REPORT URGES NYC TO FOCUS ON NEEDS OF INFANTS AND TODDLERS

New York, NY (May 13, 2008) – New York City is falling short in addressing the specific health and emotional needs of infants and toddlers, leaving them vulnerable to a host of physical, social, and educational problems later in life, according to a study released today by the nonprofit New York Zero-to-Three Network (NYZTT).

Policymakers have been paying inadequate attention to children until they are 4 or 5 years old or in public school, NYZTT contends. This is reflected in the tendency of city agencies to lump infants and toddlers with preschoolers in their collection of data, leading to serious gaps in the information needed to allocate services for the 0-3 age group. The problem is particularly acute in low-income neighborhoods, according to the report, which is titled “Unequal from the Start: A Check-Up on New York City’s Infants and Toddlers.” (For the full report and Executive Summary, visit www.nyzerotothree.org.)

“The quality of children’s earliest relationships and emotional development positively or negatively lays the foundation for later academic performance, mental health, and the capacity to form successful relationships,” said Evelyn Blanck, co-president of NYZTT. “We know that the earlier we intervene, the greater the impact.” She cited the findings of the distinguished National Scientific Council on the Developing Child lead by Harvard professor Jack Shonkoff. “The Council found that early negative experiences and excessive stress in infancy can disrupt the developing architecture of young brains and lead to lifelong problems in learning, behavior, and physical and mental health.”

New York City is spending millions of dollars on the treatment of older children for conditions that could have been prevented in their first three years of life, says the NYZTT report.

“This report is exactly the kind of work that is needed in order to bring about change,” said Barbara B. Blum, senior advisor to the National Center for Children in Poverty at Columbia University and former commissioner of Social Services for New York State. “We use the word ‘change’ a lot these days. Until we really focus in on the neighborhoods and the specific needs of these kids, as this report does, we are not going to break through.”

NYZTT’s Blanck described the report, as a key-system assessment of what New York City is doing to nurture children in their first three years of life. “While New York City has made major strides in providing a better environment for families to raise healthy children, great inequities exist across the city,” she said.

More than half of the city’s infants and toddlers live in low-income families, according to the report. Among the serious health risks the city’s young children face, noted Liz Isakson, a pediatrician and the report’s author, are low birth weight, unmet nutritional needs, lack of coordinated medical care, a dearth of mental health services, and insufficient awareness of the availability of services ranging from immunization to developmental screening. The NYZTT report cited marked disparities between communities and boroughs in rates of infant mortality, low birth weights, vaccination coverage, obesity, and anemia.

Among the report’s policy recommendations are:

• guarantee medical insurance (including mental health services) for all children;
• ensure continuous and coordinated medical services for families in one location;
• address nutritional needs by promoting breastfeeding and decreasing obesity and anemia;
• provide regular standardized screening of all children for developmental delay and emerging signs of social and emotional challenge;
• improve access to Early Intervention services;  and
• ensure access to high-quality early learning.

“New York City must take a holistic approach as it works to improve and expand programs and services for our youngest family members,” said Blanck. “A thoughtful examination of health, family, and early learning indicators will yield the kind of enlightened policies that will ensure the healthy development and success of the city’s infants and toddlers.”

Among the early childhood experts endorsing the NYZTT report are Nancy Kolben, executive director of Child Care Inc., in New York City; Dina Lieser, MD, executive director of the Doc For Tots national organization and its New York director; and Astoria, Queens’ pediatrician Gonzalo Sabogal.

“This report gives us a great opportunity to showcase the needs of infants and toddlers,” said Kolben. “We know from the research that we should expand programs for this age group. Not only can these programs be affordable, but they will also support the needs of working families.”

 “This check-up,” said Lieser, “uncovers the critical need to prescribe greater investments in New York’s youngest children—acting now will yield tremendous returns.”

Dr. Sabogal adds, “As a pediatrician, I see first-hand the differences in opportunities afforded to New York City’s children from the very beginning. By strengthening family supports and access to early learning and health, we can move towards a healthy future.”

About the New York Zero-to-Three Network (NYZTT)

Founded in 1990, the New York Zero-to-Three Network promotes the optimal development of young children, their families, their communities, and the systems that serve them in New York. By providing support, information, education programs, and networking opportunities to professionals, NYZTT seeks to foster best practices, improved care, sound policymaking, and ultimately, better futures for babies. NYZTT is the only interdisciplinary organization in New York that focuses exclusively on the needs of infants and toddlers and their families.

Participants in NYZTT include practitioners and researchers in diverse fields such as education, child care, health care, nursing, occupational therapy, physical therapy, psychology, child psychiatry, rehabilitation therapies, mental health, and social services, as well as parents and representatives from the legal, business, and philanthropic communities. NYZTT’s Policy and Public Education Committee would like to thank the following members who contributed substantially to the development of this report.

