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Healthy Steps User Manual

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1. For people who are not used to computers or haven t had much experience with computers the CD ROM was very easy to use The narrator gives instructions at the very beginning of each little piece and each heading is broken down into different steps so that you can click on exactly what you want It was helpful and very specific It is also an important interactive tool You could look at a problem at sev eral levels You can create your own objectives and bypass things that you are not interested in What I like best about the CD ROM is the ability to be able to review a section over and over again It lays out everything that Healthy Steps is and you can just go to a particular section target ages excellent way to further your clini cal skills and learn more about how your colleagues approach various situations In the chapter titled Creating Teachable Moments under the topic Teachable Moments from Birth to Three you will find about two dozen video cases that have an additional button on the screen What Others Have Said As you build your own clinical proficiency in analyzing teachable moments and discussing develop mental and behavioral issues with mothers and fathers clicking on What Others Have Said gives you the benefit of looking in on how other clinicians have grappled with these cases Contributors to this section include physicians early childhood educators nurses and pediatric
2. parenting strategies Unit Objectives After viewing the video and completing the CD ROM sec tions on Creating Teachable Moments and The Toddler Years users should be able to gt Identify the major challenges parents face during the toddler years gt Give examples of specific developmental changes during the toddler years in terms of cognitive development motor control communication skills and social development gt View and interpret toddler behavior in developmental terms p gt Use open ended questions to develop teachable moments p gt Create a sometimes state ment for a situation in which a parent s motivation is not clear The Healthy Steps Interactive Multimedia Training amp Resource Kit gt Help parents understand the role of discipline establish clear and consistent discipline goals and use a variety of strategies that set limits for their toddlers th Key gt Teachable moments can be found in all Healthy Steps interactions with families office visits Concepts home visits parent groups telephone calls and so forth gt Because the toddler period can be so difficult supporting parents though this time is particularly helpful for Healthy Steps practices to do gt Throughout the toddler years children move back and forth between dependence and independence and seek power and control over their environment and activities gt T
3. r5 ie a a y fis AnNa The Healthy Steps Interactive Multimedia Training amp Resource Kit Healthy Steps afi HEALTHY STEPS HEALTHY STEPS AN OVERVIEW Unit This unit can be used to introduce the Healthy Steps approach to physi Overview cians office administrators medical office staff and members of the commu nity It presents the major themes of the approach providing mothers and fathers with information about child development that they want and need establishing caring and supportive relationships between the practice and the family within the family and within the practice building on the belief that all behavior has meaning and can be used as a teachable moment con sistently seeking opportunities to increase the self understanding of mothers and fathers as well as their knowledge of their child s development and behavior and promoting family health and home safety in the interest of healthy children Unit Objectives After viewing the video and the Overview portion of the CD ROM users should be able to gt Identify the key Healthy Steps strategies and tell how each strategy furthers the goals of the Healthy Steps approach gt Describe the roles and rela tionships of various members of the interdisciplinary Healthy Steps team gt Discuss how a developmental ly oriented practice differs from a traditional pediatric or family medicine practic
4. all aspects of a devel opmentally oriented practice that are introduced in the videos are covered in greater detail on the CD ROM The videos range in length from 12 to 25 min utes and are documentary in style This means that no actors have been used and all of the people you see and hear are either members of Healthy Steps teams in devel opmentally oriented practices or family members who use those practices Video is a good medium to introduce a unit and to provide an understanding of the Healthy Steps approach to all members of a practice team It also can help introduce Healthy Steps to clinicians who have joined a practice that has already adopted the Healthy Steps approach P The CD ROM organizes all of the project s text VF iad print based resources and combines them with video examples and interactive case studies The CD ROM is both an interactive learning tool and a refer ence work Each Unit Study Guide indicates which CD ROM topics are most closely related to the video under study The CD ROM enables users to go deeper and deeper into a particular topic as time permits Users are encouraged to complete the case studies on the CD ROM and to share their responses with their colleagues through discussion and case management meetings User s Views ADDITIONAL TRAINING OPPORTUNITIES While this kit contains a wide variety of resources and considerable information on implementing the Healthy Step
5. Multimedia Training amp Resource Kit may qualify for Continuing Medical Education credit for physicians through Boston University School of Medicine and Contact Hours for Nurses through Advocate Health Care Boston University School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians Advocate Health Care is an approved provider of continuing nursing edu cation by the Illinois Nurses Association an accredited approver by the American Nurses Credentialing Center s Commission on Acrreditation For further information please contact For CME Boston University School of Medicine Department of Continuing Medical Education 714 Albany Street A305 Boston MA 02118 2526 For Contact Hours Advocate Health Care Healthy Steps for Young Children 205 W Touhy Suite 125 Park Ridge IL 60068 www healthysteps org ISBN 1 930783 11 6
6. RESOURCE KIT HEALTHY STEPS Case Studies Roles and Responsibilities Team Building Many Physicians Many Styles Team Building Team When Is a Nurse Not a Nurse 00 Anew Healthy Steps Specialist who used to be a pediatric nurse is accustomed to taking babies heights and weights as soon as she enters the examination room But a separate pediatric nurse has been doing these assessments in this practice for the last ten years To Think About When Is a Nurse Not a Nurse 1 How would you resolve this situation YOUR THOUGHTS will appear that shows every chapter Click on the chapter you want to review and your notes will appear Hint If you want to move your notes to a differ ent computer copy them from the c HSteps directory of Computer A onto a floppy disk and then copy them from the floppy disk to the c HSteps directory of Computer B Make sure that Healthy Steps has been installed on Computer B first Volume 1 Issue 6 WELCOME The LINK letter will 0 be mailed to you before each well child visit tell you about each well child visit give you information tips and activities for you and your growing baby WHAT To Expect AT THE 12 MONTH WELL CHILD Visit Get Ready for the Visit Bring your child s immunization record and or health journal with you to the visit Dear Pediatric Team no What can I do Bring a list of questions you h
7. The Healthy Steps Interactive Multimedia Training amp Resource Kit which clinicians can create teachable moments gt Discuss examples from their own clinical experience of missed opportunities to take advantage of teachable moments p gt Show the role of observation and listening in identifying and taking advantage of teachable moments gt Give an example of a sometimes statement Key Concepts gt Teachable moments provide a rich way to communicate with mothers and fathers B gt Opportunities for teachable moments occur in many ways including when a parent asks a question or makes a comment about information you are giving or expresses a particular concern when the child behaves in a particular way that may be of interest or concern to the family and when the team observes some thing noteworthy either on the part of the child or in the interaction among family members gt Teachable moments techniques include eliciting a particular behavior from the child that points to a general developmental change or process that you can describe observing the baby s behavior and interpreting it with the parents model ing constructive interactions with the child reframing the child s behavior in developmental terms to help the parents better understand their child s tempera ment and behavior offering sometimes statements to give parents optional inter pretations of a particular behavior as a means
8. are committed to its success That person will most likely be the practice administrator or lead physician Unit Objectives After viewing the video and completing the related CD ROM sections in Managing Healthy Steps users should be able to gt Provide a rationale for becoming a developmentally oriented practice gt Determine who will lead the process of becoming a Healthy Steps practice gt Identify a step by step man agement approach in terms of obtaining buy in from upper management providing ongo ing leadership hiring appropri ate personnel providing admin istrative support phones scheduling system office space etc and developing ongoing systems for interdisciplinary communication P gt Discuss the nature of organi zational change and how princi ples of organizational change can be applied to a practice that is adopting a developmental approach to primary care for young children B gt Show how Healthy Steps fits into and expands upon other developmentally oriented efforts in which a practice may already be involved e g parent groups Reach Out and Read distribution of parent handouts P gt Recruit or train someone in the practice to be a Healthy Steps Specialist This team member should have a back ground in child development the ability to communicate well with parents and the sensitivity to work as part of an interdisci plinary team while respecting indiv
9. gt Related Reading RESOURCES Families Parent Handouts The Healthy Steps Interactive Multimedia Training amp Resource Kit Questions 1 Why is the Healthy Steps practice a natural place for mothers and fathers to for turn during times of stress Discussion and 2 What elements of Healthy Steps make it more likely that clinicians will know when a family is in a particularly stressful situation 3 Give some specific examples of ways in which a family s stress might affect a child s development and behavior 4 Tracy Helton expresses a common concern of new parents that they cannot simply get up and go out the way they used to What stress relieving strategies might you suggest to Tracy and mothers like her 5 Name some problems that you might anticipate if you learn that a family is moving in with in laws What anticipatory guidance could you provide 6 Offering reassurance and building Tracy s confidence are two strategies that Cathie Clark used to help Tracy adjust to being a parent What could you say specifi cally to parents in similar situations What additional Healthy Steps strategies might be helpful here and how would you use them 7 What role does the parent group play for Tracy Helton What role does Cathie play in the group What role do the other parents play 8 How would you respond to the Heltons disclosure that they use physical punishment to discipline their son 9 Where would
10. most recently into Preston Helton s parents home We meet the Heltons at a home visit and also see them in a parent group Both settings show how the family s Healthy SUPPORTING FAMILIES CHALLENGING TIMES family They are expecting their second child soon and ask their physician and Healthy Steps CHALLENGING SITUATIONS Steps Specialist has supported them through numerous periods of stress and what techniques she has used to help Tracy Helton adjust to parenting The second story is about the Ortega Specialist during a well child visit how they can prepare their young daughter for this life cycle change The third story features the Jeters The Jeters s situation is not typically found on lists of common stressors they have a child with a challenging temperament that is not well matched to their expectations The Jeters have received considerable guidance and informa tion from their Healthy Steps Specialist including a referral for couples counseling when the strain of parenting seemed to be taking a toll The video features the following clinicians e CATALINA ARIZA M Ed Healthy Steps Specialist Advocate Ravenswood Maternity Family Health Center Chicago CATHIE CLARK R N M S A Healthy Steps Specialist Western Colorado Pediatric Associates Grand Junction JACQUELINE GOVERNO B A Healthy Steps Specialist Pediatric Associates of Florence South Carolina SCOTT GOVERNO R N Healthy Steps Spe
11. on the disk organized by Chapter 3 From Milestones This will display Case Studies Chapter Menus When you click on a Chapter title the Chapter Menu appears and an audio narration begins This narration provides an overview of what is in the section All narra tion can also be read as text Audio narration is italicized on screen Once you have heard the narration you may prefer to turn it off You will find a box on the sign in screen that allows you to do so The left hand section of each Chapter Menu lists all the primary Topics in that chapter When you click on a Topic text will appear on the right INTERACTIVE MULTIMEDIA TRAINING amp RESOURCE KIT aw HEALTHY STEPS Case Studies Supporting Families To Think About Breast feedin 2 Questions Mothers Ask About Breast feeding YOUR THOUGHTS 3 Infant Crying 4 Toddler Tantrums 5 Separation CETE MAIN MENU OVERVIEW CASE STUDIES RESOURCES 1 How would you respond to this mother s issue CONTENT MAP The Healthy Steps Interactive Multimedia Training amp Resource Kit organized by each of 11 age related milestones from birth to three Note that because not every Case Study is asso ciated with children of specific ages some are manage ment oriented for example this section does not con tain a complete list of Case Studies Case Studies have a common format and method of use To access a particular Case Study click on t
