The Lasting Effects of Early-Childhood Education on Promoting the Skills and Social Mobility of Disadvantaged African Americans and Their Children.

This paper demonstrates the long-term intragenerational and intergenerational benefits of the HighScope Perry Preschool Project, which targeted disadvantaged African-American children. We use newly collected data on the original participants through late middle age and on their children into their mid-twenties. We document long-lasting improvements in the original participants' skills, marriage stability, earnings, criminal behavior, and health. Beneficial program impacts through the childrearing years translate into better family environments for their children leading to intergenerational gains. Children of the original participants have higher levels of education and employment, lower levels of criminal activity, and better health than children of the controls.

Comparing China REACH and the Jamaica Home Visiting Program.

OBJECTIVES: Delayed child skill development is a common phenomenon in low- and middle-income countries. Effective and low-cost strategies suitable for application to less-developed countries are needed. We summarize empirical findings from recent papers that study a replication of the Jamaica Reach Up and Learn home visiting program in China, China REACH, and compare child skill growth profiles in the China Reach Up and Jamaica interventions. METHODS: Different interventions often use different measures for assessing early childhood skill development. To estimate the growth of underlying skills across programs, we address the challenge that different programs use different assessments. We use a modified version of the Rasch model to anchor scores on common items to estimate skill development. RESULTS: Language skill growth curves are comparable for both interventions. This pattern is consistent for the treatment and control groups across the interventions. Skill growth curves are not statistically significantly different between China REACH and Jamaican interventions. We find evidence of the importance of early investment. CONCLUSIONS: The China REACH intervention significantly improves the development of multiple skills. At the same ages, treatment effect sizes and skill growth curves are comparable across the Jamaica and China REACH interventions, despite differences in scale and cultural settings. The scale of the program is much greater in China than in Jamaica, showing that the Jamaican curriculum can be effectively expanded to larger populations. Annual costs per child are roughly $500 (2015 US dollars).

Early childhood learning patterns for a home visiting program in rural China.

This paper uses novel experimental data from a prototypical early childhood home visiting program in China with high-frequency measurements to investigate the growth of multiple skills. After identifying the presence of child skill development on multiple skills during the intervention, we further study the features of child learning patterns. We find that individual heterogeneity and previous task performance (state dependence) are key properties of the child's task performance during the intervention, consistent with models of reinforcement learning.

Parenting Promotes Social Mobility Within and Across Generations.

This paper compares early childhood enrichment programs that promote social mobility for disadvantaged children within and across generations. Instead of conducting a standard meta-analysis, we present a harmonized primary data analysis of programs that shape current policy. Our analysis is a template for rigorous syntheses and comparisons across programs. We analyze new long-run life-cycle data collected for iconic programs when participants are middle-aged and their children are in their twenties. The iconic programs are omnibus in nature and offer many services to children and their parents. We compare them with relatively low-cost more focused home-visiting programs. Successful interventions target both children and their caregivers. They engage caregivers and improve the home lives of children. They permanently boost cognitive and non-cognitive skills. Participants in programs that enrich home environments grow up with better skills, jobs, earnings, marital stability, and health, as well as reduced participation in crime. Long-run monetized gains are substantially greater than program costs for the iconic programs. We investigate the mechanisms promoting successful family lives for participants and report intergenerational effects on their children. A study of focused home-visiting programs that target parents enables us to isolate a crucial component of successful programs: they activate and promote parenting skills of child caregivers. The home-visiting programs we analyze produce outcomes comparable to those of the iconic omnibus programs. National implementation of the programs with long-run follow up that we analyze would substantially shrink the overall US Black-White earnings gap.

Comparing the reliability and predictive power of child, teacher, and guardian reports of noncognitive skills.

Children's noncognitive or socioemotional skills (e.g., persistence and self-control) are typically measured using surveys in which either children rate their own skills or adults rate the skills of children. For many purposes-including program evaluation and monitoring school systems-ratings are often collected from multiple perspectives about a single child (e.g., from both the child and an adult). Collecting data from multiple perspectives is costly, and there is limited evidence on the benefits of this approach. Using a longitudinal survey, this study compares children's noncognitive skills as reported by themselves, their guardians, and their teachers. Although reports from all three types of respondents are correlated with each other, teacher reports have the highest internal consistency and are the most predictive of children's later cognitive outcomes and behavior in school. The teacher reports add predictive power beyond baseline measures of Intelligence Quotient (IQ) for most outcomes in schools. Measures collected from children and guardians add minimal predictive power beyond the teacher reports.

