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.email@example.com
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.
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:
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 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
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.
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 .
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 .
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:
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 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.
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.
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.
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.
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 (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:
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.
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.
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:
Her research team's ongoing project examines gender-based perceptions about breastfeeding in various communities.
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.
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.
The Children's Hospital Los Angeles (CHLA) 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.
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, 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.
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.
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!
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.”
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.
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.
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.
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.
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.
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.
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.
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 they will give other training programs new ideas for how to implement the Competencies with their trainees. For information on how you can share your MCH Leadership Competency story, please contact Rita Maldonado.
Thank you to Amy Costanza-Smith from the Oregon LEND, at the Oregon Health and Sciences University, for sharing their approach to teaching the MCH Leadership Competencies.
Who is the target audience? Oregon LEND trainees come from various disciplines and include undergraduate and graduate students, as well as practicing providers. LEND trainees are preparing to work with people with disabilities, including autism and other developmental disabilities through interdisciplinary teaming.
Amy, please describe how you teach the MCH Leadership Competencies to Oregon LEND trainees.
In the Oregon LEND program, the MCH Leadership Competencies are taught in many ways, including didactic, clinical, and via our leadership projects. In addition to the leadership projects, our training coordinators work together to explicitly integrate the competencies into our program in multiple ways:
How will you know if this plan is leading to improvement?
We are in the second year of making these changes and continue to evaluate our process. We hope to see improvement in how trainees discuss MCH competencies in their leadership projects and an increase in competency awareness both for trainees and training coordinators.
Who should be contacted for more information/collaboration opportunities? Email Amy Costanza-Smith
For over 30 years, the Healthy Tomorrows Partnership for Children Program (HTPCP) has supported innovative, community-based interventions to improve maternal and child health and access to care.
HTPCP is funded by the Division of Maternal and Child Health Workforce Development in the Health Resources and Services Administration’s (HRSA) Maternal and Child Health Bureau. A key feature of HTPCP is its collaboration with the AAP. Since 1989, public health resources at HRSA have joined with pediatric expertise in child health issues at the AAP. Pediatricians have provided care and served as project directors, advisory board members and consultants in HTPCP initiatives.
Recently, HTPCP created several case studies that highlight successes and lessons learned from projects with significant pediatrician involvement.
Empowering Mothers Initiative
Joan Jeung, M.D., M.P.H., FAAP, realized that Mongolian refugee and Burmese immigrant patients at the Asian Health Services in Oakland, Calif., had no representatives in the health care system who spoke their languages. She received funding from HTPCP to hire community health workers who provide health education, interpretation and access to support for these families.
The project has evolved to offer group well-child care visits that include in-depth support for parents and early childhood development education. The initiative also is facilitating cultural and linguistic adaptation of the AAP Bright Futures Guidelines and the Nurturing Parent Program.
Approximately 200 children and their parents have received services. Parents have reported being better equipped to provide nurturing and responsive caregiving to their children. Both parents and community health workers note that the Empowering Mothers Initiative has led to stronger peer-support networks.
According to Dr. Jeung, group well-child visits and culturally and linguistically competent health workers make the program sustainable and scalable.
House of Teens
Adolescents participating in the House of Teens program took photos of conditions in their neighborhoods that posed barriers to physical activity and healthy eating such as stores that lacked fruits and vegetables. Then, they shared their stories with elected officials and offered potential solutions. Courtesy of House of Teens.
In 2007, the House of Teens (HOT) started as an after-school health promotion and obesity prevention program in New Britain, Conn. The program is a partnership between Community Health Center Inc. and the YWCA of New Britain.
Robert W. Dudley, M.D., M.Ed., FAAP, at the Community Health Center Inc. provides care to adolescents involved in the program.
“… Every single day, I would tell people, ‘Hey, you got to get out and exercise more,’” Dr. Dudley said. “Well, one of the girls took a picture of the stinky dumpster and said, ‘This is what’s outside my front door. We don’t go outside. We can’t exercise because it’s so smelly. It just isn’t going to happen.’”
Through HOT, adolescent girls are guided to document conditions in their neighborhoods with photos (e.g., abandoned parks, convenience stores that lack fruits and vegetables) and present them to elected officials along with recommended solutions. This method, called PhotoVoice, is a key component of community-based participatory research and was used by program staff to engage the teens.
Today, through their efforts, the program has grown exponentially in scope. In addition to being a free-standing center that provides access to a wide range of health care services, it’s also a place where teens can voice concerns, work with adult partners, present solutions and see changes happen.
HTPCP funded HOT several times since it began over a decade ago.
Washington State Reach Out and Read
Reach Out and Read (ROR) is a national evidence-based early literacy program that is embedded in pediatric settings. The program promotes and models reading aloud to children at their well-child visits from 6 months to 5 years. Pediatricians stock books in their waiting rooms and often send a book home with their pediatric patients.
Jill M. Sells, M.D., FAAP, an early literacy advocate, was among local stakeholders interested in expanding ROR into school readiness efforts in Washington State. With HTPCP funding, she served as the initial program director for the state’s efforts to integrate ROR into early childhood systems and school readiness initiatives. Partners in the Washington State ROR included not only pediatrician leaders, but also early learning and education professionals, social service agencies, government and businesses.
The Washington State ROR created a quality rating and improvement system that helped providers strengthen their programs’ effectiveness. There was a 35% increase in the number of local programs that attained the highest quality rating. Parents who participated in Washington State ROR reported that they read more often to their children than nonparticipants.
Since the initial funding from HTPCP in 2009, the Washington State ROR has grown from 70 locations serving 40,000 families to 236 locations serving 130,000 families.
In its 30-year history, HTPCP has funded nearly 300 community-based programs in 48 states, Washington, D.C., Puerto Rico and Guam. The program offers pediatricians an opportunity to deepen their knowledge of and involvement with community-based interventions.
Submitted by the Healthy Tomorrows Program at East Tennessee State University
The East Tennessee State University (ETSU) Department of Pediatrics is a Healthy Tomorrows grantee for their ReadNPlay in Appalachian Tennessee program. Eight primary care clinics in Northeast Tennessee and Southwest Virginia are participating in this program that aims to support families in raising healthy children. The ReadNPlay program includes engagement with community stakeholders through a community board, dissemination of clinical counseling tools and provider training, support groups for new mothers and periodic community events, and use of a coordinated social marketing campaign on Facebook.
During the past two years, the department has developed a focus on preventing childhood trauma and building resiliency among children and families in the region as part of ReadNPlay. A Project ECHO series facilitated training and case discussions around this topic and the initiatives described below. Archived ECHO presentations are available online.
Faculty, residents, and students from ETSU are publishing their experience developing and pilot-testing a pediatric primary care screening, brief intervention, and referral protocol for adverse childhood experiences (ACEs) as part of the Break the Cycle 14 Program .
The department released a free mobile application with Stellar Studios for Apple and Android devices, the ReadNPlay Baby Book (available to download from the App Store and on Google Play). This tool was previously only available in print format. It provides parents and caregivers with tips for engaging with their baby during the first 18 months of life to promote health and resilience based on Bright Futures guidelines.
Fostering reading with young children can also help to build resilience. Funding from the First Tennessee Foundation awarded to Niswonger Children’s Hospital, the department’s major ReadNPlay partner, was used to provide supplies of children’s books worth up to $2500 to partnering pediatric primary care clinics in the region. Clinics receiving the books are applying to establish their own Reach Out and Read Programs . This initiative directly addressed the major barrier to Reach Out and Read programs, affording an adequate supply of children’s books for distribution at well child visits, and will result in tripling the number of Reach Out and Read programs in the region. The department also developed a new annual community event focused on promoting literacy – the Pajama Party with Your Pediatrician – with a local public library.
For more information, please contact Dr. Karen Schetzina.
Submitted by the Pediatric Pulmonary Center Program at the University of Florida
The UF PPC strives to improve diversity and health equity by incorporating cultural and linguistic competence (CLC) and Family and Professional Partnerships (FPP) into all aspects of interdisciplinary recruitment, training and practice. Approaches to alleviating health disparities on individual and population based levels are discussed in Core Curriculum, clinic, patient-care meetings and community activities. The UF PPC engages the consultation of experts in implementing the diversity recruitment plan, which includes valuing diversity and conducting self-assessment and specific recruitment strategies. Faculty and trainees are involved in programs, workgroups and presentations to improve diversity, health equity and cultural competence. The graphic below provides sample UF PPC activities related to diversity and health equity. The number key beneath the graphic explains the activities:
Submitted by the MCH Pipeline Program at Kennedy Krieger Institute
More than 180 staff members, faculty, trainees, students and community members attended the 9th Annual Room to Grow: Journey to Cultural and Linguistic Competency Conference on September 17, 2019. The theme of this year’s conference was Ensuring Inclusion. Harolyn Belcher, MD, MHS, Director of the Center for Diversity in Public Health Leadership Training at Kennedy Krieger Institute, Sunil Kumar, Ph.D., Provost and Senior Vice President for Academic Affairs at The Johns Hopkins University, and Bradley Schlaggar, MD, PH.D., President and CEO of Kennedy Krieger Institute opened the event and emphasized the importance of striving for cultural and linguistic competence. The morning presenters included Elizabeth Hall, MSW, Director of Interagency Affairs at the Maryland Department of Disabilities who presented on Disability, the Life Perspective, and Legislative Policy; Harolyn Belcher, MD, MHS, spoke on Ensuring Inclusion: Neurons to Neighborhoods-What Have We Learned and Kisha B. Holden, Ph.D., MSCR, Associate Director and Pouissaint-Satcher Endowed Chair in Mental Health at the Satcher Health Leadership Institute at the Morehouse School of Medicine spoke on Advancing Health Equity in Diverse Communities: Mental Health and Health Policy Considerations.
In the afternoon, attendees participated in an interactive workshop conducted by AZA Stephen Allsop, MD, Ph.D, a researcher and resident in the Department of Psychiatry at Yale University and Bruce Birren, Ph.D., Institute Scientist and Director at Broad Institute Genomic Center for Infectious Diseases. The workshop, entitled, “Bias: How the Brain Takes Short Cuts,” highlighted the neural processes involved in implicit bias and the presenters shared constructive ways to address implicit bias and microaggressions. The conference concluded with Harolyn Belcher, MD, MHS challenging conference attendees to commit to engaging in activities that support well-being, diversity, inclusion, and cultural and linguistic competency in their daily work.
