Prenatal and Early Parenting Programs
Because good parenting is so important for child outcomes, one should try to make better parents, too. But in the new policy realm of parental improvement, ideas and efforts so far outstrip evidence of success, with a few exceptions (King et al. 2013). The starting point is prenatal health, where young about-to-become-parents must learn the importance of in-utero health and the costs of some of their own habits for child outcomes (Aizer and Currie 2014). The Nurse Home Visiting Program has been shown to be highly effective when properly deployed and when follow-up to emergent home-based problems is coordinated with local social service agencies (Annie E. Casey Foundation 2014; Haskins et al. 2009; Mosle et al. 2014). Still, substantial systematic differences exist in children's home learning experiences, and the few existing parenting programs that have shown promise often are not widely accessible, either due to the demands they place on parents' time and effort or cost. The widespread use, low cost, and ease of scalability of text messaging make it an attractive approach to support parenting practices (York and Loeb 2014). One exemplar program that seems to clearly make a difference in mobility and parenting just about the time of preschool is the Home Instruction for Parents of Preschool Youngsters (HIPPY) program for lower-income families with children ages 3–5. The program seeks to effectively train parents to be their child's first teacher while at the same time reducing child hyperactivity. Rigorous evaluations in New York found that the program significantly improved child reading scores (Sawhill and Karpilow 2014).
The Role of the Pediatrician
A second major type of parental-child intervention is centered on pediatricians and their role in early childhood development. The pediatrician and the parent are the bedrock of early child health and development. It is therefore essential that the physician treat the child and the parent as a single entity. Uncovering basic health issues, from allergies and asthma to hearing loss or diabetes, each require not only early detection but also successful chronic-care interventions. The burden of the habitual behaviors needed to overcome childhood asthma, for instance, requires competent parenting and regular application of medicine, cleanliness, and a host of other tasks. But that care management cannot be effectively delivered if a parent suffers from depression or high levels of stress. Health care targeting two generations at once holds the promise to improve both child outcomes and parent responsiveness to disease management programs, especially when that care is linked to social support services delivered by programs like the Nurse Home Visiting Program (Glied and Oellerich 2014). Pediatricians are often well positioned to assess children's wellbeing but usually do not ask about parental risk factors to children's health, such as smoking. One example is the SEEK Project, which trains health professionals to screen for parental risk factors and then refer the family to appropriate resources to address the problems.
Preschool: The Importance of Quality
In addition to cognitive training, there is overlap in skills training for the labor market and family formation among children and parents alike. Soft skills such as conflict resolution or how to respond to setbacks should be emphasized more in preschools and in parenting classes (Cunha and Heckman 2007, 2008). Because we do not yet have a good substitute for Head Start, we need to improve the model (Barnett 2011). One way to expand childcare may be to make such care more affordable through new, targeted subsidies for early childhood care (Ziliak 2014). A closer look at the programs that seem to work best in Boston and Chicago is a good starting point.