NPM Webinar Series - mchevidence.org · NPM 2 (Low-Risk Cesarean) –Deborah F. Perry, GU Center for Child and Human Development NPM 3 (Perinatal Regionalization) –Kate Menard,

National Performance Measures 4 – 6

April 22, 2020

NPM Webinar Series:Evidence-Based/Informed Strategies

for Title V Programs

Welcome from MCHBThanks from MCHB and Georgetown University

Introductions:• MCHB• Georgetown University

Purpose and importance of the webinar series:• Looking forward to upcoming submission of MCH Block Grant

reports and applications• Connecting the field with public health strategies remotely• Hearing questions and learning from the field

Goals for today:• NPM 4: Breastfeeding• NPM 5: Safe Sleep• NPM 6: Developmental Screening

Webinar ScheduleWebinar 1: Wednesday, April 8 from 3:30 – 4:30 EST.

NPM 1 (Well-Woman Visit) – Arden Handler, University of Illinois at Chicago, School of Public HealthNPM 2 (Low-Risk Cesarean) – Deborah F. Perry, GU Center for Child and Human DevelopmentNPM 3 (Perinatal Regionalization) – Kate Menard, University of North Carolina

Webinar 2: Wednesday, April 15 from 3:30 – 4:30 EST.NPM 7 (Child Safety/Injury) – Jennifer Leonardo, Children’s Safety NetworkNPM 8 (Physical Activity) – Rachel Brady, GU Center for Child and Human DevelopmentNPM 9 (Bullying) – Sue Limber, Clemson University

Webinar 3: Wednesday, April 22 from 3:30 – 4:30 EST.NPM 4 (Breastfeeding) – Barb Himes, First CandleNPM 5 (Safe Sleep) – Suzanne Bronheim, Georgetown UniversityNPM 6 (Developmental Screening) – Sarah Riehl, Georgetown University Medical Center

Webinar 4: Wednesday, April 29 from 3:30 – 4:30 EST.NPM 10 (Adolescent Well-Visit) – Charles Irwin, Adolescent and Young Adult Health National Resource CenterNPM 13 (Oral Health) – Katrina Holt, National Maternal and Child Oral Health Resource CenterNPM 14 (Smoking) – Beth DeFrancis, American College of Obstetricians and Gynecologists

Webinar 5: CYSHCN – Wednesday, May 6 from 3:30 – 4:30 EST.NPM 11 (Medical Home) – Christina Boothby, National Resource Center for Patient/Family-Centered Medical HomeNPM 12 (Health Care Transition) – Peggy McManus and Patience White, Got TransitionNPM 15 (Adequate Insurance Coverage) – Allyson Baughman, Catalyst Center and Elisabeth Burak, Center for Children and Families

Webinar Structure

10 minutes of introductions and background.

15 minutes for each NPM—10 for presentation/5 for questions

To help with timing, please type your questions into the chat box while speaker is presenting

Format:

• Significance of the NPM• 1-3 public health strategies• Title V approaches for implementing strategies • Evidence base for the strategies• Additional resources

5 minutes of wrap up and summarizing resources

Where Can We Find Evidence?

https://www.mchevidence.org/tools/strategies/

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Introducing Our Speakers

NPM 4 (Breastfeeding) – Barb Himes, IBCLC, First Candle

NPM 5 (Safe Sleep) – Suzanne Bronheim, PhD, GU Center for Child and Human Development

NPM 6 (Developmental Screening) – Sarah Riehl, MA, Georgetown University Medical Center

NPM 4: BreastfeedingNPM 4A: Percent of infants who are ever breastfedNPM 4B: Percent of infants breastfed exclusively through 6 months

1 American Academy of Pediatrics Section on Breastfeeding. Breastfeeding and the use of human milk. Pediatrics. 2012 Mar;129(3):e827-41.

