1. Healthy
Children
Strong Early
A Pediatricians Role in Families Learning
Promoting School Readiness &
High Quality Early Care and
Education
Elizabeth Isakson, MD
New York Zero-to-Three Network

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.  School Readiness
 Early Care and Education (ECE)
 Medical Home
◦ ECMH – Early Childhood Medical Home
 Cross-systems

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.
http://www.healthypeople.gov/2020/topicsobjectives2
020/overview.aspx?topicid=10

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.  Education
 Health
 Economic

7.  Lower special education rates
 Lower grade retention rates
 Higher achievement test scores
 Higher high school graduation rates
 Higher post secondary enrollment rates

8. Reduced Risk of Criminal
Reduced Likelihood of Behavior;
Healthy Child School Readiness and Academic, Social and Tobacco, Alcohol, Drug
Development 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. http://www.eoionline.org/ECE-
LinktoHealth.pdf

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.

11.  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

12.  “Not high”
 Group Size
 Child: Teacher ratio
 Caregiver Training
 Compensation
Ruhm, C, Future of Children Fall 2011

13.  Early Learn
 Quality Stars NY: http://qualitystarsny.org/

14. From Center for Children’s Initiatives: 2011 Primer;
http://www.centerforchildrensinitiatives.org/ccinyc/We
bsite_PDF_s/CCI-Primer-2011-FINAL.pdf page 11

15. From Center for Children’s Initiatives: 2011 Primer;
http://www.centerforchildrensinitiatives.org/ccinyc/We
bsite_PDF_s/CCI-Primer-2011-FINAL.pdf page 11

16. From Center for Children’s Initiatives: 2011 Primer;
http://www.centerforchildrensinitiatives.org/ccinyc/We
bsite_PDF_s/CCI-Primer-2011-FINAL.pdf page 29

17. From Center for Children’s Initiatives: 2011 Primer;
http://www.centerforchildrensinitiatives.org/ccinyc/We
bsite_PDF_s/CCI-Primer-2011-FINAL.pdf page 20

18. From Center for Children’s Initiatives: 2011 Primer;
http://www.centerforchildrensinitiatives.org/ccinyc/We
bsite_PDF_s/CCI-Primer-2011-FINAL.pdf page 36

19.  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

20.  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

21.  40 years
 Difficulty defining
 Difficulty measuring
 Difficulty “doing” it

22.  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.

23.  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

24.  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

25. 611 Articles
486 articles removed because not
eligible based on criteria
125 Articles
83 articles removed due to use of a
battery of test to measure school
42 Articles readiness
30 comprehensive school readiness
measures identified for inclusion in the
30 Measures review
Presented November, 2011, APHA
Annual Meeting, Washington, DC

26. Measure Pop. 5 Predictive Inter- Feasible
level domains validity rater
reliability
Early
Development X X X X X
Instrument (EDI)
Preschool
Student Rating X X ? X X
Scale
Schools Ready
for Children,
X X ? ? X
Children Ready
for Schools
NHES – school
readiness X X ? ? X

27.  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.

28.  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

29.  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

30. Neal Halfon – September 24th, 2010

31. Neal Halfon – September 24th, 2010

32. Neal Halfon – September 24th, 2010

33.  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

35.  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

36.  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