a_framework_for_child_health_services

CONTENTS
I. Introduction
II. Exploring the Healthy Development of Your Community’s Children
A. Child Health System Performance
B. Health Related Indicators for School Readiness
C. Community-Specific Data Sources
III. Identifying Critical Child Health Issues, Resources, Strengths, and Needs
A. Inventory of Critical Child Health Issues, Resources, Strengths, and Needs
B. Community-Specific, Health System Data Sources
IV. Bridging Systems of Child Health with Other Community Systems
V. Engaging Child Health Providers
A. Discussion (Focus) Groups
B. Child Health Advisor/“Champion”
C. Educating Practices in the Community (EPIC)
VI. Developing a Plan to Integrate Child Health Recommendations into Early Care and
Education Settings
A. Building Blocks of Successful Early Childhood Initiatives
B. Addressing Health Integration in Your Comprehensive Birth Through 8 Plan
VII. Community Resources and Programs in Promoting Children’s Mental Health,
Oral Health, and Nutrition and Physical Activity
A. Mental Health
B. Oral Health
C. Nutrition and Physical Activity
VIII. Appendices
1. State Assessment Record
2. Primary Care Practitioners’ Survey of Children’s Health
50
3. Parent/Caregiver Survey of Children’s Health

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I.

INTRODUCTION

A Framework for Child Health Services: Supporting the Healthy Development and School

Readiness of Connecticut’s Children (Framework) highlights the importance of child health in
overall school readiness1. Underlying the necessity of focusing on children during their earliest
years of life is an explosion in knowledge of early brain development that points to the
extraordinary influence of the early years on children’s healthy development and learning.
Indeed, research in neuroscience and the developmental and behavioral sciences proves
unequivocally that the experiences of the first few years of life have a direct and enduring impact
on children’s future learning, behavior, and health, all important determinants of a child’s
readiness to succeed in school2. An overwhelming majority of children who are not ready to
begin school at age five or six are challenged by health and socio-emotional problems rather than
academic deficits. As your community develops its school readiness agenda, it is important that
your stakeholders consider the health of your community’s children.
The Framework, based on best practices, articulates the full continuum of child health
services from primary care to highly specialized services. It also places health services within a
broader system with other sectors that serve children and families, namely, early care and
education and family support (Figure 1). The Framework suggests how child health services may
contribute to children’s school readiness through connecting with early care and education
programs and family services and supports. The resulting system, when fully integrated, should
ensure optimal healthy child development and readiness for kindergarten and ongoing school
success.
The Framework also emphasizes the critical importance of linkages across the sectors. In
particular, the Framework identifies care coordination, both within the child health services
sector and across sectors, as the integrative component to a successful system. Indeed, the
importance of such care coordination cannot be overemphasized.

1

Dworkin P, Honigfeld L, & Meyers J. A Framework for Child Health Services: Supporting the Healthy
Development and School Readiness of Connecticut’s Children. Child Health and Development Institute of
Connecticut. March 2009.
2

Center on the Developing Child at Harvard University (2007). A science-based framework for early childhood
policy: Using evidence to improve outcomes in learning, behavior and health for vulnerable children.
.

1


Figure 1. The Relationship Between Child Health Services, Family Support, and Early
Care and Education

2


Throughout this tool kit, the term “health” is used to mean developmental and physical
health problems, such as asthma and allergies; socio-emotional and behavioral health problems,
such as lack of self-awareness and self-regulation; and cognitive development problems, such as
difficulty with problem solving and decision making, all of which compromise a child’s ability to
learn. The role of health services in ensuring physical, developmental, socio-emotional,
behavioral, and cognitive health are reviewed in the Framework. In short, child health services
universally reach young children and their families and are necessary prior to child care,
preschool, and school entry.
The purpose of this tool kit is to provide a guide for implementing the major
recommendations outlined in the Framework through the identification and integration of child
health systems into early care and education settings. This tool kit is designed to help your
community determine the major child health issues experienced by young children, identify and
collect data consistent with the Results-Based Accountability framework that your community is
using, engage child health providers in working with your community to promote school
readiness, and evaluate the effectiveness of your collaborative in reaching its population result
and system objectives. This tool kit is intended for use by the William Casper Graustein
Memorial Fund Discovery Initiative communities, as well as other communities working to

