Connected Thinking Blog - NACHRI Conferences

Comprehensive Community-based Preschool Immunization Compliance Initiative

This session was shared on Monday, March 23, by the following speakers from Advocacy & Community Affairs at Children's National Medical Center in Washington, DC:

Kimberly M. Harris, MA

Ruth Fisher, MS, MBA

This program is a comprehensive initiative developed to increase the preschool immunization compliance rate among the 0-4 year population. It was established on a three D's operational framework- Discovery, Delivery, Dissemination and worked in partnership with local Head Start Centers and Licensed Childhood Development Centers.

The program includes:

• Direct care services
• Peer provider education
• Technical assistance
• Community education

In order to gain access to the hard to reach population a mobile medical unit was developed to provide these direct care services in the neighborhoods these children reside.  Intervention sites include Head Start Centers, Licensed Child Development Centers, Community Health fairs, and some other non-traditional sites such as apartment complexes and homeless shelters. This mobile unit is called the Dr. Bears Express Mobile unit and is designed to focus on not only well-child care exams and immunizations, but go beyond that with the idea of covering a wide variety of health and safety services. An example of their planned expansion is to eventually include a dental health services component called- Health Teeth Project.

Dr. Bear's Express Mobile Unit is equipped with a laptop, printer and broadband card in order to give staff real-time access to the state immunization registry. With this capability, they can look up a child's immunization record so appropriate care may be provided. Another aspect of this program is that not only are they providing direct patient services to these children but they are able to help link children with managed care organizations back to their PCP's for further care. If the family does not have a PCP or health insurance, they are provided assistance with applying for it.

Program outcomes:

For the 0-4 year population compliance rates went from approximately 72% in 2006 to 93% in 2008, and for the 5-18 year population compliance rates went from approximately 96% in 2006 to 98% in 2008.

Barriers included, but not limited to:

• Untimely submission of vaccinations to the Immunization Registry
• Site staff was unaware of record submission process
• Frequent changes to the Immunization schedule

Lessons learned included, but not limited to:

• Buy-in from executive leadership of partner institutions is essential to acquire effective results
• Appropriate staffing is necessary including back up nursing staff for the moblie unit- do not rely on temporary staffing agencies for this

As an attendee of this session I felt that this program appears to be highly replicable with the right partnerships and funding.

Another exciting resource from NACHRI and the Obesity focus group

Hello, all.  I am Sandra Allen with Le Bonheur Children's Medical Center in Memphis.  On Monday I attended a workshop on the Obesity FOCUS Group. Although my work focuses primarily in the area of child maltreatment prevention and intervention, I was very excited to learn about this project and the efforts of this group. This group is working on developing guidance for children hospitals about developing obesity programs. They are starting to post some of their work on the NACHRI home page. Just like the Defining the Children's Hospital Role in Child Maltreatment has been a great resource, I am sure that this focus group will provide us with other great resources.

Kidz Bite Back Session

The Kidz Bite Back: A Unique Approach to Childhood Obesity Prevention session by Melanie Hall  and Dewey Caruthers of St. Joseph's Children's Hospital of Tampa really is a unique way of reaching 4th and 5th graders.

Everyone knows that obesity is a huge problem among children.  St. Joseph's approached the problem in a  new way - they used a counter-marketing campaign.  The campaign is intended to run counter to advertising being aimed at children from fast food and television/video game industries.  They focused on measurable outcomes using research and formal evaluation of the program.  The best part of the campaign is their use of peer-to-peer communication  - they targeted their audiences in their natural setting.

St. Joseph's research showed that 4th and 5th graders look up to their paretns and teachers; they are role models and must be included in the campaign. 

The first year of Kidz Bite Back began last year in the middle of the school year and included a pre-and post test for students, teachers, principals and parents.  Their results showed decreased perception of the "Big Fat Industries" or fast food companies and "Couch Potato Companies" or tv/video companies; but interestingly showed a slight increase or steady consumption of fast food and soft drinks.  Teachers and parent interviews attributed that result to increased awareness of kids' consumption. 

The campaign itself is very clever. 

• Train the trainer
  •  Kid advocates and teacher liaision
• Kick off summits
  •  Kids do the training themselves with the material
• Gear incentives
  •  t-shirts
  • string backpack
  • "hand" book
  • promo items
  • Little Blue Book
  • Parentz guide
• Media campaign at schools
  •  tv ad/video for school channels
  • print ads
  • poster contests
• Video contest
  •  Top 5 voted online
  • Kids post themselves
• Dirt Ball (very popular)
  •  clean ball game
  • rules are:
    •  get it dirty
    • snap it (photo)
    • tell it (blog)
    • pass it on
  • focusing on non-athletes and shy children getting active

The campaign has already been in 16 schools and is a collaboration with health departments, schools, health partners.  Plans are underway for expansion to two more Florida counties; more partners coming on board all the time

Parents Step Up, a parental accountability program, is next on their agenda.  Great job on a unique solution to a major problem!

