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Strengthen the Evidence for Maternal and Child Health Programs

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Items in this list may be obtained from the sources cited. Contact information reflects the most current data about the source that has been provided to the MCH Digital Library.


Displaying records 1 through 20 (144 total).

Children's Health Alliance of Wisconsin. 2024. Wisconsin Seal-A-Smile administration manual. Milwaukee, WI: Children's Health Alliance of Wisconsin, 31 pp.

Annotation: This manual provides policies and procedures for Wisconsin Seal-A-Smile (SAS) grantees, with the goal of helping them administer programs and ensure consistency across programs. The purpose of SAS is to improve the oral health of Wisconsin children through school-based dental sealant programs. Topics include administrative and regulatory guidelines; program requirements; forms, reporting, and recording; and budget and funding information.

Contact: Children's Health Alliance of Wisconsin, 6737 West Washington Street, Suite 1111, West Allis, WI 53214, Telephone: (414) 292-4000 Secondary Telephone: (414) 337-4561 Fax: (414) 231-4972 Web Site: https://www.chawisconsin.org/ Available from the website.

Keywords: Administration, Data collection, Dental sealants, Disease prevention, Forms, Grants management, Oral health, Prevention programs, Reimbursement, School age children, School health programs, School health services, Screening, State programs, Wisconsin

U.S. Centers for Medicare & Medicaid Services. 2024. Transforming Maternal Health (TMaH) Model . Baltimore, MD: U.S. Centers for Medicare & Medicaid Services,

Annotation: This website describes the Transforming Maternal Health (TMaH) Model, a new CMS (Centers for Medicare & Medicaid Services) initiative designed to improve maternal health care for women enrolled in Medicaid and CHIP. The CMS site explains how the new model supports participating state Medicaid agencies in developing a whole-person approach to pregnancy, childbirth, and postpartum care that addresses physical, mental health, and social needs.It details the model's three main pillars: Access to care and workforce capacity, quality improvement and safety, and whole-person care delivery. The site includes a link to the 2024 CMS funding opportunity notice (NOFO) and identifies the 15 states selected to participate in the 10-year program that launched January 2025. It explains how the model aims to improve maternal outcomes while reducing health disparities and program expenditures and provides information about technical assistance for participating states to implement evidence-based protocols, develop health equity plans, and create alternative payment models for maternity care services. Links to related fact sheets, recorded webinars, and CMS service-delivery partners are also included.

Contact: U.S. Centers for Medicare & Medicaid Services, 7500 Security Boulevard, Baltimore, MD 21244, Telephone: (800) 633-4227 Secondary Telephone: (877) 267-2323 Fax: Web Site: https://www.cms.gov

Keywords: Applications, Childbirth, Federal initiatives, Grants, Maternal health, Medicaid, Model programs, Postpartum care, Pregnancy, State programs

2021. Learn the signs. Act Early. AMCHP's State Systems Grant: Eight Years in Review. [Washington, DC]: Association of Maternal and Child Health Programs, 17 pp. (Issue Brief)

Annotation: This report discusses the "Learn the Signs. Act Early" (LTSAE) state systems grant program's impact on improving early identification and intervention for children with Autism Spectrum Disorder and developmental disabilities. It examines three key impact areas: 1) engaging stakeholders and strengthening partnerships across 29 states, 2) training and raising awareness among key stakeholders in 28 states, and 3) developing statewide systems improvements. The document provides detailed case studies from multiple states, including Virginia's success in developing diagnostic teams, Mississippi's statewide coordination efforts, and Massachusetts' multilingual outreach program. While states faced challenges like budget constraints and system coordination, the grant program successfully built state capacity for early identification and service coordination through formalized developmental monitoring, stakeholder engagement, and increased awareness among caregivers and providers.

Contact: Association of Maternal and Child Health Programs, 1825 K Street, N.W., Suite 250, Washington, DC 20006-1202, Telephone: (202) 775-0436 Fax: (202) 478-5120 E-mail: [email protected] Web Site: http://www.amchp.org

Keywords: MCH programs, State grants, Autism, Developmental screening, Developmental disabilities, Early intervention

Le LT, Watson K, Mayer R, Pickett O, Wasman W, Hewett-Beah R, Perry DF, Richards J. 2020. Strengthen the evidence for maternal and child health programs: National performance measure 7.1 Injury hospitalization ages 0 through 9 evidence review. Washington, DC: National Center for Education in Maternal and Child Health, Strengthen the Evidence for MCH Programs, 259 pp. (brief 9 pp.).