AAP recommends all infants (including premature and sick newborns) exclusively breastfeed for about six months as human milk supports optimal growth and development by providing all required nutrients during that time. Breastfeeding strengthens the immune system, improves normal immune response to certain vaccines, offers possible protection from allergies, and reduces probability of SIDS.

Research demonstrates that breastfed children:• May be less likely to develop juvenile diabetes• May have a lower risk of developing childhood obesity and asthma• Tend to have fewer dental cavities throughout life

Breastfeeding has positive effects on the mother:• Improves confidence and bonding with the baby and reduces feelings of anxiety and postnatal depression. • Increased release of oxytocin while breastfeeding, leading to a reduction in post-partum hemorrhage and

quicker return to a normal sized uterus over time, • May be less likely to develop breast, uterine & ovarian cancer, and have a reduced risk of osteoporosis.

NPM 4: Breastfeeding

Trends in SUID by Cause, 1990-2017 from CDC’s SUID and SIDS Data and Statistics portal.

NPM 4: Breastfeeding

Strategy #1: Lactation Consultants

Approach: Maintain a 24-hour breastfeeding hotline staffed by a bilingual certified lactation consultant.

Evidence: Moderate evidence. Systematic literature reviews have returned similar findings: “Dedicated lactation specialists may play a role in providing education and support to pregnant women and new mothers wishing to breastfeed and to continue breastfeeding (duration) to improve breastfeeding outcomes.”1

Nine studies have examined the effects of lactation consultants, including:

• Bonuck K, Freeman K, Trombley M. Randomized controlled trial of a prenatal and postnatal lactation consultant intervention on infant health care use. Arch Pediatr Adolesc Med. 2006;160(9):953-960.

• Bonuck K, Stuebe A, Barnett J, Labbok MH, Fletcher J, Bernstein PS. Effect of primary care intervention on breastfeeding duration and intensity. Am J Public Health. 2014;104(S1):S119- 127.

• Meedya S, Fahy K, Yoxall J, Parratt J. Increasing breastfeeding rates to six months among nulliparous women: a quasi-experimental study. Midwifery. 2014;30:e137-e144.

1 Patel, S., & Patel, S. (2016). The Effectiveness of Lactation Consultants and Lactation Counselors on Breastfeeding Outcomes. Journal of Human Lactation, 32(3), 530–541.

These strategies have been proven effective in addressing NPM 4A: Percent of infants who are ever breastfed and NPM 4B: Percent of infants breastfed exclusively through 6 months. They

can be adapted for your program needs.

Strategy #1: Lactation Consultants

Role of Title V: Title V Agencies can support this approach by implementing:

• Informing pregnant women and new mothers about lactation consultant services.• Ensuring that lactation consultants have access to new mothers after birth.• Related Strategy: Utilize doulas in a similar role as lactation consultants to promote

breastfeeding.1

Example from the Field: Multiple Title V agencies use lactation consultants as part of their NPM 4 efforts: AS, DE, NC, OR, TN, and WY. You can see ESMs related to their projects here, including:

• Percent of local health departments who have had Maternal Health staff members trained on BF promotion and support through the NC Regional Lactation Training Centers

• Percent of home visitors who are certified by the International Board of Lactation Consultants• ercent of counties that have at least one public health nurse trained as a Certified Lactation

Consultant (CLC)

NPM 4: Breastfeeding

1 Hans SL, Thullen M, Henson LG, Lee H, Edwards RC, Bernstein VJ. Promoting positive mother–infant relationships: A randomized trial of community doula support for young mothers. Infant Mental Health Journal. 2013;34:446–457.

Strategy #2: Fatherhood Engagement

Approach: Offer non-judgmental opportunities to empower fathers by demystifying and gaining clarity on issues related to pregnancy support and infant care.

Evidence: Moderate Evidence. Four studies show significant findings for empowering fathers.

• Wolfberg AJ, Michels KB, Shields W, O’Campo P,Bronner Y, Bienstock J. Dads as breastfeeding advocates: results from a randomized controlled trial of an educational intervention. Am J Obstet Gynecol. 2004; 191:708-712.

