Healthy Tomorrows Partnership for Children Program

For more information on any of these HTPCP projects, please e-mail your name, address, telephone, and fax numbers with your specific request to healthyt@aap.org.

ALABAMA

TEENS EMPOWERED THROUGH EDUCATION AND NURTURING (TEEN) (1996)
Family Oriented Primary Health Care Clinic, Inc, Mobile, AL
The goal of this project is to decrease child abuse and neglect and reduce repeat teen pregnancy in a targeted population of 400 first-time mothers receiving care in our maternity clinic. The voluntary program will have outreach workers who will conduct home visits using an educational curriculum. The mom and the child will be followed during the child's first five years of life. The curriculum used will be the Healthy Families America Program, which has been tried successfully in other parts of the country. The social worker supervisor will supervise the family support workers and provide case management services. Project staff provide home visits to each participant beginning with weekly visits. The frequency of visits vary based on patient need. Home visits focus on family strengths, preventive health schedules, promoting positive parent/child relationships, and teaching teen mothers to cope with the burdens of parenting.

CONTINUITY OF MEDICAL CARE FOR FOSTER CHILDREN IN
JEFFERSON COUNTY, ALABAMA (2001)
Family Place Pediatric Practice (FPPP), Birmingham, AL
Foster children in Jefferson County, Alabama are particularly at-risk for inappropriate or substandard care due to a lack of continuity of care as a consequence of changed providers and case workers with placement changes. The lack of continuity of medical care results in several serious problems, including over-immunizations, under-immunizations, failure to receive routine laboratory tests or needed referrals to specialized child care services, and increased risk of missed appointments and unfinished treatment regimens. In collaboration with the Jefferson County Department of Human Services, the project will provide 150 foster children a continuous source and site of comprehensive medical care, irrespective of any change in the child's placement. The goals of the project are to provide:

1. continuity of medical care for foster children, and
2. a pilot study for statewide application.

ALASKA

NEW BEGINNINGS IN NATIVE HEALTH (1994)
Southcentral Foundation, Anchorage, AK
Although the Alaska Native and American Indian population in the Anchorage area make up less than 10% of the total population, statistics indicate that this population is responsible for 33% to 40% of the area case load related to child abuse and neglect. This Healthy Tomorrows Partnership for Children project will reduce child abuse and neglect by providing home visits and family support services to an estimated 200 Alaska Native/American Indian families over the 5-year grant period. Services will include crisis intervention, provision of emotional support to parents, informal counseling, role modeling of appropriate family relationships, enhancement of communication and life coping skills, and referral to other services as necessary. A management information system linked with the goals and objectives will be used to monitor and assess accomplishment of the goals and objectives.

RURAL TOTS (1996)
REACH Infant Learning Program, Juneau, AK
Comprehensive medical and educational services are very limited in the remote areas of Southeast Alaska. The REACH Infant Learning Program provides services to families with children with developmental disabilities from birth to three years. Rural TOTS will provide families with locally-based support and offer multidisciplinary assessments in six remote Southeast Alaska communities by developmental specialists. A family service coordinator will be hired in Hoonah. In Haines, the educator position will be expanded so that more families can be served on a regular basis. The TOTS Team (Team of Transdisciplinary Services) will travel to six remote communities to provide assessments to twelve families annually. The team includes a pediatrician, physical therapist, occupational therapist, speech therapist, educator, and nutritionist as needed by the family. The TOTS team will provide training in the communities during their visit. Twenty-five families will receive comprehensive and coordinated services during the first year. Sixty additional families will be served in the following years.

THE CHILDREN'S PLACE: A CHILDREN'S ADVOCACY CENTER FOR THE MATANUSKA-SUSITNA BOROUGH (1998)
Wasilla, AK
Alaska has the highest rate of substantiated child abuse in the nation: 38 per 1,000 children compared with the national average of 12.6 per 1,000. Our local child protection agency received nearly 1,500 reports of harm in 1997, 20% of them for sexual abuse. Of these reports, 800 were not investigated due to staffing shortages. Investigation and prosecution are limited by staffing shortages, lack of training in the area of forensic child interviewing, and lack of a coordinated interdisciplinary team approach to the problem. One way to decrease the trauma for abused children, maximize the resources we currently have, and increase the rates of prosecution for child molesters is by developing a Children's Advocacy Center, which we've named "The Children's Place." Children's Advocacy Centers are child-focused, neutral-based facilities where professionals from many disciplines meet to conduct forensic interviews and provide medical exams and other services for children who have been abused. The multidisciplinary approach brings together all team members involved in child abuse investigations: law enforcement detectives, child protection social workers (DFYS), medical examiners, prosecutors, mental health professionals and child advocates. The goals of this project are: to have a coordinated multidisciplinary team approach to child abuse investigations, improve short and long term outcomes for children and families referred for suspected abuse and neglect, and to increase community awareness and detection of child abuse and neglect.

ARIZONA

THE PHOENIX BREATHMOBILE: A MOBILE ASTHMA CLINIC FOR INNER-CITY CHILDREN (1999)
Phoenix Children's Hospital, Pulmonology Department, Phoenix, AZ
Asthma is a chronic inflammatory disease of the airways that if not treated, can cause permanent lung damage or even death. It is the most prevalent of all childhood chronic illnesses, resulting in 10 million missed school days each year and a high incidence of learning disabilities and grade failures. The prevalence of asthma in Arizona children has risen 23 percent between 1982 and 1992. Maricopa County has the third highest death rate compared to other US Counties. The problem is particularly acute in inner-city areas due to environmental conditions and lower socioeconomic groups. The target population is highly indigent, underinsured and medically undeserved children in inner-city phoenix. The primary goals of this program are to decrease asthma-related morbidity (missed school days, hospital visits, ER visits) and mortality and to improve "quality of life" in children with asthma. The secondary goals are to enroll eligible uninsured children into state Medicaid programs and establishment of medical homes. The Breathmobile is a mobile medical coach that will travel to elementary schools. The program will screen 100% of children in the school districts served and provide asthma diagnosis, medical treatment, education for children and their parents, and follow-up services. Case management and 24-hour phone support for asthma related illness and questions is provided. Eligibility screening for state Medicaid programs and assistance with the enrollment process is provided

COMMON/UNITY:CREATING OPTIMISTIC BRIGHT FUTURES FOR CHILDREN AND THEIR HOMELESS, YOUNG SINGLE PARENTS (2000)
University of Arizona, Tucson, AZ
Common/Unity is a multi-agency, community-wide effort originating with the Arizona Prevention Center at the University of Arizona. The project attends to the nationally recognized problems of child abuse and neglect. Common/Unity is designed to address the needs of single adolescent parents with little or no support systems through attention to three factors:

1. An inter-generational cycle of poor attachment between parent and child associated with insufficient or inappropriate parenting;
2. Low self-esteem and a sense of non-belonging for the adolescent; and
3. A lack of appropriate support systems.

Based within a safe and affordable apartment complex, 25 to 30 homeless, young single parents and their children will participate in a village-style community for two years. They will share common lifestyle, issues, and space. They will receive support and education in health issues, parenting skills and child development, life skills, education completion, and community involvement. Through the use of the nationally recognized Parents as Teachers curriculum administered in a stable environment, it is the objective of the Common/Unity project to interrupt the generational cycle of poor attachment and inappropriate parenting, and to enhance parental self-esteem by empowering parents to appropriately care for their child(ren). The village setting will allow these young parents to assist and support each other to improve their lives as well as the lives of their children. The project will serve as an orientation for pediatric residents and nursing students to community involvement activities.

ARKANSAS

CREATING OPPORTUNITIES TO COMBAT OBESITY IN ARKANSAS (2001)
Arkansas Children's Hospital, Little Rock, AR
Public health officials in Arkansas have listed childhood obesity as the state's number two public health problem after tobacco use. These obesity rates have lead to a dramatic increase in type 2 diabetes and hypertension in both adolescents and young adults in Arkansas. The program will provide clinical evaluations of obese children or who are overweight with co-morbidities, such as hypercholesterolemia, hypertension, and type 2 diabetes. Screenings will be provided in populations, which typically have poor access to health care and are at high risk for obesity. Finally, the program will provide community and physician targeted education about the complications of obesity and effective methods of reducing obesity.

CALIFORNIA

PROJECT FOR ATTENTION-RELATED DISORDERS (PARD) (1989)
San Diego Unified School District, Health Programs Office, San Diego, CA
Project staff are developing a network to provide diagnostic and therapeutic intervention services to low-income children and youth who exhibit symptoms that suggest attention deficit disorder. The network includes pediatricians, nurses, school teachers, and school support personnel. Now in the fifth year, project staff have provided in-service training to 130 school counselors and counseling aides, 55 school psychologists, and 140 school nurses. In-service training for teachers has been conducted at over 200 school sites, and 15 pediatricians have been recruited and trained to participate in the project. The project has conducted yearly in-service training for community pediatricians as well. There is monthly training available to all district personnel and parents. A teacher intervention manual has been provided to any district teacher requesting assistance. The project has developed a parent brochure to assist parents in understanding attention deficit and hyperactivity, its management, and treatment. To date, over 500 students have been identified and are receiving services through the project.

ADVOCATES FOR CHILDREN PROJECT (1992)
Pediatric Diagnostic Center/Associates, Ventura, CA
The goal of this project is to reduce child abuse and neglect in a targeted population of high-risk families. Women giving birth at Ventura County Medical Center are assessed for child abuse risk factors, and at-risk families who live in Oxnard, CA, are invited to participate in the project. Five part-time family support workers have been recruited from the targeted community and trained to provide home visitation and intervention services. A public health nurse supervises the family support workers and provides case management services. Project staff plan to recruit 50 families to participate initially and provide home visits to each, beginning with weekly visits during an infant's first 3 months at home. The frequency of the home visits decreases as family functioning improves, and are provided monthly for a minimum of 2 years. Home visits focus on reducing family isolation, enhancing the emotional development of the children, promoting positive parent-child relationships, and increasing parental self-esteem.

BRIGHTER TOMORROWS: INTERNATIONAL ELEMENTARY SCHOOL FAMILY CENTER HEALTH PROJECT (1992)
The Children's Clinic, Long Beach, CA
The International Elementary School, a public school serving multicultural and multiethnic low-income children in downtown Long Beach, CA, has developed the Family Center to meet health, social, and legal needs of children and families of the school. This project has addressed the health components of the Center by developing a health and fitness educational program for students, teachers, and parents to improve immunization rates and lifestyle behaviors, and reduce the rates from delayed diagnosis and care of treatable diseases. Lead by The Children's Clinic, a local nonprofit community clinic, this project also provides bimonthly immunization sessions and an on-site clinic providing screening, diagnosis, and treatment services. Students and siblings seen in the clinic receive pharmaceuticals and are eligible for specialty services at The Children's Clinic. Twenty-four hour telephone accessibility and inpatient care provides a true "medical home" and continuity of care. A nonprofit mental health clinic provides evaluations, treatment, and referrals for psychological and behavior problems, and the school-wide fitness program is coordinated through the local YMCA.

EAST COUNTY HEALTHY TOMORROWS GROUP WELL-CHILD CARE PROGRAM (1992)
East County Community Clinic, El Cajon, CA
East County Community Clinic is the only community clinic available to an ethnically and economically diverse population of 430,000 people living in this sparsely populated county. Through collaboration with various health care agencies in the San Diego area, this project aims to provide family-oriented preventive pediatric care and to coordinate services with a comprehensive perinatal program that focuses on existing resources available in the region. Through an affiliation with The BirthPlace, clinic patients will receive health education, birthing, and follow-up services in a group setting. Six to eight parent/child teams meet with a pediatric provider at the AAP-recommended periodic screening intervals for examinations, health education, and immunizations during their first 3 years of life.

HEALTHY TOMORROWS PARTNERSHIP FOR CHILDREN (1992)
AAP California Chapter 4, Orange, CA
About 26,000 elementary school children in the Santa Ana Unified School District are without adequate health care and appropriate resources for necessary follow-up care. The local AAP chapter is working with Children's Hospital of Orange County, the Santa Ana Unified School District, and the Orange County Health Department. Together, they have been developing a comprehensive school health education and direct service program. These goals have been accomplished by developing a mobile van clinic staffed by a bilingual pediatrician and a registered nurse, who are providing immunizations, well-child physical examinations, and sick visits. Follow-up care is provided by 26 area pediatricians and many pediatric subspecialists who have agreed to accept two to three patient referrals per month. A parent education coordinator is developing culturally sensitive parent education and leadership/mentor programs.

THE SAN DIEGO HOMELESS ADOLESCENT HEALTH CARE PROJECT (1993)
Logan Heights Family Health Center, Inc, San Diego, CA
This project is an effort to bring much needed medical services to homeless adolescents and their families. A bilingual health care team will provide comprehensive, case-managed health care and education on-site in places where these teens live and congregate. The team will be composed of a pediatrician/project director, outreach nurse practitioner, health educator, nurse/case manager, data specialist, and patient accounts representative. In the first year, the health team will conduct clinics, provide outreach, create a coalition of community agencies and pediatric professionals dedicated to serving adolescents, collect and disseminate data on medical conditions and contagious diseases, and obtain a detailed risk assessment to monitor clients' knowledge, attitudes, and behavior. Data will be evaluated annually to assess the impact of the intervention and will demonstrate increases in: the number of homeless and near homeless teens receiving health care and education, the number screened and treated for tuberculosis, the number using contraceptives, and the number enrolled in prenatal care. Also, case management meetings involving the various agencies serving homeless youth will improve coordination of services and reduce fragmentation.

SAN DIEGO COUNTY DENTAL HEALTH INITIATIVE (1995)
Children, Youth and Families Health-CHDP Program, San Diego, CA
The goal of this initiative is to improve the oral health of San Diego County children. This will be accomplished by developing systems to assist children who have critical oral health needs to receive immediate care and by developing education modules that emphasize the prevention of oral health problems. The dental referral system will link 200 dentists volunteering their services with low-income children who have urgent dental needs and no resources for care. A low-cost, extended-payment program will also be developed to assist children who have less severe oral health needs and who can, over time, afford to pay for some care. Additionally, a preventive component will provide community-based, culturally appropriate oral health education. To implement this, partnerships will be developed with community agencies including the Supplemental Nutrition Program for Women, Infants, and Children (WIC), Healthy Start and Head Start programs, and state preschools.

HUMBOLDT HEALTHY FAMILIES - A FAMILY HOME VISITING COLLABORATIVE (1996)
Humboldt County Public Health Department/MCAH Division, Eureka, CA
This public/private collaborative aims to address high rates of child abuse and neglect and post-neonatal death by intensively screening for risk of child abuse and neglect in families at the time of birth of a newborn. This program assures systematic referral of families at risk to long-term home visiting services by coordinating and mobilizing public and private home visiting agencies. Data collection will track health and social functioning indicators in families over time, provide evaluation information about agencies' activities, about the support activities of the Collaborative and about gaps in services in our community. Staff training and support activities will assist our rural community agencies in training professional and paraprofessional home visiting staff and in developing a common, strengths-based philosophy of work with families at risk.

8% EARLY INTERVENTION AND CHILD HEALTH IMPROVEMENT PROJECT HEALTH CARE PROGRAM (1997)
American Academy of Pediatrics CA Chapter, Orange County, CA The 8% Early Intervention Medical Project Health Care Program will works in collaboration with the Orange County Probation Department's 8% Early Intervention Program for high risk youth and their families and addresses the following concerns: high risk health behaviors in youthful offenders and their siblings; the provision of culturally appropriate, age specific, health education to address high risk behaviors, or other behavioral that facilitate developmental accomplishments; treatment of unmet medical needs and the provision of a medical home for youthful offenders and their siblings; identification and treatment of learning disability in the population; and the medical needs of the offenders and provision of treatment for siblings of the 8% minors. The goal of the of the program is to improve the health status and functional ability of the entire family. The project aims to reduce drug use, clinical depression and suicidal behavior, child abuse and neglect reports, and chronic debilitating disease and injuries among the target population, as well as increasing the number of parents receiving parenting skills education. These goals will be accomplished by linking with the Deputy Probation Officer, referral of 8% youth and family to medical services program and a case manager for screening, implementation of an abuse prevention/intervention plan, the development of a health plan for each individual and family, and linkage to a medical home.

THE ANDERSON AND HAPPY VALLEY HEALTHY CHILDREN AND FAMILIES PARTNERSHIP PROJECT (1997)
Shasta Community Health Center, Redding, CA
Children and their families in the south geographic rural area of Shasta County, California have long been medically underserved. This situation has worsened by the downturn in the local economy driven by the demise of the timber industry in the area. This has translated into low pre-school immunization and well-child exam rates, high teen pregnancy rates, and excessively high rates of spousal and child neglect and abuse. This project allows Shasta Community Health Center, a community health center based in Redding, CA, to operate two school-based/linked clinics in the south Shasta county area in cooperation with "The Anderson Partnership for Healthy Children." This partnership, a coalition of public and private organizations, as well as members of the community, was established to seek creative ways of improving the health status of the children in Redding. Services are integrated between agencies to maximize limited resources with oversight provided by the Partnership's community advisory board. Clinic services include primary care, medical consultation services, and coordinated "high risk" family case management. The primary objectives of the program are to improve well-child care and decrease rates of teen pregnancy and spousal/child neglect and abuse. Evaluation measures will be used to monitor each of these outcomes over time.

SAN DIEGO KIDS HEALTH ASSURANCE NETWORK (SD-KHAN) (1997)
San Diego, CA
There are approximately 150,000 uninsured low-income children in San Diego County who do not have access to comprehensive primary care providers. These children are more likely to be under immunized, face delays when they require medical care, as well as be more likely to require hospitalization and have longer hospital stays. Supported by an efficient automated information and referral infrastructure, San Diego Kids Health Assurance Network (SD-KHAN) will improve access to medical care by referring and matching children to a network of health care providers. Children from low income families will be provided the opportunity to establish a medical home with the most appropriate pediatric providers willing to provide services at no cost, low cost, extended payment schedule, or discounted insurance premium. Recruitment of providers, development and maintenance of the information and referral system, integrating services with California Healthy Families Program (California's plan to meet the requirement of the new Title XXII of the Social Security Act) will be carried out to support the Project Materials developed will include educational packets for families, form and documentation to support the automated information and referral system, project tracking, and evaluation.

INFANCIA FELIZ (1997)
Vista Community Clinic, Vista, CA
Mexican immigrant women experience better than expected perinatal outcomes, yet by two years of age these children are behind their peers in most measures of health including immunizations and well child checkups. Infancia Feliz provides education and support to the families of Hispanic children in an effort to improve the child's health status and to determine how to best provide infant health care services to the largest ethnic group in our state. Eligible mothers to receive prenatal care through the Vista Community Clinic are Spanish speaking and between the ages of 15 and 30, are new comers to the United States, are first time mothers, have a family income at or below the poverty level, and deliver a healthy newborn. The project objectives are:

1. to identify, enroll, and provide continuous follow-up care to all eligible mother-infant pairs through the infant's second year of life;
2. to increase utilization of the infant health care system for immunization and well child visits;
3. to improve the overall health status of project infants;
4. to educate mothers about infant health and appropriate utilization of the infant health care system;
5. to provide an accessible continuum of health care from the prenatal period through the infants first 2 years of life.

The project will provide individual case management , home visits and health education classes to all participant families, the project staff plan to provide services to a minimum of 40 mother-infant pairs per year.

ON TRACK VIOLENCE PREVENTION & PEDIATRIC COLLABORATIVE (2000)
Orange County On Track, Nonprofit Organization, Orange County, CA
Orange County On Track is a nonprofit organization dedicated to improving the quality of life for families and children through a focus on non-violence and respect for all cultures. The On Track mission is achieved through a public health model in the following unique ways: 1) Youth-to-Youth Mentoring program, which trains and matches teen role models with at-risk elementary school children: 2) Conflict Resolution Training programs; 3) Tutoring and academic enrichment programs; 4) The On Track magazine, free to the public; 5) and "Teen Councils" that give culturally diverse groups of students the opportunity to help develop and implement solutions for a safer society.

The ON TRACK VIOLENCE PREVENTION AND PEDIATRIC COLLABORATIVE was designed to expand the On Track Youth-to-Youth Mentoring and Conflict Resolution Training programs as well as the Teen Councils to an economically disadvantaged area in the City of Anaheim, where families do not have the same access to health care and special programs that are available in more affluent areas in the city. The primary goal of the Collaborative is to make life-changing improvements with the identified at-risk youth and their families in order to lower the risk of their getting involved in gangs, crime or violence. Also, the goal is to improve the health status and quality of life for these children and to create a successful public health model for other cities.

Based on successful implementation of the On Track programs in other Orange County cities, the following steps will be followed. The first step involves identifying at-risk kids as mentees, then selecting and training qualified youth mentors for the On Track Youth-to-Youth Mentoring and Conflict Resolution Training Program. The next step is to match mentors and mentees, prior to beginning a structured conflict resolution program, which includes many personal development themes. Youths are then provided with weekly tutoring by second-year pediatric residents and other volunteers. During these weekly, year-round, three-and-a-half-hour meetings at the school site (which is sake for all concerned) learning activities are interspersed with sports, arts and crafts, and snacks. All activities take place after school hours, which are the critical hours for juvenile delinquency, and are on a voluntary basis. The exception to this is: weekend special events or small group discussions on firearm injury prevention and child & adolescent health issues, in addition to leadership retreats for teens.

KIDS COME FIRST PROGRAM (2001)
YWCA of the West End, Ontario, CA
The Kids Come First project will provide pediatric care for children in the south/central region of Ontario, an economically depressed region with 20% of the population at or below the federal poverty level. Issues of poverty, substandard housing, high unemployment, low wages, a large number of undocumented immigrants, and lack of transportation impact health care access in the community. The project is centered on two Healthy Start school clusters with pre-kindergarten, elementary and middle schools in the heart of one of the region's poorest neighborhoods. The Kids Come First project assists largely immigrant and Hispanic families to access health care by providing comprehensive services and screening through a school-linked health center. Its goal is to improve student and family access to primary medical care that includes preventative health care screening and acute care treatment.

CHILDREN'S HEALTH CENTER ANEMIA PROGRAM (2001)
Sonoma County People for Economic Opportunity, Santa Rosa, CA
The Children's Health Center will embark on an anemia prevention program, combining better access to pediatric care at the neighborhood level for families and better access to pediatric expertise on a county level. The program will replicate the outreach model used for a successful program to improve immunization rates in low-income children from largely Spanish-speaking families. Program objectives include: 1) increase access to a medical home to prevent anemia among the target population; 2) decrease wait times for health supervision visits; 3) decrease anemia rates; 4) produce a countywide paper on best practices for preventing anemia; 5) produce a set of health supervision tracking sheets with accompanying information for parents in English and Spanish.

PEDIATRICIAN EDUCATION PROJECT FOR (PEP) FOR FAMILY HEALTH (2003)
Division of Community Pediatrics, University of California San Diego , La Jolla , CA
Lack of health coverage or knowledge of how to use health coverage precludes families from receiving medical care and beneficial preventive health information. The goal of PEP is to ensure children in vulnerable families have access to a medical/dental home and targeted preventive child health messages to improve their health, well-being and academic performance. The project will develop partnerships with employers at-risk of having employees with uninsured children and provide training, information, and referrals to children's health coverage and a medical/dental home. In conjunction with the state chapter of the American Academy of Pediatrics, the Dyson Initiative, and the San Diego County; Public Health Services; Children, Youth, and Families program, PEP will provide presentations and written messages at the workplace for employees without health coverage for their children as a job benefit.

THE PEDIATRIC MEDICAL HOME PROJECT AT UCLA (2003)
David Geffen School of Medicine at UCLA and the Mattel Children’s Hospital, Los Angeles, CA
The Pediatric Medical Home Project at UCLA will implement a four-pronged initiative comprising care coordination, Resident medical education, prospective pediatric health services research and community awareness and involvement for children with special health care needs. The project plans to provide care coordination for children with special health care needs in a medical home setting to be established according to guidelines established by the AAP through the outpatient general pediatric program at UCLA. In addition, it will develop and implement a structured resident education program to consist of formal lectures and seminars as well as teaching in the clinical outpatient area. In addition, prospective pediatric health services research will be conducted in conjunction with the UCLA School of Public Health to evaluate the effect of the program on both the awareness of pediatric residents with regard to medical home concepts and on the clinical outcomes of the patients enrolled in the medical home. Finally, the project will increase community awareness and involvement for children with special health care needs by developing and strengthening relationships with community organizations and by compiling and disseminating a community resource guide. The goal of the project is to provide a medical home for children with special health care needs in West Los Angeles now while training pediatricians to provide medical homes to their patients in the future.