Submitted by the MCH Pipeline Program at Kennedy Krieger Institute
Kennedy Krieger Institute hosted ten HRSA-funded Maternal Child Health Leadership, Education, Advocacy Research Network (MCH- LEARN) scholars this summer. MCH-LEARN is co-directed by Harolyn M.E. Belcher, MD, MHS, Director of the Center for Diversity in Public Health Leadership Training at Kennedy Krieger Institute and Nikeea Copeland Linder, PhD, Associate Research Professor at University of Maryland, College Park. The scholars were paired with prominent researchers and public health professionals for ten weeks and engaged in intensive training in public health research methods taught by Dr. Linder, and maternal and child health, health disparities, and the social determinants of health led by Dr. Belcher and Yvonne Bronner, ScD, Professor in the Department of Public Health in the School of Community Health and Policy at Morgan State University. In addition to conducting original research, the trainees engaged in professional development seminars, skill building workshops, and mentorship. The scholars showcased their summer projects during the Johns Hopkins Career, Academic, and Research Experiences for Students (C.A.R.E.S.) conference and joined other Center for Diversity in Public Health Leadership trainees for the Centers for Disease Control Undergraduate Public Health Scholars Program and Dr. James A. Ferguson Emerging Infectious Diseases Graduate Fellowship Student Showcase and Expo in Atlanta, GA July 29-30, 2019.
The MCH-LEARN program continues through the academic year. All ten scholars were selected to present their research at the Annual Biomedical Research Conference for Minority Students in Anaheim, California in November. The purpose of the MCH-LEARN program is to promote diversity in the Maternal and Child Health workforce and to foster a commitment to advancing health equity among future public health leaders.
Submitted by the Healthy Tomorrows Program at Maimonides Children's Hospital
This past spring the first semi-annual community advisory board meeting at Maimonides Children's Hospital helped propel a department-wide initiative to screen for and address social determinants of health (SDH). Together the BRIC-FIT program, comprised of 10 community based organizations and representatives from the hospital and outpatient clinics, created a unique Electronic Health Record based universal screening and referral process. Prior to initiating screenings, BRIC-FIT leadership trained pediatric residents, attending physicians, nurses and clerical staff on the basic tenants of SDH, and how to communicate with patients about SDH. In the first 4 months, clinic staff screened over 2000 patients for unmet psychosocial needs that may be affecting their health. Pediatric physicians then addressed these screens during visits with their patients and made appropriate referrals to community-based organizations.
Preliminary data shows that of the patients screened:
We gathered patient input through follow up phone calls made by medical students to inquire about how to improve the referral process. In the coming months, the hospital is expanding our SDH screening to the subspecialty practices and inpatient settings.
The Boston LEAH initiated PHQ-9 Screening for depression as part of the Medicaid Accountable Care Organization redesign to enhance integration of medical and mental health care. The program has been tracking the screening rates for several years. A coordinating quality improvement (QI) team was developed and staffed by medical health providers, mental health providers, and population managers. The QI team met monthly to evaluate progress, track results on a control chart, consider interventions, and set targets. Multiple PDSA cycles have been executed, including enhanced provider and trainee education and feedback, standardization of form collection, and data entry. The form color was altered, which increased rate of screening by bringing the form to providers' attention.
A clinical process map led to improvements in the clinic flow. Patients received a paper copy of the PHQ-9, a validated screening instrument for depressive symptoms, at annual physical exams and as needed. For those with a positive response (score >15 or positive response to question 9 about thoughts of injuring oneself or not worth living), the mental health team, including social workers, psychologists and a resource specialist, could be activated for same-day on-the-spot consultation for those with a positive response. Follow-up efforts were coordinated by a population manager who brought concerning scores to a behavioral health specialist to coordinate interim calls and follow-up care for at-risk patients.
This year, with increased attention to data entry into the Medical Health Record and initiation of a colorful form for providers to hand in with a billing pass, the program was able to exceed the goal of 90% screening. The monthly average screening rate was 91.4% for the 2018-2019 training year indicating a "special cause" (significant change) on the control chart with shift of the mean score. Of the patients who screened positive, 82% were seen same day, had a mental health team in place, or declined assistance. Follow up occurred within 90 days for 73%. By implementing numerous PDSA cycles, the QI team has achieved identification of patients with depressive symptoms, and improved follow-up in a busy adolescent/young adult practice. The QI team's next steps will focus on refinement of the follow-up process and increasing comprehensive mental health services to their patients.
An interdisciplinary group of faculty, trainees, and HRSA/MCHB staff participated in the Opioid Simulation created by SimUAB®, on March 15, 2019, at the LEAH national meeting in Birmingham, Alabama. Thistabletop simulation was developed by the University of Alabama at Birmingham (UAB) Office of Interprofessional Simulation for Innovative Clinical Practice through the LEAH Training Program with support from HRSA/MCHB.
There are three roles in this simulation - participants navigating life with addiction, healthcare providers responsible for making choices about resources in a resource-limited environment, and clinicians providing care for people in active addiction and in recovery. The goals of the simulation are to:
An opioid simulation tabletop kit was provided to each of the LEAH teams for continued trainings at their home institutions.
This report by MCH faculty member Dr. Rebecca Shlafer, MCH Program alumna Virginia Pendleton (MPH 2019), and colleagues provides a summary of results from a statewide survey of correctional health care workers about their facilities' treatment protocols and the challenges in providing care to pregnant women with opioid use disorder.
Key findings include:
The goal of the LET – MCH Bright Spots Qualitative Research Methods Mini-Lab is to support the growing interest in qualitative research among public health researchers and public health practitioners. We integrate the rich tradition of qualitative inquiry into current public health research so participants can gain a deeper understanding of the public health needs facing communities, integrate the experiences and perspectives of key stakeholders and community members into research designs, and find solutions to public health problems that take into account the lived experiences of community members.
The Qualitative Research Methods Mini-Lab offers participants the space to build or augment the qualitative research skills they've learned in classrooms or while at work in their agencies. Together with trainers, MCH and nutrition students, faculty, and other MCH and nutrition colleagues, participants gather regularly for training sessions labs that provide them with an opportunity to consult with experts on activities that strengthen their skills.
When students, agency staff and faculty utilize the same approach to research methods and the same software for data analysis and management—and when those data are shared—we can collectively work toward improving the health of our most vulnerable populations.
In 2018, Drs. Jamie Stang and Zobeida Bonilla devoted part of their efforts developing agency-university partnerships and building the mini-lab's infrastructure.
In 2019, the cohort met with a particular focus on reducing the prevalence of child obesity among vulnerable, diverse populations in Minnesota through the use of a "positive deviance" approach to child obesity prevention, and to share successful strategies with other states and communities.
To date, 70+ student and agency participants have attended mini-lab trainings, with more planned next year.
Adolescent patients access primary care services at lower rates than any other age group despite increased risk for morbidity and mortality due to high-risk behaviors such as substance use, sexual activity, interpersonal violence, and suicide. While these high-risk behaviors are common among adolescents, less than 20% receive recommended screening and counseling on them from their healthcare providers. To address this problem, the Adolescent Health Initiative (AHI) is embarking on a new initiative: “Building the Capacity for Adolescent-Centered Health Care in Rural and Underserved Communities in HHS Region V”.
The purpose of this project is to:
By training individuals at the state level to deliver the ACE-AP, each state will continue to disseminate the low-cost model throughout high-need communities and increase the number of youth who have access to needed services.
The Healthy Tomorrows Partnership for Children Program (HTPCP) is a public-private partnership between the MCHB and the American Academy of Pediatrics (AAP).
Beginning in 2015, HTPCP asked prior grantees in its one-year follow-up survey about innovations used in their projects. Innovations were described by respondents as new service delivery models or practices, patient education materials or strategies, new tools, professional training, or new partnerships and collaborations. About one-quarter of prior grantees reported innovations involving the use of technology.
The program supports innovative community-based interventions in maternal and child health that improve access to care.
There are many local and national data sources that can be accessed to learn about the status of women's health in Minnesota. However, there is no source that provides Minnesotans with a comprehensive review of the specific indicators of and barriers to women's health. In order to paint a broad picture of how Minnesota's women are faring, we have worked with the Minnesota Department of Health to comb through the data and compile the Minnesota Women's Health Report Card (MN-WHRC), which provides citizens, public health professionals, policymakers and others with a short, visual synopsis that highlights key areas of women's health.
ALBANY, N.Y. (June 25, 2019) - The number of women who die during childbirth is on the rise across the country, and a School of Public Health (SPH) team has joined the many forces working to help change that course in New York.
The SPH-based MCH Program, led by Christine Bozlak and Rachel de Long, was awarded $150,000 from the New York State Legislature this past year to fund research and statewide education on maternal mortality.
According to the Pew Research Center, the United States has been a notable outlier in the steady decline of maternal mortality seen in other parts of the world. While the rate of death related to pregnancy has declined in Canada, the United Kingdom and other developed nations, the rate has increased in the United States, giving it the worst rate of maternal deaths in the developed world. In New York, approximately 19 out of every 100,000 women died from complications related to childbirth from 2012-2016 according to the New York State Department of Health (DOH). Moreover, maternal death rates are disproportionately high among black women both in New York and nationally, noted de Long and Bozlak.
“There’s a real health disparity component at play here – black women in New York are three to four times more likely to die from causes related to pregnancy compared to white women,” said Bozlak, an associate professor.
Both health care and public health communities have mobilized to respond to these alarming trends, with efforts spanning public health agencies, professional medical organizations, community-based organizations, researchers and others, Bozlak and de Long note. In 2018, Governor Cuomo created the Taskforce on Maternal Mortality and Disparate Racial Outcomes as part of a multi-pronged effort to reduce maternal mortality and racial disparities and has committed $8M over two years in the 2019-2020 Executive Budget to fund these important initiatives. Additionally, the state senate has addressed maternal health as part of a larger legislative Women’s Health Initiative, including the $150,000 award to the MCH program at SPH to help explore and address the issue.
In New York, approximately 19 out of every 100,000 women died from complications related to childbirth from 2012-2016. Faculty from the School of Public Health are part of the movement working to decrease that number in the future.
Bozlak and de Long, a clinical associate professor, partnered with the SPH-based Center for Public Health Continuing Education and the DOH’s Division of Family Health to produce a special edition of Public Health Live! that was webcast to almost 1,000 health professionals and other participants. The webcast focused on the importance of engaging women and families from affected communities in order to develop initiatives, community approaches and changes to clinical systems that are responsive to their concerns – including concerns about bias and racism. It featured participants from recent community listening sessions held with women across New York as part of the Governor’s Task Force.
“A key component of this Public Health Live! was listening to community members about their experiences and ideas,” said de Long. “The more health care and public health professionals are aware of the concerns being voiced by women of color, and the more we all learn about efforts to be responsive to those concerns, the better we can address this devastating problem in New York and nationally.”
