Strategies for Scaling Effective Family-Focused Preventive Interventions to Promote Children's Cognitive, Affective, and Behavioral Health Workshop Summary (2014) / Chapter Skim
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3 Emerging Settings for Implementing Family-Focused Preventive Programs
3 Emerging Settings for Implementing Family-Focused Preventive Programs
Pages 19-34
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From page 19... ...
PEDIATRIC SETTINGS Healthy Steps Healthy Steps is an evidence-based program of primary health care for infants and young children initiated by the Commonwealth Fund in 1995. Healthy Steps focuses on promoting the emotional well-being of infants and young children and preventing mental health concerns.
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Additional optional home visits are also offered if needed. Kaplan-Sanoff emphasized, "Home visits are encouraged but optional because our goal is to make sure that parents know how to use primary care and it becomes their point of contact until they are connected to other services in the community." The Healthy Steps Specialist provides a number of services for families, including the following: • Developmental screening for the child and a child development information phone line or texting; • Screening for family risk factors, including domestic violence, sub stance abuse, maternal depression, and smoking, as well as protec tive factors, such as home safety checks; • Linking and referring to community resources; • Offering written materials emphasizing prevention; • Offering parent support groups and educational programs; and • Supporting early literacy with the Reach Out and Read program.
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These groups include public health nurses already making home visits in rural settings, doulas used by Native American tribes, and public health educators used in refugee camps. Positive outcomes from the Healthy Steps program include parents having greater knowledge of infant development, better recognition of appropriate discipline, greater compliance with immunization schedules, and increased satisfaction with their pediatric care -- as well as being less likely to disengage from it (Johnston et al., 2004; Minkovitz et al., 2003)
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Healthy Steps has enjoyed a high recruitment and retention rate in part because it was implemented in pediatric settings, Kaplan-Sanoff noted. Primary care is accessible being universal, affordable with new health insurance coverage, and offered around the clock with same-day care for sick children.
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You may have to identify another time to have those conversations, she said. Dishion agreed that time is one of the biggest challenges in pediatric settings.
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Perrin added that recently pediatric training has started to include a small amount of training in developmental behavioral pediatrics and noted that side-by-side training was key to having nurse practitioners being used more in pediatric practices. "We need to develop training programs that include pediatricians, social workers, and psychologists that are
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Some families receive brief tailored parent management training (PMT) that encourages supporting positive behavior in the child, setting healthy limits, and building family relationships.
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. To apply FCU broadly in a home visiting setting for preschoolers, in public schools, and in pediatric settings, the intervention was trimmed to make it more cost and time effective.
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Prado noted that the Patient Protection and Affordable Care Act offers new opportunities to integrating family-centered, evidence-based preventive interventions, such as Familias Unidas, within health care settings. The challenge is to make the programs minimally disruptive and not interfering with physicians' time in these settings, he added.
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Familias Unidas Online Familias Unidas online can be accessed from a variety of electronic devices, including computers, tablets, and smartphones. The online program gives the same number of behavioral sessions as the standard program, but these sessions are comprised of mock groups that are videotaped with a trained interventionist, as well as culturally compatible telenovelas or soap operas.
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interventions are often needed for children with autism. This requires supporting caregivers to apply these strategies in everyday activities before the child enters preschool.
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If a child has a communication delay, the system offers families a selfguided digital tool with social communication growth charts for children 9 to 24 months of age with tips to support development. If a child is also positively identified as having autism, the system will provide information about the importance of early intervention as well as an online guide for parents that will suggest evidence-based strategies they can use to foster their child's normal language and behavioral development.
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In the pilot study discussed above, Familias Unidas had remarkable engagement and retention for an online program, with 83 percent attending all five sessions that have been given online so far. Seventy-eight percent of families completed family visits online.
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Presentation at the workshop on Strategies for Scaling Tested and Effective Family-Focused Preventive Interventions to Promote Chil dren's Cognitive, Affective, and Behavioral Health, Washington, DC. Dishion, T
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2012a. Effects of a family intervention in reducing HIV risk behaviors among high-risk Hispanic adolescents: A randomized controlled trial.
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Presentation at the workshop on Strate gies for Scaling Tested and Effective Family-Focused Preventive Interventions to Promote Children's Cognitive, Affective, and Behavioral Health, Washington, DC. Wetherby, A., H
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