Following are several examples of MCH and Injury Prevention Success Stories.
Child Passenger Safety Training
Connecticut has used MCH block grant funding to develop child passenger safety (CPS) training for child care providers, child care health consultants, and the Department of Public Health’s child care licensing staff. The workshops cover CPS basics, state laws, and local resources so that child care professionals can provide accurate information to the families with which they work. The MCH program also offers booster seat distribution and education at child care programs serving low-income families (such as Head Start) and has run several classes titled “Safe Travel for All Children: Transporting Children with Special Health Care Needs.” These activities are conducted in cooperation with state and local Safe Kids coalitions.
Starting in 2006, the Virginia Department of Health (VDH) implemented the Olweus Bullying Prevention Program in 45 schools across the state, reaching almost 40,000 students in two years. The issue of bullying had been coming up repeatedly for staff in Virginia's Division of Injury and Violence Prevention, a unit of the MCH agency. It surfaced in their Title V needs assessment; in discussions with staff from other agencies, school personnel, and parents; and in the findings of investigations into incidents of school shootings. It became apparent that bullying had a widespread health impact and was related to depression, suicide, sexual violence, and other issues on which they were already working.
VDH immediately saw the benefits of addressing bullying. They had a lot of experience working on school-based programs and a staff who could easily integrate bullying prevention training into their MCH work. They also had some discretionary financial resources to use for materials and trainings.
Moreover, they realized that effective bullying prevention programs were available, and they chose Olweus, an evidence-based model program by Blueprints for Violence Prevention, the Substance Abuse and Mental Health Services Administration (SAMHSA), the Office of Juvenile Justice and Delinquency Prevention, and the United States Department of Education. Olweus is also highlighted on the Stop Bullying Now! website (http://stopbullyingnow.hrsa.gov/).
VDH began by using funds from the MCH Block Grant to support existing Olweus programs with training and start-up resources, including videos, manuals, and books. VDH also gave small grants to 18 community-based organizations, enabling them to start bullying prevention projects and activities. Building on this successful work and with CDC planning and implementation grants, VDH expanded its bullying prevention efforts to schools throughout the state.
VDH is evaluating its bullying prevention project and is collecting data on changes in bullying-related knowledge, attitudes, behaviors, and school and classroom practices. It is extending the understanding of bullying beyond disciplinary or behavior management issues to encompass the broader impact of bullying on individual and societal health. VDH informs bullying and violence prevention activities with health and mental health data, information, and research on the relationship of bullying to suicide risk, depression, and chronic disease. This information resonates with providers, who, as individuals, parents, and community members, see themselves as having more of a stake in addressing this problem.
Domestic Violence Screening
Preliminary work on the 2000 Massachusetts Title V Needs Assessment revealed that MCH service providers wanted more information on identifying and responding to domestic violence. As a result, Massachusetts’ Bureau of Family and Community Health engaged in an iterative process to confirm this need and shape a response. This process served as a catalyst for the creation of the Domestic Violence Screening, Care, Referral, and Information Project (DVSCRIP), which teaches MCH staff to identify and help clients who are victims of intimate partner violence.
Although DVSCRIP was developed by the Division of Violence and Injury Prevention, the need for this training extended across many MCH programs. The division worked with other MCH programs—including WIC, the Early Intervention Prevention Program, and the Family Planning Program—to train their staff in DVSCRIP. The collaboration with WIC proved especially successful. Alicia High, Assistant Health and Human Service Coordinator for the State WIC program, reports that although WIC is primarily a nutrition assistance program for low-income children as well as women who are pregnant, breastfeeding, or postpartum, it is also a strategic opportunity to intervene in domestic violence.
Initially, staff at all 35 WIC programs in Massachusetts received DVSCRIP training. Four of these WIC programs served as pilot sites for the routine domestic violence screening of pregnant, postpartum, and breastfeeding women. As part of the DVSCRIP training, staff from local domestic violence programs and State agencies—such as each of the Domestic Violence Units in the Departments of Social Service and Transitional Assistance—were invited to speak at these trainings. This approach helped WIC staff learn about the programs to which they can refer victims of domestic violence, and it provided an opportunity for staff to meet the individuals who would be accepting these referrals. DVSCRIP also teaches staff to care for their own emotional health, a critical skill for service providers addressing domestic violence issues.
The pilot program was later expanded into a statewide effort to train all staff in every WIC program in Massachusetts to routinely screen pregnant, postpartum, and breastfeeding women for domestic violence. The success of DVSCRIP also prompted WIC to add a domestic violence section to the State’s WIC Operations Manual. This section includes policies and procedures on screening, staff roles, referrals, and self-care.
Prevention of Child Abuse and Neglect
Becoming a parent for the first time definitely is a learning experience, but the Kentucky Department for Public Health (DPH) has an innovative program proven to be an invaluable resource for new moms and dads.
Known as Kentucky’s Health Access Nurturing Development Services, HANDS provides home visitation for first-time families to help meet the challenges of parenting, beginning with pregnancy and continuing through the child’s first two years of life. During the prenatal period, the health department, a doctor’s office, a place of worship, or friends and relatives may refer a new family to the state Maternal and Child Health program. After the family is screened, a DPH staff person visits the home to work with new parents on parenting skill development, provides guidance on what to expect as a baby grows, offers suggestions on making the home safe, and more.
HANDS is modeled after Healthy Families and Healthy Start programs, which are used nationwide. Kentucky combined these approaches to integrate pieces of the social and medical concepts from each, creating a program that addresses such issues as low birth weight, pre-term infants, child abuse and neglect, domestic violence, underdeveloped parenting skills, teen pregnancy, financial difficulties, and substance abuse. Piloted in 1999, HANDS expanded to 15 counties in 2000 and was established in all of Kentucky’s 120 counties by the end of 2003. The program has worked with more than 40,000 families from inception to date.
HANDS begins with a screening program that looks at 16 risk factors, including substance abuse, a history of psychiatric care, depression, marital status, smoking, poor prenatal care and a history of abortion. If any one of these risk factors is present, the family is eligible for HANDS home visitation services. The family will be offered a meeting with a professional who will complete a more in-depth assessment that considers such factors as mental health, parenting experience, coping skills, support system, anger management skills, expectations of the infant’s milestones and behavior, plans for discipline, perceptions of the new infant, bonding, and parental strengths. This assessment takes about an hour. If the results indicate that a family may be overburdened, home visiting services are provided to the family. Parents who are not appropriate for HANDS but could benefit from some services are provided with information and referrals to community agencies.
Birth indicators based on 2000–2003 data showed that HANDS participants have fewer premature births, fewer low- and very low-birth weight infants and fewer birth defects when compared to other first-time parents who did not participate in the program. A 2004 study of child abuse and neglect found that participating teens had no incidents of substantiated physical, sexual, or emotional abuse.
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