The CT Title V Program and our partners recognize the importance of access to a comprehensive health and mental health care system for all children, with a focus on underserved children and health equity. CT Title V works to advance improvements in collaboration with providers, policymakers, consumers, and state agencies with an emphasis placed on developmental promotion, developmental monitoring, early screening, evaluation, and intervention.

CT continues to support activities identified in the completed HRSA State Implementation Grant for Improving Services for Children and Youth with Autism Spectrum Disorders and other Developmental Disabilities to improve access to comprehensive, coordinated health and related services. The grant was a collaborative project between DPH – the state’s Title V agency and A.J. Pappanikou Center – the state’s University Center for Excellence on Developmental Disabilities (UCEDD). Proposed outcomes of the project included: (1) implementation of the CT State Autism Plan, with activities that strengthen stakeholders’ awareness of early signs of ASD; knowledge about and access to evidenced-based, individualized and timely screening; diagnostic assessment and interventions implemented by a competent workforce; (2) engage ASD specific family support and training organizations to provide information and education on ASD; (3) work with the AAP, pediatric primary and family care providers, and the CT Medical Home Initiative for CYSHCN (CMHI) staff to expand the number of practices providing family- centered, comprehensive, coordinated health care and related services including screening, linkage to diagnosis, and transition to evidence-based interventions.

Report numbers include the following: training on the importance of developmental screening and supporting materials were provided once again to 2,000 families and 3,500 professionals for a total of 137 trainings; Community outreach activities and distribution of developmental screening materials totaled 31,495 and “Learn the Signs. Act Early.” products were distributed 7,289 times during the project period.

CT DPH and the UCEDD continued our shared partnership of the Center for Disease Control and Prevention (CDC’s) “Learn the Signs. Act Early” Ambassador position as Bethanne Vergean, Early Childhood Technical Assistant from the UCEDD, is Connecticut’s Ambassador. The program aims to improve early identification of children with developmental disabilities including autism to raise awareness of the importance of screening and early identification through the distribution of materials for parents and professionals working with young children. “Learn the Signs. Act Early.” trainings were provided statewide to 52 Early Childhood providers; 32 State Agencies, DCF; and 27 Community Providers. The “Learn the Signs. Act Early” Connecticut Face Book Page has 605 followers and 523 likes. They also partnered with Reach out and Read at CT community health centers to provide 872 Baby Busy Day, CDC Books. CT Learn the Signs Milestones are also now located in the Sparkler App at https://www.playsparkler.org/. On Oct. 21, 2021 the Office of Early Childhood (OEC) in collaboration with partners at the Department of Public Health (DPH), the Department of Children and Families (DCF), and the State Department of Education (SDE) announced that Sparkler is now available to all CT families with children 0-5 years old and to programs serving those families. Please view the press release here: https://www.ctoec.org/wp-content/uploads/2021/10/Press-Release-OEC-and-Partners-Announce-Statewide-Launch-of-Sparkler.pdf

Developmental screening is a priority area for the CT Department of Public Health State Health Improvement Plan Advisory Council and the Maternal and Child Health Coalition. The Developmental Screening Workgroup includes a group of stakeholders committed to developmental screening made up of community providers, representatives from family organizations, state agency representatives, the group meets quarterly. The Developmental Screening Workgroup’s Action Agenda contains three strategies.

Data Source: National Survey of Children’s Health, Health Resources and Services Administration, Maternal and Child Health Bureau. https://mchb.hrsa.gov/data/national-surveys

According to the National Survey of Children’s Health, Health Resources and Services Administration, Maternal and Child Health Bureau, the percent of children, ages 9 through 35 months, who received a developmental screening using a parent-completed screening tool in 2019-2020 was 36.90% Nationwide and 49% in Connecticut. In contrast to 63.10% for parents who did not complete a developmental screening tool and 51% in Connecticut. Connecticut’s percentage is much higher than the national average.

