think what Dr. Williams shared is absolutely correct. What we saw happen with the COVID-19 pandemic is it took advantage of the existing inequities and just widened those. So actually, our existing structural racism created a broader opportunity for the pandemic to disparately impact the lives, the well-being, and the health of communities of color and communities that are disproportionately impacted by structural racism. And so, I think one of the things that we have learned or relearned is the tremendous cost of failing to truly address structural inequities with sustainable and comprehensive policy changes.

And as importantly, because we know structural racism is around these interconnected systems and institutions, but there are also these ideologies, mindsets, ways of thinking and being. And if we think about it, those ideologies and mindsets about who’s okay just to remain at risk, to not have the luxury of physical distancing, to not have the luxury of having water to wash hands and do the hygienic practices. We’ve learned that we also have mindsets that truly impact the way in which we view humanity and human dignity and human rights, and that this pandemic has completely taken advantage of the ways in which those mindsets, ideologies, and systems create structures of inequities.

**Sally:** Could you give us some examples of what changes you think need to happen in the field, particularly how communities and neighborhoods could help?

**Dr. Boynton-Jarrett:** Yeah. I think your question actually hits on where I see the biggest opportunity for change. So, one of the things we saw happen over and over during the pandemic is in the absence of plans. Strategic plans and responses are being created in real time, and often those decisions—whether they were decisions being made about how vaccines would roll out, whether they were decisions being made about what economic supports and resources will come to families, or what will happen with early care and education, childcare, school—we saw time and time again decisions being made that were not being made with true engagement. Not just engagement of communities, but engagement of community leadership. So really, in partnership with, in conversation with. Those who were closest to the inequities—experiencing them most directly—were not being engaged or brought to the table.

And time and time again, we also saw that the ideas, the wisdom, the strategies that were actually happening within communities were thoughtful, were creative, were real-time responsive. And actually, when we begin to get behind them, we see more protection happening for communities. So, we also saw tremendous community leadership, and in the absence of that leadership, I think that we would have all fared much worse in this pandemic.

**Sally:** Just anecdotally, I’ve seen that even in some of the work we’ve done at the Center too, and often finding that bringing in members of the community actively from the beginning of projects has been the thing that has made those projects so much more successful. Could you tell us more about your work at Vital Village Networks?

**Dr. Boynton-Jarrett:** So, Vital Village Networks is based at Boston Medical Center. We promote child well-being and address structural and systemic inequities and systems of care and education in early childhood by doing a couple of things. We really work around establishing sustainable, authentic, and equitable partnerships between caregivers, parents, and community residents and community-based organizations and cross sector institutions—health care, education, advocacy, social service. In this work, we all really focus on expanding leadership trajectories and pathways for community leaders, and that can be through trainings and certifications and expanded opportunities. But we also really think about how do we work to build capacity and enhance existing community-driven solutions? So, how do we build capacity within a community to promote well-being? And often, that involves helping institutions and organizations within the community work with community leaders in a different way and we use a model called co-design. So, how do we create and design things together?

We really work to think about what builds equitable partnerships. What creates a table for truly equitable participation? A lot of approaches to community engagement and community work begin with the deficit lens. They begin with the idea that there’s a problem in the community, and we have a solution, we want to bring the solution. Well, that starting point actually makes it very hard to partner equitably with communities. Because if you think about—even if you were going to pick someone for a team, would you pick someone or something that you had only framed in terms of their weaknesses? Parents don’t do that with their children, right? We all have our strengths and weaknesses. Parents are really good at framing the strengths and uplifting the strengths and building upon the strengths of their children, but we don’t do that with community engagement. We often view a problem and that’s our primary way of understanding a community, and that really creates an imbalance in power from the very beginning. Also, who gets to ask the questions? Who gets to design the evaluation? What type of technology do you need to participate virtually? So, all of these things create barriers for equitable partnerships.

With co-design, we really begin first by understanding that there are solutions that already exist within communities and if we’re not aware of those solutions, it’s because we’re not seeing them, not because they don’t exist. So really beginning by recognizing, appreciating, and valuing the strengths and the wisdom and solutions within communities, which creates a much more level playing field for partnership. The second piece is how do we plan? How do we design together? So, how can we disrupt tools and strategies that bias someone based on their training or education? And how do we create opportunities to design things together that are centered around the diversity of people in the room? And that’s also a particular invitation that no one is at the table only as an expert, but everyone is at the table, both with their expertise and their gifts, as well as as learners. And so, creating that mutuality, that ability for us to be in both roles, all of those factors really lead to the ability to partner with communities and not on behalf of.

**Sally:** Why do you think there’s a disconnect between health systems and the families they’re supposed to serve? I’m thinking particularly here about the COVID vaccine in relation to this.

**Dr. Boynton-Jarrett:** What I would share is I think we’ve had a disproportionate focus on distrust about the vaccine. So, when we think about it, when we actually look at the real data that we have, actually the vast majority of people who have been surveyed or interviewed in communities of color are along a continuum of interest in the vaccine, and/or very interested in getting the vaccine or have already received it. So, a very, very small percentage that has said, you know an absolute no. So, that is a strong signal that people are seeking an opportunity to have their questions answered, to have a conversation, and to engage around the vaccine.

Also, what I think we haven’t focused on enough is how do health care institutions demonstrate trustworthiness? So, we want people to trust the vaccine, and that it’s good for their health. And we have like this, I think an overemphasis or an over expectation that what we’re hearing from people is that they don’t trust the vaccine. What we may be hearing from people that we haven’t focused on enough is how do institutions demonstrate that they are trustworthy—that they’re going to share updated information about concerns, or warnings, or emerging complications, or side effects? That they are going to offer the vaccine in settings where you will be able to get your questions answered. That you will have opportunities to hear from other people who have received the vaccine.

And so, what I think that we need to really focus on is also taking a hard look from a lot of current and historical lessons at the ways in which, you know, despite what might be well intentioned efforts, systemic racism truly exists within our institutions, including our health care institution. And how that is experienced for people is sometimes that the institution does not appear to be trustworthy, because time and time again needs are not being heard or listened to or responded to with dignity.

If we are expecting that we can change people’s minds to make them do what it is we’d like them to do, again, that only serves to reinforce, “I’m not wanting to hear your concern. I’m wanting you to follow my guidance, my advice in a system that you have not been invited to help design what this experience would look like.” So, that’s why we’re seeing so much success of vaccines that are being administered at faith-based institutions in partnerships with the faith-based community. That’s why we’re seeing so much success with providers of color that are creating safe and brave spaces for people to learn about, talk about, and discuss the vaccine. And in our work with Vital Village Networks, we’ve had what I would just consider—led by community members—we’ve had love conversations. Conversations that aren’t so much about all of the details, but are just creating a space for people to be honest about any fears they may have, or anxieties that they may have. And time and time again, they connect to what you have learned throughout your life around untrustworthy medical institutions that have demonstrated that time and time again. So, we must do a better job and a different job of demonstrating trustworthiness.

**Sally:** I really appreciate that response.

I’m your host Sally Pfitzer. *The Brain Architects* is a product of the Center on the Developing Child at Harvard University. You can find us at developingchild.harvard.edu. We’re also on Twitter @HarvardCenter, Facebook @CenterDevelopingChild, Instagram @developingchildharvard, and LinkedIn: Center on the Developing Child at Harvard University. Brandi Thomas is our producer. Dominic Mathurin is our audio editor. Our music is Brain Power by Mila from freemusicarchive.org. This podcast was recorded at my dining room table.

Header photo by **Christina Morillo** from **Pexels**

**COVID-19 Special Edition: Superheroes of Pediatric Care: Moving Beyond the Challenges of COVID-19** Jun 02, 2021
The devastating toll of the pandemic has underscored the critical importance of connecting what science is telling us to the lived experiences of people and communities. In March of 2020, we recorded episodes exploring the impact the coronavirus pandemic could have on child development. Now, a year later, we wanted to continue these conversations and discuss what we’ve learned, what needs to change, and where we go from here.

Contents

Podcast

Speakers

Additional Resources

Transcript

In the second episode in this 4-part special series, host Sally Pfitzer speaks with Dr. Rahil Briggs, National Director of ZERO TO THREE’s HealthySteps program. They discuss the potential impact of the pandemic on infant and toddler development, how an overstressed pediatric health care system responded, and the importance of overcoming equity challenges and public fears to resume well-child visits.

Upcoming episodes of this series will feature expert speakers reflecting on the longstanding social policies and systemic racism that resulted in the pandemic disparately impacting communities of color, and the pandemic’s impact on the mental health system. The experts will discuss how we can take what we learned over the past year and make meaningful changes that will improve outcomes for children and families. Listen to the first episode of this series, where Center Director, Jack P. Shonkoff, M.D. discusses what COVID-19 revealed about the needs of caregivers with young children or during pregnancy.

Subscribe below via your podcast platform of choice to receive all new episodes as soon as they’re released.

Speakers

Sally Pfitzer, Podcast Host

Dr. Rahil Briggs, National Director of ZERO TO THREE’s HealthySteps Program

Additional Resources

Resources from the Center on the Developing Child

Re-Envisioning, Not Just Rebuilding: Looking Ahead to a Post-COVID-19 World

The Brain Architects: COVID-19 Special Edition: Self-Care Isn’t Selfish

Working Paper 15: Connecting the Brain to the Rest of the Body: Early Childhood Development and Lifelong Health Are Deeply Intertwined

InBrief: Connecting the Brain to the Rest of the Body

A Guide to COVID-19 and Early Childhood Development

Resources recommended by Dr. Rahil Briggs

*Psychology Today*: What Parents of Babies and Toddlers Need Right Now

American Academy of Pediatrics: A superhero moment

HealthySteps: Caring for Yourself and Young Children During the Coronavirus (COVID-19) Crisis

ZERO to THREE: Tips for Families: Coronavirus

Rapid Assessment of Pandemic Impact on Development (RAPID) – Early Childhood

USA Today: Opening ‘so many doors for families’: COVID-19 underscores the importance of wraparound care for new moms and children

Early Childhood Depression May Impact Brain Development in Later Years

Brazelton Touchpoints Center

ZERO TO THREE: Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood and official DC:0-5 Training for advanced infant and early childhood mental health professionals

Transcript

**Sally:** Welcome to *The Brain Architects*, a podcast from the Center on the Developing Child at Harvard University. I’m your host Sally Pfitzer. In March of 2020, we recorded episodes exploring the impact the coronavirus pandemic could have on child development. You may remember we discussed the importance of self-care for caregivers, and the importance of physical distancing, not social distancing.  And now a year later, we wanted to continue those conversations and discuss what we’ve learned, what needs to change, and where we go from here.

Joining us on today’s podcast is Dr. Rahil Briggs, National Director of ZERO TO THREE’s HealthySteps program. Rahil, thanks so much for being here with us today and just for timing, I’m going to jump right into our first question. What can we tell parents and caregivers about the potential effects the pandemic lifestyle changes could have on development, particularly on infants and toddlers?

**Dr. Briggs:** Thank you Sally, and thanks for having me. I know this question is on a lot of people’s minds. We’re a year into this and what’s been the effect? For some of these kids, it’s half of their life that they’ve lived within the COVID pandemic. But for parents of babies and toddlers, I think we mostly have really good news. Because they are learning through serve and return interactions, it doesn’t need to occur in one particular kind of learning environment or even a specific variety of environments for them to continuously be learning. So, parents can rest assured that babies and toddlers who are having that regular interaction with their primary caregivers in loving, supportive, nurturing ways with all sorts of serve and return moments all day long are still learning a lot. So, reading books, singing, playing music, just observing what’s going on around them. We often talk about—you know nobody expects that you’re going to put your life on hold and read 20 books to your kids every hour, but can you just comment on what you’re doing as you’re cooking dinner? Now I’m putting the water in the pot, and now I’m putting the rice in, and let’s watch it boil—and just really narrating or sportscasting that day.

I’ll say it again and again and again, you know, it’s about really taking care of oneself—avoiding toxic stress, bringing in mindfulness if you can. And I don’t mean that we all become yogis and meditate every day. That is not realistic right now. We’re trying to juggle 12 different things every minute.

It’s about self-care of adults. Self-care is not selfish as we’ve discussed before. Reducing that caregiver stress will reduce baby and toddler stress, and when babies and toddlers are less stressed, they learn better just like us, right? We learn better when we’re less stressed and it’s exactly the same for them. And of course, if there’s one thing we’ve all learned in this last year, it’s that stress can’t be avoided per se, but it’s about regulating. And so, for parents and caregivers it’s about self-regulating or asking for help. And when you do those things, either self-regulate or ask for help, you model really important social-emotional skill that babies will eventually learn through that example.

**Sally:** Rahil, I really appreciate that connection you just made between the health of caregivers and the health of children. I think it’s something that can easily be overlooked, especially with everything going on. And I’m wondering, are there concrete examples of things that caregivers should look out for? Something that might indicate that their child has been negatively impacted by the uncertainty and chaos surrounding the pandemic?

**Dr. Briggs:** Sure, so we know that the difference between a one-year-old and a two-year-old say in developmental terms is pretty remarkable. It’s quite different than the difference between a 33-year-old and a 34-year-old, for example. And so, developmental regression is something that you might look at and you might look for. So, is a child who used to be toilet-trained now going back to having accidents or asking for diapers? Or a child who used to be, you know, fully weaned from a bottle, or breastfeeding or a pacifier, suddenly going back in that direction? Those can be signs of them just saying like “Hey, this is all a bit overwhelming for me right now and I want to go back to a place where things are a little bit easier, and I get a lot more soothing and a lot more care.”

From some of the wonderful work of people like Joan Luby and others, we know that preschool age children can be unfortunately depressed. They can be reliably diagnosed with depression, meaning that a number of different professionals would agree: “yes, this looks like depression.” And not too unlike ourselves in the adult phase of life, you know. It could be impacting sleep, diet, interest in everyday things. So, I would say that’s a great time to really reach out to your pediatrician and say, “This is what I’m seeing. Does this feel like the new normal and just what I should expect because of how we’ve all been? Or does this feel like something that needs a little bit more attention?” And so, any prolonged or substantial changes might be something to bring to a pediatrician.

We know that lots of families have been worried about going to the pediatrician. I saw just this week, the American Academy of Pediatrics has put out a new call that parents are superheroes when they bring their children to the pediatrician to get up to date on vaccinations, but it’s also those times to ask those questions and really double-check like is this okay? Is this something to be expected? Or is this something to be worried about?

**Sally:** So, the pediatric system, like many had to adapt rapidly to the pandemic. What do you think has worked well and what has not worked well?

**Dr. Briggs:** So, talk about superheroes. When I think about my colleagues in pediatric care at Montefiore and around the country and all through healthcare, the lengths to which people have gone to support families is remarkable. We’ve heard about just pediatric practices, sort of turning themselves inside out and becoming one-stop-shops for families—diapers, formula, and the like. So, just gratitude to everyone in pediatric healthcare. They’ve been stressed, to say the least, and so that pediatric system has had to get retooled to serve adult patients. There have been some children’s hospitals where full floors have become adult-focused out of need, and of course, as people have gotten sick or been less available, we’ve seen that as well.

