Hea ealt lth h Equ quit ity an and You d Young ng Chi hild - - PowerPoint PPT Presentation

David d W. Willis, s, M.D., , FA FAAP AP

Dire rector ctor of th the Divisi ision

• n of H

Home me Visiting ng and Early ly Childhood ldhood System ems s (DHVECS) ECS) Materna ernal and Child d Health th Bureau eau Heal alth th Resou

• urces

rces and Se Servic vices s Ad Administrat nistration ion Departme partment nt of Health h and Human an Services vices

Hea ealt lth h Equ quit ity an and You d Young ng Chi hild ldren en: : Overv ervie iew w of

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eder eral al an and St d Stat ate e Con

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BUI UILD: D: He Health Equity and Young Ch Children Co Confere rence nce May 30, 2013

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Ta Take ke Ho Home e Mes essages sages

• Building health and health equity are key MCH

strategic priorities

• The emphasis on the Prenatal-to-Three period is

required for building health and education readiness for the next generation of children

• The ACA and the President’s Early Learning

Agenda have created an unprecedented

• pportunity united and coordinated with

unified vision

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A A League gue Ta Table le of f Child ld We Well-Being

• Being

Source: UNICEF, 2013

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Health inequalities can be seen as

an outcome of… Social Inequalities

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Wh What at cau auses ses he heal alth th ine nequities? quities?

“The social determinants of health are mostly responsible for health inequities - the unfair and avoidable differences in health status seen within and between

• countries. The structural roots of health inequities lie

within education, taxation, labor and housing markets, urban planning, government regulation, health care systems, all of which are powerful determinants of health, and ones over which individuals have little or no direct personal control but can only be altered through social and economic policies and political processes.”

WHO Commission on the Social Determinants of Health 5

“Social Determinants of Health”

Social-Physi hysica cal-Eco Econom nomic-Servi Service ces s Determ rmina nant nts s

• Income & income

inequality

• Education
• Race/ethnicity/gender &

related discrimination

• Built Environment
• Stress
• Social support
• Early child experiences
• Employment
• Housing
• Transportation
• Food Environment
• Social standing

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Differential Universality

On average, disadvantaged children (neighborhoods) have poorer outcomes. However, most vulnerable children are in the populous middle class.

Socioeconomic Disadvantage Socioeconomic Advantage

Clyde Hertzman, MD 7

Ge Genetics:Orchid-Dande netics:Orchid-Dandelion lion Hyp ypothesis

• thesis

“Biological Sensitivity to Context”

• W. Thomas

mas Boyce ce, , M.D., 2008

• Plasticity hypothesis, sensitivity hypothesis, or

differential-susceptibility hypothesis

• Gene x Environment Interactions
• Gene variants (orchid genes)
• SERT gene – depression/anxiety – 25% population
• Alleles:
• S/S, S/L
• L/L
• DRD4 gene – externalizing behaviors and antisocial risk, ADHD, risk –

20% population

“Risk becomes possibility” “Vulnerability becomes plasticity and responsiveness”

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Wilkinson & Pickett, The Spirit Level

Index of:

• Life expectancy
• Math & Literacy
• Infant mortality
• Homicides
• Imprisonment
• Teenage births
• Trust
• Obesity
• Mental illness

– incl. drug & alcohol addiction

• Social mobility

www.equalitytrust.org.uk

Hea ealt lth h an and s d soc

• cia

ial l pr prob

• ble

lems ms ar are e wor

• rse

e in in mo more e un uneq equa ual c l cou

• unt

ntri ries es

Index of health and social problems

10 Significant Adversity Supportive Relationships, Stimulating Experiences, and Health-Promoting Environments Healthy Developmental Trajectory Impaired Health and Development

Tr Traditional ditional Fr Framework ework Gu Guiding ding E Early ly Childhood ildhood Policy icy and Practice tice

Source: Harvard

Environment of Relationships Physical, Chemical & Built Environments Nutrition Gene- Environment Interaction Physiological Adaptations & Disruptions

Biological Embedding During Sensitive Periods Cumulative Effects Over Time

Foundations of Healthy Development and Sources of Early Adversity Health- Related Behaviors Educational Achievement & Economic Productivity Physical & Mental Health Lifelong Outcomes

How Early Experience Gets Into the Body A Biodevelopmental Framework

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12 A large portion of many health, safety and prosperity conditions is attributable to Adverse Childhood Experience. ACE reduction reliably predicts a decrease in all of these conditions simultaneously.

