Child Health Domain Annual Report

Please note, many activities were paused or slowed during 2020-2021 as a result of COVID-19 staff redirections and long-term staff vacancies. These activities are noted below by an asterisk (*) next to the activity. Where applicable, additional information is provided.

 

July 2020 – June 2021

Child Focus Area 1: Expand and support developmental screening.

Child Objective 1

By 2025, increase the percentage of children, ages 9 through 35 months, who received a developmental screening from a health care provider using a parent-completed screening tool in the past year from 25.9% (NSCH 2017-18) to 32.4%.

Objective baseline history

 

Story behind the baseline

The American Academy of Pediatrics (AAP) recommends that all children under the age of three are screened routinely for early identification of potential developmental and behavioral concerns. Expanding and supporting developmental and social-emotional screening was a key area of need identified by the local MCAH programs and key partners throughout the 2018-19 needs assessment process and is important to help ensure children in need receive early intervention services and supports.

Between 2018 and 2020, among California children aged 9 through 35 months, an estimated 36% received developmental screening by a health care provider in the past year as shown in the graph above. However, a small sample size makes this indicator relatively. The Maternal, Child, and Adolescent Health Division (MCAH) of the California Department of Public Health (CDPH) recognizes that data reliability is currently an issue. CDPH/MCAH plans to produce stable state-level and local-level estimates when California’s oversample of the National Survey of Children’s Health is available in 2023.

Child Objective 1: Strategy 1

Partner to build data capacity for public health surveillance and program monitoring and evaluation related to developmental screening in California.

What did CDPH determine as activities that would work to bring about change

1. Partner with the CDPH Center for Healthy Communities and others to assess subpopulation data to identify disparities in developmental screening through an oversample of the National Survey of Children’s Health (NSCH).
2. Review current data collected related to developmental screening and monitoring.
3. Support Department of Health Care Services (DHCS) Medi-Cal Managed Care Quality and Monitoring Division to share information on Medi-Cal-related developmental screening data, when available, and other related data with local MCAH programs and other stakeholders.*
4. Assess additional opportunities for data collection related to developmental screening and monitoring.*

Narrative section

1. In 2021, California successfully partnered with the Health Resources and Services Administration (HRSA) and the U.S Census Bureau to utilize California’s Title V Block Grant funds to purchase a state oversample of the NSCH. CDPH/MCAH will be leveraging this oversample to assess subpopulation data and identify disparities in developmental screening.
2. CDPH/MCAH continues to routinely review developmental screening data as part of statewide surveillance as well as program-specific monitoring. In FY 2020-21, the California Home Visiting Program (CHVP) served 2,105 index children. Of the 841 eligible children aged 11-25.5 months, 711 (84.5%) completed at least one
3. Ages and Stages-3 (ASQ-3) developmental screening. CHVP Local Implementing Agencies (LIAs) experienced many challenges related to COVID-19. Staffing disruptions, technology issues, and transition to virtual home visits resulted in difficulty enrolling new families, maintaining contact with previously enrolled families, completing home visits and assessments, and connecting families to community referrals.

CDPH/MCAH also assessed the NSCH developmental screening data. Due to its small sample size, data cannot be stratified by key characteristics such as race/ethnicity. We anticipate that the 2022 NSCH oversample data (available in 2023) will allow for these types of analyses.

3. *Activity paused

4. *Activity paused

Updated Performance Measure Graph/Data specific to this strategy

Among California children, 36% had a developmental screening between the ages of 9 through 35 months (NSCH, 2018-2020). Three-year aggregated data were used because California’s 2019-2020 two-year aggregated sample size was too small to produce stable estimates. Since the aggregated data time periods are overlapping, they cannot be used to establish a statistical trend.

Success Stories

In 2021, California successfully partnered with HRSA and the U.S Census Bureau to utilize California’s Title V Block Grant funds to purchase a state oversample of the National Survey of Children’s Health. This means that in addition to the usual 3,300 addresses who are invited to participate in the survey, nearly 30,000 additional addresses will be invited to participate. You can visit California's Title V Program Investing in Better Child Health Data for information about the planned oversample.

Challenges

Due to redirections and long-term staff vacancies, many state-level child health activities have either been integrated with activities in other domains or paused.

Child Objective 1: Strategy 2

Partner to foster coordination and collaboration between systems to improve developmental screening for young children.

