OHSU program helps children on Medicaid prepare for kindergarten

Access to preschool in Oregon remains limited, with more than half of the state’s school districts reporting that demand has outpaced available slots. The deficit could leave many children without the early literacy and math skills they’re expected to bring into kindergarten.

The Kinder Coaching Program at Oregon Health & Science University aims to incorporate school readiness into medical care. During a routine visit, medical providers can refer children on Medicaid to a team of community health workers who help them develop the cognition, communication and social-emotional skills they need for kindergarten.

Jaime Peterson is a pediatrician at OHSU and director of the Kinder Coaching Program. Isha Sylla is a certified community health worker and one of the program’s “kinder coaches.” They both join us to talk about the importance of providing early learning opportunities for low-income families.

Note: The following transcript was transcribed digitally and validated for accuracy, readability and formatting by an OPB volunteer.

Dave Miller: From the Gert Boyle Studio at OPB, this is Think Out Loud. I’m Dave Miller. Access to preschool in Oregon remains limited, leaving many children without the early literacy and math skills they’re expected to have by the time they get into kindergarten. A new program at OHSU is trying to address that. The Kinder Coaching Program aims to incorporate school readiness into medical care.

Jaime Peterson is a pediatrician at OHSU and the director of this program. Isha Sylla is a certified community health worker and one of the program’s kinder coaches. They both join us now. It’s great to have both of you on the show.

Isha Sylla: Thank you for having us.

Miller: Jaime Peterson, first – you were a teacher for two years before you became a pediatrician. What did you learn in middle school classrooms that you still think about now or are still applying as a doctor?

Jaime Peterson: I taught middle school science for two years in Oakland and I still think about those kids almost every day. They had health and family needs that weren’t addressed in the school setting that were really, really challenging. We had a type one diabetic. We didn’t have a school nurse. We had families in poverty. We had families without a lot of access to supports. And every day those kids came ready to learn. And they were behind. A lot of them were behind.

Miller: That’s sixth, seventh, eight grade, something like that? So how did you go from that to focusing on 3 and 4 year olds, on kindergarten readiness?

Peterson: I love that question because so many of us realize the earlier you start, the bigger bang you’re gonna get for your buck. And so we worked really hard with our sixth graders and seventh graders, and they did learn, and they did progress. But if you start earlier, brain development starts from the day that kids are born, and they develop faster and faster the earlier you start. So if you can start kindergarten ready, you are more likely to stay on track. So when they would have reached my sixth grade classroom, they would have been reading on grade level and able to engage in the material, graduate high school, and go on to have more successful lives and jobs.

Miller: How much did you talk to parents to see what they would want in a program before you created this?

Peterson: I love that question. So this program has evolved for over a decade. It was the seed of a program in a clinic in California where I trained. And when I moved to Oregon over seven years ago, we brought those stories to Oregon clinics. We sat with families in Woodburn, Washington County clinics, and then in the metro area, and we said, “tell us your story about getting ready for kindergarten.” And we did a lot of narrative inquiry and journey mapping of families with first graders, and mostly Latino families, Spanish-speaking families, and we celebrated what they were doing already that was related to kindergarten. And then they helped us identify areas where they needed more support.

Miller: What were the big themes that stood out? I’m wondering specific things you heard that led you to shape this program in specific ways?

Peterson: What we heard was they trust their pediatrician or their primary care provider as much as family members. And for many families who their immediate family wasn’t here in the U.S., they could go to the pediatrician and ask for support. So they trusted the clinic, that’s important. You don’t want to build a program if they don’t want to come to that space.

The next one was that they were nervous to ask questions about school. And then when we talked about things they were doing, when you speak your native language at home and you’re reading together, those are all things that are important for kindergarten. They said, “Wow, that’s why we came to this country. We believe in school as a tool to lift our family out of poverty and more opportunities.” So we took those strengths and then we embedded them into the program.

Miller: Isha, this coaching takes place in a medical clinic, which I think could make kids wary. It’s the building you go to get shots, among other things. That’s the least fun thing I think for most kids. Can you describe your office?

