Child Health

Annual Report - FY2023

 

Activities in this domain were carried out by the following MSDH offices, bureaus, or programs during the reporting period:

• Early Periodic Screening Diagnosis and Treatment Program (EPSDT)
• Mississippi First Steps Early Intervention Program (MSFSEIP)
• Lead Poisoning Prevention and Healthy Homes Program (LPPHHP)
• Genetics Services Bureau – Newborn Screening Program (NBS) and Mississippi Early Hearing Detection and Intervention Program (EHDI-MS)
• Office of Oral Health

 

The following section outlines strategies and activities implemented between 10/1/2022-9/30/2023 to meet the objectives and show improvement on the measures related to child health:

 

 

PRIORITY: Increase Access to Timely, Appropriate, and Consistent Health and Developmental Screenings

 

NPMs, NOMs, SPM, and ESMs:

• NPM 6: Percent of children, ages 9-35 months, who received a developmental screening using a parent-completed screening tool in the past year
• SPM 3: Percent of children on Medicaid who receive a blood lead screening test at age 12 and 24 months of age
• SPM 13: Percent of infants with a hearing loss who received confirmation of hearing status by 3 months of age
• SPM 14: Number of children ages 9-35 months of age who receive developmental screening using a parent completed tool during an EPSDT visit
• SPM 15: Percent of newborns and infants diagnosed with a genetic or metabolic condition who were screened and referred for diagnosis timely
• NOM 13: Percent of children meeting the criteria developed for school readiness (DEVELOPMENTAL)
• NOM 19: Percent of children, ages 0-17, in excellent or very good health
• ESM 6.2: Number of health professionals and parents / families who receive training on developmental screening and/or monitoring

 

Objective:

• By September 30, 2023, increase the knowledge of health professionals on collecting and submitting newborn screening for genetic/metabolic, critical congenital heart disease (CCHD), and hearing
• By September 30, 2025, increase the number of children receiving developmental screenings by 3% annually
• By September 30, 2025, increase screening rates in low-resource areas of the state
• By September 30, 2025, implement early childhood hearing screening program for children between 6-36 months of age to increase identification of children with late onset hearing loss
• By September 30, 2023, increase the number of infants with confirmed hearing loss who received confirmation of hearing status by 3 months to 67%
• By September 30, 2023, reduce the loss to follow-up and loss to documentation in screening programs
• By September 30, 2023, decrease the number of children less than six years of age identified with lead poisoning by 5%
• By September 30, 2025, increase the percent of children on Medicaid who receive a blood lead screening test at age 12 and 24 months of age by 0.5%

 

Strategy: Develop a comprehensive, coordinated, and integrated system of services for children

 

Completed Activities:

The CYSCHN Program implemented the use of universal referral form identifying all Health Service programs available to infant, children and adolescents with special health care needs to provide families and health care providers with a one-step opportunity to identify and/or connect them to the service that can best support their needs. The form can be submitted in varying ways, e.g. electronically, fax, hand mail and in-person. Submission can also be made over the phone. Once program is identified the care coordinator can began assisting/connecting families to needed supports.

 

The CAH Director served on the MDE Special Education Advisory Panel, the federally required advisory group for the provision of services according to the Individuals with Disabilities Education Act (IDEA). The SEAP addressed topics related to:

• Discipline: students being sent home but not counted as suspended

• Playground and campus accessibility in schools

• Regression during the pandemic and possible compensatory services

• Training for IDEA Hearing Officers

 

Using guidance developed by the National EHDI Outcomes Committee, the EHDI-MS and MSFSEIP implemented a data sharing agreement and process to track outcomes for infants identified as having confirmed hearing loss by EHDI and referred to the MSFSEIP. This agreement provides not only for the sharing of the IFSP date but also for type of intervention services received, specific providers, and language outcomes, with parental consent.

