A Look Back & Celebration of A Look Back & Celebration of 20 Years– CSHCN Nutrition 20 Years– CSHCN Nutrition

NetworkNetwork

Betty Lucas, MPH, RD, CDBetty Lucas, MPH, RD, CD

Maria Nardella, MA, RD, CDMaria Nardella, MA, RD, CD

May 22, 2007May 22, 2007

Other Anniversaries in 2007Other Anniversaries in 2007

100 Years of CHRMC100 Years of CHRMC 40 Years of Medical Home40 Years of Medical Home 40 Years of EPSDT40 Years of EPSDT 20 Years of CSHCN Nutrition 20 Years of CSHCN Nutrition

NetworkNetwork

UAF Nutritionists - Hood Canal, WA, 1970

UAF Nutritionists - Hood Canal, WA, 1970

A Brief History – before 1987A Brief History – before 1987 1983 contract with DOH– based on need 1983 contract with DOH– based on need

for improved local pediatric nutrition for improved local pediatric nutrition services in WA (part of high-risk contract)services in WA (part of high-risk contract)

Nutrition consultation to western WA Nutrition consultation to western WA county health depts without RDs (Clallam, county health depts without RDs (Clallam, Cowlitz-Wahkiakum, Whatcom, Skagit, Cowlitz-Wahkiakum, Whatcom, Skagit, Kitsap, Snohomish, Jefferson)Kitsap, Snohomish, Jefferson)

Eventually included some early Eventually included some early intervention programsintervention programs

A Brief History – before 1987A Brief History – before 1987

1985-86 – contract with Crippled Children’s 1985-86 – contract with Crippled Children’s Services (Ben Guthrie), MCHServices (Ben Guthrie), MCH

Lori Brizee conducts needs assessment of Lori Brizee conducts needs assessment of PHN’s and neuromuscular centers in WAPHN’s and neuromuscular centers in WA

1986-87-- in collaboration with Ilene Kasten, 1986-87-- in collaboration with Ilene Kasten, nutritionist with MCH/DOH, contract nutritionist with MCH/DOH, contract includes 5 day training (+ site visit for each includes 5 day training (+ site visit for each trainee) trainee)

CSHCN Nutrition NetworkCSHCN Nutrition Network Jan, 1987 – 3 day training for 6 RDsJan, 1987 – 3 day training for 6 RDs March-May – site visit for each participantMarch-May – site visit for each participant June – 2-day follow-upJune – 2-day follow-up Participants’ feedback – “we’re not done Participants’ feedback – “we’re not done

yet; we need ongoing training”yet; we need ongoing training” That and other evaluation led to ongoing That and other evaluation led to ongoing

training and CSHCN Nutrition Network training and CSHCN Nutrition Network (with next meeting in Nov, 1987)(with next meeting in Nov, 1987)

NUTRITION WORKSHOP, CDMRC, UNIVERSITY OF WASHINGTONJANUARY 12-14, 1987

January 12, 19879:00 Welcome - B. Worthington-RobertsIntroduction - P. Pipes9:30 Impact of a Handicapped Child on the Family - J. Leconte10:30 Break11:00 Medical Etiology of Mental Retardation - V. Holm12:00 Lunch1:00 Medical Etiology of Mental Retardation #2 - V. Holm2:00 Managing Reflux in Infants and Children - Nora Davis3:00 Observe CDMRC case conference6:00 Social Gathering - Lori Brizee's homeJanuary 13, 1987Assessment9:00 Children Who Do Not Grow Appropriately - V. Holm10:00 Anthropometry - C. Trahms10:30 Assessing Food and Nutrient Intake P. Pipes and B. Lucas11:30 Nutrient Drug Interactions - L. Brizee12:00 Lunch * Medical Etiology of Mental Retardation - Slide and Tapes 1:00 Normal Feeding Patterns - K. StewartIntervention2:00 Feeding Children with Oral Motor Problems - K. Stewart

The 1987 NovitiatesThe 1987 Novitiates

Jan Carden – WenatcheeJan Carden – Wenatchee Annie Goodwin – Tri-CitiesAnnie Goodwin – Tri-Cities Cheryl Hata – YakimaCheryl Hata – Yakima Kelly Molaski – BellinghamKelly Molaski – Bellingham Louise Peck – CHRMCLouise Peck – CHRMC Annette Pederson – Kent Annette Pederson – Kent

Plus Joan Zerzan (trainee) and Lori Brizee Plus Joan Zerzan (trainee) and Lori Brizee (project staff)(project staff)

