III.E.2.c. Child Health: Annual Report (10/1/2021-9/30/2022)

 

State Priority Need:

Reduce preventable deaths in the MCH population with a focus on reduction and elimination of inequities in mortality rates.

 

National Performance Measure (2020 - 2025):

NPM7.1- Rate of hospitalization for non-fatal injury per 100,000 children, ages 0 through 9.

 

Evidence Based/Informed Strategy Measure (2020 - 2025): 

ESM 7.1.1: Percent of sites operating mobile fitting and car seat inspection stations to make sure car seats are properly installed.

ESM 7.1.2: Percent of child deaths reviewed by Child Fatality Review Teams.

 

General Information

Injuries are a major public health issue in Indiana, especially for young children. Motor vehicle-related injuries are the leading cause of death and MCH continued to ensure families are properly using child restraints and car seats through access and education. MCH has utilized partnerships with other divisions within the Indiana Department of Health (IDOH) to assist in decreasing this measure.

 

Car Seat Safety  

The Division of Trauma and Injury Prevention (TIP) continued to support efforts with car seat clinics across Indiana. During the reporting period, TIP collaborated with the Automotive Safety Program (ASP) and Indiana Criminal Justice Institute (ICJI) to deliver standardized education regarding child passenger safety to healthcare professionals, first responders, parents, law enforcement agencies, and social service workers. TIP and ICJI shared a unified interest in facilitating programs aimed at reducing deaths and the severity of injuries associated with motor vehicle accidents on Indiana roadways and promoting child passenger safety.

 

The Injury Prevention Program Coordinator was involved in the planning committee for 2022 Indiana Child Passenger Safety Conference, which was attended by 52 families that received car seats and proper installation education. This event was attended by over 100 car passenger safety technicians garnered from all over the state to provide technical assistance. Furthermore, the coordinator aided in numerous car seat safety clinics throughout the year, wherein families could make permanent appointments for car seat provisions.

 

During the reporting period, the funds from Title V were used primarily for fitting stations with ICJI. There were 6,635 total child safety seat inspections in Indiana. These inspections were conducted by a variety of agencies comprised of trauma centers, police stations, community fire departments, local health departments, child advocacy centers, and community hospitals and clinics. A total of 3,861 child safety seats were distributed to communities. 

 

TIP also continued to fund scholarships to offset the costs for Child Passenger Safety Technicians (CPSTs) to become certified and continue efforts in their communities. The cost to become a CPST is $95 and requires a 3-to-4-day commitment for required classes. Additionally, funds were utilized to develop and disperse a community program entitled, “Booster Bash,” wherein agencies hosted their own booster seat distribution event with the support of TIP. This effort was established to provide focus on older children in booster seats and seat belts and increase services to higher risk areas and/or rural areas of Indiana. TIP was able to administer fund aids through booster seat shipments that helped conduct 11 Booster Bashes in Indiana in conjunction with their local communities’ car seat technicians.

 

Child Fatality Review

Child Fatality Review (CFR) is a critical public health process to examine the circumstances and risk factors associated with unexpected child deaths, and the process ultimately leads to recommendations on how to best prevent future deaths from occurring. Teams are required to review all deaths of children under the age of 18 that are sudden, unexpected, and unexplained; all deaths that are assessed by DCS, and all deaths that are determined to be the result of homicide, suicide, accident, or are undetermined. There is currently a Statewide CFR Committee and 67 local CFR teams covering all 92 counties in Indiana. The Statewide CFR Committee reviews findings of local CFR teams and makes recommendations for prevention and improvements to state policies and practices.

 

In 2013, Indiana law, IC 16-49, went into effect, requiring CFR teams in each county, with coordination and support for these teams to be provided by the Indiana Department of Health (IDOH). IC 16-49 was modified in July 2022 to create an ordered list of professionals/agencies who may start local teams. This change in legislation is what made it possible to have teams in all 92 counties for the first time since the program began. Two additional FRP staff were hired to assist in providing guidance and support to the CFR teams across the state. The local teams themselves are unfunded, and participants volunteer their time in addition to their professional responsibilities.

A comprehensive fatality review process includes data entry into the National Center for Fatality Review and Prevention Case Reporting System (CRS).

