PRENATAL-TO-3 STATE POLICY ROADMAP

Frequently Asked Questions

Prenatal-to-3 State Policy Roadmap

Below are answers to frequently asked questions about the Prenatal-to-3 State Policy Roadmap, assessment of states, data sources, and more.

Our team of policy analysts conducted comprehensive, systematic reviews of the causal evidence to identify which state policies and strategies are effective at creating the conditions in which young children and their families can thrive. These conditions, made clear by decades of research on the science of the developing child, are represented by our eight prenatal-to-3 policy goals. State policies and strategies that have significantly improved outcomes related to at least one of our eight policy goals are considered effective and are tracked in our annual Prenatal-to-3 State Policy Roadmap. For more information, please see the method for determining which policies and strategies are effective in Methods and Sources. As the evidence base grows and more information becomes available, the list of effective policies and strategies will expand. We welcome your input. If you have studies to review or programs to evaluate which could add to the evidence base, please contact our team at pn3exchange@austin.utexas.edu.

The policies and strategies on the Roadmap have the strongest evidence of effectiveness of those solutions that we have reviewed to date; however, this does not mean that other solutions are ineffective or that the Roadmap policies and strategies are the only effective solutions states can implement. Given the limits of existing evidence, we are slow to call a policy or strategy ineffective or harmful until it has been thoroughly studied. Many solutions reviewed in our Prenatal-to-3 State Policy Clearinghouse have been designated as Needs Further Study, meaning that current rigorous evidence focusing on the prenatal-to-3 period is insufficient to make a definitive conclusion. Our goal is to continue to grow the evidence base for effective state solutions to improve the lives of the youngest children and their families. Please see Building Evidence and Equity for our efforts to identify promising and innovative new solutions and the Prenatal-to-3 State Policy Clearinghouse for forthcoming reviews of the evidence. If you have studies to review or programs to evaluate which could add to the evidence base, please contact our team at pn3exchange@austin.utexas.edu.

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

Different from many other policy reports, the Prenatal-to-3 State Policy Roadmap only gives states full credit for a policy or strategy if those eligible can currently receive the benefit AND the benefit level is sufficient to impact prenatal-to-3 outcomes. The necessary benefit level was determined based on comprehensive reviews of rigorous causal studies. For more information, please see methodology details and source data for states’ progress toward adopting and fully implementing effective policies and strategies in Methods and Sources, as well as our research brief How States Receive Credit for Policy Adoption on the Prenatal-to-3 Policy Roadmap.

We hold ourselves to strict standards of precision and accuracy, but admit that occasionally we will fall short. We encourage rigorous engagement with our reported information and welcome any questions or corrections. For more information, please see calculation details and source data in Methods and Sources. If you have questions or feedback about our analyses and conclusions, please contact our team at pn3exchange@austin.utexas.edu.

The Prenatal-to-3 State Policy Roadmap will be updated annually to monitor states’ progress toward adopting and fully implementing the effective policies and strategies; changes in the generosity of state benefits; progress toward serving all children and families who are eligible for state benefits; changes in the overall wellbeing of children and families in each state; and efforts to reduce racial and ethnic disparities in outcomes. We will share the 2021 Prenatal-to-3 State Policy Roadmap at our event on October 6-8, 2021. We invite you to join us. For more information, please subscribe to our email list.

The 2020 Prenatal-to-3 State Policy Roadmap included national and state-specific data on 111 indicators, including the policy and strategy-specific variation measures, outcomes, and demographic characteristics. The data for 41 of these indicators were derived from state-specific sources versus single, national datasets or summary information provided by secondary sources. The remaining measures were calculated using national data sources that provide consistent information across states and are generally available on an annual basis. These sources include the public-use microdata sample (PUMS) files for the American Community Survey (ACS) and the Current Population Survey (Annual Social and Economic and Food Security Supplements); the National Survey of Children’s Health (NSCH); the National Immunization Survey-Child (NIS-Child); and vital statistics data from the Centers for Disease Control (CDC). For more information on calculation details and source data, please see Methods and Sources.

Aggregate, national level data show that there are important racial and ethnic disparities in outcomes for infants and toddlers and their families. These national level differences are likely mirrored at the state level. The small samples sizes in even large, national datasets do not allow for the careful examination of data disaggregated by race and ethnicity within states, based on the data quality recommendations by the data sources. Our focus on the prenatal-to-3 period limits the potential sample population and requires pooling data across years for most indicators for analysis at even the state level. This limits the utility of these data to understand how point in time changes in policy impact outcomes. For those indicators where disaggregation by race and ethnicity is possible, such as birth outcomes, we will include these data in our reporting. For more information on calculation details and source data, please see Methods and Sources. We will analyze and publish data for those indicators, states, and other subnational geographies where possible in future work. For information on national data, disaggregated by race and ethnicity, please see the goal profiles in the 2020 Prenatal-to-3 State Policy Roadmap.

Return on investment analyses conducted by the Prenatal-to-3 Policy Impact Center are forthcoming. We have included the existing evidence base on the cost effectiveness and return on investment of all solutions reviewed by our team in the comprehensive summaries available at the Prenatal-to-3 State Policy Clearinghouse. This information can also be found as part of the policy profiles of the 2020 Prenatal-to-3 State Policy Roadmap.

The Prenatal-to-3 Policy Impact Center is in the process of developing our equity criteria which will be used to conduct forthcoming equity audits of the effective policies and strategies. We have included the existing evidence base on the equitable impact of all solutions reviewed by our team in the comprehensive summaries available at the Prenatal-to-3 State Policy Clearinghouse. This information can also be found as part of the policy profiles of the 2020 Prenatal-to-3 State Policy Roadmap.

In response to the COVID-19 crisis, several states have demonstrated remarkable flexibility in the implementation of policies and strategies that support infants, toddlers, and their parents. Fueled in large part by federal aid, states have made temporary policy changes which have expanded eligibility, reduced copayments and fees, and made it simpler for eligible families to access benefits. For more information, please see the discussion of state responses to the COVID-19 pandemic in the 2020 Prenatal-to-3 State Policy Roadmap and the research brief Beyond the Pandemic: State Policy Options for Supporting Families.

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

We would love to discuss presenting our findings with your state or organization. For more information, please contact our team at pn3exchange@austin.utexas.edu.