COPC in DC Kathleen M. Kadow June 2000. Washington, DC 68 SQUARE MILES POP:519,000 US CAPITAL MID-ATLANTIC REGION FEDERAL GOVERNMENT ‘HOME-RULE’

COPC in DC

Kathleen M. Kadow

June 2000

Washington, DC

68 SQUARE MILESPOP:519,000US CAPITALMID-ATLANTIC REGION

FEDERAL GOVERNMENT‘HOME-RULE’

Comp Clinic Established in 1967 Community-based clinic of

Children’s Hospital Comprehensive pediatric

services Staffing Women Infants and Children

(WIC)

City, Ward, Census Tract

EIGHT WARDS IN DC

192 CENSUS TRACTS

CENSUS TRACT =3200 PEOPLE

COMP CLINIC

CHILDREN’S HOSPITAL

COPC Steps

Community DefinitionCommunity CharacterizationPrioritizationDetailed AssessmentInterventionEvaluation

Community Definition “Geographic Retrofitting”

Visits to Comp Clinic 7/98-7/99

Home address ---- census tracts

85% of visits within Washington,DC

Mapping: July 98 – July 99

Community DefinitionNUMBER OF VISITS PER CENSUS TRACT

CENSUS TRACTS

NU

MBER O

F V

ISIT

S

Community Definition

VI SI TS BY WARD

Ward 5

10%

Ward 1

54%

Ward 4

24%

Ward 2

12%

VI SI TS BY WARD

Ward 2

12%

Ward 4

24%

Ward 1

54%

Ward 5

10%

Targeted PopulationThe pediatric (0-18 years old) users and non-users of the 26 census tracts that represent the top 50% of visits to Comp Clinic

The 26 census tracts fall into four of the eight wards in DC

The Next Step...Community Definition Community CharacterizationPrioritizationDetailed AssessmentInterventionEvaluation

Community Characterization

COMMUNITY SETTING

Washington,DC<climate, environment, housing, ‘Metro’, DC Government>

Wards 1,2,4 and 5

Community Characterization

RACE/ETHNICITY DC 26 CENSUS TRACTS IN WARDS 1,2,4 AND 5

African- American 62% 78%

Caucasian 34% 18%

Hispanic 7.2% (any race) 14% (any race)

Asian/Pacific Islander/American Indian

4% 4%

Community Characterization

SOCI O- DEMOGRAPHI CS: DC VS. TARGET COMMUNI TY

I NDI CATOR DC 26 CENSUSTRACTS

Age (% 0- 17yrs old) 20% 22%Per capita income ($) $29,383 $18,827Unemployment rate (%) 7.2% 9.9%Education (%high schoolgrad/% college grad)

73%/33% 62%/18%

Community Characterization

Health Status

Natality

Mortality

Morbidity

Hospital/ Health Services/Insurance

Community Characterization

12 Key Informant Interviews

3 Focus Groups

Over 70 issues identified

Organized into ten large topic areas for prioritization step

Community Characterization KEY INFORMANTS & FOCUS GROUPS

Focus Group Top Ranked I ssuesGrade school PTA Mental health

Dental Health Urgent Care Mobile Health Care Health Awareness Outreach

High school senior group Sex and sexuallytransmitted diseases(STD’s)

Teenage pregnancy Drug use Food Lack of immunizations

Daycare staff Adequately trained staff Nutrition Need for evening clinics Kids sick in daycare Neglect Dental care

Step 3…..Community DefinitionCommunity Characterization PrioritizationDetailed AssessmentInterventionEvaluation

Prioritization Prioritization Team #1

Comp Community Board

Team Meeting #1 Step 1- review and ranking of 10

broad topics

PrioritizationRREEVVII EEWW TTEENN MMAAJJ OORR TTOOPPII CC AARREEAASS WWII TTHH

PPRRII OORRII TTII ZZAATTII OONN TTEEAAMM ((TTEEAAMM 11)) Access to Health Care Health Education Prevention/Routine Health Care Nutrition and Exercise Smoking and Substance Abuse Adolescent I ssues HIV/AIDS and STD’s Mental Health Family I ssues School and Daycare I ssues

Prioritization Prioritization Team #2

COPC Team

Team Meeting #2 Review topic selected by team

#1 Focus School and Daycare

Problems

Selected Health Problem

SCHOOL and LEARNING PROBLEMS

School and Learning Problems

WORKING DEFINITION

Any academic difficulty experienced in school,due to any cause.

