Action Plan FY2024 Perinatal and Infant Health

[SI(1] WIC and Breastfeeding

To enhance Vermont’s rates of breastfeeding initiation and duration, FCH will continue promotion of the Vermont Breastfeeding Strategic Plan broadly across the state to support local coalitions and communities. FCH nurses at the local district health offices are reconvening with local-level leaders to support the implementation strategies in their health care and community settings this fall.

Vermont Child Health Improvement Program (VCHIP) and Perinatal Quality Collaborative (PCQ-VT)

In partnership with VCHIP, Vermont launched a Perinatal Quality Collaborative (PQC-VT). The goal of the PQC-VT is to optimize health outcomes for Medicaid-eligible women and infants by improving access, efficiency and coordination of care and services. The PQC-VT provides the organizational framework through which maternal and child health quality projects are integrated, including data required for quality measures. Through collaboration, data analysis, and quality improvement activities, the PQC-VT will:

• Provide support and education on best practices to perinatal health care professionals and community-based partners who care for this population.
• Improve health care systems for the implementation of current guidelines and best practice recommendations.
• Convene collaborative meetings to improve perinatal care across the state.

This year the PQC-VT will focus on integrating the collection and analysis of data by health equity indicators to examine perinatal care access and quality for historically or currently oppressed populations. The PQC-VT plans to address birth certificate data quality and identify inequities in the collection of data related to race, ethnicity and SDOH. Additional upcoming projects are to build effective and sustainable linkages between clinical care and community-based teams to provide comprehensive and equitable perinatal care, as well as non-clinical support services across the perinatal period.  Insights from the MMRP will be incorporated into PQC-VT efforts to improve clinical care and support systems to prevent severe maternal morbidity in the post-partum period, with a focus on post-partum warning signs for non-obstetrical providers, such as emergency departments and first responders, and addressing substance use disorder supports and interventions for parenting people. 

Vermont just received the good news that we were awarded a CDC-funded PQC grant, which will begin in September 2023.

Developmental Screening and Autism Assessment

In the coming year, FCH and VCHIP will engage VCHIP’s Child Health Advances Measured in Practice (CHAMP) network in a CQI project to improve Vermont’s developmental and autism assessment and follow up system of care. While it is reassuring that developmental and behavioral/autism screening rates are high in Vermont, the wait time for developmental assessments is currently longer than a year. A key driver in this service gap is the increasing referral volume and wait times for partners such as the Autism Assessment Clinic and the Developmental Behavioral Pediatrics Program at the University of Vermont. Both programs recently announced they would stop taking referrals for a six-month period while they seek to merge into a single Autism Assessment Program. To address these barriers, we will promote and train CHAMP providers to use tools validated with diverse groups including, the Survey of Well-being of Young Children (SWYC), the Rapid Interactive Screening Test for Autism in Toddlers (RITA-T), and the Childhood Autism Rating Scale (CARS2).

Developmental Understanding and Legal Collaboration for Everyone (DULCE) and Touchpoints

Six pediatric medical homes are currently implementing a universal approach to meeting health related social needs in the pediatric care setting known as Developmental Understanding and Legal Collaboration for Everyone (DULCE). Supported by the Governor, the legislature very recently approved funding to spread and sustain additional DULCE sites across Vermont, using Medicaid funding under the Blueprint for Health care funding expansion. After demonstrating results, we are hoping to implement additional sites and sustain them with funding from other private insurers. FCH and VCHIP early childhood teams continue to support efforts to increase coordination and referrals from DULCE sites to the HMGVT Resource Hub. Vermont continues to explore additional opportunities for sustainability and funding, including potential funding through Transforming Pediatrics in Early Childhood cooperative agreement released by HRSA.

Vermont is the first DULCE site in the US to implement substance use screening with caregivers. All sites utilize CQI to inform system and practices improvements. In the upcoming year, sites will focus on training and technical assistance related to intimate partner violence and substance use screening, the implementation of a statewide family advisory council model, rollout of a new family exit survey workflow, and increasing referrals and connections to HMGVT resource hub for all DULCE families. Strategies include using a -plan-do-study-act to refer families transitioning from DULCE care coordination (when the child is six months old) to HMGVT for ongoing support.

At least two Touchpoints cross-sector trainings will be offered annually ongoing and two are planned for the coming year.

