The Division of MCH Workforce Development (DMCHWD) supports the generation and translation of new knowledge for the MCH field in order to advance science-based practice, innovation, and quality improvement in MCH programs. This month, DMCHWD shares science, innovation, and quality improvement highlights from across the network.
Obesity Prevention in Rural Care and Education Settings Compendium
In response to gaps related to childhood obesity prevention in early care and education (ECE) settings in rural areas, HRSA created a Community of Practice to facilitate and strengthen opportunities for rural ECE providers to improve nutrition knowledge and environments in ECE settings. The result is this compendium of recommendations and implementation strategies targeting stakeholders who work with rural ECE providers to support the prevention of childhood obesity for improved MCH outcomes across the life course.
Maryland Behavioral Health Integration in Pediatric Primary Care (BHIPP) Shares Research Findings through Publications and Presentations at National Conferences
Maryland Behavioral Health Integration in Pediatric Primary Care Telepsychiatry Access Program (BHIPP TAP) is a PMHCA awardee that provides support to pediatric primary care providers in addressing the behavioral and developmental needs of their patients. In 2021, BHIPP published several manuscripts and presented research at national conferences.
The first study, published in Academic Psychiatry, describes results of a needs assessment conducted with 107 PCPs from three rural Maryland regions. The main study takeaways were that PCPs were more comfortable identifying pediatric mental health problems and making referrals than providing treatments directly to their patients. However, PCP's also reported difficulty finding specialty mental health providers to refer to.
The second study, published in Psychiatric Services, describes characteristics of PCPs who use BHIPP's services. Results revealed that PCPs were more likely to contact BHIPP's warmline for consultation or resource/referral networking but not both. Further, PCPs in rural regions of Maryland were more likely to seek consultation than providers in urban/suburban areas suggesting that rural providers may be more willing to assume responsibility for providing mental health care because they recognize there is a lack of specialty care providers in their regions.
The third study, published in Psychiatric Services, describes trends in calls to BHIPP and Mississippi's PMHCA prior to and during the COVID-19 pandemic. Findings showed that compared to calls prior, there was a significant increase in: call volume, diagnostic complexity of pediatric patients who were the focus of calls, and the number of calls focused on anxiety, depression, and disruptive behaviors.
Finally, in October we presented findings from a study focused on characteristics of patients with adverse childhood experiences (ACEs). We analyzed data from more than 4,900 contacts through PCP calls to BHIPP and BHIPP co-located social worker's contacts with patients. Findings revealed that patients with ACEs for whom PCPs sought BHIPP support were more clinically severe, had more comorbid mental health conditions, and were more often taking medications than patients without ACEs.
Findings from these studies emphasize the important role of PMHCAs in increasing access to pediatric mental health care through offering training, consultation, resources and direct services as needed.
Translation of the Survey of Well-being of Young Children (SWYC) into Tagalog, Samoan, and Chuukese
Children's Hospital Los Angeles LEND
The California-Leadership in Neurodevelopmental Disabilities Program (LEND) Program at Children's Hospital Los Angeles, directed the Maternal and Child Health Bureau (MCHB)-funded Health Professional Support Program for Children with Zika Virus Infection in American Samoa and the U.S. Affiliated Pacific Basin. After working with American Samoa, the Commonwealth of the Northern Mariana Islands and Guam and traveling to American Samoa, the CA-LEND team collectively identified that developmental screening tools were not available in languages that are commonly spoken in the islands. As a response to these needs, Douglas Vanderbilt, MD, MS, Alexis Deavenport-Saman, DrPH, and Patrice Yasuda, PhD facilitated translations and back-translations of the Survey of Well-being of Young Children (SWYC) into languages commonly spoken on these islands.
The SWYC is a comprehensive screening tool for children under 5 years. It is freely available to any user, with no license required at the following website in English and in other languages. The SWYC contains a developmental domain on Developmental Milestones, along with an autism-specific screener, the Parent's Observations of Social Interactions (POSI), an Emotional/Behavioral Domain, which contains the Baby Pediatric Symptoms Checklist (BPSC) and the Preschool Pediatric Symptom Checklist (PPSC), and a section on the child's family context.
