Developmental Screening

 

Our 2020 Needs Assessment showed that Delaware is among the lowest of its surrounding states when comparing children, ages 9-35 months, who received a developmental screening in the past year.  According to the 2020/2021 National Survey of Children’s Health (NSCH), 32.1% of Delaware children received the screening.  This is slightly below the national average of 34.8% of children having a completed developmental screening.  Developmental Screening was selected as the Most Important National Performance Measure in the Child Health Domain according to our stakeholders.  In addition, it was ranked as the second highest priority, when ranking all priorities overall.

 

Studies indicate that each year, about three million children across the nation enter Kindergarten without the cognitive, social, and emotional skills necessary to be ready for school and life. The situation is even more dire as kids struggle through the aftermath of the pandemic and its impact on mental health, cognitive social and physical health.  Developmental health surveillance and screening, and its promotion, is critical to early identification and intervention to ensure that developmental health disorders are treated to improve the overall outcome and trajectory of the child’s growth and life.

 

The ECCS/HMG program continues to collaborate with the Office of Early Learning (OEL) to assure a comprehensive approach to attaining universal developmental screening in all early care and education (ECE) facilities, as mandated through HB 202. The OEL has been meeting regularly, with its partners, to implement the use of the Ages and Stages Questionnaire (ASQ) within licensed childcare facilities. The ECCS programs serves as the voice for how these changes could impact health care.

 

Over the past three to four years, the Help Me Grow @211 service was expanded to include two new hires to focus on the uptake of Ages and Stages screens. Funding support for this effort came from the Birth to Three program. With the increase in capacity, there has been a successful decrease in the backlog of ASQ screens. The staff will be instrumental when the statewide mandate (HB202) comes into effect.

 

In November 2022, the MCH/ECCS partnership to implement the CHADIS pilot project went LIVE! This meant a successful integration of the four pediatric practices’ Electronic Medical Records to the CHADIS web platform; the building of a referral platform for users to send and receive referrals; the training of all partners - this includes Child Development Watch and Child Find staff, the four pilot pediatric practices and their staff; Help Me Grow@211 staff including ECCS and DEAAP staff.  The main purpose for this project is to streamline care coordination gaps in the developmental screening continuum. Child Health and Development Interactive System (CHADIS) is a web-based patient engagement and data collection system for comprehensive developmental/physical and mental health for all ages.

MCH/ECCS is in partnership with the Delaware Chapter of the American Academy of Pediatrics (DEAAP); Medical Society of Delaware, Early Intervention programs (Child Developmental Watch and Child Find) and Help Me Grow@2-1-1- (Centralized Access Point). They are joined by four pediatric the practices from each of Delaware’s three counties.

 

The pilot is in its final stages where data is used to support scaling up and spread. Since November, when CHADIS went live, the four pediatric practices have submitted about 3,110 Peds screens to early intervention programs (Child Developmental Watch and Child Find) for assessment, if eligible for their services.

 

As the CHADIS pilot project transitions to the scaling up and spreading stage, the ECCS/AAP staff work with CHADIS staff to improve barriers or challenges as and when it becomes known. Such challenges range from training and re-training staff as they use the system; reviewing the system to assure efficiency for parents and other users, including ensuring the robustness of the data to answer the initial pilot question. Anecdotal feedback from users indicate satisfaction with the general utility of the system. The areas that need improvement pertains to a necessary cultural shift by early intervention providers to follow through with the feedback loop to physicians, and continued promotion of Help Me Grow @211 as a service that addresses referrals regarding the social determinants of health.

 

A total of 9,214 PEDS online screens were completed on children 0-59 months between January 2022 to December 2022. This corresponds to an estimated 6,574 unique or unduplicated children. There’s a decrease in the number of screens since four pediatric practices are participating in the CHADIS pilot project.  Of the total number of screens administered (9,214) by pediatric practices, 4.7% (426) were high risk for delays.  Additionally, of that number of screens (9,214), 2,559 (94.3%) of children between 18 to 24 months screened for the MCHAT, passed the test while 155 (5.0%) failed.

