CHDI and Connecticut Children’s Office for Community Child Health outline a joint vision for improving child and population health in the 2019 Framework for Child Health Services (

This month students across the state hunker down to take standardized tests measuring their own and their school’s achievement. It’s not news to anyone who lives in the nutmeg state that Connecticut has an achievement gap. As professionals who have dedicated our careers to promoting children’s health and well-being, we are mindful of the many factors that influence achievement. To narrow the achievement gap, we need to step back and look at all of the ways that we can support children’s health, development, and well-being and integrate and organize them so they work for families.

The Child Health and Development Institute and Connecticut Children’s Medical Center’s Office for Community Child Health have released a comprehensive 2019 Framework for Child Health Services with a series of recommendations on how to ensure a better future for Connecticut’s children.  We issue a call for action to transform child health services to strengthen its impact on the current and future well-being of children, equity, and connections of health to other services. We conclude that Connecticut is well poised to transform the content and delivery of child health services to ensure that they make a larger contribution to children’s development and achievement.

The 2019 Framework for Child Health Services reviews progress in implementing the recommendations put forth in an original 2009 Framework. Policy reform, system building, and practice change have advanced many of those recommendations over the last decade. For example, more than half of the state’s children insured by Medicaid are now receiving care from a National Committee for Quality Assurance recognized medical home, bringing developmental screening, care coordination, and effective professional education to pediatric primary care sites across the State.

The 2019 Framework considers present opportunities yet to be fully realized to improve children’s health and well-being, as well as innovations supported by recent scientific advances. We offer five key recommendations for transforming child health services to strengthen families, ensure health equity, and support the optimal success of Connecticut’s future citizens. We urge parents, service providers, state agencies, legislators, and payers to support the following agenda, which we believe will go a long way toward ensuring the State’s prosperous future.

  1. We need all those who pay for health services to pay for transformed child health services and, specifically, pediatric primary care that can bring about a health delivery system that produces equity and is linked to other places where children live, learn, grow, and play. Key components of such care include effective care coordination and the embedding of evidence-based, cost-effective services such as nutritionists to establish optimal feeding practices, universal home visiting to support families with newborns, and group well-child care visits to connect parents with similarly-aged children.
  2. State agencies with early childhood responsibilities and authority (e.g., Department of Social Services, Department of Public Health, Office of Early Childhood, Department of Children and Families) should consider how to best braid and blend funding to ensure that families’ have access to a broad array of support services regardless of whether they meet the stringent eligibility requirements for specific services.
  3. We must develop the methodology to capture return on investment and other financial analytics that measure the value of pediatric health promotion and prevention services across the short-, medium-, and long-term, including the savings in other publicly-financed sectors, such as education, social services, and juvenile justice.
  4. Care coordination services for children and their families must be organized across service sectors with access via a “no wrong door” model, to ensure equity and efficiency in linking families to a seamless system of services.
  5. State agencies should embrace a strength-based approach to measuring the impact of child and family services, such as the Center for the Study of Social Policy’s Strengthening Families™ Protective Factors Framework, to promote children’s resiliency.

The Framework acknowledges that many state resources are available to support its recommendations. The Office of Health Strategy (OHS) is reforming the delivery of primary care with more flexible payment to allow for an expanded mission for primary care health services. OHS is also crafting a vision for Health Enhancement Communities that provide financing, accountability monitoring, and linkage of child health services to community services. The Office of Early Childhood is ensuring strong home visiting, child care, preschool, and early intervention services for young children. The Department of Social Services is developing a proposal in response to Medicaid’s Integrated Care for Kids initiative, which will develop and test a cross-sector, service delivery model.  The Department of Children and Families is disseminating evidence-based and best practices in children’s mental health and supporting community systems of care. Legislators, advocacy organizations, and philanthropy are also onboard with reforming childhood systems. We are confident in our ability to implement the Framework’s recommendations.  The question is whether we have the will.  We hope so.

Lisa Honigfeld serves as Vice President for Health Initiatives at the Child Health and Development Institute (CHDI). Paul H. Dworkin serves as Director of Connecticut Children’s Office for Community Child Health.

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