Children's early social experiences shape their developing neurological and biological systems for good or for ill, writes Ross Thompson, and the kinds of stressful experiences that are endemic to families living in poverty can alter children's neurobiology in ways that undermine their health, their social competence, and their ability to succeed in school and in life. For example, when children are born into a world where resources are scarce and violence is a constant possibility, neurobiological changes may make them wary and vigilant, and they are likely to have a hard time controlling their emotions, focusing on tasks, and forming healthy relationships. Unfortunately, these adaptive responses to chronic stress serve them poorly in situations, such as school and work, where they must concentrate and cooperate to do well. But thanks to the plasticity of the developing brain and other biological systems, the neurobiological response to chronic stress can be buffered and even reversed, Thompson writes, especially when we intervene early in children's lives. In particular, warm and nurturing relationships between children and adults can serve as a powerful bulwark against the neurobiological changes that accompany stress, and interventions that help build such relationships have shown particular promise. These programs have targeted biological parents, of course, but also foster parents, teachers and other caregivers, and more distant relatives, such as grandparents. For this reason, Thompson suggests that the concept of two-generation programs may need to be expanded, and that we should consider a "multigenerational" approach to helping children living in poverty cope and thrive in the face of chronic stress.

Most of the authors in this issue of Future of Children focus on a single strategy for helping both adults and children that could become a component of two-generation programs. Lindsay Chase-Lansdale and Jeanne Brooks-Gunn, on the other hand, look at actual programs with an explicit two-generation focus that have been tried in the past or are currently under way. These explicitly two-generation programs have sought to build human capital across generations by combining education or job training for adults with early childhood education for their children. Chase-Lansdale and Brooks-Gunn explain the theories behind these programs and review the evidence for their efficacy. A first wave of such programs in the 1980s and 1990s produced mostly disappointing results, but the evaluations they left behind pointed to promising new directions. More recently, a second wave of two-generation programs--the authors dub them "Two-Generation 2.0"--has sought to rectify the flaws of earlier efforts, largely by building strong connections between components for children and adults, by ensuring that children and adults receive services of equal duration and intensity, and by incorporating advances in both education and workforce development. These Two-Generation 2.0 programs are still in their infancy, and we have yet to see clear evidence that they can achieve their goals or be implemented cost-effectively at scale. Nonetheless, Chase-Lansdale and Brooks-Gunn write, the theoretical justification for these programs is strong, their early results are promising, and the time is ripe for innovation, experimentation, and further study.

Much research on children in military families has taken a deficit approach--that is, it has portrayed these children as a population susceptible to psychological damage from the hardships of military life, such as frequent moves and separation from their parents during deployment. But M. Ann Easterbrooks, Kenneth Ginsburg, and Richard M. Lerner observe that most military children turn out just fine. They argue that, to better serve military children, we must understand the sources of strength that help them cope with adversity and thrive. In other words, we must understand their resilience. The authors stress that resilience is not a personal trait but a product of the relationships between children and the people and resources around them. In this sense, military life, along with its hardships, offers many sources for resilience--for example, a strong sense of belonging to a supportive community with a shared mission and values. Similarly, children whose parents are deployed may build their self-confidence by taking on new responsibilities in the family, and moving offers opportunities for adventure and personal growth. As the wars in Iraq and Afghanistan drew more and more service members into combat, the military and civilian groups alike rolled out dozens of programs aimed at boosting military children's resilience. Although the authors applaud this effort, they also note that few of these programs have been based on scientific evidence of what works, and few have been rigorously evaluated for their effectiveness. They call for a program of sustained research to boost our understanding of military children's resilience.

How do we screen all families in a population at a single time point, identify family-specific risks, and connect each family with evidence-based community resources that can help them overcome those risks-an approach known as ? In this article, Kenneth A. Dodge and W. Benjamin Goodman describe Family Connects, a program designed to do exactly that. Developed and tested in Durham, NC, Family Connects-now in place at 16 sites in the United States-aims to reach every family giving birth in a given community. The program rests on three pillars. The first is : trained nurses (or other program representatives) welcome new babies into the community, typically at the birthing hospital, then work with the parents to set up one or more home visits when the baby is about three weeks old so they can identify needs and connect the family with community resources. The second pillar, , is an assembly of all community resources available to families at birth, including child care agencies, mental health providers, government social services, and long-term programs for subgroups of families with identified needs, such as Healthy Families and Early Head Start. The third pillar, , is an electronic data system that acts as a family-specific psychosocial and educational record (much like an electronic health record) to document nurses' assessments of mother and infant, as well as connections with community agencies. In randomized clinical trials, Family Connects has shown promising results. Compared to control group families, families randomly assigned to the program made more connections to community resources. They also reported more positive parenting behaviors and fewer serious injuries or illnesses among their infants, among other desirable outcomes. And in the first five years of life, Family Connects children were significantly less likely to be subject to Child Protective Services investigations than were children in a control group.

