• Developmental Screening, Vermonters Aged 1-3, 2015-2022 (PDF)
• Mental Health Prevalence, Vermonters Aged 0-21, 2022 (PDF)
• Mental Health by County, Vermonters Aged 0-21, 2022 (PDF)
• Attribution to Primary Care, Vermonters Aged 0-26, 2022 (PDF
• Well-Care Visits, Vermonters Aged 0-26, 2022 (PDF)

Purpose

Evidence that fewer children are being seen at family physician practices has not been confirmed using population-level data. This study examines the proportion of children seen at family physician and pediatrician practices over time and the influence of patient demographics and rurality on this trend.

Methods

We conducted a retrospective longitudinal analysis of Vermont all-payer claims (2009-2016) for children aged 0 to 21 years. The sample included more than 185,000 children with 2 or more claims over 8 years. Generalized estimating equations modeled the outcome of child attribution to a family physician practice annually, with covariates for calendar year, child age, sex, insurance, and child Rural Urban Commuting Area (RUCA) category.

Results

Over time, controlling for other covariates, children were 5% less likely to be attributed to a FP practice (P <.001). Children had greater odds of attribution to a family physician practice as they aged (odds ratio (OR) = 1.11, 95% CI, 1.10-1.11), if they were female (OR = 1.05, 95% CI, 1.03-1.07) or had Medicaid (OR = 1.09, 95% CI, 1.07-1.10). Compared with urban children, those from large rural cities (OR = 1.54, 95% CI, 1.51-1.57), small rural towns (OR = 1.45, 95% CI, 1.42-1.48), or isolated/small rural towns (OR = 1.96, 95% CI, 1.93-2.00) had greater odds of family physician attribution. When stratified by RUCA, however, children had 3% lower odds of attending a family physician practice in urban areas and 8% lower odds in isolated/small rural towns.

Conclusion

The declining proportion of children attending family physician practices, confirmed in this population-based analysis and more pronounced in rural areas, represents a continuing challenge. Our analysis confirmed the temporal trend from family physician to pediatrician practices noted in survey studies, and suggested a new finding related to an enhanced trend toward pediatrician practices among children living in rural areas. This will need to be confirmed by research in other settings.

Citation

Wasserman RC, Varni SE, Hollander MC, Harder VS. Change in Site of Children's Primary Care: A Longitudinal Population-Based Analysis. Ann Fam Med. 2019;17(5):390-395. doi:10.1370/afm.2416

Journal Article

Change in Site of Children’s Primary Care: A Longitudinal Population-Based Analysis | Annals of Family Medicine (annfammed.org)
 

Purpose

Quality improvement (QI) efforts can improve guideline-recommended asthma care processes in the pediatric office setting. We sought to assess whether practice participation in an asthma QI collaborative was associated with decreased asthma-related emergency department (ED) visits.

Method

A statewide network of practices participated in a pediatric asthma QI collaborative from 2015 to 2016. We evaluated asthma-related ED visit rates per 100 child-years for children ages 3 to 21 years with asthma, using the state’s all-payer claims database. We used a difference-in-differences approach, with mixed-effects negative binomial regression models to control for practice and patient covariates. Our main analysis measured the outcome before (2014) and after (2017) the QI collaborative at fully participating and control practices. Additional analyses assessed (1) associations during the intervention period (2016) and (2) associations including practices partially participating in QI collaborative activities.

Results

In the postintervention year (2017), participating practices’ (n = 20) asthma-related ED visit rate decreased by 5.8 per 100 child-years, compared to an increase of 1.8 per 100 child-years for control practices (n = 15; difference in differences = −7.3; P = .002). Within the intervention year (2016), we found no statistically significant differences in asthma-related ED visit rates compared to controls (difference in differences = −4.3; P = .17). The analysis including partially participating practices yielded similar results and inferences to our main analysis.

