happy children, mother and child, and expecting mother and father

Science, Innovation and Quality Improvement

The Division of MCH Workforce Development (DMCHWD) supports advancements in science-based practice, innovation, and quality improvement in MCH training, policies and programs. This month, DMCHWD highlights examples of science, innovation, and quality improvement from across the MCH network.

Division Highlights

DMCHWD provides national leadership and direction in education and training our nation’s current and future leaders in maternal and child health. Highlights from 2017 include $47 million invested in 161 grants to support long-term training of 2,190 trainees and over 290,000 professionals. In addition, the Healthy Tomorrows Partnership for Children Program served over 250,000 individuals.

Virtual Grantee Meeting Exit Disclaimer

DMCHWD recently held the 2018 DMCHWD Grantee Virtual Meeting on “How to Tell Your Program’s Story to Key Stakeholders.” The meeting addressed how to compose and share program stories from a high-level perspective, emphasizing effectiveness, impact, and interaction with key audiences. It also underscored the value of building and establishing relationships with decision-makers, state agencies, community organizations, and more.

Preventing Childhood Obesity Challenge

The Challenge supports low-income families through the development of low-cost, scalable technology-based innovations to promote healthy weight and healthy lifestyles within the home environment.

Phase 1 winners will be announced soon with awards of up to $10,000 each. In Phase 2, the 7-10 winners from Phase 1 will focus on the development of their proposed intervention and small-scale testing with the support of mentors. Phase 2 winners will be announced in Spring 2019 with awards of up to $25,000 each. In Phase 3, the 3-5 winners from Phase 2 will be able to test their proposed interventions on a larger scale. One Phase 3 winner will be awarded up to $150,000 in Fall 2019.

Pediatric Mental Health Care Access Program Awards

HRSA recently awarded approximately $7.9 million to support 18 states in integrating behavioral health into pediatric primary care using telehealth. State or regional networks of pediatric mental health teams will provide teleconsultation, training, technical assistance and care coordination for pediatric primary care providers to diagnose, treat and refer children with behavioral health conditions.

2017 Highlights - Infographic

DMCHWD provides national leadership and direction in education and training our nation’s current and future leaders in maternal and child health. Highlights from 2017 include $47 million invested in 161 grants, which include support for the long-term training of 2,190 trainees and continuing education for over 290,000 professionals.


Program Highlights

Children's Healthy Weight CoIIN is Structured for Success

Using a state-to-state network, the Children's Healthy Weight Collaborative Improvement and Innovation Network (CHW-CoIIN) Exit Disclaimer supports MCH State Title V Programs in adopting 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. This program, coordinated by the Association of State Public Health Nutritionists (ASPHN) Exit Disclaimer, strengthens states' efforts to address National Performance Measures (NPMs) Exit Disclaimer as well as the National Outcome Measure (NOM) Exit Disclaimer related to healthy weight.

map graphic showing participating states.

Using CoIN methodology, the CHW-CoIIN is gathering best practices and will act as a catalyst for programmatic and systems-level change, accelerating improvement and innovation to achieve the greatest collective impact at the state level. Comprised of 18 state teams representing 13 states, including Arkansas, California, Florida, Iowa, Indiana, Louisiana, Nebraska, Nevada, North Carolina, North Dakota, Oregon, Texas and Wisconsin, the CHW-CoIIN includes three work streams: breastfeeding (BF), physical activity (PA) and innovative nutrition integration (INI). For the past year, the state teams have been working in either the BF or PA work stream and starting in Fall 2018, states will start working on the INI work stream, in addition to their BF or PA work. The aim of the INI work stream is to innovatively integrate nutrition into Title V MCH programs, with a focus on capacity building and infrastructure.

According to Marci Brewer, Louisiana's Team Lead, "This process gives us a low risk way to test out strategies with a level of additional support." Skylar Swords, Florida's Team Lead, concurs. "The opportunity to have so many resources and see what other states are doing is one of the best aspects of participating in the CoIIN. It gives us a chance to conduct in-depth work with the support of an outside organization."

The evidence-based and evidence-informed policies and practices initiated by CHW-CoIIN state teams are focused on supporting physical activity, breastfeeding, and optimal nutrition, all of which help mothers and their children shape healthy habits for life.

Key partners in the CHW-CoIIN include the Association of Maternal and Child Health Programs (AMCHP) Exit Disclaimer , the U.S. Breastfeeding  Committee (USBC) Exit Disclaimer, the National Physical Activity Society (NPAS) Exit Disclaimer, and Young Invincibles Exit Disclaimer . The CHW-CoIIN aligns with other MCHB investments, including Healthy Start, Home Visiting, and Early Childhood Comprehensive Systems, and builds on lessons learned from the Pediatric Obesity Mini CoIIN Exit Disclaimer.

