The Roots of Childrens Health and Well-being Meeting Name Presenter Name Date 1.

The Roots of Children’s Health and Well-being

Meeting NamePresenter Name

Date

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Trusted and Effective Messengers

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Levels of Opportunity

- Preventive care - Care Coordination - Lobbying- Screening - Coalitions - Legislation- Referral - Media - Systems Building- Innovative Models - Partnerships- Partnerships - New initiatives- Promotion and Health Building

Patient Community Legislative/Policy

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Why the Early Childhood Medical Home?

• Unique and comprehensive, unstigmatized access to early childhood

• Public’s deep respect for pediatricians as trusted guardians of child health

• Number of well-child visits from birth to age 5• 97% of infants and toddlers have regular access to

healthcare (CDC, 2006)

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Children 0-5 Whose Parents Were Asked About Learning, Development or Behavior Concerns

During their Well Child Visit

National Survey of Child Health, 2003

High Mean New York Low0%

10%

20%

30%

40%

50%

60%

70% 66%

48%

40% 37%

VT

TXNY

MS

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Parents’ Top Reasons for Attending Well-Child Care Visits

• Promoting Health Immunizations Screening Referrals

• Requirements School, child care, sports

• Reassurance Is my child okay? Am I doing okay as a parent?

• Opportunities for Discussion Parent priorities are key

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It’s What Parents Want!

• McCune et al reported that 81% of parental questions for pediatricians concerned psychosocial issues

• In their study, parenting issues were parents' predominant concern: 70% of mothers were more worried about some aspect of their parenting or their child's behavior than they were about their child's physical health

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Medical Home

Maternal Mental Health

Promotion (awareness, screening, treatment)

Early Literacy and Early Care

Financial Literacy, Tax

Credit, Education and Legal Supports

Community Linkages across

Systems/ Relationships; Ongoing Care Management

Team

Routine Screenings and

Surveillance including Toxic

Stress

Community Support and Advocacy

(quality pre-k, child care, home

visiting social services)

Parental Support and Education

Child/Family

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How are You Addressing EBCD?

• How are you currently supporting EBCD?• How can you enhance what you are doing with

current resources?• What is your vision for supporting EBCD in the

future?• Who are your partners (potential and existing)?• Next steps/action plan?

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Promotion Opportunities Within the Clinical Setting

• Encourage families to consider emotional development prior to visit (by using questionnaires, DVDs, newsletters, community events, parent groups etc.)

• Develop or promote a mental health section on your Web site (include questions, facts, resources etc.)

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Promotion in the Waiting Room

• Posters• Books/pamphlets (low-literacy, multi-lingual)• DVD (“I am Your Child” or maternal depression

awareness)• Waiting room questionnaires• Volunteers to role-model positive interaction or

group-talks in waiting room• Parenting groups• Parent support resources 11

Promotion in the Clinical Encounter

Use relationships as a VITAL SIGN!

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Ways to Evaluate & Support Relationships

• Ensure the mental health of parent and child are addressed at each visit

• Use open-ended questions as well as screens• Adapt Bright Futures Guidelines• Use screening protocols• Have other staff to engage in education• Connect families with resources (child care, parenting

groups, etc.) • Link into Patient Centered Medical Home (PCMH) and

Quality Improvement (QI) efforts 13

Every Day, Every Child: 5 Rs of Early Childhood

• Routines help children know what to expect of us and what is expected of them

• Reading together daily• Rhyming, playing and cuddling• Rewards for everyday successes – PRAISE is a

powerful reward• Relationships, reciprocal and nurturing – foundation

of healthy children

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Exemplary Programs Supporting Healthy Child Development…and Many More!

Connecticut’s Help Me Grow program

ABCD

Assuring Better Child Health & Development

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“Reach Out and Read”

• Integrated into primary care clinical practice (in approximately 5,000 hospitals and health centers today)

• At 6-month visit through age 5, medical providers:– Give child a developmentally-appropriate, culturally sensitive book– Model effective reading techniques for the parents/caregivers and

encourage routine reading with child at home– Help families understand developmental milestones and provide

guidance to foster stable relationships with their child

• Reach Out and Read National Center provides training, materials, technical assistance, and funding for books

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“Reach Out and Read”Research Findings

• Families read together more often• Children enter kindergarten with:

– Larger vocabularies– Stronger language skills and– A six-month developmental edge

• Program is located in approximately 5,000 hospitals and health centers and expanding

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Professional Opportunities

• Child Health & Development Interactive System (CHADIS): potential “game changer”

• Electronic Health Record (EHR) opportunity• Alignment with Patient Centered Medical Home

(PCMH) standards• Quality Improvement (QI)• Maintenance of Certification (MOC)

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Assessment

• How are we currently supporting this issue?• How can we enhance our efforts with existing

resources?• What is our vision for this area?• Who are our partners?• What are our next steps?

