2026 CHNA Implementation Strategy

CHILDREN’S HEALTH NEEDS ASSESSMENT

Implementation Strategy

2026-2028

About Children’s Since 1911, Children’s of Alabama (“Children’s”) has provided specialized medical care for ill and injured children. Ranked among the best children’s hospitals in the nation by U.S. News & World Report, Children’s serves patients from every county in Alabama and nearly every state. With more than 3.5 million square feet, it is one of the largest pediatric medical facilities in the United States. Children’s o‡ers inpatient and outpatient services at its Russell Campus on Birmingham’s historic Southside with additional specialty services provided at Children’s South, Children’s

on 3rd Outpatient Center, and in Huntsville and Montgomery. Primary medical care is provided in more than a dozen communities across central Alabama. Children’s is the only health system in Alabama dedicated solely to the care and treatment of children. It is a private, not-for-profit medical center that serves as the teaching hospital for the University of Alabama at Birmingham (“UAB”) pediatric medicine, surgery, psychiatry, research and residency programs. The medical sta‡ consists of UAB faculty and Children’s full-time physicians as well as private practicing community physicians.

CHILDREN’S BY THE NUMBERS

656,014

991

patient visits in 2025 and 16,485 patient admissions to the hospital

patients received via Critical Care Transport

49 States

33,655 encounters by 31 child life specialists and 2 medical dogs

Children’s of Alabama served patients from

across the U.S. and 6 other countries

Level IV NICU in the state and saw 380 admissions in 2025

Children’s of Alabama has the only

72,669

90%

of Alabama’s childhood cancer and blood disorders are treated at our hospital

Children’s was the busiest pediatric emergency department in the Southeast, serving

patients last year

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IMPLEMENTATION STRATEGY

CHILDREN’S HEALTH NEEDS ASSESSMENT

The 2025 Community Health Needs Assessment (“CHNA”) for Children’s of Alabama was conducted by the Public A‡airs Research Council of Alabama (“PARCA”) in accordance with IRS and A‡ordable Care Act regulations. PARCA is a trusted state-wide resource, with unique insight into the state of Alabama and the challenges faced by the pediatric and adolescent population. The study integrated quantitative data, survey responses, and focus group findings to identify the leading health, access, and safety challenges a‡ecting children in Alabama. The analysis included: A statewide community survey (780 respondents) addressing perceived child health, healthcare access, and safety issues. Four focus groups representing diverse populations: Pickens County (rural providers), Birmingham City School students, Jefferson County students, and West End (Jefferson County) caregivers. Respondents represented 58 of Alabama’s 67 counties; 55% resided in the Birmingham, Alabama, Metropolitan Statistical Area or “BMSA” (Bibb, Blount, Chilton, Je‡erson, Shelby, St. Clair, and Walker counties), and 45% lived elsewhere. 70% lived in urban counties, and 30% lived in rural areas. The 2025 CHNA confirms three priority needs for Alabama’s children: mental and behavioral health, healthcare access and a‡ordability, and child safety/risk prevention. Children’s will address these needs through statewide and regional partnerships, telehealth and outreach, provider education, transportation/navigation support, safety education, and targeted work in rural and underserved communities. Secondary data from state and national sources, including the US Census Bureau, Centers for Disease Control and Prevention, Feeding America, and VOICES for Alabama’s Children.

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IMPLEMENTATION STRATEGY

2023-2025 Implementation Plan Evaluation

Children’s engaged PARCA to conduct its 2023-2025 CHNA.

Keeping with the methodology of the 2019 CHNA, the instruments used were an online survey, focus groups, one-on-one interviews with key stakeholders, and secondary data research. The three areas of focus for the 2023-2025 timeframe were, in non-ranked order: 1 Child/adolescent safety was a top concern for all age groups, although the specific type of safety concerns shifted with older children and teens to concerns about substance abuse and mental health. Access to healthcare was important for all age bands but most important from birth to age five. Secondary data confirmed the urgency of healthcare access issues for children birth to age 5, as Alabama remains at the bottom of the national rankings for low birth weight and infant mortality. Access to healthcare for older children (6-13 and 14-18) often included references to access to mental health services. Parent and caregiver safety education about available services and resources and how to navigate them seems to be emerging as a missing piece between secondary data indicating children in Alabama are well insured and primary data including patients perceive their access to healthcare is limited. 2 3

Key measurements for the three (3) areas of focus included on pages 6 thru 8.