More about the Children’s Healthy Weight CoIIN can be found on the CHW-CoIIN infographic Exit Disclaimer.

landscape photo of WisconsinChildren's Healthy Weight CoIIN - Highlight on Breastfeeding Team in Wisconsin

The Children's Health Weight CoIIN (CHW-CoIIN) includes Wisconsin as a state team focused on breastfeeding. Team lead Shawn Meyer shared the following about Wisconsin's project.

We started our work by partnering with the Wisconsin Breastfeeding Coalition and forming the WBC Worksite Committee which includes representation from local and tribal health departments. We started our work with two PDSA cycles assessing what local businesses may want out of a statewide recognition program including what they currently offer employees, how they may want to be recognized and who they want to be recognized by. During that process, one theme that resulted was a need for more funding to support the creation of lactation spaces. We budgeted $2500 to create 10 mini-grants of $250 each to help with the creation of lactation spaces with the purpose to improve lactation services and policies within workplaces and to address disparities in lactation support offered to women of various backgrounds and experiences. We launched this initiative during Breastfeeding Week. The mini grant application asked applicants to describe how the project would promote and/or support breastfeeding among employees, especially among groups of women who may be less likely to breastfeed their infants. Examples included: creating/improving a dedicated lactation room (space, chair, table, artwork, printed materials, lock changes), developing/providing educational materials in multiple languages, etc. A lactation policy was a requirement of the project. The applicant had to be working with a local or tribal health department for support with the lactation policy and creation of the lactation space or support materials.

Successes include meeting monthly with our core team as well as our WBC Worksite Committee. This has provided the opportunity to continue efforts consistently and keep the momentum of the CHW-CoIIN going. We have had a dedicated group of WBC Worksite Committee members that have offered their expertise on their communities, breastfeeding and local efforts. Our core team included representation from the Wisconsin Breastfeeding Coalition, the Nutrition Coordinator from the Wisconsin (WI) Department of Health Services (DHS) Chronic Disease Prevention, WI DHS Maternal and Child Health Program, a local tribal agency, a local health department, a local university system and our DHS Quality Improvement (QI) director. We were grateful to have our QI Director involved in our core team. She has provided us with a wealth of knowledge and expertise related to the Plan-Do-Study-Act (PDSA) cycles and structuring of the mini grant application.

landscape photo of OregonChildren's Healthy Weight CoIIN - Highlight on Physical Activity Team in Oregon

The Children's Healthy Weight CoIIN (CHW-CoIIN) includes Oregon as a state team focused on physical activity. Oregon's CHW-CoIIN project is focused on accelerating progress in implementing new physical education standards and laws, adding more physical activity to the school day, and strengthening education and public health partnerships to improve health and well-being of students and staff.

The project includes two components. The first was focused on revising state standards for health and physical education curriculum. They also created a new flowsheet that informed partners on how to better align their curriculum with state standards.

For the second component, they wanted to better understand what school administrators felt their opportunities and barriers to physical activity before, during, and after school were. They engaged three different districts in three counties by holding focus groups. The first district they engaged was just outside the metro and had a total of 21 schools. Oregon's team had all 21 school principals and the cabinet for the school district attend and participate! They had similar successful engagement with the other two districts.

Team lead Jennifer Young says she was extremely impressed with how much physical activity was already happening in the schools. Through this process, the team learned that physical activity was very valued among these schools.

Jennifer explained that their CHW-CoIIN team met once a month to plan these focus groups. They used the PDSA cycle to review and change their plan many times. She says one of the most important things they did was to have a principal who was not a part of their focus groups read their questions in advance. This allowed someone from the target audience to provide their input. This helped reduce the jargon in some of the questions and helped rephrase questions in a way that would appeal to the principals and help the team get the best information.

Together, these two projects are beginning to address the immediate need in schools for supplemental physical education and activity curricula that align with the state standards. It has also provided the chance to learn directly from school leadership about opportunities and barriers to fulfill the physical education and activities requirement in schools for all students. These learning opportunities will assist in addressing professional development, technical assistance and training needs.

Grantee Highlights

Healthy Tomorrows for New Britain Teens

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."

Boston Children's Hospital Healthy Tomorrows & Leadership Education in Adolescent Health (LEAH)

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.

LEAH Program at the University of Minnesota

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.

