+ The Grow Clinic Evaluation Plan Julia Hilbrands PH 221 March 11, 2015

+ The Grow Clinic and Failure to Thrive (FTT) What is The Grow Clinic? At Boston Medical Center Mission and objective: addresses and reverse FTT in children from birth to age 6 What is FTT? Inadequate weight gain Organic and nonorganic causes Poverty is the single greatest risk factor

+ More about The Grow Clinic Established in 1984 Addresses a variety of food-related issues Multidisciplinary team includes physicians, dieticians, nurses, social workers, psychologist, and case workers Services: Medical attention, home and daycare visits, behavioral and occupational therapy, referrals Funding

+ Evaluation Process Evaluation Office visits/initial evaluations Home, school, and daycare visits Behavioral services Referrals, social services Outcome Evaluation Food access and availability Child health Cost benefit/cost effectiveness Impact Evaluation Long-term health status Surveillance system

+ Process: Office Visits Evaluation would include: Number of referrals received from PCPs Average number and extent of Grow Clinic services used by each patient Extent to which visits met patient and family needs How well written recommendations were understood and followed Tools used: Clinic schedule/records Satisfaction Survey Patients/families Clinicians, other clinic staff

+ Process: Home, school, and daycare visits Evaluation would include: Total number of visits Average number of visits per patient Extent to which visits aid Grow Clinic staff in formulation patient recommendations Extent to which home visits allow parents and caregivers to convey concerns and communicate with clinic staff Attitudes of daycare/school teachers towards visits and their effectiveness Tools used: Clinic records Focus groups Surveys

+ Process: Behavioral services Evaluation would include: Number/type of behavioral services available Frequency of service use Patient and family satisfaction of behavioral services Patient and clinician recommendations for more or less services? Tools used: Clinic records Surveys Focus Groups Parents/families Clinicians and other office staff

+ Process: Referrals and social services Evaluation would include: Number of medical/specialty referrals going out Number of food bank referrals Number of families connected with food assistance programs Number of housing and transportation cases Extent to which referrals and connections met patient and family needs Tools used: Clinic records Focus Groups

+ Outcome: Food access and availability Evaluation would include: Extent to which eating and feeding habits changes as a result of clinic visits Extent to which food access changed Extent to which outside services are used Patient and family satisfaction with clinic work Tools used: Surveys Focus Groups

+ Outcome: Changes in child health Evaluation would include: Comparison of anthropometric measures before and after clinic visits Examination of nutrient status in program graduates Perception of clinic success by PCPs Tools used: PCP records Focus Groups

+ Outcome: Cost Benefit/Cost Effectiveness Evaluation would include: Summary of all funding sources Complete budget analysis Extent to which finances impact clinic operation and success Tools used: Annual budget Past budgets Staff/administration interviews

+ Impact: Long-term health status Evaluation would include: Assessment of school behavior in program graduates of at least 5 years Assessment of school performance in program graduates of at least 5 years Health status of program graduates at 5 years, 10 years, 15 years post- clinic Status of food availability Tools used: PCP records School records Teacher interviews Parent interviews

+ Impact: Surveillance System Goal: establish a system that tracks Grow Clinic “graduates” after they leave the clinic Use information on long-term impact to access how current treatment could be altered for better long-term results. Tools Used School Records PCP Records Parent Surveys Patient Surveys

+ Discussion Anticipated Findings Trends in usage of certain services Greater effectiveness/satisfaction of certain services Lingering problem of food access once children graduate from the clinic Recommendations More federal funding Staff training in areas of low effectiveness/satisfaction Implementation of a long-term follow-up program