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Leveraging a Novel Web-based Child Care Center Network to Forecast Illness and Keep Children Healthy

Using child care center-based disease communication network to empower early learning providers to keep children healthy and support parents

Photo of Andrew Hashikawa
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Written by

Updates: How has your idea changed or evolved throughout the Prize? What updates have you made to this submission? (1500 characters)

Mentorship feedback was invaluable because our discussion helped us clarify our message, narrow our focus further, and to think specifically about our "asks" for the future.

Name or Organization

Andrew Hashikawa is a pediatric emergency medicine physician at Michigan Medicine and Michigan American Academy of Pediatrics Early Childhood Champion. His research focuses on preventing infectious diseases and injuries in early learning environments. He created MCRISP (Michigan Child Care Related Infection Surveillance Program), the first web-based biosurveillance platform in the US made specifically for local child care centers in the county to report and track illness-related absences.

Geography

Ann Arbor, Michigan, United States of America.

What is your stage of development?

  • Early Stage Innovator, with at least one-year experience in ECD

Type

  • University

What is the stage of your proposal?

  • Piloting: I have started to implement my solution as a whole with a first set of real users.

Describe how your solution could be a game-changer for your selected Opportunity Area (600 characters)

1. Provide child care centers a dashboard to view local, real-time, emerging Illness trends. 2. Use disease modeling to provide disease forecasting that allows for early planning and timely mobilization of center resources (cleaning protocols, immunization reminders, staff health training to identify illness) to prevent or decrease child care infections to keep children healthy, reduce child absences, and keep parents' from missing work. 3. Give child care providers just-in-time, text-based, educational health content they can use to prevent illness and also provide information to parents.

Select an Innovation Target

  • Technology-enabled: Existing approach is more effective or scalable with the addition of technology

Tell us more about your innovation (1500 characters)

MCRISP represents a novel online platform for early illness detection, disease modeling and forecasting, improved dialogue among child care-related stakeholders, and targeted dissemination of usable data and educational materials to decrease the burden of illness on children, child care centers, parents and the general community.

What problem are you aiming to solve? (3 sentences)

1-(Communication and Education): Improve dissemination of real-time disease outbreak warnings to centers and provide timely educational material for early learning stakeholders. 2-(Timing of Resource Mobilization): Develop disease forecasting models using child care data for more effective resource mobilization (Immunization timing, upstaffing, back-up child care) 3-(Disease Burden). Reduce child care illness burden to decrease both child absences and parental missed time from work.

Explain your idea (5000 characters)

BACKGROUND: A large majority of children in the United States will require nonparental child care by 6 years of age because of working parents and economic necessity. Children in early learning settings have more upper respiratory infections, diarrheal illness, ear infections, and ear tube placement than children who stay at home only. When sick children are absent, not only are they not able to develop and learn to their full potential, but their illness places a substantial burden on working families, businesses, and health care resources. Nationally, an estimated 44 million workers lack any paid sick leave benefits to care for sick children, disproportionately affecting poor and minority families. Our nationally representative survey (National Poll on Children's Health) reported a third of parents were concerned about losing jobs or pay when taking off work to care for their sick children unable to attend child care programs. Enrollment in child care has also consistently been identified as a major factor in the spread of disease in the community. Developmental, behavioral, and physiologic factors unique to the child care cohort (e.g. diapering, mouthing of toys, underdeveloped immune systems) all increase the risk of child care-associated infections. Children in child care are also up to three times more likely than their home-reared peers to require emergency department care, urgent care, or outpatient care and pharmacy services. Our nationally representative survey (National Poll on Children's Health) found that 25% of parents would seek care in the emergency department or urgent care if their sick child could not attend their usual child care program. Average annual health care expenditures are estimated to be >50% higher in children attending child care compared to those cared for at home. Child care-associated infections do not just impact the infected child; these infections are spread to their families and the vulnerable grandparents. OUR IDEA: MCRISP is the first US web-based platform for a passive surveillance system used by child care centers to report and track illness-related absences and has been featured in Time magazine http://time.com/3490067/preschoolers-disease-outbreaks/ and in the Health Security journal. Successfully piloted starting in four child care centers (with approval from the Washtenaw County Public Health) in 2013, the MCRISP network now includes 32 licensed child care centers in our county. MCRISP sends electronic data to the public health department, and more frequently during outbreaks. The MCRISP network has offered a unique opportunity to study acute child care reported illnesses in a cohort of >4,000 young children within a single county from a blend of private, university, and federally supported child care centers. MCRISP has been able to detect influenza-like illness trends two to three weeks earlier compared to standard school and hospital-based disease surveillance and has collected over 2,631 cases of influenza-like illness and 2,209 cases of gastrointestinal illness reports from participating centers. MCRISP is innovative because our goal is to improve bidirectional online dialogue between researchers, child care workers, parents and public health stakeholders. We regularly send out warning notifications for high-levels of disease activity when appropriate after consultation with our public health colleagues.

