Children's Health Branch
NPM 6-Percent of children, ages 10 through 71 months, receiving a developmental screening using a parent completed screening tool
ESM 6.2 - Establish an agreement with the Alabama Partnership for Children's Help Me Grow (HMG) Program to utilize their online Ages & Stages Questionnaires, Third Edition (ASQ-3) assessment tool so that parents can complete developmental screens prior to child health visits at county health departments.
SPM 2-Increase the percentage of Alabama Medicaid- eligible children who receive a blood lead screening test.
A registered nurse was hired to oversee the ACLPPP. An epidemiologist was also hired to help extract accurate data. In September 2018, CDC awarded funding to Alabama to increase lead screening and reporting.
Oral Health Office
NPM 13.2: Percent of children, ages 1 through 17, who had a preventive dental visit in the past year
ESM 13.2-Increase the proportion of infants and children, ages 1-17 years, who report receiving a preventive dental visit in the past 12 months by piloting the Home by One Program.
The Alabama Head Start Collaboration Office Director provided dental and other health data and continues to serve on the Oral Health Coalition of Alabama.
Dr. Ric Simpson continued to serve as a liaison between the Oral Health Coalition and the Alabama Chapter of the Academy of Pediatric Dentistry (AAPD) and shares OHO activities to promote programs/activities designed to reach very young children and their parents regarding the importance of a dental home.
OHO assisted AAP staff in applying for a DentaQuest grant to fund a statewide "Book, Brush, Bed" program to targeted children ages 0-3 years. The grant will promote interprofessional collaboration between pediatricians and pediatric dentists and promote good oral health concepts through 12 pediatric practice sites statewide. Pediatric staff will provide parent education using videos, flip charts, etc. and distribute education material (books, brochures, stickers, etc.). The pediatric offices have received and have begun to distribute approximately 500 infant toothbrushes, floss, and toothpaste kits through the 12 practice sites (6,000 kits total). OHO supported the "Book, Brush, Bed" program by purchasing the oral hygiene kits and donating them to the program. The program will target children ages 0-3 years.
OHO partnered with HCCA to promote dental health education and dental homes for at risk children in select day care centers statewide. OHO has provided free oral hygiene supplies and education material. The classroom instruction was delivered by ADPH Healthy Childcare regional nurse coordinators.
OHO developed, printed, and shipped 575,000 coloring books for all K-6th graders in Alabama public schools. Schools and other entities may submit a material request via the OHO webpage. OHO will continue to print and distribute as requests are made. OHO provided 150 oral hygiene kits, 300 coloring books, 300 “Defeat Monster Mouth” activity pages to Seth Johnson Elementary School for educational outreach.
In February 2018, the OHO requested Governor Kay Ivey sign a proclamation declaring February as Children’s Dental Health Month in Alabama–bringing recognition to the importance of children’s oral health to their overall well- being.
In February 2018 a "Share Your Smile with Alabama" campaign was launched for 3rd grade children in public, private, and home schools statewide to bring attention to National Children’s Dental Health Month. Two children, one girl and one boy, were selected from photo submissions as the overall winners of the "Share Your Smile with Alabama" campaign. Prizes of oral health products and a photo shoot in the RSA studio were met with accolades from children’s families as well as the ADPH staff. The winners appeared at a live news conference from Montgomery and will be featured in OHO marketing campaigns to promote children's oral health in the state throughout the year. The campaign is designed to increase awareness about the importance of good oral health and the value of a great smile. OHO advertisements have been published statewide in Birmingham Parent Magazine, Montgomery Parents, River Region’s Journey, River Region’s Boom, Auburn-Opelika Parents, Mobile Bay Parents, Eastern Shore Parents, Anniston Star, and Lagniappe (Mobile / Eastern Shore). In the first ad, not only are the children featured, ESM 13.2 was also highlighted.
Zika Birth Defects Surveillance
AZBDSP was established in 2016 for the purpose of rapid, active surveillance for infants with microcephaly or other adverse outcomes linked to Zika virus with support from CDC grant funding. Additional strategies include capacity building for infrastructure of a birth defects registry, connection of affected children/families to appropriate social services, support non-identified data evaluation and monitoring directly to the CDC, and coordination with USZPR to ascertain Zika-related health outcomes.
