An Integrated Approach to Child Health Promotion

W. Douglas Tynan, PhDNemours

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An Integrated Approach to Child HealthPromotion

W. Douglas Tynan, Ph.D.

Program DirectorDecember 10, 2010

dtynan@nemours.org

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VISION - Optimal health for all children

MISSION -Working with others to help children lead healthier lives

Appropriate Nutrition

Stable, Responsive

Relationships

Foundations of Healthy Development*

Safe, Supportive Environments

* Harvard’s Center on the Developing Child

Children need consistent, nurturing and protective interactions with adults that enhance their learning, and behavioral self regulation as well as help they develop adaptive capacities that promote well regulated stress response systems.

Physical spaces promote health and are free from physical, social or emotional harm or danger, home, school and community environments.

Children need appropriate nutrients critical to health and development according to their stage of life. Achieving this is affected by a set of factors including, taste, cost, convenience and economic systems that address proximity, access, affordability, availability, familiarity, and cultural relevance.

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Childhood Factors:

Families are changing More…

– Single parent births– Parents are working more hours– Poverty, Medicaid-eligible children

Fewer…– Engaged fathers– Community connections

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Childhood Factors:

Health Environment Changing More…

– More fast food meals – Screen Time

Fewer…– Family meals– Opportunities for active play– Children getting enough sleep

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Childhood Factors:

Out-of-home care is changing More…

– Children in non-parental childcare– Time spent daily in poor quality out-of-home care

And in child care & education, less…– Opportunities for professional development or for

working full time– Adequate compensation and benefits

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Childhood Factors:

Systems of care responses are changing More…

– Demand on health & education providers to address developmental, emotional and behavioral problems

Less…– Access to effective help for parents and families, often

waiting lists or difficulty finding providers

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Childhood Factors:To summarize… Many adults and systems have a hand in raising

children: They are all of our children. Nearly all children share exposure to risk for poor

health & education outcomes As risks increase, problems increase Working with child care, education, youth serving

organizations, primary care and with parents we can reduce risk

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In the state of Delaware, approximately 37% of

children and youth have an unhealthy weight – and those rates continue

to rise

Source: Delaware Survey of Children’s Health

Numbers we hope to change

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Childhood Health Outcomes:

Numbers we hope to change Nearly one out of five parents in Delaware

reported having a child with some level of emotional or behavioral difficulty

30% of low-income preschool children have emotional and behavioral problems

40.2% of Delaware child care providers asked family to withdraw a child from their care

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STRATEGY - NHPS, in partnership with others, uses evidence-based, population-level approaches that support health promotion policies, practices, and environments to improve health behaviors and outcomes for Delaware's children. The initial focus is to prevent and reduce overweight and obesity and improve emotional and behavioral health outcomes.

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The NHPS Model: Working with Over 250 Community Partners

Our goal is to change the health status and well-being of the most children possible through the deployment of evidence based policies and practices that will have the highest sustainable impact in changing behavior with the most efficient use of resources through building permanent community capacity.

Policy and Practice Change Agenda

Community Infrastructure

Behavior Change

Healthy Children

to build and sustain

that supportsthat leads to

that evidence the usefulness of

Policy and Practice Change Agenda

Community Capacity

Behavior Change

Healthy Children

to build and sustain the

that supportthat leads to

that evidence the usefulness of

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Theory of ChangeSocial-Ecological Model of Health Behavior

Individual Interpersonal CommunityOrganizational SocietalHealth Behavior

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Societal ExamplesNational/Regional National Physical Activity Plan Delaware Valley Grantmakers Communities of PracticeState Governor Markell

– COUNCIL ON HEALTH PROMOTION AND DISEASE PREVENTION State Government Departments: Division of Public Health,

Medicaid, Department of Education, Parks and Recreation Breastfeeding Advocacy Group Bike Delaware DE Greenways

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Community/ Organizational Examples Sussex Child Health Promotion Coalition (150 member organizations) NCC Healthy Kids Network (25 member organizations) Office of Child Care Licensing University of Delaware Delaware Institute for Excellence in Early Childhood 13 School Districts 48+ Elementary Schools (PEP program) 22 primary care practices with 104 providers Triple P Level 3 Trained Providers (106 accreditations) Youth Serving Organizations (e.g. B&G Clubs, YMCA, 4H)

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Interpersonal/Family Examples

Triple P Parenting– Train providers who work with parents in schools, child

care, youth serving organizations. Just in Time Parenting Programs

– Providing new parents with monthly newsletters/information for the age of their child.

Nemours Primary Care Parenting– Training primary care providers to give effective

suggestions to parents

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Example: Building & Leveraging Community Capacity for Spread Communities

– Sussex Child Health Promotion Coalition (2006-on-going/Policy/Practice) 160 member organizations with 238 members Local leadership Significant Sussex media coverage

– Community 5-2-1-Almost None Healthy Lifestyle Trainings

– Work in Wilmington/New Castle County (2009-ongoing/policy/practice) Collaborating with existing efforts aimed at reducing health

disparities within at-risk populations Building a coordinated network of collaborative efforts with local

leaders to address the prevention of childhood obesity and comprehensive child health promotion

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Sussex Coalition Results

Grown from 45 to 238 members from all sectors of community (2006 to 2010)

Incorporated as a non-profit entity in 2009 Budget grown from $100K to over $400K Awareness of healthy lifestyle message, 5-2-1-

Almost None, increased in Sussex County (7.2% in 2006 to 35.7% in 2008)

Sponsored nine health promotion programs impacting over 20,000 children and their families

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Laying the Foundation for Future Capacity Building for Sustainable Change Strengthen targeted partners to enhance spread, intensity and

sustainability Support targeted partners in engagement of families

Place more emphasis on building comprehensive, integrated systems of care for children and their families

Maximize Nemours resources in expertise and related initiatives

Remain flexible to be respond to opportunities and threats

Continued work on long-term sustainability

More targeted evaluation and performance measurement