Focusing on Children's Health Community Approaches to Addressing Health Disparities: Workshop Summary (2009) / Chapter Skim
Currently Skimming:
3 Investing in Children's Health
3 Investing in Children's Health
Pages 13-26
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 13... ...
Charles Bruner of the Child and Family Policy Center presented a paper he coauthored with Edward Schor of the Commonwealth Fund entitled "Clinical Practice and Community Building: Addressing Racial Disparities in Healthy Child Development" (Bruner and Schor, 2008) (see Appendix E)
|
From page 14... ...
Four areas of preschool child health were selected for study, including tobacco exposure, obesity, unintentional injury, and mental health, in part because they were highlighted in the Healthy People 2010 and 2000 reports. The primary objective of the review, which covers literature from 1996 to 2007, is to assess both health and cost consequences in the four focus areas across the entire life span.
|
From page 15... ...
Twenty-five to 50 percent of American children are exposed to high levels of environmental tobacco, and teen smoking is a serious concern. The additional costs related to prenatal care and complications of birth that are attributable to maternal smoking amount to approximately $4 billion per year. Direct medical costs of pediatric illnesses that are related to parental smoking reach nearly $8 billion per year.
|
From page 16... ...
16 TABLE 3-1 Examples of Reviewed Interventions Intervention Levels Child Health Areas Individual Family Community/neighborhood Society/policy Tobacco Smoking cessation Smoking cessation for Bans/restrictions in Increasing the price of exposure intervention for pregnant pregnant women with workplaces and public tobacco products and women partner support; smoking enforcing age bans cessation for adults living with children Obesity Exercise program; dietary Obesity prevention Healthier food served in and physical activity; education home visits preschools reducing TV watching Unintentional Prenatal home visitation; Community education Changes in baby walker injury home visits that assess combined with giving safety standards; child risks and provide incentives for road passenger safety laws education safety; primary-care based education; smoke detector distribution Mental health Child-focused skills training; Parent- and child-interaction Preschool-based programs Employer-based work parenting skills training training programs; including academic support through programs collaborative parent tutoring and teacher extensive child care problem solving; training assistance and health supportive consultation care subsidies programs
|
From page 17... ...
. Guyer and colleagues did not find any studies that met their criteria for interventions in the preconception or pregnancy period that would address obesity during pregnancy, even though it is now known that obesity during pregnancy is associated with low birth weight and poor pregnancy outcomes.
|
From page 18... ...
Clinical Practice And Community Building: Addressing Racial Disparities In Healthy Child Development How can we make well-child pediatric practice address all of children's needs for healthy development, Bruner asked, and what specifically around clinical health care practice can be done that also leads to community building? How do we address the determinants of good health that require nonmedical interventions, such as exposure to lead paint and other toxins?
|
From page 19... ...
To the extent we can affect child health, we can also affect other outcomes. But the clinical health services community does need to change its practice to be broader and to recognize that it has a partnering role with other institutions and organizations.
|
From page 20... ...
They must focus on total healthy child development, which is not just the absence of disease. This broader approach affects clinical health outcomes, but it also affects other health and development outcomes including education, social development, and justice.
|
From page 21... ...
Italicized bullets are those outcomes to which child health care providers should contribute by educating parents, identifying potential strengths and problems and making appropriate referrals, but for which they are not independently responsible. FIGURE 3-2 Outcomes of well-child care.
|
From page 22... ...
No Six or More Vulnerability Vulnerability Factors Factors % Single Parents 20% 53% % Poor Families with Children 7% 41% % 25+ No HS Completion 13% 48% % 25+ BA or Higher 27% 7% % HoH on Public Assistance 5% 25% % HoH with Wage Income 81% 69% % HoH with Savings, Dividend Income 42% 11% % Owner-Occupied Housing 71% 29% % 18+ Limited English 2% 18% % 16-19 not School/Work 3% 15% FIGURE 3-3 Child-raising vulnerability factors, 2000 Census data. NOTE: BA = bachelor degree; HoH = head of household; HS = high school.
|
From page 23... ...
But data from the model program shows that about one quarter of the issues identified for referral relate to parenting stress, lack of knowledge about child development, challenging child behaviors, and discipline issues around which parents feel a lack of control. Correspondingly, about one quarter of their referrals and actual scheduling of appointments relate to community-based parent support groups, church-related activities, community-based parenting education classes, and interventions that reduce the isolation and separation that parents often experience.
|
From page 24... ...
• identify and update resources for care coordination • investigate and follow-up with care coordinator for specific families • develop networks across providers and community resources Child Parenting Domestic Home Head Part C Mental Educa- Violence Visiting Start Health tion Shelter Peer Parent of Church Support Children Hispanic Parents Family Group for with Resource Anony Night Grand- ADHD Center mous Program parents Group Hartford, Connecticut. FIGURE 3-5 A model for clinical practice: Help Me Grow inFigure 3-5.eps SOURCE: Bruner and Schor, 2008.
|
From page 25... ...
We need to know what preventive strategies work, Bruner said, for example what obesity prevention approaches are effective in the early years, or what types of practices can further reduce tobacco exposure through anticipatory guidance. The current research base on preventive primary pediatric practice is quite limited compared to the available research base on other clinical practices.
|
From page 26... ...
2008. Clinical practice and community building: Addressing racial disparities in healthy child development.
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.