Annual Report Child Health

Vermont’s Title V program, the Health Department, and Agency of Human Services continues 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 FCH program is at the center of these discussions and efforts. Resilience and equity are also central to the strategies of Vermont’s State Health Improvement Program (SHIP), Invest in programs that promote resilience, connection and belonging, and includes approaches core to Vermont’s FCH 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 FCH partnerships and collaborations this year include: 

• Youth Thrive Training- A framework which encourages a strengths-based approach, viewing behaviors as normal stages of development, and supports staff working with youth by providing information, tools, 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/family and child health sectors, prioritizing family leadership and advancing equitable access to services for priority populations.
• Cross-sector use of Help Me Grow’s Ages and Stages (ASQ) Online System increased by 74%.

Help Me Grow Vermont

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 Vermont (HMGVT). Offering a one-stop-shop centralized intake and referral system resource hub, HMGVT links families to services and stays in touch so families receive support before, during, and after they are connected. All callers are screened for food security using the Hunger Vital Sign™ tool with connection to needed resources.

Our HMGVT resource hub maintains a database of over 3,000 services and programs, including mental health services and treatment supports. This includes detailed information on mental health clinicians trained in evidence-based child and family trauma treatment, perinatal mood and anxiety disorder (PMAD) treatment, and substance use disorders. There were 34 people referred to PMAD supports. HMGVT made 159 PMAD referrals on behalf of these 34 callers. Additional highlights during this reporting period include:

• HMGVT made 2,173 referrals on behalf of callers, provided 1,127 follow up calls, and confirmed that 130 individuals who called, texted or were referred got connected to at least one service. (Because we don’t have a way to track individuals who never responded to follow-up, this is very likely an undercount).
• There were 881 calls/texts/referrals to HMGVT: 112 referrals/calls were from health care providers.
• Almost all families served reported getting their needs met and indicated they had an increased understanding of child development and felt able to access services.

Through regular, on-site attendance at the Family Room, a Parent Child Center that serves Vermont’s largest population of New American immigrants and refugees, HMGVT bilingual staff are working to increase equitable access to services. Through attendance at the Crawlers, Waddlers, and Toddlers playgroup, a bilingual HMGVT child development specialist is building strong relationships with New American families and partnering with multi-lingual New American community health workers, to offer more culturally responsive, in-person information, monitoring, screening, and referral services. On average 16 families attend this playgroup and HMGVT staff have made referrals on behalf of six families to date. HMGVT staff plan to increase on-site services at the Family Room by attending the Families and Children summer playgroup that occurs outdoors at the Interval gardens. Here New American families gather to connect with other families while growing culturally appropriate vegetables and food. 

We recently completed 2020-2021 HMGVT Impact Report. Our newly revised HelpMeGrowVT.org website aligns several FCH communications campaigns, Support Delivered, One More Conversation, and Strong Families Vermont home visiting, with HMGVT as the call to action. The Support Delivered campaign is designed to raise awareness around the prevalence of perinatal mood and anxiety disorders (PMADs) and bridge connections between expecting and new parents and statewide perinatal mental health resources. Digital and print materials, including a HMGVT postcard, continue to be disseminated and will link to the new HelpMeGrowVT.org website to drive both providers and families to refer and to connect with our HMGVT Resource Hub.

Additionally, FCH ran a HMGVT digital communications six-month campaign with new creative content to drive traffic to the HelpMeGrowVT.org website and the Your Developing Child page. The campaign targeted families, health care providers, and early educators and will resume annually. Creative content is co-branded with CDC’s Learn the Signs. Act Early. Program and HMGVT information. Since the promotional campaign began:

• Web user visitors have grown by 180% compared to the prior period.
• Content was accessed from throughout Vermont including a total of 181 towns/cities (out of a possible ~237).
• 16,276 pageviews with 2:27 minutes average for view and 4:00 minutes for the Your Developing Child page