 

In 2013, Indiana Code mandated CFR team chair/members enter all fatality review data into the CRS. In January of 2022, a system was fully integrated for DCS to begin entering all data from a child fatality review into the CRS. This change was made to eliminate duplication of effort, improve accuracy in reporting information, and save valuable staff time. The data integration system project matches child welfare records, vital records, and other records/information from the local CFR teams. The goal of the data integration system project is to provide a comprehensive set of data for each infant/child decedent that is easily accessible to all FRP and DCS staff in real time. Data from all sources describes risk/protective factors and circumstantial information involved in infant/child deaths that is not compiled elsewhere. FRP and DCS will then be able create a comprehensive joint report to help guide a public health, data-informed approach to infant/child death prevention. FRP is collaborating with the Michigan Public Health Institute (MPHI) and the National Center for Fatality Review and Prevention (NCFRP) to ensure that the FRP/DCS data integration system project will provide seamless, automated data integration with the CRS so Indiana’s data can be included with the national fatality data repository.

 

Handle with Care

In 2020, FRP received a second funding opportunity awarded through the U.S. Department of Justice by OVC to increase direct services support for the youngest victims of crime related to the opioid epidemic in Allen and Wayne County. This project focuses on decreasing secondary trauma after a child has experienced a potentially traumatic event where first responders are called to a scene. A Handle with Care (HWC) notification is sent to the child’s school before the start of the next school day for schools to receive a “heads up” that a child may have experienced a traumatic event. The confidential notification includes the child’s name with the words, “Handle with Care,” and no information regarding the incident is ever shared through the notification. 

When a HWC notification is received by a school, it is distributed the next day to staff who may interact with the student to ensure they are able to watch for atypical behavior and respond in a trauma-informed manner. School staff are trained to provide additional support as needed and to not ask questions or try to gather information about the event. If the student needs additional support mechanisms outside of the classroom, schools' partner with mental health providers to connect the student and their families with mental health services.  

 

HWC funding has supported the development of programming among five school districts in Wayne County and three schools, an elementary, middle, and high school, in Allen County. Technical assistance has been provided to additional schools that choose to implement the program across the state. A bi-monthly community of practice call helps to provide further technical support while allowing for cross collaboration across the state.  

 

Funding has also allowed for support to Allen and Wayne County to implement trauma-informed practices taking a multidisciplinary approach to include health care providers, schools, first responders, courts and probation, social services, community foundations, university partners, grassroots community organizations, faith-based communities, and local business. Through this work, engaged partners work towards developing a comprehensive trauma-informed approach to decrease secondary trauma, while also increasing positive childhood experiences that have been shown to mitigate adverse childhood experiences.  

 

Since implementation in Indiana in 2021, HWC spread from two school districts in two counties, to thirteen school districts in five counties with an additional 22 counties interested in learning more or actively planning implementation. FRP continued to identify opportunities to streamline state-wide efforts to increase HWC participation and implementation. In 2022, the HWC project manager attended a Six State Trooper Conference in West Virginia where Indiana State Police (ISP) were present. The HWC project manager co-presented with Andrea Darr, Director at West Virginia’s Center for Children’s Justice. As a result of this opportunity, the project manager was able to connect with ISP leaders to further discuss HWC at the state-level. Conversations continue among these leaders. FRP has partnered with the Indiana Department of Education to increase training opportunities for Youth Mental Health First Aid and has joined a cohort to support this expansion within schools.  

 

Throughout 2022, HWC programming faced challenges relating to COVID-19 and schools transitioning from virtual to in-person learning. Many schools were impacted relating to attendance, transitional challenges between virtual and in-person, and shortages in educational professionals. In addition to these challenges, schools saw an increase in the need for mental health support for students. Unfortunately, professional shortages were experienced among mental health service providers, exacerbated further in rural communities. As part of HWC, schools partnered with mental health providers to provide trauma-focused cognitive behavioral therapy (TF-CBT). As a response, FRP connected with the Division of Mental Health and Addiction (DMHA) and national HWC partners to identify strategies to increase access for TF-CBT within Indiana schools. Conversations continue between state and national partners and solutions to address and alleviate this challenge will continue into 2023.   

 

State Priority Need:

Promote Physical Activity through policy improvements and changes to the built environment.

 

National Performance Measure (2020 - 2025):

NPM 8.1 - Percent of children, ages 6 through 11, who are physically active at least 60 minutes per day.

 

Evidence Based/Informed Strategy Measure (2020 - 2025): 

ESM8.1 Number of schools participating in an activity (training, professional development, policy development, technical assistance, PA in-school programming, PA before and after school programming) to improve physical activity among children (6-11).

ESM8.1.2: Percent of children ages 6-11 impacted by improvements to the built environment.

