Child Health - Annual Report (FY 2018-19)
CHILD Priority Need: Improve the cognitive, physical and emotional development of all children (from 2015-20 plan)
Early identification of developmental, behavioral, and social delays in young children can increase the numbers of children receiving timely early intervention services, so they may develop to their fullest potential.
Child Objective 1:
With 2016 NSCH data, the NPM 6 denominator changed to children ages 9 through 35 months. For the updated NPM 6 measure, the aggregated 2017-18 NSCH showed that 25.9 percent (95% CI: 17.2-37.0) of children ages 9 through 35 months in California received a developmental screening using a parent-completed screening tool. Data survey cycles from 2016 and later were not comparable with previous NSCH surveys due to shifts in the survey’s sampling frame and mode of survey administration.
Child Objective 1: Strategy 1:
Collaborate with relevant partners to develop goals, objectives, and activities to improve rates of behavioral, social, and developmental screening for all children and youth, especially children ages 9 months through 35 months and at-risk populations.
California Statewide Screening Collaborative (SSC): CDPH/MCAH, including the California Home Visiting Program (CHVP), actively participated in the California Statewide Screening Collaborative (SSC). CDPH/MCAH contributed Title V and Maternal, Infant, and Early Childhood Home Visiting (MIECHV) funding for the Collaborative. The Department of Developmental Services (DDS) also contributed funding to the SSC. The SSC participants included representatives from CDPH/MCAH, DDS, Department of Health Care Services (DHCS) Medi-Cal Managed Care Quality and Monitoring Division, Medi-Cal Benefits, and Integrated Systems of Care Division), First 5 Association of California, First 5 California, California Department of Education (CDE), California Department of Social Services (CDSS), American Academy of Pediatrics-California, DHCS’s Indian Health Program, developmental-behavioral pediatricians, and child-focused non-profit organizations. Two large group SSC meetings were held during 2018-19 as well as leadership meetings (WestEd, CDPH/MCAH and DDS) and subcommittee meetings.
The Provider Developmental Screening Toolkit website (http://www.cascreenbto5.org/), developed by a subcommittee of the SSC, continued to be promoted by the SSC and the Interagency Coordinating Council. The Toolkit includes developmental and behavioral screening tools, sample workflow, billing and referral information, and national, state, and local resources. SSC presentations were also posted to highlight best practices and models, including successful efforts in Los Angeles and Orange County.
During spring 2019, CDPH/MCAH with input from WestEd developed a short article about the SSC’s healthcare provider developmental and behavioral screening website and shared the article with all four California AAP Chapters for inclusion in their newsletters to their AAP members.
The Deputy Secretary and Senior Advisor to the Governor on Early Childhood at the California Health and Human Services Agency shared information about the focus on early childhood in the Governor’s budget.
DHCS/Medi-Cal Managed Care Quality and Monitoring Division presented information on Proposition 56 and DHCS plans focused on developmental and trauma screening.
Women, Infant, and Children (WIC) Division: CDPH/MCAH met with the CDPH/WIC Division to explore ways that WIC could promote developmental screening and/or incorporate developmental monitoring at WIC sites. The Centers for Disease Control’s “Learn the Signs. Act Early.” resources and information about the downloadable app were shared with WIC as well as additional information about how another state WIC program has incorporated “Learn the Signs. Act Early.” materials in their workflow and WIC staff satisfaction.
The California Health Interview Survey (CHIS): CHIS is the nation’s largest state health survey and a critical source of health data on Californians. CDPH/MCAH had representation in the CHIS Children’s Technical Advisory Workgroup and the CDPH CHIS Users’ workgroup to recommend subject matter content for the child questionnaire.
CDPH/MCAH developed a proposal to utilize a question using the wording of the NSCH developmental screening question for CHIS for the 2019-20 CHIS cycle. Current CHIS developmental screening-related results are not directly comparable to NSCH results due to differences in questions asked, sampling methodology, and age of population.
According to CHIS 2018 data, 48.2% (95% CI: 36.0-60.5) of parents/guardians with children ages 1-3 years old in their household reported completing a Standardized Development and Behavioral Screening (SDBS) tool for their child. Data by race/ethnicity using pooled years (2016-2018) showed data variability across subgroups: multiple race 43.7% (95% CI: 24.6 - 62.8), Hispanic 45.4% (95% CI: 37.7 - 53.2), White 54.6% (95% CI: 42.6 - 66.6), and Asian 56.7% (95% CI: 35.2 - 78.3). Data were unstable for Black and American Indian/Alaska Native populations.