Annotation: This evidence review describes evidence-based and evidence-informed strategies that MCH Block Grant programs can implement to ensure that hospitalization rates for infants and children from unintentional and intentional injury are reduced. Contents include an introduction and background; review methods and results, including search results, characteristics of studies reviewed, intervention components, summary of study results, and evidence rating and evidence continuum; and implications of the review. [Funded by the Maternal and Child Health Bureau]

Contact: Strengthen the Evidence for MCH Programs, National Center for Education in Maternal and Child Health, Washington, DC Web Site: https://www.mchevidence.org/ Available from the website.

Keywords: Adolescents, Block grants, Children, Evidence-based practice, Hospitalizaton, Injury prevention, Literature reviews, Measures, Model programs, Policy development, Program planning, Resources for professionals, State MCH programs, Title V programs

Le LT, Watson K, Mayer R, Pickett O, Wasman W, Hewett-Beah R, Perry DF, Richards J. 2020. Strengthen the evidence for maternal and child health programs: National performance measure 7.2 Injury hospitalization ages 10 through 19 evidence review. Washington, DC: National Center for Education in Maternal and Child Health, Strengthen the Evidence for MCH Programs, 369 pp. (brief 10 pp.).

Annotation: This evidence review describes evidence-based and evidence-informed strategies that MCH Block Grant programs can implement to ensure that hospitalization rates for children and adolescents ages 10 through 19 from unintentional and intentional injury are reduced. Contents include an introduction and background; review methods and results, including search results, characteristics of studies reviewed, intervention components, summary of study results, and evidence rating and evidence continuum; and implications of the review. [Funded by the Maternal and Child Health Bureau]

Contact: Strengthen the Evidence for MCH Programs, National Center for Education in Maternal and Child Health, Washington, DC Web Site: https://www.mchevidence.org/ Available from the website.

Keywords: Adolescents, Block grants, Children, Evidence-based practice, Hospitalizaton, Injury prevention, Literature reviews, Measures, Model programs, Policy development, Program planning, Resources for professionals, State MCH programs, Title V programs

Le LT, Brady R, Sun BD, Perry DF, Richards J. 2020. Strengthen the evidence for maternal and child health programs: National performance measure 14.1 smoking in pregnancy evidence review. Washington, DC: National Center for Education in Maternal and Child Health, Strengthen the Evidence for MCH Programs, 108 pp. (brief 8 pp.).

Annotation: This evidence review looks at evidence-based and evidence-informed strategies that MCH Block Grant programs can implement to support smoking cessation in pregnancy. Contents include an introduction and background; review methods and results, including search results, characteristics of studies reviewed, intervention components, summary of study results, and evidence rating and evidence continuum; and implications of the review. [Funded by the Maternal and Child Health Bureau]

Contact: Strengthen the Evidence for MCH Programs, National Center for Education in Maternal and Child Health, Washington, DC Web Site: https://www.mchevidence.org/ Available from the website.

Keywords: Block grants, Evidence-based practice, Literature reviews, Measures, Model programs, Policy development, Pregnant women, Program planning, Resources for professionals, Smoking during pregnancy, State MCH programs, Title V programs, Tobacco use

Le L, Brady R, Hanssen P, Perry DF, Richards J. 2019. Strengthen the evidence for maternal and child health programs: National performance measure 11 medical home evidence review. Washington, DC: National Center for Education in Maternal and Child Health, Strengthen the Evidence for MCH Programs, 104 pp. (brief, 5 pp. ). (Strengthen the evidence base for maternal and child health programs)

Annotation: This report reviews evidence-informed and evidence-based strategies that Maternal and Child Health (MCH)Block Grant programs can implement to address National Performance Measure 11: Medical Home. It gives background information on pediatric medical homes; describes the national performance measure; discusses the approach used for the evidence review analysis; summarizes strategies identified in the evidence review; and discusses implications of the research. IT also discusses how the MCH Evidence Center can help state Title V programs implement interventions selected from this review. The brief summarizes the report.

