Communities of Practice Project: The Key Elements of Sustainability
New Federal Opportunities for Promoting Child Health and Well-Being
Charles Bruner, Director
Child and Family Policy Center, BUILD Initiative
Newark, DE -- July 20, 2010
New Federal Opportunities: A Narrative for Action
1. Healthy child development is multidimensional.
2. Health practitioners are the “first contact” with young children.
3. Exemplary strategies exist that address the multidimensionality of child health.
4. Federal health provisions offer the opportunity to address children’s healthy development.
5. States and communities must be intentional and creative to take advantage of these federal provisions.
6. Those who know best are in this room (but cannot do it alone).
1. Healthy Child Development is Multidimensional.
Child health is … the extent to which individual children or groups of children are able or enabled to (a) develop and realize their potential, (b) satisfy their needs, and (c) develop the capacities that allow them to interact successfully with their biological, physical, and social environments.-- National Research Council and the Institute of Medicine. 2004. Children’s Health, the Nation’s Wealth: Assessing and Improving Child Health.
social determinants of healthlife course model of healthy child development
health equity
2. Health Practitioners are the “First Contact” with Young Children.
88.5%
40.2%
24.3%28.6%
3.8% 5.8%2.3%
PreventiveHealth Care
Visit (0-5)
EPSDT Visit (0-2)
WICParticipation
(0-5)
Formal ChildCare
Arrangement(0-4)
HeadStart/Early
Head Start (0-5)
Part B of IDEA(3-5)
Part C of IDEA(0-2)
% o
f A
ll C
hild
ren
Inv
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in F
ollo
win
g S
erv
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3. Exemplary Strategies Address the Multidimensionality of Child Health ...
Connecticut’s Help Me Grow program
ABCD
Assuring Better Child Health & Development
… in the Following Ways.
Care Coordination
• ecological assessment and response•from referral to scheduling and follow-up
Pediatric Practitioner Training/Developmental
Surveillance
• developmental screening• recognizing and responding to social determinants
Part CChild
Mental Health
Parenting Educa-
tion
Home Visiting
Head Start
Domestic
Violence Shelter
Peer Support Group
for Grand-parents
Church Family Night
Program
Parent of Children
with ADHD Group
Hispanic Resource
Center
Parents Anony-mous
Community Connections
• professional service responses• social connections and community
support
4. Federal Health Provisions Offer the Opportunity to Address Children’s Healthy
Development.
• CHIPRA Provisions– Expanded funding and options to states– Child health quality outcomes development and demonstration grants
• PPACA Provisions– Coverage for preventive care and well-child care based upon
recognized HRSA standards (Bright Futures)– Maternal, infant, and early childhood home visitation program– CMS healthcare innovation zones– Prevention and public health fund– Community transformation grants– Community health teams to support patient-centered medical homes &
primary care extension program– Spending for community health centers
+ CCAC in Head Start Reauthorization, Promise Neighborhoods, etc.
5. States and Communities Must Be Intentional and Creative to Take
Advantage of Federal Provisions.
• Includes but is more than health IT, quality outcomes, and medical records
• Includes but is more than reimbursement and screening tools
• Includes but is more than clinical/medical care
• Is more than but includes children in achieving health cost, quality, and accountable care goals
