Needs Assessment Update

Vermont continually reviews FCH data and gaps in services. Vermont’s COVID-19 has impacted FCH efforts over the last three years, as the majority of FCH staff were deployed for a large percentage of the response to the Department’s Health Operations Center (HOC). FCH is proud of this work including contact tracing and index patient interviews, quality improvement and data review to support contact tracing efforts, standing up the School and Childcare branch of the COVID-19 response, leading the effort to create a case manager program for Vermonters in need, and taking on leadership roles in the state response. Our needs assessment update includes the following:

• VT FCH’s Strategic Plan, aligns with our Title V framework, and we plan to update our Strategic Plan and process for Title V reporting in 2024.
• Annual review of FCH outcomes at the district, county and state level for key FCH topics: infant mortality, LBW, preterm delivery, pre-pregnancy BMI and weight gain during pregnancy, prenatal care entry, adequacy of prenatal care utilization, smoking around pregnancy, teen birth/pregnancy rates and new families at risk. A Vital Statistics bulletin is posted annually.
• The Vermont Perinatal Quality Collaborative, produces data annually on perinatal statistics, which are shared with individual birth hospitals and a perinatal public health report which includes key topics at the district and state levels.
• Our Division of Health Statistics and Informatics publishes regular data briefs on key FCH topics and special populations including PRAMS, BRFSS, YRBS, and School Health Profiles. While some of this work has been delayed as staff worked on the COVID-19 response, we are beginning to see the results and impacts of COVID-19 reflected in these surveys.
• VT finalized the State Health Assessment (SHA) and State Health Improvement Plan (SHIP) in 2018, which continues to guide our work. The SHA and SHIP help the state prioritize goals and objectives for health, monitor trends, identify gaps and track progress. The SHA/SHIP use a health equity framework, evaluating data by key populations that have experienced historical injustice. The SHIP priorities include outcomes that specifically relate to FCH topics: optimal child development, substance abuse and mental health. Work is currently underway to update the SHA and SHIP.
• Many of our programs solicit ongoing consumer feedback through satisfaction surveys. We convene regular advisory councils that include representation from professionals and direct consumers.
• Needs assessments are regularly conducted by programs at FCH (including, home visiting and family planning) and partners such as: The Office of Head Start, Department for Children and Families and Substance Use Programs. This information is shared and incorporated into our program planning.

Overall direction for VT’s Title V needs assessment and ongoing planning is provided by the FCH Leadership Team with representation from all programmatic areas. Our 2020 needs assessment findings are helping to develop and refine materials and methods to best meet the needs of these communities. Work is currently underway to plan for our 2025 Needs Assessment.

MCH Population Needs

Women/Maternal Health

The landscape of services for preconception and pregnant individuals continues to improve. Through the VT Blueprint for Health, women’s health providers provide enhanced health and psychosocial screening along with comprehensive family planning counseling and timely access to LARC. These screening efforts align with perinatal mood and anxiety disorder screening through the Screening, Treatment, and Access for Mothers and Perinatal Partners (STAMPP) cooperative agreement with HRSA. The Blueprint for Health provides staff capacity, training, and payments to support effective follow-up to provider screenings. New laws codify the right to reproductive liberty and the ACA’s contraceptive coverage rules into state law.

Nurse home visitors, parent educators, and WIC staff regularly screen pregnant women for tobacco use and refer to the Quit Line resources and medical follow up. FCH and its partner division: Substance Use Programs is gearing up to lead a strategic planning process around substance use in pregnancy and early parenting to identify gaps and improve systems and coordination, as well as inform programmatic efforts for Opioid Abatement funds. Vermont’s Perinatal Quality Collaborative is gaining more momentum and deeply engaged in multiple quality improvement efforts in both hospital and community settings. Vermont received the CDC PQC opportunity, which will help us to improve birth certificate quality, as well as improve clinical-community linkages to provide care and support across fields.

Perinatal/Infant Health

VT continues to be a leader in US perinatal and infant health outcomes, including low rates of elective caesarians; perinatal regionalization; services, supports, and treatment for infants exposed to opioids; and breastfeeding initiation and duration. In recent years, Vermont passed legislation to require paid sick leave for employees, which is of major significance in supporting perinatal, infant and family health; the state is also rolling out a voluntary paid family and medical leave program. Legislators have (unsuccessfully) attempted to pass a mandated paid family leave, which may be brought before the legislature again in the coming session. Vermont launched the expansion of postpartum Medicaid until 1 year postpartum in early 2023. Additionally, FCH is working to expand nurse and family support home visiting through Medicaid and we will be able to expand the DULCE model (described elsewhere) through Medicaid funding through the VT Blueprint for Health. VT is stepping up efforts around safe sleep and SUID prevention, including working with birth hospitals to implement safe sleep policies and a comprehensive messaging campaign for parents and providers. VT launched a breastfeeding strategic planning process informed by stakeholder input just before the pandemic, which is now being implemented.

