E-Update, January 4, 2005

Healthy Steps for Young Children^SM

E-UPDATE

January 2005 Issue
(Printable Version)

Stories

Early Childhood Advocacy from Surprising Quarters
New Healthy Steps Brochure is Here!
Healthy Steps in Pediatrics Residency Training - Delivering What Is Needed
Need a Quick Overview of Literature on Science of Early Childhood Development?
Healthy Steps Publications in Peer-Reviewed Journals

Early Childhood Advocacy from Surprising Quarters

Three economists – two Nobel Laureates and a Federal Reserve system executive – have gone on record to say that this country needs to invest heavily in early childhood development. Note that their argument does not include "health," but it is a bandwagon that we might join.

James J. Heckman, winner of the Nobel Prize in Economics in 2000, bases his argument on his extensive review of longitudinal studies showing the advantage of early childhood development. "On a purely economic basis, it makes a lot of sense to invest in the young… The later in life we attempt to repair early deficits, the costlier the remediation becomes." Gary S. Becker, winner of the Nobel Prize in Economics in 1992, feels strongly about the value of early childhood intervention and recommends that society make payments to parents contingent on their children's regular attendance in an early childhood program. And Arthur J. Rolnick, Senior Vice President and Director of Research at the Federal Reserve Bank of Minneapolis, recently said, "Policymakers must identify the educational investments that yield the highest possible returns. Here the literature is clear: dollars invested in early childhood development yield extremely positive returns."

So what is going on here? The answer is clear. Investment in early childhood development makes economic sense. Getting on that bandwagon for Healthy Steps is complicated because today's health care is funded with a view toward short-term returns, making it difficult to sell changes that will not yield their greatest returns until years from now.

But with the help of such notables in economics making the case for early intervention, those of us with a focus on even earlier intervention (i.e., Healthy Steps) are now fortified with supportive economic arguments as we pursue needed investment where all children start – in the medical setting.

You can access a summary of Professor Heckman’s views by going to the Ounce of Prevention publication Invest in the Very Young, available at http://www.ounceofprevention.org/downloads/publications/Heckman.pdf.

For more on Dr. Rolnick’s views, see “Early Childhood Development: Economic Development with a High Public Return,” fedgazette, March 2003, available at http://www.minneapolisfed.org/pubs/fedgaz/03-03/earlychild.cfm.

New Healthy Steps Brochure is Here!

The new Healthy Steps Brochure, “A Step in the Right Direction,” responds to the increasing interest in Healthy Steps. The brochure offers an overview of Healthy Steps, describes the range of services offered in the practice sites, provides a quick summary of the Healthy Steps evaluation, and has information on how to obtain Healthy Steps training and technical assistance.

For members of the Healthy Steps family, the brochure is a way to spread the word about Healthy Steps – to potential parents, to other physicians’ practices and residency training programs, to possible funding partners, and to community agencies.

And we encourage existing Healthy Steps sites to:

Create a sticker or stamp to present your message on the back page of the brochure (e.g., local contact information and relevant logos); or
Request the art files for your customized use. You will need to take the brochure art files to your local graphic designer or printer to have them add your text and logo to the back panel. If you choose this option, you will need to agree to the following:
- The artwork, photography, and fonts cannot be used for any other purpose.
- You will not manipulate the artwork or photography. The only permissible change is to the white space on the back cover of the brochure. With approval, you may use the brochure text in your brochure or other publication.

To discuss your use of the brochure, please contact Healthy Steps director Michael C. Barth via email at mbarth@icfi.com.

Please email Alisa Meerovich at ameerovich@icfi.com to request copies of the brochure.

Healthy Steps in Pediatrics Residency Training - Delivering What Is Needed

Residents trained in the Healthy Steps approach at The University of North Carolina – Chapel Hill and at Cornell report that the experience has filled an important gap in their training on normal pediatric growth and development. As such, it is helping fulfill requirements of the American Board of Pediatrics.

Preliminary results of a survey mailed in Spring 2004 to 60 recent Pediatric Residency graduates from UNC – Chapel Hill have been tabulated. Though a small sample, but with controlled results, evidence is that Healthy Steps provides pediatric residents with important information about early childhood, and has a positive impact on pediatricians once they are in practice.