6. Those Who Know Best Are in This Room (But Cannot Do It Alone).
• Identification of own needs and opportunities in the context of federal activities
• Access to detailed information about opportunities
• Partnerships with state and community advocates
• Compelling messages to key stakeholders and decision-makers
Additional Resources from CFPC
• Healthy Child Storybook
• Journal of Pediatrics Commentary
• Children’s Healthy Development Model Act
Contact Information
Child & Family Policy Center
and the
The BUILD Initiative
505 5th Avenue, Suite 404
Des Moines, IA 50309
515-280-9027
www.cfpciowa.org
www.buildinitiative.org
www.finebynine.org
Voices for America’s Children
1000 Vermont Street, NWSuite 700
Washington, DC 20005202-289-0777
www.voices.org
Additional Slides Outlining Outcomes, Exemplary Programs,
and Strategies
Source: Healthy Child Storybook
Outcomes of Well-Child Care During the First Five Years of Life
Domain of Well-Child Care Outcome at School Entry
Child Physical Health and Development
• All vision problems detected and corrected optimally• All hearing problems detected and managed• Management plans in place for all chronic health problems• Immunization complete for age• All congenital anomalies/birth defects detected• All lead poisoning detected• All children free from exposure to tobacco smoke• Good nutritional habits and no obesity; attained appropriate growth and good health• All dental caries treated• Live and travel in physically safe environments
Child Emotional, Social, and Cognitive Development
• All developmental delays recognized and treated (emotional, social, cognitive, communication)
• Child has good self-esteem• Child recognizes relationship between letters and sounds• Child has adaptive skills and positive social behaviors with peers and adults
Family Capacity and Functioning
• Parents knowledgeable about child’s physical health status and needs• Warning signs of child abuse and neglect detected• Parents feel valued and supported as their child’s primary caregiver and function in
partnership with the child health care provider• Maternal depression, family violence, and family substance abuse detected and referral
initiated• Parents understand and area able to fully use well-child care services• Parents read regularly to the child• Parents knowledgeable and skilled to anticipate and meet a child’s developmental needs• Parents have access to consistent sources of emotional support• Parents linked to all appropriate community services
Note: regular font bullets are those outcomes for which child health care providers should be held accountable for achieving. Italicized bullets are those outcomes to which child health care providers should contribute by educating parents, identifying potential strengths and problems and making appropriate referrals, but for which they are not independently responsible.
Bright FuturesBright Futures approach: Health supervision that promotes physical, emotional, intellectual, and social health through a developmental perspective involving health supervision guidelines, training, and support for practitioners, families, and public health personnel.Bright Futures impacts: Research of state efforts to incorporate Bright Futures into practice have shown:
Success in strengthening pediatric practice in using health supervision guidelines when champions are enlisted and training and resources provided to support that incorporation into practice
Improvements in identification, response, and family involvement in addressing child health and development concerns identified through health supervision
Improved coordination across health, education, and human services in meeting “whole child” concerns
Help Me GrowHelp Me Grow approach: Practitioner training to conduct whole child “developmental surveillance” during child health visits, with care coordinators following up with families to identify professional and community resources to address child needs and schedule appointments and visits, and community health liaisons identifying and working with community resources.
Help Me Grow impacts: Research has shown that Help Me Grow dramatically increases identification of behavioral and developmental concerns within the practitioner’s office and leads to timely follow-up services, which include:
Increased identification of developmental delays, parental depression and stress, and other child developmental concerns
Increased use of Part C (early intervention) services
Improvement in child health and development reported in follow-up pediatric visits
Reach Out and Read
Reach Out and Read approach: Training to doctors and nurses to make literacy promotion a standard part of pediatric care (encouraging parents to read to children as part of well-child visits) and proving the tools (a book at each visit) to do so
Reach Out and Read Impacts: Research has found that Reach Out and Read:
Increases parental reading to children in the home
Improves children’s ability to express themselves verbally
Increases children’s listening vocabularies
Improves children’s preschool language scores
Reduces the proportion of children with language delays that can prevent them from succeeding in school
Assuring Better Child Health and Development (ABCD)
Assuring Better Child Health and Development (ABCD) approach: Collaborations across Medicaid, pediatric providers, Maternal and Child Health, and Part C in developing strategies within Medicaid to improve developmental screening of young children and actions to improve healthy mental development.Assuring Better Child Health and Development (ABCD) impacts: Different states produced different gains in the identification and treatment of developmental issues for young children, including:
