Tuesday, Feb. 5, 2013 - Centers for Disease Control and Prevention Visit

Tuesday, Feb. 5, 2013

Atlanta, Georgia

Centers for Disease Control and Prevention Visit

Thank you, Dr. Frieden.

I have been looking forward to this visit.

Our agencies collaborate on so many joint projects to help the most vulnerable and exposed Americans.

Creating a dialogue and keeping an open channel of communication at all levels is crucial to the success of these programs.

It is incumbent upon us as stewards of the public trust to develop strategic partnerships on behalf of those we serve, especially vulnerable populations.

Just about every major program office at ACF has an ongoing, substantive partnership with an office or program here at the Centers for Disease Control and Prevention.

At the Administration for Children Youth and Families, we work together in the area of teen pregnancy prevention.

Despite declining rates, the U.S. teen pregnancy and birth rates are substantially higher than those of other western industrialized nations. To address this important public health issue in FY 2010, the Office of Assistant Secretary for Health, the Administration for Children and Families (ACF), and the Centers for Disease Control and Prevention (CDC), all within the Department of Health and Human Services (HHS), through diverse funding streams awarded grantees across the U.S. more than $200 million for the prevention of teen pregnancy.

This significant amount of funding to state and local organizations offered a unique opportunity to consider how the HHS agencies can collaboratively leverage federal resources across grantees, as well as how they might initiate and strengthen grantee planning for sustainability of teen pregnancy prevention efforts/programs.

At the Children’s Bureau our partnership is working to prevent family and domestic partner violence.

In the Office of Child Abuse and Neglect we partner with CDC’s Knowledge to Action Consortium to Prevent Child Maltreatment.

The Knowledge to Action Child Maltreatment Prevention Consortium (K2A) is an on-going CDC led partnership and process to provide new insight and ideas for transferring public health science about child maltreatment prevention to social action. 

The focus of the K2A is community and societal level[i] actions that promote safe, stable, and nurturing relationships (SSNRs) for children.  CDC’s Consortium partners include the National Alliance of Children’s Trust and Prevention Funds, Office on Child Abuse and Neglect, Parents Anonymous Inc., and Prevent Child Abuse America.

We have an ongoing partnership through the Federal Interagency Workgroup on Child Abuse and Neglect

CDC is an active member of the Federal Interagency Workgroup on Child Abuse and Neglect. 

Since 1996, the Office on Child Abuse and Neglect has led and coordinated the FEDIAWG.

Over 40 Federal agencies are represented. The FEDIAWG meets in-person on a quarterly basis and various Subcommittees meet on a more regular basis via conference calls.

The overall goals of the FEDIAWG are: 1) to provide a forum through which staff from relevant Federal agencies can communicate and exchange ideas concerning child maltreatment related programs and activities; 2) to collect information about Federal child maltreatment  activities; and 3) To provide a basis for collective action through which funding and resources can be maximized. 

Collaborations with Early Childhood Development

Developmental and Behavioral Screening Initiative

The CDC estimates that 1 in 88 children has been identified with an autism spectrum disorder and about 1 in 6 children aged 3 to 17 has a developmental disability. Many children with a developmental disability are not identified until after entering school. Early intervention can have a significant impact on a child’s ability to learn new skills as well as reduce the need for costly interventions over time.

ECD and CDC are spearheading a joint initiative between HHS and Department of Education on developmental and behavioral screening. The three components of this initiative include:

1)   Coordinated HHS-wide public outreach campaign to promote developmental and behavioral screening

2)   Efforts to validate a comprehensive, developmental and behavioral screening tool for use in the public domain in diverse settings that care for children.

3)   Work to support children and families with developmental concerns who are not eligible or do not have access to IDEA Part B or Part C services.  This will include a media campaign as well as improving the professional development of our health and education workforce who care for these families.

1. Other ECD-CDC efforts include: Legacy Parenting Program, creation of Voluntary Guidelines for Managing Food Allergies in Schools and Early Care and Education Program, and the CDC Autism Briefing for Early Childhood Leadership.

CDC is currently funding and examining the effects of parenting interventions.

ACF and CDC staff have preliminarily discussed some of these interventions, including the Triple P Parenting Intervention and the Legacy for Children intervention. Please find background information on these interventions below, in the event that these topics arise during the discussion.

Triple P Parenting Intervention

The Triple P-Positive Parenting Program is a multi-level, parenting and family support intervention developed from over 30 years of clinical research trials.

