Health Equity and Young Children: Improving Healthy Development, - PowerPoint PPT Presentation

Health Equity and Young Children: Improving Healthy Development, Closing Health Dispari6es, and Ensuring School Readiness Charles Bruner, Director Research and Evalua6on for the BUILD Ini6a6ve Child and Family Policy Center February 25, 2014

Health’s defini.on of child health Child health is … the extent to which individual children or groups of children are able or enabled to (a) develop and realize their poten;al, (b) sa;sfy their needs, and (c) develop the capaci;es that allow them to interact successfully with their biological, physical, and social environments. – Na;onal Research Council and Ins;tute of Medicine, Children’s Health, the Na1on’s Wealth. Child health is a state of physical, mental, intellectual, social and emo;onal well-being and not merely the absence of disease or infirmity. Healthy children live in families, environments, and communi;es that provide them with the opportunity to reach their fullest developmental poten;al. – World Health Organiza;on

Defini&ons of health equity Health equity is achieving the highest level of health for all people. Health equity entails focused societal efforts to address avoidable inequali9es by equalizing the condi9ons for health for all groups, especially for those who have experienced socioeconomic disadvantage or historical injus9ces. – Healthy People 2020 Of all the forms of inequality, injus9ce in health care is the most shocking and inhumane. – Mar9n Luther King We cannot allow the color of a child’s skin or the child’s zip code determine the child’s health. – Maxine Hayes

The science of healthy development and school readiness The earliest years are cri-cal to healthy development and 1. school readiness. School readiness is mul-dimensional. 2. Language and literacy • Physical health and motor development • General cogni-on • Social and emo-onal development • Approach to learning • Healthy child development is mul-dimensional. 3. Gene-c • Bio-medical • Social • Environmental • The health community has a key role to play in both, 4. par-cularly as “first responder.”

The contribu-on of different factors to children’s health • Child’s own biological factors/gene5cs (20%) • Bio-medical care and treatment of physical health condi5ons (10%) • Child’s social environment and health behaviors (50%) • Child’s physical and economic environment (20%) [70% related specifically to “social determinants of health”] Healthy People 2010, US Department of Health and Human Services, 2000

Science and the social determinants of healthy child development Social gradient • Stress • Early life • Social exclusion • Work • Unemployment • Social support • Addic1on • . Food • Transport • Social Determinants: The Solid Facts, Second Edi6on, 2003.

Defini&on of select social determinants [protec&ve factors] • The Social Gradient. Life expectancy is shorter and most diseases are more common further down the social ladder. [concrete services and supports in :mes of need] Early Life. A good start in life means suppor:ng mothers and young • children; the health impact of early development and educa:on lasts a life:me. [knowledge of healthy child development] • Stress. Stressful circumstances, making people feel worried, anxious and unable to cope, are damaging to health. [resiliency] • Social Exclusion. By causing hardship and resentment, poverty, social exclusion and discrimina:on cost lives. [posi:ve and suppor:ve ac:vi:es with children] Social Support. Friendship, good social rela:ons and strong suppor:ve • networks improve health at home, at work and in the community. [social :es] Social Determinants: The Solid Facts, Second Edi6on, 2003 .

Different literatures: Similar foci • Health Terms • Early Childhood Terms – life-course model – ecological, whole child – pa4ent-centered care – family-centered services – an4cipatory guidance – family engagement – social determinants – risk/protec4ve factors – developmental – early iden4fica4on and response screening/surveillance – domains of school readiness – child health outcomes

Unpacking health’s role in early childhood systems building Coverage Clinical Care Coordina,on Consul,ng Community Health

Concept: Models for health prac++oner roles to address health equity 1. 2. Health Prac++oner Screening & CC/HV Follow-up Ac+ons Surveillance Engaging family “Do you have ques-ons about how your Securing professional services child is learning, behaving, or developing?” Securing community supports Providing prac--oner with feedback Developmental screening tools 3. Community Resource Connec+ons Iden-fying and upda-ng resources in community Developing networks across providers and community resources Building community capacity for response Child Mental Domes-c Immunol- Home Part C Health Head Start Violence ogist Visi-ng Clinician Shelter Peer Support Parent of Church Hispanic Group for Children Parents Family Night Resource Grand- with ADHD Anony-mous Program Center parents Group

