In a recent Advancing Kids blog post, Help Me Grow National Center founding director Paul Dworkin, M.D., considersthe challenges ahead for early childhood system-builders, providers, and advocates — and how we can best respond.
Dr. Dworkin writes, “We must be vigilant in protesting devastating cutbacks that will do harm to children and families. However, I also believe that we must pledge to best continue our forward movement, going beyond the role of vocal opposition to determine how to best build on progress and common assumptions. Through such strategies as strategic framing, we may even accelerate our considerable progress.”
These commentaries suggest differing and even competing strategies. Marks calls upon us to unite in defense of a common interest, a “circle the wagons” approach. In contrast, the AAP perspective encourages us to continue to pursue our goal regardless of obstacles or criticism, i.e., to “stay the course.” Given the cogent and compelling arguments in support of each position, what are we to do?
Child health advocates are, understandably, worried that children and families may be adversely affected by cuts to Medicaid and the Children’s Health Insurance Program (CHIP). I recently had the opportunity to hear Joan Alker, executive director of the Center for Children and Families and a research professor at the Georgetown University McCourt School of Public Policy, at a convening in Washington, DC sponsored by the Campaign for Grade Level Reading. Alker is a nationally-recognized expert on health coverage for low-income children and families, with an emphasis on Medicaid, the Children’s Health Insurance Program (CHIP), and the ACA. Her sober assessment included the prediction that ACA repeal would double the number of uninsured children and families. She also warned that turning Medicaid into a block grant would have adverse consequences for child welfare, especially for vulnerable children such as those in foster care and those with special needs, and that it would result in severe cutbacks in prevention services. Indeed, such potentially devastating threats lend credence to Marks’ call to aggressively protect the status quo.
Also important to note, our experience partnering with many states and federal agencies to disseminate Help Me Grow® (HMG), with its focus on the early detection of vulnerable children and the linkage of these children and their families to community-based programs and services, suggests the potential for maintaining, and even accelerating our considerable momentum. I am encouraged that the good work of diverse states and “street-level bureaucrats” in various federal agencies may be the stimulus to continue to move forward. In our HMG experience, for example, we are impressed that progress does not correlate with a state’s red or blue color. In fact, we often speak of HMG dissemination as “apartisan.” A key to this progress is the careful framing of our advocacy and recognizing that “all politics is local.” We are mindful that viewing HMG as an entitlement may be politically perilous in certain venues, while the concept of supporting families to promote their children’s healthy development is generally desirable. In some jurisdictions, a “children are our future” campaign rings true and is sufficiently impactful. Yet in other discussions with highly diverse states and agencies, as well as funders, we find that promoting children’s healthy development and academic learning for building the workforce of the future, and even strengthening national security (e.g., a physically-fit military, cyber security capacity), is a compelling rationale that garners interest and support. My recent discussions with such renowned policy experts as the former US Senate Majority Leader Tom Daschle and Donna Cohen Ross, the former senior policy advisor and director of enrollment initiatives at the Centers for Medicare & Medicaid Services (CMS) Center for Medicaid and CHIP Services (CMCS), reinforce the promise of such an approach. We are also encouraged that a multitude of federal agencies have embraced and rallied around a “developmental promotion, early detection, referral and linkage” agenda that holds strong potential for comprehensive system building.