Children’s Health

VT continues to expand its services and supports for early childhood. VT’s Help Me Grow system is about to celebrate its seventh birthday, demonstrating considerable successes. We have rolled out the statewide developmental screening registry with health care providers, early care and learning providers and other partners. Help Me Grow now offers online developmental screening removing barriers for families and providers. Vermont is also the lead on the HRSA ECCS opportunity, is a member of the ACF-funded Preschool Development Grant leadership team and is actively engaged in statewide discussions around early childhood systems and potential restructuring.

While VT is ranked among the healthiest states for many public health indicators, we are concerned about the growing number of children who do not engage in the recommended amount of physical activity. In partnership with WIC and our chronic disease division, we are promoting physical activity recommendations in ECE environments, schools and communities.

VT is committed to strengths-based approaches to supporting children, families, and communities. In partnership with VCHIP, VT has recently reinvigorated the state’s commitment to implementing the Touchpoints approach.

Adolescent Health

VT has relatively high rates of adolescent well-visits on the National Survey but claims data and survey data with providers suggest that these are not comprehensive or quality well-visits. VT has high rates of adolescent substance use and other risk behaviors. To this end, VT was one of the first five states chosen to participate in the initial AYAH CoIIN, and we have continued our commitment to quality improvement focused on behavioral health. VT has formalized a VT Youth Advisory Council, with the goal to actively engage adolescents and young adults in strategies to create youth friendly services. In addition to improving AWVs, VT aims to promote healthy behaviors among youth through an empowerment model and coordinated linkages to after school programs.

VT has worked closely and in partnership with pediatric and family medicine providers to provide up-to-date information on COVID-19, including vaccination for adolescents as well as provide anticipatory guidance to families of babies, children, and adolescents regarding COVID-19.

CSHN

VT FCH continues to leverage substantial federal grants for systems and programs to complement the significant existing CSHN work accomplished by Title V funds for the past many years. CSHN programs have been able to move towards systems-building, population-based and enabling services to support families, a model that more thoroughly supports children and families by supporting comprehensive, coordinated, clinical service delivery, while utilizing traditional payment models. VT continues to work to improve coordination among family service entities and improve overall systems health, which we plan to do through further refinement of the role of CSHN Care Coordinators. Ongoing efforts to refine data analysis help identify gaps in and barriers to the system, to achieve a comprehensive, coordinated system of state and community services and supports.

With Title V funding, UVMMC hired a Developmental Behavioral Pediatrician, and we’ve established an integrated clinic with child psychiatry and CDC to diagnose and treat children with concerns of developmental delay and autism. This has been years in the making and is a major success for children and families. VT continues to work closely with our partners at the Department of Mental Health, Department of Aging and Independent Living, Department for Children and Families/Child Development Division, and Department of Vermont Health Access (Medicaid). We established a working group to address barriers in accessing timely developmental assessment and evaluation, and support families in accessing resources and services even during times of long waits.

Title V Program Capacity

There have been no changes in the Title V organizational structure; although, VT also seeks to expand capacity through existing staff, new staff, and partnerships. In May 2023, Vermont’s Title V program housed in the Division of Maternal and Child Health changed its name to the Division of Family and Child Health. While we we’re the same dedicated public health professionals with the same set of programs, doing the same critical work, we felt a critical responsibility to make sure all Vermonters feel included in our programming. As a division, we are committed to serving people of all genders, including those who identify as trans and non-binary. We believe that trans and gender non-conforming (TGNC) people often feel left out of services when they are described in gendered terms. Data reveals that TGNC people face the highest rates of sexual and gender-based violence and are at highest risk for negative mental health outcomes due to discrimination and systemic oppression. Our workplace is dedicated to health equity, and we recognize that feeling a sense of belonging is deeply tied to our well-being.

Title V/FCH sits within the Department of Health (VDH), the state’s health agency and is overseen by Commissioner of Health, Dr. Mark Levine. VDH is one of 6 departments within the Agency of Human Services, therefore enjoying joint leadership and close partnerships with: Departments of Mental Health, Health Access (Medicaid and health reform), Disabilities, Aging, and Independent Living, Children and Families, and Corrections. The AHS Secretary reports directly to the Governor. The Governor has identified increasing early childhood and higher education funding, as a continuum, as one of the top priorities of his administration.

The AHS Secretary and Governor have a strong interest in prevention and are focusing efforts on home visiting as a key strategy to ensure the healthy future of Vermonters. In fact, he allocated funds in the SFY20 budget for sustained home visiting which unfortunately was put on hold due to COVID, but work has restarted and launched on April 1, 2023. 

The FCH Division, led by Ilisa Stalberg, has primary oversight for all Title V programming. Several other federal initiatives are housed within the FCH Division: WIC administration, MIECHV, Help Me Grow, Title X, PREP, EPSDT/school health. VT’s CSHN program is under the FCH Division.