 

The DPH/MCH partnership with the Delaware Chapter of the AAP has evolved over time, to identify synergies and partnership with pediatric and other early childhood programs which has resulted in more collaborations now, than ever.  Over time, it became apparent that recruiting pediatricians to implement developmental screening was difficult, however they appeared to have more interest in early literacy, through the Reach Out and Read program.

 

As a strategy, the proposal now is to package early childhood programs, services, and supports such as lead screenings, oral health, Food Bank of Delaware, developmental screening, and Help Me Grow @211 while leveraging the Reach Out and Read program.  This has also led to the expansion of topics featured of the DEAAP’s web page dedicated to online education targeting pediatricians and family practitioners.  The online training was initially developed to provide an overview of developmental screening best practices, Delaware’s developmental screening initiative, PEDS online tools, the referral process, and early intervention program information, including care coordination and community resources (Help Me Grow/2-1-1).

 

With the expansion, is the inclusion of information on lead screening, oral health, food insecurity through the Food Bank of Delaware, and addressing issues of social determinants of health through accessing Help Me Grow @211.  The course will be made available on an online education platform that health providers or other stakeholders could access for professional development

 

Through Books Balls and Blocks activities, we continue with building parent/family leadership and capacity to advocate for themselves and their communities.  This past year, the virtual sessions targeting children, birth to age three, led to the creation of “Parent Meet Up” sessions. This need became apparent since most of the parents would linger after their kids’ sessions to address issues they were having in their families. The outgrowth of this need was a monthly virtual meeting targeting parents. Once a month a 15-minute general information on parenting such as “potty training” or “feeding” is shared with parents and then the agenda is open for parent-generated questions and discussions.

 

A collaboration with HMG@211 has also led to reaching a broad array of families. Staff at HMG@211 promote BBB events and other HMG events by sending text messages to the target population the day before a session, including reminder emails to registrants.  We also continue to organize community events (virtual and in-person, when appropriate) such as Books, Balls and Blocks events to increase families understanding of developmental screening and milestones, while creating opportunities to administer the Ages and Stages Questionnaire screener.  Events organized in the past year include collaboration with libraries, United Way of Delaware, Winterthur Museum, Managed Care Organizations such as Highmark, community centers and Chi Eta Phi Sorority Inc.

 

During the past year BBB, reached over 60 families virtually and face-to-face. There was also a concerted effort to organize events targeting fathers. Though not well attended, we recognize the impact of dads on their children and plan to organize another such event.

 

Since July 2020, over 30 online BBB sessions have been carried out with 124 online evaluations completed.  The satisfaction evaluation from parents shows most parents would recommend the BBB events to friends and families since they found it enjoyable and satisfactory.  The majority of participants indicated the BBB sessions were helpful in assessing their child’s growth or skills. They also indicated a willingness to follow up for early intervention services should a developmental screen indicate their child was at risk for delays.

The BBB webpage, Facebook posts and streaming on DEThrives shows views from other users who visit the social media page to view the BBB online sessions with their children. Recent data shows that virtual recordings have been viewed over 200 times beyond the initial posting.

 

For 2023 to 2024, the ECCS/HMG program will work with the Help Me Grow national center to assist the Help Me Grow Advisory committee members in strategic planning. Below are some of the areas or goals:

• Disparities in developmental screening: on-going developmental screening data indicates some disparity when it comes to Hispanic families.  We will conduct research to study its veracity.
• CHADIS: discuss the scaling up and spread including its sustainability.
• Pursue ways to improve race and poverty data collection within HMG efforts to ensure we are addressing challenges that exist across the state for vulnerable populations.
• Increase partnerships with child-serving programs such as Women Infants and Children and home visiting to leverage areas of mutual opportunities and benefits for families.
• Business engagement: discussion will center on how MCH/ECCS can leverage relationships with the business community to promote developmental screening knowledge within the workforce.

