AMCHP 2006 ANNUAL CONFERENCE
EARLY CHILDHOOD: BUILDING THE FOUNDATION FOR LIFELONG HEALTH
March 4-8, 2006
SALLY KERSCHNNER: Hi. I'm Sally Kerschnner from the Vermont Department of Health, and my colleagues, I told them I'd put their names up in lights, are in the audience: Dr. Don Schwartz, who is our MCH director, and Kathy Keller, the Director for Public Health Nursing for the Health Department.
We're the folks from the health department who work on ECCS and we also have close colleagues at the Division, the child care Folks who work with that state. And the actual coordinator in Vermont his name is Bob Costino, he's not here today, but I'm reporting out on what we're doing in Vermont, and some of it is, because I'm not involved in it as directly as Bob, some may be a little superficial and some of it is very in depth.
And we have not a huge group here. It's a nice assortment. Afterwards I would really like, after Ralph talks, I'd really like to hear a bit of a discussion about what's going on in the different states because I don't go to a lot of the specific ECCS conferences to hear what's going on. So as you listen to me and then Ralph and have things you want to add or want to ask questions or say well in my state we're doing it this way, I would love to hear that kind of a discussion.
In Vermont, we have something called Building Bright Futures, and this is in a nutshell has been the vehicle where we've incorporated ECCS funds and the ECCS mission and activities into what we call Building Bright Futures.
And this Building Bright Futures has been this coordination effort, and the goal is to establish a coordinated system of early care, health and education services. After listening to Lorraine, that probably sounds a little familiar. The goal is similar to ECCS. And in order to work through Building Bright Futures, we thought it best to go back to our public health MCH 10 Essential Services. We feel it's important to use the framework of 10 Essential Services when working with the ECCS grant activities. The 10 Essential Services help us keep the focus on maternal and child health and public health as we coordinate with our partners in early education and social work, because we have all these different disciplines at the table we all have different languages. And I know as I keep myself grounded in the 10 Essential Services it helps me be clear why there's maternal and child health and public health people and that helps to compare and contrast and see the overlaps with the other disciplines in the room, see what's the same and what's different and that works better as we get down to strategic planning.
So just to read through this a bit, with the 10 Essential Services, here's some example. Obviously we monitor health status of both children and communities to identify health assets and needs. We inform, educate and empower families with young children about health issues and services. We mobilize community partnerships. We provide leadership to develop policies and plans that support families in their communities, we link families and services to systems. We ensure capacity and competency of the work force. We evaluate effectiveness, accessibility and population based health services. Another thing right at the top when we monitor health status of children and communities who are identifying health assets and needs. In Vermont and throughout New England we're trying to work a lot on population based assets and I'll talk about that a little bit later. One of the ways of doing that is to plug it in, in all the PowerPoints when we can.
A little overview of Maternal Child Health in Vermont. This is stuff I pulled out of the Title V Block Grant and you can get an overview in your state. We're small. We have 621,000 people our total deliveries are 6,464, which I think is not a lot compared to many of the states represented in the room.
We are pleased that 91% of the pregnant women in our state receive prenatal care from the first trimester. Our teen birth rate, young teen birth rate is 6.7. In 2003, that was a numerator of 88. So that gives us a lot of opportunity to really do some in depth services to these kids.
Our infant mortality rate is five per thousand live births. We worry a lot about our WIC children who are overweight. 13% of them, and also I don't have the data here, but all of our age groups in Vermont are overweight.
95% of Medicaid children receive at least one periodic screen. About half of the low income children as measured by Medicaid services use dental services. 83% of the children receive full schedule the age appropriate immunizations. And then title five national performance measure number three, nearly 60% of the families of the children with special health needs report receiving care within a medical home.
A little bit of data now through the child care world in Vermont. And it's my understanding; here we have 80% of Vermont women with children under 6 are in the out of home workforce. It's my understanding that's very high. That's one of the highest ones in the nation. So of course that makes ECCS very important to Vermont the number of licensed registered child cares and then just the different categories. The licensed are the more rigorous licensing and then down from the center base to home day‑care, that spread of types of day‑cares.
We have the 7,000 children receiving child care subsidies. As we heard from the speaker yesterday morning, we should be considering these tuition and not subsidies and I really like that. Vermont the childcare people use the word tuition, and I'm learning about that and I really like that connotation.
