Jolie A. Limon, MD, FAAP Valley Children’s Healthcare The Health of Central California’s Children - Key Challenges and Opportunities - Jolie A. Limon, MD, FAAP Valley Children’s Healthcare

Valley Children’s Healthcare Innovating for Tomorrow Valley Grown and Owned One of a Kind Non profit specialty provider governed by a Board of community leaders Founded by a group of valley women over 60 years ago The only pediatric speciality provider of its kind in all of Central California One of the busiest children’s providers in California Innovating for Tomorrow A growing healthcare network Heightened focus on access and education Committed to providing the best care possible

Key Challenges Based on Valley Children’s most recent Community Health Needs Assessment of our 10 county service area. Four county needs assessment facilitated by Hospital Council (Fresno, Kings, Madera, Tulare) Remaining 6 counties Review of reports, studies and data on children’s health Interviews with key stakeholders Valley Children’s needs assessment included the following activities. Participating in the four county needs assessment recently facilitated by the Hospital Council for hospitals in Fresno, Kings, Madera and Tulare counties. Conducting additional needs assessment activity in Kern, SLO, Merced, Mariposa, Stanislaus and San Joaquin counties that included both a review of the most current reports, studies and data on children’s health as well as interviews with key stakeholders including school districts, county public health departments, primary care providers, health plans, and community based organizations.

Key Challenges Demographic Factors / Poverty - Percent of children living in poverty, 2014 - Valley Children’s Service Area: 34% - Statewide: 23%

Key Challenges Access to Care: A significant portion of Valley Children’s service area is designated as a Health Professional Shortage Area for primary care, including pediatrics. SJV 48/100,000 Primary care physicians vs. Sacramento 69/100,000 or Bay area 86/100,000 *Data from 2011from Council on Graduate Medical Education (US Dept. of Heath and Human Services)

Key Challenges Child Maltreatment Substantiated Cases of Child Abuse and Neglect Per 1,000 Children, 2014 - Valley Children’s Service Area: 9.97 - Statewide: 8.70 Chronic Disease / Obesity Percent of 5th graders who meet recommended weight and strength, 2014 - Valley Children’s Service Area: 55% - Statewide: 59% 45% of our Valley kids are obese-almost half

Key Challenges Chronic Disease / Asthma Percent of children diagnosed with asthma, 2011 - 2012 - Valley Children’s Service Area: 17% - Statewide: 15% Infant Health / Mortality Number of infants deaths per 1,000 live births, 2013 - Valley Children’s Service Area: 5.86 - Statewide: 4.70

Key Challenges Infant Health / Pre-Term Births Percent of infants born before 37 weeks of gestation, 2013 - Valley Children’s Service Area: 9.06% - Statewide: 8.80% Infant Health / Developmental Screening Percent of infants and young children received recommended schedule of screenings, 2013 - Statewide: 28% Regarding Development Screenings, the percent of children in Valley Children’s service area receiving the recommended level of screenings is not available, however interviews with county public health staff, primary care providers, community based agencies, and Valley Children’s staff confirmed that this is a major issue regionally.

Key Challenges Unintentional Injury The of the leading causes of death of children 19 years of age and younger in Valley Children’s service area 36.5-52/100,000 VS CA 31/100,000 Includes motor vehicle accidents, sports injuries, drowning, falls, burns, poisonings and more. Preventable Boys>girls Racial/ethnic inequity #1 cause of death for ages 1- 24 years

Key Challenges Demographic Factors / Literacy Percent of children reading at grade level by the 3rd grade, 2015 - Valley Children’s Service Area: 28% - Statewide: 38%

Approach to Opportunities Efforts to address these challenges must be guided by the following principles. Strategic: Focusing on issues and solutions that will have the biggest impact. Collaborative: Leveraging the resources and expertise of a diverse set of stakeholders. Regional: Promoting consistency and efficient use of resources by applying solutions across counties.

Opportunities Access to Care - Recruitment of pediatricians - Training of physician and non physician clinical providers Valley Children’s Residency Program - Partnering with other organizations Child Maltreatment Prevention - Valley Children’s Child Abuse Prevention and Treatment Program

Opportunities Chronic Disease Prevention - Participation in existing county based and regional collaboratives focused on obesity prevention, and diabetes prevention and management. Examples include the Fresno County Health Improvement Partnership’s diabetes work group, The Madera County Accountable Community for Health’s pre diabetes and diabetes work group, the Childhood Weight Management Task Force for Fresno and Madera Counties, and the Central Valley Health and Nutrition Collaborative.

Opportunities Infant Health - Participation in existing county based and regional collaboratives focused on preventing pre-term births and infant mortality. - Facilitation of a regional effort to increase the percentage of infants and young children receiving developmental screenings. Collaboratives focused on preventing pre term births and infant mortality include the Fresno County Pre Term Birth Initiative, the Fresno County Health Improvement Partnership’s pre term birth work group, and the California Health Collaborative’s Regional Perinatal Collaborative. Regarding developmental screenings, Valley Children’s convened a half day planning session in Sept 2015 with First 5 agencies, Regional Centers, and other providers throughout Central California, the result of which was an agreement to pursue regional implementation of Help Me Grow, a national model for increasing the level of services and care provided to infants and young children. First 5 Fresno has since taken the lead facilitating implementation.

Opportunities Unintentional Injury Prevention - Valley Children’s Injury Prevention Program - Valley Children’s leadership in Safe Kids Central California – Coalition of 40 locally based agencies Increase community awareness