achia NEWS archives

by Cason Benton, MD, FAAP, Director, Alabama Child Health Improvement Alliance (ACHIA)

Toward the end of the last century, groundbreaking work by Vincent Felitti and Robert Anda established that adults with Adverse Childhood Experiences (ACEs) are much more likely to experience lifelong poor physical and mental health outcomes at the population level. Subsequent research found that unmitigated toxic stress damages and changes the genome resulting in poor health.

Children in Alabama are at risk because of a higher level of stress: one in four live in poverty with 16 percent facing food insecurity.

Yet, adversity is not destiny. We all know children and adults who show remarkable resilience in facing adversity. Research shows that the most powerful mitigating factors for ACEs is experiencing safe, stable, nurturing relationships (SSNRs) and having positive childhood experiences (PCEs.) In addition to buffering toxic stress responses, SSNRs foster adaptive skills to cope with adversity. Rather than focusing on toxic stress for pediatric well-being, the American Academy of Pediatrics (AAP) now strongly recommends pediatricians focus on relational health.

Instead of “summing up the suffering,” we should “build the buffering.”

Specifically, AAP policy urges pediatricians to promote resiliency by integrating three levels of relational health into clinical care.

• For primary prevention, we should universally utilize a strengths-based relational health approach at health supervision visits.

• At the secondary level, we should identify and address barriers to developing SSNRs.

• At the tertiary level, we should connect families and children experiencing toxic stress with appropriate treatments to repair strained relationships.

To assist Alabama practices in honing their trauma-informed/early relational health skills, ACHIA and the AL-AAP hosted Michael Arenson, MD, Research Fellow at the UMass Chan Medical School’s Center for Child Equity, as he presented at the AL-AAP Annual Meeting on the pediatrician’s role in preventing and responding to toxic stress.

These discussions served as a soft launch for ACHIA’s Healthy Beginnings 2024: An ACHIA Trauma-Informed Care and Resiliency QI Collaborative. During the collaborative, clinical supervisors will measurably improve strengths-based messaging and add, or enhance, screening and follow-up for perinatal depression, food insecurity, and social-emotional wellness at selected early childhood health supervision visits between December 2023 and August 2024. Pediatricians who participate will engage in in-person meetings with local community organizations, which will foster SSNRs, and referrals resulting from these personal connections are more likely to be successful in leading to “warm handoffs.” Elizabeth Dawson, MD, FAAP, will be the lead content expert and Part 4 MOC points will be awarded to practices for 25 points. To enroll or learn more about the collaborative, contact Rachel Latham at rlatham@alaap.org. Limited enrollment is available on a first come, first served basis.

This article first appeared in the Third Quarter 2023 Edition of the Alabama Pediatrician Newsletter.  

Practices recognized for quality improvements

Cason Benton, MD, FAAP, Director, Alabama Child Health Improvement Alliance (ACHIA)

At the Alabama Chapter-AAP Spring Meeting, practices that participated in last year’s teen

vaccine collaborative were recognized for their commitment to quality. In addition to a certificate

of achievement, each practice received a personalized 2019-2022 report comparing their

vaccination completion rates to those of other participating practices and the state as a whole.

While the state showed a slight downturn in vaccinations, early teen vaccinations for the 2022

ACHIA collaborative practices trended upwards. The data show that even with vaccine hesitancy,

improving clinical processes increased vaccine completion in 2022.

If you missed the collaborative or spring workshop on teen vaccines but want to improve

vaccination rates, visit the ACHIA website at https://achia.org/resources/past-projects for

educational modules and change ideas.

Despite the impressive gains, ongoing data are essential to monitor if improvements are to be sustained.

As part of its mission to improve health outcomes for Alabama’s children through continuous quality

improvement, ACHIA will continue to provide the annual vaccination report for both “process” and

“outcomes” data to all collaborative participants. The annual reports will allow the practices to monitor if

2022 gains have been sustained.

If your practice is interested in receiving longitudinal data reports on a variety of quality measures, contact info@achia.org

This article first appeared in the 2nd quarter edition of The Alabama Pediatrician newsletter.

by Cason Benton, MD, FAAP

Teen Mental Health

Before the pandemic, mental health challenges were the leading cause of disability and poor life outcomes in young people with one in five adolescents having a mental health disorder. Moreover, Alabama youth, when compared to national samples, are more likely to have attempted suicide in the last 12 months and to have been treated medically as a result. Early data from emergency room usage and hospitalizations point to an alarming increase in adolescent mental health concerns during the pandemic.

