Principal Deputy Assistant Secretary
Administration for Children and Families
U.S. Department of Health and Human Services (HHS)
The State of the American Child: The Impact of Federal Policies on Children
Committee on Health, Education, Labor and Pensions
Subcommittee on Children and Families
United States Senate
Thursday July 29, 2010
Chairman Dodd, Ranking Member Alexander, and members of the Subcommittee, I am pleased to appear before you today to discuss the State of Children in America. I would first like to take this opportunity to express my thanks to you, Mr. Chairman, for your long-standing commitment to improving the lives of our Nation’s children and your tireless efforts on their behalf.
From expanding child care and strengthening Head Start to addressing child abuse and domestic violence, this Subcommittee has made enormous contributions to children across the Nation, and we are grateful for your steadfast dedication and efforts. You have been influential in targeting funding for services to improve the lives of children through these and a wide range of other programs in the Administration for Children and Families (ACF), including the Community Services Block Grant, the Low Income Home Energy Assistance Program, the Assets for Independence Program and the Developmental Disabilities Program.
For purposes of today’s hearing, I will limit the focus of my testimony to early childhood development; the safety, permanence, and well-being of our most vulnerable children; and, fatherhood and economic security (which play a major role in the lives of children and their families) and how ACF programs are contributing to these efforts.
I would like to begin by sharing some significant statistics regarding the state of many children in this country.
State of Children in America
While in many respects American children are doing well, ACF has particular stewardship of programs for children and families most at risk for negative outcomes. As you are keenly aware, there are far too many in need of our services.
- Poverty - Between 1993 and 2000, the child poverty rate declined from 22.7 percent to 16.2 percent due in substantial part to a near full-employment economy and rising employment among single mothers. Unfortunately, since 2000 these positive trends have not been sustained. By 2008, nearly 1 in 5 children lived in poverty and 8 percent of children (5.9 million) lived in extreme poverty, defined as living in a family with income less than one-half of the poverty threshold. These are the highest percentages of children living in poverty since 1998. About 22 percent of children lived in households that were food insecure at times in 2008, an increase from 17 percent in 2007 and the highest percentage recorded since monitoring began in 1995.
- Family Structure - In 2008, 67 percent of children ages 0-17 lived with two married parents, down from 77 percent in 1980. Among the 2.8 million children (4 percent) not living with either parent in 2008, 54 percent (1.5 million) lived with grandparents, 25 percent lived with other relatives, and 21 percent lived with non-relatives. Of children in non-relative homes, 38 percent (228,000) lived with foster parents. The percentage of children exiting foster care to a permanent home through adoption or guardianship has been increasing. Over 40 percent of births in the United States were outside marriage in 2008.
- Child Care - Many children spend time with a caregiver other than their parents. The majority of children (61 percent) ages 0-6 received some form of non-parental care on a regular basis in 2009.  At the same time, the parents of more than 28 million school-age children work outside the home For both young children and those in school, the cost of care and the lack of support too often do not allow families the ability to access high quality care, particularly for very young children. The average annual price of care for an infant in a center ranged from $4,560 in the least expensive State to $15,895 in the highest. A recent report from the Carsey Institute found that, among working families who made child care payments for their young children, families living in poverty paid 32 percent of their monthly family income for child care -- nearly five times more than families at 200 percent of poverty or higher.
- Child Maltreatment - In 2008, the rate of substantiated reports of child maltreatment was approximately 10 per 1,000 children ages 0-17. Younger children are more frequently victims of child maltreatment than older children. Neglect is the predominant form of maltreatment for all children and the youngest children are most at risk. In 2008, there were 22 substantiated child maltreatment reports per 1,000 children under age 1, compared with 12 for children ages 1-3, 11 for children ages 4-7, 9 for children ages 8-11, 8 for children ages 12-15, and 5.5 for adolescents ages 16-17.
While many children across the country are thriving, these statistics show that far too many children today are growing up in poverty, without adequate family support, and without access to quality care and education. The President and the Secretary have established a number of priority initiatives to address these challenges. The first I would like to discuss focuses on early learning and school readiness.
