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Talking Points: The Pediatric Health Practitioner’s Role in
School Readiness --
Enhancing the Content of
Well-Child Care
Charles Bruner, SECPTAN
September, 2005
Five Reasons for Enhancing Well-Child Care
• Opportunity: Near universal contact with young children
• Expectation: Ultimate goals for well-child care• Impact: Health’s potential contribution to closing
the gap in kindergarten readiness• Interconnectedness: Relationship of health and
social/emotional development to cognitive development
• Potential: Existence of exemplary and implementable practices and programs
Opportunity
• More than any other service providers, pediatric health practitioners see young children and their parents and can identify developmental concerns– 99% of children 0-5 visit a health
practitioner at least once during the year– 31% of children 0-5 have a well-child
visit/EPSDT screen funded by Medicaid
Source: Commonwealth Fund
Expectation Physical Health and Development -- Well-Child Visit Goals
– No undetected hearing or vision problems– No chronic health problems without a treatment plan– Immunizations complete for age– No untreated dental caries– No undetected congenital abnormalities– Good nutritional habits and no obesity– No exposure to tobacco smoke
Emotional, Social, and Cognitive Development -- Well-Child Visit Goals– No unrecognized or untreated developmental delays (social, cognitive,
communications– No unrecognized maternal depression, family violence, or family substance abuse– Parents knowledgeable and skilled to anticipate and meet child’s developmental
needs– Parents linked to all appropriate community services
Source: Dr. Ed Schor, Commonwealth Fund
Impact
Up to half of achievement gap in later grades is already evident in the readiness gap at kindergarten entry. - Rouse, Brooks-Gunn, and McClanahan
As much as one-quarter of the readiness gap may be attributable to health conditions or health behaviors of both mothers and children. - Currie
Parents play the most important role in preparing their children for school (at least one-half of all impacts on kindergarten readiness), and health services can assist in supporting parents in fulfilling that role.
Source: School Readiness: Closing Racial and Ethnic Gaps, Future of Children (Spring, 2005)
Interconnectedness
• Three in four children who start school behind cognitively also have physical or social and emotional delays as issues
• Children starting behind in more than one area have the most difficulty catching up
• Kindergarten teachers report greatest challenge in helping children learn is in dealing with social and emotional issues, not cognitive ones
ECLS-K Data and Percent of ChildrenLagging on One or More Dimensions:Interconnectnessness of Dimensions
13.2%
7.6%15.5%
8.1%
5.0%
6.4%
5.0%
Cognitive
Health
Social andEmotional
Source: Child Trends analysis of ECLS-K, base year public-use data for 1998-1999
While 24.1% ofchildren lag incognitive develop-ment, only 6.4%lag only in cognitivedevelopment!
Potential• Exemplary programs and practices exist that:
– Increase pediatric practitioner’s use of developmental screening, provision of anticipatory guidance, and identification of developmental health concerns during well-child visits
– Strengthen pediatric referrals to Part C early intervention and other community-based services to address developmental, behavioral, and parenting needs
– Link back to pediatric practitioner for monitoring and follow-up at next well-child visit
• These programs and practices work because they:– Make sense to practitioners, patients, and referring agencies – Have enlisted pediatric practitioner support and leadership and are
implementable in office settings– Do not involve major new costs and often are eligible for Medicaid funding
support
Promising Practices in Well-Child Care: A Beginning List
• Achieving Better Child Development (ABCD Initiative supported by Commonwealth Fund)
• Help Me Grow (Connecticut)
• Reach Out and Read
• Healthy Steps for Young Children
• Bright Futures and Bright Futures MH
• Touchpoints
• DSM-PC and DC:0-3
Source and Resource: Commonwealth Fund
Useful Websites
State Early Childhood Policy Technical Assistance Network -- www.finebynine.org
School Readiness Indicators Initiative -- www.gettingready.org
Commonwealth Fund -- www.cmwf.org
National Academy for State Health Policy -- www.nashp.org
National Center for Children in Poverty -- www.nccp.org
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