The project team also used the funding to support SPH faculty research on maternal health, and to enhance an array of prevention activities already underway in New York to promote women’s health and reduce maternal mortality. In the spring semester, six graduate students worked directly with DOH to gather and analyze data on maternal deaths, implement collaborative projects to improve the quality of care in birthing hospitals and support community-based public health prevention initiatives serving low-income women and infants.
Moving forward, the MCH Program will continue to partner with DOH and other key stakeholders to support women’s health while also contributing to the development of the next generation of public health professionals.
“This emerging generation of the MCH workforce is critical to addressing these pressing MCH issues, such as maternal mortality, and the University at Albany is poised to be a leader in their professional development,” said Bozlak.
The Healthy Tomorrows Partnership for Children Program (HTPCP) is celebrating a milestone this year – 30 years as a federal grant program! For the past 30 years, HTPCP has provided approximately 74 million dollars to 296 projects in 48 states, and Washington D.C., Puerto Rico, and Guam. As HRSA and the American Academy of Pediatrics (AAP) enter into a third decade of working toward improving child health, they are developing a series of case studies and activities to demonstrate program successes. The HTPCP also wants to hear from you about what makes Healthy Tomorrows special.
Help us celebrate this wonderful program as we look back on 30 years and plan for the decades to come!
Stay tuned for more information on celebratory activities and a contest!
Historically, each of the 52 Leadership Education in Neurodevelopmental and Related Disabilities (LEND) programs used idiosyncratic measures to track the effectiveness of training in family-professional partnerships and interdisciplinary/interprofessional team building. Such before-after training data provided a limited view of training quality and impact. Over the last five years, a cadre of leaders have worked together to form the LEND Program Quality Improvement (LPQI) Network, with the goals of devising common measurement tools, creating a national database, and using benchmarks to drive improvements in workforce training.
Participating LEND programs measure trainee competency in these areas using two validated tools: the LEND Core Competency Measure (CCM) is based on trainee self-evaluation, and the Interdisciplinary/Family-Centered Observation Rubric (I-FOR) relies on faculty observation. Programs use a proprietary web-based dashboard to enter trainee and faculty data collection at T1 (beginning of the training year), T2 (approximately one-third of the way through the training year) and T3 (end of the training year). A visualization tool embedded in the dashboard allows programs to see their trainees’ change from baseline to year end, filter data by variable (e.g. trainee discipline) and compare their results to a “national average” benchmark. Association of University Centers on Disabilities (AUCD) staff manage the dashboard, implement additional features based on user feedback, host monthly technical assistance calls, coordinate the development of shared resources, orient/onboard new programs, and support the production of research manuscripts.
A 2016-2017 pilot at 7 sites (23 are currently participating) found aggregate CCM and I-FOR scores increased across both competencies from baseline to year end. Programs unanimously report that the data has led to rich conversations among faculty about leadership skills across disciplines and informed curricular decisions. And as one program shared: “The process also helped us go a step further and ask how we know that all of our experiences (clinical and non-clinical) are truly family-centered and interprofessional.”
This effort has led to an increased emphasis on observable behaviors in determining trainee knowledge and skills, and a decreased reliance on self-assessment measures to drive important curricular decisions. The development and implementation of the I-FOR across sites has also initiated a national dialogue on what constitutes foundational- and advanced-level “competency” and reasonable expectations for all trainees upon program completion.
The LPQI Network will continue to recruit additional LEND programs to participate, aiming to increase data richness and the degree to which the “national average” benchmark is representative of the entire network. A subgroup of faculty is beginning to revise the I-FOR to align with language/concepts from the Maternal and Child Health Leadership Competencies, Version 4.0 and add a new component that assesses knowledge and skills in policy and working with communities and systems (“leadership”). The LPQI Network hopes to simultaneously connect with leaders from other DMCHWD grantee programs to determine if/how they could use the CCM and I-FOR to advance their training objectives.
For more information about LPQI please contact Ben Kaufman at AUCD (firstname.lastname@example.org).
This white paper approaches family involvement from the perspective of the family discipline itself, and the ongoing paradigm shift in family-centered care--from fringe to fabric. This document includes a summary of the history of family involvement in the LEND network and a series of eight individual handouts, which detail the definition, need, benefits, resources and strategies associated with each type of family involvement.
The Children's Healthy Weight Collaborative Improvement and Innovation Network (CHW-CoIIN) includes Louisiana as a state team focused on breastfeeding. Team lead Marci Brewer shared the following about Louisiana’s project.
Louisiana’s project focuses on building the capacity of and expanding the Louisiana Workplace Breastfeeding Support Program to create worksite cultures statewide that support employees who choose to breastfeed after returning to work through organizational policy and practice change. Over the last year and half of the Children’s Healthy Weight CoIIN project, the Louisiana team has had a number of successes, as well as a few barriers.
Successes for the Louisiana (LA) team include the following:
The Louisiana team also encountered the following barriers during their first year:
The following highlight was shared by the MCH Training Program at the University of Texas Health Science Center at Houston School of Public Health, funded through the Reaching Practicing MCH Professionals in Underserved Areas Through Education and Training Program.
To acknowledge the growing importance of interdisciplinary and interprofessional training and practice in public health, the Maternal and Child Health (MCH) Training Program would like to highlight our recent contributions at the University of Texas at Austin Center for Health Interprofessional Practice and Education (IPE) Showcase. Team members Mollie Ewing, RN, MPH-C, and Stephanie Reynolds, MPH-C were selected to present a poster on the Overview of Mental Wellness training course.
The Overview of Mental Wellness course was co-developed with AVANCE-San Antonio (AVANCE-SA) and has reached upwards of 600 public health professionals and trainees since its launch. AVANCE is a nonprofit organization that offers parenting skills, workforce preparation, early childhood education, health screenings, and home visits for low-income and hard-to-reach families.
The MCH Training Program’s partnership with AVANCE-SA was established in July 2017 when our team performed a needs assessment of their leadership and staff. Based on AVANCE’s training needs and topics of interest identified, we co-created the multi-modal Overview of Mental Wellness course. AVANCE-SA staff members who participated in the needs assessment represented various professional backgrounds and academic disciplines, such as business administration, management, leadership development, psychology, and the natural sciences. The interprofessional and interdisciplinary nature of their staff helps to form lasting, meaningful partnerships with organizations such as our own, and successfully serve their clientele.
Since August 2018, the MCH Training Program has disseminated the training course to a multi-disciplinary audience of trainees, and created pre- and post-evaluation surveys to measure trainees’ change in knowledge, skills, and intentions related to mental wellness. The surveys also include data on demographics of trainees and their clientele, as well as general course feedback. Our interprofessional collaboration with AVANCE-SA remains strong and optimistic. We have plans to design a mental wellness training specifically for parental clientele, in hopes of reducing stigma and empowering parents to practice mental wellness strategies with their family members.
In continuation of our interprofessional efforts, the MCH Training Program seeks to form newfound partnerships with different academic institutions and community organizations, while strengthening existing partnerships. As shown by our training needs assessments and interdiscliplinary background of our trainees, the MCH Training Program strongly values interprofessionalism. We believe it is crucial that all professions and disciplines are fully engaged, rather than merely being represented in the group. This ensures that all individuals and organizations are involved in the decision-making process.
With the ever-increasing application of interprofessionalism in the public health field, we strive to increase teamwork and collaborative efforts across sectors in order to enhance the quality and delivery of healthcare. Ultimately, our team aims to collaborate with partnering organizations to achieve our mission: to strengthen the capacity of public health professionals serving MCH populations in underserved and rural areas within HRSA Region VI (TX, NM, OK, AR, and LA) and Michigan.
To provide some background on the MCH Training Program, we are housed within the Michael & Susan Dell Center for Health Living at the University of Texas Health Science Center at Houston (UTHealth) School of Public Health and partner with Grand Valley State University in Michigan. Alongside our partners, we co-develop online and in-person trainings covering a wide array of topics, such as preconception health, early childhood nutrition, community leadership, and cultural competence. Offered at no-cost, the MCH Training Program provides a great opportunity for trainees to enhance their skills and knowledge surrounding maternal and child health and professional development. Through our collaboration with the Texas Department of State Health Services, we have more than 1,150 course completions. You can find our online courses available at https://sph.uth.edu/research/centers/dell/project.htm?project=3e747d4c-bdfb-421a-9caf-b934a6074744 .
With that, we would like to thank HRSA for their continued support and funding. If you have any questions or would like to know more about the MCH Training Program, feel free to contact the Program Manager, Cristell Perez, MPH at email@example.com or (512) 482-6150. To learn more about the Michael & Susan Dell Center for Healthy Living, contact us online.
The following highlight was shared by Mollie Ewing, RN, of the MCH Training Program at the UTHealth School of Public Health, funded through the Reaching Practicing MCH Professionals in Underserved Areas Through Education and Training Program.
To understand why the Maternal and Child Health (MCH) Training Program team at the UTHealth has focused so much of its energy in recent years on training community health workers (CHWs), it’s important to understand two things. One is that preventable chronic diseases are now a far greater burden on the public’s health than infectious diseases, which were once the heaviest health burden on our population. The other is that lifestyle behaviors that take place outside the walls of the health care system, such as diet and physical activity, are now widely acknowledged as key to preventing and treating chronic diseases.
The MCH Training Program, which provides both online and in-person training for maternal and child health professionals, didn’t begin its operations with the expectation that CHWs would be such a dominant focus of their work. But they began conducting needs assessments with partnering organizations, and quickly discovered that CHWs accounted for the vast majority of trainees enrolling in their courses. CHWs, who help individuals to navigate services and stay on track with prevention and treatment, have been rapidly emerging as a key health care workforce to supplement what’s happening inside the clinical environments. According to the 2017 Annual Report of the Promotor(a) or CHW Training and Certification Advisory Committee , there has been a 92 percent increase of certified CHWs in Texas since 2012.
Dr. Courtney Byrd-Williams and Dr. Joan Borst, co-directors of the MCH Training Program, recognized the CHWs’ interest in their courses as an opportunity to improve maternal and child health at the community level. Texas is one of the few states in the country that offers CHW certification, and it requires, as it does with other health care professions, that licensed workers earn continuing education units (CEUs) to renew their licenses. A collaborative relationship with the Texas Department of State Health Services (DSHS) enables the MCH Training Program to offer CEUs to CHWs who successfully complete courses.
Certified CHWs can earn CEUs by completing online courses, developed by the MCH Training Program, on topics like preconception health, mental health, professional leadership, community engagement, and cultural competence.
