Childho o d, E duc a tio n a nd We lfa re : Re se a rc h a nd Po - - PowerPoint PPT Presentation
Childho o d, E duc a tio n a nd We lfa re : Re se a rc h a nd Po lic y I nsig hts Wo rksho p Pre se nta tio n Ba rb a ra Wo lfe , Ric ha rd A. E a ste rlin Pro fe sso r o f He a lth E c o no mic s, Unive rsity o f Wisc o nsin-Ma diso n a
Ba rb a ra Wo lfe , Ric ha rd A. E a ste rlin Pro fe sso r o f He a lth E c o no mic s, Unive rsity o f Wisc o nsin-Ma diso n a nd Unive rsity o f Me lb o urne – F a c ulty o f Busine ss a nd E c o no mic s E mine nt Re se a rc h Sc ho la r 2017
Bro a d q ue stio n: Ho w c a n re se a rc he rs a nd po lic y ma ke rs wo rk to g e the r to
impro ve c hildho o d e duc a tio n, he a lth a nd o ve ra ll we ll-b e ing ?
Are re se a rc he rs wo rking o n the “rig ht re se a rc h”? Ho w do we impro ve the
c o nve rsa tio n b e twe e n “us”?
Are po lic y ma ke rs “liste ning ” to wha t re se a rc he rs ha ve le a rne d?
My a ppro a c h this mo rning :
Se t o ut so me q ue stio ns whic h I
ho pe a re use ful to g uide disc ussio ns o f the wo rksho p
Sha re a fe w e xpe rie nc e s fro m the U.S. with yo u
Ho w do we e nc o ura g e pro duc tive disc ussio n b e twe e n re se a rc he rs a nd
po lic y ma ke rs?
Ho w do re se a rc he rs a nd a c a de mic s c o mmunic a te so tha t re le va nt
re se a rc h is use d in the po lic y a re na ? Ho w c o nfide nt do re se a rc he rs ne e d to b e to c o nve y “a nswe rs fro m re se a rc h” to po lic y ma ke rs?
Wha t type o f e vide nc e / pre se nta tio n do po lic y ma ke rs find c o nvinc ing ? Wha t a re future c ha lle ng e s – ma jo r issue s tha t de se rve a tte ntio n fro m the
re se a rc h c o mmunity? Ho w to ide ntify future “g ra nd c ha lle ng e s? ”
Do we fo c us o n whe the r pa rtic ula r inte rve ntio ns o r po lic ie s wo rk suc h a s a
pa rtic ula r mo de l fo r pre sc ho o l? Or is the re a dditio na l pa yo ff to sta rting with de fine d g o a ls fo r c hildre n a nd the n a sking ho w b e st do we a c hie ve the m?
1. Cha ir o f Na tio na l Ac a de my Wo rksho p o n Stre ng the ning Be ne fit-Co st
Ana lysis fo r E a rly Childho o d I nte rve ntio ns
Wha t is the Na tio na l Ac a de my? Na ture o f Wo rksho p a nd its o utput Cha lle ng e s ide ntifie d
2. Me a ns te ste d he a lth insura nc e a nd re duc e d wo rk e ffo rt. Stro ng
e mpiric a l wo rk he lpe d le a d to po lic y c ha ng e whic h re mo ve d e lig ib ility fo r me a ns te ste d he a lth insura nc e fro m pa rtic ipa tio n in c a sh suppo rt
3. Gro wing a tte ntio n to ”sc ie nc e ” e vide nc e o f influe nc e o f po ve rty o n the
b ra in.
T
he Na tio na l Ac a de my o f Sc ie nc e s is a priva te , no npro fit, se lf-pe rpe tua ting so c ie ty o f disting uishe d sc ho la rs e ng a g e d in sc ie ntific a nd e ng ine e ring re se a rc h, de dic a te d to the furthe ra nc e o f sc ie nc e a nd te c hno lo g y a nd to the ir use fo r the g e ne ra l we lfa re .