Conclusions

Participation in an asthma-focused QI collaborative was associated with decreased asthma-related ED visit rates. For those considering implementing this type of QI collaborative, our findings indicate that it takes time to see measurable improvements in ED visit rates. Further study is warranted regarding QI elements contributing to success for partial participants.

Citation

Harder VS, Shaw JS, McCulloch CE, Kill L, Robinson KJ, Shepard MT, Cabana MD, Bardach NS. Statewide Asthma Learning Collaborative Participation and Asthma-Related Emergency Department Use. Pediatrics. 2020;146 (6) e20200213. doi: 10.1542/peds.2020-0213

Journal Article

Official Journal of the American Academy of Pediatrics: Statewide Asthma Learning Collaborative Participation and Asthma-Related Emergency Department Use

Abstracts

Abstract presented at Pediatric Academic Society meeting, May 2018 (PDF)

Testing a new AHRQ pediatric asthma measure: Emergency department visit rates among children with asthma following a QI learning collaborative (PDF)

Purpose

To investigate the association between adolescent and young adult (AYA) well-care visits and emergency department (ED) utilization.

Methods

Vermont's all-payer claims data were used to evaluate visits for 49,089 AYAs (aged 12-21 years) with a health-care claim from January 1 through December 31, 2018. We performed multiple logistic regression analyses to determine the association between well-care visits and ED utilization, investigating potential moderating effects of age, insurance type, and medical complexity.

Results

Nearly half (49%) of AYAs who engaged with the health-care system did not attend a well-care visit in 2018. AYAs who did not attend a well-care visit had 24% greater odds (95% confidence interval [CI]: 1.19–1.30) of going to the ED at least once in 2018, controlling for age, sex, insurance type, and medical complexity. Older age, female sex, Medicaid insurance, and greater medical complexity independently predicted greater ED utilization in the adjusted model. In stratified analyses, late adolescents and young adults (aged 18-21 years) who did not attend a well-care visit had 47% greater odds (95% CI: 1.37 - 1.58) of ED visits, middle adolescents (aged 15-17 years) had 9% greater odds (95% CI: 1.01–1.18), and early adolescents (aged 12-14 years) had 16% greater odds (95% CI: 1.06 - 1.26).

Conclusions

Not attending well-care visits is associated with greater ED utilization among AYAs engaged in health care. Focus on key quality performance metrics such as well-care visit attendance, especially for 18- to 21-year-olds during their transition to adult health care, may help reduce ED utilization.

Citation

Holland JE, Varni SE, Pulcini CD, Simon TD, Harder VS. Assessing the Relationship Between Well-Care Visit and Emergency Department Utilization Among Adolescents and Young Adults. Journal of Adolescent Health. 2022;70(1) 64-69. doi:10.1016/j.jadohealth.2021.08.011

Journal Article

Assessing the Relationship Between Well-Care Visit and Emergency Department Utilization Among Adolescents and Young Adults (PDF)

Editorial

Emergency Department Use in Adolescents and Young Adults: The Role of the Well-care Visit

Objective

Characterize the prevalence of chronic physical illness types and mental illness and their comorbidity among adolescents and young adults (AYA) and assess the association of comorbidity on hospital utilization.

Methods

This study features a population-level sample of 61 339 insurance-eligible AYA with an analytic sample of 49 089 AYA (aged 12-21) in Vermont's 2018 all-payer database. We used multiple logistic regressions to examine the associations between physical illness types and comorbid mental illness and emergency department (ED) use and inpatient hospitalization.

