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School Readiness Among Children Insured by Medicaid, South Carolina

William B. Pittard III, MD, PhD, MPH; Thomas C. Hulsey, ScD, MSPH; James N. Laditka, DA, PhD; Sarah B. Laditka, PhD

Suggested citation for this article: Pittard WB III, Hulsey TC, Laditka JN, Laditka SB. School Readiness Among Children Insured by Medicaid, South Carolina. Prev Chronic Dis 2012;9:110333. DOI:



The American Academy of Pediatrics recommends a schedule of age-specific well-child visits through age 21 years. For children insured by Medicaid, these visits are called Early and Periodic Screening, Diagnosis, and Treatment (EPSDT). These visits are designed to promote physical, emotional, and cognitive health. Six visits are recommended for the first year of life, 3 for the second year. We hypothesized that children with the recommended visits in the first 2 years of life would be more likely than others to be ready for school when they finish kindergarten.

We studied children insured by Medicaid in South Carolina, born during 2000 through 2002 (n = 21,998). Measures included the number of EPSDT visits in the first 2 years of life and an assessment of school readiness conducted at the end of kindergarten. We used logistic regression to examine the adjusted association between having the recommended visits and school readiness, controlling for characteristics of mothers, infants, prenatal care and delivery, and residence area.

Children with the recommended visits had 23% higher adjusted odds of being ready for school than those with fewer visits.

EPSDT may contribute to school readiness for children insured by Medicaid. Children having fewer than the recommended EPSDT visits may benefit from school readiness programs.

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Lack of school readiness is a public health concern with adverse physical, psychological, social, and economic consequences for many children, particularly those insured by Medicaid (1,2). Children unprepared for school often perform poorly academically, have low self-esteem, and in the long term are at greater risk than others for unemployment, poverty, and crime (3,4). School readiness begins to develop early in life, well before formal schooling (5-9). Inadequate school readiness has been associated with poverty and poor health (10-12), a lack of reading materials and cognitive stimulation in the home, and cultural variation in beliefs and attitudes about education (2,3).

Well-child care may contribute to school readiness (13). In Medicaid, well-child care is called Early and Periodic Screening, Diagnosis, and Treatment (EPSDT). The American Academy of Pediatrics (AAP) recommends a widely accepted national standard of well-child care, including at least 6 EPSDT visits in the first year of life and at least 3 in the second (14). The recommended content for EPSDT visits in the South Carolina Medicaid system is all age-based preventive care services recommended by the AAP, screening procedures designed to promote normal child development and school readiness, and anticipatory guidance for parents or caregivers (5,11,15-17). Anticipatory guidance during a well-child visit gives parents education and counseling intended to promote child health. For example, these visits include advice about physical activity, nutrition, appropriate use of health care, parent–child reading, and avoiding exposure to household toxins such as lead.

The AAP has called for research on the effectiveness of EPSDT. However, this effectiveness has been confirmed only for vaccinations (18). A large proportion of children do not have the recommended number of EPSDT visits (19,20). Underuse of these visits and lack of readiness for first-grade learning disproportionately affect children insured by Medicaid (1,3,13).

EPSDT visits provide an opportunity for clinicians to identify and address physical, developmental, emotional, social, or other problems that may impede optimal development. Beginning with anticipatory guidance during prenatal care, the visits include vaccinations, developmental and sensory evaluations, evaluation of nutrition and oral health, guidance about parenting, and other preventive services. Parents of children with the recommended number of EPSDT visits in infancy also receive more information than others about cognitive stimulation for their children and about avoiding risks to cognitive health such as lead exposure, accidents, and undernutrition (8,11,15). AAP guidelines promote guidance during these visits about excessive television watching, which has been associated with attention deficit hyperactivity disorder, poor school performance, and possible delays in the development of language skills among infants younger than 2 years (21). Thus, our hypothesis is that children insured by Medicaid who have at least the AAP-recommended number of EPSDT visits in the first 2 years of life will be more likely to be ready for school when they finish kindergarten than those with fewer visits.