• Arora S, McJunkin C, Wehrer J, Kuhn P. Major factors influencing breastfeeding rates: mother’s perception of father’s attitude and milk supply. Pediatrics. 2000; 106:E67.

• Libbus K, Bush TA, Hockman NM. Breastfeeding beliefs of low-income primigravidae. Int J Nurs Stud. 1997;34:144-150

• Sihota, H., Oliffe,J., Kelly, M.T., & McCuaig, F. (2019). Fathers’ Experiences and Perspectives of Breastfeeding: A Scoping Review. American Journal of Men’s Health.

NPM 4: Breastfeeding

Strategy #2: Fatherhood Engagement

Role of Title V: Title V Agencies can support this approach by implementing:

• Conducting father support groups, especially targeting populations where health disparities exist and the role of the father is critical in family decisions (e.g., latino families, immigrant families).

• Include fathers in discussing breastfeeding during home visiting sessions.• Develop materials that include resources for fathers (e.g., CA Department of Public Health).

Example from the Field: Detroit Health Department WIC Fatherhood Engagement – Partner with other organizations such as Sister Friends, Friend of the Court, and Focus Hope.

Daddies’ Café are held where topics such as Breastfeeding Basics for Brothers (Peter Williams, BPA, CHW, CLC) and Infant Safe Sleep are discussed.

NPM 4: Breastfeeding

NPM 4: BreastfeedingBig secret: Breastfeeding and Safe Sleep work well together 1

Two of the most important decisions parents will make are how they will feed their baby and where their baby will sleep.

Stay tuned to the next presentation to hear more!

Tip: Combine breastfeeding with safe sleepmessages to do double duty!

1 Moon, Rachel & Darnall, R.A. & Feldman-Winter, Lori & Goodstein, Michael & Hauck, F.R.. (2016). SIDS and Other Sleep-Related Infant Deaths: Updated 2016 Recommendations for a Safe Infant Sleeping Environment. Pediatrics. 138. 10.1542/peds.2016-2938.

Resources:

Implementation Toolkit for NPM 4 (AMCHP). This toolkit contains examples of state strategies being used to address NPM 4 in Title V programs.

National Action Partnership to Promote Safe Sleep (NAPPSS): An MCHB-funded technical assistance resource center, this project supports NPM 4 and 5 topic areas.

Breastfeeding: Professional Resource Brief: Select websites compiled by the MCH Library.

United States Breastfeeding Committee: Resources from over 100 professional, educational, and government organizations. Materials include: publications and policy statements, listing of existing breastfeeding laws, a directory of coalitions, and access to virtual and in-person learning collaboratives.

NPM 4: Breastfeeding

Questions and Discussion

Questions:• How are we connecting?• Questions?• A-ha moments?

Discussion:• You are the experts! Please share

strategies, programs, or experiences that you have found effective.

Contact:• [email protected]

NPM 5: Safe SleepA) Percent of infants placed to sleep on their backsB) Percent of infants placed to sleep on a separate approved sleep surfaceC) Percent of infants placed to sleep without soft objects or loose bedding

1 Taskforce on Sudden Infant Death Syndrome. SIDS and Other Sleep-Related Infant Deaths: Updated 2016 Recommendations for a Safe Infant Sleeping Environment. Pediatrics. 2016 Nov;138(5)

Sleep-related infant deaths, also called Sudden Unexpected Infant Deaths (SUID), are the leading cause of infant death after the first month of life and the third leading cause of infant death overall.

Sleep-related SUIDs include Sudden Infant Death Syndrome (SIDS), unknown cause, and accidental suffocation and strangulation in bed.

AAP’s expanded recommendations aim to help reduce the risk of all sleep-related deaths through a safe sleep environment that includes use of the back-sleep position (supine), on a separate firm sleep surface (room-sharing without bed sharing), and without loose bedding.1

NPM 5: Safe SleepThese strategies have been proven effective in addressing NPM 5: Safe Sleep – Percent of infants placed to sleep on their backs: (A) separate approved sleep surface, (B) without soft objects or loose bedding, and (C) without soft objects or loose bedding.

