HRSA/MCHB 2005 FEDERAL/STATE PARTNERSHIP MEETING

PUBLIC HEALTH ACROSS THE LIFESPAN

Luncheon Awards Ceremony and Awards

PETER VAN DYCK: Good afternoon. I love to hear the --- it’s more than a buzz in the room, it’s kind of a roar or undercurrent, but it just attests to the fact that you’re getting to know one another better and sharing ideas and it’s wonderful to hear. In some ways I hate to quiet it down, but we need to move on with the program. I’m glad you enjoyed your lunch. This is the awards luncheon, which we have every year at the partnership meeting and this year we’re particularly pleased to have our leader, Dr. Betty Duke, join us for the awards luncheon.

As you know, Dr. Duke was named Administrator for HRSA in March 2002 after serving about a year as the Acting Administrator. You know that HRSA is one of 11 operating divisions in the Department of Health and Human Services and has a budget of around seven, seven plus billion dollars to expand health care, and in our talks on Sunday, you saw some of that organizational structure. Before coming to HRSA, Betty served as the Deputy Assistant’s Secretary for Administration in another departmental operating division, the Administration for Children and Families (ACF), and in that post she was in charge of grants policy, financial management, internal and state’s systems human resources and administrative functions. I’m not quite sure what else is left. She was in charge of just about everything and she’s had more than 12 years experience as both Acting Assistant Secretary and Principle Deputy in the department’s office of the Assistant Secretary for Management and Budget.

In that role, she served as the department’s Chief Financial Officer, Management Control Officer and CIO or Chief Information Officer. Since taking the lead job in HRSA, Dr. Duke has distributed workloads more equitably among HRSA’s bureaus and offices, improved the grant making process, streamlined internal communications and legislative roles among many other things. She earned her Doctorate in political science from George Washington University and she stays connected with the academic community and with programs by teaching political science and American government courses in Washington area universities and by mentoring graduate students.

She recently spent two weeks, maybe three weeks, at the Humphrey Building providing many innovative and creative ideas and responses to the department, regarding HRSA’s programs secreted away, for working on Katrina and Rita and I think served HRSA well and clearly made suggested ideas and innovative responses that improved the health and wellbeing of people affected by Katrina as well. She’s well aware and supportive of our MCH partnership activities and of the services you bring to the nations’ mothers, children and families and has visited a number of our programs around the nation and knows them well. Betty, it’s a real pleasure to have you here at our awards luncheon; welcome.

ELIZABETH DUKE: Thank you very much, Peter. He’s taller than I am; most people are. I am just delighted to be here with you. This is a rare privilege. I said to Peter, you know, this is the way we have lunch every day at HRSA. The HRSA linens, the HRSA crystal and the HRSA silver settings; I just want you to know that. So thank you for keeping us at home. It is really lovely and I just said to Peter, it’s so nice to have an opportunity to be a human being at lunch. Usually, my colleagues and I are sitting around a table, because as Peter pointed out to you, we’d never eat lunch at our desks. We usually have our salad and about eight barrel loads of paper and we work through lunch so this is a real privilege and pleasure to have lunch, but also to have lunch with you. So, thank you for allowing us to come.

My colleague, Dennis Williams, talked with you yesterday morning a little bit about what HRSA is and how we operate and so I thought today I might pick up on the theme that Peter talked about which is the real focus of our last few weeks has been around dealing with the reality of disaster in America. You know, we always knew the power of hurricanes. I grew up in New Jersey and I grew up at sort of the waistline of New Jersey if you know that state, and so I was only about 40 miles from the coastline and as a very little girl I remember a hurricane coming. I remember the ferocity of the wind. I remember it very clearly and as Peter is fond of saying, that was more than a decade ago. Well, there I was as a little girl. I went down to help a friend’s mother who owned a house at the beach. I had spent some time with her at the beach that summer and so I knew that there were houses up at the end of the street and when we walked up to the end of the street after the hurricane, there weren’t any houses at the end of the street. I do remember very vividly that there was one post and a set of steps, so I remember a hurricane from when I was a little girl and we don’t get that vicious kind of hurricane in New Jersey that we got in our Gulf States recently.