So, the pediatric system was stressed to say the least. We saw and we continue to see dips in well-child visits. We see dips in vaccinations—not COVID, but all those other diseases that we have these wonderfully evidence-based vaccinations for—and it’s around the country. We’ve also heard about pediatric practices closing, just not being able to stay open for business because the volume was down or because the workforce issues. There’s been a slow rebound on all of these points, but I’d say we’re not quite back yet to pre-pandemic levels and so that means that families are missing out. They’re missing out on that really important care that happens at the pediatric office.

If we don’t reverse this and quickly, that will be concerning. I think about it, especially from an equity lens. When all babies and toddlers have a strong start, and when they can get that start through a partnership through a high performing pediatric practice, the entire country is better, right? Pediatric primary care is like the only setting we have in this country that almost universally reaches all babies, all toddlers, and their families no matter what your income is, no matter, you know where you’re living.

So, I’d say some of the transitions we saw, you know, as folks got to recognize that this new normal was going to be around for a lot longer than they had anticipated. We saw our HealthySteps practices really adhere to the guidance that was put out by the American Academy of Pediatrics and by the CDC. And so, for many practices that meant postponing visits for older kids and only seeing kids birth to age 2 in person. That was some early American Academy of Pediatrics guidance. Some practices experimented with drive through vaccinations, others went fully remote and started seeing families virtually. Telehealth in pediatrics is not quite as seamless as it may be for us in the adult world, right? That was a really big adjustment for people. I think it’ll be here to stay in some form, but lest you think it’s easy, try to imagine a baby or a toddler on the other side of that telehealth visit and telling them, “please sit there for the next three minutes and don’t move and show me the inside of your wrist.” Right? It’s like “uhh no.” So, not always the most compliant.

You know, but for a lot of folks, for families and providers, seeing their patients virtually was better than not seeing them at all. Again, though, I think about equity here. And so many of those inequities that we saw pre-COVID are still relevant. Perhaps more relevant than ever, and they really come to light when we think about telehealth and folks who don’t have multiple computers in the home and the one that they do have is needed for the school-age child to do online schooling. They don’t have unlimited Internet access or cell phone data. And then, when we close the public spaces, previous options like using a computer at the library or the like aren’t really feasible. We’ve heard from our practices in rural areas that broadband access is a huge issue. This was again pre-COVID, and that affects telehealth and of course, remote learning for older children and work.

As we become vaccinated, many of us, you know, practices are mostly back to in-person with the safety precautions that they need, which is really promising. And I would say we’ve all learned a lot. We’ve learned we are more flexible than we knew we could be, and we have been reminded about the inequities that existed pre-COVID because they have been magnified. My real hope is that we renew a focus on changes that really last for families—committed to health, well-being, school readiness of all babies and toddlers. Our work at HealthySteps continues with I’d say even more urgency than we had earlier. And hopefully, the world and the community at large can join us with really that mission to give all babies and all toddlers that incredibly strong start.

**Sally:** Yeah, you started talking about this a little bit, but I’m curious when families are really stressed and they’re starting to say like, “Well, a well-child visit might be something that I can skip because there’s so much going on and I’m worried about exposure.” What would you say to those families and how would you kind of help them think through what that might mean?

**Dr. Briggs:** It’s a great question. In terms of skipping well-child visits, we have data that suggests that there are negative outcomes when you skip well-child visits. So, what are some things that can happen? Well, developmental delays can go undiagnosed, and we all know that the earlier we catch those developmental delays and the earlier that we provide evidence-based treatment, the better the outcome for children, sometimes erasing what was a delay in only just a year.

We also know about the incredibly lifesaving importance of vaccinations. We all are pretty well, you know, the number of people who can talk about what an mRNA vaccination does these days is remarkable and hopefully they remember that we’ve got vaccinations for lots of other really life-threatening diseases, and it’s critical—early childhood is the moment when you’re getting vaccinated, right? Almost every visit there’s some combination of vaccinations. They’re just so important.

Growth is an obvious one. Not everybody has a perfect infant scale at home, and so being able to make sure that babies are gaining back that early birth weight and then gaining weight at the rate we would expect really has significant implications for development and well-being overall. So, it’s really one of those visits that feels pretty darn worth it to mask up, to call ahead about safety protocols, and to know that each and every one of those health care providers is going in there every day just as worried about their own health and well-being and that of their families and wouldn’t do anything to put their patients in danger.

**Sally:** You always make me feel better when I talk to you, Rahil. I love those concrete examples too, I think that’ll be really helpful.

I’m your host, Sally Pfitzer. *The Brain Architects* is a product of the Center on the Developing child at Harvard University. You can find us at developingchild.harvard.edu. We’re also on Twitter @HarvardCenter, Facebook @CenterDevelopingChild, Instagram @developingchildharvard, and LinkedIn: Center on the Developing Child at Harvard University. Brandi Thomas is our producer. Dominic Mathurin is our audio editor. Our music is Brain Power by Mela from freemusicarchive.org. This podcast was recorded at my dining room table.

**COVID-19 Special Edition: How Do We Rebuild and Re-Envision Early Childhood Services?** May 19, 2021
The devastating toll of the pandemic has underscored the critical importance of connecting what science is telling us to the lived experiences of people and communities. In March of 2020, we recorded episodes exploring the impact the coronavirus pandemic could have on child development. Now, a year later, we wanted to continue these conversations and discuss what we’ve learned, what needs to change, and where we go from here.

Contents

Podcast

Speakers

Additional Resources

Transcript

The first guest in this 4-part special series is Center Director Jack P. Shonkoff, M.D. He and host Sally Pfitzer discuss what COVID-19 revealed about the needs of caregivers with young children or during pregnancy, what we learned about the importance of science over the course of the pandemic, and how we can make changes going forward.

Upcoming episodes of this series will feature expert speakers reflecting on the pandemic’s impact on pediatric and mental health systems, and the longstanding social policies and systemic racism that resulted in the pandemic disparately impacting communities of color. The experts will discuss how we can take what we learned over the past year and make meaningful changes that will improve outcomes for children and families. Subscribe below via your podcast platform of choice to receive all new episodes as soon as they’re released.

Speakers

Sally Pfitzer, Podcast Host

Dr. Jack Shonkoff, Center Director

Additional Resources

Resources from the Center on the Developing Child

Re-Envisioning, Not Just Rebuilding: Looking Ahead to a Post-COVID-19 World

The Brain Architects: COVID-19 Special Edition: A Different World

Working Paper 15: Connecting the Brain to the Rest of the Body: Early Childhood Development and Lifelong Health Are Deeply Intertwined

InBrief: Connecting the Brain to the Rest of the Body

Health and Learning Are Deeply Interconnected in the Body: An Action Guide for Policymakers

What Is Inflammation? And Why Does it Matter for Child Development?

How Racism Can Affect Child Development

Moving Upstream: Confronting Racism to Open Up Children’s Potential

A Guide to COVID-19 and Early Childhood Development

Transcript

**Sally:** Welcome to *The Brain Architects*, a podcast from the Center on the Developing Child at Harvard University. I’m your host Sally Pfitzer. In March of 2020, we recorded episodes exploring the impact the coronavirus pandemic could have on child development. You may remember we discussed the importance of self-care for caregivers, and the importance of physical distancing, not social distancing.  And now a year later, we wanted to continue those conversations and discuss what we’ve learned, what needs to change, and where we go from here.

Joining us today is Dr. Jack Shonkoff, Director of the Center on the Developing Child. Jack, we really appreciate you being here, and I know we have a lot to cover, so let’s jump right in. Could you tell us what COVID-19 has revealed about the needs of young children, families and people who are pregnant?

**Dr. Shonkoff:** So immediately, we saw the difference between people who had access to resources that helped them get through and those who before the pandemic were always at the edge and that this put families over the edge in terms of meeting basic needs—food, clothing, housing.  But then, there’s the other universal experience of the critical importance of supportive relationships—the critical importance of extended family, neighbors, friends—and the extent to which every parent, regardless of your circumstances, cannot parent a child alone. And the social isolation that so many people felt, from the poorest to the wealthiest.

And so, I think if there’s anything good to take out of this past year, it’s a recognition of the universal needs that all families have to provide a healthy environment for their children, but the tremendous inequalities in resources and buffers and supports that we could all turn to when we are faced with really unusual hardships.  So, it’s this balance between kind of universal experience and highly unequal consequences that I think are the lessons from the past year.

**Sally:** Could you tell us what we’ve learned about science over the course of this pandemic? And especially, how that science relates to what children need.

**Dr. Shonkoff:** Our work has been deeply grounded in the importance and the value of bringing credible, trusted, scientific knowledge to the table in addressing all of the challenges and opportunities that face families with young children, especially families who are dealing with excessive adversity or burdens. And this past year, has been a real eye-opening experience I think for all of us about both the critical importance of trusted, credible science in the face of threats to our health and well-being and the very significant  limitations on how that science can provide direction or guidance about how to move forward.

We certainly learned this past year, not only that science doesn’t always have all of the answers—and especially at the beginning of problem—but that science doesn’t stand still, and that we depend upon science to keep moving forward. And we also have to learn how to make decisions based on incomplete science and based on the best science we have. And in many ways, we’ve always known that. We know that there aren’t answers to every problem.  But I think one of the really very complex and and sobering lessons we learned this past year is how science has to be aligned with the lived experiences and the values and beliefs of the population. Because when it isn’t aligned, people can choose to not only not believe in the science, but to adopt alternative perspectives that try to delegitimize science.

So, for me personally, and certainly for the work of our center, this is a real time to just step back and try to figure out how we can maximize the contributions of science and we can leverage cutting-edge science that has solutions—or partial solutions—to our problem, without expecting that science will have all the answers. And certainly, for those of us at the  Center on the Developing  Child, kind of recognize both the limitations of the science at any time and the power of the science to guide us in more effective approaches to deal with any of the challenges we’re facing.

**Sally:** Looking forward, what can we do? How can we make changes?

**Dr. Shonkoff:** We’ve all learned a lot about how much the health of any society depends upon a sense of shared responsibility for each other. To get through this together. Whether it be people caring about their communities, decision leaders caring about the well-being of the country. I think we’ve learned simultaneously that we are all in this together and we all have shared vested interests and we are not all in this with equal resources and equal assets.  And this has not just been about the pandemic. We have had the converging crises of an infection out of control,  of a massive economic disruption that did not have an equal impact on all parts of the population, and then, of course, we have the dramatically increased consciousness  about something that is not a new problem, but the dramatic increase in understanding the unbelievable threat and hardship of systemic racism and structural inequities imposes on families of color and other groups that are disadvantaged in ways that are kind of embedded in our society.

So going forward, I think the health of our society depends upon the extent to which we see all of us as having a shared investment in the well-being of each other. So, this is still politically extraordinarily complicated, but I think one lesson we might take from this is shared interest  in everybody doing well.  We do know a lot about the kinds of conditions in which young children grow up that increase the likelihood of a healthy, productive outcome: supportive relationships, manageable levels of stress, basic needs met, major opportunities for learning, and buffering and protection from excessive stress activation.

So what do we do going forward?  We start with the fact that in a society like ours with our political traditions, there’s a mix of self-reliance and kind of shared responsibility. And no family gets by by itself. So, the question is: Do you pay for it yourself or do we share the responsibility of paying for it for everyone else? Whether it be health care, child care—child care, there’s an interesting tension.  Is child care something we need so that parents can go to work or is child care something we need to make sure that children have kind of optimal environments,  for their development while their parents are working; because we have learned  how  the economy cannot move without child care to take care of children while their parents work. So, we could go down the slippery slope of seeing child care as basically something we need to promote parent employment and set very low standards and just say: make sure kids don’t fall our windows or run out in the street and we’re okay. Or we could say we need it for the economy to work, but we also need to build a strong foundation for the next generation.  We have to just recognize that at the end of the day, going forward is some combination of making sure that we find some way to support families to meet their children’s needs and promote their children’s health and development.  And then thinking about as a country, what kind of resources do we need for population health?  But let’s just remember at the end of the day,  governments do not raise children. Parents, families, caregivers, raise children.  But how they’re able to kind of provide for their children’s needs and their own needs, depends a lot on communities, depends a lot on government, and depends a lot on resources.  A lot.

And so, I think going forward for the early childhood system, I would say there are a couple of things that involve more than just how do we rebuild what’s broken down. Because, what we learned from this past year is how fragile the infrastructure is for  many essential early childhood services, whether it be child care, early education, early intervention programs, family support programs.  It’s a fragile infrastructure. It’s not permanently supported, and its funding  is always up in the air.  So going forward, I think the big challenges for the early childhood field come in two categories.  One is how do we rebuild and re-envision early childhood services so that they are able to have a more stable infrastructure and more predictable funding , so that all of the energies could go into providing supports for families instead of half of the energies going into trying to keep the money flowing. That’s a huge problem. But there’s another part of the early childhood world that hasn’t traditionally been thought of as the early childhood world, but I think is one of the most important messages just coming out of the past year. Which is that for families experiencing structural inequities—the families who are from generation to generation dealing with the way certain structures and policies in our country disadvantage some groups over others , with racism being at the top of the list—the question is how are we going to deal with that and break down those hardships and threats that are critical to the early childhood system.

So, let me be very specific about this. Right now, in the early childhood world, most of our resources, most of our energy is focused on children, their families, and adults who work in programs that provide essential services—and there is a lot that can be done to improve life prospects for children.  But, at some point, we’ve got to think about how we go upstream and how do we prevent the things that are causing the problems rather than just figuring out how better and better to kind of  treat or help people cope with things that ultimately have to be prevented. So, it’s like this is not just about rebuilding what was lost during the pandemic. It’s not just about trying to reopen child-care centers . It’s taking the best of what we have, but not just trying to kind of rebuild and replenish, but try to re-envision what an early childhood field will look like. And it’s got to be more of a balanced combination.  To do what we know how to do to  promote responsive relationships and health-promoting environments, but also start to pay more attention to going upstream and at a macro level, at a society level, dealing with what is imposing very unequal hardships and burdens and threats on families raising young children.

**Sally:** That’s such an important point, Jack. There’s clearly a lot of work that needs to be done. Thanks so much for your time again today.

I’m your host, Sally Pfitzer. *The Brain Architects* is a product of the Center on the Developing child at Harvard University. You can find us at developingchild.harvard.edu. We’re also on Twitter @HarvardCenter, Facebook @CenterDevelopingChild, Instagram @developingchildharvard, and LinkedIn: Center on the Developing Child at Harvard University. Brandi Thomas is our producer. Our music is Brain Power by Mela from freemusicarchive.org. This podcast was recorded at my dining room table.

**Connecting Health and Learning Part II: The Implications** Jan 20, 2021
How do we use the science of early childhood development to implement practical strategies and overcome longstanding barriers in the early childhood field? How can we ensure that families’ voices are heard when we create policies or programs?

Contents

Podcast

Panelists

Additional Resources

Transcript

To kick off this episode, Center Director Dr. Jack Shonkoff describes what the science means for policymakers, system leaders, care providers, and caregivers.

This is followed by a discussion among a distinguished panel of experts, including Cindy Mann (Manatt Health), Dr. Aaliyah Samuel (Northwest Evaluation Association), and Jane Witowski (Help Me Grow). The panelists discuss how we can break down the silos in the early childhood field, policies affecting prenatal-three, and how policies can change to address the stressors inflicted by poverty, community violence, and racism.

