Priority: Increase the number of infants and children receiving a developmental screen.
Interpretation of Performance Data on NOMs, NPMs, SPM and ESMs:
NPM 6: For years 2017 and 2018, the National Survey of Children’s Health (NSCH) reported that the percentage of Tennessee children who received a parent completed developmental screening improved to 42.4%, which surpassed the stated objective for Year 4.
ESM 6.1: An additional 51 Tennessee Department of Health nursing staff were trained in modules that assist in screening for Autism and Autism-Spectrum disorders.
ESM 6.2: The exposure of developmental information on web-based platform KidCentralTN saw a decline in Year 4, with 510 unique page views, 424 visits, and 401 unique visitors to developmental milestone and developmental screening web pages. The administration of KidCentraltn transitioned to Tennessee Commission on Children and Youth (TCCY) at end of FY18 and some web addresses for site material were affected, which invariably impacted accessibility of information.
ESM 6.3: The percentage of families enrolled in evidence-based home visiting in Tennessee did see a decrease to 71% in Year 4. While this number did not meet the goal of 91%, this number is only representative of families from a single funding stream, rather than all home-visiting programs that are supported by the Department of Health.
Accomplishments and Challenges (based on FY2019 Action Plan)
Strategy 1: Increase general awareness among parents and caregivers of the need for developmental screening.
Activity 1a: Develop information and tools to assist caregivers to understand the importance of screening and early intervention which will increase demand for use of screening and assessment tools in early childhood settings.
Report 1a: TNAAP has prepared several resources and tools for distribution. They can be found here https://brightfutures.aap.org/materials-and-tools/Pages/default.aspx
Activity 1b: Revise and renew contract with the Department of Human Services to promote trainings in child development and developmental screenings through the Child Care Resource and Referral (CCR&R) Network.
Report 1b: A new contract with CCRR was completed in July 2019 for them to provide training on ASQ’s. They are working on a training video to be distributed to EBHV and CHANT staff.
Activity 1c: Incorporate developmental screening pathways into the enhanced model of care coordination in the Community Health Access and Navigation in Tennessee (CHANT) integrated model of services.
Report 1c: CHANT conducts ASQ’s for all children ages 0-5 on a developmental pathway since roll out across the state in July 2019. So far, there have been 588 ASQ’s completed. Most children have received at least 2 screenings based on the timeframe for when screenings should be completed.
Activity 1d: Implement the Talk with Me Baby initiative in WIC clinics across the state to promote language nutrition and awareness of infant development.
Report 1d: There have been over 650 WIC clinic staff trained across the state. A training video was developed for all county offices to use during staff trainings. There have been 60,000 Talk with Me Baby books sent out to the counties and EBHV programs for distribution to families.
Strategy 2: Encourage and support providers to integrate developmental screening as a part of routine care.
Activity 2a: Promote the Medical Home model with an emphasis on incorporating developmental and behavioral screening, reimbursement methods, and referral pathways.
Report 2a: The medical home website was developed by TNAAP and running as of September 2019.
Activity 2b: Gather information on interagency processes between care coordination and evidence-based home visiting agencies and local primary care physicians to understand the referral process landscape across the state.
Report 2b: The call center has developed an internal referral process between welcome baby list referrals and prequalification criteria for CHANT (medium risk and EBHV high risk) External processes are handled at the local level within each county or regional health department with coordinating community stakeholders.
Activity 2c: Identify available technology tools that can help child-serving entities efficiently use and share screening data, while respecting the legal privacy rights of families.
Report 2c: There are ASQ’s online that parents can perform and share information with their providers; thereby empowering parents and resolving the confidentiality issues. This needs to be promoted within the medical and home visiting community in order to be an effective method.
Activity 2d: Continue to partner with Tennessee Early Intervention System and the Tennessee Chapter of the American Academy of Pediatrics to provide training on the Modified-Checklist for Autism in Toddlers, Revised (M-CHAT R) and ASQ-3 screening tools to all local health department regions.
Report 2d: The CNE has expired for the online modules. It expired in July 2019 . The total trained in person and online is 582. They do however continue to use the online links to CEUS for all new hires . CEUS have not expired. Their numbers are included in the 582. TNAAP in partnership with Vanderbilt and the START program have provided continuing education https://vimeo.com/228976910 and resources here https://brightfutures.aap.org/materials-and-tools/Pages/default.aspx
Activity 2e: Continue working with the Tennessee Chapter of the American Academy of Pediatrics and staff from Tennessee Early Intervention Services to discuss collaboration on training for pediatricians regarding developmental screenings and referrals for services.