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Study design

The data represent South Carolina children born during 2000 through 2002 and consistently enrolled in Medicaid in the first 2 years of life. Data were from linked state Medicaid claims, birth certificate records, and state Department of Education kindergarten school readiness assessments. The study was approved by the institutional review board of the Medical University of South Carolina and the South Carolina Data Oversight Commission. Previous research using South Carolina Medicaid data suggests that the data and linkages required for this research have a high degree of validity and completeness (22,23).

Outcome measure

The dependent variable represents results of the South Carolina Readiness Assessment (SCRA). Kindergarten teachers throughout the state conduct these school readiness assessments at the end of the kindergarten (K-5) school year (24). The SCRA assesses how well students meet state school readiness standards for personal and social development, English language arts, and mathematics (25) (Appendix). Readiness is defined using guidelines from the National Education Goals Panel (26,27). Recommended EPSDT content addresses the cognitive, emotional, physical, and social development needed to perform adequately in these assessments (13,21). Evidence indicates that results from the SCRA predict success in school (28).

Exposure variable

The independent variable of primary interest was whether each child had the recommended number of EPSDT visits in the first 2 years of life. These visits could be for vaccinations, screening services, and parental anticipatory guidance. They were identified using claims submitted by providers, which were categorized when received by Medicaid using codes developed for the Medicaid system (H. Kirby, Office of Research and Statistics, South Carolina Budget and Control Board, written communication).

Control variables

Control variables included several characteristics of mothers: age in years at the child’s delivery; years of education; marital status; race/ethnicity; rural or urban residence; parity; whether the delivery was vaginal; and whether the mother received adequate prenatal care, as defined by the Kessner Adequacy of Prenatal Care Index (29). Family income was characterized as either 1) less than or equal to 50% of the income level defined by federal guidelines as poverty or 2) greater than 50% to 185% of poverty (which included all other families in SC Medicaid). Controls for child characteristics include birth weight in grams, sex, and gestational age in weeks.

To control for baseline health status, we excluded children with conditions that might predispose them to have more health provider visits, which could result in more visits being coded as EPSDT visits. Such conditions also affect other parenting behaviors and could be associated with school readiness (30). Thus, we excluded children with birth admissions lasting 7 days or more; major heart diseases or conditions; central nervous system malformations; recognizable genetic malformations; and anomalies including genitourinary, gastrointestinal, and musculoskeletal (identified using International Classification of Diseases, Ninth Revision, Clinical Modification codes). Study children were also restricted to those who were full term with appropriate weight for gestational age by requiring 37 to 42 weeks’ gestational age and by excluding children with birth weights outside published fetal growth norms (31). Children are often not enrolled in their Medicaid insurance plan until sometime during the first month of life. Thus, we calculated the number of visits for the first year based on the 2nd through the 12th months of life.

Study population

In 2000 through 2002, there were 61,112 South Carolina births insured by Medicaid. The study restrictions excluded 16,280 (26.6%), leaving 44,832. Most exclusions were due to birth anomalies (n = 11,552), birth weight outside fetal growth norms (n = 6,878), and gestational age less than 37 or greater than 42 weeks (n = 7,491). Of the children excluded, 5,913 met more than 1 of these criteria. Of the remaining cohort, 42,485 (94.8%) met the requirements of being enrolled in Medicaid throughout the first 2 years of life and having a successful linkage of their Medicaid claims and birth certificate files. The final number of study children was established with successful SCRA data linkage for 31,751 (74.7%) of these 42,485 children.

Of those 31,751 children, 9,753 (30.7%) had missing values for at least 1 variable used in the analysis. These observations were excluded from the multivariate analysis, leaving a final analytical sample of 21,998. We conducted a separate analysis to examine the sensitivity of our results to this exclusion of observations with missing values. For that analysis, we included a dummy variable in the model associated with each variable having a missing value, indicating this missing data. Doing so permitted an estimation of the models using all 31,751 observations. The result of this sensitivity analysis was consistent with the results we report, although indicating an even larger association between EPSDT and school readiness. Thus, we report conservative results for this relationship.

