1. Role of the Life Course Framework for Improving Services to Children with Special Health Needs
Amy Fine
Center for the Study of Social Policy
APHA – San Francisco, CA
October 31, 2012

2. Presenter Disclosures
Amy Fine
(1) The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months:
No relationships to disclose

3. Overview Key life course concepts & implications for CSHCN
Applying life course concepts
CSSP’s project on life course and CSHCN, funded by the Lucile Packard Foundation for Children’s Health
A. Fine-CSSP
Oct. 31, 2012

4. Key Life Course Concepts –T2E2
Timeline – Today’s experiences and exposures influence tomorrow’s health
Timing – Health trajectories are particularly affected during critical or sensitive periods of development
Environment – The broader community environment –biologic, physical, and social – strongly affects the capacity to be healthy
Equity –Inequality in health across populations reflects more than genetics and personal choice
A. Fine –CSSP
Oct .31, 2012

5. Life Course and Public Health
LC grounded in public health
Key Qs
Why do health outcomes vary across population groups?
How do we optimize health across populations?
A. Fine-CSSP
Oct. 31, 2012

6. What’s New?
New science helps explain how social environment embeds in our bodies, and interaction of genes and environment
Timeline adds new(ish) dimension to traditional public health concerns
A. Fine-CSSP
Oct. 31, 2012

7. LC Integrates New Science with Longstanding Public Health/Population Health Concerns
Public Health Concerns: social determinants, equity, built environment, workplace and environmental exposures +
New Science: epigenetics, early programming, impact of stress on health, neuro- plasticity
A. Fine-CSSP
Oct.31, 2012

8. Implications
LC suggests the need to refocus both clinical and population health
Place greater emphasis on multiple determinants of health
Incorporate earlier detection of risks as well as early and timely interventions
Promote factors that protect against disease and disability and reduce factors that place children at increased risk of poor health and development;
Shift from discrete and episodic services to developing integrated, multi-sector service systems that build health across the lifespan
Complement the dominant medical approach that focuses on individual diseases, conditions or body systems, with a whole-person, whole-family, whole-community systems approach
A. Fine-CSSP
Oct.31, 2012

9. MCH Life Course & CSHCN Is LC theory too deterministic?
What about kids who are born with complex medical needs or who already have chronic health conditions?
How does LC theory speak to the needs and trajectories of CSHCN?
A. Fine-CSSP
Oct.31, 2012

10. MCH Life Course & CSHCN
“The development of health over a lifetime is an interactive process, combining genes, environments and behaviors.”
“Throughout life and at all stages, even for those whose trajectories seem limited, risk factors can be reduced and protective factors enhanced, to improve current and subsequent health and well- being.”
Life course concepts of equity and optimizing health across all populations important for CSHCN
A. Fine-CSSP
Oct.31, 2012

11. Applying LC – Action to Date
Focus on optimizing health/ healthy development in general, or on specific health conditions – obesity, low birth weight and infant mortality
LC implementation largely targeted to prevention at community or population level, addressing social/environmental causes of chronic health conditions
Examples
Building Blocks Collaborative – Alameda County Health Department
Best Babies Zone Project – U.C. Berkeley + 4 Sites
Healthy Eating/Physical Activity Initiative – Nemours
A. Fine-CSSP
Oct.31, 2012

12. Applying LC – What’s Needed?
More on implications & potential applications for special needs children
More attention to how can LC best be applied to health care delivery system at practice level, especially for children at high risk for diminished or diminishing functioning
Strategies for bridging practice & community level LC approaches to improve health
A. Fine-CSSP
Oct. 31, 2012

13. Applying LC – What’s Needed?
As LC theory and practice become more prominent, need to assure that CSHCN and their families can both inform and benefit from this new science and its related applications
With health systems redesign underway nationwide, it especially important that LC implementation include a focus on CSHCN, for whom the benefits of a life course approach may be greatest
A. Fine-CSSP
Oct.31, 2012

14. Project Focus: Key Qs
How can LC be incorporated into pediatric health care for CSHCN and their families?
What would this “look” like from the perspective of providers and families?
What policy supports would be needed?
How can LC be applied to community systems of care for CSHCN and how might health care providers best interface with these systems?
How can the life experiences of CSHCN be better integrated into LC science and theory as they continue to evolve?
A. Fine-CSSP
Oct. 31, 2012

15. Timeline & Methods Timeline Methods July 2012-November 2013
Literature review (CAHMI/OHSU)
Key informant interviews
Interviews discussion groups with CSHCN families
Call for nominations to identify exemplary pediatric health care practices and programs
Interviews with exemplary practices and programs
A. Fine-CSSP
Oct. 31, 2012

16. T2E2+LC Implications Frame
Initial Frameworks
T2E2+LC Implications Frame
↑ emphasis on multiple determinants of health
↑ early detection of risks & timely interventions
↑ protective/”promotive” factors ↓risk factors
↓ discrete & episodic services; ↑ integrated, multi-sector service systems that build health across the lifespan
↑ whole-person, whole-family, whole-community systems approach (to complement dominant medical approach focused on individual diseases, conditions or body systems)
Here are some of the ways we’ve begun to think about implications for CSHCN
A. Fine-CSSP
Oct. 31, 2012

17. Products Summary of key LC/ CSHCN literature
Findings from interviews and discussion groups
Succinct set of practice & policy recommendations
Incorporating LC theory into pediatric practice and systems of care for CSHCN
Incorporating needs and experiences of CSHCN into LC science, theory, practice, and systems of care
Final monograph/issue brief with key findings and recommendations
A. Fine-CSSP
Oct. 31, 2012

18. Thank you…
Comments? Questions? Recommendations? All Welcome! Amy Fine Center for the Study of Social Policy
A. Fine-CSSP
Oct. 31, 2012