Cross-Cutting/Systems Building Domain

FY21 Application

 

The FY21 workplan for the Cross-Cutting/Systems Domain includes the following performance measures:

1. Youth Leadership
2. Early and Continuous Screening (Newborn Screening)
3. MCH Workforce Development: Racial Equity

 

Funded efforts will be implemented by the following entities:

• Adolescent Health Program
• Newborn Screening Program
• State, Local, and Subrecipient Programs

 

 

I. Adolescent Health Program

 

FY21 Application Overview: Community, Family, & Youth Leadership

 

 

Strategy: Hire two part-time Youth Advisors to provide expertise, guidance and feedback on current and future public health initiatives.

Domain: Cross-Cutting/Systems

 

 

 

Strategy: Fund regional system that incorporates numerous and diverse youth voices into public health in Virginia.

Domain: Cross-Cutting/Systems

 

 

Before now, the Adolescent Health Program has not had a structured way to include youth and family input in VDH’s programs. Youth Advisors in Central Office will have the opportunity to give input on a variety of public health initiatives that affect young people, thereby increasing family voice and equity in Title V programs. Additionally, Youth Advisors will develop a structure for Regional Youth Advisory Councils, who will not only influence Title V initiatives but will also plan and implement public health interventions in their communities. This youth advisory structure allows for timely direct input from youth on VDH programs and equitable geographical representation on the regional youth advisory councils.

 

About the Emerging Youth Advisor and Youth Advisory Council Program

 

One of the emerging priorities of VDH’s Title V Program is increasing family and youth engagement in Title V-funded initiatives. As a result, VDH’s Adolescent Health Program must establish a structure that consistently brings youth voice into adolescent health programs. The Adolescent Health Program proposes two separate initiatives: Youth Advisors in Central Office and a to-be-determined structure, which the Youth Advisors will develop with Title V staff support, that organizes youth across Virginia to provide leadership and input on VDH public health initiatives.

 

The Adolescent Health Program is in the process of hiring two paid part-time Youth Advisors to serve as youth culture experts and consultants. These Youth Advisors are wage employees in VDH’s Central Office in Richmond, providing expertise, support, guidance and feedback to improve and effectively engage youth and young adults in VDH’s programs. Applicants must be between the ages of 18-22. With the guidance of the Adolescent Health Coordinator, Youth Advisors will provide feedback on current and future adolescent health initiatives and develop and manage the Regional Youth Advisory Program.

 

Long-term, VDH will fund a statewide system that allows youth leaders in every region to both provide input on existing public health initiatives and lead public health interventions in their own communities. VDH’s Youth Advisors, who are currently being hired, will be instrumental in the planning, development and management of this program. Title V staff will empower and support Youth Advisors in executing their vision for this system, whatever that vision may be. For this reason, VDH Title V staff does not yet have additional details on this regional system.

 

Youth Advisors will be brought on board at the beginning of FY21. They will spend FY21 providing input on existing VDH programs and developing and managing a sustainable regional youth advisory structure in Virginia.

 

 

II. Newborn Screening Program

 

The Code of Virginia mandates that all Virginia infants are screened for thirty-three disorders tested through dried blood spot (DBS) screening, Critical Congenital Heart Disease (CCHD) and hearing loss within 24-48 hours of birth and/or before discharge from the hospital. The Virginia Newborn Screening program consists of DBS newborn screening, the Early Hearing Detection and Intervention (EHDI) and CCHD follow-up teams.   The DBS and EHDI teams track and follow-up on all out-of-range results, facilitates access to specialty services for further testing and confirmation of diagnosis, and infants that are diagnosed with a newborn screening disorder are referred to Care Connection for Children Centers (CCC) for care coordination services. EHDI also refers diagnosed infants to Early Intervention (EI) and maintains contracts with multiple institutions to assure family-to-family support and a hearing aid loan bank. The DBS program also maintains contracts with four regional medical centers to assure diagnosis and treatment of infants who screen positive for a dried blood spot genetic disorder.  The CCHD team primarily confirms diagnosis reported from hospital facilities, refers diagnosed infants to CCC programs and performs QA/QI by analyzing CCHD data to assure that reporting is consistent, accurate and complete. 