12. see the family separate ly for at least some part of the visit how will they communicate critical information to one another 3 One of the challenges for physicians and nurses has been sharing their relation ship with a family with other members of the interdisciplinary team How big a problem do you think this would be in your practice What are some methods that you might use to help everyone become more comfortable with this new system 4 How much time does your practice typically schedule for a well child visit How much information about behavior and development are you able to provide during this period What additional information would you like to provide but cannot do so within the time constraint How could Healthy Steps help you overcome this barrier 5 Will all families in your practice receive Healthy Steps services If not how will Healthy Steps families be identified in practice records 6 How well will your current examination rooms meet the needs of a Healthy Steps visit What message do they give to families Can they accommodate up to four adults in the room at one time Is there space for siblings Do the rooms encourage moms to breast feed Do they send the message that your practice is inter ested in the whole family and in the child s emotional and intellectual development in addition to his or her physical health 7 Healthy Steps practices have identified the following six factors as critical to suc cess
13. CKERMAN M D Harvard Medical School University Medical Center STEVEN Pediatrician Boston University e CHRISTOPHER CLEMENS M D Cornell PARKER M D Pediatrician Boston School of Medicine Fo The The key sections in the CD ROM that relate to this unit wy CD ROM are listed below CLINICAL STRATEGIES Gauging The Tools a Child s Development NBAS Temperament Scale gt Overview BABES Denver II gt The Process MacArthur Getting Started Observing the Family gt Psychosocial Checkups Using Appropriate Tools Importance Interpreting Findings How the Tool Was Developed Providing Feedback to Families About the Checklist Providing Feedback to the Team The Age Range P Case Studies gt Related Reading The Healthy Steps Interactive Multimedia Training amp Resource Kit Questions for Discussion and Reflection Facilitator s Note In addition to the questions here the case studies on the CD ROM can be used for small group discussion 1 Why is a good relationship between the practice and the family essential to the proper use of these resources 2 Select and describe specific instances in the video that illustrate ways in which a developmental checkup is used as a teachable moment 3 How can the NBAS be used to help new mothers and fathers anticipate how their baby will react to various stimuli in its first few weeks What are some of the techniques that you see Sue O Brien and Jenni
14. Commonwealth Fund Reach Out and Read Boston University School of Medicine Phyllis Cokin Sonnenschein Ed D Center for Parenting Studies and Families First Wheelock College Boston The Healthy Steps Multimedia Interactive Training amp Resource Kit was funded by The Commonwealth Fund The John D and Catherine T MacArthur Foundation The Robert Wood Johnson Foundation The Colorado Trust The Fan Fox and Leslie R Samuels Foundation The Kansas Health Foundation The Gordon Russell Fund at the Peninsula Community Foundation The Jewish Healthcare Foundation The Healthy Steps Multimedia Team and the Healthy Steps Training Team at Boston University School of Medicine wish to express appreciation to the fol lowing for their advice and guidance throughout the project Kathryn Taaffe McLearn Healthy Steps National Program Coordinator and Assistant Vice President The Commonwealth Fund Margaret E Mahoney Chairman of the Healthy Steps National Advisory Committee and President MEM Associates Inc Michael C Barth Healthy Steps Program Director and Executive Vice President ICF Consulting and the many Healthy Steps physi cians specialists and administrators who have reviewed this material at various stages and contributed their thoughts expertise and experience toward making these materials an out standing source of information on Healthy Steps We thank also the Healthy Steps families who allowe
15. ICE Video This video visits two medical practices to see how they planned for and successfully adopted Healthy Steps ABC Family Pediatricians in Allentown Pennsylvania one of the first Healthy Steps practices in the nation and Western Colorado Pediatric Associates in Grand Junction Clinicians in each location discuss the challenges that they faced and how they overcame them stressing the concepts of commitment leadership personnel training scheduling teamwork communication and space planning E The video features the M S Healthy Steps Specialist SCHLAGECK Practice following clinicians e Western Colorado Pediatric Administrator BARBARA Associates Grand Junction ZIND M D Pediatrician e ABC Family Pediatricians CATHIE CLARK R N M S A Healthy Steps Chicago Allentown Pennsylvania Healthy Steps Specialist GAIL WILSON B S N M S MiCHAEL SCHWARTZ M D WILLIAM FINDLAY M D M P H Pediatrician TERRY THOMAS Pediatrician CAROL Pe The The key sections of the CD ROM that relate to this unit are listed below CD ROM MANAGING HEALTHY STEPS po licdoranaia honya Getting Ready The Process of Change Critical Success Factors Key Decisions gt Overview The Importance of Communication gt The Healthy Steps Team gt Advance Planning Physician Pediatric Nurse Practitioner Healthy Steps Specialist Nursing Staff Office Staff Orienting the Team Preparing the Office Suite Setting Up Equipm
16. If you do not see your name click on Return and sign in as a New User Overview This multimedia presentation introduces all the elements that distinguish a developmentally oriented practice from a traditional pediatric practice It is approximately 4 minutes long The first time you use the program the Overview will play automatically after you have signed in On subsequent uses you can access the Overview from the bottom menu bar Main Menu The Main Menu gives you the big picture of everything that is part of the Healthy Steps CD ROM and where it is located The program has four main sections each shown as a cube Managing Healthy Steps Clinical Strategies Child Development and Behavior Milestones from Birth to Three INTERACTIVE MULTIMEDIA HEALTHY STEPS MAIN MENU When you roll over a cube with your cursor all Chapters associated with a particular Section appear on the right For example if you roll over Clinical Strategies you will find the following list of Chapters in that Section Creating Teachable Moments Gauging a Child s Development Supporting Families Parent Groups Family Factors Home Visits Click on any of these Chapters to begin TRAINING amp RESOURCE KIT INTERACTIVE MULTIMEDIA TRAINING amp RESOURCE KIT HEALTHY STEPS CLINICAL STRATEGIES Creating Teachable Moments Overview Introduction Using Teachable Moments Finding Teachable Moments Teachable Moments I
17. M presents more information on these tools and also includes infor mation on psychosocial checkups As part of its philosophy of looking at the whole child and the whole family Healthy Steps also looks at the potential impact of family history on the child Unit 9 Family Factors Affecting Children Smoking Depression Violence and Addiction considers the important other side of this two generational checkup Unit Objectives After viewing the video and completing the related sections of the CD ROM users should be able to gt Put the process of gauging a child s developmental progress into context noting that such tools are used primarily to pro vide teachable moments and to screen children for potential developmental problems p gt Understand that such develop mental checkups are accomplished in the context of an ongoing rela tionship between the Healthy Steps team and the family gt Develop and maintain a schedule for administering developmental checkups gt Be able to administer a modi fied version of the NBAS either while the newborn is still at the hospital or during the first home or office visit gt Help parents use and understand the purpose of the Temperament Scale p gt Use BABES to help mothers and fathers think about and understand their child s tem perament and to identify specific behaviors about which they would like guidance from the Healthy Steps team gt Demon
18. Steps Specialists opportunities to take advantage of teachable moments and provide anticipatory guidance Specialists can model behavior for parents such as distracting the child limit setting or reading and allow time for discussions that help mothers and fathers understand their own goals for their child s development and behavior P It is vital that Healthy Steps Specialists communicate what they have learned at home visits to their colleagues in the practice and to tell parents that they will be doing this Unit 4 Healthy Steps Home Visits Hearty E STEPS HOME The Healthy Steps Home Visits Length 16 31 VISITS Video This video depicts home visits with parents and children from birth through the tod mp dler years in which Healthy Steps Specialists conduct developmental checkups and address such issues as child development and behavior temperament family health and home safety The video establishes the importance to both the practice and the family of conducting home visits It also discusses the respect sensitivity and atten tion to the family s routines and traditions that are required of a home visitor Several home visits illustrate various approaches that Healthy Steps Specialists take to raise issues of discipline and limit setting and demonstrate how easily teachable moments emerge in this context The video also shows strategies that Healthy Steps Specialists use to address family health issues and rev
19. The Healthy Steps CD ROM The Healthy Steps CD ROM uses text audio video examples video commentaries video and text based case studies still photographs and an extensive database of reproducible resources to form an integrated informational and training package for developmentally oriented practices Special Features e 4 Major Sections e 23 Chapters e 90 Interactive Case Studies e 33 Video Commentaries Healthy Steps Home Visits Teachable Moments The First Year e Teachable Moments The Toddler Years Gauging a Child s Development vp oN 6 Supporting Families Challenging Times Challenging Situations 9 Family Factors Affecting Children Smoking Depression Violence and Addiction apply the information to my job I think the most important part of it is that you are actually viewing some interaction between parents and the Healthy Steps team so that you can get a better understanding and apply the suggestions to the practice I liked that you could see how the other members in the room were reacting to the interaction of the Healthy Steps team member as well as to the child The video showed me how to create situations where the parents can tell you what they want from you rather than answering ques tions I felt like it broadened my understanding and gave me other ways to use teachable moments and Examples e 45 Professional Readings 11 Quick Check S
20. Toby Levine Communications Inc which was primarily respon Boston University School of Medicine Healthy Steps Training Team sible for the development of the CD ROM It is Margot Kaplan Sanoff Ed D and Barry Zuckerman M D based on the work of the Healthy Steps Training co directors Team at the Boston University School of Medicine Steven Parker M D which was supported by The Commonwealth Fund Andrea Bernard M A Kathleen Fitzgerald Rice M Ed 2000 Independent Production Fund Toby Levine Tracy Magee M S N C P N P Communications Inc and the Boston University Patricia Lawrence M S N C P N P School of Medicine Department of Pediatrics Additional credits can be found on page 48 po CONTENTS INTRODUCTION icccntcicertiincind 2 UNIT STUDY GUIDES cccccceees 11 TARGET AUDIENCES isicsccpssercdarconneys 3 Unit 1 Healthy Steps An Overview 12 WHAT S IN THE KIT oeiee 3 Unit 2 Starting a Healthy Steps Practice csscsesesesees 16 The Healthy Steps Videos 3 P Unit 3 The Healthy Steps The Healthy Steps CD ROM 3 y Step Office Visit ccccccscecscesees 20 How the Elements Work Together ssssssssessssssessssss 5 Unit 4 Healthy Steps Home Visits 24 ADDITIONAL TRAINING Unit 5 Teachable Moments OPPORTUNITIES c secccccesesecesseeseceseees 5 The First Year sesssseeesees 28 it 6 Teachable Moments CD ROM USER GUIDE cccccccce
21. User Manual 4 le Interactive Multimedia TiCrd ies T ining amp Resource Kit Ilall gt A A CLINICAL STRATEGIES Overview Limit Set Pevelonmental Domains ing and Discipline This section summarizes the Major areas of developmentas crows Other Toddler Issue and change uring the toddier YESIS Cilek on a topic above for more information Case Studies Related Reading OVERViEwW TS materials contain the opinions and ideas of their authors They are sold with the understanding that neither the publishers nor the funders are engaged in rendering medical health psychological or any other kind of personal professional services or advice Physicians should carefully review any material prior to its distribution to patients or their families to ensure that they are in agreement with all statements contained therein The publishers and funders specifically disclaim all responsibility for any liability loss or risk personal or otherwise which is incurred as a consequence directly or indirectly of the use and application of any of the contents of these materials The Healthy Steps Multimedia Training amp Co project Directors Resource Kit was developed by the Independent Lisa Zbar Independent Production Fund New York New York Production Fund which was primarily responsible Toby Kleban Levine Toby Levine Communications Inc for the videos in association with
22. ation and social work demonstrate the ways in which they enhance the work of the practice The video also shows the seven major Healthy Steps strategies in action The video features the following clinicians e Jo ANN ALLEN R N Healthy Steps Specialist Advocate Bethany Hospital Chicago JENNIFER ALONSO R N Healthy Steps Specialist Cornell Medical Associates New York City e CATALINA ARIZA M Ed Healthy Steps Specialist Advocate Ravenswood Maternity Family Health Center Hospital Chicago e ANITA BERRY R N PN P Healthy Steps Specialist Advocate Good Samaritan Hospital Downer s Grove Illinois T BERRY BRAZELTON M D Pediatrician Harvard Medical School Boston e CHRISTOPHER CLEMENS M D Pediatrician Cornell Medical Associates New York City SUSAN CURLEY M S Ed Healthy Steps Specialist MGH Revere Health Center Revere Massachusetts PATRICIA GARZA R N Healthy Steps Specialist South Texas Center for Pediatric Care San Antonio SCOTT GOVERNO R N M S N EN P Healthy Steps Specialist Pediatric Associates of Florence South Carolina REBECCA HOBART M S W L C S W Western Colorado Pediatric Associates Grand Junction MARGOT KAPLAN SANOFF Ed D Child Development Specialist Boston University School of Medicine STEVEN PARKER M D Pediatrician Boston University School of Medicine e SABRINA PROVINE R N Healthy Steps Specialist Advocate Bethany Hospi