achieve school readiness for young children, and is designed to enhance ongoing efforts in
preparing young children for school success.
Modest changes in your community’s child health system can have major impacts on school
readiness for children. The following represent the most cost beneficial recommendations from
the Framework:
1. Increase access to child health services, including primary and preventive care and dental
care, to improve child health outcomes, promote children’s school readiness.
2. Expand office-based education activities through the EPIC (Educating Practices in the
Community) program to better enable practices to function as effective medical homes.
A medical home is an approach to providing comprehensive primary care, in which the
pediatric care team works in partnership with a child and a child’s family to assure that all
of the medical and non-medical needs are met.3
3. Implement developmental surveillance and screening to ensure that children who require
intervention services are identified as young as possible.
4. Provide care coordination services for children and their families to increase the early
detection of problems, improve management of acute and chronic disorders, promote
adherence to interventions and treatment plans, and achieve efficiencies and cost savings
in health care delivery.
5. Improve mid-level assessment capacity to enable more rapid and more efficient
evaluation of at-risk children, facilitate access to helpful programs and services, and
ensure the most appropriate use of expensive and scarce resources for comprehensive
evaluations.

3

Accessed January 14, 2011.

3

II.

EXPLORING THE HEALTHY DEVELOPMENT OF YOUR COMMUNITY’S
CHILDREN
A. Child Health System Performance

With only limited exception, child health services are not effectively integrated either within
the health services sector or across the critical sectors of early care and education and family
support. Children grow, learn, and develop within a variety of settings, including traditional and
extended families, neighborhoods, and child care facilities. Yet such community-based services
are often delivered in isolation, dampening the potentially positive impact of such services on
children’s optimal development. Similarly, opportunities to share opinions on and concerns for
children’s development across the sectors in which children live and learn are limited,
undermining the effectiveness of developmental surveillance and hindering the earliest detection
of children at risk for developmental and behavioral problems and delays. An additional
consequence of the lack of integration of services across sectors is that parents and early care and
education providers do not have the opportunity to learn about the health sector’s role in
promoting healthy growth and development.
This publication defines a child health system as an array of providers and organizations that
delivers health services to children and contributes to the health or well-being of children and
families. It includes all of the players that are involved in the delivery of child health and related
services, from doctors, nurses and hospitals to state agencies that set licensing, payment, and
mandated services (such as immunizations) requirements. As part of a system, actions of each set
of players have implications for service delivery, quality and effectiveness. Families use health
care services within child health systems. Similarly, child health providers deliver health services
within child health systems. Therefore, recognizing the role that systems play in ensuring healthy
development is critical. The following Child Health System Performance Tool provides
Connecticut state and national data about some components of the health care system. By
completing the information in the column “% in your community” with your collaborative, you
can assess how your community compares with the state as a whole as well as the national

average.
When gathering data to complete this tool, consider the amount of resources that you have to
contribute to data identification and collection; where the data sources are and how you can
obtain the data; and any unique challenges and barriers to identifying and collecting your data.
Be sure to identify which key child health indicators will be most useful and pertinent to your
planning efforts. Many of the data included in this tool are very difficult to obtain. Therefore,
communities may want to focus on other methods for identifying critical child health issues, such
as those described in the following section, Health Related Indicators for School Readiness and
then develop strategies for obtaining only the health systems information that are most relevant
to the health issues selected.