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[SI(1]% in 2020.[1] Routine screening across multiple domains of development, including screening for social determinants of health, closes gaps in kindergarten readiness and promotes positive outcomes and resilience even when children have challenging experiences, such as a pandemic, poverty, violence, and trauma. HMGVT offers family-engaged developmental monitoring and screening tools, training to help families better understand their child’s early development and identify concerns so young children get connected to the services they need at an early age when the benefit is greatest. HMGVT aligns screening efforts across settings to improve early identification by offering free provider access to a statewide Ages and Stages (ASQ) Online Enterprise system as well as the ASQ Online Family Access for families to complete questionnaires. There are currently 57 programs/practices using ASQ Online with 14 programs trained during the reporting period. Of these 13 are medical practices, 27 are early care and education programs, six are Strong Families Vermont Nurse home visiting programs, and three are Children’s Integrated Services programs. By the end of the reporting period, over 11,148 screens had been entered in the ASQ Online system with 9,721 for general development and 1,427 focused on social-emotional development, a 74% increase from last year. The ASQ Online screening data will be integrated with Vermont’s Universal Developmental Screening Registry (USDR) for increased communication, coordination, and population data.

School Health and EPSDT

Vermont’s Title V is closely linked with EPSDT-funded initiatives and efforts to promote the administration of Medicaid and improve health for children and adolescents including connections with Vermont’s school health services and their school systems. The State School Nurse Consultant (SSNC) is located within the Division of FCH. This role helps to further Title V efforts and promotes the administration of Medicaid while reducing barriers to access and use of services. The role of EPSDT funding and the School Nurse Consultant are discussed in greater detail in the Adolescent Health Report.

Physical Activity and Nutrition

Vermont continues to work 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. These policy, systems, and environmental strategies include ways to help children eat healthier foods, be more physically active, and for older children, information and skills that will help them resist tobacco use. Vermont Department of Health Offices of Local Health are available to provide technical assistance to schools and childcare programs to help them sign on and continue to build on their successes. Vermont Title V supports the salary of the physical activity and nutrition director, who focuses on increasing physical activity and nutrition in settings where children and youth spend time. This position is in Vermont’s Division of Health Promotion and Disease Prevention.

During this work period, the Vermont Department of Health staff demobilized from their COVID-19 duties, with most back in their regular roles by summer 2022. Staff are supporting organizations in their areas to sign on to 3-4-50 or continue working on their 3-4-50 goals.

Oral Health

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 Health 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 (SDF) 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.

FCH partnered with the Office of Oral Health and Monica Benjamin, the Vermont AAP’s Oral Health Champion to develop, translate, and promote an oral health risk assessment/shared decision-making tool that can be used to integrate messages and services into primary pediatric medical care. The tool was translated into 10 different languages and can be co-branded by the Vermont Department of Health (VDH) and pediatric medical health care practices. Monica and Robin Miller, the VDH Oral Health Director, have had multiple opportunities to promote the tool to pediatric health care providers throughout the state.

Vermont’s 802 Smiles Network of School Dental Health programs help to ensure that every child has access to preventive, restorative, and continuous care. The network includes the various school dental health programs in Vermont. Schools in the network are organized by tier based on the level of services provided; for example, Tier one includes dental screenings and case management (school-linked programs), Tiers three and four include the provision of preventive care in schools (school-based programs), and Tier five includes school-based clinics that offer both preventive and restorative care on site.

Each year approximately 400 children undergo general anesthesia in a hospital setting to treat preventable dental disease. The number of children who are treated in this manner can be substantially reduced by incorporating minimally invasive dental treatments (like SDF) that work to address the underlying disease process and do not require needles or drilling. You don’t need to be a pediatric dental practice to see children under age three, yet only about half of Vermont children enrolled in the Medicaid program receive any dental care by their second birthday. To increase the number of dental health care providers who are using these minimally invasive techniques, the Vermont Oral Health Advisory Panel (of which FCH is a member), hosted a presentation on the use of minimally invasive treatment. This was followed up with additional training on minimally invasive treatment for dental hygienists who work with the 802 Smiles Network of school dental health programs.

FCH partnered with the Vermont Oral Health Advisory Panel to create a State Oral Health Plan, which serves as a roadmap to achieving oral health equity. Vermonters who have disabilities are a population of focus for this plan, and “Expand School-Based Dental Health Programs” is one of seven goals outlined in the plan. As stated by our Health Commissioner, Dr. Mark Levine in his opening remarks, “The activities outlined in the plan are actionable and achievable. We know how to prevent and treat oral disease; we know who is experiencing the overwhelming burden of disease, and the members of the advisory panel have demonstrated that we have the will needed to create change; the time is now to join forces to combat this winnable battle.”

