1. 1 Workshop/Breakout Title Workshop/Breakout Speaker(s) Supporting Young Children to be Healthy and Ready to learn: Lessons from State and Local Collaborations

2. 2 Vermont ECCS Team AMCHP - 2006 Sally Kerschner, RN, MSN Donald Swartz, MD Kathleen C. Keleher, CNM, MPH

3. Building Bright Futures: Integration of Public Health and Early Child Care

4. 4 Public Health: Core Functions and Essential Services

5. 5 PH/MCH Essential Services Monitor health status of both children and communities to identify health assets and needs. Inform, educate and empower families with young children about health issues and services Mobilize community partnerships to respond to family needs Provide leadership to develop policies and plans that support and family and community health efforts Link families to services and systems Assure capacity and competency of workforce Evaluate effectiveness, accessibility and quality of population-based health services

6. 6 MCH in Vermont Total state population for 2004: 621,394 Total deliveries for 2003: 6,464 91% of pregnant women receive prenatal care within the first trimester. Teen birth rate (15-17 yrs) is 6.7/1,000 for 2003. IMR for 2003 – 5.0/1,000 live births 13% WIC children overweight (2-5 yrs) 94.6% of Medicaid children received at least one periodic screen in 2003. 48% of low income children utilized dental services in 2004 83% of children (19-35 mo) received full schedule of age appropriate immunizations 57% of families with CSHCN report receiving care within a medical home (Title V NPM #3)

7. 7 Facts about child care in Vermont 80% of Vermont women with children under six years of age are in out-of- home workforce 684 licensed, 1298 registered and 1515 certified, legally exempt child care programs-providers 7333 children, 5181 families currently receiving child care subsidy 134 nationally accredited child care programs and 41 programs that are 3-5 Vermont Stars

8. 8 Vermont State Government Organizational Structure 13 Counties in Vermont No county health departments – use of district offices Agency of Human Services Department of Health Department for Children and Families – Child Development Division

9. 9 Health and Early Education Systems Development in Vermont Work of the AHS State Team for Children and Families Emphasis on local planning (e.g., MCH Coalition, Success by Six, Early Childhood Council, Regional Partnerships) Early Childhood Steering Committee Smart Start TA Ten Outcomes to guide planning and programs

10. 10 AHS Ten Outcomes (examples) Pregnant women and children thrive Children re ready for school Children succeed in school Children live in stable and supported families Youth choose healthy behaviors Youth successfully transition to adulthood

11. Historically, the planning for health, early education, and child care services for young children evolved separately. Coalitions coordinated on many aspects of their overlapping missions, but enhanced collaboration would increase effectiveness in providing a streamlined system of care for families.

12. 12 Building Bright Futures in Vermont A public private partnership comprised of private sector providers, families, business leaders, community members and state government decision makers to create a unified system of early care, health and education for young children and their families in Vermont.

13. 13 BBF Health Committee Specific responsibilities: Assess Vermont’s maternal and child health capacity to address early childhood needs Propose a health, early care and education plan that includes and integrates the service priority areas Identify priority indicators to guide resources within the early care, health and education system Develop a plan for outcome evaluation, including outcomes monitoring ECCS grant as driving mission and activities

14. 14 Early Childhood Comprehensive Systems Grants (ECCS) ECCS grants to all states from the Maternal and Child Health Bureau Initial two year planning grants New three year grant cycle, 24 states in implementation phase Technical assistance from the Mailman School of Public Health, Columbia University

15. 15 ECCS Goals Provide leadership in developing a comprehensive and unified early care, health, and education system Expand and integrate a stronger MCH focus within the overall early childhood system Address specific needs related to health and well-being of children and families

16. 16 ECCS Focus Areas Health insurance and medical and dental homes Mental health and social-emotional development Early care and education Parent education and family support

17. 17 Health Committee Parents Vermont Department of Health Vermont Department for Children and Families Vermont Department of Education American Academy of Pediatrics – Vermont Chapter Vermont Children’s Health Improvement Project (VCHIP) Home Health Agencies Community Mental Health Agencies Head Start/Early Head Start Programs Children with Special Health Needs Parent to Parent of Vermont Family, Infant & Toddler Program (Part C) Public School Health Children’s Upstream Services Healthy Babies, Kids & Families Parent Child Centers Success by Six Visiting Nurses Association Vermont Campaign to End Childhood Hunger Vermont Refugee Resettlement Program Vermont Children’s Forum Pediatricians and other health care providers

