Child Health Services: A Framework for States

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The Child Health and Development Institute of Connecticut has released a report, A Framework for Child Health Services: Supporting Healthy Child Development and School Readiness of Connecticut's Children, that offers a strategic vision and a series of specific recommendations for strengthening and integrating children's health services into a comprehensive system of early childhood services. The goal of implementing this framework is to ensure optimal healthy development and school readiness for young children.

The Issue

More than half of the nation’s children have been found lagging in health, socio-emotional, and/or cognitive development at the time they enter kindergarten, almost entirely because of physical and mental health-related issues. Research demonstrates that early brain development and experiences in the first years of life have a significant, lasting impact on children’s future health, behavior, and ability to learn, pointing to the extraordinary importance of comprehensive child health, early care, educational and family support services for young children.

Target Audience

State policymakers, physicians, educators, child care providers, advocacy organizations and families

The Intervention

In 2006, Connecticut’s Early Childhood Education Cabinet set a series of school readiness goals for the state’s young children in their report, Ready by 5 & Fine by 9. Building on that report, Paul Dworkin, M.D., of the Connecticut Children's Medical Center, and Lisa Honigfeld, Ph.D., and Judith Meyers, Ph.D., of the Child Health and Development Institute of Connecticut have developed A Framework for Child Health Services: Supporting the Healthy Development and School Readiness of Connecticut’s Children. This framework lays the groundwork for achieving those school readiness goals and proposes the integration of expanded children's health services with other state services for young children, such as early education and family support services. Two cities, Hartford and Norwalk, have agreed to be pilot sites for the implementation of this framework.

The framework identifies and describes the essential components of child health services within an integrated system of services for young children:

  1.  Universal services. Provided to all children and families to support healthy child development and early identification of concerns.
  2. Selected services. Includes developmental, medical, and mental health services. Used by children who need early interventions for health and/or developmental issues.
  3. Indicated services. Includes programs such as Birth to Three (early intervention) and Title V (for children with special health care needs). Provided to children who have identified issues and meet eligibility criteria.

The framework also outlines a series of recommendations for cost-effective investments in Connecticut’s child health system, including:

  • increased access to child health services, including primary and preventive care and dental care;
  • care coordination services for children and their families to improve management of conditions and adherence to recommended treatment, as well as linkage to important services not provided in pediatric primary care; 
  • universal developmental surveillance and screening to promote early identification of developmental concerns; 
  •  expanded office-based education activities for pediatric and family medicine practices; 
  •  expanded assessment opportunities and capacity to enable rapid, efficient evaluation of at-risk children and facilitate timely access to necessary services; and 
  •  alignment of state and local early childhood initiatives.

The implementation of these recommendations has the potential to influence outcomes for children and families in a variety of ways. For example, providing care coordination services can not only decrease emergency room usage by patients and Medicaid costs for practices, but also decrease the number of days parents miss work.

This framework can not only serve as a guide for the State of Connecticut as it seeks to improve the school readiness of its young children, but also as model for other states looking to better serve their young children and families.

For More Information

For more details, contact Lisa Honigfeld, Honigfeld@uchc.edu, or Paul Dworkin, Pdworki@ccmckids.org.

Publication Details

Publication Date: April 21, 2009

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