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Center for Healthier Children, Families & Communities Life Course Health Development: A Transformative Framework To Improve Childrens Health Neal Halfon,

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Presentation on theme: "Center for Healthier Children, Families & Communities Life Course Health Development: A Transformative Framework To Improve Childrens Health Neal Halfon,"— Presentation transcript:

1 Center for Healthier Children, Families & Communities Life Course Health Development: A Transformative Framework To Improve Childrens Health Neal Halfon, MD, MPH UCLA Schools of Public Health, Medicine, Public Affairs UCLA Center for Healthier Children, Families and Communities National Center for Infancy & Early Childhood Health Policy MCHB-AIM Child & Adolescent Policy Support Center CityMatCH 08, Albuquerque September 21, 2008

2 Center for Healthier Children, Families & Communities Goals of this Presentation To review the evidence, importance and potential impact of the developmental origins of health and disease To review the evidence, importance and potential impact of the developmental origins of health and disease To consider the strategic role that the emerging Life Course Health Development approach can play in To consider the strategic role that the emerging Life Course Health Development approach can play in Advancing a progression Health Policy Agenda Advancing a progression Health Policy Agenda Enabling significant Health Systems Reform in the US Enabling significant Health Systems Reform in the US

3 Center for Healthier Children, Families & Communities Take home Points: Power of LCHD Life Course Health Development (LCHD) is different than a life course approach LCHD –integrating framework Connecting the disparate parts of MCH Connecting MCH to rest of health and human development Leverages MCH and Positions and Prioritizes MCH policy Provides a new Operating Logic for Transforming the Health System Powerful analytic model for solving MCH problems

4 Center for Healthier Children, Families & Communities From Lifespan to LCHD Lifespan models – connect the dots- linking early life to later life Lifespan models – connect the dots- linking early life to later life Life stage models – periods of psychological development Life stage models – periods of psychological development Life-course models – are concerned with patterns and pathways that connect the dots between early and later life Life-course models – are concerned with patterns and pathways that connect the dots between early and later life Life Course Health Development models- Life Course Health Development models- Connect the dots Connect the dots Describe the pathways or heath trajectories Describe the pathways or heath trajectories Address the mechanisms that determine or influence health trajectories Address the mechanisms that determine or influence health trajectories

5 Center for Healthier Children, Families & Communities Reasons to link Health and Human Development across the life span 1. Health policy needs to better reflect our knowledge of what influences health development across the life course 2. The converging goals of medicine and public health requires a framework that can integrate personal and population health production models 3. The dynamics of health production need to be understood in era of genomics driven medicine 4. The developmental origins of disparities need to be better understood

6 Center for Healthier Children, Families & Communities

7 Center for Healthier Children, Families & Communities LCHD Where We Have Been

8 Center for Healthier Children, Families & Communities Figure 22. Life expectancy at birth and at 65 years of age by sex: United States, NOTE: See Data Table for data points graphed and additional notes. SOURCE: Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System. Life Expectancy at birth Life expectancy at 65 years Year Males Females Males Centers for Disease Control and Prevention, National Center for Health Statistics. Health, United States, Life expectancy in years

9 Center for Healthier Children, Families & Communities Health / functional Status 0 years20 years80 years Life Span Performance Span Health Span

10 Center for Healthier Children, Families & Communities Social/Nutritional/Epidemiological/ Developmental Shift Social Conditions dramatically changes over this time period Social Conditions dramatically changes over this time period Nature, Array, and Prevalence of Risk, Protective and Health Promoting factors Nature, Array, and Prevalence of Risk, Protective and Health Promoting factors Nutritional Conditions change- high sugar, high fat diets Nutritional Conditions change- high sugar, high fat diets Types, prevalence, distribution of acute and chronic disease changes dramatically Types, prevalence, distribution of acute and chronic disease changes dramatically Developmental expectancies change Developmental expectancies change Capacity of Medical Care to intervene, modify risk and treat disease Capacity of Medical Care to intervene, modify risk and treat disease

