by Elisa Vele-Tabaddor, Ph.D

Recently, I had the honor of sitting down with Dr. Jack P. Shonkoff, Julius B. Richmond FAMRI Professor of Child Health and Development at the Harvard School of Public Health and Harvard Graduate School of Education and founding Director of the Center on the Developing Child at Harvard University, to discuss his work in early childhood policy. He also discussed his thoughts about building foundations for productive and sustainable societies by investing in the healthy development of all young children.

An alumnus of Cornell University and New York University School of Medicine, Dr. Shonkoff completed his pediatric training at Bronx Municipal Hospital Center and the Albert Einstein College of Medicine and his fellowship in developmental pediatrics at Harvard Medical School and Children's Hospital Boston. He has served on numerous professional networks and public interest advisory boards, including the core scientific group of the MacArthur Research Network on Early Experience and Brain Development, the Governing Council of the Society for Research in Child Development, and the Executive Committee of the Section on Developmental and Behavioral Pediatrics of the American Academy of Pediatrics. Dr. Shonkoff chaired the Committee on Integrating the Science of Early Childhood Development for the Board on Children, Youth, and Families at the Institute of Medicine and National Research Council, which produced a landmark report entitled From Neurons to Neighborhoods: The Science of Early Childhood Development.

Currently, Dr. Shonkoff directs the Center on the Developing Child and chairs the National Scientific Council on the Developing Child. The Center, established in 2006, draws on all Harvard schools and affiliated hospitals to generate a rich portfolio of scholarship, education and public engagement to promote the health and well-being of children.

Q: What is the focus of your work in early childhood policy?
A: I'm focused on leveraging science to make a strong case for the value of investing in the healthy development of young children, particularly those who are vulnerable. To this end, I am committed to changing the policy environment in which clinicians do their work by increasing the extent to which policy makers allocate resources for the delivery of services in the early childhood years. Scientific evidence illustrates that healthy child development builds a strong foundation for successful communities, a prosperous society, and a secure nation. Stated simply, this is all about the development of human capital. My goal is to help policy makers and business leaders understand why early relationships are essential for healthy brain development and how experiences in the early years either strengthen or undermine learning, behavior, and health outcomes that can have long term implications for the economic and social well-being of our society.

Rather than trying to change the cultural beliefs, personal values, or political perspectives of decision makers, teaching them the scientific principles of early childhood development leads to a different kind of public discussion that is more likely to be open to new ways of thinking about shared responsibility for investing in "other people's children." As we wrote at the end of From Neurons to Neighborhoods, our hope is to change the public dialogue from whether we should focus our efforts on the healthy development of young children to how we can support their wellbeing most effectively.

Q: Where is early childhood policy today?
A: In the United States, we are experiencing a virtual social revolution. Five or ten years ago, public discussion about government responsibility for young children before school entry was non-existent in some states. Today, there is not a state in the nation that is not thinking about what types of early childhood policies it should be putting into place.

From a global perspective, early childhood concerns are becoming increasingly important as well. Although my own professional experience has been engaged almost entirely in the United States, our new Center has just begun a planning process to build a global agenda focused on early childhood concerns in developing countries. With all of the attention in the poorest countries typically directed toward child survival and preventable causes of infant mortality, such as infection and malnutrition, the challenge we are facing is to direct greater attention to how we can improve the life prospects of those whose lives are saved yet who continue to face a lifetime of abject poverty. To put it simply, policy makers must begin to start thinking more about how to promote healthy child development in the poorest countries and not just focus on preventing death.

Concerns about how to promote political and economic development in any society today begin with a healthy and competent population that is sufficiently educated and skilled to compete in a global economy. This brings us back to the basic science of early childhood development, which helps us understand how the roots of productivity are laid down early in life. Thus, it is essential that we educate policy makers and civic leaders about how early experience, particularly interactions between infants and their caregivers, literally shapes the architecture of the developing brain. It's also important that we explain how toxic stress, in the absence of supportive relationships, can disrupt brain circuitry, particularly in the hippocampus, which controls a great deal of memory and learning.

Q: Where do you see the future of early intervention moving?
A: I believe that the future of early childhood intervention and family support policies needs to focus on building a stronger science base and closing the gap between what we know and what we do. The field of early intervention is more than four decades old and we've made a lot of progress over the years. But we clearly don't have all of the answers and many important challenges remain.

