It Pays to Be Born in Netanya

The city is spearheading a revolution: Coordinated childcare from birth to age 6, all services under one umbrella.

Imagine a baby a year and a half old. Isn't he sweet? He's just started to walk and toddle about clumsily, and he is starting to chatter: "More!" and "Daddy," "Mama," and of course, "Bamba." He sings along with his favorite songs, plays "pat-a-cake" and, of course, understands (almost ) everything said to him.

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Babies in a maternity ward.
Alon Ron

Now imagine his parents getting a call from the day care one day. "Everything's fine, don't be alarmed," the teacher reassures them. But she sounds worried: His development is lagging behind that of other toddlers, she says. He's adorable and healthy, but he's introverted. He has difficulty communicating and doesn't really react when he's sung to.

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What now? Who to call?

If the child is lucky and he's born to doting parents with money to spare, they'll consult the best experts money can buy, who can diagnose the tot and recommend therapy.

But what if the parents have no money or experience, or don't know who to call? What happens if the day care teacher doesn't notice there's a problem? Who's supposed to help the parents figure out how best to address the problem?

The unfortunate answer is that parents are on their own when it comes to matters like these. They find themselves scurrying from one expert to the next, spending hundreds of shekels per consultation. It takes a great deal of time and money to get the information they need, and sometimes a lot more time before therapy can finally get under way. Meanwhile, the child with the problem is left untreated.

Why? Because "education" for infants in Israel has no official "parent".

According to a study by the Agnes and Beny Steinmetz Foundation - a philanthropic endeavor that promotes local government care for infants - services for children are split between no fewer than five ministries, hundreds of local authorities and 45 public organizations and associations. Moreover, supervision over day care facilities for children younger than 3 is the responsibility of the Industry, Trade and Labor Ministry.

This means that cities' education systems meet children for the first time at ages 3 or 4, and sometimes even 5. Only then can they start dealing with problems that children may have.

In other words, there is no single authority collecting and compiling the information needed to allow for continuity in care.

For our imaginary baby - the one-and-a-half-year-old whose parents don't know how to address the problem - this can have dramatic consequences.

"The municipal education system takes in children, and suddenly discovers that some have problems that were never treated," said Avi Kaminsky, chairman of the union for managers of municipal education departments. "The problem is that if these issues aren't treated from the very earliest age, around 1 or 2 years old, it gets more complicated at ages 3 or 4, creating tremendous difficulties. In the absence of a local government body to focus the treatment, the children fall through the cracks in the system."

Parents don't want to know

Let's take another toddler, also a year and a half old. This little boy isn't imaginary at all, though. Let's call him Roy. Roy's kindergarten teacher thought he was behaving a little strangely and noticed difficulty in communication.

But the routine tests at the Tipat Halav baby clinic didn't determine anything wrong with him. Happily for Roy, he lives in Netanya.

Netanya is one of the only cities in Israel that took the initiative of forming a single department to unify all care for preschoolers. In Netanya, children like Roy don't fall through the cracks.

From 2009 to 2010, after a long, thorough process, the city set up three centers to care for preschoolers, and a fourth will be built shortly. The centers provide development-monitoring services for parents and babies in cooperation with Tipat Halav, training groups for parents, a development-therapy unit, and monitoring services for preschools to locate problems. The centers also have an open-door policy for parents who want to talk with developmental psychologists. All this is under one roof, accessible and available to anyone in need.

Once every two weeks, inspectors working for the centers visit the city's day cares and preschools. During one such visit, the teacher consulted a speech therapist about a boy she thought had a problem.

The system swung into action. The child was sent for more testing, but the experts found nothing. A psychiatric test ruled out autism. Meanwhile, the psychologist at the center began working with the mother on communicating with the boy, and a social worker entered the picture.

