P3.D064: Navigating Preschool Enrollment in Primary Care

Background: Kindergarten readiness can be enhanced with preschool; however, many qualified children are not enrolled. Even more concerning is the primarily Black/African American families living in west Louisville neighborhoods have significantly poorer rates of kindergarten readiness, about 25-30% compared to 60% in eastern neighborhoods. Evidence shows this disparity is related to poverty, racism, and discrimination. Downstream effects are detrimental to children’s education and health. This program works to make connections earlier and increase the overall number of children enrolled in preschool. Preschool helps children with social skills, following rules, establishing routine, writing, language development, and more. This project increased connections to community partners who recognize that school readiness is a priority. The goal is to increase the number of Louisville children enrolled in preschool, through partnership with primary care physicians, encouraging advocacy and education related to enrollment.

Project Description: This is a single site project, funded through the AAP CATCH Program, taking place at a resident-run primary care clinic. The clinic serves more than 6300 children who primarily live in west Louisville. More than 85% of patients have Medicaid insurance. Community health workers, clinical social workers, pediatric residents, and attendings were trained on the optimal routes for connection to preschool, and available resources in our community. A partnership with Metro United Way (MUW), a local community organization was formed, and a new referral system was put into place. At three- and four-year-old well checkups parents/guardians are asked their personal knowledge on preschool enrollment and provided with information and MUW referral placed. Data was collected regarding discussion of preschool during visit and if a referral to MUW was placed.

Discussion: Data including age, zip code, race, and number of referrals are tracked throughout the project. At this time, education has been completed for 2 clinical social workers, 1 community health worker, 37 residents, and 8 attendings. Information on preschool, kindergarten readiness, and community resources were made and are accessible in clinic. Handouts made in collaboration with community partners and program Parent Advocate on preschools in Louisville in English and Spanish are also available. Since inception in December 2023, 21 referrals have been placed, and 2 children are fully enrolled in preschool, with all other connections in process.

Conclusion: This project is ongoing and continuing to make connections for families to preschool, sustainable beyond the initial CATCH Grant which will end in May 2024. This program has been well received by families and has clearly increased our conversations around preschool in the clinic setting. Next steps for the project include expanding to two additional resident clinics, and continued follow-up with families after the initial connection is established to ensure children are enrolled in and start preschool.