In the November 2018 issue of the North Carolina Medical Journal, Dr. Savithri Nageswaran (a Healthy Tomorrows Partnership for Children Program [HTPCP] grantee), Ms. Aura Rosado, and Dr. M. Stockton Beveridge published a paper highlighting the transportation challenges faced by Latino children with medical complexity (CMC).
HTPCP funds the community care coordination program for CMC at Brenner Children's Hospital in Winston-Salem, NC. This community program is part of the Pediatric Enhanced Care Program , a special program for CMC. CMC are children with serious medical problems, they receive care from many doctors and other providers, and are admitted to the hospital frequently. As a result, their families have to navigate a complex healthcare system.
Our team is interdisciplinary and includes a physician, two nurses, a social worker and a patient navigator. Our social worker and patient navigator are Latina and are bilingual. Having two bilingual care coordinators enabled our team to serve Latino families and learn about the unique challenges faced by these families as they navigate the health system. Our coordinators have also been able to build strong relationships with these families.
In this study, we used the encounter logs that the two bilingual care coordinators maintained and identified the challenges faced by families of 70 Latino CMC. We found that these families had many difficulties as they navigated the complex health system for their children. We were surprised that transportation was a major problem. Many families had problems transporting children to hospitals and doctors' appointments, but they also had difficulty using transportation benefits that were entitled to their children. There were many reasons for this difficulty, but the main issue was the language barrier. These problems had serious consequences for children, including missing appointments and having delayed arrival at appointments, leading them to miss much needed medical care. In the future, we should find out the extent of transportation problems; and test whether addressing transportation problems can improve families' ability to keep appointments with doctors. Twelve states and Washington, DC have provided temporary drivers' licenses for unauthorized immigrants, but North Carolina does not have such a policy. We should evaluate whether states that have policies for temporary drivers' licenses have less transportation problems.
Having two bilingual Latina care coordinators has uniquely positioned our program to serve and address the unique needs of Latino CMC. In recognition of her service for Latino CMC, Ms. Rosado received the Notable Latino Award by the Latino Community Coalition of Guilford in 2018.
The Nemours Foundation of Wilmington, Delaware has developed a special visiting rotation for Under-Represented Medical (URM) students called the Pediatric Scholars Program. Nemours provides a travel stipend, and selects URM medical students who are interested in doing a month-long elective with Nemours. In addition to standard clinical rotations, Nemours offers a “health disparities research and advocacy” rotation, which is more of a non-clinical academic experience. During the health disparities research and advocacy rotation, Nemours gives the students an overview of its Healthy Tomorrows project as an example of a Population Health based approach to addressing social determinants. The Nemours Aces to Aces: Accelerating Community Engagement to Address Adverse Childhood Experiences (ACEs) project aims to ensure that every child in Delaware's ACEs "hot spots" has access to a trauma-informed medical home, access to neighborhood supports, and improved parental mental health.
The 2018 Association of State Public Health Nutritionists (ASPHN) Brief on Guidelines and Health Conditions Related to Timing of Early Infant Feeding includes the most recent findings and guidelines necessary for public health nutritionists, including:
The Children's Healthy Weight Collaborative Improvement and Innovation Network (CHW-CoIIN) includes Indiana as a state team focused on physical activity. Team lead Kelsey Barrick shared the following about Indiana's project.
After the Children's Healthy Weight Collaborative Improvement and Innovation Network (CHW-CoIIN) In-Person Meeting in January 2018, Indiana's team acquired two interns from the University of Indianapolis to help research best practices related to adapting physical activity to students with special needs. The result of their work was a list of professionals in Indiana that focused their work in this area. Their findings also informed Indiana about what other states were doing regarding adapted physical activity projects.
In March, Indiana team leads Jessica and Kelsey attempted to convene a work group of professionals across Indiana who specialize in serving students with special needs. After consulting with professionals at Indiana University Bloomington, Jessica and Kelsey tried to recruit special needs advocates -- parents, educators, school professionals, after school providers, etc. Unfortunately, there was no traction with this work group.
In May, Jessica and Kelsey partnered with special needs professors at Indiana University Purdue University Indianapolis (IUPUI) and focused on regional work regarding adapted physical activity. The result of this partnership led to awarding scholarships to local districts in order to send one professional to a semester-long training, for intensive, hands-on learning for adapted physical activity.
The Adapted Movement Programs at Indiana University Purdue University Indianapolis School of Health and Human Sciences houses the Adapted Movement Programs (AMP). The mission of AMP is to provide high quality adapted physical activity programming to families and individuals with disabilities in conjunction with educating Kinesiology students on best practices. Individuals applying to the grant program will be involved in one of the two clinics during the academic year, Motor Activity Clinic (MAC) or Ability Fitness Clinic (AFC). Children that engage in MAC are between the ages of 3 to 15 years and have various disability characteristics. The focus on MAC is to provide motor development and motor skill training in the gymnasium and aquatic setting. Adults participating in AFC are from ages 16 to adulthood and have various disabling conditions.
Those applying to the grant will work one-on-one or two-on-one with a child or adult under the supervision of Dr. Katie Stanton and Mrs. Amy Oliver, MS. Both Dr. Stanton and Mrs. Oliver have expertise in adapted physical activity and considerable experience teaching and working with people with disabilities in various settings. Grantees can expect to gain skills in assessment, activity modification, appropriate planning and motor skill development, and experience in writing Individualized Education Planning goals and objectives. Grantees will also work with Dr. Stanton and Mrs. Oliver on how to apply skills gained in their own school/organizational setting.
The University of Minnesota's Leadership Education in Adolescent Health program (UMN-LEAH) is fortunate to be housed with several other adolescent health-focused programs; key among these is the Healthy Youth Development-Prevention Research Center (PRC) funded by the Centers for Disease Control and Prevention (CDC). So, when LEAH Social Work faculty member, Paul Snyder, isn't teaching and mentoring LEAH trainees, he is directing the PRC's core research study, Partnering for Healthy Student Outcomes (PHSO). And the UMN-LEAH trainees are benefiting as well.
Launched in 2014, PHSO has been working with 3 middle schools to address academic and health disparities, particularly for the most disengaged learners. Central to the program is an innovative and effective year-long teacher professional development (PD) program developed by Snyder and PRC colleague, Abigail Gadea. Years ago, both Snyder and Gadea committed themselves to more deeply understanding issues of equity and diversity, including their own unconscious or implicit biases; both are graduates of the University of Minnesota's Leaders in Equity and Diversity program. With these lenses, they quickly recognized how teachers' unconscious biases were impeding effective engagement with their students. Subsequently, they integrated into the PD program a session that encourages teachers to explore these biases so they can implement equitable teaching practices that address the needs of all students in their classroom. The evaluation of the PD program developed by Snyder and Gadea was so positive, they have translated that work into a free-standing PD program called Whole Learners©.
Snyder and Gadea brought their training on unconscious bias to the faculty and staff of the Division of General Pediatrics and Adolescent Health, where both the LEAH program and the PRC are housed. This training was so well received, they created a seminar for UMN-LEAH trainees: Examining Unconscious Bias. In this seminar, Gadea and Snyder strive to create an inclusive, open, and safe training environment by working with the trainees to establish grounding assumptions – agreements for how they will act toward and support one another during the seminar. Through individual exercises, personal stories, a video, verbal presentation, and large group and pair activities, Snyder and Gadea define unconscious bias, encourage self-reflection, provide research evidence, ask questions about trainees' personal experiences, request one verbally expressed take-away from each participant, and provide resources for further exploration.
Everyone has unconscious biases, and unconscious bias influences our actions and decisions. When we are working with others – whether that be in our teaching, planning or implementing research, recruiting or hiring new faculty or staff – only when we take the time to become aware of our unconscious biases and become actively mindful of their influence can we begin to create and support equity.
Mailman Center for Child Development
Department of Pediatrics
University of Miami Miller School of Medicine
MCH leaders in the 21st century require a remarkably diverse set of skills to be able to improve the health and well-being of children with neurodevelopmental disabilities such as autism spectrum disorders (NDD/ASD). MCH leaders must be well trained in the disciplinary skills of their everyday work; they must be family-centered and culturally competent as they adapt to an increasingly diverse population; they must be able to partner with individuals and organizations, especially those with different goals and professional backgrounds; they must be able to recognize how larger systems-level issues affect MCH; they must be innovative in using (and creating) evidence-based solutions to address individual and public health problems; and they must be focused on outcomes that matter to families and to communities.