Strategy #1: Caregiver + Provider + Hospital without Quality Improvement

Approach: Implement a multicomponent strategy (systems approach) that targets caregivers, child care providers, health care providers, and hospital systems (not including quality improvement components).

Evidence: Moderate evidence. “Studies categorized as “Caregiver + Provider + Hospital without QualityImprovement” appear to be effective as the majority of the studies had favorable results.”1

Individual components analyzed:• Hwang SS, Rybin DV, Heeren TC, Colson ER, Corwin MJ. Trust in sources of advice about infant care practices: the SAFE study. Matern

Child Health J. 2016:1-9.• Kuhlmann S, Ahlers-Schmidt CR, Lukasiewicz G, Truong TM. Interventions to improve safe sleep among hospitalized infants at eight

children's hospitals. Hosp Pediatr. 2016;6(2):88-94.• Rocca Rivarola M, Reyes P, Henson C, et al. Impact of an educational intervention to improve adherence to the recommendations on

safe infant sleep. Arch Argent Pediatr. 2016;114(3):223-231.• Srivasta S, Eden, AN, Mir MA. Infant sleep position and SIDS: A hospital-based interventional study. Journal of Urban Health: Bulletin of

the New York Academy of Medicine. 1999:75(3);314-321.

1 Lai y, Garcia S, Strobino D, Grason H, Minkovitz C. National Performance Measure 5 Safe Sleep Evidence Review. Women’s and Children’s Health Policy Center, Johns Hopkins University (2017).

Strategy #1: Caregiver + Provider + Hospital without Quality Improvement

Role of Title V: Title V Agencies can support this approach by implementing:

• Systems Building: Engaging Title V programs (e.g., Home Visitors and Healthy Start to work directly with families) and partners across systems and functions (other community based programs, AAP, healthcare provider organizations, hospitals, managed care organizations, early care organizations) to support Safe Sleep efforts.

Example from the Field: NICHQ through its MCHB funded NAPPS activities is working at sites in five states to utilize quality improvement methods to integrate safe sleep and breastfeeding promotion within hospitals, with prenatal health care providers and with community partners.

NPM 5: Safe Sleep

States Implementing PracticeSector

AK, AR ME, MN, ND, PA, OK, TN, VI, WVHospitals

AR, IL, ID ,VA Providers

HI, ID, KY, MI, OH, PA, TN, VAFamilies

ARSystem

NPM 5: Safe Sleep

Trends in SUID by Cause, 1990-2017 from CDC’s SUID and SIDS Data and Statistics portal.

Strategy #2: Building on Campaigns with Conversations

Approach: Provide training to professionals who interact with expecting and new mothers and families that emphasize a nuanced approach to take family needs, beliefs, and context into account when talking about safe sleep, breastfeeding, and smoking.

NPM 5: Safe Sleep

This is a new approach to supporting caregivers to help overcome barriers to safe sleep and breastfeeding. It is part of a greater trend in public health promotion—utilizing an individualized approach that takes into account each family’s needs, beliefs, and the context of their lives.

This training on the Conversations Approach is based on Ajzen’s Theory of Planned Behavior and follows current recommendations from the American Academy for Pediatrics (AAP) for safe sleep and optimal breastfeeding for healthy infants.

https://www.ncemch.org/learning/building/

Strategy #2: Building on Campaigns with Conversations

Evidence: Expert Review and Consensus. The NAPPSS coalition developed the conversations approach with input and review from over 70 national organizations who represent service systems, providers, programs, and community support networks. Initial articles have included the conversations approach in the group of “provider training modules that integrate effective behavior change methods, such as motivational interviewing” that “show promise to improve safe sleep practices.”1

The modules have also been identified as resources that “acknowledge nuance and encourage conversation.”2 The approach has been shared by the AAP, the United States Breastfeeding Committee, University of Washington, Healthy Start EPIC Center, the Safe to Sleep Campaign, NICHQ NAPPSS project and the Oregon Health Authority.