Dr. Vanderbilt, Dr. Deavenport-Saman, and Dr. Yasuda, PhD obtained a license from the SWYC developers in order to translate the survey into different languages. They worked with a language translation organization to translate 4 age-specific forms (9, 18, 24, and 30 months) into 3 languages, which are commonly spoken in American Samoa, the Commonwealth of the Northern Mariana Islands, and Guam: Samoan, Tagalog, and Chuukese. The POSI is embedded into the SWYC form for autism specific-screening for the 18-, 24-, 30-month versions, which is partly why they focused on the translation of the SYWC for these ages.
The American Academy of Pediatrics (AAP) recognizes the SWYC and noted in their policy statement on developmental surveillance and screening that providing additional developmental screening using validated tests is appropriate. The AAP also indicated that the screening tests in the SWYC on Developmental Milestones, BPSC, PPSC, and the POSI have acceptable psychometric properties.
Click this link, to obtain any of the translated surveys in Tagalog, Samoan, or Chuukese:
The surveys will be available soon on the SWYC website: SWYC Translations
Let's Create an Army of Advocates: A Video Series at Children's of Alabama
University of Alabama at Birmingham PPC
The Pediatric Pulmonary Center grantee at the University of Alabama at Birmingham (UAB) is based at Children's of Alabama (COA), the only free-standing children's hospital in the state. The hospital uses an in-house video system, call the "Get Well Network" or GWN, to provide education to families during a child's inpatient stay. When the PPC hired their first Family Leader Faculty, Linda Russo, in 2015, Project Director Dr. Brad Troxler asked her to envision creating an "army of advocates" by spreading the mission of family-centered care and advocacy throughout the hospital. With passionate support of the UAB PPC's Patient/Family Advisory Committee, this vision became a reality in 2020-21. A series of three videos was produced for GWN, with the UAB PPC PFAC members providing subject matter expertise, script consultation, and on-air narration. "This is exactly what I had in mind when Linda joined the PPC," says Dr. Troxler. "Family-centered care not only means providing excellent clinical care, but partnering with families in their journey as advocates, not only in advocating for their own child, but for all children with special health care needs."
In addition to playing on the GWN, the videos were highlighted in a recent podcast, and are available on You Tube:
- Video #1 - Checking In - introduces the role of being a caregiver for a child with an acute illness, including how to advocate with the medical team and coping/navigating resources while your child is in the hospital.
- Video #2 - Settling In- focuses on a child with a chronic illness; including finding and connecting to resources when your child is diagnosed with a chronic disease, identification of Alabama-specific support services (such as Medicaid Waivers, medical homes, Children's Rehabilitative Service (CRS), the Family Voices (FV) chapter, and the state Family to Family (F2F) representative) and connecting to other parents.
- Video #3 - Breaking Out- encourages parents and children of all ages to begin advocating more broadly, at system, community, state, regional and national levels and connecting to the broader community of organizations which focus on inclusion, advocacy, education, and disability rights.
University of Michigan Provides Long-term Developmental Follow-up in Congenital Cytomegalovirus Clinic
University of Michigan DBP
Congenital cytomegalovirus (CMV) affects 1 in every 200 children in the US, up to 30% of whom will develop long-term neurodevelopmental sequelae such as sensorineural hearing loss and cerebral palsy. Thanks to the growing number of congenital CMV newborn screening programs, more infants are being diagnosed. To capitalize on this opportunity for early intervention, the University of Michigan Congenital CMV Developmental Follow-up Clinic was established in January of 2021, spearheaded by Dr. Megan Pesch in the Division of Developmental and Behavioral Pediatrics.
The CMV clinic provides close developmental monitoring, support, and anticipatory guidance for families of children with cCMV. A diagnosis of congenital CMV is often unanticipated and frightening for families – there are seemingly so many unknowns. The CMV clinic aims to provide these families with a holding environment along their CMV journey by providing psychosocial support, answers to their questions, and tailored recommendations. Close follow-up by a Developmental Pediatrician who understands the spectrum of congenital CMV-associated developmental delays facilitates earlier and more intensive interventions when subtle signs emerge such as hypotonia, social delays and feeding difficulties. Due to the high rate of hearing loss in children with congenital CMV (which may be present at birth or develop into childhood), the clinic provides inclusive and tailored communication support around hearing aids, cochlear implants, verbal, and signed language.
