Program Overview

 

Title V is VT’s backbone structure for MCH. Title V allows VT both to align with national priorities, as well as seek emerging priorities within state and local context. VT has used the Title V framework and funding to support staff and programming towards meaningful integration. Title V is the connective tissue to promote and enhance systems integration and partnership for all children and families across the state.

 

The Vision of our Division of MCH is: Strong, healthy families power our world.

Our mission is: We invest in people, relationships, communities, and policies to build a healthier VT for future generations.

 

MCH works across the life course to encourage optimal health and positive outcomes for all Ver. We support programs that provide direct services to pregnant people, children and families and build healthy communities. We provide leadership and guidance to professionals who work with children and families in a variety of settings including health care, early care and learning, schools and human service organizations. We respond to the needs of families by helping them connect to resources, improving access to quality health care and services, and ensuring policies and systems are developed to allow all residents to achieve optimal health. Collaboration with local, state and national partners encourages a collective impact resulting in long-term positive outcomes. 

 

Examples of key programs administered by MCH include CSHN, reproductive health, WIC, school health, EPSDT and preventive services, adolescent health, home visiting, child injury prevention, quality improvement in clinical care and community programs, and early childhood services and programming.

 

We align our Strategic Plan with the Title V framework. (Our Strategic Plan will be extended for another year, due to the impact of the COVID pandemic on our work. We will develop a new Strategic Plan during 2023.)

 

Priorities

 

Data analyses from the 2020 Title V Needs Assessment resulted in the identification of MCH population needs and areas where data indicate areas of strength. Despite this, VT continues with longstanding significant disparities.

 

Women’s/Maternal 

 

1. PM:  % of women who smoke during pregnancy

 [State] % of women advised by a HCW to abstain from alcohol during pregnancy

 Priority: Ensure optimal health prior to pregnancy

 

VT has one of the highest rates of smoking during pregnancy in the country: 13.5% in VT (NVSS 2020) compared to the U.S. at 5.5%. This data is more striking when stratified by WIC participation. Yet, VT has good cessation benefits for pregnant individuals through Medicaid and the 802Quits Network, including a moderate financial incentive. Through improved partnerships between MCH and the Tobacco Control Program, Title V has renewed action on this. Ongoing strategies include the promotion of 802Quits Network (ESM), as well as evidence-based training for professionals and a pilot contingency management project with financial incentive.

 

Like smoking, VT has a very high rate of alcohol use in pregnancy. 11.5% of women drank during the 3rd trimester of pregnancy compared to 7.5% in the US (PRAMS, 2020). Sixteen percent of women age 35+ drank alcohol during the last 3 months of pregnancy, compared to 9.8% of women nationally (2020 PRAMS). Moreover, 14% of women who drank before pregnancy reported that their providers did not advise them to abstain from alcohol during pregnancy. VT data demonstrate higher rates of alcohol use in pregnancy among older women, yet providers are least likely to advise this population to abstain. Despite VT’s former campaign: 049 (zero alcohol during nine months of pregnancy) to message to providers to provide this essential advice, VT’s numbers did not improve significantly. Consequently, we have chosen this new PM to reinvigorate coordinated work in this area and have launched a significant evaluation and messaging project: One More Conversation to improve these rates, discussed in more detail in the Women/Maternal narrative sections.

 

Perinatal/Infant

 

2.    PM:  % of infants breastfed exclusively through 6 months

 Priority: Promote optimal infant health and development

 

VT has a strong breastfeeding support system. WIC is respected for its strong clinical and peer counseling services, and MCH works with clinical and community providers to increase awareness and knowledge as to how to support breastfeeding. While VT has high rates of initiation (90.4% in 2018, compared to 83.9% for the U.S. population), there is substantial room for improvement in sustained breastfeeding (36.5% in Vermont vs. 25.8% for the U.S.). Significant disparities regarding education, marital status, age, and WIC participation persist. Prior to the pandemic, VT launched a stakeholder-engaged breastfeeding strategic planning process to identify strategies for the next three years (on hold due to COVID-19 efforts). These included: promotion of Baby-Friendly hospital initiative, coordinated training efforts, as well as efforts aimed at early care and learning and workplaces.

 

Child

 

3.    PM:  % of children, ages 9 through 35 months, receiving a developmental screening

 Priority: Achieve a comprehensive, coordinated, and integrated state and community system of services for children

 

Data from the 2018-19 NSCH indicate that 51.8% of VT children have been screened for development.

