1. Ready for School
The Health and
Learning Connection:
Nature and Nurture?
It takes all of us
Donna LB Lowry, MD
Associate & Medical Director

2. Inform and Engage Parents
Goal of HTF
• To utilize the medical community as a forum for
parental education and engagement
• Identify and refer children and families to
community resources including Ready for School
• Assure that all children 0-5y connect with a
medical home

3. Partners in Health
• Holland PHO
• OCHD- DHS- CMH
• Holland Community Health
Center
• InterCare
• Lakewood Family Medicine
• SH Pediatrics
• SH Zeeland Physicians
• Georgetown Physicians
• Hope College
• Holland Hospital
• Spectrum Health Zeeland
Community Hospital
• Lakeshore Health Partners
• Priority Health
• BCBS Michigan
• CPS
• Physician Donors

4. Healthcare Providers
Relationship of Trust

5. 1990’s: The Decade of the Brain

7. Nature
• Critical Concepts in Early
Brain Development
• Proportional brain
growth
• Neural plasticity
• Critical periods
• Sequential development
• Role of experience
Early Brain
and Child Development

8. Nurture
• The human brain is shaped by
experience
• Experience, in turn, leads to
changes in the brain
• Birth: 50 trillion synapses
• 1 year: 1,000 trillion
• 20 years: 500 trillion
• These changes in the brain
make new experiences
possible
Early Brain
and Child Development

9. SERVICE IMPLICATIONS
Early Brain Development
• For optimal effectiveness, services must begin
as early as possible
• Stimulation during the first three years is
particularly critical to ensure optimal development
• “use it or lose it”
• Services must be comprehensive and aligned
with children’s developmental stages and needs

10. Birth
Early Infancy
Late Infancy
Early Toddler
Late Toddler
Early Preschool
Late Preschool
Prenatal 6 mo 12 mo 18 mo 24 mo 3 yrs 5 yrs
“ReadytoLearn”
“School Readiness Trajectories”
“At Risk” Trajectory
“Delayed/Disordered ” Trajectory
“Healthy” Trajectory
Parental education
Emotional health
Prenatal care
Family social connections
Quality ECE
Positive parenting
Neighborhood violence
Inaccessible health services
Poverty
Graphic Concept Adapted from Neal Halfon , UCLA Center
for Healthier Children, Families, and Communities
Health services

11. • Children with developmental/behavioral
problems are eluding early detection
• Many initiatives exist to provide services to
young children, their families
• A gap exists between child health and child
development/early childhood education
programs
• Children and their families would benefit from
a coordinated, region-wide system of early
detection, intervention for children at
developmental risk
ASSUMPTIONS
Creating a Healthy Beginning

12. Goals
• Identify critical concepts in early brain
development and early child development that
inform health services delivery
• Explain the benefits of children’s health services
focusing on promoting the optimal development
of at-risk children
• Identify the importance of whole community
cross-sector collaboration in strengthening child
health service delivery

13. Healthy Beginnings
Healthcare Provider Participation
Reach Out and Read
ASQ Assessment & Referrals
Healthcare Coordination
RN Case Manager
Community Health Worker
Healthcare Outcomes
Data Management
Data Reporting
Partnership participation

14. ROAR Outcomes
4 million children worldwide
Parents are up to 4x more likely to read aloud to
their children.
@ age 2 developmental gains in language & literacy
with a six month developmental edge over peers.
Kindergarteners score higher on vocabulary tests
and school readiness assessments.

15. Reach Out and Read
Holland Community Health Center
Mary Bosscher, Reach Out and Read coordinator
She reads, educates and encourages kids and parents to read.

16. Reach Out and Read
Holland Community Health Center
“Bringing my son to the Holland Community Health
Center was a very good thing because here they
taught us to read to him and teach him at home and
that would prove to be very helpful because he is
now a 1st grader and top of his class.
We are extremely grateful that they had Reach out
and Read program in his physicians’ office. And will
continue to use this method at home with our future
children.”
HCHC Father, November 2012

17. Developmental Surveillance
• Developmental and social-emotional delays
can be subtle and can occur in children who
appear to be developing typically so most
children who would benefit from early intervention
are not identified until after they start school.
• Pediatricians don’t detect delays more than 70% of
the time when they rely on clinical judgment alone.

18. ASQ 3
The ASQ looks at strengths and trouble spots,
educates parents about developmental milestones,
relies parents’ expert knowledge about their children.

19. Healthy Beginnings
Care Coordination
ASQ
ASQSE
Well child visits
ER/Urgent Care Immunizations

20. Partners in Outreach
Holland Rescue Mission
Read to Eat
Hope College’s Community Health Nursing Student,
Kaylee Marcinkus @ Stepping Stones Preschool

21. Community Health Nursing
Impacting Health and School Readiness
Read to Eat
Lena Jaynes & Kaylee Marcinkus @ Stepping
Stones Preschool

22. 2012 Accomplishments
• 100% increase Organizational Partners in Health
• Restructured the Health Task Force
• Healthy Beginnings: Unified program, built team
• 50K BCBSM Community Partners Grant
• Health Outcomes: Public Health Research Intern
• Reached all Providers of pediatric care
• Expanded Hope College relationships
• Nursing Department, English Department, Pre Health Professions

23. 2013 Ready Set Talk
• Speech Pilot over summer 2013-2014
• Target children 24 3 ½ -5y per summer
• 6 week program, 2 ½ hours for 18 session
• Total of 45 hours of intervention
• Build partnerships
• With Parents
• With Parent Educators
• With Kindergarten Teachers

24. 2013 ROAR Lakeshore Initiative
Goal
To support all health care providers in the Holland,
Zeeland & Hamilton area who desire to participate in
the Reach Out and Read program
What Ready for School will offer
• Provision of funds for books until 2015
• Volunteer coordination and support
• Highlighting your work in the community

25. What Next? Things to consider
• How do we sustain these efforts?
Local support
The Affordable Care Act
Insurance Companies
Large employers