Lorem ipsum dolor sit amet, consectetuer adipiscing elit, sed diam nonummy nibh euismod tincidunt. Learn More

2026 Roadmap 2025 Roadmap 2024 Roadmap 2023 Roadmap 2022 Roadmap 2021 Roadmap 2020 Roadmap
Twitter
Facebook
LinkedIn
Email
PRINT

UNITED STATES ROADMAP

ROADMAP POLICIES AND STRATEGIES

EFFECTIVE POLICIES

EFFECTIVE STRATEGIES

EMERGING STRATEGIES

INTERACTIVE
THE POLICY IMPACT CALCULATOR
Methods and Sources
FAQ
Additional Roadmap Resources

EMERGING STRATEGIES

The research landscape for state-level early childhood policies is evolving as states implement new strategies and as researchers study policy change. As the Prenatal-to-3 (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.

Similar to the existing Roadmap policies and strategies, each of the policies included in this section are 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. The PN-3 Policy Impact Center is in the process of identifying state policy levers and available data to track state progress in increasing access to these policies.

The five emerging strategies identified by the PN-3 Policy Impact Center to date include:

  • 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, temporary wage supplements, tax credits, or scholarships.

When combined with the existing Roadmap policies and strategies, these emerging strategies help create a system of care that provides broad-based economic and family supports, as well as targeted interventions to address identified needs.

Search the Prenatal-to-3 Policy Clearinghouse for an ongoing inventory of rigorous evidence reviews, including more information on the strategies included in this section of the Roadmap.

Align Policy Goals to Policy Solutions Proven to Impact Outcomes

The framework below illustrates the alignment between the PN-3 policy goals and the emerging evidence-based 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.

To learn more about each strategy included in this section, please navigate through the accordions below. Each section provides an explanation of what the strategy is and why it is important, the impacts of each strategy and for whom, and examples of how states can increase access to each emerging strategy.

To learn more about the other policies and strategies on the Roadmap, visit the US Summary.

WHAT ARE CASH TRANSFERS AND WHY ARE THEY IMPORTANT?

Cash transfers are direct monetary payments, often from governments, to individuals or families without restrictions on how the money is spent. Although the payments can take many forms, the central goal is to prevent or mitigate poverty. Unlike most peer countries, the US does not provide recurring payments to all individuals or families with children.1

Many Families With Young Children Struggle to Make Ends Meet

The US is one of the wealthiest countries in the world, but approximately 1 in 7 children lives in poverty.2 These numbers are worse for children of color, who are more likely, compared to White children, to experience poverty in the US. In 2024, 6.7% of White children under age 18 lived in poverty, compared to 21.5% of Hispanic children, 22.7% of Black children, 14.1% of American Indian and Alaska Native children, and 9.6% of Asian children.3

When families with young children struggle to meet basic needs, such as safe, stable housing and access to health care, it can lead to a range of negative outcomes for infants and toddlers.4 Cash transfers can address income instability and material hardship, while providing families with the flexibility to allocate money according to their most pressing needs.

Cash Transfers Vary in Design

Cash transfers can be targeted or universal. Targeted policies are designed to benefit specific groups, such as parents, whereas universal policies apply to all individuals. Transfers can also be conditional or unconditional. Conditional policies are those in which eligible groups must meet certain behavioral requirements to receive benefits, such as attend school or work, whereas unconditional policies do not require any conditions to be met. Lastly, cash transfers can vary in frequency (e.g., monthly and annually).

Definitions

The taxonomy of cash transfers is evolving and there is often no single definition.

Unconditional cash transfer (UCT): A recurring cash payment that does not stipulate recipients’ actions, also commonly referred to as guaranteed income (GI).

  • Universal basic income (UBI): An unconditional and universal cash transfer intended to be large enough to support basic needs.
  • Child allowance: An unconditional cash transfer targeted to all families with children. Payments are typically distributed monthly until the child reaches age 18; also, often referred to as a universal child benefit (UCB).
  • Negative income tax (NIT): An unconditional cash transfer for individuals earning below a certain threshold that is distributed through the tax system.
  • Dividend-based UCTs: An unconditional cash transfer from profit sharing.

Conditional cash transfer (CCT): A cash payment targeted to individuals or families who meet certain conditions, such as attending school or work, or maintaining health insurance coverage.

Cash Transfers Can Promote Critical Financial Stability in Early Childhood

The research is clear that money matters for children’s wellbeing and achievement, and the prenatal to age 3 period is the most rapid and sensitive period of development.5 Chronic exposure to poverty often causes stress that can hinder optimal brain development and lead to negative consequences throughout life. Greater income allows parents to better meet children’s basic needs, and financial stability can also reduce parental stress, which potentially leads to more nurturing child-parent relationships and reduces the likelihood of maltreatment in the household.6

The potential benefits of cash transfers may differ by policy design. The frequency with which a cash transfer is received, the eligible population, and whether the transfer is conditional or unconditional (e.g., work requirements) determines who is impacted and recipients’ behavior and financial decisions. Budget considerations often require tradeoffs between higher value cash transfers for a more targeted group (e.g., children under age 6 and families with the lowest incomes) or a lower value for a broader group.

Cash transfers have the greatest impact on the youngest children and those living in poverty, which suggests targeting these policies to this smaller population may be the most beneficial for improving aggregate childhood outcomes within budget constraints.

Cash Transfers Increased in Popularity Following the Temporary Expansion of the Federal Child Tax Credit in 2021

In the wake of the success of the temporary expansion of the federal child tax credit (CTC), cash transfers gained public attention and support. As part of the American Rescue Plan Act (ARPA), for tax year 2021, the federal CTC became more generous in terms of eligibility and value. In addition, half of the payment was disbursed through monthly checks of up to $300 for young children, which resembled a child allowance and lifted an estimated 2.1 million children out of poverty.7

Search the Prenatal-to-3 Policy Clearinghouse for an ongoing inventory of rigorous evidence reviews, including more information on cash transfers.

WHAT IMPACT DO CASH TRANSFERS HAVE, AND FOR WHOM?

By providing direct financial support to meet essential needs, cash transfers have been shown to increase families’ access to needed services and household resources, as well as improve parents’ emotional wellbeing and children’s healthy development. Rigorous studies have found cash transfers are beneficial for timely and adequate prenatal care, and are crucial for maternal and infant health; however, the effects on other indicators of families’ ability to access needed services have been null.8 

Though evidence on the impact of cash transfers on household resources is mixed, there is evidence that cash transfers can decrease food insecurity and poverty, as well as emerging findings suggesting the potential of cash transfers to improve housing security and earnings.9 Studies have also shown cash transfers improved parental health and emotional wellbeing, mainly depression and anxiety,10 and did not increase parental substance use or spending on alcohol and drugs.11,12

In the context of several null findings, cash transfers can also benefit optimal child health and development, specifically through improved nutrition13 and reduced child maltreatment.14 In addition, many studies show no or modest adverse impacts on labor force participation and employment.15,16

Although many international studies have found benefits of cash transfers, we focus on evidence of their impact on young children and families within the US. This includes the temporary expansion of the federal CTC, as well as many pilot programs across the country. Within the US context, we focus on evidence from three types of cash transfers, which include child allowances, dividend-based unconditional cash transfers (UCTs), and conditional cash transfers (CCTs).

Currently, most research has studied monthly and annual payments, totaling $1,000 to $3,600 per individual or child annually, with some totaling up to $12,000 annually. Research, however, continues to grow on cash transfers as these policies increase in popularity.

More Research Is Needed to Determine the Potential of Cash Transfers to Decrease Racial and Ethnic Disparities

Cash transfers will have the greatest impact on the approximately 13.4% of US children living in poverty, because relative to children who do not live in poverty, the benefit would represent a greater percentage of their family’s income.16 Because poverty rates for families headed by single mothers, families with very young children, and families of color are higher relative to other groups, these families may benefit most.18,19

The temporary expansion of the federal CTC decreased poverty rates for all children, however, the rates for Black and Hispanic children declined more compared to the decline in rates for White children.20 Researchers used the Supplemental Poverty Measure to understand the impact on poverty, which incorporates a broad range of government benefits, including the CTC, when calculating poverty rates. Research has also found that the benefits of the expanded credit on parents’ mental health may have been greatest for Black parents compared to other races.21

Further, studies also show that refundable state earned income tax credits, a policy that provides an annual increase in household income for working parents (similar to an annual cash transfer), reduces racial disparities in birth outcomes22 and poverty rates.23 These benefits may therefore extend to cash transfers, however, further research is necessary.

More research on the various types of cash transfers and their disparate impacts, including on child poverty, and related health, social, and educational outcomes, is also needed.

For more information on what we know and what we still need to learn about cash transfers, see the evidence review on cash transfers.

