Child Health/Annual Summary (Early Hearing Detection Intervention)

The narrative below describes the rationale for why Mississippi selected certain measures and provides detailed narrative to link the selected NPM’s, SPM’s with Mississippi’s identified state priorities.

Priority Area: 

Increase access to comprehensive health care.

Program summary and Purpose:

The Mississippi Early Hearing Detection and Intervention (EHDI-MS) program coordinates with primary and speciality health care providers in birth hospitals and clinics and early interventionists in implementing a state-wide system of care to ensure infants and toddlers with hearing loss are identified and receive early intervention. The EHDI-MS goals are to ensure every child receives a hearing screening by one month of age and, if needed, confirmation of hearing status via a diagnostic evaluation by three months of age and high-quality, family-centered early intervention by six months of age.

 

The EHDI-MS personnel conduct active surveillance by receiving screening reports from birthing hospitals, ensuring follow-up by diagnostic providers, and referring children with confirmed hearing loss to the Mississippi First Steps Early Intervention Program. In addition, the EHDI Program tracks children who are at-risk of late onset hearing loss to ensure timely screenings are conducted between 18 and 24 months of age. The EHDI-MS personnel also provide training and technical support to screening, diagnostic, and intervention personnel, coordinate with other maternal and child health programs, and partner with family-based organizations, health care providers, professional associations, and other stakeholders to implement quality improvement efforts.

 

Of the 37,370 babies born in Mississippi in 2017 reported to EHDI-MS, 36,872 (98.7%) were documented as having a hearing screening and 603 of those referred on their final hearing screening. Of those who referred on the hearing screening, 471 (78.1%) were documented with a confirmed hearing status of which 54 (11.5%) were documented as having a diagnosis of permanent hearing loss. Of those identified with permanent hearing loss, 32 (59%) enrolled in Part C early intervention services.

 

 

 

 

 

 

 

 

 

Child Health Annual Report (Early Hearing Detection and Intervention)

Objective 1: By March 2020, 25% more pediatric healthcare providers will be knowledgeable of the EHDI-MS system, JCIH Guidelines and Recommended Best Practices, and evidenced-informed practices, including medical home practices targeting pediatric healthcare providers.

Strategy 1: EDHI-MS will continue to conduct state level outreach on the EHDI system, JCIH Guidelines and recommended best practices.

Rationale Strategy 1:  Pediatric healthcare providers are not knowledgeable enough on the EHDI system and JCIH Best practices. The EHDI-MS will continue to train and provide documentation on the importance of screening infants by the 1-3-6 guidelines.

Activity 1a:  EHDI-MS will continue the effort with the online survey for healthcare providers, families and hospital screeners to determine their knowledge of the EHDI-MS system, JCIH Guidelines, and recommended best practices.                           

Report Activity 1a:

In 2018, EHDI-MS personnel collected follow-up data of pediatric health care provider knowledge of the EHDI system, JCIH guidelines, and best practices using survey methodology. Survey results indicated health care providers were only “fairly familiar” with the EHDI system in Mississippi and only “slightly familiar” with the causes, types, and degrees of hearing loss and its impact on development, JCIH Guidelines and Recommended Best Practices, and evidence-based practices.

Activity 1b:  EHDI-MS will continue to conduct outreach to all professional of pediatric health care providers to engage in shared learning.

Report Activity 1b:

In October 2018, the EHDI-MS held a two-day conference for 120 primary care and specialized providers, early interventionists, care and service coordinators, and State agency personnel. The conference provided general and role-specific training opportunities for better understanding the EHDI system, JCIH guidelines, and best practices. Attendees rated the conference sessions consistently as contributing to their knowledge and skills and that they knew how to apply this knowledge in their role. In addition, EHDI-MS personnel connected with state representatives of professional organizations, including the American Academy of Pediatrics (AAP) and the Mississippi Speech-Language-Hearing Association (MSHA), to promote knowledge of the EHDI system and best practices in pediatric diagnostic evaluation.

 

In 2019, the EHDI-MS held a series of regional learning community meetings in the Northern, Central, and Southern regions on topics of hearing screener survey results, timeliness of diagnostic evaluations, best practices in referral and follow-up from hospitals to audiology clinics, and culturally responsive services. These meetings included hospital personnel, audiologists, care coordinators, and families.

 

Strategy 2: EHDI-MS will have continuous opportunities to collaborate with professional health care organizations to provide training of the EHDI System.

Rationale Strategy 2:

The rationale for this strategy is to ensure all pediatric service and healthcare providers have the knowledge and skills needed to ensure proper care for diagnosed infants.

Activity 2a:  The EHDI-MS will continue to update the training calendar with dates of meetings, conferences and other important events.                            

Report Activity 2a:

Training information was shared with stakeholders at all quarterly EHDI Advisory Committee meetings and sent out via MS-HIN to assist with distribution to the professionals. Training information was also  included on the EHDI website revisions.

Activity 2b:  We will continue to set up trainings for pediatric providers and analyze the results and knowledge gaps and trends.

Report Activity 2b:

Annual EHDI Conferences are held for networking and joint learning. In addition, training for hospital screening personnel are conducted in each region of the state. Throughout 2018-2019, hospital and diagnostic providers are provided individualized training and technical assistance. In August 2019, a new Outreach/Training Consultant was hired to assist in the provision of onsite training for health care professionals.

 

Strategy 3: EHDI-MS will continue to expand the use of MS Health Information Network MS-HIN to support communication among pediatric health care providers and other medical professionals.

Rationale Strategy 3: EHDI-MS personnel will continue to work with the vendor to resolve technical issues and improve the quality of data matching across programs. To improve data sharing of electronic records with the EHDI program and among screening and diagnostic providers.

Activity 3a:  The EHDI-MS will continue the effort to recruit and assist providers to participate in MS-HIN. The EHDI-MS will utilize the expertise and advisement of the advisory board to ensure the list of providers are current and are equipped to provide services and diagnose infants and toddlers with suspected hearing loss.                                         

Report Activity 3a:

As of September 2019, 51 birth hospitals, screening professionals, and midwives have access to MS-HIN. In addition, 31 diagnostic providers have access to MS-HIN.

Strategy 4: Conduct state level outreach on the EHDI system, JCIH Guidelines and Recommended best practices.

Rationale Strategy 4: Pediatric healthcare providers are not knowledgeable enough on the EHDI system and JCIH Best practices. The EHDI-MS will train and provide documentation on the importance of screening infants by the 1-3-6 guidelines.

Activity 4a:  Develop an online survey for healthcare providers, families and hospital screeners to determine their knowledge of the EHDI-MS system, JCIH guidelines, and recommended best practices.                                         

Report Activity 4a:

In 2018, EHDI-MS personnel collected follow-up data of pediatric health care provider knowledge of the EHDI system, JCIH guidelines, and best practices using survey methodology. As few survey results were received, surveys were again distributed on paper at meetings and annual conference. Survey results indicated health care providers were only “fairly familiar” with the EHDI system in Mississippi and only “slightly familiar” with the causes, types, and degrees of hearing loss and its impact on development, JCIH Guidelines and Recommended Best Practices, and evidence-based practices. Results were used to identify topics for regional learning community meetings.

Activity 4b:  EHDI-MS will continue to conduct outreach to all professional of pediatric health care providers to engage in shared learning.                           

Report Activity 4b:

In October 2018, the EHDI-MS held a two-day conference for 120 primary care and specialized providers, early interventionists, care and service coordinators, and State agency personnel. The conference provided general and role-specific training opportunities for better understanding the EHDI system, JCIH guidelines, and best practices. Attendees rated the conference sessions consistently as contributing to their knowledge and skills and that they knew how to apply this knowledge in their role. In addition, EHDI-MS personnel connected with state representatives of professional organizations, including the American Academy of Pediatrics (AAP) and the Mississippi Speech-Language-Hearing Association (MSHA), to promote knowledge of the EHDI system and best practices in pediatric diagnostic evaluation.

 

In 2019, the EHDI-MS held a series of regional learning community meetings in the Northern, Central, and Southern regions on topics of hearing screener survey results, timeliness of diagnostic evaluations, best practices in referral and follow-up from hospitals to audiology clinics, and culturally responsive services. These meetings included hospital personnel, audiologists, care coordinators, and families.

Activity 4c:       Redesign the EHDI website with resources posted to address the gaps in knowledge.

Report Activity 4c:

The EHDI-MS developed and submitted website revisions based on feedback from stakeholders. These  changes are scheduled to be implemented September 2019.

 

Strategy 5: Collaborate with professional health care organizations to provide training of the EHDI System

Rationale Strategy 5:  The rationale for this strategy is to ensure all pediatric service and healthcare providers have the knowledge and skills needed to ensure proper care for diagnosed infants.

Activity 5a: Develop training calendar with dates of meetings and conferences.

Report Activity 5a:

Training information was shared with stakeholders at all quarterly EHDI Advisory Committee meetings and sent out via MS-HIN to assist with distribution to the professionals. Training information was also included on the EHDI website revisions.

 

Objective 2:  EHDI-MS will increase the use of the Electronic data sharing and reporting by implementing an integrated database to facilitate

Strategy 6: Expand the use of MS Health Information Network MS-HIN to support communication among pediatric health care providers and other medical professionals.

Rationale Strategy 6: EHDI-MS personnel continue to work with the vendor to resolve technical issues and improve the quality of data matching across programs. To improve data sharing of electronic records with the EHDI program and among screening and diagnostic providers.

Activity 6a: Recruit and assist providers to participate in MS-HIN

Report Activity 6a:

As of September 2019, 51 birth hospitals, screening professionals, and midwives have access to MS-HIN. In addition, 31 diagnostic providers have access to MS-HIN.

Activity 6b:  Ensure communication with providers, track and analyze data submissions and provide monthly feedback.

Report Activity 6b:

Throughout 2018-2019, EHDI-MS received data from hospital and diagnostic providers using MS-HIN. The secure email allowed for ongoing communication and technical assistance.

Evidenced Based Measure Reporting (Early Hearing Detection and Intervention)

ESM 1: Number of surveys conducted.

ESM 1 Report: 

25 diagnostic providers returned surveys; 7 families returned surveys

ESM 2: Meeting agendas and minutes

ESM 2 Report: 

4 quarterly meetings with minutes; 6 regional learning community meetings with presentations

ESM 3: MS-HIN application forms

ESM 3 Report: 

82 MS-HIN participants

Emerging Issues (Early Hearing Detection and Intervention)

EHDI-MS in partnership with Maternal and Child Health programs, including the Title V Children and Youth with Special Health Care Needs (CYSHCN) Program; newborn bloodspot screening program; Maternal, Infant, and Early Childhood Home Visiting Program; Special Supplemental Nutrition Program for Women, Infants, and Children (WIC); Early Head Start; and Family-to-Family Health Information Centers, will develop a plan to expand infrastructure, including data collection and reporting, for hearing screening for children up to age 3. The plan will propose a public health approach aligning with other public health and service programs within the state and the role of the EHDI Program in partnering and collaborating with health care professionals.  

Other Programmatic Activity/Child Health (Early Hearing Detection and Intervention)

Data system development and integration difficulties have required staff to spend a considerable amount of time addressing technological issues instead of focusing on education and outreach. As these technical issues are resolved, EHDI-MS staff will be able to implement additional training and outreach.

 

Success Story/Child Health (Early Hearing Detection and Intervention)

EHDI-MS engaged new professionals and families through the regional learning community meetings. Each meeting had between 12 and 25 participants.

 

The timely diagnostic rate improved from 59% (2016 birth cohort) to 78% (2017 birth cohort).

Child Health/Annual Summary (Early Intervention)

The narrative below describes the rationale for why Mississippi selected certain measures and provides detailed narrative to link the selected NPM’s, SPM’s with Mississippi’s identified state priorities.

Priority Area: 

Increase access to comprehensive health care.

NPM 6: Developmental Screening. Percent of children, ages 10 through 71 months, receiving a developmental screening using a parent-completed screening tool)

Program summary and Purpose: 

The Mississippi First Steps Early Intervention Program is responsible for coordinating a state-wide comprehensive interagency system of early intervention supports and services (EISS) for infants and toddlers under three years of age with a developmental delay or condition likely to lead to a developmental delay and their families. MS First Steps coordinates with providers and families across the state to ensure children receive developmental screening and/or monitoring for appropriate referrals.

 

Mississippi Developmental Screening Program focuses on improving screening, referral and early identification systems and understands that this is a shared goal and responsibility across many sectors. We have selected strategies and objectives that utilize a Collective Impact framework to bring together partners and stakeholders to reach consensus on addressing challenges to recommended screening and services, and barriers faced by families and children.  Our goals include but are not limited to:

 

• Improving screening among providers and health care practices through training, quality improvement and capacity building
• Increasing coordination among programs and systems that provide screening and linkages to services
• Working with families and communities through awareness & education campaigns
• Increasing screenings among early childcare and education providers through trainings and technical assistance
• Promoting shared policies and data sharing to increase alignment among early childhood programs

 

 

 

 

 

 

 

Child Health Annual Report (Early Intervention)

Objective 1: By September 2019, increase 10% over baseline of early care and education providers report the use of developmental screening best practices with children birth through 5.

Strategy 1: Incorporate developmental screening and monitoring practices in infant and toddler programs, ensuring consistent practices across programs serving infants and toddlers and their families.

Rationale Strategy 1: 

Screening for healthy development can help identify potential delay areas for further evaluation, diagnosis, and reduce the likelihood of developing other delays. As states look to improve developmental screening and early identification, collaborations across early childhood programs and implementation of data-driven, evidence-based strategies are critical to having functional and efficient state-wide screening systems (AMCHP, June 2015).

 

Activity 1a:  Ongoing meetings with national TA providers (Early Childhood Personnel Center-ECPC) about revising policies and procedures, including monitoring, to incorporate program standards into the employee Performance Development Assessment that will provide a more succinct and clear connection of job expectations to responsibilities.                           

Report Activity 1a:

ECPC provides guidance for the development of a state comprehensive plan for personnel development to ensure that professionals working with children with disabilities in early childhood receive quality instruction in preservice and in-service models of instruction.

Activity 1b:  Quarterly meetings with Interagency Coordinating Council (ICC) consisting of leaders in Head Start, Childcare Licensure, Medicaid, Mental Health, IHL, MS Dept of Education, UMMC- NICU, MSDH programs, and others to assist in early identification of children under age three who may be at risk for developmental delay and act as an advisory panel to provide guidance for best practices.

Report Activity 1b:

ICC voted on and approved proposal to lower lead level exposure of at-risk children from levels of greater than 15 to greater than 10 to increase identification and eligibility determination for access to MS First Steps Early Intervention Program.

 

Strategy 2: Collaborate with Mississippi Department of Education to develop state-wide materials for a Child Find public awareness campaign.

Rationale Strategy 2: Same as previous.

Activity 2a:  Continued collaboration with 619 Coordinator (MDE) to support early identification of children with disabilities and implement plans for promoting Bright Futures Guidelines.             

Report Activity 2a:

Conducted 8 regional trainings across the state between MDE and MS First Steps EIP to provide service coordinators and school district special education staff with resources and strategies to share with families to educate them on their child’s disability.

Activity 2b:  Provided eight scheduled Part C – B early childhood transition develop plan meetings ensuring effective/meaningful supports and effective services for children with disabilities and their families.

Report Activity 2b:

Local EI Program and Service Coordinators in collaboration with local school districts in their regions developed communication plan and transition plans to assist children and families in transitioning from Part C – Part B services under IDEA.

Strategy 3: Collaborate with Help Me Grow and MS Families As Allies to develop materials and provide training for mental health screenings of early childhood.

Rationale Strategy 3: Same as previous.

Activity 3a:  Conduct training sessions providing information on mental health screenings for early childhood population.                                         

Report Activity 3a:

Provide resource materials to Service Coordinators and Service providers in the MS First Steps EIP regarding identification of mental health stressors in young children as well as their caregivers.

Evidenced Based Measure Reporting (Early Intervention)

ESM 1: # of MSDH program policies and promotional literature documents containing references to Bright Futures Guidelines

ESM 1 Report: 

Incorporated guidance from Bright Futures Guidelines in multiple EI training presentations reflecting best practices for service coordinator and service provider interactions with infants/toddlers in the MSFSEIP and their families.

ESM 2: # of collaborative meetings

ESM 2 Report: 

Provided twenty 3 trainings to MSFSEIP staff, service providers and early childhood/childcare professionals across the state via regional trainings and collaboration with early childhood partners.

