MCHB ALL GRANTEE MEETING

Divisions and Offices (continued)

October 4-7, 2004

CHRIS DEGRAW: Thank you John, good afternoon. Ann asked me to do this presentation for her because she’s got a lot of responsibilities with the meeting. You all met her during the last panel. I just want to let her know that she owes me big time, because I’m missing an opportunity to meet Katie Couric at my son’s elementary school, 50-year celebration today, so. I’m here to talk about our division, which is the division of research training and education. And, because we deal with issues that we feel are really fundamental to maternal and child health, training, research, prevention, we think it’s important to understand the big picture, or the context in which we work. First, there’s the President of the United States , followed by the Secretary of Health and Human Services, the HRSA Administrator, and our own Associated Administrator for maternal and child health, Dr. van Dyck who you met earlier. And, just four steps away from the presidency as it were, is the Division of Research Training and Education. I was going to have Ann’s picture fly in here, but I didn’t think she’d like that, so I opted for our dirty symbol.

We have four very exciting programs of different magnitude in our division that we’re responsible for. And, they’re supposed to flash when I press the thing, but it doesn’t seem to be working when I tried it out, so no flashes. The MCH Training Program, and how many people in here have Training Program Grants, can you raise your hands? A lot of you. The MCH Research Program, I wouldn’t expect too many of our research, a few, good, great. The Healthy Tomorrow’s Partnership for Children Program? Quite a few of you. And, the Bright Future’s Initiative, and I know our staff from our partners at the American Academy of Pediatric are here, if you could raise your hands. Over there. Great. I’m going to talk a little bit in more detail about each of these programs. The MCH Training Program seeks to train the next generation of leaders who will provide or assure the provision of quality services for the MCH population. The training program, the training branch is led by Laura Cavanaugh, who you’ll meet in a few minutes, is down at the end of the dais here.

Quality services for mothers, children and adolescence require professional who are attuned to the special needs of children, adolescents in general, and to children with special health care needs, who are trained to provide or assure the provision of interdisciplinary family centered and culturally competent services, echoing some of the same themes that Dr. McPherson talked about in her presentation on Children’s Special Health Care Needs. And, who are focused on improving the health of the entire population. And, these are sort of the three characteristics that drive our training programs. The training program is the largest category of the SPRANS Grants with a budget of about $37 million. We support 140 active projects at 82 universities in 39 states and two jurisdictions. The training program consists of both long-term training opportunities and shorter-term continuing education. There are 12 categories of long-term training.

The Leadership Education and Adolescent Health, or LEAH Program, communication disorders, developmental behavioral pediatrics, graduate medical education and minority serving institutions, the Leadership Education and Neuro-developmental Disabilities, which is our largest training program. MCH Nursing, MCH Nutrition, Pediatric Dentistry, Pediatric Pulmonary Centers, Schools of Public Health, and MCH Social Work, as well as a Research Training Enhancement Award Program. There are five categories under continuing education, Continuing Education, Distance Learning, their Certificate Program and MCH Public Health, Collaborative Office Rounds, which fosters cooperation between mental health providers and pediatricians, and the MCH Institute that provides annual training for the state MCH Leadership. Laura and her staff, as well as the grantees and the MCH community in general have been very busy over the last couple of years developing MCH training strategic plan for the nation. And, you’ll hear more about this I’m sure during the course of the meetings, and Laura, I’m sure, would love to talk about it. And, her training program grantees will talk about it extensively at their meeting that follows the main meeting. But basically, the focus has been on strategic planning.

We’re interested in cultural competency, both in the training programs themselves, and diversity among faculty and trainees and as with the rest of the bureau programs, in performance measures and improving the capacity for administrative data about the programs. The MCH Research Program, which is led by Dr. Stella Yu is Stella here? I don’t see her, she’ll probably be joining us later. It was established in 1963 through an amendment to Title V, and the purpose is to support applied research relating to maternal and child health services that has the potential to improve health services and delivery of care for MCH populations. The MCH Research Program, the main grant program within that overall program is the R40 Program, which supports applied research, it’s extramural, we don’t sit around doing research at the Parklawn Building , but rather we support research through our grants. It’s investigator initiated, so that any of you or researchers at your institutions can make proposals to the program.

It’s multidisciplinary in orientation, which is keeping with the overall multidisciplinary orientation of the MCH field in general. We use a review process similar to that at the National Institutes of Health, a rigorous review process. And, grantees use the PHS Application Form 398 as do the other federal research programs and is supplemented by a set of HRSA MCHB specific instructions. We have a research budget that is approximately $10 million annually. We review between 90 to 100 new applications annually, and it’s a very competitive program as those of you who have submitted applications in the past may know. The application deadlines are on two cycles a year in March and August. There are a number of currently active projects in the research portfolios, somewhere between 40 and 50 at any one time. And, we’ve been very successful in this program, both in terms of support for some real important research within MCH field, and there have been large numbers of peer-reviewed publications that resulted from the research. You’ll hear more about the MCH Strategic Plan, about the Training Strategic Plan.

