The power of building systems.

Is our health care system meeting the needs of children? In Canada and the United States, approximately 4% to 5% of young children have severe disabilities. This group, added to the broader category of all children with special health care needs, accounts for 12% to 16% of children. These two groups use more than the average amount of health care resources. When we include children with behavioural, mental health and learning problems significant enough that systems are needed to evaluate and take care of them, we are talking collectively about 30% to 40% of all children. The rest are generally considered ‘good enough’ even though only a small percentage are reaching their fullest potential. When we look at our own children we don’t say, “Oh, he’s good enough”. But this is the way our systems have been set up. Most kids who we focus on, from a health care standpoint, are the relatively small numbers with severe disabilities and special health needs. The kids with behavioural and mental health problems fly under the radar until they attend school. We need to determine what percentage of our children are thriving, and reset our measurement systems to promote new goals and not simply to reduce vulnerabilities. We know that children who have problems usually have multiple problems. The kids with cognitive challenges usually have health or emotional problems, but our systems are not geared to deal with this. Service delivery is fragmented, with different sectors – health, education and welfare – providing programs. Each has different funding streams and different cultures. They lack coordination, have narrow programmatic criteria for eligibility, possess variable understanding of early years issues, and operate with little accountability or expectations of responsibility from local communities. When we look across the existing early childhood service systems, we see that demand is greater than the services available. Families have complex needs that are often beyond the capability of any one service provider; families have difficulty accessing services; there are large socioeconomic gradients of access; the focus is on treatment rather than prevention/early intervention; and contact is episodic. What can be done? The key is to make sure that the system is based on what we know about how health develops, and that it takes advantage of our capacity to optimize health for everyone. To accomplish this, we need to transform the health system, and early childhood is a logical place to begin. Optimizing child health requires the integration of clinical and targeted prevention with universal and broader social intervention. We have to adopt curve-shifting strategies that minimize risk and maximize the protective factors. We have to align policy at all levels of government and service sectors, and bring the sectors and silos together in more cross-sectoral efforts and place-based programs that bring together child development services and programs into a more integrated system. In health care, there is much discussion about costs, quality and access; much of this discussion is centred on cost control, and in the United States, insurance reform. Reform is about making little changes that incrementally improve the existing system, whereas transformation is about upgrading to a new ‘operating system’ that drives how our health systems are organized and a new set of application programs that reflect our current knowledge and capacity. It requires a paradigm shift. To support early child development, we need to go beyond merely improving early care and education, which is mostly about service quality, performance improvement and unmet needs, to a transformative agenda that really examines how we address the health sector, the early education sector, and the family care and support sector. This requires a logic model change, and an innovation and systems change.