copc in dc kathleen m. kadow june 2000. washington, dc 68 square miles pop:519,000 us capital ...
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COPC in DC
Kathleen M. Kadow
June 2000
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Washington, DC
68 SQUARE MILESPOP:519,000US CAPITALMID-ATLANTIC REGION
FEDERAL GOVERNMENT‘HOME-RULE’
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Comp Clinic Established in 1967 Community-based clinic of
Children’s Hospital Comprehensive pediatric
services Staffing Women Infants and Children
(WIC)
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City, Ward, Census Tract
EIGHT WARDS IN DC
192 CENSUS TRACTS
CENSUS TRACT =3200 PEOPLE
COMP CLINIC
CHILDREN’S HOSPITAL
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COPC Steps
Community DefinitionCommunity CharacterizationPrioritizationDetailed AssessmentInterventionEvaluation
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Community Definition “Geographic Retrofitting”
Visits to Comp Clinic 7/98-7/99
Home address ---- census tracts
85% of visits within Washington,DC
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Mapping: July 98 – July 99
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Community DefinitionNUMBER OF VISITS PER CENSUS TRACT
CENSUS TRACTS
NU
MBER O
F V
ISIT
S
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Community Definition
VI SI TS BY WARD
Ward 5
10%
Ward 1
54%
Ward 4
24%
Ward 2
12%
VI SI TS BY WARD
Ward 2
12%
Ward 4
24%
Ward 1
54%
Ward 5
10%
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Targeted PopulationThe pediatric (0-18 years old) users and non-users of the 26 census tracts that represent the top 50% of visits to Comp Clinic
The 26 census tracts fall into four of the eight wards in DC
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The Next Step...Community Definition Community CharacterizationPrioritizationDetailed AssessmentInterventionEvaluation
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Community Characterization
COMMUNITY SETTING
Washington,DC<climate, environment, housing, ‘Metro’, DC Government>
Wards 1,2,4 and 5
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Community Characterization
RACE/ETHNICITY DC 26 CENSUS TRACTS IN WARDS 1,2,4 AND 5
African- American 62% 78%
Caucasian 34% 18%
Hispanic 7.2% (any race) 14% (any race)
Asian/Pacific Islander/American Indian
4% 4%
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Community Characterization
SOCI O- DEMOGRAPHI CS: DC VS. TARGET COMMUNI TY
I NDI CATOR DC 26 CENSUSTRACTS
Age (% 0- 17yrs old) 20% 22%Per capita income ($) $29,383 $18,827Unemployment rate (%) 7.2% 9.9%Education (%high schoolgrad/% college grad)
73%/33% 62%/18%
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Community Characterization
Health Status
Natality
Mortality
Morbidity
Hospital/ Health Services/Insurance
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Community Characterization
12 Key Informant Interviews
3 Focus Groups
Over 70 issues identified
Organized into ten large topic areas for prioritization step
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Community Characterization KEY INFORMANTS & FOCUS GROUPS
Focus Group Top Ranked I ssuesGrade school PTA Mental health
Dental Health Urgent Care Mobile Health Care Health Awareness Outreach
High school senior group Sex and sexuallytransmitted diseases(STD’s)
Teenage pregnancy Drug use Food Lack of immunizations
Daycare staff Adequately trained staff Nutrition Need for evening clinics Kids sick in daycare Neglect Dental care
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Step 3…..Community DefinitionCommunity Characterization PrioritizationDetailed AssessmentInterventionEvaluation
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Prioritization Prioritization Team #1
Comp Community Board
Team Meeting #1 Step 1- review and ranking of 10
broad topics
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PrioritizationRREEVVII EEWW TTEENN MMAAJJ OORR TTOOPPII CC AARREEAASS WWII TTHH
PPRRII OORRII TTII ZZAATTII OONN TTEEAAMM ((TTEEAAMM 11)) Access to Health Care Health Education Prevention/Routine Health Care Nutrition and Exercise Smoking and Substance Abuse Adolescent I ssues HIV/AIDS and STD’s Mental Health Family I ssues School and Daycare I ssues
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Prioritization Prioritization Team #2
COPC Team
Team Meeting #2 Review topic selected by team
#1 Focus School and Daycare
Problems
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Selected Health Problem
SCHOOL and LEARNING PROBLEMS
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School and Learning Problems
WORKING DEFINITION
Any academic difficulty experienced in school,due to any cause.
