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Grantee Spotlights

POSTED: January 2022

DMCHWD is pleased to highlight examples of grantee projects and programs. Contact your Project Officer if you would like to share a highlight.

Dr. Arden Handler receives the Title V Lifetime Achievement Award

Dr. Arden Handler was recently selected as a recipient of the Title V Lifetime Achievement Award, recognizing outstanding contributions made to the field of maternal and child health over a sustained period. Dr. Handler has made it her life mission to improve MCH outcomes and support Title V programs in the United States, especially within the state of Illinois. Dr. Handler's passion is to educate the current and emerging Title V workforce to ensure that Title V will not only sustain, but thrive. She approaches all her MCH work with a sincere acknowledgement and respect for the current and former MCH leaders, as well as MCH history.

Dr. Arden Handler is the Director of the Center of Excellence in Maternal and Child Health and a Professor in the Community Health Sciences Division of the University of Illinois Chicago, School of Public Health. Dr. Handler’s research career reflects her long-standing commitment to reducing disparities and improving the health of women, children, and families. Her specific interest is the exploration of factors that increase the risk for disparities in adverse pregnancy outcomes and examining ways in which the health care delivery system, particularly how prenatal care, postpartum care, and well-woman care can ameliorate these risks and reduce disparities and inequities. Other research and teaching interests include maternal and child health advocacy and policy, building the analytic capacity of the MCH workforce, and the structure and functioning of the public health delivery system. Dr. Handler is a former member of the Secretary’s Advisory Committee on Infant Mortality (SACIM). She is a nationally renowned leader in maternal and child health advocacy, policy, epidemiology, and public health system improvement.

Maryland Behavioral Health Integration in Pediatric Primary Care (BHIPP) Shares Research Findings through Publications and Presentations at National Conferences

Maryland Behavioral Health Integration in Pediatric Primary Care Telepsychiatry Access Program (BHIPP TAP) is a PMHCA awardee that provides support to pediatric primary care providers in addressing the behavioral and developmental needs of their patients. In 2021, BHIPP published several manuscripts and presented research at national conferences.

The first study, published in Academic Psychiatry, describes results of a needs assessment conducted with 107 PCPs from three rural Maryland regions. The main study takeaways were that PCPs were more comfortable identifying pediatric mental health problems and making referrals than providing treatments directly to their patients. However, PCP's also reported difficulty finding specialty mental health providers to refer to.

The second study, published in Psychiatric Services, describes characteristics of PCPs who use BHIPP's services. Results revealed that PCPs were more likely to contact BHIPP's warmline for consultation or resource/referral networking but not both. Further, PCPs in rural regions of Maryland were more likely to seek consultation than providers in urban/suburban areas suggesting that rural providers may be more willing to assume responsibility for providing mental health care because they recognize there is a lack of specialty care providers in their regions.

The third study, published in Psychiatric Services, describes trends in calls to BHIPP and Mississippi's PMHCA prior to and during the COVID-19 pandemic. Findings showed that compared to calls prior, there was a significant increase in: call volume, diagnostic complexity of pediatric patients who were the focus of calls, and the number of calls focused on anxiety, depression, and disruptive behaviors.

Finally, in October we presented findings from a study focused on characteristics of patients with adverse childhood experiences (ACEs). We analyzed data from more than 4,900 contacts through PCP calls to BHIPP and BHIPP co-located social worker's contacts with patients. Findings revealed that patients with ACEs for whom PCPs sought BHIPP support were more clinically severe, had more comorbid mental health conditions, and were more often taking medications than patients without ACEs.

Findings from these studies emphasize the important role of PMHCAs in increasing access to pediatric mental health care through offering training, consultation, resources and direct services as needed.

Translation of the Survey of Well-being of Young Children (SWYC) into Tagalog, Samoan, and Chuukese

Children's Hospital Los Angeles LEND

The California-Leadership in Neurodevelopmental Disabilities Program (LEND) Program at Children's Hospital Los Angeles, directed the Maternal and Child Health Bureau (MCHB)-funded Health Professional Support Program for Children with Zika Virus Infection in American Samoa and the U.S. Affiliated Pacific Basin. After working with American Samoa, the Commonwealth of the Northern Mariana Islands and Guam and traveling to American Samoa, the CA-LEND team collectively identified that developmental screening tools were not available in languages that are commonly spoken in the islands. As a response to these needs, Douglas Vanderbilt, MD, MS, Alexis Deavenport-Saman, DrPH, and Patrice Yasuda, PhD facilitated translations and back-translations of the Survey of Well-being of Young Children (SWYC) into languages commonly spoken on these islands.

The SWYC is a comprehensive screening tool for children under 5 years. It is freely available to any user, with no license required at the following website in English and in other languages. The SWYC contains a developmental domain on Developmental Milestones, along with an autism-specific screener, the Parent's Observations of Social Interactions (POSI), an Emotional/Behavioral Domain, which contains the Baby Pediatric Symptoms Checklist (BPSC) and the Preschool Pediatric Symptom Checklist (PPSC), and a section on the child's family context.

Dr. Vanderbilt, Dr. Deavenport-Saman, and Dr. Yasuda, PhD obtained a license from the SWYC developers in order to translate the survey into different languages. They worked with a language translation organization to translate 4 age-specific forms (9, 18, 24, and 30 months) into 3 languages, which are commonly spoken in American Samoa, the Commonwealth of the Northern Mariana Islands, and Guam: Samoan, Tagalog, and Chuukese. The POSI is embedded into the SWYC form for autism specific-screening for the 18-, 24-, 30-month versions, which is partly why they focused on the translation of the SYWC for these ages.

The American Academy of Pediatrics (AAP) recognizes the SWYC and noted in their policy statement on developmental surveillance and screening that providing additional developmental screening using validated tests is appropriate. The AAP also indicated that the screening tests in the SWYC on Developmental Milestones, BPSC, PPSC, and the POSI have acceptable psychometric properties.

Click this link, to obtain any of the translated surveys in Tagalog, Samoan, or Chuukese:

The surveys will be available soon on the SWYC website: SWYC Translations

Let's Create an Army of Advocates: A Video Series at Children's of Alabama

University of Alabama at Birmingham PPC

The Pediatric Pulmonary Center grantee at the University of Alabama at Birmingham (UAB) is based at Children's of Alabama (COA), the only free-standing children's hospital in the state. The hospital uses an in-house video system, call the "Get Well Network" or GWN, to provide education to families during a child's inpatient stay. When the PPC hired their first Family Leader Faculty, Linda Russo, in 2015, Project Director Dr. Brad Troxler asked her to envision creating an "army of advocates" by spreading the mission of family-centered care and advocacy throughout the hospital. With passionate support of the UAB PPC's Patient/Family Advisory Committee, this vision became a reality in 2020-21. A series of three videos was produced for GWN, with the UAB PPC PFAC members providing subject matter expertise, script consultation, and on-air narration. "This is exactly what I had in mind when Linda joined the PPC," says Dr. Troxler. "Family-centered care not only means providing excellent clinical care, but partnering with families in their journey as advocates, not only in advocating for their own child, but for all children with special health care needs."