Since modern welfare reform began in the 1980s, we have seen low-income parents leave the welfare rolls and join the workforce in large numbers. At the same time, the Earned Income Tax Credit has offered a monetary incentive for low-income parents to work. Thus, unlike some of the other two-generation mechanisms discussed in this issue of Future of Children, policies that encourage low-income parents to work are both widespread and well-entrenched in the United States. But parents' (and especially mothers') work, writes Carolyn Heinrich, is not unambiguously beneficial for their children. On the one hand, working parents can be positive role models for their children, and, of course, the income they earn can improve their children's lives in many ways. On the other hand, work can impair the developing bond between parents and young children, especially when the parents work long hours or evening and night shifts. The stress that parents bring home from their jobs can detract from their parenting skills, undermine the atmosphere in the home, and thereby introduce stress into children's lives. Unfortunately, it is low-income parents who are most likely to work in stressful, low-quality jobs that feature low pay, little autonomy, inflexible hours, and few or no benefits. And low-income children whose parents are working are more likely to be placed in inadequate child care or to go unsupervised. Two-generation approaches, Heinrich writes, could maximize the benefits and minimize the detriments of parents' work by expanding workplace flexibility, and especially by mandating enough paid leave so that mothers can breastfeed and form close bonds with their infants; by helping parents place their children in high-quality child care; and by helping low-income parents train for, find, and keep a well-paying job with benefits.

When a service member is injured or dies in a combat zone, the consequences for his or her family can be profound and long-lasting. Visible, physical battlefield injuries often require families to adapt to long and stressful rounds of treatment and rehabilitation, and they can leave the service member with permanent disabilities that mean new roles for everyone in the family. Invisible injuries, both physical and psychological, including traumatic brain injury and combat-related stress disorders, are often not diagnosed until many months after a service member returns from war (if they are diagnosed at all-many sufferers never seek treatment). They can alter a service member's behavior and personality in ways that make parenting difficult and reverberate throughout the family. And a parent's death in combat not only brings immediate grief but can also mean that survivors lose their very identity as a military family when they must move away from their supportive military community. Sifting through the evidence on both military and civilian families, Allison Holmes, Paula Rauch, and Stephen Cozza analyze, in turn, how visible injuries, traumatic brain injuries, stress disorders, and death affect parents' mental health, parenting capacity, and family organization; they also discuss the community resources that can help families in each situation. They note that most current services focus on the needs of injured service members rather than those of their families. Through seven concrete recommendations, they call for a greater emphasis on family-focused care that supports resilience and positive adaptation for all members of military families who are struggling with a service member's injury or death.

It might seem strange to ask whether increasing access to medical care can improve children's health. Yet Lindsey Leininger and Helen Levy begin by pointing out that access to care plays a smaller role than we might think, and that many other factors, such as those discussed elsewhere in this issue, strongly influence children's health. Nonetheless, they find that, on the whole, policies to improve access indeed improve children's health, with the caveat that context plays a big role-medical care "matters more at some times, or for some children, than others." Focusing on studies that can plausibly show a causal effect between policies to increase access and better health for children, and starting from an economic framework, they consider both the demand for and the supply of health care. On the demand side, they examine what happens when the government expands public insurance programs (such as Medicaid), or when parents are offered financial incentives to take their children to preventive appointments. On the supply side, they look at what happens when public insurance programs increase the payments that they offer to health-care providers, or when health-care providers are placed directly in schools where children spend their days. They also examine how the Affordable Care Act is likely to affect children's access to medical care. Leininger and Levy reach three main conclusions. First, despite tremendous progress in recent decades, not all children have insurance coverage, and immigrant children are especially vulnerable. Second, insurance coverage alone doesn't guarantee access to care, and insured children may still face barriers to getting the care they need. Finally, as this issue of demonstrates, access to care is only one of the factors that policy makers should consider as they seek to make the nation's children healthier.