The Role of the Pediatrician

To address this mental health emergency, pediatricians need to be a part of the solution. The Guidelines for Adolescent Depression in Primary Care (GLAD-PC) recommend universal depression screening and follow-up for 12- to 18-year-olds, when the following can be pursued:

1. additional training regarding issues such as advances in screening, diagnosis, treatment, follow-up, liability, consent, confidentiality, and billing;

2. practice and systems changes, such as office staff training and buy-in, EMRs, and automated tracking systems, whenever available; and

3. establishing linkages with mental health services. An exciting partnership between the PATHS program (Pediatric Access to Telemental Health Services) housed at Children’s of Alabama and ACHIA’s quality improvement collaborative will help the practices “check off’ the GLAD components.

QI Learning Collaborative

Participants in the QI collaborative will engage in PATHS’ behavioral health training using Project ECHO, a guided practice model of telementoring that brings specialty knowledge to primary care practices (visit https://bit.ly/3xeIe33 for more information). Additionally, these practices will also use ACHIA quality improvement coaching and data platforms to assess the reliability of the clinician’s universal screening and follow-up systems. Those interested practices can learn more about the 2023 Teen Mental Wellness QI Collaborative at the AL-AAP’s Annual Meeting in September during a session with a teen mental health speaker. Practices may also contact Project Coordinator Rachel Latham at rlatham@alaap.org.

Rural Providers: Start the PATH to Improving Behavioral Care for All Ages Now!

While not part of the 2023 Teen Mental Wellness Collaborative due to grant stipulations, the PATHS program has behavioral health supports in addition to the ECHO training for primary care providers in Alabama’s rural communities through the following:

• care coordination for patients of all ages with complex behavioral conditions;

• referrals to behavioral health resources in the patient’s communities where available;

• provider-to-provider consultation with a member of the PATHS mental health team, when caring for a patient with behavioral health needs; and 

• behavioral health services via telemedicine in the pediatrician’s office when specialist intervention is needed.

PATHS is working on expanding these supports more broadly in Alabama. Rural providers interested in learning more, including opportunities in 2022, should visit https://www.childrensal.org/paths or contact Susan Griffin at susan.griffin@childrensal.org or at 205-638-5673.

References
Perou, el al., & Centers for Disease Control and Prevention (CDC) (2013). Mental health surveillance among children—United States, 2005-2011. MMWR. Morbidity and Mortality Weekly Report Supplements, 62(2), 1–35.

Ghandour, R. M., et al. (2019). Prevalence and treatment of depression, anxiety, and conduct problems in U.S. children. The Journal of Pediatrics 206, 256–267.

Centers for Disease Control and Prevention. (2019) Youth Risk Behavior Survey Data. Available at: www.cdc.gov/yrbs. Accessed on 2021.

Rachel A. Zuckerbrot, et al; Guidelines for Adolescent Depression in Primary Care (GLAD-PC): Part I. Practice Preparation, Identification, Assessment, and Initial Management. Pediatrics March 2018; 141 (3): e20174081. 10.1542/peds.2017-4081

This article first appeared in the Second Quarter 2022 Edition of the Alabama Pediatrician Newsletter.

Increasing and improving the teen well visit: lessons from 27 Alabama practices

by Cason Benton, MD, FAAP

Alabama pediatricians know that the teen well visit supports the “healthy cognitive, physical, sexual, and psychological development [adolescents need] to successfully enter adulthood” (AAP Policy Statement, December 2019). We also know that many1--if not most--teens do not attend the well visit. 

What can we do at the practice level to increase teen well visits? 

Twenty-seven practices tackled that question during the 2019 Alabama Child Health Improvement Alliance #StayWell learning collaborative and shared their reflections to improve care. 

Know your data: Step one is to have reliable data of who is due for a visit. #StayWell practices used various methods to track teen visits, such as scheduling systems, electronic medical records, or payer reports. Selecting a process your office can sustain is key. 

Establish reminder/recall process: Practices tested different ways to contact the families. Some found that text reminders boosted visits, while others discovered personal phone calls led to more completed visits. Practices learned to test which approach works best for them. 

Encourage teen-centered care: Practices had a number of recommendations including the following:

• Look at your office through a teen’s eyes (or better yet, have teens assess the office!) What do youth see when they walk through the door? Is the decor for younger children? Do the staff talk with the teens or only with the parents? The Adolescent Health Initiative’s (AHI)2 Youth-Led Health Center Assessment Tool captures teen input. AHI’s 15-minute staff “Spark” trainings start office conversations to have a more youth-friendly office.

• Incentivize visits. One practice held a live-stream raffle for an Apple Watch for those who completed the well visit over the summer. Another practice promoted monthly gift card drawings for both the teen and caregiver.

• Develop a transition plan. #StayWell participants standardized the office process to transition a preteen with little understanding of healthcare into a 19-year-old able to navigate health needs independently.

• Develop a confidentiality plan. Providing confidential care results in better health outcomes. Collaborative peer-to-peer learning was particularly valued as practices tested how to partner with parents while still allowing teens to have confidentiality when needed.2 Posting the clinic standard throughout the office helps communicate confidentiality clearly.