With these key principles in mind, the overarching goal of the Leadership Education in Neurodevelopmental and related Disabilities (LEND) training program at the Mailman Center for Child Development (MCCD) is to develop leadership in MCH faculty and practitioners to improve the health and well-being of families and children with NDD/ASD, especially those who experience high levels of health disparities because of race/ethnicity. In response to new evidence and the changing needs of this population, we have designed our LEND to focus on improving health outcomes at the intersection of disability and other minority status, such as race and ethnicity.
Teacher using assistive technology with child
One way we do this is by training a diverse workforce. Over the last 5 years, we have graduated 384 long-term trainees (LTTs) in 13 disciplines, 65% of whom are ethnic/racial minorities. Our 126 Hispanic LTT represent approximately one-quarter of all Hispanic long-term LEND trainees in the US. Long-term follow-up surveys demonstrate that 84% of our LTTs report family-centered, interdisciplinary practice in an MCH setting, and 75% demonstrate leadership through organizational leadership, research and publications, or other activities designed to improve systems of care. Our impact is both regional and national; half of our LTTs remain in Florida; the other half work in three countries, 21 other states, and Puerto Rico. Our graduates hold or have held regional, state, national, and international leadership positions.
A second approach is our focus on improving health in underserved communities. We are committing resources to support training and leadership capacity in two “communities of focus” (Overtown and East Little Havana) —neighborhoods adjacent to MCCD that are culturally diverse, economically challenged, and underserved by health and education professionals despite having extremely high levels of morbidity and mortality. Over the last two years, for example, we have extended three MCCD-based programs by training staff of community partners to provide behavioral health interventions, family navigation, and implementation of assistive technology. A further goal is to assist our partners in obtaining grant funding and governmental appropriations themselves, so they will have future program sustainability and opportunities for innovation. Our vision is to address population health outcomes and develop trainees who can plan community-based interventions to improve systems of care, then translate this process to other communities.
Approximately 50 faculty, staff, and trainees from the LEND, Maryland Center for Developmental Disabilities (MCDD), Center for Diversity in Public Health Leadership and Training, the Center for Innovation & Leadership in Special Education, and Senior Management of the Kennedy Krieger Institute attended a three-day, on-site technical assistance program, Embedding Cultural Diversity and Cultural and Linguistic Competence, presented by the University Center for Excellence in Developmental Disabilities (UCEDD) at Georgetown University and the Center for Child and Human Development faculty, including: Tawara Goode, Wendy Jones, and Vivian Jackson. Kennedy Krieger Institute was one of four programs that were selected from 14 UCEDDs that applied for this on-site technical assistance. Other UCEDDs selected were Alaska, Louisiana, and New Mexico. This interactive program addressed the following topics: Cultural Diversity and Competence and Linguistic Competence: Definitions, Conceptual Frameworks, and What it Means for Your Center; Envisioning a Culturally and Linguistic Competent Organization; Aligning Cultural and Linguistic Competence Values with Organizational Policy; Embedding Project Tools, Ethical Issues and Challenges; and Essential Areas of Knowledge and Skills for Aspiring and Practicing Professionals in Developmental Disabilities.
Participants of the Embedding Cultural Diversity and Cultural and
Linguistic Competence technical assistance program.
The 8th annual Room to Grow: Journey to Cultural and Linguistic Competency conference was held on Tuesday, September 18th at Johns Hopkins Hospital. During the morning session, presenters included Shelly Choo, MD, MPH, Senior Medical Advisor for the Baltimore City Health Department who spoke on B'more for Healthy Babies: A Path to Child and Family Health in Baltimore City; Michael Lu MD, MS, MPH Senior Associate Dean for Academic, Student, and Faculty Affairs at George Washington University Milken Institute School of Public Health and former Associate Administrator of the Health Resources and Services Administration's Maternal and Child Health Bureau (2012 - 2017) who spoke on Leading Change; and, Daniel E. Dawes, J.D., a nationally recognized leader in the movement to advance health equity among under-resourced, vulnerable and marginalized communities who spoke on The Danger of Futility: Creating a Sea Change for Health Equity in America. In the afternoon, Dr. Rafael Luna, Associate Dean in the Morrissey College of Arts and Sciences, Director of the Pre-Health Program, and Director of the Gateway Scholars Program for STEM conducted a workshop on Telling a Story: The Art of Scientific Writing for trainees, residents, and students. In addition, Dr. William T. L. Cox, social psychologist and currently an assistant scientist in the Department of Psychology at the University of Wisconsin - Madison, conducted a workshop on Empowering People to Break the Prejudice Habit: Creating Inclusion and Reducing Bias. Over 160 trainees, residents, students, faculty, clinicians, and community members were in attendance.
Over the past decade, Healthy Tomorrows for New Britain Teens has evolved from an obesity prevention program into a youth and community led movement that is addressing some of the city's most challenging health, education and mental health problems. With support from an initial Healthy Tomorrows Partnerships for Children Program grant (2007-2012), the program combined access to health services with an emphasis on youth leadership. A second Healthy Tomorrows grant (2013-2018) supported the establishment of a Teen Center (the House of Teens) at the YWCA, a space where teens could access family planning, stress reduction, fitness and other services, while also making their voices heard through supporting policy change. June 2018 saw the grand opening of the East side Community Center in a renovated building in one of the city's poorest communities. The center is poised to become a hub of connection and revitalization where teens and residents can access services from multisectoral partners, engage with their neighbors, and promote a safe, walkable, healthy, more vibrant community.
Key drivers of growth and sustainability are:
1) Multisectoral coalition building: A shared mission of service to adolescents was the "glue" that kept core partners (Community Health Center, Inc., YWCA of New Britain, New Britain High School) actively engaged for over a decade. As the focus on policy increased, the coalition expanded, to include partners from higher education, the City of New Britain, and the business community.
2) Community based participatory research and Photovoice: In 2009, the goal of youth empowerment took a major step forward with the addition of Photovoice (PV) to the portfolio of health promotion services. PV is a community-based participatory research strategy that taps into the "natural activism" of youth. Teens take photos documenting issues of concern to them in the community, engage in dialogue with policy makers about those issues and take action to create a healthier environment. Photovoice has proven its value as both a research tool to investigate health problems and an intervention to engage youth and community members in creating and supporting solutions.
3) Policy change: Through PV youth learned how policy decisions about the built environment (e.g., parks, pools, transportation) influence the behavioral choices that individuals make. Through civic engagement (e.g., speaking at city council meetings), teens showed their support for policies to improve the built environment (e.g., reopen pools) or their health and educational options. In a statement acknowledging the impact of Healthy Tomorrows, New Britain's mayor, Erin Stewart, noted that such policy changes "address a broad spectrum of educational and economic, as well as health, goals of the city by nurturing healthy, well-educated youth—the next generation of city's leaders."
Cost Analysis of an Asthma Home Visiting Program Using Claims Data from a Medicaid Managed Care Organization
The Boston Children's Hospital Community Asthma Initiative (CAI) provides nurse-supervised community health worker (CHW) asthma education, case management, home visiting and environmental assessment in a culturally competent and linguistically appropriate manner for low-income children in Boston. CAI specifically focuses on serving children who have had previous hospitalizations or emergency department visits or who have other risk factors identified by primary or specialty care providers that contribute to poor asthma control. By working closely with these patients and their families, CAI aims to address the substantial socioeconomic and racial/ethnic health disparities that exist among patients in the Boston area.
CAI has made considerable impacts on the asthma patient community, including remarkable reductions in children with any emergency department visits (57%) and hospitalizations (81%). A recent cost analysis conducted using claims data from one Medicaid managed care organization (MCO) yielded adjusted return on investments (ROIs) of 0.31, 0.78, and 1.37 at 1, 2, and 3 years post-CAI intervention. The use of actual insurance data rather than estimated costs allowed for a more realistic cost analysis that took into account service utilization across settings and the total corresponding costs of care to payers, providing greater validation for previous positive ROIs for the program using hospital administrative data.