Increased identification of developmental delays and more timely follow-up services under Part C of IDEA
Earlier detection of autism and reduced time between identification and initiation of services
Identification of signs of maternal depression and follow-up services to address this risk factor for healthy child development
Increased provision of anticipatory guidance to parents on child development and greater response to parental concerns raised during well-child visits
Healthy Steps for Young Children
Healthy Steps approach: Incorporating within pediatric and family practice a Healthy Steps Specialist who provides additional links to the family in promoting healthy and developmentally appropriate practices in the home and ensuring early identification and treatment of medical issues
Healthy Steps impacts: Research has found that Healthy Steps: Increases parental use of positive health practices, such as
ensuring infants sleep on their backs, receive all vaccinations, and have injury prevention tools in their homes
Improves interactions of parents with their toddlers, using more positive and less harsh disciplinary practices and paying more attention to their child’s behavioral clues
Reduces toddler television viewing and improves child expressive vocabulary
CenteringPregnancy
CenteringPregnancy approach: The goal of Centering groups is to improve the overall health outcomes of mothers, babies, and new families by adopting a group health model of care that emphasizes care, honors the contribution of each member, and uses a facilitative leadership style. CenteringPregnancy impacts: Both participants and providers report satisfaction with the Centering model. Research has shown a series of improved outcomes for women and babies, including:
reductions in emergency department visits by the third trimester
reductions in low birth-weight births among preterm deliveries
reductions in preterm births
Community Care of North Carolina/Carolina ACCESS
CCNC/CA approach: Implementing a medical home model for Medicaid and CHIP recipients, and providing care coordination to ensure continuity and ease of medical care. The goal of the program is to better address both medical and social determinants of child health.CCNC/CA impacts: Research from the University of North Carolina’s Sheps Center for Health Services Research of the asthma and diabetes management initiatives has shown:• improvement in child health outcomes, and• significant cost savings from the program.Research from the Mercer Human Resources Consulting group has shown:• increased use of primary and preventive services, and• substantial savings to Medicaid in terms of reduced emergency room use and hospitalizations.
Opportunities for Prevention, Early Identification and Treatment
During Pediatric VisitsIssue or Concern Healthy Development Impact
Nutrition and exercise Obesity and diabetes
Exposure to second-hand smoke SIDS, respiratory illness, asthma, cognitive development, adult cancer, heart problems
Maternal depression Social/emotional development, school success, safety
Oral health Propensity for illness, pain, and school success
Vision Reading and school success
Autism Early treatment leading to more success and less disruption
American Academy of PediatricsRecommended Health Supervision Practices
Regarding the Prevention of Obesity• Identify and track patients at risk by virtue of family history, birth weight, or
socioeconomic, ethnic, cultural, or environmental factors.• Calculate and plot BMI (body mass index) once a year and use change in
BMI to identify rate of excessive weight gain relative to linear growth.• Encourage, support, and protect breast feeding.• Encourage parents and caregivers to promote healthy eating patterns by
offering nutritious snacks such as vegetables and fruits, low-fat dairy foods, and whole grains.
• Encourage children’s autonomy in self-regulation of food intake and setting appropriate limits on choices; and modeling healthy food choices.
• Routinely promote physical activity, including unstructured play at home, in school, in child care settings, and throughout the community.
• Recommend limitation of television and video time to a maximum of two hours per day.
Limiting Child Exposure to Second-Hand Smoke: Recommended Actions
• Routine queries about parental smoking and exposure to second-hand smoke as part of well-child visits
• Follow-up recommendations (anticipatory guidance) regarding eliminating second-hand smoke, through:– Quitting– Using nicotine replacement therapies– Smoking only outside the home and
automobile and when not in the presence of children
Maternal Depression and Children’s Healthy Development
Recent findings on maternal depression and children’s healthy development:
• Screening for maternal depression can be done efficiently and effectively during well-child visits and there is a good uptake by mothers on further assessments and treatment, where those are available.
• Addressing and alleviating maternal depression produces positive results for children, including: improved social interactions, approaches to learning, social and emotional physical health.
Vision Screening
• Half of low-income children have vision problems that interfere with school success.
• Early vision screening and basic exercise therapies can address vision problems and lead to improved literacy and educational success as well as general healthy development.