Early Childhood Development Transcript
October 14, 2004

Participants:
Dr. John Duby
President, Ohio Chapter of the Academy of Pediatrics
Marcia Egbert
Senior Program Officer, The George Gund Foundation
Billie Osborne Fears
Executive Director, Starting Point
Joe Frolik, Associate Editor
The Plain Dealer
Colleen Olson
Assistant Professor, Early Childhood Education, Cuyahoga Community College
Peggie Price
Vice President for Children & Families, Council for Economic Opportunities in Greater Cleveland

MR. FROLIK: Well, thank you for coming here today to talk about what we, as individuals, and as the community collectively, can do to help all children reach their maximum potential. I thought I would start by just throwing out a question, asking each of you, drawing on your professional or personal experience. If someone was taking home a newborn baby wanted to make sure that that child reached their maximum potential, what would be the most important piece of advise you might give them. One important piece of advice, let's start with you, Peggie.

MS. PRICE: Well thanks, Joe. That's a very difficult question to ask, because, I think, it all has to do with the context of what the parents, or families, may find themselves. But let's just pretend that I'm a, sort of, parent living in one of our suburbs and this may be my second or third child, or even my first child, and I think the primary thing I would want to know is what to expect along the way. In other words, I'd really want to know what to expect in terms of the child milestones and developmental issues that might be in place. And in turn, when I encounter difficulties along the way, who could I go to to help me get me through that particular phase. And that's kind of a, general, broad statement.

MR. FROLIK: Okay. Billie?

MS. OSBORNE-FEARS: Well, I am going to piggy back off of Peggie. I probably would say that it will be important to know what information is available, and that's where, I think, a newborn visit or a welcome home visit for the mother that's in the hospital would come in very handy, to know that that is available to you. Because from that, you will be able to receive resources on just about anything you could possibly imagine you will be faced in raising your child from early childhood education, some of the milestones that Peggie was referring to, there's a little Will in a packet. So I think to get connected, while you are in the hospital, to other services that are available to all parents.

MR. FROLIK: Marcia?

MS. EGBERT: Well, I think that old adage that Dr. Spock gave us about 50 years ago, that you know more than you think you do still rings pretty true, and that there's nothing in the world that really substitutes for the overwhelming and amazing love that a parent has for a child. And if you can trust that, and learn to relax and enjoy, the overwhelming experience of being a new parent, then that love really has a chance to flourish and to grow, and it will take root in the little babies heart, and mind and soul in so many different ways. Whether it's just talking to your child, or singing to your child, or reading to your newborn or any of the million things that parents have done for thousands of years, instinctively, that that's worth trusting in, and that those kinds -- that initial love that you feel only grows when you trust in your instincts.

MR. FROLIK: Colleen?

MS. OLSON: I think these are wonderful examples. Expectations, milestones and the relationship. The language, is what I would really emphasize, that child be bathed in language, as well as that the parent's role is to narrate life, to try to help children understand and interpret the world around them, the love first, you know, which is so much in your nonverbal and in your responses. But also, what we know from research is that children who reach school having heard more vocabulary, having heard the sounds of our language clearly are going to thrive in an academic setting. And so, children need to hear language, they need to understand when they are being diapered, I am going to lift your right leg, and we're going to do that, and we're -- and this is your left leg, and we really talk about who the child is.

When they are a toddler, it's a different narration, like a sports caster, this is on top of the table, I think we should get off, you know, and that you are constantly bathing that child in trying to interpret the world. And through that, the tone of it which needs be positive and loving, and also, firm and kind, will help the child be able to understand his place in the world and then, be able to build the pathways that are necessary for learning when they move forward.

MR. FROLIK: Okay, great. John.

DR. DUBY: What else can I say. I think one of the things that's really critical to remember is that all newborn infants are born with a remarkable capacity to learn, and that comes through all of their senses, whether it be touch, or smell, or visual, or listening or taste. And we know that at birth, even smell is one of the most dramatically and well developed senses in that newborn infants actually can identify their moms by their own personal scents. So that that opportunity for children to have the closeness, and the touch, and the cuddling and that nurturing that comes with being close to the parent is critical to establishing that relationship that you mentioned.

If we think about it, the sense of touch encompasses our entire body, and we know that children grow and develop better if they've had loving and attentive touch to be held, and cuddled and nurtured so that they can hear that language and have that closeness.

As a pediatrician, too, I would always say that it's important to have access to good quality healthcare right from the very beginning, and to plan to have regular checkups for your child and to make sure that you have all the immunizations that will protect your child to be sure that they will be healthy and be ready to learn because they are healthy.

MR. FROLIK: Okay. Build a little bit on some of the things you just said there. A couple of folks, in some of the interviews when I have been getting prepared for this, have talked about the idea that in the last ten years, there has been a great explosion, I guess, in the knowledge we have about the brains of very young children. Can you talk a little bit about that and, kind of, how does that sort of, how does that inform, or affect, what parents need to do? And as we move on more broadly, what schools and the community need to do.

DR. DUBY: We know that the brain is developing right from, you know, the time of conception, and that even the quality of the life that you live before you are born can have an impact on your brain's development and how you function. But certainly, from the time that you are born, the brain is responding constantly to the experiences that you have from minute to minute and is creating connections between nerve cells in response to those. And many of us, I think, are surprised when we learn that the maximum number of connections that children have between their brain cells occurs when they are about 8 months old, and that after that, there's a pruning process where the ones that are being used get reinforced and the ones that aren't being used go away.

A baby's brain is 25 percent of its adult size at birth. And by the time you are 3, it's 95 percent of your adult, of its adult size. And much of that growth is related to connections that are being formed between nerve cells, based on the experiences that the children have. So those first few years are critical in building the foundation for later learning. They set the stage for everything that happens later on.

MS. OLSON: And the connections that are from the outside, as you said, are building connections on the inside. So it's those connections, human connections, relationship connections, that are just vital to building the highways. I mean, our genes give us a blueprint, but experiences are the architect for shaping that highway, and the superhighways that are formed, and the gravel roads and the bypaths of life. So we really need to know that when children are born, every child is born with a hundred billion neurons of brain cells, far more than we ever need, and how those brain cells, though, are used and connected to each other to form the dense superhighways that help us learn are really dependent on the experiences and the environment in which we grow.

MS. PRICE: I would just like to say that the importance of this research reached the early childhood community, I think, in the practical sense for, at the federal level anyway, about ten years ago. And it was at that point that Department of Health and Human Services really, for the first time, took this scientific research and tried to apply it in creating the Early Headstart Program. And without this type of research that Dr. Duby had mentioned earlier, probably, the policymakers who have been slow to move, if ever to move, even though I have to say my grandmother read to me and I am 58 years old.

So somewhere along the way there's been some instinct, going back to Marcia, your point earlier, and yours, as well, Colleen, to do what is necessary and what you feel is good and proper for your child even without the benefit of this type of scientific research. So it certainly has been a field, which, in my opinion, has just added so much important fodder to the support for public policy that supports this, as early as possible, intervention and concern for our children.