Analytic approach

Each of the 14 SCRA domain evaluations was scored on a scale of 1 to 3 (1 = rarely or never demonstrates the assessed characteristic, 2 = sometimes demonstrates, and 3 = consistently demonstrates). Of the 21,998 children, 64.6% received “consistently demonstrates” for at least 10 of the 14 evaluations and were considered ready for first grade; 35.4% received “consistently demonstrates” for fewer than 10 domains and were considered not ready for first grade. The cut-point that defined these categories is the official measure used by the South Carolina Department of Education (A. Brailsford, Coordinator of Development, South Carolina Department of Education, oral communication).

Bivariate analyses compared characteristics of mothers and children in 2 groups: children who had the recommended number of EPSDT visits and those who had fewer visits (χ2 for categorical variables; t tests for continuous variables). The χ2 test also assessed the association between having the recommended number of EPSDT visits and later school readiness. Multivariate analyses using logistic regression estimated the relative odds of the same association, adjusted for the maternal and child characteristics examined.

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Mothers of children who had the AAP-recommended number of EPSDT visits in both years had slightly more education than others (11.9 y vs 11.6 y, P < .001) (Table). They were also more likely to be married, nulliparous, white, urban residents, and to have both income greater than 50% of the income level defined as poverty and adequate prenatal care. The analogous bivariate comparisons of maternal and child characteristics associated with having the recommended number of EPSDT visits in the first year of life, and separately for the second year, suggested the same relationship for each of the 2 years (data not shown).

Only 11.2% and 26.8% of children, respectively, had at least the recommended number of EPSDT visits in their first and second years (Table). Approximately 8% of children had the recommended number of EPSDT visits in both their first and second years. Children having fewer than the recommended number of EPSDT visits had mean (standard deviation) visit rates of 3.1 (1.7) in their first year, 1.0 (0.8) in their second year, and 4.7 (2.5) for their first and second year combined.

In the analysis focused on the first year of life, 68.9% of children with at least the recommended number of visits were ready for school, compared with 64.1% of those with fewer visits (P < .001). The corresponding percentages associated with EPSDT visits in the second year of life were 68.6% and 63.2% (P < .001). For their first and second year combined, 71.0% of children with at least the AAP-recommended number of visits were ready for school, compared with 64.1% of those with fewer visits (P < .001). The adjusted odds of being ready for school were greater for those with the recommended number of EPSDT visits in the first year of life compared with those having fewer visits (odds ratio [OR], 1.12; 95% confidence interval [CI], 1.02–1.23). The corresponding adjusted OR associated with EPSDT visits in the second year of life was 1.19 (95% CI, 1.10–1.26). For children with the recommended number of EPSDT visits in their first and second year, the adjusted odds of being ready for school were greater than for those with fewer visits (OR, 1.23; 95% CI, 1.10–1.37).

Approximately 75% of the observations representing children with Medicaid records for EPSDT visits in infancy could be linked with education data for the SCRA. To examine whether this linkage rate might have biased the results, we compared maternal and child characteristics of the children linked with their SCRA evaluations with those not successfully linked. Those linked were more likely to be African American (54.9% vs 45.7%, P < .001), their mothers were less likely to be married (22.7% vs 27.9%, P < .001), and they were less likely to be Hispanic (6.1% vs 9.0%, P < .001). There were no clinically significant differences between the 2 groups in the mean number of EPSDT visits or in the proportions that had at least the AAP-recommended EPSDT visits in their first year, their second year, or their first and second year combined.

