Illness and injury in family day care: A seasonal survey

Many mothers with children under age 6 are employed and it is not usually feasible for a parent to stay home with a child who is mildly ill. Such ill children likely remain in child day care programs. The extent to which this occurs and the management of these children in family day care was studied. Over the course of a year, 1 to 3 visits were made to 714 family day care homes in order to survey providers. With enrollments ranging between 0 and 18 children per day care home at the time of each visit, information on 3,630 child enrollment days was collected. The median age of children in care was 2 years.An average of 16% of all children were ill on any one day (with seasonal variation); 1% were injured. Of ill children, 82% attended day care that day, 49% had contacted a physician about that illness, and 28% were administered a medication at the day care setting. Twenty-one percent of children receiving medication in day care had no contact with a physician for that illness. These data show that mild childhood illnesses are routinely managed by child day care providers. Physicians who traditionally limit their illness-management education to parents need to recognize the health education and consultation needs of day care providers.Howard L. Taras is an Assistant Professor of Pediatrics at the University of California at San Diego, School of Medicine, La Jolla, CA. Betty Z. Bassoff is Director of the California Child Care Standards Project at San Diego State University, Graduate School of Public Health (Division of Maternal and Child Health), San Diego, CA.Research Support: SPRANS Grant, Bureau of Maternal and Child Health, Public Health Service; and, Maternal and Child Health Division, Graduate School of Public Health, San Diego State University.     

Teaching community-oriented primary care (COPC): A practical approach

To improve education in community-oriented primary care (COPC) and to promote its practice in the community, the University of California's School of Public Health in Berkeley and School of Medicine in San Francisco are collaborating in an innovative program in cooperation with several federally-funded community clinics in the San Francisco Bay Area. The School of Public Health designed a COPC track for graduate public health students from various departments of the school who wished to work in community health care. The track includes a seminar given in the spring of the students' first year in which COPC theory is taught and teams of students working with a faculty advisor and a clinic preceptor design COPC projects for the primary care sites. These projects are then implemented in the summer and fall by students who elect to use this experience to satisfy their fieldwork requirement. This paper is a report of the first year's experience with this collaborative effort.Emilie H.S. Osborn, M.D., M.P.H. is Assistant Professor, Family and Community Medicine, University of California at San Francisco. Norman Hearst, M.D., M.P.H. is Assistant Clinical Professor, Clinical Epidemiology and Family and Community Medicine, University of California at San Francisco. Joyce C. Lashof, M.D., is Dean, School of Public Health, University of California at Berkeley. W. McFate Smith, M.D., M.P.H. is Director, Preventive Medicine Residency, School of Public Health, University of California at Berkeley.This project has been supported in part with Federal funds from the Bureau of Health Care Delivery and Assistance, Health Resources and Services Administration, U.S. Public Health Service, under contract #240-84-0124. The content of this publication does not necessarily reflect the views or policies of the Department of Health and Human Services.     

Maternal satisfaction with primary care for children with selected chronic conditions

One hundred forty mothers of children with chronic illnesses seen in two pediatric specialty clinics of a major urban teaching hospital were surveyed regarding their primary care arrangements and satisfaction with care received. Three dimensions of maternal satisfaction were measured: general satisfaction, satisfaction with access to care and satisfaction with doctor conduct (physician humaneness and technical quality). Results of multivariate analyses indicate that receipt of anticipatory guidance, access to care during evening hours and having a child in excellent reported health status were significantly associated with at least two of the three dimensions of maternal satisfaction. Findings have implications for organizing comprehensive, accessible primary care in the community, which is consistent with recent trends in child health policy. Results supported the need for enrichment of primary care for children with chronic illnesses to allow for physician continuity, provision of information and advice to families and extended office hours.Michele A. Kelley is Assistant Professor of Community Health Sciences at The University of Illinois at Chicago School of Public Health. Cheryl S. Alexander is Associate Professor of Maternal and Child Health at The Johns Hopkins University School of Hygiene and Public Health in Baltimore. Naomi M. Morris is Professor and Director of Community Health Sciences at The University of Illinois at Chicago School of Public Health.     

