Insights for Change

New Framework for Child Health Services

By: Paul H. Dworkin, MD and Lisa Honigfeld, PhD

While Connecticut has made much progress over the past decade in improving the delivery of child health services, much still needs to be done to reach our ultimate goal of ensuring the optimal health, development, and well-being of all children.

To inspire a new direction for child health providers, policy makers, insurers, and private funders to utilize going forward, we drafted A Framework for Child Health Services: Promoting optimal health, development and well-being for all children. The report is a joint publication of the Child Health and Development Institute of Connecticut and Connecticut Children’s Office for Community Child Health.

Read the new Framework and watch a video featuring the authors.

The new Framework highlights progress made toward implementing the recommendations outlined in the original report, A Framework for Child Health Services: Supporting the Healthy Development and School Readiness of Connecticut’s Children, published in March 2009. The new Framework also puts forth five new recommendations to better leverage cross-sector collaboration and existing initiatives to strengthen families and ensure optimal outcomes for all children.

Progress Over Past Decade

The explosion of knowledge regarding early brain development and early child development that occurred in the 1990’s and 2000’s, and the implications such knowledge had on child health services delivery and child health care reform provided the impetus for the initial Framework.

The initial Framework outlined opportunities for collaboration between pediatric health care providers and other services that contribute to child health outcomes, such as family support services and early care and education programs.

Successes include the state’s adoption of the medical home model for the delivery of primary care services, widespread adoption of developmental surveillance and screening, and extensive outreach to support pediatric primary care providers across Connecticut.

Strengthening Future Outcomes

Since the publication of our original Framework, our understanding about the impact of the so-called “Biology of Adversity” on child health, development, and well-being has vastly expanded. This includes the impact that toxic stress, adverse childhood experiences, social disparities, and adverse social determinants have on child outcomes.

Research has shown that 80 to 90 percent of the outcomes we seek for children are a function of social, environmental and behavioral factors, so we now embrace the critical need to engage many sectors beyond the three cited in the original Framework (child health, family support, and early care and education) in order to change the life trajectory of vulnerable children. Such additional sectors include housing, transportation, food and nutrition, neighborhood safety, workforce development and others.

The new Framework proposes adoption of the following five recommendations:

  • Engage Payers, Medicaid and commercial, in Projects to Transform Child Health Services
  • Blend Funding and Administrative Support Across Sectors to Leverage Available Resources
  • Measure Return on Investment to Support Sustained Funding
  • Coordinate the Care Coordinators
  • Embrace a New Concept of Outcome Measurement

The time is right for child health providers, policy makers, insurers and private funders to embrace a new way of delivering child health services. Child-serving sectors and systems can no longer operate in isolation if we are to ensure that future generations can participate in the workforce and maintain optimal health. Healthcare services should be delivered in a way that maximizes value for patients over the lifespan. Rather than paying for health care encounters, insurers should pay providers based on their success in improving outcomes and support providers in adopting innovations that can improve health and well-being.

We hope that all stakeholders will collectively embrace the new opportunities outlined in the 2019 Framework to transform child health service delivery and enhance lifelong outcomes for children.

Share your thoughts on the new Framework with the authors:  pdworki@connecticutchildrens.org or honigfeld@uchc.edu.

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

Lisa Honigfeld, PhD, is senior advisor to Connecticut Children’s Office for Community Child Health and vice president for health initiatives at the Child Health and Development Institute of Connecticut.

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