Early Childhood Development
Recognizing that children’s early experiences are critical in shaping the foundation for their long-term learning, development and growth, one of the Secretary’s highest priorities is early childhood development. We know that with nurturing and responsive relationships with parents and caregivers and with engaging learning environments in early care and education settings, young children are capable of tremendous growth and resilience in the face of adversity. That is why we are focused both on raising the bar on quality in early childhood programs – including child care and Head Start – and on expanding access to high quality programs so more children can participate in them.
Early childhood programs are critical to breaking the cycle of poverty in the United States, and are vital to the country’s workforce development, economic security, and global competitiveness. The early childhood programs administered by ACF are designed both to assist low-income working parents with the cost of child care, and to fund programs that provide enriching early childhood experiences that promote the long-term success of disadvantaged children.
Child care subsidies are provided to 1.6 million children nationally through the Child Care and Development Fund to reduce the burden of high child care costs for low-income working families. Additionally, Head Start funds over 1600 grantees in our poorest neighborhoods to provide enriching early childhood experiences and health services to nearly one million children in poverty.
Evidence continues to mount regarding the profound influence children’s earliest experiences have on their later success. Because of the strong relationship between early experience and later success, investments in high quality early childhood programs can pay large dividends.
Recognizing this, the Congress significantly increased funding for both the Child Care and Head Start programs through the American Recovery and Reinvestment Act (Recovery Act). The Recovery Act included $2.1 billion to fund expansions in Head Start, Early Head Start, investments in teachers, classroom materials, and services and supports for State Advisory Councils on Early Childhood Development and Education. The program will be serving nearly 50,000 additional children in Early Head Start and over 13,000 additional children in Head Start. Child Care funding increased by $2 billion in the Recovery Act, and the providers will serve an estimated 200,000 more children than would otherwise have been supported by the program.
While this is important progress, far too many children still do not have access to highquality early childhood services. Head Start serves just over half of poor children, Early Head Start serves less than five percent, and the Child Care and Development Fund serves only one in six eligible children. Further, for those receiving services, the quality of their experiences has not received adequate attention to produce the benefits that all children need and deserve.
As we move forward, we have a number of goals for our early childhood programs including, improving the quality of child care and Head Start programs, fostering the integration of ACF’s early childhood programs with other early learning programs and social services, vertically aligning programs with the elementary and secondary education system, and strengthening program integrity.
Using the Child Care and Development Block Grant’s (CCDBG) mandatory four percent quality set-aside, we are helping States build a systematic framework for quality investments. This effort includes taking actions to strengthen the quality of child care programs by expanding the number of States with Quality Rating and Improvement Systems (QRIS). The QRIS includes a set of standards that define each level of quality, an incentive and support system to help programs meet higher standards, and outreach to inform parents of what the ratings mean.
There is much more that can and should be done to raise the quality of child care for America’s children. We look forward to working with Congress to craft a child care reauthorization framework, including needed reforms to ensure that children receive high quality care that fosters healthy child development and meets the diverse needs of families. The President’s FY 2011 budget request proposed an increased investment of $1.6 billion for child care and outlined a set of principles for reauthorization focusing on serving more low-income children in safe, healthy, nurturing child care settings that are optimally effective in promoting learning, child development and school readiness. The Early Learning Challenge Fund (ELCF) also remains a priority of the Administration and we look forward to working with Congress to make the ELCF a reality.
In addition, because high quality early childhood education spans the ages of birth to age 8 and involves the transition of children from early childhood programs into our nation’s schools, continued collaboration between the Department of Health and Human Services and the Department of Education is essential. Secretary Sebelius and Secretary Duncan have been working very closely, and the two Departments have a number of joint efforts currently underway. We have formed working groups consisting of the best minds in both Departments to address the most pressing issues in the early childhood field, including creating a more educated, better trained early childhood workforce; better connecting the early education and health systems; and improving the way data are collected and used to improve early childhood systems at the state level. The two Departments also co-hosted listening sessions across the country to hear from the foremost experts and early childhood practitioners concerning these issues. The Departments consult regularly on the early childhood initiatives underway in each Department and will continue to collaborate on future initiatives and legislation that are vital to the development and education of our nation’s youngest children, especially efforts to improve the quality of these programs and services with the goal of improving child outcomes.
