MCH Stakeholder Meeting Round Table Discussion Summary
Priority
Priority 1
Title
Promote preconception health among women and men of
reproductive age with a focus on intended pregnancy and healthy
weight.
Page
2-5
Priority 2
Promote screening, referral and support for perinatal depression.
6-9
Priority 3
Improve developmental and social emotional screening and referral
rates for all children ages birth to 5.
10-13
Priority 4
Prevent obesity among all children ages birth to 5.
14-16
Priority 5
Prevent development of dental caries in all children ages birth to 5.
17
Priority 6
Promote sexual health among all youth ages 15-19.
18-21
Priority 7
Improve motor vehicle safety among all youth ages 15-19.
22-24
Priority 8
Build a system of coordinated and integrated services, opportunities 25-28
and supports for all youth ages 9-24.
Priority 9
Reduce barriers to a medical home approach by facilitating
collaboration between systems and families.
29-30
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Priority 1: Promote preconception health among women and men of reproductive
age with a focus on intended pregnancy and healthy weight.
Representation: Tri County HD, CDPHE/CASH, Weld County Dept. of Health and
Environment, CDPHE – Office of Planning and Partnership, Larimer County Dept. of
Public Health, University of Colorado – The Children’s Hospital, Colorado Children’s
Healthcare Access Program, University of Colorado – School of Medicine, Denver Public
Health, Teller County Public health, Lake County Public Health, Broomfield County
Public Health, CDPHE – WIC Program
Take a minute to read the words on the card in front of you. What words stand out
to you in either the priority area or the state performance measure?
 Obesity prevention, the age range (appreciate the focus on 18-44).
 Reproduction, intendedness
 Men – not only about women. Make services available for men too
 Obesity and healthy weight – the switch from underweight to obese
 Age – need to start before 18
 Education – needs to start at the end of Elementary school and have messages
reinforced until graduation from high school and/or college
 I like the pregnancy intendedness focus. I wish the performance measure and the
SPM were consistent (priority = focus on intended pregnancy; SPM = focus on
preventing pregnancy.
What questions does this priority raise for you?
 How do we reach target populations? (undocumented, uninsured, substance abuse,
smokers, alcohol users, people with STD’s, no birth control
 How can we assure that everyone is being reached
What excites you about this priority?
 Life Course model is not a fad
 We have known for a long time that preconception care is effective
 There is broader context thinking – focus on preparing for pregnancy
 The priority is inclusive of the life course model. The priority interfaces well with the
Life course model.
 The priority includes men
 The priority allows for integration of public health programs (example: family planning
and MCH; MCH and WIC)
 The priority will require preconception education for consumers, providers and
academics.
 Women of childbearing ages benefit, not just young women
 It is worded as a positive priority
 It includes focus on healthy weight (BMI > 30) and low weight women too
 Glad to see men added to the priority
What concerns you about this priority?
 The age range overlooks women older than 44 years. These women are still fertile,
and have the highest rates of abortion.
 Siloed funding
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The performance measures may not be accurate for small counties. Birth certificate
data is good to measure for small counties. BRFSS is not representative for small
counties. Newer smaller counties might be overlooked for lack of data and
misrepresented.
Work with IRIS, rather than BRFSS, to evaluate this measure at the county level.
We may end up with some holes in funding of services
We need to recognize that local health agency priorities are approved by County
Commissioners. Funding streams make a huge difference in the way monies can
be used.
Counties have to be able to demonstrate effectiveness. The measures make it
difficult to report to county commissioners and in the work plan.
We don’t have a birth certificate questions that will help measure SPM 1 for small
counties
How can we word the priority so that it resonates with and engages consumers?
(Preconception insinuates that the woman is actively planning a pregnancy).
Add interconception into the priority
Interconception is important too. Previous birth outcomes and birth spacing are
important. There are opportunities to target/follow-up with parents of NICU patients.
The number of young women who have pregnancies from multiple fathers
Many of our women are nomadic, so it is hard to keep them engaged in a series of
classes.
Potential problems pulling funding and resources for men’s health.
The reproductive age for men is different than for women
Schools have funding issues. They cannot incorporate these priorities into the
system
Political challenges related to the unintended pregnancy piece.
The uninsured do not seek health care
How does this priority align with your community needs? How will addressing
this priority benefit your community?
 Prevention – promoting healthy living.
 Reaching out to younger generation and where they are getting their information
 Prioritization of the Hispanic population and the Hispanic pregnancy rate.
 We are seeing an increase in pregnancy with no prenatal care, increase in
substance abuse, increase in birth defects, unprepared parents, newly uninsured
related to the recession and a repetition of ignorance.
How do your current projects relate to this priority?
 Teen prenatal classes
 Relationship building classes (abstinence, know your boundaries and empowering
youth)
 Fatherhood Initiative
 Healthiest Communities Coalition “Doing It” - Linking teens to sites for information,
using Facebook
 Larimer county community assessment – How does communication reach Hispanic
populations?
 Peer-to-peer (especially men)
 The Walking School Bus (Larimer County)
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Denver Health has a Preconception care program – Sharing what programs and
projects are out there state-wide.
WIC – works with pregnant mothers – WIC is aware that the focus is on the infant;
there is not much time to focus on the mom.
This fits within Title X. We don’t focus universally on it. If you are poor, we will help
you. If you have health insurance, you don’t need us.
What health equity issues do you think are involved in addressing this priority?
 Disparate communities are hardest hit
 Food access is a big issue
 Mental health issues are significant
 Dental issues
 Increase in undocumented immigrants
 Cultural sensitivity is difficult due to lack of resources
 Suggestion for CDPHE to contract with a single source for telephone interpretation
services that LHA can use.
 Men
 Health care providers cannot counsel or screen because there are no referral
services
 Young adults do not respect themselves
 Preparing health professionals to address differences
 CDPHE provide more links from the state website to help health care professionals
(i.e. Proven practices, evidence based practices, free stuff, promising practices)
 Enlist the help of faith communities. (Example: Hispanic -> Catholic = it is accepted
behavior to become a parent at a young age, but there is no understanding of the
implications) Different ethnicities have different pregnancies beliefs
 Evolve nutrition counseling
 Women ARE the health equity issue
 Women make health care decisions for their family
 Women are sometimes powerless in relationships
 The economic contributions of women are undervalued
 Age
 We have a lot of info on some populations but not all
What other questions does this priority raise for you?
 How can you get to the target population when they don’t seek health care until they
are pregnant?
 How do we engage women?
 Are we starting life skills planning at the appropriate age and are we doing it in the
right way? Are we including financial planning skills?
 How do we get it across that obesity causes birth defects?
What things do we need to consider as we move forward with this priority?
