The early childhood medical home 3.15.2012


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  • 2011 study:Relative to the control group, the ABC treatment group was previously found to have improved cognition and educational attainment. We found that the intervention also improved heath (P = .05) and health behaviors (P = .03) when participants were aged 21 years. These improvements in behaviors were not mediated by IQ, math and reading scores at 15 years of age, educational attainment, or health insurance.Conclusions. Effective early education programs may improve health and reduce risky health behaviors in adulthood.2009 study of Perry preschool:The PPP led to improvements in educational attainment, health insurance, income, and family environment Improvements in these domains, in turn, lead to improvements in an array of behavioral risk factors and health (P = .01). However, despite these reductions in behavioral risk factors, participants did not exhibit any overall improvement in physical health outcomes by the age of 40 years.Conclusions. Early education reduces health behavioral risk factors by enhancing educational attainment, health insurance coverage, income, and family environments. Further follow-up will be needed to determine the long-term health effects of PPP.
  • 41% of kids age 0-6th birth day in early care and education. ACS and Headstart – means tested – so no middle class or rich kids, DOE – public school
  • 8.4% of all infants and toddlers.
  • 7 C’s are competence, confidence, connectedness, character, contribution, coping, and control
  • So we went back to HP2020- what exactly did they say What can we add knowing the underlying purpose and goals of HP2020What would we add if we had any say about it…..These became our criteria because when we approached uninterested parties they said do a literature search…
  • “I know it when I see it” Potter stewart –supreme court justice
  • Would be helpful to list the primary citations for these measures in the notes section, if there is not room in the table. EDI: 17 citations: forget-dubois 2007; Corter, C.,(2008); Guhn, M.,. (2007); Guhn, . (2007); Hymel, (2011); Janus, . (2007); Janus, M., (2009); Keating, D. P. (2007); Hassan 2009; Brinkman, 2007; Lapointe 2007; Li 2007; lloyd 2009 &2010; muhajarine 2011; puchala 2010; pelletier 2005Preschool Student rating scale: mashburn 2004 - also in the Georgia pre-k longitudinal study report - (not peer reviewed) School Entry Profile: Zigler 2008 Schools Ready for Children, Children Ready for Schools: brandt 2005 Hawaii – going to be used over time so will be able to see the predictive validity – not sure if will ever be published.
  • 11 of which focused on multidomains – 5-9 (I can’t even come up with 9) 9 focused only on reading and math – DIBELS which is dynamic indictors of basic early literacy skills
  • School is referring to Kindergarten and 1st grade as well as early childhood education programs.
  • The early childhood medical home 3.15.2012

    1. 1. Healthy Children Strong Early A Pediatricians Role in Families Learning Promoting School Readiness & High Quality Early Care and EducationElizabeth Isakson, MDNew York Zero-to-Three Network
    2. 2.  Understand the important role that pediatrics plays in promoting school readiness Explain why quality early care and education matters for young children Access and utilize resources available through CCR&R Be prepared to promote school readiness in practice Be aware of the policy levers and opportunities to improve early care and education for young children
    3. 3.  School Readiness Early Care and Education (ECE) Medical Home ◦ ECMH – Early Childhood Medical Home Cross-systems
    4. 4.  EMC–1: (Developmental) Increase the proportion of children who are ready for school in all five domains of healthy development: physical development, social- emotional development, approaches to learning, language, and cognitive development. Potential data sources: National Survey of Children’s Health (NSCH), HRSA, MCHS; CDC, NCHS; National Household Education Surveys (NHES), ED. 020/overview.aspx?topicid=10
    5. 5.  1959 – Pediatrics Article 1965 – Head Start Act 1975 – Education for All Handicap Children 1994 – The Goals 2000 Educate America Act 2002 – Getting Ready- 17 state collaborative 2003 – An Idea whose Time has Come ◦ (PEDIATRICS 2003 School Readiness, Zuckerman & Halfon) 2008 – School Readiness ◦ (PEDIATRICS 2008-High et al) 2011 – HP2020 added EMC -1 2011 – Race to Top: Early Learning Challenge *Timeline not all inclusive – forgive any oversights, missed important even
    6. 6.  Education Health Economic
    7. 7.  Lower special education rates Lower grade retention rates Higher achievement test scores Higher high school graduation rates Higher post secondary enrollment rates
    8. 8. Reduced Risk of Criminal Reduced Likelihood of Behavior;Healthy Child School Readiness and Academic, Social and Tobacco, Alcohol, DrugDevelopment Coping Skills Behavioral Difficulties and Use; Teen Pregnancy; Risky Health Behaviors Less stressful living conditions Source: Brown, J. (2002). The Link between Early Childhood Education and Health, Seattle, Washington: Economic Opportunity Institute. LinktoHealth.pdf
    9. 9.  Muennig et al. "The effect of an early education program on adult health: the Carolina Abecedarian Project randomized controlled trial“. AJPH 2011. 101:3; 512-516 Muennig et al. "The effect of a pre-kindergarten education intervention on adult health: 40-year follow up results of a randomized controlled trial" AJPH 2009; 99. 1431-1437 Palfrey et al. “The Brookline Early Education Project: A 25-Year Follow-up Study of a Family-Centered Early Health and Development”. Pediatrics 2005; 116:1, 144-152.