 

Per the Code of Virginia, all infants born in Virginia are to be screened for thirty-one errors of metabolism, critical congenital heart disease (CCHD) and hearing loss.  Virginia’s newborn screening (NBS) programs, as well as its birth defects surveillance program, are housed under the Division of Child and Family Health (DCFH) and currently managed by Jennifer Macdonald, Director, Division of Child and Family Health until a Program Manager can be hired .  Each program has a team that utilizes specific, evidence-based approaches to education, tracking of screening results, follow-up, facilitating access to diagnostic and specialty services and referring to supportive services, post diagnosis.  

 

The VDH Newborn Dried Blood Spot Screening (NBS DBS) Follow-Up Program and the Department of General Services (DGS) Division of Consolidated Laboratory Services (DCLS) work in close collaboration to maintain the operations of Virginia’s NBS-DBS program.  This program is solely funded through fee-for-service enterprise funding. Fees are collected by DCLS from birthing hospitals and certain medical providers who perform the collection of DBS specimens. The current fee is $138/infant as of October 1, 2019. Fees are evaluated periodically and typically increased when new disorders are added to the panel in order to cover the cost of supplies, equipment, staffing and management of obtaining confirmatory diagnostic services, etc. VDH receives approximately $1.7 million annually from the enterprise fund via DCLS to conduct follow-up activities. The funding supports the DBS team who are VDH employees and co-locate at VDH and DCLS. The team consists of a program supervisor, 4.5 public health nurses and two  administrative staff who follow over 15,000 infants who have abnormal or critical screen results. Funding also supports contractual genetic services for four regional medical centers to assist in the follow-up of infants who screen abnormal for metabolic disorders. These centers provide healthcare provider consultation, diagnostic work-up of infants and treatment services once diagnosed.  Approximately 150 infants in the Commonwealth are diagnosed with a core NBS DBS disorder every year and then referred to CYSHCN care coordination programs for further support. 

 

 

Snapshot of Program Accomplishments

• Although challenging, the Virginia NBS-DBS program has successfully continued seven days a week screening, follow-up and referral operations in the midst of the COVID pandemic. The CCHD program has also continued to confirm and refer reported cases of CCHD during this time. 
• The NBS-DBS program released a new follow-up system in REDCap that has modernized the process in which follow-up is communicated and documented between the program and its medical specialists.  Its implementation has increased timeliness of reporting results and decreased the percentage of lost-to-follow up infants. Comprehensive programmatic policy and procedures were developed and approved this year as well. 
• The Birth Defects Surveillance Program successfully completed its Zika Birth Defects Surveillance project funded through the CDC. A Program Coordinator was hired in August 2020, a position which is the first of its kind in the agency, and is now on course to evaluate and grow the program. After a hiatus of programmatic activities due to lack of funding and staffing resources, the CCHD newborn screening program has reached a critical milestone and is up-to-date on performing case confirmations, and is now able to focus on quality assurance and improvement activities.   
• The Virginia EHDI program collaborated with the OFHS Communications Team on a variety of media, including its logo.

 

 

FY21 Application Overview: MCH Data Capacity

 

 

Strategy: Maintain the VaCARES Registry and expand capacity to document and track referrals of infants from the Newborn Screening Program to CYSHCN programs.

Domain: Cross-Cutting / Systems

 

 

In FY20, state newborn screening information will continue to be delivered to providers and parents in a timely fashion and arrangements made for necessary follow-up services are documented. If indicated the need for repeat screening and follow-up will be communicated to the providers by hospital or state program. 

 

 

Strategy: Partner with internal agency teams to identify needs, gaps and future direction of the current birth defects surveillance system.

Domain: Cross-Cutting / Systems

 

 

A comprehensive evaluation of the agency’s birth defects surveillance program and a short-term work plan will be completed by September 2021.

 

 

Strategy: Coordinate and partner with external stakeholders to increase the percentage of birthing facilities that report CCHD information into the current IS from 65% (2020 baseline) to 75% by September 2021.

Domain: Cross-Cutting / Systems

 

 

Historically, Virginia’s birth defect surveillance program has been a passive one, but in the wake of the congenital Zika virus outbreak in 2016, a renewed interest and need for this important public health activity has arisen.  In July 2019, VDH completed the Zika Birth Defects surveillance project, funded and coordinated through the Centers for Disease Control (CDC).  This project included implementation of the Zika Pregnancy Registry (ZPR), following infants enrolled in the ZPR for 24 months, and case confirmation of all Zika related birth defects reported into the Virginia Congenital Anomalies Reporting and Education System (VaCARES) in 2016 and 2017. During this project, Virginia was one of two states to participate in the March of Dimes survey of women who participated in the ZPR to gain insight into their perceptions of health care, information and social supports.  Findings are soon to be published. This was a great educational experience for VDH and with the implementation of certain information system enhancements, VDH will be well equipped to respond and expand documentation to emerging infections or conditions, such as Neonatal Abstinence Syndrome (NAS). 