The 134 of the programs are nationally accredited and 41 programs have Vermont stars. So this is modelled after another state program. Maybe you guys know what I'm talking about. It's a way of the individual child cares working on certain criteria and to be able to achieve stars as they improve the quality of their services.
A little bit about how things are organized in Vermont. We have 13 counties. That's more than the state of Delaware. Anyone from Delaware. I just love it it's three counties. Quickly I'll read through this. We have 13 counties but there are no county health departments. They're all under the auspices of the state Department of Health. So we have 12 district offices. One is for each county and one district office covers two counties. There are 12 offices for the Department of Children and Families which is a close coordinator with ECCS and these are all located so there's one stop shopping for families. Like if they come in for WIC which is administered by the health department they can also apply for other services and both of the Department of Children and Families, Child Development Division and Department of Health are under the Agency of Human Services.
So that in a nutshell is what it looks like but we've just gone through a re-organization. So you're all knowing that there's a lot more behind this PowerPoint than what's presented here. But this is how it kind of sugared out after the reorganization in 2004.
I'll read through just referring to some of the bullets on this slide. So in Vermont, we're using ECCS for major systems change. And apparently several other states are working on this approach, too. I've heard the presentation from New Mexico and Washington State yesterday and Washington State really spoke to me I think a lot of what they're doing is similar to what we're trying to do in Vermont.
We want to do a major reworking of the systems, services for children in Vermont. I'll go through a little bit of what's been happening. In 1994, there was a state team formed to help achieve the vision of all Vermont children and families will thrive. It's called the state team. But it's technically called the state team for children and families. The team is very active and consists of managers and administrators from both the district and Central Offices of the Division of Aging services especially the child development division and department of health and the key players in ECCS. In addition to the state team, over the last 15 years a variety of local coalitions have developed, all in response to a specific program or mission. These coalitions work locally in each county and have the same general mandate that they do specific work in response to the individual needs of the county where they are located.
We also have regional partnerships, which are local collaboratives formed to address the big picture part of services for families with young children. And the state team and the regional partnerships have worked together historically on initiatives or programs that are intended to address the statewide ten outcomes planning document.
And I'll give some examples of the ten outcomes. So also up here I have ‑‑ we have local county‑based MCH coalitions which work on issues around pregnant women and infants. The Success By Six, which is in many states nationally for children up to the age of six. Early childhood councils. There's just a lot going on out there.
The early childhood steering committee was formed in the early 1990s. And that was also another statewide consortium of agencies and individuals concerned about the learning and development of young children. In 2002, the early childhood steering committee received an ITAG grant, intensive technical assistance grant from North Carolina, I'm assuming you folks know more about it but as they worked with their ITAG funds and technical assistance, it was recommended that the early childhood steering committee should develop a strategic plan for unified system of early care in education that builds upon previous accomplishments.
So once again here's this ECCS theme coming around through another grant funding, funded opportunity.
These are some of the ten outcomes that, A is just ten outcomes is through all ages adulthood and elderly. But some of the ones that deal with families and young children, we have pregnant women and children thrive and we try to measure that with some of your expected measures like women getting into prenatal care, breast feeding rates, percentage of children living in food and secure homes. We have children ready for school. Sorry about the typo there.
We have a number of accredited early childhood programs, children's readiness for kindergarten through the kindergarten survey of kindergarten teachers. Youth two's healthy behaviors that would be overweight, substance abuse a lot of the asset question we have in our YRBSS.
We've also used these ten outcomes to help guide our planning and thinking as we did the Title V needs assessment. So as a summary, I've described the many efforts that have developed over the last 15 years to develop a quality system of care for families and their young children. Historically, the planning for health and early education and child care developed both statewide and locally. These various efforts will well intentioned and have created some excellent local communications among various agencies. General benefits have been better communication for program planning and implementation that are awareness of community assets and needs and better coordination of local services. Although these many efforts have accomplished great things over the last 15 years, the time has come for these groups to become more integrated in their work.
The overall specific goal for these planning efforts is to streamline the maze of services for children and families, reduce the overlap and similar services, strengthen services that meet a specific family or community need and to collaborate on new programs that fill existing gaps.
So a small task, I'm sure. So that leads us to Building Bright Futures, which actually developed ‑‑ this kind of came, morphed out of the Children's Cabinet. I think many states have children cabinets, we started that in Vermont then it came into the Building Bright Futures.
