POSTED: January 2022
DMCHWD is pleased to highlight examples of grantee projects and programs. Contact your Project Officer if you would like to share a highlight.
Dr. Arden Handler receives the Title V Lifetime Achievement Award
Dr. Arden Handler was recently selected as a recipient of the Title V Lifetime Achievement Award, recognizing outstanding contributions made to the field of maternal and child health over a sustained period. Dr. Handler has made it her life mission to improve MCH outcomes and support Title V programs in the United States, especially within the state of Illinois. Dr. Handler's passion is to educate the current and emerging Title V workforce to ensure that Title V will not only sustain, but thrive. She approaches all her MCH work with a sincere acknowledgement and respect for the current and former MCH leaders, as well as MCH history.
Dr. Arden Handler is the Director of the Center of Excellence in Maternal and Child Health and a Professor in the Community Health Sciences Division of the University of Illinois Chicago, School of Public Health. Dr. Handler’s research career reflects her long-standing commitment to reducing disparities and improving the health of women, children, and families. Her specific interest is the exploration of factors that increase the risk for disparities in adverse pregnancy outcomes and examining ways in which the health care delivery system, particularly how prenatal care, postpartum care, and well-woman care can ameliorate these risks and reduce disparities and inequities. Other research and teaching interests include maternal and child health advocacy and policy, building the analytic capacity of the MCH workforce, and the structure and functioning of the public health delivery system. Dr. Handler is a former member of the Secretary’s Advisory Committee on Infant Mortality (SACIM). She is a nationally renowned leader in maternal and child health advocacy, policy, epidemiology, and public health system improvement.
Maryland Behavioral Health Integration in Pediatric Primary Care (BHIPP) Shares Research Findings through Publications and Presentations at National Conferences
Maryland Behavioral Health Integration in Pediatric Primary Care Telepsychiatry Access Program (BHIPP TAP) is a PMHCA awardee that provides support to pediatric primary care providers in addressing the behavioral and developmental needs of their patients. In 2021, BHIPP published several manuscripts and presented research at national conferences.
The first study, published in Academic Psychiatry, describes results of a needs assessment conducted with 107 PCPs from three rural Maryland regions. The main study takeaways were that PCPs were more comfortable identifying pediatric mental health problems and making referrals than providing treatments directly to their patients. However, PCP's also reported difficulty finding specialty mental health providers to refer to.
The second study, published in Psychiatric Services, describes characteristics of PCPs who use BHIPP's services. Results revealed that PCPs were more likely to contact BHIPP's warmline for consultation or resource/referral networking but not both. Further, PCPs in rural regions of Maryland were more likely to seek consultation than providers in urban/suburban areas suggesting that rural providers may be more willing to assume responsibility for providing mental health care because they recognize there is a lack of specialty care providers in their regions.
The third study, published in Psychiatric Services, describes trends in calls to BHIPP and Mississippi's PMHCA prior to and during the COVID-19 pandemic. Findings showed that compared to calls prior, there was a significant increase in: call volume, diagnostic complexity of pediatric patients who were the focus of calls, and the number of calls focused on anxiety, depression, and disruptive behaviors.
Finally, in October we presented findings from a study focused on characteristics of patients with adverse childhood experiences (ACEs). We analyzed data from more than 4,900 contacts through PCP calls to BHIPP and BHIPP co-located social worker's contacts with patients. Findings revealed that patients with ACEs for whom PCPs sought BHIPP support were more clinically severe, had more comorbid mental health conditions, and were more often taking medications than patients without ACEs.
Findings from these studies emphasize the important role of PMHCAs in increasing access to pediatric mental health care through offering training, consultation, resources and direct services as needed.
Translation of the Survey of Well-being of Young Children (SWYC) into Tagalog, Samoan, and Chuukese
Children's Hospital Los Angeles LEND
The California-Leadership in Neurodevelopmental Disabilities Program (LEND) Program at Children's Hospital Los Angeles, directed the Maternal and Child Health Bureau (MCHB)-funded Health Professional Support Program for Children with Zika Virus Infection in American Samoa and the U.S. Affiliated Pacific Basin. After working with American Samoa, the Commonwealth of the Northern Mariana Islands and Guam and traveling to American Samoa, the CA-LEND team collectively identified that developmental screening tools were not available in languages that are commonly spoken in the islands. As a response to these needs, Douglas Vanderbilt, MD, MS, Alexis Deavenport-Saman, DrPH, and Patrice Yasuda, PhD facilitated translations and back-translations of the Survey of Well-being of Young Children (SWYC) into languages commonly spoken on these islands.
The SWYC is a comprehensive screening tool for children under 5 years. It is freely available to any user, with no license required at the following website in English and in other languages. The SWYC contains a developmental domain on Developmental Milestones, along with an autism-specific screener, the Parent's Observations of Social Interactions (POSI), an Emotional/Behavioral Domain, which contains the Baby Pediatric Symptoms Checklist (BPSC) and the Preschool Pediatric Symptom Checklist (PPSC), and a section on the child's family context.
Dr. Vanderbilt, Dr. Deavenport-Saman, and Dr. Yasuda, PhD obtained a license from the SWYC developers in order to translate the survey into different languages. They worked with a language translation organization to translate 4 age-specific forms (9, 18, 24, and 30 months) into 3 languages, which are commonly spoken in American Samoa, the Commonwealth of the Northern Mariana Islands, and Guam: Samoan, Tagalog, and Chuukese. The POSI is embedded into the SWYC form for autism specific-screening for the 18-, 24-, 30-month versions, which is partly why they focused on the translation of the SYWC for these ages.
The American Academy of Pediatrics (AAP) recognizes the SWYC and noted in their policy statement on developmental surveillance and screening that providing additional developmental screening using validated tests is appropriate. The AAP also indicated that the screening tests in the SWYC on Developmental Milestones, BPSC, PPSC, and the POSI have acceptable psychometric properties.
Click this link, to obtain any of the translated surveys in Tagalog, Samoan, or Chuukese:
The surveys will be available soon on the SWYC website: SWYC Translations
Let's Create an Army of Advocates: A Video Series at Children's of Alabama
University of Alabama at Birmingham PPC
The Pediatric Pulmonary Center grantee at the University of Alabama at Birmingham (UAB) is based at Children's of Alabama (COA), the only free-standing children's hospital in the state. The hospital uses an in-house video system, call the "Get Well Network" or GWN, to provide education to families during a child's inpatient stay. When the PPC hired their first Family Leader Faculty, Linda Russo, in 2015, Project Director Dr. Brad Troxler asked her to envision creating an "army of advocates" by spreading the mission of family-centered care and advocacy throughout the hospital. With passionate support of the UAB PPC's Patient/Family Advisory Committee, this vision became a reality in 2020-21. A series of three videos was produced for GWN, with the UAB PPC PFAC members providing subject matter expertise, script consultation, and on-air narration. "This is exactly what I had in mind when Linda joined the PPC," says Dr. Troxler. "Family-centered care not only means providing excellent clinical care, but partnering with families in their journey as advocates, not only in advocating for their own child, but for all children with special health care needs."
In addition to playing on the GWN, the videos were highlighted in a recent podcast, and are available on You Tube:
- Video #1 - Checking In - introduces the role of being a caregiver for a child with an acute illness, including how to advocate with the medical team and coping/navigating resources while your child is in the hospital.
- Video #2 - Settling In- focuses on a child with a chronic illness; including finding and connecting to resources when your child is diagnosed with a chronic disease, identification of Alabama-specific support services (such as Medicaid Waivers, medical homes, Children's Rehabilitative Service (CRS), the Family Voices (FV) chapter, and the state Family to Family (F2F) representative) and connecting to other parents.
- Video #3 - Breaking Out- encourages parents and children of all ages to begin advocating more broadly, at system, community, state, regional and national levels and connecting to the broader community of organizations which focus on inclusion, advocacy, education, and disability rights.
University of Michigan Provides Long-term Developmental Follow-up in Congenital Cytomegalovirus Clinic
University of Michigan DBP
Congenital cytomegalovirus (CMV) affects 1 in every 200 children in the US, up to 30% of whom will develop long-term neurodevelopmental sequelae such as sensorineural hearing loss and cerebral palsy. Thanks to the growing number of congenital CMV newborn screening programs, more infants are being diagnosed. To capitalize on this opportunity for early intervention, the University of Michigan Congenital CMV Developmental Follow-up Clinic was established in January of 2021, spearheaded by Dr. Megan Pesch in the Division of Developmental and Behavioral Pediatrics.
The CMV clinic provides close developmental monitoring, support, and anticipatory guidance for families of children with cCMV. A diagnosis of congenital CMV is often unanticipated and frightening for families – there are seemingly so many unknowns. The CMV clinic aims to provide these families with a holding environment along their CMV journey by providing psychosocial support, answers to their questions, and tailored recommendations. Close follow-up by a Developmental Pediatrician who understands the spectrum of congenital CMV-associated developmental delays facilitates earlier and more intensive interventions when subtle signs emerge such as hypotonia, social delays and feeding difficulties. Due to the high rate of hearing loss in children with congenital CMV (which may be present at birth or develop into childhood), the clinic provides inclusive and tailored communication support around hearing aids, cochlear implants, verbal, and signed language.
Ensuring access to quality care and subspecialists for children across the state is a priority; visits are offered in person and via telehealth. The CMV clinic works closely with a multidisciplinary group of pediatric practitioners from Otolaryngology, Audiology, Ophthalmology, Infectious Diseases, and PM&R. Care coordination among sub-specialists, therapists and the primary care physician is also provided. Over the last year, 25 patients with congenital CMV have been cared for in the Congenital CMV Developmental Follow-up clinic. To expand these efforts, the group is working to establish the University of Michigan as a state-wide multidisciplinary referral center.
University of Alabama at Birmingham, Leadership Education in Adolescent Health (UAB LEAH) Promotes Resilience Through Trauma Informed Care Training
University of Alabama at Birmingham LEAH, Dr. Heather Austin
University of Alabama at Birmingham, Leadership Education in Adolescent Health (UAB LEAH) faculty, Dr. Heather Austin, reunited with her former MCH LEND supervisor and colleague, Dr. Avi Madan-Swain, to promote trauma informed care at Children's Hospital of Alabama (COA). Dr. Madan-Swain has already been recognized by UAB for leading the family centered care rounding initiative at COA. In addition, both Dr. Austin and Dr. Madan-Swain shared common experiences of witnessing an overall increase in the impact of increased trauma, especially given the pandemic, and observing the dynamic interplay between patients and their families and health care providers related to these challenges. Family centered care at its core forms the basis of trauma informed care, by promoting optimal quality care based on the family's needs, values, perspectives, and goals. Trauma informed care builds on family centered care by increasing awareness of the patient/family experience of trauma and potential impact on the family, provider, and overall care.
Drs. Austin and Madan-Swain invited key professionals from COA and UAB including faculty and administrators in the areas of medicine, nursing, psychology, social work, pastoral care, patient advocacy and professional well-being to unite and problem-solve ways training in trauma informed care can be developed and initiated at COA. Initially, work focused on assessment of staff readiness for implementing trauma informed care training as well as a measure of their work-related traumatic stress, health, and wellbeing, including assessment of secondary traumatic stress, burn out and compassion fatigue. Training at COA is based on Substance Abuse and Mental Health Services Administration's (SAMHSA's) Four R's: Realization of the broad impact of trauma on our population, Recognition of the signs of trauma, creating a system that can Respond to trauma and Resisting re-traumatization. Work groups have formed and are in the process of creating ways to assess trauma in patients and families and to develop didactic training experiences for faculty and staff based on the Four R's, with an emphasis on interactive skills practice. On method will be the use of standardized patients and simulation to assist providers with practicing communication and de-escalation strategies such as those related to the DEF framework (Address DISTRESS, Facilitate EMOTIONAL support, and Remember the FAMILY). Most recently, we were able to secure Dr. Heather Forkey, a nationally recognized leader in childhood trauma and a co-author of Childhood Trauma and Resilience: A Practical Guide (2021), for a virtual grand rounds training at UAB/COA and consultation regarding ongoing work toward trauma informed training implementation. We are looking forward to the seeing the results of the program initiative and its positive impact on patients, their families, and our health care providers.
Use of an Advisory Committee to Support Diversity and Health Equity in the Virginia Mental Health Access Program
Virginia Mental Health Access Program
The Virginia Mental Health Access Program is a statewide initiative that supports health care professionals who care for children and adolescents with mental/behavioral health conditions. VMAP recognizes that there is not equitable access to behavioral healthcare and we are committed to addressing and reducing the disparities by working toward health equity across the state.
In response to reducing pediatric mental health disparities, a health equity advisory committee was formally established in March 2021. Its role is to support the mission and vision of the Virginia Mental Health Access Program by ensuring diversity and inclusion by applying an equity lens to all policies, practices, and program services.
Specifically, the purpose of the advisory group is to: 1) ensure a health equity lens is applied to all VMAP work; 2) promote the use of data to drive program planning and implementation; and 3) provide recommendations on ways we can adjust to improve performance.
The activities of the advisory group include:
- Assist the VMAP executive committee in ensuring program policy decisions are made though a behavioral health equity lens;
- Advise the regional hubs and executive committee on ways to expand VMAP stakeholder and provider membership through diverse partnerships statewide;
- Use program data to set goals with respect to behavioral health equity, monitor progress and provide recommendations as needed to make improvements in our approach; and
- Provide guidance through specific recommendations and program benchmarks where VMAP can make progress on behavioral health equity at both the regional hub level as well as within the state administration.
The Equity Corner
Delaware Child Psychiatry Access Program (DCAP)
Richard Margolis, MD Project Director
Joseph Hughes, Project Manager
Mindy Webb, Project Behavioral Health Care Coordinator
The Delaware Child Psychiatry Access Program (DCPAP) distributes a monthly newsletter to its registered participants, their support staff, potential participants, our advisory council, project partners, training attendees, friends, associates, and a wide range of community professionals. This publication offers general mental health, program and community information along with both provider and resource highlights.
Each month, recipients have access to our 4 corners feature offering updates for NAMI Delaware, the Mental Health Association of Delaware, COVID and Equity. Each Equity Corner focuses on national and state health equity issues and initiatives. Our goal is to increase provider knowledge of mental health needs, related challenges of around diverse populations and access to services and supports.
Center for Trauma Counseling Mobile Hope Clinic – Accessible Mental Healthcare for Children & Families
Healthy Tomorrows Partnership for Children Program
Since 2012 Center for Trauma Counseling's mission is to ensure the immediate availability of cost-effective mental health services to serve the most "in need" in Palm Beach County impacted by trauma related experiences, regardless of socioeconomic status.
Center for Trauma Counseling's Mobile Hope Clinic (MHC) is providing Palm Beach County with its first mobile counseling center, brining high quality, affordable mental health care to underserved at-risk youth and their families. MHC provides a collaborative solution to enhance youth well-being, bridging gaps and foiling barriers to mental health services to provide early preventive intervention. MHC is complementing and coordinating with healthcare providers, families, and partnering community agencies to provide assessments and personalized therapy, and brought directly to underserved neighborhoods. The solution of, The Mobile Hope Clinic, is to improve access to affordable, quality mental health services to economically disadvantaged and underserved at risk populations within Palm Beach County. With mental health and traumatic event exposure on the rise, CTC is a part of the solution by making mental health services accessible and equitable in our community.
Mobile clinics physically drive into communities, reducing barriers by reaching out to the unserved populations. MHC fits directly into the focus area of health access and diversity by offering a solution, affordable or free mental health services, to parts of the county that are otherwise unable to access affordable or free, evidence-based outpatient mental health counseling. By bringing these services into more dire areas in the county, more economically disadvantage, underserved and at-risk children, adolescents, and families will have an opportunity for equal engagement in trauma-based counseling that other residents in the county already have access to.
Telehealth Manual: Resources for Healthcare Providers Working with Children, Adolescents, and Families
Rose F. Kennedy Leadership Education in Neurofevelopmental and Related Disabilities Program
While telehealth is not a new phenomenon, since the onset of the COVID-19 pandemic, it has increasingly become a modality that clinicians and patients have come to rely on. Telehealth has afforded many children/adolescents and their families access to treatment that may have otherwise been unobtainable. Despite numerous strengths to this modality, there also come challenges and the need for clinicians to think flexibly and creatively and to individually tailor the treatment and approach to the individual, particularly when working with children with a range of neurodevelopmental disabilities. As part of the Leadership Education in Neurodevelopmental and Related Disabilities (LEND) fellowship at Montefiore Medical Center, Rose F. Kennedy, Children's Evaluation and Rehabilitation Center (CERC), psychology and social work trainees worked together to create a telehealth manual, providing resources that can be easily adapted to the clinical encounter. The objectives of the manual included providing clinicians with information on (a) a brief history of telehealth, (b) the shift to the use of, and increasing reliance on, telehealth in 2020-2021, during the COVID-19 pandemic, (c) tips for clinicians and patients who are engaging in telehealth practices, (d) activities and resources that can be implemented as part of telehealth sessions, organized by age and presenting concern (e.g., attention/executive functioning, social skills, anxiety, parent management), (e) crisis intervention resources with tips for implementation via telehealth, (f) resources for families (in English and Spanish), and (g) references, resources, and helpful links for clinicians. A presentation on the manual was provided to a group of LEND fellows and clinicians and the manual was made available to all clinicians employed at the clinic, including psychologists, social workers, developmental behavioral pediatricians, speech and language pathologists, a psychiatrist, an occupational therapist, a physical therapist, and LEND fellows from across these disciplines. Results from a survey completed by attendees revealed positive feedback on the usefulness of resources. Second Annual Transition Planning Webinar Series for Youth and Young Adults with Learning, Intellectual, and/or Developmental Disabilities Rose F. Kennedy Leadership Education in Neurodevelopmental and Related Disabilities Program Transition planning is an integral component of post-secondary planning for youth/young adults with intellectual, developmental, and learning disabilities. It can be a complicated, confusing, and intimidating process, yet one that is vital to ensure that adolescents and young adults make a successful transition out of high school and into adulthood. Transition planning is particularly important for youth/young adults with special needs. During the summer of 2020, CERC hosted a series of webinars on transition planning during the time of COVID. These webinars addressed topics regarding postsecondary transition planning for young adults including higher education programming, day programming, and community opportunities. Due to strong attendance and positive satisfaction ratings after the webinars, a second series of webinars was planned, incorporating attendees' suggestions and requests for future webinars. This 2021 webinar series targeted a range of transition related topics including: medical transition in youth with developmental disabilities (DD); medical issues in young adults with DD; special needs planning, guardianship, and supported decision making; and OPWDD eligibility, services, and self-direction. Youth/young adults, their families, and providers heard from speakers during each of three webinars with opportunities for questions and meaningful conversation after the webinars. Given a large Spanish speaking population in the Bronx, NY, separate webinars, on the same topics, were provided in Spanish, immediately following the English presentation. Attendees completed a survey at the end of each webinar, available in English and Spanish, allowing for analysis of consumer satisfaction and suggestions for future webinars. Tip sheets and resources on transition planning were made available to attendees, in both languages.
