Child Health

2018 Annual Report

Priority Need:  Child Safety Due to Intentional Injury

NPM 7: Rate of hospitalization for non-fatal injury per 1000,000 of children ages 0-9 and adolescents 10-19.

Population Domain: Child Health

The most recent federally available data (2016) on the rate of hospitalization for non-fatal injury per 100,000 children ages 0-9 and adolescents 10-19 indicates the following:

• 98.2 per 100,000 children ages 0-9 were hospitalized
• 227.4 per 100,000 adolescents ages 10-19 were hospitalized

Current Activities Related to Child Safety

Reports of Child Maltreatment in Home Visiting Programs (ESM 7.1)

According to administrative data from the Arkansas Department of Human Services’ Division of Children and Family Services, 172 of the 2,444 (7%) of families served by federally-funded home visiting programs had reports of child maltreatment in federal fiscal year 2018 (October 1, 2017 – September 30, 2018). The objective is to reduce the number of reports by at least 10% by 2024.

Shaken Baby Syndrome Education (ESM 7.2)

Shaken Baby Syndrome brochures are distributed annually to local health units, birthing hospitals, and child care centers by the Child and Adolescent Health Section. A total of 47,638 brochures were distributed in 2018. Brochures are distributed annually to each birthing hospital for inclusion in the information packet each family receives prior to discharge. The Section partners with the Division of Human Service’s Program and Professional Development Administrator to ensure the brochures are in stock at each of the 13 Child Care Aware Resource and Referral Agencies for distribution to local child care centers upon request. Also, the shaken baby syndrome brochure is available for download on the Arkansas Department of Health (ADH) and Department of Human Services websites. Lastly, local health unit’s Parent Support Mentors use the brochures during education with new parents on the dangers of abusive head trauma.

The ADH continued its partnership with Arkansas Children’s Hospital’s Injury Prevention program to support 40 Safety Baby Showers held across the state at four sites (Arkadelphia, Helena, Lake Village, and Little Rock). A total of 187 attendees participated in the showers and received education. Additionally, 119 people were trained using Arkansas Children’s Hospital’s Safety Baby Shower Train-the-Trainer curriculum.

Other Programmatic Activities Related to Child Health

Percent of children, ages 9 through 35 months, receiving a developmental screening using a parent-completed screening tool in the past year (NPM 6)

According to the 2017 National Survey of Children’s Health, 47.9% of parents of children age 9-35 months completed developmental screening.

Percent of preventative dental visits in the last year among children 1-17 years old (SPM 1)

Seventy-seven percent of children, ages 1 through 17, had a preventative dental visit in 2018.

The ADH’s Office of Oral Health works to promote early detection and treatment of dental disease, increase awareness of the importance of oral health for school readiness and learning and to participate in statewide surveillance of oral health. The ADH’s Office of Oral Health collaborates with community partners to assist in providing preventative dental services to children by participating in the Dental Health Action. In addition to the ADH, the Dental Health Action Team is comprised of the following organizations: Arkansas Children’s Hospital, Arkansas Department of Human Services, Delta Dental Plan of Arkansas, Heart of Arkansas United Way, Little Rock School District, National Children’s Oral Health Foundation, University of Arkansas Pulaski Technical College, University of Arkansas for Medical Sciences, and University of Arkansas at Little Rock’s Children International. The Arkansas Department of Human Services reported 464,024 children, between the ages of 0-17, were eligible for preventative dental services but only 199,416 children (43%) received services in 2018. Services included dental prophylaxis, topical fluoride, and dental sealants.

Future Smiles Dental Clinic. The Future Smiles Dental Clinic is located at the Wakefield Elementary School in Little Rock (Pulaski County). The clinic provides comprehensive dental services to children attending schools within the Little Rock School District without dental insurance. Services include annual dental screenings, sealants, fluoride varnish, and restorative care. To date, 29,727 students received dental screenings, toothbrush kits, and dental education; 3,857 children received dental sealants; and 8,003 children received restorative care.

