By The AMCHP Program Team
2012 was another busy and fruitful year for AMCHP. We continued to support and engage state programs and advance the AMCHP mission and strategic goals by providing technical assistance, training, and resources to Title V programs. Throughout the year, AMCHP expanded its capacity to support systems of care for our child and adolescent health and women’s and infant health program work; promote MCH best practices; and build new partnerships to improve MCH outcomes. AMCHP also continued to strengthen evaluation efforts across the organization supporting quality improvement to ensure that our work is relevant and timely for state Title V programs. A snapshot of key activities to support our strategic goals follows.
In 2011, AMCHP polled PULSE readers and asked "What is a top child health priority in your state?" The responses covered a wide range of topics, though overwhelmingly people noted child obesity and overweight as a top priority, followed by dental care/oral health and access to care. Over the past year, AMCHP has been participating in the National Initiative for Children’s Healthcare Quality (NICHQ) Collaborate for Healthy Weight Initiative, in which 50 teams spanning the United States work across clinical, public health and community sectors to implement program and policy changes in their communities to achieve local healthy weight objectives. AMCHP engaged in supporting the teams in this quality improvement effort through virtual learning events and coaching. This also was a great opportunity share resources with the collaborative teams about Title V, and to share lessons learned and resources from the collaborative with our members.
AMCHP continued to make connections with our partners in oral health, injury prevention, early childhood development, mental health, and others to increase collaborations to improve child health outcomes. An example of such collaboration in 2012 was a joint conference presentation by AMCHP and the Association of State and Territorial Dental Directors (ASTDD) at the National Oral Health Conference on opportunities for oral health and MCH programs to collaborate.
In 2012, AMCHP expanded its capacity to build systems of care for CYSHCN with work on four major projects: the State Public Health Autism Resource Center (SPHARC), the Learn the Signs Act Early Systems Grants, National Consensus Framework for Improving Quality Systems of Care for Children and Youth with Special Health Care Needs project, and partnerships addressing ease of use of services for Latino families. Through these projects, AMCHP has provided direct technical assistance (TA) to 42 states (with some states involved in multiple projects) in the past two years. AMCHP CYSHCN work focused on four types of work: 1) peer learning; 2) systems grants; 3) support for Title V CYSHCN directors and 4) systems development research.
In terms of peer learning, AMCHP SPHARC supported leadership development through its Peer-to-Peer Exchange program. In April, AMCHP hosted its fifth Peer-to-Peer Exchange in April 2012 on "the Role of Families in Developing Systems of Care for Children and Youth with Autism Spectrum Disorders and other Developmental Disabilities (ASD/DD) across the Six Core CYSHCN Outcomes." The exchange took place in New Jersey and state autism planning and implementation grantees from Connecticut, Georgia, Maine, New Jersey, Ohio and Tennessee participated. AMCHP hosted its sixth Peer-to-Peer Exchange in June 2012 on "Transition Issues for Youth with Autism and Youth Empowerment." The exchange took place in Rhode Island and state autism planning and implementation grantees from Delaware, Georgia, North Dakota, Ohio and Tennessee participated. Support for the peer exchanges is overwhelmingly positive, which led to the development of an ALC partnership with the National Center for the Ease of Use of Community-based Services on an focused on the Ease of Use of Services for Latino Families who have Children and Youth with Special Health Care Needs. An on-site meeting, organized by AMCHP staff, took place in North Carolina in October 2012 with teams from North Carolina, Oregon, Indiana, New Hampshire, Rhode Island and New Mexico attending.
For systems grants, AMCHP, in conjunction with the Association of University Centers on Disabilities (AUCD),The National Center on Birth Defects and Developmental Disabilities (NCBDDD), and MCHB, awarded a second round of Act Early State Systems Grants in early January to support the collaboration of Act Early teams. Eleven states received $15,000 grants for a 12-month period with a focus on partnerships with early childhood programs. Another 10 states will begin work in January 2013, including five states who have never received any type of Health Resources and Services Administration (HRSA) or Centers for Disease Control and Prevention (CDC) autism or Act Early funding.
In 2012, AMCHP also began to address specific issues affecting Title V CYSHCN directors by convening directors at the AMCHP Annual Conference, participating in meetings and TA calls for CYSHCN directors with specific HRSA regions. More comprehensive planning is on track for 2013.