We also continue to improve Head Start using the tools provided to us by the Improving Head Start for School Readiness Act of 2007. As you may recall, in January of this year ACF released the findings of the Head Start Impact Study which showed that at the end of one program year, access to Head Start positively influenced children’s school readiness. When measured again at the end of kindergarten and first grade, some of these benefits persisted, but the Head Start children and the control group children were at the same level on many of the measures studied. While the Head Start program has significantly changed since the study was conducted in 2002, we are using the findings of the Head Start Impact Study and that of other studies to improve the program.
We have developed a set of initiatives outlined in a planning document entitled, The Head Start Roadmap to Excellence. These initiatives will strengthen Head Start programs in preparing poor children for success in school and life. The initiatives in the Roadmap significantly increase the expectations for what Head Start programs should achieve, provide the necessary supports to meet those expectations, and strengthen the accountability provisions for programs that do not meet expectations. Specifically:
- To increase what we expect from Head Start programs, we are strengthening the Head Start Program Performance Standards. These standards provide a standard definition of quality services for all Head Start grantees. The revised program performance standards will institute best practices in the field of early education and child development and ensure that Head Start programs meet the educational, health and nutritional needs of the children and families they serve, along with improving program integrity and fiscal management.
- To provide additional support to programs, we are reinventing the training and technical assistance system. The new system will provide “cascading levels of support” for Head Start programs with National Centers providing information about best practices to State Centers, and mentor coaches helping programs to implement these best practices at the program level.
- Finally, to strengthen accountability, we will implement a system that injects competition into Head Start by requiring low performing programs to compete for continued funding as required by this Subcommittee in the Head Start reauthorization. This recompetition process is absolutely central to raising the bar on quality not only by getting rid of poor performers but in providing significant new incentives for programs to improve their performance and offer quality services. We are working hard to craft a system that is fair and transparent and that will result in a significant improvement in program quality. We anticipate publishing the proposed rules later this year.
Program integrity is one of HHS’s key priorities and applies to all programs administered by HHS. The President has charged each Federal agency with launching rigorous audits and conducting “annual assessments to determine which of their programs are at risk of making improper payments….” In response, Secretary Sebelius recently established the Council on Program Integrity, which will look at all areas within the Department—from Medicare and Medicaid, to Head Start and Child Care, to LIHEAP—to conduct risk assessments of programs or operations most vulnerable to fraud or abuse; enhance existing program integrity initiatives or create new ones; share best practices on program integrity throughout HHS; and measure the results of our efforts.
ACF already has taken steps to enhance program integrity in all of our programs, including our early childhood programs. For example, the Office of Head Start has created a fraud hotline that will allow information on inappropriate behavior to be reported directly to the Assistant Secretary. It also initiated unannounced visits of Head Start programs and is developing new regulations to strengthen program integrity at the grantee level.
I would like to turn now to our priority goals for ensuring the safety, permanence and well-being of children.
Safety, Permanency, and Well-being of Vulnerable Children
The Administration is committed to working with States to reduce the incidence of child abuse and neglect and provide safe and permanent homes for all of America’s children. The children facing challenges to safety and permanency are among the most vulnerable children in our country. Our efforts to prevent the maltreatment of children, mediate children’s exposure to violence, find permanent placements for those children who cannot safely return to their homes, and provide temporary or transitional placements and services for older youth are critical to ensuring that America’s children grow into healthy, stable adults.
The impact of not addressing the needs of these vulnerable children is far-reaching. Maltreatment in general is associated with a number of negative outcomes for children, including lower school achievement, juvenile delinquency, substance abuse, and mental health problems. Certain types of maltreatment can result in long-term physical, social, and emotional problems, and even death. Children who witness domestic violence are at a greater risk of developing behavioral and emotional problems, cognitive and attitudinal issues, and long term problems. Children who witness domestic violence in their homes are more likely to justify their own use of violence in their relationships. It is imperative that we seek solutions that build on promising practices to address the needs of these children.
We have been working closely with this Subcommittee on reauthorization of two programs offering support for these populations—the Child Abuse Prevention and Treatment Act and the Family Violence Prevention and Services Act. We look forward to continuing these efforts and finalizing enactment of these key pieces of legislation.