In addition to playing on the GWN, the videos were highlighted in a recent podcast, and are available on You Tube:

  • Video #1 - Checking In - introduces the role of being a caregiver for a child with an acute illness, including how to advocate with the medical team and coping/navigating resources while your child is in the hospital. 
  • Video #2 - Settling In- focuses on a child with a chronic illness; including finding and connecting to resources when your child is diagnosed with a chronic disease, identification of Alabama-specific support services (such as Medicaid Waivers, medical homes, Children's Rehabilitative Service (CRS), the Family Voices (FV) chapter, and the state Family to Family (F2F) representative) and connecting to other parents.
  • Video #3 - Breaking Out- encourages parents and children of all ages to begin advocating more broadly, at system, community, state, regional and national levels and connecting to the broader community of organizations which focus on inclusion, advocacy, education, and disability rights.

University of Michigan Provides Long-term Developmental Follow-up in Congenital Cytomegalovirus Clinic

University of Michigan DBP

Congenital cytomegalovirus (CMV) affects 1 in every 200 children in the US, up to 30% of whom will develop long-term neurodevelopmental sequelae such as sensorineural hearing loss and cerebral palsy. Thanks to the growing number of congenital CMV newborn screening programs, more infants are being diagnosed. To capitalize on this opportunity for early intervention, the University of Michigan Congenital CMV Developmental Follow-up Clinic was established in January of 2021, spearheaded by Dr. Megan Pesch in the Division of Developmental and Behavioral Pediatrics.

The CMV clinic provides close developmental monitoring, support, and anticipatory guidance for families of children with cCMV. A diagnosis of congenital CMV is often unanticipated and frightening for families – there are seemingly so many unknowns. The CMV clinic aims to provide these families with a holding environment along their CMV journey by providing psychosocial support, answers to their questions, and tailored recommendations. Close follow-up by a Developmental Pediatrician who understands the spectrum of congenital CMV-associated developmental delays facilitates earlier and more intensive interventions when subtle signs emerge such as hypotonia, social delays and feeding difficulties. Due to the high rate of hearing loss in children with congenital CMV (which may be present at birth or develop into childhood), the clinic provides inclusive and tailored communication support around hearing aids, cochlear implants, verbal, and signed language.

Ensuring access to quality care and subspecialists for children across the state is a priority; visits are offered in person and via telehealth. The CMV clinic works closely with a multidisciplinary group of pediatric practitioners from Otolaryngology, Audiology, Ophthalmology, Infectious Diseases, and PM&R. Care coordination among sub-specialists, therapists and the primary care physician is also provided. Over the last year, 25 patients with congenital CMV have been cared for in the Congenital CMV Developmental Follow-up clinic. To expand these efforts, the group is working to establish the University of Michigan as a state-wide multidisciplinary referral center.

University of Alabama at Birmingham, Leadership Education in Adolescent Health (UAB LEAH) Promotes Resilience Through Trauma Informed Care Training

University of Alabama at Birmingham LEAH, Dr. Heather Austin

University of Alabama at Birmingham, Leadership Education in Adolescent Health (UAB LEAH) faculty, Dr. Heather Austin, reunited with her former MCH LEND supervisor and colleague, Dr. Avi Madan-Swain, to promote trauma informed care at Children's Hospital of Alabama (COA). Dr. Madan-Swain has already been recognized by UAB for leading the family centered care rounding initiative at COA. In addition, both Dr. Austin and Dr. Madan-Swain shared common experiences of witnessing an overall increase in the impact of increased trauma, especially given the pandemic, and observing the dynamic interplay between patients and their families and health care providers related to these challenges. Family centered care at its core forms the basis of trauma informed care, by promoting optimal quality care based on the family's needs, values, perspectives, and goals. Trauma informed care builds on family centered care by increasing awareness of the patient/family experience of trauma and potential impact on the family, provider, and overall care.

Drs. Austin and Madan-Swain invited key professionals from COA and UAB including faculty and administrators in the areas of medicine, nursing, psychology, social work, pastoral care, patient advocacy and professional well-being to unite and problem-solve ways training in trauma informed care can be developed and initiated at COA. Initially, work focused on assessment of staff readiness for implementing trauma informed care training as well as a measure of their work-related traumatic stress, health, and wellbeing, including assessment of secondary traumatic stress, burn out and compassion fatigue. Training at COA is based on Substance Abuse and Mental Health Services Administration's (SAMHSA's) Four R's: Realization of the broad impact of trauma on our population, Recognition of the signs of trauma, creating a system that can Respond to trauma and Resisting re-traumatization. Work groups have formed and are in the process of creating ways to assess trauma in patients and families and to develop didactic training experiences for faculty and staff based on the Four R's, with an emphasis on interactive skills practice. On method will be the use of standardized patients and simulation to assist providers with practicing communication and de-escalation strategies such as those related to the DEF framework (Address DISTRESS, Facilitate EMOTIONAL support, and Remember the FAMILY). Most recently, we were able to secure Dr. Heather Forkey, a nationally recognized leader in childhood trauma and a co-author of Childhood Trauma and Resilience: A Practical Guide (2021), for a virtual grand rounds training at UAB/COA and consultation regarding ongoing work toward trauma informed training implementation. We are looking forward to the seeing the results of the program initiative and its positive impact on patients, their families, and our health care providers.

Use of an Advisory Committee to Support Diversity and Health Equity in the Virginia Mental Health Access Program

Virginia Mental Health Access Program

The Virginia Mental Health Access Program is a statewide initiative that supports health care professionals who care for children and adolescents with mental/behavioral health conditions. VMAP recognizes that there is not equitable access to behavioral healthcare and we are committed to addressing and reducing the disparities by working toward health equity across the state.

In response to reducing pediatric mental health disparities, a health equity advisory committee was formally established in March 2021. Its role is to support the mission and vision of the Virginia Mental Health Access Program by ensuring diversity and inclusion by applying an equity lens to all policies, practices, and program services.

Specifically, the purpose of the advisory group is to: 1) ensure a health equity lens is applied to all VMAP work; 2) promote the use of data to drive program planning and implementation; and 3) provide recommendations on ways we can adjust to improve performance.

The activities of the advisory group include:

  • Assist the VMAP executive committee in ensuring program policy decisions are made though a behavioral health equity lens;
  • Advise the regional hubs and executive committee on ways to expand VMAP stakeholder and provider membership through diverse partnerships statewide;
  • Use program data to set goals with respect to behavioral health equity, monitor progress and provide recommendations as needed to make improvements in our approach;  and
  • Provide guidance through specific recommendations and program benchmarks where VMAP can make progress on behavioral health equity at both the regional hub level as well as within the state administration.

The Equity Corner

Delaware Child Psychiatry Access Program (DCAP)

Richard Margolis, MD Project Director

Joseph Hughes, Project Manager

Mindy Webb, Project Behavioral Health Care Coordinator

The Delaware Child Psychiatry Access Program (DCPAP) distributes a monthly newsletter to its registered participants, their support staff, potential participants, our advisory council, project partners, training attendees, friends, associates, and a wide range of community professionals. This publication offers general mental health, program and community information along with both provider and resource highlights.

