Sunday, October 19,2003

1:20-3:00 PM

Ann Drum: Jeff is trying to put my talk in. It looks like a little, the thing you put in the weed whacker, at the end of the weed whacker there’s a little electronic thing, so we’re not sure if this is going to work or not. It’s going to work, okay. My name is Ann Drum and I’m the Director of the Division of Research, Training, and Education. And I am last, and if these slides don’t work, I’m going to be least also, so I’ll try to keep it short. I’m going to talk a little bit about the division. The Division of Research, Training, and Education is affectionately known as DRTE, or as we down at the end of the hall like to call ourselves, DRTE, we think it’s a little more sophisticated. But if you notice, on our symbol we bring back Dr. Van Dyck’s pyramid and we like to think of ourselves as the DRTE bottom feeders because we concentrate at the bottom of the pyramid. We’re really into infrastructure and functional kinds of things. Not to suggest that the other divisions are dysfunctional, but they are more population based or state specific. We concentrate on things like training and research and child health supervision guidelines like Bright Futures and we also have a demonstration project called Healthy Tomorrows. In our organization we’re actually divided into our four units of our major thrust: Research Training, Bright Futures, and Healthy Tomorrows. And this came out pretty light, but I wanted to mention a few people and I have some contact information at the end, but if you have questions in regards to training, the training branch chief is Laura Kavanagh, in regards to Healthy Tomorrows it’s Jose Belardo, research questions, I’m the acting Research Director at this time, but Dr. Stella Yu will be joining our staff on November 1, and questions on Bright Futures, Dr. Chris Degraw. When Dr. Van Dyck talked about the 15 percent, this grant set aside for Title V, about half of that comes down to our division, so we’re making some very large investments with our SPRANS dollars on some of these infrastructure projects. And probably our largest investment, about 38 percent of SPRANS, goes to MCH training and that’s training that next generation of MCH public health leaders like yourself, and so it’s a very large responsibility. And then according to our legislation, we are to make grants to public and private nonprofit institutions of higher learning. And so you’re probably asking yourself at this time, “Well, what do these DRTE bottom feeders have to do with me as an MCH Director?” Well, I think in training the answer is, it’s really three-fold: one, we do make large investments in universities throughout the country in training that next generation of leaders, so it’s very important as we head in new directions, and we are in the process right now in strategic planning, of getting input from our partners, the Title V folk like yourself, and we have sent out some strategic planning drafts to you and we will be sending out new drafts shortly to get your input because we need this as we go forward in trying to give you the kind of leaders and the kind of people that you need at the community level and at the state level to carry forth your work. Right now, with our $36.7 million, we are funding 11 categories of long-term training, mostly interdisciplinary, and five categories of short term, or continuing education training, and there are 77 universities we are currently funding, 39 states and two jurisdictions. Our largest investments are with the Lend program which are interdisciplinary training programs for treating in an interdisciplinary fashion children with a neurodevelopmental disabilities. We make large investments in schools of public health training and adolescent health training, again, interdisciplinary and pediatric pulmonary centers, again, interdisciplinary training, and then we’re making substantial investments in distance learning. This is where our training sites are and I’m sure the states that are kind of in the trough along the Rocky Mountains are saying, “Well, where are my training programs?” As we’ve looked back over the years, we have major concerns for some of our frontier areas, some of our rocky mountain areas, some of our areas in the pacific that we want to make sure that we reach, and so recently, as part of looking at our investments and some strategic planning changes, we’ve recently made some investments in public health training at the certificate level to train right at the front tiers and in the small communities where public health trained people are hard to find, and these are people that for various reasons, some might be financial, some may be family reasons, some may be cultural, some may be that they needed to continue to work at their state or community jobs, maybe they were originally trained as nurses, but did not have public health training or trained as other health professionals and now need strong public health training to carry on their work. We have two pilot certificate programs; one is a consortium now serving the rocky mountain area and we have another in Hawaii serving the Pacific Basin, and in next year’s preview hope to expand that into other hard to reach areas to give people on the front lines of public health and MCH some good public health training. You could receive a certificate from this program or you can go on and get a Masters in Public Health for those that choose to do so. In out strategic planning we have about six goals that we’re working on and this is where we really need your input. We want to produce a knowledgeable workforce that have the right skills and attitudes to work with the MCH population. We want to make sure we have a diverse and culturally competent workforce. We want to develop effective MCH leaders. We want to be able to better translate and generate new knowledge in MCH. And we want to increase our national support in investments for training of our MCH leaders and professionals. And particularly we’re very interested in advancing interdisciplinary in a collaborative approach. The next large investment with SPRANS dollars we have at the bottom in infrastructure is our research program, which has a very long, proud history. Again, these are to support applied research relating to Maternal and Child Health services that have potential to improve healthcare services and delivery to the MCH population. Once again, we are in the process of setting new priorities for the next five years, and recently you did receive a draft of sort of new priorities, the directions that we think the research program should go in. We do not have large research dollars like some of the research institutes, our dollars are small, and I think we’ve gotten good advice from Title V people in particular that