Vermont has made significant gains in developmental surveillance and screening and promoting overall family resilience and wellbeing with Help Me Grow. Addressing social conditions of health which impact “Optimal Child Development,” one of only six priority areas in Vermont’s State Health Improvement Plan (SHIP), has become more urgent in light of the impact of the COVID-19 pandemic on Vermont’s children and families. Help Me Grow (HMG) Vermont has been working hard to support Vermonters through the COVID-19 pandemic and recovery by helping connect essential workers to childcare and families to food resources and many other supports. Calls from families seeking food resources in response to the pandemic increased by 382% when compared to the same time last year (March 15 – June). Likewise, during this same period, our calls from families seeking support and problem-solving have increased by 600%, from 40 in 2019 to 240 in 2020. Incoming calls increased by 50.99%, from 404 in 2019 to 610 in 2020. HMG assisted 88 essential workers with connection to childcare and received 17 referrals to connect families with perinatal mood and anxiety treatment and support.

Vermont’s Title V program, and in fact much of the Health Department and Agency of Human Services is continuing to focus on the prevention of trauma and toxic stress and addressing social conditions of health to support individual, family, and community resiliency (flourishing). Prior to the pandemic and more so now, Vermont’s MCH program is at the center of all these discussions and efforts. 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.

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.
• 70% of parents report positive family experiences (protective factors) as part of their overall experience of having an enrolled child in the Strengthening Families Grant Program. This program promotes early childhood development by ensuring affordable access to high quality early childhood programs for children and families challenged by economic instability and other factors; scorecard is here.
• Youth Thrive Training

HMG Vermont promotes developmental monitoring and screening to help families better understand their child’s early development, celebrate milestones, and identify concerns so that young children get connected to the services they need at an early age when the benefit is greatest. Routine developmental and social/emotional screening closes gaps in kindergarten readiness and promotes resiliency and positive outcomes even when children experience negative things, like a pandemic, poverty, violence, and trauma. Working to align efforts across environments – the family home, medical home, and child’s early learning environment – HMG has continued to grow the online ASQ developmental screening program. This program provides online family access to Ages & Stages Questionnaires at HelpMeGrowVT.org. Additionally, HMG piloted the system this year with several pediatric practices and Strong Families Nurse Home Visiting programs. In response to COVID-19 need for telehealth, virtual well-child visits and home visits, ten additional medical homes, five Strong Families Nurse Home Visiting programs, and one Head Start/Early Head Start program are now using HMG’s ASQ online system. The ASQ online system will be integrated with Vermont’s developmental screening registry to improve communication and networking across providers and programs.

Developmental screening is a Blueprint for Health 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. 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. Find more information on Vermont’s public health dashboard.

Key developmental screening outcomes this year include:

• HMG trained 352 health care and community service providers, early childhood educators, and others to conduct developmental and social/emotional screening and to refer families for further evaluation and services. Of these providers, 208 were early childhood educators.

• HMG training supports quality measures in Vermont’s Step Ahead Recognition System (STARS), the system for recognizing and improving quality in early education programs. Help Me Grow has contributed to a 30% increase in high quality childcare between 2014-2019, as a result of having trained early childhood educators from 211 programs to conduct screening.

• Approximately 7,500 children are currently enrolled in childcare programs that have received HMG training. This includes 1,835 preschoolers that are heading off to Kindergarten better prepared to learn and succeed. This is enough children to fill over 30% (129) of Vermont’s kindergarten classrooms.

• The percentage of children screened in the first three years of life using a standardized screening tool increased from 48% in 2013 to 63% in 2018. These children are among the 65-70,000 who are attributed to primary care practices participating in the Vermont Blueprint for Health. 

• Use of the developmental screening registry more than doubled to over 412 providers, including early childhood educators and public-school districts, Head Start and Early Head Start programs, health care and community service providers.

HMG creates a reliable, centralized resource grid so families and children from all communities in Vermont can plug in and easily access the resources and services they need to thrive. HMG strengthens the grid by maintaining an up-to-date directory of available services, including mental health resources for children and families. Recognizing the need for easier access to mental health care, this year HMG added information on mental health services and supports to its resource directory to better connect mothers, partners, and providers to services to address perinatal mood and anxiety and related substance abuse disorders. HMG is also partnering with a mental health agency in Vermont’s most populous county to relieve long wait lists for care and ensure a “no wrong door” approach to connecting families to mental health services. Read our public health dashboard story for how the HMG resource hub is turning the curve serving families. This year’s highlights include:

• In 2019, there was a 55% increase in calls and referrals to Help Me Grow.
• Calls and referrals were received at approximately the same rate from counties across the state.
• Follow up has increased by 68% with 1,200 calls made in 2019.

• Referrals increased by 67% in 2019.
• HMG staff provided 214 food-related referrals in 2019; a 50% increase from the year before
• HMG staff identified over 140 people/families who sometimes or often worried they would run out of food (39% of the callers screened in 2019 using the Hunger Vital Sign™).  Twenty-six percent (96 callers) indicated they sometimes or often ran out of food. 

Help Me Grow Vermont 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 117 community outreach events in 2019 and reached 5753 families.
• In 2019, HMG trained 709 providers and partners in the following topics:

o Trauma-informed practices and building resilience

o Social and emotional development

o Accessing resources

o Preparing young children for school

• Regional councils convened partners to align developmental promotion and existing Child Find efforts by successfully engaging Pre-K and school district partners, Head Start programs, parent child centers and even a children’s museum.  All but one region hosted an event offering developmental screening with a total of 109 screens completed. Many other events were held and ASQ offered and HMG materials distributed.
• Survey results show that HMG is strengthening protective factors in both families and providers with families reporting that they had an increased understanding of child development (89%) and felt more equipped to meet their child’s needs (90%) as a result of participation in events and trainings.
• Dissemination of HMG resilience materials and child development resources occurs ongoing. In 2019, over 10,000 Milestone checklists from CDC’s Learn the Signs. Act Early program were disseminated, and 17,200 HMG rack cards, magnets and other resources were distributed to families and providers.

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. Since its inception, this initiative has garnered more than 135 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. To date, 27 childcare programs and schools have 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.

Oral Health is another SHIP 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 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 and physical activity and nutrition 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.