Report 2e: TNAAP continues to provide 26 or more Screening Tools and Referral Training programs across the state each year to Pediatricians and Family physicians.
Activity 2f: Collaborate with TennCare/MCOs to incorporate a Primary Care Medical Home (PCMH) pathways into the enhanced model of care coordination in the Community Health Access and Navigation in Tennessee (CHANT) integrated model of services.
Report 2f: CHANT began reporting in July 2019 the number of children with TNCARE who need to be referred due to no medical home or well child visit. Also, referrals are made for those who have no insurance. For the fourth quarter, there were 18 referrals made due to no medical home or well child visit. There were 151 referrals made due to no insurance.
Strategy 3: Explore opportunities for incorporating developmental screening into settings outside of primary care.
Activity 3a: Continue to partner with state and federally funded evidence-based home visiting programs to promote administration of developmental screening.
Report 3a: EBHV programs which consist of 11 agencies across the state are completing developmental screenings on all eligible children according to the administration guidelines.
Activity 3b: Partner with the Tennessee Chapter of the American Academy of Pediatrics (TNAPP) to provide ASQ-3 and ASQ:SE-2 training to care coordination and evidence-based home visiting staff across the state.
Report 3b: Train the trainer modules are being developed by TNAAP for use within Community Health Access and Navigation in Tennessee and Evidence-Based Home Visiting programs.
Activity 3c: Increase coordination and collaboration between child’s medical home and child serving agencies.
Report 3c: START program is working on this as well as our evidenced based home visiting programs (EBHV) and CHANT programs.
Activity 3d: Explore inclusion of developmental screening administration and language nutrition/Talk with Me Baby into the Gold Sneaker Initiative and designation standards at Department of Health.
Report 3d: Golden Sneaker program targets physical activity, tobacco, nutrition and may not be a good fit for the developmental screening content. Childcare resource and referral network trains on ASQ’s and talk with me baby video is available to the Child Care Resource and Referral network.
Priority: Reduce the burden of injuries among children.
Interpretation of Performance Data on NOMs, NPMs, SPM and ESMs:
NPM 7.1: The rate of hospitalizations for non-fatal injury per 100,000 children aged 0 to 9 in 2019 (119.1) remained similar to 2018’s rate (119.4).
ESM 7.1.1: In FY 2019, 2,525 parents and caregivers received education on car seats. 389 more parents were educated than in 2018. Nonetheless, the actual performance for 2019 fell short of the year’s objective of providing education on car seats to 2875 parents and caregivers.
ESM 7.1.2: The “Count it! Drop it! Lock it!” educational program expanded to all Tennessee counties (n=95). This presence of “Count it! Drop it! Lock it!” across Tennessee resulted in the state surpassing its 2019 objective of reaching 93 counties.
ESM 7.1.3: 54% of families participating in Evidence-Based Home Visiting programs received education on injury prevention. This proportion represents an 8% increase in the reported proportion for 2018. At 54%, the 2019 target of reaching 89% of families was not met.
Accomplishments and Challenges (based on FY2019 Action Plan)
Strategy 1: Promote the use of child safety seats.
Activity 1a: Provide funding and technical assistance to community agencies to purchase and distribute car seats. Agencies will ensure seats are installed correctly when distributing them to caregivers.
Report 1a: From October 1, 2018 to September 30, 2018, TDH provided $153,533 to 23 agencies that purchased 2,525 child safety seats, infant-only seats, and booster seats for distribution. Agencies conduct education while ensuring that seats are properly installed. Each agency is required to have a certified child safety seat technician on staff.
Activity 1b: Disseminate a child safety seat infographic to promote the correct use of car seats to parents and caregivers.
Report 1b: An infographic titled “The Road to Crash Prevention”—which contained general safe driving information along with child safety seat education—was disseminated. Over 1,000 infographics were sent to 23 child safety seat funded recipients for use in educational programs.
Activity 1c: Assess community agencies who distribute car seats to document how need is determined and how car seat availability is communicated to communities they serve.