ESM 3: # of primary care providers offered resources about Bright Futures Guidelines for Infants, Children, and Adolescents

ESM 3 Report: 

Using Early Intervention Child Find logs and reviewing information submitted by each local EI program, there were a total of 782 personal contacts made with medical providers informing them of EI program/practices and service provision. Regional breakdown of data reflects that 523 contacts were made in the Northern Region (this region includes hospitals in Memphis, Tn e.g. St Jude and LeBonheur and clinics in west Arkansas); 121 contacts made in the Central Region; and 138 contacts in the Southern Region.

Other Programmatic Activity/Child Health (Early Intervention)

Development of a data system that better supports needs of providers/families.

 

Success Story/Child Health (Early Intervention)

https://news.olemiss.edu/staff-member-uses-personal-experience-promote-early-intervention/

Family went to Washington D.C. to advocate for early intervention because of the success that her family has had with the program.

 

 

Child Health/Annual Summary (Office of Oral Health)

The narrative below describes the rationale for why Mississippi selected certain measures and provides detailed narrative to link the selected NPM’s, SPM’s with Mississippi’s identified state priorities.

Priority Area: 

Increase access to comprehensive health care.

NPM 13: A) Percent of women who had a dental visit during pregnancy and B) Percent of children, ages 1 through 17 who had a preventive dental visit in the past year (NEW)

Program summary and Purpose:

The Mississippi State Department of Health's, Office of Oral Health, is responsible for the promotion of oral health and prevention and control of oral diseases in the state of Mississippi.  The programs within the Office of Oral Health address children, adults, and families through collaborative partnerships with agency and external programs, public health clinics, schools, and the incorporation of interdisciplinary models of care.   Because oral health is important to overall health, we work across agency departments and with stakeholders to create a culture of health that includes oral health in the state of Mississippi.  Largely, this is accomplished through program activities and educational aids that stress the importance of securing a dental home by 6 months of life or the first eruption of a baby tooth; by teaching mothers and caregivers the importance of taking care of their teeth; and by assisting the community at large in finding a dentist in their community.

Additionally, we stay abreast of emerging public health issues that cross all disciplines like the opioid crisis, human papillomavirus immunizations and human trafficking.  Recognizing it takes collective effort to see impact in the community of various initiatives, we take pride in engaging the community by creating lasting relationships and showing that we care and are concerned about the health of citizens within our state.

The strategies and activities elected reflect national evidence-based interventions that consider the unique resources, conditions, and opportunities that exist within the state. Though current baseline data for some key oral health indicators in Mississippi show the need for improvement when compared to national statistics, it is important to note challenges and emerging issues that have been identified as part of a national trend. In addition, lack of access to and utilization of oral healthcare services for all ages remains a public health challenge, which is exacerbated for those living in rural and/or dental healthcare professional shortage areas. Strategies that have been selected are designed to improve oral health for 2018-2021. Activities selected include: implementing sealant programs throughout the state, promoting fluoride varnish application in dental and primary medical care settings, improving state oral disease monitoring, increasing access to oral health care services and increasing the number of dentists located in high priority dental health professional shortage areas in the state and refining a dental care coordination process that would assist one in securing a dental home.

 

Child Health Annual Report (Office of Oral Health)

Objective 1: By 2021, increase public knowledge about the importance of oral health over the entire lifespan by promoting health literacy materials that are readable, accurate and consistent, as well as show linkages between oral health and overall health by 12%.

Strategy 1: Continue to Increase Oral Health Awareness

Rational Strategy 1:  Tooth decay remains one of the most chronic diseases among children and in adults over 40 years. The First Surgeon General’s Report on oral health in 2000, by Dr. David Satcher, emphasized that “oral health is essential to the general health and well-being of all Americans and can be achieved by all Americans”.   As defined by the World Dental Federation in 2016, “Oral Health is multi-faceted and includes the ability to speak, smile, taste, touch, chew, swallow, and convey a range of emotions through facial expressions with confidence and without pain, discomfort and disease of craniofacial complex”.

During the 2015-2016 school year, the Mississippi State Department of Health conducted a statewide oral health survey of third grade children enrolled in Mississippi’s public elementary schools. Dental professionals screened 3,972 children in 94 randomly selected elementary schools using disposable dental mirrors and penlights. 2,764 children were included in the final analysis. 

Key findings from the survey found:

• Dental decay is a significant health problem for Mississippi’s third grade children with 61% have cavities and/or fillings (decay experience) and 22% with untreated dental decay (cavities).
• Many Mississippi children are attending school with infection or pain from dental disease. Six (6%) percent needed urgent dental care because of pain or possible infection. This could mean that more than 1,850 third grade children have pain or possible infection because of dental decay.
• While dental sealants are a proven method for preventing decay, the majority of Mississippi’s third grade children do not have access to this valuable preventive service. Only 34% of the third-grade children have dental sealants and African American children have poorer oral health and less access to preventive dental sealants.
• Compared to white children, African American children have a higher prevalence of decay experience and untreated decay. In addition, about 8% of African American children need urgent care because of pain or infection compared to 5% white children.
• Lower-income children have poorer oral health and less access to preventive dental sealants.
• Children not eligible for the free/reduce price school lunch program (FRL), children eligible for FRL have a significantly higher prevalence of decay experience, untreated decay and urgent treatment.
• Many children in Mississippi have limited access to regular dental care. Almost 29% of parents reported that their child had not been to the dentist within the last year including 1.5% who had never been to a dentist.
• 12.5% of parents reported that during the last year their child needed dental care but were unable to get it with the primary reasons reported being inability to afford dental care and difficulty in getting an appointment.
• Most children in Mississippi have dietary habits that increase their risk of dental decay. Almost 39% of children drink sweetened beverages with their meals including juice, juice drinks, and soda. Only 20% of parents reported that milk was the primary beverage at meals.
• Since 2010, there has been a decline in the prevalence of decay experience, untreated decay and need for urgent dental care in Mississippi’s third grade children.

In general, children in Mississippi, compared to children from other states, have poorer oral health. Considerable progress has been made in Mississippi to meet the Health People 2020 oral health objectives; yet, more work is needed.

For the past few decades, Mississippi has consistently ranked as a state with poor oral health outcomes:

• In 2016, BRFSS reported that 43% of the state’s adult population did not visit a dentist
• According to CDC, only 60% of the population in the state receive Water Fluoridation
• In 2017 HRSA indicated that 80 counties out of 82 in the state have Dental Health Professional Shortage Areas, with 8 of these counties being urban and 72 rural

Similarly, a state-wide cross-sectional study was conducted from September 2017 to August 2018 with a convenience sample of 763 individuals to get baseline information on oral health care, knowledge, attitude and behaviors of the adults who attended various health awareness events and professional workshops.   The objectives of the survey were twofold:   To identify and improve oral health perceptions, beliefs and behaviors among adults in the state of Mississippi and 

To address oral health barriers to care.

Much has been learned about how Mississippi adult perspective towards oral health and its value to overall health.  Understanding how  culture  influences and guides information and human behavior, assists our program with better serving our community as we create a culture of health that includes oral health .

Activity 1a:  Develop a written Oral Health Literacy Campaign focused on addressing the oral health needs of MS citizens throughout the different stages of one’s life.                                         

Report Activity 1a:

The American Dental Association (ADA) policy defines oral health literacy as the degree to which individuals have the capacity to obtain, process and understand basic health information and services needed to make appropriate oral health decisions.  Similarly, the ADA along with other entities recognizes that by improving one’s health literacy, patients become better stewards of their own health.  Our oral health literacy campaign has not been finalized. Work towards an oral health literacy plan was completed at the end of the summer 2018.  At that time, we had over 5 interns and dedicated staff to assist with this project.  Last year, our department lost CDC funding, making this objective difficult to achieve with competing priorities and interns who returned to school or other pursuits. The department has been utilizing updated materials and ordering free on-line materials to promote the importance of oral health and to show its linkage to other chronic diseases such as diabetes, HPV, cardiovascular disease, and cancer/oral cancer. Likewise, we have utilized forums like the Oral Health 2020 Network through DentaQuest Foundation to further literature review on what best practices for such a plan and messaging to various populations.  

Currently, there is discussion amongst the staff to continue tailoring literacy materials that fit the culture of our citizens. We are also revisiting current materials that are low-cost to reproduce.

Activity 1b:  Develop an oral health surveillance plan

Report Activity 1b:

In April of 2015, under the leadership of the State Dental Director, partnership with the Association of State and Territorial Dental Directors (ASTDD) and with substantial support from the Division of Oral Health at the Centers for Disease Control and Prevention (CDC), the Mississippi Oral Health Surveillance Plan was envisioned as a first step in helping the oral health program routinely document population needs and program impact with standard, feasible methods. We reviewed and summarized the efforts in Mississippi to collect data on oral diseases, conditions, and behaviors implemented at the national and other state level. The development of the plan required meetings and collaboration over the next year, with our State partnerships, the Council of State and Territorial Epidemiologists, the ASTDD and the CDC. The  consensus was to include and approve eight  major oral health indicators for public health surveillance: three for adults (most recent dental visit, most recent dental cleaning, total tooth loss) using data from the Behavioral Risk Factor Surveillance System; three for third-grade students (presence of treated or untreated dental caries, untreated tooth decay, dental sealants) collected by using a standard screening protocol; and the percentage of the population served by public water systems that receives optimally fluoridated water, tracked through the Water Fluoridation Reporting System.

Further discussions continued which include:

• Systematic collection of data from representative samples;
• One-time or sporadic experiences when data are collected at state and local levels;
• Use of visual-tactile protocols implemented at the tooth-surface or tooth-site level for data collection;
• Focus mainly on dental caries and periodontal diseases; and
• Leap-time from data collection to publication of results.

During the early part of 2017, a draft written Oral Health Surveillance Plan, was established that can be used within the Office of Oral Health. The plan was developed to measure the prevalence and severity of oral diseases, the oral disease burden on the Mississippi population, and the impact that our efforts in prevention, education, and early intervention and treatment will make on the population. Moreover, the plan established the eight core health indicators which will be measured, the frequency of measurement, and comparability with other national oral health surveillance systems. In 2018, the draft plan further aligned its indicators and measures to indirectly address the Healthy People 2020 (HP 2020) goal to “Increase the number of States and the District of Columbia that have an oral and craniofacial health surveillance system (OH-16)”. Our partners and stakeholders reviewed the draft written plan, and after going through an approval process, the final plan was published during October of 2018. In summary, the final plan helps to (1) identify the indicators needed to monitor the oral health of its residents, (2) determine timelines for oral health data collection, and (3) develop strategies for disseminating data to key stakeholders and policy makers. The goal of the Mississippi State Oral Health Surveillance plan is to obtain and disseminate actionable health information to guide public health policy and programs by the way of developing and implementing Mississippi Oral Health Surveillance System.

Evaluation is a process that critically examines a program. It involves collecting and analyzing information about a program’s activities, characteristics, and outcomes. Its purpose is to make judgments about a program, to improve its effectiveness, and/or to inform programming decisions (Patton, 1987).

 

Hence, the purpose of evaluating the Mississippi Oral Health Surveillance Plan is to ensure that the oral health indicators are monitored effectively and efficiently and to increase the utility and productivity of the oral health surveillance system. An evaluation will be performed in 2020 to determine the plan’s usefulness in monitoring oral health trends over time, determining the effectiveness of interventions, and planning future programmatic and policy initiatives.

The Mississippi State Department of Health will evaluate the plan based on CDC’s framework for program evaluation including how well the following six steps, outlined in Updated Guidelines for Evaluating Surveillance Systems, were implemented. The six steps are:

• Engage Mississippi’s stakeholders;
• Describe Mississippi Oral Health Surveillance System (MOHSS);
• Focus the evaluation design;
• Gather credible evidence regarding the performance of MOHSS;
• Justify and state conclusions, make recommendations; and
• Ensure use of evaluation findings and share lessons learned.

The evaluation of plan will focus on providing recommendations for improving the quality, efficiency, and usefulness in development of a surveillance system. The plan will also be evaluated to determine the system’s sustainability, the timeliness of analysis of surveillance data, dissemination and use of the reports by stakeholders, and the surveillance system’s impact on policy and legislative actions.

Currently, a report of oral health indicators based on the oral health surveillance plan is in development.  We hope to have it complete by September 2019 to share findings during our annual oral health stakeholders meeting in November 2019 and to further guide program activities as we move forward.  We will also share the findings on our agency webpage and through the Mississippi oral health coalition (Mississippi Oral Health Community Alliance-MOHCA).

Activity 1c:  Develop printable on-line educational materials, public service announcements and social marketing geared to target populations and health professionals (medical/dental) to promote preventive oral health services.

Report Activity 1c:

Oral health observances are placed on Mississippi State Department of Health Facebook page.   We target the months of February (National Children’s Dental Health Month); April (Oral Cancer Awareness Month); and October (Dental Hygiene month), among several others. The Office of Oral Heath has also created five fact sheets. One is titled Good Health Starts with a Healthy Mouth and is directed towards teens and covers the importance of oral hygiene and healthy food choices, the dangers of oral piercings and the negative oral effects of tobacco and alcohol.  

The second fact sheet is related to the Importance of Community Water Fluoridation and the benefits of fluoride, nature’s natural cavity fighter. The third is titled: From Your Mouth to Your Heart and shares data and stories of the possible increased risk of heart disease due to periodontal disease. The fourth fact sheet, Oral Health & Diabetes, shows the connection between diabetes and tooth loss. Lastly, The Word of Mouth on Oral Cancer relays the increased risks of oral cancer in MS citizens and the risk factors for oral cancer. The fact sheets are distributed throughout the state by the regional oral health consultants during community health fairs, conferences, and career and college health awareness events.

Activity 1d:  Partner with PHRM/ISS to provide health education, oral health materials, and referral to establish a dental home and/or receive further dental assessment/treatment to the maternity patients being seen in the clinics.

Report Activity 1d:

In the Spring of 2018, 100 dental health kits each were given to fourteen (14) PHRM nurses working in dental shortage areas as identified by the Human Resources and Services Administration (HRSAS). These kits contained an adult toothbrush, a child toothbrush, toothpaste, floss, and a booklet entitled “Healthy Smiles From the Start: Dental Care Tips for Mom and Baby”. Nurses that reported low patient intake, shared these kits with social workers in their clinic. These social workers gave kits to the parents of children who were taking part in the PHRM program. 

The relationship involved receiving reports from the nurses on the number of kits distributed and whether oral health education was given.  Unfortunately, few submitted a report and the outcome of the project was not measured.  An additional challenge we faced with this project was the creation of a process, seamless tool for clinical staff that would be able to capture the information and a process that was seamless for the clinical staff to do so.  Due the new electronic health record called EPIC and staff turnover among departments, our efforts were hindered.  The project is being re-evaluated.   Further talks between MSDH chief nurse and the program directors for Women’s Health and the Office of Oral health are underway. 

Activity 1e:  Increase capacity in Mississippi Head starts and daycare centers.

Report Activity 1e:

Specific to Healthy People 2020 oral health objectives and the 3rd grade basic screening survey results, as a state we have achieved progress in comparison to 2010 oral health status of children age 6-9 around the following measures:

Reducing the proportion of children aged 6 to 9 years with untreated dental decay in their primary or permanent teeth and increasing the proportion of children aged 6 to 9 years who have received dental sealants on one or more of their permanent first molar teeth.  In other words, 3rd graders in our state are getting more preventive treatment like sealants and fluoride varnish and they are receiving care to get cavities that need to be treated filled.

However, progress is needed towards reducing the proportion of children aged 6 to 9 years with dental caries experience in their primary or permanent teeth.  This indicates that children in Mississippi are still developing cavities during early childhood years which makes our partnerships with head starts and daycare centers critical to the reduction of early childhood caries.  Moreover, increased efforts to screen, educate and provide fluoride varnish to children in head starts and day care centers is vital to the health of all children in our state.   Unfortunately, we did not renew our Memorandum of Understanding (MOU) with grantees of the Mississippi Head start Association in September of 2018 because of new requirements. This delayed our ability to go into the Head starts to offer preventive oral health services to students during the Fall of 2018.

