Role of the Life Course Framework for Improving Services to Children with Special Health Needs

1. Role of the Life Course Framework for Improving Services to Children with Special Health Needs Amy Fine Center for the Study of Social Policy APHA – San Francisco, CA October 31, 2012

2. Presenter Disclosures Amy Fine No relationships to disclose (1) The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months:

3. Overview • Key life course concepts & implications for CSHCN • Applying life course concepts • CSSP’s project on life course and CSHCN, funded by the Lucile Packard Foundation for Children’s Health A. Fine-CSSP

4. Key Life Course Concepts –T2E2 • Timeline – Today’s experiences and exposures influence tomorrow’s health • Timing – Health trajectories are particularly affected during critical or sensitive periods of development • Environment – The broader community environment –biologic, physical, and social – strongly affects the capacity to be healthy • Equity –Inequality in health across populations reflects more than genetics and personal choice A. Fine –CSSP

5. Life Course and Public Health • LC grounded in public health • Key Qs • Why do health outcomes vary across population groups? • How do we optimize health across populations? A. Fine-CSSP

6. What’s New? New science helps explain how social environment embeds in our bodies, and interaction of genes and environment Timeline adds new(ish) dimension to traditional public health concerns A. Fine-CSSP

7. LC Integrates New Science with Longstanding Public Health/Population Health Concerns Public Health Concerns: social determinants, equity, built environment, workplace and environmental exposures + New Science: epigenetics, early programming, impact of stress on health, neuro-plasticity A. Fine-CSSP

8. Implications LC suggests the need to refocus both clinical and populationhealth • Place greater emphasis on multiple determinants of health • Incorporate earlier detection of risks as well as early and timely interventions • Promote factors that protect against disease and disability and reduce factors that place children at increased risk of poor health and development; • Shift from discrete and episodic services to developing integrated, multi-sector service systems that build health across the lifespan • Complement the dominant medical approach that focuses on individual diseases, conditions or body systems, with a whole-person, whole-family, whole-community systems approach A. Fine-CSSP

9. MCH Life Course & CSHCN • Is LC theory too deterministic? • What about kids who are born with complex medical needs or who already have chronic health conditions? • How does LC theory speak to the needs and trajectories of CSHCN? A. Fine-CSSP

10. MCH Life Course & CSHCN • “The development of health over a lifetime is an interactive process, combining genes, environments and behaviors.” • “Throughout life and at all stages, even for those whose trajectories seem limited, risk factors can be reduced and protective factors enhanced, to improve current and subsequent health and well-being.” • Life course concepts of equity and optimizing health across all populations important for CSHCN A. Fine-CSSP

11. Applying LC – Action to Date • Focus on optimizing health/ healthy development in general, or on specific health conditions – obesity, low birth weight and infant mortality • LC implementation largely targeted to prevention at community or population level, addressing social/environmental causes of chronic health conditions • Examples • Building Blocks Collaborative – Alameda County Health Department • Best Babies Zone Project – U.C. Berkeley + 4 Sites • Healthy Eating/Physical Activity Initiative – Nemours A. Fine-CSSP

12. Applying LC – What’s Needed? • More on implications & potential applications for special needs children • More attention to how can LC best be applied to health care delivery system at practice level, especially for children at high risk for diminished or diminishing functioning • Strategies for bridging practice & community level LC approaches to improve health A. Fine-CSSP

13. Applying LC – What’s Needed? • As LC theory and practice become more prominent, need to assure that CSHCN and their families can both inform and benefit from this new science and its related applications • With health systems redesign underway nationwide, it especially important that LC implementation include a focus on CSHCN, for whom the benefits of a life course approach may be greatest A. Fine-CSSP

14. Project Focus: Key Qs • How can LC be incorporated into pediatric health care for CSHCN and their families? • What would this “look” like from the perspective of providers and families? • What policy supports would be needed? • How can LC be applied to community systems of care for CSHCN and how might health care providers best interface with these systems? • How can the life experiences of CSHCN be better integrated into LC science and theory as they continue to evolve? A. Fine-CSSP

15. Timeline &Methods • Timeline • July 2012-November 2013 • Methods • Literature review (CAHMI/OHSU) • Key informant interviews • Interviews discussion groups with CSHCN families • Call for nominations to identify exemplary pediatric health care practices and programs • Interviews with exemplary practices and programs A. Fine-CSSP

16. Initial Frameworks T2E2+LC Implications Frame • ↑ emphasis on multiple determinants of health • ↑ early detection of risks & timely interventions • ↑ protective/”promotive” factors ↓risk factors • ↓ discrete & episodic services; ↑ integrated, multi-sector service systems that build health across the lifespan • ↑ whole-person, whole-family, whole-community systems approach (to complement dominant medical approach focused on individual diseases, conditions or body systems) A. Fine-CSSP

17. Products • Summary of key LC/ CSHCN literature • Findings from interviews and discussion groups • Succinct set of practice & policy recommendations • Incorporating LC theory into pediatric practice and systems of care for CSHCN • Incorporating needs and experiences of CSHCN into LC science, theory, practice, and systems of care • Final monograph/issue brief with key findings and recommendations A. Fine-CSSP

18. Thank you… Comments? Questions? Recommendations? All Welcome! Amy Fine Center for the Study of Social Policy afinehome@gmail.com A. Fine-CSSP