For more information on what we know and what we still need to learn about the state earned income tax credit, see the profile on the state earned income tax credit and the evidence review on the state earned income tax credit.

HOW CAN STATES INCREASE ACCESS TO CASH TRANSFERS?

States Have Many Options When Designing and Funding Cash Transfers

As discussed above, there are many approaches to designing a cash transfer that will determine the impact. In peer countries, these policies are typically funded through general tax revenue, which is largely composed of revenue from income, sales, and other taxes.24,25 Alaska’s cash transfer is funded through profits from oil reserves. It may be difficult to replicate this funding mechanism in states without lucrative natural resources or without other sources of profit. Most pilot cash transfer programs in cities across the US currently rely primarily on private philanthropic funding.

In contrast, Rx Kids, a program originating in Michigan, has drawn on federal Temporary Assistance for Needy Families (TANF) block grant funds. Specifically, the program uses a TANF funding pathway known as “non-recurrent short-term benefits” (NRST), which allows states to provide up to 4 months of cash assistance to families facing acute financial hardship. Rx Kids defines roughly the second and third trimesters of pregnancy and childbirth as this period of acute hardship.

Philanthropic grants cover cash transfers beyond the 4-month period, and because NRST payments are not classified as ongoing cash assistance under TANF rules, they do not activate federal work requirements. Rx Kids developed a detailed implementation guide to support replication by other states and localities.26

Some proposals recommend implementing a child allowance or cash transfers as a replacement for, not an addition to, other social infrastructure programs.27,28 However, there is no evidence to show consolidation would benefit families. The approach may even worsen outcomes, such as poverty, if a consolidation approach does not ensure that families’ total resources would not decrease as a result.29  

Other proposals include implementing guaranteed income through the tax code by expanding refundable credits, such as the earned income tax credit or child tax credit, and removing wage requirements to allow low-income households to receive direct cash support. Because cash transfers can take various forms, the examples below highlight different approaches that may help identify promising designs for achieving policy goals.

Alaska’s Unconditional Cash Transfer

Alaska is the only state with a statewide cash transfer, the Alaska Permanent Fund Dividend (APFD). This dividend is not targeted at families with children,30 and it was not originally intended to be an anti-poverty tool. However, it has measurably reduced poverty in the state.31,32 The goal of the APFD is to share a portion of the state’s oil wealth with all residents and ensure that future generations benefit from the state’s natural resource revenues.

Since 1982, every resident of Alaska has received an annual dividend funded by the state’s oil reserve investment revenue. To be eligible for the dividend payment, the individual must have lived in Alaska for at least 1 year and not have been convicted of a misdemeanor or felony in the last year. Parents can claim the dividend on behalf of dependent children. The APFD payment level changes each year because it is determined, in part, by stock performance. In past years, the dividend has reached up to $3,284 per person (in 2022); in 2025, the dividend was $1,000 per person.33

Other Cash Transfer Programs

Several cash transfer programs across states provide payments during pregnancy. For example, Rx Kids, originally piloted in Genesee County, Michigan, now operates in dozens of communities and continues to expand rapidly across the state. Individuals are provided $1,500 during pregnancy (16+ weeks pregnant) and $500 per month after birth for a set period (6–12 months) with no requirements or income limits.34 Early findings show success in meeting goals of improving health and poverty during pregnancy and infancy. The program has seen continued state support in Michigan and has plans to launch in Cleveland, Ohio in Fall 2026.

Another example with similar goals, is the Bridge Project, which launched as a pilot in 2021 in New York City. The program provides direct cash payments to low-income mothers during pregnancy and until the child reaches age 3. The Bridge Project is now in 14 states, and the exact value of the cash transfer varies by location, but participants receive a one-time payment during pregnancy and up to $375 to $1,000 per month after birth until age 3.35

Many pilot cash transfer programs continue to emerge as numerous organizations, cities, and states test differing approaches. For example, Baby’s First Years was a multi-site child allowance pilot program. The program provided mothers who have incomes below the federal poverty level with monthly unconditional cash payments from the child’s birth through age 6. The goal was to test the causal impact of these payments on child and maternal outcomes, specifically early brain development.36

The program enrolled 1,050 mothers with infants born between May 2018 and June 2019 in four US cities (New York City, NY; New Orleans, LA; Omaha, NE; and Minneapolis/St. Paul, MN). Participating mothers receive a monthly cash transfer of either $333 ($4,000 annually; treatment group) or $20 ($240 annually; control group) for the first 76 months of their child’s life.37

Another example of a pilot cash transfer program is the OpenResearch Unconditional Cash Study, in which individuals with a household income below 300% of the federal poverty level received $1,000 monthly. The program enrolled individuals ages 21 through 40 in two states (Illinois and Texas) and provided payments for 3 years from 2020 through 2023.38 The goal of the OpenResearch pilot was to evaluate the causal impact of the monthly cash transfers on spending, income, employment, housing, and health.

For more examples and information on pilot cash transfer programs, see The Stanford Basic Income Lab’s Experiments Map.

State Child Tax Credits

Although not cash transfers, state child tax credits (CTCs) can also provide critical financial support to families with children. As of tax year 2026, 16 states have enacted a state CTC.39 Only five of these CTCs existed prior to the temporary expansion of the federal credit in 2021, after which 11 additional states implemented their own credits. Many states have expanded eligibility or generosity for their credits since initial implementation. When designing CTCs, states determine whether the credit is refundable, the maximum value of the credit, the structure, and the eligibility.

For more information on state child tax credits, see the “How are states implementing other tax credits, such as the child tax credit?” section of the profile on the state earned income tax credit.

WHAT ARE PERINATAL TELEHEALTH SERVICES AND WHY ARE THEY IMPORTANT?

Telehealth involves the use of technology to support the provision of health care, often when providers and patients, or providers and their colleagues, are separated by distance.1 Telehealth is a broad term that encompasses not only direct patient services, but other health-related activities, such as provider consultations with one another regarding cases (teleconsultation) or remote breastfeeding support and education (telelactation).2 Telehealth can be used during the perinatal and broader prenatal-to-3 period for delivering a variety of services such as counseling pregnant patients, managing physical and mental health, and supporting parents postpartum.3

Perinatal telehealth services are typically delivered in one or more of the following ways:4

  • live video, or synchronous telehealth, in which a patient and provider interact in real time via screen;
  • store-and-forward services, in which a provider collects clinical data or information and sends it to another provider for an assessment or evaluation;
  • remote patient monitoring, in which patients use technological tools and devices at home to send clinical data in real time to a provider or hospital; and
  • mobile health, or mHealth, which refers to the use of mobile devices such as smartphones and tablets to support healthy behaviors through applications, text message reminder services, and other communication interventions.
Flexible Telehealth Options Can Promote Equitable Care Access

Telehealth can support children and families during the prenatal-to-3 period by providing health care access, including prenatal and postpartum care, to those who may not otherwise be able to access care because of factors such as distance, lack of transportation, or scheduling barriers, such as work or child care.

Recent guidance from the American College of Obstetricians and Gynecologists (ACOG) recommends telemedicine as an approach to promote quality health care for all individuals.5 Telehealth services such as remote patient monitoring can help keep children and caregivers in their homes and communities, where they can maintain their social supports, instead of requiring them to spend time in a medical facility.6

Families in Maternity Care Deserts Have Greater Access to Providers Through Telehealth Services

Telehealth can connect patients to specialists or subspecialists who may not practice in their area, improving health outcomes when children and families are able to get the tailored health evaluations or services they need. In 2024, March of Dimes reported that 35.0% of counties in the US are considered maternity care deserts, and an estimated 2.3 million women of reproductive age live in those affected counties.7

ACOG has found that women living in rural areas tend to experience worse health outcomes and receive preventive health care, including screenings for cervical and breast cancer, at lower rates than their urban counterparts.8 Telehealth offers flexible options to receive preventive health care and continuous support during the perinatal period, regardless of in-person provider availability.

Search the Prenatal-to-3 Policy Clearinghouse for an ongoing inventory of rigorous evidence reviews, including more information on perinatal telehealth services.

WHAT IMPACT DO PERINATAL TELEHEALTH SERVICES HAVE, AND FOR WHOM?

Perinatal telehealth services increase access to quality health care, education, and screenings for parents by making care available outside of scheduled in-person visits. Participation in perinatal telehealth services can improve some parental health outcomes such as stress, nutrition, and hypertension. Impacts on breastfeeding rates can be mixed, depending on the type of services provided.

Few studies analyze the impact of telehealth services on birth outcomes, but limited evidence suggests that telehealth leads to equivalent, if not better, outcomes compared to traditional care. The most rigorous studies on perinatal telehealth generally find no significant difference between in-person and telehealth care during the perinatal period suggesting that perinatal telehealth services can be a safe alternative to traditional care.

