GRANT PROJECTS: NEW MEXICO, NEW YORK

NEW MEXICO

HEALTHY FAMILIES SANTA FE:  AN EARLY INTERVENTION PROGRAM FOR 
PREVENTION OF CHILD ABUSE AND NEGLECT 
(Formerly Santa Fe First Steps) ⁽¹⁹⁹¹⁾ New Mexico Department of Health, Santa Fe, NMThe purpose of this program is to identify the needs of the families in the community and provide the intensive home visitation component to those who qualify. In partnership with Healthy Families America (HFA), which operates 60 HFA pilot sites including Santa Fe, and whose overall goal is to lay the foundation for voluntary, neonatal, home visitation systems nationwide, 500 families have been referred to date. Families are referred at the birth of their first child and graduate from the program when the child turns three. Support workers empower the families by offering child development information, infant stimulation, and linkage to community resources including a medical home, group activities, and transportation to clinic appointments. An evaluation component is in place to determine the program's effectiveness to significantly reduce the incidence of child abuse and neglect in Santa Fe County and improve the home environment of families of newborns.

HELPING INDIAN CHILDREN OF ALBUQUERQUE (HICA) ⁽¹⁹⁹⁴⁾ All Indian Pueblo Council Inc, Albuquerque, NMHICA (Helping Indian Children of Albuquerque) will provide service coordination for urban Indian children in the Albuquerque metropolitan area. The All Indian Pueblo Council will administer the grant with the guidance of an active advisory board consisting of local pediatricians, parents, public school personnel, and agencies that provide services to people with disabilities. The project aims to improve access to and utilization of health care and related resources by urban Indian children and their families. Project staff will work with families through a process of home visitation, development of an IFSP, parent education, case management and advocacy training, and formal collaborative agreements with participating agencies. A network of parents will be organized to provide a support system for participating families.

THE PUENTES TEEN PARENT SUPPORT PROJECT ⁽¹⁹⁹⁴⁾ Taos County Maternal and Child Health Council, Taos, NM The Puentes project is a comprehensive, long-term, case management, teen parent support program initiated by the Community Wellness Council (the Taos Maternal Child Health Council), a Presbyterian Medical Services program in a community of approximately 7,000 in a rural county that documented 40 births to teens in 1994. The case management component will assess individual participant needs for schooling, job training, public assistance, housing, and medical care; will assist participants in accessing these services; and will serve as a liaison between care providers. Home visitation is a primary facet of this component. The counseling component will provide two support groups weekly, which will be a forum for parenting and child development education as well as counseling, and will involve the participation of several peer facilitators as well as the counseling coordinator. Staff and participants will jointly undertake a project to document and validate traditional and developmentally appropriate child care and child rearing practices in the Taos area. The program is designed to serve 20 pregnant and parenting teens at a time, for a 3-year period.

GIRL TIME YOUTH DEVELOPMENT PROGRAM ⁽¹⁹⁹⁹⁾ Community Wellness Council, Taos, NM Girl Time is an after-school enrichment program for at-risk nine and ten year old girls, which meets three days a week. Girl Time's primary goal is to prevent future teen pregnancy by empowering girls to develop and realize their goals and dreams in every aspect of their lives. Girl Time will include educational support, health promotion, age appropriate sexual health education, alcohol and drug prevention, and assertiveness and self-defense training. Music, dance, arts and crafts, sports, cultural enrichment, and community service also will be a major part of Girl Time. The program provides support to the entire family through case management, information and referral, advocacy, and parent/child activities. Our goal is to have girls participate in our program from age nine and ten years until age fourteen. From age fourteen until age nineteen, girls will continue with case management, educational support, and community service and leadership opportunities. Eligibility requirements for participants include: academic underachievement, poor school attendance, known family dysfunction, divorced or single parent families, low income level, early physical maturation, family history of teen pregnancy, and lack of religious or community involvement.

PREVENTIVE ON SITE WELL CHILD CARE FOR CHILDREN
ATTENDING CUIDANDO LOS NINOS THERAPEUTIC CHILD CARE
FOR HOMELESS CHILDREN ⁽¹⁹⁹⁹⁾ Cuidando Los Ninos, Inc, Albuquerque, NM The Well Child Care Center at Cuidando Los Ninos Child Care is providing preventive health care for 55 children from 6 weeks to 5 years old, whose parents, primarily mothers, are attempting transition to a permanent housing situation. Social workers aid the parents in the transition process. Therapeutic childcare is provided 5 days a week. Developmental evaluations, play therapy, and psychological consultations are available.

