HOW CAN STATES USE THE STATE POLICY ROADMAP TO BUILD AN EFFECTIVE PRENATAL-TO-3 SYSTEM OF CARE?
The prenatal to age 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 families are strong and 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 19 outcome measures of child and family wellbeing.
Rigorous Research Identifies Effective Solutions to Strengthen the Prenatal-to-3 System of Care
Comprehensive reviews of the most rigorous evidence available identified numerous state-level policies and strategies that positively impact at least one of the eight PN-3 policy goals. The 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.
The research landscape for state-level early childhood policies continues to evolve as states implement new strategies and as researchers study policy change. As the PN-3 Policy Impact Center conducts new comprehensive reviews of the most rigorous evidence available and updates past reviews, we continue to identify evidence of effective state policies to improve outcomes in the earliest years and update the Roadmap accordingly.
This year, we identified five new strategies proven to positively impact at least one of the eight PN-3 policy goals that describe the conditions children need to thrive from the start. However, because each of these policies was recently reviewed, the PN-3 Policy Impact Center has not yet identified state policy levers or available data to track state progress in increasing access to these policies. Review the emerging strategies profiles for additional information.
- Cash transfers are direct monetary payments to individuals or families, typically intended to prevent or mitigate poverty.
- Perinatal telehealth services use technology to deliver or enhance health care services or medical training in a remote setting during the perinatal period.
- Shared book reading programs provide free, age-appropriate books to children and families with training and guidance on how to read together.
- Early literacy coaching programs provide education and training to parents on how to promote their children’s emergent literacy skills.
- Child care workforce retention incentives provide temporary financial relief for early educators, often through cash bonuses, tax credits, or scholarships.
We define policies as an approach for which the rigorous research demonstrates causal impacts on PN-3 policy goals and supports clear state legislative or regulatory action. We define strategies as an approach for which the rigorous research demonstrates causal impacts on PN-3 policy goals but does not yet provide precise guidance for state legislative or regulatory action. The 2025 Roadmap includes a new category, emerging strategies, for which the current evidence base does not provide clear guidance on how states should implement each evidence-based strategy to positively impact outcomes and we have not yet identified state policy levers or data to measure progress.
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.
A profile of emerging strategies summarizes the rigorous evidence behind each strategy.
Align Policy Goals to Policy Solutions Proven to Impact Outcomes
Each of the effective solutions in the Roadmap is proven to impact at least one of the eight PN-3 policy goals. The framework below illustrates the alignment between the 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.
Similar to the policies and strategies, the emerging strategies on the Roadmap are also aligned with the PN-3 policy goals.
WHAT PROGRESS HAVE STATES MADE IN THE LAST YEAR TO ADOPT AND IMPLEMENT EFFECTIVE POLICIES?
No States Newly Implemented Any Effective Roadmap Policy
Since the release of the 2024 Roadmap, no states have fully implemented any of the four effective Roadmap policies. However, four states (Delaware, Maine, Maryland, and Minnesota) are in the process of implementing statewide paid family and medical leave programs.
States Made Considerable Progress on Each Roadmap Policy
Although no states newly implemented any of the effective policies this year, several states invested in increasing access to them by expanding eligibility or making policies more generous. Additionally, many states took important action to consider effective policies, even if legislation to enact the policies was ultimately unsuccessful. Summaries of state actions in the last year on each effective policy is discussed below; details are available in each policy profile.
10 States Have Fully Implemented All 4 Effective Policies
Ten states have 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.
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 effective Roadmap policies, states also invested in the 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.
State Investments in Effective Strategies Were Focused on Child Care Subsidies and Community-Based Doulas
The number of states implementing each key lever is identified in the US Roadmap summary graphic at the top of the page. In the last year, states have made the most significant investments in their child care subsidy programs and in increasing access to community-based doulas. Modest policy changes were made in other areas.
Additionally, federal policy changes enacted in H.R. 11 and through administrative actions from the executive branch may impact the implementation of the effective strategies included in the Roadmap. Policy changes in the federal law regarding SNAP and Medicaid funding, may place strain on state budgets and will impact these two programs directly. Additionally, policy changes may also impact strategies funded by or covered under Medicaid (e.g., comprehensive screening and connection programs, group prenatal care, community-based doulas, evidence-based home visiting, and Early Intervention), and programs housed within the Department of Education (e.g., Early Intervention). For more information on the potential impacts of the federal policy change on state policy, please see each strategy profile.
To learn more about state context and legislative activity for 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 taxes and 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 $56,200 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 North Carolina, and most of the resources are benefits that the federal government provides. However, because North Carolina has expanded Medicaid under the ACA, the parent is eligible for Medicaid coverage.
Learn More About the Impact of State Policy Choices with the Policy Impact Calculator
Newly launched in 2025 as an interactive dashboard, the Policy Impact Calculator allows users to:
- Explore how your state ranks on the Policy Impact Calculator using annual data, starting in 2020.
- Explore how federal and state policy choices interact to reach Lina’s total resources. See which policies have the biggest impact on family resources.
- How do state policy changes impact Lina’s family resources? See comparisons over time and across states and simulate policy changes to see their potential impact.
NOTES AND SOURCES
Full source citations can be found throughout the Roadmap policy and strategy profiles as well as Methods and Sources.
- L. 119-21
