increase in the number of mothers working outside the home and (2) the increase in the number of single-parent families. Today, 65 percent of mothers with school age children work outside the home. The figure for moth- ers ofpreschool children is 60 percent. Amongwomen with children less than 1 year old, 54 percent work outside the home. Moreover, the Department of Labor estimates that, by the year 2010, labor shortages will draw even more mothers into the work force. Today more than 25 percent of all American children and 50 per- cent ofblackchildren grow up in single-parent families. Research 011 the impact of daycare on children, Dr. Zigler noted, has shown that good dayare is good for children and bad daycare is bad for children. M'e know how to provide good care, but we don't want to pay what it costs. "The general state of childcare as experienced by children in this counts is abysmal," he stated. "This country is getting what it pays for." The average annual turnover in childcare facilities is about 40 percent. As many as 90 percent of daycare centers in the U.S. are completely unregulated. No national standards exist, and there is wide variation among States. Even where standards exist, they are too lax to be of much use. Based on studies recently completed in California, Dr. Zigler estimated that about one-third of centers in this counts are so poorlv managed and the qualit) ofcare is so low that children are being "serioush compromised." He went on to say, "We cannot treat children the way we are currently treating them in the childcare setting in America and expect this to be a great nation." &Uthough the 1990 Childcare Block Grant has been hailed by many as a victon for childcare reform, Dr. Zigler expressed doubt that it will have any signifi- cant positive effect. Seventy-five percent of the funds allocated to the Block Grant are earmarked for poor or nearly poor families. The middle class, which is equall) in need of good childcare, will see almost no benefit, and Dr. Zigler expressed his fear that this situation ma) lead to backlash against the grant and against childcare reforms in general. He stressed the relationship of good daycare to achieving the President's six National Education Goals. "Five lousy years of childcare will 126 Parents Speak Out for America's Children guarantee that the\- [children] tvill show up at school guarantee that the\- [children] tvill show up at school not ready to learn." not ready to learn." In Dr. Zigler's opinion, the system as it currently In Dr. Zigler's opinion, the system as it currently esists does not lvork and cannot he made to work. esists does not lvork and cannot he made to work. Instead of tt7ing to retrofit the current system, he Instead of tt7ing to retrofit the current system, he proposes a whole new system that he calls the School of proposes a whole new system that he calls the School of the Tlventy-First (:entur\.. The program, as Dr. Zigler the Tlventy-First (:entur\.. The program, as Dr. Zigler envisions it, will incorporate the following key features: envisions it, will incorporate the following key features: * * * Two systems will exist: first, the formal, Y-month, 8:00 am to 300 pm school, and second, the 12- month. 7:OO am to 9:00 pm school. Children will enter the system at the age of three for full-day. developmentally appropriate school. In commmlities that already have Head Start programs, Head Start could simply be blended into the system; parents with earnings above the poverty line will pay an enrollment fee. Before- and after-school childcare will be pro- vided for children aged 6 to 12. Each family will be assigned a home visitor who lvill conduct developmental screening. offer sup- port to parents, etc. All family daycare programs will be tied in to the school, which will offer support and periodic training sessions for childcare providers. The school will contain a comprehensive informa- tion and refer-al system that can direct families to appropriate health and social senices agencies (such as immunization clinics or night care providers). Successful pilot programs to build Schools of the T\vent\-First Centun. alreadr. exist in several States, including Missouri, C:onnecticut. Colorado. \l'\oming, Texas, Kansas. Idaho, Arkansas. and Mississippi. .-\nother proposal Dr. Zigler is attempting to present to Congress is the "(:hildren's Allowance for America." This plan would allow a new parent to \\-ithdraw up to S.?,OOO from his or her o\vn Social Security account to allow the parcwt to stay home or to help pay for good childcare. Nancy Van Doren President, Tmveh:r Companies Fouwlntion Director, ~V~tionnl and Community .-lffir~ LXvisio,7 Thp Trcwe1cr.r Cornponies Ms. Van Doren spoke on behalf of the Travelers Com- panies Foundation about the role that businesses and private organizations can play in securing good care for children and pregnant women. The Travelers are headquartered in Hartford, Connecticut-one of the poorest cities in the country, located in one of the richest states. Disproportionately large numbers of children in Hartford are born to teenage mothers, are underimmunized, and have asthma, attention deficit disorders, or learning disabilities. All of these condi- tions are usually preventable. As one of the organization's social responsibility commitments, the Travelers are working to improve the health ofchildren and the prenatal care of mothers in the greater Hart- ford area. M71en a new children's hospital was proposed for Hartford, the Travelers commissioned an independent analyst to conduct an evaluation of Harti&-d's health cart delivevneeds. The consultant found that,while Harttijrd would indeed benefit from haling another- hospital, it was even more important to increase availabilip of priman and preventive health care for children and expectant mothers. Ms. \`an Doren said that it has been a challenge to persuade contributors and decisionmakers to redirect their limited resources fi-om "glamorous." high-lisibilih projects such as new hospitals to more mundane (but effectivy) applications such as prenatal and perinatal health clinics for low-income mothers. 11s. \7an Doren said that she is motivated in her efforts b!. a mixture of rage and shame that people in her communit\. are unable to have even their most basic needs met. She urged the audience to let their rage and shame move them to act and to search for opportunities to push for the redirection of resources to the places \vhere theI. can do the most good. Hartford has been successful $0 far in its drive to reallocate resources from prisons to scl~oola, and from neonatal intensive care units to preventive care. Ms. \`an Doren emphasized the importance of prel,enting health crises rather than remedving them. CHILDREN WITH SPECIAL HEALTH CARE NEEDS: LESSONS LEARNED This panel offered wluable insights about setting up systems that address the problems of children with special health care needs. The speakers offer three perspectives-all key to successful programs: (1) par- ent empowerment, (2) program-level development, and (3) State-lel,el involvement. The panel uxs moder- ated by Rear Admiral~Julia R. Plotnick, M.P.H., R.S.