Second Annual Transition Planning Webinar Series for Youth and Young Adults with Learning, Intellectual, and/or Developmental Disabilities
Rose F. Kennedy Leadership Education in Neurodevelopmental and Related Disabilities Program
Transition planning is an integral component of post-secondary planning for youth/young adults with intellectual, developmental, and learning disabilities. It can be a complicated, confusing, and intimidating process, yet one that is vital to ensure that adolescents and young adults make a successful transition out of high school and into adulthood. Transition planning is particularly important for youth/young adults with special needs.
During the summer of 2020, CERC hosted a series of webinars on transition planning during the time of COVID. These webinars addressed topics regarding postsecondary transition planning for young adults including higher education programming, day programming, and community opportunities. Due to strong attendance and positive satisfaction ratings after the webinars, a second series of webinars was planned, incorporating attendees' suggestions and requests for future webinars.
This 2021 webinar series targeted a range of transition related topics including: medical transition in youth with developmental disabilities (DD); medical issues in young adults with DD; special needs planning, guardianship, and supported decision making; and OPWDD eligibility, services, and self-direction. Youth/young adults, their families, and providers heard from speakers during each of three webinars with opportunities for questions and meaningful conversation after the webinars. Given a large Spanish speaking population in the Bronx, NY, separate webinars, on the same topics, were provided in Spanish, immediately following the English presentation. Attendees completed a survey at the end of each webinar, available in English and Spanish, allowing for analysis of consumer satisfaction and suggestions for future webinars. Tip sheets and resources on transition planning were made available to attendees, in both languages.
Rose F. Kennedy LEND program at Montefiore Children's Hospital "Preparing Back to School" multilingual Webinars
Rose F. Kennedy Leadership Education in Neurodevelopmental and Related Disabilities Program
This year may be a transition for families, as schools return to in-person learning. The change may bring up many questions, concerns and anxieties for children and parents. In order to support families through this transition, staff at Rose F. Kennedy LEND program at Montefiore Children's Hospital developed a webinar with helpful tips. Topics included:
- identifying emotions and concerns,
- coping skills,
- dealing with uncertainties,
- having play dates,
- creating social stories,
- visiting the school,
- screen time,
- healthy sleeping and eating habits.
To serve our multicultural and ethnically diverse audience, multilingual staff developed the webinar, which is available in English, Spanish, French, Italian, Korean and Mandarin.
Attendees can complete a survey at the end of each webinar in each language.
Promoting Diversity and Health Equity through Research, Training, Clinical Activities and Public Policy
University of California San Francisco Leadership Education in Adolescent Health
The Division of Adolescent and Young Adult Medicine at the University of California, San Francisco is actively working to promote diversity and health equity on multiple fronts.
Leveraging technology to advance health equity
The following are two noteworthy projects:
Engaging Adolescents in Health Careers with Technology-Rich Personalized Learning
Primarily supported by an NIH Science Education Partnership Award (SEPA) in collaboration with North Carolina State University and the UCSF Office of Diversity and Outreach, with additional support by MCHB, Health Quest aims to address the underrepresentation of racial and ethnic minorities and women in health research and the health professions. A diverse biomedical, behavioral, and clinical research workforce would be significantly better equipped to serve the nation's health needs and it is imperative for all students to learn about the exciting careers in the field of health sciences. Health Quest is designed to increase middle school students' interests in health science careers by: 1) Allowing students to learn about the career paths of health professionals through interactive video interviews. Specifically, students will learn firsthand how professionals in biomedical, behavioral and clinical research fields became interested in their career fields and how they prepared for them while also getting to explore some of the day-to-day activities of these scientists; 2) Engaging students in a rich narrative driven health sciences adventure game where students can choose which science field to explore and then embark on a mission to help solve a scientific problem or answer a critical research question; and 3) Providing classroom teachers with the tools and resources they need to implement Health Quest in their classrooms. Health Quest Website
Health-E You / Salud iTu
Health-E You / Salud iTu is an innovative, interactive, individually tailored web-based mobile health application (app) in English and Spanish to promote equitable access to comprehensive contraceptive information and services for adolescents, to improve the delivery of patient-centered contraceptive care, and to reduce racial/ethnic disparities in unintended pregnancies. A cluster randomized control trial of 18 school-based health centers (SBHCs) with 1,360 Latina adolescents from the 2nd largest school district in the nation, were randomized to implement the app or to a control standard of care. Prior to their visit with a health care provider, participants completed a baseline survey, intervention participants then used the app, and then they proceeded to their visit. Participants received follow-up surveys 48 hours, 3- and 6-months after their recruitment visit. Health-E You significantly increased adolescents' sexual health knowledge; helped prepare adolescents to select a contraceptive method; and increased self-efficacy (in talking with their doctor about birth control, having the information to choose birth control and using birth control correctly). App user had greater increases in non-barrier contraceptive use from baseline (29% intervention vs. 30% controls) to 3 months (63% vs. 45%; OR = 3.29, 95% CI 1.04–10.36, p = 0.04) and 6 months (63% vs. 44%; OR = 5.54, 95% CI 1.70–18.06, p = 0.005). Providers and adolescents reported high app satisfaction and stated it improved visit quality. We are now implementing this intervention in 28 SBHCs representing 11 states across the country to promote health equity in access to adolescent-centered contraceptive information services and care. This project is funded by the Patient Centered Outcomes Research Institute (PCORI), DI-2020C2-20372. LINK:
Child and Adolescent Gender Center
The Child and Adolescent Gender Center (CAGC), is a collaboration between UCSF and community organizations. It uses a multidisciplinary approach to offer comprehensive, gender affirming care to gender diverse/transgender youth and adolescents. The UCSF CAGC Clinic is housed within the Division of Pediatric Endocrinology. Our clinic providers include pediatric endocrinology physicians and nurse practitioners, adolescent medicine physicians, pediatric psychologists, a psychiatry nurse practitioner, social workers, and administrative support staff. Our overarching goal is to provide medical and psychological care, as well as advocacy and legal support to all our patients. We help children and families connect to local resources and support groups, refer to counselors who are trained in the care of transgender youth, and provide legal and educational support. We support children and their families through their social, medical, and/or surgical transition. If and when children and their families are ready to pursue medical therapies, we prescribe and manage puberty blockers, menstrual suppression, and gender affirming sex hormones.
Transgender Youth Curriculum
Our Division is dedicated to training multidisciplinary providers to provide gender-affirming care to youth and young adults. Therefore, we have developed a comprehensive pediatric transgender curriculum for multidisciplinary clinical trainees comprised of online modules, an observership in a pediatric gender clinic, and standardized patient encounters. The interactive online modules have a primary care focus with topics regarding transgender terminology, taking a gender history, taking a psychosocial history, performing a sensitive pubertal examination, and developing psychosocial and medical plans. For the observership, trainees are exposed to real patients with an experience in a pediatric transgender clinic. The most recent addition to the curriculum is a standardized patient encounter half-day, which allow trainees to practice skills in interacting with transgender youth while being remotely observed by faculty who complete skills checklists. These encounters involve trainees taking a history and counseling an actor portraying transgender teens presenting with questions about medical transitioning. To date, our curriculum has trained over 150 pediatrics interns, psychiatry interns, medical students, and nurse practitioner trainees. Additionally, the curriculum has been rigorously evaluated and found to improve learner knowledge, skills, and self-efficacy in gender-affirming care.
Examining Mental Health Outcomes and Gender Affirmation for Transgender Youth of Color Study
This research is supported by Robert Wood Johnson Foundation and uses large datasets to quantify and document disparities experienced by Black and Latinx transgender youth. Using the California Healthy Kids Survey, which is a school-based survey administered to secondary students throughout the state of California, multivariable analyses are used to compare Black and Latinx transgender youth to two cohorts of peers: White transgender youth and Black and Latinx cisgender youth. This research found that that Black and Latinx transgender youth had similar levels of depressive symptoms and suicidality compared to White transgender youth but significantly higher than Black and Latinx cisgender peers. Additionally, compared to White transgender youth, Black and Latinx transgender youth had lower levels of school connectedness. Compared to Black and Latinx cisgender peers, Black and Latinx transgender youth experienced higher gender-based, race-based, and sexuality-based harassment. Furthermore, harassment and victimization were associated with higher odds of both past-year depression and suicidality among Black and Latinx transgender youth when controlling for demographic covariates.
Salinas Teen Health Study Understanding Latino adolescents' trajectories of risk and resilience
This research is conducted in partnership with colleagues from RTI, UC Berkeley, and the Monterey County Health Department, examines the relationship between gang violence, unintended teen pregnancies, and mental health in Salinas, California - a small, predominantly Latino community in California's rural central coast. Although some research has examined the association between violence and teen pregnancies in large urban centers, little is known about this association in rural communities. Formative work from this investigation highlighted the critical role that family plays in positive youth development and reproductive health knowledge. This formative work, and the community engagement associated with it, also revealed wide-spread concern about the mental health of Salinas youth. Current papers under development focus on immigrant-specific Adverse Childhood Events as well as the relationship between exposures to discrimination and mood disorders in later adolescence. This group just received additional NIH funding to follow the original cohort of 600 adolescents into young adulthood.
Supporting training, technical assistance, and program evaluation for Expectant and Parenting Youth (EPY) through the California Maternal Child and Adolescent Health (MCAH) Division, within the Department of Public Health
The Adolescent Family Life Program Positive Youth Development (AFLP PYD) Model provides comprehensive case management services to EPY throughout the state. AFLP PYD predominantly serves Latina adolescents and is focused on improving health equity and positive outcomes for both the mother and their offspring. AFLP PYD case managers meet with their clients in-person twice per month (over the course of a year and in many cases, longer). With youth-centered support, EPY and their children can draw on their personal strengths and community services and supports to achieve positive social, educational, health and economic outcomes. Case managers support youth in developing a sense of purpose, positive identity, and skills, such as resourcefulness and problem solving, to build resilience. During the Pandemic, Division faculty conducted a study is to showcase some of the challenges experienced with the transition to and implementation of tele-visits and to identify strategies both in terms of practice and policy that enhance case managers' ability to connect, engage and continue to support EPY.
Disparities in Access to Eating Disorder Therapy for Publicly Insured Youth and Youth of Color
Minorities in the United States have lower rates of access to most forms of health care, with particularly disparities in access to mental health care. Little is known about access to mental health care among minority patients with eating disorders, though these are among the most fatal metal health illnesses for teens. The objective of this study is to examine the association between insurance type and therapy received by racially/ethnically diverse youth in UCSF's outpatient eating disorders program. The UCSF Eating Disorder Program sponsored a summer research position for a Latina UCSF medical student, mentored by two Latina faculty members in Adolescent Medicine and Psychiatry as well as the medical director of the Eating Disorder Program. With mentorship the student conducted a retrospective chart review of youth ages 11-25 (N=1,060) presenting to our urban adolescent medicine specialty program for management of eating disorder symptoms between June 1, 2012 and December 31, 2019. Charts were reviewed for demographics, diagnosis, and therapy received. Bivariate and logistic regression analyses were performed for factors predictive of receiving indicated specialized mental health therapy within six months of evaluation. Results demonstrated that patients with private insurance were three times more likely to receive indicated therapy than patients with public insurance. Latinx and Asian patients were half as likely to receive indicated therapy as White patients. Overall, this study demonstrates that while access to mental health care is a necessary and important first step towards equity in eating disorder care, additional work is needed to dismantle systemic inequities that contribute to disparities in care for youth of color.
Supporting training and program development for the California Medical Association and regional hospital systems within the state of California to recognize systemic racism as it impacts racial and ethnic minority patients and providers
The California Medical Association (CMA) has been working to increase diversity, equity, and inclusion for the past 5 to 6 years. As part of this effort CMA established a committee entitled the Justice, Equity, Diversity and Inclusion Council (JEDI). To advise the CMA on recommendations for moving CMA to support additional pipeline programs to promote a diverse work force and address issues of health disparities and injustice. This committee sought expert advice from Dr. Raymond-Flesch related to structural racism as it impacts patients' health as well as workforce issues related to diversifying the medical education pipeline and creating more supportive and inclusive work environments for providers who are underrepresented in medicine. Dr. Raymond-Flesch has also advised regional medical systems within California on these topics including the Health Improvement Partnership of Santa Cruz County.
Diversity and Health Equity at Children's Hospital Los Angeles
Children's Hospital Los Angeles Leadership Education in Adolescent Health
In 2019, Children's Hospital Los Angeles (CHLA) was one of 9 institutions, and the only free-standing children's hospital, selected to participation in the Accreditation Council for Graduate Medical Education Pursuing Excellence Initiative. This initiative is focused on eliminating Health Care Disparities and one of our Leadership Education in Adolescent Health (LEAH) faculty is a key participant in this effort. As a result of our involvement in this initiative, CHLA incorporated equity goals as a cross-cutting theme across all components of the enterprise strategic plan. CHLA created a health equity dashboard and added equity measures to the organizational performance dashboard. Internal quality improvement training as well as standard tools and templates for root cause analysis and lean/six sigma now include equity principles and checklists. We created a teaching and learning collaborative to bring together interdisciplinary groups of staff, faculty, and trainees, to develop and implement education on cultural humility, structural competency, and personally mediated racism and bias.
The Division of Adolescent and Young Adult Medicine (DAYAM) has also been working on an internally focused diversity, equity, and inclusion initiatives and each program within the DAYAM has been developing concrete action plans and sharing it broadly with our peers and establishing accountability mechanisms. This work fits well into the hospital's global DEI initiative that has included improving data collection around race and ethnicity, improving SOGI data, reducing disparities in behavioral health emergency calls, and addressing disparities in patient satisfaction.
Talking Race, Kids & Health
Maryland Behavioral Health Integration in Pediatric Primary Care (BHIPP)
Maryland Behavioral Health Integration in Pediatric Primary Care Telepsychiatry Access Program (BHIPP TAP) is a Pediatric Mental Health Care Access (PMHCA) awardee that provides support to pediatric primary care providers in addressing the behavioral and developmental needs of their patients.
The state of Maryland has considerable diversity in sociocultural determinants of health, health outcomes, and demographic characteristics across jurisdictions. MD has one of the highest opioid overdose rates in the nation, and quite a few counties have overall health outcomes and overall health factors in the bottom-ranked quartile in the state, with several others in the bottom half. With respect to sociodemographic makeup of residents, MD has one of the fastest growing Latino populations in the US, and several counties have a higher proportion of African American residents than the state as a whole. Given these unique and varying characteristics which impact health and health disparities in a myriad of ways, BHIPP utilizes numerous approached to address health disparities at the individual and community levels.
As part of a series of interactive, web-based learning sessions called BHIPP Resilience Breaks, BHIPP recently featured a webinar on Talking Race, Kids & Health, presented by Jacqueline Douge, MD, MPH, FAAP. These Resilience Breaks are designed as a virtual space for pediatric primary care and behavioral health providers to connect, learn and share about strategies, practices, and resources to promote mental health and resilience among children and families as well as providers. Throughout this presentation, Dr. Douge highlighted strategies to increase cultural and linguistic competence and improve diversity and health equity in the pediatric primary care setting. Learning objectives focused on 1) the role of pediatric health care providers in addressing race and racism, 2) how healthcare providers can develop cross-sector collaborations to improve health outcomes and 3) using books to open and further the conversations about race with children. To access archived webinars, please visit BHIPP Resilience Breaks.
Additionally, BHIPP recently launched an Anti-Racism Resources page on our website which highlights resources specific to families, healthcare providers, coping with community violence and racial trauma, and mental health resources for black, indigenous, and people of color.
MCH Diversity, Equity and Inclusion
University of North Carolina MCH Center of Excellence
The UNC Center of Excellence in Maternal and Child Health Education, Science and Practice and the UNC Department of Maternal and Child Health is committed to fostering inclusive excellence. In 2020, the Department implemented new guidelines that require all faculty and staff complete 8 hours of Diversity, Equity and Inclusion (DEI) trainings each year, and formed a DEI Workgroup comprised of faculty, staff, and student representatives. DEI training topics include race and cultural competence; special populations; sexual orientation/gender expression; mental health; sexual assault/intimate partner violence; employment equity. The DEI Workgroup is committed to transparency in the process of meeting, organizing, and taking action steps toward antiracism and inclusive excellence.
The initiatives implemented by the UNC Department of Maternal and Child Health align with the commitment and initiatives already established by the University and the Gillings School of Public Global Health. At Carolina, diversity and inclusion are about building understanding across differences, creating conditions to ensure the equitable educational and social benefits of diversity and cultivating an inclusive and supportive environment for undergraduate, graduate and professional students, faculty and staff – where every person feels valued and has an opportunity to add value.
UNC Center of Excellence in MCH Leadership Panel
University of North Carolina MCH Center of Excellence
The UNC Center of Excellence in Maternal and Child Health Education, Science and Practice will be hosting a virtual Leadership Panel on October 5, 2021 via Zoom Webinar. The theme of this year's panel is Leading for Equity in MCH: Collaborations between practice and research to enhance the health of MCH populations. The effects of the pandemic have exposed disparities in equitable access to quality health care and resources in our communities, the U.S. and across the globe. It is times like these leaders in MCH push even harder to close the gap. Three talented groups of panelists comprised of maternal and child health leaders from academia, state government, and non-profit organizations will demonstrate how they effectively collaborate to advance equity in MCH practice, policy and or research.