 

General Information:

Indiana continues to fall short on the percent of children meeting physical activity recommendations with only an estimated 32.5% of youth aged 6-11 getting 60 minutes of physical activity every day of the week as of 2020-2021. To make the biggest impact, MCH has continued to partner with the Division of Nutrition and Physical Activity (DNPA) who has been primarily responsible for implementing strategies to increase physical activity is youth, ages 6-11.

To impact the greatest number of children, DNPA gathered policy and programming information from the schools over the last year and provided a variety of technical assistance to educators and other professionals working directly with large groups of adolescents to increase activity during school hours. Professional development was conducted through a variety of platforms based on need. DNPA continued to provide policy reviews for all school corporations who participate in the National School Lunch Program. A consultation session including a complete review through Well-SAT 3.0 and a virtual meeting to review the findings was encouraged.

DNPA also provided grant funding focused on providing physical activity opportunities for youth and adolescents in the classroom, during school, or within before- or after-school program settings to multiple organizations/schools during the year. These were offered to help increase physical activity and physical education knowledge among youth 6-17 years old (K-12) in Indiana. Special considerations were given to organizations and schools that prioritize inclusion and health equity in their proposed program whether that be physical, mental, or emotional health.

In addition, DNPA continued to fund grants to communities for tactical urbanism demonstration projects. This funding implements temporary traffic safety improvements that lead to long term permanent changes supporting safe walking and bicycling to places for youth to be active. DNPA provides funding to organizations implementing bicycle and pedestrian safety measures demonstrating the ability to create safer, healthier neighborhoods by promoting active lifestyles and active transportation for children and adults.

GOAL University

The DNPA contracted with GOAL University to expand the after school, family-focused community program that encouraged healthy lifestyles for children and their families through nutrition, behavior, and physical activity education. GOAL initially began in Bloomington and expanded to Lafayette, Indianapolis, and surrounding rural cities with multiple training sites in each city. The GOAL University program utilized nursing students from universities in each location to help carry out daily lessons and reinforce positive messaging. Additionally, middle school students participated in a health education program in their homeroom and participate in GOAL University during summer camps in summer 2022. 

 

Physical Activity Minutes

While the time varied slightly each week due to the unique lesson plans, students typically spend about 30 minutes (of the 60-minute program) being physically active. The breakdown of a weekly program is below:

• Goal Setting and Checking: 10 minutes (sedentary)
• Nutrition Lesson: 25 minutes (15 minutes sedentary, 10 minutes active)
• Physical Activity Lesson: 25 minutes (5 minutes sedentary, 20 minutes active)

Program Attendance/Reach

Below were the total numbers of nursing student leaders and youth that participated in the GOAL University program in the Fall 2021 and Spring 2022:

• 198 nursing college student leaders
• 1,135 students (6-11 years old)

 

Physical Activity Minutes Trainings

The DNPA supported Playworks in conducting three types of training opportunities:

• Recess Implementation (at two elementary schools in the same district): two days of recess instruction, eight hours each, per training
• Team Up Program (at four elementary schools in the same district): one semester of on-site training
• Recess Reboot (one elementary school in one district): four-day on-site training

Each program listed produces at least 30 minutes of physical activity instruction daily.

Program Attendance/Reach

Below lists the final student reach from the professionals who participated in the Playworks recess programs/trainings:

• Recess Implementation: 515 students
• Team Up Program: 2,090 students
• Recess Reboot: 496 students
• Total: 3,101 students

 

Community Mini Grants:

The DNPA supported five community mini grants. The programs funded ranged from classroom specific to community wide initiatives. They also provided schools, educators, and students the resources to be physically active both in and out of school. DNPA provided the opportunity for each entity to continue their program throughout the reporting period.

Below is the final reach of each grantee’s program.

• Bloomington Parks and Recreation
  • Reach: 81 students K-3rd grade
  • Program: Provided All Kids Swim class to local Bloomington youth where many of these kids experienced childhood trauma, hold high ACE scores, and are ethnically and racially diverse.
     
• Oak Park Church & Early Learning Academy
  • Reach: 47 students 6-11 years old
  • Program: Enhanced playground environment for the church/early learning academy outdoor health and fitness park; provided youth and adolescents the opportunities for outdoor learning and physical education, expanded self-awareness, taught mindfulness, and benefited their mental health by being outside in nature. Next to the playground, an already existing vegetable garden had been planted to teach youth and adolescents of all ages about healthy eating and gardening.
     
• Orleans Elementary School
  • Reach: 225 students K-2nd
  • Program: Expanded Mindfulness Movement Program; sensory pathways inside the building and outside on the playground in the elementary school. The program included the following activities: yoga poses & exercises along with breath awareness that focus on balance, coordination, strength, and flexibility. The school also transformed their hallways into sensory hallways and outside on the playground.
     
