RESUMEN
Oklahoma established the first health services initiative (HSI) to expand Reach Out and Read (ROR), increase developmental screening and improve the quality of well-child visits (Early and Periodic Screening, Diagnostic and Treatment (EPSDT)). ROR uses a book in the exam room to assess development and parent-child interaction, however, little is known about the relationship between this training and using a formal developmental screening tool. The purpose of this study is to see if using federal funding would facilitate ROR expansion and if this expansion would improve developmental screening and EPSDT visits in Oklahoma. Medicaid billing data for state fiscal year (SFY) 2018 and 2019 were analyzed. Standard statistical methods were used to analyze the data descriptively to determine the proportion of developmental screenings performed and EPSDT visits. Comparisons were made between ROR and non-ROR sites. Nine new ROR sites were added with 26 new providers/staff and 130 providers/staff at existing sites trained in ROR from Novenber 2018 to June 2019. In SFY 2018, the developmental screening percentage at non-ROR sites was 33% vs 47% at ROR sites (p<0.0001), in SFY 2019 non-ROR sites were 36% vs 48% at ROR sites (p<0.0001). The EPSDT visit percentage in SFY 2018 was 50% at non-ROR sites vs 69% at ROR sites and in SFY 2019 was 51% at non-ROR sites vs 72% at ROR sites. HSIs are an effective way to fund ROR. Additional funding allowed for increased ROR sites and training. ROR sites are more likely to perform developmental screenings and EPSDT visits.
RESUMEN
The South African government has put in place a range of laws, policies and programmes that are designed to give effect to children's rights and support children's survival, health and optimal development. These rights do not just exist on paper. They have the potential to transform professional practice and improve the quality of care across a range of health care services. A child-rights' approach requires nurses to act in the best interest of children, respect their evolving capacities, think more holistically about a child's well-being and work with others to address the broader social determinants of health--such as access to food, water and sanitation. This article draws on lessons learned from a short course in children's rights and child law for health professionals offered by the Children's Institute, University of Cape Town from 2011-2014. It encourages nurses to reflect critically on their current practice and to take action to improve a child's well-being. It also advocates for the inclusion of children's rights to be at the heart of education and training, professional codes of conduct and standards of care.
