Child Health Domain - Annual Report

Illinois’ priority for the Child Health Domain is:

• Strengthen families and communities to assure safe and healthy environments for children of all ages and to enhance their abilities to live, to play, to learn, and to grow. (Priority #4).

Equitable access to healthcare remains a top priority for assuring the health and wellbeing of Illinois children. In 2019, 4% of children in Illinois were uninsured (NOM #21). This rate has increased slightly in recent years but remains relatively low compared to other states. Access to care varies based on race/ethnicity and socioeconomic status.

Child mortality (NOM #15) in Illinois has remained steady over the last 8 years. However, there are inequitable rates of child mortality for non-Hispanic Black children and children residing in rural areas. The leading cause of mortality for children ages 1-14 was unintentional injuries. For children ages 10-14, suicide and homicide were the next two leading causes of death.

Early childhood is a place to focus on cross-disciplinary collaborations to improve child health trajectories and school readiness. In 2019-2020, approximately half of Illinois’ young children received a parent-completed developmental screening (NPM #6). This rate is lower, only 41%, for children of parents born outside the United States.

Title V utilized the following strategies to address the Child Health Domain priority:

4-A.  Participate on the Illinois Early Learning Council to facilitate coordination between early childhood systems to assure that health is recognized as an integral component of improving children’s educational outcomes as well as overall health and well-being.

The Title V director services as an appointed member on the Illinois Early Learning Council (ELC), which was established by Public Act 93-380. It was created to strengthen, to coordinate and to expand programs and services for children, birth to 5 years of age, throughout Illinois. The council seeks to achieve its purpose by building on current programs and infrastructure to ensure a comprehensive, statewide early learning system that provides greater access to high quality early learning programs, assessments, and supportive interventions so children, including those with special needs, are kindergarten ready. Membership is appointed by the governor and includes senior state officials and non-government early child development stakeholders. The ELC has an executive committee and five other committees that focus on various aspects of early learning.

• Community Equity and Access Committee works to support and to increase access to high-quality early learning programs for populations with the greatest need.
• Family Advisory Committee consists of a group of diverse parents from across the state who will provide insight and perspective of the early childhood system and policy landscape.
• Health and Home Visiting Committee ​​seeks to improve the quality of and access to evidence-based home visiting programs for all at-risk families, to increase coordination between home visiting programs at multiple levels, and to identify opportunities to connect home visiting with other systems.
• Integration and Alignment Committee uses a racial equity lens to make recommendations to change early childhood systems and improve coordination integration.
• Quality and Workforce Committee seeks to ensure a coordinated early childhood system of aligned standards, professional development, monitoring, and support; and ensure educators receive the proper knowledge, skills, and compensation to support the development and learning of all young children in Illinois.

4-B. Collaborate with home visiting programs, including the MIECHV program and early childhood providers, to support the alignment of activities.

Title V collaborates with various early childhood systems and programs in a variety of ways. During FY21, the Title V director participated routinely in statewide committees, such as the Early Learning Council and the Home Visiting Task Force. Title V also continues to connect MIECHV to other partners for collaboration and support (e.g., Task Force on Infant and Maternal Mortality Among African Americans).

4-C.  Convene partners to develop administrative rules and to coordinate implementation of a new state law requiring social/emotional screening during school physicals.

During FY18, OWFHS leadership, the Title V director, and the School Health Program led an ad hoc workgroup to develop a draft rule and solicit feedback from other offices within IDPH and outside partners. In FY19, the rule language was submitted through the formal processes and, as of FY21, was still in review.

4-D. Identify gaps in mental health programs and resources for Illinois children, develop partnerships with and within organizations focused on improving mental health among children and adolescents, and support the implementation of mental wellness programs that facilitate system level improvements as well as address social determinants of health.

ICMHP has continuously expressed that Illinois’s children and families face a mental health crisis, and the COVID-19 pandemic only exacerbated the crisis. In FY21, ICMHP embarked on a systematic, comprehensive, interdisciplinary process to create new recommendations, goals, and strategies to ensure that Illinois continued to prioritize the mental health and wellness of children and families across the state. It is anticipated the Illinois Children’s Mental Health Plan will be completed and ready for distribution in FY22.

Title V program is participating in the Illinois Children’s Mental Health Partnership (ICMHP) and exploring opportunities to leverage or develop new initiatives that address child and adolescent mental health.

4-E. Certify and support school-based and school-linked health centers to expand access to primary health care, mental health, and oral health services for Illinois children and adolescents.

IDPH School Health Program certifies and monitors 63 school-based health centers (SBHCs) across Illinois. SBHCs focus on improving the overall physical and emotional health of school-aged youth by promoting healthy lifestyles and providing accessible preventive health care. These centers are essential resources for their respective communities and to Illinois as a whole because they ensure that students are healthy and ready to learn through services that focus on prevention, early detection and treatment of chronic and acute health problems; assist in the identification of risk‐taking behaviors; and promote appropriate anticipatory guidance, treatment, and referrals. Some school health centers not only provide services to students in the schools but also opt to provide services to community members. Title V provides direct funds for almost 60% of the centers through its longstanding School-Based Health Center grant program.