23. ation of Developmental Stages PEDS This maeks good use of waiting room time and provides results that can be shared with the team P gt BABES is a short checklist of social and emotional behaviors that is often used at the 12 and 18 month visits Parents answer questions about their child with regard to eating sleeping cuddling playing and toilet habits Their answers help the Healthy Steps team identify any areas of potential difficulty and lay the groundwork for future discussions gt The MacArthur Communicative Development Inventory is a questionnaire designed to provide parents with a sense of whether their children s language skills are developing on target To help determine the child s developing receptive and expressive language skills language screening tools such as the Early Language Milesone Scale ELMS are very helpful Unit 7 Gauging a Child s Developement Gauging a Child s Development tength 19 50 This video focuses on the five child development checkups used by Healthy Steps practices In the first segment a physician conducts an NBAS with a four day old baby and her mother Next we see a Healthy Steps Specialist introduce the GAUGNG A Temperament Scale to the mother of a four month old at a well child checkup The CHILD S third segment features a Healthy Steps Specialist informally using BABES to begin a DEVELOPMENT discussion with the mother of a one year old on such topics as eating sleeping
24. ave about your child Dear Mom Linking the Family Practice and Community THE 12 MONTH OLD ASK Youre Per Now that my 12 month old can walk a few steps it seems that she is always in danger of getting hurt am exhausted from following her everywhere and saying Using Healthy Steps Resources To view a Resource click on the title that interests you and then click on Open in the lower right hand corner In a few seconds the Resource that you have chosen will appear in Adobe Acrobat a software program that enables you to view a graphically enhanced page Adobe Acrobat is part of the Healthy Steps CD ROM and does not need to be purchased or downloaded THE 12 MONTH OLD TRIC TEAM Tired Mom Bring in any questions from the You and Your Child parent activities found in the last LINK letter At This Visit Your Pediatric Clinician May Measure baby s length ODS NO VRCKS Metis Great news Your child is walking Your baby s first steps are very exciting but they are a challenge Beginning walkers don t have the ability to keep themselves from getting hurt That is your job You can do many things to keep your child safe but remember bumps and bruises are a NORMAL part of toddlerhood Iry the following tips to help keep your child safe 1 CHLOPROOF YOUR HOUSE AGAIN A 12 month old who is walking is different from a 9 month old who crawls Look at each room of your hou
25. cialist Pediatric Associates of Florence South Carolina e MARGOT KAPLAN SANOEFF Ed D Child Development Specialist Boston University School of Medicine STEVEN PARKER Pediatrician Boston University School of Medicine e SILVANA SHLIAPOCHNIK M D Family Physician Advocate Ravenswood Maternity Family Health Center Chicago e BARRY ZUCKERMAN M D Pediatrician Boston University School of Medicine F The cD ROM CLINICAL STRATEGIES Supporting Families gt Overview gt The Practice and the Family gt Building Relationships Set Agendas Collaboratively Use the Right Tone Interviewing Techniques Use Teachable Moments Consider the Family s Background Understand Boundaries gt Healthy Steps Materials gt Other Services Prenatal Care Child Development Telephone Information Line Reach Out and Read gt Special Times of Stress Breast feeding Separation Divorce Remarriage The Arrival of Siblings Other Difficult Times P Case Studies gt Related Reading SSeS Rl CLINICAL STRATEGIES Parent Groups gt Overview The key sections in the CD ROM that relate to this unit are listed below gt Why Offer Parent Groups The Research View Parents Views gt Types of Parent Groups Purposes of Groups Structure and Format gt Marketing Concerns Market Research Session Planning Selecting a Time and Place Effective Promotion gt What Makes a Good Leader P Case Studies
26. communicate developmental information at a moment when parents natural interest is high Parents questions and behavior also stimulate teachable moments Like all Healthy Steps strategies the use of teachable moments both is a part of and is enhanced by the development of an ongoing relationship between the practice and the family Teachable moments consistently increase mothers and fathers self understand ing along with their understanding of their child s behavior and development Listening and observation are stressed throughout as the key skills physicians and Healthy Steps Specialists need to succeed in using teachable moments Unit Objectives After viewing the video and completing the Creating Teachable Moments portion of the CD ROM users should be able to gt Recognize and describe examples of teachable moments that concern a behavioral or developmental issue gt Differentiate between teach able moments and anticipatory guidance gt Explain why taking advantage of teachable moments is impor tant and how the use of this strategy enhances well child care gt Be able to identify and use at least five different types of encounters with parents and or children in which clinicians have opportunities to take advantage of teachable moments gt Give examples of at least three different types of situa tions in which teachable moments are addressed gt Demonstrate various ways in
27. creates an environment in which family health issues can be addressed A practice s ability to help parents will depend as well on the research that it has done in the community to identify appropriate resources and on its ability to operate as a team Unit Objectives After viewing the video and questions about these factors violence is present completing the related sections are asked CED RONNE gt Help parents understand the eE gt Respond appropriately to relationship between their own family members who disclose upbringing and the parenting gt Understand that involve involvement with these style that they want to be able ment in family health grows out behaviors to offer their own children of a caring and supportive rela tionship between the practice gt Explain the Stages of B gt Develop and implement a and the family and is part of pro Change model and tell what plan for identifying community viding enhanced well child care SUPpott would be appropriate resources that can be accessed for individuals at each stage for assistance on these issues gt Discuss why family factors and put in place a plan to keep are important to a child s gt Tell how you would differ this information current healthy growth and develop entiate a woman with baby ment blues from one who is p gt Determine what clinical clinically depressed supervision is available to Healthy gt Be able to cite t
28. cts part of a Denver II Developmental Screening Test and relays her findings to Dr Christopher Clemens who then completes the visit with the mother and child The video features the M S W L C S W Healthy Hospital Chicago JENNIFER following clinicians Steps Specialist Western PROZUMENT M Ed Healthy Colorado Pediatrics Grand Steps Specialist Advocate e T BERRY BRAZELTON M D Junction e MARGOT KAPLAN Ravenswood Hospital Pediatrician Harvard Medical SANorr Ed D Child Chicago TERESA WILSON School Boston Development Specialist R N Healthy Steps e CHRISTOPHER CLEMENS Boston University School of Specialist Cornell Medical M D Pediatrician Cornell Medicine STEVEN PARKER Associates New York City Medical Associates New York M D Pediatrician Boston e BARRY ZUCKERMAN M D City WILLIAM FINDLAY University School of Pediatrician Boston M D Pediatrician Western Medicine ANDY PHAN University School of Colorado Pediatrics Grand M D Pediatric Resident Medicine Junction REBECCA HOBART Advocate Ravenswood Pe The The key sections of the CD ROM that relate to this unit a CD ROM are listed below MANAGING HEALTHY STEPS gt Case Studies Getting Ready gt Related Reading gt Overview RESOURCES Clinical gt The Healthy Steps Team Quick Check Sheets Physician Pediatric Nurse Practitioner RESOURCES Family Healthy Steps Specialist LINKletters Nursing Staff Parent Prom
29. cud dling activity level playing and toileting The fourth segment demonstrates the Denver II Developmental Screening Test being used by a pediatric clinician with an 18 month old and the ensuing discussion of her findings with the child s father Finally the video concludes with a brief commentary on the importance of using the MacArthur Communicative Development Inventory and a discussion of strategies for telling parents what they can learn from these checkups The video features the Medical Associates New York City University School of Medicine following clinicians e PATRICIA GARZA R N Healthy e SABRINA PROVINE R N B S N Steps Specialist South Texas Center Healthy Steps Specialist Advocate e CATALINA ARIZA M Ed Healthy for Pediatric Care San Antonio Bethany Hospital Chicago Steps Specialist Advocate e MARGOT KAPLAN SANCEF Ed D e VALENTINA VIELMA M D Ravenswood Maternity Family Health Child Development Specialist Boston Pediatrician South Texas Center Center Chicago ANITA BERRY University School of Medicine for Pediatric Care San Antonio R N P N P Healthy Steps Specialist PATRICIA LAWRENCE R N M S N e TERESA WILSON R N Healthy Advocate Good Samaritan Hospital PN P Pediatric Clinician Boston Steps Specialist Cornell Medical Dower s Grove Illinois T BERRY University Medical Center SUSAN Associates New York City BRAZELTON M D Pediatrician O BRIEN M D Pediatrician Boston e BARRY ZU
30. d D Child Development Specialist Boston University School of Medicine Grove Illinois JERRY e Mary MORTLOCK R N C P N P Healthy Steps Specialist Advocate Good Samaritan Hospital Downer s NIEDERMAN M D Pediatrician The University of Illinois Chicago STEVEN PARKER M D Pediatrician Boston University School of Medicine e ROGER PASINSKI M D Pediatrician MGH Revere Medical Center Revere Massachusetts SABRINA PROVINE R N Healthy Steps Specialist Advocate Bethany Hospital Chicago JENNIFER PROZUMENT M Ed Healthy Steps Specialist Advocate Ravenswood Maternity Family Health Center Chicago SILVANA SHLIAPOCHNIK M D Family Physician Advocate Ravenswood Maternity Family Health Center Chicago BARRY ZUCKERMAN M D Pediatrician Boston University School of Medicine a gt The QF cp Rom CLINICAL ISSUES Family Factors gt Overview gt Universal Screening gt How to Begin gt The Role of the Practice gt The Five Factors Smoking Depression Alcoholism Drug Addiction Parents Childhoods Domestic Conflict gt Making Referrals P Case Studies gt Related Reading CHILD DEVELOPMENT AND BEHAVIOR Relationships Are the Key to Development gt Overview gt Parent Parent Relationships The Effects of Discord The Role of Fathers The key sections in the CD ROM that relate to this unit are listed below gt Parent Child Relationships Barriers to A
31. d us to bring video cameras into their lives The Healthy Steps Interactive Multimedia Training amp Resource Kit Multimedia Training Kit Technical Advisory Committee Marilyn Augustyn M D Boston University School of Medicine Andrea Bernard M A Boston University School of Medicine Michael C Barth ICF Consulting Henry Bernstein O D Bright Futures Harvard University Linda Eggbeer M Ed Zero to Three The National Center for Infants Toddlers and Families Margot Kaplan Sanoff Ed D Boston University School of Medicine Margaret Mahoney MEM Associates Tracy Magee M S N C P N P Boston University School of Medicine Kathryn Taaffe McLearn Assistant Vice President The Commonwealth Fund Gerald Mettner MEM Associates Susan O Brien M D Boston University School of Medicine Steven Parker M D Boston University School of Medicine Kathleen Fitzgerald Rice Boston University School of Medicine Michele Yellowitz Shapiro The Commonwealth Fund Barry Zuckerman M D Boston University School of Medicine Multimedia Training Kit Health Care Leaders Advisory Committee Joel J Alpert M D Professor of Pediatrics Department of Pediatrics Boston Medical Center Ann Segal Deputy Assistant Secretary for Policy Initiatives U S Department of Health and Human Services Kathryn E Barnard Ph D R N Professor of Nursing and Associate Dean for Academic Programs Center for Human Developmen
32. e CHRISTOPHER CLEMENS M D Cornell Medical Associates New York City SUSAN CURLEY M S Ed Healthy Steps Specialist MGH Revere Health Center Revere Teachable Moments The First Year Length 18 07 This video presents many examples of teachable moments in practice It shows office visits with several children a two month old whose father is the sole daytime caregiver for the first time that day a six month old taking part in a Denver II Developmental Screening Test which provides numerous opportunities for teachable moments and anticipatory guidance and a nine month old whose mother raises a variety of issues about the child s increasing demands Teachable moments strategies also are shown at a home visit that focuses on the relationship between a nine month old girl and her two year old brother and a one year office visit in which issues of autonomy and limit setting begin to emerge Strategies shown include reframing the child s behavior in developmental terms observing and interpreting the child s behav ior asking evocative questions eliciting and then discussing specific behaviors and modeling specific interactions with the child Massachusetts MARGOT KAPLAN SANOEFF Ed D Child Development Specialist Boston University School of Medicine JENNIFER LISKE M A Healthy Steps Specialist MGH Revere Health Center Revere Massachusetts AMY OH M D Pediatrician MGH Revere Health Center Revere Massachu
33. e Moments Anticipatory Guidance Missed Opportunities gt Using Teachable Moments Techniques Creating Teachable Moments Finding Teachable Moments gt Teachable Moments in the Office At Toddler Visits gt Teachable Moments from Birth to Three 15 Months 30 Months 18 Months 36 Months 24 Months P Case Studies gt Related Reading RESOURCES Clinical Quick Check Sheets RESOURCES Family LINKletters Parent Prompt Sheets Parent Handouts Child Health and Development Record The key sections in the CD ROM that relate to this unit CLINICAL STRATEGIES The Toddler Years gt Overview gt Developmental Domains Cognitive Development Motor Development Communication Development Social Development Review of Developmental Milestones gt Limit Setting and Discipline What is Discipline Discipline in the Context of Parent Child Relationships Discussing Discipline with Parents Predisposing Behaviors to Discipline Problems gt Healthy Steps Strategies Working with Parents Limit Setting The ABC Approach Discipline Techniques to Avoid gt Other Toddler Issues Feeding Toilet Training Sleeping p gt Case Studies gt Related Reading MILESTONES FROM BIRTH TO THREE 15 Months 30 Months 18 Months 36 Months 24 Months The Healthy Steps Interactive Multimedia Training amp Resource Kit Questions 1 Pediatrician Steven Parker talks about why parents are so open to advice dur for ing their child s