 Policy change
 Culture shift
 Decrease unintended pregnancy, increase intended pregnancies in women with no
birth control experience
 Educate the public about how insurance and Medicaid work and improve their ability
to navigate the health care system.
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The roles of providers and schools
How we speak to kids and prepare a child for the next level of care
Parents are not talking to kids
Females struggle with body image and do not know their nutritional needs
Female weight has two extremes – the 14 years old weighing 80 lbs. and the obese
patient
How to educate providers and clinic staff about the relationship between public
health, prevention and illness
Group education (examples: videos, PSA’s, do what appeals to that age group)
What opportunities for integration exist across the life course in addressing this
priority?
 Parents and babies all seen in the same clinic – Young parents clinic
 Coordinated school health clinics
 Nutrition in science class
 Combine messages (example: weight and intended pregnancy)
 Childhood growth effects future pregnancies
 Have local level staff share their stories with others (peer-to-peer)
 Provide “life mapping skills” education in schools; If possible, include reproductive
content; combine parents and kids; include after school programs for those at risk
 Partner with insurance companies (can they report on items too?)
 Preconception Birth control should be part of the Obama plan
 Home visitation programs
 WIC
 Reproductive Health/ Title X
 Immunizations
 Workforce Agencies
 Private health insurance (care coordination and case management)
 Early childhood coalitions
 Child/parent programs
 Businesses
 City/County transportation
 Rock Stars/famous people to speak our message
 FQHC’s
What advice do you have on how to implement this priority?
 Use social media
 Peer-to-peer
 Teach youth to make choices earlier
What strategies could be employed at the state and/or local level to achieve the
state or national performance measure?
 Bundle billing possibility for preconception care
 Life skills teaching/planning for youth
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Priority 2: Promote screening, referral and support for perinatal depression.
Partners represented in these discussions:
Denver Public Health, Pueblo City-County Health Dept, Northeast Health Dept.,
Cheyenne County Public Health, Tri-County Health Dept, Larimer County Health Dept.,
Boulder County Public Health, Weld County Health Dept, Jefferson County Public
Health, University Hospital, Children’s Hospital, Colorado Dept. of Public Health &
Environment
Professional areas represented in these discussions:
Children with Special Health Care Needs (CSHCN), Family Planning, Immunization,
Preconception, Neonatology, Labor & Delivery, OB Practice, Nutrition Services, Maternal
Wellness, Public Health Nursing, MCH Supervisors/Directors, Perinatal Programs:
Nurse-Family Partnership, Prenatal Plus… Absent: mental health providers
What excites you about this priority?
 We are shining a light on this important issue, and it is being acknowledged
 The lifelong impact it can have on the health of the child
 That it crosses over so many areas, continuum across the life course
 The possibility to identify more cases once universal screening is implemented
 The impact it could have on maternal mortality
 The opportunities to broaden capacity to treat & provide support for these women
 The possibility of addressing this starting prior to conception too
 Connections that can be made with pediatric offices
 That there will be some $ put in to these efforts
 The opportunity for systems building
 We have the opportunity to improve the experience of early motherhood for new
moms
 Could be recognized as a medical illness, eliminate stigma
 The potential to package this within the family unit – mother, father, child
What questions does this priority raise for you?
General
 How do we operationalize this?
 How do we know if we really achieve the bigger outcome?
 How does this interact with HB 1451 and other agencies such as human services,
judicial system?
 What about current limited infrastructure to address the need?
Provider Capacity
 How prepared are doctors/nurses to do this?
 How will we address the anxiety that this may create for providers in doing
screening?
 What about limited provider time?
 Is there a way to be able to treat the babies and mothers together (i.e.
reimbursement for services to mother when infant is being seen)?
 Are there opportunities in the Centering Pregnancy or group care models to create
supports in the community for these women?
 What is the liability involved for providers?
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Where else can the message be shared beyond traditional medical provider?
Referral Capacity
 What do you “do” after screening? What if there is nowhere to refer to? We shouldn’t
screen unless you can do something about it.
 How do we build capacity for referrals?
 What about gaps in funding for mental health services, especially among Medicaid
when coverage is lost at 2 months postpartum or for those who are undocumented or
uninsured?
 How do we facilitate women accessing services when they are overwhelmed?
 This is a complicated issue, how do we make sure all areas are addressed
appropriately?
 How do we know the outcome of the referral? Did they get help?
Family Capacity
 How do we address the stigma/acceptability of this issue?
 What about the literature that shows impact on fathers too?
 How do we approach this issue with a frame around family-centered care, not just
the woman?
How does this priority align with your community needs?
 It is important for families within CSHCN due to impact of grief, bonding, stress
 Builds a healthier community
 Helps with school readiness
 Current program in Boulder (Community Infant Program) has worked on this for a
long time – very high-level coordination between HHS, PH & MH
 Some have started to integrate mental health services into their medical practices
 Neonatology sees a need for this in their patient community
 University has a new program that is working well
 Seems like there are opportunities under health care reform
 Provides an opportunity to change from direct services to population-based services
 Perinatal depression was identified as the one priority that cut across all 5 programs
within the various Maternal & Child Health services offered in Boulder County
 No coordination currently, this will help align various partners
 Could provide opportunity to build capacity to address the issue
 Could insert into efforts addressing preconception health status too
 Some FQHCs have mental health services co-located in their agency
Is this a priority that has both state and local action steps?
Yes, see below.
What strategies could be employed at the state and/or local level to achieve the
state or national performance measure?
State
 Promote screening every time
 Help define reimbursement/work with insurance companies
 Provide general tools/resources (prevent locals for recreating the wheel by creating
standardized methods)
 Share known resources
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State-level training opportunities/materials
Present to groups outside the usual conferences
Build public will (use media, broad awareness)
Help measure outcomes, provide TA in designing local evaluation components
(EPE)
Share successes in other communities (web-based forum for this?)
Local
 Has to be supported at the community level first
 Present/train providers
 Coalition-building
 Allow for local flexibility (rural vs. metro)
 Build public will (local agencies can select media options that work well in their
community)
 Provide group postpartum visits to help create social support in community
 Develop neighborhood capacity to support each other
 Preconception education (FP clinics)
 Partnering with other agencies (Mental Health, Community Health Centers, hospitals,
schools, Healthy Start, CSHCN…)
Distribute materials
Engage community groups (MOPS, story time at libraries, postpartum exercise groups,
Curves)
What advice do you have on how to implement this priority? What things do we
need to consider as we move forward with this priority?
