(B)(4) Identifying and addressing the health, behavioral, and developmental needs of High-Need Children to improve school readiness

(B)(4) Identifying and addressing the health, behavioral, and developmental needs of High-Need Children to improve school readiness

The extent to which the State is identifying and addressing, or has a High-Quality Plan to identify and address, the health, behavioral, and developmental needs of High-Need Children by-

  1. Establishing a progression of standards for ensuring children's health and safety, ensuring that health and behavioral screening and follow up are done, and promoting children's physical, social, and emotional development across the levels of its Program Standards;
  2. Meeting ambitious yet achievable annual targets to increase the number of Early Childhood Educators who are trained and supported in meeting, the health standards;
  3. Leveraging existing resources to meet ambitious yet achievable annual statewide targets to--
    1. Screen all High-Need Children using screening measures that align with the Medicaid Early Periodic Screening, Diagnostic and Treatment benefit (Section 1905(r)(5) of the Social Security Act) or the well-baby and well-child services available through the Children's Health Insurance Program (42 CFR 457.520), and consistent with "Child Find" (Sections 612(a)(3) and 635(a)(5) of the Individuals with Disabilities Education Act (20 U.S.C. 1400)), as appropriate;
    2. Refer children for services based on the results of those screenings, and confirm that follow-up occurred, where appropriate;
    3. Promote participation in ongoing health care as part of a schedule of well child care; and
    4. Promote healthy eating habits and expanded physical activity and improved nutrition.


PACER recommends that Section “a.” include adaptive development as well, including the use of assistive technology, as appropriate.

Heather Kilgore
Public Policy Director
PACER Center
(952) 838-9000

The Campaign for Grade Level Reading endorses the "whole child approach to school readiness" that is emphasized in Section B including Identifying and addressing the health, behavioral, and development needs of High-Need Children to improve school readiness.

  • (B)(4)(a) After “… a progression of standards,” add “, which may be aligned with existing State standards related to children.”
  • (B)(4)(b) After: “… annual targets,” add: “, which may be aligned with existing State targets related to children.”
  • Add: (B)(4)(c)(v) “other health, behavioral and developmental targets established by the State.”

Most states consider that the key focus of their licensing regimes is to secure the health and safety of children in care, but the RTT-ELC presents a significant opportunity for states to show how their rules and regulations also enhance and support the behavioral, developmental and learning needs of children, and particularly those children at high risk of school failure.

We urge the Administration to require States to develop a specific plan for ensuring access to and continuity of high quality Early Learning and Development Programs for all children within the following categories:

children of teen parents; children who have been exposed to domestic violence in the home; children who are or have ever been connected to the child welfare system and differential response system; children who are at risk of developmental delays or disabilities; and children whose parents suffer from depression, other mental health problems, or substance abuse.

The plan should require Memoranda of Understanding to be adopted among local and State agencies that serve children in the above categories specifying roles and responsibilities for carrying out the plan. The plan itself should:

• Specify and ensure delivery of training on child development, the State’s Family Leadership and Support Standards, and the systemic elements (such as information, referral sources) available to assist in accessing high quality Early Learning and Development Programs. This training should be required for State and local program administrators and staff of all programs that serve children in the situations listed above.

• Establish training and performance requirements for contracted foster care and differential response providers, and training for foster parents that incorporate the State’s Early Learning and Development Guidelines and the Family Leadership and Support Standards.

• Require active planning across agencies to ensure seamless policies and procedures.

• Include policies and procedures to ensure continuity of care for children who have experienced trauma or who are developmentally delayed, etc. These should include, for example, requiring that children remain in their Early Learning and Development program regardless of their status as foster children, and requiring that the placement be as close as possible to both the foster parents and biological parents so that the child can remain in the same program regardless of family status.

Frank Farrow, Director, Center for the Study of Social Policy
Judy Langford, Senior Fellow and Director, Strengthening Families Initiative, Center for the Study of Social Policy
Teresa Rafael, Executive Director, National Alliance of Children's Trust and Prevention Funds

On behalf of the Office of the Governor of the State of Illinois, the Illinois State Board of Education and the Illinois Department of Human Services: We request clarification on whether the Administration is referring broadly to the health and safety of programs or if it is referring to the desired health outcomes for children.

Comments submitted on behalf of the Early Intervention Family Alliance:

The Early Intervention Family Alliance (EIFA) is a national group of family leaders dedicated to improving outcomes for infants and toddlers with disabilities and their families. The EIFA represents family leaders involved in Part C programs in states and other jurisdictions implementing the Individuals with Disabilities Education Act (IDEA) Part C for infants and toddlers with disabilities and their families.

