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MCH Checkpoints Tracking Healthy Development Along Life Trajectories

MCH Checkpoints Tracking Healthy Development Along Life Trajectories. Wm Hollinshead MD MPH Rhode Island Department of Health CityMatCH Conference Albuquerque September 2008. Trajectories of Health…. MCH Checkpoints Tracking Healthy Development Along Life Trajectories. Propositions:

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MCH Checkpoints Tracking Healthy Development Along Life Trajectories

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  1. MCH CheckpointsTracking Healthy Development Along Life Trajectories Wm Hollinshead MD MPH Rhode Island Department of Health CityMatCH Conference Albuquerque September 2008

  2. Trajectories of Health…

  3. MCH CheckpointsTracking Healthy Development Along Life Trajectories Propositions: Parents, and others, always have important information about a child’s developmental risks, assets, and needs. Developmental risks and protective factors can be recognized much earlier, before conception or very early in life, and addressed then to alter developmental trajectories. But our systems don’t ask, don’t retain, and don’t pass forward developmental data to help families succeed.

  4. MCH CheckpointsTracking Healthy Development Along Life Trajectories And so: Who knew? When did they know it? How did they respond?

  5. MCH CheckpointsTracking Healthy Development Along Life Trajectories In Rhode Island: • Patients and parents know, but “…no one asked”, and so  WHSRP, ASQ, PEDS • Pre/perinatal providers know/should ask, but it didn’t get sent  NBDevelScreen • Medical homes should ask, but don’t  evidence based ASQ, PEDS • Some are medically homeless  RIte Care and PediPracticeEnhancementProj • Child care staff know, but don’t connect to developmental services  Watch Me Grow

  6. MCH CheckpointsTracking Healthy Development Along Life Trajectories MCH Checkpoints are predictable points of contact between parents/children and professionals, in which healthy development can be addressed.

  7. MCH CheckpointsTracking Healthy Development Along Life Trajectories In a community system of family-centered medical homes, MCH Checkpoints are organized into a coherent, connected longitudinal system – from before conception to young adulthood - that recognizes and addresses risks and protective factors that will influence children’s healthy development.

  8. MCH CheckpointsTracking Healthy Development Along Life Trajectories PROTECTIVE FACTORS: [RAISE TRAJECTORY] Born Wanted and Well Skilled Parents Healthy Home Early Reading Full Preventive Care Safe Play Space Good Schools Social Capital Mentors Physical Activity HIGH TRAJECTORY PGY YOUNG ADULT BIRTH GRADUATIONS LOW TRAJECTORY PGY ADOLESCENT BIRTH RISK FACTORS: [DEPRESS TRAJECTORY] Poverty Premature Birth Isolated Parent Lead Poisoning Poor Nutrition Violence Obesity Unaddressed illness Depression/Isolation School Failure Tobacco/EtOH Unintended Pregnancy SCHOOL AGE LEAVE SCHOOL PRE SCHOOL SCHOOL ENTRY INFANT YOUNG ADULT PGY BIRTH MCH Checkpoints O B O B O B AGE  -,5 0 1 2 4 6 12 18 24

  9. MCH CheckpointsTracking Healthy Development Along Life Trajectories Sally A. is 16 years old,a Sophomore at Hope High School,living at 454 Pine St. in Providence, who comes to Central Health Center for a pregancy test.

  10. MCH CheckpointsTracking Healthy Development Along Life Trajectories We already know: Sally A. has no medical record at Central Health Center or in KIDSNET Providence schools have low attendance, low graduation, and Hope High is troubled Rhode Island has New England’s highest teen birth rate, most in Providence 454 Pine is the back door of Amos House

  11. MCH CheckpointsTracking Healthy Development Along Life Trajectories Central Health Center will offer Sally the Women’s Health Screening and Referral Program (WHSRP) while Sally waits for her pregnancy test results. She’ll answer 19 questions about her health, reproductive past and plans, home resources, threats, and supports – all cued for action and referrals.

