Developing an evaluation strategy for a multi-disciplinary clinic for undernourished children

Failure to thrive (FTT) among children is a complex condition of undernutrition that has several contributing factors, including underlying medical conditions, socioeconomic status, and interpersonal and individual behaviors. Long-term health effects of FTT include poor cognitive and social development and poor overall, behavioral and mental health. Immediate, comprehensive treatment for FTT is important because the first three years of life, when most FTT is diagnosed, is the most critical time for brain growth and cognitive development. The Philadelphia GROW Clinic's multidisciplinary team treats children with FTT and their families with on-site medical, psychiatric, nutritional, and social work services. The team also works closely with public health researchers in developing and implementing the evaluation strategy.

Evaluation of the Clinic's efforts is complex because it must respond to a variety of stakeholders. Not only must the Clinic demonstrate improvement in clinical outcomes, but also how the team's efforts lead to such improvement for research, fundraising and advocacy purposes. The evaluation strategy must incorporate measures of changes in growth as well as behavioral change among patients and their families, and linkage to appropriate social services. We discuss how these factors create opportunities and challenges to developing an appropriate evaluation strategy as well as other considerations, such as dependence on paper charts, the need for a strategy that facilitates constant, timely review, and the differences in evaluation terminology used by the Clinic team and researchers. Finally, we describe the evaluation strategy itself, including data collection, analysis, reporting and dissemination.