Maternal and Child Health Training Program

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Dr. Renee Sieving, PhD, RN, FAAN, FSAHM

Dr. Renee Sieving, PhDDr. Renee Sieving, PhD, RN, FAAN, FSAHM, Nursing Faculty with the LEAH Training Program at the University of Minnesota, is working in tandem with community partners and the Centers for Disease Control (CDC)-funded Healthy Youth Development -Prevention Research Center at UMN on going to scale with an evidence-based teen pregnancy prevention program. This program, Prime Time, Exit Disclaimer has been recognized by both the U.S. Department of Health & Human Services and the CDC as effective and has now catapulted Dr. Sieving and her colleagues into an interesting translational phase of providing technical assistance and consultation to groups who wish to implement this program in their own settings. Prime Time is designed to be implemented by clinics that serve teens who are at high risk for pregnancy. The program’s aim is to reduce two primary precursors to teen pregnancy, specifically risky sexual behaviors and disconnection from school. The current translational work with Prime Time is an extension of the intervention research itself, and one Dr. Sieving and her colleagues at UMN are happy to take on, because like all of the LEAH Programs and Prevention Research Centers, the UMN Program aims to make a real difference for adolescents, health services systems, and communities! The full article, about Dr. Sieving’s work, can be accessed here. Exit Disclaimer


CMV: Interprofessional and Interagency Collaboration in Utah

group photo from CMV: Interprofessional and Interagency Collaboration in UtahCytomegalovirus (CMV) is a common virus affecting individuals of all ages, but most healthy children and adults don’t realize they have it, noticing little or no symptoms. However, if a pregnant woman has CMV during pregnancy, there can be devastating consequences to her baby. Despite this, many are not aware of the virus, its transmission or how to prevent it. It is estimated that congenital CMV is the cause of hearing loss in nearly 1 of 3 of deaf/hard of hearing children.

In 2013 legislation was passed in Utah to create public education programs to inform women and medical providers about the risk of CMV during pregnancy. From 2013-2016, the Utah Regional LEND (URLEND) program worked closely with individuals from the Utah Department of Health (UDOH) Children with Special Health Care Needs bureau, to produce CMV awareness materials, from a mini-documentary to public service announcements in both English and Spanish (health.utah.gov/CMV). group photo from CMV: Interprofessional and Interagency Collaboration in UtahAssisting with these projects were URLEND trainees from many different disciplines, including audiology, public health, dentistry, physical therapy, genetic counseling, psychology and medicine. These trainees conducted various surveys and held focus groups at community health centers and with families affected by congenital CMV. This information guided the creation of the CMV awareness materials currently in use by UDOH. URLEND trainees have also presented on CMV at the National Early Hearing Detection & Intervention (EHDI) Conferences in 2015 and 2016 (see attached photos), and at the National CMV Public Health & Policy Conference in 2014.

URLEND is proud to work with UDOH and our community partners to share this important information with pregnant women and medical providers as an outstanding model of interdisciplinary work for the URLEND trainees.


The MCH Interdisciplinary Pipeline Training Program (PTP) at the University of Wisconsin-Milwaukee (UWM)

The MCH Interdisciplinary Pipeline Training Program (PTP) at the University of Wisconsin-Milwaukee (UWM) is designed to address four critical needs in undergraduate personnel training in maternal and child health (MCH) professions, including the need for personnel prepared and committed to providing MCH services in ways that are interdisciplinary, family-centered, and community-based. One of the objectives of the program is to prepare trainees with leadership competency and interdisciplinary/ interprofessional experience, including experience with inter-organizational collaboration and awareness of long-term training in MCH. Throughout their participation in the program, trainees will interact with trainees from other disciplines and with interdisciplinary faculty members, thus supporting early interdisciplinary training across the undergraduate careers of these students. Research interns may be paired with an interdisciplinary faculty mentor if this pairing best matches the research interests of the intern. group photo at at the University of Wisconsin-Milwaukee

The program also will offer two courses in interdisciplinary research training for research interns, and a required Interdisciplinary MCH seminar for all program trainees. Eight disciplines/undergraduate majors and 10 pre-professional tracks from across four colleges/ schools come together in this program. An “interprofessional” component has been added to the final year of training where trainees will participate in UW LEND/PPC collaborative events, and will be introduced to the Care Coordination clinic at UW-LEND.

http://uwm.edu/healthsciences/maternal-and-child-health Exit Disclaimer


Boston Children’s Hospital Down Syndrome Program

group photo from Boston Children's Hospital Down Syndrome ProgramThe Down Syndrome Program provides medical and neurodevelopmental care for children with Down syndrome from birth through age 22 years. From birth to age 3 years, our program provides interdisciplinary services in which the family and child meet with a team comprised of a developmental pediatrician or nurse practitioner, physical therapist, nutritionist, speech pathologist, dentist, audiologist, and the program coordinator. For children from 3 – 22 years old, we offer personalized, multidisciplinary care including neurodevelopmental and behavioral evaluations, psychological assessments, psychiatry consultation, and customized subspecialty care.

In connection with the teaching philosophy of Boston Children’s Hospital and Harvard Medical School, the Down Syndrome Program within the Developmental Medicine Center is dedicated to training pediatricians, psychologists, developmental behavioral pediatrics fellows, and trainees in neurodevelopmental disabilities. The Down Syndrome Program also welcomes medical students, genetic counseling students, and other healthcare professionals who are interested in learning more about Down syndrome through observations. Our program is one of the oldest and largest Down Syndrome programs, and continues to serve as a model for interdisciplinary and family-centered care for individuals with Down syndrome nationally and internationally.


UIC Professor Receives Prestigious Award from the Maternal and Child Health Bureau

Photo of Dr. Arden HandlerDr. Arden Handler, professor of community health sciences, is the recipient of this year’s 2016 Vince Hutchins Partnership Award from the Maternal and Child Health Bureau (MCHB) of the U.S. Department of Health and Human Services (HRSA). Named in honor of Dr. Vince L. Hutchins, this award is presented to an outstanding individual that exemplifies skills in partnership and collaboration with Maternal and Child Health (MCH) programs.

Dr. Handler began working on behalf of women’s and children’s health during her college years at Cornell University, where she fought for women’s rights and health care for low-income families. A respected teacher and researcher at the University of Illinois at Chicago (UIC) for almost thirty years, she directs the work of the Center of Excellence in Maternal and Child Health at the UIC School of Public Health. With a five-year $1.75 million grant from HRSA, the Center is part of an elite group of only 13 such centers across the United States, and is the only one of its kind in Illinois.

“I’ve admired Arden for her decades of intellectual leadership in MCH, especially around women’s health and prenatal and preconception care,” said Dr. Michael Lu, associate administrator of the Maternal and Child Health Bureau. “But it’s her activism, championing MCH through her work with EverThrive Illinois, Illinois CHIPRA, Region V CoIIN, the Secretary’s Advisory Committee on Infant Mortality, and her tireless advocacy of and partnership with Illinois Title V program that truly exemplifies the spirit of partnership and collaboration that our beloved leader Dr. Hutchins embodies.”


Children's Vision News Story Western MA

Links to News Story with video clipHealthy Tomorrows grantee, Prevent Blindness MA, in partnership with Live Well Springfield and its Eye-See Program, recently held a community event in Springfield where 29 infants and toddlers up to three years of age were screened and examined for early vision impairments. Currently, early vision screening for children under five is limited. Prevent Blindness MA and Live Well Springfield hope to implement early vision screening in all of Springfield preschools with the spot device which is evidence-based for children between the ages of 36 to 72 months.

Children's Vision Full story Exit Disclaimer


Maternal and Child Health Pipeline Training Program (ASUMCHPTP) Alabama State University

Dexter Constant

The Alabama State University (ASU) Maternal and Child Health Pipeline Training Program (MCHPTP), is currently in its 10th year. The program, which began in 2006, was established with the goals of: (a) addressing the identified need to support efforts at the local, state and federal levels to diversify the national healthcare workforce; (b) providing enhanced academic opportunities and establishing a mentoring framework for undergraduate ASU students to explore careers in maternal and child health; and (c) to establish a sustainable undergraduate academic certificate program in maternal and child health. The MCHPTP program has had a great impact on the local, state and national levels. More than 200 students have benefited both directly and indirectly from the opportunities afforded through this grant. Many of the trainees have gone on to purse health or health-related graduate/professional studies or they are working in MCH related fields.

The program is most proud of its trainees, who are persevering despite all odds. One of those distinguished former trainees is Dexter Constant, a native of Montgomery, Alabama. Dexter became an MCHPTP trainee in 2009 with the hopes of becoming a physical therapist. Uncertain of the pathway he would take, he was still determined and dedicated to the process. Through his participation in the MCHPTP, along with the mentoring provided by the program staff, Dexter was able to find the path that led him to his ultimate passion. In May 2012, Dexter graduated with his bachelor’s degree in biology. Shortly after the commencement exercises were held, Dexter returned to ASU as one of four students to enroll in the University’s new Master of Science in Prosthetics and Orthotics (MSPO) program in the College of Health Sciences.