What did CDPH determine as activities that would work to bring about change

1. Partner with MCAH/CHVP and CDPH/MCAH Children and Youth with Special Health Care Needs (CYSHCN) Domain to identify areas of opportunity to improve early childhood systems coordination and collaboration.
2. Co-fund the Statewide Screening Collaborative (SSC) to improve collaboration with other state programs to align system priorities and strengthen connections between systems to increase developmental screening.
3. Support First 5 Association and local First 5 programs and partner with local MCAH programs on their Help Me Grow (-like) efforts.*
4. Partner with DHCS Indian Health Program’s American Indian Maternal Support Services and other programs to incorporate developmental screening, positive and responsive parenting, reading infant cues, calming/soothing, reading, singing, and playing with their infant.

Narrative section

1. MCAH leadership conducted internal meetings to align and collaborate between MCAH Title V and MCAH CHVP (MIECHV-funded) teams. Action steps were put on hold due to staff vacancies; however, the team integrated CHVP staff within the Title V Domain teams and plans to establish an Early Childhood Systems internal workgroup to partner and align Title V and MIECHV efforts.

      Title V staff attended the CHVP Early Childhood Home Visiting Collaborative meetings which are jointly facilitated by CDPH and Department of Social Services with key partners in the field. Additional activities were put on hold due to limited staffing in the Child Health branch during the pandemic.

2.    WestEd Early Childhood Intervention, Mental Health, & Inclusion Program leads efforts of the SSC to improve screening, referrals, and access to services for children under three years old in California. This is a collaborative effort with joint funding by California Department of Developmental Services (CDDS) and CDPH. WestEd convened and facilitated meetings of the SSC leadership; organized virtual presentations; developed and shared a range of resources with the SSC leadership and the Screening Collaborative listserv; and updates materials posted on the SSC website (See https://www.cascreenbto5.org/) monthly.

      Due to the continuing COVID-19 pandemic, communication was conducted virtually throughout the year. SSC leadership meetings focused on discussing and prioritizing continuing priorities/focus areas of work for the two departments.

      The SSC also collaborated with California First 5 Association of California/Help Me Grow in co-creating and co-sponsoring a webinar series on underserved and hard to reach populations in the State. SSC partnered with First 5 Association of California to co-sponsor the webinars and relied on Native American experts and representatives of tribal communities from both urban and rural regions to develop the content and recommend potential participants in their community that could be included.

      The SSC has begun to reach out to several Tribal Elders who have indicated an interest in engaging in this dialogue. The SSC is also determining culturally appropriate products that could be developed to better engage Native American families being served by infant and toddler agencies across the state.

3.   Activity paused

4.   The American Indian Maternal Support Services (AIMSS) program continues to provide developmental screenings and current evidenced-based visiting models that cover the social and safety needs through an infant's first year of​ life. AIMSS maintains critical partnerships with First 5; Women, Infants, and Children (WIC); Early Head Start; and Regional Centers and makes referrals to these agencies as necessary. Resources such as Birth to Five, Watch Me Thrive and ZERO TO THREE are included as appropriate.

Success Stories

Examples from the local MCAH Annual Reports to foster coordination and collaboration between systems to improve developmental screening for young children.

• City of Berkeley – The Sudden Infant Death Syndrome Coordinator reached out to licensed and unlicensed childcare providers and provided AAP guidelines around safe sleep and mitigation strategies. The guidelines were shared in electronic and hard copy formats and provided in both English and Spanish languages. Comprehensive Perinatal Services Program (CPSP) and Help Me Grow sites were also provided with an e-mail of resources. Information about safe sleep was also provided to WIC parenting groups.
• Los Angeles - The Community and Family Engagement Council’s (CFEC) collaboration with local MCAH over the past year succeeded in ensuring several key deliverables were centered around maintaining and strengthening the family voice in the development of Help Me Grow, LA. CFEC was instrumental in the co-development of the Help Me Grow website, messaging framework, and communications materials. Council recommendations ensured content and language were easy to understand, culturally appropriate, and relevant to the diversity of families and caregivers of young children in the county.
• Santa Barbara County - In October 2020, First 5 Santa Barbara County received an 18-month grant from First 5 California to help families with difficulties the encountered as a result of  COVID-19. In December 2020, the planning committee, representing 13 local agencies, was formed and began examining existing home visiting programs in Santa Barbara County to determine coordinated services. There has been intentional coordination with two other county-wide efforts around Adverse Childhood Experiences (ACEs) and Help Me Grow during this planning phase.

