Setting the Pace for Windfall

A scared first-time mom heads home from the hospital with her premature baby. A suburban preschool director has a waiting list and two classrooms but no teachers.

Until a new California cigarette tax created the nation’s largest pot of money for early childhood programs, Alameda County’s ability to deal with these problems was severely limited.

Now, money to pay child-care workers and bring health professionals to infants’ homes will come from the county’s share of a $560-million fund set up by the tax, championed by actor and director Rob Reiner.

What sets Alameda County apart from the rest of California is that it is one of the first counties to take advantage of the windfall.

Partly because of political turf battles and institutional inertia, many counties lag behind. Los Angeles County, for example, has not even come up with a permanent director to help plan how to spend its $170-million share.

Opponents of the controversial 50-cent-a-pack cigarette tax have seized on the delays in their campaign to repeal it with Proposition 28 on the March ballot. The tax passed by a razor-thin margin in November 1998.

Supporters of the repeal effort cite government ineptitude, contending that “not one penny has been spent” on children, education, tobacco research and preventing teenage smoking.

“I think people thought, ‘Oh, we put up this money and it’s actually going to do things,’ ” said Ned Roscoe, a major cigarette distributor.

With that added pressure, Alameda County is increasingly being held up as a model for the rest of the state.

“They’ve done an incredible job, everything that I envisioned a county doing when we passed [the tobacco tax initiative],” said Reiner, who heads the state Children and Families Commission. Reiner called Alameda the state’s “crown jewel.”

Health Worker Visits Vowed

The most ambitious promise in Alameda’s $20-million program is to eventually offer health worker visits to the parents of every infant born there--20,000 annually--building on existing programs that now serve fewer than 1,000.

Social worker Chela Rios Munoz is one of the home visit staff, dividing her time among 25 infants and toddlers. She advises parents on everything from appropriate toys to how to strengthen babies’ neck muscles.

“I get to know these families. I sit on their beds,” Munoz said. “In a clinical setting, I wouldn’t know half what I know about them.”

On a recent afternoon, Munoz sits on the floor with 2-year-old Genesis Vega. Out of her toybag she pulls a Berenstain Bear book. Mother Alma Vega protests that it is in English, but Munoz has brought the book for a reason.

In Spanish she tells the mother: The important thing is that you pull her into your lap (Munoz demonstrates) and talk about the book together.

“Donde esta el oso?” (Where is the bear?) Munoz asks, and Genesis points to it. “Y que es esto?” (And what is this?) It’s a cake, and Genesis says, “Postre.”

Vega did not expect to be pregnant for the first time at age 35, and when her blood pressure shot sky-high, that was a surprise too. The situation quickly worsened, and five months into the pregnancy she found herself having an emergency C-section.

Genesis was born weak and sick, weighing less than a pound and a half. When Vega first saw the palm-sized girl in Oakland’s Children’s Hospital, Genesis could not breathe on her own. Her body was laced with tubes and wires.

It took 4 1/2 months before Genesis was ready to leave the hospital. What might have been a joyous day was filled with anxiety.

“I did not feel brave enough to take my daughter home,” Vega said. “She was so little!”

Offered home visits, Vega eagerly agreed, as do eight in 10 mothers given the option in Alameda County.

When Genesis could not sit up at seven months, Munoz explained that she started out life five months behind the rest.

When her speech did not progress beyond monosyllables, Munoz referred Vega to a speech therapist. Now the girl strings together three-word phrases.

Alameda plans to offer visits to every newborn within the next three years. A similar program started by Vermont Gov. Howard Dean nine years ago is credited with cutting child abuse and neglect by a third in his state, improving kindergarten readiness and helping reduce teenage pregnancy to the nation’s lowest level.

Dean got the idea from a school nurse, who decided to venture outside school gates to visit students at home. He extended it as an option for all infants to avoid stigmatizing the program.

Visiting families at home “helps us understand who really needs the services, even if they don’t ask for them,” Dean said.

Key Leaders Acted Quickly

Credit for Alameda’s early success is generally given to the Alameda Children & Families Commission’s executive director, Mark Friedman, and its chairwoman, county Supervisor Wilma Chan.

Chan, the county board’s president and a former Oakland school board member, is known for her interest in children and a penchant for getting things done. Most recently chief of staff to Chan, Friedman had previously run a community development bank and a children’s services agency.

They moved quickly to establish an interim committee of county supervisors and employees, which drew on recommendations of two countywide planning councils to set funding priorities. The county advanced Friedman a $470,000 loan to get the planning done.

Meanwhile, some counties grappled with issues of control.

A few, including Los Angeles, insisted that the Board of Supervisors would have to approve any expenditures. Those attempts were squelched by a state attorney general’s opinion defending commission autonomy.

California’s sparsely populated rural counties faced a different problem: no money. With allocations based on annual births, counties like Alpine and Sierra in far Northern California found little incentive to get started. Their malaise lifted only last month, when the state commission voted to award all counties a minimum of $200,000 this year.

Others were cautious about spending the money well. Santa Barbara has decided to hold off writing checks until after a three-month application period, followed by a three-month review.

Like a doting parent, Reiner warns against comparisons of counties. The initiative was intended to stir up the status quo, he said, and that takes time.

“When you create something brand new, it doesn’t come with instructions on how to assemble,” said John Redmond, acting children and families director in Los Angeles County.

Bonuses for Child-Care Workers

Whether Alameda County’s approach will work remains to be seen. Already questions are arising about whether it has adequately dealt with the same lack of child-care facilities and workers that plagues the entire state.

The Children & Families Commission plans to create annual bonuses of $500 to $6,000 for child-care workers who seek additional training, based on their education and workload.

In an October poll, 40% of child-care directors surveyed in Alameda County reported that when a preschool teacher quit, it took five weeks or more to find a replacement. Turnover rose to nearly a third this year, from a quarter in 1995.

But with thousands of parents on waiting lists for spaces in child-care centers, many say stipends for workers are hardly enough. Chan counters that were the county to try to address the whole child-care problem, the $20 million “would be gone in a day” and the problem still would not be solved.

Any help at all would be a relief for Sheryl Common, who expanded her 48-student preschool in middle-class Pleasanton just before the state decided to shrink primary class size.

Gone were the preschool teachers with bachelor’s degrees, wooed by the higher salaries and better benefits offered by school districts. Gone with them were the potential profits from an expected doubling of the center’s enrollment and plans for new play equipment, new carpet in the old building and new linoleum.

Common has not been able to find teachers for the two new rooms at her Early Years Children’s Center, with its 100-student waiting list.

The stipends “will make a difference,” Common said. “We need to make early childhood [care] a viable profession.”

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Timetable for Spending on Children

A year after voters approved a 50-cent tax on cigarettes to fund programs for infants and toddlers, Alameda County is the first county ready to begin spending the money.