Step 4….

Community DefinitionCommunity CharacterizationPrioritization Detailed AssessmentInterventionEvaluation

Detailed Assessment

School Data

Students in District of Columbia Public Schools(DCPS) who performed at basic level on theStanford 9 Achievement Tests for readingincreased from 1997- 98 at every grade forwhich scores were available.

Students in DCPS improved their mathperformance on the Stanford 9 in 1998

Detailed Assessment School Data

Students in DCPS score, on average, one fifth lowerthan children nationally on the Scholastic AptitudeTest (SAT). DCPS scores have been declining since1995.

Students in DCPS are far behind the nationalaverage in math AT ALL grade levels for which datais available (3rd, 6th, 8th and 10th)

Detailed AssessmentELEMENTARY SCHOOL (Pre- K to 3rd grade) SAMPLE

School/Ward

STANFORD- 9% of studentsbelow basic

ACHIEVE-MENT% ofstudentsbelowbasic

TEST% ofstudentsbelow basic

Reading Math CombinedMeyer/1 16.9 18.9 17.9Garrison/2 22 36.6 29.3Powell/4 24.3 36.5 30.6MalcolmX/5 39.5 47.7 43.7OVERALLDC (1999)

24 26

Detailed AssessmentSENIOR HIGH SCHOOL (9th – 12th grades) SAMPLE

School/Ward

STANFORD- 9% of studentsbelow basic

ACHIEVEMENT% of studentsbelow basic

TEST% of studentsbelow basic

Reading Math CombinedCardozo/1 64 90 77SchoolWithoutWalls/2

0.4 26 13.1

Coolidge/4

43 81 62

Spring-arn/5

64 85 75

OVER-ALL DC

45 70

Detailed AssessmentDISTURBING TRENDS

•Reading and Math Skills

•Ward vs DC data

•Math scores, widening gap

Detailed Assessment Literature and Experience Medical Behavioral/Psychiatric Psychosocial Educational School Problems Clinic

Detailed Assessment

Screening Tools Child Health and Family Functioning

Questionnaire

Parents’ Evaluation of Developmental Status

Pediatric Symptom Checklist

Einstein Assessment of School Related Skills

Getting Closer….

Community DefinitionCommunity CharacterizationPrioritizationDetailed Assessment InterventionEvaluation

Intervention What has been done?

Federal/City/Local What else can be done?

Create baseline data concerning the risk factors associated with school problems

Effectively screen for school problems within the targeted community

Intervention HYPOTHESIS:

The use of a standardized screening protocol to assess school and learning problems will enable primary care providers and staff to identify children (5-11yrs old) with an existing school or learning problem.

Intervention

GOAL To identify children 5-11years

old, in a primary care pediatric clinic with school and learning

problems using a standardized screen.

Intervention Objectives Program Activities Community and Staff

Participation Resources and Budget Surveillance and Monitoring

ObjectivesExamples Screening 5-11 year olds over 6

months Disposition after screen Referrals Increase correct identification of

school and learning problems Increase awareness

Program Activities

Examples COPC Meeting # 3 Chart Review (before/after) Training of staff Comparison (screen/provider) Community educators Resource review

Are you still awake?….

Community DefinitionCommunity CharacterizationPrioritizationDetailed AssessmentIntervention Evaluation

Evaluation Relevance Quality Efficiency Satisfaction Differential Value

Evaluation

Outcomes Number receiving screen Number of referrals/reason Rates of identification (pre/post) Survey (pre/post) of staff Satisfaction (pre/post)

Evaluation

Process/Structure Acceptability Ease of administration Barriers Length of time. Differential value.

Conclusion

Review COPC Process

Future plans

Thank you for your attention