P2.139: Promoting Kindergarten Readiness: Insights from Children's Healthcare Care Providers

Background: School readiness is foundational to lifelong learning and mental and physical wellbeing, yet many children in the U.S. are not healthy and ready to learn. Inequities in school readiness stemming from racism for children from marginalized communities are also widespread. Children’s primary care providers (PCPs) are well positioned to promote school readiness (hereafter referred to as kindergarten readiness) in their communities during the 13 well visits before kindergarten. We sought to understand children’s primary care providers’ (PCP) current approaches to fostering kindergarten readiness for their patients, perceptions of barriers, and ideas for improvement to inform kindergarten readiness promotion efforts.

Methods: Children’s PCPs were recruited for interviews between June and August 2021; a purposive sampling strategy was used to ensure diverse representation of practice types and geographic areas. The interview focus included current strategies to promote kindergarten readiness, barriers faced, and suggestions for improvement. Interviews were audio-recorded, transcribed, and analyzed to identify key themes through a qualitative, iterative approach.

Results: Eleven PCPs were interviewed from eleven unique practices across rural and urban settings. Key themes included improving kindergarten readiness by 1) Integrating Kindergarten Readiness in the Primary Care Clinic, 2) Partnering with Communities, and 3) Promoting Equity. For clinic-based strategies, PCPs valued extended care teams for coordinating care. Providers valued developmental screening tools but reported a lack of consistent, focused approaches to kindergarten readiness. One PCP stated, “I would love to see a short but well-validated and helpful tool to assess kindergarten readiness that we can do in the office.” PCPs appreciated programs like Reach Out and Read but also expressed a desire for more in-office interventions. On community partnerships, providers wished for better collaboration and communication with schools and community organizations. One noted, “As I'm talking to families, I'm wondering who else is mentioning going to Pre-K, has anyone talked to you about Head Start?” Regarding equity, many PCPs identified inequities in their patients’ school systems, with one commenting, “You're sort of dependent on the school system and the school systems are not equitable, both in terms of access to pre-K services and in terms of developmental evaluation services.” Recommendations included removing cultural and language biases from assessments, improving racial/ethnic concordance, advocating for culturally competent screening, and advocating as providers for policies that promote more equitable kindergarten readiness for underserved communities.

Conclusion: Children’s PCPs identified many current and future opportunities to partner with families and communities to optimize children’s school readiness throughout early childhood. In the future, school readiness promoting activities recommended by PCPs in this study could be supported through quality measures that track and provide financing for these actions; reimbursement linked to quality measures could then be reinvested in practices to fund actions that support kindergarten readiness.