Evelyn Blanck, LCSW, Associate Executive Director, Manhattan Center for Early Learning and Co-President, NYZTT

Susan Chinitz, PsyD, Director, Early Childhood Center, and Associate Professor of Clinical Pediatrics, Albert Einstein College of Medicine

Bonnie Cohen, LCSW, Early Intervention Program Director, University Settlement Society of New York

Evelyn Efinger, MSEd, Infant/Toddler Project Coordinator, New York State Child Care Coordinating Council

Laura Ensler, MS, Director, Community Development and Outreach, Children and Family Services Division, Visiting Nurse Service of New York

Barbara Greenstein, LCSW, PhD, Deputy Executive Director, Queens Child Guidance Center

Dorothy Henderson, LCSW, Associate Director, Infant-Parent Study Center; Director, Judicial Consultation Project, Institute for Infants, Children & Families, Jewish Board of Family and Children’s Services

Liz Isakson, MD, FAAP, Pediatrician and Candidate, Master’s in Public Health, Mailman School of Public Health, Columbia University

Dina Joy Lieser, MD, FAAP, Executive Director, Docs for Tots, Pediatric Attending New York Hospital Queens, and Assistant Professor of Pediatrics, Weil Cornell Medical College

Priscilla Lincoln, PhD, Supervisor, Early Head Start Program, Columbia University School of Public Health

Carole J. Oshinsky, MLS, Co-President, NYZTT

Anne Oppenheimer, LCSW, Chief of Early intervention Services, Northside Center for Child Development

Rebecca Shahmoon Shanok, LCSW, PhD, Director, Institute for Infants, Children, & Families, Jewish Board of Family and Children’s Services, and Founder, NYZTT

Ann Schurmann, MPH, Manager, Programs and Development, New York Zero-to-Three Network

Barbara Schwartz, PhD, Associate Clinical Professor, Department of Teaching and Learning, Steinhardt School of Education, New York University

Manisha Tare, OTR/L, MPH, Occupational Therapist, and Secretary, NYZTT

Julia Travers, RN, MSN, New York City Infant /Toddler Coordinator, Child Care Inc. and Chair, Policy and Public Education Committee, NYZTT

Andronike C. Tsamas, PhD, Child welfare consultant

Unequal from the Start: A Check-Up on New York City’s Infants and Toddlers

General Messages

• New York City’s infants and toddlers are unequal in three major domains necessary for child well-being: healthy children, strong families, and early learning from birth.
• Experience and evidence prove that the best time to intervene to optimize the development of our children and eliminate these disparities in a cost-effective manner is in the first three years of life.
• By investing in young children and their families, New York City will benefit by improving health outcomes, social and economic well being, and educational success throughout the life span.

What this report does

We defined what healthy children, strong families, and early learning meant for children in New York City and then went looking for meaningful data to “check-up” on progress.

The data in the report shows New York City:

• lacks data concentrated on the 0-3 age group
• needs more information at the neighborhood and borough level to tease out the extreme contrasts in health outcomes and access to services
• needs more meaningful data points for important but difficult to assess areas of infancy, such as adequate developmental screening and referral.

Key Findings

Healthy Children:

• Large disparities in birth outcomes
• The worst neighborhoods had twice the rates of infant mortality then the best neighborhoods in NYC.
• Insufficient and disparate immunization information across neighborhoods.
• Lack of medical homes
• A medical home is a consistent place with coordinated care for families.
• In New York State, 36% of children have a medical home.
• Unmet nutritional needs:
• There are significant anemia and obesity  rates for WIC-enrolled children
• There is breastfeeding progress but not full support.

• Incomplete knowledge about developmental screening and referral and receipt of services:
• All infants and toddlers should be screened using a standardized developmental screen during well child visits.
• Disparities in Early Intervention services based on neighborhood and income exist and are being addressed by the city.
• Dearth of mental health services for children under age 3
• Because of the lack of qualified providers, most existing mental health services are unable to treat young children within the context of relationships and integrate their services into the total care of the child.

Strong Families:

• Over half of NYC infants and toddlers live in low-income or poor families
• Most parents of young children work outside the home and struggle to balance work/family demands
• Many families with infants and toddlers never access the services already available to them—WIC, SCHIP, Medicaid, food stamps, Housing supports
• A third of NY State parents with a child under age 5 had to change jobs or change child care arrangements in the past year
• A huge stress and instability for a young family to have to deal with
• Maternal pregnancy related depression is under-diagnosed by as much as 50% in NYC
• Home visiting exists in NYC for approximately 4,000 high-risk individuals to help support new families but is unavailable to the vast majority

Early Learning:

• Only 7% of children under age 3 (more than 100,000) are in regulated child care
• NYC lacks sufficient regulated child care spots to meet need
• Support and education for parents and the large network of informal caregivers is lacking
• Regulated child care is expensive
• Child care standards at the city level do not meet state and best practice standards.

General Conclusions

• Data for 0-3 age group is insufficient across the board: infants and toddlers are overlooked
• Great disparities based on income and neighborhood exist from the beginning of life in health outcomes and access to resources
• While there are examples of a wide variety of excellent programs in NYC that exist to help infants, toddlers and their families, gaps remain in access, utilization, capacity , coordination and quality of programs.