THE DAY-CARE DILEMMA

By JAMES COLLINS

Environment matters. For anyone wondering how the latest brain research applies to the care of infants and toddlers, that is the crucial finding. Yes, proper brain development is a matter of genetics and nutrition and whether a mother-to-be drinks or smokes, but it also depends on the stimuli, as the scientists call them, that a baby receives. It depends on what the baby sees, hears and touches and on the emotions he or she repeatedly experiences. But if environment matters, we are faced with a question: At a time when children suffer from perhaps the gravest social problems of any group in the U.S., how do we ensure that they grow up in the best environment possible?

In many ways, children are better off today than they were in previous decades. They are healthier, their families have a higher income, the level of their mother's education (the most important determinant of a child's intelligence) has risen. But 1 out of every 10 children three years old and younger lives in "extreme poverty"--at or below 50% of the federal poverty level. And the well-being of many others is threatened by such social changes as the rise of single-parent households, the uneven quality of day care, the decline of communities and, some would argue, the push to reform the welfare system.

Social policy cannot ameliorate all these conditions. A change in attitude toward parenting and marriage would do children far more good than any government program. Over the past few years, however, there has been a movement in Washington and the state capitals to address the problems of children, from newborn to the age of three. Now neuroscientists, by confirming much of what social scientists had already surmised about early development, are giving that movement added momentum.

The recent concern about infants and toddlers has been inspired in part by Starting Points, a landmark report published by the Carnegie Corporation in 1994, which identified a "quiet crisis" in the lives of the youngest children. Hillary Clinton has begun to speak out on the importance of a child's earliest years, and several Governors have forcefully taken up the issue. The size of the programs in place is quite modest. But to their advocates they hold out promise not only of helping children fulfill their potential but also of saving society the costs ncurred when intellectually and socially impaired children grow up to be intellectually and socially impaired adults.

Government policy in any number of areas--health care, taxes, the economy, crime--touches children. But the initiative that will have the most particular and powerful effect on them is welfare reform. If, as some predict, the incomes of poor mothers are drastically reduced as a result of the new system, children will be harmed. But let's assume that the reforms work as intended and mothers get jobs that pay them more than paupers' wages. What effect may the changes have on childhood development?

There is some evidence that children benefit if their mothers stay home with them until they are one year old, and the welfare law allows states to exempt new mothers from work requirements for a year. But so far, states do not seem to be taking advantage of the provision. For example, in Wisconsin, which is a leader in welfare reform, mothers must start looking for work when their baby is 12 weeks old. Those who favor these reforms say a mother who has a job will be a prouder and more responsible parent, and some studies suggest that children do benefit if their mother receives earned income rather than a government check for the same amount.

If mothers are out working, however, the quality of child care provided by others will largely determine how well the children fare under the states' new plans. To care for their children, many mothers will rely on relatives and friends, some of whom will be loving and attentive and some of whom will not. Also, the strain on the day-care system is a matter of grave concern to child-development and child-care experts. A recent study found that 40% of day-care centers for infants and toddlers gave less than the minimal standard of care. Problems ranged from safety hazards to unresponsive caregivers to a lack of toys. If a caregiver spoons food from one bowl into the mouths of half a dozen toddlers lined up in high chairs, as has been known to happen, not only is the health of the children at risk but they are surely not receiving the kind of attention that promotes healthy brain development.

"If you push more children into this system through welfare reform," says Ellen Galinsky, co-president of the Families and Work Institute, "and you are saying to these families, 'Just get any child care you can find and can pay for,' there's a real danger."

The challenge for the states is to regulate and subsidize child care in such a way as to increase the likelihood of good outcomes for children. This is true regardless of welfare reform, of course. Bad day-care can harm the development of any child. Research has shown that children benefit when caregivers are trained and the ratio of staff to children is high. Several states license centers accordingly, requiring a minimum amount of training and setting ratios for different age groups. Welfare mothers themselves are not necessarily the best caregivers, and it is possible that in some instances welfare reform will actually improve the care of children. But high-quality care is expensive, and states do not have adequate budgets to subsidize it.

The Federal Government and the states do have programs specifically aimed at helping the development of infants and toddlers, although as social policy they are nowhere near as sweeping as an overhaul of welfare. The most notable federal initiative is Early Head Start, which was created in 1994 when Congress reauthorized funding for Head Start, the 32-year-old program that brings three-, four- and five- year-olds into classroom settings in part to prepare them for school. Mary Jo Bane was working at the time at the Department of Health and Human Services (she quit over welfare reform), and she led a task force charged with finding ways to improve Head Start. Child-development experts, she says, "pointed the group toward the importance of interventions earlier than age four."