Arkansas Children’s Hospital Dental Sealant Program. Arkansas Children’s Hospital coordinates with community stakeholders to provide portable, preventive dental services to underserved populations statewide using three mobile dental clinics. The program provides oral health education and preventive care to approximately 1,200 school-aged children statewide.

           Infant and Child Death Review. The ADH’s Family Health Branch continues providing support to the Arkansas Infant and Child Death Review Program (https://www.archildrens.org/health-and-wellness/injury-prevention-center/infant-and-child-death-review) to review deaths of infants less than one year of age. There are currently 11 Death Review teams covering all 75 counties. Representatives from the medical examiner/coroner, Arkansas State Police’s Crimes Against Children Division, law enforcement, public health, Division of Children and Family Services, prosecuting attorney, Emergency Medical Services, and a physician/nurse with specialized training assisted in reviewing 134 (82%) cases. Twenty-nine (18%) cases are in adjudication and will be reviewed following the completion of the legal process.

The Death Review Program provided recommendations based on review findings to promote reductions in preventable child deaths. In 2018, the program conducted educational campaigns and local teams implemented discretionary projects.

Statewide Suicide Campaign. Prevention resource packets were created as a part of the campaign and, to date, 10% of schools received an informational card stating the packets were available and asked for a copy of the packet. Suicide prevention messaging from American Foundation for Suicide Prevention was displayed on seven billboards in rural areas statewide.

Statewide Safe Sleep Campaign. The campaign promoted the ABCs of Safe Sleep (babies should sleep Alone, on their Backs, and in a Crib) messaging on seven billboards in rural areas statewide. Messaging for ABC brochure inserts assures parents and providers that pack n’ plays are safe. The Safety Baby Shower guide was revised to simplify the message and target safe sleep messaging. The guide was translated to Spanish.

Projects by Local Teams. In 2018, local teams led projects focused on Sudden Unexpected Infant Death (SUID) investigation training, water safety education, and safe sleep messaging. SUID kits were distributed to all Pulaski County law enforcement agencies following training. Fifteen officers representing five various law enforcement agencies attended the training. Water safety education occurred at the Monticello Intermediate School Safety Fair. As a result, 401 students in grades 3-5 received education and lifejackets. Lastly, local teams collaborated with Springdale High School EAST lab to begin developing safe sleep materials in Marshallese.

Baby and Me Parenting Program

Baby & Me is an Arkansas-based pilot project implemented by six staff members in nine Women, Infant and Children (WIC) clinics. The project launched in November 2018 and came about through a collaboration between the Arkansas Department of Health’s WIC Program and Family Health Branch, Arkansas Children’s Trust Fund, and the University of Arkansas for Medical Science’s Department of Family Medicine Psychology Research Group. The project started in response to data from the 2016 National Survey of Child Health, which stated Arkansas children have the highest percentage of adverse childhood experiences of all states. This program focuses on strengthening the parent-child relationship, promoting healthy child development, and connecting parents to community resources.

The project uses parent support mentors (PSMs) to deliver the one-on-one parenting intervention prenatally and for six months following the birth of the child. The PSMs meet with interested families during WIC clinic certification visits. The mentors provide brief learning sessions paired with facilitated mother-child interaction time focused on enhancing secure attachment and reinforcing education parents may have received from the birthing hospital and/or primary care physician. The prenatal module focuses on safe sleep. Once the child is born, the PSMs provide the following education: crying (month 1), home safety (month 2), stress and depression (month 3), routines (month 4), preparing for discipline (month 5), and developmental milestones (month 6). Each educational session includes an activity designed to promote nurturing and attachment. Participants receive diapers and wipes upon completion of each module. The PSMs collect data at each session and enter the data into a REDCap database. As of April 5, 2019, the PSMs have completed intake on 286 parents and completed 409 modules. Two of the six PSMs completed the requirements to achieve the Certified Lactation Educator credential designation. The states’ coordinator for the Breastfeeding Peer Counseling Program led the Certified Lactation Educator training funded by a special USDA mini-grant. The Baby & Me project is hiring PSMs for three additional WIC clinics in two other regions of the state. The additional PSMs will be contract employees though MidSOUTH, which is housed in the Social Work Department of the University of Arkansas Little Rock. An evaluation will compare results of the employee-led education to results of the contractor-led evaluation.