Upo n the a utho rity o f the c ha rte r g ra nte d to it b y the Co ng re ss in 1863, the
Ac a de my ha s a ma nda te tha t re q uire s it to a dvise the fe de ra l g o ve rnme nt
T
he Na tio na l Ac a de my o f Me dic ine (o ne c o mpo ne nt o f the Na tio na l Ac a de mie s)wa s e sta b lishe d in 1970 b y the Na tio na l Ac a de my o f Sc ie nc e s to se c ure the se rvic e s o f e mine nt me mb e rs o f a ppro pria te pro fe ssio ns in the e xa mina tio n o f po lic y ma tte rs pe rta ining to the he a lth o f the pub lic .
Ho w do e s a po lic y ma ke r de c ide whic h c hildho o d inte rve ntio ns a re the b e st inve stme nt? A wo rksho p o n Stre ng the ning the use fulne ss o f Be ne fit c o st a na lysis fo r c hildho o d inte rve ntio ns
Go a l: ide ntify suc c e ssful c hildho o d inte rve ntio ns. Ma jo r I
SSUE S :
Sa mple se le c tio n.
Sa mple se le c tio n, o n the pa rt o f the pro g ra m de sig ne r o r the pa rtic ipa nts, in
e ithe r the initia l re c ruiting pro c e ss o r the sub se q ue nt b a se line e va lua tio n, o r b o th
Attritio n
L
e ng th o f fo llo w-up pe rio ds Ma ny o f the e c o no mic re turns to c hildho o d inte rve ntio ns a nd, e spe c ia lly, e a rly c hildho o d inte rve ntio ns o c c ur re la tive ly fa r into the future .
Size a nd c o mpo sitio n o f Sa mple s studie d. Ge ne ra liza b ility Re plic a b ility
Asse ssing lo ng -te rm o utc o me s
A c ha lle ng e tha t c uts a c ro ss studie s a nd do ma ins is ide ntifying a nd me a suring
L
the ye a rs c a n b e a se rio us pro b le m, a nd, b y de finitio n, the da ta pro duc e a nswe rs o nly ye a rs a fte r the inte rve ntio n b e g ins.
Appro a c he s to ma ke b e tte r use o f e xisting da ta : (1) po sing ne w q ue stio ns
tha t c a n b e a nswe re d using e xisting da ta , (2) me rg ing ne w info rma tio n into e xisting da ta se ts, a nd (3) me rg ing se ve ra l e xisting da ta se ts.
T
he c o nundrum we fa c e is this: vo lume s o f re se a rc h studie s a re b e ing pro duc e d. So me studie s a ddre ss spe c ific po lic y q ue stio ns a nd o the rs pro vide va lua b le b a c kg ro und o n the myria d o f so c ie ta l c ha lle ng e s tha t c o nfro nt a nd c o nfo und po lic yma ke rs. Ye t a g a p e xists (so me sa y a c ha sm) b e twe e n the pro duc tio n o f re se a rc h a nd its utiliza tio n b y po lic yma ke rs.
An impo rtant ac tivity o f an o rg anizatio n like the Me lb o urne I
nstitute o r the I nstitute fo r Re se arc h o n Po ve rty (b o th unive rsity b ase d) o r the Natio nal Ac ade mie s are to c lo se this g ap. But ho w?
Cha lle ng e s I de ntifie d: An e xa mple o f a n e ffe c tive g ro up tha t b ridg e s the re se a rc h c o mmunity a nd po lic y ma ke rs: Wa shing to n Sta te I nstitute fo r Pub lic Po lic y
Se t up to to pro vide a na lysis o f po lic y o ptio ns fo r la wma ke rs. T he institute ha s b e c o me a va lua b le re so urc e fo r sta te le g isla to rs,
loc a lly ba se d a nd c lo se ly tie d to the c o mmunity a nd the la wma king pro c e ss. sta ff ha s c lo se working re la tionships with the la wma ke rs, the y kno w e xa c tly whic h o ne s to a ppro a c h o n a g ive n issue .
I
nc lude info rma tio n fro m ma ny so urc e s, o fte n c o nduc t o wn me ta a na lyse s, distill a nswe rs to the pre c ise q ue stio ns tha t a re c urre nt in the sta te .