Panelists

Cindy Mann

Dr. Aaliyah Samuel

Jane Witowski

Additional Resources

Resources from the Center on the Developing Child

The Brain Architects: Connecting Health & Learning Part I: The Science

Working Paper 15: Connecting the Brain to the Rest of the Body: Early Childhood Development and Lifelong Health Are Deeply Intertwined

InBrief: Connecting the Brain to the Rest of the Body

Health and Learning Are Deeply Interconnected in the Body: An Action Guide for Policymakers

What Is Inflammation? And Why Does it Matter for Child Development?

How Racism Can Affect Child Development

Resources from the Panelists

Testing America’s Freedom Podcast

Help Me Grow National Center

Transcript

**Sally**: Welcome to the Brain Architects, a podcast from the Center on the Developing Child at Harvard University. I’m your host, Sally Pfitzer. Our Center believes that advances in science can provide a powerful source of new ideas that can improve outcomes for children and families. We want to help you apply the science of early childhood development to your everyday interactions with children and take what you’re hearing from our experts and panels and apply it to your everyday work.

Today, we’ll discuss how the science we shared in our previous episode, on the early years and lifelong health, can change the way we think about early childhood policy and practice, and what this shift means for policymakers, practitioners, and caregivers. So, I’d like to welcome back Dr. Jack Shonkoff, Professor of Child Health and Development and the Director of the Center on the Developing Child at Harvard University. Hi, Jack. Welcome back.

**Jack**: Hey, Sally.

**Sally**: So we talked in the last episode about how the brain is connected to the rest of the body, and especially how the early years really matter when it comes to lifelong health. What does this science mean for policymakers, system leaders, or even caregivers?

**Jack**: That’s a really important question, Sally. From the beginning of the early childhood field, it’s always been focused on early learning and improving children’s readiness to succeed in school. In the policy world, it’s in education policy, comes out of the education budget. For people who work in early childhood programs, and for parents, it’s about programs that encourage and provide rich learning opportunities for children to develop early literacy competencies.

But the mindset shift here is that it’s not just about early learning in school—it‘s about the foundations of physical and mental health. It’s not just about improving outcomes for greater economic productivity—better educational achievement. It’s also about decreasing the likelihood that you’ll develop heart disease or hypertension, or diabetes, or a wide range of the most common chronic illnesses in society. It’s not just a matter of return on investment—asking “So, how much more economically productive will the population be? How much will we save in incarceration?” It’s also how much will we save in the cost of health care.

**Sally**: We’ve previously discussed the coronavirus pandemic, as well as the national reckoning regarding systemic racism, and the impact that this current climate has on children and families. Could you talk about how both of those issues are playing out in the context of policy and systems change?

**Jack**: From a science point of view, disparities in health outcomes is not a new discovery. But from a public understanding point of view, the COVID-19 epidemic and its gross inequalities in exposure and in infection and in complications and in deaths has really put front and center the incredibly important impact of systemic racism and interpersonal discrimination as it affects health. We know that more people of color, particularly African Americans—but also Latino and Indigenous populations—have greater exposure to the infection because of working in jobs that cannot be done at home, more reliance on public transportation, tighter housing circumstances—all of which make it more difficult to be protected from exposure to the infection.

But what’s getting less attention is not just rates of exposure and infection, but also rates of complications. We do know that of those people who are infected, people with underlying medical conditions are more likely to be sicker, and in many cases, more likely to die from the infection. And those underlying conditions are not equally distributed across the population. And they are particularly a higher prevalence in populations of color and in people who have grown up in poverty.

And here, what this new science is telling us is: this is not about adult exposure. These diseases have their roots early in childhood. They have their origins in excessive stress activation—excessive adversity—related to poverty, related to racism, related to exposure to violence, related to unstable housing, and related to food insecurity, all of which present tremendous burdens for families raising young children that increase the risk for excessive stress activation, which early on in life—doesn‘t always affect—but can affect brain development, the development of the immune system, development of metabolic systems.

On the one hand, the impacts of racism belong on the list of a lot of other sources of stress for families. But on the other hand, there are burdens and hardships that are unique to experiencing racism that we have to start to come to grips with in a very different way. If we don’t protect children from that, if we don’t provide the support for families to be able to help protect their children from the stresses in the environments in which they live, then what we see is over time, not only influences on early learning affecting readiness to succeed in school, but greater likelihood to have many of these chronic diseases later in life. And this is a rude awakening and an opportunity for the early childhood field to focus much more not just on early learning and school readiness, but to focus on the early origins of lifelong health problems, both physically and mentally.

**Sally**: I completely agree with that Jack. And I’d also say that it’s so important that people at the policy and systems level work directly with families who are experiencing these stressors just to make sure they really understand their perspectives and their needs. And up next, Jack’s going to answer a question that’s been submitted by one of our listeners.

Musical interlude

**Sally**: And we’re back! For this segment, we asked audience members who listened to the podcast to send in any questions they may have for Jack. Today’s question involves the role of significant stress on our abilities to use core life skills—the skills that help us manage information, make decisions, and plan ahead to make healthier long-term choices or avoid impulsive risks, reduce stress, and ultimately improve health. Today’s question comes from a listener named Abbi Wright.

**Abbi**: My name is Abbi Wright, and I’m a first–year graduate student at Oklahoma State University studying speech language pathology. And my question for Dr. Shonkoff is: how does strengthening core life skills in children affect lifelong health? How can we strengthen those skills in families that are especially vulnerable because of immigration status or racism?

**Jack**: So that’s a really important question, Abbi. Let me try to answer in the following way. Building core skills is part of a strong foundation of resilience that will help you deal with stresses and engage in more health promoting behavior over your life course and further decrease the risk for disease. For young children, strengthening those skills helps to build coping capacities. That helps bring the stress response down so that when these systems are developing very early on, they’re not being disrupted. One of the things that we are beginning to understand in a much clearer way is that reducing excessive stress activation in the early childhood period helps to protect all these developing biological systems that not only affect learning, but also affect physical and mental health.

Part of the way that we reduce stress activation in young children is by the adults who care for them to provide a sense of safety and security and buffer children from the stresses that are present in the lives of their caregivers. Families are experiencing significant stress. The pressures are greater to be able to provide that sense of safety for children—help them build their own coping skills. We know that some groups are particularly at risk, not for their ability to be good parents, but for the level of threat and hardship and burden that is imposed on families because of structural inequities in our society. Systemic racism is one obvious example. Immigrant families in the United States right now are another good example of families who are dealing with more than the usual amount of stress because even for immigrants whose legal status is not in question, there is an atmosphere of anxiety and threat and concern about the discrimination experienced by many immigrant families. So, the basic biology is the same regardless of your life circumstances. The level of threat—the level of hardship—varies based less on parents’ abilities to help build skills in their children, but more in terms of how much of an external burden of hardship and threat is imposed on families in their everyday lives raising their young children.

**Sally**: Thanks, Jack. And thank you, Abbi, for that thought provoking question. Up next, our panel will talk more about the implications of this new science for people across the early childhood field.

Musical interlude

**Sally**: So, on today’s podcast, we have with us Dr. Aaliyah Samuel. She’s the Executive Vice President of Government Affairs and Partnerships at Northwest Evaluation Association, and a Senior Fellow at the Center on the Developing Child. Thanks for being here today, Aaliyah.

**Aaliyah**: Thanks so much, Sally, for having me. I’m really looking forward to the conversation today.

**Sally**: Also joining us on today’s podcast, we have Cindy Mann, partner at Manatt Health and former Deputy Administrator at the Centers for Medicare and Medicaid Services, and former Director of the Center for Medicaid and CHIP services. Hi, Cindy, great to have you with us.

**Cindy**: It’s a pleasure. Thanks so much for including me.

**Sally**: And also, on today’s podcast, we have Jane Witowski. State Director of Help Me Grow South Carolina. Thanks for joining us, Jane.

**Jane**: Thanks so much. I’m happy to join the group today for this very important conversation.

**Sally**: My first question is for you, Aaliyah. Could you discuss the policy silos in state and federal government? What mindsets have shaped the current policy landscape?

**Aaliyah**: I will say one of the fundamental challenges is really the cross and inter-agency communication. It’s just really important both at the federal level and as well as the state and local level, that we get individuals that represent multiple systems to come to the table and have conversations. That is how we can start to really think about how to blend and braid funding to ensure that we get the maximum number of families—children—getting access to these programs.

We have seen the evolution over really the last I would say five to 10 years, where it has moved from early childhood being a woman’s issue to a workforce issue and a non-partisan issue. When I was Director at the National Governors Association of the Education Division, we watched the 2018 gubernatorial campaigns very closely. And of the 36 governors that were running at the time, there was not one that did not make a reference to early childhood and its importance to some degree. So, I can say that early childhood and this issue around childcare, families, our youngest citizens, is truly a non-partisan issue, which I think is important to underscore because it creates a recognition that it doesn’t matter what side of the aisle you’re on, this is an important issue.

I think too as we talk about some of the mindsets or even the current policy landscape, I will say, one of the things COVID has really done is exposed the inequities that were hidden in plain sight. We can’t ignore the data, we can’t ignore the disparities, we can’t ignore the communities and individuals and families that have been hit the hardest, and who have historically been hit the hardest, and will also have the most challenges recovering from the pandemic and all that’s come with it. I think, ultimately, what is really lacking is the voice of those who are impacted the most. I heard a quote once, that I really do believe, which says, don’t do anything for us without us. I think as we start to really think about reshaping the policy landscape to address some of these inequities, we need to make sure that there is diversity at the table of decision makers, but also those who will be impacted the most, and making sure that we’re underscoring their voices.

**Sally**: Yeah, that’s such a great point, and leads into my next question for you, Cindy. Can you speak about the policies affecting prenatal to three?

**Cindy**: Let me just start by underscoring a point, which is that the country is moving in this direction. I’m seeing all across the country, movements in pediatric practice, in health care, in Medicaid programs, in state government, in local communities along these paths. So, I really do think these are all achievable.

Everybody has to have access to health care coverage. Start there. That is not the case now. And while children are more likely to be covered than other groups, the rate of insurance for children has been dropping in the last couple of years. And mostly, they’ve been dropped off in Medicaid and not picked up elsewhere, and there’s a lot of different reasons for that. There’s also groups of children who because of their immigration status are just not eligible for coverage. Also, one of the I think really important tenets of good pediatric practice is to make sure that parents’ needs are met as well. We also have a number of states that have not extended Medicaid to low-income parents, and that really disenfranchises the family in terms of being able to access the kind of care that families need to make kids strong and healthy.

Some of the other policy issues that need to happen are, is to really begin to integrate behavioral health and physical health. Those two worlds have lived often in very separate silos. That’s not how kids live, that’s not how families live. We need attention to the social and economic needs of families as a very integrated way of addressing those issues in the practice of the provision of health care coverage. A real focus on equity throughout all of the policies that we’re moving forward. As Aaliyah said, there’s no secret to the fact that we have significant structural racism and disparities based on race, and COVID has laid bare and put that, again, in our face, and we need to do something about it. And it really does take a very intentional focus on trying to address disparities to deal with it.

We also have a financing issue. So much of the recent investments around social determinants—help with homelessness, help with hunger—have been driven by this perception of a return on investment to the healthcare sector. Well, that mostly leaves kids out, because while there is a market return on investment if you invest in young children’s health care, that return doesn’t always happen in a very short period of time, and that return also sometimes happens to other parts of our system. To our education system, to our juvenile justice system, to our child welfare system. So, we need a way of really having cross-sector collaboration in the design and in the financing of the full range of services for kids.

**Sally**: And Jane, I’m wondering if you could speak to us from the healthcare and community service perspective, how do the families you work with feel about the policies in early childhood? Is there a sense that change is needed?

**Jane**: Sure. I would characterize the mindset as hopeful and encouraged. And what I’ve experienced is a real desire to work together across sector, and was pleased to hear Cindy bring that up as one of her last points in that cross-sector collaboration how necessary it is. And I’ve seen that at the local level and at the state level. However, it’s accompanied by a real frustration about how to go about it. There’s still a lot of confusion, and also barriers. When providers are faced with funding restrictions, staff capacity, regulatory mandates, and still this mindset of needing to stay in your lane. One of the reasons that I’m hopeful is the Help Me Grow system, which 20 years ago was seen as an innovation and an opportunity to bring together those service providers with the common goal of meeting family’s needs. And so, I’ve seen how it can allow service providers to break down those barriers, and to help make connections that are really meaningful for families.

**Aaliyah**: Sally, can I just chime in here? Jane, when you said the flexibility, particularly in the regulations and staff capacity that is so spot on. I do a lot of advocacy work both at the federal and state level. One of the things we are advocating hard on is allowing for flexibility in the regulation so that at the community level, the funds can be used in the way that best fits the community needs. We fundamentally have to take a step back and stop being so prescriptive on what we think communities need, and create the funding structure to then package it to a community to make the changes and provide the supports that they need.

And also, it’s ironic when you mentioned the innovation piece or staff capacity. It’s so hard to be innovative when you’re pumping out reports, when you’re seeing families one after another. And so, we have to think about how do we create the place and space for innovation to happen. And that takes time, that takes time to plan, it takes time to collaborate across systems. We can’t keep expecting do what you’re doing with no additional funds or support, and then be innovative on top of that. It just doesn’t happen that way. And you can have the most well-intended people who have the passion and the ideas to innovate, but if they don’t have the capacity it’s not going to happen.

**Cindy**: I’d love to jump in on this part of the conversation as well. Another important point is to build the infrastructure in the community to be able to help connect people—health care sector—to community-based organizations and other resources. You can’t expect that a pediatrician is going to figure out where to send their families if they’re homeless or if they’re hungry. Or maybe you can send them, but you can’t necessarily do the follow up that’s needed to make sure that those needs get met. So, increasingly different communities are coming up with and states coming up with integrator organizations. They can be Accountable Communities of Health, is what Washington state calls them. North Carolina is planning to set up lead entities to help coordinate community–based organizations in certain regions and connect them to the healthcare sector.

So, we absolutely can’t do this just on the fly. We’ve got to create systems—systems of financing and systems of working together—that are adequately funded so that this can work. And let me just also underscore a point made before that I neglected to raise, which I so firmly believe in the importance of families being not only at the table, but really in leadership to really figure out what those priorities are, and whether the system is working well, and whether the system is not working well. So, both at the policy table, and then as real time monitors of how well the system is working for kids.

**Sally**: How can policies change to address the stressors inflicted by poverty, community violence, and racism?

**Aaliyah**: First, we have to acknowledge that they exist. That has to be step one. The stressors, the impacts of racism, bias, violence. What is real to someone who exists and has to exist in those communities, versus those who only have a perception based off of what their realities are, what their community is. It creates that disconnect. And the realities of families at all levels are different, and we have to acknowledge that. We can’t turn a blind eye, we can’t say, well, I’ve never seen it, so, I don’t think that that’s true. I will say—I‘ll give a personal example. I have two sons, but my youngest son has some really significant health care needs. I didn’t understand the challenges of being a mom with a child with special healthcare needs until I had one. I was an educator, I have a master’s degree in special education. But it’s very different when it’s your child and you’re trying to navigate the education system, the health care system, and advocate for your child who is struggling.