“We make the trainings available online so they are easily accessible to CHWs across the state, especially CHWs who may be working with populations in rural or hard-to-reach communities, “ said Byrd-Williams, Assistant Professor of Health Promotion and Behavioral Sciences at UTHealth School of Public Health in Austin.
The courses are multimodal and interactive, and they’re developed in consultation with groups like the Dallas-Fort Worth Community Health Workers Association (DFW-CHW).
One of the most popular courses, Gestational Diabetes Mellitus (GDM), provides information that equips trainees to help their clients understand the risk factors and warning signs of GDM and, if needed, guide clients to the appropriate services. Promoting healthy diet, exercise, and weight for their fellow community members is emphasized in the GDM course and in another popular course, Addressing Infant Mortality: Preconception Health . This course highlights the importance of a healthy lifestyle before, during, and after pregnancy, along with information on guidelines to follow during pregnancy. The Addressing Infant Mortality course also teaches trainees how to develop a life plan with their clients. This is a tool that can be used to help guide people through considering their health and lifestyle goals, then setting realistic steps to achieve them.
“Community health workers are unique in that they tend to have an unusually close understanding of the community they serve,” said Ashley Rodriguez, Vice-President of the DFW-CHW Association. “The vital trusting relationships CHWs build, by meeting people where they are, enables the workers to serve as a truly functional link between public health and social services. Navigating and facilitating access to needed services is their overall goal and function, but their ability to reach underserved, underrepresented, and under-educated populations is at the center of everything they do and is a core public health principle.”
CHWs can also attend in-person trainings developed by the MCH Training Program. Martha Maldonado, DFW-CHW Association board member and Certified CHW Instructor, has presented several of these courses at DFW-CHW Association meetings over the past year. Between 20 and 50 local CHWs typically receive training at these quarterly meetings. The MCH Training Program recently gathered participant data when Maldonado presented the Overview of Mental Wellness course. The CHWs in attendance completed a pre- and post-test to evaluate knowledge acquisition, behavioral intention and self-efficacy to apply the information and attitudes towards the course content. Significant increases were found in all four of the constructs measured.
“The trainings allow us to better serve CHWs by providing quality continuing education,” said Rodriguez. “They also help us as an organization, by drawing more members to our quarterly meetings, and attracting new members throughout the metroplex.”
In order to keep up with the pace of this quickly growing profession, the MCH Training Program is continuing to gather data and feedback from trainees to better understand who is taking advantage of these training opportunities and what information will empower CHWs to make a meaningful impact in their community.
“We are excited to have found this opportunity to help train the public health workforce and look forward to continuing our collaboration with the DFW-CHW Association, DSHS, and CHWs across the state,” said Byrd-Williams.
More information about the Maternal and Child Health Training Program , our online courses, and the certificate and fellowship programs is available online. The MCH Training Program is funded by a Health Resources and Services Administration grant and housed at the Michael and Susan Dell Center for Healthy Living at the UTHealth School of Public Health in Austin, Texas .
In the past, ArizonaLEND has hosted a 90-minute Lunch-and-Learn focused on Leadership and Culture. However, it quickly became apparent that an entire day was needed to address this important topic, so a Saturday workshop was developed.
Cristina Castaneda and Darold Joseph, ArizonaLEND faculty members, led the workshop and shared personal stories and examples from their Hispanic and Native American cultures. They discussed the importance of cultural awareness, responsiveness and interpretation, and addressed critical perspectives about intersections of disability, race and culture. Faculty and trainees also had the opportunity to share their own cultural experiences. This workshop had an interprofessional approach as 17 professional fields were represented and participants discussed ways in which they could apply these concepts when interacting with patients, families and other professionals within their discipline.
Due to the vulnerability, openness, and respect of each participant and the presenters, this workshop was a great success. One trainee stated, “I feel like I can listen and speak from a more informed place.” The day started and ended with Darold playing a traditional Native American flute, giving everyone an opportunity to reflect on what they learned.
The annual sponsored meeting of MCHB-funded state systems initiatives to improve autism services called the “Peer-to-Peer” Exchange will take place in Madison, Wisconsin on April 16-17, 2019. The four states (WI, DE, RI, WA) currently funded through Innovation in Care Integration for Children and Youth with Autism Spectrum Disorders and Other Developmental Disabilities Program grants will be joined by several states who had been funded previously. The State Public Health Autism Resource Center (SPHARC) coordinates the meeting, and the host state provides a forum and local/regional expertise.
This year’s Peer-to-Peer Exchange will focus on using data and quality improvement to advance health equity, which is a major strategy of the Wisconsin Care Integration Initiative (WiCII) grant funded 2016-2019 to the University Center for Excellence in Developmental Disabilities (UCEDD) at the Waisman Center, University of Wisconsin-Madison. The Wisconsin Care Integration Initiative is co-led by Waisman Center researcher Maureen Durkin (PI), Gail Chodron (co-PI, WI Leadership Education in Neurodevelopmental and Related Disabilities (LEND) Training Director) and Anne Harris (co-PI, WI LEND Director), and team members Kari Mueller (Project Coordinator) and Lynn Hrabik (Project Evaluator). WiCII has focused on reaching medically underserved families of children with, or at risk for, autism and other developmental disabilities who have not been able to access services. For some individuals with autism and other developmental disabilities and their families, inequities based on race, ethnicity, socio-economic status, and location of residence make it exceedingly difficult to reach their full potential for health and life in the community. Quality improvement (QI) and data-driven approaches provide strategies and information to target modifiable aspects of providing access and care delivery to advance health equity. Meaningful engagement with individuals most affected by inequity helps ensure that change efforts are locally valued, effective, and sustainable. A significant focus of the work in Wisconsin has been funding community partners to offer family navigation, ensure accessible shared resources, and cultivate opportunities to use telehealth to improve access to services. WI LEND trainees have participated in community-based activities such as community conversations and parent focus groups in urban Milwaukee and rural locations (Northwoods and southwest WI), data collection and analysis, literature reviews and information dissemination for WiCII. Significant progress has been made in identifying barriers and enablers for access to services in underserved populations in Wisconsin.
The Peer-to-Peer Exchange in 2019 aims to increase knowledge and skills of state teams to use data and QI to advance health equity through a variety of learning activities. Participants will have opportunities to engage with peers, individuals impacted by inequity, providers, and policy experts. The following strategies for advancing health equity will be threaded throughout all of the activities: 1) using data to identify disparities, 2) engaging in local data collection and tests of change to monitor progress, and 3) partnering with community members to ensure sustainable change.
The UAB LEND incorporates autism awareness throughout their daily work in clinical settings, training, and community outreach. Recent highlights include co-sponsoring the 18th Annual Alabama Autism Conference in February, which focused on “Building Communication in autism spectrum disorder (ASD) by Strengthening Skills and Systems,” with nearly 500 participants attending the day-long event, including educators, clinicians, trainees, caregivers, and self-advocates. Community awareness activities include supporting the Autism Society of Alabama and collaborations with other local and state organizations during the month of April and year-round, including co-sponsoring and participating in the 6th Annual Autism-Friendly Birmingham Barons baseball game on April 14th. Several LEND faculty participate in the state Autism Council and associated workgroups, with contributions to revisions of the statewide strategic plan and providing technical assistance to state departments as Alabama works to improve the systems of care for individuals with ASD and their families. Finally, the UAB Regional Autism Network, a component of the UAB LEND and UCEDD, which is funded by the Alabama Department of Mental Health, continues to expand its impact in providing monthly community education workshops for caregivers of individuals with autism spectrum disorder, with 2019 topics including addressing challenging behaviors, navigating the school system, and toilet training.
In recognition of National Nutrition Month, we would like to highlight work from our Maternal and Child Health (MCH) Training Program and the Michael & Susan Dell Center for Healthy Living (Center for Healthy Living) at The University of Texas Health Science Center at Houston (UTHealth) School of Public Health in Austin. The MCH Training Program is housed within the Center for Healthy Living, whose vision of "healthy children in a healthy world" aligns strongly with our purpose.
With the goal of addressing disparities in access to MCH-related training, and in collaboration with Grand Valley State University in Michigan, our team provides accessible and relevant education for the growing MCH workforce in HRSA Region VI (TX, NM, OK, AR, and LA) and Michigan. Specifically, we develop online and in-person training courses for professionals who are serving diverse MCH populations, often in geographically-isolated and rural areas. These courses engage learners with dynamic content, active learning, and real-life scenarios to develop and enhance skills. Through our collaboration with the Texas Department of State Health Services, we have more than 1,000 course completions.
The MCH Training Program has 14 online courses available on the MCH Training Program website. All courses are provided at no cost and can also be offered in-person. During National Nutrition Month, we would like to spotlight our Nutrition and Exercise for Mental Wellness and Nutrition: 6 Months to 2 Years courses. These trainings are great for those who are interested in gaining newfound skills and knowledge in the realms of nutrition and mental wellness.
Additionally, the Center for Healthy Living has various nutrition resources online, such as the Food at School Parties infographic for parents describing healthier, nutritious alternatives to party snacks. In March 2019, we will release Texas Child Health Status Reports covering topics such as Child Nutrition, Child Beverage Consumption, Child Obesity, and more.
The reports will provide an overview on the status of child and adolescent health across Texas. Available to community members, policymakers, and advocacy groups, these one-page reports identify priority areas and assess health needs at a regional level in an attempt to guide informed decision-making. Check out the Center for Healthy Living website throughout National Nutrition Month to see more updates.
The Center for Healthy Living and MCH Training Program believe that with access to knowledge and practical training, people can create lasting, meaningful change in their local communities. We would like to thank HRSA for their continued support and funding. If you have any questions or would like to know more about the MCH Training Program, feel free to contact the Program Manager, Cristell Perez, MPH at firstname.lastname@example.org or (512) 482-6150. To learn more, contact us about the Michael & Susan Dell Center for Healthy Living.
Fresh Food for All Policy Brief Team: Marissa Black, Marleah Payne,
Marsha Spence, Chelsea Allison, Jennifer Russomanno, Marissa McElrone
As part of the University of Tennessee’s MCH Nutrition Leadership Education and Training Program, Marsha Spence, PhD, MPH, RDN, LDN, Program Director, taught a doctoral nutrition policy course in Spring 2018. One short-term trainee and four long-term trainees were enrolled in the course and funded trainee and doctoral candidate, Marissa McElrone, was a graduate teaching assistant. As the culminating experience, trainees wrote a policy brief and participated in the University of Tennessee’s Howard Baker Center’s Public Policy Challenge, which was open to all University of Tennessee (UT) graduate and undergraduate students. As part of the course and challenge, the trainees developed a blog post, prepared a video , a policy brief, entitled Fresh Food for All, and a presentation for review by an expert panel. The team received the first-place award and received $3,000 to advance their policy initiative, which aimed to increase WIC Farmer’s Market Nutrition Program (FMNP) voucher redemption during summer months in 2019.