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IMPLEMENTATION STRATEGY

CHILD AND ADOLESCENT SAFETY

• Child and adolescent safety have remained a priority for Children’s since the first CHNA in 2013. Patient health and safety programming is within the purview of the Children’s Health Education and Safety Center (“HESC”). The HESC includes Safe Kids, Alabama LifeStart, and ThinkFirst. These programs focus on general safety, brain and head trauma and sudden cardiac arrest. From 2023 – 2025, the Center reached more than 47,300 children and adults across all 67 counties. During the evaluation period, HESC statistics included:

– More than 1,800 car seats and booster seats were provided to those in need throughout the state of Alabama. – Approximately 6,500 teens across Alabama received education on safe teen driving and Alabama’s Graduated Driver License Law. – More than 22,200 students, representing 10 di‡erent counties, participated in the ThinkFirst program, promoting brain and spinal cord injury prevention. Through this program, more than 1,900 bike helmets were distributed. – Through the School Nurse Outreach Program, 24 virtual education sessions were provided to school nurses, with more than 6,700 nurses in attendance. – The Alabama LifeStart program focused on raising awareness of sudden cardiac arrest and was a community advocate for CPR/AED readiness. Approximately 80 public and private schools, daycares, More than 1,900 bike helmets distributed

and athletic programs were designated as ‘Heart Safe’ through this program. – In 2025, the Center began safe firearms storage education, reaching more than 600 individuals and distributing more than 335 cable gun locks. – In 2024 and 2025, the Center was awarded a grant from the Alabama Department of Economic and Community A‡airs (“ADECA”) to raise awareness across the state of pediatric vehicular heatstroke.

• The Alabama Poison Information Center (“APIC”) at Children’s of Alabama handled an average 118,000 calls annually from all 67 counties in 2023-25. The APIC has served the state since 1958, o‡ering free, confidential poison and snakebite envenomation information and treatment recommendations to the public and health care providers. The sta‡ includes nurses and pharmacists certified by the American Association of Poison Control Centers. The management team includes a doctoral credentialed clinical toxicologist and medical directors credentialed in emergency medicine, pediatrics, and toxicology.

• The APIC participated in a yearly average of 170 hours of community health events, distributing poison prevention information to over 10,000 Alabamians. Along with Healthy Child Care Alabama (HCCA), the APIC provided 1,900 poison prevention programs, reaching approximately 11,000 parents across all counties.

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IMPLEMENTATION STRATEGY

As the mental health crisis continues across the country, children and teens are in greater need of mental health services than ever before.

HEALTHCARE ACCESS

• Partner with Kid One Transport – COA’s contribution helps support the non-emergent transport for children in over 50 counties to pediatric and primary care appointments. Annual transports average 15,000 - serving 2,000 children and parents. • Pediatric Access to Telemental Health Services (“PATHS”) - PATHS is a program dedicated to increasing capacity for primary care providers in all Alabama communities to diagnose, treat and manage mild to moderate behavioral health conditions in children and adolescents. It is designed to help primary care providers in these communities be better equipped to address pediatric mental health concerns.

PATHS provides: Behavioral health case consultation for primary care providers.

Referrals to behavioral health resources in the patient’s community where available.

Educational programs in the treatment of a variety of behavioral health disorders in children and adolescents.

Behavioral health services via telemedicine between a patient in the primary care office and a PATHS behavioral health professional at Children’s of Alabama, when specialist intervention is needed.

Care coordination for those patients with complex conditions or comorbid disorders.

As 2025 concluded, PATHS had enrolled over 130 practice sites and 517 participants, handling almost 1,500 telemedicine visits.

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IMPLEMENTATION STRATEGY

PARENT AND CAREGIVER SAFETY EDUCATION

Childrenʼs of Alabama served as a partner to the community for parent and caregiver health and safety education during the 2023-2025 period.

Psychiatric Intake Response Center (“PIRC”) - PIRC, located in the Emergency Department at Children’s, is a free, confidential phone response center designed to help adult callers and community providers in finding the appropriate level of mental health care. These services are provided via telephone by licensed mental health clinicians trained to assess a child or teen’s mental, emotional, and behavioral needs and recommend the best treatment options.

During the evaluation period, PIRC statistics included: 2,174 2,300 calls, averaging 181 a month Over

Emergency Department psychiatric consults, averaging 366 a month 4,395

providers in the PIRC database statewide and surrounding states in the Southeast. Focused e‡orts were to more ARC programs; autism, psychological, and neuropsychological testing providers; residential facilities; and certified adoption-competent and registered play therapists.

35+ events Attended an average of

200+ hours of PIRC outreach events eclipsed 5,500 community members. Impacted population by the

that PIRC either exhibited, sponsored or educated the community, with more than half reaching Alabama’s rural counties.

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IMPLEMENTATION STRATEGY

2026 2028 IMPLEMENTATION STRATEGY OVERVIEW

The CHNA is the foundational basis for a three-year community benefit implementation strategy (“IS”) designed to better coordinate and further develop Children’s general community-based e‡orts in support of improved child health and wellbeing. Children’s serves a geographically broad primary service area across Alabama, as defined in the CHNA. Patient origin data demonstrates that approximately 70% of discharges and visits originate from a multi-county

region that is not tightly clustered around the Birmingham campus.