There’s two parts. One, policymakers have to be more intentional in bringing in the voices of the people most proximate to these issues. And really include their voices, not just into the considerations, but into the actual decision making. I also think from the community aspect, we really have to hone in and recognize that policymakers work for us. They work for us. And it is okay as a community to stand up and require our policymakers to not only adhere to their campaign promises or challenges within the community, but recognizing that in their role, it is their fundamental obligation to hear from the constituents. And so, whether that is writing a letter, whether it’s writing an email, whether it’s having a phone call, all of those small actions at a community and individual level do matter. The more active we are at the local level and really elevating our voices and the needs, it makes policymakers pay attention. We have to recognize that not addressing racism, stress, poverty, has a multi-generational effect. It doesn’t only affect the adults right now, but it affects the children and even the children’s children. And so, if we really want to start breaking these cycles of poverty and racism, we have to start addressing them now.

And so, I think holistically, it’s just time to take a step back and think about how do we really ensure access to these support programs, to health care, and what that means so that we can really start to address and see the changes around improving wealth outcomes for families, health outcomes for families, and really educational outcomes as well.

**Sally**: To follow up on that, I have a pretty big question for this panel, which is, what does an ideal future look like from your perspective in this cross-policy system space?

**Cindy**: That is a big question. So, let’s imagine a world where first of all, everybody has a source of payment for their healthcare needs. That seems to be basic, it’s true in most westernized countries, it is not true in the United States. So, let’s start with that. And then, let’s go to the narrow world of healthcare, and let’s break down those lanes—those silos. I think it was Jane that mentioned everybody’s in their lane and it’s hard to break out. Well, children and families, they don’t live in lanes. They live in the community, they live in their homes, they live in their real life, and we need to meet them where they are. So, let’s start with having an integrated healthcare delivery system where we treat the whole family and the whole child. And then, let’s go beyond the healthcare system. Let’s look at all of the agencies and departments and entities that are really in very close regular contact with kids, and think about how they can work together with the healthcare sector. That’s schools, that’s child care, that’s the juvenile justice system, that’s parks and recreation. What do we need to keep kids and families healthy? So, beginning to work together.

And then working—as I mentioned before—with community-based organizations, who really do have a lot of expertise on how to address homelessness and hunger. They may not have all the resources they need for sure, but they need to be working together in concert both to deliver the services and to have everybody advocate for more resources to the extent that more resources are needed.

We need to have a very intentional equity lens as we go about these collaborations in the delivery of services and the thinking about where the financing should be prioritized. And we need to have all of this with the construct of families in the lead. And particularly, communities of color, given the health disparities. I’ve had the occasion of working with community-based organizations that are led by the community, and I’m taken by Aaliyah’s reference. I never learned more about the system as when I’m talking to parents of kids with special health care needs. They are so expert not just on what their kid needs, but on what works and what doesn’t in the health care system.

So, if you’re really wondering how to get smart on all of this, sit down with some families that have really been trying to navigate the struggle, whether it’s because they’re homeless and they’re trying to get care for their kids, or whether their kid has special health care needs. They are the experts and they really need to guide us as we go forward.

**Sally**: I really love this thread and I feel like it’s been followed through our entire conversation today. Really just making sure you have the right voices at the table—not for them to just for react to something that’s already been created, but to be there to actually create these things, and I think that’s extremely important. And Jane, I’m wondering if you could talk a bit more from your perspective about how these silos that everyone’s been referring to throughout the conversation truly impact families and communities.

**Jane**: I would like to tell you the story about a family we worked with, a lower income family who identified themselves as Latino. Dad worked in construction, mom was home with four children. The older children were in school. And she had reached out to Help Me Grow because she had some real concerns about her youngest child—lack of language skills primarily, but also some behavior issues, which may have been associated with those communication challenges.

The family lives in a rural part of our state, which while services are available in a nearby city, transportation is not available. And the mom and the child were connected with our early intervention to have an evaluation. But when we did some follow up with them, we understood they missed the appointment. Why? Because the car that they were using broke down, and the family had no money to get the car fixed. So, the story could have ended right there with the child in need, a frustrated parent, and a frustrated service provider not truly understanding what was going on. But it didn’t thank goodness, and I think that shows the resiliency that this mom had in understanding that she really had a child who had some needs and she wanted to get help for her child. And a care coordinator at Help Me Grow, who really understood the social and environmental challenges that that family was facing, and who came up with some innovative solutions to make sure that the child and the mom could get to the appointment. So, we ended up with a child who was evaluated and qualified and is still receiving early intervention services. And I just feel like that’s an example of how we can work together in a coordinated fashion to have a positive impact on outcomes for children.

Imagine a community where children and families could access services without any restrictions. A community where every individual member shared a common goal of improving outcomes for all children, and where programs and resources and services that families might need, such as the health care, early learning experiences, healthy nutrition, would work together as a coordinated system. I do see one challenge, and I’d love to hear some thoughts that Cindy might have around this, is that historically, child health care providers haven’t been viewed as full participants in this community network. And yet, ironically, they are the very first service providers for children, and really continue to see the majority of children on a regular basis throughout their earliest years.

And so, I think one of our goals should also be to intentionally embed child healthcare practitioners seamlessly into this network of community providers. Think about this provider network as an electrical power grid. So, when the grid is really functioning well, there’s this reliable flow of resources, and families can access them and plug in whenever it is that they need to. Help to keep children healthy and really provide opportunities for them to be successful, and for their families to be well. There’s work to be done on building and maintaining such a strong grid because it’s complex and it often requires some work to untangle pieces of the grid so that there is a guarantee that we won’t experiences any outages.

But I think that that is an opportunity for us, if you think about how we can provide access to multiple resources and have a reliable flow of resources for families so that we can have some influence on that lifelong healthy trajectory that we want children to begin with.

**Aaliyah**: Sally, if I could just build on that. Jane, I so see the same future and community that you just outlined. That is the world that I not only want to exist in, but I want for my sons as well. For those who would say, well, you know what, I don’t have kids, why should this matter? And for people who respond in that way or have that question, my response is, we are all connected in some way, shape, or form. None of us exists in isolation. We all have a mother, a brother, a sister, an aunt, a cousin, a coworker, somebody that we care about. And our communities are all interconnected. We have to think about not only the health and well–being and safety for those in our immediate concentric circles, but thinking about how those concentric circles are nestled within others. And if we don’t really think about the support of all, that as a whole, as a community, as a state, as a nation, we are not going to be able to succeed.

**Cindy**: I want to jump in too at Jane’s invitation to talk a little bit about the issue she raised, which is our children’s health care providers not really given the resources and the voice that is commensurate with the importance of the work that they do. We really do need to build the mechanisms to hear from those pediatric providers, to support those pediatric providers, and to bring the families, again, into the discussion and into the dialogue. We’ve got the future of the nation and children in our hands, and we’re being very short-sighted by not devoting the kind of resources that’s needed.

Now, there are a lot of advances in this area. We’re really seeing some additional investments put into those practices. Extra dollars to help with care coordination. Extra dollars to make sure there’s family navigators, child navigators, to really help families make their way through the health care system, but also beyond the health care system. If they need to apply for SNAP, if they need to have assistance in terms of housing subsidies. So, the design is not a mystery. Help Me Grow has that design, other pediatric practice innovations have that design. We need to value it and to put our resources in it.

**Aaliyah**: When you mentioned the care coordination, that was the game changer for us with our youngest son. Between the age of nine months and three, he had over eight specialists in two different states. And I was a working mom, I had a four-year-old, and I was trying to consistently figure out which specialist, track medications, give the referral. I mean, it was a true nightmare. And finally, at the age of three, we finally got a care coordinator who managed all five of the primary specialists that my son was seeing at the time. That was when I could finally take a step back and breathe because I had someone helping me navigate this complex health system.

**Cindy**: Thank you for sharing that. We need to really have a much more family-centered system of care management, where the alliance of that care manager is to the child and the family, not to a particular institution, not to a hospital or a rehab center or a specialty practice. But I am here for the child, I am here for the family. We also need to not just put all the burden on the families, we also need people in power positions to align with those families’ voices, and to say, yes, it is time to put a different balance in our investments in this country. And that’s healthcare sector leaders, that’s business leaders as well really stepping up to the plate and saying we’ve got to do things differently.

Many, many years ago, I was working with a pediatric clinic in Boston Medical Center. And they were seeing a system—a lot of no shows as they call them, in terms of people not coming for their appointments. And they did a survey. They reached out and asked their patients, what’s going on in your lives? Why aren’t you able to make appointments? In a non-judgmental way, really trying to find out what was happening. And of course, not surprisingly, the two issues were, I didn’t have childcare and I didn’t have transportation. I was desperately trying to come into the appointment. It was really high priority, it’s not that it wasn’t a priority for families, but they had very concrete barriers of lack of transportation and lack of childcare. And then the institution said, fine, we’ll develop some shuttle buses. And they developed their own system of transportation. It couldn’t solve everybody’s problem, it wasn’t perfect, but it was a really important step forward in the community. And they also set up childcare in the clinic so that a mom could come and bring her other children and not worry that they weren’t going to be attended to or that they would be bored or otherwise get into trouble. And so, it really became a family center.

So, it really goes to the point of listening on a one-on–one basis to the family, and also soliciting their advice and respecting that they very much want to be full partners in the system, and mostly care so much about the well–being of their children. Instead, entities have imposed copayments, saying, well, people don’t appreciate care unless they pay money. Well, that will be a barrier to care. So, listen to what people want and construct your policies accordingly.

**Jane**: As a service provider, we have to be not just engaging parents, but really listening to parents. And include them in the work we do, the plans that we make. Too many times, I think parent engagement is looked at sort of as a have to, check the box, we do it. But, that’s not enough. So, I would definitely put that out there as an opportunity and sort of a mandate, a challenge to all of us who are not truly in a meaningful way, including that voice at the table.

**Aaliyah**: I think the only thing I would say is as we continue to move towards equitable outcomes, we have to really understand that moving towards equitable outcomes is not going to confirm equity. There are two different things. By trying to make sure everyone has access, that doesn’t mean we’ll get the outcomes that we need. There are some that are resting back and kind of sitting back and saying, well, they could access that program if they wanted to. But if we don’t really unpack it, like the perfect example that Cindy just gave, then we’re not going to get to the outcomes that we’re really trying to drive towards.

**Sally**: Thank you all so much for joining us. I really enjoyed this conversation, and especially, the different perspectives that you each brought to the table. When we come back, Dr. Shonkoff and I will be discussing another common misconception about early childhood development and lifelong health.

Musical Interlude

**Sally**: I’m joined again by Dr. Jack Shonkoff, who’s going to help clear up another myth that exists in the early child development field. So Jack, we’ve talked a lot about how interactions between genes and environment shape human development and lifelong health. And yet, when some people talk about adult diseases, the conversation can turn to being about whether the disease that person has or this person has is a result of genetics or if it’s a result of their lifestyle choices.

**Jack**: The reason why that’s a myth is that it’s basically telling us that if you develop a chronic disease as an adult, particularly the most common chronic diseases like heart disease and hypertension, diabetes, addictions, depression, that it’s either genetic or it’s because you are not living a healthy lifestyle. And that kind of setup is a really important myth to burst. Because what we do know is that all health outcomes are a mix of differences in genetic predispositions, and whether we’re living health promoting or health disrupting lifestyles. Not to say that it doesn’t matter how well you exercise or how well you eat. It’s also not true to say that there’s no genetic contribution to the greater risk to have a particular health impairment.

Very, very few, and none of these common chronic conditions are primarily genetically determined. And many of these conditions that are found to be associated with not very healthy lifestyles, you don’t exercise, you eat poorly, you’re overweight, your blood pressure’s up and you have a heart attack, people can look at that and say, well, yeah, that’s your own fault because of the way you live. What we’re missing is that the relatively higher risk or protection against these diseases starts very early in life. It starts prenatally and the first few years after birth. And that’s why it is so important that we try to protect children from excessive adversity, and why we want to help bring down excessive stress activation because it affects these developing systems very early in life, when they are relatively immature, that can have an effect on the greater likelihood of good health or the greater likelihood of being at risk for many common diseases.

Musical Interlude

**Sally**: And we’re back with Dr. Jack Shonkoff to wrap up today’s episode. Jack, we’ve talked a lot about changes that need to happen at the policy level, the systems level, and even the program level. What would you say to parents or caregivers who are hearing this information and thinking, well, I can’t wait for these changes to happen, I need to help my child now. Why should this new science make our listeners more hopeful that these changes can occur, and what can we be doing in the meantime?

**Jack**: Let me answer first by saying that not being hopeful is never an alternative. Ever. If we’re talking about the health and wellbeing of young children, both our own children, if we’re looking at it from a family perspective, or all of our own children, if we’re looking at it from a community or societal perspective, there’s no room for hopelessness.

I think the most important message for parents about this new mindset is that all of the things that you have been doing right to provide an environment for your young child that promotes early learning, healthy social and emotional development, and prepares your child to come to school ready to succeed, you don’t have to do anything differently to build a strong foundation for your child’s physical and mental health. A lot of attention has been directed in the early childhood field to the importance of responsive relationships, the need for serve and return interaction between young children and the adults who care for them. The importance of buffering children from stresses in the lives of families who work really hard to help build their children’s ability to be able to adapt to the stresses of everyday life. The importance of building skills to help to deal with stresses and hardships. The importance of building resilience that then transforms into being able to cope with adversity and to learn effectively and do well in school. That same resilience, those same kinds of coping skills, not only protect the developing brain, they protect the developing immune system. They protect developing metabolic systems. All of the wonderful things that parents do for their children. It used to be done in the service of early learning without even thinking about you doing the same thing to protect your child’s health now and in the future.

The reason to be more hopeful about this is that we have a very strong science-based explanation for why what happens early in life influences all of the things that make for a healthy, productive, successful, engaged population for society. It’s very hopeful to think that if that science message gets out with the credibility that it deserves, that a broader part of the population will understand what a terrible missed opportunity is to not invest very early in the lives of children whose families are facing significant adversity and to understand that we will all benefit at the end of the day. Doesn’t mean that there isn’t a lot of hard work to be done at the policy level, a lot of hard work to be done at the service delivery level. A lot of hard work to be done to help families with young children across the population to be empowered, to advocate for what families need to kind of raise healthy and competent children. All of that to me presents a lot of hope. It doesn’t underestimate the struggle to change policies, but we have more information and knowledge to work with.

**Sally**: Absolutely. There’s clearly a lot of work that needs to be done. But hearing your perspective as well as the voices of our panelists earlier in the call definitely makes me feel optimistic that change is possible. I’d like to once again thank our guests, Cindy Mann, Dr. Aaliyah Samuel, Jane Witowski, and Dr. Jack Shonkoff. And thanks to Abbi Wright for your question. I’m your host, Sally Pfitzer, and we’ll see you next time.

The Brain Architects is a product of the Center on the Developing Child at Harvard University. You can find us at developingchild.harvard.edu, where we’ll post any resources that were discussed in this episode. We’re also on Twitter @Harvardcenter, Facebook at Center Developing Child, Instagram @developingchildharvard, and LinkedIn Center on the Developing Child at Harvard University. Brandi Thomas and Charley Gibney are our producers. Bridgette Cyr is our audio editor. Our music is Brain Power by Mela from freemusicarchive.org.