For poor families, the possession of assets--savings accounts, homes, and the like--has the potential not only to relieve some of the stress of living in poverty but also to make a better future seem like a real possibility. If children in families that own certain assets fare better than children in families without them, then helping poor families build those assets would be an effective strategy for two-generation programs. Indeed, write Michal Grinstein-Weiss, Trina Williams Shanks, and Sondra Beverly, plenty of evidence shows that assets are connected to positive outcomes for poor children. For example, young people who have any college savings at all, even a very small amount, are more likely to go to college; children in households with assets score higher on standardized achievement tests; and children of homeowners experience fewer behavioral problems. But this evidence comes from longitudinal data sets and is therefore correlational. Looking for causal relationships, the authors examine the results of experimental programs that opened various types of savings accounts for poor people and matched their contributions. Several of these trials included a control group that did not receive a savings account, making it possible to attribute any positive outcomes directly to the savings accounts rather than to their owners' personal characteristics. These programs dispelled the myth that poor people can't save; participants were generally able to accumulate savings. It's too early to tell, however, whether assets and asset-building programs have long-term effects on children's wellbeing, though one experiment found positive impacts on disadvantaged children's social-emotional development at age four. The most promising programs share several features: they are opened early in life; they are opened automatically, with no action required from the recipients; and they come with an initial deposit.

In recent decades, writes Wendy Manning, cohabitation has become a central part of the family landscape in the United States-so much so that by age 12, 40 percent of American children will have spent at least part of their lives in a cohabiting household. Although many children are born to cohabiting parents, and cohabiting families come in other forms as well, the most common cohabiting arrangement is a biological mother and a male partner. Cohabitation, Manning notes, is associated with several factors that have the potential to reduce children's wellbeing. Cohabiting families are more likely than married families to be poor, and poverty harms children in many ways. Cohabiting parents also tend to have less formal education-a key indicator of both economic and social resources-than married parents do. And cohabiting parent families don't have the same legal protections that married parent families have. Most importantly, cohabitation is often a marker of family instability, and family instability is strongly associated with poorer outcomes for children. Children born to cohabiting parents see their parents break up more often than do children born to married parents. In this way, being born into a cohabiting family sets the stage for later instability, and children who are born to cohabiting parents appear to experience enduring deficits of psychosocial wellbeing. On the other hand, stable cohabiting families with two biological parents seem to offer many of the same health, cognitive, and behavioral benefits that stable married biological parent families provide. Turning to stepfamilies, cohabitation's effects are tied to a child's age. Among young children, living in a cohabiting stepfamily rather than a married stepfamily is associated with more negative indicators of child wellbeing, but this is not so among adolescents. Thus the link between parental cohabitation and child wellbeing depends on both the type of cohabiting parent family and the age of the child.

The United States shows striking racial and ethnic differences in marriage patterns. Compared to both white and Hispanic women, black women marry later in life, are less likely to marry at all, and have higher rates of marital instability. Kelly Raley, Megan Sweeney, and Danielle Wondra begin by reviewing common explanations for these differences, which first gained momentum in the 1960s (though patterns of marital instability diverged earlier than patterns of marriage formation). Structural factors-for example, declining employment prospects and rising incarceration rates for unskilled black men-clearly play a role, the authors write, but such factors don't fully explain the divergence in marriage patterns. In particular, they don't tell us why we see racial and ethnic differences in marriage across all levels of education, and not just among the unskilled. Raley, Sweeney and, Wondra argue that the racial gap in marriage that emerged in the 1960s, and has grown since, is due partly to broad changes in ideas about family arrangements that have made marriage optional. As the imperative to marry has fallen, alongside other changes in the economy that have increased women's economic contributions to the household, socioeconomic standing has become increasingly important for marriage. Race continues to be associated with economic disadvantage, and thus as economic factors have become more relevant to marriage and marital stability, the racial gap in marriage has grown.

As this issue of the Future of Children makes clear, we have much yet to learn about military children and their families. A big part of the reason, write Anita Chandra and Andrew London, is that we lack sufficiently robust sources of data. Until we collect more and better data about military families, Chandra and London say, we will not be able to study the breadth of their experiences and sources of resilience, distinguish among subgroups within the diverse military community, or compare military children with their civilian counterparts. After surveying the available sources of data and explaining what they are lacking and why, Chandra and London make several recommendations. First, they say, major longitudinal national surveys, as well as administrative data systems (for example, in health care and in schools), should routinely ask about children's connections to the military, so that military families can be flagged in statistical analyses. Second, questions on national surveys and psychological assessments should be formulated and calibrated for military children to be certain that they resonate with military culture. Third, researchers who study military children should consider adopting a life-course perspective, examining children from birth to adulthood as they and their families move through the transitions of military life and into or out of the civilian world.