Report 1c: An assessment was conducted among 20 funded agencies to ensure that recipients understood the scope and regulations of the program and to gather recommendations to improve the program. Fifteen agencies were contacted by phone and five were interviewed in person. The criteria to receive funding, reporting guidelines, and service recipients were also discussed with participants. Findings suggested that: i) currently funded agencies varied in their measurement of car seat safety; ii) agencies differed on the methods of distributing car seats; and iii) hospitals had a greater capacity to serve non-English speaking families. Also, very few entities reported that they had additional funding to purchase car seats. As a result of the assessment, changes were made to the application process to clearly identify private non profit agency status.
Strategy 2: Promote safe storage of medications.
Activity 2a: Promote safe storage and disposal of medications through the Count it, Lock it™, Drop it initiative. The goal of Count It, Lock It, Drop It™ is to increase the number of individuals tracking medication, securing medication in a locked medicine box, and utilizing medicine drop boxes. Staff will collaborate with partners to conduct four presentations to promote Count It, Lock It, Drop It™ to increase safe storage and disposal of medication.
Report 2a: As of September 30th, 2019 all 95 counties had implemented the Count It! Lock It! Drop It!™ program that includes education and securing medication in locked medicine boxes. In fact, a total of 106 (one hundred and six) groups in Tennessee are conducting the program with some multiple programs in some counties. This sustainability and increase in this program has been a success story for our local partners. This year, we ranked groups on their “level of effort” defined by criteria designed to measure the community engagement of the program from 0 (just starting) to 3 (full implementation with multiple community entities). Six counties were successful in increasing the level of activity including: Bedford County (02): Cannon County (02): Lake County (12): Loudon County (12): Monroe County (03) Wilson County (02). Next year, we plan to continue to encourage existing groups to increase levels of community engagement.
Activity 2b: Partner with a minimum of 25 hospitals by September 30, 2019 to promote safe storage of medications to patients.
Report 2b: TDH partnered with Count It! Lock It! Drop It! (CLD) staff to encourage hospitals and medical providers to provide information to patients to monitor, secure, and dispose of medication at twenty-five (25) medical facilities. Programs included: patient information efforts, prescription safety training, drug take back events, medical forum on safe prescribing, and coalition training regarding drug take back events.
Activity 2c: Continue to utilize Title V funding to support (in part) the operation of the Tennessee Poison Center.
Report 2c: TDH provided $279,532 in Title V funding to support a portion of the operation of the Tennessee Poison Center (TPC). TDH meets regularly with TPC to align priorities and address emerging issues such as unintentional pediatric opioid ingestions.
Strategy 3: Provide injury prevention education to parents and caregivers.
Activity 3a: Discuss injury prevention topics with a minimum of 83% of eligible families served through TDH evidence-based home visiting programs. Topics to be discussed include: use of car seats, safe sleep, drowning, smoke detector use and gun storage.
Report 3a: Fifty-four percent of parents enrolled in evidence-based home visiting (EVHB) programs received education/counseling on the AAP Checklist. During FY19, the IVP manager presented to home visitors at the Tennessee Home Visiting Summit in Chattanooga. He shared state injury data relevant to the APP Safety Checklist and encouraged home visitors to utilize the AAP Safety Checklist to educate parents and caregivers to decrease injury risk in the home.
Activity 3b: Complete a child injury data report and distribute to home visiting staff and partners.
Report 3b: EVHB grantees received the annual agency specific Performance Measurement Report which includes data on: 1) the percentage enrolled in TDH funded home visiting that had a DCS investigation; 2) rate of injury-related emergency department visits; and 3) percent of infants whose parents use safe sleep practices. This is important both to inform grantees and partners and to legislators and other stakeholders interested in assessing the impact of home visiting on safe sleep practices.
Activity 3c: Develop and distribute infographics on a minimum of 3 child injury topics.
Report 3c: Three thousand infographics on suicide, safe sleep and motor vehicle crashes were updated with 2017 child fatality data and distributed to childcare providers who serve families with at-risk children.
Priority: Reduce the number of children who are overweight/obese.
Interpretation of Performance Data on NOMs, NPMs, SPM and ESMs:
Overall, Tennessee (TN) continues to see modest improvements in child health and primary prevention indicators that promote healthy weight among children as follows:
NPM 8.1: Combined 2017-2018 data from the National Survey of Children’s Health show that nearly one-third of children ages 6-11 meet physical activity guidelines. This rate is in line with the Year 4 target objective and represents an increase over Years 2 and 3. The increase is likely due to more statewide programming leading to enhanced opportunities for physical activity.