That was legislatively authorized by our Governor in 2004. In Washington, they have something similar. They call it the Kids Matter. Was anybody on the Washington talk yesterday and they were talking about that? Yeah. So I think Vermont's version is the Building Bright Futures. This is the overall mandate for the Building Bright Futures health committee. We have Building Bright Futures, the overall board and a lot of the structure on that is still getting figured out. That will be a lot of interesting conversations in the next many months. But the health committee is what's being funded by the ECCS grant. And the health committee's responsibilities and mission is overlaps hugely with what Building Bright Futures wanted to do and what ECCS was to do.
I think Lorraine went over most of this. We are going to ‑‑ planning our grant is still for planning in Vermont. And we're also benefiting from technical assistance specifically from Kay Johnson, who presented earlier this morning. And Kay lives in Vermont. So that was convenient. And I'll say ‑‑ we have rowdy folks behind us ‑‑ the folks in New Mexico are presenting and they have Mark Friedman and he's done a lot of national work. You folks may know him on budget base and outcomes planning. And he lives in Santa Fe, so they use him. And so Kay lives in Hindburg so we use her. And she's providing specific TA to a couple of the states. So we're very lucky that way.
So, again, this is just ‑‑ Lorraine went over some of the ECCS goals. And in Vermont we have ‑‑ Lorraine talked about the five focus areas. And in Vermont, the committee chose to put it in four focus areas, health insurance, mental, dental home, mental health, social early education. We took the family support and put it in with parent education for specific focus on that.
Our health committee was formed. It's an ad hoc committee, but they stand ready to be called back whenever we need them. They started meeting last spring. And I think it was three meetings, day‑long, very intense meetings, and they were incredibly helpful and a nice variety of people from obviously parents and families and the state agencies and the public schools. AAP has been a huge partner in this. They're very helpful. We also have the VCHP, Vermont Children's Health Project out of University of Vermont and Fletcher Medical Center, major medical center, one major medical center. And they too are very helpful.
We did our environmental scan, as everyone has done. On that, as you might remember with your own ECCS work we wanted to assess Vermont's maternal and child health capacity to address early childhood services within the framework of the five or four components.
And we want to emphasize these elements as we went through the process. Family centered, quality improvement and evidence‑based practice. And I think a lot of you folks would have done this, too. We contracted with JSI for the environmental scan. At the same time we're contracting with JSI to do our, some of the background work for the Title V needs assessment. And a lot of the information they were pulling up really overlaps so it's a great way to get these two projects done with one major effort.
I like that because I had to do the needs assessment. So I'm not going to start singing and dancing. So with health insurance, medical and dental home, we have our goals, our outcomes. These are ‑‑ you folks all have outcomes and strategies like these, I'm sure. And also what's happened with ECCS is that a lot of the strategies, there's a lot of work going on already before ECCS. And that's the beauty of ECCS to kind of get it all coordinated. But it's not like we're starting from scratch on many of these. With medical home, there's been a lot of great stuff done in Vermont. We have our partner with VCHP and AAP. They've done a lot of work with pediatric provider practices on quality improvement and that's, of course, a key element of medical home.
We had a children's special health needs medical home grant and they do a lot of work with pediatricians who are general pediatricians but have children with special health needs in their practices on how to identify these children and work on getting them out to resources. There's medical home project with VCHP on medical homes for foster children, children in foster care.
Oh, we also have our new state oral health plan, and that, a lot of strategies in that directly overlap with our desires to strengthen dental homes. So that's another opportunity.
We have the focus area mental social health. One thing that's happening in Vermont as the reorganization happened, and I took a couple pot shots at that, but we used to have the Department of Health and the department of metals. Now, after reorg, we're all one department. And I'm really excited about that. And so the department of mental health, those folks historically have done a lot with intervention and coordinating services for intervention, and they are really excited about being able to work on the upstream level and doing more intervention or more prevention. So they're excited about working with the health department. Then we throw in the whole early childhood systems and it's a lot to get worked out but there's a lot of ‑‑ we'll be able to do a lot of really good stuff with this.
