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Healthy Steps Fresno: Partners in Developing Healthy Children

Healthy Steps Fresno: Partners in Developing Healthy Children. Veronica Ybarra-Tamayo, HSS Kathleen Ramos, Ph.D. Rick Brandt-Kreutz, LCSW First 5 Fresno Commission Presentation April 5, 2006. Objectives. Healthy Steps CHILDREN Healthy Steps RESIDENTS Healthy Steps FUTURE.

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Healthy Steps Fresno: Partners in Developing Healthy Children

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  1. Healthy Steps Fresno:Partners in Developing Healthy Children Veronica Ybarra-Tamayo, HSS Kathleen Ramos, Ph.D. Rick Brandt-Kreutz, LCSW First 5 Fresno Commission Presentation April 5, 2006

  2. Objectives • Healthy Steps CHILDREN • Healthy Steps RESIDENTS • Healthy Steps FUTURE

  3. The Children’s Health Center: PATIENTS • 50% are 0-5, about 4000 children • 97% MediCal or no insurance • 80% Hispanic • About half speak only Spanish

  4. The Children’s Health Center: RESIDENTS • 350 pediatricians since 1947 • Over 60% stay in the Central Valley • Over 40% stay in Fresno • Today: 27 residents and growing to 30

  5. PATIENT SERVICES • Plus: • Prenatal home visits • Community leadership and training • Enhanced well childcare • Home visits • Child development phone line • Screening and surveillance • Healthy Steps written materials • Parent groups • Linkages and referrals • Reach Out and Read

  6. PATIENT SERVICES • NEW: • Selective Prevention • Postpartum depression screening • PEDS • CHDP Provider Outreach

  7. RESIDENT TRAINING • Co-management of 8-10 babies over 3 years • Joint prenatal and/or postnatal home visits • Evidence-based screening using the “Ages and Stages” questionnaires • Huggins Child Development Center training in normal development observation skills • Video-based interactive didactic training • Training tools • Reach out and Read

  8. RESIDENT TRAINING • NEW: • Follow the Resident: Healthy Steps approach with all the patients • Family Practice

  9. Assessing Outcomes • 230 families enrolled and 200 active • Enrolled at or before birth • Some have been enrolled for two years • Compared to 244 families (children of various ages 0-3) who came to clinic for well-child care but who had not been enrolled in the program

  10. Outcomes (109 families) • Safety practices • HS infants (2 months and 9 months) more likely to be placed on their back, less likely to be placed on side to sleep • HS infants less likely to be exposed to cigarette smoke • Breastfeeding • HS were more likely to have initiated breastfeeding • Duration of breastfeeding a bit longer for HS infants • Other feeding issues • HS infants less likely to be given water, juice and cereal in the first two months

  11. Outcomes • Health Care Utilization: ER visits • 2 months: 11% HS vs. 22% comparison • 9 months: 22% HS vs. 36% comparison • Mothers’ parenting behaviors • 2 months: HS mothers more frequently talk to baby while working around the house • 16 months: HS moms talking to baby more often • Fathers’ parenting behaviors • 2 months: HS fathers more frequently talk to baby while working around the house, play with baby, diaper and bathe baby • 16 months: HS dads reading to and singing to baby more often

  12. Outcomes • Mothers’ Beliefs About Discipline (Infants) • 2 months: HS mothers more likely to believe distraction is appropriate, and less likely to believe that taking a toy away is appropriate (the experts would agree!) • 9 months: HS mothers more likely to endorse distraction • Mothers’ Discipline Tactics (Toddlers) • 16 months: HS moms less frequently yell in anger, slap child’s hand, spank with hand, and spank with object

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