mch checkpoints tracking healthy development along life trajectories

MCH CheckpointsTracking Healthy Development Along Life Trajectories

Wm Hollinshead MD MPHRhode Island Department of Health

CityMatCH Conference

Albuquerque

September 2008

Trajectories of Health…


Propositions:Parents, and others, always have important

information about a child’s developmental risks, assets, and needs.

Developmental risks and protective factors can be recognized much earlier, before conception or very early in life, and addressed then to alter developmental trajectories.

But our systems don’t ask, don’t retain, and don’t pass forward developmental data to help families succeed.


And so:Who knew?

When did they know it?

How did they respond?


In Rhode Island:• Patients and parents know, but “…no one

asked”, and so WHSRP, ASQ, PEDS• Pre/perinatal providers know/should ask, but it

didn’t get sent NBDevelScreen• Medical homes should ask, but don’t

evidence based ASQ, PEDS • Some are medically homeless RIte Care and

PediPracticeEnhancementProj• Child care staff know, but don’t connect to

developmental services Watch Me Grow


MCH Checkpoints are predictable points of contact between parents/children and professionals, in which healthy development can be addressed.


In a community system of family-centered medical homes, MCH Checkpoints are organized into a coherent, connected longitudinal system – from before conception to young adulthood - that recognizes and addresses risks and protective factors that will influence children’s healthy development.


BIRTH

SCHOOLENTRY

LEAVE

SCHOOL

GRADUATIONS

BIRTH

BIRTH

YOUNGADULT

INFANT

SCHOOLAGE

ADOLESCENT

PRESCHOOL

YOUNGADULT

PGY

PGY

PGY

HIGH TRAJECTORY

LOW TRAJECTORY

OB

OB

OB

MCH Checkpoints

PROTECTIVE FACTORS:[RAISE TRAJECTORY]Born Wanted and WellSkilled ParentsHealthy HomeEarly ReadingFull Preventive CareSafe Play SpaceGood SchoolsSocial CapitalMentorsPhysical Activity

RISK FACTORS:[DEPRESS TRAJECTORY]Poverty Premature BirthIsolated Parent

Lead PoisoningPoor Nutrition

ViolenceObesityUnaddressed illnessDepression/IsolationSchool FailureTobacco/EtOH Unintended Pregnancy

AGE -,5 0 1 2 4 6 12 18 24


Sally A. is 16 years old,a Sophomore at Hope High School,

living at 454 Pine St. in Providence, who comes to Central Health Center for a

pregancy test.


We already know:Sally A. has no medical record at Central Health

Center or in KIDSNETProvidence schools have low attendance, low

graduation, and Hope High is troubledRhode Island has New England’s highest teen

birth rate, most in Providence454 Pine is the back door of Amos House


Central Health Center will offer Sally the Women’s Health Screening and Referral Program (WHSRP) while Sally waits for her pregnancy test results.

She’ll answer 19 questions about her health, reproductive past and plans, home resources, threats, and supports – all cued for action and referrals.


On the WHSRP, Sally A. tells us:• She’s uninsured, not using contraception, not

sure if she’ll keep a baby• They’re living at Amos House shelter, d/t

police drug action against her brother• She has felt depressed, worried• She has friends and family to count on• She likes school, especially the track team

Pregnancy test is negative…


MCH vectors we can address:Sally A. is given appt. for young adult checkup,

o.c.’s, and shots. Sally says she’ll bring her mother next time, and maybe talk about depression.

Central Health Parent Consultant encourages Sally’s enrollment in culinary training at Amos House, and running for Hope High.

She leaves with ample condoms for self and 2 teammates.


