Launching the Childhood Obesity Action Network for Clinicians
Between December 2005 and March 2007, a project team at the National Initiative for Children's Healthcare Quality (NICHQ) in Cambridge, Mass., worked to create a learning network aimed at accelerating clinical improvements in the prevention and treatment of obesity in children.
To develop the network of clinicians, researchers, public policy experts and others interested in combating childhood obesity in the health care sector, NICHQ:
- Held a "Health Care Summit on Childhood Obesity" on September 19, 2006, in Washington, D.C., which drew 91 people, representing 70 organizations.
- Held a "National Congress on Accelerating Improvements in Childhood Obesity" on September 20, 2006, which drew 265 people, primarily doctors and nurses.
- Sought best practices in clinical care through an awards competition and coordination with an expert committee from a collaboration of the American Medical Association, the federal Health Resources and Services Administration and Centers for Disease Control and Prevention.
- The national initiative launched the Childhood Obesity Action Network in June 2007. A total of 350 people signed up for the network before the official debut.
- From 85 applications submitted for the awards competition for innovative programs in childhood obesity, the project team selected three winners and produced a short DVD highlighting each.
- The project team created and disseminated a set of findings and policy recommendations for combating childhood obesity.
- By January 2007, project staff had raised $425,000 to continue the work of the network.
The Robert Wood Johnson Foundation (RWJF) supported the project with a grant of $505,245.
During the past three decades, the rate of childhood obesity has more than doubled for children aged 2 to 5 and youth aged 12 to 19, and more than tripled for children aged 6 to 11 (Institute of Medicine, Preventing Childhood Obesity: Health in the Balance, 2005). More than nine million children and youth over age 6 are obese, according to the report.
Most recent national efforts to address the childhood obesity epidemic have focused on sectors other than health care, such as schools or the "built environment," such as access to recreational facilities and safe neighborhoods. ("Childhood Obesity: What's Health Care Policy Got To Do With It?", Health Affairs, 26(2). Available online.)
According to the National Initiative for Children's Healthcare Quality, locally, clinics and health settings are tackling the problem, but staff members often operate in isolation, with little knowledge of what others are doing and few opportunities to share lessons learned. Lack of communication among these groups leads to the duplication of guidelines, tools, training materials and measurement strategies.
RWJF is committed to tackling one of today's most pressing threats to the health of children and families—childhood obesity. The goal is to reverse the childhood obesity epidemic by 2015. Projects and programs funded by RWJF work mainly in schools and communities, where the goal is to improve access to affordable, healthy foods and to opportunities for physical activity.
RWJF places emphasis on reaching children at greatest risk: African-American, Hispanic, Native American and Asian/Pacific Islander children living in low-income communities.
RWJF has a three-pronged approach to halting the increase in childhood obesity:
- Building the evidence regarding what works to promote healthy eating and to increase physical activity among children.
- Testing innovative approaches in order to spread promising models.
- Educating leaders and investing in advocacy strategies.
In addition, during the early phase of program development, the Childhood Obesity Team identified a set of limited but strategic investments to engage the health care sector in addressing childhood obesity. The team wanted to drive quality improvement through better assessment and referral of children who were obese or at risk of becoming obese, including the development of baseline surveys to measure quality of care.
Charles J. Homer, M.D. M.P.H., a pediatrician and professor at Harvard University, launched the National Initiative for Children's Healthcare Quality (NICHQ) in 1998 to promote improvements in evidence-based clinical care and equity in outcomes for children with chronic medical conditions, including obesity, asthma and attention deficit hyperactivity disorder (ADHD).
Beginning in 2005, a project team with the national initiative undertook a number of activities to create a learning network made up of medical researchers, clinicians, public policy experts and medical guideline developers—all working to improve the quality of obesity-related health services for children.
Project staff members envisioned using NICHQ's existing Web site to disseminate information on clinical best practices in a variety of ways, including discussion boards, online faculty office hours, implementation guides, national meetings and conference calls. They also planned to create regional subnetworks as part of the national network.
Building the Network
To build the network, the project team, with guidance from a steering committee, planned:
- A one-day strategic summit for representatives of organizations with an interest in addressing childhood obesity in a clinical setting.
- A one-day educational congress for front-line providers, primarily doctors and nurse practitioners.
In preparation for the summit and conference, two subcommittees directed work to:
- Identify best practices in clinical care for childhood obesity.