    10. 10.  Quality matters For ECE - who is the population in question? ◦ Most of the studies are on low- income, disadvantaged children ◦ A lot address care in the 3-5 y.o age range and not in the <3 y.o age group All the outcomes mentioned earlier are assume HIGH QUALITY Setting Ruhm, C, Future of Children Fall 2011
    11. 11.  “Not high” Group Size Child: Teacher ratio Caregiver Training Compensation Ruhm, C, Future of Children Fall 2011
    12. 12.  Early Learn Quality Stars NY:
    13. 13. From Center for Children’s Initiatives: 2011 Primer; page 11
    14. 14. From Center for Children’s Initiatives: 2011 Primer; page 11
    15. 15. From Center for Children’s Initiatives: 2011 Primer; page 29
    16. 16. From Center for Children’s Initiatives: 2011 Primer; page 20
    17. 17. From Center for Children’s Initiatives: 2011 Primer; page 36
    18. 18.  Developmental Screening ◦ AAP Guidelines 2006 ◦ Including social and emotional Referral to Early Intervention ◦ Access, follow-up, and coordination of care Anticipatory guidance ◦ Child care ◦ Positive parenting Reach Out and Read Promoting Resilience ◦ 7Cs of resilience; Ginsburg KR. 2006 AAP Teaching the brain research and science ◦ Ring the Alarm - Nikolai Pizarro
    19. 19.  The Bellevue Project for Early Language, Literacy and Education Success (BELLE) ◦ Mendelsohn, et al. NICHD ABCD States: Implementing Developmental Screening in Primary Care ◦ Commonwealth Fund 2000-current Help me grow… ◦ Connecticut model for linking parents and children to developmental services ◦ Now in at least 4 other states
    20. 20.  40 years Difficulty defining Difficulty measuring Difficulty “doing” it
    21. 21.  Focus on the whole child: 1. Physical/motor development 2. Social-emotional development 3. Approaches toward learning 4. Language and literacy development 5. Cognitive development including math and science Population-level Predictive validity Feasible Inter-rater reliability Age of children 4 yrs. through 6 yrs.
    22. 22.  Purpose: identify population-level measure of school readiness that can be incorporated into existing data collection efforts Goal: move EMC-1 from a developmental objective to an adopted objective Databases used: ◦ Medline-Ovid ◦ PsychInfo-Ovid ◦ ERIC Presented November, 2011, APHA Annual Meeting, Washington, DC
    23. 23.  Total is more than the sum of it’s parts….. Despite decades talking about it difficulty exist in defining school readiness Keyword search terms: ◦ School readiness + assessment ◦ School readiness + measurement ◦ School Readiness + early childhood development ◦ School Readiness + child development ◦ School Readiness + parental concern Presented November, 2011, APHA Annual Meeting, Washington, DC
    24. 24. 611 Articles 486 articles removed because not eligible based on criteria125 Articles 83 articles removed due to use of a battery of test to measure school42 Articles readiness 30 comprehensive school readiness measures identified for inclusion in the30 Measures review Presented November, 2011, APHA Annual Meeting, Washington, DC
    25. 25. Measure Pop. 5 Predictive Inter- Feasible level domains validity rater reliabilityEarlyDevelopment X X X X XInstrument (EDI)PreschoolStudent Rating X X ? X XScaleSchools Readyfor Children, X X ? ? XChildren Readyfor SchoolsNHES – schoolreadiness X X ? ? X
    26. 26.  23 states have a school readiness measure already in place All applicants to Early learning challenge grant had to show they had kindergarten assessment in place or are planning to establish one Few, if any, of the measures are rigorously evaluated for standard psychometric properties, none are used as a public health measure Stedron, J. M., & Berger, A. (2010). NCSL Technical Report: State Approaches to School Readiness Assessment.
    27. 27.  Only a handful of measurement tools met our criteria based on EMC-1 Only one involved asking parents via telephone EDI stands out as a population-level measure for use with children from diverse backgrounds that has well documented psychometric properties ◦ Possible data collection through ED, NAEP Method of survey is an issue for HP2020: ◦ Most school readiness assessments are done in “school” ◦ Speaks to need for collaboration between Education and Public Health to make most of this opportunity
    28. 28.  104 Items Extensice validity and reliability data Not a TEST Child’s teacher at age 5 is respondent – has to know the child 6 months prior to filling out Five developmental domains ◦ Sixteen subdomains Neal Halfon – September 24th, 2010
    29. 29. Neal Halfon – September 24th, 2010
    30. 30. Neal Halfon – September 24th, 2010
    31. 31. Neal Halfon – September 24th, 2010
    32. 32.  Cross systems approach – health, social welfare and education Increasing the overall investment in young children – from health, to families, to education Focus the lens on long-term solutions to heavy tax-burden issues
    33. 33.  Continue to be a leader and innovator in child health and well-being ◦ Program level and the policy level HIGH QUALITY early care and education Measurement and accountability in the systems that serve young children and their families Link patients to high quality early care and education
    34. 34.  Dina Leiser, MD & Jack Levine, MD NCCP - Taniesha Woods, PhD Leslie Davidson, MD & Janice Cooper, PhD New York Zero-to-Three Network- Carole Oshinsky, Co-Director, Infancy Leadership Circles