 

Title V funding has historically only funded the maintenance of the reporting system, VaCARES, and additional funding now supports critical staff positions to maintain, evaluate, plan and grow the program.  Title V funding is supporting a Birth Defects Program Coordinator, who was hired in July 2020, and contracted position to maintain the CCHD NBS program.   

 

CCHD NBS is considered a point-of-care test done at the bedside before discharge of the infant. If an infant fails its CCHD screening, immediate action is routinely taken before the infant’s discharge and well before it is reported to VDH. For that reason the Virginia CCHD NBS program centers its activities on confirmation of diagnosis, quality assurance and referral to services, which is more in alignment with current birth defect surveillance activities and thus moved to that team in 2019.  Historically, these activities were absorbed by DBS NBS staff and the program’s reporting system, VaCARES, maintenance are funded by Title V. In aligning with the birth defects surveillance program, Title V now funds a contractor to continue CCHD NBS activities.  This increased staff resource has created the ability to expand CCHD-NBS activities beyond case confirmation and referral, but to include quality assurance, technical assistance, and educational outreach.   

 

 

Strategy: Partner with NYMAC (New York - Mid-Atlantic Regional Genetics Network) to assess and respond to state needs related to genetic services.

Domain: Cross-Cutting / Systems

 

 

NYMAC is currently establishing state to work on issues that prevent families from having access to genetic services. There is strong interest in having Title V involved in all of our state teams. The vision is for NYMAC to put together a state needs assessment summary that will be provided to the state team. Then, a team of 10-15 stakeholders (families, genetics providers, Medicaid rep, state genetics organizations, primary care, etc) will identify a key barrier to accessing genetic services and select a project that we will fund to address that problem. This will consist of monthly team calls.

 

The NBS Manager and Title V state representative will serve as team co-leads. The Title V and CSHCN Directors will serve on the state team.

 

 

FY21 Application Overview: Community, Family, & Youth Leadership

 

 

Strategy: Maintain and expand family engagement on state NBS Advisory Committee.

Domain: Cross-Cutting / Systems

 

 

 

The voting membership of the Virginia Newborn Screening Advisory Committee consists of multiple stakeholders representing all aspects of the newborn screening system, including affected family and parent representatives.  This body meets bi-annually to provide consultation to the program and when needed, workgroups are convened to review disorders requested to be on the Virginia DBS NBS panel.  Starting January 1, 2019, the program implemented screening for two new disorders, Pompe and Mucopolysaccharidosis Type I (MPS I), and expanded its operations to seven days/week.  Currently, the regulatory review and program planning is underway to implement screening capability for two additional disorders, Spinal Muscular Atrophy (SMA) and X-linked adrenoleukodystrophy (X-ALD).  The program has recently received funding from CureSMA and the Assoication of Public Health Laboratories (APHL) to assist in the implementation of SMA screening. 

 

 

Consumer/Family Engagement & Partnership

 

On a daily basis, the follow-up nurses engage independently with parents who call with questions and concerns, but full consumer and family engagement in the NBS-DBS program is in evolution.  The Newborn Screening Advisory Committee by-laws stipulate that two family advocates shall compose two of the twenty committee members.  Currently, there are two family members whose children have been affected newborn screening disorders. When by-laws are up for review in Fall 2020, it will be requested that a consumer advocate be added that has not been affected by a diagnosed newborn screening disorder, but understands that their infant received a newborn screening. This member provide prospective and inform educational initiatives that focus on general public education and informing families of results, whether positive or negative.  

 

The program is currently adding to the body of knowledge and collaborating with Children’s National Medical Center (CNMC) on a study with the goal to learn more about the experiences of parents after they receive their child’s newborn screening result. The study is being led by a study team at CNMC and it is anticipated that 1,500 people from multiple states will take part.

 

The NBS-DBS Program Coordinator also participates on the Genetics Alliance Family Training and Education Workgroup and informs educational initiatives.  The VDHNBS-DBS program has also entered into an agreement to become a “Community Outreach Partner” for their Newborn Screening Family Education Program.  Genetic Alliance’s Expecting Health program is building a network to support the dissemination of Navigate Newborn Screening, a free online newborn screening educational module for families to learn vital knowledge and skills to participate in the newborn screening system.