For example, Healthy Steps graduates:

Report that Healthy Steps was their primary source of knowledge on subjects such as sleep issues, toilet training, behavior and discipline, developmental milestones, community resources, and injury prevention.
Were more likely than controls to report that Healthy Steps prepared them to manage postpartum depression in mothers, promote early learning during infancy and early childhood, and use community resources for early intervention services in their practice.
Were more likely than controls to report that their behavioral and developmental training during residency was extremely useful in their current practice, and that exposure to Healthy Steps during residency positively affected their performance as a practicing physician.
Rated Healthy Steps as the most important mechanism for learning and understanding developmental and behavioral pediatrics, compared to other training mechanisms such as continuity clinic preceptors, behavior/development rotation, and educational conferences.

Another study at Cornell University Weill Medical College collected data from focus groups with residents, producing similar results:

Healthy Steps was valued and needed.
Residents initially expressed a feeling of inadequacy regarding issues of child development.
As a result of being exposed to Healthy Steps, their “radar was up” regarding issues beyond physical health.
While the traditional development rotation trained the residents to diagnose and treat blatant developmental pathology, Healthy Steps was the only part of their training in which they were encouraged to develop significant skills and insights that apply to all of their patients.
The biggest challenge to Healthy Steps is the time constraints placed on residents due to their work schedules.

These findings are noteworthy in light of a recent Commonwealth Fund Web-based survey, in which "general pediatric faculty reported a need for improved resident education and additional faculty development. Only four percent of respondents felt the quality of current residency training in developmental and behavioral pediatrics was excellent and most (64 percent) felt that too little time was devoted to training in this subject. Nearly all the respondents agreed that increasing faculty skills in this area would significantly improve residents' training but cited the lack of release time (67 percent) and funding (74 percent) to attend continuing education as important barriers." For the full Commonwealth report, see http://www.cmwf.org/publications/publications_show.htm?doc_id=245576.

Need a Quick Overview of Literature on Science of Early Childhood Development?

In "Starting Out on the Right Path," published in the Spring 2004 issue of UCLA Magazine, prominent pediatrician Neal Halfon provides an excellent brief summary of the converging body of scientific research that links the issue of early childhood experiences to school success, and highlights some of the shifts in public policy as a result.

Halfon reports on four important discoveries in developmental neurobiology and developmental psychology that have contributed to current understanding of childhood development and educational readiness:

1. Significant brain development takes place prenatally and throughout the first decade of life, and much resculpting of the brain continues into the second decade.

2. Patterns of experience can be linked to specific nerve-cell connections and changes in behavior, learning, and skill development. Children exposed to environments rich in verbal stimulation have as much as a four-fold greater vocabulary by age three, leading to earlier literacy and educational success.

3. Positive relationships play a significant role in supporting basic emotional development. Secure attachments, and the ability to develop trusting relationships, are integral to the "emotional scaffolding" that supports cognitive and language development.

4. Adversity negatively impacts brain development. Although adversity is manifested in many forms, the most common factor contributing to adversity in early childhood is poverty, which limits a child's access to the material, social, and psychological resources necessary for healthy development.

As we have learned from longitudinal evaluations, early interventions can significantly alter and improve developmental outcomes for children at risk. The full text of this article can be found at http://www.magazine.ucla.edu/year2004/spring04_05.html.

For a more detailed review of the scientific research and its implications for improving early childhood experiences and educational and social outcomes, as well as the role of early intervention to enhance positive outcomes, see From Neurons to Neighborhoods: The Science of Early Childhood Development (National Research Council, Institute of Medicine, 2000).

Healthy Steps Publications in Peer-Reviewed Journals

Healthy Steps’ peer-reviewed literature is growing, providing research results on such topics as the positive effects of Healthy Steps on parental satisfaction with pediatric care; how Healthy Steps has changed delivery of pediatric services for the better; the value of an adapted version of Healthy Steps for Pediatric Nurse Practitioners; and the quality of Healthy Steps sites. The first publication on Healthy Steps, “Listening to Parents with Young Children,” was published in the Archives of Pediatric and Adolescent Medicine in 1998. Since then, 17 articles have been published and two are awaiting publication. Peer-reviewed articles on Healthy Steps have appeared in other respected publications, notably including The Journal of the American Medical Association, Pediatrics, the American Journal of Preventive Medicine, and The American Journal of Evaluation.

A complete list of the publications on Healthy Steps is available at the Healthy Steps Website at http://www.healthysteps.org. Click on 'Publications and Related Links,' 'Healthy Steps Publications,' and then on 'Healthy Steps Peer-Reviewed Publications,'

View previous issues of the Healthy Steps E-Update.

If you know someone who should receive the Healthy Steps E-UPDATE, please forward the E-UPDATE e-mail you initially received or email bmiller@icfi.com and we will add the name to the E-Update mailing list.
Thanks!