In January of 2019, our program director and legal team were invited to a Head Start Association directors meeting where we gained consensus in moving forward with the MOU.  To date, most of the Mississippi Head Start Association Grantees have signed the MOUs.  We extended the time frame for renewal of the MOU from annually to every 5 years.  Due to the lateness of this occurring in Spring 2019, we will be working aggressively to get into the Head Starts and their respective daycare centers the Fall of 2019.

In addition, our last Head Start Basic Screening Open Mouth Survey was conducted in 2006-2007.  We also talked with the Head Start Association directors about conducting another surveillance with children in Head Start.  We are currently working on the methodology and hope to start this project also in the Fall of 2019.  This will give us more information regarding the oral health of children in Head Start and guide program implementations to eradicate oral disease in children under 5 years old.

Meanwhile, since we had challenges getting into Head Starts, we enhanced our partnership with day care centers throughout the state.  We now have well over 50 daycare centers who we have executed MOUs with our agency.

 

 Although we were delayed in getting into the Head Start, we continued our partnership with head start by attending their conferences, facilitating breakout sessions at said conferences, and educating their staff regarding best ways to incorporate Oral Health into the student curriculum via the Cavity Free Kids Curriculum.

Objective 2:  Fully integrate oral health literacy into all nine MCH programs within Health Services at MSDH

Strategy 2: Provide oral health literacy to all MCH programs and its participants within Health Services at MSDH.

Rational Strategy 2: The Maternal and Child Health (MCH) Services Block Grant is a federal-state partnership program that aims to improve the health of low-income pregnant women, mothers, and children. In addition, the program aims to connect low-income families with other services and programs, such as Medicaid and the State Children’s Health Insurance Program (CHIP). MCH also provides services and programs that include non-pregnant women who are over 21 years of age.

MCH Services Block Grant funds are distributed for funding core public health services provided by maternal and child health agencies in four core categories: (1) direct health care, (2) enabling services, (3) population-based services, and (4) infrastructure building. Within these categories, the MCH Services Block Grant supports a wide array of programs, including newborn screening, health services for children with special health care needs (CSHCNs), and immunization programs.

Providing comprehensive care that improves the overall health and well-being for the mother and child is MCH greatest objective. Oral health is a vital component in meeting this objective. Largely preventable, tooth decay remains the most common chronic disease of children aged 6 to 11 years and adolescents aged 12 to 19 years is in America.  It is (tooth decay) four times more common in adolescents aged 14-17.  Children with poor oral health may experience difficulties with learning, poor school attendance, or have difficulties with creating socialization skills.  They may also be more likely to have greater adult health problems than those with better childhood oral health experiences. 

Oral health is also important to overall health because studies have shown a direct association between oral infections -primarily periodontal infections- and diabetes, heart disease, and stroke. Poor oral health in pregnant mothers may be associated with adverse birth outcomes. Additionally, because tooth decay is caused by a bacterium, these bacteria can be passed on to one’s baby through kissing.  It is important that interdisciplinary collaboration increase between the medical and dental providers to contribute to the improved health outcomes for mother and child.

Activity 2a:  Work with the Title V director on developing activities for all other MCH programs that reflect the importance of proper Oral Care.                                         

Report Activity 2a:

During the early part of the summer 2018, the Title V director and our program director met to share program initiatives and to identify partnership opportunities to leverage expertise and funds for each program.  One mutual area of concern was the children with special health care needs component specific to oral health disparities.   With the vulnerability of this population and with the recent changes to the CYSCHCN program, both agreed on working together to better address oral health infrastructure and access to care needs of those within this population of patients. 

Children and youth with special health care needs (CYSHCN) are "...those who have or are at increased risk for a chronic physical, developmental, behavioral, or emotional condition and who also require health and related services of a type or amount beyond that required by children generally. CYSHCN, making up approximately 24.4% of Mississippi's population, often require complex care across several medical specialties and are vulnerable to psychosocial and developmental difficulties. Having a medical and dental home improves their access to services and enhances quality of life.  Additionally, provision of optimal care requires linkages to community-based services as appropriate to meet the needs of the child and family across the life span.

With the dental provider shortages in our state, our initial work was to develop a resource guide identifying providers in the state who treat patients with special health care needs and to create a special needs toolkit which would include anticipatory guidance, adjunct oral hygiene aids, and oral health instructions at a minimum.   One of the first steps towards these goals was the inclusion of the oral health director as part of the advisory team with the CYSHCN Cares 2 learning initiative which began the first part of 2019.  In this role, our program director has provided guidance to clinical teams regarding the good oral health hygiene challenges with CYSHCN patients and has assisted teams involved in integration of oral health within their primary care settings.  She has also provided a resource of pediatric dentist and practice locale throughout the state to participants of CYSCHN Cares 2.

 A goal of the CYSCHN Cares 2 learning initiative in relation to oral health is that clinics would Increase the number of children with special care needs who have a medical and dental home.  Also, the following were some of the required measures for teams participating in the initiative to collect data around:  

• Patients receiving care in a dental home (the number of patients ages 0-17 with specific health care needs receiving care in a dental home).
• Patients referred for annual dental visit (the number of patients ages 0-17 with special healthcare needs referred for an annual dental visit).

Many of the teams expressed difficulties in capturing this data due to the lack of an electronic health records system between dental and medical that were not interfaced; lack of triage protocols between medical and dental; and dental providers at their facilities who did not see patients with special health care needs or who were under 6 years of age.

 

As this initial learning initiative was short, we did not have time to provide technical assistance to each clinic but are working with the CYSHCN program director on a strategic plan to better address some of these concerns in the next learning initiative.

Activity 2b:  Meet with program directors and exchange ideas on how to integrate oral health into programs.

Report Activity 2b:

The Office of Oral Health is under the Division of Health Services which is also shared with the Offices of Child and Adolescent Health, Women’s Health, Women Children and Infants Program and Tobacco Control.  As a division, program directors meet biweekly to share program activities and discuss how to better coordinate integration of programs throughout the agency.  These meetings provide insight and has enabled the Office of Oral Health to participate in programs that correlate with our overarching goals.  Similarly, in these meetings, the Health Services Director may share with the directors’ information about other projects she’s learned about in other meetings and how they can align with our programs. The Office of Oral Health director has worked collaboratively with other directors from Children and Adolescent Health, Women’s Health, Genetics, Tobacco, WIC, Early Intervention, Reproductive Health, and Asthma to ensure that oral health is incorporated in their various program activities throughout the state.  Oral health fliers, fact sheets, pamphlets, toothbrushes, toothpaste, and floss have been given to each department when requested.  These items are used whenever a department is presenting at a health fair or conference.  The number of supplies contributed to each department has not be yet been quantified.

Also, we receive regular updates  from all departments as we work  with various programs on several initiatives.  For example, with the increase in E-Cigarette use and vaping, we are partnering with the Office of Tobacco Control to get dental providers more involved in providing tobacco cessation counseling and documenting tobacco cessation consultations via coding.  Do you smoke or have you ever smoked are routine questions asked in a dental office.   Our initial conversations have centered around the  gathering of the Quit Line information to disseminate to dental providers in the community and finding out what the reimbursement coding consist of.  Similarly, we are working to be able to register an office portal to input data regarding citizens who would like to quit smoking that are identified at community events where oral health team members may attend.  At our request, we have received numerous boxes of brochures from the Office of Tobacco control on topics like Tobacco and oral health, tobacco and diabetes and the like.  During the summer months, we work with members from the Tobacco Coalition in presenting to the youth about the importance of oral health and not smoking.  We partnered in several events this year and have a busy summer planned to do more education.  This tends to go over very well with youth and adolescents as we have demonstration models on healthy teeth and those affected by tobacco use.

Similarly, the Office of Oral Health is well integrated within the Mississippi Quality Improvement Initiative:  Asthma Cohort.  A main oral health problem for people with asthma is a reduction in the quantity and quality of the saliva. Saliva helps protect the teeth, gums and soft tissues of the mouth. Inadequate saliva can lead to a dry mouth which increases one’s potential for tooth decay, erosion, gum disease and fungal infections in the mouth. This is no different for children with asthma.

Our program director is a part of the leadership team with this initiative and conducts several learning sessions on an array of topics linked to oral care and asthma diagnosis.  Most recently, she talked about emergency preparedness in patients with asthma far beyond action plans.  Unfortunately, this year in Chickasaw MS, a pregnant woman who had Asthma died in Mississippi as a result of the closure of the emergency room at a hospital in her community and the distance her family had to travel when seeking care for her.  This story was highlighted in our program director’s presentation and shared with other Health Services directors too better consider the impact of hospital closures in rural communities when discussing access to care issues with the patients we serve. 

Strategy 3: Increase the number of Women Infants and Children (WIC) centers and health departments where oral health education is provided by regional oral health consultants.

Rational Strategy 3: Inadequate access to oral health care is a significant concern for low-income children and their families, as it affects both oral and overall health. Per the Mississippi Medicaid 2018 report, as of December 2018, 344,279 children were Medicaid-enrolled and entitled to free, comprehensive dental screenings under the Early and Periodic Screening, Diagnostic and Treatment benefit. These visits involve at a minimum service for the relief of pain and infections, restoration of teeth, and maintenance of dental health. The Office of Oral Health knows that ensuring mothers receive oral health care services and education will increase the likelihood that her child or children will start good oral health habits at an earlier age. Through the federal Women, Infants and Children (WIC) program, low income pregnant, breastfeeding, and postpartum women and their children up to age five are eligible to receive supplemental food, health care referrals as needed, nutrition education, and breastfeeding support, delivered at WIC sites.

Because WIC sites serve people from low-income families who have the least access to oral care, the Office of Oral Health regional oral health consultants provide oral health information and education in a more accessible format for WIC participating pregnant women and children under age five. Our activities are supported by the 2015 Burden of Oral Disease in MS report which released findings that indicated that 44% of adults did not visit a dentist or dental clinic within the past year. Seventy-one (71%) percent of pregnant women had not visited a dentist or a dental clinic during their most recent pregnancy. Fifty-four (54%) percent of women had not had their teeth cleaned in more than 12 months. White women were more likely (40%) to have visited a dentist or dental clinic during their most recent pregnancy than black women (25%).

Activity 3a:  Provide updated Successful Partners In Reaching Innovative Technology (SPIRIT) training to all ROHCs (regional oral health consultants).  

Report Activity 3a:

There have been no updates to the SPIRIT program nor additional oral health consultants hired to work within our WIC program. Therefore, SPIRIT training has not been completed this year.

Activity 3b:  Synchronize protocol on data input and retrieval from the SPIRIT system.

Report Activity 3b:

To date, data has not been received from the SPIRIT system. The initial agreement was to create reports in the SPIRIT system that would calculate the number of WIC participants that receive oral health education; however, it was later established that the current SPIRIT format was unable to create these reports unless an addition to the program was purchased.  A different data collection method was established by the oral health director. The ROHCs collect sign in sheets of the participants that receive oral health education at their respective WIC facilities twice per month.

The number of participants served is recorded by the program’s epidemiologist trainee. Annually, we are working to report analysis on these reports to include impact of the program to participants along with an evaluation of the program from the perspective of our Regional Oral Heath Consultants and WIC departmental team members.  These evaluations assist with our continuous program quality improvement efforts.

Activity 3c:  Increase by a minimum of two the number of WIC sites each ROHC provides oral health education.

Report Activity 3c:

WIC is currently undergoing a restructuring process to improve their participant numbers. In an environment of change WIC managed to provide 1,408 mothers, children, and extended family members have received oral health education in 31 WIC county locations, which has doubled over the last two years. Many WIC facilities have suspended the oral health services until the restructuring is complete. To date, three of our oral health ROHCs are currently not providing oral health education in a WIC center.  To address this issue, one ROHC in the Northeastern part of the state has partnered with local Head Start centers that have started a WIC program in their facility. The ROHC provides these parents with oral health education 101 on center-selected days.  Another partnership opportunity established to reach WIC participants was with the WIC Baby Cafes. WIC Baby Cafés are in designated locations where free resources are provided for pregnant and breastfeeding mothers. The cafes offer mothers’ breastfeeding support from trained staff, baby items, and refreshments. 

MS WIC Baby Cafes are in the North,Central, and Gulf Coast of MS. Other avenues where young and/or pregnant mothers and children have received oral health education are: Mississippi Early Childhood Association Imagine Conference, Winston Co Parenting Classes, Head Start Advisory Board Monroe Co OHE, Greater Meridian Pregnant Mothers Project, Forrest Co. Community Baby Shower, MSPTI Positive Parenting Webinar, Jackson Hinds Comprehensive Prenatal Classes, Greenwood-Leflore Hospital Breast Feeding classes, Yazoo Baby and Me Breast feeding classes, Holmes Co. Liberty Hill AME Zion Church Health Ministry, and George Co Mommy and Me Classes. 436 person’s participants took part in these events.

We continue to work to expand the number of WIC facilities  where oral health education is provided.  We are also looking to expand the services from just oral health education to possibly oral screenings and fluoride varnish application as applicable.  The oral health program director has already mentioned this possibility to the WIC director, and they will be meeting this summer to further discuss this possibility.

Activity 3d:  Incorporate a dental care coordination system that will follow up with participants of WIC to assure they have identified and utilized a dental home.

Report Activity 3d:

To improve the quality of care and the timely prevention of disease, a care coordination protocol is critical.  Care coordination across systems of care, caregivers, and health care providers is important in keeping children and adults free from a life of pain and poor health. The American Academy of Pediatric Dentistry (AAPD) and the American Academy of Pediatrics (AAP) 2015 Policy on the Dental Home, recommends that within 6 months, children should be referred to a dental home. Establishing this dental home early increases the likelihood of earlier intervention and carries prevention.  

Office of Oral Health is currently providing Cavity Free in Mississippi training to public and private Medicaid-accepting medical providers to do oral evaluations and applications of fluoride varnish for children up to 3 years old who have no access to dental providers. With the training, medical providers can more confidently perform an oral health evaluation, know the benefits and how to apply fluoride varnish, and provide caregiver education on good oral hygiene practices. Billing and coding of these services is also covered as well as a list of suppliers and materials needed to provide these services are given to each provider participant.  The dental care coordination protocol for the WIC participants is being refined.  Due to the small number of medical and dental integrated electronic health records on the market,  a better internal process needs to be established on how to follow up with these providers to ensure they are receiving our referred patients, treatment is being provided to said patients and we are addressing barriers associated with the referral process.

With the EPDST program, we have worked with MSDH Chief nurse in seeing how to extract this data from the new electronic health record (EHR) system called EPIC.  As an oral health evaluation and fluoride varnish application are a part of these assessments, our hope is to follow up with mothers/guardians to assure each child is directed to a dental home.  The nurses within the MSDH network do not provide fluoride varnish applications and we currently don’t have a process to assure that families referred to a dentist receive treatment.  The Oral Health program has not been phased into our EPIC EHR system.  We are working with EPIC super users to determine if this can be accomplished.  This will provide the agency with better integration of agency services and tracking of referrals.

Strategy 4: Increase the number of faith-based organizations we work with who provide resources to families.

Rational Strategy 4:

Faith-based organization (FBO) health programs have been proven to produce significantly increased knowledge of disease, improve screening behavior and readiness to change, and reduce the risk associated with disease and disease symptoms. According to the 2017 U.S. Census Bureau Report, there were 28.5 million uninsured citizens in the United States. There are more churches per capita in the United States than in any other country, and faith communities are involved in public health and community development issues related to social justice.

According to the Journal of Primary Prevention, uninsured individuals are more likely than those with insurance coverage (1) to forgo or postpone preventive care and skip recommended tests or treatments, (2) to be hospitalized for conditions that can be treated in outpatient settings (e.g., uncontrolled diabetes), and (3) to be diagnosed with late-stage colorectal cancer, melanoma, breast cancer, and prostate cancer. Given the types of health services offered through FBOs, increased collaboration between health professionals and FBOs serving African American and Hispanic populations could potentially improve quality of life in these vulnerable groups.

Many faith- based organizations receive oral health education through the chronic disease program that our ROHCs are certified to teach through the Office of Preventive Health. During these classes, participants are not only taught about how to manage with living with chronic diseases but also how these diseases can affect their oral health as well.  Some faith-based organizations provide health fairs at the beginning the of class to promote the class to church members. These members may be prenatal or postpartum mothers

Activity 4a:  Provide oral health education at faith-based conventions in the state.

