The Boston LEAH initiated PHQ-9 Screening for depression as part of the Medicaid Accountable Care Organization redesign to enhance integration of medical and mental health care. The program has been tracking the screening rates for several years. A coordinating quality improvement (QI) team was developed and staffed by medical health providers, mental health providers, and population managers. The QI team met monthly to evaluate progress, track results on a control chart, consider interventions, and set targets. Multiple PDSA cycles have been executed, including enhanced provider and trainee education and feedback, standardization of form collection, and data entry. The form color was altered, which increased rate of screening by bringing the form to providers’ attention.

A clinical process map led to improvements in the clinic flow. Patients received a paper copy of the PHQ-9, a validated screening instrument for depressive symptoms, at annual physical exams and as needed. For those with a positive response (score >15 or positive response to question 9 about thoughts of injuring oneself or not worth living), the mental health team, including social workers, psychologists and a resource specialist, could be activated for same-day on-the-spot consultation for those with a positive response. Follow-up efforts were coordinated by a population manager who brought concerning scores to a behavioral health specialist to coordinate interim calls and follow-up care for at-risk patients.

This year, with increased attention to data entry into the Medical Health Record and initiation of a colorful form for providers to hand in with a billing pass, the program was able to exceed the goal of 90% screening. The monthly average screening rate was 91.4% for the 2018-2019 training year indicating a “special cause” (significant change) on the control chart with shift of the mean score. Of the patients who screened positive, 82% were seen same day, had a mental health team in place, or declined assistance. Follow up occurred within 90 days for 73%. By implementing numerous PDSA cycles, the QI team has achieved identification of patients with depressive symptoms, and improved follow-up in a busy adolescent/young adult practice. The QI team's next steps will focus on refinement of the follow-up process and increasing comprehensive mental health services to their patients.

The goal of the LET – MCH Bright Spots Qualitative Research Methods Mini-Lab is to support the growing interest in qualitative research among public health researchers and public health practitioners. We integrate the rich tradition of qualitative inquiry into current public health research so participants can gain a deeper understanding of the public health needs facing communities, integrate the experiences and perspectives of key stakeholders and community members into research designs, and find solutions to public health problems that take into account the lived experiences of community members.

The Qualitative Research Methods Mini-Lab offers participants the space to build or augment the qualitative research skills they’ve learned in classrooms or while at work in their agencies. Together with trainers, MCH and nutrition students, faculty, and other MCH and nutrition colleagues, participants gather regularly for training sessions labs that provide them with an opportunity to consult with experts on activities that strengthen their skills.

When students, agency staff and faculty utilize the same approach to research methods and the same software for data analysis and management—and when those data are shared—we can collectively work toward improving the health of our most vulnerable populations.

In 2018, Drs. Jamie Stang and Zobeida Bonilla devoted part of their efforts developing agency-university partnerships and building the mini-lab’s infrastructure.

In 2019, the cohort met with a particular focus on reducing the prevalence of child obesity among vulnerable, diverse populations in Minnesota through the use of a “positive deviance” approach to child obesity prevention, and to share successful strategies with other states and communities.

Trainings included:

• NVivo and atlas.ti training, mixed methods research design
• Case studies, participant observations, interviews, qualitative data analysis techniques
• Conducting focus group interviews
• Coding procedures
• Data representation

To date, 70+ student and agency participants have attended mini-lab trainings, with more planned next year.

Adolescent patients access primary care services at lower rates than any other age group despite increased risk for morbidity and mortality due to high-risk behaviors such as substance use, sexual activity, interpersonal violence, and suicide. While these high-risk behaviors are common among adolescents, less than 20% receive recommended screening and counseling on them from their healthcare providers. To address this problem, the Adolescent Health Initiative (AHI) is embarking on a new initiative: “Building the Capacity for Adolescent-Centered Health Care in Rural and Underserved Communities in HHS Region V”.

The purpose of this project is to:

1. Build the capacity of pediatric practices in rural and underserved communities in HHS Region V (Illinois, Indiana, Ohio, Michigan, Minnesota, and Wisconsin) to provide youth-friendly health care for adolescents through engagement in the evidence-based Adolescent-Centered Environment Assessment Process (ACE-AP) and,
2. Equip each HHS Region V state with the ability to continue to build the capacity of youth-serving primary care centers beyond the duration of the project by training coaches to facilitate the ACE-AP. 

By training individuals at the state level to deliver the ACE-AP, each state will continue to disseminate the low-cost model throughout high-need communities and increase the number of youth who have access to needed services.

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The Healthy Tomorrows Partnership for Children Program (HTPCP) is a public-private partnership between the MCHB and the American Academy of Pediatrics (AAP).

Beginning in 2015, HTPCP asked prior grantees in its one-year follow-up survey about innovations used in their projects. Innovations were described by respondents as new service delivery models or practices, patient education materials or strategies, new tools, professional training, or new partnerships and collaborations. About one-quarter of prior grantees reported innovations involving the use of technology.

The program supports innovative community-based interventions in maternal and child health that improve access to care.

Healthy Tomorrows - Innovations and Community
Impact Data Placemat (PDF 282KB)

ALBANY, N.Y. (June 25, 2019) - The number of women who die during childbirth is on the rise across the country, and a School of Public Health  (SPH) team has joined the many forces working to help change that course in New York.

The SPH-based MCH Program, led by Christine Bozlak and Rachel de Long, was awarded $150,000 from the New York State Legislature this past year to fund research and statewide education on maternal mortality.