The more experts came to deal with the mother, the clearer the picture became: The mother was battered by her life partner, and this was having a terrible effect on the child. "We don't know what the child saw and what he was exposed to, but at that young age, he was screaming the family's distress," said Hagit Eden, head of the Kiryat Nordau Early Childhood Center in south Netanya.

The sheer number of experts involved in the process (some of whom are booked up for months in advance ) shows that without effective handling by the center, the boy's case probably would have gone untreated for a long time.

His case was borderline, not absolute. "Possibly the teacher wouldn't have said a thing to the parents if not for the speech therapist," said Sivana Golan, head of the department for preschoolers up to age 6 at the Netanya City Hall, and the person behind the city's idea for consolidating care.

Even if the teacher had told the parents, they probably wouldn't have wanted to hear it. "The tendency is to deny," Golan said. "If not for therapeutic intervention, the patterns with his mother would have solidified." She can imagine the rest, based on experience: "The mother would have been lost. ... The kindergarten would call to complain about the boy's behavior." He would be rejected, and this rejection would impair his confidence. He would feel discouraged about learning, and it would be a short road from there to special education, she said.

Children whose trouble isn't diagnosed in time feel that something is wrong with them, she added.

The Netanya centers aren't just for extreme cases. They're meant to meet the needs of children's problems in general. Take the case of Maayan Luz-Schwartz, a resident of the Poleg neighborhood. She manages projects and analyzes groups at the Adler Institute - and she is also a mother who needs help potty-training her boy.

An involved mother like Luz-Shwartz likely would have found a way to handle the problem regardless, but by virtue of the city's system, the potty-training issue became trivial, and cheaper than it might otherwise have been.

"The teacher referred me to the developmental psychologist at the Young Children Center, who kept track of my boy, me and my husband weekly," Luz-Shwartz said. "Now we're starting work with a speech therapist, and instead of waiting for months for an appointment at the kupat holim health fund, we can start almost immediately." Since the systems in Netanya cooperate with each other, the speech therapist met with the teacher and they talked with the parents together, she said.

The cost? Luz-Schwartz, who is relatively wealthy, paid the maximum rate of NIS 100 per meeting. In the private market, the cost per meeting starts at NIS 300. Poorer parents would pay less.

Guidance and support for NIS 15 a session

In an attractively designed room scattered with toys and new cushion seats, nine mothers sit in a circle, lifting and lowering their babies along to the music of a children's song. They are following the example of the development trainer, who's using a doll. In this course for toddlers and their mothers, most of the moms are first-timers learning how to care for their children. The exercises are designed to strengthen bonding.

Many young mothers feel they need help during the first months after birth. Private centers such as "First Step" and "Dyada" have sparkling branches in wealthy areas around Israel, offering courses for NIS 500 and up.

Ronit Hanaaman-Hillel is one of the mothers exercising on a mat. An operations manager at Cellcom, she's there with her nine-month-old daughter Tamar. "Almost all of us are first-time mothers, she said. "Beyond the exercises, it's an opportunity to talk about issues, like if the child isn't crawling or nursing."

This course doesn't cost hundreds of shekels. It costs NIS 15 an hour, because it isn't a course for profit; it's a service offered by Netanya City Hall at the Neot Shaked Young Children Center. The center serves not only the neighborhood of Neot Shaked - which is characterized by a large population of immigrants from Ethiopia and the former Soviet states - but also the better-off neighborhoods next door such as Neve Oz and Galei Yam.

The Netanya municipality's aim was to break down the walls between social classes and encourage meetings between people of different statuses, centering on the healthiest common denominator - children.

"It's nice here because the place is so new and pretty, and above all, it's insanely cheap," said Hanaaman-Hillel. "My friends in other cities pay a fortune for activities like these, and if they need developmental advice, they have to go to a one-off meeting in north Tel Aviv that costs a ton of money. Here I get everything in one place."