DR. DUBY: I think in 1898 Horace Mann said the most important thing that you can do to help prepare your children to learn was to read aloud.

MS. PRICE: I think my grandmother was around then.

DR. DUBY: We have known for more than 100 years about the importance of the simple things that make a big difference for young children.

MR. FROLIK: I have heard from several pediatricians this talk of early literacy. Can you talk -- what does that mean, and as a pediatrician, how does that infiltrate or how does that play itself out in a practice.

DR. DUBY: Well, it can play itself out in a pediatric or family practice in a variety of ways. One way is there's a national program called Reachout and Read, which has been very popular in the Greater Cleveland and Akron areas. It's an opportunity for physicians and their colleagues within their offices to just have a chance to share with young parents, that value of beginning to share books with children at a very early age, even as early as six months of age. And also, that particular program allows physicians to give new developmentally appropriate books to children at all of their well-child visits between six months and five years of age so that, by the time a child is ready to enter kindergarten, they have their own personal library of ten books that they can learn to love, and memorize, and chew, and tear, and tackle and just learn to love books. So the opportunity for physicians is to be able to promote a strategy that really has some research behind it, that will promote children's development and help them be able to enter school better, ready to learn.

And we're not talking about trying to teach kids how to read when they are 2 or 3 years old. What we're really trying to do is foster a love of books so that when they get to school they know what a book is, they know the tremendous opportunity that it provides to broaden their world and learn about the world around them, and even about their own day-to-day experiences. And so, then, when they get to school they know exactly what to do with the book.

MS. OLSON: And they have a relationship -- if their mother has read Goodnight Moon, or their father, and they come to school and their teacher reads it, too, then, I can trust this place because this is something that I share with, this is a relationship I had with the book with my mother, and this is a relationship that I have with my teacher. And then, later, I have a relationship with the person who wrote that book because books are written by people. And if your name is Margaret Wise Brown, or your name is Peggie, then you are someone who can write books. And so then, you write your own little books in school.

So the early literacy is all built on we need to know about books, we need to know how they work, we need to know how they open the world to us, but they are also written by people just like me and I can write a book. And I can read my book, then, even if it's a scribble. And then it has meaning, then it has power. And it's not so much knowing the ABCs in order, as is knowing that they have power and I can write a note to the cook when she does a good meal at a childcare center and say, thank you, I love barbecues. Then, you know that letter, even if it's scribble, it's power because there is power in books and there's power in the relationship of the love from the home where that book was shared to the school, then to the author.

MR. FROLIK: Let me ask you, again, from the parent's standpoint, we're bombarded in a consumer culture with all kinds of things that you can buy for your children and stuff. And what would be, if you were, again, helping someone outfit their nursery, and then, maybe, when they are two-year-old or four-year-old, what would be the kind of toys that would be good for a child to have around that would encourage the kind of development that we're talking about here to get you ready for school, to stretch your imagination.

MS. PRICE: Well, I think, first and foremost, especially with infants, we know about the sensory stimulation that Dr. Duby addressed before. And, you know, there's been research whether or not, I think, most recently the popular colors were black and white for awhile. We have seen them go back -- well, perhaps red isn't good because it stimulates, but nonetheless, I think that the toys, the environment have to be those which are not only addressing their sensory stimulation, but also are developmentally appropriate for their developmental stages.

And whether it's a soft cuddly toy for very young children or a push and pull toy for a toddler, all of those toys are tools, if you will, for the children's development at that particular time. And again, I go back to some of the -- originally we started discussing this information we think is so commonly held, and yet, it is amazing how uncommon it is. And so, whether or not we're working with an inner city program or we're working with a childcare program in Pepper Pike, I think this is still information that all parents need to have.

MS. EGBERT: This is definitely, I think, another one of those areas where you don't have to go overboard though. I mean, I watched my five year old and a little friend the other day occupy themselves for the better part of an hour with a balloon and piece of string. It reminded me, I don't really need to go get that big electronic toy or the big expensive thing that is being pushed through this or that, kind of, commercial venue, that kids really are brilliant in their way to find joy in simple things.

And so the most common, ordinary things around our houses, how many generations of kids have occupied themselves with, exactly, with kitchen, safe, soft kitchen equipment and things like that. That it really is more about making sure children have something that's there to find fun, as opposed to it being the absolutely right, perfect promoted, commercially available kind of, and probably expensive, products.

MS. OLSON: And we talk about the box being more important than the toy, and that the children will play with the box far longer. And again, it's the connections to the world, to nature, and just in the way -- I have some leaves here, and we have plenty of opportunities to look at color, and shape, and size, and number and all kinds of good things. Now infants wouldn't be a good idea toddlers even, no, but some toddlers certainly, but when nature provides so much a balloon and a string, leaves, everything is possible here to talk about, lines, and shapes, and number and size. And then it's connecting it to our world in Cleveland. We have wonderful leaves, you know. If you live in, where, you know, Santa Fe, there's a different kind of foliage. But it kind of makes you connect to your community. It makes you connect to your neighborhood, you know, it's a very simple thing.

So I know there's been a lot of, like, Baby Einstein tapes, everything one with the brain research, we need to run out and buy a few of those, the Mozart in the background and that, there's no research to indicate that's a good thing or that's going to do better. But if parents do that and they're involved with their child, even in that, it's the involvement. I'm involved with my child with something, it's taking a walk, it's having some leaves, it's watching the balloon and the string, it takes an interaction. It's not going to happen, and it's not a good place, maybe to say this, but, I think another thing that is really important is that we turn off the TV. Probably not a good place to say that because we're on TV.

MS. PRICE: Everyone over the age of 5.

MS. OLSON: It's real things, it's that sensory stimulation that is important to stimulate the whole brain. You know, your occipital lobe you have to help me on this, you seize it. And then it goes to the temporal lobe and it starts to get -- and if it's pleasurable than the limbic system says it's fun, I am enjoying, then it will go to the cortex so it can be stored. Those are the kind of things that parents don't know and many of us didn't know. When my child was born 34 years ago, that's when I went into early childhood education because I looked at him and thought, I don't have a clue. You know, my parents had died when I was younger and I hadn't had good models for that, so I needed some information. And you know, it's in books, but it's in people, it's in mentors, it's in neighbors and friends.

DR. DUBY: You mentioned those 2 to 4 years olds and, I think one of the wonderful things that is happening in 2 and 3 year old children is that their imagination is growing. So any kinds of activities, whether it be just being able to use normal household items, or toys that really try to stimulate creativity and imagination, I think, can make a big difference for that group of kids. What I love to see in those 2 to 2 year olds is them starting to move into making things into something else that they aren't really are, to really stimulate that true imagination, and so that opportunities to explore the world and then, to make up your own way of exploring the world, I think, are very important at that age.

