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