Ensuring access to quality care and subspecialists for children across the state is a priority; visits are offered in person and via telehealth. The CMV clinic works closely with a multidisciplinary group of pediatric practitioners from Otolaryngology, Audiology, Ophthalmology, Infectious Diseases, and PM&R. Care coordination among sub-specialists, therapists and the primary care physician is also provided. Over the last year, 25 patients with congenital CMV have been cared for in the Congenital CMV Developmental Follow-up clinic. To expand these efforts, the group is working to establish the University of Michigan as a state-wide multidisciplinary referral center.
University of Alabama at Birmingham, Leadership Education in Adolescent Health (UAB LEAH) Promotes Resilience Through Trauma Informed Care Training
University of Alabama at Birmingham LEAH, Dr. Heather Austin
University of Alabama at Birmingham, Leadership Education in Adolescent Health (UAB LEAH) faculty, Dr. Heather Austin, reunited with her former MCH LEND supervisor and colleague, Dr. Avi Madan-Swain, to promote trauma informed care at Children's Hospital of Alabama (COA). Dr. Madan-Swain has already been recognized by UAB for leading the family centered care rounding initiative at COA. In addition, both Dr. Austin and Dr. Madan-Swain shared common experiences of witnessing an overall increase in the impact of increased trauma, especially given the pandemic, and observing the dynamic interplay between patients and their families and health care providers related to these challenges. Family centered care at its core forms the basis of trauma informed care, by promoting optimal quality care based on the family's needs, values, perspectives, and goals. Trauma informed care builds on family centered care by increasing awareness of the patient/family experience of trauma and potential impact on the family, provider, and overall care.
Drs. Austin and Madan-Swain invited key professionals from COA and UAB including faculty and administrators in the areas of medicine, nursing, psychology, social work, pastoral care, patient advocacy and professional well-being to unite and problem-solve ways training in trauma informed care can be developed and initiated at COA. Initially, work focused on assessment of staff readiness for implementing trauma informed care training as well as a measure of their work-related traumatic stress, health, and wellbeing, including assessment of secondary traumatic stress, burn out and compassion fatigue. Training at COA is based on Substance Abuse and Mental Health Services Administration's (SAMHSA's) Four R's: Realization of the broad impact of trauma on our population, Recognition of the signs of trauma, creating a system that can Respond to trauma and Resisting re-traumatization. Work groups have formed and are in the process of creating ways to assess trauma in patients and families and to develop didactic training experiences for faculty and staff based on the Four R's, with an emphasis on interactive skills practice. On method will be the use of standardized patients and simulation to assist providers with practicing communication and de-escalation strategies such as those related to the DEF framework (Address DISTRESS, Facilitate EMOTIONAL support, and Remember the FAMILY). Most recently, we were able to secure Dr. Heather Forkey, a nationally recognized leader in childhood trauma and a co-author of Childhood Trauma and Resilience: A Practical Guide (2021), for a virtual grand rounds training at UAB/COA and consultation regarding ongoing work toward trauma informed training implementation. We are looking forward to the seeing the results of the program initiative and its positive impact on patients, their families, and our health care providers.
Kylie Boyd, B.S., B.A.
Kylie Boyd is currently an Audiology Doctoral student at the University of Arizona. She has always known that she wanted to pursue a career that would help improve the lives of children. Throughout her undergraduate education, she obtained a double degree in Speech and Hearing Science and Early Childhood and Family Studies. She wanted to learn as much as possible about childhood development and what barriers to communication children and their families may face. Her background in pediatrics has lent well to her current training as a student clinician and LEND fellow. Throughout the past semester, she has had the opportunity to work with patients at the Arizona-Sonora Border Projects for Inclusion (ARSOBO) in Nogales, Mexico.
