DMCHWD promotes innovation and quality improvement through such projects as the Diversity & Health Equity Learning Collaborative and the Children's Healthy Weight CoIIN. This month, DMCHWD highlights several of the ways our grantees and programs engage in science, innovation, and quality improvement to support MCH.
The Health Resources and Services Administration (HRSA) recently awarded approximately $7 million through the National Health Service Corps Loan Repayment Program (LRP) and the Leadership Education in Neurodevelopmental and Other Related Disabilities (LEND) program to combat the Zika virus and meet the health care needs of people living in Puerto Rico, American Samoa, and the U.S. Virgin Islands. Grantees receiving support through LEND include the University of Miami, Children’s Hospital of Los Angeles, and Trustees of Indiana University. These recipients will use methods such as training, clinical consultation through telehealth, and interdisciplinary clinical care through telemedicine to support a range of local health professionals treating children exposed prenatally to the virus.
In Fiscal Year 2016, $47 million was invested in 152 DMCHWD MCH leadership training and workforce development grants. These grants helped to support 2,100+ long-term trainees, 2,000+ medium-term trainees, 25,000+ short-term trainees, and 280,000+ professionals. Additionally, over 2,000 peer reviewed publications were contributed by MCH Training Programs. The Division is proud to support the work of nearly 100 grantees.
The National MCH Workforce Development Center offers an online, interdisciplinary course designed to prepare participants to contribute successfully to state and national health transformation. The course, "Applied Methods for Health Transformation Implementation in MCH", is open to any MCH professional interested in lifelong learning AND to students enrolled in any of the MCHB-funded Graduate Education Programs to Educate the Next Generation of MCH Leaders (CoE, Catalyst, LEND, LEAH, DBP, MCH Nutrition, and PPC Programs). Course participants may elect to earn graduate credit (1 or 3-credits) or a certificate of completion.
Students and professionals benefit from engaging and interacting with each other via the online learning platform. By viewing online lectures and presentations, sharing experiences and ideas in weekly discussion forums, and responding to varied assignments, course participants gain essential competencies in evidence-based decision making, implementation, systems thinking, and change management. By having a mixed cohort of credit-seeking and certificate-seeking participants from interdisciplinary graduate programs and state Title V programs, course participants are able to network with an enthusiastic and skilled online learning community.
The course was intentionally designed as a means to bring Center knowledge, expertise, and tools into the academic setting for MCH training. Many of the weekly modules were developed in partnership with Center staff and feature recently-developed Center products, such as briefs related to MCH financing, summaries of trends in health transformation, and recorded lectures/presentations on quality improvement, systems thinking, and leadership. Having access to MCH professionals working in the field helps to illuminate the broader context for health transformation in MCH. Course participants are invited to apply their learning directly to their professional experiences and goals and to consider implications and opportunities for Title V programs.
Demand for the course has exceeded expectations. The course has been offered twice previously, and will be held again in Fall 2017. There are no course prerequisites. Learning is asynchronous. Registration is open now on the Center’s website.
For more information, please contact Rebecca Greenleaf, MPH, Adjunct Faculty in the Department of MCH at UNC-CH.
In October 2015, the American Academy of Pediatrics (AAP) engaged Altarum Institute to provide Technical Assistance (TA) to the Healthy Tomorrows Partnership for Children Program (HTPCP) grantees on conducting Return on Investment analyses. Over the course of one year, Altarum provided TA to eight HTPCP grantees on how to use their evaluation data to conduct economic analysis that may be appropriate for their programs, including Return on Investment (ROI) analysis, cost effectiveness analysis, or cost benefit analysis. From the project, Altarum developed a set of Return on Investment tip sheets to provide HTPCP grantees and other community-based MCH programs the opportunity to conduct economic analyses of their program interventions.
CoIINs bring states and partners across geographic areas, sectors, and organizational silos together. CoIIN is a rigorous methodology that is action-oriented, data intensive, has ‘SMART’ focused aims, clear strategies grounded in the best science, and clear metrics. The Children’s Healthy Weight CoIIN, coordinated by the Association of State Public Health Nutritionists (ASPHN) , supports MCH State Title V Programs to adopt evidence-based or evidence-informed policies and practices related to nutrition, physical activity, and breastfeeding to promote healthy weight among all children, including those with special health care needs. It strengthens states’ efforts to address the National Performance Measures (NPMs) as well as the National Outcome Measure (NOM) related to childhood obesity management and prevention. In July 2017, 23 states applied to participate in Phase 1 of the Children’s Healthy Weight CoIIN.