According to the Pew Research Center, the United States has been a notable outlier in the steady decline of maternal mortality seen in other parts of the world. While the rate of death related to pregnancy has declined in Canada, the United Kingdom and other developed nations, the rate has increased in the United States, giving it the worst rate of maternal deaths in the developed world. In New York, approximately 19 out of every 100,000 women died from complications related to childbirth from 2012-2016 according to the New York State Department of Health  (DOH). Moreover, maternal death rates are disproportionately high among black women both in New York and nationally, noted de Long and Bozlak.

“There’s a real health disparity component at play here – black women in New York are three to four times more likely to die from causes related to pregnancy compared to white women,” said Bozlak, an associate professor.

Both health care and public health communities have mobilized to respond to these alarming trends, with efforts spanning public health agencies, professional medical organizations, community-based organizations, researchers and others, Bozlak and de Long note. In 2018, Governor Cuomo created the Taskforce on Maternal Mortality and Disparate Racial Outcomes as part of a multi-pronged effort to reduce maternal mortality and racial disparities and has committed $8M over two years in the 2019-2020 Executive Budget to fund these important initiatives. Additionally, the state senate has addressed maternal health as part of a larger legislative Women’s Health Initiative, including the $150,000 award to the MCH program at SPH to help explore and address the issue.

In New York, approximately 19 out of every 100,000 women died from complications related to childbirth from 2012-2016. Faculty from the School of Public Health are part of the movement working to decrease that number in the future.

Bozlak and de Long, a clinical associate professor, partnered with the SPH-based Center for Public Health Continuing Education  and the DOH’s Division of Family Health to produce a special edition of Public Health Live!  that was webcast to almost 1,000 health professionals and other participants. The webcast focused on the importance of engaging women and families from affected communities in order to develop initiatives, community approaches and changes to clinical systems that are responsive to their concerns – including concerns about bias and racism. It featured participants from recent community listening sessions held with women across New York as part of the Governor’s Task Force.

“A key component of this Public Health Live! was listening to community members about their experiences and ideas,” said de Long. “The more health care and public health professionals are aware of the concerns being voiced by women of color, and the more we all learn about efforts to be responsive to those concerns, the better we can address this devastating problem in New York and nationally.”

The project team also used the funding to support SPH faculty research on maternal health, and to enhance an array of prevention activities already underway in New York to promote women’s health and reduce maternal mortality. In the spring semester, six graduate students worked directly with DOH to gather and analyze data on maternal deaths, implement collaborative projects to improve the quality of care in birthing hospitals and support community-based public health prevention initiatives serving low-income women and infants.

Moving forward, the MCH Program will continue to partner with DOH and other key stakeholders to support women’s health while also contributing to the development of the next generation of public health professionals.

“This emerging generation of the MCH workforce is critical to addressing these pressing MCH issues, such as maternal mortality, and the University at Albany is poised to be a leader in their professional development,” said Bozlak.

Reposted from the New York State University at Albany's News Center

The Healthy Tomorrows Partnership for Children Program (HTPCP) is celebrating a milestone this year – 30 years as a federal grant program! For the past 30 years, HTPCP has provided approximately 74 million dollars to 296 projects in 48 states, and Washington D.C., Puerto Rico, and Guam. As HRSA and the American Academy of Pediatrics (AAP) enter into a third decade of working toward improving child health, they are developing a series of case studies and activities to demonstrate program successes. The HTPCP also wants to hear from you about what makes Healthy Tomorrows special.

Help us celebrate this wonderful program as we look back on 30 years and plan for the decades to come!

Stay tuned for more information on celebratory activities and a contest!

Historically, each of the 52 Leadership Education in Neurodevelopmental and Related Disabilities (LEND) programs used idiosyncratic measures to track the effectiveness of training in family-professional partnerships and interdisciplinary/interprofessional team building. Such before-after training data provided a limited view of training quality and impact.  Over the last five years, a cadre of leaders have worked together to form the LEND Program Quality Improvement (LPQI) Network, with the goals of devising common measurement tools, creating a national database, and using benchmarks to drive improvements in workforce training.

Participating LEND programs measure trainee competency in these areas using two validated tools: the LEND Core Competency Measure (CCM) is based on trainee self-evaluation, and the Interdisciplinary/Family-Centered Observation Rubric (I-FOR) relies on faculty observation.  Programs use a proprietary web-based dashboard to enter trainee and faculty data collection at T1 (beginning of the training year), T2 (approximately one-third of the way through the training year) and T3 (end of the training year).  A visualization tool embedded in the dashboard allows programs to see their trainees’ change from baseline to year end, filter data by variable (e.g. trainee discipline) and compare their results to a “national average” benchmark.  Association of University Centers on Disabilities (AUCD) staff manage the dashboard, implement additional features based on user feedback, host monthly technical assistance calls, coordinate the development of shared resources, orient/onboard new programs, and support the production of research manuscripts.

A 2016-2017 pilot at 7 sites (23 are currently participating) found aggregate CCM and I-FOR scores increased across both competencies from baseline to year end.  Programs unanimously report that the data has led to rich conversations among faculty about leadership skills across disciplines and informed curricular decisions.  And as one program shared: “The process also helped us go a step further and ask how we know that all of our experiences (clinical and non-clinical) are truly family-centered and interprofessional.”

This effort has led to an increased emphasis on observable behaviors in determining trainee knowledge and skills, and a decreased reliance on self-assessment measures to drive important curricular decisions. The development and implementation of the I-FOR across sites has also initiated a national dialogue on what constitutes foundational- and advanced-level “competency” and reasonable expectations for all trainees upon program completion.

The LPQI Network will continue to recruit additional LEND programs to participate, aiming to increase data richness and the degree to which the “national average” benchmark is representative of the entire network.  A subgroup of faculty is beginning to revise the I-FOR to align with language/concepts from the Maternal and Child Health Leadership Competencies, Version 4.0 and add a new component that assesses knowledge and skills in policy and working with communities and systems (“leadership”).  The LPQI Network hopes to simultaneously connect with leaders from other DMCHWD grantee programs to determine if/how they could use the CCM and I-FOR to advance their training objectives.