MR. FROLIK: I think sometimes parents sometimes get concerned that he shouldn't pretend, you shouldn't live in an imaginary world. But that's very much part of being a child isn't it?

MS. OLSON: And Very important for literacy, it's symbolic representation. If I can make a stick into everything, you make a stick into anything. You know, then I can make these marks into an A. Symbolically, my brain needs be able to take something, make something out of nothing in order to take three lines on a paper and make them sound like an A.

MS. PRICE: And I think the challenge is to have adults in the lives of children who can do those kinds of things, who don't necessarily have the theoretical framework that their Dr. Duby or Colleen have. And that's the challenge, particularly, again, for low income populations where you may not necessarily have that type of environment just naturally occurring, and how do we, in fact, infuse that into the lives of our children.

In fact, I think that there was a study recently that actually favored pots and pans and Tupperware over -- are you aware of this? There were testing that was done with young children and they were given a choice of this toy over a set of Tupperware or pots and pans and, in fact, they attended to the pots and pans and Tupperware longer than they did with that new fancy toy. So, I think everything that is being said here is pretty much supported in a lot of common sense, but also, in what we know in the way the children learn to develop.

MR. FROLIK: I want to pick up on something that Colleen just said about when you have your child sometimes, you realize sometimes how much you don't know. I want to go to the comments that was made at the Town Hall Meeting in Akron. We're talking about the difficulty we have about admitting what we don't know. So if we could see that, please.

(Videotaped played)

I was thinking, I wonder how trusting parents are for asking for help or admitting that they're depressed, or admitting that they're overwhelmed. We don't give awards or thanks for asking questions. In fact, we try to portray an image of I have it together. Everyone has, not everyone, but, everyone wants a bumper sticker my child was student of the month or whatever. And we all try portray ourselves as having our act together. Very rarely do any of us admit what an overwhelming task it is to parent a child in every dimension, physically, academically, socially. And we don't sit around complaining. We all portray ourselves as having our act together.

MR. FROLIK: As a parent, obviously I can admit here, I have not had my act together many times and probably most parents do. First off, how do we help the people, let people know what is available to them in those times that they don't have their act together? How do you, particularly those who work as professionals with families, how do you sort of, approach somebody who you think might not have it together, but, like the person at the meeting, it's hard to admit that publicly or even privately, one on one, to somebody.

MS. EGBERT: Well, there's just a couple of things I would say. We are so lucky in our community to have the amazing library system that we have available and the resources that are available in a very private way. You go on your own time, you go at your own pace and try and see what's available, not only for children, in libraries, but so much more that's now available in term of learning about parenting, that, gosh, you could never even begin to read all the books that are out there on parenting.

But, if there's something in particular that is troubling you, or concerning you, or worrying you, there's a free, generally available, expert resource at your disposal. And sometime I think that it's easy to forget that down the street or around the corner there's that kind of free resource waiting to be taken advantage of.

We're also lucky that, in this community, we have several, I'd say not enough, but at least three that I know, of places called Family Resource Centers. These are really wonderful, again, either no cost or extremely low cost friendly, open, warm places where parents can come in and be with other parents, learn about great parenting skills, but also, find some respite from the pace of parenting, find some resources, books or videos or other kinds of things to take out if you would like to, have your kids be a part of a play group with other parents, get some support, maybe, I'm sorry, with other kids, get some support if you are worried about a particular problem.

For example, you are an adoptive parent and you are wondering how to, maybe connect with other adoptive parents. Or you have a child that has an attention problem, and can you connect with other parents and learn there. We have three of those in this community and they're a wonderful resource to help parents learn and grow in that role.

MS. OSBORNE-FEARS: I think also, that in our community, not only do we have a wonderful library system and family resource centers, but we have a lot of early childhood program that have a focus on parent education and parent support. And I think, part of our responsibility in building these systems and programs is to make sure those components are very, very strong. I think many times a parent drops her child off at childcare on the way to work, she's very comfortable with the people that are working in that program, or she drops them off at Headstart, very comfortable, a cup of coffee and she'll tell you her whole life story. The question is, can we, the Headstart teacher or the childcare teacher or director have the resources available for that parent. So I think that there are a lot of resources and that parents, you know, need to know, number one, that they can talk to folks about what is going on in their lives.

I do understand, though, that many parents really don't want to share their life story or their problems or as the lady said at the Summit Town Meeting, that they don't necessarily want you in their business. We understand that, however, I think it's a very touchy situation and a person that's working in a social service agency or any type of a service organization has to walk very, very, very lightly when approaching a parent about different things that are going on, or that you have noticed, because of the issue of parents need their privacy, and also, no parent wants be told that their a bad parent. So it takes a lot of skill, and we have to take the time to make sure that our front line folks have those skills, but it's very difficult.

MS. PRICE: I just would like to follow-up on that a little bit. I'm a social worker by training, and I think we have talked about the basic tenant of social workers, that you really take your client where they are and you start out with where they are. And so frequently, I think Billie did a very good job of just laying out, this is what frequently happens in centers where children are, and frequently we're dealing with parents who are in a rush, and yet, somehow, if we can indicate to our parents that the issue that we see with the child in the center is not necessarily a reflection of them being bad parents. It may be circumstantial, or it may be simply related to a lack of resources, whether it's an understanding of child development, whether it's because there are financial problems with the family, or whether or not there are personal problems that that individual may be having with the other parent.

And so what you really have to do, I think, is always try to create an environment of trust. And I think, to some extent, you also have to normalize these situations by simply pointing out that we all have difficulties with parenting and that they didn't come here with instruction books. And all of our love notwithstanding, we all need assistance in getting through this.

And so, that's the relationship building, and that's the basis of relationships that, actually, when they are productive, take to cognitive development, but also, the child's emotional and social development, as well, as well as the context with the parent in which the parents are functions at times.

MS. OSBORNE-FEARS: I think another piece to that, and certainly, it's being played out in the development of the early childhood initiative for the phase 2, invest in children, is that, if we can provide what we know are good services, good resources to parents and make it universal, then no one feels that this is a service for a low income family or this is a service for a mother who doesn't know how to control her children, it is just something that is available because we all understand as a community what it takes to raise a child.

MR. FROLIK: Billie, before we go on, you mentioned Early Childhood Initiative and Invest in Children. Can you explain to people who are watching and listening who, maybe, are not part of the system or who maybe don't have young children, haven't had child born in the last five years like Marcia has, what those programs mean if you life in Cuyahoga County.

MS. OSBORNE-FEARS: If you live in Cuyahoga County the Early Childhood Initiative, now, has been renamed Invest in Children. There are four major components to it. Effective parents, and that's where you can get a home visit from a nurse if you have a newborn baby, and that's a nurse from the birthing hospital. You can get additional home visits also, from the Help Me Grow Program, if you need a little more help, if you want to feel a little more stable in your parenting.