General
 Start small
 Help define the shift in the role of public health to population-based services
 Address continuum (lifecourse)
Collaboration
 Consider other inter-agency opportunities beyond just medical providers
 Human services
 Faith-based communities
 Doulas
 Hospital personnel
 Build networks (coalitions) to address this in communities
 Connect to medical home efforts
 Improve local communication
 Community has to say it is important first, can’t just mandate screening without
community buy-in
 Promote integrated services within practices
 Coordinate efforts across agencies (ex: Connections group in Larimer County,
Community Infant Program in Boulder County)
Screening
 Nine questions is a little overwhelming, consider 2 or 3 question survey
 Importance of screening every time
 Use screening tools/resources to help build capacity (ex: notebook)
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Training for primary care
Availability of treatment resources (or lack of)
Awareness
 Increase awareness/normalization (decrease stigma)
 Develop media messaging that addresses decreasing the stigma
Community/Family Involvement
 Create a “family” intervention, connect with families, involve partners
 Opportunities for creating peer support networks
 Opportunities for social support networks (hospital support groups)
What health equity issues are involved in addressing this priority?
 There are cultural differences when addressing mental health.
 Cultural differences exist in willingness to discuss this topic
 How do we know what these are?
 How do we increase provider skills in addressing differences?
 Not just Hispanic, now see Somali, Burmese and others
 Refugees are different than immigrants
 Cost of language line services is high at $2/minute, conversation is difficult to have
over the phone
 Possible cultural taboos – consider messaging and screening questions
 Low-income/uninsured populations have less access to services
 Undocumented persons have less access to services
 Maternal age – could be an expectation that older women are able to better deal with
pregnancy and newborn
 Rural areas may face more problems with stigma due to small-town culture
 Perception that it is just a low-income problem
 Experience of depression itself (leads to accessing less services)
 Health literacy – how do you provide information in the right way to activate women
to get treated?
What opportunities for integration exist across the life course in addressing this
priority?
 Think about effects beyond just the mother – impact on whole family
 Children with Special Health Care Needs
 Hospital role postpartum
 Continuity of care (prenatal into early childhood)
 Consider communication systems for connecting across the lifecourse
 Reimbursement for mother as part of child’s treatment (Medicaid?)
 Can involve all MCH populations (preconception (adolescents too), prenatal, early
childhood, CSHCN, fathers)
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Priority 3: Improve developmental and social emotional screening and referral
rates for all children ages birth to 5.
Initial Reactions
 Jefferson Child Abuse and Prevention Treatment Act provides the screening and
refer. They are received 150 referrals this year.
o 1451 Amendment to ensure children do not fall through the cracks. Also
doing Parent indexes for parents.
o CAPTA requires developmental screening.
 ABCD in Pueblo provides training and screening tools to providers.
o Colorado Trust funds request for social and emotional screening in day care
and mental health communities.
 Eagle County, using ABCD through indigent health care.
 NFP does 500 plus screening
o Trial projects for A&S 10-15 years ago. All providers use A&S so parents are
used to completing the screens.
o Physicians still wait to refer
o Why limited to providers; teams in communities could provide the screen and
refer
 Pueblo -Physicians referral not required to refer to EIC. Educate physicians, parents
on who to call
 Eagle – lack of services for those identified
 Right on
 Larimer County – EIC was the initiator but HCP pulled together the community. EIC
has capacity concerns; the ABCD team has worked as a team to educate physicians;
tried to encourage S/E screening – frustrations with providers
 Helpful to include S/E as part of ABCD from the beginning; priority in ABCD grant
funding
 NE – Centennial mental health had a grant to do S/E at child finds, healthy child
clinics, the PCP’s obtain a summary of the screenings ; involve school
districts/BOCES; included immunizations and oral health; find parents who do not
typically go to EIC such as low income parents; f/u is referred to EIC; s/e referrals
can go back to school districts or Centennial MH; El Palmer and CO Trust grant
 Boulder – s/e largest gap for referral
 Mental health in Colorado Springs vacillates between ages they can see
 Insurance determines where families/children can go too e.g. MH Center vs. private
practice
 FQHC collocate MH provider in Bolder can help bridge gaps for referral
 Convincing to refer to EIC; physicians may want to keep referrals in house and then
families cannot afford the co pays
 Challenges and stigma issues rel. to CCB and referral for Child Find/EIC
 Physicians tend to not do standardized screening
 Medicaid at least receive EPSDT/ need better cooperation
 Private health care only pays $7; Medicaid pays $36
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Collaborating with oral health, developmental, S/E
Preconception – engage families into thinking about child health
Risk factors, social determinants of health screening at preconception, maternal,
infancy, post natal
ECC engaged into the process of screening through EI
Messaging for oral health; early OH and interventions for providers; importance;
challenges of oral health funding;
Issues regarding language barriers within systems from health to education
DH does dental screening in many clinics; anticipatory guidance
Incorporate into family mental health
Marti – ECC for Kiowa County. Concerns regarding child find or lack of - ??
Report card for communities from public health; then develop an action plan
Closing the Loop project between TCH, DH, Kaiser – utilizing local public health for
referral and resources
Does EPSDT require standardized screening
Immunization birth to five – screening programs
NFP used ASQ and interested in how PCP are implementing; oral health and how to
improve
School based health needs to partner with the initiatives
Concerns re: dentist telling parents not coming in until age 5.
Different education by providers
Mixed messages from providers
Align with Community Needs
 ABCD team in Jefferson County has not gotten off the ground; However Carolyn can
referral to those physicians
 Boulder county feels coordination with providers needs to happen e.g. Kaiser does
and FHCQ do not
 Engagement in parents on their child development; ASQ paper support for families
for activities to encourage development; helps parents empower themselves to
advocate for their child – anticipatory guidance.
 Bright Beginnings is an opportunity to collaborate
 Coordinating language
 What happens to communities who do not have physicians who want to see children
on public health?
 CHAP is helping physicians – need to work with Eagle and Aspen, Glenwood
o Issues with access
 Social/Emotional screening in Eagle County – ABCD going well but no one is doing
the s/e screening
 Access to resources for referrals and non English speaking
 Funding for treatment
 Mental health resources – any strategies to overcome with capacity issues;
o Coaching and Consultation was being used in Eagle but funding has gone
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Pyramid model from CDHS that state can be used to educate teachers, NFP,
home visitation
o Colorado Health Foundation – screen all women for depression and the
funding pays for services; mental health can also provide coaching to the
NFP program (Glenwood). Increase the capacity in the community to engage
families;
o Engage parents early
o Early Childhood Framework
Funding for Part C/CDE and programs - strategies
o Reprioritize greatest need with community; ensure no duplication;
o Public Health Improvement Process
o Mental Health for State Trainings – helping to identify those that have MH
issues and get them to triage
Important for children – e.g. immunizations do not cause developmental delays
Empowers parents to advocate
Coordination between providers (sectors) is needed.