Sally returns with her mother and sib:

She has records at several health centers, and Hasbro Children’s Hospital

Younger sibling was hospitalized for abuse by man now in jail

Her sibs are in KIDSNET, with home visits, Early Intervention, and Pb poisoning data

Track coach helps with mood and plans


Annual school survey shows 83% of Hope High Sophomores lack adult support at school, and 35% are home alone 3+ afternoons each week

YRBS shows 30% of RI Sophs sexually active, 32% sad/hopeless x 2+weeks

WHSRP collects pre/perconception risks from 2600 low income women who will deliver in subsequent 12 months (~60% of RI low income deliveries)

MCH CheckpointsHealth Trajectory of Sally A. - 16 y.o. Sophomore

BIRTH

SCHOOLENTRY

GRADUATIONSBIRTH

YOUNGADULT

INFANT

SCHOOLAGE

ADOLESCENT

PRESCHOOL

YOUNGADULT

PGY

PGY

HIGH TRAJECTORY

LOW TRAJECTORY

OB

OB

MCH Checkpoints

PROTECTIVEFACTORS:[RAISE TRAJECTORY]Born Wanted and WellSkilled ParentsHealthy Home -Early ReadingFull Preventive Care -Safe Play Space Good Schools -+ Social Capital+ Mentors+ Physical Activity

RISK FACTORS:[DEPRESS TRAJECTORY]- Poverty Premature Birth Isolated Parent Lead Poisoning Poor Nutrition- Violence Obesity Unaddressed illness- Depression/Isolation School Failure Tobacco/EtOH ? Unintended Pregnancy

AGE -,5 0 1 2 4 6 12 18 24

SALLY A’s VISIT


Louise S. is a 24 y.o. retail workerwith 8 years of education in

the Dominican Republic,living at 774 Hope St. in Pawtucketwith her 7yo, 2yo, and relatives,

now taking home a 35 week 2155gm boy from Memorial Hospital

MCH CheckpointsSome Care Answers about Lou

[24yo Single Mother of 6, 2, and 5 d.o.]

We know:Lou attended Family Planning and full prenatal care for

first 2 children, less this timeNewborn Developmental Screening flags single parent,

limited education, LBW infant, incomplete prenatal care. Referred and accepts MCH home visit.

Both sibs are in KIDSNET, up to date on preventive and WIC services. 2yo is known to Early Intervention for hearing tests, but not active now

774 Hope St has had two previous 2yo residents with Pb levels 15-19mcg/dl

MCH CheckpointsSome More MCH Info about Lou[24yo Single Mother of 7, 2, and 2d.o.]

At first home visit we learned:1. Her 7yo is thriving in 1st grade at nearby

Cunningham School, and the 2yo attends the Child Opportunity Zone there

2. Her apartment at 774 Hope is in a clean, dilapidated “3-decker” tenement owned by a cousin, with mortgage problems

3. She’s worried about that, and her supermarket job hours will not allow her to keep all medical appointments

BIRTH

SCHOOLENTRY

LEAVESCHOOL

BIRTHS of CHILDREN

YOUNGADULT

INFANT

SCHOOLAGE

ADOLESCENT

PRESCHOOL

YOUNGADULT

PGY

PGY

HIGH TRAJECTORY

LOW TRAJECTORY

OB

OB

MCH Checkpoints

PROTECTIVEFACTORS:[RAISE TRAJECTORY]Born Wanted and Well+ Skilled Parents+ Healthy Home+ Early Reading+? Full Preventive Care+ Safe Play Space+ Good Schools+ Social CapitalMentorsPhysical Activity

RISK FACTORS:[DEPRESS TRAJECTORY]- Poverty - Premature BirthIsolated Parent- Lead PoisoningPoor NutritionViolenceObesityUnaddressed illnessDepression/Isolation- School FailureTobacco/EtOH - Unintended Pregnancy

AGE -,5 0 1 2 4 6 12 18 24

PGY

Lou S.Delivery

PGY

MCH CheckpointsHealth Trajectory vectors for Louise

[24yo Single Mother of 7, 2, and 2d.o.]

OB

OB

MCH CheckpointsSome Basic Propositions

Healthy Human Development is a long, dynamic integration of genetic, social, educational, and environmental influences.