In 2010, the AROSBO clinic opened shop to construct standard and custom all-terrain wheelchairs for individuals with disabilities. In 2013, ARSOBO expanded and began creating prosthetic limbs and orthotics and the following year, partnered with the University of Arizona Speech Language and Hearing Science faculty, along with the Au.D. students, to begin providing hearing healthcare for the community. Each month, faculty and students have the opportunity to travel to Nogales and provide full audiologic evaluations and hearing aid fittings for patients across the lifespan. ARSOBO is a sustainable program achieved through the apprenticeships that this non-profit organization creates and continues to contribute to the educational experience of audiology students. Additionally, during the month when students are not present, an audiology assistant provides services and continued care to patients.
During each monthly visit, the focus is on providing quality hearing healthcare and building trusting relationships with their patients and the community. Although the COVID-19 pandemic delayed monthly visits last year, they have been able to come back with vigor. Throughout the last few months, they have been able to expand their scope of care by providing auditory brainstem response (ABR) testing, meaning that they are now able to evaluate infants and those who cannot test behaviorally. Additionally, they will soon be offering Real Ear Measures (REM) for hearing aid fittings, which can evaluate the acoustic properties of each patient's specific ear canal, providing more accurate fitting outcomes. Overall, ARSOBO is an incredible organization and clinic that provides quality and accessible healthcare to those in the community.
Kylie believes that every person has the ability to make an impact on the lives of others, and she feels extremely fortunate to be a part of the ARSOBO clinics. Every child deserves the right to quality hearing healthcare and every child has the right to reach their full communication potential. She is certain that her past experiences have provided her with a solid foundation to continue to develop her clinical skills and make a difference within the community.
Ettya Fremont, PhD, MPP
Children's Hospital of Philadelphia LEAH
I am passionate about translating scientific literature, and helping others understand how that information is (or could be) relevant to their lives. Throughout my CHOP LEAH Program fellowship, I have been fortunate enough to work with the Center for Parent Teen Communication at CHOP to practice synthesizing research in adolescent development and writing translation pieces in a way that is applicable and accessible to caregivers, teens, and others who work with adolescents. But writing is not the only way scientist-practitioners are called upon to disseminate research. We must also be able to speak to non-scientists about our research.
I had the opportunity to practice my oral communication skills through a CHOP/UPenn sponsored competition called the Three-Minute Thesis Competition (3MT). To enter the competition, I video recorded and delivered a three-minute speech about my research on parental remote monitoring of their adolescents' glucose levels. The rules also stipulated that I create a single slide that would be visible the duration of my presentation. In drafting the script and designing my slide, I learned a few lessons that I hope will help others as they think of ways to broaden their audiences:
- Use analogies to connect with your audience. Analogies are an effective way to simplify your research while making it relevant to your listeners. I asked my audience to recall their adolescence (likely) before cell phones, and to imagine that they were at a sleepover when their mother called, asking if they'd forgotten their toothbrush. By having my audience recall their reaction to their own parents' over-monitoring, I broadened the relevance of my talk to individuals, regardless of whether they have experience with Type 1 Diabetes.
- It is okay to feel as though you're leaving out information. Ask yourself, what is the biggest takeaway from your research. Then select one or two key points that you want your audience to remember (or that you find particularly fascinating); save the details for a 1:1 conversation at another time.
- Visual aids should enhance understanding and help convey a message. Instead of using words to duplicate your speech, use images to compliment your words. I talked over my ideas with friends outside of my field (another great way to practice your elevator pitches or science translation!). Ultimately, I used seesaws accompanied by light text to relay the importance of balance in parental monitoring and communication.
I recently received notification that I was one of two runners up in the 3MT competition. Not only am I thrilled about the present recognition, I am also excited to carry the above three takeaways with me throughout my career.