Families who live in poverty face disadvantages that can hinder their children's development in many ways, write Greg Duncan, Katherine Magnuson, and Elizabeth Votruba-Drzal. As they struggle to get by economically, and as they cope with substandard housing, unsafe neighborhoods, and inadequate schools, poor families experience more stress in their daily lives than more affluent families do, with a host of psychological and developmental consequences. Poor families also lack the resources to invest in things like high-quality child care and enriched learning experiences that give more affluent children a leg up. Often, poor parents also lack the time that wealthier parents have to invest in their children, because poor parents are more likely to be raising children alone or to work nonstandard hours and have inflexible work schedules. Can increasing poor parents' incomes, independent of any other sort of assistance, help their children succeed in school and in life? The theoretical case is strong, and Duncan, Magnuson, and Votruba-Drzal find solid evidence that the answer is yes--children from poor families that see a boost in income do better in school and complete more years of schooling, for example. But if boosting poor parents' incomes can help their children, a crucial question remains: Does it matter when in a child's life the additional income appears? Developmental neurobiology strongly suggests that increased income should have the greatest effect during children's early years, when their brains and other systems are developing rapidly, though we need more evidence to prove this conclusively. The authors offer examples of how policy makers could incorporate the findings they present to create more effective programs for families living in poverty. And they conclude with a warning: if a boost in income can help poor children, then a drop in income--for example, through cuts to social safety net programs like food stamps--can surely harm them.

Military children don't exist in a vacuum; rather, they are embedded in and deeply influenced by their families, neighborhoods, schools, the military itself, and many other interacting systems. To minimize the risks that military children face and maximize their resilience, write Harold Kudler and Colonel Rebecca Porter, we must go beyond clinical models that focus on military children as individuals and develop a public health approach that harnesses the strengths of the communities that surround them. In short, we must build communities of care. One obstacle to building communities of care is that at many times and in many places, military children and their families are essentially invisible. Most schools, for example, do not routinely assess the military status of new students' parents. Thus Kudler and Porter's strongest recommendation is that public and private institutions of all sorts--from schools to clinics to religious institutions to law enforcement--should determine which children and families they serve are connected to the military as a first step toward meeting military children's unique needs. Next, they say, we need policies that help teachers, doctors, pastors, and others who work with children learn more about military culture and the hardships, such as a parent's deployment, that military children often face. Kudler and Porter review a broad spectrum of programs that may help build communities of care, developed by the military, by nonprofits, and by academia. Many of these appear promising, but the authors emphasize that almost none are backed by strong scientific evidence of their effectiveness. They also describe new initiatives at the state and federal levels that aim to break down barriers among agencies and promote collaboration in the service of military children and families.

Parents' health and children's health are closely intertwined--healthier parents have healthier children, and vice versa. Genetics accounts for some of this relationship, but much of it can be traced to environment and behavior, and the environmental and behavioral risk factors for poor health disproportionately affect families living in poverty. Unhealthy children are likely to become unhealthy adults, and poor health drags down both their educational attainment and their income. Because of the close connection between parents' and children's health, write Sherry Glied and Don Oellerich, we have every reason to believe that programs to improve parents' health will improve their children's health as well. Yet few programs aim to work this way, except for a narrow category of programs that target pregnant women, newborns, and very young children. Glied and Oellerich assess these programs, discuss why there are so few of them, and suggest ways to expand them. Their chief conclusion is that structural barriers in the U.S. healthcare system stand in the way of such programs. Some of these barriers have to do with health insurance, access to care, and benefits, but the biggest one is the fact that physicians typically specialize in treating either children or adults, rather than families as a whole. The Affordable Care Act has begun to break down some of these barriers, the authors write, but much remains to be done.

How are children's lives altered when a parent goes off to war? What aspects of combat deployment are most likely to put children at risk for psychological and other problems, and what resources for resilience can they tap to overcome such hardships and thrive? To answer these questions, Patricia Lester and Lieutenant Colonel Eric Flake first examine the deployment cycle, a multistage process that begins with a period of anxious preparation after a family receives notice that a parent will be sent into combat. Perhaps surprisingly, for many families, they write, the most stressful part of the deployment cycle is not the long months of separation that follow but the postdeployment period, when service members, having come home from war, must be reintegrated into families whose internal rhythms have changed and where children have taken on new roles. Lester and Flake then walk us through a range of theoretical perspectives that help us understand the interconnected environments in which military children live their lives, from the dynamics of the family system itself to the external contexts of the communities where they live and the military culture that helps form their identity. The authors conclude that policy makers can help military-connected children and their families cope with deployment by, among other things, strengthening community support services and adopting public health education measures that are designed to reduce the stigma of seeking treatment for psychological distress. They warn, however, that much recent research on military children's response to deployment is flawed in various ways, and they call for better-designed, longer-term studies as well as more rigorous evaluation of existing and future support programs.