Pre se nt the ir info rma tio n in c o nsiste nt wa ys (the y use a Co nsume r Re po rts –type
fo rma t) so it is e a sy fo r b usy le g isla to rs to find wha t the y ne e d a nd unde rsta nd the b a sis fo r the c o nc lusio ns.
Nonpar
tisan; b e ne fit-c o st a na lysis the mo st use ful to o l fo r he lping De mo c ra ts a nd
Re pub lic a ns to ide ntify a n a ppro a c h the y c a n a g re e o n, re g a rdle ss o f the pro b le m. Be c a use the institute ha s b e e n willing to re c o mme nd c utting pro g ra ms whe n e vide nc e e me rg e s tha t the y do no t wo rk, the y ha ve b uilt trust in the e vide nc e -b a se d a ppro a c h
“T
he E ffe c t o f the Me dic a id Pro g ra m o n We lfa re Pa rtic ipa tio n a nd L a b o r Supply” b y Ro b e rt Mo ffitt a nd Ba rb a ra Wo lfe in T he Re vie w o f E c o no mic s and Statistic s and “Me dic a id, We lfa re De pe nde nc y, a nd Wo rk: I s T he re a Ca usa l L ink? ” in He alth Care F inanc ing Re vie w.
Use d Surve y o f I
nc o me and Pro g ram partic ipatio n to e stimate the e ffe c t o f Me dic aid (me ans te ste d he alth insuranc e tie d to re c e ipt o f c ash assistanc e ) and private he alth insuranc e o n partic ipatio n in c ash assistanc e and e mplo yme nt fo r fe male he ads o f ho use ho lds.
F
assistanc e and Me dic aid and de c re ase d e mplo yme nt 2) inc re ase d availab ility o f private insuranc e at the wo rkplac e inc re ase d e mplo yme nt and de c re ase d c ash assistanc e and Me dic aid take -up.
Simulatio n fo und that if private c o ve rag e similar to Me dic aid o ffe re d wo uld
de c re ase tho se o n c ash assistanc e b y 25% and inc re ase e mplo yme nt b y 18%
HCF
R artic le : a simula tio n o f a n inc re a se in mo nthly Me dic a id b e ne fits o f $50 fo und tha t suc h a n inc re a se wa s e xpe c te d to ra ise the AF DC pa rtic ipa tio n ra te b y 2 pe rc e nta g e po ints (fro m 34 to 36 pe rc e nt) a mo ng po o r sing le mo the rs.
T
he AF DC c a se lo a d wo uld inc re a se b y 6 pe rc e nt, a nd the e mplo yme nt ra te wo uld dro p b y mo re tha n 5 pe rc e nta g e po ints.
A simula tio n in whic h we inc re a se priva te he a lth insura nc e b y $50 a mo nth
sug g e sts la rg e r e ffe c ts: T he , the AF DC c a se lo a d wo uld de c re a se b y a lmo st 16 pe rc e nt, a nd the e mplo yme nt ra te wo uld c limb b y 12 pe rc e nta g e po ints
Co ntr
ibute d to the de c isio n to br e ak the link be twe e n Me dic aid and AF DC.
L a st E xa mple : re se a rc h on “Assoc ia tion of Child Pove rty, Bra in De ve lopme nt, a nd Ac a de mic Ac hie ve me nt”
E
xplo re the e xte nt to whic h g ro wing up in po ve rty a ffe c ts c ritic a l a re a s o f the b ra in tha t c o ntinue to de ve lo p po st b irth; tie the se g a ps to pe rfo rma nc e o n sta nda rdize d a c hie ve me nt te sts.
Use NI
H da ta fro m 6 c itie s tha t inc lude s pa ne l da ta inc luding a na to mic a l b ra in sc a ns
Ste p o ne : e sta b lish re fe re nc e fo r no rma l b ra in de ve lo pme nt Ste p two : me a sure e a c h c hild’ s re g io ns o f b ra in re la tive to no rm b a se d o n a g e
a nd se x
Ste p thre e : e stima te ro le o f po ve rty in “e xpla ining ” size o f re g io n o f b ra in.
Co ntro ls inc lude b irth we ig ht, se x, a g e , fa mily size , mo the r’ s e duc a tio n, ra c e / e thnic ity.
