The Other 60 Percent

Early education…in the doctor’s office

Stepheny Renteria, six months old, tentatively took the brand new board book from pediatrician Meghan Treitz just as the check-up began. It was called “Dulces Sueños,” or “Sleepy Heads.”

Sitting in her mother’s lap in a sunny exam room at the Child Health Clinic at Children’s Hospital in Aurora, she gazed wide-eyed at the book’s baby faces. She turned it upside down. She brought it to her mouth as if she might take a bite out of it. A few minutes later, she dropped it on the floor.

Stepheny Renteria, who is six months old, takes a new board book from Dr. Meghan Treitz at a Children's Hospital clinic in Aurora.
Stepheny Renteria, who is six months old, looks at a new board book held by Dr. Meghan Treitz at a Children’s Hospital clinic in Aurora.

While Stepheny played with her new book, Dr. Treitz spoke to Stepheny’s mother Maria Giron about the importance of reading, using a phone interpreter to translate her words into Spanish.

It only took a few minutes, but Dr. Treitz and others who hand out free children’s books and reading advice at routine doctor visits through the “Reach Out and Read” program believe it makes a difference for the low-income families it targets.

The same is true of another early childhood program called Colorado Bright Beginnings, which encourages all parents, regardless of income, to talk to, read to and play with their zero to three-year-old children, usually through doctor’s office visits or home visits by volunteers.

As advocates pay more attention to the power of early exposure to language, many of the most well-known programs are far from meeting demand. In Colorado, only a small fraction of young children are served by programs like Early Head Start, Head Start or intensive home-visiting programs.

Programs like Reach Out and Read and Bright Beginnings step into that void with a unique offer: to reduce early literacy deficits at a much lower cost and on a greater scale. Plus, by connecting with so many families at clinics or other medical establishments, both programs capitalize on the fact that during the early years of their children’s lives, many parents have their only contact with trusted professionals in health care settings.

The importance of starting early

It may seem strange that babies would be the focus of school readiness efforts when they are years away from entering a classroom, but there’s lots of evidence to support the idea that the first years of a child’s life are critical to future success.

One often-cited piece of evidence is a book published in 1995 called “Meaningful Differences in the Everyday Experience of Young American Children.” In it, two university professors, Betty Hart and Todd Risley, share findings from their painstaking study examining how and how much parents of difference socioeconomic statuses talk to their babies and toddlers.

A stack of Bright Beginning bags containing books, learning games and parent guides.
A stack of Bright Beginning bags containing books, learning games and parent guides.

“It was an amazing study,” said Treitz.

One of the most jarring results from the research, she said, demonstrated that babies of higher-income parents begin pulling away from the pack in terms of vocabulary size at just 14 months old. Children of working class families pulled away from their low-income peers when they were 22 to 23 months old.

In other words, massive differences in literacy can be traced back to the parent-child banter that takes place before most children celebrate their second birthdays. By four years old, Hart and Risley assert that children of professional parents hear nearly 45 million words compared to about 13 million words for children of low-income parents.

It’s statistics like this that drive programs like Reach Out and Read and Bright Beginnings, as well as others such as Parents as TeachersHIPPY and the Parent-Child Home Program.

Dr. Stephen Berman, chair of general pediatrics at Children’s Hospital and a founding member of the Bright Beginnings board, said the idea behind Bright Beginnings is to give parents and caregivers the tools they need “to lessen the socioeconomic influence on school readiness.”

And while intensive preschool programs such as Head Start attempt to compensate for deficits accumulated in early childhood, they are very expensive relative to programs like Bright Beginnings, he said.

In 2011, only about 16.5 percent of low-income Colorado children aged zero to five were served by Head Start or Early Head Start, according to data from Kids COUNT, an annual report on the well-being of children. In addition, 51 percent of the state’s three- to four-year old children didn’t attend any kind of preschool program between 2009 and 2011.

Low intensity and low cost

At baby Stepheny’s check-up, Treitz spent only a few minutes at the beginning of the appointment talking about the benefits of reading. She explained to Giron that reading to Stepheny would improve her vocabulary and make it easier for her to learn to read. She noted that babies Stepheny’s age are likely to put books in their mouth.

“That’s normal. That’s a six-month-old’s way of getting to know things” said Treitz,who is also an assistant professor of pediatrics at the University of Colorado.

While Treitz and others hope the impact of those bite-sized Reach Out and Read sessions will last a lifetime, their short-and-sweet nature is part of what makes the program inexpensive and scalable.