Sylla: So the kinder coaching room, we have a room in the clinic space. And in the room we have a rug, like a rug you’ll find in a preschool or kindergarten. We have a bookshelf. We have different posters up with ABCs and colors. We have a little table that we have, puzzles, and pencils and crayons set out on, so it’s really, really kid friendly. A lot of the times when I go out to pick kids up, I just immediately tell them, like, “you’re not gonna get shots today, we’re here to learn and have fun.”

Miller: That’s one of the first things you say?

Sylla: Yes.

Miller: And I imagine that they’re happy to hear that?

Sylla: Yes. Sometimes they’re still a little hesitant, but then as soon as I open my room, they’re like “whoa!” and immediately run to the puzzle and want to play.

Miller: What you’re describing sounds more like a preschool classroom than a medical clinic office.

Sylla: Exactly.

Miller: So there isn’t a place to get your blood pressure checked or a scale or those things?

Sylla: Not in my room.

Miller: Outside that room in the medical clinic offices themselves. So how do you connect with kids in those first meetings?

Sylla: I try to make it really fun. At that age, everything really is play-based. Kids just really want to have fun, and they learn best when they’re having fun and when we’re playing. So when I meet them, I introduce myself. When they come into my room, I’m immediately like, “Do you want to have a seat? Let’s sit down, let’s play.” Just really so they can warm up to me.

Miller: What are you looking for? What are you assessing? They’re there to play as far as they’re concerned. But what you’re doing is much more serious. So I’m curious what you’re on the lookout for?

Sylla: So a coaching appointment, when they come in, it’s about an hour long, and I talk to parents about kinder readiness. What is kinder readiness? What are the skills they need? And then in that assessment, we have 15 minutes where I ask them questions about colors, numbers, letters, shapes. And then from there we can kind of see what they know and what they don’t know. But we make it really fun.

Miller: And then what do you do with that information?

Sylla: We talk about it with the parents. One of the nice things is that the parents are right there with me, so they can see me do the assessment and they can see all the great things that their kids do know, and then they can see what their kids don’t know and what they need to work on.

Miller: Is this happening in English, Spanish or other languages that might be the first languages of these kids and their parents?

Sylla: It happens in English, but we also have interpreters. We have two other coaches that are Spanish speakers, so they are able to do their sessions in Spanish.

Miller: What role do parents play in this program and in this process?

Sylla: Parents are really important because they are the ones who have built the program. They have told us that they want to know what they need for kindergarten, so that’s what we tell them. And they told us they want to know what their child knows, so we have an assessment that tells us what their child knows.

Miller: Jaime, that’s an important point here. What are kids supposed to be able to do or be ready to do by the time they arrive in kindergarten for their first day of school?

Peterson: There are five sort of domains that we talk about for school readiness. The first is sort of obvious in the medical space: physical health. Are they growing normally? Is nutrition OK? Are we getting our shots? Growth and development.

The second is language and communication. So, when you enter that kindergarten classroom, you need to be able to express your needs to your new teacher, an adult that you have to build a new relationship with. And you need to be able to communicate with your peers. “May I borrow your scissors?” “Do you want to play blocks with me?” So, speech and language skills are important.

The third domain are the cognitive skills, which we focus a little bit more on this program than in others because that is where the gaps have been for Latino families. They have really strong social-emotional skills, but behind there. So that’s things like recognizing letters, that letters make words, words make sentences, they turn into books. And then early math, colors, shapes, counting. “That’s a big ball,” “that’s a small ball,” “big dinosaur, little dinosaur.”

Then the fourth domain, social-emotional skills. Can you manage your emotions? Can you take turns with peers?

And then the last one is either called self-help or approaches to learning. Can you manage your needs? Can you go to the bathroom by yourself, zip your jacket, blow your nose. So when you’re in a classroom of 20 to 25 kids, there’s not an adult to do those things for you.

Miller: Who is this program for exactly? I mean, you mentioned Latino families, but there’s all kinds of Latino families in Oregon. There are some people all across the state who have access to various versions of preschool, folks who don’t. Who’s the real target audience for this program?

Peterson: So we designed it with families who have the most need, so that then it can be generalizable to everybody else. The way Isha described it is it’s really individualized. So you’re going to focus on the domain or the skill area that you most need as a family. We have partnered with the Medicaid program with our CCO locally, to say this is for families who often have less resources, who may enter kinder behind. It’s for 3, 4 and 5 year olds who are on OHP, so public insurance or Medicaid insurance, at our three partner sites.