NORTH COAST PEDIATRIC DENTISTRY INITIATIVE (2004 Oral Health Grant)
California Parenting Institute, Santa Rosa, CA
NCDPI is a collaboration of child health advocates from California's Sonoma, Lake, and Mendocino counties that consists of Delta Dental, public health officials, Sonoma, Mendocino and Lake County First 5 Commissions (created by Proposition 10 to fund early childhood programs), child advocates, dentists, Tribal and Indian Health, pediatricians, Head Start, directors of Community Health Centers, Regional Centers, and parents. This community-driven collaboration developed out of the desire of parents and service providers to address a serious gap in services for young children living in the north coast of California. Thousands of children living in the region suffer the effects of Early Childhood Caries (ECC) and are unable to find accessible dentistry with anesthesia. To solve this problem, NCPDI is creating a community-based surgery center in the tri-county region. NCPDI's goal is to open an outpatient care delivery site for children with ECC and children and adults with developmental disabilities. Providing locally available, self-sustaining dental surgery services will reduce long wait times for intervention and eliminate the pain, suffering, and developmental challenges untreated ECC imposes. The surgery center will provide restorative dentistry services for children regardless of their insurance status or ability to pay and will provide access to dental services to people with special needs who are unable to utilize regular dentist office services. NCPDI's long term goal is to reduce the need for surgery by improving parents' and providers' understanding of the need for oral hygiene and regular dental visits, through incorporating prevention efforts into a comprehensive case management program to serve the families of children receiving services at the surgery center. NCPDI will also provide a care subsidy program to assist families in paying for services, particularly families of children who are uninsured.

CREATING OPPORTUNITIES FOR PHYSICAL ACTIVITY (2005)
Little Company of Mary, Torrance, CA
Creating Opportunities for Physical Activity (COPA) in San Pedro, California motivates children and families to increase the frequency of physical activity in their daily lives and expand community access to public and private recreation and activity sites. The goals of COPA are to increase the frequency of developmentally appropriate physical activity in elementary aged school children, encourage parents/guardians and school staff to become health champions for themselves and their children, and to involve community stakeholders to raise the community priority for physical activity in children through advocacy and improvements in community infrastructure. The COPA project proposes to engage first through sixth grade students in an eight week, twice a week after school intervention designed to increase the frequency of physical activity in children, expand the mastery of age appropriate movement skills, improve attitudes about physical activity, and teach self-assessment skills.

FORTALECIENDO COMUNIDADES (STRENGTHENING COMMUNITIES) (2006)
Community Action Partnership of Sonoma County, Santa Rosa, CA
The Fortaleciendo Communidades (Strengthening Communities) project brings together an active group of community members and community organizations to address health issues among low-income children due to poor nutrition and lack of adequate physical activities. The focus of the project is childhood obesity. The project will address this issue through a multi-faceted approach including community organizing, working with the schools, parks and recreations, partnering with health care providers, and strengthening the nutrition safety net. The goals of this project are to provide low-income children with access to a culturally competent medical home, to increase access to health care providers for low-income children, and to improve community access to healthy foods and physical activity in the low-income community through the Family Activity and Nutrition Task Force.

SAN YSIDRO HEALTH CENTER SCHOOL READINESS INITIATIVE (2007)
Centro de Salud de la Communidad de San Ysidro, San Ysidro, CA
A strong need exists for early screening, detection and intervention of conditions that impact children’s health, well-being and ability to learn. The San Ysidro Elementary School District and the South County Special Education Local Planning Area have developed strategies to improve school readiness. These strategies include identifying children with developmental and behavioral conditions prior to starting school and assuring children have a “health care home” for ongoing care. The School Readiness Initiative will implement a comprehensive screening, assessment, and clinical intervention program for children ages 3-5 living in the San Ysidro Elementary School District catchment area. This project will expand the outreach screenings to include developmental screenings. The project will also enhance access to developmental and behavior pediatrics, provide pediatric care coordination services, and establish “health care homes” for children in the community. These new components will address a community need for developmental and behavioral health services and coordination of health care services for at-risk Latino children and families. The ultimate goal of San Ysidro Health Center School Readiness is to ensure children in the San Ysidro Elementary School District catchment area enter school healthy and ready to learn.

THE CHILDREN'S CLINIC MENTAL HEALTH PARTNERSHIP FOR CHILDREN PROGRAM (2008)
The Children's Clinic, Serving Children and Their Families, Long Beach, CA
Approximately 20% of all children experience mental disorders, however only about 21% of those children who need mental health services are able and willing to access them.  There are large ethnic and racial disparities with minorities receiving less and lower quality mental health care.  The stigma of accessing mental health services, lack of insurance and other financial issues, limitations with carve-out programs or benefit caps, cultural and linguistic barriers, and a shortage of mental health professionals contribute to the disparities. The Children’s Clinic, Serving Children and Their Families (TCC) is developing the Mental Health Partnership for Children program to improve the overall health and wellness of TCC patients by (a) improving screening and identification of mental health disorders, (b) improving access to mental health services for those in need through on-site mental health staff, and (c) increasing collaboration among community agencies.

HEALTH SERVICE OUTREACH, EDUCATION AND PREVENTION FOR WILMINGTON, CALIFORNIA (2008)
Robert F. Kennedy Institute, Wilmington, CA
The residents of Wilmington, Los Angeles are predominately poor, Latino immigrants who have some of the worst health indicators and, correspondingly, lowest health insurance and health service utilization rates of any population in the state. The Robert F. Kennedy Institute (RFKI) of Wilmington will expand its education and outreach efforts in the public school system, where it runs the area’s Healthy Start, to focus on health care and health services in the Latino community. The project will use their highly successful promotora model, in which people from within the target community are trained as outreach facilitators, to begin bringing underserved residents into the health care system. The project goal is to enroll eligible, needy children and families in public health insurance programs and assist them to access locally available services.

MENTAL HEALTH SERVICES FOR CHILDREN IN PUBLIC HOUSING (2009)
UCLA Community Health and Advocacy Training Program, Los Angeles, CA
The Mar Vista Gardens Health Center is located on the campus of a public housing development in an underserved area of Los Angeles. Most children are Latino from immigrant families and demonstrate significant disparities in areas of health and development. The proposed School Function Program is a prevention strategy to address high-incidence conditions in mental health to optimize these children’s school success. The project will address high-incidence mental health conditions in order to optimize the school success of children living in public housing by expanding Medical Home services for children in this working poor, low-income community who do not have a regular provider, as well as providing community-based prevention strategies in mental health and developmental/behavioral issues. The goals of this project are to expand pediatric health services, develop and implement prevention strategies in mental health, promote community relationships and to disseminate and sustain our collaborative pediatric primary care-based mental health services model. The activities include hiring a Pediatric Social Worker who will supervise UCLA social work interns to provide mental health services in the pediatric clinic. Prevention programs will be delivered as parenting and health education and outreach at community meetings. The Pediatric Social Worker will be integral in linking identified children and families to need services. The School Function Program will also help families enroll in Medicaid or SCHIP.

VISTA COMMUNITY CLINIC HEALTHY TOMORROWS (VCC HT) PROJECT (2009)
Vista Community Clinic, Vista, CA
According to school nursing staff, barriers to healthcare access for the targeted low-income, Hispanic school children are numerous, and include lack of health insurance, transportation, communication between clinics and schools (HIPAA has increased the complexity of communication requirements and limited the nature and usefulness of communications), and ability for parents working in low wage hourly jobs to miss work for healthcare appointments due to loss of pay. In an informal survey of Emergency Contact Cards at Bobier Elementary School, nearly one-third of students reported no health insurance. In addition, schools are seeing more and more children with long term, chronic healthcare needs requiring consistent knowledgeable management, such as ADHD, obesity and asthma. In these targeted school communities, there is also rare usage of oral healthcare. The project will improve the health status of low-income, high-risk elementary school children by providing case management, advocacy and enabling services designed to connect them to care as defined by completion of a minimum of one health and one dental visit; and increasing the knowledge and understanding of parents of preventive and ongoing healthcare through provision of health education workshops and health literacy coaching. This will be accomplished through a partnership between Vista Community Clinic, and the Vista and Oceanside School Districts that will include the stationing of a VCC HT Case Manager at each of two elementary school sites and the provision of case management, enabling and advocacy services at each school site.

COLORADO

HEALTHY START/CHILDREN'S CLINIC (1989)
Fort Collins, CO
This private nonprofit clinic provides access to high-quality, comprehensive pediatric care for county children from indigent families, regardless of their ability to pay. Emphasis is given to collaboration with the local health department to provide preventive and acute care for children. Clinic staff is comprised of a pediatrician, nurse practitioners, registered nurses, social workers, office assistant, receptionist/biller, and director. In the first 5 years the clinic provided over 33,000 office visits for over 4,000 children. More than 100 community volunteers and physicians participate in the project by accepting overflow and specialty patient referrals. Patients who are not Medicaid-insured are able to obtain medications by donating $1 to the program. After-hours and emergency care for clinic patients is provided through an arrangement with the residency program of Poudre Valley Hospital. Project services have been expanded to provide a teen clinic, behavioral modification clinics, a visiting friend/health advocate program, parenting classes, bike safety classes, and health education. A chronic care program exists to provide consistent medicine and follow-up

HEALTHY TOMORROWS FOR DENVER (1992)
Denver Health and Hospitals, Denver, CO
The Denver Health and Hospital (DHH) system is the primary provider of care for low-income and culturally diverse populations in Denver, Colorado. Many infants and children with or at-risk for developmental delays lack access to early intervention and other services guaranteed under Public Law 102-119. The Healthy Tomorrows for Denver project provides children aged 0 to 5 and their families with improved access to early intervention services by identifying children who need services, increasing system outreach, facilitating the Denver Child Find process, promoting family utilization of early intervention services, and developing a tracking and monitoring system. To achieve these ends, Healthy Tomorrows for Denver has institutionalized the referral process from the DHH to Child Find, and provides coordination services to identified families. In addition, professionals and paraprofessionals will visit approximately 850 families in their homes to enhance services through interdisciplinary assessment, individualized family education plans, service identification and implementation, and review and evaluation of plans.

BREATHE EASY ASTHMA MANAGEMENT (BEAM) PROJECT (1999)
The Children's Hospital, Denver, CO
Asthma is the most common chronic childhood illness and the fourth leading cause of disability in children. In low-income, ethnic minority populations, the prevalence and severity of asthma increases dramatically. Even when diagnosed in minority children, asthma often goes untreated, poorly managed, with little family education and involvement. Lack of access to care primarily contributes to poor asthma management and outcomes. The Breathe Easy Asthma Management Project (BEAM) builds upon an existing collaboration of school, family and community to improve asthma identification and management in high-risk preschool and elementary school children in the Adams County School District 50 in Westminster, Colorado. The program objectives focus on providing access to a medical home and coordinated, consistent care through the school-based health center or primary care provider; education of children and families on effective management of the physical and psycho-social aspects of asthma; and increased involvement of school and the community in supporting children and families with asthma. Evaluation of the BEAM Project will include process and outcome measures delineating the number of children enrolled, number of clinical contacts with families, emergency room visits and hospitalizations; and the number of teachers and child care providers trained to recognize signs of asthma, asthma management in the classroom, and referral procedures. Outcome measures will assess changes in knowledge, skills, attitudes, behavior, health status, and parent satisfaction resulting from the project interventions.

HEALTHY TOMORROW'S FOR DENVER'S FAMILIES (HTDF) (2000)
UCHSC, School of Medicine, Dept of Pediatrics, Kempe Children's Center, Denver, CO
The growth of kinship care placement in the child welfare system for maltreated infants and toddlers has increased dramatically throughout the country as well as in Denver. Because these infants and toddlers typically enter care with unmet medical, developmental and emotional needs, the HTDF program was developed to improve the overall health status of abused and neglected infants who are place with relatives. Developed by a consortium of programs serving these young children, and led by the Kempe Children's Center, the focus is on coordinated case management and an early behavioral intervention for these infants entering kinship care in Denver. The program will:

1. Provide case management services under the direction of a primary care physician in order to obtain coordinated pediatric care;
2. Provide developmental and behavioral screening and follow-up referrals for services; and
3. Administer intensive behavioral intervention to a subset of infants, by experts in infant emotional development from the Kempe Center.

Extensive linkages and collaboration partners include The Children's Hospital, Denver Health and Hospitals, Denver Department of Human Services, Denver Options, and the Colorado Department of Health. Evaluation of the program includes a pre- and post-test of the program's effects, including medical, developmental, and behavioral outcomes. Qualitative data, from various sources including focus groups, will provide additional understanding of children, families and the service system.

GROWING CONNECTIONS FOR KIDS (2007)
Denver Health and Hospital Authority, Denver, CO
Growing Connections for Kids is an expansion of an existing collaborative program between the Denver Health and Hospital Authority and Denver Department of Human Services. Through this expansion and the coordinated efforts of both agencies, Growing Connections for Kids will provide improved coordination of care by establishing a medical home for each Denver County foster child in order to address chronic or urgent health needs and ensure continuity of care. The project will track each child’s medical history through Child Health Passports and a database. A nurse care coordinator will monitor and ensure adequate receipt of care for foster children within their medical home. The goals of the project are to: 1) Coordinate health care services for children in foster and kinship care, 2) Ensure every child in foster care has a medical home, 3) Provide increased preventive health care services, and 4) Meet or exceed all federal guidelines regarding health care for children in foster care.

CONNECTICUT

HEALTHY TOMORROWS FOR NEW HAVEN (1990)
City of New Haven, Department of Health, New Haven, CT
This project is an effort to strengthen existing school health resources to enable the Brennan (elementary school-based clinic and Troup (middle) school-linked clinic to serve as access points for children to obtain comprehensive health care. To accomplish this, a pediatric nurse practitioner was added to the nursing staff at Brennan and contracts were established to obtain primary pediatric services and mental health/child development consultation. In addition, services are offered to newborns and preschoolers at the site. At Troup, linkages were established between the full-time school nurse and the Primary Care Center at a local hospital. All students, regardless of ability to pay, receive services at both sites, which are located in economically depressed, geographically isolated areas of the city.

PRENATAL-TO-PEDIATRIC TRANSITION PROJECT (1993)
Fair Haven Community Health Center, New Haven, CT
This Healthy Tomorrows grant will increase coordination among existing health care resources in order to improve access to health care for young parents and their families. Emphasis will be placed on providing expanded bilingual and bicultural health education and services. Major aspects of the project will include enhanced prenatal education and pediatric care, improved case management/social service referrals, and a new parental education initiative focusing on literacy, using the Reach Out and Read program. Transportation and translation services will also be provided as necessary. Participants will be monitored to demonstrate improved immunization and nutritional status, decreased emergency room visits, increased parental knowledge of child development, parenting skills, and optimal use of available health care resources.

PARENTS AND CHILDREN TOGETHER, PACT (2001)
Fair Haven Community Health Center, New Haven, CT
Parents and Children Together (PACT) builds on the successful Prenatal Group
Program at the Fair Haven Community Health Center (FHCHC) to provide
additional support for families beyond the prenatal period both individually and in a group setting. The most vulnerable families have the most difficulty obtaining
and using health services and gaining support from institutions. We are
developing new systems to meet the needs of teen-led families, immigrant families and families living in poverty by providing intensive home-visiting during
pregnancy and the first two years of life and by extending the prenatal groups
into group well-child care. The home-visiting program is a collaboration with
the Minding the Baby Program based at the Yale Child Study Center and the Yale
School of Nursing. Families are invited and encouraged to participate in a
variety of neighborhood programs that address healthy infant and toddler
development, including programs at the local library and children’s museum, as well as the WIC, Healthy Start and Reach Out and Read programs at FHCHC. We are also piloting group well-child care with small groups of families and their
primary pediatric clinicians beginning at the 2-month well-child visit. This
multi-disciplinary team approach will restructure the well-child program for
our most needy families with the goal of reducing risk factors and promoting the
healthy development of our most vulnerable children.

FOOD SMART AND FIT PROGRAM (2007)
Community Health Center, Inc, Middletown, CT
The Food Smart and Fit Program is a new component to the primary care, mental health and dental services offered through the Community Health Center in New Britain. This project will implement a multi-component health promotion, obesity prevention, and policy change intervention for young women (Grades 9-12) in New Britain High School, Connecticut’s largest high school. The program will partner with the school’s existing clinic-based education program that helps students with diabetes manage their disease through setting goals for healthy eating and physical activity. The project coordinator and registered dietician will provide nutritional counseling to obese and overweight girls, including girls with diabetes. The overall goal of the project is to address both individual and environmental dimensions of risk by: 1) Promoting and sustaining behaviors that prevent obesity and promote lifelong health, and 2) Empowering girls to mentor their peers and advocate for a school environment where healthy choices are available.  

DISTRICT OF COLUMBIA

PRIMARY HEALTH CARE HOME (1994)
DC Linkage and Tracking, Commission of Public Health, Washington, DC
The goal of this project is to promote the concept of the Primary Care Home, where every child has one clinician who insures continuity of health care services. Project staff will provide in-depth and culturally sensitive health education and case management to enable families in the target group to access the medical and social service systems. Specific objectives include:

1. an increase in Medicaid for project participants;
2. an increase in the number of children and families who receive recommended primary care services in accordance with Year 2000 goals;
3. an increase in immunization rates for children less than 2 years of age, and
4. an increase in lead screening rates for children who are at environmental risk.

Comprehensive evaluation will occur, using an experimental and control group.

MAKING DREAMS POSSIBLE FOR HISPANIC TEENS (1994)
Mary's Center for Maternal and Child Care, Inc, Washington, DC
This project aims to improve the health, educational, and psychosocial well-being of 200 Hispanic low-income uninsured teens in the District of Columbia, with an emphasis on teen pregnancy prevention. Each year 35 pregnant teens and their newborns will receive bilingual/bicultural services including early pre and postnatal care, reproductive health, home visiting, STD/HIV screening and counseling, primary pediatric care and immunizations, intensive case management, and developmental screening. The center will also provide parenting training with an emphasis on child development, stimulation techniques, and the prevention of child abuse and neglect. In addition, the project will provide community outreach and education focused on pregnancy prevention.

HEALTH STREET (1999)
Upper Cardozo Community Health Center, Washington, DC
Health Street is a collaborative project between the pediatric clinic of the Upper Cardozo Community Health Center, a Federally Qualified Health Center (FQHC) and the Latin-American Youth Center, a non-profit multi-cultural agency which promotes the social and economic development of Latinos and other minority groups. This partnership will attract and maintain high-risk adolescents in a culturally sensitive and linguistically appropriate medical home that provides comprehensive medical and mental health services for participants and their families. Health Street was established to address the unmet health and behavioral health needs of adolescents and their families in Wards 1 and 2 of Washington, DC, two of the most racially, ethnically and linguistically diverse areas of the city. Health Street objectives are:

1. to provide comprehensive preventive and curative health care to adolescents in a teen health clinic;
2. to offer a full range of family centered behavioral health services to include individual and group counseling by a licensed social worker, and referrals to other community mental health and substance abuse services;
3. to offer peer health counseling to adolescent clients;
4. to expand access to primary and mental health services through outreach to schools and other local community organizations.

TEEN PROGRAM AT MARY'S CENTER FOR MATERNAL AND
CHILD CARE, INC (2002)
Mary Center for Maternal and Child Care, Inc, Washington, DC
The purpose of the Mary's Center Teen Program is to address the problem of pregnancy prevention among low-income immigrant teens - primary Latinas - in the District of Columbia. The Teen Programs' holistic approach employs the following strategies:

1. voluntary case management and counseling services for female teens ages 13-21 and their male partners;
2. twice monthly low-cost Saturday Teen Clinics where teens receive physicals, annual exams, pregnancy testing, family planning, and STD/HIV testing from pediatricians;
3. preparation of individual education plans and referrals to education resources such as English as a Second Language classes;
4. peer educators receive weekly training and present health education sessions at local high schools;
5. regular health education events such as monthly birthday celebrations that includes a guest speaker on a health education topic; and
6. monthly activities (such as special HIV testing days) coordinated between the Teen Program and Mama and Baby Bus that can assist hard-to-reach teens. The bus can serve as a non-threatening mechanism to help bring teens into a primary care setting to access the regular health care services they need.

All services are available in both Spanish and English. Through an arrangement with another community clinic, some translation services are available for other languages when needed at the clinic.

DELAWARE -- NOT AVAILABLE

FLORIDA

CITRUS SMILES: PROMOTING ACCESS TO PEDIATRIC DENTAL CARE (2002)
Citrus County Health Department, Inverness, FL
Access to dental care for low-income families in Citrus County, Florida is extremely limited and poses a significant health problem. Only 22% of Medicaid-eligible children in Citrus County visit a dentist annually. This project will expand dental health services to low-income children. This will be accomplished by increasing staffing of the Citrus County Health Department Dental Clinic, offering conscious sedation to extremely anxious and fearful children in need of dental services, and providing a comprehensive oral health education program for parents and caregivers. Goals of the program are to:

1. remove barriers that prevent access to dental care,
2. provide parents and caregivers with appropriate knowledge regarding age-appropriate oral hygiene practices, and
3. increase the number of dental health services available to low-income children.

PARTNERSHIP AGAINST LEAD (PAL) (2002)
Florida International University (FIU), North Miami, FL
Several communities in South Florida have been identified as at-risk areas for lead poisoning because of risk factors such as percentage of housing units built before 1950, poverty levels, income levels, number of children under 6 years of age, and number of children enrolled in Medicaid. The disparities observed are a result of a high percentage of linguistically isolated households and other cultural factors that need to be addressed. The goals and objectives of "Project PAL" are to:

1. motivate health care providers to routinely screen children under 6 years of age for lead poisoning;
2. establish a partnership among providers, health care professionals, educational institutions, and other community organizations and individuals to provide initial and follow-up services to at-risk children; and
3. decrease lead exposure in the home by educating children about the sources of lead and hand-mouth behaviors.

CARIDAD HEALTH CLINIC (CHC) – PEDIATRIC PREVENTIVE CARE PROJECT (PPCP) (2003)
Caridad Health Clinic, Boynton Beach, FL
The Caridad Health Clinic provides free medical and dental care and support services to children and adults of migrant farm workers and their families and strives to improve the health status of low-income minority children, thereby increasing their chance of becoming healthy, productive adults. The Pediatric Preventive Care Project will provide prevention, early detection and treatment of disease in the children of migrant farm workers and other indigent children. CHC will screen at least 1,000 children at risk of Type 2 Diabetes Mellitus (DM). If diagnosed, the project will provide glucose monitoring, diabetic testing supplies and medication, as necessary, or referral to specialty care. Parents will be educated on recognizing the symptoms of Type 2 DM, the importance of healthy food choices, and exercise. All services will be delivered in a user friendly, culturally appropriate and language specific manner.

MEDICAL HOME FOR HOMELESS FAMILIES: THE JACKSONVILLE HOMELESS FAMILY HEALTH PROJECT (2004 General Grant)
Each night in Jacksonville, hundreds of families are either homeless or on the verge of becoming homeless. Often compounding their loss of housing, the families and children suffer from many social, economic, and mental and physical health problems. The University of Florida, Department of Pediatrics, and the Duval County Health Department are forming a collaboration to provide services to the Sulzbacher Center, the only homeless shelter for families and children in Jacksonville. The goals of the program are to: 1) improve the health of homeless children and families through access to comprehensive health, mental health, and social services; and 2) provide a temporary Medical Home for the children during their homeless episode, connecting them to a permanent Medical Home once they resettle.

THE VILLAGE FIT KIDS PROJECT (2005)
The Village South, Inc. Miami, FL
Children of substance abusers are at high-risk for behavioral, psychosocial and mental health problems and the opportunity to intervene in relation to these problems is often overlooked. The Village Fit Kids Project proposes to develop a child-centered case management model, which will be integrated into a residential treatment program for substance-abusing parents (including pregnant and post-partum women) and their children, ages 0 to 12. The project will include mental health and developmental screening and assessment, mental health promotion groups, substance abuse and violence prevention groups, and service planning coordination. Services provided to parents include weekly education groups delivered as part of their participation in residential treatment.

GEORGIA

IMPROVING HEALTH CARE ACCESS FOR HISPANIC FAMILIES (1991)
Mercy Mobile Health Care, Atlanta, GA
Mercy Mobile Health Care is the only hospital-affiliated provider of medical/health care outreach and education to Atlanta's multicultural community, which has more than doubled in population since 1980. This Healthy Tomorrows grant will enable the program to establish monthly mobile pediatric screening clinics in three Hispanic/Asian neighborhoods. Project staff will identify children with special health needs who lack a regular source of care, will make appropriate referrals, and will provide families with full assistance to complete the referrals. The mobile clinics will be supported by a network of bilingual health promoters who will be recruited from targeted communities and trained to deliver health care information in a culturally sensitive manner. The promoters will identify families with medical needs and assist them in accessing health services, including enrolling them in the Medicaid and WIC programs. Another project objective will be to increase the cultural sensitivity of local health care providers who serve large numbers of Hispanic patients.