An Evaluation of Independent Consumer Assistance Centers on Problem Resolution and User Satisfaction: the Consumer Perspective

Individuals who wish to receive independent assistance to resolve access to care health problems have limited options. The Health Consumer Alliance (HCA) is an independent, coordinated effort of nine legal services organizations that provide free assistance to low-income health consumers in 10 California counties. The need for the HCA stems from the vast number of health consumers with unanswered questions and unresolved problems relating to access to care issues, among both insured and uninsured populations. However, little is known about the effectiveness of independent consumer assistance centers. This paper examines the effectiveness of a network of independent consumer assistance programs in resolving consumer problems and consumers level of satisfaction with services received. As the project evaluators, we conducted telephone surveys with 1,291 users of the HCA to assess if this independent program resolved consumer problems, and to measure the level of satisfaction among HCA users. Specifically, we asked questions about the HCAs influence on problem resolution, consumer satisfaction, health insurance status and use of preventive care services. From 1997 to 2001, more than 46,000 consumers contacted the seven health consumer centers (HCCs). According to our sample of respondents, results show that the HCCs are an important resource for low-income Californians trying to access health care. After contacting the HCCs, 62 percent of the participants report that their problems were resolved. In addition, 87 percent of the participants said the HCCs were helpful and 95 percent said they would be likely to contact the HCC again if necessary.Lori Miller Nascimento is Associate Director, Michael R. Cousineau is Director, all at the Division of Community Health, Department of Family Medicine, University of Southern California Keck School of Medicine.Requests for reprints should be addressed to Lori Miller Nascimento, MPH, Division of Community Health, USC Keck School of Medicine, 3716 South Hope Street, Suite 256, Los Angeles, CA 90007     

Preventing adolescent abuse

High school-level child abuse prevention programs are described and critically examined. Programs are typically less than two hours, focused on date rape and sexual abuse prevention and reporting, and not integrated into existing family life education programs. Little attention is given to neglect or emotional abuse. Instructional methods are typically limited to demonstration and lecture with less use of more powerful techniques such as peer instruction and student-to-student role plays. The four goals of high school child maltreatment prevention programs are articulated and appraised. Implications for decision making about the emphasis, form, and sequencing of child abuse prevention content are forwarded.Richard P. Barth is Associate Professor and Principal Investigator; David Derezotes was Project Director and is now Assistant Professor, University of Utah; and Holly Danforth is a Doctoral Student and Research Assistant, Family Welfare Research Group, School of Social Welfare, University of California at Berkeley. The authors thank Susan Katzenellenbogen, Wendy Goss, Jack Light, Lin Wan I, Marcia Meyers, and Jeanne Pietrzak. The authors made equal contributions to this article. Funding was provided by the State of California Department of Social Services, Office of Child Abuse Prevention Grant #C7101. Address reprint requests to Rick Barth, Family Welfare Research Group, 1950 Addison St., Suite 104, Berkeley, CA 94704     

Practical issues,ethical concerns and future directions in the prevention of alcohol-related problems

This article explores some basic assumptions that underlie the prevention of alcohol-related problems. Using a standard public health definition of prevention, the strategies of health promotion, disease prevention and health protection are explored along several dimensions. These dimensions are problem definition, ways of understanding the problem and ethical principles. The article argues for a broader definition of prevention based on a more holistic approach premised on the tenets of an ethical perspective linked to social justice. A general heuristic model for looking at relevant factors to be considered in the development of prevention research, planning and programming.The author is an Assistant Professor at the School of Public Health, University of California, Berkeley. He is also Director of the Prevention Research Center, Pacific Institute for Research and Evaluation. The center, located in Berkeley, is funded by an Alcohol Research Center Grant from the National Institute on Alcohol Abuse and Alcoholism. Requests for reprints should be addressed to Dr. Wallack at the University of California, Berkeley, CA 94720.     

Meeting minority health needs through special MCH projects

The maternal and child health programs of the Public Health Service have always been directed to minority populations; however, the recent surges of immigrants from Asian and Central American countries have caused the agency to appraise its efforts to meet the special health needs of these people. Through grants for special projects of regional and national significance (SPRANS), the Office of Maternal and Child Health is funding projects to break down language, culture, and access barriers to health services for pregnant women, infants, and children. Recent and current SPRANS projects have taken innovative approaches to solving the special health problems of the minority populations. They range from a breastfeeding initiative in the Commonwealth of the Northern Mariana Islands to an areawide genetic service program in the Virgin Islands. Examples of projects that have been conducted are presented.     