Who benefits? (1500 characters)

1. Child Care Center Staff: Staff will benefit from the information and feel empowered to anticipate needs, implement disease prevention cleaning strategies, and more effectively screen children that are becoming sick. Child care center staff will also receive tailored information about trending illnesses and disease prevention strategies (emphasis on exercise, nutrition, hand-washing, immunizations) that can be used immediately in the center and also shared with new parents and families. 2. Parents: Child care related infections places a substantial socioeconomic burden on families. Our initiative supports parents' awareness of illnesses and improved access to educational material (from the child care center) for encouraging timely health-related behaviors, including scheduling immunizations, improved hand-hygiene practices, and improved strategic planning for back-up child care when necessary. 3. Children: Improved timely disease reducing interventions will lead to an improved healthy environment and reduced absences that allows children to maximize their learning and development. 4. Community and vulnerable family members: Decreasing the burden of illness in the child care age cohort will reduce disease spread to the larger community, especially among the geriatric population (grandparents) who are particularly susceptible to influenza because of their declining immune system and poor influenza vaccine effectiveness.

What kind of impact will your idea have? (1500 characters)

1. Development of child-care based forecasting models to help child care workers and parents anticipate additional resources, cleaning strategies, heightened screening measures (child care worker training), and opportunity for increased preventative measures (immunizations). 2. Early warning data to change child care provider and parent behaviors and interventions to reduce parental time missed from work. 3. Finding ways to reduce the spread of infections early can decrease transmision of illness to community members at large who are vulnerable to diseases. This would begin on a regional level, then expanding state-wide, and then other states. Partnership with other AAP early childhood champions and key early learning stakeholders will be key in other geographic locations.

How does or how could your idea impact low-income children? (1500 characters)

The majority of low-income families require child care services. Our nationally representative survey reported a third of parents were concerned about losing jobs or pay when taking off work to care for their sick children unable to attend child care programs. These results highlight the struggle that these families face when their children are sick - parents cannot work, cannot get paid, or lose their jobs. MCRISP is innovative because it leverages child care centers to actively participate in communicating disease trends that can impact other centers, parents, caregivers to make decisions about cleaning, vaccinations, or plan for additional need for resources (staffing, back-up child care).

Innovation: What makes your concept innovative? (5000 characters)

Our concept is innovative because . . . 1.) We engage child care providers working in child care centers in a way that has never been done before - by leveraging the child care center as a central hub where illness data can be collected and then shared to public health, primary care providers, parents, and the community at large. 2.) We allow for the bi-directional sharing of public health information between child care centers and the medical community by using the MCRISP platform. All other community biosurveillance systems allow for unidirectional flow of information - where the schools and child care centers report disease information, but they do not allow the reporters to have real-time access to illness data that would be helpful in mobilizing resources and initiate timely infection prevention measures. 3.) We are relying on a cohort (child care center workers) that are underutilized. Child care center workers routinely provide absence and illness data, but we leverage their illness reporting so that children, workers, parents, and public health benefits. Other social media or search engine-based illness reporting networks rely on parents or users that report when they are ill or are searching for illness trends, but does not consistently provide year-round reporting and data are substantially affected by local media reporting (eg. Google Flu, which was discontinued). Child care centers are typically open year-round and consistently provide absentee data. Child care absentee data is much more reliably tied to illness when compared to grade school or high school absentee data (which is often not always due to illness). 3.) Our concept of using real-time data to then tailor short-educational text based messages and text-accessible video links about disease prevention and management to child care providers (that can also be shared with parents).

