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Workshop/Breakout Title
Workshop/Breakout Speaker(s)
Supporting Young Children to be Healthy and Ready to learn: Lessons from State
and Local Collaborations
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Vermont ECCS TeamAMCHP - 2006
• Sally Kerschner, RN, MSN
• Donald Swartz, MD
• Kathleen C. Keleher, CNM, MPH
Building Bright Futures: Integration of Public
Health and Early Child Care
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Public Health: Core Functions and Essential
Services
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PH/MCH Essential Services• Monitor health status of both children and
communities to identify health assets and needs.
• Inform, educate and empower families with young children about health issues and services
• Mobilize community partnerships to respond to family needs
• Provide leadership to develop policies and plans that support and family and community health efforts
• Link families to services and systems• Assure capacity and competency of
workforce • Evaluate effectiveness, accessibility and
quality of population-based health services
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MCH in Vermont• Total state population for 2004: 621,394 • Total deliveries for 2003: 6,464• 91% of pregnant women receive prenatal care
within the first trimester.• Teen birth rate (15-17 yrs) is 6.7/1,000 for
2003.• IMR for 2003 – 5.0/1,000 live births• 13% WIC children overweight (2-5 yrs)• 94.6% of Medicaid children received at least
one periodic screen in 2003.• 48% of low income children utilized dental
services in 2004• 83% of children (19-35 mo) received full
schedule of age appropriate immunizations• 57% of families with CSHCN report receiving
care within a medical home (Title V NPM #3)
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Facts about child care in Vermont
• 80% of Vermont women with children under six years of age are in out-of-home workforce
• 684 licensed, 1298 registered and 1515 certified, legally exempt child care programs-providers
• 7333 children, 5181 families currently receiving child care subsidy
• 134 nationally accredited child care programs and 41 programs that are 3-5 Vermont Stars
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Vermont State Government Organizational Structure
• 13 Counties in Vermont• No county health departments – use of
district offices• Agency of Human Services• Department of Health• Department for Children and Families –
Child Development Division
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Health and Early Education Systems Development in Vermont
• Work of the AHS State Team for Children and Families
• Emphasis on local planning (e.g., MCH Coalition, Success by Six, Early Childhood Council, Regional Partnerships)
• Early Childhood Steering Committee• Smart Start TA• Ten Outcomes to guide planning and programs
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AHS Ten Outcomes(examples)
• Pregnant women and children thrive• Children re ready for school• Children succeed in school• Children live in stable and supported
families• Youth choose healthy behaviors• Youth successfully transition to
adulthood
Historically, the planning for health, early education, and child care services for young children evolved separately.
Coalitions coordinated on many aspects of their overlapping missions, but
enhanced collaboration would increase effectiveness in providing a streamlined
system of care for families.
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Building Bright Futuresin Vermont
• A public private partnership comprised of private sector providers, families, business leaders, community members and state government decision makers to create a unified system of early care, health and education for young children and their families in Vermont.