CSHCN Nutrition NetworkCSHCN Nutrition Network

1988, 1989, 1990 – continued to have 2-1988, 1989, 1990 – continued to have 2-day training and 3 day follow-up in spring day training and 3 day follow-up in spring (2 days for new members; 1 day for entire (2 days for new members; 1 day for entire NN); plus 1-day fall meetingNN); plus 1-day fall meeting

1992, 1994, 1995, 1998, 2001, 2004, 2006 1992, 1994, 1995, 1998, 2001, 2004, 2006 -- 3-day initial training, then 2 meetings/yr-- 3-day initial training, then 2 meetings/yr

Other active members from Other active members from the “early days”the “early days”

1988:1988: Diane ArmbrustDiane Armbrust Judie EngelJudie Engel Kari FisherKari Fisher Eileen HarperEileen Harper Terri WeijohnTerri Weijohn

1989:1989: Becky EsveltBecky Esvelt Becky HermsenBecky Hermsen

Mary Jo Mengarelli Mary Jo Mengarelli Joyce SatoJoyce Sato

1990:1990: Laura BoyceLaura Boyce Sandi LaneySandi Laney Jeanne SmithJeanne Smith Isabel SoleyIsabel Soley Linda BurtonLinda Burton

The first “Pink Book”The first “Pink Book”

To have some To have some consistent guidelines consistent guidelines for nutritionistsfor nutritionists

Published in 1989Published in 1989 Editors – Lori Brizee, Editors – Lori Brizee,

Christine SophosChristine Sophos Authors – NN Authors – NN

members and othersmembers and others Lots of work by manyLots of work by many

Early WA CSHCN nutrition projectsEarly WA CSHCN nutrition projects

1988- workshop “Early 1988- workshop “Early Identification of High Risk Identification of High Risk Infants and Children” – Infants and Children” – Tacoma and SpokaneTacoma and Spokane

1989-90 Workshop 1989-90 Workshop “Which Kids Should We “Which Kids Should We Really Worry About?” Really Worry About?” Seattle, SpokaneSeattle, Spokane

(for public health, (for public health, therapists, WIC)therapists, WIC)

Early WA CSHCN nutrition projectsEarly WA CSHCN nutrition projects

1990 (Mar – Apr) – Nutrition for CSHCN 1990 (Mar – Apr) – Nutrition for CSHCN workshops for WICworkshops for WIC

A “dog & pony show” by Pipes and Lucas A “dog & pony show” by Pipes and Lucas TacomaTacoma

Vancouver Vancouver

Mt. VernonMt. Vernon

KennewickKennewick

WenatcheeWenatchee

19921992

CSHCN Program CSHCN Program established a full time established a full time Nutrition Consultant Nutrition Consultant positionposition

Maria Nardella moves Maria Nardella moves back to Washingtonback to Washington

Charged with doing a Charged with doing a Nutrition Needs Nutrition Needs AssessmentAssessment

Parent Parent Focus Focus GroupsGroups

Feeding Team TrainingFeeding Team Training

From Nutrition Network From Nutrition Network efforts, identified need efforts, identified need for local feeding teamsfor local feeding teams

1993- first feeding team 1993- first feeding team training – Benton-training – Benton-Franklin and Cowlitz-Franklin and Cowlitz-Wahkiakum countiesWahkiakum counties

1994 - “Guidelines” 1994 - “Guidelines” published (now on the published (now on the web)web)

Meeting the Needs of ChildrenMeeting the Needs of Childrenwith Feeding Tubes: with Feeding Tubes:

Families and Providers TogetherFamilies and Providers Together

Funding for Nutrition Services Funding for Nutrition Services in Washingtonin Washington

Health Care Reform Era – Costs of Health Care Reform Era – Costs of Nutrition ServicesNutrition Services

Addressing issues of Addressing issues of benefits, costs, benefits, costs, outcomesoutcomes

20 RD cases and 10 20 RD cases and 10 Feeding Team casesFeeding Team cases

Contributors – Contributors – CSHCN Nutrition CSHCN Nutrition Network and Feeding Network and Feeding TeamsTeams

Nutrition Network members assisted with the collection of nutrition case studies.

Costs Consideration publicationCosts Consideration publication

This document was This document was shared by MCHB shared by MCHB electronicallyelectronically

Used by state dietetic Used by state dietetic associations, ADA associations, ADA practice groups, and practice groups, and others to help others to help document need for document need for nutrition servicesnutrition services

Not how Sharon and Betty were looking as they finished editing this document.