Summary of Advancing Health Equity Through Reproductive Justice Syllabus
University of North Carolina MCH Center of Excellence
Ariel Lewis, MPH developed a syllabus titled Advancing Health Equity Through Reproductive Justice for the UNC Gillings School of Global Public Health. This 4-credit elective course introduces graduate-level public health students to the history, theory and practice of reproductive justice within the context of the United States.
Advancing Health Equity Through Reproductive Justice is designed to provide students with foundational knowledge and skills to become informed anti-racist and reproductive justice advocates who lead with compassion and ensure the dignity of all people. Learning objectives for this course correlate with the following competencies: MCH substantive knowledge, MCH leadership, and health equity, social justice and human rights. As such, this course can be cross-listed between the Maternal, Child and Family Health concentration and the Health Equity, Social Justice and Human Rights concentration offered by the Gillings School of Global Public Health.
There is increasing engagement with reproductive justice (RJ) within the public health sphere. A review of the MCFH core curriculum reveals an opportunity to enhance content on the following communities and topics for the U.S. specifically: anti-racism praxis, LGBTQ-GNCNB (Lesbian, Gay, Bisexual, Transgender, Queer and Gender Non-Conforming, Non-Binary) communities, BIPOC (Black, Indigenous and People of Color) communities, historical reproductive injustices in the U.S., the disability community and disability justice, and domestic policy advocacy. Advancing Health Equity Through Reproductive Justice is therefore a unique and timely offering for students in the MCFH Concentration and other graduate-level public health students at Gillings seeking to gain a deeper understanding of health equity, social justice and human rights in the context of sexual and reproductive health in the U.S.
Boston LEAH Brings Sexual Health Education to At Risk Youth, Emphasizing Identity and Autonomy
Boston Leadership Education in Adolescent Health
EXPRESS Yourself is a Boston LEAH Fellow led experience designed to embolden diverse young people in the community to take charge of their sexual health through an interactive educational curriculum. The program is rooted in human rights principles, drawing upon expertise from advocates, educators, and medical providers with tailored content according to the developmental capacity and lived experiences of the adolescents and young adults in attendance. The youth are insufficiently served by school-based sexual and reproductive health education models as a result of inconsistent school attendance, homelessness, trauma history, and other unique barriers. Through this program, Fellows engage with the community in a meaningful way while learning the basics of sexual health education through observation and participation. Partners include Boston HIV Adolescent Provider and Peer Education Network for Services (HAPPENS), Bridge Over Troubled Waters, and ROCA. Priscilla Portugal-Moreno, Boston HAPPENS Health Services Advocate and EXPRESS Yourself Outreach Coordinator, developed and teaches the program curriculum. Priscilla and Drs. Alexandra Edwards and Sydney Hartman-Munick, two senior fellows in the Boston Children's Hospital LEAH Program, have taken the lead to develop this experience for current and future trainees.
Teen CHWs Bring Health Resources to Communities of Color
HRSA Healthy Tomorrows: The East Side Community Center: A Hub of Health and Empowerment for Youth and Community YWCA New Britain; New Britain, CT
Teens from New Britain High School completed a Community Health Worker (CHW) training course (90 hours) and are focusing on Health Equity for their 1,000 hour Fieldwork requirement to become state certified CHWs. Teens helped organize a 'Summer Bash' at Chesley Park which focused on bringing health resources, including COVID19 vaccinations, to New Britain, CT's East Side community. Teens surveyed 63 residents regarding: hesitancy surrounding the COVID19 vaccine, resources and education services that were needed as a result of the pandemic, and what (if any) mental or physical effects the pandemic had on local families. Community based organizations were present to talk with the community regarding: rental & housing assistance, mental health services, alcohol & opioid addiction, neighborhood safety, and more. The Community Health Center brought their mobile vaccine clinic, and at the completion of the event, vaccinated 14 people. Regarding her CHW training course, Danyelix stated, "We learned about people- how to treat them and communicate with them. If people don't trust you, they're not going to listen to you. Being able to talk with somebody is the most important thing. We also learned a lot about health. I feel like not judging people is the most important thing. Instead of seeing someone and judging them, as yourself, 'How do I help that person or reach that person'."
Diversity Scholars Leadership Program - Supporting Students of Color through Mentorship
Center of Excellence in Maternal and Child Health at Boston University School of Public Health (BUSPH)
Higher education represents academic and professional growth and increased opportunities. However, it is costly and taxing for Black, Indeginous, and people of color (BIPOC) or first generation students. Predominantly white institutions often leave BIPOC and first generation students feeling isolated and overwhelmed. These students have unique challenges - providing emotional and financial support to their families and navigating microaggressions that permeate social and classroom interactions. These experiences tax students' health and well-being and compromise their ability to flourish.
To address the challenges BIPOC and first generation students face, BUSPH Center of Excellence in Maternal and Child Health created the Diversity Scholars Leadership Program (DSLP).1 DSLP offers support and community among students with shared experiences through: 1) mentorship, 2) tuition support1, and 3) community building among scholars, alumni, and faculty.
A core aspect of DSLP is the alumni mentorship. Each DSLP scholar is matched with a BIPOC mentor who supports scholars from professional development and navigating academic and professional settings as BIPOC individuals, to sharing lived experiences and building connections over shared passions.
"One of the best things about being a part of DSLP is the ability to build community through shared experiences and affirmations! I've had much of my experiences validated which has empowered me to strengthen my mission to pioneer change in my lineage. Also, being paired with a mentor who support and elevates my initiatives on this effort has been rewarding and therapeutic. There's just something about growing and elevating each other in the process that bring so much healing and internal harmony." - current DSLP scholar.
Mentors also offer valuable advice, drawing from their experiences in the MCH and greater public health space.
"My DSLP mentoring experience has been empowering. She is an incredible role model and has really opened my eyes to all the opportunities available in our field. I've been able to approach every conversation with honesty and curiosity, and that alone has had a tremendous impact on my personal, academic, and professional life." - current DSLP scholar.
DSLP creates a space that validates and affirms students' experiences, encouraging authenticity and allowing them to thrive.
Virtual DSLP Dinner in February 2021 with current
scholars, alumni, faculty, and mentors.
Promoting Diversity and Health Equity: UNC Greensboro Names 10 Undergraduate Scholars for the LEAD in MCH Traineeship
The UNC Greensboro School of Nursing accepted 10 pre-licensure BSN students to the Leadership, Education and Diversity in Maternal Child Health (LEAD in MCH) scholar program this summer. To promote diversity in nursing, student scholars were recruited from culturally diverse, underrepresented, and underserved backgrounds and demonstrated a passion for maternal child health and/or public health. The program aims to address the health disparities gap by bringing socioeconomic, racial and ethnic diversity to the maternal child health workforce. The LEAD in MCH program offers student scholars the opportunity to complete enhanced MCH coursework, attend monthly seminars specific to MCH leadership competencies, as well as participate in tutoring, advising and MCH focused simulations. Student scholars also participate in an MCH internship and have expanded clinical options as part of the program.
This is the first year for the LEAD in MCH program at UNCG. The LEAD in MCH program is led by Carrie Hill, PhD, RN, Director of the RN to BSN Program and Audrey Snyder, PhD, RN, Associate Dean for Experiential Learning and Innovation at UNCG School of Nursing.
San Ysidro Health - Improving the health and well-being of the communities we serve with access for all
Healthy Tomorrows Centro De Salud La Comunidad De San Ysidro Inc (San Ysidro Health)
Born out of the civil rights movement in 1969, San Ysidro Health (SYHealth) was founded with diversity and inclusion in mind. From its humble beginnings, SYHealth's focus has been to provide the highest quality of care to families and individuals with the utmost compassion. As the organization's growth continues throughout San Diego County its priority to provide access to care for all, without exception remains at the forefront. With the commitment and determination to advance its diversity, equity and inclusion efforts, SYHealth strives to ensure all are welcomed when entering any of its clinics.
Today, SYHealth stands on the shoulders of its founding mothers, staff and volunteers who have left a lasting impact through the support and care provided to its 108,000 patients. As a trusted community messenger, SYHealth hires within the communities it serves to ensure its team is reflected of the community it serves. The COVID-19 pandemic has disproportionately impacted the families SYHealth serves in Central, South, East and Rural San Diego County. Data showed that infection rates were rampant in communities made up of essential workers that did not have an opportunity to work from home and are employed in high-contact and high exposure jobs. To support San Diego County's COVID-19 recovery efforts, SYHealth has been on the frontlines providing COVID-19 vaccination, testing, resources while continuing to provide comprehensive care services. To date, SYHealth has provided more than 50,000 vaccines to individuals in neighborhoods affected most by the pandemic. SYHealth continues to lead vaccination efforts by going to locations that are most convenient for individuals. "Even though most vaccination stations are offering walk-ins, patients are still being referred to us internally to help them schedule COVID vaccines through the county which is a reflection of the need that there still is to reach certain members of our community and how our resource centers are essential in filling the gap for populations with greater limitations and access to health care". Daniel Ramirez, Program Manager. COVID-19 vaccines, testing and routine care services are available to all individuals, specifically targeting essential workers, many of whom are Latino and reside in the South Region.
Although the COVID-19 pandemic hindered routine care for individuals, it did not disrupt SYHealth's ability to stay open and continue providing the highest quality of care with compassionate.
Healthy Tomorrows Partnership for Children Program – Enhancing Family Engagement
Earlier this year, the Healthy Tomorrows Partnership for Children Program (HTPCP) grantees had the opportunity to compete for a $5,000 stipend to strengthen family engagement activities in their respective projects. Below are a compilation of stories from HTPCP grantees across the U.S. sharing successes they have seen in their projects by incorporating family engagement activities. The following HTPCP projects involved families in their projects through activities such as Advisory Board participation, reviewing materials and resources produced by the project for cultural/linguistic competence and health literacy levels, leading family support groups, and participating in the development of staff trainings.
New York-Presbyterian Hospital's Turn 2 Us Family Engagement Stipend Project brought mental health focused workshops to caregivers of New York-Presbyterian Hospital's Ambulatory Care Network pediatric patients
New York-Presbysterian Hospital's Turn 2 Us – Healthy Tomorrows Partnership for Children
New York-Presbyterian Hospital (NYP)'s Turn 2 Us (T2U) is a school-based mental health promotion and prevention program, serving elementary schools in Northern Manhattan, NYC. T2U promotes mental health and academic success in at-risk children. We hope to empower the entire school community (students, caregivers, and school staff) to engage in healthy lifestyle practices that promote wellbeing. The program aims to enhance the mental health literacy of school personnel and caregivers, so they are equipped to ensure our youths' progress emotionally, socially, and academically. T2U aims to also raise awareness of the importance of mental health, even in the absence of mental health conditions, and decrease the stigma associated with mental health.
The Family Engagement Stipend Project aimed to support caregivers in the community, reaching beyond our targeted audience of the local school community. Workshops were promoted amongst caregivers of patients in NYP Ambulatory Care Network's pediatric outpatient practices. T2U held three workshops: 1) Identifying and Managing Stress in Children; 2) The Real Impact of Social Media on Youth and; 3) Self-Care is Essential for Caregivers. Workshop participants completed a mental health literacy survey to gauge the mental health literacy of participating caregivers; after completing the survey, participants received a $25 gift card. The mental health literacy survey allows T2U to better understand the needs of the community and tailor programming to meet those needs. This project allowed T2U to expand services, reaching more community members during a time with increased mental health needs.
New York-Presbyterian Hospital's CHALK Jr Family Engagement Stipend Project brought early childhood center parents together to lead wellness workshops for their peers
Healthy Tomorrows Partnership for Children, New York-Presbysterian Hospital CHALK Jr
New York-Presbyterian Hospital (NYP)'s CHALK Jr program partners with early childhood centers in the Northern Manhattan, NYC, to increase access to healthy lifestyles for children and their families. Northern Manhattan's predominately Latinx community is tight-knit and faces high rates of childhood obesity and food insecurity. The neighborhood was hard hit by the COVID-19 pandemic.
As residents and community-based organizations come together to support families in need, NYP CHALK Jr launched the Family Engagement Stipend Project to amplify the voices of early childhood center parents and caregivers. Three parent leads received a stipend and $850 budget to train and then lead wellness workshops for their peers. Workshop themes included healthy eating (MyPlate), sugar-sweetened beverages, physical activity (dance and yoga), and childhood stress and resilience. Each parent tailored their workshops to respond to the unique needs, interests, and strengths of their early childhood center communities.
In their words:
"I love these types of programs that affect the community directly. This is definitely something I would love to do again."
"It was so great to meet two new people who will continue to be my partners!"
"There were times I was scared and wanted to back out, but I'm glad I didn't. I liked all the topics and am now offering my son milk or water each morning instead of juice."
NYP CHALK Jr will continue to champion this approach, offering paid opportunities for community members to engage in leadership roles. Thank you to our early childhood center partners and parent leads!
Consumer Empowerment in HealthCare!
Skagit County Public Hospital District #304 a Healthy Tomorrows Partnership for Children Program
As part of our work to initiate the HealthySteps program in a local pediatrician's clinic in rural Skagit County, Washington, AAP provided a Family Engagement Stipend to work with the Family Advisory Council at our local pediatric clinic. With the support of our clinic staff, we were able to work with a group of 10 parents. The first thing was to determine how to make the most of this opportunity. The parents decided they wanted to create a Patient Experience Survey. Their goal was to create a survey that would empower patients and parents to evaluate their healthcare journey, while providing important feedback to the Skagit Pediatrics' staff regarding their consumer experience.
Through discussion, research, and negotiation the work group members created a Patient Experience Survey with questions encouraging reflection and evaluation of the patient's experience with the established health care process. There was much concern expressed regarding language and diversity. Our community has many indigenous speaking families which requires an oral option for communicating. Concerns about equity and accessibility also arose regarding internet access and literacy. English and Spanish were determined to be the primary languages spoken in our community, so the survey was created in those two languages. The work group also decided to provide an electronic assistive device for accessing the internet survey and for the option to use "text to speech" functionality for non-readers. They also purchased a banner, ink pens, and 200 coloring books all inscribed with the tag line "Your opinion counts, take our survey!" (In both English and Spanish) to inform patient families about the survey and create some excitement.
This was a wonderful experience which illustrated the importance of providing parents/patients with a path to empowerment that directly involves them with their family's medical care. Developing a Patient Experience Survey and marketing plan provided these families with a sense of accomplishment. It strengthened their faith in the power of the consumer and in the sincere caring of their chosen healthcare provider.
Advancing Nutrition in MCH: Establishing a partnership between Louisiana Title V & Tulane Nutrition Leadership Training Program
Nutrition is vital to the healthy development and well-being of infants, children, youth, and adults, including those with special health care needs. Partnerships between state Title V programs and academic institutions offer unique opportunities to draw from respective strengths and expertise to promote the nutritional well-being of maternal and child (MCH) populations across the lifespan. This is the story of the Title V program joining forces with Tulane Nutrition Leadership training program to advance nutrition outcomes in Louisiana.
In 2018, the Bureau of Family Health within the Louisiana Office of Public Health (OPH) participated in the Children's Healthy Weight Collaborative Improvement and Innovation Network (CHW-COIIN) on a project to support further integration of innovative nutrition strategies into the state's Title V (MCH) block grant. While working on this project, OPH learned that Tulane University School of Public Health and Tropical Medicine was recently established as a HRSA funded MCH Nutrition Training program and could provide TA and expertise to advance their project.
OPH launched an academic-practice partnership between Louisiana Title V and the Tulane Nutrition Leadership Training Program to develop a 20-hour immersive collaborative with two purposes:
- Improve integration of nutrition concepts into Title V programming, and
- Provide MCH Nutrition Trainees practical real-life public health experience within the state Title V agency.
Listen to Marci Brewer, MPH, Neonatal Initiatives Manager and Colleen McCullough, Title V Program Coordinator describe this partnership in their poster presentation for the 2021 Association of State Public Health Nutritionists (ASPHN) Annual Meeting. ASPHN developed an infographic describing the Louisiana Innovative Nutrition Integration project.
Since Fall 2020, two cohorts of MCH Nutrition Trainees have rotated through the program. As part of the Title V 5-year Statewide Needs Assessment, Cohort 1 trainees investigated the role that nutrition plays in reducing health disparities and improving health outcomes within Title V's populations. They also explored opportunities to integrate nutrition-focused strategies into Title V programming.
The trainees in Cohort 2 initiated a Bureau-wide conversation about food security by assessing Louisiana Title V staff's existing knowledge of food security. Informed by the assessment findings, students delivered a 20-minute educational presentation to staff. Key findings included:
- Louisiana Title V staff have varying degrees of knowledge about food security.
- Louisiana Title V staff recognize the importance of food security to MCH and are interested in learning more about how they can address food insecurity issues in the populations they serve.
- There is a need for consistent nutrition messaging within Title V and Bureau of Family Health programming.
With supplemental financial support received through the Children's Healthy Weight COIIN, the Title V team will consult with two nationally recognized subject matter experts (SMEs) to bolster integrationof trainees into Title V and assist with future cohort project planning. During Summer 2021, the Title V team will work with the SMEs and partners from Tulane University to:
- Reflect upon the key findings and recommendations from both cohorts
- Develop options for practical, actionable Title V nutrition integration strategies
- Facilitate a discussion with program leads and decision-makers to determine which strategies to implement
- Determine the scope and focus of future cohort projects
The third cohort of MCH Nutrition Trainees will begin their Title V practical rotation in Fall 2021.
An important aspect of this collaboration is to recognize and value the expertise of the trainees as nutrition professionals. On the Louisiana Title V end, this required humility and honesty about the limitations of their nutrition experience.
Trainees from Cohort 1 expressed the following about their experience:
"The Bureau of Family Health allowed us as students to exercise our professional skills and empowered us to be confident in our nutrition knowledge. We truly felt heard, respected, and trusted while being given the space to showcase our public health education and experiences we have had with the New Orleans community."