• Springs Valley Community Schools Corporation:
  • Reach: 364 students K-5; five elementary school teachers trained in Mindfulness in Motion Program
  • Program: Provided training to teachers to implement Mindfulness in Motion program and sensory hallways in elementary schools; the school corporation also purchased new physical education equipment for their Jr./Sr. high school general PE classes and advanced PE classes which included yoga mats, jump ropes, and resistance bands. The corporation also partnered with a locally certified strength and conditioning coach to teach students how to properly utilize equipment, ways to prevent injuries, and set S.M.A.R.T. goals.
     
• Evansville Trails Coalition:
  • Reach: Community-based
  • Program: Story Trail signage for new story trail in a highly vulnerable area in a local park; featured stories from local authors; partners included YMCA and local library; all volunteer-based; The story trail consisted of children's books featured on permanent and durable signs, with the ability to replace stories over time. Signs also included inclusive and adaptable physical activities for youth and families to engage in along the trail. The installation of the story trail has been postponed due to back orders in materials and weather. Materials were purchased during the grant year and installation will happen once the ground is ready. More details will be available for this project in the coming months.

 

Built Environment Strategies

Temporary Changes to the Built Environment: Tactical Urbanism Grant Program

The DNPA continued to grant funds to organizations implementing pedestrian safety measures demonstrating the ability to create safer, healthier neighborhoods by promoting active lifestyles and active transportation for children and adults. Grantees were selected by a competitive application process and grant amounts ranged from $7,500 – $10,000. Grant projects included new pedestrian crosswalks, pop-up bike lanes, traffic calming installations, traffic speed reduction improvements, walking programs for schools, and pedestrian wayfinding improvements that increase safe access to everyday destinations for children and adults. The following grantees were awarded Tactical Urbanism Demonstration Grants in 2022 spanning from March – September.

• City of Fort Wayne:  Fort Wayne Consolidated School Corporation
  • Reach: 12,928 children ages 6 - 11
  • Program: This project implemented low-cost demonstration improvements in highly visible locations along the Pontiac Street Corridor between Hanna St and S. Anthony Blvd. The project temporarily reconfigured the street to slow traffic and create placemaking opportunities that interact with the surrounding community. The implementation of the project showcased additional pedestrian and bicycle projects along the street corridor. Additionally, the project enabled the City’s newly created Neighborhood Planning and Activation workgroup to engage with the local community in a more personable and hands on capacity, helping to create safe access to destinations for children and adults along the street corridor within the neighborhood.

 

• City of Gary: Gary Community School Corporation
  • Reach: 2,003 children ages 6 – 11
  • Program: This project in Gary implemented low-cost improvements in highly visible locations including the 900 block of Broadway (downtown's southern entrance) and the Adam Benjamin Metro Center, an intermodal transportation facility on the north end of downtown Gary. It features installations of artistic crosswalks adjacent to wheelchair ramps and path-of-travel improvements at locations lacking any marked paths or ramps across a state highway, helping to create safe access to public transportation and destinations for children and adults, including nearby schools.

 

• Indianapolis Community Heights Neighborhood Association: Indianapolis Public Schools School District
  • Reach: 10,610 children ages 6 – 11
  • Program: This project improved safe walking and bicycling connections for students traveling to Indianapolis Public School 88 and the Irvington branch of the Indianapolis Public Library; Ellenberger Park and other amenities around the Community Heights neighborhood and Irvington. The installation calmed traffic and created safer walking and bicycling environments for children and adults in the neighborhood.

 

Changes in the Built Environment

Title V funding was used to promote increased levels of physical activity at the community level through changes to the built environment. Technical assistance was provided to stakeholders and Purdue Extension Community Wellness Coordinators at the local, regional, and state level to identify opportunities to make changes to the built environment supporting physical activity. Technical assistance activities included providing guidance to stakeholders for the planning and installation of multi-use trails, safe pedestrian crossings, bikeways, safe routes to schools and parks, and complete streets. The technical assistance helped enable children ages 6-11 to walk and bicycle to everyday destinations, including schools, libraries, friends’ houses, and extracurricular activities. These types of built environment changes can help children and adults get to places safely, while also increasing levels of physical activity, to help set them up for lifelong health and wellness.