Implementing these teen-friendly activities led to the following improvements over the nine-month collaborative: the well visit rate increased by 10 percent; practices with a transition plan increased from 4 percent to 72 percent. Teen well visits increased by 9,000 from 2018 to the 2019 collaborative year. The #StayWell practices demonstrate that increasing teen well care is possible in Alabama when we establish reminder/recall systems and a teen-friendly office.

For more information on the #StayWell collaborative and resources to help you get started in your own practice, visit https://achia.org/resources/past-projects-resources.

1Medicaid.gov Accessed January 27, 2021 https://www.medicaid.gov/state-overviews/scorecard/adolescent-well-care-visits/index.html

2Adolescent Health Initiative. Accessed January 27, 2021 https://www.umhs-adolescenthealth.org/improving-care/spark-trainings/

This article first appeared in the First Quarter 2021 Edition of the Alabama Pediatrician Newsletter.

Alabama’s children achieve better outcomes when challenges in infancy and toddlerhood related to development, autism, social-emotional concerns, and maternal depression are identified and addressed early on. The Best Beginnings collaborative began in January 2020 to support primary care practices in improving their current screening processes or to introduce new screenings into their workflow. Fourteen pediatric practices and 67 pediatricians began orientation, module work and data collection using the American Academy of Pediatrics’ Quality Improvement Data Aggregator with practice interventions aligning around the key drivers of engaging QI team and practice, managing population, building community capacity, reliable screening and referral completion, and parent/guardian engagement. Practices self-selected ONE of the early screening tools (development, autism, social-emotional, or postpartum depression) to change workflow to increase the rate of recommended well-child visit screenings and referral for services for conditions impacting children ages one month to three years. 

This work, however, was interrupted in early March as the nation was hit with the COVID-19 crisis; screening and referral completion paused from March through May to focus on COVID-19 workflow changes while working on early screening, documentation and referral tracking. 

Practices continued to attend the regularly scheduled monthly practice webinars and report out on shared experiences around COVID-19 during the last three months, which included the following: 

Workflow revisions

• Increased well-child visits picked up in early May

• Collaborative practices never suspended early screenings for well-child visits during COVID pivot months

• Triage protocol changed from the triage room to patient rooms

• Practices are seeing a much lower sick visit rate

Staff/Office impact

• Important to stay vigilant for other comorbidities that can be identified through well-child visits

Telehealth

• Heavy use of telemedicine, phone contact, some video

• Telehealth – queries on ADHD, asthma, depression

Reminder/Recall/Connecting to families

• Reminder recalls through several platforms/programs, including phone calls and running reports

• Use of social media and patient portals to encourage well visits and keep families informed of changes

• Practices have been communicating safety measures to families through social media and text messaging

• Messaging to families for follow-up appointments

• Using ImmPRINT for vaccines reconciliation

• Using EHR to connect with families with asthma, ADHD, depression

• Practices have used COVID-19 time to increase outreach to asthma and ADHD patients

Status of routine vaccinations at well visits

• Practices reporting vaccines are remaining stable or actually increasing with well visits.

• Some practices have focused on vaccine visits – one to two times per week; calling patients from call service each night.

This article first appeared in the Second Quarter 2020 Edition of the Alabama Pediatrician Newsletter. See full newsletter here.

QI collaborative will focus on developmental, autism, social-emotional and maternal depression screening

Alabama’s children achieve better outcomes when challenges in infancy and toddlerhood related to development, autism, social-emotional concerns, and maternal depression are identified and addressed early on. Best Beginnings, an Alabama Child Health Improvement Alliance (ACHIA) Early Screening and Referal collaborative, will support primary care practices in 2020 to improve their current screening processes or to introduce new screenings into their workflow.

Participating practices will be encouraged to focus on one screening process during the collaborative. Online modules for all practice members will provide clinical education, and the one-hour monthly webinars, held from January through September, will allow practices to learn from one another and from Alabama-based content experts about screening processes, best practices, and quality improvement. Practices will track data over time to ensure interventions lead to improvements.

Which practices should participate?

Any practice that wants to introduce a new screen and referral process for development, autism, socialemotional, or maternal depression should consider participating in the collaborative. Likewise, your practice may want to sign up if you are interested in improving a current process, such as the following:

• Improving workflow

• Identifying new partners or strengthening connections with current partners in order to support patients with positive screens 

• Administering the correct age ASQ for patients with prematurity or who have preventive visits off schedule

• Reliably administering the screen in the preferred language

• Accurately scoring screens when answers are skipped

• Tracking referrals to close care gaps

• Training providers and staff to create a shared culture for screening

• Updating clinic policies/job descriptions to support screening process

• Switching from paper to electronic screening

• Learning from colleagues’ experiences from around the state

• Reviewing coding practices

There is no charge to participate. Additional benefits of participation include MOC Part 4, CME, and meeting PCMH re/certification requirements. Look for recruitment information coming soon to your email box. For questions or to request a registration packet, contact Linda Champion.