So I thought I’d talk a little bit with you about what we, as the Department of Health and Human Services, and particularly what HRSA did in that period of time. Basically, the hurricane in New Orleans destroyed the HRSA presence in New Orleans. We had, for example, eight health centers in New Orleans. All eight of them were destroyed, totally, 100% gone. It also destroyed our entire delivery system for our Ryan White CARE Act, the HIV/AIDS program and a lot of the people that you saw wading in that chest high water in those devastating days trying to get to the Superdome or the Convention Center, many of those were our clients because HRSA really exists to make sure that people who would not have health care otherwise, get health care. So we had a deep commitment to continuing care along the Mississippi coast, along the Louisiana coast and that was an absolute commitment. We also had some services in Alabama as well.

Well, what we did was we did a division of labor in HRSA. We were coming up on the end of the fiscal year and you all know what the end of the fiscal year is. Well, we made some decisions a few years ago, which really held us in good stead. One of the things we had done was to do a full stop, new paragraph, we’ve got a huge program and we’ve got to manage this program across the full fiscal year and you know it wasn’t easy making those changes along the way that brought us so that we distributed our grants across the whole fiscal year and we really worked hard at it and it was a change. All I can say is we didn’t know how desperately we needed to make that change until this year, but we went through the end of the fiscal year without dropping a stitch because we had spread our work across the full fiscal year and we weren’t hitting the end of the fiscal year crunch the way we had done in a lot of programs in the federal government in previous lives. So Steve Smith, the Senior Advisor who’s with me today, stayed in the Park Lawn building, and worked with Peter and the other map parts of management team, and kept the train on track. Dennis Williams, whom you met yesterday, and I, left our quarters in Park Lawn and went down to our swing space in the Humphrey Building, which is the main headquarters of the Department of Health and Human Services.

Now, you might think that that would be really an elegant abode; actually, it’s two rooms without windows. So for close to four straight weeks, and I do mean straight weeks because there were no such things as weekends, Dennis and I, with a group of HRSA fellow sufferers, went to the swing space, the room without windows, and tried to work with our programs, with our grantees and with the rest of the department, to help. Anytime we felt like complaining, we really couldn’t complain because we would look at the purpose of our being there and we had nothing to complain about, so we felt we were very fortunate and well served, again, by a decision we had made earlier.

A few years earlier I had wanted to have the capacity to map the HRSA grantees. I wanted to know where you all were and they all chuckled at me because I’m a schoolmarm at heart as Peter told you, and I said to my IT team one afternoon, you know, I want to have a map that has all the HRSA grantees on it and I said, you know, the way we used to do things like that is you had an overhead projector, and I bet there’s some people in my generation in this group. You remember those. You’d put the one piece on and then you’d lay the next factor and the next factor and the next factor and soon, you had a picture of the whole universe. So I looked at them and I said I know there’s got to be an electronic way to do that and I want it. I’m a redhead under the bleach and so when I say things, I say things with a fair amount of passion and so we set off to make this capacity. It’s called a geospatial warehouse and mapping capacity and what we did is we dumped a whole lot of data about our programs into a program that would allow us to bring together information that might, in another setting, not be able to be brought together.

So, we have this capacity and I know last year, the IT staff came to your All Grantee meeting and showed you this wonderful capacity and if you want to use that capacity, it is on our web site. We’ve made it available to the whole world because we just think it’s great. Anytime I go traveling, we take with us a map and you push the button and a lot of other data will come up behind the map and we just think it’s terrific. You cannot imagine how tickled we were to have that capacity in this storm because what we did is we would input new data into the system we had, such as which counties had been declared emergencies, and then we could push that in and then we could paint out a picture that would show the state of Louisiana. It would show where our grantees were. It would show, because we color coded it, which ones were destroyed, which ones were closed but could be repaired and which ones were open. It was just a boon to us and so we actually were benefited by some decisions we’d made for totally different purposes.

As soon as the hurricane hit we set about trying to find out how everybody was and that wasn’t easy. Trying to find out those that were open, those that were closed and those that were destroyed became a real challenge. We ultimately got all the data, but remember, phones were down, areas were closed off and it was particularly challenging. Well, that led us to think about, we’d better start thinking about the ring areas around the disaster because they were the ones who were going to be receiving the evacuees and would need to have service support in order to take care of those with whom they would now have a responsibility.

