Health Equity and Young Children: The Imperative and Opportunity to - - PowerPoint PPT Presentation
Health Equity and Young Children: The Imperative and Opportunity to Achieve the Triple Aim: Georgia Edition Angelica Cardenas-Chaisson, Kelly Perez, and Gerrit Westervelt BUILD Ini?a?ve and Child and Family Policy Center April 2014 THE
Angelica Cardenas-Chaisson, Kelly Perez, and Gerrit Westervelt BUILD Ini?a?ve and Child and Family Policy Center April 2014
Health Equity and Young Children: The Imperative and Opportunity to Achieve the “Triple Aim”: Georgia Edition
Of all the forms of inequality, injus4ce in health care is the most shocking and inhumane.
We cannot allow the color of a child’s skin
Health’s defini.on of child health and health equity
Child health is a state of physical, mental, intellectual, social and emo.onal well-being and not merely the absence of disease or infirmity. Healthy children live in families, environments, and communi7es that provide them with the
World Health Organiza7on Health equity is achieving the highest level of health for all
avoidable inequali7es by equalizing the condi7ons for health for all groups, especially for those who have experienced socioeconomic disadvantage or historical injus7ces. – Healthy People 2020
Equity versus Equality – More Than “Equal Treatment”
Health’s Role in Early Childhood: The Intersec7on of Health Equity and Social Readiness
A mother brings her one-year-old in for a check-up and it’s clear that the mom is stressed, if not depressed, and shows little sign of responding to the child’s cues for attention. While the child isn’t “diagnosable” today, if things proceed as the primary health practitioner expects, in two years there will be significant indicators of development delay and likely social and emotional problems, including a DSM-IV diagnosis. The primary health practitioner does not want to wait two years to take action and the mom seems receptive to receiving help. At the same time, pointing out problems without offering help could be considered malpractice.
1. Our youngest are our most diverse and most in need 2. The first years are the most cri5cal to lifelong health (but where we invest the least) 3. Child health is in jeopardy 4. Health dispari5es are profound and preventable 5. Affec5ng the health trajectory is essen5al to future health
1. Health prac++oners have key roles to play in early and effec+ve response 2. There are exemplary programs upon which to build 3. These exemplary prac+ces can become the rou+ne standard 4. Neighborhoods ma=er too 5. Investments pay off– and must be financed for the long-term
Georgia Racial/Ethnic Information By Age
Source: United States Census, 2010 American Community Survey
Source: United States Census, 2010 American Community Survey
Georgia Poverty/Income Level by Age Group
condi9ons
life, stress, social exclusion and social support – all related to health equity (70% of total)
– life-course model – pa5ent-centered care – an5cipatory guidance – developmental screening/surveillance – child health outcomes
– Social gradient – Early life – Stress – Social exclusion – Social support
– ecological, whole child approach – family-centered services – family engagement – early iden5fica5on and response – domains of school readiness
– Concrete services in 5mes of need – Knowledge of child development – Resilience – Inclusive ac5vi5es for children – Social 5es and connec5ons for parents
BUILD Initiative. Early Learning Left Out (2013).
Per Child Expenditure by Age Group as % Per Child (6-18) Expenditure
US GA Per child (0-2) Exp as % Per Child (6-18) 7% 6% Per Child (3-5) Exp as % Per Child (6-18) 25% 27% Per Child (0-5) Exp as % Per Child (6-18) 16% 17%
For the first time in our country’s history, children face the prospect of growing up less healthy and living less long lives than their parents– not because of medical care but due to demographics, social determinants, and exercise, nutrition, and obesity.