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In this study of children insured by Medicaid in South Carolina, consistent with our hypothesis, children having at least the AAP-recommended number of EPSDT visits in the first 2 years of life were more likely to be ready for school at the end of the K–5 school year. This finding is consistent with the expectation that mothers of children having at least the recommended number of EPSDT visits in the first 2 years of life receive more guidance about child health and development and parenting and that their children receive more screening and preventive care (5,6,9,13). Thus, for example, children with the recommended EPSDT visits may be less likely to have unaddressed vision or hearing impairments, which can affect both cognitive and social development as well as performance in kindergarten. Parents whose children have the recommended number of visits receive regular health education and guidance about risk avoidance, cognitive development and emotional health, and social development. As a result, they may improve their children’s diets, promote physical activity, arrange more social activity, and avoid environmental toxins, all of which may be associated with cognitive development and the social skills that are evaluated in the school readiness assessment (8,13,16,17).

The clinical effectiveness of well-child care other than vaccinations has not been objectively confirmed. State Medicaid program administrators often question whether increasing well-child care in infancy is worth the added cost (18,32). Yet lack of school readiness has long-term consequences for children and society. The study represented infants born to mothers insured by Medicaid. Families insured by Medicaid often have limited access to health care even though they are insured. They are more likely to have problems accessing needed services due to factors such as limited health literacy, difficulty arranging for child care or time away from employment, and problems getting transportation to obtain needed services. Infants in these families are at high risk of poor health and poor social outcomes. The difference we found in school readiness associated with EPSDT may indicate an opportunity to improve infant outcomes by expanding use of EPSDT services. In our analysis, approximately 8% of children had the recommended number of EPSDT visits in the first 2 years of life. The potential to increase this percentage, and possibly the rate of readiness for school, is large. Improving school readiness by correcting underuse of well-child care by children insured by Medicaid (92% did not have the recommended number of EPSDT visits) may be worth the cost of those services (2-4).

We acknowledge study limitations. The SCRA linkage could not be made for 25.3% of the children who met the study’s other inclusion criteria; however, there were no significant differences between the 2 groups in their mean number of EPSDT visits. The AAP recommends an age-based schedule for EPSDT visits (18). The available data did not permit us to assess whether this schedule was followed. The results may be related to the timing of these visits as well as their number. Using the number of Medicaid claims to document clinical care use can underestimate the amount of service provided (33). Although the expected content of EPSDT visits is an accepted standard of care and is routinely available to physicians (14,21), specific services provided to children during these visits were not recorded in our data. Physician discretion may affect the content of these visits (34). If the services provided or the procedures for filing claims vary in a consistent fashion between the groups examined, the results could be biased. We have no reason to suspect systematic variation. In addition, because EPSDT visits do not typically occur during the first month of life, our calculation of the number of visits for the first year based on the 2nd through the 12th months of life is unlikely to have introduced bias (21).

Children in this analysis were not randomly selected. We addressed potential selection bias by adjusting for likely confounding variables. Nevertheless, the study design does not permit inferences about causality. Children with conditions that might predispose their parents to use more EPSDT services, such as physical anomalies at birth, not being full term and appropriately grown at birth, or having an extended newborn hospitalization, were excluded. Inferences from the results to children in these high-risk groups are not warranted.

Although regression models adjusted for several potential confounding variables, there was no direct control for parenting skills. The analysis controlled for various factors that may be associated with parenting skills, including maternal age and education, marital status, and family income (5,7,10,12,23). EPSDT use may be correlated with parenting skills, which may be more important determinants of school readiness than EPSDT visits. However, many parenting skills can be taught and are typically addressed by parental anticipatory guidance in well-child care (5,11).

The data used for this study provided detailed information about mothers and infants and supported a linkage with education data, providing information that is rarely available for research in this area. Lack of objective evidence confirming the value of well-child visits has been a serious gap in available information. Lacking such evidence, some policy makers are uncertain whether increasing compliance with existing recommendations for well-child care in infancy through more provider outreach and parental education is worth any short-term added cost. This study provided evidence that well-child care during the first 2 years of life may contribute to school readiness for children insured by Medicaid. Pending additional research that may support this study’s findings that adherence to the recommended number of well-child visits may serve as an early marker for school readiness, the findings could be used to identify children who might benefit from early childhood programs designed to improve school readiness.

