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This report examines whether states are investing in home visiting in ways that promote better outcomes for young children and whether they meet the needs of children facing the greatest social and developmental risks. The purpose was to assess the direction of state policies and programs, not to evaluate program effectiveness.

Policy and finance barriers reduce access to preconception care and, reportedly, limit professional practice changes that would improve the availability of needed services. Millions of women of childbearing age (15–44) lack adequate health coverage (i.e., uninsured or underinsured), and others live in medically underserved areas. Service delivery fragmentation and lack of professional guidelines are additional barriers. This paper reviews barriers and opportunities for financing preconception care, based on a review and analysis of state and federal policies. We describe states' experiences with and opportunities to improve health coverage, through public programs such as Medicaid, Medicaid waivers, and the State Children's Health Insurance Program (SCHIP). The potential role of Title V and of community health centers in providing primary and preventive care to women also is discussed. In these and other public health and health coverage programs, opportunities exist to finance preconception care for low-income women. Three major policy directions are discussed. To increase access to preconception care among women of childbearing age, the federal and state governments have opportunities to: (1) improve health care coverage, (2) increase the supply of publicly subsidized health clinics, and (3) direct delivery of preconception screening and interventions in the context of public health programs.

"In the thirty-five years since China instituted its One-Child Policy, 120,000 children--mostly girls--have left China through international adoption, including 85,000 to the United States. It's generally assumed that this diaspora is the result of China's approach to population control, but there is also the underlying belief that the majority of adoptees are daughters because the One-Child Policy often collides with the traditional preference for a son. While there is some truth to this, it does not tell the full story--a story with deep personal resonance to Kay Ann Johnson, a China scholar and mother to an adopted Chinese daughter. Johnson spent years talking with the Chinese parents driven to relinquish their daughters during the brutal birth-planning campaigns of the 1990s and early 2000s, and, with China's Hidden Children, she paints a startlingly different picture. The decision to give up a daughter, she shows, is not a facile one, but one almost always fraught with grief and dictated by fear. Were it not for the constant threat of punishment for breaching the country's stringent birth-planning policies, most Chinese parents would have raised their daughters despite the cultural preference for sons. With clear understanding and compassion for the families, Johnson describes their desperate efforts to conceal the birth of second or third daughters from the authorities. As the Chinese government cracked down on those caught concealing an out-of-plan child, strategies for surrendering children changed--from arranging adoptions or sending them to live with rural family to secret placement at carefully chosen doorsteps and, finally, abandonment in public places. In the twenty-first century, China's so-called abandoned children have increasingly become "stolen" children, as declining fertility rates have left the dwindling number of children available for adoption more vulnerable to child trafficking. In addition, government seizures of locally--but illegally--adopted children and children hidden within their birth families mean that even legal adopters have unknowingly adopted children taken from parents and sent to orphanages. The image of the "unwanted daughter" remains commonplace in Western conceptions of China. With China's Hidden Children, Johnson reveals the complex web of love, secrecy, and pain woven in the coerced decision to give one's child up for adoption and the profound negative impact China's birth-planning campaigns have on Chinese families."

Kay Ann Johnson provides much-needed information about women and gender equality under Communist leadership. She contends that, although the Chinese Communist Party has always ostensibly favored women's rights and family reform, it has rarely pushed for such reforms. In reality, its policies often have reinforced the traditional role of women to further the Party's predominant economic and military aims. Johnson's primary focus is on reforms of marriage and family because traditional marriage, family, and kinship practices have had the greatest influence in defining and shaping women's place in Chinese society. Conversant with current theory in political science, anthropology, and Marxist and feminist analysis, Johnson writes with clarity and discernment free of dogma. Her discussions of family reform ultimately provide insights into the Chinese government's concern with decreasing the national birth rate, which has become a top priority. Johnson's predictions of a coming crisis in population control are borne out by the recent increase in female infanticide and the government abortion campaign.

In den Waisenhäusern der VR China befinden sich zu über 90 Prozent Mädchen. Der Autor versucht, unter Berücksichtigung der staatlichen Geburtenkontrolle, die in den 80er Jahren eingeführt wurde, einen Grund für dieses disproportionale Verhältnis der Geschlechter zu finden. Die Familienplanung hat zur Folge, daß zwei Kinder pro Familie gezeugt werden dürfen. Ist unter diesen Kindern kein männlicher Nachkomme, so sinkt der gesellschaftliche Status, da nur Söhne als Kinder definiert werden. Der Autor unternahm 1991 eine Fahrt nach China und berichtet über die Zustände in den überfüllten Weisenhäusern. Er geht ferner auf die Problemlösungsstrategien der chinesischen Regierung ein, die die Waisenkinder teilweise zur Adoption ins Ausland freigibt, um die mißlungene Familienplanungspolitik abzufangen. (FUB-Hfs)

This document is part of a policy series intended to improve social, emotional, and learning outcomes for young children. Building on NCCP's work over the past several years (see Promoting the Emotional Well-Being of Children and Families series, at www.nccp.org), Spending Smarter describes effective programs, highlights policy opportunities, and offers fiscal strategies to promote the emotional health of young children and their families. The analyses in this series will help state officials, community leaders, and advocates take action to ensure the healthy development of children and their families. Spending Smarter focuses on strategies to maximize existing funding streams by building on federal programs. The companion document, Resources to Promote Social and Emotional Health and School Readiness in Young Children and Families—A Community Guide, describes targeted interventions that can help parents and other early care providers, such as home visitors and teachers, be more effective in promoting healthy relationships and reducing challenging behavior in infants, toddlers, and preschoolers.

The Early and Periodic Screening, Diagnosis and Treatment (EPSDT) program, which was designed to ensure that Medicaid-eligible children receive comprehensive health services, is the only national attempt to provide a right to these services. The political factors that have shaped national EPSDT policy during the past decade are described, based on a conceptual framework developed by John W. Kingdon. The analysis focuses on the roles of two distinct sets of policy entrepreneurs: child health advocates and fiscally conservative governors. Their activities are described in relation to the larger political environment, or "political stream," from the period of the expansion of Medicaid eligibility for pregnant women and children in the late 1980s to the enactment of a new State Children's Health Insurance Program (SCHIP) in 1997. The relative saliency of eligibility and benefit issues in children's health policies had a major influence on the politics and outcomes.

This issue brief reflects NCCP's continuing commitment to ensuring that every low-income child enters school with the skills to succeed, and that policymakers have access to the very best research to create policies that use public resources in the most effective, smartest way. It is based on a meeting convened through NCCP's Project THRIVE to identify and promote solutions to emerging issues that impact young children's healthy development and school readiness. The brief is being jointly published by Project THRIVE, through which NCCP serves as a resource to the Maternal and Child Health Bureau-funded State Early Childhood Comprehensive Systems (ECCS) systems program and Pathways to Early School Success, NCCP's on-going project to help policymakers, program administrators and practitioners address barriers that get in the way of reducing the achievement gap for young low-income children.

Drawing on lessons from six case studies, this policy paper highlights the most innovative approaches states and communities are currently using to finance early childhood mental health services and explores what else might be done to mix, match, and leverage all available resources. The focus is on prevention and early intervention services to not only help children directly, but equally important, to help their families and other caregivers address the social and emotional challenges children face. The case studies are based on interviews with policy and program leaders in the states of Florida, Indiana, Ohio, and Vermont, as well as two metropolitan areas—San Francisco and Cuyahoga County, Ohio (where Cleveland is located).