**Connecting Health and Learning Part II: The Implications** Jan 20, 2021
How do we use the science of early childhood development to implement practical strategies and overcome longstanding barriers in the early childhood field? How can we ensure that families’ voices are heard when we create policies or programs?

Contents

Podcast

Panelists

Additional Resources

Transcript

To kick off this episode, Center Director Dr. Jack Shonkoff describes what the science means for policymakers, system leaders, care providers, and caregivers.

This is followed by a discussion among a distinguished panel of experts, including Cindy Mann (Manatt Health), Dr. Aaliyah Samuel (Northwest Evaluation Association), and Jane Witowski (Help Me Grow). The panelists discuss how we can break down the silos in the early childhood field, policies affecting prenatal-three, and how policies can change to address the stressors inflicted by poverty, community violence, and racism.

Panelists

Cindy Mann

Dr. Aaliyah Samuel

Jane Witowski

Additional Resources

Resources from the Center on the Developing Child

The Brain Architects: Connecting Health & Learning Part I: The Science

Working Paper 15: Connecting the Brain to the Rest of the Body: Early Childhood Development and Lifelong Health Are Deeply Intertwined

InBrief: Connecting the Brain to the Rest of the Body

Health and Learning Are Deeply Interconnected in the Body: An Action Guide for Policymakers

What Is Inflammation? And Why Does it Matter for Child Development?

How Racism Can Affect Child Development

Resources from the Panelists

Testing America’s Freedom Podcast

Help Me Grow National Center

Transcript

**Sally**: Welcome to the Brain Architects, a podcast from the Center on the Developing Child at Harvard University. I’m your host, Sally Pfitzer. Our Center believes that advances in science can provide a powerful source of new ideas that can improve outcomes for children and families. We want to help you apply the science of early childhood development to your everyday interactions with children and take what you’re hearing from our experts and panels and apply it to your everyday work.

Today, we’ll discuss how the science we shared in our previous episode, on the early years and lifelong health, can change the way we think about early childhood policy and practice, and what this shift means for policymakers, practitioners, and caregivers. So, I’d like to welcome back Dr. Jack Shonkoff, Professor of Child Health and Development and the Director of the Center on the Developing Child at Harvard University. Hi, Jack. Welcome back.

**Jack**: Hey, Sally.

**Sally**: So we talked in the last episode about how the brain is connected to the rest of the body, and especially how the early years really matter when it comes to lifelong health. What does this science mean for policymakers, system leaders, or even caregivers?

**Jack**: That’s a really important question, Sally. From the beginning of the early childhood field, it’s always been focused on early learning and improving children’s readiness to succeed in school. In the policy world, it’s in education policy, comes out of the education budget. For people who work in early childhood programs, and for parents, it’s about programs that encourage and provide rich learning opportunities for children to develop early literacy competencies.

But the mindset shift here is that it’s not just about early learning in school—it‘s about the foundations of physical and mental health. It’s not just about improving outcomes for greater economic productivity—better educational achievement. It’s also about decreasing the likelihood that you’ll develop heart disease or hypertension, or diabetes, or a wide range of the most common chronic illnesses in society. It’s not just a matter of return on investment—asking “So, how much more economically productive will the population be? How much will we save in incarceration?” It’s also how much will we save in the cost of health care.

**Sally**: We’ve previously discussed the coronavirus pandemic, as well as the national reckoning regarding systemic racism, and the impact that this current climate has on children and families. Could you talk about how both of those issues are playing out in the context of policy and systems change?

**Jack**: From a science point of view, disparities in health outcomes is not a new discovery. But from a public understanding point of view, the COVID-19 epidemic and its gross inequalities in exposure and in infection and in complications and in deaths has really put front and center the incredibly important impact of systemic racism and interpersonal discrimination as it affects health. We know that more people of color, particularly African Americans—but also Latino and Indigenous populations—have greater exposure to the infection because of working in jobs that cannot be done at home, more reliance on public transportation, tighter housing circumstances—all of which make it more difficult to be protected from exposure to the infection.

But what’s getting less attention is not just rates of exposure and infection, but also rates of complications. We do know that of those people who are infected, people with underlying medical conditions are more likely to be sicker, and in many cases, more likely to die from the infection. And those underlying conditions are not equally distributed across the population. And they are particularly a higher prevalence in populations of color and in people who have grown up in poverty.

And here, what this new science is telling us is: this is not about adult exposure. These diseases have their roots early in childhood. They have their origins in excessive stress activation—excessive adversity—related to poverty, related to racism, related to exposure to violence, related to unstable housing, and related to food insecurity, all of which present tremendous burdens for families raising young children that increase the risk for excessive stress activation, which early on in life—doesn‘t always affect—but can affect brain development, the development of the immune system, development of metabolic systems.

On the one hand, the impacts of racism belong on the list of a lot of other sources of stress for families. But on the other hand, there are burdens and hardships that are unique to experiencing racism that we have to start to come to grips with in a very different way. If we don’t protect children from that, if we don’t provide the support for families to be able to help protect their children from the stresses in the environments in which they live, then what we see is over time, not only influences on early learning affecting readiness to succeed in school, but greater likelihood to have many of these chronic diseases later in life. And this is a rude awakening and an opportunity for the early childhood field to focus much more not just on early learning and school readiness, but to focus on the early origins of lifelong health problems, both physically and mentally.

**Sally**: I completely agree with that Jack. And I’d also say that it’s so important that people at the policy and systems level work directly with families who are experiencing these stressors just to make sure they really understand their perspectives and their needs. And up next, Jack’s going to answer a question that’s been submitted by one of our listeners.

Musical interlude

**Sally**: And we’re back! For this segment, we asked audience members who listened to the podcast to send in any questions they may have for Jack. Today’s question involves the role of significant stress on our abilities to use core life skills—the skills that help us manage information, make decisions, and plan ahead to make healthier long-term choices or avoid impulsive risks, reduce stress, and ultimately improve health. Today’s question comes from a listener named Abbi Wright.

**Abbi**: My name is Abbi Wright, and I’m a first–year graduate student at Oklahoma State University studying speech language pathology. And my question for Dr. Shonkoff is: how does strengthening core life skills in children affect lifelong health? How can we strengthen those skills in families that are especially vulnerable because of immigration status or racism?

**Jack**: So that’s a really important question, Abbi. Let me try to answer in the following way. Building core skills is part of a strong foundation of resilience that will help you deal with stresses and engage in more health promoting behavior over your life course and further decrease the risk for disease. For young children, strengthening those skills helps to build coping capacities. That helps bring the stress response down so that when these systems are developing very early on, they’re not being disrupted. One of the things that we are beginning to understand in a much clearer way is that reducing excessive stress activation in the early childhood period helps to protect all these developing biological systems that not only affect learning, but also affect physical and mental health.

Part of the way that we reduce stress activation in young children is by the adults who care for them to provide a sense of safety and security and buffer children from the stresses that are present in the lives of their caregivers. Families are experiencing significant stress. The pressures are greater to be able to provide that sense of safety for children—help them build their own coping skills. We know that some groups are particularly at risk, not for their ability to be good parents, but for the level of threat and hardship and burden that is imposed on families because of structural inequities in our society. Systemic racism is one obvious example. Immigrant families in the United States right now are another good example of families who are dealing with more than the usual amount of stress because even for immigrants whose legal status is not in question, there is an atmosphere of anxiety and threat and concern about the discrimination experienced by many immigrant families. So, the basic biology is the same regardless of your life circumstances. The level of threat—the level of hardship—varies based less on parents’ abilities to help build skills in their children, but more in terms of how much of an external burden of hardship and threat is imposed on families in their everyday lives raising their young children.

**Sally**: Thanks, Jack. And thank you, Abbi, for that thought provoking question. Up next, our panel will talk more about the implications of this new science for people across the early childhood field.

Musical interlude

**Sally**: So, on today’s podcast, we have with us Dr. Aaliyah Samuel. She’s the Executive Vice President of Government Affairs and Partnerships at Northwest Evaluation Association, and a Senior Fellow at the Center on the Developing Child. Thanks for being here today, Aaliyah.

**Aaliyah**: Thanks so much, Sally, for having me. I’m really looking forward to the conversation today.

**Sally**: Also joining us on today’s podcast, we have Cindy Mann, partner at Manatt Health and former Deputy Administrator at the Centers for Medicare and Medicaid Services, and former Director of the Center for Medicaid and CHIP services. Hi, Cindy, great to have you with us.

**Cindy**: It’s a pleasure. Thanks so much for including me.

**Sally**: And also, on today’s podcast, we have Jane Witowski. State Director of Help Me Grow South Carolina. Thanks for joining us, Jane.

**Jane**: Thanks so much. I’m happy to join the group today for this very important conversation.

**Sally**: My first question is for you, Aaliyah. Could you discuss the policy silos in state and federal government? What mindsets have shaped the current policy landscape?

**Aaliyah**: I will say one of the fundamental challenges is really the cross and inter-agency communication. It’s just really important both at the federal level and as well as the state and local level, that we get individuals that represent multiple systems to come to the table and have conversations. That is how we can start to really think about how to blend and braid funding to ensure that we get the maximum number of families—children—getting access to these programs.

We have seen the evolution over really the last I would say five to 10 years, where it has moved from early childhood being a woman’s issue to a workforce issue and a non-partisan issue. When I was Director at the National Governors Association of the Education Division, we watched the 2018 gubernatorial campaigns very closely. And of the 36 governors that were running at the time, there was not one that did not make a reference to early childhood and its importance to some degree. So, I can say that early childhood and this issue around childcare, families, our youngest citizens, is truly a non-partisan issue, which I think is important to underscore because it creates a recognition that it doesn’t matter what side of the aisle you’re on, this is an important issue.

I think too as we talk about some of the mindsets or even the current policy landscape, I will say, one of the things COVID has really done is exposed the inequities that were hidden in plain sight. We can’t ignore the data, we can’t ignore the disparities, we can’t ignore the communities and individuals and families that have been hit the hardest, and who have historically been hit the hardest, and will also have the most challenges recovering from the pandemic and all that’s come with it. I think, ultimately, what is really lacking is the voice of those who are impacted the most. I heard a quote once, that I really do believe, which says, don’t do anything for us without us. I think as we start to really think about reshaping the policy landscape to address some of these inequities, we need to make sure that there is diversity at the table of decision makers, but also those who will be impacted the most, and making sure that we’re underscoring their voices.

**Sally**: Yeah, that’s such a great point, and leads into my next question for you, Cindy. Can you speak about the policies affecting prenatal to three?

**Cindy**: Let me just start by underscoring a point, which is that the country is moving in this direction. I’m seeing all across the country, movements in pediatric practice, in health care, in Medicaid programs, in state government, in local communities along these paths. So, I really do think these are all achievable.

Everybody has to have access to health care coverage. Start there. That is not the case now. And while children are more likely to be covered than other groups, the rate of insurance for children has been dropping in the last couple of years. And mostly, they’ve been dropped off in Medicaid and not picked up elsewhere, and there’s a lot of different reasons for that. There’s also groups of children who because of their immigration status are just not eligible for coverage. Also, one of the I think really important tenets of good pediatric practice is to make sure that parents’ needs are met as well. We also have a number of states that have not extended Medicaid to low-income parents, and that really disenfranchises the family in terms of being able to access the kind of care that families need to make kids strong and healthy.

Some of the other policy issues that need to happen are, is to really begin to integrate behavioral health and physical health. Those two worlds have lived often in very separate silos. That’s not how kids live, that’s not how families live. We need attention to the social and economic needs of families as a very integrated way of addressing those issues in the practice of the provision of health care coverage. A real focus on equity throughout all of the policies that we’re moving forward. As Aaliyah said, there’s no secret to the fact that we have significant structural racism and disparities based on race, and COVID has laid bare and put that, again, in our face, and we need to do something about it. And it really does take a very intentional focus on trying to address disparities to deal with it.

We also have a financing issue. So much of the recent investments around social determinants—help with homelessness, help with hunger—have been driven by this perception of a return on investment to the healthcare sector. Well, that mostly leaves kids out, because while there is a market return on investment if you invest in young children’s health care, that return doesn’t always happen in a very short period of time, and that return also sometimes happens to other parts of our system. To our education system, to our juvenile justice system, to our child welfare system. So, we need a way of really having cross-sector collaboration in the design and in the financing of the full range of services for kids.

**Sally**: And Jane, I’m wondering if you could speak to us from the healthcare and community service perspective, how do the families you work with feel about the policies in early childhood? Is there a sense that change is needed?

**Jane**: Sure. I would characterize the mindset as hopeful and encouraged. And what I’ve experienced is a real desire to work together across sector, and was pleased to hear Cindy bring that up as one of her last points in that cross-sector collaboration how necessary it is. And I’ve seen that at the local level and at the state level. However, it’s accompanied by a real frustration about how to go about it. There’s still a lot of confusion, and also barriers. When providers are faced with funding restrictions, staff capacity, regulatory mandates, and still this mindset of needing to stay in your lane. One of the reasons that I’m hopeful is the Help Me Grow system, which 20 years ago was seen as an innovation and an opportunity to bring together those service providers with the common goal of meeting family’s needs. And so, I’ve seen how it can allow service providers to break down those barriers, and to help make connections that are really meaningful for families.

**Aaliyah**: Sally, can I just chime in here? Jane, when you said the flexibility, particularly in the regulations and staff capacity that is so spot on. I do a lot of advocacy work both at the federal and state level. One of the things we are advocating hard on is allowing for flexibility in the regulation so that at the community level, the funds can be used in the way that best fits the community needs. We fundamentally have to take a step back and stop being so prescriptive on what we think communities need, and create the funding structure to then package it to a community to make the changes and provide the supports that they need.

And also, it’s ironic when you mentioned the innovation piece or staff capacity. It’s so hard to be innovative when you’re pumping out reports, when you’re seeing families one after another. And so, we have to think about how do we create the place and space for innovation to happen. And that takes time, that takes time to plan, it takes time to collaborate across systems. We can’t keep expecting do what you’re doing with no additional funds or support, and then be innovative on top of that. It just doesn’t happen that way. And you can have the most well-intended people who have the passion and the ideas to innovate, but if they don’t have the capacity it’s not going to happen.

**Cindy**: I’d love to jump in on this part of the conversation as well. Another important point is to build the infrastructure in the community to be able to help connect people—health care sector—to community-based organizations and other resources. You can’t expect that a pediatrician is going to figure out where to send their families if they’re homeless or if they’re hungry. Or maybe you can send them, but you can’t necessarily do the follow up that’s needed to make sure that those needs get met. So, increasingly different communities are coming up with and states coming up with integrator organizations. They can be Accountable Communities of Health, is what Washington state calls them. North Carolina is planning to set up lead entities to help coordinate community–based organizations in certain regions and connect them to the healthcare sector.

So, we absolutely can’t do this just on the fly. We’ve got to create systems—systems of financing and systems of working together—that are adequately funded so that this can work. And let me just also underscore a point made before that I neglected to raise, which I so firmly believe in the importance of families being not only at the table, but really in leadership to really figure out what those priorities are, and whether the system is working well, and whether the system is not working well. So, both at the policy table, and then as real time monitors of how well the system is working for kids.