Dexter felt prepared to meet this next step in his professional development because of the educational foundation afforded him as an undergraduate student at ASU. His participation and involvement in organizations such as the MCHPTP and the Biomedical Club helped him gain valuable insight into health and health-related fields. In the fall of 2014, Dexter Constant received is Masters of Science degree in Prosthetics and Orthotics from Alabama State University. He was the first undergraduate from ASU to be accepted and the first African-American graduate of the program.

Dexter is currently completing his orthotic residency in Memphis, Tennessee at the Center for Orthotics and Prosthetics, Incorporated. Dr. Steven Chesbro, former Dean of the College of Health Sciences commented, “We’re excited that Dexter not only pursued a professional degree in prosthetics & orthotics, but that he selected a residency program that focused on the needs of children.” Dexter Constants’ educational and career path supports the program’s objective of increasing the number of minority health care providers who are focusing on the needs of women and children. Mrs. Catrina Waters, project coordinator for the MCHPTP also commented of Dexter’s accomplishments, “We are really excited for Dexter, and knowing he is one of the few African-Americans in the prosthetics & orthotics field, and that he chose a residency focusing on the needs of children, is exactly what the MCH Pipeline Training Program at ASU was designed to do.”

Recently, Dexter was asked to reflect on the past eight years and the impact ASU’s MCHPTP has had on his personal and professional development. He replied, “The Maternal and Child Health Pipeline Training Program was very enriching in my professional development into a healthcare profession. I was exposed to many health disparities that plague our local communities. I was given the opportunity to explore health and health-related careers in detail and learn how they each work together to provide care to not only women and children but the community as a whole. The MCHPTP piqued my interest in the realm of prosthetics and orthotics and I am proud to have been able to successfully pursue a career in P&O with a focus in pediatrics. In my current professional residency, I'm able to apply what I have learned from the pipeline program by providing patient care at Le Bonheur Children's Hospital in Memphis, Tennessee. By participating in the Alabama State University Maternal and Child Health Pipeline, I'm able to understand how to better serve our multi-cultural communities and have an increased awareness of the challenges health professions face throughout their careers.”

In this end, ASU MCHPTP continues to work towards creating a more diverse and culturally prepared workforce.


Lewis H. Margolis

Lewis H. Margolis, a pediatrician and epidemiologist, and Associate Professor of Maternal and Child Health at the University of North Carolina Gillings School of Global Public Health, assumed the role of Principal Investigator for the UNC MCHB-funded Center of Excellence. He has a wide array of research, practice and teaching interests. He serves on the UNC MCH Interdisciplinary Leadership Training Consortium, created to enhance interdisciplinary efforts to build capacity for MCH leadership development among UNC campus graduate training programs. Building on the activities of the Consortium, he was the PI on an MCHB R-40 research/training grant to examine the effects of interdisciplinary training on MCH professionals. He is one of the two lead faculty instructors for the MCH department’s redesigned year-long master’s core course, Foundations in MCH.

He serves on the UNC Center for the Study of Young Drivers, an interdisciplinary undertaking, established in 2006, to ameliorate the driving risks of this group. He has led a number of studies to evaluate the effects of graduated drivers licensing on youth and to help parents teach their teens to drive, supported from diverse sources including State Farm Insurance Companies, the NC Department of Transportation, and the Centers for Disease Control and Prevention. He has played the role of liaison between the School and assorted Title V and other public health programs throughout the Southeast, engaging in projects that translate research into practice. For example, during 2005-06 he served as PI for an MCHB R-40 research grant, Measuring the Performance of State CSHCN Systems, which explored the relationship between state capacity and the reported well-being of children and youth with special health care needs.

He served as the evaluator for North Carolina SafeKids, collaborating with this organization to understand both the recent impact of injuries on young people in North Carolina and the effectiveness of local community coalitions, and currently sits on its advisory committee. Since the establishment of the UNC MCH Workforce Development Center three years ago, he has headed the evaluation team. As an advocate, Dr. Margolis has challenged the ethics of youth football, arguing that given what is already known about the harmful consequences of traumatic brain injury, parents should find alternative physical activities for their sons.


Let’s Get Healthy California

The California Health and Human Services Agency (CHHS) and the California Department of Public Health (CDPH) announced, in January, 23 community-based health innovations that advance the Let’s Get Healthy California effort to make California the nation’s healthiest state by 2022. One of those honored was Healthy Tomorrows grantee, Clinic in the Park, led by Dr. Phyllis Agran and based at OneOC in Santa Ana, CA. Clinic in the Park received its award in the Redesigning the Health System category. Clinic in the Park is a community collaborative designed to connect young children to medical and dental homes, and to provide select screenings, and prevention services, while introducing families to the health benefits of a public park. The Clinic is held on the 2nd Sunday of the month at a Farmers Market. Let’s Get Healthy California website Exit Disclaimer


The Hospital to Medical Home Program

Hospital to Medical Home is a Healthy Tomorrows Partnership for Children Program (HTPCP) in Toledo, Ohio that connects hospitalized pediatric patients in a tertiary care center to primary care pediatric medical homes. The project utilized evaluation results to demonstrate its impact on children and families and expanded to a sustainable statewide program in partnership with the Ohio’s Maternal and Child Health Block Grant program at the Bureau for Children with Medical Handicaps.

The program utilizes a hospital based “medical home liaison (MHL)” who builds relationships with families utilizing a strength/respect based communication tool, “Listening with Connection” using precepts of Hand in Hand Parenting. The MHL meets families in the hospital and connects them to primary care providers. The liaison is intimately involved with measurement and evaluation of the program by conducting follow-up with every family both immediately after discharge from the hospital and one year later. Evaluation data shows that 97% of patients kept their first primary care appointment after hospital discharge. At one year, 95% were able to identify their primary care provider and 87% had kept “all or almost all” of their appointments with their primary care provider, subspecialists, and community resources.

In a recent interview with the National Center for Medical Home Implementation (NCMHI), project director Pam Oatis, MD, FAAP, explained that being able to quantify the impact of the project allowed hospital leadership to support the program and ensured its sustainability beyond the grant. Additionally, Ohio’s Title V program adapted the initiative on a systems/state level, providing medical home training to over 700 pediatric providers (including physicians, nurses, Head Start teachers and childcare providers). The state utilized questions from the National Survey of Children with Special Health Care Needs to evaluate, at a state level, the number of children and youth with special health care needs receiving care within a medical home as a result of the Hospital to Medical Home program. The state is currently collecting data and results will be available in the future.

The Hospital to Medical Home Program created multiple resources throughout the implementation of its HTPCP grant, including a comprehensive care notebook for families and an e-Learning module. For more information, visit the Ohio state page, Healthy Tomorrows Partnership for Children Program Web site Exit Disclaimer, or the Hand in Hand Parenting website Exit Disclaimer, or contact Dr. Oatis directly.


An Interview with Healthy Tomorrows Partnership for Children Program Grantees

Medical Care Management for Complex Prenatal Patients is a Healthy Tomorrows Partnership for Children Program (HTPCP) facilitated through St John's Well Child and Family Center in Los Angeles, California. Over 70% of the project's patients and families are of Hispanic or Latino origin. The project utilizes a bilingual care team consisting of physicians, nurse practitioners, care coordinators, a dietitian and a care manager. The team provides breastfeeding education, peer support, and connections with community services to women, mothers, infants, and children. Preliminary results demonstrate that the project has served over 800 women and successfully improved continuity of care, care coordination, increased breastfeeding initiation, and connected new mothers and infants to pediatric medical homes.

In a recent interview with the National Center for Medical Home Implementation (NCMHI), St John's Well Child and Family Center Chief Medical Officer Helen M. DuPlessis, MD, MPH, and Rebecca Sussman, MPH, Associate Director of Programs and Grants Management discussed strategies the project utilizes to enhance cultural competency, including the following:

  • Recruiting bilingual and bicultural staff who are community members and familiar with the culture and language of the project's target population.
  • Collaborating with local organizations, such as the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) to distribute culturally effective educational resources in multiple languages.
  • Continuously seeking family and patient feedback by including bicultural community members on its board of directors.

The Medical Care Management for Complex Prenatal Patients project is exploring options for sustainability by collaborating with multiple state and local organizations such as the California Community Foundation and Kaiser Permanente of South California. For more information, visit the California state page or the Healthy Tomorrows Partnership for Children Program Web site.

For more visit the National Center for Medical Home Implementation Website Exit Disclaimer


Links to the PDF of the article "Seeing Clearly" Seeing Clearly

Partnership between Healthy Tomorrows grantee, Prevent Blindness Massachusetts, and the Massachusetts Coalition for Reach Out and Read, is featured in the MA AAP winter newsletter. The article gives several tools for clinicians to use in connecting parents to the importance of healthy vision impairment.

