april 29 - may 1, 2015 best start initiative: helping babies by integrating health care and home...
TRANSCRIPT
April 29 - May 1, 2015
BEST START INITIATIVE: Helping Babies By Integrating Health Care and Home
Visiting Services
Why Babies?
Brain Architecture
Increases in heart rate, blood pressure, serum glucose, stress hormones, and inflammatory cytokines fuel the “fight or flight response” to deal with acute threat...
…but excessive or prolonged activation of stress response systems can lead to long-term disruptions in brain architecture, immune status, metabolic systems,
and cardiovascular function.
The Biology of Stress
Source: National Scientific Council on the Developing Child
Toxic StressToxic StressProlonged activation of stress response systems Prolonged activation of stress response systems
in the absence of protective relationships.in the absence of protective relationships.
Toxic StressToxic StressProlonged activation of stress response systems Prolonged activation of stress response systems
in the absence of protective relationships.in the absence of protective relationships.
Household dysfunctions: % Reporting
Substance abuse 27% Parental sep/divorce 23% Mental illness 17% Battered mother 13% Criminal behavior 6%
Abuse: Psychological 11% Physical 28% Sexual 21%
Neglect Emotional 15% Physical 10%
Source: Kaiser Permanente and CDC Study. Over 17,000 adult HMO members interviewed
Adverse Childhood Experiences (ACEs)
DevelopmentDevelopmental Delaysin the First Three Years
Number of Risk Factors Source: Barth et al. (2008)
Ch
ild
ren
wit
h
Develo
pm
en
tal D
ela
ys
1-2 3 54 6 7
20%
40%
60%
80%
100%
ACE Score vs. Serious Job Problems
0
2
4
6
8
10
12
14
16
18
% w
ith J
ob P
robl
ems
0 1 2 3 4 or more
ACE Score
Adult Substance AbuseAdult Substance Abuse
0
2
4
6
8
10
12
14
16
0 1 2 3 4
Self-Report: Alcoholism Self-Report: Illicit DrugsSelf-Report: Alcoholism Self-Report: Illicit Drugs
Source: Dube et al, 2002 Source: Dube et al, 2002 Source: Dube et al, 2005 Source: Dube et al, 2005
% %
ACEs
0
5
10
15
20
25
30
35
40
0 1 2 3 4 5+
Schilling et al, BMC Public Health 7 (2007)
Risk Factors for Adult Heart Disease are Embedded in Adverse Risk Factors for Adult Heart Disease are Embedded in Adverse Childhood ExperiencesChildhood Experiences
Adverse Experiences Source: Dong et al. (2004)
Od
ds R
ati
o
0 1 2 3 4 5,6 7,8
0.5
1
1.5
2
2.5
3
3.5
Similar connections appeared between early adversity and later:• Smoking• Chronic Depression• Stroke• Obesity• Cancer
Toxic StressProlonged stress in early childhood, in the absence of protective relationships:
•Leads to some of the most serious, costly problems in our society
•Leads to problems in Education,
Financial Stability, and Health
Why Focus on Home Visiting?
• Help parents develop a strong, trusting bond with their child
• Start early with the family - even prenatally
• Bring the services to the family
• Connect family members to other most appropriate community resources
By starting at the very
beginning,how big a
difference can we make?
3-Year Regional Plan DevelopedKey Partners:•Maine Families•Early Head Start•Public Health Nursing
• Mid Coast Medical Group• Mid Coast Hospital
Barriers• Funding: Cost is about $2,000
per family.• Current Referrals: Only
perceived high-risk families referred.
• Medical staff often unsure where to refer.
• Drop-Off: Many referred never actually connect with a home visitor.
• Parent Resistance/Stigma.
Collective Goal for Mid Coast Maine
For Home Visiting/Parent Education
to become the ‘norm’, so most families benefit
and more adverse childhood experiences
are prevented or reduced.
Four Key Components of the Plan
• Integrate medical practices and community-based programs, including new Best Start Specialist position.
• Increase Home Visiting capacity.
• Evaluate the initiative and child outcomes.
• Ongoing “backbone” support.
Target PopulationFamilies receiving prenatal care
at Mid Coast Medical Group(approximately 465 families per year)
Goal to Increase Home Visitswith Families
20%
93 families
70%
325 families
Recruited Funding PartnersUnited Way received 3 significant foundation grants, totaling $485,000 to implement and
evaluate our 3-year plan.
Progress Prior to Launch• Outreach to our UW Partner Agencies in 2012• Defined new Best Start Specialist job &
contracted with partner to hire and support her.
• Contracted with an Evaluation Research Firm.• MOUs with key partners.• Confidentiality and Access to Medical Records.
Since Launch in September 2014• Facilitated System Changes, e.g. Electronic Medical
Record integration.• Moving to a “norm” – part of the prenatal care
system. To date, 132 women have met with the Best Start Specialist.
• ____ of pregnant women/families have enrolled and are receiving supports.
Spin-offs & Sustainability• Diaper Project.• Developmental Screening Initiative.• Integration project with Home Visitors and
Pediatricians.• Advocacy at
state and federal levels for home visiting.
LESSONS LEARNED• Strong support because based on research.• This is changing SYSTEMS, which takes time.• Strong leadership and support at key partners.• Challenges of integrating complex health system with community-
based programs.
• Several years of participating in a Early Childhood Funders Group helped to build foundation partners for our initiative.
Key Steps for Your Community• Identify key partners – Home Visiting Programs, Medical
OB/GYN Practice, Community Partners.
• Build on current relationships (e.g. UW Board/volunteers)
• Build consensus for a Plan.
• Work to identify and nurture potential champions within different systems, e.g. within medical professions.
• Backbone Organization – clarity of roles, continually reviewed.
A BIG BOLD PLAN!• We see this as Collective Impact, putting resources
toward starting early!• We see this as Systems Change, changing the
thought processes and system procedures among medical and home visiting staff.
• We see this as behavioral change among professional staff and prospective/new/current parents.
See you in Vancouver!
Contacts
Barbara Reinertsen Peter LindsayExecutive Director Director, Community Impact [email protected] & Success By 6
United Way of Mid Coast Maine34 Wing Farm ParkwayBath, ME 04530207-443-9752www.uwmcm.org
A Science-Based Framework for Early Childhood Policy, Center on the Developing Child at Harvard University, 2007http://developingchild.harvard.edu/index.php/resources/
reports_and_working_papers/policy_framework/
The Long Reach of Early Childhood PovertyGreg J. Duncan and Katherine Magnuson,
Pathways magazine, Stanford Center for the Study of Poverty and Inequality, Winter 2011
http://www.stanford.edu/group/scspi/_media/pdf/pathways/winter_2011/PathwaysWinter11.pdf
Adverse Childhood Experiences Studywww.acestudy.org
The Relationship of Adverse Childhood Experiences to Adult Health:Turning gold into lead
www.acestudy.org/files/Gold_into_Lead-_Germany1-02_c_Graphs.pdf
For more links to ACEs reports and information, go to:www.binghamprogram.org