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Core Community Connections: It Takes a Village

• Child Care Resource & Referral (CCR&R) agencies• Early Education and Child Care Systems• Women, Infants, and Children (WIC)• Mental Health Support• Parenting Groups (Fatherhood Initiatives)• Domestic Violence Support• Breast Feeding Support• Early Intervention

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Approaches

• Awareness and referral• Sharing materials• “Promoting”• Co-location: service and education models• Contributing• Project• Working to achieve a common vision

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CCR&R: Child Care Resource and Referral Agency

Help parents take the guesswork out of choosing care by providing:

• Referrals to local child care providers• Information on state licensing requirements• Information on availability of child care subsidies

CCR&Rs provide guidance by phone, in person, and even online, that is tailored to each family FOR FREE!

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You Can Find Your Local CCR&R with a Click!

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Head Start & Early Head Start • Federal programs designed to promote school readiness

for low-income children ages 0-5– Early Head Start: for pregnant women and families with

children under age 3 (with strong home-based component)– Head Start: for children ages 3-5 and their families, in preschool

center model

• Use a comprehensive approach: whole child and family – Cognitive, social, and emotional development– Screenings and referrals to health, nutrition, and social services– Family support and family/community engagement

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Early Head Start: National Evaluation Documents Strong Positive Impacts

• Positive child outcomes (at 36 months) include :– Larger vocabularies – Greater ability to solve problems and understand basic

concepts– Higher levels of functioning– Better outcomes on several aspects of social-emotional

development

• Positive parent outcomes include: – Parents more likely to read to their children daily– Parents more positive with their child and greater

repertoire of discipline strategies

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Home Visiting Programs

• A voluntary service, designed to reach expectant parents, babies and young children, who face barriers in supporting their child’s healthy development

• Offers support and information in the home environment

• Increasing recognition of the need to coordinate with other early childhood programs (e.g. Early Head Start)

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The Research on Home Visiting Programs • High quality programs have positive outcomes for parents and

children including:– Improved parenting skills and quality of home environment– Improved intellectual development– Enhanced maternal employment and education– Improved detection and management of postpartum depression– Improved childhood immunization and breastfeeding rates

• Nurse Family Partnership Home Visiting Model has $5.70 Return on Investment per Tax Dollar Spent*

*As home visiting programs expand, evaluation is increasingly important to determine which delivery models have greatest impact and savings. 27

EI: Early Intervention Program for Infants and Toddlers (IDEA Part C)

• A system of services that helps babies and toddlers with developmental delays or disabilities.

• Serve eligible to children from birth through age two• Eligible children have an Individualized Family Service

Plan (IFSP) developed by team of professionals with the family– Services vary based on individual child’s needs– May include: assistive technology, audiology or hearing

services, medical services, nutrition services, physical therapy, speech therapy, psychological services, and/or counseling and training for the family

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Positive Impacts of EI

• Specialized services and support increase the chances young children will develop to their full potential

• Young children who receive EI are better prepared for school and later life

• Family needs are addressed by providing emotional support and information to help them promote their child’s development and function as their child’s best advocate

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Role in the Community

It is limitless!• Connections• Advising• Presenting• Media• Projects• Outreach

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The Win/Win

• Healthy, thriving children as a result of building lifelong health and an economically sound and thriving community/society

• Opens up professional doors and opportunities for you and the families and communities you serve

• It’s fun and rewarding!!!!

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Barriers

• Time, time, time• “One more thing”• Reimbursement• Education and knowledge• Perceived or real lack of community resources• “I identified an issue, now what?”

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Making Bright Futures Real!

• There can be a disconnect between the goal and practice

• Back to original vision: child-centered goals and outcomes with community support and implementation

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Professional/Institutional Advocacy

• What are you doing within your own institution? How can you take it further?

• Working with your AAP Chapter• Working to promote change in medical students,

residents, or physician training is a policy mechanism for change

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Systems Building: What is it All About?

Early Learning

Family Support

Special Needs/ Early

Intervention

Early care and education opportunities in nurturing

environments where children can learn what they need to succeed in

school and life.

Economic and parenting supports to ensure children have nurturing and stable relationships with caring

adults.

Early identification, assessment and

appropriate services for children with special health care needs, disabilities, or

developmental delays.

Comprehensive health services that meet children’s vision,

hearing, nutrition, behavioral, and oral health as well as medical

health needs.

Health, Mental Health

and Nutrition

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Restating the Framework

• Clinical• Community • Professional• Policy

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A journey of a thousand miles begins with a single step.- Lao-tzu, The Way of Lao-tzu, Chinese philosopher (604 BC - 531 BC)

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What Are We Building?

HEALTHY CHILD DEVELOPMENT

Educational Achievement

Economic Productivity

Responsible Citizenship

Lifelong Health

Strong Communities Healthy EconomySuccessful Parenting of Next Generation

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For More Information

• Contact Name• Email• Chapter Web link

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