E-Update, September 8, 2004

Healthy Steps for Young Children^SM

E-UPDATE

September 2004 Issue

Stories

Healthy Steps Works
Healthy Steps Innovations
Healthy Steps Identifies and Helps Depressed Mothers
And the Winner Is...DuPage County Healthy Steps!
Healthy Steps in Residency Training

Healthy Steps Works

The American Journal of Preventive Medicine has recently published (May 2004) three articles reporting positive results from a Healthy Steps experiment in pre- and postnatal care. This experiment was based on a sample of insured families enrolled in the Group Health Cooperative of the Puget Sound/Kaiser Permanente HMO. This experiment compared infants who were randomly assigned to two groups based on when they began to receive Healthy Steps: either prenatally or at birth. Then these groups were compared with infants who received usual care that did not include Healthy Steps. Key findings determined three months following enrollment in the study are:

Mothers who received Healthy Steps prenatally or shortly after giving birth were more likely to continue breastfeeding and more likely to read to their three-month-olds;
Mothers of infants who received Healthy Steps prenatally or shortly after giving birth were less likely to report depressive symptoms and more likely to describe themselves as pleased with their role as parents;
Knowledge of infant development and recognition of appropriate discipline and satisfaction with pediatric care were greater among parents who received the Healthy Steps services; and
The rate of disengagement from the HMO was 75 percent lower among families enrolled in Healthy Steps during the prenatal period.

The research group at Group Health, headed by Robert S. Thompson, MD, plans to report on follow-up of these cohorts in the coming years. To view abstracts of the three articles, visit
http://www.ajpm-online.net/article/PIIS0749379704000108/abstract.

Note that the positive evaluation results on the first 15 Healthy Steps sites, previously reported here and in JAMA's December 17, 2003 issue, show further evidence of the successes created by Healthy Steps. For a summary, go to www.healthysteps.org and click on The Healthy Steps Evaluations.

Healthy Steps Innovations

Pediatric care providers in Mesa, AZ, and Detroit, MI, are taking Healthy Steps into new types of settings.

In Mesa, the Banner Desert Medical Center provides the Healthy Steps approach to families of some 150 babies in the neonatal intensive care unit (NICU). A NICU nurse has completed the Healthy Steps training and, with Healthy Steps Specialist Pamela Klatt Michael, identifies families for Healthy Steps, develops relationships early, offers guidance and support, and provides continuity of care from hospital to home. "We understand that the NICU is a stressful place and most of the parents are just worried about their baby surviving," said Pamela Michael. "Healthy Steps gives families additional support and someone else to talk to about caring for their baby. We make the transition from the NICU to home easier by providing advice to families on such things as bathing and feeding their baby at home." The Healthy Steps team hopes eventually to serve all families in the NICU.

In Detroit, Healthy Steps Specialist Mary Mueller and her team from Children's Hospital of Michigan use a mobile van to travel to three locations – a school, a church, and a community center – to provide Healthy Steps as part of general pediatric care to a low-income community with a large number of uninsured. "Many of the families we serve are homeless or nearly homeless, living temporarily with a relative or friend, or falling behind on their rent," said Mary Mueller. "The issue of unstable housing affects the family's ability to attend to their child's health and developmental needs. It also impacts their ability to stay engaged with the Healthy Steps team."

For some families in this Detroit setting, the Healthy Steps team has added an intensive home visit component, visiting as frequently as once a week to make it even easier for families to receive Healthy Steps. The home visits allow for parent education, relationship building, and ongoing health care for the young child.

Healthy Steps Identifies and Helps Depressed Mothers

Depression screening is a regular and important part of the Healthy Steps approach to whole child-whole family health care. Three Healthy Steps sites are addressing depression, particularly, postpartum depression, in innovative ways.