So, we began drawing information about their capacity and their needs. What kind of influx were they facing and how could we be helpful in that? A second thing that we did in HRSA was we made available the Commission Corps officers who are part of our personnel. In HRSA, we have 1,726 people; that’s an absolute fact. We know exactly how many we have. We used to say about 2000. Well, we’ve shrunk, but we’re at 1,726. Of those, 459 are Commission Corps officers who are supposed to be ready to deploy in any national or regional emergency. So, my view was that’s their role and the rest of us will simply have to step up and fill in behind, and so I can report that as of this moment, over 250 of our Commission Corps officers have deployed from anywhere from a weekend to 30 days, or in some cases, well beyond 30 days now. We had people actually on the ground before the hurricane hit. So, we are very proud of our Commission Corps officers who rose to the occasion.

One of our nurses from the Bureau of Health Professions actually set up the hospital in Baton Rouge, which was the first point to receive a major influx of evacuees in New Orleans. One of our doctors set up the hospital in Meridian, Mississippi. That particular doctor was activated to set up the hospital in Meridian. He was there for over 30 days. He came back and was back for less than two weeks and he’s been activated again and this time for six months. So, HRSA has given at the office. We have talent and it’s our job to find ways to share that talent. We also have a social worker from our Bureau of Health Professions again, who went to San Antonio to help get things set up and running. The next thing he knew, he was running a major shelter for the second wave of evacuees when Houston had to be evacuated in order to deal with the next hurricane, Hurricane Rita. So, he found himself running a major logistical operation. One of the things we had to do was look at our own policies and see where we had control of those policies and where we could use discretion and flexibility.

The Secretary asked us, could we get grants available to a group of health centers who had been selected to receive health center grants, but whose actual awards were not to be distributed until December 1. With tremendous teamwork from the entire organization, we found a way, legally, to do that, but more important, we had to find the money. So it was a major effort, but on September 9, the Secretary was able to announce that we were pre-funding our 26 health centers in the disaster area and in the ring, in order to allow them to be a service in this disaster and I was very proud of that.

Another thing that we did was we expedited the processing of National Health Service Corps Scholars and loan re-payers with the idea that if they wanted to serve in the disaster impacted areas, we would expedite their placement more quickly and so we were able to get some practitioners into service very soon. We also expedited the process for designating health profession shortage areas, which is a crucial step in allowing folks to go in and help and we turned those applications around in 48 hours. They say feds can’t move fast; well, we did. The other thing we had to do, and this one is really the most cumbersome of all of the things we had to do, was people wanted to volunteer. They wanted to help, so we found, for example, people from our programs outside the area wanted to go to help in the impacted area. For example, our health centers wanted to go, because they say we know the health center population. We know the processes and procedures and we would be able to help and we thought that was a great idea.

However, you know that little thing called insurance. How do you get the insurance, the malpractice insurance, to go with our practitioners from one state to another? Our lawyers said you can’t do that because it doesn’t go with the person, it goes with the site. So, then we had to put our heads together and come up with there’s got to be a way, and there was. What we did was we made it possible for folks who wanted to go and volunteer to become what’s called an “Intermediate Federal Employee” and so we swore them in as federal employees for the time that they were actually serving. That gave them tort coverage from the government and allowed them to serve and we did a number of those, believe it or not, swearing in ceremonies on the site. So, we tried very hard to live down the idea that bureaucrats are inflexible and that bureaucrats are slow. We tried to be speedy and very flexible.

So, what did that bring to the American people? Well, our health centers, in 33 different states have made themselves available to serve over 50,000 evacuees. A lot of them were in Texas and a lot of them were in Louisiana, but they were in 33 states of the union, including Alaska. I actually was at another meeting and I met some folks I knew from Alaska and I said I don’t imagine you got any evacuees? Oh, yes we do! Oh, yes we do! We have evacuees. Even in Alaska -- so our health centers have been really tremendously helpful.

Our Maternal Child and Health grantees in 18 states and Puerto Rico have served over 25,000 hurricane affected individuals. Our Healthy Start grantees in nine states have treated almost 40,000 people. So, I just simply want you to know that our programs really were stretched and some of you were part of that stretch and for that we thank you very much because that was a tremendous service and very, very important.