Miller: Isha, kids who are fortunate enough to be able to go to preschool might spend two or three years there. You’re trying to, in a sense if I understand this correctly, bridge that gap or at least do some movement towards bridging that gap in just a handful of visits. What do you see as the limitations of this program compared to years of preschool?

Sylla: So the program is really family focused. We really want to focus on empowering parents to be their child’s first teacher. We want to also promote them going to preschool. So a lot of the times in my appointments when we’re setting goals on things that they can practice at home like reading and practicing letters, we are also setting the goal of finding a preschool. I also support parents in finding preschools, applying to preschools, finding the preschool that’s closest to their house.

Miller: Almost working like a social worker or a caseworker, saying these are resources to help you do more. So it’s not simply, “read to your kid at night for 20 minutes every night,” it’s also, if they want, “here’s how to get into preschool.” But are there spots for them to do that?

Sylla: So Preschool for All just opened up in Multnomah County, we have that. There’s also Head Start. It can be really tricky because it’s not free preschool all over Oregon, but I do try my best to kind of squeeze in where they can. A lot of places have preschool.

Miller: Jaime, implicit in what you were saying, one of the reasons this works is that the families you’re dealing with have a lot of trust in their pediatricians and their doctors. They’re going to a place where there’s existing trust and I think they’re more ready for the message that you’re giving.

That makes sense in terms of how this program could work. But why embed this in the medical setting? It seems like you’re trying to plug a societal hole in the place where you happen to work?

Peterson: So where’s the one place that every kid goes before kindergarten? You could name a whole bunch of places that kids have access to, or community resources. But there’s one social system that touches all children, and it’s the health system. We are inherently responsible for the health and well-being of kids. We are supposed to connect them to preschool. We’re supposed to make sure development’s on track. We should be promoting things that families need support with. And so in this case, families told us, “I wish my pediatrician had told me that counting was important or that preschool was important.” But in our visits, they’re short, 20 to 30 minutes. I can’t do it all. I can’t talk about growth, nutrition, shots, water safety, sunscreen, all the things. So this is a chance for us to extend our reach, our trust, within a safe space.

Miller: How is this program funded?

Peterson: We were funded through a quality grant from the IDS and now we are primarily funded through Medicaid billing.

Miller: Did you have to get permission from the federal government to use Medicaid dollars for an education program?

Peterson: This is a quality grant through the OHSU IDS, so it’s local funding. We did not need permission. If you’ve heard of the social-emotional metric, which is a metric on the state level to help kids be on track in terms of social-emotional stuff, this falls within that kind of work.

Miller: So could looming cuts to Medicaid affect that? Or is the pot of money you’re talking about separate enough that this can continue or grow?

Peterson: That’s a real challenge. So our goal with the pilot funding was to develop the model, implement it and show it’s sustainable. That’s working. But with recent cuts, we are going to lose some of those resources. That’s happening now.

Miller: Isha, what does success look like to you from your perspective?

Sylla: Success is when I am able to schedule an appointment for families to come in. Like a couple of weeks ago when I had a family come in for an hour-long appointment, and I was able to talk to mom about kinder readiness and all the things that they’re doing. And mom was just like, “we do this, we do that,” and I’m like, “great!” In that appointment, we also gave an assessment and we were able to see what their child does. And one of the things that came up was that they have a speech delay. So they do speak, they’re able to say one syllable sentences, but not longer. So when we created our goal at the end of our appointments, we said three-syllable sentences and working on fine motor skills, on how to hold a pencil.

And then I saw them again three months later. And in that three months, she’s speaking more, she’s able to express herself, she’s able to hold a pencil. And she’s excited to learn. Mom’s excited about all the things that you’re doing. Our appointments are only for two sessions, but it can be however long they want. So she’s 3 years old, and I can see her again when she’s 4 and 5.

Miller: Isha and Jaime, thanks very much.

Peterson: Thanks for having us.

Sylla: Thank you.

Miller: Isha Sylla is a community health worker and a coach with OHSU’s Kinder Coaching Program. Jaime Peterson is a pediatrician at OHSU and the director of this program.

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