So mental and social emotional health with our strategies. We have the early care in education. You can see from some of the slides earlier, for years we've been working around issues like with the state team and the regional coalitions, we've been doing a lot of work with our partners in early care. So as we sit down on ECCS all the faces are familiar. And some of the specific programs, for example, under parent education, some of the strategies. I just won't read through all of these, but I mean for years public health has been teaching parents about safety in the home and safety issues. So this is not, oh we have to go do this. We've been doing it how do we do it better and how do we stretch ourselves by coordinating with other people?
The other thing is the woman who is at the, that oversees all the licensing of the childcares in Vermont sits on the Vermont state child fatality review committee. And that committee in Vermont has been going on for over 20 years.
As many committees it started as reviewing suspected cases of child abuse that ended in homicide. But we've been moving the committee to more of a prevention focus and that's childhood injuries. As we see a lot of children are in day‑care. So it's a great way to take some of this philosophy and put it into practice by having this person sit routinely on the fatality review committee.
Talk a little bit about how we're overlapping between ECCS and Title V. And as many of you know we have Title V Block Grant every five years we do the Title V needs assessment. And back to our efforts to incorporate strengths and needs in Vermont. We called it the Title V strength and needs assessment. And this goes back to in all throughout Region I in New England we've wanted to take the concept ‑‑ I'm sure a lot of you know the concepts out of the Search Institute and resiliency and measuring assets. And a lot of work has been done on that for individuals and families or how do you do that in like a mental health practice.
And we want to take those concepts and apply them to a population. How do you measure the strengths of the population from a public health view and not like maybe a social worker working with a community type view. So we wanted to see how much we could incorporate that theme and make it really real in our needs assessment. So for one we started by changing the title and called it a strengths needs assessment. We've been doing a lot of this processing and this thinking through our regional phone calls that we have monthly in Region I. We all get together once a month and talk about these sort of things and we get updates and all. But we also process this. And it's very stimulating.
So I'll talk about how we've used this concept on our state performance measures. And ones directly related to ECCS and one is not quite as directly but it's still interesting.
In about a year ago we started saying wouldn't it be cool to have some common measures throughout the New England region. And we thought we would do two measures or attempt to do two. And we kept one open for an early childhood measure. So I'll get to that in maintain. That's the one that goes with ECCS and we also thought we'd do one that deals with youth strengths.
And in Vermont, on our YRBSS, we have I think it's five questions that deal with strengths, measuring youth strengths. It's the one listed here about in my community. I feel like I matter to people. There's one about measuring how often the teen and their parents talk about school work. About the number of hours a week they volunteer in community activities that are outside the school. And I know other states have done this. I don't know if any of you here are in states that do that. But the questions are fully researched and then put onto the YRBSS.
Historically we've talked a lot with Maine about this, and so it just has come out that both Maine and Vermont in the New England region has this one question in the YRBSS that is worded the same so we can use it the same. In my community I feel like I matter to people. And then the youth who is filling out the survey checks off what reflects the extent they agree with that. So we're having that as our common indicator. Measuring the youth strength in Vermont and Maine and at our regional breakfast this morning, this is still very much a work in process, we talked with the other New England states about what do they have that they might be able to use that's similar. And the whole idea is we have a common indicator we can measure it and then compare ourselves and see well why is one state doing better than another state and well what are you doing in New Hampshire that's working for and you maybe we can try it in Vermont. So a lot of that thinking goes into this.
So we're working on that measure and we're also working on an early childhood indicator. Now, this comes out of just we think we're very close to the point of adopting the indicator that measures the percent of child cares with access to child health consultants. There's been a lot of talk about that at this conference. And there's a group called Healthy Child Care New England also formed out of Healthy Child Care America, one of their purposes is supporting the training, the system for training and systems for these child care consultants. So they've done work and took language out of the Caring For Our Children, the day‑care recommendations, and the measure, the specific wording will look something like the percentage of licensed child care centers serving children age birth to five who have on‑site healthcare participation and standards for caring for our children. We're very close on agreement that each New England state will use this as one of their state performance measures.
So there's what we think is a great example of taking what real work has to be done and measuring it through these two different funding initiatives as Title V and ECCS.
So to kind of summarize it, we have, as we've all figured out, united we stand as a collaborative using the knowledge and skills of all of our respective disciplines such as health, education and all the developmental specialists. Divided, we just can't serve our children in the way that they deserve. So we need to all pull together and use our strengths and develop great early childhood systems.
Here's more contact information. As I say Bob Costino is our main ECCS coordinator.