 

The Birth Defect Surveillance Program has been very limited in scope and the evaluation planned for this year will inform how family and community participation can be incorporated into programmatic activities.

 

 

Strategy: Sustain Early Hearing Detection & Intervention Program, to include support for paid 1-3-6 Family Educators. 

Domain: Cross-Cutting / Systems

 

 

The Virginia Early Hearing Detection and Intervention (EHDI) Program provides technical assistance and follow-up for hearing loss newborn screening services.  The Virginia EHDI Program budget totals approximately $750,000 and is funded through a variety of federal grantors: HRSA EHDI, CDC EHDI and HRSA Title V.

 

The funding supports the VDH EHDI team which consists of a program supervisor, two full-time follow-up specialists, 2 wage staff and fifty percent of an epidemiologist to support programmatic data needs.  Funding also supports contractual services with VDH Office of Information Management for IS support, Virginia Commonwealth University’s (VCU) Center for Family Involvement (CFI) and the University of Virginia’s (UVA) Hearing Aid Loan Bank (HALB). Program activities focus on meeting the overall goal of developing and maintaining a comprehensive and well-coordinated system of care that promotes early diagnosis and early entry into supportive family services. 

 

A long standing goal of the program has been to increase family and health care provider engagement and leadership within the EHDI system. A major component of the HRSA EHDI grant was to increase family engagement throughout the 1-3-6 process. The Virginia EHDI Advisory Committee’s voting membership is now made of up of 25% parents and the co-chair is a parent of a child who is deaf/hard of hearing. The Virginia EHDI program has also coordinated and hosted may initiatives and events to engage families and healthcare providers together.  Along with outreach to many conferences and support group events, these include funding for regional 1-3-6 family educators and the implementation of six regional learning communities, which eventually transfer to parent lead communities, and the funding and hosting of a trauma informed care conference and the nationally recognized The Care Project retreat (http://www.thecareproject.com/retreats/).  Out of the EHDI Learning Communities came a Shared Plan of Care (SpoC) specifically for families and their primary professional support systems.  Guides/checklists have been created for families, providers, audiologists and Early Interventionists to assist them in their specific key roles and functions as it pertains to the navigation of services to a newly diagnosed infant in their first year of life.  

 

The program is additionally working on the requirement of HB2026 which was passed in the 2019 Virginia General Assembly and directs the Board of Health to amend regulations governing newborn screening to include congenital cytomegalovirus (cCMV) in newborns who fail their newborn hearing screening.  A total of $198,000 was included in the state general fund budget for FY20 to initiate the cCMV program at the state level.  First year funds will be utilized to hire a wage staff resource and make enhancements to the EHDI-IS.  Funding in subsequent state fiscal years will only support staff resources.  As of this application submission date, a statewide workgroup has drafted regulations and the Virginia EHDI Advisory Committee approved them and sent them to the Commissioner of Health to initiate the regulatory process on behalf of the Board of Health.  It is predicted that Virginia will go live with screening and follow-up activities in early 2020. 

 

Another major focus of the Virginia EHDI Program is assuring infants diagnosed with any type of hearing loss are entered into the Early Intervention system in a timely manner and based on 1-3-6 national EHDI guidelines. The Virginia Department of Behavioral Health and Developmental Services (DBHDS) is the leady agency for Part C in Virginia.   Historical analysis of EHDI data reflects that mothers reporting less than a high school education or GED, mothers less than 20 years of age, African Americans and families in the Blue Ridge and Southwest regions of the state are less likely to enroll in EI services.  Since an automated referral system was added to the EHDI-IS,  the system has proven to ensure that all diagnosed children are referred to EI on a timely basis, but reporting of enrollment has declined due to factors such as FERPA requirements that DBHDS adheres to, lack of knowledge of reporting capabilities, and lack of knowledge and socioeconomic factors of families. The Virginia EHDI Program continues to partner with multiple stakeholders and spearhead efforts to educate and promote appropriate resources for families affected by a diagnosis of hearing loss, including VCU CFI 1-3-6 Family Educators, the Virginia chapter of Hands and Voices, and six regional Learning Communities. A collaborative effort with DBHDS will improve data sharing, ensure compliance with national guidelines and improve the quality of enrollment information reported to VDH. 

 

VDH contracts with VCU CFI to implement the 1-3-6 Family Educators Program and assist in the start up and maintenance of six regional learning communities throughout the Commonwealth. 

