We are excited to share the completely updated and streamlined version of our 2021 Prenatal-to-3 State Policy Roadmap. The 2021 Roadmap is similar to the 2020 Roadmap in that it identifies the most effective investments that states can make to empower parents and foster environments in which children can thrive from the start. The two biggest differences between the two versions are in format and content. With regard to format, we heard from many state policy leaders that the 2020 version could be somewhat difficult to use. In the 2021 version, all of the information is available for a state in one location, rather than having to navigate between the larger Roadmap and the state-specific Roadmap. With regard to content, the focus of the 2021 Roadmap is on the progress states have made over the past year toward adopting and fully implementing the 11 effective solutions that are identified in the Roadmap. The 2020 Roadmap provided a baseline of what works and where states stood. Each year moving forward, we will focus also on how states are doing toward creating stronger and more equitable prenatal-to-3 systems of care.

Our team of policy analysts conducted comprehensive, systematic reviews of the existing causal evidence to identify which state policies and strategies are effective at creating the conditions in which young children and their families can thrive. These conditions, made clear by decades of research on the science of the developing child, are represented by our eight prenatal-to-3 policy goals. State policies and strategies that have significantly improved outcomes related to at least one of our eight policy goals are considered effective and are tracked in our annual Prenatal-to-3 State Policy Roadmap. For more information, please see the method for determining which policies and strategies are effective in Methods and Sources. As the evidence base grows and more information becomes available, the list of effective policies and strategies will expand. We welcome your input. If you have studies to review or programs to evaluate which could add to the evidence base, please contact our state policy team.

The policies and strategies on the Roadmap have the strongest evidence of effectiveness of those solutions that we have reviewed to date; however, this does not mean that other solutions are ineffective or that the Roadmap policies and strategies are the only effective solutions states can implement. Given the limits of existing evidence, we are slow to call a policy or strategy ineffective or harmful until it has been thoroughly studied. Many solutions reviewed in our Prenatal-to-3 State Policy Clearinghouse have been designated as Needs Further Study, meaning that current rigorous evidence focusing on the prenatal-to-3 period is insufficient to make a definitive conclusion. Our goal is to continue to grow the evidence base for effective state solutions to improve the lives of the youngest children and their families. Please see Building Evidence and Equity for our efforts to identify promising and innovative new solutions and the Prenatal-to-3 State Policy Clearinghouse for forthcoming reviews of the evidence. If you have studies to review or programs to evaluate which could add to the evidence base, please contact our state policy team.

In the 2020 State Policy Roadmap, we assessed states’ progress toward adopting and implementing reduced administrative burden for SNAP based on whether states allowed and implemented a recertification interval of at least 12 months for SNAP-eligible households with children. To be consistent with the growing evidence base for SNAP, which shows that a combination of low-burden policies for SNAP is more effective at increasing SNAP participation than any single policy, we have developed a ranking methodology that gives states credit for implementing multiple evidence-based policies to reduce administrative burden for SNAP for families with children:

1. A 12-month recertification period;
2. Simplified income reporting; and
3. The availability of online services, including the initial application, change reporting, and renewal.

Polices and strategies are each effective at impacting at least one PN-3 goal, but in the Roadmap, we define policies as having clear legislative or regulatory action, based on systematic reviews of the causal evidence. State progress toward implementing the five effective policies, therefore, is measured based on the implementation of specific policy actions. By contrast, the evidence on effective strategies does not yet provide clear legislative guidance on how to fund or implement the strategy to garner the impacts at a statewide level that were demonstrated in the rigorous studies. Progress toward state implementation of many strategies is measured relative to other states, rather than against an absolute standard. For more information about each effective policy and strategy, please see the Prenatal-to-3 State Policy Clearinghouse.

Different from many other policy reports, the Prenatal-to-3 State Policy Roadmap only gives states full credit for a policy if those eligible can currently receive the benefit AND the benefit level is sufficient to impact prenatal-to-3 outcomes. The necessary benefit level was determined based on comprehensive reviews of rigorous causal studies. For example, nearly all of the evidence on Paid Family Leave programs is based on California’s program when it offered 6 weeks of leave. Although more states are now offering up to 12 weeks of paid leave, these longer programs have not been rigorously studied yet. Thus, our threshold for an effective Paid Family Leave program is currently 6 weeks. For more information, please see methodology details and source data for states’ progress toward adopting and fully implementing effective policies and strategies in Methods and Sources.