POPULATION ATTRIBUTABLE RISK

Social- economic environment Genetic, Prenatal and Neurodevelop- mental Factors Attachment and Relational Patterns (ACE Scores)

LI LIFE FE CO COUR URSE SE

Drivers ivers of

• f Dev

evel elop

• pmen

mental tal Traj ajec ectori tories es

• Neurodevelopmental
• Social-economic
• Relational

Relational Health

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Re Relat ational ional He Heal alth

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We’re in the “building health and developmental assurance” business…

Physical health Developmental health Relational health

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“Innovation lies at the intersection between tween early ly ch childhood ldhood sy syst stems ems and child health”

Jack Shonkoff, M.D, 2011

Harvard’s Center on the Developing Child

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17 New Protective Interventions

Bui uild ldin ing g an an En Enha hanc nced ed The heor

• ry of
• f Cha

hang nge tha e that t Bal alan ances es Enr nric ichmen hment t an and P d Prot

• tec

ection tion

Significant Adversity Healthy Developmental Trajectory Supportive Relationships, Stimulating Experiences, and Health-Promoting Environments

Source: Harvard Center on Developing Child

Pediatric and OB Practitioners CHC’s Economic Assistance (TANF, WIC, Foodstamps) Child Care Centers Head Start Family Resource Centers Others CBO’s

An n Ear arly ly Chi hild ldho hood

• d Syste

stem

Families

Home Visiting Programs Subsidized Child Care Early Interv.

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Birth

Early Infancy Late Infancy Early Toddler Late Toddler Early Preschool Late Preschool

Age

6 mo 12 mo 18 mo 24 mo 3 yrs 5 yrs

Developmental Progress

St Strategies ategies to to Im Impr prov

• ve

e Dev evelo elopmen pmental tal Traj ajec ectories tories

“At Risk” Trajectory “High risk” Trajectory “Healthy” Trajectory

What will push children in red and yellow categories towards green?

Reading to childx Pre-school Appropriate Discipline Health Services Anticipatory Guidance Parent Responsiveness Language Stimulation High quality ECE Home visiting Specialized services

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MIE IECHV CHV

Maternal Infant and Early Childhood Home Visiting

• Section 2951 of the Affordable Care Act of 2010
• Amends Title V of the Social Security Act to add

Section 511: Maternal, Infant, and Early Childhood Home Visiting Programs (MIECHV)

• A collaboration between MCHB and ACF
• $1.5 billion over 5 years
• Grants to states
• 3% set-aside for grants to Tribes & Tribal Organizations
• 3% set-aside for research, evaluation, and TA)

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MIECHV IECHV Op Oppo portunities rtunities

• Advance the field of maternal and early childhood

heath and development

• Translate science into policy
• Demonstrate a data collection framework to drive

Quality Improvement practices

• Impetus for frontier, rural and urban infrastructure
• Catalyst for collaboration and partnerships
• Systems integration of HV with early intervention
• Early Childhood Comprehensive Systems (ECCS)
• Medical home
• Early child care and education

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MIE IECHV CHV Pri riority

• rity Pop
• pula

ulations tions

• Families in at-risk communities
• Low-income families
• Pregnant women under age 21
• Families with a history of child abuse or neglect
• Families with a history of substance abuse
• Families that have users of tobacco in the home
• Families with children with low student achievement
• Families with children with developmental delays or Disabilities
• Families with individuals who are serving or have served in the Armed

Forces, including those with multiple deployments continued 23 23

Ho Home me Visiting siting Pro rogram gram Go Goal als

Improvements in:

