Vermont has made significant gains in developmental surveillance and screening with Help Me Grow. This is further underscored by the recent publication of Vermont’s State Health Improvement Plan (SHIP) which names “Optimal Child Development” as one of only six priority areas.

The Help Me Grow system is designed to help states and communities leverage existing resources and build efficient and effective early childhood systems that mitigate the impact of adversity and strengthen protective factors among families so that all children can grow, learn and thrive to their full potential. Vermont is using HMG as a system strategy to increase surveillance and screening of children across various settings, including CYSHCN, and then link children and families to existing quality services and resources, including their medical home. Continuous quality system improvement is assured through data collection and analysis across four interdependent core components:

1. Family & Community Outreach to bolster healthy child development through families and facilitate provider networking and collaboration.
2. Child Health Provider Outreach provides training to support early detection and intervention, use of the Help Me Grow contact center, and use of Vermont’s Universal Developmental Screening Registry.
3. Centralized Phone Access Point/Contact Center serves as the hub to link children and their families to community-based services and answer caregivers' questions about their child's development and behavior. Dial 2-1-1 ext. 6, text HMGVT to 898211, or email at info@helpmegrowvt.org.
4. Ongoing Data Collection & Analysis for continuous system improvement, to identify systemic gaps and bolster advocacy efforts.

Although Help Me Grow Vermont is funded primarily by Vermont’s Preschool Development Grant Birth to Five, we have leveraged Title V funds to support specific training and outreach activities for scale up and spread. Title V funds support our twelve regional Maternal and Child Health (MCH) coordinators to provide Child Health Provider Outreach promoting developmental screening, use of the Universal Developmental Screening (UDS) registry, and use of the HMG contact center to support timely referrals and linkage of children and families to community-based services. As a result of training and outreach in 2018, there was an 89% increase in calls and referrals to the HMG contact center from early care and learning, health care and community service providers, and educators. And, over 200 providers are using the UDS registry. Find our 2018 HMG annual report and other impact statistics.

The UDS registry allows screening results and follow up/referral information to be securely shared between medical homes, early care and education programs, public schools, and other community service providers to improve early identification of risks and/or delays to ensure that children and families are linked to appropriate services and developmental supports. Tools included in the UDS registry are the Ages & Stages Questionnaires®, Third Edition (ASQ-3™), Ages & Stages Questionnaires®: Social-Emotional, Second Edition (ASQ:SE-2™) and the Modified Checklist for Autism in Toddlers, Revised with Follow-Up (M-CHAT-R/F).

Developmental screening is a Blueprint for Health Accountable Care Organization (ACO) quality measure that child health care providers can fulfill by using the registry. Participating practices and providers are encouraged to access and review developmental screenings completed by community providers to inform their surveillance and screening activities during health supervision visits. Family practice and pediatric practitioners can use the UDS registry to view a screen done by another provider, interpret and discuss the results with families, and then work with them to create a plan to address any needs that may have been identified. Medicaid will reimburse the child health provider for these activities. If a child does not receive a screen in an early childhood setting, child health providers proceed with screening according to AAP Bright Futures guidelines. New AAP Bright Futures guidelines, 4th edition, include updated developmental milestones, surveillance questions and screening guidelines that support Vermont efforts to promote greater collaboration for improved early identification.

HMG trained 625 cross-sector providers to use developmental and behavioral screening tools, the Ages & Stages Questionnaires®, Third Edition (ASQ-3™) and the Ages & Stages Questionnaires®: Social-Emotional, Second Edition (ASQ®:SE-2), and to refer families for further evaluation and services. As a result, the trend line has moved toward a significantly younger age of referral to IDEA Part C Early Intervention services: from 26 months average age of referral in 2014 down to 14 months in 2017. CDC’s Act Early program materials are embedded in program protocols and practices to support parent-engaged developmental monitoring and compliment routine screening. Providers are also trained to enter screening results into the UDS registry for system coordination and to streamline the process for families. Find more information on Vermont’s public health dashboard.

Vermont’s Title V program, and in fact much of the Health Department and Agency of Human Services is turning its eye towards the prevention of trauma and toxic stress, as well as building individual, family and community resiliency (flourishing). Vermont’s MCH program is at the center of all these discussions. A newly named Director of Trauma Prevention and Resilience Development sits within VT’s health care reform initiative and MCH is represented on a cross-agency team. Resiliency is also central to the strategies of Vermont’s SHIP: Invest in programs that promote resilience, connection and belonging, and includes strategies 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 cross-sector system to strengthen families’ 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.