(:., who holds the rank ofAssistant Surgeon General and is the Associate Director. Division of Senices for (:hildren with Special Health (;arr Needs. at the \f;irtTIld a11d (1hiltl Health Kureau. Ms. Robinson se17w as a parent/child advocate at the Robert Ta!4or (:otni-ntulit!.-kno~vn to he the largest public housing divisiott in the I_`nited States-w+et-e she has resided for more than 20 >`ears. Her video presentation highlighted the dail!. struggles of a com- munity with high& concentrated and severe povert) and its associated problems: extreme overcrowding, extremely high infant mortality and morbidity rates, high incidents of low birth iveight, high percentage of teenage tnothers, and high rates of violence. The commrmi~ is further crippled b!, threatened famih unity; psychological and phvsical absence of fathers; anger, depression, and despair: and social isolation. 11s. Robinson`s determination to help herself and fellow community members led to her advocacy work on the Beethoven Project at the Center for Successful Clhild De\,elopment. The (:entet- protides cot~irntuni~.-based senices that address the health, education, and social needs of the coniniuni~. The (;entet-`4 philosoph\. is based on two beliefs: that each individual has the abilip. toachie~-eandbrindepende~ttanctin controlofhisot.ht,l- life, and that strong fLnily relationships are important. Set-r-ices are tailored to the needs ofindi\idual titmilies. in a n.pe of holistic set3icr plan. Instead of' focusing on the barriers to itnprwing communin. life. said 11s. Rohittson. the <:rnter builds on community strengths to deal lvith the problems. From her experience at the CIenter, 11s. Robinson shared t~vo basic problems and approaches to sohing them. ( 1 ) Economic entrapment and iwlation leads to a nlolltll-ttr~llo~ltll sttxtggle to meet basic needs. To address this problem. the (23iter offers ongoing employment training, coutwling. and I-efcr-t-als. The Center also provides other tools to make lift- rasirr and help people to help themselves. Project staff at-e empathetic rather than y-mpathetic, and support groups abound. (2) Educational opportuni?. is lacking in the communit\: Project staff help parents to become better persons as well as better parents. The Center recognizes that parents who feel powerless and/or inadequate as parents don't read to children. Staff tn~nnhet-s stress the importance of reading to their children and other approaches parents can use to foster school success. The staff encourage strong parent-child relationships and emphasize taking pride in the child's academic achievement. Finally, parents are taught to become accountable and take an active role in their children's lives and in their community. Said Ms. Robinson, "Healthy parents read\, to learn will provide LB with healthy children ready to learn." Polly Arango Ms. .It-ango introduced her audience to Sew Mexico from the \-ielvpoint of Sew .\lexico's parents of children \vith special health care needs lvho have been working to impt-o\e the State's medical and educational systems. \Vhilc Sew Llvsico i\ a State ofgreat physical beau? and diwrGt~-. it also faws many challenges: It Ont'of'sc\en Sew Slesicochildt-en lil,esin paver?. Ir Stv Slesico ranks .`ilst in the Sation in the per- ccntagr of \vomen rect%ing prenatal care. + The State's tern suicide t-ate is dismal. Thet-rfot-c. Sew Mexico's families have arranged to makt~ the lives 01.1 heir children better, one famil!,and oiie issne at a time. 11s. .\rango became involved as an advocate j\hen she and her family learned that their youngest son, Sick. has cerebral palsy and developmental delays. As Ivith many middle-class families, the .-\rangos discov- ered that fe\j- avenues existed to assist them as thev stt-uggled to pay Sick's medical and preschool bills. For example, although Nick was adopted, his adoption occurred before the emergence of adoption subsidies. Sick is an LXnierican Indian, but his birth parents chose not to enroll hitn in the tribe, a decision honored by Nick's adoptive farnil!,. & a result, Nick is not eligible for services through Indian Health Service or the Bu- reau of Indian Mfairs. Because they were decided]) 128 Parents Speak Out for America's Children middle class, the Xrangos could not meet income guide- lines for the State's crippled children program. To deal with her frustration. Ms. Arango joined with other parents to found a statewide organization called Parents Reaching Out (PRO) for any and all families with children who have chronic conditions. disabilities, or illnesses of any kind. Twelw years later. PRO has 500 members ~vho at-e from e\w?. pat-t of the State and every ethnic background and ~vho have chil- dren with many challenges. Man!. of' PRO's membet-r are the professionals, friends. and relations of families \vho ha\,e children with special health needs. PRO began as an organization to provide peer support and information to families. and this fitnction continues to he the heart and SOLII of its ef'fot-t5 to&t\. Holye\-et-. PRO's parent\ soott tackled Ijiggct. ihsttca such as \\riting rhc lcgi&ttiott that created a (;omptx- hensive High Risk Insut-ancc Pool for Sew Nrsico. The list of issues they have addressed goes on and on. The following elements have contributed to their success in changing the s\xtem: * Ordinal parents have united to form a common bond. * They have forged strong partnerships\vith health. education, and other professionals. * One parent usualI!