Engage parents; anticipatory guidance
Strategies and Opportunities
 NE- County meeting that included physicians; HCP developed a referral form to
ensure f/u; close the loop at the local level
 Larimer – Child find offends physicians by not following through; HCP intervenes by
providing care coordination and serve as a referral/resource; helping to liaison with
medical and education
 MCH can advocate for reimbursement for private insurance.
 Boulder – Perinatal depression, S/e screening using County funding; referrals from
social services, medical providers, WIC, FQHC; no income criteria
o Janet Dean directs the MH program – opportunities for other communities
o Child Health Promotion Program in child care centers provides screenings
o Kids Connects provide consultation and referrals (grant funded, TANIF) –
mental health center; involved in ECC
o High collaboration
 PSA’s with cultural competency/ relevance
 Pediatricians need to address the oral health issue
 Bright Futures screening tool authorized by CO AAP, CO FPA
 Five minute education video in waiting room
 Utilize dental hygienists vs. dentists
 Mobile dental vans in Early Head Start programs
 Start with teething, to link to sleep, nutrition, developmental, mental behavior
 Use other health care providers to look at screening e.g. dental hygienist
 PSA’s on sesame street
 “One stop” screening
 Address stigma
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Find mechanisms to ‘close the loop’, improve communication
Advocate for increased reimbursement
Increase mental health capacity through coaching/consulting
Pyramid Model implementation
State provides marketing campaign
 Engage everyone who works with young children
 Early childhood councils – a way to engage community
Link immunization with developmental screening in the interest of addressing fears
(immunizations causing autism)
Culturally relevant PSAs
Use Bright Futures with health care providers
Use waiting room video messaging
Involve dental hygienists in primary prevention
Engage residency programs
Opportunities for integration across life course
 Alignment with prenatal screening?
o CSD being used in Glenwood with immigrant population – some funding for
treatment.
o Boulder has a nurse and therapist to do prenatal depression; referrals come
through Child Infant Health Program; physicians, hospitals
o Opportunities for coordinated messages
o Create a screening continuum through life course
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MCH Priority 4: Prevent obesity among all children ages birth to 5.
What questions does this priority raise for you?
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Plays across many areas of public health, very broad-based. How would you
coordinate such broad-based programs, intervention?
How do you encourage breastfeeding in Hispanic population? Most won’t exclusively
breast feed.
How to modify/work around cultural norms to not breastfeed or breastfeed
exclusively in Hispanic population?
Can Do 5! Program to train hospital staff to encourage/enable breastfeeding
How to get past cultural norms related to fast food, TV and sedentary behaviors?
State measurement is difficult to match to priority. What other indicators can be used
to show progress, especially with regard to measuring midway results?
What research has been done around cultural factors that play into this? Even
beyond Hispanic; Asian or refugee populations in Colorado?
Hear about programs that are going on, but want to see more data that is going on
locally. Are counties doing research ahead of selecting programs and approaches or
are they relying upon other programs?
Would we be looking at changing our priorities away from our current Healthy Baby
program to focus on new MCH program? Are we expanding?
Grading on research aligns with preconception health; fits with Life Course Model.
How can we collaborate across agencies (WIC, clinics, extension agencies, etc.)?
What about evidence for physical activity in early childhood obesity prevention and
how does PA fit into MCH priorities?
One of biggest problems is the relative lack of evidenced-based best practices for
children.
If moms become concerned with obesity, do you find that they water down the
formula or other undesirable practices
Is there a screening that takes into account all the childhood obesity factors to
assess risk?
Does it align with your community needs?
 Yes, in Larimer county lots of work on obesity; community needs assessment around
environments where children will be.
 Elected officials are interested in obesity-related issues
 Rural areas have difficulty to get fresh foods. Poor transportation. Accessibility
issues.
 Widely recognized, nationwide problem.
 Budget cuts may reduce breath of coverage by smaller communities. WIC will be
covered by other priorities may take over for the larger population.
 Need to coordinate this priority with other priorities, especially with regard to
communication plan.
 Gives teeth to collaboration efforts beyond just being nice to each other. Give teeth
to directors that obesity-related efforts are important
 Yes.
 Our county health department hasn’t done much with this issue; obesity prevention is
directed at older children when identification occurs.
 HCP department has a dietitian to work with FFT babies.
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Lincoln county working on Live Well grant.
Most agencies aren’t going to catch all the factors such as infant sleep.
What strategies could be employed at the state and/or local level to achieve the state
or national performance measure?
Registered dietitian at Weld county health department (funded for 10 hr/week from
general county funds) accessible to any eligible persons (spec Dx) in the community.
1:1 approach.
CSU Extension office offers class on Cooking on a Budget. Several weeks, some
cost but can get a rebate through.
CSU EFNEP Healthy Families, Healthy Babies. Go into home. Food safety
component.
Mapping & communication of all the work being done across the state, and what the
higher policy levels are these priorities are trying to address?
Need to know who is doing what at the different level. Need top down and bottom up
integration. Need coordination to reduce duplication and environmental change to
keep programs going if money goes away.
Convener idea resonates.
Sharing data is important.
Health district sends out newsletters with nutrition information. Can Do program.
Integration of different planning components into one comprehensive plan.
Breakdown of silos. Link familiar with unfamiliar.
Bring community into the planning and policy making. Community has an attitude
toward “policy.” Need to hear concerns, but people with concerns may not have time
to attend a meeting.
Low income population doesn’t use the same media outlets as mainstream
population. You have to go to them. This is where champions from communities is
important. Champions can be a voice for a community. This is true for any health
priority. Many targeted populations are hard to reach.
Need to address culture; should give diet information in-line with cultural norms.
Prescription for physical activity from physician helpful to motivate some cultures.
Need cross-program resources and recommendations. Example different models
from WIC and family planning, and nurse-family partnership require accessing
tobacco but each has a different assessment plan. Push one model for a priority or
goal.
Need to train to the proper staff if you want to implement a policy or model. Example,
talk to MAs or PAs instead of physicians.
Weld county prenatal and pregnancy classes incorporate Healthy Baby tools. Have
participants take weight gain grids to their doctors and complete them. Get rewards
with infant car set for attendance and completion of grid.
Encourage pregnant woman to bring a support person to classes with them.
Expands effect into postnatal and early childhood phases. Incorporate WIC
fundamentals into a more encompassing program.
Is this a priority that has both state and local action steps?
 Immunization registry is a consideration for BMI screening. Registry ties into birth
statistics because the registry receives data from vital statistics. Would include
everyone as opposed to only people participating in a particular program. How do
questions get added to birth statistics?