Challenges

MCAH continued to face leadership vacancies which resulted in reduced capacity, however, the SSC executed and continued to do strong work with MCAH participation.

Child Objective 1: Strategy 3

Partner to educate and build capacity among providers and families to understand developmental milestones and implement best practices in developmental screening and monitoring within MCAH programs.

What did CDPH determine as activities that would work to bring about change

1. Assess current program policies on developmental screening and monitoring developmental milestones.*
2. Assess current education regarding child development, monitoring of developmental milestones, and developmental screening within MCAH programs.
3. Partner with local MCAH programs to assess specific educational and resource needs regarding developmental screening and monitoring of developmental milestones.
4. Partner to educate MCAH service providers and families about developmental screening recommendations and tools (e.g., ASQ) and developmental milestones (e.g., Learn the Signs. Act Early.)*
5. Partner with WIC and other stakeholders to disseminate developmental milestone information, resources, and tools (e.g., Learn the Signs. Act Early, resources and mobile app) to families.*

Narrative section

1.   Activity paused

2.   CHVP screens children for developmental delays by using the ASQ-3 and ASQ-SE. Children who score positive for developmental delays are referred to early intervention services. CHVP LIAs have Memoranda of Understanding (MOUs), Letters of Agreement or Support (LOA/Ss) with early learning and care agencies that include Early Head Start, childcare agencies, and Help Me Grow systems that focus on promoting developmental screenings and services.

3.   MCAH case management and home visiting programs continued to the extent possible to assess needs regarding developmental screening and monitoring of developmental milestones. However, additional activities were paused during this period due to the pandemic.

4.   Activity paused

5.   Activity paused

Success Stories

Examples from the local MCAH Annual Reports to educate and build capacity among providers and families to understand developmental milestones:

• Imperial County – As part of the Developmental Screening Outreach for pediatric offices, AAP guidelines were given to all clinics and providers (MDs, PAs and NPs) within each clinic. Additional safe sleep educational materials were provided addressing needs of clients, social workers/families, and other participants they serve.
• San Diego County - The MCAH Family Support Collaborative (FSC) run by the County of San Diego's MCAH team convened monthly through January 2021 to review referral data, address gaps and concerns around referral practices, strengthen communication among partners, and share resources. The MCAH FSC includes partners, such as the First 5 Commission, AAP, California Chapter 3, Black Infant Health, Public Health Nursing (implements Nurse-Family Partnership and the home-grown Maternal Child Health home visiting programs), Jewish Family Service of San Diego (has the AFLP contract), Project Concern International (runs the Healthy Start program), MotherToBaby, San Diego Unified School District Pregnancy Prevention and Parenting Program, and Early Head Start programs. Referral systems and processes were often discussed and improved to streamline referral processes among participating agencies. Throughout the COVID-19 pandemic, this collaborative was able to convene virtually to connect, share, problem solve and strengthen referral systems, partnerships, and programs to better serve the women, children, and families in San Diego County.

Challenges

Due to redirections and long-term staff vacancies, many state-level child health activities have either been integrated with activities in other domains or paused. COVID restrictions caused in-person home visits to be moved to virtual visits and many LIAs reported challenges with completing screenings virtually. Across programs, staff used creative ways to assess and educate about child development. For example, home visitors asked the parent to film the child doing the screening activity and send it to the home visitor, or home visitors would meet in a park/outdoor location to educate and assess child development.

Child Objective 1: Strategy 4

Support implementation of Department of Health Care Services (DHCS) policies regarding developmental screening quality measures and reimbursements to health care providers.

What did CDPH determine as activities that would work to bring about change

1. Disseminate information regarding the new DHCS developmental screening-related policies.*
2. Work with health care provider organizations to prioritize early childhood well-child visits during the COVID-19 emergency and later bring children back into well-child care to assure children receive appropriate developmental screenings.*
3. Build capacity of local public health professionals to educate local providers about the new Medi-Cal developmental screening reimbursement and quality measure.*

Narrative section

Please note, many state-level activities were paused or slowed during 2020-2021 as a result of COVID-19 staff redirections and long-term staff vacancies. These activities are noted above by an asterisk (*) next to the activity.