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The Commonwealth Fund provided financial support for this research.

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Author Information

Corresponding Author: William B. Pittard III, MD, PhD, MPH, Department of Pediatrics, Division of Pediatric Epidemiology and Health Systems Research, Medical University of South Carolina, 165 Ashley Ave, Charleston, SC 29425. Telephone: 843-792-4499. E-mail:

Author Affiliations: Thomas C. Hulsey, Medical University of South Carolina, Charleston, South Carolina; James N. Laditka, Sarah B. Laditka, University of North Carolina at Charlotte, Charlotte, North Carolina.

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  1. Wold C, Nicholas W. Starting school healthy and ready to learn: using social indicators to improve school readiness in Los Angeles County. Prev Chronic Dis 2007;4(4): PubMed
  2. Crnic K, Lamberty G. Reconsidering school readiness: conceptual and applied perspectives. Early Educ Dev 1994;5(2):91-105. CrossRef
  3. Willis E, Kabler-Babbitt C, Zuckerman B. Early literacy interventions: Reach Out and Read. Pediatr Clin North Am 2007;54(3):625-42. CrossRef PubMed
  4. Williamson D. Study: N.C. kindergartners from low income families face disadvantage in school readiness [press release]. Chapel Hill (NC): University of North Carolina News Services; April 23, 2001. Accessed February 8, 2011.
  5. Currie J. Health disparities and gaps in school readiness. Future Child 2005;15(1):117-38. CrossRef PubMed
  6. Lunkenheimer ES, Dishion TJ, Shaw DS, Connell AM, Gardner F, Wilson MN, et al. Collateral benefits of the Family Check-Up on early childhood school readiness: indirect effects of parents’ positive behavior support. Dev Psychol 2008;44(6):1737-52. CrossRef PubMed
  7. Lloyd JE, Li L, Hertzman C. Early experiences matter: lasting effect of concentrated disadvantage on children’s language and cognitive outcomes. Health Place 2010;16(2):371-80. CrossRef PubMed
  8. Raikes H, Pan BA, Luze G, Tamis-LeMonda CS, Brooks-Gunn J, Constantine J, et al. Mother-child bookreading in low-income families: correlates and outcomes during the first three years of life. Child Dev 2006;77(4):924-53. CrossRef PubMed
  9. Magnuson KA, Waldfogel J. Early childhood care and education: effects on ethnic and racial gaps in school readiness. Future Child 2005;15(1):169-96. CrossRef PubMed
  10. Aber JL, Bennett NG, Conley DC, Li J. The effects of poverty on child health and development. Annu Rev Public Health 1997;18:463-83. CrossRef PubMed
  11. Dworkin PH. Ready to learn: a mandate for pediatrics. J Dev Behav Pediatr 1993;14(3):192-6. PubMed
  12. Currie J, Lin W. Chipping away at health: more on the relationship between income and child health. Health Aff (Millwood) 2007;26(2):331-44. CrossRef PubMed
  13. Schor EL, Abrams M, Shea K. Medicaid: health promotion and disease prevention for school readiness. Health Aff (Millwood) 2007;26(2):420-9. CrossRef PubMed
  14. Committee on Practice and Ambulatory Medicine, Bright Futures Steering Committee. Recommendations for preventive pediatric health care. Pediatrics 2007;120(6):1376. CrossRef
  15. Shrivastava Dev LS, Shrivastava N. Anticipatory guidance. Clin Fam Pract 2003;5(2):313-42. CrossRef
  16. Oja L, Jurimae T. Physical activity, motor ability, and school readiness of 6-yr. old children. Percept Mot Skills 2002;95(2):407-15. CrossRef PubMed
