Pittsburgh Collaborative Launches
“Helping Families Raise Healthy Children” Initiative

The demands of caring for infants and young children can easily become overwhelming for mothers, fathers and other caregivers. Feelings of stress, isolation and fatigue are common and normal. But some parents, especially those whose children have special medical or developmental needs, may develop depression. Still others may be depressed before they become parents. Parental depression is a growing problem, but it is not always easy to recognize in oneself, and many parents are not receiving the support and care that they need. As a result, the child’s critical early development and the well-being of the family may be affected.
In Allegheny County, that is about to change. A collaborative of visionary Pittsburghers has developed an initiative that promises to create a new paradigm for the care of families facing the related and often co-existing challenges of parental depression and early childhood developmental delays.
The Helping Families Raise Healthy Children program, developed by a partnership among Community Care Behavioral Health, The Alliance for Infants and Toddlers and the RAND-University of Pittsburgh Health Institute, will offer screening, social support and family-centered services to dual risk families. Community Care, the managed behavioral healthcare organization in Allegheny County, has received a three-year, $500,000 matching grant from the Robert Wood Johnson Foundation (RWJF) to implement the program.
Parental depression and early childhood developmental delays often co-exist in families, but until now these problems have been addressed separately. Helping Families Raise Healthy Children will enhance the care of these families by providing services that recognize and support the early parent-child relationship. Parents who are depressed may be less able to engage their child in a way that facilitates the establishment of a reciprocal attachment that is critical to the child’s growth, health and development. Furthermore, the care of a child with special needs, including developmental delay, can overwhelm vulnerable caregivers and lead to depression.
According to Michele Myers-Cepicka, executive director of the Alliance, maternal depression is a major public health problem. In the general population, 20% of women experience maternal depression but among mothers with young children with developmental delays, the incidence doubles, to 40%. “Maternal depression is increasingly recognized as a risk factor impacting early child development, especially when combined with other risk factors,” says Myers-Cepicka. “It affects the quality of the mother-child relationship and the attachment between them. The child’s development is impacted by that attachment.” Despite this, mothers with children with developmental delays are not routinely screened for depression and children from birth to age three cannot be referred for Early Intervention (EI) services based on maternal depression alone as a risk factor. A major goal of this initiative is to change practice and policy in both of these areas.
The Alliance for Infants is Allegheny County’s Early Intervention Service Coordination Agency. It serves children from birth through age 3 with risk factors for developmental delay, such as premature birth, low birth weight, drug and alcohol exposure, high levels of lead or admission to a Neonatal Intensive Care Unit. The Alliance monitors infants and toddlers at risk for delays and provides referrals to therapy providers for those in need of EI services. With the Helping Families initiative, children can be referred for EI services on the basis of maternal depression alone, even in the absence of other risk factors, and family members can be connected to services for themselves. John Lovelace, Chief Program Officer for Community Care, explains that Early Intervention makes a critical difference. “We know that developmental delay is associated with maternal depression. The earlier that you identify a problem and begin treatment, the better the outcome for the child will be. This is a treatable problem with the potential for very good outcomes.”
The grant is part of the RWJF Local Funding Partnerships Program and is being funded locally by the Highmark Foundation, UPMC Health Plan, Pittsburgh Foundation, Fine Foundation, FISA Foundation and Jewish Healthcare Foundation. According to Donna Keyser, Management Scientist at the RAND Corporation and Project Director for the initiative, Community Care will provide program management and oversight. Staff at the Alliance will be trained to conduct screenings to identify parents with depression, assess family functioning and help them access treatment and support services. All services will be provided within a family-centered context by the county’s early intervention service providers and behavioral health specialists. The RAND-University of Pittsburgh Health Institute will provide training, technical assistance and evaluation support.
The Alliance is offering screenings to any primary caregiver – mothers, fathers, grandparents or relative caregivers. The screenings are voluntary and there is no charge.
“At the Alliance, we have a strong interest in the social and emotional well being of infants and children,” says Myers-Cepicka. “Every baby needs someone to love them, an adult ‘partner’ in their world who will give them a solid social/emotional foundation. Many things can undermine that relationship, including maternal depression. Through this program, our staff will nurture and support that relationship so that the parent can improve their coping skills, relate better to the child, meet his needs and help him develop to his fullest capacity. We believe that when the parent understands the impact that depression has on the child, they will be more likely to seek treatment. For a child with a developmental delay, a loving relationship makes the journey much easier.”
For more information about the initiative, contact Patty Schake, MSW, LSW, Project Manager, Community Care Behavioral Health at (412) 402-7546 or www.schakepl@ccbh.com.