we need to really hone and focus our research efforts into the kind of research that can support our mission and support our strategic plan for the Bureau and really support our Title V colleagues. And I really ask you to look very carefully at the draft that was sent to all Title V programs throughout the state and give us your strong input. We’re trying to head in a new direction where we will be giving a priority in research funding to some of that more difficult, messy, if you like, public health research that needs to be done, that has to be done with all the issues and problems that states are facing. So we’re going to be looking at some of the more community infrastructure systems kinds of questions, again around quality, around disparity, about building and healthy development, pretty much in line with our Bureau of Strategic Planning, so we really would like your input because the research program is really meant to generate new knowledge in ways of doing business that will help you at the state level, and while I think we’ve made some very stellar investments and have a long, proud history, I still think we can do a much better job of targeting and shaping our research to be better partners with you. Again, these can go to public and nonprofit organizations of higher education and learning as well as public and private agencies, and so states can also be recipients and partners in the research grants. Again, most of our programs are extramural, but we’re making some fairly large infrastructure investments on research networks. We have one with the pediatric research in the office setting, the PROS network. We have a network with the American College of Gynecologists, a smaller network, the CARN network, and we have a very large network, the PCARN network which is looking at emergency medical services kinds of issues across the nation. As you’re aware, many of the emergency medical service research questions happen sporadically in small numbers and this is an attempt of getting numbers of nodes and sites together to be asking some of the same research questions so that we could get the volumes and the number to answer some of these very difficult questions, and this is a collaboration between our division and the DCAFH EMSC program. And we’ve also recently made some new investments in the next generation of researchers and investigators as well. Again they’re applied, they’re multidisciplinary in focus, and in the past they’ve been uniquely focused on a lot of health disparity questions as well as reaching out for vulnerable populations. The budget’s about $10 million and we are unique in the sense that we have a secretarial appointed research committee and they’re reviewed very much in the NIH process. And these are some of the examples of some of the kinds of research in the past we have focused on. Again, some are more infrastructure in nature, like health insurance coverage for special needs children. Others have been more specific as like reducing barriers to care for vulnerable children with asthma. We also, in our division, fund the Healthy Tomorrows Partnership for Children’s Program, which is a collaborative project between the Bureau, HRSA, and the American Academy of Pediatrics, and these are small seed projects to engage communities to work towards better children’s health prevention and access primarily. They cross the board in terms of topics that communities choose to work on. These are important to you because you also are eligible for these and the expectation for these small seed grants are that communities work with state Title V partners. They’re $50,000 a year to work on a specific problem or issue within the community, they require a match in years two through five, and the thought is that after the fifth year, when the federal dollars dry up, with the local match that they should be sustainable. We have looked over the years at many of these projects to look at sustainability through a major evaluation and have found that about 70 percent of these projects are sustainable under this Healthy Tomorrows model. Some of the topics vary greatly, everything from mental health issues to playground safety issues to oral health issues to adolescent teen prevention to literacy to child abuse and neglect. And in the next cycle for the preview we have some targeted issues that fit the HRSA targeted issues of mental health, oral health, and telemedicine. Again, this is to express that under the major evaluation we found this to be a very excellent investment with Healthy Tomorrow as being able to leverage many millions of dollars worth of other funds and 70 percent of them being sustainable. Finally, last but not least, the Bright Futures project is a health supervision guidelines project that has been going on in the Bureau for over a decade now. DRTE is the home of Bright Futures for Infants, Children and Adolescents, to distinguish it from the Bright Futures Women’s Health Project in Debbie Maiese’s office. It is a vision, a philosophy, a set of expert guidelines and approaches. There have been numbers of products and spin off and subsequence guidelines around oral health, nutrition, physical activity, more recently, the mental health guide which has been very, very well received. The grantee that is now handling the Bright Futures Initiative for the agency is the American Academy of Pediatrics, and there is a Bright Futures website which is brightfuturesaap.org and there’s another Bright Futures website which is brightfutures.org, and both of those websites will have the version of the main guidelines as well as some of the subsequent spin off guidelines. Last but not least, these are our phone numbers. If you have any questions, please give myself a call at 301-443-2340, or the training branch at 443-2190, or the research branch at 443-2207. Healthy Tomorrows and Bright Futures can be reached also at my number. One of the things that I didn’t mention within our training projects spread throughout the United States that within their grants they are required to provide continuing education as well as provide technical assistance to states and Title V folks. So if you’re not familiar with the training programs within your state, it’s a wonderful opportunity for you to become familiar with them and if we need to serve as, I’m not sure what the--not the enforcer, but to help grease that relationship we would be very, very happy to do that for you and please give my office a call. Laura Kavanagh and we can make you very familiar with the programs and the resources that are in your state or your region and maybe help you find some opportunities to work more effectively with them. Thank you very much, and if you have any questions I think we still have about two or three minutes. Yes?