34. e and describe the ways in which it provides mothers and fathers with desired information and services The Healthy Steps Interactive Multimedia Training amp Resource Kit Key gt Healthy Steps is an approach to primary care for children from birth to three Concepts that increases a medical practice s ability to address children s behavioral emo tional and cognitive development during these important early years B gt Healthy Steps also looks at the well being of the whole family in the interest of the young child B Healthy Steps practices form a strong bond with mothers and fathers support ing their desire for greater understanding of their children s needs at different stages through information special services and access to community resources gt To accomplish its goals Healthy Steps adds a professional or trains someone already in the practice Called a Healthy Steps Specialist this individual specializes in issues related to child development and family factors referring medical questions to the practice s doctors and nurses Healthy Steps Specialists have varied back grounds including pediatric nursing early childhood education and social work B gt The seven major strategies of Healthy Steps are Enhanced well child care Home visits Child development and family health checkups Special written materials Access to a child development telephone information line Links to community resources Par
35. e in the form of Healthy Steps parent handouts B Healthy Steps practices participate in the national Reach Out and Read program In this program physicians give children books at each well child visit starting when a child is six months old and model ways in which mothers and fathers can use these books to help support their child s early learning experiences p gt All members of the Healthy Steps practice team strive to end each visit on a positive note praising mothers and fathers for their successes and building their self confidence Unit 3 The Healthy Steps Office Visit THE HEALTHY STEPS The The Healthy Steps Office Visit Length 14 14 OFFICE Video This video looks at two enhanced well child visits Each uses members of the interdis VISIT ry ciplinary team somewhat differently The first visit takes place in Grand Junction Colorado and features Dr Mike Whistler and Healthy Steps Specialist Rebecca Hobart who is a licensed social worker The video shows what such a joint visit looks like starting when the family arrives for a visit and provides an important opportunity to see how members of the interdisciplinary team work together It also illustrates how the Healthy Steps Specialist engages the parents in setting the agenda for the visit The second segment shows a visit at Cornell Medical Associates in New York City Healthy Steps Specialist Teresa Wilson who has a background in pediatric nursing condu
36. e recertification Healthy Steps for Young Children is a nation al initiative that focuses on developmentally oriented pediatrics from birth to age three It emphasizes the importance of a close relationship between health care professionals and mothers and fathers in addressing the physical emotional and intellectual growth and development of children in the early years Healthy Steps has been supported by The Commonwealth Fund from the design stage onward in a collaboration that has been an unusually productive partnership augmented greatly by the active co sponsorship of the American Academy of Pediatrics These materials will help physicians individualize the care of each child with the focus on the whole child and the whole family and will help clinicians and families build a relationship that will get young children off to a good start A Commonwealth Fund survey of parents with young children has documented the need for this approach The survey shows that the number one concern of parents today is their child s ability to learn and adapt to the ever changing world in which he or she will live Moreover the survey documents that parents want more information and support to address this concern and that they listen to what their child s physician tells them But the survey also reports that clinicians are not discussing with parents their child s The Healthy Steps Interactive Multimedia Training amp Resou
37. ed by target age Video Commentaries and Examples organized by topic and Related Readings organized alphabetically by author Related Readings are journal and magazine articles that provide either documentation or additional information on the topic under study CONTENT MAP This button leads to a complete outline of all material on the CD ROM and allows you to access any topic quickly by clicking on it NOTES This button accesses your personal Notes file that contains your own responses to all interactive case studies The Healthy Steps Interactive Multimedia Training amp Resource Kit HOW THE ELEMENTS WORK TOGETHER All elements can be used individually or together as part of an integrated learning system Unit Study Guides begin on page 11 Each Unit Study Guide contains the following elements An overview of the unit Unit objectives Key concepts A synopsis of the video including the clinicians seen A list of related CD ROM sections Questions for reflection and discussion that can be used by both individuals and groups to further learning and reinforce key principles The primary purpose of the videos is to show s how a developmentally oriented pediatric practice looks and to provide developmentally oriented practices with models they can use to norm their own decisions and behaviors Because video is a medium that is better at telling stories and showing behaviors than it is at providing didactic information
38. eeeee 6 Unit 6 The Toddler Years 0 605 32 Technical Requirements 6 a Unit 7 Gauging a Child s Installing the CD ROM 6 Development ccesseescee 36 Technical Assistance 04 6 Unit 8 Supporting Families d Challenging Times H o os A z Challenging Situations 40 First Use ccsesesesesscseveses 6 Unit 9 Family Factors Affecting Subsequent Uses 000s00 6 hild kine D OVELVICW cc cccscccscseseseseseees 7 Children Smoking Depression Man MONU 7 Violence and Addiction 44 Chapter Menusiiwusicsesscancas 8 Using the Case Studies 8 Accessing Your Notes 9 Using Healthy Steps Resources 9 Printing Resources Closing Adobe Acrobat 10 Duplicating Resources Exiting the CD ROM Accessing Your Operating System While Using the CD ROM INTRODUCTION This kit is designed to help medical practices adopt a new approach to primary care for very young children the Healthy Steps approach The enclosed videos and CD ROM can be used to introduce the Healthy Steps approach to serve as a reference after attending a training institute to review developmental milestones to train new clinical staff in developmentally oriented pediatrics to help pediatric and family medicine residents fulfill their requirement in behavioral pediatrics or to help physi cians achiev
39. egularly and in a sensitive fashion The most sen sitive questions are best discussed when a relationship has been established unless there are specific physical indications that immediate discussion is necessary if for example a mother has a bruised face or a black eye P gt Secondhand smoke has very negative effects on a child s health Healthy Steps prac tices can work with family members who smoke using a five stage change model precon templation contemplation readiness for action action maintenance B gt Depression affects 5 to 10 percent of all adult women and can seriously affect a per son s ability to parent Because depression is treatable however the effort of Healthy Steps practices to identify and refer depressed parents is all the more imperative gt Parental addiction to alcohol and or drugs also poses a serious problem for children Healthy Steps teams need to know how to talk with families who disclose substance abuse what treatment programs are available in their community how effective they are and what procedures an individual must follow to obtain treatment gt By the time they become parents mothers and fathers usually are long past their own early childhood experiences Yet these experiences echo sometimes loudly in the parents own caregiving style Helping parents understand how their own childhood experiences relate to the kind of parenting they want to offer their children is a p
40. ent Establishing Community Connections Planning Time Line Estimating Costs gt Training and Technical Assistance gt Case Studies The Healthy Steps Training Institute Technical Assistance gt Related Reading Healthy Steps Videos Healthy Steps CD ROM Staff Turnover The Healthy Steps Interactive Multimedia Training amp Resource Kit Questions for Discussion and Reflection Facilitator s Note In addition to the questions here the Management Case Studies section of the Getting Ready for Healthy Steps chapter on the CD ROM includes a number of interactive exercises that can be used as decision making tools in the start up process 1 The practice administrator is key to a successful Healthy Steps practice What responsibilities will this individual have in your practice e g developing and imple menting a scheduling system arranging for facilities equipment and supplies Who is the best person to fulfill these responsibilities Does that person have the necessary authority and access to solve problems as they are identified 2 Healthy Steps offers a number of ways in which physicians and Healthy Steps Specialists can work together to enhance a well child visit What do you think are the advantages and disadvantages of these clinicians seeing the family together or seeing the family sequentially Which method feels as if it would work best for your practice Why do you think so If members of your team will
41. ent groups B Healthy Steps practices also participate in the national Reach Out and Read program B Healthy Steps clinicians frequently use a technique called teachable moments Teachable moments help parents better understand how behavior is related to their child s developmental stage e g why a child who has developed the concept of object permanence will cry when a parent leaves the room B Clinicians can learn what issues are important to mothers and fathers and cre ate teachable moments by asking open ended questions listening carefully to the responses and probing when necessary to be sure that the issue of importance to the family has been identified B Healthy Steps provides mothers and fathers with the information and support that they want and need and helps physicians accomplish the goals that they established early in their careers Unit 1 Healthy Steps An Overview HEALTHY OVERVIEW The CD ROM a ww Healthy Steps An Overview Length 15 18 This video shows Healthy Steps at work in a variety of medical practices in different parts of the country Physicians and parents demonstrate the advantages of this devel opmental approach to primary care for young children A major focus of the video is on the addition of a new member of the practice team called a Healthy Steps Specialist Healthy Steps Specialists from a variety of academic backgrounds includ ing nursing early childhood educ
42. erent strategies for providing information and supporting both the everyday and extraordinary needs of families These strategies include a Child Development Telephone Information Line parent groups and home visits by a Healthy Steps Specialist gt To give parents ready access to needed information on child development and behavior Healthy Steps uses varied print materials These include LINKletters Parent Prompt Sheets parent handouts on dozens of topics and a Child Health and Development Record gt Reach Out and Read is another important service that developmentally oriented practices can offer It combines several activities physicians give books to children at each well child visit beginning at six DEENA ba z months and show parents how they can use the books to help build their child s love of learning and promote learning readiness In addition volunteers read books to children in the waiting room B Healthy Steps practices also have an important role to play in encour aging mothers to breast feed some practices are now adding prenatal visits to their services to help get breast feeding mothers and their babies off to a good start Unit 8 Supporting Families Challenging Times Challenging Situations Supporting Families Challenging Times Challenging Situations Length 17 37 The video has three stories The first features the Helton family The Heltons have moved four times in two years
43. f Developmental Milestones The Healthy Steps Interactive Multimedia Training amp Resource Kit Questions for Discussion and Reflection Facilitator s Note In addition to the questions here the interactive case studies on the CD ROM can be used for small group discussion 1 Review the video section in which Dr Barry Zuckerman talks with Mrs Valiuddin as her nine month son Hussain plays on the examining table In what way does Dr Zuckerman model ways of interacting with Hussain 2 Dr Zuckerman asks Mrs Valiuddin a number of questions about her current life Why do you think he does this What does he learn in so doing What are some open ended questions that you find helpful in your practice 3 Describe how Dr Zuckerman helps Mrs Valiuddin understand Hussain s clinginess in developmental terms Why is this reframing important 4 What do you observe about Hussain s behavior in this office visit How might you describe and interpret your observations to his mother 5 How might Dr Zuckerman have involved the child development specialist in this visit Why might it be important for the child development specialist to observe the family 6 What techniques does child development specialist Margot Kaplan Sanoff use to find out more about Mrs Valiuddin s child rearing preferences 7 Review the portion of the video in which Healthy Steps Specialist Jennifer Liske conducts a home visit
44. f these venues and why is this array of choices important 8 Dr Michael Schwartz talks about the value of the extra time that a Healthy Steps Specialist can spend with a family How would the addition of a Healthy Steps Specialist help the families in your practice 9 What is the value of adding a Reach Out and Read program to your practice 10 In what ways is a home visit likely to differ from an office visit Why is this important 11 In what ways does Healthy Steps consider the health of the whole family in the interest of a healthy child 12 Which of the following Healthy Steps components does your practice currently use a child development tele phone information line home visits parent groups parent handouts and other special written material community referrals Which components would you like to learn more about e dimer e Unit 1 Healthy Steps An Overview al 2 HEALTHY STEPS Unit Overview TARTING A HEALTHY STEPS PRACTICE This unit focuses on the process of preparing to become a Healthy Steps prac tice Two critical success factors for Healthy Steps concern how well a practice plans for the changes in staffing and services that it will undergo and how well everyone on the team is oriented to and trained in the Healthy Steps approach and strategies It is vital that someone take charge of this process and ensure that all members of the team