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Need a partnership about what can be shared. Schools have rich repositories of data
that cannot be shared at this time. Is there a report that can be published in lieu of
primary data?
What advice do you have on how to implement this priority?
 Need to go to bottom of triangle and that means going upstream. Where is the
problem starting? Going to Parents. Systems building over presentations.
 Lower barriers to collecting data.
 Directors at agencies need to see MCH push to focus on bottom of pyramid in
writing.
 Need to build culture and provide training on how to shift to need bottom of pyramid
paradigm.
 Focus on what we do instead of just what we eat. Programs to encourage physical
activity
 Need referral resources.
 Medicaid ASPT form asks outdated questions; physicians may not know which
questions are outdated. Example: How much whole milk do you drink question
directed at kids up to age 19???
 Need to standard what is addressed at specific doctor visits.
 What health equity issues are involved in addressing this priority?
 Income, less money can’t afford high quality, healthier food options, lack of
transportation
 Built environments: unsafe areas, no access to playgrounds, more liquor stores, etc.
 Other cultures need to be addressed.
 Cultures beyond Hispanic.
What opportunities for integration exist across the life course in addressing this
priority?
 Sharing across programs, state and local levels working together. Opportunity for
integration.
 Takes enormous amount of time and resources. Need many, many conveners.
 Capacity for integration is a important concern; resource cuts makes it more difficult.
 Increase education about obesity resources to providers; need a main place for
information for nutrition and barriers.
 Coalitions of local entities within communities for each priority. Stated funding.
 Plain partnership for health, community gardens.
 Program for families with nutrition ed and cooking classes. Special classes for small
children with appropriate foods and pottery activity.
 Weld Country: Tax incentives to convenience stores to offer healthier options,,
connect producers with local buyers and to create coops, connecting trails, build
sidewalks,
 Education of store owners on what are healthy options to offer. Need to address
business/financial side.
 Business Case for Breastfeeding is an area that can be promoted to affect one
aspect. Going back to work is major barrier to duration of breastfeeding.
 Work with neighborhood stores to offer fruits and vegetables.
 Gardens maintained by prisoners???
 MCH priorities can give you the right to be at the table.
 Teachers want to be able to help with childhood obesity.
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Priority Five: Prevent development of dental caries in all children ages birth to 5.
What questions does this priority raise for you?
 How do we reach all parents, not just low income, and raise importance of this issue.
Messages concerning: baby bottle tooth decay; dental visit by age 1; importance of
brushing.
 Are parents in tune with oral health? They may not know or receive information. Is
this due to cultural differences?
 Untreated dental cavities. Is this neglect, abuse?
 How aware are care providers (WIC, etc.) regarding oral health?
 Dental caries are a cause of lost school days/truancy.
 Need a message for all populations and in many different places (in clinics, on radio,
etc.).
 Periodontal disease is contagious.
 Key message could be: Early intervention means less pain. Reduces trauma for the
child.
What strategies could be employed at the state and /or local level to achieve the
state or national performance measure?
 Use hygienists in WIC clinics, etc. to deliver services and education around prenatal,
postpartum and early childhood dental care and caries prevention. Tap into
professional expertise on education and prevention.
 Provide assistance in finding a dental home.
 Include “oral health” as part of the screenings performed in child care settings.
Conduct phone follow-up for parents of kids screened.
 Rekindle importance of old messaging. Example: bottle propping.
 Address oral health in CSHCN clinics.
 Tie culturally relevant messaging through WIC, blood lead program.
 Encourage professional dental organizations or dentists to do 1:1 technical
assistance with colleagues to increase awareness on importance of the first dental
visit before age 1.
 Receive continued support from Cavity Free at 3 after initial presentation and
trainings.
 Increase number of providers applying fluoride varnish.
 Look for ways to enhance purchasing power of materials.
What health equity issues are involved in addressing this priority?
 Cultural issues – language, value?
 Low-income challenges.
What opportunities for integration exist across the life course in addressing this
priority?
 Integrate oral health messages into CSHCN clinic.
 Dental Aid in Louisville has a program delivering comprehensive services for
pregnant women.
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Breakout: Priority #6 - Promote sexual health among all youth ages 15 – 19.
What do you think of the priority?
 Sexual health is part of the broader, more encompassing overall health
 Priority related to HPV
 Like the strengths-based approach
 Changing the way parent think about sexual health
 More info getting out into community/word of mouth
 More male involvement
 More inclusive of males, females and families
 Value-based conversation
 HPV vaccine increase in community
 Needs to include STI, pregnancy and emotional needs of teens
 Where to start? Limited $
 It’s a priority listed by youth
 Provide more info/education
 Costly issue
 Good to see the lower age range
 Need prevention/upstream approach
 Youth moms (has a 13 year old mom)
 Primary and secondary interventions
 Mandy disadvantages for teen and baby
 At-risk population
 Good that this is a PH priority
 Not as much stigma as in the past
 Recreation vs. re-creation
 Youth part of the solution
 Sex is out there/seems more the norm
 Missing their potential/need mentors
 Address risky behaviors/positive youth development
 Increase in STI, HPV and partners
 Teen brain and body not developed at same rate
 Once a community decides that reproductive health is a priority, the state can be a
resource to that community
 Seen an increase in Hispanic teen pregnancy
 NFP in the community is ½ Hispanic and ½ White
 In Eagle it’s an issue of the haves and have nots; the “haves” have a distinct opinion
of this issue
 Community doesn’t always work together, not always collaborative
 The Eagle Youth Coalition is made up of adults, not youth.
 Need to standardize sex education in schools (potential to have this happen through
a health educator)
 There’s a paradigm shift in community; the youth are organizing themselves around
their needs and issues
 Need teen dating violence/healthy relationships
 Great idea!
 Not sure if it aligns with local priorities.
 It’s not just sexual health – it’s all health. Need to include 10 – 14 year olds.
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Does it fit with your community?
 Small county/high pregnancy rate – aligns with community need
 Able to get sex education in middle school, now trying to get into high school (9th
grade)
 Does align with community needs assessment, especially for Latino community.
 We have programs (in Denver) that address this/parents and youth discuss sexual
health.
 Needs to be something for all youth.
 There is a preconception program in Denver – primarily for Latinos but also for males
and parents.
 Not aware of any organized way.
 Youth and Family Connections (1-on-1 program) making referrals to family planning.
 “Pretty conservative” community.