Select Child Health Dispari/es by Race and Income
Race/Ethnicity Child Poverty1 25-34 year-olds with Associates Degree or Higher2 Children in Single Parent Families3 Teen Birth Rate (per 1,000)4 Hispanic 43% 13% 28% 59 White, non-Hispanic 15% 42% 20% 29 Black, non-Hispanic 40% 29% 57% 48
Georgia Family Demographics
* = estimates based on sample sizes too small to meet standards for reliability or precision S = estimates suppressed when the confidence interval around the percentage is greater than or equal to 10% points 1. http://www.childrensdefense.org/child-research-data-publications/state-of-americas-children/ 2. http://dashboard.ed.gov/statecomparison.aspx?i=o&id=0&wt=40
Race/Ethnicity Live in an Unsupportive Neighborhood Fair/Poor Maternal Mental Health Parents are Usually or Always Stressed about Parenting Hispanic 25% 10% 16% White, non-Hispanic 11% 8% 9% Black, non-Hispanic 26% 9% 16%
Georgia Family Concerns and Stressors
http://www.childhealthdata.org/browse/survey
Race/Ethnicity Concerns About Child’s Development1 Low – Birthweight2 Percent Proficient
Grade Reading NAEP Assessment3 Hispanic 57% 6% 24% White, non- Hispanic 35% 7% 45% Black, non- Hispanic 38% 13% 20%
Georgia Child Outcomes
*= estimates based on sample sizes too small to meet standards for reliability or precision 1 http://www.childhealthdata.org/browse/survey 2 http://www.cdc.gov/nchs/data/nvsr/nvsr61/nvsr61_01.pdf 3 http://nces.ed.gov/nationsreportcard/naepdata/report.aspx
Source: BUILD Ini0a0ve and the Child and Family Policy Center (February 2013
Improving children’s health and reducing health, social, and educational disparities is key to Georgia’s future development and well-being. It is critical important to look to the earliest years of life for oppor- tunities to improve health equity.
The mother comes in with her child for the 36-month well-child visit. Her daughter is looking forward to coming, knowing she will receive a free book and excited to tell the nurse she will be going to Head Start next month with her best friend from the Hispanic family
family day-care home, and a set of questions for the practitioner about her daughter, who’s already starting to read but mixing up letters, and is wondering if there might be dyslexia. The mother is in a mutual assistance group with other parents and wants help from the practitioner in getting more dentists who will serve children in their community.
ACA: The law of the land. EXPECTATIONS FOR WELL-CHILD
CARE, TO IDENTIFY AND BE AT LEAST FIRST RESPONDERS TO:
development
Health Leads
Child Health Prac..oner
Developmental surveillance and screening An.cipatory guidance Referral for “medically necessary” services Referral to care coordina.on
Care Coordinator/Networker
Mo.va.onal interviewing and whole child/family approach to iden.fy further needs/opportuni.es Iden.fica.on of available services and supports which can meet those needs Connec.on to services (referral/scheduling/follow-up/prac..oner no.fica.on of ac.ons)
Community Service Maven (Community u.lity)
Georgia Data: Primary and Preven/ve Health Services for Children (0-5) US GA Child reported as having some form of health insurance coverage 94.5% 92.8% Child reported as having preven<ve, well-child visit in past 12 months 84.4% 81.1% Child reported as having coordinated, ongoing comprehensive care within a medical home 54.4% 51.7% Child reported as having been screened for being at risk of developmental, behavioral, and social delays, using a parent-reported screening tool during a health care visit (10 months to 5 years only) 30.8% 40.8%
Source: National Survey for Children’s Health 2011-12
1. Crea%ng Awareness of the Need for and Ability to Change 2. Promo%ng/Incen%vizing New Prac%ce and Inves%ng in Innovators and Innova%on 3. Developing Mainstream Management, Financing, and Accountability Systems to Make Exemplary Prac%ce the Norm
Through Medicaid