**Sally**: How can policies change to address the stressors inflicted by poverty, community violence, and racism?

**Aaliyah**: First, we have to acknowledge that they exist. That has to be step one. The stressors, the impacts of racism, bias, violence. What is real to someone who exists and has to exist in those communities, versus those who only have a perception based off of what their realities are, what their community is. It creates that disconnect. And the realities of families at all levels are different, and we have to acknowledge that. We can’t turn a blind eye, we can’t say, well, I’ve never seen it, so, I don’t think that that’s true. I will say—I‘ll give a personal example. I have two sons, but my youngest son has some really significant health care needs. I didn’t understand the challenges of being a mom with a child with special healthcare needs until I had one. I was an educator, I have a master’s degree in special education. But it’s very different when it’s your child and you’re trying to navigate the education system, the health care system, and advocate for your child who is struggling.

There’s two parts. One, policymakers have to be more intentional in bringing in the voices of the people most proximate to these issues. And really include their voices, not just into the considerations, but into the actual decision making. I also think from the community aspect, we really have to hone in and recognize that policymakers work for us. They work for us. And it is okay as a community to stand up and require our policymakers to not only adhere to their campaign promises or challenges within the community, but recognizing that in their role, it is their fundamental obligation to hear from the constituents. And so, whether that is writing a letter, whether it’s writing an email, whether it’s having a phone call, all of those small actions at a community and individual level do matter. The more active we are at the local level and really elevating our voices and the needs, it makes policymakers pay attention. We have to recognize that not addressing racism, stress, poverty, has a multi-generational effect. It doesn’t only affect the adults right now, but it affects the children and even the children’s children. And so, if we really want to start breaking these cycles of poverty and racism, we have to start addressing them now.

And so, I think holistically, it’s just time to take a step back and think about how do we really ensure access to these support programs, to health care, and what that means so that we can really start to address and see the changes around improving wealth outcomes for families, health outcomes for families, and really educational outcomes as well.

**Sally**: To follow up on that, I have a pretty big question for this panel, which is, what does an ideal future look like from your perspective in this cross-policy system space?

**Cindy**: That is a big question. So, let’s imagine a world where first of all, everybody has a source of payment for their healthcare needs. That seems to be basic, it’s true in most westernized countries, it is not true in the United States. So, let’s start with that. And then, let’s go to the narrow world of healthcare, and let’s break down those lanes—those silos. I think it was Jane that mentioned everybody’s in their lane and it’s hard to break out. Well, children and families, they don’t live in lanes. They live in the community, they live in their homes, they live in their real life, and we need to meet them where they are. So, let’s start with having an integrated healthcare delivery system where we treat the whole family and the whole child. And then, let’s go beyond the healthcare system. Let’s look at all of the agencies and departments and entities that are really in very close regular contact with kids, and think about how they can work together with the healthcare sector. That’s schools, that’s child care, that’s the juvenile justice system, that’s parks and recreation. What do we need to keep kids and families healthy? So, beginning to work together.

And then working—as I mentioned before—with community-based organizations, who really do have a lot of expertise on how to address homelessness and hunger. They may not have all the resources they need for sure, but they need to be working together in concert both to deliver the services and to have everybody advocate for more resources to the extent that more resources are needed.

We need to have a very intentional equity lens as we go about these collaborations in the delivery of services and the thinking about where the financing should be prioritized. And we need to have all of this with the construct of families in the lead. And particularly, communities of color, given the health disparities. I’ve had the occasion of working with community-based organizations that are led by the community, and I’m taken by Aaliyah’s reference. I never learned more about the system as when I’m talking to parents of kids with special health care needs. They are so expert not just on what their kid needs, but on what works and what doesn’t in the health care system.

So, if you’re really wondering how to get smart on all of this, sit down with some families that have really been trying to navigate the struggle, whether it’s because they’re homeless and they’re trying to get care for their kids, or whether their kid has special health care needs. They are the experts and they really need to guide us as we go forward.

**Sally**: I really love this thread and I feel like it’s been followed through our entire conversation today. Really just making sure you have the right voices at the table—not for them to just for react to something that’s already been created, but to be there to actually create these things, and I think that’s extremely important. And Jane, I’m wondering if you could talk a bit more from your perspective about how these silos that everyone’s been referring to throughout the conversation truly impact families and communities.

**Jane**: I would like to tell you the story about a family we worked with, a lower income family who identified themselves as Latino. Dad worked in construction, mom was home with four children. The older children were in school. And she had reached out to Help Me Grow because she had some real concerns about her youngest child—lack of language skills primarily, but also some behavior issues, which may have been associated with those communication challenges.

The family lives in a rural part of our state, which while services are available in a nearby city, transportation is not available. And the mom and the child were connected with our early intervention to have an evaluation. But when we did some follow up with them, we understood they missed the appointment. Why? Because the car that they were using broke down, and the family had no money to get the car fixed. So, the story could have ended right there with the child in need, a frustrated parent, and a frustrated service provider not truly understanding what was going on. But it didn’t thank goodness, and I think that shows the resiliency that this mom had in understanding that she really had a child who had some needs and she wanted to get help for her child. And a care coordinator at Help Me Grow, who really understood the social and environmental challenges that that family was facing, and who came up with some innovative solutions to make sure that the child and the mom could get to the appointment. So, we ended up with a child who was evaluated and qualified and is still receiving early intervention services. And I just feel like that’s an example of how we can work together in a coordinated fashion to have a positive impact on outcomes for children.

Imagine a community where children and families could access services without any restrictions. A community where every individual member shared a common goal of improving outcomes for all children, and where programs and resources and services that families might need, such as the health care, early learning experiences, healthy nutrition, would work together as a coordinated system. I do see one challenge, and I’d love to hear some thoughts that Cindy might have around this, is that historically, child health care providers haven’t been viewed as full participants in this community network. And yet, ironically, they are the very first service providers for children, and really continue to see the majority of children on a regular basis throughout their earliest years.

And so, I think one of our goals should also be to intentionally embed child healthcare practitioners seamlessly into this network of community providers. Think about this provider network as an electrical power grid. So, when the grid is really functioning well, there’s this reliable flow of resources, and families can access them and plug in whenever it is that they need to. Help to keep children healthy and really provide opportunities for them to be successful, and for their families to be well. There’s work to be done on building and maintaining such a strong grid because it’s complex and it often requires some work to untangle pieces of the grid so that there is a guarantee that we won’t experiences any outages.

But I think that that is an opportunity for us, if you think about how we can provide access to multiple resources and have a reliable flow of resources for families so that we can have some influence on that lifelong healthy trajectory that we want children to begin with.

**Aaliyah**: Sally, if I could just build on that. Jane, I so see the same future and community that you just outlined. That is the world that I not only want to exist in, but I want for my sons as well. For those who would say, well, you know what, I don’t have kids, why should this matter? And for people who respond in that way or have that question, my response is, we are all connected in some way, shape, or form. None of us exists in isolation. We all have a mother, a brother, a sister, an aunt, a cousin, a coworker, somebody that we care about. And our communities are all interconnected. We have to think about not only the health and well–being and safety for those in our immediate concentric circles, but thinking about how those concentric circles are nestled within others. And if we don’t really think about the support of all, that as a whole, as a community, as a state, as a nation, we are not going to be able to succeed.

**Cindy**: I want to jump in too at Jane’s invitation to talk a little bit about the issue she raised, which is our children’s health care providers not really given the resources and the voice that is commensurate with the importance of the work that they do. We really do need to build the mechanisms to hear from those pediatric providers, to support those pediatric providers, and to bring the families, again, into the discussion and into the dialogue. We’ve got the future of the nation and children in our hands, and we’re being very short-sighted by not devoting the kind of resources that’s needed.

Now, there are a lot of advances in this area. We’re really seeing some additional investments put into those practices. Extra dollars to help with care coordination. Extra dollars to make sure there’s family navigators, child navigators, to really help families make their way through the health care system, but also beyond the health care system. If they need to apply for SNAP, if they need to have assistance in terms of housing subsidies. So, the design is not a mystery. Help Me Grow has that design, other pediatric practice innovations have that design. We need to value it and to put our resources in it.

**Aaliyah**: When you mentioned the care coordination, that was the game changer for us with our youngest son. Between the age of nine months and three, he had over eight specialists in two different states. And I was a working mom, I had a four-year-old, and I was trying to consistently figure out which specialist, track medications, give the referral. I mean, it was a true nightmare. And finally, at the age of three, we finally got a care coordinator who managed all five of the primary specialists that my son was seeing at the time. That was when I could finally take a step back and breathe because I had someone helping me navigate this complex health system.

**Cindy**: Thank you for sharing that. We need to really have a much more family-centered system of care management, where the alliance of that care manager is to the child and the family, not to a particular institution, not to a hospital or a rehab center or a specialty practice. But I am here for the child, I am here for the family. We also need to not just put all the burden on the families, we also need people in power positions to align with those families’ voices, and to say, yes, it is time to put a different balance in our investments in this country. And that’s healthcare sector leaders, that’s business leaders as well really stepping up to the plate and saying we’ve got to do things differently.

Many, many years ago, I was working with a pediatric clinic in Boston Medical Center. And they were seeing a system—a lot of no shows as they call them, in terms of people not coming for their appointments. And they did a survey. They reached out and asked their patients, what’s going on in your lives? Why aren’t you able to make appointments? In a non-judgmental way, really trying to find out what was happening. And of course, not surprisingly, the two issues were, I didn’t have childcare and I didn’t have transportation. I was desperately trying to come into the appointment. It was really high priority, it’s not that it wasn’t a priority for families, but they had very concrete barriers of lack of transportation and lack of childcare. And then the institution said, fine, we’ll develop some shuttle buses. And they developed their own system of transportation. It couldn’t solve everybody’s problem, it wasn’t perfect, but it was a really important step forward in the community. And they also set up childcare in the clinic so that a mom could come and bring her other children and not worry that they weren’t going to be attended to or that they would be bored or otherwise get into trouble. And so, it really became a family center.

So, it really goes to the point of listening on a one-on–one basis to the family, and also soliciting their advice and respecting that they very much want to be full partners in the system, and mostly care so much about the well–being of their children. Instead, entities have imposed copayments, saying, well, people don’t appreciate care unless they pay money. Well, that will be a barrier to care. So, listen to what people want and construct your policies accordingly.

**Jane**: As a service provider, we have to be not just engaging parents, but really listening to parents. And include them in the work we do, the plans that we make. Too many times, I think parent engagement is looked at sort of as a have to, check the box, we do it. But, that’s not enough. So, I would definitely put that out there as an opportunity and sort of a mandate, a challenge to all of us who are not truly in a meaningful way, including that voice at the table.

**Aaliyah**: I think the only thing I would say is as we continue to move towards equitable outcomes, we have to really understand that moving towards equitable outcomes is not going to confirm equity. There are two different things. By trying to make sure everyone has access, that doesn’t mean we’ll get the outcomes that we need. There are some that are resting back and kind of sitting back and saying, well, they could access that program if they wanted to. But if we don’t really unpack it, like the perfect example that Cindy just gave, then we’re not going to get to the outcomes that we’re really trying to drive towards.

**Sally**: Thank you all so much for joining us. I really enjoyed this conversation, and especially, the different perspectives that you each brought to the table. When we come back, Dr. Shonkoff and I will be discussing another common misconception about early childhood development and lifelong health.

Musical Interlude

**Sally**: I’m joined again by Dr. Jack Shonkoff, who’s going to help clear up another myth that exists in the early child development field. So Jack, we’ve talked a lot about how interactions between genes and environment shape human development and lifelong health. And yet, when some people talk about adult diseases, the conversation can turn to being about whether the disease that person has or this person has is a result of genetics or if it’s a result of their lifestyle choices.

**Jack**: The reason why that’s a myth is that it’s basically telling us that if you develop a chronic disease as an adult, particularly the most common chronic diseases like heart disease and hypertension, diabetes, addictions, depression, that it’s either genetic or it’s because you are not living a healthy lifestyle. And that kind of setup is a really important myth to burst. Because what we do know is that all health outcomes are a mix of differences in genetic predispositions, and whether we’re living health promoting or health disrupting lifestyles. Not to say that it doesn’t matter how well you exercise or how well you eat. It’s also not true to say that there’s no genetic contribution to the greater risk to have a particular health impairment.

Very, very few, and none of these common chronic conditions are primarily genetically determined. And many of these conditions that are found to be associated with not very healthy lifestyles, you don’t exercise, you eat poorly, you’re overweight, your blood pressure’s up and you have a heart attack, people can look at that and say, well, yeah, that’s your own fault because of the way you live. What we’re missing is that the relatively higher risk or protection against these diseases starts very early in life. It starts prenatally and the first few years after birth. And that’s why it is so important that we try to protect children from excessive adversity, and why we want to help bring down excessive stress activation because it affects these developing systems very early in life, when they are relatively immature, that can have an effect on the greater likelihood of good health or the greater likelihood of being at risk for many common diseases.

Musical Interlude

**Sally**: And we’re back with Dr. Jack Shonkoff to wrap up today’s episode. Jack, we’ve talked a lot about changes that need to happen at the policy level, the systems level, and even the program level. What would you say to parents or caregivers who are hearing this information and thinking, well, I can’t wait for these changes to happen, I need to help my child now. Why should this new science make our listeners more hopeful that these changes can occur, and what can we be doing in the meantime?

**Jack**: Let me answer first by saying that not being hopeful is never an alternative. Ever. If we’re talking about the health and wellbeing of young children, both our own children, if we’re looking at it from a family perspective, or all of our own children, if we’re looking at it from a community or societal perspective, there’s no room for hopelessness.

I think the most important message for parents about this new mindset is that all of the things that you have been doing right to provide an environment for your young child that promotes early learning, healthy social and emotional development, and prepares your child to come to school ready to succeed, you don’t have to do anything differently to build a strong foundation for your child’s physical and mental health. A lot of attention has been directed in the early childhood field to the importance of responsive relationships, the need for serve and return interaction between young children and the adults who care for them. The importance of buffering children from stresses in the lives of families who work really hard to help build their children’s ability to be able to adapt to the stresses of everyday life. The importance of building skills to help to deal with stresses and hardships. The importance of building resilience that then transforms into being able to cope with adversity and to learn effectively and do well in school. That same resilience, those same kinds of coping skills, not only protect the developing brain, they protect the developing immune system. They protect developing metabolic systems. All of the wonderful things that parents do for their children. It used to be done in the service of early learning without even thinking about you doing the same thing to protect your child’s health now and in the future.

The reason to be more hopeful about this is that we have a very strong science-based explanation for why what happens early in life influences all of the things that make for a healthy, productive, successful, engaged population for society. It’s very hopeful to think that if that science message gets out with the credibility that it deserves, that a broader part of the population will understand what a terrible missed opportunity is to not invest very early in the lives of children whose families are facing significant adversity and to understand that we will all benefit at the end of the day. Doesn’t mean that there isn’t a lot of hard work to be done at the policy level, a lot of hard work to be done at the service delivery level. A lot of hard work to be done to help families with young children across the population to be empowered, to advocate for what families need to kind of raise healthy and competent children. All of that to me presents a lot of hope. It doesn’t underestimate the struggle to change policies, but we have more information and knowledge to work with.