Help Me Grow, Support Delivered, Home Visiting, and Early Childhood Comprehensive Systems (ECCS)

We will align Title V efforts with our HRSA Early Childhood Comprehensive Systems (ECCS), or Vermont Integration Project Prenatal- to-Three (VIP-3), grant opportunity. The spread of Touchpoints is a key VIP-3 strategy to increase professional leaders engaged in state-level maternal and early childhood initiatives, as well as enhance equity by building professional capacity to deliver culturally and linguistically responsive care to Vermont’s most vulnerable families. Another strategic alignment is to increase use of our Help Me Grow (HMG) resource hub, a one-stop-shop coordinated information and referral system, by health care providers, early educators, and families. HMGVT next steps include (see also Child Action Plan):

• Support family wellbeing by offering community activities and events that help families learn about and nurture their child’s development.
• Strengthen the resource hub database to include more mental health services, in coordination with Vermont’s HRSA-funded Child Psychiatry Access Program.
• Raise awareness and increase use of the resource hub.
• Increase use of Help Me Grow’s ASQ Online platform among health, education, and human service providers to ensure earlier identification of developmental concerns and increase kindergarten readiness.

Vermont will continue to work with the Maternal Early Childhood Sustained Home Visiting (MECSH) model consultants, home health agency leadership, and direct service staff to support the fifth year of our MIECHV funded nurse home visiting program. We will partner with VCHIP and the PCQ-VT, HMGVT, and STAMPP partners to address our upcoming CQI aim to increase referrals for Strong Families Vermont nurse home visiting services. Leveraging HRSA’s Early Childhood Comprehensive System (ECCS) opportunity, we will continue our partnership with HMGVT and the Building Bright Futures State Early Childhood Council to address a shared priority to advance health equity, address structural racism, and inequitable access to services and social and structural determinants of health. Strategies include screening for health disparities and linking families to a variety of services and basic need supports, including using the HMGVT resource hub to support access and ensure family connection to services. We will complete translation of MESCH materials into the 15 Vermont languages to create more opportunities for services to be accessible, culturally, and linguistically appropriate. And we will partner with our new FCH Family and Community Partnerships Coordinator to increase family engagement. Additionally, we will increase referrals for mental health services and supports for MECSH clients through provider training, use of innovative evidence-based programs to address maternal depression, increase access to treatment and existing state referral pathways and expanding partnerships, and promotion of the Support Delivered campaign materials.

Vermont is working hard to expand and sustain evidence-based home visiting, using Global Commitment funds to expand MECSH and implement Parents as Teachers (PAT) home visiting with delivery fully integrated into Vermont’s early childhood system of care. In the coming year:0

• The Vermont Home Visiting Rule will go through the official legislative process for approval; the new up-dated Home Visiting Manual will be disseminated to all home visiting service providers.
• Full programmatic and Medicaid billing implementation will continue for the coming year as the SFVT Sustained Family Support Home Visiting Program using PAT continues to unfold across the state.  This will include staff training, support, guidance, and on-going consultation as programs reach capacity to provide PAT to families, receive Medicaid reimbursement, and collect and track required data for program fidelity.
• Continue implementation of the evidence-based Parents as Teachers model:

• On board three additional PAT affiliates to the current eight PAT affiliates (by January 2024)
• Develop training and guidance for PAT affiliates and grantees to learn to bill Vermont Medicaid case rate for PAT home visiting.
• Family support home visitors will also be trained to use HMGVT’s ASQ online system.

Injury and Violence Prevention

In the coming year, Vermont Title V proposes several strategies aimed at promoting safe sleep practices in hospital and community settings:

• Develop materials to promote safe sleep practices and align messaging across multiple organizations across the state.
• FCHCs will continue to connect with local hospitals, pediatric providers, and community organizations to provide training and promote safe sleep across multiple sectors.
• Assess childcare readiness to implement safe sleep practices and provide training and consultation to help them achieve their goals.

Additionally, Vermont FCH applied for a CDC Sudden Unexpected Infant Death (SUID) grant and if awarded, will expand our capacity to track SUID cases and identify disproportionately affected populations to target intervention strategies.

Newborn Screening and Early Hearing

Vermont’s Newborn Screening Program is continuing progress towards several goals in the coming year:

• Increasing the use of Health Information Technology to maximize efficiency and improve results reporting. 
• Working to strengthen follow-up procedures for the four newest conditions added to the RUSP.
• Reducing rates of initial unsatisfactory screens
• Increasing outreach to families and providers about newborn screening.

In the coming year, the NBS Program aims to enhance service delivery by pursuing electronic reporting of results to hospitals and providers. This initiative is more complex than anticipated and is ongoing from the last reporting period. The program expects to obtain access to an eFaxing solution during this calendar year. The program will begin engaging hospitals and clinicians to facilitate this transition. In response to the addition of GAMT and MPS II, the program will begin engaging key stakeholders to discuss the potential addition to the Vermont screening panel.

Please note: Only those strategies the link with national and state performance measures are identified in the Action Plan Table for this section.

[SI(1]This is in the past, should be future oriented.