More Research Is Needed to Determine the Potential of Perinatal Telehealth Services to Decrease Racial and Ethnic Disparities

Perinatal telehealth services can theoretically decrease disparities in health and wellbeing outcomes for parents and infants because services can increase access to care for parents who may live in care deserts or are otherwise unable to routinely get to in-person appointments. Subgroup analyses in some studies indicate that telehealth services can have greater impacts on breastfeeding rates for Spanish-speaking mothers9 and Black mothers,10 compared to White mothers, depending on the intervention.

These results, however, are not sufficient to conclude that perinatal telehealth services address racial and ethnic disparities. Future research should focus on examining the differential impacts of perinatal telehealth services by race and ethnicity and the impact of perinatal telehealth in rural areas that experience lower levels of wealth.  

For more information on what we know and what we still need to learn about perinatal telehealth services, see the evidence review on perinatal telehealth services.

HOW CAN STATES INCREASE ACCESS TO PERINATAL TELEHEALTH SERVICES?

States can make perinatal telehealth services more accessible by expanding access to telehealth services generally. States can expand telehealth options through policies determining which services can be delivered through telehealth, which telehealth services can be reimbursed through Medicaid, whether telehealth must be reimbursed at levels equivalent to in-person services (parity laws), and which providers can offer telehealth services, among other key policy levers.

Although strong causal evidence supports the effectiveness of perinatal telehealth interventions, the evidence base does not currently provide clear guidance on the most effective method to implement perinatal telehealth interventions statewide.

State Telehealth Insurance Policies
  • All 51 states allow Medicaid to reimburse for real-time live video telehealth services.
  • 47 states allow Medicaid to reimburse for audio-only telehealth services.
  • 41 states allow Medicaid to reimburse for remote patient monitoring services.
  • 40 states allow Medicaid to reimburse for store-and-forward telehealth services.
  • 45 states have some form of service parity law requiring the same services to be covered via telehealth and in-person.
  • 35 states have some form of payment parity law requiring the same reimbursement rate for telehealth services and equivalent in-person services.11
Federal Investments Offer Opportunities to States

The One Big Beautiful Bill Act (OBBBA) provided $50 billion over 5 years starting in 2026 for the Rural Health Transformation Program.12 States must use funds to meet certain goals for expanding access to care in rural areas, including enhancing technology software and developing technology-abled solutions.

States can also use federal funds to invest in broadband. Two national and 12 regional telehealth resource centers are participating in a 4-year grant program from the US Health Resources and Services Administration (HRSA). The telehealth resource centers will provide technical assistance and expand the use of telehealth technology. Other grants are available from HRSA for states to expand access to broadband and, therefore, increase access to telehealth services.13 States can promote access to perinatal telehealth services by reducing gaps in broadband services. Federal grants and funding are dependent on annual federal budget decisions, as determined by Congress and the current administration.

WHAT PROGRESS HAVE STATES MADE IN THE LAST YEAR TO INCREASE ACCESS TO PERINATAL TELEHEALTH SERVICES?

During the 2026 legislative session, 11 unique states introduced legislation related to perinatal telehealth services. Among the 11 states that introduced legislation related to telehealth services, only one state successfully enacted legislation.

Virginia Enacted Legislation to Expand Telehealth Medicaid Coverage

In the last year, legislators in Virginia enacted two pieces of legislation related to telehealth Medicaid coverage. The first expands coverage of any provider-to-provider consultation to include consultations provided through telehealth services. The second requires the Department of Medical Assistance Services to assess whether to expand Medicaid coverage of remote monitoring services to all pregnant patients over age 35 through 12-months postpartum. A report is due to the legislature by November 1, 2026.

10 States Introduced Legislation to Expand Perinatal Telehealth Services

Five states (District of Columbia, Mississippi, New Jersey, Oklahoma, and West Virginia) introduced, but did not enact, legislation related to remote patient monitoring during the perinatal period. Legislation included Medicaid coverage of remote blood pressure monitoring, ultrasound services, and non-stress tests for pregnant or postpartum women.

Four states (Georgia, Mississippi, New York, and Ohio) introduced, but did not enact, legislation related to maternal mental telehealth services. Legislation included allowing for virtual referrals after perinatal behavioral health screenings and insurance coverage for maternal mental health screenings provided via telehealth.

Louisiana introduced legislation to declare maternal mortality a public health emergency and urge the Department of Health to create a comprehensive plan to reduce maternal mortality including access to perinatal telehealth services. Additionally, North Carolina introduced legislation to require a report on lactation consultation including experiences with insurance coverage of telelactation services. These bills did not pass this session.

Furthermore, Mississippi introduced legislation to establish a 3-year pilot program that would provide virtual prenatal care to pregnant women living in areas with limited or no maternity care options. However, the bill did not pass.

2 States Introduced Legislation Related to Broader Telehealth Services

Mississippi introduced legislation to require telehealth services provided by FQHCs, rural health clinics, and community mental health centers to be reimbursed at the same rate as in-person services. The bill did not pass this session. New Jersey introduced legislation to expand telehealth insurance coverage to include remote patient monitoring devices. As of September 2026, the bill had not passed. Both bills would affect telehealth services outside of and including the perinatal period.

WHAT ARE SHARED BOOK READING PROGRAMS AND WHY ARE THEY IMPORTANT?

Shared book reading is a term used to describe the interactions between an adult and a child while reading a book together.1 Shared book reading programs provide free, age-appropriate books to children and families with the goal of encouraging shared reading practices and ultimately building literacy skills.

These programs deliver books in a variety of ways: directly to the home, in health care clinics, and through local community partnerships (e.g., library, book fair). Often, there is a training component associated with these programs that focuses on how to read together effectively, ranging from reading tips on a handout to step-by-step in-person guidance.

Building Emergent Literacy Skills to Support Later Literacy Skills

The early years of a child’s life lay the foundation for healthy development and learning, and this age period provides a crucial window of opportunity for infants, toddlers, and their families, including for language development.2,3 Early literacy developed in the first 3 years of life—also known as emergent literacy—refers to the skillset infants and toddlers need to develop before they can learn to read and write effectively in the future.4

Emergent literacy skills – including vocabulary expansion, print knowledge, and understanding letter-sound connections – play a crucial role in child language and literacy development and are critical for school readiness and academic success.5,6 Reading, talking, and interacting regularly with infants and toddlers is shown to develop children’s emergent literacy skills by stimulating their brain and motivating them to learn.7-12 By promoting reading behaviors and nurturing interactions with parents, shared book reading programs can stimulate children’s learning and healthy development.

1 Shared Book Reading Program Has Been Rigorously Studied

Reach Out and Read (ROR) is the most prominent and widely studied shared book reading program. ROR gives every child a new, age-appropriate book at each well-child pediatric visit from birth through age 5; on average, a child receives 10 books throughout the program.13 In addition to distributing books, during each well-child visit, the clinician provides families with guidance on how to read together effectively. Often, ROR has volunteers in clinic waiting areas modeling how to read aloud and distributing handouts on reading strategies to families.

ROR was founded in 1989 at Boston Medical Center by a group of pediatricians and early childhood educators.14 Since then, ROR has grown through both public and private funding. Today, ROR programs exist in all states and the District of Columbia, with approximately 6,800 program sites (41,000 trained clinicians), serving 4.8 million children, and providing 9 million books each year during 11.2 million well-child visits across the country.15

Other common shared book reading programs include Dolly Parton’s Imagination Library, Raising A Reader, and Read to Grow. Although evidence of these programs suggests positive impacts on families and children, the existing evidence cannot draw conclusions on causality. To date, ROR is the only program that has been rigorously evaluated through randomized controlled trials, which allows us to draw causal conclusions about the program.

Search the Prenatal-to-3 Policy Clearinghouse for an ongoing inventory of rigorous evidence reviews, including more information on shared book reading programs.

WHAT IMPACT DO SHARED BOOK READING PROGRAMS HAVE, AND FOR WHOM?

Shared book reading programs promote nurturing and responsive child-parent relationships through the frequent practice of shared reading and the accumulation of literacy resources at home. Shared book reading programs also improve developmental outcomes by improving child vocabulary skills.

More Research Is Needed to Determine the Potential of Shared Book Reading Programs to Decrease Racial and Ethnic Disparities

None of the experimental studies on ROR explored reductions in disparities or identified differential impacts by race, ethnicity, or socioeconomic status. Nonetheless, two observational studies highlight the potential of ROR in reducing disparities across racial/ethnic and socioeconomic groups.

One study found that Hispanic parents who participated in the program were more likely to engage in shared reading with their children, compared to Hispanic parents who were not in the program.16 Another study found that Hispanic and Black families who were in ROR were also more likely to attend well-child visits after receiving ROR, compared to White families who were in ROR.17

These findings suggest that shared book reading programs may play a crucial role in reducing disparities in public health outcomes. However, more experimental research is needed to establish whether shared book reading programs reduce disparities in outcomes for parents and children by race, ethnicity, and socioeconomic status.