Medicaid-Nutrition Costs ProjectMedicaid-Nutrition Costs Project

Costs, outcome, Costs, outcome, reimbursement for reimbursement for children on WA children on WA Medicaid Medical Medicaid Medical Nutrition ProgramNutrition Program

Betty, Sharon, Maria Betty, Sharon, Maria and NN members and NN members who contributed who contributed casescases

New “Pink Book” - 2002New “Pink Book” - 2002 Improved, updated, Improved, updated,

biggerbigger Supported by state Supported by state

WIC programWIC program Editors – Lisa Campo, Editors – Lisa Campo,

Maria Nardella, Beth Maria Nardella, Beth OgataOgata

Authors (again) – you Authors (again) – you great NN folks!great NN folks!

Distributed outside Distributed outside WA and on-lineWA and on-line

Forming Feeding TeamsForming Feeding Teams

4

Training and Formation

of Feeding Teams in Washington State...

http://depts.washington.edu/cshcnnut/feeding_teams_list.html

DOH partners & supporters over DOH partners & supporters over the yearsthe years

Programs – CCS, WIC, MCH, CSHCNPrograms – CCS, WIC, MCH, CSHCN People:People:

Ilene KastenIlene Kasten

Loren BellLoren Bell

Joyce GardnerJoyce Gardner

Cathy FranklinCathy Franklin

Maria NardellaMaria Nardella

Yuchi YangYuchi Yang

CSHCN Nutrition Network todayCSHCN Nutrition Network today

Jan 2006 was the 11Jan 2006 was the 11thth training of training of community RDs in WA State community RDs in WA State (supported by (supported by nutrition contract between CSHCN-DOH and nutrition contract between CSHCN-DOH and CHDD/UW)CHDD/UW)

Currently there are ~100 members of the Currently there are ~100 members of the CSHCN Nutrition Network CSHCN Nutrition Network

Members come from community (WIC, Members come from community (WIC, public health, Head Start/ECEAP, public health, Head Start/ECEAP, schools), hospital, home health careschools), hospital, home health care

Benefits -- CSHCN Nutrition Benefits -- CSHCN Nutrition Network membersNetwork members

Participation in 2 annual CSHCN Nutrition Participation in 2 annual CSHCN Nutrition Network meetings – spring and fallNetwork meetings – spring and fall

Participation in 2 listserves – CSHCN Participation in 2 listserves – CSHCN Nutrition Network and Pediatric Nutrition Nutrition Network and Pediatric Nutrition Consultation On-lineConsultation On-line

Better able to communicate and Better able to communicate and collaborate with other providers and health collaborate with other providers and health care systems in WA statecare systems in WA state

A great network of CSHCN RDs!A great network of CSHCN RDs!

Nutrition Network contributions Nutrition Network contributions

Become local resource re: nutrition and Become local resource re: nutrition and CSHCNCSHCN

Assist in data collection and surveysAssist in data collection and surveys Authors and reviewers Authors and reviewers Help advocate for nutrition/health services Help advocate for nutrition/health services

for CSHCN in WA, i.e. Medicaid nutrition for CSHCN in WA, i.e. Medicaid nutrition changeschanges

Sharing expertise, resources, new toolsSharing expertise, resources, new tools Others Others

Establishment of Washington Establishment of Washington State State

Pediatric Nutrition Practice Pediatric Nutrition Practice

GroupGroup

Nutrition Network Members are Nutrition Network Members are Leaders!Leaders!

PNPGPNPG: Sharon Feucht, Betty Lucas, Beth : Sharon Feucht, Betty Lucas, Beth Ogata, Annie Frederick, Cris TrahmsOgata, Annie Frederick, Cris Trahms

WSDAWSDA: Annie Frederick: Annie Frederick WA-PNPGWA-PNPG: Jan Gilliam, Kim Cooperman, : Jan Gilliam, Kim Cooperman,

Kari Fisher, David Teske, Annette Kari Fisher, David Teske, Annette Pedersen, Sharon Feucht, Sandi Laney, Pedersen, Sharon Feucht, Sandi Laney, Beth Ogata, Connie Warner, Adrienne Beth Ogata, Connie Warner, Adrienne DorfDorf

Nutrition Network RDs Receive Nutrition Network RDs Receive Honors!Honors!

WSDAWSDA: Kim Cooperman, Sharon Feucht, : Kim Cooperman, Sharon Feucht, Jan Gilliam, Beth Ogata, Betty Lucas, Jan Gilliam, Beth Ogata, Betty Lucas, Annette Pedersen, Sandi Laney, Nancy Annette Pedersen, Sandi Laney, Nancy James, Annie Frederick, Becky Esvelt, James, Annie Frederick, Becky Esvelt, Michelle Hagen, Cris TrahmsMichelle Hagen, Cris Trahms

ADAADA: Cris Trahms, Betty Lucas: Cris Trahms, Betty Lucas

Ongoing FundingOngoing Funding

Eat Right

Stay Bright!