Mary McCord

Community Health Workers as Drivers of a Successful Community-Based Disease Management Initiative

In 2005, local leaders in New York City developed the Washington Heights/Inwood Network for Asthma Program to address the burden of asthma in their community. Bilingual community health workers based in community organizations and the local hospital provided culturally appropriate education and support to families who needed help managing asthma. Families participating in the yearlong care coordination program received comprehensive asthma education, home environmental assessments, trigger reduction strategies, and clinical and social referrals. Since 2006, 472 families have enrolled in the yearlong program. After 12 months, hospitalizations and emergency department visits decreased by more than 50%, and caregiver confidence in controlling the childs asthma increased to nearly 100%. Key to the programs success was the commitment and involvement of community partners from program inception to date.

Effect of Routine Mental Health Screening in a Low-Resource Pediatric Primary Care Population

Objective. Despite evidence for its feasibility, the usage of mental health screening in primary care practices with overburdened providers and few referral options remains unclear. This study explores the effects of routine screening on mental health problem identification and management in a low-resource setting. Methods. Medical records of 5 to 12 year-old children presenting for well visits before and after screening was implemented were reviewed. Multivariate logistic regression was used to explore associations between study period and identification/management practices. Changes in the number of visits and wait times for a co-located referral service were assessed post hoc. Results. Parents disclosed more mental health problems, and providers initiated more workups but referred fewer patients after screening was implemented. The proportion of new visits and wait times for the referral service did not change. Conclusions. Even in low-resource settings, screening may facilitate parental disclosure and increase clinical attention to mental health problems without overburdening referral services.

Awareness of Sickle Cell among People of Reproductive Age: Dominicans and African Americans in Northern Manhattan

Sickle cell disease is a chronic condition that is characterized by severe anemia, painful crises, and organ dysfunction. In the USA, sickle cell is a health burden typically associated with African Americans. Dominicans constitute the largest Latino group in New York City (NYC) and have the second overall highest prevalence of sickle trait—one in 20 births, compared to one in 12 African American births. We aimed to document the prevalence of sickle within the largely Dominican and African American community of Northern Manhattan (Washington Heights, Inwood, Harlem), assess and compare knowledge about sickle disease and carrier status in young adults of reproductive age between African Americans and Dominicans, and elicit preferred sources of health information. NY State Newborn Screening data in Northern Manhattan were analyzed by zip code. A brief oral survey was administered to 208 parents of young children—150 Dominicans and 58 African Americans. Significant differences were seen in knowledge about sickle—27% of Dominican parents surveyed correctly defined sickle cell disease as an inherited blood disorder, compared to 76% of African Americans (p < 0.001). Only 7% of African Americans did not know their own trait status, compared to 43% of Dominicans (p < 0.001). Parents were better informed if they or family members were affected by sickle conditions. Participants from both groups prefer receiving information from doctors and online. A separate group of 168 predominantly Dominican youth, ages 14–24, demonstrated knowledge levels similar to that of Dominican parents. These results suggest that many of reproductive age in a NYC community affected by sickle conditions frequently lack basic relevant information, with larger information gaps among Dominicans. Expanded efforts are warranted to inform young adults of diverse affected communities.

Characteristics of Failure to Thrive in a Referral Population Implications for Treatment

Failure to thrive (FTT) in children is an important pediatric problem. Environmental and behavioral causes predominate, and detrimental effects on neurocognitive development are well documented. Multidisciplinary clinics designed to identify and treat FTT are effective but have not been widely adopted. A retrospective chart review was conducted of all patients with FTT seen at the authors’ large inner-city children’s hospital over a 40-month period, including those referred to a new multidisciplinary clinic. Over 40 months, only 75 children were referred and only 20 had moderate or severe FTT (z-score <−2.0). Nutritional status improved with treatment, but the small number of referrals who were severely affected led to the closing of the clinic. Recommendations for evaluating and treating children with mild FTT in primary care settings and a standardized definition of FTT that warrants more intensive treatment would help ensure that children were referred and treated appropriately.

The Healthy Schools Healthy Families Program - Physical Activity Integration Into Elementary Schools In New York City

Increasing physical activity delivers proven results in combating childhood obesity. The high prevalence of childhood obesity and the lack of effective treatment mandate a prevention approach that targets all children. School based programming is an important tool to reach all children. Healthy Schools Healthy Families (HSHF) partnered with teachers, community groups and school leadership to increase physical activity during school hours, targeting all children in seven low resource inner city schools. The intervention targeted 5000 children in seven inner city schools in New York City. Results are reported from 2009-2010. A multi-faceted approach targeted in-class, recess and gym time with programming varying from school to school, tailored to specific school needs. Minutes of physical activity were tracked using a classroom-based logging system, with incentives provided to teachers, school-aides and schools documenting the most activity. HSHF schools averaged 110.8 minutes/week/class with significant variation between schools. HSHF successfully generated by, at all school levels, with 2010 data reaching the CDC recommendation for physical activity during school hours, despite severe resource limitations in program schools. HSHF offers a feasible model for increasing activity for all children in low-resource, inner city schools and for tracking results.