All told, Reach Out and Read includes eight to 10 doctor visits in which children get free books and parents get free advice on reading to their children. The cost, which is covered through private grants and donations, is $5 per visit or up to $50 per child over five years. About 86,000 children in 48 of 64 Colorado counties receive new books through the program annually. 

Bright Beginnings, which  can include up to three annual sessions in which parents receive advice and age-appropriate kits containing children’s books, learning games and parent guides, has a similarly modest price tag. It costs about $55 per visit or $165 per child over three years.

Last year, just over half of Bright Beginning sessions took place at medical clinics. About one-third took the form of home visits led by volunteers and the rest occurred in group settings at libraries, museums or other locations.

Christopher Price, chief operating officer at Colorado Bright Beginnings, said the program reached around 19,000 parents and caregivers last year.

Like Reach Out and Read, Bright Beginnings relies on private grants and donations to cover costs. Leaders of both organizations say they don’t anticipate receiving funding from President Obama’s early learning initiative, which proposes a variety of investments in early education efforts.

While the low-intensity aspect of the two interventions are part of what makes them easy to disseminate, there is sometimes skepticism about the impact of  programs that take only about 15 to 45 minutes a year to administer to a family.

Price said his organization must constantly overcome the question: “How much difference can you really make with a single visit?”

New research

Guidelines on Reach Out and Read posted  at the Child Health Clinic at Children's Hospital.
Guidelines on Reach Out and Read posted at the Child Health Clinic at Children’s Hospital.

More than a dozen studies have been done on Reach Our and Read since its creation 24 years ago. They have found that parents served by the program are four times more likely to read aloud to their children and that preschool children served by Reach Out and Read score three to six months ahead of peers who have not participated.

While there have been a few studies on Bright Beginnings and several surveys that generally show positive feedback from participants, the organization continues to seek evidence supporting its model.

“We have validity to what we’re doing,” said Price. “What we need is credibility.”

New studies underway on both Bright Beginnings and Reach Out and Read in collaboration with Children’s Hospital  may strengthen those findings and explore new ways of reinforcing the early intervention message with parents.

Dr. Treitz is just beginning a $15,000 study that will determine whether a video tutorial demonstrating a technique called “dialogic reading” will help parents engage their children in conversations about books.

“You don’t necessarily read every word that’s on the page. It’s kind of a dialogue between the parent and child,” said Treitz. “The more we can get parents to talk to their kids the better.”

The study will examine whether the video is effective in teaching parents of two- to three-year-olds dialogic readings skills.

The goal, Treitz said, is to “take Reach Out and Read to the next level.”

“[Treitz’s] research, I know for a fact, it will impact our clinics across Colorado, but we’ll share that nationally as well,” said Megan Wilson, executive director of Reach Out and Read Colorado.

Osvaldo Narvaez-Huerta, two, looks at his new book while Dr. Meghan Treitz looks on.
Osvaldo Narvaez-Huerta, two, looks at his new book while Dr. Meghan Treitz looks on.

Wilson noted that because Reach Out and Read occurs in a health care setting, “we have unprecedented access to children…and also the parents themselves.”

She cited a Colorado Trust brief stating that while 90 percent of children ages five and under go to the doctor for preventive care, less than 30 percent are in a child care setting, the next most common contact with a “formal service system.”

Dr. Maureen Cunningham, co-investigator on a planned study of 2,000 Aurora and Denver children in Bright Beginnings, agreed that doctors’ offices are an ideal vehicle for disseminating early learning materials.

“Everybody brings their child to the doctor,” said Cunningham, a primary care research fellow at Children’s Hospital.

Dr. Cunningham and Dr. Berman are collaborating on the Bright Beginnings study, which will pilot an effort to reinforce the program’s face-to-face parent interactions with text messaging and social networking.

For example, researchers may include daily text messages reminding parents to read with their children or suggesting learning games from the Bright Beginnings kits, which come in brightly colored cloth bags. They may also organize “virtual playgroups” of six to eight moms with babies the same age who will share their experiences with Bright Beginnings games and books through online posts or photos.

The additions “will speak the language of young moms,” said Dr. Berman.

The study will initially target families with children in the 12-24 month age range, with follow ups into their school-age years.

Dr. Berman said the study will help answer the question, “Can we strengthen the ability to change parent behavior?”