- has risen to the forefront as a symbol of the movement. * Public and private agencies have supported the 2 campaigns Mith technical assistance and in-kind contributionsasawayofenlighteningandeducat- ing the public. + At least one policymaker who is willing to "bleed and die" for the issue has become involved. * The highly visible work and people are supported by a broad-based grass-roots community of fami- lies and professionals who voluntec~r at hotne. Sr Evenone remembers the bottom line: improving the health of children and ensuring that their fami- lies can raise them with dignin., rrspwt. and lo\r. \Ihen 11s. McConnell's child required an osygtw tank. she had to learn about health cat-e svstems and ho~v IO make thetn\vork. Because ofherexperience, ILlc(~ot~ttcll ~vas hired b\. the Michigan Department of Public Hwltlt to work on a peer level lvith "weigh?," issues for a ttrwl\ creatrd parent participation program. The program, horn out of` decentralization at the State level, nccdtd more parent involvement at the local level. Ms. \lc(Ionnell dexribed the initial ambivalence of` one sup~r~~iso~~ who did not understand the need for parent in\ oh t' mrnt at the State le\.el. Holvever, as the program gained \vide acceptance, she gained this pet-son's full wppo1-t. \Is. \lc(:onnell's job was to build relationships; create task forces; make appro\.als: and set policies for hospitals. physicians, L md home health senices. She is proud of the f:nct that all hospitals in her State now tired pal-en t ad\-isot-y committees and parent staff. She stressed the benefits gained from building relationships among parents, communi~. and Cgoverntnent: the establishment of enormous power bases that took action when funding cuts 1vet.e threatened. They influenced senators so that "Families have both an immediate vested interest to get things changed and the freedom to act. . . ." l);trcttt~ receij-ed needed appropriations. The!, helped est;thlish boilerplate in law that required that t`atnilies and conseqttences to them be considered before pt-OgtTttllS are changed or funds are Gthdt-awl. In effect. the legislsladon mandated State government to work with bnilies. Ms. McConnell noted that parents are willing to take t-i&s to support the continuance of needed sen-ices. "Even if they are not sure the steps at-e right," she said, "[parents] are \%illing to follow their instincts." Ms. McConnell introduced four strategies to help families meet children's special health care needs. (1) Support. State agencies should nurture and facilitate the develop tnent of statelzide coalitions of and support groups for persons with disabled children. State agencies should encourage refer]-dls to these groups. Financial sttpport is also vet-y important. Parent consultants must get reim- bursed for their time and expenses. ,~wther t\pe of support involves helping parents acquit-e a \vealth of knokvledge. They need information, for example, about who in the communi~ has had a bad experience lvith clinics, etc. (2) Dissemination of Infi)rmation. State agencies must establish effective, routine mechanisms for receiving information from parents and parent support groups and for disseminating information to them (Ltm- il! support nenvorks). .%gencies must pt-o\idc families with clear written information describing programs. ser- \-ices. and mechanisms foracces\ittg those senicrs. .+tt- ties must prwide read\ access fi)r parents to unhiaaed attd complete information from their child's records. (3) (:ollabordtion. Fatnilies that participate across the State must represent the culn~ral and economic di\.et-sit\. of the State. They must participate fully Ivith professionals in polic! development, program itnplementatiott. coot-di- nation of senices. and e\.aluation of programs. State agencies must financially support parents involved in these activities. (4) Integration (the ultitnate goal of senicrs). State agencies must have a written poliq that reflects the pivotal role offamilies. Integration recognizes the concept of fdmil>,vol\-ed in the program. Thirteen states. ittctuding l\lissouri, have Parents ;is Teachers p~-og~x~~is in place. .\Iatty use fundsfion~ Even Start, (:hapter I. <:hapter II. childt-en's ttw+t hinds. private cotp~~t- Con\ ;u~l fi~tuntlations. and public set~ice gwups such its the Ki\\;utis Club. 111 closing. Ms. \$inters said that while the Parents it\ Teachers proqtm does not solve all of the prob lems that f&e chilclren ant1 their families today, she and her organi/ation are proud to be part of the solution. Following Sk. Lj?nter's presentation, a member of the audience [Sandra McElhany of the National Mental Health Association] urged attendees to write their representatives in (Congress to ask them to support an amendment to the Bill for Educational Reseu-ch and Education thatwill be proposed b> Senator Kitt Bond of Mssouri. The amendment, which has the support of Senators Kennedy (Massachusetts), Dodd (Connecticut), and Pell (Rhode Island), would grant States fitnding-$20 million per year for .3 years-to start or expand Parents as Teacher programs. Mary Louise Alving, M.Ed. Project Diwrtor, Pormt Ltmhhip Training Citizms Educnfion Gnfpr Ms. Aking presented a set of proven guidelines fot setting up parent involvement programs. Although it is widelv known that parent involvement improves children's self-esteem and school performance. 73 percent of parents still do not get involved. Ms. Xlviug offered wa\`s to increase parent itnvlvemen~ in school programs. The Parent Leadership Training Project at the (:iti/etts EdItcation (:enter begat1 in Seattle in 1986 " . . .parent involvement improves children's self-esteem and school performance. . . ." to address the needs of !&grant f'nmilies. Since then, it has expanded to include families and schools of all backgrounds. Ms. Ahing first talked about the four myths that people use to sal'that parent involvement is not practical. The first was that "parellt involvement" means volunteer- illg for school activities. .\ls. .-\l\ing disap-eed, ca!ing that a parent who helps his child with her home~\w-k. or who takes an active role at school hoard meetings. is iit lea5t a4 involved as the volunteer. The second mvth is that pawllts don't have time to participate in scl~ool activities. Sht pointed out that parents do COIW to school \~Ix~n the\ have lvhat they think is a good reason (for example. debates about cc?ndom distribution in high sc11oo1~). "Parents are hard to reach"~vas the third nn.th. Yls. .\l\illg asserted that it is the schools, not the parents. lvho are m~welcoming. The fourth m\-th she confronted \vas the "at risk" classification of families from certain csthliic groups or economic levels. She said that all famil.ies are at risk at some time. and that these kinds of classifications promote division within the communiE. Ms. Alving presented eight "do`s" for successful par(;nt involvement programs. These were repeated in the video that \sas shown at the end of the session. + All activities and programs should be based on the idea that all families have something to shark. * Parent im~olvement programs should include members of other programs--such as Chapter I and Head Start-and should collaborate with other programs. Ir Slost successful programs focus on the child's teacher. Parents want to meet and get to know their children's teachers. Teachers are often the best way to reach parents. Ir The program should he coordinated by a team; a ~oocl program lvill rapidf expand to a size where it simple cannot be administered by only one person. Teams should consist of the school prin- cipal, two parents, tlvo teachers, a school district represrntati\,e. a business/comlnulli~ represen- tative, a social ser\-ices professional, and a cul- ture/language specialist (as- required). Before the team begins planning, they should attend a 5 day training session. Ir * * * Succtwful prograrns ahvays allow room for adjust- ment. Evcrv scl~ool is different. and programs must be adapted to lit thrir audiences. Teacher training is an important part of parent iliwhwiicnt programs. Teachers often have no training on ho\\- to pork \vitli parents. Ongoing fiinding for parent involvement pro- ~T;lIll~ 410~11d be olmiJlrd. .7 Too often, when funding rt111s out. the parent invol\.enient pro- g:1-an1 goes with it. Begill to lvork for permanent funding earl!