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COPC in DC

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COPC in DC

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  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

  9. 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 <climate, environment, housing, ‘Metro’, DC Government> • Wards 1,2,4 and 5

  13. Community Characterization

  14. Community Characterization

  15. Community Characterization 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 • 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 School Data

  26. Detailed Assessment • School Data

  27. Detailed Assessment

  28. Detailed Assessment

  29. Detailed Assessment • DISTURBING TRENDS • Reading and Math Skills • Ward vs DC data • Math scores, widening gap

  30. Detailed Assessment • Literature and Experience • Medical • Behavioral/Psychiatric • Psychosocial • Educational • School Problems Clinic

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

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

  33. 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

  34. 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.

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

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

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

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

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

  40. Evaluation • Relevance • Quality • Efficiency • Satisfaction • Differential Value

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

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

  43. Conclusion • Review COPC Process • Future plans

  44. Thank you for your attention