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.

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.

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