Trainee Highlights

Trainee Ambassador GroupNatasha Ludwig "Time With TAG"

The day my little brother was born was the best day of my life. Although he crashed my fifth birthday party with his early arrival, I quickly forgave him when I realized I was finally a big sister. My brother immediately became my best friend and I was proud of him, so proud I dubbed him "King of the Babies." I would show him off to everyone, even strangers in the grocery store: "Guess what? My brother can say DOG! Say DOG!," and he would. However, when my brother was two years old, he stopped saying "dog." In fact, he stopped speaking altogether. Several months later, my parents came home after a doctor's appointment and told me he had been diagnosed with autism, and he may never talk again. In that moment, I didn't know what autism was or what this meant for my brother and family, but I told him not to worry because I promised to help him talk again. While I did not know it at the time, it was this promise that would guide me to the field of maternal and child health.

In the years after my brother’s autism diagnosis, I became interested in child development and how to optimize outcomes for individuals with neurodevelopmental disabilities. I went on to obtain a doctoral degree in clinical psychology at Georgia State University (GSU) where my clinical training and research focused on pediatric neuropsychology and the early identification of autism and other neurodevelopmental conditions. When I became a Maternal and Child Health Leadership Education in Neurodevelopmental and Related Disabilities (LEND) fellow during my graduate training, I was excited about the opportunity to expand my understanding of the health and educational systems that impact the children and families I work with to enhance my practice. Through my experiences as a LEND fellow, both at GSU and currently as a pediatric neuropsychology resident at Kennedy Krieger Institute, the experiential learning opportunities have not only enhanced my knowledge of systems, but have guided and shaped my values as a clinician, researcher, and advocate. 

One of the greatest aspects of my LEND training has been the opportunities for learning through collaboration with colleagues and families. My work on interdisciplinary care teams has emphasized the value of care-coordination and the benefits of providing family-centered care in optimizing outcomes. The opportunity to work on collaborative community projects with family members and clinicians from a broad range of disciplines showed me the importance of reflecting on and learning from the process just as much as the outcome. These experiences have also encouraged me to work to empower others by finding the most effective balance of humility and confidence in the approach I take to my work; something I will continue to look to my mentors, colleagues, and interactions with children and families for guidance. My interactions with self-advocates and family member advocates have also shown me that being a good leader means sharing power, not withholding it, from the stakeholders impacted by the decisions made. Through school meetings and community leadership trainings, I have collaborated with parents and colleagues who have asked important questions, which have challenged me in ways that have enhanced my work.

My LEND experiences have also provided me opportunities to broaden the scope of my knowledge and skills within the realm of systems of care and policy. Through my fellowship at GSU, I was able to attend the annual meeting for the Association of University Centers on Disability (AUCD). Here, I observed collaboration and dissemination of ideas between leaders from various states to facilitate problem solving on a systems level, while also learning the importance of being intentional about making scientific writing and presentations accessible to a broader audience of consumers, stakeholders, and policymakers. Attending Disabilities Day at both the Georgia and Maryland state capitols with a group of self-advocates and family members also enhanced my understanding of the legislative process and showed me the power of sharing a story. I am looking forward to the fellowship opportunities I will have next spring working at the Maryland Center for Developmental Disabilities to follow legislation related to healthcare and education that impacts the families we work with at Kennedy Krieger Institute and partner with colleagues, self-advocates, and families in their efforts.

I am honored to serve as a current member of the Maternal & Child Health Bureau’s (MCHB) Division of MCH Workforce Development Trainee Ambassador Group (TAG). This experience continues to broaden my opportunities to learn from and collaborate with colleagues from various disciplines in a shared effort to strengthen the connection between trainees and MCHB. We have been working on some exciting new initiatives this year that will provide new ways to stay connected with MCHB.

Although I made a promise to help my brother, it was really he and all of the children, families, and colleagues I have encountered through my professional and personal endeavors who have helped me, guided me, and shaped my values in the work that I do. While my brother remains minimally verbal, his many strengths, including his ability to make any stranger smile with his friendly fist-pound in greeting, continue to make me so proud. His strengths and the strengths I see in so many of the children, families and colleagues I work with continue to inspire and motivate me to cultivate and utilize my own strengths within the realm of MCH.

Mei Elansary

Boston Children's Hospital - Division of Developmental Medicine, 2nd year Fellow

Mei is interested in understanding how caregiver beliefs and practices impact childhood development in order to improve childhood outcomes, especially in underserved populations. Her research project “Caring in Adversity” explores the role of caregivers’ beliefs about early childhood development on developmental outcomes in the context of adversity.