11 Center for Healthier Children, Families & Communities The Evolving Health Care System The First Era (Yesterday) The Second Era (Today) The Third Era (Tomorrow) Focused on acute and infectious disease Focused on acute and infectious disease Germ Theory Germ Theory Medical Care Medical Care Insurance-based financing Insurance-based financing Reducing Deaths Reducing Deaths Increasing focus on chronic disease Increasing focus on chronic disease Multiple Risk Factors Multiple Risk Factors Chronic Disease Mgmt & Prevention Chronic Disease Mgmt & Prevention Pre-paid benefits Pre-paid benefits Prolonging Disability free Life Prolonging Disability free Life Increasing focus on achieving optimal health status Increasing focus on achieving optimal health status Complex Causal Pathways Complex Causal Pathways Investing in population-based prevention Investing in population-based prevention Producing Optimal Health for All Producing Optimal Health for All Health System 1.0 Health System 2.0 Health System 3.0

12 Center for Healthier Children, Families & Communities 2004 National Research Council and Institute of Medicine Report

13 Center for Healthier Children, Families & Communities IOM/NRC Definition of Childrens Health (2004) Childrens health is the extent to which individual children or groups of children are able or enabled to (a) develop and realize their potential, (b) satisfy their needs, and (c) develop the capacities that allow them to interact successfully with their biological, physical, and social environments. From Childrens Health, the Nations Wealth, National Academies Press, 2004.

14 Center for Healthier Children, Families & Communities LCHD Defines Health as a developmental process Defines Health as a developmental process Builds upon Ecological and Transactional models of Life Span Development Builds upon Ecological and Transactional models of Life Span Development Utilizes a rapidly Expanding Evidence Base Utilizes a rapidly Expanding Evidence Base Life Course Chronic Disease Epidemiology Life Course Chronic Disease Epidemiology Neurobiology Neurobiology Early Intervention Research Early Intervention Research Economics of Human Capital Formation Economics of Human Capital Formation Gene-Environment/ Social Epidemiology Gene-Environment/ Social Epidemiology

15 Center for Healthier Children, Families & Communities Health as a Developmental Process Health is a developmental process Health is a developmental process Health develops across the life course Health develops across the life course Health development can be represented by health trajectories Health development can be represented by health trajectories Critical/ Sensitive periods Critical/ Sensitive periods Gene - Environment – Interaction have different impacts during different periods Gene - Environment – Interaction have different impacts during different periods Macro and Micro pathways delineate how toxic environments and risky families get under the skin Macro and Micro pathways delineate how toxic environments and risky families get under the skin

16 How Risk Reduction and Health Promotion Strategies influence Health Development FIGURE 4: This figure illustrates how risk reduction strategies can mitigate the influence of risk factors on the developmental trajectory, and how health promotion strategies can simultaneously support and optimize the developmental trajectory. In the absence of effective risk reduction and health promotion, the developmental trajectory will be sub-optimal (dotted curve). From: Halfon, N., M. Inkelas, and M. Hochstein The Health Development Organization: An Organizational Approach to Achieving Child Health Development. The Milbank Quarterly 78(3): Trajectory Without RR and HP Strategies 020 Health Development Age (Years) HP RR Risk Reduction Strategies Health Promotion Strategies Optimal Trajectory Protective Factors HP RR Risk Factors

17 Center for Healthier Children, Families & Communities Fig. From: Lamberts SWJ, van den Beld AW, van der lely A. The endocrinology of aging. Science. 1997;278:

18 Center for Healthier Children, Families & Communities From: Kuh D, Ben-Shlomo Y. A life course approach to chronic disease epidemiology. New York: Oxford University Press

19 Center for Healthier Children, Families & Communities Birth Early Infancy Late Infancy Early Toddler Late Toddler Early Preschool Late Preschool Age 6 mo 12 mo 18 mo 24 mo 3 yrs 5 yrs Ready to learn Strategies to Improve Health Development Trajectories At Risk Trajectory Delayed/Disordered Trajectory Healthy Trajectory Back to Overall Model Parent education Emotional Health Literacy Reading to child Pre-school Appropriate Discipline Poverty Lack of health services Family Discord Graphic Concept Adapted form Neal Halfon, UCLA Health Services

