Child

Vermont’s Title V program, the Health Department, and Agency of Human Services is continuing to focus on the prevention of trauma and toxic stress and addressing social and structural conditions of health to support individual, family, and community resilience (flourishing) and health equity. Prior to the pandemic and more so now, Vermont’s MCH program is at the center of all these discussions and efforts. Resilience and equity are also central to the strategies of Vermont’s SHIP: Invest in programs that promote resilience, connection and belonging, and includes approaches core to Vermont’s MCH mission:

1. Home Visiting – Expand access to an array of home visiting services for families who have young children or are expecting
2. Strong Families – Promote the Strengthening Families approach to strengthen protective factors and mitigate the impact of adverse experiences
3. Resilient Youth – Expand community-based opportunities such as mentoring, peer support and after-school programs to build resilience and protective factors among youth

Key highlights of our MCH partnerships and collaborations this year include: 

• Vermont Afterschool was endorsed by the Governor to realize his goal of universal afterschool and offers strengthening programs like Building Flourishing Communities, a proven public health model to increase resiliency and lifelong health outcomes
• Youth Thrive Training: A framework which supports staff working with youth by providing information and tools which encourage strengths base approaches, viewing behaviors as normal stages of development, and productive interventions
• Vermont’s HRSA Early Childhood Comprehensive System: Health Integration Prenatal-to-Three (P-3) Program, known as Vermont Integration Prenatal-to-Three (VIP-3), is strengthening partnerships between our early childhood and maternal and child health sectors. VIP-3 priorities include: 1) using existing infrastructure to identify gaps, assets, and areas of duplication; 2) promote family leadership; 3) increase participation of health providers in use of our Help Me Grow Resource Hub; and 4) develop and implement innovative financing, health, and equity strategies to improve policies, services provision, and outcomes for P-3 families.

Addressing social conditions of health which impact Optimal Child Development, a priority area in Vermont’s State Health Improvement Plan (SHIP), has become more urgent in light of the continued impact of the COVID-19 pandemic on Vermont’s children and families. Vermont continues to make gains in screening across multiple domains, including social conditions of health, and works to ensure earlier access to existing resources for overall family resilience and wellbeing with Help Me Grow. Offering a one-stop-shop information and referral resource hub, all callers are screened for food security using the Hunger Vital Sign™ tool. HMG links families to services and stays in touch so families receive support before, during, and after they are connected. Key highlights include:

• HMG received 1,343 incoming calls and 106 referrals (during the reporting period)
• HMG made 1,602 follow up calls
• The 2020-2021 Hunger Vital Sign™ screening results indicate an increased concern about food access, but a decrease in reports of families running out of food than in the previous year.

• Referrals for perinatal mood and anxiety disorders (PMADs) increased when a new media campaign to raise awareness launched in 2020. HMG staff made over 171 referrals for 26 individuals.

Routine screening across multiple domains of development, including screening for social determinants of health, closes gaps in kindergarten readiness and promotes resiliency and positive outcomes even when children have challenging experiences, such as a pandemic, poverty, violence, and trauma. HMG provides training on use CDC’s Learn the Signs. Act Early. Program tools for family-engaged developmental monitoring and use of developmental screening tools, to help families better understand their child’s early development and identify concerns so that young children get connected to the services they need at an early age when the benefit is greatest. HMG aligns screening efforts across settings to improve early identification by offering free access to a statewide Ages and Stages (ASQ) Online system, which will be integrated with Vermont’s developmental screening registry, to improve communication and coordination among providers and reduce screening duplication. Developmental screening is a Blueprint for Health and Accountable Care Organization (ACO) quality measure that child health care providers can fulfill by using the registry. Vermont’s developmental screening guidelines encourage participating practices and providers to access and review developmental screenings completed by community providers to inform their surveillance and screening activities during health supervision visits. Key highlights of this work include:

• Between 2020 to 2021 HMG trained 423 health care and human service providers, early childhood educators, and others to conduct developmental and social/emotional screening and to refer families for further evaluation and services.