For more information about LPQI please contact Ben Kaufman at AUCD (bkaufman@aucd.org).

A Whitepaper from AUCD's Family Discipline Workgroup 

This white paper approaches family involvement from the perspective of the family discipline itself, and the ongoing paradigm shift in family-centered care--from fringe to fabric. This document includes a summary of the history of family involvement in the LEND network and a series of eight individual handouts, which detail the definition, need, benefits, resources and strategies associated with each type of family involvement.

The Children's Healthy Weight Collaborative Improvement and Innovation Network (CHW-CoIIN)  includes Louisiana as a state team focused on breastfeeding. Team lead Marci Brewer shared the following about Louisiana’s project.

Louisiana’s project focuses on building the capacity of and expanding the Louisiana Workplace Breastfeeding Support Program  to create worksite cultures statewide that support employees who choose to breastfeed after returning to work through organizational policy and practice change. Over the last year and half of the Children’s Healthy Weight CoIIN project, the Louisiana team has had a number of successes, as well as a few barriers.

Successes for the Louisiana (LA) team include the following:

• Convening a diverse statewide improvement work group and conducting a kick off meeting in July 2018.  The work group consists of a variety of employers, employees' representatives, public health program representatives/state health department, professional groups, as well as community/mother representatives.
• After the U.S. Breastfeeding Committee Children’s Healthy Weight CoIIN Breastfeeding Teams Peer Sharing meeting, the LA team successfully established contact with a local Community Outreach and Resource Planning Specialist.  The contact has agreed to attend our work group meetings!  
• Partnership development with organizations like the LA Association of Occupational Nurses. Organizational contacts have assisted with disseminating information about the program at organizational board meetings and conference exhibiting.  
• The Louisiana core team consistently conducted meetings and refined their work plan.  
• Assessed and streamlined employer designation processes.
• Learning and sharing with other states has been very helpful!

The Louisiana team also encountered the following barriers during their first year:

• Engaging mothers in the statewide improvement work group has been challenging, but we aren’t giving up. The team will continue to identify different strategies to ensure mother/employee representation and engagement.  
• Team capacity to carry out a comprehensive work plan has been limited, however we have identified some funding to sustain this work into the next state fiscal year.

The following highlight was shared by the MCH Training Program at the University of Texas Health Science Center at Houston School of Public Health, funded through the Reaching Practicing MCH Professionals in Underserved Areas Through Education and Training Program.

To acknowledge the growing importance of interdisciplinary and interprofessional training and practice in public health, the Maternal and Child Health (MCH) Training Program would like to highlight our recent contributions at the University of Texas at Austin Center for Health Interprofessional Practice and Education (IPE) Showcase. Team members Mollie Ewing, RN, MPH-C, and Stephanie Reynolds, MPH-C were selected to present a poster on the Overview of Mental Wellness training course.

The Overview of Mental Wellness course was co-developed with AVANCE-San Antonio (AVANCE-SA) and has reached upwards of 600 public health professionals and trainees since its launch. AVANCE is a nonprofit organization that offers parenting skills, workforce preparation, early childhood education, health screenings, and home visits for low-income and hard-to-reach families.

The MCH Training Program’s partnership with AVANCE-SA was established in July 2017 when our team performed a needs assessment of their leadership and staff. Based on AVANCE’s training needs and topics of interest identified, we co-created the multi-modal Overview of Mental Wellness course. AVANCE-SA staff members who participated in the needs assessment represented various professional backgrounds and academic disciplines, such as business administration, management, leadership development, psychology, and the natural sciences. The interprofessional and interdisciplinary nature of their staff helps to form lasting, meaningful partnerships with organizations such as our own, and successfully serve their clientele.

Since August 2018, the MCH Training Program has disseminated the training course to a multi-disciplinary audience of trainees, and created pre- and post-evaluation surveys to measure trainees’ change in knowledge, skills, and intentions related to mental wellness. The surveys also include data on demographics of trainees and their clientele, as well as general course feedback. Our interprofessional collaboration with AVANCE-SA remains strong and optimistic. We have plans to design a mental wellness training specifically for parental clientele, in hopes of reducing stigma and empowering parents to practice mental wellness strategies with their family members.

In continuation of our interprofessional efforts, the MCH Training Program seeks to form newfound partnerships with different academic institutions and community organizations, while strengthening existing partnerships. As shown by our training needs assessments and interdiscliplinary background of our trainees, the MCH Training Program strongly values interprofessionalism. We believe it is crucial that all professions and disciplines are fully engaged, rather than merely being represented in the group. This ensures that all individuals and organizations are involved in the decision-making process.

With the ever-increasing application of interprofessionalism in the public health field, we strive to increase teamwork and collaborative efforts across sectors in order to enhance the quality and delivery of healthcare. Ultimately, our team aims to collaborate with partnering organizations to achieve our mission: to strengthen the capacity of public health professionals serving MCH populations in underserved and rural areas within HRSA Region VI (TX, NM, OK, AR, and LA) and Michigan.

To provide some background on the MCH Training Program, we are housed within the Michael & Susan Dell Center for Health Living at the University of Texas Health Science Center at Houston (UTHealth) School of Public Health and partner with Grand Valley State University in Michigan. Alongside our partners, we co-develop online and in-person trainings covering a wide array of topics, such as preconception health, early childhood nutrition, community leadership, and cultural competence. Offered at no-cost, the MCH Training Program provides a great opportunity for trainees to enhance their skills and knowledge surrounding maternal and child health and professional development. Through our collaboration with the Texas Department of State Health Services, we have more than 1,150 course completions. You can find our online courses available at https://go.uth.edu/MCHTraining .