20 Center for Healthier Children, Families & Communities Risk and protective factors Risk Factors Child Family Community School Protective Factors Child Family Community School Outcome Negative vulnerability Positive resilience

21 Center for Healthier Children, Families & Communities LCHD Connecting the Dots

22 Center for Healthier Children, Families & Communities Adverse childhood events and adult depression Odds Ratio Adverse Events Chapman et al, 2004

23 Center for Healthier Children, Families & Communities Adverse childhood events and adult ischemic heart disease Dong et al, 2004 Adverse Events Odds Ratio

24 Center for Healthier Children, Families & Communities Adverse childhood events and adult substance abuse % Self-Report: Alcoholism Self-Report: Illicit Drug Use Dube et al, 2002 Dube et al, 2005 %

25 Center for Healthier Children, Families & Communities LCHD Actionable Mechanisms for Intervention

26 Center for Healthier Children, Families & Communities Cumulative, Programming and Pathway Mechanisms Influence LCHD Three basic mechanisms influence LCHD Three basic mechanisms influence LCHD Cumulative - additive effect of multiple risks and protective factors, weathering Cumulative - additive effect of multiple risks and protective factors, weathering Programming - time specific influence of stimulus or insult during a critical or sensitive period on selection, adaptation, compensatory processes Programming - time specific influence of stimulus or insult during a critical or sensitive period on selection, adaptation, compensatory processes Pathways-chains of (eco-culturally constructed) linked exposures that create a constrained conduit of gene- environment transactions Pathways-chains of (eco-culturally constructed) linked exposures that create a constrained conduit of gene- environment transactions

27 Center for Healthier Children, Families & Communities Cumulative SES (birth - 33 yrs) poor health, age 33 % fair/poor health Lifetime SES score bestworst Source: Power et al, 1999

28 Center for Healthier Children, Families & Communities LCHDProgramming

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31 Center for Healthier Children, Families & Communities Life Course Chronic Disease Epidemiology: Barker Hypothesis Affiliation: MRC Environmental epidemiology unit in South Hampton Affiliation: MRC Environmental epidemiology unit in South Hampton Design: Historical Cohort Design: Historical Cohort Key Finding: Fetal growth and development, and other factors, in first year(s) of life related to cardiovascular and other chronic disease in the fifth and sixth decade Key Finding: Fetal growth and development, and other factors, in first year(s) of life related to cardiovascular and other chronic disease in the fifth and sixth decade

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35 Center for Healthier Children, Families & Communities Barker Hypothesis Birth Weight and Coronary Heart Disease Age Adjusted Relative Risk Rich-Edwards 1997

36 Center for Healthier Children, Families & Communities Birthweight and CVD Outcomes Nurses Health Study Curhan et al., Rich-Edwards et al.

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38 Center for Healthier Children, Families & Communities Smoking During Pregnancy & Offspring Obesity Pooled AOR 1.46 (1.33, 1.59) Oken et al., unpublished

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40 Center for Healthier Children, Families & Communities Odds ratio of obesity: breast versus formula fed 0.87 (95% CI 0.85, 0.89) Owen et al, Pediatrics, 2005 ( From Gilman)

41 Center for Healthier Children, Families & Communities LCHD Programming leads to Latent Effects Long time horizons between exposure and outcomes

42 Center for Healthier Children, Families & Communities Cumulative, Programming and Pathway Mechanisms Influence LCHD Three basic mechanisms influence LCHD Three basic mechanisms influence LCHD Cumulative - additive effect of multiple risks and protective factors, weathering Cumulative - additive effect of multiple risks and protective factors, weathering Programming - time specific influence of stimulus or insult during a critical or sensitive period on selection, adaptation, compensatory processes Programming - time specific influence of stimulus or insult during a critical or sensitive period on selection, adaptation, compensatory processes Pathways- chains of (eco-culturally constructed) linked exposures that create a constrained conduit of gene- environment transactions Pathways- chains of (eco-culturally constructed) linked exposures that create a constrained conduit of gene- environment transactions