In addition to providing care and support for families in the Boston area, CAI is currently focused on replicating the CAI model at Pediatric Physicians' Organization at Children's (PPOC) primary care sites in the South Coast and Western MA, both of which have unique vulnerabilities for asthma exacerbations, including high levels of poverty.
Dr. Nimi Singh, Adolescent Medicine Physician
From the time she completed fellowship training in 1995, Dr. Nimi Singh, MD, MPH, MA, Adolescent Medicine Faculty with the University of Minnesota LEAH Training Program, has focused her teaching, scholarly activity, and clinical work on mental health promotion among adolescents from varying socioeconomic and cultural contexts. In 2014, she was invited to share her perspective on translating best practices in adolescent mental health promotion into teaching modules for health care practitioners, which were then published as a series of chapters in "Reaching Teens: Strength-based Communication Strategies to Build Resilience and Support Healthy Adolescent Development". This American Academy of Pediatrics publication, endorsed by the Society for Adolescent Health and Medicine, is designed to impart practical strategies for clinicians to improve their communication skills in working with teens across a wide array of health care settings.
One of the foundational approaches that Dr. Singh has come to embrace in her own work, supported by a substantial body of evidence, is the role of lifestyle in supporting or compromising the mental health of young people. More specifically, she emphasizes the importance of clinicians focusing on the critical roles that optimal sleep, nutrient-dense whole foods, self-regulation strategies, and physical activity play in supporting the mental health needs of all adolescents, including those who are struggling with mental illness. To this end, she has developed screening questions and brief teaching points for clinicians to use in encounters with adolescents, which are currently being incorporated into a newly-developed "Adolescent Depression Action Plan" for the University of Minnesota’s health care organization.
The MCH Training programs in Wisconsin (Pipeline, LEND, and PPC) partnered with a community-initiated program, Strong Baby Sanctuary, to host and participate in the first annual Shared Day of Learning. The Strong Baby program works to reduce infant mortality in the Milwaukee zip codes with the highest rates of infant mortality by training community facilitators from faith-based organizations to become sanctuaries of support for vulnerable pregnant mothers and mothers with newborns. Over 60 MCH trainees/faculty and 40 community members from 30 sanctuaries participated in this interdisciplinary day-long event. Programming included panels of mothers and Sanctuary facilitators who provided real-life stories of community challenges and successes, epidemiologists from the City of Milwaukee Health department, a speaker from WIC who also introduced an integrated early literacy program for the Sanctuaries, and interdisciplinary MCH student panels that provided training for community members on early nutrition for moms and babies, transitioning from bottle to cup, early play, and CDC resources for early developmental milestones.
To kick off the event, MCH trainees from across the three programs had conducted diaper drives on their respective campuses and then came together on the morning of the event to organize these supplies for distribution to the Sanctuary sites. The development and evaluation of this event was framed by the (pre-2018) MCH Leadership Competencies including: knowledge base, ethics and professionalism, critical thinking, communication, cultural competence, family-centered care, interdisciplinary team building, and policy and advocacy. Feedback from community and Sanctuary members included appreciation for information that "allows us to go back and help the young mothers/fathers in our program," for "materials we can distribute to our sanctuary team," and for "useful resources for questions asked by the new moms who come to us." Feedback from the MCH trainees included appreciation of "community stories to help [them] learn about the real issues families face," appreciation for the opportunity "to interact with community leaders," and powerful comments about the day "making disparities real." The second annual Shared Day of Learning is presently being organized to continue this impactful collaborative event to reduce infant mortality and support children and families in inner city Milwaukee.
The Northwest Public Health Leadership Institute at the University of Washington’s Northwest Center for Public Health Practice (NWCPHP) teaches collaborative leadership skills with a focus on the life-course perspective and health equity. Combining onsite sessions in Seattle with distance-based learning, the program incorporates individual and team-based learning components, including problem-based learning (PBL) cases about MCH-related challenges leaders face. Scholars assess their leadership skills, design and implement leadership projects in their agencies, and apply what they learn to their career.
Scholars, faculty, and guest presenters come from a range of roles and backgrounds working to advance health across the life course. Director Michelle Sarju, MSW, is a former midwife and a long-time MCH advocacy professional. Faculty have hailed from public health practice, various academic departments, primary care, organization development, and other areas. Guest presenters and panelists from the region bring career expertise in topics such as applying a life-course perspective to MCH leadership, using data for decision making, collaborating across sectors, resolving conflict using an equity lens, and communicating about sensitive issues. Scholars’ professional backgrounds range from MCH epidemiology, to public health nursing, to youth advocacy.
That breadth of disciplines and professions reflects an intentional and strategically expansive vision of MCH. As the cornerstone of NWCPHP’s HRSA-funded MCH Professionals Leadership Training Program, the Leadership Institute curriculum and program structure are interdisciplinary and interprofessional, particularly because of the life-course focus. Improving population health and equity at critical times across the life course involves many disciplines, professions, and roles working simultaneously and collaboratively on intersecting issues. The Leadership Institute is designed to both teach and model this for emerging public health leaders. This mirrors priorities of the new MCH Leadership Competencies version 4.0, which emphasizes the interprofessional nature of MCH.
School nurses in Alabama have very few opportunities for high-quality continuing education (CE), which are accessible and affordable. The Pediatric Pulmonary Center (PPC) at the University of Alabama at Birmingham (UAB) has helped to fill this need for many years. Every January, the PPC Trainees meet with the lead nurses for two local school systems, the Jefferson County Board of Education and Birmingham City Schools. These lead nurses typically have a “wish list" of topics that have been requested by school nurses. These topics, combined with areas of high priority to MCHB, inform the program for an annual CE event, which is held at the end of the school year. Trainees work as a group to plan all aspects of the event, including budget management, logistics, locating speakers, printing programs, obtaining nursing continuing education units (CEU), and handling registration.
UAB PPC Nursing Faculty Dr. Theresa Rodgers supervises this project. “The trainees learn a lot about event planning and working together as a team, including handling conflicts," according to Dr. Rodgers. “They do it all – from learning about purchase orders to introducing speakers."
The 2018 event, held on 5/25/18, had six different topics. The CEUs, breakfast, and lunch were all provided free of charge for the 60 attendees. Several PPC-specific topics, such as asthma and tracheostomy care, are requested nearly every year, while other topics, such as use of naloxone, are emerging issues. Former PPC Trainees consistently report that planning this event helps them gain confidence in interdisciplinary teamwork and leadership, as well as skills in event planning and working with community partners.
Recently, the LEND Program at Westchester Institute for Human Development (WIHD) added a new learning experience to the Interdisciplinary Clinical and Field Practice Module of their Interdisciplinary Leadership in Action Course. The new community-based site visits and post-visit full-class discussion activities support trainees in gaining insight into the practical aspects of model interdisciplinary practice. The learning objectives and pre-visit questions guide active observational experiences at community-based sites in multiple settings: a neonatal ICU; an independent specialty children’s hospital; inclusion preschool classes for children with language, communication, cognitive and motor delays and/or autism; early intervention and preschool special education classrooms at a post-acute care center; and a work-readiness program that supports students transitioning from school to work and community. Trainees make site visits in small groups with a LEND faculty member. All trainees participate in a large group discussion after the visits to share new knowledge and insights. At several of the sites, former WIHD LEND trainees, who are now on staff, host the visit. Trainee feedback on this new curricular element has been extremely positive.
For more than forty years, the Leadership Education in Adolescent Health program at the University of Minnesota (UMN LEAH) has been dedicated to improving the capacity of the workforce serving adolescents and young adults (AYA). Located within a land-grant university, UMN LEAH embraces the land-grant mission to translate and disseminate research with an aim of supporting real-world systems in making evidence-based and evidence-informed changes that positively impact young people’s health and well-being. Not only do faculty embrace this core principle but it is integrally woven into our interdisciplinary fellowship curriculum, providing trainees the skills for conducting, translating, and disseminating research, and the ability to provide technical assistance and support for policies that promote youth health.