Primary Service Area

Geographic Scope and Resource Allocation

Because Children’s of Alabama serves a geographically broad pediatric population, with patients originating from every county in Alabama and a primary service area that extends well beyond the Birmingham metropolitan region and the needs identified in the CHNA are not confined to one county or community, Children’s will use a layered implementation approach that combines statewide reach, regional partnerships, and targeted investments in communities with elevated need or high patient utilization. Children’s will prioritize resources based on a combination of patient origin data, CHNA findings, community input, program capacity, existing partnerships, and demonstrated barriers to care. This approach recognizes that some strategies are appropriately statewide, such as poison prevention, tele-mental health consultation, school nurse education, and injury prevention messaging, while others may be targeted to counties or regions with higher patient volume, rural access barriers, pediatric provider shortages, transportation challenges, or elevated safety risks. Implementation e‡orts will be reviewed annually to assess geographic reach, alignment with identified needs, and opportunities to adjust partnerships or outreach based on emerging data.

Layer

Purpose

Examples

Statewide Reach

Programs available to children, families, schools, and providers across Alabama

APIC, PATHS, PIRC, HESC digital education, school nurse training

Collaborations with providers, schools, hospitals, and community organizations in high-need or high-volume regions

COACHES, Kid One Transport, rural hospital partnerships, school trainings, community health events

Regional Partnerships

Focused work in communities with elevated need, access barriers, or strong alignment with CHNA priorities

Black Belt outreach, rural pediatric deserts, high-volume referral counties, firearm safety events, abuse prevention education

Targeted Local Investment

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IMPLEMENTATION STRATEGY

2026-2028 Implementation Stategy

This Implementation Strategy outlines Children’s of Alabama’s three year plan to address the significant pediatric health needs identified in the 2025 CHNA. The CHNA process confirmed persistent and emerging challenges facing Alabama’s children, with strong alignment between community perceptions and quantitative indicators. Mental and Behavioral Health The leading community concern (73% of survey respondents ranked it in their top three), driven by rising youth anxiety, depression, suicide (Alabama’s youth rate ranks 8th nationally), trauma, and behavioral challenges, compounded by stigma and limited counseling access. Healthcare Access and Affordability Barriers related to ability to pay (despite 97% insurance coverage), availability of quality pediatric and specialty services (especially in rural “pediatric deserts”), parent and caregiver safety education/ awareness, and transportation underscore concerns over healthcare access. Child Safety and Risk Prevention This identified need includes child abuse (rate of 10.6 per 1,000 children), caregiver substance use, firearm-related injuries, suicide, and youth risk behaviors linked to screen time/social media exposure and lack of safe spaces/supervision. The prioritized significant health needs that will guide our community benefit investments and partnerships from 2026 through 2028 are:

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IMPLEMENTATION STRATEGY

Caregiver education will focus on practical prevention strategies, including firearm safe storage.

APPROACH AND FRAMEWORK

Parent and Caregiver Education as a Cross-Cutting Strategy

Across the CHNA survey, focus groups and secondary data review, parent and caregiver education emerged as a recurring theme. Families often need not only access to services, but also clear information about available resources, when and where to seek care, how to navigate referrals, and how to prevent avoidable risks in the home, school, and community. Accordingly, Children’s will treat parent and caregiver education as a cross-cutting strategy across all three priority areas. In mental and behavioral health, parent and caregiver education will focus on early identification of anxiety, depression, behavioral concerns, grief, trauma, suicide risk, and crisis warning signs, as well as reducing stigma and connecting families to appropriate resources such as PATHS, PIRC, the Amelia Center, and community providers. In healthcare access, parent and caregiver education will focus on helping families understand available pediatric primary and specialty care resources, telehealth options, transportation supports, referral pathways, financial assistance where applicable, and how to prepare for and follow through with care. In child safety and risk prevention, parent and caregiver education will focus on practical prevention strategies, including safe sleep, car seat use, safe driving, poison prevention, firearm safe storage, heatstroke prevention, vaping/tobacco education, CPR/AED education, and recognizing signs of abuse, neglect, or unsafe environments.

Children’s will deliver parent and caregiver education through multiple channels, including community events, school partnerships, clinical encounters, digital and social media content, safety classes, care navigation resources, and partnerships with community-based organizations.

