Scott County Child Health Initiative

State: TN Type: Model Practice Year: 2006

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In 2 ½ years of operation, the program has served over 5,400 Scott County children through the provision of preventive education related to well-child screenings or the actual provision of a complete well-child screening. The program addresses the provision of services related to well-child screening/EPSD&T (Early Periodic Screening, Diagnosis, & Treatment) and the low percentage of children ages birth-21 years who receive these services regularly as recommended. The program addresses the issue through both education as well as the actual provision of screenings in local elementary schools.

The focus is targeted through the following goals:

  • EPSD&T/well-child screenings will be offered to the 2nd and 3rd grade students in the Oneida City School System and the 1st, 2nd, & 3rd grade students in the Scott County School System.
  • Identify students screened through the school-based clinics who have referral indicators and make appropriate referrals for further follow-up.
  • Provide preventive education related to well-child screenings to 800 clients annually through telephone contacts or home visitation.
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Anderson County Health Department
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Scott County Child Health Initiative
In 2 ½ years of operation, the program has served over 5,400 Scott County children through the provision of preventive education related to well-child screenings or the actual provision of a complete well-child screening. The program addresses the provision of services related to well-child screening/EPSD&T (Early Periodic Screening, Diagnosis, & Treatment) and the low percentage of children ages birth-21 years who receive these services regularly as recommended. The program addresses the issue through both education as well as the actual provision of screenings in local elementary schools. The focus is targeted through the following goals: EPSD&T/well-child screenings will be offered to the 2nd and 3rd grade students in the Oneida City School System and the 1st, 2nd, & 3rd grade students in the Scott County School System. Identify students screened through the school-based clinics who have referral indicators and make appropriate referrals for further follow-up. Provide preventive education related to well-child screenings to 800 clients annually through telephone contacts or home visitation.
In 2002, statistics provided by the State of Tennessee noted that Scott County’s completion rate for EPSD&T screenings was only 20 %, this included both the health department and local physicians. Therefore, local and regional health department representatives began meeting with community leaders to address developing a program that would promote preventive care, targeting regular well-child screenings for children. The traditional means of scheduling appointments and “waiting for clients to come to the health department” just wasn’t working. The Scott County Child Health Initiative was developed to “take the services to the children” instead. To accomplish this task the program implemented the following two components for service provision. The school-based component of the program involves actual well-child screening clinics being operated (at separate times) in each elementary school in both county and city school systems (6 total). Complete well-child screenings / EPSD&T’s are provided to students in grades 1-3. Both the Scott County School System and the Oneida City School System worked with the health department to make well-child screening a mandatory component for school attendance in these designated grades. Parents have the choice of receiving the screening through the school-based clinics or with their private physician. The (home visitation / education) component of the program targets children listed on TennCare delinquency lists, ages birth-21 years. Community Health Workers initially target ages birth to 5 years and provide a combination of home visits and phone contacts. Once contact is established with a family, services are also provided to siblings/parents ages 6-21 as well. The Community Health Workers provide education related to well-child screenings, EPSD&T, immunizations, and WIC.
Agency Community RolesThe Scott County Child Health Initiative is a program developed and directed by the East Tennessee Regional Health Department and the Scott County Health Department. It is staffed by three health department employees which include a Community Health Nurse, a Community Health Worker, a Community Health Worker / Clerk, and is directed by the health department’s nursing supervisor. Despite the fact the program is operated by the health department, its success lies with the cooperation and support it has received from the community, such as physicians, school officials, governing entities, the Regional Health Department, and Regional Health Council. The health department realized the importance of community support during the planning process and worked hard over several months to include community partners in the program’s development. A program such as this could never be successful without the community’s support, especially its medical community. During planning, it was stressed that the intent of the program was to target children “currently not receiving well-child screenings” for various reasons. Therefore, there has never been an attempt to compete with local physicians. ImplementationPrior to implementation of the program, numerous meetings were held between the health department and community leaders, including school officials, governing officials, and