Safety Stores--best practices in PR & Marketing

Greetings to all who are interested in getting the word out about your safety stores.  I led an interactive, workshop-style session, immediately following the panel discussion of hospital-based safety stores.  Children's Hospital of Orange County is one of 10 NACHRI hospitals augmenting their injury prevention education by selling child safety products.  Since our program is in its embryonic stages, I wanted input on best practices.  We approached the topic with a communication plan structure.  Following are our thoughts from the session, and I invite you to add to these.  Jan Lansing, CHOC

Communication Objectives

• Generate traffic
• Encourage staff interaction

We also discussed a few risks that might accompany wildly successful promotion of the safety stores:

• Overwhelmed with interest and traffic
• Giving the impression that the hospital safety store = typical retail (it's definitely not)
• The location might not be readily accessible to customers
• Sales and education may put the hospital at risk (financial and reputational) due to inaccurate education and product recalls.  And, the store may be a financial drain (poor margins and high volume exacerbates the problem)

Target Audiences

We can reach out and communicate to:

• Daycare centers
• Schools
• CPR centers
• Hospital staff
  • Trauma staff
  • Residents/fellows
  • Nurse practitioners
• Baby Registries
• Birthing centers
• Physician educators

Communicate in multiple languages, of course.

Messages/Tactics

We agreed that since injury prevention education is so crucial, the sale of products needs to always link to that education.

Here are some of the tactics we discussed--ways you can leverage the distribution and promotion of the stores within your hospital:

• Be mobile within hospital – flex your locations to Ortho clinic or the ED, for example
• Use plasma screens around the hospital to promote
• Use your website, of course

Then, consider these external opportunities:

• Partner with Scholastic magazines & books, Babies R Us
• Birthing centers/adult hospital
• Integrate with Prenatal Education at those birthing centers.  Provide a "prenatal binder" that includes injury prevention/safety messages with other education, and promote the store there.

Final note:  We agreed that safety stores should not carry a separate brand.  Use the hospital brand to maintain the masterbrand's consistency and integrity.

Teaching Weight Management on a Slim Budget

With obesity front and center as public enemy number one -- at least in most media coverage of child health issues -- it's amazing how hard it can be to implement a weight management program to help guide children into a healthy lifestyle. The problem of course is money. Insurance isn't paying for obesity prevention or obesity management efforts, and few hospitals have the resources to feed money into a program that seems "optional" and is almost certain to lose money.

At Children's Hospital of the King's Daughters in Norfolk, VA, Barbara (Babs) Benson took it upon herself to put together a low-cost weight management program back in 2001. Her strategy for keeping costs low has been to do most of the work herself on a 30-hour-a-week salary, and to borrow everyone else as needed from other programs in the hospital.

She spends a lot of her time and energy to network, network, network. It's been her key to succeeding and growing the program. She serves on community boards related to children's health, volunteers through her program role to help at YMCA events, nurtures relationships with local media, and anything else she can think of to build mutually supportive relationships within the community. She has established herself -- and her program -- as community experts on child health and weight management, and that has created a lot of unexpected opportunities.

Babs teaches the 10-week weight management program to children ages 8-11 in sessions twice a week -- one lifestyle class and one exercise class -- and parents are required to attend. Getting parents involved has been one of the most successful aspects of the program, because it helps teach the entire family about better health and helps children see their parents are invested in improving their lives; the parents often lose weight, too.

Approximately 900 children have participated in the program since it started in 2001. The program has an annual budget of ~$100,000, which it meets. Thanks to early successes, Babs was able to bring on a half-time licensed clinical social worker to help her -- they are the only two paid staff.

Thirty-five percent of students are regular enrollees, charged the full $350 fee; 50 percent of enrollees are from families on Medicaid and are charged only $35; the remaining 15 percent of enrollees are charged an intermediate amount, based on need. Historically, about 75 percent of enrollees fulfill their financial obligation -- the 25 percent who default are never penalized (though this policy is not made public to students). Through experience, Babs learned it was necessary to charge Medicaid families some amount of money to ensure their commitment to the program -- when they offered it for free, more than half the students didn't show up.

