bridging health care and early education system ......transformations to achieve kindergarten...

Bridging Health Care and Early Education System Transformations to Achieve Kindergarten Readiness

in Oregon

January 12, 2015

The BUILD Mission

The BUILD Initiative

supports state leaders to develop a comprehensive system of programs, policies and services that equitably meet the needs of young children and their families.

This systems-building approach

effectively prepares our youngest children for a successful future, while carefully using private and public resources.

BUILD Equity Point of View

BUILD promotes early childhood systems work that identifies and addresses the root causes of disparities and supports state remedies to address them. BUILD’s vision for a racially equitable early childhood system would ensure that all children have an opportunity to develop and reach their full potential, without experiencing discrimination or bias within the early childhood system. It would assure that early childhood systems provide equitable opportunities and resources for excellent educational and developmental outcomes for children from groups historically discriminated against due to race. In addition, an equitable early childhood system would take concerted actions to correct or respond to discrimination in other arenas that negatively impact young children and their families. It would intentionally build leadership at all levels of systems that reflect the racial diversity of the children and families. It would ensure that systems recognize and provide culturally and linguistically responsive services contoured to the needs of the child in the context of the child’s family and community. Race and place would no longer be predictive of children’s healthy development and readiness for success in school and life.

What We Know

• The foundation of a successful society is built in childhood

• Early life experiences impact child development—for better or worse

• Experiences build brain architecture

• Toxic stress derails healthy development

• Significant adversity in the first three years impairs development

• Multiple risk factors can lead to developmental delay

Source: Center for Developing Child (2010)

Aligned EC Systems Include:

• Public and private sectors

• Not-for-profit and for profit

• Formal and informal

• Center-based, family child care and public preschool

• Family, friend, and neighbor care

• After school and out-of-school time

• Head Start, Early Head Start and Home Visiting

• Pediatricians and other health services

• Early Intervention

• Family support and engagement

• Museums, libraries, parks & recreation and other community supports

Multiple Risk Factors (2011)

U.S. Children under Six: Risk Factors Experienced

Source: National data were calculated from the 2011 American Community Survey, representing information from 2011. State data were calculated from the 2009-2011 American Community Survey, representing information from the years 2009 to 2011.

A System of Systems: The Four Ovals

http://buildinitiative.org/TheIssues/SystemsBuilding.aspx

Presenters

Moderator: Sherri Killins, Director of Systems Alignment and Integration, BUILD Initiative

Carrie Hanlon, Program Manager, National Academy for State Health Policy (NASHP)

Dana Hargunani, Child Health Director, Oregon Health Authority

David Mandell, Director of Policy, Early Learning Division/Oregon Department of Education

Bridging Health and

Early Education System

Transformations

PRESENTED BY +DAVID MANDELL [Director of Policy, Early Learning Division/Oregon Department of Education]

+DANA HARGUNANI [Child Health Director, Oregon Health Authority]

Triple aim: A new vision for Oregon

Coordinated care model

Coordinated Care Organizations (CCOs): local networks of all

types of health care providers working together to deliver care for

Oregon Health Plan (Medicaid) clients.

Quality and accountability: Oregon’s measurement strategy

CCO incentive measures Patient-centered primary care home enrollment

Developmental screening in the first 36 months of life

Mental, physical, and dental health assessments within 60 days for children in DHS custody

Adolescent well-care visits

Alcohol or other substance misuse (SBIRT)

Depression screening and follow-up plan

Effective contraceptive use among women at risk of unintended pregnancy

Prenatal and postpartum care: Timeliness of prenatal care

State performance measures Child and adolescent access to primary care practitioners

Childhood immunization status

Other CHIPRA core measures

Developmental screenings in the first 36 months of life

Developmental screenings by CCO

Developmental screening by race and ethnicity

Early learning system goals

ENSURE ALL CHILDREN ARE READY FOR KINDERGARTEN & READING AT GRADE LEVEL IN 3rd GRADE

CHILDREN RAISED IN HEALTHY, STABLE AND ATTACHED FAMILIES

ALIGNED, COORDINATED AND

FAMILY-CENTERED SYSTEM

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The Early Learning Division, which manages the day-to-day efforts

to achieve the system goals, is overseen by the Early Learning

Council, a 17-member public policy board appointed by the

Governor.