In 2018, active surveillance, intervention, and referral activities continued, and the AZBDSP managed 166 pregnant referrals and 13 newborn referrals. There have been no infants identified in Alabama with congenital Zika syndrome since surveillance began. A Zika Birth Defects Surveillance nurse coordinator was also hired. In April the program learned that CDC funds would end and no further federal funding would be available for birth defects surveillance activities. However, a no cost extension was made available for states to continue efforts of surveillance until 2019. Thus, due to the loss of funding, plans to hire additional staff were impeded.
NEDSS was utilized as the surveillance database for documenting Zika related birth defects data. Pregnant and infant pages were created and added into the database based on the CDC consultation forms. Aggregate data was extracted and submitted to the CDC USZPR to ascertain Zika-related health outcomes. A birth defects logo was developed, and Zika birth defects educational material was developed. Zika education was provided at CRS, UAB, and at the 43rd Annual Bruce A. Harris Symposium for obstetric providers.
Zika surveillance protocol was developed for rapid notification and data collection of Zika exposed babies. Challenges faced included frequent CDC guidance changes, loss of one of two data abstractors hired, closeout of federal funding, and following transient populations who move out of jurisdiction or who are unable to be located. Activities continue to improve rapid and accurate ascertainment of microcephaly and other Zika related birth defects to include providing a list to healthcare providers of all Zika related birth defects with ICD-10 codes for more accurate and complete reporting.
Plans are to establish a birth defects registry program in Alabama with CDC funds. Several meetings, in 2017, were held with the Office of General Counsel and ADPH Administration to discuss establishing a birth defects rule. Ongoing efforts continue in the establishment of an administrative birth defects rule to provide authority and access to required data. Plans are to gather stakeholders to discuss plans to move forward with the birth defects registry to promote buy-in.
Child Health Partnerships
FHS continued to participate in the advisory group for the Early Childhood Comprehensive Systems Planning Grant and received input on its implementation of early childhood system initiatives.
The Alabama Department of Early Childhood Education
DECE's mission is to provide state leadership that identifies, promotes, and coordinates services for children, their families, and communities. DECE is the state designee for the federally mandated Early Childhood Advisory Council, home of the Alabama Head Start Collaboration Office, coordinator of Alabama's state and local Children's Policy Councils, administrator of the Children First Trust Fund, lead agency for early learning and home visiting programs, and developer and operator of the nationally-recognized First Class Pre-K Program. DECE has also designed and coordinated the state plan for developing a continuum of home visiting services for children from prenatal to age five, including all relevant state agencies.
DECE receives and disperses any funds appropriated by state and federal sources for the establishment, operation, and administration of its programs. DECE is responsible for coordinating and organizing all efforts for the federal Preschool Development Grant and serves as its fiscal agent. DECE was awarded a $70 million ($17.5 million per year for four years) federal preschool development grant in 2014 to expand access to quality First Class Pre-K. In 2018 the Alabama Legislature approved an $18.5 million expansion for First Class Pre-K,
increasing the FY 2019 program budget to $96 million. 18,720 children were enrolled for the 2018- 2019 school year in 1,040 classrooms in all 67 counties, serving 33 percent of the state's eligible four-year-old population. Since 2012, investment in First Class Pre-K has grown from $19 to $100 million, by more than 420 percent. There has been a 380 percent increase in additional classrooms and number of students served during the same period.
Healthy Childcare Alabama
HCCA expanded to statewide coverage in October 2015 and now has 12 registered nurse consultants located throughout the state. The nurse supervisor continues to supervise the nurse consultants and to assist with providing interim health and safety training, consultation, and technical assistance to child care providers as needed in the extended absence of a nurse consultant. HCCA continues the use of its online documentation and reporting system. In 2018 The Alabama Child Care Safety Act was enacted to require all child care providers that receive subsidies to become licensed. We proposed a plan to expand HCCA throughout Alabama and were awarded an increased budget for FY2019 and FY2020. Four additional nurse coordinators, an administrative assistant, and a nurse supervisor will serve child care providers in the state. When the expansion is complete the program will be comprised of 16 registered nurse consultants, two nurse supervisors, two ASAs and a nurse manager.