Each month, recipients have access to our 4 corners feature offering updates for NAMI Delaware, the Mental Health Association of Delaware, COVID and Equity. Each Equity Corner focuses on national and state health equity issues and initiatives. Our goal is to increase provider knowledge of mental health needs, related challenges of around diverse populations and access to services and supports.

Health Equity Guide for Public Health Practitioners and Partners 

Center for Trauma Counseling Mobile Hope Clinic – Accessible Mental Healthcare for Children & Families

Healthy Tomorrows Partnership for Children Program

Since 2012 Center for Trauma Counseling's mission is to ensure the immediate availability of cost-effective mental health services to serve the most "in need" in Palm Beach County impacted by trauma related experiences, regardless of socioeconomic status.

Center for Trauma Counseling's Mobile Hope Clinic (MHC) is providing Palm Beach County with its first mobile counseling center, brining high quality, affordable mental health care to underserved at-risk youth and their families. MHC provides a collaborative solution to enhance youth well-being, bridging gaps and foiling barriers to mental health services to provide early preventive intervention. MHC is complementing and coordinating with healthcare providers, families, and partnering community agencies to provide assessments and personalized therapy, and brought directly to underserved neighborhoods.  The solution of, The Mobile Hope Clinic, is to improve access to affordable, quality mental health services to economically disadvantaged and underserved at risk populations within Palm Beach County. With mental health and traumatic event exposure on the rise, CTC is a part of the solution by making mental health services accessible and equitable in our community. 

Mobile clinics physically drive into communities, reducing barriers by reaching out to the unserved populations.  MHC fits directly into the focus area of health access and diversity by offering a solution, affordable or free mental health services, to parts of the county that are otherwise unable to access affordable or free, evidence-based outpatient mental health counseling.  By bringing these services into more dire areas in the county, more economically disadvantage, underserved and at-risk children, adolescents, and families will have an opportunity for equal engagement in trauma-based counseling that other residents in the county already have access to.

Telehealth Manual: Resources for Healthcare Providers Working with Children, Adolescents, and Families

Rose F. Kennedy Leadership Education in Neurofevelopmental and Related Disabilities Program

While telehealth is not a new phenomenon, since the onset of the COVID-19 pandemic, it has increasingly become a modality that clinicians and patients have come to rely on. Telehealth has afforded many children/adolescents and their families access to treatment that may have otherwise been unobtainable. Despite numerous strengths to this modality, there also come challenges and the need for clinicians to think flexibly and creatively and to individually tailor the treatment and approach to the individual, particularly when working with children with a range of neurodevelopmental disabilities. As part of the Leadership Education in Neurodevelopmental and Related Disabilities (LEND) fellowship at Montefiore Medical Center, Rose F. Kennedy, Children's Evaluation and Rehabilitation Center (CERC), psychology and social work trainees worked together to create a telehealth manual, providing resources that can be easily adapted to the clinical encounter. The objectives of the manual included providing clinicians with information on (a) a brief history of telehealth, (b) the shift to the use of, and increasing reliance on, telehealth in 2020-2021, during the COVID-19 pandemic, (c) tips for clinicians and patients who are engaging in telehealth practices, (d) activities and resources that can be implemented as part of telehealth sessions, organized by age and presenting concern (e.g., attention/executive functioning, social skills, anxiety, parent management), (e) crisis intervention resources with tips for implementation via telehealth, (f) resources for families (in English and Spanish), and (g) references, resources, and helpful links for clinicians. A presentation on the manual was provided to a group of LEND fellows and clinicians and the manual was made available to all clinicians employed at the clinic, including psychologists, social workers, developmental behavioral pediatricians, speech and language pathologists, a psychiatrist, an occupational therapist, a physical therapist, and LEND fellows from across these disciplines. Results from a survey completed by attendees revealed positive feedback on the usefulness of resources. Second Annual Transition Planning Webinar Series for Youth and Young Adults with Learning, Intellectual, and/or Developmental Disabilities Rose F. Kennedy Leadership Education in Neurodevelopmental and Related Disabilities Program Transition planning is an integral component of post-secondary planning for youth/young adults with intellectual, developmental, and learning disabilities. It can be a complicated, confusing, and intimidating process, yet one that is vital to ensure that adolescents and young adults make a successful transition out of high school and into adulthood. Transition planning is particularly important for youth/young adults with special needs. During the summer of 2020, CERC hosted a series of webinars on transition planning during the time of COVID. These webinars addressed topics regarding postsecondary transition planning for young adults including higher education programming, day programming, and community opportunities. Due to strong attendance and positive satisfaction ratings after the webinars, a second series of webinars was planned, incorporating attendees' suggestions and requests for future webinars. This 2021 webinar series targeted a range of transition related topics including: medical transition in youth with developmental disabilities (DD); medical issues in young adults with DD; special needs planning, guardianship, and supported decision making; and OPWDD eligibility, services, and self-direction. Youth/young adults, their families, and providers heard from speakers during each of three webinars with opportunities for questions and meaningful conversation after the webinars. Given a large Spanish speaking population in the Bronx, NY, separate webinars, on the same topics, were provided in Spanish, immediately following the English presentation. Attendees completed a survey at the end of each webinar, available in English and Spanish, allowing for analysis of consumer satisfaction and suggestions for future webinars. Tip sheets and resources on transition planning were made available to attendees, in both languages.

Second Annual Transition Planning Webinar Series for Youth and Young Adults with Learning, Intellectual, and/or Developmental Disabilities

Rose F. Kennedy Leadership Education in Neurodevelopmental and Related Disabilities Program

Transition planning is an integral component of post-secondary planning for youth/young adults with intellectual, developmental, and learning disabilities.  It can be a complicated, confusing, and intimidating process, yet one that is vital to ensure that adolescents and young adults make a successful transition out of high school and into adulthood. Transition planning is particularly important for youth/young adults with special needs. 

During the summer of 2020, CERC hosted a series of webinars on transition planning during the time of COVID.  These webinars addressed topics regarding postsecondary transition planning for young adults including higher education programming, day programming, and community opportunities. Due to strong attendance and positive satisfaction ratings after the webinars, a second series of webinars was planned, incorporating attendees' suggestions and requests for future webinars.
This 2021 webinar series targeted a range of transition related topics including: medical transition in youth with developmental disabilities (DD); medical issues in young adults with DD; special needs planning, guardianship, and supported decision making; and OPWDD eligibility, services, and self-direction. Youth/young adults, their families, and providers heard from speakers during each of three webinars with opportunities for questions and meaningful conversation after the webinars.  Given a large Spanish speaking population in the Bronx, NY, separate webinars, on the same topics, were provided in Spanish, immediately following the English presentation.  Attendees completed a survey at the end of each webinar, available in English and Spanish, allowing for analysis of consumer satisfaction and suggestions for future webinars.  Tip sheets and resources on transition planning were made available to attendees, in both languages.

