THE HEALTH CARE INSTITUTE A Breakthrough Health Literacy, Research, Training and Education Program

1. THE HEALTH CARE INSTITUTE A Breakthrough Health Literacy, Research, Training and Education Program Ariella Herman, PhD Research Director Health Education in Europe "Turning Europe into the Healthiest Society“ • March 4, 2009 • Brussels • European Parliament

2. Low Health Literacy in America* • Poor health literacy is "astronger predictor of a person's health than age, income, employment status, education level, and race“ • Costs the American economy $73 billion annually • 90 million people cannot understand and use health information appropriately • People are more likely to use emergency services, not preventive services • People are more likely to be hospitalized, not be compliant with medication • Annual health care costs are 4 times higher • Populations most at-risk for low health literacyinclude: Poor, Less Educated, Older, Ethnic Minorities, and Persons with Chronic Health Conditions & Disabilities *Quote and data provided by the AMA, Report on the Council of Scientific Affairs, Ad Hoc Committee on Health Literacy for the Council on Scientific Affairs. Health Literacy: A Prescription to the End Confusion, the Institute of Medicine (IOM 2003)

3. The Head Start Program in America • Created as part of President Lyndon B. Johnson’s WAR ON POVERTY efforts. • Since 1965, has served over 25 million low income families and children (ages 0-5). • Provides educational, parent involvement services, health and nutritional services. • Currently, 1 million children and families are served with a $7B operating budget. • Poor health literacy is an obstacleto achieving better health outcomes for these families. ** • UCLA/J&J Health Care Institute created in 2001 at UCLA Anderson. **“The status of Health Care in Head Start: A Descriptive Study”, Sept 2000, UCLA Anderson, A Herman

4. HCI OBJECTIVES Building a better future for the most vulnerable children by providing their parents with skills and knowledge to: • ENABLEthemto become better caregivers by improving health care knowledge and skills. • EMPOWER themin decision making. • ENHANCEtheirself esteem and confidence. • CONTRIBUTEto reducing escalating healthcare costs. Providing training and information for the successful implementation of healthcare literacy programs.

5. 55 PROGRAMS TRAINED IN 38 STATES • 14,000 FAMILIES TRAINED • 7 LANGUAGES • 10 ETHNICITIES 2001-2008 Impact of UCLA/J&J Health Care Institute Research Phase Funded by J&J

6. Key Findings

7. “Reducing use of Emergency Medical Resources Among Head Start Families”, Journal of Community Health, June 2004, A.Herman.

8. 2001-2008 Impact of UCLA/J&J Health Care Institute “What To Do When Your Child Gets Sick” Research Phase Funded by J&J

9. 2001-2008 Impact of UCLA/J&J Health Care Institute “What To Do When Your Child Gets Sick” Research Phase Funded by J&J

10. 2001-2008 Impact of UCLA/J&J Health Care Institute “What To Do When Your Child Gets Sick” Research Phase Funded by J&J

11. COST BENEFIT ANALYSIS

12. POTENTIAL NET SAVINGS FOR MEDICAID (BASED ON NUMBER OF FAMILIES TRAINED) * BASED ON $554 SAVINGS PER FAMILY TRAINED ** AVERAGE PROGRAM COST OF $60 PER FAMILY

13. MORE THAN JUST FINANCIAL • INCREASEDparental awareness of health warning signs • QUICKERresponse to early signs of illness • USEof health reference book • BETTERunderstanding of common childhood illnesses • FEWERschool absences leads to happier children • DECREASEin ER and Doctor/Clinic Visits • EMPOWEREDparents

14. GLOBAL HCI OBJECTIVES AND GOALS OUTPUT INPUT OUTCOME IMPACT 14,000 families trained 275 trainers trained 55 Agencies 38 States Change in knowledge, behavior and attitude HCI methodology taught can be applied to train families in other important health issues (oral health, diabetes, nutrition, obesity) Community partnerships are strengthened to improve delivery of comprehensive services & foster healthy development in low-income children Awareness of Head Start in community as a leader in improving children’s/families’ health Parents/families have increased knowledge to lead healthier lifestyles Increased parent involvement Importance of preventive care is emphasized Healthier children, families Increased health literacy Reduced healthcare costs ($5.5M net annual savings) Reduced ER use (58% decrease) Reduced doctor/clinic use (41% decrease) Increase in school readiness (29% fewer school days missed) Increase in Parents’ work productivity (42% fewer work days missed) Increase in parents’ attendance at other training sessions offered by agency (increase from an average of 30% to 75%) Health Improvement Project (HIP) HCI/J&J Community Website Curriculum Design Faculty Instruction Pre/Post Surveys TTT Assessments Pre/Post Tracking Kansas Head Start 5,000 families trained 2005-2007(Head Start Association) New Mexico Head Start 5,000 families trained 2007-09 (Pfizer) Washington Head Start 7,000 families trained 2007-09 (State Legislature) OHS Grant in partnership with CMCA (Missouri) 2008-2011 Federal Grant UCLA in LA Community Partnership Grant 2008-2010

15. Applying the Model to Chronic Disease Management: Diabetes Prevention Example OUTCOMES INPUT Short Medium Long-Term NUTRITION Adoption of: • Healthy eating behaviors • Limited budget and available resources balance • Adult-Child synergy leads to behavior change • Attain appropriate body weight NUTRITION Increased knowledge of • Healthy food choices • Consequences of poor nutrition • Selection of affordable and healthy food Improved attitude regarding healthy eating Awareness of appropriate body weight • DECREASEDrisk factors for nutrition-related health problems and chronic diseases • DECREASED development of chronic diseases • MAINTAINEDhealthy body weight • DECREASEDhealth care costs Training of Staff Parents Children EXERCISE • Increased knowledge of • Importance of physical activity • Health consequences of inadequate physical activity • Identifying appropriate level and types of physical activity • Improved attitudes regarding physical activity • Awareness of appropriate body weight EXERCISE • Adoption of: • Appropriate level of routine physical activity: • Practice of balancing diet and exercise • Increase in family physical activity • Adult-Child synergy leads to behavior change • Attain appropriate body weight

16. TRAINING IN 2 LANGUAGES!

17. TRAINING IN 4 LANGUAGES!

19. TRAINING IN 7 LANGUAGES PHYSICIAN HOME VISITOR/ TRANSLATOR

20. “This process supports our thinking as a Head Start program, which is that one of the most powerful things we can do is not only to make a difference in the lives of our children, but also to effect changes for our families as a whole…” • “..the J&J Health Care Institute has not only enriched their abilities as parents, it has strengthened the parents’ self esteem and the parent-child bond within the family….” • “..the result is a family that has a brighter future…” • “As we continue to fight for the future fate of Head Start, it is passionate individuals like who you are invaluable to our Head Start community …” • “It is people like you that change the world…one family at a time…”