Report Activity 4a:

Last year, the Office of Oral Health had in its employment a staff member that who great connections with the FBOs from both the State and national level. This staff member created a partnership with the state’s 2018 Youth Baptist Convention that allowed our office to provide oral health education to all its participating members. We had about 5 tables set up demonstrating different aspects of oral health education.  Activities were set up to show how much soda is in soft drinks and the Tobacco Coalition partnered in this event to discuss the harms of smoking.  With this outreach effort, we shared the importance of oral health to overall health to approximately 1,,000 children and young adults. This employee is no longer with the department and a re-connection with the youth Pastor of the Mississippi Baptist Convention has been established. Our office is finalizing plans of inclusion in a similar event scheduled the end of July 2019 and or the event scheduled for the first of October 2019.

Activity 4b:  Identify oral health missions offered through churches in the state.

Report Activity 4b:

Two on-going oral health missions’ projects are in progress.  One project is partnering with But God Ministries, a 501(c) (3), non-profit, Christian organization, that builds sustainable communities around the world. They are currently building two sustainable communities in Haiti and one in the Mississippi Delta. The first Haitian community is in Galette Chambon, which is about 17 miles east of Port-au-Prince near Ganthier, Haiti. The second Haitian community is called Thoman and is about a two-hour drive east of Port-au-Prince near the border with the Dominican Republic. The second community is in the Mississippi Delta.  Jonestown, MS, located in the northwest part of Mississippi, is about 12 miles northeast of Clarksdale, in Coahoma County and has a population of about 1,200. This organization has assisted with the advancement of oral health services in Coahoma County in non-traditional dental settings.

In August of 2005, Louisiana, Mississippi, and Alabama experienced the devastating effects of Hurricane Katrina.  In response to this catastrophic event, Tomorrow’s Dental Office Today (TDOT), a mobile dental unit, was deployed throughout the state to assist with providing dental care to residents affected by the hurricane.  TDOT is an 18-wheeler that was equipped with state-of-the-art dental equipment and two dental chairs.  In 2013, MSDH discontinued providing dental services through TDOT due to decreases in funding and associated operational cost.  TDOT was parked in Coahoma County.

In 2016, MSDH partnered with But God Ministries to include the TDOT in mission activities.  Since 2016, our office has assisted with the readiness of the TDOT for clinical activities which include, clean up and repair, equipment inventory, supply ordering, personnel staffing, and operation manual preparation. TDOT had its first opening in November 2018 and continues to provide dental care (oral health education, exams, x-rays, cleanings, fillings and extractions) on most Fridays at no cost to adult residents. Volunteer dentists, dental hygienist and dental assistants throughout the state participate during the clinic’s hours of operation. While this dental mission only sees adults right now, these efforts are still critical to our MCH efforts as a mother’s health is directly related to the health of her children.  But God Ministry efforts in Coahoma county were highlighted in the Christian Living Magazine December 2018 edition.

Secondly, our office partners with Petal Baptist Church located in Forrest County. For the past two years, a mobile van from the church escorts dental hygiene volunteers to Forrest County in the month of September to assist with providing adult patients with oral health education and cleanings under the direct supervision of on-site dentists from the community.  Patients with unmanaged diabetes and high blood pressure are identified and properly referred to a local physician or linked to a free clinic in the area. Tobacco cessation information and the Quit Line number is also shared with patients who state a desire to stop smoking. Several of our ROHCs assisted with the event last October in various capacities (oral health education, dental cleanings, and mission workflow).

Activity 4c:  Identify oral health services available to maternal child population in dental free clinics usually run out of churches.

Report Activity 4c:

We have 10 volunteer free dental clinics in the state:  two (2) located in Northern, MS, five (5) in Central, MS, and three (3) in Southern, MS. About 10% of the clinics provide services to women and children due to their reliance on volunteer dentists.  Waiting lists are also very long and patients may have to wait 2-3 months before they can be seen.  In the coming year, the Office will seek to create a collaboration with the volunteer free dental clinics in an effort to create a robust dental public health infrastructure which should exist at all levels to ensure that the entire profession of dentistry is working toward common goals to improve the public’s health through strategies that include improved health literacy; efficient, effective delivery systems; adequate workforce (quantity and distribution) to meet the public’s oral health care needs; and building the scientific body of knowledge related to oral and systemic health.

Strategy 5: Monitor dental care coordination efforts.

Rational Strategy 5:  Over recent years, across the U.S., efforts have been made to combat oral disease through the integration of oral health care into the medical setting through medical provider training, workflow redesign and improvement practices.  This care coordination is critical in improving quality of care and health outcomes.  Creating cross-coordination systems of care will ensure a system is in place that appropriately shares information on treatment plans and medical management between the medical/dental provider and caregiver as well as ensure the completion of dental referrals, improve oral health behaviors and reduce the cost of oral disease.

Activity 5a:  Create dental care coordination protocol

Report Activity 5a:

The Office has been meeting with the staff epidemiologist to discuss ways of creating a dental care coordinated registry for the state. A contract is also in place with Dr. Denise Krause who is the former Professor and Associate Director of Research at the University of Mississippi Medical Center. She is currently serving as Managing Director/Senior Consultant with Health Data Analytics (HDA) in Ashland, OR. HDA collects, maintains, visualizes, and analyzes data, as well as develops custom web-based applications and underlying supporting databases to visualize data important to an organization's needs. Dr. Krause is assisting our Office in creating a dashboard for our website that will show real time data on dentist in various parts of the state.

To further guide our efforts, our office is also reviewing a White Paper written by Altarum, a non-profit organization in Michigan. This state’s care coordination protocol was completed through a partnership with Michigan-based Altarum, DentaQuest and resources from the Center for Medicare and Medicaid Innovation to address issue of dentals carries (tooth decay) through the creation of the Michigan Dental Registry (MiDR℠).  To date, our office has had four meetings concerning the development of a dental care coordination protocol and workflow.  Although care coordination often occurs at the individual level; success, however, requires a structure of coordination even before the patient enters the system.

Indeed, more health systems are recognizing the importance of working with community partners to manage chronic diseases and keep patients healthy outside an expensive hospital setting. Oral diseases should be no exception. Systems that improve coordination of dental and medical care will have the best chance of improving quality for individual patients, improving population health, and containing costs. Chief among the many challenges facing the dental care coordination is trying to incorporate inter-professional differences in billing and information technology, time constraints on providers, referral difficulties, and the minimal evident effect of dental care on quality measurement and improvement as those metrics are currently structured.

 

Our dental care coordination model will utilize our ROHCs and other designated staff to link citizens to care who may not have a dental home and to further assess barriers to care within various communities.  We hope to have this protocol and tool finalized by December 2019 to incorporate by January 2019 with most of our programs.

 

Activity 5b:  Incorporate oral health as EPIC users

Report Activity 5b:

The phasing of MSDH programs into the EPIC system is at the discretion of senior management. The Office is waiting to receive confirmation of its implementation. In the Fall of 2018, the University of Mississippi Medical Canter, School of Dentistry began using EPIC as an electronic health record.  In preparation for being added to EPIC, the program director had a meeting this summer  with the Dean of the Dental School and other staff to view the Go Live use of Epic and to engage discussions on the electronic health record system process, challenges and how it has assisted with providing integrated healthcare within the institution.  In this meeting, several team members were identified by the Dean with whom our program director can work with to find out more regarding their electronic health record.

Activity 5c:   Incorporate integrated templates in EPIC for internal agency use

Report Activity 5c:

This activity cannot be implemented until we are added to the EPIC system.

Strategy 6: Work with the Mississippi Division of Medicaid to get benchmark information regarding Medicaid-funded dental providers and oral health services.

Rational Strategy 6:  

Medicaid, the nation’s health coverage program for poor and low-income people, provides millions of low-income women across the nation with health and long-term care coverage. Before the passage of the Affordable Care Act (ACA), women comprised most of the adult Medicaid population. For women, the program offers coverage of a wide range of primary, preventive, specialty, and long-term care services which are important to them across their lifespans. Medicaid also covers 44% of children >18. In December 31, 2018, 437,875 children were covered by Medicaid MississippiCAN program. The numbers for pregnant moms are inconclusive due to the numbers being lumped into an “adult” category that tabulates these numbers along with parents, caregivers, and adult refugees

The 2015-2016 state-wide oral health assessment survey of 2,764 MS 3rd graders (8-9 years) found that (1) 61% had cavities or fillings, (2) 22 percent had untreated decay (cavities), (3) 6% (1,850) need urgent care and may be experiencing pain and possible infection due to dental decay, (4) 34 % have dental sealant which are proven method to prevent tooth decay, (5) almost 29% of parents reported that their child had not been to the dentist within the last year including 1.5% who had never been to a dentist, (6) 12.5% of parents reported that during the last year their child needed dental care but were unable to get it with the primary reasons reported being inability to afford dental care and difficulty in getting an appointment, and lastly (7) lower-income children have poorer oral health and less access to preventive dental sealants.

To date, MS has an average of 558 dentists across the state that accept Medicaid payment for dental services. The Division of Medicaid is a critical partner in moving the needle forward in providing the state’s eligible children with insurance coverage. Each child covered by Medicaid receives two annual preventive visits and up to $2500 for other dental services.

In addition, there are limitations of Medicaid dental coverage during pregnancy based on one’s age.  This makes our efforts of oral disease prevention more critical to women of childbearing age. We are increasing our efforts to address this lapse in comprehensive dental coverage to women of childbearing age.   According to Douglass, Douglass and Silk (2008), physiologic changes occur during pregnancy which may result in noticeable changes in the oral cavity.  These changes include pregnancy gingivitis, benign oral gingival lesions, tooth mobility, tooth erosion, dental caries and periodontitis.  It is important to reassure women about these various changes to the gums and teeth during pregnancy and to reinforce good oral health habits

 

Activity 6a:  Meet with the Division of Medicaid to determine how our office can assist with providing information on eligibility requirements and enrollment.

Report Activity 6a:

We have had conference calls and email correspondence with persons from Medicaid regarding our program efforts.  Medicaid has a new director and we will be working with him (or other team members) over the next few months.

Activity 6b:  Request baseline data from Medicaid regarding number of dentists enrolled in Medicaid program, dental procedures rendered and emergency room care related to an oral pain

Report Activity 6b:

Our office submitted a Medicaid Data Use agreement, which was approved on 12/3/18.  Medicaid covers dental services for all enrolled children as part of a comprehensive set of benefits referred to as the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit. States submit annual reports to CMS describing the percentage of children enrolled in Medicaid, their eligibility for the EPSDT benefit, and the various health and oral health services received during the year.

The Data Use Agreement helps the office to collect Medicaid and Children’s Health Insurance Program eligibility and enrolment data, and utilization and expenditure data from our state. This data also includes dental services and utilization data.

The information received from Medicaid through this agreement to gather include in our oral health surveillance report.

Activity 6c:  Participate in Medicaid sponsored provider or program trainings.

Report Activity 6c:

MS Medicaid Provider Workshops are held annually July through September, at varied location across the state. The purpose of these two-day Workshops is to provide updates and changes related to Medicaid and MSCAN. Last year, the Office ROHCs attended meetings held in Hattiesburg, Tupelo and Gulfport, MS.

 

Objective 3: By December 2019, increase our program participation with the Healthy Start Initiatives at Federally Qualified Community Health Centers in the state.

Strategy 7: Increase the knowledge and awareness about the safety of oral health care during pregnancy to women of childbearing age  

Rationale Strategy 7:

The Pregnancy Risk Assessment and Monitoring system of 2011 released a report in 2015 on the oral disease burden of expectant and post-partum mothers who received oral health education and services. It indicated that 71% of women did not visit the dentist or a dental clinic during their most recent pregnancy.  Fifty-four (54) percent had not had their teeth cleaned in more than 12 months. However, white women were more likely (40%) to have visited the dentist or dental clinic during their most recent pregnancy than black women (25%). In response to this report, and the need to find out more regarding pregnancy and oral health disparities in the state, our department began working with Jackson Hinds Comprehensive Health Center’s (an FQHC) Healthy Start Initiative and with the MSDH Social Workers who see pregnant moms.

Pregnancy has varied effects on the oral health of women.  Some women may have soar gums that appear to be red and swollen or they may bleed during tooth brushing. Research has stated that women who have poor oral health during pregnancy are at an increased risk of having babies that are premature or have a low-birth rate. Visiting a dentist during pregnancy is extremely important. The PRAMS report indicated that 71% of the women in Mississippi did not visit a dentist during their most recent pregnancy. These numbers signify the importance to teaching oral health to all pregnant mothers of every ethnic group in the state.

As 19 of the 21 Federally Qualified Health Centers (FQHCs) in Mississippi offer dental services and serve as a safety net for the underserved and the uninsured, we will expand our partnership efforts to assure expectant mothers are receiving oral health care.

 

Activity 7a: Regional oral health consultants (dental hygienists) will work with local FQHCs to provide oral health education materials regarding the safety of oral health during pregnancy, and information on the importance of good oral health over one’s lifespan.  

Report Activity 7a:

Office of Oral Health worked with Women’s Health to create a medical clearance form to use with pregnant women referred from their programs to dentist in the community .We have gathered numerous pamphlets from the Mate.

We were unable  to work with the FQHC dental providers in our r MS SEALS program due to our inability to get contracts and training executed in a timely manner.  This partnership program involved dental providers offering school based oral education, screenings, sealant and fluoride varnish application. In return, our office provided the sealant and fluoride varnish materials and received state surveillance data.  Though we were unable to establish our usual contracts, we did execute five MOUs with school-based clinics for the 2018-2019 school year.  These MOUs were extended for three years to not interrupt coordination efforts. 

Our partnership with the mobile dental units was expanded, many of which are in several school districts across the state.  As with the MOU with the FQHCs, we also provide sealant materials and fluoride varnish to these units and received state surveillance data. 

Strategy 8: Provide region-specific dental directory to expectant mothers for routine exams and dental procedures during and after pregnancy.

Rational for Strategy 8:

There are approximately 3 million residents living in MS. Of those 3 million, 1.6 million live in rural MS.  The directory was created (1) to increase access to dental care for low-income patients as well as those living in rural communities, (2) to help dentists who participate in the Medicaid program, and (3) to enhance their capacity and provide community-based prevention services. The Office of Oral Health collaborated with the Mississippi State Board of Dental Examiners to create a region-specific Directory of Dentists. This directory identifies Medicaid approved dentists as well as provide a listing of all area dentists. A directory was created for all five regions of the state.    

In 2017, the Office of Oral Health published its first MS Dental Safety Net Provider report that shared the dental health professional shortage areas across the state, using information from HRSA.  Dental Health Professional Shortage Area (HPSA) designations are used to identify areas and population groups within the United States that are experiencing a shortage of dental health professionals. The primary factor used to determine a Dental HPSA designation is the number of dental health professionals relative to the population with consideration of high need. Federal regulations stipulate that, to be considered as having a shortage of providers, an area must have a population-to-provider ratio of a certain threshold. For dental care, the population to provider ratio must be at least 5,000 to 1 (4,000 to 1 if there are unusually high needs in the community).  This report is updated annually, and the 2019 version is available on our departmental webpage.

Activity 8a:  Distribute region-specific dental directory during oral health education at WIC, Baby Café, and other local health events.

Report Activity 8a:

The referral guides are complete. These guides are region-specific to make finding a dental provider easier. Offices that accept Medicaid as payment for services have an asterisk beside their names to assist Medicaid recipients with choosing a dental provider.  We also included in the resource guide the various providers per dental specialty.  ROHCs provide these guides in their area at community events held in their assigned service locations.  Currently, the number of residents that have utilized the referral guides are unknown; however, as a part of the dental care coordination effort, tracking referred patients will be  created to increase the activities value.  We are waiting to receive our printed copies from the Office of Communications for further distribution in the community.

Activity 8b:  Oral Health Administrative staff and consultants to make  follow-up calls to expectant mothers that acknowledged no dental home to encourage and assist in establishing one.

Report Activity 8b:

No activity in this area as we are finalizing the care coordination protocol.

Strategy 9:  Combat oral disease in MS children and adolescents by integrating oral health education training into the medical setting.

Rationale for Strategy 9: The Bright Futures/American Academy of Pediatrics (AAP) developed a set of comprehensive health guidelines for well-childcare, known as the "periodicity schedule." It is a schedule of screenings and assessments recommended at each well-child visit from infancy through adolescence.  The AAP recommends that children be referred to a dental home within 6 months of the appearance of the first tooth and no later than the child’s first birthday. A primary care provider (PCPs) is more likely to see a child than the dentist. In this clinical setting, PCPs can consistently provide to patients’ fluoride varnish applications, oral health screenings, and provide counseling to parents/caregivers that identify risky behaviors and improve oral health habits.  PCPs can also influence parents/caregivers of the importance of establishing a dental home and getting early and regular visits for their child/children.  