Systems Coordination: Creating an Aligned & Effective System • Early Learning Hubs • OEIB Equity Lens • Race to the Top

Stable and Attached Families: Getting Children & Families the Supports They Need

Ready for Kindergarten & Reading at Grade Level in 3rd Grade: Success in School & Beyond • Oregon Pre-Kindergarten

• Head Start • Kindergarten Partnership & Innovation

Grant • Early Literacy Grant

Oregon Early Learning Division: Our work

• Child care licensing & subsidy

• Quality Rating and Improvement System (QRIS) and quality early learning environments

• Relief nurseries • Home visiting

Early Learning Hubs

Role of the Early Learning Hubs

Identify children at-risk of arriving at Kindergarten unprepared for school;

Work with families to identify specific needs;

Connect families to the supports or services that most meet their needs;

Collaborate across sectors; and

Account for outcomes collectively and cost effectively.

Early Learning Hub Metrics

Diversity of Early Learning Hub models

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EducationalService District

Non-profit IntergovernmentalEntity

CCO CommunityCollege

CountyGovernment

Number of Hubs by Type of Backbone Organization

Number of Hubs

Joint ELC/OHPB Committee

Chartered by the Early Learning Council and the Oregon Health Policy Board in 2012

Focus: Assess areas for potential alignment and/or

integration across health and early learning Build collective impact across Oregon’s

transformation efforts Provide opportunities to spread knowledge and

best practices across CCOs and Hubs Address barriers to community-level coordination

and capacity building Develop measures for shared success

Example: Building community capacity across health and early learning

CCOs are required to complete a community needs assessment and a community health improvement plan (CHIP) to drive their work

Example: Eastern Oregon Coordinated Care Organization

Largest service area including 12 counties (10 are considered “frontier”)

Needs assessment: quantitative/qualitative data

Regional prioritization informed final CCO CHIP

Ranking of priorities: Early childhood #1

Goal: improve health outcomes for children ages 0-5 through integrated services

Strategy: establish regular communication and strategic planning with each Hub in region; increase developmental screening and prenatal care

Evidence: Collective impact

Emerging Hub-CCO Collaboration

Cross-representation on governance bodies/co-location

Community needs assessment

Shared resource referral systems & forms

Marketing/branding: Shared approaches/funding

Professional development activities (e.g. oral health trainings for early childhood providers)

Blending of resources (e.g. Early Literacy projects implemented in primary care settings)

Thank you.

david.p.mandell@state.or.us

dana.hargunani@state.or.us

www.oregonearlylearning.com www.health.oregon.gov

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Key Takeaways for Aligning Early Education

and Health Care Systems

Carrie Hanlon, Program Manager

National Academy for State Health Policy (NASHP)

chanlon@nashp.org

+ Three Strategies

Joint staffing and advisors

Dedicated staff liaison

Joint Subcommittee

Transformation Center

Blended funding

National awards (e.g., Race to the Top, State Innovation Model)

State general funds

Shared expectations

Collaboration

Metrics (e.g., developmental screening, medical home, kindergarten readiness)

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Funding

• How were the individual and joint efforts funded?

• What were challenges and opportunities that supported funding the alignment of health and early learning?

• What sources of funding were used to fund joint efforts?

Policy

• What governance/advisory structure is primarily responsible for the integration and alignment of health and early learning? Did the State Advisory Council play a role?

• What policy changes were required?

• What were the cultural changes in institutions, organizations and staff required for implementation of the integration and alignment?

Screening and Developmental Assessments

• Can you describe how you have increased opportunities for screening/assessment?

• How has the screening/assessment been linked to identifying and meeting early learning and health care needs?

• Are there data agreements between health and early learning?

Kindergarten Readiness

• How does Oregon define this concept?

• What created interest in health for attaining Kindergarten readiness?

• What data is Oregon using to measure Kindergarten readiness?

Disparities

• How is this work addressing disparities?

• What health assessment tools are used to determine disparities?

Questions, Reflections, Comments

For more information: www.buildinitiative.org

BUILD Initiative