Annual Report Fiscal Year 2020:  This section provides a summary of Federal Fiscal Year 2020 (FFY20) activities, accomplishments, and challenges related to National Performance Measures (NPMs) and State Performance Measures (SPMs) (2016-2020) for the Child Health domain.

Developmental surveillance, screening, and observations are important in all aspects of a child’s growth and development. The American Academy of Pediatrics (AAP) Bright Futures Guidelines for Health Supervision of Infants, Children, and Adolescents recommends standardized developmental screening be used at 9-month, 18-month, and 2.5-year visits. Additionally, the AAP recommends developmental screening any time concerns are identified.

Strategy 1: Provide Ages and Stages training to Wyoming providers

The Child Health Program (CHP) has continued to support efforts to increase developmental screening through the distribution of the Ages and Stages Questionnaire (ASQ) screening tools. In addition, the Child Health Program Manager (CHPM) has remained an active member of the Governor’s Early Intervention Council (EIC). The EIC’s mission is to advise and assist coordinated community-based programs and services for families and their children ages birth through five who are identified as having developmental delays and/or disabilities.

The CHP maintains a commitment to providing limited training and support of the ASQ tool to community providers and partners. WY MCH does not currently have any staff certified to train on the ASQ tool and has relied on trained partners at the Wyoming Children's Trust Fund as needed.

PHN launched a new data system in October 2018, increasing the capacity to track ASQ screening implementation as part of the Healthy Baby Home Visitation Program. In FFY20, 2,215 ASQ screenings were completed in partnership between parents/caregivers and PHN staff. This is a large reduction from the previous year, which reported 1,798 ASQ screenings. In addition, in December 2019, WY MCH distributed 17 ASQ kits to five county PHN offices and one medical clinic. The CHP reached out to all county PHN offices to offer additional ASQ kits as needed.

In FFY20, WY MCH continued to focus on the importance of developmental surveillance, screening, and observations through participation as steering committee members for the Wyoming Preschool Development capacity-building grant. WY MCH staff provided subject matter expertise and connection to knowledge leaders. In addition, WY MCH staff participated in weekly needs assessment and strategic planning meetings representing WY MCH. WY MCH leveraged this opportunity to promote AAP Bright Futures recommendations and guidelines as a standard of care for Wyoming families, as well as other related Title V priorities.

WY MCH also maintained active representation on the Governor's Early Childhood State Advisory Council, providing guidance and recommendations to members of the Wyoming early childhood system. This membership provided opportunities to expand partner knowledge of Title V priorities and alignment with other efforts within the early childhood system.

Strategy 2: Promote lead screening

WDH lost funding for a dedicated Environmental Health/Lead Prevention Program in 2014. Due to this absence and the increased interest related to lead exposure, detection, and prevention, WDH staff led by the State Health Officer and including representatives from WY MCH, the Wyoming Public Health Laboratory, Wyoming Medicaid, WIC, Immunizations, and PHN have partnered internally to better coordinate messaging, education, screening, and prevention efforts related to lead screening. As one respondent to the 2021 public input survey stated, “Regular lead testing is a must.” Through this work, a draft letter was created to be endorsed by the State Health Officer for publication in the Wyoming Medical Society magazine addressing the need for child lead screening. In early 2020, the work group also began drafting an application to the Centers for Disease Control and Prevention (CDC) Childhood Lead Poisoning Prevention and Surveillance of Blood Lead Levels in Children grant funding opportunity. Unfortunately, due to COVID-19, the letter has not yet been submitted to the magazine and the CDC temporarily suspended the grant opportunity. However, in April 2021, WDH-PHD submitted an application for the CDC Childhood Lead Poisoning Prevention and Surveillance of Blood Lead Levels in Children grant and is waiting for notification of award status. Within the grant application, WDH was authorized to budget for an at-will state position that will focus on statewide lead surveillance and prevention efforts. In addition, the grant application includes a role for WY MCH staff to support provider education and improve linkages of lead-exposed children to recommended services. WY MCH staff coordinated the effort to draft and submit the CDC application.

Strategy 3: Train providers on Bright Futures recommendations  

The CHP continued to convene the Bright Futures Implementation Task Force (BFITF) in FFY20 but meetings ended at the start of COVID-19. The BFITF is composed of stakeholders including, but not limited to, Wyoming Medicaid, the Wyoming Medical Society, the Wyoming Primary Care Association, the Wyoming Chapter of the American Academy of Pediatrics, practicing primary care providers, and multiple WDH-PHD programs (e.g. Public Health Nursing, Immunizations). The BFITF adopted the following vision and mission statements:

• Vision: The BFITF envisions a future where all children and their families are provided the information, tools, and resources for optimal growth and development.
• Mission:  The BFITF seeks to increase the quality, affordability, and availability of preventive health services for children and families. We strongly value community engagement and collaboration in accomplishing this.

The BFITF identified four primary target areas to focus efforts and potential to establish workgroups over time. These four target areas are:

• Provider Education
• Family / Consumer Education
• Medical Coding
• Access to Care

WY MCH coordinated with AAP to offer a short-term demonstration trial of the AAP Bright Futures virtual toolkit to BFITF members in 2020. After assessing the functionality of the toolkit, WY MCH purchased the licensing rights to distribute virtual toolkit access to any Wyoming provider. Distribution of toolkit licenses was delayed due to COVID-19 but will resume in late 2021. Additionally, WY MCH purchased AAP Bright Futures pocket guides for distribution to Wyoming providers; WY MCH distributed copies of the pocket guide to all PHN offices as an initial step in evaluating the functionality and usefulness of the tool prior to establishing a larger distribution plan.