For more information on what we know and what we still need to learn about shared book reading programs, see the evidence review on shared book reading programs.

HOW CAN STATES INCREASE ACCESS TO SHARED BOOK READING PROGRAMS?

To increase access to shared book reading programs, states can leverage federal funding mechanisms, invest state funds directly in evidence-based shared book reading programs, or include eligible shared book reading programs, such as ROR, in early literacy grants.

Although strong causal evidence supports the effectiveness of shared book reading programs, the evidence base does not currently provide clear guidance on the most effective method to increase access to programs statewide. Examples of state support for shared book reading programs are outlined below.

States Can Leverage Federal Funds to Support Shared Book Reading Programs

States can leverage federal funding mechanisms such as the Children’s Health Insurance Program (CHIP) and the Maternal and Child Health (Title V) Block Grant to expand and sustain evidence-based shared book reading programs.18 CHIP allows states to use up to 10% of funding to implement health services initiatives (HSI), which can be directed to shared book reading programs. States can also receive federal matching funds for shared book reading programs through CHIP.19

Recent examples of states that used CHIP or Title V funding to support shared book reading programs:

  • The Oklahoma Health Care Authority (OHCA) awarded a 5-year contract of CHIP funds to Reach Out and Read (ROR) Oklahoma to collaborate on an HSI to train pediatricians in how to promote early literacy in 2018.
  • North Carolina used CHIP funds to support the expansion of ROR in the state in 2020.
  • The Indiana Department of Mental Health and Addiction funded ROR Indiana through the state’s federal Title V Grant to expand programming, train staff, and purchase books for new sites across the state in 2020.
  • The Arizona Department of Health Services awarded ROR a multiyear grant beginning in 2022 funded by the state’s federal Title V Grant to provide training for pediatric clinicians and to distribute books at an additional 10,000 well-child visits.
States Can Directly Invest in Shared Book Reading Programs

Additionally, states can support shared book reading programs through direct allocations or through state grants to evidence-based shared book reading programs. As of Fiscal Year 2025, Reach Out and Read reported public investment across 24 states, including direct state-level funding partnerships in at least 18 states.20

Recent examples of state investment in shared book reading programs:

  • Illinois appropriated Department of Public Health funds to support the Illinois chapter of the American Academy of Pediatrics’ ROR programming in Fiscal Year 2024. Connecticut appropriated funds to the State Library to support three shared book reading programs (Dolly Parton’s Imagination Library, Read to Grow, and ROR) in Fiscal Years 2024 and 2025.
  • Michigan allocated funding from the state school aid fund to improve children’s access to books and other literacy materials in Fiscal Year 2025, including ROR, Dolly Parton’s Imagination Library, or any other shared book reading program to children birth to age 5.
  • Minnesota appropriated $500,000 over 2 years in 2023 to expand Reach Out and Read as part of a statewide initiative to improve child outcomes.

WHAT ARE EMERGENT LITERACY COACHING PROGRAMS AND WHY ARE THEY IMPORTANT?

Emergent literacy coaching programs provide education and training to parents on how to promote their children’s emergent literacy skills, which are defined as the skillset infants and toddlers need to develop before they can learn to read and write effectively in the future.1,2 These programs focus on increasing interactive back-and-forth talk between parents and children, improving the quality of parental speech during interactions, increasing the frequency of child-initiated conversations, and developing literacy-promoting practices and routines.3,4

Emergent Literacy Coaching Programs Can Promote Quality and Frequent Conversations Between Parents and Children

Emergent literacy skills, including vocabulary expansion, print knowledge, and understanding letter-sound connections, play a crucial role in child language and literacy development and are critical for school readiness and academic success.5,6 Conversational turns—or the back-and-forth talk between parents and children—and rich home language environments during the birth-to-3 period can activate brain development in regions responsible for language learning, which motivates children to initiate conversations and further promotes their school readiness.7-12

Therefore, emergent literacy coaching programs provide parents with education and training on how to increase conversational turns with children, improve the quantity and quality of parental speech at home, encourage child-initiated conversations, and support literacy-promoting practices and routines.

3 Evidence-Based Coaching Programs Have Been Rigorously Studied

Three emergent literacy coaching programs, (1) Language Environment Analysis (LENA) Start, (2) Tune In, Talk More, Take Turns (3Ts)–Home Visiting, and (3) Book Babies Home Visiting have been evaluated through rigorous randomized controlled trials (RCTs). These programs focus on coaching parents on knowledge and skills to promote emergent literacy during the birth-to-3 period.13,14 Other parent education programs focused on overall early relational health are outside of the scope of this strategy.

LENA Start Coaches Parents In a Group Setting, Virtually or In Person

LENA Start targets families with infants, toddlers, and sometimes preschoolers. All parents with children from birth to age 3 are eligible to participate if the families are already part of an organization (e.g., school district) that implements LENA Start.

During the program, families use LENA technology, a speech tracking device, to measure conversational turns, parent speech, and child speech.15 LENA Start includes 10 weekly coaching sessions that are delivered in a group setting either virtually or in person. The coach and families explore the weekly data provided by the LENA device and discuss strategies to increase conversational turns and to improve home language environments.13

3Ts-Home Visiting Coaches Parents Individually at Home

3Ts-Home Visiting was developed by the TMW Center for Early Learning + Public Health at the University of Chicago.16 It includes 12 coaching sessions, which take place every other week at home. Throughout the program, a home visitor guides parents through a series of modules that teach parents how to create rich language environments and encourage children to participate in conversations. The program also offers booster sessions after parents have completed the first 12 sessions, with similar training components, to help parents refresh their skills.

Book Babies Combines Home Visiting, Literacy Coaching, and Access to Books

Book Babies was developed by Book Harvest, a nonprofit organization that provides books and literacy support to families with young children.17 Families receive quarterly literacy visits beginning at birth and continuing through age 5. During each visit, families receive five developmentally appropriate children’s books, resulting in more than 100 books throughout their time in the program.

Home visitors coach parents on literacy-promoting practices such as reading frequently with children, pointing to text while reading, engaging children in conversations about books, and establishing family reading routines.

Search the Prenatal-to-3 Policy Clearinghouse for an ongoing inventory of rigorous evidence reviews, including more information on emergent literacy coaching.

WHAT IMPACT DO EMERGENT LITERACY COACHING PROGRAMS HAVE, AND FOR WHOM?

Emergent literacy coaching programs promote nurturing and responsive child-parent relationships by bolstering parent-child conversational turns, improving parental speech quantity and quality, and increasing child-initiated conversations. These programs also help families establish literacy-promoting practices and family reading routines, as well as improve parental knowledge of early childhood development and positive parenting.

More Research Is Needed to Determine the Potential of Emergent Literacy Coaching Programs to Decrease Racial and Ethnic Disparities

To date, no rigorous evidence exists to draw conclusions on whether emergent literacy coaching programs are effective in reducing racial, ethnic, or socioeconomic disparities for families in the prenatal-to-3 period. However, research shows children from low-income communities are disproportionally affected by adverse language and literacy outcomes.18-21 Gaps in children’s vocabulary and speech processing skills start to appear as early as 18 months of age.22

Research on Book Babies explored differences in outcomes by language status and found suggestive evidence that Spanish-speaking children in the intervention group demonstrated higher language comprehension scores over time, although these differences were not statistically significant.

Emergent literacy coaching programs have the potential to address these disparities in language development by increasing conversation quality, establishing literacy-rich family routines, and enriching home language environments. More research is needed on how emergent literacy coaching programs may promote equitable child development for families with low incomes.

For more information on what we know and what we still need to learn about emergent literacy coaching programs, see the evidence review on emergent literacy coaching programs.

HOW CAN STATES INCREASE ACCESS TO EMERGENT LITERACY COACHING PROGRAMS?

Although strong causal evidence supports the effectiveness of emergent literacy coaching programs, the evidence base does not currently provide clear guidance on the most effective method to increase access to programs statewide. No states actively support emergent literacy coaching programs for parents; however, states can leverage education, early childhood, and child health funds to support these programs, including collaborating with local communities (e.g., school districts).

Examples of State Support for Emergent Literacy Coaching Programs

To date, only one state agency has piloted LENA Start.23 In partnership with the Jefferson Parish School District, the Louisiana Department of Education (LDOE) adopted LENA Start in 2021. After reaching 100 families through the program, LDOE transferred the LENA Start contract to another parish school district to continue serving more families in the state of Louisiana.

