Sorted by Assessment
As identified in the 2024 Early Childhood Needs Assessment
The Early Childhood Needs Assessment directory below features highlights from needs assessments conducted in Vermont in the last five years. The goal is to inform others in the early childhood field and reduce the need for additional needs assessments when possible. You may use this directory as a resource for writing grant proposals or working on policy and/or testimony for the legislature, for example.
The PDG Implementation Grant Needs Assessment activity led by Building Bright Futures (BBF) included the development and implementation of a replicable meta-analysis of needs assessments conducted in the last five years in order to make these findings more accessible and useful. This page is organized by assessment, showing the most recent first. You can also view this directory sorted by theme. This directory will be updated on a regular basis.
- Improving Screening, Treatment and Access to Perinatal Mental Health Services for Refugee Women
- Vermont Agency of Education McKinney-Vento Services Assessment
- 2022 Early Childhood Family Needs Assessment
- 2022 Vermont Head Start and Early Head Start Needs Assessment Report
- CACFP Participation in Vermont
- Providing Meals in Early Childhood Settings: 2022 Early Childhood Nutrition Report
- Vermont Child Care and Early Childhood Systems Analysis
- 2020 Early Childhood Systems Needs Assessment
- COVID-19 Vermont Family Impact Survey
- Vermont Maternal, Infant, Early Childhood Home Visiting Program
- Title V Five-Year Needs Assessment
- Report: Women with Lived Experience of Perinatal Mood and Anxiety Disorders in Vermont
Key Themes of
Improving Screening, Treatment and Access to Perinatal Mental Health Services for Refugee Women
Conducted by Vermont Department of Health, Vermont Department of Mental Health, Vermont Child Health Improvement Program (VCHIP), Larner College of Medicine, University of Vermont, London School of Hygiene and Tropical Medicine in 2023
“Amongst these life stressors are financial insecurity, unstable housing, and food insecurity. Many of the participants worked prior to their child’s birth and now lived on a one income salary as well as some social welfare benefits. All participants mentioned that they struggle with living with only one income and not being able to work.” —p. 8
“All interviewees mentioned having financial stress and being worried about meeting their basic financial commitments. Five interviewees mentioned that they have to not only support their family here in Vermont, but also send funds monthly to their family back in their country of origin.” —p. 9
“One interviewee said that she always answers no to all the questions on the screening form and later expressed that she had mistrust in health care professionals.” —p. 4
“Language barriers were repeatedly stated as one of the most important cultural obstacles to engage in any type of health care services, including mental health services. Amongst the twelve interviewees, the seven individuals that did not speak English were particularly vulnerable to the impact of language barriers as they could not communicate effectively and directly with health care providers and clinic staff.” —p. 5
“Many participants mentioned that the presence of an interpreter is a deterrent to discussing a highly sensitive and stigmatized topic such as mental health problems.” —p. 6
“Either directly or indirectly, all interviewees acknowledge that stigma was a barrier to seeking mental health services… The consensus amongst all interviewees is that if someone in their community is identified as having a mental health problem, they will be stigmatized and discriminated against because this illness is associated with marginalized populations and comes with a label of being ‘crazy.’ Some of the participants directly showed reluctance in discussing mental health problems, and shared negative feelings about mental health problems. These interviewees did not want to be associated with this type of health problems because they were afraid of being stigmatized. Within this cultural context, many interviewees find ways to cope with life stressors and symptoms of mental health issues in isolation, with limited assistance from family members and no external mental health providers.” —p. 6
“To date, there is no published literature specifically on the experience of Vermont’s refugee women with perinatal mental health experiences, and their perspectives on accessing and utilizing mental health services… A significant number of the refugee populations resettled in Vermont are women of childbearing age and families with small children.” —p. 3
“Ten interviewees had limited understanding of perinatal mental health problems, including perinatal mood and anxiety disorders (PMADs). The interviewees disclosed symptoms of perinatal mental health problems such as exhaustion, feeling sad, anxious, trouble sleeping and difficulty managing daily life situations, but did not recognize these symptoms as perinatal mental health problems.” —p. 5
“Interviewees shared that using [mental health] services is at times difficult because of competing household responsibilities and the lack of childcare coverage to attend an appointment” —p. 4