43 Center for Healthier Children, Families & Communities Poverty & ECD Parent Distress Parent Behavior Parent Investment Child Cognitive Developmen t Child Physical Developmen t Child Social- Emotional Developmen t Parent- and Family- Level Predictors of Income And Hardship Parent Work Status Job Prestige Education Level Parent Marital Status Race-Ethnicity Neighborhood- and Community-Level Influences Family Income Poverty Financia l Hardshi p

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47 Center for Healthier Children, Families & Communities LCHD: Childhood Antecedents of later Childhood and Adult Health From Starfield 02/03 Source: van de Mheen et al, IJE 1998 Early social and material deprivation (financial, educational, environmental) Prior poor health, fetal nutrition, case-mix Immunologic & physiologic moderators Prior adverse behavior Prior poor physical activity Current poor health/ premature mortality Current poor physical activity Current adverse behavior Current social and material deprivation

48 Center for Healthier Children, Families & Communities LCHD: New Approaches to Old Problems

49 Center for Healthier Children, Families & Communities How are LCHD concepts being used Health System Reform (US) Health System Reform (US) Adays Reinventing Public Health Adays Reinventing Public Health Breslows 3 rd Era of Health and Health Care Breslows 3 rd Era of Health and Health Care Snydermans Future Medical/Health System analysis Snydermans Future Medical/Health System analysis Health System Reform ( Intl) Health System Reform ( Intl) UK – Acheson Report, Sure Start, Health Development Agency UK – Acheson Report, Sure Start, Health Development Agency Canada –CIAR, Major Measurement Strategy focused on curve shifting across the life course Canada –CIAR, Major Measurement Strategy focused on curve shifting across the life course WHO- ECD initiative, Commission on Social Determinants of Health WHO- ECD initiative, Commission on Social Determinants of Health

50 Center for Healthier Children, Families & Communities Disease Progression SymptomsCost Years = current practice 2 = current capability 3 = future capability Source: Snyderman R. AAP presidential address: the AAP and the transformation of medicine. Journal of Clinical Investigation. 2004;114(8): (suppl)

51 Center for Healthier Children, Families & Communities Paradigm Shift Traditional medical evaluation and record Prospective evaluation and record Chief complaint History of illness Past medical history Family history Social history Physical exam Diagnostic tests Assessment and plan Health profile summary Current (immediate) Health Status Health risk analysis – Genetic – Environmental – Lifestyle 1-year health plan 5-year health plan Requires: Life Span Health Risk assessments Early detection Means for prevention/early intervention Individual health plan Effective Life course health delivery system Effective reimbursement Source: Snyderman R. AAP presidential address: the AAP and the transformation of medicine. Journal of Clinical Investigation. 2004;114(8): (suppl)

52 Center for Healthier Children, Families & Communities Risk Assessment for Prospective Health Source: Snyderman R. AAP presidential address: the AAP and the transformation of medicine. Journal of Clinical Investigation. 2004;114(8): (suppl) SymptomsCost Years Risk assessment decision support Low riskHigh risk Early chronic Late chronic Health Promoting PlanRisk modificationDisease management Personalized health plan Wellness education and Internet and health provider guided planning for all Individual-focused; integrated provider systems. Focus on quality of life and palliation at appropriate late stages

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54 Center for Healthier Children, Families & Communities LCHD and Birth Outcomes Pregnancy White African American Reproductive Potential Age

55 Center for Healthier Children, Families & Communities LCHD and Birth Outcomes Pregnancy White African American Reproductive Potential Age

56 Center for Healthier Children, Families & Communities Life Course Health Development Poor Nutrition Stress Abuse Tobacco, Alcohol, Drugs Poverty Lack of Access to Health Care Exposure to Toxins Poor Birth Outcome 05 Puberty Pregnancy Age White African American