Results

The analytic sample was 50% female, 63% Medicaid, and 43% had ≥1 chronic illness. Mental illness was common (31%) and highly comorbid with multiple physical illnesses. Among AYA with pulmonary illness, those with comorbid mental illness had 1.74-times greater odds (95% confidence interval [CI]: 1.49-2.05, P ≤.0005) of ED use and 2.9-times greater odds (95% CI: 2.05-4.00, P ≤.0005) of hospitalization than those without mental illness. Similarly, comorbid endocrine and mental illness had 1.84-times greater odds of ED use (95% CI: 1.39-2.44, P ≤.0005) and 2.1-times greater odds of hospitalization (95% CI: 1.28-3.46, P = .003), comorbid neurologic and mental illness had 1.36-times greater odds of ED use (95% CI: 1.18-1.56, P ≤.0005) and 2.4-times greater odds of hospitalization (95% CI: 1.73-3.29, P ≤.0005), and comorbid musculoskeletal and mental illness had 1.38-times greater odds of ED use (95% CI: 1.02-1.86, P = .04) and 2.1-times greater odds of hospitalization (95% CI: 1.20-3.52, P = .01).

Conclusions

Comorbid physical and mental illness was common. Having a comorbid mental illness was associated with greater ED and inpatient hospital utilization across multiple physical illness types. 

Journal Article

Associations Between Mental and Physical Illness Comorbidity and Hospital Utilization | Hospital Pediatrics | American Academy of Pediatrics (aap.org)

Abstract

Associations Between Mental and Physical Illness Comorbidity and Hospital Utilization Among Adolescents and Young Adults (PDF)

Citation

Holland JE, Rettew DC, Varni SE, Harder VS. Associations between mental and physical illness comorbidity and hospital utilization. Hospital Pediatrics. 2023;13(9) 841-848; doi:10.1542/hpeds.2022-00698

Purpose

Depression among adolescents is a leading public health problem. Although screening for adolescent depression in primary care is strongly recommended, screening rates remain low. Effective quality improvement (QI) initiatives can facilitate change. This study aims to assess the impact of a QI learning collaborative on adolescent depression screening and initial plans of care in primary care.

Methods

Seventeen pediatric-serving practices in Vermont participated in a QI learning collaborative aimed at improving practitioner knowledge and office systems around adolescent depression screening. Monthly medical record reviews provided monitoring of adolescent depression screening and initial plans of care over 7 months for QI. Randomly sampled annual medical record review data allowed comparison of screening and initial plans of care after the QI learning collaborative between participating and 21 control practices.

Results

As practices improved their office systems around adolescent depression screening and initial plans of care, data showed marked improvement in depression screening at all 17 practices, from 34% to 97% over 7 months. Adolescents at participating practices had 3.5 times greater odds (95% confidence interval [CI], 1.14–10.98, P = .03) of being screened for depression and 37.5 times greater odds (95% CI, 7.67–183.48, P < .0005) of being screened with a validated tool than adolescents at control practices, accounting for patient characteristics.

Conclusions

There were significant within practice increases in adolescent depression screening after a QI learning collaborative, as well as in comparison with control practices 1 year later.

Citation

Harder VS., Barry SE., French S, Consigli AB, Frankowski BL. Improving Adolescent Depression Screening in Pediatric Primary Care. Academic Pediatrics. 2019;19(8), 925-933. doi:10.1016/j.acap.2019.02.014

Journal Article

Improving Adolescent Depression Screening in Pediatric Primary Care

Purpose

Pediatric asthma is a common, relapsing-remitting, chronic inflammatory airway disease that when uncontrolled often leads to substantial patient and health care system burden. Improving management of asthma in primary care can help patients stay well controlled.

Methods

The Vermont Child Health Improvement Program (VCHIP) developed a quality improvement (QI) learning collaborative with a primary objective to improve clinical asthma management measures through improvement in primary care office systems to support asthma care. Seven months of medical record review data were evaluated for improvements on eight clinical asthma management measures. Pre and post office systems inventory (OSI) self-assessments detailing adherence to improvement strategies were analyzed for improvement. Logistic regressions were used to test for associations between OSI strategy post scores and the corresponding clinical asthma management measures by month seven.

Results

This study found significant improvement from baseline to month seven on seven of the eight clinical asthma management measures and between pre and post OSI for seven of the nine strategies assessed (N = 19 practices). Additionally, one point higher average OSI scores on the assessment and monitoring of asthma severity, asthma control, asthma action plans, and asthma education strategies were associated with significantly greater odds of improvement in their respective clinical asthma management measures.