The first strategy is to conduct an education and awareness campaign that targets families and communities on the importance of developmental screening. The Developmental Screening Workgroup is supporting the media campaign message which includes information on and the promotion of developmental screening, a focus on families & relationships, and the Strengthening Families’ Protective Factors. The success of the campaign is monitored through the counting of several screening and referrals items available through Child Development Infoline and are tracked overtime. Ages and Stages Questionnaires (ASQ) new enrollments 957; ASQ Screenings Completed 5,787; Birth to Three referrals 10,173; ASQ web hits 3,546; ASQ enrollment from web hits 1,398; total ASQ enrollments 8,513, Promote awareness and use of Child Development Infoline. Total number of Child Development Infoline and Help Me Grow (CDI/HMG) calls is 2,927; CDI/HMG cases related to monitoring a child’s development 428; Help Me Grow Referrals 2,656. Expand the number of “Learn The Signs. Act Early.” materials distributed statewide to families and community providers 2,109; “Learn The Signs. Act Early.” web hits at Child Development Infoline 155.

Data Source: CDI/HMG Data 2016-2021

According to Child Development Infoline/Help me Grow Data the total number of Child Development Infoline and Help Me Grow (CDI/HMG) calls between 2016-2021 was 2,841; 3,285; 2,850, 3,002; and 2,927 and the number of cases between 2016-2021 was 1,284; 356; 6,082, 226; and 2,109. Due to Covid the number of cases were relatively low in 2019.

The second strategy is to train community and healthcare providers to improve screening rates and coordination of referrals and linkages to services within the state. Success is tracked through a variety of Educating Practices trainings. The Educating Practices program offers 23 training topics to help pediatric practices across Connecticut improve delivery of child health services. From July 1, 2020, to June 30, 2021, 26 presentations were completed on 11 different topics to 17 practices (including two grand rounds presentations) with 476 participants. During this period of time, the program transitioned from CHDI (Child Health and Development Institute) to Connecticut Children’s. As a result, the program did not function fully during the transition.

Due to the ongoing COVID-19 Pandemic, CT Association for Infant Mental Health (CT-AIMH) were offering all trainings and conferences virtually, in 2021. They offered one (1) virtual spring statewide conference for 166 people, one (1) fall conference for 160 people. Also offered were four (4) different virtual CT-AIMH infant and toddler audience-specific training series that included 208 people, for a total of 535 trained.  Also they reached the goal of having 100 Infant and Early Childhood Mental Health Endorsed professionals in 2021, including the first person to get endorsed using the Spanish version.

The third strategy is to engage in cross system planning and coordination of activities around developmental screening. Members of the Developmental Screening Workgroup joined state level groups to support communication among and coordination of statewide efforts around developmental screening and the promotion of healthy development through the Help Me Grow Advisory Council. The Help Me Grow Advisory Council has come together to address many issues that are facing the community in CT. One meeting feature a presentation on the SEI-FASD (Substance Exposed Infant-Fetal Alcohol Spectrum Disorders) statewide initiative's work.  This initiative aims to strengthen capacity at the community, provider, and systems levels to improve the safety, health, and well-being of substance exposed infants and support the recovery of pregnant and parenting birthing people and their families. It is funded by the Department of Mental Health and Addiction Services (DMHAS) and the Department of Children and Families (DCF).

Another meeting included a legislative wrap up by Maggie Adair, OEC’s Director of Government & Community Relations and a presentation on the newly convened Reproductive Justice Alliance. In 2021 the Alliance was established by the March of Dimes, Department of Public Health, and Carey Consulting in response to the 2020 PRAMs Data to Action project around discrimination before and during pregnancy. The need to address reproductive justice in Connecticut was also inspired by the work being done in New York City to address inequity in maternal outcomes. Alliance members, including HMG Advisory Committee who are knowledgeable on the issue and committed to ensuring reproductive justice for birthing people in Connecticut. The Alliance is working to ensure individuals receive respectful and quality care, which ultimately serves to reduce maternal and infant mortality and morbidity.