Get a PDF copy of the Newsletter here Exit Disclaimer


MHRC's 2015 Summer Enrichment ProgramUAB MHRC SUMMER ENRICHMENT PROGRAM

Each summer, the UAB Minority Health & Health Disparities Research Center (MHRC) hosts the Summer Enrichment Program (SEP), a summer training program for undergraduate students interested in pursuing careers in healthcare. Through this program not only do students become more competitive in their applications to graduate and professional programs but many SEP participants begin research careers; thus, building the pipeline of researchers dedicated to advancing health equality. Click here to view the the full article Exit Disclaimer


NICHQ Highlights Mark Wolraich’s Work on the Vanderbilt Assessment Scale

Mark Wolraich, MDThe National Institute for Children’s Health Quality (NICHQ) recently invited Dr. Mark Wolraich, the creator of the Vanderbilt Rating Scales to share the story of the scales’ development, utility and their continued relevancy. The rate of ADHD diagnosis has jumped 15 percent in the last six years according to recent data from the Center for Disease Control and Prevention. The Vanderbilt Assessment Scale, developed by Dr. Wolraich remains a foremost tool for helping healthcare professionals diagnose the disease. The interview, “A Retrospective: The Development and Use of the Vanderbilt ADHD Behavior Rating Scales” can be accessed via the following link: http://nichq.org/blog/2015/august/adhd_wolraich Exit Disclaimer

Mark Wolraich, MD, is chief of the Section of Developmental and Behavioral Pediatrics (DBP) and directs the Oklahoma University (OU) Child Study Center. He ran the statewide program for children with Spina Bifida when he was at the University of Iowa. He has also had a strong interest and worked clinically with families of children with attention-deficit hyperactivity disorder (ADHD) for the past 39 years. Dr. Wolraich is also an inductee in the CHADD Hall of Fame and served on their Professional Advisory Board. Dr. Wolraich's research interests have focused on ADHD, the relationship between sugar and behavior, communication skills training, and spina bifida. He has received funding from the National Institutes of Health and Mental Health, the Maternal and Child Health Research Program, the National Institute on Disabilities and Rehabilitation Research, Center for Disease Control and Prevention and the Office of Special Education and Rehabilitation.


Links to AMCHP Pulse full articleMoving Toward Alignment of Early Childhood Systems: On-site with Guam

As part of their work with the National MCH Workforce Development Center (the Center) Cohort 2 intensive training and adaptive consultation, Guam is seeking to develop and implement a comprehensive plan for alignment of early childhood programs in several areas of their infrastructure, including public health and education systems. The project aims to analyze current systems of early childhood education, health and social services, develop common measures across systems and close gaps in early childhood programs. The project also seeks to implement evidence-based, family-centered practices in early childhood programs, reduce duplication of early childhood services, and increase enrollment and provision of early childhood systems to ultimately improve health outcomes of children from birth through age eight. Click here to view the the full article Exit Disclaimer


Links to AMCHP Pulse full articleHealthy Tomorrows Success Stories: Youth & Family Services, Inc. Boys' Health Advocacy Program

Who would have thought that mentoring could be so critical to a boy's health? When the Boys' Health Advocacy Program began in South Dakota 10 years ago, the advocates accepted referrals of boys, ages four to 17, with unmet health care needs and ensured that they received medical, optical, and dental care. In time, they came to realize that their clients' overall health and well-being was much more complex. Click here to view the the full article Exit Disclaimer


Dr. Arden HandlerUIC Awarded Grant for Center of Excellence in Maternal and Child Health

The School of Public Health at the University of Illinois at Chicago was awarded a five-year $1.75 million grant from the Health Resources and Services Administration (HRSA), Maternal and Child Health Bureau to fund a Center of Excellence in Maternal and Child Health. The center is a continuation of the long-standing Maternal and Child Health (MCH) Training Program at UIC, directed by Dr. Arden Handler, professor in the Division of Community Health Sciences. According to HRSA, the recently awarded Centers of Excellence in MCH will serve as "regional hubs for training, research, and innovation." Click here to view the the full article Exit Disclaimer


Healthy Tomorrows Spotlight on “Clinic in the Park” a One Stop Shop for Health

Grantee: Healthy Tomorrows Partnership for Children Program (HTPCP)

Healthy Tomorrows info booth at a public park“Clinic in the Park” is an innovative community-based program which integrates community health and primary care to provide preventive health care services to children and youth in Orange County, California. Clinic in the Park operates at a local farmer’s market during community gatherings and events. The clinic provides preventive health services to many newly insured children and their families including those related to general nutrition and behavioral health screenings.

In a recent interview with the National Center for Medical Home Implementation (NCMHI), Clinic in the Park medical director Phyllis Agran, MD, MPH, FAAP described this HTPCP project as an “enhancement to the pediatric medical home model.” Children who receive preventive services through the program are encouraged to share information provided with their primary care pediatric clinicians. As a strategy to enhance this information sharing, Dr. Agran and her team are planning to pilot medical “passports” which are used for data tracking and subsequent coordination with the child’s primary care clinician and pediatric medical home team.

A woman demonstrates good oral hygeine to a group of childrenThe clinic is also working with the local chapter of the American Academy of Pediatrics to promote coordination between Clinic in the Park and pediatric practices. Letitia Clark George, MPP, Executive Director of the AAP Orange County Chapter, works in partnership with the clinic team to encourage outreach and coordination with pediatric practices throughout the county.

For more information, visit clinicinthepark.org Exit Disclaimer


Healthy Tomorrows Spotlight: Holyoke Health Center

Starting a Community Healthy Weight Clinic

children learning about healthy eatingGrantee: Vincent Biggs, MD
Project Name: Let’s Move Holyoke 5-2-1-0
Location: Holyoke, Massachusetts

In 2008, Dr. Vincent Biggs started a healthy weight clinic, located at the Holyoke Health Center, in the Pediatrics Department. As a result, hundreds of families in this culturally and economically diverse town have benefited from nutritional counseling, physical activity recommendations and referrals to community resources.

The healthy weight clinic has seen most participating families make significant lifestyle changes. Patients are eating more fruits and vegetables, drinking fewer sugar-sweetened beverages, getting more physical activity and viewing less screen time. As a result, over a third of the clinic’s patients have decreased their body mass index (BMI). In a recent 5-month group session nearly 50 percent of the participants decreased their BMI.

Components of the Clinic:

  • Staffing: pediatrician, dietitian, case manager and medical assistant
  • Healthy Living Plan (HLP): an assessment tool which is a healthy weight plan
  • Individual Visits: Including Medical Assessment (24 hour diet recall, nutrition evaluation, specific nutritional education, goal setting, referrals if needed)
  • Group Visits: collaborative approach to learning about healthy habits which typically includes five to eight families (cooking demonstrations, topic discussions: such as preparing healthy meals and snacks, using alternative ingredients to make meals healthier, portion size, the value of fruits and vegetables and limiting sugar-sweetened beverages)

Biggs is documenting his expertise in creating and running the Holyoke clinic in a Healthy Weight Clinic Guide, which is expected to publish this spring. The purpose of the document is to guide any clinic interested in starting a healthy weight clinic. For an advance lesson on some of the top tips Dr. Vincent Biggs has to offer, visit the website. Exit Disclaimer


Dr. Maria Mercedes Avila has been awarded the Kroepsch-Maurice Excellence in Teaching Award

photo of Maria Mercedes Avila MD

Maria Mercedes Avila MD

Dr. Maria Mercedes Avila has been awarded the Kroepsch-Maurice Excellence in Teaching Award in the Assistant Professor category for 2015 at the University of Vermont. Her nominations came from students and was enthusiastically supported by faculty, for her critical work in developing a Diversity 1 course for the College of Nursing and Health Sciences at UVM.

Dr. Avila writes: “It is an honor to be recognized for my work in the D1:Racism and Health Disparities health courses, especially because I was nominated by my students. I will receive the official letter next week and there will be a ceremony in the fall. I developed this course from a 3.5-hour training “Cultural and Linguistic Competence” originally created under the Vermont Child Mental Health Initiative (SAMHSA funded project) to address and eliminate behavioral health disparities in the state. Under this model I have trained more than 1000 providers and now more than 600 graduate and undergraduate students at UVM. The training’s evaluation results will appear in a book “Theory to Practice: Fostering Diverse and Inclusive Campus Environments” under “Cultural Competence in Medical and Mental Health Education” (Avila & Kamon) this spring; and in the Journal of Cultural Diversity: An Interdisciplinary Journal as “Addressing Health Disparities through Cultural and Linguistic Competence Trainings” (Avila, Beatson & Kamon) this coming fall.”

Dr. Avila is a role model for us all as she works for social justice and health equity at UVM, in the state of Vermont, and nationally. Join me in congratulating Dr. Avila for this well deserved honor.


Developmental-Behavioral Pediatrics Spotlights

photo of Lauren M Hubner MD MPH

Lauren M Hubner MD MPH

Stanford University

DBP Fellow: Lauren M Hubner MD MPH
Project: Parent-reported Shared Decision-Making: Autism and Other Neurodevelopmental Disorders

Dr. Hubner, a second year fellow in DBP, undertook a secondary data analysis to understand the perceptions among parents of children with autism about their engagement in shared decision-making (SDM) with their child’s physician or other clinicians. Previous studies had found lower rates of SDM in families of children with autism than among families of all other neurodevelopmental disorders. However, differences could have been due to inclusion of children with mild conditions in the comparison group. With this limitation in mind, Dr. Hubner re-evaluated the data.

Objectives: To assess for differences in parent-reported SDM with their child’s doctor or other health care provider, in a nationally representative sample of children with one of three different and severe neurodevelopmental disorders (autism spectrum disorder [ASD], cerebral palsy [CP], Down syndrome [DS]).