  12. MCH CheckpointsTracking Healthy Development Along Life Trajectories On the WHSRP, Sally A. tells us: • She’s uninsured, not using contraception, not sure if she’ll keep a baby • They’re living at Amos House shelter, d/t police drug action against her brother • She has felt depressed, worried • She has friends and family to count on • She likes school, especially the track team Pregnancy test is negative…

  13. MCH CheckpointsTracking Healthy Development Along Life Trajectories MCH vectors we can address: Sally A. is given appt. for young adult checkup, o.c.’s, and shots. Sally says she’ll bring her mother next time, and maybe talk about depression. Central Health Parent Consultant encourages Sally’s enrollment in culinary training at Amos House, and running for Hope High. She leaves with ample condoms for self and 2 teammates.

  14. MCH CheckpointsTracking Healthy Development Along Life Trajectories Sally returns with her mother and sib: She has records at several health centers, and Hasbro Children’s Hospital Younger sibling was hospitalized for abuse by man now in jail Her sibs are in KIDSNET, with home visits, Early Intervention, and Pb poisoning data Track coach helps with mood and plans

  15. MCH CheckpointsTracking Healthy Development Along Life Trajectories Annual school survey shows 83% of Hope High Sophomores lack adult support at school, and 35% are home alone 3+ afternoons each week YRBS shows 30% of RI Sophs sexually active, 32% sad/hopeless x 2+weeks WHSRP collects pre/perconception risks from 2600 low income women who will deliver in subsequent 12 months (~60% of RI low income deliveries)

  16. MCH CheckpointsHealth Trajectory of Sally A. - 16 y.o. Sophomore HIGH TRAJECTORY PGY PROTECTIVE FACTORS: [RAISE TRAJECTORY] Born Wanted and Well Skilled Parents Healthy Home - Early Reading Full Preventive Care - Safe Play Space Good Schools - + Social Capital + Mentors + Physical Activity YOUNG ADULT BIRTH GRADUATIONS ADOLESCENT LOW TRAJECTORY RISK FACTORS: [DEPRESS TRAJECTORY] - Poverty Premature Birth Isolated Parent Lead Poisoning Poor Nutrition - Violence Obesity Unaddressed illness - Depression/Isolation School Failure Tobacco/EtOH ? Unintended Pregnancy SCHOOL AGE SALLY A’s VISIT PRE SCHOOL SCHOOL ENTRY INFANT YOUNG ADULT PGY BIRTH MCH Checkpoints O B O B AGE  -,5 0 1 2 4 6 12 18 24

  17. MCH CheckpointsTracking Healthy Development Along Life Trajectories Louise S. is a 24 y.o. retail worker with 8 years of education in the Dominican Republic, living at 774 Hope St. in Pawtucket with her 7yo, 2yo, and relatives, now taking home a 35 week 2155gm boy from Memorial Hospital

  18. MCH CheckpointsSome Care Answers about Lou[24yo Single Mother of 6, 2, and 5 d.o.] We know: Lou attended Family Planning and full prenatal care for first 2 children, less this time Newborn Developmental Screening flags single parent, limited education, LBW infant, incomplete prenatal care. Referred and accepts MCH home visit. Both sibs are in KIDSNET, up to date on preventive and WIC services. 2yo is known to Early Intervention for hearing tests, but not active now 774 Hope St has had two previous 2yo residents with Pb levels 15-19mcg/dl

  19. MCH CheckpointsSome More MCH Info about Lou[24yo Single Mother of 7, 2, and 2d.o.] At first home visit we learned: • Her 7yo is thriving in 1st grade at nearby Cunningham School, and the 2yo attends the Child Opportunity Zone there • Her apartment at 774 Hope is in a clean, dilapidated “3-decker” tenement owned by a cousin, with mortgage problems • She’s worried about that, and her supermarket job hours will not allow her to keep all medical appointments