We offer well child exams, as well as exams at the first sign of illness to allow early medical intervention and to decrease the absentee rate. Dietary evaluations and assessment of dental health will be regular components of our services. Few parents use their Medicaid insurance effectively. Teaching sessions with parents are planned to provide basic, practical information on child rearing and common ailments and to provide parents with skills to become effective advocates for their children once they leave the program. Community nurses and local pediatricians will work in the clinic, as well as medical, nursing and physician assistant students.

THE SEAD (SUPPORT, EMPOWERMENT, ADVOCACY,
AND DOULAS) PROJECT ⁽²⁰⁰⁰⁾ New Mexico Advocates for Children and Families, Albuquerque, NM Non-English-speaking immigrant women and their infants face formidable language and cultural barriers to health care, which may result in poor health outcomes. Childbirth represents an especially vulnerable time for these women, who may be unable to communicate effectively with providers during deliveries, or may experience health care providers who are unaware of other cultural practices related to childbirth, resulting in culturally inappropriate care. The SEAD project was developed in response to needs expressed by women with limited English-speaking skills for quality medical interpreting, culturally competent health information, and emotional support during pregnancy, labor, delivery, and early parenting. The project develops leadership capacity among these women, while training bilingual women as doula/medical interpreters to provide prenatal education, medical interpretation, and support during childbirth, postpartum, and at home to new parents. The SEAD collaboration consists of community women and organizations, health care providers, service agencies, the University of New Mexico, and the New Mexico Department of Health. Project objectives include: 1) Improving birth outcomes and breastfeeding rates among women with limited English-speaking skills; 2) Empowering community women to improve their own health and the health of their families; and 3) Increasing local health care systems' multi-lingual and multi-cultural perinatal services for women.

NEW YORK

FOSTERING IMPROVED HEALTH STATUS FOR FOSTER CARE CHILDREN ⁽¹⁹⁹⁰⁾ Kids Adjusting Through Support, Inc, Rochester, NYUnder this project, support groups will be developed for foster care children and their foster parents. In addition, programs will be developed for families in which a family member has a life-threatening illness or has died. The children's groups will be organized by age groups and will be led by mental health counselors. The foster parent groups will meet simultaneously to assist the parents in dealing with issues including child behavior, limit setting, value systems, and forming attachments with their foster children. The support groups, which will address emotional and social impact, will be led by volunteers and will meet weekly for 10 weeks, with a minimum of 50 foster families being served annually. Project staff will conduct pre- and post-participation evaluations and will make referrals for children and/or parents assessed as needing health care or mental health services. Special activity outings, such as bowling and swimming, will be held about every 5 weeks to foster friendships among the children in the project.

PARENTS AND CHILDREN TOGETHER (PACT) PROGRAM ⁽¹⁹⁸⁹⁾ The Children's Hospital of Buffalo, Buffalo, NYThe Children's Hospital of Buffalo established a pilot program in 1988, to provide primary care to children at high risk for physical or sexual abuse, many of whom were being raised by parents with substance abuse problems. The Healthy Tomorrows grant has helped to support the addition of three new components to this pilot program. As part of a maternal and child health advocacy component, participating families receive parent education classes and intensive home-based support from "maternal-infant specialists" who have been recruited from the community and trained to conduct home visits and provide surrogate parenting. Project staff also coordinate support groups for the mothers of children enrolled in the project. The other two added components include one that focuses on research regarding the outcomes for program participants and another that facilitates program planning through intra and interagency linkages.

THE PEDIATRIC COMPREHENSIVE ASTHMA MANAGEMENT PROGRAM ⁽¹⁹⁹²⁾ Women and Children's Health Center of Western Queens Borough 
The New York Hospital-Cornell Medical Center, New York, NYThe primary goal of this project is to reduce asthma/bronchitis hospitalization rates by 80% for enrolled children. A full-service satellite program of the New York Hospital Children's Asthma and Allergy Center will be established at the Women and Children's Health Center in western Queensboro. During the 5-year project period, staff plan to provide comprehensive evaluations and treatment plans for between 300 and 400 asthmatic residents of a nearby public housing complex. About 80% of the patients evaluated will be enrolled in the asthma management project, which will provide one-on-one training for patients and their families, asthma case management services, and 24-hour access to physician/nurse specialist advice for asthma care. Project staff also will develop an asthma education seminar series for patients and their families.