 

DEThrives ran a single image newsfeed ad to promote HMG at Delaware 211 services.  The ad targeted women and men aged 18-65+, new parents, parents of children 0-12, and grandparents who lived in Delaware.  The objective was to increase site traffic to the HMG landing page. The HMG landing page earned 474 pageviews during the quarter (Oct. – Dec. 2022) and 130 of those sessions stemmed from users clicking on this post.  In terms of performance metrics, the ad reached over 18K users, and had over 48K impressions, earned 192 clicks.  In terms of the social engagement metrics, the post earned 26 post reactions, 1 post comment, 9 post shares, and 4 post saves. 

 

The HMG system was first developed in November of 2012 with the help of the MCH Bureau of the DPH and a partnership with Delaware 211.  A decade later, HMG Delaware celebrated its 10th anniversary.  The title of the event was “A Decade of Help Me Grow Delaware: Where Families Grow, Learn, and Thrive” and was sponsored by the Delaware Health and Social Services (DHSS), United Way of Delaware, and Delaware 2-1-1.  It was a free, all day, in person, two-part, event hosted at the Route 9 Library and Innovation Center in New Castle, Delaware.  The two-part session was made up of the morning and early afternoon that catered to partners and stakeholders while the second part of the event offered in the early afternoon acted as a Community Resource Fair for the general public, where a Books, Balls, and Blocks (BBB) session was offered for children and their parents.

 

The first part of the day was kicked off by sharing a proclamation reading recognizing that November 9th, 2022, will be known as the “Help Me Grow/211 10th Year Anniversary” in the state of Delaware.  It was then followed by talks from different speakers such as Ms. Kimberly Martini-Carvell, the HMG National Director, who provided a recording of her personal speech for Delaware’s HMG program and also mentioned HMG national goals and direction.  Fireside style chats were done by Norma Everett, an Early Childhood Advocate, Matthew Denn who led the 2009 legislation that mandated private insurers to cover Developmental Screenings, and Dr. Doug Tynan, a retired Child Psychologist from Nemours and was a huge contributor in the QT30 messaging.  Two participants shared their experiences of using HMG services, how it has helped them and their families, and any advice they could give to others about the free HMG services.

 

About 41 people registered for the event beforehand, there were about 60 participants present throughout the day, and over 10 vendors who participated in the Community Resource Fair.  Giveaways were also given out to families who were present during the second part of the day as a thank you.  An evaluation was also provided after the event to receive feedback from the two-part event.  Based on the feedback, most people appreciated learning the HMG history, the HMG recognition and accomplishments, the real-life stories of HMG participants, and networking with other agencies.

 

News of this event was shared on social media with partners reposting it.  There was also an eblast message that went out to partners and stakeholders to share news of the event and to increase enrollment.  After the event, DHSS released a Press Release sharing news of the celebratory event.

 

 

 

 

Dental Visit

 

According to the 2020/2021 National Survey of Children’s Health (NSCH), 77.3% of Delaware children, ages 1 through 17, have had a preventive dental visit in the past year.  Delaware is slightly above the national average of 75.1% of children with a preventive medical visit.  The Preventive Dental Visit (child/adolescent) was another priority that is important to Delaware stakeholders.  Our stakeholders recognize that dental health equals overall health and the Title V team has identified that MCH is able to align our collaborations and resources to make an impact on this population.

 

During the last reporting cycle, MCH supported the Bureau of Oral Health and Dental Service (BOHDS) efforts to complete the Basic Screening Survey.  The students in 3rd grade were screened in addition to students in kindergarten.  Challenges persisted due to fears of COVID, increase of COVID cases during the screening period and additional factors.  However, the total number of students screened was four times higher than the last survey completed over 5 years ago.  A total of 4,236 students participated in the survey.  2,088 third grade students were screened and 2,135 kindergarten students.  The following document represents a snapshot of the data that will be in the upcoming report.

 

BOHDS released the report detailing the results of the survey in 2023.  The information will be used to assist with updating the oral health state action plan and developing oral health programs.  Also attached is the Delaware Health and Social Services Dental Data Brief.  We learned that 53% of Delaware’s third grade children have at least one tooth with decay experience, which is lower than the national average of 60%.  In addition, 45% of Delaware’s kindergarten children have at least one tooth with decay experience, which is higher than the national average of 42%.  In Delaware, there are significant oral health disparities.  Tooth decay remains more common in children from lower-income household and among Hispanic children.