Contact: Strengthen the Evidence for MCH Programs, National Center for Education in Maternal and Child Health, Washington, DC Web Site: https://www.mchevidence.org/ Available from the website.

Keywords: Block grants, Child health, Evidence-based practice, Literature reviews, Measures, Medical home, Model programs, Policy development, Program planning, Resources for professionals, State MCH programs, Title V programs

Le LT, Watson K, Mayer R, Pickett O, Perry DF, Richards J. 2019. Strengthen the evidence for maternal and child health programs: National performance measure 14.2 smoking in the household evidence review. Washington, DC: National Center for Education in Maternal and Child Health, Strengthen the Evidence for MCH Programs, 139 pp. (brief 8 pp.).

Annotation: This evidence review looks at evidence-based and evidence-informed strategies that MCH Block Grant programs can implement to decrease the percentage of children, ages 0 through 17, who live in households where someone smokes. Contents include an introduction and background; review methods and results, including search results, characteristics of studies reviewed, intervention components, summary of study results, and evidence rating and evidence continuum; and implications of the review. [Funded by the Maternal and Child Health Bureau]

Contact: Strengthen the Evidence for MCH Programs, National Center for Education in Maternal and Child Health, Washington, DC Web Site: https://www.mchevidence.org/ Available from the website.

Keywords: Measures, Adolescents, Block grants, Children, Evidence-based practice, Infants, Literature reviews, Model programs, Passive smoking, Policy development, Program planning, Resources for professionals, Smoking cessation, State MCH programs, Title V programs, Tobacco use

Association of Maternal and Child Health Programs. 2019. Learn the signs. Act early. AMCHP's state systems grant: Eight years (2011-2019) in review. Washington, DC: Association of Maternal and Child Health Programs, 17 pp. (Issue Brief)

Annotation: This issue brief highlights the successes, challenges, and lessons learned from the CDC's Learn the Signs. Act Early. (LTSAE) state systems grant program spanning eight years (2011-2019). Administered by the Association of Maternal & Child Health Programs in partnership with the Association of University Centers on Disabilities, the program funded 34 states to strengthen early identification and coordination of services for children with autism spectrum disorder and developmental disabilities. The document outlines three key impact areas: formalizing developmental monitoring as a priority, activating stakeholders and strengthening partnerships, and increasing awareness among caregivers and providers. Through state-specific case studies and survey data from grantees, the brief demonstrates how even modest funding ($10,000-$20,000 per state) led to sustainable system improvements, innovative cross-sector collaborations, and enhanced capacity to monitor development and connect families to early intervention services. The brief also addresses implementation challenges and emphasizes the critical role of relationship-building and family engagement in sustaining these efforts beyond the grant period.

Contact: Association of Maternal and Child Health Programs, 1825 K Street, N.W., Suite 250, Washington, DC 20006-1202, Telephone: (202) 775-0436 Fax: (202) 478-5120 E-mail: [email protected] Web Site: http://www.amchp.org

Keywords: Title V programs, Autism, State CHSCN programs, Grants, Case studies, Nebraska, Mississippi, Virginia, Montana, Oklahoma, California, New Mexico, Massachusetts

Bussanich P, Corona A, Leahy M, Taft K, Tage S. 2019. Learn the signs. Act Early. AMCHP's state systems grant: Eight years (2011-2018) in review. Washington, DC: Association of Maternal and Child Health Programs, 1 pp.

Annotation: This poster uses colorful maps and other graphics to summarize an eight-year review (2011-2018) of AMCHP's "Learn the Signs. Act Early" (LTSAE) state systems grant program, which aimed to strengthen early identification and service coordination for children with autism spectrum disorder and other developmental disabilities (ASD/DD). The analysis, based on an environmental scan of program documents and a survey of grant leads from 31 states (91% response rate), demonstrates the program's success in building state and community capacity through various approaches, including developing state autism plans, increasing legislative awareness, and creating multilingual educational programming. The initiative, part of the CDC's Act Early Initiative launched in 2007, has supported 34 states and jurisdictions through AMCHP's partnership with the Association of University Centers on Disabilities (AUCD), providing not only funding but also technical assistance and interstate collaboration opportunities, ultimately showing that while implementation approaches varied across states, successful strategies could be adapted and replicated to improve developmental monitoring and screening systems.