In its systems development work, AMCHP received funding from the Lucile Packard Foundation to compile, define and reach consensus among key national stakeholders on the desired capacity and performance of systems of care serving CYSHCN. In-depth work to compile and synthesize system standards of care for CYSHCN from existing sources and literature started. Additionally, AMCHP conducted guided interviews with more than 25 key informants at the state and national level to obtain input and guidance on this work. These key informants include representatives from state Title V CYSHCN programs, provider groups, families, federal agencies, children’s hospitals and health services researchers. The content of the analysis and key informant interviews will be summarized in a background white paper.
Big, exciting changes took place in 2012 for the AMCHP adolescent health team. Staying true to its commitment to honoring the life course perspective and strengthening connections across programs, AMCHP brought its adolescent health programs together with the child health and CYSHCN programs to form the new child and adolescent health team.
In this time of tight public health budgets, leveraging partnerships is more important than ever. Effective partnerships and meaningful collaborations between health and education agencies are essential to improving health outcomes for children and adolescents and critical to closing the achievement gap. However, more successful models of partnership and collaboration between health and education agencies are needed, as well as partnerships that strengthen linkages between state and local government. In 2012, AMCHP seized an opportunity to explore these collaborations in-depth and, with funding and oversight from the CDC Division of Adolescent and School Health (CDC-DASH), initiated a multilevel collaboration with DASH-funded partners at the National Association of County and City Health Officials (NACCHO), the Texas Education Agency, and the Houston Independent School District. The resulting Building Bridges for Adolescent Sexual Health Through State-Local Collaboration project seeks to establish an effective state and local health and education agency collaboration to impact the health of adolescents in schools in Houston and across Texas. The initial May 2012 meeting of the Building Bridges project in Austin, TX included the partners listed above, as well as adolescent health staff from the Texas Department of State Health Services. Participants committed to working together and developed a collective vision to drive the project. Following the meeting, the core partners determined that the project would focus on strengthening the structure and function of School Health Advisory Councils, which play an important role in shaping health education instruction and practice across Texas. In December 2012, AMCHP and NACCHO staff presented a poster on the project at the CityMatCH/MCH Epi conference in San Antonio, TX.
Several states have led the way in pursuing comprehensive approaches to adolescent health, a direction that AMCHP has supported since the 2010 publication of the AMCHP white paper: Making the Case for a Comprehensive Systems Approach to Adolescent Health, a comprehensive approach incorporates life course theory, positive youth development principles, and a systemic analysis that considers all the systems – across agencies, organizations and issues – that impact and respond to adolescents. To determine how best to support states making progress in implementing comprehensive systems for adolescent health, AMCHP convened a Thought Leaders Roundtable in May of 2012 that brought together seven state adolescent health coordinators who have been leaders in those efforts. During the day-long meeting, the participants discussed challenges and opportunities in implementing a comprehensive systems approach to adolescent health and identified effective practices, strategies, and recommendations for advancing a comprehensive systems approach to adolescent health nationwide.
Advancing a comprehensive systems approach in your state sounds great, but where to start? Did you know that
AMCHP provides an assessment tool that can help answer that question? Since 2005, AMCHP has published and consistently updated a practical assessment tool for state health departments interested in assessing their capacity to effectively support adolescent health system-wide. The Adolescent Health System Capacity Assessment Tool (SCAY) was tested by 13 states since 2005, but in 2012 AMCHP and NACCHO collaborated to adapt the tool for use by local health departments, and together selected six local public health agencies to pilot test the tool in their communities. The pilot program participants gathered in Washington, DC in September to receive facilitation training and orientation to the project, and by the end of the year were implementing 90-day action plans.
At the AMCHP Annual Conference in February 2012, AMCHP staff partnered with the State Adolescent Health Resource Center to present a range of programming for state adolescent health coordinators, including an all-day adolescent and young adult skills-building institute on adolescent development and life course health. A workshop and Knowledge Café session on PREP were presented in partnership with Administration for Children and Families and the National Campaign to Prevent Teen and Unplanned Pregnancy, as well as a Knowledge Café on youth empowerment for CYSHCN. AMCHP also proudly hosted the annual meeting of the leadership team of the National Network for State Adolescent Health Coordinators at the conference.
Birth Defects and Developmental Disabilities
Compared to women without disabilities, women with disabilities are underserved in health services and less likely to receive routine clinical preventive services. As a population, they tend to be overlooked in public health programs, including maternal and child health. To help address this, CDC and AMCHP partnered together to explore ways to improve the receipt of clinical preventive services among women with disabilities who may receive maternal and child health program services. In April 2012, CDC and AMCHP hosted a meeting for MCH experts and stakeholders who examined examples of existing tools and provided recommendations on developing a one-stop online toolbox for programs and staff who may encounter women with disabilities and special heath care needs in their work. The energy from this meeting and recommendations provided opportunities for state and local public health programs to examine their roles in improving clinical preventive services to women with disabilities and to incorporate available tools into their work, especially those programs that have not traditionally seen themselves as advocates for women with disabilities.