Using lay health workers: Case study of a community-based prenatal intervention

This article reports on the design and implementation of a prenatal outreach and education intervention for low income, Hispanic women living in three migrant and seasonal farmworker communities in Arizona. The program included three major elements: a Spanish language prenatal curriculum; a group of mature Hispanic women recruited from the target communities and trained as Comienzo Sano (healthy beginning) Promotoras (health promoters), and the organization of a support network of local health professionals. The rationale for the demonstration is reviewed, and the structure of the intervention is described. Factors which facilitated and constrained implementation of the program are identified, and guidelines are provided for other health care providers and health educators interested in developing similar programs.Joel S. Meister is Director, Southwest Border Rural Health Research Center, Member, Arizona Cancer Center: Louise H. Warrick is Research Assistant Professor of Family Medicine; Jill Guernsey de Zapién is Program Coordinator of Community Health; Anita H. Wood is Research Assistant in Rural Health; all in the Department of Family and Community Medicine, College of Medicine, University of Arizona, Tucson, Arizona 85724.The authors gratefully acknowledge the support and continued interest of the A.L. Mailman Family Foundation, which provided the initial funding for this project, of the March of Dimes, which has made possible the project's continuation by providing support for the promotoras, and of the Arizona Department of Health Services, Maternal and Child Health Division, for providing funding for the ongoing administration of the project. The Yuma County Health Department has provided the staff to supervise the program. We also wish to recognize the contribution made by the project's first coordinator and supervisor, W. Marie Roberts, RNP, CNP. During the latter phases of the project's first year, E. Lee Rosenthal, a graduate student intern from the School of Public Health, University of California at Berkeley, provided invaluable assistance, and, more recently, anthropological field work was conducted by Tamar Gottfried, a medical student at the University of Arizona.     

Process and outcome evaluation of preventive care for infants in two types of practices

Process and outcome of preventive and promotive infant care have been evaluated in a maternal and child health (MCH) service and compared with that of a comprehensive care family practice (FP), both serving a low middle class population in West Jerusalem. Both services are provided by the Community Health Center of the Department of Social Medicine. Community oriented primary care is integrated into the practices, including ongoing surveillance of the communities' health status. Preventive and promotive programs have been developed, implemented and evaluated.The process evaluation indicated a similar use of the preventive service in the MCH and FP services. Some of the routines were carried out to a lesser extent in the FP than in the MCH framework, such as growth monitoring, hearing tests and advice on iron supplementation. The small difference in compliance with routines did not affect a child's growth between birth and one year of age, but the anemia rate in the FP practice was higher than in the MCH practice. The high level of care and relatively small differences in process and outcome between the two types of services have been achieved by ongoing inservice training, a high level of personnel, similar protocols and supervision in both practices.H. Palti, M.D. M.P.H., Associate Professor, Head of Maternal and Child Health Unit, Department of Social Medicine, Hadassah, and School of Public Health, Hebrew University and Hadassah, P.O.Box 12000, Jerusalem 91120, Israel; D. Haustein, M.D. M.P.H., former student at the School of Public Health, Hebrew University and Hadassah, Jerusalem. Present address: Chabrier 179, San Isidro, Lima 27, Peru; R. Gofin, M.D. M.P.H., Lecturer & Physician, Department of Social Medicine, Hadassah, and School of Public Health, Hebrew University and Hadassah, P.O.Box 12000, Jerusalem 91120, Israel; B. Knishkowy, M.D. M.P.H., Family Physician, Department of Social Medicine, Hadassah, and School of Public Health, Hebrew University and Hadassah, P.O.Box 12000, Jerusalem 91120, Israel; B. Adler, M.Sc., Statistician, Department of Social Medicine, Hadassah, and School of Public Health, Hebrew University and Hadassah, P.O.Box 12000, Jerusalem 91120, Israel.This study was supported by The Temin Endowment Fund. We wish to express our thanks to staff of MCH and FP practices of the Hadassah Community Research and Health Center, for their ongoing contribution to the MCH programs.     

Partnership to build sustainable public health nurse child care health support

Child care health consultation, an emerging health care delivery system aimed at improving the health and well-being of children enrolled in child care settings, is consistent with the public health core function of assurance. Public health nurses are the primary workforce for such consultation. Few states have critical masses of consultants, and many are struggling to financially support such programs. Through an academic-community partnership, Georgia's public health nurses are building a consultative system of child care health support. This partnership focuses on adding value in child care while strategically and financially supporting the sustainability of this population-focused practice.     

Assessing Indiana’s Health and Safety in Early Care and Education Programs: Identifying Areas for Improvement

The objective of this study is to describe the key National Health and Safety Standards (NHS) met in early care and education (ECE) programs in Indiana and to establish reliability for the Indiana Health and Safety Checklist. The Indiana Health and Safety Checklist, modified from the California Childcare Health Program’s Health and Safety Checklist, includes 87 items and 11 subscales. It was completed in 2 h by trained child care health consultants in 82 ECE programs to assess the number of key NHS met. The 82 ECE programs met the majority of NHS items. Thirteen items were not met in more than 50% of the programs. The items with the lowest compliance were emergency food supplies, children’s hand washing, special health care plans, cleaning and sanitizing counters, and impact surfaces under playground equipment. The Indiana Health and Safety Checklist had moderate internal reliability for 6 of the 9 subscales analyzed. ECE programs strive to provide high quality care and the programs met the majority of NHS on the checklist. The Checklist is a reliable instrument that helped identify health and safety gaps and thus, identified the targeted interventions for child care health consultation.     