SPM 2: Breastfeeding initiation among newborns remained relatively steady at 80.8% in 2018 compared to 2017. This rate was somewhat below expectations, although the rate has increased from 78.3% in 2016. Tennessee continues to engage with community-based partners, health care providers, and lactation care providers in WIC to promote breastfeeding efforts.
ESM 8.1.1: The number of Gold Sneaker-recognized childcare facilities decreased substantially from 501 in 2018 to 306 in 2019. However, the decline followed the redesign of the initiative’s policies and certification process in partnership with the Tennessee Department of Human Services. This redesign resulted in all facilities having to reapply for certification. Since November 2018, certifications have increased at the fastest rate ever due to Gold sneaker being included as a requirement in DHS’s coveted 3-star rating for child care centers.
ESM 8.1.2: The average number of monthly calls to the TN Breastfeeding Hotline declined moderately from 519 in 2018 to 475 in 2019. This decline is most likely due to an increased availability of other support (e.g., Designated Breastfeeding Experts in every local health department) for breastfeeding families. Also, TBH’s call volume might have been impacted by Tennessee’s transition to an out-of-state vendor and decreased promotion of the available service.
ESM 8.1.3: The number of TN Baby Friendly-designated birthing hospitals held steady at six in 2019. Though TN has remained stagnant in the number of Baby Friendly-designated hospitals (likely due to the rigor and extensive cost of attaining and maintaining the designation), TDH created BEST (Breastfeeding, Early Elective Delivery Reduction, and Safe Sleep for Tennessee Babies) to celebrate hospital efforts to reduce infant deaths. In addition to the six Baby-Friendly hospitals, fifteen hospitals had a breastfeeding initiation rate at or above 82.0%.
Accomplishments and Challenges (based on FY2019 Action Plan)
Strategy 1: Continue the Gold Sneaker voluntary recognition program for licensed childcare centers (recognizing that overweight/obese preschoolers are more likely to grow up to be overweight/obese children).
Activity 1a: Recruit a minimum of 50 childcare facilities statewide by educating facility directors about the benefits of Gold Sneaker certification or re-designation.
Report 1a: Local health educators across the state and central office staff continue to educate licensed child care facilities about the benefits of Gold Sneaker certification. The Gold Sneaker Director also promotes the initiative by engaging facilities directly through direct training. The Gold Sneaker web page also contains current information specific to certification training under the revised policies. As of September, 2019, 254 daycares obtained Gold Sneaker certification under the revised policies.
Activity 1b: Provide technical assistance to childcare centers to help in the development and implementation of policies related to physical activity, nutrition, and tobacco exposure.
Report 1b: Gold Sneaker policies were revised in November 2018, requiring all participating childcare facilities to complete a new certification training and application. As a result of the policy revision, technical assistance requests to childcare facilities have primarily focused on training and updates to the application requirements. Technical assistance is available upon request. Additionally, in-person educational workshops and webinar opportunities were designed to assist providers with maintaining compliance with Gold Sneaker policies.
Activity 1c: Collaborate with the Department of Human Services to implement the Gold Sneaker Three Star requirement and to continue exploring the possibility of adding Gold Sneaker requirements to childcare licensing standards.
Report 1c: TDH staff continues its collaboration with TDHS following the successful integration of GS policies with TDHS Star-Quality Rating System. Tennessee’s 2018 licensing revisions catapulted the state from 39th in the nation for strength of ECE regulations supportive of Healthy Weight Practices. TDH and TDHS staff continue to participate in quarterly partner meetings.
Activity 1d: Continue evaluation processes that support existing Gold Sneaker facilities.
Report 1d: TDH and TDHS are in discussions specific to the annual evaluation of certified Gold Sneaker facilities by TDHS evaluators. An online GS certification application was implemented during the reporting period. A brief 5-question survey was developed to gauge a user’s experience and satisfaction with the online submission of the GS certification application.
Activity 1e: Continue Gold Sneaker Advisory Group collaboration to assist in the ongoing certification and re-designation process for Gold Sneaker facilities.
Report 1e: The Gold Sneaker Advisory Group continues to meet annually to provide feedback on the certification process and annual childcare facility evaluation.
Activity 1f: Provide a minimum of 1-2 Gold Sneaker trainings for public health educators and 2-4 trainings with DHS staff statewide, as required.
Report 1f: TDH staff provided a total of 6 training webinars for partners including TDH Health Educators, TDHS Evaluators, and Tennessee Child Care Resource and Referral Network staff. Webinars were recorded and made available to partners unable to attend the live training.