GRADY FIRST STEPS TO HEALTHY FAMILIES (1992)
Grady Memorial Hospital, Atlanta, GA
This project provides primary and secondary child abuse prevention services to first-time mothers under the age of 21 who deliver at Grady Memorial Hospital. An early identification worker screens all targeted women and conducts an assessment for child abuse risk factors. High-risk families receive home-based family support services for 3 to 5 years, while low-risk families receive intervention through telephone follow-up for at least 3 months. Culturally competent, trained personnel offer emotional support and parenting education. Staff also works to establish linkages between new mothers and community/medical resources.

COBB HEALTH FUTURES ALLIANCE (1993)
Cobb County Board of Health, Marietta, GA
Developed to encourage a comprehensive system of primary health care for children and adolescents who do not have insurance, this grant will provide salary support for an additional pediatrician who will work with project staff to expand and extend health related services to children and adolescents in Cobb County, Georgia. This will be accomplished by: expansion of clinic hours; establishing 24-hour physician coverage; developing capacity for hospital admissions and inpatient follow-up; and establishing a structure for integration of services. In addition, parents of the Alliance children will be partners in the evaluation process and will participate in focus groups and a survey on client satisfaction.

GUAM

GUAM FLUORIDE VARNISH PROGRAM (2004 Oral Health Grant)
Department of Public Health and Social Services Dental Program Division of Public Health, Hagatna, Guam
The goals of the program are to reduce the incidence of caries in children less than 6 years of age, and to educate families on the importance of good oral health. To achieve these goals, the program will encourage and educate physicians who care for children in the well-child clinics to apply fluoride and varnish to their young patients with the help of nurses and other medical staff. Dentists will collaborate with the physicians and staff in developing ways to provide better dental care for children in the medical setting. Children from WIC and Health Start programs will receive oral exams and placement of fluoride, if needed, and parents will receive dental health education.

HAWAII

PARENT-PEDIATRIC PARTNERSHIPS: SUPPORTING FAMILIES TO STRENGTHEN THE VULNERABLE BUT INVINCIBLE (1989)
Hawaii Dept of Health, 
Zero-to-Three Hawaii Project, Honolulu, HI
This project is a partnership between families and their medical home to develop a demonstration model for care coordination for environmentally at-risk infants and toddlers. The families are being served as part of the eligible population under PL 102-119, with an IFSP developed for each child. The target group includes many different ethnicities and immigrants. A primary objective this year is to develop a plan for project expansion and continuation after the end of federal funding of the project. There is also a priority to find ways to expand the age group being served to include at least all preschool children. A major focus of activity during this year will be entering all the children into the tracking system that is now operational. Another major activity will be the establishment of procedures to participate in third-party billing. Initial plans are to link the billing system with the tracking system. A proposal is currently being developed that will include the project in a longitudinal evaluation study of outcomes for children and families served under Part H.

ENHANCED COMMUNITY HEALTH OPTIONS  KO'OLAULOA HEALTHY TOMORROWS (1994)
State of Hawaii, Dept of Health, 
Maternal and Child Health Branch, Honolulu, HI
The Ko'olauloa Healthy Tomorrows Project will address the system problems that currently exist and improve access to child health services for families residing in the area. This goal will be realized through increased and coordinated outreach services, promotion of an integrated system of comprehensive health care, improved continuity of care through home visiting, increased paternal participation in accessing health care, and the provision for developmental/psychological assessments of at-risk children. The project will work with the existing health care system and the community to provide a community-based, family-centered comprehensive and culturally relevant system of care.

INTEGRATED PEDIATRIC BEHAVIORAL HEALTH PROJECT (2004 Behavioral & Mental Health Grant)
Kalihi-Palama Health Center, Honolulu, HI
This program will integrate mental health services into the pediatric primary care setting to improve pediatric access to behavioral health services and children's overall quality of health. The project will consist of four innovative elements: 1) coordination of care between primary care and behavioral health teams through a care manager; 2) the use of behavioral health consultants for initial and on-going assessments; 3) brief interventions by the behavioral consultant for children in need; and 4) outreach for higher risk or noncompliant patients.

IDAHO

MALHEUR MATERNITY PROJECT (1991)
Valley Family Health Care, Inc, Payette, ID
The Malheur Maternity Project (MMP) is an existing program that provides perinatal care to mostly uninsured and Medicaid-insured, low-income women who live in the western Treasure Valley, a region of more than 10,000 square miles that includes portions of eastern Oregon and western Idaho. The Healthy Tomorrows grant enables the project to hire a part-time project manager and a case manager. The addition of these two staff members enables the project to add coordinated postpartum and infant care follow-up services and to serve an additional 80 women each year. The project manager develops and maintains a current directory of locally available maternal and child health services. Current objectives are to increase the number of women beginning prenatal care in their first trimester from 50% to 60%, to increase the number of patients receiving nutrition counseling from 40% to 60%, to increase the number of patients receiving documented postpartum care and infant follow-up care from 72% to 90%, to continue to reduce the ratio of low birthweight babies, and to decrease to less than 50% the number of repeat patients of MMP who have close conceptual spacing of less than 2 years.

HOME VISITOR SERVICES FOR PREGNANT/PARENTING SUBSTANCE ABUSERS (1995)
YWCA of Pocatello, Pocatello, ID
This project will develop, implement, and evaluate in-home services for pregnant or parenting substance abusers. The program will emphasize early identification and intervention, followed by intensive and prolonged visits. Participants will also be referred to local community agencies to provide coordination of services such as: health care, substance abuse counseling, child development programs, and employment development and training.

TREASURE VALLEY CHILDREN'S MENTAL HEALTH PROJECT (2005)
Warm Springs Counseling Center, Boise, ID
The Treasure Valley Children's Mental Health Project (TVCMPHP) will increase access to mental health services for high risk, low-income children by enhancing the capacity of primary care physicians to serve these children. TVCMHP will train primary care physicians in best practice, research-based protocols and evaluation/assessment tools regarding mental health issues. A clinical psychologist/case manager will coordinate contact between participating physicians and the consulting psychiatrist(s), with bi-lingual evaluation available in Spanish. Monthly training sessions will offer continuing education credits for physicians in children's mental health issues and will include bi-monthly updates on new psychotropic medications.

STARTING POINTS FOR IDAHO YOUTH (2006)
Mountains States Group, Inc., Boise, ID
Low-income youth in Idaho's rural and frontier counties lack health insurance coverage. Often their families are not aware of their eligibility or know how to enroll in state coverage programs. Starting Points for Idaho Youth is a direct service project that adds the partnership of SERVE Idaho and builds on the success of the Covering Kids and Families in Idaho Project and Coalition. This project will increase the rates of insured low-income youth in five rural and frontier Idaho counties. The goals of the project are to create new and innovative strategies to reach uninsured youth with information about state health coverage programs and to enroll 1,500 eligible youth in rural Idaho counties in the state's health insurance coverage programs.

ILLINOIS

RESOURCES, EDUCATION, AND CARE IN THE HOME (REACH) FUTURES (1989)
Maternal/Child Health Nursing, University of Illinois at Chicago, Chicago, IL
A maternal/child health promotion model has been established through collaboration between the University of Illinois Hospital, the Chicago Department of Health, and the community action agency, West Side Futures. The model has been developed and used to recruit, train, and employ nine community residents who, under the supervision of professional nurses, conduct home visits for a minimum of 20 months during the prenatal and postneonatal period. Project staff have established an innovative, multiagency service delivery model that aims to insure early detection of neonatal and postneonatal morbidity and reduce preventable postneonatal mortality in a high social risk, low-income, inner-city Chicago community. The service team promotes primary health care through home-based health assessments, individualized culturally sensitive child care instruction, and peer resource groups focused on family support and healthy lifestyles.

INFANT AND FAMILY FOLLOW-UP PROGRAM (1991)
The Pritzker School of Medicine, University of Chicago, Chicago, IL
The Infant and Family Follow-up Program, which was established in 1989, and funded by Healthy Tomorrows in 1991, provides comprehensive medical and social service support for high-risk infants born at the University of Chicago Perinatal Network Hospitals. Its objectives are:

1. to identify, enroll, and provide continuous follow-up of all eligible infants and their families until the infant is 5 years of age;
2. to strengthen the coordination of services and establish a partnership with the various agencies that impact the families;
3. to provide social and psychosocial support for enrolled families until their children are 5 years of age; and
4. to track and monitor the families to ensure comprehensive and continuous care.

Eligible infants have birthweights less than 1,500 grams or documented presence of any risk factors for poor neurobehavioral outcomes. Pediatric-aged siblings may receive primary pediatric care and pediatric developmental service as needed. Half-day clinics are held twice a week. Annually, about 200 very low birthweight (less than 1,500 grams) infants and infants at high-risk for poor neurobehavioral outcome are expected to enter the program with their families. The project will provide preconception prenatal care and family planning services through parent support group sessions. Families will be closely monitored to assure family planning enrollment, and compliance with methods will be emphasized. The ultimate goal of this program is to promote building healthy family environments for infants and, at the same time, prevent repeat low-birthweight births in their families.

PEDIATRIC CARE for INFANTS of PARENTING TEENS: A COLLABORATIVE MEDICAL DEVELOPMENTAL APPROACH (1996)
Illinois Masonic Medical Center, Chicago, IL
Parenting teens are a vulnerable group who often lack the skills and motivation for accessing and utilizing health care for their infants. Efforts to engage young mothers in comprehensive follow-up programs at delivery are complicated by increasingly early discharge times, sending young mothers and their infants into the community poorly prepared to cope with the stresses of motherhood. The program is a collaborative effort of the Pediatric Ambulatory Care Center and the Developmental Center of Illinois Masonic Medical Center in Chicago and will provide pediatric care for the infants of 100 parenting teens annually. In a group well child care setting, infants will receive pediatric care and young mothers will participate in activities to facilitate responsive mother-child relationships. Central to the program is a plan for intensive individual case management as well as a linkage of the teen parents to community-based comprehensive services. Evaluation will focus on decreasing rates of emergency room visits, hospitalization and injury as well as enhancing parent skill and competence.

TEENS EDUCATION LEARNING AND LEADING (TELL) (1997)
University of Illinois at Chicago, Chicago, IL
Adolescent childbearing presents challenges that impact the entire family, as well as the broader community. Experience has demonstrated that successful interventions are those that promote a broad-based family and community specific response. However, traditional health care delivery systems tend to offer individual rather than family care. This approach focuses on the health and concerns of the adolescent mother and child in isolation from their social, economic, and cultural context. The TELL program will develop, implement, and evaluate a model which promotes healthy lifestyles for the parenting adolescent within the socio-cultural context of the family. The model uses a community-based, interdisciplinary team that includes trained adolescent "peer" health advocates, experienced community workers (adult health advocates), and family and health care professionals. The team provides parenting support, health education, and health screenings in the school, in the home, and in other community settings. Essential components of the project are the adolescent health advocate training, home visits to prevent, or detect infant morbidity, integration within the school to promote school attendance and graduation ,and linkages to family and community resources to increase self-sufficiency. Key objectives include enhancing adolescent self-esteem, improving infant outcomes at one year, delaying subsequent pregnancies among program participants, and preventing first pregnancies among peer health advocates.

PEDIATRIC DEAF ACCESS PROGRAM (2000)
Sinai Family Health Centers, Chicago, IL
Access Community Health Network, the Chicago area's largest community health center organization, is currently establishing a Pediatric Deaf Access Program with support from the Healthy Tomorrows Program. The program goal is to serve deaf children and children of deaf parents with comprehensive community-based pediatric services, accessible to all, on a sliding-scale basis regardless of insurance status or ability to pay. The program strategies include:

1. Provision of outreach and school linkage,
2. Provision of pediatric care with sign language interpretation;
3. Creation of access to program services for low income and uninsured patients in a predominantly African-American area;
4. Definition of a cost-effective, replicable program model; and
5. Heightening of professional awareness of the need for pediatric services accessible to deaf parents and deaf children. A hearing-impaired nurse practitioner, skilled in sign language, will work with the director of the Pediatric Deaf Access Program.

PARENT-RUN EVENING PRESCHOOL (PREP) (2000)
Chicago Youth Programs, Inc, Chicago, IL
Physical threats, inconsistent nutrition, poverty, and instability in caregiving arrangements can impair the emotional, intellectual, and social development of children. Inner-city parents are often highly stressed due to poor living conditions, large family sizes, single-parent households, and violent neighborhoods. In addition, many parents were, or are, teenage mothers who were themselves raised by teenage mothers. As a result, few learned effective parenting skills. The Parent-Run Evening Preschool (PREP) provides a unique opportunity in a supportive environment for inner-city mothers to gain work-related skills and improve their parenting skills as child care providers in an evening preschool program. Mothers receive training in topics such as discipline techniques, child development, and injury prevention. Under the supervision of an individual trained in child development, mothers learn appropriate childcare techniques as a provider for the evening preschool program, which includes early childhood enrichment activities such as counting, color identification, and learning the alphabet. The program not only prepares children for school, but also involves the mothers in their children's education. Key objectives of the program include:

1. Improvement in parenting skills;
2. Improvement in maternal self-esteem; and
3. Improvement in the children's school readiness.

ERIE FAMILY HEALTH CENTER HEALTHY TOMORROWS PROJECT (2006)
Erie Family Health Center, Inc, Chicago, IL
Erie Family Health Center will launch a new innovative oral health program at one of Erie's three primary health care sites, Erie Helping Hands Health Center. The new oral health program will serve the largely Latino low-income children and pregnant women population in the Albany Park community of Chicago. The Erie Family Health Center proposes a tri-fold strategy to prevent oral health disease among the low-income Latino children and pregnant women through prevention, treatment and education. The goals of the project are to increase access to comprehensive oral health services for new patients, provide an age-appropriate anticipatory guidance curriculum to Erie's medical providers, provide comprehensive oral health prevention education to community members, and improve the oral health status of low-income children by reducing cavity burden and improve oral health status of pregnant women by addressing periodontal disease.

HEALTHY FUTURES: A SCHOOL-BASED MENTAL HEALTH MODEL (2009)
Access Community Health Network (ACCESS), Chicago, IL
Low-income, African American children and youth on Chicago's south side are not receiving culturally appropriate mental health treatment services, putting them at higher risk for long-term mental and physical health issues. This is due to a lack of screening/early identification of mental health issues in children and youth, a lack of community mental health access points for low income and/or uninsured families, and a lack of culturally relevant health prevention and education for children, youth and parents/caregivers. The project will provide low-income, African American children and youth with culturally sensitive mental health services by establishing a comprehensive, integrated student-focused mental health program enhancing the ability of these children to learn and succeed. The project will (1) establish a mental health screening intervention in a school-based health center setting and use research-based, best practice tools to assess children’s mental health in schools; (2) increase access to mental health treatment for uninsured and underinsured children in need of services through the provision of on-site social work at the ACCESS Comer Student Health Center and in the community schools; (3) establish programs to educate youth and families about mind and body interactions and how to take care of their health; and (4) train the next generation of mental health providers in a youth-focused, integrated community health model that provides clinical experience and draws on community assets.

INDIANA

COMMITTED TO KIDS PEDIATRIC WEIGHT-MANAGEMENT PROGRAM (2007)
Clarian Health Partners, Inc, Indianapolis, IN
The Committed to Kids Pediatric Weight-Management Program is implementing a school-based weight management program for 9-13 year olds to promote wellness as a mechanism to prevent excess weight and diseases related to being overweight. This program will serve two middle schools at high risk for being overweight due to economic, social, and environmental factors within the community. Program staff will work with parents, pediatricians, school-based health clinic staff, and health educators to implement a 12-week after school program that features nutrition, education sessions, and physical activities. The goals of the program are to: 1) Identify safe and effective methods for achieving and maintaining weight loss, 2) Acquire knowledge of the basic principles of good nutrition and healthy eating patterns, 3) Increase awareness of eating behaviors and activity patterns, 4) Learn alternative behaviors to promote long-term health, and 5) Gain the physiologic and kinesthetic awareness necessary to adopt activity patterns that promote long-term health.

IOWA -- NOT AVAILABLE

KANSAS

HEALTHY CHILDREN PROJECT (1995)
Wichita Primary Care Center, Wichita, KS
This community-based, family-oriented, school health center will address the deteriorating health status of school-age children from six elementary and two middle schools in the Wichita area. The center will provide primary care and dental and mental health services to over 3,600 children in its first year; transportation will be provided, if necessary. Schools were chosen based on the students' poor health and economic status. Cities in Schools, a dropout prevention program and partner in the project, has a full-time site coordinator at each school. As part of a multidisciplinary team, pediatric residents, medical students, nurse practitioners, students, and school nurses will be trained in school health and community pediatrics.

PROJECT EAGLE - CENTRAL INTAKE AND REFERRAL SYSTEM (2004 General Grant)
University of Kansas Medical Center (Project EAGLE), Kansas City, KS
The Project EAGLE Central Intake and Referral System is a mechanism for screening multiple risks in families with children zero to 5 years of age and for providing referrals to address multiple needs. The Central Intake and Referral System is based on the idea that early identification and timely access to appropriate services leads to healthy development and children entering school ready to succeed. The program has been piloted with 73 families since 3/1/03. The goals of CIRS are to identify immediate family needs via a collaborative relationship that includes multiple risks screening; to provide appropriate referrals and problem-solving support to improve parents' self-advocacy in accessing services; and to improve utilization of community resources.

KENTUCKY

FAMILY CARE CENTER HEALTH PROJECT (1989)
Lexington-Fayette Urban County Government, 
Department of Social Services, Lexington, KY
The Family Care Center was established to provide comprehensive psychological, health, social, day care, and educational services to unemployed or low-income, at-risk families with preschool-age children. The HTPCP grant will enable the center to extend primary health care services to 1,000 children whose family incomes are at or below 185% of the federal poverty level (both Medicaid and non-Medicaid eligible). Services will include medical, dental, nursing, psychological, speech therapy, occupational therapy, pharmacy, laboratory, x-ray services, home health visits, and transportation. Eligible families may participate in a preschool enrichment program, and will be given the opportunity to complete their high school education and receive vocational training and job placement assistance. In 1993, an adolescent clinic was started for mothers in the adult education program.

HOME NETWORK PROJECT (1997)
Family Care Center, Lexington, KY
The Family Care Center (FCC), established in 1989, is a multi-disciplinary, integrated service delivery model addressing needs of adolescent mothers and their children. Comprehensive health care (physical, mental, and dental), adolescent high school education, child care, along with individual case management is provided at a single site. The FCC Home Network Project helps complete and integrate the existing comprehensive service model. Home visitors, trained in the Healthy Families America curriculum, will establish relationships with high risk adolescent mothers prenatally through the child's fifth birthday. They will provide weekly visits in the adolescents home providing support, education, and facilitation of the success of the family, as well as foster the individual success of each child. Health, development, mental wellness, and asset building will also be emphasized. Outcomes in all in these areas will be measured.

COVINGTON YOUNG FAMILIES PROJECT (1997)
St. Elizabeth Medical Center, Edgewood, KY
This project, a collaborative effort between health, education, and social service agencies to improve the self-sufficiency, parenting, well-being, and developmental outcomes for teen mothers and their children in Covington, Kentucky. Paraprofessional resource mothers, operating out of neighborhood gathering sites, will be matched to 100-150 teen mothers. Through home visits and small group activities they seek to strengthen the teen's informal supports and to better connect them to the formal supports in the generic service systems. Pediatrician volunteers from St Elizabeth Medical Center provide health education, pediatric screening, as well as other health-related services at the neighborhood gathering sites. An extensive evaluation research design with multiple outcome measures is employed using both intervention and comparison groups.

FAMILY CARE CENTER FOR HEALTHY FUTURES (2005)
Family Care Center, Lexington, KY
The Family Care Center is a single site, multi-service program for low-income children with a special focus on adolescent families. The Center offers comprehensive primary child and adolescent health services, dental care, mental health services, home visitation services, social services, and speech and language services. The goals of this project are to empower families and provide support to families on solving important family resource needs. The Family Center for Healthy Futures will provide within a pediatric practice resource support for families that include housing, education, food, clothing, employment, parenting skills, bilingual services, family health care, transportation, childcare, and financial assistance. Meeting the needs of families will leave them with time energy, and resources to meet the demands of parenting and improve the health of their children.

LOUISVILLE METRO HEALTH DEPARTMENT HEALTHY TOMORROWS PROJECT (2006)
Louisville Metro Health Department, Louisville, KY
The Somali Bantu are the third largest documented immigrant group living in Louisville, KY. The purpose of the Louisville Metro Health Department Project is to increase access to culturally competent healthcare for the Somali Bantu refugee women and children in Louisville, KY while reducing the overall costs of healthcare through partnerships, health promotion, prevention and early intervention. Health education will be delivered on-site via a mobile health unit. Health care professionals will provide health services weekly to two specific housing developments, where Somali refugees primarily live in Louisville. In addition, the project will include lay health helpers to distribute health education materials door-to-door offered in an audio format, as the Bantu do not have a written language.

LOUISIANA

FIRST STEPS PRIMARY PREVENTION PROGRAM (1990)
Louisiana Council on Child Abuse, Inc, Baton Rouge, LA
This initiative was designed to establish a hospital-based program that seeks to reduce the stress experienced in the early weeks and months following childbirth by first-time and teen parents. Over 5,000 families have been served to date by volunteers or hospital staff in nine delivery hospitals across Louisiana. Emotional support and education during their postpartum stay is offered through personal contact by trained community volunteers, and early childhood development and stress prevention information is disseminated; follow-up continues for 3 months following the birth of an infant. The goal is to establish a program that can be replicated statewide. Collaboration with the Office of Maternal and Child Health (MCH) has taken place on local and regional levels through training and networking opportunities for public health nurses. On the state level, a task force has been formed between MCH and the Louisiana Council on Child Abuse, as well as other state agencies and advocacy groups, to bring the Hawaii Healthy Start model to Louisiana through the expansion of existing home visitor programs. A statewide conference took place in 1994, to educate service providers and other interested groups in implementing home visitation in their communities.

PROJECT HOPE PARENTING CENTER HOME VISITATION PROJECT (2008)
North Louisiana Area Health Education Center, Bossier City, LA
The lack of proper health care, both prenatal and postnatal, impacts health outcomes for not only mothers, but for their infants and children as well. The North Louisiana Area Health Education Center (NLAHEC) project will work in conjunction and collaboration with NLAHEC’s Healthy Start ABCs Project and Project HOPE Parenting Center. The project aims to provide home visitation services to low income, African American, expectant mothers and mothers of newborns, infants, and children under the age of two at risk for poor health and developmental outcomes due to the lack of access to health care in Ouachita Parish.  Through home visitation, this project intends to: (1) improve access to prenatal and postnatal health care; (2) reduce preterm birth and low birth weight; and (3) improve the safety of the home environment for infants and children.

MAINE

HOMELESS AND AT-RISK YOUTH HEALTH SERVICES (1996)
Portland Public Health Division, Portland, ME
Portland, the largest urban center in Maine, has become the destination for many of the State's homeless adolescents. To achieve the goals of increased access and culturally-appropriate health care for homeless youth, a homeless and at-risk clinic has been developed in the context of a multi-service resource center, designed to provide age-appropriate services. The grant funds a nurse coordinator who provides health-related case management services, collaborates with clinicians from other agencies, and coordinates the volunteer and paid staff of the clinic. Much of the direct care is provided by volunteer pediatricians, resident interns, and other volunteer health care providers. Ancillary services are provided through an affiliation with a local hospital. We anticipate providing health care services to over 300 youth in the project's first fully-funded year.

PEDIATRIC PARTNERSHIP TO PROTECT CHILDREN IN TWO MAINE COMMUNITIES (1996)
The Spurwink Clinic, Portland, ME
The Child Abuse Program at the Spurwink Clinic in Portland, Maine, using Healthy Tomorrow's Partnership for Children Program funding, will expand it's expert services in evaluating physically and sexually abused children to two currently underserved Maine communities, Rockland and Augusta. An expert diagnostic team, representing medicine, psychology, nursing, and social work, will conduct the evaluations at the local sites. Follow-up will be coordinated by a local site coordinator social worker at the Kennebec Valley Medical Center in Augusta, and the Pen Bay Medical Center in Rockland. Services provided will include medical evaluations for possible child abuse, social work evidentiary interviews, and psychological evaluations of parents and children. The team is based on the philosophy that multidisciplinary diagnostic collaboration, offer the best diagnostic and outcome options for abuse and neglected children. This five year grant will include outcome assessment in the form of measuring individual behavioral outcomes of children, various family assessment scales including re-abuse rates.

COLLABORATE FOR KIDS (2003)
Southern Maine Medical Center, Biddeford, ME
Numerous studies have indicated that there is a lack of locally available, high quality mental health services for children with the state of Maine. Collaborate for Kids will develop collaborative relationships with local schools and state government to provide assessment services for children within York County who are experiencing mental health, developmental or behavioral issues and who would benefit from a more coordinated system of care, such as children in the foster care system. Assessment teams will conduct interdisciplinary assessments of the children to determine a diagnosis and develop a treatment plan.