Better-educated parents generally have children who are themselves better educated, healthier, wealthier, and better off in almost every way than the children of the less educated. But this simple correlation does not prove that the relationship is causal. Neeraj Kaushal sifts through the evidence from economics and public policy and reviews large national and international studies to conclude that, indeed, education has large intergenerational payoffs in many areas of children's lives, and that these payoffs persist over time. Kaushal shows that, if anything, traditional measures of returns to education--which focus on income and productivity--almost certainly underestimate the beneficial effects that parents' education has on their children. She reports causal positive effects not only on children's test scores, health, and behavior, but also on mothers' behaviors that can affect their children's wellbeing, such as teenage childbearing and substance use. Her findings suggest that, as a component of two-generation programs, helping parents extend their education could go a long way toward reducing inequality across generations and promoting children's healthy development. Thus the rationale for two-generation programs that boost parents' education is compelling. However, Kaushal cautions, the U.S. education system reinforces socioeconomic inequality across generations by spending more money on educating richer children than on educating poorer children. By themselves, then, two-generation programs will not necessarily ameliorate the structural factors that perpetuate inequality in this country.

The U.S. military has come to realize that providing reliable, high-quality child care for service members' children is a key component of combat readiness. As a result, the Department of Defense (DoD) has invested heavily in child care. The DoD now runs what is by far the nation's largest employer-sponsored child-care system, a sprawling network with nearly 23,000 workers that directly serves or subsidizes care for 200,000 children every day. Child-care options available to civilians typically pale in comparison, and the military's system, embedded in a broader web of family support services, is widely considered to be a model for the nation. The military's child-care success rests on four pillars, write Major Latosha Floyd and Deborah A. Phillips. The first is certification by the military itself, including unannounced inspections to check on safety, sanitation, and general compliance with DoD rules. The second is accreditation by nationally recognized agencies, such as the National Association for the Education of Young Children. The third is a hiring policy that sets educational and other requirements for child-care workers, and the fourth is a pay scale that not only sets wages high enough to discourage the rapid turnover common in civilian child care but also rewards workers for completing additional training. Floyd and Phillips sound a few cautionary notes. For one, demand for military child care continues to outstrip the supply In particular, as National Guard and Reserve members have been activated during the wars in Iraq and Afghanistan, the DoD has sometimes struggled to provide child care for their children. And force reductions and budget cuts are likely to force the military to make difficult choices as it seeks to streamline its child-care services in the years ahead.

Health care reaches more children under age three in the United States than any other family-facing system and represents the most common entry point for developmental assessment of and services for children. In this article, Adam Schickedanz and Neal Halfon examine how well the child health care system promotes healthy child development early in life. They also review children's access to health care through insurance coverage, the health care system's evolution in response to scientific and technical advances, and the shifting epidemiology of health and developmental risk. The authors find that the health care system is significantly underperforming because it is constrained by antiquated conventions, insufficient resources, and outmoded incentive structures inherent in the traditional medical model that still dominates pediatric care. These structural barriers, organization challenges, and financial constraints limit the system's ability to adequately recognize, respond to, and, most importantly, prevent adverse developmental outcomes at the population level. To achieve population-level progress in healthy child development, Schickedanz and Halfon argue that pediatric care will need to transform itself and go beyond simply instituting incremental clinical process improvement. This will require taking advantage of opportunities to deliver coordinated services that bridge sectors and focusing not only on reducing developmental risk and responding to established developmental disability but also on optimizing healthy child development before developmental vulnerabilities arise. New imperatives for improved population health, along with the growing recognition among policy makers and practitioners of the social and developmental determinants of health, have driven recent innovations in care models, service coordination, and coverage designs. Yet the available resources and infrastructure are static or shrinking, crowded out by rising overall health care costs and other policy priorities. The authors conclude that child health systems are at a crossroads of conflicting priorities and incentives, and they explore how the health system might successfully respond to this impasse.