Many developmental risks and protective factors can be recognized before conception or very early in life, and addressed then to alter developmental trajectories

Linkage of MCH system components and data can therefore have powerful impacts on outcomes for individual kids, families, and groups


MCH Checkpoints will give everyone:

• A broadened vision of all the important forces and players in healthy child development.

• Shared professional and parent language and tools for consistent recognition of development risks, assets and needs as early as possible.

• Horizontal and longitudinal information transfer among preconception, prenatal, perinatal, early childhood, and school health providers…with and through parents.


There is a short list of basic questions we all can ask at intervals along life trajectories, If we’re consistent and comfortable and caring, and if we help parents and professionals keep track of these MCH Checkpoints, we can finally “have our act together.”


How can you pull your community’s MCH Checkpoints together, to advance parents’ and professionals’ shared use of good information on healthy development?

More: [email protected]

[email protected] (KIDSNET)

[email protected] (Watch Me Grow)

MCH CheckpointsHealth Trajectory vectors for Lou[24yo Single Mother of 7, 2, and 2d.o.]

BIRTH

SCHOOLENTRY

LEAVE

SCHOOL

BIRTHS of CHILDREN

YOUNGADULT

INFANT

SCHOOLAGE

ADOLESCENT

PRESCHOOL

YOUNGADULT

PGY

PGY

HIGH TRAJECTORY

LOW TRAJECTORY

OB

OB

OB

MCH Checkpoints

PROTECTIVEFACTORS:[RAISE TRAJECTORY]Born Wanted and Well+ Skilled Parents+ Healthy Home+ Early Reading+? Full Preventive Care+ Safe Play Space+ Good Schools+ Social CapitalMentorsPhysical Activity

RISK FACTORS:[DEPRESS TRAJECTORY]- Poverty - Premature BirthIsolated Parent

- Lead PoisoningPoor Nutrition

ViolenceObesityUnaddressed illnessDepression/Isolation- School FailureTobacco/EtOH - Unintended Pregnancy

AGE -,5 0 1 2 4 6 12 18 24

PGY

Lou S.Delivery

PGY

MCH Checkpoints ’02

MCH CheckpointsSome Core MCH Questions about Sally

[16yo Sophomore at Hope High]

• What does Sally want/expect/deserve from MCH?

• Is Sally a mature and informed manager of her own (and a child’s?) needs?

• Does Sally live in a good safe place?• Does Sally have reliable family/social support? • Does Sally have significant personal health

needs?• Can the MCH system/community offer what

Sally needs? Will she engage with help?

Trajectories of Health and Child Development

Preconcept

Birth12 months

24 months

36 months

48 months

60 months

72 months

Age

Dep

end

ency

to

Pro

du

ctiv

ity HIGH TRAJECTORY

Healthy HomeAbatement

Pb Poisoning

LOW TRAJECTORY


Preconcept

Birth12 months

24 months

36 months

48 months

60 months

72 months

Age

Dep

end

ency

to

Pro

du

ctiv

ity


Pb Poisoning

LOW TRAJECTORY:RISK FACTORS:PovertyPrematurityIsolationObesityToxins

WICPrgm

Poor Nutrition

READING

Parent <9th grade

Reach Out and

Family/NeighborSupport - COZ

PROTECTIVE FACTORS:Born wanted and wellSkilled parentingSocial CapitalHealthy HomeGood Schools

Absent Parent

HIGH TRAJECTORY


Preconcept

Birth12 months

24 months

36 months

48 months

60 months

72 months

Age

Dep

end

ency

to

Pro

du

ctiv

ity


Pb Poisoning

LOW TRAJECTORY:RISK FACTORS:PovertyPrematurityIsolationObesityToxins

WICPrgm

Poor Nutrition

Parent <9th grade

Reach Out and Read

Family/NeighborSupport - COZ

Absent Parent

HIGH TRAJECTORYPROTECTIVE FACTORS:Born wanted and wellSkilled parentingSocial CapitalHealthy HomeGood Schools

READING

mch checkpoints tracking healthy development along life trajectories

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