Health Promotion

Our Community Impact: A Conversation with Dr. Paul Dworkin

Paul-Dworkin-7501.jpgPaul H. Dworkin, MD serves as executive vice president for community child health at Connecticut Children’s, director of Connecticut Children’s Office for Community Child Health, and founding director of the Help Me Grow National Center. Dr. Dworkin is also a professor of pediatrics at UConn School of Medicine. This interview on Connecticut Children’s community impact was first published in the latest Connecticut Children’s Community Benefit Report, which you can read here.

Describe the role of the Office for Community Child Health in Connecticut Children’s community impact approach.

Dr. Dworkin: We formed the Office for Community Child Health (the Office) to be very mindful of the importance of Connecticut Children’s as a critical community resource. It is imperative that we are seen as a valuable resource in addressing the many challenges that confront the community in which we reside. We cannot address critical needs unless we know what the community priorities are. Our Community Health Needs Assessment, which is a requirement of the IRS, is an extremely important tool to ascertain the needs of the Hartford community. We are very fortunate to have the Office, which is responsible for assessing community priorities through the Community Health Needs Assessment, developing community-oriented solutions to address identified needs, and reporting progress through our annual Community Benefit Reports.

What are the current and future priorities of the Office?

Dr. Dworkin: We think about our work as encompassing local and regional initiatives of statewide and national significance. At the local level in Hartford, we are strongly committed to furthering place-based initiatives, which provide support to targeted neighborhoods. In the south end of the city, Connecticut Children’s Healthy Homes Program and the Southside Institutions Neighborhood Alliance (SINA), which is a partnership between Connecticut Children’s, Hartford Hospital, and Trinity College, primarily facilitate this work. One example of a place-based initiative is our Building for Health program, in which Healthy Homes and SINA collaborated with local utilities and other community partners to launch a cross-referral program where each partner can
refer families to the other partners for needed services. In the north end of the city, we participate in the North Hartford Triple Aim Collaborative to bring our programs to scale and impact there. This work enables efforts like the Promise Zone to achieve their potential in addressing the priorities and needs of residents living in some of
the most challenging neighborhoods in the city.

At the state level, we are committed to enabling the work of such agencies as the Office of Health Strategy, the Department of Social Services and Medicaid, the Department of Housing, the Office of Early Childhood, and the Department of Public Health in promoting well-being. The State Innovation Model (SIM), which includes primary care modernization and Health Enhancement Communities as key initiatives, guides our
work with these agencies. The State’s Health Enhancement Community effort has set two priority aims to 1) improve child well-being in Connecticut, pre-birth to age 8 years, to assure all children are in safe, stable, and nurturing environments; and 2) improve healthy weight and physical fitness for all Connecticut residents.

At the national level, we are committed to maintaining our very strong engagement with federal agencies primarily, but not exclusively, through the Help Me Grow National Center, which works to promote the development of early childhood comprehensive systems around the country.

You have long advocated for a child-first approach to healthcare reform. Can you provide more information about the Office’s ongoing advocacy in this area?

Dr. Dworkin: Since the passage of the Affordable Care Act, we have been mindful of the triple aim of healthcare reform, which is to improve the health of the population, improve the quality of healthcare services, and decrease healthcare costs. So far, healthcare reform efforts and payment reform efforts have been primarily, although not exclusively, driven by what we refer to as the “relentless pursuit of scorable savings.” Children and children’s healthcare typically do not constitute huge expenses, so there
are limited opportunities for cost savings. Because of that, child health services transformation has not been a priority in healthcare reform in general.

The state of Connecticut, through its Office of Health Strategy, has taken the bold step of prioritizing child well-being as a key priority within the State Innovation Model, as exemplified by its effort to promote Health Enhancement Communities, which provide funding for targeted interventions in select communities to improve community health and health equity and prevent poor health outcomes. We completely support this approach and believe that transforming child health services should come early, rather than late, in the process.

We have access to the population that needs to be served through child health services transformation since the vast majority of children visit child health providers, including pediatricians. Also, we know the innovations and the interventions that can be implemented to promote children’s optimal health, development and well-being and achieve both the short- and long-term outcomes we seek. In addition, child health services transformation and the implementation of these interventions and innovations are not nearly as expensive as interventions often needed across the lifespan.

We have advocated for a child-first approach to health services transformation that can demonstrate success and inform healthcare transformation across the lifespan. The state model calls out the opportunity to prioritize child health services transformation as a key step in healthcare reform efforts. We are committed to collaborating with the state in ensuring that this approach is successful. We know that if we intervene and promote children’s optimal health, development and well-being there will be large savings but they accrue over many years to decades. We need to place a priority on those long-term savings and be patient enough to wait. The savings will be there and the benefits to society will be there.

In the last year, multiple national experts presented at Connecticut Children’s about the housing and health connection. Where do you see the Office’s work in this area evolving to in the near future?

Dr. Dworkin: Our Healthy Homes program, which has been around for decades, has long done outstanding work. For many years, its focus was on identifying homes where children were exposed to dangerous levels of lead and performing lead abatement to hopefully minimize, if not eliminate, the problem of lead poisoning. Over those same years, we have come to appreciate how even what were once viewed as relatively low
levels of lead are still dangerous.

In addition to lead abatement, Healthy Homes has also been able to address other issues. Such issues include mold and mildew that may contribute to asthma, as well as unsafe structures that may contribute to injuries particularly among children with disabilities. We have now come to appreciate that housing is a critically important sector in supporting families and enabling families to strengthen their children’s optimal health, development and well-being. Housing is also a critical sector in our comprehensive,
integrated, cross-sector approach to promoting the best outcomes for children.

We recently restructured and recruited new leadership to our Healthy Homes program. This refocusing of Healthy Homes supports the program in evolving toward not only addressing health issues in the home, such as lead, mold, mildew, and dangerous windows or stairwells, but also addressing any other housing structural factors that pose a risk to children and families.

In addition, we recognize that while healthy housing is extremely important, we also need to think more broadly about housing security and housing stability, which are proven to impact health outcomes and well-being. Healthy Homes is an effective vehicle through which to collaborate with community-based agencies to address issues of housing stability and security. We know the impact of stable housing on families and children’s development. We anticipate Healthy Homes continuing to grow not only in the work that it undertakes supported by grants and state bond dollars, but we also see Healthy Homes increasing its partnering with community-based organizations to ensure that housing is healthy, stable and secure.

Read more articles on the Advancing Kids Blog related to health promotion here.

Our 2019 Community Health Needs Assessment will guide our community benefit work for the next three years. What do you see as the Office’s role in addressing needs identified in the report?

Dr. Dworkin: The Community Health Needs Assessment is so helpful in identifying critical priorities as defined by the community. It is our responsibility to make sure those needs are known to all of our partners in our community child health work, including programs within Connecticut Children’s Office for Community Child Health as well as across Connecticut Children’s and its leadership. These needs should inform the activities
and direction of Connecticut Children’s as a whole, so we really see the Community Health Needs Assessment as helping us to set the agenda for our community work at the level of the Office and the organization for the next three years.

Access additional Connecticut Children’s Community Benefit Reports here.

To sign up to receive E-Updates from Connecticut Children’s Office for Community Child Health, click here.

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