DR. DUBY: Then there is healthcare, we feel that it is very important that all of our children have access to healthcare and that they actually use the healthcare, the families, or parents, are taking their children in for a well-baby, help me, doctor, well-care visits, and that they're doing it on a regular visit. And of course we're concerned about environmental issues around lead poisoning. We know that that is a major issue in Cuyahoga County so we'll be working with the City on how do we eliminate lead from our housing. And then there is the preparing children for school, and that's where Headstart, childcare, be it a center based program, family, childcare home, public preschool, that's where we're all going to come together and build on all of the successes and the good parts of each program using early learning standards that have been put out by the State. Making sure that programs are loving, nurturing and also understand what it takes to help a child succeed.

MR. FROLIK: Colleen, did you want to say something?

MS. OLSON: I think when you were saying it should be universally available, that every mother has a home visit when she has a baby, I think that's really important. So I was thinking today, at the grocery store, maybe grocery stores need to have the parent education piece. So if, you know, that's universal and children go to the grocery stores with their mom's or their dad's. And so, if they buy a pumpkin, which I have a pumpkin out, should I bring it out, so buy the pumpkin, it would say something like, you know, pick a small pumpkin, a medium pumpkin and a large pumpkin. How much do you think a pumpkin weighs? What is the circumference a pumpkin? I mean, the grocery can put questions that parents could talk about with their children at the grocery store.

There really isn't a better educational environment than a grocery store that I know of. There are -- I know a little 2 year old boy who knows his numbers because he says, aisle 2, aisle 6 and 8 are open because he looks at the numbers. You know, his mother taught him that so he knows which ones are open. And so, I think if we can incorporate the business community somehow to be our next partners, to put the standards, I mean, what are the standards for pre-K? What would be something related to the pumpkins that they could put up there that would provoke the mother or child to have a conversation, or some interaction or some fun around the grocery shopping? We're usually in a rush and we don't have time, but we're there and some of that might happen.

You think of public service announcements or, I thought, the buses need to be full of this, your child has brain cells, help him connect them. Or some little things that we can put on cereal boxes, something universally about child development that can be promoted better. And so, we as a profession need think about how to get the word out, because the word is out on a lot of other things and I think, we need new partners, maybe, to make it grow bigger.

MS. EGBERT: I think your point, Joe about saying, how do you make this topic real to people who may not have children, or perhaps, whose children are grown, is an extremely important point and one that also relates to Colleen's point a second ago about, maybe bringing in the business community. One of the things that I think, we're so fortunate, in this community, to have is already a significant public investment. So the investment of a good number of our tax paying dollars in early childhood programs and development through Invest in Children.

But I would argue that we haven't gone far enough and there's, obviously, a tremendous conversation going on in this community these days about what can be do to bring Cleveland back to the economic development? How do we make Cleveland a stronger town, and Greater Cleveland a stronger region? And I would argue that there's no greater investment that a community can make than in putting public resources behind the development of their youngest children. And while we are off to a great start on that in this community, there's certainly even more that we can do, not the least of which is making these services that Billie has talked about universal and giving all our kids an opportunity for a high quality, early learning program, experience, setting, et cetera.

MR. FROLIK: I definitely want to come back to that later in the conversation. But we talked a little about the early learning environment and stuff. For lots of parents, because they work, finding a daycare provider, a little bit later a preschool setting for the children is so very important. What are the kinds of things that, if you are a parent, you ought to be looking for to find a good environment for your child during the time you have to be at work, if that's the arrangement you are going to need to make?

MS. OSBORNE-FEARS: You are experienced.

MS. PRICE: She's actually a consumer.

MS. OSBORNE-FEARS: You are very experienced.

MS. EGBERT: Gosh, so many things that just come to the top of your mind. Of course, safety is the first and foremost. And so clean, warm and then you quickly go to the person who is going to be with your child or the people that are going to be with your child, what's their experience? Maybe that doesn't automatically make you think what is their education level, but you certainly want to know what is their experience with young children? Have they had a lot, and do they know how to take care, and nurture and love a child in the absence of its parent. Are there enough people in the setting to do that job right and well so that you are not spreading that care too thin among children, so the ratio of caregivers to the number of children in any given setting is so important.

What are they using to develop the children socially, emotionally and cognitively. I think there's been a huge amount of emphasis in the last few years around the cognitive development of children which is understandable. But we can't ever forget the fact that children are more than their wonderful brains, but also their feelings, and emotions, and hearts and souls. And so, what is a setting doing to promote the health of the whole child, not only the growth of their mind, but getting along socially and emotionally in the world, as well. That's the short list.

MS. OLSON: Well, and there's research that has, sort of, looked at the 7 indicators of quality, the Early Childhood Environmental Rating Scale, which was developed in North Carolina, and I think that should be readily available to parents. Not that -- and some states do have, they have had a rating. They have had someone come in and look at these 7 criteria and say, your score is a 4.5 as a center, you know, that's the standards according to the scale that we see here. And so that's public knowledge. Now that isn't true in Ohio, 4.5 not true in Cleveland, but there are measures of quality that we can look at in the field and that we should look at. And Marcia certainly has hit on the two important research measures, the experience and training of the staff, the education of the staff, and the ratio of the children. But there are many other things that we can look at, as a community say, we're going to use this measure and before we have standards for children we need to have standards for the care that they receive, so that all children have an equal quality start wherever they live.

MS. OSBORNE-FEARS: Also, you know, in looking at the safety of the child. I mean, in Ohio you have to have a criminal background check and all of that is very, very important for a parent to know about the people that are working or will be working with their children. I think another good point that Marcia made earlier is that when a parent walks into a childcare facility or family childcare home, whatever it is, her senses will tell her a whole lot from the moment she walks in that door. What does it smell like? What does it sound like? Are the children happy? Are they laughing? Because if it's too quiet and it's not nap time I'm a little worried. And once again, is it clean? Do you see a lot of interaction going on? Do you see teachers getting down to the level of the child and talking to the child? Are they playing with the child? You know, you want to see some touchy feely kind of things going on. And you want to listen to your heart and you want to listen to your gut. I mean, we cannot take that gift that mothers have, and dads have away from them. Pay close attention to what you are feeling in there and trust your senses first of all.

MS. EGBERT: Hopefully there's some help on the way, locally, for parents, as well, in two different ways. One being that as part of the Invest in Children initiative that Billy brought up, we hope that there'll be a big push to have more accredited centers, or places of care for children. Right now Ohio has a licensing system and I worry that a lot of parents, if they are looking for a childcare center or a preschool setting, see that something is licensed and think that means it's really good when in reality that is sort of a floor rather than a ceiling.

MR. FROLIK: Explain what you mean by licensed and accredit and if there's some steps in between. Is there a ladder?

MS. EGBERT: Sure. And my colleagues know a lot more about this than I do, but the simplest way that I can explain it is, the State of Ohio, through the Department of Job and Family Services, licenses childcare, professional childcare settings. Now there's some caveats to that, but that's a basic statement.