Activity 9a:  Provide health care providers with information regarding on-line continuing education training on several oral health modules using the Smiles for Life: A National Oral Health curriculum.

Report Activity 9a:

The Smiles for Life: A National Oral Health curriculum is a product of the Society of Teachers for Family Medicine (STFM) and is an online tool that offers CEU credits.  The curriculum consists of eight 60-minute modules covering core areas of oral health relevant to health professionals. User competencies are measured through assessments at course completion. Users must score an 80% or higher to receive credit for each course.

The course covers (1) Relationship of Oral & Systemic Health, (2) Child Oral Health, (3) Adult Oral Health, (4) Acute Dental Problems, (5) Pregnancy & Women’s Oral Health, (6) Carries Risk Assessment Fluoride Varnish & Counselling, (7) The Oral Exam, and (8) Geriatric Oral Health. The registered usage map identifies MS as having an average of 50-99 users; however, the data collected by STFM has limitations. The curriculum registration is based only on numbers of CE registered users tracked on the website.

Many individuals complete the online courses without registering on the website, some do not obtain CE credit for the course(s), and some organizations download the courses for use in academic settings or workplace trainings in which users do not register on the website. These users are not included in the website data; therefore, we are unable to get an accurate number of participants of the curriculum.

Activity 9b:  Provide face-to-face training to health care providers on oral health assessments and fluoride varnish application in medical settings using the Cavity Free in MS curriculum.

Report Activity 9b:

The Cavity Free in Mississippi offers face-to-face training with health care providers on how to perform an oral health evaluation, the benefits and application of fluoride varnish and caregiver education on good oral hygiene practices. Medical providers also receive training on billing/coding for services rendered, fifty (50) .25 gram of 5% Sodium fluoride varnish, education pamphlet on fluoride varnish, and a list of dental suppliers and products. Since March 2018-April 2019, Cavity Free in MS training and supplies have been provided to 172 physicians, nurse practitioners, RN, family nurse practitioners and other administrative staff at FQHCs and PCP and pediatric practices across the state.

Strategy 10: Build connections and strengthen opportunities with university and allied health schools with dental degree and dental hygiene degree programs.  

Rational for Strategy 10:

In the Fall of 2018 “Dentistry” magazine, printed by the alumni of the University of Mississippi (UMMC), School of Dentistry, it was written that MS was 49th in the national with the highest patient to dentist ratio with 2,120 residents for every licensed dentist. An estimated 192 dentists will retire in the next three years. According to the Mississippi State Board of Dental Examiners website, nearly 14 percent of Mississippi’s active, licensed dentists are 65 or older.

The state’s oral health plan outlines 10 essentials for promoting oral health in Mississippi, and one of those is to “assure an adequate and competent public and private oral health workforce.” The oral health plan also explained the health ramifications of oral disease in Mississippi, based on 2015 figures. A quarter of adults 65 or older has no teeth. More than 400 new cases of oral cancer are diagnosed each year, and 590 adults died from oral cancer between 2008 and 2012. Forty-four (44%) percent of adults have not visited a dentist in the past year. Almost thirty-one (31%) percent of Mississippi’s third graders had untreated tooth decay. Poor oral health affects diet and nutrition. People who have lost their teeth prefer softer foods over fresh fruits and vegetables.

Currently, the only dental school in the state has a student capacity of 40 per class; yet, the number of graduating students that remain in the state are low. In 2013, the Mississippi Legislature authorized the Mississippi Rural Dentists Scholarship Program (MRDSP). This scholarship is a unique longitudinal program that identifies rural college students who aspire to return to their roots to practice general dentistry or pediatric dentistry. Students must apply one year before they are accepted into dental school.  Recipients’ must remain in a high needs area in rural MS for two years to fulfill the scholarship’s requirements.  The scholarship also provides academic enrichment, faculty and dentist mentoring plus solid dental school financial support. Though a great idea, competition for the scholarship is very high and the number of recipients is low.

Activity 10a:  Strengthen public health dentistry portion of curriculum with the dean of UMMC School of Dentistry and the dental hygiene school. 

Report Activity 10a:

Dental public health (DPH) is that part of dentistry that provides leadership and expertise in population-based dentistry, oral health surveillance, policy development, community-based disease prevention and health promotion, and the maintenance of the dental safety net. DPH and the private practice model of care delivery together bear the responsibility of assuring optimal oral health for all Americans - individuals and populations. Students at UMMC, School of Dentistry currently receives one week of public health dentistry; however, a greater focus on this type of dentistry provides students with not just a primarily a clinical specialty but also a focus on dental and oral health issues in communities and populations rather than individual patients.

Fortunately, last year, the dental hygiene school relocated and combined with UMMC School of Dentistry.  Prior to this, the UMMC Dental Hygiene program was a part of the school of allied professions and located in a different building.  Since 2016, the relationship with UMMC School of Dentistry and our office has been strengthened.  The Dean of the Dental School and our program director meet several times throughout the year to stay connected to working cooperatively together.

In December of 2018, our office was asked to provide the Diversity Training for dental school faculty, staff and students. On January 10, 2019, the Mississippi State Department of Health (MSDH), Office of Oral Health provided diversity training themed "Culturally Responsive Care in Healthcare Settings" to University of Mississippi Medical Center, School of Dentistry, faculty, students and staff- totaling about 370 persons. Diversity training is a mandate for accredited dental school programs, and we were fortunate to provide the training this year to the School of Dentistry. This training opportunity coincides with goals outlined in the MSDH Oral Health Plan 2016-2021 under Core Area 3: Address Workforce Shortage; Goal 3: Enhance the adequacy of the Mississippi dental health workforce to address the oral health needs of all Mississippians; Objective 3.2: Incorporate health literacy and cultural competency training into the curriculum of state oral health provider education programs. Prior to the training, participants completed a customized Cultural Competence Checklist for Oral Health with the following sections relating to cultural, language and organization practices: SECTION A: My Cultural Beliefs SECTION B: Language Barriers SECTION C: About the Limited English proficient or Deaf patient, after intake my organization typically knows: SECTION D: After intake is completed, my organization typically knows: SECTION E: My organization makes every effort to learn: SECTION F: My behavior and that of my colleagues toward all patients reflects: We are currently analyzing the cultural competence checklist responses, training post evaluation comments and presenter ratings. We are planning to send out a post cultural competence checklist to further evaluate participants’ beliefs post the training to provide a comparative analysis. After which, we will meet with the Dean of UMMC, School of Dentistry and other administrators to discuss recommendations and next steps. Impact: The below section from the Commission on Dental Accreditation, Accreditation Standards for Dental Education Programs best summarizes the importance of diversity and cultural competence training in dental education programs: “Diversity in education is essential to academic excellence.

A significant amount of learning occurs through informal interactions among individuals who are of different races, ethnicities, religions, and backgrounds; come from cities, rural areas and from various geographic regions; and have a wide variety of interests, talents, and perspectives. These interactions allow students to directly and indirectly learn from their differences, and to stimulate one another to re-examine even their most deeply held assumptions about themselves and their world. Cultural competence cannot be effectively acquired in a relatively homogeneous environment. Programs must create an environment that ensures an in-depth exchange of ideas and beliefs across gender, racial, ethnic, cultural and socioeconomic lines.” By providing this training to faculty, students and staff at the University of Mississippi Medical Center, School of Dentistry, we sought to increase self-awareness and receptivity of participants to diverse client and patient populations. We were also able to share legal, regulatory and relevant standards (National CLAS Standards) to the participants trained. Once we share the analysis of the training with recommendations to program administrators at the dental school, we can work collaboratively with the School of Dentistry in their efforts to recruit a more diverse student and faculty population; deliver a higher quality of care to help patients in meeting their oral health care goals, while honoring and respecting their cultural beliefs and practices; decrease clinical errors that may arise due to cultural and linguistic differences in communication and differences in oral health literacy; gain essential tools to help recognize and lessen the racial and ethnic health care disparities that persist in oral health. The U.S. Department of Health and Human Services, Office of Minority Health identify these as benefits of said trainings. Long term, it is hoped that this training will lead to annual assessments of the University of Mississippi Medical School of Dentistry diversity program, updates to program curriculum (as needed) and implementation of policies which will assure proper delivery of dental care by diverse dental providers and auxiliary staff who are meeting the needs of our racial and ethnic population in Mississippi.

Similarly, in 2016, under the leadership of its new Dean, the University of Mississippi Medical Center, School of Dentistry incorporated annual Mission Week activities for children and adults during the month of February which is nationally known as Children’s Dental Hygiene Month.  During its third mission week, the UMMC SOD served over 1000 patients during their Mission Week Feb 4-8, 2019.  During this week, dental and dental hygiene students provided free dental care to 1,444 underserved children, adults and veterans under the supervision of faculty.  This number was about 100 more patients that the previous years.  Limited exams, cleanings, sealants and fluoride treatments for children were done on that Monday February 4, 2019.  Throughout the rest of the week, dental students and faculty made 22 sets of dentures worth up to $5,000 each for patients in three days.  Funding from this grant opportunity supported the purchase of supplies and materials for the event.

Several conversations between the director and the dean of the college about expanding the curriculum have occurred.  To assist with these endeavours, our program director was appointed associate professor of the Pediatric Dental and Community Oral Health department with the School of Dentistry.  In this role, she provided guest lectures in several of the classes for dental students this Spring 2019 centers around social determinants of health and oral health disparities.

Activity 10b:  Partner with Hinds Community College community dental health coordinator program 

Report Activity 10b:

Strategy 11: Increase oral health awareness with the three MCH community-based partners.

Rational for Strategy 11:

Many Mississippians suffer with oral related treatable diseases, , and many more are at risk of other oral-related disease, often because they don’t have access to preventative dental health care and education.  Trouble finding a dentist often has more to do with other community factors such as poverty, geography, language and cultural barriers, and the availability of childcare or transportation,  as opposed to the lack of dentists able to treat patients. The Office is aware that many community-based organizations may have access to residents that may typically not receive care from a dentist because they are in an underserved rural, urban and Native American community. 

According to America’s Health Rankings, from 2016 to 2018, an average of 12.6 percent of Mississippian’s lacked health insurance. In 2015, 21% of African American residents and 53% of Latino/Hispanic, the highest rate in the country, were without health insurance, compared to 16% of Caucasian Mississippians.

Activity 11a:  Increase oral health awareness by providing oral health educational materials to the Mississippi Department of Education (MDE) Move to Learn Program. 

Report Activity 11a:

The Mississippi Department of Education (MDE) has agreed to implement an oral health component to their Move to Learn program.  MDE Office of Healthy Schools initiative supports the goals of the MDE and serves to assist and enhance the services and support provided to local school districts in making the connection between good student health and high academic achievement.  In the Spring of 2019, a teen component was added to the programming to address the specific health issues of growing teens and its effect on educational attainment. This program is located on YouTube. 

Our office has had numerous meetings and conference calls with representatives from MDE to discuss what this oral health inclusion might look like.  We are looking for large dental hygiene props to use in upcoming presentations as oral health is added. 

Activity 11b:  Establish oral health education days with the MS Urban League of Jackson. 

Report Activity 11b:

In June  2017, the Mississippi Urban League received a grant from the Kellogg Foundation entitled Community Transformers. The MS Urban League is a community-based project that is supported by the W.K. Kellogg Foundation and the USDA.  Its primary focus is on raising awareness, leading to community action where health and social disparities exist. The mission of Mississippi Roadmap is to achieve health equity by advocating for changes within the community institutions that influence people’s everyday lives.

This grant enabled the organization to start a Baby Café and to create a lactation room.  The ROHC located in central MS provides oral health education to

the mother’s participating in the program every third Wednesday of the month starting in March of 2018.  The education classes have been put on hold until a new coordinator is hired.

Activity 11c:  Include oral health education within Families First for MS parenting classes. 

Report Activity 11c:

The ROHCs in Region IV and V and central staff licensed dental hygienist taught oral health 101 and provided dental care kits to 80 parents that participate in Families First parenting classes at 10 sites across the state.  These classes cover parenting and life skills, anger management, family unit conflict and financial literacy. First Families has also partnered with the Mississippi Department of Human Services (DHS) to develop the Non-Custodial Fatherhood Program. Approximately half of all children will live in a single-parent household at some point during childhood. Unfortunately, a common pattern is for non-custodial parents to become increasingly detached over time.

The Non-Custodial Fatherhood Program is designed to facilitate a sense of responsibility towards their child. The program achieves this by offering classes in effective parenting, healthy relationships, conflict resolution, soft skills and life skills.  The ROHCs also attend coalition meetings at locations in Leflore and Lafayette County.

Evidenced Based Measure Reporting (Oral Health)

ESM 1: # of WIC sites where oral health education is given to program participants

ESM 1 Report: 

31 WIC sites are provided oral health education.

Our Regional Oral Health Consultants (ROHCS) for the 2018 year  provided oral health education to WIC recipients in 31 counties throughout the state from 1/1/2018 to date.  These activities included: (1) providing mothers and their families with educational materials that help to develop and strengthen knowledge on how to clean infant gums after drinking and eating; (2) information on how to prevent dental cavities; (3) the importance of  nutritional snacks; (4) when to the see a dentist and (5) the importance of mom/dad taking care of their teeth.

ESM 2: # of expectant and post-partum mothers who received oral health education.

ESM 2 Report: 

765 expectant and post-partum mothers at WIC Sites received oral health education at WIC sites and 43 expectant and post-partum mothers  received oral health education at WIC Baby Cafes.

ESM 3: # of pregnant women who saw the dentist post referral

ESM 3 Report: 

Unfortunately, we have no program data to report.

 

A collaboration between MSDH Office of Oral Health and the Office of Women’s Health in use of social workers and regional oral health consultants who are hygienist to increase the number of pregnant mothers in Tallahatchie and Yalobusha Counties who received post-partum oral health education was halted due to staff turnover in those counties

 

Due to the attrition of staff for both offices (Oral Health and Women’s Health) of personnel identified who could assist with this program, we were not able to move forward with quantitative program data supporting this occurrence.

 

Currently we are revisiting this objective with Women’s Health to see if we can

move forward with this initiative in addition to exploring other opportunities where this information can be captured

 

Additionally, we plan on working with various Healthy Start initiatives throughout the state to capture this information from their participant pool

 

ESM 4: # of referrals of children 0-3 years old from MSDH nurses; # of patients who actually went to referred dentist

ESM 4 Report: 

MSDH nurses made 868 referrals of children aged 0-3 years to the dentist in accordance with EPSDT guidelines.  From medical providers who participated in the Cavity Free in Mississippi training, we only heard back from one partner who identified 10 children ages 0-3 years old who were referred to the dentist

Of the patients referred from MSDH Nurses to dentist in the state, we are unsure how many saw a dentist; we are working on a tracking mechanism in EPIC or separately to assure proper care coordination.  Our redefined dental care coordination process will assist with capturing this data in the future.

ESM 5: # of inter/external agency partnerships implemented to coordinate dental and other services.

ESM 5 Report: 

150 interoffice and external agency partnerships were forged this year to better coordinate dental and other services

ESM 7: # of organizations provided with oral health educational materials and supplies.

ESM 7 Report: Oral Health educational materials are provided at all our community outreach events we participate in.  However, we often get requests from organizations within the community for  educational material and hygiene supplies.  We provided oral health educational materials and supplies to over 200 plus organizations this grant year.

 

Emerging Issues Child Health (Office of Oral Health)

A common emerging issue for our state, related to oral health is the shortage of dentists in our state.  In Mississippi, there are many rural communities and low population areas.  Dentists are disproportionately distributed in the two major metropolitan areas of the state (See Appendices, Figures 1 and 2). Currently, the state of Mississippi had only 1,407 practicing dentists, serving 2.9 million citizens. Additionally, Mississippi has one dental school that produces most practicing dentists in the state. The viable workforce needed to provide treatment to our culturally diverse population is deficient, specifically in rural communities.