Essential Domains of School Readiness
We were surprised that the adaptive domain was not included in the definition of essential domains of school readiness. The adaptive domain is one of the five domains (cognitive, communication, physical, social-emotional adaptive) required in multi-disciplinary evaluations of infants and toddlers to determine developmental delay under Part C of IDEA. The adaptive domain refers to self-help skills. When newborns develop different cries to indicate their different levels of engagement or frustration they are learning their first self-help skills. Being able to assist with dressing, feeding and having the ability to self-soothe are all key skills that children need to possess in order to be ready for the work of kindergarten. Without these skills children, and the adults who work with them, will be frustrated an unable to focus on language, literacy, mathematics or scientific discovery.

High-Need Children
We would encourage the Administration to use people first language, and change this to Children with High-Needs. Further, we would request that this phrase be used whenever referring to the targeted population for this grant. We note that in the cover letter the phrase low-income children appears before the term High-Needs Children, however that term is never defined in the grant application and we believe that use of that term may result in the failure by some to address the significant needs of a variety of children, who while their incomes may not be low, have barriers to access to programs and supports for early learning and development and fit the definition of Children with High-Needs. Additionally, we question the distinction made between low-income children and children with High-Needs, it is a well-known fact that children with High-Needs are disproportionately found in low-income communities and therefore programs need assistance in identifying and serving children who fall into both categories.

Early childhood mental health consultation services for young children with emotional or mental health problems is an important intervention tool that strengthens children, families, the early childhood workforce and programs. High-Need Children who experience trauma or do not have healthy early relationships may respond to early care settings with severe behavior that indicates an emotional or mental health problem. Behavior that is destructive, sudden, or inappropriate is easiest to detect in the early childhood classroom because it requires immediate intervention. Sadly, the intervention of first resort is usually removal of the child from the program. Behaviors that often go undetected, such as withdrawal, very little emotion, loss of earlier skills, or a rejection of being held, touched, or playing with others are equally concerning. The Early Childhood Educator is often under stress and may be impacted by his or her own trauma experiences, so adding a mental health consultant is extremely desirable as a strategy for improving the quality of early care.

Thank you,
Dr. Mimi A. Graham, Director
Florida State University
Center for Prevention & Early Intervention Policy
Tallahassee, FL

Although this is only one of many sections in the current field of discussion, it is an extremely important one. During the early years, the child's brain is rapidly developing like at no other time in their life. Current research has shown that the experiences of the child are being encoded in their developing brain and laying down the foundation, not only for their cognitive development, but their social and emotional development as well. This early period, from fetal development to around age 5, presents a window of opportunity for supporting healthy development in which observation and screening would permit early corrective intervention if need be.

If children enter the education system with unresolved issues in their social and emotional development this could undermine, not only the future course of their experience with school, but also their social and emotional functioning as adults in society.

Because the early care and education environment touches so many children, it provides a great opportunity for support and timely intervention to assure their healthy cognitive, social, and emotional development.

As a past teacher, school principal, college professor of children's literacy and now the Executive Director of Philadelphia READS, a non-profit that supports children's literacy in our city, I agree with the above comment. As noted, the time period between fetal development and age 5 is a critical time in the development of the brain and also the development of concepts, priorities and skills. It is also a time that is key to their emotional development. However, all of this is greatly dependent on the values and mindset of the parents. We believe that it is important to work on this aspect as does the Mayor of Philadelphia. For example, • Early reading experiences with their parents prepare children for the benefits of formal literacy instruction. Indeed, parental involvement in their child’s reading has been found to be the most important determinant of language and emergent literacy (Bus, van Ijzendoorn & Pellegrini, 1995). Furthermore, parents who introduce their babies to books give them a head start in school and an advantage over their peers throughout primary school (Wade & Moore, 2000).
Parents who read to their children give them a great gift – a significantly increased chance of academic success in school and beyond. Unfortunately, many parents and other caregivers don’t know how powerful the simple experience of reading together can be in a young child’s life. Constrained by lack of time, resources, and the pull of television and other media, many Philadelphia families have not made reading part of their day-to-day experience. While they want the best for their kids, these busy, burdened parents have not yet been inspired to add reading to their long ‘to do’ lists.

It’s a hard message for busy parents to hear, especially for those who may not enjoy reading themselves or feel confident in their reading skills. It’s an even harder message to get to the parents who most need to hear it: the outliers who do not access Philadelphia’s existing resources for low-income families, such as Head Start, Pre-K Counts, and the city’s libraries and recreation centers. Reaching families not yet plugged in to these networks is a particular challenge. Yet all parents want to be engaged with their children and to give them the best start possible.
PHILADELPHIA READS would like to do more to help these parents and others understand their role in the early development of their children's education.

When working with High-Need Children, it is important to realize that after identifying health, behavioral, and developmental needs, effective learning tools must be put in place so that learning can still occur. Typically when a child's need is addressed, the focus goes to the need and not the fact that their need may afford them a different learning style which could yield great results if addressed appropriately.

B(4)(c) iv. Promote healthy eating habits and expanded physical activity and improved nutrition.

Why is this only for 'high-need children'? I would sugest it apply to all children bith to age 8.