1 Hirai AH, Kortsmit K, Kaplan L, et al. Prevalence and Factors Associated With Safe Infant Sleep Practices. Pediatrics. 2019;144(5):e201912862 Main M. The Perplexing State of Sleep-Related Infant Death – Emerging Data, New Trends, and Current Approaches. Northwest Bulletin. 2018.

NPM 5: Safe Sleep

Strategy #2: Building on Campaigns with Conversations

Role of Title V: Title V Agencies can support a conversations approach/motivational interviewing in several ways:

• Encouraging professionals to take the course directly.• Conduct a train-the-trainer session to deputize professionals on how to promote the

conversations approach.• Engage with NICHQ (NAPPSS-IIN project) to use the modules across the state in multiple

sectors and across different professional groups (e.g., AL, FL, GA, IL, OH, MA, NY, TX)

Example from the Field: Wisconsin has developed a guide to implement a conversations approach with families. West Virginia developed an on-line continuing education module for home visitors on how to implement the conversations approach (through their Abused Children’s efforts, which is where safe sleep sits organizationally).

NPM 5: Safe Sleep

NPM 5: Safe SleepBig secret: The best efforts in lowering SUID/SIDS should include NPM 4: Breastfeeding and NPM 14: Smoking! 1

Breastfeeding. The protective role of breastfeeding on SIDS is enhanced when breastfeeding is exclusive and without formula introduction. (pp. 160–162)

• AHRQ’s “Evidence Report on Breastfeeding in Developed Countries:” 6 studies found that ever having breastfed was associated with a lower risk of SIDS (adjusted summary OR: 0.64; 95% confidence interval [CI]: 0.51–0.81). (p. 160)

• German Study of Sudden Infant Death: exclusive breastfeeding at 1 month of age halved the risk of SIDS (adjusted OR: 0.48; 95% CI: 0.28–0.82). (p. 161)

• 18 case-control studies found an unadjusted summary OR for any breastfeeding of 0.40 (95% CI: 0.35–0.44) and a pooled adjusted OR of 0.55 (95% CI: 0.44–0.69). The protective effect of breastfeeding increased with exclusivity, with a univariable summary OR of 0.27 (95% CI: 0.24–0.31) for exclusive breastfeeding of any duration. (p. 162)

1 Moon, Rachel & Darnall, R.A. & Feldman-Winter, Lori & Goodstein, Michael & Hauck, F.R.. (2016). SIDS and Other Sleep-Related Infant Deaths: Updated 2016 Recommendations for a Safe Infant Sleeping Environment. Pediatrics. 138. 10.1542/peds.2016-2938.

NPM 5: Safe Sleep

Smoking: • Maternal smoking during pregnancy has been identified as a major risk factor in almost every

epidemiologic study of SIDS.(pp. 285–288) • Smoke in the infant’s environment after birth has been identified as a separate major risk factor in a

few studies, (pp. 286,289) although separating this variable from maternal smoking before birth is problematic.

• Third-hand smoke (residual contamination from tobacco smoke after the cigarette has been extinguished); there is no research to date on the significance of third-hand smoke with regard to SIDS risk. (p. 290) – more research is needed.

Smoke exposure:• Adversely affects infant arousal (pp. 291–297)• Increases the risk of preterm birth and low birth weight, both risk factors for SIDS. • Is dose-dependent. The risk of SIDS is particularly high when the infant bed-shares with an adult smoker

(OR: 2.3–21.6), even when the adult does not smoke in bed. (pp. 89,90,191,200,201,206,212,298)

It is estimated that one-third of SIDS deaths could be prevented if all maternal smoking during pregnancy was eliminated. (pp. 299,300) The AAP supports the elimination of all tobacco smoke exposure, both prenatally and environmentally.