WAR ON ASTHMA: THE EAST HARLEM ASTHMA WORKING GROUP ATTACKS PEDIATRICS ASTHMA RATES IN EAST HARLEM ⁽¹⁹⁹⁷⁾ Mount Sinai School of Medicine, New York, NYThe purpose of this project is to improve the health of vulnerable children in a low income neighborhood of New York City by intervening in the home to eliminate and/or control asthma allergens and to empower children and their parents to understand the appropriate use and management of the asthma medications and devices; to assure that children have a true medical home; and to train community workers as asthma counselors. The East Harlem Community Health Committee, an alliance of consumers, community health agencies and other providers and businesses had charged its Pediatric/Child Health Subcommittee to work toward reducing the excessive asthma rates among East Harlem children. The east Harlem Asthma working group was formed to meet this challenge.

We will enroll 20 families and provide the following services: visit the patients' homes, using the Little Sisters of the Assumption, a home nursing program, to assess and actually intervene in cleaning the environment, teaching the parents and children and stressing the control of asthma triggers and the importance of proper use and storage of asthma medications; raising the self-esteem of parents and children in the process. Follow-up visits at one, three, seven and ten months will measure progress and reinforce education. We also assure that the child has a true medical home, makes appropriate preventive visits, and understand what to do when asthma flares occur to alleviate the need for emergency treatment. Outcomes will be measured by reduced emergency room visits and hospitalizations due to asthma attacks.

In future years, community workers will be trained to implement this approach and serve as asthma counselors. Intervention will be expanded to incorporate high rise projects and tenement buildings.

HARLEM ADOLESCENT AND CHILD TOTAL SERVICES ⁽¹⁹⁹⁷⁾ Harlem Hospital Center, Department of Pediatrics, New York, NY Harlem ACTS center provides a community-based medical home for adolescents and their children. The center provides a continuum of comprehensive, family-centered care focusing on identified issues of the adolescent parent. In this model, pregnancy is but one phase in the continuum of care, therefore, the provision of prenatal and primary care at one site by the same set of providers fosters continuity. Strong emphasis is placed on preventable causes of morbidity and mortality such as unplanned pregnancy, sexually transmitted diseases, injury (especially related to violence), cigarette smoking, alcohol/drug use, poor nutrition, school dropout, anti-social behavior, poor parenting skills, and delays in immunization. Each adolescent mother/child dyad and adolescent father will be followed by a case manager who will assess the social and health related needs of the family and schedule appointments for: primary and prenatal care, mental health, and social services. Parenting classes; computer-assisted educational instruction; child care, and educational, vocational and legal counseling will be provided. Each adolescent will attend a three training sessions on alternatives to violence/conflict resolution led by peer counselors under adult supervision. Each adolescent also will be given the opportunity to be matched with a Family Friends community volunteer who will provide support throughout the pregnancy and delivery, as well as provide parenting education.

PRO-ACTIVE, SCHOOL-BASED ASTHMA INITIATIVE ⁽¹⁹⁹⁸⁾ Montefiore Hospital, Bronx, NY Asthma has become an increasingly common cause of hospital admissions among inner-city children. Factors including poor access to health care contribute to high hospitalization rates. School Based Health Centers (SBHC) overcome many access barriers and provide an opportunity to engage children in the appropriate use of outpatient services. They also offer an ideal setting for in introduction and evaluation of an asthma intervention designed to reduce morbidity and costs. This project involves six Bronx elementary schools-two schools that do not have SBHC's, and four that have SBHC's run by the Montefiore Medical Center School Health Program. Two schools with SBHC's are designated as proactive or intervention sites. Outcomes will be compared according to three models of school health: 1) the control model, for schools without SBHC's; 2) the traditional model, for schools with SBHC's treating children who present for care; and, 3) the proactive model for schools with SBHC's and aggressive outreach programs. The proactive model has five components: 1) identification and classification of asthmatics in the school, 2) outreach to children with asthma, 3) individual treatment and education, 4) pediatric asthma group education, and 5) outreach to caregivers and teachers. Evaluation will focus on the effect on acute symptoms and chronicity of wheezing, normalization of lifestyle, and the effect on Emergency Department visits and hospitalizations.