Price said if the study by Dr. Berman and Dr. Cunningham goes as planned, it will provide indisputable evidence that the effects of early disadvantages can be eliminated with a program that costs around $150 per child

“Where else are you going to get that impact with so little cost?” he asked. “We can change the world with that.”

Coverage of early literacy is supported in part by a grant from Mile High United Way. EdNews Colorado retains sole editorial control over the content of this coverage.

 

How I Help

Students were obsessed with social media. Here’s what this middle school counselor did about it.

PHOTO: Hero Images | Getty Images

In our “How I Help” series, we feature school counselors, social workers, and psychologists who have been recognized for their work. You can see other pieces in the series here.

Students at Eagle Valley Middle School in western Colorado were spending lots of time on social media, and too often their comments turned mean. Counselor Kayleen Schweitzer decided things needed to change, so last year she spearheaded a schoolwide campaign urging students, staff and parents to take a five-day break from social media. More than 150 people signed the pledge.

The results were encouraging. Participating students reported that they had more free time and were getting to bed earlier. Some even said the break made them realize they had been addicted to social media.

Schweitzer, who was named 2018 Middle School Counselor of the Year by the Colorado School Counselor Association, talked about how campaign organizers got students to participate, what she wants parents to know about middle-schoolers, and why she wants students to regard visiting a counselor as normal.

This interview has been condensed and lightly edited.

Why did you become a school counselor?

When I was 15, I lost my father. It was very unexpected and I found out at school. When I returned to school no one checked on me or followed up to see if I was doing OK. I remember wishing I had more support at school. That was the first time I realized that one day I wanted to be someone who could be there for students going through a hard time or transition.

When I was in college my favorite classes had to do with child development. I went on to pursue a degree in family and human services and a graduate degree in school counseling. I’m definitely happy with my decision to be a school counselor and I look forward to going to work every day.

Tell us about an effort or initiative you spearheaded at your school that you’re particularly proud of?

In the 2016-17 school year, my principal Katie Jarnot and I identified a need for something that would help with some of the conflicts occurring at our school. Katie came across a national program called No Place For Hate. It was just what we were looking for. In the 2017-18 school year, we brought No Place For Hate to our school. It has been amazing and powerful.

We noticed a lot of mean behavior on social media and that our students were spending so much time online. Also, with a surge of recent research into the detrimental effects of screen time, social media, and the correlation to depression and anxiety, it was clear there needed to be a change. So Eagle Valley Middle School’s No Place for Hate Coalition created a schoolwide activity that attempted to give students, staff, and parents a glimpse into positives that can come from limiting social media use and taking back control of our lives. We asked our school community to commit to giving up social media for five days.

During those five days, everyone who took the pledge was asked to do a daily reflection on the differences that they noticed. We offered a chance to win prizes as an incentive. To our surprise, we had 110 students (about one-third of our school), 18 staff, and 30 parents sign up.

Though not everyone completed the five days, we felt we brought some awareness to this problem. Students noticed how much more time they had when not using social media and they were able to get to bed earlier. Some actually admitted this activity helped them realize that they are addicted to social media. A few parents reported they were able to be more present with their family at night and have fewer distractions.

Is there a tool, curriculum or program you couldn’t live without in your job?

The tool I couldn’t live without is Google forms. Students can fill out a form to let me know they need to see me. When they fill out the form it notifies me with an email and I can see who is requesting to see me. It also allows me to keep data on what issues my students need support with. This helps me plan what supports I need to put in place through classroom guidance lessons, small groups, and individual counseling.

What’s the biggest misconception you’ve encountered about your role in the school where you work?

The biggest misconception I have encountered is that it’s a bad thing to go to the school counselor and that you need to have a huge problem. I have noticed that some middle school students are embarrassed to be seen going to the school counselor. I have worked really hard to make it normal to come to me and teach them that the strongest, most successful people need help sometimes.

You spend lots of time with students. Knowing what you know, what advice would you give to parents?

I would remind parents that students’ frontal lobes are not fully developed and when they say they don’t know why they did something, they are probably being honest. I would also let them know that even if a student says they want parents to give them space and leave them alone, it’s not really what they want or need.

Tell us about a time when you managed to connect with a challenging student or a student facing a difficult situation. How did you do it?

