Ready and Healthy for Kindergarten: A Primary Care Innovation to Promote a 360-degree View of Child Health

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PROJECT SUMMARY/ABSTRACT Education is a critical social determinant of health (SDOH). Low-income, Latino dual language learners face large gaps in school readiness, which perpetuate inequities in academic achievement and subsequent health. Primary care is an ideal setting to promote school readiness for at-risk children given its frequent near universal contact with children and the opportunity to build on established relationships with their families. In fact, school readiness is a Bright Futures priority topic at the 4 and 5-year well child visits. However, the current structure of well child visits, which seeks to address a growing list of topics during 10-15 minute appointments, is limited in its ability to achieve this goal. To date, primary care innovations to address SDOH have largely missed an opportunity to promote 360-degree child health by simultaneously addressing academic and physical readiness for school. To address this gap, we developed an online family wellness program that uses anticipatory guidance on health topics intrinsically important to school readiness (e.g., nutrition, physical activity) to introduce basic language and literacy skills to low-income, Latino dual language learners, a fast- growing and particularly high-risk group, and their families (AHRQ priority populations). The online family wellness program was developed through a cross-sector partnership between educators and pediatric professionals and consists of parent-child workshops led by bilingual educators and reminder text messages. The program occurs during the transition into Kindergarten, a critical developmental stage, and uses promising approaches such as group structure, strategic use of technology, and partnerships with non- medical professionals. The yearlong program tightly integrates Bright Futures anticipatory guidance with the Kindergarten curriculum. During pilot testing, our team found that the family wellness program was feasible, well attended, and highly acceptable. We now propose testing the effect of the family wellness program on child and parenting outcomes using a rigorous mixed methods and community-engaged approach. In aim 1, we will conduct a developmental evaluation to refine the family wellness program and optimize the likelihood of successful implementation. In aim 2, we will conduct a randomized controlled trial testing the effects of the family wellness program on child language, literacy, and social-emotional outcomes as well parent health routines, learning activities, and self-efficacy. In aim 3, we will conduct a mixed methods process evaluation, which will provide insight into reach and implementation as well as user experience. The current proposal will yield insight into how primary care innovations can address education, which responds directly to AHRQ's interest in primary care innovations that address SDOH (NOT-HS-19-011). If effective, the online format will allow us to work with local, state, and national partners to disseminate the program rapidly to promote high- quality healthcare for vulnerable populations.