Each year, DMCHWD releases an infographic to highlight program impact. In 2018, DMCHWD engaged 30+ disciplines in interdisciplinary training, reached 270,000+ professionals through continuing education activities, and supported the development of 2,600+ peer-reviewed publications. In addition, DMCHWD supported innovative approaches to address childhood obesity and nutrition through the Children’s Healthy Weight CoIIN, Childhood Obesity Enhancement Projects, and Preventing Childhood Obesity Challenge.
The Maternal and Child Health Bureau (MCHB) is pleased to share an infographic highlighting HRSA MCHB 21st Century Cures Act Programs - Pediatric Mental Health Care Access Program and Screening and Treatment for Maternal Depression and Related Behavioral Disorders Program.
The Trainee Ambassador Group (TAG) is a virtual trainee work group, designed to foster connections between trainees across MCH Training Programs and to strengthen the link between trainees and MCHB. The TAG is composed of 10 trainee representatives from DMCHWD’s graduate and undergraduate education programs.
The MCH Timeline highlights significant scientific achievements in MCH history, including improved infant incubators in 1938, the Apgar method in 1949, and the Guthrie Test in 1961. Learn about these scientific points in history and more on the MCH Timeline.
The MCH Navigator and the National Maternal and Child Health Workforce Development Center have developed an innovative resource to ensure that professionals have the knowledge and tools to incorporate principles of health equity into all aspects of their work by answering a question frequently raised by state and jurisdictional Title V agencies: “What strategic steps can we take to advance health equity in our health departments?”
This tool, Strategies for Promoting Health Equity in Your State, provides learners with focused, short recordings that set the stage for advancing this work as well as summaries of ten strategies that have been tested in the field. The tool concludes with examples from states and jurisdictions and additional resources from both the MCH Navigator and the National MCH Workforce Development Center.
This format allows for learners to quickly locate specific topics of interest and is innovative in its use of content from a previously recorded, live webinar that has been curated into an enduring online learning opportunity, drawing on the strengths of both organizations. It is part of the MCH Navigator’s focus on translational learning that focuses on moving knowledge into practical actions that can be implemented in strategic, measurable activities.
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 American Academy of Pediatrics (AAP) recommends long-acting reversible contraceptives (LARCs), including intrauterine devices and hormonal implants, as first-line contraception for adolescents, yet fewer than 5% of adolescents ages 15-19 use these methods. Although pediatric providers are well-positioned to increase LARC use among adolescents, provider knowledge, attitudes, and experience inserting LARCs continue to be barriers. In short, pediatric providers are missing opportunities to prevent teen pregnancy.
To improve adolescent access to LARCs, a trainee-led team (a University of Minnesota Pediatrics resident and two LEAH Adolescent Medicine fellows) initiated a QI project to address barriers experienced by providers. The project began with a needs assessment of Twin Cities community providers and trainees in pediatrics that revealed two key findings: (1) the majority of community pediatric providers were not providing LARCs, and (2) 88% of pediatrics trainees desired LARC training, yet training opportunities were limited.
Subsequently, a LARC workshop for pediatric trainees and community providers was developed and offered monthly starting in July 2018. The 3.5-hour workshop, led by the two Adolescent Medicine fellows, includes an interactive educational session on LARC methods, followed by a hands-on hormonal implant training and certification. This workshop has become a requirement for all UMN Pediatric residents and is open to all pediatric providers in the state of Minnesota.
To date, a total of 143 clinicians have participated in the workshop, including 54 medical residents and fellows (38%), 61 nurse practitioners and PAs (43%), and 24 attending physicians (17%). Participant knowledge, comfort, attitudes, and intention to deliver LARCs were assessed using brief pre- and post- surveys. Clinicians who attended the workshop reported increased knowledge and comfort with LARC methods, and were more likely to recommend and provide a LARC method. Ninety-one percent of participants were likely or very likely to place hormonal implants in their clinical practice after completing the workshop.
This trainee-driven project was completed in collaboration with a multidisciplinary group of partners spanning the University of Minnesota and community, industry, and professional organizations. Funded by an AAP Community Access to Child Health grant, the team will evaluate the long-term impact of this workshop on clinician practice and adolescent utilization of LARCs, and assess remaining barriers to access.
For more information on the LARC QI project, please contact Taylor Argo, MD, Pediatrics Resident; Janna Gewirtz O’Brien, MD, Adolescent Medicine Fellow; Katy Miller, MD, Adolescent Medicine Fellow; and Emily Borman-Shoap, MD, Pediatrics Vice Chair for Education and Assistant Professor.
2004-2005 LEND Fellow, University of Massachusetts Medical School
I completed my LEND fellowship at the E. K. Shriver Center at UMass Medical School in 2005 and am now the Director of the Autism Insurance Resource Center at the Shriver Center, and an instructor in the Department of Psychiatry at University of Massachusetts Medical School. My extensive background in insurance issues related to autism has played a major role in passing several significant pieces of autism insurance legislation in Massachusetts, including the groundbreaking 2010 ARICA law. This law requires health insurance to cover medically necessary treatment for autism. I also serve as a Commissioner on the State’s Autism Commission.