In FY21, approximately 82,600 individuals sought care from the SBHC for an estimated total of 145,000 visits for medical, mental health, and dental services. Medical services provided during these visits included nutritional counseling, vision screenings, hearing screenings, STI testing and treatment, contraception, and general well visit care. As for mental health services, SBHCs must provide care or a referral for care to all patients seeking mental health services to meet certification requirements. The centers offer an array of services tailored to the needs of their respective communities. Evidence of the importance of these services to youth is reflected in the following testimonies provided by mental health professionals working within the SBHCs: 

Testimony #1: I ran a middle school art therapy group after school that really gave some students a space to connect with peers, vent about remote learning/pandemic emotions, and express themselves through various therapeutic art projects. We were able to get art supplies donated for each group member to pick up from the school to use for groups. I still have kids now saying they enjoyed and miss the group.

Testimony #2: Another student began meeting with me virtually after his aunt passed from COVID – we were able to meet weekly to provide emotional support and process his grief. We continued to meet even into this year to work on developing emotional regulation skills and self-esteem. This student has begun to show improved regulation, increased positive peer interactions, and has participated well in the school soccer team.

Testimony #3: [Patient received] behavioral health services due to depressed mood and family conflict. At the start of services [Patient] reported experiencing difficulties concentrating, low motivation, difficulties sleeping, feelings of loneliness, thoughts of self as a failure, and irritability. Through talk therapy and expressive art activities [Patient] became more attuned with emotions. [Patient] identified a pattern of avoiding emotions resulting in dysregulation and irritability. Psychoeducation was used to help [Patient] learn to use more effective communication with [the patient’s] family and friends by practicing assertive communication techniques. [Patient] also identified and implemented healthy coping strategies to help manage stressors and has shared [the patient] now feels more hopeful and optimistic. [Patient] is preparing to graduate and is looking forward to attending a four-year university.

On site dental services are not a requirement for certification, but many SBHCs offer these services as access to oral health has been reported by families as a barrier to care. In FY21, there were an estimated 25,900 dental visits with 14,100 unique clients.  

Certification of SBHCs

In FY21, IDPH nurse consultants conducted site visits to determine if SBHCs were following Illinois’ statutory and medical practice standards. Due to the COVID-19 pandemic, the site visits were virtual to ensure the safety of the nurse consultants and the SBHC staff. Based on the site visits and supplemental information, the nurse consultants either certified the center or issued a corrective action letter.

New SBHC Grant to Address the COVID-19 Pandemic

In FY21, Title V created the Emergency Response Supplemental Grant for School Health Centers (ERSHC) to support school health centers during the COVID-19 pandemic and address any hardships they experienced. It provides additional assistance to SBHCs to ensure their sustainability and positive contributions to the overall health of their surrounding communities. Title V supported SBHCs as they

sought to improve staff and community readiness for COVID-19 and other infectious diseases through educational programs; developed and distributed COVID-19 materials to the community, especially specific populations of the community that were disproportionately affected by COVID-19; purchased equipment (including PPE and other supplies) to promote health and safety of the staff and patients; and secured technology that facilitated e-learning, helped deliver personal services, and facilitated social distancing. Title V awarded 42 grants totaling $3 million.

Statewide School Nurse Training

During FY21, the School Health Program offered its annual School Health Days. The conferences were held in November 2020 and again in December 2020. Nearly 940 school nurses from across the state attended the trainings. Conference topics included mental health for children and adolescents with an emphasis on suicide, depression, and anxiety; sexual harassment; immunizations; and COVID-19 updates.

CDPH Specific Activities

CDPH implemented a seamless experience for participants using follow-up services, consulted with the Chicago Public Schools (CPS) Office of Student Health and Wellness to continuously improve the Student Health Forms booklet for school year 2021-2022 (released in May of each year) that parents/guardians complete. These forms allow students to receive services under the school-based dental and vision programs, and the booklet is a unique opportunity for health messaging for parents/guardians that is co-branded from both CPS and CDPH.

4-F. Collaborate with organizations and programs to address the impact of adverse childhood experiences (ACE) and toxic stress on mental and physical health in children and adolescents.

In FY21, Title V began developing a new grant program entitled the Maternal Child Health (MCH) Adverse Childhood Experiences (ACEs) Grant Program. This program is expected to strengthen families and communities by ensuring safe and healthy environments for children to learn and grow and to assure access to systems of care that are youth friendly and youth responsive. More specifically, the program will advance efforts to prevent, mitigate, and treat childhood adversity and trauma in Illinois through an equity lens.

Illinois Title V has identified two key partners currently emersed in ACEs that will complement each other’s work by engaging different segments of the population. Prevent Child Abuse Illinois (PCA-IL) will focus on activities targeting the general public and community-based organizations, and Health & Medicine Policy Research Group (HMPRG) will focus on activities targeting health professionals/ providers. The two organizations are expected to collaborate with each other to leverage activities across Illinois. In addition, the program will include a learning collaboration approach that allows MCH and ACEs experts to convene and share insight on their work and identify opportunities for additional Title V work.