1. An Innovative Approach to Pediatric Access to Healthcare and Obesity Prevention
Chelcie Oseni, MBA, BSN, RN
Clinical Nursing Supervisor – Delta Grant
Community Outreach

2. “Healthier Families, Stronger Communities, Brighter Futures”
Grow Well
Provides obesity-related preventative clinical and health services to children and adults in rural communities who are at risk for obesity in the 20 rural counties of West TN
“Healthier Families, Stronger Communities, Brighter Futures”
Funding for the activities of this consortium is provided by HRSA – Federal Office of Rural Health Policy – Community Based Division
Delta States Rural Development Network Program

3. Le Bonheur on the Move (LOM)
Le Bonheur on the Move (2004) is a medical mobile unit that travels throughout the 20 rural counties of West Tennessee
Goal 1: To provide affordable, accessible health care services for children who are uninsured or underinsured (Medicaid)
Goal 2: Assist children/families to access a medical home
The Le Bonheur on the Move program is financially supported in part by Children’s Health Fund, HRSA Delta States Rural Development Network Program and medical insurance reimbursement.

4. Process for LOM Services
Currently partner with 12 school systems in 8 counties
20,000+ consents distributed at the beginning of each school year
History, Developmental Screening, PSC-17
Insurance and PCP information
Priority List created (uninsured, underinsured)
Patient schedule arranged through CSH (goal of patients per clinic day)
Goal is to visit each school system or county at least once per month
1,841 children seen during the school year

5. LOM Services Provided
Comprehensive Well-Child Examinations (EPSDT) include:
Hearing and Vision Screening
Lab Work: Lead, Hemoglobin, Glucose, Cholesterol, UA, HgA1c
Vital Signs: Height, Weight, BMI, Blood Pressure
HPI: History of Present Illnesses
ROS: Review of Systems
Physical Examination by APN
*Sick Visits and/or Sports Physicals are also performed as requested by schools

6. LOM Follow-Up At completion of examination:
Visit summary is faxed to PCP on file and mailed to parents
Parents contacted if medications prescribed or referral is indicated
RN Health Education Program
Referrals made in participating school systems for children 10 years and older who are overweight, obese, have elevated blood pressure or high cholesterol
Behavioral Health Care Navigation Program
Referrals made in participating school systems for children with undiagnosed or untreated behavioral/mental health conditions

7. RN Health Education Coordinates one-on-one health education sessions
Typically four 15-minute sessions
Focused on message
Collects pre- and post- health habits and knowledge survey
Collects pre- and post- clinical measures
Height, Weight, BMI
Blood Pressure
Parents are encouraged to participate in sessions

8. RN Health Education
Program Outcomes: 327 children participated during school year
Decrease in BMI Percentile
Year 1: 72% of participants had a decrease of ANY amount
0.9% overall decrease in BMI percentile
Year 2: 61% of participants had a decrease of ANY amount
0.43% overall decrease in BMI percentile
Decrease in Blood Pressure
Year 1: 46% of participants with an elevated BP decreased to normal
Year 2: 71% of participants with an elevated BP decreased to normal
Increased Fruit/Vegetable Consumption
Year 1: 47% of program participants
Year 2: 44% of program participants
Increased Physical Activity
Year 1: 38% of program participants
Year 2: 41% of program participants

9. Behavioral Health Care Navigation
Pilot began August 2017 in one county (two school systems)
Program is implemented by a Licensed Clinical Social Worker
One-on-one counseling visits
Child and family home visits
Navigation to appropriate community resources
Collaboration with the child’s family and school personnel
Develop interventions for the home and/or school environments
Assist with making specialty health care appointments
Assist with insurance and public assistance enrollment
Facilitate transportation needs

10. Behavioral Health Care Navigation
Program Outcomes
39 children received services during the school year
Data collected from multiple Behavior Improvement Assessment Tools completed by LCSW, parent/guardian, teachers and other school staff revealed:
57.9% of children showed improvement in academic behavior
56.1% of children showed improvement in behavior at school
57.1% of children showed improvement in behavior at home
48.9% of families showed improvement in parental involvement

11. Strategies for Success
Networking and Partnerships
Coordinated School Health
Meeting identified needs
Accountability
Timeliness
Billing Practices
LOM
Began 3 years ago as a sustainability measure
Bill only to MCOs we contract with
Child or family never receives a bill
Average of $100 reimbursement per insured child
RN Health Education
Bill MCOs same as LOM
Reimbursed for Preventative Counseling, 15 (99401) or 30 (99402) minutes