Action Plan: Child:

Towards achieving Vermont’s new performance measure regarding childhood physical activity: we are planning the following strategies (also dependent on COVID-19):

• Ongoing Title V funding in support of the Physical Activity and Nutrition Director in the Department’s Division of Health Promotion and Disease Prevention
• Broadly promote the 3-4-50 initiative to early care and learning settings, after school care, and schools to promote physical activity within the context of the school day and to parents and communities beyond the school day. 3-4-50 is the Health Department’s cross-sector initiative to engage individuals, worksites, schools, cities and towns and faith-based communities in better understand the overwhelming impact of chronic disease and inspire them to take action to change. This is particularly important now, as we are seeing the effects of chronic disease on COVID-19 outcomes
• Continue to advocate for nutrition and physical activity standards being added to our early care and learning quality rating system: Vermont’s Quality Improvement and Rating System (QRIS)/Step Ahead Recognition System (STARS). The preliminary language has been added to the drafted revision, which will go through final review this year.
• Work with Vermont’s early care professional development system (Northern Lights) to increase professional development opportunities in physical activity and nutrition for early care and learning providers
• Broadly promote the use of Vermont’s FitWIC: materials for parents and their preschoolers
• FitWIC Activities will help foster child health and development through active physical play
• Promote the implementation of the 10 schools who have new and improved school wellness policies and increase the number of schools willing to work on their wellness policies

• Provide increased parent education through provider offices about the importance of physical activities during the school day, whether school is online or in person. Information about how to learn more and advocate for physical activity during the school day should be shared with parents. We are committed to this strategy but recognize the need to be mindful of provider bandwidth due to COVID-19
• Increase distribution of AAP policy statement Crucial Role of Recess

In the coming year, we plan to increase use of the Help Me Grow (HMG) Vermont system by health, early education, human service providers, and consumers/families. We will leverage the newly awarded HRSA Early Childhood Comprehensive Systems: Health Integration Prenatal to Three Program grant opportunity to provide leadership for coordinated, cross-sector efforts between medical homes and early childhood settings to improve developmental screening rates and address social conditions of health. We plan to increase child health provider use of the HMG Resource Hub to expand the capacity and professional development of local providers to increase earlier access to existing resources for the prenatal to age eight population.

HMG will continue to align regional Child Find screening and referral efforts to build family resilience across the family home, medical home, and child’s early learning environment. We will host and increase use of the Ages and Stages Questionnaires (ASQ) Enterprise Online System for families and providers to access screening tools at HelpMeGrowVT.org. We will increase cross-sector provider use of Vermont’s Universal Developmental Screening Registry (USDR) to improve communication and coordination for earlier identification of developmental concerns. We will fully integrate the USDR with HMG’s ASQ Enterprise Online System, an effort delayed this year by COVID-19, to remove a system barrier by obviating the need for manual screening data entry. We will continue to coordinate HMG activities with Vermont’s ACOs and the Blueprint to leverage health reform and enhanced payment opportunities.

Additional planned strategies include:

• Increase family engagement and understanding of early childhood development by promoting CDC’s LTSAE tools and offering screening questionnaires at HelpMeGrowVT.org
• Continue to offer trainings and activities for families and providers to increase their knowledge of early childhood development, including social and emotional development, to address disparities, promote equity, and strengthen families and encourage positive parenting/caregiving practices that build resilience
• Scale up and spread ongoing training, individual TA, and coaching on developmental and social determinant screening for early childhood professionals across sectors (e.g. training with community of practice/coaching component). Offer VT Northern Lights professional development CEUs for early educators.
• Ensure communities are fully plugged into a reliable grid of resources, including elements such as quality early care and learning opportunities, healthy food, housing, and supportive relationships, to ensure that all children have what they need to thrive
• Deliver care coordination and follow-up for families accessing the HMG Resource Hub to ensure young children get connected to the services they need at an early age when the benefit is greatest

In the coming year, Vermont Title V has several proposed strategies aimed at reducing childhood injury:

• Provide public health leadership in the prevention and approach to child maltreatment
• Support statewide implementation of evidence-based home visiting programs that have demonstrated effect in improving parenting practices
• MCH Coordinators at the District Office level serve as members of local Child Protection Teams
• MCH leadership serves on the Vermont Citizen’s Advisory Board (VCAB) to examine policies, practices, and procedures of the Vermont’s child protection agency, and provide for public outreach and comment to assess the impact of current procedure and practice on Vermont children and families
• MCH leadership serves on Vermont’s Child Fatality Review Team and works with this team to update data gathering, assessment, and review procedures. Key areas of concern are infant safe sleep, suicide, and deaths in child care
• MCH Coordinators at the local level coordinate with the Department for Children and Families to improve the health status of children in state custody (Fostering Healthy Families)
• Vermont contracts with a Child Safe Physician to provide medical leadership and case-specific consultation for community efforts and coordination around child abuse and neglect and trauma response
• Work with the Child Safe Physician and VDH Health Statistics to perform analysis of morbidity and mortality due to child abuse and neglect
• Organize and implement trainings for MCH home visitors on child home safety with a specific emphasis on rural and farm related injury prevention

