1. An Integrated Approach to Child Health Promotion W. Douglas Tynan, PhD Nemours

2. 2 An Integrated Approach to Child Health Promotion W. Douglas Tynan, Ph.D. Program Director December 10, 2010 dtynan@nemours.org

3. 3 VISION - Optimal health for all children MISSION - Working with others to help children lead healthier lives

4. Appropriate Nutrition Stable, Responsive Relationships Foundations of Healthy Development* Safe, Supportive Environments * Harvard’s Center on the Developing Child Children need consistent, nurturing and protective interactions with adults that enhance their learning, and behavioral self regulation as well as help they develop adaptive capacities that promote well regulated stress response systems. Physical spaces promote health and are free from physical, social or emotional harm or danger, home, school and community environments. Children need appropriate nutrients critical to health and development according to their stage of life. Achieving this is affected by a set of factors including, taste, cost, convenience and economic systems that address proximity, access, affordability, availability, familiarity, and cultural relevance.

5. 5 Childhood Factors: Families are changing  More… –Single parent births –Parents are working more hours –Poverty, Medicaid-eligible children  Fewer… –Engaged fathers –Community connections

6. 6 Childhood Factors: Health Environment Changing  More… –More fast food meals –Screen Time  Fewer… –Family meals –Opportunities for active play –Children getting enough sleep

7. 7 Childhood Factors: Out-of-home care is changing  More… –Children in non-parental childcare –Time spent daily in poor quality out-of-home care  And in child care & education, less… –Opportunities for professional development or for working full time –Adequate compensation and benefits

8. 8 Childhood Factors: Systems of care responses are changing  More… –Demand on health & education providers to address developmental, emotional and behavioral problems  Less… –Access to effective help for parents and families, often waiting lists or difficulty finding providers

9. 9 Childhood Factors: To summarize…  Many adults and systems have a hand in raising children: They are all of our children.  Nearly all children share exposure to risk for poor health & education outcomes  As risks increase, problems increase  Working with child care, education, youth serving organizations, primary care and with parents we can reduce risk

10. 10 In the state of Delaware, approximately 37% of children and youth have an unhealthy weight – and those rates continue to rise Source: Delaware Survey of Children’s Health Numbers we hope to change

11. 11 Childhood Health Outcomes: Numbers we hope to change  Nearly one out of five parents in Delaware reported having a child with some level of emotional or behavioral difficulty  30% of low-income preschool children have emotional and behavioral problems  40.2% of Delaware child care providers asked family to withdraw a child from their care

12. 12  STRATEGY - NHPS, in partnership with others, uses evidence-based, population-level approaches that support health promotion policies, practices, and environments to improve health behaviors and outcomes for Delaware's children. The initial focus is to prevent and reduce overweight and obesity and improve emotional and behavioral health outcomes.

13. 13 The NHPS Model: Working with Over 250 Community Partners Our goal is to change the health status and well-being of the most children possible through the deployment of evidence based policies and practices that will have the highest sustainable impact in changing behavior with the most efficient use of resources through building permanent community capacity. Policy and Practice Change Agenda Community Infrastructure Behavior Change Healthy Children to build and sustain that supports that leads to that evidence the usefulness of Policy and Practice Change Agenda Community Capacity Behavior Change Healthy Children to build and sustain the that support that leads to that evidence the usefulness of

14. 14 Theory of Change Social-Ecological Model of Health Behavior IndividualInterpersonalCommunityOrganizationalSocietal Health Behavior

15. 15 Societal Examples National/Regional  National Physical Activity Plan  Delaware Valley Grantmakers  Communities of Practice State  Governor Markell –COUNCIL ON HEALTH PROMOTION AND DISEASE PREVENTION  State Government Departments: Division of Public Health, Medicaid, Department of Education, Parks and Recreation  Breastfeeding Advocacy Group  Bike Delaware  DE Greenways

16. 16 Community/ Organizational Examples  Sussex Child Health Promotion Coalition (150 member organizations)  NCC Healthy Kids Network (25 member organizations)  Office of Child Care Licensing  University of Delaware  Delaware Institute for Excellence in Early Childhood  13 School Districts  48+ Elementary Schools (PEP program)  22 primary care practices with 104 providers  Triple P Level 3 Trained Providers (106 accreditations)  Youth Serving Organizations (e.g. B&G Clubs, YMCA, 4H)

17. 17 Interpersonal/Family Examples  Triple P Parenting –Train providers who work with parents in schools, child care, youth serving organizations.  Just in Time Parenting Programs –Providing new parents with monthly newsletters/information for the age of their child.  Nemours Primary Care Parenting –Training primary care providers to give effective suggestions to parents

18. 18 Example: Building & Leveraging Community Capacity for Spread  Communities –Sussex Child Health Promotion Coalition (2006-on- going/Policy/Practice)  160 member organizations with 238 members  Local leadership  Significant Sussex media coverage –Community 5-2-1-Almost None Healthy Lifestyle Trainings –Work in Wilmington/New Castle County (2009- ongoing/policy/practice)  Collaborating with existing efforts aimed at reducing health disparities within at-risk populations  Building a coordinated network of collaborative efforts with local leaders to address the prevention of childhood obesity and comprehensive child health promotion

19. 19 Sussex Coalition Results  Grown from 45 to 238 members from all sectors of community (2006 to 2010)  Incorporated as a non-profit entity in 2009  Budget grown from $100K to over $400K  Awareness of healthy lifestyle message, 5-2-1- Almost None, increased in Sussex County (7.2% in 2006 to 35.7% in 2008)  Sponsored nine health promotion programs impacting over 20,000 children and their families

20. 20 Laying the Foundation for Future Capacity Building for Sustainable Change  Strengthen targeted partners to enhance spread, intensity and sustainability  Support targeted partners in engagement of families  Place more emphasis on building comprehensive, integrated systems of care for children and their families  Maximize Nemours resources in expertise and related initiatives  Remain flexible to be respond to opportunities and threats  Continued work on long-term sustainability  More targeted evaluation and performance measurement