2019 Child Health Annual Report

The Child and Adolescent Health (CAH) Section continues to provide services for children from birth to adolescence through the delivery of program activities, section initiatives, and collaborations with intra-agency departments such as WIC and federally-funded home visiting programs. 

Priority Need:  Developmental Screening

NPM 6: Percent of children, ages 9-35 months, who received a developmental screening using a parent-completed screening tool in the last year.

The most recent federally available data (2018) on the percent of children, ages 9-35 months, who received a developmental screening using a parent-completed screening tool in the last year indicates the following:

• 21% of children ages 9-35 months completed a developmental screening

Strategy 6.1: Developmental Milestone Education

The Arkansas Department of Health (ADH) continues to provide education on early supports to new parents. The agency promotes the use of the CDC’s Milestone Tracker app (https://www.cdc.gov/ncbddd/actearly/milestones-app.html). The app provides parents with information on how their child should develop during early years, birth to age five. Parents who request a birth certificate for a child under the age of three years will receive a letter from the Child and Adolescent Health Medical Director about the Milestone Tracker app as well as information about toxic stress, breastfeeding, safe sleep, and how to locate a primary care physician. Additional educational material for parents is available on the CAH website, https://www.healthy.arkansas.gov/programs-services/topics/parent-support. During 2019, immediate access to birth certificates became available in each of ADHs local health units. Prior to this, parents had to request birth certificates from the ADH Central Office. As a result of this change, the Vital Records department distributed 9,221 developmental milestone letters with birth certificates in 2019 and the parent support webpage received 522 views from 465 first time visitors.

Strategies 6.2, 6.3, and 6.4: Adverse Childhood Experiences

The CAH Section did not meet expectations regarding adverse childhood experiences (ACEs) education and screening because the CAH Medical Director, an ACEs content expert, resigned in 2019. However, staff continued to support and promote awareness of ACEs on the CAH website (https://www.healthy.arkansas.gov/programs-services/topics/adverse-childhood-experiences). The CAH staff also participated in the state’s ACEs/Resilience workgroup and promoted the School Based Mental Health program’s ACEs educational opportunities.

Strategy 6.5: Developmental Monitoring

The ADH’s WIC program replicated the delivery of the developmental monitoring pilot at three sites (Faulkner, Bradley, and Pulaski-North Little Rock local health units) using the CDC’s Learn the Signs Act Early checklist. In 2019, the parents of 54% (912/1692) of WIC certified infants at the pilot sites completed a developmental checklist that asked about their child’s progress in reaching developmental milestones. As a result, 13% of those infants were referred to a provider (primary care physician or the state’s First Connections early intervention services) for additional assessment. First Connections reported receiving 17 referrals and creating six individual family service plans as a result.

The WIC program also continued implementation of the Baby and Me program. This parenting program focuses on strengthening the parent-child relationship, promoting healthy child development, and connecting parents to community resources in WIC clinics. Parent Support Mentors meet with interested families during WIC clinic certification visits to provide brief learning sessions. The sessions include facilitated mother-child interaction time, which is focused on enhancing secure attachment and reinforcing hospital and primary care physician education. Parents can receive six education sessions during WIC certification visits: All Babies Cry (preventing abusive head trauma), Routine Child Care, Depression and Stress, Monitoring Home Safety, Preparing for Discipline, and Developmental Milestones.

Arkansas’s Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program served 2,490 children (divided equally between male and female during 2019). English was the primary language spoken in the home amongst 80% of participants followed by Spanish (14%). Most children served by the MIECHV program (82%) received the last recommended well-child visit based on the American Academy of Pediatrics schedule. Eighty-five percent of children were screened for a developmental delay using a validated parent-completed tool, and almost one-third (32%) of the households served had a child with a developmental delay or disability. These families were referred for treatment services and connected to resources.

Priority Need:  Injury Hospitalization

NPM 7: Rate of hospitalization for non-fatal injury per 1000,000 of children ages 0-9 and adolescents 10-19.

The most recent federally available data (2018) on the rate of hospitalization for non-fatal injury per 100,000 children ages 0-9 and adolescents 10-19 indicates the following:

• 98.2 per 100,000 children ages 0-9 were hospitalized
• 227.4 per 100,000 adolescents ages 10-19 were hospitalized

Strategy 7.1: Reports of Child Maltreatment in Home Visiting Programs

In 2019, 6.5% (140/2168) of families in home visiting programs reported child maltreatment. Arkansas’s MIECHV program implements four evidence-based (Health Families America, Home Instruction for Parents of Preschool Youngsters (HIPPY), Nurse-Family Partnership, and Parents as Teachers) and one promising (Following Baby Back Home) home visiting models. Although each home visiting model works with a specific population and provided targeted care, each model also promotes positive parenting skills, helps parents become self-sufficient, and addresses maternal and child health issues that may create significant cost savings for the state. Additionally, home safety assessments are completed every six months to reduce risk of injuries in the home and provide educational interventions for increasing safety as needed.

Strategy 7.2: Shaken Baby Syndrome Education

In 2019, a total of 21,890 Shaken Baby Syndrome brochures were distributed to local health units, birthing hospitals, and child care centers by the CAH. The brochure provides education from the All Babies Cry curriculum on the dangers of abusive head trauma (https://www.healthy.arkansas.gov/programs-services/topics/child-adolescent-health). Home visitors and parent support mentors also use the All Babies Cry material when educating new parents about how to calm a crying baby.  