Methods: This secondary analysis of data from the 2009-2010 National Survey of Children with Special Health Care Needs explored parent reports of 3966 children age 2-17 years with ASD (n=3055), CP (n=558), or DS (n=353). SDM was defined categorically (SDMcat, present or absent) and continuously (SDMcont, score range 0-12). Logistic and linear regression models adjusted for potential moderators (child/family descriptive characteristics, presence of medical home, level of functional impairment, diagnostic group).

Results: Parent-reported participation in SDM, measured categorically (SDMcat) and continuously (SDMcont), was significantly lower in the ASD group (56.7%[95% confidence interval = CI 53.4-59.9], Mean 8.7[95% CI 8.5-9.0]) compared to the CP group (70.5%[95% CI 63.4-76.7], Mean 9.7[95% CI 9.3-10.1]) or DS group (70.8%[95% CI 61.2-78.8], Mean 10.0 [95% CI 9.5-10.4]). In adjusted analyses of SDMcat and SDMcont, SDM was more likely among children with a medical home (adjusted odds ratio [AOR] 6.6, P<0.001, Mean=11.9, P<0.001), and less likely for children with greatest functional impairment (AOR 0.4, P=0.002, Mean=10.1, P=0.001). Only adjusted analysis of SDMcont showed differences based on diagnostic group, with lower SDMcont scores in ASD (Mean=10.1, P=0.005) compared to DS.

Conclusions: Medical home was associated with higher SDM. SDM was lower among children with greater functional impairment and among children with ASD. This study highlights the importance of focusing clinicians and parents to engage families in the care of the children with ASD. Her paper has been submitted for consideration of publication.


photo of Christina A Buysse MD

Christina A Buysse MD

Stanford University

DBP Fellows: Christina A Buysse MD; Lauren M Hubner MD MPH
Project: The Patient Protection and Affordable Care Act of 2010 and Children and Youth with Special Health Care Needs

The Patient Protection and Affordable Care Act (ACA: Public Law No: 111–148, March 23, 2010), the most sweeping health care regulatory reform in the United States (US) since the passage of Medicare and Medicaid in 1965, was designed to move the US toward universal and affordable health insurance coverage while simultaneously improving health outcomes and performance of the health care system. The legislation was enacted with minimal consideration for the distinctive needs of children. The faculty and fellows at Stanford University, including third year fellow Christina A Buysse MD and second year fellow Lauren M Hubner MD MPH, decided to make a study of the law the focus of their MCH Leadership course in 2014. Together, they prepared a manuscript that will be published as a Special Article in Journal of Developmental and Behavioral Pediatrics. Here are the major points:

The Patient Protection and Affordable Care Act (ACA) was designed to (1) decrease the number of uninsured Americans, (2) make health insurance and health care affordable, and (3) improve health outcomes and performance of the health care system. During the design of ACA, children in general and children and youth with special healthcare needs and disabilities (CYSHCN) were not a priority because prior to ACA a higher proportion of children than adults had insurance coverage through private family plans, Medicaid, or the State Children’s Health Insurance Programs (CHIP). ACA benefits CYSHCN through provisions designed to make health insurance coverage universal and continuous, affordable, and adequate. However, there are several limitations of ACA for CYSHCN. First, so-called grandfathered plans that were in existence before ACA are exempt from its provisions. Second, the Secretary of Health never specified national standards for essential insurance benefits, and so benefits can be decided by states and insurance plans. Third, though CHIP is slated to continue until 2019, funding is only guaranteed through 2015. The possible elimination or reductions in funding for CHIP could adversely impact CYSHCN. Finally, the law calls on the Centers for Medicare and Medicaid to fund alternative models of health care delivery. However, there is limited experience with these models in CYSHCN. In particular, the amount of savings that is possible in the care of children may be much lower than the savings in adult and elder care. Advocacy efforts on behalf of CYSHCN must track implementation of ACA at the federal and at the state level. An immediate and pressing focus for advocacy in 2015 should be continued funding for CHIP. Systems and payment reforms for health care for children and CYSHCN must emphasize access and quality improvements for CYSHCN over cost savings. Developmental-behavioral pediatrics must be represented at the policy level and in the design of new delivery models in order to assure high quality and cost-effective care for CYSHCN.


photo of Neha Patel

Neha Patel

University of Oklahoma

Our 3rd year fellow, Neha Patel, is currently working on her fellowship research study, which involves exploring how families who have a child with autism participate in family rituals, or activities that are meaningful for families. Decreased engagement in family rituals results in loss of family identity and cohesion. Past studies in families with members affected by a chronic medical illness have shown that participation in family rituals plays a protective role against anxiety and stress, but this has been less well studied in the context of autism. Her study uses qualitative research methodology known as grounded theory to better understand the experience of participating in family rituals in families affected by autism to build a plausible theoretical relationship between these experiences and family functioning. She is currently conducting audio-taped semi-structured interviews with families of children age 5-10 years who have been diagnosed with autism. Her hope is that this study will help identify challenges families face in developing and participating rituals and how they overcome them. This study is also a beginning step in exploring potential interventions and strategies that may help families to function better together and develop stronger family ties.


photo of Anacani Fonseca

Anacani Fonseca

Medical University of South Carolina

Anacani Fonseca is a first year fellow in Developmental and Behavioral Pediatrics training program at the Medical University of South Carolina. She is also participating as a LEND trainee this year and her group project has focused on the improvement of transition planning for adolescents and young adults with Autism Spectrum Disorders (ASD) and Developmental Disabilities (DD). The project has included the administration of the Children’s Assessment of Activities and Participation (CAPE). The CAPE is a tool used to help identify what activities adolescents enjoy, what they are actually involved in and what they would like to be involved in. Parents of children and adolescents with ASD and DD have also been interviewed to survey gaps in transition services and to assess community needs. Dr. Fonseca attended South Carolina’s Interagency Transition Conference, Building Bridges: Construction and Navigating Transition Services for Youth with Disabilities. She has also been involved with the Charleston Coalition Action Network which is a community organization working to improve education, independent living, transportation, employment and resources in the community for adolescents and adults with ASD and DD. Ultimately the project will lead to the production of a transition guide that will be utilized in MUSC clinics and in the community to assist parents and children as they navigate the transition process in hopes of making all individuals as successful and independent as possible.


photo of Marisa Toomey, MD

Marisa Toomey, MD

The Children’s Hospital of Philadelphia

Preliminary Validation of the PROMIS® Pediatric Parent-Proxy Peer Relationships Measure in Children with Autism Spectrum Disorder: A Developmental Behavioral Pediatrics Research Network Study

One of the core features of Autism Spectrum Disorder (ASD) is impairment in social interactions, which often creates difficulties in peer relationships. Prior research has shown that the severity of ASD symptoms and co-existing intellectual disabilities can negatively impact the ability of children with ASD to interact with their peers. Although the importance of studying interventions to improve social functioning in children with ASD has been emphasized, few tools exist to effectively evaluate peer relationships in such children. In 2004, the National Institutes of Health initiated a program, known as the Patient Reported Outcome Measurement Information System (PROMIS®) to develop publically available, valid, and efficient patient-reported outcomes. PROMIS® measures are item banks developed using qualitative methods, classical test theory, and item-response theory. They can be administered using computerized adaptive testing, which reduces respondent burden while maintaining measurement precision.

Peer Relationships is a PROMIS® pediatric parent-proxy measure that has been validated for the assessment of quality of childhood friendships. It has not yet been studied in children with ASD.

The goals of our project are:

  • To determine whether the PROMIS® pediatric parent-proxy Peer Relationships measure assesses the full range of the trait with acceptable precision in 5-12 year old children with ASD.
  • To determine whether intellectual functioning and ASD-specific symptom severity are associated with scores on the PROMIS® Peer Relationships measure in the manner predicted based on existing literature.

Parents of children with a diagnosis of ASD will be enrolled at three sites that participate in the Developmental-Behavioral Pediatrics Research Network (DBPNet). Inclusion criteria are children between 5-12 years old who have a confirmed diagnosis of ASD and who have had an IQ test or global developmental assessment performed at age 48 months or older. Exclusion criteria include children with moderate-to-severe hearing or vision impairment, children with profound intellectual disability, and parental inability to communicate via English or Spanish.

Parents who enroll in the study are able to access a secure website in order to complete a consent form, demographic form, the PROMIS® pediatric parent-proxy Peer Relationships measure, and the Social Responsiveness Scale, 2nd Edition (as a marker of ASD severity).

We are currently in the data collection and analysis phase of our study. Full analysis will include measurement of the distribution of IRT-based theta estimates and standard errors. We will compare these distributions to the distributions in the normative sample. We will also calculate correlation coefficients between the Peer Relationships scores and the children’s ASD severities and cognitive levels.

We hope to determine if the PROMIS® pediatric parent-proxy Peer Relationships measure can serve as an efficient, precise, and valid measure of peer relationships in 5-12 children with ASD.


photo of Boston DBP Fellows

Thusa Sabapathy, MD

Children’s Hospital Los Angeles

Fellow Spotlight: Thusa Sabapathy, MD

Dr. Sabapathy is a second year MCHB Developmental-Behavioral Pediatric (DBP) fellow at Children’s Hospital Los Angeles who is studying the use of strength based approaches with families of children with autism spectrum disorders (ASD). She also completed the CA-LEND long term training last year.