In October 2010, the HHS Secretary’s Advisory Committee on Heritable Disorders in Newborns and Children (SACHDNC) recommended the addition of Critical Congenital Cyanotic Heart Disease (CCHD) to the committee Recommended Uniform Screening Panel (RUSP). In September 2011, HHS Secretary Sebelius adopted the SACHDNC recommendation to add CCHD to the RUSP. As states began to adopt this recommendation, guidance was need on program implementation and potential roles of state health departments. Working with our partners at CDC, AMCHP hosted a webinar in March on the implications of the CCHD recommendations for state programs, which included lessons learned from the New Jersey experience implementing mandated screening.
In July, AMCHP released Forging a Comprehensive Initiative to Improve Birth Outcomes and Reduce Infant Mortality, a compendium of policy and programmatic options state agencies and their partners can use to accelerate progress in improving birth outcomes, reducing prematurity and infant mortality and narrowing glaring health disparities.
Women’s and Infant Health
The AMCHP Women’s and Infant Health (WIH) team works with a wide variety of partners implementing projects that span MCH topics, such as life course, home visiting, infant mortality, health reform and health system redesign, maternal mortality, chronic disease, and preconception health. As the team reflected on 2012, two cross cutting themes emerged, data systems capacity building and improving birth outcomes. As we look ahead, work in these areas will continue and expand to incorporate many exciting initiatives on maternal health as well.
Data Systems Capacity Building
Throughout 2012, AMCHP efforts to support the skills and capacity of the MCH Epidemiology workforce included four training sessions prior to the 18th Annual MCH Epidemiology Conference. These sessions included trainings on spatial analysis, quality improvement, leadership, and scientific writing. Overall, the training participants were very satisfied with the training (91 percent), they felt the tools were relevant to their work (95 percent), they felt that they would be able to apply the training information to their work (90 percent) and that their knowledge about the techniques increased (89 percent). Offerings at the 2012 AMCHP conference included a skills-building session on strategies for performance and outcome measurement, and sessions about preconception health indicators and MCH epidemiology methods and practices.
Life Course Metrics
Simultaneously, with funding from the W.K. Kellogg Foundation, AMCHP worked with two main stakeholder groups on the development of set of life course metrics, which will be a core set of indicators that states can use to measure factors that encompass a life course approach to maternal and child health. A national expert panel was convened to establish a framework for these indicators and provide guidance for screening potential indicators. Seven state teams were recruited via a competitive application process to propose and screen indicators. The indicator work will be completed in late 2013.
In addition to the direct program implementation work, this past year AMCHP strengthened partnerships with organizations like the CDC and National Association for Public Health Statistics and Information Systems (NAPHSIS) to explore topics important to our members, such as data linkage, timeliness of vital event reporting, collaboration between MCH and chronic disease, and surveillance of maternal mortality. As a partner with the Home Visiting Technical Assistance Coordinating Center, we identified areas of need for TA, coordinated the provision of TA, and provided TA directly to the MIECHV participating home visiting programs.
Improving Birth Outcomes
At the beginning of 2012, national coordination grew between the multiple exciting, simultaneous initiatives to reduce infant mortality and improve overall birth outcomes. AMCHP is an active partner in the implementation of these initiatives. To help state-level stakeholders strengthen and accelerate comprehensive initiatives to prevent infant mortality and improve birth outcomes, AMCHP developed Forging a Comprehensive Initiative to Improve Birth Outcomes and Reduce Infant Mortality, also known as the AMCHP Compendium. This resource was offered to states participating in the HRSA Infant Mortality Collaborative Improvement and Innovation Network (CoIN), as well as shared directly with Title V programs and other partners, including the HHS Secretary’s Advisory Committee on Infant Mortality.
Best Babies Zone
In addition, AMCHP has worked directly with specific groups of state teams to enhance work on improving birth outcomes. Through funding from the W.K. Kellogg Foundation, the AMCHP women’s and infant health (WIH) team is working with the Best Babies Zone (BBZ) initiative. The BBZ Initiative is an innovative, multi-sector approach to reducing infant mortality and racial disparities in birth outcomes and improving birth and health outcomes by mobilizing communities to address the social determinants that affect health. The vision of the BBZ initiative is to ensure that all babies are born healthy, into communities that enable them to thrive and reach their full potential. AMCHP, along with the BBZ community sites, and partnering organizations CityMatCH and the National Healthy Start Association, is assisting in developing community assessment guidelines, creating workbooks to assist with future dissemination of the initiative and establishing learning communities for the BBZ participating sites.