In collaboration with community partners at the Knox County Health Department’s Supplemental Nutrition Program for Women, Infants, and Children (WIC) and Nourish Knoxville, a non-profit organization that operates farmers’ markets in the Knox County area, the trainees developed an information flyer that was distributed by Knox County Health Department WIC staff, a website to assist WIC participants, and informative rack cards for display at participating farmers’ booths. Currently, the trainees and Dr. Spence are working to evaluate the policy initiative to see if it helped increase redemption rates via Knox County FMNP redemption rates, to determine the number of hits on the website, and to ascertain WIC participants’ overall experiences at area farmers’ markets using an online survey developed by the team. Jennifer Russomanno, a short-term trainee and doctoral candidate in Public Health, will present the findings at the University of Tennessee’s upcoming Promoting Healthy Weight 3.0 Colloquium: A Socio-Ecological Perspective - Policy at All Levels on March 29, 2019.
The UT MCH Nutrition Leadership Education and Training Program has a long history of partnership with community partners. MCH faculty work closely with community partners, including public health nutritionists from the Knox County Health Department, to develop community assessment projects that provide practice experience integrated with didactic learning components. A recently published manuscript highlights one of these projects , which demonstrates how partnering with community agencies can improve graduate education and children’s access to healthy foods.
Using longitudinal administrative data from children who participated in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) in Los Angeles County between 2003 and 2016, Dr. Chaparro is evaluating the impact of the 2009 WIC food package change on growth trajectories from 0-4 years and obesity risk at age 4 years. Along with her colleagues at UCLA and PHFE WIC, Dr. Chaparro found that exposure to the new food package (compared to the old) from 0 to 4 years was associated with healthier growth trajectories (i.e. weight-for-height z-scores [WHZ] closer to the mean of 0 and further from the overweight category of WHZ>2) and a 10-12% lower obesity risk at age 4 years (10% for girls, 12% for boys). A manuscript based on these findings was recently accepted for publication at the American Journal of Clinical Nutrition (forthcoming). Next steps include investigating if the type of infant food package received from 0-12 months could explain the observed improved obesity outcomes among children exposed to the new food package, and whether the effect of exposure to the new food package on child obesity varies by family and/or neighborhood socioeconomic characteristics. This study is funded by the American Heart Association (AHA)'s Scientist Development Grant (Grant No. 17SDG33660878; 7/1/2017-6/30/2020). Beginning Fall 2019, Tulane's MCH Nutrition trainees will support this and other faculty-led MCH Nutrition research projects as part of their research rotations.
Dr. Pia Chaparro is an Assistant Professor at the Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine and Core Faculty of the Tulane’s Nutrition Leadership Training Program.
CHALK, New York-Presbyterian Hospital’s childhood obesity program, has expanded their programming to early childhood centers (CHALK Jr.) through Healthy Tomorrows. CHALK Jr. is currently partnering with three different early childhood centers in Washington Heights, located in Northern Manhattan. In addition to bringing direct programming at the centers to enhance healthier eating and active lifestyle practices amongst toddlers, parents, and staff, CHALK Jr. has been committed to strengthening and leveraging community resources in order to provide lower-income families with programs that promote overall well-being.
One such project is a partnership with New York City Parks and Recreation Center Department, specifically with Highbridge Recreation Center (HRC) located in Washington Heights. CHALK Jr. has engaged community fitness instructors, and purchased toddler fitness equipment, healthy snacks, and water in order to host free monthly "Family Wellness Saturdays" to the community at HRC. These monthly Saturdays consist of a combination of:
As part of the recruitment effort, CHALK Jr. has been hosting parent workshops at its early education partner sites on the importance of sleep, physical activity, nutrition, and overall family wellness. CHALK Jr. staff has facilitated workshops to increase family engagement in the overall topic of wellness and successfully sign families up for a tour at HRC. The purpose of the tour is to help motivate and bring families to the facility to see what is there, and to partake in the free family wellness session. CHALK Jr. aims to increase awareness and exposure to existing community resources and increase family participation in wellness activities.
The CHALK Jr. program takes into account that some families may not regularly have access nor the means to afford the cost of memberships to facilities, healthy eating options, and/or physical activity promoting toys. Although children under 18 have free membership to the recreation centers, adults need to buy a membership. Therefore, CHALK Jr. is sponsoring a raffle at these wellness Saturdays to help increase parents' ability to access the full facility while also helping to increase membership numbers for HRC.
College students may not be a population that we traditionally thought of as dealing with hunger, but new research indicates that rates of food insecurity are high on college campuses throughout the US. Through a partnership with the Southeastern Universities Consortium on Hunger Poverty and Nutrition, MCH Nutrition Trainee, Ms. Ruth Wooten, and MCH Nutrition faculty Drs. Betsy Anderson Steeves and Marsha Spence completed a cross sectional survey assessment of more than 4,000 college students to measure the rates of food insecurity among college students within a large university system. They found that more than 1 out of 3 college students within the University system experienced food insecurity, meaning that the students’ struggled to get enough food overall, or enough variety of food to live a healthy lifestyle. This research has been published in the journal, Public Health Nutrition, and was featured on the local Knoxville NPR affiliate, WUOT, where Dr. Anderson Steeves was interviewed for a weekly health-focused program, Health Connections.
Drs. Anderson Steeves and Spence continue to work on addressing the issue of food insecurity on college campuses by serving as members of the Hunger and Homelessness Task Force at the University of Tennessee, and by forging innovative partnerships with the University of Tennessee, Knoxville, Student Health Center to routinely screen and provide referrals for campus-related resources to address food insecurity.
Left to Right: Ruth Wooten, MS, RDN; Betsy Anderson Steeves, PhD, RDN;
and Marsha Spence, PhD, MPH, RDN, LDN
The University of California, Berkeley School of Public Health’s Center of Excellence in MCH, Education, Science, and Practice has created a free, open-source, self-directed, training module series on Maternal, Child, and Adolescent Health (MCAH) Life Course Perspective, Practice, and Leadership.
This resource provides access to high-quality training for working healthcare clinicians, public health practitioners, students, and professionals from across disciplines, locations, and backgrounds to expand their knowledge of key MCAH concepts in research and practice. The training module series is also accessible to community members and community-based organizations.
Each module includes an interview with a subject matter expert, available readings, case studies of organizations in practice, and opportunities for reflection. The video series highlights 15 partner organizations and covers the following topics:
For additional information on the Maternal, Child, and Adolescent Health (MCAH) Life Course Perspective, Practice, & Leadership training series, contact Center Director Julianna Deardorff.
The Michigan Child Collaborative Care Program (MC3) provides access to mental health consultation for primary care providers (PCPs) treating children, youth and pregnant women. This includes same-day phone consultation for PCPs with University of Michigan Child, Adolescent, and Perinatal Psychiatrists (CAPPs); remote tele-psychiatric evaluation of patients and families requiring a more in-depth assessment; coordination of care and brief treatments using a statewide network of masters prepared Behavioral Health Consultants (BHCs); group case consultation wherein multiple providers can discuss a number of cases in a single session and web-based mental health education for enrolled providers.
MC3-Connect, a partnership between the University of Michigan, Michigan State University and the Michigan Department of Health and Human Services, will enrich the current MC3 Program in the following ways:
The Alabama Department of Mental Health (ADMH) is a recent recipient of one of HRSA’s grants to develop a Pediatric Mental Health Care Access (PMHCA) Program. The Department of Mental Health, led by Commissioner Lynn Beshear, provides extensive services to Alabamians with mental illnesses, developmental disabilities, and substance use disorders.
The purpose of the PMHCA Program is to promote behavioral health integration in pediatric primary care by supporting the development of new or improvement of existing statewide pediatric mental health care telehealth access programs. To implement the Program, a collaboration was formed between ADMH and Children’s of Alabama, a private, not-for-profit medical center providing specialized medical care for ill and injured children.
Children’s of Alabama, through the Ireland Center, provides a full array of behavioral health services in both inpatient and outpatient settings. Services are delivered by a multidisciplinary team of child/adolescent psychiatrists, nurse practitioners, clinical psychologists, therapists, and nurses. Children’s of Alabama also operates the Psychiatric Intake Response Center (PIRC), located in the emergency department of the hospital. PIRC is a confidential psychiatric response center designed to assist patients, their loved ones and/or caregivers, and community providers in finding the appropriate level of mental health care. These services are provided via telephone or in person by licensed mental health clinicians trained to assess a child or teen’s mental, emotional, and behavioral needs and recommend the best treatment options. Children’s of Alabama is ranked among the best pediatric medical centers in the nation by U.S. News & World Report, and offers an array of both inpatient and outpatient services. Other collaborators include the University of Alabama at Birmingham School of Public Health Evaluation Team, and the Alabama Department of Public Health.
The Project is led by Jane Duer, M.Ed., ECSE, who has been employed by ADMH for six years as the Coordinator of Early Intervention Services. Jane is co-author and Project Director for the Alabama Pediatric Telemental Health Network, and in that role provides oversight, contract management, and administrative liaison with HRSA. Susan Griffin, LICSW, PIP, CHCQM, with Children’s of Alabama, is the Project Manager, and has responsibility for daily oversight and implementation of the Program, ensuring that all clinical and administrative activities of the Program are carried out, and that all performance expectations and goals are clear and met according to the program description.
The Pediatric Mental Health Care Access Program has two main elements to be implemented over the next five years:
Children’s of Alabama has established internal mental health teams who will be providing both the telementoring and telemedicine components of the Program. Curriculum content is being developed to enable the Program to commence its first ECHO session in the third quarter of 2019. The Program is modeled after a telemedicine project that was implemented between Children’s of Alabama through Dr. Tommy Vaughan, a child/adolescent psychiatrist, the Department of Mental Health, and Dr. Marsha Raulerson, a pediatrician in rural Brewton, Alabama. This model has served over 500 children during the past 15 years and will be the basis for development and expansion of telehealth activities outlined for the Program. Current activities include conducting a needs assessment with pediatricians statewide, assisted by the Alabama chapter of the American Academy of Pediatrics and the University of Alabama at Birmingham's Evaluation Team, as well as identifying pediatricians in Alabama’s rural counties who wish to partner with us to join the Pediatric Telemental Health Network Program. This five-year project represents a unique collaboration between many stakeholders who are serving the children of Alabama, and whose goal is to improve access to quality behavioral health care services for Alabama’s underserved children, particularly in rural areas of the state.