**Sally**: Absolutely. There’s clearly a lot of work that needs to be done. But hearing your perspective as well as the voices of our panelists earlier in the call definitely makes me feel optimistic that change is possible. I’d like to once again thank our guests, Cindy Mann, Dr. Aaliyah Samuel, Jane Witowski, and Dr. Jack Shonkoff. And thanks to Abbi Wright for your question. I’m your host, Sally Pfitzer, and we’ll see you next time.

The Brain Architects is a product of the Center on the Developing Child at Harvard University. You can find us at developingchild.harvard.edu, where we’ll post any resources that were discussed in this episode. We’re also on Twitter @Harvardcenter, Facebook at Center Developing Child, Instagram @developingchildharvard, and LinkedIn Center on the Developing Child at Harvard University. Brandi Thomas and Charley Gibney are our producers. Bridgette Cyr is our audio editor. Our music is Brain Power by Mela from freemusicarchive.org.

Connecting Health and Learning Part I: The Science Dec 08, 2020

How do our biological systems work together to respond to chronic stress? What do these responses mean for early learning and lifelong health? And when we say that early experiences matter, what do we mean by early? This episode of The Brain Architects podcast addresses all these questions and more!

Contents

Podcast

Panelists

Additional Resources

Transcript

To kick off this episode, Center Director Dr. Jack Shonkoff describes the body’s stress response system, how our biological systems act as a team when responding to chronic stress, and the effects chronic stress can have on lifelong health.

This is followed by a discussion among a panel of scientists including Dr. Nicki Bush (University of California-San Francisco), Dr. Damien Fair (University of Minnesota), and Dr. Fernando Martinez (University of Arizona). The panelists discuss how our bodies respond to adversity, inflammation’s role in the stress response system, the effects of stress during the prenatal period and first few years after birth, and how we can use this science to prevent long-term impacts on our health.

Panelists

Dr. Nicki Bush

Dr. Damien Fair

Dr. Fernando Martinez

Additional Resources

Resources from the Center on the Developing Child

Articles

Biel, M.G., Tang, M.H., & Zuckerman, B. (2020). Pediatric mental health care must be family mental health care. JAMA Pediatrics, 174(6):519-520.
Boyce, W.T., Levitt, P., Martinez, F.D., McEwen, B.S., & Shonkoff, J.P. Genes, environments, and time: The biology of adversity and resilience. Pediatrics. In press.
Bush, N.R., Savitz, J., Coccia, M., et al. (2020). Maternal stress during pregnancy predicts infant infectious and noninfectious illness. The Journal of Pediatrics.
Graignic-Philippe, R., Dayan, J., Chokron, S., et al. (2014). Effects of prenatal stress on fetal and child development: A critical literature review. Neuroscience & Biobehavioral Reviews, 43, 137-162.
LeWinn, K.Z., Bush, N.R., Batra, A.B., et al. (2020). Identification of modifiable social and behavioral factors associated with child cognitive performance. JAMA Pediatrics, 174(11):1063-1072.
O’Connor, T.G., Monk, C., & Fitelson, E.M. (2014). Practitioner review: Maternal mood in pregnancy and child development: Implications for child psychology and psychiatry. J Child Psychol Psychiatry, 55(2): 99-111.
Racine, N., Plamondon, A., Madigan, S., et al. (2018). Maternal adverse childhood experiences and infant development. Pediatrics, 141(4).
Shonkoff, J.P., Boyce, W.T., Levitt, P., P., Martinez, F.D., & McEwen, B.S. Leveraging the biology of adversity and resilience to transform pediatric practice. Pediatrics. In press.
Shonkoff, J.P., Slopen, N., & Williams, D. Early childhood adversity, toxic stress, and the impacts of racism on the foundations of health. Annual Review of Public Health. In press.

Transcript

Sally: Welcome to The Brain Architects, a podcast from the Center on the Developing Child at Harvard University. I’m your host Sally Pfitzer. Our center believes that advances in science can provide a powerful source of new ideas that can improve outcomes for children and families. We want to help you apply the science of early childhood development to your everyday interactions with children and take what you’re hearing from our experts and panels and apply it to your everyday work.

In today’s episode, we’ll discuss how early experiences, especially during the prenatal period and first few years after a baby is born, get inside the body and can have long–term impacts on lifelong health. Here to help us dig into that science around the early years and lifelong health is Dr. Jack Shonkoff who is the Professor of Child Health and Development, and the Director of the Center on the Developing Child at Harvard University. Hi Jack. It’s really great to have you back.

Jack: Hi Sally. Great to be with you. Thanks very much.

Sally: Let’s dive right in. In previous podcasts, we’ve discussed the impacts of stress and specifically you referred to this term of toxic stress, but we never really went too much into the detail about the body’s stress response system. I’m wondering if you could explain how the body responds to stressors or adverse experiences and environments.

Jack: Yeah. That’s a really good question. For starters, the fact that we have a stress response system is really good. It’s protective for us. It actually can be lifesaving. It’s built into our body because this is how we deal with threat or challenges or hardships. This is the basis of the fight or flight response. So, what’s going on inside our body? Well, when we are stressed, a number of systems in the body get activated. Stress hormone levels are elevated and distributed all through the body. Our heart rate goes up, our blood pressure goes up. This is controlled by signals from the brain to the heart and the cardiovascular system. Our immune system is activated and there’s an inflammatory response. Our metabolic systems are activated to produce more energy for our body—more energy for our muscles, if we have to run or if we have to fight or more energy to think more clearly.

The important message here is that the stress response is not just in our brain, it’s in all of the biological systems in our body that are constantly communicating with each other. They’re all reading the environment, they’re getting feedback, they’re communicating with each other. And this is what allows us to deal with challenges, to deal with an acute threat. The best way to think about this is to think about your brain and your immune system and your metabolic system and your cardiovascular system as all different members of a team. Success as a team depends upon each member of the team having a specific contribution to make. And a successful team depends upon interaction and alignment with each other. If any one part is not pulling its own weight, that affects the whole team.

The immune system is another one of those team players. It is our body’s defense against infection. It’s our body’s ability to respond to injuries that require wound repair, and also helps us to be protected against other kinds of toxic exposures that might come in. Inflammation is the first response of the immune system to the threat of let’s say infection, or let’s say a wound like a cut. Think of it as the mobilization of the kind of first responders of our biological system. Now, everybody knows what inflammation looks like outside the body. When you have a cut or some kind of an injury that’s bleeding, and as it starts to heal, you notice that the area around the cut is red, it can be warm in the beginning, it may be particularly sensitive or painful. That’s the inflammatory response that is actually fighting against germs coming in. It’s kind of cleaning out body tissue that may have been injured by bacteria or viruses or trauma, physical trauma and it is beginning to initiate the healing process. And then over time the redness goes away and it’s less painful and the wound is healed.

Well, that inflammation also can happen internally in the body. Now, in the beginning in a stressful situation, inflammation is very helpful internally. It mobilizes your body’s defenses against infection, and it’s meant to then deal with that acute injury or threat and suppress it. But what happens if the stress continues? This is what we refer to as toxic stress. So, in the beginning, it’s protective, but over time, that inflammation can then start to have a wear and tear effect on the body. It can actually start to disrupt organ systems. Here’s one or two examples. We know that inflammation accelerates atherosclerosis, kind of forming plaques that can clog up your arteries around your heart. Inflammation can also affect metabolic systems leading to insulin resistance internally and increasing the risk for diabetes. Individuals who have severe depression have elevated inflammatory markers in their body, evidence of elevated inflammation.

We know that chronic inflammation internally doesn’t automatically mean you’ll get any of the diseases that I just mentioned, but it means that it increases your risk, which is now beginning to help us understand what is it about chronic severe stress that makes people more likely to develop chronic diseases, not just mental health problems, but physical health problems.

Sally: That’s really interesting. And hearing you talk about how early experiences of chronic stress can have more of a long–term impact, I’m imagining that these impacts are not likely evenly distributed. Right? And I’m wondering if you can talk a little bit more about that.

Jack: We have a very serious problem certainly in this country of unequal access to healthcare and unequal treatment in the health care system. And those are very important and clearly need a lot of work. But that’s not the whole story about disparities in health outcomes. Before we get to issues about healthcare, how does it happen that we have inequalities in the prevalence of many stress-related diseases like heart disease and hypertension and stroke? The new science is helping us get inside the body and say what is it about chronic stress and chronic hardship that leads to health problems? How does that happen? Some of this we’ve talked about already, which is the chronic activation of multiple parts of the stress response system that can have a wear and tear effect on different organs and biological systems leading to the most common and the most expensive chronic diseases in adult life.

So, when we think about that problem of chronic adversity, and we know there are some very consistent and predictable differences in terms of racial and ethnic disparities in health outcomes, starting with prematurity and low birth weight, and then extending all the way up to obesity and heart disease and type 2 diabetes and a variety of other chronic disorders. So how do we understand this? Well, here is some of the things that are very important for all of us to focus on. Number one, the differences by race and ethnicity are not genetic. There may be for some individuals, a greater risk for some diseases related to genetics, but from a population basis, certainly for race, race is a social construct, there’s no biological basis for race and certainly not when we’re talking about illnesses.

This gets us back to the discussion that we’ve been having about how chronic stress and chronic stress activation lays the foundation for greater risk for health problems later in life. Often, we make a list of sources of chronic adversity. We talk about poverty, we talk about racism, we talk about exposure to violence, we talk about a serious mental illness in a family, a young child living alone with a mother with severe depression who loves her child as much as any mother does but can’t be consistently responsive because of depression which is an illness. The body’s stress system and its response is the same regardless of the source of the stress.

There’s something about systemic racism and the kind of interpersonal discrimination that’s part of the daily lives of people who are subjected to structural inequities, things that are built into society, that really requires us to take a careful look and say on the one hand, racism is a source of stress like many other sources of stress, but on the other hand, systemic racism and being constantly subjected to the indignities of discrimination raises a different question, which is: what do we do about that? How do we protect young children from the racism that their families and other caregivers have to deal with?

The real solution to this is to go upstream and to deal at the source with the hardships and the threats of systemic racism that are bearing down on families, rather than focusing on helping families to cope with that racism. This is prevention in its true sense, which is not just to kind of put a band–aid on things, but to go to the source. I think the increased consciousness that we have in our society right now about systemic racism in a way that has always been known to families of color, but has sometimes been invisible—many times been invisible to families who do not know what it’s like to be victimized by chronic racism presents a really important opportunity for us to be much smarter and much more effective about how we think about this issue.

Sally: You brought up some really important points. And we’re actually going to be getting more into the policy and system solutions in the next episode, so stay tuned. But can you tell us a little bit more about why early in childhood development is so important? So, I know we say early a lot, but what does that actually mean?

Jack: Yeah. This is a really important question about what we mean by early and this is one of the real game changers about connecting the brain to the rest of the body. There’s an increasing public understanding that chronic stress activation can affect the development of the brain and ultimately affect your readiness to come to school prepared to succeed. But what this new science is telling us as we connect the brain to the rest of the body, is it’s not just about early learning, it’s also about the foundations of lifelong health.

And if you think about the way we approach early childhood policies and early childhood programs, we have over the years realized that kindergarten is a nice time to start school, but actually it’d be better to start school earlier especially for children who are living under difficult circumstances. We have been increasing our investment in preschool for three and four-year-olds. Makes a lot of sense, good decision in terms of public policy. But for the children who are experiencing the most severe stress, that’s not early because the effects of this serious adversity begin very early.

In fact, they begin even before you’re born. A pregnant woman who is in an environment where there’s very little support, where there’s constant stress activation, and also may be problems with inadequate nutrition, exposure to pollutants in the environment, these kinds of stressors and adversities can actually affect the development of the fetus before a baby is born. And certainly, in early infancy in an environment that is constantly stressed, this can really affect the environment of relationships in which very young children grow up.

When we start to talk about health and not just learning, and we think about how all of these biological systems are responding to the environment, the science is sending us a very clear message. In the face of significant chronic adversity, we need to begin way before age three and four, in terms of providing an environment that’s more supportive of healthy development to reduce those sources of external stress. Metabolic systems and the immune system begin to show effects that may be more difficult to change later as early as the prenatal period and certainly in the first two years after birth.

And so, that’s the important message of this new science for the early childhood period. It’s about health as well as about learning. And early in the face of severe adversity means prenatal and the first two or three years after birth. The bottom line for all of this is we are now learning that what happens early on prenatally and in the first couple of years sets you on a pathway to be either more at risk for some problems or more protected for some problems. But it’s not an absolute prediction. It’s never too late to make things better, but in the long run, you’re always better off by having the best health-promoting experiences as early as possible.

Sally: Yeah. I’ve often heard you use that phrase that early is better, but it’s never too late. And I’m really glad to hear that continue to come up in our podcast because it’s such an important message for listeners to take home. When we come back, we’re going to have Jack answer a question that was submitted by a listener, and we’re going to dive into that question together.

Musical interlude

Sally: And we’re back, and now we’re going to answer a question from one of our listeners. I know how much I enjoy getting a chance to ask you questions, Jack. And this time we thought we’d ask the audience. Here’s one from Sid Gardner.

Sid: Hello. I’m Sid Gardner, President of Children and Family Futures. And my question for Dr. Shonkoff is the impact of prenatal substance exposure is mentioned briefly as one item in the list of toxic effects. How does this affect physical and mental health and what can we do about it?

Jack: Sid, that’s a really important question and I really appreciate it. There’s a very well-described phenomenon of fetal alcohol effects or fetal alcohol syndrome that exposure to alcohol at different times during pregnancy can have significant effects on brain development and also physical features that are very noticeable after a baby is born.

We have lots of examples of how certain exposures to substances that are particularly disruptive to different organ systems based on where they are in their development before birth can have significant consequences after birth. This is about sensitive periods in development, which by definition are periods when that particular organ or that particular function is optimally responsive to environmental influences, even the environment in the uterus. And so, positive experiences promote healthy development and adverse experiences or exposures can disrupt development. That question about prenatal substance exposures, substance abuse is a critical question because it’s the poster child for how we need to pay attention to making sure that we promote a healthy environment in which pregnancy takes place.

All of the systems, the biological systems that we’ve been talking about, the brain, the immune system, the metabolic system develop over time. And when we’re very young, including before we’re born, these systems are relatively immature and they are developing their capacities and they’re developing their structures in part on a timetable that’s genetically determined. When things develop is pretty much genetically determined, but how they develop is literally shaped by the environment in which that development is taking place.

So, if we think about alcohol, whether this is threatening or not to health depends not simply on exposure, but on the timing. And so that’s why from a prevention point of view, the more we know about when are the sensitive periods and how can we prevent exposure to substances or infections that can influence later development, that’s how we promote and preserve good health and promote healthy development. It’s about timing and it’s about the differential sensitivity, the different levels of sensitivity of different parts of the developing brain and developing body as the normal processes of growth and development take place.

Sally: Thanks Jack. And thanks Sid for that great question. Remember if you have a question for Dr. Shonkoff, you can always send us a message on one of our social media channels. We’re on Twitter, Facebook, Instagram, and LinkedIn. Up next, our panel will dig even deeper into the science of early childhood development.

Musical interlude

Sally: Joining us on this podcast today is Dr. Damien Fair. Dr. Fair is the Redleaf Endowed Director of the Masonic Institute for the Developing Brain, Professor in the Institute of Child Development, College of Education and Human Development, Professor in the Department of Pediatrics at the University of Minnesota Medical School and a 2020 MacArthur Fellow. Thanks for being on the podcast today, Dr. Fair.