In addition, resources at 2-1-1 Infoline allows for phone and digital access to educational information, screening resources and connectivity to support services; expansion of parent participation at the state level young child wellness council and linkage to national parenting activities; and partnering with local schools around initiatives that support family strengthening. Information is available on a variety of resources including: Text4baby a free service for pregnant and new moms that offers tips on baby development, pregnancy, and childcare; Milestone Tracker Mobile app to track your child’s development from age 2 to 5 months which includes tips on development and what to do if you are ever concerned; support from the Early Childhood Consultation Partnership that provides early childhood mental health promotion, prevention and intervention services to children who are at risk of suspension or expulsion from early care and education settings due to behavioral and mental  health concerns; and Vroom an app that provides parents with science-based tips and tools to give a child a great start in life.

DPH staff edited the “Learn the Signs.Act Early” Milestones Moments Booklets in both English and Spanish to include Connecticut specific information for referral to 2-1-1 Child Development Infoline. The logos of “Learn the Signs.Act Early”, 2-1-1 Child Development Infoline, CT Department of Public Health, UCONN Center for Excellence in Developmental Disabilities, and the Office of Early Childhood were added to reflect the collaborative efforts to support developmental monitoring, screening and referral in CT. Combined funding allowed the printing of 7,500 of English and 7,500 Spanish “Learn the Signs.Act Early” Milestone Moments Booklet and Track Your Child’s Developmental Milestones Brochures.  Finally, 100 “Learn the Signs.Act Early” Candy Land mats were distributed along with 50 mat carrying bags. The Family Resource Center and Children’s section of the Hartford Public Library staff distributed 10 mats. Through a partnership with Connecticut Children’s Medical Center (CCMC) to other physicians, private practices, and families 40 of the mats were distributed. Printed materials were shared with all partners for distribution through their community networks and materials are available from 2-1-1 Child Development Infoline for statewide distribution.

Each regional Screening to Succeed Community Education Session identified developmental awareness and screening activities to focus on in the coming year some examples include the following; improve outreach to families with an emphasis on fathers, ensure cultural competence, enhance support for screening in Primary Care settings, provide screenings at Family Resource Centers, and complete Ages and Stages Questionnaires (ASQ) at enrollment.

The Help Me Grow Advisory Council continued its mission to ensure screening and follow-up services are accessible and fully integrated and to build capacity of the system to respond to increased need for referrals and services. The Help Me Grow Advisory Council developed out of the Early Childhood Comprehensive Systems grant that had an Action Plan that utilized national materials shared at the CT Act Early meeting including the adoption of objectives such as establishing a statewide learning collaborative and creating a marketing message to emphases the promotion of good health/development.

Children’s brains grow rapidly in their earliest years, laying the foundation for the rest of their lives with learning fueled by play and interactions between children and their parents and caregivers. Sparkler was piloted in five communities in the State of Connecticut, and it has been introduced in more than 70 communities in order to help all children in the state get off to a strong start through regular developmental screening, ongoing play-based learning, and connection to local resources. Sparkler allows families to: Know: Understand their child’s development with the mobile Ages & Stages Questionnaires® (ASQ); Play: Spark learning with fun, off-screen activities to play together and tips for parents; Grow: Follow their child’s progress in their Sparkler scrapbook; and Connect: Get tips and answers from experts at 211 Child Development or their school/provider. Providers in Connecticut have the option of using Sparkler’s web-based dashboard for free to engage the families they serve with messaging, screening, co-play activities, and more. 

The MAVEN online reporting system is available to care coordinators within the CT Medical Home Initiative for Children and Youth with Special Health Care Needs (CMHI) with enhanced fields specifically related to developmental screening. Fields include whether the child received a developmental screening, screening results, confirmation of screening results and referrals made. This mandatory data entry gathered information from parents on developmental screening of CYSHCN under the age of four who are currently served by CMHI contractors.