- Identify and communicate policy levers that can promote and sustain improvement efforts.
Seeking Best Practices in Clinical Care
To identify best treatment and prevention strategies around the country, the project invited innovative programs in childhood obesity to enter an awards competition and produced a DVD of the three winners.
Project staff also coordinated efforts with the Expert Committee on the Assessment, Prevention and Treatment of Child and Adolescent Overweight and Obesity. The committee was a collaborative effort of the American Medical Association (AMA), the federal Health Resources and Services Administration (HRSA) and the federal Centers for Disease Control and Prevention (CDC) charged with revising medical guidelines on childhood obesity.
The project team received copies of the committee's draft and final recommendations and attended some of the committee's meetings.
The Summit and Conference
The "Health Care Summit on Childhood Obesity," held September 19, 2006, in Washington, D.C., drew 91 attendees representing 70 organizations, including the AMA; American Academy of Pediatrics and American Diabetes Association.
In advance of the summit, representatives from 40 organizations signed an "Act, Share and All Pursue (ASAP) Change Statement" in which they pledged to support efforts to launch a Childhood Obesity Action Network.
The "National Congress on Accelerating Improvement in Childhood Obesity," held September 20, 2006, in Washington, D.C., drew 265 attendees, primarily doctors and nurses. Presentations included the work of the three award winning programs, how to provide culturally competent care to all patients and families and a policy change strategy from the state of Arkansas.
To promote the network and improvement in clinical care of childhood obesity, the project staff:
- Distributed 180 copies of a DVD, Accelerating Improvement in Childhood Obesity: Outstanding Programs of 2006, which showcased the three programs chosen as award winners for work addressing childhood obesity.
- Published a commentary, "Childhood Obesity: What's Health Care Policy Got To Do With It" in the March/April 2007 issue of Health Affairs. The article summarizes recommendations from the health care summit. See Appendix. Abstract available online.
The project reported these results:
- A total of 350 people signed up for the Childhood Obesity Action Network in advance of its official debut in June 2007.
- From 85 applications submitted for the awards competition for innovative programs in childhood obesity, the project team selected three winners and produced a short DVD highlighting each. The winners were:
- Pediatric Overweight Prevention Collaborative, Envision New Mexico, located in Albuquerque, sponsored by the University of New Mexico Health Sciences Center Department of Pediatrics. The obesity initiative links providers with patients. It included a promotional campaign—"Get More Energy, Energy Means More Fun!"—to encourage children and youth to get more physical activity, less television time, five servings of fruit and vegetables and fewer drinks sweetened with sugar.
- Maine Youth Overweight Collaborative tested a model of treatment for overweight children—involving measurement, counseling and education—at 12 pediatric practices. The Maine Chapter of the American Academy of Pediatrics, Auburn, and the Maine Center for Public Health, Augusta, sponsored the program.
- "Overweight Children: A Comprehensive Approach to Address the Epidemic," Kaiser Permanente Northern California, which involved the creation of evidence-based guidelines for treating childhood obesity and training of 500 pediatricians and nurse practitioners.
- Created a set of findings and recommendations with insight from a policy steering committee. They are based on:
- A literature review
- 10 expert interviews
- A review of 20 policy-related submissions for the awards contest
- A review of policy position statements of 30 advocacy organizations
- Information from state Medicaid directors and state chapters of the American Academy of Pediatrics.
They are published in a monograph, Childhood Obesity: The Role of Health Policy, Report to the Second National Childhood Obesity Congress. It is available online. See Appendix for findings and policy recommendations.
- The project raised $425,000 as of January 2007 from the following organizations to continue work begun with the RWJF grant:
- Create a well-honed message to differentiate your project from the myriad efforts aimed at addressing childhood obesity. The project team recruited attendees to the conference and summit because they clearly defined the topic—the health sector's response to the problem—as one that had not received the attention that other initiatives had. (Project Director/Homer)
- Launch an action-oriented, interactive learning network. The project team found that people didn't want to join another static e-mail list. They were excited about the Childhood Obesity Action Network because it included online educational resources, educational conference calls and discussion boards. (Project Director/Homer)
- Build relationships early with those who are experts in addressing the needs of underserved populations. To identify best practices among providers serving low-income populations, the project team built relationships with national experts after the conference and summit, but wished they had done so earlier. They did include one session on the topic at the national congress. (Final Report to RWJF)
- Address the sometimes incongruent missions of national, regional and local groups proactively. The project team found that many grantmaking organizations are focused on local areas so the team redesigned the Childhood Obesity Action Network to include regional special interest groups. (Final Report to RWJF)
AFTER THE GRANT
By June 2008, some 2,200 people, primarily clinicians, had joined the Child Obesity Action Network, according to Project Director Homer.