Q: What is the name of your project?
CBW: Our project is titled The Maternal and Child Health Training Program. It is a collaboration between the UTHealth School of Public Health, Austin and the Grand Valley State University, Michigan, co-directed by Dr. Joan Borst and myself (Dr. Courtney Byrd-Williams).
Q: What is your project trying to achieve?
CBW: We aim to increase capacity in rural health workers serving maternal and child populations to address public health issues. We develop training modules on an online portal, edX, to equip rural MCH workers with crosscutting competencies. Our trainings are interdisciplinary and free of cost, and are developed keeping in mind the training needs of the MCH workforce in rural areas. A second part of the program is training students in our fellowship program in MCH Leadership skills. These fellows develop the trainings for rural health workers, and are closely guided and supported. In the process, they are learning how to identify capacities that need strengthening among a workforce and determine how to address them with training.
Q: What are the next steps for reaching rural health workers?
CBW: We are looking to expand our reach across HRSA region VI. By building partnerships with organizations in each state, we will be able to develop new training content that serves a broader diversity of health workers. We have been working with smaller, home-visiting organizations and Community Health Workers so far, and are eager to learn about the training needs of other professional groups in clinical and health department settings over the coming year.
Q: What community partners are involved in your MCH Training Program?
CBW: The success of our program stems from our broad range of collaborations and partnerships. We have community partners such as Texas Public Health Training Center; Healthy Start in Dallas (TX), Hugo (OK), and Lafayette (LA); Go Austin, Vamos Austin; and the Michael and Susan Dell Center for Healthy Living. All of our collaborators have been very helpful in supporting the first round of trainings. Of course, other organizations have also participated in our trainings and we are always looking to expand our partnerships.
Q: What is your process for developing trainings and evaluating them?
CBW: Once a training topic is determined with a partner, we develop a curriculum committee to discuss the contents of the training and develop a plan. We research, develop, and revise internally. When the content is finalized, we send the training to content experts. The curriculum committee members and others in the community run through the training and provide thorough feedback. We talk with the curriculum committee about edits and then revise. Then, the training goes to the Texas Department of State Health Services for their review process and certification. We have not started evaluating learning outcomes yet, but plans are in the works and we do have some data to begin examining!
Q: What does your fellowship program include?
JB: The MCH Leadership seminar is aimed at teaching through faculty and guest lectures, readings, and learning modules created by fellows to train public health clinic staff. Women and children are consistently some of the most vulnerable in the world in terms of poverty, lack of education, weak human rights and abusive or absent policies. As part of an educator team, we try to build a platform for discussion regarding the lifespan of development as well as many of the above outlined issues, ultimately hoping to empower students to engage meaningfully with the MCH community, both personally and professionally.
In this program, we train fellows from various healthcare fields and prepare them to become a valuable part of the rural MCH workforce. Our fellows are from diverse professional backgrounds and bring a plethora of skills and knowledge to this program from their varied experiences. The development of these learning modules has also been of great benefit to the fellows as they research and think creatively about the best ways to share information online. The creativity at every level of the project has been delightful to be a part of and observe.
Q: Why interdisciplinary training for rural health workers and fellows?
JB: The grant is inter-professional in nature. Social work and public health drive the curriculum, but in reality, the best efforts we can make for women and children will come from disciplines working together for the benefit of women and children. Sharing professional knowledge across disciplines benefits all.
As I mentioned earlier, the reality of public health and social interventions to teach, support and lift up the needs of women and children’s health cannot be accomplished by one profession. It is important that we learn about what other professions do so that we can refer appropriately, respect the efforts of our colleagues from other professions, and strengthen our efforts through better planning. Inter-professional training efforts reduce the barriers of reaching out to other professionals and strengthen the efforts we make on behalf of the MCH community.
Q: Tell us about how the GVSU and UTHealth partnership has benefited the program.
JB: The MCH Training grant has a couple of distinct benefits for educating our students. Since both these universities differ geographically and demographically, there is a unique contribution from each, which adds to the versatility and broad-ranging application of our trainings in the real world. Although we learn about differences through this wider geographic lens, we also see what women and children have in common, despite geography--a desire for healthy and safe bodies, healthy and nurtured babies and children, resources to answer questions, and support for potential problems.
Finally, completion of the fellowship aspect of this training grant has benefited students in their job-seeking efforts. Agencies and clinics are looking for professionals who come prepared to think critically about programming and services to the MCH populations.
Q: Has the project experienced challenges/anything that was not anticipated?