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Health Related Indicators

% of children ages birth through 17 who are
uninsured
% of children ages birth through 17 with both a
medical and dental preventive care visit in the
past year
% of children ages 1 through 17 with emotional,
behavioral, or developmental problems
receiving some mental health care in the past
year

% in Your
2005Community 2006
CT (%)
6.8%

71.6%

74.1%

2005-2006
National
Average (%)

2005-2006
National Best
State (%)

11.3%
58.8%

58.7%

4.9%
74.9%

% of children ages birth through 17 whose
personal doctor or nurse follows up after they
get specialty care services

46.1%

Connecticut Voices for Children
Local health departments
Local school system

77.2%

Local mental health agencies
Local school system
Parent/caregiver surveys

61.0%

Parent/caregiver surveys
Local school system (how many
children do not have a completed
health form or receive a sports
physical from the school system
medical consultant)

% of children ages birth through 17 with a
medical home
59.1%

Where to Find this Information

Parent/caregiver surveys
57.5%

57.8%

68.0%
Child health providers

% of children ages birth through 17 with special

health care needs who have problems getting
referrals to specialty care services

18.8%

21.9%

13.5%

% of children ages 1 through 5 years at
moderate/high risk for developmental delay

23.4%

24.5%

16.4%

Child health providers

* Source: U.S. Variations In Child Health System Performance: A State Scorecard, The Commonwealth Fund, May 2008.

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CHILD HEALTH SYSTEM PERFORMANCE
INSTRUCTIONS
1. Purpose: To assess how your community compares on child health system performance
with the state as a whole as well as with the national average.
2. Description of Elements

a. Health Related Indicators: Factors that influence the healthy development of
children. These factors have been shown to influence the school readiness of
young children
b. % in Your Community: Percent of children in your community that meet the
criteria for the health related indicator
c. 2005-2006 CT (%): Percent of children in Connecticut that met the 2005-2006
criteria for the health related indicator
d. 2005-2006 National Average (%): Percent of children in the United States that
met the 2005-2006 criteria for the health related indicator
e. 2005-2006 National Best State (%): Percent of children that met the 2005-2006
criteria for the health related indicator by top score (percent) in the United States
f. Where to Find this Information: Sources for gathering data about key child
health related indicators
3. How to Use: The Program Coordinator completes the tool with the collaborative.
Complete the second column, “% in Your Community”, by using the indicated data
source and any additional data resources of your own.
4. Impact: To help align your child health data with your Results-Based Accountability
framework to track progress over time in improving the healthy development of young
children in your community. To inform program planning, strategic planning, local and
state policy, program evaluation, and to secure additional grant funding.

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B. Health Related Indicators for School Readiness
Given the multitude of factors that determine school readiness, such as secure attachment and
early exposure to developmentally stimulating activities, the richest opportunities may well
reside within the early care and education and family support sectors. Nonetheless, child health
services offer the opportunity to address certain prerequisites for school success, particularly
since they are the one point of contact that is nearly universal for children during the infant,

toddler, and preschool years.
The following Health Related Indicators for School Readiness Tool provides a list of key
health indicators from the Framework that is useful for exploring and understanding the health
needs of your community’s children. By completing the information in the column “% in your
community” with your collaborative, you can determine the impact and/or areas of need that
health status may be having on the school readiness of your community’s children.
Unfortunately, many of these data are not readily available. Completion of some items in the tool
requires surveying school personnel, early care and education providers, health care providers,
and parents and caregivers. Therefore, when gathering data to complete this tool, consider the
amount of resources that you have to contribute to data identification and collection; where the
data sources are and how you can obtain the data; and any unique challenges and barriers to
identifying and collecting your data. Be sure to identify which key child health indicators will be
most useful and pertinent to your planning efforts. In many instances, you may have to settle for
second-best proxy indicators using currently available data while you work on your Data
Development Agenda to obtain the data needed for the critical indicators.
The Commonwealth Fund has identified key indicators for school readiness that have
particular relevance for child health services.4 Examples within the realm of physical health and
development include such indicators as: immunizations being complete; all children having care
plans for management of chronic problems; healthy teeth and gums; and no undetected lead
poisoning, vision or hearing abnormalities, or congenital abnormalities (i.e., birth defects). With
respect to family capacity and function, key indicators particularly influenced by child health
services include parents serving as active partners in promoting children’s healthy development
and no undetected or untreated maternal depression, family violence, or substance abuse.
Similarly, a relevant indicator for social-emotional, behavioral, and cognitive development is no
unrecognized or untreated delays.