The Healthy Steps site at Infant Welfare Society of Chicago, IL, has a formal screening process to identify postpartum depression in new mothers. About 8-15 percent of new mothers nationally suffer from postpartum depression. But at Infant Welfare, postpartum depression is seen more frequently – in 27 percent of new mothers – due to factors such as poverty, social isolation, and other life stressors. As a result, the site has incorporated postpartum depression screening into every family's one-month pediatric visit. The screening includes 35 questions addressing such issues as changes in sleeping patterns, eating habits, and levels of anxiety. The Healthy Steps team, composed of a Healthy Steps Specialist and a family therapist, administers the screening. The family therapist, Ellen T. O'Donovan, meets with mothers and completes an assessment to determine whether support is needed for the mother and family.

"Healthy Steps has become an excellent vehicle for addressing postpartum depression because the team has more time to spend with each mother and provides a safe haven for mothers to seek advice and support," said Ellen O'Donovan. The open discussion with mothers occurs as the Healthy Steps team addresses many factors beyond physical health that affect a child's development, including emotional issues and family support. Due to the efforts of the Healthy Steps Specialist to address postpartum depression, doctors and other pediatric providers at Infant Welfare are asking more questions about how mothers are doing and providing referrals to the Healthy Steps team.

At the new Healthy Steps initiative at Mesa, AZ, the neonatal intensive care unit (NICU) of the Banner Desert Medical Center is also addressing postpartum depression. Due to the stress for families with babies in the NICU, Healthy Steps Specialist Pamela Klatt Michael works closely with the NICU nurses to identify mothers who may be suffering from postpartum depression. The team takes a tiered approach to identifying these mothers in the NICU, at a home visit, or through family members. Once identified, mothers who appear to be suffering postpartum depression are referred to their primary care physicians and other resources in the community for additional support and assistance.

The Healthy Steps site in Detroit, MI, uses the Center for Epidemiological Studies Depression Scale, a 20-item inventory developed by the National Institute of Mental Health, to identify mothers at risk for postpartum depression. Because many of the families are transient, Mary Mueller, the Healthy Steps Specialist, and her team try to identify potential depression in mothers in a timely manner. Most recently, the team found that 15 of 32 mothers screened were possibly depressed – which is 22 percent of all parents enrolled in Healthy Steps in Detroit. To address depression, a social worker on staff provides counseling to families during home visits.

For more information on addressing postpartum and other types of depression, see the Family Health Checkup section of the CD-ROM in the Healthy Steps^SM Interactive Multimedia Training & Resource Kit or in the Healthy Steps training manual, "Strategies for Change," or contact Margot Kaplan-Sanoff (sanoff@bu.edu).

And the Winner Is...DuPage County Healthy Steps!

Healthy Steps in DuPage County, IL, is an award-winning model that received an Illinois state "Jewels of Excellence" award. On May 25, 2004, Carol L. Adams, Secretary of the Illinois Department of Human Services, honored DuPage Healthy Steps with the award – a Gold Crown of Leadership for DuPage's integrated approach in serving clients in a creative and effective manner.

This award is given to individuals and groups dedicated to helping Illinois families strive for self-sufficiency. Award winners are praised for their commitment to the Illinois Department of Human Service's mission of assisting Illinois residents in achieving maximum independence and health through education and prevention. Pictured (center, left to right) are: Mary Lally, MPH, Family Health Unit Manager, DuPage County Health Department; Jeanna Sleight, MS, Program Manager, DuPage County Health Department; and Anita Berry MSN, CNP-APN, Director, Healthy Steps for Young Children Program at Advocate Health Care. Flanking the winners are Illinois Department of Human Services staffers, who made the award.

Healthy Steps in Residency Training

Healthy Steps welcomes the University of Kansas, Residency Training Program in Wichita. Since most physicians in this program will later practice in the state, the Wichita program eventually will have an impact state-wide, with families throughout Kansas receiving care from a physician trained in the Healthy Steps approach.

Click here to view previous issues of the Healthy Steps E-Update.

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