____________________________________________

A Parent’s Guide to Flatfoot

Common sense is a parent’s best medical tool when evaluating the health and wellbeing of children. With some scientific knowledge, your common sense can become more accurate. So, let’s examine some facts, and basic insight about a common pediatric malady, Pes Planus - “flatfoot disorder”.
There are many contributors to this condition and many problems caused by this condition. Therefore, this condition must be recognized early and steps taken toward treatment. The worst expectation is that “the child will grow out of it” - in most cases this is not true and the condition will worsen if not treated.
Normally, children are born without an arch, which develops over the first ten years of life. It’s important to point out that “flatfoot” deformity takes many forms, and that the lack of an arch, is just one manifestation of this condition (usually the mildest). Developmental norms occur at known points in a child’s growth, and are important to understand.
Children are normally born “Bow Legged” and then “Knock knees” are normal at certain points of growth. Acknowledging these stages is important because as the angles at the knee change, so do forces on the foot. When evaluating a child, these changes must be considered.
Most children are very flexible, which allows them to adapt to these changes without issue. But, occasionally, these adaptations lead to abnormal function within the extremity. During development, issues may be caused by other malformations, such as improper spine curvature or one leg slightly longer than the other.
Another consideration is your child’s body mass. Simply put, the heavier your child, the greater risk of adversely affecting the foot’s function. This is just as important if not more, than other factors, and, when associated with poor biomechanics, can quickly perpetuate the problem. The pain, discomfort, and fatigue caused by these issues, can alter the child’s fitness.
Flatfoot commonly presents with the child bearing weight on the inside of the foot, best noted by observing stance from behind. The heels appear to be tilted outward. Also, “knock knees”, and/or an outward pointing of the feet are noted. There may be complaints of pain or discomfort in the feet, knees, hips, or back, and complaints of rapid fatigue while performing activities.
Here, your parental common sense factors in. Observe his/her normal activities, and if they appear to be struggling or “just not right”, there is likely a problem (especially if not progressing as mentioned). At this point the child should be assessed by a specialist. Usually, these issues are treated successfully with shoe gear changes, strength training, custom inserts, and basic education.
If the problem worsens or persists, surgery may be required to restore proper function and prevent further injury. Remember, the sooner the issue is addressed, the less chance that more invasive treatment is needed, and the child can experience activities appropriately and pain free, preventing development into adult issues! When it comes to your child’s health, trust your common sense.
Dr. C. Robert Dushack is a Podiatrist at Pittsburgh Family Foot Care, P.C. For more information or to make an appointment, visit www.pffcpc.com or call (724) 941-9440.

______________________________________________________________________

Helping Kids and Their Families Live Healthy

In 2005, Armstrong School District administrators were surprised to find out that according to national standards almost 35% of children in the district were overweight or obese.
As a result of this finding, several organizations in Armstrong County came together to develop HEALTHY Armstrong, a collaborative that focuses on improving the health and well-being of children and their families. HEALTHY stands for Healthy Eating Active Lifestyles Together Helping Youth. Key stakeholders include ACMH Hospital, ACMH Hospital Foundation, Armstrong School District, UPMC Health Plan, Children’s Community Pediatrics (Armstrong), and the County of Armstrong.
“The coordination of key community stakeholders has helped us make gradual changes that assist children and their families in making healthier food choices and increasing their physical activity levels,” says Harold Altman, MD, Chief Medical Officer of ACMH Hospital. Dr. Altman, a pediatrician, is also a member of HEALTHY Armstrong’s Executive Council.
The Executive Council includes one representative from each key partner organization and directs the efforts of the coalition. The Steering Committee, which includes the project director, school program coordinator, and representatives from all partner/community organizations, meets monthly to address key program details and to make sure their decisions follow the direction set by the Executive Council.
Armstrong School District has made gradual healthy changes to the food choices available in district schools. Changes include removing deep fryers from school cafeteria kitchens and removing soda pop from vending machines in student areas. School-based programs include daily morning exercises and after-school activities that include parents. The district incorporates the National Institutes of Health’s We Can!TM program, an easy-to-use wellness program for parents and teachers.
A community-wide campaign, Healthy Recipe of the Week, has engaged families throughout Armstrong County by helping residents understand the importance of proper food choices, nutritional content, and portion control. At several grocery stores throughout the county, weekly recipes are featured in a prominent grocery display and provided to residents so they have easy access to healthy food choices.
“This event helps parents make changes to their family diet, which is important to the overall mission of the HEALTHY Armstrong collaborative,” explains Michael Culyba, M.D., Vice President, Medical Affairs, at UPMC Health Plan, and an Executive Council member.
In July 2009, HEALTHY Armstrong gained national recognition when Congresswoman Kathy Dahlkemper (PA-3) introduced legislation — Healthy Communities Act of 2009 — that is modeled after the HEALTHY Armstrong collaborative. Through public-private partnerships, this legislation will offer grants to community organizations that develop programs to help residents live a healthier lifestyle.
For more information about HEALTHY Armstrong , contact Kay Owen, Project Director, at (724) 543-8580 or owenk@acmh.org or visit www.healthyarmstrong.com.

______________________________________________________________________