In the November 2018 issue of the North Carolina Medical Journal, Dr. Savithri Nageswaran (a Healthy Tomorrows Partnership for Children Program [HTPCP] grantee), Ms. Aura Rosado, and Dr. M. Stockton Beveridge published a paper highlighting the transportation challenges faced by Latino children with medical complexity (CMC).
HTPCP funds the community care coordination program for CMC at Brenner Children's Hospital in Winston-Salem, NC. This community program is part of the Pediatric Enhanced Care Program , a special program for CMC. CMC are children with serious medical problems, they receive care from many doctors and other providers, and are admitted to the hospital frequently. As a result, their families have to navigate a complex healthcare system.
Our team is interdisciplinary and includes a physician, two nurses, a social worker and a patient navigator. Our social worker and patient navigator are Latina and are bilingual. Having two bilingual care coordinators enabled our team to serve Latino families and learn about the unique challenges faced by these families as they navigate the health system. Our coordinators have also been able to build strong relationships with these families.
In this study, we used the encounter logs that the two bilingual care coordinators maintained and identified the challenges faced by families of 70 Latino CMC. We found that these families had many difficulties as they navigated the complex health system for their children. We were surprised that transportation was a major problem. Many families had problems transporting children to hospitals and doctors' appointments, but they also had difficulty using transportation benefits that were entitled to their children. There were many reasons for this difficulty, but the main issue was the language barrier. These problems had serious consequences for children, including missing appointments and having delayed arrival at appointments, leading them to miss much needed medical care. In the future, we should find out the extent of transportation problems; and test whether addressing transportation problems can improve families' ability to keep appointments with doctors. Twelve states and Washington, DC have provided temporary drivers' licenses for unauthorized immigrants, but North Carolina does not have such a policy. We should evaluate whether states that have policies for temporary drivers' licenses have less transportation problems.
Having two bilingual Latina care coordinators has uniquely positioned our program to serve and address the unique needs of Latino CMC. In recognition of her service for Latino CMC, Ms. Rosado received the Notable Latino Award by the Latino Community Coalition of Guilford in 2018.
The Nemours Foundation of Wilmington, Delaware has developed a special visiting rotation for Under-Represented Medical (URM) students called the Pediatric Scholars Program. Nemours provides a travel stipend, and selects URM medical students who are interested in doing a month-long elective with Nemours. In addition to standard clinical rotations, Nemours offers a "health disparities research and advocacy" rotation, which is more of a non-clinical academic experience. During the health disparities research and advocacy rotation, Nemours gives the students an overview of its Healthy Tomorrows project as an example of a Population Health based approach to addressing social determinants. The Nemours Aces to Aces: Accelerating Community Engagement to Address Adverse Childhood Experiences (ACEs) project aims to ensure that every child in Delaware's ACEs "hot spots" has access to a trauma-informed medical home, access to neighborhood supports, and improved parental mental health.
The 2018 Association of State Public Health Nutritionists (ASPHN) Brief on Guidelines and Health Conditions Related to Timing of Early Infant Feeding includes the most recent findings and guidelines necessary for public health nutritionists, including:
The Children's Healthy Weight Collaborative Improvement and Innovation Network (CHW-CoIIN) includes Indiana as a state team focused on physical activity. Team lead Kelsey Barrick shared the following about Indiana's project.
After the Children's Healthy Weight Collaborative Improvement and Innovation Network (CHW-CoIIN) In-Person Meeting in January 2018, Indiana's team acquired two interns from the University of Indianapolis to help research best practices related to adapting physical activity to students with special needs. The result of their work was a list of professionals in Indiana that focused their work in this area. Their findings also informed Indiana about what other states were doing regarding adapted physical activity projects.
In March, Indiana team leads Jessica and Kelsey attempted to convene a work group of professionals across Indiana who specialize in serving students with special needs. After consulting with professionals at Indiana University Bloomington, Jessica and Kelsey tried to recruit special needs advocates -- parents, educators, school professionals, after school providers, etc. Unfortunately, there was no traction with this work group.
In May, Jessica and Kelsey partnered with special needs professors at Indiana University Purdue University Indianapolis (IUPUI) and focused on regional work regarding adapted physical activity. The result of this partnership led to awarding scholarships to local districts in order to send one professional to a semester-long training, for intensive, hands-on learning for adapted physical activity.
The Adapted Movement Programs at Indiana University Purdue University Indianapolis School of Health and Human Sciences houses the Adapted Movement Programs (AMP). The mission of AMP is to provide high quality adapted physical activity programming to families and individuals with disabilities in conjunction with educating Kinesiology students on best practices. Individuals applying to the grant program will be involved in one of the two clinics during the academic year, Motor Activity Clinic (MAC) or Ability Fitness Clinic (AFC). Children that engage in MAC are between the ages of 3 to 15 years and have various disability characteristics. The focus on MAC is to provide motor development and motor skill training in the gymnasium and aquatic setting. Adults participating in AFC are from ages 16 to adulthood and have various disabling conditions.
Those applying to the grant will work one-on-one or two-on-one with a child or adult under the supervision of Dr. Katie Stanton and Mrs. Amy Oliver, MS. Both Dr. Stanton and Mrs. Oliver have expertise in adapted physical activity and considerable experience teaching and working with people with disabilities in various settings. Grantees can expect to gain skills in assessment, activity modification, appropriate planning and motor skill development, and experience in writing Individualized Education Planning goals and objectives. Grantees will also work with Dr. Stanton and Mrs. Oliver on how to apply skills gained in their own school/organizational setting.
The University of Minnesota's Leadership Education in Adolescent Health program (UMN-LEAH) is fortunate to be housed with several other adolescent health-focused programs; key among these is the Healthy Youth Development-Prevention Research Center (PRC) funded by the Centers for Disease Control and Prevention (CDC). So, when LEAH Social Work faculty member, Paul Snyder, isn't teaching and mentoring LEAH trainees, he is directing the PRC's core research study, Partnering for Healthy Student Outcomes (PHSO). And the UMN-LEAH trainees are benefiting as well.
Launched in 2014, PHSO has been working with 3 middle schools to address academic and health disparities, particularly for the most disengaged learners. Central to the program is an innovative and effective year-long teacher professional development (PD) program developed by Snyder and PRC colleague, Abigail Gadea. Years ago, both Snyder and Gadea committed themselves to more deeply understanding issues of equity and diversity, including their own unconscious or implicit biases; both are graduates of the University of Minnesota's Leaders in Equity and Diversity program. With these lenses, they quickly recognized how teachers' unconscious biases were impeding effective engagement with their students. Subsequently, they integrated into the PD program a session that encourages teachers to explore these biases so they can implement equitable teaching practices that address the needs of all students in their classroom. The evaluation of the PD program developed by Snyder and Gadea was so positive, they have translated that work into a free-standing PD program called Whole Learners©.
Snyder and Gadea brought their training on unconscious bias to the faculty and staff of the Division of General Pediatrics and Adolescent Health, where both the LEAH program and the PRC are housed. This training was so well received, they created a seminar for UMN-LEAH trainees: Examining Unconscious Bias. In this seminar, Gadea and Snyder strive to create an inclusive, open, and safe training environment by working with the trainees to establish grounding assumptions – agreements for how they will act toward and support one another during the seminar. Through individual exercises, personal stories, a video, verbal presentation, and large group and pair activities, Snyder and Gadea define unconscious bias, encourage self-reflection, provide research evidence, ask questions about trainees' personal experiences, request one verbally expressed take-away from each participant, and provide resources for further exploration.
Everyone has unconscious biases, and unconscious bias influences our actions and decisions. When we are working with others – whether that be in our teaching, planning or implementing research, recruiting or hiring new faculty or staff – only when we take the time to become aware of our unconscious biases and become actively mindful of their influence can we begin to create and support equity.
Mailman Center for Child Development
Department of Pediatrics
University of Miami Miller School of Medicine
MCH leaders in the 21st century require a remarkably diverse set of skills to be able to improve the health and well-being of children with neurodevelopmental disabilities such as autism spectrum disorders (NDD/ASD). MCH leaders must be well trained in the disciplinary skills of their everyday work; they must be family-centered and culturally competent as they adapt to an increasingly diverse population; they must be able to partner with individuals and organizations, especially those with different goals and professional backgrounds; they must be able to recognize how larger systems-level issues affect MCH; they must be innovative in using (and creating) evidence-based solutions to address individual and public health problems; and they must be focused on outcomes that matter to families and to communities.
With these key principles in mind, the overarching goal of the Leadership Education in Neurodevelopmental and related Disabilities (LEND) training program at the Mailman Center for Child Development (MCCD) is to develop leadership in MCH faculty and practitioners to improve the health and well-being of families and children with NDD/ASD, especially those who experience high levels of health disparities because of race/ethnicity. In response to new evidence and the changing needs of this population, we have designed our LEND to focus on improving health outcomes at the intersection of disability and other minority status, such as race and ethnicity.
Teacher using assistive technology with child
One way we do this is by training a diverse workforce. Over the last 5 years, we have graduated 384 long-term trainees (LTTs) in 13 disciplines, 65% of whom are ethnic/racial minorities. Our 126 Hispanic LTT represent approximately one-quarter of all Hispanic long-term LEND trainees in the US. Long-term follow-up surveys demonstrate that 84% of our LTTs report family-centered, interdisciplinary practice in an MCH setting, and 75% demonstrate leadership through organizational leadership, research and publications, or other activities designed to improve systems of care. Our impact is both regional and national; half of our LTTs remain in Florida; the other half work in three countries, 21 other states, and Puerto Rico. Our graduates hold or have held regional, state, national, and international leadership positions.
A second approach is our focus on improving health in underserved communities. We are committing resources to support training and leadership capacity in two “communities of focus” (Overtown and East Little Havana) —neighborhoods adjacent to MCCD that are culturally diverse, economically challenged, and underserved by health and education professionals despite having extremely high levels of morbidity and mortality. Over the last two years, for example, we have extended three MCCD-based programs by training staff of community partners to provide behavioral health interventions, family navigation, and implementation of assistive technology. A further goal is to assist our partners in obtaining grant funding and governmental appropriations themselves, so they will have future program sustainability and opportunities for innovation. Our vision is to address population health outcomes and develop trainees who can plan community-based interventions to improve systems of care, then translate this process to other communities.
