Transcript Healthy Steps Program Outcome Assessment

Healthy Steps:
Integrating Research Into
Pediatric Practice
Kathleen D. Ramos, PhD
Rick Brandt-Kreutz, MSW, LCSW
CHCC Pediatric Resident Workshop
1 August 2006
Agenda
• Background: What is Healthy Steps?
• Results of Fresno research on the
Cadillac model of Healthy Steps
• How the Healthy Steps program at
CHC is changing
• Plans for research on the new model
• Opportunities for residents to answer
their research questions
Healthy Steps for Young Children
1994:
1995:
Today:
Commonwealth Fund and Boston
University
24 original sites
34 sites
“I think Healthy Steps can help us do better
what we already do.”
Healthy Steps Fresno and First 5
• Grant: 2003 – 2006: $453,490
• 220 kids/families
• ≈43 residents
Healthy Steps Fresno
COST?
• $933/year@162 families
• $402/year@463 families
Fresno?
• $687/year@220 families
Quality Enhancement in Pediatrics and
Family Medicine for Children 0 to 3
Families
Clinical Team
+
Healthy Steps
Specialist
Healthy
(HSS)
Components:
• Enhanced Well Child Care
• Home Visits by HSS
Steps
Outcomes*
• Infants sleep on back
• Focuses on Behavior
and Development
• Nurtures Families
• Greater compliance
with immunization
schedule
• Developmental Screening
• Special Printed Material
• Linkages to Community
Resources
• Moms use less physical
punishment
• Provides Important • Moms match behaviors
Information Parents
to children’s
development
Want and Need
• Telephone Information Line
• Parent Groups
• Moms openly discuss
feelings of sadness
THE CADILLAC MODEL
• Parents and physicians
more satisfied with care
• Reach Out and Read
* JAMA 12/17/03
• Healthy Steps
Specialist followed a
caseload of 220
patients with all the
Healthy Steps services
• Protocol of intensive
individual and family
services
• Independent AND
alongside the resident
Healthy Steps THE CADILLAC MODEL
Did it Help?
• Yes! (but only small numbers of families)
• How do we know?
Healthy Steps
• More likely to nurse beyond 12 months (33%
HS versus 9% comparison)
• Less likely to introduce water (35% vs 75%),
cereal (7% vs 34%), and other foods early
• Dads more involved in diapering (77% vs 60%)
and bathing (67% v 42%) baby
• Moms and dads read to baby more frequently
• Moms more often offer explanations to
children and less often use harsh parenting
(threaten, yell, slap, spank)
• Less likely to visit the ED (0% vs 28% of
toddlers)
The New Healthy Steps…
The Prius Model
Healthy Steps Pediatrics and Family Medicine
• Expanded to Family & Community Medicine
• Healthy Steps Institute: October 24-26
• Follow the resident and the resident’s patient
• Focus on education
• Community Expansion Support
The Prius Model
http://www.fresno.ucsf.edu/pediatrics/program_info.htm
Fresno, California
supported by a grant from First 5 Fresno
Other Questions
• Did the Cadillac Model improve motherchild attachment?
– Strange Situations being conducted this
summer
– Video clips:
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Quality of play
Secure base behavior
Self-soothing
Avoidance & Resistance
Secure behavior
Other Questions
• Do securely attached pairs show up for
more well-child checks? Get sick less?
Use clinic instead of ED?
– Adults with secure attachment styles are
more compliant patients, keep chronic
diseases under better control, and trust
their doctors more.
• Is infant sleep (particularly cosleeping
and sleep training) related to security
of attachment?
Other Questions
• Prevalence and correlates of bed-sharing
among Mexican immigrant families
– 0-5 months: 68%
– 6-12 months: 63%
– 12-14 months: 62%
• Similar to other studies, bed-sharing is more
common in father-absent homes; among young
babies, associated with breastfeeding.
• Unlike other studies, bed-sharing is
consistent across ages.
Other Questions
• What do you want to know about the
clinic patients that we might be able to
answer using this dataset?
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Feeding
Reading promotion
Father involvement
Harsh parenting
Sleep habits
Attachment