Calvin C.J. Sia (born Calvin Chia Jung Sia; June 3, 1927 – August 19, 2020) was a primary care pediatrician from Hawaii who developed innovative programs to improve the quality of medical care for children in the United States and Asia. Two particular programs have been implemented across America: the Medical Home concept for primary care that has been promoted by the American Academy of Pediatrics and the federal Emergency Medical Services for Children program administered by the U.S. Department of Health and Human Services’ Health Resources and Services Administration, Maternal and Child Health Bureau. His Medical Home model for pediatric care and early childhood development began to take root in several Asian countries in 2003.
Sia also created the Hawaii Healthy Start Home Visiting Program to prevent child abuse and neglect and co-founded Hawaii's Zero to Three program and Healthy and Ready to Learn Center. The Hawaii Healthy Start program, which targets expecting and new parents who may be at risk of abusing or neglecting their children, became the model for the Healthy Families America home visiting program that the United States Department of Justice's Office of Justice Programs identified in 2010 as a "promising" approach to child abuse prevention. The Healthy and Ready to Learn Center was a three-year pilot project to initiate training and health delivery services in an integrated system of care, with pediatric residents and graduate students in social work and early childhood education working as a team.
In addition, Sia spearheaded the creation of the Variety School for learning disabled children, a Honolulu-based educational institution for children ages 5 through 13.
Education Sia was a 1945 graduate of Punahou School in Honolulu and a graduate of Dartmouth College in 1950. He received his medical degree at Western Reserve University School of Medicine in 1955 and did a general rotating internship as a lieutenant in the U.S. Army Medical Corps at William Beaumont Army Hospital in El Paso, Texas from 1955 to 1956. Sia then served his pediatric residency under Dr. Irvine McQuarrie at Kauikeolani Children's Hospital in Honolulu, and obtained his license to practice medicine in Hawaii in 1958. He was certified by the American Board of Pediatrics in 1960 and recertified in 1987. The University of Hawaii awarded Sia an honorary Doctor of Humane Letters degree in 1992.
Public service
Early years As a young practicing pediatrician, Sia joined the early cadre of American Academy of Pediatrics consultants for Head Start and Parent Child Centers in Hawaii in the 1960s and developed a strong interest in prenatal, neonatal, and postnatal causes of physical and mental disabilities in children. In a paper he presented in 1964 to the Hawaii Academy of Sciences on advances in neonatology, Sia cited progress in the care of premature babies but also noted that "completeness" of the first physical exam and the education of nurses to be on the alert for early signs of disabilities were possible ways to save newborns with previously lethal birth defects. He concluded by observing, "One of the basic problems will be in solving the causes and prevention of prematurity."
Inspired by one of his mentors, Dr. Robert E. Cooke, the Johns Hopkins pediatrician behind the creation of the Hopkins hospital's Kennedy Institute for Handicapped Children, Sia helped establish Hawaii's Variety School for Learning Disabilities in 1967 and served as chairman of its board of directors for many years. Sia broadened the scope of his community work to address all children with special health care needs. In the early 1970s, he invited Dr. C. Henry Kempe, founder of the Denver-based National Center for the Prevention and Treatment of Child Abuse and Neglect, and Dr. Ray E. Helfer of Michigan—two pioneers in the identification and treatment of child abuse—to help him and a small group of child advocates develop a plan to prevent and treat child abuse and neglect in the islands. That effort netted one of the first 12 demonstration grant awards by the newly created National Center on Child Abuse and Neglect in 1975, with $1 million going to establish the first Hawaii Family Stress Center. The center, later renamed the Hawaii Family Support Center, established several child abuse and neglect programs on Oahu, including a home-visiting program based on Kempe's effective use of "lay therapists." These were home visitors from the community, properly trained and supervised by public health nurses and social workers who could earn the trust of at-risk families and focus on family strengths to reduce environmental risk and prevent child abuse and neglect. The center's goal was to identify vulnerable families before their day-to-day stresses, isolation, and lack of parenting knowledge and good role models gave rise to abusive and neglectful behavior.
The center's operations coincided with an effort launched by Dr. Vince L. Hutchins and Dr. Merle McPherson of the Maternal and Child Health Bureau in 1977 to revise and update the mission of the federal agency's Title V and companion "crippled children's" programs to address child development and the prevention of developmental, behavioral and psychosocial problems. McPherson took note of Sia's call for a continuous system of care originating with the primary care pediatrician. The AAP collaborated in this effort by asking each state's AAP chapter to develop a Child Health Plan that set priorities for using MCHB block grants. Sia spearheaded the Hawaii planning effort, bringing together representatives from the Hawaii AAP Chapter, the UH medical school, the Hawaii Medical Association, and Kapiolani Medical Center for Women and Children. Armed with anecdotal evidence showing home visitors were able to promote effective parenting and ultimately improve outcomes, the group wrote a plan that incorporated a coordinated system of care that emphasized wellness and prevention for children, especially those with special needs.