And those are minimal safety standards and guidelines that childcare providers have to have in order to get that State Licensing. And with licensing comes payments from the State to the provider. So that's how they are able to stay in business and how parents find their way to them. That's good and extremely important, but again, it's only a minimal level of basic safety standards as opposed to what we've all been talking about, in term of quality. So what we're hoping is, and Cuyahoga is lucky to be one of pilot sites for this, is to launch a new effort called Step Up To Quality, that will basically be a rating system that parents will be able to use, a star rating system. So is a facility a one star, a two star or a three star facility. One star being you are licensed, you have the basic minimal standards. And then on up the scale with three stars meaning you have got an accreditation from a national body of childcare experts saying this is a primo place, it's a place of high quality, the right ratios, the right teacher qualifications, et cetera, that a parent can read as a, sort of, good housekeeping seal of approval, and know that for the money that they'll invest, or pay to that particular setting, they're going to get a higher quality of care for their child than they might at a one star place.

MS. OLSON: That's exciting. I'm glad that's here.

MS. EGBERT: It's taken a few years.

DR. DUBY: I think these are very important issues. I also think a little bit about some of the challenges that we face as we try to address issues with regard to high quality childcare and preschool services. One of the first things that comes to mind is affordability. And so we talk about, you know, these things that we value as being what our children need, but yet, how do you balance that with making it affordable to families so that they're able to have a little bit left over from their paycheck after they have paid for their childcare. And one of the challenges in order to keep it affordable, sometimes then the folks that are working in the childcare centers are not paid sufficiently to make them see this as a long-term career option. And as a result, the turnover rates in many childcare centers are very high. And so, the other challenge I see is the consistency in caregiving, in that, children need to have that consistent caregiver who they know they can rely on on a day-to-day basis. And if their caregivers are changing from month to month or even year to year, that can be a challenge to their social and emotional development as we were talking about earlier. And in many childcare settings, I know there's tendencies when you reach a certain age, you move up to a next group and then you have a new caregiver. And so that child losses that continuity of care and needs to adjust to a new caregiver who may have a totally different personality or temperament and those kinds of things. So those, I think, are important issues. And the final challenge that I think about along those lines is that most of us did not grow up in a setting where we were with 6 or 8 or 12 other kids the same age that we were, you know. We grew up in multi age kind of group, and the older kids tend to mentor the younger kids, and the younger kids would learn from the older kids. And we when have kids that are all in the same age group in a single group some of those opportunities are lost. And I think that those are some of the things that we need to think about and explore as we begin to really make an investment in our children, and begin to think about, are there different ways, or new ways or other options that we can consider to balance these whole issues of quality and affordability with consistency and an opportunity for inner-age experiences.

MS. PRICE: And that goes back to some of the issues that we raised earlier as they relate to licensing, because right now, our licensing rules and regulations really circumscribe what age groups can be together and what cannot be. The other comment that I wanted to kind of speak to a little bit around the quality and what you look for. I think that there is another issue that relates to a preschool program. And if, in fact, a parent is looking for something beyond the floor, as Marcia indicated before, and for us that really speaks to care, custody and control, the three Cs that all licensed entities are charged with as a bare minimum has to be this notion of intentionality. And that intentionality is a part of the overall learning environment, whether it's with materials and supplies and equipment in the room, whether it's with group size or credentials of the teachers, or in our case, not only all of those things, but also this bible for our Federal Headstart Program, called the Federal Headstart Performance Standards which speak to things like initial screenings for health for nutritional issues, for developmental delays, and then, not only in screening and identifying them, but charging the program with the responsibility for seeing to it that families receive treatment and follow, or at least refer to it, and that each family has a medical home and that's a recent terminology to speak. I think it's really the old, primary care doctor person, but now we sexed it up and it's now a medical home terminology, we have to change the terminology every few years. So what I am saying is that I really commend, especially the State of Ohio, and I know that this is not always coming out of my lips, a commendation to the State, but in this case that these licensing rules, I think, have been ratcheted up and they can only, but help the daycare community, Headstart community, private daycare providers and home care whatever, and really increase the quality of our care for our children. Particularly, in light of the fact that some of our neighbors have, in fact, neighboring states have, in fact, done away with licensing rules such as the State of Michigan, for example. Many of them are still being rolled back in other states because of the very reason that you cited. It costs us to do this. Our federal program, for example, which we would like to think of as, if it's not accredited by the NAYC Accreditation System, certainly contains probably about 95 percent of the elements that would do that. We're funded at a rate of almost $13,000 per child per year for a full day of service. And by full day that means for us, probably 10 to 10 hours of service in any given day. So it is not cheap. And when you begin to cut corners something is sacrificed for it. I think that's a public policy issue, but that's something that all of us in our community, I think, especially at this table we're aware of, but the policy is not doesn't always follow the promise. And you are constantly faced with, how do you fill the holes of unfunded mandates, for example, as we face. And one final thing is that, in our community, we are fortunate to have an enormous array of childcare environments and options, if you will. And we also have a phenomenon called Parental Choice in which once parents are aware of the possible environments and milieus and arrays that childcare can be delivered, they are not forced into this is what you have to have. It wasn't always that way. And so that has become a blessing for our community. I think, however, at the same time we have to be very realistic, that poverty and low income limits ones choice, whether it's around childcare, whether it's around medical care, whether it's around housing or anything else. We don't want it to be that way but, in fact, that's reality. And we have been fortunate in this community for the last, oh, almost 40 years, to be funded as a Federal Headstart Grantee. And currently, we are funded to serve over 4800 low income families. And frequently we are faced with the challenge of how do we get this information, this message through to the population that we serve. And it is a complex system and sometimes very difficult to navigate. We like to simplify it as much as we can, but those types of standards that we have all been talking about, are ones which the Headstart Programs have been striving to maintain and reach and exemplify in some kind of ways, and specifically for our low income population. Universiality is a wonderful goal. We are often stopped at the door of achieving that with the dose of reality. And that dose of reality comes, frequently, in the form of limited resources for our families.

MS. OSBORNE-FEARS: To take the conversation about the cost of care is expensive to families, but I wanted to do a flip side. If you think about the childcare teacher or family childcare provider, let's look at a cost of about $300 a week for infant care. Let's divide that by 5, what is that? $60; right? Now divide that by 10 hours. Six, so are we close to the minimum wage.

MS. PRICE: $5.15 is the minimum wage, we're over by 45 cents.