  17. Ruff HA, Bijur PE, Markowitz M, Yeou-Cheng M, Rosen JF. Declining blood lead levels and cognitive changes in moderately lead-poisoned children. JAMA 1993;269(13):1641-6. CrossRef PubMed
  18. Hakim RB, Bye BV. Effectiveness of compliance with pediatric preventive care guidelines among Medicaid beneficiaries. Pediatrics 2001;108(1):90-7. CrossRef PubMed
  19. Byrd RS, Hoekelman RA, Auinger P. Adherence to AAP guidelines for well-child care under managed care. American Academy of Pediatrics. Pediatrics 1999;104(3 Pt 1):536-40. CrossRef PubMed
  20. Zuckerman B, Stevens GD, Inkelas M, Halfon N. Prevalence and correlates of high-quality basic pediatric preventive care. Pediatrics 2004;114(6):1522-9. CrossRef PubMed
  21. Tanski S, Garfunkel LC, Duncan PM, Weitzman M. Performing preventive services: a Bright Futures handbook. Accessed December 12, 2011.
  22. Pittard WB 3d, Laditka JN, Laditka SB. Early and periodic screening, diagnosis, and treatment and infant health outcomes in Medicaid-insured infants in South Carolina. J Pediatr 2007;151(4):414-8. CrossRef PubMed
  23. Pittard WB 3d, Laditka JN, Laditka SB. Associations between maternal age and infant health outcomes among Medicaid-insured infants in South Carolina: mediating effects of socioeconomic factors. Pediatrics 2008;122(1):e100-6. CrossRef PubMed
  24. New assessment provides more detailed results on students’ readiness for school. Accessed March 29, 2012.
  25. South Carolina readiness assessment kindergarten and first grade developmental guidelines. Office of Assessment, South Carolina Department of Education; 2005. Accessed December 12, 2011.
  26. Kagan SL, Moore E, Bredekamp S. Reconsidering children’s early development and learning: toward common views and vocabulary. Washington (DC): National Education Goals Panel; 1995.
  27. High/Scope Educational Research Foundation. From implementation to impact: an evaluation of the South Carolina First Steps to School Readiness program 2006. Accessed December 16, 2011.
  28. South Carolina Kids Count. South Carolina ranks in the bottom 4 states in child well-being: improving development and readiness of our youngest children is the key to South Carolina’s future. Columbia (SC): South Carolina Budget and Control Board; 2006.
  29. Kessner DM, Singer J, Kalk CE, Schlesinger ER. Methodology: New York City analysis. In: Kessner DM, editor. Infant death: an analysis by maternal risk and health care. Washington (DC): Institute of Medicine and National Academy of Sciences; 1973:50-65.
  30. Klaus MH, Kennel JH. Care of the parents. In: Klaus MH, Fanaroff AA, editors. Care of the high risk neonate. 5th edition. Philadelphia (PA): WB Saunders Company; 2001:195-222.
  31. Alexander GR, Himes JH, Kaufman RB, Mor J, Kogan M. A United States national reference for fetal growth. Obstet Gynecol 1996;87(2):163-8. CrossRef PubMed
  32. Chassin MR, Galvin RW. The urgent need to improve health care quality. Institute of Medicine National Roundtable on Health Care Quality. JAMA 1998;280(11):1000-5. CrossRef PubMed
  33. Rosenbach ML, Gavin NI. Early and periodic screening, diagnosis, and treatment and managed care. Annu Rev Public Health 1998;19:507-25. CrossRef PubMed
  34. Bethell C, Reuland CH, Halfon N, Schor EL. Measuring the quality of preventive and developmental services for young children: national estimates and patterns of clinicians’ performance. Pediatrics 2004;113(6, Suppl)1973-83. PubMed