Captured under the rubric Translating Research into Practice, UMN LEAH provides a 5-part seminar series to all first-year trainees that flips the traditional “research to practice” model by starting with “practice.” Focused on MCH Competencies of Communication, Family-Centered Care, Interdisciplinary Teams, and Policy and Advocacy, the overall goal of this series is to reframe how research and practice go together and build connections between academic and applied endeavors. Taught by a multi-disciplinary faculty (public health nursing, marketing/communications), these seminars provide foundational information about public health systems; dive deeply into how these systems use research; and enhance fellows’ translation, partnership and communication skills.
Over the course of the seminars, and with guidance from seminar faculty, trainees are actively engaged in translating their research into user-friendly products for practice audiences. Previously, a LEAH post-doctoral trainee and faculty member created a legislative brief for the MN Governor's Task Force on Bullying highlighting UMN LEAH research on youth bullying and prevention. This brief was used in concert with Governor’s Task Force testimony, to inform legislators and their staff about research relevant to the Safe and Supportive MN Schools Act, legislation that became MN law in 2014.
In addition to attending all seminars, trainees engage in a mentored collaboration with state public health agencies which could include:
This collaboration results in some research-to-practice “product” based on the needs of the system partner. Products include:
The MCH-Link Program is an innovative public health scholarship program that offers graduate-level Maternal and Child Health (MCH) courses addressing the current educational and training needs of practicing MCH professionals working in rural, frontier, and tribal reservation communities in the Rocky Mountain region. A critical shortage of MCH professionals exist in these areas due to geographic isolation, limited financial resources, few educational opportunities in their community or workplace, and family responsibilities. The MCH-Link Program is helping to bridge this gap by providing educational equity through opportunities for higher education and ultimately career advancement for the hard-to-reach MCH workforce. Funded by the Division of MCH Workforce Development at HRSA, the program has created and delivered a diverse mix of ten MCH courses (1 credit-hour online and conference-based) through state-of-the-art learning methods. Students can select course content in maternal and childhood nutrition, intimate partner violence, early childhood health including adverse childhood experiences (ACEs), adolescent health, AI/AN child development, sexual and reproductive health, and childhood obesity. Several other courses are currently under development. A MCH Certificate program was also created and launched during the first few years of MCH-Link, and is now fully funding five remote students who will complete their degree in 2019.
Through a collaborative network of MCH stakeholders, along with community, tribal, and rural public health partners, targeted marketing and outreach strategies are implemented each semester in order to recruit the hard-to-reach MCH workforce. Students who have been accepted into MCH-Link serve populations essential to the mission of the MCH workforce. They are public health and MCH nurses, home visitors, parent educators, MCH managers, consultants, epidemiologists, local public health directors, tribal head start staff, Indian Health Service employees, nutrition counselors and educators, violence prevention specialists, oral health workers, speech and language pathologists, and other disciplines. Now in its fourth year, MCH-Link has accepted and funded 75 rural and tribal MCH professionals to take the 1 credit-hour courses, and has also delivered these courses to over 350 graduate public health students. Extensive orientation and academic mentoring are provided to each MCH-Link student so that they are well prepared for graduate-level education. Some of the students have taken one course with MCH-Link, and other students have taken several courses in order to enhance their careers. Almost one-fourth of the MCH-Link students have experienced job changes representing professional advancement, or are now enrolled in another program of graduate study due to their success in the program. The majority of MCH-Link students come from Colorado (36%) and Wyoming (22%), along with Montana (16%) and South Dakota (12%). Students who live and work in other states have also taken courses with MCH-Link. Almost 25% of the MCH-Link students are American Indian and 5% are Hispanic or Latino. Tribal affiliations have included Oglala Lakota Sioux, Navajo, Southern Ute, Zia and Acoma Pueblo, and Northern Cheyenne.
Reaching the MCH workforce is proving to be a foundational step in quickly translating knowledge gained from course content into best practices, and is ultimately enhancing MCH services by helping promote the health and well-being of MCH populations in the Rocky Mountain region. Not only is this impacting the health of their clients, but the thinking and work of other professionals in their current rural and tribal environments. The program is housed at Colorado School of Public Health, Department of Community and Behavioral Health, at the University of Colorado Anschutz Medical Campus in Aurora, Colorado. It is directed by Dr. Elizabeth Greenwell, ScD and Dr. Kathy Kennedy, DrPH. Dr. Michelle Sarche, PhD serves as Tribal Liaison and Caitlin Trucksess, MPH is the Program Manager.
For more information about the MCH-Link Program, please contact Dr. Elizabeth Greenwell.
The Center of Excellence in MCH Education Science & Practice at UAB School of Public Health has teamed up with the Alabama Department of Rehabilitation Services/Children’s Rehabilitation Service to create the Pediatric Nutrition Training Modules . The modules feature foundational information designed to refresh knowledge levels pertaining to the nutritional outpatient follow-up of children with commonly seen diagnoses. Nutritionists desiring information regarding the outpatient care of children with special health care needs can use these modules to meet their professional development goals while also receiving free Continuing Professional Education (CPE) units.
The UAB LEND incorporates autism awareness throughout their daily work in clinical settings, training, and community outreach. Recent highlights include co-sponsoring the 17th Annual Alabama Autism Conference in February, which focused on “Improving Daily Life for Individuals with Autism Spectrum Disorder (ASD): Addressing Real Life Challenges,” with over 500 participants attending the day-long event, including educators, clinicians, trainees, caregivers, and self-advocates. In March, LEND faculty and trainees met side-by-side with self-advocates and families to educate legislators of the benefits of funding early intervention for children with ASD to promote increased independence and better long-term prognosis and satisfaction as adults. Several LEND faculty are part of the UAB Extension for Community Healthcare Outcomes (ECHO): Autism interdisciplinary team that meets bimonthly to provide telementoring to pediatricians and other healthcare providers across the state focused on identification and intervention with children and teens with autism spectrum disorder. Community awareness activities include supporting the Autism Society of Alabama and collaborations with other local and state organizations during the month of April and year-round, including co-sponsoring and participating in the 5th Annual Autism-Friendly Birmingham Barons baseball game on April 29th, providing technical assistance and support in community sensory-friendly theater and music events, and participation in the state Autism Council. Finally, the UAB Regional Autism Network, which is housed at UAB University Centers for Excellence in Developmental Disabilities (UCEDD) in Developmental Disabilities/LEND, just finished its first year of existence, with a huge accomplishment of providing monthly education workshops for caregivers of individuals with autism spectrum disorder.
Under the course direction of Alison Schonwald, MD**, Carrie Mauras, PhD, Holly Hodges, MD*, and Arda Hotz, MD^, over 20 pediatric residents and early career primary care pediatricians attended the 1st Annual Developmental Behavioral Pediatrics (DBP) Booster Course at Boston Children’s Hospital (BCH).
This two-day conference taught high-yield, relevant DBP topics for senior residents committed to primary care pediatrics and for pediatric providers newly in practice. Using innovative and adult-centered educational methods, including small groups discussions, use of technology, and case-based learning, participants boosted their knowledge in the following topics:
Faculty included DB Pediatricians, Psychologists, Primary Care Pediatricians, LEND Family Faculty member, and a Psychiatrist. This course was designed to address practicing pediatric primary care providers reported lack of sufficient skills to care for their patients with DBP needs. Despite dedicated time during pediatric residency for DBP training, these rotations often occur during internships, before career tracks are determined and when the information load is great. Revisiting this material as senior residents preparing to enter primary care (or early career) will serve to boost participant knowledge and confidence in behavioral and developmental concerns as they enter or continue in early practice. Program evaluation of the Booster is underway, and we hope to offer the course again to a wider audience.
*Current DBP Fellows
^Current LEND Fellow
**DBP Fellowship Graduates
Dr. Lauren Ethridge, neuroscientist, and Dr. Ami Bax, developmental & behavioral pediatrician, at the OUHSC Section of Developmental & Behavioral Pediatrics are conducting an innovative study involving the use of EEG for comparisons of reward processing in 6-12 year old boys with autism spectrum disorder, ADHD, comorbid autism spectrum disorder and ADHD, and typically-developing peers. They are hoping to gain a better understanding of the underlying neurobiologic similarities and differences among these conditions that will lead to important diagnostic and treatment recommendations.