Arek Hidirsah, MD and Kate Rand, MD
Children's Hospital Los Angeles LEAH
Children's Hospital Los Angeles (CHLA) LEAH fellow Dr. Arek Hidirsah has been collaborating with CHLA Pediatrics resident Dr. Kate Rand for the last two years on a quality improvement (QI) project with the aim to increase access to the etonogestrel subcutaneous implant, a highly effective long-acting reversible contraceptive method, to youth seen in pediatrics clinics. Their project began with a knowledge and comfort assessment of pediatrics residents and general pediatrics faculty at CHLA related to counseling for and provision of the contraceptive implant, 37 residents and 19 faculty completed the survey. Overall, they found that there was significant variability in comfort with counseling on the benefits and side effects of the etonorgestrel implant, with the majority of respondents reporting neutral or discomfort. 77% of respondents were interested in getting trained in implant insertion. They proceeded to work together with the drug manufacturer (previously Merck, now Organon) and CHLA faculty to increase training opportunities. The result of this effort was the certification of CHLA Adolescent Medicine faculty Dr. Michele Roland as a Nexplanon trainer, and she now provides Nexplanon training to every pediatric resident rotating through Adolescent Medicine. Additionally, the training has been offered to general pediatrics faculty at CHLA, as well as residents who had already completed their adolescent medicine rotation prior to the initiation of the project.
Prior to the initiation of this QI project, CHLA only had 1/109 residents trained. 10 months after initiation 29 residents have completed the training process. Drs. Hidirsah and Rand's ultimate objective is to increase the number of providers confident in the placement of Nexplanon not only at CHLA, but also wherever CHLA trainees move on to practice. The next phase of this project will be to find clinical opportunities for residents to solidify the skills they learn in the training provided by Dr. Roland, so they can feel confident enough in the insertion and removal that they could provide this care independently in their future practices. This in turn will provide adolescents and young adults in diverse practices settings with increased access to this very effective form of contraception.
Adriana Hurley, MPH, BSN, RN
Florida International University MCH Catalyst Trainee
Adriana Hurley, MPH, BSN, RN, graduated with the first cohort of MCH Catalyst Trainees from FIU's Robert Stempel College of Public Health and Social Work. She has worked with the Miami-Dade Nurse Family Partnership (NFP) at the Health Choice Network (HCN), a nationally-recognized health services organization based in Miami, Florida, for the past seven years. She has served as NFP's Clinical Manager of Maternal and Child Health Programs since 2018. Through prenatal and postpartum home visiting, parenting education, and infant growth and development support, the NFP transforms the first two years of life of babies born to first-time, low-income mothers.
As Clinical Manager, Adriana directs maternal and child community health services within the HCN and leads Miami-Dade County's Home Visiting Collaborative Improvement and Innovation Network (HV CoIIN 2.0), funded by HRSA in support of the Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program. HV CoIIN 2.0 builds on the success of HV CoIIN 1.0, the first national quality improvement (QI) collaborative focused on advancing health equity in home visiting. HV CoIIN 2.0 uses a dynamic approach of the Breakthrough Series from the Institute for Healthcare Improvement, that disseminates evidence-based practices to achieve fast results and create a culture of change while preparing new leaders to work on QI initiatives.
Adriana is committed to mentoring the next generation of MCH leaders in South Florida. She frequently guests lectures in MCH courses at FIU and has already served as a preceptor to four MCH trainees. Under her mentorship, FIU students have been afforded the invaluable experience of taking part in HV CoIIN QI training and are already playing vital roles in improving the practice of home visiting and linking families to MCH services in Miami. Now that she is precepting students, she is proud to say she has "come full circle," in the training process and always looks forward to mentoring FIU students interested in pursuing careers in the field of maternal and child health.
University of South Carolina Catalyst Trainee
Growing up in Kentucky, Amanda Elmore witnessed many of her neighbors lose loved ones to addiction and overdose as a result of the opioid epidemic. To learn more, she studied medical lab sciences at the University of Kentucky before pursuing a Master of Public Health at Florida State University. It was during this time that she became interested in maternal and child health.
"I was hired as an abstractor with the Florida Birth Defect Registry during the Zika virus outbreak," Elmore says of her first experiences in the field. "I believe improving and supporting the health of women and children is key to a healthy, thriving population."