With that, we would like to thank HRSA for their continued support and funding. If you have any questions or would like to know more about the MCH Training Program, feel free to contact the Program Manager, Cristell Perez, MPH at mch@uth.tmc.edu or (512) 482-6150. To learn more about the Michael & Susan Dell Center for Healthy Living, contact us  online.

The following highlight was shared by Mollie Ewing, RN, of the MCH Training Program at the UTHealth School of Public Health, funded through the Reaching Practicing MCH Professionals in Underserved Areas Through Education and Training Program.

The Maternal and Child Health Training Program team at UTHealth is working to integrate community health workers into the spectrum of maternal and child health care.

To understand why the Maternal and Child Health (MCH) Training Program   team at the UTHealth has focused so much of its energy in recent years on training community health workers (CHWs), it’s important to understand two things. One is that preventable chronic diseases are now a far greater burden on the public’s health than infectious diseases, which were once the heaviest health burden on our population.  The other is that lifestyle behaviors that take place outside the walls of the health care system, such as diet and physical activity, are now widely acknowledged as key to preventing and treating chronic diseases. 

The MCH Training Program, which provides both online and in-person training for maternal and child health professionals, didn’t begin its operations with the expectation that CHWs would be such a dominant focus of their work. But they began conducting needs assessments with partnering organizations, and quickly discovered that CHWs accounted for the vast majority of trainees enrolling in their courses. CHWs, who help individuals to navigate services and stay on track with prevention and treatment, have been rapidly emerging as a key health care workforce to supplement what’s happening inside the clinical environments. According to the 2017 Annual Report of the Promotor(a) or CHW Training and Certification Advisory Committee , there has been a 92 percent increase of certified CHWs in Texas since 2012. 

Dr. Courtney Byrd-Williams and Dr. Joan Borst, co-directors of the MCH Training Program, recognized the CHWs’ interest in their courses as an opportunity to improve maternal and child health at the community level.  Texas is one of the few states in the country that offers CHW certification, and it requires, as it does with other health care professions, that licensed workers earn continuing education units (CEUs) to renew their licenses. A  collaborative relationship with the Texas Department of State Health Services (DSHS)   enables the MCH Training Program to offer CEUs to CHWs who successfully complete courses.

Certified CHWs can earn CEUs by completing online courses, developed by the MCH Training Program, on topics like preconception health, mental health, professional leadership, community engagement, and cultural competence.

“We make the trainings available online  so they are easily accessible to CHWs across the state, especially CHWs who may be working with populations in rural or hard-to-reach communities, “ said Byrd-Williams, Assistant Professor of Health Promotion and Behavioral Sciences at UTHealth School of Public Health in Austin.

The courses are multimodal and interactive, and they’re developed in consultation with groups like the Dallas-Fort Worth Community Health Workers Association (DFW-CHW).

One of the most popular courses, Gestational Diabetes Mellitus  (GDM), provides information that equips trainees to help their clients understand the risk factors and warning signs of GDM and, if needed, guide clients to the appropriate services.  Promoting healthy diet, exercise, and weight for their fellow community members is emphasized in the GDM course and in another popular course, Addressing Infant Mortality: Preconception Health .  This course highlights the importance of a healthy lifestyle before, during, and after pregnancy, along with information on guidelines to follow during pregnancy. The Addressing Infant Mortality course also teaches trainees how to develop a life plan with their clients. This is a tool that can be used to help guide people through considering their health and lifestyle goals, then setting realistic steps to achieve them.

“Community health workers are unique in that they tend to have an unusually close understanding of the community they serve,” said Ashley Rodriguez, Vice-President of the DFW-CHW Association. “The vital trusting relationships CHWs build, by meeting people where they are, enables the workers to serve as a truly functional link between public health and social services. Navigating and facilitating access to needed services is their overall goal and function, but their ability to reach underserved, underrepresented, and under-educated populations is at the center of everything they do and is a core public health principle.”

CHWs can also attend in-person trainings developed by the MCH Training Program. Martha Maldonado, DFW-CHW Association board member and Certified CHW Instructor, has presented several of these courses at DFW-CHW Association meetings over the past year.  Between 20 and 50 local CHWs typically receive training at these quarterly meetings. The MCH Training Program recently gathered participant data when Maldonado presented the Overview of Mental Wellness  course. The CHWs in attendance completed a pre- and post-test to evaluate knowledge acquisition, behavioral intention and self-efficacy to apply the information and attitudes towards the course content.  Significant increases were found in all four of the constructs measured. 

“The trainings allow us to better serve CHWs by providing quality continuing education,” said Rodriguez. “They also help us as an organization, by drawing more members to our quarterly meetings, and attracting new members throughout the metroplex.”

In order to keep up with the pace of this quickly growing profession, the MCH Training Program is continuing to gather data and feedback from trainees to better understand who is taking advantage of these training opportunities and what information will empower CHWs to make a meaningful impact in their community.

“We are excited to have found this opportunity to help train the public health workforce and look forward to continuing our collaboration with the DFW-CHW Association, DSHS, and CHWs across the state,” said Byrd-Williams.

More information about the Maternal and Child Health Training Program , our online courses, and the certificate and fellowship programs is available online.  The MCH Training Program is funded by a Health Resources and Services Administration grant and housed at the Michael and Susan Dell Center for Healthy Living  at the UTHealth School of Public Health in Austin, Texas .

More information about the DFW-CHW Association is available online at www.dfwchw.org .

