This political season, one cannot help but be impressed by the widely divergent and perhaps exaggerated views expressed by presidential candidates. As both Democratic and Republican candidates attempt to distinguish themselves, claims of extreme progressivism and conservatism abound.
As many pundits have noted, the current political climate is unique and contrary to conventional wisdom and practice. By design, our political structures and processes typically maintain the status quo, with only occasional bursts of change. Political scientists Baumgartner and Jones used the term “punctuated equilibrium theory” to explain these long periods of policymaking stability and policy continuity, occasionally disrupted by short but intense periods of instability. They adapted the phrase from evolutionary scientists Stephen Jay Gould and Niles Eldredge who, in 1972, proposed the term to describe a mode of evolution in which species are generally morphologically stable, changing little for millions of years. This leisurely pace is “punctuated” by rapid change that results in a new species.
In this context, Bernie Sanders’ call for a “political revolution” is all the more noteworthy. It stands in rather sharp contrast to the pleas for incremental change by his opponent, Hillary Clinton. In this part of the nomination race, we are literally seeing the “equilibrium” and the “punctuation” locked in debate, side by side.
Incremental and Revolutionary Change in Child Health Services
Two articles in the most recent issue of the journal Pediatrics (February 2016) illustrate this contrast between incremental and radical change in the delivery of child health services (not politics or zoology).
First, Weisleder and colleagues report on the impact that pediatric primary care interventions focusing on the promotion of positive parenting through reading aloud and play have on vulnerable toddlers’ socio-emotional development. Findings support the efficacy of the Video Interaction Project (VIP) for promoting children’s healthy development, and the authors call for supporting the expansion of pediatric-based parenting programs for the primary prevention of socio-emotional problems before school entry.
The second article, by our collaborator and Help Me Grow New Jersey supporter Manny Jimenez and colleagues, examines the associations between adverse childhood experiences (ACEs) in early childhood and teacher-reported academic/behavioral problems in kindergarten. Among the study population of urban children, the experience of ACEs in early childhood was associated with below-average, teacher-reported academic and literacy skills, as well as behavior problems in kindergarten. The authors conclude that findings underscore the need for integrated, cross-sector approaches to enhance the development of vulnerable children and reference Help Me Grow as playing a critical role in building an integrated system.
Notwithstanding their creativity and efficacy, interventions such as VIP may be viewed as an incremental approach to strengthening the content of child health services. Our own research over the years has informed the delivery of such content as anticipatory guidance and developmental surveillance and screening. Admittedly, evidence-informed interventions such as VIP are modest in number, with Reach Out and Read perhaps best researched of such interventions brought to scale and impact across the country. Other promising practice-based interventions pose logistical and financial challenges (e.g., Healthy Steps for Young Children) or have more limited evidence, to date, of efficacy (e.g., Project DULCE).
The Jimenez article calls for a more “revolutionary” approach—that of active collaboration with partners in education, home visitation, and other social services sectors “in synergistic efforts to strengthen families.” While acknowledging that pediatricians are uniquely positioned to detect adverse experiences and link families to community resources, the authors clearly emphasize the need for cross-sector collaboration in the context of a comprehensive system that includes child health services.
Both/And, Not Either/Or
Politicians embroiled in campaign rhetoric call for completely incremental or thoroughly revolutionary approaches. However, the issue is a straw-man argument when applied to promoting children’s healthy development.
Efforts to strengthen the content of child health services to more effectively engage parents, elicit concerns, and support families are imperative, as reflected in both professional guidelines (e.g., Bright Futures) and technological innovations (e.g., Well-Visit Planner). Yet we must also be mindful that child health services are but one of many sectors so critical to the well-being of families and their young children.
We must continue our efforts to build robust and comprehensive early childhood systems that ensure cross-sector collaboration and the linkage of vulnerable children and their families to crucial community-based programs and services.
During this primary season, candidates have taken extreme, all-or-nothing stances on many issues. In our efforts to promote the healthy development of vulnerable children, we must refrain from this “either/or” mentality. We must embrace all strategies. The choice is not, in fact, between incremental change and revolution. We must advance both to achieve our lofty goals.