As more and more families are presenting for comprehensive developmental evaluations, there is a growing interest in including discussions about the positive aspects of the child, in addition to discussing parental concerns. DBPs have a unique opportunity in supporting families with children with ASD and help decrease stress in their caregivers. There is a need to encourage more clinicians to discuss parental well-being on a more consistent basis and to increase awareness of the positive contributions their child makes to the family.

Dr. Sabapathy is currently working on her fellowship research project, which is a mixed methods, cross sectional observational study of children between the ages of 3-8 years who presented for an interdisciplinary team diagnostic evaluation and were found to meet diagnostic criteria for Autism spectrum disorders. Her research project explores the relationship between child difficult behaviors and parenting stress, and examines whether this relationship is moderated by the child’s strengths listed by the parent. Potential implications of her study are that by increasing awareness of a child’s strengths in this population can help support families to find hope, empower families to build upon those strengths at home, and be incorporated into subsequent interventions.


photo of Boston DBP Fellows

Boston DBP Fellows

Boston Children’s Hospital

It is well-documented that children with Autism Spectrum Disorder (ASD) require increased health care services even when compared to other children with Special Health Care Needs. However they often have difficulty accessing appropriate care. At Boston Children’s Hospital (BCH), anecdotes of delayed or missed care are common for patients with ASD, in part due to parent concerns about their child’s behaviors. To address this issue, the BCH Autism Spectrum Center launched an "Autism Friendly Hospital" initiative which included development of strategies to support patients with ASD in the hospital including staff trainings. Given the paucity of training provided to non-clinical personnel who are often the first in contact with patients with ASD and their families, my fellow’s quality improvement project sought to address this need in this population.

As part of a grant through the BCH Program for Patient Safety and Quality, we are delivering and analyzing the efficacy of a multidisciplinary, multimodal trainings to non-clinical personnel to improve their knowledge, comfort and competency in working with patients with ASD. We identified 8 hospital departments most frequented by patients with ASD including Neurology, Development, Psychiatry, Audiology EEG, phlebotomy and some of the BCH satellite multispecialty clinics. Trainings are tailored to specific departments after a thorough online and in-person needs assessment. An online module with basic ASD knowledge is followed by an in-person training that includes video, case discussion, and reflection delivered by a multidisciplinary team of ASD-trained clinicians. Pre- and post-training assessments of staff knowledge, behaviors, and attitudes are collected via electronic surveys. We are also aiming to capture the more distal outcome of family access to and experience of care though the Autism Barriers to Care survey that was developed in the Autism Spectrum Center. This survey asks parents about experiences obtaining recommended care as well as their overall hospital experience, and we hope to see improvement in a variety of measures as departments are trained over time. Ultimately, we hope this quality improvement project will increase the capacity of hospital personnel to deliver appropriate care to ASD patients, and improve the patient and family care experience at BCH. We will refine our model as we move through training cycles, to develop an optimal and feasible curriculum that will eventually be disseminated more widely throughout our institution and potentially to other institutions.


photo of Dr. Ayesha Cheema-Hasan

Dr. Ayesha Cheema-Hasan

Rhode Island Hospital (RIH)/Hasbro Children’s Hospital (HCH)/Brown University and Rhode Island Consortium for Autism Research and Treatment (RI-CART)

Autism Research in Teens Utilizing the Rhode Island Statewide Autism Registry

Study Title: Evaluation of PROMIS Self Report for Peer Relationship and Psychological Distress in Teens with High Functioning Autism Spectrum Disorders

Autism Spectrum Disorder (ASD) affects as many as 1 in 68 children. Despite the fact that ASD is this common, there are no widely accepted way to measure the outcome of medical care or educational interventions for children and youth with ASD. In particular, patient reported outcomes are needed. The NIH has developed the Patient Reported Outcome Measurement Information System (PROMIS) to provide tools for assessments in children and adults with many medical concerns, but they have not been used for or validated in children and youth with ASD.

Dr. Ayesha Cheema-Hasan, a 2nd year Developmental Behavioral Pediatric (DBP) fellow at Brown University/Hasbro Children’s Hospital, is conducting a study to test whether the PROMIS Pediatric Peer Relationships and Psychological Distress Response surveys are accurate and valid measures for self report assessment in youth with high functioning ASDs. She also seeks to understand whether these youth find that the PROMIS measures accurately assess the constructs of Peer Relationships and Psychological Distress for them.

Dr. Cheema-Hasan plans to utilize the Rhode Island Consortium for Autism Research and Treatment (RI-CART) registry to find 100 youth with high functioning ASD between 12-17 years of age and their parents who are interested in participating in her study. RI-CART is composed of a wide array of individuals, including psychologists and parents, nurses and teachers, speech pathologists and psychiatrists, pediatricians, neurologists, scientists and researchers working tirelessly to help people with ASDs in Rhode Island and neighboring states. Its mission is to improve the lives of individuals with autism spectrum disorders by promoting collaborative, cutting-edge research, improving health care and support services, and providing data-driven education and advocacy.

photo of Dr. Pei-Chi Wu

Dr. Pei-Chi Wu

Eligible youth will be those enrolled in RI-CART who have completed a Module 3 or 4 of the Autism Diagnostic Observation Schedule-2nd Edition (ADOS -2). Dr. Pei-Chi Wu, DBP faculty member at Brown University/Hasbro Children’s Hospital and a former fellow in the program, is mentoring Dr. Cheema-Hasan in this work. RI-CART has enrolled over 600 participants to date, with over 100 of these between the ages of 11 and 17 years and having completed Module 3 or 4 of the ADOS -2. Interested parents will complete parent proxy PROMIS measures for peer relationships and psychological distress. Interested youth will be screened for their reading level using the Rapid Estimate of Adolescent Literacy in Medicine, a list of 60 medical words. Those reading at or above a 3rd grade level will be enrolled and will complete both PROMIS measures of Peer Relationships and Psychological Distress on an iPAD. Each measure will contain no more than 8 questions. They will also complete the Youth Strength and Difficulty Questionnaire which has 25 questions. Of these 100 youth, 40 of them will be recruited to participate in individual interviews immediately after they complete the PROMIS measures. Interviews will explore how comprehensively and appropriately the PROMIS measures assess the characteristics of peer relationships and psychological distress for them.

The DBP team at Brown University/Hasbro Children’s Hospital is excited about this collaboration with RI-CART, and possibly giving teens with high functioning ASD a voice in their own care.


photo of Morgan White

Morgan White

University of California, Davis

Sex Differences in Maternal Auto-antibody Related (MAR) Autism

The Autism Spectrum is a heterogeneous group of disorders encompassing a wide range of atypical behaviors.  Distinct clinical patterns of behavior and co-morbidity may allow for some differentiation of disease within this spectrum.   Once identified, the etiology of specific phenotypes can then be more accurately pursued. 

An emerging area of research points to maternal auto-antibodies against specific proteins in the developing brain as a risk factor for autism.  Using the CHARGE (Childhood Autism Risks from Genetics and the Environment) study, it was found that 23% of a sample of children with ASD had mothers with a specific combination of auto-antibodies against fetal brain.  Only 1% of typically developing children’s mothers had the same combinations of antibodies (1).   Preliminary evidence suggests that autism characteristics related to such antibodies may differ between the sexes.  
My research will examine the developmental and behavioral characteristics of maternal antibody related (MAR) autism and how it varies based on sex.  Using the CHARGE study, children of mothers with positive ASD specific antibody patterns will be compared to children of ASD specific antibody negative mothers on measures of behavior, adaptive functioning and development.  Additionally, we will explore how MAR positive autism differs between males and females when compared to MAR negative autism.  We plan to examine behavior with the Autism Diagnostic Observation Schedule, Aberrant Behavior Checklist and Vineland Adaptive Behavior Scales.  Development will be compared using the Mullen Scales of Early Learning. 

1. Braunschweig D, Krakowiak P, Duncanson P, Boyce R, Hansen RL, Ashwood P, Hertz-Picciotto I, Pessah IN, Van de Water J. Autism-specific maternal autoantibodies recognize critical proteins in developing brain. Translational Psychiatry. 2013; 3:e277

Healthy Tomorrows Partnership for Children Program, Hawaii

Q: What is the focus of your project?
Kokua Kalihi Valley Health Center (KKV) is in a unique position because it is located at the doorstep of a community that has a high concentration of Pacific Islander, Asian, immigrant and local families. Through Maternal Child Health (MCH) services, and the Healthy Tomorrows Hawaii project, KKV strives to address health determinants, such as, poverty, low-literacy rates, poor health outcomes, homelessness, and cultural and language barriers. Healthy Tomorrows Hawaii works to identify needs and gaps in services, and bring collaborative partners together to increase resources and services focused on child and family strengthening, health and wellbeing like CenteringPregnancy and parenting programs.

Q: What roles do family members play in your project?
The Healthy Tomorrows Hawaii project provides KKV the opportunity to invite family members to participate in planning, decision-making and provide cultural guidance in our work. The information and cultural perspective they bring to the table is instrumental in decision-making and meeting of family needs. An example is families waiting for medical appointments at `Ohana Play and Learn and PEDS clinic wait rooms asked for informal “Talk Story” culturally appropriate parenting classes with language interpretation. Recently, we launched two “Parent Talk Story Time” groups, held monthly to provide parenting education in a talk story format while sitting on mats and playing together.