Success Stories

Not Applicable

Challenges

Due to redirections and long-term staff vacancies, many state-level child health activities have either been integrated with activities in other domains or paused. Both CDPH/MCAH and DHCS faced many challenges and competing priorities due redirections caused by the pandemic.

Child Focus Area 2: Raise awareness of adverse childhood experiences and prevent toxic stress through building resilience.

Child Objective 2

By 2025, increase the percentage of children, ages 0 through 17 years, who live in a home where the family demonstrated qualities of resilience (i.e., met all four resilience items as identified in the NSCH survey) during difficult times from 82.0% (95% CI: 78.2-85.3%) to 84.5%.

Objective baseline history

Story behind the baseline

This is a composite measure based on responses to the following four survey items:

“When your family faces problems, how often are you likely to do each of the following?” (a) Talk together about what to do, (b) Work together to solve our problems, (c) Know we have strengths to draw on, and (d) Stay hopeful even in difficult times.1

According to the CDC Essentials for Childhood initiative, “young children experience their world through their relationships with parents and other caregivers.2” Family resilience protects against the potential negative impacts of adverse experiences and helps children and families recover from stressful experiences. Key factors in developing resilience include stable, nurturing relationships, and interactions with trusted and supportive adults.

In terms of behaviors that support resilience, overall, 63% of California children aged 0-5 years were read to by their parents or guardians every day3. Prevalence varied by race/ethnicity, with a higher percentage of White children (80%) being read to by their parents/guardians, as compared to Asian (59%), Latino (52%), and Black (50%) children.3 Especially in light of the challenges of the COVID-19 pandemic, there is a need for improved support to help parents and caregivers access the time, resources, and skills they need to nurture resilience in their children.

1. Data Resource Center for Child and Adolescent Health supported by the U.S. Department of Health and Human Services, Health Resources and Services Administration (HRSA), Maternal and Child Health Bureau (MCHB). Retrieved [02/03/2022] from [www.childhealthdata.org].
2. Essentials for Childhood - Creating Safe, Stable, Nurturing Relationships and Environments for All Children (cdc.gov) Retrieved [02/03/2022] from [https://www.cdc.gov/violenceprevention/pdf/essentials-for-childhood-framework508.pdf].
3. 2016-2018 California Health Interview Survey

Child Objective 2: Strategy 1

Partner with CDPH Essentials for Childhood and other stakeholders to build data capacity to track and understand experiences of adversity and resilience among children and families.

What did CDPH determine as activities that would work to turn the curve of the baseline.

1. Partner with stakeholders to have a California oversample of the National Survey of Children’s Health (NSCH) to better understand key child health-related measures.
2. Partner with CDPH Essentials for Childhood, CHIS, and other stakeholders to explore options for measuring family resilience and positive childhood experiences in CHIS or other surveys.
3. Assess and review other child health-related data, including childhood poverty and social determinants of health, as well as maternal mental health and substance use.

          Conduct trend data analyses on child poverty by age, race/ethnicity, and county to be included in MCAH Tableau dashboards that are under development.

4. Assess and explore feasibility of adding additional data related to child adversity and family resilience in MCAH programs.*

Narrative section

1. In 2021, California successfully partnered with HRSA and the US Census Bureau to utilize California’s Title V Block Grant funds to purchase a state oversample of the NSCH. CDPH/MCAH will be leveraging this oversample to understand positive childhood experiences, adverse childhood experiences (ACEs), and family resilience across various populations in California.

2.      CDPH/MCAH collaborated with Essentials for Childhood, Lucille Packard Foundation, and Population Reference Bureau regarding the COVID Family Experiences Survey. An MCAH epidemiologist served on the Essentials for Childhood Data Subcommittee, learned about children’s health data sources, and networked with partners and stakeholders. The epidemiologist reviewed and provided feedback on the data dissemination plan for the first wave of the Family Experiences During COVID-19 Questionnaire. The epidemiologist also analyzed and shared data from the COVID Family Experiences Survey at the local MCAH Directors meeting in Spring 2021. Family resilience was analyzed against supportive neighborhood as they relate to ACEs using aggregated 2016-2018 NSCH data. CDPH/MCAH continues to partner with CHIS to assess questions related to child development, including positive childhood experiences.

3.   CDPH/MCAH conducted trend analyses on child poverty using American Community Survey data, stratified by sex, age group, race/ethnicity, and county. These data will be included in the MCAH Tableau dashboard that is in development.