“When discussing perinatal mental health screening with participants, many of them felt like it was hard to engage in deeper conversations with health care professionals not only because of the language barrier, but also because they felt like healthcare providers did not spend adequate time with them.” —p. 7
“The majority of interviewees experienced real barriers to accessing and utilizing any health-related resources, including mental health services available for pregnant and postpartum women in Vermont.” —p. 8
“Interviewees that spoke English felt like they had to come prepared with questions and advocate for themselves to get the information they needed.” —p. 7
“Those that did not speak English and had arrived in Vermont more recently were unaware of many of the resources available for pregnant and postpartum women, including mental health services.” —p. 8
“None of the participants who had completed a screening on perinatal mental health appeared to be knowledgeable about the purpose of the screening and had limited to no follow-up discussions with a health care professional after the screening was completed.” —p. 4
Key Themes of the
Vermont Agency of Education McKinney-Vento Services Assessment
Conducted by Vermont Agency of Education in 2023
Transportation: “Transportation is the single greatest challenge LEAs [Local Education Agency-based McKinney-Vento liaisons] confront in McKinney-Vento implementation, with issues ranging from lack of transportation providers such as buses or taxis, costly and time-consuming demands to transport students to other LEAs, difficulty implementing the requirements when both school and community transportation systems are under-resourced, and challenges related to understanding how to implement McKinney-Vento transportation obligations effectively and efficiently for growing numbers of students.” —p. 4
“There is no statewide data system for LEAs [Local Education Agency-based McKinney-Vento liaisons] to track and/or communicate about homeless students, making it difficult to ensure that students receive consistent support when they move within the state.” —p. 4
“Definitions of ‘homeless’ differ across state agencies and programs, making it challenging for LEAs [Local Education Agency-based McKinney-Vento liaisons] and community organizations to clearly determine which students and families are eligible for services under various support programs.” —p. 4
“Staffing resources to support homeless students vary widely across LEAs [Local Education Agency-based McKinney-Vento liaisons]. Those with the most robust services for homeless students have full- or part-time staff positions such as ‘family specialists’ or ‘home school coordinators.’” —p. 4
“In the 22-23 school year AOE-directed funding provided LEAs [Local Education Agency-based McKinney-Vento liaisons] with about $668 per homeless student to provide services (with McKinney-Vento and Title 1A Homeless Reservation Funding). Especially in LEAs serving the largest numbers of homeless students, the available financial and staffing resources are insufficient in comparison to the number of students and levels of need.” —p. 4
“There are differences in how LEAs [Local Education Agency-based McKinney-Vento liaisons] interpret and understand some McKinney-Vento requirements (especially related to students’ school of origin), suggesting opportunities to provide additional training resources to support more consistency across LEAs.” —p. 4
“LEAs [Local Education Agency-based McKinney-Vento liaisons] have the greatest challenges identifying preschool children under age 6 who are homeless, as well as unaccompanied minors, who are most often older high school students. Liaisons were confident that both preschoolers and unaccompanied minors are well served once they are identified as homeless, but most reported that systems and outreach are inadequate to be certain all students in each group are identified.” —p. 4
Key Themes of the
2022 Early Childhood Family Needs Assessment
Conducted by Building Bright Futures in 2022
“While there are free and low-cost services and supports, and financial assistance for some families, the cost of child care in particular was highlighted as a key barrier to access and financial comfort.” —p. 11
“When breaking out these [access to basic needs] findings by race, non-white and multiracial respondents were less likely than white respondents to agree that they had access to food (82% and 90%) and necessities (78% and 94%) than their white counterparts.” —p. 7
“Of note, although mental health services were not one of the seven services and supports specifically identified in the survey, difficulty accessing mental health services was highlighted by respondents and in meetings of the Families and Communities Committee.” —p. 10
“Respondents highlighted challenges including knowing where to go for information, understanding which services and supports were available and how they connect to each other, difficulties with paperwork and communication.” —p. 12
“Respondents who shared their experiences with kindergarten transitions related mixed experiences…For [some] families, the process was unclear and caused anxiety for the child and family.” —p. 11
“For the majority of the services and supports, respondents identified limited availability as a key barrier to access. This could be due to geographical distance, limited or no openings, or services that were a mismatch with the respondent’s needs and desires.” —p. 10
Key Themes of the
2022 Vermont Head Start and Early Head Start Needs Assessment Report
