AAP Chapter Partnerships with Healthy Families America and Prevent Child Abuse America

Alabama

Chapter Executive Director: Linda Lee, APR

Project Lead: Elizabeth Dawson, MD, FAAP

Primary Organizational Partners: Alabama Department of Child Abuse and Neglect Prevention/Children’s Trust Fund/PCA Alabama

Project Summary

Through their partnership, the Alabama AAP Chapter (AL-AAP) and PCA Alabama hosted meetings in four geographically disparate regions of the state--in one community from each quadrant of the state: north, south, east, west. These local forums created partnerships between local pediatricians and home visiting professionals around prevention of child abuse in Alabama.
For the project’s state leadership team, the AL-AAP and PCA Alabama recruited their existing partners. The team included at least one pediatrician champion whose focus is on the treatment of child abuse and neglect, as well as representatives from AL-AAP, PCA Alabama, the Alabama Network of Family Resource Centers, Alabama Department of Human Resources, Alabama Department of Mental Health, Healthy Families Tuscaloosa, Healthy Families Huntsville, Children’s Trust Fund Parent Advisory Council parent leaders, and VOICES for Alabama’s Children.

The forums were held in December 2022 and January 2023 in Dothan, Tuscaloosa, Huntsville, and Opelika, AL. Each meeting provided an opportunity for physicians to connect with the home visiting and parenting resource providers in their area, with a goal of creating partnerships to strengthen families and communities as extensions of the pediatric medical home. The template agenda for each included:

1. Gathering Activity – Who’s in the Room?
2. Welcome/Overview – AL-AAP and CTF/PCA AL Chapter
3. Table Discussion – My Community Resources and Services Community Mapping
4. Large Group Discussion/ Share-back
5. Closing and Next Steps for local teams

At each meeting, attendees focused on the outcomes listed in #4 above, with a global aim of addressing how to build resilient communities. Table work included sharing resources to help pediatrician attendees locate resources for patients and families that will ultimately prevent child abuse and foster resilience. The outputs from this work will be shared with all attendees, other identified partners, and the entire AL-AAP membership.

Successes and Limitations

The breakfast forums were a great success and provided a protected space and time for the pediatricians to form meaningful initial relationships with the providers. Interestingly, there were many “a ha!” moments as pediatricians found out about services that they had no idea existed in their own communities! It was evident that these discussions could continue well past the allotted time; we are hopeful that more of these forums can be scheduled in the future for further connections to be made. The state leadership team is pondering ways to help guide the communities to continue the conversations, in addition to providing the web site with resources collected.
There were not many limitations or barriers outside of finding a time in the day for everyone to come together. We decided on scheduling early-morning meetings to not interfere with the attendees’ work schedules. Such an early start may have been a deterrent to some pediatricians and providers. In addition, the biggest challenge moving forward will be assuring that the conversations move forward at the local level, although we do believe that the tools we provide for them and a postcard reminder will both encourage continued collaboration.

Lessons Learned

We strongly believe that the relationship that the Chapter has built with our state PCA Chapter had a lot to do with the success of this work, and we cannot emphasize enough the importance of beginning those collaborations so that when opportunities such as this one present themselves, the relationship-building phase has already occurred. We also encourage finding a Chapter champion in each local area that will help drum up support for the project among their peers. We had a champion in each area and that helped assure participation. We were more than pleased with the turn-out among pediatricians, even during flu season!

This project was one of the most gratifying for our staff and pediatricians, because it provided a much-needed, in-person opportunity to connect with child resource providers in their own community. This grant opportunity fueled the fire for the attendees who participated, and we anticipate relationships to continue based on what we saw at these meetings.

Chapter Executive Director: Meredith Kennedy, MPH

Project Lead: Miriah de Matos (Associate Project Director)

Primary Organizational Partner: South Bay Community Services – First Steps (CA026) (South region HFA site)

Project Summary

As part of this project, the AAP CA-3 Chapter planned and executed a communications campaign and in-service training for a federally qualified health center in the South region of San Diego County. This project laid the groundwork for what the team hopes will become a stronger partnership between pediatric offices and San Diego County HFA sites, especially in the South region of the county. During the 6 months of the project, AAP-CA3 worked to develop a shared understanding of how the goals of Chapter pediatricians and HFA sites are aligned.

The field of evidence-based home visiting is well-known and respected among pediatricians. That said, pediatricians and office staff often do not have enough information to promote referral pathways, especially the office support staff who typically facilitate referrals. This grant allowed the team to develop awareness and understanding of the HFA model and First Steps (the local San Diego County HFA program). This learning began within the organization with collaboration between AAP-CA3 staff managing Chapter pediatricians and staff serving on the HFA Central Administration project team. While individual efforts align with the organization's mission, the target audience and partners differ. The AAP-CA3 Marketing and Communications Specialist, who leads outreach and communication with the local pediatric community, has not been trained in the HFA model or the HFA Advantage, which sets this program apart from other evidenced-based programs. The HFA Central Administration team is equally as disconnected from the pediatric side of the CA-3 chapter’s work. This grant allowed the Central Administration team to build a stronger relationship with the Communications Specialist and Pediatric Champion as well as identify opportunities to promote the First Steps program when outreaching to pediatricians about the other programs (Reach Out and Read and Healthy Development Services). The project team recognized the gaps in understanding across the two teams and, through this partnership, began to fill those gaps.