The Injury Prevention Center at Arkansas Children’s Hospital continued multiple programs in 2019. The Center uses data from the state’s Infant and Child Death Review (ICDR) along with hospital admission trends to inform program activities, including:

• Safety Baby Showers provide education about safe sleep, abusive head trauma, drowning, motor vehicle safety, and other injury risks for baby’s first year of life to new and expectant parents. The Period of Purple Crying app is discussed with participants to address shaken baby syndrome prevention. The program is working to expand efforts to partner with the state’s Nursery Alliance to get hospitals trained to deliver safety baby showers and car seat education. The Safety Baby Shower guide was revised to simplify the message and target safe sleep messaging. The guide is available in English and Spanish.
• Motor vehicle safety presentations were delivered to provide child passenger safety education and the use of car seats from birth to age 8 or 9 when booster seats can be used. A TWEEN motor vehicle safety program, which promotes riding in the back seat and using the seatbelt, is being pilot tested with target children between the ages of 8 to14.
• Drowning prevention efforts continued. The Injury Prevention Center partnered with Safety Before Skill to reach out to pediatricians and provide drowning education messaging and swim classes. The Center also distributed lifejackets at community events.
• Statewide Suicide Campaign created prevention resource packets. To date, 10% of schools that received an informational card stating the packets were available have asked for a copy of the packet. Suicide prevention messaging from the American Foundation for Suicide Prevention was displayed on seven billboards in rural areas statewide.
• Statewide Safe Sleep Campaign promoted the ABCs of Safe Sleep (babies should sleep Alone, on their Backs, and in a Crib) messaging on seven billboards in rural areas statewide. An insert with language about the safety of pack n’ plays was added to the state’s ABC brochures.

Priority Need:  Preventive Dental Visit

NPM 13: Percent of children ages 1 through 17, who had a preventative dental visit in the past year.

The most recent federally available data (2018) on the percent of children, ages 1 through 17, who had a preventive dental visit in the last year indicates the following:

• 72% of children, ages 1 through 17, had a preventative dental visit.

The ADH Office of Oral Health works to promote early detection and treatment of dental disease by increasing awareness of the importance of routine oral health care. The Office of Oral Health collaborates with community partners to assist in providing preventative dental services to children including topical fluoride and dental sealants.

The Office of Oral Health developed the Paint a Smile program to increase access to preventive dental care and close gaps for children without regular access to comprehensive dental care. Access to care is inhibited because a high proportion of the state’s 75 counties do not have dental practices. This program provides opportunities for medical personnel to receive training so they can complete risk assessments, apply fluoride varnish, and deliver education about the importance of routine dental care. During the project period, 92 local health units provided 8,288 risk assessments, oral screenings, and fluoride varnish applications to children between the ages of first tooth eruption through 18 years of age. Additionally, 5,084 third grade students, ages of 7 through 11, received the CDC Basic Screening Survey (tool for obtaining data for an oral health surveillance system) and 487 elementary students received screenings via a CDC contracted school-based sealant program.

The Office of Oral Health also supports the Future Smiles Dental Clinic, which is located at the Wakefield Elementary School in Little Rock (Pulaski County). The clinic provides comprehensive dental services to children who do not have dental insurance and who attend a school within the Little Rock School District. Services include annual dental screenings, sealants, fluoride varnish, and restorative care. During the 2019 – 2020 school year, 890 students made 1,027 visits to the clinic and 2,033 screenings were completed. As a result, 118 children received sealants, 569 untreated caries were identified, 32 students received an urgent referral for care, and 548 students received an early referral for care. Screenings also indicated 34% (734) students had sealants present.

Arkansas Children’s Hospital coordinates with community stakeholders to provide preventive dental services to underserved populations in each of the five public health regions. There are 79 regional sites that partner with local dentists and schools to offer a program that provides preventive dental sealants and oral health education. In 2019, the Dental Sealant Program screened 7,884 students and provided 6,589 sealants for 2,174 students.

Priority Need:                      Adequate Insurance

NPM 15:                               Percent of children ages 0-17 who are continuously  

  and adequately insured

The most recent federally available data (2018) on the percent of children ages 0 through 17 who are continuously and adequately insured indicates the following:

• 70% of children ages 0 through 17 reported adequate insurance

Strategy 15.1: Health Insurance Coverage in Home Visiting Programs

Arkansas’s MIECHV program continues to promote continuous and adequate insurance for children. Families participating in a home visiting program receive assistance connecting to appropriate services. As a result, MIECHV reported 84% (996/1186) of pregnant and parenting mothers and children in home visiting programs were insured.

Strategy 15.2.: Decreasing the Number of Children without Health Insurance

The CAH Section programs continue to promote the importance of every child having access to health insurance. The state’s ARKids First program provides health insurance coverage to over 70,000 children. This coverage enables children receive appropriate, consistent health services. The CAH Section staff participate in the ACH Natural Wonder’s Access to Quality Care workgroup to connect with partners working to mitigate the number of uninsured children. Arkansas Advocates for Children and Families released the report, Removing the Hurdles to the Finish Line: Reaching 100 Percent of Health Insurance Coverage for Children In Arkansas in 2019.  

Highlights included the following activities:

• The Immigrant Children’s Health Improvement Act of 2017 was implemented. Challenges retaining or obtaining legal status documents for parents has limited the potential positive effect of this law.
• School-Based Health Centers assist families with ARKids First enrollment. Arkansas has over 30 School-Based Health Centers around the state that serve as a safety net access to care for many students.
• Arkansas Foundation for Medical Care produced a video guide to help families with enrollment.