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IMPLEMENTATION STRATEGY

Scope of Children’s Role and Partnership Approach

Children’s of Alabama will focus its implementation strategy on areas that align with its pediatric expertise, statewide role, community benefit responsibilities, clinical programs, educational capacity, and established partnerships. Many of the needs identified through the CHNA are influenced by broader social, economic, educational, and community conditions that no single hospital or health system can address alone. Accordingly, Children’s will address these needs through a combination of direct services, education, telehealth, provider training, care navigation, data-sharing, advocacy, and strategic partnerships. For needs that extend beyond Children’s direct service capacity — such as poverty, housing instability, food insecurity, community violence, transportation infrastructure, a‡ordability of care, and statewide provider shortages — Children’s will seek to support, convene, partner, educate, refer, and advocate rather than duplicate the role of public agencies, insurers, or community-based organizations. This approach allows Children’s to remain focused on improving child health and well-being while working collaboratively with schools, public agencies, healthcare providers, transportation partners, nonprofits, law enforcement, faith-based and civic organizations, and community leaders. The following details Children’s of Alabama’s planned actions for each prioritized need. Implementation will begin in fiscal year 2026, with annual reviews to adjust for emerging data and/or community feedback. This IS was reviewed and approved by the Children’s Board of Trustees on May 21, 2026, and will be posted publicly on childrensal.org in compliance with federal requirements.

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IMPLEMENTATION STRATEGY

Mental and Behaviorl Health

Mental and behavioral health was the top community concern identified in the 2025 CHNA.

Community Need Mental and behavioral health was the top community concern identified in the 2025 CHNA. Children’s will address this need by extending pediatric behavioral health expertise into communities through telehealth, primary care consultation, school-based education, crisis navigation, grief support, abuse prevention, and statewide partnerships. This approach is designed to improve early identification, expand access to appropriate services, reduce stigma, and strengthen the ability of families, schools, pediatricians, and community providers to respond to the mental health needs of Alabama’s children. Children’s Role Children’s of Alabama is positioned to address this need by extending pediatric behavioral health expertise beyond the hospital walls through telehealth, provider consultation, crisis navigation, school-based education, grief support, abuse prevention, and statewide partnerships. Children’s will focus on strengthening the capacity of parents, schools, pediatricians, community providers, and local systems to identify needs earlier, connect children to appropriate services, and reduce avoidable crisis utilization. Strategic Response Children’s will use a multi-channel behavioral health strategy focused on: • expanding access to pediatric mental health consultation and telehealth; • supporting primary care providers in diagnosing and managing mild to moderate behavioral health conditions; • improving crisis navigation and referral pathways for families; • reducing stigma through education and community outreach; • strengthening school and community capacity to recognize and respond to behavioral health concerns; • equip parents and caregivers to recognize early warning signs, reduce stigma, understand crisis resources, and connect children to appropriate behavioral health services; • supporting children and families affected by grief, trauma, abuse, and neglect.

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IMPLEMENTATION STRATEGY

Children’s seeks to improve support for rural and underserved children and families.

Intended Outcomes Through these e“orts, Children’s seeks to: • improve timely access to pediatric behavioral health expertise;

• support earlier identification and intervention; • reduce stigma around mental health needs; • improve referral completion and care navigation; • reduce avoidable emergency department utilization for behavioral health crises; • improve support for rural and underserved children and families.

Measure of Progress Children’s will track annually:

Measure

Suggested Metric

Access

Number of PATHS practice sites, counties reached, providers enrolled, telemedicine visits, and tele-consults

Provider Capacity

Number of ECHO sessions, PCIT-trained providers, school trainings, and conference attendees

Crisis Navigation

PIRC call volume, referral completion rate, types of referrals made, counties represented

Timelines

Wait times for outpatient behavioral health services where Children’s has available data

Community Reach

Number of school systems, community events, and outreach participants

Outcomes

ED psychiatric consult trends, crisis call trends, suicide ideation/attempt data where available through partners

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IMPLEMENTATION STRATEGY

PATHS brings behavioral health case consultation and treatment service to primary care practices that are enrolled in the program.

2026 2028 STRATEGIES AND TACTICS

Pediatric Access to Telemental Health Services (“PATHS”)

More than 500 physicians and allied health professionals in over 150 practices participate in the HRSA-funded PATHS initiative in over 45 counties statewide. PATHS brings behavioral health case consultation and treatment service to primary care practices that are enrolled in the program, via tele-mental health services provided by Children’s. Providers include licensed behavioral health professionals and an infant/early childhood mental health consultant. The PATHS team comprises child/adolescent psychiatrist, psychiatric nurse practitioners, child/adolescent

psychologists, licensed clinical social workers, and licensed professional counselors. Although the grant covers approximately 80% of PATHS operations, Children’s provides a match of 20%, although Children’s consistently contributes on average 22 – 25% of support.