Scale: Describe how your idea could reach a significant number of end-users. (1500 characters)

The need for child care services by working parents is substantial and the number of early learning centers that provide child care services is extensive. Child care infections not only lead to reduced productivity and loss of work for parents and caregivers, but impact the child's ability to effectively learn and develop. The potential number of end-users of our platform is substantial given the extensive impact of child care-associated infections. Public health surveillance platforms do not routinely include child care centers and also do not allow for bidirectional communication between health experts and early learning providers. We would be providing a novel communication platform, useful education content, with data crowd-sourced by end-users. Anticipated barriers include ensuring messaging is clear and effective and that data entry remains user-friendly. The child care community has considerable incentive to report illnesses and absences and to reduce infections in the child care environment to ensure optimal learning conditions for children and easing the burden on parents. Long-term financial sustainability includes potential for disease forecasting (using data that can potentially predict disease outbreaks ahead of current available models) and parents wanting reliable information for trending diseases in their area. This platform allows for the dissemination of materials and the potential for continuing education credit for early learning workers.

Feasibility: Where are you with understanding the feasibility of your idea? Describe what you’ve done so far and your plans. (3000 characters)

Our project is feasible because it relies on invested child care centers staff and owners who benefit from reporting about illness trends in their individual centers in exchange for access to warnings and real-time illness trends. We tested proof-of-concept starting with 4 centers in 2013 and have now expanded to 32 centers in a little over 3 years. The system allows individual illness entry without requiring any protected health data and is faster and easier than the previous paper-based, weekly reports that were emailed or faxed individually to the local public health department. Currently, using only a web-based system, data entry is simple, disease categories are straightforward, and data management is not-time consuming. Centers are motivated to report and have done so consistently and regularly because, unlike school-based attendance, this occurs year-round and absences are typically caused by illness. We imagine that this type of platform could be easily managed at the individual state level - with direct input from county public health departments. Future plans: 1.) Simplify the platform with more easy-to-read infographics 2.) Automate messaging for reports (opt-in option for child care centers) using text or email options. 3.) Use available data and center locations to develop robust disease models and disease forecasting and tap into University of Michigan School of Public Health Department of Epidemiology with vast and substantial experience in disease transmission modeling and disease forecasting 4.) Expand the data entry and communication platform to include an intelligent app-based or text-based system. For example, during non-flu season, use of an intelligent text-based platform that would send reminder texts to child care centers smartphones or cell phones on a weekly basis - with general questions about illness symptoms and percent of children that are ill (only a few questions); however, based on their responses - more questions could be added (based on specific symptoms being reported) and increased frequency of texts sent to providers if answers indicate rising illness levels. An app for both data/entry, viewing disease trends, and consumption of educational content would facilitate expansion into other child care centers. 5.) Expansion to larger national chain child care centers to support both regional and national illness monitoring, data collection, and educational support for child care centers to improve children's health in early learning settings. 6.) Collaboration with the Centers for Disease Control and Prevention (CDC) for reporting on illness (influenza) in a very vulnerable demographic.