As a graduate scholar with the Maternal and Child Health Public Health Catalyst Program
at the University of South Carolina's Arnold School of Public Health, Elmore is integrating these two interest areas. Her project involves conducting a longitudinal study of mother and infant dyads to determine the long-term effects of opioid dependency on maternal and child health outcomes. While previous research has examined the immediate risks to maternal and infant health, Elmore's work will investigate how children with in-utero opioid exposure and mothers with opioid use disorder are impacted up to 20 years later.
"Amanda will examine the association between maternal opioid use disorder and hospital readmission over time for both the mother and the infant to assess long-term morbidity outcomes," says Nansi Boghossian, an associate professor in the Department of Epidemiology and Biostatistics. "This study will provide very important contributions to the field of maternal and child health and is highly relevant to care providers and policy makers."
The Ph.D. in Epidemiology student is one of just three students selected to join the inaugural cohort of the Arnold School of Public Health's Maternal and Child Health Graduate Scholars Program. Now in year four of her program, Elmore has published five peer-reviewed papers (four as first author). She is also a member of UofSC's Behavioral Biomedical Interface Program – a National Institutes of Health-funded predoctoral fellowship that offers interdisciplinary training in epidemiology, exercise science and psychology to better prepare the next generation of behavioral scientists – and a Board Member of the National Birth Defects Prevention Network. In addition, Elmore is the current Treasurer of the UofSC Maternal and Child Health Student Association (MCHSA) and a student representative for the Maternal and Child Health National Network.
Time with TAG
Boston University SPH, Center of Excellence in Maternal and Child Health
My interest in MCH started as an undergrad at Florida Atlantic University. Having majored in Neuroscience and Behavior with a minor in Women, Gender, and Sexuality studies, I had the amazing opportunity to work as a researcher at FAU's Infant Cognition Lab. This was my first hands-on opportunity working with both parents and babies that inspired me to pursue graduate education to have a stronger and deeper understanding of maternal and child health topics.
While working on my MPH in Health Policy and Law with a concentration in Maternal and Child Health, I spent my practicum working as a research assistant at Boston Medical center in their OB/GYN clinic. Part of my role as a research assistant was to recruit and survey patients in the clinic to better understand the degree to which pregnant women worry about experiencing pain during childbirth and the postpartum period. Specifically, comparing the attitudes of women with opioid use disorder maintained on methadone or buprenorphine to those of opioid-naive women. We were also interested in identifying other patient characteristics that may contribute to anxiety around the anticipation of pain. This experience allowed me to work alongside midwives, doulas, and OB/GYNs and apply so many concepts that I had learned throughout my program. Through this opportunity, I was able to not solidify my passion for maternal and child health but set a solid foundation for my future career in medicine.
Being a member of TAG has allowed me to network with other MCH professionals across the nation. Having started my MCH training at the start of the pandemic, it was difficult to foster strong connections throughout my program. It's been inspiring to work alongside a diverse group of MCH trainees who come from so many backgrounds but have a similar passion for maternal and child health. As I finish up my graduate program at Boston University, I look forward to continuing my work in the field of maternal and child health while staying connected to the amazing colleagues I've met through this program.
My experience with TAG built upon a foundation of skills that I began developing as a graduate student. As an MPH student and MCH Catalyst Trainee at Drexel University, I also served as the President of Drexel's Maternal and Child Health Student Organization (MCHSO). Due to COVID-19, this experience strengthened my communication skills as I led MCHSO's officers and membership. I also developed a knowledge of best practices for virtual engagement. Our group organized a variety of student led discussions of recent academic work and non-profit driven webinars that illustrated how COVID-19 directed the struggles, strategies, and partnerships of various local Philadelphia organizations. As COVID-19 rattled our international health systems and magnified socioeconomic and racial health related barriers, MCHSO worked to engage with the difficulties and disparities that we were seeing affect maternal and child health populations.
This work served as my inspiration to get involved with TAG and to continue to build strategies for increasing engagement in our new mostly virtual reality. Working with our diverse team has been a great opportunity to expand my own understanding of how best to utilize our MCH network. Our national collaborations have allowed me to continue building upon the local experiences that I had through my MPH. My ultimate goal is to amplify this network's unique professional development and service opportunities to enhance our shared learning environment for all current and former trainees.