medical providers. Following several meetings, all parties agreed that a program such as this would benefit many of Scott County’s children who were not receiving preventive care (well-child screenings) for numerous reasons. The health department envisioned the program being taken one-step further than just “offering” well-child screenings to students. A request was made for both school systems to make a well-child screening (physical exam) a mandatory requirement for school attendance in grades 1-3. If approved, Scott County would be the only school system in the state of Tennessee to initiate such a requirement. The health department was fortunate enough to be working with school officials who were truly interested in the health of their students and believed in the importance of preventive health care. Both health department and school officials felt if screenings were only “offered”, the same children not receiving preventive care would continue to go unserved. The mandatory requirement would assure all students received a screening whether through the new health department program or with their local physician. This requirement helps assure 100 % of the students receive screenings as compared to approximately 30 % when the same services are offered on a “voluntary” basis. ImplementationPrior to implementation of the program, numerous meetings were held between the health department and community leaders, including school officials, governing officials, and medical providers. Following several meetings, all parties agreed that a program such as this would benefit many of Scott County’s children who were not receiving preventive care (well-child screenings) for numerous reasons. The health department envisioned the program being taken one-step further than just “offering” well-child screenings to students. A request was made for both school systems to make a well-child screening (physical exam) a mandatory requirement for school attendance in grades 1-3. If approved, Scott County would be the only school system in the state of Tennessee to initiate such a requirement. The health department was fortunate enough to be working with school officials who were truly interested in the health of their students and believed in the importance of preventive health care. Both health department and school officials felt if screenings were only “offered”, the same children not receiving preventive care would continue to go unserved. The mandatory requirement would assure all students received a screening whether through the new health department program or with their local physician. This requirement helps assure 100 % of the students receive screenings as compared to approximately 30 % when the same services are offered on a “voluntary” basis.
Goal: To provide or help assure the provision of well-child screenings for Scott County children ages birth - 21 years. Objective: 85% of the students in the designated grades in the city and county school systems will receive a well-child screening (EPSD&T): Performance measures: 100% of students received a screening either at the school clinic or through their local physician. Data collection: 1) statistics from secretaries or nuses at each school; 2) program director, school nurse, or secretary; 3) each child enrolled in the designated grades was required to have a screening.  Outcomes (long-term): Targeted students are receiving well-child screenings annually as part of the attendance requirement. Objective: 100% of students determined to need a referral are referred for follow-up and 70% will keep their follow-up appointments with physicians:   Performance measures: As of 12-05, 72 % of students referred have kept their appointments.  Data collection: 1) a list of all students referred was kept; 2) the Community Health Nurse; 3) calls were made to parents of all referred students to see if follow-up was accomplished and its outcome.  Outcomes (long-term): The program is meeting its goal. However, promoting the importance of preventive health care with some parents will be a long term goal.   Objective: Provide education to 800 clients annually through phone contacts or home visitation: Performance measures: Approximately 1150 clients have been served annually over the past 2 ½ years with a total of 2900 served. Data collection: The community health workers manually keep a notebook on every client they serve including client needs and the education services they provide.  Outcomes (long-term): The program met its short-term goal in serving clients, but needs to continue with the long term goal of parent education.
As a result of the health related benefits the program has provided to Scott County’s children, it has gained not only the support of its local community but the support and interest of health departments across the State of Tennessee. At their request, the program has been presented to groups of interested public health workers in several areas of the state as well as state public health officials at the government level and is being considered for expansion to other Tennessee counties. The initial three- year Health Access Grant was scheduled to end in June 2006, but was recently extended for funding through June 2007. The State Department of Health is also currently considering transferring the program’s grant funded positions to full-time county health department positions. The program has been operating for over 2 ½ years, and has been able each year to prove that children’s health needs are being addressed and met through both the health department and local physicians. Without this program, many of these children would not have received a complete well-child screening.
 
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