Business Viability: How viable is your business model? (5000 characters)

Child care center owners and directors have a vested business interest in keeping children and child care center staff healthy. Children constantly have runny nose and cough, and so excluding all these children is not feasible from a business perspective. Having access to information about circulating symptoms and illnesses is advantageous for child care centers: 1.) Cleaning and disinfecting the center is a substantial burden - knowing when to clean and how often is valuable information to a center 2.) Child care centers often disseminate health and safety information to parents based on circulating illnesses - having access to knowledge about what diseases are in the community and information for parents that are evidence-based and American Academy of Pediatrics approved will be key in helping parents prevent illness and keep the child healthy 3.) Knowing when to encourage vaccinations (influenza) is critical for both child care staff and reminding parents 4.) Disease forecasting based child care centers reporting for optimization when screening for disease and anticipating when up-staffing will need to occur - all are reasons this business model will succeed. 5.) Finally as more health systems and insurance companies begin exploring telemedicine opportunities, we anticipate that child care centers (especially larger chains) will be looking for ways to connect to primary care physicians for potential advice about inclusion or exclusion of children, or evaluation of mildly ill children remotely (via telemedicine) while the parents are at work (so that a medical evaluation in the urgent care or emergency department is not necessary because the primary care doctor's offices are already closed after parents leave work). We see MCRISP potentially being able tie into telemedicine and this would substantially reduce the stress that parents have about seeking medical care for their children who are mildly ill but require off-hours medical evaluation (for pink-eye, ear infection).

HCD: How have you used human centered design to build or refine your concept? (5000 characters)

Development of MCRISP concept began about 10 years ago. In our study of over 300 child care centers that was published in Pediatrics (http://pediatrics.aappublications.org/content/125/5/1003.short), we interviewed over 300 child care center directors and found that there were high rates of children being sent home unnecessarily, mainly because directors were unaware of national American Academy of Pediatrics child care illness guidelines. We then held several focus group of inner-city and suburban child care center directors and parents with children in child care to find out what the challenges and obstacles were related to preventing and managing sick children in child care (funded by an American Academy of Pediatric CATCH grant). Using feedback from both parents and child care center directors, I then began developing the concept of a web-based platform that would not only encourage disease reporting as a public health surveillance tool, but that could be used as a platform to communicate tailored, relevant information about disease management and prevention. Our pilot that began with four child care centers has been published in the peer-reviewed journal of Health Security http://online.liebertpub.com/doi/abs/10.1089/hs.2016.0124. When developing this platform we trained child care center directors about disease management, toured facilities, and have obtained feedback via survey this past summer to ensure that the MCRISP platform remains relevant and user-friendly.

Tell us more about you (3000 characters)

Dr. Hashikawa first become interested in the child care population as a junior medical student. He interviewed a mother and her child at midnight in the emergency department - the mom, after waiting for hours, had brought their young, well appearing toddler for concerns for pink-eye. At first, this was confusing, because it did not seem like an emergency - but to the mother it was an urgent issue because the child had been sent home from the child care center and would not be allowed back unless they either had a doctor's note or antibiotics. She said she would lose her job if she couldn't return to work in the morning because she did not get any paid time off of work to care for her sick child. This event sparked his interest in child care-infections and its impact on children and families. Dr Hashikawa is now a Pediatric Emergency Medicine at the University of Michigan. He earned his MD and completed Pediatric residency at the Mayo Clinic. He completed a PEM fellowship/Masters (Epidemiology) at the Medical College of Wisconsin. Dr Hashikawa has served as the AAP Michigan Early Childhood Champion (2011). He was awarded AAP Healthy Futures, Building Bridges, and CATCH grants. He led the effort for creating the new AAP’s Healthy Futures Curriculum for Injury Prevention. He has experience working closely with child care centers to promote policies to reduce child care-related infections He has substantial experience in community-based education and training of child care and preschool workers on infectious diseases, injury prevention, medication safety, and disaster preparedness. He has received several community-based grants from the AAP that have enabled him to build partnerships with local child care center networks and the public health department. Nationally, he is a member of the AAP Executive Committee on the Council of Early Childhood and a member of the National Resource Center’s Injury Prevention and Infectious Disease Panel Advisory Groups charged with revising and updating the 3rd edition of the Caring for Our Children, joint standards published by the American Public Health Association and the AAP. He serves as a local child care health consultant, has provided over 100 health lectures for child care providers since 2012, and works with pediatric residents to engage them in presenting lectures to child care providers. His research focuses on child care environments and health outcomes, including infectious diseases, injury prevention, and disaster preparedness. He has presented at national meetings and published child care-based research examining unnecessary exclusion of mildly ill children from child care (Pediatrics, 2010); child care directors’ return to care practices for mildly ill children (Pediatrics, 2012); impact of illness for children in child care on parents’ need to use emergency and urgent care services (Pediatrics, 2014), and disaster preparedness in child care centers (Pediatric Emergency Care, 2016).

