Disclaimer: Moving Health Care Upstream is a collaborative effort originally co-led by Nemours Children’s Health System (Nemours) and the Center for Healthier Children, Families & Communities at the University of California- Los Angeles (UCLA). The views and opinions expressed in this article are those of the author(s) and do not necessarily reflect the official policy or position of Nemours, UCLA or the Moving Health Care Upstream initiative.
The COVID-19 pandemic has profound and likely long-lasting impacts on children, youth and families. It has created and exacerbated negative impacts across every aspect of life: mental and physical health, suicidal ideation, learning loss, food insecurity, poverty, a diminished childcare sector, housing insecurity and homelessness, skyrocketing youth unemployment, and growing racial and economic inequities. The American Rescue Plan (P.L. 117-2) makes critical down payments to address these deep challenges and support the resilience of children and youth. The American Families Plan proposes additional, once in a generation investments in children and youth. To most effectively implement the provisions in the American Rescue Plan and build out a bold agenda that can successfully optimize equity, health, and well-being for children and youth over time, we need coordinated, sustained federal leadership.
Alongside the fact that children and youth simply deserve these opportunities, providing them also matters tremendously from a national economic perspective. Children, youth and families are key to current and future economic success. Healthy, productive, and skilled young adults are critical to the nation’s workforce, global competitiveness, public safety and national security. Prioritizing the health and well-being of children will lead to better health and economic outcomes for decades. For example, high-quality birth-to-five programs can have substantial lifecycle return on investment and result in better outcomes in education, health, social behaviors, and employment. Yet, the share of the federal budget devoted to children in FY 2020 was 7.48% — a decline of almost 10% since 2016.
Out of this historic global health crisis comes a unique impetus to invest more deeply in children, youth, and families in order to rebuild. We can develop and implement long-lasting policy changes that prioritize children and youth – a population that simultaneously has huge potential and vulnerability. Delivering effectively, however, requires policymakers to address a structural gap at the federal level that imperils our ability to support the next generation and to stay competitive globally – and prevents us from effectively engaging young people in creating solutions and shaping the future.
This opinion piece calls for filling that gap through the establishment of a White House Office on Children and Youth and a federal Children’s Cabinet to coordinate across agencies to maximize the opportunity to significantly reduce child poverty and improve overall child outcomes.
Establish a White House Office for Children and Youth and a Federal Children’s Cabinet
A White House Office on Children and Youth directly reporting to the President or Vice President, and supported by a Children’s Cabinet with leadership from across key federal agencies, would serve as a single leadership structure to drive an agenda and comprehensive strategy for children and youth from cradle to career. This comprehensive approach is critical — without it, fragmented silos create deep cracks and disconnects that too many children, youth, and families fall into. The Office and Cabinet could set forth a cross-department vision, measurable goals, federal budget and policy agenda for children and youth with a focus on advancing racial and economic justice to ensure all children can enter pre-school, k-12, college, and adulthood healthy, thriving, and ready to learn. In addition to these critical high-level steps, the Office and Children’s Cabinet could also support effective implementation in practice. For example, they could issue guidance, provide technical assistance, disseminate best practices, and implement waivers to federal awardees regarding how to legally share data across sectors, blend and braid funds, and maximize the financial impact of multiple programs serving children, youth and their families.
Build on state and local successes leveraging children’s cabinets to advance policies that address the unique needs of children and youth and lift-up families
Children’s cabinets and similar coordinating entities have been effective at the state and local level. For example, many states have established children’s cabinets that create policy frameworks and strategic plans for addressing the comprehensive needs of children and coordinate cross-agency responses to their needs. Accomplishments include Maryland’s Child Well-Being Scorecard that tracks outcomes for eight child and youth well-being measures, as well as Virginia’s improvements in school attendance, school suspensions, student nutrition and school accreditation. Indiana’s Commission on Improving the Status of Children developed and is implementing a cross-agency Guide for Equity Consideration to identify and help address unintended consequences of policies, practices, and decisions and to incorporate the voices of those most impacted by decisions being made on behalf of Indiana’s children.
In the COVID-19 pandemic, local-level children’s cabinets such as in Hamilton County, Tennessee have served as “quarterbacks” for galvanizing and coordinating cross-sector responses to holistic needs, from meals to computers and internet access to mental health supports to childcare to learning hubs for school-aged youth. The Minneapolis Youth Coordinating Board also engaged young people in generating and spreading reliable information about preventing spread and supporting positive mental health.