The current evidence base does not provide clear direction on how states can effectively implement a strategy. In the 2020 Roadmap we relied on the distribution of the data for various indicators to determine whether a state had made substantial progress toward fully implementing a strategy. States that met these criteria were given a Yes, and states that did not meet with criteria were given No on the strategy. This approach was unsatisfactory because the criteria that we used were not well supported by the research, and provided a somewhat ambiguous sense of achievement for many states. In 2021, we decided to develop criteria that define how states can serve more families, and identify a handful of leading states for each strategy that other states can learn from on how to more effectively implement the strategy.

We encourage you to use the graphics of your state Roadmap to support your own work. Hover your cursor over table or graphic and if a circle with 3 dots (ellipsis) shows up in the right corner, then you can download the graphic. Click on the dots, then the download icon and choose from JPG, PNG, and PDF formats.

We hold ourselves to strict standards of precision and accuracy, but admit that occasionally we will fall short. We encourage rigorous engagement with our reported information and welcome any questions or corrections. For more information, please see calculation details and source data in Methods and Sources. If you have questions or feedback about our analyses and conclusions, please contact our state policy team.

The Prenatal-to-3 State Policy Roadmap will be updated annually to monitor states’ progress toward adopting and fully implementing the effective policies and strategies; changes in the generosity of state benefits; progress toward serving all children and families who are eligible for state benefits; changes in the overall wellbeing of children and families in each state; and efforts to reduce racial and ethnic disparities in outcomes. To get notified of the next Roadmap release, please subscribe to our email list.

The Prenatal-to-3 State Policy Roadmap includes national and state-specific data on over 100 indicators, including the policy and strategy-specific variation measures, outcomes, and demographic characteristics. Approximately 40% of these indicators were derived from state-specific sources versus single, national datasets or summary information provided by secondary sources. The remaining measures were calculated using national data sources that provide consistent information across states and are generally available on an annual basis. These sources include the public-use microdata sample (PUMS) files for the American Community Survey (ACS) and the Current Population Survey (Annual Social and Economic and Food Security Supplements); the National Survey of Children’s Health (NSCH); the National Immunization Survey-Child (NIS-Child); and vital statistics data from the Centers for Disease Control (CDC). For more information on calculation details and source data, please see Methods and Sources.

Aggregate, national level data show that there are important racial and ethnic disparities in outcomes for infants and toddlers and their families. These national level differences are likely mirrored at the state level. The small state samples sizes in even large, national datasets do not allow for the careful examination of data disaggregated by race and ethnicity within states, based on the data quality recommendations by the data sources. Our focus on the prenatal-to-3 period limits the potential sample population even further, and requires pooling data across years for most indicators for analysis at even the state level. This limits the utility of these data to the impact of policy changes on PN-3 outcomes. For those indicators where disaggregation by race and ethnicity is possible, such as birth outcomes, we include these data in our reporting. For more information on calculation details and source data, please see Methods and Sources. For information on national data, disaggregated by race and ethnicity, please see the goal profiles in the Prenatal-to-3 Policy Clearinghouse and the United States Roadmap.

Return on investment analyses conducted by the Prenatal-to-3 Policy Impact Center are forthcoming. We have included the existing evidence base on the cost effectiveness and return on investment of all solutions reviewed by our team in the comprehensive summaries available at the Prenatal-to-3 State Policy Clearinghouse.

The Prenatal-to-3 Policy Impact Center is in the process of developing our equity criteria which will be used to conduct forthcoming equity reviews of the effective policies and strategies. We have included the existing evidence base on the equitable impact of all solutions reviewed by our team in the comprehensive summaries available at the Prenatal-to-3 State Policy Clearinghouse.

In response to the COVID-19 crisis, several states have demonstrated remarkable flexibility in the implementation of policies and strategies that support infants, toddlers, and their parents. Fueled in large part by federal aid, states have made temporary policy changes which have expanded eligibility, reduced copayments and fees, and made it simpler for eligible families to access benefits.

To build a system to ensure all children get off to a strong start and thrive, each state can use the Prenatal-to-3 State Policy Roadmap to prioritize its prenatal-to-3 policy goals, adopt and implement effective policies and strategies aligned with those goals, monitor progress toward policy adoption and implementation, and measure the outcomes which demonstrate the health and wellbeing of its children and families. For more information, please see your state’s Prenatal-to-3 State Policy Roadmap, as well as our Resources and other tools.

We would love to discuss presenting our findings with your state or organization. For more information, please contact us and someone from our team will reach out.

The recommended citation is:

Prenatal-to-3 Policy Impact Center. (2021, October 7). 2021 Prenatal-to-3 State Policy Roadmap. Child and Family Research Partnership. Lyndon B. Johnson School of Public Affairs, University of Texas at Austin. https://pn3policy.org/pn-3-state-policy-roadmap-2021/.