Amy FineCenter for the Study of Social Policy

APHA – San Francisco, CAOctober 31, 2012

Role of the Life Course Framework for Improving Services to Children with Special Health Needs

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Presenter Disclosures

(1) The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months:

Amy Fine

No relationships to disclose

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Overview

Oct. 31, 2012A. Fine-CSSP

Key life course concepts & implications for CSHCN

Applying life course concepts CSSP’s project on life course and CSHCN,

funded by the Lucile Packard Foundation for Children’s Health

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Key Life Course Concepts –T2E2

Oct .31, 2012A. Fine –CSSP

Timeline – Today’s experiences and exposures influence tomorrow’s health

Timing – Health trajectories are particularly affected during critical or sensitive periods of development

Environment – The broader community environment –biologic, physical, and social – strongly affects the capacity to be healthy

Equity –Inequality in health across populations reflects more than genetics and personal choice

 

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Life Course and Public Health

Oct. 31, 2012A. Fine-CSSP

LC grounded in public health Key Qs

Why do health outcomes vary across population groups?

How do we optimize health across populations?

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What’s New?

Oct. 31, 2012A. Fine-CSSP

New science helps explain how social environment embeds in our bodies, and interaction of genes and environment

Timeline adds new(ish) dimension to traditional public health concerns

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LC Integrates New Science with Longstanding Public Health/Population Health Concerns

Oct.31, 2012A. Fine-CSSP

Public Health Concerns: social determinants, equity, built environment, workplace and environmental exposures

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New Science: epigenetics, early programming, impact of stress on health, neuro-plasticity

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Implications

Oct.31, 2012A. Fine-CSSP

LC suggests the need to refocus both clinical and population health

Place greater emphasis on multiple determinants of health Incorporate earlier detection of risks as well as early and timely

interventions Promote factors that protect against disease and disability and

reduce factors that place children at increased risk of poor health and development;

Shift from discrete and episodic services to developing integrated, multi-sector service systems that build health across the lifespan

Complement the dominant medical approach that focuses on individual diseases, conditions or body systems, with a whole-person, whole-family, whole-community systems approach

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MCH Life Course & CSHCN

Oct.31, 2012A. Fine-CSSP

Is LC theory too deterministic? What about kids who are born with

complex medical needs or who already have chronic health conditions?

How does LC theory speak to the needs and trajectories of CSHCN?

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MCH Life Course & CSHCN

Oct.31, 2012A. Fine-CSSP

“The development of health over a lifetime is an interactive process, combining genes, environments and behaviors.”

“Throughout life and at all stages, even for those whose trajectories seem limited, risk factors can be reduced and protective factors enhanced, to improve current and subsequent health and well-being.”

Life course concepts of equity and optimizing health across all populations important for CSHCN

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Applying LC – Action to Date

Oct.31, 2012A. Fine-CSSP

Focus on optimizing health/ healthy development in general, or on specific health conditions – obesity, low birth weight and infant mortality

LC implementation largely targeted to prevention at community or population level, addressing social/environmental causes of chronic health conditions

Examples Building Blocks Collaborative – Alameda County Health

Department Best Babies Zone Project – U.C. Berkeley + 4 Sites Healthy Eating/Physical Activity Initiative – Nemours

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Applying LC – What’s Needed?

Oct. 31, 2012A. Fine-CSSP

More on implications & potential applications for special needs children

More attention to how can LC best be applied to health care delivery system at practice level, especially for children at high risk for diminished or diminishing functioning

Strategies for bridging practice & community level LC approaches to improve health

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Applying LC – What’s Needed?

Oct.31, 2012A. Fine-CSSP

As LC theory and practice become more prominent, need to assure that CSHCN and their families can both inform and benefit from this new science and its related applications

With health systems redesign underway nationwide, it especially important that LC implementation include a focus on CSHCN, for whom the benefits of a life course approach may be greatest

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Project Focus: Key Qs

Oct. 31, 2012A. Fine-CSSP

How can LC be incorporated into pediatric health care for CSHCN and their families? What would this “look” like from the perspective

of providers and families? What policy supports would be needed?

How can LC be applied to community systems of care for CSHCN and how might health care providers best interface with these systems?

How can the life experiences of CSHCN be better integrated into LC science and theory as they continue to evolve?

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Timeline & Methods

Oct. 31, 2012A. Fine-CSSP

Timeline July 2012-November 2013

Methods Literature review (CAHMI/OHSU) Key informant interviews Interviews discussion groups with CSHCN

families Call for nominations to identify exemplary

pediatric health care practices and programs Interviews with exemplary practices and

programs

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Initial Frameworks

Oct. 31, 2012A. Fine-CSSP

T2E2+LC Implications Frame ↑ emphasis on multiple determinants of health ↑ early detection of risks & timely interventions ↑ protective/”promotive” factors ↓risk factors ↓ discrete & episodic services; ↑ integrated, multi-

sector service systems that build health across the lifespan

↑ whole-person, whole-family, whole-community systems approach (to complement dominant medical approach focused on individual diseases, conditions or body systems)

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Products

Oct. 31, 2012A. Fine-CSSP

Summary of key LC/ CSHCN literature Findings from interviews and discussion groups Succinct set of practice & policy

recommendations Incorporating LC theory into pediatric practice and

systems of care for CSHCN Incorporating needs and experiences of CSHCN into

LC science, theory, practice, and systems of care Final monograph/issue brief with key findings

and recommendations

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Thank you…

Oct. 31, 2012A. Fine-CSSP

Comments? Questions? Recommendations?

All Welcome!

Amy FineCenter for the Study of Social Policy

afinehome@gmail.com