MARYLAND

FAMILIES IN TRANSITION (1991)
University of Maryland School of Medicine, Baltimore, MD
Families in Transition (FIT) is a comprehensive health care program for homeless children that is a collaborative effort of the Pediatric Ambulatory Center at the University of Maryland School of Medicine and Health Care for the Homeless, Inc, in Baltimore. A centralized health care source for homeless children, the FIT project provides primary health care services and a wide array of psychosocial services to homeless children and their families. Although some psychosocial services are clinic based, substantial emphasis is placed upon outreach services that involve linking and collaborating with other service systems in the community. This includes all systems impacting upon the welfare of children and families -- schools, social services, juvenile services, mental health services, and other health care service providers. A primary goal of the program is to educate other providers regarding the health care needs of homeless children and to advocate for individual children as well as the development of community resources for the population of homeless families. Advocacy extends to attempts to influence the public policy process regarding the needs of homeless and impoverished children.

HEALTHY TOMORROWS PARENTING PROJECT AT THE CENTER FOR ADDICTION AND PREGNANCY (CAP) PROGRAM (1993)
Baltimore, MD
This project is incorporating a parenting program for substance abusing mothers into the Center for Addiction and Pregnancy of the Johns Hopkins Bayview Medical Center in Baltimore. Efforts are being made to improve the mother-child interaction and the parenting skills of mothers by developing/implementing a parenting curriculum adapted to each phase of the drug using women's treatment. The administration of various developmental and behavioral screening tools to the child in the presence of the mother during intervention sessions are assisting in improving maternal appreciation of the child's development and strengths. Evaluation of the mother-child interaction and the child's developmental status is performed, and the parenting curriculum is being evaluated to demonstrate the effectiveness of the program. A questionnaire to evaluate parenting knowledge and beliefs among pregnant abusing women is being developed.

BUILDING FOR A HEALTHY TOMORROW--CONSTRUYENDO POR UN MANANA SALUDABLE (1996)
Spanish Catholic Center, Inc, Silver Spring, MD
The Spanish Catholic Center's bilingual, primary care, medical clinic serves residents from North West Prince George's County and Montgomery County which have the largest number of medically unserved persons in the entire State of Maryland. The Center's service area has recently been designated by the State of Maryland to be a Medically Underserved Area and a Health Professions Shortage Area. This region of the State also has the largest concentration of Latino persons, and approximately half of the Center's patients can not speak English. The primary goal of this program is to promote the access to care for medically uninsured children. The Center will be augmenting the primary care services that it provides in coordination with local health departments. Specifically, the Center will begin to offer Saturday hours in the second year of the program, and the SCC will promote the awareness of health care issues through a public information campaign in the local Spanish-language medias. In addition, the Center will become a clinical rotation site for Pediatric Nurse Practitioner Students (Catholic University of America School of Nursing) and Master of Social Work student Interns (Catholic University of America School of Social Service) who will assist the SCC families in applying for all of the community resources for which they are eligible.

NEW BRIDGES TO IMPROVED CHILD HEALTH (1997)
Sinai Hospital of Baltimore, Baltimore, MD
New Bridges to Improved Child Health is the expansion of a home visiting model program originally designed to reduce infant mortality by offering psychosocial support services, as well as health education services to pregnant women and new mothers in order to assist them in overcoming barriers to preventive health care for themselves and their babies. The HTPCP grant funding supports expanded service delivery to families with children through the age of five who are at high risk for poor health. The program uses a home visiting model. Para-professional health educator/outreach workers to families' homes to provide education on preventive health measures and child safety while also assisting the family with referral to available hospital and community resources to assist with psychosocial problems impeding their use of health care. Home visitors work in partnership with pediatricians, both at the hospital's outpatient pediatric service and in the community, to provide consistency and reinforcement of preventive health teaching obtained in the pediatrician's office. Program staff will also work with providers to assist them in understanding the problems of poverty in which their clients live.

THE BREATHMOBILE PROGRAM (2007)
University of Maryland Medical System Foundation, Baltimore, MD
Since 2002, the University of Maryland Hospital for Children Breathmobile program, a specialized mobile clinic, has provided free preventive asthma care for underserved, primarily African American children in Baltimore. With the recent large influx of Hispanic families to the Baltimore area, this program is expanding its free specialized asthma services to the underserved Hispanic community. Expansion of the program to the Hispanic community has been limited due to lack of partnership with established Hispanic community groups and lack of bilingual medical personnel on the unit. Through a partnership with the Centro de la Communidad, the Breathmobile program will identify Hispanic families in need of asthma care. The Breathmobile team includes four board certified pediatricians, a nurse practitioner, a nurse, a driver/patient service worker, a research nurse who assists with data collection and analysis, and a part-time bilingual nurse. The children will be assessed, prescribed a course of treatment, and given written asthma management plan. They will also receive age-appropriate education materials to learn more about their condition. The children will be seen every 4-6 weeks to provide a continuum of care based on the National Health, Lung, Blood Institute guidelines for asthma care.

MASSACHUSETTS

DEAF FAMILY CLINIC: HEALTH CARE PROMOTION  FOR DEAF YOUTHS AND CHILDREN OF DEAF PARENTS (1992)
New England Medical Center, Boston, MA
Clinics tailored to the needs of deaf families will be established at the New England Medical Center (NEMC) in Boston, and at a satellite location in Framingham, MA. The project will target area children and youths under age 22 who are deaf or hard of hearing, or who have parents with those characteristics. The Boston clinic also will serve infants born or treated at NEMC who have characteristics that put them at risk for hearing loss. The clinics will be staffed by teams consisting of a pediatrician, a nurse, a receptionist, an interpreter, a program coordinator, and an ethnic consultant. Clinic services will include primary care, medical consultation services, and family-centered, coordinated health management. Project staff plan to provide clinic services to between 150 and 200 children per year, and to screen about 150 infants per year.

THE PEDIATRIC FAMILY VIOLENCE AWARENESS PROJECT (1992)
Carney Hospital, Community Oriented 
Primary Care (COPC) Program, Dorchester, MA
This project represents a collaborative effort between the Massachusetts Health Research Institute (the grantee), the Massachusetts Department of Public Health, Neponset Health Center's Family Advocacy Clinic, and the AAP Massachusetts Chapter. Overall project goals are to support health care providers to improve identification and response to maternal and child victims of family violence through training, consultation, and specialized clinical service. Over 750 Massachusetts providers attended the project's 32 continuing medical, nursing, and social work education workshops in 1993 and 1994. A minipreceptorship, written training curriculum, and intensive "training the trainers" seminar will be offered in project years 3 through 5.

INJURY PREVENTION FOR PREGNANT AND PARENTING TEENS: A HOME VISITING MODEL (1993)
New England Medical Center Hospitals, Inc, Boston, MA
Division of General Pediatrics and Adolescent Medicine, Boston, MA The goal of this project is to develop a home-based injury prevention model for high-risk adolescent families. Objectives include improving the quality of parenting provided by adolescent parents, reducing the risk of injuries sustained by children of adolescents, and enhancing the delivery of health care services to pregnant and parenting adolescents. A full-time outreach worker will utilize The Injury Prevention Program (TIPP) and community resources to provide home visitation and counseling for families identified. An outcome evaluation will compare intervention (home visited) and comparison groups for outcome measures of parenting behaviors and injury prevention behaviors. The evaluation will also measure the health status of the children, including numbers and types of injuries sustained.

MOTHERS' MENTORS (1993)
Networking for Life/Project Mattapan 
The Medical Foundation, Inc, Boston, MA
The Mothers' Mentors project will establish a maternal and child health promotion model by using 24 trained community residents as mentors to improve the health status, functional ability, and developmental capability of 144 infants and children. Project staff will link pregnant and parenting women with mentors who have had successful pregnancies and parenting experiences. Mentors will provide health education, facilitate linkages to primary health care, pediatric care, and family support services; conduct referral and advocacy as needed; and provide skill development opportunities for young mothers. The project has hired a male mentor to work with male parents in the community, assisting them to support the socioemotional needs of pregnant and parenting women and enhancing their own parenting skills. The project will provide a nurse consultant, child care, and transportation to augment its direct service capacity. Data will be collected to indicate the success of interventions.

PRESCHOOL ASTHMA EDUCATION PROJECT (1994)
Boston City Hospital, Boston, MA
The goal of the preschool asthma education project is to reduce the excessive morbidity experienced by young, inner-city children with asthma enrolled in a Head Start program. Specific objectives are to:

1. increase asthma care knowledge among parents and teachers,
2. increase asthma preventive care visits to primary care clinicians,
3. decrease asthma symptom levels among children in the target population,
4. reduce excess health care utilization (emergency room visits and hospitalization),
5. reduce asthma-related absences from Head Start programs,
6. reduce exposure to asthma triggers in the home, and
7. increase family use of adaptive behaviors regarding asthma.

Objectives will be accomplished through focus group meetings with parents and teachers, training sessions for Head Start staff, education and support groups for parents, and educational/play sessions with children. Data will be reviewed regarding asthma symptoms, therapy, health care utilization patterns, family asthma knowledge, decision-making, and adaptive behaviors as well as exposure to asthma triggers in the home both before and after program participation. The program will result in the creation of methods and materials suitable for use in all Head Start programs.

PROJECT SEED (1995)
Dimock Community Health Center, Roxbury, MA
Project SEED: "Support, Empowerment, Education, and Development," is a family-centered, developmental pediatric health care demonstration project that promotes optimal health and development of children by providing an enriched primary care prevention program that integrates child development services, family literacy, and family self-sufficiency programs. The goal of Project SEED is to ensure that young children are developmentally and educationally prepared to enter school. This project will include a new home-based component. A family advisor will be part of the multidisciplinary pediatric primary care team that will administer the home-based component. This component will provide the essential link between the family, community, and health care providers.

PROJECT HEALTHY ASIAN TEENS (PHAT) (1996)
South Cove Community Health Center, Boston, MA
This program teaches youth that it is "PHAT" ("cool") to be healthy. The project, under the guidance of South Cove Community Health Center, is the only community health center in the Greater Boston area that provides health care services primarily to the Asian communities. Ethnic-cultural barriers in accessing primary care services have been eliminated by the multicultural and multilingual staff who have developed a program for youth aged 13 to 17 that facilitates their accessing of primary health care services and educates them about practicing healthy behaviors. Participation is based on determining health risk factors for Asians, specifically for Chinese immigrants and Cambodian and Vietnamese immigrants and refugees. Activities for the youth include educational, social, and recreational components such as focus groups; bilingual flyers; biannual newsletters for youth; a youth health committee; health screenings and follow-ups; and a lunar new year party.

THE WORCESTER MEDICAL HOME INITIATIVE (2002)
Massachusetts Society for the Prevention of Cruelty to Children, Worcester, MA
The Worcester Medical Home Project supports the creation of a coalition of families, primary and subspecialty care providers, care coordinators, and home visitors. This Medical Home team will ensure that the delivery of medical and non-medical services will be comprehensive, accessible, coordinated, culturally effective, continuous, and family-centered within three inner city practices in Worcester, MA. The goal of the project is to improve health outcomes by creating medical homes for children with special health care needs attending the 2 pediatric and 1 family practice office sites. We will use evaluation tools to measure the organization and delivery of primary care services in supporting chronic condition management, care coordination, community outreach, data management, and quality improvement. Simultaneously, families will participate in an evaluation to measure emotional, physical, social, health, and developmental progress as well as consumer satisfaction.

ADVOCATING SUCCESS FOR KIDS (ASK) (2002)
Children's Hospital, Boston, MA
Children's academic success during preschool and primary grades may be compromised by developmental concerns caused or exacerbated by psychosocial stressors such as substandard housing, complex family situations, substance use, and domestic violence. In partnership with the Boston Public Schools and 6 community-based urban primary care sites, the Advocating Success for Kids (ASK) program will provide diagnostic consultations and follow-up visits for children presenting with behavioral, developmental, or learning difficulties that impair their ability to learn effectively in their classrooms. A multidisciplinary ASK team, consisting of a psychologist, educator, developmental pediatrician, and case manager, will meet with families at their community health center and provide case coordination-linking families with indicated educational, medical, and psychosocial support services. Goals of the ASK program are to work with families, primary care providers, and the local school system to:

1. improve school readiness and performance of children ages 3 to 9 years; and
2. improve the emotional well-being of children served through the ASK program.

PROJECT E-SMART: USING THE PEDIATRIC ELECTRONIC MEDICAL RECORD TO SCREEN MOTHERS FOR DEPRESSION AND REFER FOR TREATMENT (2003)
Boston Medical Center/Boston University School of Medicine, Boston, MA
Maternal depression, a condition associated with a host of poor child health and developmental outcomes, is alarmingly prevalent in women of childbearing age. Yet the disorder is seriously underdiagnosed and undertreated, largely due to women’s fragmented contact with the health care system. The pediatric setting offers an alternative location to focus identification and referral efforts for maternal depression in that the current schedule of childhood immunizations and health supervision visits creates a strong and necessary link between families and pediatric primary care. Project E-SMART aims to create a mechanism within pediatric settings to systematize both the detection of maternal depression and the referral-making process using the technology of the electronic medical record (EMR). Specifically, Project E-SMART will develop an electronic screening form, which will be linked to educational handouts for providers and consumers. The screening form will be inserted into EMR templates for the 4-month, 12-month, 18-month, 3-year, and 4-year well-child visits. The project will also develop and implement an electronic referral protocol for women who screen positive for depression. Project E-SMART is a joint effort between Boston Medical Center and the Health Services Partnership of Dorchester, which is an organizational collaboration between two community health centers in inner-city Boston that serve a culturally diverse population, including significant numbers of Vietnamese, Haitian, Cape Verdean, Dominican, and Caribbean families. The two health centers, Dorchester House Multi-Service Center and Codman Square Health Center, will implement screening for maternal depression in their pediatric and family medicine departments and refer women, as appropriate, to primary care and mental health services. The project will evaluate the implementation of standardized screening for maternal depression in a community setting. Additionally outcomes to be evaluated include the prevalence of maternal depressive symptoms, maternal acceptance of screening and referral for follow-up care within the pediatric setting. Staff of both health centers will participate in trainings provided by the project on the impact of maternal depression on child well-being and the screening and referral protocol. A major focus of Project E-SMART will be dissemination of the screening tool and project approach to additional venues in Massachusetts through collaboration with key agencies, particularly the Massachusetts Department of Public Health (MDPH) to integrate screening for maternal depression at MDPH-funded pediatric primary care sites.

PEDIATRIC MENTAL HEALTH SCREENING & INTERVENTION IN PRIMARY CARE OFFICES (2003)
Cambridge Health Alliance, Institute for Community Health, Cambridge, MA
Child and adolescent mental health has become one of the top five public health priorities for the city of Cambridge. A recent needs assessment on child mental health conducted by the Institute for Community Health and the Harvard Children’s Initiative found that children in Cambridge were falling through the cracks and families were having an increasingly difficult time negotiating a fragmented, complex system of care. This Pediatric Mental Health Screening and Intervention Project (PMHSIP) is the result of a collaborative effort between parents, providers, school and city agencies, public health and pediatrics that has identified mental health screening in pediatrics as a targeted priority for the community. Through an integrated delivery system, this project will link children and their families to appropriate mental health services and coordinate efforts between primary care providers and schools in providing care.

FAMILY ADVOCATES OF CENTRAL MASSACHUSETTS (2004 General Grant)
University of Massachusetts Medical School, Worcester, MA
Family Advocates of Central Massachusetts is a partnership between the University of Massachusetts Medical School and the Legal Assistance Corporation of Central Massachusetts that incorporates legal advocates on the multidisciplinary team providing a Medical Home for children of low-income families in Worcester County, Massachusetts. Family Advocates of Central Massachusetts will improve the health of low-income children and their families by focused advocacy in four areas. For families in the targeted practices, the program goals are:

1. to improve housing stability (e.g. by reducing or eliminating lead poisoning, homelessness, mold and allergens);
2. to improve financial security (e.g. by increasing access to disability benefits, food stamps, Medicaid);
3. to improve dignity and safety (e.g. by addressing immigration status, domestic violence); and
4. to improve access to health care (e.g. by ensuring appropriate dental, mental health, and/or special education services).

In order to accomplish these goals, the program has developed a practical screening protocol within each medical practice; trained health care providers to recognize and refer patients with issues to Family Advocates for triage and management; and provided advocacy and/or full representation in cases requiring those services within practice population.

HEALTHY TEETH FOR TOTS: PROMOTING A COMMUNITY-BASED MODEL TO REDUCE EARLY CHILDHOOD CAVITIES (2004 Oral Health Grant)
Dorchester House Multi-Service Center, Dorchester, MA
The goals of the project are to develop a reproducible community-based model to: 1) reduce the proportion of children with primary tooth decay and, 2) reduce the proportion of young children with untreated primary tooth decay. The program will increase pediatric provider participation in oral health screenings for young children through the introduction of an oral health education curriculum for pediatric providers. Resource tools, such as the Cavity Risk Assessment Tool, will also be provided to pediatricians to improve screening for oral health during well-child visits. Parental education will also be key to the program's success.

CHILDREN'S HOSPITAL BOSTON COMMUNITY ASTHMA PROGRAM (2006)
Children's Hospital Boston, Boston, MA
The Children's Hospital Boston Community Asthma Program is implementing a comprehensive and community-based approach to asthma management for low-income inner city children and their families. The project will focus on children ages 2 to 18 years old living in the Boston neighborhoods of Roxbury and Jamaica Plain. This project will include a combination of case management, home visitation, and community education intervention. The goals of the project are to reduce disparities in childhood asthma, raise public awareness, and advocate for public policy changes to ensure families have access to asthma related educational and medical resources.

MICHIGAN

CENTER FOR FAMILY HEALTH (1990)
Region II Community Action Agency, Jackson, MI
The goal of the Center for Family Health is to reduce the infant mortality rate in Jackson County by providing access to prenatal care to a population of which approximately 90% are Medicaid-insured. Now in its fifth year of operation, the Center staff delivers approximately 400 babies per year. A nurse-midwifery/physician model is used to deliver care that includes a wide scope of services including the services of a general practice physician who provides medical care to children, men, and women. Many services are available on-site including the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), perinatal substance abuse treatment, and dietitian services. The Center's C-section rate is less than 12%, and the rate of low-birthweight babies is approximately 28/100 births. The center has formed a strong partnership with its local hospital and many other health and human service providers.

COLLABORATIVE DEVELOPMENTAL CLINIC (1990)
Michigan State University, East Lansing, MI
The goal of this project is to impact on school-related behavior and learning problems by implementing a system that brings together a pediatrician, a child psychologist, and a school consultant to provide comprehensive evaluation and treatment. The focus will be family-oriented, and interventions will be designed to address educational, psychological, and medical needs. Factors contributing to the poor representation of lower socioeconomic families will be examined. A further goal will be for the model of collaboration between community medical and educational institutions to become economically viable over the funding period.

CONSULTATION SERVICE FOR CHILDREN WITH CHRONIC ILLNESS (1992)
Michigan State University, East Lansing, MI
Project goals include increasing access to primary care for children with chronic illness and assisting community-based primary care physicians in providing comprehensive care for children with chronic conditions. Team assessments will be provided for children with chronic illness in a targeted 18-county region. An individual health plan will be developed for each child and sent to his or her primary care physician as well as the district health department's coordinator for children with special health care needs. Continuing medical education will be provided at the four university branch campuses, and the AAP Michigan Chapter will assist with educational efforts as well as distribution of program information.

MADRES Y NINOS COLONIA HEALTH PROGRAM (1995)
Midwest Migrant Health Information Office 
(Project Site: Mercedes, Texas), Monroe, MI
The Madres y Ninos Colonia Health Program is a cooperative venture between the Midwest Migrant Health Information Office and Avance, a family support and education agency. This project assists Hispanic women and children to access health care through the use of peer educators. Colonia health workers are migrant farmworker women of the same socioeconomic background as the colonia families. The woman are trained to provide health education, advocacy, and/or referral to services to participants for a wide range of services such as: drug abuse counseling, health care services, and HIV/AIDS education.

FOCUS: FAMILIES OF COLOR UTILIZING SERVICES (1997)
Ele's Place, Lansing, MI
Children suffer adverse health outcomes, both mental and physical, when they lose a loved one to death. Since 1991, Ele's Place has been creating awareness of and support for grieving children and their families. In an urban setting, the agency is aware of families of color who are in need of services but not fully using the program. The FOCUS at Ele's Place Project (Families of Color Utilizing Services) will increase access to these services to the minority community through efforts directed specifically at recruiting families, facilitators, and clinicians of color. This outreach initiative will be accomplished through collaboration with local agencies, community leaders, and churches in the minority community. Additionally, efforts to provide health care professionals with a theoretical understanding of grieving children and appropriate interventions will expand and intensify.

PREGNANCY EDUCATION AND SUPPORT PROJECT (PEAS PROJECT) (2002)
B-H-K Child Development Board, Houghton, MI
Michigan's "Copper Country" is located in the most northern part of its Upper Peninsula. Many families are geographically isolated and poor with high rates of child abuse/neglect and alcohol use. Pregnancy-specific concerns include late entry into prenatal care, low breastfeeding rates, and high smoking rates during pregnancy. The PEAS Project was created to address the community's critical need for prenatal education and support. Through the program, all pregnant women will have the opportunity to:

1. receive a single home visit which will provide them with information and link them to insurance, prenatal care, and other needed services;
2. participate in an ongoing support and education group that will offer socialization with peers and information about pregnancy, childbirth, and parenting; and
3. take part in a gentle perinatal fitness program. Project goals include increased entry into first trimester prenatal care, decreased high-risk behavior during pregnancy, increased parental knowledge of pregnancy and early childhood care, increased breastfeeding rates, and increased utilization of existing health and social support services.

The project's overall goal is to help parents deliver healthy babies into healthy homes.

SCHOOL- BASED HEALTH CENTER (2003)
Center for Family Health, Jackson, MI
To eliminate health disparities for Northeast Elementary children, the program will provide access to complete, quality health care for the children and their families, including translation services, case management, and Medicaid or sliding discount enrollment. The bilingual staff will include a family nurse practitioner, dental hygienist, and social worker. A physician and dentist will also provide services for more complicated cases. Health education needs will be addressed through a health educator who will provide programs focusing on obesity and diabetes prevention and asthma education.

TLC (TOGETHER LEARNING TO COPE): SUPPORTING CHILDREN WHOSE FAMILIES FACE A LIFE-THREATENING ILLNESS (2004 General Grant)
Ele's Place, Lansing, MI
The TLC Program will enlist the collaboration of hospice, medical, and social service providers to develop and distribute information packets for families facing the life-threatening illness of a family member, and to design and implement support services. The applicant's staff will consult with families seeking services via the phone or the applicant's website/e-mail address, will make home visits as needed, and will offer support groups and workshops free of charge for the children and their parents/guardians. Volunteers will be recruited and trained to facilitate support groups and assist with outreach efforts. Educational services will be offered to service providers in the form of informational material and presentations. A comprehensive community outreach plan will ensure the TLC services will be accessible and welcoming to all eligible families, including families of color.

MINNESOTA

PARTNERSHIP PROJECT (1990)
Health Start, Inc, St Paul, MN
The goal of this project is to facilitate the development of secure mother/infant attachments and to minimize closely-spaced pregnancies within the client population. Project staff will recruit between 40 and 50 participants from the clientele of the prenatal clinics operated by Health Start, Inc. Project participants will be mothers who are at risk for dysfunctional parenting and demonstrate a need for and an ability to benefit from project services. These services will include case management, home visits, pediatric health care, support groups, and nutrition and family planning services. Intervention efforts will begin in the last 4 months of each woman's pregnancy and will continue for 2 1/2 years.

AIR CARE: IMPROVED ASTHMA MANAGEMENT FOR YOUNG CHILDREN AND ADOLESCENTS (1992)
Children's Health Care, Minneapolis, MN
Minority inner-city children and adolescents with asthma will receive assessments, asthma education, and home visits in an effort to improve their health services utilization, including asthma management medications. A home care nurse will work with physicians and social workers to conduct the assessments and will collaborate with the American Lung Association of Hennepin County and area schools. Eligible patients will be enrolled in a summer camp program for children with asthma. Project staff plan to use functional outcomes to measure improvements in each patient's asthma condition. Asthma management will follow guidelines for asthma care published by the National Heart, Lung, and Blood Institute.

NORTH STAR ELEMENTARY SCHOOL-BASED COMMUNITY HEALTH CENTER (1994)
Minneapolis Dept of Health and Family Support, Minneapolis, MN
The North Star School-based Community Health Center is an elementary school-based primary care clinic serving students, their families, and community residents in the near north community of Minneapolis. Through a multidisciplinary and multiagency approach, the clinic will provide comprehensive health and social services that have been scarce in this diverse and underserved community. The goal of the project is to improve the health and educational status of families and children within this community.