Conclusions

A QI learning collaborative approach in primary care can improve office systems and corresponding clinical management measures for pediatric patients with asthma. This suggests that linking specific office systems strategies to clinical measures may be a helpful tactic within the learning collaborative model.

Citation

Weinberger SJ, Cowan KJ, Robinson KJ, Pellegrino CA, Frankowski BL, Chmielewski MV, Shaw JS, Harder VS. A primary care learning collaborative to improve office systems and clinical management of pediatric asthma. Journal of Asthma. 2018, 395-404. doi:10.1080/02770903.2019.1702199

Journal Article

A primary care learning collaborative to improve office systems and clinical management of pediatric asthma

Objectives

Despite the proven benefits of immunizations, coverage remains low in many states, including Vermont. This study measured the impact of a quality improvement (QI) project on immunization coverage in childhood, school-age, and adolescent groups.

Methods

In 2013, a total of 20 primary care practices completed a 7-month QI project aimed to increase immunization coverage among early childhood (29-33 months), school-age (6 years), and adolescent (13 years) age groups. For this study, we examined random cross-sectional medical record reviews from 12 of the 20 practices within each age group in 2012, 2013, and 2014 to measure improvement in immunization coverage over time using chi-squared tests. We repeated these analyses on population-level data from Vermont's immunization registry for the 12 practices in each age group each year. We used difference-in-differences regressions in the immunization registry data to compare improvements over time between the 12 practices and those not participating in QI.

Results

Immunization coverage increased over 3 years for all ages and all immunization series (P ≤ .009) except one, as measured by medical record review. Registry results aligned partially with medical record review with increases in early childhood and adolescent series over time (P ≤ .012). Notably, the adolescent immunization series completion, including human papillomavirus, increased more than in the comparison practices (P = .037).

Conclusions

Medical record review indicated that QI efforts led to increases in immunization coverage in pediatric primary care. Results were partially validated in the immunization registry particularly among early childhood and adolescent groups, with a population-level impact of the intervention among adolescents.

Citation

Harder VS, Barry SE, Ahrens B, Davis WS, Shaw JS. Quality Improvement to Immunization Coverage in Primary Care Measured in Medical Record and Population-Based Registry Data. Academic Pediatrics. 2018;18(4):437-444. doi: 10.1016/j.acap.2018.01.012

Journal Article

Quality Improvement to Immunization Coverage in Primary Care Measured in Medical Record and Population-Based Registry Data

Objective

Although clinical trials demonstrate the efficacy of quality improvement outreach in improving service delivery, evidence for broad community effectiveness has been lacking. The objective of this study was to test the effectiveness of a statewide pediatric quality improvement outreach program in improving preventive services for children who are younger than 5 years.

Methods

All pediatric practices in Vermont (n = 35) were invited to participate in a preventive services quality improvement initiative. Ninety-one percent agreed. Participating practices serve >80% of all Vermont children who are younger than 5 years. The main outcome measured was change in 9 preventive services areas: (1) immunizations up to date; (2) anemia screening; (3) tuberculosis risk assessment and indicated screening; (4) lead screening; (5) infant sleep position counseling; (6) environmental tobacco smoke-exposure risk assessment; (7) blood pressure screening; (8) vision screening; and (9) dental risk assessment.

Results

All practices demonstrated improvement in 1 or more preventive services areas. The mean number of areas chosen was 5 (range: 1-9). Practices that selected a specific preventive service area as a quality improvement goal were more likely to demonstrate improvement in that area than practices that did not choose to focus on that preventive services area.

Conclusions

The work in this project has provided the evidence for an effective statewide pediatric quality improvement outreach program to improve preventive services for children who are younger than 5 years. Practices' decision to focus on a specific preventive service area as a quality improvement goal seems necessary for improvement in that area. This approach may be effective in other states or regions.