4.   Activity paused

Updated Performance Measure Graph/Data specific to this strategy

 

Families whose children are in the 0 to 5 years age group have surpassed the 2021-2025 target of 84.5% for Objective 2 of the Child Health Domain.

 

 

 

 

 

 

 

 

 

Families with female children have reached the 2021-2025 target of 84.5% for Objective 2 of the Child Health domain

 

Families of the Asian and Hispanic racial/ethnic groups have not reached the 2021-2025 target of 84.5% for Objective 2 of the Child Health Domain.

Families in the 0-99% and 200-399% ratios of household income to poverty threshold have not reached the 2021-2025 target of 84.5% for Objective 2 of the Child Health Domain

*Ratio of the total parent- or caregiver-reported annual family income to the family poverty threshold established by the U.S. Census Bureau. Poverty thresholds are based on the number and age of adults and the number of children under age 18 in a family unit.

a “When your family faces problems, how often are you likely to do each of the following?” 1) Talk together about what to do, 2) Work together to solve our problems, 3) Know we have strengths to draw on, 4) Stay hopeful even in difficult times.” Family resilience was defined as responding “all” or “most” of the time to all four items.

Data source: Child and Adolescent Health Measurement Initiative, (2019-2020) National Survey of Children’s Health Data Resource Center for Child and Adolescent Health supported by Cooperative Agreement U59MC27866 from the U.S. Department of Health and Human Services, Health Resources and Services Administration (HRSA), Maternal and Child Health Bureau (MCHB).

Success Stories

The Injury and Violence Prevention Branch of CDPH and the California Department of Social Services, Office of Child Abuse Prevention Essentials for Childhood provided CDPH/MCAH a chance to participate in the COVID Family Experiences Survey. The survey was intended to provide information about the impact of the pandemic on children and families and  covered a wide range of content areas, including ACEs and emotional and behavioral health..

Challenges

Due to redirections and long-term staff vacancies, many state-level child health activities have either been integrated with activities in other domains or paused.

Child Objective 2: Strategy 2

Partner to build capacity and expand programs and practices to build family resilience by optimizing the parent-child relationship, enhancing parenting skills, and addressing child poverty through increasing access to safety net programs within MCAH-funded programs.

What did CDPH determine as activities that would work to turn the curve of the baseline.

1. Lead within CHVP by improving family resilience through support and education of families on positive parenting and linkage of families to needed services in the community.
2. Assess current practices to promote healthy, safe, stable, nurturing parent-child relationships, including activities and policies that promote positive parent-child interactions, parent-child play activities, co-regulation strategies, and positive parenting practices within MCAH programs.
3. Identify key statewide initiatives and programs that address social determinants of health.*
4. Assess current capacity of MCAH programs to strengthen economic supports for families, including access to safety net programs (e.g., WIC, CalFresh, school meals, Earned Income Tax Credit, Child Tax Credit, housing subsidies, COVID-related assistance, unemployment) for families.*
5. Partner and support CDPH Essentials for Childhood Program to develop a plan to enhance parenting knowledge/skills and strengthen economic supports for families.
6. Support and communicate with All Children Thrive leaders to strengthen economic supports for families.*

Narrative section

1. CHVP’s mission is to promote maternal health and well-being, improve infant and child health and development, strengthen family functioning, and cultivate strong communities. Through the development of family goal-setting, the home visitors implement activities that focus on building family resilience. Home visitors provide education around positive parenting, teach and practice positive parent-child interactions, complete screenings and make referrals, when appropriate. Children are screened for developmental delays and referred for appropriate services when the child’s score indicates the possibility of a developmental delay. Parents are screened for mental health, intimate partner violence, and substance use challenges. Parents are referred for other services when appropriate. Home visitors use culturally proficient home visiting practices.
2. MCAH provided consultation and review for California Essentials for Childhood collaborative reports and documents, including the following:
   1. Family Experiences During the COVID-19 Pandemic Data Brief, Wave 1
   2. Reimagining Child Wellbeing: Policy Strategies to Prevent and Reduce Adverse Childhood Experiences (ACEs) in California’s Communities
   3. Utilizing Data to Improve Child Wellbeing Through Community Action
   4. Creating Safe, Stable, Nurturing Relationships and Environments for Children