I have a student who is now in eighth grade and has been coming to see me on a regular basis when she needs support. As a sixth-grader, she was so closed off and worried about being seen coming to talk to me. I have been very consistent with her and kept reminding her that I’m always here if she needs anything. I ended up running a group with her and a lot of her friends. She saw that her friends loved coming to see me and were willing to talk to work through some of their problems. I also spent time with her and showed her it was a safe place to talk. Over time she broke down her walls and was able to trust me. Today, she stops by when she is doing well and when she is struggling. She loves to come and eat lunch with me. She has grown so much and I’m going to miss her dearly when she goes to high school.

What is the hardest part of your job?

The hardest part of my job is going home and worrying about my students. You always wish you could do more or make students see things can get better and they are enough. Middle school is such a hard time for students as they struggle to find where they fit in and deal with personal changes.

Tell us about a memorable time — good or bad — when contact with a student’s family changed your perspective or approach.

In my first years as a school counselor, I had a student who was consistently falling asleep in class and missing a ton of school. When I had a meeting with his family, I found out that his mother was a single mom and his grandma, who also lived in the house, was very sick. The student was staying home to help take care of his grandma and his siblings so his mom could work and make money for the family. His father was an alcoholic who was in and out of rehab.

I realized that different cultures have unique values and priorities. It also taught me that you never know what someone is going through so we need to really take time to talk to kids to figure out what is happening in their personal lives before jumping to conclusions.

You spend your days trying to help students and staff with any number of things. How do you wind down after a stressful day?

The way I wind down after a stressful day is to come home and spend time with my children. They are still young and innocent. I try to really enjoy this precious time with them when they have fewer worries and just want to have fun. I also love spending time with friends and clearing my mind of the worries of my job. Last, I enjoy catching up with email and work-related tasks as every time I scratch out something on my to-do list I seem to get stress relief.

Chilling effect

Five ways a proposed immigration rule could impact Colorado students and schools

PHOTO: JGI/Jamie Grill | Getty Images

Advocates for immigrant families fear that a proposed federal rule governing green card decisions could lead to more children going hungry and losing housing and health care. That, in turn, could pose challenges for educators and schools.

The proposed rule would allow the government to penalize some legal immigrants who have used public benefits by denying them permanent residency — a possibility that could prompt families to forgo any kind of government help. For children in those families, many of them citizens, the result could be hunger pangs, untreated illness, or outsized worry that their parents won’t be able to stay in the U.S. Inside schools, the new rule could mean more time and energy spent addressing students’ basic needs and the loss of funding from some public programs.

Fear that immigrants will shy away from benefit programs is nothing new. Stricter immigration rules since President Trump took office — stepped-up raids, efforts to discontinue the DACA program, and family separations at the U.S.-Mexico border — have already led to a chilling effect on the legal use of public benefits by immigrants. Advocates say changes to the so-called “public charge” rule will only exacerbate the problem.

The rationale behind the proposed rule, a stricter version of one that’s been in place for years, is to prevent immigration by people who will end up dependent on government help. Opponents of the rule say it punishes working-class immigrants who may need short-term aid, but contribute much more to the country’s economy over the long term.

The existing public charge rule penalizes immigrants for using programs such as Temporary Assistance for Needy Families or long-term care. The proposed version adds several more to the list, including Medicaid, food stamps, and housing vouchers. Free and reduced-price school meals aren’t included in the existing or proposed rule.

Mónica Parra, program manager of the Denver school district’s migrant education program, said families she works with are reluctant to sign up for any kind of help, even assistance heating their homes during the winter.

“They’d rather struggle or find other ways to get support,” she said. “It’s going to be very challenging to keep students motivated, but also safe. Maybe they’re going to be cold. Maybe they’re going to get sick.”

The proposed public charge rule doesn’t apply to refugees and asylum-seekers, and doesn’t penalize immigrants for public benefits used by their children. Still, like other advocates, Parra said she hears anxiety about the proposed rule from all kinds of immigrants, including citizens and those who already hold green cards.

They worry that using public benefits could get their own legal status revoked or hurt their chances to sponsor family members who want to immigrate to the U.S.

“The fear has always been there in these communities,” she said. “Now, people are even more afraid.”

The new public charge rule likely won’t take effect for months. First, there will be a 60-day public comment period, scheduled to start Wednesday, and then Trump administration officials will consider the comments and decide whether to make any adjustments.

Here’s a look at some of the ways the proposed rule could affect Colorado schools and students.

More kids come to school hungry

There are at least two ways schools could see more hungry students walking through their doors due to the public charge rule. First, families may be afraid to take advantage of food stamps — either by deciding not to enroll, or by dis-enrolling current recipients, such as citizen children.

