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

1. A Look Back & Celebration of 20 Years– CSHCN Nutrition Network Betty Lucas, MPH, RD, CD Maria Nardella, MA, RD, CD May 22, 2007

2. Other Anniversaries in 2007 • 100 Years of CHRMC • 40 Years of Medical Home • 40 Years of EPSDT • 20 Years of CSHCN Nutrition Network

3. UAF Nutritionists - Hood Canal, WA, 1970

4. UAF Nutritionists - Hood Canal, WA, 1970

8. A Brief History – before 1987 • 1983 contract with DOH– based on need for improved local pediatric nutrition services in WA (part of high-risk contract) • Nutrition consultation to western WA county health depts without RDs (Clallam, Cowlitz-Wahkiakum, Whatcom, Skagit, Kitsap, Snohomish, Jefferson) • Eventually included some early intervention programs

9. A Brief History – before 1987 • 1985-86 – contract with Crippled Children’s Services (Ben Guthrie), MCH • Lori Brizee conducts needs assessment of PHN’s and neuromuscular centers in WA • 1986-87-- in collaboration with Ilene Kasten, nutritionist with MCH/DOH, contract includes 5 day training (+ site visit for each trainee)

10. CSHCN Nutrition Network • Jan, 1987 – 3 day training for 6 RDs • March-May – site visit for each participant • June – 2-day follow-up • Participants’ feedback – “we’re not done yet; we need ongoing training” • That and other evaluation led to ongoing training and CSHCN Nutrition Network (with next meeting in Nov, 1987)

11. NUTRITION WORKSHOP, CDMRC, UNIVERSITY OF WASHINGTON JANUARY 12-14, 1987 January 12, 1987 9:00 Welcome - B. Worthington-Roberts Introduction - P. Pipes 9:30 Impact of a Handicapped Child on the Family - J. Leconte 10:30 Break 11:00 Medical Etiology of Mental Retardation - V. Holm 12:00 Lunch 1:00 Medical Etiology of Mental Retardation #2 - V. Holm 2:00 Managing Reflux in Infants and Children - Nora Davis 3:00 Observe CDMRC case conference 6:00 Social Gathering - Lori Brizee's home January 13, 1987 Assessment 9:00 Children Who Do Not Grow Appropriately - V. Holm 10:00 Anthropometry - C. Trahms 10:30 Assessing Food and Nutrient Intake P. Pipes and B. Lucas 11:30 Nutrient Drug Interactions - L. Brizee 12:00 Lunch * Medical Etiology of Mental Retardation - Slide and Tapes 1:00 Normal Feeding Patterns - K. Stewart Intervention 2:00 Feeding Children with Oral Motor Problems - K. Stewart

12. The 1987 Novitiates • Jan Carden – Wenatchee • Annie Goodwin – Tri-Cities • Cheryl Hata – Yakima • Kelly Molaski – Bellingham • Louise Peck – CHRMC • Annette Pederson – Kent Plus Joan Zerzan (trainee) and Lori Brizee (project staff)

13. CSHCN Nutrition Network • 1988, 1989, 1990 – continued to have 2-day training and 3 day follow-up in spring (2 days for new members; 1 day for entire NN); plus 1-day fall meeting • 1992, 1994, 1995, 1998, 2001, 2004, 2006 -- 3-day initial training, then 2 meetings/yr

14. 1988: Diane Armbrust Judie Engel Kari Fisher Eileen Harper Terri Weijohn 1989: Becky Esvelt Becky Hermsen Mary Jo Mengarelli Joyce Sato 1990: Laura Boyce Sandi Laney Jeanne Smith Isabel Soley Linda Burton Other active members from the “early days”

15. The first “Pink Book” • To have some consistent guidelines for nutritionists • Published in 1989 • Editors – Lori Brizee, Christine Sophos • Authors – NN members and others • Lots of work by many

16. Early WA CSHCN nutrition projects • 1988- workshop “Early Identification of High Risk Infants and Children” – Tacoma and Spokane • 1989-90 Workshop “Which Kids Should We Really Worry About?” Seattle, Spokane • (for public health, therapists, WIC)

17. Early WA CSHCN nutrition projects • 1990 (Mar – Apr) – Nutrition for CSHCN workshops for WIC • A “dog & pony show” by Pipes and Lucas Tacoma Vancouver Mt. Vernon Kennewick Wenatchee

21. CSHCN Program established a full time Nutrition Consultant position Maria Nardella moves back to Washington Charged with doing a Nutrition Needs Assessment 1992

22. Parent Focus Groups

24. Feeding Team Training • From Nutrition Network efforts, identified need for local feeding teams • 1993- first feeding team training – Benton-Franklin and Cowlitz-Wahkiakum counties • 1994 - “Guidelines” published (now on the web)

25. Meeting the Needs of Childrenwith Feeding Tubes: Families and Providers Together

26. Funding for Nutrition Services in Washington

28. Health Care Reform Era – Costs of Nutrition Services • Addressing issues of benefits, costs, outcomes • 20 RD cases and 10 Feeding Team cases • Contributors – CSHCN Nutrition Network and Feeding Teams

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

30. Costs Consideration publication • This document was shared by MCHB electronically • Used by state dietetic associations, ADA practice groups, and others to help document need for nutrition services Not how Sharon and Betty were looking as they finished editing this document.