-. . Buiiding a developmental e\-aluatioli process into the program means that staff can evaluate their progress at an!. point and can make any necesy acljustm&ts. Letitia Rennings, M.S. Evrn $0 ft Coodiru7tor Last to speak in this session was Ms. Rennings, who discussed the Even Start program. This family literac) program has ir?creased in Federal funding from 132 Parents Speak Out for America's Children $14,820,000 in 1989 to $70 million in 1992. President Bush is recommending that funding for the 1993 fiscal vear be $90 million. There are c7trrrntl\- 240 f71nded programs, including 9 Migrant progratns. Even Stat-t is open to children front birth thro77gh agv wven living itt a Chapter I elementat:, attendance area and a parent who is eligible for adult basic education. Even Start is composed of three cow cotnpo- nents-parenting education. early- cltildl7ood etl71ca- tion, and adult education. The projtacts build OII tG;l- ittg progratns in the cotntnltnit~.. i;71cl1 a Head Start, Chapter I, Ch;7ptet- II, ad77lt education. progratn\ fot children u-ith disabilities, .JTP.L and .JOBS. Thy progtwn's goal is to break the c\.cle of illiteracy tliar plague5 so tnati~. .-\tiwt-icati fattiilirs. The brnefits of E\wi Start's foc714 on litety at-e inativ. Parents \vho Icarn to read dcwlop att ititrrest in school, and sonic of theni choow to go back to scl~ool ac a result of their involvement. In additiott. cItiIdtx*tt feel pro7tcl of their parents and \\orl\ to cw~ttlatc tItc.ir parents acadeniic success. In somr projects, p;~tx~tIs lrve f in-med their 0~11 support networks ;III(\ 11;1\x~ learned the importance of proper health c;w and n7ttrition. talking and reading to their childrw. att(1 scning as good role nwdels. The self-estccwt ;71td cotifidcttceofpxticipants-adults andchildt-rti alike- is great]! increased. The results of first !-eat- ( 1989) pt-ograttt r~xl~~a- tions sh01\ that `70 pet-cent of fxmilies set~td ltavc ann71al ittcome\ of. less than 510,000. Evtv .St:ur ha\ rcacli~d 13.000 adults ant1 48.X)0 children acros4 tht co7tntt-v. The nlajorit~-ofad7tlt participantsaw brt\vcac.tt the ;lcrC% of 2 1 and 29. h To cloce her presentation. Ms. Reriningsoff~t-ctl rhr a77dietice sonic specific ill7tstrations ofthr good Even Start can do fix- fiumilies and for Ivhole conitn7tnities. She llt-iefl\- drsctii~ed three stlcccssfitl pt-ogratns-one itt a tt.;tiiet- park in Fort (Zoiiitls. (kAorado. one it1 a \.etT poot- cotntnuttitv in Snt~arl~iile, Tennessee. and one in the town of'Hidaigo, Texas. on the Mesican border. Each of thrse prograni\ has tailored its set-\ices to fit the specific needs of the cotntnttnit_\ and lamilies it sexes. Recognizing that fanlilies' basic needs initst be nlet before the! can begin to ;tpph, thetnseives to stttd$lg, thr (Colorado progtxn &et-s not oni!. (kneral Eqtti\-alettr!- Diploma (GEL)) trainingfot~patw~ts. btlt also teachesl);tt.etltitlg skills, basic nutrition, and h@xie, anti coordinates a food donation progratn. In Sneachiiie, where nxttn people hale never been inside a school bttiiclit~g, 1.50 f:,\tniiies--ainlc)st t7xy- otle in the count--is inwived it1 Even Start. 1lot-e than .X0 people attended the progratn's spring picnic. rvith rvenxme in the coti~tii7ttiitx participating. The tmvn sheriff cooked. and the staff of the bat-bershop gave free haircuts-wine to 1vottttw \vho had tte\w had their hair cut bv sotneotle outside their imtnediatc farnil!. .-\t the end of the )`ear. -lH ~vottwn twroiied in Evm Start had passed the GED and IO of them recei\wl drivers` licenses. In Hidaigo. Tesas. the Ewn Start progranl setTes ;I cotnttt7ttlity that is nlo\ti!- Hispanic and poor: the faniiiies participatiti, 0 in Earn Start had no pitttmhin~o~ server svstetns. Their hotttrs t-esetnhlrd small toc~isi~ed~. Seat+ 1'10 pat-etttsand 130 children atx~etiroilecl iii the progratn. Before E\wl Start catne to Hidalgo. tnan!. \vomrn. who had had evett less rdttcatiott than thrit husbands. lvere completely illiterate. 51atl!, families \\`ere entitled to food assistance, but could not negotiate the system because they could not read. The Hidalgo Even Stat-t home visit has proved the most effective titeatis of`itiipro\~ing families ' iiterac\. skills iii ;I cttitrtr- ally srnsiti\.e tnannt`r attd of'assistitlg families in dealing uith social set-i-ice agencies. CHILDCARE: TWO PERSPECTIVES (:hiidcarr C;III be \ie\veci frotn two perspectives: that of the parents and that of childcare providers. This panel. tuodet-ated by Barbara A. M'iller, Ph.D., Public Affairs Director for the National Xssociation for the Education of Young Children (NXEYC), pt-esentrd the results of t\vo national childcare s7113ty, one from each perspec- tive. Dr. L\`iiier noted that these projects, which u'ere separatei~ funded and designed, are ttttiqtte because the!- highlight partnerships (collaborations). The first stud\- \vas the National Childcare survey sponsored 1~1. S.kE\rY: and the Xdtllittistlatiotl ott <~hiidt-en, Youth, and Fanlilies. U.S. Departmrttt of Health and Human Setlices. The stud!. ttwcl a tviephone sutTey of parettts cleGgtted atttl anaivzeci 1~1. the Urbatl Institute. It ex- piotwl gvnetxi clttrstionsahottt childcare at-rangetnents 134 Parents Speab Out for America'\ Children and included substudies of low-income families and militay families. The secottd stud!-. the Profile of Childcare Settings, was sponsored by the Department of Education. \ The study dealt with the supple of childcare services, use by low-income families. range of senices, and qualit!,. Patricia Divine-Hawkins Publir .4@iry Co-Dimtw .Ycttionnl .