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BBF Health CommitteeSpecific responsibilities:• Assess Vermont’s maternal and child health
capacity to address early childhood needs• Propose a health, early care and education
plan that includes and integrates the service priority areas
• Identify priority indicators to guide resources within the early care, health and education system
• Develop a plan for outcome evaluation, including outcomes monitoring
• ECCS grant as driving mission and activities
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Early Childhood Comprehensive Systems
Grants (ECCS)• ECCS grants to all states from the
Maternal and Child Health Bureau• Initial two year planning grants• New three year grant cycle, 24 states
in implementation phase• Technical assistance from the
Mailman School of Public Health, Columbia University
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ECCS Goals
• Provide leadership in developing a comprehensive and unified early care, health, and education system
• Expand and integrate a stronger MCH focus within the overall early childhood system
• Address specific needs related to health and well-being of children and families
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ECCS Focus Areas
• Health insurance and medical and dental homes
• Mental health and social-emotional development
• Early care and education
• Parent education and family support
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Health Committee
• Parents• Vermont Department of Health • Vermont Department for Children
and Families• Vermont Department of Education• American Academy of Pediatrics
– Vermont Chapter • Vermont Children’s Health
Improvement Project (VCHIP)• Home Health Agencies• Community Mental Health
Agencies• Head Start/Early Head Start
Programs• Children with Special Health
Needs• Parent to Parent of Vermont
• Family, Infant & Toddler Program (Part C)
• Public School Health• Children’s Upstream Services• Healthy Babies, Kids &
Families• Parent Child Centers• Success by Six• Visiting Nurses Association• Vermont Campaign to End
Childhood Hunger• Vermont Refugee Resettlement
Program• Vermont Children’s Forum• Pediatricians and other health
care providers
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Environmental Scan
• Family centered philosophy and approach
• Quality Improvement & Quality Assurance activities
• Evidence-based practice
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Health Insurance and Medical and Dental Home
Goal: All pregnant women and children have a source of coordinated, comprehensive, family-centered medical and dental care
Outcomes: Pregnant women and children have a medical homePregnant women and children have a dental homeInsurance companies reimburse for medical home activitiesMedical homes have care coordinators
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Health Insurance and Medical and Dental Home
Strategies: Establish standards for a medical home Increase the number of practices that meet
the definition of medical home Ensure that health coverage provides for a
medical home Develop a plan for oral health promotion in
childcare settings Provide funding for care coordinators
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Mental and Social-emotional Health
Goal: All children are routinely screened for strengths, resiliency and needs in social, emotional and behavioral development.
Outcomes: Children are routinely screened in their medical home for social-emotional and other developmental issues using a standardized tool.Primary Care physicians have access to early developmental and mental health consultationCommunity agencies jointly hire a child psychiatrist for consultation
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Mental and Social-emotional Health
Strategies: Identify screening tools to look at protective
and risk factors for children and families Provide reimbursement for screening in
primary care settings Develop a referral system from the primary
care provider to community services Provide reimbursement for a social worker,
mental health worker, early interventionist to provide screening
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Early Care and Education
Goal: Early care, health and education providers are knowledgeable about and linked to the overall service system and community resources.
Outcomes:Links exist between early care, health and education providers and programsEarly care health and education programs have a common referral systemProviders refer children to appropriate programs and servicesAll programs utilize consultants for health and social/emotional issues
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Early Care and Education
Strategies: Assure all districts have an ongoing health
and safety team All pediatric providers have a list of early
childhood programs in their area Increase the number of health and social-
emotional consultants available to early care and education providers
Provide subsidies for consultants to child care and education programs
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Parent Education and Family Support
Goal: All children are raised in a safe, supportive, healthy, nurturing environment
Outcomes:All parents, caregivers and service providers have the necessary skills to provide a healthy, nurturing environment for childrenAll childcare providers offer nutritious mealsParents have knowledge about nutrition and development of feeding skillsChildren have access to affordable programs during out of school time
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Parent Education and Family Support
Strategies: Increase participation in child and adult food care
programs in both child care settings and homes Support parents and other caregivers in
understanding, practicing and teaching children the value of positive behavior
Identify and offer preventive services to families at risk of abuse and neglect
Encourage parents to implement safety measures, i.e. seat belt/car seat use, bicycle helmet use, poison prevention
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Title V Planning
• 2005 Title V Strengths and Needs Assessment
• Region wide emphasis on strengths assessment in addition to needs assessment
• Development of State Performance Measures
• Region 1 (New England) commitment to create two common regional indicators
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Youth Asset Indicator
• “In my community, I feel like I matter to people”
• Common language in YRBS for Vermont and Maine
• Other NE states may be able to adopt this question to achieve a Region wide performance measure
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Early Childhood Indicator
• Common indicator for Region 1• Draws on common work in New England
from Healthy Child Care America initiative
• Suggested wording of the indicator will measure the percent of child cares with access to child health consultants.
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MORAL OF THIS COLLABORATION
UNITED WE STAND
DIVIDEDWEFALL
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Contact InformationDonald Swartz, M.D.Director, Division of Health Improvement(802) [email protected]
Kathleen Eaton PatersonAsst. Director, Child Development Division(802) [email protected]
Bob CostantinoChild Development Division(802) [email protected]
Sally KerschnerDivision of Health ImprovementVermont Department of [email protected]
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Questions?Questions?
