happy children, mother and child, and expecting mother and father

Funded Projects

Grant Status: Active

Grant Title: Connections for Health: Integrated Group and Community Services for Kalihi Valley Keiki and ‘Ohana

Web Site: Kokua Kalihi Valley Comprehensive Family Services Project Exit Disclaimer

Project Director(s):

Doris Matsunaga
Kokua Kalihi Valley Comprehensive Family Services
Honolulu, HI
Phone: (808) 791-9445
Email: dmatsunaga@kkv.net

Problem:

Kalihi Valley residents face systemic cultural, linguistic and socioeconomic barriers to accessing health care, resulting in stark health disparities. KKV will institutionalize culturally-appropriate group visits for prenatal and pediatric care, and foster an enhanced service provider network.

Goals and Objectives:

Goal 1: Empower Kalihi Valley parents to better support their children's healthy socio-emotional development through peer learning and KKV staff mentorship. Objective 1: 100 parents will take part in Baby's First Year support groups by the end of Year 5. Objective 2: At least 80% of regular participant parents will report one or more of the following: increased confidence in their own ability to care for their child(ren); improvement in family protective factors; and a stronger support network; Objective 3: At least 75% of regular participants will demonstrate increased parent-child nurturing behaviors (as measured through staff observation). Goal 2: Streamline Kalihi Valley families' access to health, legal and social services through collaboration with key agency partners. Objective 1: 200 children will access screening, education or clinical services provided by KKV at Linapuni Elementary School by the end of Year 5. Objective 2: 80% of Linapuni students will have a medical home by the end of Year 5. Objective 3: By the end of Year 5, late enrollment due to medical reasons will decrease by 25%. Goal 3: Improve families' access to health care and parents' skills and confidence by implementing medical group visits for prenatal and pediatric care. Objective 1: 120 families will take part in prenatal group visits by the end of Year 5. At least 80% of families will express satisfaction with the services received, and 80% of CP participants will report and demonstrate increased knowledge and confidence levels regarding pregnancy, childbirth and parenting. Objective 2: 50 families will take part in pediatric group visits by the end of Year 5. 80% will report feeling more comfortable talking with their medical provider about their children's health and development. Participation and no-show rates will compare favorably with standard well-child visits. Objective 3: 80% of regular Pediatric group visit parent participants will report and demonstrate increased knowledge and confidence levels regarding child development, nurturing and attachment, and/or care for common childhood illnesses. Goal 4: Increase medical providers' capacity to provide culturally-competent health care. Objective 1: 20 Peds Residents will learn from KKV's multicultural staff by the end of Year 5. 20 Peds Residents will engage in community gardening and/or reforestation efforts, working alongside community members, at Ho‘oulu ‘Aina by the end of Year 5. Objective 2: At least 75% of residents will demonstrate increased cross-cultural competency including the ability to work with medical interpreters. Objective 3: Increase UH Pediatrics Residency Program's capacity to promote a more comprehensive perspective on health. Goal 5: Build collaboration and capacity among Kalihi area health and social service providers. Objective 1: Representatives of at least 4 agencies will participate in quarterly Advisory Board meetings. 80% of Advisory Board members will feel they have gained knowledge on community health issues and enhanced opportunities for collaboration. Objective 2: Group medical visits will be institutionalized at KKV. Objective 3: Health education, screening and/or clinical services will be institutionalized as part of the Linapuni One-Stop-Shop.

Methodology:

KKV will continue to pilot the evidence-based CenteringPregnancy(R) (CP) model for prenatal group visits, with cohorts of 8-10 women meeting monthly for 10 sessions, including one or two on postpartum. KKV will subsequently implement in phases an evidence-based model for pediatric group visits. Objective 3: Streamlining Health and Social Services. KKV is working with partners to establish a "One-Stop-Shop" for health, legal and social services at Linapuni Elementary. KKV will pilot activities to make health services accessible at the school, such as screenings or awareness days; health related trainings, and parent-led activities. Objective 4: Provider Training on Cultural Competence and the Social Determinants of Health. Students in the UH Medical School's Pediatrics Residency Program will participate in educational sessions with KKV's multicultural staff and land-based healing activities at Ho‘oulu ‘Aina. Cultural competency and social determinants of health concepts will be added to the PRP's Community Pediatrics rotation curriculum.

Coordination:

American Academy of Pediatrics, Hawaii Chapter share best practices. Maternal Child Health Branch & Title V; advocacy and support via Advisory Board. Lei Hipu'u Leadership Council serve as the HTHPC Advisory Board, with members from groups such as: Linapuni Elementary School; Medical-Legal Partnership for Children; Parents and Children Together; Hawaii Early Childhood Comprehensive Systems program; Hawaii DOH Public Health Nursing Branch and, UH Schools of Nursing and Medicine.

Evaluation:

The Project Coordinator will track project outputs. Evidence-based tools including those provided by the CP curriculum will be used to assess qualitative group visit outcomes (e.g. patient knowledge and confidence). The Protective Factors Survey maybe used as pre- and post-measures of parents' nurturing attitudes and behaviors. Observation will also be used to assess changes in participant behavior and attitudes over time. Clinical services will be monitored by KKV's Quality Assurance program.

Experience to Date:

1) In 2015 HTH Family Strengthening programs have emerged as an vital part of the KKV services to families. The `Ohana Play and Learn (OPL) waiting room is well used by families waiting for appointments. The Peer Educator models appropriate play and learn activities for parents to encourage them to play and read with children. This room has become a "safe heaven" and drop-in, for parents who are isolated or facing domestic challenges. 2 )A play and learn is also held in PEDS clinic. It is a mini version of the OPL.3 ) A play and learn is held at Linapuni Elementary School 2 times a month for families with children 0-3 years old. A nutritionist provides and demonstrates how to use WIC foods as healthy snacks for kids. Recipes are given to parents.(10 sessions completed) This play and learn is focused on school readiness, health and wellness. 4)The Centering programs continue. Patients report a high satisfaction for these groups. Centering groups will continue in 20165. ) Staff has been working on adapting parent information and producing low-literacy products. In the summer of 2015 an MPH intern did her practicum at MCH and has been hired p/t. Her focus has been on evaluation of Family Strengthening programs6. ) The Healthy Tomorrows Advisory group meets 3 times a year. The HTH Parent Advisory disbanded due to families moving away. However, parent involvement continues through informal 1-1 discussions and Q/A with parents, which seems to be a more comfortable approach.

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