 

 

The Delaware Smile Check Program originated as a school-based preventive oral health outreach and case management program in 2017 that provided dental screenings, fluoride varnish applications and referrals to a dentist.  Over time this program has been evaluated and has transitioned to meet the needs of the community and improve outcomes.  From July 1, 2022, through May 30, 2023, the Delaware Smile Check Program provided a dental screening to 2,670 students.  During that same time frame, 2,550 students received a fluoride varnish application.  There were162 students that were identified as having an urgent dental need (pain or swelling) and 742 with suspected dental decay.  Through case management we were able to confirm 269 students that received follow up treatment with a dental provider in the community.

 

During the last reporting cycle, an oral health landing page (https://dethrives.com/smile-check) was posted live on our DEThrives.com website.  The term “Healthy Smiles” is where general oral health information is placed on the DEThrives site in collaboration with the Bureau of Oral Health and Dental Services (BOHDS).  The term “Smile Check” is the name of the dental program by the BOHDS, known as the “Delaware Smile Check Program”.  The “Smile Check” landing page easily allows the public to enroll their child for virtual or in-person school dental services.  Organizations and schools are also encouraged to participate in this program and to receive “Smile Check” services by signing up.  Items such as the “Dental Resource Guide”, dental tips for children with special needs, a prescreening checklist, on-site and virtual forms are available in both English and Spanish.

 

                             

 

After more than two years of planning and preparation, our newly designed DEThrives website when live on April 3, 2023.  The newly designed dental site still has all the same information that was on the original site, but it is now designed in a way where the user’s experience and the website’s functionality are significantly improved by making it easier to navigate and find dental information.

 

MCH worked with the Bureau of Oral Health and Dental Services to create an online sign-up form for the Delaware Smile Check Program.  Students can access the online form through a QR code or a link.  During this reporting cycle, 689 student consent forms were completed, and 115 school/organizational consent forms were completed using the DE Thrives website.

 

The Bureau of Oral Health and Dental Services has been working with schools to integrate dental into the school wellness centers.  A portable dental clinic was opened in Warner Elementary School.  It includes 4 dental chairs and offers comprehensive examinations, dental cleanings, fluoride application, dental sealants, and oral health education.  In addition, we are looking at options to expand into taking x-rays and restorative treatment.  To date, 38 students have been seen at the Warner Elementary School location.

 

• 38 students received an examination
• 30 students have received a dental cleaning
• 29 students received a fluoride varnish
• 83 sealants were completed
• 20 of the students were found to have dental decay and connected to a provider for treatment

 

MCH assists with marketing oral health activities, events, education through DE Thrives Facebook, Twitter and sharing with other Title V partners.  The Bureau of Oral Health and Dental Services coordinates with MCH to release information through DEThrives at a minimum monthly on Facebook and Twitter.  This includes preventive education and oral health events available to the public to support children and their families to maintain good oral health and improve oral health literacy.  Together, MCH and BOHDS are also in development of blog posts to raise public awareness and to emphasize the importance of good dental habits.  We are currently reviewing old dental related blog posts and checking to ensure the information and hyperlinks are correct and up to date with the resources provided.  We are also ensuring the language and tone in which the post was written are appropriate.  We are attempting to have general dental health blogs in addition to holiday related ones with certain messaging (e.g., a Halloween related blog post to reduce the consumption of sticky, sugary sweets).

 

The Bureau of Oral Health and Dental Services is dedicating a considerable amount of effort and time towards drafting and garnering support to make changes to current Delaware legislation.  Encouraging dentists to practice in Delaware has been hindered by the requirement that “All applicants for Dentist licensure, regardless of years in practice, must pass the Delaware Practical Board Examination in dentistry and the Delaware Jurisprudence Examination.”  This test has often been an obstacle to encouraging dentist to practice in Delaware.  The first step to improving access was to remove the Delaware testing requirement for dentists who will be employed by a Federal Qualified Health Centers and the Bureau of Oral Health and Dental Services to make it easier to attract dentists for these organizations.  In May 2023, Senate Bill 28 was passed allowing for a new type of license for these organizations to bypass the Delaware Practical Board Exam. Below is a link to the legislation.