At the same time, this Administration has placed a significant priority on the development and implementation of evidence-based and evidence-informed research and practice. We are committed to investing in programs and strategies that have proven effective through rigorous evaluation, building on promising practices, and promoting innovation to expand the body of knowledge all of which increase the portfolio of interventions proven to positively impact children’s safety, permanence and well-being. Proven strategies are particularly important in the child welfare and well-being arenas because the stakes for children are so high.
The Administration recently demonstrated its commitment to identifying and replicating best practices for children who stay in foster care the longest by proposing a $20 million grant program to fund innovative strategies for moving these children to permanent homes. The first year of funds for these grants will be awarded in September and the President’s Budget proposes continued funding for these grants to identify effective practices for our most vulnerable children. The goals of the innovative approaches to foster care program are to: implement innovative intervention strategies that are informed by the relevant literature; reduce long-term foster care stays and improve child outcomes; and rigorously evaluate these efforts to provide substantial information about the effectiveness of the programs, interventions, and practices in reducing long-term foster care. State projects that meet negotiated targets will be eligible for incentive payments that will be awarded above and beyond the base award amount and will be given flexibility in using the incentive payments to enhance project-related activities. This initiative to reduce long-term foster care is a significant step toward improving services and outcomes for vulnerable children who pass through, and often remain in, the child welfare system.
Another example of the President’s commitment to targeting funds towards evidence-based approaches and testing innovation is the new Home Visiting program created in the Affordable Care Act. Just last week, HHS released $88 million for development and implementation of high-quality, evidence-based statewide home visiting programs, to assure effective coordination and delivery of critical health, development, early learning, child abuse and neglect prevention, and family support services to young children and families.
Additionally, the President’s FY 2011 budget requests a $10 million increase in child abuse discretionary activities. These funds will be used to establish a new competitive grant program for States to support increased use, and high quality implementation, of evidence-based and evidence-informed child maltreatment prevention programs and activities. The competitive grant program is intended to encourage States to use existing funding streams to support community-based prevention activities rooted in a strong evidence base. Funds also will be used to insure that child maltreatment prevention and family support is integrated with other State systems for children and youth.
With the current condition of the economy putting additional stress on families, States are seeing an increase in child abuse and neglect and domestic violence. At a time of increasing pressure on State budgets it is imperative that funding is targeted to evidence-based and evidence-informed approaches to maximize every dollar spent protecting and supporting children and families. Further, the cost of addressing the consequences of abuse and neglect after maltreatment has happened far exceeds the cost of investing in evidence-based interventions that prevent abuse from occurring or effectively mitigate the consequences of the abuse.
The last priority area impacting the state of our nation’s children that I would like to discuss is advancing economic security and fatherhood.
Economic Security and Responsible Fatherhood
There is no question that families are the core support for children. Children’s well-being depends on financial and emotional support from both parents, and parental employment is the key to long-term economic security for families. To help families succeed in the workforce, we seek to connect parents not only with work, but also with educational opportunities and other supports to help them move into better jobs, child care to help meet the costs of work and basic needs, and with services to address the barriers that sometimes make work difficult for some individuals.
The Temporary Assistance for Needy Families Program (TANF) provides assistance and work opportunities to needy families and is one of the nation’s primary safety net programs for low-income families with children. Under this $16.5 billion block grant program, States have broad flexibility to design programs that strengthen families and promote work, personal responsibility, and self-sufficiency. Within certain Federal requirements, States can determine their own eligibility criteria, benefit levels, and the type of services and benefits available to TANF recipients.
As with child care, Head Start, and Child Support, the Recovery Act included significant investments to bolster the safety net for low income children and families. This legislation affected the TANF program in several key ways, including the establishment of a new $5 billion Emergency Contingency Fund for States, Territories, and Tribes for FY 2009 and FY 2010. This Emergency Fund was structured with the recognition that there are multiple ways to help families during an economic downturn by expressly providing additional funding for basic assistance, short-term needs, and subsidized employment. To date, ACF has awarded over $4 billion in TANF Emergency Funds to 47 States, 17 Tribes, the District of Columbia, and the Territories of the Virgin Islands and Puerto Rico.
