Maternal and Child Health Library
This and past issues of the MCH Alert are available at http://www.mchlibrary.info/alert/archives.html
October 2, 2009
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1. E-Journal Focuses on Preventing Child Maltreatment
2. Brief Highlights Findings on the State Children's
Health Insurance Program
3. Analysis Assesses Economic Burden of Disease for Women
4. Study Evaluates the Effects of Health Consultation
Intervention on Child Care Center Policies and Practices
5. Article Provides Clinicians' Perspectives on Well
Child Care
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1. E-JOURNAL FOCUSES ON PREVENTING CHILD MALTREATMENT
The fall 2009 issue of The Future of Children presents research on
policies and programs designed to prevent maltreatment. The volume,
published by Princeton University's Woodrow Wilson School of Public and
International Affairs and the Brookings Institution, examines the
gradual shift in the field of child maltreatment toward a "prevention
perspective" and explores how insights into the risk factors for
maltreatment can help target prevention efforts to the most vulnerable
children and families. Contributors assess whether a range of specific
programs, such as community-wide interventions, parenting programs,
home-visiting programs, treatment programs for parents with drug and
alcohol problems, and school-based educational programs on sexual
abuse, can prevent maltreatment. They also explore how child protection
system agencies, traditionally seen as protecting children who are
maltreated from further abuse and neglect, might take a more active
role in prevention. The full-text issue, executive summary, policy
briefs, and article summaries are available at
http://www.futureofchildren.org/futureofchildren/publications/journals/journal_details/index.xml?journalid=71
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2. BRIEF HIGHLIGHTS FINDINGS ON THE STATE CHILDREN'S HEALTH INSURANCE
PROGRAM
What Has Been Learned About Expanding Children’s Health Insurance?
summarizes findings from research on the State Children's Health
Insurance Program (SCHIP) conducted by the Child Health Insurance
Research Initiative from (primarily) 1999 to 2003. The brief and the
research upon which it is based were supported by the Agency for
Healthcare Research and Quality, the David and Lucile Packard
Foundation, and the Health Resources and Services Administration.
Topics include what was learned and policy implications. Figures
present data on the unmet needs of children and adolescents by special
health care needs status at pre-enrollment and follow-up; children's
enrollment in SCHIP at age 24 months; and insurance status of SCHIP
enrollees at pre-enrollment and follow-up. Information about SCHIP
design and enrollment, definitions, the Children's Health Insurance
Program Reauthorization Act of 2009, study methodology and sources, and
related studies of interest is also provided. The brief is available at
http://www.ahrq.gov/chiri/chiribrf10/chiribrf10.pdf
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3. ANALYSIS ASSESSES ECONOMIC BURDEN OF DISEASE FOR WOMEN
Women's Health and Health Care Reform: The Economic Burden of Disease
in Women underscores the roles of both preventive care and continuity
of care for women across the lifespan, including primary care,
specialty care, and pregnancy care. The report, prepared by the Jacobs
Institute of Women's Health at the George Washington University School
of Public Health and Health Services with support from the Women Donors
Network and the Communications Consortium Media Center, is based on
secondary data sources from nationally representative surveys. Topics
include direct and indirect cost estimates for the major chronic health
conditions faced by women (cardiovascular disease, mental disorders,
breast cancer, cervical cancer, diabetes, osteoporosis, intimate
partner violence, sexually transmitted infections, HIV, and AIDS), as
well as for health-related behaviors (smoking and obesity). Health
disparities in outcomes are also identified. A figure illustrates the
range of health care screening, counseling, and early intervention
health care services that are important for women at each stage of
their lives. The report is available at http://www.wellwoman09.org/materials/GWReport-CostBurdenofChronicIllnessFINAL.pdf
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4. STUDY EVALUATES THE EFFECTS OF HEALTH CONSULTATION INTERVENTION ON
CHILD CARE CENTER POLICIES AND PRACTICES
"Child care health consultation programs in 5 California counties
improved their child care centers' abilities to meet many NHS [national
health and safety] standards, including health and safety policies and
to some degree practices," state the authors of an article published in
the September-October 2009 issue of Academic Pediatrics. During the
past 10 years, child care health consultants have been trained to
address the health and safety needs of young children in child care.
These consultants are health professionals who work with child care
providers to help them adhere to state licensing regulations and NHS
performance standards. In California, First 5 California funded the
Child Care Health Linkages Project to support 20 county-level child
care health consultation programs, establish standardized training for
health professionals as health consultants and child care professionals
as child care health advocates, and conduct an experimental study in 5
counties on the effect of the consultation services. The article
presents findings on the effect of child care health consultation on
child care centers' health and safety policies and practices.