This article first appeared in the Third/Fourth Quarter 2019 Edition of the Alabama Pediatrician Newsletter. See full newsletter here.

The Alabama Chapter of the American Academy of Pediatrics (AAP) hosted its annual awards dinner on Saturday, Sept. 28 in Birmingham, Alabama. E. Cason Benton, M.D., FAAP, Academic General Pediatrics, was among those honored.

Dr. Benton received the Marsha Raulerson Advocacy Award. This award recognizes service to children through dedication to better policies for improved child health. The award is named in honor of Marsha Raulerson, M.D., FAAP, of Brewton, who has worked tirelessly for children in Alabama during her more than 30 years of practicing community pediatrics through consistent and effective advocacy for children’s programs and policies at the local, state and national levels. Dr. Benton states, “It is both an honor and humbling to receive an award named for Dr. Raulerson, one of my pediatric heroes. I hope to continue in her footsteps.”

May 2, 2019

The University of Alabama School of Public Health released the 2018 Asthma Collaborative Evaluation. The final evaluation incorporates surveys and interviews with participating providers, QI coaches, and Health and patients. Also available is the one page 360 summary of the collaborative.

Elizabeth Dawson, M.D., FAAP (founder of the Troy Resilience Project and Medical Director of the Charles Henderson Child Health Center in Troy) reflects upon introducing screening for ACEs (Adverse Childhood Experiences) into a practice:

“In the previous issue of The Alabama Pediatrician (First Quarter 2019) I laid out how:
• Childhood adversity changes our brains, our bodies, and even our DNA;
• Toxic stress can lead to chronic disease and poor life outcomes due to impacts on the developing brain; and;
•Early intervention is key!

What could be more fundamental to the role of a pediatrician? Yet when I discuss ACEs screening with colleagues I hear, ‘How can I add one more screen to my already busy clinic visit?’ and ‘What do I do when I find something?’ And you know what? I get that. I know adding a screen takes more than the will and interest of one provider. It necessitates practice system change as well as making community connections beyond the clinic walls.

Some practices are in a place to take full advantage of the ACEs resources highlighted in the previous newsletter. But there is another path to bringing ACEs screening to your practice: participate in the ACHIA Early Screening 2020 Collaborative! Previous collaboratives helped us at Charles Henderson Child Health to systematically introduce an online screening process while learning from Alabama experts and other practices, earning CME and Part 4 MOC, and meeting our patient-centered medical home requirements.”

More on Early Screening 2020

The ACHIA Early Screening 2020 collaborative will support practices that want to introduce a new screen or refine a current process, such as moving from paper to electronic screening. Practices will focus on one or more screens for assessing:
• Development
• Autism
• Social-emotional needs
• Maternal depression.

Over the nine-month collaborative, practice teams will select a screen (or refine a screening process), integrate the screen into workflow, develop community supports and track referrals.

Learn from Alabama experts and other practices around the state while earning CME and MOC Part 4 credit! The Chapter’s 2019 Annual Meeting & Fall Pediatric Update, set for September 27-29, 2019 in Birmingham, also has opportunities to expand understanding of ACEs and how to address these in primary care.

This article first appeared in the Second Quarter 2019 Edition of the Alabama Pediatrician Newsletter. See full newsletter here.

Adolescents are among those least likely to have access to health care, and they have the lowest rate of primary care use of any age group in the United States. The #StayWell practices are empowering adolescents to be actively engaged in their preventative health care and equip them with the knowledge and skills for a healthy transition into adulthood.

Physician Champion of the collaborative, Nola Ernest, MD, FAAP, shares why this particular collaborative is important to her as well as to pediatric offices that need to work together to provide excellent adolescent care.

What is so important about the adolescent visits that you were motivated to lead and your practice motivated to participate in this collaborative?
Whether a child is eight months, eight years, or 18 years old, he deserves access to physicians who will provide evidence-based, compassionate care. Unfortunately, whether due to discomfort or perceived lack of benefit, annual well visits tend to drop off in adolescence. This results in missed opportunities to address issues that lead to chronic disease in adulthood.

What do you think are the biggest barriers for practices around the state?
We all perceive barriers to practicing optimal adolescent medicine in our practice. These barriers include confusion around confidentiality laws, lack of a clear transition policy, discomfort with addressing sexual health issues, lack of mental health referral sources, and more.

How does participating in the ACHIA collaborative help address these barriers?
The ACHIA collaborative directly addresses some of these barriers by providing practices with access to a summary of Alabama confidentiality laws. We will also be creating and implementing transition policies for our practices. And, although not addressed directly, the ACHIA website offers CME modules regarding sexual health, mental health, and many other topics. The nine-month collaborative began in January, with most of the change ideas being rolled out March through August. Practices interested in adolescent care can visit the ACHIA website at achia.org.