Citation

Shaw JS, Wasserman RC, Barry S, Delaney T, Duncan P, Davis W, Berry P. Statewide quality improvement outreach improves preventive services for young children. Pediatrics. 2006;118(4):e1039-47. doi: 10.1542/peds.2005-2699.

Journal Article

Statewide quality improvement outreach improves preventive services for young children - PubMed (nih.gov)

 Statewide Quality Improvement Outreach Improves Preventive Services for Young Children (PDF)

Abstract

As the COVID-19 pandemic highlighted gaps in meeting adolescent behavioral health needs, primary care providers (PCPs) were a locus for interventions to address adolescent mental health and substance use concerns. Strength-based approaches may support PCP promotion of positive behavioral health in adolescents, but competing priorities or other factors may inhibit their use. We analyzed health record review data from 31 primary care practices to assess utilization of strength-based approaches during the health supervision visit (HSV) for adolescents with and without behavioral health concerns. We found that most had strengths identified (78%) or well-being topics addressed (83%). However, adolescents screening positive for depression were 40% less likely to have strengths identified, whereas those screening positive for anxiety or substance use were 89% and 163%, respectively, more likely to have well-being topics addressed. Primary care providers may need support for integrating strength-based approaches when managing adolescents screening positive for depression.

Journal Article

Assessing Strengths and Well-Being in Primary Care for Adolescents With Mental Health and Substance Use Concerns (journals.sagepub.com)

Citation

Singh D, Schumacher HK, Pellegrino CA, Holmes BW, Garfield RL, Harder VS. Assessing strengths and well-being in primary care for adolescents with mental health and substance use concerns. Clinical Pediatrics. 2024;64(3):340-347. doi:10.1177/00099228241264769

Purpose

Students in Vermont with incomplete or undocumented immunization status are provisionally admitted to schools and historically had a calendar year to resolve their immunization status. The process of resolving these students’ immunization status was challenging for school nurses.

Methods

The Vermont Child Health Improvement Program (VCHIP) conducted a school-based quality improvement effort to increase student compliance with Vermont immunization regulations using a collaborative learning approach with public health school liaisons and school nurses from public schools to reduce provisional admittance in 2011–2012. Strategies included using a tracking system, accessing the immunization registry, promoting immunization importance, tracking immunization plans, and working with medical homes to update records.

Results

Participating school nurses observed decreases in the number of provisionally admitted students, although this reduction was not significantly different than matched comparison schools. We also found the number of provisionally admitted students fluctuated throughout the year and resolving the immunization status of New Americans and exchange students required special attention.

Conclusions

Our approach supports the coordinated school health model and demonstrates the critical role school nurses play in improving population health outcomes.

Citation

Davis WS, Varni SE, Barry SE, Frankowski BL, Harder VS. Increasing Immunization Compliance by Reducing Provisional Admittance. The Journal of School Nursing. 2016;32(4):246-257. doi:10.1177/1059840515622528

Journal Article

Increasing Immunization Compliance by Reducing Provisional Admittance (sagepub.com)

Purpose

Health care reform in Vermont promotes patient-centered medical homes (PCMH) and multi-disciplinary community health teams to support population health.

Methods

This qualitative study describes the expansion of Vermont's health care reform efforts, initially focused on adult primary care, to pediatrics through interviews with project managers and facilitators, CHT members, pediatric practitioners and care coordinators, and community-based providers.

Results

Respondents shared three main challenges with health care reform efforts: achieving PCMH recognition, adapting community health teams for pediatric patients and families, and defining roles for care coordinators.

Conclusions

For health care reform efforts to support pediatric patients and be family-centered, states may need additional resources to understand how pediatric and adult primary care differ and how best to support pediatrics during health care reform efforts.