4

Edward Schor, M.D., Vice President, State Health Policy and Practice Program, The Commonwealth Fund

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Health Related Indicators

HEALTH RELATED INDICATORS FOR SCHOOL READINESS*
% in Your
Where to Find this Information
Community

Physical Health and Development
% of 2 year olds with immunizations complete

% of children with dental caries (age 3)

Department of Public Health
Children with Special Health Care Needs Care
Coordinators
Department of Public Health

% of children receiving lead screening by age 2

Department of Public Health

% of children with hearing screening performed prior to kindergarten

Local school systems

% of children with vision screening performed prior to kindergarten

Local school systems

% of children in kindergarten with previously undetected congenital anomalies

Child health providers
Child health providers/ECE providers/ Local
school systems
Child health providers/ECE providers/ Local
school systems

% of children with chronic illness who have care plans

% of children who are obese
% of children who are overweight
Social-Emotional/Behavioral/Cognitive Development
% of children in kindergarten with delays not detected prior to school entry
% of children in preschool special education who did not receive Birth to Three
services
% of children who enter Birth to Three after their second birthday

Local school system

% of children expelled from full-day preschool programs **

Early care and education providers

% of children suspended from full-day preschool programs **

Early care and education providers

% of children put on reduced-day schedules at full-day preschool programs **

Early care and education providers

Family Capacity and Functioning
% of parents see themselves as partners with child health providers in promoting
healthy development
% of parents who have their families health and socio-emotional needs met

Local school system
Local school system

Parent/caregiver surveys
Parent/caregiver surveys
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* Source: Edward Schor, M.D., Vice President, State Health Policy and Practice Program, The Commonwealth Fund
** Source: Opportunity Knocks for Middletown’s Preschool Children Collaborative, Middletown, CT.

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HEALTH RELATED INDICATORS FOR SCHOOL READINESS
INSTRUCTIONS
1. Purpose: To explore and understand the health and school readiness of your
community’s young children.
2. Description of Elements
a. Health Related Indicators: Factors that influence the physical, social,
emotional, behavioral, cognitive, and family functioning development of young

children and/or their caregivers. These factors have been shown to influence the
school readiness of young children.
b. % in Your Community: Percent of young children, parents, and/or caregivers in
your community that meet the criteria for the health related outcome.
c. Where to Find this Information: Sources for gathering data about key child
health related indicators.
3. How to Use: The Program Coordinator completes the tool with the collaborative.
Complete the middle column, “% in Your Community”, by using the indicated data
source and any additional data resources of your own. When gathering data to complete
this tool, consider the amount of resources that you have to contribute to data
identification and collection; where the data sources are and how you can obtain the
data; and any unique challenges and barriers to identifying and collecting your data.
Since these data are not readily available and can be difficult to collect, be sure to identify
which key child health indicators will be most useful and pertinent to your planning
and focus you data collection efforts in those areas.
4. Impact: To help align your child health data with your Results-Based Accountability
framework to track progress over time in improving the healthy development of young
children in your community. To inform program planning, strategic planning, local and
state policy, program evaluation, and to secure additional grant funding.

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C. Community-Specific Data Sources
Obtaining community-specific, child health data to complete the Child Health Systems
Performance and the Health Related Indicators for School Success tools can be a challenge and
more time intensive than obtaining national and state child health data. Additionally, your data
should align with your Results-Based Accountability approach, which will help you track
progress over time in improving the healthy development of young children in your community.
State of Connecticut Department of Education Health Assessment Record