HABITAT HEALTH SERVICES (1995)
Univ of Minnesota/Duluth School of Medicine,
Department of Family Medicine, Duluth, MN
The Habitat Program and Unity School in Duluth, Minnesota, will use HTPCP funding to serve high-risk adolescent mothers, infants, and toddlers by establishing Habitat Health Services (HHS), a local collaborative effort including the University of Minnesota, Duluth School of Medicine, St Louis County Nursing Division, and Duluth public school nurses. In-school day care will be provided for infants and toddlers of adolescent mothers who are enrolled in Duluth public schools; Unity High School provides an alternative program for students, including single mothers of young children, with behavior and/or emotional problems. Health care for infants and toddlers of adolescent mothers and health care and health education for mothers will be provided by HHS. The project will also serve as a training site for Duluth School of Medicine second-year medical students and nurse practitioner students from the College of St Scholastica, in Duluth.

SUPPORTING PAN ASIAN RUNAWAY AND HOMELESS YOUTH PROJECT
(2007)
Asian Media Access, Inc, Minneapolis, MN
The number of runaways and homeless Asian-American and Pacific Islander (AAPI) youth have increased in Minnesota. In order to provide culturally-appropriate health services to homeless and runaway youth, the project will utilize a strong collaborative network with partners such as the Asian Women United Shelter, Children’s Hospital, Sexual Offense Services, and the University of Minnesota. The project will conduct street outreach, health education, prevention and intervention services for AAPI youth ages 10-18, with a special focus on Hmong runaway girls who bear the highest risk of being sexually abused. The goals of this project are to assist AAPI runaway and homeless youth to live healthy and substance-free life styles and to increase community awareness of available resources and health care services for the vulnerable youth.

MNCHIP: INVESTING IN HEALTH AND EARLY LEARNING FOR NEW AMERICANS (2009)
Minnesota Academy of Pediatrics Foundation, St Paul, MN
Disparities exist in Minnesota children in immunization rates by race, well child check-ups by income and geography, health insurance coverage by race/ethnicity, and reduction in kindergarten readiness ratings as 'proficient' or 'in process' for 'Language and Literacy' and 'Mathematical Thinking' by income and English as the primary home language. Well baby visit rates for all races less than 2 years of age were met 49.8% of the time using AAP standards. The project will provide supportive health/developmental screening to low-income, new Americans (Somali, West African, Hmong, Burmese, Hispanic) 0-3 years in 4 target areas of urban and rural Minnesota. Pediatricians will increase cultural awareness with elders and other pediatricians. Bi-lingual navigators will outreach to families linking them to health care and enriched Early Child Development scholarships. The goal of the project is to reduce barriers that have prevented new American families from participating in well-baby/child services and enriched child care as a path to school readiness. Three strategies will be used: (1) a lead pediatrician will be responsible for peer education and outreach to new American elders and other pediatricians serving children in each target area; (2) Bi-lingual Navigators will be contracted to provide outreach to families with children 0-3 years in target neighborhoods and clinics; and (3) low income three year olds from the target neighborhoods will be connected to Minnesota Early Learning Foundation scholarships for enriched child care prior to school entry.

MISSISSIPPI

SHARKEY-ISSAQUENA HEALTH ALLIANCE (1989)
The Luke Society, Cary Christian Health Center, Vicksburg, MS
This Healthy Tomorrows grant has enabled the Cary Christian Health Center to add five new service components. Center staff have developed a perinatal care network that includes all who provide care to expectant mothers, new mothers, and infants. The center has expanded the prenatal and parenting classes offered to encourage participation by families who receive primary care from another source. Other new components include providing education on dating and sexual relations within a targeted secondary school, adding to the center staff a social worker who specializes in child abuse cases, and developing a program for training lay people to serve as home visitors and provide instruction and evaluation.

DELTA HEALTH PARTNERS, HEALTHY TOMORROWS PARTNERSHIP FOR CHILDREN PROGRAM (2004 General Grant)
Tougaloo College, Health and Wellness Center, Delta HealthPartners Initiative,
Tougaloo, MS

The goal of Delta HealthPartners Healthy Tomorrows Partnership for Children Program is to increase the rate of compliance with the recommended periodic schedule for well child care. Delta HealthPartners will recruit, train and supervise outreach workers comprised of Temporary Assistance for Needy Families (TANF) recipients who are indigenous to the area. The outreach workers will be responsible for case finding and recruitment activities with targeted population that will include ascertaining the level of participation among enrolled children and youth, providing well child care education, linking non enrolled children and youth to partnering screening resources, and following up with failed appointments. Further, outreach workers will educate and assist eligible families to access Mississippi Health Benefits (MHB).

PONTOTOC CATCH KIDS EXPANSION PROJECT (2005)
CATCH Kids, Inc. Tupelo, MS
The goal of the Pontotoc Expansion Project is to provide comprehensive, high quality medical and dental care for children with barriers to assessing care. CATCH Kids will establish both school-based clinics and evening community-based clinics in which free medical care and medications will be provided. Preventive dental care instructions along with oral hygiene care products and pre-determined restorative dental care will also be provided. Families will be assisted in enrolling for Medicaid and CHIPS when appropriate.

MISSOURI

FAMILY FRIENDS: NEIGHBORHOOD VOLUNTEER CORPS (1993)
The Children's Mercy Hospital, Kansas City, MO
This Healthy Tomorrows grant will focus on improving the health outcomes for children and adolescents in families where substance abuse is a problem. Health care professionals and trained community volunteers will work together to visit families on a weekly basis, establish a social support system for parents and peer support outside of the drug network, and facilitate referrals to meet identified health care needs. Through data collected during emergency room visits and hospital stays, project staff hope to show decreased repeat pregnancies, increased birth weights of infants conceived during the course of the grant, decreased incidence of child neglect/abuse, and an increase in knowledge of appropriate parenting behaviors.

SOUTH SIDE INFANT AND FAMILY CENTER (2004 General Grant)
South Side Daycare Nursery (SSDN), St Louis, MO
The family center will be open for both drop-in and structured parent-child sessions. All participating families will have the opportunity to maintain on-going relationships with each other and with the SSIFC through scheduled "open times" at the Center. All families served by the family center for this project will complete the following assessments; Child Abuse Potential Inventory, Dunst Family Support and Resource Scales, Service Coordination Scale, and Child Behavior Checklist. Based on the information obtained in these assessments, an action plan will be developed. Referrals to health and human services will be made as needed. Confirmation of referral follow-ups will be made within 48 hours. Following a referral, the Family Center Coordinator Assistant will conduct a family and agency satisfaction surveys at two and six-weeks. On a monthly basis, satisfaction feedback will be provided to families utilizing the referral services and agencies receiving referrals.

MONTANA

FOLLOW THE CHILD (2004 General Grant)
Missoula City-County Health Department, Missoula, MT
Foster children represent an especially vulnerable segment of the population, often with complicated and on-going medical needs. In Missoula County, over 160 children are in out-of-home placement each year. There is currently no system to assure these children have a consistent medical provider, receive routine and preventive medical and dental care, immunizations, and specialty care when needed. Because the children lack integrated health care services, they often lack complete or comprehensive medical records to track or guide the health care they do receive. Foster parents currently receive little or no health information or education concerning the health needs of children in their care. The Follow the Child project will develop a system of retrievable health information (medical record) that can follow the child through multiple placements, reunification with family, or transition to living on his/her own. The project's foundation is the collaborative efforts of local physicians and dentist, Child and Family Services Department, Missoula City/County Health Department, WIC, and many other community-based service and education programs. The program goals are: 1) enhance continuity of care and access to preventative, routine, and specialty care; 2) create and regularly update a centralized, retrievable medical record that can follow the child; 3) provide education for foster parents and caseworkers on health issues relevant to the children in their care; and 4) link foster families to preventative health services and parenting assistance available through existing public health programs and other community resources.

NEBRASKA

RURAL PARTNERSHIP FOR CHILDREN (1990)
Dept of Pediatrics, Univ of Nebraska Medical Center, Omaha, NE
This project is an initiative to improve access to community-based pediatric consultative care for children with special health care needs who live in a rural four-county targeted area in northwest Nebraska, complementing the on-going health care provided by local family physicians. The project provides the mechanism to link pediatricians with local providers in the children's medical home. Through monthly Pediatric Consultation Service (PCS) Clinics, a team of general pediatricians plus behavioral psychologists and a nutritionist spend 1 to 2 days providing consultation in the offices of local "host" physicians. The PCs clinics rotate among four sites to enhance geographic access. From these host sites, the consulting team sees children with chronic or recurrent illnesses who have been referred by local providers and confirms diagnoses, recommends treatment, and develops, along with the family, comprehensive, coordinated health care plans for children served. A child advocacy coordinator in the local area works with local providers, families, and the consultation team to provide outreach and follow-up.

HEALTHY BEGINNINGS PARENTING PROGRAM (2000)
Mary Lanning Memorial Hospital, Hastings, NE
Healthy Beginnings is a nurse model of home visitation providing health education and parenting support to families enrolled in the Early Head Start program who are at risk for poor parenting. Factors identifying families at increased risk are widely varied, and include a past history of being abused as a child, substance abuse, intellectual limitations or mental illness in the parent, bonding and attachment issues, child health or developmental risks, unstable lifestyle, domestic violence, or inadequate prenatal care. Enrolled families receive prenatal education, including Lamaze and breastfeeding support, child health and developmental assessments, home safety appraisals, age-appropriate anticipatory guidance, and infant mental health interventions. Repeat pregnancy prevention efforts include contraceptive education and referral. All interventions are linked with appropriate parenting education, referrals to other services, and a primary medical home. Long-term, intense, and positive support is initiated prenatally and extends until the youngest child reaches age 5 years. The key objective of this program is to provide nurse home visits, health education, and parenting support to the Early Head Start curriculum. The project will provide family health and developmental education and parenting support to families from two nationally recognized models of home visiting. This public/private partnering is a natural blend of two solidly-based programs in five counties of South Central Nebraska.

PROJECT WIN (WELCOMING INFANTS INTO NEIGHBORHOODS (2004 General Grant)
Visiting Nurse Association, Omaha, NE
Project WIN is a program of public health nurse home visitation to pregnant women, or vulnerable families with children less than one year old living in Douglas County, Nebraska who are identified as at risk. The purpose is to promote healthy behaviors, create healthy environments, and increase access to health care, specifically related to disparities noted between Healthy People 2010 and county maternal child data. In response to these disparities, VNA Maternal Child Services have established the following four outcomes:

-Promoting positive birth outcomes.
-Reducing accidental childhood injuries and infant mortality.
-Reducing the incidence of vaccine-preventable diseases in infants and children.
-Increasing awareness about environmental hazards.

Project WIN is a point of entry for families who are not connected to the network of community services. This is accomplished through the activities of assessment, teaching, collaboration, and referral, occurring on home visits at the newborn stage, and again at six and twelve months of age. Both Spanish speaking and African immigrant families are served by this program, which strives to provide culturally competent care to a diverse ethnic and socio-economic population.

BOYS TOWN TRANSITION CLINIC (2007)
Father Flanagan’s Boys Home, Omaha, NE
Youth who have experienced trauma resulting in out-of-home placement often enter care with challenges related to physical health. In order to prepare youth for accessing health care and leading healthier lives following out-of-home placement, staff at Girls & Boys Town are developing a Transitions Clinic. Through this clinic, the nurse manager will assess youth understanding of preventive health care by utilizing the health care component of the Ansell-Casey Life Skills Assessment, an evaluation of youth independent living skills. Youth will receive health education, guidance and resources based on their identified needs. Clinic staff will work with youth to: 1) Assess knowledge of self-care and provide needed preventative health care education, 2) Develop a personal health record for each youth, including a care plan for youth with chronic conditions, 3) Perform a comprehensive physical exam prior to discharge from Girls and Boys Town, and 4) Connect each youth with a medical home in their own community.

VNA’S LOVE & LEARN TEEN INTER-DISCIPLINARY HOME VISITATION (2009)
Visiting Nurse Association, Omaha, NE
Pregnant adolescents present with risk factors that lead to adverse pregnancy outcomes, including: low pre-pregnancy weight; use of nicotine, alcohol, and other drugs; no early and regular prenatal care; and poor pre-pregnancy nutritional status and eating habits, including lack of prenatal vitamins. The Visiting Nurse Association (VNA) Love & Learn Teen Home Visitation program (Love & Learn) is an interdisciplinary home visitation program to address the numerous needs of pregnant and parenting teen parents and their children. The project will improve birth outcomes and promote optimal health and development of the infant by providing services based on an intensive home visitation model for pregnant and parenting teens, with services of high intensity and frequency. Each teen will receive visits in the home or other community setting by a public health nurse and a parent coach, who work as a team with the teen to provide health and parenting information and social work support. An evidence-based curriculum will be used by the nurse and parent coaches. A partnership with Omaha Public Schools will provide opportunities for nurse presentations in the teen parenting classes of 5 high schools, and will serve as a referral source. The primary program goals will be to: (1) improve birth outcomes through regular prenatal care and reducing unhealthy lifestyle choices during a teen's pregnancy, (2) promote optimal health and development of the infant by increasing access to preventative health care and nutrition, and (3) promote optimal health and development of the infant by increasing the teen’s knowledge of infant development.

NEVADA

NEVADA CARE PROGRAM (2008)
Southern Nevada Area Health Education Center, Las Vegas, NV
In Clark County, NV, there is currently no comprehensive, coordinated program of prevention, outreach and treatment services for HIV+ pregnant women and their children. The Nevada Care Program will develop a fully inclusive program of prevention and care services for HIV+ pregnant women, infants and children. The project will deliver the first, culturally competent, family centered, comprehensive prevention and intervention program for HIV+ pregnant women, children, and adolescents in Las Vegas, Clark County, Nevada. The project will target African American, Native American and Hispanic pregnant women, and will provide prevention and intervention healthcare services for a population of low income pregnant women, including those who are HIV+, their infants and children. The Project will implement a community-wide, culturally relevant HIV Public Information and Education Campaign targeted to women and pregnant women of color, community obstetricians, and the HIV community. Program components include: HIV/AIDS prevention, education and outreach services; prenatal care; infant and child care; access to screening and HIV treatment services; case management and access to AIDS Drug Assistance Program (ADAP) and social services resources; and program evaluation.

NEW HAMPSHIRE

SEACOAST HEALTHNET (1995)
Exeter, NH
This project will provide staffing to significantly expand the existing health education efforts and enhance the family support services currently within the Seacoast HealthNet. A professional health educator and three lay health educators will develop a family-centered project designed to provide a comprehensive package of health education services. The health education program will use the family strength model to assist families in identifying their own areas of concern and will help families to address these concerns by identifying and building on each family's strengths and maximizing the use of existing medical, mental health, and social services in the area.

GOOD BEGINNINGS HOME VISITING NETWORK EXPANSION PROJECT (2005)
Good Beginnings of Sullivan County Claremont, NH
Families and children who are uninsured are less likely to have access to a medical home and a personal physician to coordinate care. The goals of the Good Beginnings Home Visiting Network are to promote healthy pregnancy and birth outcomes; to promote a healthy, safe and nurturing environment for children; and to enhance the families' life course and development. The target population for this project is uninsured families who do not have access to the full array of preventive healthcare services available to others in our community. This project will provide nurse case management, health education, parenting education, and assessment services to families in their homes. Case managers will follow families until the child turns 6 years old.

GET IN SHAPE PROGRAM (2007)
Weeks Medical Center, Inc, Lancaster, NH
The Get In Shape Program is an intensive 10-session therapy program to address the increasing needs of overweight and obese children in the primary care setting. Over the course of the grant, the child and parent will demonstrate effective and lasting therapy outcomes by participating in the successful Shapedown curriculum and therapy sessions. The therapy sessions will include an Interdisciplinary Therapy Team (ITT) to identify/treat the specific therapeutic needs of the child and parent. The team will consist of a pediatrician, pediatric mid-level provider, a registered dietitian, a certified recreational therapist, and a licensed clinical social worker. The goals of this project are to: 1) Develop and implement an intensive interdisciplinary therapy program based on the proven results of the Shapedown curriculum and 2) Establish a Pediatric Obesity Advisory Board to insure the ongoing contributions to children’s health and wellness and provide oversight to the program.

NEW JERSEY

TLC (TRENTON LOVES CHILDREN - HOME VISITOR PROJECT (1996)
City of Trenton Division of Health, Trenton, NJ
In cooperation with Trenton area prenatal clinics and hospitals, TLC will identify a cohort of infants born in Trenton and establish a long-term relationship with the family. The project staff will track and monitor selected health behaviors (primary care, immunizations, lead screening, WIC participation, etc.) within these families through the child's second birthday. TLC will conduct home visits to at-risk families and become the link between families and the primary care/managed care provider to ensure access to comprehensive health services and improve outcomes. The home visit staff will asses health and developmental status, parenting skills, home environment, family supports, internal/external barriers to care; and offer anticipatory guidance to families regarding basic health and social service needs.

NEW MEXICO

HEALTHY FAMILIES SANTA FE: AN EARLY INTERVENTION PROGRAM FOR PREVENTION OF CHILD ABUSE AND NEGLECT (Formerly Santa Fe First Steps) (1991)
New Mexico Department of Health, Santa Fe, NM
The purpose of this program is to identify the needs of the families in the community and provide the intensive home visitation component to those who qualify. In partnership with Healthy Families America (HFA), which operates 60 HFA pilot sites including Santa Fe, and whose overall goal is to lay the foundation for voluntary, neonatal, home visitation systems nationwide, 500 families have been referred to date. Families are referred at the birth of their first child and graduate from the program when the child turns three. Support workers empower the families by offering child development information, infant stimulation, and linkage to community resources including a medical home, group activities, and transportation to clinic appointments. An evaluation component is in place to determine the program's effectiveness to significantly reduce the incidence of child abuse and neglect in Santa Fe County and improve the home environment of families of newborns.

HELPING INDIAN CHILDREN OF ALBUQUERQUE (HICA) (1994)
All Indian Pueblo Council Inc, Albuquerque, NM
HICA (Helping Indian Children of Albuquerque) will provide service coordination for urban Indian children in the Albuquerque metropolitan area. The All Indian Pueblo Council will administer the grant with the guidance of an active advisory board consisting of local pediatricians, parents, public school personnel, and agencies that provide services to people with disabilities. The project aims to improve access to and utilization of health care and related resources by urban Indian children and their families. Project staff will work with families through a process of home visitation, development of an IFSP, parent education, case management and advocacy training, and formal collaborative agreements with participating agencies. A network of parents will be organized to provide a support system for participating families.

THE PUENTES TEEN PARENT SUPPORT PROJECT (1994)
Taos County Maternal and Child Health Council, Taos, NM
The Puentes project is a comprehensive, long-term, case management, teen parent support program initiated by the Community Wellness Council (the Taos Maternal Child Health Council), a Presbyterian Medical Services program in a community of approximately 7,000 in a rural county that documented 40 births to teens in 1994. The case management component will assess individual participant needs for schooling, job training, public assistance, housing, and medical care; will assist participants in accessing these services; and will serve as a liaison between care providers. Home visitation is a primary facet of this component. The counseling component will provide two support groups weekly, which will be a forum for parenting and child development education as well as counseling, and will involve the participation of several peer facilitators as well as the counseling coordinator. Staff and participants will jointly undertake a project to document and validate traditional and developmentally appropriate child care and child rearing practices in the Taos area. The program is designed to serve 20 pregnant and parenting teens at a time, for a 3-year period.

GIRL TIME YOUTH DEVELOPMENT PROGRAM (1999)
Community Wellness Council, Taos, NM
Girl Time is an after-school enrichment program for at-risk nine and ten year old girls, which meets three days a week. Girl Time's primary goal is to prevent future teen pregnancy by empowering girls to develop and realize their goals and dreams in every aspect of their lives. Girl Time will include educational support, health promotion, age appropriate sexual health education, alcohol and drug prevention, and assertiveness and self-defense training. Music, dance, arts and crafts, sports, cultural enrichment, and community service also will be a major part of Girl Time. The program provides support to the entire family through case management, information and referral, advocacy, and parent/child activities. Our goal is to have girls participate in our program from age nine and ten years until age fourteen. From age fourteen until age nineteen, girls will continue with case management, educational support, and community service and leadership opportunities. Eligibility requirements for participants include: academic underachievement, poor school attendance, known family dysfunction, divorced or single parent families, low income level, early physical maturation, family history of teen pregnancy, and lack of religious or community involvement.

PREVENTIVE ON SITE WELL CHILD CARE FOR CHILDREN ATTENDING CUIDANDO LOS NINOS THERAPEUTIC CHILD CARE FOR HOMELESS CHILDREN (1999)
Cuidando Los Ninos, Inc, Albuquerque, NM
The Well Child Care Center at Cuidando Los Ninos Child Care is providing preventive health care for 55 children from 6 weeks to 5 years old, whose parents, primarily mothers, are attempting transition to a permanent housing situation. Social workers aid the parents in the transition process. Therapeutic childcare is provided 5 days a week. Developmental evaluations, play therapy, and psychological consultations are available.

We offer well child exams, as well as exams at the first sign of illness to allow early medical intervention and to decrease the absentee rate. Dietary evaluations and assessment of dental health will be regular components of our services. Few parents use their Medicaid insurance effectively. Teaching sessions with parents are planned to provide basic, practical information on child rearing and common ailments and to provide parents with skills to become effective advocates for their children once they leave the program. Community nurses and local pediatricians will work in the clinic, as well as medical, nursing and physician assistant students.

THE SEAD (SUPPORT, EMPOWERMENT, ADVOCACY, AND DOULAS) PROJECT (2000)
New Mexico Advocates for Children and Families, Albuquerque, NM
Non-English-speaking immigrant women and their infants face formidable language and cultural barriers to health care, which may result in poor health outcomes. Childbirth represents an especially vulnerable time for these women, who may be unable to communicate effectively with providers during deliveries, or may experience health care providers who are unaware of other cultural practices related to childbirth, resulting in culturally inappropriate care. The SEAD project was developed in response to needs expressed by women with limited English-speaking skills for quality medical interpreting, culturally competent health information, and emotional support during pregnancy, labor, delivery, and early parenting. The project develops leadership capacity among these women, while training bilingual women as doula/medical interpreters to provide prenatal education, medical interpretation, and support during childbirth, postpartum, and at home to new parents. The SEAD collaboration consists of community women and organizations, health care providers, service agencies, the University of New Mexico, and the New Mexico Department of Health. Project objectives include:

1. Improving birth outcomes and breastfeeding rates among women with limited English-speaking skills;
2. Empowering community women to improve their own health and the health of their families; and
3. Increasing local health care systems' multi-lingual and multi-cultural perinatal services for women.

NEW YORK

PARENTS AND CHILDREN TOGETHER (PACT) PROGRAM (1989)
The Children's Hospital of Buffalo, Buffalo, NY
The Children's Hospital of Buffalo established a pilot program in 1988, to provide primary care to children at high risk for physical or sexual abuse, many of whom were being raised by parents with substance abuse problems. The Healthy Tomorrows grant has helped to support the addition of three new components to this pilot program. As part of a maternal and child health advocacy component, participating families receive parent education classes and intensive home-based support from "maternal-infant specialists" who have been recruited from the community and trained to conduct home visits and provide surrogate parenting. Project staff also coordinate support groups for the mothers of children enrolled in the project. The other two added components include one that focuses on research regarding the outcomes for program participants and another that facilitates program planning through intra and interagency linkages.

FOSTERING IMPROVED HEALTH STATUS FOR FOSTER CARE CHILDREN (1990)
Kids Adjusting Through Support, Inc, Rochester, NY
Under this project, support groups will be developed for foster care children and their foster parents. In addition, programs will be developed for families in which a family member has a life-threatening illness or has died. The children's groups will be organized by age groups and will be led by mental health counselors. The foster parent groups will meet simultaneously to assist the parents in dealing with issues including child behavior, limit setting, value systems, and forming attachments with their foster children. The support groups, which will address emotional and social impact, will be led by volunteers and will meet weekly for 10 weeks, with a minimum of 50 foster families being served annually. Project staff will conduct pre- and post-participation evaluations and will make referrals for children and/or parents assessed as needing health care or mental health services. Special activity outings, such as bowling and swimming, will be held about every 5 weeks to foster friendships among the children in the project.

THE PEDIATRIC COMPREHENSIVE ASTHMA MANAGEMENT PROGRAM (1992)
Women and Children's Health Center of Western Queens Borough
The New York Hospital-Cornell Medical Center, New York, NY
The primary goal of this project is to reduce asthma/bronchitis hospitalization rates by 80% for enrolled children. A full-service satellite program of the New York Hospital Children's Asthma and Allergy Center will be established at the Women and Children's Health Center in western Queensboro. During the 5-year project period, staff plan to provide comprehensive evaluations and treatment plans for between 300 and 400 asthmatic residents of a nearby public housing complex. About 80% of the patients evaluated will be enrolled in the asthma management project, which will provide one-on-one training for patients and their families, asthma case management services, and 24-hour access to physician/nurse specialist advice for asthma care. Project staff also will develop an asthma education seminar series for patients and their families.