No state has collaborated with the 3Ts-Home Visiting program, which is primarily supported by private foundations.24 Book Babies is operated by Book Harvest through partnerships with health care systems, community organizations, and philanthropic funders in North Carolina, however, no state-level funding mechanisms have been used to support implementation.

WHAT ARE CHILD CARE WORKFORCE RETENTION INCENTIVES AND WHY ARE THEY IMPORTANT?

Child care workforce retention incentives offer temporary financial relief provided by the state to motivate early educators to stay in the field of early childhood education. These retention incentives may be in the form of cash bonuses, temporary wage supplements, tax credits, or scholarship stipends. Retention incentives are typically offered for early educators based on tenure, and the amount of the incentive can vary by educational attainment and role.

Examples of retention incentives include:

  • Cash bonuses to early educators, a fixed amount delivered as a one-time incentive or on a regular basis (e.g., bi-annually, quarterly), such as the WAGE$® program;1
  • Temporary wage supplements to increase the hourly wages of the child care workforce, typically through a supplement from the state to providers, such as the Colorado Child Care Assistance Program Teacher Salary Increase Pilot;
  • Tax credits to child care staff (directors and teachers), with credits varying in refundability and eligibility (e.g., educators in facilities participating in the state quality rating and improvement system [QRIS] or Early Head Start/Head Start); and
  • Scholarship stipends to child care educators pursuing higher degrees or other professional development (fixed dollar amount, usually delivered quarterly or monthly), such as T.E.A.C.H. Early Childhood® scholarships.2
Ongoing Wage Supplement Programs

Beyond financial relief strategies (e.g., retention incentives), states may also pursue policies to directly supplement early educator wages. States can establish salary scales that account for an educator’s work experience, educational attainment, and role, thus establishing a defined wage floor.

The District of Columbia Pay Equity Fund was originally established as a cash bonus program that provided lump sum payments to early educators and was transformed in Fiscal Year 2024 into a wage supplement program for early educators, now providing quarterly payments to teachers according to established pay scales.3

Because ongoing, non-time limited wage supplement programs are directly tied to workforce compensation, which has a broader scope than temporary financial relief, these programs may have different mechanisms than those of workforce retention programs. To date, rigorous research has not examined the effectiveness of ongoing, non-time limited wage supplement programs.

Low Wages Are Common in the Early Care and Education Field

Low wages are the norm in the early care and education workforce. In 2024, median wages were $13.07 per hour for child care educators (caring for children birth through age 5).4 These wages are lower than 97% of all other occupations and below the living wage for a single adult with no children in every state. Child care educators serving infants and toddlers tend to have the lowest pay, and this wage penalty by age of children served persists regardless of educators’ levels of educational attainment.5

To learn more about the challenges faced by the early care and education workforce, including low compensation, explore the Center’s original research on the landscape in Nashville, Tennessee and North Texas.

By Increasing Total Pay, Child Care Workforce Retention Incentives Can Encourage Staff Retention

To ameliorate the effects of low pay, states can implement retention incentives to provide temporary financial relief for early educators. Higher financial compensation may lead to early educators feeling encouraged, appreciated, and valued to remain in their role and field.6 By increasing compensation, even if it is only temporary, these incentives can alleviate financial stress, increase job satisfaction, and promote mental health and wellbeing.7 In doing so, early educators may be more likely to engage positively with children, which can lead to higher-quality teacher-child interactions and a more supportive learning environment.

In turn, these benefits may encourage staff retention. Retaining experienced early educators not only can contribute to more consistent, higher-quality classrooms but also help build a sustainable workforce.

A Stable Child Care Workforce Can Lead to High-Quality Early Childhood Education and Optimal Learning Outcomes

Low teaching staff turnover can foster stable, positive connections between early educators and children, and teacher-child relationships will further improve classroom quality and learning environments.8 Additionally, without having to constantly rehire and onboard new staff, early learning programs can dedicate more time and resources to support educators’ professional development. A stable workforce allows early educators to build expertise over time, which in turn leads to more optimal child learning and development.9

WHAT IMPACT DO CHILD CARE WORKFORCE RETENTION INCENTIVES HAVE, AND FOR WHOM?

Child care workforce retention incentives improve teacher financial wellbeing, job satisfaction, and working conditions. Evidence also suggests these strategies reduce teaching staff turnover and increase the size of the early care and education workforce, thus promoting nurturing and responsive care in safe settings.

More Research Is Needed to Determine the Potential of Child Care Workforce Retention Incentives to Decrease Racial and Ethnic Disparities

No strong causal research explores the impact of child care workforce retention incentives on reducing racial/ethnic disparities, or disparate outcomes for children or for the child care workforce.

However, over 90% of early educators are women, and approximately 36% to 50% of the total female child care workforce are women of color, depending on the child care setting.10 Early educators of color are often underpaid compared to their White counterparts. For example, Black early educators earn approximately $8,000 less per year than their White peers, and the pay disparity may be even greater among those who work with infants and toddlers.11

More research is needed to establish whether child care workforce retention incentives contribute to reducing disparities in outcomes for early educators by race and ethnicity, and the specific policy levers that states should adopt to ensure equitable pay among early educators.

For more information on what we know and what we still need to learn about child care workforce retention incentives, see the evidence review on child care workforce retention incentives.

HOW CAN STATES INCREASE ACCESS TO CHILD CARE WORKFORCE RETENTION INCENTIVES?

Although strong causal evidence supports the effectiveness of child care workforce retention incentives, the evidence base does not currently provide clear guidance on the most effective method to increase access to incentives statewide. Depending on their overall goals and the needs of the workforce, states may design child care workforce retention incentives differently.

To date, only a few states (e.g., Virginia, Colorado, and the District of Columbia) have implemented and evaluated the effectiveness of their statewide programs; however, the evidence base will continue to grow as more states (e.g., Washington) implement and evaluate their programs. Because child care workforce retention incentives can take various forms, the examples below highlight different approaches that may help identify promising designs for achieving policy goals.

Examples of State Support for Child Care Workforce Retention Incentives

Cash bonuses provide a fixed amount of money for early educators, delivered as a one-time incentive or on a regular basis (e.g., bi-annually, quarterly). Examples include:

  • In Minnesota, the Great Start Compensation Support Payment Program provides a monthly bonus to eligible child care programs. Each full-time staff member receives $375 per month.12
  • In Pennsylvania, the Fiscal Year 2025-26 state budget established a Child Care Recruitment and Retention program funded at $25 million. The program provides one-time payments of approximately $645 to nearly 39,000 child care educators working in programs that participate in the Child Care Works subsidy system.13
  • In Tennessee, the state allocated $7.2 million to expand the Tennessee WAGE$® Program, which provides bonuses of up to $7,800 annually to eligible early educators.14
  • In Wisconsin, the REWARD Wisconsin Stipend Program provides a bi-annual bonus between $150 and $500 to early educators earning less than $25 per hour. The amount awarded varies based on educational attainment according to the Wisconsin early childhood workforce registry.15

Temporary wage supplements increase hourly wages for early educators, typically through state funding provided to eligible child care providers. Examples include:

  • In Colorado, the Colorado Child Care Assistance Program (CCCAP) Teacher Salary Increase Pilot was a 2-year initiative that used $9 million in federal Child Care and Development Fund (CCDF) and state stimulus funding to provide participating early educators with hourly wage increases ranging from $3.00 to $7.60.16

Tax credits provide tax benefits to child care staff and typically vary in refundability and eligibility criteria. Examples include:

  • In Colorado, the Early Childhood Educator Income Tax Credit provides educators a refundable tax credit between $750 and $1,500, based on the level of state credential they hold.17
  • In Louisiana, the Teacher and Director School Readiness Tax Credit provides refundable tax credits to eligible early educators and directors. In 2025, the credits ranged from $2,192 to $4,381 depending on the educator’s credential level. Credit amounts are adjusted annually for inflation.18
  • In Nebraska, the School Readiness Tax Credit provides a refundable tax credit to early educators. The credit ranges from $2,300 to $3,500 based on the educator’s training level.19

Scholarship stipends provide a fixed amount of money for early educators pursuing higher degrees or professional development. Examples include:

  • North Carolina: The TEACH Early Childhood® North Carolina Scholarship Program provides a one-time stipend between $1,200 and $2,000 and tuition support for early educators who work toward a certificate or a degree in early childhood education.20

To learn more about state approaches to improve early educators’ compensation, check out our brief on the topic.

Notes and sources for this page are sorted by policy area.

