ARDEN HANDLER: Okay. We are waiting for people to come on in. Because of the webcast we would like to get started. For those of you just here today. I'm a faculty member of the university of -- we had an amazing conference. Everyone who has been here is completely charged up and very excited about the whole issue of the use of evidence for practice. And we've actually had some very provoking, cutting edge presentations so far that have been just so stimulating. The good news is if you missed yesterday, the plenary sessions are being webcast live and you can -- they will be archived. You can come back to our website and see them. That eye really exciting. If you are here for the first time or as well as yesterday, we are asking everyone to fill out evaluation forms for every session they attends. They are the salmon colored forms towards the ends of the book. In the beginning of the book there's another salmon colored form where we would like you to put give us any input about structure, focus, timing, dates, et cetera. After the meeting ends today at 2:30 we are having a planning committee meeting. We haven't officially selected the committee, waiting to hear about the funding. But the conference has become a national conference and we have applied for funding to go national. We invite any of you who would like to join us today on whether this is a full-time -- whether you commit yourself to joining the committee or want to come and give your input. Chris will be letting us know which room it is in. We don't know yet, but the registration people will know. If you have your name down, we can find you. By 2:30 I'll know which room they are giving us for the planning committee. We are very, very excited about the next plenary session today. Arthur Reynolds is a faculty member at the University of Wisconsin. He's a professor not only of social work but also educational psychology and human development. He has Ph.D. from our very own University of Chicago Illinois here in public policy analysis. What he is going to be talking today is something he has been working on since 1986. He is a 20-year or more project in which he has been studying early childhood education through the Chicago longitudinal study. We are very happy to have Dr. Reynolds. Thank you. (Applause.)
ARTHUR REYNOLDS: Thank you very much for the kind introduction. It's great to be home in Chicago. I'm sort of home grown here. Now I live in the Mecca of the Midwest, Madison, Wisconsin. Chicago is a second Mecca. But it's great to be back here in Chicago. I come back frequently. It's a quick jaunt. And I wanted to talk today really about, you know, some of the most exciting work going on in the human development and family studies field today, which is early childhood education. And what I want to do is, you know, within the context of kind of the national trends towards, you know, promoting educational policy and also healthy child and family development across the life span. And the role of early childhood education, investments in the early years of life. The impact, the consequences those investments can have on life course development into adulthood. I think a couple of things are a little different here.
One, I'm going to use my research in the Chicago longitudinal study, would be of the longest running longitudinal studies of the long-term effects of early childhood programs, but also do more of a focus on cost effectiveness of this intervention program and the implications for public policy and also the implications for other investments in the early years of life, and particularly the first decade of life and ultimately my perspective is a first decade perspective that we know not to give too much away, but we know now that we haven't known really until now is that, you know, the impact of the investments, the return on the dollar, so to speak of investments in the first ten years of life seem to far exceed the returns on investments afterwards. I think what we have, we have among the best evidence to date for that. That's kind of where I'm going and what the implications are for policy development. I think from the health perspective, my focus in the Chicago longitudinal study also was kind of a main logic model or focus of this project is that, one, there's also strong evidence about this. That the educational success leads to social success, which leads to economic wellbeing and also more health conscious living, more positive health promotion practices. So all those links are very important. And so to look at the educational perspective I think is very valuable also from a public health perspective. Educational success are major contributing factors to health conscious living throughout the life span. That also is built into the presentation here.
Now, let me give you sort of the national context of early childhood education. Speaking mainly about programs in the first five years of life. And that the priority of the emphasis of these early years of life, I think, were brought home in the State of the union message in 2002 when president Bush said we need to prepare our children to read and succeed in school with improved Head Start, early childhood development programs. This is not just from an educational perspective, but to ensure that high quality early childhood education programs not only are they well funded, but they also meet the quality tests and have comprehensive services for children in the areas of health services, family support services, outreach services, and the like.
So with this focus, and it wasn't like, you know, the things weren't going on at this time. But I think because of the Presidential leadership and the funding and the emphasis that was provided at the national level, that this helped encourage and also to provide incentives for states and lots to increase their investments in early childhood programs and also increase the quality of the investments and the quality of the programs. It has led now to I think in 2004 there are many questions. And we can, there certainly are parallel questions. How should health care, you know, be provided? How do we provide health insurance coverage universally across the country?
There's certainly issues there. But in the early childhood field, I think the challenge today is, I think these six: One, if we want to go to a universal access system of early care and education, that we need to be able to know first how should an early care and education system be organized? Would it be through schools? Would it be in partnership with action agencies and community agencies? To what role would a hospital and health care agencies have as well? What are the key elements vs. effective programs? Are programs that only provide a focus on education and academic skill building more effective than programs that just provide family support? Or do you need to do both? And in addition to that provide direct health services and provide outreach services and the like? What constitutes age? There's lots of combinations you can speak of. We know now that programs don't necessarily have to have all those to be effective, but to the optimal, that we need to be able to know what are the key elements of success that we can't do without? If we lose them, we would no longer have effective programs. Are these key elements the same, you know, providing family support, academic programs, health care, the same for all children?
The children from middle class families really, do they get the same benefit that children from low income families do to comprehensive service programs? We don't necessarily know the answer to that, but the preliminary results so far is that no, that key elements aren't necessarily the same for all children above and beyond quality of the early education experiences that the kids are getting. Another main question is, how can the timing and duration of services be balanced from birth to age eight? I'm sort of kind of in a trance disciplinary field here. If we look at the early education field, the first decade of life, what we have over the years is, we have kind of people who have staked claim to certain areas of the life span, certain times of the life span.
People more interested in prenatal development, programs like WIC, those interested in the early education programs the first three years of life, the infancy group an those who are the more preschool and school age group, more public school based programs as well. Each sort of interest area and interest group is sort of committed to greater investments in their chosen age group, not necessarily looking at the continuum of services that kids get in the first decade of life. I think all have been guilty of this in the last 30 or 40 years. But you know, the goal is appear the increasing evidence is that these programs, these ages of investment have to have a more continuous structure so that we have transition services from, say, WIC programs to early Head Start and from early Head Start to Head Start, and then the school aged programs as well. Programs that can build the bridges and have continuation services are the programs that are going to be more likely to be effective. Also are much more consistent with an ecological theory of human development where one period of age time needs a transition to the neglects to be effective.