Bicycle and Pedestrian Master Planning

The DNPA provided grants for two communities to prepare and adopt community-wide bicycle and pedestrian plans. Each of the two grantees received a $20,000 grant and provided dollar for dollar matching funds. The planning and adoption of bicycle and pedestrian master plans is recognized as an effective way to implement policy, systems, and environmental changes in communities that support higher levels of physical activity and create safe, active routes to everyday destinations for children and adults. The following community grantees were awarded planning grants in 2022:

• City of LaPorte: LaPorte Community School Corporation
  • Reach: 2,682 children 6-11
  • Program: The grant provided funding to hire a consultant to help the city to prepare a Trails, Greenways, and Blueways Master Plan that contributed to achieving the community's vision by identifying specific streetscape enhancements that prioritize safety and ease of non-motorized transportation. The Plan also identified opportunities to enhance the Blueways network connections between each public waterbody and the trails network. The plan identified opportunities for walking and bicycling connectivity to everyday destinations for children and adults to entertainment, retail, public institutions, recreational areas, and downtown. The main goal of the Plan is to allow safe movement and access to healthy transportation options throughout the city.
• Eskenazi Health Indianapolis: Indianapolis Community School Corporation
  • Reach: 10,610 children 6-11
  • Program: Eskenazi Health hired a consultant to prepare a “small area or neighborhood plan" in Indianapolis that promotes walking and bicycling to everyday destinations such as schools, parks, and shopping to include a focus on Creating Safe Routes in three neighborhoods that contain Eskenazi Health Centers. The planning effort highlighted opportunities to connect safe routes and trails more directly to health center sites. This planning effort enhanced both safe access to healthcare and facilitated programming opportunities such as Eskenazi Health Wellness Walks that encouraged physical exercise. The planning effort is part of the Health Equity Zone initiative, in which Eskenazi Health conducted in depth community engagement, facilitated focus groups with staff, patients, and neighborhood resident leaders. This outreach was complemented by Eskenazi Health’s Community Health Workers and Community Weavers, a newly created role that connects community partners to each health center location.

 

Active Living Workshops

Title V funding supported communities across Indiana in hosting a series of Active Living Workshops. These workshops enabled residents to create action plans that lead to changes in the built environment supporting higher levels of physical activity in their communities. A virtual workshop was hosted in Elkhart and in-person workshops were held in Terre Haute, Gary, and LaPorte. Over 125 community leaders attended the four active living workshops. The workshops will help children, ages 6 – 11, travel safely to everyday destinations within their communities with their families. This process will also allow for safer walking and bicycling to school access, as well.

 

Professional Development Trainings
DNPA provided three Coordinated Approach to Child Health (CATCH) professional development trainings to all K-12 PE teachers and before and after school professionals in Bedford, Indianapolis, and Warsaw. DNPA offered a diverse group of professional development trainings. One training focused on grades 6th-8th physical education, physical activity, and social emotional learning (SEL) activities and curriculum. Two training courses focused on grades K-5th physical education, physical activity, and SEL activities and curriculum. These activity-based trainings included teaching easy ways to engage students and inspire movement and healthy lifestyle habits, as well as introducing SEL into lesson plans. 

 

A total of 38 participants attended and interacted in the three training courses from all over the state of Indiana. 

 

Wellness Policies

The DNPA offered a free opportunity for school corporations to submit their district wellness policy for DNPA’s Child Wellness Coordinator and Youth Physical Activity Coordinator to review. They utilized the WellSAT 3.0 Quantitative Assessment Tool to score and provided an in-depth feedback letter including strengths and suggested ways to improve their wellness policy language. 

 

In FY 2021-2022, DNPA reviewed, scored, and provided feedback to 14 school corporations, with a combined total enrollment of 111,885 students grades K-12.

 

Schools Mini Grants

The DNPA supported five school mini grants. The activities performed under this grant program included various physical activity initiatives targeting areas such as physical education, physical activity breaks, and after-school physical activity. See below for additional details and the final reach of each school serving this age group:

• Fort Wayne Community Schools

• Reach: 12,874 students in grades 1-6
• Program: Provided classroom yoga cards and activity dice to teachers in support of incorporating physical activity breaks throughout the school day

• School City of Hammond

• Reach: 5,044 students in grades 1-6
• Program:
  • Painted stencils on Lew Wallace Elementary School parking lot (enrollment: 465) to expand opportunities for physical activity at recess
  • Purchased physical education equipment for elementary schools
  • Purchased physical activity supplies for use at Summer Food Service Program meal delivery sites

• Huntington County Community School Corporation

• Reach: 2,285 students in grades 1-6
• Program:
  • Purchased adaptive equipment for special education students in physical education class to improve the quality of instruction to these students
  • Created sensory hallways to encourage child movement and activity while traveling between classrooms
  • Provided teachers with yoga training and materials to encourage the provision of physical activity breaks to students