-issociatio~~ ,Jor the Educntion cf kbuug CXiltiw,l Ms. Divine-Hawkins reported imtnense change Gth respect to childcare in this cotmtt-~ in this generatiott. In the 1990s. man!' mothers are lvorking. resulting in a large proportion of' children in preschool and ;I large number of children caring for thernsel\~r~. She also reported a shift from informal toTGtt-d formal childc~art centers and homes. (ivi5us studies of part~nts and national studies h>. the hdtttinistratiott on (:ttildrett, Youth, attd Familirs point touwtl these conclusion\. She noted that the cot~st~met- studie5 of 19% through 1976were prototvpesofour understandingofchildcare. but the! did not include f:ntnily daycare providers. r\ccording to Ms. Divittc-Hawkins, social policies of the 1990s are oriented more toward children and the family. Childcare is a central component of etnplo!ve benefits in many companies. Head Stat-t created nrv partnerships between Federal, State. and local govern- ments. The continuitv between earlv childhood educa- tion programs and elementary school has enhanced and eased the transition between early cltildhood and kindergarten. However, these social factors create a complex situation and thus a need to look at childcare issues more holistically. Ms. Hawkins-Divine related that N;\EYC's research examines how the supply of and demand for childcare work together. It is the first research that (1) studies the range ofoptions for different families in different types of situations, (2) explores characteristics of individual families, (3) develops a comprehensive database with individual data tailored to individual circumstances. and (4) examines socioeconometrics. NXEYC also emphasizes the importance of partnerships in addrew- ing childcare issues. Dt-. Hofferth was the principal investigator of. the ~a- tional Childcare Sunny. which explored sttpplemettt;tl caw for children (center care, family daycare, in-hotttc cat-e. care b\. a relative. or no supplemental care). The components of the sttt~e\. included the n~~tntbet- of households l\ith children under certain ages, ttumbet- of children enrolled itt da\care, a parent suney, and ;t provider WIVV. The sttt~-c~ revealed a high pet-centagt ofsttpplrttletttal c;w and a major shift in the provider\ of ~llpplelllental cat-(`: more and more children ~vho receive care out of' the home are enrolled at centers AS opposed to wcei~iiig care at ltotiws of relatives. The sunr! examined primat? care for the )wungest pre- school child by income, for employed mothers. Enroll- ment in center-based prograttts has increased particu- larly among lolvest income families whose childrett are placed in subsidized programs and who receive direct financial assistance. etc. The \vorking poor and low- to middle-income families, by contrast, are participating at a louver rate in center-based programs. Dr. Hofferth said it is noteworthv that the cost of care has not increased significantl!. relative to the cost of living. But, she affirmed. 35 the high-income familiesget tax credits and low-income families get assistance, the middle class gets squeezed out. Dr. Hofferth's research shows that parenti learn about childcare arrangements for the youngest child through relatives. friends, and neighbors (informal nrt- works) and ft-om referrals. The most important factors fi)t- measuring daycare are quality (above all else), reliability. teacher training, and student-ttrteacher ratios. The SIN- veyfottnd thatparentsweregenet-allysatisfirdwith daycarr arrangements. One-fourth oftheparentssrtrveyedwanted to change arrangements. Of those, one-half wanted to switch to childcare centers. Childcare centers are the preferred alternative. Intel\iews wi\ith SII~TV\~OI~S S~OISXY~ that some centers were regulated, and others were ttot. Sottrrgttlatrd cetttet-4 ottt~trtmberetl regulated centus. S0ttre@ated ccntet-\ differed flrottt regulated one4 itt that the!, lvere smaller. had shorter operating hours, charged less. and bvt`re not run bv professionals. The major findings were that, during the preschool years, more and more children are in childcare centers and some, especially the poor, mav be suffering. Elizabeth Farquhar, Ph.D. Ptyqwl tt1 `4 tz n!yst lkf,ntfttifwt of Educntiott Dr. Farquhar talked briefly about the Department of' Education's role in creating policies and studies concerning earl>- childhood education, childcare, and family education. The Department of Education supports Chapter I creation of Even Start for adults in need of literacy skills. Preparing Young Children fat Success is a Department of Education program that prepares children for schools. The Department also sponsors the Profilr of Childcare Settings Studs. The Department also collaborates efforts with the Department of the Health and Hunlan SelTices. Since the 198Os, the Department has lvorked \vith the States. who became active in de\.eloping preschool programs. "(:ollaboration." Dr. Farquhar stated. "is \`er\' effective in these studies." Ellen Eiiason Kisker, Ph.D. .%tliot~ I&wc1rchrt .\ln thma t im Poliry Knrcrt~rh, It1 c. Dr. Kisker, who directed the Profile of (~hiltlcart~ Settiilg.\ Study, described her extensive research on the supply of` childcare for preschool and school-age children and on childcare utilization bv low-income mothers in terms of two aspects: availability and qualiv. Dr. Kisker discussed availabilit\ in trrms of formal earlI, education and care at centers and at regulated farnil!. daycare progmms. She found that the number of programs has tripled and enrollments have quadrupled since the 1970s. She con- firms that utilization rates are high and that most \-acan- ties are concentrated in fewer than one-half of da\,care facilities. Ho\ve\-er. more infornratioll is needed from parents to determine if shortages exist in specific areas for certain tl\-pes of children. Dr. Kisker noted that not all programs provide all services. As a starting point, one can l(,ok at adlnissions policies and determine whether the f'ncility accepts infants, children who need futl-time ser- tices. and handicapped and/or sick children. In terms of quality, Dr. Kisker noted, daycare centers can take manv forms. "A davcare center that is considered quality," said Dr. Kisker, "promotes child development. . You can't assess childhood develop- ment by individual child, but there are certain indica- tors of qualit!,." These indicators include (1) average group size, by various ages (look at the various laws pertinent to the regulations); (2) average child-staff ratios, bv various ages; (3) teacher qualifications, b\ type of degree; (4) teacher turnover (profit versus nonprofit), and (-5) parental fees (not changed since 1970s if adjusted for inflation). The Childcare Settings s&d? led to new childcare policies. The 1990 baseline data lvere used to assess what has happened since the early education initiatives \vere developed, and programs have since been implemrntrd. To illustrate Dr. Kisker's statement, Ms. Divine-Halvkini; shared that 32 projects in 32 States have e\.aluatcd the transition of Head Start graduates over the nest three grades, assessed their progress, and tlet~rmined under Ivhat conditions they progress. HEALTHY START, HEAD START, EVEN START, AND WIC: INTEGRATING HEALTH, EDUCATION, AND SOCIAL SERVICE PROGRAMS L\`ade Horn, (Commissioner of the Administration for (Children, Youth and Families. sewed as moderator for this session on collaboration among various health and social senice agencies. A. Kenton Williams, Ed.d .