Contact: Association of Maternal and Child Health Programs, 1825 K Street, N.W., Suite 250, Washington, DC 20006-1202, Telephone: (202) 775-0436 Fax: (202) 478-5120 E-mail: [email protected] Web Site: http://www.amchp.org

Keywords: Title V programs, Autism, Data analysis, State grants, State CHSCN programs

Johns Hopkins Bloomberg School of Public Health, Women's and Children's Health Policy Center. 2018. Strengthen the evidence base for maternal and child health programs: NPM 4: Breastfeeding [NPM 4 brief]. Baltimore, MD: Johns Hopkins Bloomberg School of Public Health, Women's and Children's Health Policy Center, 4 pp.

Annotation: This brief identifies evidence-informed strategies for state Title V programs to consider to increase the percent of infants who are ever breastfed and the percent of infants brastfed exclusively through 6 months of age. Contents include information about the evidence continuum and the approach to the review, including examples of each type of intervention and its evidence rating; key findings; and implications. The full review is also available. [Funded by the Maternal and Child Health Bureau]

Contact: Johns Hopkins Bloomberg School of Public Health, Women's and Children's Health Policy Center, 615 North Wolfe Street, Room E4143, Baltimore, MD 21205, Telephone: (410) 502-5450 Fax: (410) 502-5831 Web Site: http://www.jhsph.edu/wchpc

Keywords: Block grants, Breastfeeding, Evidence-based practice, Infants, Literature reviews, Measures, Model programs, Policy development, Program planning, Resources for professionals, State MCH programs, Title V programs

Garcia S, Payne E, Strobino D, Minkovitz C, Gross S. 2018. Strengthen the evidence for maternal and child health programs: National performance measure 4 breastfeeding evidence review. Baltimore, MD: Johns Hopkins Bloomberg School of Public Health, Women's and Children's Health Policy Center, 69 pp. (brief 4 pp.).

Annotation: This document identifies evidence-informed strategies that state Title V programs might consider implementing to increase the percent of infants ever breastfed and the percent of infants breastfed exclusively through 6 months. Contents include an introduction and background; review methods and results, including search results, characteristics of studies reviewed, intervention components, summary of study results, and evidence rating and evidence continuum; and implications of the review. [Funded by the Maternal and Child Health Bureau]

Contact: Johns Hopkins Bloomberg School of Public Health, Women's and Children's Health Policy Center, 615 North Wolfe Street, Room E4143, Baltimore, MD 21205, Telephone: (410) 502-5450 Fax: (410) 502-5831 Web Site: http://www.jhsph.edu/wchpc

Keywords: Block grants, Breastfeeding, Evidence-based practice, Literature reviews, Measures, Model programs, Policy development, Program planning, Resources for professionals, State MCH programs, Title V programs

Johns Hopkins Bloomberg School of Public Health, Women's and Children's Health Policy Center. 2018. Strengthen the evidence base for maternal and child health programs: NPM 6: Developmental screening [NPM 6 brief]. Baltimore, MD: Johns Hopkins Bloomberg School of Public Health, Women's and Children's Health Policy Center, 4 pp.

Annotation: This brief identifies evidence-informed strategies for state Title V programs to consider to increase the percent of children ages 9-71 months receiving a developmental screening using a parent-completed screening tool.. Contents include information about the evidence continuum and the approach to the review, including examples of each type of intervention and its evidence rating; key findings; and implications. The full review is also available. [Funded by the Maternal and Child Health Bureau]

Contact: Johns Hopkins Bloomberg School of Public Health, Women's and Children's Health Policy Center, 615 North Wolfe Street, Room E4143, Baltimore, MD 21205, Telephone: (410) 502-5450 Fax: (410) 502-5831 Web Site: http://www.jhsph.edu/wchpc Available from the website.

Keywords: Block grants, Developmental screening, Evidence-based practice, Literature reviews, Measures, Model programs, Policy development, Program planning, Resources for professionals, State MCH programs, Title V programs, Young children

Garcia S, Brown E, Strobino D, Minkovitz C. 2018. Strengthen the evidence for maternal and child health programs: National performance measure 6 developmental screening evidence review. Baltimore, MD: Johns Hopkins Bloomberg School of Public Health, Women's and Children's Health Policy Center, 48 pp. (brief 4 pp.).