HMG is focused not only on physical health, but also addresses the social determinants of health, trauma/toxic stress, and behavioral health issues. Title V funds support HMG family and community outreach which offers local trainings on these child health and development topics in partnership with Building Bright Futures (BBF) regional coordinators. In addition, BBF coordinators engage families to support education in developmental promotion and early identification and build collaboration among community providers and services. BBF coordinators partner with MCH coordinators to promote health care provider involvement in regional councils and build stronger connections to Blueprint Community Health Teams, family and primary care practices, etc. With the release of Bright Futures 4th Edition and Vermont’s focus on developmental and social determinants of health screening for all children, BBF is continuing to convene community partners and host conversations as follow up to the AAP Bright Futures 4th Edition Road Show held last year. Evaluation survey data of the BBF-sponsored trainings shows that community partnerships were strengthened among providers.

Our centralized telephone point of access for the Help Me Grow Vermont system is a call/contact center staffed by two trained child development specialists who provide connection to resources with follow up and care coordination. Operated in partnership with Vermont 2-1-1, a program of the United Ways of Vermont, the contact center offers a “go-to” place for family members and providers seeking information, support, community resources, and referrals. The Help Me Grow (HMG) child development specialists answer family's questions about their child's development and behavior and offer high quality parent education resources – tools and tips to support parents and caregivers to better understand child development, find teachable moments during everyday routines, and address challenging behaviors.  Specialists promote protective factors in conversations with families, link to developmental screening/assessment programs and specialized services when appropriate and refer to community and basic needs resources. Our call volume and referrals continue to increase. Read our public health dashboard story for how we are turning the curve serving families through our HMG contact center.

Our 2018 HMG annual report was created this year and the HelpMeGrowVT.org website was redesigned, and both feature a Strengthening Families section. Read our 2018 HMG annual report and find other impact statistics. Both the website and Facebook@helpmegrowvt promote protective factors. The website offers a clearinghouse of early childhood information for families and providers, and includes an online referral process for early educators, community service and healthcare providers to refer directly to the HMG child development specialists. Families are able be able to self-refer from the website and find developmental and parenting resources, and links to national resources - including resources that support young children's social emotional competence. Families can also complete a developmental screening questionnaire online and receive follow up from our HMG child development specialists who convey screening results to the family and provide follow up, referrals and care coordination for needed services or further evaluation.

Help Me Grow (HMG) VT recently concluded participation in a three-year Strengthening Families Protective Factors pilot project, supported by the JPB Foundation, HMG National Center and the Center for the Study of Social Policy. HMG VT worked with pediatricians on mitigating the impact of toxic stress and ways to help families reduce it. Pediatric providers at the University of Vermont Medical Center Pediatric and Pediatric New American Clinics worked to improve postpartum depression screening, child mental health history, developmental screening, the frequency with which parent concerns are elicited and the proportion of children that are connected to intervention services for the approximately 7,500 patients they serve. Findings were shared by HMG VT staff at the HMG National Forum in Buffalo, NY this year. Here is the link to the full report and executive summary for the project.

Recognizing the tendency to address chronic disease prevention and health promotion from discrete silos based on behavior or disease, the Health Department has planned and implemented a two-pronged approach to communicate a coordinated message about chronic disease and engage new partners from multiple sectors to address it. 3-4-50 is a statewide initiative to create an epiphany about chronic disease and spur action to reduce the incidence of disease. Based on San Diego County’s efforts using the three numbers, Vermont’s chronic disease unit has created a series of data briefs, communication tools and partner engagement materials that focus attention on the three behaviors of tobacco use, physical inactivity and poor diet that lead to the four chronic diseases of cancer, cardiovascular disease, diabetes and lung disease that together result in more than 50 percent of deaths in Vermont.

This initiative seeks to make chronic disease prevention simple and to help leaders across multiple sectors in the community recognize that they are partners in prevention. Engaging worksites, schools and childcares, cities and towns, retailers, and faith communities, the message and strategies of 3-4-50 bring data and evidence-based interventions together to create a simple to understand initiative that spurs urgent action. In a little over six months, this initiative has garnered more than 50 partners statewide across all sectors to commit to straight-forward, low or no cost strategies that will help promote better nutrition, more physical activity, and less tobacco use thus helping to prevent chronic disease.

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. 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 nutrition director in Vermont’s division of health promotion and disease prevention.

Title V partially funds the salary of the VDH Oral Health Director. “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. Public health dental hygienists also deliver community education by doing outreach and training to medical and dental providers and supporting community organization and prevention programs such as community water fluoridation, the 802Smiles Network of School Dental Health programs, and access to care.

MCH recently 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 will work with Communications and 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 helps to ensure that every child has access to preventive, restorative and continuous care. The network is an umbrella that consists of all the different 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.

Partnerships

Help Me Grow Vermont is a massive system change effort involving many partners. These include: VCHIP, MCH coordinators, Vermont 2-1-1, a program of the United Ways of Vermont, Vermont Family Network, Building Bright Futures State and Regional Councils, Child Development Division of the Department for Children and Families, Agency of Education, and Let’s Grow Kids, among others.

Vermont’s oral health 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.