In the coming year, Vermont has several planned strategies aimed at improving the oral health of children:

• Vermont MCH supports a portion of the salary of the Oral Health Director in the Health Department’s chronic disease division; this funding supports programmatic planning as it relates to the MCH population
• MCH staff and the Oral Health Director will work with Communications and Vermont Oral Health Advisory Panel partners to promote Vermont’s oral health periodicity schedule: current best practice guidance to pediatricians, family medicine providers, dentists, and families
• Provide oversight to the 802Smiles Network of School Dental Programs to help to ensure that every child has access to preventive, restorative and continuous care in a dental office
• Regional MCH Coordinators in district offices work in tandem with co-located public health dental hygienists to assess the local dental health landscape and share resource availability with health care providers and community partners
• MCH Coordinators and PHDHs provide outreach to pediatricians regarding: a) oral health education and referral to a dental home; and 2) fluoride varnish application.

Vermont continues its commitment to promoting protective factors and resiliency among Vermont’s families and leveraging Title V activities to do so. Planned strategies include:

• Continue to incorporate the Strengthening Families framework into all relevant work, with an emphasis on preventing and mitigating the impact of toxic stress and with special attention to the inclusion of Strengthening Families into the release of Bright Futures 4th edition

• Continue to promote the Vermont Resilience Messaging Project (VRMP) resilience messaging toolkit for diverse audiences to unite the many efforts to foster resilience and build flourishing communities across the state. Increase the number of stakeholders serving as ambassadors for integrated messaging with their peers and other organizations through ongoing trainings, technical assistance, and promotional activities.

• Our full-time coordinator of Adolescent Sexual and Reproductive Health oversees the Division’s PREP program and other adolescent sexual and reproductive health related efforts. This staff member is now one of 30 certified trainers in the state in the Youth Thrive Framework, which grew out of the Strengthening Families model. VT Afterschool now oversees Youth Thrive.  Youth Thrive utilizes the most current science on adolescent brain development, trauma, and resilience. Regional communities of practice were formed in Vermont to support local implementation of the Youth Thrive Framework. We will continue to expand on opportunities to increase the number of people trained in the Youth Thrive approach
• With HMG system partners, MCH coordinators in district offices will continue to provide HMG Child Health Provider Outreach and training to child health providers and community partners to increase use of the HMG Resource Hub
• Promote and expand Help Me Grow Vermont to promote optimal child development by enhancing protective factors. Research indicates that referrals to Help Me Grow and subsequent linkages to community-based programs and services enhance protective factors, and perhaps even mitigate risk factors. Even among families with differing needs, HMG support to families and their connection to programs and services has been shown to enhance parents’ perceptions of family functioning relevant to protective factors. This positive shift in parents’ attitudes, knowledge, and behaviors contributes to engaged and educated parents better equipped to meet their children’s needs and foster healthy development (Hughes, 2016)

• Families accessing the HMG contact center are surveyed on follow up calls and asked to respond to two or three protective factors questions, when applicable: 1) I am able to access services if I need it; 2) I have a better understanding of services for me and/or my child; 3) I have a better understanding of my child’s development and information that will impact my child’s wellbeing. In addition to these survey questions, HMG contact center staff continue to refine and promote protective factors strategies to use during telephone conversations with families.

• MCH is supporting efforts to establish a Vermont Touchpoints site at VCHIP. We have begun initial planning efforts and have identified 5 trainers. We are hoping to send a VT team to the fall 2021 Brazelton Touchpoints Institute Train the Trainer Community Level Training program. The purpose of Vermont’s Touchpoints site is to create a shared approach and common language to promote well-being for Vermont’s families from pregnancy to early childhood using TP method. It is our assumption that when parents work with supportive professionals, they become more confident in their parenting and form strong, resilient attachments with their children, laying the foundation for children’s early learning and health development

• We will continue to educate providers and community partners on the impact of Adverse Childhood Experiences and mitigating strategies by:

• Presenting epidemiological data to a variety of professional audiences on ACEs
• Participating in state and local community planning sessions to address trauma in health care, schools, and communities

• We will support the Vermont Family Based Approach whose long-term goal is to help the well remain illness free, prevent at-risk children from developing psychiatric illness, and intervene comprehensively on behalf of children and families challenged by emotional or behavioral disorders

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