The TANF Emergency Fund has played a crucial role in allowing TANF jurisdictions to respond to the needs of vulnerable children and families during this economic downturn. TANF jurisdictions have taken advantage of the opportunities provided by the Emergency Fund to implement programs and provide benefits that specifically target children. For example, ACF has awarded Emergency Fund dollars for benefits such as back-to-school clothing allowances, scholarships for summer camps, and services provided through partnerships with local agencies that operate Summer Food Service Programs, and community organizations, such as The Boys and Girls Club.
Further, as of July 25, 34 States, the District of Columbia and the Virgin Islands have established subsidized employment programs using $1 billion in Emergency Funds. These States have plans to create nearly 200,000 jobs by September. This is an unprecedented use of funds for subsidized employment programs. In January, the Department of Labor and HHS issued a joint letter encouraging workforce and human services agencies to work together to explore all funds available for the creation and expansion of subsidized summer employment programs for low-income youth. Taking advantage of this opportunity, and in the absence of additional Workforce Investment Act (WIA) funding for this purpose, 21 States and the District of Columbia are using emergency funds to expand and develop programs specifically designed for youth; some have even partnered with their local WIA One Stop Centers in order to maximize recruitment and implement effective practices. Since youth employment is at a 60-year low, this is a crucial investment in supporting a robust economic recovery.
Given the difficult fiscal choices States are facing in an economy that still has high unemployment, and the recent extremely positive activity by States, we strongly urge Congress to take action so that all States can access the Emergency Fund in 2011 when, unfortunately, unemployment and poverty are likely to remain elevated in the aftermath of the recession. By extending the Emergency Fund through FY 2011 and providing additional funding, Congress can help States continue their innovative efforts to expand employment and strengthen the safety net so desperately needed by many low-income children and families. In addition, the Department of Labor’s FY 2011 request includes second-year funding for their Transitional Jobs Program to demonstrate and evaluate program models, which combine short-term subsidized or supported employment with a well-designed suite of supportive services and job search assistance during and after the transitional job to help individuals with significant barriers to obtain the skills they need to secure unsubsidized jobs. FY 2010 funding will be used to support and rigorously test transitional jobs programs targeting non-custodial parents, a group whose employment outcomes are likely to have an important effect on children.
While employment is a key element of providing support to children, research suggests that the most stable families consist of two parents who also are involved and invested in their children’s success. Children who have a quality relationship with their father are more likely to stay in school and pursue higher education and are less likely to be sexually active, or give birth out of wedlock at a young age. Unfortunately, too many fathers today are not engaged and participating in their children’s lives. They are not making the emotional and financial contributions they could and are, therefore, not having the kind of impact that promotes family and child well-being.
Responsible fatherhood programs can help fathers find work and stay engaged in their children’s lives, allowing fathers to provide the emotional and financial support every child needs. The President is committed to promoting responsible fatherhood and helping fathers meet their obligations by ensuring that they have the broad range of services (including job, relationship, and parenting skills training) that they need to be successful. On Father’s Day this year President Obama said, “Now, I can’t legislate fatherhood – I can’t force anybody to love a child...What we can do is come together and support fathers who are willing to step up and be good partners and parents and providers….”
The vision of the President’s fatherhood initiative in conjunction with services offered through Child Support Enforcement, Child Care and TANF offers an integrated set of strategies to bolster the economic security of especially vulnerable families and their children. Our FY 2011 budget request to create a new Fatherhood, Marriage and Family Innovation Fund would build a strong evidence base around what service intervention models work to remove barriers to employment and increase family functioning and parenting capacity, and identify best practices that could be replicated within TANF, Child Support Enforcement, and other state and community-based programs. The Innovation Fund will provide for comprehensive programs that can meet the multiple needs that fathers and their families face.
A guiding premise for us is that children need and deserve the financial and emotional support of both of their parents. Accordingly, we have placed a high priority on the effective operation of the Child Support Enforcement program. Child Support Enforcement is integral to family economic security and, of course, is an important aspect of our responsible fatherhood efforts. This program serves 17 million children overall, and half of all poor children. Most families in the program are low-income working families and the majority of children are born outside of marriage. Forty-five percent of these families formerly received TANF and 13 percent are currently in the TANF program.