PARTICIPATION IN MEDICAID AND EPSDT BY CHILD AGE (416 FORMS AND ACS DATA) – US and Georgia 2011 US GA 0-2 Medicaid/EPSDT Enrollment of all 0-2 year olds as percent
56.0% 72.0% Average Number of EPSDT Visits Annually for Enrolled Child 2.2 2.23 3-5 Medicaid/EPSDT enrollment of all 3-5 year olds (416/ACS) 51.5% 57% Average Number of EPSDT Visits Annually .71 .64 6-17 Medicaid/EPSDT Enrollment of All 6-17 year-olds (416/ACS) 35.6% 43% Average Number of EPSDT Visits Annually .42 .35
Most Vulnerable Tracts All U.S. Tracts Richest in Young Children (% of popula7on under 5) 9.2% 6.8% Most Racially/Ethnically Diverse (% of popula7on of color) 82.6% 30.2% Most in Need of Public Investment (ra7o of working age to dependent age popula7on (18-64 to rest) 1.40:1 1.64:1
Need for Family-Centered Health Homes and Neighborhoods – Village Building Places/Loci
Percent of Children Living in Census Tracts at Different Poverty Levels
US GA 40% or above 4.1% 3.8% 30-39.9% 6.5% 7% 20-29.9% 14.2% 19.7% 0-19.9% 75.2% 69.5%
Source: US Census Bureau, 2006-2010 American Community Survey
U.S. Georgia Children living in areas with 30% of residents or more 11% 11% living below the poverty threshold, 2006-2010
Source: Kids Count Data Snapshot on High-Poverty CommuniOes 2012
Young Child Child-Adolescent Adult Health Costs Preventable injuries Trauma-induced treatment Preventable injuries Trauma-induced treatment Psychiatric care Type 2 diabetes Other emerging health conditions All adult health conditions (ACEs) Costs from risky lifestyles (smoking, drug involvement, etc.) Offspring health risks Other Costs Child welfare/foster care Special education Child welfare/foster care juvenile justice Grade retention Public welfare Lost earnings/taxes Criminal justice involvement Offspring at high-risk
Es>ma>ng the Benefits of Investments and Health and Other Dividends
investment: high multiples (5:1 to 20:1 +), increasing with time
investment: 3-10 years
Health Equity… and Three Things We Need to Do with What We Know
and the Young Child PopulaJon
Building: Addressing Racial DispariJes in Healthy Child Development
impac+ng lifelong healthy development
“triple aim” of improved health services, improved popula+on health, and reduced per capita health care costs
developmental, and ecological/family-centered
because they are not current drivers of health costs
results through innova2on and diffusion (COIN)
innovators and experts in the field to state/community policy makers
within states to develop policy approaches to further build the field
aHen2on, investment, and response to young children and health equity
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The Fifty State Chart Book provides detailed information on the indicators listed below: 1. Racial and Ethnic Population of Children in the United States 2. Young Child Poverty Levels by Race and Ethnicity 3. Maternal Education Attainment for Women Age 16 and Over with Children 0- 5 4. Low Birthweight by Race and Ethnicity 5. Infant Mortality Levels by Race and Ethnicity 6. Late or No Prenatal Care by Race and Ethnicity 7. Health Insurance by Race and Ethnicity 8. Access to Medical Home by Race and Ethnicity 9. Immunization Rates for Children 19-35 Months 10. Percent of Children Having Well-Child Visits 11. Children 10 Months to 5 Years Screened for Developmental, Behavioral, and Social Delays 12. Percent in Part C by Race and Ethnicity 13. Children Under 6 Years Exposed to Risk Factors 14. Mothers’ Mental Health by Race and Ethnicity 15. Neighborhood Safety by Age and Race and Ethnicity 16. NAEP 4th Grade Reading Proficiency Scores
Gerrit Westervelt, Director
BUILD Ini.a.ve www.buildini.a.ve.org
Kelly Perez, Director of Race and Equity Ini.a.ves BUILD Ini.a.ve kperez@buildini.a.ve.org Charles Bruner, Director
Child and Family Policy Center: www.cfpciowa.org
Mary Nelle Trefz and Angelica Cardenas-Chaisson
Center for Health Equity and Young Children: mnt@cfpciowa.org; acardenas@cfpciowa.org