An Innovative Approach to Pediatric Access to Healthcare and Obesity Prevention Chelcie Oseni, MBA, BSN, RN Clinical Nursing Supervisor – Delta Grant Community Outreach

“Healthier Families, Stronger Communities, Brighter Futures” Grow Well Provides obesity-related preventative clinical and health services to children and adults in rural communities who are at risk for obesity in the 20 rural counties of West TN “Healthier Families, Stronger Communities, Brighter Futures” Funding for the activities of this consortium is provided by HRSA – Federal Office of Rural Health Policy – Community Based Division Delta States Rural Development Network Program

Le Bonheur on the Move (LOM) Le Bonheur on the Move (2004) is a medical mobile unit that travels throughout the 20 rural counties of West Tennessee Goal 1: To provide affordable, accessible health care services for children who are uninsured or underinsured (Medicaid) Goal 2: Assist children/families to access a medical home The Le Bonheur on the Move program is financially supported in part by Children’s Health Fund, HRSA Delta States Rural Development Network Program and medical insurance reimbursement.

Process for LOM Services Currently partner with 12 school systems in 8 counties 20,000+ consents distributed at the beginning of each school year History, Developmental Screening, PSC-17 Insurance and PCP information Priority List created (uninsured, underinsured) Patient schedule arranged through CSH (goal of 16-20 patients per clinic day) Goal is to visit each school system or county at least once per month 1,841 children seen during the 2017-2018 school year

LOM Services Provided Comprehensive Well-Child Examinations (EPSDT) include: Hearing and Vision Screening Lab Work: Lead, Hemoglobin, Glucose, Cholesterol, UA, HgA1c Vital Signs: Height, Weight, BMI, Blood Pressure HPI: History of Present Illnesses ROS: Review of Systems Physical Examination by APN *Sick Visits and/or Sports Physicals are also performed as requested by schools

LOM Follow-Up At completion of examination: Visit summary is faxed to PCP on file and mailed to parents Parents contacted if medications prescribed or referral is indicated RN Health Education Program Referrals made in participating school systems for children 10 years and older who are overweight, obese, have elevated blood pressure or high cholesterol Behavioral Health Care Navigation Program Referrals made in participating school systems for children with undiagnosed or untreated behavioral/mental health conditions

RN Health Education Coordinates one-on-one health education sessions Typically four 15-minute sessions Focused on 85210 message Collects pre- and post- health habits and knowledge survey Collects pre- and post- clinical measures Height, Weight, BMI Blood Pressure Parents are encouraged to participate in sessions

RN Health Education Program Outcomes: 327 children participated during 2017-2018 school year Decrease in BMI Percentile Year 1: 72% of participants had a decrease of ANY amount 0.9% overall decrease in BMI percentile Year 2: 61% of participants had a decrease of ANY amount 0.43% overall decrease in BMI percentile Decrease in Blood Pressure Year 1: 46% of participants with an elevated BP decreased to normal Year 2: 71% of participants with an elevated BP decreased to normal Increased Fruit/Vegetable Consumption Year 1: 47% of program participants Year 2: 44% of program participants Increased Physical Activity Year 1: 38% of program participants Year 2: 41% of program participants

Behavioral Health Care Navigation Pilot began August 2017 in one county (two school systems) Program is implemented by a Licensed Clinical Social Worker One-on-one counseling visits Child and family home visits Navigation to appropriate community resources Collaboration with the child’s family and school personnel Develop interventions for the home and/or school environments Assist with making specialty health care appointments Assist with insurance and public assistance enrollment Facilitate transportation needs

Behavioral Health Care Navigation Program Outcomes 39 children received services during the 2017-18 school year Data collected from multiple Behavior Improvement Assessment Tools completed by LCSW, parent/guardian, teachers and other school staff revealed: 57.9% of children showed improvement in academic behavior 56.1% of children showed improvement in behavior at school 57.1% of children showed improvement in behavior at home 48.9% of families showed improvement in parental involvement

Strategies for Success Networking and Partnerships Coordinated School Health Meeting identified needs Accountability Timeliness Billing Practices LOM Began 3 years ago as a sustainability measure Bill only to MCOs we contract with Child or family never receives a bill Average of $100 reimbursement per insured child RN Health Education Bill MCOs same as LOM Reimbursed for Preventative Counseling, 15 (99401) or 30 (99402) minutes