• Prenatal, maternal, and newborn health
• Child health and development, including the

prevention of child injuries and maltreatment

• Parenting skills
• School readiness and child academic achievement
• Family economic self-sufficiency
• Referrals for and provision of other community

resources and supports Reductions in crime and/or domestic violence

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AA AAP P Bu Buil ildi ding ng Br Brid idge ges Am Amon

• ng

g Hea ealt lth h an and d Ear arly ly Chi hild ldho hood

• d Systems

tems Proj

• jec

ect t 2 201 013 Goals

• Establish collaborative leadership for EBCD

message carrying

• Emphasize the importance of “First 1000 Days”

across all EC systems

• Establish collaborations that yield linkages

between expanding medical home and EC activities and programs

• Focus on “crossing the data divide” and

intentionally building health and developmental capacity

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5 Cr Critical cal Co Components nts  Medical Homes/ Health Care  Early Care and Education  Social-Emotional Development/Mental Health  Family Support Services  Parent Education

EC ECCS S Critica itical l Com

• mpo

pone nent nts

Ne New w EC ECCS CS Gr Gran ant Op Oppo portunity unity

• Requires:
• Partnership with Early Childhood System teams

and, preferably, state AAP Chapter

• Strategy choices:
• Mitigation of toxic stress and trauma in infancy

and early childhood

• Coordination of the expansion of developmental

screening activities in EECC settings

• Improvement of state infant/toddler child care

quality initiatives by incorporating 10 or more Caring for Our Children: National Health and Safety Performance Standards

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Br Breakthroug eakthrough h Ea Early y Childhoo ldhood d Ac Acti tivities vities

• Project LAUNCH (SAMHSA)
• MIECHV (Maternal Infant and Early Childhood Home Visiting)
• Help Me Grow
• ECCS (Early Childhood Comprehensive Systems)
• Race to the Top States
• TECCS (Transforming Early Childhood Community Systems)
• Place- Based Initiatives
• California: First 5 Alameda County, Magnolia Place
• Children’s Service’s Council Palm Beach County
• Promise Neighborhoods (US Department of Education)
• Magnolia Place

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Pr Project ct LAU AUNCH: Dual Fo Focus: s: Sy System ems s Change

Forging partnerships: public, private, parents Uniting around a common vision for young child wellness Scanning, planning, and evaluating progress Improving policies and practices, smart spending, integrated data systems and common outcomes Young ng Child ld Wellness llness Counci ncils ls

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Ne New w Op Oppo portunities rtunities fo for r Co Collaborative llaborative Par artners tners

Yi Yiel elds ds ne new pa partn tners ers an and i d inn nnov

• vat

atio ion

• Health Reform
• Trauma informed systems / ACE scoring
• Triple Aim
• Information technology / unified data sets
• ReadyNation – ROI, workforce development
• Early education readiness as health outcome

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Th The e Fi Five e Co Cond nditions itions of

• f

Collective llective Im Impact act Succ ccess ess

• Common agenda – shared vision
• Shared Measurement – collecting data and measuring

results consistently

• Mutually Reinforcing Activities – differentiating while

still coordinated

• Continuous Communication – consistent and open

communication

• Backbone Organization – for the entire initiative and

coordinate participating organizations and entities

Source: J. Kania and M. Kramer, 2011

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It’s all about:

• Building health, First 1000 Days
• “Building brains, forging futures!”
• The earliest relationships and their sturdiness
• Breaking the generational transmission of abuse, ACE

transmission and toxic stress mitigation

• Partnerships and shared values of communities of all

agencies that becomes a collective impact approach

• A culture of quality, measurement and accountability
• Population approaches and management upstream
• Driving innovation in all we do
• Proven, wise and sustainable investments for young

children’s future

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Take Home Messages

• Building health and health equity are key MCH

strategic priorities

• The emphasis on the Prenatal-to-Three period is

required for building health and education readiness for the next generation of children

• The ACA and the President’s Early Learning

Agenda have created an unprecedented

• pportunity united and coordinated with

unified vision

34

Co Contac ntact t In Info formation rmation

David W. Willis, MD, FAAP

Director, Division of Home Visiting and Early Childhood Systems Maternal and Child Health Bureau, HRSA 301-443-8590

dwillis@hrsa.gov

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