This article first appeared in the First Quarter 2019 Edition of the Alabama Pediatrician Newsletter. See full newsletter here.

Three of the participating practices share what they are doing in their specific offices to promote the #StayWell collaborative.

Elizabeth Dawson, M.D., of Charles Henderson Child Health Center, shares the focus of their #StayWell adolescent collaborative--confidentiality and depression screening.

Fairhope Pediatrics encouraged adolescents to make their check-ups with a fun incentive program, which has increased their adolescent visits significantly. 

Dothan Pediatric Network, which includes Dothan Pediatric Clinic, Enterprise Pediatric Clinic, Eufaula Pediatric Clinic and Ozark Pediatric Clinic, held a contest throughout the months of June and July. Watch the video of the announcement of the winners and the amazing numbers of patients seen this summer here. 

Cason Benton, M.D., was featured in the American Board of Pediatrics 2018 Annual Report, speaking about cultivating a culture of QI. Dr. Benton was awarded the ABP 2018 Paul V. Miles (PVM) Fellowship Award. Read the entire annual report here.

By Cason Benton, MD, FAAP, Medical Director, Alabama Child Health Improvement Alliance

On November 12-13, 2018, the Alabama Child Health Improvement Alliance hosted the National Improvement Partnership Network (NIPN) Annual Meeting at the Elyton Hotel in Birmingham, Alabama to share best ideas for improving outcomes with quality improvement. Children’s of Alabama CEO Mike Warren and Mitch Cohen, M.D., FAAP, UAB Department of Pediatrics Chair, welcomed the attendees. David Gremse, M.D., FAAP, USA Department of Pediatrics Chair, introduced the keynote speaker Cathy Caldwell, Director of ALL Kids, and participated in a panel on how Alabama’s child health improvement partners work together to close care gaps. Also on the panel were Robert Moon, M.D., Alabama Medicaid; Susan Coburn, Family Voices; Melinda Davis, Children’s Rehabilitation Services; Lori Moler, Children’s of Alabama; Katrina Trammell, M.D., FAAP, Gulf Coast Health Care; and Wes Stubblefield, M.D., FAAP, AL-AAP Chapter President. One participant wrote, “We are returning home inspired…the meeting was FABULOUS and we learned so much.”

This article first appeared in the Fourth Quarter 2018 Edition of the Alabama Pediatrician Newsletter. See full newsletter here.

By Cason Benton, MD, FAAP, Medical Director, Alabama Child Health Improvement Alliance

To increase adolescent well-visit rates, collaborative practices will assess and address office “adolescent friendliness” as well as strengthen confidentiality and transition to adult care approaches. From a “return on investment” viewpoint, #StayWell meets some payor incentives, aligns with Patient-Centered Medical Home (re)certification competencies, and provides 25 points MOC IV (QI) and Continuing Medical Education/CEUs. But mostly, with Nola Ernest, MD, FAAP, as the Physician Champion, this collaborative will be fun and a great way to get the office working together to deliver excellent adolescent care. The nine-month collaborative begins in January with most of the change ideas being rolled out March through August. For questions, or to enroll now, contact Linda Champion at lchampion@alaap.org or 334-324-9307

This article first appeared in the Fourth Quarter 2018 Edition of the Alabama Pediatrician Newsletter.

 See full newsletter here.

By Cason Benton, M.D., FAAP, Medical Director, Alabama Child Health Improvement Alliance

As announced earlier this summer, the Alabama Child Health Improvement Alliance’s (ACHIA) 2019 Collaborative #Stay Well: An Adolescent Well Visit Learning Collaborative, will kick off in January and run through September 2019.

This quality improvement collaborative will focus on increasing adolescent well visit rates and clarifying practice consent, confidentiality, and transition policies. In addition, practices will have the opportunities to track optional adolescent measures.

“Pediatricians offer adolescents guidance through potentially turbulent times, however, teens have low annual visits. What can we do to increase adolescent well visit rates? That is what we will tackle in this learning collaborative,” said Nola Ernest, MD, FAAP, #StayWell physician champion and pediatrician with Enterprise Pediatric Clinic.

Here are the top 10 reasons you should participate!
10. Teens are fun to have around...Really!
9. Dr. Preud’Homme, our content expert, and Dr. Ernest, our physician champion, are a hoot!
8. New this year: CME available at the Chapter’s Annual Meeting & Fall Pediatric Update or through online web modules.
7. Simplify your patient-centered medical home applications and renewals with #Stay Well’s emphasis on transition of care
6. You can tailor your experience with optional measures--such as increasing vaccination rates or screening for depression.
5. Upcoming Medicaid changes in patient panel attribution and incentives favor increased adolescent visit rates.
4. Practice improvements occur during the spring and summer, outside of the busy winter months.
3. You will obtain MOC Part IV while improving teen care!
2. You’ll be assured that everyone in your practice will be able to navigate consent and confidentiality.
1. #Stay Well is a fun way to be sure your practice’s teens are receiving the very best care.