Rose F. Kennedy LEND program at Montefiore Children's Hospital "Preparing Back to School" multilingual Webinars

Rose F. Kennedy Leadership Education in Neurodevelopmental and Related Disabilities Program

This year may be a transition for families, as schools return to in-person learning. The change may bring up many questions, concerns and anxieties for children and parents. In order to support families through this transition, staff at Rose F. Kennedy LEND program at Montefiore Children's Hospital developed a webinar with helpful tips. Topics included:

  • identifying emotions and concerns,
  • coping skills,
  • dealing with uncertainties,
  • having play dates,
  • creating social stories,
  • visiting the school,
  • screen time,
  • healthy sleeping and eating habits.  

To serve our multicultural and ethnically diverse audience, multilingual staff developed the webinar, which is available in English, Spanish, French, Italian, Korean and Mandarin.

Attendees can complete a survey at the end of each webinar in each language.

Rose F. Kennedy LEND program Webinar 

The Rose F Kennedy Children's Evaluation & Rehabilitation Center CERC/UCEDD The Children's Hospital at Montefiore Montefiore University Hospital for Albert Einstein College of Medicine

Promoting Diversity and Health Equity through Research, Training, Clinical Activities and Public Policy

University of California San Francisco Leadership Education in Adolescent Health

The Division of Adolescent and Young Adult Medicine at the University of California, San Francisco is actively working to promote diversity and health equity on multiple fronts.  

Leveraging technology to advance health equity

The following are two noteworthy projects:

Engaging Adolescents in Health Careers with Technology-Rich Personalized Learning

Primarily supported by an NIH Science Education Partnership Award (SEPA) in collaboration with North Carolina State University and the UCSF Office of Diversity and Outreach, with additional support by MCHB, Health Quest aims to address the underrepresentation of racial and ethnic minorities and women in health research and the health professions. A diverse biomedical, behavioral, and clinical research workforce would be significantly better equipped to serve the nation's health needs and it is imperative for all students to learn about the exciting careers in the field of health sciences. Health Quest is designed to increase middle school students' interests in health science careers by: 1) Allowing students to learn about the career paths of health professionals through interactive video interviews. Specifically, students will learn firsthand how professionals in biomedical, behavioral and clinical research fields became interested in their career fields and how they prepared for them while also getting to explore some of the day-to-day activities of these scientists; 2) Engaging students in a rich narrative driven health sciences adventure game where students can choose which science field to explore and then embark on a mission to help solve a scientific problem or answer a critical research question; and 3) Providing classroom teachers with the tools and resources they need to implement Health Quest in their classrooms. Health Quest Website 

Health-E You / Salud iTu

Health-E You / Salud iTu   is an innovative, interactive, individually tailored web-based mobile health application (app) in English and Spanish to promote equitable access to comprehensive contraceptive information and services for adolescents, to improve the delivery of patient-centered contraceptive care, and to reduce racial/ethnic disparities in unintended pregnancies. A cluster randomized control trial of 18 school-based health centers (SBHCs) with 1,360 Latina adolescents from the 2nd largest school district in the nation, were randomized to implement the app or to a control standard of care. Prior to their visit with a health care provider, participants completed a baseline survey, intervention participants then used the app, and then they proceeded to their visit. Participants received follow-up surveys 48 hours, 3- and 6-months after their recruitment visit. Health-E You significantly increased adolescents' sexual health knowledge; helped prepare adolescents to select a contraceptive method; and increased self-efficacy (in talking with their doctor about birth control, having the information to choose birth control and using birth control correctly). App user had greater increases in non-barrier contraceptive use from baseline (29% intervention vs. 30% controls) to 3 months (63% vs. 45%; OR = 3.29, 95% CI 1.04–10.36, p = 0.04) and 6 months (63% vs. 44%; OR = 5.54, 95% CI 1.70–18.06, p = 0.005). Providers and adolescents reported high app satisfaction and stated it improved visit quality. We are now implementing this intervention in 28 SBHCs representing 11 states across the country to promote health equity in access to adolescent-centered contraceptive information services and care. This project is funded by the Patient Centered Outcomes Research Institute (PCORI), DI-2020C2-20372. LINK:

Child and Adolescent Gender Center

The Child and Adolescent Gender Center (CAGC), is a collaboration between UCSF and community organizations. It uses a multidisciplinary approach to offer comprehensive, gender affirming care to gender diverse/transgender youth and adolescents. The UCSF CAGC Clinic is housed within the Division of Pediatric Endocrinology. Our clinic providers include pediatric endocrinology physicians and nurse practitioners, adolescent medicine physicians, pediatric psychologists, a psychiatry nurse practitioner, social workers, and administrative support staff. Our overarching goal is to provide medical and psychological care, as well as advocacy and legal support to all our patients. We help children and families connect to local resources and support groups, refer to counselors who are trained in the care of transgender youth, and provide legal and educational support. We support children and their families through their social, medical, and/or surgical transition. If and when children and their families are ready to pursue medical therapies, we prescribe and manage puberty blockers, menstrual suppression, and gender affirming sex hormones.

Transgender Youth Curriculum

Our Division is dedicated to training multidisciplinary providers to provide gender-affirming care to youth and young adults. Therefore, we have developed a comprehensive pediatric transgender curriculum for multidisciplinary clinical trainees comprised of online modules, an observership in a pediatric gender clinic, and standardized patient encounters. The interactive online modules have a primary care focus with topics regarding transgender terminology, taking a gender history, taking a psychosocial history, performing a sensitive pubertal examination, and developing psychosocial and medical plans. For the observership, trainees are exposed to real patients with an experience in a pediatric transgender clinic. The most recent addition to the curriculum is a standardized patient encounter half-day, which allow trainees to practice skills in interacting with transgender youth while being remotely observed by faculty who complete skills checklists. These encounters involve trainees taking a history and counseling an actor portraying transgender teens presenting with questions about medical transitioning. To date, our curriculum has trained over 150 pediatrics interns, psychiatry interns, medical students, and nurse practitioner trainees. Additionally, the curriculum has been rigorously evaluated and found to improve learner knowledge, skills, and self-efficacy in gender-affirming care.

Examining Mental Health Outcomes and Gender Affirmation for Transgender Youth of Color Study

This research is supported by Robert Wood Johnson Foundation and uses large datasets to quantify and document disparities experienced by Black and Latinx transgender youth. Using the California Healthy Kids Survey, which is a school-based survey administered to secondary students throughout the state of California, multivariable analyses are used to compare Black and Latinx transgender youth to two cohorts of peers: White transgender youth and Black and Latinx cisgender youth. This research found that that Black and Latinx transgender youth had similar levels of depressive symptoms and suicidality compared to White transgender youth but significantly higher than Black and Latinx cisgender peers. Additionally, compared to White transgender youth, Black and Latinx transgender youth had lower levels of school connectedness. Compared to Black and Latinx cisgender peers, Black and Latinx transgender youth experienced higher gender-based, race-based, and sexuality-based harassment. Furthermore, harassment and victimization were associated with higher odds of both past-year depression and suicidality among Black and Latinx transgender youth when controlling for demographic covariates.