To promote consumer awareness about the importance of well-child visits, WY MCH, Wyoming Medicaid, and Wyoming Vital Statistics Services partnered to draft and distribute a letter to all new mothers based on birth certificate data. The letter encourages parents and caregivers to schedule and attend their first well-baby visit and postpartum visit for mother and to continue to follow the recommended well baby and well child visits throughout childhood. In addition, parents and caregivers are introduced to resources that support family knowledge building. The letter referred parents and caregivers to the My 307 Wellness phone application as an important health information resource.

In late 2020, the CHPM and Women and Infant Health Program Manager partnered to draft a Request for Proposal to implement focus groups on four key MCH topic areas including consumer knowledge and understanding of well visit recommendations and Bright Futures, 4th. Edition guidelines. The OMNI Institute was selected to lead this focus group project and will begin work in summer 2021. Results of these focus groups will inform FFY21 and FFY22 Bright Futures consumer education strategies.

Of the May 2021 public input survey respondents who indicated that they have a child age 2-11 in their household, 77.36% indicated that they believe the Child Health Program’s focus on sharing more information on Bright Futures with healthcare providers and the public, getting more childcare centers to use the Healthy Policies Toolkit, and childhood blood testing for lead levels fits well or very well with the needs of their family or community.

The prevention of childhood obesity was selected as a Wyoming priority for 2016-2020.  Increasing physical activity remains the key strategy to reduce childhood obesity.

Strategy 1: Partner with the Wyoming Chronic Disease Prevention Program to implement evidence-based childhood obesity prevention strategies in early childhood facilities and schools.

WY MCH continued to connect with state-level partners to support the increase in childhood physical activity (SPM5) through the following activities.

WY MCH continued to promote and actively support the Healthy Policies Toolkit and provided TA and training to the University of Wyoming, Cent$ible Nutrition Program. The Cent$ible Nutrition Program maintains Certified Nutrition Educators (CNEs) in all 23 Wyoming counties and the Wind River Indian Reservation. The CNEs have targeted childcare facilities serving low-income populations for site-specific TA and training reaching 838 children. All CNEs utilize the policy toolkit as a standardized framework to support settings in increasing physical activity and reducing obesity.

Each year, Cent$ible Nutrition conducts a statewide conference for CNEs. The CHPM developed a presentation on the importance of the Healthy Policies Toolkit and implementation considerations. The CHPM was able to present this information to every Cent$ible Nutrition CNE in FFY20. The CHPM placed primary emphasis on encouraging and supporting Wyoming early childhood education providers to adopt physical activity priorities from the toolkit.

The CHPM also actively participated in a state-level nutrition collaborative, the Wyoming State Nutrition Action Coalition. This group consists of representatives from the University of Wyoming, Wyoming Hunger Initiative, Wyoming Department of Health, Wyoming Department of Workforce Services, Wyoming Department of Education, Wyoming Department of Family Services, and Wyoming chapter of the American Academy of Pediatrics, as well as other applicable invitees depending upon the meeting topic. The CHPM applies a Title V lens to the collective areas of work on hunger, obesity, food sustainability, access, and the promotion of physical activity within the state collaborative.

Of the May 2021 public input survey respondents who indicated that they have a child age 2-11 in their household, 92.45% indicated that they believe it is important or very important to address child obesity in their community.

Injury-related hospitalization and death remains the leading cause of preventable hospitalization and death in Wyoming. CHP remained committed to reducing the rate of children being hospitalized due to preventable injury. CHP was also equally committed to reducing the child mortality rate.

Strategy 1: Implement community-based grants with targeted evidence-based strategies to address the major causes of childhood injury/hospitalizations in Wyoming

Based on ongoing and continuous data gathering and needs assessment, WY MCH identified that the burden of childhood injury-related hospitalization and death was on the adolescent population. WY MCH adjusted its focus on the “Prevent Childhood Injury” priority in 2018 to address the emerging topics of adolescent motor vehicle safety and adolescent suicide prevention. As a result of this adjustment, the Youth and Young Adult Health Program (YAYAHP) took on primary leadership of this priority. The CHPM continued to serve as an active member of the Child Safety Network Childhood Injury Learning Collaborative (CSLC).

In spring 2020, the Wyoming CSLC team elected to continue participating in the second cohort of the CSLC. The YAYAHP will utilize membership in the CSLC to support both the Promote Adolescent Motor Vehicle Safety and the Prevent Adolescent Suicide priorities.

Other Programmatic Activities

My 307 Wellness Phone Application

WY MCH staff supported the application developers by serving as subject matter experts and also provided content reviews for their respective population domains. In addition, WY MCH staff served in several leadership and administrative roles in support of expanding public use of this free health resource which provides valuable health information to adolescents, parents, caregivers, and the general public. The My 307 Wellness application also connects Wyoming residents to identify resources within the state.

COVID-19 Response

COVID-19 impacted the CHP’s ability to interact with critical partners in support of child-related priorities. For example, statewide closures of early childhood care and education centers impacted partnership with University of Wyoming Cent$ible Nutrition Program and the ability to provide ongoing education and support on the Healthy Policies Toolkit. In addition, the CHPM was one of several WDH-PHD staff partially reassigned to COVID-19 related support and response efforts as a primary call taker for the WDH COVID-19 provider hotline.  This shift in staff responsibility impacted the CHP’s ability to focus on the Title V identified priorities.