Q: How has involving families improved your practice and your community?
We have both community and parent Advisory Board help guide our patient-centered cultural practices and Family Strengthening programs. These programs engage families in “sharing conversations” that provide them the opportunity to share their stories, ask questions and learn together, as they play with children. It also allows staff the opportunity to learn about the needs and barriers facing families. Based on what we learn from families we can share resources and information. It further offers unexpected opportunities for our team to assess family needs and expand services. A Chuukese-Phonpeian speaking Peer Parent Educator provides guidance on child development and parenting and does “warm hand-offs” as needed.

Q: What recommendations and tips can you provide for other projects that are interested in further involving families?
The best service we can give our families is to be respectful listeners of their stories. By listening we learn. By learning, we can assess, plan and implement culturally appropriate programs and services. When we take time to engage families, listen and include them in decision-making it allows them to feel respected and valued as their children’s primary care giver. Families are our teaching partners. They help to make our work meaningful and joyful.

Contact:

Healthy Tomorrows Hawaii Project Coordinator
Kokua Kalihi Valley Comprehensive Family Services
Honolulu, Hi 96819

photo of mother, child and Health Tomorrows Program staff

Peer Parent Educator talks with parent about child's development. "Look what baby can do, Mom!"

photo: Collaborative partners teach hands-on learning (poi pounding)

Collaborative partners teach hands-on learning (poi pounding)

photo:  CenteringParenting group parents learn how to do health assessments on baby.

CenteringParenting group parents learn how to do health assessments on baby.

photo:  'Ohana Play and Learn waiting room, where children and parents play and learn together as they wait for appointments.

'Ohana Play and Learn waiting room, where children and parents play and learn together as they wait for appointments.


Children’s Hospital Boston Community Asthma Initiative - Boston, MA

photo of Elizabeth R. Woods, MD, MPH

Elizabeth R. Woods, MD, MPH

Q: What is the name of your project?
Children’s Hospital Boston Community Asthma Initiative

Q: What is your project trying to achieve?
To address health disparities and improve asthma health outcomes by providing asthma education, case management, home visits, and environmental assessment and remediation.

Q: What are the next steps for your project?
CAI and some of our other partners are working with Massachusetts Medicaid to develop an asthma bundled payment pilot. CAI is also collaborating with other community agencies to develop efficient/effective asthma case management and home visiting programs that can be replicated nationally and can explore novel reimbursement systems with payers to ultimately address social determinants of health and improve outcomes.

 

Q: What community partners are involved in your CAI Project?

  • Parents and families of children served by CAI
  • Boston Y’s (previously called YMCA’s/YWCA’s)
  • Action for Boston Community Development (ABCD), Inc.’s Head Start programs
  • Community health centers including Martha Eliot Health Center
  • ESAC/Boston Asthma Initiative (BAI)
  • Boston Public Health Commission
  • Asthma Regional Council
  • Boston Healthy Homes and Schools Collaborative (formerly called BUAC)
  • Boston Public Schools
  • Brigham and Women’s Hospital Community Programs
  • Children’s Office of Child Advocacy, Asthma Quality Program and primary care programs

Q: Please describe the most important changes that have occurred within your local community as a result of having a HTPCP project in that community.
Group photo of project staffAs of September 30, 2011, from parental reports at 12 months compared to pre‐enrollment, there were significant reductions in any ED visits (62% reduction, p<0.001), hospitalizations (81% reduction, p<0.001), days of limited physical activity (31% reduction, p<0.001), missed school days (43% reduction, p<0.001), missed work days for parents (47% reduction, p<0.001), and an increase in current asthma action plans (48% increase, p<0.001).

Q: Has the project experienced challenges/anything that was not anticipated?
One of the barriers to progress continues to be the difficultly connecting to families for follow‐up, especially the 12‐month questionnaire. Because cell phone numbers often change or are disconnected, reaching families is always challenging. To overcome this barrier, CAI sent reminder letters to families. Another barrier is that some families were resistant to initial outreach and/or denied services offered by the program. To combat this challenge, the clinical director or nurse case manager monitored inpatient and emergency department computer logs to try to meet the families in person. They also connected to patients through primary care or subspecialty clinics. Barriers to home visits included overwhelming demands on parents’ time, as well as work and school schedules that did not allow for visits during regular work hours. CAI accommodated parents’ schedules by offering evening and weekend visit times. Having bilingual (Spanish‐ speaking)/bicultural staff who were from the communities served also had a positive impact.

Q: What is your plan for evaluating the project?
CAI is evaluated through parent‐completed interviews at enrollment as well as 6‐months and 12‐ months post‐enrollment. Data evaluated included ED visits, hospitalizations, missed school and work days, days with limitation in physical activity, and having an up‐to‐date asthma action plan.

Young african american girl and mother in a medical settingQ: Overall, what would you say about your HTPCP experience?
We are grateful for funding from HTPCP and the connection to local, regional and national collaborations.

Q: Any last words?
CAI has remarkably improved health outcomes and the return on investment indicates that it is a cost‐ effective intervention. This model of asthma care has generated information to develop policy advocacy efforts to improve services and financing of enhanced asthma care. Health care reform offers an opportunity to develop bundled or global payment approaches for care that improves quality measures and reduces cost with potential for shared savings for providers and payers.



Well Care and Adolescent Immunizations in Rochester (WECAIR) - Rochester, NY

photo of Peter Szilagyi, MD, MPH, FAAP

Peter Szilagyi, MD, MPH, FAAP

Q: What is your project name?
Well Care and Adolescent Immunizations in Rochester (WECAIR)

Q: What is your project trying to achieve?
Improve receipt of preventive care services (immunizations, preventive visits, screening tests, anticipatory guidance) among inner‐city adolescents.

Q: How do you define community pediatrics?
A comprehensive approach to pediatric care that encompasses the family, primary care medical home, and a variety of community‐based organizations and services.

Q: Describe your community pediatrics work in the area where you live and/or practice.
In collaboration with other community pediatricians, human service providers, insurers, policy makers and parents we are working together to promote and strengthen access to and utilization of quality preventive health care for underserved and vulnerable teens in our community. The program model relies on patient navigators (outreach workers) based in large urban practices that serve low‐income adolescents. The navigators follow an evidenced based, tiered approach to systematically track patients receipt of immunizations and preventive services, perform reminders, recall, and if needed home visits to engage families in primary care and connect families to other needed community services. We are serving several thousand urban adolescents.

Q: What are the next steps for your project?
This upcoming year we will work with primary care practices and one of our community partners (Metro Council for Teen Potential) to develop and implement quality improvement initiatives to reduce high‐risk behaviors among youth.

Q: What community partners are involved in your project?

  • Metro Council for Teen Potential (a consortium of organizations all focused on improving health and social services for high‐risk youth)
  • The Monroe Plan and Mohawk Valley Plan (MVP)—the two dominant insurers for Medicaid and CHIP (and commercial) Primary care practices
  • Three hospital systems
  • NYSDOH (Title V) and District II AAP chapter
  • And of course the families and adolescents receiving our services

Q: Please describe the most important changes that have occurred within your local community as a result of having a HTPCP project in that community.
Our preliminary work, funded by the Greater Rochester Health Foundation, demonstrated that the navigator (outreach) program improved both immunization rates and preventive care visits by more than 10% across the city of Rochester.

Q: Has the project experienced challenges that were not anticipated?
Several practices are implementing electronic medical records at the same time as the Healthy Tomorrows Program, requiring revision to work flow and provider communication processes. Although the transition is initially slowing project progress, ultimately the EMR’s should create greater efficiency for the navigators.

Q: What is your plan for evaluating the project?
We will evaluate, on an annual basis, (a) immunization rates, (b) receipt of preventive services among the population and also across the city of Rochester and Monroe County, using medical chart reviews, insurer claims, and NYS immunization registry data).

Q: Overall, what would you say about your HTPCP experience?
The HTPCP program is inspiring! The HTPCP encourages us to focus on important Bright Futures components, vulnerable populations, and evidence‐based methods. When you consider that we are but one program, and there are many analogous programs across the US, we are inspired!

Q: Any last words?
Strong community collaboration that includes data exchanges with Medicaid Managed Care Plans, guidance from parents and grass roots organizations , and engagement of community pediatric programs in the initiative have been critical to the successful implementation of the project.



AAP Ohio Chapter Receives Healthy Tomorrows Grant to Support Quality Improvement Initiative

From the Ohio Chapter, American Academy of Pediatrics

Ohio Healthy Tomorrow Grant

The Ohio Chapter, American Academy of Pediatrics has a history of using quality improvement methodology to address important issues in child health, such as asthma, childhood obesity, and autism. Now, with the support of a Healthy Tomorrows Partnership for Children grant, the Chapter is expanding the reach of one quality improvement program focused on the prevention of infant mortality. This project uses an innovative combination of providing anticipatory guidance and products, and has shown improvements in pediatric practitioner injury counseling and self-reported changes by parents to practice safer behaviors.