Caring in Adversity - Significant adversity in the first years of a child’s life elevates the risk of lifelong problems in learning, behavior, and health. Caregivers who provide stimulation and responsive interactions positively impact children’s outcomes and buffer the negative impact of adversity. There is also increasing evidence that caregivers’ mindsets about intelligence contribute to their interactions with their children. Yet knowledge of how caregivers conceptualize childhood development and their own role in promoting their child’s development in the context of adversity is limited. This project, which is an interdisciplinary collaboration with the Laboratory of Cognitive Neuroscience and the Harvard Graduate School of Education, uses mixed methods to gain understanding of the relationship between caregiver beliefs and developmental outcomes in populations at-risk for adversity. Specific novel aims include: 1) To determine whether caregivers with different levels of education, age, mindsets, and exposures to adversity differ qualitatively in their reported beliefs about early childhood development and their own role in supporting their child’s development; 2) To determine quantitatively whether caregiver mindset and exposure to adversity interact to differentially predict children’s developmental outcomes, specifically skills in cognitive and socioemotional domains; and 3) To explore home language environment as a potential mediator in the relationship between caregiver mindset and exposure to adversity, and early childhood developmental outcomes.

Marissa Black

Nutrition Trainee, University of Tennessee

Marissa Black is a Maternal and Child Health Nutrition Leadership Trainee from the University of Tennessee. Marissa is currently pursuing a Master of Science in Public Health Nutrition. She will begin her Dietetic Internship in January 2019. Marissa hopes to work with the MCH population as a registered dietitian.

This summer, I had the opportunity to lead an innovative youth development program at a local community center. The program, titled Youth Can! Grow in Communities, lasted for eight weeks with two one-hour sessions per week. The youth learned about nutrition, gardening, and advocacy. The lessons were designed to empower the youth to develop their own project to improve the health of their community using the produce from the community center’s garden. The youth came up with an idea to use the produce to cook healthy food for their community members. They had the opportunity to meet with their community leaders to discuss their project and how they could help their community. They developed an action plan to involve local gardeners, chefs, the health department, and city officials to help their plan come to fruition. During the community center’s end of the year presentation, the youth presented their action plan to the director of the program, their peers, and their family members.

Trainee Ambassador GroupSuzanne Stern-Brant “Time With TAG”

The trajectory of a life can be altered by great and small events. After graduating with a Master’s in Social Work this May and passing my national licensing exam in September, I marvel at the profound shift in my life’s focus. Specifically, how one quiet, but significant book facilitated a second career in Maternal Child and Health.

Sue Gerhardt in Why Love Matters: How Affection Shapes a Baby’s Brain outlines why loving relationships in a person’s early years are the key to future emotional and physical well-being. She distills scientific research in neuroscience, developmental psychology and neurobiology into one salient truth – supporting mothers and young children is necessary for the social, economic and moral health of any culture.

At the University of New Mexico, I was fortunate to experience a hybrid of two DMCHWD-funded Graduate Education Programs: the Pediatric Pulmonary Center (PPC) and Leadership Education in Neurodevelopmental and Related Disabilities (LEND). New Mexico is a poor rural state with limited resources. Training health care professionals and supporting a diverse population, both geographically and culturally, requires sharing resources and working across programs and disciplines. New Mexico is a minority/majority state requiring a broad knowledge of distinct cultural practices. I am proud to say that both programs focused on cultural sensitivity in every aspect of training, from understanding the importance of including Native Healers in medical interventions to issues of historical trauma, and the profound effects of poverty on families and communities.

During my placement at the PPC, I worked directly with the pulmonary team to provide services for pediatric cystic fibrosis patients and their families from across our state. Having no background in medicine, being part of an interdisciplinary team was a crash course in an unfamiliar and demanding system. Through the generosity and support of team members, I was able to become competent and confident in my abilities as a clinical social worker in a medical setting. The educational support that I received through my practicum at the PPC augmented my academic program in expanding my professional skills and competency.

Sharing educational activities with the University of New Mexico LEND provided me with a solid comprehension of development and disability, and the unique challenges facing medically fragile individuals and family systems. The curriculum ensured a deep understanding of governmental and nonprofit supports, and public policy issues affecting families in New Mexico. Other skills were taught through academic team building projects, actual family needs assessments and action planning, and shadowing a state senator during a legislative session.

I am fortunate to be continuing my professional development through my tenure with the Trainee Ambassador Group (TAG). Working with team members from across the country has given me the opportunity to develop new skills and expand my abilities to work in a virtual environment. My experience with MCH Training Programs and now the TAG have been among the most valuable in my social work education. I continually encourage students and established professionals to explore the possibility of participating in a DMCHWD educational opportunity.

There is a quote from Sue Gerhardt that I hold in the back of my mind when working with children: “If someone is a great human being, it can only mean one thing. They were loved.” MCH professionals understand that love matters. Early interventions which support mothers and their children can be quiet and small in contrast to policy discussions and political discourse, but human interactions alter outcomes and change trajectories.

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