If established through an Executive Order, a White House Office on Children and Youth and Children’s Cabinet would address the cross-sector needs of children and youth as we emerge from the pandemic. It would help to rebuild from economic declines that have exacerbated poverty in our nation and would promote long-term equity. Once established, Congress should pass authorizing legislation to memorialize these structures to ensure that they endure.
Establish a National Family and Youth Advisory Board
Youth have powerful lived experiences and insights that policy often fails to account for. Their voices and perspectives should be amplified to inform federal policy. Congress should provide funding to establish a National Family and Youth Advisory Board consisting of young people aged 14-26, as well as families to help represent the needs of younger children. The Advisory Board would review federal policy on an ongoing basis, drawing best practices from existing boards at the state and local level and would engage with the Cabinet and Office.
Similar structures exist and are growing at the state and local level, where youth engagement and advisory entities aim to create channels for youth power, rely on their lived experiences as critical knowledge, provide a forum to express ideas and bridge the gap between elected officials and the youth they serve. Examples can be found from the Minneapolis Youth Congress to the New Orleans Youth Advisory Board, from the Maryland Youth Advisory Council to the Maine Young People’s Caucus to the State of Iowa Youth Advisory Council and Youth Action Squads. They help inform policy priorities, review existing programs and initiatives, make recommendations on policies impacting youth and envision new solutions. Establishing a similar structure at the federal level would promote greater civic engagement, better policy decisions, and ultimately better outcomes for young people in America.
Organize a White House Conference on Children and Youth
A White House Conference on Children and Youth would harness the power of the bully pulpit to shine light on the needs of children, youth and their families; bring greater attention to existing and emerging research; and highlight policy solutions to advance racial and economic equity for families. It could broadly engage policymakers, nonprofits, the private sector, and children, youth and families themselves.
Since 1909, White House Conferences on Children have led to action within and beyond the government sector. Early conferences had a great impact on the programs and services for children and youth with special health care needs. Accomplishments of more recent White House conferences and summits include contributions to the growth of adoption agencies, administrative action to strengthen the Amber Alert system, and greater awareness of research on early brain development that informed policy and resource allocations. Similar White House conferences to end hunger have resulted in substantial cross-sector collaboration, including the implementation and improvement of the Supplemental Nutrition Assistance Program; the Special Supplemental Nutrition Program for Women, Infants and Children; and the National School Lunch Program.
Given the enormous stressors on the systems serving children in the wake of the COVID-19 pandemic, there is a powerful opportunity for another summit, combined with a federal backbone structure for children and youth, to once again spur meaningful policy change for children, youth and their families.
Harness the Power of Foundations and the Private Sector
The philanthropic community and the private sector have a meaningful role to play in supporting strong policies and programs for children, youth and families. Their grantees can bring voice to powerful, lived experiences, and they can provide technical assistance and know-how to help, research, evaluate, spread and scale what works. The new Administration should meaningfully engage nonprofits, philanthropy, businesses and community leaders in developing, funding and implementing the National Children and Youth Strategy. My Brother’s Keeper and Partnership for a Healthier America could offer instructive models.
Children and youth will endure some of the most lasting effects from the pandemic, as an entire generation experienced potential exposure to adverse childhood experiences that could impact them for years to come. Our nation’s pandemic response should include an enhanced focus on identifying, advancing and coordinating federal policies to promote the physical and mental health, educational outcomes, and equity for children and youth now and in years to come. The new Administration and Congress should use their respective executive power and legislative authority to develop, fund and sustain a federal leadership structure for children and youth, building on the recommendations above.
• Daniella Gratale, Director, Office of Child Health Policy and Advocacy, Nemours Children’s Health System
• Joshua Ogburn, Manager of Policy, Office of Child Health Policy and Advocacy, Nemours Children’s Health System
• Kara Odom Walker, Executive Vice President and Chief Population Health Officer, Nemours Children’s Health System
• Nathaniel Counts, Senior Vice President of Behavioral Health Innovation, Mental Health America
• Bruce Lesley, President, First Focus on Children
• Elizabeth Gaines, Executive Director, Children’s Funding Project
• Mary Ellen Wiggins, Director of Policy & Research, Forum for Youth Investment
• Jennifer Davis, Senior Advisor, The Education Redesign Lab, Harvard Graduate School of Education