HEALTH ASPECTS OF KINDERGARTEN READINESS TECHNICAL WORKGROUP March - - PowerPoint PPT Presentation
HEALTH ASPECTS OF KINDERGARTEN READINESS TECHNICAL WORKGROUP March 9, 2018 Agenda Welcome Meeting goals and agenda overview Introductions Workgroup charter and ground rules Background Scope and work plan Break
HEALTH ASPECTS OF KINDERGARTEN READINESS TECHNICAL WORKGROUP
March 9, 2018
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What do you hope to contribute to the workgroup (expertise, experience, perspective) and where will you be looking for support and information from others?
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you tend to dominate the conversation, step back and give space for others.
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Neural Networks Brain Size
Growing Awareness of the Importance
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readiness predict gaps in high school graduation and
being
behind other states
Growing Awareness of the Importance
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2009 2010 2011 2012 2013 2014 Oregon Health Authority created (HB 2009) PCPCH legislation (SB 2009) CCOs created (HB 3650) First CCOs launched CCO Transformation Center created through State Innovation Model (SIM) grant Oregon Ed. Investment Board created (SB 909) Early Learning Council created (SB 909) Early Learning Hubs established (SB 4165) Early Learning Division created at DoE (HB 3234) First Early Learning Hubs launched Shared Goal: Kindergarten Readiness
Concurrent Health and Early Learning System Transformation
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Every child in Oregon arrives at school ready to learn.
All sectors—health, education, human services, and beyond—collectively support children, parents, caregivers, and communities to achieve kindergarten readiness.
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changed over the past several years, Oregon has maintained a commitment to kindergarten readiness
are carrying the vision
impact kindergarten readiness through the health system
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Recommend a health system quality measure that:
investments that meaningfully contribute to improved kindergarten readiness
kindergarten readiness
What is the health system’s role and responsibility for achieving kindergarten readiness for Oregon’s children? Then, given that role, what are specific short-term and long-term metrics that would operationalize whether the health system is playing that role?
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the goal “By the year 2000, all children in America will start school ready to learn.”
Oregon Progress Board identifies school readiness as a critical state benchmark.
what children should know, understand, and be able to do during the first 5 years of life.
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establishes the Early Learning Council to oversee a unified early learning system.
that the Early Learning Council has adopted.
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Nationally, there is no universally accepted definition
“Although researchers, educators, parents, and policymakers agree that a child’s future academic success is dependent on being ready to learn and participate in a successful kindergarten experience, the exact definition of readiness depends on who is doing the
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In 2015, Oregon’s Early Learning Council adopted a strategic plan that includes this goal for school readiness: “All children enter kindergarten with the skills, experiences, and supports to succeed.” Oregon has not formally adopted a definition of kindergarten readiness. Oregon has done some work to identify the domains and indicators of school readiness (child, family, school, community).
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National Education Goals Panel: Domains of Early Development and Learning Head Start Early Learning Outcomes Framework: Central Domains Oregon Early Learning and Kindergarten Guidelines: Domains of Development and Learning Physical well-being and motor development Perceptual, Motor, and Physical Development Literacy Social and emotional development Social and emotional development Social-emotional development Approaches toward learning Approaches to learning Approaches to learning Language development Language and literacy Language and Communication Cognition and general knowledge Cognition Mathematics
Some Agreement on the Domains of Kindergarten Readiness at the Child Child Le Level el
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Oregon’s entering kindergarteners’ strengths and gaps in key developmental and academic skills
system
areas of greatest need
emotional development (interpersonal skills)
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This year, OHA is piloting the addition of questions related to children’s development and skills for kindergarten readiness in its annual statewide survey of Medicaid members (CAHPS survey).
simple task?
preschool because of behavior?
This data will be shared back with Coordinated Care Organizations to inform their understanding of the children they serve.
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and priorities
into elementary school
Child and Family Well-being Measures Workgroup)
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supports young kids and families.
the skills necessary for kids to be successful when they enter kindergarten; this is not a comprehensive whole-child assessment.
local), not to determine individual children’s “readiness.”
for the early learning system goals, and indicators for the role of Early Learning Hubs in achieving kindergarten readiness.
