Policy Blueprint

High-quality child care, pre-kindergarten programs, and elementary school environments are crucial for preparing children for later school and life success.

For children birth through age 5 — 300,000 (65%) of whom have all available parents in the workforce –Tennessee needs a system of early care and education that ensures their families have a diverse array of high-quality, affordable options that meet their children’s learning and development needs while offering locations and schedules that support parents’ ability to earn a living. Unfortunately in a recent TQEE survey, parents reported child care challenges, including affordability (58%), quality (50%) and access (70%).

For children Kindergarten – 3^rd Grade: Tennessee’s public education system needs highly effective teachers and leaders for all early grades classrooms, positive school climates, and robust additional learning supports for children who are in many cases already behind upon kindergarten entry.

Policy Priorities:

• Build a robust early care and education (ECE) workforce.
• Invest in child care quality.
• Make quality child care affordable for more working families.
• Establish incentives for employers to co-invest in child care for their employees.
• Strengthen the child care business model through shared services.
• Make high-quality Pre-K an option for more Tennessee families, and develop a mixed delivery system to optimize parent choice.
• Strengthen academic supports for children in the early grades.
• Leverage modern technology and real-time data for a better consumer experience and informed decision-making for parents, providers and policymakers.

Children’s health and development impacts their ability to learn beginning at birth, and benefits can extend well into adulthood. Children who are often sick, have tooth pain, are dealing with chronic unmanaged or undiagnosed physical, mental or behavioral health conditions, or who struggle with developmental delays and lack the services and supports they need, are less likely than their peers to be on track in reading and math by the end of third grade.

In Tennessee more than one-third of children are overweight and obese, and an increasing number suffer from chronic health conditions like asthma. Tennessee also has a mental health crisis. A Vanderbilt University Medical Center child health survey conducted in Fall 2021 found that 1 in 7 parents reported their child was diagnosed with anxiety in 2021, compared to 1 in 10 in 2019. Concerns about undiagnosed anxiety rose from 14% to 17%, and concerns about undiagnosed stress rose form 10% to 16% during the same period. And a year ago, The American Academy of Pediatrics, the American Academy of Child and Adolescent Psychiatry and the Children’s Hospital Association jointly declared a national emergency in children’s mental health. Additionally, Tennessee children’s hospitals were reporting record number of mental health cases and hospitalizations among children.

Especially important to note is that in the earliest years of life, children infants and young children experience a period of rapid brain development marked by great possibility and vulnerability. During this time, healthy development depends on positive, attuned, and nurturing relationships and interactions with parents and caregivers. Yet many infants and young children suffer from diagnosable and treatable mental and behavioral health problems. 10-16% experience mental health conditions, including PTSD and anxiety, and that number jumps to 22% for young children in poverty. Prolonged stress brought on by trauma – parental substance abuse, poverty, and other family, social, and/or environmental factors – places healthy development at great risk. Nurturing relationships with parents and caregivers can mitigate these risks, especially with early identification and support for young children’s mental health needs along with those of their parents. (Source)

Policy Priorities:

• Build up the mental and behavioral health workforce.
• Invest in infant and early childhood mental and early relational health, specifically through:
  • Evidence-based home visiting and and parenting programs
  • Team-based pediatric care models
  • Early care and education workforce training and supports
• Ensure early identification and intervention for developmental delays or disabilities.
• Grow school-based physical, mental and behavioral health services.
• Build on pilots across the state that leverage TennCare to address social determinants of health.

Parents are children’s first and most influential teachers, playing a central role in the development of children’s brains, social-emotional skills and academic achievement. Beginning at birth, parents support their child’s learning by having nurturing conversations with their child, asking and answering questions, reading with their child, singing songs, and participating in shared experiences like meals together. Research from the fields of neuroscience, molecular biology, education, economics, and human development point to the critical importance of these early child-adult interactions as a primary vehicle for children’s brain development.

Conversely, frequent and reoccurring negative stress diminishes young children’s brain development. This is especially true of prolonged periods of stress caused by adverse childhood experiences, or ACEs. Examples of ACEs include domestic violence, loss of a parent, abuse, neglect, parental mental illness or substance abuse and poverty.

For parents and families in acute distress, or having difficulty getting basic needs met, community supports can play a key role in helping parents bring their best selves to nurturing their children.

Furthermore, it’s well documented that when parents are supported to be proactively engaged with their children’s caregivers and teachers in their children’s learning, children tend to do better academically and socially.

Policy Priorities:

Most of the policy priorities mentioned in the previous two sections are in some way applicable to supporting parents to be present, positive and nurturing — from health and mental health care for their children and themselves, to having access to affordable, quality early learning settings that meet their families’ needs as they work to earn a living.  Here we highlight a couple of priorities again for emphasis, and add two additional priorities.

• Invest in full-service community schools.
• Expand evidence-based initiatives that support family-educator engagement.
• Invest in voluntary evidence-based home visiting and other parenting support programs.
• Create incentives to expand team-based pediatric care models throughout underserved communities.

Primary responsibility for Tennessee’s early care and education landscape is shared across the Tennessee Department of Education (TDOE) and Tennessee Department of Human Services (TDHS), with additional oversight provided by the Tennessee Department of Intellectual and Developmental Disabilities (TDIDD) and the Tennessee Department of Health (TDOH). TDOE is primarily responsible for early care and education provided in or affiliated with public and private schools, while TDHS is primarily responsible for early care and education provided in licensed and regulated spaces, such as child care centers and family child care homes. TDOH and TDOE have separate and uncoordinated funding streams, separate quality standards and definitions, separate approaches and staff for licensing and approval, separate training and professional development for the early educator workforce, and separate administration. Further, data systems across those two departments, as well as the other departments providing services to young children and their families, are siloed and limited, preventing data-driven decision making. This fragmented administration of early care and education services prevents Tennessee leaders from addressing problems of affordability, quality, and access to early care and education for Tennessee families.

Policy Priorities:

• Establish primary accountability with a single department and leader responsible for streamlined early care and education.
• Establish an early childhood integrated data system (ECIDS) to ensure a strategic, data-driven approach to early childhood system governance.