The work of both cohorts has increased visibility and understanding of relevance of food insecurity in Title V programming. Creating meaningful experiences for trainees requires capacity and structure. Louisiana Title V and MCH Nutrition Trainees are co-creating that structure and capacity, making this a unique learning experience on both sides.
UC Berkeley's Cassondra Marshall DrPH, MPH Receives NIH Career Development Award to Support Reproductive Decision-Making among Black and Latina Women with Type 2 Diabetes
UC Berkeley Center of Excellence in Maternal and Child Health
Cassondra Marshall DrPH, MPH, Assistant Professor in Residence in Maternal, Child and Adolescent Health at UC Berkeley School of Public Health, has received a Mentored Research Scientist Career Development Award from the NIH National Institute on Minority Health and Health Disparities. The award will allow Dr. Marshall to achieve her long-term goal of advancing reproductive and maternal health equity through the translation of evidence into practice, focusing on type 2 diabetes among racial/ethnic minorities.
Type 2 diabetes, linked to maternal and neonatal morbidity and mortality, is increasing among women of childbearing age, with Black and Latina women disproportionately affected. Dr. Marshall hopes to develop new evidence-based strategies to implement clinical guidelines for improving reproductive outcomes among adult women with type 2 diabetes.
Dr. Marshall will receive training in person-centered and structurally competent reproductive health interventions, advanced mixed methods, implementation science and stakeholder engagement, and designing and implementing trials in the primary care setting. She will work with an interdisciplinary mentoring team which includes Dr. Hector Rodriguez, health policy expert from UC Berkeley School of Public Health; Dr. Christine Dehlendorf, MD, MAS, family physician and professor at UCSF with advanced training in family planning; Margaret Handley, PhD, MPH, professor of biostatistics and epidemiology at UCSF; and UC Berkeley-trained health services and policy expert Dr. Julie Schmittdiel from the Kaiser Permanente Division of Research.
Says Dr. Marshall, "I am thrilled to receive this career development award that will further my training and equip me with the skills to develop, implement, and evaluate person-centered interventions to advance reproductive and maternal health equity, and to collaborate with community health centers, which provide an excellent setting for this work focused on the understudied intersection of family planning services and chronic disease management."
Angela Miney, BA, Receives AMCHP's Merle McPherson Family Leadership Award
University of Florida College of Medicine Pediatric Pulmonary Center
Angela Miney is the Family Partner of the University of Florida College of Medicine Pediatric Pulmonary Center (UF PPC) and the coordinator of the Florida Family Leader Network (www.floridaleaders.org ). In this role, she works with the Health Resources and Services Administration's Maternal and Child Health Bureau (HRSA MCHB) funded organizations, proving her depth of knowledge regarding family-centered care, engagement, and leadership to related projects. Ms. Miney has accomplished and contributed in many ways to increasing family involvement across AMCHP and Title V efforts. One of the most significant examples was a proposal for Florida to benefit from a network of family leaders and health care champions, with her recommendation at a 2016 statewide meeting of HRSA MCHB funded organizations, that quickly developed into a formal partnership with Florida's Title V CYSHCN Program and the UF PPC to develop and grow such a network. In a few short years, Ms. Miney created the framework, initiated the startup and has overseen the growth of the Florida Family Leaders Network (FFLN) to over 200 members. Currently, the FFLN is an organization committed to supporting CYSHCN with an international reach. Ms. Miney has been a member of numerous committees at the University of Florida College of Medicine and has presented several chronic illness and family-centered presentations, as well as research and publications.
The Transformative Effect of Interdisciplinary Training
University of Minnesota Leadership Education in Adolescent Health
Interdisciplinary training, foundational to the University of Minnesota LEAH program (UMN-LEAH), is the reason the current first-year cohort of fellows chose this fellowship program. These fellows, representing medicine (general and development/ behavioral pediatrics, and family medicine), nursing, social work and kinesiology, came to the fellowship with experience working with other disciplines. Yet this intensive submersion into micro- and macro-level approaches to supporting adolescent and young adult health was beyond what they expected.
"It's intellectually humbling"
UMN-LEAH Fellows participate in a range of opportunities to learn and work together. Hearing how other disciplines approach the same issue is a consistent discussion point. After immersion in a particular discipline's academic training, it can be 'intellectually humbling' to understand that no one discipline has all the answers to what young people need for healthy development. Beyond a simple exchange of perspectives is the possibility to integrate other disciplines' perspectives in a way that is transformative. The formative experiences of collaborative research, teaching one another from their own areas of expertise, learning skills and techniques from clinical care to systems change, helping one another find and express leadership, along with time for reflection has shifted fellows' views of young people's development and how best to support their health. After 9 months together – despite having never met in person – UMN-LEAH fellows have found that their interdisciplinary training coupled with a breadth of experiences offered by the program has expanded their vision of what a future career might look like.
Interdisciplinary Training = More Allies
An interdisciplinary approach opens the door to seeing the overlap of issues and interests. For example, a social work fellow working in foster care found an unexpected partner in an adolescent medicine fellow working with homeless and highly mobile youth. A kinesiology fellow interested in physical activity as central to healthy youth development found shared interests with a developmental/behavioral pediatrics fellow working to find everyday activities for patients with disabilities. Fellows are building life-long relationships across disciplines focused on shared outcomes of health and well-being of young people. As one fellow noted: "Interdisciplinary training creates more allies in the fight!"
National MCH Trainee Blog Authors Reflect on their Interdisciplinary/Interprofessional Work
University of Minnesota Center of Excellence in Maternal and Child Health
The National MCH Trainee Blog is a trainee-led site hosted by the University of Minnesota (UMN) Center for Leadership Education in Maternal and Child Public Health and the University at Albany Maternal and Child Health (MCH) Public Health Catalyst Program. This blog, co-edited by trainees Alexis Chavez (UMN) and Alyssa Pochkar (Albany), is for MCH students from HRSA-funded Centers of Excellence (COEs) in MCH Education, Science, and Practice programs and Catalyst programs to share their MCH research and practice experiences.
Trainee authors have exemplified interdisciplinary/interprofessional work in their involvement with the MCH populations. Ariana Roman, trainee at the University of Illinois-Chicago COE in MCH, and her peers wrote about exploring the relationship between Adverse Childhood Experiences (ACE), parental separation, and youth having higher odds of receiving specialized education plans. Their efforts required collaboration and teamwork, and an interdisciplinary review of community health sciences, epidemiology, and environmental and occupational health research and data.
Natasha Borgen and Cheralynn Corsack, trainees at the University of California, Berkeley COE in MCH, and undergraduate Hailey Windsor, wrote about hosting a student-led Human-Centered Design Workshop focused on answering the question "How might we reframe preconception health to be inclusive and center the current and future health of the community using stage-of-life relevant messaging?" This method allowed for different activities focused on team-building, collaboration, social innovation, and systems change, and helped students practice an approach they could later use in their public health careers. Of the experience they said, "...we learned that [this] is a collaborative approach to problem-solving that not only encourages interdisciplinary team-work, but relies on it. It is a creative process that is grounded in empathy and puts people first; it is a process that is rooted in deep learning through continuous inquiry and a willingness to learn through failure."
New blog posts resume in fall 2021, so check back to learn how MCH trainees from across the nation are contributing to interdisciplinary/interprofessional and other public health efforts.
By Alexis Chavez, Trainee, and Sara Benning, Center for Leadership Education in Maternal and Child Public Health (UMN COE in MCH)
GET MINDFUL: Interdisciplinary Development of a Parent Wellness and Support Group for Parents of Individuals on the Autism Spectrum
University of California Davis Leadership Education in Neurodevelopmental and Other Related Disabilities
Shereen Cohen, Ph.D., is a psychology postdoctoral fellow and LEND trainee at the University of California Davis MIND Institute. As her Leadership project, she decided to develop an online parent wellness and support group for parents of individuals on the autism spectrum. To ensure an interdisciplinary focus, Dr. Cohen worked with two of her fellow LEND trainees, Abiramy Duraiswamy, parent of an autistic adolescent, and Kristen Wallman, M.A., social work intern and parent of two young adults on the spectrum, to create a program grounded in principles of Mindfulness-Based Stress Reduction and Positive Psychology.
Parents of children diagnosed with autism report higher parenting stress than parents of typically developing children, or even parents of children with other disabilities. This population of parents has been under even greater stress since COVID, becoming not only full-time parents but teachers and ABA providers as well. Given limitations of services, it was imperative to offer this group via video conferencing platform. Parents participated in 6 weekly sessions to learn, practice, and discuss tools and strategies for managing stress and improving well-being, with a focus on topics related to self-care, mindfulness, grief, self-compassion, strengths, and resources.
GET MINDFUL has run for two cycles, serving 24 parents. Participants completed self-report measures of parenting stress, family empowerment, and satisfaction with life. Based on preliminary data, participants showed significant reductions in parenting stress, as well as trends toward increases in family empowerment and satisfaction with life, after the group. Participants reported appreciating the convenience of the telehealth approach. Participants also offered feedback and suggestions for improving the group in the future. Modifications are currently underway in preparation for a third cycle.
We intend for this group to continue forward, not only as a resource for parents, but also as a wonderful training opportunity for future trainees. The remarkable diversity of personal and professional backgrounds of the three creators of this group led to a rich and meaningful experience for facilitators and participants alike. The parent perspective, along with the advanced mental health education backgrounds of the facilitators were instrumental in the development and implementation of this program, and we are excited to see the ongoing development with future trainees and participants.
Telehealth in Oklahoma: A New Opportunity
University of Oklahoma Leadership Education in Neurodevelopmental and Other Related Disabilities
The University of Oklahoma Health Sciences Center interdisciplinary JumpStart clinic at the Child Study Center evaluates children under 7 years of age who are at risk for autism spectrum disorder. The JumpStart team includes two OKLEND (Oklahoma Leadership Education in Neurodevelopmental and Related Disabilities) graduates, one who is the Co-Director of the OKLEND program, and one who is a third-year developmental-behavioral pediatrics fellow. The interdisciplinary team also includes a first-year DBP Fellow/OKLEND trainee, a psychologist (who is also a faculty member in OKLEND), an occupational therapist, a speech-language pathologist, and a family partner. A variety of learners observe and assist in this clinic setting; the learners include medical students, residents, and fellows, as well as OKLEND trainees from up to 16 different disciplines.
As the COVID-19 pandemic began, the JumpStart clinic team quickly realized the need to adapt to continue serving children and families despite new restrictions. The team brainstormed about the possibilities and developed strategies that included use of the Developmental Profile and the Tele-ASD-Peds as our primary assessment methods. The team conducted clinic appointments using distance video conferencing software with appropriate consent obtained from the caregivers beforehand. The team had brief preparation sessions virtually the day before the clinic sessions to determine how best to evaluate our patients. During the pandemic, the JumpStart team saw 30 children virtually with 63% of them receiving an autism spectrum diagnosis.
The virtual JumpStart clinic has been effective to continue the work of diagnostic assessment and provide valuable recommendations to the families. An unexpected benefit of the telehealth option was the opportunity to see the children in their home environments where they interacted more naturally with family members. Additionally, families who lived long distances from the clinic were able to avoid the time and expense of transportation, and OKLEND trainees from distant areas of the state were able to participate. The JumpStart clinic team is developing more telehealth assessment options for families. The team also hopes to work together on early childhood developmental assessments in underserved, tribal, and rural communities through telehealth and mobile outreach initiatives.
It Matters – A Parent Panel : It is their journey, not ours. Let's walk beside them.
Rhode Island LEND
Alexia Arriaza, Amanda Silva
Jennifer Franchetti, Margaret Greene-Bromell
It Matters project's goal is to lend perspective to professionals around a family's journey through diagnosis and services. Our hope is that providers take away a different perspective and learn how important it is to look at the big picture, understand the grief cycle and most of all learn how important it is to meet these families where they are.
Because a family's story matters.
It Matters – A Parent Panel will help professionals gain insight into the family perspective. These experiences can be used to learn how to better support families in their own journey. Through this work we hope to build stronger partnerships between providers and families.
The panel will help providers foster stronger trusting connections that will result in a better understanding of the family. In turn this will only improve the supports and resources provided to them.
The resource portion of this panel aims to help providers become more familiar with state resources that are available to families. Often when professionals enter their fields as new graduates, they are often unaware of resources in the state or how to assist families in accessing them.
The It Matters team presents 45–60-minute panel discussion, a viewing of "A Family's Journey," a resource review and then a 30-minute Q & A session at the end.
The It Matters participants have been working with state colleges and universities on ways to include this project into their curriculum for teacher candidates and with the schools of social work. Our goal is that this will expand their knowledge on resources available to their future clients, students, and families.
An Interdisciplinary Approach to Tackling Maryland's Child Mental Health Needs
Maryland Behavioral Health Integration in Pediatric Primary Care (BHIPP)
Maryland Behavioral Health Integration in Pediatric Primary Care Telepsychiatry Access Program (BHIPP TAP) is a Pediatric Mental Health Care Access (PMHCA) awardee that provides support to pediatric primary care providers in addressing the behavioral and developmental needs of their patients. BHIPP offers telephone consultation, resource and referral networking, care coordination, telemental health services, training and educational opportunities, and social work co-location in primary care practices in collaboration with Salisbury University (SU) and Morgan State University (MSU).
Since 2012, BHIPP has collaborated with SU to offer regionally specific social work co-location in select MD primary care practices in the Mid and Lower Shore and Western MD. In 2019, BHIPP launched a new partnership with MSU to expand this model to Baltimore City practices and address the unique needs of urban providers and families.
In this model, Master of Social Work (MSW) students are trained and placed in primary care offices to serve as co-located mental health providers. BHIPP collaborates with faculty from SU and MSU to provide training and host monthly consultation calls that allow each student to present a case to a BHIPP consultant for feedback.
Students are embedded in primary care settings and work side by side with the medical team to address barriers to improving patient health. Patients receive mental health evaluations and care faster, without the months of waiting common in many facilities, which often leads people to give up trying to get care for behavioral health issues. BHIPP interns can provide support with screening, case management, and brief interventions for common behavioral health concerns such as ADHD, anxiety, depression, and to support positive parent-child interaction.
In addition to increasing access to evidence-based behavioral health treatment services for patients at the host sites using this interdisciplinary approach, the co-location component of BHIPP also contributes to the development of the local behavioral health workforce.
For more information please visit the Maryland BHIPP website.
29 MN LEND Fellows Complete Year - Online
University of Minnesota Leadership Education in Neurodevelopmental and Other Related Disabilities
Capping a year of learning and interacting almost entirely online, the 29 graduates of the Institute of Community Integration's (ICI) Minnesota Leadership Education in Neurodevelopmental and Related Disabilities (MN LEND) certificate program recently closed out their final ceremony with a few last words of their own.
"I am changed."
"A place where we begin, but not where we end."
"An astonishing amount of information."
"Disability is not the problem. [Lack of] accessibility is the problem."
"You've given me space to learn, and a voice to advocate for families like mine."
"Take this knowledge and pass the mic."
The online gathering celebrated not only the fellows' learning about disabilities and disability advocacy, but also showcased the projects each one pursued during the year. They included fine-tuning a national survey of family caregivers, helping create a roadmap for distinguishing between symptoms of trauma and presentation of neurodevelopmental disability characteristics, and conducting a survey of dentists exploring the extent to which they treat patients with neurodevelopmental disabilities. Another team focused on inclusion efforts at faith-based organizations. Others focused on the intersectionality of disability with characteristics including race and sexual orientation.
"Participating in MN LEND has shaped me as a leader more than I could have anticipated," said Sally Sexton (left), a fellow who helped develop the Minnesota Inclusive Higher Education Consortium, a learning community that aims to expand postsecondary opportunities for students with intellectual disability.
MN LEND is an interdisciplinary leadership training program spanning approximately 14 disciplines across the University of Minnesota, funded by the Maternal & Child Health Bureau.
Minnesota Lt. Gov. Peggy Flanagan, in a recorded message, lauded the graduates for delving into the deep inequities that the COVID-19 pandemic exposed. "I know the past months have been incredibly challenging," she said. "But each and every one of you rose to that challenge."
State Senators John A. Hoffman and Jim Abeler, as well as Deeqaifrah ("Deeqa") Hussein (MN LEND Fellow, 2017–18), a director of special education for Minneapolis Public Schools, attended the event and addressed the graduates.
ICI Director Amy Hewitt acknowledged the difficulties fellows faced in navigating their learning experience and the rest of their lives during the pandemic.
"Despite the barriers and hurdles, I know you've made lasting connections," said Hewitt, part of the MN LEND leadership team. "Your tenacity…and commitment to improving the lives of people with intellectual disabilities is a true sign of the leaders you are and will continue to be."
Andrew Barnes, a University of Minnesota Medical School associate professor and a member of the MN LEND leadership team, urged fellows to take their experiences during the year and turn them into learning opportunities for others.
"Stay alert for a ready and willing student to appear before you," he told the fellows. "Speak to a group. Serve on a board. Write new laws. You'll do all this and more because you are the good in the world, and you are the teachers now."
Interprofessional Approach to Addressing Mental and Behavioral Health Needs in Pediatric Primary Care
KSKidsMAP Pediatric Mental Health Access Program
Interprofessional work is integral to Kansas' PMHCA program, KSKidsMAP. At the heart of the program is the Pediatric Mental Health Team (PMHT), which includes two board-certified child and adolescent psychiatrists, a board-certified child and adolescent psychologist, a board-certified pediatrician, and a licensed social worker care coordinator. Having Dr. Kari Harris, pediatrician, on the PMHT adds validity to the team. She acts as a liaison to KSKidsMAP participants and shares her primary care expertise with the PMHT. Equally important is the team's social worker, Polly Freeman. Polly's expertise has proven to be invaluable in recommending and locating resources for PCPs who participate in the TeleECHO Clinic or request a case consultation. Many PCPs lack social workers in their offices, and Polly's ability to help with the "leg-work" of finding resources has been highly valued by participants. One physician said, "Thank you so much for coordinating this and providing this resource. It is a relief to have this resource – It really makes a difference...really glad we have a plan," in response to Polly's care coordination efforts.