Cash Transfers
  1. Thomas, D. (2021). Federal relief efforts protected millions of children from poverty. Child Trends. https://www.childtrends.org/‌‌blog‌/federal-relief-efforts-protected-millions-of-children-from-poverty
  2. Haider, Areeba. (2021). The basic facts about children in poverty. Center for American Progress. https://www.americanprogress.org/article/basic-facts-children-poverty/
  3. Shrider, E & Bijou, C. (2025). Poverty in the United States: 2024. United States Census Bureau. https://www.census.gov/library/publications/2025/demo/p60-287.html
  4. Duncan, G., Morris, P., & Rodrigues, C. (2011). Does money really matter? Estimating impacts of family income on young children’s achievement with data from random-assignment experiments. Developmental Psychology, 47(5), 1263-1279. http://doi.org/10.1037/a0023875
  5. Shonkoff, J. (2017). Breakthrough impacts: What science tells us about supporting early childhood development. Young Children, 72(2), 8-16. https://www.jstor.org/stable/90004117?seq=1
  6. Crouch E, Radcliff E, Brown M, Hung P. (2019). Exploring the association between parenting stress and a child’s exposure to adverse childhood experiences (ACEs). Children and Youth Services Review. https://doi.org/10.1016/j.childyouth.2019.05.019
  7. Burns, K. & Fox, L. (2023). The Impact of the 2021 Expanded Child Tax Credit on child poverty. United States Census Bureau. https://www.census.gov/library/working-papers/2022/demo/SEHSD-wp2022-24.html
  8. Hanna, M., Agarwal, S., & Shaefer, H. L. (2025). Unconditional Cash Transfers and Prenatal Care Utilization in Flint, Michigan. JAMA Network Open, 8(10), Article 2538406. https://doi.org/10.1001/jamanetworkopen.2025.38406
  9. Adams, E., Brickhouse, T., Dugger, R., & Bean, M. (2022). Patterns of food security and dietary intake during the first half of the child tax credit expansion. Health Affairs 41, No. 5. https://doi.org/10.1377/hlthaff.2021.01864 [Cash Transfers Evidence Review Study O]
  10. Batra, A., Jackson, K., & Hamad, R. (2023). Effects of the 2021 Expanded Child Tax Credit on adults’ mental health: A quasi-experimental study. Health Affairs 42, No. 1. https://doi.org/10.1377/hlthaff.2022.00733 [Cash Transfers Evidence Review Study Q]
  11. Yoo, P.Y., Duncan, G.J., Magnuson, K. et al. (2022). Unconditional cash transfers and maternal substance use: findings from a randomized control trial of low-income mothers with infants in the U.S. BMC Public Health 22, 897. https://doi.org/10.1186/s12889-022-12989-1 [Cash Transfers Evidence Review Study R]
  12. Donahoe J., Brown-Podgorski B., Gaire S., Krans E., & Jarlenski M., (2025) Advanced child tax credit monthly payments and substance use among US Parents. JAMA Health Forum. https://doi.org/10.1001/jamahealthforum.2024.4699 [Cash Transfers Evidence Review Study GG]
  13. Gennetian, L., Maury, M., Stilwell, L., Shah, H., Magnuson, K., Noble, K., Duncan, G., Fox, N., Halpern-Meekin, S., & Yoshikawa, H. (2024). The impact of monthly unconditional cash on food security, spending, and consumption: Three year follow-up findings from the Baby’s First Years study. Social Science Research Network. http://dx.doi.org/10.2139/ssrn.4781670 [Cash Transfers Evidence Review Study EE]
  14. Bullinger, L., Packham, A., & Raissian, K. (2023). Effects of universal and unconditional cash transfers on child abuse and neglect. NBER Working Paper Series. https://www.nber.org/papers/w31733 [Cash Transfers Evidence Review Study I]
  15. Ananat, E., Glasner, B., Hamilton, C., Parolin, Z., & Pignatti, C. (2024). Effects of the expanded Child Tax Credit on employment outcomes. Journal of Public Economics. https://doi.org/10.1016/j.jpubeco.2024.105168 [Cash Transfers Evidence Review Study CC]
  16. Jones, D., & Marinescu, I. (2022). The labor market impacts of universal and permanent cash transfers: Evidence from the Alaska Permanent Fund. American Economic Journal: Economic Policy 14(2). https://doi.org/10.1257/pol.20190299 [Cash Transfers Evidence Review Study G]
  17. US Census Bureau. (2025). 2024 American Community Survey (ACS) 1-Year Public Use Microdata Sample (PUMS).
  18. Wilson, V., & Schieder, J. (2018). The rise in child poverty reveals racial inequality, more than a failed war on poverty. Economic Policy Institute. https://www.epi.org/publication/the-rise-in-child-poverty-reveals-racial-inequality-more-than-a-failed-war-on-poverty/
  19. Shrider, E. A., Kollar, M., Chen, F., & Semega, J. (2021). Income and poverty in the United States: 2020. United States Census Bureau. https://www.census.gov/library/publications/2021/demo/p60-273.html
  20. Wimer, C., Curran, M., Collyer, S., & Parolin, Z. (2021). Monthly poverty rates among children after the expansion of the child tax credit. Center on Poverty and Social Policy at Columbia University. Poverty & Social Policy Brief 5(4). https://povertycenter.columbia.edu/publication/monthly-poverty-july-2021
  21. Kovski, N., Pilkauskas, N., Michelmore, K., & Shaefer, H. (2023). Unconditional cash transfers and mental health symptoms among parents with low incomes: Evidence from the 2021 child tax credit. SSM – Population Health. https://doi.org/10.1016/j.ssmph.2023.101420 [Cash Transfers Evidence Review Study S]
  22. Komro, K. A., Markowitz, S., Livingston, M. D., & Wagenaar, A. C. (2019). Effects of state-level earned income tax credit laws on birth outcomes by race and ethnicity. Health Equity, 3(1), 61–67. https://doi.org/10.1089/heq.2018.0061 [State EITC Evidence Review Study II]
  23. National Academies of Sciences, Engineering, and Medicine. (2019). A roadmap to reducing child poverty. Washington, DC: The National Academies Press. https://doi.org/10.17226/25246 [State EITC Evidence Review Study ZZ]
  24. (2020). Universal child benefits: Policy issues and options. https://www.unicef.org/reports/universal-child-benefits-2020
  25. Milligan, K., & Stabile, M. (2011). Do child tax benefits affect the well-being of children? Evidence from Canadian child benefit expansions. American Economic Journal, 3, 175-205.
  26. Rx Kids. (n.d.). TANF & Benefits Playbook. Rx Kids: A Prescription for Health, Hope, and Opportunity. https://rxkids.org/about/start-up-guide/playbook/
  27. Tharoor, I. (2020). The pandemic strengthens the case for universal basic income. The Washington Post. https://www.washingtonpost.com/world/2020/04/09/pandemic-strengthens-case-universal-basic-income/
  28. Gordon, N. (2014). The conservative case for a guaranteed basic income. The Atlantic. https://www.theatlantic.com/politics/archive/2014/08/why-arent-reformicons-pushing-a-guaranteed-basic-income/375600/
  29. OECD (2017). Basic income as a policy option: Can it add up? Policy Brief on The Future of Work, OECD Publishing Paris. https://www.oecd.org/content/dam/oecd/en/publications/reports/2017/05/basic-income-as-a-policy-option_6d481cff/77d7fe00-en.pdf
  30. Kozminsky, E. (2017). Children and Alaska’s Permanent Fund Dividend: Reasons for rethinking parental duty, 34 Alaska Law Review 85-110. http://scholarship.law.duke.edu/alr/vol34/iss1/
  31. Berman, M., & Reamey, R. (2016). Permanent Fund Dividends and poverty in Alaska. Institute of Social and Economic Research. https://iseralaska.org/static/legacy_publication_links/2016_12-PFDandPoverty.pdf
  32. Berman, M. (2018). Resource rents, universal basic income, and poverty among Alaska’s Indigenous peoples. World Development, 106, 161-172. https://doi.org/10.1016/j.worlddev.2018.01.014
  33. State of Alaska. (n.d.). Permanent Fund Dividend. Department of Revenue. https://pfd.alaska.gov/
  34. Rx Kids. (n.d.). About Rx Kids. Rx Kids: A Prescription for Health, Hope, and Opportunity. https://rxkids.org/about/
  35. Bridge Project (n.d.). Programs. https://www.bridgeproject.org/programs
  36. Baby’s First Years (2018). Data and Documentation. https://www.babysfirstyears.com/
  37. Baby’s First Years (2018). Study Background. https://www.babysfirstyears.com/
  38. Vivalt, E., Rhodes, E., Bartik, A., Broockman, D., & Miller, S. (2024). The employment effects of a guaranteed income: Experimental evidence from two U.S. States. NBER Working Paper Series. https://www.nber.org/papers/w32719