• Invent Learning Hub

• Reach: 116 students in grades 1-6

• Program:
  • Provided students with classes from Kids Dance Outreach to encourage physical activity during the school day
  • Created sensory stations throughout the school to encourage student movement during the school day
  • Provided families with sensory kits to encourage child movement at home

• Metropolitan School District of Warren Township

• Reach: 5,026 students in grades 1-6
• Program:
  • Hired a wellness intern to conduct the School Health Index in order to assess physical activity practices and gaps in each school environment
  • Created a physical activity resource library for teachers to check out supplies for temporary use that promote physical activity in the classroom

State Priority Need:

Access to High-quality, family-centered, trusted care is available to all Hoosiers.

 

State Performance Measure (2020 - 2025):

SPM 5: Promotion of optimal health, development, and well-being

 

General Information

Indiana’s Title V Needs Assessment data revealed that there is a significant need to address the health, development, and well-being around multiple areas for all children, including children with special health care needs. We understand that this cannot be achieved without also engaging and meeting the needs of their caregivers. For Indiana, this extends beyond our prior SPM with a sole focus on developmental screening. Our goal behind this measure was to enhance and expand the promotion of optimal health, development, and well-being of children and their caregivers through education, awareness, and the development of common language across multiple sectors and platforms.  

 

MCH/CSHCS began gathering the total number of trainings and materials offered to children, youth, and families who are striving for optimal health. Reaching families was a collaborative effort measured through the work of the MCH Systems Building, Genomics and Newborn screening, and Early Hearing Detection and Intervention teams, and partner divisions such as CSHCS and Lead and Healthy Homes. MCH collected data through our MCH community outreach team and grantees. MCH also tracked the number of resources shared, what resources were shared, how they were shared, and to whom they were shared to ensure families were getting the information on optimal health. Over the next year, we tracked the following:  

• Learn the Signs Act Early (LTSAE): materials included the milestone tracker booklet, growth charts, children’s books, and development checklists for providers and families. These materials were shared at community events, with Home Visitors, First Steps, WIC providers, physicians, and families. Our LTSAE materials had specific Indiana resources listed on them.  
• Developmental Screening: MCH also tracked materials distributed around developmental screening (the Ages and Stages Questionnaire (ASQ)) were shared. MCH also reported the number of screens completed.  
• My Healthy Baby (MHB): With the rapid growth and expansion of MHB, materials and resources were provided to connect pregnant women to home visiting services. We measured our reach as the rollout of MHB has continued.  

 

Newborn Screening Family Education

The newborn screening program continued education to families. During this report period, 1,772 materials were distributed directly to the public at community events. In September 2022, the newborn screening program joined Expecting Health’s Newborn Screening Education and Communication Workgroup with a focus on education to families.

Newborn Screening Provider Education

The newborn screening program hosted two webinars for birthing hospitals, licensed birth centers, home birth attendants, and midwives to attend. The first webinar was held in January 2022 which discussed updates to the program that occurred during the COVID-19 pandemic. There were 123 healthcare providers that attended. The second webinar was held in June 2022, and the program discussed the newly revised newborn screening program manual. These opportunities allowed healthcare providers to ask questions directly from the program staff about updated policies, best practices, and each healthcare professional’s responsibilities in the newborn screening system. Therefore, regardless of the location of birth, each newborn is accounted and screened appropriately to state guidelines.

The newborn screening program provided online training modules for healthcare providers regarding the policies, procedures, and best practices for newborn screening in Indiana. During this annual report, 955 providers completed at least one of the six training modules available. The newborn screening program distributed 61,996 education materials to healthcare providers, community organizations, birthing hospitals, and midwives across the state to increase awareness of newborn screening during this reporting period.

 

Folic Acid Education

Indiana has disparities in neural tube defect rates among the Hispanic population compared to the Non-Hispanic White and Non-Hispanic Black populations. The birth defects program created and printed folic acid education materials including an infographic and a checklist of common food items containing folate. These materials were printed double-sided to include both English and Spanish languages and with the goal of reducing neural tube defect rates and potentially mortality associated with severe neural tube defects in the Hispanic population.

 

Early Hearing and Detection and Intervention Program (EHDI)  

Indiana’s EHDI team provided technical assistance and training to birthing hospitals, healthcare providers, and parents to meet the federal and state mandated goals of “1-3-6.” The EHDI “1-3-6” goals were mandated in 2000 by the Joint Commission on Infant Hearing and American Academy of Pediatrics and ensure the following: all babies born in Indiana receive a newborn hearing screening by “1” month of age, if they do not pass newborn hearing screening, they receive a diagnostic audiology exam by “3” months of age, and if identified as deaf or hard of hearing, are enrolled in early intervention by “6” months of age.  