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IMPLEMENTATION STRATEGY

• Providers pursuing this training on their own would have to pay approximately $5000 to attend. Children’s provides this training at no cost to the participant. • This is the only evidence-based treatment option in the state for children ages 2-7 for behavior management. • Host an annual education conference for PCIT providers statewide, allowing providers to receive ongoing education specific for PCIT treatment modality. PATHS will continue to: Provide Parent-Child Interaction Therapy (“PCIT”) training for providers statewide, which includes one week of in-person trainings and periodic virtual check ins to ensure competency. • These trainings are provided by mental health professionals that have expertise in the topic being presented. • Practical tips/takeaways are provided which can immediately be used in the school setting. • Common topics addressed: anxiety in teens, classroom behavior management, youth social media/electronic device usage, classroom support for students with Autism. • The trainings are interactive, provide education on the identified topic, and allow for questions and clarifications at the end, promoting engagement and adding needed support for school personnel. School Trainings - PATHS will deliver trainings to school systems (teachers, counselors, nurses, administrators) on various topics the school system determines to be a need. • Continue the core work being done to support primary care providers throughout Alabama (e.g., ECHO education sessions, tele-consult, tele-medicine, etc.). • Continue supporting the PCIT providers with resources and ongoing education to maintain their expertise and competence in this treatment modality. • Continue School Trainings and standardize a toolkit of options from which schools can choose, allowing Children’s to reach more schools (i.e., having a robust library of trainings and presentations developed vs. creating new education/presentation materials). • Expand tele-consults into the specialty clinics at Children’s, allowing specialists to contact a psychiatrist through PATHS for patient mental health related concerns. • O‡er opportunities to primary care providers for our mental health experts to provide recommendations on creating sensory friendly spaces within their o®ces. Other Planned Initiatives: be used in the school setting.

Practical tips/takeaways are provided which can immediately

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IMPLEMENTATION STRATEGY

Approximately 4,500 adults and 24,000 children are reached by the CHIPS Centerʼs educational sessions and trainings annually.

Psychiatric Intake Response Center (“PIRC”)

The PIRC is a no cost, confidential phone response center. Licensed mental health professionals answer calls and link adult

the state, averaging a community outreach of over 3,000 individuals annually. The PIRC receives around 2,000 calls annually from almost every county in Alabama. The Center also provides ongoing behavioral health consultation and presentations to area school systems. PIRC will continue the core work to develop and maintain the PIRC database to provide additional resources and support to individuals who contact the PIRC line. PIRC will also plan a media and marketing push in 2026 to raise awareness/ education on the service to the general public.

caregivers and community providers to the most appropriate mental health resources for children and teens. Additionally, support, education, and safety planning are provided. The PIRC team exhibits at multiple conferences, providing information to professionals, schoolteachers, counsellors, DHR personnel, and others throughout

Amelia Center

The Amelia Center serves an average of 300 children from over 25 counties annually. The center provides grief counseling to children impacted by the death of a sibling, parent/guardian and adults impacted by the death of a biological child, or child for whom they are the guardian. Individual and family counseling is available at no fee to parents or grandparents anticipating or grieving the loss of a child or grandchild. Group counseling is also available, including parents peer support, a mother’s group, a father’s group, and an infant loss group. Children’s of Alabama and the United Way of Central Alabama provide funding for the Amelia Center.

Children’s Hospital Intervention and Prevention Services (“CHIPS”) Center

Approximately 4,500 adults and 24,000 school-aged children in four counties (Je‡erson, Lawrence, Pickens and Shelby counties) are reached by the CHIPS Center’s educational sessions and trainings annually. The CHIPS Center also provides counseling for suspected victims of child abuse and neglect at no cost to the community. CHIPS will continue to promote health and healing for

those a‡ected by suspected child abuse and neglect and provide annual school and community training on Erin’s Law, a measure passed by 38 states including Alabama, which requires all public schools to implement a prevention-oriented child sexual abuse program.

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IMPLEMENTATION STRATEGY

Mental Health Awareness Conferences

Children’s will continue to host an annual mental health conference, o‡ering practical tools to help mental health professionals who work with children and families. Attendees include schoolteachers, counselors, DHR case workers, social workers, and nurses.

Regional Pediatric Pandemic Network (“PPN”)

Children’s and UAB Department of Pediatrics will continue to be one of the nation’s 10 pediatric hub sites, equipping healthcare systems and communities in Alabama with the tools, training, best practices, and resources needed to deliver high-quality pediatric care—both in routine emergencies and during major crises like pandemics and disasters, or global health threats. One program within the PPN slated for growth in 2026 is PSySTART (Psychological Simple Triage and Rapid Treatment), an evidence-based, rapid mental health triage and incident management system designed for use during disasters, pandemics, public health emergencies, and mass casualty events. This work is grant funded through HRSA.