  39. Prenatal-to-3 Policy Impact Center review of state income tax statutes. Please contact us for state-specific citations.
Perinatal Telehealth Services
  1. Marcin, J., Shaikh, U., Steinhorn, R. (2016). Addressing health disparities in rural communities using telehealth. (2016). Pediatric Research, 79(1): 169-176. https://www.nature.com/articles/pr2015192.pdf
  2. Health Resources and Services Administration. (2019). Telehealth programs. https://www.hrsa.gov/rural-health/telehealth
  3. Magann, E., McKelvey, S., Hitt, W., Smith, M., Azam, G., & Lowery, C. (2011). The use of telemedicine in obstetrics: A review of the literature. Obstetrical and Gynecological Survey, 66(3), 170-178. https://doi.org/10.1097/OGX.0b013e3182219902
  4. New England Journal of Medicine. (2018). What is telehealth? https://catalyst.nejm.org/doi/full/10.1056/CAT.18.0268
  5. The American College of Obstetricians and Gynecologists. (2025). New ACOG Guidance Recommends Transformation to U.S. Prenatal Care Delivery. http://acog.org/news/news-releases/2025/04/new-acog-guidance-recommends-transformation-to-us-prenatal-care-delivery
  6. Sasangohar, F., Davis, E., Kash, B., & Shah, S. (2018). Remote patient monitoring and telemedicine in neonatal and pediatric settings: Scoping literature review. Journal of Medical Internet Research, 20(12), e295. https://dx.doi.org/10.2196%2Fjmir.9403
  7. March of Dimes. (2024). Nowhere to Go: Maternity Care Deserts Across the US 2024 Report. https://www.marchofdimes.org/sites/default/files/2024-09/2024_MoD_MCD_Report.pdf
  8. The American College of Obstetricians and Gynecologists. (2016). Health disparities in rural women. https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2014/02/health-disparities-in-rural-women
  9. Ahmed, A., Roumani, A., Szucs, K., Zhang, L., & King, D. (2016). The effect of interactive Web-based monitoring on breastfeeding exclusivity, intensity, and duration in healthy term infants after hospital discharge. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 45(2), 143-154. http://doi.org/10.1016/j.jogn.2015.12.001
  10. Uscher-Pines, L., Kapinos, K., Waymouth, M., Howell, K., Alvarado, G., Ray, K., Demirci, J., Mehrotra, A., Rogers, R., James, K. F., & DeYoreo, M. (2025). Telelactation Services and Breastfeeding by Race and Ethnicity: A Randomized Clinical Trial. JAMA Network Open, 8(2), e2461958. https://doi.org/10.1001/jamanetworkopen.2024.61958
  11. Center for Connected Health Policy, The National Telehealth Policy Resource Center. (2025). Policy Trend Maps. https://www.cchpca.org/policy-trends/
  12. Centers for Medicare & Medicaid Services. (n.d.) Rural Health Transformation (RHT) Program. Retrieved May 12, 2026 from https://www.cms.gov/priorities/rural-health-transformation-rht-program/overview
  13. Health Resources and Services Administration Office for the Advancement of Telehealth. (n.d.). Grants & Programs. Retrieved June 15, 2025 from https://www.hrsa.gov/telehealth/grants
Shared Book Reading
  1. Whitehurst, G. J., Falco, F. L., Lonigan, C. J., Fischel, J. E., DeBaryshe, B. D., Valdez-Menchaca, M. C., & Caulfield, M. (1988). Accelerating language development through picture book reading. Developmental Psychology, 24(4), 552–559. https://doi.org/10.1037/0012-1649.24.4.552
  2. Shonkoff, J. (2017). Breakthrough impacts: What science teaches us about supporting early childhood development. Young Children, 72(2), 8–16. https://www.jstor.org/stable/90004117?seq=1
  3. Lenneberg, E. H. (1967). Biological foundations of language. New York: Wiley.
  4. Early Childhood Learning & Knowledge Center, Office of Head Start. (2024, March 27). Emergent literacy. https://eclkc.ohs.acf.hhs.gov/school-readiness/home-visitors-online-handbook/emergent-literacy
  5. Crane Center for Early Childhood Research and Policy, The Ohio State University. (n.d.). Shared story book reading: Resources and evidence. Retrieved July 16, 2024, from https://crane.osu.edu/our-work/shared-story-book-reading-resources-and-evidence/
  6. Center on the Developing Child, Harvard University. (2007). In brief: The science of early childhood development. https://developingchild.harvard.edu/resources/inbrief-science-of-ecd/
  7. Pillinger, C., & Vardy, E. J. (2022). The story so far: A systematic review of the dialogic reading literature. Journal of Research in Reading, 45, 533–548. https://doi.org/10.1111/1467-9817.12407.
  8. Lorio, C. M., Delehanty, A. D., & Romano, M. K. (2022). A systematic review of parent–child shared book reading interventions for infants and toddlers. Topics in Early Childhood Special Education, 42(3), 222-233. https://doi.org/10.1177/0271121421998793
  9. Jeong, J., Franchett, E.E., Ramos de Oliveira, C.V. Rehmani, K., & Yousafzai, A.K. (2021). Parenting interventions to promote early child development in the first three years of life: A global systematic review and meta-analysis. PLOS Medicine, 18(5), e1003602. https://doi.org/10.1371/journal.pmed.1003602
  10. Noble, C., Sala, G., Peter, M., Lingwood, J., Rowland, C., Gobet, F., & Pine, J. (2019). The impact of shared book reading on children’s language skills: A meta-analysis. Educational Research Review, 28, 100290. https://doi.org/10.1016/j.edurev.2019.100290
  11. Dowdall, N., Melendez-Torres, G.J., Murray, L., Gardner, F., Hartford, L. & Cooper, P.J. (2020), Shared picture book reading interventions for child language development: A systematic review and meta-analysis. Child Development, 91, e383-e399. https://doi.org/10.1111/cdev.13225
  12. de Bondt, M., Willenberg, I. A., & Bus, A. G. (2020). Do book giveaway programs promote the home literacy environment and children’s literacy-related behavior and skills? Review of Educational Research, 90(3), 349-375. https://doi.org/10.3102/0034654320922140
  13. Reach Out and Read (n.d.). What We Do. Retrieved July 16, 2024, from https://reachoutandread.org/what-we-do/
  14. Reach Out and Read. (n.d.). Our history. Retrieved July 16, 2024, from https://reachoutandread.org/about/
  15. Reach Out and Read (2025). FY25 Annual Report. https://reachoutandread.org/fy25-annual-report/
  16. High, P., Hopmann, M., LaGasse, L., & Linn, H. (1998). Evaluation of a clinic-based program to promote book sharing and bedtime routines among low-income urban families with young children. Archives of Pediatrics and Adolescent Medicine, 152(5), 459-465. DOI: 10.1001/archpedi.152.5.459
  17. Needlman, R., Dreyer, B. P., Klass, P., & Mendelsohn, A. L. (2019). Attendance at well-child visits after Reach Out and Read. Clinical Pediatrics, 58(3), 282-287. DOI: 10.1001/archpedi.152.5.459
  18. Reach Out and Read (2024, February). Public policy agenda 2024-2026. https://reachoutandread.org/wp-content/uploads/2024/02/ROR23_PublicPolicyAgenda_FINAL-1.pdf
  19. Medicaid and CHIP Payment and Access Commission. (2019, July). CHIP health services initiatives: What they are and how states use them. https://www.macpac.gov/wp-content/uploads/2019/07/CHIP-Health-Services-Initiatives.pdf
  20. Reach Out and Read (2025). FY25 Annual Report. https://reachoutandread.org/fy25-annual-report/
Emergent Literacy Coaching
  1. Early Childhood Learning & Knowledge Center, Office of Head Start. (2024, March 27). Emergent literacy. https://eclkc.ohs.acf.hhs.gov/school-readiness/home-visitors-online-handbook/emergent-literacy
  2. National Reading Panel. (2000). Teaching children to read. Washington, DC: U.S. Department of Health and Human Services. https://www.nichd.nih.gov/sites/default/files/publications/pubs/nrp/documents/report.pdf
  3. Neuman, S., & Dickinson, D. (2001). Introduction. In S. B. Neuman & D. K. Dickinson (Eds.), Handbook of early literacy research (pp. 310). New York: Guilford Press.
  4. Snow, C. E. (2006). What counts as literacy in early childhood? In K. McCartney & D. Phillips (Eds.), Handbook of early childhood development, Blackwell Publishing Ltd, Oxford, UK.
  5. Crane Center for Early Childhood Research and Policy, The Ohio State University. (n.d.). Shared story book reading: Resources and evidence. Retrieved July 16, 2024, from https://crane.osu.edu/our-work/shared-story-book-reading-resources-and-evidence/