Following a successful career in real estate and banking, I decided to merge my personal passions and professional experience. I joined the Shriver Center’s LEND program in 2004-05 where I researched and incubated my ideas and work on expanding insurance coverage for autism services. I served as president of the outreach organization of the Lurie Center for Autism at Massachusetts General Hospital for two years prior to being appointed Chair of the Insurance Committee for Advocates for Autism of Massachusetts (AFAM).
My work has been recognized through numerous awards, including the Federation for Children with Special Needs Martha H. Ziegler Founders Award, the Margaret L. Bauman Award for Excellence, the Massachusetts ARC’s Distinguished Citizens Award, the Doug Flutie Jr. Foundation Essential piece award, and the Northeast ARC’s Edward C. O’Keefe Memorial Award.
Updates from UNC Chapel Hill Center of Excellence in Maternal and Child Health
This summer, two Center of Excellence in MCH trainees from UNC Chapel Hill were selected for the Title V MCH Internship Program. Each summer, the National Maternal and Child Health Workforce Development Center at UNC supports teams of MCH students to participate in internships at state Title V agencies. Each two-person team consists of a graduate student from a Center of Excellence program and a student from an undergraduate MCH Pipeline program or graduate MCH Public Health Catalyst program. The aim of the program is to provide future MCH professionals with experience working in state Title V agencies, with mentorship and guidance from Title V agency preceptors.
Allie Atkeson is working with José De La Arechiga, an MCH Pipeline student at University of Wisconsin-Milwaukee, and the Vermont Department of Health to evaluate families' knowledge and use of Medicaid's Early, Periodic, Screening, Diagnosis, and Treatment (EPSDT) benefit services, such as well care checkups, developmental screenings, and dental and vision care, through qualitative interviews and data analysis. The goal of their research is to provide the state of Vermont with recommendations to improve their communication with families and ultimately increase use of preventative services.
Laura Powis is working with the Women’s and Children’s Health Section at the North Carolina Division of Public Health on the North Carolina MCH Title V Services Block Grant Needs Assessment. The Needs Assessment serves as an opportunity for the Section to re-evaluate the state’s past MCH priority needs, and to inform the selection of new priorities for the next five years. Along with Madison Czerepak, an MCH Pipeline student at the University of South Florida, and Section staff, Laura has been conducting qualitative research through focus groups, key informant interviews, and qualitative surveys to better understand unmet needs, challenges, and disparities faced by women and children across North Carolina. The goal of their research is to help the Section develop specific and actionable MCH priorities to inform the state’s Title V Action Plan. The Center of Excellence in Maternal and Child Health and the National MCH Workforce Development Center at UNC are funded by the Maternal and Child Health Bureau of the Health Resources and Services Administration.
MCH Catalyst Trainee, Florida International University
It was a privilege to be among MPH students selected to join the Great Indoors research team. This study focused on examining the impact of integrated pest management and home-based support on the quality of life of mothers and children living in an urban public housing community in Liberty City (Miami, FL). The opportunity to work in this community and interact with mothers and children in their homes was one I will always cherish. Immersing myself in community-based research gave me a better understanding of the current situation outside of the classroom. In particular, I came to understand the needs and struggles of members of this underserved community in South Florida. I was also given the opportunity to serve the community in various ways. Services I was able to provide included participating in the community’s events and health fairs, providing a listening ear, and delivering customized health education during home visits. I learned how to be culturally sensitive during my time in the community and discovered that I did not struggle to connect with the families; instead, I gained their trust and respect. Working on Great Indoors has equipped me with invaluable skills for working within the community and engaging with other professionals. I benefited tremendously from the team’s thoughtful mentorship and also learned so much from the community members. I am currently analyzing the data I collected. I eagerly look forward to continuing the work of helping mothers and children in underserved communities.
Former MCH Catalyst Trainee
As a former high school teacher, it is important to me to improve the lives of youth through evidence-based and trauma-informed policies and practices. The MCH Catalyst program at Drexel University Dornsife School of Public Health gave me the opportunity to integrate my passion for maternal and child health into my academic and professional training. I helped lead the program’s Maternal and Child Health Student Organization and focused my academic work and research on MCH topics such as racial disparities in birth outcomes, teen dating violence, community-based doula programs, and adverse childhood experiences.
During my time in the program, I was accepted to the Title V Maternal and Child Health Internship program. I spent the summer working with another MCH trainee from Johns Hopkins in the Immunization program at the Vermont Department of Health. We conducted a mixed-methods quality improvement program evaluation for their Vaccines for Children program. This evaluation focused on the experiences of pediatric vaccine providers across the state and their satisfaction with the supports and services provided by the program. We interviewed and surveyed almost half of all providers in the state, identified strengths and areas of need within the program, and presented our recommendations for further quality improvement to program leadership and stakeholders.