One often overlooked source of data on children in schools and preschools in your
community is the information available on the State of Connecticut Department of Education
Health Assessment Record. This item is frequently referred to as “the blue form.” Schools,
camps, and many early childhood programs require that parents submit the completed blue form
annually. Parents complete one side; the child health provider completes the other side. The blue
form contains information on medications, height, weight, illnesses, hearing, vision and general
health status. Schools generally retain hard copies of the blue form and do not enter the
information into an electronic data base. However, some communities have used student interns
from local colleges to enter information from blue forms into a computerized data base so that it
can be used to look at children’s health status in the aggregate. For example, a computerized file
containing the heights and weights for all kindergartners can be created to calculate Body Mass
Index for children entering the school system. This provides an indicator of the rate of obesity. A
copy of the blue form is included in Appendix 1.
Community level resources to help find data about children’s health in your community
include, but are not limited to, the following:


Web-based Information
Connecticut Voices for Children. Connecticut Voices for Children posts information on
insurance coverage for major cities in Connecticut as well as counties on its website.
/>


Programs and Entities
Birth to Three Early Intervention. Data about developmental issues in young children is
available from the Birth to Three Early Intervention programs. To find the programs in your
area, use the Birth to Three map. />You can find services contact information for programs at
/>
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Connecticut Hospital Association (CHA). The hospital in your community can also be
a good source of data on child health issues. Look on the CHA’s website to find the
contact information for local hospitals. />Local Departments of Public Health. Your local health department may be the best
source of data on the health of children in your community. You can find contact
information for your health department on the State of Connecticut Department of Public
Health’s website. />Local school districts. School districts are essential partners for gathering data and
implementing community plans. Consider arranging a conversation with the medical
director for your school district to discuss data on the health problems of children in the
public schools. You can see your community’s profile for children requiring special
education services, including services for behavioral health issues, on the State of
Connecticut Department of Education’s website.
/>

Community Surveys

Surveys can yield important information about what people in the community are thinking
about children’s health. However, they can be expensive to carry out, and may not provide
the best information for planning. Surveys are good tools for getting a sense of what child
health providers, parents and caregivers think about the health and health issues of children
in your community.
Primary care practices. The Primary Care Practitioners’ Survey of Children’s
Health (Appendix 2) is designed to assist you in exploring and understanding the health
of your community’s young children by obtaining information from child health primary
care practitioners about the issues they believe are important in ensuring that children are
ready for school and lifetime achievement. The Program Coordinator, in collaboration
with Practice Managers or other practitioners, provides the survey for providers to
complete and is typically responsible for the data collection, management, and reporting.
The Primary Care Practitioners’ Survey of Children’s Health can be used to complete
portions of the Child Health System Performance, Connecticut and Your Community, and

the Health Related Indicators for School Success tools. Unfortunately, some communities
have found that practitioner response rates are typically low and, therefore, yield little
results. Consider the amount of resources that you have to contribute to data collection
and any unique challenges and barriers to collecting your data, such as the scarcity of
child health providers in your community.
Parents and caregivers. The Parent/Caregiver Survey of Children’s Health
(Appendix 3) is designed to assist you in describing families with young children, ages
birth through eight, in your community; learn more about young children’s health, health
care, and/or insurance coverage; and understand children’s health from the parents/
caregivers who use systems of health care and early care and education. Parent and
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caregiver feedback can be a time- and resource-efficient way to collect specific data
about the health of your community’s children, and provide a mechanism to explore and
understand the barriers and challenges to raising healthy children. The Parent/Caregiver
Survey of Children’s Health can be used to complete portions of the Child Health System
Performance, Connecticut and Your Community, and the Health Related Indicators for
School Success tools.
The Program Coordinator, in collaboration with the Collaborative, determines which
parents and/or caregivers to distribute the survey to, the method of data collection (e.g.,
written, electronic, on-line), and which survey questions to use. The parent/caregiver
survey included in the tool kit would take too much time for parents/caregivers to
complete. Consider using just a few questions from some of the focus areas or focus on
just one or two focus areas.
You can modify the parent/caregiver survey in Appendix 3 or create your own. The
following tips should be helpful for survey design and modification.
1.
2.
3.

4.
5.
6.
7.
8.