If we were to fully fund the very best programs we've developed to date, and could staff them all with adequately trained personnel, there is no question about whether we would make a huge difference in the lives of many vulnerable children. And yet, we still would fall short of all that needs to be done for children with biologically-based disabilities as well as for far too many who are burdened by developmental challenges that are caused by adverse life experiences. Stated simply, we desperately need new ideas to guide more effective interventions.

I believe that we've learned just about all we can from the Perry Preschool Project, the Abecedarian project, and the original early education programs for children with disabilities. Much progress in the effectiveness of these programs has been fueled by science, but a great deal of the expanded availability of services has been driven by advocacy. And yet, advocacy can only go so far without the continuing infusion of new ideas anchored to new knowledge. The next leap forward is going to depend on dramatic scientific breakthroughs.

For children with disabilities, most of what we do currently is to facilitate the most adaptive development we can in the context of the child's biological constraints. Thus, we work on strengthening children's skills, helping them adapt to their disability, and providing information and support for their families. These are critically important services but they are not enough in the broader context of the current revolution that is unfolding in molecular biology, neuroscience, and genomics which will, at some point, generate exciting new knowledge that will help us actually prevent significant disabilities --- such as autism, fetal alcohol syndrome, and Down syndrome --- and treat others more effectively. Although most of these breakthroughs are not just around the corner, they are on the horizon and we should be investing substantial energy and resources in finding ways to prevent and cure significant disabilities rather than merely managing them.

For children who are burdened by the toxic stress associated with family violence, parental substance abuse, and/or severe maternal depression, we know that such adversity can actually disrupt a young child's brain circuitry. We also know about the impact of excessive, early stress on long-term health outcomes such as diabetes, cardiovascular disease, and mental health. Knowing the long-term, detrimental effects of adversity on young children increases our sense of moral responsibility to address these issues. As important to some, there is also growing evidence that there are strong financial returns on investing early in young children who are highly vulnerable. These include savings in lower special education costs, higher school retention rates, more economically sufficient adults, fewer individuals on public assistance, and fewer people in prison.

On an international level, the U.S. is an outlier among almost all industrialized countries because we allocate the least amount of public resources to support early care and education as well as parental leave. In almost all other developed nations, social policies reflect an understanding of the value of supporting early relationships in the lives of young children. Even in the very poorest countries, evidence-based early intervention offers a promising strategy for human capital development that can have widespread and long-term payback, but the political obstacles and resource constraints are formidable.

Q: What are your recommendations to providers about how they can contribute to early childhood policy in their own work?
A: First and foremost, everyone must understand the importance of evidence-based practice and the need for services to be grounded in state-of-the-art knowledge. The implication for providers is the fundamental importance of a strong commitment to continuous education and skill development, as all service providers must stay abreast of the most recent research evidence that informs their work.

Second, we must transform the culture of service delivery around program evaluation. To state it bluntly, we have to make the political environment safe to do honest evaluation. There is so much pressure to prove that our interventions are effective that we don't spend enough time examining what is not working. This kind of climate poses a serious threat to the long-term vitality of the field, which makes it difficult to grow and learn. This is especially important for serving children who are the most disadvantaged and living in the most stressful environments, and whose families are the most likely to contribute to low program participation and high attrition. How can we help them?

We need to think of early intervention programs as learning environments for staff and incubators for creating the future of the field. Important areas that are crying out for innovation include the provision of enhanced economic opportunities and financial supports for parents, greater service integration across health care and education, and increased services to prevent and treat mental health problems in children, parents, and service providers.

Simply put, our goal should be to ask questions about how we can do things better and how we can generate new ideas. If we don't consistently ask such questions in the service of continuous program improvement, we will not grow professionally as individuals and the field of early intervention will stagnate. In contrast, if we can motivate all early childhood service providers to see themselves as innovators, their jobs would be even more stimulating and rewarding.

Finally, there need to be far more productive partnerships between academic researchers and early intervention service providers to share in the responsibility to advance our field. The task for all of us is to assure that the future of early childhood intervention looks very different from what we do now, and that it produces even greater returns on our collective investment.