NYC’s childcare system is built for the 9-to-5 employee, a grandparent nearby or a daycare down the block. Families who work different hours or can’t afford it are left to figure it out on their own, experts said Monday at a summit on the economics of care.
The Care Dividend, hosted by Epicenter NYC, brought together childcare researchers, employers, health leaders and caregivers at the Commonwealth Fund on Monday. Speakers made the economic case for investing in childcare – and for mental health support, because caregivers deserve care, too.
Here are some of the standout takeaways from health and childcare leaders, advocates and community journalists at the convening:
Caregivers’ choice
Families need meaningful choices that reflect how they actually live and work, said Dr. Elizabeth Wong, a research scientist at the Institute for Equity in Child Opportunity & Healthy Development at Boston University’s School of Social Work.
After all, she said, not all parents want or need formal childcare providers – nor does everyone have family members who can help out. Some parents have 9-to-5 work schedules, while others juggle multiple part-time jobs or keep nontraditional work shifts.
The disparities in who gets more and fewer options are also sharp: While the free 3-K and 2-K rollout this year in New York City were wins for affordability, there are roughly only 2,000 seats available for the program’s first phase.
And, as Council Member Linda Lee noted, childcare providers that operate outside a Department of Education building receive a lower per diem rate of reimbursement than those in one, despite largely teaching the same curriculum. That can make it harder to cover operating costs, recruit childcare workers and expand and can even contribute to closures — making childcare less accessible for families in the neighborhood.
Being flexible about flexibility
An important first step to expand childcare can start with a simple conversation between employers and policymakers to gauge these diverse needs, according to Dr. Darshini Mahadevia, who co-leads the McKinsey Health Institute’s Healthy Workforces division.
“We often jump to … providing a solution before even diagnosing what is actually not working,” she said in conversation with Hari Sreenivasan, anchor of Amanpour & Company.
Businesses feel the childcare shortage when workers can’t show up or need to adjust their schedules. Will Holden, director of storytelling at Gary Community Ventures, recalls a woman who started a childcare center at a ski resort in Colorado to help offset the impact of critical employees missing work because of childcare needs.
She also started a conversation with and on behalf of other local businesses — a testament to “we did everything we could to solve the problem, and it’s still not enough,” Holden said. “We can’t have every business start a childcare center.”
Why the childcare debate stalls
Most caregivers are women. But representing and addressing this group’s needs is only part of the challenge. It’s also important to gain buy-in and trust from people who have historically felt removed from childcare issues. That includes men, Holden said, because of societal gender roles.
Holden has seen the power of trusted messengers — people who share lived experiences with the target audience — in Gary Community Ventures’ storytelling campaigns calling attention to the vast number of children waiting for a spot in a childcare center. With one group of business leaders, many of whom were fathers, he shared a Rocky Mountain PBS story about Michael Gonzalez, a single dad raising four children after his wife’s death. While mourning, Gonzalez missed a re-enrollment period for a free tuition program and lost their aid.
“Nobody said, ‘Oh, you know, it’s his fault for missing the enrollment deadline,’” Holden said. “It was this person who looks like me, sounds like me, got screwed over by the system, and we’ve got to fix it in order for that to not be … the policy.”
A similar video told by a woman drew a vastly different reaction: distrust and suspicions of manipulation. “As much as it pains us, … messengers matter, format matters,” he said. “There’s no universally resonant childcare story.”
There is, however, a nearly universal way to turn people off: calling it a crisis. Many communities are already navigating a lack of stable housing, food and other basic needs. “If we call it a crisis, sometimes we alienate folks,” Holden said.
That framing can also miss opportunities to connect neighbors with actionable solutions: “‘Here’s actually something you can vote on. Here’s something that you can support. Here’s something that you can sign up for that allows us to change the system,’” he said.
The cultural puzzle piece in mental health care
Caregiving is complex. Mental health is part of the equation: Overall, family caregivers report greater rates of depression and anxiety than their peers. And caring for a family member with a serious mental illness can add to those risks. It doesn’t help that when people take on the role of caregiver for a relative with a mental illness, they may not be adequately equipped to do so.
Mental health is something families don’t always discuss. Silence and stigma can be caused by cultural barriers. Lee knows this firsthand: One family member who starved herself was a licensed counselor, but relatives knew little about their situation until it was too late.
“Nobody talks about it,” Lee said. “We just know, ‘Oh, there’s something going on there. I think they’re on some sort of medication,’ but they don’t know exactly what is going on.”
Knowing how to support loved ones or neighbors is crucial — both for people experiencing mental health distress and for those supporting someone with their mental health.
“Your job is not to solve” the mental health crisis, said Dr. Bipin Subedi, chief of psychiatric services at NYC Health + Hospitals/Bellevue. “Your job is to help support the person while they take the next step.”
Dr. Subedi offered some tips:
- Notice whether someone seems more withdrawn, overwhelmed or socially isolated. For instance, do they say “I can’t do this”?
- Engage by saying something like “You don’t seem like yourself. Can we talk about it?”
- Assess and, if warranted, ask whether they’re having thoughts of suicide and whether there’s an immediate plan or threat.
- Connect with a mental health professional, 988 or mobile crisis services, depending on the situation.