Consider a survey’s length in terms of time, not pages.
Pay attention to how the survey is formatted.
Use appropriate language.
Make sure you give culturally appropriate options in your answer choices.
Check your assumptions.
Avoid biased questions.
Ask questions one at a time (avoid merging two questions together).
If you want respondents to select one answer from a list, make sure the options
you give for answers are mutually exclusive.
9. Steer clear of objectionable questions.
10. Consider whether people have enough information to answer the question.
11. Make sure your questions are specific.
The Parent/Caregiver Survey of Children’s Health questions are based primarily on the
National Study of Children’s Health (NHSC) survey of households in the United States
with children ages birth through seventeen, and elicits parental and/or caregiver responses
to several areas focusing on child and adolescent health5. The Survey contains the
majority, but not all, of the questions and focus areas from the NHSC survey, and is
designed to elicit responses from parents and/or caregivers, of children ages birth through
eight, about demographic information, health insurance, health care access and utilization
(including questions about preventive medical and dental visits), family functioning, and
early childhood. Each focus area is labeled and numbering begins at 1 for ease of use.
The NHSC survey in its entirety can be found at
/>
5

National Survey of Children’s Health, Data Resource Center. />Accessed on November 19, 2010.

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Some communities in Connecticut have employed the following parent/caregiver
survey collection strategies6 at early care and education programs to ensure an
“acceptable” return/response rate (about 60%):


Collaborate with early care and education programs. Set up a table at your
community’s programs for “drop off” time. As parents enter the building, ask them to
complete a survey after they have dropped off their child. If parents cannot complete
it at that time, ask if they would complete it at “pick-up” time. You, or someone from
your collaborative, should be available to facilitate this process at both “drop off” and
“pick up”. Offer an incentive for completing the survey such as light refreshments
(e.g., muffins and cider). Alternatively, you can ask early care and education
providers to distribute and collect the surveys; however, be mindful of the time and
energy that it will take for them to distribute and collect the surveys. The survey
return rate also will likely be lower than if asking parents/caregivers as they enter or
leave the building. Talk with your providers to determine which strategy will work
best. Remember, however, that collecting data at early care and education programs
limits your potential responses to only those children and families that are in centerbased care. In general, it is always a good idea to determine who completed your
survey in terms of demographic information and which community groups
participated.



Offer incentives. If possible, provide an incentive that is consistent with your budget

for parents/caregivers to complete the survey. Examples include light refreshments at
“drop off” and “pick up” time, a $1.00 coupon to a grocery store, or a small cash
stipend.

6

Fahey C & Belyea M. Opportunity Knocks for Middletown’s Preschool Children Collaborative. Personal
communication. November 18, 2010.

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III.

IDENTIFYING CRITICAL CHILD HEALTH ISSUES, RESOURCES,
STRENGTHS, AND NEEDS
A. Inventory of Critical Child Health Issues, Resources, Strengths, and Needs

In addition to documenting the health status of children in your community, you will also
find it useful to develop a local inventory of the health resources to help your planning team
identify strengths as well as gaps (or needs) in services. The following Critical Child Health
Issues, Resources, Strengths, and Needs Inventory is designed to assist communities in
creating their local inventory. The Inventory is stratified by child health issue and type of service
(universal, selected, or indicated), and includes resources for, strengths of, and gaps in services
as well as where to find this information. Resources can include any child health related
programs, practices, and personnel. Strengths can include services that are available and
effective in your community. Gaps can include lack of resources (e.g., physicians, specialists,
hospitals) as well as training and technical assistance needs that keep health providers from
effectively addressing young children’s health and developmental needs.
As you complete the inventory, keep in mind the following:







Tailor the inventory to the meet the specific needs of your community
Complete as much of the inventory as possible before sharing it with your collaborative
For rural communities, consider ways to work regionally with other communities (e.g.,
complete the inventory collaboratively, share data and resources including a practitioner
“champion” of children’s health)
Engage providers of child health in the completion of the inventory

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INVENTORY OF CRITICAL CHILD HEALTH ISSUES, RESOURCES, STRENGTHS, AND NEEDS
Child Health
Issue or Service*
Focus areas in child health