Conducted by Vermont Head Start and Early Head Start in 2022
When asked to rate their involvement and degree of difficulty engaging with data-related entities, “A majority of recipients reported high levels of involvement with the Agency of Education and the Child Development Division, however, a majority also reported high degrees of difficulty when sharing data with and accessing data from the Agency of Education. Nearly half of VT recipients also expressed higher levels of difficulty when accessing data from the Child Development Division.” —p. 27
“When asked about their involvement with McKinney-Vento Liasons, most Vermont Head Start recipients reported high-levels of involvement yet expressed difficulty developing and implementing family outreach and support efforts in coordination with LEAs [Local Education Agency-based McKinney-Vento liaisons] around transition planning for children experiencing homelessness.” —p. 48
“A majority of Head Start recipients reported a majority of coordination activities with their LEAs [Local Education Agency-based McKinney-Vento liaisons] as difficult. Table 4: Level of Difficulty Coordinating with LEAs [shows] 17 of 19 items were difficult to coordinate between VT Head Start recipients and LEAs.” —p. 42
“Promoting access to timely health care services, including those related to general, oral, and mental health” —p. 66
“When asked to identify the most pressing health and safety needs of children and families served by their programs, six out of the seven Vermont Head Start recipients identified connecting dental health providers to Head Start programs so all Head Start children have a dental home as a top need.” —p. 56
“The VHSCO [Vermont Head Start Collaboration Office] also asked Head Start and Early Head Start recipients to identify their program’s top three professional development needs. All recipients indicated a need for additional professional development on behavior management strategies, trauma-informed care, and supporting children with disabilities. Family engagement, supporting dual-language learners, reflective supervision, and data-informed decision-making were also a need identified by a majority of recipients.” —p. 36
Key Themes of
CACFP Participation in Vermont
(Child and Adult Care Food Program)
Conducted by Nemours Children’s Health, Child Care Aware of America, Vermont Department of Health, Child Development Division, and Agency of Education in 2022
Basic Needs/Nutrition: “During the pandemic, access to child care in Vermont existed in a state of flux, and a lack of access to food proved to be a challenge for the providers who remained open.” —Introduction tab
“CACFP [Child and Adult Care Food Program] is not wholly universal to all child care programs with low reimbursement rates identified as a barrier by the early childhood field.” —Strategies for Change tab
“There are 39 census tracts, or neighborhoods, designated as food deserts in Vermont, meaning there is low access to healthy and nutritious food within 1 mile for urban areas and 10 miles for rural areas by census tract.” —Food Deserts tab
“There are 308 child care programs in Vermont operating in food deserts, 249 (80%) of which do not participate in CACFP [Child and Adult Care Food Program].” —Food Deserts tab
“Early childhood providers’ report spending too much time on [Child and Adult Care Food Program] administrative duties. —Strategies for Change tab
Key Themes of
Providing Meals in Early Childhood Settings: 2022 Early Childhood Nutrition Report
Conducted by Hunger Free Vermont in 2022
“For years it has been apparent that Vermont’s early childhood data systems are antiquated, siloed, and duplicative…Data infrastructure would also help to close data gaps and promote data informed decision making across early childhood sectors in Vermont.” —p. 15
“It should be noted that the CDD does not define “Food Program Participation” as participating in the Child and Adult Care Food Program (CACFP), so when a program says they operate a food program, it does not necessarily mean that they participate in the CACFP according to this data. It should also be noted that, while it is recommended that programs update their information regularly after they are onboarded, it is not required.” —p. 13
“One of the most commonly mentioned barriers to participating in the CACFP [Child and Adult Care Food Program] is the fact that early childhood providers have to take attendance for the meal program separately from all of the other programs they have to take attendance for on a day-to-day basis. Attendance collection duplication contributes to the amount of time it takes to administer the meal program, and was captured as one of the top four most commonly mentioned barriers to being able to provide meals and snacks in early childhood settings.” —p. 15
“In January 2020 five hundred seventy five (575) Vermont early education programs were enrolled in CACFP [Child and Adult Care Food Program], while in January 2022 that number decreased to four hundred thirty eight (438) programs. This decrease can be attributed partially to program closures resulting from the pandemic. The decrease could also be due to early childhood programs in communities most impacted by hunger being disproportionately affected by the pandemic and not being able to access the resources necessary to continue operating a meal program.” —p. 14