I am now a clinical research coordinator at the Children’s Hospital of Philadelphia PolicyLab. I primarily work on quality improvement and research projects in partnership with local and state government to improve the access to and quality of public health services for children and families. My projects include an assessment of Maternal, Infant, and Early Childhood Home Visiting program needs and risks across the counties of Pennsylvania, an evaluation of the barriers and facilitators to identifying and engaging families with opioid use disorder through evidence-based Home Visiting, and the creation of a tool to assess the quality of foster care services provided to children and youth. I routinely use the skills I learned as an MCH trainee to engage community stakeholders in a mixed-methods and interdisciplinary approach that informs evidence-based and community-centered solutions to MCH issues.
Former MCH Catalyst Trainee
Kiana Hardy has been working to serve and improve the lives of others through healthcare since she began her undergraduate career at Spelman College in 2010. She has since received a BA from Spelman College and MPH from the Drexel University Dornsife School of Public Health with a concentration in Health Management and Policy and additional training in Maternal and Child Health in June 2016.
As Kiana came upon her junior year at Spelman, she began to research graduate programs that focused on public health and maternal and child health. These two areas of healthcare became her passion. Once accepted to the Drexel University Dornsife School of Public Health, she began to focus her maternal and child health interests with her class selections, assignments, and extracurricular activities. It was during this time that she found not only peers that shared these interests, but also professional organizations such as American Public Health Association (APHA) and Association of Teachers of Maternal and Child Health (ATMCH): a maternal and child health professional world that she never knew existed. Excited to jump into the professional world of MCH, Kiana became a student fellow of the maternal child health section of APHA and the Student Liaison for ATMCH. Both of these positions allowed Kiana to help aid in the development of the maternal and child health section of APHA and ATMCH over the last few years. Her work includes planning the yearly activities of the APHA Annual Meeting for both the MCH section and ATMCH, and developing and establishing a social media presence for ATMCH on multiple platforms.
The United States has an ever-growing problem around the birth outcomes of our women and children. This epidemic has been linked to a number of factors such as several socioeconomic factors, a lack of psychosocial support, generational and perceived racism, and untreated mental health issues. It is Kiana’s hope that the field of maternal and child health will become a priority for all in this country and the work of organizations such as ATMCH and APHA will remain in the forefront.
LEAH Psychology Fellow, Children’s Hospital of Philadelphia
I have always been interested in improving the health and well-being of underserved and underrepresented individuals. I thought a degree in public health would enable me to contribute positively to the well-being of underserved communities, but after a couple of years I learned that sometimes a global approach to health and well-being neglects the individual and his or her specific needs. During my time in the LEAH program, I have come to appreciate that we can elevate the well-being of a population when a number of health professionals—from various backgrounds and with different expertise—work together to meet the needs and concerns of the individuals they serve. For instance, without a psychologist or social worker on the team, the clinician may avoid asking her adolescent patient about depressive symptoms, not know how to move forward when the patient responds affirmatively to questions about depression, or may struggle to address the myriad of factors contributing to the adolescent’s health. My experience in the LEAH program has been a perfect integration of my interests and research background in public health and developmental psychology. As someone who has been heavily invested in conducting research, participating in the LEAH program has brought to life a lot of the concepts, theories, and implications that drive academic research. During my final year of LEAH training, I am looking forward to undertaking a community leadership project to translate research findings into empowering tools to help bolster positive outcomes for adolescents and their families.
Former LEAH Fellow
During my time as a Maternal and Child Health graduate student at the University of Minnesota, my favorite experience was being a LEAH fellow. I think the key to LEAH being the most fulfilling component of my graduate education was the interdisciplinary/ interprofessional component of the training program. I learned a lot from the experiences and viewpoints of my colleagues, which I would not have learned without the interdisciplinary nature of the fellowship. In particular, my communication skills improved because I learned to work within the social norms of other disciplines when communicating, which improved our discussion and what we could accomplish together. It’s for this reason that I applied for the Trainee Ambassador Group (TAG). I didn’t want that growth that can only come from an interdisciplinary context to stop. I am thrilled to continue to build relationships across disciplines as a member of this year’s TAG. I am almost halfway through my time on the TAG and I am excited to see what my cohort can build together to support fellow trainees and other MCH professionals. It is inspiring to collaborate with others who bring great ideas and new perspectives each month to our projects. Participating in both interdisciplinary experiences of LEAH and the TAG will help me work with others both inside and outside of my discipline in the future. Public health is a collaborative profession that needs to work with other agencies and community members to do its work. I will be better prepared to collaborate in my professional career thanks to my experiences in the LEAH fellowship and in the TAG.