PUBLIC HEALTH

Jm

Cluster Health Program for Day Care Children VYMUTT J. GURURAJ, MD RAYMOND M. RUSSO, MD HARANATHA V. REDDY, MD DOLORES E. JACKSON, RN JOHN E. ALLEN, MD

Introduction An essential component of a day care service is a meaningful health care program to protect, maintain, and improve the health of each child enrolled.1' 2 The lack of adequate programs to promote these goals provides a unique opportunity for organizers of health care to develop and evaluate innovative health services to these predominantly preschool children. The Pediatric Ambulatory Service at Kings County Hospital Center in Brooklyn has undertaken the task of developing a health program for day care children in the community. In the first phase a pilot health program was established and evaluated at one day care center. The experience gathered from the projects has led to the development of a program serving the health care needs of children and their siblings in a cluster of day care centers in the community.

day care centers (4) the granting agencies, and (5) the Kings County Hospital Center.

The Team The medical team is formed with representatives of the various partners. The team consists of a project director, a public health nurse-coordinator, a social worker (from Kings County Hospital Center), a primary physician (from the health department), a registered nurse (from the Agency for Child Development), a psychologist and a dentist (through funds by a granting agency), and family counselors from the participating day care centers. Of these, the primary physician, the dentist, the coordinator, the registered nurse, and occasionally the social worker form a "roving health team," which visits individual day care centers to provide on-premises primary care on a scheduled basis.

The Facilities and Services

The Cluster Eight centers, with a total of 995 children, including the Pilot Day Care Center (PDCC) form the cluster. A majority of these children were receiving fragmentary and episodic care at Kings County Hospital Center and a few smaller health services in the community. Some were receiving care through "Medicaid clinics" which did not provide comprehensive or continuous care.

The Health Partnership The program is conceived as a partnership venture in which individual partners offer resources which, when consolidated, accomplish the common objective of providing well rounded health services to children and their siblings. These resources, in most instances, are already being expended on behalf of these children but in an independent and ineffective manner. The partners sharing in this experience are: (1) the Department of Health in New York City, (2) the Agency for Child Development, (3) the 1102

AJPH OCTOBER, 1975, Vol. 65, No. 10

The following facilities and services are utilized. (1) The premises of the participating centers act as primary care facilities. In addition, a labcrratory capable of performing basic laboratory tests, a facility for dental screening, an audiovisual testing room, and a community room for parent education sessions are provided at one center, the PDCC. (2) Kings County Hospital serves as a secondary and tertiary care facility and (3) the liaison service at the hospital coordinates the health care activities of children referred from the primary care facilities. The primary physician, the coordinator, and the social worker of the health care team are also members of the liaison service. Thus, the arrangement enables the referred patient to receive his hospital care under the direction of the same primary physician who supervises his health at the primary care facility.

The Health Program The roving health team evaluates children in each of the participating centers, excepting the PDCC, once in 2

to 3 weeks on a scheduled basis. The frequency of visits depends on the size of the individual center. The team visits the PDCC once every week. Each session lasts for approximately 3 hr. Children scheduled for a medical evaluation by the visiting team are prepared prior to the visit in the following manner. Comprehensive historical data are obtained through parent-completed health questionnaires. Laboratory and screening tests are performed on a scheduled basis at the PDCC. Denver Developmental Screening Tests are performed by family counselors at their respective centers. The parents are instructed in advance to be present at the time of their children's evaluation. Although the on-premises care is predominantly preventive in nature, minor acute problems are also managed when the need arises. The health educational activities of the program consist of parental education in the form of discussions by qualified speakers on such topics as child development and child health supervision, and personnel education which is directed toward the discussion of normal and abnormal child behavior by the team's psychologist.

Comment The day care program is a fertile territory for implementing imaginative health services. Inasmuch as the population concerned is predominantly composed of preschoolers, the need to provide adequate health supervision is obvious. The program that is described attempts to meet this need by reorganizing available resources that are presently being ineffectively expended on behalf of these children. The resources are integrated in a manner that renders their application more meaningful. The day care personnel and health care professionals work together and thus mutually contribute to a better understanding of the children's overall needs; manpower resources of one agency are reinforced with financial contributions of another to broaden the scope of the service. The model that emerges from this integrated effort has many qualities generally accepted as essential in a primary care service,4 i.e., comprehensiveness, continuity of care, cooperative division of responsibilities among persons from separate disciplines, and efficient use of resources with necessary coordination.

Another important feature of the model is the delivery of primary care on the premises of the centers themselves. Questions have been raised concerning the wisdom of using a hospital setting to administer primary pediatric care.These questions are particularly valid with respect to communities where many children with sociomedical problems wait long hours in overcrowded outpatient services of inner city hospitals for minimal health services." The on-premises approach has created a type of atmosphere that both children and the health team find helpful. Children have begun to consider the team as an integral part of their own organization and therefore more willingly participate in health care activities. For the team members, on the other hand, it has provided a convenient setting from which they not only can observe the children better, giving due attention to the interplay of factors that might be influencing them, but also relate more efficiently with parents and teachers whose input they must seek to structure the health care needs of an individual child. No one model of health delivery can be ideal under all circumstances in a society where priorities and patterns of health care vary in different geographic locations and socioeconomic circumstances. The model described here is built around an inner city population largely dependent on publicly funded health services for their ongoing medical care. However, the basic elements of the model should be useful in other programs serving a different population. 1. 2. 3. 4.

5. 6.

REFERENCES Recommendation for Day Care Centers for Infants and Children. American Academy of Pediatrics, 1973. Policy Statement on Day Care. Pediatrics 51:947, 1973. Gurraj, V. J., Russo. R. M., Reddy, V. H., and Allen, J. E. Health Care for Day Care Children. N. Y. State J. Med. 74:340343, 1974. Hansen, M. D., and Aradine, C. R. The Changing Face of Primary Pediatrics. Pediatr. Clin. North Am. 21:245-256, 1974. Korscn, B. M. Introduction. Adv. Pediatr. 20:9-13, 1974. Russo, R. M., Allen, J. E., and Gururaj, V. J. Outpatient Management of the Severely Ill Child. Am. J. Dis. Child. 124:235-239, 1972.

The authors are from the Department of Pediatrics, Kings County-Downstate Medical Center, Brooklyn, New York 11203. Dr. Allen's present address is Monmouth Medical Center, Long Branch, New Jersey 07740. This article was presented at the 102nd Annual Meeting of the American Public Health Association, New Orleans, October, 1974.

Editor's Note: The articles which appear in PUBLIC HEALTH BRIEFS have been condensed by the authors for publication in the American Journal of Public Health. An extended version of each report published in this Journal Department is on file at APHA headquarters. Single copies of the extended version are available for a limited period of time from the American Journal of Public Health, APHA, 1015 Eighteenth Street, NW, Washington, DC 20036. When requesting the extended report, please cite the title of the published article, name of principal author, and the AJPH issue in which the condensed report appeared in PUBLIC HEALTH BRIEFS.

PUBLIC HEALTH BRIEFS 1103

Cluster health program for day care children.

PUBLIC HEALTH Jm Cluster Health Program for Day Care Children VYMUTT J. GURURAJ, MD RAYMOND M. RUSSO, MD HARANATHA V. REDDY, MD DOLORES E. JACKSON,...
337KB Sizes 0 Downloads 0 Views