Both Denver and Adams counties have seen dips in the number of people participating in the program over the last couple years. In Denver, about 2,000 fewer children receive the benefit now than in November 2016 when President Trump was elected. However, city officials caution that it’s hard to make a direct connection between falling participation and federal immigration policies since historically low unemployment rates may also be contributing to the trend.

While free and discounted school lunches are not part of the public charge rule, some advocates report that immigrant parents have been wary of enrolling their kids since Trump’s election. By law, public schools must serve students regardless of their immigration status and can’t ask for information regarding a family’s or student’s status.

A week after the Department of Homeland Security released a draft of the new public charge rule on its website, the Eagle County school district emailed parents asking them to help squash the rumor that signing children up for free or reduced-lunches “will inform ICE,” a reference to the U.S. Immigration and Customs Enforcement agency.

The letter concluded, “There is NO RISK in applying for free and reduced lunch, help us spread the word.”

So, what happens when kids go to school hungry? They may have trouble paying attention, misbehave more easily, or suffer from headaches or stomach aches. In short, less learning.

More children without health insurance, more student absences

The public charge rule’s chilling effect could have a major impact on child health, according to a recent Colorado Health Institute analysis. An estimated 48,000 Colorado children — the vast majority of them citizens — could be disenrolled from one of two public health insurance programs, Medicaid or Child Health Plan Plus. That would double the state’s rate of uninsured children from 3 percent to 6.7 percent, according to the institute.

The reason for so much dropoff is that health insurance is typically a family affair. So even when different rules govern adults and children in the same family, they tend to be enrolled as a group or not at all.

When students don’t have health insurance, school attendance and performance can suffer. For example, children may be absent more if they lack help managing chronic conditions like asthma, or if they’re not getting treatment for acute illnesses or painful dental problems.

Loss of health-related funding for schools and school-based clinics

School districts stand to lose two health-related funding streams if the number of uninsured children swells. The first would impact the state’s 62 school-based health clinics, which would likely see a drop in Medicaid and Child Health Plan Plus reimbursements if fewer students enroll in those programs.

Such an enrollment decline, which some clinic leaders have already reported, could make it harder for school-based clinics to stay afloat financially, said Bridget Beatty, executive director of the Colorado Association for School-Based Health Care.

With more uninsured students, “The need will go up,” she said, “but conversely the ability to financially sustain them will get more challenging.” 

In addition, 53 Colorado school districts receive funding through a program that could be affected by the proposed public charge rule. It’s called the School Health Services Program and allows districts to seek Medicaid reimbursements for services provided to low-income students with disabilities. That money can be used for health-related efforts that benefit all students, such as the addition of school nurses, wellness coordinators, or suicide prevention programs.

Funding received through the program ranges from a couple thousand dollars in small districts to a few million in large districts.

High-poverty schools have a harder time offering universal free meals

Nearly 40,000 students in 20 Colorado school districts can eat school meals for free because their schools participate in a federal program designed to make breakfast and lunch easily accessible to low-income students. But that number could drop if the public charge rule decreases food stamp participation.

The special meal program, called Community Eligibility Provision, is open to schools or districts where at least 40 percent of students come from families that use certain public benefits, including food stamps or Temporary Assistance for Needy Families. Unlike in traditional school lunch programs, parents don’t have to fill out applications for free or reduced-price meals.

“Any time when you have eligible families not participating in SNAP, it does have a negative impact on community eligibility,” said Crystal FitzSimons, director of school programs at the national nonprofit Food Research and Action Center.

Even if schools or districts remain eligible for the program, a drop in students getting public benefits could mean a change in how schools are reimbursed for the free meals, she said. That, in turn, could make the program less financially viable for schools or districts to participate.

Immigrants could turn away from publicly funded early childhood programs

Crystal Munoz, who heads the nonprofit Roots Family Center in southwest Denver, worries that the Spanish-speaking families her program serves will stop using programs like Head Start, state child care subsidies, and the Denver Preschool Program, which provides tuition assistance to the city’s 4-year-olds.

Even though those programs aren’t part of the proposed rule, there’s still trepidation, she said. It’s because of the constant flurry of rule changes and the generally negative tone around immigration right now.

“We find ourselves very afraid to even give out resources or referrals to certain programs because we’re not sure,” she said. “For us, it’s waiting and seeing.”

She said if families do drop out of Head Start or other child care programs, it could push children — many of them citizens — into unlicensed care with relatives or neighbors, or force parents to cut back work hours to stay at home with them.