“For early childhood programs existing in areas defined as food deserts or where there are less community support programs, mainly in the extremely rural corners of our state such as Windsor and Essex/Orleans counties, it is that much more difficult to access resources.” —p. 14
“We also heard from many early childhood programs that with increasing food costs and staffing shortages reimbursements need to be higher overall and should not be based on income tiers.” —p. 20
“65.63% of participating early childhood programs identified cost as being one of the primary barriers to operating any type of meal program in their early childhood program.” —p. 4
“This program noted that the reimbursement consistently covers less than half of the cost of operating a meal program.” —p. 21
“37.50% of participating early childhood programs identified the time it takes to operate any type of meal program as a barrier to being able to provide snacks and meals. Time refers to the time it takes to procure food, prepare food, serve food, and to complete the necessary meal counts and other meal program requirements.” —p. 4
“46.88% of participating early childhood programs identified lack of staff as a barrier to operating a meal program. Many programs lack staff capacity for procuring food, preparing meals and snacks, and administering the federal Child and Adult Care Food Program (CACFP). —p. 4
Key Themes of the
Vermont Child Care and Early Childhood Systems Analysis
Conducted by Foresight Law and Policy and Watershed Advisors (supported by BBF) in 2022
“Stakeholders indicated that the comprehensive nature of the CIS approach has made it hard to define success for CIS—or to collect data on what success looks like. The divide in the stakeholder community among human services, education, and public health also has made it more difficult for CIS to expand its constituency.” —p. 19
“Stakeholders agreed that more could be done to improve data collection. Making data useful to the programs actually collecting information would be important to improving the accuracy of data. Moreover, those providers need better supports and training – and the data systems they are using need to be more user-friendly.” —p. 21
“A lack of systemic data. While individual services have data about their enrollment, the state does not have useful overarching data that can give policymakers a sense of how the system as a whole is serving children and families – including how some families may be accessing multiple services.” —p. 22
“Stakeholders generally acknowledged that there is not yet a consistent culture of using data for decision-making at the policy level, but pointed to important work going on to change that culture (including a new BBF website, and a new Data & Evaluation Committee organized by BBF). At the operational level there are some examples of successful data use, although there is inconsistency in data use practices across state agencies—and across communities.” —p. 21
“Access deserts. There are some communities that are simply underserved by CCECE [child care and early childhood education] programs, and the lack of data and coordination at the state level has made it harder to systemically address those service gaps.” —p. 22
“[T]he lack of focus on local capacity leads to significant equity issues among communities. Some communities have had the resources to develop more coherent local approaches, and there are examples of outstanding community collaborations. Unfortunately, the communities with the greatest need generally have not been able to develop successful local structures.” —p. 17
“One concern raised about the formal collaborative structures is that they are a place where participants put their best foot forward in a scripted manner, rather than digging into complex problems and trying to solve them; by this take, the behaviors at common tables are not reflective of those away from those tables.” —p. 20
“In sum, neither agency has an empowered senior leader focused solely on early childhood. Some of the problems that have festered in the system – described further below – seem to us symptomatic of that lack of high-level focused leadership.” —p. 10
“The early childhood system is diverse, and has a broad set of stakeholders central to its success. The lack of a high-level leader to whom a diverse set of stakeholders can raise awareness of concerns and have confidence they are empowered to solve, increases the complexity of the challenge: no single elevated leader feels accountable to all the groups needed for a successful early childhood system.” —p. 10
“Accordingly, the tension between the roles of the Agency of Human Services and the Agency of Education is a structural problem, not a personality problem. Indeed, the agencies repeatedly reminded us that they are in fact collaborating with each other; if they are actually collaborating, and providers are not seeing positive impacts from that collaboration, that reinforces the idea that the problem is a structural one. The current system simply does not allow for responsiveness to the challenges the system is facing.” —p. 9
“Another concern raised was that collaboration is a means, not an end – and that the existence of collaborative structures does not appear to have led to meaningful policy change.” —p. 20