Email Linda Champion at lchampion@alaap.org to register and for more information!

This article first appeared in the Third Quarter 2018 Edition of the Alabama Pediatrician Newsletter.

See full newsletter here.

In March, the Chapter leadership learned that the Alabama Department of Public Health had reached out to school superintendents, encouraging the administration of adolescent vaccinations – Tdap, Meningococcal and HPV – via vaccine clinics carried out in schools (much like the flu vaccination clinics already administered). The Chapter leadership immediately responded with a letter and a face-to-face meeting with the State Health Officer to underscore the importance of the medical home and comprehensive well visits for adolescents.

In late March/early April, the Chapter was also able to successfully advocate that the Governor not sign a legislative resolution that encourages school-based vaccination so that there would not be any legislative mandates on the table.

Meanwhile, ADPH Immunization’s current goal is to increase state adolescent rates, especially for HPV. The current rate of up-to-date HPV vaccination in Alabama is 18 percent and overall, the adolescent rate is 19 percent. The Chapter subsequently met with ADPH representatives, Department of Education staff and those representing mass school vaccinators to sort through ways to encourage the medical home and increase vaccination rates at the same time. Although it was clear that vaccination of adolescents in schools will move forward as part of the mix to increase vaccination rates, Chapter leaders were able to drive home the importance of protecting the medical home and the need for communication between primary care pediatricians and the schools if vaccines are administered outside of the medical home. Chapter Executive Director will be working with ADPH on the details of this communication. It’s important to note here that for VFC providers, point-of-service use of ImmPRINT for all vaccines is now required, with ADPH planning to require it for all providers soon.

Partners at the meetings also agreed to push out information to parents and teens on the importance of seeing their doctor throughout adolescence.

To that end, the Chapter is working with the Alabama Child Health Improvement Alliance (ACHIA) and adolescent pediatricians at UAB on a statewide flier for teens/ parents that simply states why the adolescent teen visit is so important. The flier will be part of a larger campaign, for which the Chapter hopes to partner with ADPH, that will parallel ACHIA’s 2019 quality improvement collaborative on the adolescent visit. The name for both: #StayWell!

Also as part of this initiative, the Chapter is exploring advocacy for the medical home among students who play sports and only receive the required sports physical, which we maintain, is not a substitute for comprehensive adolescent care.

This article first appeared in the Second Quarter 2018 Edition of the Alabama Pediatrician Newsletter. See full newsletter here.

By Cason Benton, M.D., FAAP, Medical Director, Alabama Child Health Improvement Alliance

Pediatricians offer adolescents guidance through potentially turbulent times, however, teens have low annual visits. What can offices do to increase adolescent well visit rates? That is the question tackled in the Alabama Child Health Improvement Alliance’s (ACHIA) 2019 Collaborative #Stay Well: An Adolescent Well Visit Learning Collaborative.

Join Nola Earnest, M.D., FAAP, #StayWell physician champion and pediatrician with Enterprise Pediatric Clinic (check out her twitter feed @Alabama KidDoc), and Daniel Preud’homme, M.D., FAAP, Director of Adolescent Medicine and Pediatric Healthy Life Center at the University of South Alabama, for a January-September 2019 quality improvement collaborative that:
• fits into a practice’s daily routine
• improves patient outcomes
• improves the practice’s bottom line, and
• provides CME/CEU and 25 Part IV Maintenance of Certification points.

The collaborative will review preventive care recommendations as well as how to navigate thorny issues of consent and confidentiality. Practices may also select optional focus areas – screening for depression, healthy active living, screening for sexually transmitted infections, immunizations, or family planning. New this year: #StayWell CME educational content may be completed at the Alabama Chapter- AAP Fall meeting or online. 

Questions? Contact Cason Benton, MD, FAAP, ACHIA Medical Director, at cbenton@peds.uab.edu.

This article first appeared in the Second Quarter 2018 Edition of the Alabama Pediatrician Newsletter.

See full newsletter here.

The 2018 National Improvement Partnership Network (NIPN) Annual Meeting will be hosted by ACHIA (Alabama Child Health Improvement Alliance) in Birmingham, Alabama, November 12-13. 

The meeting on November 12 will be from 8:00 a.m. to 4:15 p.m. and the meeting on November 13 will be from 8:00 a.m. to 3:00 p.m. 

Click here to download the Save the Date 

Click here for more information on the meeting

Elizabeth (Cason) Benton, M.D., has received the 2018 Paul V. Miles Fellowship Award from the American Board of Pediatrics, an honor that highlights a pediatrician who is dedicated to improving the quality of health care for children.

