Veronica Ybarra-Tamayo, HSSKathleen Ramos, Ph.D.

Rick Brandt-Kreutz, LCSW

First 5 Fresno Commission Presentation

April 5, 2006

Healthy Steps Fresno:Partners in Developing Healthy

Children

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

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

PATIENT SERVICES

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

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

RESIDENT TRAINING

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