Child Care Health Consultation Programs: Barriers and Recommendations

Objectives: While many studies describe the need for health services in early care and education (ECE) settings and the role of child care health consultants (CCHCs), little information exists about the challenges to developing health consultation programs. The goal of this paper is to provide insight for the development of current and future child care health consultation programs by describing the barriers identified by CCHCs related to program implementation in 20 California counties. Methods: Forty-four child care health consultants participated in nine focus groups during their health consultation training at the California Training Institute. Participants were asked to discuss the barriers they encountered while establishing new county-wide child care health consultation programs. Themes were assigned to each response, and frequency and percentage of each theme were documented and trends were identified. Results: The four general themes describing barriers to program implementation were: Program Management, Child Care Culture, Geography and Community Services. Twenty additional sub-themes, including Multi-agency involvement, Chaos, Travel time, and Fragmentation, were assigned to each response. The most frequent general theme was Program Management. The most frequent sub-theme was Professional Support. Conclusions: The barriers identified by the child care health consultants can be valuable for administrators and clinicians establishing or developing child care health consultation programs. Program managers should be prepared for the unique challenges of child care health consultation and provide flexibility and support for child care health consultants.     

Quality of maternal and child health care in different models of Primary Health Care

This study evaluated the quality of the maternal and child health care in two different models of Primary Health Care. Interviews were carried out by trained personnel with 1200 families randomly selected. Processes of assistance for maternal and child health care were evaluated by Family Health Strategy Teams and traditional health centers. In the evaluation of child health care, the precocity of the first consultation, the regular assessment of growth and development, the recommendations for accident prevention and prophylactic use of iron supplementation and vitamin A had been statistically associated with the model of the health care. Regarding prenatal health care the results showed statistically significant differences between the two models for breastfeeding counseling, nutritional recommendations and cervical preventive screening using Papanicolaou smear. For women health care out of pregnancy period, the results revealed that counseling for breasts auto-examination, preventive screening using Papanicolaou smear in last year and participation in family planning programs were associated with health Primary Health Care model. All the pointed differences had shown better performance of the Family Health Strategy Teams.     

Promoting Community-Based Maternal and Child Health Services: A University-Health Department Partnership

Objectives: Funded by the Federal Maternal and Child Health Bureau, a partnership between the Johns Hopkins University School of Public Health, Department of Maternal and Child Health (JHU), and the Baltimore City Health Department (BCHD) identifies maternal and child health problems, and develops appropriate interventions. This paper presents the organization and activities of the JHU/BCHD Maternal and Child Community Health Science Consortium as a result of overcoming traditional barriers to collaborative efforts, and discusses what role the Consortium has had in its own collaborative success. Method: A review of the literature uncovered a number of barriers to productive interaction. A number of factors contributing to overcoming the barriers was also revealed. The organization and activities of the work of the JHU/BCHD Maternal and Child Community Health Science Consortium has been applied to these barriers and associated factors, and discussed in context of implications for future collaborative efforts. Results: The Consortium has developed a fully integrated administrative structure bridging both the BCHD and JHU. The mission of the Consortium has been translated into four categories of work, each one designed to complement, extend, and augment the other. The infrastructure established in Baltimore, as a direct result of this partnership, has served to overcome traditional barriers to productive academic/agency collaboration, while promoting organizational productivity. This outcome is a result of overcoming the recognized barriers to collaboration. Conclusions: Health agencies and university public health programs must link resources and collaborate to address public health issues. Commitment to a collaborative approach to the public's health will determine its future.     

A global budget pilot project among provider partners and blue shield of california led to savings in first two years

Health care plans and providers in the private sector are developing alternative payment and delivery models to reduce spending and improve health care quality. To respond to intense competition from other organizations, Blue Shield of California created a partnership with health care providers to use an annual global budget for total expected spending and to share risk and savings among partners for providing health care. The patient population consisted of certain members of the California Public Employees' Retirement System in Northern California. Launched in 2010, the pilot accountable care organization in Sacramento provided a framework for operations and established goals and financial risk arrangements. The model shows early promise for its ease of implementation and effectiveness in controlling costs. During the two-year period, the total compound annual growth rate for per member per month cost was approximately 3?percent, or less than half the rate at which premiums rose over the past decade. Some of the savings stemmed from declines in inpatient lengths-of-stay and thirty-day readmission rates. Results suggest that the approach can achieve considerable financial savings in as little as one year and can gain wide acceptance from reform-minded providers.     