“Different requirements for personnel in different settings. The state has no overarching definition of quality teaching in early childhood. AOE and AHS have different visions of teacher competency, which leads to very different expectations for professional development. Stakeholders reported a lack of alignment between the professional development offered to private providers and that offered to schools – and added that there is often significant inconsistency among schools themselves. Moreover, neither the AOE or AHS professional development systems are aligned with Head Start, nor is any of that professional development aligned with the coursework offered at community colleges and four-year institution.” —p. 22
“Some education stakeholders have articulated special education as a key reason to centralize early childhood services at school districts, given their capacity in that area. Human services stakeholders were more likely to advocate for increased flexibility in special education service delivery, allowing children to receive services in the settings where families have actually placed them.” —p. 20
“There can be a divergence between where special education services are needed and where they are offered. School districts are allowed to provide special education services in private settings, but generally choose not to. This can be challenging for parents who seek CCECE services outside a school setting – particularly in settings outside their home school district. Many parents seek private providers near where they work (or at least on their way to work), which might be outside the boundary of their home school district; for many such parents, obtaining special education services has been challenging.” —p. 22
“Overall, the sense of many stakeholders is that the state’s laudable emphasis on expanding access to child care and early childhood education services has not been accompanied by a necessary commitment to develop the staff capacity needed to help CCECE providers improve quality and expand capacity to meet the need.” —p. 16
“Many stakeholders also offered their view that for years the Agency of Education has not had a sufficient number of staff to meet its mandate. If the state is going to change its governance model, that provides an opportunity to redesign its capacity.” —p. 10
“The low pay for early childhood professionals makes it hard to attract talented staff, and most communities cannot afford to support local coordination and collaboration.” —p. 17
Key Themes of the
2020 Early Childhood Systems Needs Assessment
Conducted by Building Bright Futures – Vermont’s Early Childhood State Advisory Council in 2020
“When families struggle to meet their basic needs like food, shelter, diapers, health care, child care, and/or internet access, it increases stress, which can challenge their ability to effectively care for themselves and their children. Supporting parents’ ability to meet the basic needs of their child and family is critical to a child’s developmental trajectory.” —p. 15
“EC stakeholders have reported that Vermont currently lacks the data and resources to sufficiently collect data that answers key policy and program questions. Vermont’s technological infrastructure is antiquated, and there are limited people and time to collect and analyze data. Additionally, the culture does not promote data literacy at all levels of the EC system, or the collection and use of data in cross-sector collaboration.” —p. 47
“There is a clear need for an integrated early childhood (prenatal period to 8 years) data system that is connected to a longitudinal data system and other related public, nonprofit and private data sources and systems (e.g. child welfare, health, families and communities).” —p. 49
“BBF survey respondents identified a number of system-wide gaps in data, including: 1) a need to use proxy data because needed data is unavailable; 2) limited longitudinal outcomes data from and about statewide systems; 3) limited demographic data about children in Vermont who participate in programs; and 4) limited data about children with disabilities by town or geographic region.” —p. 60
“Currently, stakeholders generally agree that data is not being effectively used to understand and improve services and inform policy. Participants in the Needs Assessment identified challenges such as too many separate systems with out of date information, too little data being shared with stakeholders in a meaningful way, and a lack of ‘crosswalks’ for data when systems are not well aligned. Furthermore, Vermont is not yet using a strategy, including assignment of unique identifiers, to track child, parent, or workforce members across programs or over time to create a comprehensive, integrated data picture.” —p. 49
“[C]hild care capacity remains a critical need, especially for infants and toddlers, in addition to identifying gaps for other vulnerable populations…data from the 2020 Stalled at the Start Report shows that 50% of all children up to age three who are Likely To Need Care (LTNC) lack a regulated EC program in their county or region, with 62% of infants lacking access, and up to 89% of infants lacking access in rural counties.” —p. 22
“The Needs Assessment demonstrates how data collection is frequently siloed based on the service or sector. This creates challenges in understanding the quality and availability of all EC services; i.e. seeing the big picture. It is difficult to recognize opportunities for cross sector partnerships, when data is siloed within each sector, often due to funding and or policy restrictions from varying sources. Further, this can lead to misrepresentation or inequitable representation of the services used. —p. 27