3.  Activity paused

4.  Activity paused

5.  CDPH/MCAH partnered with CDPH/Injury Violence Prevention Branch’s Essentials for Childhood Initiative to develop and disseminate a data brief titled “Connecting Families to Tax Credits to Improve Child Wellbeing in California: A Brief for Local Health Departments and Children and Family Service Providers.” This document is intended to assist Local Health Departments and children & family service providers in their efforts to educate about how the collection of the California Earned Income Tax (CalEITC), California Young Child Tax Credit, federal EITC, federal child tax credit, and other associated economic supports can improve the well-being of Californians. The brief was disseminated to 61 local health jurisdictions as well as local CHVPs, Adolescent Family Life Programs, and Black Infant Health agencies because of the critical direct role they play in strengthening family resilience. This collaborative document was the final product of a nine-month CDC policy lab focused on promoting tax credits to increase economic supports for families.

6.  Activity paused

Success Stories

Two important goals of the “Connecting Families to Tax Credits to Improve Child Wellbeing in California: A Brief for Local Health Departments and Children and Family Service Providers” were 1) broadening the role of local public health departments to be better positioned to promote tax credits and other national and state economic supports for the populations they serve and 2) strengthening the relationship between public health and social services to work in parallel to improve family resilience. The CDPH team worked closely with the California Department of Social Services on the development and dissemination of the brief.

Challenges

Due to redirections and long-term staff vacancies, many state-level child health activities have either been integrated with activities in other domains or paused.

Child Objective 2: Strategy 3

Support the California Office of the Surgeon General and DHCS’s ACEs Aware initiative to build capacity among communities, providers, and families to understand the impact of childhood adversity and the importance of trauma-informed care.

What did CDPH determine as activities that would work to turn the curve of the baseline.

1. Support the Surgeon General and DHCS’s efforts on trauma screening and training for Medi-Cal providers by disseminating information to local MCAH programs and other partners. *
2. Identify and disseminate resources and training opportunities to raise awareness of ACEs and the impact on health outcomes and importance of trauma-informed care across family-serving organizations in California communities.
3. Identify training opportunities on ACEs and trauma-informed care and disseminate to local MCAH programs. *

Narrative section

1.  Activity paused

2.  The MCAH State Update newsletter was used to disseminate training opportunities and resources to local MCAH programs. MCAH state teams also disseminated information to local Program Directors via email and program SharePoint sites.

3.  Activity paused.

Success Stories

None.

Challenges

Due to redirections and long-term staff vacancies, many state-level child health activities have either been integrated with activities in other domains or paused.

Child Focus Area 3: Support and build partnerships to improve the physical health of all children

Child Objective 3

By 2025, increase the percentage of children, ages 1 through 17 years, who had a preventive dental visit in the past year from 80.2% (95% CI: 76.0- 83.9) [NSCH 2017-18] to 82.6%.

Objective baseline history

The 2019-2020 NSCH shows that the percentage of children who had a preventive dental visit in the past year dropped from the 2017-18 baseline of 80.2% to 77.5%.

Story behind the baseline

Physical well-being and access to health care for children are areas of need where CDPH/MCAH plays a critical supporting and partnership role. One of the top priorities identified in this area throughout the needs assessment was oral health. Prior to the pandemic, local MCAH agencies identified a clear need for MCAH to support interventions that enable children – especially in early childhood – to have access to routine dental services.

Child Objective 3: Strategy 1

Support the CDPH Office of Oral Health (OOH) in their efforts to increase access to regular preventive dental visits for children by sharing information with MCAH programs.

What did CDPH determine as activities that would work to turn the curve of the baseline.

1. Support the efforts of the CDPH/OOH to improve access to pediatric preventive dental care, including establishment of a dental home by age one year.
2. Support CDPH/OOH by sharing information and resources with local MCAH programs about the recommendation that all children establish a dental home by age one year.