Strategies to employ:
 Access to kids via after-school programs
 Train teachers, staff of community organizations to talk about sex health
 Health professionals partnering with others to reach kids/youth using medically
accurate info
 Use Safe Choices program
 Get parent, principal support
 NFP
 Genesis in Boulder/added program for sisters of pregnant teens
 WAIT/abstinence – in the schools
 Need health relationships/health classes
 Youth and Family Connections (12 – 17 year olds) – multi-agency
 HB1292: comprehensive sex education
 Schools seek out community experts/advocates
 Find dynamic local champion
 Increase awareness – sexual health also applies to children with special health care
needs – they are also at-risk
 Practitioners need to talk to youth about sex health and make appropriate referrals
STATE ROLE
 MCH data resources
 EPE role
 Other resources: link to other sources or
create new ones as needed
 Coordinate/connect locals to one
another/learning community/mentor one
another
 Use language that is teen friendly/family
friendly
 Change public perception/emphasize
preventative health
 Coordinate adolescent and family
planning efforts
 State-wide youth sexual health plan
(Oregon)
LOCAL ROLE
 Use language that is teen-friendly/familyfriendly
 Building that are teen-friendly
 Change public perception/emphasize
preventative health
 Access to providers/information on local
services
 Create “teen days” at the clinic
 Co-locate in places where teens likely to be
(community center, schools)
 Need to get community on same page
 Negotiate/agree to disagree/have the
conversation
 Frame it as loss of potential for youth
 Partner with schools/create trusted
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Use interactive technology to
disseminate medically accurate
information (STI, HIV, nutrition, family
planning, etc) (like Florida)
Positive youth development
Better vision for youth
Attitude shift
Help communities communicate with
local officials/leaders
Data
Reports/evidence-based info
Plan that speaks to varying opinions
Lessons learned from tobacco/2nd hand
smoke
Engage diverse parents & youth
Interview series/collect local perspectives
Evidence-based strategies on how to talk
about teen sex health
Work together to streamline and
coordinate youth programs and efforts.
Models of care to replicate/provide
training and TA
How to education community (use data)
on how to talk about it; communication
and messaging
Prioritize and/or require youth advisory
group as a condition for funding/need
youth engagement (community-specific)
Build understanding/value for youth
engagement
Foster youth/adult interaction
Inform locals of this priority
Support locals
Give guidance about what is ok/not ok
(there are policies that make it hard to
get this work done)
Share success/information among
counties
Connect counties/share resources
Share good/successful grant
applications, including evaluations
MCH generalists facilitate sharing
Use some technology/social
media/Skyping (many issues with this
one)
Post on website
Semi-annual or annual community calls
(careful not to overload/overwhelm)
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partnerships
Education public on true role of PH
Reshape PH image
Get community to talk about teens
Have to deal with local opposition and fears
Have youth be a catalyst/youth voice
Find trusted person/right person from the
community
Remember to enlist males, couples,
LGBTQ
Share knowledge, collaborate, coordinate
Enlist family planning program, include in
workplan
Embed in local plans
Cross-cut MCH priorities
Build understanding/value for youth
engagement
Programs in schools
SBHC/FQHCs – makes their resources
known in community
Also make child welfare/human services
(foster care youth), alternative schools
aware of reproductive health services
Youth advisory group
Engage youth – youth interns
Program development with youth and
parent focus groups/use surveys
Find policy (little “p”) ways to do this work
Youth coalitions
Find appropriate/effective community
leads/partnerships
Capitalize on current efforts and success
Communicate with state on local needs
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Health Equity/Life Course:
 Latina teens – huge page of the population (men are “in charge” of reproductive
decisions), Males, LGBTQ – each differ, have their own needs, need a varied
approach
 Enlist males more/role models
 Latina rates
 What does “positive sexual health” really mean for varying populations?
 Start educating at younger ages
 Are we “over-sexed?”
 As a nation, not sexually healthy
 How do we shape ideas for our kids?
 Get parents comfortable with subject
 Learning community?
 Capitalize on commonalities
 Account for different cultures (Latino, LGBTQ, males, etc.)
 Hire staff that connects with the community; bi-lingual staff
 Educate community about challenges of specific people – is it understood?
 Culturally responsive, appropriate and responsible
 18 & 19 years have no insurance – they’re in a transitional phase
 LGBTQ – sex education and tolerance issues, need to make the general public
aware of the needs of this group, change social norms about this (some people think
it’s a choice)
 Inclusive curriculum, teach in schools
 Outreach to bathhouses and gay bars
 Educate that sexual identity is only one aspect of a person
 Health providers and other community partners (churches, schools, employers, Boys
& Girls Club) need more education and resources; they need to be more comfortable
and forthcoming with sex health info.
 Healthy youth = healthy adults
 Use motivational interviewing – help young people talk openly and comfortably about
sex health – listen to youth as they need to be heard
Other:
Responsive state staff (family planning, Greta Klingler)
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Priority 7: Improve motor vehicle safety among all youth ages 15-19.
What questions does this priority raise for you?
 How do you improve motor vehicle safety in rural areas when there is not a lot of
support from the community? How is law enforcement involved in rural areas?
 Is motor vehicle safety really a public health issue? Isn’t this the Department of
Transportation and law enforcement’s responsibility?
 How is mental health related to motor vehicle safety?
 How can you help kids with behavioral health concerns be safe on the roads?
 How can we support families in teaching their teens to drive safely?
 How can you create policies that truly impact families?
 What kind of technical assistance is available, especially for local level policy-related
activities?
 What resources do the state have that local communities can use?
 How can local public health advocate when there are so many restrictions on policyrelated activities? Can the state tell communities how other have gotten around
advocacy restrictions, particularly in small settings?
 How do you get information out there to the community?
 How do we prove that youth coalitions are effective?
 How do we get people to understand the data?
 What are different ways to structure teen driving safety coalitions? What is the most
effective structure?
 What is evaluation—how do you do it? How do we get people at all levels to
understand its importance?
 How does teen motor vehicle safety relate to traumatic brain injuries?
 How are hospitals involved in this issue?
Does it align with your community needs?
 This is a fringe issue in some smaller counties. There is recognition that this is a
public health problem, but the incidence is small so it is not seen as a priority for the
health department to address in some areas. There is maybe some support for
starting coalitions or doing some sort of advocacy.
 There is very low seat belt use in rural Colorado. Parents don’t buckle up so kids
don’t either.
 Cell phones and distracted driving are a major issue.
 LHA’s that already are working on teen motor vehicle safety issues are glad to see
teen motor vehicle safety remain a priority so their activities can continue.
 Farm safety is an issue—in rural areas, teens drive farm equipment very early and
do not necessarily receive proper training to operate machines safely.
 Teens identify driving safety as one of their top health concerns.
 There is a need, but there seems to be fragmentation of efforts. Some people are not
clear that there is public health role in this issue.
What strategies could be employed at the state and/or local level to achieve the
state or national performance measure?
 Promoting existing policies related to teen driving e.g. the graduated drivers license
law.