“Vermont’s EC system is chronically underfunded which impacts the ability to meet the needs of each and every child and their family.” —p. 68
“There are several examples of incredible programs and initiatives (e.g. Help Me Grow, Children’s Integrated Services, Building Bright Futures, etc.) that have had strong initial investment, sometimes through legislative allocation and federal dollars, that are challenged to reach their full potential due to lack of sustainable funding sources. This elevates the concern for stable funding throughout the EC system.” —p. 45
“Vermont does not have a universal early childhood budget that identifies the resources, finances and supports allocated across all early childhood programs and services.” —p. 45
“EC services rely on a variety of funding sources, many of which do not provide the adequate funding required to meet demand. Having multiple funding sources also highlights the importance of reducing duplicative procedures, a barrier many EC programs have reported.” —p. 44
“Allocating funding for staff to have time to reflect and strategize at an individual, organizational and system level is critical to moving the EC field forward. In addition, funding for training is also necessary to provide system-wide partners with access to baseline knowledge and language to support discussions and strategy.” —p. 18
“The Needs Assessment identified a lack of integration among state agencies specific to administrative practices. This includes duplicative data collection procedures that don’t allow for data sharing or the tracking of longitudinal outcomes across programs for children and families.” —p. 39
“The early childhood field has strongly reported a need for aligned messaging and clarity in guidance documentation disseminated by state agency partners, and for those documents to be written in an accessible way.” —p. 39
“Parent leaders have outlined several barriers to participation including resources, transportation, professional development, inadequate interpretation services, and generally a lack of partnership and prioritization. Creating a culture that invites and supports family engagement, and provides the necessary training and coaching, is also needed to attract families who are unfamiliar or uncomfortable with formal school/organizations and the systems, language and processes used in the current decision-making structure.” —p. 43
“The Needs Assessment confirmed the need for more highly trained staff. This represents a need for greater workforce capacity, and more training with regard to mental health, social emotional development and trauma-informed approaches that are used across settings.” —p. 33
“The EC workforce is educating and supporting the health and well-being of Vermont’s future; our children. Yet, these professionals are still not paid in alignment with their value, skills and competencies, and disparities in pay exist across private and public settings.” —p. 34
Key Themes of
COVID-19 Vermont Family Impact Survey
Conducted by Let’s Grow Kids, Voices for Vermont’s Children, Building Bright Futures, Hunger Free Vermont, and Vermont Early Childhood Advocacy Alliance in 2020
“Concerns related to accessing preventive health care, fresh fruit or vegetables, and child care were particularly high for families…Families with children with special needs were more likely to identify concerns about accessing a variety of services following the ‘Stay Home, Stay Safe’ order including special education services, groceries and preventative health care.” —p. 10
“Almost half of survey respondents (48.4%) identified that their family is meeting their financial needs but living paycheck to paycheck.” —p. 2
“Households without children with special needs reported living ‘paycheck to paycheck’ 46% of the time, households with children with special needs reported living ‘paycheck to paycheck’ 60% of the time.” —p. 4
“Half of the essential workers who responded to this survey reported they could not meet their financial needs during this time.” —p. 8
“Over 17% of households surveyed indicated having Children with Special Needs. These families were also more likely to indicate that they were struggling to make ends meet.” —p. 2
Key Themes of
Vermont Maternal, Infant, Early Childhood Home Visiting Program
Conducted by Vermont Department of Health – Maternal and Child Health in 2020
“Families have more complex needs than ever before, and for low-income families meeting basic needs such as stable housing and access to food are critical.” —p. 25
“Nurse home visitors and community members described limited availability of high quality early childhood care (especially for infants).” —p. 26
“When staff turnover among any of the partners occurs, and especially when a vacancy is prolonged, partners have difficulty maintaining communication/ information flow and coordination.” —p. 39
“In addition, direct service providers who are part of the home visiting care continuum hold their roles tightly and benefit from clarity about the roles of others and where each fits in the system of care; some identified confusion about roles as a challenge in service delivery.” —p. 39