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Step 4….
Community DefinitionCommunity CharacterizationPrioritization Detailed AssessmentInterventionEvaluation
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Detailed Assessment
School Data
Students in District of Columbia Public Schools(DCPS) who performed at basic level on theStanford 9 Achievement Tests for readingincreased from 1997- 98 at every grade forwhich scores were available.
Students in DCPS improved their mathperformance on the Stanford 9 in 1998
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Detailed Assessment School Data
Students in DCPS score, on average, one fifth lowerthan children nationally on the Scholastic AptitudeTest (SAT). DCPS scores have been declining since1995.
Students in DCPS are far behind the nationalaverage in math AT ALL grade levels for which datais available (3rd, 6th, 8th and 10th)
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Detailed AssessmentELEMENTARY SCHOOL (Pre- K to 3rd grade) SAMPLE
School/Ward
STANFORD- 9% of studentsbelow basic
ACHIEVE-MENT% ofstudentsbelowbasic
TEST% ofstudentsbelow basic
Reading Math CombinedMeyer/1 16.9 18.9 17.9Garrison/2 22 36.6 29.3Powell/4 24.3 36.5 30.6MalcolmX/5 39.5 47.7 43.7OVERALLDC (1999)
24 26
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Detailed AssessmentSENIOR HIGH SCHOOL (9th – 12th grades) SAMPLE
School/Ward
STANFORD- 9% of studentsbelow basic
ACHIEVEMENT% of studentsbelow basic
TEST% of studentsbelow basic
Reading Math CombinedCardozo/1 64 90 77SchoolWithoutWalls/2
0.4 26 13.1
Coolidge/4
43 81 62
Spring-arn/5
64 85 75
OVER-ALL DC
45 70
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Detailed AssessmentDISTURBING TRENDS
•Reading and Math Skills
•Ward vs DC data
•Math scores, widening gap
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Detailed Assessment Literature and Experience Medical Behavioral/Psychiatric Psychosocial Educational School Problems Clinic
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Detailed Assessment
Screening Tools Child Health and Family Functioning
Questionnaire
Parents’ Evaluation of Developmental Status
Pediatric Symptom Checklist
Einstein Assessment of School Related Skills
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Getting Closer….
Community DefinitionCommunity CharacterizationPrioritizationDetailed Assessment InterventionEvaluation
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Intervention What has been done?
Federal/City/Local What else can be done?
Create baseline data concerning the risk factors associated with school problems
Effectively screen for school problems within the targeted community
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Intervention HYPOTHESIS:
The use of a standardized screening protocol to assess school and learning problems will enable primary care providers and staff to identify children (5-11yrs old) with an existing school or learning problem.
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Intervention
GOAL To identify children 5-11years
old, in a primary care pediatric clinic with school and learning
problems using a standardized screen.
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Intervention Objectives Program Activities Community and Staff
Participation Resources and Budget Surveillance and Monitoring
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ObjectivesExamples Screening 5-11 year olds over 6
months Disposition after screen Referrals Increase correct identification of
school and learning problems Increase awareness
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Program Activities
Examples COPC Meeting # 3 Chart Review (before/after) Training of staff Comparison (screen/provider) Community educators Resource review
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Are you still awake?….
Community DefinitionCommunity CharacterizationPrioritizationDetailed AssessmentIntervention Evaluation
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Evaluation Relevance Quality Efficiency Satisfaction Differential Value
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Evaluation
Outcomes Number receiving screen Number of referrals/reason Rates of identification (pre/post) Survey (pre/post) of staff Satisfaction (pre/post)
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Evaluation
Process/Structure Acceptability Ease of administration Barriers Length of time. Differential value.
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Conclusion
Review COPC Process
Future plans
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Thank you for your attention