Developed at the University of Queensland, the intervention aims to prevent developmental, emotional, and behavioral difficulties, targeting children from birth through age 16.

Within each developmental period, Triple P incorporates five levels of intervention of increasing intensity to mirror the spectrum of child and family needs.

Families can begin intervention at any level, depending on need.

Legacy Parenting Intervention

Legacy for Children is an evidence-based program, developed by the CDC, whose aim is to improve child outcomes by promoting positive parenting among low-income mothers of infants and young children.

The intervention is focused on four key areas of parenting: parent self-efficacy, the parent–child relationship, parent responsibility, and a sense of community.

A core part of the Legacy program is regular group meetings of mothers, including mother-only sessions and mother–child sessions. In addition, Legacy includes one-on-one sessions with mothers that reinforce the curriculum.

Collaborations with OCS

The CDC is one of OCS’s many partners on the Healthy Food Financing Initiative, and OCS is looking to partner with the CDC around their Healthy Homes initiative, which would particularly involve the Low Income Home Energy Assistance Program.

Collaborations with ORR

ORR works primarily with CDC’s Division of Global Migration and Quarantine (DGMQ) under the National Center for Emerging and Zoonotic Infectious Diseases, but also with CDC’s Office of Public Health Preparedness and Response.

Below is a summary of key areas of collaboration: 

Refugee Health

Onsite Technical Assistance by CDC Medical Officer

Last May, ORR and CDC entered an interagency agreement to have a CDC Medical Officer provide onsite technical assistance with refugee health and other health issues affecting ORR’s service population. 

As a result of that interagency agreement, Dr. Curi Kim has been working with ORR staff on a number of projects, including operationalizing  domestic medical screening guidelines for refugees and evaluating the screening process. 

Implementation of the Rapid Health Assessment

Last year, CDC and ORR entered into another agreement to have ORR’s Refugee Health Team Lead, Ms. Essey Workie, spend three months with CDC’s refugee health program in Kenya. 

During that time, Ms. Workie supported CDC’s Rapid Health Assessment of Congolese refugees living in Rwanda – in camps or urban settings. 

Ms. Workie provided planning and implementation support to a team of medical and public health officials who collected blood, urine and stool samples for rapid tests to detect hepatitis B, malaria, anemia, HIV, intestinal parasites, and other medical conditions. 

The data gathered from this innovative project will help clinicians and public health officials in the U.S. to better understand the health profile of Congolese refugees. 

CDC is currently in the data analysis phase of the project and Ms. Workie continues to engage with CDC Atlanta and CDC-Kenya on this front. 

Development of the Domestic Medical Screening Guidelines

In July, ORR issued guidance that established a minimum standard of care for conducting the domestic medical screening of newly arriving refugees and corresponding reimbursement rates. 

ORR developed the guidelines in consultation with the Centers for Disease Control and Prevention (CDC) and in accordance with CDC’s 12 subject-based guidelines, formally known as the U.S. Domestic Medical Examination for Newly Arriving Refugees. 

CDC arranged for ORR to confer with their consultant on refugee health, Dr. Bill Stauffer of Minnesota. 

CDC and ORR continue to discuss the domestic medical screening guidelines with regard to potential updates based on research findings and patterns in refugee health. 

Epidemiological Investigation of Suicides

Over the last four years, ORR received disheartening news of suicides among refugee communities.

ORR requested that the Centers for Disease Control and Prevention (CDC) conduct an epidemiological study to describe the suicides that occurred and identify factors associated with suicidal ideation.

CDC recently published a report of their findings titled An Investigation into Suicides among Bhutanese Refugees in the US 2009 – 2012: Stakeholders Report. 

The report outlines recommendations for the local resettlement network, community mental health providers, ORR and other Federal partners.

U.S. Repatriation Program

The U.S. Repatriation Program provides temporary assistance to U.S. citizens and their dependents who need to be brought back to the U.S., because of destitution, illness, war, threat of war or similar crisis.  The program is divided into non-emergency and emergency activities. Operationally these activities involve different kinds of preparation, resources and implementation. 

For the past six years, the U.S. Repatriation Program has established a working relationship with CDC’s Division of Global Migration and Quarantine (DGMQ) to support both non-emergency and emergency repatriation activities.  

Non-emergency Activities

The Repatriation program’s non-emergency activities encompass the ongoing routine arrivals of individual repatriates including mentally ill persons. 