Unidentified Speaker: There’s a bullet on your slide about minorities, the MCH Minority Initiative. What was that?

Ann Drum: Yeah. In our research projects under a number of initiatives in this year’s preview, and I kind of raced through it because there seems to be some question of which projects are going to be able to stay in the preview because of the budget because the President’s budget, unfortunately, is a little different than what may happen in Congress, and this was a new initiative that we put fort, hoping that we will be able to receive some of the President’s budget. So that’s still all up in the air, but if it manages to stay in because the budget seems good, this is a project to really address the fact that with the changing demographics in the U.S., many in the field feel there is a strong need to build some of the infrastructure to support minority researchers and this was an attempt, a pilot program to try to do some infrastructure supporting in minority serving institutions to strengthen their ability, not only trainees but also faculty and also environment to help us produce a strong next generation of researchers that are more diverse and that could perhaps better serve diverse communities. And we’re very hopeful that that is going to remain and I kind of brushed through it because I wasn’t sure what’s going to happen with that, but we’re very hopeful that we’re going to be able to have that in the fiscal year ’04 budget and it’s kind of a new pilot project if it remains. Thank you for that question.

Unidentified Speaker: The Bright Futures materials are all of really excellent quality and cutting edge (inaudible). Do you know who’s adopting these, who’s using them and who (inaudible)?

Ann Drum: Yes. That’s a very big answer. We just recently, and we haven’t really made it available for publication because it’s still in the draft form, but we just are about to have completed and reported out a major evaluation of Bright Futures and in it we ask that very same question, who is using Bright Futures and in what ways? And the answer is that it’s being used in many, many different ways and some quite unexpected. Our main interests were is it being used in clinical settings and in managed care settings in various ways? Is it being used in educational settings, residency training settings, etcetera? And also is it being used at the state and community level in terms of setting policy? And the answer to all three of those questions is yes, yes, and yes, it is being used. In some areas much more than ever conceived, in other areas less desirable, but it has been used in many ways and many innovative ways and we’ll be reporting out on that soon. But there are many, many numerous examples. I think what surprised many of us, it certainly has been picked up very strongly in the educational community, particularly in nursing. I think it was like 100 percent of pediatric nurse practitioner programs used Bright Futures in their curriculum and that was an astonishing fact, and has been picked up pretty readily in pediatric training programs and less so in other programs. In terms of states, it’s been used in all kinds of ways. Some of the more aggressive states in using Bright Futures have been Virginia, Massachusetts, Washington State, but it’s been used in many ways beyond what we expected it to be used and with many different disciplines, and I’d be happy to share that in much more detail because it’s quite an exhaustive list, but thank you for the question. I think with Bright Futures looking in the next generation and it’s always hindsight is a wonderful thing, but some of the things that we’re going to work real hard to improve with Bright Futures is, one, being more comprehensive in terms of reaching into the children with special healthcare needs piece that we’ve touched on but didn’t do a thorough job with to try and to make sure that everything is very well documented so that the evidence base component of it is strongly written throughout the document, and the third is to try to maintain and keep that very strong interdisciplinary and multidisciplinary focus that we think is a real strength of Bright Futures in terms of bringing partner and ownership along. Any others? Thank you.