In the past, ArizonaLEND has hosted a 90-minute Lunch-and-Learn focused on Leadership and Culture. However, it quickly became apparent that an entire day was needed to address this important topic, so a Saturday workshop was developed.

Cristina Castaneda and Darold Joseph, ArizonaLEND faculty members, led the workshop and shared personal stories and examples from their Hispanic and Native American cultures. They discussed the importance of cultural awareness, responsiveness and interpretation, and addressed critical perspectives about intersections of disability, race and culture. Faculty and trainees also had the opportunity to share their own cultural experiences. This workshop had an interprofessional approach as 17 professional fields were represented and participants discussed ways in which they could apply these concepts when interacting with patients, families and other professionals within their discipline.

Due to the vulnerability, openness, and respect of each participant and the presenters, this workshop was a great success. One trainee stated, “I feel like I can listen and speak from a more informed place.” The day started and ended with Darold playing a traditional Native American flute, giving everyone an opportunity to reflect on what they learned.

The annual sponsored meeting of MCHB-funded state systems initiatives to improve autism services called the “Peer-to-Peer” Exchange will take place in Madison, Wisconsin on April 16-17, 2019. The four states (WI, DE, RI, WA) currently funded through Innovation in Care Integration for Children and Youth with Autism Spectrum Disorders and Other Developmental Disabilities Program grants will be joined by several states who had been funded previously. The State Public Health Autism Resource Center (SPHARC) coordinates the meeting, and the host state provides a forum and local/regional expertise. 

This year’s Peer-to-Peer Exchange will focus on using data and quality improvement to advance health equity, which is a major strategy of the Wisconsin Care Integration Initiative (WiCII) grant funded 2016-2019 to the University Center for Excellence in Developmental Disabilities (UCEDD) at the Waisman Center, University of Wisconsin-Madison. The Wisconsin Care Integration Initiative is co-led by Waisman Center researcher Maureen Durkin (PI), Gail Chodron (co-PI, WI Leadership Education in Neurodevelopmental and Related Disabilities (LEND) Training Director) and Anne Harris (co-PI, WI LEND Director), and team members Kari Mueller (Project Coordinator) and Lynn Hrabik (Project Evaluator). WiCII has focused on reaching medically underserved families of children with, or at risk for, autism and other developmental disabilities who have not been able to access services. For some individuals with autism and other developmental disabilities and their families, inequities based on race, ethnicity, socio-economic status, and location of residence make it exceedingly difficult to reach their full potential for health and life in the community. Quality improvement (QI) and data-driven approaches provide strategies and information to target modifiable aspects of providing access and care delivery to advance health equity. Meaningful engagement with individuals most affected by inequity helps ensure that change efforts are locally valued, effective, and sustainable. A significant focus of the work in Wisconsin has been funding community partners to offer family navigation, ensure accessible shared resources, and cultivate opportunities to use telehealth to improve access to services. WI LEND trainees have participated in community-based activities such as community conversations and parent focus groups in urban Milwaukee and rural locations (Northwoods and southwest WI), data collection and analysis, literature reviews and information dissemination for WiCII. Significant progress has been made in identifying barriers and enablers for access to services in underserved populations in Wisconsin.

The Peer-to-Peer Exchange in 2019 aims to increase knowledge and skills of state teams to use data and QI to advance health equity through a variety of learning activities. Participants will have opportunities to engage with peers, individuals impacted by inequity, providers, and policy experts. The following strategies for advancing health equity will be threaded throughout all of the activities: 1) using data to identify disparities, 2) engaging in local data collection and tests of change to monitor progress, and 3) partnering with community members to ensure sustainable change.

The UAB LEND incorporates autism awareness throughout their daily work in clinical settings, training, and community outreach. Recent highlights include co-sponsoring the 18th Annual Alabama Autism Conference in February, which focused on “Building Communication in autism spectrum disorder (ASD) by Strengthening Skills and Systems,” with nearly 500 participants attending the day-long event, including educators, clinicians, trainees, caregivers, and self-advocates. 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 6th Annual Autism-Friendly Birmingham Barons baseball game on April 14th. Several LEND faculty participate in the state Autism Council and associated workgroups, with contributions to revisions of the statewide strategic plan and providing technical assistance to state departments as Alabama works to improve the systems of care for individuals with ASD and their families. Finally, the UAB Regional Autism Network, a component of the UAB LEND and UCEDD, which is funded by the Alabama Department of Mental Health, continues to expand its impact in providing monthly community education workshops for caregivers of individuals with autism spectrum disorder, with 2019 topics including addressing challenging behaviors, navigating the school system, and toilet training.   

In recognition of National Nutrition Month, we would like to highlight work from our Maternal and Child Health (MCH) Training Program and the Michael & Susan Dell Center for Healthy Living (Center for Healthy Living) at The University of Texas Health Science Center at Houston (UTHealth) School of Public Health in Austin. The MCH Training Program is housed within the Center for Healthy Living, whose vision of “healthy children in a healthy world” aligns strongly with our purpose.

With the goal of addressing disparities in access to MCH-related training, and in collaboration with Grand Valley State University in Michigan, our team provides accessible and relevant education for the growing MCH workforce in HRSA Region VI (TX, NM, OK, AR, and LA) and Michigan. Specifically, we develop online and in-person training courses for professionals who are serving diverse MCH populations, often in geographically-isolated and rural areas. These courses engage learners with dynamic content, active learning, and real-life scenarios to develop and enhance skills. Through our collaboration with the Texas Department of State Health Services, we have more than 1,000 course completions.

The MCH Training Program has 14 online courses available on the MCH Training Program website. All courses are provided at no cost and can also be offered in-person. During National Nutrition Month, we would like to spotlight our Nutrition and Exercise for Mental Wellness and Nutrition: 6 Months to 2 Years courses. These trainings are great for those who are interested in gaining newfound skills and knowledge in the realms of nutrition and mental wellness.