Strategy 2: Increase support for breastfeeding initiation and duration (recognizing the impact of breastfeeding on long-term overweight/obesity risk for children).
Activity 2a: Promote breastfeeding among the general population through public outreach campaigns (e.g., Breastfeeding Welcomed Here outreach to employers and businesses, Tennessee Hospital Association, Tennessee Breastfeeding Coalition, and Primary Prevention Initiatives).
Report 2a: Breastfeeding has been promoted through many avenues-Head Start, local community organizations, websites like KidCentral, TN WIC Program, physician offices, local county health departments, the breastfeeding initiatives of the TN Academy of Pediatrics, and many meetings where MCH partners were in attendance.
Activity 2b: Enhance the awareness and utilization of the Breastfeeding Hotline among the general public, providers, and new families (e.g., hotline magnets and/or other promotional material in the “Welcome Baby” mailer).
Report 2b: Breastfeeding Hotline materials have been distributed as requested throughout the performance period. The Welcome Baby booklets were recently updated and the breastfeeding information was reviewed and updated.
Activity 2c: Partner with the Tennessee Hospital Association (THA) to offer 20 continuing medical education credits (CMEs) to medical providers for breastfeeding education (as funding allows).
Report 2c: The promotion of the CMEs through THA continued for all professionals who work with pregnant and breastfeeding women. Unfortunately the funding source for this project has ended; however, THA is committed to providing information about these CMEs.
Activity 2d: Collaborate with THA to provide technical assistance to birthing hospitals pursuing Baby-Friendly designation or the adoption of other hospital policies to improve breastfeeding practices (e.g. Best for Babies recognition).
Report 2d: THA is an active supporter in improving breastfeeding practices and encourages hospitals to adopt breastfeeding practices to work toward a BEST hospital. BEST = Improvement in BF initiation rates by 5% from one year to the next or have a BF initiation rate of 82% or higher; decreasing early elective deliveries (5% or less aggregate rate for prior year, submit documentation of safe sleep practices in TN.
Strategy 3: Support the Office of Coordinated School Health in school-based efforts to promote physical activity and good nutrition.
Activity 3a: Utilize Title V funding to support a State School Nurse Consultant to be housed in the Department of Education, Office of Coordinated School Health.
Report 3a: The State School Nurse Consultant is working to increase health education through school nurses regarding health and wellness, including physical activity and nutrition as it relates to establishing healthy lifestyles. The nurse consultant also provides support and guidance of health screenings as it provides additional avenues to educate students on healthy habits.
Activity 3b: Collaborate with the Office of Coordinated School Health, state, regional and local health departments that are focusing on obesity-related primary prevention to increase the number of physical activity clubs that promote lifelong physical activity.
Report 3b: During the reporting period, TDH was informed of 273 physical activity clubs. TDH and CSH partnered to conduct physical activity clubs and activities, including but not limited to: walk/run clubs, Go Girl Go, jump rope contests, Walk to School Day and dance challenges. A link to a free, downloadable run club toolkit (designed to help those interested in starting a run club) was also provided to staff interested in establishing a run club.
Activity 3c: Provide resources (toolkits) to schools planning to implement a run club, physical activity club or other CSPAP activity. Promote resources through webinars, conference calls, group trainings, and other avenues, as they arise.
Report 3c: Physical education (PE) and physical activity (PA) trainings were facilitated by the Coordinated School Health State Physical Education Coordinator. Multiple trainings were conducted for districts on topics included but not limited to: PE best practices, TN state standards, standards-based instruction, classroom physical activity, recess policy guidance and best practices, and Comprehensive School Physical Activity Programs (CSPAP). The Coordinator also facilitated three (3) grand regional PE workshops providing two free days of breakout sessions for up to 12 hours of educator professional development (only 1 day in East TN). A new workshop was also hosted, serving over 160 attendees addressing the supervision and evaluation of physical education in a four-hour TASL event. This workshop was conducted a total of six times (twice in each grand region).
Activity 3d: Continue evaluating processes that support school-based physical activity/clubs strategies.
Report 3d: A tracking document is used to determine the number of physical activity clubs. During the reporting period, TDH was informed of 273 physical activity clubs. Staff conducting the clubs revised the tool used to capture information on physical activity clubs. Information requested included: (club name, location, name of organizer, school based/community-based, and date initiated). This information is helpful in reducing the possibility of reporting duplication. Additionally, the link to a free, downloadable run club toolkit (designed to help those interested in starting a run club) was provided to staff interested in establishing a run club.