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Health System Transformation and CCO Incentive Program Background
CCO Incentive Measure Program
Sara Kleinschmit, MSc Policy Advisor Office of Health Analytics
Oregon’s health system transformation
mental health, and dental care) who work together to serve Oregon Health Plan (Medicaid) members
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Oregon’s Coordinated Care Model
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CCO Accountability to OHA
CCO Incentive Measures
CCO met benchmark or demonstrated certain amount of improvement
Measure specifications and guidance documents online at: http://www.oregon.gov/oha/analytics/Pages/CCO-Baseline-Data.aspx
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annually for each of the incentive measures to earn quality pool funds.
year.
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To earn their full quality pool payment for 2017, CCOs must:
✓ Have at least 60 percent of their members enrolled in a patient- centered primary care home (PCPCH); and, ✓ Meet the benchmark or improvement target on at least 12 of the 16 remaining measures. Money left over from the quality pool goes to a challenge pool. To earn the challenge pool payments, CCOs have to meet the benchmark or improvement target on the challenge pool measures (a subset of full measure set). All money in the pool is distributed every year.
Quality Pool methodology (reference instructions) online at: http://www.oregon.gov/oha/analytics/Pages/CCO-Baseline-Data.aspx
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Metrics and Scoring Committee
3 members at large 3 members with expertise in health outcome measures 3 representatives of CCOs
measures and benchmarks.
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Metrics & Scoring Committee Metrics Technical Advisory Workgroup Public Testimony: advocates,
Stakeholder Input: Providers, CAPs, CACs, community
Health Plan Quality Metrics Committee
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Measures should…
coordination, prevention, etc…
(2017 – 2022 goals below)
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Measures should…
measures (smoking cessation; drug and alcohol screening [SBIRT]; children in DHS custody; effective contraceptive use)
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Measure Selection Criteria
(with room for innovation)
Across the SET of measures:
http://www.oregon.gov/oha/HPA/ANALYTICS/MetricsScoringMeetingDocuments/Measure_selection_crit eria.pdf
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CCO Incentive Measures since 2013
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CCO Incentive Measures 2013 2014 2015 2016 2017 2018 Adolescent well-care visits x x x x x x Alcohol or other substance misuse screening (SBIRT) x x x x Ambulatory care: Emergency department (ED) visits x x x x x x CAHPS composite: Access to care x x x x x x CAHPS composite: Satisfaction with care x x x x x Childhood immunization status x x x Cigarette smoking prevalence x x x Colorectal cancer screening x x x x x x Controlling high blood pressure x x x x x x Dental sealants x x x x Depression screening and follow-up plan x x x x x x Developmental screening (0-36 months) x x x x x x Disparity measure: ED visits among members with mental illness x Early elective delivery x x Diabetes: HbA1c poor control x x x x x x Effective contraceptive use x x x x Electronic health record adoption x x x Follow-up after hospitalization for mental illness x x x x x Follow-up for children prescribed ADHD medication x x Health assessments within 60 days for children in DHS custody x x x x x x Patient centered primary care home enrollment x x x x x x Timeliness of prenatal care x x x x x x Weight assessment and counseling for children and adolescents x
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2018 Incentive Measures
Access to care (CAHPS survey) Dental sealants for kids Adolescent well-care visits Depression screening and f/u plan Emergency department utilization Developmental screenings Assessments for kids in DHS custody Diabetes HbA1c poor control Childhood immunization status Disparity measure: ED utilization for members with mental illness Cigarette smoking prevalence Effective contraceptive use Colorectal cancer screening PCPCH enrollment Controlling high blood pressure Weight assessment and counseling for kids and adolescents Timely prenatal care
Bold: Measures related to early childhood and family well-being ****=challenge pool, additional bonus $ (challenge pool focuses on early childhood health; Committee ultimately wants a measure of kindergarten readiness)
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CLAIMS-based measures
Access to care (CAHPS survey) Dental sealants for kids Adolescent well-care visits Depression screening and f/u plan Emergency department utilization Developmental screenings Assessments for kids in DHS custody Diabetes HbA1c poor control Childhood immunization status Disparity measure: ED utilization for members with mental illness Cigarette smoking prevalence Effective contraceptive use Colorectal cancer screening PCPCH enrollment Controlling high blood pressure Weight assessment and counseling for kids and adolescents Timely prenatal care