MS. OSBORNE-FEARS: My point is, these are people who are taking care of, what we say in this country is, one of our greatest resources. People who work at the Cleveland Zoo and the Akron Zoo, you have a zoo, make more money caring for the monkeys and the elephants than people who are working in childcare. And the field of early care and education is labor intensive because of child staff ratios. We don't want it any different. As a matter of fact, the ratios are still too high and I challenge people, I mean, if you look at the state law, one teacher for 14 four-year-olds. Well, I challenge anyone, I would love to give the policymakers that put that into affect 14 four-year-olds by themselves just for an hour. But in the field of early care and education we are talking about all day and many of the woman, because it's predominantly woman working in the field, they don't have any benefits and I can't really understand this at this point, how we can talk about healthcare for children and not talk about healthcare for their parents. Now I don't understand why we don't have healthcare or someone hasn't figured out how we can, and I'm a part of trying to figure that out, how can we provide healthcare to people who are working with young children. Now, if you have young children you know you really need health insurance. You have colds and all kinds of things going on, you need to be healthy. So I think that, as we talk about affordability, we need to talk about whose missing in the equation. You know, we know that parents cannot afford to pay for, the average parent cannot afford to pay for a quality early care and education experience. We know that the government cannot take on the whole cost. Where is the employer in the conversation?

MR. FROLIK: Just a little on the quality question. What would the kinds of things that would improve quality, is it more training for the teachers? Is it smaller groups? How do we improve the quality of what is offered in the daycare or preschool settings?

MS. OSBORNE-FEARS: Well, certainly we know, based on, we have all been talking about research, because the environment that we live in right now is that if it hasn't been proven to be a best practice then it's not necessarily a good practice. But what we do know is that people who have a degree in early care and education, they're working with children and understanding how they grow and develop, seem to have a better impact. And it's all about the individual that's caring for the child, it gets back to that relationship. And you do need to understand how children grow and how they learn or else you cannot teach them. And what we have in our state at this particular time, it's interesting because this was something you were talking about earlier, is that our state licensing laws do not require that anyone, really, other than the director, have any college background. So training is very, very important to our community, as well as nationally. And not only are we concerned about moving people towards getting a degree, in many cases we have to start off with getting them a national credential, a credential that means something just to wet their appetites to get them used to going back to school, to just begin to cover the baseline and then create some type of a professional development ladder. The other thing is, once again, smaller group sizes. That's nothing new, you hear it when we're talking about school financing, we're talking about smaller classes in the public school systems. It is true and even more so in the early childhood setting.

MR. FROLIK: Colleen, when somebody comes to your department at Tri-C for the early childhood education, tell us a little bit about what's involved in getting to that degreed level. What kinds of things do you hope to help them learn so they can then pass on to the students they work with?

MS. OLSON: Well, at Tri-C about half of our students are already working with children. They are coming back because their agency or they themselves need more information. And I think they come with a lot of life experience. They really know the children, they know the families, they know how it works.

What they need and what is often missing is the variability of children at different ages, how infant's are different than toddlers, and preschoolers think differently than you do, and how you need to be very understanding of all that, and appreciative of it and joyous in children's very much original way of looking at the world. So they need that milestones, just like we start with, they need to know what to expect. Our students need, then, to now how to plan curriculum that will be responsive and meaningful. So first, they need to know how to do relationships and then they need to know how to plan an art activity, or a math activity or a science activity that will be full of joy and also full of challenge. And what we find the most difficult is that many of our students have difficulty with the academic part of the college life, because their own preparation for school was probably a long time ago. So they are coming back to school after a long time. The reading and writing skills of the teachers have, it's difficult for them to go through the English series or the writing part of being a teacher, but they have a tremendous spirit about wanting to help their community, wanting to make a difference in children's lives.

And so, and yet at Tri-C, and our student I would say 90 percent of them have children, they have a full-time job and they are going to school. So it's a miracle that they show up every night, and every Saturday and ever morning. So the way -- if we could respect what they do more, and we don't as a culture, you can stop a conversation if you say I'm a childcare teacher, I am a teacher of 3 year olds. People will say, oh, isn't that nice, that's really cute. And then -- but it has no status, it has no respect as a culture. So when woman left homes to do this work, to do whatever other work there was, I don't think somehow we valued who the person would be who would be taking care of their children. Somehow they are going off to do more important work, but the most important work is this work and it needs be valued with money, and with status and with respect. And that's what I grieve for them about, because I want to recruit them to do this work, and yet I feel that they are going to enter a field and a world that doesn't respect what they do.

MR. FROLIK: How much of that do you think is a factor, probably 90 percent, maybe 90 somewhere in the higher 90s, percent of people who do childcare are woman.

DR. DUBY: I would say it's 99 percent.

MS. OLSON: And my husband teaches at John Carroll University, he's a math professor. He has been working with me the last two years on math and early childhood. And the first day he went to a childcare center, he worked with them an hour, he was exhausted. He said, I could never do this, even with a lot of training. It is far beyond what people know, because children's brain are very active. Their bodies are very, they're moving all the time, and movement is so important to their growth and development. And they're not going to sit quietly and listen to you say something wise and important. So they need -- what they need is probably, doesn't really attract men, but it has always been woman's work. And the best time that it was woman's work was during World War II, when woman were working in the shipyards in Seattle, I think the Kaiser Shipyards, I am remembering this from some of my history. The men were at war, the woman were there. The teachers who were working with -- they had the best facilities.

So another thing on quality is we need better environments. We have had a lot of Rite Aids turn into childcare centers and the windows are up here. Well, children have no way to see the trees. But anyway, at that point in history, the teachers who taught were people with Master's degrees. And so, still in New York City and, what they call the Private Ivies, these private childcare centers in Manhattan, those teachers have Master's degrees from Bank Street College. Columbia University just opened a lab school and their requirement is a Ph.D. to teach young children. And Burton White, years ago, wrote, we need better trained people at that end than we do at the college end.

We need to pay them better, because it's a more important time. So I have wandered a little bit on that question, but I just want you, you know, our culture as a culture doesn't value the work of children. And sometimes I don't think we value children. They become consumers, they're targeted for consumerism very early. They're invisible, pretty much. I think of ways that we could honor them or support them and I don't see it when you go out in the world.

MS. EGBERT: We've launched something in this community to try and help with this, it's not enough but it's a great start and one that was overdue. Folks at this table have been very instrumental in making it happen, something called the Teach Program that would allow for woman just like we've talked about, or men, of course, if they choose, to get help in getting advanced education. It would underwrite the cost of college tuition at Tri-C and in exchange for that kind of support they, for every year that they go through the Teach Program, the individual student signs a contract to say I will stay in the field of early childhood another year. So it helps cut down on that turnover that Dr. Duby talked about in the setting. And it simultaneously raises the quality of our early care providers.

We're off to a great start with this in Cuyahoga County, but we need it to last and we need it to be bigger.

MS. OSBORNE-FEARS: It also pays a bonus for each year that they complete their contract which helps a little bit with the wages.