Resources

Strengths

Needs/Gaps

Where to Find this Information

Any child health related

program, practice, policy,
or personnel

Effectiveness of resources in
addressing child health
issues or services

Lack of or
ineffectiveness/inefficiency
of resources in addressing
child health issues and
services

Data sources about child health issues and services

Universal Services provided to all children and families to support optimal healthy development and early identification of health and
developmental concerns, ideally through a medical home.
Pediatric Primary Care
 Local Health Department
Services
(i.e., where do children
get their primary care?)
Developmental/
 Child Development Infoline
Behavioral Monitoring
 MCH providers/program
and Screening
 Behavioral Health Consultation
 ECE providers
Parent Education

 ECE programs
About Health Related
 MCH providers/programs
Issues
 Family Support programs
Literacy Promotion
(e.g., Reach Out and
Read)
Pediatric Oral Health
Services

Nutritional Services

 Literacy Programs
 Reach Out and Read
/> MCH providers/programs
 Local and State Health Departments
 CT Dental Health Partnership
 MCH providers/programs
 Oral Health programs
 ECE programs
 MCH providers/programs

*See A Framework for Child Health Services: Supporting the Healthy Development and School Readiness of Connecticut’s Children (pages 6 – 11) for definitions and more
information about these services.

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Child Health

Issue or Service*
Focus areas in child health

Resources

Strengths

Needs/Gaps

Any child health related
program, practice, policy, or
personnel

Effectiveness of resources in
addressing child health issues or
services

Lack of or
ineffectiveness/inefficiency of
resources in addressing child
health issues and services

Where to Find this
Information
Data sources about child health
issues and services

Selected Services including developmental, medical, and mental health services, available to all children and families and likely to be
accessed by some for early intervention for health and developmental problems.
Medical / Surgical Subspecialty Services

 Local Health Department
Allergy
 Local Hospital
Mental Health

Nutrition

Other specialists that your
health needs assessment
identifies as important
Developmental/Behavioral
Evaluation Services

Mental Health Services

 Child Development
Infoline
 Family Support programs
 Child Development
Infoline
 Local Hospital
 ValueOptions

*See A Framework for Child Health Services: Supporting the Healthy Development and School Readiness of Connecticut’s Children (pages 6 – 11) for definitions and more
information about these services.

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Child Health

Issue or Service*
Focus areas in child health

Resources

Strengths

Needs/Gaps

Any child health related
program, practice, policy, or
personnel

Effectiveness of resources in
addressing child health issues or
services

Lack of or
ineffectiveness/inefficiency of
resources in addressing child
health issues and services

Where to Find this
Information
Data sources about child health
issues and services

Indicated Services, such as those available through Birth to Three and Title V (for children with special health care needs), provided to those
children that have identified difficulties and fulfill certain eligibility criteria.
Birth to Three

 Child Development
Infoline
 Birth to Three programs
Care Coordination Centers

 State and Local Health
Departments

Elementary
school/Preschool special
education
Children and Youth with
Special Health Care Needs

 Individual school systems

 See DPH contractors for
services in each
community

*See A Framework for Child Health Services: Supporting the Healthy Development and School Readiness of Connecticut’s Children (pages 6 – 11) for definitions and more
information about these services.

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INVENTORY OF CRITICAL CHILD HEALTH
ISSUES, RESOURCES, STRENGTHS, AND NEEDS
INSTRUCTIONS
1. Purpose: To identify strengths as well as gaps in child health services.

2. Description of Elements
a. Child Health Issue or Service: Focus areas in child health
b. Resources: Any child health related program, practice, policy, or personnel
c. Strengths: Effectiveness of resources in addressing child health issues or services
d. Needs/Gaps: Lack of or ineffectiveness/inefficiency of resources in addressing
child health issues and services
e. Where to Find this Information: Sources for gathering data about child health
issues and resources
3. How to Use: The Program Coordinator completes the tool with the collaborative.
Complete the second, third, and fourth columns, “Resources”, “Strengths”, and
“Needs/Gaps”, respectively, by using the indicated data source and any additional data
resources of your own.
4. Impact: To inform program planning, strategic planning, local and state policy, program
evaluation, and to secure additional grant funding.