Dr. Bonnie McBride, LEND core faculty in ASD, presented a poster session at the Autism CARES 2017 Conference in Bethesda, Maryland on the results of a recently completed randomized controlled trial (RCT) comparing a center-based, inclusive behavioral intervention model for toddlers with ASD called Project DATA for Toddlers to standard care in two states.
The Autism Spectrum Disorder Family Voices Project is an initiative of Minneapolis Public Schools (MPS) that focuses on improving service delivery to multilingual and underserved young children (3-5 years) with autism spectrum disorder and their families. In the 2016-2017 school year, MPS and MNLEND launched a collaborative partnership to create an evaluation project to analyze the effectiveness of MPS services and processes for multilingual children and families who receive services in the Early Education, Special Education and Multilingual Departments. The project design included a literature review, an analysis of MPS student data, development and implementation of a family survey, analysis of survey results and recommendations for an Autism Spectrum Disorder Family Voices Project 2.0.
The project design was created by a multicultural team of LEND Fellows and MPS staff. The survey cohort included MPS multilingual families, whose children received early childhood screening, special education evaluation and an IEP under the education eligibility of autism spectrum disorder. The team reviewed each child’s student information identifying 20 Somali and 20 Latinx students who met the criteria for the cohort. From the chosen participants, 8 Somali-speaking and 10 Spanish-speaking families completed surveys.
The 3-part survey included demographic information of caregiver and child, MPS communication and information received, and services received in health, education, county and family supports. MNLEND Fellows administered the survey by phone, documenting survey responses using Google forms, with direct oversight from MPS staff. Analysis of the survey responses included review of aggregate data as well as individual responses. The chart below summarizes the survey responses.
Almost all families reported that their culture and family norms were respected and that MPS services supported their child. Areas for improvement included communication of education eligibility, identification and documentation of access and links to health and county services, and connection to support groups. The 2017-2018 MNLEND Fellows will address the topic of timely access to services in health and human services and family supports. They will create map links to services and use person- and family-centered design theory while working with families to address gaps in services. The work will be aligned with other MPS projects underway. The survey cohort will be expanded to include all underrepresented and underserved ethnically diverse groups with the aim of completing 50 family surveys in total.
Service access is a barrier to the provision of high quality intervention for adults and children with developmental disabilities, including autism (ASD) and their families who reside outside of metropolitan areas. Dr. Jessica Simacek (former MNLEND fellow) and Dr. Adele Dimian (MNLEND post doc), through the Institute on Community Integration (ICI), engage in training, technical assistance, and developing research projects with the aim of improving access to intervention through telehealth (e.g., connecting over video conferencing) for people with developmental disabilities. Both Drs. Simacek and Dimian were trained and advised by MNLEND Research Director, Dr. Joe Reichle.
One key telehealth related project at ICI provides mentoring to pre- and post-doctoral and community fellows from the Minnesota Leadership Education in Neurodevelopmental and Related Disabilities Program (MNLEND). MNLEND fellows receive training and mentorship to gain knowledge and experience in the use of telehealth to provide assessment and intervention. The project utilizes a train-the-trainer model, delivering in-home support services to families through coaching parents to assess and intervene to improve challenging behavior and social-communication skills. Dr. Dimian describes telehealth as “a way to support and connect families with resources who may not otherwise receive them, or who may spend long periods of time on ‘waitlists’ prior to accessing services.”
A second key telehealth related project at ICI is TelePBS. Dr. Simacek utilizes telehealth as a component of the larger Positive Behavioral Supports project, with ICI’s Dr. Rachel Freeman, to connect with and train community-based service providers on positive behavior support practices to support people with developmental disabilities.
Potential future directions for the ICI telehealth projects include collaboration with Dr. Amy Esler and the UMN’s ASD/Neurodevelopmental Disorders (NDD) Clinic Clinic to improve challenging behavior. In addition, our telehealth team hopes to develop telehealth intervention research aimed at improving social and communication skills, including augmentative and alternative communication intervention in continued collaboration with Dr. Joe Reichle. As a result of their work, their collaboration in ongoing telehealth research has also been shared via national presentations and publications intended for numerous cross-disciplinary academic communities (see details below). In sum, MNLEND fellows are helping to bring a range of telehealth options to improve service access for families in underserved and rural communities via participating in a number of innovative and interdisciplinary telehealth projects underway.
Dimian, Elmquist, Reichle, & Simacek. (in press). Teaching communicative responses with a speech generating device via telehealth coaching. Advances in Neurodevelopmental Disorders.
Simacek, J., Reichle, J., Byiers, B., Parker-McGowan, Q., Dimian, A.F., & Elmquist, M. (in press). Promoting conditional use of communication skills for learners with complex communication needs: A tutorial. American Journal of Speech-Language Pathology.
Simacek, J., Pennington, B., Reichle, J., & Parker-McGowan, Q. (2017). Aided augmentative and alternative communication interventions for people with severe to profound and multiple disabilities: A review of interventions and treatment intensity. Advances in Neurodevelopmental Disorders, 1-16.
Benson, S. S., Dimian, A. F., Elmquist, M., Simacek, J., McComas, J. J., & Symons, F. J. (in press). Coaching parents to assess and treat self-injurious behavior via Telehealth. Journal of Intellectual Disability Research.
Simacek, J., Dimian, A.F., & McComas, J.J. (2017). Communication intervention for young children with severe neurodevelopmental disabilities via telehealth. Journal of Autism and Developmental Disabilities, 1-24. doi: 10.1007/s10803-016-3006-z
Reichle, J., Simacek, J., Bambara, L., & Halle, J. Teaching Alternative Skills (Chapter in preparation).
McComas, J.J., Schielz, K.M., Simacek, J., Berg, W.K., & Wacker, D.P. Functional Communication Training for Durable Behavior Change. (Chapter in press).
Reichle, J., Simacek, J., & Parker-McGowan, Q. Considerations in implementing aided low-tech AAC applications for persons with autism spectrum disorder. (Chapter in press).
Simacek, J., McComas, J.J., Dimian, A.F., Pennington, B., & Reichle, J. The persistence of augmentative and alternative mands during functional communication training following fixed and variable reinforcement schedules for two children with autism. Symposium presentation accepted for presentation at the Association of Applied Behavior Analysis International. San Diego, CA, May, 2018.
Simacek, J., McComas, J.J., Dimian, A.F., Pennington, B., & Elmquist, M. Programming functional communication training for persistence: Requests during extinction following fixed and variable reinforcement schedules for two participants with autism. Poster accepted for presentation at the annual Gatlinburg conference. San Diego, CA, April, 2018.
Gunderson, J., Simacek, J., Dimian, A.F., Reichle, J. Measurement of Responsive and Initiated Joint Attention for Two Children with Autism via Telehealth. Poster presentation accepted for presentation at Applied Behavior Analysis International. San Diego, CA. May, 2018.
*MNLEND fellows, former fellows, and faculty in bold
When Minneapolis Park and Recreation Board (MPRB ) ADA Coordinator Elise Niedermeier (MNLEND fellow) learned of an inclusion microgrant opportunity through the National Park and Recreation Association (NPRA ), she knew immediately what project to pitch.
“We have so many loud, crowded, outdoor summer events, I thought it would be great to offer a sensory or escape tent for people to take a break,” noted Niedermeier. Through the grant award, MPRB has begun piloting sensory tents to give people with sensory processing needs a space to soothe or stimulate their senses at crowded park events.
As a MNLEND fellow, Niedermeier knew to think about this project collaboratively and across disciplines. By working with LEND faculty mentor, Ellie Wilson, now Director of the Autism Society of Minnesota (AuSM ), LEND parent trainees, and MPRB’s Community Outreach Event Coordinator and Therapeutic Recreation and Inclusion Coordinator, the project team succeeded in making events and programming more accessible.
“The connections and conversations through my participation in LEND all sparked this vision for what could be,” said Niedermeier. The tent provides materials including slime and foams, scented crayons, a mini trampoline, hammock swing, calming lights and noise-cancelling headphones - all materials suggested and selected through consultation with AuSM.