Do you have the people and partners you need to do what you’ve described? (600 characters)

1. Public Health Department 2. Infectious and communicable disease expert (University of Michigan School of Public Health - Department of Epidemiology) - Dr. Emily Toth Martin in the University of Michigan School of Public Health with expertise in pediatric infections, infectious diseases transmission, epidemiology, evaluation of methods. 3. Computer Disease Modeling: Dr. Michael Hayashi (University of Michigan School of Public Health), an expert in mathematical modeling, dynamical systems, network theory. 4. Technology-based health applications company (Ubitrix) - can build health apps.

As you consider your next steps, what kinds of help could you use? Is there a type of expertise that would be most helpful? (1800 characters)

Expertise related to expanding networks or platforms that have leveraged crowd-sourcing to provide data and wisdom on how to best disseminate sometimes complex information in a user-friendly, but effective manner to continue to provide regular feedback to users of the system.

Would you like mentoring support?

  • Yes

If so, what type of mentoring support do you think you need? (1200 characters)

1. Technology - integrating to a mobile or smartphone based platform for improved disease reporting and data collection for enhanced disease forecasting. 2. Social Media/Publicity/Marketing - leveraging ways to further improve communication using the MCRISP platform among stakeholders 3. Mentorship for anticipated expansion to child care centers beyond our county and throughout the state.

Are you willing to share your email contact information submitted on OpenIDEO with Gary Community Investments?

  • Yes, share my contact information

[Optional] Biography: Upload your biography. Please include links to relevant information (portfolio, LinkedIn profile, organization website, etc).

https://medicine.umich.edu/dept/emergency-medicine/andrew-hashikawa-md https://experts.umich.edu/en/persons/andrew-n-hashikawa http://time.com/3490067/preschoolers-disease-outbreaks/ https://healthblog.uofmhealth.org/childrens-health/how-to-choose-a-child-care-provider-6-tips-from-a-pediatrician

Mentorship: How was your idea supported? (5000 characters)

Feedback from the mentor was invaluable in several ways: 1.) Forced us to concentrate on the story-telling aspect 2.) Narrow our focus

Updates: How has your idea changed or evolved throughout the Prize? What updates have you made to this submission? (1500 characters)

Mentorship feedback was invaluable because our discussion helped us clarify our message, narrow our focus further, and to think specifically about our "asks" for the future.

Name or Organization

Andrew Hashikawa

Geography

Ann Arbor, Michigan, USA

What is your stage of development?

  • Early Stage Innovator, with at least one-year experience in ECD

Type

  • University

What is the stage of your proposal?

  • Piloting: I have started to implement my solution as a whole with a first set of real users.

Describe your submission in one clear sentence

Using child care center-based disease communication network to empower early learning providers to keep children healthy and support parents

Describe how your solution could be a game-changer for your selected Opportunity Area (600 characters)

1. Provide child care centers a dashboard to view local, real-time, emerging Illness trends. 2. Use disease modeling to provide disease forecasting that allows for early planning and timely mobilization of center resources (cleaning protocols, immunization reminders, staff health training to identify illness) to prevent or decrease child care infections to keep children healthy, reduce child absences, and keep parents' from missing work. 3. Give child care providers just-in-time, text-based, educational health content they can use to prevent illness and also provide information to parents.

Select an Innovation Target

  • Platform: Creating a community or market that facilitates interaction between users and resources.

Tell us more about your innovation (1500 characters)

MCRISP represents a novel online platform for early illness detection, disease modeling and forecasting, improved dialogue among child care-related stakeholders, and targeted dissemination of usable data and educational materials to decrease the burden of illness on children, child care centers, parents and the general community.

