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Communities of Practice Project: The Key Elements of Sustainability


Communities of Practice Project: The Key Elements of Sustainability New Federal Opportunities for Promoting Child Health and Well-Being Charles Bruner, Director – PowerPoint PPT presentation

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Title: Communities of Practice Project: The Key Elements of Sustainability

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
  • 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 childrens healthy
  • 5. States and communities must be intentional and
    creative to take advantage of these federal
  • 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. Childrens Health, the Nations
    Wealth Assessing and Improving Child Health.
  • social determinants of health
  • life course model of healthy child development
  • health equity

2. Health Practitioners are the First Contact
with Young Children.
3. Exemplary Strategies Address the
Multidimensionality of Child Health ...
ABCD Assuring Better Child Health Development
Connecticuts Help Me Grow program
in the Following Ways.
4. Federal Health Provisions Offer the
Opportunity to Address Childrens Healthy
  • 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
  • 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
  • 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
  • Partnerships with state and community advocates
  • Compelling messages to key stakeholders and

Additional Resources from CFPC
  • Healthy Child Storybook
  • Journal of Pediatrics Commentary
  • Childrens 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

Voices for Americas Children 1000 Vermont
Street, NW Suite 700 Washington, DC
20005 202-289-0777
Additional Slides Outlining Outcomes, Exemplary
Programs, and Strategies
  • Source Healthy Child Storybook

Outcomes of Well-Child Care During the First Five Years of Life 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 childs physical health status and needs Warning signs of child abuse and neglect detected Parents feel valued and supported as their childs 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 childs 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. 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 Futures
  • Bright 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
  • Success in strengthening pediatric practice in
    using health supervision guidelines when
    champions are enlisted and training and resources
    provided to support that incorporation into
  • Improvements in identification, response, and
    family involvement in addressing child health and
    development concerns identified through health
  • Improved coordination across health, education,
    and human services in meeting whole child

Help Me Grow
  • Help 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 practitioners 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)
  • 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
  • Improves childrens ability to express themselves
  • Increases childrens listening vocabularies
  • Improves childrens preschool language scores
  • Reduces the proportion of children with language
    delays that can prevent them from succeeding in

Assuring Better Child Health and Development
  • 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

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
  • 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 childs behavioral clues
  • Reduces toddler television viewing and improves
    child expressive vocabulary

  • 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 Carolinas 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
Issue 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
  • 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 childrens 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 Childrens Healthy
  • Recent findings on maternal depression and
    childrens 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.