Alabama Project LAUNCH
Alabama Project LAUNCH (Linking Actions for Unmet Needs in Children's Health) is a grant through the Substance Abuse and Mental Health Services Administration (SAMHSA). Project LAUNCH is designed to promote the healthy development of young children within targeted communities through activities that advance the social, emotional, and behavioral health development of children. The population of focus is children ages birth to eight. The target implementation county for the grant is Tuscaloosa. Project LAUNCH is a five-year grant that was implemented in Alabama in 2014.
Project LAUNCH grantees are guided by Young Child Wellness Councils (YCWC) that bring families and public/private partners together to improve policies, programs and approaches to use data and funds effectively. Monthly YCWC meetings are held in Tuscaloosa and quarterly meetings are held in Montgomery. Various agency representatives participate in the meetings.
Through Project LAUNCH, HMG Alabama was formed. HMG is a free information and referral line that utilizes 2-1-1 to help connect families of children birth to age eight to health and developmental resources in their community, as well as developmental monitoring and support. Families may dial 2-1-1 statewide or enroll online at helpmegrowalabama.org. Providers may call or refer to any regional care coordinators. During FY 17, the FHS Children’s Health Branch began working on a plan to assist HMG expand to underserved areas of the state. The plan will increase the number of 10-71 month olds who are provided ASQ3 developmental screening.
Since Tuscaloosa County is the implementation site for the LAUNCH grant, all activities are in Tuscaloosa. Books, Balls and Blocks (BBB) events are held at various sites (the housing authority, community resource centers, etc.) This event is free and held for children and their families. The purpose of the event is to screen children for developmental delays. While children engage in games/activities, parents complete the ASQ-3. ASQs are scored on site and parents learn if the child's development is on schedule or if further assessment is needed. Free community resources are available at the events. A "Read and Romp" is also held annually in Tuscaloosa. At this event, children are able to receive free books and play while families learn about community resources that are available to them. All literature is provided free to the families and children that attend. The Tuscaloosa LAUNCH coordinator is housed at the Child Development Resources Center in Tuscaloosa. The Tuscaloosa LAUNCH coordinator is very involved with the Parents As Teachers program, Home Visiting Program, Tuscaloosa's One Stop and various other programs in Tuscaloosa County.
As part of Project LAUNCH, the Alabama Association for Infant and Early Childhood Mental Health was formed in January 2017, and operates under "First Five Alabama." First Five Alabama became an affiliate of the Alliance for the Advancement of Infant Mental Health. The goals of the association are to promote the healthy social, emotional, cognitive, and physical development of children; facilitate interdisciplinary collaboration with others; encourage the realization that infancy is a sensitive period in the psychosocial development of individuals and to promote education and research, and to study the effects of cognitive development during infancy; promote the education, professional development, and endorsement of professionals across multiple disciplines, to increase the supply of early childhood mental health consultants, to enhance programs of care, intervention, and prevention of mental impairment in infancy and early childhood. ADPH is currently one of the founding board members of First Five Alabama.
Project LAUNCH grantees are required to have key staff at the state and local levels. ADPH staff serve as the Young Child Wellness Partner (YCWP) for the grant. The partner complements the role of the YCWE (Young Child Wellness Expert), through a public health perspective and links with other programs within the agency. The partner is responsible for: participating in SAMHSA and National Resource Center calls, developing and revising the disparity statement as needed, monitoring and revising the strategic plan as needed, participates in all YCWC meetings (state and local), participating in BBB events, recruiting parents to the YCWC meetings, planning for the annual PDI/Summit, working with team members on the evaluation plan, collaborating with other partners (states and tribes), providing data for monthly government project officer calls, attending out of state trainings as required, and coordinating service delivery among providers.
As of March 2018, there were 178,018 children enrolled in CHIP; with 90,546 enrolled in ALL Kids and, of those, 56,362 were 1 through 12 years of age.
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