barth.berry.workshop

MCB.AB.UICMCH.4.27.05.rev 1

Experience in Sustainability and Evolution

DISSEMINATING HEALTHY STEPS FOR YOUNG CHILDREN

UIC School of Public HealthMaternal and Child Health

ConferenceMay 16, 2005

MAKING CHANGE HAPPEN

Michael C. Barth Anita Berry

MCB.AB.UIMCH.4.21.05 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


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

Healthy Steps

FamiliesClinical Team

+Healthy Steps

Specialist (HSS)

* JAMA 12/17/03

• Focuses on Behavior and Development

• Nurtures Families

• Provides Important Information Parents Want and Need

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

Quality Enhancement in Pediatrics and Family Medicine for Children 0 to 3


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


Healthy Steps for Young Children: Current Status


Evaluations of Healthy Steps

• JAMA• American Journal of Preventive Medicine


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

Healthy Steps

FamiliesClinical Team

+Healthy Steps

Specialist (HSS)

* JAMA 12/17/03

• Focuses on Behavior and Development

• Nurtures Families

• Provides Important Information Parents Want and Need

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

Quality Enhancement in Pediatrics and Family Medicine for Children 0 to 3


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.


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;

Source: B.D. Johnston, et al., “Expanding Developmental and Behavioral Services for Newborns in Primary Care.” AJPM, 26(4),

May 2004.


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.


Healthy Steps for Young Children: Key Points

• Flexible Component selection Intensity

• Venues Private practice Hospital clinics and FQHCs Residency Training Public Health


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 BlueSee: www.healthysteps.org; click “For Medical Practices and Other Organizations” and “Healthy Steps Operating Support Materials”


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


Healthy Steps in Chicago 1997 - 2001

Evaluation Site

Affiliate Sites

Residency Programs


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


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


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


Other Areas of Involvement

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


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.


EDOPC Partners

Illinois Chapter American Academy of Pediatrics

Illinois Academy of Family Physicians

The Ounce of Prevention Fund

Advocate Health Care


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


Methods of Intervention

Teleconferences

Office Based Training

Learning Collaboratives

Technical Assistance Center


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


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


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


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 [email protected]

Documents

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