Results from the 2018 CHIS showed that 71.3% (95%CI: 61.6-81.0) of children aged 1-3 years old had a developmental assessment or test conducted by a doctor, other health provider, teachers or school counselors. Data by race/ethnicity using pooled years (2016-18) showed variability: Hispanic 59.1% (95% CI: 51.4 – 66.7), Asian 62.6% (95% CI: 43.1 – 82.2), and White 78.4% (95% CI: 67.0 – 89.7). Data for Black, American Indian/Alaska Native, and multiple race populations were statistically unstable so could not be reported.
The CDPH/MCAH California Home Visiting Program (CHVP) provided two evidence-based home visitation models: Healthy Families America (HFA) and Nurse Family Partnership (NFP). Each of the models followed a different curriculum, however the primary goals of the home visiting programs are to help ensure a healthy pregnancy and a healthy baby. CDPH/MCAH CHVP is not funded by Title V but receives federal Maternal, Infant and Early Childhood Home Visiting (MIECHV) funding and has recently received new state funding for expansion.
CHVP shared leadership of the HV-SIT (Home Visiting State Interagency Team) with the newly established CDSS California Work Opportunity and Responsibility to Kids (CalWORKs) Home Visiting Program. The two state home visiting programs share responsibility for agenda discussion topics and facilitation of quarterly meetings. HV-SIT participants included a CHVP NFP graduate and representatives from the following organizations and State departments: First 5 Los Angeles, First 5 California, Project LAUNCH, Family Resource Centers Network of California, Children Now, Alameda County Public Health Department, Nevada County Public Health Department, Department of Developmental Services, CDPH, California Department of Social Services, and California Department of Education.
In 2018-19, the Nurse-Family Partnership home visiting program enrolled 1,781 index children. Of the 821 eligible children aged 11-25.5 months, 764 (93.1%) completed at least one Ages and Stages Questionnaire-3 (ASQ-3) developmental screen.
In 2018-19, the Healthy Families America home visiting program enrolled 585 index children. Of the 266 eligible children aged 11-25.5 months, 262 (98.5%) completed at least one ASQ-3 developmental screen (98.5%).
CHVP collected information about children who were read to, told stories to, and/or sang songs with every day during a typical week. This information is obtained by interviewing the parent and recording the response in a form. The results for 2018-19 were the following:
HFA: of the 584 eligible children, 410 (70.2%) were reported to be read to, told stories to, and/or sang songs with every day during a typical week.
NFP: of the 1,771 eligible children, 1,245 (70.3%) were reported to be read to, told stories to, and/or sang songs with every day during a typical week.
CHVP total: of the 2,355 eligible children, 1,655 (70.3%) were reported to be read to, told stories to, and/or sang songs with every day during a typical week.
American Indian Maternal Support Services (AIMSS): CDPH/MCAH funds the DHCS Indian Health Program (IHP) to fund the clinics providing AIMSS services using Title V funding. Prior to this funding cycle the IHP completed a community stakeholder process with the goal of improving California American Indian/Alaska Native perinatal health. This groundwork resulted in the IHP providing funding for four grantees to secure staffing for perinatal case management services and maternal-child home visitation. The resulting Scope of Work required grantees to address perinatal health by providing case management services from pregnancy throughout the first year of the infant’s life and to develop goals, objectives, and activities to improve rates of behavioral, social, and developmental screenings. The program is planning to conduct developmental screening and promote child health through developmentally appropriate play, reading, singing, and positive parenting. Lessons regarding learning to read infant behavioral cues and the need to respond promptly to reassure and calm the infant are also included.
DHCS Medi-Cal Managed Care: CDPH/MCAH supported the DHCS/Medi-Cal Managed Care Quality and Monitoring Division by sharing information about their developmental screening and child health quality initiatives, including implementation of all the CMS Core Child Measures (e.g., developmental screening and well-child visits) as well as upcoming 2020 reimbursements to Medi-Cal health care providers for developmental screening and trauma screening. Information about the new DHCS initiatives was shared at Statewide Screening Collaborative meetings as well as through the MCAH newsletter, which is sent to the MCAH Directors and Coordinators in the 61 local health jurisdictions. The upcoming reimbursements for reporting developmental and trauma screening may have the added benefit of improving health care providers’ historically inconsistent reporting to health plans as well as a potential additional data source on developmental screening rates for Medi-Cal clients at the local level. Medi-Cal providers who complete a certified training on toxic trauma and Adverse Childhood Event screening, will be able, starting in 2020, to directly receive Medi-Cal enhanced reimbursement for screening children for traumatic experiences and toxic stress.