Primary Intervention Summary

Intervention

Role in Strategy

Primary Audience

Expands pediatric behavioral healthconsultation, telemedicine, provider education, PCIT training, and school trainings statewide

Primary care providers, schools, children/families

PATHS

Provides no-cost mental health phone response, safety planning, caregiver education, referral navigation, and provider/community resource support Provides grief counseling for children and families a‡ected by the death of a child, sibling, parent, or guardian Provides education, prevention, and healing services related to suspected child abuse and neglect

Parents, caregivers, schools, community providers

PIRC

Amelia Center

Grieving children and families

Children, families, schools, communities

CHIPS Center

Mental Health Awareness Conference

Equips professionals who work with children and families with practical tools

Teachers, counselors, DHR, social workers, nurses

Regional Pediatric Pandemic Network / PSySTART

Builds pediatric crisis-response and mental health triage capacity during emergencies and disasters

Healthcare systems and communities

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IMPLEMENTATION STRATEGY

Healthcare Access and Affordability

Children’s will address healthcare access by focusing on barriers it can meaningfully influence through its statewide pediatric role.

Community Need

The 2025 CHNA identified persistent healthcare access barriers for Alabama children, including transportation, a‡ordability, provider shortages, limited pediatric specialty availability, rural “pediatric deserts,” and lack of family awareness about available services and referral pathways. Although most Alabama children have health insurance coverage, families may still experience a‡ordability challenges related to out-of-pocket costs, uncovered services, transportation, time away from work, and di®culty understanding available assistance or coverage options.

Children’s Role

Children’s will address healthcare access by focusing on barriers it can meaningfully influence through its statewide pediatric role: strengthening care closer to home, supporting transportation and navigation resources, expanding telehealth and provider education, and helping build the future pediatric workforce. Children’s will partner with public agencies, community organizations, rural hospitals, clinics, transportation providers, pediatricians, and educational institutions to reduce practical barriers to pediatric

care. Children’s will address a‡ordability as part of its broader access strategy by helping families understand available resources, connecting eligible families to financial assistance or coverage-related information where appropriate, supporting transportation partnerships, and working with community and public partners to reduce practical barriers to care. Children’s will not be able to eliminate all cost-related barriers, but it can improve awareness, navigation, and connection to available supports.

Strategic Response Children’s will focus its healthcare access strategy on four primary barriers: • Geographic access: strengthening pediatric readiness and specialty support in rural and community settings, especially in areas with limited pediatric resources. • Transportation access: supporting transportation partnerships that help children and caregivers get to necessary medical appointments. • System navigation and family awareness: helping families understand available pediatric services, referral pathways, telehealth options, transportation supports, and community resources. • Local provider capacity: supporting rural hospitals, primary care providers, allied health professionals, and future healthcare workers through education, simulation, training, and partnership. • A“ordability and resource connection: helping families understand available financial assistance, coverage-related resources, transportation supports, community services, and other practical supports that may reduce cost-related barriers to care.

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IMPLEMENTATION STRATEGY

Children’s seeks to help families access care closer to home when appropriate.

Intended Outcomes Through these e“orts, Children’s seeks to: • reduce missed appointments related to transportation and navigation barriers; • improve pediatric readiness in rural and community hospitals; • reduce disparities for children in rural and low-income communities; • support earlier intervention and more appropriate care; • strengthen the pediatric workforce pipeline;

• improve care navigation, reduced practical barriers to care, stronger support for children with high medical needs, reduced educational disruption during hospitalization, and smoother transitions back to school and community life; • help families access care closer to home when appropriate.

Measure of Progress Children’s will track annually:

Measure

Suggested Metric

Rural Readiness

Number of hospitals reached by COACHES, counties served, providers trained, simulation sessions completed

Provider Confidence

Pre/post training evaluations from COACHES participants

Transportation

Number of families assisted through transportation partnerships, counties served, appointment completion where available

Telehealth

Utilization of telehealth/mobile services, counties reached, visit volume

Workforce

Number of students, interns, allied health trainees, and professional learners trained through Children’s

Family Navigation

Number of families connected to services, financial assistance information, referral support, or community resources

Partnership Reach

Dollars invested or organizations supported, where appropriate; number of children/families reached through partner organizations

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IMPLEMENTATION STRATEGY

2026 2028 STRATEGIES AND TACTICS

Strengthen Pediatric Readiness Closer to Home

Children’s of Alabama Community Healthcare Education Simulation (“COACHES”) will continue to enhance pediatric readiness in community hospitals across Alabama, with particular emphasis on rural and underserved areas. Through mobile, multidisciplinary simulation training, COACHES supports community providers in managing acutely ill and injured children, improving team performance, strengthening communication, and reinforcing systems of care.

COACHES provides education and training through simulations to community hospitals across the state.

