HRSA/MCHB 2005 FEDERAL/STATE PARTNERSHIP MEETING

PUBLIC HEALTH ACROSS THE LIFESPAN

Division of Research, Training and Education

CHRIS DEGRAW: I’m here today to talk about the Division of Research Training and Education. We have a very interesting division and one that we think relates to a lot of the work that you folks do in the field. We have programs that span the four levels of the MCH pyramid, research and training that are certainly integral parts of the infrastructure, and more applied programs such as Healthy Tomorrow’s Partnership for Children and the Bright Futures Initiative.

Now, this slide I’m going to show you now, you may have seen before, it’s been widely borrowed and appropriated by various bureau people, but this is the official version. What we want to do is use this slide to show you where our division, which is affectionately known as DRTE; the Division of Research Training and Education, fits into the big picture of the United States Government. At the top, of course, the President of the United States. That may be where we stop here. Well, just left click? Oh, okay, it’s followed by the Secretary of Health and Human Services. The HRSA Administrator. And, of course, Dr. Van Dyck who you met earlier this afternoon. And, next, just four steps away from the White House, the Division of Research Training and Education.

We are lead by Dr. Ann Drum, who you also met during the last panel, who’s the Director of the division. And, is a dentist by background, and we really pride our division in modeling the inter-disciplinary standards that we like to encourage of our grantees. As I mentioned before, we have four major areas of emphasis within the division. The training program. Oops. How do we go back? Or, don’t we? Oh. A lot of the bells and whistles, obviously didn’t translate during the emailing of this from person to person to get it on here, so the little flashes and spins, and what-not, aren’t accounted for.

So, we have in the upper left, the MCH training program, which is our largest program in terms of the sprans dollars that support it, the MCH Research program, the Healthy Tomorrow’s Partnership for Children program, and the Bright Futures Initiative. The MCH Training program is lead by Laura Cavanaugh, which I hope many of you have met and all of our division folks will be around here over the next couple of days, and please, if you have questions about specific programs or comments or suggestions, we’ll all be happy to talk with you.

The training program seeks to train the next generation of leaders who will provide or assure the provision of quality services for the MCH population. Quality services for mothers, children, and adolescents require professionals who are attuned to the special needs of children, adolescents, and children with special healthcare needs, trained to provide or assure the provision of interdisciplinary family centered and culturally component services, and focused on improving the health of the entire population. The training program that I mentioned is the largest of the programs in our division. It has an annual budget of approximately $37 million. We support 133 active projects at 79 Universities and 38 states in two jurisdictions. So, most of you have an MCH training program in your state, and one of the programs that I’ll talk about in a moment. And we really encourage all of our training programs to have an active partnership with the state, MCH, and Children Special Healthcare Needs programs. I’m sure that varies from state to state, but we hope that you will reach out to the training programs and let them help you, and work together.

There are eleven categories of long term training, which include the Leadership Education and Adolescent Health, or the LEAH program, programs support trainees and communication disorders, the Developmental Behavioral Pediatrics training program, our largest training program which the Leadership Education in Neuro-Developmental disabilities, or LEND program. We have MCH nursing, MCH nutrition, pediatric dentistry, the Pediatric Pulmonary Centers, and in the past, we have had the research training enhancement program. We support schools of public health. The MCH infrastructure in schools of public health across the country, and MCH social work.

There are six categories of continuing education, including the continuing education in MCH, distance learning, the certificate in MCH public health, the graduate medical education program, which is being transformed into a new program I’ll speak about in a moment, collaborative office rounds which seeks to cause some collaboration between pediatricians and child health professionals and mental health professionals at the local level, and the MCH Institute which provides continuing education for folks such as yourselves.

We have a new program which is just going on-line as we speak, the MCH pipeline program, which will support activities of minorities serving institutions of higher education to reach out to undergraduates to try to interest them in the various maternal and child health careers; hopefully providing a pipeline into programs such as yours.