-\ssociate Cornrnissionn HPCMI Stcu-t Bu,ucc u "Head Start is alive and kicking because itworks." So Dr. M'illiams, the newly appointed Associate Commissioner for the Head Start Bureau, opened his discussion of the 136 Parrnts Speak Out for America's Children Head Start program. Head Start is a comprehensive child development program that works lvith the whole child to promote self-esteem, education and literac!-. and health through four channels: education, health services (including medical, dental, psychological, and nutrition), social semices, and parent involvement. President Bush has recommended that Head Start he allocated $600 million for the coming fiscal \~ar. Head Start is proud of its cooperative I-elationshipc\~ith other programs and agencies. including the Health (:are Financing Xdministration. the Public Health %I-\-ice. and the Department of Edlwation. Dr. M'illiams said that he is happv to be tvorking with cuch a successful p~-og~-am and nanwd the fi,llo\v- in? priorities for Head Start in the coming yw * To better se17.e prrgnant uw1ne11 and to provide optimal prenatal care to keep mothers health!. and to help them bear healthy children. * To maintain continuing relationships with pri- ma? care physicians. * To improve clients' access to secondary care. Ir To provide referrals to appropriate psychological counseling, substance abuse treatment, etc. * To reduce the number of low-birthweight babies and to reduce the infant mortalitv rate. * To improve clients' understanding of wellness and increase personal responsibility for health, including cessation of cigarette smoking, alcohol or substance abuse, etc. Donna F. LaVallee, M.S. Nutrition Coorclinator ,Yew I'isions for.Vezuport County Dividing her work week between M'IC and Head Start in her job as nutrition coordinator for this program in Sewport County, Rhode Island, Ms. LaVallee had man!- insights about how to integrate efforts between these programs. Because N'IC and Head Start seme the same popu- lation, both proaVallee offered many simple wggrs- tions to help foster collaboration behveen local M7C and Head Start offices, such as open houses, cross-referrals, membership on each other's policy committees, guest speaker exchanges, and assistance in program evaluation. Because M7C and Head Start have so much in common, they can share many things, including resources, cospon- sored clinics and health fairs, joint newsletters, all-in-one application forms, community needs assessment data, and more. Ms. L.a\`allee urged program staff to "commu- Ilicate, cooperate, and coordinate." Thurma McCann, M.D., M.P.H. Acting lAmfor, (?ffp of HecclthJ Stnrt He<~lth Ke..tourre., nnd Swuires .-idminist,ntion Dr. hIc(h~n described the Healthy Start program, \vhich is based on recommendations from the President's Commission on Infant Mortality. Nowin its early stages. Healthy Start is being implemented in 13 communities lvith the aim of reducing infant mortalit) in those communities by 30 percent. Program applicants were required to meet five basic criteria to have their proposals considered: ( 1) innovation in deliverv svstems (e.g., user friendli- ness, etc.), (2) community commitment to Health>- Start's goals, (3) the ability to offer increased access to health care to reduce low birth weight and other causes of infant mortality. (4) integration of medical and social seIT.ices. and (.5) multiagency participation. As a \vhole, the Healthy Start program is unique in that it allocates unprecedented resources to prenatal and perinatal care, mandates community choice and flex- ibility. and empowers communities to build the kinds of programs that will work best for them. Although Healthy Start funding lasts for only .5 years. Dr. McCann stressed that a community that has "`bought into" the program can find a way to keep it in place even after Fedeml funding is withdrawn. Healthy Start encourages communi?, involvement and has won support fi-om \zrious churches, civic k~oups. tribal councils, schools, and business orgmizatkms. Such agenciesas thePublic Health Senice, the Health (Zare Financing .\dministration% the Department of E~luc;~tio~~, ad tlw Department of Health and Human Sri-\icc\ ;II*` also dcthv pmtm-rs in the national prygmm. Patricia A. McKee Now in its third year, the Even Start program is proud of its cooperatit.e relationships with other agencies and within the commux~ities it selves. W. WKee presented a briefoveniew of what Even Start is doing in this area. Mrhen Even Start was mandated by (Congress 3 years ago, part of that mandate required that Even Start work with other agencies to achieve their common goals. The 76 programs established to date contain a total of 869 collaborative arrangements for prima? (or "core") ser- \rices and 1,600 collaborative arrangements for support senices. More than 67 percent of all Even Start programs work with their local Head Start programs. Howard T. Miller Coordinator Even Start Family Literq Procgrum Ptinc~ George's Conrn~~ Publir Schools Mr. Miller opened his presentation \vith a brief o\-eniew of the statistics on illiteracy in America rued what it costs. More than 40 percent of all milita? sellice enlistetls are functionally illiterate. More than nvo-thiI-cls of all L.5;. colleges must offer remedial English classes. SIore than one-half of all prison inmates are functionally illiterate. He stated that these and other data show that the deleterious effects of illiteracy lead to financial losses, crime, Liolence, poverty, and depression. Even Start's approach in Prince George's Comnty is based on t\vo important assumptions: (1) parents' level of educa- tional achie\rement affects their children's success in school and (2) a child raised in a literate home lvill naturally learn to read,just as he will learn to talk and to feed himself, through learning "reading behaviors." The second assumption is called "emergent literacy." Mr. Miller stressed the importance of educators' getting to know the families of the children they teach, to form a cooperative partnership between the school and the parent. Parents who are enrolled in the Even Start program along with their children are able to go to classwhen it is convenient for them, and transportation is provided. Parents learn new skills in preparing for the "If we can help the parent become literate, these families can succeed." GED, and they also learn parenting skills that help them teach their children. General health and nutrition sen-ices also play an important part in helping families to learn and grow together; recognizing this importance. Even Start coordinates closely with Head Start, M?C, the Cooperative Extension, and schools. "If we can help the parent become literate, "Mr. lfillersaid, "these families can succeed." 