1. U.S.G. Action Plan on Children in Adversity Strategic framework for international assistance White House Launch December 2012 www.childreninadversity.org

2. Children in Adversity: who are they? 1.9 billion children in LMIC Adversity: Serious deprivation or danger Poor health and nutrition Lack of stimulation- attachment (< 5 years) Living outside of family care Exposure to violence, exploitation, abuse United Nations Population Division World Population Prospects 2010 UNICEF State of the World’s Children 2012

3. FIRST YEAR -8 -7 -6 -5 -4 -3 -2 -1 1 2 3 4 5 6 7 8 9 10 11 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 Birth(Months)(Years) Sensory Pathways (Vision, Hearing) Language Higher Cognitive Function Source: C.A. Nelson (2000) Neural Circuits are Wired in a Bottom-Up Sequence

4. Early Experiences Leave Lasting Chemical “Signatures” on Genes External Experience Gene Regulatory Proteins Epigenetic “Signature” Turns Gene On or Off

5. U.S.G. Framework for International Assistance Promote Evidence- Base Integration Strengthen Systems Put Family Care First Protect Children from Violence, Exploitation, Abuse, and Neglect Build Strong Beginnings PRINCIPAL SUPPORTING OBJECTIVES 1 3 4 5 6 2

6. “It is easier to build strong children than to repair broken men.” Frederick Douglass 6 Obj 1 - Build Strong Beginnings

7. The global burden 6.9 million children under the age of 5 worldwide die each year. More than 25 times that number -- over 200 million children -- survive, but do not reach their developmental potential. As a result, their countries have an estimated 20 percent loss in adult productivity. Grantham McGregor, S. et al., (2007). Developmental potential in the first 5 years for children in developing countries. Lancet, 369:60-70 WHO and UNICEF. Care for Development. 7 Obj 1 - Build Strong Beginnings

8. 109 891 Expected to die before their 5 th birthday. Expected to live past their 5 th birthday. Approximately 1/3 are not expected to reach their developmental potential Grantham-McGregor et al. Lancet. 2007 January 6; 369(9555): 60–70 In Sub-Saharan Africa, for every 1000 children born in 2011… 8 Obj 1 - Build Strong Beginnings

9. Adversity impairs development 9 Obj 1 - Build Strong Beginnings

10. Jamaica Study 10

11. Sustained results Source: Van der Gaag, J. School Performance and Physical Growth of Underprivileged Children: Results of the Bogotá Project at Seven Years. (1983). World Bank, Washington D.C. 11 Obj 1 - Build Strong Beginnings

12. “Any proposed programs should respect the primacy of the family.” James J. Heckman, Nobel Laureate in Economics 12 Obj 2 - Put Family Care First

13. The global burden Children outside of family care – have fallen off the statistical map. Global estimates: 17.8 million children have lost both parents 2-8 million children may be living in institutional care 1.1 million children are trafficked for forced labor 1.8 million children are victims of sex trafficking or pornography 300,000 children are associated with armed forces or groups All children count, but not all children are counted. 13 Obj 2 - Put Family Care First

14. Children are at high risk of growing up without a biological parent, usually their father Percentage of children under 5 living with their biological mother but w/o their biological father Percentage of children under 5 living with their biological father but without their biological mother, and Percentage of children under 5 living without both biological parents (x-axis) Source: UNICEF. Inequities in Early Childhood Development: What the data say - Evidence from the Multiple Indicator Cluster Surveys. February 2012. Figure 5, Page 9. Note: This analysis included 40 countries. 14 Obj 2 - Put Family Care First

15. The effects of caregiving Institutionalization can lead to serious developmental, cognitive, emotional delays and challenges.  Children placed in appropriate family care by age 2 recover normative growth and development by age 8.  Children removed from institutions after age 2 do not reach normative ranges. EEG level: Institutionalized childrenEEG level: Never-institutionalized children Placing children in protective family care results in better child outcomes and is significantly less expensive than institutional care. 15 Obj 2 - Put Family Care First

16. “Safety and security don’t just happen; they are the result of collective consensus and public investment. We owe our children, the most vulnerable citizens in our society, a life free of violence and fear.” Nelson Mandela 16 Obj 3 - Protect Children

17. The global burden Between 133 million and 275 million children are estimated to witness domestic violence annually. 25-30% of children experience severe forms of punishment. 150 million girls and 73 million boys under 18 experienced forced sexual intercourse or other forms of sexual violence in one year. 36 percent of girls and 29 percent of boys globally have been sexually abused. 115 million children are engaged in hazardous work; 5.5 million are in forced labor. 1.8 million children are victims of sex trafficking or pornography. An estimated 300,000 children are associated with armed forces or groups. 17 Obj 3 - Protect Children

18. The lasting effects of adversity 18 CDC. Adverse Childhood Experiences. Obj 3 - Protect Children

19. APCA Roll Out Three core outcomes In six priority countries, achieve significant reductions in the number of: 1.Children not meeting age-appropriate growth and developmental milestones 2.Children living outside of family care 3.Children who experience violence and exploitation Results-based Approach

20. Public-Private Partnership Global Alliance for Children Mission: Mobilize public and private knowledge, commitment and resources at the global and country levels to support country-driven strategies and accountability around three core outcomes that will demonstrate significant, measurable and sustainable results for children in adversity, beginning in a select number of countries. Inaugural meeting (February 2013): 19 senior leaders and decision makers 15 organizations 11 nationalities 4 regions

21. Example Outcomes for Cambodian Children  40% reduction in the number of children under the age of five with cognitive delays  70% reduction in the number of children living outside of family care  30% reduction in childhood violence and exploitation