Area 4: Health and Wellness

Childhood Health and Family Wellness

In 2017, the U.S. Department of Health and Human Services and the U.S. Department of Education issued Policy Statement to Support the Alignment of Health and Early Learning Systems, providing recommendations to improve young children’s access to services that improve their health and early learning outcomes.

A few of the recommendations were:

  1. Build on existing structures to establish and sustain coordination and alignment across health and early learning programs and systems at the state and local levels

  2. Expand, coordinate, and streamline health and early learning enrollment processes for families eligible for multiple public benefits to minimize barriers to families accessing health and early learning services

  3. Implement innovative approaches to coordinate, co-locate, and integrate comprehensive services for young children to meet families where they are.

  4. Build universal screening, referral, and linkage systems to ensure that all children receive age-appropriate health screenings including assessing families’ health and wellbeing (maternal depression, family violence, and food insecurity)

  5. Ensure that children’s nutrition, physical activity, and oral health needs are addressed in early learning programs

The State Plan posits that children’s health and their families’ wellbeing are absolutely foundational for optimal child development and learning. Therefore, creating a Strategic Implementation Plan focused on health and wellbeing, although not specifically required by the PDG B-5 grant, is essential in supporting all the other Implementation Plans.

Key Priorities for Collective Action

Collaborate on policy and program initiatives that enable families and children, with particular attention to children with special health needs, to have equitable access to healthcare and services in their communities, including reproductive health, pediatric care, dental care, environmental health, physical health, nutritional health, and mental health supports. (BB1, B, drawn from the Hawaiʻi Early Childhood State Plan, 2019-2024)*

* The work group chose to focus on 1) families experiencing a lack of geographic access to healthcare and 2) social-emotional and behavioral health concerns of children and families. (BB2 ii)

Objective 1: Family-Focused

Ensure every child has a medical home and is screened at recommended ages for health, wellbeing, and developmental milestones, and is connected to services as needed. (BB1 ii) [Note: Patient-centered medical home is defined by the American Academy of Pediatrics as an “approach to providing comprehensive primary care that facilitates partnerships between patients, clinicians, medical staff, and families.”]

Click to View Objective 1 Details


  • Department of Health

  • Early Childhood Action Strategy:

    • Team 3 On-Track Health & Development

  • Family Hui Hawaiʻi

  • Hawaiʻi Children’s Action Network


  • Design and implement a model prototype of a health/behavioral health “village” in a community with a vulnerable population

  • Support existing, community-based model for child and family wellbeing focusing on developmental screening, caregiver depression screening, and trauma-informed care using a two-generational (multi-gen) approach; expand to one more community; and develop policy recommendations using a community-based model

  • Sustain and expand upon existing community-based model of developmental, behavioral, hearing, and vision screening of children 2-5 years old, and develop policies for a statewide screening and referral system

  • Promote parent training on advocacy so parents are able to articulate the health needs of their child

Indicators of Success

  • Number of partners coordinating services for young children and families has increased

  • Data collection system to track screenings, referrals, and services and support is developed

  • Families demonstrate increased knowledge and awareness of child development and available resources

  • Sustainability plan is in place and model expanded to one additional community

  • Number of children screened and receiving services has increased

  • Number of families who report understanding their role in advocating for their child has increased

Objective 2: Provider-Focused

Develop and implement learning opportunities for providers of all types utilizing best practice materials and models to ensure public information and social supports are available to address injury and abuse prevention and promote the safety and wellbeing of families and children. (BBI, D, modified)

Click to View Objective 2 Details


  • Early Childhood Action Strategy:

    • Team 2: Safe & Nurturing Families

  • Kamaliʻi Ola i ka ʻĀina/Farm to ECE


  • Develop, utilize, and/or expand:

    • Pre-service and in-service programs to support trainings or learning opportunities on Department of Human Services’ Basic Health & Safety Practices: Child Care Provider’s Guide

    • Farm to ECE in targeted communities

    • Educational awareness of the Early Care and Education Wellness Guidelines so early care and education providers, caregivers, and families work together to achieve total wellness