In FY 2008, the Child Support Enforcement Program collected $26.6 billion in child support, while the total federal contribution to costs was $4.1 billion. By securing support from non-custodial parents, the Child Support Enforcement Program lifts a million people out of poverty every year and helps families avoid the need for public assistance. Child support provides about 30 percent of income for the poor families who receive it, and over 90 percent of the child support money collected by the program is distributed directly to children and families. This represents a shift in programmatic mission that began with welfare reform, to move the program from one that sought to reimburse the Federal and State governments for public assistance paid to families. Distributing more of the support collected to families increases and stabilizes family income and strengthens positive outcomes for families. The emerging mission of the child support program is to improve child well-being by working with both parents to improve parental capacity to support their children.
The Recovery Act temporarily restored federal matching funds for State expenditures made with child support incentive payments – a long-standing policy that was ended by the Deficit Reduction Act of 2005. In the past, State programs relied heavily on this authority to fund operations, and we estimate that program expenditures would be cut by over 10 percent without the continued matching funds, since it is unlikely that States could afford to make up the reduction in Federal funding. The President’s FY 2011 budget requests a total of $4.3 billion for the Child Support Enforcement Program and includes several legislative proposals, the most significant being a one-year continuation of the Recovery Act provision.
With the work of this Subcommittee, and under your committed leadership, Mr. Chairman, significant strides have been made in understanding where we are most challenged in improving the state of American children and targeting funding and attention to policies that seek to address these challenges. As I have discussed in my testimony, the Administration has developed an integrated set of strategies to bolster ongoing efforts. Where we can, we are making policy changes and targeting resources to effect the change that is needed, but as I have outlined there are a number of key areas where we need your help. We look forward to working with the Congress to ensure that legislative changes and key investments are made to continue to improve the lives of children in America.
Thank you for the opportunity to address the Subcommittee today. I would be happy to answer any questions.
 Administration for Children and Families, Office of Planning, Research and Evaluation. (2004b). Children ages 3 to 5 in the child welfare system. NSCAW Research Brief No. 5. Washington, DC: Author.
English, D. J., Widom, C. S., & Brandford, C. (2004). Another look at the effects of child abuse. NIJ journal, 251, 23-24.
 Felitti, V. J. (2002). The relationship of adverse childhood experiences to adult health: Turning gold into lead. Zeitschrift für Psychosomatische Medizin und Psychotherapie 48(4), 359-369. Retrieved June 18, 2007, from www.acestudy.org/docs/GoldintoLead.pdf
Flaherty, E. G., et al. (2006). Effect of early childhood adversity on health. Archives of Pediatrics and Adolescent Medicine, 160, 1232-1238.
 Stapleton, J.G., Phillips, K.G., Moynihan, M.M., Wiesen0Martin, D.R., Beulieu, A.L. (2010) New Hampshire endowment for health planning grant final report: The mental health needs of children exposed to violence in their homes.Retrieved July 26, 2010 from http://www.nhcadsv.org/Maureen/EFHReportFINAL.pdf
 Singer, M.I., Miller, D.B., Guo, S., Slovak, K and Frieson, T. (1998) The Mental Health Consequences of Children’s Exposure to Violence. Mandel School of Applied Social Sciences, Community Health Research Institute, Case Western Reserve University, Cleveland, OH: Cuyahoga County.
Jaffe, P. G., &Geffner, R. (1998). Child custody disputes and domestic violence: Critical issues for mental health, social service, and legal professionals. In G. Holden, R. Geffner, &E. Jouriles (Eds.), Children exposed to marital violence: Theory, research, and applied issues (pp. 371-408). Washington, DC: American Psychological Association.
 Pew/PCA, "Time for Reform: Investing in Prevention, Keeping Children Safe at Home". See http://www.pewtrusts.org/uploadedFiles/wwwpewtrustsorg/Reports/Foster_care_reform/time_for_reform.pdf
The Effects of Father Involvement: A Summary of the Research Evidence Sarah Allen, MSc and Kerry Daly, PhD, University of Guelph (2002) (http://www.ecdip.org/docs/pdf/IF%20Father%20Res%20Summary%20(KD).pdf)
Last revised: June 18, 2013