Ste p fo ur: e stima te ro le o f inc o me a nd inc o me plus re la tive size o f b ra in re g io n
Of Br ain Study
Assoc iation of Child Pove r ty, Br ain De ve lopme nt, and Ac ade mic Ac hie ve me nt
JAMA Pe dia tric s AL
T ME T RI C ra ting o f 678 (99th pe rc e ntile o f o utputs o f sa me a g e )
Ac c o mpa nie d b y the le a d e dito ria l Be c a use the b ra in is the o rg a n fro m whic h a ll c o g nitio n a nd e mo tio n o rig ina te s, he a lthy huma n b ra in
de ve lo pme nt re pre se nts the fo unda tio n o f o ur c iviliza tio n. Ac c o rding ly, the re is pe rha ps no thing mo re impo rta nt tha t a so c ie ty must do tha n fo ste r a nd pro te c t the b ra in de ve lo pme nt o f o ur c hildre n. Building o n a we ll-e sta b lishe d b o dy o f b e ha vio ra l da ta a nd a sma lle r b ut e xpa nding b o dy o f ne uro ima g ing da ta , Ha ir e t a l1 pro vide e ve n mor
e powe r ful e vide nc e of the tangible de tr ime ntal e ffe c ts of gr
ty on br ain de ve lopme nt and r e late d ac ade mic outc ome s in c hildhood.
Using da ta fro m the Na tio na l I nstitute s o f He a lth Ma g ne tic Re so na nc e I ma g ing Study o f No rma l Bra in De ve lo pme nt, the inve stig a to rs de mo nstra te d tha t c hildre n living 1.5 time s b e lo w the fe de ra l po ve rty le ve l ha d sma lle r vo lume s o f se ve ra l b ra in re g io ns c ritic a l fo r c o g nitive a nd a c a de mic pe rfo rma nc e (g ra y ma tte r, fro nta l a nd te mpo ra l lo b e s, a nd the hippo c a mpus). While sma lle r b ra in vo lume s in c hildre n re a re d in po ve rty ha ve b e e n pre vio usly de mo nstra te d in se ve ra l inve stig a tio ns2,3 a nd po o r a c a de mic a nd c o g nitive o utc o me s o f c hildre n living in po ve rty ha ve b e e n we ll kno wn fo r se ve ra l de c a de s,4 Ha ir e t a l1 we nt furthe r to e luc ida te the me c ha nism o f this re la tio nship. T he finding s o f the Ha ir e t a l study1 showe d that poor
c ognitive and ac ade mic pe r for manc e among c hildr e n living in pove r ty was me diate d by a smalle r hippoc ampus and fr
al lobe s and that the de c r e ase in volume of the latte r 2 str uc tur e s e xplaine d as muc h as 15% to 20% of the ac hie ve me nt de fic its found. Give n the na ture o f the study sa mple inve stig a te d, whe re c hildre n fa c ing nume ro us
re pre se nt a n unde re stima te o f the ma g nitude o f risk in the g e ne ra l po pula tio n.
“T wo re c e nt influe ntia l re po rts c ra c ke d o pe n a pub lic c o nve rsa tio n o n the ma tte r. I n
tha t suppo rts info rma tio n pro c e ssing a nd e xe c utive b e ha vio r—in the ir hippo c a mpus (invo lve d in me mo ry), fro nta l lo b e (invo lve d in de c isio n ma king , pro b le m so lving , impulse c o ntro l, judg me nt, a nd so c ia l a nd e mo tio na l b e ha vio r) a nd te mpo ra l lo b e (invo lve d in la ng ua g e , visua l a nd a udito ry pro c e ssing a nd se lf-a wa re ne ss). Wo rking to g e the r, the se b ra in a re a s a re c ruc ia l fo r fo llo wing instruc tio ns, pa ying a tte ntio n a nd
“ne uro sc ie nc e ha s no w linke d the e nviro nme nt, b e ha vio r a nd b ra in a c tivity—a nd tha t c o uld le a d to a stunning o ve rha ul o f b o th e duc a tio na l a nd so c ia l po lic ie s, like re thinking He a d Sta rt–style pro g ra ms tha t ha ve tra ditio na lly e mpha size d e a rly lite ra c y. Ne w a ppro a c he s, he sa ys, c o uld fo c us o n so c ia l a nd e mo tio na l de ve lo pme nt a s we ll, sinc e sc ie nc e no w te lls us tha t re la tio nships a nd inte ra c tio ns with the e nviro nme nt sc ulpt the a re a s o f the b ra in tha t c o ntro l b e ha vio r (like the a b ility to c o nc e ntra te ), whic h a lso c a n a ffe c t a c a de mic a c hie ve me nt (like le a rning to re a d).”
