Childhood Obesity Prevention Program

1. Childhood Obesity Prevention Program A PROPOSAL TO: Harrisonburg Community Health Center Board of Directors December 8, 2011 RebekahCharles Carrielyn Rhea Monica Millbrooks-Scott Heather Shlosser

2. Introduction • Purpose of the presentation: • Propose integration of childhood obesity prevention program into FQHC programs. • Proposed Program: • Integrate a childhood obesity prevention program into the current Harrisonburg Community Health Center Community Health Worker Program. • Harrisonburg Community Health Center: • Harrisonburg, Virginia has a federal designation as a Medically Underserved Population. • From that designation an action committee formed and successfully created the Harrisonburg Community Health Center. • The Harrisonburg Community Health Center is a non-profit 501(c)3 federally qualified health center (FQHC). • The Community Health Center receives an annual grant from the federal government in order to create a universal access medical facility. • Carries a mission of providing comprehensive primary care health services to anyone in the community regardless of their financial situation.

3. What does a FQHC do? • A FQHC generally furnishes the following services: • Physician services; Nurse practitioner (NP), physician assistant (PA), certified nurse midwife (CNM), clinical psychologist (CP), and clinical social worker (CSW) services; • Services and supplies incident to the services of MDs, DOs, NPs, PAs, CNMs, CPs, and CSWs; • Visiting nurse services to the homebound in an area where the Centers for Medicare & Medicaid Services (CMS) has determined that there is a shortage of Home Health Agencies; • Preventive primary health services when furnished by or under the direct supervision of a physician, NP, PA, CNM, CP, or CSW: • Medical social services; • Nutritional assessment and referral; • Preventive health education; • Children’s eye and ear examinations; • Well child care, including periodic screening; • Immunizations including tetanus-diphtheria booster and influenza vaccine; • Voluntary family planning services; • Taking patient history; • Blood pressure measurement; • Weight measurement; • Physical examination targeted to risk; • Visual acuity screening; • Hearing screening; • Cholesterol screening; • Stool testing for occult blood; • Tuberculosis testing for high risk beneficiaries; • Dipstick urinalysis; and • Risk assessment and initial counseling regarding risks. • Prenatal and post-partum care; • Prenatal services; • Clinical breast examination; • Referral for mammography • Federally Qualified Health Center Preventive Primary Services That Are Not Covered: • Group or mass information programs, health education classes, or group education activities, including media productions and publications; and • Eyeglasses, hearing aids, and preventive dental services.

4. Use of Community Health Workers • Community Health Workers (CHW): • A widely accepted definition was proposed by WHO: • Community health workers should be members of the communities where they work, should be selected by the communities, should be answerable to the communities for their activities, should be supported by the health system but not necessarily a part of its organization, and have shorter training than professional workers. • Why use CHWs? • Health profession shortages • Allows everyone to work to the top of their role or licensure • Already budgeted into the FQHC grant • The enhanced role allows for further justification of the CHW position

5. Child & Adolescent Obesity • WHY IS THIS IMPORTANT? • Obesity is a multifaceted issue with significant health, social, and fiscal consequences. • Addressing the obesity epidemic will require a comprehensive approach involving federal, state, and local public organizations, schools, communities, the medical community, as well as the food industries. Prevention of obesity is crucial to this effort particularly among children and youth. Intervention taken today to promote healthy behaviors among children, and their families and communities can begin to counteract the many factors contributing to the rising trend of obesity in America. • Healthy People 2020 have a goal to reduce the proportion of children and adolescents who are considered to be obese to 14.6%. • Healthy people 2020 suggests this goal can be accomplished through education, access to healthy foods, increased health care provider awareness and assessment of the child’s body mass index (BMI). • According to the Centers for Disease Control since 1980 childhood & adolescent obesity has tripled! 