An associate professor in UAB’s Department of Pediatrics, Benton is the founding director of the Alabama Child Health Improvement Alliance and also sees patients at the UAB Primary Care Clinic located at Children’s of Alabama. Her interest focus is in quality improvement in children, and she has helped lead the development of quality improvement initiatives at UAB and across the state of Alabama.

Specifically, with the Alabama Child Health Improvement Alliance, Benton has developed and led five quality improvement collaboratives across the state regarding obesity treatment and prevention, screening for developmental delay, autism, social emotional issues, and preventing HPV-related cancers.  

Read original press release from UAB News here

“Which measures should primary care practices prioritize in the next five years to improve health outcomes for children and youth?”

To answer that question, ACHIA’s partners, including UAB and Children's of Alabama, weighed the impact and feasibility of more than 100 health measures during a year-long process guided by the UAB School of Public Health. 

From the measures list, three were determined to provide the best opportunities for improvement:

• Asthma

• Adolescent Well Child Visits

• Developmental Screening

ACHIA’s 2018-2020 quality improvement learning collaboratives will tackle these topics. The collaboratives incorporate the Model for Improvement, run over 9 months and provide Part 4 MOC and CME.  Practices complete online modules taught by Alabama experts; benefit from QI coaching; and share best practices with one another on monthly webinars.

Interested in partnering with ACHIA to work with engaged practices on these health topics? 

Contact Cason Benton, MD, FAAP cbenton@peds.uab.edu.

Interested in participating in the 2018 Asthma collaborative?

Contact Linda Champion, lchampion@alaap.org.

More information on Continuous Quality Improgement Collaborative: 

2016 QSORT Final Report

2017 CQIC Members

2017 CQI Impact/Feasibility Template

2017 CQI Four Quadrant Prioritization

The Alabama Child Health Improvement Alliance (ACHIA) is enrolling practices in a learning collaborative to improve screening and referrals for children at risk of delays, autism, and behavioral concerns.

Which practices should enroll?

• Practices that want to start screening.

• Practices that want to increase screening consistency.

• Practices that want to switch screens from a paper to an electronic format.

While only 25 percent of Alabama’s children are appropriately screened for developmental delay, 11 practices from across the state tripled developmental screening to 96 percent and nearly doubled autism screening to 91 percent over the course of a nine month quality improvement learning collaborative lead by the Alabama Child Health Improvement Alliance (ACHIA). Moreover, these practices reliably referred at-risk children to further evaluations and support such as Early Intervention and Help Me Grow. Practices in the Tuscaloosa area incorporated social-emotional screening to link children in need with behavioral resources piloted by Project LAUNCH. UAB staff involved in the ACHIA collaborative included: Myriam Peralta-Carcelen, M.D., FAAP, collaborative content expert; Justin Schwartz, M.D., FAAP,  guest speaker; and Cason Benton, M.D., FAAP was the course director and QI coach.

Click here for an overview of the collaborative.

Every continuous quality improvement collaborative has a story.  The Alabama Child Health Improvement Alliance (ACHIA) has developed a one-page “360” to quickly tell the improvement story for its Healthy Active Living and Help Me Grow Alabama collaboratives:  why the topic is important, who participated, what improved, as well as lessons learned.  Check them out here and here!

- “The Big Sort”:  All health issues for children are important—but what are the most critical issues for Alabama child healthcare providers to prioritize in the next few years?  Asthma? ADHD? Screening for delay? The University of Alabama at Birmingham School of Public Health is leading ACHIA partners and others interested in child health in a process to sort and prioritize health topics.  The results will be used to channel energies for future ACHIA collaboratives and other continuous quality improvement endeavors.  At the Chapter’s Spring Meeting at the end of April, we will present more information about the sort process and how members can participate.

As part of its ongoing efforts to serve as a leader in cancer prevention and control, the UAB Comprehensive Cancer Center has led the establishment of a coalition of organizations from across Alabama to address barriers and improve human papilloma virus vaccination rates in the state. Alabama Child Health Improvement Alliance (ACHIA) is a proud participant of this coalition. 

“It is critical for us to understand the barriers to HPV vaccination so that we can implement concrete strategies to promote access, acceptability and uptake of HPV vaccination,” said Isabel Scarinci, Ph.D., MPH, professor in the UAB Division of Preventive Medicine and associate director of Globalization and Cancer at the UAB Comprehensive Cancer Center. “We have a great coalition with dedicated professionals who are truly committed to the elimination of this cancer among women in the United States and in Alabama.”

Organizations participating in the coalition include the Alabama Chapter of the American Cancer Society, American Academy of Pediatrics-Alabama Chapter, Alabama Department of Public Health Immunization Division, Alabama Comprehensive Cancer Coalition, Alabama Breast and Cervical Cancer Early Detection Program, Alabama Vaccines for Children Program, Alabama Medicaid Agency, Alabama Pharmacy Association, Alabama Child Health Improvement Alliance, Area Health Education Center-Alabama Chapter, and researchers from both UAB and the Mitchell Cancer Institute. The coalition has also counted on the support of the Immunization Services Division at the Centers for Disease Control and Prevention.

