There is increasing interest in schools as extensions of the health care delivery system—and rightfully so. Children spend the majority of their day in schools—many as early as age 3. Children do not leave their health care needs at the school’s front door: those health care needs and children’s access to services impact their educational outcomes and longterm health. This week, our colleagues at Center for the Urban Child at the Boston Medical Center published a blog in Health Affairs that highlights school-readiness as the next important quality metric for Medicaid. We whole-heartedly agree. Learn more by reading the Health Affairs blog here.

Why School-Readiness?

Children’s health care needs and their health care costs are not microcosms of the adult experience. Investments in young children are inherently upstream. They are preventive efforts to address the emergence and prevalence of chronic illnesses such as diabetes, mental health disorders and heart disease later in life. While this preventive approach does not yield immediate annual cost savings that provide states with a budget justification to invest in children’s health on the front end, this approach may result in savings twenty years down the road. Changing the conversation around cost and investment in children’s health is key to advancing an agenda that prioritizes children’s health. Quality measurement must be anchored to key milestones in a child’s development that are multi-dimensional and multi-generational.

School-readiness is a helpful metric–conceptually, school readiness encompasses multiple aspects of a child’s development including physical well-beingsocial and emotional well-being and cognitive and language development. Pediatricians and the medical home team play a key role in monitoring a young child’s readiness for school across these dimensions. Yet the work should not stop there – many sectors play a role in readiness. While health care stakeholders need to engage more deeply in addressing readiness, partnerships with key early childhood and development agencies and programs are necessary. Thanks to the growing research on early brain development, there is a flurry of activity in the early childhood development space working to align and evidence-based practice more robustly. This work must extend further along the continuum of childhood development to support children throughout elementary and secondary years.

Why Now?

Reaching across sectors is vital to our long-term success in meeting the various needs of children and families facing adversity. Reframing how we define success to capture the importance of education, as a first threshold to economic stability and good health, is one way to advance our goals around whole-family health. At local and state levels, education stakeholders are listening, learning and eager to engage in cross-sector partnerships that will increase the success of their students. Research shows how academic performance and students health are intertwined particularly in the area of children’s mental health. We know that most children seek and receive their mental health services inside school walls and that we need to increase access to those services and supports. We know that children, more than ever, attend school with multiple chronic conditions and school nurses continue to be the front line of support, caring for their daily needs to keep them in school and thriving.

How Can Advocates Lend their Voice?

Advocates can play an important role in facilitating connections across these important sectors and actively pursuing promising avenues. Below are some state examples:

  • Increase Medicaid Access in Schools: Massachusetts is currently working to implement an expansion of school health services by reversing restrictive Medicaid policy for reimbursement. Providing health services in schools has been shown to increase access to care and improve health outcomes. Expanding both covered services and provider types inside schools walls is key to institutionalizing the connections between education and health, increasing coordination across sectors and building infrastructure to meet children’s health needs. Advocates continue to work to influence the implementation process to ensure that children gain access to needed services.
  • Demand that Health System Transformation Efforts Require CrossSector Accountability: Oregon is simultaneously transforming its early childhood development system and its health care system, requiring cross-sector engagement. Specifically, they are working to develop key quality metrics such as a school-readiness that will incorporate not just Medicaid but thread together multiple agency partners, tying them to this key barometer of high quality cross-sector care coordination. Advocates continue to work to elevate consumer voices in the implementation process.
  • Build New Relationships: Advocates everywhere are working across sectors to elevate the needs of children and families. These important relationships build the foundation for alignment of policies and programs required to prepare children for school and create the infrastructure needed to continue services and supports for children as they age into adulthood. For example, social service advocates in North Carolina are forging new relationships with a local school principal and superintendent to provide mental health services in schools. Tennessee health advocates are working with a local community health center to learn more about childhood adversity to ensure health services match local need. 

If we are playing the long game, it is kinder, more effective and more cost-efficient to prevent a problem than it is to address the fallout. Using school-readiness as a barometer of success will allow us to identify warning signs and intervene before a child develops a chronic condition or suffers an adverse health event.