MCH, with key partners, continues work on our system of universal developmental screening through Help Me Grow (HMG). 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 Universal Developmental Screening (UDS) Registry, to improve communication and coordination among providers and reduce screening duplication. 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. Developmental screening is a Blueprint for Health and Accountable Care Organization (ACO) quality measure that child health care providers can fulfill by using the UDS Registry. Developmental screening is a standard for all home visiting programs and Children’s Integrated Services programs, bringing synergy across multiple initiatives. 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.

 

4.    PM:  % of children, ages 6 - 11, who are physically active at least 60 min/day

  % of children, ages 1 - 17, who had a preventive dental visit in the past year

 Priority:  Reduce the risk of chronic disease across the lifespan

 

While VT has comparably higher rates of physical activity among 6 to 11-year-olds (33.5% in VT compared to 26.2% in the U.S.- NSCH 2019-20), this rate is shockingly low. VT has long-been engaged in strategies to improve this and is using the opportunity of Title V to enhance coordination with our chronic disease division and other partners. This work includes strategies such as: promoting VT’s 3-4-50 initiative to early care and learning settings and schools; offering bonuses in our early care and learning quality rating system; working with VT’s early care professional development system; promoting the use of FitWIC: materials for parents and preschoolers; and promoting school wellness policies. The AHS Secretary has signed increasing interest in this topic so our MCH and chronic disease teams have just begun some internal strategic planning to further joint efforts.

 

More than 84% of VT children ages 1-17 had a preventive dental visit in the past year, compared to 78% for the U.S. population (NSCH 2019-20)). While VT has fairly good dental coverage rates, access to dental providers is limited, particularly for the Medicaid population. There are significant gaps in knowledge among medical and dental providers regarding oral health guidance. VT has a strong oral health program, coalition, and key strategies are increasing WIC participation in our public health dental hygienist program, increasing student/school participation in the 802Smiles Network of school dental health programs (ESM), and promoting midlevel dental therapists.

 

5. PM:  [State] % of children 6 months to 5 years who are flourishing

Priority:  Promote protective factors and resiliency among VT’s families

 

According to the 2019-20 NSCH, 82.3% of children ages 6 months to 5 years are flourishing, suggesting that about one-sixth of VT’s children are not thriving in at least one of four areas: curiosity, resilience, attachment to caregivers, and positive affect. To this end, VT has incorporated Strengthening Families Framework into all relevant work, with an emphasis on preventing and mitigating the impact of toxic stress. We are continuing to promote and expand Help Me Grow VT to promote optimal child development by enhancing protective factors, as well as home visiting. We will continue our systemic work to prevent domestic and sexual violence. The state is also investing in Building Flourishing Communities framework with MCH as an essential partner to make a broader connection for our work to increase resiliency in young children and are partnering with the Agency of Human Services Trauma Prevention and Resilience Director to help set priorities and identify and plan activities to promote resilience, as well as developing statewide resiliency messaging and toolkit.

 

Children with Special Health Needs

 

6.    PM:  % of adolescents with and without special health care needs, ages 12 through 17, who received services necessary to make transitions to adult health care

 Priority: Achieve a comprehensive, coordinated, and integrated state and community system of services for children

 

VT has an already very high percentage of children with medical homes, so we have turned our attention to transitions. According to the 2019-20 NSCH, only 30.8% of adolescents with a special health care need received transition services. VT’s CSHN program continues work on establishing strong relationships between its medical social workers and primary care practices with a focus on care coordination activities statewide. CSHN and UVM’s Center for Disability Community Inclusion are working together to inventory statewide activities and identify opportunities through a statewide summit. CSHN has worked to build relationships with the statewide network of HireAbility (formerly VocRehab) Transition Counselors.

 

Data from the 2019-20 NSCH shows that youth without special health needs receiving transition services (24.7%) is similar with to those with special health needs (30.8%) and slightly higher when compared to the nation (17.6%). Clearly, there is much work to do here.

 

Adolescent

 

7.    PM:  % of adolescents, ages 12 - 17, with a preventive medical visit in the past year

  [State] % of adolescents that feel they matter to people in their community

 Priority: Youth choose healthy behaviors and thrive

 

While VT appears to do well on this measure on national surveys exceeding the HP2030 target and national average (VT 84.8%, US 75.6% in 2019-20, NSCH), state specific data from practice improvement chart audits and all-payor claims data suggest this is still an area of concern. MCH plans to identify and develop communication materials and social marketing strategies for providers, parents/caretakers, and adolescents, to be used in tandem with EPSDT outreach and informing letters, school nurse materials, and patient handouts. Specifically, MCH is working with schools to promote Bright Futures recommendations of an annual well-exam. We are creating opportunities to assess and convene school-based health centers and plan to promote the PATCH for Teens.