 

To comply with these requirements, Indiana EHDI is responsible for collecting hearing screening results on approximately 80,000 children born annually in Indiana. This includes providing onsite monitoring and training to all 85 birthing hospitals by our regional audiology staff. In addition, when a new birthing hospital staff member is identified for reporting newborn hearing screening results, Indiana EHDI trains them: approximately 40 staff members annually. Technical support includes staff working on 14,000 child files per year through phone calls and emails providing guidance to healthcare providers, parents and other programs and entities to ensure “1-3-6” goals.  

If a baby does not pass the newborn hearing screening (3600 babies annually), our staff is responsible for ensuring that those babies receive diagnostic audiology testing by 3 months of age. The follow up procedures for children who do not pass newborn hearing screening for those 3600 children include phone calls to parents and sending letters to parents and physicians with several resources: including information on Help me Grow, MOMS Help Line, Safe Sleep, frequently asked questions about newborn hearing screening and developmental milestones (in Spanish and English). These efforts continue several times until a child’s first birthday or until diagnostic audiology results are entered in our system.  

 

If a child is identified as deaf or hard of hearing, we provide education (230 children per year identified with congenital hearing loss by age one) to the child’s parents and physician through a tool kit that includes state and local resources and guidance for best practice services for deaf and hard of hearing children. We also provide one year of parent-to-parent support for any family with a newly identified deaf or hard of hearing child (any age of diagnosis). This parent-to-parent support is provided through a program called Guide by Your Side program and is a collaboration between Indiana EHDI and Indiana Hands and Voices. Each family is assigned to a parent guide who can provide support to the family after identification of permanent hearing loss through enrollment into early intervention services. To provide additional parent support after early intervention, EHDI now offers the ASTra program, which is primarily funded by Title V.  

 

ASTra is a Deaf and Hard of Hearing Educational Advocacy Program that embodies the mission and vision of Hands & Voices, which is to provide support to families with children who are deaf or hard of hearing (D/HH) without a bias around communication models, methods, and educational settings so that every D/HH child has the opportunity to achieve their full potential. ASTra content is derived from years of direct advocacy experience working with families in schools, attending advocacy trainings from legal experts, providing trainings, and the Hands & Voices Advocacy Guidebook. Indiana is the 12th State to attain the ASTra Program Certification. ASTra advocates are parents of deaf and hard of hearing children who have been highly trained in the education law and parent rights and can help families navigate the individual educational plan process. This is important for deaf and hard of hearing children to ensure adequate access to classroom and social interactions and academic accommodations are in place to support academic progress. During the first year of this program (2019-2020) we served, trained, and provided six Certified Astar Advocates with specialties in ASD, twins, Progressive Loss and native Spanish speaking. The program expanded from serving 47 families from 2020-2021 to 111 families from 2021 to 2022. Of the 111 families served, 40 were Hispanic, 13 Black/African American, 54 Caucasian and 2 Asian.  The families served had D/HH children between the ages of two-and-a-half years old to 16 years old. Of the 111 families served, 45 families use a different language than English.  

 

EHDI has initiated several collaborations with internal and external stakeholders to improve outcomes for deaf and hard of hearing children. It is well known that 3/1,000 children are identified with congenital hearing loss through mandated newborn hearing screening efforts. It is also known that an additional 3/1,000 children are identified with permanent hearing loss after the age of one.  EHDI has been tasked by CDC and HRSA to expand the education and collection of hearing screenings through age five. In order to accomplish this goal, the EHDI team has expanded their collaboration efforts with early childhood partners including Head Start and the Part C First Steps program, to identify ways to improve education to stakeholders on the importance of hearing screenings.  

 

We have improved our partnership with the Genomics Newborn Screening program by providing guidance and live webinars for birthing hospitals, audiologists and other healthcare providers regarding guidance for newborn screening procedures and follow up. We have identified several opportunities to exhibit at conferences such as the School Health Conference, WIC, Public Health Nurses, Physician conferences, First STeps and others to improve education about newborn screening and follow up. 

We also collaborate with other stakeholders through an EHDI Advisory Committee that includes representatives parent organizations, Head Start, WIC, Center for Deaf and Hard of Hearing Education, Audiologists, physicians, nurses, parents, early intervention providers and parents. The Director of EHDI also participates in the Advisory Committee for the Center for Deaf and Hard of Hearing Education and the Indiana Perinatal Quality Improvement Collaborative Perinatal Genetics and Genomics committee for the Genomics Newborn Screening Program and on the MCH Lead team.  