57 Center for Healthier Children, Families & Communities LCHD: AA – White Birth outcomes Prenatal Care Poor Birth Outcome 05 Pregnancy Puberty Internatal Care Primary Care for Women Early Intervention Prenatal Care Primary Care for Children Age White African American

58 Center for Healthier Children, Families & Communities LCHD Framework: Service Delivery System Applications Health Services Moving from health maintenance to health development organizations Moving from health maintenance to health development organizations Integration strategies for newly engineered health systems Integration strategies for newly engineered health systems Vertical – Primary, Secondary, Tertiary Vertical – Primary, Secondary, Tertiary Horizontal – Biological, Behavioral, Social, Env. Horizontal – Biological, Behavioral, Social, Env. Longitudinal – Life-course/Lifespan Longitudinal – Life-course/Lifespan

59 Center for Healthier Children, Families & Communities Source: Wise PH. The transformation of child health in the United States. Health Affairs. 23, No. 5 (2004): 9-25.

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61 Center for Healthier Children, Families & Communities Changing Pattern of Childhood Morbidity Increase in chronic health problems (10-14%) Increase in chronic health problems (10-14%) Greater recognition of mental health problems (15-20%) Greater recognition of mental health problems (15-20%) Greater appreciation of role and impact of developmental health problems – learning, language (10-17%) Greater appreciation of role and impact of developmental health problems – learning, language (10-17%)

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63 Center for Healthier Children, Families & Communities Children & Youth at Risk 4-6% Severe Disabilities 12-16% Special Health Care Needs 30-40% Behavioral, Mental Health Learning Problems 50-60% Good Enough What % are thriving ? 30% ? 40% ? 50% ?

64 Center for Healthier Children, Families & Communities How well is the 2.0 Child Health System Performing?

65 Center for Healthier Children, Families & Communities The existing child health service system Demand greater than services available Demand greater than services available Families have complex needs - often beyond capability of any single service Families have complex needs - often beyond capability of any single service Difficulty accessing services Difficulty accessing services Socio-economic gradient of access Socio-economic gradient of access Focus on treatment rather than prevention/early intervention Focus on treatment rather than prevention/early intervention Episodic contact Episodic contact Poor quality of Well Child Care Poor quality of Well Child Care

66 Center for Healthier Children, Families & Communities The existing child health service system Fragmented service delivery Fragmented service delivery Different sectors (health, public health, population health, civic) Different sectors (health, public health, population health, civic) Different funding streams Different funding streams Different cultures Different cultures Lack of co-ordination Lack of co-ordination Narrow programmatic criteria for eligibility Narrow programmatic criteria for eligibility Variable understanding of child health issues Variable understanding of child health issues Local community generally has limited accountability or responsibility Local community generally has limited accountability or responsibility

67 Center for Healthier Children, Families & Communities How do we get the health system that children need? Incremental vs. Transformational Reforms

68 Center for Healthier Children, Families & Communities Transforming the Child Health System: New Paradigm vs. Old System Child health system was designed for the first era of health care ( acute, infectious disease model) Child health system was designed for the first era of health care ( acute, infectious disease model) It was upgraded a bit for the 2 nd era, with more regionalization, chronic disease care It was upgraded a bit for the 2 nd era, with more regionalization, chronic disease care Ill equipped for this new era Ill equipped for this new era Under-performing Under-performing Facing many new challenges Facing many new challenges

69 Center for Healthier Children, Families & Communities Child Health 3.0 : the New & Improved approach Integrated and comprehensive approach - broadbanding of services to achieve curve shifting outcomes Integrated and comprehensive approach - broadbanding of services to achieve curve shifting outcomes Greater flexibility of services and improved coordination at local community level Greater flexibility of services and improved coordination at local community level Increased community and consumer participation Increased community and consumer participation Prevention, health promotion, early intervention, developmental optimization focus Prevention, health promotion, early intervention, developmental optimization focus Focus on outcomes through improved systems performance Focus on outcomes through improved systems performance Innovative funding and accountability arrangements Innovative funding and accountability arrangements