During the 2026–2028 implementation period, Children’s will seek opportunities to expand COACHES statewide, including through potential funding from the Alabama Rural Health Transformation Program. If funding is secured, COACHES will prioritize program sustainability, dedicated faculty and equipment resources, evaluation capacity, and data tracking to assess long-term impact on provider confidence, team dynamics, and patient safety.

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IMPLEMENTATION STRATEGY

Reduce Transportation Barriers

Children’s will continue to support Kid One Transport, a non-emergent transportation service that helps children and caregivers access pediatric and primary care appointments in more than 50 counties. Transportation support is especially important for rural families, low-income families, and children who require recurring specialty care. Children’s will research interventions and explore new partnerships to improve access for underserved communities and families who face barriers traveling to Children’s facilities including ways to bring interventions closer to families with use of telehealth or mobile health unit options. Children’s will strengthen family navigation and resource education to help parents and caregivers understand available pediatric services, referral pathways, transportation supports, telehealth options, financial assistance resources where applicable, and community-based services. This work may include plain-language materials, digital education, referral pathway information, and coordination among Patient Experience, Patient Financial Services, social work/care coordination, Primary Care Services, Communications, and community partners. Because a‡ordability barriers often extend beyond the direct cost of medical care, Children’s will also work to connect families with transportation, community-based, and public resources that may reduce the practical costs of seeking care, including missed work, travel burden, and di®culty navigating available assistance. Improve Family Navigation Around Affordability and Available Resources

Children’s will continue to strengthen Alabama’s pediatric healthcare workforce through education, clinical training, simulation, and career exposure across the workforce continuum. As the teaching hospital for UAB pediatrics and pediatric surgery, Children’s trains physicians, nurses, allied health professionals, child life specialists, social workers, and other professionals who serve children and families. Children’s will also support earlier career exposure for junior high and high school students, particularly students from underserved and underrepresented communities, through partnerships with educational institutions and workforce development initiatives. During the 2026–2028 implementation period, Children’s workforce pipeline e‡orts may include continued partnerships with UAB, community colleges, four-year institutions, the Birmingham Black Nurses Association, Holy Family Cristo Build the Pediatric Workforce Pipeline

Rey Catholic High School, teen volunteer and summer career exploration programs, the City of Birmingham’s Cradle to Careers initiative, Birmingham Promise, and the proposed Invictus Career Institute and Regional Workforce Development Center in Bessemer. These e‡orts may include clinical training, internships, practicums, career exposure, simulation-based learning, and potential support for a simulation room to help high school students explore health worker career pathways. These workforce strategies are intended to build a more diverse and prepared pediatric workforce, expand access to healthcare career pathways, and help address long-term workforce shortages

that affect healthcare access for Alabama children and families.

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IMPLEMENTATION STRATEGY

Enhance Care Coordination and Early Identification for Children with High Medical Needs

Children’s will explore opportunities to enhance and deepen its relationship with Alabama’s Coordinated Health Networks (“ACHNs”) to support earlier identification, referral, and intervention for medically complex children and children with high medical needs. By strengthening communication and coordination with ACHNs, Children’s can help identify children who may benefit from specialty care, care navigation, family support, or other interventions before needs escalate or families experience avoidable barriers to care. Children’s will also explore opportunities to o‡er continuing education, in-service training, and pediatric-focused resource support to the Alabama Department of Human Resources (“DHR”). These

o‡erings would be designed to strengthen Children’s partnership with DHR and equip sta‡ serving children and families with information that supports timely referral, appropriate care coordination, and more e‡ective service to children with medical, developmental, behavioral, or safety-related needs. In addition, Children’s has launched Family Partners, a Family Advisory Council designed to create structured, two-way communication between Children’s and families of children with high medical needs. Family Partners will provide input on barriers families experience, opportunities to improve care coordination and communication, and ways Children’s can enhance services for children and families who rely heavily on pediatric specialty care.

Together, these strategies are intended to improve earlier identification, strengthen cross-system coordination, incorporate family voice into service improvement, and help children with high medical needs access the right care and support at the right time.

Support Educational Continuity and School Re-Entry for Hospitalized Children

Children’s will continue to support educational continuity for hospitalized children through the Sunshine School, which employs certified teachers who help patients remain connected to their academic work while receiving care. Sunshine School teachers coordinate with a hospitalized child’s regular teacher and school to obtain assignments, support academic progress during hospitalization, and help reduce learning loss. For children with Individualized Education Programs (“IEPs”) or other educational supports, Sunshine School teachers work with the child’s school, family, and care team as appropriate to understand applicable accommodations and support the child’s educational needs during hospitalization. This outward-facing coordination with schools and teachers helps promote smoother transitions back to the classroom, reduces disruption caused by illness or injury, and supports the child’s overall well-being.