The tent will appear this summer at outdoor concerts and movies in the parks. A schedule for sensory friendly Sundays is being developed, and MPRB staff are collaborating with MNLEND alumna, Julia Anderson, at the Walker Art Center and Twin Cities Public Television (TPT ) to share successes and learning around creating inclusive events. MPRB also is collaborating to make sure sensory-friendly event dates do not overlap, so families have many options to explore this summer.Anyone interested in the project can contact Elise Niedermeier
Summary of Grant Project
In a community on the South Side of Chicago, which consisted primarily of low income African-American residents, grew an overwhelming need to provide quality, affordable health care. The few places that did provide care did not tailor their services to meet the specific needs of this population. There was a lack of routine screenings to identify future health complications, and other health barriers, like transportation and financial stability, were not addressed. These barriers prevented residents from obtaining the health care support and services they needed. Due to the lack of access to primary and preventative health care, children in this community were also at high risk for developing long-term mental and physical health issues.
With the help of a Healthy Tomorrows grant, Access Community Health Network (ACCESS) opened the ACCESS at Gary Comer Youth Center in 2010 to ensure students and other community residents received culturally appropriate mental and primary health care. The convenience of having a health center onsite at the youth center was a great benefit for the community. Medical compliance increased to 98% in the high school and early dismissal rates fell sharply.
ACCESS’ commitment continued after the Healthy Tomorrows grant period ended in 2014 and continues even today with the health center seeing more than 700 patients a year on average. Although barriers to health are still a significant issue facing this population, the staff members at ACCESS at Gary Comer Youth Center remain committed to supporting their community and addressing the health disparities residents still face, day in and day out.
Example of How ACCESS Helps
Randall was just 17 years old when he was displaced from his home in Iowa and moved to Chicago to live with his 24-year-old sister, Daria, who is blind in one eye. Already afflicted with her own health complications, Daria now had the added responsibility of caring for Randall. Randall came to her without health insurance nor enough clothing to keep warm during the harsh Chicago winters. Additionally, they lacked the basic funds for adequate food and transportation.
Randall’s high school contacted the staff at ACCESS at Gary Comer Youth Center, which was a resource available in part due to the Healthy Tomorrows grant. First, the ACCESS staff helped Randall and Daria sign up for health insurance. Then, they ensured Randall was up-to-date on all the required immunizations. Daria and Randall are now insured and know that the ACCESS school-based health center is always there to help them and provide support.
By placing this health center right in a school-based community in need, more underserved children and young adults on the South Side of Chicago now have better access to health care.
The Florida International University (FIU) MCH Public Health Catalyst training program is in Miami, a “majority-minority” city of over 2.3 million, with the highest proportion of foreign-born persons of any US major metropolitan area. FIU students mirror the amazing diversity of Miami, with Latino/as from throughout Latin America, African-Americans, and Caribbean young people making up most of the student body. In 2015, the Catalyst grant awarded to FIU’s Stempel College of Public Health and Social Work supported a unique program to support MPH students as MCH Scholar Consultants, who would help guide all aspects of course preparation and adaptation, and educational activities such as MCH Grand Rounds. The Grand Rounds bring together professionals from multiple disciplines from the community, including the health department, and expose our students to the diversity of professional opportunity in Miami MCH practice. The student group, Leaders in Maternal and Child Health, now boasts over 85 members, and frequently joins with the Stempel Public Health Association on community-based service events.
Beginning in Fall 2017, the Leaders in Maternal and Child Health are undertaking their next challenge: Great Indoors. Great Indoors is a community-based participatory research project in Liberty City public housing, a historically African American community with some of the most troubling MCH indicators in the county. As part of this project, Catalyst trainees seek to assess the impact on quality of life and health of mothers and children before and after innovative integrated pest management, improved conditions in the apartments and health promotion strategies to support smoking cessation are implemented.
Texas Southern University (TSU) and Baylor College of Medicine (BCM) offer a joint one-year undergraduate fellowship program leading to the award of an undergraduate certificate in Maternal and Child Health (MCH). The MCH Student Training for Academic Readiness and Success (STARS) program recruits economically and educationally disadvantaged students, including students from racially and ethnically diverse groups. The program developed and implemented an effective and enriching MCH research mentoring program that meets the learning and skill development needs of the students as they navigate through the pipeline program and consider future career options in MCH-related fields. To date, four manuscripts have been submitted for review by the first cohort of 28 MCH undergraduate students. The first manuscript was recently published in the American Journal of Infection Control.Article: Hospital length of stay and cost burden of HIV, tuberculosis, and HIV-tuberculosis coinfection among pregnant women in the United States
In December 2014, a Diversity Learning Collaborative (DLC) for the MCH Nutrition Grantees was established.
Accomplishments of the DLC include:
For almost four decades, Michael Resnick has been serving adolescents and young adults through his roles at the University of Minnesota. Joining the UMN in 1981, Michael has held various positions during his tenure; Professor of Pediatrics, Nursing, and Public Health, the Gisela and E. Paul Konopka Chair in Adolescent Health and Development, and Director of the Leadership Education in Adolescent Health program and the Healthy Youth Development - Prevention Research Center (20 years). He serves on the Board of Directors for the Guttmacher Institute and the Women's Foundation of Minnesota, while also serving as the 2015-2016 President of the Society for Adolescent Health and Medicine.
Dedicating his career to disseminating and translating findings into best practices and promising approaches to improving the health and well-being of adolescents and promoting excellence among those who care for young people, Michael has often been credited with helping to shape the field of adolescent health in the US and globally. In the early 1980s, Michael directed the National Adolescent Health Resource Center (NAHRC), working with the states of Alaska, Delaware, Hawaii, Minnesota, and North Carolina to create, implement, analyze, and disseminate findings from comprehensive youth health surveys involving tens of thousands of young people. This ground-breaking research set the stage for additional state- and national-level adolescent health surveys (the Minnesota Student Survey - MSS, and CDC's Youth Risk Behavior Surveillance System) and helped implement measures focused on assessing protective factors in the lives of young people, something not explored prior. Michael also served as the co-investigator of the National Longitudinal Study of Adolescent Health (Add Health), for which Michael and colleagues developed and published the first paper from this landmark national survey, one of the most frequently cited adolescent health papers in the world.
In addition to his contributions to the science of adolescent health, Michael's career also includes accomplishments in teaching, with various awards and contributions to the public good. His teaching, advising, and mentoring styles exemplify his overall dedication to assuring that young people are regarded as whole human beings living in the context of family, peers, school, and community, not to be regarded as a simple set of risk indicators.
In retirement, with his spouse Lyn Bearinger, Michael is enjoying more time for travel, grandchildren, music, and various hobbies. He thanks the wonderful colleagues and students who have helped to create a varied and deeply meaningful career.
Q: What is the name of your project?
CBW: Our project is titled The Maternal and Child Health Training Program. It is a collaboration between the UTHealth School of Public Health, Austin and the Grand Valley State University, Michigan, co-directed by Dr. Joan Borst and myself (Dr. Courtney Byrd-Williams).
Q: What is your project trying to achieve?
CBW: We aim to increase capacity in rural health workers serving maternal and child populations to address public health issues. We develop training modules on an online portal, edX, to equip rural MCH workers with crosscutting competencies. Our trainings are interdisciplinary and free of cost, and are developed keeping in mind the training needs of the MCH workforce in rural areas. A second part of the program is training students in our fellowship program in MCH Leadership skills. These fellows develop the trainings for rural health workers, and are closely guided and supported. In the process, they are learning how to identify capacities that need strengthening among a workforce and determine how to address them with training.
Q: What are the next steps for reaching rural health workers?
CBW: We are looking to expand our reach across HRSA region VI. By building partnerships with organizations in each state, we will be able to develop new training content that serves a broader diversity of health workers. We have been working with smaller, home-visiting organizations and Community Health Workers so far, and are eager to learn about the training needs of other professional groups in clinical and health department settings over the coming year.
Q: What community partners are involved in your MCH Training Program?