The Injury Prevention Learning Collaborative, which launched a pilot wave in 2012, incorporated a specific focus on safe sleep. The program uses age-appropriate screening tools (birth-4 months and 6 months-1year) to determine areas where parents may be unaware of injury risks such as co-sleeping or items in cribs, and offers clinicians standard injury prevention advice to discuss with families based on their screened responses. During the second wave of the project, from October 2013 to May 2014, nearly 2,500 sleep sacks were distributed, with injury anticipatory guidance, through participating practices at well-child visits because research has shown that families tend to practice safer behaviors if given the information along with specific products.1,2

Additional questions on the age-appropriate screening tools addressing other safety topics include:

  • Car Safety
  • Choking
  • Fall Prevention
  • Family Interactions
  • Fire/Burn
  • Home Safety
  • Play Safety
  • Unintentional Ingestions
  • Water Safety

Participating practices saw an increase in discussions with families on all age-appropriate injury prevention topics from about 15% at baseline to 84% by the close of the project only 7 months later. Safe sleep discussions in the newborn to 4-month well-child visits increased from 18% to almost 90%. The project also measured self-reported changes in behavior by parents following anticipatory guidance provided at each well-child visit. In the newborn to 4-month visits, 52% of families made at least one change to improve safety practices for their child based on counseling they received from the primary care provider. For 6-month to 12-month visits, 62% of families made a change to at least one-parenting practice , reported at subsequent visits.

In addition to safety behavior changes reported by families , providers who participated in the project report that having a method for determining which areas of injury prevention to discuss with a family during the office visit increased their efficiency. During the Learning Collaborative practices also take part in monthly Action Period Calls, where they share experiences and receive focused education on injury prevention topics, including safety around car seats, water, sleep and food. Medical Directors Michael Gittelman, MD, FAAP and Sarah Denny, MD, FAAP lead the project. Both work directly with patients in the emergency department, and see many of the injuries addressed in this project firsthand. They used this experience, along with their passion for childhood injury prevention, to develop the screening tool and quality improvement project with the support of the Ohio AAP. Through the 5-year funding commitment of the Healthy Tomorrows grant, Drs. Denny and Gittelman have the opportunity to refine and expand the reach of this project. This includes exploring methods to test the validity of parent responses, extending the tool to reach more practitioners nationally, and expanding the tool to screen for children of older ages.

A third wave of the Injury Prevention Learning Collaborative is scheduled to begin in early spring 2015, and will include practices in Ohio as well as possible participants from other states. Participants in the Injury Prevention Learning Collaborative are eligible to receive up to 25 Maintenance of Certification Part 4 credits from the American Board of Pediatrics. Pediatric practitioners who are interested in learning about participation opportunities for upcoming waves of the project should contact Hayley Southworth at the Ohio AAP. For more information on the Healthy Tomorrows Partnership for Children, visit: http://www2.aap.org/commpeds/htpcp/. Exit Disclaimer

(1) Christophersen ER, Sullivan MA. Increasing the protection of newborn infants in cars. Pediatrics 1982; 70: 21-25.
(2) Gittelman MA, Pomerantz WJ, Laurence, S. The effects of an Emergency Department intervention on increasing booster seat usage in a high-risk population. Academic Emergency Medicine 2006; 13 (4): 396-400.



Healthy Tomorrows Partnership for Children Program Grantee Profile

Dr. Kara Gerger and child State House Advocacy DayGrantee: National Society To Prevent Blindness
Project Leads: Kira Baldonado and Kathy Majzoub, RN, MBA
Location: Boston, Massachusetts

The objectives outlined for the Healthy Eyes Healthy Futures Massachusetts project will result in earlier identification and treatment of vision problems in young children that may lead to developmental delay. Through collaboration between Prevent Blindness America, the Children’s Vision Massachusetts Coalition, experts, and key stakeholders, the project results will elevate the role of vision health in existing developmental assessment and parent education efforts in community settings and primary care practices. The outcomes of this project will lead to a reduction of visual impairment and developmental delay in high risk young children.

Q: What is your issue of focus in community pediatrics?
Vision assessment in young children is essential for the detection and treatment of amblyopia, strabismus and other conditions which may lead to vision loss. The prognosis for these conditions is excellent if treatment is timely and supported, however, improved visual outcomes for children are often not accomplished. Children’s Vision Massachusetts (CVMA), a coalition supported by the National Center for Children’s Vision and Eye Health at Prevent Blindness, developed a set of initiatives designed to improve the visual health of children by expanding community based best practices. These initiatives are the focus of Healthy Eyes Healthy Futures Massachusetts.

Q: Please describe how you have worked to address this issue in practice, and in your community.
Twenty-five health providers, educational professionals, and parents, formed the Developmental Questionnaire Work Group and are charged with reviewing existing developmental tools, authoring new vision-related questions and piloting them in various settings. CVMA will work with the Reach Out and Read program to include vision messaging and eye health education, and the MA Department of Early Education and Care is providing education and materials to its family and community engagement network to pass on to families. Finally, CVMA is working with Live Well Springfield-Kids to design and implement a community based program for children’s eye health in Springfield, MA.

three children drawing and smiling

Q: Please describe any community partners that are involved in your work, including any involvement from patients and families.
Community partners for the Healthy Eyes Healthy Futures Massachusetts initiatives are the Boston Children’s Hospital Pediatric Physicians’ Organization, Community and Family Engagement Grantees for the MA Department of Early Education and Care, the Reach Out and Read Organization, the Live Well Springfield—KIDS Coalition, Community Catalyst and members of the Children’s Vision Massachusetts Coalition. Other partners are the National Center for Children’s Vision and Eye Health and Prevent Blindness.

Q: How has a community pediatrics approach improved children’s health in your practice, and in your community?
Challenges facing health care providers and families in efforts to detect and treat vision problems in children include: (1) Public health activities are limited due to lack of resources (2) Recommended screening protocols are not completed due to lack of training and compensation (3) Communication between pediatricians and eye doctors has not been established (4) Eye care providers are centered in urban areas and/or near tertiary care training programs making access difficult In an attempt to address these issues, the project has adopted a community pediatric approach which employs strategies designed to engage stakeholders in overcoming these challenges.

Q: What resources or tips can you provide for other pediatricians that are interested in addressing this issue in their practice or community?

  1. Establish relationships and expectations with others involved with the visual health and education of young children including health managers, public health professionals, school nurses, parent groups, pediatric eye care providers and community based early educators
  2. Provide education to staff, families, and community to raise awareness and assure appropriate screening skill set and responsibilities
  3. Create systems for communication, monitoring, and surveillance of ongoing care regarding results of eye exams, compliance with treatment plans, etc.

Q: What advice would you share with someone interested in working on a project similar to yours?
A broad based coalition, including community members, professional organizations and clinical and public health experts is essential for project design, commitment and implementation. Engage leadership with potential collaborating organizations from the top down to ensure that adequate resources are committed to the work.



LEAH Grantee Spotlight

Photo of Gregory J. Redding, MDRebecca Shlafer, Ph.D., is an Assistant Professor within the Department of Pediatrics at the University of Minnesota and a former trainee of the Leadership Education in Adolescent Health (LEAH) program. Dr. Shlafer is involved in several innovative projects addressing the issue of parental incarceration. She serves as the Research Director for Isis Rising Exit Disclaimer, a rapidly expanding community-university partnership aimed at providing pregnancy and parenting support to incarcerated women. As a result of these efforts -- after systematically providing birth support -- the cesarean section rate decreased from 63% to 3%. Highlights of these projects have been featured on Kare 11 Exit Disclaimer, the UMN homepage Exit Disclaimer, and the Star Tribune. Exit Disclaimer

Dr. Shlafer also utilized her legislative advocacy training by testifying on behalf of a bill she and her colleagues co-wrote Exit Disclaimer, which aims to better address the pregnancy and childbirth needs of incarcerated women in Minnesota. As a result of the passage of this legislation, she was asked to lead a new Legislative Advisory Committee on the reproductive health of incarcerated women.

In addition, Dr. Shlafer recently partnered with Sesame Street, using their resources for the initiative: Little Children, Big Challenges: Incarceration Exit Disclaimer, which was announced last June at the White House Exit Disclaimer. Her trip to the White House earned her another invitation in September, where she was asked to talk about mentoring children impacted by incarceration. Since then, she has helped lead the state-wide dissemination of these resources to community-based organizations, correctional facilities, schools, clinics, and families designed to support children with incarcerated parents. As part of this project, her team is also piloting an intervention with the resources in a multi-site, randomized control trial in two jails in Minnesota and two jails in Wisconsin. A separate, but related project Dr. Shlafer is working on is examining children and adolescents’ experiences visiting their jailed parents, through systematic observations of the parent-child visits at the correctional facility. Last month, her team received a proclamation from Governor Dayton. Exit Disclaimer

Dr. Shlafer’s reflections on LEAH Training:

For me, the highlight of being a LEAH fellow was the interdisciplinary training. I came to the MN LEAH program with a PhD in child psychology and without any experience working directly with physicians, social workers, nurses, or public health professionals. The LEAH program gave me the skills to learn to work within and across disciplines to improve the lives of youth impacted by a parent's incarceration. I use my LEAH training in life course and social determinants of health every day as I work to solve the complex challenges facing children and families affected by incarceration. I frequently find myself reflecting on the communication, media, and advocacy trainings I received as a LEAH fellow. Such trainings have helped me craft my messages to local reporters, legislators, MCH professionals, and other scholars. Now, as a member of the training faculty, I find it so rewarding to work with new LEAH fellows who are passionate about addressing critical public health issues.