Cognitive, psychosocial, and behaviour gains at age 31 years from the Jamaica early childhood stimulation trial.

BACKGROUND: There is little evidence on adult benefits from early childhood interventions in low and middle-income countries. We assessed adult cognition, psychosocial skills and behaviour from a stimulation trial conducted in Jamaica. METHODS: Children with stunted growth (height-for age <-2SD of references) aged 9-24 months were enrolled in a two-year randomised-controlled trial of nutritional supplementation and/or stimulation. At mean age 31.79 (SD 0.40) years, 95 of 127 participants (74.8%; 53.7% male) were assessed. Children without stunted growth were also followed as a comparison group (64 of 84 participants, 76.2%). Measurements included IQ, executive function, mental health, psychosocial skills, personality traits and risk behaviours. A block permutation test, valid for small sample sizes, was used. Analyses accounted for the randomisation protocol, multiple hypothesis testing and attrition. RESULTS: Treatment group participants (stimulation intervention with or without supplementation, n = 48) had significantly greater IQ (Hedges g effect size 0. 57; 95%CI 0.20, 0.95) and cognitive flexibility (0.61; 0.25, 0.98) compared with no-treatment (no-intervention and supplementation only, n = 47). They also had reduced depressive symptoms (0.61; 0.28, 1.00), increased grit (0.53; 0.16, 0.92) and conscientiousness (0.66; 0.31, 1.07), lower substance use (rank mean score, 0.45; 0.08, 0.81) and risk taking related to health and work (0.64; 0.27, 1.00). There were 18 significant outcomes of 33 assessed. Comparison participants had higher IQ than no-treatment (1.17; 0.81, 1.54) and treatment groups (0.62; 0.18, 1.07); and better executive function, lower social inhibition and risk taking than the no-treatment group. CONCLUSIONS: The wide-ranging benefits at 31 years from the stimulation intervention supports investment in larger scale programmes to promote early childhood development in disadvantaged children. The lower IQ in the treatment group compared with comparison participants, emphasises the need for continued efforts to prevent early childhood growth retardation.

Causal Inference of Social Experiments using Orthogonal Designs.

Orthogonal Arrays are a powerful class of experimental designs that has been widely used to determine efficient arrangements of treatment factors in randomized controlled trials. Despite its popularity, the method is seldom used in social sciences. Social experiments must cope with randomization compromises such as noncompliance that often prevents the use of elaborate designs. We present a novel application of orthogonal designs that addresses the particular challenges arising in social experiments. We characterize the identification of counterfactual variables as a finite mixture problem in which choice incentives, rather than treatment factors, are randomly assigned. We show that the causal inference generated by an orthogonal array of incentives greatly outperforms a traditional design.

The Econometric Model for Causal Policy Analysis.

This paper discusses the econometric model of causal policy analysis and two alternative frameworks that are popular in statistics and computer science. By employing the alternative frameworks uncritically, economists ignore the substantial advantages of an econometric approach, resulting in less informative analyses of economic policy. We show that the econometric approach to causality enables economists to characterize and analyze a wider range of policy problems than alternative approaches.

Using a Satisficing Model of Experimenter Decision-Making to Guide Finite-Sample Inference for Compromised Experiments.

This paper presents a simple decision-theoretic economic approach for analyzing social experiments with compromised random assignment protocols that are only partially documented. We model administratively constrained experimenters who satisfice in seeking covariate balance. We develop design-based small-sample hypothesis tests that use worst-case (least favorable) randomization null distributions. Our approach accommodates a variety of compromised experiments, including imperfectly documented re-randomization designs. To make our analysis concrete, we focus much of our discussion on the influential Perry Preschool Project. We reexamine previous estimates of program effectiveness using our methods. The choice of how to model reassignment vitally affects inference.

Early childhood education and life-cycle health.

This study forecasts the life-cycle treatment effects on health of a high-quality early childhood program. Our predictions combine microsimulation using nonexperimental data with experimental data from a midlife long-term follow-up. The follow-up incorporated a full epidemiological exam. The program mainly benefits males and significantly reduces the prevalence of heart disease, stroke, cancer, and mortality across the life-cycle. For men, we estimate an average reduction of 3.8 disability-adjusted life years (DALYs). The reduction in DALYs is relatively small for women. The gain in quality-adjusted life years is almost enough to offset all of the costs associated with program implementation for males and half of program costs for women.