Strategies to engage pediatricians included development of social media posts and communications with language and messaging to raise pediatric awareness of San Diego’s HFA program. While AAP-CA3 previously had a captive audience of engaged pediatricians before this grant, the communication tools had not been used to educate them on the HFA program and the South region site.

Reach Out and Read (ROR), an AAP-CA3 chapter program, is working to introduce the HOPE Framework across San Diego County, which aligns closely with the HFA goals. First Steps was presented at a HOPE training for pediatric clinics, participating in ROR, to highlight HFA sites as a referral source to promote HOPE. The HOPE presentation ended with two slides highlighting First Steps as a support to families and a bridge to pediatric well-child care. The new First Steps flyer, targeting pediatricians, was included in the chat.

During this project, the team also established a partnership with Family Health Centers of San Diego, a Federally Qualified Health Center, through the Pediatric Champion, Marsha Spitzer. She has provided background and details on how the South Bay clinics operate and expertise on engaging these sites based on their current perinatal programming and understanding of home visitation. The Chapter team is actively working on scheduling a presentation with pediatricians and obstetrics departments and have already begun revising the typical presentation to address pediatric clinics' unique interests and language so that they are engaged and motivated to seek referral partnerships.

First Steps was recently contacted by the Kaiser Pediatrics and Obstetrics departments. We are working on scheduling a meeting to present the program and to be added to the Thrive local referral process. This partnership would benefit all four First Steps HFA programs, including our SBCS site in South region.

Successes and Limitations

Pediatrics and child abuse prevention programs share similar goals but often speak completely different languages. While the ACES initiative in California has created an initial bridge in language around adversity and trauma-informed care, we don't yet share the language of prevention.

To further bridge the language gap, much of our work for this project focused on learning how to outreach and communicate with pediatricians in their “language”. For example, HFA is an infant mental health program. The pediatric community refers to this work as early relational health.

A common challenge among HFA programs is organizations assuming that HFA staff are equivalent to a "case manager" role. This is especially prevalent in community clinic settings. This assumption overlooks the 140+ hours of training staff receive upon hire, ongoing professional development, and reflective supervision. In the field of home visiting and locally, this has resulted in low-pay and high turnover. During the project, we also learned that some clinics in the South Bay use the title of Family Support Specialist for staff who provide a brief service for families in pediatrics. This knowledge informed our messaging campaign around what sets an HFA FSS apart from other family support workers or case managers. That said, there are parallels in the role, and shifting clinics' understanding will require training and strong partnerships to develop a long-term referral partnership.

Lessons Learned

HFA is releasing new training for funders and partners, which may benefit AAP chapters. Pediatricians and their staff are overburdened and strained, especially after the pandemic. Chapters will need to address the gaps in understanding through careful messaging and partnerships to create a space where pediatricians and their staff see HFA partners as an extension of their efforts.

Chapter Executive Director: Cindy Calderon, MD, FAAP

Project Lead: Cindy Calderon, MD, FAAP

Primary Organizational Partners: Healthy Families Puerto Rico (Familias Saludables)

Project Summary

As part of this project, Dr Calderon participated in the Puerto Rico Healthy Families America Advisory Committee, to promote best practices pertaining to health and wellness by providing support, orientation, and advice in health topics of relevance to the program’s intervention. Additionally, 3 family representatives (all young mothers) were recruited (and compensated) for their participation on regional advisory committees for the Healthy Families Puerto Rico program. As part of the collaboration between staff and the family representatives, needs and gaps related to the health of children (and parent participants) were identified and strategies to address them were proposed.
To ensure that the family representatives felt comfortable and empowered to contribute during their respective regional meetings, Dr Calderon met with them virtually to provide training and mentorship. She also created tools to help support their engagement in the advisory committees.

Strategies to address the unique needs identified as part of this family engagement collaboration included the creation of print posters promoting vaccination schedules, the importance of preventive pediatric visits, and signs of perinatal depression. Magnets were developed with QR codes so that families could more easily access information about first aid and breastfeeding. A social media campaign with messaging around safe holidays and family time were created and published as advertising on social media. A CPR training was also implemented for HFA staff and families, as this was a need identified by both families and HFA staff. Finally, a workshop for HFA staff, families, and pediatricians will be held in the summer of 2023, and will be titled “Supporting Families in Crisis”. The workshop will focus on navigating social media misinformation on vaccinations, promoting resiliency, and the identification and management of mental health concerns in families.

Social media posts and posters developed through this collaboration with families can be accessed via the AAP Puerto Rico Facebook page and Instagram page.

Successes and Limitations

The team found it very valuable to meaningfully collaborate with 3 family representatives to better understand the needs and gaps within the HF program. The development of strategies to address these needs and gaps were also successful.

Lessons Learned

The Puerto Rico AAP Chapter collaboration with the Healthy Families Advisory Committee is a very gratifying experience. Pediatricians can help HF staff to better understand many of the evidence-based recommendations from the AAP and how to promote them to the participating families. Additionally, the engagement of family representatives supported the development of materials that were linguistically and culturally sensitive to the population served in Puerto Rico.