During the October 2021 to September 2022 period the Office of Oral Health (OOH) laid the groundwork for the 2022-2023 oral health survey of Vermont Children. FCH worked with the OOH to recruit schools from a representative sample developed by the Association of State and Territorial Dental Directors. This data allows us to assess the oral health of Vermont children and understand our progress towards closing the gap on oral health disparities. Since data are collected in a similar manner across all states it also allows us to assess our oral health indicators (treated and untreated decay, dental sealant rates, and potentially treated decay) compared to other states. We expect the survey report to be publicly available by the fall of 2023. 

Injury Prevention

Vermont Title V worked to improve health and safety outcomes for children including:

• Support statewide implementation of evidence-based home visiting programs that have demonstrated effect in improving parenting practices.
• FCH Coordinators at the District Office level serve as members of local Child Protection Teams
• FCH leadership serves on the Vermont Citizen’s Advisory Board (VCAB) to examine policies, practices, and procedures of the Vermont’s child protection agency, and provide for public outreach and comment to assess the impact of current procedure and practice on Vermont children and families.
• FCH leadership serves on Vermont’s Child Fatality Review Team and works with this team to update data gathering, assessment, and review procedures. Key areas of concern are infant safe sleep, suicide, and motor vehicle accidents.
• FCH Coordinators at the local level coordinate with the Department for Children and Families to improve the health status of children in state custody (Fostering Healthy Families).
• Vermont contracts with a Child Safe Physician to provide medical leadership and case-specific consultation for community efforts and coordination around child abuse and neglect, and trauma response.
• FCH works with the Child Safe Physician and VDH Health Statistics to perform analysis of morbidity and mortality due to child abuse and neglect.
• FCH provides injury prevention leadership through regular webinars with childcare providers through Let’s Grow Kids.

Partnerships

We leverage and sustain family partnerships through the FCH Family and Community Partnerships Coordinator full-time position, recently established to elevate the voices of those with lived experience, support racial equity, and address health disparities for BIPOC Vermonters. This position is tasked with increasing family leadership across the system of care by creating a culture that invites and supports family partnership and provides the necessary training and coaching needed to attract families who are unfamiliar or uncomfortable with formal organizations and the systems, language, and processes used in the current decision-making structure. Equitable reimbursement and professional development support and training for families, offered in culturally and linguistically responsive ways, will help mitigate barriers to participation for those with lived experience.

The Public Health and Primary Care Integration group transformed into a larger partner network, known as The Monthly Scoop. The Monthly Scoop is convened by a partnership between American Association of Pediatrics – Vermont chapter (AAPVT), VCHIP, Vermont Association of Family Physicians (VTAFP) and FCH at VDH. This monthly meeting continues to include hot topics in child health (COVID and otherwise) and will also be a platform to hear from Vermont child health professionals and community colleagues about all things that impact outcomes for Vermont’s children, youth, and families. Taking a CQI approach, this meeting continues primarily focus on health-related issues pertaining to health professionals.

FCH 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, FCH formed an internal early childhood unit to align early childhood and health work and opportunities and implement Roadmap recommendations. [CS2][SI(3]This includes prioritizing family leadership and health equity under the guidance of our new FCH Health Equity Coordinator and FCH Family and Community Engagement Coordinator. FCH efforts have been expanded by VIP-3 implementation partners including: the Vermont Department of Health, HMGVT, 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 liaisons and community health workers, and Vermont’s FCH health system partners [e.g. Vermont Chapter of American Academy of Pediatrics (AAP), Vermont Academy of Family Physicians (VAFP), American College of Obstetricians and Gynecologists (ACOG), American College of Physicians (ACP), Blueprint for Health, VDH’s Office of Health Equity, 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 Local Health Division and the regional Local Health district office FCH Coordinators and School Liaisons.

[1] Our data source was the Vermont Health Care Uniform Reporting and Evaluation System (VHCURES), Vermont’s all-payer medical claims database. VHCURES contained an estimated 90% of Vermonters’ medical and pharmaceutical claims, from 2008 to 2016. Mid-2016, because of the Gobeille v. Liberty Mutual Insurance Company decision, VHCURES no longer included approximately half of all the individuals with Commercial Self-Pay insurance. Since mid-2016, VHCURES contained an estimated 75% of Vermonters’ claims.

[SI(1]Nothing more current?

[CS2]This sentence is not making a lot of sense to me

[SI(3]I think it is fine, but also can delete.