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From the President: Emerging Issues

 Child & Adolescent Health: Reflections on a Year of Collaboration and Improvement and a Look Ahead

​By Kate Taft, Cori Floyd and Iliana White
Child and Adolescent Health Team, AMCHP

The past year has been a successful one for the Child and Adolescent Health team as we addressed emerging and existing needs of members related to adolescent and youth adult health, child health and children and youth with special health care needs. While the team developed many products and resources, collaborative learning and quality improvement were the focus of how we supported states in 2016 and plan to in 2017. Some highlights are below:

Adolescent Health

iStock_000044018552_Double.jpgAMCHP's adolescent health efforts saw a productive and inspiring 2016. Through our partnership within the Adolescent and Young Adult Health National Resource Center, AMCHP has been working with the first cohort of states in the AYAH CoIIN to build their capacity in strategies and approaches to increase access to and the quality of preventive services for youth. Through multidisciplinary teams, the five states (Iowa, Mississippi, New Mexico, Texas and Vermont) have worked diligently to test and implement quality improvement activities both within clinical demonstration sites and the broader systems of public health and care, with the global aim to increase the receipt of annual adolescent well-visits. Each state team developed a specific action plan unique to their resources, current opportunities and the needs of the youth population in their communities.

Concurrently, CoIIN teams also contributed lessons learned and shared measurement data to the National Strategy Teams (NSTs) originally established to collaborate collectively on the following three strategies:

  1. Improve access & uptake of preventive services.

  2. Improve the quality of preventive services.

  3. Improve state/systems-level policies and practices to assure access to high-quality preventive services.

Each NST worked to define specific goal statements and shared measures that would capture the scaled efforts of each participating state to a common set of goals. The NSTs have engaged in peer knowledge and resource sharing through virtual learning sessions and forums facilitated by AMCHP and the staff from the National Resource Center.

2016 also saw the launch of the AYAH Center Bulletin, a periodic e-newsletter to inform the greater Title V field and key partners about the Resource Center's collective efforts and issues affecting the health of adolescents and young adults.

Looking ahead, the AYAH-NRC will continue to assist with promising efforts of the first cohort of the CoIIN, as well as support a second cohort of state teams to work on improving preventive health services and systems for this population. AMCHP will also aid its other partner organizations within the AYAH Resource Center to launch its series of broader technical assistance learning forums (virtually) so states and other partners can learn and build capacity to advance AYAH through a variety of encouraging practices and approaches. Finally, to share updates on the CoIIN and other goals of the Resource Center with broader audiences in Title V and other stakeholders, the AYAH Center Bulletin will continue to be disseminated, with editions focusing on the following proposed themes: access to mental health services, confidentiality in practice and policy, Medicaid, equity, engagement, infusion of the well-visit in other initiatives and clinical service delivery for youth. Overall, AMCHP is committed to translating and disseminating lessons learned as well as creating resources to aid those states and territories that have selected NPM 10 and/or developed a state performance measure) related to the provision of health services for young people.

Child Health

Depositphotos_5403143_L.jpgAMCHP participated on several exciting child health-related CoIINs and similar projects with partners, including child safety, early childhood comprehensive systems, healthy weight and newborn screening. AMCHP also led an effort with partners and state experts to provide recommended updates to the National Newborn Screening Contingency Plan, with a focus on addressing gaps in laboratory and clinical follow-up. AMCHP also works with the Association of Public Health Laboratories on NewSTEPs 360 and its efforts to help states improve systems related to timeliness of newborn screening.

The updates were submitted to federal partners and it is expected the new version will be released in time for a workshop at the AMCHP Annual Conference in March. Over the coming year, AMCHP looks forward to continuing those partnerships and engaging our members and partners in promoting child health through quality improvement and collaborative learning.