CBW: The success of our program stems from our broad range of collaborations and partnerships. We have community partners such as Texas Public Health Training Center; Healthy Start in Dallas (TX), Hugo (OK), and Lafayette (LA); Go Austin, Vamos Austin; and the Michael and Susan Dell Center for Healthy Living. All of our collaborators have been very helpful in supporting the first round of trainings. Of course, other organizations have also participated in our trainings and we are always looking to expand our partnerships.
Q: What is your process for developing trainings and evaluating them?
CBW: Once a training topic is determined with a partner, we develop a curriculum committee to discuss the contents of the training and develop a plan. We research, develop, and revise internally. When the content is finalized, we send the training to content experts. The curriculum committee members and others in the community run through the training and provide thorough feedback. We talk with the curriculum committee about edits and then revise. Then, the training goes to the Texas Department of State Health Services for their review process and certification. We have not started evaluating learning outcomes yet, but plans are in the works and we do have some data to begin examining!
Q: What does your fellowship program include?
JB: The MCH Leadership seminar is aimed at teaching through faculty and guest lectures, readings, and learning modules created by fellows to train public health clinic staff. Women and children are consistently some of the most vulnerable in the world in terms of poverty, lack of education, weak human rights and abusive or absent policies. As part of an educator team, we try to build a platform for discussion regarding the lifespan of development as well as many of the above outlined issues, ultimately hoping to empower students to engage meaningfully with the MCH community, both personally and professionally.
In this program, we train fellows from various healthcare fields and prepare them to become a valuable part of the rural MCH workforce. Our fellows are from diverse professional backgrounds and bring a plethora of skills and knowledge to this program from their varied experiences. The development of these learning modules has also been of great benefit to the fellows as they research and think creatively about the best ways to share information online. The creativity at every level of the project has been delightful to be a part of and observe.
Q: Why interdisciplinary training for rural health workers and fellows?
JB: The grant is inter-professional in nature. Social work and public health drive the curriculum, but in reality, the best efforts we can make for women and children will come from disciplines working together for the benefit of women and children. Sharing professional knowledge across disciplines benefits all.
As I mentioned earlier, the reality of public health and social interventions to teach, support and lift up the needs of women and children’s health cannot be accomplished by one profession. It is important that we learn about what other professions do so that we can refer appropriately, respect the efforts of our colleagues from other professions, and strengthen our efforts through better planning. Inter-professional training efforts reduce the barriers of reaching out to other professionals and strengthen the efforts we make on behalf of the MCH community.
Q: Tell us about how the GVSU and UTHealth partnership has benefited the program.
JB: The MCH Training grant has a couple of distinct benefits for educating our students. Since both these universities differ geographically and demographically, there is a unique contribution from each, which adds to the versatility and broad-ranging application of our trainings in the real world. Although we learn about differences through this wider geographic lens, we also see what women and children have in common, despite geography--a desire for healthy and safe bodies, healthy and nurtured babies and children, resources to answer questions, and support for potential problems.
Finally, completion of the fellowship aspect of this training grant has benefited students in their job-seeking efforts. Agencies and clinics are looking for professionals who come prepared to think critically about programming and services to the MCH populations.
Q: Has the project experienced challenges/anything that was not anticipated?
CBW: There isn’t a well-developed infrastructure in rural areas in terms of public health and that makes it difficult to assess the needs of the MCH workers in these areas. We need to find new ways to get the word out to organizations that we will work with them to develop tailored training content.
JB: This project has grown significantly in the past 2 years, adding new complexity to our team’s operations. Although we experienced technological challenges initially, the work has moved forward more rapidly in the last 12 months with the creation of online modules that bring “the classroom” to the clinic workers.
Q: Anything you'd like to add?
JB: While we often face challenges with respect to setting up lectures and meetings across two different states and time zones, it is well worth the efforts we all make to find a way to connect Texas and Michigan. Students and faculty greatly benefit by contributing and hopefully find the environment a safe one where they can challenge their misunderstandings and examine their perspectives. I look forward to the coming academic year!
Twelve undergraduate students from various colleges across the University of South Florida (USF) have been accepted into a Maternal and Child Health (MCH) Pipeline Training Program, known as MCH Train-A-Bull, at the USF College of Public Health's Department of Community and Family Health (CFH).
The two-year program provides mentorship, training, and guidance for underrepresented undergraduate students from economically, educationally disadvantaged, and diverse backgrounds.
Funded by the Maternal and Child Health Bureau within the Health Resources and Services Administration, the program aims to increase the diversity of the MCH workforce by supporting scholars who seek graduate training in MCH and health-related fields.Click for more information about the MCH Train-A-Bull Program
The Intensive Family Services Program (IFSP) at Youth & Family Services, Inc. (YFS) provides comprehensive, coordinated, individualized services for children and their families. IFSP targets families whose children are at risk for out-of-home placement—whether through the juvenile justice system or residential drug/alcohol treatment facilities—due to behavioral health issues. A majority of the children served come from low-income and/or American Indian families. Principal goals of the program are to increase family functioning, improve individual family members’ overall health and well-being, and provide a cost-effective alternative to the community and state.
IFSP is a community-based initiative first piloted in 2014 in the Rapid City area. The program developed from a focus on community mental health needs by the grassroots Rapid City Systems of Care Collaborative (SOCC) and implemented by YFS. IFSP staff, families, and youth work in partnership with informal supports, schools, mental health centers, psychiatric treatment programs, social service agencies, juvenile justice programs, and primary health care organizations to design services that are coordinated, individualized, community-based, and youth and family-driven. A central core of service provision is the IFSP Team, which works toward the goal of “One Family, One Team, One Plan.” A team is organized based on the individual needs of each family and typically meets once per week with family members and their support system until a plan is in place and the family is successfully working toward their goals. The Team meets with the family to discuss wraparound services that build on increasing the strengths of individuals, nurture their healthy growth, and address each person’s cultural and linguistic needs.
IFSP is establishing new relationships with the South Dakota Title V Office of Maternal-Child Health/Child & Family Services, local membership of the American Association of Pediatrics (AAP), and the Community Health Center of the Black Hills. IFSP contracts with an external evaluator who is working closely with program staff to employ assessments that explore improvement in child behaviors, parent stress, and family functioning. The evaluator is also tracking increased access to medical, dental, and mental health homes. The evaluation will include a cost-benefit analysis comparing out-of-home placement with the program.Click for more information: http://www.youthandfamilyservices.org/intensive-family-support/
The Ohio Chapter, American Academy of Pediatrics offers Quality Improvement programs to pediatricians that improve performance and outcomes for children, and many of these programs have been possible thanks to the support of a Healthy Tomorrows Partnership for Children grant that began in 2013. Since that time, the Ohio AAP has used the successful Injury Prevention Learning Collaborative as a model to develop other injury prevention QI programs, offered in a variety of methods and settings.
The goal of the LEND Program Quality Improvement (LPQI) Network is to help individual programs improve the quality of LEND training in core competencies (e.g. family-centered care, interprofessional teaming) by: (1) using standardized measurement tools, (2) developing a voluntary inter-institutional database, (3) providing feedback to programs to use for quality improvement, and (4) identifying programs that demonstrate changes consistent with “best practices.” The effort began in 2013 with the creation of appropriate measures and the design of a web-based data entry system. Each stage of development has been pilot-tested and, to date, has included the input of 21 LEND programs.
This past year, 11 LEND programs successfully completed beta-testing of a fully functional data entry system that also enables administrators to run visual data reports – comparing their results to national averages across years, disciplines, and other variables. We also presented data at a national meeting to help demonstrate the validity of the measures, and a manuscript has been submitted to the Journal of Graduate Medical Education for publication. In July 2017, the LPQI Network was opened to all LEND programs for use during the 2017-18 training year; leadership for the Network has been transferred from the Mailman Center (FL LEND) to AUCD. LEND programs that choose to participate can use their LPQI data reports to determine areas for improvement, devise and implement quality improvement plans, and measure outcomes in subsequent years.
The LPQI data dashboard and Network coordination activities are technical assistance tools offered by AUCD to LEND programs. It is not endorsed by or required by MCHB.