The Autism Services & Resources Connecticut houses the user-friendly clearing house on their website at https://ct-asrc.org/professional-resource-guide/. The guide is a user-friendly clearinghouse to facilitate access to services, catalog resources currently available (federal, state, private), catalog qualified professionals/facilities based on Qualified Credentialing Application; and catalog existing training opportunities for parents and professionals. DPH staff serve as the liaison for the comprehensive resource guide initiative and the training initiative.

The Medical Home Advisory Council (MHAC) was established to provide guidance and advice to the CT Department of Public Health in its efforts to improve the community-based system of care for children and youth with special health care needs (CYSHCN) by ensuring their connection to a medical home that is accessible, compassionate, comprehensive, coordinated, continuous, culturally effective, and family-centered. Parents representing different organizations are at the table including staff from the CT Family Support Network (CTSFN). CTFSN provides direct support to individuals and families in their homes and communities by sharing information and resources that empower people to make their voices heard and to become their own best advocate. 

The DPH Medical Home Advisory Council has a Family Experience Workgroup who provides consistent support for quarterly meetings and offers a gateway to additional family voices through the facilitation of focus groups on behalf of the consumer input section of the MCHBG. The Family Experience Workgroup serves as a conduit to ensure a broad representation of family experiences are shared with Council members and to distribute materials and information gathered at MHAC and Family Experience meetings to families statewide.

Immunizations

The Immunization Program provides all recommended childhood vaccines to approximately 700 providers statewide including private physician offices, community health centers, School Based Health Centers, urgent care centers and local health departments. In 2021, over 1,000,000 doses of vaccine were distributed by the Immunization Program and the program continues to universally offer all Advisory Committee on Immunization Practices (ACIP) vaccines for all children up through 18 years of age in Connecticut regardless of insurance status. Adult vaccines including HPV for uninsured patients 19-45 years of age are provided to local health departments, community health centers, STD clinics, and drug treatment facilities. Uninsured and Medicaid patients 9-18 years of age as well as privately insured 11- and 12-year-olds are also provided HPV vaccine.

All nationally recommended childhood vaccines are provided to School Based Health Centers (SBHC) for children up through 18 years of age free of charge. The Immunization Program also partners with the WIC program to promote timely immunizations and well-child exams at WIC locations statewide.

The Connecticut Immunization Information System (IIS) generates immunization coverage rates on a statewide level, by practice and by Immunization Action Plan (IAP) areas. IAP areas are target areas of need and include IAP Coordinators, under the state immunization program’s contracts, who conduct outreach and tracking to raise immunization rates on preschool age children. In fiscal year 2020, nine local Immunization Action Plan (IAP) Contracts (Hispanic Health Council, Ledge Light Health District, Naugatuck Valley Health District, New Britain Heath Department, New Haven Health Department, Norwalk Health Department, Southwestern AHEC, Torrington Area Health District, and Waterbury Health Department) worked with providers, maternal and child health partners, and local WIC agencies to ensure that all children have a medical home and have access to age appropriate vaccinations.

IAP Coordinators and state immunization program Epidemiologists also conduct site visits called IQIP (Immunization Quality Improvement for Providers) with providers as a continuous quality improvement process developed by the CDC to raise immunization coverage rates, reduce missed opportunities to vaccinate, and improve standards of practice at the local level.

The Connecticut Immunization Registry and Tracking System (CIRTS) was replaced with a new Immunization Information System (IIS) platform called CT WiZ in September 2018. The CT WiZ tracks children statewide from birth up through age eighteen as reported from providers enrolled in the Connecticut Vaccine Program (CVP), as will be described below. CT WiZ capture vaccines throughout the lifespan. All children born in Connecticut are automatically enrolled through State Vital Records and their provider offices, unless the parent opts out. CT WiZ enables providers to report electronically which reduces data entry and enables CT WiZ to capture timely data on children up through age eighteen and beyond.