Quantifying the Life-Cycle Benefits of an Influential Early-Childhood Program.

This paper quantifies and aggregates the multiple lifetime benefits of an influential high-quality early childhood program with outcomes measured through midlife. Guided by economic theory, we supplement experimental data with non-experimental data to forecast the life-cycle benefits and costs of the program. Our point estimate of the internal rate of return is 13.7% with an associated benefit/cost ratio of 7.3. We account for model estimation and forecasting error and present estimates from extensive sensitivity analyses. This paper is a template for synthesizing experimental and non-experimental data using economic theory to estimate the long-run life-cycle benefits of social programs.

Sensitivity of self-reported noncognitive skills to survey administration conditions.

Noncognitive skills (e.g., persistence and self-control) are typically measured using self-reported questionnaires in which respondents rate their own skills. In many applications-including program evaluation and school accountability systems-such reports are assumed to measure only the skill of interest. However, self-reports might also capture other dimensions aside from the skill, such as aspects of a respondent's situation, which could include incentives and the conditions in which they complete the questionnaire. To explore this possibility, this study conducted 2 experiments to estimate the extent to which survey administration conditions can affect student responses on noncognitive skill questionnaires. The first experiment tested whether providing information about the importance of noncognitive skills to students directly affects their responses, and the second experiment tested whether incentives tied to performance on another task indirectly affect responses. Both experiments suggest that self-reports of noncognitive skills are sensitive to survey conditions. The effects of the conditions are relatively large compared with those found in the program evaluation literature, ranging from 0.05 to 0.11 SDs. These findings suggest that the effects of interventions or other social policies on self-reported noncognitive skills should be interpreted with caution.

Medical Scribes, Provider and Patient Experience, and Patient Throughput: a Trial in an Academic General Internal Medicine Practice.

BACKGROUND: Medical scribes have been proposed as a solution to the problems of excessive documentation, work-life balance, and burnout facing general internists. However, their acceptability to patients and effects on provider experience have not been tested in a real-world model of effectiveness. OBJECTIVE: To measure the effect of medical scribes on patient satisfaction, provider satisfaction, and provider productivity. DESIGN: Quasi-experimental difference-in-differences longitudinal design. PARTICIPANTS: Four attending physicians who worked with scribes, 9 control physicians who did not, and their patients in a large, hospital-affiliated academic general internal medicine practice. MAIN MEASURES: Provider experience and patient experience using 5-point Likert scale surveys from the AMA Steps Forward Team Documentation Module, and visits and wRVUs per hour during 4 weeks before and 12 weeks after initiation of a practice model that included use of scribes and a shortened visit template. KEY RESULTS: Participating providers worked a total of 664 clinic sessions and returned 547 (82%) surveys. Average provider experience scores did not differ between providers working with scribes and control providers working without (4.01 vs. 3.40 respectively; p time-by-group interaction = 0.26). Providers with scribes were more likely to agree that work for the encounter would be completed during the visit then controls (3.58 vs. 2.48 respectively; p interaction = 0.04). A total of 6202 visits occurred during the study period. Average patient experience scores did not differ between the experimental and control groups (4.73 vs. 4.75 respectively; p interaction = 0.90). Compared with the control providers, providers with scribes completed more visits per hour (2.29 vs. 1.91; p interaction < 0.001) and generated more wRVUs per hour (3.42 vs. 3.27; p interaction < 0.001). CONCLUSIONS: In this test of a modified practice model, scribes supported greater patient throughput and improved provider perceptions of documentation burden with no decrement in high patient satisfaction.

Early childhood education and crime.

This article presents new evidence on the crime-reducing impacts of a high-quality, intensive early childhood program with long-term follow-up, evaluated by a randomized controlled trial. Proportionately, more women than men decrease their criminal activity after participating in the program. This gender difference arises because of the worse home environments for girls, with corresponding greater scope for improvement by the program. For both genders, treatment effects are larger for the least-advantaged children, as measured by their mother's education at baseline. The dollar value of the social cost of criminal activity averted is higher for men because they commit more costly violent crimes.