amy fine center for the study of social policy apha – san francisco, ca october 31, 2012 role of...
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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
+
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