  6. Center on the Developing Child, Harvard University. (2007). In brief: The science of early childhood development. https://developingchild.harvard.edu/resources/inbrief-science-of-ecd/
  7. Gilkerson, J., Richards, J. A., Warren, S. F., Oller, K., Russo, R., & Vohr, B. (2018). Language experience in the second year of life and language outcomes in late childhood. American Academic of Pediatrics, 142(4), e20174276. https://doi.org/10.1542/peds.2017-4276
  8. Huber, E., Corrigan, N. M., Yamykh, V. L., Ramirez, N. F., & Kuhl, P. K. (2023). Language experience during infancy predicts White matter myelination at age 2 years. Journal of Neuroscience, 43(9), 1590-1599. https://doi.org/10.1523/JNEUROSCI.1043-22.2023
  9. Ramirez, N. F., Weiss, Y., Sheth, K. K., & Kuhl, P. K. (2023). Parentese in infancy predicts 5-year language complexity and conversational turns. Journal of Child Language, 51(2), 359-384. doi:10.1017/S0305000923000077
  10. Romeo, R. R., Leonard, J. A., Robinson, S. T., West, M. R., Mackey, A. P., Rowe, M. L., & Gabrieli, J. D. E. (2018). Beyond the 30-million-word gap: Children’s conversational exposure is associated with language-related brain function. Psychological Science, 29(5), 700-710. https://doi.org/10.1177/0956797617742725
  11. Wang, Y., Williams, R., Dilley, L., & Houston, D. M. (2020). A meta-analysis of the predictability of LENA automated measures for child language development. Developmental Review, 57, https://doi.org/10.1016/j.dr.2020.100921
  12. Zimmerman, F.J., Gilkerson, J., Richards, J.A., Christakis, D.A., Xu, D., Gray, S., Yapanel, U. (2009). Teaching by listening: The importance of adult-child conversations to language development. Pediatrics, 124(1), 342-9. doi:10.1542/peds.2008-2267. PMID: 19564318.
  13. Language Environment Analysis. (n.d.). LENA Start. Retrieved July 31, 2024, from https://www.lena.org/lena-start/
  14. TMW Center for Early Learning + Public Health. (n.d.). 3Ts-Home Visiting. Retrieved July 31, 2024, from https://tmwcenter.uchicago.edu/innovate/3ts-home-visiting/
  15. Language Environment Analysis. (n.d.). Understanding LENA technology. Retrieved July 31, 2024, from https://www.lena.org/technology/
  16. TMW Center for Early Learning + Public Health. (n.d.). TMW Center for Early Learning + Public Health. Retrieved July 31, 2024, from https://tmwcenter.uchicago.edu/
  17. Book Harvest (n.d.). Book Babies. Retrieved June 9, 2026, from https://www.bookharvest.org/book-babies
  18. Piot, L., Havron, N., & Cristia, A. (2021). Socioeconomic status correlates with measures of Language Environment Analysis (LENA) system: A meta-analysis. Journal of Child Language, 49(5), 1037-1051.doi:10.1017/S0305000921000441
  19. Gilkerson, J., Richards, J. A., Warren, S. F., Montgomery, J. K., Greenwood, C. R., Oller, K., Hansen, J. H., & Paul, T.D. (2017). Mapping the early language environment using all-day recordings and automated analysis. American Journal of Speech-Language Pathology, 26(2), 248-265. https://doi.org/10.1044/2016_AJSLP-15-0169
  20. Merz, E.C., Maskus, E.A., Melvin, S.A., He, X. and Noble, K.G. (2020), Socioeconomic disparities in language input are associated with children’s language-related brain structure and reading skills. Child Development, 91, 846-860. https://doi.org/10.1111/cdev.13239
  21. Romeo, R. R., Segaran, J., Leonard, J. A., Robinson, S. T., West, M. R., Mackey, A. P., Yendiki, A., Rowe, M. L., & Gabrieli, J. D. E. (2018). Language exposure relates to structural neural connectivity in childhood. Journal of Neuroscience, 38(36), 7870-7877. https://doi.org/10.1523/JNEUROSCI.0484-18.2018
  22. Fernald, A., Marchman, V. A., & Weisleder, A. (2013). SES differences in language processing skill and vocabulary are evident at 18 months. Developmental Science, 16(2), 234-248. https://doi.org/10.1111/desc.12019
  23. Language Environment Analysis. (n.d.). How state agencies are partnering with LENA. Retrieved August 1, 2024, from https://www.lena.org/state-agencies/
  24. PNC Foundation. (n.d.). About the 3Ts program. Retrieved August 1, 2024, from https://www.pnc.com/en/about-pnc/corporate-responsibility/grow-up-great/the-3ts.html
Child Care Workforce Retention Incentives
  1. T.E.A.C.H. Early Childhood National Center (2014). Child Care WAGE$ overview. https://www.teachecnationalcenter.org/wp-content/uploads/2014/10/WAGE-Overview-2015.pdf
  2. T.E.A.C.H. Early Childhood National Center (2021). T.E.A.C.H. Early Childhood Overview. https://www.teachecnationalcenter.org/wp-content/uploads/2021/03/TEACH-overview-FactSht-2-15-21.pdf
  3. Office of the State Superintendent of Education. (n.d.). Early childhood educator Pay Equity Fund. Retrieved July 1, 2025, from https://osse.dc.gov/node/1592046
  4. Center for the Study of Child Care Employment. (2024). Early Childhood Workforce Index 2024. https://cscce.berkeley.edu/workforce-index-2024/
  5. Bureau of Labor Statistics. (2025). Occupational Employment Statistics: May 2025 Occupation Profiles. https://www.bls.gov/oes/current/oes_stru.htm
  6. Sandstrom, H., Mefferd, E., Parra, L. J., Nelson, V., Doromal, J. B., Greenberg, E., Nikolopoulos, E., Lamb, R., & Gonzalez, A. (2024). Early educators’ reflections on the DC early childhood educator Pay Equity Fund. https://www.urban.org/research/publication/early-educators-reflections-dc-early-childhood-educator-pay-equity-fund
  7. Totenhagen, C. J., Hawkins, S. A., Casper, D. M., Bosch, L. A., Hawkey, K. R., & Borden, L. M. (2016). Retaining early childhood education workers: A review of the empirical literature. Journal of Research in Childhood Education, 30(4), 585-599. https://doi.org/10.1080/02568543.2016.1214652
  8. Whitebook, M., & Sakai, L. (2003). Turnover begets turnover: an examination of job and occupational instability among child care center staff. Early Childhood Research Quarterly, 18, 273-293. http://dx.doi.org/10.1016/S0885-2006(03)00040-1
  9. Bridges, M., Fuller, B., Huang, D. S., & Hamre, B. K. (2011). Strengthening the early childhood workforce: How wage incentives may boost training and job stability. Early Education and Development 22(6), 1009-1029. https://doi.org/10.1080/10409289.2010.514537
  10. Center for the Study of Child Care Employment. (2024). Early Childhood Workforce Index 2024. https://cscce.berkeley.edu/workforce-index-2024/
  11. Center for the Study of Child Care Employment. (2024). Early Childhood Workforce Index 2024. https://cscce.berkeley.edu/workforce-index-2024/
  12. Minnesota Department of Children, Youth, and Families. (n.d.). Great Start Compensation Support Payment Program. Retrieved July 1, 2025, from https://dcyf.mn.gov/programs-directory/great-start-compensation-support-payment-program
  13. Pennsylvania Department of Human Services. (2026). Child Care Recruitment and Retention Grant. Retrieved June 1, 2026, from https://www.pa.gov/agencies/dhs/newsroom/shapiro-administration-announces-child-care-grant-for-altoona-ch
  14. Child Care Wage$ Tennessee. (n.d.). About Tennessee Wage$. Retrieved June 1, 2026, from https://www.tnwages.org/about
  15. Wisconsin Early Childhood Association. (n.d.). Reward Wisconsin: A WECA Program. Retrieved July 1, 2025, from https://wisconsinearlychildhood.org/programs/reward/
  16. CCCAP: Teacher Salary Increase. (2023). Colorado Department of Early Childhood. Retrieved June 1, 2026, from https://cdec.colorado.gov/cccap-teacher-salary-increase
  17. Colorado Department of Revenue. (n.d.). Early Childhood Educator Income Tax Credit. Retrieved July 1, 2025, from https://tax.colorado.gov/early-childhood-educator-income-tax-credit
  18. Louisiana Department of Revenue. (2025). School Readiness Credit. Retrieved June 1, 2026, from https://revenue.louisiana.gov/individuals/general-resources/school-readiness-credit/
  19. Neb. Rev. Stat. §§ 77-3601 to 77-3607. School Readiness Tax Credit Act. 2023.
  20. Early Years. (n.d.). TEACH Early Childhood® North Carolia. Retrieved July 1, 2025, from https://www.earlyyearsnc.org/programs/teach-north-carolina/

Follow us:

Twitter Facebook Linkedin Youtube
Newsletter Sign-up