1. “What to Do When Your Child Gets Sick” Training
A Training for Providers Working with Parents of Young Children
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2. Overview
What is Literacy? What is Health Literacy? Why is it important? What can we do about it?

3. What is Literacy?
“An individual’s ability to read, write, and speak in English and compute and solve problems, at levels of proficiency necessary to function on the job, in the family of the individual, and in society.”
1998 Adult Education and Family Literacy Act
There are many definitions of literacy and they have changed over time. Around the turn of the century you were literate if you could sign an X by your name. By the 1940’s if you could read at a 4th grade level and by 1960’s if you finished the 6th grade you were considered literate. Today it has dramatically changed to include the ability to function in society. That includes things like computer literacy, numeracy (budgeting) and health literacy. Computer literacy is now vital for a job.

4. Learner’s story http://www.youtube.com/watch?v=NrdHkXgDE0k
This is a YouTube video from the California Library System of an adult learner. Click on “Slide Show” mode and choose “From Current Slide” and click on the link. Be sure that your speakers are turned on to a good volume setting. Once you have finished the video, maximize the presentation and use the escape button to return to this mode.

5. What is Literacy?
What are some of the things that you should be able to do if you are literate?
Use computers
Communicate with a team member on the job
Read a newspaper
Make informed political decisions
Know where to get outside help
Numeracy and understanding how to read a receipt is so important in today’s society. For example, someone with literacy issues would have difficulty double checking a credit card bill and really struggle with writing a letter to try to clarify the error if they should find one. Perhaps the most important skill is the last one “knowing where to go to get help”. This relates to self sufficiency, a cornerstone for literacy.

6. 46 % 50 % 1.5million Literacy statistics
Prison inmates who do not have a high school diploma (NCFL, 2002) Adults on Public Assistance who do not have a high school diploma or GED (National Institute for Literacy) Adults in Wisconsin (nearly 39%) that qualify for literacy services (National Institute for Literacy, 1998)
50 %
1.5million
According to the OECD Program for the International Assessment of Adult Competencies (PIAAC) Report release in October, 2013, low basic skills in literacy and numeracy are more common in the US than on average across participating countries. One in six adults in the US have low literacy skills and nearly one third have weak numeracy skills. Adults in the US fared less well with “problem-solving in technology-rich environments” than the cross-country average.
Low literacy is very common in jails and prisons. 46% of prison inmates do not have a high school diploma. Therefore, once they are rehabilitated and released, their chances of finding a living wage job are very limited. Literacy programs in jails and prisons are crucial to reduce recidivism. 50% of adults on Public Assistance also have the same challenges. Poverty and low literacy have a high correlation. Without adequate literacy skills it is difficult to move out of the cycle of poverty. In Wisconsin almost 39% of adults struggle with low literacy.

7. What does it feel like?
n.” said B y. “W r “Comeo ets ehav di cku i o n. eto pth sc eqon’ anot fqodc W thave her orn.” cano
Try to read this with the following rules:
Letters will not appear on one line
Spacing may not be correct
A P may be a Q or a B a D
How did this make you feel?
Translation:
“Come on.” said Betsy. “We have to pick up this corn. We don’t have another can of popcorn.”
This is just a demonstration of what it feels like to have dyslexia, a reading learning disability. Not everyone has these same struggles when they have dyslexia, but these are common.

8. What people feel about their limited reading ability:
Ashamed, embarrassed
Less of a person
Stupid, anxious, angry
“Something is wrong with me.”
No wonder people try to hide their reading struggles.

9. The big secret
Percent of low literate adults who have not told their: Children 52% Friends 62% Spouse 68% Health care providers 75% Co-workers 85%
Low level literacy issues are associated with shame. Most adults who struggle with literacy do not want anyone else to know. That is what makes this issue so difficult to identify and solve. Creating a shame free environment is crucial to the success of any interventions to literacy challenges. 52% of low literate adults have hidden it from their children, 62% from their friends, 68% from a spouse, 75% from their health care providers and 85% from co-workers.

10. Identifying “red flags”
“I forgot my glasses. I’ll read this when I get home.”
“Let me bring this home so I can discuss it with my spouse.”
“I don’t have time to wait today.”
“I don’t feel well.”
So, how can you tell if someone struggles with literacy? Here are some red flags that you might hear.

11. “Red flags” often misjudged
Incomplete forms
Frequently missed appointments
Lack of follow-through
These are things that often are not recognized as literacy issues. They are also red flags for health literacy struggles.

12. What is Health Literacy?
“The degree to which individuals have the capacity to obtain, process, and understand basic information and services needed to make appropriate decisions regarding their health.”
- Institute of Medicine, 2004
There are numerous definitions available for health literacy, just as there are numerous definitions for literacy. The key concept is the ability to understand information to make appropriate decisions. This is especially crucial for parents trying to understand how to make the best decisions for their children’s health as well as their own.

13. Literacy vs. Health Literacy
Almost everyone will have difficulty with Health Literacy at some point.
Times of stress
Role of medications
Much harder for those that do not:
Read very well; or
Speak English as their primary language.
Since so many things factor into our ability to understand and communicate in a health care situation, we all will struggle with health literacy at some point. But, if you struggle with literacy issues, you will likely need help with understanding health care.

14. 2003 National Assessment of Adult Literacy - Health Literacy
14%
12%
22%
53%
Over 90 million Americans – almost half the U.S. adult population - struggle with low health literacy. Only 12% of our population is considered proficient. And even those in the proficient category struggle during certain times with health literacy.

15. What is “Proficient”? (12%)
Would be able to calculate an employee’s share of health insurance costs for a year, using a table
Only 12% of people are able to function at this level. Those regarded as proficient in health literacy would be able to make this calculation.