Appendices Figure 1 and 2 shed light on the distribution of dentists in MS based on county, age and gender. Also shown is Figure 3, a map of MS’s counties depicting dental health professional shortage areas, along with the safety net facilities in those communities. Hinds and Rankin counties share a large population of dentists in the state while in other counties, providers are scattered throughout.

Additionally, most of the dentist in Mississippi.  As we consider a Mississippi where oral health for all is priority, we must address our workforce scarcity of dentists. As we consider the challenges, we are forging working partnerships with other MSDH agencies such as Preventive Health and Women’s Health, to create a shared workforce to meet everyone’s objective, which is improved overall health for the citizens of MS.  We recognize the importance of interdisciplinary models of care that aid in prevention of disease and promotion of health.  Also, we continue our work with the University of Mississippi Medical Center, School of Dentistry in promoting a diversified workforce and exposure of students to underserved communities; the National Health Services Corps in recruiting students and practicing dentists to participate and work in dental health provider shortage areas; public school districts and colleges and universities to discuss careers in dentistry and provide financial assistance in doing so; and with the Community Health Association of Mississippi in dental provider recruitment and retention in the state.  We are also evaluating other state programs and how they are addressing workforce matters to consider other best practices.

HPV and Oral Cancer-Use of Social Media to share

Oropharyngeal cancer diagnosis has increased nationally and in the state of Mississippi.  Our office continues to share the relationship between HPV and oral health and thus promote HPV vaccination.  We have created various posters and brochures that are disseminated at health department and community events around HPV and oral cancer.  This year we collaborated with the Office of Immunizations to expand efforts to create a toolkit that could be shared with dentists requesting that also educate parents and patients about the benefits of the HPV vaccination.  This information is also shared on our webpage.  This year we were able to monitor the social media buzz regarding it in April for oral Cancer Awareness Month; in October 2018 for Dental Hygiene Month;  and in February 2019 for National Children’s Dental Health Month.  The number of hits is below:

 

 

 Human Trafficking and Access to Health Care

As human trafficking in the United States and locally is increasing, our office is working with national and local representatives to identify oral health implementations and best practices when it comes to safety protocols for our field worker staff members and dental provider’s opportunities for identification and helping with this public health issue.  We are also working with Tougaloo College’s modern slavery initiative to bring attention to this issue.  In 2018, the Office of Oral Health entered into a contractual agreement with an expert on Human Trafficking, Sunny Slaughter, who has provided onsite and web-based trainings to team members. She has sent us literature to use in community events and is reviewing agency policies to guide discussions and protocols on field staff safety in relation to increased human trafficking in the state.  This work will be coordinated with efforts with the MSDH Office Against Interprofessional Violence.

 Our program director spoke at the Tri-state Oral Summit in Birmingham, Alabama on June 14, 2019 about Human Trafficking and gave an overview of human trafficking  activity in MS Georgia and TN, emphasizing the  role of the dental provider.

Other Programmatic Activities Child Health (Office of Oral Health)

As our current State Oral Health Plan ends 2021, we are working with our current state plan stakeholders, identified by the core function areas they work with: infrastructure, prevalence of disease and workforce, to provide an annual update on activities towards meeting the goals outlined in the document.  We will continue with our quarterly stakeholder meetings and annual state plan stakeholder meeting which will be in November 8,  2019.

 

Update 2018:

We are using the analysis from the 3rd Grade Basic Screening survey guide program activities.  We are planning for a Head start Basic Screening Survey and Geriatric Basic Screening Survey

Children and Youth with Special Health Care Needs

Our program director serves on the advisory board for the Care Coordination Project with Children and Youth with Special Health Care Needs.  She has assisted with the facilitation of several learning session and with this project, we are tracking several outcomes as it relates to dental visits and referrals.

The program director will be assisting in the future to help create a special needs toolkit and work with our oral health state plan core area infrastructure in the development of this community toolkit which will include anticipatory guidance, dental provider who see CYSHCN patients and hygiene aids that can be bought for patients who have dexterity issues.

Health Equity

Eleven team members are certified trainers of Culturally Responsive Care in Healthcare Settings which aligns with Oral Health State Plan Objectives 2016-2021.  We have provided numerous Culturally Responsive Trainings in Healthcare Settings trainings over this last year.

 

They include:

Fall 2018-Office of Genetics

Jan 2019-UMMC School of Dentistry Diversity Training

April 2019-MSDH Office of Preventive Health-Head start Grantee (Culture and Nutrition emphasis)

May 2019-Jefferson Comprehensive Community Health Center

June 2019-Jefferson Comprehensive Community Health Center; MSDH Early Hearing Detection

Between the months of September and October 2019, our office will provide this training to Jackson State University, School of Public Health students and Mississippi State Department of Health, Pharmacy Department.

Success Story Child Health (Office of Oral Health)

Expanded partnerships for maximal impart:

Region VI Consultant (Carla) had the opportunity to partner with MSU Ext Services in Clarke County.  The MSU Coordinator teaches a class on healthy pregnancies and healthy babies once a quarter at the Clarke Co Health Department.  This consultant was able to provide healthy smiles from the start brochures and dental care kits to moms. Region VII Consultant also had the opportunity to provide oral health education quarterly at a substance abuse counseling program in Pearl River for women and children from the homeless shelters.

Region VI Consultant (Carla) has made a connection with MSU Ext Services Healthy Science course offered in the vocational classes in Forrest Co. She teaches 8th grade students the oral health and cultural competency components of the curriculum developed by UMMC during a 1hr. lecture. Due to rave reviews from the experience she’s been asked to come to Jasper county and provide the same education to their students.

Region VII Consultant (LaNeidra) participated in the Pathways to Possibilities (P2P) conferences that were held in the Delta and MS Gulf Coast area.  She shares it was a wonderful experience that provided our program excellent exposure to the local school district administration.   P2P is an interactive, hands-on career expo for 8th graders in public, private and home schools, as well as at-risk youth, ages 16-24. Over 7,000 8th grade students were exposed to the field of dentistry through oral health education and activities related to the profession.   Additionally, each student experiences a variety of career pathways, aligned with the U.S. and Mississippi Departments of Education.    Gautier and Pascagoula High schools invited her to take part in their mock interview program where she made a connection with 10 students who are interested in dentistry and dental hygiene.

Region III Consultant (Grady) was able to make a connection with a Faith-Based organization at the December 2018 Lafayette Coalition meeting. This organization’s program is called Beds for Kids and they have a manufacturing facility within their church where they make beds for children in Marshall co who do not have a bed. This will be a great connection so that every child that receives a bed can also receive a dental care kit reminding them the importance of brushing before bed and when they rise in the morning. Grady also shared that mothers of whom he is educating stated that they had no idea of the connection between oral health and the total body.  Some mothers even mentioned that they didn’t know that they needed to keep their children’s mouths clean.  Providing education at the Baby Café’s and Breastfeeding classes is helping to reduce childhood caries by making mothers aware of the importance of keeping theirs and their children’s mouths clean. 

Region VI Consultant (Carla) had the opportunity to educate a father of a 6month old child with down syndrome who had a feeding tube. He stated that he never knew the importance of oral health and the ROHC provided him with detailed questions to ask his pediatrician on their next medical check-up.  She has been able to reach 10 counties within her region and has educated 408 WIC Participants. 

Region VII Consultant (Marsha) During Men’s Health Month (June) she had the opportunity of educating fathers at the McComb WIC site. It was a great experience for both she and the fathers. She stated that they were all very engaged and posed great questions during the Cavity Free Kids Educational session.

Region VI Consultant (Carla) stated that the Meridian Baby Café had over 20 participants during the parent education classes. This is truly a success story because parent participation across the state has been low and to have a large turnout like this was great. Region III Consultant stated that the mothers of whom he’s educated stated that they had no idea of the connection between oral health and the total body. Some mothers even mentioned that they didn’t know that they needed to keep their children’s mouths clean. Providing education at the Baby cafés and Breastfeeding classes is helping to reduce early childhood caries by making mothers aware of the importance of keeping theirs and their children’s mouths clean.

New Opportunity: The Office of Oral Health is embarking on a collaborative with Families First for Mississippi at their new Hinds county site on State Street in Jackson MS. Families will be able to come to his location and receive education and counseling on day to day activities such as banking, resume building, cooking, workforce development, maternal child health, anger management, early childhood literacy. Participants will be able to receive 10 lbs. of free food by participating in the educational curriculum for the total family. 50 Pack and plays will be provided to new mothers monthly. The Office of Oral health will integrate into this facility by providing oral health education to new moms during the maternal child classes. We’ll provide oral health instruction during the job readiness and motivational interviewing components for program participants. We will be obtaining price quotes on Dental typodonts to incorporate into the workforce simulation room where program participants can gain a hands on career experience in the field of dentistry.

National Dental Hygiene Liaison:  The state dental hygienist liaison (DHL) is recognized as an early childhood oral health leader and advocate in their state. The DHL works in a voluntary capacity, and their primary functions are to:

• Serve as a communication link between NCECHW and early-childhood-education programs on topics related to improving the oral health of pregnant women, infants, and children.
• Collaborate with state organizations and networks, including the state oral health program, the Head Start state collaboration office (HSSCO), and childcare agencies.
• Promote evidence-based and evidence-informed oral health information and materials.

One of our Regional Oral Health Consultants, Carla Bassett has served as the Mississippi Dental Hygiene Liaison for over 1.5 years and has been very instrumental in helping to maintain our relationship with the Mississippi Head start Association and sharing of brochures and other resources from the National Center on Early Childhood Health and Wellness to team members and program stakeholders.

One of the National Dental Hygiene Liaison projects was recently shared and highlighted in the May/June 2019 publication of the American Dental Hygiene Association:  “Dental Hygienist Liaisons Improve Oral Health for Pregnant Women and Children”.

 

Child Health Annual Report Summary (Office of WIC Services)

Priority: Increase Child Nutrition and early childhood obesity prevention.

SPM 2: Percentage of children, ages 2to 5 years, receiving WIC services with a Body Mass Index (BMI) at or above the 85th percentile.

Program Purpose and Summary:

The Special Supplemental Nutrition Program for Women, Infants and Children (WIC) is a public health program funded and guided by the United States Department of Agriculture (USDA) Food and Nutrition Services (FNS) to provide nutrition education, nutritious foods, breastfeeding support, and healthcare referrals for income-eligible women who are pregnant or postpartum, infants, and children up to age 5. WIC’s purpose is to safeguard the health of low-income women, infants, and children up to age 5 who are at nutrition risk by providing nutritious foods to supplement diets, information on healthy eating, and referrals to healthcare. WIC serves pregnant women, breastfeeding women, postpartum non- breastfeeding women, infants, and children less than five years of age who live in Mississippi and meet income requirements. The WIC food package provides nutritious foods to supplement your regular meals. WIC participants can choose some or all of the following, free of charge: eggs, beans, cheese, baby formula, peanut butter, white and chocolate milks, hot and cold cereals, 100% fruit juices, canned tuna (for breastfeeding mothers), whole wheat bread and tortillas, fresh and canned fruits and vegetables, baby food fruits and vegetables, and/ or baby food meats (for breastfed infants).

A portion of each state's WIC funds must be spent on breastfeeding promotion and support. WIC is a strong supporter of breastfeeding and has designated that breastfeeding be promoted and supported by the Breastfeeding Program staff and all WIC clinic staff members. The purpose of the WIC Breastfeeding Promotion and Support Program is to promote and support breastfeeding. To promote breastfeeding is to focus on the advantages of breastfeeding on a personal, local, regional, and state level. To support breastfeeding is to focus on interactions with WIC families and communities to enhance the breastfeeding experience. WIC staff provide breastfeeding information and support to all pregnant and breastfeeding women receiving services from the Mississippi WIC Program. The MS WIC Program serves as an adjunct to good health care by providing peer support, breastfeeding management, information, and assistance throughout the prenatal and postpartum period.

Childhood obesity is a serious health issue plaguing Mississippians. Combatting childhood obesity takes a multifaceted approach involving children, families, and communities. According to research by Zhang et al. (2014) in 2013, 14.5% of 2- 4-year-old WIC participants in Mississippi were obese. This rate is higher than 22 of the 51 states. Combatting childhood obesity takes a multifaceted approach involving children, families, and communities. The MSDH WIC Program provides nutrition education and healthy foods to pregnant and postpartum women, infants, and children up to age 5. According to the Academy of Pediatrics, breastfeeding may lower a child's risk of overweight and obesity. The MSDH WIC Program partners with various community agencies to ensure mothers who may be eligible for services are enrolled to receive nutrition- related care. One of these agencies is Head Start, who services children from 0- 5 by aiming to meet the child and family's nutrition and physical activity, educational, mental, and social needs. 

According to the Mississippi State Department of Health 2018 Infant Mortality Report, of the 37,370 infants born in Mississippi 326 died. This represents 8.72 infant deaths per 1000 live births. This number represents a 1.7% increase  from the 2016 rate of 8.57. Breastfeeding is one of many strategies aimed at lowering infant mortality rates. The American Academy of Pediatrics recognizes breastfeeding as a means of decreasing rates of sudden infant death syndrome. The 2018 CDC Breastfeeding Report card shows that in Mississippi 63.2% of infants were ever breastfed and 35.4% were breastfeeding at 6 months. This is a 11.2% increase in infants ever breastfed and a 1.7% increase for infants breastfed at 6 months from the 2016 CDC Breastfeeding Report card. The 2011 Surgeon General's Call to Action to Support Breastfeeding identified hospital practices that make it hard to get started with successful breastfeeding, not enough opportunities to communicate with other breastfeeding mothers, lack of up-to-date instruction for healthcare professionals, and lack of accommodation for breastfeeding mothers to express milk at work as obstacles to breastfeeding. This report also recognizes Baby Friendly accreditation and access to breastfeeding professionals as actions the healthcare community can take; and strengthening programs that provide mother-to-mother support and peer counselling as actions the community can take to support breastfeeding families.

Child Health Annual Report (Office of WIC Services)

 Accomplishments and Challenges

Objective 1: Decrease the number of children in Mississippi WIC Program with BMI's at or above the 85th percentile by 2% annually.

Strategy 1: Implement a state-wide partnership between WIC and Head Start agencies.

Rationale Strategy 1: According to the USDA Food and Nutrition Services (2017), WIC and Head Start programs share common goals. Both programs promote positive health outcomes, and provide young children and families nutritious foods, health and nutrition education, and assistance in accessing on-going preventive health care. In many communities, WIC and Head Start serve the same families. By working together, programs have an opportunity to coordinate these services and maximize use of scarce resources (e.g., funding, staff, space). Working together can mean minimizing duplicative efforts on the part of families and staff; more opportunities for WIC and Head Start to benefit from each program’s strengths, expertise and best practices; and positively impacting the health and nutrition status of the children and families served.

 

Activity 1a:  Update MOU to include data sharing agreement to allow seamless transfer of participant information between MSCH WIC Program and Head Start.

Report Activity 1a:

The Head Start MOU has been updated to include a data sharing agreement. In partnership with the Mississippi Head Start Association, the MSDH WIC Program successfully updated the current MOU to include a data sharing agreement.   

Activity 1b:  Acquire signed MOU with at least 75% of the 19 Head Start agencies in Mississippi.

Report Activity 1b:

Of the 19 Head Start agencies, 17 agencies were recruited to acquire a signed MOU for MSDH WIC to provide services on site at Head Start Centers. One agency was excluded because it was an Indian/ Tribal Organization with its own on-site WIC Program. Another agency was excluded because they have a standing MOU with a federally qualified health center to provide WIC services on- site. Of the 17 Head Start agencies, 15 currently have a MOU in place with MSDH WIC. This represents 88% of the Head Start agencies at which a MOU was sought, and 79% of all Head Start agencies in Mississippi.

The MSDH WIC Program uses the FNS website, WIC Works, for motivational interviewing training needs. In June, 2017, a grant was awarded from FNS entitled “Putting Knowledge in the Flow of Work” to assist in the development of specialized training based on staff needs. From April to May, 2018, focus groups were held by the MS Public Health Institute to determine the local (clinic) and regional office training needs. In June 2018, a findings report was completed. Based on focus group findings, training needs have been identified and transformed into training topics.

 

Strategy 2: Assist in the creation and maintenance of Baby Cafes across the state of Mississippi.