Annotation: This document identifies evidence-informed strategies that state Title V programs might consider implementing to increase the percent of children, ages 9 through 71 months, receiving a developmental screening using a parent-completed screening tool. Contents include an introduction and background; review methods and results, including search results, characteristics of studies reviewed, intervention components, summary of study results, and evidence rating and evidence continuum; and implications of the review. [Funded by the Maternal and Child Health Bureau]

Contact: Johns Hopkins Bloomberg School of Public Health, Women's and Children's Health Policy Center, 615 North Wolfe Street, Room E4143, Baltimore, MD 21205, Telephone: (410) 502-5450 Fax: (410) 502-5831 Web Site: http://www.jhsph.edu/wchpc Available from the website.

Keywords: Block grants, Developmental screening, Evidence-based practice, Literature reviews, Measures, Model programs, Policy development, Program planning, Resources for professionals, State MCH programs, Title V programs, Young children

Garcia S, Yarborough C, Pelaez D, Strobino D, Minkovitz C. 2018. Strengthen the evidence for maternal and child health programs: National performance measure 10 adolescent well visit evidence review. Baltimore, MD: Johns Hopkins Bloomberg School of Public Health, Women's and Children's Health Policy Center, 37 pp. (brief 4 pp.).

Annotation: This evidence review looks at interventions designed to increase the percentage of adolescents, ages 12 through 17, who received a preventive medical visit in the past year. Contents include an introduction and background; review methods and results, including search results, characteristics of studies reviewed, intervention components, summary of study results, and evidence rating and evidence continuum; and implications of the review. [Funded by the Maternal and Child Health Bureau]

Contact: Johns Hopkins Bloomberg School of Public Health, Women's and Children's Health Policy Center, 615 North Wolfe Street, Room E4143, Baltimore, MD 21205, Telephone: (410) 502-5450 Fax: (410) 502-5831 Web Site: http://www.jhsph.edu/wchpc Available from the website.

Keywords: Adolescents, Block grants, Evidence-based practice, Health supervision, Literature reviews, Measures, Model programs, Policy development, Program planning, Resources for professionals, State MCH programs, Title V programs, Well child care

Corona A. 2018. State systems for parent-engaged developmental monitoring: A review of eight years of state system-level grantee work. Washington, DC: Association of Maternal and Child Health Programs, 16 pp.

Annotation: This presentation reviews eight years of state system-level grantee work through the Learn the Signs. Act Early. (LTSAE) initiative focused on improving parent-engaged developmental monitoring. It examines how the Association of Maternal & Child Health Programs (AMCHP) provided grants to states to strengthen early identification systems for developmental delays and disabilities, including autism. The presentation identifies three key impact points: increased awareness among caregivers and providers about developmental monitoring, activated stakeholders and strengthened partnerships, and formalized developmental monitoring as a priority. It showcases case studies from Massachusetts, Oklahoma, and Virginia demonstrating successful approaches to integrating LTSAE developmental monitoring tools into state systems. Survey results indicate high rates of success, with 94% of grantees meeting their objectives and maintaining sustainable efforts. The presentation concludes by highlighting freely available LTSAE resources that can be integrated into existing early childhood systems.

Contact: Association of Maternal and Child Health Programs, 1825 K Street, N.W., Suite 250, Washington, DC 20006-1202, Telephone: (202) 775-0436 Fax: (202) 478-5120 E-mail: [email protected] Web Site: http://www.amchp.org

Keywords: Developmental screening, Autism, Grants, State CHSCN programs, Case Studies, Massachusetts, Oklahoma, Virginia

Pudelski S. 2017, 2018. Cutting Medicaid: A prescription to hurt the neediest kids. Alexandria, VA: AASA, The School Superintendents' Association, 11 pp. (addendum 4 pp.).

Annotation: This report presents findings from a survey of school leaders about how service delivery and student health would be impacted by a decline in Medicaid reimbursement. The report outlines the survey questions and findings, highlights how students with disabilities and students with low incomes will be impacted by a per-capita cap or Medicaid block grant, describes how communities will be economically affected by a per-capita cap or Medicaid block grant for school districts, details the potential of districts to lose critical mental health supports for students that are reimbursable by Medicaid, and notes how district efforts to expand Medicaid coverage to students and their families will be undermined by a block grant or per-capita cap.

