December 14, 2020 by
Vermonters have a reputation for showing up for their community – whether there’s a pandemic or not. That’s also true for the faculty and staff of the Vermont Child Health Improvement Program (VCHIP), who have underscored over the past nine months just how important their role is to ensuring providers get access to critical resources and tools that allow them to deliver quality care.
Following the state’s first confirmed case of COVID-19 on March 7, the Vermont Department of Health (VDH) set up an 8 a.m. to 5 p.m. hotline and was quickly inundated with calls from medical professionals and community members alike. Within a span of about 48-hours, well child visits moved to telehealth, which led to new workflows, new technology, and reimbursement issues.
A regular partner with VDH, VCHIP representatives, including Executive Director Judy Shaw, Ed.D., M.P.H., R.N., Professor of Pediatrics Wendy Davis, M.D., and Associate Professor of Pediatrics Breena Holmes, M.D., realized that instead of helping staff phone calls, they could leverage VCHIP’s CHAMP (Child Health Advances Measured in Practice) program to help share just-in-time and sorely-needed COVID-19 information with providers in their network – and beyond.
Answering the call for help with CHAMP
“VCHIP is known for saying ‘how can we help?’” says Shaw, a professor of pediatrics and nursing who has built VCHIP – founded in 1999 – to nimbly rise and respond to the Vermont pediatrics community’s needs.
On March 13, VCHIP and VDH leaders met, and on March 18, they tested their idea to hold the COVID edition of the CHAMP call to push out information, while Department of Health representatives listened. “What transpired was just magical,” Shaw says.
“Schools and childcares were closing; the health department staff was trying to keep up with accurate and up-to-date information-sharing and VCHIP answered the call,” said Holmes, who is a physician advisor to the Division of Maternal Child Health at the VDH. “Integrating clinical medicine and public health was our pre-COVID approach, so it felt natural to be supportive and team up during this crisis.”
Founded on long-term partnerships with VDH, the Vermont Chapter of the American Academy of Pediatrics (AAP), and the Vermont Academy of Family Physicians, the CHAMP initiative was launched in 2012 by Sara Barry, M.P.H., now director of clinical and quality improvement for OneCare Vermont and a VCHIP senior advisor. Through regular webinar calls, CHAMP offers collaborative improvement activities to meet the evolving needs of health care professionals, children, and families.
Pre-pandemic, says Davis, the VCHIP CHAMP team would support efforts to “strengthen Vermont’s system of high-performing pediatric medical homes.” The call discussions focused on such topics as delivering primary care for infants, children and adolescents according to the Bright Futures guidelines, particularly working to ensure that the Vermont Medicaid population receives the same level of care as all others. Then COVID-19 hit.
“We made a split-second decision to step up this activity on March 16 or 17,” says Davis, who was health commissioner in 2009 during the H1N1 pandemic. “VCHIP felt there was a need to collate data focused on the pediatric population and extract the information most relevant to children and families.” One example was pregnant women and newborn care and determining what type of policies should be set for women coming into hospital to deliver, arranging breastfeeding assistance, etc. “We said ‘we’re going to step into that space and see how we can support people,’” explains Davis.
The CHAMP webinar calls are available through an Adobe Connect meeting online, which provides the slides and a chat for questions and responses, and several options for connecting to audio – a call-in number and code that folks can dial on their phone, a dial-out option to receive a call from the Adobe Connect meeting to connect to the audio, or an option to use the microphone on their computer/device. Currently conducted on Mondays, Wednesdays and Fridays, the calls take place from 12:15 to 12:45 p.m. – often extending to 1 p.m. – and are all archived, along with the slides, and available through a link on the VCHIP home page.
Co-led by Davis and Holmes, the calls start with a brief situation update, with information the CHAMP team curates from the Governor’s press conferences, critical updates from the AAP and Centers for Disease Control and Prevention, health advisories and alerts, and a segment called “practice issues.” There are also expert guests, like infectious disease (ID) specialists William Raszka, M.D., professor of pediatrics, and Benjamin Lee, M.D., assistant professor of pediatrics, who have answered ID questions, provided information on the severe inflammatory response when it began showing up in kids, and discussed safe practices in schools. On December 7, the practice issue was a VDH Immunization Program Update – a timely topic as the world was readying for the first distribution of the Pfizer vaccine.
Shaw says more than 100 people participate in each call – a sign that they are needed.
The secret to CHAMP’s success
“We’ve leveraged the uniqueness of our programs, using the foundation of CHAMP and the credibility of VCHIP, and aligned all the people interested in children and families – including schools,” said Shaw. “We are walking this path together, shoulder-to-shoulder.”
She credits Davis and Holmes with possessing a unique blend of skills, perspectives and experience that have led to the CHAMP calls’ success. Both had careers as general pediatricians before transitioning into public health. In addition to being a former Vermont health commissioner, Davis is on the board of the national AAP, a Vermont AAP leader, associate director of the National Improvement Partnership Network and a VCHIP faculty and Senior Advisory Group member. A former director of Maternal Child Health at VDH, Holmes is a VCHIP faculty and Senior Advisory Group member and has served in a national capacity on the AAP’s Council on School Health. The two were recently honored jointly with the Vermont AAP’s 2020 Green Mountain Pediatrician award in recognition for their work on the CHAMP calls.
Pediatricians, family medicine physicians, and a wide range of folks who work with children and families have embraced the sense of partnership and collaboration the calls offer.
At a November 2020 Pediatrics Grand Rounds CHAMP COVID presentation, Professor and Chair of Pediatrics Lewis First, M.D., lauded the pair, saying “What you have done is anchored all of us, allowed us to breathe and continue, and accomplish far more than we thought we could.”
Pediatrician Alexandra Bannach, M.D., medical director of North Country Pediatrics in Newport, Vt., is living proof of the calls’ positive impact.
“Drs. Breena Holmes and Wendy Davis are my heroes!” she exclaims. “The guidance from the experts . . . makes it possible to always have the latest information about COVID. It would be impossible to do patient work and filter information on my own. The knowledge that I gain from the calls allows me to advocate and educate in our area, provide that information to other clinicians in my area and be a voice to the public.”