 Monitoring trends and analyzing data related to teen driving.
 Building coalitions to address the issue.
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 Researching and implementing evidence-based practices.
 Educating the public about the need for stronger laws and enforcement of existing
laws.
Is this a priority that has both state and local action steps?
 Yes, this priority has both state and local action steps
What advice do you have on how to implement this priority?
State Role
 Provide direction to local health departments about how to improve teen motor
vehicle safety. Help local public health develop strategies and priorities that can be
implemented at the local level.
 Respond to community needs for technical assistance.
 Be sensitive about community needs in grants and work plan documents. Provide
LHAs stronger language to use.
 Provide data.
 Research and provide information to LHAs about evidence-based programs and
practices.
 Provide more robust technical assistance around evidenced-base practices and help
LHAs understand how promising practices can become best practices.
 Assist communities to evaluate their programs so that what communities are doing
now can become recognized evidence-based practices.
 Monitor what teen motor vehicle activities are occurring around the state, and share
that information with local communities.
 Connect LHAs with other LHAs that are working on teen motor vehicle safety so that
people can learn from each other.
 Share grant applications between counties—perhaps create some sort of grant
repository.
 Provide training on grant writing and project management on a routine basis.
 Provide training on the “lower level of the pyramid,” particularly on how to do policy
work.
 Provide on-line courses and technical assistance so that rural communities have the
opportunity to participate. Have a message board for LHAs or some sort of on-line
community, as well as face-to-face opportunities.
 Teach local MCH programs how to use technology to advance teen motor vehicle
safety.
 Maintain a state-level coalition.
 Create simply data presentations that local communities can use.
 Provide funding for local communities to be able to work on this issue and ensure
that LHAs know about grant opportunities through CDOT and other sources (create
and regularly update a funding resources list).
 Provide training no how to interact with different (and non-traditional) partners.
 Host another motor vehicle safety symposium so that everyone can share ideas.
 Provide LHAs with information about best practices for improving motor vehicle
safety in rural areas where issues like gravel roads and dangerous intersections
exist.
Local Role
 Convene partners and build local teen driving safety coalitions.
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Build partnerships with local law enforcement, schools, insurance companies, youth
coalitions, kids, and families.
Perform advocacy activities at the local, such as pushing for school-level polices
around education for parents, staff, and students about teen driving safety.
Create or support existing youth coalitions that address a variety of issues, including
teen motor vehicle safety.
Document the success of youth coalition activities.
Participate in opportunities that the state creates for LHAs to connect with each other
and learn from the successes/challenges experienced by other communities.
Utilize the resources offered at the state (resources through the MCH website and
brochures from the Colorado Teen Driving Alliance).
Ensure family and teen evolvement by holding coalition meetings at a convenient
time for teens and families.
Coordinate activities with state-level initiatives such as CDOT’s Regional Medical
and Trauma Advisory Council Seat Belt projects.
Distribute educational materials and do general community education.
Write articles for local papers about teen motor vehicle safety.
Offer classes to parents about the graduated drivers license law and how to teach
their teens to drive.
Raise awareness of the issue at the community level.
Think of creative interventions such as having police reward teens for good behavior
instead of punishing them for bad behavior.
What health equity issues are involved in addressing this priority?
 Rural teens don’t always have the same educational opportunities or safety
programs as urban teens.
 Low seat belt use in the Latino community.
What opportunities for integration exist across the life course in addressing this
priority?
 Track outcomes with youth coalitions, especially those that address issues that are
related to several different MCH outcomes.
 Educate parents early on about what programs are going on. Start with elementary
schools.
 Work with parents at their places of work.
 Involve grandparents and stress the fact that parents and grandparents are role
models for their kids.
 Connect programming between different stages through coalitions or other work.
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Priority 8: Build a system of coordinated and integrated services, opportunities
and supports for all youth ages 9-24.
What do you think of this priority? Does it align with your community needs?
What is already happening in your community?
 Age Range: how was that determined (Prenatal – 8 and 9-24 years)
 Boulder County will be engaging in strategic planning process to address issues
raised through local YRBS data
 Role of schools -- primary mission to educate children…SBHC’s
 SBHCs are good example of integrated services
 Boulder County uses YRBS data to work with schools collaboratively
 MEHD: 9-10 years—15 years old seems like a population that we are overlooking in
public health
 Transition of youth into adulthood
 Age range could include two subgroups with the older end of the range/focus on
transition
 HB1451 aligns with this priority
 Jeffco has a coalition that is focused on the age range. Supported through divorce
fees. Also have children and youth leadership commission
 Adams and Douglas also have 1451 collaborations -- who else?
 Jeffco: because of the children/youth collaboration-facilitated writing the teen
pregnancy prevention grant and pulling partners together
 Jeffco: focusing on youth with dual diagnosis and provide care coordination
 A population that we have overlooked and because of funding streams have been
siloed, causes system fragmentation
 Lake County 21 grant to fund “hub”/center for youth—could be a good beginning for
integration of services
 CDHS funding is Larimer County to support the Nurturing Program for pregnant and
parenting teens who have been recipients of CDHS services
 Larimer-health care coordination for children in foster care (kinship care homes)—
Healthy Harbors relates to health equity-transition age available supports vary by
age of youth
 Guardianship support for CSHCN costs $2 - 2500 to obtain guardianship of their
child when they turn 18 and can’t live independently (and takes time and legal
support)
 Larimer County Healthier Communities Coalition youth report card-law enforcement,
health, other indicators
 Caring and Sharing Coalition—monthly info sharing r/t services and supports for
children and youth, creates important networking opportunity 40-50 people;
connections with local medical home coalition (Ken Sharpe)
 NEHD-teen parents in Morgan County-have supports for parents of young children,
but as children get older, fewer supports exist
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Pueblo Alliance for Healthy Teens—H.D. is very involved as a partner in the allianceincludes community partners who provide services for youth, includes youth voice
PYD training through this local group includes info sharing
House Bill 1452—focused on high risk youth
Larimer County also has a HB 1451 team
Pueblo has grant for Safe and Healthy Schools
Real shift (decrease) in services and supports when children go to school and
transition out of early childhood services
Common themes:
 Everyone agreed with the need.
 Some felt that it would be important to specify a target population within the 9-24 age
range given the enormity of such a system-building effort.
 There are many efforts already underway that local communities could build on or
from which the state could learn.
What is the MCH role at the state and local level to address this priority? What are
some strategies that could be employed? What support would be needed to
implement these strategies?
 Coordination of services and supports for youth could include judicial and other
partners
 Importance of engaging youth in process and into the evaluation
 Where do we start? Mapping/assessing existing resources/gaps of services/supports
for youth?
