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

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

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

PATIENT SERVICES

• 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 • Plus: – Prenatal home visits – Community leadership and training

PATIENT SERVICES NEW:

•Selective Prevention •Postpartum depression screening •PEDS •CHDP Provider Outreach

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

RESIDENT TRAINING NEW:

•Follow the Resident: Healthy Steps approach with all the patients •Family Practice

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

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

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

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