Resources:

Safe to Sleep Campaign: Eunice Kennedy Shriver National Institute of Child Health and Human Development

Taskforce on Sudden Infant Death Syndrome. SIDS and Other Sleep-Related Infant Deaths: Updated 2016 Recommendations for a Safe Infant Sleeping Environment. Pediatrics. 2016 Nov;138(5)

National Action Partnership to Promote Safe Sleep (NAPPSS) Improvement and Innovation Network: An MCHB-funded TA resource center, this project supports NPM 4 and 5 topic areas

AMCHP: NPM Resource Sheet | Pulse Newsletters: 2009 | 2015

Children's Safety Network: An MCHB-funded technical resource center, this project supports NPM 5: • Safe Sleep Topic Area• Data and Resources on Sudden Unexpected Infant Death (SUID)

Data Resource Center for Child and Adolescent Health (DRC): A project of the Child and Adolescent Health Measurement Initiative, the DRC is a national data resource providing access to children’s health data

NPM 5: Safe Sleep

Questions and Discussion

Questions:• How are we connecting?• Questions?• A-ha moments?

Discussion:• You are the experts! Please share

strategies, programs, or experiences that you have found effective.

Contact:• [email protected]

NPM 6: Developmental ScreeningPercent of children, ages 9 through 35 months, who received a developmental screening using a parent-completed screening tool in the past year.

GOAL: To increase the percent of children who receive a developmental screening.

Why is this important?

• Early childhood (ages birth to 3) is a critical period that can determine a child’s health trajectory.

• Timely identification of developmental delays can prompt specific and appropriate therapeutic interventions.

• In the U.S., nearly 18% of children have a developmental disability.1 Less than half of children with developmental delays are identified before starting school.2

1 Zablotsky, B., Black, L.I., Maenner, M.J., Schieve, L.A., Danielson, M L., Bitsko, R.H., ... & Boyle, C.A. (2019). Prevalence and Trends of Developmental Disabilities among Children in the United States: 2009–2017. Pediatrics, 144(4), e20190811. 2 Boyle CA, Boulet S, Schieve LA, et al. (2011). Trends in the prevalence of developmental disabilities in U.S. children, 1997-2008. Pediatrics, 127: 1034-42.

NPM 6: Developmental ScreeningImportance and Background of the NPM

What is “screening”?

• Uses a standardized tool to assess if a child is learning basic skills, and to identify if a child is at risk for a developmental delay.

• Should take place in addition to developmental surveillance (monitoring) in the primary care setting.

Where can screening take place?

• Primary care setting — Approximately 90% of children under age 3 receive well-child care.1

• Also can take place in other health care, community, or childcare settings.

1 Child Trends Databank. (2018). Well-child visits. Available at: https://www.childtrends.org/well-child-visits

Where are we now?

The percent of children with a developmental disorder has been increasing, yet overall screening rates have remained low:

• According to the 2017-2018 National Survey of Children’s Health, only 33.5% of children age 9 to 35 months received a developmental screening using a parent-completed screening tool in the past year.1

• This represents a small improvement over 31.1% measured in 2016-2017.2

1 Child and Adolescent Health Measurement Initiative. 2017-2018 National Survey of Children’s Health (NSCH) data query. Data Resource Center for Child and Adolescent Health. Retrieved from www.childhealthdata.org. 2 Child and Adolescent Health Measurement Initiative. 2016-2017 National Survey of Children’s Health (NSCH) data query. Data Resource Center for Child and Adolescent Health. Retrieved from www.childhealthdata.org.

NPM 6: Developmental ScreeningImportance and Background of the NPM

These strategies have been identified as effective in addressing NPM 6. They can be adapted for your program needs.

Strategy #1: Quality Improvement Programs in Health Care Settings (Systems Level Approaches)

Approach: Support practice-based learning collaboratives for primary care practices. There are six studies that have examined the effectiveness of improving developmental screening delivery through quality improvement programs in health care settings.