Office of Oral Health

The Office of Oral Health’s (OOH) CT Oral Health Surveillance System (COHSS) tracks and monitors over twenty oral health indicators for children. Of note, in 2020 per the CT Behavioral Risk Factor Surveillance Survey, 82.2% of CT children between the ages of 1 and 17 received an annual dental visit. Additionally, in 2020, per the National Survey of Children’s Health, CT’s percentage of “dental visit among children aged 1-17 years with special health care needs” was 91.6%, which is above the national percentage at 78.5%. Lastly, in 2020, per CMS-416, for “preventive dental visit among children aged 1-20 years enrolled in Medicaid/SCHIP” CT’s percentage was 49.8%.

The OOH continues to implement the SEAL CT! program, a school-based sealant program, which aims to support the placement of dental sealants and the expansion of programs in schools where 50% or more students are eligible for the Free and Reduced Meal Program. In the last year, the OOH has implemented a Communications Plan for school-based dental sealant programs, which includes strategies to foster community and parent awareness, develop bilingual resources, and promote resources through the DPH website and social media. The OOH also developed a Sustainability Plan, which outlines strategies for continued implementation once federal funding is no longer available.

Nutrition, Physical Activity, and Obesity (NPAO) Program

The DPH Nutrition, Physical Activity, and Obesity (NPAO) Program has been working with early care and education (ECEs) sites to provide nutrition and physical activity education and support the creation of healthier environments for the children and families they serve for over 10 years. Over the years, these efforts have expanded with the receipt of new funding and development of new partnerships, including other DPH programs addressing children’s health and wellness.

The NPAO Program partnered with the DPH Office of Oral Health to create Water First for Your Thirst! (WFFYT) initiative for ECE sites to increase the availability of fluoridated drinking water in ECE sites and promote fluoridated drinking water as the primary beverage for young children (birth to 5 years old). The WFFYT initiative was developed as a result of a group of partner organizations that wanted to improve sugary drink intake in young children and as an extension of an existing marketing and communications campaign developed by UConn Health.  The WFFYT initiative focused on providing training and support to ECE providers, including a self-directed toolkit, a training on implementation, and resources to use in classroom and on-site.  The WFFYT website provides consumer information and resources on the value of drinking and cooking with fluoridated water and healthy food choices. From 2017-2019, the WFFYT initiative was successfully implemented in 11 center-based and 66 home-based ECEs serving 1,014 children. Starting in 2019, the NPAO Program shifted to include the WFFYT initiative tools and resources as part of the Go Nutrition and Physical Activity Self-Assessment for Child Care (Go NAPSACC) initiative.

Go NAPSACC implementation began in 2019 with center and home-based ECEs to address childhood obesity with funding from the Centers for Disease Control and Prevention (CDC) State Physical Activity and Nutrition Program (SPAN) and U.S. Department of Agriculture (USDA) Supplemental Nutrition Assistance Program-Education (SNAP-Ed) funding.  Go NAPSACC is an evidence-based online platform that helps ECEs create a healthier environment for the children they serve through a five-step improvement process: best practice assessment, action planning, implementation, training and technical assistance support, and re-assessment to evaluate progress. Best practices include policy, systems, and environmental changes to support healthy behaviors and are grouped into seven modules: Breastfeeding & Infant Feeding, Child Nutrition, Farm to ECE, Oral Health, Infant & Child Physical Activity, Outdoor Play & Learning, and Screen Time.  ECEs that opt to work on the Oral Health module will also receive the WFFYT toolkit and resources described earlier.

Participating ECEs receive the following supports as part of the Go NAPSACC initiative:  

Unlimited access to the online Go NAPSACC platform, which includes self-assessments, action planning tools, materials and resources, and online training for each module. 

A dedicated technical assistance consultant (TA) to help them through the process, address barriers, and monitor progress. 