Currently, approximately 1000 individuals are repatriated on a yearly basis.  The support to non-emergency activities includes but is not limited to consultative revisions of medical case files with potential contagious conditions. 

A draft MOU has been approved by counsel for both CDC and ACF and is at its final signature stages. 

The purpose of this MOU is for DGMQ to provide consultative medical support to the Repatriation program’s non-emergency activities on cases with potential contagious conditions. 

Emergency Activities

The Repatriation program’s emergency activities cover group repatriations, evacuations of 50-500 individuals, and emergency repatriations, evacuations of 500 or more individuals.

During emergency repatriations ACF/ORR is responsible for leading national coordination and response.  

CDC’s support to the U.S. Repatriation Program was instrumental in 2006 during the Lebanon Emergency Repatriation and in 2010 during the Haiti emergency repatriation.

CDC support/assistance included but was not limited to visual screenings at the port of entry for potential conditions, federal and state collaboration with after action reports and surveys of repatriates. 

The Repatriation program will continue having discussions with the CDC Office of Public Health Preparedness and Response regarding an MOU for emergency repatriation activities.  

The National Survey of Family Growth (NSFG)

The NSFG gathers information on family life, marriage and divorce, pregnancy, infertility, use of contraception, and men's and women's health.

The survey results are used by the U.S. Department of Health and Human Services and others to plan health services and health education programs, and to do statistical studies of families, fertility, and health. Links to some of those studies are included on this web site, under "Publications and Information Products."

Collaborations with OHSEPR

OHSEPR Preparedness and Community Resilience Team Lead has worked with the Office of Public Health Preparedness and Response Office of the Director, Communications Office for National Preparedness Month in September of 2012.

The Team Lead wrote a blog for children and family preparedness before a disaster. OPHPR/OD and OHSEPR have been collaborating for social media interventions.

CDC participates actively in the Children’s HHS Leadership in Disasters (CHILD) Working Group, which is co-led by ACF’s Office of Human Services Emergency Preparedness and Response (OHSEPR) and ASPR’s Division of At-Risk Individuals, Behavioral Health, and Community Resilience (ABC). 

The CHILD Working Group, which originated within HHS in response to the National Commission on Children and Disasters, coordinates ongoing work across HHS to address the needs of children in disasters and public health emergencies.

We even collaborate at the regional level

In Region IV, we work together to collaboratively explore the feasibility of implementing the Legacy for Children (Legacy) model within the Early Head Start infrastructure. 

Legacy is a group-based, parent- focused intervention approach aimed at improving child outcomes among low-income mothers of infants and young children by fostering positive parenting and parenting self-efficacy. 

The Legacy model has been tested for its impact on early childhood outcomes.   Preliminary results revealed a positive impact on children in poverty; significant positive effects on child IQ, child behavioral problems, and maternal-child behavior measured within the home environment. 

Intervention activities are designed to enhance sensitive and responsive parenting, parent/child interaction, and promote a sense of community. 

Other activities include verbal and cognitive stimulation through parent and parent/child group meetings, visits to the home, and participant in community events. 

Centers for Disease Control and Prevention/Coordinating Center for Health Promotion/National Center for Chronic Disease Prevention and Health Promotion/Division of Nutrition, Physical Activity and Obesity Preventive Program

ACF Region IV staff met with representatives from the Division of Nutrition, Physical Activity and Obesity Preventive Program (DNPAOP) to discuss opportunities for sharing resources and to learn more about the available intervention programs to improve nutrition and physical activity for children.

The scope of DNPAOP activities includes research, training and education, intervention development, health promotion, policy and environmental change.

The Center has several programs and campaigns including Youth Media Campaign, VERB, Color Me Healthy and Fruits and Veggies Matter that pertain to the importance of physical activity and nutrition through interactive learning experiences. CDC has supported obesity prevention programs in 28 states that focus on capacity-building in communities. 

Goals are to hire staff with expertise in public health nutrition and physical activity, build broad-based coalitions, develop state plans and policies, identify community resources and gaps, implement small-scale, targeted interventions, and raise public awareness of behavioral changes needed to enhance nutrition and physical fitness. 

The program also provides funding for the implementation of child care and school-based programs to help youth avoid behaviors that increase their risk for obesity.

These are just some of the many, many ways the CDC and ACF are working together to serve vulnerable populations.