Counties were selected on the basis of geography (urban, rural, or
mixed), population density (from low to high), and poverty rate (at
least 27 percent of children under age 6 living in poverty). Centers
were selected if they were licensed, cared for infants or children up
to age 5, and had no child care health consultation services. Centers
were matched by enrollment size, children's ages, and ethnic diversity
and then randomly assigned to intervention and comparison groups.
Demographic data on children's characteristics were reported by
parents, and center characteristics were collected during director
interviews. Trained research assistants completed a policies checklist
(based on NHS standards) and observed health and safety practices at
baseline and post-intervention.
The authors found that
- At baseline, there were no significant differences between the
intervention and comparison centers on health and safety policies. At
post-intervention, the intervention centers had significantly more
written policies and higher-quality policies than comparison centers on
9 of 10 policies.
- At baseline, there were no statistically significant differences
between the intervention and comparison centers. Analyses showed that
the intervention centers significantly improved their health and safety
practices in emergency preparedness and handwashing compared with the
comparison centers, controlling for baseline scores, advocate model
(county or center based), length of time between measures, and director
turnover.
"Health and safety policies and practices may improve when child care
programs affiliate regularly with health consultants and advocates,"
conclude the authors.
Alkon A, Bernzweig J, To K, et al. 2009. Child care health consultation
improves health and safety policies and practices. Academic Pediatrics
9(5):366-370. Abstract available at http://www.academicpedsjnl.net/article/S1876-2859(09)00123-5/abstract
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5. ARTICLE PROVIDES CLINICIANS' PERSPECTIVES ON WELL CHILD CARE
"In this qualitative study, pediatric clinicians reflected on the most
important
elements of high-quality, comprehensive well-child care. Their
experience and ideas support a vision of pediatric preventive care that
is comprehensive, family-centered, and developmentally relevant," write
the authors of an article published in the September 2009 issue of
Pediatrics. Well child care visits have changed little over several
decades, whereas child health concerns and practices have changed
considerably. Using a qualitative study design to provide a range of
expression not possible with questionnaires, the authors examined the
complexities of providing preventive care and elicited clinicians'
visions of how to support developmental and adaptational needs of
children and families. The study addresses two core issues from the
pediatrician's perspective: (1) what is most important about how you
currently provide well child care, including your priorities for the
content of care? and (2) what, if any, changes are needed to provide
high-quality, comprehensive well-child care?
The authors conducted 31 focus groups between December 2005 and May
2007, with 282 pediatricians and 41 pediatric nurse practitioners.
Sites were selected to ensure geographic and patient diversity and
reflected a wide range of urban, suburban, and rural practice sites and
income, racial, and cultural patient characteristics. Initial questions
were developed on the basis of pilot interviews with selected pediatric
professionals and parents and tested on the first three focus groups.
In the subsequent groups, participants were presented with the same
series of open-ended questions designed to stimulate open discussion
between peers in areas of particular interest and concern to them. On
the basis of participants' responses to the discussion guide questions,
more specific concepts and categories generated from the participants
were formed.
The authors found that
- Overall, clinicians reported positive opinions on the value of
well child care to provide child-rearing information, support, and
guidance and to provide an opportunity to get to know the child and
parent during a non-illness encounter.
- In each group, clinicians emphasized the importance of the
doctor-patient relationship.
- Clinicians agreed on the importance of eliciting parent concerns
as the first priority for visits. Beyond that, they most often
mentioned priorities consonant with existing American Academy of
Pediatrics health supervision guidelines but also expressed frustration
with the overwhelming number of recommended health directives.
- Regarding long-term goals for well child care, clinicians
described areas needing more attention, the majority of which centered
on developmental and behavioral concerns and better support for
families."
- Many clinicians suggested looking beyond the current office-based
model to create linkages with the community.
- Most clinicians embraced standardized parent questionnaires to
screen for developmental delays and behavior problems.
- Clinicians frequently noted the importance of professional
education to improve well child care practices.
The authors conclude that "recent parent focus group findings . . .
strengthen the argument for using in-depth explorations to frame future
research questions and rethink the priorities for high-quality
pediatric care."
Tanner JL, Stein MT, Olson LM, et al. 2009. Reflections on well-child
care practice: A national study of pediatric clinicians. Pediatrics
124(3):849-857. Abstract available at http://pediatrics.aappublications.org/cgi/content/abstract/124/3/849
Readers: More information about well child care is available from the
Bright Futures Web site at http://www.brightfutures.org
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and
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