TheKSKidsMAP TeleECHO fosters interprofessional collaboration. Currently, the program has had engagement from social workers (n=5), register nurses (n=3), physician assistants (n=3), nurse practitioners (n=26), pediatricians (n=44), family medicine physicians (n=29), child and adolescent psychiatrist (n=2), general psychiatrists (n=1), clinical psychologist (n=3), counselors (n=3) and telehealth coordinators (n=1). Having this interprofessional makeup allows for rich discussion and learning around each presented case. To date (January 2019 – May 2021), the KSKidsMAP PMHT has provided interprofessional recommendations for 27 patients through TeleECHO and 89 through the Consultation Line. A participating physician sums up the program's aim in this statement, "KSKidsMAP provides the extension of care of a pediatric medical home with the psychiatry expertise to provide the best mental health care to children under one roof." This would not be possible without the interprofessional nature of KSKidsMAP.
Michael Kramer, PhD Receives the ASPPH Teaching Excellence Award
Congratulations to Dr. Michael Kramer, director of the MCH Center of Excellence at Emory University, for receiving the ASPPH Teaching Excellence Award! The award recognizes faculty who are outstanding in teaching and mentoring students toward distinction in public health research, teaching, and practice. The award is given annually to a full-time faculty member from an ASPPH-member, CEPH-accredited school or program of public health.
Susan Horky, LCSW, Receives an MCHB Director's Award
Congratulations to Susan Horky, LCSW for receiving a MCHB Director's Award during the Title V AMCHP Partnership Meeting on February 18, 2021.
Susan earned this prestigious recognition as a result of her longstanding dedication and support for children and youth with special health care needs (CYSHCN) in Florida, specifically as related to pediatric pulmonary and sleep health, as well as her outstanding commitment to interdisciplinary training across the maternal and child health (MCH) workforce.
Throughout her career, Susan has been actively engaged in developing the next generation of MCH leaders through the Pediatric Pulmonary Centers (PPC) program, advancing shared goals around interdisciplinary training, family leadership and promoting diversity on the MCH workforce. In particular, she has been a leader in advancing systems for children and youth with Cystic Fibrosis (CF), a thought leader on transition care for CYSHCN, and an advocate in promoting models of interdisciplinary, culturally competent, family-centered care in Florida, throughout the region, and in the national arena.
Susan Horky recently retired as the PPC co-Project Director and Social Work Faculty at the University of Florida (UF) where she served in this role since 1998. Under her leadership, the UF PPC trained approximately 180 long-term trainees, 1,300 medium-term trainees, and 650 short-term trainees.
Susan was the driving force behind the creation of Making Lifelong Connections (MLC), a national trainee-focused conference that connects current and former MCH trainees across programs, leveraging their impact for the vulnerable population they serve. MLC have evolved into a training program-wide conference, now in its 11th year. Under her leadership, UF's PPC demonstrated commitment to developing and strengthening leadership for Florida's system of care for children with special healthcare needs.
MCHB recognizes Susan Horky for her career-long commitment to training an interdisciplinary and culturally competent MCH professionals and leaders in support of our nation's mothers, children, and families.
PMHCA Programs Support Children with ASD/DD and Their Families
The Pediatric Mental Health Care Access (PMHCA) Program promotes behavioral health integration into pediatric primary care using telehealth. State or regional networks of pediatric mental health teams provide tele-consultation, training, technical assistance, and care coordination for pediatric primary care providers to diagnose, treat, and refer children with mental and behavioral health conditions, including Autism Spectrum Disorder and other developmental disabilities (ASD/DD).
NC-PAL Intellectual/Developmental Disability Program
Pediatric Mental Health Care Access Program - The North Carolina Psychiatry Access Line (NC-PAL)
Even when children and young adults with intellectual/developmental disabilities (I/DD) are connected to a primary care medical home, there are often unmet needs and confusion about how to best provide the medical and mental health care needed by these individuals and their families. Family members of individuals with I/DD in North Carolina and nationally report high levels of frustration with health care and IDD system navigation.
NC-PAL I/DD is an extension of the North Carolina Psychiatry Access Line (NC-PAL) Program, which offers provider-to-provider consultation to the primary care workforce around pediatric and perinatal behavioral health needs. NC-PAL I/DD is a partnership between Duke University Department of Psychiatry, North Carolina Systemic Therapeutic, Assessment, Resources and Treatment (NC START START), University of North Carolina at Chapel Hill Department of Pediatrics, and the Carolina Institute for Developmental Disabilities (CIDD).
The goals of NC-PAL I/DD are to:
- Provide telephone-based psychiatry consultation to Primary Care Providers and behavioral health teams caring for individuals from 3 to 22 years of age.
- Offer education around identification of local behavioral health resources, educational advocacy, linkage to vocational rehabilitation, information on guardianship and supportive decision making, as well as guidance on screening forms and referral processes.
- Implement multi-modal evaluations of children with complex needs by a multidisciplinary team including a psychiatrist, pediatrician, psychologist, and neurologist through partnership with NC START.
- Incorporate family partners with lived experience who are able to provide expertise in care navigation.
- Compliment reactive telephone consultation and education with proactive case identification using administrative data to identify practices and providers serving children with I/DD diagnoses that might benefit from consultation.
Exploring ASD through the Lenses of Lived Experience
Delaware Child Psychiatry Access Program
The Delaware Child Psychiatry Access Program (DCPAP) funded by HRSA under the Delaware Department of Services for Children, Youth and Their Families' (DSCYF) Division of Prevention and Behavioral Health Services (DPBHS) hosted a 2 part training series in cooperation with the School of Education and the Center for Disabilities Studies with the University of Delaware. Presented by: Mark S. Borer, MD, Brian Freedman, PhD, & Sarah B Mallory, PhD
Autism Spectrum Disorder (ASD): Presentation, Best Practice and the Parent Perspective (archived training session part 1) provided an overview for primary care providers, behavioral health and education professionals around the prevalence and core characteristics of ASD and sensory processing differences. Participants were introduced to screening and diagnostic measures, evidence-based practices, national and local resources. The parent perspective provided the need to consider the person beyond the diagnosis, the benefit of parent participation in treatment planning and the rationale for real life applicability of best practices and interventions when supporting patients and families.
Autism and Mental Health (archived training session part 2) encouraged participants to utilize current prevalence rates of common mental health challenges among people with ASD when evaluating patients and families. Identification of symptoms and characteristics of mental health challenges among people with ASD aided in determining potential comorbid diagnoses and treatment options. Providing the perspective of a young adult diagnosed with Autism and additional mental health needs, illuminated the broad spectrum that is ASD and frequent comorbidities. This session helped providers consider the common challenges faced by people with ASD and their families during the diagnosis and treatment process.
Mallory, S.B., Freedman, B., Borer, M., and the Center for Disabilities Studies Team. (2021). Autism Spectrum Disorder: Presentation, Best Practice, and the Parent Perspective. Delaware Child Psychiatry Access Program Training Series.
Freedman, B., Borer, M., Mallory, S.B., and the Center for Disabilities Studies Team. (2021). Autism and Mental Health. Delaware Child Psychiatry Access Program Training Series.
Consultation Line Supports Mental Health Care in Kansas Youth with Autism
KSKidsMAP – A Pediatric Mental Health Care Access Program
Psychiatric symptoms in people with Autism Spectrum Disorder (ASD) diagnosis have often been attributed to autism rather than to a distinct psychiatric disorder. Evidence indicates that people with ASD experience depression at rates four times greater than the general population, and that other mental disorders are also common. Research shows treatment interventions effective for psychiatric disorders are also effective, albeit when modified, for people with ASD.
Kansas Kids Mental Health Access Program (KSKidsMAP) is a recipient of HRSA's Pediatric Mental Health Care Access Program grant. KSKidsMAP increases primary care practitioners' (PCP) capacity to identify and treat behavioral health conditions through various supports including a toll-free Consultation Line. Two case consultations received by the KSKidsMAP team illustrate the impact expert consultation recommendations can have for effective treatment of psychiatric symptoms in patients with ASD.
Following COVID-19 related school shutdowns, KSKidsMAP received a call from a PCP concerning a patient with ASD. Prior to the pandemic, the patient had done well with home and school supports and had no history of psychiatric illness. Inability to attend school caused significant distress requiring multiple psychiatric hospitalizations and psychotropic medications. Her PCP consulted KSKidsMAP for recommendations regarding next steps in management. Follow up with the child's PCP revealed that the patient had improved significantly with increased school-based resources and was able to titrate down on the psychotropic medications.
A second case highlighting the synergy between KSKidsMAP and a PCP managing a child with autism involved an adolescent who had been recently diagnosed with ASD. This patient presented with exacerbation of a tic disorder and a co-occurring anxiety disorder in addition ASD. Recommendations were provided for tic focused cognitive behavioral therapy, medication interventions and school and community resources.
The increasing prevalence of the ASD diagnosis and shortage of specialists requires PCPs to care for many of these patients in their own practices. The KSKidsMAP Pediatric Mental Health Team has expertise in treating ASD allowing for evidenced based, interdisciplinary advice to PCPs on biopsychosocial interventions for children and adolescents with ASD and co-occurring psychiatric disorders, further improving access to quality care for this patient population.
Healthy farm share grocery boxes provided for early childhood center students and families experiencing food insecurity during the COVID-19 pandemic in Northern Manhattan
Healthy Tomorrows Partnership for Children Program New York Presbyterian Hospital Choosing Healthy and Active Lifestyles for Kids (NYP CHALK JR)
The community of Northern Manhattan was hard hit by the COVID-19 pandemic and its economic fall-out. When NYP CHALK Jr's early childhood center partners closed their doors to observe COVID-19 precautions, we worked with our wellness champions at each site to continue supporting young children and families as the community's needs and priorities changed. In partnership with Corbin Hill Food Project and West Side Campaign Against Hunger, we provided healthy grocery boxes monthly to 211 families between April and December 2020. We began with a central distribution at a community center, and then launched an onsite distribution at Rena Day Care Center, training Rena's staff to screen for food insecurity and run a safe, appointment-based emergency food distribution program. The success of this initiative stems from the clinical-community partnerships built through the Healthy Tomorrows Partnership for Children Program. Our CHALK Jr food insecurity response will continue into 2021.
Maine Pediatric and Behavioral Health Partnership
Maine Pediatric and Behavioral Health Partnership (MPBHP) is a recent recipient of one of HRSA's grants to develop a Pediatric Mental Health Care Access (PMHCA) Program in the state of Maine.
The Mission of MPBHP is to educate, support and empower pediatric care providers through training and ongoing web-based and telephonic consultations with behavioral health providers, thereby improving access to behavioral health expertise for children and families.
The vision of MPBHP is to foster, support, and enhance the children's behavioral health system of care throughout Maine, especially in rural and medically underserved areas.
MPHBP addresses current and emerging MCH workforce needs by engaging with and providing support to pediatric clinical providers by increasing timely detection, assessment, treatment, and referral of children and adolescents with behavioral health disorders in pediatric care settings; by improving access to behavioral health care for children and adolescents, especially in rural and underserved areas; by increasing knowledge of pediatric behavioral health through continuing education/ training and resources for healthcare providers; by increasing access to resources for families and communities and by sustaining strategies and interventions that are effective in improving practice.
Capacity Building Coaches Hone Skills with Motivational Interviewing Training
Adolescent Health Initiative, Midwest Adolescent Health Project (Building the Capacity for Adolescent-Centered Health Care in Rural Communities in HHS Region V)
Most people are familiar with Motivational Interviewing (MI) as an approach for helping clients or patients strengthen their motivation for change. The team at Michigan Medicine's Adolescent Health Initiative (AHI) has often encouraged staff and providers who participate in their Adolescent-Centered Environment Assessment Process (ACE-AP) to use MI skills. The goal is to create supportive environments that allow youth to disclose risk behaviors and then improve their commitment to change. However, the team found themselves wondering if these same MI skills could support them as capacity building coaches when working with health center staff on making adolescent-centered changes to their clinics.
Working with a certified trainer from the Motivational Interview Network of Trainers, the AHI team, along with the recently-trained ACE-AP coaches from the Midwest Adolescent Health Project , participated in an 8-hour training to hone and adapt Motivational Interviewing skills for their work with health centers participating in the ACE-AP. Coaches found that many of the MI skills were a perfect fit for their work. Strategies like maintaining a spirit of collaboration, compassion, acceptance and evocation; asking open-ended questions, affirming, reflecting and summarizing; and identifying change versus sustain talk, among many others. The whole experience encouraged the coaches to explore how to better support and motivate their ACE-AP sites who, in turn, will provide even better care to adolescent patients. To learn more about the Midwest Adolescent Health Project please visit AHI's website .
Building a Professional Cohort to Tackle Indiana's Maternal and Child Health Needs
Indiana University School of Public Health MCH Catalyst Program Trustees of Indiana University - Dr. Cecilia S. Obeng (PD)
The Program has awarded diverse student fellowships, which has enabled the students to take the MCH Foundational course. The MCH program faculty, led by the Program Director, Professor Cecilia Obeng, has developed MCH courses as part of a proposed Graduate Certificate curriculum. The Foundational course has been designed to meet the requirements of the new Maternal and Child Health concentration within our School of Public Health.
Our graduate students have expressed delight about the course content of this new MCH concentration, given its professional and academic importance. The students' interests range from sudden infant death syndrome (a leading cause of infant mortality in the US), to maternal mortality, maternal and child well-being immediately after birth, immigrants' health, as well as breaking down the stigma of trauma and other experiences that contribute to mental health.
Professor McCluskey, a Senior Program personnel, has developed a course on Violence against Women; this course highlights the important topic of gender-based violence and how this influences women's health across the life-course. This important MCH course also provides information on other forms of violence, such as female-selected infanticide, intimate partner violence, and femicide. Furthermore, the course extensively covers and interrogates the impact of violence on women's reproductive health, physical & sexual health, as well as mental health.
These curricular developments are significantly important, given that they have collaborative support from other Title V programs via the provision of guest lectures and experiential learning opportunities to better prepare the next generation of MCH professionals. Our courses are designed and delivered with an exclusive objective of giving student trainees essential research skills and professional knowledge that will help them acquire expertise in cultural congruency to enable them to become successful upon completion of their training. Thus, our curriculum is customized to give student trainees the needed skills to meet the challenges faced by the MCH population in the 21st Century.
Harvard Center of Excellence Students Apply Real-World Evaluation Training to National Indian Health Board
Harvard University MCH Center of Excellence
Each year, Harvard University's MCH Center of Excellence conducts a winter session Program Evaluation course run in collaboration with the Centers for Disease Control and Prevention (CDC), and the Association of Maternal and Child Health Programs. The course provides students and staff of state health departments with a short course in program evaluation and reward them with valuable real-world experience and training at various public health agencies.
In 2020, the National Indian Health Board approached the CDC with a research proposal for a tribally led Maternal Mortality Review Committee (MMRC). The idea stems from a few shortcomings in the traditional MMRC model as applied to American Indian and Alaska Native (AIAN) communities. Most MMRCs are hosted by individual states, and the boilerplate model lacks sufficient attention to cultural practices, historical traumas, and social determinants of health of AIAN communities. Two students from the Harvard T.H. Chan School were matched with the team of the National Indian Health Board. Guided by a respect for tribal sovereignty and the diversity, values, and histories of tribal communities, the students proposed a three-part logic model for establishing, developing, and ensuring the long-term sustainability of tribally-based MMRCs. The model holds the values of respect for tribal sovereignty and respect for tribal diversity, history, and traditions central to its functioning, such that the logic model for tribally-led MMRCs depends on them. It leaves space for iterative change, such that it can grow with changing social, political, and environmental dynamics. Implementation for the evaluation proposal will be initiated and supported by NIHB. This project is made possible by a combination of funding and support from the Maternal and Child Health Bureau Title V grants and the CDC. The aim of this evaluation model is to reduce AIAN mortality and morbidity resulting in healthier communities overall.
Maryland Behavioral Health Integration in Pediatric Primary Care (BHIPP)
Telepsychiatry Access Program
Established in 2012, Maryland Behavioral Health Integration in Pediatric Primary Care (BHIPP) is a statewide program funded by the Maryland Department of Health that supports pediatric primary care providers in addressing and managing mental health concerns. BHIPP offers telephone consultation, resource and referral networking, a variety of training and educational opportunities, and social work co-location in primary care practices in collaboration with Salisbury University and Morgan State University.
As a recipient of a HRSA Pediatric Mental Health Care Access (PMHCA) Program grant, BHIPP launched Maryland Behavioral Health Integration in Pediatric Primary Care Telepsychiatry Access Program (BHIPP TAP). The goal of BHIPP TAP is to increase the availability and accessibility of pediatric behavioral health treatment through the following activities:
Telemental Health Services including telepsychiatry evaluation and medication management, tele-counseling, and care coordination services via secure videoconferencing.
BHIPP TeleECHO to deliver monthly specialized interactive, web-based training and technical assistance to both primary care providers and mental health specialists statewide using the ECHO model™.
Partnership with Mental Health Association of Maryland (MHAMD), Maryland's only volunteer nonprofit citizens organization bringing together consumers, families, professionals, advocates, and concerned citizens for unified action in all aspects of behavioral health. Through this partnership, MHAMD and BHIPP have developed and distributed Telemental Health Fact Sheets for providers, families, and teens/youth that are available for download in both English and Spanish (see below).
BHIPP hosts monthly Resilience Break webinars aimed at promoting provider resiliency and we continue to identify topics and collaborate with local partners, including our local Maryland AAP Chapter, to meet the needs of primary care providers statewide. Additional resources specific to the COVID-19 pandemic can be found on our website .