E mb e d with individua l e xa mple s
Po lic y ma ke rs “c o nvinc e d b y this e vide nc e ”. “Ha rd, no t b ia se d”
Ca n we use sc a ns to q uic kly le a rn is a n inte rve ntio n “wo rks” a nd we c a n
e xpe c t to se e lo ng te rm g a ins?
Co mmunic a tio n—”b e twe e n” vs. “fro m” No npa rtisa n le g isla tive se rvic e o rg a niza tio ns (CBO o r OMB) c a n b e se t up b ut
do the y ha ve the c a pa c ity to kno w a nd judg e re se a rc h pub lishe d in hig h q ua lity jo urna ls?
Ma jo rity o f po lic y inte rme dia rie s a re no t fa milia r with so urc e s o f hig h-q ua lity
a nd o b je c tive re se a rc h .. muc h o f it is ina c c e ssib le to b ro a de r a udie nc e s,
One so lutio n: Cre a te infra struc ture tha t ta ilo rs a c c e ssib le info rma tio n to
po lic yma ke rs-- a “o ne -sto p sho p” tha t pulls to g e the r hig hly re g a rde d so urc e s o f re se a rc h to inc re a se the flo w o f hig h-q ua lity a nd o b je c tive info rma tio n to po lic yma ke rs in a time ly ma nne r.
A se c o nd so lutio n: c re a te a fe w visiting po sitio n in a g e nc ie s. Ma ke the
c o mpe titio n “pre stig io us.” Assig n do lla rs with it fo r the winne rs to b e a b le to se t up sma ll se mina rs o n impo rta nt to pic s o f inte re st.
Do e s the type o f re se a rc h we do ma ke it mo re o f a c ha lle ng e to g e t po lic y ma ke rs to a do pt o ur re se a rc h?
I
f the re is a n e xpe rime nt, a re e va lua to rs c a lle d in e a rly e no ug h in the de sig n pro c e ss?
Are tho se running the e xpe rime nt willing to a llo c a te suffic ie nt re so urc e s to
do the e va lua tio n?
I
f the e va lua tio n is o f a n e xisting pro g ra m, ho w to c re a te a n a ppro pria te c o unte r fa c tua l?
I
s the re a pe rc e ive d vie w tha t the e va lua tio n ha s b ia s in it – b y q ue stio ns a ske d? By re sults re po rte d?
I
s the re a te nde nc y fo r pra c titio ne rs running a pro g ra m o r tho se o ve rse e ing the e xpe rime nt to think o f it a s “T he irs” a nd to re sist e va lua tio n tha t mig ht sug g e st it is no t use ful?
Ho w do re se a rc he rs a nd a c a de mic s c o mmunic a te so tha t re le va nt
re se a rc h is use d in the po lic y a re na ? Ho w c o nfide nt do re se a rc he rs ne e d to b e to c o nve y “a nswe rs fro m re se a rc h” to po lic y ma ke rs?
Wha t type o f e vide nc e / pre se nta tio n do po lic y ma ke rs find c o nvinc ing ? Wha t a re future c ha lle ng e s – ma jo r issue s tha t de se rve a tte ntio n fro m the
re se a rc h c o mmunity? Ho w to ide ntify future “g ra nd c ha lle ng e s? ”
Do we fo c us o n whe the r pa rtic ula r inte rve ntio ns o r po lic ie s wo rk suc h a s a a
pa rtic ula r mo de l fo r pre sc ho o l? Or is the re a dditio na l pa yo ff to sta rting with de fine d g o a ls fo r c hildre n a nd the n a sking ho w b e st do we a c hie ve the m?