The last question is what is the optimal funding structure among federal, state, and local agencies for funding early childhood programs? Should it be federally funded? Should it be state funded? Should it be run through school districts so it's paid for by property taxes? There's a whole bunch of available funding opportunities. California does a lot of funding of early education programs actually through the tobacco Tax Commissions. One recent example in 2000, Los Angeles County through their tobacco Tax Commissions gave $500 million to L.A. County to improve access to preschool programs beginning at age three in L.A. County around Los Angeles. In Georgia we have the lottery funded preschool programs, universal access preschool programs. In Illinois here at the State block grants from the state legislature. All the states are going to do it differently. But funding and financing is really a key element here. And if you look at this in terms of funding, if you -- from 1997 to 2002, we spent about, in 2002 to date about $22 billion annually at all levels of government for center based early childhood programs from birth to age five. That's a 50 percent increase since 1997. Big changes, big increases in investments.
If we look at the rates of participation in center based programs, in the last 20 years, I'll direct you here to the standard to universal access would be kindergarten, about 90 percent of all five-year-olds participate in programs in the United States. The goal of universal access would be to try to get up to 90 percent. We know in terms of health insurance coverage, 85 percent of coverage from children zero to 18 in the United States. It's not quite at the level of kindergarten, but if we look at early education programs, I'll focus on the age four group. You see here in the last 20 years the percentage of all four year olds in the United States have participated in at least part day center based early parent education program has gone up about 33 percent since 1983. So now about 65 percent of all four year olds participate at least part day in a center based early education program. That's good news. But obviously, it's a little less for younger kids and certainly there's a lot of room to grow there to get up to the 90 percent. It's also the case that if you look at the programs that kids are participating in, just because you are in a center based program doesn't mean you are getting a high quality education experience. That's another focus.
In addition to access, you can't miss the focus on quality as being crucial here. So this kind of sets the ground work, sets some of the road ahead for early education programs. And in about the research, over the years now I'm going to talk just a little bit about it. Before I talk about the Chicago longitudinal study. You see here that if we look at the impact of early education experiences, how can it be that an early childhood experience in the first few years of life can have a lasting impact on life course development? You heard from David Olds and his Elmira and other projects how this could take place. Based on our review of the literature in the last 40 years, there's kind of five ways, five paths by which early education can lead to these long-term life course changes in terms of higher educational attainment, lower rates of delinquency and crime, higher levels of school achievement, greater likelihood in employment and re-deducts in child maltreatment.
The first we call the cognitive advantage hypothesis, early school readiness advantage. We know that that's a known predictor of these later competence behaviors. Programs can do that. Then kids are more likely to get a persistent effect from early education. Of course, there's others as well. I talk about the family support hypothesis. There's another path by which programs can lead to long-term success. Take a Head Start program with emphasis on parent involvement in providing parenting skills, training for parents shall home visitation, participation in governance, volunteering in the classroom and on field trips. Those are providing engagement for parents and also reduce socialize isolation. That can have a benefit, greater committed to school and that can lead to later social competence behaviors as well. There's others as well in terms of motivation and the like. The extent to which early childhood programs impact any of these five paths, these five hypothesis, you can probably add health status one there as well. So the bottom line here is, it's not magic. Over 40 years that we know the processes by which programs can be effective. If we just make sure that programs are having an impact on these skills, and support experiences, then they are more likely to have long-term impact. Just if you look at the research, I guess a couple things to say about the research.
The theme of the conference here is evaluation research. If I look at the early childhood field since the early 1960s. Head Start started in 1965. There probably has been more research on early childhood programs than any other social or educational program, you know, that exists. And one of the functions of the studies is when they last a long time you have lots of longitudinal studies, you can follow the progress of children over many many many years. We don't have the benefit of this for things like welfare reform or other programs, but we do in early childhood the. You can see here some of the well-known programs. You see the infant health and development, the Elmira project, David Olds, the child and parent centers that I will be talking about and others a well. These are the most frequently cited programs but they are also programs model or large scale, they would be more publicly funded for large scale, provide evidence of long-term effects of early intervention.
The study I will talk about is consistent with some of the longer term studies. In a sense and as I'll argue later, there's overwhelming evidence that long-term persistent effects are -- map of you may not know the, Chicago's own early childhood program built off of the Head Start model, but it's not a Head Start program at all. It's not funded by health and human services. It's funded through Title I of now the No Child Left Behind Act. And in Chicago, in the mid 1960s, the school superintendents in the highest poverty areas in Chicago on the west side of Chicago, Lawndale and East and West Garfield Park.
They wanted to improve children's attendance and achievement. And they saw the Head Start model existed. So in 1967, Chicago public schools developed their own early childhood program called the Child-Parent Centers and put in place in the highest poverty neighborhoods in Chicago that were not serving Head Start programs in these neighborhoods. So what you have is a comprehensive service intervention program. Let me just say a couple things about the overall structure that I want to focus really on the preschool part of the program. So the idea here is, as I talked about the first decade perspective, the idea that in concept the Child-Parent Centers is supposed to begin or does begin at age three and can go to age nine in a single site, attached to or kind of separated from an elementary school in that children get, in all low income areas, preschool for at least one or two years, kindergarten in the same location and also a school age program that has things like reduced class sizes in the elementary grade. Its six years. It isn't just a preschool program. It's called an extended early childhood intervention program. The same concept here obviously could go down the age to birth as well. When we say comprehensive services, what we mean, there's concentration on academic school readiness skill building, providing family support for children's education through heavy parent involvement, provision of health services in the centers as well with health screening, doctor visits, things like that, speech therapy and the like. And also outreach services that would be associated with sort of a social worker function, providing resource mobilization, home visitation, and the like, to families and resource mobilization to mental health services, to economic services and the like as well. And the unique part of the program is that many don't know this, that the Child-Parent Centers is the second oldest federally funded preschool program in the United States. Chicago was the first city in the United States to use money from Title I that goes to low income schools serving low income -- he used the money from Title I for preschool education back in 1967 and developed sort of a super Head Start program in the sense that it is not just a preschool program. It can continue for up to six years of intervention.
This is what the research I'm going to talk to you about today. As an example, this is the center around the North Lawndale neighborhood, not far from here on the west side. On the left is the Johnson child parent center and on the right is Johnson elementary school. The school, this is one of the highest poverty neighborhoods in Chicago. Beginning at age three, the child goes into the Child-Parent Center for two years and gets all day kindergarten program in the same site on the left side there. That's three years. First, second, third grade. Walks across the street and gets a continuation program with the same level of resources, comprehensive services. But that is located in a class that has much smaller class size. A parent resource room in the center itself. And also a lot more focus on kind of one-on-one tutoring and small group activities to kinds of foster intensity of childhood development. You can see the continuity concept is built into the program quite dramatically.