Evidence-based and evidence-informed practices utilized for this strategy:
Programs (NFP, HFA, and AIMSS) use validated developmental screening tools recommended by AAP’s Bright Futures (e.g., ASQ-3) to assess children in the areas of communication, gross motor skills, fine motor skills, problem solving, and personal-social skills to identify children that would benefit from further evaluation for developmental delays.
CDPH/MCAH programs used evidenced-based models of home visiting (NFP, HFA).
AIMSS used Family Spirit (FS), an evidence-based home visitation model designed by the John Hopkins Center for American Indian Health that provides education and support to American Indian families in their homes during the first year of the child’s life.
AIMSS grantees were trained on the evidence-informed California Perinatal Services Program (CPSP) model for their pregnant American Indian women.
Challenges for this strategy:
Although developmental screening was added as a Medi-Cal managed care quality measure, the fact that it is not a HEDIS measure does not allow a comparative national measure to be used as a minimum performance measure for the health plans at this time.
The role out of eWIC limited any additional staff time for assessment and planning to consider possible incorporation of developmental monitoring within WIC programs. CDPH/MCAH will contact CDPH/WIC to meet again after the roll-out of eWIC is complete.
Challenges within AIMSS in attaining this strategy during this funding period included program start-up, unexpected delays in recruiting the necessary staff, developing policies and procedures, and establishing Memoranda of Agreement with community partners.
Collaboration with community agencies at the local level can sometimes be challenging for CHVP due to competing priorities.
Child Objective 1: Strategy 2:
Collaborate with relevant partners to develop goals, objectives, and activities to strengthen systems to improve referrals and linkage to needed services for all children and youth, especially children birth through five years and at-risk populations.
American Indian Maternal Support Services (AIMSS): AIMSS grantees were able to use funding to train Registered Nurses on the CPSP model. Grantees were able to train Registered Nurses and home visitors to use the Johns Hopkins Family Spirit training. Both models address early intervention services for children.
California Home Visiting Program (CHVP): Local CHVP sites are well connected within their local early childhood systems. CHVP has a System Integration Policy to provide guidance to local CHVP sites on the development and maintenance of a Community Advisory Board (CAB) that promoted a community support system for home visiting programs and the local early childhood system of services. Local CHVP sites convened a CAB that served in a consultative and/or governing capacity in the planning and implementation of program-related and systems-integration activities. This included collaboration with Regional Centers, schools, hospitals or any local agency that provided services to children with behavioral, social, and developmental needs.
During the 2018-19 fiscal year, CHVP focused on improving the referral process at the LHJ sites and integrated the topic of Screening and Referrals into quarterly CHVP Technical Assistance (TA) calls with LHJs to continue to improve developmental screening rates and referrals. Through these, CHVP learned site-level processes and system challenges that affected developmental screening and referral completion rates. CHVP used the tools developed the previous year - Decision Trees and the Referrals-to-Services Tracking Report - and provided guidance through TA calls and webinars. The tools used are the following:
- Decision Trees: Provide instructions to home visitors for completing the required forms. They help home visitors understand how to report their referral efforts accurately in the data management system.
- Referrals-to-Services Tracking Report: Developed so local teams could use their data to identify opportunities to improve their referral process and follow-up on outstanding referral.
The supervisors reinforced that home visitors use the Decision Trees and used the Referrals-to-Services Tracking Report to monitor positive screens.
California Statewide Screening Collaborative (SSC): SSC work related to referrals and linkage to needed services, included:
- Presentation to SSC members on a screening registry through Help Me Grow Orange County.
- SSC’s one-page Part C eligibility reference tool addressing who could be referred to Part C early intervention services directly from the birthing hospitals was finalized and shared with our SSC members and CPQCC partners.