138 Parents Speak Out for America's Children a closing Remark chapter 7 Antonia C. Novello, M.D., M.P.H. Su,rgeo,n General I have onl)- a few comments. I think that toda!, you have seen that when people get together, things work. But I can also tell you I am proud of your three capable I-epresentatives who communicated your wisdom about what this counts needs and what this administration can do to sohe our problems. This wz unrehearsed; it was collectiveI\ put together; and I think it probabl) represents us better than anyone talking from their own pain. This is what makes this Conference unique. Moreover, it's even more difficult for me to speak after haying heard people like this. I also can tell you that. when this Conference is done and Ivhen 1t.e all go our separate ways back to the States and commmnities, rn\ impression will be that we ha\-e come together for onl\- one purpose, and that's the purpose of taking care of children and families. The President said his vision is that. in the !~ar 2000, this countn' and these children are going to mo~c` forward. The children of tody will he the explorers. lvriters, teachers, doctors, and imentors of tomorro\v. President Bush said that, in America, families come first, and that's what makes this conference unique. You are here from 50 States and from Territories asfarawayasGuam. You are here from PuertoRico, and VOLI are here from eveqlvhere. ContraIT to \\hat the only reporter that has come aboard asked yesterday. yowl are not all Republicans. In this Conference, I have taken great pain to make sure that we are not labeled b! ethnicity, language, or gender. N'e are here with only one mission, no matter where we come from and who we are. That mission is to care for the children and families of this count?. You have articulated what ~0~1 need, and I have never heard it so well expressed. This Conference is focused on our children, and we're working tolvard the benefits of every child. I have been much more im- pressed than ever by people who perhaps neyer knew the\. col11d speak for others and be taken seriouslv. M'e said this is about respect, respect across the board. I think in these 3 days, we have shared the commonality that, e\-en if !.oL~ don't speak the same language, it doesn't mean that you are not intelligent. Most impor- tantl!., \ve recognize that "poop " is a transient state of mind: todal. it is ~011; tomorrow, it can be me. So let's not only be culturallv sensitive, let's also be culturall! responsive. I think this Conference has concentrated on that. Whatever personal circumstances we brought here-and I can assure you that some ofyour faces said, "Show me," and some of your faces said, "One more conference; don't bother me with trivia"-1 can assure you that b\. having come here for whatelrer was the message VOLL thought you \\.anted to bring, you have adI,anced the field of every child, and you will perhaps be as responsible for having made one more child part of these Cnited States byjust having been here. For that ~OLI should be complimented. \Ve came here to deal with awareness, transition, and participation. .-\fter ha\ing listened to the parents, VOLI realize that parents do all three at once, and some- times one parent does it all. I hope now that you realize parents are crucial fol-\vhate\er\~e're going to do in this countll. for the f:nnnilies. If I.011 don't believe me, then I \\`ant to know where \-ou'\e been for the last 3 days. i\hen I charged !.ou on Monday, I told J.OLI I lt'as going to ask the best ofyu. But I warn you. I'm going to ask even more of you, even when you think you're going to go home and forget about this Conference. I can tell J-ou that \\-e'\,e heard the parents and the groups. I've felt the pain, and I've talked to you. I've talked to every one of 1~1 indi\iduall~ or coltectivelv. M'hen we leave this place, we will have everything that's been said included in a proceedings compendium. We will complete the docu- ment as quickly as possible, but remember we must go through the General Services Administration and Gen- eral Accormting Office to have it printed. We're going to make sure that this goes to eve? Governor, every one of you, and el-er) legislatorwho asks for it; right now the Hill is also clamoring for it. So this is going to be a public cloculllent for all of those who need it. 140 Parents Speak Out for America's Children But the document Lvill bc-just a docttmettt if`ytt do not work with us to make it a reality. ji)ti \\w-t' able to see that out- officials at-e committed. but don't evet put the rights and the benefits of !uur famil!, only- on some other people's shoulders. You have IO sl1at-e the t-esponsihility: otherwise, it will not become a rtAit\-. The reforms of this countt?- uill come fixwat-d through the families; the parents spoke today, and the\ no longer Irant to be silent partners. They want to he activists and advocates, and to do that YOU also have to speak for vowself. Othenvise, w.e't-e ttot going to get amwhere. I also heard that parents, especiallv f:nthers. have to be part of e\-et?,thing that NY do. I think. as I'vv said beforr, we have to find \sax-s hv \\,hich \se bt-in' \vhere your mouth is." $Z'e must make sure that we write in the language that proplc understand. Yesterday, I ~YBS in a transplan- tation meeting, and the\- told me 1 need bilingual pet-mits todonate m\.ot-gatts..&ld thel-salminoritiesdo not donate. \Vould you donate your organs b>. signing a docttttirtit gi\wt to ~wii hv a pet-son who is not culttir- all\- settGtivc. itt ;I lanp~age that \Y)U do not understand? 