The parent resource room, every center in the Child-Parent Centers, this is like most other early childhood programs. There's a parent resource room in every single center throughout the city. There's 24 in Chicago at the time of the project. You can see here, receiving parenting skills workshops, volunteering in the classroom, getting involved in social support groups with other parents as well, receiving, you know, economic training, other kinds of training, parenting skills and the like. This is kinds of a focus of the family support program. You can see the contrast here because the typically family support program is a home visitation program where social workers or nurses come into the home. Or teachers, and provide parenting skills. Certain that's a viable option and can be very effective. But a school affiliation model family support has the extra advantage that parents and families can participate, can affiliate by definition with the larger social environment that you can't do necessarily in a home visitation program. So I call this a school affiliation, community affiliation model of family support. And so it's another option, another avenue enhancing family support.
The focus on the academic skills program, the school readiness program is on literacy. But also in the focus of activity based instruction where lots of field trips, lots of small group activities. It's not just a mere phonics approach to education. The types of parent involvement in the Child-Parent Centers, this is the most renowned aspect of the program and one of the reasons that the centers have claimed and this is a study that we have actually found that 80 percent of the parents participate in the child parent center on a regular basis compared to 50 percent for most I early childhood programs. Part of it is the menu system here. There's lots of ways to get involved from receiving home visits. That's one aspect of the program. To enrolling in educational courses, participating in school activities, getting direct parent training in the centers themselves.
And in my project, the Chicago longitudinal study, which is about 20 years old this year, we have examined a complete cohort of children from the child parent center program. Again, this is an established publicly funded program that has been around since 1967. It served over 100,000 families. We took a complete cohort of kids, all who were born in 1980 who participated in the centers. Nobody was excluded and we followed progress up to age 22, which is over 20 years later. We compared them to kids that enrolled in what I would call the treatment as usual at the time in the mid 1980s, in these neighborhoods. Most kids in poverty families, many in Chicago weren't getting Head Start. What they were getting instead was no preschool in a center based program and but instead an all day kindergarten program. The intervention would start in kindergarten and get a big dose. All day kindergarten especially in the 1980s is a big dose of education. It's a mass comparison group. We followed the progress of these two groups over time. Notice that the comparison group here, it's not a no treatment group. They got the treatment as usual at the time.
So we are comparing an innovative treatment to alternative treatment that was usual at the time of the intervention and compared the progress over time. So in a sense here the finding I am going to show you are somewhat conservative in that if we had a no treatment group, the gap would be even greater than what I am going to show you. We followed the progress. Matched on poverty status, matched on family involvement, education, things like that. And we followed the progress over time. So here in a nut shell is what we have found, groups we followed over time. Out of the total sample of 1539, by age 22 we have followed from 85 to 90 percent of the sample successfully. So we determined there are, you know, school achievement, high school completion, the delinquency and crime reports, things like that, even economic wellbeing in the early 20s. I will not present that data today. That's a high sample recovery for a high poverty sample in Chicago. See the key attributes here.
The groups, there are very few differences on background factors. If you look at the family risk status of, you know, a composite of whether its family is below the poverty level, whether the parent has a high school certificate, whether they live in a single parent family, the mean number of family risks out of six is three and a half to four for both groups. That's what you are going to be seeing in terms of the comparisons. And the intervention level here so again you get the treatment as usual. You get some in the first group did get he start, but not very many. Everyone in the CPC intervention group got preschool, half got kindergarten. Compared to everyone got full day. The school age program I am not going to focus on, was eligible for any child that was in the school attendance area, would get the program as well. That's why you see some in the school age program. To estimate the impact of the CPC preschool program, all those other things are taken into account, the fact that they participated in the intervention services and were getting the value added participation in the CPC program. That's pretty much what I just told you. As far as an evaluation of the project, the advantage of having longitudinal data, you can look at the long range outcome.
In the beginning you have to make that in a formative evaluation sense that the program is implemented and designed, and the initial pass here, the school readiness advantage in the parent involvement advantage are actually showing themselves early. Because that's the whole theory of the program. And if you remember, that path chart there, there is an approach that links that together that I call confirmatory evaluation, there's a paper on the 12th floor that kind of documents that. It's a process by understanding, you know, when you see gaps in performance between groups, you really know it's because of the program and not something else. Even if you have a random assignment study, you don't necessarily know that. You have to know about implementation, you have to know is the program having impact on the programs most implemented by the theory. The answer to all those questions is yes. I just want to focus here on the age five composite. That's a school readiness composite.
Basically literacy skills and math knowledge, basic mathematics knowledge. You see here by age five by school entry, kids in the CPC preschool group were about the 50th percentile nationally. That's not compared to low income children, that's nationally compared to all income levels, the 50, the comparison group that got no preschool of any kind in the CPC was at the 28 percentile. At age five, that is a very big difference. That 19 percentage point difference is a massive difference, about half a year of growth in literacy. There is a little bit of catch-up in kindergarten as a result of the all day kindergarten program. But the biggest news is the age five composite. We saw parallel changes in parents involvement in children's education. Big differences in parents' engagement in school, participation of parents in the CPC program and their kids' education related to parent involvement.
Over the years, of course, in the 20-year study there's lots of reports we have done, evaluation reports we have done. Some of the ones we did after that early advantage you saw in school readiness was looking another school achievement and retention in grade, need for special education, and then this followed longitudinally over time. There are large school achievement differences that in many ways are actually giving us these findings I'm presenting here. Let me look at four we looked at by age 18. One, juvenile arrest. The rate of juvenile arrest. Again, this is just preschool versus the comparison group controlling for family circumstances and the socioeconomic profile of the neighborhoods. You see here, I'll go through this quickly. Juvenile arrest, these have been reported in the literature, in JAMA and others.
We find that by age 18, the CPC preschool was associated with 30 percent reduction in the rate of juvenile arrest. 40 percent reduction in the rate of grade retention over the comparison group. Same 40 percent reduction in special education placement associated with program participation and fairly new fining, the issue of child maltreatment, substantiated child maltreatment. Actually, before 2003, the only study that showed actually a connection again early intervention participation and child abuse an neglect is actually the Elmira program of David Olds, sounds methodology , looking only at substantiated child abuse appeared neglect. We find the same here with the school affiliation model of child parent involvement. There is a 52 percent reduction in substantiated child maltreatment through the cook county DCFS. You know, associated with preschool participation. Those are striking findings that indicate that school based interventions could be useful as another kinds of viable intervention for maltreatment.