Last year, AMCHP was pleased to award Learn the Signs. Act Early. (LTSAE) State Systems Grants to 10 states and two territories: California, Florida, Georgia, Guam, Massachusetts, Minnesota, Montana, New Mexico, North Carolina, South Carolina, Tennessee and the Virgin Islands. The grantees will increase parent-engaged developmental monitoring through a wide range of early childhood systems, including Title V, home visiting, Head Start/Early Head Start, Help Me Grow, early childhood education partners and more. AMCHP promoted collaborative learning among the grantees to regular calls, technical assistance and coordination with the broader Act Early Network.

AMCHP engaged in several efforts to support state MCH and CYSHCN leaders in their response and planning to the emerging Zika virus. Related to child health, AMCHP held peer calls and a special session at the December MCHB Technical Assistance Partnership Meeting, which allowed members to share challenges, questions and strategies with each other related to ongoing monitoring and follow-up for infants and children affected by Zika. AMCHP plans a special session at the upcoming Annual Conference to continue those conversations as they relate to systems of care for these children.

Children & Youth with Special Health Care Needs (CYSHCN)

Familywithdisabilityandhappydog_Medium.jpg2016 proved to be a productive year for AMCHP's work to support CYSHCN programs, including those focused on autism spectrum disorders and other developmental disabilities (ASD/DD).

ASD/DD: Through our State Public Health Autism Resource Center (SPHARC), AMCHP provided many opportunities for collaborative learning through a range of mechanisms from technical assistance calls on Transition, Telehealth/Autism Awareness and Data Systems Integration to an in-person peer-to-peer exchange on addressing gaps in ASD/DD diagnosis.

In October, SPHARC, in partnership with HRSA, kicked-off an Autism Community of Learners for the new HRSA state autism grantees: Delaware, Rhode Island, Washington and Wisconsin. Following an in-person meeting, SPHARC has helped lay the groundwork for national partner and peer-to-peer support around grantee activities for the project period, which focus on implementation of three key evidence-based/informed strategies: shared resource, family navigator and telemedicine/telehealth. The community has access to a new team SharePoint site and is participating in monthly technical assistance calls that cater to grantee needs by providing access to experts and national partners, as well as a forum to discuss successes and best practices with one another. More information about the Community of Learners and state approaches is highlighted in a recent PULSE article. Information about SPHARC and recent resources can be found at the revamped webpage, which features a new interactive map and state spotlights, resource search engine and much more.

In the coming year, SPHARC will continue to the support the Community of Learners as they implement their evidence-based/informed strategies, with a focus on implementing quality improvement methods. SPHARC will also be creating resources and providing collaborative opportunities for the broader ASD/DD and Title V community.

Profile of CYSHCN State Programs: AMCHP has laid the groundwork for some exciting resources to come this year. In late 2015 to early 2016, AMCHP fielded a survey to capture data from CYSHCN programs about family engagement, life course theory, medical home and transition initiatives, quality improvement and financing. Forty-seven jurisdictions, including the District of Columbia and one territory, completed the profile, yielding a response rate of 94 percent. Analysis of survey data has been completed, and a report will be released in March, in conjunction with a workshop session at the AMCHP Annual Conference. This report will offer insight into CYSHCN programs and provide an opportunity for AMCHP to identify specific areas of technical assistance for CYSHCN directors.

National Consensus Framework for Improving Quality Systems of Care for CYSHCN: As part of phase III of the Standards project, AMCHP, in partnership with the National Academy for State Health Policy, continues to focus on increased outreach to Medicaid and health plans, provision of intensive technical assistance to states, and continued effort to condense and streamline the standards for ease of use. The team is nearing completion of the revised standards, which include the addition of new federal regulations and guidelines and reflect feedback from states that have previously implemented the standards. In July, AMCHP and NASHP convened a successful meeting of the National Standards Workgroup to provide input and guidance on these revisions. The team continues to embrace family leaders in the development and creation of the Standards.

The team continued to develop tools that will be piloted during conferences and this year's upcoming Action Learning Collaborative, such as organizational assessments, partnership and alignment tools and a crosswalk guide of the Standards document and National Committee for Quality Assurance regulations. AMCHP looks forward to continued work to support states on strengthening their state system of care for CYSHCN by using or adapting the national standards.