  20. MCH CheckpointsHealth Trajectory vectors for Louise[24yo Single Mother of 7, 2, and 2d.o.] HIGH TRAJECTORY PROTECTIVE FACTORS: [RAISE TRAJECTORY] Born Wanted and Well + Skilled Parents +Healthy Home + Early Reading +? Full Preventive Care + Safe Play Space + Good Schools + Social Capital Mentors Physical Activity YOUNG ADULT P G Y LOW TRAJECTORY P G Y ADOLESCENT RISK FACTORS: [DEPRESS TRAJECTORY] - Poverty - Premature Birth Isolated Parent - Lead Poisoning Poor Nutrition Violence Obesity Unaddressed illness Depression/Isolation - School Failure Tobacco/EtOH - Unintended Pregnancy PGY SCHOOL AGE BIRTHS of CHILDREN LEAVE SCHOOL Lou S. Delivery PRE SCHOOL SCHOOL ENTRY INFANT YOUNG ADULT PGY BIRTH MCH Checkpoints O B O B O B O B AGE  -,5 0 1 2 4 6 12 18 24

  21. MCH CheckpointsSome Basic Propositions Healthy Human Development is a long, dynamic integration of genetic, social, educational, and environmental influences. Many developmental risks and protective factors can be recognized before conception or very early in life, and addressed then to alter developmental trajectories Linkage of MCH system components and data can therefore have powerful impacts on outcomes for individual kids, families, and groups

  22. MCH CheckpointsSome Basic Propositions MCH Checkpoints will give everyone: • A broadened vision of all the important forces and players in healthy child development. • Shared professional and parent language and tools for consistent recognition of development risks, assets and needs as early as possible. • Horizontal and longitudinal information transfer among preconception, prenatal, perinatal, early childhood, and school health providers…with and through parents.

  23. MCH CheckpointsSome Basic Propositions There is a short list of basic questions we all can ask at intervals along life trajectories, If we’re consistent and comfortable and caring, and if we help parents and professionals keep track of these MCH Checkpoints, we can finally “have our act together.”

  24. MCH CheckpointsTracking Healthy Development Along Life Trajectories How can you pull your community’s MCH Checkpoints together, to advance parents’ and professionals’ shared use of good information on healthy development? More: Wm.Hollinshead@gmail.com Ellen.Amore@health.ri.gov (KIDSNET) Blythe.Berger@health.ri.gov (Watch Me Grow)

  25. MCH CheckpointsHealth Trajectory vectors for Lou[24yo Single Mother of 7, 2, and 2d.o.] HIGH TRAJECTORY PROTECTIVE FACTORS: [RAISE TRAJECTORY] Born Wanted and Well + Skilled Parents +Healthy Home + Early Reading +? Full Preventive Care + Safe Play Space + Good Schools + Social Capital Mentors Physical Activity YOUNG ADULT P G Y LOW TRAJECTORY P G Y ADOLESCENT RISK FACTORS: [DEPRESS TRAJECTORY] - Poverty - Premature Birth Isolated Parent - Lead Poisoning Poor Nutrition Violence Obesity Unaddressed illness Depression/Isolation - School Failure Tobacco/EtOH - Unintended Pregnancy PGY SCHOOL AGE BIRTHS of CHILDREN LEAVE SCHOOL Lou S. Delivery PRE SCHOOL SCHOOL ENTRY INFANT YOUNG ADULT PGY BIRTH MCH Checkpoints O B O B O B AGE  -,5 0 1 2 4 6 12 18 24

  26. MCH Checkpoints ’02

  27. MCH CheckpointsSome Core MCH Questions about Sally[16yo Sophomore at Hope High] • What does Sally want/expect/deserve from MCH? • Is Sally a mature and informed manager of her own (and a child’s?) needs? • Does Sally live in a good safe place? • Does Sally have reliable family/social support? • Does Sally have significant personal health needs? • Can the MCH system/community offer what Sally needs? Will she engage with help?

  28. READING

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