• HMG provided comprehensive training that was followed by coaching to nine early childhood education programs on how to use developmental screening tools, with cultural responsiveness, and connect families to needed resources.

• Over 9,000 children are currently enrolled in childcare programs that have received HMG training. This includes well over 2,000 preschoolers that are better prepared to learn and succeed as they enter kindergarten. This is enough children to fill almost half of Vermont’s kindergarten classrooms.

• The proportion of young children receiving at least one developmental screening in the first three years of life increased from 46.6% in 2015 to 57.5% in 2020.

• With the need for telehealth, tele-home visiting, and virtual classrooms during the pandemic, use of HMG’s ASQ Online system increased exponentially. By the end of 2020, 2,325 developmental screenings had been completed online.  By the end of 2021, this number had grown to 6,418 with over 660 screenings focused on social-emotional development. The ASQ Online screening data will be integrated with Vermont’s Developmental Screening Registry for increased communication, coordination, and population data.

HMG works with community partners to strengthen families and build their resilience so that all Vermont children can reach their full potential. Families participate in activities that build supportive relationships and teach coping skills to counterbalance things like poverty, toxic stress, and trauma, which can negatively impact child wellbeing. Key outcomes this year include:

• HMG held 47 community outreach events and, by shifting outreach to virtual platforms, reached almost 38,000 families. 
• HMG trained 902 providers and families in the following topics: trauma-informed practices and building resilience, social and emotional development, accessing resources, preparing young children for school, equity, anti-racism, and gender inclusive teaching strategies.
• Almost all families reported getting their needs met and indicated they had an increased understanding of child development and felt able to access services.

As mentioned in previous reports, Vermont works within the 3-4-50 framework to draw attention to health behaviors that, if followed, will help prevent chronic disease. This framework goes further to engage organizations in a variety of sectors (communities, worksites, retail establishments, schools and childcare programs asking them to commit to promoting these healthy behaviors through policy changes in their organization. Specifically, in schools and childcare programs, 3-4-50 calls out ways to help children learn healthy behaviors from the start. Tips for each include ways to help children eat healthier foods, be more physically active and, for older children, information and skills that will help them say no to tobacco use. The 3-4-50 tips and sign on sheets build from simple, effective interventions to more complex but longer lasting policy changes that will solidify strong nutrition and physical activity programs and prevent tobacco use initiation. Before this work period, 31 childcare programs and schools had signed on, in addition to organizations that serve children, youth and families including human services organizations, recreation departments, afterschool programs, libraries and churches. VDH Offices of Local Health are available to provide technical assistance to schools and childcare programs to help them sign on and to continue to build on their successes. Vermont Title V supports the salary of the child physical activity and nutrition director in Vermont’s division of health promotion and disease prevention.

Vermont Department of Health staff have predominantly been detailed to work on the pandemic response since March 2020. Because of this, efforts such as 3-4-50 engagement have needed to be in the background, with staff ready to take inquiries from organizations interested in 3-4-50, but not actively recruiting new organizations. Additionally, these organizations have been occupied in their own pandemic responses. Because of this our expected number of new schools and childcare programs engaging in 3-4-50 is less than we had hoped for this period, with only one childcare program signing on to 3-4-50.

Oral Health is another SHIP and Title V priority area. Title V partially funds the salary of the VDH Oral Health Director, who coordinates the Local District Office Public Health Dental Hygienist (PHDH) program. “Embedded” public health dental hygienists in our local district office WIC clinics conduct oral health risk assessments, fluoride varnish and silver diamine fluoride application, and link pregnant women and children to local oral health services and dental homes. PHDHs also provide community education (e.g., health fairs, wellness events) and provide training to medical and dental providers to promote early (by age one) preventive dental care.  Lastly, they support Office of Oral Health programs such as community water fluoridation and the 802Smiles Network of School Dental Health programs.

