A Primary Care-Based Approach to Improving Kindergarten Readiness

This quality-improvement project aimed to develop personalized literacy plans (PLPs) during the 3- and 4-year preventive care visit to promote kindergarten readiness in busy primary care settings.

Two clinics serving primarily Medicaid-eligible patients hired staff members with training in early childhood education to serve as kindergarten readiness coordinators (KRCs). KRCs assessed child literacy using a standardized measure, The Reading House (TRH), or if there was a language barrier, by asking the caregiver about the child's literacy skills. The KRCs provided a PLP, including parental guidance, home literacy kits, and referrals to community programs and services. All children, regardless of literacy skill, were referred to an early literacy program (eg, preschool, home kindergarten readiness program) if not already connected. The goal was that at least 65% of patients would be given a PLP by a KRC. Linkages to services were tracked with phone follow-up 1 and 3 months after referral.

After 12 months, the centerline for the proportion of eligible 3- and 4-year-old children receiving a PLP was 64%. For the 24-month evaluation period, 85% (n = 1076) of children with a PLP were referred to an early education program, of whom 43% (n = 463) had confirmed linkage by 3 months.

By the end of this project, most children had a PLP and nearly half were confirmed to be linked to an early education program. Future work is needed to understand the impact of assessment and referral on kindergarten readiness, linkage to early education, and sustainability.