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November 9, 2021

As simple as ABC: Evidence-based program improves children’s heath, parental confidence

This opinion piece by Health Fund President and CEO David Jordan and Katie Schoenhoff, director of programs, originally appeared in the Kansas Reflector on Tuesday, November 9.

A child’s earliest years have a lifelong impact. Nearly 80% of brain development occurs by age 3. Having a healthy start affects health, educational attainment and earnings throughout a person’s life.

Toxic stress and adverse childhood experiences (ACEs) also have a major influence on a child’s overall development, affecting school readiness, student success, physical and mental health, and other factors, including the ability to exercise self-control. ACEs include abuse, neglect, witnessing violence, mental health or substance use problems in the household, and instability in the household such as separated parents, among other  experiences.

ACEs are incredibly common. According to the CDC, approximately 61% of adults surveyed across 25 states reported they had experienced at least one ACE, while 1 in 6 had experienced at least four. In Kansas, 39% of children have experienced an ACE and 20% have experienced two or more ACEs.

Caring and responsive relationships are critical to mitigating the effects of toxic stress. Research shows that infants and toddlers who have experienced adversity can benefit from early intervention that focuses on building supportive adult relationships.

One strategy to counteract early adversity is the evidence-based Attachment and Biobehavioral Catch-up program, better known as ABC. Over the course of the 10-week program, parents increase their knowledge and skills in order to create secure attachments and help their children have better outcomes.

Prior research has found the ABC program is effective in improving attachment between children and caregivers and in helping regulate behavior and biology in at-risk children. Although the program is short, research has shown measurable effects lasting at least into middle childhood.

The United Methodist Health Ministry Fund, Hutchinson Community Foundation, Kansas Health Foundation, REACH Healthcare Foundation and Wyandotte Healthcare Foundation launched an innovative statewide ABC demonstration project to address toxic stress in young Kansas children by building attachment between them and their caregivers.

In the three-year study of the Kansas project released last week, more than 400 families and 900 children were affected by the ABC program. The intervention resulted in healthier children and more confident parents.

After completion of the program, children’s cortisol levels — an indicator of stress — were more normalized, parents were more confident in their caregiving abilities, and parent coaches rated children’s overall wellbeing as more positive. Families reported statistically significant improvements in their children’s social emotional functioning, which can lead to improved school readiness.

In the Kansas study, 22% of the families served primarily spoke Spanish in the home. The evaluation found similar promising results when the ABC program was delivered in Spanish as when it was delivered in English.

The use of ABC in other states is equally promising. In New York City, use of ABC resulted in decreased caseloads and savings of $90 million over five years.

As policymakers explore strategies to keep kids in their own homes, improve health and build parenting skills, ABC and other evidence-based programs show great potential.

Kansas has already moved in this direction by providing Family First funding, which is designed to prevent family interaction with the child welfare system, to support ABC projects as part of child welfare prevention strategies. Likewise, the Kansas State Department of Education has recognized ABC as an approved program for equity funds, and Medicaid is reimbursing mental health providers using ABC for eligible children.

Through state support or the Medicaid program, greater investment from policymakers is critical to sustain evidence-based home visiting and early childhood programs promoting secure, stable caregiver-child relationships. These investments will improve school readiness, student success, decrease interaction with the child welfare system and promote long-term health and economic well-being.

Beyond promising health, education, and child welfare outcomes, investing early creates the best health outcomes and the greatest return on investment. According to the Heckman Equation, high quality birth-to-5 programs for disadvantaged children deliver a 13% return on investment per year.

Continued investment from foundations, businesses, and early childhood stakeholders in ABC and other evidence-based programs offers important opportunities to test, pilot, and evaluate programs to inform and maximize the return on future investments affecting generations to come.

Through support for evidence‐based early childhood development programs, we can ensure the youngest Kansans enjoy nurturing family environments, so they are primed for a healthy life and for academic success. Investing in proven early childhood interventions, like ABC, will result in future benefits for the state, including a more capable workforce, reduced healthcare and mortality costs, and reduced demand for public services.

Investing early in our parents and children ensures a brighter future for all Kansans.

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