Contact: AASA, The School Superintendents' Association, 1615 Duke Street, Alexandria, VA 22314, Telephone: (703) 578-0700 Fax: (703)-841-1543 E-mail: [email protected] Web Site: http://www.aasa.org Available from the website.

Keywords: Adolescent health, Adolescents, Block grants, Child health, Children, Financing, Low income groups, Medicaid, National surveys, Policy development, Reimbursement, School age children, School districts, Service delivery, Special health care needs, State programs, Students

Segal LM, Martin A. 2017. A funding crisis for public health and safety: State-by-state public health funding and key health facts. Washington, DC: Trust for America's Health, 23 pp. (Issue report)

Annotation: This report examines the status of federal public health funding for states, state public health funding, and key health facts. Topics include an overview of federal funding for states from the Centers for Disease Control and Prevention (CDC), CDC's Public Health and Prevention Funding for states, Health Resources and Services Administration's funding by state, state public health funding, key health facts, rising epidemics, effective investments to curb crises and cut costs, and recommendations.

Contact: Trust for America's Health, 1730 M Street, N.W., Suite 900, Washington, DC 20036, Telephone: (202) 223-9870 Fax: (202) 223-9871 E-mail: [email protected] Web Site: http://healthyamericans.org Available from the website.

Keywords: Community based services, Data analysis, Federal programs, Government financing, Grants, Health statistics, Prevention programs, Public health infrastructure, State programs

Mann R, Mays A. 2017. State ESSA plans to support student health and wellness: A framework for action (3rd ed.). Chicago, IL: Healthy Schools Campaign, 29 pp.

Annotation: This document provides guidance on developing state plans for implementing the Every Student Succeeds Act (ESSA) in ways that support student health and wellness. Topics include engaging stakeholders in a way that ensures an effective ESSA state plan is developed and implemented; implementing a state accountability system and creating a school report card that supports the health and learning connection; integrating health and wellness into standards, assessments, and a well-rounded education; integrating student learning through staff wellness and professional development; supporting the transition from early childhood programs to elementary school; transferring funding to strengthen ESSA health and wellness programming; the Student Support and Academic Enrichment grant; and looking ahead. For each topic, the document outlines why it's important, what the law says, action steps, and resources. An overview of ESSA is included.

Contact: Healthy Schools Campaign, 175 N. Franklin, Suite 300, Chicago, IL 60606, Telephone: (312) 419-1810 Fax: (312) 419-1806 Web Site: http://www.healthyschoolscampaign.org Available from the website.

Keywords: Academic achievement, Accountability, Adolescent health, Case studies, Child health, Federal initiatives, Financing, Grants, Learning, Needs Assessment, Organizational change, Policy development, School age children, School health programs, Schools, Service integration, Standards, Statewide planning, Students, Transitions

Karp C, Lai Y-H, Garcia S, Grason H, Strobino D, Minkovitz C. 2017. Strengthen the evidence base for maternal and child health programs: NPM 2–Low-risk cesarean deliveries [NPM 2 brief]. Baltimore, MD: Johns Hopkins Bloomberg School of Public Health, Women's and Children's Health Policy Center, 3 pp.

Annotation: This brief and evidence review summarize the literature on evidence-based and evidence-informed strategies to promote the safety and effectiveness of receiving oral health care during pregnancy. They provide background information on oral health during pregnancy, discuss key research methods and results, and present key findings and implications. [Funded by the Maternal and Child Health Bureau]

Contact: Johns Hopkins Bloomberg School of Public Health, Women's and Children's Health Policy Center, 615 North Wolfe Street, Room E4143, Baltimore, MD 21205, Telephone: (410) 502-5450 Fax: (410) 502-5831 Web Site: http://www.jhsph.edu/wchpc Available from the website.

Keywords: Block grants, Cesarean section, Childbirth, Childbirth education, Doulas, Evidence-based practice, Intervention, Literature reviews, Measures, Model programs, Patient care, Policy development, Program planning, Resources for professionals, State MCH programs, Therapeutics, Title V programs

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The MCH Digital Library is one of six special collections at Geogetown University, the nation's oldest Jesuit institution of higher education. It is supported in part by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under award number U02MC31613, MCH Advanced Education Policy with an award of $700,000/year. The library is also supported through foundation and univerity funding. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.