HRSA/MCHB 2005 FEDERAL/STATE PARTNERSHIP MEETING

PUBLIC HEALTH ACROSS THE LIFESPAN

Division of Child, Adolescent and Family Health (DCAFH)

DAVID HEPPEL: Hi. Peter was talking about how there were new people here and some old people here. I’ve always thought of myself as a new person. But last night I went to my 40 th high school reunion. And while there was one woman there who was absolutely stunning, looked almost as pretty as my wife, Janie, there were a lot of us who can’t say that we’re new anymore. So I’m still trying to recover from that.

This division is responsible for the ordinary health needs of children. We address the needs of all children and adolescence and that’s in contrast to the speaker you’ll hear next, Bonnie Strickland, talking about Children with Special Health Needs. So between the two of us, we should pretty much cover the waterfront, I hope. I have the great honor and privilege of not having this work. Oh, there we go, of representing the 18 members of this division today. They’re divided among several units; Infant and Early Childhood Health Group, Adolescent Health Group and Emergency Medical Services for Children Group, and the Injury and Violence Prevention Group. The first two obviously are population focused while the latter two are crosscutting. Division programs are authorized through the MCH Block Grant, as you heard from Peter, and also from the Public Health Service Grant, at least the Emergency Medical Services for Children Program.

Now, you may wonder why there are numbers by these people. Part of it is that I am old and I forget and so I tell now that there are 18 people in the division. But the other reason is this slide. This is a listing of what this division does, the various programs that we have. It’s engaged in a wide variety of efforts and they focus on a multitude health and related issues and we can only skim what we’re doing today. But what’s being passed out to you is a single-page, two-sided sheet, which contains this slide and the previous slide. And between the two, you can figure out which human being is responsible or which human beings are responsible for the various programs in the division. They have their telephone numbers so you can contact us directly.

First, I want to talk about Adolescent Health. Its activities can be categorized under the following themes, and I’ll say a little bit about each. The first is the National Coordinating Committee on School Health. And it’s something that we inherited from higher up in the department. There were two committees that dealt with school health issues. One was a federal committee and the other was a non-federal committee. And this happens to be the non-federal committee. It’s made of up about 70 health, education and nutrition organizations. And while there are federal partners involved in it, it’s primarily from the private sector. And the intent of this is to improve health safety and nutrition and educational achievement as students in a coordinated fashion. It’s one of the partnership activities that we have here in MCH. The center on school-based health care is a resource center. And I guess I should say something about resource centers.

When Dr. van Dyck put up the slide about the budget, I don’t know about you, but it looked to me like a lot of money. However, in comparison to other programs, we don’t really have a lot. And when we take SPRANS and CISS and divide it up, there aren’t a lot of resources. It’s hard to do a lot of discretionary grant programs and really have any impact. And as he said, all of the discretionary programs that we’re doing this, but we’re supposed to do in service for your state programs. So in some cases, we’ll start off with a series of demonstration programs in discretionary grant programs, but very quickly we end up aggregating those dollars into places like this, like resource centers, because we can then have something that can impact all of you. It can help all of you, as opposed to the few who actually get the demonstration grants. So the school-based center is a resource center that’s designed to improve the quality of care provided by and developed the financial sustainability of school-based health centers.

Then in the area of mental health, Isadora Hare, who is the person who got stuck passing the sheet out to you, is responsible for two national centers to strengthen the ability of schools, school districts, communities and health and mental health service providers to address students’ mental health needs in the psycho-social issues through training and infrastructure development. And then lastly, this is a demonstration activity integrated health and behavioral health here, trying to do something to see if we could improve the coordination between mental health services and primary care services. This has been going on for a while. We’re entering the latter part of this program. And related to this, a newer program called the Child Health Practitioner’s Support Program, which just started this year, is also intended to try to provide resources to people in practice dealing with mental health and actually also oral health issues.

The public partnerships, partners in program planning for adolescent health, represents eight national membership professional organizations that promote Adolescent Health and paused to use development and used Healthy people 2010 framework. The membership of these organizations is a little over a million people so we’re using this to try to get information and broadly distribute it. I mentioned something about the coordinating committee on school health and safety already. And these resource cooperative agreements provide technical assistance and resource to states, communities and professionals. They analyze, review and synthesize and disseminate relevant evident-based knowledge. And they examine provision of health services and effects on public policies.

All of this comes under the national initiative to improve Adolescent Health by the year 2010. Some folks decided that while Healthy people 2010 is a nice encyclopedic document, it’s awfully large and it doesn’t allow you to focus very well on particular populations. So with that in mind, this activity was put together that identified the most important objectives in the 2010 package as they relate to Adolescent Health and is being used to develop programs to improve adolescent health.