Well, this year in the MCH Research Program we’ve come out with strategic research issues for the next five years. And, they were developed based on broad input from the field, but from researchers and from Title V directors, and MCH people across the country. It’s closely tied to MCHB’s strategic plan. In the past we’ve really--because it has been investigator initiated research, there have been priorities, but we’ve supported a broad array of research. We’d like to focus more on MCH Public Health Services and systems questions that may not be addressed by other federal research programs to really find the niche for the MCH Research Program, so we’re not duplicating what other research at NIH or HRQ are doing. And, really so that we can make sure that there is a pod of research funding going for these MCH important issues. Our four strategic research issues for the next five years are to look at research on public health service systems and infrastructures, on eliminating health disparities, on services and systems to assure quality of care for MCH populations, and for promoting the healthy development of MCH population. So, they’re still fairly broad, but we’re truly trying to start to narrow the program to really focus on MCH in systems.

Types of research that has been funded in the past include health services research, behavioral or psycho-social research, medical and clinical, epidemiological, and secondary data analysis. And, I think Dr. Yu is expecting to fund more research on secondary data analysis as time goes on. We’re trying to get the word out that we do fund that kind of research. In addition to our major research grant program we also support the Pediatric Emergency Care Applied Research Network or the PECARN, the Pediatric and Office Settings Networks or PROS, the Collaborative Ambulatory Research Network, which is housed at the American College of Obstetrics and Gynecology. We have supported dissertation awards for trainees in MCH. And, the Research Training Enhancement Awards. Another exciting program is the Healthy Tomorrows Partnership for Children Program that Jose Balardo runs in our division. It’s a collaborative grant program in partnership with the American Academy of Pediatrics, and its purpose is to engage communities to work to improve children’s health through prevention and through better access to health care.

One of the beauties of the Healthy Tomorrows Program is that it’s one of the few grant programs that really focuses at the community level. So, whenever people from communities call and ask me, you know, are there grant programs that they can apply for I always send them to Healthy Tomorrows, probably much to Jose’s chagrin, but it’s a real opportunity for community folks to receive some grant funding. Projects are funded for five years at $50,000 a year, there’s a required non-federal match in years two through five of the project period, and this we found to be very successful in fostering long-term sustainability and leveraging of community resources. An evaluation of the Healthy Tomorrows Program showed a 70% sustainability rate among these grants. There are a lot of examples of Healthy Tomorrows’ projects, again, the focus is on prevention and on access to care, but within that rubric there are a lot of different types of things that can be funded. This past year we had some targeted issues in Healthy Tomorrows Program and they targeted on some grants on oral health and on mental health, two hot topics in MCH.

And, finally, I want to talk about the Bright Future’s initiative, which I work on at the bureau. It’s MCHB’s Health Promotion and Prevention Initiative for Infants, Children and Adolescents. And, it’s been around a long time and I hope you’ve all heard about it, but I want to tell you about some of the new exciting things going on with Bright Futures. Again, it began in 1990, and it’s to promote desired social, developmental and health outcomes of infants, children, and adolescents. To enhance health care professional’s knowledge, skills and practice of developmentally appropriate healthcare in the context of family and community, to increase family knowledge, skills and participation in health promotion and prevention activities, and to foster partnerships between families, health professionals and communities to promote the health of children. Over the years Bright Futures Initiative has produced many materials and books and other things to help people really carry out quality health promotion. I mean, a lot of different settings, the core is the Bright Futures guidelines for health supervision of infants, children and adolescents, which you see in the middle, and just a sampling of the other Bright Futures tools, includes the Bright Futures and practice oral health, nutrition, physical activity, mental health, the new Bright Ideas Newsletter from the American Academy of Pediatrics, lots of different things.

Our partnership with the American Academy of Pediatrics came about a couple of years ago, and the Bright Futures Initiative is going great guns I want to report under their leadership. The Bright Futures guidelines are undergoing a comprehensive revision and are expected to come out in 2005. There will be opportunities for all of you to participate in an online review of the guidelines in the coming months, and we’ll keep you posted about that. We’re really excited, I think when we went into this we thought a review would be sort of a tweaking of the original guidelines, and fine tuning and updating. But our expert panels have really decided to take a look at the guidelines from the ground up, and we’re expecting some great things coming out of that. There will be new tools for Bright Futures implementation. We’re really focusing on Bright Futures as a quality improvement mechanism for health promotion and preventive services and provider practices, and the Bright Futures staff who’s here at the meeting today can tell you about some of the things that are going to be coming up in the coming months. We’re going to be doing two round tables, both on Tuesday morning and Wednesday morning on Bright Futures.

We’re also going to have an opportunity to talk to the Healthy Tomorrows grantees tomorrow afternoon, I mean, Tuesday afternoon. So, and there’s a booth on Bright Futures at the exhibit hall. So, I hope everybody will take an opportunity to talk with Garcia and the staff about that. There will also be some new opportunities for Bright Futures in training this coming year, so, we’re excited. Here’s a picture of our dirty staff, I’m sure you recognize some of your project officers and the people you talk to on the phone and when you call us up, and most of these folks will be here over the course of the next few days, and we welcome any opportunity to talk more about our division and our programs in general. Thanks.