Additionally, the Center for Healthy Living has various nutrition resources online, such as the Food at School Parties infographic for parents describing healthier, nutritious alternatives to party snacks. In March 2019, we will release Texas Child Health Status Reports covering topics such as Child Nutrition, Child Beverage Consumption, Child Obesity, and more.

The reports will provide an overview on the status of child and adolescent health across Texas. Available to community members, policymakers, and advocacy groups, these one-page reports identify priority areas and assess health needs at a regional level in an attempt to guide informed decision-making. Check out the Center for Healthy Living website throughout National Nutrition Month to see more updates.

The Center for Healthy Living and MCH Training Program believe that with access to knowledge and practical training, people can create lasting, meaningful change in their local communities. We would like to thank HRSA for their continued support and funding. If you have any questions or would like to know more about the MCH Training Program, feel free to contact the Program Manager, Cristell Perez, MPH at mch@uth.tmc.edu or (512) 482-6150. To learn more, contact us about the Michael & Susan Dell Center for Healthy Living.

As part of the University of Tennessee’s MCH Nutrition Leadership Education and Training Program, Marsha Spence, PhD, MPH, RDN, LDN, Program Director, taught a doctoral nutrition policy course in Spring 2018. One short-term trainee and four long-term trainees were enrolled in the course and funded trainee and doctoral candidate, Marissa McElrone, was a graduate teaching assistant. As the culminating experience, trainees wrote a policy brief and participated in the University of Tennessee’s Howard Baker Center’s Public Policy Challenge, which was open to all University of Tennessee (UT) graduate and undergraduate students. As part of the course and challenge, the trainees developed a blog post, prepared a video , a policy brief, entitled Fresh Food for All, and a presentation for review by an expert panel. The team received the first-place award and received $3,000 to advance their policy initiative, which aimed to increase WIC Farmer’s Market Nutrition Program (FMNP) voucher redemption during summer months in 2019.

In collaboration with community partners at the Knox County Health Department’s Supplemental Nutrition Program for Women, Infants, and Children (WIC) and Nourish Knoxville, a non-profit organization that operates farmers’ markets in the Knox County area, the trainees developed an information flyer that was distributed by Knox County Health Department WIC staff, a website to assist WIC participants, and informative rack cards for display at participating farmers’ booths. Currently, the trainees and Dr. Spence are working to evaluate the policy initiative to see if it helped increase redemption rates via Knox County FMNP redemption rates, to determine the number of hits on the website, and to ascertain WIC participants’ overall experiences at area farmers’ markets using an online survey developed by the team. Jennifer Russomanno, a short-term trainee and doctoral candidate in Public Health, will present the findings at the University of Tennessee’s upcoming Promoting Healthy Weight 3.0 Colloquium: A Socio-Ecological Perspective - Policy at All Levels on March 29, 2019.

The UT MCH Nutrition Leadership Education and Training Program has a long history of partnership with community partners. MCH faculty work closely with community partners, including public health nutritionists from the Knox County Health Department, to develop community assessment projects that provide practice experience integrated with didactic learning components. A recently published manuscript highlights one of these projects , which demonstrates how partnering with community agencies can improve graduate education and children’s access to healthy foods.

Using longitudinal administrative data from children who participated in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) in Los Angeles County between 2003 and 2016, Dr. Chaparro is evaluating the impact of the 2009 WIC food package change on growth trajectories from 0-4 years and obesity risk at age 4 years. Along with her colleagues at UCLA and PHFE WIC, Dr. Chaparro found that exposure to the new food package (compared to the old) from 0 to 4 years was associated with healthier growth trajectories (i.e. weight-for-height z-scores [WHZ] closer to the mean of 0 and further from the overweight category of WHZ>2) and a 10-12% lower obesity risk at age 4 years (10% for girls, 12% for boys). A manuscript based on these findings was recently accepted for publication at the American Journal of Clinical Nutrition (forthcoming). Next steps include investigating if the type of infant food package received from 0-12 months could explain the observed improved obesity outcomes among children exposed to the new food package, and whether the effect of exposure to the new food package on child obesity varies by family and/or neighborhood socioeconomic characteristics. This study is funded by the American Heart Association (AHA)’s Scientist Development Grant (Grant No. 17SDG33660878; 7/1/2017-6/30/2020). Beginning Fall 2019, Tulane’s MCH Nutrition trainees will support this and other faculty-led MCH Nutrition research projects as part of their research rotations.

Dr. Pia Chaparro is an Assistant Professor at the Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine and Core Faculty of the Tulane’s Nutrition Leadership Training Program.

CHALK, New York-Presbyterian Hospital’s childhood obesity program, has expanded their programming to early childhood centers (CHALK Jr.) through Healthy Tomorrows. CHALK Jr. is currently partnering with three different early childhood centers in Washington Heights, located in Northern Manhattan. In addition to bringing direct programming at the centers to enhance healthier eating and active lifestyle practices amongst toddlers, parents, and staff, CHALK Jr. has been committed to strengthening and leveraging community resources in order to provide lower-income families with programs that promote overall well-being.