Priority: Reduce the number of children exposed to adverse childhood experiences.
Interpretation of Performance Data on NOMs, NPMs, SPM and ESMs:
SPM 1: The number of children who reported two or more adverse child experiences (ACEs) saw a slight decline to 24.1% in Year 4 reporting period. Such initiatives as Building Strong Brains are seeing and impact on the number’s continual decline since it’s initial monitoring in FY 16.
ESM for SPM 1.1: This ESM was retired in FY 16,Year 2.
ESM for SPM 1.2: There were only four ACEs presentations across the state in Year 4, which is considerably less than Year 3 (59). Data collection for this measure has declined over time as regional offices have completed training for all staff members. Considerations to expand the training to more professional groups will be needed to see improvements for this measure.
ESM for SPM 1.3: Evidence-based home visiting caregiver enrollees were only screened for ACEs 69.9 % of the time during the reporting period, which is a decline over the previous year. No trend can be established yet from the years’ data collected this far.
Accomplishments and Challenges (based on FY2019 Action Plan)
Strategy 1: Increase general awareness of adverse childhood experiences (ACEs) in the community.
Activity 1a: Under the leadership of the Title V Program staff, disseminate the Tennessee ACEs Briefs related to the “Big 4” (TDH priorities areas of obesity, physical activity, substance abuse, and tobacco use) and present information about the CDC ACEs Study to early childhood and health professionals in order to raise awareness of the implications of ACEs.
Report 1a: Tennessee’s current Strategic Priorities are now guiding the development of ACEs briefs. These briefs are in development and will focus on the current priorities of 1) supporting local leadership; 2) Youth Obesity; 3) Tobacco Use; 4) Substance Misuse; 5) prevention and mitigation of ACEs. These will be distributed to stakeholders and young child wellness partners and be posted on kid central website. We will use any CDC publications already developed that may meet these priority areas.
Activity 1b: Review and update ACEs Handout, How to Protect Your Child from Toxic Stress in the Welcome Baby packets to increase parents’ understanding of ACEs and strategies to protect their child, and promote the concept of resilience.
Report 1b: The Welcome Baby Booklet has been updated and the Booklet has been mailed to the families of 75,930 newborns between 10-1-2018 and 9-30-2019.
Activity 1c: Explore alternate ways to educate parents and other caregivers on ACEs, with a focus on non-English speakers. This will include translation of new Welcome Baby packet into Spanish
Report 1c: The Welcome Baby Book revision 3 is in the process of being finalized. This version has all the ACE edits from parent focus groups and field staff. A vendor has been located and version 3 of the Welcome Baby Book will be translated into Spanish, followed by the second most identified language, Arabic.
Activity 1d: Provide ongoing leadership to Building Strong Brains, Tennessee’s ACEs Initiative formed in 2015.
Report 1d: TDH continues to meet weekly with the Steering Committee of the Building Strong Brains Initiative. Participation also includes working on the development of a statewide strategic plan. Added to the plan developed in May of 2019 is an action to train representatives from TDOH as a Building Strong Brains Trainer of Trainers. This will allow TDH to develop the capacity to provide enough trainers across the TDH Regions to meet the volume of trainings needed to maintain the trained workforce.
Activity 1e: Provide ACEs training to the 34 Child Fatality Review teams during their annual meeting.
Report 1e: In April of 2019, ACEs training was presented as a work session at the Annual Child Fatality Review Team Meeting in Franklin, Tennessee.
Strategy 2: Collect Tennessee-specific data on ACEs and utilize that data to inform program and policy decisions.
Activity 2a: Continue to collect and disseminate Tennessee specific data such as from Evidence-Based Home Visiting Programs, and compare to state and nationally representative data sources such as BRFSS and NSCH.
Report 2a: The TDH Office of Population Health Surveillance is preparing an updated ACE handout and has provided updated information to TCCY for use in the Building Strong Brains presentation. Building Strong Brains has presented to X persons between 10/1/2018 and 9/30/2019.
Activity 2b: Collect ACEs data in underserved and at risk populations such as home visiting and compare to state and national measures. Disseminate findings to appropriate stakeholders serving these populations.