MS. PRICE: And I think this is certainly an amicable step. I would just like to go back to my comments earlier. You can't cut too many corners on this and get the quality that we're talking about. Because embedded in that $12,000 per child that we're funded from the federal government for a full day of service is the support to minimize the classroom size. 10 to 1 is our classroom size versus a 12 or 14 to 1 in a licensed care facility. Our teachers are required to have, either an Associate of Arts degree or be in the process of obtaining one. We don't hire any staff in our classrooms anymore without a CDA, which is the child development associate, I'm sorry, I always get the A -- a credential. And two thirds of a childs daily nutritional needs are met if the child is in the Headstart Program a full day, that all of our children who are identified with special needs receive the most resources that is we can bring to it and that the parents are engaged and involved in this process, as well as in the operation of the program. These types of services are all embedded a $12,000 per child ticket and that maintains, therefore, the type of stability that Dr. Duby is talk about in continuity of care. And by the way, our children in our Early Headstart Program keep the same primary caregiver. They age with the child, and they do age sometimes, believe me, a lot more than just three years. And it also does retain, we have a very low turnover rate. I think our attrition rate this year was probably around 11 percent, which is very low for most childhood. We do guarantee most, if not all, of our health insurance coverage for our staff. And of course, we have embedded in that $12,000 per child per year the cost of sending them and paying their tuition, of hiring their relieve staff so that they can go, for insuring that they have their books and the supplies, et cetera and, in fact, increasing their salaries.

But there is no free lunches. You either put this into the system so that children are in the care of the credentials that research says they should have, that they are in the smaller classroom sizes, that their health needs are identified. And finally, let's just say that in our community it's in the Headstart Program and it's not, it's free to the family but it is not free. It is not free.

There are funds that are supporting this and we have been fortunate to be a part of that system. I think that the disconnect sometimes is that because this is a program for poor children, the question is is this a good use of the tax payers dollar. I go back to the CDF formula, for every dollar invested up front, we save $7 in the long run.

MR. FROLIK: Let me -- this is a point -- I would like to go to another one of the, from one of the public forums. It would be the number 4, the one about, the person talking about public support. We always say we support children, we're all for it this person took a question to that reality if you have that one, if we could see that.

VIDEOTAPE: "We know from looking at educators of older children that recent statistics indicate that on average, people who graduate from college with degrees in education and go on to work in schools typically leave the profession after only five years, so that's an immense amount of time and money they are investing in preparing themselves."

"I'm skeptical. Somebody said, Billie, I think you said we have the public will. I question whether we do. I think we have a cynical politicized system that uses things for the wrong purposes. No child is left behind, I think most educators would question whether we are leaving children behind or whether we're not. In Akron, we have now closed four and I think maybe five day care programs. I find it hard to believe that we're committed to children when we allow that to happen."

MR. FROLIK: Peggie had been talking about Headstart and the system they have set up and the amount of money that is spent per child on that. That was 40 some years ago set up as a pilot program and in theory, a pilot program, we set them up so if they succeed, we make them the norm. Clearly we haven't made that the norm in terms of funding enough to be universal.

What about what this person said? Are we, as a society, committed to children, especially to the least among us, and if we're not, how do you go about changing that and making it, maybe make it clear to people, convince people that there is an obligation or even a practical, a pragmatic sense that we need to make those kinds of investments? Anybody want to start on that one?

You were a lobbyist in a past life.

MS. EGBERT: First of all, I agree with the speaker that we don't invest nearly what we could or we should and, of course, there's always questions of choice if you are sitting in the seat of an elected official and there's always limited resources, but if you are trying to make wise decisions about where to invest those always too limited public dollars and taxpayers funds, it really is hard to argue with the evidence that the investment made at the earliest stages of life has, as Peggie noted, this extraordinary return later in life.

What we have seen and all the science and research tells us this that investments in quality early care programs lead to a number of tremendous benefits, higher graduation rates which, of course, is on the minds of many educators in the K through 12 arena; higher rates of eventual home ownership which, of course, help stabilize our communities which is a great concern, particularly in the City of Cleveland; higher wages over a lifetime; a greater trained work force which, again, is another issue of great civic concern in this community, and the tail goes on and on.

What we know is that that early investment has the greatest potential payoff of virtually any public investment that we can make, and so are we on a path that is starting to recognize that? Yes, whether it be investment in Headstart or in the Invest in Children in Cuyahoga County. But have we done enough? No. This community I think has a chance to be one of the handful of communities in America to distinguish itself around how it cares for our youngest citizens through even greater local and state public investment and I hope that we do that.

And there will be a lot of effort made over the next few years to see that come closer to happening. Certainly one of the biggest drivers of that is that we have so many more women in the workplace than we did a generation ago or think back one hundred years when we had the kindergarten movement in this country. Now we have got upwards of 70 percent of children, our youngest children experiencing some number of hours in out of home care in our community. If that doesn't help start driving public policy, I don't know what does.

MR. FROLIK: What would be, if you tried -- are there models out there, other cities or other countries, that do an better job on the early childhood end that we should --

MS. PRICE: I think one thing is that European countries, for example, will give three to six months unpaid -- I mean paid leave, I think, for women who want or men who want to stay home with those children at those very early ages and really do the type of nurturing that we have all been discussing here today. That kind of, perhaps, reallocates the funds somewhere in the system, but it may be more of an obligation than on the private sector because the employers have to kick in some portion of that. It's not just simply paid for out of the government's coffers.

But I think certainly engaging and bringing more responsibility by the private sectors is -- I don't know how we can do it without that, and whether it's the corporate -- I have to -- can I plug a corporation like Johnson and Johnson, for example, which has been at the forefront of going forth with this corporate child care in place and they support, as a corporation, all kinds of other training and investment for young children and yet somehow they still manage to do very well, thank you very much on the stock exchange. It hasn't hurt them one bit. If anything, it's grown it. So I think that sector has to be brought into this, into this equation and I don't know exactly how you do that.

We have tried the it makes good business approach in this community. Certainly I know that we have done that and out of, what, about 20 years ago when there was a great push to have on-site child care and very few of our corporations, if any, stepped up to the plate. So we have got to have that part, and at the same time I think we have to recognize that there is not a one size fits all for all the various sectors of our community. There has to be -- maybe it is the sweeter system, because I'm going to say there has to be a smorgasbord. There has to be those resources that are available for families to fit their needs.

And again, Marcia, you are absolutely right. We're not going to turn back the clock of women pursuing their professions and working outside of the home because we have always worked in the home, working outside of the home in addition to continuing the hope to have children.

So it isn't a problem that is just going to go away and it isn't something that should be up for re-authorization every five years as, by the way, the Headstart program is. It's still just a project. It's not a permanent line item in the federal budget. But I don't see us coming to a point until everyone and every part and every sector of the community owns it. It's not just a problem of the people around the state.

MS. OLSON: We need a woman president. When we have a woman president, I think that might make a difference. I just say that lightly and I say it very seriously because I think this is an issue that women have cared more about, we have been closer to, so I think that's an important thing, too, and I hope in our lifetime that might happen. Somebody's lifetime here anyway.