CBW: There isn’t a well-developed infrastructure in rural areas in terms of public health and that makes it difficult to assess the needs of the MCH workers in these areas. We need to find new ways to get the word out to organizations that we will work with them to develop tailored training content.
JB: This project has grown significantly in the past 2 years, adding new complexity to our team’s operations. Although we experienced technological challenges initially, the work has moved forward more rapidly in the last 12 months with the creation of online modules that bring “the classroom” to the clinic workers.
Q: Anything you'd like to add?
JB: While we often face challenges with respect to setting up lectures and meetings across two different states and time zones, it is well worth the efforts we all make to find a way to connect Texas and Michigan. Students and faculty greatly benefit by contributing and hopefully find the environment a safe one where they can challenge their misunderstandings and examine their perspectives. I look forward to the coming academic year!
Twelve undergraduate students from various colleges across the University of South Florida (USF) have been accepted into a Maternal and Child Health (MCH) Pipeline Training Program, known as MCH Train-A-Bull, at the USF College of Public Health's Department of Community and Family Health (CFH).
The two-year program provides mentorship, training, and guidance for underrepresented undergraduate students from economically, educationally disadvantaged, and diverse backgrounds.
Funded by the Maternal and Child Health Bureau within the Health Resources and Services Administration, the program aims to increase the diversity of the MCH workforce by supporting scholars who seek graduate training in MCH and health-related fields.Click for more information about the MCH Train-A-Bull Program
The Intensive Family Services Program (IFSP) at Youth & Family Services, Inc. (YFS) provides comprehensive, coordinated, individualized services for children and their families. IFSP targets families whose children are at risk for out-of-home placement—whether through the juvenile justice system or residential drug/alcohol treatment facilities—due to behavioral health issues. A majority of the children served come from low-income and/or American Indian families. Principal goals of the program are to increase family functioning, improve individual family members’ overall health and well-being, and provide a cost-effective alternative to the community and state.
IFSP is a community-based initiative first piloted in 2014 in the Rapid City area. The program developed from a focus on community mental health needs by the grassroots Rapid City Systems of Care Collaborative (SOCC) and implemented by YFS. IFSP staff, families, and youth work in partnership with informal supports, schools, mental health centers, psychiatric treatment programs, social service agencies, juvenile justice programs, and primary health care organizations to design services that are coordinated, individualized, community-based, and youth and family-driven. A central core of service provision is the IFSP Team, which works toward the goal of “One Family, One Team, One Plan.” A team is organized based on the individual needs of each family and typically meets once per week with family members and their support system until a plan is in place and the family is successfully working toward their goals. The Team meets with the family to discuss wraparound services that build on increasing the strengths of individuals, nurture their healthy growth, and address each person’s cultural and linguistic needs.
IFSP is establishing new relationships with the South Dakota Title V Office of Maternal-Child Health/Child & Family Services, local membership of the American Association of Pediatrics (AAP), and the Community Health Center of the Black Hills. IFSP contracts with an external evaluator who is working closely with program staff to employ assessments that explore improvement in child behaviors, parent stress, and family functioning. The evaluator is also tracking increased access to medical, dental, and mental health homes. The evaluation will include a cost-benefit analysis comparing out-of-home placement with the program.Click for more information about the Intensive Family Services Program.
The Ohio Chapter, American Academy of Pediatrics offers Quality Improvement programs to pediatricians that improve performance and outcomes for children, and many of these programs have been possible thanks to the support of a Healthy Tomorrows Partnership for Children grant that began in 2013. Since that time, the Ohio AAP has used the successful Injury Prevention Learning Collaborative as a model to develop other injury prevention QI programs, offered in a variety of methods and settings.
The goal of the LEND Program Quality Improvement (LPQI) Network is to help individual programs improve the quality of LEND training in core competencies (e.g. family-centered care, interprofessional teaming) by: (1) using standardized measurement tools, (2) developing a voluntary inter-institutional database, (3) providing feedback to programs to use for quality improvement, and (4) identifying programs that demonstrate changes consistent with “best practices.” The effort began in 2013 with the creation of appropriate measures and the design of a web-based data entry system. Each stage of development has been pilot-tested and, to date, has included the input of 21 LEND programs.
This past year, 11 LEND programs successfully completed beta-testing of a fully functional data entry system that also enables administrators to run visual data reports – comparing their results to national averages across years, disciplines, and other variables. We also presented data at a national meeting to help demonstrate the validity of the measures, and a manuscript has been submitted to the Journal of Graduate Medical Education for publication. In July 2017, the LPQI Network was opened to all LEND programs for use during the 2017-18 training year; leadership for the Network has been transferred from the Mailman Center (FL LEND) to AUCD. LEND programs that choose to participate can use their LPQI data reports to determine areas for improvement, devise and implement quality improvement plans, and measure outcomes in subsequent years.