Implementation resources including toolkits, classroom materials and supplies, and educational handouts for families. 

Recruitment occurs on a rolling basis throughout the year, and participating ECEs complete the selected module(s) at their own pace. Implementation of one or more modules typically occurs over a six to nine-month period, depending on the number of action items identified, the ECE site’s time, and any barriers faced during implementation.  From October 1, 2020 - September 30, 2021, 109 sites were actively working through Go NAPSACC, reaching 3,704 children. The Oral Health module specifically addresses reducing sugary beverages and increasing plain fluoridated drinking water access in ECE sites.  During the reporting period, 7 of the 109 ECE sites selected the Oral Health module as their focus for implementation.  The NPAO Program continues to work with TAs to ensure sites that start the process complete the full Go NAPSACC implementation process, including a second self-assessment to measure changes in best practice attainment. The below chart includes a summary of mean scores for those providers that completed one or more of the seven (7) available modules. The most significant improvements occurrent in sites working in the Breastfeeding and Infant Feeding, Child Nutrition, and Outdoor Learning and Play modules.

The NPAO Program, in partnership with the University of St. Joseph (USJ) is also implementing Coordinated Approach to Child Health (CATCH) Early Childhood (CEC) in ECE sites with SNAP-Ed funding.  Modeled after the nationally recognized CATCH Program for grades K-12, CEC is an obesity prevention intervention designed to increase physical activity and promote healthy eating in children ages 3-5. ECE staff are trained to deliver CEC curriculum in their classrooms, which includes nutrition and gardening lessons and 30 minutes of daily physical activity in the classroom. Because of COVID-19, the NPAO Program was unable to provide in-person CEC training as planned. However, the NPAO Program partnered with CATCH Global to provide two virtual CEC trainings for a total of 16 ECE programs (30 teachers) from October 1, 2020 - September 30, 2021. Technical assistance was offered remotely to support implementation following the virtual training. A total of 15 ECE programs surveyed at the end of the reporting period actively implemented CEC. Of these 15 programs, 7 were of those trained during this reporting period, and 8 were trained during the previous reporting period. All sites that completed the survey noted significant challenges with implementation due to continued barriers associated with COVID-19.

ECE programs reported through Survey Monkey on the number of children and staff at their locations. Data for this reporting period showed a total of 16 ECE programs reported 1,503 children and 30 staff were reached. In addition, as part of the CEC curriculum, nutrition education materials with activities were given to the children to share and interact with their parents. According to the US Census Bureau American Community Survey, 33% of Connecticut kids live with a single parent (496 parents) and 67% live with both parents (2,014 parents); or 2,510 parents reached. Thus, the total reached including staff, parents, and children is estimated to be 1,503+30+2,510=4,043.

Funded by SNAP-Ed, the NPAO Program in collaboration with the University of St. Joseph (USJ) delivers evidence-based nutrition and physical activity education sessions and workshops for the parents/caregivers of young children with the goal of improving overall nutrition and increasing physical activity of families.  Parents/caregivers are targeted as they have the most influence on food choices and are able to enforce healthy messages within their families. The educational content is based on Eating Smart • Being Active, a curriculum developed at Colorado State University and University of California at Davis for low-income adults with young children. The program curriculum has eight different topics: Get Moving, Plan Shop Save, Fruits and Veggies Half Your Plate, Make Half Your Grains Whole, Build Strong Bones, Go Lean with Protein, Make a Change, and Celebrate! Eat Smart and Be Active.  ECE sites participating in Go NAPSACC and CEC are targeted for these sessions and workshops to employ a layered approach to obesity prevention.  From October 1, 2020 - September 30, 2021, 79 sessions and workshops were delivered to 414 participants.

The NPAO Program has been working with MCH Block Grant staff to develop a one-page handout for School Based Health Center staff outlining existing nutrition education materials for distribution to students and their families on reducing sugary drinks.  The content has been compiled and will be organized in an easy to read and use format in the upcoming year.