Related Experiment Video
Updated: Jul 4, 2025
Setup of Consumer Wearable Devices for Exposure and Health Monitoring in Population Studies
Published on: February 3, 2023
Early Correlates of School Readiness Before and During the COVID-19 Pandemic Linking Health and School Data
Kristen A Copeland1, Lauren Porter2, Michelle C Gorecki3
1Fisher Child Health Equity Center, James M. Anderson Center for Health Systems Excellence, Division of General and Community Pediatrics, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio.
Insights
Primary care data can predict kindergarten readiness, with lower scores observed during the COVID-19 pandemic. Early developmental screenings like the Ages & Stages Questionnaire (ASQ) and factors like food insecurity impact readiness. Collaboration between primary care providers (PCPs) and schools can help identify risks.
Area of Science:
- Pediatrics
- Public Health
- Early Childhood Education
Background:
- Primary care data is underutilized in predicting kindergarten readiness.
- Known correlates of kindergarten readiness are often captured in developmental screenings.
- Understanding these predictors is crucial for early intervention and support.
Purpose of the Study:
- To identify early Kindergarten Readiness Assessment (KRA) correlates by linking electronic health record (EHR) data with school district KRA data.
- To examine the impact of the COVID-19 pandemic on KRA scores between 2018 and 2021.
- To explore the predictive value of primary care data for school readiness.
Main Methods:
- Retrospective cohort study linking primary care practice (PCP) EHR data with school district KRA data.
- Patient linkage was performed using name, date of birth, and address.
- Included students with KRA scores from 2018, 2019, or 2021 and at least one prior well-child visit.
Main Results:
- Kindergarten Readiness Assessment (KRA) scores were significantly lower in 2021 compared to 2019 and 2018, mirroring a larger school district trend.
- Factors significantly lowering KRA scores included failing the Ages & Stages Questionnaire (ASQ), Medicaid insurance, Hispanic ethnicity, requiring an interpreter, and food insecurity.
- No association was found between KRA scores and race, caregiver depression, housing insecurity, or problems receiving benefits in the final model.
Conclusions:
- The COVID-19 pandemic showed a deleterious association with early learning and development.
- Primary care data can predict kindergarten readiness, highlighting the importance of developmental screenings.
- Collaboration between PCPs and school districts can facilitate earlier identification and mitigation of risks to child development.
Importance:
Many known correlates of kindergarten readiness are captured in developmental and social screenings in primary care; little is known about how primary care data predicts school readiness.
Objective:
To identify early Kindergarten Readiness Assessment (KRA) correlates by linking electronic health record (EHR) data with school district KRA data and to examine potential outcomes of the COVID-19 pandemic using KRA scores between 2018 and 2021.
Design, Setting, And Participants:
This was a retrospective cohort study linking a large primary care practice (PCP) with school assessment data. Linkage used patient name, date of birth, and address. The setting was an urban school district and PCP affiliated with an academic medical center. Students had a KRA score from fall of 2018, 2019, or 2021 (no 2020 KRA due to the COVID-19 pandemic) and at least 1 prior well-child visit at the PCP.
Exposures:
Exposures included year KRA administered, reported child race and ethnicity, child sex, interpreter for medical visits, child ever failed Ages & Stages Questionnaire (ASQ) 18 to 54 months, ever rarely read to, Medicaid status, food insecurity, housing insecurity, problems with benefits, and caregiver depressive symptoms.
Main Outcomes And Measures:
KRA score (continuous), with a possible range of 0 to 300 (passing score = 270).
Results:
A total of 3204 PCP patients (mean [SD] age, 67 [4] months; 1612 male [50.3%]; 2642 Black [82.5%]; 94 Hispanic [2.9%]; 244 White [7.6%]) were matched to their KRA score. Mean (SD) KRA scores were significantly lower in 2021 (mean [SD], 260.0 [13.0]; 214 of 998 [21.4%]) compared with 2019 (mean [SD], 262.7 [13.5]; 317 of 1114 [28.5%]) and 2018 (mean [SD], 263.5 [13.6]; 351 of 1092 [32.1%]), a pattern mirrored in the larger school district. In the linear regression final model (n = 2883), the following binary variables significantly lowered the child's KRA score (points lowered [95% CI]) below a mean passing score of 270.8: child ever failed ASQ after 18 months (-6.7; 95% CI, -7.7 to -5.6), Medicaid insured (-5.7; 95% CI, -9.0 to -2.3), Hispanic ethnicity (-3.8; 95% CI, -6.9 to -0.6), requires interpreter (-3.6; 95% CI, -7.1 to -0.1), 2021 year (-3.5; 95% CI, -4.7 to -2.3), male sex (-2.7; 95% CI, -3.7 to -1.8), ever rarely read to (-1.5; 95% CI, -2.6 to -0.4), and food insecurity (-1.2; 95% CI, -2.4 to -0.1). Race, caregiver depression, housing insecurity, and problems receiving benefits were not associated with KRA scores in final model.
Conclusions And Relevance:
Findings of this cohort study suggest a deleterious association of the COVID-19 pandemic with early learning and development. There may be potential for PCPs and school districts to collaborate to identify and mitigate risks much earlier.
Related Concept Videos
02:20Correlations
01:18Factors Affecting Illness
For instance, risk factors are connected to illness,...
01:18Steps in Outbreak Investigation
01:26Principles of Disease Surveillance
01:30Stress and Mental Health
Individuals with depression often experience challenges in both their personal and professional...
01:08Prevalence and Incidence
Prevalence indicates the proportion of individuals in a population who have a specific disease or health...