Tulsa children s project addressing the social determinants of health
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Tulsa Children’s Project: Addressing the social determinants of health. Jennifer Hays-Grudo, PhD George Kaiser Family Foundation Chair in Community Medicine School of Community Medicine, OU-Tulsa Principal Investigator, Tulsa Children’s Project. Tulsa Children’s Project.

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Tulsa Children’s Project: Addressing the social determinants of health

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Tulsa Children’s Project: Addressing the social determinants of health

Jennifer Hays-Grudo, PhD

George Kaiser Family Foundation Chair in Community Medicine

School of Community Medicine, OU-Tulsa

Principal Investigator,Tulsa Children’s Project

Tulsa Children’s Project

  • Based at Tulsa Educare 1

  • OU-Tulsa engaged during first planning year

  • Multi-faceted intervention

    • Enhance early childhood curriculum

    • Adult education, workforce training for parents

    • Promote physical health for family, staff

    • Integrate positive mental health in all components

  • Funded by George Kaiser Family Foundation

Tulsa Educare

Caren Calhoun, Vicki Wolfe


School of Community Medicine: Jennifer Hays-Grudo, Jerry Root

School of Social Work: Julie Miller-Cribbs, graduate assistants

College of Education: Diane Horm

Family and Children’s Services

Ruth Slocum

Educare mental health & family support specialists

Harvard University

Center on the Developing Child: Jack Shonkoff

Graduate School of Education: Catherine Snow, Hiro Yoshikawa

Boston Children’s Hospital: William Beardslee

U of Texas, Ray Marshall School of Public Policy

Chris King, Bob Glover

George Kaiser Family Foundation (GKFF)

Annie Van Henken and Monica Basu, project officers

TCP: Collaborative Partners

Intervention Model

Low-Income Families

Children prepared to succeed in school (foundation for life-long success)


Children (birth-5) enrolled in Tulsa Educare

Medical Home


Physical activity


Early Childhood Education

Healthy Competent Children in Healthy Competent Families

Social- Emotional Health

Low-opportunity communities

EduCareers: Adult Education Workforce Training

Parents actively improving their own & their children’s life circumstances

Economic security

Reduction in inter-generational poverty

Current Situation

Short-term outcomes

Long-term outcome


Key features of interventions

  • Curriculum development and training

    • Mental health (socioemotional literacy) integrated in curriculum (Snow’s VOICES) and in teacher/staff training (Beardslee’s Family Connections)

    • Interactive process with Tulsa (Educare master teachers, Ruth Slocum)

  • Health promotion

    • Integrated with mental health messages (yoga for reflective practice, physical activity and depression)

    • Parents and staff: self-care and role models

  • Workforce, adult education (EduCareers)

    • Integrated with FCS goals, Workforce Tulsa initiatives

    • Focused on work readiness: job and life skills

3 Components of EduCareers

Nursing Cohort

Focus on high demand occupation: Nursing (CNA, LPN, RN)

Team-based college education (TCC, TTC)

Financial incentives

Workforce Tulsa/WIA

Weekly partner support meetings

Transportation support

Limited slots: 10 currently enrolled

Adult Education

GED (Union PS)

ESL (Union PSon-site at Educare

Civic and Work Readiness

Open eligibility

Free childcare

Biweekly partner support meetings

Transportation support

Limited seats

GED: 10 enrolled

ESL: 30 enrolled

Individual CareerCoaching

One-on-one coaching through Workforce Tulsa

Educational/employment focus

Enhanced Employment Planning (EEP) process

Biweekly partner support meetings

Transportation support

Limited seats: 4 enrolled

Why? Education and income are major drivers of health


Socioeconomically determined factors

Social circumstances 15%

Environmental exposure 5%

Behavioral patterns 40%

Health care access 5-10%


Determinants of health*

*and their contributions to premature mortality; Schroeder, NEJM, 2007

Social determinants of health

The World Health Organization Commission defined social determinants of health as the conditions in which people are born, grow, live, work and age, including the health system.”

“The structural determinants and conditions of daily life constitute the social determinants of health and are responsible for a major part of health inequities between and within countries”

(WHO Commission on Social Determinants of Health, Final Report, 2008).

WHO Commission on Social Determinants of Health, final report, 2008.

WHO Commission on SDH (2008)

  • Three action areas:

  • tackle the daily living conditions in which people are born, grow, live, work and age

  • tackle the structural drivers of those conditions at global, national and local levels

  • carry out more research to measure the problem, evaluate action and increase awareness

What have we been doing? (where did it get us?)

What do we see that could be done?

What do we sense from the community?

What is our deepest purpose?

What is possible? What can we begin to do?

Let’s start.

Apply Theory U to address SDH

Interventions to address SDH

  • Downloading: what do we know? (health outcomes tied to SDH: education and income)

  • Seeing fresh: what are we not seeing? (programs don’t target root causes, not coordinated)

  • What do we sense is needed? (partners, communication, trust)

  • What are we called we do? (build relationships, develop organic programs)

  • What would it look like? (user friendly, responsive)

  • Let’s try it.

Engaging community partners in new ways



Possible Disciplines Clinical medicine Behavioral science Public health Nursing Education Social work Public policy Economics Law Architecture Urban design Marketing Media Nutrition Exercise science



health care


built environment

economic environment

Engage community



physical resources








school boards


Health disparities and social determinants of health: framing the conversation

Public opinion/messaging research, funded by Robert Wood Johnson Foundation

  • What do you feel and think of when you hear this

  • Participants: Republican and Democratic Congressional staff

    Political difference on issue of imbalance:

    Democrats see it as unnatural, cause for anger

    Republicans see it as natural, fear effort to redistribute resources

    But agree on importance of fairness and personal responsibility

Shared beliefs

  • Health starts long before illness, in our homes, schools and jobs.

  • Your neighborhood or job shouldn’t be hazardous to your health.

  • All Americans should have the opportunity to make the choices that allow them to live a long, healthy life, regardless of their income, education or ethnic background.


Putting health into context

The conditions in which we live and work have an enormous impact on our health, long before we ever see a doctor (social determinants of health).

It’s time we expand the way we think about health to include how to keep it, not just how to get it back (prevention).

The more we see the problem of health this way, the more opportunities we have to improve it, individually and as a society.


  • Schroeder SA. We can do better--Improving the health of the American people. N Engl J Med 2007;357:1221-8.

  • WHO Commission report: http://www.who.int/social_determinants/en/

  • Adler NE, Marmot M, McEwen BS, Stewart J (eds.) (1999). Socioeconomic Status and Health in Industrial Nations: Social, Psychological, and Biological Pathways. New York: New York Academy of Sciences.

  • Framing the message: http://www.rwjf.org/files/research/vpmessageguide20100729.pdf

  • Centers for Disease Control: http://www.cdc.gov/socialdeterminants/

  • AMA: http://www.ama-assn.org/ama/pub/physician-resources/public-health/eliminating-health-disparities.shtml

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