ACES ACES Clinic Clinic - Dell Children's is ACES clinic? ACES clinic visits are conducted in clinic rooms at the Marnie Paul Specialty Care Center at Dell Children’s Medical Center.

Activating Children Empowering Success

Who We AreThe ACES Clinic at Dell Children’s Medical Center of Central Texas is a collaborative team of pediatricians, registered dietitians, physical activity specialists, and behavioral health specialists who work together to help improve your child’s physical, mental and emotional health. Every family is unique and, so we work with your family to create an individualized action plan to fit your family’s needs.

LocationMarnie Paul Specialty Care Center at Dell Children’s Medical Center4900 Mueller Blvd. • Austin, TX 78723

EligibilityChildren/teens aged 2 to 18 years referred by their primary care provider with a Body Mass Index (BMI) for age greater than 95th percentile with an additional medical condition, or a BMI for age greater than the 99th percentile, who are interested in making healthy changes. Children and teens need support from their parents and caregivers to be successful at making changes, and so other family members or caregivers are encouraged to attend ACES clinic visits. We find that the families who are most successful are those who: 1) make small changes that stick, 2) makes changes as a family and 3) who keep it positive! Being healthy is good for everyone regardless of shape or size!

To schedule an appointment, or for more information,

please call:512-324-9999 ext.86437

Texas Center for thePrevention and Treatmentof Childhood Obesity

dellchildrens.net/healthyliving

ACES Clinic

Specialty Care Center

StrictlyPediatricsBuilding

Texas Center for the Prevention and Treatment of Childhood Obesity

ACES (Activating Children Empowering Success) Clinic Dear interested potential patient and family, Thank you for your interest in our clinic! We’d love to work with you as you strive to lead a healthier, happier life. Change is usually challenging, and that is why we have assembled an expert team to help you and your family find success. We want to make sure that our clinic is what you’re looking for, so please read this letter carefully to decide if ACES is a good fit for your family at this time.

What is ACES Clinic? The ACES Clinic at Dell Children’s Medical Center is a collaborative team of pediatricians, registered dietitians, physical therapists, social workers, psychologists, and mental health specialists who work together to help improve your child’s physical, mental, and emotional health. We provide comprehensive, multidisciplinary evaluation, management, and treatment for obese children and teens, ages 2 through 18 years. We work with your family to create an individualized action plan to fit your family’s needs. Plans usually include goals related to healthier eating habits, increased physical activity, decreased TV/screen time, and positive family changes. ACES is NOT a quick diet or weight loss program. Quick weight loss is usually not safe or recommended for growing children and teens. Making healthy changes is a gradual process and will take some time, but we are committed to working with you to find success.

Who is ACES for? ACES is for children aged 2-18 referred to our clinic through their primary care provider. Children eligible for referral to ACES include those with a body mass index (BMI) at or greater than the 99

th percentile for their age, or those with a BMI

at or greater than the 95th percentile for their age who also have a weight-related health problem. Weight-related health

problems may include high blood pressure, pre-diabetes, and high cholesterol. ACES is not just for the children referred. Children and teens need support from their parents and caregivers to be successful at making changes. Parents and guardians are expected to come with their children to clinic visits. Other family members or caregivers are invited and encouraged to attend ACES clinic visits so that everyone in the family can be involved in the plan. We find that the families who are most successful are those who get everyone involved in making healthy lifestyle changes together.

How do I make an appointment for the ACES clinic? Once we have received a referral from your pediatrician AND this pre-packet, your child will be placed on our waitlist for an appointment. Our waitlist can be anywhere between 3 – 8 months at any given time so it is important to have all your paperwork turned in as soon as possible and provide our office with accurate contact numbers where you can be reached to schedule. Once we have reached your child on the wait list, Carmen Torres will call and provide you with your insurance benefit coverage and schedule your initial and first follow up appointment. Feel free to contact our office periodically to check the status of the waitlist.

Where is ACES clinic? ACES clinic visits are conducted in clinic rooms at the Marnie Paul Specialty Care Center at Dell Children’s Medical Center. The Specialty Care Center is located on the 2

nd floor of the Dell Children’s Medical Center of Central Texas.

Our address is: 4900 Mueller Blvd. Austin, TX 78723. Please park in the Outpatient Parking lot on the South-East side of Dell Children’s. The entrance is on Philomena Street. You will receive a parking ticket that will be validated so your parking will be free.