Through this work, Children’s seeks to help hospitalized children maintain academic connection, reduce avoidable learning loss, and re-enter school with stronger continuity of support.

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IMPLEMENTATION STRATEGY

Primary Intervention Summary

Intervention Role in Strategy

Primary Audience

Strengthens pediatric readiness in rural and community hospitals through mobile, multidisciplinary simulation training for providers caring for acutely ill and injured children. Supports non-emergent transportation to pediatric and primary care appointments, helping reduce missed appointments and travel-related access barriers. Helps families understand available pediatric services, referral pathways, telehealth options, transportation supports, financial assistance resources where applicable, and community-based services. Connects eligible families with available financial assistance, coverage-related information, transportation supports, and community resources that may reduce cost-related barriers to care. Explores opportunities to strengthen coordination with Alabama Coordinated Health Networks to support earlier identification, referral, and intervention for medically complex children and children with high medical needs. Explores pediatric-focused education and in-service opportunities for the Alabama Department of Human Resources to strengthen collaboration, timely referral, and care coordination for children and families. Creates structured, two-way communication with families of children with high medical needs to identify barriers, improve coordination, and inform service improvement. Evaluates development of a mobile health unit to bring selected pediatric services, screenings, education, and care navigation closer to underserved communities and families who face barriers traveling to Children’s facilities. Uses telehealth and related outreach models to reduce geographic barriers, support timely access, and connect children to appropriate specialty or follow-up care. Continues support for organizations that address health, family support, transportation, wellness, and accessrelated needs across the Birmingham metropolitan area and statewide. Introduces junior high and high school students, particularly students from underserved and underrepresented communities, to healthcare careers and pediatric workforce pathways. Trains current and future pediatric healthcare professionals through clinical rotations, internships, practicums, simulation-based education, and partnerships with UAB, community colleges, four-year institutions, and workforce initiatives. Supports educational continuity for hospitalized children by coordinating with schools and teachers, obtaining assignments, supporting IEP-related needs where applicable, reducing learning loss, and helping children transition back to school.

Rural and community hospitals, emergency departments, pediatric providers, children/families in underserved areas

COACHES

Children and caregivers facing transportation barriers, especially rural and low-income families

Kid One Transport

Parents, caregivers, families with access barriers, medically complex families

Family Navigation and Resource Education

Families facing out-of-pocket costs, uncovered services, transportation costs, or di®culty navigating available assistance

A“ordability and Resource Connection

ACHNs, medically complex children, families, care coordination teams, specialty clinics

ACHN Partnership Development

DHR Continuing Education / In-Service O“erings

DHR sta‡, children and families served by DHR, social workers, care teams

Families of children with high medical needs, Patient Experience, clinical and administrative leaders

Family Partners

Underserved communities, rural families, families with transportation or geographic barriers

Mobile Health Access Strategy

Telehealth and Specialty Support

Rural families, medically complex children, primary care providers, specialty clinics

Community-Based Partner Support

Children, families, community-based organizations, underserved communities

Junior high and high school students, underrepresented students, education partners Medical students, residents, fellows, nurses, allied health professionals, child life specialists, social workers, high school students, workforce partners

Healthcare Career Exposure

Pediatric Workforce Pipeline

Hospitalized children, families, teachers, schools, children with IEPs or educational supports

Sunshine School

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IMPLEMENTATION STRATEGY

Child Safety and Risk Prevention

Community Need

The 2025 CHNA identified child safety and risk prevention as a significant concern, including child abuse and neglect, caregiver substance use, firearm-related injuries, suicide risk, excessive screen time and social media exposure, and lack of safe supervision. Children’s will address these risks through statewide injury prevention, parent and caregiver education, school readiness initiatives, poison prevention, abuse prevention education, safe transportation programming, firearm safe storage education, and partnerships with schools, public agencies, law enforcement, healthcare organizations, and community groups.

Children’s has a long-standing statewide role in child injury prevention, safety education, poison prevention, school nurse education, abuse prevention, and family education. Through HESC, APIC, CHIPS and community partnerships, Children’s can reduce preventable injury risk, equip caregivers and schools, and promote safer home, school, transportation, and community environments.

Children’s Role

Strategic Response Children’s will address child safety and risk prevention through a strategy focused on: • preventing avoidable injuries through education and environmental safety supports; • strengthening parent and caregiver education; • promoting safe transportation practices; • improving school and community readiness for emergencies; • advancing firearm safe storage education; • preventing poisoning, substance-related harm, and vaping/tobacco-related risks; • strengthen parent and caregiver education on practical safety behaviors, injury prevention, safe storage, poison prevention, substance/vaping risks, and supervision; • supporting prevention and education related to abuse and neglect.

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IMPLEMENTATION STRATEGY