 

Adverse Childhood Experiences  

The Indiana Youth Services Association, funded by Title V, created a statewide director position for the ACEs Indiana Coalition. The coalition consists of a team of individuals who went through the ACEs master training modules and commit to training others in their community. The training creates a common language among community members and enhance and encourage resilient communities. The ACEs Indiana Coalition is dedicated to growing awareness on Adverse Childhood Experiences and building self-healing communities. The coalition was able to provide training in 22 cities throughout the state of Indiana. Through the various trainings, 1,731 individuals were trained through ACE Interface Master Training Program. In addition to the training, the ACEs hosts two yearly coalition meetings and 27 additional meetings regarding ACEs. 

 

Lead and Healthy Homes

The primary goals of the Indiana Department of Health Lead and Healthy Homes (LHH) Division are to track the prevalence of lead exposure in children throughout Indiana and to support local health departments and community partners in taking the necessary steps to promote primary prevention efforts to minimize that exposure and the resulting health risks. One way this is done is through performing risk assessments to identify lead hazards.

 

The most common lead exposure for children in Indiana occurs through lead-based paint. Lead was an additive to most paints prior to the ban on lead-based paint in 1978. As lead based paint deteriorates with age or is disturbed during, for example, repair or remodeling projects, it can generate paint fragments, chips, and dust. These particles can be ingested or inhaled, causing potentially significant health consequences.

 

Exposure to lead most often results in the lead being stored in the body’s blood, bones, and tissues, causing prolonged, consistent exposure. This exposure, especially at high levels, can result in symptoms such as abdominal pain, tiredness, headache, irritability, memory, and appetite loss. Prolonged exposure can result in additional symptoms such as depression, forgetfulness, irritability, and nausea. While lead is toxic to everyone, unborn babies, and children younger than seven years of age may be more susceptible to the negative health effects lead can have on development and growth, as they are likely to experience toxicity at lower levels than adults. Children under the age of two are particularly vulnerable due to the lack of a fully formed blood brain barrier. There is also evidence that early lead exposure has direct ties to significant health concerns later in life, such as: high blood pressure, heart disease, kidney disease, and fertility issues. 

 

In March of 2022, LHH received funding supported through the American Rescue Plan Act (ARPA). The purpose of this Request for Applications (RFA) is to fund entities within the State of Indiana to implement programs focused on addressing health issues and challenges within Indiana. These funds must be used to develop and implement services focused on increasing health outcomes and preventing and/or reducing the prevalence of lead exposure. As a result, LHH requested application from LHD’s to hire a risk assessor for their counties. Over 51 counties applied.

 

Through the support from Maternal & Child Health, LHH was able to license thirteen new risk assessor and renew the licenses of nine existing risk assessors. As a result of these risk assessors being licensed, Indiana was able to perform 595 risk assessment identifying lead hazards in homes were children have elevated blood levels.

 

Oral Health

To help promote children’s oral health, MCH allocated funding in the 2021 Title V funding proposal specifically to fund oral health initiatives throughout Indiana. On October 1, 2021, two organizations were funded: Community Dental Clinic and Dunebrook.

 

• Community Dental Clinic aims to enhance access and promote optimal pediatric oral health through prevention, intervention and education by bringing high-quality, compassionate dental care to Amish, Mennonite, and other under-served communities of rural northern Indiana. Community Dental Clinic served families in LaGrange, Elkhart and surrounding counties. Patients were prioritized based on needs and the feedback from the Plain Community has been positive. Certain schools were identified for teacher training and lesson plans were created to emphasis the important of oral health and dental hygiene. Community Dental Clinic continues to hold a strong partnership and presence within the Plain Community.
• Dunebrook aims to promote and deliver oral health education to low-income Healthy Families participants, deliver parenting education to expectant/new parents, and families with children to improve family functioning and harmony to optimize children's mental, social and emotional health. Dunebrook served families in LaPorte and Porter Counties. For the Healthy Families participants, a webinar outlining the 12 objectives of dental health was created and presented. Dental kits were also distributed to families. The kits are available in English and Spanish and are made for: pregnancy, 1st tooth, ages 1-3 years, and ages 3-5 years but are also available for older children in the household as well.

 

Since starting the work with these two grantees, the office of Oral Health has hired a new Director, Nelly Chawla, who will lead future efforts to address oral health in children. MCH is excited to partner with Nelly moving forward.