Partnerships, collaboration, and coordination – public, private, family

VT is a small rural state with proportionally small state government agencies. Committed staff across children and family-serving state agencies work closely with each other and family organizations to address the needs of children and families. VT has many strengths and is at the leading edge of significant innovation and advancement in health care delivery and financing. Title V is actively engaged in ensuring a statewide system of services, which reflects principles of comprehensive, community-based, coordinated, family-centered care. Examples of key partnerships:

Vermont Department for Children and Families. FCH works in close partnership with the Division of Family Services to ensure public health is at the core of child welfare programming, including ensuring that all children newly entering state’s custody have up-to-date medical and dental health services. We also work very closely with the Child Development Division (CDD) to align our early childhood efforts, including Children’s Integrated Services (CIS). These efforts provide a continuum of prevention and early intervention services for eligible prenatal/postpartum women, infants and children 0-6, and their families. During the pandemic, FCH worked very closely with the childcare team and CIS at CDD to ensure guidance for childcare providers and timely response to emerging topics.

VT Child Health Improvement Program (VCHIP). VCHIP is a population-based child and adolescent health services research and QI program of the UVM. Since 2000, the partnership between the FCH and VCHIP has resulted in measurable improvements in child health outcomes across the pediatric age spectrum and a variety of health service areas.

American Academy of Pediatrics VT Chapter (AAPVT). VDH collaborates with AAPVT to assist VDH in the development of more efficient and effective health care services for children and families through consultation with the health care professional community and to identify and improve systems of care for children at risk. A monthly Primary Care and Public Health Integration meeting convenes the leadership of FCH, VCHIP, AAP, AAFP, Planned Parenthood, ObGyns, and internal medicine providers, to coordinate various projects.

University of VT Medical Center/University of VT Children’s Hospital: VT works very closely with UVMMC to improve the system of care for children and families.

Agency of Education. FCH collaborates with the health education consultant at Agency of Education to align skills and content in our state’s approach to health education in public schools. We also work closely with AOE around essential school health services through our state school nurse consultant. AOE and FCH worked in tight partnership during the pandemic to develop policy and implement guidance for schools throughout the pandemic, including the 2023-2024 upcoming school year.

VT Family Network: VFN is committed to a mission that promotes better health, education and well-being for all children and families, with a focus on children and young adults with special needs. VFN regularly participates in our annual Title V submission, needs assessment, and attends the block grant review yearly.

Vermont Afterschool is a public-private statewide partnership dedicated to supporting and sustaining innovative learning opportunities that extend beyond the school day for all VT’s children and youth. Activities are directed toward increasing the quality and availability of education programs during non-school hours.

Emerging Issues

Maternal and Child Health works to align our approaches to our Governor’s platform which is:

• Growing the Economy through Expanding and Strengthening VT's Workforce
• Making VT More Affordable:
• Protecting the Vulnerable and Natural Resources
• Addressing the Opioid Epidemic
• Preserving the Environment
• Supporting Safe and Healthy Communities

VT is committed to continued engagement and learning around the social determinants of health and heath equity. While VT is consistently ranked as one of the healthiest states in the nation, data shows not everyone has an equal opportunity to be healthy. To further promote the understanding and recognition of SDOH, VT has engaged in several strategies, including: Bright Futures Guidelines Roadshow, and implementation of the Developmental Understanding and Legal Considerations for Everyone (DULCE) model (both described elsewhere). Additionally, through participation in the CHHS Aligning Early Childhood and Medicaid (AECM) initiative and in partnership with the ACO, VT is advancing strategies to modify how we stratify risk for children in health care payment reform.

As in all states, VT continues to work to address the opioid crisis. VT is the recipient of the HRSA funded initiative: Screening and Treatment for Maternal Depression and Related Behavioral Disorders Program. A Vermont team is currently receiving 2-years of in-depth technical assistance from the Children and Family Futures and is developing an action plan to address postnatal support for families with SUD; Vermont Title V is leading this work. VT is also advancing a coordinated message around the prevention for and treatment of all substance use, including alcohol, tobacco, cannabis, opioids and other drugs: One More Conversation.

VT works closely with colleagues in the Family Services (FS) Division (child welfare) at DCF. Efforts are underway to ensure the medical and dental needs of children in custody are known to FS Caseworkers and foster parents, as well as the clear identification of children with special health needs, as these cases are often overlooked with serious consequences. Additionally, Vermont (including FCH) is participating in a CMS Affinity Group to improve coordination and care for children in foster care.

VT continues to work to align its suicide prevention and response efforts but is challenged by siloed strategies and competing priorities. We are engaging state level leadership to help coordinate suicide prevention efforts across our agency including Department of Mental Health and Medicaid.

On August 15, 2019, Vermont relinquished our Title X funding and has only just rejoined the program (April 2022). The Vermont Department of Health has partnered for over 40 years with U.S. Department of Health and Human Services (HHS) and our family planning network, Planned Parenthood of Northern New England (PPNNE), to provide critical family planning services to thousands of Vermonters through the Title X program. During the hiatus from Title X, the Health Department moved forward to use state funds to preserve the access to services provided by PPNNE. This means that from a patient perspective, the type and range of care received should have been the same as it was funded under Title X. Funding for the administration of this new state-funded program (staff time) was supported directly through Title V.