One such project is a partnership with New York City Parks and Recreation Center Department, specifically with Highbridge Recreation Center (HRC) located in Washington Heights. CHALK Jr. has engaged community fitness instructors, and purchased toddler fitness equipment, healthy snacks, and water in order to host free monthly “Family Wellness Saturdays” to the community at HRC. These monthly Saturdays consist of a combination of:

• Two to three family fitness classes such as, yoga, dance, or kickboxing
• An open toddler play space with play and fitness equipment
• A raffle for 6-month recreation center memberships or healthy café gift cards for adults, and age-appropriate sports balls for kids
• Healthy and fresh fruit and/or herb infused water to promote hydration
• A healthy snacks station with fruit and/or vegetables with hummus

As part of the recruitment effort, CHALK Jr. has been hosting parent workshops at its early education partner sites on the importance of sleep, physical activity, nutrition, and overall family wellness. CHALK Jr. staff has facilitated workshops to increase family engagement in the overall topic of wellness and successfully sign families up for a tour at HRC. The purpose of the tour is to help motivate and bring families to the facility to see what is there, and to partake in the free family wellness session. CHALK Jr. aims to increase awareness and exposure to existing community resources and increase family participation in wellness activities.

The CHALK Jr. program takes into account that some families may not regularly have access nor the means to afford the cost of memberships to facilities, healthy eating options, and/or physical activity promoting toys. Although children under 18 have free membership to the recreation centers, adults need to buy a membership. Therefore, CHALK Jr. is sponsoring a raffle at these wellness Saturdays to help increase parents’ ability to access the full facility while also helping to increase membership numbers for HRC.

College students may not be a population that we traditionally thought of as dealing with hunger, but new research indicates that rates of food insecurity are high on college campuses throughout the US. Through a partnership with the Southeastern Universities Consortium on Hunger Poverty and Nutrition, MCH Nutrition Trainee, Ms. Ruth Wooten, and MCH Nutrition faculty Drs. Betsy Anderson Steeves and Marsha Spence completed a cross sectional survey assessment of more than 4,000 college students to measure the rates of food insecurity among college students within a large university system. They found that more than 1 out of 3 college students within the University system experienced food insecurity, meaning that the students’ struggled to get enough food overall, or enough variety of food to live a healthy lifestyle.  This research has been published in the journal, Public Health Nutrition, and was featured on the local Knoxville NPR affiliate, WUOT, where Dr. Anderson Steeves was interviewed for a weekly health-focused program, Health Connections.

Drs. Anderson Steeves and Spence continue to work on addressing the issue of food insecurity on college campuses by serving as members of the Hunger and Homelessness Task Force at the University of Tennessee, and by forging innovative partnerships with the University of Tennessee, Knoxville, Student Health Center to routinely screen and provide referrals for campus-related resources to address food insecurity.

The University of California, Berkeley School of Public Health’s Center of Excellence in MCH, Education, Science, and Practice has created a free, open-source, self-directed, training module series on Maternal, Child, and Adolescent Health (MCAH) Life Course Perspective, Practice, and Leadership.

This resource provides access to high-quality training for working healthcare clinicians, public health practitioners, students, and professionals from across disciplines, locations, and backgrounds to expand their knowledge of key MCAH concepts in research and practice. The training module series is also accessible to community members and community-based organizations. 

Each module includes an interview with a subject matter expert, available readings, case studies of organizations in practice, and opportunities for reflection. The video series highlights 15 partner organizations and covers the following topics:

• Overview Life Course Perspective – Featuring Dr. Michael Lu, MD, MS, MPH, the former Director of the Maternal and Child Health Bureau for the U.S. Department of Health and Human Services from 2012 to 2017.
• Health Equity & Social Determinants of Health – Featuring Dr. Paula Braveman, MPH, MD, Director of the Center on Social Disparities in Health at the University of California, San Francisco.
• Timing of Exposures and Cumulative Impacts of Risk and Protective Factors across the Lifespan: Opportunities for Intervention – Featuring Kiko Malin, MSW/MPH is the Director of the Family Health Services Division at the Alameda County Public Health Department.
• Place Matters: The Impacts of Physical, Social, and Economic Environments on MCAH Outcomes – Featuring Dr. Anthony Iton, MD, JD, MPH Senior Vice President for Healthy Communities at The California Endowment
• Moving Towards Health Equity – Integrating a Life Course Perspective in MCAH Practice-Featuring Dr. Vijaya Hogan, MPH, DrPH, perinatal epidemiologist and Program Officer for the W.K. Kellogg Foundation.

Please watch this video on YouTube for an overview.

For additional information on the Maternal, Child, and Adolescent Health (MCAH) Life Course Perspective, Practice, & Leadership training series, contact Center Director Julianna Deardorff.

The Michigan Child Collaborative Care Program (MC3) provides access to mental health consultation for primary care providers (PCPs) treating children, youth and pregnant women. This includes same-day phone consultation for PCPs with University of Michigan Child, Adolescent, and Perinatal Psychiatrists (CAPPs); remote tele-psychiatric evaluation of patients and families requiring a more in-depth assessment; coordination of care and brief treatments using a statewide network of masters prepared Behavioral Health Consultants (BHCs); group case consultation wherein multiple providers can discuss a number of cases in a single session and web-based mental health education for enrolled providers.

MC3-Connect, a partnership between the University of Michigan, Michigan State University and the Michigan Department of Health and Human Services, will enrich the current MC3 Program in the following ways:  

