Is your Patient Ready for School?

How do we define school readiness?

School readiness extends beyond the child to the school and community:

  • An individual child’s skills across physical, social, emotional, cognitive, and linguistic domains;
  • A school’s ability to engage with students, parents, and the community in ways that are culturally and developmentally appropriate; and
  • A community’s resources in supporting young children and their parents, including prenatal and primary care, early childhood education, nutrition, movement, and a healthy environment

Why is school readiness important?

School readiness correlates with long-term educational attainment, which then correlates with positive long-term physical, emotional, financial, and community level health outcomes.

Kindergarten readiness definition in Rhode Island:

“In Rhode Island, expectations for what children should know, understand and be able to do at 60 months when they transition into Kindergarten, are defined in the Rhode Island Early Learning and Development Standards (RIELDS). The RIELDS outline the nine key knowledge and skill areas (Domains), as well as the specific Learning Goals for children at the end of Pre-K. The RIELDS, are aligned with the Rhode Island adopted Common Core State Standards in English Language Arts/Literacy & Mathematics and the Next Generation Science Standards. Additionally, RIDE believes that although kindergarten readiness is a goal for all children, it is the schools that must be ready to receive all children. In Rhode Island, the only requirement to participating in kindergarten is that children must be 5 on or before September 1st.”

Rhode Island Department of Education

What should school readiness NOT be?

In the 1980s/90s, school readiness tests were often used means to exclude age-appropriate children from kindergarten based on test results or behavioral observations. Pushback on this approach by the mid-1990s led to decreasing use.

Factors influencing school readiness

Many factors play a role, but one of the predominant themes is social determinants of health:

  • Poverty
  • ACEs (especially foster care and trauma)
  • Prenatal substance exposure
  • Maternal (parental) depression
  • Low birth weight
  • Food insecurity
  • Developmental delay
  • Access to high-quality early childhood education
  • Structural racism

Children who live in poverty start school at a disadvantage in terms of their early skills, behaviors, and health. Fewer than half of poor children are ready for school at age 5yo, compared to 75% of children from families with moderate/high income.

Schools’ readiness for children

Funding, staffing, class sizes and types, breakfast and lunch programs, transportation, physical school environment, are all key in school systems’ ability to provide appropriate learning environments for all learners.

Schools must support children who are dual language learners and come from diverse cultural and racial backgrounds.

  • A school without ramps and elevators is not ready to teach a child who uses a wheelchair
  • A school without working heat or AC, and with lead in the water fountains, is not ready to keep children healthy in their time there
  • A school that disproportionately suspends or criminalizes black children for acting out in ways that are not criminalized in their white peers is not ready to educate black learners

Preschool & Pre-K

High quality public preschool and pre-K has been shown to improve school readiness, especially in groups that are typically disadvantaged. Examples:

  • In 2006, the Boston public school system implemented public preschool for 1 in 4 four-year-olds, with significant improvement in education outcomes
  • Studies in California, Minnesota, and Michigan have shown significant financial return on investment from high-quality pre-K programs

the Pediatrician’s role in school readiness

“Pediatricians, by the nature of their relationships with families and children, may significantly influence school readiness. Pediatricians have a primary role in ensuring children’s physical health through the provision of preventive care, treatment of illness, screening for sensory deficits, and monitoring nutrition and growth. They can promote and monitor the social-emotional development of children by providing anticipatory guidance on development and behavior, by encouraging positive parenting practices, by modeling reciprocal and respectful communication with adults and children, by identifying and addressing psychosocial risk factors, and by providing community-based resources and referrals when warranted. Cognitive and language skills are fostered through timely identification of developmental problems and appropriate referrals for services, including early intervention and special education services; guidance regarding safe and stimulating early education and child care programs; and promotion of early literacy by encouraging language-rich activities such as reading together, telling stories, and playing games. Pediatricians are also well positioned to advocate not only for children’s access to health care but also for high- quality early childhood education and evidence-based family supports such as home visits, which help provide a foundation for optimal learning.”

Council on Early Childhood; Council on School Health. The Pediatrician’s Role in Optimizing School Readiness. Pediatrics. 2016

In short, pediatricians offer support in multiple ways:

  • Developmental screening (age-adjusted for prematurity!)
  • Social determinants of health screening
  • Parenting and discipline techniques
  • Supporting language and literacy development
  • Identifying abuse and neglect
  • Discussing transition to kindergarten with parents to identify areas needing support

A few Rhode Island resources for PCPs:

  • Reach Out And Read Rhode Island
    • Program that provides children with books during pediatric well visits so that families can read to their children at home
  • Early Intervention Program
    • Free to children <3yo with any developmental delay
    • Children do not have to be eligible for RI Medicaid to receive services
  • Head Start & Early Head Start
    • Head Start offers free preschool to low-income children who are ages 3 and 4
    • Early Head Start serves low-income children <3yo and their families

How can we improve?

No standardized teaching curriculum exists for school readiness; however, the Stanford Pediatrics Residency Program authored a 2020 study piloting a school readiness curriculum that included a pre-survey, didactic session, preschool visits, and a post-survey.

In May 2022, the Rhode Island Senate passed a legislative package to expand and strengthen early childhood care and education system. Other bills are also in the works!

Further reading!

Blog post based on Med-Peds Forum talk by Laura Schwartz, PGY2

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