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
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