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71 Center for Healthier Children, Families & Communities Transformation Framework Components Current System 2.0 Transformed System 3.0 Change Strategies Logic Organization of Health Producing Sectors Organization & Delivery of Individual Care Medical Education & Workforce Market Funding Planning Regulation & Governance Performance Monitoring

72 Center for Healthier Children, Families & Communities Transformation Framework Components Current System 2.0 Transformed System 3.0 Change Strategies Logic ID and Tx Disease Episode LCHD-optimizing health trajectories Build LCHD prevention, promotion into the DNA of the System Organization of Health Producing Sectors Silos, Medical Care Dominates Integrated, Organization & Delivery of Individual Care Vertically Integrated, 1°, 2°, 3° care Vertically, Horizontally, and Longitudinal Integ. Market Embedded, Competition on Value Funding Pay for illness care Invest in health capital Performance Monitoring Individual quality, Systems Performance Measures- ind, pop, community

73 Center for Healthier Children, Families & Communities TargetedInterventions NUMBER OF CHILDREN FUNCTION Median High income Low income VULNERABLE Universal Curve Shift DISABLED Clinical/Individual Interventions

74 Center for Healthier Children, Families & Communities NUMBER OF CHILDREN FUNCTION VULNERABLE Median High income Low income Universal Curve Shift

75 Center for Healthier Children, Families & Communities CHILD FAMILY NEIGHBORHOOD SERVICES COMMUNITY POLICY Includes: Physicians, dentists Schools Child Care Child HealthFamily Support Education Clinical/Individual Targeted Universal Civic Society

76 Center for Healthier Children, Families & Communities Pediatric Office 2.0 Developmental Services Home-visiting network Early Intervention Child Care Resource & Referral Agency Early HeadStart & HeadStart Early Child Mental Health Services Preventive Care Acute Care Chronic Care Developmental Services Parenting Support Lactation Support

77 Center for Healthier Children, Families & Communities 18 month visit Pediatric Care 2.0 Pediatric Care 2.0 C.D – Disability C.D – Disability Screen 4-6 % w/ disability Screen 4-6 % w/ disability Screening tools & Pathway Screening tools & Pathway Pediatric Office connected to Regional Center Pediatric Office connected to Regional Center Pediatric Care 3.0 Optimize Developmental Health I.D 30-40% developmental risk Screening tools & Pathway Pediatric Office connected: Child care Many other programs Coordination Regional center ++

78 Center for Healthier Children, Families & Communities Preventive Care Acute Care Chronic Care Developmental Services DS Community Services Pathway Screening Pediatric Services Sector Surveillance Community Services and Resource Sector Assessment Peds/HPlan/ PHSector Evaluation (IDEA Sector Child Care/Family Resource Center Mid-Level Assessment Center Surveillance Program IDEA Regional Center for Developmental Disabilities Other Specialized Services COORDINATIONCENTER

79 Center for Healthier Children, Families & Communities 01357Years Trajectory Optimizing Service Linkage Pathway NHVFRC PED RORFRC PED SRFRC PED Tutor FRC PED Pediatric Continuity Network Connections Development Optimal Health Development Lower Health Development Trajectory

80 Center for Healthier Children, Families & Communities Optimizing Trajectories: Multisector Multilevel Strategies Health Development Age (Years) Social Welfare Familysupport Education Health Family Neighborhood Services Community Policy Child

81 Center for Healthier Children, Families & Communities Early Childhood System Building Blocks Family Support Services Child Health Services Desired Outcomes at School Entry Family Capacity and Function Emotional / Social / Cognitive Development Physical Health & Development Trajectory of Child Development and Family Function Birth Early Infancy Late Infancy Early Toddler Late Toddler Early Preschool Late Preschool Age 6 mo 12 mo 18 mo 24 mo 3 yrs 5 yrs Ready to learn At Risk Trajectory Delayed/Disordered Trajectory Healthy Trajectory A. Early Care and Education Programs B. C.