Our Healthy Start grantee in Laredo took their mobile van and drove it to Baton Rouge where they helped the Red Cross provide services to evacuees there because Baton Rouge was really inundated. That city has really doubled in size since Katrina. I mean, just think about it, if you can, think of your town doubling in size over a period of a week. We had another Healthy Start mobile unit that went from San Antonio to Biloxi and there, was on duty 18 hours a day, seven days a week, serving over 1,000 individuals daily. Just to give you some sense of the enormity of our contribution. Our grantees in our Ryan White CARE Act, 15 states received evacuees in that program and that totaled over 1,500 individuals. Now, this was particularly challenging because the interruption in the pharmaceutical program could have really life threatening implications for the individuals involved and so our goal was to get the maximum flexibility possible and we really made just incredibly dramatic innovations. We did emergency enrollments in programs as people came from Louisiana to Texas. Texas just stepped up big time. I mean, Texas has a reputation for being big and big-hearted. Well, Texas really was big and big-hearted. They really bent over backwards to be helpful. They did emergency enrollments in their program. We wrote prescriptions. We honored prescriptions written elsewhere. We worked with the pharmaceutical companies to get donated medications and we felt that it was really one of the federal government’s sterling moments.

I think our grantees did heroic work. The evacuees really arrived with nothing. I mean, just think of it, just think of it; think of your own life. One of my dear friends -- I hadn’t known her very well, but I got to know her very well -- and one of the things she said to me at one point early in our friendship was well, I actually can’t get too hung up about whatever the situation was at the time. I thought, gee, that’s unusual, most people get hung up about situations like that and she said, you know, my house burned down when I was about 30 and everything I had from my mother and dad and everything I had from my children just was gone and I just had to realize that life goes on and you can’t tie yourself to those really material things and I learned a lot from that friend as you can tell.

Well, that’s what we also learned from our evacuees. They arrived without anything. No jobs, no houses, no cars, their lives really in shreds and their health care at great risk because we didn’t know what medications they were on. Sometimes, they didn’t know what medications they were on. So, we really had to be very, very creative and one of the very creative things that happened was the Health Information Technology office that is housed in the Department of Health and Human Services, but really is the President’s initiative, worked with the private sector, and with the Department of Justice to make sure it was legal and with a lot of protections to make sure we didn’t violate people’s privacy, but they worked with the drug stores to see if we could get the prescription records for some of our evacuees so that we would know what they were taking and that was a tremendous step forward. It was a small pilot, but it shows the creativity and the real partnerships that we developed and it all pointed to the fact that America ’s health care system that operates with a paper system is really antiquated. It took nothing more than one disaster to drive home the fact that the paper system was going to leave us high and dry. And so, we are pursuing with renewed vigor and renewed commitment, the President’s goal of basically having us on an inter-operable electronic medical records system within 10 years.

Our Secretary is absolutely devoted to this idea and just last week he announced that we would have an American health information community which would be made up of 16 commissioners and their goal is to help us achieve that paperless system so that when we face emergencies in the future, we will have more records that will make it better for people who are affected by the system. We believe that we can do that. We believe we can do it with adequate protections for privacy. We believe that it will eliminate or greatly reduce medical errors, can improve the quality of health care, lower costs, eliminate the paperwork hassle and make first responders able to respond in a disaster better than we were able to this time when we jury-rigged the system. Let’s face it, though, it was a tough slog, and right in the middle of a disaster.

One of the strategies the Secretary has come up with to help implement this 10 year strategy is that the federal agencies who pay a little over a third of all health care costs in the country, when you think of Medicare, Medicaid, SCHIP, you go put all those together have a leadership potential in working with the private providers and with the private insurance companies with the goal of developing an architecture and standards and certification processes, as well as a way of governing our information technology resources. Once we have that system in place then the whole market system will take it and move it as patients and providers and vendors can then improve what we’ve begun.

This is a very important step. Katrina drove home that when we’re dependent on paper records, we are going to be in the dark and so we are aware, and I think have renewed commitment to that. So, at HRSA one of the things we’ve done, and actually had done before Katrina, is we’ve named a head of HRSA’s Health Information Technology office and we are pulling together the pieces of HRSA’s Health Information Technology to see if we can’t do a better job of working with you to provide a better service to this country. You’ll probably be hearing the name Cheryl Austein Casnoff who is our new head of HRSA’s Office of Information Technology.

