Many complex issues can impact the overall health of a child such as inadequate access to care, the consequences of living in poverty and exposure to community violence. Boston Children’s Hospital developed its community health programs to address health disparities. These efforts aim to 1) support community-based efforts; 2) improve systems of care for children; 3) build community capacity to tackle the contributors to disparities; and 4) make care easier to access for families.
Obesity: Supporting community-based approaches
Obesity remains a pressing health issue for children across the country including in Boston. Latino and black children have higher rates of obesity than white children. To address these disparities, Boston Children’s wanted to support both prevention and treatment efforts in community-based settings.
Recognizing the strong link between primary care providers and patient families, Boston Children’s developed the Fitness in the City (FIC) program. FIC partners with 10 Boston community health centers to help families manage their child’s weight. FIC supports case-management services and enables health centers to implement appropriate nutrition education and physical activity programs as well as connect families to local resources.
In FY13, FIC provided services to more than 800 obese or overweight patients. The program was able to show that 63 percent of participating children maintained or decreased their Body Mass Index. FIC plays a key role in Boston Children’s strategy to support community-based approaches as the best way to help children make the behavioral changes needed to meet their health and wellness goals.
Asthma: Improving systems of care
Asthma is a widespread chronic disease. It’s more prevalent in children from low-income neighborhoods and among Latinos and African Americans, whose rate of hospital admission is three to five times higher than for white children.
Boston Children’s has been able to prove that its Community Asthma Initiative (CAI) is a cost-effective way to improve health outcomes for children with asthma. CAI utilizes a team of community health workers, supervised by a nurse, who offers case management services based on a child’s unique needs. Families benefit from home visits, environmental assessments and remediation as well as asthma education.
In FY13, CAI provided services to 170 children with asthma; and it reduced the percentage of patients with any hospitalizations by 80 percent and emergency room visits by 57% after one year. Boston Children’s has been able to use the results to advocate for changes in how asthma care is delivered in Massachusetts and the approach has informed models in other states.
Mental health: Building community capacity
Mental health has been consistently identified as one of the most pressing concerns for families in Boston. Nearly 20 percent of all students experience undiagnosed mental health disorders. The rates are higher in urban neighborhoods where children have greater exposure to poverty and violence. Access to mental health services is a challenge for families due to both institutional and cultural barriers, such as insurance issues or language differences.
Boston Children’s Hospital Neighborhood Partnerships (CHNP) is a community mental health program that places clinicians in seven Boston area schools and four community health centers to provide mental health services to children. The CHNP team also is building community capacity by training and consulting with teachers, staff and principals to help them better address student needs and improve school climate.
In FY13, CHNP provided services to 1,932 students. But Boston Children’s impact is far reaching in that CHNP has been able to provide more than 200 teachers with over 1,400 hours of training and consultation to help them better identify and address the needs of their students within the school setting.
Early childhood: Increasing access to care
Nearly 20 percent of children have developmental or behavioral disorders, and fewer than 30 percent of them are identified by a clinician before entering school. Children living in urban areas often have limited access to needed developmental evaluation and monitoring.
The Advocating Success for Kids Program (ASK) provides access to these services for children experiencing school-functioning problems and learning delays. The team works with diverse populations in two community-based pediatric practices and in Boston Children’s Primary Care at Longwood. ASK provides feedback and educates other community providers about patient diagnoses, care and treatment resources.
In FY13, 332 children were seen in the ASK program and 10 educational sessions were held for parents, providers, nurses and social workers. Through this clinical service, Boston Children’s is able to improve and increase access to care by directly linking families with specialty services and help connect providers with a child’s teachers and school.