Partnership to Eliminate Disparities in Infant Mortality
The Partnership to Eliminate Disparities in Infant Mortality (PEDIM) is an ALC focused on addressing the impact of racism on birth outcomes. Through this ALC, participating teams have convened on-site meetings to learn from national experts and develop action plans to address infant mortality. In addition, these teams also received on-site technical assistance in various arenas, such as how to engage stakeholders, how to measure racism and training on concept mapping, which engages community members to work toward identifying ways to ameliorate infant mortality. The WIH team also partnered with the AMCHP policy team on an ALC that brought six states together to find ways to optimize health reform to improve birth outcomes and promote preconception health in their communities. These teams convened for two in-person meetings and participated in two additional webinars to report on their current efforts and share best practices. Work from both of these ALCs was highlighted in the September/October edition on Pulse and was also presented at the CityMatCH Annual Conference in December 2012.
An overarching goal for the AMCHP program team is to be a resource for what is working in MCH and to share lessons learned and promising practices with our members. In the same vein, evidence-based programming has long been a priority for states, and one of the ways AMCHP is collecting and sharing effective practices and how states have overcome challenges and documented successful outcomes is through the Innovation Station database. Innovation Station also is a venue to contribute to the evidence-base through an established peer-review by the Best Practices Committee. Over the past year, nine new programs were added and three especially innovative practices were highlighted at the 2012 conference with awards – the Utah Power Your Life Campaign; South Carolina PASOs Program; and Ohio/Kentucky Every Child Succeeds. Also at the 2012 conference, AMCHP hosted a workshop on building an evidence base into MCH practices, which featured presentations from three Innovation Station practices.
AMCHP continued efforts over the past year to increase submissions through a targeted marketing campaign (via publications, social media, listservs, regional calls, partner meetings, etc.) that focused on monthly topics and through focused outreach by AMCHP staff. We also began evaluation efforts to assess the usefulness and effectiveness of the program in helping Title V programs strengthen their capacity to improve MCH status. The most recent focus, to expand capacity of the best practices program is an effort to help states replicate promising MCH practices. This fall, AMCHP released an RFA for a best practices replication technical assistance project through which states could request technical assistance support to learn how to adapt a specific Innovation Station practice to their state or community. Montana and Iowa will begin wotking on implementing their selected best practice in 2013.
In 2012, family involvement continued to be a focus for AMCHP. The Family Scholars Program participants for 2011-2012 engaged in monthly topics to enhance and strengthen their leadership development, traveled to the AMCHP annual conference in February, made visits to their elected officials on the Hill, and completed the program in June. A couple of comments from the scholars are:
"I admire the willingness of FSP leaders to learn from experience, to incorporate suggestions and to engage personally with us. I know that it’s a work in progress, which will always improve it. Participating in this was a marvelous growth experience! I am grateful to all who facilitated."
"The family scholar program taught me about Title V Programs, advocacy, as well as my own leadership style & strengths. It gave me confidence to continue being involved in my state and taught me how to also be involved nationally. Thank you for this opportunity it has been a great year of personal and professional growth."
AMCHP revised the program to 10 months and initiated the next cohort of scholars in September. The Family and Youth Leadership Committee held monthly teleconferences to discuss and work on youth and family involvement activities. Most notably, the committee crafted a document detailing the family role in AMCHP, assisted in support of the Family Scholars Program through application review and webinar participation, reviewed the Ryan Colburn Scholarship applications and supported the recipient, and hosted quarterly calls for Family Delegates.
MCH Workforce & Leadership Development
Over the course of the year, some of the key workforce and leadership development highlights were continuing to grow the New Director/Mentor Program (starting the process of developing learning modules), supporting the leadership development of 12 new Title V/MCH/CYSHCN directors through our New Director/Mentor Program, working with Realityworks and Go Beyond MCH to support the Emerging MCH Graduate Student Scholarship, and supporting AMCHP adoption of the MCH Leadership Competencies. Additionally, the workforce and leadership development team continued to work with the Family Involvement program to cultivate and enhance the Family Scholars Program as highlighted above.
As you can see, the AMCHP team was busy in 2012, but 2013 holds many promising opportunities and projects as well.