31. Medicaid-Nutrition Costs Project • Costs, outcome, reimbursement for children on WA Medicaid Medical Nutrition Program • Betty, Sharon, Maria and NN members who contributed cases

32. New “Pink Book” - 2002 • Improved, updated, bigger • Supported by state WIC program • Editors – Lisa Campo, Maria Nardella, Beth Ogata • Authors (again) – you great NN folks! • Distributed outside WA and on-line

33. Last Updated 01/17/03http://depts.washington.edu/cshcnnut/ Last Updated 01/17/03http://depts.washington.edu/cshcnnut/ CSHCN Nutrition Network CSHCN Nutrition Network Washington State Community Feeding Teams Washington State Community Feeding Teams Washington State Publications Washington State Publications Nutrition Services in Washington State Nutrition Services in Washington State Nutrition Resources Nutrition Resources Continuing Education/Training Continuing Education/Training Current Nutrition Issues Current Nutrition Issues Nutrition for Children With Special Health Care Needs in Washington State Nutrition for Children with Special Health Care Needs in Washington State is a collaboration between the Children with Special Health Care Needs Program in the Department of Health, and the Center on Human Development and Disability at the University of Washington in Seattle, WA. This information is meant to support nutrition services for children with special health care needs and their families in Washington State. Others outside the state may also find the information helpful. Registered dietitians, nurses, primary care providers, occupational therapists, physical therapists, speech therapists, educators, social workers, and others working with the pediatric special needs population will find useful information, available services, resources, publications, and links to related Web sites. Nutrition for Children With Special Health Care Needs in Washington State Nutrition for Children with Special Health Care Needs in Washington State is a collaboration between the Children with Special Health Care Needs Program in the Department of Health, and the Center on Human Development and Disability at the University of Washington in Seattle, WA. This information is meant to support nutrition services for children with special health care needs and their families in Washington State. Others outside the state may also find the information helpful. Registered dietitians, nurses, primary care providers, occupational therapists, physical therapists, speech therapists, educators, social workers, and others working with the pediatric special needs population will find useful information, available services, resources, publications, and links to related Web sites. Center on Human Development and Disability University of Washington, Seattle, WAhttp://depts.washington.edu/chdd Center on Human Development and Disability University of Washington, Seattle, WAhttp://depts.washington.edu/chdd Children with Special Health Care NeedsDepartment of HealthOlympia, WAhttp://www.doh.wa.gov/cfh/mch/CSHCNhome2.htmhttp://www.doh.wa.gov/cfh/mch/ Children with Special Health Care NeedsDepartment of HealthOlympia, WAhttp://www.doh.wa.gov/cfh/mch/CSHCNhome2.htmhttp://www.doh.wa.gov/cfh/mch/ Feedback/Questions? Contact Betty Lucas at: blucas@u.washington.edu Disclaimer StatementThis site is designed for educational purposes only and is not engaged in rendering medical advice or professional services. The information provided through Nutrition for Children with Special Health Care Needs should not be used for diagnosing or treating a health problem or a disease. It is not a substitute for professional care. If your child has or you suspect your child may have a health problem, you should consult your health care provider. Feedback/Questions? Contact Betty Lucas at: blucas@u.washington.edu Disclaimer StatementThis site is designed for educational purposes only and is not engaged in rendering medical advice or professional services. The information provided through Nutrition for Children with Special Health Care Needs should not be used for diagnosing or treating a health problem or a disease. It is not a substitute for professional care. If your child has or you suspect your child may have a health problem, you should consult your health care provider. Who are children with special health care needs? Who are children with special health care needs? What are the nutrition concerns for children with special health care needs? What are the nutrition concerns for children with special health care needs? How can registered dietitians help children with special health care needs? How can registered dietitians help children with special health care needs?

34. Forming Feeding Teams http://depts.washington.edu/cshcnnut/feeding_teams_list.html

36. DOH partners & supporters over the years • Programs – CCS, WIC, MCH, CSHCN • People: Ilene Kasten Loren Bell Joyce Gardner Cathy Franklin Maria Nardella Yuchi Yang

39. CSHCN Nutrition Network today • Jan 2006 was the 11th training of community RDs in WA State (supported by nutrition contract between CSHCN-DOH and CHDD/UW) • Currently there are ~100 members of the CSHCN Nutrition Network • Members come from community (WIC, public health, Head Start/ECEAP, schools), hospital, home health care

42. Benefits -- CSHCN Nutrition Network members • Participation in 2 annual CSHCN Nutrition Network meetings – spring and fall • Participation in 2 listserves – CSHCN Nutrition Network and Pediatric Nutrition Consultation On-line • Better able to communicate and collaborate with other providers and health care systems in WA state • A great network of CSHCN RDs!

44. Nutrition Network contributions • Become local resource re: nutrition and CSHCN • Assist in data collection and surveys • Authors and reviewers • Help advocate for nutrition/health services for CSHCN in WA, i.e. Medicaid nutrition changes • Sharing expertise, resources, new tools • Others

47. Establishment of Washington State Pediatric Nutrition Practice Group

48. Nutrition Network Members are Leaders! • PNPG: Sharon Feucht, Betty Lucas, Beth Ogata, Annie Frederick, Cris Trahms • WSDA: Annie Frederick • WA-PNPG: Jan Gilliam, Kim Cooperman, Kari Fisher, David Teske, Annette Pedersen, Sharon Feucht, Sandi Laney, Beth Ogata, Connie Warner, Adrienne Dorf

49. Nutrition Network RDs Receive Honors! • WSDA: Kim Cooperman, Sharon Feucht, Jan Gilliam, Beth Ogata, Betty Lucas, Annette Pedersen, Sandi Laney, Nancy James, Annie Frederick, Becky Esvelt, Michelle Hagen, Cris Trahms • ADA: Cris Trahms, Betty Lucas

50. Ongoing Funding