In partnership with Early Start directors and SSC volunteer members, a survey was created to evaluate the feedback loops between Primary Care Physicians (PCP) and Regional Centers. The report was disseminated at the cross-organizational SSC meeting. Of the 17 Regional Center responses, 53% provide primary care providers with some degree of feedback, usually (75%) with a letter after obtaining parental consent. The type of feedback provided includes qualification for Early Start Services (89%), ineligible for Early Start Services (78%), developmental documentation supporting eligibility determination (44%), requests for follow-up from PCP regarding formal services, parent no show/cancellation of appointment (33%), specific services offered to family (22%), parental refusal of recommended services (22%), and inability to contact family (22%).
A new state agency workgroup of the SSC was formed to examine workforce issues that had been expressed at prior SSC meetings related to new California initiatives on developmental and trauma screenings. The workgroup met and identified the need for more resources and additional workforce capacity for mental, behavioral, and developmental assessment and services (particularly related to social-emotional concerns and trauma issues identified). The workgroup is planning to collect data to document screening issues and referral availability; identify barriers, challenges, and potential strategies to improve screening and referrals; and compiling resources that support screening efforts in communities.
Medical Investigation of Neurodevelopmental Disorders (MIND) Institute: CDPH/MCAH participated in planning and attended the annual MIND Summer Institute on Neurodevelopmental Disorders at the University of California, Davis. A concerted effort to outreach to families, including scholarships and a family track was included in this year’s Summer Institute. Presentations included:
- Visual supports and social narratives: strategies for supporting positive behavior in the home and community
- Brothers and sisters of people with disabilities: unique concerns, unique opportunities
- All means all: Equity and access for all students through a multi-tiered systems of support framework (Collaboration with Orange County Department of Education in partnership with CDE, Butte County Office of Education, and the SWIFT Educational Center) about their focus on the whole child through academic supports, social-emotional learning, and behavior systems.
Evidence-based and evidence-informed practices utilized for this strategy:
See Objective 1: Strategy 1
Challenges for this strategy:
There were reported delays after a child was noted to be at risk for developmental delay to receive an initial evaluation through the Regional Centers.
Health care providers reported long waits after referral to early intervention and lack of feedback regarding their referral.
Challenges within the AIMSS program during this period included delays in program start-up, recruiting key clinic staff, developing policies and procedures, and establishing Memoranda of Agreement with community partners.
Child Objective 1: Strategy 3:
Provide technical assistance to MCAH programs to implement their SOW, promote the use of Birth to 5: Watch Me Thrive! or other appropriate materials, develop protocols to screen and refer, all children in MCAH home visiting or case management programs to early intervention services and develop quality improvement plans to ensure CYSHCN are identified early and connected to needed and ongoing services.
Adolescent Family Life Program (AFLP): Case managers worked with youth and their children to complete child developmental screening by:
Providing child development and parenting education, including the use of validated early childhood developmental screening tools (e.g. ASQ, ASQ SE), education on positive parenting, linkage to preventive and primary care for the young parent and their child(ren), and linkage to early intervention support services when indicated.
Providing anticipatory guidance and education regarding child development and well child visits.
Modeling positive parenting skills and strategies for scaffolding child development, providing related educational materials and resources, and referring youth to parenting classes.
The AFLP team worked toward aligning program activities with other CDPH/MCAH programs to ensure consistency and integration of best practices.
The AFLP utilized evidence-based and evidence-informed materials and practices when possible in supporting youth and their children in the program. Some AFLP sites utilized Triple P Positive Parenting Program, the ASQ and the ASQ SE. Some AFLP sites participated and collaborated with locally organized Birth to 5: Watch Me Thrive! and First 5 efforts
Black Infant Health (BIH): Pregnant and postpartum BIH participants received information on child development in session 12 of the BIH curriculum. During 2018-19, 302 participants attended session 12, and 143 participants received referrals for child development/early intervention. The curriculum provided an overview of brain development, the role that parents play in infant brain development, discussion of developmental milestones with CDC’s “Learn the Signs. Act Early.” handout, and discussion of developmental screening with a standardized tool with their doctor during well-child visits. In session 13, effective parenting skills within the African American culture were covered. Participants also worked with their Family Health Advocate to cope with stressors, discuss concerns with their health care provider, and help them navigate through systems to receive the resources that they needed. BIH has added language to its SOW to promote “Birth to 5: Watch Me Thrive!”