82 Center for Healthier Children, Families & Communities Early Childhood System 2.0: Building Blocks Universal Discretionary Categorical / Intensive Care Coordination Medical Home Child Health Services Developmental Services Medical Services Home Visiting Prt C (B-to-3) \CYSHCN Spec Ed Desired Outcomes at School Entry Family Capacity and Function Emotional / Social / Cognitive Development Physical Health & Development Birth Early Infancy Late Infancy Early Toddler Late Toddler Early Preschool Late Preschool Age 6 mo 12 mo 18 mo 24 mo 3 yrs 5 yrs Ready to learn At Risk Trajectory Delayed/Disordered Trajectory Healthy Trajectory A. B. C. Universal Preschool Head Start & Family Literacy Early HS Early Care & Education Family Support Services Family Resource Centers

83 Center for Healthier Children, Families & Communities Child Health Services Building Blocks Family Support Services Child Health Services Desired Outcomes at School Entry Family Capacity and Function Emotional / Social / Cognitive Development Physical Health & Development Early Care and Education Programs.

84 Center for Healthier Children, Families & Communities Child Health Services Building Blocks Family Support Services Child Health Services Desired Outcomes at School Entry Family Capacity and Function Emotional / Social / Cognitive Development Physical Health & Development Early Care and Education Programs.

85 Center for Healthier Children, Families & Communities Early Childhood System 3.0 Desired Outcomes at School Entry Family Capacity and Function Emotional / Social / Cognitive Development Physical Health & Development. Surveillance Assessment Family Resource Center ECE Center Health Center Co-located or virtually connected service centers – creating new pathways Screening

86 Center for Healthier Children, Families & Communities Systematic Data Collection For tracking Health Development Trajectories School Readiness 5 ysBirth1yr4 ys3 ys2 ys Pediatric Early Child Assessment Birth Certificate Preschool Assessment Physical Wellbeing & motor devt Social & emotional devt Approaches to learning Language devt Cognition & general knowledge

87 Center for Healthier Children, Families & Communities What does LCHD New Synthesis Provide to the Discourse on Health System Reform ? Big Idea – Forward looking Big Idea – Forward looking Integrative Framework Integrative Framework Connect up an increasingly balkanized field Connect up an increasingly balkanized field Reframe for health system reform goals Reframe for health system reform goals Positions child/MCH in Vanguard of New Era in Health and Health Care Reform Positions child/MCH in Vanguard of New Era in Health and Health Care Reform New Rational for current and future activities New Rational for current and future activities

88 Center for Healthier Children, Families & Communities Take home Points: Power of LCHD Life Course Health Development (LCHD) is different than a life course approach LCHD –integrating framework Connecting the disparate parts of MCH Connecting MCH to rest of health and human development Leverages MCH and Positions and Prioritizes MCH policy Provides a new Operating Logic for Transforming the Health System Powerful analytic model for solving MCH problems

89 Center for Healthier Children, Families & Communities LCHD Framework: Think Different! Developmentally - in order to optimize outcomes Developmentally - in order to optimize outcomes Population and upstream determinants of the outcomes that we want to achieve Population and upstream determinants of the outcomes that we want to achieve How to shift population risk curves and not just work at the individual level How to shift population risk curves and not just work at the individual level How to use alignment, connection, networking strategies to join up people, sectors, systems into a more functional approach - open source for a flatter health policy world How to use alignment, connection, networking strategies to join up people, sectors, systems into a more functional approach - open source for a flatter health policy world How to change the culture of the system we work in How to change the culture of the system we work in To frame health in terms of its life long impacts To frame health in terms of its life long impacts

90 Center for Healthier Children, Families & Communities UCLA Center for Healthier Children, Families and Communities & National Center for Infancy and Early Childhood Health Policy AIM-MCHB Child and Adolescent Policy Support Center Http.//healthychild.ucla.edu


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