“As a leader in cancer care in the southeastern United States, we are committed to making progress with an aggressive effort so we can achieve the best results,” Scarinci said. By coming together, coalition members have had the opportunity to share their initiatives, integrate efforts and establish a roadmap to achieve their goal of increasing use of the HPV vaccination. The UAB Cancer Center has long been a proponent of the HPV vaccine, recently joining all 69 of the nation’s top cancer centers to issue a statement in support of HPV vaccination as an effective cancer-prevention strategy.

To read the original press release, click here. 

What are the health care areas most important for practices providing care to Alabama’s children and adolescents to improve in the next 3-5 years?  That is the question ACHIA’s partners and guests will tackle at the Alabama Q-Sort on July 27, 2016. 

Should providers improve: the number of children being seen for well child visits? asthma care? obesity prevention and treatment? adolescent depression screening? Screening for developmental delays? delivery of HPV and other vaccinations?  or perhaps some other area? 

Through a Q-Sort of Quality measures lead by the University of Alabama School of Public Health, ACHIA partners and guests will assess which of these topics have the greatest need and the greatest ability to be improved at the practice level in the next few years.  The results will be reported out in Fall 2016 and will provide the foundation for ACHIA to marshal resources to support practices around the state as they tackle continuous quality improvement.

If you would like more information about the Alabama Q-sort, please contact Cason Benton.

The Alabama Child Health Improvement Alliance (ACHIA) recently published its first newsletter. Click here to read about current quality improvement initiatives, collaborative outcomes and more. This edition highlights pediatricians and family physicians across Alabama decreasing their patients’ risk of Human Papilloma Virus (HPV) related cancers through the Prevent HPV Cancers Today! collaborative, as well as, the Healthy Active Living (HAL) collaborative and Help Me Grow Alabama. Check it out!

The Alabama Child Health Improvement Alliance, in partnership with the University of Alabama at Birmingham Division of eLearning and Professional Studies and the UAB Division of Continuing Medical Education, has become the first organization in Alabama to offer performance improvement continuing medical education for exclusively practice-based physicians through its current developmental screening project, Help Me Grow/Project LAUNCH.

Unlike CME lectures, PI CME-approved activities are based on a learner’s participation in a three-stage project in which a physician: identifies an education need through a measure of his or her performance in practice, engages in education experiences to meet the need, integrates learning into patient care, and re-evaluates his or her performance.

ACHIA, which helps pediatric providers improve child health quality, recently developed an online quality improvement, or QI, collaborative that allows practice-based pediatricians and their nursing staffs to earn 20 CME credits as they abstract and review data, hold practice QI meetings, perform PI activities, and make sustainable practice changes to increase rates of developmental screening and referral of children with developmental delays.

UAB Department of Pediatrics Division of General Pediatrics

“Providing pediatricians and other physicians with this meaningful type of education as they work in their day-to-day practices is very rewarding,” Benton said. “We look forward to the possibilities that lie ahead as we apply it to the other project work.”

Click the links to read the article on UAB Newsor AL.com.

With a goal of aligning Alabama child health quality improvement initiatives under one sustainable umbrella, ten Alabama organizations have collaborated to establish a formal state child health improvement partnership (IP), the Alabama Child Health Improvement Alliance (ACHIA), which was accepted last month as a member of the National Improvement Partnership Network.

“In order to improve health outcomes for Alabama children, there is a need for a public-private child health improvement partnership that builds on existing efforts to provide quality child health care and brings in key partners such as universities, health care providers, health systems, government agencies, children’s advocacy groups, and health plans,” said Wes Stubblefield, MD, FAAP, Quality Improvement Chair for the Alabama Chapter-American Academy of Pediatrics (ALAAP).

ACHIA was formed in late 2013, when ALAAP brought together key partners from Children’s of Alabama, University of South Alabama, University of Alabama at Birmingham (UAB), Alabama Medicaid Agency, the Children’s Health Insurance Program, the Alabama Department of Public Health, and others.

Since January, the UAB Department of Pediatrics Division of General Pediatrics has served as ACHIA’s administrative home.

“Our mission is to coordinate data-driven quality measurement and improvement across the state and support evidence-guided quality activities in clinical practices,” said Cason Benton, MD, FAAP, associate professor of pediatrics, who directs ACHIA.  “We are very excited about the future.”

Improvement partnerships (IPs) are a growing phenomenon across the country, with public health, Medicaid, professional organizations, and academic centers serving as core partners in the 20 state IPs that have been established over the past 13 years to assist primary care providers and their practices in improving care delivery in a changing healthcare environment.

Click the links to read the article on AL.com or Children's of Alabama.