California Perinatal Services Program (CPSP): CDPH/MCAH developed a one-page summary on infant and early childhood developmental milestones and the importance of both monitoring using resources such as CDC’s “Learn the Signs. Act Early.” materials and mobile app as well as formal developmental screening at 9-, 18-, and 30-months and autism-specific screening at 18- and 24-months. This summary and a handout on CDC’s milestone tracker app was included in CPSP’s Steps to Take manual for CPSP providers.
Evidence-based and evidence-informed practices utilized for this strategy:
Birth to 5: Watch me Thrive
The AFLP utilized evidence-based and evidence-informed materials and practices when possible in supporting youth and their children in the program. Some AFLP sites utilized Triple P Positive Parenting Program, the Ages and Stages Questionnaire (ASQ) and the ASQ Social Emotional (SE).
Challenges for this strategy:
Understanding appropriate developmental milestones for their baby can be a challenge for families. Some BIH participants stated that they did not feel as though they were being listened to by doctors and aren’t receiving comprehensive information about their child’s development. BIH plans to address this by assisting moms to advocate for themselves at doctor appointments. BIH also assisted mothers to overcome this challenge by providing families with information and bringing in guest speakers on challenging topics.
The AFLP team worked toward aligning program activities with other MCAH programs to ensure consistency and integration of best practices across sites. However, local partnerships and collaborations varied across sites, leading to inconsistent practices.
Child Objective 1: Strategy 4:
Assist MCAH LHJs to implement developmental screening, referral and appropriate linkages for all children using a parent-completed validated screening tool; provide technical assistance to improve provider, family and community outreach, and develop centralized telephone access and data collection processes.
CDPH/MCAH sponsored a webinar, coordinated by our MCAH contractor, UCSF Family Health Outcomes Project (FHOP), for local MCAH programs on Behavioral Health Services for Children and Adolescents – Perspectives of California Pediatricians, based on a survey sent to American Academy of Pediatrics, Chapter 1 members, for MCAH Directors and Coordinators and other stakeholders. The webinar provided necessary and helpful information regarding access to mental and behavioral health care at the county level (including barriers to care) and the relationship between primary and pediatric care and mental and behavioral health screening and/or intervention.
LHJs were required to follow AAP guidelines for developmental screening, promote AAP-recommended preventive visits, and to adopt protocols/policies to screen, refer, and link all children in MCAH home visiting and case management programs. LHJs were encouraged to collaborate with partners that have an interest in this work in order to leverage resources and create systemic, collective impact changes. LHJs conducted activities to improve rates of developmental screening and improve timely early intervention for children with developmental delays. Examples included:
Alameda County – “Starting Out Strong” program required developmental screening at recommended intervals during preventive medical visits. The program tracked the following measures: receipt of developmental screening, the referral of children who screen positive to services, and the receipt of treatment services. Alameda County’s MCAH Director was a member of the Help Me Grow committee, which promoted systems coordination to improve developmental screening rates and access to developmental services for children. The Help Me Grow phone line connected community members to needed services while following up to ensure families follow through with referrals. Help Me Grow continued to support health care providers to increase screening numbers. 581 children received developmental screening through Help Me Grow in Alameda County of which 70 children screened positive and completed a follow-up visit with their primary care provider while 100 children were screened positive and referred and linked to services.
El Dorado County – The “Community Hub Health” program engaged parents, provided linkages to community resources, promoted health through educational materials and assessments for clients, and screened clients from ages 0-5 years for developmental delays, as needed. El Dorado County worked closely with First 5 and the County Office of Education to promote the routine use and promotion of ASQ and ASQ SE in children 0-5 years. More comprehensive developmental assessments were completed for children suspected of being delayed, and children with delays were enrolled into early intervention services by PHNs. In 2018-19, El Dorado began surveying medical providers in order to see what developmental screening tools were being used and the periodicity in application. PHNs continuously provided education on PHN developmental monitoring, developmental screening, and linkages to services for private practice pediatricians. 178 children received developmental screening in El Dorado County of which 90 children screened positive and completed a follow-up with their primary care provider and 68 children were referred and linked to services.