Then the key outcome probably in addition to juvenile arrest, the probably most important outcome at the end of adolescence would be high school completion in Chicago, in the economic circumstances that they face. You can see here the gap is always about ten points. By age 23 here, again this is following 90 percent of the sample successfully over the 20 years of their life. We find a gap of about ten points there. 68 percent of the CPC preschool kids completed high school by age 23, compared to only about 58 percent for the comparison group. And that's a substantial difference. Now, taking this to the next step because there's a lot of -- I think there's a lot of studies that show some of these findings. But together there's very few studies show what I just showed you. The other fact to take into account is the fact that this is not a model program.
This is a program that was a grassroots developed program by, you know, rather innovative school district superintendent in the Chicago public schools in the mid 1960s where it became established and publicly funded over the last 40 years. The way to think about this, it's gone to the next level. We have an established program beyond the model program that actually existed in public institutions for 35 years. It's been up scaled in Chicago. So it's gone to the next level. Of course, the next level is we need evidence about nationally implemented programs such as we are learning in the impact evaluation for Head Start nationally. But so that's a couple of differences.
And the other differences, to date the only studies that have looked at cost effectiveness, in other words the economic returns or cost benefit analysis are model programs that have been around for 30, 40 years where they followed the progress of 100 to 200 families. And cost effectiveness has rarely been applied to child development programs in a lot of the fields I work in, such as psychology and education and human development. And we have to think about this for society today, there's lots of investments we can, you know, we can give our money to. And a lot of programs we can invest in but we need to know what is the economic return of alternative kinds of investments. So I tend to think of effect sizes are the magnitude of the impact of the program. You can look at this in terms of return on the dollar. For every dollar you invest, what is the return you get from early education? And so what we've done now is, I'm going to give you a summary of really the first cost benefit analysis of a publicly funded early child childhood program.
So you can take those findings I just gave you in terms of reduction in cost for special education, reduce expenditures for extra schooling because of grade retention. Reduction in cost to the child welfare system for reduced treatment and administrative cost and cost savings to the victims of child maltreatment because of hospitalization or other costs. And also reduction in costs for juvenile treatment in administrative costs, and also savings to crime victims. That's obviously a very large cost. In Illinois we know that housing a child in juvenile detention for a year is now over $40,000 per year right now. So if you can make a dent in that, that's going to have some savings. Also we can also make projections for the likely adult criminal history of children from the information we have on juvenile crime. So we can have the projected benefits there as well.
And the last thing we can take, why high school completion is so importance tan, the biggest projector of economic wellbeing is educational attainment by far. So programs can impact educational attainment, you can estimate lifetime earnings capacity. Two individuals that were participants. And you can also estimate the tax retches. Hire earnings means greater tax revenues to state and federal coffers. We can all use that these days. That's what we've done. Cost benefit analysis. I'll be happy to give you the paper that was published in 2002.
I want to give you a summary here and go into some of the details. If we look at the CPC preschool components of the program. In 1998, the cost per participant for every child was about $6,700. And the total benefit converting those group differences, the 40 percent reductions in special education, 40 percent reductions in the, and the 50 percent reduction in child maltreatment, the total benefit to society of that $6,700 investment was about $48,000 per that investment. And you can do the math there. That's a return of about seven dollars for every dollar invested. If you look at just the public benefits, take out individual earnings. In cost benefit analysis, I know cost benefit analysis isn't as popular in the health field in public health as it is in other fields where you do cost effective analysis, but in human intervention, it's a good way to look at cost benefit analysis. If you take out the earnings. That only benefits the individual. It has no benefit to society. It's only through tax revenues and reduction in public costs that the earnings have some difference. If you take out the earnings, you get a ratio of four to one for preschool. Every dollar invested in preschool gives a return of four dollars for the program as well. Now, the school age, I have up here as a comparison, I'm not going to dwell on them. But only to say that the largest bang for the buck here is coming from the preschool program and not the other two components of the program. The school age program will be kids that don't get the CPC preschool program or the kindergarten program. They get intervention and reduced class sizes starting in the second grade.
The goal here is to get a return of a dollar per dollar invested. Both programs do that as well. Extended intervention, kids get both preschool plus school age compared to everybody else. That benefit is also substantial as well. We have here direct evidence that these reductions in problem behaviors, in increasing in wellbeing are producing large economic consequences for society. Now, if we were to break this down into different categories, I'll direct your attention to the society bar here. Now we have about half of the benefits go directly to participates in terms of increased income. The other half go to a wide variety of categories, goes to direct education savings, about 30 percent goes to crime savings, adult or juvenile and about 15 percent is increased tax revenues. Now, just looking at those categories, one implication is that the consequences of, the benefits of preschool, they are not necessarily only in a small sense are they educational. Most of it is in terms of larger public health, in terms of reduced crime, increased tax revenues, kind of a broad eclectic mix of benefits.
In many ways this is the best evidence that investment in preschool, it's not about education. It's about enhancing kids' well being and enhancing public health for the entire country in terms of the benefits as well. Because very little of the actual long-term benefits are in education in terms of economic benefits. It's more long-term, reduction in crime and victimization in society. And of course, if we look at the public side of it, it's more substantial as far as the education savings goes. If I look at the benefits in terms of per dollar average per participant, you can see that average per participants in 1998 discounted 3 percent is about 6700. You can see the individual category. So that's average per participant. You can see the big impact of educational attainment here. Lifetime earnings, the average preschool participant is getting a lifetime earnings benefit above and beyond the comparison group of about $20,000. Now, that's discounted, it takes into account the fact that we can take the money at age three and invest it somewhere else.
You have to discount, you have to subtract out sort of the opportunity costs, the fact that we can put this in a bank and earn interest on it or invest it. So it's subtracted out there. That's substantial. Just a lifetime earnings benefit is a ratio of three to one. It returns three dollars per dollar invested, just looking at lifetime earnings. Look at the special education benefit, $4,100 per participant benefit. That's almost two thirds of the cost of the program. So if we wiped out every other benefit category, we would be close to getting back the cost of one year of preschool just by looking at special Ed. But in a broader sense, in a more comprehensive sense, we add all these up. This adds up to the seven-dollar return per dollar invested for this publicly funded preschool program. And I'll skip over the government savings. Obviously savings are coming to program participants, to governments and savings to crime victims in terms of reduced hospitalization and the like. Again this is just preschool. I gave you the ratios before, focused just on the preschool components in terms of the ratio. It's $7.14 return for preschool. It's four dollars for public benefits. Other components of the program give above a dollar, but not close to what preschool is giving.