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EHR and other data sources
Access to care (CAHPS survey) Dental sealants for kids Adolescent well-care visits Depression screening and f/u plan Emergency department utilization Developmental screenings Assessments for kids in DHS custody Diabetes HbA1c poor control Childhood immunization status Disparity measure: ED utilization for members with mental illness Cigarette smoking prevalence Effective contraceptive use Colorectal cancer screening PCPCH enrollment Controlling high blood pressure Weight assessment and counseling for kids and adolescents Timely prenatal care
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Measure specifications
Developmental Screening in the First Three Years of Life
Name and date of specifications used: Core set of Children’s Health Care Quality Measures, Updated June 2017 URL of Specifications: https://www.medicaid.gov/Medicaid-CHIP-Program-Information/By- Topics/Quality-of-Care/Downloads/Medicaid-and-CHIP-Child-Core-Set-Manual.pdf Measure Type: HEDIS PQI Survey Other Specify: NCQA & CAHMI (Children and Health Measurement Initiative) Measure Utility: CCO Incentive State Quality Measure CMS Adult Core Set CMS Child Core Set Other Specify: Data Source: MMIS/DSSURS Measurement Period: January 1, 2018 – December 31, 2018 2013 Benchmark: 50%; from Metrics and Scoring Committee consensus 2014 Benchmark: 50%; from Metrics and Scoring Committee consensus 2015 Benchmark: 50%; from Metrics and Scoring Committee consensus 2016 Benchmark: 50%; from Metrics and Scoring Committee consensus 2017 Benchmark: 60.1%; 2015 CCO 75th percentile 2018 Benchmark: 74.0%; 2016 CCO 90th percentile 2018 Improvement Targets: Minnesota method with 3 percentage point floor Incentive Measure changes in specifications from 2017 to 2018: none. Member type: CCO A CCO B CCO G Specify claims used in the calculation: DS Claim from matching CCO Denied claims included Numerator event Y Y
Measure Basic Information
Data elements required denominator: Children who turn 1, 2, or 3 years of age in the measurement year and had continuous enrollment in a CCO for the 12 months prior to their birthdate in the measurement year, regardless if they had a medical/clinical visit or not in the measurement year. See Core Set of Children’s Health Care Quality Measures for details. Required exclusions for denominator: None. Deviations from cited specifications for denominator: None. Data elements required numerator: Children in the denominator who had a claim with CPT code 96110 in the 12 months preceding the birthday in the measurement year. See new Clarification section below. Required exclusions for numerator: N/A Deviations from cited specifications for numerator: If the claim was for CPT 96110, the claim was included regardless of the inclusion of any modifiers. This deviates from published specifications. What are the continuous enrollment criteria: Enrollment must be continuous for one year prior to the birthday in the measurement year, with a maximum of a 45 day gap. What are allowable gaps in enrollment: No more than one gap in continuous enrollment of up to 45 days in the 12 months prior to the birthday in the measurement year. Define Anchor Date (if applicable): Child’s birth date. Clarification for coding and billing for developmental screening To review, developmental screening is defined by the American Academy of Pediatrics as “the administration of a brief, standardized and validated tool that aids the identification of children at risk for developmental, behavioral or social delays.” Federal Bright Futures Recommendations call for children to be screened, using a global developmental screening tool, at three different times in the first three years of life in the context of routine well-child visits or when a concern is raised through standardized developmental surveillance. The CCO incentive metric is intended to operationalize whether that Bright Futures recommended care is provided for young children.
Measure Details
Questions?
Sara Kleinschmit, OHA (sara.kleinschmit@state.or.us)
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readiness in Oregon?
readiness?
Oregon through the health system?
that will bring us closer to our vision for achieving kindergarten readiness in Oregon?
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Every child in Oregon arrives at school ready to learn. All sectors—health, education, human services, and beyond—collectively support children, parents, caregivers, and communities to achieve kindergarten readiness. Long-term goal: Shared accountability and collective action for kindergarten readiness across sectors
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measurement recommendations for child and family well-being, including kindergarten readiness.
innovative partnership between OHA and Children’s Institute.
proposed KR workgroup and approved its formation, with a request for further details within 120 days.
referral and follow-up practices has highlighted challenges and opportunities with cross- sector collaboration and continues to ignite interest.