    • Training developed by home visitors to early care and education providers of all types on: suffocation, car safety, water safety, fall safety, fire/gun safety, and fire prevention

  • Pilot training on resiliency addressing adverse childhood experiences using a trauma-responsive approach

  • Link patient-centered medical home system with early childhood system to promote health and wellness

  • Develop a Child Abuse and Neglect Prevention Plan for Hawaiʻi that will serve as a community-wide plan or roadmap

Indicators of Success

  • Curriculum on Basic Health & Safety Practices is developed and available to providers

  • Increases in:

    • Number of families using online modules

    • Number of early care and education providers trained on Farm to Keiki

    • Number of providers trained on ECE Wellness Guidelines

    • Number of early care and education providers utilizing evidence-based curriculum on child safety

    • Number of early care and education providers utilizing a trauma-responsive approach

    • Long-term: Number of programs focusing on prevention of child abuse and neglect

  • Long-term: Rates of child abuse and neglect have decreased

Objective 3: Community-Focused

Generate increased community understanding and support for child development and family wellbeing and engage healthcare system partners in advocating for and securing adequate healthcare services statewide, especially in remote and rural areas. (BB1 iii)

Click to View Objective 3 Details


  • Department of Health, Family Health Services Division


  • Increase partnerships with Federally Qualified Health Centers (FQHCs) in rural/remote communities to promote access to healthcare for children

  • Work collaboratively with partners to promote young children’s oral health

Indicators of Success

  • FQHCs are promoting information about young children’s early care and education opportunities

  • Expanded access to dental care exists

Objective 4: Social-Emotional/Behavioral Health Focus

Ensure communication and cross-sector collaboration to bring evidence-based child development and behavioral health information into all settings, including the medical home, early care and education programs, K-3 programs, and family support programs within the community in two pilot sites. (BB1, C)

Click to View Objective 4 Details


  • Department of Health, Children with Special Health Needs Branch

  • Early Childhood Action Strategy

  • Hawaiʻi Community Foundation


  • Implement and expand Communities of Practice (CoP) models to support children’s social-emotional development (e.g., Promising Minds)

  • Re-establish Infant and Early Childhood Mental Health Consultation model in pilot community to see if it can be expanded statewide

Indicators of Success

  • 1 CoP exists on each island

  • Sustained funding for mental health consultants for early care and education programs exists

Needs Assessment Summary

Health Screenings


  • Center-based and family-child interaction programs are required to secure the DHS Form 908 documenting children’s health screenings, but only 70% of centers and 83% of FCILs report doing so


  • No additional information


  • Establish a system-wide tracking of programs conducting developmental screenings

Health Disparities in Hawaiʻi


  • Health professional shortages: Hāna, Kalihi Valley, Kalihi-Pālama, Kaʻū, Kauaʻi, Molokaʻi, North Hawaiʻi, North Shore, Puna, Waikōloa

  • Medically Underserved (high infant mortality, poverty and/or elderly): Hawaiʻi County entirely, Kalawao, Kalihi Valley, Koʻolauloa, and Waiʻanae

  • Medically Underserved (economic, cultural and/or linguistic barriers to healthcare): Kalihi-Pālama, Kauaʻi County entirely, Maui County entirely, Wahiawā, Waikīkī and Waimānalo


  • High health risk (infant mortality, mothers with late or no prenatal care, children without health insurance): 14% of children birth to five (est. 12,651) in: Kaʻū, Kealakehe, Konawaena, and Laupāhoehoe, Kaimukī, Kalāheo, Kalani, and Waiʻanae/Nānākuli

  • High wellbeing risk (food, housing and economic insecurity, foster care placement permanence, child care assistance): Hilo/Waiākea, Kaʻū, Laupāhoehoe, Lānaʻi, and Molokaʻi


  • Invest in a healthy start to live, including mothers and children, especially high-risk pregnancies, prenatal care, infant care, nutrition, quality child care, and early education

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