16. What is “Intermediate”? (53%)
Would struggle with being able to determine what time to take a prescription medication.
Time is based on information on the prescription drug label that relates the timing of medication to eating.
What does it mean to take a medication twice daily? What does it mean to take something once? In Spanish “once” means eleven. To interpret once daily to mean eleven times per day could have tragic consequences.

17. What is “Basic”? (22%)
Would struggle with being able to give two reasons someone should get screened for a disease even if they have no symptoms
based on information from a clearly written pamphlet .
What does it mean to be screened? Most patient education brochures are written at a 12th grade or above level. Most Americans read at a 6th grade level. Our newspapers are written at a 6th grade level.

18. What is “Below Basic”? (14%)
Would not be able to locate and circle the date of a medical appointment on a hospital appointment slip
It is no wonder that patients miss appointments. Even if they have the date correct, the likelihood of their being able to find the correct location is low. We use many different words for the same place. If this were an appointment for an x-ray, it might be designated as radiology or imaging or another name. The best suggestion to help people navigate through the heath care system is to have them go to the information desk first and ask for help. Creating a shame free environment is the best thing that can be done to address low health literacy issues.

19. Real people with real problems
This video clip was shortened from a video clip put out by the Institute of Medicine (IOM). Listen carefully to these people as they tell their stories about issues of literacy and health care. As with the other video, click into the Slide Show mode and select From Current Slide and then click on the link to get it started.
Did you notice the section with the young woman who says that she would give her 4 year old child a table spoon and a half (should be a teaspoon and a half) of Motrin? That would be 3 times the correct dose. And in the final story that Toni Cordell told, can you imagine how she felt? Can you imagine how she still feels? Are these outliers? Are these rare cases?

20. The impact on health Poorer health knowledge Poorer health status
Higher death rates
More hospitalizations
Higher health care costs

21. Money matters
$106-$238 billion is lost every year on health care costs because of poor communication between patients and providers.
In Wisconsin: $ billion is lost annually
Vernon, J. et al, University of Connecticut, Oct
If we could solve the health literacy crisis, we could help address the high cost of health care.

22. As a patient, you should: Ask Questions
What can you do?
As a patient, you should: Ask Questions
So, what can you do as a patient? One of the best things that you can do is to ask questions!

23. “Questions Are the Answer”
And here’s another one, follow the instructions from the previous videos.

24. “Good Questions for Good Health”
What Is my main problem?
What do I need to do?
Why is it important for me to do this?
You should ask as many questions as you need to understand your health care. You do not need to limit your questions to these three, but if you do not feel comfortable asking questions, start with these three. The parents of your students may not feel comfortable asking questions, so encouraging them to ask these questions is also valuable.
Remember, it is important for you to be able to ask and have answered these 3 questions before you leave your doctor’s visit.
Diagnosis
Treatment
Context

25. You can offer a great resource: “What To Do When Your Child Gets Sick”
Part of a series
Available in:
English
Spanish
Vietnamese
Korean
Chinese
As an instructor, you can help the parents of your students by giving them the “What To Do When Your Child Gets Sick” book. There are also other books in the series that include:
“What To Do When You're Having a Baby”
“What To Do For Teen Health”
“What To Do For Senior Health”
“What To Do For Healthy Teeth”
“What To Do For Heavy Kids”
“What To Do For Kids With Asthma”

26. “What To Do When Your Child Gets Sick”
Multiple independent studies have shown that giving parents a copy of the easy to read book, What To Do When Your Child Gets Sick, and training them how to use it at home to care for their child's minor ailments and injuries led to:
57-61% reduction in ER Visits
39-56% decrease in doctors/clinic visits
43-60% fewer missed school days by children due to illness or injury
41-47% less work days missed by parents due to child's illness
This is a study done in California and reported on in an article by Molly Hennessy-Fiske, Los Angeles Times, October 20, 2010

27. “What To Do When Your Child Gets Sick”
One study that included parents on Medicaid also showed that the reduced hospital ER visits saved more than $550 per family annually.
This was a study conducted by UCLA/Johnson & Johnson Health Care Institute.

28. In Wisconsin
Recent projects with Head Starts and Childcare Providers in Northwest WI
643 parents
1090 children
71% felt that the book helped them deal with a health care problem at home instead of calling a hospital or clinic
62% felt that the book helped them deal with a problem at home instead of going to the Emergency Room (ER) or Urgent Care
In Wisconsin, from similar previous projects, 643 parents with 1090 children were given books and filled out a survey 3-4 months after getting the book. 71% felt that the book helped them deal with a problem at home instead of calling a hospital or clinic. 62% felt that the book helped them deal with a problem at home instead of going to the Emergency Room or Urgent Care.

29. What is in the book?
The book covers the management of more than 50 common childhood illnesses, injuries, and health problems.
It is written in easy-to-read language for parents and caregivers of children from birth to 8 years of age

30. What is in the book? For each condition, the following
questions are answered:
What is it?
What do I see?
What can I do at home?
When do I call the doctor or nurse?
What else should I know about it?

31. Distribution
Surveys revealed that those who were introduced to the book and not just handed it, were more likely to use it.
What do you do with a book that you are given?
Why would you go back to that book?
What can you do to make it a “Go To” resource?
It is very important that you introduce the book to parents. There is a scavenger hunt available for download on the website if you are looking for a fun activity to do with the parents. Another good way to get the parents to interact with the book is to have them fill out the information on the first two pages of the book and then have them pick something to look up with you.

32. After the book has been given to parents with a short introduction
After the parents have had a chance to use the book (2-3 months after distribution), conduct the survey located online Survey.
If the parents do not have access to the online survey or do not feel comfortable using it, you can use the printed version of the survey. Fill it out with your parents and then give them to your coordinator.

33. Who will answer my questions?
Margarete Cook Allison Machtan http: //