WAR ON ASTHMA: THE EAST HARLEM ASTHMA WORKING GROUP ATTACKS PEDIATRICS ASTHMA RATES IN EAST HARLEM (1997)
Mount Sinai School of Medicine, New York, NY
The purpose of this project is to improve the health of vulnerable children in a low income neighborhood of New York City by intervening in the home to eliminate and/or control asthma allergens and to empower children and their parents to understand the appropriate use and management of the asthma medications and devices; to assure that children have a true medical home; and to train community workers as asthma counselors. The East Harlem Community Health Committee, an alliance of consumers, community health agencies and other providers and businesses had charged its Pediatric/Child Health Subcommittee to work toward reducing the excessive asthma rates among East Harlem children. The east Harlem Asthma working group was formed to meet this challenge.

We will enroll 20 families and provide the following services: visit the patients' homes, using the Little Sisters of the Assumption, a home nursing program, to assess and actually intervene in cleaning the environment, teaching the parents and children and stressing the control of asthma triggers and the importance of proper use and storage of asthma medications; raising the self-esteem of parents and children in the process. Follow-up visits at one, three, seven and ten months will measure progress and reinforce education. We also assure that the child has a true medical home, makes appropriate preventive visits, and understand what to do when asthma flares occur to alleviate the need for emergency treatment. Outcomes will be measured by reduced emergency room visits and hospitalizations due to asthma attacks.

In future years, community workers will be trained to implement this approach and serve as asthma counselors. Intervention will be expanded to incorporate high rise projects and tenement buildings.

HARLEM ADOLESCENT AND CHILD TOTAL SERVICES (1997)
Harlem Hospital Center, Department of Pediatrics, New York, NY
Harlem ACTS center provides a community-based medical home for adolescents and their children. The center provides a continuum of comprehensive, family-centered care focusing on identified issues of the adolescent parent. In this model, pregnancy is but one phase in the continuum of care, therefore, the provision of prenatal and primary care at one site by the same set of providers fosters continuity. Strong emphasis is placed on preventable causes of morbidity and mortality such as unplanned pregnancy, sexually transmitted diseases, injury (especially related to violence), cigarette smoking, alcohol/drug use, poor nutrition, school dropout, anti-social behavior, poor parenting skills, and delays in immunization. Each adolescent mother/child dyad and adolescent father will be followed by a case manager who will assess the social and health related needs of the family and schedule appointments for: primary and prenatal care, mental health, and social services. Parenting classes; computer-assisted educational instruction; child care, and educational, vocational and legal counseling will be provided. Each adolescent will attend a three training sessions on alternatives to violence/conflict resolution led by peer counselors under adult supervision. Each adolescent also will be given the opportunity to be matched with a Family Friends community volunteer who will provide support throughout the pregnancy and delivery, as well as provide parenting education.

PRO-ACTIVE, SCHOOL-BASED ASTHMA INITIATIVE (1998)
Montefiore Hospital, Bronx, NY
Asthma has become an increasingly common cause of hospital admissions among inner-city children. Factors including poor access to health care contribute to high hospitalization rates. School Based Health Centers (SBHC) overcome many access barriers and provide an opportunity to engage children in the appropriate use of outpatient services. They also offer an ideal setting for in introduction and evaluation of an asthma intervention designed to reduce morbidity and costs. This project involves six Bronx elementary schools-two schools that do not have SBHC's, and four that have SBHC's run by the Montefiore Medical Center School Health Program. Two schools with SBHC's are designated as proactive or intervention sites. Outcomes will be compared according to three models of school health:

1. the control model, for schools without SBHC's;
2. the traditional model, for schools with SBHC's treating children who present for care; and,
3. the proactive model for schools with SBHC's and aggressive outreach programs.

The proactive model has five components:

1. identification and classification of asthmatics in the school,
2. outreach to children with asthma,
3. individual treatment and education,
4. pediatric asthma group education, and
5. outreach to caregivers and teachers. Evaluation will focus on the effect on acute symptoms and chronicity of wheezing, normalization of lifestyle, and the effect on Emergency Department visits and hospitalizations.

THE NORTHEAST ROCHESTER YOUTH AND FAMILY WELLNESS PROJECT (1998)
University of Rochester, Rochester, NY
The major causes of morbidity and mortality among adolescents in the U.S. today are the direct result of high-risk behavior and unhealthy lifestyle practices. Effective community-based prevention programs that emphasize education and skills training are generally unavailable or culturally unacceptable to inner-city minority youth and their families, who may be at highest risk for the behaviors as well as the short and long-term adverse consequences. The Northeast Rochester Youth and Family Wellness Project is a collaborative effort of the Department of Pediatrics at Rochester General Hospital and 6 community sites, including recreation centers and settlement houses that serve youth and their families in the Northeast quadrant of the city of Rochester. The project will provide a series of health education programs for young adolescents, ages 11-14 years, and their parents at the community sites. The three central topics are sexual risk reduction, interpersonal violence prevention, and healthy lifestyle behavior such as nutrition and exercise. Programs have been designed to increase knowledge and enhance skills and attitudes towards healthy behaviors and are structured to include parents, through several joint sessions and two "parent-only" workshops, in order to address parenting issues related to the specific topic areas. A core team of "educators" consisting of pediatricians, nurse practitioners, health educators, nutritionists, and community site staff workers will implement the programs. Outcome evaluations will assess changes in knowledge, attitudes and intention towards the target behaviors; changes in the target behaviors, health status, and functioning. This program builds on previous efforts within the Department of Pediatrics at Rochester General Hospital to enhance coordination with community youth agencies in order to integrate services for high-risk youth and families.

FINGER LAKES PRIMARY CARE OUTREACH PROGRAM (2001)
Department of Pediatrics, University of Rochester School of Medicine, Rochester, NY
The purpose of this program is to address lower than expected immunization rates and preventive services in the Finger Lakes rural region of upstate New York. The project was modeled after a successful program in Rochester, New York that utilized an interdisciplinary team designed to address both health and psychosocial barriers preventing access to and receipt of preventive care by at-risk children. Children ages two years and younger will be tracked for preventive care and services will be provided as necessary. The interdisciplinary team will include a physician, a social worker, and administrator, a programmer, and paraprofessional outreach workers. The project goals are to assure access to and delivery of preventive, well child care services to infants and toddlers in the rural Finger Lakes region as measured by improved immunization rates, and lead and anemia screening attendance at well child visits, as well as patient satisfaction.

LIVING HEALTHY-LIVING WELL "PARENT TALK" INITIATIVE (2002)
Today's Child Communications, Inc (TCC), New York, NY
The Living Healthy-Living Well "Parent Talk" Initiative is a health promotion and education program which seeks to educate low-income African-American families with school-aged children residing in New York City, NY about the importance of obtaining a medical home and employing preventive health care measures. The program uses a multi-leveled media strategy that includes a radio show and other broadcast media, a national coalition serving as an expert advisory board, internet services, and health education forums. The program will address racial disparities in maternal and child health in the African-American community through the implementation of a culturally relevant health promotion and public information campaign. The initiative also will promote preventive care for children, such as screening for developmental disabilities, dental care, and the elimination of environmental health hazards, such as lead. Additionally, it will encourage parents to undertake safe practices such as putting an infant on its back to prevent Sudden Infant Death Syndrome (SIDS); maintaining a smoke-free environment; and using safety locks on cabinets for families with young children. The program goals are to:

1. educate and raise awareness about racial disparities in maternal and child health outcomes, particularly those identified in the Healthy People 2010 objectives;
2. promote prevention and child safety practices using Bright Futures and the American Academy of Pediatrics guidelines as resources;
3. develop a citywide culturally relevant media strategy for disseminating family and child health promotion information to poor and low-income African-American families;
4. foster a cooperative initiative through the National Black Family Promotions Coalition and other professionals from the fields of health, education, social service, business, and government; and
5. strategize other cost-effective ways to educate the African-American community, particularly those who are poor and low-income, regarding promoting child health and family wellness.

THE MOUNT SINAI CHILD & FAMILY SUPPORT PROGRAM: FOCUS ON MENTAL HEALTH IN NEW YORK (2002)
Mount Sinai School of Medicine, New York, NY
The Mount Sinai Child & Family Support Program: Focus on Mental Health was developed to address the high rate of child maltreatment victimization rate in East Harlem. The program links the detection/evaluation of child abuse with access to psychological trauma-focused rehabilitation of abused children and the non-offending parent. A multidisciplinary team will provide on-site mental health services to children and parents. All children will receive comprehensive medical, developmental and neurological evaluations. This is achieved by partnering the clinical expertise of the Children and Family Support Team with community-based agency mental health expertise and professional schools of social work to increase program capacity to render mental health services and eliminate barriers to care.

DENTAL HOME FOR CHILDREN PROJECT (2004 Oral Health Grant)
Eastman Dental Center, Rochester, New York
The access to and utilization of comprehensive dental care by economically disadvantaged children remain unsolved problems in many communities, including Rochester, New York. As a consequence, poor children suffer a disproportionate amount of dental disease. They are characterized by periods of intermittent pain, premature loss of primary and permanent teeth, and varying degrees of untreated dental disease. Factors such as low family income, parental perceptions, insurance coverage, and limited access to care contribute to episodic treatment, urgent care, or no treatment at all. By offering a range of on-site case management/outreach services designed to foster and sustain positive experiences with the dental care system, the Dental Home for Children Project expects to 1) change the utilization of pediatric dental services of approximately 250 children per year and 2) improve communication between the dental and primary pediatric care health systems. The project's evaluation will measure changes in communication between health systems and the utilization of dental services by targeted families.

THE HEALTH EDUCATION AND ADULT LITERACY (HEAL) PROGRAM (2007) Trustees of Columbia University, New York, NY
Health care providers recognize that health literacy is a significant concern, however, they are often unprepared to identify, screen, and follow-up with patients who have low literacy. The HEAL program, in collaborative partnership with the Community Health Worker Institute, is developing a health literacy program for low-income families with children of Northern Manhattan, New York. Specifically, the program will implement a culturally and linguistically-appropriate curriculum targeted to health workers and pediatric providers. The project will use focus groups of community members to identify causes of poor medication adherence and misunderstanding of provider instructions. The feedback will be used to design plain-language health education materials, which will include the correct way to use medications.  Trained pediatric providers and community health workers will test and launch the new education materials and techniques at four pediatric outpatient clinics and programs served by the Community Health Worker Institute. The overall goal of this project is to decrease medication errors and increase compliance with treatments prescribed by physicians through improving health literacy in the local community. 

THE BRONX NUTRITION AND FITNESS INITIATIVE FOR TEENS (B'N FIT) FAMILY-CENTERED RETNETION INITIATIVE (2009)
Children's Hospital at Montefiore, Bronx, NY

Obesity prevalence rates are highest in Hispanic and African-American youth and in families below the poverty line. Effective multidisciplinary weight management programs to address obesity in inner-city adolescents are hard to develop. High program attrition rates contribute to poor long-term meaningful weight loss outcomes. Retention at B'N Fit has historically been low. This may be attributed to poor family involvement. This project will implement a family-centered initiative designed to improve program attendance and clinical and behavioral outcomes in B'N Fit, a comprehensive, adolescent-focused weight management program to improve the health of obese Bronx adolescents. This will be done through a family-centered initiative that will improve family involvement and increase accountability measures. Specifically, the project will: (1) implement a screening program to determine which youth and families are able to commit to B'N Fit requirements and decrease wait times for initial program appointments; (2) institute a family incentive program to promote youth and family compliance with program requirements; (3) augment family support; and (4) partner with referring primary care providers and community partners to support program participants.

NORTH CAROLINA

MENTAL HEALTH TREATMENT FOR SEXUALLY ABUSED CHILDREN (1992)
Child Protection Team, Duke University Medical Center, Durham, NC
This project aims to improve access to appropriate mental health services for sexually abused children and their families. The project annually targets 250 to 300 children living in six counties of north central North Carolina who are diagnosed each year by the Duke Child Protection Team (CPT) as having been sexually abused. CPT members and community workers provide follow-up to ensure that mental health services are accessed after referral. Interventions will be provided based upon barriers to care identified by the families through completion of a questionnaire. Project staff have conducted an inventory of the mental health services available in the area. This project has led to a major effort to establish a local, multidisciplinary, coordinated case management system backed by regional child maltreatment resource centers throughout North Carolina.

CONNECTING THE DOTS (2005)
University of North Carolina Chapel Hill, Chapel Hill, NC
Connecting the Dots takes advantage of existing relationships among the Local Health Departments, community-based out-of-home childcare providers, and the local childcare health consultant. Connecting the Dots will establish a hierarchy of services to prevent problem behaviors among children in out-of-home childcare from becoming behavioral and psychosocial health conditions. Child Care Health Consultants will offer consultation and technical assistance to out-of-home childcare providers to improve their response to challenging behaviors. Children needing medical services will be screened and referred to their medical homes for primary health services, and those with more serious needs will be referred on to pediatric mental health services.

COMMUNITY-BASED CARE COORDINATION FOR CHILDREN WITH COMPLEX CHRONIC CONDITIONS (2009)
Department of Pediatrics Wake Forest University School of Medicine, Winston-Salem, NC
Children with complex chronic conditions (CCC) receive a variety of different medical services and non-medical services, such as educational, social and family-support services through various agencies for a prolonged period of time. Unfortunately, coordination of care between providers serving these children is lacking in most communities, resulting in gaps and inefficiencies in care, as well as redundancy, duplication, and fragmentation of services. The project will develop an innovative community-based care coordination program, called the Community-Based Pediatric Enhanced Team (CPECT) by pooling resources from the community to improve access to coordinated care for children with CCC in Forsyth County, North Carolina. The project will accomplish its goals by (1) providing comprehensive care coordination and ongoing psycho-social support, and (2) increasing the capacity of medical homes and other agencies that serve CCC to provide family-centered, coordinated care to children with CCC.

NORTH DAKOTA

HEALTHY SMILE FOR THE RED RIVER VALLEY (2001)
Red River Valley Dental Access Project, Fargo, ND
Lack of access to dental care for low-income families in the Red River Valley region of North Dakota and Minnesota is a significant problem. Only 34 percent and 52.4 percent of Medicaid-eligible children in North Dakota and Minnesota, respectively, visit a dentist annually. This project will develop a community-based system of care designed to reduce the access barriers to dental care for low-income children and their families. This will be accomplished through development of a case management system, the integration of dental hygiene education/counseling into Maternal and Child Health programs, and providing dental screenings to children in high-risk areas. Goals of the program are to:

1. remove barriers that prevent access to dental care;
2. provide parents and caregivers with appropriate knowledge regarding proper oral hygiene practices; and
3. provide dental screenings to assess children at high-risk for oral health complications.

OHIO

COLLABORATIONS FOR HEALTHIER CHILDREN (1991)
Good Samaritan Medical Center, Zanesville, OH
This project will add a pediatric well-child component to an existing prenatal care and gynecology clinic and will provide services to families regardless of their abilities to pay. The well-child clinic will provide care 5 days a week, and will be staffed by area pediatricians, registered nurses, social workers, and support staff. Staff will provide comprehensive, family-centered care, including developmental screenings, immunizations, parent education, community outreach, and social services. A specialized education and parenting program will be offered to teen mothers. A referral network will be established to facilitate referrals to community agencies, other health care providers, and schools. To ensure continuity of care, the pediatric group that will staff the clinic also will provide hospital care when children require admission. Establishment of a referral system to local pediatrician and family practitioner offices will be implemented as a method of establishing physician relationships for continuing care. The project expects to serve approximately 1,500 children yearly.

HTPC-CFHS PEDIATRIC TRACKING PROGRAM (1992)
City of Cincinnati, Department of Health, Cincinnati, OH
This project builds upon an existing pediatric tracking program with a lay community outreach worker component designed to improve broad outcomes of certain high-risk infants with an infant mortality rate of 37 per 1,000 live births. Project services will be provided to women in target neighborhoods who deliver at either of two Cincinnati hospitals after receiving suboptimal prenatal care. Community outreach workers who reside in the West End neighborhood serve as case managers with a focus on access to preventive services for participating families. Community outreach workers meet with mothers during their postpartum hospital stays, accompany public health nurses during home visits, and identify barriers the families they serve face in obtaining comprehensive, preventive health services. A data clerk coordinates the health information tracking system to ensure that it is available to local care givers in a confidential manner.

TOLEDO HEALTHY TOMORROWS (1994)
Children's Center of Northwest Ohio, Toledo, OH
Children's Center of Northwest Ohio together with a coalition of parents, pediatricians, and representatives of the Maternal Child Health Bureau, Ohio Department of Health, designed and developed Toledo Healthy Tomorrows, which will serve 80 targeted teen families over the 5-year grant period. Extensively trained, volunteer CAPS visiting moms will counsel, support, assist, and educate the parents and link them with health and social service agencies in the community through a series of pre and postnatal home visits until the infants are 2 years of age. Nurses will visit the families (and an equivalent comparison group of families) when the children are 1 month, 6 months, 1 year, and 2 years of age. Throughout the course of these visits, the health status of the infants will be assessed, health issues will be discussed, and Home Observation Measurement of the Environment will be administered. Assessment of the effectiveness of the project will be measured with an equivalent group of teen families using the CAP Home Observation for Measurement of the Environment by Caldwell, reported incidents of child abuse/neglect confirmed by Lucas County Children's Services, immunizations rates, and frequency and appropriateness of well-baby visits.

COMMUNITY ACTION FOR PLAYGROUND SAFETY (CAPS) PROGRAM (1999)
The Center for Injury Research and Policy, Children's Hospital, Columbus, OH
Injuries are the leading cause of child mortality and morbidity in the United States. When ranked among other public health problems, injuries account for almost 1/3 of all years of potential life lost (YPLL) before age 65. Indeed, injuries account for more YPLL than heart disease, cancer, and stroke combined. In collaboration with community organizations, the Columbus Department of Recreation and Parks, and others, the Community Action for Playground Safety (CAPS) Program will address injuries to children associated with public playgrounds, and as bicyclists, and pedestrians. An estimated 200,000 children are treated annually in hospital emergency departments in this country for playground-related injuries, and more than 2/3 of these injuries occur on public playgrounds. Transportation-related injuries are the leading cause of injury death during childhood; therefore, pedestrian and bicycle-related inures will also be targeted. A combination of active and passive injury prevention strategies will be employed based on the science of injury prevention. The CAPS Program promises to offer an effective model for addressing these important causes of childhood injury.

RURAL INTERDISCIPLINARY DEVELOPMENTAL EVALUATION CLINIC INITIATIVE (2001)
Athens-Meigs Educational Service Center, Athens, OH
In the Ohio counties of Athens, Meigs, and Vinton, more than half of the population live below the poverty level, with limited access to care. This program will expand existing developmental and behavioral assessment clinics to these three counties to provide interdisciplinary assessment services in partnership with local health and educational service providers for families with children ages 0 to 6 years old. The interdisciplinary team consists of a developmental pediatrician, physical therapist, occupational therapist, psychologist, speech pathologist, nurse consultant, and clinic coordinator. The goal of the program is to improve the overall health status and educational programming, functional abilities, and developmental outcomes of children ages birth to six years old living in Athens, Meigs, and Vinton Counties who have special needs.

HEALTHY TOMORROWS PARTNERSHIP FOR CHILDREN'S BEHAVIORAL HEALTH (2004 Behavioral & Mental Health Grant)
St. Vincent Mercy Medical Center, Toledo, OH
An estimated 20% of youth in the U.S. suffer from emotional and behavioral disorders, but fewer than 20% of children who need treatment receive it. The U.S. Surgeon General's landmark report on mental health featured primary care as one of the prime portals into treatment. Yet few programs are structured to integrate behavioral and primary health care in large part due to barriers that include societal stigma, varying capacity of primary care providers to diagnose and treat behavioral disorders, and the fragmentation and poor financing of specialty behavioral health services. The key feature of this project model is the identification, referral and treatment of emotional and behavioral problems in children within the context of primary health care. The model will maximize early identification of problems, decrease the stigma of entering the mental health system, allow primary care providers to transfer their rapport and trust to behavioral health professionals, and improve the coordination of care. Three strategies will be utilized to achieve the project's goal: 1) identification of behavioral and psychosocial problems in the primary care setting, 2) increased referral by primary care providers to behavioral health care services, 3) improved referral process with staff specifically dedicated to supporting the patient, reducing barriers to service, and facilitating communication between physicians, families, and behavioral healthcare providers.

HOSPITAL TO MEDICAL HOME PROJECT (2009)
St. Vincent Mercy Medical Center/Children’s Hospital, Toledo, OH
Community medical practices often do not meet AAP criteria for qualified medical home. Children with special health care needs who do not have a qualified medical home have more health care needs and less health care than those who do. Community medical practices believe that community-based palliative care should be available but do not feel confident to provide it. Family needs for direct, respectful, responsive communication with hospital and community clinicians are often not met in hospital or community care settings. The goal of the St. Vincent Mercy Children’s Hospital (SVMCH) Hospital to Medical Home Project is to maximize the health status and quality of life of children with life limiting and/or life threatening special health care needs in a 17-county northwest Ohio region by implementing a model for their safe transition from the acute care hospital setting to a qualified medical home. The project will expand the SVMCH pediatric palliative care program from an exclusively hospital-based, acute care approach to a partnership between the hospital and community-based medical home. The project will (1) provide at least 100 pediatric palliative care hospital consultations annually with special attention to care coordination, and transition to a qualified medical home; (2) refer 95% of patients to a qualified, accessible medical home; (3) enable 75% of patients/families to effectively utilize their community medical home; (4) improve the capacity of 25 community practices to serve as qualified medical home providers to children with special health care needs; and (5) improve the quality of communication between the patient, family, medical home and hospital providers.

OKLAHOMA

SCHOOLS FOR HEALTHY LIFESTYLES PROJECT (1998)
Oklahoma County Medical Society Community Foundation, Oklahoma City, OR
The Schools for Healthy Lifestyles Project (SHL) addresses the poor health of Oklahoma County residents by implementing community-based health promotion programs in elementary schools. The project teaches healthy lifestyles related to the prevention of the leading causes of death for our children, teens, and adults. The priority health issues include physical activity and the prevention of cardiovascular disease, cancer and injury. The project employs three main approaches:

1. Building and maintaining infrastructure. Three agencies (Oklahoma County Medical Society, Oklahoma City County Health Department, and Oklahoma City Public Schools) convened a broad-based Advisory Board of community agencies and organizations with expertise and interest in the needs of children and families to support the interventions implemented in the elementary schools,
2. Conducting training. Each participating school sends representatives of their school health advisory committee to a five-day Summer Health Institute to receive intervention materials and intensive training on fostering the development of healthy behaviors related to the priority health concerns, and
3. Providing extensive follow-up.

Site-specific strategic plans are implemented with extensive involvement of project staff and community agencies. Volunteer pediatric health professionals are assigned to each school to provide assistance in implementing the program. Evaluation focuses on changes in student health knowledge, attitudes, practices and physical fitness.

KIDSLINE (1999)
Community Service Council of Greater Tulsa, Tulsa, OK
Poor children have poor health. More than race or single parent living arrangement, poverty is the risk factor with the strongest effect on child health (Montgomery, et al, 1996). In Tulsa County, Oklahoma, 139,204 children are eligible for insurance through SoonerCare (Medicaid managed care) and less than 30% are enrolled. According to census data from 1994-96, Oklahoma is the fourth worst state in the nation for percentage of children uninsured (Children's Defense Fund, 1998). Kidsline is a centralized contact point for information, referral for SoonerCare enrollment, referral for ancillary support services and first available appointments for pediatric care for the Tulsa community. The goals for this project are to

1. improve the access to health care for the uninsured in Tulsa and
2. increase the utilization of health care by the uninsured and insured children in Tulsa.

Outcome objectives include

1. increased enrollment in SoonerCare,
2. an increase in the number of children who received EPSDT and
3. an increase in the number of children who are immunized by age two.

Kidsline is collaborating with Planned Parenthood, two federally qualified health centers, two university-based clinics, and other organizations in order to meet the project's mission.

OREGON

KIDS' CLINIC (1993)
Eugene School District 4J, Eugene, OR
The Kids' Clinic project seeks to provide indigent elementary school-age children with a "medical home" by expanding services in school-based clinics located in community high schools. School nurses will refer students and their families to the clinics, transportation will be provided, and a nurse practitioner will see eligible students. Those students needing additional medical care will be referred to an already established network of local physicians or health care providers. Services to Hispanic students and families will be enhanced by adding bilingual staff, distributing materials in Spanish, and providing existing staff with heightened cultural awareness training. Data will be collected to determine that progress is being made toward objectives, including a decrease in emergency room visits as well as an increased number of target population students seen in the clinics.