Spotlight on Gregory J. Redding, MD

Photo of Gregory J. Redding, MDPediatric Pulmonary Center grantee Gregory J. Redding, MD, is the 2015 recipient of the Edwin L. Kendig Award for lifetime achievements in the field of pediatric pulmonary medicine. This award is sponsored by the American Academy of Pediatrics every other year. The award is presented to an individual for distinguished clinical service and dedication to patient care, significant contributions to clinical or basic pediatric pulmonary research, and dedication to the education of pediatric pulmonary fellows, pediatric residents, and other trainees in the health professions. He is chief of the Division of Pulmonary Medicine at Seattle Children’s Hospital and Professor of Pediatrics at the University of Washington School of Medicine. He is also the Project Director of the Maternal and Child Health Bureau’s (MCHB’s) Pediatric Pulmonary Leadership Training Center at the University of Washington.

Dr. Redding has served in leadership positions for national professional organizations, lectured nationally and internationally, and participated in planning and evaluation of training for MCHB. He has published more than 150 original research articles and reviews and currently studies the health of indigenous children in the U.S. and abroad. He has received multiple teaching awards at the University of Washington and has been one of America’s Top Doctors for more than a decade.

Dr. Redding created the Pediatric Pulmonary and Sleep Medicine Division at Seattle Children’s Hospital and has provided regional pulmonary care in the Pacific Northwest for 34 years. He earned his medical degree at Stanford University School of Medicine. He completed his pediatric residency training at Harbor General Hospital/UCLA and his pulmonary fellowship at the University of Colorado.

The Division of MCH Workforce Development congratulates Dr. Redding on this well-deserved award!


University of Pittsburg LEND logo

Assessment of the impact of LEND training has been challenging for 2 reasons:  (1) NIRS data tracking LEND graduates over the long-term has been inconsistent and difficult to obtain for some programs; and (2) even when the NIRS Graduate Survey is completed, there is no comparison point.  The NIRS Graduate Survey is currently used post-training at 1, 5, and 10 years and graduates are asked to fill out 14 brief questions.  The aim of this short-term project at the Pittsburgh LEND is two-fold:  (1) to develop a methodology to ensure high retention rates among core LEND long term trainees with the NIRS Graduate Survey, and (2) establish a matching design with comparison peers who are not receiving LEND training.  For each of Pittsburgh’s core LEND long term trainees, a classmate from their graduate program will be recruited.  Comparison classmates will be selected on the basis of (in priority): a) same program of study; b) interest in children/pediatrics; c) same gender; d) same starting year in the program; and e) same race.  The project is a pilot feasibility trial that has been approved by the local IRB and requires informed consent from LEND trainees and comparison peers.


Photo of Pamela C. High, MD

Pamela C. High, MD


Brown University Logo Brown University

 

Brown University Logo

HASBRO CHILDREN’S HOSPITAL

 

Download a PDF of article from Pediatrics

Spotlight on Dr. Pamela C. High, Project Director for the DBP program at Brown University and lead author of the new American Academy of Pediatrics policy statement “Literacy Promotion: An Essential Component of Primary Care Pediatric Practice”

Pamela C. High, MD, is Professor of Pediatrics at the Alpert Medical School of Brown University in Providence, RI. She directs the Division of Developmental-Behavioral Pediatrics (DBP) at Hasbro Children’s/Rhode Island Hospital where she serves as the Program Director for fellowship training in DBP and for the HRSA/MCHB sponsored Brown Leadership Education in DBP Program. Dr. High is recent Past President of the Society of Developmental and Behavioral Pediatrics (SDBP) and member of the American Academy of Pediatrics’ (AAP’s) Early Brain and Child Development Leadership Workgroup. Her local advocacy efforts have included serving on RI’s Early Learning Council and on the boards of RI Kids Count and RI Reach Out and Read.

Dr. High is the lead author on the new Policy Statement from the AAP: “Literacy Promotion: An Essential Component of Primary Care Pediatric Practice.Exit Disclaimer The statement urges the 62,000 AAP members to talk to parents about how critical reading aloud is for fostering young children's brain development and building their early language and literacy skills. Pediatricians are also encouraged to provide books during health maintenance visits for all low-income, high-risk young children. The statement also calls for literacy promotion to be included in pediatric residency training, and for federal and state funding to help manage the costs of making age-appropriate books available in pediatric medical homes.

In a related article in the Huffington Post (6/30/2014) entitled, “Pediatricians Call For Parents To Read Aloud To Their Children Every Day” and interviews on the Public Broadcast Station (PBS) Exit Disclaimer, Dr. High, referring to parents, said they should remember the so-called "5 Rs" of early education: reading with their children daily as fun family activity; rhyming, singing and cuddling with them throughout the day; establishing routines and regular times for meals and sleep; rewarding them for their efforts and successes to boost self-esteem; and developing relationships that are reciprocal, enduring and nurturing which are the foundation of healthy development. "Pediatricians are taking a stand to spread the news more widely that early shared reading is both fun and ultimately very rewarding," Dr. High said.




group photo of CHALK team

Spotlight on Healthy Tomorrows Grantee: CHALK

Healthy Tomorrows Grantee's CHALK program (Choosing Healthy & Active Lifestyles for Kids) received national recognition by Michelle Obama through her Let's Move! Active Schools initiative. The American Academy of Pediatrics, Division of Community-based Initiatives newsletter, Community Pediatrics E-News, features an interview with CHALK project leaders Andrea Hausel, MPH, RD, CDN and Dodi Meyer, MD, FAAP.

Read more about the CHALK program... Exit Disclaimer




group photo of CHALK team

Honoring T. Berry Brazelton, MD and his work with DBP Fellows

T. Berry Brazelton, MD, Professor of Pediatrics Emeritus at Harvard Medical School, is one of the world’s foremost authorities on pediatrics and child development. Author of over 200 scholarly papers, he has written over 40 books on pediatrics, child development, and parenting. Translated into more than 20 languages, these include the now classic Infants and Mothers, and the bestselling Touchpoints series. His groundbreaking Neonatal Behavioral Assessment Scale (NBAS) is now used... read more about Dr. Brazelton...


Photo of Dorothy Cilenti

Dorothy Cilenti, DrPH, MPH, MSW

Logo for UNC Gillings School of Global Public Health

MCH Workforce Development Center

Dorothy Cilenti is the Project Director of the new MCH Workforce Development Center, a cooperative agreement with Maternal and Child Health Bureau, Division of MCH Workforce Development. Dr. Cilenti is Clinical Assistant Professor in the Department of Maternal and Child Health and Administrator of the NC Local Health Department Accreditation Program at the UNC Gillings School of Global Public Health in Chapel Hill. Dorothy was previously the Local Health Director of Alamance and Chatham counties in North Carolina. She also served as Interim Health Director for the Orange County Health Department. Prior to working as a senior executive in local public health, she served as the Deputy Director of the NC Division of Public Health. She received her master’s in public health and social work from UNC-Chapel Hill in 1989. In 2009, she completed a doctoral program in Health Policy and Management at the Gillings School of Global Public Health.


Kennedy Krieger Institute
LEND Program

In recognition of national commitment to women, children and families, the Maternal and Child Health (MCH) Training Programs of Maryland hosted a luncheon and seminar on October 22, 2010 to commemorate Title V and the Social Security Act, and to pay special tribute to the memory of Dr. Vince Hutchins.


 

John Hopkins University
School of Public Health Program

In recognition of national commitment to women, children and families, the Maternal and Child Health (MCH) Training Programs of Maryland hosted a luncheon and seminar on October 22, 2010 to commemorate Title V and the Social Security Act, and to pay special tribute to the memory of Dr. Vince Hutchins.


University of Maryland, Baltimore
Social Work Program

In recognition of national commitment to women, children and families, the Maternal and Child Health (MCH) Training Programs of Maryland hosted a luncheon and seminar on October 22, 2010 to commemorate Title V and the Social Security Act, and to pay special tribute to the memory of Dr. Vince Hutchins.


John Hopkins University
LEAH Program

In recognition of national commitment to women, children and families, the Maternal and Child Health (MCH) Training Programs of Maryland hosted a luncheon and seminar on October 22, 2010 to commemorate Title V and the Social Security Act, and to pay special tribute to the memory of Dr. Vince Hutchins.


John Hopkins University
COR Program

In recognition of national commitment to women, children and families, the Maternal and Child Health (MCH) Training Programs of Maryland hosted a luncheon and seminar on October 22, 2010 to commemorate Title V and the Social Security Act, and to pay special tribute to the memory of Dr. Vince Hutchins.


Reflections From My DBP Fellowship Training

Neel Soares, MD, Assistant Professor of Pediatrics at the University of Kentucky, describes the rich educational experience provided by an innovated Developmental-Behavioral Pediatric Fellowship Program supported by the MCHB Training Program.


Meet the UF PPC Program

Meet the trainees and fellows of the University of Florida Pediatric Pulmonary Center MCH Training program. Their enthusiasm for training, clinical care and community involvement is truly inspiring. Watch this video. More on the UF PPC Funded Project.

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