This shifts a little bit. This is one of the programs that’s not part of Title V. This is the Emergency Medical Services for Children Program. It’s something though that we see is an important partner to the Title V program, and that the state Title V program should have a significant amount of influence over. Every state, District of Columbia and five of the territories have programs and have had programs for a number of years. There are also a number of targeted activities that are listed here on this slide as well. The program started out and continues to be a partnership with the National Highway Traffic Safety Administrations. The way EMSC is set up in this country, at least before you get to a hospital, is through the National Traffic Safety Administration. And originally, this was set up to try to reduce the toll on traffic accidents. There’s nothing that we can do for children, if there’s not a strong EMSC program underneath. So it’s critically important, both for the program specifically and for MCH in general that this partnership will continue. There’s a similar partnership with the Centers for Disease Control.

Okay, oral health. Something that’s becoming increasingly important. It’s something that I think impacts every MCH program. You heard Dr. van Dyck mention the oral health earmark among the earmarks that have come out. This program is funded in a number of different ways, and reflects a number of the partnerships that MCH provides. There is some SPRANS money in this program. There is obviously the five million dollars of oral health earmark that is in this program. And there is money through interagency agreements, primarily Headstart, and the Administration for Children and Families that also provides money for this program.

In the area of Infant and Child Health, we have the following points of emphasis. The SIDS program originally started out as a bereavement program, then with the back to sleep campaign in the early 90s, became a prevention activity. And so now working with Michael’s group, we’re finding some fascinating new data about what’s happening with SIDS and the contributing factors to what was originally called SIDS. The Child Death Review Program that Michael referred to in his talk is more closely analyzing some these deaths and we’re looking at things in a slightly different way. The Health and Safety and Childcare, Healthy Child Care America, for those of you who’ve been around for a while, is something that’s been going on for eight years. It’s created an evidence base and quality approach that wasn’t there before and it’s been a collaboration between MCH and the Child Care Bureau in the Administration for Children and Families. And that program has evolved into the one on the -- at the bottom, which I hope every state representative here is aware of, and that’s Early Childhood Comprehensive Systems Program, which has been going for a couple of years and expect it will be going considerably longer into the future. The Childcare Program dealt with these three issues; quality assurance, infrastructure, building and outreach. Outreach particularly for SCHIP and Medicaid, medical home kind of activities, and evolved into the Early Childhood Comprehensive Systems Program, which has the five major areas of support that are listed below.

The other activity is in injury and violence prevention, it’s a small activity that we do. We used to have demonstration grants for the states and have aggregated the resources, the financial resources for that into the bottom bullet here, the children’s safety network. That is designed as a technical assistance resource for all state and Title V programs, and you all are supposed to be their major consumer. There’s a national bullying prevention campaign that was started actually by an earmark in Congress that has come to the MCH program. Stephanie Brend is primarily responsible for our Injury and Violence Prevention Activities, runs that program. And finally, out a couple of months ago, it feels like an elephant giving birth, the gestational period of this has been very, very long. The health, mental health safety in schools guidelines are out and are on the web.

The final thing I wanted to talk about is what we used to call the partnership for information and communication. We’re still trying to find a name for it so I just used the old one for those of you who are here and been here in the past. I want you to take a look at the membership list there. And what the bureau has done, this is something that really isn’t part of my division. It’s just that we’re the stewards of the program. This represents grants to all of these organizations to work together to better tell us in the federal program what the concerns are of their constituents and to give us in the federal program a means to talk directly to the various constituents. And we do that in a number of ways, both with each organization individually and with organizations in collaboration.

Recently, there was a meeting of the seven southern states made up of legislative leadership and executive leadership. Some of you may have been at that meeting in Florida. It represents an opportunity for MCH directors to talk directly to policymakers in their states and something that we at least found in the past has been useful. Not so much for the couple of days of the meeting, although the meetings are usually held in very nice places. So for those of you who get to go, so that’s nice. But it’s more the ongoing relationship that we’re trying to set up. So that’s what goes on in the program. Last word; I don’t know about my colleagues in the division, but I’ve never had an original thought in my life. And what you see here in these programs represents implementation of ideas that people have come to talk to us about. And a lot of the people, there are a number in this room, have given us ideas and we have tried to implement them. Well, the only way we can come up with bright new ideas is if you will tell us what you think needs to be done and we will do our damnedest to try to make sure that happens. So thanks very much.