Interest in Measures of Health Sector’s Role in Kindergarten Readiness
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sector
levers for focusing attention, driving quality improvement, and promote collaboration
early learning system
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What is the health sector’s role and responsibility for achieving kindergarten readiness for Oregon’s children? Then, given that role, what are specific short-term and long-term metrics that would operationalize whether the health system is playing that role? Recommend a health system quality measure that:
improvement, and investments that meaningfully contribute to improved kindergarten readiness
for achieving kindergarten readiness
metrics program
Health Sector’s Role
Kindergarten Readiness
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measure of the health system’s role in kindergarten readiness to be applied as a CCO incentive measure
recommendations to achieve desired goals
Phase 1 Phase 2 Phase 3
Shared accountability and cross-sector collective action to achieve kindergarten readiness
recommendations, i.e., data sharing or new measure development
apply the measure to
payers
health system quality measure into the early learning system data dashboard
joint accountability and shared measurement
Engagement and coordination with the ELD, ELC, and other sectors to ensure alignment and impact
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Within Scope
term
development Outside of Scope
health care
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March Establish workgroup role, process, and workplan Review key background information April–May Establish conceptual framework for health sector’s role in kindergarten readiness Discuss and adopt principles for measure recommendations Review spectrum of potential recommendations, generate additional options June–August Measure exploration and prioritization based on framework and principles Seek and incorporate input from stakeholders, including Metrics and Scoring Committee September Finalize measure recommendations with group consensus Present recommendations to Metrics and Scoring Committee October Debrief presentation of recommendations Discuss next steps and future work
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and CCOs
reporting
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Children’s Institute contracted with the Center for Improvement
conduct 8 focus groups with parents and caregivers statewide to inform the Health Aspects of Kindergarten Readiness Technical Workgroup.
THE PSU RESEARCH TEAM
Callie Lambarth Project Director & Analyst Heidi McGowan Lead Facilitator & Analyst Diane Reid Co-Facilitator & Analyst Ron Joseph Translator & Co-Facilitator Beth Green Consultant
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definition of health sector’s role in KR
recommendations to reference and apply during all workgroup discussions
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participated in?
do differently to better support you and your child to be ready for school?
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87 total parents/caregivers with children ages 0-8
belonging to racial and ethnic minority groups, and families of children with special health needs 18 participated in Spanish with simultaneous English translation 69 participated in English Identified communities had primary local contacts with existing relationships with Children’s Institute, PSU, or stakeholder partners, in order to convene parent focus groups on a short timeline
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11 Baker City 9 Enterprise 5 Eugene 8 Grants Pass 16 Gresham-Fairview 16 Medford 14 Portland 8 Yoncalla
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1% 2% 4% 11% 28% 61% 6% 1% 3% 3% 12% 89% Asian Native Hawaiian/Pacific Islander American Indian/Alaska Native Black/African American Latino White Focus Groups Oregon
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17% 21% 24% 29% 54% 59% 70% 84% Early Head Start Head Start TANF EI/ECSE SNAP WIC OHP Public library
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feelings
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Having social-emotional skills were most important to most families
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Having social-emotional skills were most important to most families
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Having strong executive functioning skills was also very important
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Having strong executive functioning skills was also very important
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Being familiar with the school and understanding classroom and school routines
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Pre-academic skills were not as big of a concern to most families but were more important for families whose home language was Spanish
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Que sepan por lo menos algo como escribir su nombre. Sabiendo el abecedario y los números de 1 al 20 de contar. [They should at least know something like how to write their name. Know the alphabet and count from 1 to 20.]
Pre-academic skills were not as big of a concern to most families but were more important for families whose home language was Spanish
being away from parents
the bathroom on their own
pencils, crayons
learning
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Some parents described additional skills
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Develop ways to support children’s learning at home from birth
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Develop ways to support children’s learning at home from birth
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Establish routines
screenings and get connected to needed supports
place in early learning and elementary school settings
needs of children with special health needs in early learning and elementary school settings
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Health supports are in place
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Putting together a patchwork of different medical specialists, therapists, in different settings…The [health care provider] is thinking about the medical side and also about when [child] gets to school, how to learn to do [her own medical care].
Health supports are in place
child’s learning at home and connect to learning in the classroom
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Build relationships and talk with early learning providers and teachers
and their child
the community, e.g., public, charter, private schools
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Obtain information about kindergarten transition and expectations
school supplies, uniforms
supports and programs
understand and accept that there is a range of parenting values, strategies, and challenges that families face
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Some parents described additional needs
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access care
checks, dental services, and developmental screenings
language therapy
massage, homeopathic treatments
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Families described accessing a variety of health services
Early Intervention, Healthy Birth Initiative, Healthy Start
supports through WIC, SNAP
health fairs
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Families also described accessing health services in home, school, and community- based settings
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Most importantly, through providers who take the time to build trust and listen
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[My child’s pediatrician] didn’t rush through any appointment. If I had questions, she’d explain it thoroughly. She’d explain everything, even if I had a question about another kid – behavior problems, developmental problems.