Citation

Shaw JS, Varni SE, Tolmie EC, Mohlman MK, Harder VS. Successful Integration of Pediatrics into State Health Care Reform Efforts. Journal of Pediatric Health Care. 2018;32(1) e1-e8. doi:10.1016/j.pedhc.2017.07.008

Journal Article

Successful Integration of Pediatrics Into State Health Care Reform Efforts - ScienceDirect

Purpose

Health care reform efforts often begin by focusing on conditions and processes specific to adult patients, and this focus can result in challenges for pediatric-serving practitioners to meet required improvements. One example was the Patient-Centered Medical Home (PCMH) transformation effort following the National Committee for Quality Assurance (NCQA) guidelines.  

Realizing the potential challenges to be faced by pediatric practices, the Vermont Child Health Improvement Program (VCHIP) and the Department of Vermont Health Access (DVHA) of the State of Vermont partnered together to support pediatric-informed facilitators to help pediatric practices during PCMH transformation.

Methods

This study characterizes the impact of pediatric-informed facilitators, provides benchmark data on NCQA scores, number of facilitation meetings and the time between facilitation start and end, and compares pediatric and adult-serving practices.

Results

This study found no difference between pediatric and matched adult-serving practices in NCQA score, number of facilitation meetings, or weeks to NCQA scoring.

Conclusion

These results suggest that pediatric-informed facilitators can help pediatric practices achieve NCQA PCMH recognition on par with practices serving adult patients. Supporting primary care practices with specialty-informed facilitators can assist integration into health care reform efforts.

Citation

Harder VS, Long WE, Varni SE, Samuelson J, Shaw JS. Pediatric-Informed Facilitation of Patient-Centered Medical Home Transformation. Clinical Pediatrics. 2017;56(6):564-570. doi:10.1177/0009922816669788

Journal Article

Pediatric-Informed Facilitation of Patient-Centered Medical Home Transformation (sagepub.com)

Introduction

Patient experience, 1 of 3 aims for improving health care, is rarely included in studies of patient-centered medical home (PCMH) transformation. This study examines the association between patient experience and National Committee on Quality Assurance (NCQA) PCMH transformation.

Methods

This was a cross-sectional study of parent-reported child patient experience from PCMH and non-PCMH practices. It used randomly sampled experience surveys completed by 2599 patients at 29 pediatric and family medicine PCMH (n = 21) and non-PCMH (n = 8) practices in Vermont from 2011 to 2013. Patient experiences related to child development and prevention were assessed using the Consumer Assessment of Health care Providers and Systems (CAHPS).

Results

A 10-point increase in NCQA score at PCMH practices is associated with a 3.1% higher CAHPS child prevention score (P = .004). Among pediatric practices, PCMH recognition is associated with 7.7% (P < .0005) and 7.2% (P < .0005) higher CAHPS child development and prevention composite scores, respectively. Among family medicine practices, PCMH recognition is associated with 7.4% (P = .001) and 11.0% (P < .0005) lower CAHPS child development and prevention composite scores, respectively.

Conclusions

Our results suggest that PCMH recognition may improve child patient experience at pediatric practices and worsen experience at family medicine practices. These findings warrant further investigation into the differential influence of NCQA PCMH transformation on family medicine and pediatric practices.

Citation

Harder VS, Krulewitz J, Jones C, Wasserman RC, Shaw JS.  Effects of Patient-centered Medical Home Transformation on Child Patient Experience. Journal of the American Board of Family Medicine. 2014: 29(1) 60-68. doi:10.3122/jabfm.2016.01.150066 

Journal Article

Effects of Patient-centered Medical Home Transformation on Child Patient Experience | American Board of Family Medicine (jabfm.org)

Abstract

The rate of drug overdose deaths in the U.S. increased more than three-fold since 1999, with more than two-thirds of overdose deaths in 2016 related to opioids and opiates. In July, 2016, Maine enacted new opioid prescribing restrictions. One year later, in July 2017, Vermont did the same. These policies in Vermont and Maine put major restrictions on prescription opioid amount and duration.