Narrative section

1. During FY 2020-21, MCAH participated in regular quarterly meeting as an active member of the California Oral Health Plan. CDPH/OOH created the Partnership for Oral Health consists of eight workgroups whose goal is to assess progress with respect to the implementation of the California Oral Health Plan strategies and objective. Identification of workgroups, recruitment of partners in the workgroups, and convening workgroup members were the initial steps during the FY 2020-21. MCAH recruitment and participation took place in two workgroups:  the Oral Health Equity Workgroup and Local Health Program Workgroup. It is anticipated that involvement in these workgroups will support access and available resources for California families.
2. MCAH involvement with the Local Oral Health Program (LOHP) Workgroup: The LOHP workgroup provides an opportunity for partners in state government, local health departments, and non-governmental organizations to come together to support efforts at the local level. The LOHP workgroup will share experiences and resources to implement evidenced-based interventions and best practice approaches to promote oral health; promote health equity so that disparities in oral health status are identified and actively monitored for improvement; strive to optimally fluoridate water; ensure that children entering kindergarten or first grade in public schools for the first time receive oral health assessment; improve oral health literacy; foster community-clinical linkages (e.g., school-based programs) and care coordination; address dental workforce deserts; integrate oral health into primary care; create oral health networks to achieve improvement in oral health through policy, financing, education, dental care and community engagement strategies.  

Updated Performance Measure Graph/Data specific to this strategy

83% of children and adolescents aged 12 to 17 years had a preventive dental visit and have surpassed the 2020-2025 objective target of 82.6%.

 

Families of the Asian and Hispanic racial/ethnic groups have not reached the 2021-2025 target of 84.5% for Objective 2 of the Child Health Domain.

 

 

Only children living in households with incomes of 400% or more of the poverty level had past-year preventive dental visits at rates above the 2020-2025 objective target of 82.6%.

*Ratio of the total parent- or caregiver-reported annual family income to the family poverty threshold established by the U.S. Census Bureau. Poverty thresholds are based on the number and age of adults and the number of children under age 18 in a family unit.

Data Source: Child and Adolescent Health Measurement Initiative. 2016-2020 National Survey of Children’s Health (NSCH) data query. Data Resource Center for Child and Adolescent Health supported by the U.S. Department of Health and Human Services, Health Resources and Services Administration (HRSA), Maternal and Child Health Bureau (MCHB).

Success Stories

Examples from the local MCAH Annual Reports to increase access to regular preventive dental visits for children

• Alameda County – Local MCAH collaboratively planned community health events in which dental care services were offered to children and families. Through WIC referrals, 108 parents/guardians received oral health education and 49 children were scheduled for dental appointments. Through community-based organizations, 70 parents/guardians and 95 children received oral health education through virtual presentations.
• San Bernardino County - In collaboration with Smile California, all CPSP providers received Smile California posters, videos, and patient flyers with information related to Medi-Cal coverage and dental care during pregnancy.
• San Joaquin County - Education on oral health for women and children was provided, and San Joaquin Treatment and Education for Everyone on Teeth and Health (SJ TEETH) was used to refer families seeking a new dentist. Education included risk factors such as sugary foods, sharing of germs, promotion of fluoride varnish, and more. Free oral care kits for adults, children, and infants were distributed to each family member in case-managed families. Kits were donated at no cost by the local Public Health Oral Health Initiative Program and contained toothbrushes, floss, toothpaste, and a card with SJ TEETH contact information.

Child Objective 4

By 2025, decrease the percentage of fifth grade students who are overweight or obese from 40.5% (2018) to 39.3%.

Objective baseline history

Story behind the baseline

Physical well-being and access to health care for children are areas of need where MCAH plays a critical supporting and partnership role. One of the top priorities identified in this area throughout the local needs assessment during 2018-19 was healthy weight.

Child Objective 4: Strategy 1

Partner with WIC and others to provide technical assistance to local MCAH programs to support healthy eating and physically active lifestyles for families.

What did CDPH determine as activities that would work to turn the curve of the baseline.

1. Partner with WIC and support local MCAH programs to identify resources on healthy eating to disseminate to local programs.
2. Partner with WIC and local MCAH programs to identify best practices and tools to refer and link eligible clients to the WIC program.
3. Promote the Policies, Systems, and Environmental Change Toolkit on MCAH web page with focus on nutrition, physical activity and breastfeeding, limiting sedentary activity, and safe communities as a resource.
4. Partner with CDPH Center for Healthy Communities, WIC, California WIC Association, the California Department of Social Services, and others to develop a collective impact by addressing (via nutrition and physical activity) and monitoring child overweight/obesity.
5. Lead efforts to develop a new child MyPlates (for ages 2-5 and for ages 6-12 years) to promote healthy eating in children.