Penny-wise

If there's somebody spending a fortune on all this it's Netanya, at hundreds of thousands of shekels a year. But the city leaders feel they're economizing, and their assumption isn't baseless. A child's first years are formative ones, shaping cognitive and social abilities, and determining how children will feel about themselves and their surroundings. At later stages of life it is harder to narrow gaps that emerge during infancy.

A report by World Bank states that for each dollar the state invests in diagnosis, identification and treatment for infants, it saves $7 on correcting the problems at a later age. Therefore, what may seem like another showy class at a ludicrous price may be a clever financial move: It's a risk-free investment with assured returns.

"We realized that as a local authority we can't afford to meet these children for the first time at age 3 or 4," explains Sivana Golan. "Huge gaps between the children create huge stress on various systems, including education, welfare and healthcare, and cause a lot of suffering and pain to children, parents and the teams treating them."

With this in mind, the department for preschoolers up to age 6 at the Netanya City Hall set out to establish the centers. It was a toilsome task. For months, Golan met with all the local experts and agencies dealing with young children, mapping out the needs of the children, their parents and even their careers.

One day in October 2007, all those involved met in a single room to study and discuss their findings.

"There were almost 40 people in that conference room at the municipality," Golan said. "For hours we talked about the municipal map for a child in Netanya from birth to age 6. Each presented information about the children they handle at Tipat Halav, preschools, the psychological service - and how many at-risk children each one has."

"Then each presented the services they offer and what they need," Golan said. "For the first time we saw the big picture. We saw that our needs were very similar, and so were our difficulties."

Social workers, for instance, said they needed the psychological service agency to devote more hours to the cases they bring in. The psychological service agency said it wanted access not only to preschools but to day care as well. The teachers said they wanted parents to be able to consult with psychologists at the preschools.

"We understood that by sharing resources, we could hire more professionals and have the various divisions share them, thus meeting shared needs," said Golan.

The upshot was synchronicity that doesn't exist at the level of national government. And thus the city of Netanya's program for young children began, creating a chain of centers for young children.

Silent screaming

How does Netanya differ from every other local authority in Israel? The uniqueness of its division for young children lies in the coordination between the myriad agencies dealing with that age group at its Young Child centers. Elsewhere, most city halls have a preschool division under their education departments that generally starts handling children around age 3.

Netanya isn't alone: Safed, Pardes Hannah-Karkur, Or Akiva, Kiryat Ata, Carmiel and a few other local authorities also have divisions for young children, but the difference is that Netanya is the only one of the 15 large cities in Israel to have this initiative. It is highly heterogeneous, with rich and poor, and some 19,000 children younger than 6 years old.

Money doesn't necessarily make the difference for infants, though. "Many children don't grow up with true parental images and presence, but with careers," said Golan. Parents may be busy with their careers and unable to create the intimacy the child needs, she said. "We are dealing with a growing number of divorces. We see a lot of children with developmental problems and emotional problems, children who can't manage their feelings who deal with frustration and can't delay gratification. Some may cry, scream, show aggression that puts them at risk. There are also introverted children, sad ones, who could pass a whole day at day care without anybody noticing they're there. These children are screaming silently. They're the invisible children, and they worry me a lot. They're everywhere, but particularly in the wealthy families."

Although the city of Netanya is not required to take responsibility for very young children, it invests some NIS 2 million a year on manpower and developing programs for infants. The state provides more than NIS 1 million a year, and foundations such as the Steinmetz fund and the Detroit Federation donate as well, some NIS 750,000 a year. There is a separate state budget for preschools from age 3.

Netanya Mayor Miriam Feirberg Ikar was central to the endeavor. Most mayors want to see the fruits of their investment during their time in office, so they invest in high schools or middle schools, she explains; they want to improve matriculation test results. The whole idea came from "Good Start," a program led by Aliza Olmert, wife of former prime minister Ehud Olmert. The program's aim was to reduce the risk for children by starting community care early. It was a great success in Netanya, according to the city's mayor: "We felt it should be leveraged. I think that what is special about our initiative is that we don't sit around waiting. We take action."