Our overall objective of this research project was to quantify the impact of opioid prescribing policies on opioid overdoses and related events. Our Specific Aims were:

1. Measure the impact of opioid prescribing policies on hospital utilization (Emergency Department and Inpatient) due to opioid overdose and opioid-related adverse effects
2. Identify patient-level clinical predictors of hospital utilization for opioid overdose and related medical events in relation to opioid prescribing policies.

Notes:

The analyses, conclusions, and recommendations from these data are solely those of the researchers, and are not necessarily those of the Green Mountain Care Board

This research was supported by the National Institute of General Medical Sciences of the National Institutes of Health for the Northern New England Clinical and Translational Research network as a supplement [Award Number U54 GM115516-S1]

Citation

Harder VS, Varni SE, Murray KA, Plante TB, Villanti AC, Wolfson DL, Maruti S, Fairfield KM. Prescription opioid policies and associations with opioid overdose and related adverse effects. International Journal of Drug Policy. 2021;97:103306. doi: 10.1016/j.drugpo.2021.103306.

Harder VS, Plante TB, Koh I, Rogers EB, Varni SE, TVillanti AC, Brooklyn JR, Fairfield KM. Influence of Opioid Prescription Policy on Overdoses and Related Adverse Effects in a Primary Care Population. Journal of General Internal Medicine. 2021;36(7):2013-2020. doi: 10.1007/s11606-021-06831-4.

Journal Articles

Prescription opioid policies and associations with opioid overdose and related adverse effects

Influence of Opioid Prescription Policy on Overdoses and Related Adverse Effects in a Primary Care Population

The objective of Pediatric Care Coordination Learning Collaborative was to plan, implement and evaluate the impact of effective care coordination among Vermont’s network of children’s primary and specialty health care professionals, with meaningful engagement of patients, families, and representatives from appropriate community-based, child-serving agencies and organizations.  

VCHIP, in collaboration with the Center for Health and Learning, conducted an evaluation of the Vermont Youth Suicide Prevention Project (VYSPP). Funded by the US Substance Abuse and Mental Health Services Administration (SAMHSA), to engage a broad range of Vermont schools and agencies to facilitate trainings for suicide prevention gatekeepers.

Gatekeepers learn about signs of suicidality, appropriate responses, and how to connect young people with needed services. The VCHIP evaluation uses a wide array of tools and data sources to assess the effectiveness of the trainings, and will be working to help identify gaps in the mental health referral system. Suicide is the second leading cause of death for young people between the ages of 10-24 in the state of Vermont. The Vermont Youth Suicide Prevention Platform describes the problem of suicide and offers concrete goals to address the many issues that impact prevention efforts. This platform is a guide for setting priorities, allocating funds, and highlighting the things ordinary Vermonters can do to address the issue.

Objectives

• Evaluated suicide prevention trainings conducted in half of the Vermont school supervisory unions.
• Evaluated the effectiveness of a statewide social marketing campaign aimed at youth and adults.
• Conducted focus groups and surveys in Vermont communities that are implementing broad-based suicide prevention programs.

Resources

• Preventing Youth Suicide in Vermont (video)
• Suicide Prevention
• Vermont Youth Suicide Prevention Coalition

Maine and Vermont have been awarded one of 10 grants from the U.S. Department of Health and Human Services to improve the quality of health care delivered to children in their states, with a particular focus on those enrolled in Medicaid and the Children's Health Insurance Program (CHIP).

Maine and Vermont have two of the lowest child uninsured rates in the nation, and a record of innovative activities that improve the quality of children’s health services. This collaboration capitalizes on the leading roles each state has taken in health reform.

In Vermont, the grant will allow the state to expand its nationally-recognized model for health care, “Blueprint for Health,” to include children. “Blueprint for Health” is focused on preventing illness and complications, rather than reacting to  health emergencies, by helping providers offer more effective, proactive care and  helping patients better manage their chronic conditions.