“Focus group participants expressed concern that practitioners in other fields do not conduct or use screening tools with the same consistency or fidelity, or that the professional culture of nurse home visitors differs from that of other kinds of providers serving low-income, at-risk families, with different values around the use of screening tools.” —p. 27
“Vermont’s integrated home visiting system is working well at the leadership level; there is room to improve coordination at the direct service level.” —p. 39
“Home visiting nurses and other service providers who refer families to home visiting and/or also serve home visiting populations (such as Parent Child Center staff, early childhood care providers, and providers who serve children with special needs) agree about the benefits of integration and coordination, but also identified numerous places where coordination could be strengthened.” —p. 39
“Nurse home visitors and community members described…few mental health providers when referrals are needed and a need for more mental health providers who are skilled in addressing postpartum depression and other maternal mental health conditions.” —p. 26
Health Care: “Home visiting nurses identified needs for flexible scheduling to better align with the needs of the families they serve.” —p. 40
“Throughout the state, there is a need for family-centered, accessible substance use treatment designed for mothers of young children, and offered in settings and approaches that reduce stigma associated with seeking treatment.” —p. 26
“In addition, nurses described limited ‘social work’ training within their nursing education, and expressed a need for more and different training and resources that reflects the scope of services they provide, and especially to address basic needs, poverty, trauma, and related topics.” —p. 40
“While the home visiting nurse’s job description is to provide traditional maternal and child care using nursing tools (breastfeeding support, nutrition and parenting education, well-baby support and screening, emotional support for new mothers), the vulnerability and multifaceted needs of families necessitates that home visiting nurses provide a much broader scope of care.” —p. 40
“Nurse home visitors and other MCH providers identified workforce shortages as a significant issue. Concerns related to this theme included high turnover, limited professional pathways for home visiting and public health nurses, need to protect staff from burnout, lower pay in public nursing settings when compared to hospital-based positions, and a desire for greater flexibility and autonomy within their roles. Many nurse home visitors stated that their roles require ‘too much paperwork,’ and that the time burden of administrative tasks detracts from their professional satisfaction.” —p. 26
“In addition, nurse home visiting supervisors expressed concern that many home visiting nurses have an income below the median in Vermont, and face similar concerns as they families they work with, such as difficulty finding affordable housing and childcare, or being unable to afford winter tires to safely drive to home visits.” —p. 26
Key Themes of
Vermont Department of Health Maternal and Child Health Division: Title V Five-Year Needs Assessment
Conducted by Vermont Department of Health – Division of Maternal and Child Health in 2019-2020
Basic Needs: “According to individuals who responded to the Access to Health and Wellness Survey, housing, food, and accessible and affordable healthcare were the three most ‘critically necessary factors for women, children, and families to thrive.’” —p. 15
Housing: “In focus groups and surveys, access to housing was the most commonly identified unmet need for families.” —p. 14
Transportation: “Transportation barriers, including lack of public transportation in rural areas, no usable vehicle (including no winter tires, need for repairs, vehicle not insured or not inspected), difficulty accessing family-friendly transportation for low-income households where a child or adult has special health needs were common themes.” —p. 14
“Providers and consumers described difficulty finding local childcare providers who are trained and registered to provide care for CSHN [Children with Special Health Needs]; issues with providers ‘expelling’ young children with CSHN (and especially CSHN with spectrum disorders) from care.” —p. 29
“According to Vermont Afterschool, between 12% and 30% of Vermont middle and high school students do not participate in any sort of group activity supervised by trained adults when they are not at home or school.” —p. 26
“Needs that were identified included limited access to dental care, needs for more culturally responsive mental health care services, and needs for culturally responsive prenatal, maternity, and perinatal services and supports.” —p. 31
“According to 2018 PRAMS [Pregnancy Risk Assessment Monitoring System] data, young women and low-income women in Vermont experience substantially higher rates of unintended pregnancies.” —p. 20
“Which barriers prevent you or your family from receiving services or resources? For pre-pregnancy/ pregnancy-related care, language barriers (69.6%); For perinatal/infant care, language barriers (65.2%).” —p. 16
Mental health, services and specialty care: “Regional differences in levels of care may undermine equity and positive results in some areas of Vermont.” —p. 3
