1. COPC in DC Kathleen M. Kadow June 2000

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

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

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

5. COPC Steps Community Definition Community Characterization Prioritization Detailed Assessment Intervention Evaluation

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

7. Mapping: July 98 – July 99

8. Community Definition

10. 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

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

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

13. 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%

14. Community Characterization

15. Health Status Natality Mortality Morbidity Hospital/ Health Services/Insurance

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

17. Community Characterization  KEY INFORMANTS & FOCUS GROUPS

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

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

20. Prioritization

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

22. Selected Health Problem SCHOOL and LEARNING PROBLEMS

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

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

25. Detailed Assessment SCHOOLS BY WARD

26. Detailed Assessment School Data

27. Detailed Assessment School Data

28. Detailed Assessment

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

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

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

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

34. 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

35. 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.

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

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

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

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

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

41. Relevance Quality Efficiency Satisfaction Differential Value

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

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

44. Conclusion Review COPC Process Future plans

45. Thank you for your attention