 

Although it is difficult to move the needle on adolescents who feel they matter (58.2% in 2019, down from 60.5% in 2017, but up from 50.5% in 2015; source: YRBS), VT aims to promote healthy behaviors among youth through an empowerment model. VT has joined with other organizations in highly innovative and effective programming: Getting to 'Y' is an opportunity for students to take steps to strengthen their school and community by addressing risks and promoting strengths. Additionally, VT has formalized a Youth Advisory Council. New strategies include participation in the VT9to26 (afterschool) coalition; leadership to the Youth Systems Enhancement Council, and promotion of Youth Thrive as a key framework to support positive youth development. A key concern is the impact of COVID on school attendance and mental health and how this measure will be impacted. MCH will keep close monitor of this, as well as implement COVID recovery programming and systems improvements to address emerging concerns.

 

8.    PM:  % HS students who made a plan to attempt suicide in the past 12 months

 Priority: Children live in safe and supported communities

 

VT has a high rate of high school students who made a plan to attempt suicide in the past year -- 13.4% in 2019, above the Healthy Vermonter’s 2020 target rate of 8% and the Title V target of 7%. Significant differences exist in this indicator when looking at health equity. 21.1% of Latinx students, 17.8% of multiracial, and 13.7 of Native American students compared to 14.8% of black students made a suicide plan, compared to 12.7 of white students. Disparities exist by sexual orientation, as well (35.6% of LGB compared to 9.6% of heterosexual students).

 

VT’s MCH program has long been committed to addressing injury prevention in the MCH population; however, several years ago, VT lost dedicated injury funding and it has been challenging to prioritize this work. New efforts around suicide prevention, farm health, child maltreatment, and infant safe sleep have enabled a renewed commitment to this work. VT’s primary strategies include: collecting and report on QI data from pediatric practices on depression screening in partnership with VCHIP; participation in AYA CoIIN for systems improvement in screening youth for depression and other factors that may lead to suicidality; promoting suicide screening in primary care using the nationally recognized Zero Suicide approach; assessing ED protocols and coding for response to patients who have attempted suicide; and supporting UMatter Youth and Young Adults Mental Health Wellness Promotion and community Action in schools. Vermont is digging even deeper into these topics, in the context of COVID and its impact on mental health and substance use.

 

9.    PM:  % of MCH programs that partner with family members, youth, and/or community members

 

In 2021 eight out of nine (88.9%) MCH programs that partner with family members, youth, and/or community members. VT has a long tradition of promoting family-centered care and involving families in all levels of decision making. Our MCH Division values family input across programming and planning and works to do this in an authentic and meaningful manner. VT is advancing a new state performance measure on family partnership which aims to ensure that MCH programming partners with families across all levels of engagement.

Partnerships

 

Vermont’s Title V is actively engaged in ensuring a statewide system of services, which reflect principles of comprehensive, community-based, coordinated, family-centered care.

 

The MCH Division works very closely with other divisions within VDH to carryout activities under and connected to Title V. VT does not have county level health departments, but local offices at the district level. MCH Coordinators and School Liaisons in each of these district offices carry out Title V and other MCH-related work within communities. The Division of Health Promotion and Disease Prevention houses programmatic activities related to tobacco control and prevention, oral health, physical activity and nutrition, and chronic disease. MCH works with the Division of Emergency Preparedness, Response and Injury Prevention to address childhood injury, Environmental Health around toxic exposure, and the Division of Substance Use Programs on shared planning around substance use in pregnancy and youth substance use. MCH epidemiology, data analysis, surveillance and immunization is conducted by staff within the Divisions of Health Statistics and Informatics and Laboratory Science and Infections Disease.

 

VT is a small rural state with a population of slightly more than 600,000, with proportionally small state government agencies. Committed staff across children and family-serving state agencies and nonprofit organizations work closely with each other and family organizations to address the needs of VT children and families. VT has many strengths and is at the leading edge of significant innovation and advancement in health care delivery and financing for VT’s children, including those with special health care needs.