 

The MCH/Title V Child and Adolescent Health programs has worked extensively the University of Connecticut, Early Childhood Personnel Center (ECPC) to engage systems-building in Mississippi to serve infants, toddlers and children birth to eight years with and without disabilities and their families to ensure they have the resources and supports needed to aid their growth and development. The CAH Director and CYSHCN Director led a multiagency team in partnerships with the Mississippi Department of Education (MDE), Division of Medicaid, Institutions of Higher Learning, Head Start, Department of Human Services, and family leaders to revamp the state’s Comprehensive System of Personnel Development (CSPD) for professionals serving these MCH populations. The CSPD Leadership team served on work groups to development of multiprong plan for personnel preparation both preservice and inservice, recruitment and retention, and evaluation. The goal of the plan was to collaborate and pool resources to support professionals who serve MCH populations so they were prepared to identify and support children with disabilities and developmental delays and families to mitigate the impact of the child’s disability and/or resolve their delays. Due to these efforts, state leaders advocated for and secured funding for a CSPD Coordinator to be housed within the MDE to focus on implementation of the plan and continue to lead collaborative efforts with all state agencies serving children birth to eight years with and without disabilities and their families. This position was filled after the reporting period. Additional details will be shared in the FY24 report.

 

Part of the continued efforts of improving on our comprehensive system of supports, MCH/CAH staff (CYSHCN Director) has most recently participated in the ECPC leadership academy that connects early childhood systems of other states in the development of improved referrals and leveraging of financial partners to improve and integrate care. As a result, it solidified the MCH programs commitment to a universal referral form to ensure that those seeking support get to the MCH program that best meets their need.

 

Children’s Trust Funds play a leadership role with other organizations in the community when seeking to prevent child abuse and neglect before it occurs. Children’s Trust Funds have demonstrated the capacity to serve as leaders of coalitions and collaborative efforts focused on prevention. Additional strengths include supporting and promoting innovative strategies to strengthen families and prevent abuse. Children’s Trust Funds are well respected in the professional community for their leadership and commitment to prevention. It consists of a 13- member board including four state agencies: MSDH, MDE, DMH, and DHS. The MCH Engagement and Coordination Office Director is the MSDH representative on the Mississippi Children’s Trust Fund Advisory Board.

 

Staff across Health Services participated in monthly American Cancer Society Mississippi Chapter HPV Roundtable meetings to receive/provide relevant updates. The work of the HPV Roundtable has gained national attention from NIH, NCI, and CDC for its work in supporting the larger STRIDES study, a partnership with the National Cancer Institute, University of Mississippi Medical Center, and Mississippi State Department of Health to evaluate risk and look for new biomarkers in women undergoing screening for cervical cancer.

 

Strategy: Provide professional development opportunities for healthcare professionals to learn about best practices and state requirements for newborn screening (genetic/metabolic, CCHD, and hearing), lead screening, and developmental screening

 

Completed Activities:

During the reporting period, the program through a partnership with the MSDH Pharmacy Program and the resident interns, contacted 81 provider clinics across the state to schedule one-on-one education regarding lead poisoning screening, testing, reporting and follow-up. Outreach with each provider was attempted 3 times each. Through this, 23 provider visits were scheduled with 20 visits completed (10 in-person, 5 virtually, 5 telephone). Three of the scheduled visits were no-shows.

 

October 19th-21st, 2022, Perkin Elmer and UMMC provided 3 virtual Newborn Screening (NBS) educational trainings for birthing hospitals and district health departments. Education was added to Health Streams for review. In addition, an evaluation tool was developed to assess learning and to receive recommendations. As a result of the evaluation recommendations, the October training agenda was adjusted to increase training from one hour to two hours to allow participants more time to ask questions and provided feedback. Certificates of completion were sent to all attendees.

 

In June 2023, the Office of Child & Adolescent Health and the Genetics Bureau partnered with St. Jude Research Hospital to host Sickle Cell and Trait Counseling training in each region of the state. This training reviewed characteristics of the disease and trait, evidence-based treatment and care, counseling education, training, family planning and family centered strategies. More than 100 participants consisting of health professionals, social workers, nurse case managers, parents of children with Sickle Cell, and community volunteers were in attendance.