Narrative section

1. Each county’s local MCAH Director and/or Perinatal Services Coordinator (PSC) collaborates with WIC to ensure their CPSP Providers have the most updated nutritional information available. The information is disseminated to Providers in numerous ways, including informal local roundtable discussions with other stakeholders in the community, email blasts, or distribution of local newsletters.
2. Local MCAH Directors and the PSCs work closely with the providers and their staff in each local health jurisdiction (LHJ) to ensure families are appropriately referred to WIC and other services that are available to families in their community. The PSCs encourage local clinicians to use the most updated nutritional assessment tools and resources that are available on the MCAH website.

3. CDPH/MCAH updated the Systems and Environmental Toolkit to incorporate additional strategies and resources that address systems and environmental changes to improve, nutrition, physical activity and breastfeeding, and safe communities. MCAH promoted the toolkit on the MCAH webpage and across statewide channels of communication.
4. The CDPH/MCAH NUPA Coordinator collaborated with WIC and Center for Healthy Communities to conduct an environmental scan to learn what is already being done within each program and help identify future possible activities and collaboration to jointly address child overweight/obesity. From this information, a draft work plan was completed, however, more conversations were needed to fully develop and finalize the work plan. These conversations were postponed due to COVID-19 focused activities and staff.

5. MCAH developed four new MyPlates: MyPlate California for People Who May Become Pregnant; MyPlate California for People With Gestational Diabetes; MyPlate California for Pregnant and New Parents That Are Breastfeeding; and MyPlate for Children Ages 2-12. MCAH also developed two new tools: Perinatal Food Group Recall Tool for Pregnant and New Parents and Perinatal Food Group Recall Tool for Gestational Diabetes. The new MyPlates and Perinatal Food Group Recall Tools will be available on the MCAH webpage.

Updated Performance Measure Graph/Data specific to this strategy

According to the California Department of Education, in 2019 41.3% of California fifth graders were overweight or obese. This reflects an increase from 2018 baseline of 40.5%.

Differences were seen by sex, with 37.3% of female fifth graders and 45.0% of male fifth graders being overweight or obese.

Rates of overweight and obesity among Asian, White, and Multiple Race fifth graders are below the 2020-2025 objective target of 39.3%.

By economic status, 47.7% of economically disadvantaged fifth graders were overweight or obese, while the rate was 30.8% among fifth graders who were not economically disadvantaged. Children were considered to be economically disadvantaged if they lived in households with incomes of $48,000 per year or less (for a family of four).

Success Stories

MCAH developed four new MyPlates: MyPlate California for People Who May Become Pregnant; MyPlate California for People With Gestational Diabetes; MyPlate California for Pregnant and New Parents That Are Breastfeeding; and MyPlate for Children Ages 2-12. MCAH also developed two new tools: Perinatal Food Group Recall Tool for Pregnant and New Parents and Perinatal Food Group Recall Tool for Gestational Diabetes. The new MyPlates and Perinatal Food Group Recall Tools will be available on the MCAH webpage.

Challenges

The Adolescent Nutrition Guidelines for the ALFP Case Manager were identified as resources that needed to be updated. MCAH convened state MCAH experts and external partners to review specific sections, update references, and add information on health equity. While progress was made, MCAH determined that more dedicated resources and staff time were needed to update the content and integrate strengths-based and positive youth development concepts throughout. The project was put on hold until dedicated resources and time are identified to support revisions and updates to the guidelines.

CHILD Domain Partners

Who are our partners?

1 CA MIECHV Funded Tribal Organization, Lake County Tribal Health Consortium; Gouk-Gumu Xolpelema Tribal HVP 2 CA MIECHV Funded Tribal Organization, Riverside-San Bernardino County Indian Health 3 CA WIC Association 4 CalFresh Healthy Living Program, California Department of Social Services 5 California Department of Developmental Services 6 California Department of Education 7 California Department of Education, Early Learning and Care Division, Learning, Innovation, and Improvement Office 8 California Department of Education; Policy and Program Services, Special Education Division 9 California Department of Health Care Services; Indian Health Program 10 California Department of Health Care Services; Integrated Systems of Care Division 11 California Home Visiting Program 12 California Partership to End Domestic Violence, Capacity Building Program 13 Children Now; Early Childhood 14 Early Start Project Directors -Family Resource Centers Network of California 15 First 5 Association of California 16 First 5 Center for Children's Policy 17 John Bell Associates (JBA) 18 John Hopkins University 19 Monitoring and Family Services Branch, Department of Developmental Services 20 Project LAUNCH 21 WestEd Center for Early Intervention, Resilience and Inclusion 22 Zero to Three