45. fer Alonso using in the video 4 What would you expect to be your biggest challenge in administering the NBAS How will you meet this challenge When would it make the most sense for you to do the NBAS at the hospital at the first office visit or at the first home visit Why 5 What does the term goodness of fit mean in looking at the relationship between a child s temperament and a parent s expectations Give an example of how a parent s expectations and a child s temperament are not in agreement and what situations you would expect to result from the difference 6 Have you reviewed other early language screening tools such as the Early Language Milestone Scale ELMS 7 Pick a partner to play the parent Practice explaining what you learn from doing a Denver II and how you interpret your findings Switch roles 8 In the video you see parts of the Denver II being administered to two children a one year old and an 18 month old What are some ways in which Patricia Lawrence draws Mr Alobwede into the conversation to check out some Denver items Replay this segment and describe how Ms Lawrence uses the occasion for teachable moments 9 Have you reviewed other early developmental scales that rely on parental report such as the Ages and Stages Questionnaire ASQ or the Parents Evaluation of Developmental Status PEDS 10 Dr Parker talks about how he would approach a situation in which he felt a chi
46. g with stressful periods and situations gt Determine how to set up a B Identify likely times of stress Reach Out and Read program for families and develop ways to in a Healthy Steps practice support such families during these difficult periods gt Plan a parent group program for their practice The Healthy Steps Interactive Multimedia Training amp Resource Kit Key gt Building a caring informed and supportive relationship with mothers and fathers is Concepts one of the most important services that Healthy Steps practices can offer It is at the root of all Healthy Steps components and strategies gt From time to time every family faces stress The stressors need not be extreme to affect a child s development and behavior In fact the most common problems emerge from everyday situations over which we may have little control such as moving or life cycle changes Because of the strong relationships that Healthy Steps Specialists form with mothers and fathers the Healthy Steps practice has an important role to play at times of family stress and may be the only place to which parents can go for informa tion and guidance P gt Among the potential consequences of stress on children are such behavioral changes as acting out or withdrawing and such physical symptoms as headaches or stomachaches Parents may experience difficulties in relationships and parenting as a result of stress B Healthy Steps recommends many diff
47. he potential Steps Specialists negative effects on a child s P Without overstepping development of the family fac therapeutic boundaries identify P gt Plan a way to help a family tors highlighted in this unit specific kinds of support that develop a safety plan in case of a Healthy Steps Specialist domestic violence gt Be able to conduct a family might offer a family in which history in which appropriate either addiction or domestic The Healthy Steps Interactive Multimedia Training amp Resource Kit Key B gt Children s health is determined by many factors including family social psycho Concepts logical and biological issues The following family factors are known to have a nega tive impact on a child s health development and behavior smoking depression alco holism and drug addiction domestic violence and parents own difficult childhoods These issues are more likely to affect a child s well being negatively than most viruses ever will Failure to recognize them and their impact on children is a missed opportu nity to provide a real service to children and families gt Family and psychosocial problems are not confined to any one economic level or geographic area Limiting your assessments to settings that are typically considered high risk actually misses the majority of families with these problems Only universal screening can improve detection markedly P It is important to raise these issues r
48. he title of the Case in the box at the left This will bring up an upper screen and a lower screen on the right Upper Screen If the Case is text based the case itself will be on the upper screen If it is video based you will see a video screen and video controls Start the video by clicking on gt You can make the video screen larger by clicking on Maximize you can return it to its original size by clicking on Minimize You can stop the video by clicking on E Lower Screen The lower screen contains the interactive part of the program First you will see the direction To Think About This direction is followed by one or more questions Each question is followed by the words Your Thoughts When you click on Your Thoughts a dialog box will appear MAXIMIZE NOTES EXIT in which you can write in your own responses to each question If you wish to save your answer click on Save at the lower right before you go to another section and your answers will be saved to your per sonal Notes file Hint Your responses will not be saved automatically You must click on Save before you leave the screen Accessing Your Notes To review your Notes you must be working at the same computer on which you saved your Notes and you must have signed in using the same name under which you worked when you created the notes Click on Notes on the bottom menu bar A screen INTERACTIVE MULTIMEDIA TRAINING amp
49. he visit Why does she always wind up yelling at her two year old daughter and what else could she be doing The third segment shows an 18 month home visit Here too the major issue is discipline In this family however it soon becomes evident that the mother and father have very different approaches to discipline and limit setting The Healthy Steps Specialist helps them understand their own ghosts in the nursery and begins the process of helping them set common goals The fourth segment shows how teachable moments emerge in a parent group in which toddlers are present The video features the M S W L C S W Healthy Steps Boston University Medical Center following clinicians Specialist Western Colorado e SABRINA PROVINE R N Healthy Pediatric Associates Grand Junction Steps Specialist Advocate Bethany e CATHIE CLARK R N M S A e MARGOT KAPLAN SANOFF Ed D Hospital Chicago MICHAEL Healthy Steps Specialist Western Child Development Specialist WHISTLER M D Pediatrician Colorado Pediatric Associates Boston University Medical Center Western Colorado Pediatric Grand Junction REBECCA HOBART STEVEN PARKER M D Pediatrician Associates Grand Junction Unit 6 Teachable Moments The Toddler Years 6 TEACHABLE MOMENTS THE TODDLER YEARS a gt The wp CD ROM are listed below CLINICAL STRATEGIES Creating Teachable Moments gt Overview gt Introduction Teachabl
50. heets for Clinicians e 11 LiNkletters for Parents e 11 Parent Prompt Sheets e 50 Parent Handouts for use during Year One e 30 Parent Handouts for use during the Toddler Years e Child Health and Development Record in English and Spainish User s Views When asked what the main theme of a video was pilot users said Teaching observation skills tuning in to what is happening in the family life and then expanding on that point Identifying problem areas and concerns supporting par ents about their decisions and recognizing cultural issues Respecting families and learning to really listen to parents CD ROM OUTLINE Managing Healthy Steps Getting Ready Clinical Strategies e Creating Teachable Moments e Gauging a Child s Development Supporting Families Parent Groups Family Factors Home Visits Child Development and Behavior e Relationships Are the Key to Development e The First Year e The Toddler Years Milestones from Birth to Three Each chapter contains a brief overview of child development at the target age and links to all resources on the disk that relate to that age e 3 5 Days e 12 Months e 2 Weeks e 15 Months e 1 Month e 18 Months e 2 Months e 24 Months e 4 Months e 30 Months e 6 Months e 36 Months e 9 Months The disk also contains a variety of supporting material that can be accessed at any time User s Views
51. hen was it last updated Unit 9 Family Factors Affecting Children Smoking Depression Violence and Addiction Editorial and Research Staff CD ROM Design and Programming Managing Editor Toby Kleban Levine Programmers Tom Cheyney Travis Communications Manager Kelley McDonald Lynch Sam Miller Hilda Editorial Associate Joan Seidman Welsh Smith Lynn Whiteley Project Assistant Jeannette Boline Design Directors Jennifer Kirby Jerome Researchers Bryan Elrod Kirsten Lukas Carol Parry Hawkins Hana Rab Artists Brian Baker Jason Hickey Lakeshia McCoy Dan Video Production Staff Rodriguez Joanie White Executive Producer Alvin H Perlmutter Narrator Josh Cohen Senior Producer Lisa Zbar Special Thanks John Carney Mary White Producer Pamela Wheaton Brett Wilson Associate Producer Andrea Holmes Candee Wilson Editors Dina Potocki Girish Barghava Packaging and User Manual Additional Editing Erick Jean Baptiste Graphic Design DRPollard amp Associates Production Assistant Erick Jean Baptiste Vienna Virginia Other Contributors Ann Adalist Estrin M S Parent Resource Association Philadelphia Pennsylvania Marilyn Augustyn M D Boston University School of Medicine Michael C Barth and Juliet Fried ICF Consulting Fairfax Virginia Emily Fenichel Claire Lerner Jeree Paul and G Gordon Williamson Zero to Three The National Center for Infants Toddlers and Families Washington D C Kathryn Taaffe McLearn The
52. ideo and completing the related CD gt Describe a typical Healthy gt Determine how such Steps enhanced well child Healthy Steps materials as ROM sections in Managing a ee ec See edi office visit Quick Check Sheets Parent able to Prompt Sheets and parent gt Differentiate between joint handouts will be used in a visits and linked visits and well child visit determine which would work best in your practice gt Identify how traditional well child visits differ from Healthy gt Discuss the roles of the Steps well child visits receptionist physician nurse practitioner nurse and Healthy B gt Plan the addition of a Reach Steps Specialist in a well child Out and Read program for their visit and tell how these roles practice relate to one another in a developmentally oriented B Discuss ways in which the practice interdisciplinary team works together and show communica tion across roles The Healthy Steps Interactive Multimedia Training amp Resource Kit Key gt Healthy Steps follows the guidelines of the American Academy of Pediatrics Concepts for well child visits p gt Enhanced well child office visits are a key Healthy Steps strategy They involve an interdisciplinary team and support mothers and fathers around issues of behavior and development in addition to meeting the child s health needs B gt Healthy Steps enhanced well child office visits are characterized as eithe
53. idual roles gt Identify the kinds of changes to the office facility that are needed to communicate that the practice is a nurturing and open environment that supports the needs of mothers and fathers and is as interested in children s development behav ior and temperament as it is in their health B gt Determine how physicians and Healthy Steps Specialists will structure well child visits gt Identify the impact of Healthy Steps on personnel and facility scheduling and develop a plan for modifying the exist ing scheduling system to accom modate Healthy Steps The Healthy Steps Interactive Multimedia Training amp Resource Kit Key gt Change is hard and threatening to some It takes time an ongoing Concepts commitment leadership and continuous communication among all members of the team gt Healthy Steps adds a child development specialist to the medical team or trains someone already on the team This individual may already be part of your practice or may need to be recruited Look for people who are knowledgeable about child development from birth to three and experienced in working with families The number of specialists that a practice will need depends on how many new babies come into the practice each month gt Training in specific Healthy Steps strategies and more generally about the Healthy Steps approach to primary care for young children is a key part of the start up process Training is ava
54. ies and materi als that Healthy Steps practices use to support the families and the strong relationships that make possible these various forms of assistance The CD ROM offers practical guid ance about how to create and maintain such relationships emphasizes the role of the Healthy Steps Specialist in this process discusses the use of various Healthy Steps print materials and examines in detail some particularly stressful situations that families often face It also provides tools and suggestions for setting up parent groups in your practice Unit Objectives ee ee video and gt Be familiar with and know p gt Understand the boundaries peas a ao e how and when to use the fol of the relationship between A aga lowing Healthy Steps materials Healthy Steps clinicians and tions of the CD ROM users LINKIletters Parent Prompt families and know when it is adk abico Sheets parent handouts and necessary to refer a family to an gt Identify strategies that mem the Child Health and outside agency bers of the Healthy Steps team Development Record use to form strong relationships with mothers and fathers gt Establish a means of provid gt Develop strategies for ing clinical supervision to encouraging breast feeding Healthy Steps Specialists p gt Use techniques that are like ly to further the development of relationships with mothers and fathers gt Be able to offer mothers and fathers concrete strategies for dealin
55. iew age appropriate home safety guidelines The video features the Healthy Steps Specialist SANOFF Ed D Child following clinicians Advocate Good Samaritan Development Specialist Hospital Downer s Grove Boston University School of e Jo ANN ALLEN R N Illinois JACQUELINE Medicine JENNIFER LISKE Healthy Steps Specialist GOVERNO B A Healthy M A Healthy Steps Advocate Bethany Hospital Steps Specialist Pediatric Specialist MGH Revere Chicago JENNIFER ALONSO Associates of Florence South Health Center Revere R N Healthy Steps Carolina CHARLES JORDAN Massachusetts STEVEN Specialist Cornell Medical M D Pediatrician Pediatric PARKER M D Pediatrician Associates New York City Associates of Florence South Boston University School e ANITA BERRY R N PN P Carolina e MARGOT KAPLAN of Medicine e The The key sections of the CD ROM that relate to this unit wy CD ROM are listed below CLINICAL STRATEGIES gt Making Arrangements Home Visits Prepare a Brief Introduction Call in Advance The Day of the Visit gt Overview Arranging Subsequent Visits Common Pitfalls gt Importance Relationship Building P gt Case Studies Natural Appeal to Parents Unique Position of Medical Team gt Related Reading gt Schedule and Activities RESOURCES Clinical 3 5 Days 18 Months Quick Check Sheets 9 Months 24 Months RESOURCES Family 12 Months 30 Months Parent Handouts The Healthy Steps Interactive Mul
