Child Health

The Biden Administration and Congress have recognized and emphasized the need to address racial disparities and advance population health through investing in a community health workforce, particularly in poor and medically underserved neighborhoods. 

InCK Marks and it Child Health Equity Leadership Group have taken on the task of describing the specific need to focus upon a PEDIATRIC community health workforce.

Three research syntheses by InCK Marks describe the opportunity and imperative for Congress to make specific investments in PEDIATRIC community health workers (practice, finance, and metrics) to achieve the highest value and return for expanded investments in CHWs overall.  These are downloadable from the resources section, below.

COVID-19 has brought to attention both the value of community health workers and the special role they play in medically-underserved and poor neighborhoods, which both are racially and ethnically diverse and have high proportions of children.

The American Rescue Plan Act, President Biden's own commitments, and different bills in Congress call for building back the public health system with a particular focus upon those underserved and poor communities and with emphasis upon community-based workers who have intimate knowledge of their communities.

The House Energy and Commerce Committee mark-up of the Build Back Better Act provisions for public health -- including $762 million in funding over the next decade -- could follow-up on the Rescue Plan Act in providing funding to sustain and build such a workforce and to emphasize its role in supporting children and their families. 

Doing so requires Congressional guidance and direction to do so -- which does not now exist in the mark-up -- but could be inserted.  Possible amendments to the Energy and Commerce Committee's mark-up related to community health workers and a description of why this is essential to advancing racial equity are provided in the "Making the Case" set of resources.

Child health care can play a key role in advancing children's healthy development, but for most effectiveness, this involves moving beyond providing medical care to supporting children and families in their healthy development (physical, cognitive, social, emotional, and relational). The InCK Marks Initiative (www.inckmarks.org) has drawn from the field of leading practitioners and policy experts in describing this transformation and its components in practice transformation, finance transformation, metrics transformation, and culture transformation. InCK Marks working papers (see the select resources section) provide state-of-the-field information on such transformation, with the overall conclusion that "we know enough to act boldly through public policy."

Multiple child health organizations -- including the American Academy of Pediatrics, the InCK Marks Initiative, the Effective Parenting in Primary Care Collaborative, the Association of Children's Hospitals, and Zero to Three -- have issued statements and recommendations for action to strengthen child health care. They share common themes in:

1. Completing the task of ensuring all children have coverage and mothers have coverage under Medicaid and CHIP for a year post-partum.

2. Expanding Medicaid and CHIP's role in advancing responses to strengthening the safety and nurturing in the child's home and community,

3. Supporting innovation and diffusion through an explicit focus on and investments in innovation child health as part of the Center for Medicare and Medicaid Innovation.

4. Expanding the relational care/public health workforce to engage and support children and families and supporting healthy development.

5. Bringing an equity focus to providing health care, diversifying the field and placing additional emphasis upon place-based responses.

The InCK Marks statement is included with other organizational statements in the resources section -- and is endorsed by a broad range of practitioner and organizational leaders.

Multiple child health organizations -- including the American Academy of Pediatrics, the InCK Marks Initiative, the Effective Parenting in Primary Care Collaborative, the Association of Children's Hospitals, and Zero to Three -- have issued statements and recommendations for action to strengthen child health care. They share common themes in:

1. Completing the task of ensuring all children have coverage and mothers have coverage under Medicaid and CHIP for a year post-partum.

2. Expanding Medicaid and CHIP's role in advancing responses to strengthening the safety and nurturing in the child's home and community,

3. Supporting innovation and diffusion through an explicit focus on and investments in innovation child health as part of the Center for Medicare and Medicaid Innovation.

4. Expanding the relational care/public health workforce to engage and support children and families and supporting healthy development.

5. Bringing an equity focus to providing health care, diversifying the field and placing additional emphasis upon place-based responses.

The InCK Marks statement is included with other organizational statements in the resources section -- and is endorsed by a broad range of practitioner and organizational leaders.

Multiple child health organizations -- including the American Academy of Pediatrics, the InCK Marks Initiative, the Effective Parenting in Primary Care Collaborative, the Association of Children's Hospitals, and Zero to Three -- have issued statements and recommendations for action to strengthen child health care. They share common themes in:

1. Completing the task of ensuring all children have coverage and mothers have coverage under Medicaid and CHIP for a year post-partum.

2. Expanding Medicaid and CHIP's role in advancing responses to strengthening the safety and nurturing in the child's home and community,

3. Supporting innovation and diffusion through an explicit focus on and investments in innovation child health as part of the Center for Medicare and Medicaid Innovation.

4. Expanding the relational care/public health workforce to engage and support children and families and supporting healthy development.

5. Bringing an equity focus to providing health care, diversifying the field and placing additional emphasis upon place-based responses.

The InCK Marks statement is included with other organizational statements in the resources section -- and is endorsed by a broad range of practitioner and organizational leaders.

The American Rescue Plan Act of 2021 includes $1.9 trillion in funding, much of which addresses or could address the health needs of America's children. This includes coverage for mothers for one year post-partum under Medicaid and CHIP, expansion of community health centers, extended paid family leave, and tripling of support for a community health workforce, as well as funding for community schools that can be deployed for health and health-related staff (nurses, counselors, psychologists). At the same time, these provisions could be strengthened to build upon the research on child health and health equity. InCK Marks has assembled possible language to do so within the initial House mark-up of the legislation. 

The Biden Administration has called for transformational investments in a 21st Century Caregiving and Education Workforce that includes child care as well as frontline staff providing in-home and other caregiving services. The latter includes caring for children with special health care needs. Legislation has been introduced in both House and Senate to establish a Community Health Force and Resilience Force, focused upon poor and underserved neighborhoods, and recruiting a supporting staff within those neighborhoods. A resolution introduced in both House and Senate provides the rationale for transformational investments in the caregiving community, with many specific references to the needs of families with young children and bolstering services to strengthen and support those families. These proposals deserve public dialogue and further review, with particular reference to how they can ensure that they address the specific needs for children and families. As research has shown, poor neighborhoods are rich in young children, and investments with the highest return and greatest long-term impact are those that are directed to children and their optimal development.