By: Paul H. Dworkin, MD

It is widely recognized that the social determinants of health, which are circumstances in which people live and work, play a crucial role in children’s optimal healthy development. The Campaign for Grade Level Reading hosted a convening in Washington D.C. to explore how health determinants impact early school success and what role Medicaid can play in improving outcomes for children. I was honored to participate in the discussion.

The event was held at the National Press Club. It drew a broad array of participants including funders, program partners, health experts, education leaders, and policy advocates.

During my remarks, I offered six recommendations that were designed to stimulate discussion on how we can leverage Medicaid and child health services to not only promote children’s optimal healthy development, but to also achieve true system transformation that will benefit children far beyond their childhood years.

My experience at Connecticut Children’s, leading the Connecticut Children’s Office for Community Child Health and serving as the founding director of the Help Me Grow^® National Center, shaped those recommendations, which are outlined below:

1. Expand our focus beyond children with complex medical needs to also reach vulnerable children who are at risk for delays or disorders. Nobel Prize winning economist James Heckman has proven through research that early intervention has the greatest return on investment. Promoting optimal healthy development for all children will improve both academic success and future occupational outcomes.
2. Ensure that Medicaid’s Early and Periodic Screening, Diagnostic, and Treatment efforts are performed in the context of a comprehensive, integrated process of developmental promotion and early detection that includes a plan for referring and linking children and families to community programs and services. It is not enough to simply detect concerns early. We must strive to always link families to beneficial programs and services, as failing to do so would be ineffective and unethical. We need a firm process in place to ensure families in need are successfully connected to services.
3. Support strategies to engage all sectors that are critical to ensuring optimal outcomes for children. Research shows that quality health care only accounts for ten percent of children’s developmental outcomes, so we must look to other sectors that influence the social, environmental, genetic and behavioral factors that contribute to the other 90 percent. At Connecticut Children’s, we focus on the traditional sectors of child health services, family support and early care and education. We also focus on additional sectors impacting children including food and nutrition, housing, transportation, economic development, neighborhood health and safety, among others. We have also placed a strong focus on enhancing care coordination efforts across sectors to increase efficiency, reduce duplication of services, and create a health neighborhood for families.
4. Support research that acknowledges the importance and validity of proximate measures to assess the impact of programs and services on children’s healthy development. Such measures should be measurable and correlate with the elusive, long-term desirable outcomes we are trying to achieve. They should also incorporate measures that align with the Center for the Study of Social Policy’s Protective Families Framework that seeks to strengthen families. For example, one measure could include assessing enhanced family resiliency as an outcome measure, which is one of the Protective Factors Framework’s five focus areas.
5. Support innovative efforts to collect population health measures across sectors. Data collection can be used to identify gaps in existing programs and services and to assess whether institutions have the capacity to deliver solutions to close those gaps. Data can also be used to demonstrate the efficacy of adopted interventions.
6. Develop methodologies to effectively and convincingly demonstrate cost savings and a return on investment. Research on short-term cost savings should include a look at the savings that occur when medical, developmental, or behavioral concerns are detected early enough for families to be connected to existing community-based programs and services, thereby decreasing unnecessary referrals to medical specialists through “demedicalization.” Also, we should embrace the need for a longer window to calculate a program’s return on investment. Such returns are often difficult to demonstrate in the short term as the savings realized from many interventions will occur years later and often in other sectors. For example, early investments in child health, early care and education, and family support may yield substantial returns over years, and even decades, in the areas of special education, behavioral health, and the corrections system.

It is clear that our growing knowledge of early brain development, early childhood development, and the biology of adversity presents an extraordinary opportunity for us to leverage Medicaid and child health services to not only promote children’s optimal healthy development, but to also transform the systems that serve children. It is crucial that we not only focus on children who have delays or disorders, but instead serve all children who are at risk due to poverty, housing hazards and other health determinants. This is a population where we can truly see a return on our investment not only during the childhood years, but across entire lifespans as well.

Paul H. Dworkin, MD, is the executive vice president for community child health at Connecticut Children’s, the director of the Connecticut Children’s Office for Community Child Health and the founding director of the Help Me Grow^® National Center. Dr. Dworkin is also a professor of pediatrics at the UConn School of Medicine. Learn more »

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