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Experience in Sustainability and Evolution

DISSEMINATING HEALTHY STEPS FOR YOUNG CHILDREN. Experience in Sustainability and Evolution. UIC School of Public Health Maternal and Child Health Conference May 16, 2005 MAKING CHANGE HAPPEN Michael C. Barth Anita Berry. Topics. Healthy Steps for Young Children

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Experience in Sustainability and Evolution

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  1. DISSEMINATING HEALTHY STEPS FOR YOUNG CHILDREN Experience in Sustainability and Evolution UIC School of Public Health Maternal and Child Health Conference May 16, 2005 MAKING CHANGE HAPPEN Michael C. Barth Anita Berry MCB.AB.UICMCH.4.27.05.rev

  2. Topics • Healthy Steps for Young Children • Evaluations of Healthy Steps • JAMA • American Journal Preventive Medicine • Healthy Steps in Action • Financing Healthy Steps • Healthy Steps in Chicago • Getting Started • Implementation • Next Steps MCB.AB.UIMCH.4.21.05

  3. Quality Enhancement in Pediatrics and Family Medicine for Children 0 to 3 Families • Outcomes* • Infants sleep on back • Moms openly discuss feelings of sadness • Moms use less physical punishment • Moms match behaviors to children’s development • Greater compliance with immunization schedule • Parents and physicians more satisfied with care Clinical Team + Healthy Steps Specialist (HSS) • Focuses on Behavior and Development • Nurtures Families • Provides Important Information Parents Want and Need Healthy Steps • Components: • Enhanced Well Child Care • Home Visits by HSS • Telephone Information Line • Developmental Screening • Special Printed Material • Parent Groups • Linkages to Community Resources • Reach Out and Read MCB.AB.UIMCH.4.21.05 * JAMA 12/17/03

  4. Evolution of Healthy Steps • Phase 1 – Evaluation (15 + 9 sites) • Phase 2 – Sustainability and Dissemination • 10 of 24 sustained • 9 of 24 with significant spin-off • 28 new sites • Total Current Sites: 38 • 13 in Residency Training • 16 in Planning or Discussion MCB.AB.UIMCH.4.21.05

  5. Healthy Steps for Young Children: Current Status MCB.AB.UIMCH.4.21.05

  6. Evaluations of Healthy Steps • JAMA • American Journal of Preventive Medicine MCB.AB.UIMCH.4.21.05

  7. Quality Enhancement in Pediatrics and Family Medicine for Children 0 to 3 Families • Outcomes* • Infants sleep on back • Moms openly discuss feelings of sadness • Moms use less physical punishment • Moms match behaviors to children’s development • Greater compliance with immunization schedule • Parents and physicians more satisfied with care Clinical Team + Healthy Steps Specialist (HSS) • Focuses on Behavior and Development • Nurtures Families • Provides Important Information Parents Want and Need Healthy Steps • Components: • Enhanced Well Child Care • Home Visits by HSS • Telephone Information Line • Developmental Screening • Special Printed Material • Parent Groups • Linkages to Community Resources • Reach Out and Read MCB.AB.UIMCH.4.21.05 * JAMA 12/17/03

  8. Healthy Steps IS Quality Improvement • IOM-AHRQ Dimensions of Quality • Effectiveness • Patient-Centeredness • Timeliness • Efficiency Source: Minkovitz et al (2003) “A practice-based intervention to enhance quality of care in the first three years of life: Results from The Healthy Steps for Young Children Program.” JAMA, 290, 3081-3091. MCB.AB.UIMCH.4.21.05

  9. Evaluation: American Journal of Preventive Medicine, May 2004 • Comparing prenatal Healthy Steps with Healthy Steps with Comparison Group • Mothers who received Healthy Steps prenatally or shortly after giving birth were more likely to continue breastfeeding and to read to their infants; • Mothers of infants who received Healthy Steps prenatally or shortly after giving birth were less likely to report depressive symptoms and more likely to describe themselves as pleased with their role as parents; MCB.AB.UIMCH.4.21.05 Source: B.D. Johnston, et al., “Expanding Developmental and Behavioral Services for Newborns in Primary Care.” AJPM, 26(4), May 2004.