We believe that what you as grantees, and we, as federal sponsors of some of your programs have done over the last six weeks has been fairly remarkable. You know, we tend to focus on sort of the tough stuff and we are focusing on the tough stuff, because right now we’re taking a very heavy look, what I call “The Lessons Learned.” We actually started that on the first day. I said to my executive secretary, I said at least for now I want you to be taking down notes about what we’re doing and notes about what foul-ups we have and I don’t care who did it; that’s not the issue. I want to know what the foul-up was and I want to know how we fixed it and if we didn’t fix it, why didn’t we fix it, so that we can do a better job next time, because you know, there will be a next time. It may not be a hurricane but we really need to be prepared for whatever nature or other human beings can throw at us. We have to be ready and so we’ve been working on that.

So, as things have been calming down a little bit I actually had a weekend off. Do you know how good it is to go to the grocery store? It felt good. I hate to grocery shop, but it felt good to go to the grocery store. I was actually tired of living out of my freezer. I don’t know about you but every time I cook something and I have too much, I put it in the freezer. Well, you know, those leftovers from the freezer can get real boring. Well, that’s sort of the mindset. We’ve actually begun to see a little more order coming into light, so now we’ve taken a step back and I’ve asked Lyman Van Nostrand, who heads our Office of Planning and Evaluation, to take over and really do a thorough job working with those notes and with things that the management team have put together that said, this worked and that didn’t; this was fouled up, this was terrific. We’re putting that together to see what lessons we can learn and what changes we need to make or changes that we can feed into the department and into the government as a whole.

Another thing that we’ve done is we’ve asked another one of our staffers to assume the full time leadership of our emergency operations. We had the most incredible group of volunteers who have managed an emergency operation center on a volunteer basis. Ann Drum was the saint who led it for a chunk of the time and that’s tough work. We set up our center working 24 hours a day in the first part. We dropped back to 7 a.m. to 11 p.m. after a week or so. We dropped back then to 7 a.m. to 7 p.m. You get the picture. The folks who were there were just incredible. They got there early. They worked hard and they were absolutely essential to our success, but we had our Continuing Operations program, which was the program that has to do with what would we do if something happened to drive down our own capacity, were something to happen that our building didn’t operate anymore. So we had that in one place. We had the Emergency Operations in another place. We had our Hospital Preparedness for All Hazards preparation in a third place and in a fourth place we had our Curriculum Development for Health Professionals.

That worked just fine when you didn’t have an emergency. When you had an emergency what happened was the integration of all that came together at the top, which added additional stress for Dennis and Steve and me because it was all sort of coming in at this level and that is not good management. It worked fine when we were dealing with intermittent problems but when we had a long-term problem; we said we’ve got to manage that. So, we’ve now set up an Emergency Operations Group under Tim Miller who is one of our stalwarts and he’s pulling that together so that the next time we have to face a major emergency, we will have a synergy that can come out of having collocated those programs. So, we’ve already started making some repairs, even before the report of opportunities for change has come about.

Well, that’s sort of my attempt at giving you a report on a part of our operation that involved you through Peter and through Peter’s wonderful staff, and very much involved you out in the field, particularly if you were in an impacted state or in a ring state. I wanted to share that with you because I think what it says is human beings can do great things. They can be really compassionate. They can deliver tremendous care for each other under difficult circumstances and I hope you take as much pride in what we’ve accomplished and I hope that you have as much hope as I have that the future can be a better one. So, thank you very much for letting me come today. I appreciate being here.

PETER C. VAN DYCK: Thank you Betty, so much and it’s wonderful that you’re going to be able to stay and hear about some of these wonderful activities and people that we’re giving awards to and to share in this celebration of some wonderful people and wonderful peoples’ activities. This is the awards luncheon as I said before and I would like to begin with the Directors’ Awards. The Directors’ Award are presented to an individual for noteworthy contributions made to the health of infants, mothers, children, adolescents and children with special health care needs in the nation. Nominations for this award can be made by anybody, in or out of the MCH program sphere. If you’ll just wait to come up and let me read a little bit about you first and then you’re all close so you can walk up towards the end.