1. EXPANSION: Expansion throughout the state of Michigan including to tribal populations of rural Upper Peninsula (UP), and those in “the thumb” and surrounding counties of the Lower Peninsula; minorities in underserved urban and rural counties; and Hispanic and Latino seasonal migrant workers from these areas. The expansion will also incorporate school-based Child and Adolescent Health Centers (CAHCs) in Michigan.
2. EDUCATION: Using the MC3 infrastructure, additional trainings using webinars and group case-consultations will be developed, tailored, and delivered to school-based health providers, PCPs, and medical trainees with content based on the didactic domains most needed. Michigan State University (MSU), a land grant university with seven community campuses and hundreds of clinical sites across the state of Michigan, will train the next generation of providers. Webinars will be developed in: suicide assessment/safety planning, substance use, autism, trauma and preschool mental health.
3. LINKAGE: MC3-Connect will link the MC3 program to other current initiatives at the University of Michigan, Michigan State University (MSU), and Michigan Department of Health and Human Services (MDHHS) that provide training for clinicians in evidence-based interventions. In this way, MC3-Connect will serve as a “hub” leveraging these available programs to its expansive network of providers.
4. SCREENING AND REFERRAL:
   Schools: MC3-Connect will harness the power of the MC3 BHCs to assist school-based Child and Adolescent Health Center providers in incorporating mental health and substance use screening into their practice workflow, and to connect at-risk youth to community and MC3 resources.
   Primary Care: MC3 faculty and staff currently work with primary care providers to implement workflow procedures that include mental health and developmental screening, and when appropriate, referral to MC3. The MC3-Connect screening in primary care will expand support for Edinburgh Postpartum Depression Scale (EPDS) screening of postpartum mothers in pediatric offices, with referral of high-risk women for MC3 phone consultation. Additionally, the MC3 team will work with pilot PCP sites to screen for high-risk mother-child dyads using the Relational Health Screen Tool to enhance resilience and promote attachment security. This screening/intervention tool is commonly used in dyads where there is a history of maternal trauma, mental illness, or addiction to prevent intergenerational transmission of trauma and resulting physical, emotional and psychiatric issues in children.

The Alabama Department of Mental Health (ADMH) is a recent recipient of one of HRSA’s grants to develop a Pediatric Mental Health Care Access (PMHCA) Program. The Department of Mental Health, led by Commissioner Lynn Beshear, provides extensive services to Alabamians with mental illnesses, developmental disabilities, and substance use disorders.

The purpose of the PMHCA Program is to promote behavioral health integration in pediatric primary care by supporting the development of new or improvement of existing statewide pediatric mental health care telehealth access programs. To implement the Program, a collaboration was formed between ADMH and Children’s of Alabama, a private, not-for-profit medical center providing specialized medical care for ill and injured children.

Children’s of Alabama, through the Ireland Center, provides a full array of behavioral health services in both inpatient and outpatient settings. Services are delivered by a multidisciplinary team of child/adolescent psychiatrists, nurse practitioners, clinical psychologists, therapists, and nurses. Children’s of Alabama also operates the Psychiatric Intake Response Center (PIRC), located in the emergency department of the hospital. PIRC is a confidential psychiatric response center designed to assist patients, their loved ones and/or caregivers, and community providers in finding the appropriate level of mental health care. These services are provided via telephone or in person by licensed mental health clinicians trained to assess a child or teen’s mental, emotional, and behavioral needs and recommend the best treatment options. Children’s of Alabama is ranked among the best pediatric medical centers in the nation by U.S. News & World Report, and offers an array of both inpatient and outpatient services. Other collaborators include the University of Alabama at Birmingham School of Public Health Evaluation Team, and the Alabama Department of Public Health.

The Project is led by Jane Duer, M.Ed., ECSE, who has been employed by ADMH for six years as the Coordinator of Early Intervention Services. Jane is co-author and Project Director for the Alabama Pediatric Telemental Health Network, and in that role provides oversight, contract management, and administrative liaison with HRSA. Susan Griffin, LICSW, PIP, CHCQM, with Children’s of Alabama, is the Project Manager, and has responsibility for daily oversight and implementation of the Program, ensuring that all clinical and administrative activities of the Program are carried out, and that all performance expectations and goals are clear and met according to the program description.

The Pediatric Mental Health Care Access Program has two main elements to be implemented over the next five years:

• To develop a clinical network of pediatric primary care practices who will work closely with the Children’s of Alabama mental health team to deliver telemental health (Clinical Telemental Health Network). The Network will provide direct consultation and guidance using a team of mental health professionals and primary care providers, as well as mental health consultations for patients via videoconferencing for comprehensive health care management. The model will capitalize on the long established pediatric periodicity schedule of preventative and interventional care for a child from birth through adolescence.
• To provide/conduct broad group education of primary care providers and other health professionals via the Extension of Community Healthcare Outcomes (ECHO) model (Group Telementoring). Through this evidence-based telementoring program, interactive relationships will be formed with many providers across Alabama to disseminate subspecialty knowledge. Children’s of Alabama is partnering with the American Academy of Pediatrics to replicate the ECHO model. Educational programming will be open to primary care providers as well as other behavioral health professionals, Department of Public Health social workers, school counselors and nurses, and other interested individuals. Children’s of Alabama will also provide continuing education credits for participating professionals.

Children’s of Alabama has established internal mental health teams who will be providing both the telementoring and telemedicine components of the Program. Curriculum content is being developed to enable the Program to commence its first ECHO session in the third quarter of 2019. The Program is modeled after a telemedicine project that was implemented between Children’s of Alabama through Dr. Tommy Vaughan, a child/adolescent psychiatrist, the Department of Mental Health, and Dr. Marsha Raulerson, a pediatrician in rural Brewton, Alabama. This model has served over 500 children during the past 15 years and will be the basis for development and expansion of telehealth activities outlined for the Program. Current activities include conducting a needs assessment with pediatricians statewide, assisted by the Alabama chapter of the American Academy of Pediatrics and the University of Alabama at Birmingham's Evaluation Team, as well as identifying pediatricians in Alabama’s rural counties who wish to partner with us to join the Pediatric Telemental Health Network Program. This five-year project represents a unique collaboration between many stakeholders who are serving the children of Alabama, and whose goal is to improve access to quality behavioral health care services for Alabama’s underserved children, particularly in rural areas of the state.

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 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.

For more information, visit the Children's Healthy Weight CoIIN website.