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Child Health Notes – Outcomes

Child Health Note Evaluation Survey Executive Summary, March 2005

Purpose of the Evaluation

Child Health Note – A Descriptor

Evaluation Process

Evaluation Respondents

Evaluation Results

Recommendations

Purpose of the Evaluation

The objectives were to:

1. Evaluate the benefits of using Child Health Notes (CHN) amongst local health staff, and
2. Develop recommendations for increasing the number of providers using Child Health Notes in Washington State.
   

Child Health Note – A Descriptor

Child Health Notes are a medical home tool designed to promote communication and partnerships between:

• Primary health care providers
• Local health jurisdictions – CSHCN Program Families
• Family resource coordinators, early intervention programs and public schools
• Others who care about the health & well-being of children with special health needs

The Child Health Notes provide information for early identification and management of special health and developmental concerns. Formatted as a concise double-sided newsletter they are written for a primary health care provider audience, but are widely distributed for readership by other audiences including: childcare providers, early intervention programs, WIC programs, and other local public health programs as appropriate. Users customize the CHN with resource information specific to their county.

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Evaluation Process

Local health staff in Adams, Benton-Franklin, Island, Kittitas, Lincoln, Snohomish, Spokane and Whatcom counties were interviewed by telephone. The staff were informed by email that they would be receiving a phone call from the UW contract staff to discuss their local Child Health Note project. A copy of the project logic model and the survey questions were included in the email. The telephone interviews were scheduled at a time that was mutually agreed upon. All of the telephone interviews were conducted in November and December 2004. The interview ranged from 30 minutes to 1-1/2 hours.

Evaluation Respondents

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Evaluation Results

Most respondents

• Expressed strong enthusiasm for using the Child Health Notes (CHNs) in their county
• Indicated that the CHNs serve as an important medical home tool for promoting communication and partnership with PCPs and others in their communities
• Plan to continue using the CHNs in their county
• Encouraged promoting the use of CHNs in more counties across Washington State

Some respondents

• Reported an increase of referrals from PCPs when a diagnostic CHN was distributed

Summary of responses

How the CHNs Are Used

• Eight counties distribute CHNs to PCPs (pediatricians, family practice physicians, ARNPs, PAs)
• # of counties that report distribution to:
  • Child care programs &CCHC - 6
  • Public Health Nurses – 4
  • FRCs – all
  • Birth to Three Program – 3
  • ICC meetings – 5
  • Other LHJ offices/programs – 1
  • Local DDD & DSHS office – 1
  • Parents – 1 (five parents in one county requested to be on CHN mailing list)
• Frequency of distribution:
  • 2-3 x year – 1 county
  • 4x year – 4 counties
  • 6 x year – 1 county
  • monthly – 2 counties
• Methods of distribution: one or more method used in each county
  • mail as a one page flyer
  • mail in an envelope (allows for two full pages of text) - email distribution
  • hand deliver to PCP offices
  • place in PCP mailboxes at hospital
  • distribute at community meetings (ICC meetings, health fairs, etc…)
  • one county developed several CHN notebooks; content included copies of all CHN topics on the project website, and local county resource information. Notebooks were placed in PCP, Head Start, and DSHS offices.
• Post on LHJ website – 4 counties

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Reasons for Using CHNs

• Increase PCP awareness of the LHJ CSHCN program, early intervention resources in the county, and other county resources for CYSHCN; tips on how to access and make referrals to these programs.
• Provide periodic and consistent reminders to the PCPs about the above listed county programs and access points.
• Provide consistent communication with PCPs to enhance relationships and partnerships.
• Desire to impact the timeliness of referrals from PCPs for early intervention; reduce the “wait and see attitude”. (It is undocumented if timeliness of referrals is increased as a result of using CHNs.)
• Offer an opportunity for PCPs who have been in practice for a long time, to receive current information on office practice and management tips on issues relevant to CYSHCN and their families. One county commented that the CHN serves as a non-threatening teaching/informing tool.
• Offer an avenue for community-wide response to a particular need or issue that is “hot” within the community (e.g. hearing screening).
• A signature Medical Home Team activity
• In some instances the CHN is used as a handout for families or a teaching tool for nursing students.