Okay? Now we take an example here across different studies because the fact is, I talked earlier about this -- -- (Gap in audio, through the early adult hood years as least. Those three programs are the high preschool child centers and the Abecedarian Project. As you can see here, the bottom line for this is that the programs they cost a lot, the costs are very different from each other. High school, most kids had two years-- the cost per participant is two thousand two dollars. All the teachers had masters’ degrees. The child teacher ratios were five to six to one. Child-Parent Centers program, half had one year, half had two years, the teacher salaries, teachers had bachelors’ -- the teachers did not haves masters degree. The Abecedarian Project is a university run year round full day childcare program provides a lot of educational support. So that's $35,000 per child is a lot bigger than the other two programs, but just as a function of the program, it was full day program year rounds for five years, five years, and the others were only two years. Duration explains a lot of the cost figures. But the bottom line is no matter what the cost of the program is, even if it's in the stratosphere, so to speak, the return that, you know, the second to last row, the total benefit per dollar invested in all three cases, it's from four dollars to ten dollars return regardless of the cost of the program that you have here.
And that the other thing to say about the three programs, very well-known interventions, primarily for low income children, but they differ in so many ways, yet the final result is pretty much the same. High scope was implemented in 1960s, about 100 children total. The Abecedarian project in the 1970s in rural North Carolina. There was high scope in Ypsilanti Inner city poverty of the highest kinds in the United States. Different investigator teams. Different research instruments. Two of them were randomized, the Child-Parent Centers was no match. Sample sizes were different yet they all came up with the same result largely. So this is very strong evidence that there's obviously large benefits accruing from these investments in high quality programs. The things they had in common, we've learned lessons for interventions for the future.
One is that all the teachers had at least Bachelor's degrees and were on, and were getting salaries competitive with public schools. That means salaries of $50,000 for an experienced teacher for nine or ten months of education -- nine or ten months of the program as well. That's one thing. All of them had emphasis on providing comprehensive services. All of them were longer than one year. All of them were implemented with high quality. And so those are some of the lessons that programs appear to be the most successful had those things in common. Now, you know, there are a couple differences here I'll get to here. I'm going to skip over that one. Let's go back for a minute. We look at the ratios hears of three programs -- I have one more. The Olds program, the Elmira Prenatal Early Infancy Project also a cost benefit analysis provided of five to one as well. You know, a couple things to talk about these programs in terms of crime, reductions in crime. In the Abecedarian Project there was no reduction in crime or reduction in child maltreatment. Most study haven't looked at child maltreatment at all.
The studies that show reduction in juvenile delinquency, the CPC program, the high scope, the Olds programs, to some extent those programs had heavy emphasis on family support. Intervention or heavy parent involvement in the program as well. If you get early interventions to impact child delinquency and child maltreatment you have to provide, based on the findings you have to provide heavy emphasis on family involvement. So that's what is happening with the program there. There is a critical mass of studies that show the benefits of early education in the first five years of life. Long-term benefits that go to
adulthood. Long-term benefits that we now have evidence that publicly funded programs can provide the same pattern of benefits. We also have strong evidence now, the best we've ever had, that the cost effectiveness of early education programs, you know, far exceeds what we get from other programs.
The point I want to make about it is comparing the return on the dollar of investment over the first 20 years of life. Certainly economist James Heckman at the University of Chicago looked at one in terms of human capital, the softer social sciences were reluctant to think of this as human capital investment because we are talking about people's lives and a lot of things you can't measure about outcomes of child development and the like. But it's an increasingly useful way to look at the benefits we get from different investments. So this takes to some extent some of his work but also adds significantly to incorporating the benefits of the cost benefits analysis over the life course. What I want to show you shall the risk here is that it's a horse race comparison. We zero in on the one that gives you the biggest bank for the buck and you ignore the other investments. That's not my purpose here. The purpose is, in a public policy sense we have to fund those things that give us the bigger bank for the buck. That doesn't mean defund those that don't, but we have to look at the kind of investment we make in kids. In some ways we have to do a horse race comparison, based on what we know, recognizing there are limitations.
Obviously one limitation here is if we only looked at studies that have done cost benefit analysis. The evaluations have to be good enough that you can make a call or inference in terms of what we call ordering, that the program is generating these differences. There are lots of programs out there that haven't done cost benefit analysis that are programs that may have benefits that far exceed costs. We can't know that. So what we can only look at is what is known in the scientific field. So lots of studies. I'll walk through these a little bit. The pattern is obviously, if you go up to preschool, the biggest bang we are getting is the first five years of life. I'm not interpreting that the difference between five is that. WIC has published a number of reports years ago. Every dollar you invest in WIC, based on this published study, WIC returns three dollars for every dollar invested.
This may be conservative. It only looks at the reduction in low birth weight birth and reduction in hospital costs associated with low birth weight birth in the first year of life. It stopped there. Beyond that, maybe it's, it may be over time that it's bigger p that. But the evidence is that we get at least three dollars per dollar invested from the WIC program. Infant programs, that's an average of really the, the Abecedarian Project and the Olds Elmira Project. We get four and a half dollars from each dollar invested in those studies. Looking at other infant programs that have done evaluations, the Olds program and the Abecedarian are the best evidence. Many studies of those infant type programs, those that don't use nurses and others, the pattern is actually lower p that. So that 4.50 could be slightly overestimated because the quality of the other studies aren't up to that. Certainly it's four and a half to one ratio, which is pretty sizable.
Preschool CPC, the preschool is a combination of Perry and the CPC study in Chicago. That's where you get eight dollars. I'm not necessarily interpreting the difference as that differently. The fact is that after age five, though, we get a dramatic downturn in the effect sizes of studies that looked at investments in social programs. I'll give you one. This is new. This is reduced class sizes. This is a huge program in Wisconsin, called Wisconsin Sage that pays, that funds lots of teachers to reduce class sizes to 15 to one, from 25 to 30 to one. Very expensive undertaking given the average cost of teachers and fringe benefits an the like. What we get here is that the biggest benefit of reduced class sizes is that kids have higher achievement test scores later by age ten or the early adolescent years. There has been a lot of work in economics that is correlating now, test score improvements to earnings increases. So that, you know, two dollars, twenty four cents per dollar invested comes from the projected earnings increase as a result of higher test scores. And so we get, you know, a ratio, certainly greater than one. Any number greater than one is something that society is gaining from. And then now we look at, especially this is quite relevant to Chicago's experience with grade retention, ending social promotion, the fact there is that investments don't have to be positive. They can be negative and they can be harmful to society.