Developmental Milestone Education

The ADH is working to support parents by increasing awareness of developmental milestones. The agency’s goal is to promote the use of the Center for Disease Control and Prevention’s Milestone Tracker app, which provides parents with information on how their child should develop during early years, birth to age five. (https://www.cdc.gov/ncbddd/actearly/milestones-app.html). Parents who request a birth certificate for a child under three years of age will receive a letter from the Child and Adolescent Health Medical Director with information about the Milestone Tracker app, locating a primary care physician, toxic stress, breastfeeding, and safe sleep. ADH’s Office of Vital Records distributed 7,389 letters with birth certificates in 2018.

The Arkansas WIC Program is one of three programs, including WIC Programs from Nevada and Massachusetts, to receive funding to participate in a project based on the Centers for Disease Control and Prevention’s (CDC) Learn the Signs, Act Early model. The project will replicate work done by Missouri’s WIC Program. The Association of State Public Health Nutritionists and the CDC will provide ongoing guidance and support during the implementation process. The goal of this project is improve early identification of developmental delays and disabilities by helping WIC Program parents learn about early childhood development so they can monitor their child’s development. The participating WIC Program clinics will have engaging images on the walls and floors that introduce the concept of developmental milestones. The WIC clinic staff will also provide and review milestone checklists with parents and provide referrals for developmental screening as necessary. To date, 28 participants completed the survey: nine participants passed the checklist while 19 failed the checklist, missing one or more of the developmental milestones recommended for their child’s age. Each of the participants that failed the checklist was referred to their primary care provider for further screening.

Arkansas’s Learn the Signs, Act Early team includes the WIC Epidemiologist, two Regional Directors, and the CDC Learn the Signs Ambassador for Arkansas. The team held its first meeting in April 2019 and launched with three pilot clinics in July 2019. Statewide implementation is projected to begin in Spring 2020. Arkansas’s WIC Director and WIC Nutrition Education Coordinator spoke about being a recipient of this grant on a National WIC Association Webinar in March 2019.

Adverse Childhood Experience (ACE) Education

Almost one-in-four (24.4%) children have two or more adverse childhood experiences (ACEs) compared to 19.3% nationally, which ranks Arkansas 42 of 50, with 50 being the worst (https://www.childhealthdata.org/browse/survey/results?q=6760&r=1&r2=5). White, non-Hispanic children in Arkansas experience less ACEs than African-American, non-Hispanic children. A higher percentage of Arkansas children experience ACEs compared to the nation as a whole, regardless of race/ethnicity.

Family Health Branch staff work with the Arkansas Foundation of Medical Care and participate on the Arkansas ACEs/Resilience Workgroup. The workgroup hosted the second ACEs/Resilience Workgroup Summit: Building Resilience for Every Child, in Every Community. The summit invited health care professionals, community and faith based organizations, school staff, elected officials, and state and local agency staff to attend. Dr. Howard Pinderhughes, Associate Professor at the University of California San Francisco School of Nursing, and Dr. Renee Boynton-Jarrett, Associate Professor at Boston University School of Medicine and founding director of the Vital Village Community Engagement Network, served as the keynote speakers. Dr. Pinderhughes presented information on Health Communities and Restoring Community Resilience and Dr. Boynton-Jarrett presented information on Science, Practice, and Partnership to Transform Early Childhood Systems of Care and Education.

The Child and Adolescent Health Medical Director continued ACEs/Resilience education efforts by providing 44 ACEs/Resilience presentations to the general population and two presentations to primary care physicians.