Framework Proposed to Improve Child Health Services in CT

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The Child Health and Development Institute (CHDI) and Connecticut Children’s Office for Community Child Health have outlined a joint vision for improving child and population health, updating a framework from a decade ago to face new challenges and seize unfolding opportunities in children’s health.

The new report, Framework for Child Health Services: Promoting optimal health, development, and well-being for all children,” highlights progress on implementing recommendations from the original framework developed in 2009, and advances five new recommendations for integrating child health services with a fuller range of services from other sectors, such as housing and nutrition, that contribute to optimal health and development.

“We developed the 2019 Framework to inspire a new direction for child health providers, policy makers, insurers, and private funders to guide their efforts as they work to reform health care and improve population health,” said Paul H. Dworkin, MD, co-author of the 2019 and 2009 Framework reports and director of Connecticut Children’s Office for Community Child Health.

The new Framework proposes adoption of five recommendations:

  • Engage Medicaid and commercial payers in demonstration projects to transform child health services

  • Blend funding and administrative support across sectors to leverage available resources

  • Measure return on investment over the long term to make the case for sustained funding

  • Coordinate the care coordinators to provide families with a seamless system of services

  • Embrace a new concept of outcome measurement that values outcomes beyond those related to health (e.g., school attendance, reading, social relationships)

While children in Connecticut are relatively healthy overall compared to children in other states, there are significant racial and ethnic health disparities, which start early and extend into education, employment, and adult health, organizers of the new framework noted.

Over the past decade, research 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, and adverse social determinants have on child outcomes.

Supporting pediatric primary care providers to address families’ needs more broadly and connect them to social services or other supports that improve their well-being could lead to better long-term outcomes, including improved school performance, a healthier workforce, and reduced adult health care costs.

“The time is right to embrace a new way of funding, organizing, and delivering child health services, as states reform payment and delivery systems” said Lisa Honigfeld, PhD, co-author of the 2009 and 2019 Frameworks and vice president for health initiatives at CHDI. “A new payment model can give health providers greater flexibility to match a child’s need with a broad range of services that can support their long-term health and development.”

The report notes that “The lack of robust state-level coordination has hindered uptake of promising innovations that could bring efficiency to service provision and support families in their optimal use of services. Mid-level developmental assessment, an innovation that quickly identifies children’s developmental needs and ensures that they are connected to community resources, is another example of a recommendation from the 2009 Framework that has not achieved scale and spread and has left too many families working to fill in gaps in services when their children do not qualify for publicly funded interventions.”

The explosion of knowledge regarding early brain development in the 1990’s and 2000’s and its implications for child health service delivery provided the impetus for the initial Framework, officials explained. Successes from the original Framework 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.

“Since the publication of our original Framework, we understand more about how social, environmental and behavioral factors affect children’s lifelong outcomes and now know we have to engage many sectors beyond health, family support, and early care and education to change the life trajectory of vulnerable children,” Dworkin said.


The report also points out that “Disparate funding streams and regulations that determine eligibility for services are barriers to pediatric health care providers addressing children’s needs within the context of their families” and suggests that “State agencies with early childhood responsibilities and authority (eg, Department of Social Services, Department of Public Health, Office of Early Childhood, Department of Children and Families) should convene with commercial insurers, philanthropic organizations, and family members to design and develop a child health system that braids and blends available public and private dollars in support of children’s health and well-being.”