 

 

Emerging Issues

 

The Virginia NBS-DBS has incorporated second-tier molecular testing in the screening algorithms for at least four disorders: Cystic Fibrosis (CF), Severe Combined Immunodeficiency (SCID), Pompe disease and Mucopolysaccharoidosis Type I (MPS-I). Molecular testing has enabled national newborn screening programs to better inform physicians and diagnose disorders, but this ability also has crossed the lines of programmatic goals of screening versus diagnosis.  The Virginia NBS-DBS program will continue to weigh implementation strategies and costs that may incorporate molecular testing as part of a potential disorder’s algorithm. Currently, the Newborn Screening Advisory Committee, as a result of a legislative mandate, is taking up Krabbe disorder as a potential addition to Virginia’s newborn screening panel and is weighing the molecular options available.  Krabbe disease is also not on the Secretary of Health and Human Services’ Recommended Uniform Screening Panel (RUSP) and poses a few challenges that include lack of national data, and since it is not on the RUSP, ethically, a lack of screening uniformity across the nation.  

 

The Virginia NBS-DBS does not conduct long term tracking/follow-up of children diagnosed with certain disorders, but understands this is a needed arm of current programming.  With the addition of two lysosomal disorders in 2019, the increased NBS fee covered such a position, but with the current environment of COVID, the human resources process has thwarted efforts.  The program will continue to  work with the agency to meet this goal . 

 

The Birth Defect Surveillance Program will most likely face challenges when rapid surveillance of birth defects, as a result of emerging infections and disorders, is required. An example of this may be future activities of Neonatal Abstinence Syndrome (NAS) monitoring.  It will be challenging to assess stakeholder organizational obstacles in the wake of COVID, its impact on reporting into Virginia’s current system, and reengaging them into the process. 

 

 

IV. State, Local, and Subrecipient Programs

 

FY21 Application Overview: Racism

 

 

Strategy: Incorporate racial equity training into individual staff training plans and minimum strategic planning requirements into subrecipient agreements.

Domain: Cross-Cutting

 

 

 

Strategy: Provide support to Central Office, LHD, and interagency staff on planning and implementing MCH programs with attention to racial equity and upstream factors.

Domain: Cross-Cutting

 

 

Title V funds are allocated to 35 local health districts (LHDs) to address locally-identified priorities; each LHD must maintain a workplan and report annually on successes, challenges, and emerging needs. The Title V Director provides technical assistance to LHDs through site visits and webinars.

 

LHD priorities for the previous five-year grant cycle included: (1) access to maternal/prenatal care, (2) substance use, including tobacco and opioid use among pregnant women, (3) safe sleep, and (4) increased coordination with family support and community-based organizations. Each LHD was required to select at least one of these four priorities.

 

For the 2021-2025 grant cycle, workplans will focus on the health of pregnant women and children 0-17, with emphasis on the following 4 topics:

1. MCH initiatives that center equity,
2. Coordination with community-based organizations,
3. Place-based, upstream/cross-sector strategic planning (e.g. housing, transportation),
4. Coordinated systems of care for children.

 

 

FY21 Application Overview: Racism

 

 

Strategy: Support 35 local health districts in developing and maintaining equity-focused, data-driven workplans aligned with findings from the 2020 MCH Needs Assessment and local Community Health Assessments, to include (1) MCH equity considerations, (2) coordination with community-based organizations, (3) upstream/cross-sector strategic planning, and (4) coordination with broader systems of care for children.

Domain: Cross-Cutting/Systems

 

 

Title V LHD funding will continue to balance addressing local emerging issues within specific populations with sustained commitment to a core set of statewide MCH priorities and services. Beginning September 2020, a team-based will be implemented to deliver technical assistance (TA) and workforce development for LHD staff. Led by the Title V Director, this team of subject matter experts will be available to deliver technical assistance through cross-team TA and site visits. Districts will receive coaching on developing workplans, selecting local performance measures, and building capacity for grant-writing and outcome reporting.

 

Each LHD is charged with conducting a community health assessment (CHA) every 5 years. This process includes identifying local priorities for MCH populations. Local CHAs, combined with the results of the 2021-2025 Title V needs assessment, will drive strategies and activities within each district. The first six months of the new grant cycle will be dedicated to intensive 1:1 strategic planning with each district.

 

 

Strategy: Pilot racial equity training with statewide partners.