Salinas Teen Health Study Understanding Latino adolescents' trajectories of risk and resilience

This research is conducted in partnership with colleagues from RTI, UC Berkeley, and the Monterey County Health Department, examines the relationship between gang violence, unintended teen pregnancies, and mental health in Salinas, California - a small, predominantly Latino community in California's rural central coast. Although some research has examined the association between violence and teen pregnancies in large urban centers, little is known about this association in rural communities. Formative work from this investigation highlighted the critical role that family plays in positive youth development and reproductive health knowledge. This formative work, and the community engagement associated with it, also revealed wide-spread concern about the mental health of Salinas youth. Current papers under development focus on immigrant-specific Adverse Childhood Events as well as the relationship between exposures to discrimination and mood disorders in later adolescence. This group just received additional NIH funding to follow the original cohort of 600 adolescents into young adulthood.

Supporting training, technical assistance, and program evaluation for Expectant and Parenting Youth (EPY) through the California Maternal Child and Adolescent Health (MCAH) Division, within the Department of Public Health

The Adolescent Family Life Program Positive Youth Development (AFLP PYD) Model provides comprehensive case management services to EPY throughout the state. AFLP PYD predominantly serves Latina adolescents and is focused on improving health equity and positive outcomes for both the mother and their offspring. AFLP PYD case managers meet with their clients in-person twice per month (over the course of a year and in many cases, longer). With youth-centered support, EPY and their children can draw on their personal strengths and community services and supports to achieve positive social, educational, health and economic outcomes. Case managers support youth in developing a sense of purpose, positive identity, and skills, such as resourcefulness and problem solving, to build resilience. During the Pandemic, Division faculty conducted a study is to showcase some of the challenges experienced with the transition to and implementation of tele-visits and to identify strategies both in terms of practice and policy that enhance case managers' ability to connect, engage and continue to support EPY.

Disparities in Access to Eating Disorder Therapy for Publicly Insured Youth and Youth of Color

Minorities in the United States have lower rates of access to most forms of health care, with particularly disparities in access to mental health care. Little is known about access to mental health care among minority patients with eating disorders, though these are among the most fatal metal health illnesses for teens. The objective of this study is to examine the association between insurance type and therapy received by racially/ethnically diverse youth in UCSF's outpatient eating disorders program. The UCSF Eating Disorder Program sponsored a summer research position for a Latina UCSF medical student, mentored by two Latina faculty members in Adolescent Medicine and Psychiatry as well as the medical director of the Eating Disorder Program. With mentorship the student conducted a retrospective chart review of youth ages 11-25 (N=1,060) presenting to our urban adolescent medicine specialty program for management of eating disorder symptoms between June 1, 2012 and December 31, 2019. Charts were reviewed for demographics, diagnosis, and therapy received. Bivariate and logistic regression analyses were performed for factors predictive of receiving indicated specialized mental health therapy within six months of evaluation. Results demonstrated that patients with private insurance were three times more likely to receive indicated therapy than patients with public insurance. Latinx and Asian patients were half as likely to receive indicated therapy as White patients. Overall, this study demonstrates that while access to mental health care is a necessary and important first step towards equity in eating disorder care, additional work is needed to dismantle systemic inequities that contribute to disparities in care for youth of color.

Supporting training and program development for the California Medical Association and regional hospital systems within the state of California to recognize systemic racism as it impacts racial and ethnic minority patients and providers

The California Medical Association (CMA) has been working to increase diversity, equity, and inclusion for the past 5 to 6 years. As part of this effort CMA established a committee entitled the Justice, Equity, Diversity and Inclusion Council (JEDI). To advise the CMA on recommendations for moving CMA to support additional pipeline programs to promote a diverse work force and address issues of health disparities and injustice. This committee sought expert advice from Dr. Raymond-Flesch related to structural racism as it impacts patients' health as well as workforce issues related to diversifying the medical education pipeline and creating more supportive and inclusive work environments for providers who are underrepresented in medicine. Dr. Raymond-Flesch has also advised regional medical systems within California on these topics including the Health Improvement Partnership of Santa Cruz County.

Diversity and Health Equity at Children's Hospital Los Angeles

Children's Hospital Los Angeles Leadership Education in Adolescent Health

In 2019, Children's Hospital Los Angeles (CHLA) was one of 9 institutions, and the only free-standing children's hospital, selected to participation in the Accreditation Council for Graduate Medical Education Pursuing Excellence Initiative. This initiative is focused on eliminating Health Care Disparities and one of our Leadership Education in Adolescent Health (LEAH) faculty is a key participant in this effort. As a result of our involvement in this initiative, CHLA incorporated equity goals as a cross-cutting theme across all components of the enterprise strategic plan. CHLA created a health equity dashboard and added equity measures to the organizational performance dashboard. Internal quality improvement training as well as standard tools and templates for root cause analysis and lean/six sigma now include equity principles and checklists. We created a teaching and learning collaborative to bring together interdisciplinary groups of staff, faculty, and trainees, to develop and implement education on cultural humility, structural competency, and personally mediated racism and bias.

The Division of Adolescent and Young Adult Medicine (DAYAM) has also been working on an internally focused diversity, equity, and inclusion initiatives and each program within the DAYAM has been developing concrete action plans and sharing it broadly with our peers and establishing accountability mechanisms. This work fits well into the hospital's global DEI initiative that has included improving data collection around race and ethnicity, improving SOGI data, reducing disparities in behavioral health emergency calls, and addressing disparities in patient satisfaction.

Talking Race, Kids & Health

Maryland Behavioral Health Integration in Pediatric Primary Care (BHIPP)

Maryland Behavioral Health Integration in Pediatric Primary Care Telepsychiatry Access Program (BHIPP TAP) is a Pediatric Mental Health Care Access (PMHCA) awardee that provides support to pediatric primary care providers in addressing the behavioral and developmental needs of their patients.

The state of Maryland has considerable diversity in sociocultural determinants of health, health outcomes, and demographic characteristics across jurisdictions. MD has one of the highest opioid overdose rates in the nation, and quite a few counties have overall health outcomes and overall health factors in the bottom-ranked quartile in the state, with several others in the bottom half. With respect to sociodemographic makeup of residents, MD has one of the fastest growing Latino populations in the US, and several counties have a higher proportion of African American residents than the state as a whole. Given these unique and varying characteristics which impact health and health disparities in a myriad of ways, BHIPP utilizes numerous approached to address health disparities at the individual and community levels.

As part of a series of interactive, web-based learning sessions called BHIPP Resilience Breaks, BHIPP recently featured a webinar on Talking Race, Kids & Health, presented by Jacqueline Douge, MD, MPH, FAAP. These Resilience Breaks are designed as a virtual space for pediatric primary care and behavioral health providers to connect, learn and share about strategies, practices, and resources to promote mental health and resilience among children and families as well as providers. Throughout this presentation, Dr. Douge highlighted strategies to increase cultural and linguistic competence and improve diversity and health equity in the pediatric primary care setting. Learning objectives focused on 1) the role of pediatric health care providers in addressing race and racism, 2) how healthcare providers can develop cross-sector collaborations to improve health outcomes and 3) using books to open and further the conversations about race with children. To access archived webinars, please visit BHIPP Resilience Breaks.  

