Healthy Steps: Integrating Research Into Pediatric Practice

1. Healthy Steps:Integrating Research Into Pediatric Practice Kathleen D. Ramos, PhD Rick Brandt-Kreutz, MSW, LCSW CHCC Pediatric Resident Workshop 1 August 2006

2. 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

3. Healthy Steps for Young Children 1994: Commonwealth Fund and Boston University 1995: 24 original sites Today: 34 sites

5. “I think Healthy Steps can help us do better what we already do.”

6. Healthy Steps Fresno and First 5 • Grant: 2003 – 2006: $453,490 • 220 kids/families • ≈43 residents

7. Healthy Steps FresnoCOST? • $933/year@162 families • $402/year@463 families Fresno? • $687/year@220 families

8. Healthy Steps Quality Enhancement in Pediatrics and Family Medicine for Children 0 to 3 Families Clinical Team + Healthy Steps Specialist (HSS) • Outcomes* • Infants sleep on back • Moms openly discuss feelings of sadness • Moms use less physical punishment • Moms match behaviors to children’s development • Greater compliance with immunization schedule • Parents and physicians more satisfied with care • Focuses on Behavior and Development • Nurtures Families • Provides Important Information Parents Want and Need • Components: • Enhanced Well Child Care • Home Visits by HSS • Telephone Information Line • Developmental Screening • Special Printed Material • Parent Groups • Linkages to Community Resources • Reach Out and Read THE CADILLAC MODEL * JAMA 12/17/03

9. Healthy Steps • 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 THE CADILLAC MODEL

10. Did it Help? • Yes! (but only small numbers of families) • How do we know?

11. 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)

12. The New Healthy Steps… The Prius Model

13. 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

14. http://www.fresno.ucsf.edu/pediatrics/program_info.htm Fresno, California supported by a grant from First 5 Fresno

15. Other Questions • Did the Cadillac Model improve mother-child attachment? • Strange Situations being conducted this summer • Video clips: • Quality of play • Secure base behavior • Self-soothing • Avoidance & Resistance • Secure behavior

16. 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?

17. 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.

18. Other Questions • What do you want to know about the clinic patients that we might be able to answer using this dataset? • Feeding • Reading promotion • Father involvement • Harsh parenting • Sleep habits • Attachment