 

 

The Bureau of Oral Health and Dental Services has been working closely with the Redding Consortium and the Department of Education to pass legislation that will require all students entering kindergarten to receive a dental screening.  This legislation is significant because it will allow us to gather data for all students in kindergarten, provide a point for early intervention and improve dental literacy.  This bill passed the house on May 9, 2023, and is on the Ready List.  Below is a link to the legislation.

 

Dental Hygienists from the Bureau of Oral Health and Dental Services hosted 16 educational events at Delaware Public Libraires for Storytime.  Each session was one to two hours long.  Children are read a book about oral health, given an oral health activity and assistance is provided to families if they need help with finding a dentist, securing dental insurance or have dental questions.  In addition, two educational sessions were held about oral and systemic health.  The sessions included doctors and nurses from Christina Hospital.

 

Our Fluoride Varnish training program is active and currently being advertised.  This is a program where a BOHDS dental hygienist provides training to staff at pediatric medical offices for applying fluoride varnish during a well child visit for children under the age of five, who do not have a dental home.  Smile for Life courses are assigned prior to training to allow staff to ask any questions.  Topics such as, age of first dental visit, how to take care of teeth, bottle mouth, nutrition and appropriate dental supplies and toothpaste are discussed with staff.  All staff are given the BOHDS dental helpline phone number if they need assistance, or the families need to be connected to a provider or secure dental insurance.  After training is provided, the office is given a certificate indicating they completed the training.  BOHDS supplies infant and child toothbrushes and toothpaste as well as infant tooth wipes and education materials are distributed to the offices who are providing fluoride varnish.  To date, 5,681 dental education, toothbrushes and tubes of toothpaste have been distributed to pediatric medical offices for their patients.

 

BOHDS coordinated and participated two Special Olympics events during this reporting cycle.  This included dental screenings, education, and providing assistive devices for oral health products and instructions on use.  Over 100 participants received dental screenings and education and 46 participants required assistive devices for toothbrushing.  In addition, Reach out and Read is an early literacy program collaboration with oral health education.  BOHDS buys the books needed for this program, provides fluoride varnish training to staff who are participating, as well as supplying the oral health supplies.  During this past grant cycle, 1,000 Brush, Brush, Brush books were purchased and distributed by a dental hygienist.  We recently ordered an additional 3,000 books to continue with this partnership.

 

 

MCH continues to support BOHDS through expanding oral health information, messaging, and marketing on the Delaware Thrives website.  Between December 27th, 2022 – January 9th, 2023, DEThrives ran a single image newsfeed ad to promote the Delaware Smile Check program.  The ad targeted women aged 18-45 (since women usually schedule their family’s health appointments), new parent and parents of children aged 0-17 audiences who live in Delaware.  The objective was to maximize clicks to the Healthy Smiles program page.  There was an average 0.39% click through rate (the percentage of impressions that turn into views).  The last time there was a promoted dental post was back in May 2022 and that post received a 0.16% click through rate.  So, this ad far surpassed that previous number.  From this post, the Healthy Smiles program page earned 56 sessions with the average user spending 28 seconds on the site.  In terms of the social engagement metrics, the post earned 6 post reactions, 2 post saves, and 1 post share.

 

MCH has also helped build a lasting connection and relationship between CYSHCN and BOHDS.  Information has been shared to assist families with finding a dental provider.  The Delaware Smile Check Program has targeted schools that have many children with disabilities and collaborated with dental specialist that can meet the needs of the families for treatment.   As the transition of the Family SHADE project took place in October of 2021, the Family SHADE website continued to promote the Bureau of Oral Health and Dental Services (BOHDS) to expand their reach to the CYSHCN population by putting the BOHDS information on their Family SHADE website.  This continues to afford families easy access to dentists that are able to serve their CYSHCN.  Having the BOHDS information on the Family SHADE website continues to make it more convenient for families to access the dentists that will best serve their CYSHCN and eliminate them calling each dentist to ask if they can serve their child.