In 1996, the budget for Early Head Start was $146 million, and hhs awarded grants to 143 sites. The money is used to provide a variety of services to poor families with children under the age of four and to poor pregnant women. How the funds are spent is determined to some extent by the communities that receive them. Some communities are experimenting with family interventions that include grandparents; others are trying to address the special health needs of newborns or to provide extra help to teen parents with a history of drug abuse.

SMART START, HEALTHY START

North Carolina has instituted a flexible program called Smart Start. Under it, parents, teachers, doctors and nurses, child-care providers, ministers and businesspeople form partnerships at the county level that set goals for the education and health care of children under six. These partnerships then administer private and public funds as they see fit. In one county, for example, administrators chose to give subsidies to new parents so that mothers could stay home from work during a baby's first year. More than half of North Carolina's 100 counties are participating in the program, at a cost to the state of $68 million.

Governor James Hunt hopes that by adding hard science to his arguments, he will strengthen his position when battling for increases in Smart Start funding. "This is revolutionary information," he says of studies demonstrating the sensitivity of babies' brains in the first years of life. "Now that we can measure it and prove it, and if it can be made known widely so people understand this, then they'll understand why their schools aren't going to work for them, their technical training isn't going to work, other things we do later on aren't going to work fully unless we do this part right and do this at the appropriate time."

Some states have found that a very simple but powerful way to help parents is simply to coordinate the various services that they already offer. In West Virginia, for example, single sites that provide more than a dozen services have been established in seven communities. "Parents typically get a runaround and may only get a long list of phone numbers," says Kimberly Veraas, chairwoman of the state's Early Childhood Implementation Commission. "If they're really motivated, they can get information. But now we're rolling out the red carpet to parents. They only have to tell their story once."

As developmental experts often point out, child rearing is not an innate skill, and several states are trying to help educate parents about parenting. Home visits by social workers or nurses are among the most promising methods. In Oregon such visits occur under a program called Healthy Start. Sandra Daus, 22, a single mother of an 18-month-old girl, recalls the help she received from Mellissa Magill. "She encouraged me to read books, a lot of books," says Daus. "I thought when Sydney got older, maybe two or three, we'd start reading. Mellissa said no, start reading to her now. Sydney was a month old."

In Vermont someone from the state's Success by Six program first visits a home within two weeks of a baby's birth. "That gets us in the door at age zero instead of age five, so we can assess what families need," Governor Howard Dean points out. Visits may continue for up to three years. "It is so inexpensive," says Dean, "to take care of children relative to the other things we do, such as build jails and put up expensive social-service networks for runaway youth."

With the new scientific evidence to bolster it, the logic for spending money on early-childhood development programs may seem incontrovertible. But not everyone is convinced. The question of what approaches have worked and will work has not been resolved. Research supports the long-term benefits of older programs that are used as models today, but those studies are criticized because they look at very small samples of children who were given special attention and care.

"We have seen over and over and over that even if you can produce good results with small programs, when you expand to a national level, the effect often disappears," says Ronald Haskins, a top Republican staff member of the House Ways and Means Committee. "That is the case with Head Start. We still do not have evidence that Head Start produces any long-term effects."

Social science, however, is an imperfect discipline. Referring to programs for young children, Isabel Sawhill, a scholar at the Urban Institute and former official in the Clinton Administration, has written, "The evidence is always mixed. We simply do not know whether they work. In these cases, one must weigh the risk of doing something and having it not work against the risk of doing nothing and missing an opportunity to improve lives. It can be just as costly to not fund a potentially successful program as it is to fund a potentially unsuccessful one."

Right now, the total public expenditure on early-childhood development is tiny. Given the potential rewards, how risky is a bigger investment?

--Reported by Ann Blackman/Washington, Wendy Cole/Chicago, Rita Healy/Denver, Melissa Ludtke/Cambridge and Lisa H. Towle/Raleigh

With reporting by ANN BLACKMAN/WASHINGTON, WENDY COLE/CHICAGO, RITA HEALY/DENVER, MELISSA LUDTKE/CAMBRIDGE AND LISA H. TOWLE/RALEIGH