What problem are you aiming to solve? (3 sentences)

1-(Communication and Education): Improve dissemination of real-time disease outbreak warnings to centers and provide timely educational material for early learning stakeholders. 2-(Timing of Resource Mobilization): Develop disease forecasting models using child care data for more effective resource mobilization (Immunization timing, upstaffing, back-up child care) 3-(Disease Burden). Reduce child care illness burden to decrease both child absences and parental missed time from work.

Explain your idea (5000 characters)

Already filled out above.

Who benefits? (1500 characters)

1. Child Care Center Staff: Staff will benefit from the information and feel empowered to anticipate needs, implement disease prevention cleaning strategies, and more effectively screen children that are becoming sick. Child care center staff will also receive tailored information about trending illnesses and disease prevention strategies (emphasis on exercise, nutrition, hand-washing, immunizations) that can be used immediately in the center and also shared with new parents and families. 2. Parents: Child care related infections places a substantial socioeconomic burden on families. Our initiative supports parents' awareness of illnesses and improved access to educational material (from the child care center) for encouraging timely health-related behaviors, including scheduling immunizations, improved hand-hygiene practices, and improved strategic planning for back-up child care when necessary. 3. Children: Improved timely disease reducing interventions will lead to an improved healthy environment and reduced absences that allows children to maximize their learning and development. 4. Community and vulnerable family members: Decreasing the burden of illness in the child care age cohort will reduce disease spread to the larger community, especially among the geriatric population (grandparents) who are particularly susceptible to influenza because of their declining immune system and poor influenza vaccine effectiveness.

What kind of impact will your idea have? (1500 characters)

1. Development of child-care based forecasting models to help child care workers and parents anticipate additional resources, cleaning strategies, heightened screening measures (child care worker training), and opportunity for increased preventative measures (immunizations). 2. Early warning data to change child care provider and parent behaviors and interventions to reduce parental time missed from work. 3. Finding ways to reduce the spread of infections early can decrease transmision of illness to community members at large who are vulnerable to diseases. This would begin on a regional level, then expanding state-wide, and then other states. Partnership with other AAP early childhood champions and key early learning stakeholders will be key in other geographic locations.

How does or how could your idea impact low-income children? (1500 characters)

The majority of low-income families require child care services. Our nationally representative survey reported a third of parents were concerned about losing jobs or pay when taking off work to care for their sick children unable to attend child care programs. These results highlight the struggle that these families face when their children are sick - parents cannot work, cannot get paid, or lose their jobs. MCRISP is innovative because it leverages child care centers to actively participate in communicating disease trends that can impact other centers, parents, caregivers to make decisions about cleaning, vaccinations, or plan for additional need for resources (staffing, back-up child care).

Innovation: What makes your concept innovative? (1500 characters)

Our concept is innovative because . . . 1.) We engage child care providers working in child care centers in a way that has never been done before - by leveraging the child care center as a central hub where illness data can be collected and then shared to public health, primary care providers, parents, and the community at large. 2.) We allow for the bi-directional sharing of public health information between child care centers and the medical community by using the MCRISP platform. All other community biosurveillance systems allow for unidirectional flow of information - where the schools and child care centers report disease information, but they do not allow reporters to have real-time access to illness data that would be helpful in mobilizing resources and initiate timely infection prevention measures. 3.) We are relying on a cohort (child care center workers) that are underutilized. Child care center workers routinely provide absence and illness data, but we leverage their illness reporting so that children, workers, parents, and public health benefits. Other social media or search engine-based illness reporting networks rely on parents or users that report when they are ill or are searching for illness trends, but does not consistently provide year-round reporting and data are substantially affected by local media reporting (eg. Google Flu, which was discontinued). Child care centers are typically open year-round and consistently provide absentee data. C

Scale: Describe how your idea could reach a significant number of end-users. (1500 characters)