Approximately 50 faculty, staff, and trainees from the LEND, Maryland Center for Developmental Disabilities (MCDD), Center for Diversity in Public Health Leadership and Training, the Center for Innovation & Leadership in Special Education, and Senior Management of the Kennedy Krieger Institute attended a three-day, on-site technical assistance program, Embedding Cultural Diversity and Cultural and Linguistic Competence, presented by the University Center for Excellence in Developmental Disabilities (UCEDD) at Georgetown University and the Center for Child and Human Development faculty, including: Tawara Goode, Wendy Jones, and Vivian Jackson. Kennedy Krieger Institute was one of four programs that were selected from 14 UCEDDs that applied for this on-site technical assistance. Other UCEDDs selected were Alaska, Louisiana, and New Mexico. This interactive program addressed the following topics: Cultural Diversity and Competence and Linguistic Competence: Definitions, Conceptual Frameworks, and What it Means for Your Center; Envisioning a Culturally and Linguistic Competent Organization; Aligning Cultural and Linguistic Competence Values with Organizational Policy; Embedding Project Tools, Ethical Issues and Challenges; and Essential Areas of Knowledge and Skills for Aspiring and Practicing Professionals in Developmental Disabilities.
Participants of the Embedding Cultural Diversity and Cultural and
Linguistic Competence technical assistance program.
The 8th annual Room to Grow: Journey to Cultural and Linguistic Competency conference was held on Tuesday, September 18th at Johns Hopkins Hospital. During the morning session, presenters included Shelly Choo, MD, MPH, Senior Medical Advisor for the Baltimore City Health Department who spoke on B'more for Healthy Babies: A Path to Child and Family Health in Baltimore City; Michael Lu MD, MS, MPH Senior Associate Dean for Academic, Student, and Faculty Affairs at George Washington University Milken Institute School of Public Health and former Associate Administrator of the Health Resources and Services Administration's Maternal and Child Health Bureau (2012 - 2017) who spoke on Leading Change; and, Daniel E. Dawes, J.D., a nationally recognized leader in the movement to advance health equity among uder-resourced, vulnerable and marginalized communities who spoke on The Danger of Futility: Creating a Sea Change for Health Equity in America. In the afternoon, Dr. Rafael Luna, Associate Dean in the Morrissey College of Arts and Sciences, Director of the Pre-Health Program, and Director of the Gateway Scholars Program for STEM conducted a workshop on Telling a Story: The Art of Scientific Writing for trainees, residents, and students. In addition, Dr. William T. L. Cox, social psychologist and currently an assistant scientist in the Department of Psychology at the University of Wisconsin - Madison, conducted a workshop on Empowering People to Break the Prejudice Habit: Creating Inclusion and Reducing Bias. Over 160 trainees, residents, students, faculty, clinicians, and community members were in attendance.
Over the past decade, Healthy Tomorrows for New Britain Teens has evolved from an obesity prevention program into a youth and community led movement that is addressing some of the city's most challenging health, education and mental health problems. With support from an initial Healthy Tomorrows Partnerships for Children Program grant (2007-2012), the program combined access to health services with an emphasis on youth leadership. A second Healthy Tomorrows grant (2013-2018) supported the establishment of a Teen Center (the House of Teens) at the YWCA, a space where teens could access family planning, stress reduction, fitness and other services, while also making their voices heard through supporting policy change. June 2018 saw the grand opening of the East side Community Center in a renovated building in one of the city's poorest communities. The center is poised to become a hub of connection and revitalization where teens and residents can access services from multisectoral partners, engage with their neighbors, and promote a safe, walkable, healthy, more vibrant community.
Key drivers of growth and sustainability are:
1) Multisectoral coalition building: A shared mission of service to adolescents was the "glue" that kept core partners (Community Health Center, Inc., YWCA of New Britain, New Britain High School) actively engaged for over a decade. As the focus on policy increased, the coalition expanded, to include partners from higher education, the City of New Britain, and the business community.
2) Community based participatory research and Photovoice: In 2009, the goal of youth empowerment took a major step forward with the addition of Photovoice (PV) to the portfolio of health promotion services. PV is a community-based participatory research strategy that taps into the "natural activism" of youth. Teens take photos documenting issues of concern to them in the community, engage in dialogue with policy makers about those issues and take action to create a healthier environment. Photovoice has proven its value as both a research tool to investigate health problems and an intervention to engage youth and community members in creating and supporting solutions.
3) Policy change: Through PV youth learned how policy decisions about the built environment (e.g., parks, pools, transportation) influence the behavioral choices that individuals make. Through civic engagement (e.g., speaking at city council meetings), teens showed their support for policies to improve the built environment (e.g., reopen pools) or their health and educational options. In a statement acknowledging the impact of Healthy Tomorrows, New Britain's mayor, Erin Stewart, noted that such policy changes "address a broad spectrum of educational and economic, as well as health, goals of the city by nurturing healthy, well-educated youth—the next generation of city's leaders."
Cost Analysis of an Asthma Home Visiting Program Using Claims Data from a Medicaid Managed Care Organization
The Boston Children's Hospital Community Asthma Initiative (CAI) provides nurse-supervised community health worker (CHW) asthma education, case management, home visiting and environmental assessment in a culturally competent and linguistically appropriate manner for low-income children in Boston. CAI specifically focuses on serving children who have had previous hospitalizations or emergency department visits or who have other risk factors identified by primary or specialty care providers that contribute to poor asthma control. By working closely with these patients and their families, CAI aims to address the substantial socioeconomic and racial/ethnic health disparities that exist among patients in the Boston area.
CAI has made considerable impacts on the asthma patient community, including remarkable reductions in children with any emergency department visits (57%) and hospitalizations (81%). A recent cost analysis conducted using claims data from one Medicaid managed care organization (MCO) yielded adjusted return on investments (ROIs) of 0.31, 0.78, and 1.37 at 1, 2, and 3 years post-CAI intervention. The use of actual insurance data rather than estimated costs allowed for a more realistic cost analysis that took into account service utilization across settings and the total corresponding costs of care to payers, providing greater validation for previous positive ROIs for the program using hospital administrative data.
In addition to providing care and support for families in the Boston area, CAI is currently focused on replicating the CAI model at Pediatric Physicians' Organization at Children's (PPOC) primary care sites in the South Coast and Western MA, both of which have unique vulnerabilities for asthma exacerbations, including high levels of poverty.
Dr. Nimi Singh, Adolescent Medicine Physician
From the time she completed fellowship training in 1995, Dr. Nimi Singh, MD, MPH, MA, Adolescent Medicine Faculty with the University of Minnesota LEAH Training Program, has focused her teaching, scholarly activity, and clinical work on mental health promotion among adolescents from varying socioeconomic and cultural contexts. In 2014, she was invited to share her perspective on translating best practices in adolescent mental health promotion into teaching modules for health care practitioners, which were then published as a series of chapters in "Reaching Teens: Strength-based Communication Strategies to Build Resilience and Support Healthy Adolescent Development". This American Academy of Pediatrics publication, endorsed by the Society for Adolescent Health and Medicine, is designed to impart practical strategies for clinicians to improve their communication skills in working with teens across a wide array of health care settings.
One of the foundational approaches that Dr. Singh has come to embrace in her own work, supported by a substantial body of evidence, is the role of lifestyle in supporting or compromising the mental health of young people. More specifically, she emphasizes the importance of clinicians focusing on the critical roles that optimal sleep, nutrient-dense whole foods, self-regulation strategies, and physical activity play in supporting the mental health needs of all adolescents, including those who are struggling with mental illness. To this end, she has developed screening questions and brief teaching points for clinicians to use in encounters with adolescents, which are currently being incorporated into a newly-developed "Adolescent Depression Action Plan" for the University of Minnesota's health care organization.
The MCH Training programs in Wisconsin (Pipeline, LEND, and PPC) partnered with a community-initiated program, Strong Baby Sanctuary, to host and participate in the first annual Shared Day of Learning. The Strong Baby program works to reduce infant mortality in the Milwaukee zip codes with the highest rates of infant mortality by training community facilitators from faith-based organizations to become sanctuaries of support for vulnerable pregnant mothers and mothers with newborns. Over 60 MCH trainees/faculty and 40 community members from 30 sanctuaries participated in this interdisciplinary day-long event. Programming included panels of mothers and Sanctuary facilitators who provided real-life stories of community challenges and successes, epidemiologists from the City of Milwaukee Health department, a speaker from WIC who also introduced an integrated early literacy program for the Sanctuaries, and interdisciplinary MCH student panels that provided training for community members on early nutrition for moms and babies, transitioning from bottle to cup, early play, and CDC resources for early developmental milestones.
To kick off the event, MCH trainees from across the three programs had conducted diaper drives on their respective campuses and then came together on the morning of the event to organize these supplies for distribution to the Sanctuary sites. The development and evaluation of this event was framed by the (pre-2018) MCH Leadership Competencies including: knowledge base, ethics and professionalism, critical thinking, communication, cultural competence, family-centered care, interdisciplinary team building, and policy and advocacy. Feedback from community and Sanctuary members included appreciation for information that "allows us to go back and help the young mothers/fathers in our program," for "materials we can distribute to our sanctuary team," and for "useful resources for questions asked by the new moms who come to us." Feedback from the MCH trainees included appreciation of "community stories to help [them] learn about the real issues families face," appreciation for the opportunity "to interact with community leaders," and powerful comments about the day "making disparities real." The second annual Shared Day of Learning is presently being organized to continue this impactful collaborative event to reduce infant mortality and support children and families in inner city Milwaukee.
The Northwest Public Health Leadership Institute at the University of Washington's Northwest Center for Public Health Practice (NWCPHP) teaches collaborative leadership skills with a focus on the life-course perspective and health equity. Combining onsite sessions in Seattle with distance-based learning, the program incorporates individual and team-based learning components, including problem-based learning (PBL) cases about MCH-related challenges leaders face. Scholars assess their leadership skills, design and implement leadership projects in their agencies, and apply what they learn to their career.
Scholars, faculty, and guest presenters come from a range of roles and backgrounds working to advance health across the life course. Director Michelle Sarju, MSW, is a former midwife and a long-time MCH advocacy professional. Faculty have hailed from public health practice, various academic departments, primary care, organization development, and other areas. Guest presenters and panelists from the region bring career expertise in topics such as applying a life-course perspective to MCH leadership, using data for decision making, collaborating across sectors, resolving conflict using an equity lens, and communicating about sensitive issues. Scholars' professional backgrounds range from MCH epidemiology, to public health nursing, to youth advocacy.
That breadth of disciplines and professions reflects an intentional and strategically expansive vision of MCH. As the cornerstone of NWCPHP's HRSA-funded MCH Professionals Leadership Training Program, the Leadership Institute curriculum and program structure are interdisciplinary and interprofessional, particularly because of the life-course focus. Improving population health and equity at critical times across the life course involves many disciplines, professions, and roles working simultaneously and collaboratively on intersecting issues. The Leadership Institute is designed to both teach and model this for emerging public health leaders. This mirrors priorities of the new MCH Leadership Competencies version 4.0, which emphasizes the interprofessional nature of MCH.