I think what we find from retention, research on grade retention is that grade retention significantly increases the risk of children dropping out of school. And because dropping out is lowering your educational attainment by definition, that means you have lower earnings capacity over the life course. For every dollar invested based on that evidence, from many studies, Chicago, Baltimore, national data. There's lots of studies that show that grade retention could show a bump in achievement, but long-term shows it harms children's educational attainment. That's a net loss to society based on that evidence. The last is the Job Core programs, the kids that drop out of school, get a residential GED education, that returns 90 cents on the dollar. Close to even break there. So this is sort of the best evidence we have to date on cost effectiveness studies across the first two decades of life. What the bottom line results is, the earlier the investment, the larger the bang for the buck you are getting. This is quite stark because many investments are now being directed towards any social promotion, job training, reduced class size. And there are some investments going into more infant and preschool programs, but nothing near proportional to the benefits they give back to society. So that's why the analysis like this is very important, recognizing that there are certainly limitations.
Lots of things could be measured here. Just in my own study, health benefits, health insurance, smoking behavior, things like that, we didn't measure any of those. We are measuring them now in the adult survey. It may be that many of these estimates for, are lower, they may be larger if we finds a correlation between early intervention and smoking. Just as a aside, the Abecedarian Project actually found that, found a borderline significant relationship where kid got the intervention were slightly to modestly less likely to be smoking in the adolescent years. But it's not, it's not strong enough effect to really be tremendously significant. So here it gives us a mark for the future. In terms of implications from our study and from this critical mass of other studies, early childhood programs in the first five years of life are among the most effective interventions, cost benefit analysis shows pay off. Length of participation can matter as much as timing. That comes from the evidence of looking at the impact of extended intervention, preschool plus follow-on intervention. Tine timing is critical.
The family, think of family support. We shouldn't just think of home visitation as the vehicle for family support enhancements. That we have to look at the school based, building community and affiliations with community institutions. Focus on enrichment, school readiness and also other comprehensive services is certainly critical. Because the CPC program, you know, provided health services and had a wide range of services that were provided. Certainly focusing school age programmed on school organization such as reduced class sizes could be very beneficial because of the economic benefits that it gives you. Now, what people want to do now is they want to take the findings and provide, this is, you know, Exhibit A for investing, going to universal access early education across the country.
Now, I think we have to be very careful for a number of reasons. One, the success of any preschool program, universal access program in the states or the federal government helps sponsor is going to totally depend on the level of coordination and the integration of services. Of course, that means quality. Recruiting and keeping well trapped staff. You know the evidence that programs that have teachers that are paid on a public school scale or have Bachelor's degree, hopefully both, that those are the programs that are going to have the long-term effects, more likely to have long-term effects. We have to recruit and keep well trained staff across the board. And it's difficult to do some time. The last is tailoring services to the needs of families. The kids aren't going to need the same path of intervention children. We are finding the benefits from high quality childcare from middle income families, it's only about half to 23rd of the size of the effect of intensive early intervention services to low income families. In other words, it's about nearly half the benefits I showed you here is what you get from a high quality childcare experience. So obviously, it I providing a benefit, but not providing the same kind of benefit.
What we have to do is focus on quality and the bottom line for me is that high quality childcare does provide major educational benefits, a pattern of benefits that are similar to what I showed you here. You are not going to get the same bang for the buck generally speaking. These intensive interventions, one, they are more intensive, they also compensate for disadvantages in the educational environment of families. In middle income families, it's more supplemental as well. Those things have to be taken into account.
The last point I make, certainly there's lots of movement in this area. States around the country are trying to find out how to get universal access because of the other interest that families want that, too. Over 70 percent of the public says they want the state governors to provide access to preschool programs, you know, in my state. 70 percent of the public says that. So obviously, the train is moving. It's how to make it the best system. The last point I make is about evaluation. Obviously evaluation is key here. The benefits of our study is that certainly the formative evaluations have turned into understanding what was implemented and how well, has turned into, it's an examination of the short-term intermediate and long-term effects that are quite useful.
Then the next step, I think, is cost benefit analysis where we have to know the economic return. That's the language of policy makers. They are not impressed with percentage reduces in behavior as much as they are impressed with benefit dollars. That's unfortunate in many ways, but that's what programs have to do to better market the findings that they have. The last thing is we have to compare. We can't be shy anymore about comparing the return for different kinds of childhood investments because school districts, community agencies make those kind of judgments all the time about what they fund with. Usually it's with the absence of evidence. Now we have evidence and we know what programs, based on what we've done, provide the biggest bang for the buck and our investments in the public are not proportional to the evidence that we are actually using to provide increased investments in childhood programs. These are things for the future we have to sort out. I'm going to stop there and take questions. Thank you very much for inviting me. (Applause.)
MARY DRISCOLL: Hi. My name is Mary Driscoll, Cook County Bureau of Health Services. I have two questions. One, when you did your cost benefit analysis on preschool, did you use dollar figures from the highest quality preschool? That's my first question. Like were the teachers paced at Chicago public school and public school salary? What was the teacher-student ratio, et cetera, et cetera. The next question, what is CPS going to do with these findings, do you have any idea?
ARTHUR REYNOLDS: Very good question. One, the preschool, the estimates of cost are based on the average across all kids that were in the CPC program. So the average teacher salary. Basically it's taking the itemized budget from the Chicago public schools child parent centers and taking an average of costs across all of the centers. In this case it was 20 centers. And all the costs associated with that. So we get an average cost per participant. So it doesn't take just the lowest cost centers or the highest quality centers, but the average cost. That gives us the best estimate of actually the cost of providing education. In Chicago public schools, I think today the average salary for a teacher, the experience is $55,000 for nine or ten months. If you added fringe benefit, that's another 20. So we are talking 80 or $90,000 total compensation investment in teachers. And that's the biggest cost, but it's also the most critical cost. And those kind of salaries, they attract quality and retain quality. They are more likely to in other places. That's very important. Chicago public schools, yeah, one thing I didn't say at the beginning is this, I used to work in the Chicago public schools, department of research and evaluation. That's how the study actually started. I worked with two early childhood educators.
This was an internally funded project by the Chicago Public Schools shall not only was the project funded, but they provided the funding -- you have to remember in the mid '80s, all federally funded programs had mandated evaluations for them-- in the early days it was mandated but we took it to the next level in terms of ongoing supports as well. They used this evidence from the study, one, to help support the Illinois pre kindergarten program and also to expand access to preschool to improve the quality of preschools in Chicago and other cities around the country have taken the findings from the CPC model, especially the composite academic skill building and parent involvement and have tried to make it their own as well. I think it has had some impact. I'm probably not the best person to report on the impact, but certainly it is key in the early education field in Chicago.