The need for child care services by working parents is substantial and the number of early learning centers that provide child care services is extensive. Child care infections not only lead to reduced productivity and loss of work for parents and caregivers, but impact the child's ability to effectively learn and develop. The potential number of end-users of our platform is substantial given the extensive impact of child care-associated infections. Public health surveillance platforms do not routinely include child care settings and also do not allow for bidirectional communication between health experts and early learning providers. We would be providing a novel communication platform, useful education content, with data crowd-sourced by end-users. Anticipated barriers include ensuring messaging is clear and effective and that data entry remains user-friendly. The child care community has considerable incentive to report illnesses and absences and to reduce infections in the child care environment to ensure optimal learning conditions for children and easing the burden on parents. Long-term financial sustainability includes potential for disease forecasting (using data that can potentially predict disease outbreaks ahead of current available models) and parents wanting reliable information for trending diseases in their area. This platform allows for the dissemination of materials and the potential for continuing education credit for early learning workers.

Feasibility: Where are you with understanding the feasibility of your idea? Describe what you’ve done so far and your plans. (3000 characters)

Our project is feasible because it relies on invested child care centers staff and owners who benefit from reporting about illness trends in their individual centers in exchange for access to warnings and real-time illness trends. We tested proof-of-concept starting with four centers in 2013 and have now expanded to 32 centers in a little over 3 years. The system allows individual illness entry without requiring any protected health data and is faster and easier than the previous paper-based, weekly reports that were emailed or faxed individually to the local public health department. Currently, using only a web-based system, data entry is simple, disease categories are straightforward, and data management is not-time consuming. Centers are motivated to report and have done so consistently and regularly because, unlike school-based attendance, this occurs year-round and absences are typically caused by illness. We imagine that this type of platform could be easily managed at the individual state level - with direct input from county public health departments. Future plans: 1.) Simplify the platform with more easy-to-read infographics 2.) Automate messaging for reports (opt-in option for child care centers) using text or email options. 3.) Use available data and center locations to develop robust disease models and disease forecasting 4.) Expand the data entry and communication platform to include an intelligent app-based or text-based system. For example, during non-flu season, use a intelligent text-based platform that would send reminder texts to child care centers smartphones or cell phones on a weekly basis - with general questions about symptoms and percent of children ill (only a few questions); however, based on their answers - more questions could be added (based on symptoms they are seeing) and increased frequency of texts sent to providers if answers indicate rising illness levels. An app for both data/entry, viewing disease trends, and consumption of educational content would facilitate expansion into other child care centers. 5.) Expansion to larger national chain child care centers to support both regional and national illness monitoring, data collection, and educational support for child care centers to improve children's health in early learning settings. 6.) Collaboration with the Centers for Disease Control and Prevention (CDC) for reporting on illness (influenza) in a very vulnerable demographic.

Business Viability: How viable is your business model? (1500 characters)

Child care center owners and directors have a vested business interest in keeping children and child care center staff healthy. Children constantly have runny nose and cough, and so excluding all these children is not feasible from a business perspective. Having access to information about circulating symptoms and illnesses is advantageous for child care centers: 1.) Cleaning and disinfecting the center is a substantial burden - knowing when to clean and how often is valuable information to a center 2.) Child care centers often disseminate health and safety information to parents based on circulating illnesses - having access to knowledge about what diseases are in the community and information for parents that are evidence-based and American Academy of Pediatrics approved will be key in helping parents prevent illness and keep the child healthy 3.) Knowing when to encourage vaccinations (influenza) is critical for both child care staff and reminding parents 4.) Disease forecasting based child care centers reporting for optimization when screening for disease and anticipating when up-staffing will need to occur - all are reasons this business model will succeed. 5.) Finally as more health systems and insurance companies begin exploring telemedicine opportunities, we anticipate that child care centers (especially larger chains) will be looking for ways to connect to primary care physicians for potential advice about inclusion or exclusion of children, or evaluation of mildl

HCD: How have you used human centered design to build or refine your concept? (1500 characters)

