The Roots of Children’s
Health and Well-being
Meeting Name
Presenter Name
Date
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Trusted and Effective Messengers
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Levels of Opportunity
Patient
Community
- Preventive care
- Screening
- Referral
- Innovative Models
- Partnerships
- Promotion and
Health Building
- Care Coordination
- Coalitions
- Media
- Partnerships
- New initiatives
Legislative/Policy
- Lobbying
- Legislation
- Systems Building
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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
70%
66%
60%
VT
50%
40%
48%
TX
40%
NY
30%
37%
MS
20%
10%
0%
High
Mean
National Survey of Child Health, 2003
New York
Low
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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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Maternal Mental
Health
Promotion
(awareness,
screening,
treatment)
Parental Support
and Education
Community
Support and
Advocacy
(quality pre-k,
child care, home
visiting social
services)
Early Literacy
and Early Care
Medical
Home
Financial
Literacy, Tax
Credit,
Education and
Legal Supports
Child/
Family
Routine
Screenings and
Surveillance
including Toxic
Stress
Community
Linkages across
Systems/
Relationships;
Ongoing Care
Management
Team
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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
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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
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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!
ABCD
Assuring Better Child
Health & Development
Connecticut’s Help
Me Grow program
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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.
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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: childcentered 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?
Comprehensive health services that
meet children’s vision, hearing,
nutrition, behavioral, and oral health as
well as medical health needs.
Early
Learning
Health,
Mental
Health and
Nutrition
Early identification, assessment
and appropriate services for
children with special health care
needs, disabilities, or
developmental delays.
Early care and education
opportunities in nurturing
environments where children
can learn what they need to
succeed in school and life.
Family
Support
Special Needs/
Early Intervention
Economic and parenting supports
to ensure children have nurturing
and stable relationships with
caring adults.
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Restating the Framework
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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?
Successful Parenting
of Next Generation
Economic Responsible Lifelong
Educational
Health
Achievement Productivity Citizenship
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For More Information
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Contact Name
Email
Chapter Web link
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