Evidence: Moderate evidence.1

1 Garcia, S., Brown, E., Strobino, D., Minkovitz, C. (2018). National Performance Measure 6 Developmental Screening Evidence Review. Strengthen the Evidence Base for Maternal and Child Health Programs. Women’s and Children’s Health Policy Center, Johns Hopkins University, Baltimore, MD.

NPM 6: Developmental Screening

Role of Title V: Title V Agencies can support quality improvement programs in health care settings through a number of approaches:

• Use Medicaid to fund learning collaboratives to engage practices in the QI process around developmental screening.

• Have an agreed-upon set of quality standards based on evidence and best practices, creating a common foundation for community and health care partners to implement screening and referral processes.

Example from the Field: Seven pediatric primary care practices participated in New Mexico’s Developmental Screening Initiative in a year-long quality improvement project with the goal of implementing standardized developmental screening tools. The initiative used a learning collaborative approach and the Model for Improvement to promote AAP best practice. Overall, the use of standardized developmental screening increased from 27% at baseline to 92% at the end of the project.1

1Malik, F., Booker, J. M., Brown, S., McClain, C., & McGrath, J. (2014). Improving developmental screening among pediatricians in New Mexico: findings from the developmental screening initiative. Clinical pediatrics, 53(6), 531-538.

NPM 6: Developmental Screening

Strategy #2: Home Visiting Programs

Approach: Utilize home visiting/Maternal, Infant, and Early Childhood Home Visiting (MIECHV) programs to provide the Ages and Stages Developmental Screening tool to clients.

Evidence: Moderate evidence1

Role of Title V: Title V Agencies can support developmental screening via home visiting programs through a number of approaches:

• Support MIECHV and other state home visiting programs to provide developmental screening using the Ages and Stages Developmental Screening tool.

• Implement a Medicaid/CHIP reimbursement claim code for developmental screening activities at the provider level.

• Educate parents about developmental screening tools.1 Garcia, S, Brown, E, Strobino, D, Minkovitz, C. (2018). National Performance Measure 6 Developmental Screening Evidence Review. Strengthen the Evidence Base for Maternal and Child Health Programs. Women’s and Children’s Health Policy Center, Johns Hopkins University, Baltimore, MD.

NPM 6: Developmental Screening

Example from the Field: Healthy Families Oregon is a free family support and parent education home visiting program that focuses on strengthening the parent-child relationship. Home visitors support parents in establishing and building a nurturing, positive relationship with their baby at each visit.

An assessment of the program found that 93.8% of the children of mothers assigned to the Healthy Families program group received developmental screenings, vs. 86.5% of the control group.1

1 Green, B.L., Tarte, J.M., Harrison, P.M., Nygren, M., & Sanders, M.B. (2014). Results from a randomized trial of the Healthy Families Oregon accredited statewide program: Early program impacts on parenting. Children and Youth Services Review, 44, 288-298.

NPM 6: Developmental Screening

Strategy #3: Health Care Provider Training

Approach: Train medical, social service, and childcare providers on developmental screening.

Evidence: Moderate evidence.1

Role of Title V:• Provide opportunities for training on developmental screening to health care and social services

providers. • Provide training on developmental screening to home visitors. • Offer online training modules to primary care clinicians and pediatric/family medicine residents to

improve provider knowledge, attitudes, and actions toward promoting healthy child development, screening and recognizing infant and toddler mental health concerns, and referral to appropriate developmental and mental health resources for young children and their families.

• Offer training on the Bright Futures guidelines to primary care providers, home visitors, public health nurses, early child care and education professionals (including Head Start), school nurses, and nutritionists.

1 Garcia, S, Brown, E, Strobino, D, Minkovitz, C. (2018). National Performance Measure 6 Developmental Screening Evidence Review. Strengthen the Evidence Base for Maternal and Child Health Programs. Women’s and Children’s Health Policy Center, Johns Hopkins University, Baltimore, MD.