56. ilable from the Boston University School of Medicine and through this package of materials A practice will need to decide who will participate in training and the manner in which they will be trained B Regularly scheduled meetings will help the staff to work as a smoothly func tioning interdisciplinary team Some meetings should include the entire office staff so that everyone understands and is committed to the same goals gt The right scheduling system can make the difference between chaos and clari ty In developing such a system consider the number of people who need to be available to see the family during a well child visit e g the physician the pedi atric nurse and the child development specialist the amount of time each clini cian needs with the family and whether these visits will overlap and when child development specialists need to be out of the office on home visits gt Some space planning may be necessary to accommodate new staff and new services Child development specialists will need office space computers files materials and access to typical office services A room in which Healthy Steps Specialists can conduct developmental checkups may be needed gt The time to net work survey and build relationships with community resources is during the start up process Unit 2 Starting A Healthy Steps Practice STARTING A HEALTHY STEPS Starting a Healthy Steps Practice Length 12 25 PRACT
57. ining Team at the Boston University School of Medicine The group first examines a case in which a child is being exposed to domestic violence The group discusses the many ways in which they learn about families at risk the boundaries of their roles issues of confidentiality and strategies for responding to this particular situation Other issues discussed include the impact of parents own upbringing on the ways in which they discipline their child Healthy Steps whole child whole family approach to primary care the role of community resources and the challenge of families with multiple problems Throughout the video suggests the questions to ask and Healthy Steps team members discuss their very personal reactions to providing this kind of support to families The video features the following clinicians Jo ANN ALLEN R N Healthy Steps Specialist Advocate Bethany Hospital Chicago e CATALINA ARIZA M Ed Healthy Steps Specialist Advocate Ravenswood Maternity Family Health Center Chicago ANITA BERRY R N P N P Healthy Steps Specialist Advocate Good Samaritan Hospital Downer s Grove Illinois e SCOTT BRENNER M D Pediatrician ABC Family Pediatricians Allentown Pennsylvania SUSAN CURLEY M S Ed Healthy Steps Specialist MGH Revere Medical Center Revere Massachusetts e PATRICIA GARZA R N Healthy Steps Specialist South Texas Center for Pediatric Care San Antonio MARGOT KAPLAN SANOFF E
58. ld might have a developmental lag Using this approach role play with a partner exactly what you would say to Sara s parents 11 Working with your team members determine which developmental check ups the practice will use and on what schedule and develop a system for sharing with other members of the team the results of these checkups Consider also whether the individuals who will be administering these checkups will require any specialized training neither the video nor the CD ROM would fully prepare an individual to administer the complete instrument but intensive training is available for both the NBAS and the Denver for practices that want to pursue such options Unit 7 Gauging a Child s Developement HEALTHY STEPS Unit Overview SUPPORTING FAMILIES CHALLENGING TIMES CHALLENGING SITUATIONS This unit focuses on two of the principal elements of developmentally oriented practices that differentiate them from other medical practices fostering strong personal relation ships with mothers and fathers and using numerous strategies to help mothers and fathers better understand their parenting decisions and weather challenging family situations The video visits three families experiencing different kinds of stress that can often occur moving having a baby and adjusting to a child with a challenging temperament that is poorly matched to her parents expectations It shows the variety of strateg
59. management commitment buy in teamwork role clarity leadership resources and willingness to change Select the two factors that you think are most critical for your practice Determine what you need to achieve success in these areas and how you will get it 8 What do you think might impede the successful adoption of Healthy Steps in your practice How will you avoid or overcome these factors Unit 2 Starting A Healthy Steps Practice all Unit Overview THE HEALTHY STEPS tamses ERFICE VISIT This unit is directed to all members of the practice team who are likely to be part of well child office visits the receptionist the physician or nurse prac titioner the nurse and the Healthy Steps Specialist It looks at the various ways in which this interdisciplinary team organizes itself during well child office visits and provides a view of the ways in which such visits are enhanced by the presence of a Healthy Steps Specialist The overriding theme of this unit is that a developmentally oriented practice consistently seeks opportuni ties to increase both the self understanding of mothers and fathers and their knowledge and understanding of their child s behavior and development A second important theme is that caring and supportive relationships between the practice and the family contribute to healthy child development and are key to a developmentally oriented practice Unit Objectives After viewing the v
60. ment information with parents and maintain ing effective connections between the family and the practice The materials in this kit delineate clearly how these tasks are accomplished through home and office visits telephone contact and special materials keyed to each well child visit Healthy Steps also stresses the importance of identifying and maintaining strong relationships with other community resources so that referrals can be made when necessary TARGET AUDIENCES The major audiences for these materials are as follows e Pediatricians e Pediatric Nurses e Pediatric Nurse Practitioners e Early Childhood Specialists e Pediatric Residency Training _ Programs e Pediatric Nurse Training Programs Pediatric Nurse Practitioner Training Programs e Family Physicians e Family Medicine Residency Programs e Practice Administrators e Family Social Workers Many clinicians pilot tested parts of this package as they were being developed You will find their reactions throughout this introduction under the heading User s Views WHAT S IN THE KIT The Healthy Steps Interactive Multimedia Training amp Resource Kit consists of the following elements e 9 videos e CD ROM The Healthy Steps Videos 1 Healthy Steps An Overview 2 Starting a Healthy Steps Practice 3 The Healthy Steps Office Visit User s Views The videos showed how to
61. n The Office F Teachable Moments from Birth to Three Related Readings MAIN MENU OVERVIEW CASE STUDIES Newborn 4 Months Teachable Moments from Birth to Three During each weil chiid visit you can create a teachabie moment by engaging the child in 2 simple activity or maneuver that demonstrates to the parents 2 particuiar behavioral or temperamental quality or a developmentally appropriate skill This section lists examples of behaviors that lend themselves to creating teachable moments Most occur naturally or can be easily elicited during an office visit in each example the behavior is presented first followed by the way in which you might explain the baby s behavior to parents Look for Video Examples of these and other behaviors throughout this section and practice developing your explanations of these teachable moments RESOURCES CONTENT MAP Using the Case Studies Throughout the program you will find numerous Case Studies These are meant to give you clinical practice in analyzing particular behaviors and responding to a variety of situations by using teachable moments Some Case Studies are video based others are text based You can access Case Studies in three ways T From within a Chapter Each Chapter includes a Topic named Case Studies When you click on it a list of Case Studies relating to the content of that chapter will appear 2 From the bottom Menu Bar This will display all Case Studies
62. nduct a home safety assessment in the home of a nine month old child gt Define methods for commu nicating back to the rest of the medical team what has been learned at a home visit gt Develop guidelines on how Healthy Steps Specialists should behave at home visits including ways of showing respect for cul tural differences and discuss issues of safety providing concrete strategies that Healthy Steps Specialists can use in scheduling traveling to and communicating about home visits The Healthy Steps Interactive Multimedia Training amp Resource Kit Key B gt Home visits are part of an integrated approach to supporting mothers fathers Concepts and children from birth to age three Home visits complement office visits and enhance the practice s understanding of the family and the home s influence on the child s development and behavior P gt Home visits focus on child development temperament family health and home safety and offer an ideal time to use such developmental checkups as the Neonatal Behavioral Assessment Scale and the Denver II Developmental Screening Test both of which are designed to help mothers and fathers better understand their child s development and behavior P gt Home visits sometimes help the practice to know about and act on situations long before they affect a child s development e g postpartum depression smoking and domestic stress P gt Home visits give Healthy
63. nurse practitioners RESOURCES This button links to all Resources for families and clinicians and is organized by type of resource Family Resources include LINKletters Parent Prompt Sheets Parent Handouts and the Child Health and Development Record All are available in both English and Spanish and are presented by Note 1 The immunization chart in the Child Health and Development Record was last updated in January 2000 Note 2 All materials for distribution to families should be reviewed to ensure that the messages they present are in agreement with those used by your practice OVERVIEW A 44 minute presentation sets out the principles on which Healthy Steps is based and identifies the major strategies that distinguish a Healthy Steps practice from other medical practices that serve young children The overview plays automatically the first time an individual uses the CD ROM Thereafter it can be accessed via the bottom menu bar CASE STUDIES This button leads to the complete set of case studies organized by chapter Case studies allow you to see or read about specific behaviors and then explain how you would use such behavior as a teachable moment for parents You can write in your thoughts and save your responses to a private Notes file Bear in mind that these cases seldom have only one right answer or approach Discussing your responses with colleagues is an Clinical Resources include Quick Check Sheets organiz
64. of helping them clarify their own intent and asking evocative questions that give parents the opportunity to further explore or gain insight into an issue gt Teachable moments occur in all the situations in which you are likely to encounter the family in the office at home visits in parent groups and on the Child Development Telephone Information Line B gt Anticipatory guidance is a form of teachable moment that looks to the future offering parents information about what to expect from their young children as they develop along with ideas about how to meet parenting challenges that are likely to arise gt Missed opportunities are situations that occur when you are with a family but that you neglect or decline to pursue as teachable moments Sometimes letting a particular teachable moment go by is a deliberate clinical decision that you make because you know that the parents cannot process additional information at this time or that they are not ready to consider the problem that you have noticed gt Many specific examples of teachable moments can be found in the Creating Teachable Moments section of the CD ROM which also contains the following print materials the Child Health and Development Record LINKletters Parent Prompt Sheets and Quick Check Sheets Unit 5 Teachable Moments The First Year The Video TEACHABLE MOMENTS THE FIRST YEAR The video features the following clinicians
65. osi tive role that Healthy Steps teams can play B gt Domestic violence refers to acts of physical abuse sexual abuse and psychological maltreatment chronic situations in which one person controls or intends to control another person s behavior and misuse of power that may result in injury or harm to the psychological social economic sexual or physical well bring of family members Children who are exposed to domestic conflict suffer psychological trauma Knowledge of how to develop a safety plan with a family and what community programs are avail able can enable you to respond rapidly and positively to families in crisis gt The Healthy Steps team can help support families with problems and one another but is not expected to be able to solve all family problems Healthy Steps teams need to be able to acknowledge the need for and obtain clinical supervision Unit 9 Family Factors Affecting Children Smoking Depression Violence and Addiction FAMILY FACTORS AFFECTING CHILDREN SMOKING DEPRESSION VIOLENCE FANID VEND DI OSU ON Family Factors Affecting Children Smoking Depression Violence and Addiction Length 25 27 This video shows Healthy Steps clinicians brainstorming strategies for working with families around issues that have the potential to impact negatively on their children s development The meeting is led by Margot Kaplan Sanoff Ed D who is co director of the Healthy Steps Tra
66. pt Sheets Office Staff Parent Handouts gt Understanding Change Child Health and Development Record The Process of Change Key Decisions The Importance of Communication The Healthy Steps Interactive Multimedia Training amp Resource Kit Questions for Discussion and Reflection Facilitator s Note In addition to the questions here the interactive case studies on the CD ROM can be used for small group discussion 1 Healthy Steps Specialists have varied backgrounds Some are early childhood educators others are social workers and still others are pediatric nurses What background would you seek in a Healthy Steps Specialist to best complement the existing skills in your practice 2 Which makes more sense to you for the dynamics of your practice a joint visit or a linked visit What makes your choice attractive 3 Why is good communication among team members critical in a Healthy Steps practice 4 What impact would the addition of a Healthy Steps Specialist to an office visit have on your scheduling procedures 5 Who will take responsibility in your practice for establishing a Reach Out and Read program 6 Why do you think Reach Out and Read recommends that the physician be the one to distribute books to children 7 Where do you see teachable moments used in the video 8 What approaches do the various clinicians in the video use to help parents articulate what
