Every three years not-for-profit hospitals are required to conduct a Community Health Needs Assessment (CHNA) of the local populations they serve. Nicklaus Children’s Hospital completed our CHNA in partnership with Professional Research Consultants, Inc. (PRC): interviewing families, surveying key informants, reviewing public source information, and based on the needs identified in the research, prioritizing areas of focus. Our goal in conducting the assessment was to better understand the health status, behaviors, and needs of children and adolescents in South Florida so that we as a community – patients, families, Nicklaus Children’s, and partner organizations – can optimally support their health and wellbeing. Information on both the CHNA and Implementation Plan can be found below.
Pediatric & Adolescent Health in South Florida
The Implementation Plan below captures Nicklaus Children’s commitments to address the specific findings of the 2018 CHNA. This public document is intended by way of summary and as an invitation to organizations and individuals in the community interested in collaborating on the defined areas of focus.
Mental & Emotional Health
- Nicklaus, in collaboration with community partners, is committed to significantly grow our mental health program with more services and more types of services to facilitate greater prevention, treatment, and management.
Access to Healthcare
- Of the tested access barriers, inconvenient office hours impacted the greatest share of Total Service Area children (25.1%). Nicklaus has begun offering evening and weekend appointments for select sub-specialties in its physician group practice, Pediatric Specialists of America (PSA). This is an ongoing and high priority initiative for the PSA; and NCHS looks for the collaboration of affiliated private groups to do the same within their offices.
- The PSA created open access slots for patients with a STAT diagnosis and/or as recommended by the PCP/referring provider.
- NCHS will be adding more formal structure to support multidisciplinary clinics and programs – centralizing dedicated resources and where possible allowing for global billing.
- Nicklaus Children’s continues to grow subspecialty and ancillary services throughout the ambulatory network to ‘be where the children are’.
- Almost a quarter of children in South Florida were reported to have a lapse in insurance coverage in the past year (vs. 13.0% nationally). NCHS intends to work with the Florida legislature to pass some form of ‘auto-enrollment’ so children are not left without insurance.
- Nicklaus Children’s School Health Program currently services 74 schools. The program is actively looking to expand to more schools, and has recently added or is working to add specific programming around weight management, mental health counseling, incorporating parents and guardians for training and guidance, and various targeted violence prevention and health promotion initiatives.
Nutrition, Physical Activity & Weight
- #GiveMe5 is a multidisciplinary, training, educational and marketing tool to encourage the consumption of fruits and vegetables among children of all different ethnic and cultural backgrounds in South Florida. Since the program’s launch, in response to the 2015 CHNA, fruit and vegetable consumption went from significantly below to being in line with rates reported across the US. Based on the success of the program, NCHS and our community partners are committed to continued support for community nutrition and the #GiveMe5 campaign. #GiveMe5 is made possible with the generous support of Kohl’s Cares.
- NCHS strives to work with payors to cover outpatient nutrition therapy. Most plans list outpatient nutrition as a covered benefit, but it largely remains an out-of-pocket service. This is a carry-over from the prior Implementation Plan.
- The Nicklaus Children’s Pinecrest Sports Health Center offers a suite of services to enhance performance and facilitate safe play. Programmatic growth targeted around wellness, concussion, and other areas.
- NCHS is exploring building out more enhanced programming specifically focused on obesity medicine.
Prenatal & Infant Health
- The Fetal Care Center at Nicklaus Children’s is devoted to the care of high risk fetal patients with medical needs requiring intervention at birth. The special delivery unit for healthy women who are anticipating a baby with medical/surgical needs is set to open in 2019.
- Nicklaus Children’s Fetal Care Center, in partnership with OBs, MFMs, and other community organizations are working together to improve prenatal health though quality collaboratives and joint outreach.
- NCHS is exploring the development of a neurodevelopmental clinic and other programs for NICU graduates.
- Nicklaus is expanding diabetes care into the community. The Diabetes program now offers services in NCHS’s West Kendall and Doral outpatient centers; plans are also underway for growth in Martin County.
- The Diabetes program has increased the number of Certified Diabetes Educators and is working with psychology to provide more counseling services.
- NCHS is developing a roadmap to create a Diabetes Center of Excellence with best-in-class evidenced-based structure, process, and outcomes.
Asthma & Other Respiratory Conditions
- 2018 CHNA findings suggest in South Florida the prevalence of asthma, ED/Urgent Care utilization for asthma, and asthma related inpatient admissions are all above the rest of the country and comparatively worse than the CHNA findings from 2015. The Division of Pulmonology is exploring ways to support PCPs and families in the community to reinforce critical asthma management education.
Injury & Safety
- Nicklaus Children’s Safe Kids - Buckle Up program provides car seat inspections / installation appointments; presentations at community events; and offers courses. NCHS is committed to injury prevention in the community and looks for ways to reach more families with these services.
- The School Health Program offers health education in every school where we operate, touching on a range of health, safety, and injury prevention topics. A sample of planed projects include a distracted driving/impaired driving pilot, stop the bleed training, and a drowning prevention initiative.
- Adolescent Medicine physicians counsel patients on high risk behaviors including sexual activity, alcohol and drug use. NCHS endeavors to reach more patients needing this service.
- Within the Division of Adolescent Medicine several initiatives are underway to improve HIV screening rates in accordance with national guidelines, use of long-acting reversible contraceptives, and to improve rates of screening for sexual abuse.
Potentially Disabling Conditions
- NCHS is scheduled to open a Gait and Motion Analysis Laboratory to aid in the targeted treatment of orthopedic, neurological, and muscular conditions.
- NCHS is exploring the development of a complex chronic / stabilization / NICU graduate clinic or program to centralize and coordinate care for the most medically involved pediatric patients in our community.
- The Personalized Medicine Initiative (PMI) at Nicklaus Children’s is one of the nation’s first programs focused on the development and delivery of precision and personalized approaches for children’s medical care, health and wellness. The PMI offers a comprehensive approach to tailoring medical management to each child’s individual characteristics, needs, and preferences from prevention, diagnosis, treatment, and follow up. The PMI serves as the innovation hub for genomics, immunotherapies, 3D printing, imaging innovation, and biobanking. PMI is closely linked to various programs across NCHS including the Brain Institute, the Heart Program, the Center for Cancer & Blood Disorders, Orthopedics and Sports Medicine, the Victor Center for Prevention of Jewish Genetic Diseases, and the Fetal Care Program. The team is actively engaged with community partners to build capacity and support efforts in science and STEM/STEAM education with an emphasis on genetics and genomics. Areas for targeted growth include pharmacogenomics, health economics and augmented and virtual reality.