Rationale Strategy 2: Initiating breastfeeding is an important part of ensuring a child receives healthy first foods. According to the National Institute of Health, benefits of breastfeeding include the provision of nutritionally balanced meals, some protection common childhood infections, and better survival in the first year of life including lower risk of Sudden Infant Death Syndrome. Baby Café is a network of breastfeeding drop-ins. They aim to offer help and support to breastfeeding and prenatal mothers at any stage in their breastfeeding journey. Baby Cafes may be an effective way to assist mothers and increase breastfeeding initiation and duration.

 

Activity 2a:  Support the creation of Baby Cafes state-wide.

Report Activity 2a:

The MSDH WIC Program has partnered with local hospitals to refer potentially WIC eligible mothers to the WIC Program. MOUs have been signed with 14 of the 42 delivering hospitals in Mississippi. The MOUs allow the hospitals to refer potentially eligible patients to WIC, and allows WIC staff to serve as community partners on the Baby Friendly committees, provide breastfeeding support groups and education sessions for hospital patients, and provide WIC literature to delivering families.

 

Activity 2b:  Assist in the creation and sustainment of breastfeeding support groups, including Baby Cafes

Report Activity 2b:

There are currently 6 Baby Cafes located in the state of Mississippi, including 1 cluster. Baby Cafes include the following: Sipps Baby Café in Jackson MS, Crossroads Baby Café in Clarksdale MS, Delta Hills Baby Café in Greenville MS, and Circle of Mom’s Baby Café Clusters including KDMC Cluster (Brookhaven), Brookhaven Library Cluster, and McComb Cluster.

The MSDH WIC Program assists with staffing of each by providing peer counselors and CLC's weekly to provide education and peer support to local mothers.

Strategy 3: Provide ongoing staff training on Motivational Interviewing Techniques to influence participant behavioral change.

Rationale Strategy 3: Motivational Interviewing is a participant-centered method that encourages change by addressing an individual’s needs and concerns. Motivational interviewing has been found to be an effective tool both in increasing WIC participant satisfaction with the education component of the WIC Program and also initiating positive health behaviors (North Dakota WIC Program, 2004).

 

Activity 3a:  Identify staff members providing nutrition education to WIC participants.

Report Activity 3a:

Compiled list of MSDH WIC staff including certifiers, clerks and breastfeeding support.  

Activity 3b:  Identify staff training needs.

Report Activity 3b:

Used results of focus group sessions conducted by MS Public Health Institute (MSPHI) to develop training sessions which focused on professional core development and included interactive learning activities to improve communication.

Activity 3c:  Develop specific online training aimed at increasing staff ability to provide excellent customer service and utilize Motivational Interviewing techniques.

Report Activity 3c:

Online customer service and interactive training was developed by MSPHI and put on the MSDH Learning Management System (LMS).

Activity 3d:  Provide on-going staff training.

Report Activity 3d:

Will develop staff training on WIC policies and procedures related to new eWIC process.

Strategy 4: Increase breastfeeding initiation and duration rates through prenatal breastfeeding education and post-discharge support.

Rationale Strategy 4:

Initiating breastfeeding is an important part of ensuring a child receives healthy first foods. According to the National Institute of Health, benefits of breastfeeding include the provision of nutritionally balanced meals, some protection common childhood infections, and better survival in the first year of life including lower risk of Sudden Infant Death Syndrome. Baby Café is a network of breastfeeding drop-ins. They aim to offer help and support to breastfeeding and prenatal mothers at any stage in their breastfeeding journey. Baby Cafes may be an effective way to assist mothers and increase breastfeeding initiation and duration.

 

Activity 4a:  Create community partnerships as referral sources to the MSDH WIC Program. 

Report Activity 4a:

The MSDH WIC Program established a Memorandum of Understanding (MOU) to provide support for Step 3 (prenatal breastfeeding education) and Step 10 (post-discharge breastfeeding support) of the Baby Friendly Hospital Initiative. The MOU has been signed by 22 of the 41 delivering hospitals in the state. As a part of supporting Step 3, WIC staff are teaching prenatal breastfeeding education classes’ onsite at partnering hospitals. As a part of Step 10, WIC staff promote Baby Café’s to mother’s for access to post-discharge breastfeeding support. We also have partnerships with other support groups such as the Mississippi Breastfeeding Coalition, Le Leche’ League, Mothers Milk Bank of MS and Mother and Baby Time groups for additional referrals to the MSDH WIC Program.

Activity 4b:  Assist in the creation and sustainment of breastfeeding support groups, including Baby Cafes.

Report Activity 4b:

MSDH WIC continues to support the creation and sustainment of breastfeeding support groups and Baby Café’s by providing WIC staff the time to provide facilitation support for group meetings. As partners, we share WIC resources with Baby Café’s to ensure mothers and babies receive support and services needs for successful breastfeeding outcomes.

Activity 4c:  Provide breastfeeding education and support to prenatal WIC participants.

Report Activity 4c:

MSDH WIC staff provide group and individual breastfeeding education within the clinic setting. As a result of our ongoing commitment to collaborations and partnerships, MSDH WIC staff provide breastfeeding classes in the community setting. For example, two of our OB/GYN partners are allowing WIC staff to teach breastfeeding classes to their prenatal clients. This extension of breastfeeding education not only serves WIC clients, but also reaches families who may be eligible for WIC but not currently enrolled in the program.

Strategy 5: Initiate partnerships between Mississippi WIC and Head Start agencies via memorandums of understanding.

Rationale Strategy 5:

According to the USDA Food and Nutrition Services (2017), WIC and Head Start programs share common goals. Both programs promote positive health outcomes, and provide young children and families nutritious foods, health and nutrition education, and assistance in accessing on-going preventive health care. In many communities, WIC and Head Start serve the same families. By working together, programs have an opportunity to coordinate these services and maximize use of scarce resources (e.g., funding, staff, space). Working together can mean minimizing duplicative efforts on the part of families and staff; more opportunities for WIC and Head Start to benefit from each program’s strengths, expertise and best practices; and positively impacting the health and nutrition status of the children and families served.

Activity 5a:  Initiate communication with Head Start centers statewide. 

Report Activity 5a:

The Office of the Governor and Mississippi Head Start agency was engaged to initiate communication with the Head Start agencies statewide. The Office of the Governor provided a list Head Start agencies statewide, including the address, phone numbers, executive directors, and funded enrolment. Representatives from the WIC Program spoke at the Mississippi Head Start Association Board meeting to further engage Head Start directors and provide information about the WIC- Head Start partnership. Letters were sent to Head Start directors statewide providing detailed information about and asking for participation in the WIC- Head Start partnership.

Activity 5b:  Get signed MOU's with Head Start agencies/ grantees.

Report Activity 5b:

Letters were sent to all Head Start directors statewide asking for participation in the WIC- Head Start partnership. MOUs were emailed. Once communication was initiated with the Head Start directors, the they were emailed a link to complete the MOU via electronic signature. Once the Head Start director signed, the MSDH state health officer signed, and a signed copy was emailed to the Head Start director informing him or her of the executed agreement. There are currently MOUs in place with 15 Head Start agencies statewide.

Strategy 6: Partner with Head Start agencies to enroll children on the WIC Program.

Rationale Strategy 6:

According to the USDA Food and Nutrition Services (2017), WIC and Head Start programs share common goals. Both programs promote positive health outcomes, and provide young children and families nutritious foods, health and nutrition education, and assistance in accessing on-going preventive health care. In many communities, WIC and Head Start serve the same families. By working together, programs have an opportunity to coordinate these services and maximize use of scarce resources (e.g., funding, staff, space). Working together can mean minimizing duplicative efforts on the part of families and staff; more opportunities for WIC and Head Start to benefit from each program’s strengths, expertise and best practices; and positively impacting the health and nutrition status of the children and families served.

 

Activity 6a:  Develop procedures for WIC services that will be provided in Head Start Centers and train staff on new procedures.   

Report Activity 6a:

Procedures for providing WIC services in Head Start centers were developed in November 2016 and finalized March 2017. An evaluation of procedures and equipment was completed January 2018. Procedures, forms and the MOU were updated April 2018. The data collection form and MOU were approved by MSDH in May 2018. Forms and MOU are currently awaiting agency approval.

 

Activity 6b:  Train MSDH WIC staff in two public health areas and develop training for new staff.

Report Activity 6b:

Staff training was provided bi-annually at regional nutritionist meetings to share the updated PowerPoint with regional staff. Regional staff provided Head Start training procedure training to all WIC certifier staff who will be providing WIC services at Head Start centers. 

 

Activity 6c:  Statewide rollout of WIC services in Head Start centers.

Report Activity 6c:

Evidenced Based Reporting (Office of WIC Services)

 

ESM 1: Number of Head Start agencies collaborating with WIC Program.

ESM 1 Report: 

15

ESM 2: Number of Head Start children enrolled in WIC through the WIC partnership.

ESM 2 Report: 

1340

 

ESM 3: Number of Baby Café sites in Mississippi.

ESM 3 Report: 

14

ESM 4: Number of staff members trained.

ESM 4 Report: 

210

ESM 5: Breastfeeding initiation rate.

ESM 5 Report: 

49.91 (April 2019)

Emerging Issues (Office of WIC Services)

The opioid crisis facing families in Mississippi provides additional stress to low income families who receive WIC and Head Start services. This has caused several parents to abandon families due to being incarcerated, leaving grandparents or other friends and relatives responsible for the wellbeing of children. This makes mental health and social services provided by Head Start and the food and nutritional education provided by WIC a necessity for survival for these families. However, it also presents challenges surrounding producing enrollment documents and establishing official guardianship of children.

Other Programmatic Activities (Office of WIC Services)

MSDH WIC Program currently provides Pacify® smartphone application to WIC participants and partnering birthing hospitals.  Mobile technology opens a new avenue for Mississippi WIC to provide professional lactation support to participants, and there is mounting evidence that tele-medical lactation support from professionals improves breastfeeding rates.  Most recently, one study found that mothers receiving telephone-based support breastfed three times as long as a control group (American Journal of Clinical Nutrition, 2013). Telemedicine technology is making this sort of support easier and more cost-effective to provide. Additionally, the newest technologies are video-enabled, and provide a deeper level of connection between mothers and clinicians. Pacify’s mobile application provides an efficient and engaging way for participants to receive professional support, via video consultation to IBCLCs. When a woman needs support, she simply opens the app and selects the type of help desired. Pacify’s unique technology activates a nationwide network of practitioners, who are connected instantly, by video, to the user. Video-enablement fosters more personalized care and replicates the feeling of the in-person professional support that is currently unavailable to many Mississippi WIC participants due to the shortage of IBCLCs across the state. The application also allows users to provide feedback on the services provided. This feedback is provided to MSDH WIC Program.

 

MSDH WIC Program partnered with Mississippi Urban League (previously Mississippi Roadmap to Health Equity) to apply for the BUILD Health Challenge. From this grant opportunity, Breastfeeding Friendly Designation was created. The Breastfeeding Friendly Designation aims to promote implementation of policies supportive of breastfeeding and establishing spaces for mothers to express breast milk in Jackson by educating school administrators and business owners about the individual, family, community, and business-related benefits of breastfeeding, and by providing technical support to implement these policies. Currently 16 businesses in the Jackson MS area have been designated, and Mississippi Urban League is planning a launch the initiative statewide.

 

The MSDH WIC Program is currently partnering with delivering hospitals in Mississippi to address Steps 3 and 10 of the Baby Friendly Hospital Initiative Ten Steps to Breastfeeding by providing a WIC lactation professional to conduct monthly prenatal/breastfeeding classes in your facility and refer mothers to breastfeeding support groups after discharge.  There are currently memorandums of understanding in place with 26 of the 41 delivering hospitals in Mississippi.  Partners agree to the following:

As a partner in this agreement, the MSDH WIC Program agrees to:

 

1. Participate as a member of your hospital’s task force to broaden your reach with the community.
2. Prepare WIC mothers prenatally for positive maternity care practices to help ease the load on your maternity staff.
3. Provide a WIC lactation professional to conduct monthly prenatal/breastfeeding classes at your hospital for patients.
4. Assist your hospital with post-discharge support group meetings.
5. Refer WIC mothers to providers, hospital staff, and other community resources.
6. Provide direct patient care for WIC mothers experiencing breastfeeding issues post discharge.

 

As a partner in this agreement, the Delivering Hospital agrees to:

1. Inform WIC Lactation Professionals of the dates, times, and locations of task force meetings
2. Work collaboratively with WIC Lactation Professionals regarding the hospital’s prenatal and postpartum breastfeeding needs
3. Refer prenatal and postpartum families to the WIC Program

 

Success Stories (Office of WIC Services)

Katrina Burch, RN, WIC Certifier at the Hinds County Health Department saved a premature infant’s life by performing CPR.  Ms. Burch is always humble when she shares the story.  Ms. Burch was certifying a WIC participant, when she heard a terrible noise coming from her coworkers’ office.  Ms. Burch rushed in the room and noticed the infant was limp and was not breathing.  Ms. Burch’s nursing instincts were now in high gear.  She asked her coworker to get help and call 911 and immediately started CPR.  Nurses from around Health Department rushed in the room to help. Needless to say, if Ms. Burch had not stepped in, the outcome could have been grim.  When MSDH staff followed up, the infant’s mother was overwhelmed with gratitude.  They were truly at the right place at the right time.  Sometimes guardian angels wear scrubs. 

 

The Milky Magnolias Baby Cafè is the second Cluster in MS. It is located in Southeast MS. One location is at the C.E. Roy Center (downtown) Hattiesburg and the other is West Hattiesburg in the Magnolia Room at Revolution Fitness Gym. The CE Roy Center location is a special success story as the Mayor of Hattiesburg played an active role in the ground work and opening of this Baby Cafè for the community. Mayor Toby Barker supports breastfeeding as a whole for his community and the work baby Cafè, WIC does for the community. He allows the Milky Magnolias Baby Cafè to meet there the first Thursday of each month from 1:30-3:00pm. It’s Lead Facilitator is Peggy Disbrow, CLC, WIC Peter Counselor and Co-Facilitator is Zakiyyah Smith, WIC Peter Counselor. 

The West Hattiesburg Milky Magnolias Baby Cafè is another success story since it was given a room in a local owned gym. To make it easier to find and special, the owner who is a CHEER champion named the designated room the Magnolia Room for the Milky Magnolias Baby Cafè. The Facilitators are the same for this Cafè cluster as the CE Roy Center.  Both sites share Facilitators and volunteers to help meet mom’s needs at both locations. These cafes are in not alone in Hattiesburg for breastfeeding support it is also the home of Forrest General Hospital; FGH was the first Baby-Friendly Hospital in MS. Now, both delivering hospitals are Baby Friendly designated which means the Baby Cafés can meet the moms needs between prenatal visits and postpartum delivery or checkups with the doctors. In addition, when breastfeeding and/or pregnancy is going well the moms can come enjoy time of fellowship with other moms living similar life time frame to share in good, bad and all between. 

Child Health Annual Summary (Bureau of Genetic Services)

 Priority

Increase Access to Comprehensive Health Care for Women

Program Purpose and Summary

The Bureau of Genetic Services includes the Newborn Screening Program and the Birth Defects Surveillance Registry. The Newborn Screening Program screens all newborns for metabolic, congenital birth disorders and provides follow-up and referral to internal and external programs.  The newborn screening system includes birthing hospitals, screening laboratory, public health staff, and tertiary care centers that provides screening, diagnosis, counseling, and follow-up for a range of genetic disorders. T. The primary goal of the Newborn Screening Program is to screen every infant born in the state and refer infants with abnormal results to appropriate centers for medical evaluation, confirmatory testing, and initiation of medical and/or nutritional treatment if indicated. Genetic coordinators in the three public health regions provide short term follow-up with parents and medical providers. This short-term follow-up process assist in the identification of certain serious or life-threatening conditions that may cause organ damage, developmental delay, or death if left undiagnosed and untreated. In addition, the program collects data from medical providers for a statewide birth defects registry. Includes expenditures for the Birth Defects Surveillance Registry program. 

The Birth Defects Surveillance Registry is housed in the Office of Child and Adolescent Health, Bureau of Genetic Services. Section 41-21-205 of the Mississippi Code established a Birth Defects Surveillance Registry in the Mississippi State Department of Health.  The law authorizes the MSDH to adopt rules to govern the operations of the registry which focuses primarily on live births and stillbirths within the state. All hospitals, clinics, and other health facility personnel that serve patients from newborn to 21 years of age should report to the Mississippi Birth Defects Surveillance Registry. Birth defects are captured by ICD-10 codes obtained through discharge summaries from hospitals (Passive case-finding without case confirmation). Data contained in this registry are confidential. The objectives are: To monitor, regularly and systematically, the births of children with defects for changes in incidence or other unusual patterns suggesting preventable causes; and to increase the number of providers reporting to the registry.