6. Importance Continued…

7. SUPPORTING THE HEALTH CENTER MISSION • Harrisonburg Community Health Center is a Federally Qualified Health Center (FQHC) who is working towards a patient-centered medical home model of care. • As both a medical home model and FQHC the health center is required to have core services inclusive of preventive care programs in which a childhood obesity prevention program would fit appropriately into. • The Community Health Center receives an annual grant from the federal government in order to create a universal access medical facility. • The childhood obesity prevention program can help to fulfill the center’s mission of providing comprehensive primary care health services to anyone in the community. These services are offered to community members regardless of their financial situation and by expanding preventive care services to include obesity prevention we will likely subsequently reduce accompanying chronic co-morbid conditions.

8. Mission Support Cont… • This prevention program can assist the center to comply with elements of NCQA PCMH standards • Enhanced Access: • Medical Home Responsibilities • Culturally and Linguistically Appropriate Services (CLAS) • Identify & Manage Patient Populations • Patient Information • Clinical Data • Comprehensive Health Assessment • Using Data for Population Management • Plan & Manage Care • Implement Evidenced Based Guidelines (American Academy of Pediatrics) • Identifying High Risk Patients (Obesity or at risk for Obesity) • Manage Care • Self Care Support & Community Resources • Track & Coordinate Care • Measure / Improve Performance • Measures of Performance • Patient / Family Feedback • Implement & Demonstrates Quality Improvement • Performance Improvement • Reports Data

9. How will this program work? • The Community Health Center has an existing fully staffed and funded Community Health Worker Program in place. • The obesity prevention program will fit into the existing program thus negating any need for additional staffing requirements. • The community health workers will integrate outreach into their current care coordination role. • Community health workers will be trained for outreach and education around obesity prevention. The health workers will have algorithms for referral to the nurse clinic and from the nurse clinic to providers depending on the level of required intervention for the child/family. • Nursing and provider staff will integrate evidenced based standards and guidelines into visit plans to focus on obesity assessment and prevention. • Existing guidelines and recommendations from the Centers for Disease Control, Academy of Pediatrics and the National Let’s Move Campaign will be the core framework for this prevention program. • Primary focus will be designed around fitness and nutrition education, promoting healthy lifestyles, parental involvement, access to safe environments, access to adequate amounts of healthy foods, decreasing screen time, and tracking BMI. This focus will be predominantly attained through outreach to high risk children & adolescents.

10. Systems Standpoint… Extracted from Ten Essential Environmental Services as outlined by Carl S. Osaki , University of Washington School of Public Health and Community Medicine, Seattle, WA

11. How will this program be evaluated? • Patient and staff satisfaction surveys data • Utilized to assure patients/families feel this program is worthwhile. (Patient/family Satisfaction) • Survey data will also help to evaluate if this program allows for each staff persons to work to the top of their role or licensure and is feeling optimally professionally challenged. (Staff Satisfaction & Financial Viability) • The Healthcare Effectiveness Data and Information set (HEDIS) tool will be utilized to measure performance and the potential impact of this program on certain dimensions of care and service. • Internal quality improvement projects and federally mandated indicators will also be tracked and reported on as deemed appropriate or necessary by the organization.

12. Why should the board support this? • Federal grant funding is already in place – FQHC. • Community Support & involvement. • Addresses a serious community health issue. • Could decrease clinic case loads of providers & nurse clinics with enhanced use of community health workers. • Enhanced community health worker role will support need for continued funding of the community health worker position.

13. Next Steps… • Should this be approved by the board: • Establish a registry of children & adolescents currently deemed to be obese & at risk for obesity (overweight) using BMI data. Further variables to be determined by clinical team. • Algorithms for outreach, intervention and follow-up to be developed based on existing American Academy of Pediatrics (AAP) Guidelines & Centers for Disease Control (CDC) Guidelines. • Existing AAP, CDC & National Let’s Move programmatic training, outreach, patient education and follow-up tools will be utilized in this program. • A pilot program will be developed and implemented per protocol. • Results from the pilot program will be shared with the board for further assistance with determining long term viability of this program.