Children’s Right to Thrive Invest in Children 10 th Annual Meeting November 20, 2009 Craig T. Ramey, Ph.D. Sharon Landesman Ramey, Ph.D. Directors and Professors, Georgetown University Center on Health and Education

It is the totality of a child’s experience that lays the foundation for a lifetime of greater or lesser competency. Ramey & Ramey, 2000

Consequences of very low resource environments on children’s school entry skills and later performance Delays of 1 to 2.5 years in overall academic and intellectual competence Marked reduction in vocabulary as well as expressive and receptive language skills Fewer skills in interacting with “teachers” and peers in a learning environment Lack of supportive learning at home and in summer further increases “the gap” over the first 4 years in school

Key Research Question for Abecedarian (ABC) Project Can the cumulative developmental toll experienced by high-risk children be prevented or reduced significantly by providing systematic, high-quality, early childhood education from birth through kindergarten entry?

Control Group _ Adequate nutrition Supportive social services Low-cost or free primary health care Abecedarian Preschool Program Treatment Group _ Adequate nutrition Supportive social services Free primary health care Preschool treatment: Intensive (full day, 5 days/week, 50 weeks/year, 5 years) “Learningames” Curriculum Cognitive / Fine Motor Social / Self Motor Language Individualized pace Campbell & Ramey, 1995 American Educational Research Journal

Pre-K Educational Treatment prevents decline in children’s low-IQ classification (% with IQs <85) Martin, Ramey, & Ramey, 1990 American Journal of Public Health

Estimated Influences on IQ Regression Coefficients (95% CI) Age in Months Educational Preschool Maternal IQ<70 Positive Home Enviornment Adapted from Martin, Ramey, & Ramey, American Journal of Public Health, 1996

Reading achievement scores are significantly higher for ABC children at 8, 12, 15, & 21yrs Campbell & Ramey, 2001 Developmental Psychology

ABC educational program reduced grade repetition and special education placement Ramey & Ramey, 1999 MR/DD Research Review

Key Findings from Abecedarian Project (“Abecedarian” …one who learns the basics such as the alphabet) 18 Months to 30 Years Old Intelligence (IQ) Reading and math skills Academic locus-of-control Social Competence Years in school, including college Employment outcomes Grade Repetition Special Education placement Teen Pregnancies Smoking and drug use Teen depression Plus benefits to mothers of these children (education, employment) Ramey et al, 2000; Campbell et al, 2009

Project CARE RCT designed to be a replication of Abecedarian Project (ABC) with an additional home visit group to help mothers use the ABC educational curriculum (6 wks– 5 yrs)

Ramey & Ramey, Preventive Medicine, 1998

Project CARE Age in Months (assessment type) 6(MDI)12(MDI)18(MDI)24(S-B)36(S-B) Early Intervention Follow-up Ramey & Ramey Preventive Medicine, 1998

Adapted from Wasik, Ramey, Bryant, & Sparling. Child Development, 1990

Infant Health and Development Program (IHDP) Designed to test the efficacy of ABC intervention for children who were < 37 weeks gestation and < 2500 gm at birth Conducted at 8 sites Intervention modified for biological risk factors Intervention lasted only until 36 mos. CA

Infant Health and Development Program ( grams)

Children’s IQ at 36 months: Maternal Education X Treatment Group (n=232)(n=162)(n=166)(n=104)(n=134)(n=63)(n=76)(n=48) Infant Health and Development Program Ramey & Ramey (1998), Preventive Medicine

Outcomes Affected Positively (*p<.01) by the Infant Health & Development Program 12 Months24 Months36 Months Cognitive Development NS++ Adaptive and Prosocial Behavior --+ Behavior Problems -++ Vocabulary -++ Receptive Language -++ Reasoning --+ Home Environment NS-+ Maternal Interactive Behavior --+ Maternal Problem Solving --+ Ramey 1999, adapted from Gross, Spiker, & Haynes, 1997, Helping Low Birth Weight, Premature Babies

Did IHDP benefits last? Follow-up through age 18 showed significant benefits, particularly for children from low-resource families The dosage of the early intervention predicted magnitude of benefits, even after multiple adjustments for correlated variables

Differential response to early educational intervention The children who benefited the most had:  mothers with IQs below 70  mothers with low levels of education  poor birth outcome indicators (PI, Apgar, LBW)  teen mothers (Martin, Ramey, and Ramey, American Journal of Public Health, 1990; Ramey & Ramey, 2000)

Recent findings from Maryland and Louisiana Pre-K initiatives Strong visionary leadership and commitment to pre-K as a means of improving student achievement and “closing the gap” for children of poverty Willingness to conduct research that will provide timely information to inform changes in the classroom practices and policy The programs differ in ways that provide insights about benefits of full-day vs half-day pre-K and differential risk

Similarities in MD and LA Pre-K programs Implemented by public schools Certified early childhood teachers (full benefits, comparable salaries to other teachers) Classroom sizes of no more than 20 Adult to child ratio of no more than 1 to 10 Specified pre-K curriculum in resource-rich classrooms and high standards Ongoing professional development Strong focus on language and early literacy

Differences in MD and LA Pre-K MCPS Pre-K classrooms are half-day while LA classrooms are full-day Children in LA4 start at slightly lower levels than do children in MCPS MCPS classrooms serve more diverse children in terms of nationality and language backgrounds LA4 is not limited to “at risk” students, while MCPS currently is LA4 implemented longitudinal data collection from the beginning, for all children and for all classrooms, linked to later school progress

LA4 Study Design: Population-based, Cohort Sequential, Case/Control Longitudinal Study Pilot year (Jan – May 2002) n=1358 Cohort 1 ( ) n=3711 Cohort 2 ( ) n=4767 Cohort 3 ( ) n=4665 Cohort 4 ( ) n=7998 Cohort 5 ( ) n>10,000 Note: LA legislature committed $82 million for school year

Louisiana Kindergarten Retention Rates ( Cohort) n = 22,105 n = 2,886 n = 13,257 n = 555 * p <.001

Louisiana Kindergarten Retention Rates ( Cohort) n = 17,416 n = 3,132 n = 11,785 n = 666 * p <0.001

Louisiana Special Education Placement Rates ( Cohort) n =23,523 n=2,994 n =14,841 n=698 * p <.01 ** p <.001

Louisiana Special Education Placement Rates ( Cohort) n =21,421 n=3,835n =14,201 n=912 * p <.01 ** p <.001

A Comparison of Children’s Academic Progress in Pre-K Programs that differ in dosage

Why Some Well-Intended Early Childhood Programs Have Failed to Benefit Children Adult caregivers and teachers not well prepared or supported in their everyday work Dosage of early intervention and pre-K is too low Inadequate instruction to promote cognitive, language, early literacy, and early math skills Ineffective communication with and engagement of parents and other key service providers Instruction is too harsh, rigid, or punitive

The future for our nation’s children Positive health and education outcomes can be achieved for all children – during pre-K years and beyond Benefits include much more than “academics” Language and reading success are key, because they influence all learning and social adjustment Strategic investments yield substantial social and fiscal benefits to society

For copies of this powerpoint presentation: Contact Drs. Craig and Sharon Ramey Georgetown University Center on Health and Education