Arranging child care.

More than half of the children in families supported by welfare are under age six, and another third are in grade school. The mothers of these children cannot leave welfare for employment unless they can find and pay for child care. Yet, as this article points out, the child care needs of these families are not easily met: Many require care for infants and toddlers, care at odd hours, and care in poor neighborhoods-all of which are scarce. Evidence reviewed by the authors indicates that problems with child care affordability, availability, and quality impede mothers from participating in the labor force and in job training programs. Recent public finding for child care subsidies has helped families leaving welfare to afford the child care they need, although the demand for financial assistance outstrips available funding. This article urges that policymakers work to facilitate access to subsidies, increase the supply of care that can meet the needs of poor working families, and guard against exposure to poor-quality care that can jeopardize both children's well-being and parents' employment.

Do school-based health centers improve adolescents' access to health care, health status, and risk-taking behavior?

PURPOSE: The purpose of this investigation was to assess the School-Based Adolescent Health Care Program, which provided comprehensive health-related services in 24 school-based health centers. METHODS: The outcomes evaluation compared a cohort of students attending 19 participating schools and a national sample of urban youths, using logit models to control for observed differences between the two groups of youths. Outcome measures included self-reports concerning health center utilization, use of other health care providers, knowledge of key health facts, substance use, sexual activity, contraceptive use, pregnancies and births, and health status. RESULTS: The health centers increased students' access to health care and improved their health knowledge. However, the estimated impacts on health status and risky behaviors were inconsistent, and most were small and not statistically significant. CONCLUSIONS: School-based health centers can increase students' health knowledge and access to health-related services, but more intensive or different services are needed if they are to significantly reduce risk-taking behaviors.

Child care for children in poverty: opportunity or inequity?

Data from a nationally representative survey of child care centers and a 5-site, observational study of centers were used to examine the quality of care provided to children from low-income families. Comparisons were made to a national sample of centers; among Head Start, public school-sponsored, and other community-based subsidized centers; and among centers that served families from differing socioeconomic groups. The quality of care in centers that served predominantly low-income children was adequate, but highly variable, with structural indices exhibiting higher quality than observations of global quality and of staff-child interactions. When compared to Head Start and public school-sponsored centers, the community-based centers had smaller groups and fewer children per teacher for preschoolers, but also had less well educated and compensated staff. Centers that predominantly served children from upper-income families provided the highest quality of care across multiple indices, and those that predominantly served children from middle-income families almost uniformly provided the poorest quality of care. The centers that served children from low-income families did not differ significantly in quality from the upper-income centers on most indices. However, the teachers in these programs were observed to be less sensitive and more harsh than teachers in the centers that served more advantaged families. The implications of the findings for research and policy are discussed.