And there are bright stars around the world. Reggie Omelia, people have all heard about. There's this little community in Italy who decided after World War II that the devastation of that was enough that they would put all their resources into children and never use any of their tax money to fight anymore. And so over 35 years, in a very quiet way, they developed a model of excellence where children represent their knowledge in 100 languages, and it's been -- become this sacred place where people from America run over there and look at it and they come home and put out some pretty things on the table. They do more than that, but we're all kind of imitating that place, and we could have a place like that in this country, too, and we could have a place like that in Cleveland where people would come here and look at a model.

And I think we have the expertise and we have the resources to do that, but maybe there has to be a way to coordinate that. There are places in -- Seattle has wonderful early childhood models of excellence. I think the Chicago Commons in Chicago in a very low income neighborhood as a model, they took their curriculum from Reggie Omelia. They used that. So I think we could together maybe think of ways to have demonstration schools where people would come and say, this is how it should look for all children and that's important.

MS. EGBERT: There's certainly places that are starting to step up to the plate in terms of public investment. I agree with you completely that there are these wonderful models and we are lucky to have what we already talked about here in our community in terms of Invest in Children, but the county can't go at it alone. As we look around the country, we don't have to look really all that far to places that aren't too dissimilar to Cleveland or to Ohio to see where really a stronger level of public commitment has been made, whether it's in Florida where voters passed a Constitutional amendment saying we're going to have the opportunity for universal quality learning experiences for all four year olds in the state or in the state of New Jersey where they use their Supreme Court case around school funding to say that we're going to build in a preschool component to our public policy debate around how we fund schools in New Jersey.

Obviously, that's an avenue that is available in Ohio, as well. New York did it by legislation saying access to a quality early learning opportunity is going to be available for four year Olds and they did it through their state legislature. So there's a variety of mediums to choose from a public standpoint that we just need to collectively capture the political will to do it here in Ohio.

MS. OSBORNE-FEARS: I think two comments on the model issue. I think that what we have seen is that there are lots of other models on how to do early childhood classrooms, preschool, a good medical model and then another program may have a good parenting model. What we know as a field is that the model has to be comprehensive, and so as we begin to move forward, I think part of what we're looking for is is there a model that's a community model that addresses the health care, the parenting, the early care and education portion of it, economics, because if the basic needs of a family aren't met, we can just shut down this conversation right now and let's get them some food and a house.

I think our biggest challenge is where do we find that type of a model that puts it all together where a community is coming together the best, because I happen to believe that northeast Ohio has the best and the brightest and we have some of the best services in northeast Ohio, which includes Summit County, and we have put it together both in the public sector as well as in the non-profit sector as well as in the for-profit sector. We have the best. We have the best media. We have the best of almost everything, and there is no reason why we can't put it all together.

But once again, the whole issue around public will and I know I baited the gentleman at the summit because no one was getting into it and so I knew that would make some people pretty angry, but the whole issue of building public will is something that is critical.

In June of 2003, which was last year, we issued a report on working family policies and we surveyed all of the corporations, both small -- well, not all but a substantial number of them, small, medium and large, in our four-county area, and what's interesting is that all of the employers cited that they thought working family friendly policies were very important and they rated very high on their list. But when we asked the question of, you know, which of these services do you provide, very few of them provided any but they thought it was very important. I understand what is going on because they still think that there's a lot of liability and then there's the issue of if we provide child care support, to name one, what do we provide for the employees that we have that don't have small kids. So the whole issue of equity.

So I think as we begin to have this dialogue around or continue the dialogue around how do we build public will and how do we build working family friendly work places that we really have to begin to talk about the whole community. You know, what's good for grandma is good for the little child. The little child needs grandma. Grandma is a very important person in that child's life. We need for grandma to have health insurance. We need her healthy. We need for her to have housing. We need her to have that. So I think that part of our big challenge in this country is how do we bring it all together and how do we work on it all together and view the family as the family.

MS. EGBERT: There seems like there's some live opportunities in the not too distant future to try and really push this question. We know that our civic leadership in this community has a conversation that's going on around poverty. Those were startling numbers that came out a few weeks ago and the banner headlines in The Plain Dealer around our having the highest level of poverty in the country, in this community. We know there's a huge civic debate going on around how to invest economic development dollars. Most of that conversation so far seems to center around high tech and job development kinds of things, very important. But why shouldn't this issue of early childhood development be on the table in those set of conversations, as well, because it does help our future work force.

And then finally, I mean, in the not too distant future, we'll be choosing a new governor in this state with another election around the corner. 2006 might seem a little far away, but there's time and opportunity on an electoral level for folks who care about this issue, not only just us but so many others, to say this is an issue that should be a priority for the next person that leads this state.

MS. PRICE: Just to kind of comment to that, too, and I think we can do a plug for some of our colleagues who are not immediately here at this panel, and I am thinking specifically of the Voices for Children's forum apropos of your comment about candidates and how do you support that, and that is upcoming October 4th at the Trinity Cathedral is the arena for that. It's not religious, but that happens to be -- they have a nice facility and they welcomed us through the doors, and I think that that always is an interesting event and it certainly is the one that begs the question who's for children and who is just kidding.

MR. FROLIK: I want to take, maybe in closing, something that Billie just mentioned about the multi-generational thing and the overall health of families, and maybe, John, maybe you could talk to us a little bit about that family unit and stuff. We started out talking about how children develop.

How important is having the cross-generational contacts, the social environment in which a child grows up? How important is that in determining, again, sort of are they going to be able to meet their sort of maximum potential.

DR. DUBY: Well, I think that it's vital that a child grow up within a healthy family and that a healthy family has a support system in place that allows it to have a little bit of give and take and room for when there's stress, to have some extra support, and certainly an extended family can provide that for many but not for all.

We know with our mobile society these days, there aren't as many of us who live near our own parents and so our children don't have that same opportunity to have that multi-generational experience. It's a valuable experience and it's hard to find a substitute for that, but it's also an opportunity, perhaps. We talk about the issues of, you know, how can a grandparent think about the needs of the grandchild.

One of the things that the American Academy of Pediatrics is trying to do right now is engage AARP in a dialogue where we begin to talk about don't you want your grandchild to have the same kind of health care that you have and what can we do to work together to meet the needs of our youngest ones who don't have a voice in our legislature and who don't have somebody who's there every day lobbying for them except in very limited ways. So there's that family context that is so important, but then there's opportunities to start to engage those different generations to become advocates for the kids and we talk about are we going to have a community forum where we talk to our legislators about these kinds of issues. Well, we all have an opportunity to do that.

I heard some statistics before that one call to a congressman or senator's office represents hundreds or thousands of votes so that each of us has an opportunity to make an impact on that public policy if we just take the time to write a letter or make a phone call or attend a rally or ask a question, and those are the things that are going to get this dialogue going, I think.

MR. FROLIK: Okay. Great. Well, thank you. We have had a good conversation here today. Thank you all.