Report 2b: EBHV programs complete the ACE questionnaire with families and enter that data through the RedCap database. This data was included in the 2019 Home Visiting Legislative Report, and provided to HRSA to be used in the Home Visiting Yearbook. CHANT addresses ACES in the Child Health and Development Pathway. 2496 families screened into that Pathway; 599 families completed the Pathway and 496 families are actively working on completing the Pathway as of 09/30/2019.
Priority: Reduce exposure to tobacco among the MCH population (secondhand smoke exposure for children).
Interpretation of Performance Data on NOMs, NPMs, SPM and ESMs:
NPM 14.2: The percentage of Tennessee children who live in households where someone smokes has decreased by 12% since FY17. This is likely due to continuing social norm changes across the state as well as statewide programs providing cessation services (QuitLine & BMTF) and social support (EBHV & CHANT) to families in Tennessee.
ESM 14.2.1: The number of child care facilities that voluntarily implemented a tobacco free policy under the Gold Sneaker initiative saw a precipitous drop in FY19 following the revision of the program’s policies and designation process in partnership with the Tennessee Department of Human Services at the start of the fiscal year. However, uptake of the new policies since the revision has drastically outpaced previous years and is continued to increase due to the policy’s inclusion in DHS’s 3-star requirements for child care centers.
ESM 14.2.2: The percentage of primary caregivers enrolled in home visiting who screened positive for tobacco use and were referred to the QuitLine has remained at 100%. This is due to the continued, systematic implementation of the screening and referral process EBHV has instituted.
Accomplishments and Challenges (based on FY2019 Action Plan)
Strategy 1: Continue the Gold Sneaker voluntary recognition program for licensed childcare centers (one of the policy areas is promotion of tobacco-free child care campuses).
Activity 1a: Recruit a minimum of 50 childcare facilities statewide by educating Facility Directors about the benefits of deciding to pursue Gold Sneaker certification or re-designation.
Report 1a: As part of the Tennessee Department of Human Services’ standards for 3-star designation, the Gold Sneaker Initiative underwent changes to the application process. The new GS training was available January 2019. There are currently 432 certified Gold Sneaker facilities.
Activity 1b: Provide technical assistance to childcare centers to help in the development and implementation of policies related to tobacco exposure.
Report 1b: Health Educators and Tobacco Coordinators continue to schedule Gold Sneaker Trainings to recruit new daycare centers and childcare facilities to apply for the program. As part of the new application process, applicants are asked to complete a web-based survey that will help gauge potential for process revisions and the need for further technical assistance. A resource packet including information related to tobacco exposure is sent to certified Gold Sneaker facilities.
Activity 1c: Provide information for center staff and parents to educate about harm resulting from the use of Electronic Nicotine Delivery Systems (ENDS), the dangers of secondhand and thirdhand smoke exposure, and the benefits of tobacco-free childcare centers and homes, and provide tobacco-free signage.
Report 1c: Tobacco Coordinators and Health Educators across the state provide health education materials to licensed child care facilities. TDH provides palm cards promoting the Tobacco Quitline as well as other health education pamphlets including information on 2nd and 3rd hand smoke and ENDS. Information and TA is provided when a request is made by the facility.
Strategy 2: Refer participants in federally-funded programs to smoking cessation services where appropriate.
Activity 3a: Continue to screen participants in home visiting to the Tobacco QuitLine and other community-based cessation services.
Report 3a: During Year 4, 100% of participants in home visiting were screened for tobacco use and referred to the Tennessee Tobacco QuitLine or to BABY & ME Tobacco Free.
Activity 3b: Refer 98.5% of smoking participants in home visiting to the Tobacco QuitLine and other community-based cessation services within three months of enrollment.
Report 3b: Home Visitors continue working to ensure that all primary caregivers enrolled in the Evidence-based Home Visiting program who report using any tobacco products at enrollment are referred to Tobacco Quitline within three months of enrollment.
Activity 3c: Support integration of smoking assessment, including ENDS use, and cessation resources into the TDH electronic health record (EPI) as it is scheduled to be deployed statewide during this reporting year.
Report 3c: The TDH electronic health record (EPI) system has integrated smoking assessment to include all tobacco products including use of ENDS. Providers are prompted to ask what products are used, age of initiation, product used, whether the patient would like to quit tobacco, and offers an option for preventative counseling.
Activity 3d: Provide quality improvement education and technical support to home visiting staff regarding available tobacco cessation services.
Report 3d: Central Office tobacco program staff continue to offer subject matter expertise and materials for use by home visiting when interacting with primary caregivers who report using any tobacco products throughout enrollment.
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