Dr. Fair: Thanks, Sally. Glad to be here.

Sally: Also joining us is Dr. Nicole Bush, Associate Professor in the University of California, San Francisco Department of Psychiatry and Pediatrics, the Director of the Division of Developmental Medicine and the Lisa and John Pritzker Distinguished Professor of Developmental and Behavioral Health. Welcome to the podcast, Dr. Bush.

Dr. Bush: Thank you. It’s a pleasure to be here.

Sally: We also have Dr. Fernando Martinez, University of Arizona Regents Professor of Pediatrics and the Director of the Asthma and Airway Disease Research Center. Nice to speak to you, Dr. Martinez.

Dr. Martinez: Nice to be here.

Sally: I’m going to start by asking this question to you Dr. Fair. Science is now telling us more about how the brain works with other systems in the body to respond to adversity, and could you say more about what’s actually happening in a child’s body developmentally among these systems?

Dr. Fair: That’s a great question. Now, some would argue that the two most complex systems of the body are the brain and the immune system. Of course, I’m a neuroscientist so I always put the brain at number one. But unlike other organs in the body, like the heart or the lungs or the gut, which are located in very specific parts of our body, the immune system is simply everywhere. Immune cells and the chemical messengers flow freely through our bloodstream. They wiggle their way into different parts of our body everywhere.

For many years, it was very difficult to identify or even think about how the brain might interact with the immune system in response to stress or adversity, anxiety, things like that. And it’s now quite clear that they interact in lots of ways and very specifically in development. For example, immune cells, and again, the chemical messengers that are generated in these immune organs like bone marrow, the spleen, lymphatic system, which kind of cleans out a lot of stuff related to the immune system, all have very intricate ties to the brain.

And we know that stress in particular has a very large effect on the immune system in development. The highest vulnerabilities are likely in younger ages. The immune system is critical for normative development. It may actually come to some surprise to most, but all the neurons that we’re ever going to have for our lives typically are at their final resting place right about the time that we’re born.

And then by the time we’re two, you have this proliferation of connections that go throughout the entire brain related to all those neurons. And then over time, over development, we slowly start to prune away these neurons and these different connections. That’s what it means to mature. Now it’s almost like a sculpture where you’re slowly chipping away to get the final product. Well, it turns out that the immune system is really important for that pruning and that cleaning things up. It probably doesn’t come to too much surprise that the changes in the activity of the immune system have very big impacts on brain development over our lifetime.

Dr. Martinez: I think it’s important to stress what Damien was saying. There’s no one system that reigns. We are one thing. And therefore, while we’re developing, if there are extreme sources of stress, it is the whole system that responds wrongly. That’s why none of these effects are on just one organ. Of course, they may be more important for one organ, for example exposures to pollution may affect more the lungs, but now we know that it affects all other organs, including the heart, the brain, of course, the immune system and so forth. That’s an important concept, that we respond like a whole body, not like a single organ.

Sally: That’s actually a really good segue into the next question which I have for you Dr. Martinez. Could you for our listeners go into more detail about inflammation’s role in the stress response system and how it can help or actually hurt us, especially young children whose systems are still developing.

Dr. Martinez: Well in the face of exposures, the body has a system of recognition of these exposures. This process of recognizing what is out there that is not dangerous and what is out there that is dangerous. The response is that of activating the cells that are there, that are part of the immune system that are kind of the first stage of response. That first stage of response is perhaps the most primitive that we have, but it’s very effective sometimes and it’s enough for this danger to go away.

When we are unable to completely clear that first stage, then the second stage occurs. And during that second stage, other cells come from other organs, and a full-blown response develops. Inflammation then is the result of these two phases of the response. Its main objective is to get rid of an acute insult, whatever that insult may be. But when these insults become chronic, in other words, when they develop for a long period of time, or when we have learned not to recognize what is acute and what is dangerous, we start developing what is called a chronic inflammatory response. It’s almost as if we are overdoing it as thinking that we have to be defending ourselves constantly. And that is what is called the chronic inflammatory response.

It’s important to understand that there are these two dimensions of inflammation. One is inflammation as a good thing. Inflammation is a way in which the body responds to an insult to get rid of the insult, to control the insult, to destroy bacteria, viruses, whatever it is that is attacking. But there is a second aspect to it which is this chronic aspect. When you have all these chemical signals and all these cells hanging around the organs that are affected by chronic inflammation, what starts happening is that the organ starts something that we call remodeling. In other words, it starts reorganizing itself. And this is very important during development when the organs are growing. Because now, together with the normal signals of growth and development, you’re seeing these other signals that are interfering with the normal signals that tell the organs how is it that they have to grow. And they start growing “the wrong way.” Asthma, for example, becomes a disease that has transformed the organ. And now we don’t only have to reverse the inflammation that caused this in the first place, but we have to reverse the remodeling of the organ, the remaking of the organ. That’s why it’s important to understand that avoiding the factors that determine chronic inflammation is very important because it has long-term consequences for the individual.

Sally: Dr. Bush, what does the science say about the effects of adversity and stress during the prenatal period and the first few years after a baby is born?

Dr. Bush: It’s a great question. Young children’s brains are remarkably malleable and they constantly are seeking and absorbing information from their environments that their brains need and use to adapt. And this helps ensure their survival and optimize capacity to learn and thrive. But childhood adversities have the potential to affect these systems in a way that leads to impacts on things such as cardio-metabolic health, depression, diabetes, and multiple other health domains across the life course.

People have been getting kind of earlier and earlier in the chain of development to understand where can we make the biggest impact? Where can we understand both the influence and opportunity for intervention? And so, some folks are leaning closer towards thinking their priorities should be focused on the first 1000 days of life. Adversity during this period has strong prediction of a variety of health outcomes. That’s why early safety–net programs, paid parental leave, and high-quality childcare and preschool are so critical to our nation’s health.

Something that hasn’t received as much public attention is that an increasing number of studies are demonstrating that children’s biological systems begin to be shaped in the womb during pregnancy, and at this developmental stage, they’re substantially influenced by their mother’s biology. Most people recognize that a mother’s pregnancy nutrition or her exposure to cigarette smoke is something we really need to be careful about because they’re so important for the baby’s development, but also things like her sleep health and experiences of stress actually affect her physiology in a way that programs the fetus’s development, and then influence that fetus’s risk for a range of developmental, emotional and physical health problems throughout their life course.

One of our team’s studies of low-income families just recently showed that mom’s reports of feeling overwhelmed by stressors during pregnancy predicted major increases in number of infants’ infections and non-infectious illnesses. So basically, babies of stressed pregnant mothers were sicker and they required more care from their pediatrician in the emergency room. And findings like this point to how critical it is for us to take care of pregnant women, not just for their own health and wellbeing, but for that of their children.

Recent evidence that it isn’t just maternal stress during pregnancies that’s transmitted, but a mother’s own adverse childhood events, her ACEs, or her traumatic experiences during her own childhood appear to affect her biology through her adulthood in a manner that affects her baby’s development in utero. So, to put that in another way, a mom’s own childhood stress can 20, 30 years later have a programming influence on her offspring’s early and later life mental and physical health. This shows a truly trans-generational inheritance of the experiences of major environmental stressors, and it also shows us that intervening to help children either by preventing trauma or supporting them in coping with it after the fact can impact future generations’ health too.

Sally: Our listeners may be hearing this and they may be thinking something along the lines of, if my children experienced a lot of adversity or stress early on that they might be in trouble in terms of their development. Or even if I experienced a lot of stress and adversity early on that I might be in trouble. What could you do to prevent chronic health conditions from developing or to help build resilience?

Dr. Bush: Well, since I just ended with some stressful news about pregnancy stress, I’m really happy to point out that we are finding out a lot about how pregnancy is also an incredible window of opportunity to improve maternal and child health. We have findings showing that a stress reduction intervention in pregnancy leads to improved stress physiology, function, and more adaptive, emotional, and behavioral responses in infants. And we’re also finding that high–quality parenting in the first year of life buffers infants from prenatal stress effects. And another study showing that parental understanding of infant development and having appropriate expectations for infant or toddler behavior completely buffer one-year-olds from the risk of prenatal stress associations. Although more importantly, data suggests that if we were to reduce or eliminate major stressors like racism, poverty, food insecurity, and abuse, we would prevent the need to focus on building up those protective factors, and it would certainly have major cost benefits for society.

Dr. Fair: I will add to that great discussion and just highlight that the early brain, the child brain, just as it’s vulnerable to certain types of changes with regard to stress and factors that we’ve been discussing here, the time is also when it’s most malleable, plastic, and resilient. Meaning the interventions are going to be more effective at this early age as well. And it provides an opportunity for us to really try to change thetrajectory by correcting things that may have gone wrong in the past.

Dr. Martinez: It’s also important to understand that for anything that we’re exposed to, there is a very high diversity of responses in the population. There are many sources for this diversity, which is also called heterogeneity of response. Among these sources, there are exposures and behavioral changes and so forth that Dr. Bush was saying counteract other exposures and other effects. It’s not written than the person who is exposed to a very significant amount of distress during the first years of life is condemned to have chronic inflammation and to have remodeling, reorganization of the organs, and there’s nothing to do about it. Quite surely, there are people who live in that situation but come along and don’t develop those responses. That may be in the future a way in which we counterbalance those negative effects by this resilience that is also so marked as a characteristic of human beings.

Dr. Bush: I love that Dr. Martinez highlighted the kind of individual differences in who has adverse outcomes after experiencing a lot of chronic adversity. At the same time, a lot of people are remarkably resilient for a variety of reasons, some internal, some external. And what we want to do is promote that resilience, but also not frighten everyone into thinking they’re doomed to cardiovascular disease because they had a difficult childhood. The flip side, also very glad that Dr. Fair highlighted how malleable we are for positive changes in early childhood. We have some really exciting evidence across a range of studies that show you can reverse the harmful effects of traumatic events on child biology, through evidence-based therapy interventions. In some cases, the children receiving therapy actually show biological repair and healthier outcomes than some control group kids. And so, there’s lots of reasons to be hopeful that our bodies have the capacity to not only survive and cope with adversity, but rise above sometimes doing better in the end.

Dr. Fair: And the good news is there are a whole host of things that our policy makers can assist to make sure the trends are good. Individual and family support structures, strong access to good education, economic security, all those social factors have a large, large impact on long-term outcomes in our kids, depending on some of the things that we’re talking about today.

Dr. Bush: In addition to caring for children and their parents, it’s also really important for listeners to recognize that adversity and trauma do harm children and families across the entire socioeconomic spectrum. We need to address those directly for all people, all communities by screening in early childhood, screening in pregnancy and screening in adulthood for histories of trauma, so that we can address these social needs of individuals. I’m really hoping that we can make efforts to help insurance providers see the benefit of evolving their understanding, how to care for children, and that that includes caring for their caregivers, both family caregivers, and preschool and early childcare, reimbursement for screening and follow-up for treatment. The data are really compelling that in addition to those solutions being both just and right, that investments in prevention and early treatment could save incredible amounts of money in our societies.

Sally: Thank you all for being here. We really appreciate hearing your individual expertise and also how your knowledge can really build off of each other to give us a full picture of what’s going on. When we come back, Dr. Shonkoff will be discussing a common misconception about early childhood development and lifelong health.

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Sally: I’m joined again by Dr. Jack Shonkoff, who’s going to help clear up some myths and misconceptions in early childhood development. So, Jack, we’ve talked a lot about how early experiences can affect health many years later, but many people wonder how it can be possible that experiences we have before we can even remember them could affect lifelong health.

Jack: It’s really one of the most important myths that we need to bust. And the simple answer to that is that we may not have conscious memories of things that happened very early in our lives, in our infancy, especially traumatic experiences or significant adversity, but what the science is telling us is, the body doesn’t forget what’s happening in these very early months and years. We’re not talking about inevitable poor outcomes,but significant stress activation well before a young child tends to have any sense of what’s going on, creates physical changes, physiological changes, inside the body that affect brain development, can affect the development of the immune system, the cardio-metabolic systems.

So, people who may be a little bit skeptical that something that happened when you were an infant can affect your mental health later, but at least you could begin to see the connection. There’s no logic for people to think that that would have something to do with whether you get heart disease 50 years later. But what the science is telling us is that those biological changes early on can increase your risk for these physical health problems later on. That’s one of the most important messages coming from this new science that is compelling us to connect the brain to the rest of the body. Because what happens early on is not only important for learning and social and emotional development and school achievement, but it’s an important influence on your physical and mental health for the rest of your life.

Sally: That’s such an important point Jack. And I think today’s myth was a particularly dangerous one. I’m really glad we had an opportunity to discuss it at greater length and that you were able to bust it.

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Sally: We discussed a lot of important issues today to explain why the early years are so important and especially why intervening early is so important. And I’m sure we gave our listeners a lot to consider or at least I hope we did. I’d like to end by asking you, Jack, to give our listeners one key takeaway that they should leave this podcast with today.

Jack: I think what’s really important about the big picture for what the science is telling us is a couple of things. Number one is, there are no perfect brains, there are no perfect immune systems. How we grow up, how we learn, what our health is like is related to the interaction between how we are individually wired to begin with and what our life experiences are about. And the important part of our life experiences, the most important, is the environment of relationships that we grow up in. And then also of importance is the physical environment in which we grow up. How safe is it? How protected or exposed are we to toxic substances in the environment, lead, mercury? How much space do we have to move around? So all of these things together, interacting with how everybody is unique from a genetic point of view results in a wide, wide range of normal development.

Our role as parents, as other caregivers, as a community and as a society is to do whatever we can to provide a health-promoting and growth-promoting environment for children, recognizing that everything we do that’s supportive will increase the likelihood of a very successful and fulfilling life.

The bottom line for all of this is it’s a matter of balance. The more the pile up of risk factors and threats, the greater the risks. The more we build up protection and support for the environment in which children grow up, the smaller the likelihood of problems. The important thing to remember is that the way biology works, it’s always trying to make things right. When things happen in the environment that threaten health, all of the systems in our body are reading the environment and they are responding to try to keep us healthy, they’re responding to get us back on track. These new scientific insights should really be a source of reassurance for us and at the same time, a wake-up call about the kinds of life experiences that are threatening so that we can protect children as early in their lives as possible.

Sally: Thanks so much for your time again today, Jack.

So how can we protect children and promote healthy development and lifelong health as early as possible? In our next episode, we’ll discuss what this science means for listeners, including caregivers, policymakers, practitioners, and system providers.

I’d like to once again thank our guests, Dr. Damien Fair, Dr. Nicole Bush, Dr. Fernando Martinez, and Dr. Jack Shonkoff. And thanks to Sid Gardner for your question. I’m your host, Sally Pfitzer, and we hope you’ll join us next time!

The Brain Architects is a product of The Center on the Developing Child at Harvard University. You can find us at developingchild.harvard.edu, where we’ll post any resources that were discussed in this episode. We’re also on Twitter, @HarvardCenter, Facebook, @centerdevelopingchild, Instagram, @developingchildharvard, and LinkedIn- Center on the Developing Child at Harvard University. Brandi Thomas and Charley Gibney are our producers. Bridgette Cyr is our audio editor. Our music is Brain Power by Mela from freemusicarchive.org.