LANE COUNTY LATINO MEDICAL ACCESS COALITION'S HEALTHY TOMORROWS PROJECT (1996)
PeaceHealth Medical Group, Eugene, OR
Lane County, Oregon, is experiencing a rapid change in population demographics caused by recent in-migration of Latino families. Many newly-arriving, undocumented Latinos are economic refugees who are ineligible for government-sponsored health and social service programs. They are unlikely to seek out available health care services for fear of possible legal sanctions. Prenatal care is available and accessible for pregnant Latino women, who currently represent 50% of the PeaceHealth Prenatal Clinic caseload (local "safety net" provider). Unfortunately, the existing system of providing well baby care for low income families is failing to reach Latino infants in need of early screening, health monitoring and immunizations. In conjunction with the PeaceHealth Prenatal Clinic, the Latino Medical Access Coalition proposes to improve the health status of low income families in Lane County by providing on-site well baby care services at the Prenatal Clinic site, and developing working agreements with local physicians for pediatric care services.

CHILD CARE-HEALTH LINKS (2002)
Oregon Department of Human Services
Office of Family Health, Portland, OR
Currently, many child care providers in Oregon communities experience significant isolation and difficulty in addressing physical health and safety issues, as well as social and emotional issues of children in their care. Many providers do not have the knowledge of, or ready access to, consultation with trained health care professionals, to effectively handle complex behavioral or physical health issues, or to create environments that optimally promote health. A collaborative Health Consultation System will be piloted in 3 Oregon communities. Local public health nurses, specifically trained as child care health consultants, will provide direct services to child care providers with the Office of Family Health providing state level coordination, training, and technical assistance. The community Child Care Resource and Referral programs will provide outreach and marketing of health consultation services to child care providers.

LATINO MEDICAL ACCESS COALITION - ACCESS TO PEDIATRIC ORAL HEALTH SERVICES IN LANE COUNTY, OR (2004 Oral Health Grant)
PeaceHealth Medical Group, Eugene, OR
The program continues to provide health care for indigent children, primarily Latino at no cost. The rate of dental decay in this population is very high (over 60% of children in the clinic) as well as in the community at large (over 90% of Eugene-Springfield Head Start students). The community water is not fluoridated and repeated attempts to do so have been thwarted. There is very limited to no access to dental care for unfunded children. A pilot project has been started at the clinic that involves adding fluoride varnish applications during the well child exam. The pilot has been so successful in re-mineralizing early caries that there are plans to extend it to the Head Start population. This grant provides for a Dental Hygienist with an advanced practice permit to operate in WIC, Head Start, and through kindergarten and first grade. With parental consent and under the auspices of this program, the Health Department and a voluntary supervising dentist examine, triage, clean, educate, and apply varnish to the teeth of a large numbers of children. The nurse practitioner works with community pediatricians to encourage them to incorporate fluoride varnish into their practice due to the lack of access and compliance issues that exist in the Oregon Health Plan population.

PENNSYLVANIA

COMMUNITY-BASED MEDICAL/EDUCATIONAL PROGRAM: TECHNOLOGY DEPENDENT CHILDREN'S SERVICE (1989)
Ken-Crest Services, Philadelphia, PA
This project has added pediatric and nursing components to an existing early intervention preschool program so that it can accommodate medically fragile and technology-dependent children. An individual family service plan has been developed for each child which integrates medical and nursing services with educational and therapy services to achieve parent-prioritized objectives for their children. Parent training and support help them deal more effectively with their children's special medical and developmental needs. Physician education about the developmental needs of these children and about the availability and effectiveness of community-based educational services for them is achieved through conference presentations and regularly scheduled visits to the program by pediatric residents from area hospitals.

PRIMARY CARE PHYSICIANS: CARING FOR LOW-INCOME CHILDREN WITH SPECIAL HEALTH NEEDS (1989)
Western Pennsylvania Caring Foundation, Inc
Blue Cross of Western Pennsylvania, Pittsburgh, PA
This project will establish a model for providing family-centered, community-based, coordinated care for chronically ill children from low-income families. The project advocates that primary care physicians provide a medical home for these children and seeks to support their role through a care coordinator. In the first year, staff have surveyed 933 families to determine the prevalence of chronic health problems in the project's target population. Pediatric care providers within the targeted region also have been surveyed regarding their self-perceived education needs and general issues related to caring for children with chronic illnesses. Also, a care coordinator has been hired to work with participating families and their primary care physicians in providing comprehensive, coordinated care for project participants.

THE FAMILY GROWTH CENTER PILOT PROJECT (1990)
Dept of Pediatrics, Allegheny General Hospital, Pittsburgh, PA
The goal of this project is to use an integrated primary prevention approach to promote the health and development of at-risk teen/young parents and their children. This will be accomplished by increasing their social supports and enhancing their parenting abilities by providing hospital-based perinatal coaching and by linking selected families with a Family Growth Center. The center will be established under the guidance of a neighborhood council in response to an assessment of community needs. The center will feature a drop-in/drop-off child-care program and family-oriented social recreation programs. Support services available through the center will include a parent support group, parenting skills workshops, and a home-based involvement program for newborns and mothers.

PRIMARY CARE FOR CHILDREN IN FOSTER CARE AND
HOMELESS SHELTERS (1990)
Family Intervention Center, Children's Hospital of Pittsburgh, Pittsburgh, PA
The goal of this project is to coordinate primary health care delivery and monitoring for 500 children who are 6 years old or younger and live in homeless shelters, or are in foster care. Project staff will provide case management services through the hospital's Family Intervention Center and will develop individualized health care plans for each child. Assistance will be provided to link the children with permanent "medical homes," and project staff will provide and/or monitor necessary follow-up care. Project staff also plan to develop adequate medical history records for the children and to develop a computerized tracking system for children in foster care in this county.

PREVENTION AND REMEDIATION THROUGH INCLUSIVE
EARLY INTERVENTION (1998)
Ken-Crest Services, Philadelphia, PA
The project joins medical and education services in order to bring medically fragile children with developmental disabilities, age three to five years, into greater interaction with their typical peers. The program targets children who are not eligible for Early Intervention services, but show detectable delays which place them at-risk of more significant disabilities.

We will advance the developmental achievements of both groups of children who will play, learn, and interact together in an inclusive educational and therapeutic program. The children who are more advanced developmentally will have preventive developmental experiences while providing the stimulation and modeling of typical language and play for the children with greater delays.

THE TIOGA COUNTY FIT FOR LIFE PROJECT (1998)
Laurel Health System, Wellsboro, PA
The Tioga County Fit for Life Project is a comprehensive school/community based program aimed at Kindergarten through eight grade children and their families. The program focuses on the importance of proper nutrition and fitness as a way to a healthier lifestyle. Through a collaboration of area professionals (pediatricians, dietitians, psychologists), schools, the Tioga County Partnership and local community members, the program encourages healthy nutrition and increased activity. The multi-faceted approach includes:

1. enhancement of school physical education curriculum to incorporate fit for life concepts,
2. nutrition education for food service personnel,
3. community-based programs for increased physical activity,
4. community-based nutrition and fitness education, and
5. access to existing weight management programs for overweight children. The primary goal of the project is to reduce the incidence of obesity in Tioga County to levels consistent with the Healthy People 2000 objectives.

HEALTHY FAMILIES EXPANSION PROJECT (2000)
Family Enhancement Center, Plains, PA
The FAMILY ENHANCEMENT CENTER of the Wyoming Valley Health Care System is a community-based, hospital-supported program providing preventative care with family support and education to new families. As a Healthy Families America site, the FAMILY ENHANCEMENT CENTER identifies and intervenes early with at-risk families to address and prevent situations of abuse, illiteracy and ill health or malnutrition. The vision of this grant is to expand the scope of these outcomes to include an additional 51 at-risk families from Northwest Luzerne County, Pennsylvania. The goals and objectives to address the needs of these at-risk families include:

1. Increase overall childhood medical/developmental wellness;
2. Increase the number of children remaining safely at home:
3. Reduce stress factors related to child abuse and neglect;
4. Increase parental knowledge and skills reported by parents;
5. Increase the rate of high school or equivalency education;
6. Increase the employment rate with a corresponding decrease in the use of public assistance; and
7. Continuation of the Healthy Families America philosophy and model through a collaboration of private, community and public agencies.

CHESTER COUNTY COMMUNITY DENTAL CENTER (2003)
Chester County Community Dental Center, West Chester, PA
The goal of this project is to expand the maternal child health infrastructure in Chester County, Pennsylvania to increase migrant, minority, and low-income families’ access to preventive and restorative dental health services and oral health education. A non-profit dental center will be established in a federally designated dental health professional shortage area in western Chester County. The Center will be staffed by bilingual and multicultural staffs accept all private and government insurances, offer a sliding fee scale, and provide free care when appropriate. Relationships with other medical and dental providers and area hospitals will be established to provide a holistic approach to patient care that integrates oral health and general health services. Referrals will be made to medical care when medical issues are identified during the dental examination. The project's objectives are: 1) to increase the number of families in the targeted population that are seen at least annually by a dental provider; 2) to screen and enroll families in eligible health insurance programs; 3) to provide oral and general health programs to patients and targeted groups; and, 4) to increase awareness within the professional medical and dental communities as to the impact poor oral health has on an individual’s general health. An advisory committee of maternal child health and human service providers will be developed, as well as an advisory committee of medical and dental professionals. These committees will be utilized to develop and execute countywide educational initiatives to educate health care providers and the public regarding the link between oral health and other health conditions (i.e., cardiovascular disease, premature deliveries, osteoporosis, and diabetes). Center staffs will also be trained to educate patients and targeted populations on dental health, tobacco use cessation, and nutrition.

EXPANSION OF THE NURSE FAMILY PARTNERSHIP TO PIKE COUNTY (2004 General Grant)
Pocono Medical Center, East Stroudsburg, PA
Many children in Monroe and neighboring Pike Counties are born into a life circumstance of poor economic security and/or social environments, which can hinder health and development. Without intervention, many high-risk mothers will not obtain prenatal care or follow through with well child visits. The Nurse Family Partnership (NFP) is a home-based education program for first time mothers at risk. This national program has been operational in Monroe County since July 2002. Families develop confidence, skill for parenting, and economic self sufficiency by volunteering to work with a nurse home visitor. Specialized professional nurses visit families regularly during a 2 ½ year period, beginning in pregnancy. The NFP achieves its goal by focusing on three objectives: 1) fostering healthier pregnancies; 2) improving the health and development of children; and 3) encouraging self-sufficiency.

215GO! A COMPREHENSIVE PEDIATRIC OBESITY CLINIC (2006)
Philadelphia Department of Public Health, Philadelphia, PA
This project will address the epidemic of child overweight through the development of the Comprehensive Pediatric Obesity Clinic 215GO!. The 215GO! Clinic is a new component added on to an existing full-scale pediatric primary care services clinic. The goals of 215GO! are to: 1) Provide comprehensive care for overweight children and adolescents and those at risk for overweight who seek care at the center, 2) Prevent and reduce obesity-related complications, 3) Link patients without a medical home to primary care at the center, 4) Improve self-esteem and increase positive life-style changes among these patients through behavior modification, education, nutrition assessment and counseling, and 5) Collect and analyze data to assess the effect of the project.

CONNECT KIDS TO HEALTH (2008)
Philadelphia Department of Public Health, Philadelphia, PA
Health insurance and access to a medical home are essential to Well Child Care and regular physical examinations.  Twenty-four percent of children attending public schools and Head Start programs in North Philadelphia (Zip Codes 19121 and 19132) do not have health insurance and/or medical home, even though most of these children are eligible for Medical Assistance or S-CHIP programs. The lack of health insurance leads to lack of consistency in preventative medical care, delinquent immunizations, delay in diagnosis and treatment of medical conditions leading to poor health outcomes.  Connect Kids to Health will work with the identified public schools, Head Start programs, and the Philadelphia Housing Authority to identify eligible children, follow up with parents, educate them about the program, set up an appointment with a pediatrician, and assist uninsured children in enrolling in health insurance. The goal of the project is to identify children with no medical home or no health insurance, link them with primary care services at Philadelphia Health Care Center #5 and Strawberry Mansion Health Center, and facilitate procurement of health insurance.

MEDICAL HOME/CARE COORDINATION FOR HIGH-RISK INFANTS: BABY STEPS FOR HEALTH (2009)
Albert Einstein Medical Center, Philadelphia, PA
Medically fragile infants are at high risk for poor developmental and medical outcomes and death. After discharge from the Neonatal Intensive Care Unit (NICU) these high-risk babies require intense medical care. Helping caregivers navigate medical systems of care can prevent poor outcomes for these infants and can help strengthen families by reducing parental stress. This project will optimize the health and developmental outcomes of high-risk infants through systems improvements, advocacy and the delivery of family-centered, coordinated care at the Pediatric Medical Home of Albert Einstein Medical Center (AEMC) by (1) establishing the Baby Steps to Health Program, (2) developing an integrated, seamless system to transition high-risk newborns from the NICU to the Pediatric Center, (3) providing intensive care coordination services for 200 high-risk infants over the 5-year period, (4) increasing parent satisfaction with the Medical Home, (5) activating a Community Advisory Board (CAB) to advise the Baby Steps Program and Medical Home Team, and (6) exploring ways to develop a sustainable program.

PUERTO RICO

PROJECTO LACTA (1995)
Centro Pediátrico de Lactancia y Crianza, Inc,
Ashford Presbyterian Community Hospital, San Juan, PR
This project focuses on increasing breastfeeding rates in low-income families of the San Juan Health District in order to improve the health status, functional ability, and developmental capability of medically indigent infants. Health care professionals who are in contact with pregnant and newly delivered women will be educated to promote and support breastfeeding and to acquire basic breastfeeding assessment skills. The project will also provide affordable expert breastfeeding assessment and assistance to mother-infant dyads in a lactation clinic.

CANTERA PENINSULA DENTAL CLINIC (2006)
University of Puerto Rico School of Dentistry, San Juan, PR
This project will focus on one of the poorest and most isolated urban communities in San Juan, the Cantera Peninsula. The goals of the Cantera Peninsula Dental Clinic are to assure access to quality oral health care for infants and children between 0 and 6 years and to strengthen and increase the effectiveness of the Community Network for the Oral Health of Cantera Peninsula. In order to achieve these goals, the project is adding two new components; a family-centered dental home program and the involvement of pediatricians and other pediatric health professionals into a network that will work closely with the existing community-based health committee to enhance oral health service provision in the community.

RHODE ISLAND

RHODE ISLAND FOSTER CHILDREN'S ASSESSMENT, REFERRAL, AND CARE COORDINATION (1994)
The Rhode Island Public Health Foundation, East Providence, RI
This project will provide a permanent system of foster children's assessment, referral, and care coordination, which will assure that all foster children have a "medical home"; ie, a regular provider of pediatric primary care services in his/her community, delivering preventive, diagnostic, and therapeutic care; appropriate referral (and follow-up) for special medical, developmental, mental health and inpatients services; and referral to a qualified provider of comprehensive care coordination for medically indicated social and support services. Specific objectives of the project are to assure that:

1. every child receives an initial health and developmental assessment,
2. every child is referred to a medical home in his/her community with results of the initial assessment and (where available) prior medical records, and
3. primary care physicians are assisted in identifying a qualified community-bases source of medically indicated care coordination.

The project will:

1. develop an initial health and development assessment protocol for children newly in custody of the Department of Children, Youth, and Families (DCYF);
2. identify a panel of pediatric primary care providers willing to accept referrals from DCYF;
3. identify and contract with community-based providers (eg, visiting nurse associations) to provide assessment and referral services and medically indicated care coordination for a pilot test of the proposed system for a sample of DCYF children;
4. provide information on care coordination providers in their communities to primary pediatric care providers statewide;
5. evaluate results of the pilot test, to revise the system and estimate average costs per child served.

COMMUNITY ALLIANCE FOR CHILDREN'S HEALTH AND THE ENVIRONMENT (CACHE) (1999)
The Providence Community Health Centers, Inc, Providence, RI
Recent studies have implicated environmental allergens in the dramatic rise in the incidence and severity of asthma among children living in underserved, urban communities. The prohibitive costs of the supplies necessary to reduce environmental triggers in the home and the lack of educational materials and resources which are accessible to families with diverse language and literacy needs have been identified as significant challenges in efforts to control asthma. The Community Alliance for Children's Health and the Environment (CACHE) is working to develop a family-centered network of services which responds to these challenges on the individual, the community, and the systemic levels. A partnership between Providence Community Health Centers, the Draw-A-Breath Program and the Health and Education Leadership for Providence Coalition's Lead Safe Center, CACHE has been developed in collaboration with environmental scientists from the RI Department of Health and the Center for Environmental Studies at Brown University as well as staff at the Howard R. Swearer Center for Public Service at Brown University. CACHE's programming includes: clinic-based care; home visits focused on asthma education and the elimination of environmental triggers in the home; community-based asthma and environmental health workshops; and recreational opportunities for children and adolescents with asthma. These efforts will be complemented by the development of asthma educational materials which are accessible to participating families' language and literacy needs. As well, CACHE staff will design a home visiting model which will comprehensively address and assess the environmental health needs of families affected by both lead poisoning and asthma. Cache's overall efficacy will be assessed according to the following indicators: decreased asthma-related emergency room visits and hospitalizations; increased knowledge about asthma and disease management; and implementation of strategies to control environmental triggers in the home.

THE CHILD CARE HEALTH AND MENTAL HEALTH CONSULTATION NETWORK OF RHODE ISLAND (THE NETWORK) (2006)
State of Rhode Island and Providence Plantations Department of Health, Providence, RI. The Child Care Health and Mental Health Consultation Network of Rhode Island will provide program-level child care health and mental health consultation for child care centers and family child care homes. The goals of the network are to: 1) Develop an infrastructure to support accessible and effective health and mental consultation for child care providers, 2) Increase child care provider's knowledge and ability to support young children's healthy development, 3) Identify children at risk for poor developmental outcomes and connect these children and families to the medical home and other developmental intervention services, and 4) Improve collaboration and coordination between child care providers, medical homes, and other community resources to ensure child and family access to services that promote health and development.

SOUTH CAROLINA

THE SECOND CHANCE CLUB: A FAMILY-CENTERED INTERVENTION FOR ADOLESCENT MOTHERS (1993)
Charleston, SC
The Second Chance Club project targets adolescent mothers and their families by providing health education and counseling, both in their homes and in group sessions, in a culturally appropriate, multigenerational approach that is combined with medical services. The overall goal of this project is to reduce the rate of repeat adolescent pregnancies while the adolescents are still in school. The specific objectives of this project are to:

1. increase effective use of contraception by increasing access to medical care, increasing medical funding, and by using skills-based education to improve decision making;
2. increase effective discussion within the family about sexuality and family planning by increasing the parents' knowledge about these issues, using skills-based education and counseling about communication and by providing this education in an appropriate cultural context for the families being served.

The project coordinator serves as a case manager for all participants, provides group counseling, coordinates educational sessions, and makes home visits. Nursing students are used as educators and mentors by the project coordinator. The project is located in an urban high school as part of a school-based clinic. The project has included weekly meetings at the school, a weekend retreat, participation in a tri-county health fair, representation at a state writing workshop, and a graduation ceremony.

EARLY LEARNING PARTNERSHIP OF YORK COUNTY (2002)
The Early Learning Partnership of York County, Rock Hill, SC
The project aims to establish affordable, accessible health care in western York County, SC. The overall goal of the program is to facilitate and maintain a medical home for children who previously received fragmented care. Through a collaborative partnership, a health clinic and nurse partnership program will be established. A part-time family nurse practitioner, a full-time partnership registered nurse, and volunteer pediatricians will staff the clinic. The health clinic aims to increase preventive care to children in western York County by providing a facility and staff who will conduct well child visits. There are more than 2,100 children in western portion of York County who are Medicaid eligible and countless other with no medical insurance in the area who are not regularly seen by a physician for routine well child visits. The core principal of the partnership nurse program focuses on the use of public health personnel to perform specific functions including care coordination, home visiting, immunization, health education, in-hospital visits, transportation and after-hours call service.

HEALTHY CONNECTIONS (2003)
United Way of Greenville County, Greenville, SC
Healthy Connections is a coordinated effort between school nurses, health care liaisons and health care providers to improve access to health care services. School nurses will identify students who have a health problem, determine whether they need assistance accessing care and contact a Healthy Connections staff person to coordinate services. Healthy Connections staff will make the child’s appointment, provide safe transportation, accompany the child (as needed), offer age appropriate education during the visit, provide follow-up with parents and coordinate any additional medical visits. Healthy Connections aims to remove barriers many parents face related to cost, transportation, leaving work and locating care for their children.

SOUTH DAKOTA

HEALTH CONNECTIONS: HEALTH ADVOCACY FOR CHILDREN (1999)
Youth & Family Services, Rapid City, SD
Health Connections will provide access to and increase the utilization of basic and preventive health care services for at-risk girls ages 5-8. Even through the majority of these children are entitled to health care services through Medicaid or the Indian Health Service, virtually none of them have received regular or preventive medical care. Through referrals from local school counselors the Indian Health Service, the South Dakota Department of Social Services, parents, juvenile justice programs, other agencies serving children and youth, and Youth and Family Services Girl Incorporated, 50 children, ages 5-8, will be identified as being at especially high risk for medical problems. These children will be offered health advocacy services precisely because they have an unmet health care problem or do not receive regular medical attention. There are two specific goals of this program:

-Make health care services available to Rapid City at-risk girls, ages 5-8 to ensure that they receive annually all the clinical preventive services as recommended by the US Preventive Services Task Force and Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents.
-Provide the opportunity for parents and guardians to have long-term accessibility to health care services for the child(ren).

SOUTH DAKOTA DENTAL - MEDICAL INTERFACES PROJECT (2004 Oral Health Grant)
South Dakota Dental Association, Pierre, SD
The primary goal of the South Dakota Interfaces project is to improve the oral health of South Dakota children with an objective of increasing by 25% the number of Medicaid eligible children ages 1-5 who have access to oral health care. The project will use a train-the-trainer format using selected South Dakota dentists as trainers to train non-dental primary care providers. The project will utilize a consultant to inventory and assess curricula that may be suitable for South Dakota. The project will also train general dentists in pediatric dental techniques, building upon an existing program with similar goals. The capstone of the project is the proposed development of an inter-professional referral system that medical personnel can use to refer children in need of dental treatment to a dentist. The system will be a centralized referral network through which
medical providers can make dental appointments for their patients without a dental home.

BOYS HEALTH ADVOCACY PROGRAM (2005)
Youth and Family Services, Inc., Rapid City, SD
In Rapid City, SD, at-risk children and their families are a vulnerable group who often lack the skills, motivation, and opportunity to access and utilize basic and preventive health care services. The Boys Health Advocacy program, a unique program of Youth & Family Services (YFS), provides health focused case management designed to meet the needs of underserved boys. The Boys Health Advocacy program connects boys with unmet healthcare needs to various area service providers; assists boys in learning and developing patterns of behavior that will enhance their health; works with boys to connect them with appropriate medical, dental, optical, and counseling services; and works closely with families and school personnel. The boys are selected to participate in this project because they have an unmet health care problem or do not receive regular medical attention. The Health Advocate draws up an individualized health care plan with each participating boy and his family. Additional health benefits are reaped from the encouraging and supportive personal relationship that develops between the Advocate, the boy, and his family.

TENNESSEE

IMPROVING CARE FOR FAMILIES OF SCHOOL-AGED CHILDREN WITH SPECIAL NEEDS (1998)
Vanderbilt University School of Nursing, Nashville, TN
The purpose of this project is to improve health and psychosocial outcomes for school-aged children and families with chronic conditions through school-based interventions. The project population includes low- and middle-income children with chronic physical and mental health conditions who attend two urban elementary schools served by the Vanderbilt University School of Nursing School-Based Health Program. School health nurses and school-based nurse practitioners, in collaboration with their physician preceptors and project medical consultants, will work within each school multi-disciplinary team to assess the psychosocial supports and stressors in school-age children with chronic conditions and their families. Project staff will work collaboratively with school-based professionals to develop family-centered plans of care aimed at increasing knowledge of their child's condition, implementing skills to manage the condition, and to strengthen systems of support. Efforts will be made to improve coordination of care in the school setting with pediatricians, mental health professionals, and others in the community providing services to children with special needs. Programs also will be implemented to increase participation of the target group in well-child services and to expand knowledge and self-care skills among children with chronic conditions. Protocols for integrating school health services into multidisciplinary team structures will be developed, and assessment approaches for measuring family and child coping and management skills will be evaluated in the school setting.

BREATHE EASY CROCKETT COUNTY PROJECT (2007)
Le Bonheur Community Outreach, Memphis, TN
The Breathe Easy Crockett County project is a collaborative effort designed to improve the quality of life for children with asthma. The project will focus on the physical functioning and emotional well-being of children with asthma and will assess participation in age-appropriate school and social activities. The target population for this project is elementary age children with current asthma conditions, along with their caregivers, in rural Tennessee. The project’s case management model will utilize home visitation and home environment assessment to assist families in controlling asthma triggers. Each child in the program will receive an individualized education and treatment plan. The purpose of this project is to implement a comprehensive, community-based approach that will: 1) Provide asthma education to children, teachers and parents utilizing the American Lung Association’s “Open Airways” curriculum, 2) Create asthma-friendly communities, and 3) Reduce disparities in childhood asthma morbidity and mortality.