Benefits of Using the CHNs

• None of the respondents have quantitative evidence of the benefits of using the CHNs. Their opinions on the benefits are qualitative in nature.
• Respondents state that they feel the CHNs are an effective communication and partnership- building tool between PCP and the LHJ – CSHCN Program. In a few instances they report that PCPs have directly commented that they like the CHNs and appreciate receiving them.
• Two respondents reported instances of PCPs calling the LHJ in follow-up to a CHN. (For example received request for the new growth charts and assistance with an office charting system for the new charts; PCP to requested to be added to a list of local resources for vision screening.)
• Two respondents indicated that they have witnessed an increase of referrals following distribution of a diagnosis-focused CHN topic. Other respondents report that they have not witnessed increased referrals to the LHJ-CSHCN Program.
• Increased awareness and referral of families to parent support programs and the Father’s Network.
• Cost and time effective communication tool. The costs to the LHJ are: staff time to coordinate the CHN efforts, Xeroxing and mailing costs. Use of direct/in-person distribution or email distribution reduces these latter costs. All programs using the CHN have absorbed costs within their operating budget.

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Recommendations

1. Continue the development of new CHN topics. To determine the annual new topics: solicit topic ideas from the counties using the CHNs, consider the DOH-CSHCN Program priorities, and obtain input on “hot topics” from the Washington State Medical Home Network. Based on the needs of the communities using CHNs, it is reasonable to prepare 4-5 new CHN topics per year as part of the UW-Medical Home Partnership Contract.
2. Increase the number of Washington counties or medical home teams using the CHNs on a regular basis. Steps to consider :
   • Attend the Regional CSHCN meetings and reintroduce the CHNs – use testimonials from counties in the region who are successfully using the CHNs. Conduct a shared dialogue on the barriers to use and brainstorm responses to these barriers.
   • DOH will support promotion of expanding use of the CHNs. Consider having the CSHCN program develop strategies with LHJs to support the use of CHNs in their county. Consider writing some CHN action steps into existing Consolidated Contracts
   • Explore the need for and resources for monetary support or other incentive for those counties using the CHNs.
3. Focus UW contract staff time to partner with one or more of our larger urban counties (for example King or Pierce Counties) to design methods of CHN distribution and use in a large metropolitan area with a large number of PCP providers.
4. The Spokane County Medical Home Team and LHJ-CSHCN office propose that they be funded to develop a CHN format that can be used by any/all of the counties in their East Region. The goal would be to support all of the counties in the East Region to distribute the CHNs. Spokane County serves as a regional tertiary referral source for the communities in the East Region and this proposal is logical. The Spokane Team is a huge supporter of the CHN project; they have done an exceptional job creating a distinctive and visually attractive CHN format, and they have developed an effective and broad distribution system. It would be interesting to pilot this proposal. A first step would be to secure agreement from the counties in the East Region that they want to participate in a project to distribute the CHNs in their communities.
5. It may be useful for the CHN Project to collaborate with a survey tool that is already recognized and used by the PCPs. In the past it has been difficult to obtain feedback from the CHN readership – particularly the PCPs. Previous efforts to solicit PCP feedback using a mailed CHN survey resulted in a low response rate and inadequate data to draw clear conclusions. One county suggested that we partner with ESIT to include a single question/probe about the CHNs in the provider surveys that are sent out on a bi-annual basis. ESIT requires and supports counties to send out a provider (PCP) survey every two years. It is reported that the response rate on these surveys is quite high.
   

For more detailed information, view the Summary of Phone Interviews

Evaluation report prepared by Susan Wendel, University of Washington – CHDD,
for the Washington State Department of Health – CSHCN Program.
March 2005

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