HOW CAN STATES USE THE STATE POLICY ROADMAP TO BUILD AN EFFECTIVE PRENATAL-TO-3 SYSTEM OF CARE?
The prenatal to age 3 (PN-3) period is the most rapid and sensitive period of development, and it sets the foundation for long-term health and wellbeing. The science of the developing child points to eight PN-3 policy goals that all states should strive to achieve to ensure infants and toddlers get off to a healthy start and thrive.
View state-level outcomes pages to identify priority outcomes within policy goals in your state and explore the wide variation across states on 18 outcome measures of child and family wellbeing.
Rigorous Research Identifies 12 Effective Solutions to Strengthen the Prenatal-to-3 System of Care
Comprehensive reviews of the most rigorous evidence available identified four state-level policies and eight strategies that positively impact at least one of the eight PN-3 policy goals. The 12 effective solutions are profiled throughout this Prenatal-to-3 State Policy Roadmap. When combined, the policies and strategies create a system of care that provides broad-based economic and family supports, as well as targeted interventions to address identified needs.
We define policies as an approach for which the research demonstrates impacts on PN-3 policy goals and supports clear state legislative or regulatory action. We define strategies as an approach for which the research demonstrates impacts on PN-3 policy goals but does not yet provide precise guidance for state legislative or regulatory action.
A profile of each policy and strategy provides extensive information on the impact each solution has on the eight PN-3 policy goals, the choices states can make to effectively implement the solutions, the progress states have made in the past year toward implementation, and how states compare to one another in their generosity and reach of the policies and strategies.
Align Policy Goals to Policy Solutions Proven to Impact Outcomes
Each of the 12 effective solutions in the Roadmap are proven to impact at least one of the eight PN-3 policy goals. The framework below illustrates the alignment between goals and the evidence-based policies and strategies that impact each goal, as well as selected outcomes that illustrate the wellbeing of children and families. To improve outcomes within a policy goal area, state leaders can prioritize the effective solutions aligned with the goal that demonstrate beneficial impacts.
WHAT PROGRESS HAVE STATES MADE IN THE LAST YEAR TO ADOPT AND IMPLEMENT EFFECTIVE POLICIES?
3 States Have Newly Implemented At Least 1 Effective Roadmap Policy
Since the release of the 2023 Roadmap, Colorado and North Carolina have fully implemented one of the four effective Roadmap policies; and Montana newly implemented two policies.
States Made Considerable Progress on Each Roadmap Policy
In addition to those states newly implementing one or more effective Roadmap policies, many states also invested in increasing access to effective policies by expanding eligibility or making policies more generous. Additionally, several states took important action to consider effective policies, even if legislation to enact policies was ultimately unsuccessful. Details on state actions in the last year on each effective policy is discussed below.
10 States Have Fully Implemented All 4 Effective Policies
Because of the progress states made this past year, 10 states have now adopted and fully implemented all four effective Roadmap policies. “Fully implemented” means that families in the state can currently access the level of benefits that rigorous research finds is necessary to impact PN-3 outcomes.
This year, Colorado fully implemented its paid family and medical leave program for families with a new child, which put the state in the group of 10 states that are providing all four of the broad-based economic and family supports identified in the Roadmap for the first time.
To date, eight states have not fully implemented any of the effective policies, indicating that there is much work to be done to support children and families in the US.
Importantly, even among states that have implemented a given policy, the generosity and reach of the policy varies considerably across states. We discuss this variation in detail in each of the policy and strategy profiles.
To learn more about state context and legislative activity for each state within a policy area, view the compiled state progress narratives available here.
WHAT PROGRESS HAVE STATES MADE IN THE LAST YEAR TO EXPAND ACCESS TO EFFECTIVE STRATEGIES?
In addition to the four effective Roadmap policies, states also invested in the eight evidence-based strategies this past year through legislative or administrative action. Although the current evidence base does not identify a specific policy lever that states should adopt and fully implement to increase access to the eight effective strategies, the Policy Impact Center has identified a set of key policy levers that may increase families’ access to them. The number of states implementing each key lever is identified in the US Roadmap summary graphic above. Details on state actions in the last year on key policy levers is discussed below.
To learn more about state context and legislative activity in each state within a strategy area, view the compiled state progress narratives available here.
HOW DO POLICY CHOICES IMPACT FAMILY RESOURCES ACROSS STATES?
A state’s policy choices do not operate in isolation from one another. Instead, they interact to create a system of support of varying generosity for parents and children. Minimum wages, paid leave, child care subsidies, nutrition benefits, and tax credits are significant drivers of the variation across states in the amount of resources a working parent has available to support their family.
The Policy Impact Calculator simulates the minimum level of annual resources available to a model family. The calculator includes earnings from the state minimum wage and paid family leave benefits, out-of-pocket child care expenses after receiving a subsidy, nutrition benefits, and federal and state income taxes and credits.
In the simulation, the mother works full time, year round and earns the state minimum wage. She receives the benefits she is eligible for and files her taxes. The mother takes 12 weeks of leave following the birth of her infant and sends her children to center-based care that charges the 75th percentile of the market rate.
The Policy Impact Calculator demonstrates wide variation in available resources due to state policy choices. The working parent has over $53,000 in annual resources to provide for their family in Colorado, and the majority of these resources are their earnings from their minimum wage job. Importantly, the parent in Colorado is also eligible for Medicaid, has access to paid family and medical leave, receives generous state tax credits, and may have access to evidence-based comprehensive screening and connection programs, community-based doulas, and evidence-based home visiting programs due to the state’s action on key state policy levers.
By contrast, because of low minimum wages, no paid family leave, and high out-of-pocket child care expenses, this same working parent would have just under $21,000 in annual resources for their family if they live in Idaho, and most of the resources are benefits that the federal government provides. However, the parent does have access to Medicaid in Idaho.
For more information including how the level of resources varies across states once adjusted for the cost of living, visit the Policy Impact Calculator.