Domain: Cross-Cutting

 

 

VDH will contract with VHC to partner with Dialectix Consulting and Virginia Center for Inclusive Communities to provide twelve free racial equity trainings to partners across Virginia. VHC will coordinate with facilitators to create meaningful, customized trainings to address real-world issues related to health equity. Marketing materials including flyers and social media messaging will be developed and shared to promote the trainings to partners and other organizations state-wide. An online registration system will be created and utilized to manage participant registration and send event confirmations and reminders. The trainings will be provided throughout the remainder of the year and will include a training evaluation. Evaluation and training results will be detailed in the form of a summary report. These trainings will be virtual to allow partners from across Virginia to participate. The trainings will be offered in three bundles, and each bundle will be offered twice (six total bundles offered). To ensure the most people can attend, participants will only be able to sign up for one course bundle. Each bundle will focus on a different topic area. 

 

Course Bundle One: Understanding Racial Equity

 

Exploring Racial Equity in Health Care: In an increasingly multicultural society, it is critical for healthcare providers to work across lines of difference to support its most vulnerable populations. These individuals’ interactions and experiences are often shaped by biases around race. This workshop will provide participants with an opportunity to reflect on their own race and consider its impact in workplace and community dynamics. Attendees will walk away with practical tips and approaches to bias-free decision-making in the workplace and while providing healthcare to underserved communities.

 

Course Bundle Two: Addressing Racism Daily

 

Unconscious Bias: Understanding the latest research on how our brain wiring relies on mental shortcuts, and how these unconscious impulses impact our behaviors in ways that perpetuate disparities and inequity. Focuses on knowledge, tools, and strategies for interrupting individual bias, as well as dialogue about how to implement anti-bias strategies organization-wide.

 

How to be an Ally: How do you effectively work on a social justice issue that doesn’t impact you directly? There is a unique challenge for allies in navigating the conundrums involved in allyship, for example, when do you speak up for others, and when do you step back to allow others a voice? This workshop offers a path forward for allies, focusing on providing a developmental path, tools, and skills to be more effective in the fraught role of an ally.

 

Conflict Resolution: This workshop focuses particularly on microagressions, and the challenging task of navigating conversations of unintended slights and othering. Participants will learn how to spot and interrupt microagressions effectively, with an eye towards creating greater inclusion within the organization, protecting people from the impact of harmful statements, and nonjudgmentally educating offenders and others.

 

Course Bundle Three: Implementing Change in the Workplace

 

Action Plan Development: Participants will work through the Action Planning process and consider how they would like individuals and institutions to address bias and what it takes to stand up to it—in the moment and the long term. By the end of the program, participants will receive resources to develop and implement a 1-3 year action plan for diversity, equity, and inclusion at their organizations.

 

Action Plan Implementation: Participants will share their experiences and lessons learned from the process of implementing their Action Plans, discuss any issues or challenges they have and receive feedback from the facilitator(s) and partner organizations. Facilitators will also share how to assess the success of their Plans and how to sustain them long-term, and will celebrate participant successes.

 

 

Other Programmatic Activities

 

 

 

Families calling the F2FHIC and Title V programs are reporting higher anxiety and stress from changes in routines, finances and health as a result of COVID-19 stay at home, virtual schooling and social distancing orders.  Being able to cope with life’s struggles, or being resilient and able to bounce back from difficult situations, is an important skill that positively impact healthy choices.  

 

The F2FHIC proposes to develop a 4 week skill building session for culturally & linguistically diverse families (at least two underserved communities) that focuses on identifying individual leadership behaviors, finding fresh approaches to old problems, and reinforcing trusting, collaborative relationships with community agencies, planning teams and/or health care professionals. Over the 4 weeks, families will participate in virtual group sessions, complete self-assessments, develop an individualized resiliency plan, and receive support from a coach/mentor.  

 

 

Budget Update

 

Personnel
Salary	FTE
Principal Investigator , Dana Yarbrough	0.20
Cultural Broker, Af American Community	0.20
Cultural Broker, Refugee Community	0.10
Project Evaluator, Seb Prohn	0.05
Other
Stipends for Family Participants (30 x $500)

 

 

Equity Considerations

 

To transform the way diverse families perceive themselves and the systems in which they and their CYSHCN interact, we must make deliberate efforts to understand the different and complex ways in which structural racism has affected families in the past and continues to affect them today. Resilience and racial equity will be deliberately embedded into every facet of the training/mentoring project.