This was the birth of the Medical Home concept for primary care, to which Sia attached the slogan, “Every Child Deserves a Medical Home.” Under this idea, which the American Academy of Pediatrics adopted as a policy statement in 1992, the medical care of all infants, children and adolescents should be accessible, continuous, comprehensive, family-centered, coordinated, compassionate, and culturally effective. It should be delivered or directed by well-trained physicians who provide primary care and help to manage and facilitate essentially all aspects of pediatric care. The physician should be known to the child and family and should be able to develop a partnership of mutual responsibility and trust with them. As Sia and his co-authors of a 2006 monograph on the Medical Home noted, this new model broadens the traditional focus on acute care to include prevention and well care at one end of the continuum and chronic care management of children with special health care needs at the other. One expert observed, for example, that for a child born with spina bifida, Sia's Medical Home model would have the family and its health care provider compose a list of specialists and therapists who would be caring for the child and a timeline of anticipated surgeries and interventions. The aim would be to have as few emergencies and unanticipated events as possible.
As the lead author of an often-cited article published by the journal Pediatrics in May 2004, Sia traced the development of the Medical Home concept.
Pilot programs By 1984, Sia had begun to implement the Medical Home concept in Hawaii. As chairman of an ad hoc state legislative task force on child abuse, he persuaded Hawaii lawmakers to authorize the Hawaii Healthy Start Home Visiting Program for the prevention of child abuse and neglect. This state-funded pilot program, carried out by Hawaii Family Support Center in collaboration with the Hawaii Department of Health, focused on a neighborhood in the Ewa community on Oahu, a community with relatively high rates of child abuse and neglect. A year later, he spearheaded the Hawaii Medical Association's effort to obtain a grant from the U.S. Maternal and Child Health Bureau, under the Special Projects of Regional and National Significance (SPRANS) initiative, to train primary care physicians to provide a "Medical Home" for all children with special health care needs. The demonstration project—which sought to help first-time families give their newborn children the best start in life—was so successful it was expanded from a small part of Oahu to other areas of Hawaii, and as word of the demonstrated positive outcomes spread, Hawaii's Healthy Start became a model for parenting education programs nationwide. In the early 1990s, Healthy Families America and the National Healthy Start Association began to standardize and credential programs to ensure effectiveness and research-based practices. Across the United States, according to the MCHB, the home visiting program has shown that it can reduce child maltreatment and increase children's readiness for school.
Meanwhile, Sia launched the Hawaii Early Intervention Program for infants and toddlers in 1986 and also became actively involved with Hawaii's Early Intervention Coordinating Council for Zero to Three, placing this under Hawaii's Department of Health instead of the Department of Education. The focus of this effort was to support the Medical Home system of care with prevention and early intervention programs.
Implementation At a June 1987 conference called by Surgeon General C. Everett Koop and sponsored by the AAP and MCHB to address children with special needs, Sia and his delegation from Hawaii made a presentation of the Medical Home concept. Koop appeared to embrace it by issuing a report that endorsed a system of family-centered, community-based, coordinated care for children with special needs. This was followed in 1989 by the first National Medical Home Conference, which drew 26 AAP state chapters to Hawaii for presentations organized by Sia and MCHB officials on how to train pediatricians in the Medical Home system of care. This led to consultations to introduce the Medical Home training program to interdisciplinary teams of pediatricians, families, and other health care–related professionals in Florida, Minnesota, Nebraska, Pennsylvania, Washington and other states.
The pace of activity prompted Sia to close his private medical practice in 1996 so he could devote his time as principal investigator on various early childhood grant projects promoting the Medical Home and its integrated system of care. He launched several initiatives with a MCHB Health Education Collaboration grant in support of interprofessional training in early childhood, a Carnegie Corporation of New York Starting Points planning grant in early childhood, and Consuelo Foundation of Hawaii's Healthy and Ready to Learn grant–all with the emphasis on integrating the continuum of care of the Medical Home with other health, family, and community services from a holistic approach. The MCHB funding enabled him to travel across the country to promote the Medical Home concept to various communities, state AAP chapters, family advocacy groups and state Title V maternal and child health officers.
A three-year pilot project creating a Healthy and Ready to Learn Center in Hawaii began in 1992 and helped gauge the effectiveness of Sia's family-centered interprofessional collaboration approach. Lessons learned from this project were subsequently adopted by the Office of Children and Youth of the Governor's Office of Hawaii with Sia as Co-Principal Investigator. The Carnegie Corp. Starting Points grant then was assumed by the Good Beginnings Alliance in Hawaii.