  10. Evaluation: American Journal of Preventive Medicine, May 2004 (2) • Comparing prenatal Healthy Steps with Healthy Steps with Comparison Group • Knowledge of infant development and recognition of appropriate discipline and satisfaction with pediatric care were greater among parents who received the Healthy Steps services; and • The rate of disengagement from the HMO was 75 percent lower among families enrolled in Healthy Steps during the prenatal period. Source: B.D. Johnston, et al., “Expanding Developmental and Behavioral Services for Newborns in Primary Care.” AJPM, 26(4), May 2004. MCB.AB.UIMCH.4.21.05

  11. Healthy Steps for Young Children: Key Points • Flexible • Component selection • Intensity • Venues • Private practice • Hospital clinics and FQHCs • Residency Training • Public Health MCB.AB.UIMCH.4.21.05

  12. Healthy Steps in Action • “Marketing” Healthy Steps (Allentown, PA) • Healthy Steps and Public Health • Sarasota, FL • Stillwater, OK • DuPage County, IL • Substitution Model • Western Colorado Model • Rochester Blue See: www.healthysteps.org; click “For Medical Practices and Other Organizations” and “Healthy Steps Operating Support Materials” MCB.AB.UIMCH.4.21.05

  13. Financing Healthy Steps • Marketing • Substitution • State funds • Medicaid claiming • Medicaid grants • HHS/ACF Early Learning grants • Tobacco settlement • California First Five • Billing • “Old” CPT Codes • “New” CPT Codes MCB.AB.UIMCH.4.21.05

  14. Healthy Steps in Chicago 1997 - 2001 • Evaluation Site • Affiliate Sites • Residency Programs MCB.AB.UIMCH.4.21.05

  15. HEALTHY STEPS IN CHICAGO2000-2002 • Expanded to two additional residency pediatric residency programs at Advocate and one at UIC • Residency survey • Expanded role of Healthy Steps Specialist within residency programs at Advocate • Day Care • Public Health MCB.AB.UIMCH.4.21.05

  16. Advocate Health Care - ChicagoShift in Focus – 2003-2004 • Continue Healthy Steps training in residency programs • Increase number of primary care practices trained in Developmentally Oriented Primary Care using the Healthy Steps approach • Provide office based training for physicians and their staff • Provide technical assistance for physician offices to facilitate changes in practice MCB.AB.UIMCH.4.21.05

  17. Goals • Improve knowledge of normal child development for residents and established pediatric and family practice team • Change the manner in which health care teams interact with families of young children • Support transition of residents into developmentally oriented primary care • Provide regional training for the Chicago area and state of Illinois MCB.AB.UIMCH.4.21.05

  18. ICAAP IAFP AAP Ounce Of Prevention Fund Voices for Illinois Children Perinatal Task Force Erikson Institute MCH CISS/CAP Worksite Wellness Health Fairs National Association of Pediatric Nurse Practitioners ABCD II Other Areas of Involvement MCB.AB.UIMCH.4.21.05

  19. Enhancing Developmentally Oriented Primary Care Overall Goal • To work collaboratively to improve the delivery and financing of preventative health and developmental services in primary health care settings for Illinois children under the age of three and to align goals of physicians and parents around high quality health care. MCB.AB.UIMCH.4.21.05

  20. EDOPC Partners • Illinois Chapter American Academy of Pediatrics • Illinois Academy of Family Physicians • The Ounce of Prevention Fund • Advocate Health Care MCB.AB.UIMCH.4.21.05

  21. Areas of Focus • Federally Qualified Health Centers • Physician Practices • Pediatric and Family Practice Residency Programs • Nurse Practitioner and Physician Assistant Programs • Parents • Community Resources • Advocacy MCB.AB.UIMCH.4.21.05

  22. Methods of Intervention • Teleconferences • Office Based Training • Learning Collaboratives • Technical Assistance Center MCB.AB.UIMCH.4.21.05

  23. Assuring Better Child Development II • Work with Department of Public Aid and Ounce of Prevention Fund as well as numerous other local agencies to focus on social emotional and mental health needs of children and their families • Focus on training physicians and parent materials MCB.AB.UIMCH.4.21.05

  24. Getting Started • Commitment to increasing quality of care • Decision on Healthy Steps • Program details. Technical assistance from • Boston University School of Medicine • Advocate Health Care—Anita Berry • Healthy Steps National Program Office • Cost and workload model • Fundraising • Staffing/Training MCB.AB.UIMCH.4.21.05

  25. Healthy Steps for Young Children: Implementation • Critical operating and management factors • Bottom-up AND top-down • Scheduling • Space • “Bagels and Donuts” for administrative staff • Stability is important • Train and retrain after turnover • CHAMPION MCB.AB.UIMCH.4.21.05

  26. Next Steps • Read JAMA (12/17/03), AM J PREV MED (5/04), and PEDIATRICS (9/04) on Healthy Steps to discover how Healthy Steps components will improve your practice’s effectiveness and quality • Consider how operating as a team would enhance your practice • Query a few patients on whether they would have liked a home visit from your practice post birth • Visit www.healthysteps.org • For further discussion contact the Program Director, Mike Barth, at 703-934-3090 or mbarth@icfconsulting.com MCB.AB.UIMCH.4.21.05

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