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Return to your place in the textTable. Maternal and Child Characteristics for Medicaid-Insured Children Born During 2000–2002 and the Number of Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Visits During the First and Second Years of Life, South Carolinaa
Characteristic Had at Least the Recommendedb No. of EPSDT Visits P Valuec
Yes No
Mothers’ characteristics
Age at delivery, mean (SD), y 23.0 (5.3) 23.1 (5.2) .43
Education, mean (SD), y 11.9 (1.8) 11.6 (1.9) < .001
Married, n (%) 483 (26.4) 4,505 (22.3) < .001
Nulliparous, n (%) 1,027 (56.2) 8,129 (40.3) < .001
Vaginal delivery, n (%) 1,571 (85.9) 17,606 (87.3) .099
Race/ethnicity, n (%)
White 821 (44.9) 6,946 (34.4) < .001
African American 927 (50.7) 12,056 (59.8) < .001
Hispanic 53 (2.9) 877 (4.4) < .003
Other 27 (1.5) 291 (1.4) .91
Urban residence, n (%) 1,292 (70.7) 12,509 (62.0) < .001
Family income ≤50% of federal poverty guidelines, n (%) 378 (20.7) 5,439 (27.0) < .001
Adequate prenatal care, n (%)d 1,274 (69.7) 12,642 (62.7) < .001
Children’s characteristics
Male, n (%) 876 (47.9) 9,769 (48.4) .68
Gestational age, mean (SD), weeks 39.1 (1.2) 39.1 (1.1) .18
Birth weight, mean (SD), g 3,258 (401) 3,258 (398) .95
Had recommended no. of EPSDT visits
First year of life, n (%) 2,455 (11.2) 19,543 (88.8) < .001
Second year of life, n (%) 5,893 (26.8) 16,105 (73.2) < .001
First and second years combined, n (%) 1,828 (8.3) 20,170 (91.7) < .001

a Data source: South Carolina Office of Research and Statistics, representing children enrolled in Medicaid from birth until second birthday, linked with their South Carolina Readiness Assessment of preparedness for school (n = 21,998).
b As recommended by the American Academy of Pediatrics (14).
c Calculated by using χ2 tests for categorical variables, t tests for continuous variables.
d Identifies mothers who had at least adequate prenatal care as defined by the Kessner Adequacy of Prenatal Care Index (29).


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Return to your place in the textAppendix. Domains and Skills Evaluated by the South Carolina Readiness Assessment

South Carolina kindergarten teachers conduct this assessment at the end of the kindergarten year to assess student readiness for first grade (25).

I. Personal and Social Development

A. Self concept: demonstrates self-confidence and shows initiative and self-direction.

B. Self control: follows classroom rules and routines, uses classroom materials purposefully and respectfully, and manages transitions and adapts to changes in routine.

C. Approaches to learning: shows eagerness and curiosity as a learner; sustains attention to a task, persisting even after encountering difficulty; and approaches tasks with flexibility and inventiveness.

D. Interaction with others: interacts easily with 1 or more children, interacts easily with familiar adults, participates in the group life of the class, and shows empathy and caring for others.

E. Social problem solving: seeks adult help and begins to use simple strategies to resolve conflicts.

II. English Language Arts

A. Communication: gains meaning by listening, follows directions that involve a series of actions, speaks clearly and conveys ideas effectively, and uses expanded vocabulary and language for a variety of purposes.

B. Reading: shows interest in and knowledge about books and reading; shows some understanding of concepts about print; demonstrates beginning phonemic awareness; knows letters and sounds and how they form words; and comprehends and responds to fiction and nonfiction text.

C. Writing: represents stories through pictures, dictation, and play; uses letter-like shapes, symbols, letters, and words to convey meaning; and understands purposes for writing.

III. Mathematics

A. Mathematical processes: uses and explains strategies to solve mathematical problems and uses words and representations to describe mathematical ideas.

B. Numbers and operations: shows understanding of number and quantity and shows emerging understanding of relationships between quantities.

C. Patterns, relationships, and functions: sorts objects into subgroups, classifying and comparing according to a rule; and recognizes, duplicates, and extends patterns.

D. Geometry and spatial relations: recognizes and describes some attributes of shapes and shows understanding of and uses direction, location, and position words.

E. Measurement: orders, compares, and describes objects by size, length, capacity, and weight; explores and uses common instruments for estimating and measuring during work or play; and shows awareness of time concepts.

F. Data collection and probability: collects data and makes records using lists or graphs.

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