67. r gt The Temperament Scale focuses on the baby s activity level adaptability persis tence and mood It helps parents identify which aspects of a child s temperament might present the greatest problems for the family and opens the door to assist parents in adjusting to various temperamental differences between the parents and the child The Temperament Scale raises parents awareness of whether their expectations for the baby s behavior match the baby s temperamental style With this awareness mothers and fathers are better able to adapt their parenting style to their child s temperament to create what is called goodness of fit p gt The Denver II Developmental Screening Test is administered at six month intervals beginning at six months of age It provides a simple method for the early identification of children at risk for developmental problems Many Healthy Steps Specialists find this assessment easiest to administer during a home visit both because of time constraints in office visits and because they find that children are more relaxed and thus more likely to complete tasks successfully It is important to note that this tool may indicate a possible developmental problem but is not suffi cient in and of itself to provide a diagnosis gt Many practices that find they do not have time to administer the Denver ask par ents to fill out such questionnaires as the Ages and Stages Questionnaire ASQ or the Parents Evalu
68. r joint visits or linked visits In a joint visit the Healthy Steps Specialist typically spends some time alone with the family and then stays in the examination room with the physician or nurse practitioner PNP In a linked visit the physician or nurse practitioner and the Healthy Steps Specialist see the family separately In this model the Healthy Steps Specialist typically will see the family first and may return after the physician or PNP has completed the health part of the visit In either case if the Healthy Steps Specialist has spent time with the family before the physician or PNP arrives it is important for the specialist to engage parents in helping to set the agenda for the visit strengthen the practice s rela tionship with the family and brief the physician or nurse practitioner on what he or she has learned and observed in the early part of the visit gt Many practices use variations of these approaches but the essential outcome is that the Healthy Steps Specialist can spend additional time with the family and focus specifically on issues relating to development and behavior gt During enhanced well child visits both the Healthy Steps Specialist and the physician may conduct developmental checkups take advantage of teachable moments provide anticipatory guidance to the family on upcoming develop mental changes and provide additional information on topics that parents have asked about Some of this information may com
69. rce Kit cognitive and emotional development nor are all parents routinely engaging in activities that nurture their child s healthy development such as reading to and playing with their child Further the survey found that many clinicians do not regularly raise behavioral issues such as crying or toilet training nor do they typically address the clinically important and troubling association between maternal depression and daily child rearing activities including setting limits and maintaining routines These materials respond to those issues They document child rearing needs from birth to three years integrating medical care with behavioral and psychological information in the context of an expanded focus on normal growth and development They also address such issues as child safety in the home breast feeding and smoking Methods include using teachable moments opportunities when the practice team can share information that will increase parents understanding about their young child and about their roles as mothers and fathers The issue of maternal depression is addressed by helping clinicians both recognize depression and encourage its treatment In the Healthy Steps approach an important member of the pediatric or family practice team is the Healthy Steps Specialist That specialist is a nurse child development expert social worker or other pro fessional who is particularly capable of sharing child develop
70. rol Panels from the drop down Apple menu then Appearance then Appearance again Set the appearance to Apple Platinum and choose blue or grey for your Highlight Color and Variation Installing the CD ROM Select the disk that is appropriate for your computer s operating system One CD ROM is for use in Macintosh systems the other is for PCs Put the Healthy Steps CD ROM disk in your CD ROM disk drive and watch your screen The disks include an automatic installation pro gram On the PC follow on screen directions On the Mac double click on the Healthy Steps CD ROM desk top icon and then on the Healthy Steps Installer folder Technical Assistance If you experience difficulty with installing or using the CD ROM first check that your computer meets the technical requirements for the program Then close all other programs including Healthy Steps Start Healthy Steps again and see if you experience an improvement If you are still having difficulty call 1 800 727 2470 The Healthy Steps Interactive Multimedia Training amp Resource Kit Getting Started Once you have completed the installation look for Healthy Steps in your Program directory When you click on Healthy Steps the program should start automatically Healthy Steps will play most efficiently if all other programs on your computer are closed You will first hear a whirring sound on your CD ROM drive as the machine prepares to read the disk You will kno
71. s approach practices are encouraged to take advan tage of opportunities for face to face training with members of the Boston University School of Medicine Healthy Steps Training Team For further information on how such a program can be tailored to your needs contact Healthy Steps Attention Margaret LaVoye MAT Building 5th Floor Boston Medical Center 1 Boston Medical Center Place Boston MA 02118 Telephone 617 414 3665 The video can be useful as part of a group workshop on a particular subject whereas the CD ROM is more of a resource that you would use individually 1 P w CD ROM USER GUIDE Technical Requirements For PCs e Windows 95 Operating System or later 166 Pentium II Processor with MMX 32 MB RAM 16 MB hard drive space 8x CD ROM Sound Blaster compatible sound card with speakers e SVGA video card e Color monitor capable of supporting 256 colors Hint To maximize color compatibility with the Healthy Steps program from the Start menu choose Settings then Control Panel then Display then Appearance Select Windows Standard from the drop down menu under Scheme and dark blue under Color For Macintoshes e Macintosh OS 7 6 1 or higher PowerPC Processor 604 optimum e 32 MB RAM e 16 MB hard drive space e 8x CD ROM 256 color monitor Hint To maximize color compatibility with the Healthy Steps program select Cont
72. s statement with a parent who is worried about a toddler who is not eating 9 How would you characterize Mr and Mrs Gibbs s approach to discipline How would you help them find some strategies that are comfortable for both of them 10 How would you help parents establish limit setting goals for their toddler 11 What does ghosts in the nursery mean Give an example of how this issue might affect a family with whom you are working 1 2 In meeting with Ms Bishop Margot Kaplan Sanoff relates the struggles of parenting a toddler to those of parenting an adolescent What does she mean Unit 6 Teachable Moments The Toddler Years GAUGING A CHILD S DEVELOPMENT Healthy Steps uses a variety of developmental checkups to help parents understand their HEALTHY STEPS Overview young child s growth and development The use of these checkups has two purposes to stimulate ways of discussing children s development and behavior with their mothers and fathers and to screen for potential developmental problems The video in this unit presents five checkups that Healthy Steps practices can use to gauge a child s development the Brazelton Neonatal Behavioral Assessment Scale NBAS the Temperament Scale BABES Behavioral Assessment of Baby s Emotional and Social Style the Denver II Developmental Screening Test and the MacArthur Communicative Development Inventory The CD RO
73. se and try to think like your 12 month old What are danger You may print the list of available resources by clicking on Print Printing Resources To print the actual resources you must be in Adobe Acrobat This program will activate as soon as you click on Open for a particular resource Printing in Adobe Acrobat is similar to printing from other Word Processing and Graphics software Click on File on the upper menu bar and then select Print from the drop down menu Closing Adobe Acrobat You close Adobe Acrobat the same way in which you would close other Word Processing or Graphics software click on the X in the upper right hand corner or select Exit from the drop down menu under File Hint 1 If you want to view several resources in a row close each individual file when you com plete your review of it but keep Adobe Acrobat open This will save loading time Hint 2 You can return to the Healthy Steps screen from Adobe Acrobat by pressing Alt Tab Exiting the CD ROM You can exit the program at any time by clicking on Exit on the right end of the lower menu bar The pro gram will always ask you Do you really want to Exit Accessing Your Normal Operating System While Using the CD ROM You can access your regular computer screen by pressing Alt Tab You need to do this after each use of a Resource in Adobe Acrobat ee Aj OO nt we eae nn j z gt i ee w lt eee E aie
74. se your judgment 9 Anita Berry conducts part of the Denver II Developmental Screening Test while she is visiting the Kohls What are your observations of Cassidy Kohl s development How would you discuss your impressions with her parents 10 One function of Healthy Steps is to help mothers and fathers understand their own goals for their child s behavior Where do you see this occurring in the video and what else might you have done in similar circumstances 11 What would you do if you went on a home visit and noticed clear signs of smoking in the household even though you had been told that no one smokes 1 2 What are the advantages of seeing all members of the family together Unit 4 Healthy Steps Home Visits av HEALTHY STEPS Unit Overview T EACHABLE MOMENTS HE FIRST YEAR The concept of teachable moments is at the heart of the Healthy Steps approach and is a major aspect of providing enhanced well child care This unit focuses on the skills of recog nizing and using teachable moments and provides numerous examples of its application with children from birth to 12 months Unit 6 addresses teachable moments with toddlers The overriding theme of the unit is that all behavior has meaning and that clini cians and parents shared observations of children s behavior create teachable moments instances when clinicians can draw on their observations of the child s actual behav ior to
75. setts STEVEN PARKER M D Pediatrician Boston University School of Medicine TERESA WILSON R N Healthy Steps Specialist Cornell Medical Associates New York City BARRY ZUCKERMAN M D Pediatrician Boston University School of Medicine The QF cp RoM CLINICAL STRATEGIES Creating Teachable Moments gt Overview gt Introduction Teachable Moments Anticipatory Guidance Missed Opportunities gt Using Teachable Moments Techniques Creating Teachable Moments Finding Teachable Moments gt Teachable Moments in the Office At a One year Visit gt Teachable Moments from Birth to Three Newborn 4 Months 12 Months 1 Month 6 Months 2 Months 9 Months The key sections of the CD ROM that relate to this unit are listed below gt Case Studies gt Related Reading gt How Children Cope Self regulation Mutual Regulation p gt Case Studies gt Related Reading a CHILD DEVELOPMENT amp BEHAVIOR The First Year __ aT MILESTONES FROM BIRTH TO THREE gt Overview gt Early Brain Developemnt p f 3 5 Days 2 Months 9 Months gt Concepts in Child 2 Weeks 4Months 12 Months Development 1 Month 6 Months Endowment een i RESOURCES Clinical emperamen k Ch k Shi gt Developmental Processes Ouch Cheers Motor Control RESOURCES Family Communication Skills LINKletters Parent Prompt Sheets Parent Handouts Child Health and Development Record Social Development Cognitive Development Review o
76. strate the use of the Denver II Developmental Screening Test to assess a child s development in four domains gross motor skills language devel opment fine motor adaptive skills and personal social skills gt Explain to parents how to use the MacArthur Communicative Development Inventory to gauge children s emerging language skills and help them develop additional vocabulary gt Provide examples of how the Healthy Steps team gives bad news to mothers and fathers stressing the ongoing support available from the Healthy Steps team The Healthy Steps Interactive Multimedia Training amp Resource Kit Key Concepts gt The NBAS is a running dialogue between the clinician and the mother and father about the baby s behavioral and neurological response to the people and events in his or her environment The clinician should conduct at least one assessment in each of the following clusters response decrement state range and regulation motor organization neurological response social organization and physiological regulation Note that administration of the NBAS is a key first step in developing a relationship with the family instilling confidence in the mother and father and helping the parents under stand the innate temperament of their new child Healthy Steps Specialists unless they are specially trained and certified typically use a modified version of the NBAS that takes 10 to 15 minutes to administe
77. t and Disability University of Washington School of Nursing Howard Berman President and Chief Executive Officer Finger Lakes Blue Cross and Plue Shield Rochester Laurel Cutler Member Board of Directors Fallon McElligott Robert Haggerty M D Professor of Pediatrics Emeritus University of Rochester School of Medicine David Heppel M D Director Division of Maternal Infant Child Care and Adolescent Health Maternal and Child Health Bureau U S Health Resources and Services Administration Matthew E Melmed Executive Director Zero to Three The National Center for Infants Toddlers and Families Robert J Nolan M D Department of Pediatrics University of Texas Medical School Scott Serota Executive Vice President and Chief Operating Officer Blue Cross Blue Shield Association Chicago James A Stockman III M D President The American Board of Pediatrics Tom Tonniges M D Director Department of Community Pediatrics American Academy of Pediatrics Healthy Steps National Advisory Committee Margaret E Mahoney Chair Howard Berman T Berry Brazelton Peter Budetti Katie Couric Barbara A DeBuono Fernando Guerra Robert Haggerty Myron A Hofer Judith B Igoe Nancy Kassebaum Baker David Lawrence Charlene Rydell Ruth J Simmons Edward Zigler Healthy Steps Professional Development Opportunities Users of the Healthy Steps for Young Children Interactive