 CSH (Coordinated Schools Health) is another strong influence on integrated services
(in Teller County school RNs sending home info on student BMI’s)
 Need policy approach in working with schools
 Need to be intentional about identifying public health role
 Teller County: NOT (Not On Tobacco) Program implemented in schools x5 years.
First year of 7th grade class having 0% of students reporting tobacco use.
 Youth ownership of their own health care (males and females): “health literacy”
 Transition of youth with special needs really applies to all children
 Use existing youth focused collaborative (i.e., Build A Generation)
 State role: helping to identify best practice strategies for different sub-groups of the
9-24 year olds
 Youth advisory boards exist across the state-can we tap into their expertise?
 Include health and mental health providers in process
 Usefulness of a document like the early childhood framework for the 9-24 year old
 Need to look to existing youth-serving entities to partner with
 State role: have ACAH and YPH—what do they see as role and focus? Sharing of
info-what works/what doesn’t? Sharing of evaluation and outcomes. Capture what
has been happening across the state
 Need best practice info in order to justify shifting resources to this priority
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Denver has WACCHO grant-hired public health intern to work on project-I.D.
strategies for how to engage youth in PH issues
Promotion and support for youth to have a core set of skills that can help promote
healthy choices and prevent choices that lead to violence-related issues, etc.
Public health could serve as convener and could write grants to help address specific
issues identified.
Not a short term objective—5-10 years of work
State role could be coordinating Learning Community model to help share
experiences and lessons learned.
Connect the developmental stages with the “subgroups” within the 9-24 year age
span
Need to shift expectations of our partners at the state and local level-key messages
to communicate this and plan for the shift.
Need to give up something to shift, can just add
At state level, the Adolescent 12 workgroup could be a partner
How does health care reform interface with this priority? The health care system will
be changing-do we have an opportunity to help shape that?
Why up to 24 years?
What is the interface with the Medical Home Initiative?
Important to have role at both the state and local level-need mapping of what already
exists to build upon
Goals/capacity could change depending upon the election lowering school funding
(60, 61 and 101 could tremendously impact services and supports for children and
For children/youth with special needs how do we achieve true integration/inclusion?
Including youth/engaging youth is critical for success
Seems like we/re better at including youth voice with older teens but not with the 913 year olds
Integration of DD system and healthy-this could be an opportunity to strengthen this
relationship
Expand MCH datasets to include a more comprehensive view of youth (education
data—Larimer County has tried to do this- could look at it as a model)
Need both state and local role to succeed in this priority
State could facilitate into sharing within and amongst communities
Reaching out to CCI (CO Counties Inc.) healthy and human services sub-committee
Need: info available within local communities (resource and referral) about available
resources and/or coalitions who may be working on certain issues
“Help Me Grow” for 2nd decade? Robust R&R system for youth
Compass (Larimer County) could we link county data sets/community assessment
information? Role of OPP?
System acronyms-language can be different across systems
Need investment in support of youth leadership
Training-how to build coalitions
Tool Kit for how to carry this out—coalition building youth)
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Common themes:
 It is critical to involve youth!
 Use existing advisory groups / efforts.
 There is a lot of learning to be gained from local efforts.
 No unfunded mandates.
 Some communities will need best practice resources, collaboration training, toolkits,
etc.
What health equity issues are involved in addressing this priority and how would
you address these issues?
 Real differences exist between “have” and “have nots” at the local level, i.e., MCH
funding is not equitable across the state
 Health equity issues exist related to youth who have newly integrated to the U.S. Big
issues like poverty and racism exist and are bigger than MCH
 Access to services and information is a disparity creates a “hard to reach population”
 HCP local programs role: already have specific services to provide-capacity issues
exist, role could be “being a voice for children/youth with special needs”
 Access to health insurance is a healthy equity issue for the 19-224 year old as well
as by income; pre-existing conditions; youth not in college who are not eligible to be
on parents’ insurance and may not receive insurance through work
Opportunities for integration across the life course?
Accessing health care from young adulthood into adulthood
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Priority 9: Reduce barriers to a medical home approach by facilitating
collaboration between systems and families.
What questions does this priority raise for you?
 Access to health care in rural areas. How?
 How do you measure this outcome?
 Medical Home team approach vs. place, how to define?
 Measure bigger population impact? How?
 Barriers are known – how to tackle?
 How do we capture collaboration across programs?
 How do we write objective (Process outcome)
 How do we measure this effort?
 How does a Medical Home team communicate
 Measure collaboration does it affect system? Who knows about it?
 PCPs need to get to other providers & specialists
 TEAM – How to get it; Advocate for it?
What Strategies could be employed at state/local level? Is this a priority that has
both state a local action steps? What is your advice?
 Have expertise & funding for CSHCN – this is bigger
 Already have connections with schools. Connect with their priorities
 Need to focus on outcomes
 ID data, Rural health
 New moms don’t think about care for child – address it in prenatal care
 Mental Health – Across life course
 Break down silos at CDPHE
 Identify barriers we have overcome
 Obesity
 Chronic disease across life course
 Complete Wellness approach (Schools)
 Staff expertise and capacity needs to be addressed
 We can/need to measure at state & local level
 Measure child/family outcomes: Barriers/Trust
 Small communities – lack resources, everything in Denver (barrier)
 Telemedicine can help but everything is in Denver
 “Get what you pay for”
 Health Care Reform
 Bill care coordination services; pool resources for care coordination
 Public Health is the convener,measuring overcoming barriers
 Promote team & communication
 ECC is a good example of system work
 Communication & collaboration
 Convene with families
 Measure family involvement at individual & community levels
 Learn from Education system
 Publc Health referral system developed – ABCD (also help providers
know about each other) Barriers – need data and “Surveys to
Solution”
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What health equity issues are involved in addressing this priority?
 This fits with Social network analysis
 What do families say?
 Target families’ needs
 Community Assessment should include coll & overcoming barriers; trends
 Cultural impact, how to measure
 Work on terminology
 Nurses – know what it is
 Patient Rights for Medical Home
 Terminology important
 Family Centered Care
 Family Engagement
 Family Leadership
 Communities may want to partner to identify barriers
 Advocate youth & families – know “Rights” – know what to ask for
 Engage families & providers
What opportunites for Integration exist across the lifecourse?
 Identify models of success
 Many agencies engage in collaboration models
 Collaborate with set agencies
 Where can we file/store Community Assessments
 Start with defining Public Health & Medical Home role
 Both family & system needs/barriers are important
 Start early to be a part of your care
 Public Health already doing this - Nurses – know what it is; Bigger
than HCP/CSHCN (Broad, All kids)
TEAM
Medical
Mental
Community
Oral
System
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