Additionally, BHIPP recently launched an Anti-Racism Resources  page on our website which highlights resources specific to families, healthcare providers, coping with community violence and racial trauma, and mental health resources for black, indigenous, and people of color.

MCH Diversity, Equity and Inclusion

University of North Carolina MCH Center of Excellence

The UNC Center of Excellence in Maternal and Child Health Education, Science and Practice and the UNC Department of Maternal and Child Health is committed to fostering inclusive excellence. In 2020, the Department implemented new guidelines that require all faculty and staff complete 8 hours of Diversity, Equity and Inclusion (DEI) trainings each year, and formed a DEI Workgroup comprised of faculty, staff, and student representatives. DEI training topics include race and cultural competence; special populations; sexual orientation/gender expression; mental health; sexual assault/intimate partner violence; employment equity. The DEI Workgroup is committed to transparency in the process of meeting, organizing, and taking action steps toward antiracism and inclusive excellence.

The initiatives implemented by the UNC Department of Maternal and Child Health align with the commitment and initiatives already established by the University and the Gillings School of Public Global Health. At Carolina, diversity and inclusion are about building understanding across differences, creating conditions to ensure the equitable educational and social benefits of diversity and cultivating an inclusive and supportive environment for undergraduate, graduate and professional students, faculty and staff – where every person feels valued and has an opportunity to add value.

UNC Center of Excellence in MCH Leadership Panel

University of North Carolina MCH Center of Excellence

The UNC Center of Excellence in Maternal and Child Health Education, Science and Practice will be hosting a virtual Leadership Panel on October 5, 2021 via Zoom Webinar. The theme of this year's panel is Leading for Equity in MCH: Collaborations between practice and research to enhance the health of MCH populations. The effects of the pandemic have exposed disparities in equitable access to quality health care and resources in our communities, the U.S. and across the globe. It is times like these leaders in MCH push even harder to close the gap. Three talented groups of panelists comprised of maternal and child health leaders from academia, state government, and non-profit organizations will demonstrate how they effectively collaborate to advance equity in MCH practice, policy and or research.

Summary of Advancing Health Equity Through Reproductive Justice Syllabus

University of North Carolina MCH Center of Excellence

Ariel Lewis, MPH developed a syllabus titled Advancing Health Equity Through Reproductive Justice  for the UNC Gillings School of Global Public Health. This 4-credit elective course introduces graduate-level public health students to the history, theory and practice of reproductive justice within the context of the United States.

Advancing Health Equity Through Reproductive Justice is designed to provide students with foundational knowledge and skills to become informed anti-racist and reproductive justice advocates who lead with compassion and ensure the dignity of all people. Learning objectives for this course correlate with the following competencies: MCH substantive knowledge, MCH leadership, and health equity, social justice and human rights. As such, this course can be cross-listed between the Maternal, Child and Family Health concentration and the Health Equity, Social Justice and Human Rights concentration offered by the Gillings School of Global Public Health.

There is increasing engagement with reproductive justice (RJ) within the public health sphere. A review of the MCFH core curriculum reveals an opportunity to enhance content on the following communities and topics for the U.S. specifically: anti-racism praxis, LGBTQ-GNCNB (Lesbian, Gay, Bisexual, Transgender, Queer and Gender Non-Conforming, Non-Binary) communities, BIPOC (Black, Indigenous and People of Color) communities, historical reproductive injustices in the U.S., the disability community and disability justice, and domestic policy advocacy. Advancing Health Equity Through Reproductive Justice is therefore a unique and timely offering for students in the MCFH Concentration and other graduate-level public health students at Gillings seeking to gain a deeper understanding of health equity, social justice and human rights in the context of sexual and reproductive health in the U.S.

Boston LEAH Brings Sexual Health Education to At Risk Youth, Emphasizing Identity and Autonomy

Boston Leadership Education in Adolescent Health

EXPRESS Yourself is a Boston LEAH Fellow led experience designed to embolden diverse young people in the community to take charge of their sexual health through an interactive educational curriculum. The program is rooted in human rights principles, drawing upon expertise from advocates, educators, and medical providers with tailored content according to the developmental capacity and lived experiences of the adolescents and young adults in attendance. The youth are insufficiently served by school-based sexual and reproductive health education models as a result of inconsistent school attendance, homelessness, trauma history, and other unique barriers. Through this program, Fellows engage with the community in a meaningful way while learning the basics of sexual health education through observation and participation. Partners include Boston HIV Adolescent Provider and Peer Education Network for Services (HAPPENS), Bridge Over Troubled Waters, and ROCA. Priscilla Portugal-Moreno, Boston HAPPENS Health Services Advocate and EXPRESS Yourself Outreach Coordinator, developed and teaches the program curriculum. Priscilla and Drs. Alexandra Edwards and Sydney Hartman-Munick, two senior fellows in the Boston Children's Hospital LEAH Program, have taken the lead to develop this experience for current and future trainees.

From left to right: Priscilla Portugal-Moreno, EXPRESS Yourself Outreach Coordinator and Boston HAPPENS Health Services Advocate, Alexandra Edwards, MD, Boston LEAH Adolescent Medicine Fellow, Sydney Hartman-Munick, MD, Boston LEAH Adolescent Medicine Fellow

Teen CHWs Bring Health Resources to Communities of Color

HRSA Healthy Tomorrows: The East Side Community Center: A Hub of Health and Empowerment for Youth and Community YWCA New Britain; New Britain, CT

In Photo from Left to Right: Itzel Colon, Yeyris Ortiz, Danyelix Echevarria, Asli Aden

Teens from New Britain High School completed a Community Health Worker (CHW) training course (90 hours) and are focusing on Health Equity for their 1,000 hour Fieldwork requirement to become state certified CHWs. Teens helped organize a 'Summer Bash' at Chesley Park which focused on bringing health resources, including COVID19 vaccinations, to New Britain, CT's East Side community.  Teens surveyed 63 residents regarding: hesitancy surrounding the COVID19 vaccine, resources and education services that were needed as a result of the pandemic, and what (if any) mental or physical effects the pandemic had on local families.  Community based organizations were present to talk with the community regarding: rental & housing assistance, mental health services, alcohol & opioid addiction, neighborhood safety, and more.  The Community Health Center brought their mobile vaccine clinic, and at the completion of the event, vaccinated 14 people.  Regarding her CHW training course, Danyelix stated, "We learned about people- how to treat them and communicate with them.  If people don't trust you, they're not going to listen to you.  Being able to talk with somebody is the most important thing. We also learned a lot about health.  I feel like not judging people is the most important thing.  Instead of seeing someone and judging them, as yourself, 'How do I help that person or reach that person'."

Diversity Scholars Leadership Program - Supporting Students of Color through Mentorship

Center of Excellence in Maternal and Child Health at Boston University School of Public Health (BUSPH)

Higher education represents academic and professional growth and increased opportunities. However, it is costly and taxing for Black, Indeginous, and people of color (BIPOC) or first generation students. Predominantly white institutions often leave BIPOC and first generation students feeling isolated and overwhelmed. These students have unique challenges - providing emotional and financial support to their families and navigating microaggressions that permeate social and classroom interactions. These experiences tax students' health and well-being and compromise their ability to flourish. 