Michigan Department of Health and Human Services, Michigan Child Collaborative Care- Connect
MC3-Connect Partners with the Michigan Chapter of the American Academy of Pediatrics to Train Primary Care Providers on Screening for Suicide in Youth
The Michigan Child Collaborative Care Program (MC3) provides access to mental health consultation for primary care providers (PCPs) treating children, youth and perinatal women. In 2018 the Michigan Department of Health and Human Services was awarded a Pediatric Mental Health Care Access Program expansion grant to expand the services provided by MC3 to the rural Upper Peninsula and Thumb Region, and school-based Child and Adolescent Health Centers. One goal of MC3-Connect is to enhance provider capacity for screening. To address this goal, MC3-Connect partnered with the Michigan Chapter of the American Academy of Pediatrics to offer virtual Adolescent Mental Health and Suicide Prevention Trainings to pediatricians, nurse practitioners, physician assistants and medical assistants. Trainings included information on how to screen for behavioral health and substance use in youth (i.e., depression, anxiety, alcohol use, and suicide risk). There were 71 total participants across six trainings. Two trainings occurred in the Upper Peninsula and four trainings occurred in the Thumb region. Groups ranged from 7 to 20 participants. Participants were eligible for 20 performance improvement Continuing Medical Education credits, and 25 Maintenance of Certification credits.
MC3-Connect is Educating the "Next Generation" of Primary Care Providers.
The Michigan Child Collaborative Care Program (MC3) provides access to mental health consultation for primary care providers (PCPs) treating children, youth and perinatal women. In 2018 the Michigan Department of Health and Human Services was awarded a Pediatric Mental Health Care Access Program expansion grant to expand the services provided by MC3 to the rural Upper Peninsula and Thumb Region. Part of this expansion includes establishing a partnership between the University of Michigan, Michigan State University, and the Michigan Department of Health and Human services. Within this partnership, Michigan State University partners Zakia Alavi, MD, and Jane Turner, MD, have taken on the lead of educating the "Next Generation" of primary care providers on topics related to pediatric behavioral health.
Boston LEAH faculty at Boston Children's Hospital and the Harvard Chan School of Public Health Create Online Education for Primary Care Providers to promote Early Detection and Prevention of Eating Disorders (ED's) through the Strategic Training Initiative for Prevention Eating Disorders (STRIPED): A Public Health Incubator
Bryn Austin, ScD
STRIPED Principle Investigator
Boston Leadership Education in Adolescent Health (LEAH) Faculty
Boston LEAH faculty Bryn Austin, ScD, Kendrin Sonneville RD, ScD (LEAH graduate and faculty, now at U Michigan), Tracy Richmond MD, MPH (LEAH graduate and faculty), and colleagues have created a national resource for research, education, and policy. STRIPED spans the Harvard T.H. Chan School of Public Health (HCSPH) and Boston Children's Hospital LEAH program and AYA Division and provides TA, curricula, and grants to faculty and trainees, universities, health departments, and professional societies to prevent eating disorders. STRIPED faculty train health professionals and students in public health approaches to eating disorders prevention across SES and racial/ethnic groups and work with clinical faculty on the early detection of ED's in primary care practices and lessening weight stigma. Over the past several years, there has been a growing call for clinical training for pediatric primary care providers focused on how to recognize the signs and symptoms of eating disorders in children, adolescents, and young adults, as well as how to perform screening and appropriately refer patients to specialized care. To answer this call, STRIPED has created a free online education program for clinicians in primary care settings. Drs. Sara Forman (LEAH faculty and Clinical Chief) and Holly Gooding (LEAH graduate and previous LEAH faculty, now Section Head of Adolescent Medicine at Emory University School of Medicine) teamed up to create the webinar which is offered in 2 modes – a one hour webinar and an 8 week course, with spaced questions.
Building Capacity to Improve Pediatric Asthma Outcomes in Urban, Under-resourced Communities
ECHO-Chicago at the University of Chicago, a Healthy Tomorrows Grantee
Extension for Community Health Outcomes - Chicago (ECHO-Chicago) is an innovative workforce development model that aims to improve access to high quality primary care and reduce health care disparities in underserved communities. Using Zoom, ECHO-Chicago creates a virtual space for community-based primary care providers and subject matter experts (in our case: pulmonologist, nurse practitioner, case manager, and patient family member) from academic medical centers to learn from each other and discuss practical strategies for implementing evidence-based practices. Unlike a webinar, providers actively participate by presenting their own deidentified patient cases on which they receive "telementoring" from their peers and subject matter experts.
With support from the HRSA Health Tomorrows program, since 2016 ECHO-Chicago used this model to build community capacity to better address complex pediatric asthma. It started with a 12-session series for health care providers that builds skills in asthma diagnosis, treatment, symptom control, and management of co-morbidities. To date, this program has trained nearly 100 providers from more than 70 health clinic sites. We have observed a significant increase in provider self-efficacy post-series as compared to baseline (average increase of 0.7 points on a 7-point Likert scale; p<0.0001). Providers have also self-reported changes they have made to their practice as a result of participating, including:
- Paying greater attention to home/environmental factors
- Assessing and re-assessing patient inhaler technique at each visit and increasing patient education
- Using the Asthma Control Test (ACT) to monitor disease progression
- Ordering spirometry and pulmonary function tests (PFTs) more often
- Increased use of asthma action plans
This past year, with funding from the Coleman Foundation, ECHO-Chicago expanded training to families with children living with asthma. Co-led by a pulmonary nurse practitioner and community health workers, the 7-session pilot series focused on building the knowledge and skills of parents and caregivers to manage asthma attacks, recognize environmental triggers, understand asthma medications, and dispel common asthma misconceptions. Participants self-reported key takeaways: learning how to keep their child calm during an asthma attack, how to use different asthma medications, and green cleaning. Using lessons learned from the pilot, we plan to train a second group in 2021.
Delivering Integrated Team Care to Positively Impact the Lives of Transition Age Youth
The Achievable Foundation, a Healthy Tomorrows Partnership for Children Program
The Achievable Foundation's Whole Person Care Project (WPCP) focuses on delivering behavioral health services integrated into a primary care setting in order to address the mental health, physical health and social-emotional needs of children, youth and young adults. The WPCP targets underserved children and youth in Los Angeles County, with a special emphasis on the most vulnerable transition age youth (TAY) living with intellectual and/or developmental disabilities (I/DD). Through this project, children, youth and young adults have access to a multidisciplinary care team, which includes primary care physicians, therapists, a psychiatrist and care coordinators, who work together to address and treat patients in a whole-person manner. The multidisciplinary team also works with a patient's social and educational support team members to help ensure a patient is successful and independent in all domains of their lives. This team-based care model is especially important for TAY with I/DD who traditionally face significant challenges with transition into adulthood and independence, including higher rates of anxiety and mental health issues.
An example of how the WPCP has positively impacted participants is that of James English (name changed for privacy). James, a TAY patient of the WPCP for several years, lives with Autism Spectrum Disorder and receives services from the local regional center (a state contracted agency providing case management and social supports to individuals with I/DD). James struggles with anxiety, problems with self-esteem and interpersonal relationships. He is generally independent, and receives weekly support to ensure his health and safety. In the past, James has experienced an aversion to completing medical treatment, such as having laboratory work done, and he has struggled with getting access to mental health services for his unique needs.
Since joining the WPCP, James has made significant positive progress. The care team has utilized desensitization and other special techniques to help lower James' anxiety levels with regards to medical care, and ensure that he receives the care he needs to stay healthy. Further, for the past 9 months, James has been receiving cognitive behavioral therapy. James' treatment goals are to decrease symptoms of anxiety, increase his level of independence, and learn skills to build healthy relationships. James' progress is continuously monitored by the interdisciplinary WPCP care team and his regional center support team. Recently, James was accepted to the local 4-year California State University. The first semester was difficult for James because he experienced decreased self-esteem as he was confronted with the ways in which his learning style is different. Nonetheless, with ongoing therapy and support through the WPCP, he overcame these challenges and is continuing on to the next semester. With help through this transition, and a care team to support his health and growth, James hopes to one day achieve his dream of becoming a video game programmer. James is naturally mechanically and technically savvy, and we are confident he is on his way to achieving his dreams.
Dr. Donna Strobino Recieves the Zena Stein and Mervyn Susser Award for Lifetime Achievement
Dr. Donna Strobino, associate director of the Bloomberg School of School of Public Health's Center of Excellence in Maternal and Child Health Education, Science, and Practice; and director of the MCH Epidemiology Training programs, was awarded the Zena Stein and Mervyn Susser Award for Lifetime Achievement at the 2020 CityMatCH Leadership and MCH Epidemiology Conference. Congratulations, Donna, and thank you for your contributions to maternal and child health!
Dr. Savithri Nageswaran Receives the 2020 Calvin (C.J.) Sia Community Pediatrics Medical Home Leadership and Advocacy Award
Dr. Savithri Nageswaran, Project Director for the Healthy Tomorrows-funded Community-based Pediatric Enhanced Care Program at Brenner Children's Wake Forest Baptist Health, is the 2020 recipient of the AAP's Calvin (C.J.) Sia Community Pediatrics Medical Home Leadership and Advocacy Award! Named in honor of Calvin C. J. Sia, MD, FAAP, this award honors pediatricians who have advanced the medical home through practice and advocacy, especially for children with special health care needs.
A Synergy of Strengths – Title V collaboration with DMCHWD in Nebraska
NEP-MAP Nebraska Partnership for Mental Healthcare Access in Pediatrics Nebraska Department of Health and Human Services, Division of Public Health
Nebraska Department of Health and Human Services was a successful applicant for the DMCHWD Pediatric Mental Health Care Access Program in 2018 – with Nebraska's Title V agency leading project direction and management. Today, the University of Nebraska Medical Center Munroe Meyer Institute delivers a clinical demonstration project and the behavioral health expert team. Yet the scope of NEP-MAP (the Nebraska Partnership for Mental Healthcare Access in Pediatrics) is much broader than the clinical demonstration project alone.
With Title V as lead agency, NEP-MAP is grounded in strong principles of equity, family-centered care, inclusion, and systems change. A large statewide Systems Advisory Committee, which includes family members and family advocates as equal and respected partners along with all others, meets quarterly. The advisory committee helps ensure that NEP-MAP activities don't occur in a silo. NEP-MAP promotes integration and alignment with other system efforts and resources – in order to make a greater and more lasting positive impact on outcomes in the population.
The NEP-MAP Systems Advisory Committee is also home to several Technical Workgroups that draw specifically on the expertise of partners across the state to advance project goals and objectives. In the area of Screening, a common agenda exists to increase screening and referrals in both community and clinical settings, using standardized and normed instruments that are culturally- and linguistically-appropriate for family members. One of the NEP-MAP Technical Workgroups produced a Screening and Referral Guide, which takes a life course approach to screening for mental well-being among children, youth, and their parents/caregivers. NEP-MAP, working with the clinical project partners and behavioral health consultants, also delivers training in behavioral health to primary care providers in rural and underserved areas of the state, in both clinical and community settings.
Title V has identified mental health topics affecting MCH populations in Nebraska as priorities in each of the last three five-year statewide needs assessment cycles, in the form of maternal depression, youth suicide, early childhood development, and/or access to mental and behavioral health services for children with and without special health care needs. Title V has long been engaged in workforce development projects. Heading into late 2020, the need for "all hands on deck" in terms of helping address mental health needs as they impact MCH populations has never been so immediate and visible.
Nebraska Title V continuously delivers training and professional development to licensed health care professionals, to the Community Health Worker workforce, and to youth-serving professionals from across education and health sectors. Stepping into the role of delivering workforce development in order to increase the capacity of primary care providers to screen, refer, and treat children and youth with mild to moderate mental health conditions was a natural and important collaboration for Title V.
For more information contact: Kathy.firstname.lastname@example.org
Power in Partnerships
UAB Pediatric Pulmonary Center on behalf of the Alabama MCH Network
Former MCHB Associate Administrator Dr. Michael Lu was fond of quoting an African proverb: "if you want to go fast, go alone, but if you want to go far, go together." He used this quote often to talk about the power of partnerships in Maternal and Child Health. Alabama has been home to multiple DMCHWD grantees over time, including LEND, LEAH, PPC, MCH Nutrition, MCH Pipeline, Pediatric Access to Mental Health, Centers of Excellence, and MCH Nursing. Many years ago the grantees formed the Alabama MCH Leadership Network, with the goal of providing collaborative training, raising awareness of MCH throughout the state, and creating synergy between grantees. Network grantees meet monthly for program updates and to plan joint events, typically one trainee networking event and two seminars in each academic year. Trainees are also encouraged to rotate across project sites. In June of 2020, the COVID-19 pandemic caused the annual "Grand Rounds" visit to the UAB campus by the Alabama State University Pipeline trainees to become a virtual event. Trainees from the other Network grantees stepped up to plan and implement a well-received "virtual visit" to explore MCH careers and graduate programs. The Network maintains a joint web page . Title V collaboration extends to the state level as well. As one of the few states with the MCH and CSHCN programs housed in different state agencies, the Alabama state Title V programs began having regular collaborative meetings in the late 1990s. In the early 2000s, these collaborative efforts expanded to include all Title V funded programs in the state, including Family Voices, training and home visiting grantees, and later expanded to include representatives from partners such as the state Medicaid agency. Now held three times a year, these meetings provide an opportunity for sharing of program updates, developing professional relationships, planning collaborative work, and modeling these collaborations for trainees.
Children's Hospital Los Angeles (CHLA) Leadership Education in Adolescent Health (LEAH)
Title V Collaborative Activities
Children's Hospital Los Angeles is fortunate to have a range of interdisciplinary MCHB funded training programs, some of which have been operating for a long time and some that are brand new. These include:
- California Leadership Education in Neurodevelopmental and Related Disabilities (CA-LEND) program, which trains leaders, educates community providers, conducts research and promotes systems change to improve the health of children with, or at risk for, neurodevelopmental disabilities (funded since 1966)
- Developmental-Behavioral Pediatrics Training Program (DBP), which aims to build the capacity of professionals to evaluate, diagnose, develop and provide evidence-based interventions to individuals with autism spectrum disorders (ASD) and other developmental disabilities (funded in 2013)
- Leadership Education in Adolescent Health (LEAH) program, which provides interdisciplinary training to prepare leaders in clinical care, research, public health policy and advocacy as it relates to adolescent health (funded in 2017)
- Pediatric Pulmonary Center (PPC), dedicated to developing leaders who will improve the health of children with respiratory conditions (funded in 2020)
While these programs are based at Children's Hospital Los Angeles, they are physically housed at three different sites in the central Los Angeles area. Historically, we relied primarily on two shared faculty to keep each other current on our individual training activities. The pandemic and the pivot to virtual meetings created new opportunities for faculty collaboration and for trainees to learn together. Preliminary plans for the 20-21 training year include, but are not limited to, the following: 1) combining components of our respective leadership training for fellows across programs; 2) collaborating on diversity, equity, and inclusion (DEI) education and projects for trainees; 3) creating a community advisory board to advise all 4 programs; 4) exploring strategies to expand the diversity of trainees in the future; and 5) creating a shared forum for the final presentation of CA-LEND, DBP, LEAH, and PPC fellow projects.
Kennedy Krieger Institute Hosts Virtual Summer Research Program to Promote Health Equity
Kennedy Krieger Institute hosted seven Maternal Child Health-Leadership, Education, Advocacy, and Research Network (MCH- LEARN) scholars this summer who attended college in the Maryland and Washington, DC region. Scholars participated in virtual seminars on (1) Prevention of Health Disparities Across the Life Course using National Academy of Sciences reports as a foundation for readings, (2) Research Accountability and Design Seminars, (3) Professional Development and Advocacy Seminars, and (4) Examining CDC Winnable Battles through a Social and Cultural Lens. A mentoring team was developed for MCH-LEARN scholars that included both a researcher and professional developmental mentor during their 10-week MCH research, leadership and advocacy experience. The scholars showcased their summer MCH research projects virtually during the Johns Hopkins Career, Academic, and Research Experiences for Students (C.A.R.E.S) Symposium. Each MCH-LEARN scholar submitted their research for presentation to the Annual Biomedical Conference for Minority Students. The MCH-LEARN program is designed to prepare scholars to conduct original research and to address the social determinants of health and health disparities through research, advocacy, and practice. Below are the scholars' future career goals and research project titles.
Biostatistician: Associated Risk Factors of Language-Based Disorders in Sickle Cell Disease
Lawyer/Public Health and Equity Advocate: Everyday Racial Discrimination Experiences, Cumulative Violence, and Substance Use among Black Young Men: Moderating Effect of Masculinity Norms
Psychologist: Parenting as a Protective Factor for Youth Exposed to Violence in Adolescence
Public Health Medical Professional, Research, Advocate Doctor, OB/GYN: Comparing Apples and Oranges: Examining Developmental and Behavioral Differences Between Young Children with Autism Spectrum Disorder and Young Children with Developmental Delay Research Disparities in Health Disparities: Social Determinants of Health and Nursing Research
Neuroscience and Linguistics, Research, Academics Psychologist/Business Owner: Telehealth Satisfaction at Kennedy Krieger Institute During the SARS-CoV-2 Pandemic Translatable and Preventive Perinatal HIV Transmission Strategies
Collaborating to Improve Healthcare Transition Outcomes
The Waisman Center University Center for Excellence in Developmental Disabilities (UCEDD) at the University of Wisconsin-Madison, is the home of the WI Leadership Education in Neurodevelopmental Disabilities (LEND) Training program, and also contracts with the state's Title V Block Grant program at the WI Department of Health Services for several of the state's Children and Youth with Special Health Care Needs (CYSHCN) programs, including the WI Youth Health Transition Initiative. In 2020, two LEND trainees made significant contributions to the work of the Health Transition Initiative as part of their practicum and summer research experiences.
In May 2020, LEND graduate Kristen Crabtree, DNP, presented to over 70 members of the Health Transition Learning Community on "Supported Decision-Making: What Health Professionals Need to Know." This webinar focused on how health professionals can use a Supported Decision-Making process in their practice for youth with special health care needs to encourage independence in decision-making. A Supported Decision-Making agreement can be used as an alternative to or as a tool under guardianship. Attorney George Zaske provided a parent perspective. Kristen's presentation is incorporated into one of the modules of the Youth Health Transition curriculum for health professionals.