The first awardee for the Director’s Award is Claire Brindis. Claire is Professor of Pediatrics and Health Policy in the Department of Pediatrics, the Division of Adolescent Medicine, the Department of OB/Gyne and Reproductive Health Sciences at the University of California in San Francisco. She is Executive Director of the National Adolescent Health Information Center and Associate Director of the Policy Information and Analysis Center for Middle Childhood and Adolescence. Both organizations are sponsored by the Division of Adolescent Medicine and the Institute for Health Policy Studies and funded in large part by the Maternal Child and Health Bureau, HRSA. Dr. Brindis exemplifies the spirit of collaboration between local, regional and national public, private, professional, community and university groups throughout the country.

Claire has created unique and valuable perspectives on promoting positive policies to enhance the health of middle childhood and adolescence in the United States. Her research on adolescent and child health policy, her synthesis of important aspects of public health, her extensive writings, teachings and trainings, her state and national visibility along with her leadership in national projects such as the Federal National Initiative to Improve Adolescent Health, all speak to her tremendous influence on the field. She’s working closely with the Bureau, with CDC and over 30 national organizations to promote the health of adolescents and young adults. Under this initiative she has recently co-authored a monograph on implementing the Healthy People 2010, Adolescent Health Objectives with the CDC and the Federal Bureau of Maternal and Child Health. Improving Adolescent Health, A Guidebook for States and Communities is now available.

Her personal interests in Latino health are also reflected in her recent monograph, A Future with Promise: A Chart Book on Latino Adolescent Reproductive Health. She’s been an ardent promoter of youth development and building on the assets of youth in the United States. We take particular pride in the Bureau because we invested early on, and as Betty would now say a little more than a decade ago, in her training, both as for her Masters in Public Health and as a Doctor of Public Health student. Finally, Dr. Brindis is actively working towards assuring, and I’m told this on good authority, that an “A” will one day be included as part of the MCHB logo. I assume that means Maternal Child Adolescent Health Bureau.

Claire, we’re really pleased to be able to offer you this award. She gets one of these wonderful MCHB pyramids and it says “Directors Award presented to Claire Brindis, Doctor of Public Health, in recognition of contribution made to the health of infants, mothers, children, adolescents and children with special health care needs in the nation 2005.”

CLAIRE BRINDIS: Thank you Peter. I will be very brief, but I want to say I am very humble about accepting this award. I really represent an incredible network of very dedicated individuals across the country who are committed to advancing Adolescent Health, the Health of Young Adults and Middle Childhood, and I compel you that if you are taking care of pregnant moms or young children or children with special needs, to make linkages with those individuals in your states that are working on adolescent health, particularly the state adolescent health coordinators.

I could stand here for the rest of the afternoon thanking all the people who have contributed to this award but I do want to point out a couple of individuals and that is *Trina England who is the Director of the Office of Adolescent Health whose vision has really helped to fuel my work and I am very much in her debt as well as Dr. Steinberg who is the Maternal Child and Adolescent Health Coordinator in our state of California who has wonderful staff and who we work with very closely, and finally I want to thank Dr. van Dyck for this affirmation of the work that we are so involved in. Thank you.

PETER VAN DYCK: William Carl Cooley is Medical Director of the Crotchett Mountain Foundation Rehabilitation Center, Co-Director of the Center for Medical Home Improvement in Greenfield, New Hampshire and Associate Professor of Pediatrics at Dartmouth Medical School. Carl received his M.D. degree from the University of Pennsylvania, 1973 and his pediatric residency at the University of Michigan in 1976. As a Developmental Pediatrician, Dr. Cooley is interested in Down’s syndrome, autism, family resilience and adaptation to having a Child with Special Needs. In 2001, he was named New Hampshire Pediatrician of the Year. He is married and the father of three children, including a 21-year-old daughter with Down’s syndrome who lives in Concord, New Hampshire with his family.