The program priorities for the MCH training program, at present, are strategic planning, developing leadership competencies, and measuring performance. The training program is very excited to have a relatively new website. They’re working with contractors at the University of Florida, Gainesville, which have provided a very excellent training program website which encourages collaboration both among our trainees, among our training programs, and hopefully between our training programs and our other MCH supported efforts such as the state directors. There’s a wealth of information on the training program website which you can access through the MCHB website.

The MCH Research program is lead by Dr. Stella Yu. It was established in 1963 through an amendment to the

Title V Legislation, with the purpose 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 main program within the MCH branch, is the R-40 or Extra Mural Research Program. It supports applied research. It’s extra mural that means we don’t do that research in-house, such as Dr. Kogan’s shop does, but rather it supports investigators in the field. It’s investigator initiated in that most of our ideas for the research projects come from the field. It’s multi-disciplinarian orientation, and it uses a review process similar to that used by the National Institutes of Health.

The research program has a budge of approximately $10 million, annually. We review between 90 and 100 new applications annually, and the competition is very stiff in that we are generally with our funding that’s available, we are able to support around 8 sometimes 10 new projects a year. The application deadlines are twice yearly, in March and August. The number of currently active projects supported are 40 to 50 at any one time. And, we really prided ourselves in that one of the benchmarks of this program has been the large numbers of peer review publications that have resulted from this program, which I think attests to the high level of research scholarship that’s going on. We also are working very hard to try to make this program more relevant to the needs of the MCH community; to really have the types of research we support be much more applied and systems oriented.

The research agenda is developed based on input from the field, including folks such as you. It’s closely tied to MCHB’s strategic plan and, as I mentioned, it’s focused on MCH public health services and systems questions that may not be addressed by other federal research programs, and I think that is a key point. People often ask us, “Why do we need an MCH research program, we have the National Institutes of Child Health and Human Development, we have the Agency for Healthcare Research and Policy, why this relatively small MCH program?” And our counter to that is that we’re really trying to support research that focuses on the MCH systems and the MCH needs, it’s not necessarily supported by other program, public or private.

The strategic research issues for this current five year period, extending through the decade, include public health service systems and infrastructures, eliminate health disparities, services and systems to assure quality of care for MCH populations, and promoting the healthy development of MCH populations. We support several different types of research through our program, health services research, behavioral psycho-social research, medically oriented and clinical research, epidemiological research, and secondary data analysis. And, Dr. Yu has put an increasing emphasis on the secondary data analysis type of research, feeling that it’s one that we can make use of existing data sets such as those that Dr. Cogan mentioned that the bureau has made a sizable investment in, and really target the use of our limited MCH dollars in a way that’s strategic and useful.

In addition to supporting specific research projects, we also have a history of support research networks. And these were developed in various areas to try to bring a critical mass of research infrastructure to an area that would encourage research in a particular areas. One, at the top, is the Pediatric Emergency Care Applied Research Network. Our division has worked very closely with Dr. Heppel's division where the EMSC program has it’s origins and to develop this network. It supports a nationwide network of emergency care researchers and emergency facilities that collaborate in research, and has really had a great track record in the brief period of three or four years that it’s been in existence.

We have supported, for a long time, the Pediatric Research and Office Settings Network. The PROS network, which is in collaboration with the American Academy of Pediatrics to really encourage research in the settings where our children are being seen for the healthcare. And, last the MCH Research Network on Pregnancy Related Care through the American College of Obstetrics and Gynecology.

The next program is the Healthy Tomorrows Partnership for Children program, which I hope a lot of you are familiar with because these projects are located in many of the states. It’s, again, a collaborative grant program and partnership with the American Academy of Pediatrics. It’s purpose is to engage communities to work to improve children’s health through prevention and better access to care. It’s lead by Jose Belardo, who’s a social worker and attorney, in keeping with our interdisciplinary focus. It funds projects for five years. These are relatively small grants of $50,000 a year for five years, but they really carry a lot of clout in terms of the impact that they’ve had the community level. In the past, we’ve required a non-federal match in years two through five of the project period, and evaluation has shown this to foster a long term sustainability and leveraging of community resources with a 70% of sustainability level for Healthy Tomorrows projects. There’s a little hiatus in the match requirement presently, but we’re hoping that will again be re-instituted soon.