78. tal Chicago CATHY RUTMAN R N Healthy Steps Specialist ABC Family Pediatricians Allentown Pennsylvania MICHAEL SCHWARTZ M D ABC Family Pediatricians Allentown Pennsylvania e SILVANA SHLIAPOCHNIK M D Family Physician Advocate Ravenswood Maternity Family Health Center Chicago e BARRY ZUCKERMAN M D Pediatrician Boston University School of Medicine The Overview on the CD ROM is the key section to review The Overview will play automatically the first time you use the CD ROM Thereafter you can access this section by clicking on the word Overview on the bottom menu bar The Healthy Steps Interactive Multimedia Training amp Resource Kit Questions 1 What makes Healthy Steps different from other approaches to primary for care for children Discussion and 2 What are the seven key strategies of Healthy Steps Reflection 3 What are some of the advantages that parents see in a Healthy Steps practice 4 What are some of the advantages that physicians see in a Healthy Steps practice 5 How do Healthy Steps clinicians view their relationship with mothers and fathers 6 What is the role of the Healthy Steps Specialist and why is the addition of this individual important in a Healthy Steps practice 7 Child development specialist Margot Kaplan Sanoff says that Healthy Steps offers parents many venues in which they can talk about issues that are of concern to them What are some o
79. they want to get out of the visit Why is this collaborative agenda setting important 9 What strategies do you see used for providing parents with answers to their questions 10 In the video pediatrician Steven Parker says that he thinks it would be very difficult to fulfill the goals of Healthy Steps without a Healthy Steps Specialist What do you think the Healthy Steps Specialist adds to a practice 11 What do you think parents gain from a Healthy Steps enhanced well child visit that might not be possible from a more traditional well child visit 1 2 What do you think the physician gains from this arrangement that would not be a product of a traditional well child visit Unit 3 The Healthy Steps Office Visit HEALTHY STEPS HOME Unit Overview a HEALTHY STEPS VISITS Healthy Steps home visits provide a special opportunity for the Healthy Steps Specialist to get to know mothers fathers and children in an informal and relaxed atmosphere apart from the medical office Such visits typically present numerous teachable moments allow time to conduct a variety of develop mental checkups and offer many opportunities to provide anticipatory guid ance Home visits supplement the guidance on development and behavior that is given at office visits and strengthen the relationship between the family and the practice During infancy home visits typically focus on general health n
80. timedia Training amp Resource Kit Questions 1 What are some advantages of home visiting for both the practice for and the family Discussion and 2 Who will conduct home visits in your practice 3 What home visit schedule will your practice follow How will you determine the particular needs of specific families with regard to home visits 4 How will you ensure the safety of staff members who conduct home visits and how will everyone s whereabouts be communicated within the practice 5 Although Mrs Tejada seems to be breast feeding quite successfully some mothers need assistance in this area Is a lactation specialist associated with your practice If not what community resources can you recommend to a mother who needs information about and support for breast feeding 6 Mrs Tejada seems quite attuned to the possibility of postpartum depression and talks easily with Jennifer about her feelings How might you encourage a mother who is less verbal than Mrs Tejada to discuss this issue What signs of depression would you look for What resources are available in your community to help a depressed parent 7 What behaviors do you observe on the part of the Healthy Steps Specialists in this video that indicate their respect for the families they are visiting 8 From your observations of the families in these home visits how typical do you think these days are for the families involved On what observations do you ba
81. tly today In what way 6 Dr Kaplan Sanoff describes a sometimes statement as a way of laying out the options in a particular situation Imagine that a child disclosed to you that he or she had seen Daddy hit Mommy and you were about to discuss this revelation with the mother Frame a sometimes statement 7 If parents came to you with their concerns about the effects of their upbringing on their own parenting style how would you respond 8 Some Healthy Steps Specialists find it difficult to ask parents to stop smoking even though it is in their child s best interest that they not smoke What questions might you ask to determine a parent s stage of change If you determined that the parent was in the contemplation stage what actions could you take to move him or her to action 9 What signs would you look for to determine whether a parent is depressed How would you differentiate between a new mom with baby blues and a clinically depressed woman 10 Suppose you were working with the family described at the end of the video Identify the various family factors that you see in this situation and brainstorm possible ways of responding 1 1 Under what circumstances might it be appropriate to meet with members of the extended family or key adults in a child s life other than the parents 12 What is the status of your community referral book How comprehensive is it How current is the information W
82. toddler years What are some of the reasons he gives Why do Discussion you think this is such a critical time in the relationship between the practice and and the family Reflection 2 How does Healthy Steps Specialist Cathie Clark get Jordan Newton s mother to talk about what she does when she needs a break from Jordan s persistent behavior How else might you have tried to get Mrs Newton to talk about some of the stresses of parenting a toddler What are some other strategies you might have recommended to Mrs Newton for days when being the parent of a toddler is really tough 3 Mrs Newton says she distracts Jordan by telling him to look for his sister or dad Suppose she had said instead I put him in a playpen and I go to my bed room or If he won t stop when I tell him to I spank his fanny What would you consider before responding How would you respond 4 From what you can see of Jordan s behavior what can you say about his development 5 What is Cathie Clark s role during Dr Whistler s medical examination of Jordan 6 How does Dr Whistler reframe Jordan s persistent behavior in positive terms 7 How would you respond to a parent who says My child is into everything all the time He is driving me crazy 8 In the scene with Tricia and Margot Kaplan Sanoff Dr Kaplan Sanoff uses a sometimes statement to probe why Tricia yells at her daughter How would you use a sometime
83. ttachment Biological Effects on Attachment Scenes from the Nursery gt Child Child Relationships gt Influences on Relationships Ghosts in the Nursery The Extended Family Other Influences P Case Studies gt Related Reading The Healthy Steps Interactive Multimedia Training amp Resource Kit Questions 1 What do you fear most about discussing difficult or sensitive issues with a for family How realistic is your fear How can your colleagues help you overcome it Discussion and 2 In the video Dr Zuckerman talks about the limitations of a biomedical model Reflection How does this concept apply to Healthy Steps Facilitator s 3 The video shows a Healthy Steps team talking about difficult cases and how to Note respond to them How could you create such a team meeting in your practice In addition to the What are the advantages of approaching family factors in this way questions here the case studies on the 4 What kinds of clinical support are available to the Healthy Steps Specialists in CD ROM may be your practice used to stimulate pa 5 In the video Dr Kaplan Sanoff says that it often strikes me that when parents want us to know something they will sometimes figure out a way to tell us What experiences have you had in which you learned something about a family in an indirect way Did you recognize the significance of the situation at the time How did you handle it Would you handle it differen
84. utrition breast feeding sleep and strategies for comforting babies As the child grows the emphasis typically shifts to home safety issues of toddler autonomy and managing such behavioral and developmental concerns as limit setting early learning and stimulation eating and toilet training Unit Objectives After viewing the video and completing the related CD ROM sections users should be able to gt Provide a rationale for med ical practices that serve young children to offer home visits P Differentiate home visits from office visits in terms of goals tim ing agendas and strategies gt Describe an ideal schedule for home visiting and tell why they have chosen it gt Identify ways in which a Healthy Steps Specialist can support the continuation of breast feeding B Explain why 9 month and 24 month home visits are impor tant in terms of the developmen tal changes that children are poised to undergo at these points and discuss the related adjust ments in parent thinking and behavior that may be needed p gt Use Quick Check Sheets to prepare for a home visit B gt Describe strategies that a Healthy Steps Specialist might use to help mothers and fathers identify their own goals for their child s behavior and how they will achieve them B gt Model behaviors that parents can use to guide and set limits for their child gt Demonstrate how a Healthy Steps Specialist might co
85. w the program is starting when you hear the Healthy Steps theme music You can exit from this screen at any time by clicking anywhere on the screen Sign in Screen The purpose of this screen is to create a file that saves your personal notes The notes will be saved to the hard drive of the computer on which you are working To access them in the future you need to work on the same computer Alternatively you can transfer your Notes file to a floppy disk and use it on other computers The file will have the name you used to sign in First Use On your first use select New User Enter your First Name Press Tab Enter your Last Name Press Enter You may choose to use initials or an identifying code in place of your name You will see two other options on the New User screen Return will take you back to the Sign in screen Use this option if you have made an error and want to start again or realize that you already have a file started Exit will cause you to leave the program entirely If this is your first time using the program once you press Enter the Overview will start immediately Subsequent Uses On subsequent uses when the Sign in screen appears choose Current User This will bring up a list of indi viduals whose files are stored on the hard drive of the computer on which you are working Click on your name or the identity you have chosen Click on Enter This will take you directly to the Main Menu
86. with Stephanie Emmons and her two children ages nine months and two years What teachable moments do you observe in this scene How would you take advantage of them 8 What are the three most likely developmental issues to come up at the following visits two months six months nine months twelve months 9 What would you expect to be the key teachable moments in a four month old s well child visit 10 How would you encourage parents to sup port a child s emerging independence toward the end of the first year What anticipatory guidance would you give 11 How can you create situations in which teachable moments will emerge 12 In thinking about your clinical interactions over the last few days cite some examples of teachable moments that you took advantage of and some missed opportunities to do so Unit 5 Teachable Moments The First Year HEALTHY STEPS Unit Overview sy EACHABLE MOMENTS HE TODDLER YEARS This unit extends the concept of teachable moments to the toddler years It provides a basic understanding of the big issues that parents of toddlers face autonomy separation power and control and shows how these issues are played out behaviorally in everyday events The unit also addresses how clinicians in developmentally oriented practices help mothers and fathers understand toddlers behavior in developmental terms and use effective and developmentally appropriate
87. you turn for personal guidance and support if you were working with a family that was faced with a particularly challenging situation 10 What strategies do Dr Silvana Shliapochnik and Healthy Steps Specialist Catalina Ariza use to help the Ortega family anticipate the effects of a new sib ling on 15 month old Nashla In what areas do they provide anticipatory guid ance What effects might you anticipate in addition to the ones discussed 11 Have you explored the availability of parent groups currently offered in your community 12 How can your practice provide lactation consultation 13 Why is it important to set an agenda collaboratively with parents during well child and home visits 14 How would you explain temperament and goodness of fit to a family 15 What Healthy Steps strategies does Scott Governo use to provide information and support to the Jeter family Unit 8 Supporting Families Challenging Times Challenging Situations FAMILY FACTORS am AFFECTING CHILDREN SMOKING DEPRESSION VIOLENCE AND ADDICTION Unit This unit focuses on family factors that have the potential to impact negatively on a child s Overview health and development The two overriding themes of the unit are that healthy child development depends on many factors at least some of which concern parental behavior and that developing a caring and supportive relationship between the Healthy Steps team and mothers and fathers
88. ypical toddler issues include activity repetition interest in genitals toilet training limit setting consistency among caregivers biting the effect of new siblings on behavior issues of independence and control the need for reassurance and parents adjustment to the end of infancy p gt Using teachable moments can help parents understand typical developmental changes reframe a child s challenging behavior in positive terms increase parents confidence help parents understand why they make certain parenting choices help parents articulate their goals and improve the good ness of fit between a child s temperament and the parents expectations gt Not every teachable moment needs to be addressed immediately Sometimes it is better to think about a situation consult with colleagues and wait for an opening to come up again It almost always will if the issue is important to the mother and father The Teachable Moments The Toddler Years Length 17 15 Video The video features four stories The first segment shows a 24 month well child checkup and is an excellent illustration of teamwork between a physician and a Healthy Steps Specialist In this visit oy the child s behavior and the mother s comments provide numerous opportunities for teachable lt moments The second segment shows part of a well child visit in which the Healthy Steps Specialist is following up with a mother on an issue that had arisen earlier in t

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