While the Bureau of Genetic services is housed within, the Office of Health Services the Mississippi State Department of Health’s MCH programs recognize the need to increase collaboration with the Genetics Bureau. The Bureau will be included in the 2020 needs assessment and we anticipate increased collaboration in developing future program goals and objectives. 

Child Health Annual Report (Bureau of Genetic Services)

Accomplishments and Challenges

A Genetics Reporting Portal developed in collaboration with and managed by PerkinElmer genetics laboratory to capture Critical Congenital Heart Disease (CCHD) screen results, Birth Defects reporting, and medical record abstraction data was launched on May 15, 2019. The portal allows for a secure, centralized and electronic method for hospital and clinic staff to report state mandated data. 

The Genetic Advisory Committee (GAC) met on March 27, 2019 and recommended the addition of Mucopolysaccharidosis I (MPS1) and Spinal Muscular Atrophy (SMA) screens to the Mississippi Newborn Screening Panel.  An oral hearing is scheduled for June 10, 2019 for public comment.  After review and approval from the Board of Health, screening for Mucopolysaccharidosis I (MPS1) and Spinal Muscular Atrophy (SMA) will be added.

The program is in the final stages of development of a Genetics Epic build. Regional staff participated in a review of the Epic system on May 23, 2019 to highlight and address any needed changes or updates.  Go Live is set for June 24, 2019.

Genetic Services and the Early Hearing Detection and Intervention (EHDI) program continue work with NATUS Medical Inc. on a newborn screening and hearing database. 

Strategic Planning/Training/Quality Improvement

Newborn Screening program staff and regional care coordinators provided Folic Acid Education at statewide WIC Food Centers during National Birth Defects Prevention Month. The theme for 2019 was “Best for You. Best for Baby.” Information and resources about the importance of using folic acid to prevent certain types of serious birth defects were provided. Dr. Alyce Stewart, Genetic Services Director was invited to WMPR 90.1 radio station to talk about National Birth Defects Prevention Month and planned activities. 

Genetic Services held a training May 21-23, 2019 for MSDH Newborn Screening follow-up staff (regional nurses and social workers) to increase their knowledge and understanding related to the genetic conditions screened for in the state of Mississippi. With many changes and additions to the Mississippi Newborn Screening Panel and staff turnover; the program addressed the need to provide this training in partnership with our tertiary hospital medical providers and Genetic Counselors.

The overall objective of the training was to provide nurses and social workers with additional skills and resources for ongoing improvement of newborn screening short-term follow-up, birth defects, and long-term follow-up for Children and Youth with Special Health Care Needs (CYSHCN).

• There were 70 Newborn Screening follow-up staff representing the northern, central and southern regions of the state in attendance.

 

• Presentations by UMMC Pediatric Geneticist, Endocrinologist, Pulmonologist, Allergist/Immunologist, Hematologist, Neurologist, Genetic Counselors, Metabolic Nurse Practitioner, Metabolic Dietician, Pediatric Consultant, MSDH Newborn Screening Program Genetic Nurses, EI/EHDI and CYSHCN Directors were provided. 

 

•  Great feedback and suggestions to make this an annual training were provided.

The program continues to monitor hospital performance and timeliness related to newborn screen specimen collection and reporting.  As a result of last year’s training for hospital staff (April 17-19, 2018), the program has noticed improvement in hospital’s collection performance.

Another strategy the program is looking to implement is a formal assessment of family knowledge and awareness about Newborn Screening.   What we’ve noticed is that parents aren’t aware of Newborn screening until a positive diagnosis is made or the need of a repeat screen. Additionally, the program is looking to enhance its collaboration with our UMMC partners on developing strategies for family education, resources, support training. 

ZIKA

The program finalized its report of efforts related to Zika surveillance, intervention and referral to service activities from August 2016 – November 2018. The report is currently being routed and will be available on the agency’s website once approved. 

Report Highlights:

• A total of three medical record abstraction trainings were held to enhance capacity for public health nurses and social workers from across the state who conducted case findings. These trainings enhanced competency in rapid identification of cases, referral of services, follow-up, monitoring and evaluation.
• A total of 342 referrals were made to interagency programs (PHRM/ISS, Early Intervention, and CYSHCN programs for long term follow-up, connection to resources, and support) for babies that meet case inclusion criteria.
• 61,000 educational materials related to Zika prevention and awareness were handed out to residents of the state. A total of 23 educational materials were developed to be culturally and linguistically appropriate for the intended audience. 
• Data was collected from 151 Mississippi residents during community outreach events.  Analysis of data using the Qualtrics software system, revealed significant improvements in three knowledge categories. This included contraction of Zika, mode of transmission, and best products to use when traveling to a location where the Zika virus has been located. These findings suggested an increased awareness related to Zika prevention.
• Overall evaluation findings related to program success since awareness of Zika virus and prevention has been improved throughout the state. In addition, identification of cases and data reporting procedures have become more efficient for healthcare providers. This also lends to success of the program and supports sustainability for the future.

Child Health/Annual Summary (Lead Poisoning Prevention/Healthy Homes)

The narrative below describes the rationale for why Mississippi selected certain measures and provides detailed narrative to link the selected NPM’s, SPM’s with Mississippi’s identified state priorities.

Priority Area: 

Increase access to comprehensive health care.

Currently the Lead Poisoning Prevention/Healthy Homes program does not have an associated NPM or SPM. We feel its valuable to show the work of the program.

Program summary and Purpose:

The Mississippi State Department of Health Lead Poisoning Prevention and Healthy Homes Program (MSLPPHHP) was established as a result of the federal law (42 U.S.C. at 1936a) requiring states to screen children enrolled in Medicaid for elevated blood lead levels (EBLLs) as a part of prevention services provided through the Early and Periodic Screening, Diagnosis and Treatment Program (ESPDT). The program provides practical prevention measures through care coordination, education, and risk reduction activities for children and their families. Families of children with a confirmed venous blood lead level (BLL) greater than or equal to 5 micrograms per deciliter (µg/dL) receive care coordination services (i.e., home visit; environmental assessments, lead poisoning, healthy homes and Sudden Infant Death Syndrome education; nutritional counseling and referrals) which are designed to identify lead and other environmental home health hazards, and provide recommendations for decreasing hazards.

 

Lead poisoning is the nation’s number one preventable environmental health problem facing children today and exposure in children can cause permanent neurologic damage and behavioral disorders. The goal of the Lead Poisoning Prevention and Healthy Homes Program (LPPHHP) is to reduce the number of children exposed to lead and environmental hazards through strategies focused on increasing public awareness of risk of lead poisoning and organizations to facilitate community awareness and prevention activities.

While the number of children with elevated blood lead levels (EBLLs) has decreased over the years, the LPPHHP continues to identify cases annually. Sources of lead exposure can be: deteriorated lead-based paint, lead dust, vinyl-plastic mini-blinds, job and work related, home remedies, keys, and Mari Gras beads. The Centers for Disease Control and Prevention (CDC) has concluded that even low blood levels can cause lifelong health effects. CDC uses a reference level of 5g/dL to identify children who have been exposed to lead and who require care coordination.

According to the Mississippi State Department of Health’s (MSDH) List of Reportable Diseases and Conditions, blood lead poisoning is a Class 2 and Class 3 Reportable Disease; therefore labs, clinics, and hospitals in Mississippi (MS) are required to report all blood lead levels for children less than 6 years of age to the LPPHHP.

 

The Blood Lead Level testing is targeted, rather than universal, and should be done at the following age intervals:

• Routinely, at age 12 and 24 months if Medicaid-eligible
• At any time between ages 6-72 months if risk assessment indicates possible exposure
• Annually (ages 6-72 months) with risk factors
• Anytime when medically indicated in work-up of some unexplained illnesses

Any child identified with a confirmed EBLL above the CDC’s reference value of 5g/dL should be monitored and retested according to follow-up guidelines.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Child Health Annual Report (Lead Poisoning Prevention/Healthy Homes)

Objective: By September 30, 2019, increase by 15% the number of children less than 6 years of age tested for blood lead.

Strategy 1: Improve data usage that leads to a greater identification of geographic areas and populations at high-risk for lead exposure.

Rational Strategy 1:  While the number of children with elevated blood lead levels (EBLLs) has decreased over the years, the LPPHHP continues to identify cases annually. Sources of lead exposure can be deteriorated lead-based paint, lead dust, vinyl-plastic mini-blinds, job and work related, home remedies, keys, and Mardi Gras beads. These are a few reasons why it is important to have accurate data related to lead in homes.

Activity 1a:  Implement a surveillance reporting system that will collect, compile, and track blood lead data and lead hazards.                                         

Report Activity 1a:

The program implemented the Centers for Disease Control and Prevention’s Healthy Housing Lead Poisoning Surveillance System. This system is utilized to store all blood lead data reports, and to record the results of all risk assessments, inspections, care coordination services, referrals and lead and healthy homes activities that are performed throughout the state.   

 

Activity 1b:  Develop and implement blood lead data collection, data quality and dissemination plan.

Report Activity 1b:

Program staff developed and implemented a Data Quality Assurance Protocol that details how the blood lead data will be collected, analysed and disseminated to partners.

Strategy 2: Increased identification of children exposed to lead and linkage to recommended services.

Rational Strategy 2: Exposure to lead in children can lead to development delays, learning problems, hearing problems and speech problems. These are reasons why it is important for the LPPHHP to provided referrals to other health services programs.

Activity 2a:  Collaborate with partners, stakeholders and community resources that can provide services to mitigate the effects of high blood lead levels (e.g. Early Intervention, MS Department of Environmental Quality etc.)                                         

Report Activity 2a:

The program has strengthened collaborations with the Mississippi State Department of Health’s First Steps Early Intervention Program, which provides services to children less than three years of age. The First Steps program currently has automatic eligibility for children identified with blood lead levels of ≥10µg/dL.    

Activity 2b:  Connect children with elevated blood lead levels to community services (e.g. Safe Housing Program, Healthy Start Program, etc.)

Report Activity 2b:

The program collaborates with the City of Jackson’s Safe Housing Program to make referrals for families of children with elevated blood lead levels who live within the Jackson city limits. Through this program, families may qualify for lead risk assessments, lead-based paint hazard control, window replacement, and healthy homes repairs if certain eligibility requirements are met.

Strategy 3: Increased knowledge and awareness among the lay public, public health professionals, childhood lead prevention workforce members, and other partners and stakeholders about childhood lead poisoning and prevention interventions through tailored education and outreach. 

Rational Strategy 3: While it is a requirement of Medicaid that children be tested for lead poisoning at 12 and 24 months of age, data shows that only a small percentage of children are being tested as required. Providers across the state do not see lead poisoning as a significant issue and therefore aren’t testing children as required. These are reasons why it is important to provide education and trainings for providers and other public health professionals across the state.

Activity 3a:  Develop and conduct train-the-trainer sessions for hospital staff, city officials, and rental property owners.                                         

Report Activity 3a:

Lead poisoning train-the-trainer sessions for hospitals staff has been held in 6 of the 23 high-risk counties for lead poisoning. These trainings include a 45-minute presentation that will cover topics such as local burden/prevalence of lead poisoning, risk factors, prevention strategies and educational resources.  In these same six counties, healthy home community forums are being provided to local government, housing authorities, housing counselling agencies and persons working in community development to build local capacity to reduce lead poisoning and increase access to resources that improve housing quality, health and affordability. In addition, educational trainings are also being provided to community organizations, landlords, tenants and potential renters regarding tenant rights, fair housing, lead laws and the Lead Disclosure Rule.    

Strategy 4: Increased knowledge and awareness among families of children less than six years of age about childhood lead poisoning and prevention interventions through tailored education and outreach.

Rational Strategy 4: Lead poisoning is the nation’s number one preventable environmental health problem facing children today. However, the LPPHHP has found that families in the state are not as knowledgeable about lead hazards, the effects lead can have on small children,  and what can be done to reduce a child’s exposure. That is why the LPPHHP is working to raise awareness about lead poisoning, 

Activity 4a:  Provide door-to-door assessments and counseling in the targeted zip codes about the importance of lead testing for children less than 6 years of age.                                         

Report Activity 4a:

The program has developed a Verbal Risk Assessment Questionnaire along with an informed consent form to be used during the door-to-door assessments.     

Activity 4b:  Provide community outreach to Head Start centers and child care facilities in the targeted zip codes to raise awareness about the importance of blood lead testing of children less than 6 years of age.                                         

Report Activity 4b:

Community Health Workers are providing community outreach to head start centers, child care facilities, schools and neighbourhood associations regarding project goals, project benefits and outcomes. A second presentation is being provided that provides general information about lead poisoning and healthy homes to include: what is lead, sources of lead, signs and symptoms of lead exposure, risk reduction strategies, a healthy home environment and the ABC’s of safe sleep.      

Evidenced Based Measure Reporting (Lead Poisoning Prevention/Healthy Homes)

ESM 1: Number of referrals made to outside organizations for services.

ESM 1 Report: 

40

ESM 2: Number of outreach events/trainings conducted.  Number of individuals educated.

ESM 2 Report: 

45 events conducted with over 1,000 participants educated.

ESM 3: Number of materials distributed.

ESM 3 Report: 

Over 2,000 pieces of educational materials.

Emerging Issues(Lead Poisoning Prevention and Healthy Homes)

The LPPHHP could face funding cuts, in the future, as federal funding for lead poisoning prevention from the Centers for Disease Control and Prevention are cut. With the cuts in federal funding, the program will not be able to sustain all activities and projects at the same level as it currently does.

 

Other Programmatic Activity/Child Health (Lead Poisoning Prevention and Healthy Homes)

The Mississippi State Department of Health is participating in the Maternal and Child Environmental Health CoIIN with 9 other states. This initiative aims to build state capacity to increase the number of infants and children who have access to a system of coordinated care to address their needs as a results of exposures to lead and decrease maternal and child morbidity and mortality associated with exposure to lead. We have selected three Aims for the state which include: increase by 5% the number of children tested for lead poisoning at one and two years of age; increase by 20% the number of children tested with elevated blood lead levels confirmed with a venous within 12 weeks per the Centers for Disease Control and Prevention guidelines and decrease by 15% the number of three year old who are identified on first test with a blood lead level of 5 or higher.

 

Success Story/Child Health (Lead Poisoning Prevention and Healthy Homes)

According to the Centers for Disease Control and Prevention, approximately 4 million households have children exposed to high levels of lead. For many years, the Mississippi Lead Poisoning Prevention and Healthy Homes Program has referred children with elevated blood lead levels ≥ 15 µg/dL to the Early Intervention Program.  With the minimum venous blood lead level for Early Intervention Program referral at 15µg/dL, numerous children with blood lead levels less than 15µg/dL did not qualify. 

At the January 2019 State Interagency Coordinating Council meeting, the Mississippi State Department of Health’s Pediatric Clinician discussed the importance of lowering the blood lead level threshold for the Early Intervention Program referral for children with an elevated blood lead level.  As a result, the State Interagency Coordinating Council agreed to lower the threshold for automatic Early Intervention Program referrals to 10µg/dL. Since lowering of the threshold for automatic Early Intervention Program eligibility, the Mississippi Lead Poisoning Prevention and Healthy Homes Program has made several referrals to the Early Intervention Program. The Early Intervention Program is a voluntary program. Parents can decline the services, however, the majority of parents will not refuse Early Intervention services.

The referral process for children with elevated blood lead levels of ≥10µg/dL to receive services in the Early Intervention Program is to submit a Referral Form. After the referral is submitted, the program does the following:

• Mail a notice of referral letter within two days.
• Within five days, a service coordinator is assigned and makes contact with the family. 
• The service coordinator has forty-five days to determine eligibility, by conducting a comprehensive and multidisciplinary evaluation, and to conduct an assessment of the child and family.
• An Individualized Family Service Plan is developed, which includes educational, medical, and developmental services needed to support the child and family. The family will be linked to support and services, ensuring the provision of family-focused, evidence-based early intervention practices within thirty days of the services being put in place.

Since lead exposure can cause many problems for children, decreasing the blood lead level threshold for the Early Intervention Program will allow more children to be provided with the needed services to improve their quality of life.