Most importantly, through providers who take the time to build trust and listen
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It’s a really healthy mix of conversation, resources, handouts, websites, Apps. It
[with health care provider] and then you know you can call and get help if you need it.
Most importantly, through providers who take the time to build trust and listen
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Comprehensive prenatal and postpartum care, and parental health services, give families a healthy and stable foundation
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Comprehensive prenatal and postpartum care, and parental health services, give families a healthy and stable foundation
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Sometimes I have a hard time leaving the house, just going to the park is hard for me because of my anxiety. I already know that I’m not being the best parent I could be for my
[but] I don’t see anything that has been easy to get access to.
Comprehensive prenatal and postpartum care, and parental health services, give families a healthy and stable foundation
home visitors, and in early learning settings
about it and learning how to help child reach milestones was most important. This was described by many parents as a missing step.
between providers, e.g., health and early learning settings
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Conducting developmental screenings and monitoring child development
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Conducting developmental screenings and monitoring child development
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Thinking about the well-child checks I took my kids to before starting school, there wasn’t a whole lot of conversation about what types of gross motor activities they should be doing or fine motor skills. I think there needs to be more conversations taking place and opportunities for parents to really understand the why and the how and the impact of the importance of those things for later in school.
Conducting developmental screenings and monitoring child development
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Provide additional kinds of developmental supports
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Provide additional kinds of developmental supports
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Make referrals to other health, early learning, and family supports
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One thing we have benefitted from in the clinical environment…clinics include a social worker, so having someone there to say have you tried this, have you tried this and they can name off all the different resources available. That care coordinator, or nurse who specializes in making referrals to the community. Someone who can
Make referrals to other health, early learning, and family supports
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Spend more time with families and develop trusting relationships
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I feel that [health care providers] haven’t necessarily made it a safe environment for parents to ask. If I don’t feel I’m accepted that is not someone I would go to and ask [about parenting], because that takes a relationship.
Spend more time with families and develop trusting relationships
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In the context of a trusting relationship, share expertise, information, and guidance
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In my experience with our doctors and dentists, they’ve empowered me in choice. They give me the information about immunizations or
could do this or this,’ then there’s a personal connection and I can say, ‘For my family this is what I would choose.’ But they let you make that choice based on your cultural beliefs.
In the context of a trusting relationship, share expertise, information, and guidance
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Identify and communicate developmental concerns earlier
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I would like them to be more upfront about what is developmentally appropriate. I feel that is the missing link, where I don’t feel like my child is ready emotionally for school. But I would love if health care providers would either look at the situation and provide me the documentation to go [to Early Intervention], or let me know that I’m being overprotective.
Identify and communicate developmental concerns earlier
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Follow-up on referrals
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[Health care provider] made sure to get on the phone, either her or her assistant, and they called back and forth and back and forth [with insurance and pharmacy] until they figured out what was going
can’t go to school or community events. So [health care providers] are very much on top of making sure that phone calls get made and I’m not so stressed out and the family is good.
Follow-up on referrals
communities
settings either through providers and/or translation services, and translated materials
and including specialty providers
life span, starting peri/prenatally, and including parent mental and behavioral health
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Some communities had additional suggestions to meet their needs
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No hablamos inglés, por lo que tratamos de ir a la cita y no
clínica no ofrecen. Eso es algo que es difícil, porque no podemos obtener detalles, por lo que podemos entender lo que está sucediendo. [We don't speak English, so we try and go to the appointment, and they don't provide a Spanish interpreter. They don't speak Spanish, and at the clinic, they don't provide translators. That is something that is difficult, because we cannot get details, so we can understand what is going on.]
Some communities had additional suggestions to meet their needs
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support
schools, and specialty care providers
and how parents can support future development
developmentally supportive activities, and provide
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Providers can meet child and family needs to help prepare children for school
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There has been so much support from the time [child] was diagnosed until now. [Health providers and Early Intervention] communicate with each other. Without that, I don’t think I would have learned how to take care of my [child].
Providers can meet child and family needs to help prepare children for school
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Providers can meet child and family needs to help prepare children for school
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A mí en la clínica me daban tiempo de leer desde pequeños. Yo pienso que eso les ayudó a mis hijas porque a la más grande le gusta mucho leer. [The clinic also taught me to read to them starting when they were young. I think this helped them a lot because my oldest loves to read.]
Providers can meet child and family needs to help prepare children for school
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What did you hear today that informs how we think about the health sector impacting kindergarten readiness?
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Next meeting: TBD
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