1fu~1 sign. I hi117 a bridge I want to talk to x'oit about. This I~c~partntcnt is making sure that evet?thing is put itt the latlgu;igc that people \\A1 understand. hlost itttportantl\.. some of our groups have no tnore than an 8th grads education. So again YOU said it, "Put it in wxds that people understand." In medicine, we't-e ah\~~i~~s talkittg about EKG [electrocardiogram] and EEG [el~ctroencepl~~tlogr~~t~~] . and I asked a doctor, "Mhat is an EC;<;?" He didn't ktto~v, so I told him, "an egg." It's aIs;0 important to remember that the cottntt~ is ft~ll of' childt-rtt ha\.ing children. Lye have to wort-~ about them. too. The] do not love their children less because the\ arc children themselves. The), at-e going to tteed m~d~t~~tattdittg. and they are going to need us to help them, too. Self-esteem \vas another issue raised here. Self- estt'em is no longer just for the child. It also has to come from the parents, and that is something that we cannot by.. ;2Iedicare. Medicaid, not-Social Security can bu!,it. That has to come from within. But \ve cannot only think of self-rsteem for the children. 14-e have to give it for the parents. Occasionalh., tak;t. vow time to tell us \vhen Eve d<) good, and. occasionally-.just forget that xve did bad. 1 think positive is part of \vhere \\`e have to go. One \I-omati said wr have to help people to help themsrlves. rather than offer programs that foster de- pendrnc~~. I ~gwe. I h;nx~ the feeling that that should be au+ \ve should mo\~ to1vat.d our goal. LZ'e might use diffewttt \\oi-d\. \Ve might sa\ "ad\ ocac~" or "enipowcr- mc3it." Eithczt- \~a!, \vv tit4 ;I little more positi\istii itt ;gcittittg togvthct-. The title of the Conference has been "Healthy Children Ready to Learn: The Critical Role ofparents." I do believe-and I hope you do, too-that this Conference has done one thing beautifully: It has vindicated the parents. It has helped people realize that they can no longer be silent. No single program in this country should be done in the absence of the parents' participation; otherwise, it will be one more useless piece of paper. I said in my opening remarks that this Conference was the result of 18 months of planning. I believe that is totally obsolete at the end of these 3 days. This is just the beginning, not the end of 18 months. I have seen all my Assistant Secretaries involved in this with me, and we're going to make sure that whatever we plan will be with families, parents, and children in mind. For that reason, this is a success story. I know I told you not to ever get discouraged with the Federal Government. It's a powerful one, and you have to learn how to use it as a tool. Today you had everyone at the top discussing how they see it. As I told you, perception versus reality is the problem here. You might perceive one thing, and the reality might not be so bad, but I think it worked on both sides of the table. You have heard from all of us-from the Secretary of Health and Human Services, the Secretary of Agriculture, the Secretary of Education, six Assistant Secretaries, and the President of the United States. But most importantly, we heard from you. That's what makes this Conference unique. I think we should never underestimate the power of a coalition. Alone, we are not going to do anything, including the President himself. We all have to be able to tell the Government we're here. We're part of the solution. Please, let's not be part of the problem. I want all of us to get together, regardless of what we felt when we came here, because united we can do a lot ofwork. I know that you probably have thought, "She's going to repeat herself again." No one alone can work. We have to unite. But I also told you to use anger if necessary. I can tell you that I feel good that you did, because when you used anger, you were collectively expressing something that I hope the Conference has alleviated. Perhaps now you at least know a place where you can find a solution for your problem. I know that I have told you that we have to be creative. Part of this world is discourage- ment, but I'm not going to let anyone use it to take care of you or me. Discouragement is a state of mind. I ask you to join me to share the responsibility for making your family and your children well. Share with us at the local and at the State and at the National levels and in the public and the private sectors. It's no longer one person's responsibility. There is too much at stake! So look at everything that works, and look at everything you think needs to be replaced. Then call and cajole and make sure that you get involved. I know that we are "conferenced out," but I know also that we are accelerated to the "max." You have to use that momentum when you get back to work and to your communities and say, `You know when the Surgeon General, the Secretaries, and the President speak, they are committed to make the family top priority." Let's get real. Let's get real! I can tell you that when the experts go home, they are not going to be devoid of work because I am not going to be devoid of work. I have your telephone numbers, your fax numbers, and even your grandfather's numbers. So, rest assured that this is not just the ending of 3 days, but it's the begin- ning of a coalition of parents taken seriously, trying to 142 Parents Speak Out for America's Children determine, through their collective actions, what this government can do for you. I'm with you. Are you with me? I want to bring six people to the podium because without them I don't think we could have done this. They are the three parents' representatives and the three parents' alternates. I think we should give an applause to our panel. We had six parents, three to come forward and three to be available in case they fainted. Obviously, we didn't need the other three, but they were there and ready to go. So, I would like to do something. There's not much I can do for you all, but I can certainly give what I call the Surgeon General's Certificate of Appreciation, and believe me, I do not give that too freely. But, when people give of them- selves, as they did to represent you, I think a Certificate ofAppreciation from me isjust the first step. I think that you should be able to thank these six people who represented you so well. Because without them, and you, this Conference would have never happened. So how about if we applaud for all of us. Ellie Valdez- Honeyman, Larry Bell-I am eating squash all my life- Sandy Slavet, Rosa Palacious, and Jesus Sada. Sherlita [Reeves] had to go and pick up her little child, so we'll keep Sherlita's and mail it to her. We might be "conferenced out," but I think we are motivated to go out there and do a lot for what we have tried to accomplish. Most important, is that, collec- tively, we will be able to do it. This document will not stay on anybody's shelves; I guarantee you that. So today's the beginning, but I need you. Remember, united we will succeed. Separated, we will not get anywhere. Today's the first day. Thank you for coming, and God bless you. le program in this c Report of the Surgeon General's Conference 143