From May-August 2020 Kelly Kuehl, a medical student and intermediate LEND trainee at UW-Madison, completed a summer research experience through the Shapiro Scholarship Program, working with Anne Harris, WI LEND Director and Maria Stanley, Waisman Center Medical Director. The goal of the project was to determine the needs and barriers related to obtaining high quality healthcare and healthcare transition for adults with Down syndrome (DS) in Wisconsin as perceived by stakeholders within the DS and health care communities. While the original plan was to engage with the community through in-person meetings and interviews, Kelly transitioned her work to online data gathering due to COVID-19. Significant findings are being used to inform training curricula and transition outreach activities by the Youth Health Transition Initiative. These two examples represent just two of the ways in which the LEND program collaborates with the WI Title V CYSHCN programs to train professionals and improve services for CYSHCN and their families.
New York State Title V and MCH programs partner to support state's COVID-19 Maternity Task Force
University at Albany School of Public Health Maternal and Child Health Program (Maternal and Child Health Public Health Catalyst Program Grantee)
This spring, the University at Albany (UAlbany) School of Public Health's Maternal and Child Health (MCH) Program was tapped to support the state's COVID-19 Maternity Task Force by helping to review the impact of COVID-19 on pregnancy.
The task force was established in April 2020 by Secretary to the Governor Melissa DeRosa and the New York State Council on Women and Girls, and was convened to address challenges related to COVID-19 for pregnant people. Part of the task force's charge included conducting a literature review to help the task force assess the impact of COVID-19 on pregnancy and make recommendations.
Staff from the New York State Department of Health's Division of Family Health collaborated with faculty and students from the UAlbany MCH Program to complete the review, which included early published and gray literature and emerging guidelines from governmental and professional medical organizations. The Division of Family Health oversees the New York's Title V Program and is a longstanding partner of the MCH program.
The team presented a summary of its preliminary findings in a webinar with the state's regional perinatal centers in May. A copy of the early review and other COVID-19 resources are available on the NYS Perinatal Quality Collaborative website .
The University of Florida Pediatric Pulmonary Center, Gainesville FL
University of Florida Pediatric Pulmonary Center (UF PPC) and the Florida Department of Health Children's Medical Services Title V Office of Children and Youth with Special Health Care Needs (FL DOH CMS) Collaboration: The Florida Family Leader Network (FFLN).
The FFLN is a collaboration between the Florida Network of MCHB programs and the FL DOH CMS and is coordinated by the UF PPC.
The Florida MCHB network, which includes the UF PPC, University of Miami Mailman Center on Leadership and Education in Neurodevelopmental Disabilities (UMLEND), the University of South Florida (USF) School of Public Health Center of Excellence in Maternal and Child Health Education Science and Practice met for their annual meeting in 2016. Representatives from FL DOH CMS and community family leaders were also in attendance. Discussions at the meeting confirmed the MCHB programs' commitment to strengthening family-professional partnerships in Florida. Family leaders expressed a desire to connect with one another as they reported often feeling isolated in their individual settings. There was consensus that family leaders needed and wanted to improve their leadership skills and the best setting for this would be in collaboration with compassionate, supportive health professionals. The FFLN emerged as an outcome of this meeting.
The goal of the FFLN is to "breakdown silos to optimize the health and wellbeing of CYSHCN." The network is a family-professional partnership comprising family/youth leaders and professionals in Florida. It currently has more than 180 members, two thirds of whom are family/youth leaders. Angela Miney, the UF PPC Family Partner, coordinates the network's activities. Members connect via a private Facebook group and listserv. Webcasts sponsored by the FFLN include topics on supported decision making, advocacy, and patient and family-centered care.
Since 2018, the FFLN has met for an annual summit which fosters the goals of networking and leadership development. The 2020 virtual summit "Developing Partnerships" had over 130 participants, with sessions on "Resonant Leadership", "Friendship in the Time of COVID'" and "Family Youth Engagement". For more information visit the FFLN website .
Georgia State University's Partnerships with the Georgia Title V Program
Center for Leadership in Disability, Georgia State University, Leadership Education in Neurodevelopmental Disabilities
The Center for Leadership in Disability (CLD) at Georgia State University (GSU) collaborates with Georgia's Title V program across five different initiatives under their Children and Youth with Special Health Care Needs (CYSHCN) and home visiting programs. Beginning in 2015, GSU and the Georgia Leadership Education in Neurodevelopmental Disabilities (GaLEND) program began supporting Georgia's Title V CYSHCN program on the following three projects:
- providing positive behavior support (PBS) training for Part C early intervention providers and families of young children,
- organizing Georgia's autism stakeholders and initiatives into a comprehensive plan referred to as the Autism Plan for Georgia , and
- supporting an annual Autism Conference & Expo , which brings together all of Georgia's autism stakeholders to learn from and network with each other.
Through the PBS project, GSU has provided nearly 600 in-home coaching sessions to families in Part C on the use of PBS with their young children. We have trained over 100 families on PBS in small-group trainings, and we have trained 1,358 Part C Early Intervention providers on the use of PBS in the homes. The annual Autism Conference & Expo has provided professional development and networking in the area of autism policy, advocacy, and supports to over 3,000 registrants over the past five years. The GaLEND trainees support all of the Title V CYSHCN projects and they report the value of their experience. For example, one social work trainee noted:
"As a social work trainee, I had the opportunity to participate in multiple positive behavior support trainings for families. In addition to providing me with helpful strategies that I could use with families, this experience also provided insight into the diverse job responsibilities of social workers. This project allowed me to observe a licensed master social worker provide didactic trainings and individual consultation with families, develop curricula and resources, collaborate with local and state partners, and participate in a research study. Lastly, by traveling throughout Georgia, I became more aware of the gaps in services and various struggles that families were experiencing daily."
In 2019, GSU partnered with Georgia's home visiting program to evaluate the use of the Learn the Signs.Act Early (LTSAE) and Talk With Me Baby (TWMB) curricula within home visiting settings. GSU has engaged 12 home visitors and 31 families in the use of LTSAE and TWMB. In 2020, GSU and Georgia's Part C program began a five-year partnership to rebuild Georgia's Early Childhood Intervention Comprehensive System of Personnel Development. Through this new initiative, GSU and Georgia's Part C program will support the following activities: (a) creating a Part C leadership program; (b) creating an early childhood higher education consortium; (c) building a scholarship program for Part C providers; and (c) increasing the early childhood intervention content in Georgia's university training programs.
KSKidsMAP: Pediatric Mental Health Care Access Program
KSKidsMAP staff embarked on a (pre-COVID) trip across Kansas! The team met with physicians and clinicians in rural Northwest Kansas to share information about the Pediatric Mental Health Care Access program. The trip resulted in the enrollment of primary care providers in 15 of the 21 counties in the Northwest Kansas region.
Healthy Tomorrows: The East Side Community Center: A Hub of Health and Empowerment for Youth
2019-YWCA's East Side Community Center, New Britain's East Side residents, and Central Connecticut State University's Community Art class collaborate to paint a mural on a prominent retaining wall located at 600 East Street as part of a civic engagement project to improve walkability and revitalize the neighborhood.
Turn 2 Us: New York Presbyterian Hospital Healthy Tomorrows Partnership for Children Program
This academic year, Turn 2 Us at New York Presbyterian Hospital served 675 students and teachers in Northern Manhattan through in-class mindfulness exercises that promote positive mental well-being and academic success among youth. The Turn 2 Us program is supported by a Healthy Tomorrows Partnership for Children Program grant.
Congratulations to Kelsee Torrez, winner of the 2020 AMCHP Emerging MCH Professional Award for Region VII
Kelsee Torrez, Behavioral Health Consultant in the Kansas Department of Health and Environment, Bureau of Family Health
Kelsee currently serves as the Project Director for the HRSA Screening and Treatment for Maternal Depression and Related Behavioral Disorders and the Pediatric Mental Health Care Access programs. Kelsee also supports the development, implementation, and coordination of programmatic activities within Title V Maternal and Child Health programs related to behavioral health. Kelsee previously worked for the Single State Agency that oversees both mental health and substance use prevention and treatment services in Kansas. Kelsee served as the Project Director for a program that supported the wide-scale operation, expansion, and integration of the System of Care approach to improve behavioral health outcomes for children and their families. Her previous work experience also includes providing care coordination for women offenders with mental health and substance use disorders, pregnant, and/or disabled as they were releasing from the state correctional facility.
University at Albany School of Public Health's Public Health Live! Webcast Wins 10th Telly Award
The University at Albany School of Public Health has received a Bronze Telly Award for its Public Health Live! Webcast, "Raising Community Voices to Reduce Maternal Mortality." The episode was a collaboration between the UAlbany Maternal and Child Health program, and the New York State Department of Health Division of Family Health.
Missouri Child Psychiatry Access Project Uses Quality Improvement to Improve Consultations
Missouri Child Psychiatry Access Project (MO-CPAP) is a Pediatric Mental Health Care Access program awardee that provides same-day telephonic consultations with a child and adolescent psychiatrist to enrolled pediatric primary care providers (PCPs). MO-CPAP has five child and adolescent psychiatrists (CAPs) to field consultation calls. A consultation implies a one-time conversation to deliberate and discuss the particular information of a case at hand.
As utilization has grown over the past two years, pediatric PCPs have increasingly made multiple calls for support for the same patient. However, the CAP may not have fielded the original call and therefore have no background on the previous consultation. MO-CPAP staff recognized the opportunity for quality improvement in tracking follow up calls and thereby shifting some pediatric cases from the level of a single curbside consultation to a process of ongoing collaboration.
Staff identified points during the intake call workflow for call center counselors to flag the consultation request as a follow up and provide the previous case number to the psychiatrist on call via email. With the new notification process and prior case number, the CAP was able to quickly pull previous consultation summaries from the MO-CPAP database and review notes before discussing the case with the PCP. In addition, project staff modified the CAP documentation form to capture this information, providing a way to "connect the dots" of prior calls.
The result? MO-CPAP's intake workflow and documentation structure now enables:
- The psychiatrists to easily access information from previous calls for a particular patient.
- The pediatric PCP and CAP to recognize when a call may involve a more complicated behavioral health issue.
- True collaboration with PCPs evolving over time to enable better informed treatment.
- More patients to receive behavioral health in in their own community with their own PCP, and remedy obstacles to treatment involving time, transportation and trust.
- Stronger support for patients and families facing severe diagnoses as bridging care can occur while they await psychiatric assessment and services.
Case Example: One PCP made three consultation phone calls over several months involving a female middle school student. Reported symptoms of bi-polar, depression, anxiety, and autism varied over time, as is common with adolescents. The PCP and CAPs at MO-CPAP used the new workflow and access to prior consultation summaries to review previous interventions, factor family history, consider more information on possible diagnosis, review appropriate medications and brainstorm alternative approaches. The PCP was able to establish a solid diagnosis and refer the patient and family to appropriate care and supports. This case clearly moved the MO-CPAP services from consultation to true collaboration.
Brenner Children's Hospital Healthy Tomorrows Partnership for Children Program Publishes Two Papers
This month, our team published 2 research papers highlighting different aspects of the care of children with medical complexity (CMC). Both these papers were made possible because of funding support from a Healthy Tomorrows Partnership for Children (HTPC) grant (H17MC11288; PI: Dr Nageswaran).
The Pediatric Enhanced Care Program (PECP) of Brenner Children's Hospital is an integrated complex/ palliative care program established in 2008. PECP includes a community-based care coordination model of care in 10 counties in northwestern NC, funded by 2 HTPC grants (2009 to 2020), and an Integrated Community Systems for CSHCN Grant (2011 to 2015) from HRSA. PECP's interdisciplinary team has expertise caring for CMC, a subgroup of children with special health care needs (CSHCN) with very high healthcare needs.
The first of the 2 papers, published in Home Healthcare Now and titled "Practical Needs in the Home Care of Latino Children with Medical Complexity" was led by Dr. Emily Ware (former medical student at Wake Forest School of Medicine). We analyzed the encounter logs of 70 Latino children served by PECP's two bilingual team members (a care coordinator and a patient navigator). Presence of bilingual team members enabled us to gain an understanding about the unique challenges faced by Latino caregivers of CMC. We found that caregivers of these children faced financial challenges, and had difficulties meeting the basic needs of their families and necessary medical supplies for their children. Bilingual care coordinators played a large role in addressing caregiver challenges.
The second paper, "Transitioning Children With Medical Complexity From Hospital to Home Health Care: Implications for Hospital-Based Clinicians," is published in Hospital Pediatrics. We used qualitative data obtained from a stakeholder focus group of community- and hospital-based providers (funded by the HTPC grant), and 4 focus groups of home health nurses. Good communication, specific and accurate home health orders, clinical support for home health nurses, and adequate preparation of caregivers of CMC were important in high-quality transition of CMC from hospital to home care.
Both these papers showed gaps in the current system of care for CMC, but identified potential strategies to improve care delivery for this population.
Indiana University - Training the Next Generation of Breastfeeding Educators in a Public Health School
The Breastfeeding Scaling up Project (BSP), spearheaded by Dr Cecilia Obeng is in Indiana University School of Public Health-Bloomington. The goal of the project is to provide Public Health students behaviorally oriented training that enables them to work on breastfeeding education initiatives in the State of Indiana. The project involves participants learning about ways to promote breastfeeding in various communities in Indiana, with a particular focus in African American communities, owing to disparities within this community. Students learn critical skills regarding how to perform health disparities research and complete the course with actionable knowledge to make a significant impact in disadvantaged communities. They also learn how to design and implement projects which are essential in scaling up breastfeeding in communities.
Dr. Cecilia Obeng designed the breastfeeding course (H504 Breastfeeding Practice and Policy) as a three-credit-hour course for graduate students. It combines skill-based hands-on activities and scientifically based materials to help students understand the need to encourage breastfeeding. Forty- three (43) students have taken the course so far, with many giving rave reviews about the impact of it on their professional development.
Dr. Cecilia Obeng has published a book, as well as several peer-reviewed papers with students on breastfeeding. She has also given several presentations on breastfeeding and child health with students. Selected recent publications include:
- Obeng, C.S., Foster, D. & Weinstein, M., (2019) Once a child leaves the womb, the community has to become the womb. Breastfeeding in Black Communities. Koln: Germany, Rüdiger Köppe Verlag
- Obeng, C., Dickinson, S. & Golzarri Arroyo, L (2020). Women's Perceptions about Breastfeeding, Children,7(6)
Her research team's ongoing project examines gender-based perceptions about breastfeeding in various communities.
KSKidsMAP – Strengthening Physician and Clinician Capacity for Pediatric Mental Health Care in Kansas
Of the 105 counties in Kansas, 99 are designated as mental health professional shortage areas. This leaves more than 70% of Kansas children with unmet mental health needs. Out of those 99 mental health shortage areas, 23 have primary care physicians (PCPs) filling the gap. KSKidsMAP, Kansas' Pediatric Mental Health Care Access Program, established a TeleECHO Clinic to support PCPs in their efforts. This virtual clinic that meets twice a month for case consultation and didactic learning on childhood and adolescent mental health needs in primary care settings. The TeleECHO Clinic philosophy is enhancing primary care by moving knowledge, not patients, and aims to create an All Teach/All Learn environment for PCPs to learn how to provide the best care for children and adolescents with mental and behavioral health concerns.
The KSKidsMAP pediatric mental health team facilitates the TeleECHO Clinic sessions and offers mentorship through the case-based learning, clinical discussion, and didactic learning to support knowledge in practice. Each participant has opportunity to present a case and receive feedback and recommendations from other TeleECHO Clinic participants, as well as the KSKidsMAP team. Following each TeleECHO Clinic session, the recommendations are summarized and additional resources are compiled and emailed to all session participants.
To expand upon their efforts to offer continual support and training opportunities, KSKidsMAP will soon be launching maintenance certification credit (MOC IV) projects as quality improvement strategies. This certification helps programs assess and improve the quality of patient care and processes that will lead to improved child health. MOC IV credit will be available to practitioners enrolled in KSKidsMAP for their meaningful participation in a child/adolescent depression screening quality improvement project.
Children's Hospital Los Angeles Pediatric Pulmonary and Sleep Medicine Center
The Children's Hospital Los Angeles Pediatric Pulmonology and Sleep Medicine Center (CHLA PPSMC) addresses the urgent need to train a diverse group of pediatric pulmonology and sleep medicine leaders to care and advocate for a culturally and linguistically diverse population of children and youth with special healthcare needs in Los Angeles. Through our efforts we strive to improve the healthcare of children and youth with special healthcare needs and pulmonary disease. During the COVID-19 pandemic we have transitioned many of our services to online and now are able to provide Teleheath visits making it easier than ever to obtain specialized pulmonary care in patients homes. We have extensive COVID-19 testing to allow patients to continue to have the pulmonary testing and procedures that they require.
The COVID-19 pandemic has accelerated our creation of online learning, especially for our trainees. Educational seminars online are now shared from other pediatric pulmonology programs in the nation during live and recorded sessions.
Children's Hospital Los Angeles Leadership Education in Adolescent Health (LEAH): Process Improvement at Children's Hospital Los Angeles Interdisciplinary LEAH Training Clinic
The Children's Hospital Los Angeles (CHLA), Division of Adolescent and Young Adult Medicine, Leadership Education in Adolescent Health (LEAH) program has been engaged in the development and ongoing refinement of a unique interdisciplinary clinic model that is designed to balance the training needs of graduate, pre-doctoral, and post- doctoral fellows from the fields of medicine, nursing, nutrition, psychology and social work with the goal of providing high quality care to patients seeking both primary and consultative care.
During the first three cohorts of the CHLA LEAH program, 32 long-term trainees, as well as faculty and program staff, have been engaged as providers, supervisors, and mentors in the LEAH clinic and have provided critical feedback into clinic operation. As a result, the team has implemented a series of iterative and adaptive changes to the clinic schedule, clinic flow, and care coordination to (1) improve the learner experience, (2) enhance the integration and function of the interdisciplinary team (3) and improve the patient experience. LEAH faculty are evaluating the clinic model and adaptations through observation of trainees' adoption of and increased comfort with the interdisciplinary model and trainee competency self-evaluations conducted at beginning and end of LEAH trainee year. The team model that is currently being used seems particularly well-suited to the development of connection, respect, and shared values between interdisciplinary trainees; additional data analysis for year 3 of the grant are still in process.