The LPQI data dashboard and Network coordination activities are technical assistance tools offered by AUCD to LEND programs. It is not endorsed by or required by MCHB.
The LEND Outcomes Study is designed to compare outcomes for professionals or advocates with an interest in pediatrics who received formal LEND training to others from their graduate program or community with similar pediatric interests but no LEND training. The model is inclusive of family and self-advocates. Our fundamental question: Do responses to the 14 questions on the NIRS Graduate Survey (a survey specific to LEND grantees) differentiate LEND graduates from peers with similar pediatric interests who have not received LEND training? One supplementary question: Does participation in the LEND Outcomes Study improve NIRS survey participation rates for LEND graduates?
The LEND Outcomes Study began in 2014/2015 in Pittsburgh. While the initial plan was to demonstrate feasibility at one site, the LEND of Pittsburgh was joined in year 1 by the Nisonger and Waismann Centers. These 3 programs will be starting year 4 of their work this fall. In addition to this core group of 3 participating LEND programs, we have been joined by 7 additional sites (UC, UCONN, IOWA, KANSAS, ROCHESTER, TEXAS, and VERMONT)—10 total sites participating. Current efforts are focused on dissemination of the outcomes model to additional LEND programs and developing supplemental questions that can be used along with the NIRS Graduate Survey to measure the effects of LEND training. Feedback from other LEND centers has suggested that the primary challenge faced by this outcomes evaluation is a shortage of resources to implement the project and sustain the work. Issues related to institutional review boards (IRB) have also been raised. The three initial sites are in the process of developing a set of open and closed ended questions that can be asked of LEND graduates and comparison peers from 2014/2015 to supplement NIRS and demonstrate proof of concept.
Healthy Tomorrows grantee, Clinic in the Park in Santa Ana, CA, recently was selected as a poster winner at the 2017 Practical Playbook National Meeting for their poster entitled “Clinic in the Park: A One-Stop-Shop Model Bridging Medicine to Public Health."
Pipeline Training Program
Four years ago, I was introduced to the Maternal and Child Health-Pipeline Training Program (MCH-PTP). As an undergraduate student nurse passionate about addressing healthcare disparities within minority populations, in my eyes, MCH-PTP was the perfect opportunity for me to learn more about my field and to network with healthcare leaders. For the 2014-2015 academic years, MCH-PTP offered me the opportunity to learn under the mentorship of a well-respected clinical assistant professor at the University of Wisconsin— Milwaukee College of Nursing. I was able to collaborate with her on an extended research project and presented at the University of Wisconsin Milwaukee (UWM) Systems Symposium in April 2015. As a result of my experience, I fell deeper in love with research and interdisciplinary studies so much that it has greatly influenced my future career trajectory.
Furthermore, through the 2015-2016 academic year, MCH-PTP granted me and three other UWM students the opportunity to embrace our untapped talents. Through a well-respected strength-based psychology assessment, Strength Finder 2.0, we were able to magnify our natural strengths and work as a team to develop and participate in several group projects. Specifically, we developed an “MCH Project of the Year,” which essentially moved the pipeline back to the middle school level to mentor at-risk youth in hoping for their future and planning for college. Through this experience, we completed a “Student Inspirational Gallery Walk” and a public speaking video entitled, “Hearing our Words & Honoring our Grit.”
Recently, as a MCH Trainee Ambassador, I had the opportunity to travel to the 2017 MCH Making Lifelong Connections Conference in Seattle, Washington. I was able to network with MCH leaders from across the nation and able to share the work MCH-PTP completed with our students in Milwaukee. As a recent graduate from the University of Wisconsin—Milwaukee College of Nursing and a new Registered Nurse, reflecting on my experiences with MCH is quite humbling. In fact, I am reminded of the countless times I felt unsure of myself and questioned my abilities as a scholar. MCH-PTP continuous mentorship was not only uplifting, but also exerted a relationship that allowed me to excel in ways I would have never imagined! Acceptance into MCH-PTP and TAG has helped me cultivate my goals and has greatly influenced my career trajectory today. Collaborating with TAG members has connected me with future leaders and current MCH leaders and challenged me to embrace talents learned from the Strength Finder 2.0 assessment. This opportunity has been life changing! I am excited to continue growing and learning from my peers.
