1. Veronica Ybarra-Tamayo, HSS Kathleen Ramos, Ph.D. Rick Brandt-Kreutz, LCSW First 5 Fresno Commission Presentation April 5, 2006 Healthy Steps Fresno: Partners in Developing Healthy Children

2. Objectives Healthy Steps CHILDREN Healthy Steps RESIDENTS Healthy Steps FUTURE

3. 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

4. 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

5. 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

7. NEW: Selective Prevention Postpartum depression screening PEDS CHDP Provider Outreach PATIENT SERVICES

8. 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

10. NEW: Follow the Resident: Healthy Steps approach with all the patients Family Practice RESIDENT TRAINING

11. 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

12. 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

13. 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

14. 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