The LEND Outcomes Study is designed to compare outcomes for professionals or advocates with an interest in pediatrics who received formal LEND training to others from their graduate program or community with similar pediatric interests but no LEND training. The model is inclusive of family and self-advocates. Our fundamental question: Do responses to the 14 questions on the NIRS Graduate Survey (a survey specific to LEND grantees) differentiate LEND graduates from peers with similar pediatric interests who have not received LEND training? One supplementary question: Does participation in the LEND Outcomes Study improve NIRS survey participation rates for LEND graduates?
The LEND Outcomes Study began in 2014/2015 in Pittsburgh. While the initial plan was to demonstrate feasibility at one site, the LEND of Pittsburgh was joined in year 1 by the Nisonger and Waismann Centers. These 3 programs will be starting year 4 of their work this fall. In addition to this core group of 3 participating LEND programs, we have been joined by 7 additional sites (UC, UCONN, IOWA, KANSAS, ROCHESTER, TEXAS, and VERMONT)—10 total sites participating. Current efforts are focused on dissemination of the outcomes model to additional LEND programs and developing supplemental questions that can be used along with the NIRS Graduate Survey to measure the effects of LEND training. Feedback from other LEND centers has suggested that the primary challenge faced by this outcomes evaluation is a shortage of resources to implement the project and sustain the work. Issues related to institutional review boards (IRB) have also been raised. The three initial sites are in the process of developing a set of open and closed ended questions that can be asked of LEND graduates and comparison peers from 2014/2015 to supplement NIRS and demonstrate proof of concept.
Healthy Tomorrows grantee, Clinic in the Park in Santa Ana, CA, recently was selected as a poster winner at the 2017 Practical Playbook National Meeting for their poster entitled “Clinic in the Park: A One-Stop-Shop Model Bridging Medicine to Public Health.”
Current and former trainees from Maternal and Child Health Bureau funded training programs met on April 5-7, 2017 in Seattle, Washington for the seventh annual Making Lifelong Connections meeting. The Making Lifelong Connections meeting brings together trainees in an interdisciplinary setting with the specific intent of enhancing networking and leadership skills, and providing professional development beyond the boundaries of a specific training grant setting. These activities provide reinforcement to the Maternal and Child Health Leadership Competencies and provide a real-world application of leadership skills for trainees as they prepare to enter the MCH workforce, and for former trainees in the early stages of their careers. Presentations and more can be found here.
Each year we have a combined seminar between our OKLEND program and the Interdisciplinary Training Program in Child Abuse and Neglect (ITP). Both training programs have an interdisciplinary focus but are different in the team members and focus. The ITP includes psychologist students and interns, social worker students, occasionally PT and OT students, and law students. The OKLEND consists of all the LEND disciplines including the family member and self-advocate. The faculty from both programs also participate. The seminar is trainee led and it includes readings and videotape presentations by the program directors (Mark Wolraich, M.D. OKLEND and Barbara Bonner, Ph.D. ITP) that the trainees are expected to read and listen to prior to the seminar. During the seminar, the trainees are expected to ask questions to Drs. Bonner and Wolraich about their presentations. They are also clustered into 4- to 6-person groups, mixing trainees from both programs. They work together to respond to questions about a theoretical case that includes both disability and abuse issues. The trainees are able to experience the differences both across disciplines and across systems, which have a different focus on child issues. We have now held the seminar for 12 years and it has provided an opportunity to explore similarities and differences, not only across disciplines but across different aspects of child services.
The Connections for Health: Integrated Group and Community Services for Kalihi Valley Keiki and Ohana, also known as "Healthy Tomorrows Hawaii", is a Healthy Tomorrows Partnership for Children Program grantee in Honolulu, Hawaii coordinated by Kokua Kalihi Valley Comprehensive Family Services (KKV), a Federally Qualified Health Center. "Healthy Tomorrows Hawaii" engages families in culturally appropriate ways in clinical and community settings, offering services in environments that are welcoming and engaging for families. The program is featured in the May 2017 e-newsletter of the National Center for Medical Home Implementation.
Healthy Tomorrows grantee, Community Health Center, Inc. of New Britain, CT, recently had a book chapter published in Practical Research with Children. The work of the "House of Teens: A Center for Health Promotion and Youth Advocacy for New Britain Teens” is described in Chapter 8: Qualitative research with a ‘Double Life’: A mixed methods approach to research and advocacy with adolescents (Jayme Hannay, Robert Dudley, Stephanie Milan, Paula Kellogg Leibovitz, & Valerie L. Rodino). In the chapter, the authors cite the Healthy Tomorrows project and make the point that, with a community-based participatory research framework, an intervention with teens can contribute to a sound research methodology.
The New Hampshire-Maine Leadership Education in Neurodevelopmental and Related Disabilities (NH-ME LEND) Program was recently selected to participate in the 2017 Diversity & Health Equity Peer Learning Collaborative, supported by the Maternal and Child Health (MCH) Bureau, Division of MCH Workforce Development. Read more at AUCD.
This Autism Awareness Month the Children’s Hospital of Philadelphia (CHOP) LEND is celebrating the success of its advocacy efforts in New Jersey. Five years ago, the fellows and faculty took on an important advocacy project to help families in New Jersey with Autism transition services. It started from a community project one of the LEND faculty members proposed. Living in New Jersey with a child with Autism who was getting older, she was hearing from other parents in the community that the transition services in New Jersey were scarce. That year, the CHOP LEND faculty decided they were going to help in this advocacy effort and offered a community project that would energize and train this parent community. Three fellows in the cohort helped organize community meetings to train the families to advocate and work with other community groups to bring Autism Spectrum Disorder (ASD) transition to the attention of local lawmakers.
Assemblywoman Pam Lampitt and Assemblyman Louis Greenwald representing Camden County heard this community and wanted to champion this effort. They brought together a group of community stakeholders, including families who were trained through the LEND project. In addition, after attending the Disability Policy Seminar and learning how to advocate with lawmakers, Jonathan Kratchman, the LEND faculty member’s son, decided he was interested in politics and was able to secure a supported internship with Assemblywoman Lampitt and Assemblyman Greenwald’s office where he became familiar with the work they did, and their staff got to see first-hand the benefits of utilizing job coaches for people with ASD. Jonathan also brought to their attention the fact that some New Jersey colleges and universities have Autism Support Programs but there were very limited funds to support them.
After hearing from Jonathan and others in their constituent community, the lawmakers convened a roundtable of post-secondary programs in New Jersey to hear about the barriers they were facing and what supports they would need to help more New Jersey residents with ASD who were aging out of the school system. Last year, they introduced Bill A3432 to the State Assembly and S1825 to the State Senate to create a taskforce, which would identify barriers young adults with ASD have in New Jersey in accessing transportation, post-secondary programs, vocational opportunities and other needs within the transition age Autism community. Just last month the bill unanimously passed the State Assembly and Senate and is on its way to the Governor to be signed.
LEND teaches fellows a very important fact that they carry with them throughout their practice, which is “nothing about us without us.” This message was sent to Assemblyman Greenwald and Assemblywoman Lampitt as they were writing the Bill. As a result, there will be an appointed position on the task force for a young adult with Autism Spectrum Disorder, clearly demonstrating that this is an important and necessary voice to have at the table.
The Kennedy Krieger LEND sponsored a continuing education course on Autism, March 20-22, 2017. This interdisciplinary course was planned by representatives from 4 LEND programs and was attended by approximately 300 professionals. Speakers addressed issues in identification, diagnosis, and management and represented the disciplines of education, epidemiology, genetics, neurology, pediatrics, psychiatry, psychology, and speech and language. Some of the talks presented included, “The Case for Universal Targeted Screening for Autism” by Daniel Coury, MD, “Early Identification, How Early is Early?”, “Children who ‘Outgrew’ their Autism, Successful Intervention, Maturation or Misdiagnosis?” by Catherine Lord, PhD, “Food Selectivity, Restrictive Diets, and Supplements” by Eric Levey,MD , “Sleep Disorders: Interdisciplinary Management ” by Jennifer Accardo, MD, “Treatment Approaches for Preschoolers with ASD” by Samuel Odom, PhD ,”Meeting the Challenges of Middle School” by Jill Locke, PhD, CCC-SLP, “Transitional Issues, A Practical Approach” by Deepa Menon, MD.