Breaking the cycle of disadvantage: Children's health care

Arizona Nurse,  Jan 1999  by Primas, Phyllis J Krause

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"Breaking the Cycle" is an innovative program of outreach primary health care for children and youth in Phoenix. It was developed at Arizona State University, College of Nursing, as a partial response to increasing concern for the deplorable state of Arizona's children, and as an outgrowth of studies of the health needs of homeless children. It was originally funded by the Arizona Department of Health Services as a demonstration project (1990-1995). In 1996, a contract was awarded by the Arizona Department of Health Services to expand and enhance "Breaking the Cycle" with tobacco tax revenues. Needed supplementary funding has been obtained through a number of grants and donations into the Krause Memorial Children's Fund in the ASU Foundation.

The mission of this program is to provide free, comprehensive, accessible, culturally acceptable outreach primary health care services to high risk, underserved children and youth. Additionally, the program addresses the following goals: 1) To evaluate the cost-effectiveness of this mobile, " portable" nursing model of health care delivery;

2) To provide learning experiences for students that will increase their sensitivity to vulnerable populations; 3) To provide opportunities for faculty and student research that will improve health care; and 4) To provide opportunities for faculty to professionally practice, thereby providing service to the community.

The model is based upon a defined but simple philosophy: children have a fundamental right to the opportunity to achieve their individual potential for health and well-being. Multiple and interacting factors - physical, social and economic environment, lifestyle attitudes and behaviors, inherited characteristics, and the health care system itself - influence health status and therefore need to be considered in planning for and providing care to individuals, families and communities. The concept of primary health care includes an approach to families as the unit of service; supports bringing services as close as possible to where people live and work; and constitutes the first element of a continuing health care process.

The three equally important dimensions of this system are: Aggressive outreach to identify children in need; the free, comprehensive primary care clinic that includes well child care, immunizations, treatment of minor illness (including prescription drugs), health education and referral; case management and follow-up to assist in obtaining care that is needed beyond the scope of the project and to determine successful outcomes. The emphasis is on prevention, early detection of problems and health promotion. Other unique characteristics of this model include: Flexible hours and sites to suit the nee ls of the target population and improve access to care; visits by staff in homes, schools and community to provide continuity of faculty and students, and enhance a synergy of education, research and public service. The staff includes nurse practitioners with prescribing and dispensing privileges, community health nurses, bilingual outreach specialists, volunteer dentists and pediatricians and other community volunteers.

Collaborative efforts within the community and the University in the planning, funding, implementation and evaluation of this endeavor have contributed significantly to its success. We are reaching and serving children whose health needs may not otherwise be addressed. Community sites at which the model has been tested and children served are: The Salvation Army Homeless Family Shelter, Trinity Episcopal Cathedral and three high risk pre-school programs in the Creighton Elementary District. Beginning in 1996 we initiated a school based health service in the William T. Machan Elementary School. In 1997 our Machan partnership was awarded a Robert Wood Johnson/W.T. Kellogg Turning Point planning grant to develop a healthy community in the Machan neighborhood.

The "Breaking the Cycle" model has the potential for adaptation to serve other disadvantaged populations, and to include services to the families and neighbors of our children.

[About the author: Phyllis Krause Primas, PhD, is Director of Break the Cycle with numerous articles published in nursing journals about her project. She is a member of organizations such as AzNA and Sigma Theta Tau. Dr. Primas is an Associate Professor in the College of Nursing at Arizona State University.]

Copyright Arizona State Nurses Association Jan 1999
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