Prior to starting my Masters in Public Health at the University of Washington’s Center of Excellence in Maternal and Child Health (MCH), I had the opportunity to study and work on a variety of projects that eventually drew me to MCH. As an undergraduate Environmental Studies student, I researched in Vietnam with an organization called Project Gaia Inc., studying indoor cooking with ethanol fuel and stoves. After graduating, I worked as an AmeriCorps member on the Blackfeet American Indian Reservation and focused on building capacity through the Blackfeet Teen Pregnancy/Parenting Coalition. From there, I joined the Public Health Associate Program with the Centers for Disease Control and Prevention (CDC), and was placed at a local health department in Ft. Lauderdale, Florida where I focused on STI/HIV prevention. Listed on paper, my path to MCH seems winding, but as I was working in these positions, I felt that MCH was a common thread between them.
Through my experiences, I began to consider how healthy mothers, children, and families are the foundation of healthy communities, healthy societies, and a healthy planet. I also thought about the distribution of resources and the distribution of disease, and how good health is often connected to wealth. In contrast, income inequality, racial discrimination, and gender discrimination are often connected with poor health outcomes. For example, it is often the poorest mothers who cook with wood fuels because they cannot afford clean-burning alternatives. As a result, they and their children often suffer from the negative health impacts of indoor air pollution from wood smoke. In the US, adolescent women in general, and low-income or minority women in particular, often face stigma in the healthcare system. Understanding the importance of MCH and the disparities within it led me to a passion for health equity, and a desire to ensure that all women have the freedom, opportunities and resources they need to raise children in a healthy and supportive environment, if they decide to do so.
My time working with the Trainee Ambassador Group (TAG) has helped me to understand how other MCH professionals are working in different disciplines, including medicine, nutrition, and developmental sciences, to reach similar goals. Addressing issues of health inequity and promoting health across generations are difficult tasks that will ultimately require collaboration between people of different backgrounds, with different perspectives, and in different sectors and focus areas. I think the TAG has been an excellent way to start building those partnerships, and working to connect MCH professionals who will help to solve future issues in MCH and in public health.
MCH Nutrition Leadership
In 2015, I became an MCH Nutrition Leadership Trainee at the University of Washington (UW). At the time, I was entering the second year of UW’s Graduate Coordinated Program in Dietetics (GCPD) – a program designed to equip future dietitians with the knowledge base to work both at the individual and systems levels. While the program highlighted many facets of nutrition, I was drawn to topics that served the MCH population. In particular, I was struck by the concept of the Life Course approach and the potential to impact health disparities early in life. This interest developed into a passion for breastfeeding and opportunities to empower breastfeeding families. With the encouragement of my MCH Traineeship advisor and GCPD peers, I took a deep dive into breastfeeding. I began to focus most assignments on topics surrounding lactation and completed my thesis on the drivers of breastfeeding policy adoption in Washington State Clinics. As an MCH Trainee, I continued to expand my understanding through participation in annual trainee conferences and collaborative discussions with fellow MCH Nutrition Trainees. Each of these actions, paired with my public health nutrition training, led me to value the impact of multilevel strategies upon breastfeeding and other aspects of MCH.
While my long-term goals to pursue higher education and research remained, I began to rethink my first step out of graduate school with a new appreciation for each level of the system. To influence breastfeeding at the policy level, I wanted to first experience breastfeeding at the individual level. With a new degree and credential in tow, I accepted a position as a Nutritionist-RD at a local community health center WIC program. I also joined the Maternal Child Health Bureau Traineeship Ambassador Group (TAG).
As a WIC Nutritionist-RD, I see the downstream effects of policies and the resilience of families. In particular, the topic of breastfeeding continues to stand out in my daily endeavors. I built a basic knowledge of breastfeeding through my training, yet I learn more each day from families who push beyond the aggressive marketing strategies, social stigmas, and lack of paid parental leave to provide the best start for their children. I am grateful for the opportunity to invest in future generations through these one-on-one interactions.
As a TAG Ambassador, I collaborate with peers who share a similar passion for the MCH population. Each of us brings a unique strength to the projects at hand and subsequently reinforce the value of interdisciplinary, multi-level strategies. The emphasis of the Maternal Child Health Bureau’s (MCHB) Division of MCH Workforce Development (DMCHWD) to build relationships and networks across professions has been a key driver in my professional experience and time with TAG. I look forward to maintaining and building additional connections with the MCH community.
Third year UCSD DBP Fellow Dr. Sai Iyer is highlighted in Pediatric News for her research on the 10-item Early Literacy Assessment Tool (ELSAT), which is used to screen preschool children for delayed literacy skills.