City of Long Beach– Developmental monitoring and screenings using ASQ tools were performed on all MCAH families and children who were assigned and case managed by PHNs. A referral process to the Harbor Regional Center for those identified with positive screenings was established. Long Beach works with Medi-Cal health plans to identify barriers to screening, referral, and linkage to assist health plans in increasing developmental screening for their members, per AAP guidelines, through education, provider feedback incentives, and quality improvements. Long Beach screened 43 children for developmental delays of which 35 children screened positive and completed a follow-up visit with their primary care provider while 35 children were referred and linked to services.
Based on a 2018-19 survey of LHJs (with 60 of 61 LHJs responding), adoption of the core components of Help Me Grow by 61 LHJs was reported as follows:
- 53 LHJs had an updated resource directory for families with children at risk for developmental or behavioral health concerns
- 46 LHJs had educational or informational materials targeting medical providers to conduct developmental screening
- 42 LHJs maintained a designated phone number, warm line or hotline for parents/guardians, pediatricians, social service agencies or organizations to call
- 38 LHJs collected information on the number of children that have been screened for behavioral or developmental concerns and linked to services
- 52 LHJs have adopted at least two of the components of the developmental screening protocol
In the 2018-19 Year End survey, CDPH/MCAH assessed the types of resources and services available in local communities to screen children for developmental and behavioral health concerns. Forty MCAH LHJs reported that 4,214 children who screened positive for developmental or behavioral concerns were linked or referred to services.
Challenges for this strategy:
Some LHJs lacked the resources and capacity to fully implement these policies.
Staff turnover and limited local Title V staffing to address child health made it difficult to implement child health-related SOW activities fully or in a comprehensive way.
LHJs continued to hear that providers were reluctant to screen for developmental delays due to barriers to referrals for additional evaluation, including lack of local resources, long waiting time for services, or limited knowledge of where to refer a child who screened positive.
Child Priority Need: Increase access and utilization of health and social services (from 2015-20 plan)
Child Objective 2:
By June 30, 2020, increase the rate of children ages 1-17 years who received a dental visit in the last year from 78.1% (2016/17 NSCH) to 79.1%.
Based on NSCH 2017-18 the percent of children ages 1 through 17 years who had a preventive dental visit in the past year was 82.0%, of which 79.9% (95% CI: 75.6-83.6) saw a dentist, and 2.0% (CI: 1.0-4.1) saw another health care provider. This objective was updated this year since the prior objective used 2011-12 NSCH data as its baseline. Due to changes in the survey’s mode of data collection and sampling frame, as well as adjustments to item wording for the NSCH, results from surveys prior to 2016 are not directly comparable. The 2011-12 NSCH asked parents to report the number of preventive dental visits during the past 12 months, and the response was reported as a continuous number. Response options were reported as categorical (No visit, 1 visit or 2 or more visits) in the 2016 NSCH.
Child Objective 2: Strategy 1:
Under the guidance of the CDPH State Dental Director, MCAH and the Office of Oral Health (OOH) will collaborate to implement the State’s Oral Health Plan to identify priorities, goals, objectives and key strategies.
CDPH/MCAH supported the CDPH/OOH by participating on their Oral Health Advisory Committee. The development of the California Oral Health Plan (COHP) was led by the CDPH State Dental Director along with input and participation by the Oral Health Advisory Committee with a wide variety of oral health stakeholders. The COHP informed the development of a work plan that outlines the steps and processes for improving the oral health of all Californians and achieving oral health equity. A two-year work plan based on COHP priorities was developed through 2020. Each of the 59 Local Oral Health Programs (LOHPs) will develop a Community Health Improvement Plan (CHIP), an action plan and evaluation plan per the Scope of Work to address the oral health needs of underserved areas and vulnerable population groups for the planning and implementation phases to achieve the state oral health objectives. About 32 LOHP’s have submitted an approved CHIP.
Evidence-based and evidence-informed practices utilized for this strategy:
Several evidence-based or informed practices will be used within the Local Oral Health Programs, including: community water fluoridation, school-based/school-linked programs, promotion of dental sealants, promotion of first dental visit by age 1, and increasing access to fluoride varnish application by non-dental providers.
Challenges for this strategy:
CDPH/OOH’s limited staffing was a challenge to roll out the new program. CDPH/OOH had to develop the funding procurement process and execute 59 contracts in a short period of time. Once LOHPs were funded they experienced delays due to similar challenges to hiring staff. In addition, most of the LOHPs did not have staff with experience working in oral health.
