COPC in DC Kathleen M. Kadow June 2000

Washington, DC  68 SQUARE MILES  POP:519,000  US CAPITAL  MID-ATLANTIC REGION  FEDERAL GOVERNMENT  ‘HOME-RULE’

Comp Clinic Established in 1967 Community-based clinic of Children’s Hospital Comprehensive pediatric services Staffing Women Infants and Children (WIC)

City, Ward, Census Tract  EIGHT WARDS IN DC  192 CENSUS TRACTS  CENSUS TRACT = 3200 PEOPLE  COMP CLINIC  CHILDREN’S HOSPITAL

COPC Steps Community Definition Community Characterization Prioritization Detailed Assessment Intervention Evaluation

Community Definition “Geographic Retrofitting” Visits to Comp Clinic 7/98-7/99 Home address ---- census tracts 85% of visits within Washington,DC

Mapping: July 98 – July 99

Community Definition

Targeted Population The pediatric (0-18 years old) users and non-users of the 26 census tracts that represent the top 50% of visits to Comp Clinic The 26 census tracts fall into four of the eight wards in DC

The Next Step... Community Definition Community Characterization Prioritization Detailed Assessment Intervention Evaluation

Community Characterization COMMUNITY SETTING Washington,DC Wards 1,2,4 and 5

Community Characterization RACE/ETHNICITYDC26 CENSUS TRACTS IN WARDS 1,2,4 AND 5 African- American62%78% Caucasian34%18% Hispanic7.2% (any race)14% (any race) Asian/Pacific Islander/American Indian 4%

Community Characterization

Health Status Natality Mortality Morbidity Hospital/ Health Services/Insurance

Community Characterization  12 Key Informant Interviews  3 Focus Groups  Over 70 issues identified  Organized into ten large topic areas for prioritization step

Community Characterization  KEY INFORMANTS & FOCUS GROUPS

Step 3….. Community Definition Community Characterization Prioritization Detailed Assessment Intervention Evaluation

Prioritization Prioritization Team #1 Comp Community Board Team Meeting #1 Step 1- review and ranking of 10 broad topics

Prioritization

Prioritization Team #2 COPC Team Team Meeting #2 Review topic selected by team #1 Focus School and Daycare Problems

Selected Health Problem SCHOOL and LEARNING PROBLEMS

School and Learning Problems WORKING DEFINITION Any academic difficulty experienced in school,due to any cause.

Step 4…. Community Definition Community Characterization Prioritization Detailed Assessment Intervention Evaluation

Detailed Assessment SCHOOLS BY WARD

Detailed Assessment School Data

Detailed Assessment School Data

Detailed Assessment

DISTURBING TRENDS Reading and Math Skills Ward vs DC data Math scores, widening gap

Detailed Assessment Literature and Experience  Medical  Behavioral/Psychiatric  Psychosocial  Educational  School Problems Clinic

Detailed Assessment Screening Tools  Child Health and Family Functioning Questionnaire  Parents’ Evaluation of Developmental Status  Pediatric Symptom Checklist  Einstein Assessment of School Related Skills

Getting Closer…. Community Definition Community Characterization Prioritization Detailed Assessment Intervention Evaluation

Intervention What has been done? Federal/City/Local What else can be done? Create baseline data concerning the risk factors associated with school problems Effectively screen for school problems within the targeted community

Intervention HYPOTHESIS: The use of a standardized screening protocol to assess school and learning problems will enable primary care providers and staff to identify children (5-11yrs old) with an existing school or learning problem.

Intervention GOAL To identify children 5-11years old, in a primary care pediatric clinic with school and learning problems using a standardized screen.

Intervention Objectives Program Activities Community and Staff Participation Resources and Budget Surveillance and Monitoring

Objectives Examples Screening 5-11 year olds over 6 months Disposition after screen Referrals Increase correct identification of school and learning problems Increase awareness

Program Activities Examples COPC Meeting # 3 Chart Review (before/after) Training of staff Comparison (screen/provider) Community educators Resource review

Are you still awake?…. Community Definition Community Characterization Prioritization Detailed Assessment Intervention Evaluation

Relevance Quality Efficiency Satisfaction Differential Value

Evaluation Outcomes  Number receiving screen  Number of referrals/reason  Rates of identification (pre/post)  Survey (pre/post) of staff  Satisfaction (pre/post)

Evaluation Process/Structure  Acceptability  Ease of administration  Barriers  Length of time.  Differential value.

Conclusion Review COPC Process Future plans

Thank you for your attention