To address the challenges BIPOC and first generation students face, BUSPH Center of Excellence in Maternal and Child Health created the Diversity Scholars Leadership Program (DSLP).1 DSLP offers support and community among students with shared experiences through: 1) mentorship, 2) tuition support1, and 3) community building among scholars, alumni, and faculty.

A core aspect of DSLP is the alumni mentorship. Each DSLP scholar is matched with a BIPOC mentor who supports scholars from professional development and navigating academic and professional settings as BIPOC individuals, to sharing lived experiences and building connections over shared passions.

"One of the best things about being a part of DSLP is the ability to build community through shared experiences and affirmations! I've had much of my experiences validated which has empowered me to strengthen my mission to pioneer change in my lineage. Also, being paired with a mentor who support and elevates my initiatives on this effort has been rewarding and therapeutic. There's just something about growing and elevating each other in the process that bring so much healing and internal harmony." - current DSLP scholar.

Mentors also offer valuable advice, drawing from their experiences in the MCH and greater public health space.

"My DSLP mentoring experience has been empowering. She is an incredible role model and has really opened my eyes to all the opportunities available in our field. I've been able to approach every conversation with honesty and curiosity, and that alone has had a tremendous impact on my personal, academic, and professional life." - current DSLP scholar.

DSLP creates a space that validates and affirms students' experiences, encouraging authenticity and allowing them to thrive.

Virtual DSLP Dinner in February 2021 with current
scholars, alumni, faculty, and mentors.

Promoting Diversity and Health Equity: UNC Greensboro Names 10 Undergraduate Scholars for the LEAD in MCH Traineeship

The UNC Greensboro School of Nursing accepted 10 pre-licensure BSN students to the Leadership, Education and Diversity in Maternal Child Health (LEAD in MCH) scholar program this summer. To promote diversity in nursing, student scholars were recruited from culturally diverse, underrepresented, and underserved backgrounds and demonstrated a passion for maternal child health and/or public health. The program aims to address the health disparities gap by bringing socioeconomic, racial and ethnic diversity to the maternal child health workforce. The LEAD in MCH program offers student scholars the opportunity to complete enhanced MCH coursework, attend monthly seminars specific to MCH leadership competencies, as well as participate in tutoring, advising and MCH focused simulations. Student scholars also participate in an MCH internship and have expanded clinical options as part of the program.

This is the first year for the LEAD in MCH program at UNCG. The LEAD in MCH program is led by Carrie Hill, PhD, RN, Director of the RN to BSN Program and Audrey Snyder, PhD, RN, Associate Dean for Experiential Learning and Innovation at UNCG School of Nursing.

San Ysidro Health - Improving the health and well-being of the communities we serve with access for all

Healthy Tomorrows Centro De Salud La Comunidad De San Ysidro Inc (San Ysidro Health)

Born out of the civil rights movement in 1969, San Ysidro Health (SYHealth) was founded with diversity and inclusion in mind. From its humble beginnings, SYHealth's focus has been to provide the highest quality of care to families and individuals with the utmost compassion. As the organization's growth continues throughout San Diego County its priority to provide access to care for all, without exception remains at the forefront.  With the commitment and determination to advance its diversity, equity and inclusion efforts, SYHealth strives to ensure all are welcomed when entering any of its clinics.

Today, SYHealth stands on the shoulders of its founding mothers, staff and volunteers who have left a  lasting impact through the support and care provided to its 108,000 patients.  As a trusted community messenger, SYHealth hires within the communities it serves to ensure its team is reflected of the community it serves. The COVID-19 pandemic has disproportionately impacted the families SYHealth serves in Central, South, East and Rural San Diego County. Data showed that infection rates were rampant in communities made up of essential workers that did not have an opportunity to work from home and are employed in high-contact and high exposure jobs. To support San Diego County's COVID-19 recovery efforts, SYHealth has been on the frontlines providing COVID-19 vaccination, testing, resources while continuing to provide comprehensive care services. To date, SYHealth has provided more than 50,000 vaccines to individuals in neighborhoods affected most by the pandemic. SYHealth continues to lead vaccination efforts by going to locations that are most convenient for individuals. "Even though most vaccination stations are offering walk-ins, patients are still being referred to us internally to help them schedule COVID vaccines through the county which is a reflection of the need that there still is to reach certain members of our community and how our resource centers are essential in filling the gap for populations with greater limitations and access to health care". Daniel Ramirez, Program Manager. COVID-19 vaccines, testing and routine care services are available to all individuals, specifically targeting essential workers, many of whom are Latino and reside in the South Region.

Although the COVID-19 pandemic hindered routine care for individuals, it did not disrupt SYHealth's ability to stay open and continue providing the highest quality of care with compassionate.

Healthy Tomorrows Partnership for Children Program – Enhancing Family Engagement

Earlier this year, the Healthy Tomorrows Partnership for Children Program (HTPCP) grantees had the opportunity to compete for a $5,000 stipend to strengthen family engagement activities in their respective projects. Below are a compilation of stories from HTPCP grantees across the U.S. sharing successes they have seen in their projects by incorporating family engagement activities. The following HTPCP projects involved families in their projects through activities such as Advisory Board participation, reviewing materials and resources produced by the project for cultural/linguistic competence and health literacy levels, leading family support groups, and participating in the development of staff trainings.

New York-Presbyterian Hospital's Turn 2 Us Family Engagement Stipend Project brought mental health focused workshops to caregivers of New York-Presbyterian Hospital's Ambulatory Care Network pediatric patients

New York-Presbysterian Hospital's Turn 2 Us – Healthy Tomorrows Partnership for Children

New York-Presbyterian Hospital (NYP)'s Turn 2 Us (T2U) is a school-based mental health promotion and prevention program, serving elementary schools in Northern Manhattan, NYC. T2U promotes mental health and academic success in at-risk children. We hope to empower the entire school community (students, caregivers, and school staff) to engage in healthy lifestyle practices that promote wellbeing. The program aims to enhance the mental health literacy of school personnel and caregivers, so they are equipped to ensure our youths' progress emotionally, socially, and academically. T2U aims to also raise awareness of the importance of mental health, even in the absence of mental health conditions, and decrease the stigma associated with mental health.

The Family Engagement Stipend Project aimed to support caregivers in the community, reaching beyond our targeted audience of the local school community. Workshops were promoted amongst caregivers of patients in NYP Ambulatory Care Network's pediatric outpatient practices. T2U held three workshops: 1) Identifying and Managing Stress in Children; 2) The Real Impact of Social Media on Youth and; 3) Self-Care is Essential for Caregivers. Workshop participants completed a mental health literacy survey to gauge the mental health literacy of participating caregivers; after completing the survey, participants received a $25 gift card. The mental health literacy survey allows T2U to better understand the needs of the community and tailor programming to meet those needs. This project allowed T2U to expand services, reaching more community members during a time with increased mental health needs.