Development of MCRISP concept began about 10 years ago. In our study of over 300 child care centers that was published in Pediatrics (http://pediatrics.aappublications.org/content/125/5/1003.short), we interviewed over 300 child care center directors and found that there were high rates of children being sent home unnecessarily, mainly because directors were unaware of national American Academy of Pediatrics child care illness guidelines. We then held several focus group of inner-city and suburban child care center directors and parents with children in child care to find out what the challenges and obstacles were related to preventing and managing sick children in child care. Using feedback from both parents and child care center directors, I then began developing a web-based platform that would not only encourage disease reporting as a public health surveillance tool, but that could be used as a platform to communicate tailored, relevant information about disease management and prevention. Our pilot that began with four child care centers has been published in the peer-reviewed journal of Health Security http://online.liebertpub.com/doi/abs/10.1089/hs.2016.0124. When developing this platform we trained child care center directors about disease management, toured facilities, and have obtained feedback via survey this past summer to ensure that the MCRISP platform remains relevant and user-friendly.

Tell us more about you (3000 characters)

Dr Hashikawa is a Pediatric Emergency Medicine at the University of Michigan. He earned his MD and completed Pediatric residency at the Mayo Clinic. He completed a PEM fellowship/Masters (Epidemiology) at the Medical College of Wisconsin. Dr Hashikawa has served as the AAP Michigan Early Childhood Champion (since 2011). He was awarded AAP Healthy Futures, Building Bridges, and CATCH grants. He led the effort for creating the new AAP’s Healthy Futures Curriculum for Injury Prevention. He has experience working closely with child care centers to promote policies to reduce child care-related infections He has substantial experience in community-based education and training of child care and preschool workers on infectious diseases, injury prevention, medication safety, and disaster preparedness. He has built partnerships with community based agencies and received several community-based grants from the AAP that have enabled him to build partnerships with local child care center networks and the public health department. Nationally, he is a member of the AAP Executive Committee on the Council of Early Childhood and a member of the National Resource Center’s Injury Prevention and Infectious Disease Panel Advisory Groups charged with revising and updating the 3rd edition of the Caring for Our Children, joint standards published by the American Public Health Association and the AAP. He serves as a local child care health consultant, has provided over 100 health lectures for child care providers since 2012, and works with pediatric residents to engage them in presenting lectures to child care providers. His research focuses on child care environments and health outcomes, including infectious diseases, injury prevention, and disaster preparedness. He has presented at AAP, PAS, and APHA national meetings and published child care-based research examining unnecessary exclusion of mildly ill children from child care (Pediatrics, 2010); child care directors’ return to care practices for mildly ill children (Pediatrics, 2012); impact of illness for children in child care on parents’ need to use emergency and urgent care services (Pediatrics, 2014), and disaster preparedness in child care centers (Pediatric Emergency Care, 2016).

Do you have the people and partners you need to do what you’ve described? (500 characters)

1. Public Health Department 2. Infectious and communicable disease expert (University of Michigan School of Public Health - Department of Epidemiology) - Dr. Emily Toth Martin in the University of Michigan School of Public Health with expertise in pediatric infections, infectious diseases transmission, epidemiology, evaluation of methods. 3. Computer Disease Modeling: Dr. Michael Hayashi (University of Michigan School of Public Health), an expert in mathematical modeling, dynamical systems, n

As you consider your next steps, what kinds of help could you use? Is there a type of expertise that would be most helpful? (1800 characters)

Expertise related to expanding networks or platforms that have leveraged crowd-sourcing to provide data and wisdom on how to best disseminate sometimes complex information in a user-friendly, but effective manner to continue to provide regular feedback to users of the system.

Would you like mentoring support? [Relevant only for Early Submission Deadline]

  • Yes

If so, what type of mentoring support do you think you need? (1200 characters) [Relevant only for Early Submission Deadline]

No longer applicable.

Mentorship: How was your idea supported? [Relevant only for our early submission participants] (1500 characters)

Feedback from the mentor was invaluable in several ways: 1.) Forced us to concentrate on the story-telling aspect 2.) Narrow our focus

Are you willing to share your email contact information submitted on OpenIDEO with Gary Community Investments?

  • Yes, share my contact information

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