MCH partnered with the Office of Oral Health to update Vermont’s EPSDT periodicity schedule for dental services to align with the newly released 4th edition of, Bright Futures. MCH has also partnered with VCHIP, AAP VT, and other community partners to arrange 8 regional Bright Futures 4th edition rollout events around the state. MCH staff and the Oral Health Director worked with Communications and the VT Oral Health Advisory Panel members to promote Vermont’s new oral health periodicity schedule: current best practice guidance to pediatricians, family medicine providers, dentists, and families.

Vermont’s 802Smiles Network of School Dental Health programs help to ensure that every child has access to preventive, restorative, and continuous care. The network is an umbrella that consists of the various tiers of school dental health program that exist in the state. Different tiers include case management (school-linked programs), the provision of preventive care in schools (school-based programs), and school-based clinics that offer both preventive and restorative care on site.

Vermont’s Oral Health program partners with the University of Vermont’s Office of Primary Care and Area Health Education Centers (AHEC) to coordinate From the First Tooth trainings for primary care providers throughout Vermont, offering first time trainings as well as refresher courses at no charge to the practice. This program helps primary care providers integrate the following practices as standard of care for young pediatric patients: 1) Assess the oral health of young children; 2) Apply fluoride varnish to help prevent tooth decay; 3) Educate parents and caregivers about pediatric oral health; and 4) Make dental referrals. MCH leadership serves on the statewide oral health advisory panel, 802Smiles Network of School Dental Health Programs Planning Committee, and will work with the oral health program and chronic disease and disability advisory group to promote oral health for VT children with intellectual disabilities.  

The Vermont Oral Health program developed a communications campaign to keep oral health on the radar during the pandemic. We distributed 3,724 dental kits containing a toothbrush, dental floss, a timer, and a bookmark (with tips for good oral health and resources to find a dentist) to 38 schools in Vermont and plan on distributing kits to additional schools during the upcoming school year. Previously, the program implemented a basic screening survey of VT children:

https://www.healthvermont.gov/sites/default/files/documents/pdf/oral_health_survey_1617.pdf

Plans are underway to conduct another survey during the 2022-23 school year.

Partnerships

MCH has adopted the framework in AMCHP’s Roadmap for Collaboration among Title V, Home Visiting, and Early Childhood Systems Programs to strengthen collaboration and shared priorities across Title V MCH programs, MIECHV, our HRSA ECCS VIP-3 project, and HRSA Maternal Depression and Related Substance Abuse Disorders Program partners. Following Roadmap recommendations, MCH has formed an internal early childhood unit to align early childhood work and opportunities and implement Roadmap recommendations. This includes prioritizing family leadership and health equity under the guidance of our new MCH Health Equity Team Lead and VDH’s Health Equity and Community Engagement (HECE) Team. MCH efforts have been expanded by VIP-3 implementation partners including: the Vermont Department of Health, Help Me Grow Vermont, Department of Vermont Health Access (DVHA); Vermont Children’s Health Improvement Project’s (VCHIP), the Building Bright Futures (BBF) Early Childhood State Advisory Council (SAC) network, and United Ways of Vermont. Additional critical partners include child and family serving agencies and professionals, Vermont State Agency representatives, Agency of Education, family leaders and the BBF Families and Communities Committee, cultural brokers, and Vermont’s MCH health system partners [e.g. American Academy of Pediatrics (AAP), American Academy of Family Physicians (AAFP), American College of Obstetricians and Gynecologists (ACOG), American College of Physicians (ACP), Blueprint for Health, VDH’s Health Equity and Community Engagement (HECE) Team, Medicaid and other health payer systems like OneCare Vermont.]

Vermont’s oral health and physical activity and nutrition programs sit within the Division of Health Promotion and Disease Prevention. Likewise, we work closely with our Office of Local Health and the regional MCH Coordinators and School Liaisons.