Prac%ce: Exemplary programs embodying these roles Health Leads

The fron)er in child health: Where the rubber hits the road A mother brings her one-year-old in for a check-up and it is clear that the mom is stressed, if not depressed, and shows li:le sign of responding to the child’s cues for a:en<on. While the child isn’t “diagnosable” today, if things proceed as the medical home prac<<oner expects, in two years there will be significant indicators of development delay and likely social and emo<onal problems, including a DSM-IV diagnosis. The medical home does not want to wait two years to take ac<on and the mom seems recep<ve to receiving help. At the same <me, poin<ng out problems without offering help could be considered malprac<ce.

for more informa*on … Charles Bruner, Director cbruner@cfpciowa.org Publica*ons: Ten Things Policymakers Need to Know About Health Equity and Young Children 505 5th Street, The Healthy Child Storybook Suite 404 Clinical Care and Community-Building Des Moines, IA (with Ed Schor) 50309 Medical Homes and Early Childhood Systems Building (515) 280-9027 FiFy State Chartbook on Young Children and Health Equity

BONUS SLIDES: the what of coverage (in context of medical/health homes) • Medical home defini.on: “Prac..oner/office who takes a partnership approach with families to provide care that is accessible, family-centered, coordinated, comprehensive, con@nuous , compassionate, and culturally effec.ve” • Goal for coverage – every child has a source of health coverage that provides for a medical home providing con5nuous health care over 5me

Medical homes: the what of clinical care • Clinical care defini,on: Primary, preven,ve, developmental health services ( Bright Futures) as well as responses to illness, injury, and chronic health condi,ons • Goal for clinical care – medical homes will ensure that all young children are assessed and treated to achieve child health outcome goals

Medical home responsibili1es for young child health outcomes Physical health and development No undetected hearing or vision problem • • No chronic health problems without a treatment plan • Immuniza8ons complete for age No undetected congenital anomalies • Emo1onal, social and cogni1ve development No unrecognized or untreated delays • Family’s capacity and func1oning • Parents knowledgeable about child’s physical health status and needs No unrecognized maternal depression, family violence, or family substance • use • No undetected early warning signs of child abuse or neglect

Medical homes: the what of coordina2on with other services • Coordina(on defini(on: Care coordina(on and clinical referrals to subspecialty care and community services • Goal for coordina(on – children and their families will be referred to needed services, appointments scheduled and kept, and results reported back to the medical home

Medical homes: the what of consul2ng and follow-up with other providers • Consul'ng defini'on: Integrated plans across service systems that respond to clinical treatments for the child and draw upon the clinician’s exper'se • Goal for consul'ng – clinical exper+se will guide responses to children and their families in non-health se7ngs, when children require care suppor+ng clinical care and treatment

Medical homes: the what of contribu4ng to community health • Community health defini0on: Iden0fying and responding to popula0on health concerns and advoca0ng for community ac0ons • Goal for community health – medical homes will contribute to community understanding of child health needs and par6cipate in promo6ng community health

BONUS SLIDES: Rela0ve federal resources directed to children 0-2 % of 0-2 popula0on Funding Source/Program $ (million) served Medicaid 21.4 56.0% WIC 4.9 28.5% Foster Care/Adop=on Assistance 0.5 <1% Part C of IDEA 0.6 2.8% CCDF/TANF Child Care 4.4 4.0% Early Head Start 0.8 1.0% MIECHV 0.2 <1% Source: Adapted from Urban Ins=tute Kids Share. Note: Refunded tax credits, SNAP, and other income supports provide the majority of the $66 billion (the 1.8%) directed to infants and toddlers in the federal budget.