Over the years, Dr. Cooley has forged a formidable relationship with HRSA and the Maternal Child and Health Bureau. He participated in the U.S. Public Health Service Senior Co-Step program during medical school and served two years as lieutenant commander in the National Health Service Corps in rural New Hampshire. He received the United States Public Health Service Award for “exceptional meritorious service” in 1978 and as a grantee he’s been a principal investigator on at least four HRSA/MCHB integrated services grants. National professional organizations are also aware of Dr. Cooley’s intrinsic capacity for partnership. He serves on the American Academy of Pediatrics Medical Home Initiatives Program advisory committee as well as a raft of other committees for the Academy.

In linking his state and federal Title V interests, Carl established the Center for Medical Home Improvement in New Hampshire, which has developed many helpful materials that are used by Title V programs across the nation; programs to guide families and professionals to enhance chronic disease management through quality health care measures in primary care settings. One example of these efforts includes the development of a widely adopted quality improvement methodology for primary care practices to help implement the medical home model in which primary care improvement teams include a physician, an office based care coordinator and parents of children with special needs. He’s also created and standardized a quality improvement instrument called the Medical Home Index to measure the medical “homeness” of individual practices. This has been used and accepted widely across the United States and, in fact, in other countries as the gold standard for assessing medical homes in primary care pediatric practices.

Dr. Cooley is a highly skilled developmental pediatrician with outstanding academic and leadership abilities who has advanced the medical home concept across the Unites States with his creative and innovative strategies in promoting quality of health care for children with special health care needs. Carl, I am really honored to present this Director’s Award to you.

DR. WILLIAM CARL COOLEY: You know, everyone’s probably wanting to get on with the afternoon and I just want to mention that the work that I’ve been involved with improving care for children with special health care needs is really entirely about relationships and it’s about relationships with many of you in this room, which I value highly and feel that you should all be up here with me. It’s relationships with families much like my own and it’s relationships with the enormous breadth of primary care providers and practitioners across the country who really do want to provide better care and I think are beginning to welcome a model like Medical Home in order to do so, so I thank all of them. I can’t leave the podium without thanking my colleague and partner, Jean McAllister. Many of you are probably scratching your heads and wondering why it isn’t Jean that’s up here instead of me, but she has really been instrumental in making the work we do happen, so thank you very much.

PETER VAN DYCK: Jana Monaco has worked tirelessly to raise awareness of newborn screening both in her state of Virginia and nationally. She is on the Board of Directors of the Organic Acidemia Association. She has appeared before a Congressional Subcommittee hearing on newborn screening. Ms.  Monaco testified before two House Subcommittees of the Virginia General Assembly as well as having spoken at the Virginia Genetics Advisory Committee and Northern Virginia Pediatrics Society meeting. She received a commendation from the Prince William County Board of Supervisors for her efforts to pass the Virginia legislation, which expanded newborn screening from nine to 30 disorders.

Jana and her husband also are recognized by the Prince William County Disability Services Board for advocating for the passage of Virginia House Bill No. 1824 for newborn screening. She is a member of the Advisory Committee on Heritable Disorders and Genetic Diseases in Newborns and Children Subcommittee on Laboratory Standards and Procedures. Mrs. Monaco also is working with the Bureau’s LEND program at Children’s National Medical Center and serves on the Advisory Committee of the New York Mid-Atlantic Collaborative.

When you speak with Jana about her work, she considers herself first a mother of four children. She entered the world of newborn screening because her son Stephen, who is with her here today, and her daughter Caroline, both children, were diagnosed with isovaleric acidemia, a metabolic disorder that can be detected through newborn screening. Stephen was not detected because the state of Virginia was not screening for this disorder when he was born. Stephen suffered a crisis and brain damage because of the delayed diagnosis, but he has been her driving force. Jana indicates that all children should be screened early and continuously for their medical needs and has worked toward that goal for all children in this country. I’ve heard Jana testify before the Genetics Committee now several times. She’s calm, rational before the Committee, yet so passionate and committed, one can’t help but listen with respect; Jana.

JANA MONACO : Okay, I know to be brief because the Advisory Committee has trained me well. It’s an honor to be here because I’m on the receiving end of what all of you here work for with my children, but know that all that we do is truly grateful, for I am one family member who represents many across America who are doing exactly what I do. I just have the advantage of living close to D.C. and can attend all these things whether I might want to be there or not, but my commitment did come from when Stephen was diagnosed and living with the prognosis was difficult by itself, but living with the fact that it could have been prevented was, still to this day, more than what our family can swallow at times.

