The Commonwealth Fund Improving Childrens Healthy Development Through Federal Child Health Policy Webinar Presentation Dr. Ed Schor, Vice-President, Commonwealth Fund – Moderator Dr. Charles Bruner, Director, Child & Family Policy Center & Chair, Member Leadership Council of Voices for Americas Children – Paper Presenter Alan Weil, Director, National Academy for State Health Policy Bruce Lesley, President, First Focus - - Respondents Co-sponsored by Voices for Americas Children, the National Academy for State Health Policy, and First Focus

The Case for Federal Leadership in Promoting Comprehensive Well-Child, Preventive and Developmental Health Services Child health insurance coverage improves access to health care Childrens healthy development can be improved through comprehensive primary, preventive, and developmental health services provided through that coverage Exemplary health services and recognized practice guidelines (Bright Futures) exist for providing such primary care but are not yet part of routine practice The federal government finances primary health care for a large share of Americas children, including the majority of the most vulnerable children The federal government can play a leadership role in promoting the adoption of exemplary primary, preventive, and developmental health practices

Providing access to coverage (Medicaid, SCHIP, and private insurance) Getting children enrolled (outreach and easy enrollment) Health Insurance Coverage Use of Primary Health Services Follow-up for Needed Medical and Other Services = Healthy Child Development Providing a medical home and well-child visits Providing comprehensive screening (physical, dental, mental, environmental) Providing effective referrals to further assess and treat medical and other health-related needs Higher health trajectory and greater safety and success Reduced need for remediation and chronic disease management Improving Childrens Healthy Development – A Multi-Part Strategy

The Importance of Well-Child Care as an Early Detector of Young Childrens Needs Sources: Preventive Health Visit: National Survey of Children's Health; EPSDT 416 Forms, Centers for Medicare and Medicaid Services (CMS); WIC - FDA, Food and Nutrition Services, Office of Analysis, Nutrition, and Evaluation; Formal Child Care: Census Bureau Special Report: Whos Minding the Kids?; Head Start: National Head Start Association, Program Fact Sheets; Part B: U.S. Department of Education, Office of Special Education Programs, Data Analysis System; Part C: IDEAdata.org Data Tables for Office of Special Education Programs State Reported Data

The Importance of Medicaid and SCHIP in Providing Child Health Coverage Children Enrolled in Medicaid or SCHIP by Child Age, Nation 2007 Source: 2007 ASEC supplement to the Current Population Survey

The Evidence Base for Improving Childrens Healthy Development through Primary Developmental Services ABCD Initiatives Assuring Better Child Health & Development Help Me Grow

Current Federal Proposals on Child Health Coverage and Quality HR976. SCHIP reauthorization contains quality provisions that speak primarily to developing child health quality measures S1226. Childrens Health Care Quality Act speaks primarily to hospital and chronic health care services for children S2376 Medical Home Act has a primary focus upon children with chronic health conditions Limited emphasis upon primary, preventive and developmental child health services within these proposals.

Expanding Federal Policy Leadership to Improving Childrens Healthy Development Core set of primary care child health service outcomes Structure within CMS focusing upon strengthening primary and preventive child health Additional research on child health quality and outcomes in primary care Incentives to states to promote evidenced-based practices in primary care Coverage of services and care coordination that lead to improved child health

Childrens Health and Development Age 0 Risk Factors Protective Factors Improving the trajectory of child health and development involves increasing protective factors and reducing risk factors -- which requires a broad definition of child health services. Opportunities Are to Affect the Trajectory of Childrens Health, with Long-Term Benefits to Children and Society