Babs -- through her first-hand experience -- has a lot of solid advice to offer and a lot of proven success. The program has received a $60,000 grant to replicate itself in nearby Williamsburg, VA, and a $25,000 grant to fund a publication helping educate children on successful weight management. Babs says, "It's not about money, it's about doing what is right for our children."

The biggest drawback to the program has been its lack of any long-term metrics or follow-up studies to show the efficacy of the program. Short term, patients have seen small, but statistically significant improvements in the body mass index (BMI), but there is no evidence to show that they continue to make improvements after they complete the program. Babs has had trouble convincing people to return after the program for follow up assessments.

When the major focus of weight management education is enabling children to live healthier lifestyles, hopefully forestalling long-term health problems of diabetes, hypertension, joint injury, heart and liver disease, etc., there needs to be an evidence-based case that shows that education has a long-term effect on children's health. Because it will take evidence-based, long-term studies to make the case for other hospitals to implement similar programs and for insurance companies and government legislation to provide incentives for prevention and early intervention.

Listen to the audio recording. (MP3, 57 MB)

What do you think? What weight management initiatives exist in your area and what results have you seen that will help make the case for early intervention and prevention of childhood obesity?

NACHRI Selects Six Hospitals for 100K FEMA Grants

NACHRI selected six children’s hospitals to each receive a $100,000 grant to integrate the Safe Escape Program into newly established or expanded hospital-based safety stores. The six recipients are:

1. University of Iowa Children's Hospital, Iowa City, IA
2. Children's Hospital of Michigan, Detroit, MI
3. St. Louis Children’s Hospital, St. Louis, MO
4. Rainbow Babies and Children’s Hospital, Cleveland, OH
5. Legacy Emanuel Children’s Hospital, Portland, OR
6. Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, TN

These hospitals will develop or enhance their safety stores to meet the mission of the Safe Escape Program, offering families of children with disabilities and special health care needs education, information and equipment to prepare for safe escape during emergencies.

“The Safe Escape Program grants will impact families directly who have children with special health care needs or disabilities,” said Lawrence A. McAndrews, president and CEO of NACHRI. “Parents who are reached through the Safe Escape Program at the six selected children’s hospitals will have greater peace of mind knowing that they can safely evacuate their children in an emergency.”

Pioneered by Riley Hospital for Children in Indianapolis, in its hospital-based safety store, the Safe Escape Program at Riley’s has helped over 1,150 families of children with special needs with adapted fire safety products to help support safe escape in fires.

Several “saves” also have been documented as a direct result of families having access to safety equipment and injury prevention education. Riley will provide training and technical assistance for the six grant recipients.

Each of the six new or expanded stores will be unique to its children's hospital and reflect the specific needs of the local population based on a risk analysis of its inpatient and outpatient visits. The analysis will determine patterns of unintentional injury and injury-related death in its service areas and drive the development of the safety store, its educational support and tools, data collection, product inventory and an evaluation plan for the project.

Through the Safe Escape Program, families meet with a trained hospital staff member to assess their home life, emergency evacuation concerns and their children’s health condition. The hospital staff member helps the families select products that would address their concerns and are taught how to use equipment effectively to maintain their family safety.

The Safe Escape Program grants were made possible by a $1 million grant awarded to NACHRI by the U.S. Department of Homeland Security under the Federal Emergency Management Agency’s (FEMA) Assistance to Firefighters Grant program — Fire Prevention and Safety Grant number EMW-2006-FP-02952. The six finalists were selected from among 44 applications by a panel of eight reviewers, experts in the field of injury risk and prevention.

Holtz Children's Hospital Tour Showcases Injury Prevention Bus

With three health education staff and one driver/car seat inspector, Holtz Children's Hospital's injury prevention bus is in the field four days each week training parents and care providers how to keep children safe.

Using custom-designed exhibits, Holtz pediatrician Dr. Julie Belkowitz, tested the knowledge of tour participants in common household situations. Luckily, most of us did the "right" thing, such as removing stuffed animals and blankets from the crib and moving the pan to the back burner of the stove, but I have to admit that when Julie asked for somone to answer the ringing phone when she was simulating giving a child a bath, I said, "Sure," leaving the scene -- BIG no-no. I thought it was a real phone ringing, but she was creating simulated distractions using a control panel by the bathtub to create a true teachable moment.

The parents and other care givers who usually go through the tours also are given a survey to test their knowledge at the beginning and the end of the tour. They can purchase several of the demonstrated safety devices, and receive a free choke tube and safety brochures. Holtz stresses, however, that no safety device could ever replace good supervision.

Holtz also has all its residents go through safety training as part of their behavior and development rotation.

For more information on this program, contact Gayane Stepanian, director of community affairs at gstepanian@jhsmiami.org.