So, he has like Dr. van Dyck, has been my driving force to help make a change, and I was asked to attend that first meeting a little over a year ago and thought I’d have five minutes to sum up four weeks in an I.C.U., six weeks in a rehab center and three years of becoming a special needs family. So, I thought it was a one-shot deal and I’d give it my best and little did I know that I’d become a regular member of the Advisory Committee in the Subcommittee, so a regular attendee. But, on behalf of all the family members and the children like Stephen or the children that did not survive their crises, I thank you and the Advisory Committee for the work that you’ve done and Dr. Van Dyck to commit to making a change with newborn screening and bringing newborn screening to where it needs to be today. We look for a brighter future for these kids and as he said, to give everybody a chance to know that their children are going to be screened in the way that they should be. Thank you.

PETER VAN DYCK: The next citations are presented to Cassie Lauver, Director of the Division of State and Community Health and Ann Drum, Director of Research, Training and Education for their strong and steady leadership in planning and executing the first ever MCHB All Grantee Meeting last year at this time; the Power of Partnership in October of 2004. Cassie and Ann are both nominated for the Directors Award for their leadership in planning and implementing the first ever All Grantee Meeting of the MCHB partners entitled “Meeting Today’s MCH Challenges Through the Power of Partnership.”

With limited time and budget, both individuals executed this pivotal meeting of over 1,100 participants representing over 1,000 Maternal and Child Health HRSA grantees from throughout the nation. This meeting provided national leadership in working with states, communities, public and private partners and families to strengthen the MCH infrastructure. These two MCH leaders co-chaired the Planning Committee, worked with staff, partners, contractors and others to organize presentations and workshops that focused on improving MCH through the synergy of ideas. The ideas generated with our partners on the future of MCH from this important conference have resulted in modifying the Bureau’s priorities for strategic planning.

Cassie came to the Bureau in 2000 to direct the Division of State and Community Health. Previously, she directed the Bureau for Children, Youth and Families in Kansas. Cassie was President Elect of MCHIP before surrendering her post to come to work for the federal government.

Ann is a Captain in the Commission Corps and a dentist. She has also been the Director of the Division of Research, Training and Education since 2000. Previously Ann worked in the Office of the Surgeon General in region 6 and has also worked at NIH. Cassie and Ann.

I might add they’re not off the hook yet because this committee is still doing work as a result of those meetings and some of you in this room have either had a meeting already or are having one later this afternoon on following up from this meeting.

Now the Bureau also gives an award called the MCH Fellowship Award and this is an award that’s coordinated between HRSA’s Maternal and Child Health Bureau and the American Association of Schools of Public Health, and Larissa Estes is the 2005-2006 Association of Schools of Public Health Fellow in the HRSA office of Women’s Health and this year’s Bureau’s Vince L. Hutchins Fellowship recipient. A native of Portland, Oregon, Larissa received her Bachelor of Science in athletic training from Ducane University and her Masters of Public Health from the University of Arizona. While at the University of Arizona, Larissa focused her research thesis on a qualitative analysis of violent screening protocols in Oahu, Hawaii.

She was also a graduate assistant for HRSA/MCH funded grant at the University of Arizona, participated as a Public Health Student Alliance board member and Project Export, “Export” standing for excellence in partnership for community outreach research on health disparities and training. Project Export is an NIH funded fellowship program aimed to increase the number of underrepresented minority health professionals in the areas of substance abuse and diabetes. As an Export Fellow, Larissa created diabetes education materials for the Hispanic population in Tucson. In the HRSA Office of Women’s Health, Larissa provides support for the Bright Futures for Women’s Health and Wellness Initiative, coordinates the HRSA’s Women’s Health Coordinating Committee monthly meetings and activities, attends monthly department Coordinating Committee on Women’s Health and works on various violence and HIV/AIDS related projects.

Larissa, we’re pleased to have you for the next year or two as a Public Health Fellow. Please come and receive your award.

LARISSA ESTES: I’m not a big fan of podiums because I can’t really see over them, but as long as you can hear me I’d like to thank the Office of Women’s Health, Sabrina Matloff-Stepp, Dr. van Dyck and the Association of Schools of Public Health. Thank you.