School nurses in Alabama have very few opportunities for high-quality continuing education (CE), which are accessible and affordable. The Pediatric Pulmonary Center (PPC) at the University of Alabama at Birmingham (UAB) has helped to fill this need for many years. Every January, the PPC Trainees meet with the lead nurses for two local school systems, the Jefferson County Board of Education and Birmingham City Schools. These lead nurses typically have a "wish list" of topics that have been requested by school nurses. These topics, combined with areas of high priority to MCHB, inform the program for an annual CE event, which is held at the end of the school year. Trainees work as a group to plan all aspects of the event, including budget management, logistics, locating speakers, printing programs, obtaining nursing continuing education units (CEU), and handling registration.
UAB PPC Nursing Faculty Dr. Theresa Rodgers supervises this project. "The trainees learn a lot about event planning and working together as a team, including handling conflicts," according to Dr. Rodgers. "They do it all – from learning about purchase orders to introducing speakers."
The 2018 event, held on 5/25/18, had six different topics. The CEUs, breakfast, and lunch were all provided free of charge for the 60 attendees. Several PPC-specific topics, such as asthma and tracheostomy care, are requested nearly every year, while other topics, such as use of naloxone, are emerging issues. Former PPC Trainees consistently report that planning this event helps them gain confidence in interdisciplinary teamwork and leadership, as well as skills in event planning and working with community partners.
Recently, the LEND Program at Westchester Institute for Human Development (WIHD) added a new learning experience to the Interdisciplinary Clinical and Field Practice Module of their Interdisciplinary Leadership in Action Course. The new community-based site visits and post-visit full-class discussion activities support trainees in gaining insight into the practical aspects of model interdisciplinary practice. The learning objectives and pre-visit questions guide active observational experiences at community-based sites in multiple settings: a neonatal ICU; an independent specialty children’s hospital; inclusion preschool classes for children with language, communication, cognitive and motor delays and/or autism; early intervention and preschool special education classrooms at a post-acute care center; and a work-readiness program that supports students transitioning from school to work and community. Trainees make site visits in small groups with a LEND faculty member. All trainees participate in a large group discussion after the visits to share new knowledge and insights. At several of the sites, former WIHD LEND trainees, who are now on staff, host the visit. Trainee feedback on this new curricular element has been extremely positive.
For more than forty years, the Leadership Education in Adolescent Health program at the University of Minnesota (UMN LEAH) has been dedicated to improving the capacity of the workforce serving adolescents and young adults (AYA). Located within a land-grant university, UMN LEAH embraces the land-grant mission to translate and disseminate research with an aim of supporting real-world systems in making evidence-based and evidence-informed changes that positively impact young people's health and well-being. Not only do faculty embrace this core principle but it is integrally woven into our interdisciplinary fellowship curriculum, providing trainees the skills for conducting, translating, and disseminating research, and the ability to provide technical assistance and support for policies that promote youth health.
Captured under the rubric Translating Research into Practice, UMN LEAH provides a 5-part seminar series to all first-year trainees that flips the traditional "research to practice" model by starting with "practice." Focused on MCH Competencies of Communication, Family-Centered Care, Interdisciplinary Teams, and Policy and Advocacy, the overall goal of this series is to reframe how research and practice go together and build connections between academic and applied endeavors. Taught by a multi-disciplinary faculty (public health nursing, marketing/communications), these seminars provide foundational information about public health systems; dive deeply into how these systems use research; and enhance fellows' translation, partnership and communication skills.
Over the course of the seminars, and with guidance from seminar faculty, trainees are actively engaged in translating their research into user-friendly products for practice audiences. Previously, a LEAH post-doctoral trainee and faculty member created a legislative brief for the MN Governor's Task Force on Bullying highlighting UMN LEAH research on youth bullying and prevention. This brief was used in concert with Governor's Task Force testimony, to inform legislators and their staff about research relevant to the Safe and Supportive MN Schools Act, legislation that became MN law in 2014.
In addition to attending all seminars, trainees engage in a mentored collaboration with state public health agencies which could include:
This collaboration results in some research-to-practice "product" based on the needs of the system partner. Products include:
The MCH-Link Program is an innovative public health scholarship program that offers graduate-level Maternal and Child Health (MCH) courses addressing the current educational and training needs of practicing MCH professionals working in rural, frontier, and tribal reservation communities in the Rocky Mountain region. A critical shortage of MCH professionals exist in these areas due to geographic isolation, limited financial resources, few educational opportunities in their community or workplace, and family responsibilities. The MCH-Link Program is helping to bridge this gap by providing educational equity through opportunities for higher education and ultimately career advancement for the hard-to-reach MCH workforce. Funded by the Division of MCH Workforce Development at HRSA, the program has created and delivered a diverse mix of ten MCH courses (1 credit-hour online and conference-based) through state-of-the-art learning methods. Students can select course content in maternal and childhood nutrition, intimate partner violence, early childhood health including adverse childhood experiences (ACEs), adolescent health, AI/AN child development, sexual and reproductive health, and childhood obesity. Several other courses are currently under development. A MCH Certificate program was also created and launched during the first few years of MCH-Link, and is now fully funding five remote students who will complete their degree in 2019.
Through a collaborative network of MCH stakeholders, along with community, tribal, and rural public health partners, targeted marketing and outreach strategies are implemented each semester in order to recruit the hard-to-reach MCH workforce. Students who have been accepted into MCH-Link serve populations essential to the mission of the MCH workforce. They are public health and MCH nurses, home visitors, parent educators, MCH managers, consultants, epidemiologists, local public health directors, tribal head start staff, Indian Health Service employees, nutrition counselors and educators, violence prevention specialists, oral health workers, speech and language pathologists, and other disciplines. Now in its fourth year, MCH-Link has accepted and funded 75 rural and tribal MCH professionals to take the 1 credit-hour courses, and has also delivered these courses to over 350 graduate public health students. Extensive orientation and academic mentoring are provided to each MCH-Link student so that they are well prepared for graduate-level education. Some of the students have taken one course with MCH-Link, and other students have taken several courses in order to enhance their careers. Almost one-fourth of the MCH-Link students have experienced job changes representing professional advancement, or are now enrolled in another program of graduate study due to their success in the program. The majority of MCH-Link students come from Colorado (36%) and Wyoming (22%), along with Montana (16%) and South Dakota (12%). Students who live and work in other states have also taken courses with MCH-Link. Almost 25% of the MCH-Link students are American Indian and 5% are Hispanic or Latino. Tribal affiliations have included Oglala Lakota Sioux, Navajo, Southern Ute, Zia and Acoma Pueblo, and Northern Cheyenne.
Reaching the MCH workforce is proving to be a foundational step in quickly translating knowledge gained from course content into best practices, and is ultimately enhancing MCH services by helping promote the health and well-being of MCH populations in the Rocky Mountain region. Not only is this impacting the health of their clients, but the thinking and work of other professionals in their current rural and tribal environments. The program is housed at Colorado School of Public Health, Department of Community and Behavioral Health, at the University of Colorado Anschutz Medical Campus in Aurora, Colorado. It is directed by Dr. Elizabeth Greenwell, ScD and Dr. Kathy Kennedy, DrPH. Dr. Michelle Sarche, PhD serves as Tribal Liaison and Caitlin Trucksess, MPH is the Program Manager.
For more information about the MCH-Link Program, please contact Dr. Elizabeth Greenwell.
The Center of Excellence in MCH Education Science & Practice at UAB School of Public Health has teamed up with the Alabama Department of Rehabilitation Services/Children’s Rehabilitation Service to create the Pediatric Nutrition Training Modules. The modules feature foundational information designed to refresh knowledge levels pertaining to the nutritional outpatient follow-up of children with commonly seen diagnoses. Nutritionists desiring information regarding the outpatient care of children with special health care needs can use these modules to meet their professional development goals while also receiving free Continuing Professional Education (CPE) units.
The UAB LEND incorporates autism awareness throughout their daily work in clinical settings, training, and community outreach. Recent highlights include co-sponsoring the 17th Annual Alabama Autism Conference in February, which focused on "Improving Daily Life for Individuals with Autism Spectrum Disorder (ASD): Addressing Real Life Challenges," with over 500 participants attending the day-long event, including educators, clinicians, trainees, caregivers, and self-advocates. In March, LEND faculty and trainees met side-by-side with self-advocates and families to educate legislators of the benefits of funding early intervention for children with ASD to promote increased independence and better long-term prognosis and satisfaction as adults. Several LEND faculty are part of the UAB Extension for Community Healthcare Outcomes (ECHO): Autism interdisciplinary team that meets bimonthly to provide telementoring to pediatricians and other healthcare providers across the state focused on identification and intervention with children and teens with autism spectrum disorder. Community awareness activities include supporting the Autism Society of Alabama and collaborations with other local and state organizations during the month of April and year-round, including co-sponsoring and participating in the 5th Annual Autism-Friendly Birmingham Barons baseball game on April 29th, providing technical assistance and support in community sensory-friendly theater and music events, and participation in the state Autism Council. Finally, the UAB Regional Autism Network, which is housed at UAB University Centers for Excellence in Developmental Disabilities (UCEDD) in Developmental Disabilities/LEND, just finished its first year of existence, with a huge accomplishment of providing monthly education workshops for caregivers of individuals with autism spectrum disorder.
Under the course direction of Alison Schonwald, MD**, Carrie Mauras, PhD, Holly Hodges, MD*, and Arda Hotz, MD^, over 20 pediatric residents and early career primary care pediatricians attended the 1st Annual Developmental Behavioral Pediatrics (DBP) Booster Course at Boston Children's Hospital (BCH).
This two-day conference taught high-yield, relevant DBP topics for senior residents committed to primary care pediatrics and for pediatric providers newly in practice. Using innovative and adult-centered educational methods, including small groups discussions, use of technology, and case-based learning, participants boosted their knowledge in the following topics:
Faculty included DB Pediatricians, Psychologists, Primary Care Pediatricians, LEND Family Faculty member, and a Psychiatrist. This course was designed to address practicing pediatric primary care providers reported lack of sufficient skills to care for their patients with DBP needs. Despite dedicated time during pediatric residency for DBP training, these rotations often occur during internships, before career tracks are determined and when the information load is great. Revisiting this material as senior residents preparing to enter primary care (or early career) will serve to boost participant knowledge and confidence in behavioral and developmental concerns as they enter or continue in early practice. Program evaluation of the Booster is underway, and we hope to offer the course again to a wider audience.
*Current DBP Fellows
^Current LEND Fellow
**DBP Fellowship Graduates