I think Chicago public schools actually is a leader, one of the main leaders in early education to. In cities around the country. They have a phenomenal list of things they are doing to improve quality, access. They have tuition based preschool. I don't work with the public school. I don't work for the Chicago public schools anymore but just examining the programs and preschool access that they have, light House model. They have lots of things they are trying to do to improve programs. What they haven't done is expanded the CPC program across the State. It remains insurance 23 sites around the country. The center closed a year or two ago. There's more they can do with the findings. But they have had a lot of impact.
>>: Okay. I have someone from the City of Milwaukee health department. I have two questions for you. You mentioned you had a similar program going on in Wisconsin. And I notice you were very specific about saying how important parental involvement is. I'm wondering in that system of welfare to work, if you are getting a good parent involvement, particularly during the daytime hours.
ARTHUR REYNOLDS: That's a good question. The Madison public schools is actually replicating the model in Madison, Wisconsin. The first year occurred already and it's going very well. Certainly since welfare reform and I've done work looking at contemporary programs here an elsewhere, preschool programs. I've noticed in my interviews and my programs here there has been a drop off in parental reform -- involvement since welfare reform took place. You see less participation in school. That doesn't mean there's less participation at home, but that's another challenge. What the programs have to do is see this as a challenge. Yeah, it dropped down. I don't think in the CPC model, you won't see necessarily 80 percent of families often, frequently participated inside the building in the parent resource rooms and the like. It dropped own a little bit. It is a challenge, but probably hasn't been as affected as it would be in other programs because programs to be serious about parent involvement, you have to commit resources to a staff. And you have to provide a menu system of options that parents can participate in lots of ways. They can go on field trips, home visits, after school programs, they can participate in GED night courses, things like that.
The menu system allows 30 different ways to participate, can really help buffer the drop off in parent involvement. So what that means is what helps you in an era of welfare reform, one is for every center having a dedicated staff that is responsible for the parent resource program in the site is very important. One person in each site is in charge. And this one person counts doesn't have to service 30 or 40 other center which is often the case. The second thing, there's a room, dedicated room for a place for parents to go. That also increases participation an the comprehensiveness of options. Of course, using home visitation is a complement for this. What the centers have done, it's not the primary way of parent involvement, but it's also useful as well. They might have to rely on that more in the future as well. Those are the things they do.
>>: Thank you. My second question, you didn't need to spend a lot of time on. But just as an observation, it's not always very good to compare Sweden to the United States, but in fact they have done their research such that they have their children, almost all of them going to childcare at age two until age seven. In that process, they get socialization and art classes, but no literacy, no structured he education whatsoever until age seven. I just thought you might make some comment on that.
ARTHUR REYNOLDS: Sure, sure. I think cross cultural comparisons are good in many ways. There's a lot of ways to have impact on children's development, high impact. In the United States, certainly having activity based, doing lots of interesting things inside classrooms is important. Can be literacy, social, emotional, extraordinarily play based. All of those things are possible. My review of the research in the United States in the last 40 years is that there's no kind much one thing that is done in the classroom that separates good quality and effectiveness from low quality. It's really how teachers deploy the resources. The key might be to provide a blend of lots of different things, literacy and otherwise, including social and emotional development. Certainly it's a good point and we have to learn from what is crucial in providing a rich, whole child approach. We can do that in a lot of different ways.
ARDEN HANDLER: I actually, she asked my question but I want to follow up by literacy. How has your study been used by the Bushed administration in terms of the play based stuff and -- I was curious how your studies were used.
ARTHUR REYNOLDS: I think the research has been used in a couple ways. One, the research has been used as sort of a phonics based literacy model. That's what the CPC model is. It is partially, but that's only a partial explanation of what it is. People followed early childhood here, the whole movement in the '60s, the bang street model was get kids out to experience the world, go on field trips in communities. In Chicago, there's amazing numbers of field trips you can go to museums, art institutes. That's a key element of the program. It's only a partial explanation, the literacy piece of it is. The other thing, what is missing often in the focus on literacy is the importance of parent involvement and the support of families as well. I think those other aspects, the more complex an the more multifaceted aspects of quality, they now are in the discussion whereas initially a couple years ago it was less, you know, critical. And all those are partly in reaction to Head Start people saw insufficiencies in the focus on literacy. It was true that Head Start in the last ten years only focused more on literacy and they should have been more focused on literacy to begin with. And it's true, that needed more incentive. That's what the national movement has been. Quality comes in a lot of ways. You have to have an eclectic model in some way and heavy emphasis on parent involvement. That's what we found. Important point.
ARDEN HANDLER: My other question is, the last 24 hours we have seen the results of randomized control trials. Your study was not a quasi experimental design, well done. I want to know how you know that those are -- the people who march are different. Was it serendipity, what is the sense of the difference you got there, how do you adjust for that.
ARTHUR REYNOLDS: Certainly it's a good question. The issue, you know, has come up. How families get involved in the program. In a larger sense, the theme of the conference is evaluation. What is important today, we need to encourage and to strengthen valid causal inference and certainly one way to strengthen it is to do whenever possible randomized experiments. On the other hand, randomized experiments can fall to, you know, to match studies easily by tracking attrition rates. You usually fall by the wayside if you don't maintain equal recovery rates and don't have differential attrition and knowing what you get as well. What we have done and there's a number of studies I can point you to research. We didn't talk about it today because we could have had it in the literature and shown rather dramatically that regardless of how you analyze the data, using the most sophisticated methods of economy metric studies, the quality of participation in the program is almost identical between the program and comparison group. If there's any bias, it's probably towards under estimation given the reasons I made before about the fact that the program -- the comparison group got an alternative intervention.
The other thing to say, the CPC kid came from the highest poverty neighborhoods in Chicago. It's hard to find a match comparison group to that. If you're from the highest poverty neighborhoods, everybody is going to be from slightly lower poverty neighborhoods. The resource issues were more of a challenge in the CPC neighborhoods than in the other conservatives. And in all other analysis we certainly find there's a strong level of consistency. You may know, just historical note, the problem with -- you know shall it's easy to do a randomized study, easier to do randomized programs with experimental programs. With established programs, it's more difficult. You already had evidence available. Communities already adopted the program. It's hard to withhold treatment to an already established program. Very difficult to do that. So CPC intervention, it was ethically impossible to do a randomized study in this intervention. That's why it wasn't done. We would have had to deny intervention services to families when we know the services appear to be effective in prior studies. So that was just a determination as well.