An assessment of the adequacy of self-care by adult asthmatics

Little is known about how individuals who have chronic disease actually manage their symptoms. This study involving a community-based population of 157 adult asthmatics assesses their ability to take care of their disease and to alter their behavior following a change in symptoms. Multiple techniques (interview, direct observation, and diary) were used to determine their behavior with respect to medications and physician use; these were then compared with criteria defining the requisite level of a behavior to reduce symptoms. Of the population assessed, 66% had no bronchodilator medication at home, 24% used an inhaler ineffectively, and 68% did not see a physician regularly. When faced with increasing symptoms, at least 40% of the asthmatics did not perform three basic and appropriate behaviors in medication use and physician contact. If physicians and other health care providers could decrease the frequency of these inappropriate self-care behaviors, it could result in improved health.From the UCLA Robert Wood Johnson Foundation Clinical Scholars Program, Department of Medicine, School of Medicine and School of Public Health, University of California, Los Angeles, California 90024. Preparation of this paper was assisted by a grant from the Robert Wood Johnson Foundation, Princeton, New Jersey. The opinions, conclusions, and proposals in the text are those of the authors and do not necessarily represent the views of the Robert Wood Johnson Foundation. Requests for reprints may be addressed to Robert H. Brook, M.D., The Rand Corporation, 1700 Main Street, Santa Monica, California 90406. The authors are indebted to Dr. Donald Tashkin for valuable assistance in reviewing the criteria used in this study to judge quality of care, to Dr. Roger Detels and Mrs. Anne Coulson whose UCLA Chronic Obstructive Respiratory Disease Study provided the study population, to Mrs. Xuan Le for diligent administrative assistance, and to Ms. Karen Kashiwagi for fine technical assistance.     

Health services in infant day care centers

A study of 13 infant day care centers in Santa Clara County (California) was undertaken to determine the content of the health program, types of health workers participating, utilization of community health resources, admissions policies on children with handicaps and illnesses, and unmet needs in health services. Although there was minimal provision for the health and safety of infants served there were limited services by health workers, irregular utilization of health resources, and neglect of other aspects such as grouth and development of the infants. There is need for more assistance and consultation from community health resources for preventive health services, health education and services for sick children.This study was supported by Grant No. MC-R-060208-03-C from the Maternal and Child Health Service, Office of Clinical Services, U.S. Department of Health, Education and Welfare, Rockville, Maryland.     

Health promotion and health education at the school of governance in health, National School of Public Health, Brazil

Schools of public health should define their teaching, research, and technical cooperative programs on the basis of epidemiological, epistemological, and health care parameters, which are heavily affected by the socioeconomic context of their countries. Brazil's demographic and epidemiological transition has been characterized by an increasing prevalence of diseases and risk factors associated with life styles, thus requiring an extensive and in-depth change in the country's health care model, with a greater supply of evidence-based services and preventive and health promotion measures, including new initiatives in information, education, and communications. This article approaches the recent experience at the Brazilian National School of Public Health, which has added to its long-standing academic tradition with a strategic reorientation known as the School of Governance in Health, including distance education as one of its main teaching options. Given Brazil's prevailing social and health situation, we conclude by highlighting the importance of training health professionals and promoting research and technological development in the fields of health promotion and education within the context of the School of Governance in Health at the National School of Public Health.     

Constructive and destructive anger in child care work: An exploratory study and a conceptual schema

A little-discussed subject in the field of child care work, the anger felt by child care workers in their daily practice with difficult children, is examined in this article. An exploratory study which sought to understand the worker's experience of anger at children is reviewed. A conceptual scheme of constructive and destructive anger in child care work is proposed, and stages in these experiences are suggested. Factors which promote the expression of destructive and constructive anger are analyzed. The article concludes with an examination of the implications of the kinds of expressions of anger for the practice of professional child care work.This article is based on a research study completed in partial fulfillment of the requirements for the degree of Master of Science, Department of Child Development and Child Care, School of Health Related Professions, University of Pittsburgh (Helmer, 1975). The author wishes to extend her thanks to Dr. Martha Mattingly for her guidance and support during the development and conduct of the study and to Dr. Karen VanderVen for her assistance in the preparation of this paper.