Terry L. Bazzarre, Ph.D., M.S., senior program officer at RWJF, noted that the National Initiative for Children's Healthcare Quality was "doing a lot to assist physicians and other health care providers to do BMI (body mass index) assessments and refer kids and their families to other supportive services." For example, the initiative:
- Produced and published online an implementation guide, tools and resources to help clinicians implement recommendations by the Expert Committee on the Assessment, Prevention and Treatment of Child and Adolescent Overweight and Obesity, dated January 25, 2007. As of January 2008, there had been more than 2,500 downloads of the guide.
- Hosted a March 19, 2008 Childhood Obesity Congress in Miami. As part of this meeting the Childhood Obesity Action Network will award up to three obesity programs with the 2008 National Recognition Award for Health Care Programs Addressing Childhood Obesity.
- In May 2008, completed and published the monograph, Childhood Obesity: The Role of Health Policy, Report to the Second National Childhood Obesity Congress, Miami, Florida, 2008, which is available online.
GRANT DETAILS & CONTACT INFORMATION
2006 Health Care Provider Congress on Childhood Obesity - Laying the Groundwork for a Learning Network to Improve Clinical Services
National Initiative for Children's Healthcare Quality (Cambridge, MA)
Dates: December 2005 to March 2007
Charles J. Homer, M.D., M.P.H.
Policy Findings and Recommendations on Addressing Childhood Obesity
The project team presented findings and recommendations on addressing childhood obesity at the "Health Care Summit on Childhood Obesity" on September 19, 2006. These are explained in detail in a policy monograph, Childhood Obesity: The Role of Health Policy, Report to the Second National Childhood Obesity Congress, which is available online.
- Front-line caregivers, often in partnership with local communities or health plans, are creating innovative ways to prevent and treat childhood obesity. As a result of limited budgets, however, studies to measure the success of these programs are scarce.
- Not all national health care advocacy organizations identified childhood obesity as a priority. Only 14 of the 30 policy position statements reviewed by the project team had a formal position on childhood obesity.
- In many instances, state governments are addressing childhood obesity through legislation and regulations; however, much of the activity is focused on schools and not the health care sector.
- The health care sector has been slow to address the disproportionate impact of obesity on children from low-income and minority families.
Key Recommendations (selected by Homer)
- Public and private insurers should provide adequate reimbursement to clinicians who provide obesity-related medical care.
- Public and private insurers should share information about reimbursement strategies that encourage practitioners to provide obesity-related care, and thus, influence medical outcomes.
- Through both Medicaid and the State Children's Health Insurance Program (SCHIP), policy-makers and administrators need to ensure that children from low-income families receive adequate medical attention for both the prevention and treatment of obesity.
- Vendors of electronic health information systems should add features that automatically calculate body mass index (BMI), plot BMI results and link to patient registries.
(Current as of date of this report; as provided by grantee organization; not verified by RWJF; items not available from RWJF.)
Homer C and Simpson LA. "Childhood Obesity: What's Health Care Policy Got To Do With It?" Health Affairs, 26(2): 441444, 2007. Abstract available online. From that link, you can view the whole article at Health Affairs.
Childhood Obesity: The Role of Health Policy, Report to the Second National Childhood Obesity Congress, Miami, Florida, 2008. Cambridge, MA: National Initiative for Children's Healthcare Quality, May 2008. Available online.
Audio-Visuals and Computer Software
Accelerating Improvement in Childhood Obesity: Outstanding Programs of 2006, DVD featuring profiles of three programs that address childhood obesity. Cambridge, MA: National Initiative for Children's Healthcare Quality, 2006. To purchase the DVD, email NICHQ at email@example.com.
World Wide Web Sites
www.nichq.org/online_communities/coan. This Web site was created as a clearinghouse of information for members of the Childhood Obesity Action Network.
Report prepared by: Linda Wilson
Reviewed by: Kelsey Menehan
Reviewed by: Molly McKaughan
Program Officer: Terry L. Bazzarre