Incomplete Follow-up of Hemoglobinopathy Carriers Identified by Newborn Screening Despite Reporting in Electronic Medical Records

OBJECTIVE Has the recent availability of newborn hemoglobinopathy screening results within patient electronic medical records (EMR) of birth hospitals facilitated follow-up by primary care pediatric providers? METHODS An online survey of all 137 primary care pediatric providers at a New York City academic medical center was conducted in 2008-2009 to assess practices for hemoglobin-apathy trait follow-up. Physicians were resurveyed 1 year later, following educational outreach and a letter of instruction underscoring the availability of screening results in the EMR. All 62 primary care pediatricians were surveyed at a nearby city hospital for comparison. RESULTS Overall response rate for the initial survey at the teaching hospital was 58% for pediatricians (N = 57) and family physicians (N = 23), and 50% for pediatricians at the city hospital (N = 31). Despite high prevalence of hemoglobinopathies in the population served and screening results in EMRs, only 46.2% of providers surveyed at the academic center reported routinely checking results of their infant patients: 38.6% of pediatricians and 66.7% of family practitioners. Some respondents were unaware that results are available in the EMR. The proportion of providers checking screening results was not significantly affected by educational intervention (N = 40). Provision of recommended follow-up for a positive trait result was modestly improved, especially in referring families for genetic counseling (25% to 50%, p<.01). In contrast, most pediatricians (83%) at the city hospital routinely check and perform follow-up. CONCLUSION Despite access to results in the EMR and targeted educational outreach, follow-up of hemoglobinopathy screening by primary care varies widely across clinical sites.

Engaging Caregivers in School-Based Obesity Prevention Initiatives in a Predominantly Latino Immigrant Community: A Qualitative Analysis.

Objectives: To explore caregiver perceptions of, and barriers and facilitators to, their involvement in school‐based obesity prevention programs in underserved Latino immigrant communities. Methods: Focus groups discussions were conducted with caregivers (n = 42) at 7 elementary schools with an academic partnership‐based obesity prevention program. Thematic analysis was used to identify key findings in the data. Results: Caregivers described their role as (1) learners of new and often complex health information using their children as primary messengers and (2) champions within their homes in which healthier choices are assimilated. Barriers to involvement included lack of time, financial pressures, unhealthy family practices, and concern that attempts to engage peers would be perceived as intrusive. Facilitators included assurance that stigmatizing health issues would be addressed with sensitivity. Conclusions and Implications: Caregiver involvement in obesity prevention may be fostered by transmitting information through children, addressing cultural barriers, and avoiding potentially stigmatizing approaches to delivering health messages.

Latino Immigrant Children's Health: Effects of Sociodemographic Variables and of a Preventive Intervention Program

The number of Latino immigrant children is expanding rapidly, and the factors that affect their health are multiple and interlinked. We therefore propose to describe the sociodemographic characteristics of a mostly Dominican immigrant population, to examine to what extent immigrant status and other factors play a role in determining measures of their childrens health and well-being, and finally to investigate whether a home visiting intervention modified any of these factors. The data were collected as part of an evaluation of a primary prevention home visitation program for high-risk mothers and their children. Bivariate and multivariate models were constructed to investigate the factors that affected the outcome variables. We found that numerous factors, especially a composite for overall stress, affected the health and well-being of participant children. We also demonstrated that the visitation program had a positive effect on many of these outcomes. Future program planners will need to understand the strengths and weaknesses of the specific population they serve.

Wellness Councils Build Capacity for School-Based Obesity Prevention in Harlem and Washington Heights, New York City:

Schools experience barriers when implementing wellness policies, and there is a dearth of research detailing how district wellness policies are implemented at the school level. Wellness councils were established in 7 elementary schools in Harlem and Washington Heights, New York City (NYC), to help these schools implement the NYC district wellness policy. Data on 4 wellness council process indicators and wellness council self-evaluation scores were correlated with obesity prevention process outcomes using Kendall tau correlations. An average of 8.9 (standard deviation = 0.7) wellness council meetings were held per school throughout the 10-month academic year. The average attendance at each meeting ranged from 7.1 to 15.2 members. There was a positive relationship between wellness council attendance and the number of participant encounters at staff physical activity events (r = .71, P = .02). Higher self-evaluation scores on staff wellness initiatives were associated with more student nutrition encounters (...