What happens at an ACES clinic visit? At your initial visit, you will meet one of our pediatricians and one of our mental health/behavior change experts. They will gather information about your family and your child’s health and behaviors as part of a comprehensive evaluation and assessment. They will order any additional labs and/or studies that will be helpful when developing your treatment plan. They may also help you set initial goals for changes. The first visit may last up to 2 hours. At your first follow-up visit, you will meet the additional members of our team, including our dietitian, recreation therapist and social worker. They will continue our team’s assessment and begin to work with you to create a treatment plan. Your plan may include starting one of our group programs (see below), setting specific goals for lifestyle changes, and/or seeking additional support from our nutrition and/or mental health services. The doctor may review your lab work or study results at this visit. We may also recommend other resources or services in the community that your family may benefit from. ACES visits may last 1-3 hours, depending on your family’s needs and treatment plan. They last longer than a typical visit to the doctor or dietitian because we have multiple team members who work with you to develop the best possible plan.

How many ACES visits will I have? Because we share space with other clinics at the Specialty Care Center, ACES appointments are held on Monday & Friday mornings ONLY. After your first two visits, follow-up visits will be scheduled according to your needs and preferences, but generally we like to see families for at least 4 visits within the first 2-3 months. You may not see every provider at every visit. We will review your progress and challenges at each visit, but after your fourth visit, we will take the opportunity to review your overall progress and your family’s thoughts about the clinic. You will have the opportunity to provide feedback on what has been helpful (or not), how you feel you need more information or support, and if/when you’d like to follow-up with ACES in the future. Many families need ongoing support for lifestyle changes, and we will schedule your visits according to the level of support you want. Many families choose to continue to work with ACES clinic for several months to over a year. The doctor may request that your child has certain blood work repeated at various times throughout your treatment.

How do I know if my family is ready for ACES? Ask yourself the following questions about your situation:

• Is this a good time to focus on making healthy changes? • Can everyone in the family be involved? • Can you commit to attending all scheduled ACES visits? • What challenges, if any, do you see to participation in ACES clinic at this time? • What are your ideas for dealing with those challenges?

What group programs does ACES offer? Our group programs currently include Healthy Living Happy Living and TEEN group. Healthy Living Happy Living (HLHL) is a 10-week afterschool program for children aged 6-11 and their parents. It includes nutrition, physical activity, and behavioral health components. TEEN group focuses on cooking and nutrition, as well as social emotional skill building. Teens and their families learn to follow a recipe, plan a healthy menu, read labels and shop for a healthy meal. Families get hands on practice by cooking their own dinner at each meeting. Teens also learn to improve their health by improving emotion regulation, relationships, and self-image. Families learn to work together for both physical and emotional health. Programs are offered in English and Spanish and require a referral from a primary care physician or ACES clinic. If we feel one of these is a good fit for your family, we will give you details of how to get started at your ACES visit. You will be expected to return to ACES for continued support during and/or after each of these group programs. **NOTE** There may be a nominal fee for these alternative programs.

What is ACES clinic’s cancellation policy? You will receive a courtesy reminder call for all of your appointments. At least one parent/guardian is expected to attend each clinic visit with the child or teen patient. If you arrive 15 minutes late to a clinic visit, you may be asked to reschedule your appointment, or you may be offered a shortened clinic visit with whichever providers are available. If your child is sick enough to stay home from school (with a fever or contagious), please call to reschedule your ACES appointment (which will be excused). We require 24 hours notice when you need to cancel or reschedule an appointment for any other reason. Any patient who cancels or does not show up to two scheduled clinic visits without proper notice will be discharged from the clinic. The ACES team reserves the right to discharge patients based on clinical judgment. Healthy Living Happy Living and the TEEN group have their own cancellation/no-show policies.

What should my child/teen wear to ACES appointments? Please bring your child dressed in comfortable clothing, like light gym shorts and a light t-shirt, and athletic shoes for their appointment. They will be doing fitness testing and physical activity at most appointments. If you have any further questions or concerns, please contact us at the information below:

Phone: 512-324-9999, ext 86437 Email: [email protected] Fax: 512-406-6520 Attn: Carmen Torres

Mail pre-packet back to: Dell Children’s Medical Center/SCC ATTN: ACES Clinic 4900 Mueller Blvd Austin, TX 78723 Best regards,

Stephen J. Pont, MD, MPH, FAAP Medical Director Texas Center for the Prevention and Treatment of Childhood Obesity

Caron Farrell, MD, PhD Medical Director Healthy Living Happy Living Program Texas Center for the Prevention and Treatment of Childhood Obesity

Texas Center for the Prevention and Treatment of Childhood Obesity

Empowering Families to Live Healthy Happy Lives CL ● E ● A ● R

CLinical ● Education ● Advocacy ● Research

www.dellchildrens.net/healthyliving V5/12

Date: _____________ Specialty Care Center DCMC Activating Children Empowering Success (ACES) CLINIC

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As we prepare for your first visit with us, we would like to get to know you a bit better. Please fill out the following:

Patient Name: Patient DOB: Race/Ethnicity: Age: Language Preferred: Spoken: Sex: Written:

Name of person completing form: Relationship to patient: Language Preferred: Spoken: Written:

Who will be accompanying the patient to clinic? (must be parent or legal guardian)

Patient’s Primary Care Physician and Phone Number Patient’s Preferred Pharmacy

Please list any specialists who care for your child and please let us know for what condition(s):

Home Address: Home Phone: Alternate / Work Phone:

What would you like to get out of coming to the ACES clinic?