CLINIC TEAM ADAPTATIONS:
Year 1 – Physician-Fellow led teams: Schedule templates were built around each of two Adolescent Medicine (AM) fellows, and trainees from nutrition, psychology, and social work (SW) were called upon individually as needed to provide consultation to patients, as determined by the medical fellow and discipline supervisors. Nurse practitioner (NP) students shadowed the fellows until they achieved a certain comfort level and were then called upon to see patients presenting for primary care visits.
Year 2 – Implementation of Team Approach: Fellows were divided into three interdisciplinary teams. Schedule templates were built for each team; one team included an AM fellow and an NP student, and two teams included either one AM fellow or one NP student. Typically, primary and urgent care patients were assigned to NP students, and consult patients were assigned to AM fellows. Each team also included a nutrition, psychology, and SW trainee respectively. Learners from different disciplines were encouraged to shadow each other in order to enhance both their hands-on learning, and their ability to "hand off" patients more seamlessly between disciplines.
Year 3 – Refinement of Team Approach and Addition of Clinic Coordinator: Two teams were formed, comprised of one member of each of the five core disciplines, with patients scheduled for each team. Psychology and SW trainees shared responsibility for assessing each patient using HEADDSS exam; nutrition service needs were assessed on an individual basis. A clinic coordinator/patient navigator was added to the LEAH clinic in order to assist with patient flow and communication to front office and nursing staff. A patient navigation tool was piloted in the LEAH clinic to assist patients in understanding the plan for their visit. Lastly, an interdisciplinary quality improvement project was conducted (along with the other LEAHs) to better understand the readiness of our AYA primary care patients for transition to adult care.
Year 4 – The CHLA LEAH program is currently in the planning stages and will build upon what the faculty and administrative team has learned from the first three years. As our division and institution are undergoing significant initiatives to more comprehensively embrace and integrate racial equity and anti-racism, we hope to add a more explicitly anti-racist framework and structure to our clinic and approach to care, among other potential changes.
Dr. Jean Emans, Boston LEAH PI, is recognized by Harvard for Lifetime Achievement in promoting Diversity
Dr. Jean Emans, PI of the MCHB/HRSA Boston Leadership Education in Adolescent Health (LEAH) training program, was honored by Harvard Medical School (HMS) with the 2020 Diversity Lifetime Achievement Award on June 9, 2020 via a Zoom celebration. She is the fifth faculty member (first woman) since 2001 to receive this honor. In 1968, while a second year student at Harvard Medical School (and one of 12 women in the class of 1970), Dr. Emans joined with other HMS students (including her husband, Dr. John Emans) to petition Dean Ebert to recruit substantially more black students to the next class, and to improve the health of black residents in the neighboring communities. It was April 1968 and Martin Luther King was assassinated April 4 so activism was an important part of student life. Amazingly, HMS increased the acceptance of black students from 1-2/year to 15 for the next class of 1973! Dr. Emans has continued to advocate for diversity throughout her career, including recruitment of women and minority trainees and faculty in the LEAH program, creating an Office of Faculty Development and an Office of Health Equity and Inclusion at Boston Children's Hospital, advocating for research pertaining to health disparities as well as LGBTQ issues, and creating novel mentoring programs.
Telehealth at Children's Hospital Los Angeles
Leadership Education in Adolescent Health (LEAH) Children's Hospital Los Angeles (CHLA)
In response to the COVID 19 pandemic and the need for social distancing, LEAH fellows participated in a rapid pivot to telehealth services alongside their supervisors. This provided an opportunity for the fellows to learn new clinical skills required for effective provision of interdisciplinary telehealth services to adolescents and young adults (AYA) and to address the following: (1) appointment structure, (2) confidentiality/privacy, (3) engagement, and (4) supervision.
Without the natural structure provided by an in-person appointment, patients and family members often forgot appointments or joined sessions while engaged in other tasks such as cooking meals or tending to other children. Fellows learned to clarify expectations for telehealth sessions in advance with patients/clients and families, which also meant helping caregivers to understand their role in helping their youth participate in the session and minimizing distractions during appointments. Fellows also developed a pre-clinic virtual team “huddle,” to plan visits and determine which team members would meet with each patient. This was particularly important for patients with eating disorders, who frequently need and benefit from care with each of our five core disciplines: medicine, nursing, psychology, social work, and nutrition.
Fellows discussed with patients and caregivers the specifics of their living situation, reviewed the value of privacy, and engaged in joint problem-solving to allow as much privacy as possible, given practical limitations for families sheltering at home. A chat feature of the telehealth platform allowed youth a means for confidential communications when others may be within earshot. Clinicians needed to be sensitive to the impact on client communication when others were present, even in another room.
Fellows developed new strategies to help patients and caregivers remain engaged. Patients faced with uncomfortable topics became more easily disengaged, or even walked away from the screen. Fellows learned that they needed to be more animated and creative during visits, and that communication needed to be clearer and often briefer. They also built into the sessions methods to re-engage caregivers following private conversations with youth, in order to communicate back any treatment recommendations and/or referrals for services.
Given the need to provide rapid feedback on the development of a new “virtual” clinical skillset, supervisors observed fellows throughout their encounters with patients. While this presented a new challenge to fellows (they are not accustomed to such intensive observation at their level), it allowed for a new and higher degree of exchange and interaction between fellows and faculty in regard to their clinical history taking, motivational interviewing, and intervention skills using virtual platforms.
The rapid pace of coronavirus impact on the community meant that trainees were working with a population significantly impacted by a major life event, without the opportunity to plan and carefully develop and implement the most effective health and mental health response. Trainees quickly learned strategies to help patients with a variety of responses, to provide accurate information about the pandemic, and to support patients’ and families’ ability to stay safe and cope with the challenges they were facing, and to improve the delivery of virtual care.
MCH Nutrition Leader Dr. Diego Rose, PhD, MPH, RD Honored with Sarah Samuels Memorial Award
Dr. Diego Rose, PhD, MPH, RD (MCH Nutrition – Tulane University’s School of Public Health & Tropical Medicine) received the Sarah Samuels Memorial Award for his leadership in nutrition policy. The award honors those who conduct research to inform policy, use environmental approaches to improve population nutrition and health, and work with community partners to promote social justice. His research focuses on nutrition assistance programs, food security, and the food environment. Congratulations, Diego!
University of Mississippi Medical Center Pilot Project Becomes Mental Health CHAMP During Pandemic by Expanding Statewide
Much of the groundwork for behavioral health care offered through telehealth to children in Mississippi during the COVID-19 pandemic was first laid two years ago. Child Access to Mental Health and Psychiatry Service (CHAMP), a pilot project launched in 2018 by the University of Mississippi Medical Center (UMMC), the Mississippi Department of Mental Health, and Families as Allies, is helping bridge access barriers separating families in Mississippi from the behavioral health care their children need. CHAMP is in the second year of a five-year $2.3 million federal cooperative agreement through the MCHB-funded Pediatric Mental Health Care Access Program. The project is being implemented through UMMC’s Department of Psychiatry and Human Behavior. The project works as a hotline connecting primary care providers to child mental health experts at UMMC. “Instead of waiting for an appointment with a mental health professional, a child’s primary care provider can call us,” said Dr. Dustin Sarver, assistant professor of pediatrics and a clinical child psychologist. “Within 30 minutes or less, a UMMC mental health professional is available through telehealth to consult with their physician to help that child and family.” Consults for providers include help with diagnostic clarification, medication adjustment or treatment planning.
CHAMP was originally started in medically underserved areas of the Mississippi Delta as well as in the Jackson metro area, covering 24 counties of the state. Mississippi has the lowest number of psychiatrists per capita in the nation and the third lowest ratio of behavioral health professionals to primary care providers. Of Mississippi’s 82 counties, 45 do not have a single practicing psychiatrist or psychologist.
In the pandemic’s first wave, there was a medical response, Sarver said, “but in a second wave, we will likely see increases in child abuse, trauma, anxiety, stress and worry that will call for a mental health response as well, and we are here to help.”
Involving Youth in Interdisciplinary Training and Practice: The Youth Advisory Board
The University of Alabama at Birmingham LEAH Training Program engages young people through a Youth Advisory Board (YAB) to develop clinical and community programming to foster the health and wellbeing of youth. Working collaboratively with interdisciplinary trainees, faculty and staff, YAB members have led activities like the development of messaging related to the adolescent well child visit, creation of a photo voice exhibit highlighting youth perspectives on community strengths and vulnerabilities affecting health, and youth forums addressing issues such as mental health, social justice, and community violence. Members of the YAB have been instrumental in training future interdisciplinary adolescent health professionals to be more culturally responsive. Additionally the YAB fosters leadership development for these young people and may serve as a pipeline program for interdisciplinary MCH careers.
Interprofessional Teamwork Highlighted in Study of Telemedicine Implementation in UCSF Adolescent and Young Adult Medicine Clinic
Leadership Education in Adolescent Health (LEAH)
University of California San Francisco (UCSF)
In response to the COVID-19 pandemic, the inter-professional team within the Adolescent and Young Adult (AYA) clinic at UCSF worked to rapidly transition its primary and specialty care practices to telemedicine. LEAH medicine fellow, Angela Barney, worked with medical fellows and co-authors Sara Buckelew, Veronika Mesheriakova, and Marissa Raymond-Flesch to gather reports of this transition from staff and other fellows/trainees as well as data describing the number of clinic/videoconference visits throughout the transition. Within one month, the AYA clinic went from zero videoconference visits to 97% of encounters as videoconference visits. This transition, and the crucial inter-professional teamwork that facilitated the implementation, is described in an article accepted for publication in the Journal of Adolescent Health (JAH).
The article highlights challenges faced in the implementation of telemedicine, particularly regarding confidentiality, translation of evidence based guidelines to telemedicine practice, and best practices for inter-professional communication, and how all team members participated in overcoming these challenges. Clerical and clinical supportive staff helped patients schedule and access videoconference visits for comprehensive adolescent and young adult services, including medical, social work, and nutrition services in an effort to promote physical distancing and reduce traffic between communities; thus protecting patients and staff from exposure to COVID-19. The UCSF LEAH team found that many of these services can be provided remotely. In order to continue to care for the AYA clinic’s patients during the pandemic, providers including LEAH medical fellows worked closely with clinical support staff and clerical support staff to ensure timely access and to maintain confidentiality for patients. The team continues to provide care for general AYA health, mental health, reproductive health, substance use, and eating disorders via videoconference visits augmented with in-clinic visits as needed.
- The COVID-19 Pandemic and Rapid Implementation of Adolescent and Young Adult Telemedicine: Challenges and Opportunities for Innovation
Implementing the MCH Leadership Competencies: Stories From The Field
In an effort to learn from one another and share best practices for teaching, we are continuing our series, Implementing the MCH Leadership Competencies: Stories from the Field. These stories describe how MCHB funded training programs are teaching the MCH Leadership Competencies. We hope that stories from the field will give other training programs new ideas about how to teach trainees to use and implement the Competencies Information, on how you can share your MCH Leadership Competency story, is available at the end of this story.
University of Florida Pediatric Pulmonary Center Interdisciplinary Leadership Training Program
Thank you to Susan Horky from the University of Florida, Pediatric Pulmonary Center (UF PPC) for sharing their approach to using the MCH Leadership Competencies.
Who is the target audience? PPC trainees are interdisciplinary, graduate and post-graduate health professional students, and practicing providers preparing to develop or improve community-based, family-centered health care for children with chronic respiratory diseases, such as asthma.
Susan, please describe how you are using the MCH Leadership Competencies in your program.
Several years ago, the UF PPC re-organized its Core Curriculum Leadership Seminar (Core), so that Core is now organized according to the MCHB competencies. Each 1½ hour, weekly meeting now centers on one of the twelve competencies (with an additional session to provide basics of clinical care). We also moved from our previous lecture format to a modified “flipped classroom” approach. In the approach we currently use, trainees prepare for the Core ahead of time, learning on their own (or sometimes in dyads or small groups) in preparation for Core, and the seminar itself is used for an interactive, interdisciplinary discussion on the identified competency. Trainees are provided with a list of (fewer than 10) questions that they should be prepared to discuss. They are given suggestions of what preparatory work they might do (specific articles, videos, PowerPoints to read or view) but are also given latitude to explore the internet, library or other resources on their own in order to learn.
For “Family Professional Partnerships” the UF PPC leads a collaborative, distance, two session class with the other PPCs. Trainees are grouped into inter-PPC groups. Each PPC will have already taught Family Professional Partnerships. For Session 1, trainees and faculty from the six PPCs meet and discuss Patient Engagement. Trainees are then given group assignments to complete before Session 2. They are asked to present their assignments in Session 2.
Discussions of all 12 competencies are also included during clinical discussions, informal discussions and patient-care meetings.
How do you know it has led to improvement?
The UF PPC has developed a modification of the MCH Navigator Self-Assessment. This is somewhat less detailed than the online version and is given to students in hard copy at the start and end of their traineeships. Pre-post differences are calculated. We also conduct verbal debriefs.
Who should be contacted for more information/collaboration opportunities? contact Susan Horky
To share your MCH Leadership Competency Implementation Story, please contact Rita Maldonado.
Two approaches used by the University of Wisconsin- Milwaukee MCH Pipeline Training Program to teach the MCH Leadership Competencies
Thank you to Dr. Victoria Moerchen, from the University of Wisconsin-Milwaukee (UW-Milwaukee), MCH Pipeline Training Program for sharing how the program engages trainees on interdisciplinary/interprofessional team building and communication.
Who is the target audience?
Pipeline trainees are undergraduate students from backgrounds currently underrepresented in MCH. The purpose of the Pipeline program is to educate, mentor, guide, and provide enriching experiences for these trainees to increase their interest in MCH careers.
Describe how you are working with your trainees to teach communication skills.
The UW-Milwaukee MCH Pipeline Training Program annually hosts a Community Shared Day of Learning, wherein the MCH Training Programs in Wisconsin come together and interact with community members around the theme of reducing infant mortality (in Milwaukee). Each year, the activities that are part of this event, are grounded in the MCH Leadership Competencies. This year, the focus of the student learning activities was on active listening—to be able to respectfully and sensitively relay a person’s story, so as to build trust. The MCH Leadership Competencies that were used to guide this activity were Competency 5: Communication – skills 1, 4, 5, 6 (1. Share thoughts, ideas, and feelings effectively and with cultural and linguistic proficiency in discussions, meetings, and presentations with individuals and diverse groups. 4. Listen attentively and actively. 5. Tailor information for the intended audience(s), purpose, and context by using appropriate communication messaging. Audiences can include consumers, policymakers, clinicians, and the public. 6. Demonstrate the ability to communicate clearly through effective presentations and written scholarship about MCH populations, issues, and/or services).
Describe how you are working with your trainees to teach interdisciplinary team building skills.
The UW-Milwaukee MCH Pipeline Training Program also engages students in an annual team-building and leadership retreat. This retreat functions to kick-off the final year of MCH training, which is heavily focused on leadership and team development. In addition to a Strengths Finder self-assessment and discussion, students are immersed in a high ropes team activity. The goal of this experiential learning is to have students push their comfort zones in terms of challenging themselves, AND to be restricted to moving forward only when everyone has a role in moving the team forward. The leadership competency that provides the foundation for this active learning day is “Interdisciplinary/Interprofessional Team Building,” skills 4-7 (4. Facilitate group processes for team-based decisions, including articulating a shared vision, building trust and respect, and fostering collaboration and cooperation. 5. Model curiosity about differences and appreciation for individual contributions, as these are essential to effective ID/IP teams. 6. Identify and redirect forces that negatively influence team dynamics. 7. Use shared outcomes to promote team synergy. 8. Share leadership based on appropriate use of team member strengths in carrying out activities and managing challenges.)
Student reflections after this experience are always impressive. One exemplar: “I looked at the ropes and thought I could not do this. I was afraid of heights and am not athletic. [A fellow student] reminded me of my strengths and then used hers to help me overcome my weaknesses. I went farther and higher than I had thought I could. We all pushed our limits and got there together. I learned that when you pool strengths, fear loses its voice. We were all different, but on that day, we became one. And I saw myself in a whole new light. I had no idea I could do that. Now I feel like I can do anything.”
For more information or for possible collaboration opportunities contact Victoria Moerchen.
To share your MCH Leadership Competency Implementation Story, please contact Rita Maldonado.
Boston Children's Hospital Releases a New Digital Wellness Guide for Parents and Caregivers
The Family Digital Wellness Guide, from the Center on Media and Child Health at Boston Children's Hospital, is a comprehensive handbook of essential evidence-based information, tips, and guidance for parents struggling to manage their child's relationship with smartphones, tablets, laptops, gaming platforms, and television. Organized by developmental stage from toddlers to adolescents, the guide focuses on the physical, social, cognitive, and
psychological outcomes related to media use--both the positive and negative health outcomes. Topics include social media and sleep; cyberbullying and mental health; and video gaming and aggression. The guide is freely available at and features an interactive video that walks parents through each of the guide's components. The guide is available in both English and Spanish.
Masks for MOMS
University of Illinois at Chicago Center of Excellence in MCH
Recognizing the potential harm to pregnant persons and those giving birth in Chicago and throughout Illinois from the COVID-19 pandemic, the Masks for MOMS campaign was developed by a group of Chicago and Illinois maternal and child health organizations to ensure that pregnant persons and those in labor and delivery have access to face masks at their prenatal visits, when they arrive at hospitals for delivery, and when they are discharged postpartum. Even though masks don't provide absolute protection from COVID-19, the Centers for Disease Control and Prevention (CDC) recommends all individuals wear masks to help slow the spread of illness and cities and states across the US are now requiring individuals wear masks in public places. The Masks for MOMS campaign recognizes that individuals attending prenatal care in person and those about to give birth will also benefit from the reduced stress that is likely to come from wearing a mask in their interactions with prenatal care providers. In addition, when all pregnant persons, their families, and support persons have access to masks, the health care team is protected from exposure to people with COVID-19 infection but no obvious symptoms. Masks are also important for postpartum people and their families, because when an infant and parent leave the hospital for home, protection against infection is still a priority for the new family. To learn more, visit Masks for MOMS , on the UIC CoE website.