Children's Health Branch
NPM 6-Percent of children, ages 10 through 71 months, receiving a developmental screening using a parent-completed screening tool
ESM 6.1 - Proportion of children birth to age 19 that received a well child appointment in the past year
ESM 6.2 - Proportion of children birth to age 19 that received a developmental screening in conjunction with a well child appointment in the past year
ESM 6.3 - Proportion of children aged 12 & 24 months that have a reported blood lead screening in the past year
According to the Child and Adolescent Health Measurement Initiative (CAHMI), in 2018-2019, 44.6 percent of children ages 9-35 months received a developmental screening using a parent-completed tool. This is trending better from 39.8 percent of Alabama’s children ages 9-35 months received a developmental screening using a parent-completed tool in 2017-2018.
In addition, according to CAHMI, Alabama fared better than the national average of 36.4 percent of parents completing a parent-completed tool for developmental screening for children 9-35 months old in 2018-2019.
The Children's Health Branch continues to partner with Help Me Grow (HMG) to measure the number of developmental screenings (ASQ3) is provided and uploaded to their Enterprise data collection system. In addition, EPSDT screening numbers are provided through Medicaid to measure developmental screenings and adolescent well-visit.
Alabama Childhood Lead Poisoning Prevention Program
ACLPPP receives funding through a memorandum of agreement with Medicaid, a cooperative agreement with CDC, and more recently through the Title V MCH Block Grant. The combined goal of these funding sources is to maintain a childhood lead poisoning prevention program which ensures blood lead testing and reporting, enhances blood lead surveillance, improves linkages of lead-exposed children to recommended services, and develops targeted population-based policy interventions with a focus on Medicaid-enrolled children.
In order to achieve program goals, education and outreach has been and remains a program priority. An integral part of this is the contract and partnership with subgrantee MCHD. MCHD provides targeted education and outreach for lead poisoning prevention in the high-risk area of Mobile County. In FY 2020, ACLPPP and MCHD attended or hosted a total of 10 trainings or events in spite of the limitations that COVID-19 created. Included in these events was the first Alabama Childhood Lead Poisoning Prevention Advisory Committee (ACLPPAC) meeting, with 22 partners in attendance. This committee was created to leverage existing partnerships and establish new partnerships to meet the goals of ACLPPP. Moving forward, ACLPPAC will be instrumental in developing an updated strategic plan for blood lead testing and follow-up. Additionally, from 2018 to 2020, ACLPPP participated in the Maternal and Child Environmental Health Collaborative Improvement and Innovative Network, learning from other state lead programs and applying concepts and activities by ACLPPP.
In 2020, the number of children less than 18 years of age in Alabama receiving at least one blood lead level (BLL) screening was 37,857. Of those children, 413 children received presumptive positive screens. The number of reported confirmed cases was 344; however, 495 children, which includes some presumptive positives as well, were referred for treatment and received case management services. BLL testing and reporting decreased in 2020 from 44,369 in 2019 due to COVID-19 limitations. However, preliminary data from the year 2021, shows an upward trend (40,816) toward pre-COVID-19 numbers. This upward trend was accomplished despite the Magellan LeadCare recall which temporarily halted point-of-care testing at medical clinics. During this time, upon inquiry, concerned clinics were referred to the Bureau of Clinical Laboratories (BCL), which has the capability to perform blood lead analysis. The BCL also has a process in place to provide microvettes, mailing containers, and order forms, at no cost, to perform capillary blood lead screening in clinics that do not utilize point-of-care testing.
Beginning in calendar year 2018, the ACLPPP blood lead reference value (BLRV) was adjusted to align with the CDC blood lead reference value of 5 micrograms per deciliter (μg/dL) based on the current National Health and Nutrition Examination Survey’s data.
Oral Health Office
NPM 13.2: Percent of children, ages 1 through 17, who had a preventive dental visit in the past year
ESM 13.2- lncrease the proportion of infants and children, ages 1-17 years, who report receiving a preventive dental visit in the past 12 months by piloting the Home by One Program.
Oral Health Screening
The OHO completed the Basic Screening Survey (BSS) of 54 schools throughout the state. The schools were randomly selected by the Association of State and Territorial Dental Directors (ASTDD). The target population consisted of kindergarten and third grade children. A total of 5,579 children were screened, following the standardized guidelines established by ASTDD and CDC, collecting information regarding treated decay, untreated decay, presence or absence of sealants, height, and weight. BSS took two school years to complete due to the sporadic and unpredictable virtual classroom requirements with COVID-19 outbreaks. Educational materials were provided to school nurses on HPV vaccines, community water fluoridation, and importance of preventive dental visits for children 1-17 years of age.
In addition to the BSS, the Oral Health Office conducted Pre-K and Head Start screenings for 1,899 children.
Tuscaloosa County Health Department Dental Clinic
ADPH only operates one dental clinic and that is the Tuscaloosa County Health Department (TCHD) Dental Clinic. The TCHD Dental clinic focuses on providing dental treatment for the MCH population—namely children ages 1-17 years of age, and expectant mothers. Antiquated and failing conventional radiographic equipment in the clinic prevented the ability to adequately diagnose and create proper treatment plans. Utilizing unused OHO budgetary funds, new digital radiographic equipment was purchased for the TCHD dental clinic in 2020. In FY 21, there were 663 child and adolescent patient visits.
Ongoing activities in Alabama to improve oral health:
HPV Education and Vaccine Awareness/Promotion
Year 2021 marked the third year of the #WATCHYOURMOUTH campaign. The campaign was created in collaboration with USA Mitchell Cancer Institute. It is a multi-faceted campaign that highlights the importance of the FDA approved vaccine for HPV related oropharyngeal, as well as other head and neck, cancers. The pinnacle of the campaign occurs in April so as to coincide with Oral Cancer Awareness Month. The campaign attracted the attention of Merck, the only manufacturer of the 9-valent, recombinant HPV vaccine. Merck, as well as the American Dental Association, has promoted the campaign nationally to other stakeholders as well. An ad campaign designed with Spectrum aired in April. The television component of the commercial aired 9,995 times on 51 networks in 15 zones throughout Alabama. The streaming version provided 357,264 impressions with 352,180 completions for a completion rate of 98.5 percent. See the ad by clicking here.
Share Your Smile with Alabama
Year 2021 marked the fourth annual Share Your Smile with Alabama contest for third grade children in public, private, and home schools statewide to bring attention to National Children's Dental Health Month. Two children, one girl and one boy, were selected from photo submissions as the overall winners of the smile contest. The winners received a prize basket of oral health products and the opportunity to be featured in OHO marketing campaigns to promote children‘s oral health in the state throughout the year. Winners were pictured on flyers sent to CHDs and schools, as well as billboards near their respective schools. Due to COVID-19, a much-abbreviated award ceremony was held in the ADPH Central Office.
ADPH/Calhoun/Wallace State
The partnership initiated between ADPH’s Northern Public Health District, Calhoun Community College, and Wallace State Community College will also provide dental services to children. Educational information regarding importance of preventive dental visits for children and HPV vaccines will be provided to the patients.
ADPH Public Health District Initiative
District MCH coordinators submitted project proposals in 2020 to address needs within the Child Health Domain. These county specific projects targeted access to oral health care, increasing EPSDT visits, injury prevention, and suicide prevention in FY21.
West Central Public Health District
In the rural West Central District (WCD), there is a lack of dental services in Greene, Hale, and Perry counties. Two out of three of these counties have only one dental provider and one county has no dentist at all. An additional barrier to care that was identified in these counties and in Tuscaloosa County is the lack of dentists to serve children and pregnant women. The goal for the district project was to provide oral health care to pregnant women and children under the age of 21. The CHD WIC staff utilized dental screening forms to help identify children and pregnant women who were in need of dental care. A total of 948 WIC participants were screened for oral health needs and of those screened, 530 were referred for dental services and a total of 80 exams were completed. WCD partnered with TCHD Dental Clinic to provide dental services for those who were identified as needing dental care if they did not already have a dental home.
WCD began providing dental services at the Greene County Health Department (GCHD) in July 2021, and some of the first patients seen in the GCHD mobile clinic were children. The coordinator participated in several limited community events in Greene, Hale, Perry, Pickens, and Tuscaloosa counties where oral health information and promotional items were distributed at each community event.
In addition to the CHD services, the district MCH coordinator accompanied the TCHD dental staff as they screened students at elementary schools in the Tuscaloosa County School System. A total of 331 K-3rd grade students were screened by the TCHD dental staff as part of the statewide BSS. In addition to the screenings, resources such as pamphlets, toothbrushes, toothpaste, dental floss, and T-shirts were provided to promote awareness of preventive dental care.
Northeastern Public Health District
Tooth decay is known as the most common chronic disease among children. It unequally affects minorities and children living in low–socioeconomic status households. Tooth decay is associated with many poor health outcomes. Loss of teeth, impaired growth, decreased weight gain, poor school performance, and poor quality of life are among the poor outcomes. Recent data of children in Alabama showed 30-50 percent have early childhood caries. Potential risk for children often identified in WIC visits include both infrequent daily dental hygiene and yearly dental exams. The goal of the Northeastern Public Health District (NED) project was to improve oral health in children ages six months to five years, that are currently receiving WIC, to increase routine dental exams and to identify dental caries. Partnerships were developed with the NED WIC nutritionists to complete a dental questionnaire to determine if yearly exams had been completed and to screen for dental problems. Parents were then given a list of dental providers to choose for their child’s exam. Subsequent to the screening, clerical staff and the district MCH coordinator completed monthly follow-ups to ensure dental appointments were scheduled. Medicaid eligibility was checked monthly to determine if a child had been seen by the dentist. If a child did not have Medicaid, then parents were called to determine if the child was seen by a dentist. Each child screened received educational materials to promote oral health.
Other ADPH Child Health Programs
Healthy Child Care Alabama Program
The Healthy Child Care Alabama program distributes flu information to all parents of children attending day care and preschool. In addition, well-child visit information is also distributed. The importance of the well-child visit, to include immunizations and developmental screening, is emphasized. Additional resources including information about COVID-19; Hand, Foot, and Mouth Disease; and Respiratory Syncytial Virus are also available to inform parents. Technical Assistance is provided to day care providers to include infectious disease and emergency preparedness. Nurse Consultants serve as a resource to assure a healthy environment by providing all required health and safety programs.
Child Passenger Safety
ADPH has long been a leader and partner in injury prevention and child passenger safety in the state. New funding has allowed for the expansion of those efforts. In 2019 the BPPS received a grant from the Alabama Department of Economic and Community Affairs, which allowed that bureau to develop the Alabama Child Passenger Safety Program. The goals of the Alabama Child Passenger Safety Program are to educate Alabamians on the safe use of child passenger restraints, provide training for individuals to become certified Child Passenger Safety technicians, and establish new car seat fitting stations. Due to COVID-19 and the temporary reassignment of program staff as a result, this program was on hiatus for the majority of 2020. The program did restart in late 2021, and ADPH child passenger safety technicians installed 37 car seats.
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