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B. Community-Specific, Health System Data Sources
Community-specific resources to help find data about the performance of children’s health
systems in your community include, but are not limited to, the following:


Birth to Three Early Intervention. Data about developmental issues in young children is
available from the Birth to Three Early Intervention programs. To find the programs in your
area, use the Birth to Three map ( You can
find services contact information for programs at />


Child Development Infoline of the United Way of CT

(800-505-7000)



CT Dental Health Partnership
(866-420-2924)



Individual school systems
/>


Local health departments
/>


State Department of Public Health (DPH)
Contractors for indicated services in your community
/>sitng_color_072209.pdf



State of Connecticut Department of Social Services (DSS) HUSKY
/>


ValueOptions for mental health services for children insured by HUSKY
/>


Behavioral Health Consultation
(e.g., Early Childhood Consultation Partnership (ECCP), />Area Cooperative Educational Services (ACES), )



Early Care and Education (ECE) programs
(e.g., Community, Center-based, and Family child care; Subsidized child care: Early Head
Start, Head Start, Even Start, Family Resource Centers, School Readiness)



Family Support
(e.g., the Special Supplemental Nutrition Program for Women, Infants, and Children
(WIC); Nurturing Families Network; Family Enrichment Services through the State
Department of Children and Families (DCF))
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

Maternal and Child Health (MCH) providers
(e.g., dentists; hygienists; pediatricians; family physicians; nurse practitioners; school nurses;
Medical Director for school district; hospital programs; Community Health Centers; Healthy
Mothers, Healthy Babies coalition; the Special Supplemental Nutrition Program for Women,
Infants, and Children (WIC); System of Care; Managed Service System)



Literacy

(e.g., Reach Out and Read program ;
State Department of Education (SDE) ;
local library; local health department; School Readiness Council)



Oral Health
(e.g., dentists; hygienists; Community Health Centers; State Department of Public Health
(DPH) Open Wide and Home by One curriculums; Child Health and Development Institute
(CHDI) EPIC oral health component)

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IV.

BRIDGING SYSTEMS OF CHILD HEALTH WITH OTHER COMMUNITY
SYSTEMS

Health Services in the Early Childhood System
As stated previously, the Framework, based on best practices, articulates the full continuum
of child health services from primary care to highly specialized services. It also places health
services within a broader system with other sectors that serve children and families, namely,
early care and education and family support. The Framework suggests how child health services
may contribute to children’s school readiness through connecting with early care and education
programs and family services and supports (e.g., routine dental cleanings on-site in early care
and education programs; nutrition/dietary policy changes to meet national accreditation standards
at early care and education programs; family support through Nurturing Families Network for
children referred through early care and education programs). The resulting system, when fully
integrated, should ensure optimal healthy child development and readiness for kindergarten and

ongoing school success.
Using the Health Services in the Early Childhood System (Figure 2) as a guide, complete the
Health Services in the Early Childhood System Venn Diagram with your collaborative.
Consider working regionally if your community is rural. When completed, the diagram is
designed to help your community determine which sectors (early care and education programs,
child health services, and family support services) are available in your community or region,
and if these systems are delivering integrated services across sectors. As your community
completes the diagram and considers ways to use the information in your strategic planning,
keep in mind that successful communities serve as platforms for:





Engaging families, service providers and communities in promoting healthy development
Improving services and service delivery within individual sectors
Organizing and delivering integrated services across sectors
Working toward broader policy and systems change to better meet the needs of children
and families

Perhaps most important, your collaborative should serve as a neutral convener and
facilitator, brokering collaboration across service providers and systems of care 7.

7

Fine A & Hicks M. Health Matters: The Role of Health and the Health Sector in Place-Based Initiatives for Young
Children. W.K. Kellogg Foundation. Pages vi and 15. November 2008.

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