NURSE ADVOCACY: IMPROVING ACCESS TO QUALITY CARE FOR LATINO WOMEN AND CHILDREN (2008)
Baptist Hospital Department of Obstetrics, Nashville, TN
Baptist Hospital Department of Obstetrics delivers more babies than any other hospital in Middle Tennessee. Twenty percent of the hospital’s obstetrics patients have limited English proficiency. Through partnerships with local pediatricians and community-based organizations, the Baptist Hospital seeks to improve access to culturally competent care, including preventive and follow-up services, for Spanish-speaking women and their infants. Key activities of the project include: (1) childbirth education in Spanish; (2) discharge education (postpartum care and newborn care) in Spanish; (3) follow-up services in Spanish whereby mother and newborn health status is assessed post discharge; (4) coordination of pediatrician referrals to help facilitate newborn care; and (5) face-to-face translation services for situations in which sensitive information must be conveyed (and in which telephone interpretation services would not be ideal).

TEXAS

A FAMILY-FOCUSED STRATEGY FOR REDUCING PREMATURE AND UNPROTECTED SEXUAL ACTIVITY AMONG MINORITY YOUTH IN SCHOOL-BASED HEALTH CLINICS (1989)
Children and Youth Project, Dallas County Hospital District, Dallas, TX
This project aims to reduce occurrences of premature and unprotected sexual intercourse among a group of 320 African-American and Hispanic 10-year-olds recruited from two pediatric school-based health clinics. All youths receive an initial health maintenance evaluation when they enroll and most have received one annually during the 5-year project period. Nurses and social workers continue to provide both individual and group educational counseling and intervention services in an effort to improve the communication and decision-making skills of the youths and their families. Project staff have coordinated social events that include field trips for the participating families. In the last year, staff have developed peer support groups for the teens.

PROJECT FIRST STEP (1990)
Parkland Memorial Hospital, Dallas, TX
The goal of this project is to reduce infant mortality and morbidity in targeted areas of Dallas County by improving the health status of medically indigent, low-birthweight infants. Four geographically targeted low-birthweight clinics have been established, with each staffed by a pediatrician, a public health nurse, a social worker, and a community outreach worker. Clinic services will be provided at each site one to three times monthly for 4 hours, and project staff will work with other programs to ensure that all eligible infants have access to quality health care. The clinic public health nurses will serve as case managers. Home visits will be conducted by the community outreach workers, the nurses, and the social workers, as appropriate. Project participants will include infants who live outside the city of Dallas and are ineligible to receive intensive follow-up services through existing programs. Approximately 100 infants will be enrolled in the program each year.

PEDIATRIC CLINIC FOR DENTON COUNTY (1991)
North Texas Community Clinics, Denton, TX
In 1988, Denton County lost its only public and only non-profit hospital. At the same time, none of the 62 primary care physicians in the county were accepting new Medicaid patients. A Healthy Tomorrows grant allowed concerned community members to provide pediatric health care for low-income families by establishing and providing major funding for a pediatric primary care clinic. The clinic is a part of North Texas Community Clinics, a private, nonprofit community-based organization. The Pediatric Clinic is staffed by certified pediatric nurse practitioners working with volunteer pediatricians in the community, providing comprehensive well and acute care, immunizations, screening, and referrals. Of the over 5,000 patients enrolled, 90% are Medicaid-eligible.

HEALTH EDUCATION LITERACY PARTNERSHIP (1992)
Department of Health and Human Services, City of Dallas, Dallas, TX
Community service workers provide developmental, language, and early literacy guidance to parents. In addition, they encourage them to complete their own education. A clinic waiting room program includes volunteer readers who model reading to children for parents. Public health providers distribute free books and provide anticipatory guidance about family literacy. Goals of the program include increasing the literacy rate among teenage mothers and the emergent literacy of their children, and increasing community and pediatricians' awareness about the importance of literacy in relation to improving health outcomes and as a way to nurture children.

CAMPUS CARE CENTERS (Formerly Teen Clinic) (1992)
Brownsville Community Health Center, Brownsville, TX
The name of the project funded by the HTPCP has been changed to reflect growth of the project. The Campus Care Center concept started as a small project that provided comprehensive health care to the adolescents of Brownsville (a community on the Texas-Mexico border). Using HTPCP funds as leverage, the Brownsville Community Health Center has secured funding from twelve other funding partners, including the Texas Department of Health and the Robert Wood Johnson Foundation, to expand services to two sites in the Brownsville Independent School District. The Campus Care Centers are open 5 days per week and are staffed by pediatricians, a family nurse practitioner, social workers and support staff. Any student enrolled in the school district is eligible for services and the centers receive more than 400 visits per month. This year a health education component will be added. The Campus Care Centers received an Award for Excellence in School Health from the Texas Department of Health.

PEDIPLACE (1993)
Pediatric Healthcenter for Southern Denton County, Texas, Lewisville, TX
PediPlace is in place to provide a "medical home" to children who do not have access to health care and to encourage parents to be responsible for their child's home health management. The goal of improved access to health care will be accomplished by providing a pediatric center for sick and well child care to be staffed by pediatric nurse practitioners. Extended hours will improve access for parents who work full-time. Community agencies will work together to promote continuity of care and appropriate referral when needed. Efficacy will be measured by tracking a reduction in emergency room visits for non-emergency situations, an increase in immunizations, an increase in the number of children enrolled in Medicaid, and an increase in follow-up care and well baby/child visits.

MONTWOOD WELLNESS CENTER (2002)
Texas Tech University Health Science Center Department of Pediatrics
El Paso, TX
The mission of the Montwood Wellness Center is to improve the health and quality of life within the community by integrating the education system, the health care system, and community groups to provide comprehensive care with dignity and respect. The project provides comprehensive pediatric care for children in the Socorro Independent School District area, a community with 38.6% of the population at or below the federal poverty level. This collaboration between Texas Tech University Health Science Center Department of Pediatrics and Socorro Independent School District establishes a medical home for children who face many barriers to access health care. Program goals include:

1. establish a medical home for children who have no primary care provider;
2. increase and enhance each student's academic potential through health maintenance and education;
3. create a new system of community support individuals that will work as a link between individual homes, parents, families, and the wellness center; and
4. develop continuous evaluation, feedback, and research based on the results of the program.

BABIES FIRST! IN DALLAS: A HEALTHY STEPS APPROACH (2003)
Dallas County Hospital District, Parkland Health & Hospital System, Dallas, TX
The goal of the Babies First! Program is to reduce disparities in health care by promoting sound child-rearing practices culturally and linguistically sensitive health education for vulnerable Hispanic mothers. The program will employ trained bilingual paraprofessionals as child advocates to work with the mothers and their infants. The educational offerings and follow-up include home visits, case management and linkage to community resources. The child advocates will be trained in preventive health and well-child topics as well as developmental milestones and other pertinent parent education issues.

BEHAVIORAL DEVELOPMENTAL PRIMARY CARE PROGRAM- THE "GOALS" PROGRAM (2005)
People's Community Clinic, Austin, TX
The "GOALS" Program focuses on integrating behavioral and developmental health into a comprehensive primary care model, to include routine screening, specific expertise in evaluation and management of more complex behavioral and developmental patients and their families, and ongoing coordination of care within a medical home.

The goals of this project are to provide an improved system of behavioral/mental health/developmental screening, assessment, and care coordination for school- aged (3-19) patients and to offer an improved, formalized resource to the larger Central Texas community by providing diagnostic assessments, case coordination, and a medical home to youth and families referred specifically to the program by schools, youth serving agencies, and individuals because of behavioral/developmental/mental health concerns.

UTAH

EL PROGRAMA DE LAS PROMOTORAS: LAY HEALTH WORKERS IN AN INDIGENT CLINIC (1999)
University Clinic at South Main Public Health Center,
University of Utah, Salt Lake City, UT
University Clinic at South Main Public Health Center (South Main Clinic or SMC) is a community-based prenatal and pediatric primary care clinic for indigent and underserved women and children in Salt Lake County and is a collaborative effort between the Salt Lake City/County Health Department (SLCCHD), the Department of Obstetrics and Gynecology, and the Department of Pediatrics of the University of Utah School of Medicine. "El Programa de las Promotoras" joins the resources of SMC and Holy Cross Ministries (HCM) in order to expand an existing community-based program of HCM that utilizes indigenous, bilingual, lay health workers (Las promotoras) and to integrate their activities into those of SMC with the specific purpose of addressing the barriers that prevent mothers and infants from receiving appropriate health care. The specific measurable objectives are:

1. to increase the attendance rate at post-partum clinic;
2. to increase adherence to American Academy of Pediatrics (AAP) recommended pediatric health supervision visits; and
3. to increase the percentage of pediatric patients who are fully immunized.

Promotoras will meet all mothers receiving prenatal care, gather important demographic information, and implement a mail reminder system and an intensive promotora involvement group. Evaluation will focus on determining the most effective and efficient methods of improving attendance to health supervision visits in this clinic population.

NIÑOS ESPECIALES/FAMILIAS FUERTES (SPECIAL CHILDREN/STRONG FAMILIES) (2006)
University of Utah, Salt Lake City, UT
Latino children with special health care needs (CSHCN) often do not receive appropriate health care because their parents have difficulty accessing and understanding health services due to language, economic and cultural barriers and a lack of social support. This project is a collaborative effort between a community-based health clinic and a faith-based community organization that will improve access to health care for Spanish-speaking families with CSHCN. The project will focus on family advocacy and provide support groups to increase knowledge and skills to assist families in obtaining appropriate health care for their children.

VERMONT

PEOPLE'S CO-OP DOULES: A PRENATAL PARENTING PEER SUPPORT PROGRAM (1996)
Minority Business Association, Burlington, VT
This program was developed to serve the hard to reach expectant and new parents in the Old North End community of Burlington, Vermont who were not being reached through the Healthy Babies Program (a statewide program that provides outreach to pregnant women and infants on Medicaid). The Old North End community has a higher incidence of poverty, with its incumbent stresses, and a higher minority and immigrant population than the rest of the state. Under the auspices of the Minority Business Association, the Co-op seeks to form a partnership with local health care providers to ensure adequate nutrition and health care support for pregnant women and families with young children through health education, care coordination, and peer support.

WHATEVER IT TAKES (2000)
University of Vermont Department of Social Work, Burlington, VT
Whatever It Takes (WIT) is a partnership between the University of Vermont Department of Social Work and Mousetrap Pediatrics, a large practice in rural northwestern Vermont. WIT's primary goal is to reduce the numbers of children whose healthy development is at risk by increasing access to a comprehensive medical home. Whatever It Takes places four social work students and an experienced social work supervisor at Mousetrap's offices, where they provide intensive social work services to children and families. Children are referred to WIT by pediatricians due to unmet needs that are impacting the children's health. Very young parents, families with children with special health needs or with challenges related to migrant status, poor housing or transportation, and families needing help developing productive relationships with schools are among those referred for social work intervention. The students develop family/social work/pediatrician/ community partnerships in order to ensure that children and families receive comprehensive, high quality, coordinated services. The project's methodology includes the provision of direct services to children and families, consultation with the pediatricians, and resource development in the community.

VIRGINIA

THE COMPREHENSIVE HEALTH INVESTMENT PROJECT OF ABINGDON (1995)
People Inc of Southwest Virginia, Abingdon, VA
Healthy Tomorrows funding will be used to expand the service delivery area of a program that assists low-income families in accessing health care. Additional services will be provided to 60 low-income families with children who may have special medical needs, who lack a medical home, are under-immunized, who inappropriately frequent emergency rooms, or who have other special family support needs. In addition, services will be expanded to include 20 low-income pregnant women who also may have special medical needs, lack prenatal care, or who have other special family support needs. Paraprofessional home visitors and a public health nurse will conduct a needs assessment and develop and implement an individual assistance and health plan for each family.

EZ BREATHERS: PARTNERSHIP FOR ASTHMA AWARENESS AND PREVENTION IN HEAD START CHILDREN (2000)
Center for Pediatric Research, Norfolk, VA
Asthma is the most common chronic disease in childhood and frequently undertreated in low income minority populations, such as pre-school aged children enrolled in the Head Start program. These families frequently seek episodic care for their children's acute symptoms of asthma instead of preventive asthma care with a primary care provider. In order to improve control and treatment of asthma in this setting, we have designed the EZ Breathers Asthma Education Program, a community-based asthma awareness and prevention program which is family-centered and culturally relevant to the Head Start setting. The program will include asthma education and training for Head Start staff and parents, identification of parents to serve as peer counselors, a home health visit, subspecialty care for the more severe asthmatics, and a smoking cessation program. Key objectives of this program are to decrease emergency room visits and hospitalizations for children with asthma and improve school attendance and quality of life for asthmatic children and their families.

ASTHMA CONTROL TODAY (ACT) (2001)
People Incorporated of Southwest Virginia, Abingdon, VA
In southwest Virginia, public health nurses and doctors identified nearly half of the 302 Medicaid-eligible children under age six as having pediatric asthma or allergy and chronic respiratory problems. The project serves families in the Appalachian Mountains of Southwest Virginia, an area with an extremely high percentage of children living in poverty, which puts those children at greater risk for asthma or other chronic respiratory problems. The project will provide a home visitor and nurse to evaluate families' needs and provide education, monitoring, and referral for the families regarding their children's asthma or respiratory illness. Program goals include:

1. assist 100 children and their families with improving the asthmatic child'' health through education, prevention, and maintenance;
2. reduce the number of emergency room visits by 30 percent;
3. reduce the number of acute doctor visits by 25 percent;
4. reduce the number of hospitalizations and the length of stay by 25 percent;
5. reduce the number and severity of asthma episodes a child experiences;
6. reduce the number of homes by 30 percent where adults smoke in the house; and
7. reduce the number of environmental triggers within 50 percent of the homes.

CHILD HEALTH INTEGRATED CULTURAL OUTREACH SERVICES (CHICOS) (2002)
CHIP of Virginia, Richmond, VA
The CHICOS project will build CHIP of Virginia's capacity to meet the health and family support services needs of language minority children and their families. The CHIP of Virginia is a statewide network of 11 local programs offering health-focused home visiting for families with young children (0-6 years). The CHIP nurses and outreach workers offer health and developmental screenings for young children, help to enroll them in insurance programs, give referrals to medical and community services, and provide parent education. CHICOS will allow CHIP to:

1. hire language minority home visiting staff,
2. translate CHIP documents;
3. mobilize foreign language materials so they are readily available to local CHIP programs and other groups serving children, and
4. train CHIP staffs in cultural competence.

CHICOS will increase CHIP's enrollment of language minority children by 88% over 5 years. Within 1 year of enrollment, at least 90% of these children will have a medical home and be fully immunized.

BEGIN WITH A GRIN PROGRAM (2008)
Child Health Investment Partnership of Roanoke Valley, Roanoke, VA
Five times more prevalent than asthma and seven times more common than hay fever, dental caries affect a child’s growth, lead to malocclusion, and result in significant pain. Low-income children tend to experience dental disease and its consequences in epidemic proportions. The problem is exacerbated by a shortage of pediatric dentists, a lack of parental education on oral health and hygiene, language and cultural barriers to care, and rural areas depending on private, non-fluoridated wells for water. Child Health Investment Partnership (CHIP) of Roanoke Valley’s Begin with a Grin Program will reduce the incidence of long term oral hygiene disease in children ages 6 months to 36 months who are enrolled and followed by CHIP. The program will fill gaps in dental health care caused by a lack of regional pediatric providers, increase caregiver education about oral hygiene, and meet the basic preventive dental needs of young children in a traditionally high-risk population.

WASHINGTON

PARENTS, PEER EDUCATORS AND HEAD START: BUILDING HEALTHY TOMORROWS (1997)
Pudget Sound Educational Service, Burien, WA
The HTPCP funded project utilizes a Head Start program to impact the health care knowledge and self-care skills of the low-income families served through the Pudget Sound Educational Service District's (PSESD) Early Childhood Department. The project uses a peer health education model. Parent peer health educators participate in a ten week training program in which they learn how to facilitate interactive workshops on medical self-care, and health advocacy for parents. The peer health educators also facilitate informal parent-to-parent interaction to discuss, and exchange, ideas about self-care, use of health services, and healthcare advocacy. The primary goals of the project are:

1. to increase knowledge about and use of self-care practices by parent peer health educators, and ultimately, all parents enrolled in all PSESD Head Start sites, and
2. to increase parent peer health educators' and parent participants' understanding about how
3. to use formal healthcare systems in ways that foster better health and enable parents to be effective advocates for their children and themselves.

BETTER REGIONAL ACCESS FOR IMMIGRANTS AND REFUGEES WITH DEVELOPMENTAL DISABILITIES: BRAIDD-2 (2002)
The Arc of King County, Seattle, WA
Families of children with developmental disabilities (Down syndrome, autism, cerebral palsy, mental retardation) must negotiate a complex system of evaluation and documentation to access services. These families face incredible emotional and practical challenges. Language and cultural differences in immigrant and refugee families compound these challenges and increase their feelings of isolation. One of the greatest needs expressed by parents of children with developmental disabilities from refugee and immigrant communities is the need for more information and culturally appropriate advocacy and referral services. The goals of this project are to:

1. form support groups for parents from refugee and immigrant communities with children with developmental disabilities to provide emotional support and practical advice,
2. provide comprehensive community advocacy and case management services for participating families,
3. provide outreach to parents of children who have not presented to care,
4. develop a clearinghouse of information about services for children with developmental disabilities, and
5. increase awareness of developmental disabilities within the targeted communities.

For each language group, the project will train a bilingual/bicultural family advocate who will organize the support group meetings to provide emotional support, practical information, community advocacy, interpretation, and referral services.

SUCCESSFUL LEARNING IN VULNERABLE PRESCHOOL CHILDREN THROUGH IMPROVED MENTAL HEALTH (2008)
Child and Adolescent Clinic, Longview, WA
It has been documented that 51 percent of children entering kindergarten in the largest school district in Cowlitz County are at “some risk” or “at risk” of not being ready to learn to read.  This is related to a high level of poverty in the community with associated maternal depression and childhood emotional and developmental problems. These children will be identified so that they and their families can receive support and mental health care from a collaboration of community organizations. The primary goal of the project is to improve the emotional and social development of children from pre-birth to age 6 who are at risk so that they are better prepared to learn when they enter school. This will involve: (1) finding vulnerable children from pre-birth to age 6 and engaging them in a medical home; (2) evaluating the development and mental health of the vulnerable children and the emotional status of their mothers using newly-introduced screening instruments; (3) referring identified children and parents to the collaborating agencies for additional help; (4) teaching families better ways to nurture their young children; and (5) conducting a community and family awareness campaign.

IMPROVING SCHOOL READINESS IN WASHINGTON STATE THROUGH REACH OUT AND READ (2009)
Reach Out and Read Washington State, Seattle, WA
Currently, less than half of all children in Washington state arrive at kindergarten with the skills they need; and children who arrive behind rarely catch up with their peers. Early brain and economic research demonstrate that effective interventions in early childhood enhance school readiness and life outcomes, and have a positive return on investment to society. Reach Out and Read (ROR) is a program within the medical home which increases parent-child reading, and improves early literacy outcomes. This project will expand access to ROR programs and integrate them into Washington state’s school readiness efforts. The goal of the project is to improve school readiness in Washington state through the expansion and integration of ROR within statewide and local community early learning efforts. The project will use state and local school readiness partnerships to increase access to ROR for low-income children ages 6 months to 5 years in Washington state. ROR has been proven to improve parental attitudes about books and reading, increase reading, and improve children language skills. Within the medical home ROR doctors (1) talk with families about reading and promoting literacy at each check up; (2) give families developmentally, linguistically, and culturally appropriate new books to keep, and (3) have literacy rich waiting rooms. ROR reinforces the parent’s role as the first and most important teacher, and gives parents the knowledge, skills, and books to help their children succeed.

WEST VIRGINIA

WEST VIRGINIA CARES (COORDINATING ACCESS TO RESOURCES AND EMERGENCY SERVICES) PROJECT (2007)
Marshall University Research Corporation, Huntington, WV
Homeless and foster care children are a complex and especially vulnerable group of children with special health care needs. The West Virginia CARES project will improve access to a medical home for Appalachian children who are homeless or in foster care. The project will select and train two parents of children with special health care needs to serve as parent care coordinators. These coordinators will become an integral part of the medical home improvement team and will create a Medical Passport and Education Passport for all families in the program. The coordinators will also be responsible for screening for developmental delays and school issues, including ADHD. This project will improve the health status of homeless and foster care children by establishing a model for coordination of health care and improvement of the medical home led by trained parent care coordinators.

WISCONSIN

TEEN PREGNANCY SERVICE: ADOLESCENT PRIMARY CARE (1993)
Medical College of Wisconsin, Department of Pediatrics, Milwaukee, WI
This project aims to provide effective comprehensive primary health care to adolescent mothers in a cost-effective and culturally relevant manner. Pediatric primary care teams will include a nurse practitioner, pediatrician, and social worker who will assess the adolescents' general physical and mental health, risk-taking behaviors, and other issues related to growth and development. Clinic visits will be monitored to ensure teen clients have the opportunity to receive comprehensive primary health care. An existing parent support program will be expanded to improve the parenting skills and support systems of adolescent parents at risk for child abuse and neglect. Pre- and post-intervention data will be collected to monitor the incidence of sexually transmitted diseases and repeat pregnancies.

HEALTHY CHILDREN IN CHILD CARE (1998)
Children's Health System, Milwaukee, WI
The Healthy Children in Child Care Project will address the community wide problem of system fragmentation and poor coordination of health care resources for children in child care settings in Milwaukee. Young children in low income families are increasingly being cared for in out-of-home settings due to the implementation of Wisconsin's Welfare program (W-2). These children are at increased risk for poor health outcomes. By securing direct pediatric health care involvement and offering health care education to providers and parents, the project will improve the health, safety, growth, and development of children in child care being served in Milwaukee's central city. The project will decrease barriers to accessing health care (ie, insurance coverage, transportation, etc), increase skill levels of providers, implement the National Health and Safety Standards: Guidelines for Out-of-Home Care Programs and expand pediatric health education opportunities for parents.

The Healthy Children in Child Care Project proposes to address the health care needs of young low-income, urban children through the child care setting by establishing a pediatric health resource system that will:

1. Increase the skills of child care providers in preventive health strategies and management of common acute illness.
2. Improve parent understanding and utilization of preventive health care strategies and primary health care services.
3. Enhance the awareness and participation of pediatric health care providers in meeting the special health care needs of children in child care.

IMPROVING HISPANIC CHILDREN'S ORAL HEALTH BY PRENATAL AND POSTNATAL (2004 Oral Health Grant)
16th Street Community Health Center, Milwaukee, WI
Dental care especially in low income and minority children, has recently been identified as the most prevalent unmet health need in US children. Tooth decay is the most common chronic disease of childhood. It affects more than 50% of children by mid- childhood and is 5 times more common than asthma. A recent survey of 3-6 year old Head Start children in Wisconsin indicated 48% had a history of dental caries and Hispanic children in Wisconsin are disproportionately affected by dental caries. It is well known that pregnancy causes many changes in mouths of the prospective mother. Changes in hormone level during pregnancy have been shown to influence the composition of plaque and to exacerbate the gingival response to plaque. In addition, there is significant evidence that many conditions that occur in the mother pose a risk to the child both pre and post natal. In response to the oral health issues many of our patients face, 16th Street Community Health Center will incorporate oral health into the medical component of our health center in cooperation with our dental clinic. The goals and objectives of the Hispanic Children's Oral Health Project are: 1) to provide basic oral health education to our medical providers; 2) to provide oral health education and counseling to our expectant mothers, particularly those exhibiting high risk, as determined by the Caries Risk Assessment Tool developed by the American Academy of Pediatric Dentistry; 3) to institute a fluoride varnish program, in which a high concentration fluoride is painted directly onto the teeth; and 4) improve oral health care access in order to establish a "dental home" for both mother and baby.

EMOTIONAL HEALTH SCREENING FOR FOND DU LAC COUNTY YOUTH PROJECT (2004 Behavioral & Mental Health Grant)
Fond du Lac School District, Fond du Lac, WI
The project will enable schools and health professionals to promote voluntary screening of emotional health needs by all 9th grade students, and develop procedures for referring other at-risk middle and high school students for screening. School health officers within Fond du Lac School District, and health specialists and trained volunteers in other districts and communities will provide case management services to students (and family members) who receive referrals for follow-up emotional health/suicide prevention treatment. School health specialists, area pediatricians and mental health professionals will also provide youth, parents and other family members with periodical educational awareness workshops and programs on the nature of emotional health disorders and available resources.

WYOMING -- NOT AVAILABLE

For more information on any of these HTPCP projects, please e-mail your name, address, telephone, and fax numbers with your specific request to healthyt@aap.org.