Child Objective 2: Strategy 2:
LHJ staff informs all eligible and enrolled clients of currently available dental benefits offered by Medi-Cal promote the dental promote the dental home and Medi-Cal warm transfer service through 1-800 customer service phone number or other referral services.
CDPH/MCAH supported CDPH/OOH efforts to promote the dental home and access to Medi-Cal dental services. DHCS Medi-Cal’s Dental Program’s “Smile, California” representatives have provided information and resources to promote Medi-Cal Dental services and finding a dental home to the LOHPs. LOHP’s have implemented activities such as providing training for community partners to ensure robust knowledge of transportation options to access oral health services. In addition, a majority of LOHP’s will address the following activities: establishing care coordination, referral, and navigation support, single-point-of entry to dental homes, and working with oral health providers to accept a certain number or percent of Medi-Cal dental service patients annually.
CDPH/OOH supported oral health and primary care integration and the Medical Dental Services Program Dental Transformation Initiative to increase access to care, identify and treat dental disease and incentivize continuity of care for the approximately 5 million children enrolled in the Denti-Cal program. Local Dental pilot programs initiated a Virtual Dental Home (VDH) an innovative teledentistry model to increase access, improve health outcomes and cut costs. In order to leverage efforts CDPH/OOH, collaborated with CDPH/MCAH to identify priorities, leverage resources at the local level, and defined state roles and limitations of local resources.
Adolescent Family Life Program (AFLP): AFLP case managers continued to work with youth in the program to assess needs, provide education, and link the youth and their children to medical and oral health services as needed. One AFLP agency (Altamed) provided “Baby and Me” dental screenings for AFLP participants and their child(ren) onsite to streamline access to care.
Evidence-based and evidence-informed practices utilized for this strategy:
These oral health strategies are recommended by the American Academy of Pediatric Dentistry, Bright Futures in Practice: Oral Health, and the Centers for Medicare & Medicaid Services (CMS).
AFLP Case Managers use motivational interviewing techniques to support goal setting around access to care.
Challenges for this strategy:
State funding for CDPH/OOH was approved in August 2019. The CDPH/OOH had limited staff during 2018-19 and has been working to fill the new positions to build capacity.
Child Objective 2: Strategy 3:
Under the guidance of the CDPH State Director, MCAH and OOP will collaborate to implement the newly funded Local Oral Health Programs and pursue a coordinated system involving various State Programs that serve children’s dental needs.
CDPH/MCAH met monthly with CDPH/OOH to coordinate and collaborate efforts, including providing updates on program progress to identify areas for program planning and future activities. CDPH/OOH worked with partners to promote oral health by developing and implementing prevention and healthcare policies and guidelines for programs, health care providers, and institutional settings (e.g., schools) including integration of oral health care and overall health care.
CDPH/OOH provided funding for CDPH/MCAH’s Maternal Infant Health Assessment (MIHA) survey to fund questions that will help to determine progress in priority oral health areas. MIHA will be used for ongoing state and local surveillance of oral health services for pregnant women in California.
Evidence-based and evidence-informed practices utilized for this strategy:
To accomplish this Objective, LOHPs can choose the following evidence-based or best practice strategies: convene partners (e.g., First 5, Early Head Start/Head Start, Maternal Child and Adolescent Health (MCAH), Child Health and Disability Prevention (CHDP), Black Infant Health (BIH), Denti-Cal, Women, Infant and Children (WIC), home visiting, schools, community-based organizations, etc.) to improve the oral health of 0-6 year old children by identifying facilitators for care, barriers to care, and gaps to be addressed; and/or increase the number of schools implementing the kindergarten oral health assessment by assessing the number of schools currently not reporting the assessments to the System for California Oral Health Reporting (SCOHR), identifying target schools for intervention, providing guidance to schools, and assessing progress.
Challenges for this strategy:
The LOHPs are completing their planning phase and will enter the implementation phase in the next fiscal year. About half of the local programs experienced a delay of building capacity, putting them about 6 months behind. Most of the delays were attributed to the process of hiring in their local health jurisdiction. All local programs are currently staffed and a majority are now fully staffed.
The state AFLP team was not able to provide local AFLP sites with information and share resources regarding the newly funded Local Oral Health Programs but will consider what opportunities exist in the current year.