New York-Presbyterian Hospital's CHALK Jr Family Engagement Stipend Project brought early childhood center parents together to lead wellness workshops for their peers

Healthy Tomorrows Partnership for Children, New York-Presbysterian Hospital CHALK Jr

New York-Presbyterian Hospital (NYP)'s CHALK Jr program partners with early childhood centers in the Northern Manhattan, NYC, to increase access to healthy lifestyles for children and their families. Northern Manhattan's predominately Latinx community is tight-knit and faces high rates of childhood obesity and food insecurity. The neighborhood was hard hit by the COVID-19 pandemic.

As residents and community-based organizations come together to support families in need, NYP CHALK Jr launched the Family Engagement Stipend Project to amplify the voices of early childhood center parents and caregivers. Three parent leads received a stipend and $850 budget to train and then lead wellness workshops for their peers. Workshop themes included healthy eating (MyPlate), sugar-sweetened beverages, physical activity (dance and yoga), and childhood stress and resilience. Each parent tailored their workshops to respond to the unique needs, interests, and strengths of their early childhood center communities.

In their words:

"I love these types of programs that affect the community directly. This is definitely something I would love to do again."

"It was so great to meet two new people who will continue to be my partners!"

"There were times I was scared and wanted to back out, but I'm glad I didn't. I liked all the topics and am now offering my son milk or water each morning instead of juice."

NYP CHALK Jr will continue to champion this approach, offering paid opportunities for community members to engage in leadership roles. Thank you to our early childhood center partners and parent leads!

Consumer Empowerment in HealthCare!

Skagit County Public Hospital District #304 a Healthy Tomorrows Partnership for Children Program

As part of our work to initiate the HealthySteps program in a local pediatrician's clinic in rural Skagit County, Washington, AAP provided a Family Engagement Stipend to work with the Family Advisory Council at our local pediatric clinic. With the support of our clinic staff, we were able to work with a group of 10 parents. The first thing was to determine how to make the most of this opportunity. The parents decided they wanted to create a Patient Experience Survey. Their goal was to create a survey that would empower patients and parents to evaluate their healthcare journey, while providing important feedback to the Skagit Pediatrics' staff regarding their consumer experience.

Through discussion, research, and negotiation the work group members created a Patient Experience Survey with questions encouraging reflection and evaluation of the patient's experience with the established health care process. There was much concern expressed regarding language and diversity. Our community has many indigenous speaking families which requires an oral option for communicating. Concerns about equity and accessibility also arose regarding internet access and literacy. English and Spanish were determined to be the primary languages spoken in our community, so the survey was created in those two languages. The work group also decided to provide an electronic assistive device for accessing the internet survey and for the option to use "text to speech" functionality for non-readers. They also purchased a banner, ink pens, and 200 coloring books all inscribed with the tag line "Your opinion counts, take our survey!" (In both English and Spanish) to inform patient families about the survey and create some excitement.

This was a wonderful experience which illustrated the importance of providing parents/patients with a path to empowerment that directly involves them with their family's medical care. Developing a Patient Experience Survey and marketing plan provided these families with a sense of accomplishment. It strengthened their faith in the power of the consumer and in the sincere caring of their chosen healthcare provider.

Advancing Nutrition in MCH: Establishing a partnership between Louisiana Title V & Tulane Nutrition Leadership Training Program


Nutrition is vital to the healthy development and well-being of infants, children, youth, and adults, including those with special health care needs. Partnerships between state Title V programs and academic institutions offer unique opportunities to draw from respective strengths and expertise to promote the nutritional well-being of maternal and child (MCH) populations across the lifespan. This is the story of the Title V program joining forces with Tulane Nutrition Leadership training program to advance nutrition outcomes in Louisiana.

In 2018, the Bureau of Family Health within the Louisiana Office of Public Health (OPH) participated in the Children's Healthy Weight Collaborative Improvement and Innovation Network (CHW-COIIN) on a project to support further integration of innovative nutrition strategies into the state's Title V (MCH) block grant. While working on this project, OPH learned that Tulane University School of Public Health and Tropical Medicine was recently established as a HRSA funded MCH Nutrition Training program and could provide TA and expertise to advance their project.

OPH launched an academic-practice partnership between Louisiana Title V and the Tulane  Nutrition Leadership Training Program to develop a 20-hour immersive collaborative with two purposes:

  1. Improve integration of nutrition concepts into Title V programming, and
  2. Provide MCH Nutrition Trainees practical real-life public health experience within the state Title V agency.

Listen to Marci Brewer, MPH, Neonatal Initiatives Manager and Colleen McCullough, Title V Program Coordinator describe this partnership in their poster presentation for the 2021 Association of State Public Health Nutritionists (ASPHN) Annual Meeting. ASPHN developed an infographic describing the Louisiana Innovative Nutrition Integration project.

Trainee Activities

Since Fall 2020, two cohorts of MCH Nutrition Trainees have rotated through the program. As part of the Title V 5-year Statewide Needs Assessment, Cohort 1 trainees investigated the role that nutrition plays in reducing health disparities and improving health outcomes within Title V's populations. They also explored opportunities to integrate nutrition-focused strategies into Title V programming.

The trainees in Cohort 2 initiated a Bureau-wide conversation about food security by assessing Louisiana Title V staff's existing knowledge of food security. Informed by the assessment findings, students delivered a 20-minute educational presentation to staff. Key findings included:

  • Louisiana Title V staff have varying degrees of knowledge about food security.
  • Louisiana Title V staff recognize the importance of food security to MCH and are interested in learning more about how they can address food insecurity issues in the populations they serve.
  • There is a need for consistent nutrition messaging within Title V and Bureau of Family Health programming.

Next Steps

With supplemental financial support received through the Children's Healthy Weight COIIN, the Title V team will consult with two nationally recognized subject matter experts (SMEs) to bolster integrationof trainees into Title V and assist with future cohort project planning. During Summer 2021, the Title V team will work with the SMEs and partners from Tulane University to:

  • Reflect upon the key findings and recommendations from both cohorts
  • Develop options for practical, actionable Title V nutrition integration strategies
  • Facilitate a discussion with program leads and decision-makers to determine which strategies to implement
  • Determine the scope and focus of future cohort projects

The third cohort of MCH Nutrition Trainees will begin their Title V practical rotation in Fall 2021.


An important aspect of this collaboration is to recognize and value the expertise of the trainees as nutrition professionals. On the Louisiana Title V end, this required humility and honesty about the limitations of their nutrition experience.

Trainees from Cohort 1 expressed the following about their experience:

"The Bureau of Family Health allowed us as students to exercise our professional skills and empowered us to be confident in our nutrition knowledge. We truly felt heard, respected, and trusted while being given the space to showcase our public health education and experiences we have had with the New Orleans community."

The work of both cohorts has increased visibility and understanding of relevance of food insecurity in Title V programming. Creating meaningful experiences for trainees requires capacity and structure. Louisiana Title V and MCH Nutrition Trainees are co-creating that structure and capacity, making this a unique learning experience on both sides.


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