Spreading and Scaling Prevention and Treatment Approaches: Centers of Excellence Model Janet E. Farmer, PhD School of Health Professions University of Missouri

Recommended Policy Actions Prevention Child care licensing, training & support services Support for school-based health and wellness Treatment Medicaid reimbursement for professionals with specialized training in family-centered, evidence-based weight reduction programs Prevention & Treatment Infrastructure Centers of Excellence Commission on Childhood Obesity Subcommittee on Childhood Obesity State of Missouri Children’s Services Commission

Overview Challenges within the service delivery system Lessons from Autism Spectrum Disorders (ASD) Vision and goals for the Missouri Centers of Excellence for Childhood Obesity

The Challenge: Gaps in Care No or low dose treatment of obesity in children, with little or no care coordination Health professionals lack awareness of and training in evidence-based weight control strategies Reimbursement is inadequate to meet the need Traditionally underserved groups (e.g., rural, low income) have less access to effective care Collaborative partnerships sometimes exist, but in general the care delivery system is fragmented

Systems of Care for Healthy Weight Children Primary care Child care and school services Agency resources Mental health services Therapies Family-to-family supports Child Family Community resources Specialty care

Systems of Care for Healthy Weight Children: Key Elements Comprehensive Coordinated Family-centered Community-based Culturally competent (Association of Maternal & Child Health Programs, 2014; Boudreau et al, 2014)

What Can We Learn From ASD? Children with obesity and those affected by Autism Spectrum Disorders (ASD) show similarities: Increasing prevalence of both conditions Range in level of severity; often chronic and stigmatizing Complex etiologies that require a multi-faceted approach to service delivery, c utting across care settings Growing public awareness of the unmet needs of children and families

What Can We Learn From ASD? Children with obesity and those affected by Autism Spectrum Disorders (ASD) show similarities: Effective behavioral treatments have emerged Family involvement is critical Early intervention is the best approach, but children are often not identified in a timely way Inadequate number of providers to meet the need for evidence-based treatment, especially for vulnerable groups Readiness for change in systems of care through collaborative partnerships

Models of Care: Missouri Autism Centers (DMH) 2007 Children’s Mercy Hospital (University of Missouri-Kansas City) Knights of Columbus Child Development Center, Cardinal Glennon Children’s Hospital (St. Louis University) Thompson Center for Autism & Neurodevelopmental Disorders (University of Missouri) 2008 ASD Diagnostic and Treatment Center (Southeast Missouri State University)

Missouri Autism Centers Seek to help families Obtain accurate and timely diagnosis Gain access to a full continuum of care in their home communities Coordinate care with other health and educational services Seek to serve the state Building community capacity through education and training Establishing models of quality ASD health service delivery Aligning with federal healthcare standards

Clinical Scope FY children and youth evaluated for ASD 6,737 total service visits for ASD Education/Training FY students in clinical training 137 educational presentations with 7,206 participants Program Snapshot: MU Thompson Center

Broader Impact FY12 Basic and clinical research on ASD National Autism Treatment Network Simons Simplex Collection Federal grants to improve comprehensive and coordinated care for those with ASD in Missouri, including early identification of those from underserved groups Program Snapshot: MU Thompson Center

Centers of Excellence for Childhood Obesity Centers will forge collaborative relationships with other centers and with partners in effective prevention and treatment Caregivers Primary and specialty health care providers Schools Child care centers Non-profit organizations State agencies Centers will serve as a central point of contact and support for Treatment delivery Training for families, providers and communities Research to advance the knowledge base about effective care and service delivery

Specific Recommendation The Missouri Department of Health & Senior Services will establish at least three university-based Centers of Excellence to: Assure regional, coordinated access to treatment in health care and community settings through a network of affiliated partners Meet standards to provide evidence-based, multi-component (EBMC) weight reduction programs Provide training for health care providers, school staff, and others in their region about screening, treatment, prevention and referral strategies Conduct research to evolve prevention and treatment best practice approaches.

Centers of Excellence Summary Partner Treat Train Advance the field Establish a national model of care for children, youth and families affected by obesity