So the approach, I guess I refer you to the approach, confirmatory program evaluation that addresses the issues about strengthening causal inference. You can -- the study in my example is a did one for how to better understand whether your findings are causal or more likely to be because of the program.
MYRTIS SULLIVAN: I have a question from one of our Internet participants. Her name is Penny Selby. Her question is, it seems that you are comparing apples and oranges by including the WIC program as part of your comparison. The goal of the WIC program is nutrition supplementation with linkage of participants to other perhaps. Help us understand the purpose of including WIC in the cost comparison, looking at early childhood prevention programs.
ARTHUR REYNOLDS: Okay. Yeah, I think -- I knew there would be a question on that. (Laughter.)
ARTHUR REYNOLDS: On the WIC, what we did is look at, for the goals are all programs including WIC have goals that you need to achieve to show that it's an effective program. It's just, relative to the goals that have been laid out and one of the goals of WIC is to reduce low birth weight birth. That's in fact one of the largest goals of the program. Just looking at the evidence, what we see, there's a positive return on investment. And so each program, even though they might be different, that doesn't mean you can't compare the return on investment to different interventions. Because if you took that to a logical extreme, you could never compare programs to each other because they are all different and implemented differently and have different outcomes. The thing about cost benefit analysis programs, you can put the same things on the return metrics. What is the dollar returned for the services they provided. Under the sums that the program is implemented women and you can monetize the outcomes. You can't monetize some outcomes, you have to take some accommodation for that. But we can compare programs on return on investment if we know that the studies were done well and that they measured well the outcomes. But there may be some things missing. I will be the first to admit that the WIC, there has been no cost benefit studies beyond the first year of life. It may be that the three dollars is low. WIC is way ahead of most other social programs. That's good news to me. Thank you.
>>: Quick question. I was struck that in the comparison data you had, you didn't factor in, and you alluded, the potential health care benefits. I would think that would be a very ripe area for adding to the power of the whole project. And would wonder a little bit what your thinking was at the time for not including it.
ARTHUR REYNOLDS: Good question. We are doing it now. Before we did this through age 21 with the cost benefit analysis when it came up. We didn't have sufficient good quality information on health status of participants. The only thing we had, we had some preliminary data on food stamps participation and Medicaid participation in our sample. What we are fining so far, we haven't done a thorough analysis, but there's no difference between the groups on either of those two factors, either of those two outcomes. With the cost benefit analysis, even if you include them, there may not be a comparison between the groups. We are doing it now, doing an adult survey now, we completed surveys with over a thousand of our original sample at age 23 and 24. It's still in the field and we asked lots of questions about health insurance coverage, use of preventive health care, drug use, other kind of behavioral outcomes from program participation. Teenage pregnancy, things like that. You have pretty hard data. I think in the next three months or so we will have very strong data to add the cost benefit from the health perspective on it.
>>: Just a quick suggestion, I guess. You should be getting gross spending on Medicaid for the comparison groups to see if they are different. There are a lot of reasons you don't spends money in Medicaid besides the health of the person. One of the things I encourage you to look at is the number of kid who do not rise to the level of eligibility for developmental disability services because you have been able to increase their IQ, which is the threshold for making you eligible. That's some conversation with some of the researchers in Abecedarian, the numbers are small, but it suggests that it is probably true.
ARTHUR REYNOLDS: That's a good suggestion. We'll follow up on that definitely.
MYRTIS SULLIVAN: Okay. We have time for one further question.
>>: Just a comment on WIC. Most of us in Illinois don't have anyone on WIC much beyond the age of one. So there is no studies up to five. Those days are gone. I just wanted to say, you know, the book goes from the nursery is such a significant lead-in to the Olds Mohammed and I'm a provider of that. One thing I would like to see is the zero to three, implications of some of the studies that that book brings us to. Because I think when you look at the long-term, if the zero to three aren't a part of some of these studies, we miss the point, you know, because the child that is interviewed in that thing didn't have anything in the history between zero to three. That's just an extremely important point when you talk about home visitation.
ARTHUR REYNOLDS: You're right. That is a very good point. But as far as WIC, I was talking about the evaluations, following kids after age one, after they are done with the program to five, ten, 15 years old. Those studies haven't been done and might be useful in the future. That is exactly a great point. There is a book I put together called I recall childhood development for the new century. The perspective is critical here. That's what we need to think about more. How do we support kids in the first decade of life through an amalgam of intervention service that is we know are more effective, other than more services they could be getting are or are getting. That really is a strong theme in the human development field today. So I think the lessons here about high quality staff, low teacher-child ratios. Because the ratio of children to teachers is eight to one in the preschool program. You know, it's a little bit less in Abecedarian as well. The evidence from zero to three are consistent as far as staffing, intensity, size. And I think, you know, focused on kind of sort of the community building aspect of early intervention is quite important, too. That's why we have the location of the centers in conjunction with the communities.
The community is very important as well. Today those studies could be done because you have families that participate in WIC that now have the opportunity and go on to early he start and then go on to Head Start, who then after full day kindergarten and then on to other grade. That composite of things, people have not looked at those together and we have to if you take the first decade perspective seriously. That's a good point to kind of move us into the future. Thank you.
>>: I think what you said at the end is so important because we have been following kids ... (inaudible).
We have been following some kids in the kindergarten program where we have a school base health center and many of these kids have been through like preschool, Head Start programs then they get plopped into a kindergarten program where there's one teacher for 32 kids, maybe 35 kids. And more coming. And it's sort of creates this insane situation. You see a lot of regression with kids that were starting the year out doing well. By the end of the year they've regressed and those kids who had no experience with preschool are really way behind by the end of that time. I think that's really an excellent point that you made and that has to happen. That smaller class size in the Kindergarten, first, second grade has to be part of this overall program.
ARTHUR REYNOLDS: Teachers are interested in making full day kindergarten universal today to fill that void.
>>: (inaudible).
ARTHUR REYNOLDS: We need lots more. I think we have to stop looking -- we have to look at the continuum, not stopping at the first five years of life. Every age period has to reinforce and will re-extend the earlier age period. That's key. I totally endorse your comment and suggestion. (Applause.)
ARTHUR REYNOLDS: Thank you.
MYRTIS SULLIVAN: We would like to thank Dr. Reynolds for the excellent presentation. Early intervention is so key to the maternal and child health programs. The next session will be upstairs on the 12th floor much we have snacks up there. Feel free to go up and enjoy yourselves.