When did you first become concerned about your child’s growth/weight? What factors do you feel contribute to your child’s weight gain? What concerns you the most about your child’s health and weight? What changes have you tried to help with your child’s weight?

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What are some of your biggest challenges when it comes to making a healthy change at home? What is the most important thing you would like help with?

Has your child ever been on diet? If Yes, please describe:

Has your child ever been in an exercise or weight-loss program (besides sports or play)? If Yes, please describe:

PAST MEDICAL HISTORY Birth History

Was your child born on time (at term)? If No, If early, how early?

If you remember what your child’s birth weight and length: lb oz inches

Did Mom have diabetes during pregnancy?

Did Mom smoke during pregnancy?

Did mom have high blood pressure during pregnancy?

Other pregnancy info:

Was your child breastfed? If so, for how long/until what age? At what age did they start taking solid foods?

Developmental History

Has your child had any developmental delays (walking, talking, etc.)? If Yes to any, please explain: Have they had any developmental testing? Have they received any special services (such as physical therapy, occupational therapy, or speech therapy)?

Please list any current or past medical problems your child has: Does not have any past or current medical problems

Please list any medications (prescribed, over-the-counter,

vitamins, supplements, and herbal) your child is taking: _____Medication Dose__________

1. 2. 3. 4. No medications

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Please list any Past Hospitalizations and Surgeries: Reason Date______________ Never been hospitalized / no surgeries

Medicine or Food ALLERGIES: Medication/Food Reaction_______ No allergies to medicines or foods

Are your child’s immunizations up to date / current? If No, please explain:

Past Mental Health History

Has/does your child ever see a psychiatrist, psychologist, therapist, or counselor? If yes, who did they see and please describe:

Has your child been diagnosed with any of the following? If so, please check: Depression Anxiety ADHD/ADD Bipolar Disorder Other

FAMILY HISTORY

Has anyone in the family been in a weight management program? If yes to either, please describe: Has anyone in the family been on diet?

Health Condition: Check the Family member(s) with the health condition: Who:

Diabetes (Type 2) None Brother/Sister Mother Father Mother’s family Father’s family ________________________________

Heart Disease None Brother/Sister Mother Father Mother’s family Father’s family ________________________________

Heart Attack before 50 None Brother/Sister Mother Father Mother’s family Father’s family ________________________________

High Cholesterol None Brother/Sister Mother Father Mother’s family Father’s family ________________________________

High Blood Pressure None Brother/Sister Mother Father Mother’s family Father’s family ________________________________

Obesity/overweight None Brother/Sister Mother Father Mother’s family Father’s family _________________________________

Stroke None Brother/Sister Mother Father Mother’s family Father’s family _________________________________

Asthma None Brother/Sister Mother Father Mother’s family Father’s family _________________________________

Thyroid Problems None Brother/Sister Mother Father Mother’s family Father’s family _________________________________

Weight Loss Surgery None Brother/Sister Mother Father Mother’s family Father’s family _________________________________

Gasping/ Trouble None Brother/Sister Mother Father Mother’s family Father’s family _________________________________ Breathing when sleeping

Mental Health Problems None Brother/Sister Mother Father Mother’s family Father’s family _________________________________

Other: None Brother/Sister Mother Father Mother’s family Father’s family _________________________________

Does anyone in the family have problems with: Alcohol Drug use Other If yes, who: _____________________________________ Does anyone in the family currently use any form of tobacco products? Who: ________________________________________

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SOCIAL HISTORY Who lives with your child? Please specify if step-parent, biological parent, foster/adoptive parent, etc.

Name Relationship to child

DOB Employer (if applicable) Anything you feel we should know about them

What family and/or friends are actively involved in your child’s life but do not live with them?

Name Relationship to child

Age Anything you feel we should know about them

School

Thank you for completing this form! We look forward to meeting you at your appointment.

Any big stressors or recent changes at home, for example moving, unemployment, illness in the family, etc.? If yes, please describe:

School Name

Grade

How is your child’s level of school performance/grades □ Above Average □ Average □ Below Average

Please check any concerns from teachers/school □ None □ Academic □ Social □ Behavior □ Attendance □ Other:

Please check any school concerns you have □ None □ Academic □ Social □ Behavior □ Attendance □ Other: ___________________________________________________

Average number of hours per night spent doing homework:

Has your child ever been tested for special education services? Is your child receiving special education services? Has your child ever repeated a grade?

If yes to any, please describe: