Child Health Domain

 

Child Injury Prevention Report (October 2021 – September 2022)

 

National Performance Measure:

Rate of injury-related hospital admissions per population ages 0 through 19 years

 

Trends in NPM Data:

Between 2008 to 2019, Oregon has seen a steady decline in the rate of injury hospitalizations for children 0-9 years old, from 183 per 100,000 to 125 per 100,000 children. Oregon’s improvement has been consistent with the national trend over that 10-year period. Despite these improvements, injuries are a leading cause of death for children and adolescents. The leading causes of injuries and injury deaths vary by age, and some groups experience disparities.

 

Child Injury Prevention Strategy #1:

Identify child injury prevention needs and priorities; use them to develop, promote and/or implement data-informed child injury policy.

ESM:

• ESM 7.1.1:  Injury death rate among children 0 - 9 years of age

Progress: Between 2020-2021, Oregon has seen a slight increase in the rate of injury deaths for children 0-9 years old, from 6.3 per 100,000 to 6.4 per 100,000 children.

• ESM 7.1.2: Transportation injury death rate among children 0 - 9 years of age

Progress: Between 2020-2021, Oregon has seen a small increase in the rate of transportation-related deaths for children 0-9 years old, from 2.2 per 100,000 to 2.5 per 100,000 children.

• ESM 7.1.3: Drowning death rate among children 0 - 9 years of age

Progress: Between 2020-2021, Oregon has seen no change in the rate of drowning deaths for children 0-9 years old, steady at 0.9 per 100,000 children.

• ESM 7.1.4: Poisoning injury rate among children 0 - 9 years of age

Progress: Between 2020-2021, Oregon has seen no change in the rate of poisoning injuries for children 0-9 years old, steady at 85.9 per 100,000 children.

 

Accomplishments (state level):

• MCH staff participated in meetings led by Oregon Safe Kids including the Water Safety Task Force meetings.
• The MCH research analyst provided analysis of water related injuries and drowning deaths to the task force to support discussions and planning.
• MCH staff prepares an annual data report with summary and trend statistics of leading causes of child injury-related emergency department visits, hospital stays and deaths in Oregon. The report is typically released during the summer each year.
• During the reporting period, MCH staff prepared individual data reports for each of the Title V local grantees who selected child injury prevention for the 2022-2023 budget year.
• MCH staff met with several analysts from the Northwest Portland Area Indian Health Board (NPAIHB) to discuss creating a tailored child injury report for Tribal communities. We learned about the deficiencies of existing administrative datasets and the Tribal Data Center’s methods to improve the representativeness of data for Tribal populations.
• MCH staff participated in four gatherings of the State Child Death Review and Prevention Team. During these meetings, MCH staff participates on subcommittees, such as to revise and update the Team Charter, and presents annual summary child injury and injury-related death data.
• MCH staff initiated an assessment of child injury prevention guidance, tools, assessments, and educational materials in use by Oregon’s public health home visiting programs, Babies First! and CaCoon. This assessment is ongoing.
• MCH staff facilitated and participated in a County Child Death Review Teams and Safe Sleep Coalition Listening Session held on 9/14/22.

 

Accomplishments (local level):

• All grantees gained access to county level analysis of child injuries and deaths to inform and prioritize their prevention activities and decisions about where to concentrate capacity. Local grantees began focused activities for injury prevention in their communities. Highlights follow:
  • Benton: developed community wide partnership for Child Abuse Prevention observance;
  • Linn: grew community partnerships for injury prevention education for families enrolled in public health programs;
  • Crook: provided education and safe storage lockboxes for clients who report unsafe storage of harmful substances;
  • Jackson County: provided safe sleep anticipatory guidance to each family served through home visiting. Partnered with EMS and police for safe sleep education to the community.
  • Marion: partnered with local hospitals to support CPS technician training, health fairs, car safety and bike safety trainings;
  • North Central Public Health District: participated in local injury prevention coalition;
  • Polk: integrated injury prevention, assessment into home visits with families;
  • Wheeler: established and developed partnerships w/ schools and clinics to assess injury prevention gaps, provided health education and prevention messaging through website;
  • Confederated Tribes of Warm Springs: conducted Back to the Board classes for safe infant sleep and distributed car seats to families of newborns.

 

Challenges/emerging issues:

Local public health and tribal grantee capacity to undertake and implement Title V plans has been strained due to the ongoing impacts of the Coronavirus 19 public health emergency, an underlying public health workforce shortage and/or staffing churn. Similarly, state MCH capacity to support and provide technical assistance to local grantees has been limited due to vacancies and increased workloads for staff.

 

Child Injury Prevention Strategy #2:

Strengthen workforce capacity to address child injury prevention at the state and local level.

ESM:

• ESM 7.1.5: Among local grantees who select child injury prevention, percent who report improved knowledge, skills, or policies based on provided technical assistance

Progress: 86% (6/7) grantees reported improved knowledge, skills, or policies based on provided technical assistance.

• ESM: 7.1.7: Completed assessment of injury prevention risk assessment, education, and remediation in Oregon’s public health home visiting programs

Progress: Assessment of integration of injury prevention in Oregon’s public health home visiting programs is approximately 40% complete.

 

Accomplishments (state level):

• MCH staff presented a webinar on 9/15/2022 to Oregon’s local and Tribal Title V grantees to introduce the comprehensive injury data report in advance of sending out the local reports.
• MCH staff performed technical assistance calls with local public health and tribal grantees in May - June of 2022 to support plan development and implementation.
• MCH staff performed technical assistance calls with local public health and tribal grantees in September 2022 to help grantees complete their annual reports and submit them via the online tracking data system.
• MCAH staff planned and hosted a three-part topical Injury Prevention Learning Series during the summer of 2022 for Center for Prevention & Health Promotion staff. The purpose of the sessions was to develop a shared foundation of knowledge and create opportunities for future collaborations. Session topics included:
  • An Overview of Shared Risk and Protective Factors
  • Preventing Sexual Violence
  • Children with Special Health Care Needs
• MCH staff initiated an assessment of child injury prevention guidance, tools, assessments, and educational materials in use by Oregon’s public health home visiting programs, Babies First! and CaCoon. This assessment is ongoing.

 

Accomplishments (local level):

• Local grantees conducted activities for injury prevention in their communities. Highlights follow:
  • Marion: partnered with local hospitals to support CPS technician training, health fairs, car safety and bike safety trainings;
  • Polk: integrated injury prevention, assessment into home visits with families;

 

Challenges/emerging issues:

Local public health and tribal grantee capacity to undertake and implement Title V plans has been strained due to the ongoing impacts of the Coronavirus 19 public health emergency, an underlying public health workforce shortage and/or staffing churn. Similarly, state MCH capacity to support and provide technical assistance to local grantees has been limited due to vacancies and increased workloads for staff.

 

Child Injury Prevention Strategy #3:

Strengthen partnerships and coalitions to support child injury education, prevention plan implementation, and communication strategies.

 

Accomplishments (state level):

• MCH staff participated in meetings led by Oregon Safe Kids including the Water Safety Task Force meetings.
• MCH staff met with several analysts from the Northwest Portland Area Indian Health Board (NPAIHB) to discuss creating a tailored child injury report for Tribal communities. We learned about the deficiencies of existing administrative datasets and the Tribal Data Center’s methods to improve the representativeness of data for Tribal populations.
• MCH staff participated in four gatherings of the State Child Death Review and Prevention Team. During these meetings, MCH staff participates on subcommittees, such as to revise and update the Team Charter, and presents annual summary child injury and injury-related death data.
• Staff from MCH, Injury and Violence Prevention Program (IVPP) and Department of Human Services – Child Welfare Services (DHS-CPS) partnered as a “Prevention Collaboration Team” to develop a Memorandum of Understanding to describe our shared commitments and responsibilities related to child injury and abuse prevention.
• MCH staff created and disseminated 33 original social media posts on child injury prevention topics and shared another 32 posts from other entities on the MCH FaceBook page.
• MCH staff facilitated and participated in a County Child Death Review Teams and Safe Sleep Coalition Listening Session held on 9/14/22.

 

Accomplishments (local level):

• All local grantees included health education, partnership and/or communication related activities for injury prevention in their communities. Highlights follow:
  • Benton: developed community wide partnership for Child Abuse Prevention observance;
  • Linn: grew community partnerships for injury prevention education for families enrolled in public health programs;
  • Crook: provided education and safe storage lockboxes for clients who report unsafe storage of harmful substances;
  • Jackson County: provided safe sleep anticipatory guidance to each family served through home visiting. Partnered with EMS and police for safe sleep education to the community.
  • Marion: partnered with local hospitals to support CPS technician training, health fairs, car safety and bike safety trainings;
  • North Central Public Health District: participated in local injury prevention coalition;
  • Polk: integrated injury prevention, assessment into home visits with families;
  • Wheeler: established and developed partnerships w/ schools and clinics to assess injury prevention gaps, provided health education and prevention messaging through website;
  • Confederated Tribes of Warm Springs: conducted Back to the Board classes for safe infant sleep and distributed car seats to families of newborns.

 

Challenges/emerging issues:

Local public health and tribal grantee capacity to undertake and implement Title V plans has been severely strained due to the ongoing impacts of the Coronavirus 19 public health emergency, underlying public health workforce shortages and/or staffing churn.  Similarly, MCH capacity to complete state level work and to support and provide technical assistance to local grantees is strained.

 

Child Injury Prevention Strategy #4:

Improve data collection, analysis, interpretation, and dissemination of child injury data to focus on prevention efforts.

ESM:

• ESM 7.1.6: Percent of engaged partner groups including other state departments, local grantees, and marginalized communities, that report satisfaction with level of engagement in the development of a collaborative child injury report

Progress: This activity is ongoing. To date, we have engaged members of the Oregon Safe Kids Advisory Committee, local county and Tribal grantees, and staff from the Northwest Portland Area Indian Health Board in reviewing and providing feedback about the data report.

 

Accomplishments (state level):

• The MCH research analyst provided analysis of water related injuries and drowning deaths to the task force to support discussions and planning.
• MCH staff prepares an annual report with summary and trend statistics of leading causes of child injury-related emergency department visits, hospital stays and deaths in Oregon. The report is typically released during the summer each year.
• During the reporting period, MCH staff prepared individual data reports for each of the Title V local grantees who selected child injury prevention for the 2022-2023 budget year.
• MCH staff met with several analysts from the Northwest Portland Area Indian Health Board (NPAIHB) to discuss creating a tailored child injury report for Tribal communities. We learned about the deficiencies of existing administrative datasets and the Tribal Data Center’s methods to improve the representativeness of data for Tribal populations.
• MCH staff participated in four gatherings of the State Child Death Review and Prevention Team. During these meetings, MCH staff participates on subcommittees, such as to revise and update the Team Charter, and presents annual summary child injury and injury-related death data.
• MCH staff presented a webinar on 9/15/2022 to Oregon’s local and Tribal Title V grantees to introduce the data report in advance of sending out the local reports.
• All grantees gained access to county level analysis of child injuries and deaths to inform and prioritize their prevention activities and decisions about where to concentrate capacity.

 

Challenges/emerging issues:

Local public health and tribal grantee capacity to undertake and implement Title V plans has been severely strained due to the ongoing impacts of the Coronavirus 19 public health emergency, underlying public health workforce shortages and/or staffing churn.  Similarly, MCH capacity to complete state level work and to support and provide technical assistance to local grantees is strained.

 

Other Title V Work in the Child Health Domain:

In addition to work on child injury prevention, Title V provided leadership, technical and analytic expertise for multiple programs, surveillance systems and initiatives for improved child health. Programs supported include PRAMS and ECHO surveillance systems; early hearing detection and intervention (EHDI).

 

Specific accomplishments across the above programs include providing:

• Leadership and analytic expertise to support the development and implementation of the ECHO (3-year follow back survey to PRAMS);
• Leadership and analytic expertise to support the day-to-day programmatic activities of the EHDI (early hearing detection and intervention) program;
• Leadership and analytic expertise to support data collection, analysis, and capacity to support Oregon’s Birth Anomalies Surveillance System (BASS);
• Technical expertise for analysis of legislative bills impacting children and youth in Oregon;
• Leadership and subject matter expertise in Oregon’s State Child Death and Prevention Review Team and in providing technical assistance to county child fatality teams;
• Leadership representing public health multiple collaborations with Oregon’s Early Learning System partnerships.
• Leadership and subject matter expertise in reviewing Oregon Coordinated Care Organization’s Community Health Assessments and Health Improvement Plans for maternal and child health content and alignment;
• Leadership and representation on Oregon’s State Interagency Coordinating Council (SICC), convened by the Oregon Department of Education;

 

Title V also continues to provide backbone support for children’s oral health in Oregon through the MCH Section’s Oral Health Program. The Oral Health Program is responsible for advancing evidence-based strategies to improve the oral health of all Oregonians across the lifespan. The Program is designed after the Association of State and Territorial Dental Directors' (ASTDD) model for state-based oral health programs and focuses on these activities:

• Creating systems and leadership capacity to incorporate oral health into overall health prevention strategies;
• Collecting data and maintaining the Oregon Oral Health Surveillance System;
• Developing and analyzing oral health policy;
• Overseeing the delivery of school-based oral health programs;
• Promoting oral health through education for all Oregonians,
• Building partnerships and collaboration to support the integration of oral health; and
• Providing opportunities for oral health workforce development.

 

The Oral Health Program uses Title V funding to conduct the Oregon Smile & Healthy Growth Screening (formerly survey) every five years. It is a public health data collection tool that monitors the oral health and overweight/obesity status of Oregon children in first, second and third grades. These health problems can contribute to increased absenteeism, poor school performance, poor self-esteem, and less success later in life. We began planning for the 2022 Smile & Healthy Growth Screening in March 2022 and contracted with a coordinator in October 2022 to assist with logistics and gaining school participation. Over the summer and fall 2022, we contracted with and trained six dental hygienists and one large dental care organization (Advantage Dental) to conduct the data collection. During the 2022-23 school year, data collection for 30 elementary schools was completed.

 

The Oral Health Program has participated in activities of the Oregon HPV Prevention Alliance and HPV Dental Task Force (subcommittee) since February 2020. We assisted the Task Force in developing materials for the Oregon HPV Dental Toolkit that was released in March 2022. The goal of the toolkit was to assist dental providers with educating clients on oral HPV and cancer, as well as encouraging adolescents to get the HPV vaccine. The toolkit includes a dental office poster, patient brochure, provider checklist and provider fact sheet. In the fall of 2022, we partnered with the American Cancer Society to mail around 250 HPV kits to school-based health centers (SBHCs), federally qualified health centers (FQHCs), and some dental offices that serve Oregon Health Plan (OHP-Medicaid) clients.

 

The Oral Health Program supports oral health integration and policy development across the Oregon Health Authority (OHA). Key activities include:

• The Program’s Team Lead serves in a leadership role co-facilitating the OHA Oral Health Team that coordinates oral health efforts across the agency. The team meets every other month.
• The Program’s Team Lead served on the Core Team for the Advancing Prevention and Reducing Childhood Caries in Medicaid CHIP (MAC) Affinity Group from July 2021 to March 2023. The Affinity Group worked with four coordinated care organizations to improve rates of topical fluoride varnish application for children (ages 1-5) on OHP in primary care settings.
• Since March 2022, Oral Health Program staff has been providing clinical guidance and staff support to the Medicaid Program regarding oral health changes to the Early Periodic Screening, Diagnosis, and Treatment (EPSDT) benefit for children. Oregon has had a longstanding EPSDT waiver, allowing the state to deny medically necessary care to children if the provider’s requested treatment is not on the state’s prioritized list of medical conditions and treatments. OHA did not seek renewal of this waiver as part of its 2022-2027 1115 Medicaid Demonstration Waiver, so the remaining components of EPSDT needed to be covered effective January 1, 2023. Handicapping malocclusion – severe orthodontic condition that negatively affects dentofacial function or speech – was one of the services. Staff has assisted in developing implementation guidance (e.g., prior authorization, billing, etc.) around orthodontics for craniofacial anomalies and handicapping malocclusion.