“Vermont’s rural nature means that many kinds of health and human services are concentrated in a few larger towns. In Vermont’s most remote counties, residents may have to travel outside of their region to receive services…Services that are provided via contracts with local service agencies may be especially likely to provide different levels of care for similar services.” —p. 39
“In this assessment, MCH providers and services users rarely discussed the health needs and concerns among BIPOC communities who are not immigrants or refugees. The low visibility for the health concerns that BIPOC mothers, infants, children and adolescents face warrants continued investigation.” —p. 4
“In rural Vermont, conditions for low-income women and families can be obscured by state and county-level data because of their small proportion of the population.” —p. 12
“Many MCH providers stated that mental health support for children, including screening, psychiatric evaluations, outpatient counseling, and intensive/inpatient treatment services are largely unavailable, or that there are long waitlists for pediatric mental health specialists. The number of children who accessed mental health services has increased substantially in the last two decades, from 1,708 children in 1999 to to 3,322 in 2018.” —p. 26
“All MCH populations identified mental health conditions and access to mental health care as important concerns.” —p. 21
“Substance use and dependence during pregnancy is a significant problem in Vermont, where the rate of substance use during pregnancy (28.2 per 1,000 births) is four times higher than the U.S. rate (6.8 per 1,000 births).” —p. 20
“MCH providers agreed that addressing substance use among pregnant women is difficult, largely because of the significant stigma women encounter. Providers stated that pregnant women may be reluctant to identify and seek care for substance use, fearing negative responses from physicians and other health care providers. Home visitors noted that they may receive and follow different guidance pertaining to alcohol, marijuana, and substance use during pregnancy than the physicians who are providing prenatal care.” —p. 21
Healthcare, mental health, services, and specialty care: “Regional differences in levels of care may undermine equity and positive results in some areas of Vermont.” —p. 3
Figure 6: “Perceived barriers to care: application forms too complicated, not eligible for services, needed service not offered by provider, language barriers, do not know what services and resources are available, access to information.” —p. 17
Children with special health needs: “Providers stated that in most regions of Vermont families with CSHN [Children with Special Health Needs] encounter difficulty when children reach any transition point, including as CSHN age (from 0-3 to pre-K/school-age services, across grade levels, and from pediatric to adult systems), as well as when families are ‘handed off’ from and/or served by multiple systems.” —p. 29
“Vermont’s child protection system under the Department for Children and Families (DCF) has encountered rising caseloads and increasingly complex cases, including rising cases where parental substance use is a factor.” —p. 24
Complexity of cases healthcare: “In general, providers noted that low-income families’ needs have become more complex, and that providers are rarely called upon to address only one category of need. For example, a family with a newborn may have older children with special health needs, a parent dealing with substance use issues, and have difficulty maintaining stable housing. Fully addressing families’ diverse needs requires substantial cross training among providers of services for families, and well-coordinated team approaches when multiple kinds of specialized expertise are needed.” —p. 22
“Nurse home visitors, CSHN [Children with Special Health Needs] staff, and other MCH providers identified workforce shortages as a significant issue. Concerns related to this theme included high turnover, limited professional pathways for public health nurses, need to protect staff from burnout, lower pay in public nursing settings when compared to hospital-based positions, and a desire for greater flexibility and autonomy within their roles. Many direct service providers stated that their roles require ‘too much paperwork,’ and that the time burden of administrative tasks detracts from their professional satisfaction.” —p. 35
Key Themes of
Report: Women with Lived Experience of Perinatal Mood and Anxiety Disorders in Vermont
Conducted by Vermont Department of Health in 2019
“The most common barriers to accessing mental health treatment discussed by participants included:
- Finding a mental health provider with whom they stated they felt a connection
- Difficulty opening up to the mental health provider
- Difficulty opening up to their medical provider about their need for mental health support
- Challenges finding a mental health provider that accepted the participant’s insurance
- Concerns about psychotropic medication
- Financial barriers and insurance
- Hard to get alone time for appointments
- Difficulty finding providers with specialization in PMADs [Perinatal Mood and Anxiety Disorders]
- Hard to find a provider in my area
- Getting providers to listen to concerns
- Lack of knowledge of resources
- Lack of provider follow-up
- COVID-19 safety
- Seeing different providers each time
- Inability to take time out of the day to access supports
- Timeframe of accessing supports
- Transfer of care.”
—pp. 8-9