NPM 6: Developmental Screening

Example from the Field: The Enhancing Developmentally Oriented Primary Care(EDOPC) project created training programs to address barriers to developmental screenings, including lack of practitioner confidence in using validated screening tools. Project staff and peer educators (physicians and nurse practitioners) delivered a 1-hour, on-site training on using Ages & Stages Questionnaires to primary care providers and their entire office staff.

The project also promoted the routine use of screening tools by increasing awareness of opportunities for providers to bill for screening services. Among a sample of primary care sites at which chart reviews were conducted, the EDOPC project increased developmental screening rates to the target of 85% of patients at most sites.1

1 Allen, S. G., Berry, A. D., Brewster, J. A., Chalasani, R. K., & Mack, P. K. (2010). Enhancing developmentally oriented primary care: an Illinois initiative to increase developmental screening in medical homes. Pediatrics, 126 Suppl 3, S160–S164. https://doi.org/10.1542/peds.2010-1466K.

NPM 6: Developmental Screening

Resources:

CDC’s Learn the Signs. Act Early. Program: Includes a range of guidance for providers and families, including an app that families can use to track their child’s development, and resources to support developmental surveillance.

Birth to 5: Watch Me Thrive Resources, including Birth to 5: Watch Me Thrive! A Compendium of Screening Measures for Young Children: Tools focused on child development as well as developmental and behavioral screening.

Bright Futures: National health promotion and disease prevention initiative; offers resources for health care and public health professionals to use in improving and maintaining the health of all children and adolescents.

Screening Technical Assistance and Resource (STAR) Center (AAP): Offers free assistance to pediatric health care providers seeking to improve early childhood screening, referral, and follow-up in their practice or health care system.

NPM 6: Developmental Screening

Questions and Discussion

Questions:• How are we connecting?• Questions?• A-ha moments?

Discussion:• You are the experts! Please share

strategies, programs, or experiences that you have found effective.

Contact:• [email protected]

The Role of Title V• Assessing ongoing community needs: Title V can use data collected by programs,

evaluations, or more formal needs assessment findings to see if the strategy could address identified service gaps or build equity in access and positive health outcomes.

• Informing and educating the public: Title V can provide educational/outreach materials to families/consumers to advance the strategy through training and peer support.

• Engaging community partners and families: Title V can serve as the convener for those groups/organizations that can implement the strategy.

• Integrating systems of public health. Title V can help ensure access, sharing of resources, and coordination of services to assure maximum impact of the strategy (coordinating the public health approach, health care, and related community services).

• Educating the MCH workforce (building capacity): Title V can partner with groups actually conducting this strategy in order to train MCH and healthcare professionals in strategy implementation.

• Developing public health policies and plans: Title V can support adoption of the strategy at a state level.

• Ensuring quality improvement and promoting applied research: Title V can collect data and evaluate programs in the state/jurisdiction that are implementing this strategy to build the evidence base and promote rapid innovation.

https://www.mchevidence.org/tools/strategies/role-of-title-v.php

Wrap Up

John [email protected]

Webinar 4: Wednesday, April 29 from 3:30 – 4:30 EST.

NPM 10 (Adolescent Well-Visit) – Charles Irwin, Adolescent and Young Adult Health National Resource Center

NPM 13 (Oral Health) – Katrina Holt, National Maternal and Child Oral Health Resource Center

NPM 14 (Smoking) – Beth DeFrancis, American College of Obstetricians and Gynecologists

Webinar 5: CYSHCN – Wednesday, May 6 from 3:30 – 4:30 EST.

NPM 11 (Medical Home) – Christina Boothby, National Resource Center for Patient/Family-Centered Medical Home

NPM 12 (Health Care Transition) – Peggy McManus and Patience White, Got Transition

NPM 15 (Adequate Insurance Coverage) – Allyson Baughman, Catalyst Center and Elisabeth Burak, Center for Children and Families

Keriann [email protected]