18. 18 Environmental Scan Family centered philosophy and approach Quality Improvement & Quality Assurance activities Evidence-based practice

19. 19 Health Insurance and Medical and Dental Home Goal: All pregnant women and children have a source of coordinated, comprehensive, family-centered medical and dental care Outcomes: Pregnant women and children have a medical home Pregnant women and children have a dental home Insurance companies reimburse for medical home activities Medical homes have care coordinators

20. 20 Health Insurance and Medical and Dental Home Strategies:  Establish standards for a medical home  Increase the number of practices that meet the definition of medical home  Ensure that health coverage provides for a medical home  Develop a plan for oral health promotion in childcare settings  Provide funding for care coordinators

21. 21 Mental and Social- emotional Health Goal: All children are routinely screened for strengths, resiliency and needs in social, emotional and behavioral development. Outcomes: Children are routinely screened in their medical home for social-emotional and other developmental issues using a standardized tool. Primary Care physicians have access to early developmental and mental health consultation Community agencies jointly hire a child psychiatrist for consultation

22. 22 Mental and Social- emotional Health Strategies:  Identify screening tools to look at protective and risk factors for children and families  Provide reimbursement for screening in primary care settings  Develop a referral system from the primary care provider to community services  Provide reimbursement for a social worker, mental health worker, early interventionist to provide screening

23. 23 Early Care and Education Goal: Early care, health and education providers are knowledgeable about and linked to the overall service system and community resources. Outcomes: Links exist between early care, health and education providers and programs Early care health and education programs have a common referral system Providers refer children to appropriate programs and services All programs utilize consultants for health and social/emotional issues

24. 24 Early Care and Education Strategies:  Assure all districts have an ongoing health and safety team  All pediatric providers have a list of early childhood programs in their area  Increase the number of health and social- emotional consultants available to early care and education providers  Provide subsidies for consultants to child care and education programs

25. 25 Parent Education and Family Support Goal: All children are raised in a safe, supportive, healthy, nurturing environment Outcomes: All parents, caregivers and service providers have the necessary skills to provide a healthy, nurturing environment for children All childcare providers offer nutritious meals Parents have knowledge about nutrition and development of feeding skills Children have access to affordable programs during out of school time

26. 26 Parent Education and Family Support Strategies:  Increase participation in child and adult food care programs in both child care settings and homes  Support parents and other caregivers in understanding, practicing and teaching children the value of positive behavior  Identify and offer preventive services to families at risk of abuse and neglect  Encourage parents to implement safety measures, i.e. seat belt/car seat use, bicycle helmet use, poison prevention

27. 27 Title V Planning 2005 Title V Strengths and Needs Assessment Region wide emphasis on strengths assessment in addition to needs assessment Development of State Performance Measures Region 1 (New England) commitment to create two common regional indicators

28. 28 Youth Asset Indicator “In my community, I feel like I matter to people” Common language in YRBS for Vermont and Maine Other NE states may be able to adopt this question to achieve a Region wide performance measure

29. 29 Early Childhood Indicator Common indicator for Region 1 Draws on common work in New England from Healthy Child Care America initiative Suggested wording of the indicator will measure the percent of child cares with access to child health consultants.

30. 30 MORAL OF THIS COLLABORATION UNITED WE STAND DIVIDED WE FALL

31. 31 Contact Information Donald Swartz, M.D. Director, Division of Health Improvement (802) 863-7270 dswartz@vdh.state.vt.us Kathleen Eaton Paterson Asst. Director, Child Development Division (802) 241-4466 kpaterson@srs.state.vt.us Bob Costantino Child Development Division (802) 241-3942 bcostantino@srs.state.vt.us Sally Kerschner Division of Health Improvement Vermont Department of Health 802-865-7707 skersch@vdh.state.vt.us

32. 32 Questions?