Healthy Tomorrows is one of the more exciting programs that we have in the bureau because it really, when it happens at the community level, and these are projects that the nature of which are derived by the folks at the community. They come up with their own needs and their own ideas on how to address those needs, and that’s what gives Healthy Tomorrows the richness. And, as you can see, I’m not going to through this list but some examples of the projects, the areas of focus, really are very wide ranging, addressing almost any program, any problem in maternal and child health that you can think of. And, one nice thing about Healthy Tomorrows, when people call in, sort of at random into bureau, and want to know where they can apply for funds, we just send them to Healthy Tomorrows because it has such a wide focus. In the FY04 competition, we decided to target some funds to some particular areas of emphasis for the bureau. These include oral health and mental health, and those projects are on-going now.

And, finally, the Division of Research Training and Education has the administrative responsibility for a bureau wide initiative, the Bright Futures Initiative. Bright Futures is the bureau’s on-going national initiative on prevention and health promotion for infants, children, adolescents, and their families. This is suppose to flash a couple of times but I guess it’s not going to do that. It’s been going on since 1990, so that I hope all of you, except maybe some of the very newest, have heard of Bright Futures. It’s purpose has several; to promote the desired social, developmental, and health outcomes of infants, children, and adolescents. To enhance healthcare professionals knowledge skills and practice of developmentally appropriate healthcare in the context of family and community. To increase family knowledge, skills, and participating in health promoting and prevention activities, and to foster partnerships between families, health professionals, and communities to promote the health of children.

Over the years, Bright Futures has prepared a number of materials and publications to help implement those four ideas that we’re trying to do. They include the Bright Futures Guidelines for health supervision of infants, children and adolescents, which is the one in the middle and has been the lynch-pin of the initiative, and various other materials that address important health promotion areas such as oral health, physical activity, and nutrition, mental health.

In the last several years, we’ve really tried to, while maintaining the current nature of the Bright Futures publications, we’ve really tried to put an emphasis on implementation; trying to make sure that this information, this philosophy of Bright Futures, the supporting publications and other materials and tools, get out into the hands of the people who need them. Not just healthcare professionals in the clinical setting, but public health professionals, families, and others in the community. There’s a new website we’ve had up. A couple years ago we entered into a partnership that’s now been, I guess it’s going fast, time’s going fast, it’s been almost four years now, with the American Academy of Pediatrics to really be the focus for the implementation of Bright Futures.

There’s a website that I hope you, if you haven’t used, will become familiar with. It’s an excellent website. www.brightfutures.aap.org It has access to the materials, it has access to ideas of how Bright Futures has been implemented around the country, and you can look in your states and if you don’t see anything going on in your state, please try to identify things and let us know about them. There’s a focus on quality improvement for health promotion and preventive services, and provider practices. Really trying to cast Bright Futures in the quality improvement vain, which is so important in healthcare field today. And, we’re tying to find new opportunities for Bright Futures and training.

I’m real excited to share with you the unveiling of the Bright Futures Guidelines third edition. This is the cover for the new Bright Futures Guidelines. This is the second time it’s been shown in public. It was unveiled, actually, at the AAP meetings last week. Still, the book itself is still in progress, but we hope to have it by the end of the coming year. There’ll be opportunities later this year, at the beginning of next year, for widespread review in the field of the Bright Futures Guidelines. We hope that all of you will participate in that review. You can let me know and we’ll make sure that you have access and others in your departments at the state level to reviewing that material to make sure that it’s really relevant for your work.

And, finally, the bureau is very collaborative a division is as well, and we love to hear form you. We love to have your input, the way that we can make our programs work for you is knowing how they’re working and what your suggestions are. You can contact us there at the main phone number, or any of us individually through our emails. Thank you.