Child Priority Need: Increase the proportion of children, adolescents and women of reproductive age who maintain a healthy diet and lead a physically active lifestyle (from 2015-20 plan)
Child Objective 3:
By June 30, 2020, reduce the proportion of WIC children aged 2-4 years who are overweight or obese from 34.5% (WIC PC 2012) to 33.5%.
In 2016, 30.9% of children two through four years of age enrolled in WIC were overweight or obese.
Child Objective 3: Strategy 1:
Improve capacity for nutrition and physical activity for children through collaboration and technical assistance, especially by sharing science-based resources such as new nationally recognized guidelines and initiatives as well as trainings and funding opportunities with LHJ MCAH directors and MCAH funded program contacts.
CDPH/MCAH partnered with UCLA through their MCHB funded technical assistance to promote Policy, Systems and Environmental change for nutrition and physical activity. CDPH/MCAH provided links to training to WIC, LHJs, Indian Health, and CDPH Nutrition Education and Obesity Prevention Branch (NEOPB).
CDPH/MCAH partnered with CDPH/NEOPB, WIC, DHCS Integrated Systems of Care, and Emergency Medical Services Authority (EMSA) to promote national guidelines on weight, nutrition, and physical activity for young children. CDPH/MCAH disseminated information and tools through key partners to help low-income children meet the Dietary Guidelines for Americans. California promoted and provided updates to the EMSA Childcare Nutrition web page that CDPH/MCAH was a partner in developing through a CoIIN process. CDPH/MCAH partnered with other CDPH programs to update links and resources, including new data links on the MCAH/Nutrition and Physical Activity (NUPA) initiative page, including the Systems and Environmental Changes toolkit to support optimal nutrition, physical activity, and breastfeeding through fostering partnerships between LHJ MCAH programs and existing organizations to promote healthy environmental changes.
CDPH/MCAH promoted a two-question validated screening tool for food security as recommended by AAP to our MCAH programs (e.g., CHVP, BIH, AFLP, CPSP) and WIC. The questions were adopted by CPSP and WIC. MCAH promotes and will continue to promote “Rethink Your Drink” and “Healthy Snack” days in monthly mailings by our communications team.
Adolescent Family Life Program (AFLP): The AFLP state team continued to provide education, resources for case management, and technical assistance related to nutrition and physical activity for children and youth, including sharing science-based resources. AFLP case managers continued to support expecting and parenting youth with leading physically active lifestyles through education, referrals and goal setting regarding nutrition, physical activity and breastfeeding. Through one-on-one education, referrals and goal setting, case managers provided evidence-informed and medically-accurate materials to raise awareness and support youth with promoting their health and wellbeing. AFLP case managers continued to make referrals to WIC as needed to support healthy nutrition for themselves and for their child(ren). Additionally, MCAH shared WIC handouts, such as “Healthy Choices for Kids!,” with local AFLP agencies.
Evidence-based and evidence-informed practices utilized for this strategy:
Hawkins J, R. A. The Built Environment; Association of Maternal and Child Health Programs: 2012.
Lyn R, Aytur S, Davis TA, et al. Policy, systems, and environmental approaches for obesity prevention: a framework to inform local and state action. J Public Health Manag Pract. 2013;19:S23‐S33. 10.1097/PHH.0b013e3182841709. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4943076/
Khan LK, Sobush K, Keener D, et al. Recommended community strategies and measurements to prevent obesity in the United States. MMWR Recomm Rep. 2009;58(RR-7):1–26.
Centers for Disease Control and Prevention. Strategies to Prevent Obesity and Other Chronic Diseases: The CDC Guide to Strategies to Increase Physical Activity in the Community. Atlanta: U.S. Department of Health and Human Services; 2011.
U.S. Department of Health and Human Services. Physical Activity Guidelines for Americans, 2nd edition. Washington, DC: U.S. Department of Health and Human Services; 2018.
U.S. Department of Health and Human Services and U.S. Department of Agriculture. 2015–2020 Dietary Guidelines for Americans. 8th Edition. December 2015. Available at http://health.gov/dietaryguidelines/2015/guidelines/.
AFLP case managers use motivational interviewing techniques to support behavior change.
Challenges for this strategy:
Nutrition is a strong component of the California MCAH Division, yet there is only one registered dietitian/public health nutritionist. To build capacity and consider succession planning, the MCAH nutritionist offered nutrition related educational opportunities to MCAH staff and has brought a number of MCAH staff into the Association of State Public Health Nutritionists.
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