Spreading and Scaling Prevention and Treatment Approaches:Centers of Excellence ModelJanet E. Farmer, PhDSchool of Health ProfessionsUniversity of Missouri

Recommended Policy Actions• Prevention

• Child care licensing, training & support services• Support for school-based health and wellness

• Treatment• Medicaid reimbursement for professionals with specialized

training in family-centered, evidence-based weight reduction programs

• Prevention & Treatment Infrastructure• Centers of Excellence• Commission on Childhood Obesity

Subcommittee on Childhood ObesityState of Missouri Children’s Services Commission

Overview

• Challenges within the service delivery system

• Lessons from Autism Spectrum Disorders (ASD)

• Vision and goals for the Missouri Centers of Excellence for Childhood Obesity

The Challenge: Gaps in Care • No or low dose treatment of obesity in children, with

little or no care coordination• Health professionals lack awareness of and training in

evidence-based weight control strategies• Reimbursement is inadequate to meet the need• Traditionally underserved groups (e.g., rural, low

income) have less access to effective care• Collaborative partnerships sometimes exist, but in

general the care delivery system is fragmented

Systems of Care for Healthy Weight Children

Primary care

Child care and school services

Agency resources

Mental healthservices

Therapies

Family-to-familysupports

ChildFamily

Communityresources

Specialty care

Systems of Care for Healthy Weight Children:Key Elements

• Comprehensive

• Coordinated

• Family-centered

• Community-based

• Culturally competent

(Association of Maternal & Child Health Programs, 2014; Boudreau et al, 2014)

What Can We Learn From ASD? Children with obesity and those affected by Autism Spectrum Disorders (ASD) show similarities:

• Increasing prevalence of both conditions• Range in level of severity; often chronic and

stigmatizing• Complex etiologies that require a multi-faceted

approach to service delivery, cutting across care settings

• Growing public awareness of the unmet needs of children and families

What Can We Learn From ASD? Children with obesity and those affected by Autism Spectrum Disorders (ASD) show similarities:

• Effective behavioral treatments have emerged• Family involvement is critical• Early intervention is the best approach, but

children are often not identified in a timely way• Inadequate number of providers to meet the need

for evidence-based treatment, especially for vulnerable groups

• Readiness for change in systems of care through collaborative partnerships

Models of Care: Missouri Autism Centers (DMH)

• 2007• Children’s Mercy Hospital (University of Missouri-Kansas

City)• Knights of Columbus Child Development Center, Cardinal

Glennon Children’s Hospital (St. Louis University)• Thompson Center for Autism & Neurodevelopmental

Disorders (University of Missouri)

• 2008• ASD Diagnostic and Treatment Center (Southeast Missouri

State University)

Missouri Autism Centers

• Seek to help families • Obtain accurate and timely diagnosis• Gain access to a full continuum of care in their home communities• Coordinate care with other health and educational services

• Seek to serve the state• Building community capacity through education and training• Establishing models of quality ASD health service delivery• Aligning with federal healthcare standards

• Clinical Scope FY12• 465 children and youth evaluated for ASD• 6,737 total service visits for ASD

• Education/Training FY12• 369 students in clinical training• 137 educational presentations with 7,206 participants

Program Snapshot: MU Thompson Center

5826

1405

298

ProfessionalsStudentsFamilies

• Broader Impact FY12• Basic and clinical research on ASD• National Autism Treatment Network• Simons Simplex Collection• Federal grants to improve comprehensive and coordinated

care for those with ASD in Missouri, including early identification of those from underserved groups

Program Snapshot: MU Thompson Center

Centers of Excellence for Childhood Obesity

• Centers will forge collaborative relationships with other centers and with partners in effective prevention and treatment • Caregivers• Primary and specialty health care providers• Schools• Child care centers• Non-profit organizations• State agencies

• Centers will serve as a central point of contact and support for• Treatment delivery• Training for families, providers and communities• Research to advance the knowledge base about effective care and

service delivery

Specific RecommendationThe Missouri Department of Health & Senior Services will establish at least three university-based Centers of Excellence to:• Assure regional, coordinated access to treatment in health

care and community settings through a network of affiliated partners

• Meet standards to provide evidence-based, multi-component (EBMC) weight reduction programs

• Provide training for health care providers, school staff, and others in their region about screening, treatment, prevention and referral strategies

• Conduct research to evolve prevention and treatment best practice approaches.

Centers of Excellence Summary• Partner• Treat• Train• Advance the field• Establish a national model of care for

children, youth and families affected by obesity