First in the Nation Health Metric Aims to Address Social and Emotional Health


by Rafael Otto



Oregon recently took a significant step toward ensuring young children are prepared for kindergarten by focusing on their social and emotional health.  Oregon’s Metrics and Scoring Committee approved a new incentive metric for the 16 Coordinated Care Organizations (CCOs) serving nearly 1.3 million people on the Oregon Health Plan, or 30 percent of the state’s population. 

Development of the metric started in 2018 through a partnership between Children’s Institute, the Oregon Pediatric Improvement Partnership at Oregon Health & Science University, and Oregon Health Authority

The metric is designed to shift attention to social-emotional health services for children from birth to age 5, a groundbreaking effort that will help Oregon’s Medicaid system focus on prevention and increased investment in kids. 

Elisabeth Wright Burak, senior fellow at the Center for Children and Families at Georgetown University’s McCourt School of Public Policy, said that no other metric like this exists in the country. “The health care system is not set up to invest a lot in kids and there are almost no incentives to improve preventive services, particularly for young children. Getting a disease-oriented system to work on prevention, that’s innovation, it’s a big boulder to move.”

For CCOs, incentive measures show how well the organizations are “improving care, making quality care accessible, eliminating health disparities, and curbing the rising cost of health care.” The new social-emotional health metric will incentivize CCOs to establish a much improved foundation for health and school readiness that will directly impact communities, families, and children. Incentive funds CCOs receive for making progress on metrics incentives are invested back into the community. 

“Ample research suggests that the first five years of a person’s life are critically important to laying the foundation for long-term social, mental, and physical outcomes,” said Colleen Reuland, director at the Oregon Pediatric Improvement Partnership. 

Elena Rivera, senior health policy advisor at Children’s Institute, said that “early experiences shape the architecture of the brain, so providing services as early as possible will help kids get what they need, and help parents and families support their kids.”

Rivera continued, “We know that from working with parents and families as we developed this metric that this remains a top priority. Families are looking for better programs and stronger relationships with providers. They want culturally- and linguistically-responsive services, assessment, and referrals, and better access to health services, particularly in rural communities.”

Wright Burak said that a focus on social-emotional health means focusing on the social factors that impact health. “We’re not just looking at the needs of the child, we’re looking at the context they’re living in. The health care system hasn’t been great at this historically, and also can’t do it alone.  A dedicated focus on prevention and early intervention can show results for children and their families for years to come.”

Reuland said so few children are getting recommended social and emotional screenings and services they need that there is a tremendous amount of work ahead to get the health system moving in the right direction. “According to services paid for, only 6 percent of children on the Oregon Health Plan get any type of social-emotional health assessment or service related to their social or emotional health,” she said. 

Beginning January 1, 2022 CCOs will start to dig deep to understand and address the gaps in social-emotional health services for children from birth to age 5 in their communities. That will include analyzing current services and working with local providers and early educators to create community-specific action plans by the end of the first year. 

In public testimony, Dana Hargunani, the chief medical officer at the Oregon Health Authority, said the metric is aligned with priorities for the state related to children’s health, behavioral health, and health equity.

“Social emotional development and the connection to health services are key components of our state’s early learning strategic plan, Raise Up Oregon,” she said. “This metric helps to tie together cross sector priorities and efforts in a nicely coordinated approach.”

Additional public testimony provided in support of the metric was the strongest for any metric under consideration for the CCO incentive measure program, and the metric ranked the highest for transformative potential.

Since 2018, Children’s Institute has been working with the Oregon Pediatric Improvement Partnership and Oregon Health Authority to create a set of measures designed to engage the health sector in kindergarten readiness. The first two — dental visits and well-child visits — were adopted as incentive measures for CCOs in 2020. The social-emotional metric is the third in a package of four that is expected to evolve in the years to come.  “Community and family input has been a core part of our work,” Rivera said. “Changing the health system can feel overwhelming and complicated, but parents and families know what they need, and know what their kids need. Their voice and perspective will help make this work transformational.

Behind the scenes, state and national foundations have supported the development of the social-emotional health metric.  Kali Thorne Ladd, chief executive officer at Children’s Institute, said that philanthropy can often serve as a lever for creating lasting change, in this case an unprecedented approach that connects Oregon’s health and education systems. “Foundation support for this multi-year effort will not just improve the lives of young children, but improve health outcomes as our youngest learners get older and move into adulthood.”

State and National Funders Supported the Development of the Social and Emotional Health Metric 

  • The David and Lucile Packard Foundation
  • MJ Murdock Charitable Trust
  • Northwest Health Foundation
  • Oregon Community Foundation
  • W.K. Kellogg Foundation
  • The Ford Family Foundation
  • Silver Family Foundation
  • Maybelle Clark MacDonald Fund
  • Kaiser Permanente


Children from birth to age 5, and their families, have equitable access to services that support their social-emotional health and are the best match for their needs. 


Drive CCOs to address complex system-level factors that impact the services kids and families receive and how they receive them, and for which there may be payment or policy barriers that need to be addressed; Address gaps in existing CCO incentive metric set.


Build capacity within CCOs for enhanced services, integration of services, cross-sector collaboration, and future measurement opportunities; Use child-level data to guide and inform efforts, assess the sensitivity and specificity of the child-level metric to those efforts.

“In the midst of the COVID-19 pandemic,” Rivera said, “we’ve seen access to crucial health care services weaken. Families are struggling to get their needs met. Fewer children are getting timely immunizations, dental care, well-child visits, and other physical and mental health assessments. Doing this work now is a step in the right direction, a step toward improving health equity for Oregon’s publicly insured children and families.”

Wright Burak said there is palpable interest in how this metric will impact health services for kids. “Oregon has lots of work ahead of it, but everyone is looking at this and is eager to see progress. We hope it serves as a pilot and a blueprint for how to do this in other states.”


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