THE NORTHEAST ROCHESTER YOUTH AND FAMILY WELLNESS PROJECT ⁽¹⁹⁹⁸⁾ University of Rochester, Rochester, NY The major causes of morbidity and mortality among adolescents in the U.S. today are the direct result of high-risk behavior and unhealthy lifestyle practices. Effective community-based prevention programs that emphasize education and skills training are generally unavailable or culturally unacceptable to inner-city minority youth and their families, who may be at highest risk for the behaviors as well as the short and long-term adverse consequences. The Northeast Rochester Youth and Family Wellness Project is a collaborative effort of the Department of Pediatrics at Rochester General Hospital and 6 community sites, including recreation centers and settlement houses that serve youth and their families in the Northeast quadrant of the city of Rochester. The project will provide a series of health education programs for young adolescents, ages 11-14 years, and their parents at the community sites. The three central topics are sexual risk reduction, interpersonal violence prevention, and healthy lifestyle behavior such as nutrition and exercise. Programs have been designed to increase knowledge and enhance skills and attitudes towards healthy behaviors and are structured to include parents, through several joint sessions and two "parent-only" workshops, in order to address parenting issues related to the specific topic areas. A core team of "educators" consisting of pediatricians, nurse practitioners, health educators, nutritionists, and community site staff workers will implement the programs. Outcome evaluations will assess changes in knowledge, attitudes and intention towards the target behaviors; changes in the target behaviors, health status, and functioning. This program builds on previous efforts within the Department of Pediatrics at Rochester General Hospital to enhance coordination with community youth agencies in order to integrate services for high-risk youth and families.

FINGER LAKES PRIMARY CARE OUTREACH PROGRAM ⁽²⁰⁰¹⁾
Department of Pediatrics, University of Rochester School of Medicine, Rochester, NY

The purpose of this program is to address lower than expected immunization rates and preventive services in the Finger Lakes rural region of upstate New York. The project was modeled after a successful program in Rochester, New York that utilized an interdisciplinary team designed to address both health and psychosocial barriers preventing access to and receipt of preventive care by at-risk children. Children ages two years and younger will be tracked for preventive care and services will be provided as necessary. The interdisciplinary team will include a physician, a social worker, and administrator, a programmer, and paraprofessional outreach workers. The project goals are to assure access to and delivery of preventive, well child care services to infants and toddlers in the rural Finger Lakes region as measured by improved immunization rates, and lead and anemia screening attendance at well child visits, as well as patient satisfaction.

LIVING HEALTHY-LIVING WELL "PARENT TALK" INITIATIVE ⁽²⁰⁰²⁾
Today's Child Communications, Inc (TCC), New York, NYThe Living Healthy-Living Well "Parent Talk" Initiative is a health promotion and education program which seeks to educate low-income African-American families with school-aged children residing in New York City, NY about the importance of obtaining a medical home and employing preventive health care measures. The program uses a multi-leveled media strategy that includes a radio show and other broadcast media, a national coalition serving as an expert advisory board, internet services, and health education forums. The program will address racial disparities in maternal and child health in the African-American community through the implementation of a culturally relevant health promotion and public information campaign. The initiative also will promote preventive care for children, such as screening for developmental disabilities, dental care, and the elimination of environmental health hazards, such as lead. Additionally, it will encourage parents to undertake safe practices such as putting an infant on its back to prevent Sudden Infant Death Syndrome (SIDS); maintaining a smoke-free environment; and using safety locks on cabinets for families with young children. The program goals are to: (1) educate and raise awareness about racial disparities in maternal and child health outcomes, particularly those identified in the Healthy People 2010 objectives; (2) promote prevention and child safety practices using Bright Futures and the American Academy of Pediatrics guidelines as resources; (3) develop a citywide culturally relevant media strategy for disseminating family and child health promotion information to poor and low-income African-American families; (4) foster a cooperative initiative through the National Black Family Promotions Coalition and other professionals from the fields of health, education, social service, business, and government; and (5) strategize other cost-effective ways to educate the African-American community, particularly those who are poor and low-income, regarding promoting child health and family wellness.

THE MOUNT SINAI CHILD & FAMILY SUPPORT PROGRAM: FOCUS ON MENTAL HEALTH IN NEW YORK ⁽²⁰⁰²⁾
Mount Sinai School of Medicine, New York, NYThe Mount Sinai Child & Family Support Program: Focus on Mental Health was developed to address the high rate of child maltreatment victimization rate in East Harlem. The program links the detection/evaluation of child abuse with access to psychological trauma-focused rehabilitation of abused children and the non-offending parent. A multidisciplinary team will provide on-site mental health services to children and parents. All children will receive comprehensive medical, developmental and neurological evaluations. This is achieved by partnering the clinical expertise of the Children and Family Support Team with community-based agency mental health expertise and professional schools of social work to increase program capacity to render mental health services and eliminate barriers to care.

 

For more information on any of these HTPCP projects, please e-mail your name, address, telephone, and fax numbers with your specific request to healthyt@aap.org.