 

In July 2023, the Genetics Bureau Director and MCH ECO partnered to develop a Standard Operating Procedures and train Care Coordinators and MS Social workers to support Mississippi Newborn Screening follow-up and provide education for sickle cell trait counseling for families of SCD patients and SCT carriers.

 

In addition, the Genetics Bureau met with the MSDH LMS management director to discuss current newborn screening training and additions for future educational training materials resulting in updates to the “Newborn Screening Quality Assurance and Improvement” training. The purpose of the training is for users to:

• Understand the importance of timely screening/ specimen collection and reporting in relation to early identification and treatment of disease.
• Differentiate between acceptable and unacceptable specimen collection and reasons for unacceptability of the Dried Blood Spot card.
• Provide important points to remember about Newborn Screening.

These training modules are provided free of charge for hospital personnel who conduct NBS across the state.

 

To further extend virtual learning options, the training provided via St. Jude Children’s Research Hospital was incorporated into two education modules included in the MSDH LMS on Sickle Cell and Hemoglobin Disease and Sickle Cell Trait and Counseling and Management Practices. Thes modules provide educational support for genetic counselors, genetics nurses, hospitals, social workers, and other related practitioners in obtaining skills and providing education to families on the disease and holistic family centered counseling.

 

The EHDI-MS Program provides outreach and training to hospitals and diagnostic clinics to ensure timely reporting of hearing screenings and diagnostic reports.

We originally scheduled an EHDI-MS Conference for the spring of 2023, but it had to be postponed because it interfered with other spring conferences. Consequently, we rescheduled the EHDI-MS Conference for October 2023.

 

The EHDI-MS Program provides professional development opportunities through the yearly EHDI-MS Conference and virtual professional development with The CARE Project. We collaborated with The CARE Project to organize a virtual professional development opportunity titled "Empathy: Insights and Strategies" in August through September 2023 but scheduled for January 2024.

 

Strategy: Improve newborn bloodspot, CCHD, and hearing screening and reporting, including specimen collection procedures among hospital nurseries and laboratory staff

 

Completed Activities:

The Genetics/NBS Bureau collaborated with Revvity Omics to plan future training, including a comprehensive course titled, Newborn Screening A-Z. The goal is to develop professional videos and educational materials on the newborn screening process, reviewing the importance of newborn screening, early detection, and early diagnosis to provide better health outcomes and prevent permanent damage and death through early intervention and specialized treatment. The training module was submitted for review for inclusion in the LMS:

• MSDH Newborn Screening A-Z
  • Blood Spot Check
  • NBS Handling Procedures
  • NBS Today
  • Revvity Omics IT Support Solutions
  • Specimen Rejection
  • UPS Lab Pickup Point
  • UPS Ship Exec. Cloud User.

Upon completion of the course the learner will be able to:

• Relate to and identify genetic conditions that may affect a child’s long-term health outcome.
• Gain an overview of the complete newborn screening process.
• Review and expand on specific genetic conditions.
• Use educational tools to implement and refer to when completing newborn screening(s).

The planning process for this series began August 2023 with a go-live date after this project period. Detailed updates will be provided in the FY24 report.

 

The Genetics/NBS Bureau met monthly with PerkinElmer/Revvity to develop trainings that were conducted for hospital and health department staff in October 2022. These three newborn bloodspot collection trainings were held in Fall 2022 for health department staff to provide examples of proper specimen collection and timely transit to increase timely diagnosis reporting and treatment. Evaluations recommended edits to ensure virtual participants could have a more interactive process during these trainings.

 

In addition to these trainings:

• Bloodspot collection training was provided by UMMC and Perkin Elmer and uploaded into the MSDH LMS for future use on-demand.
• New Nurse orientation was provided by the Regional Nurse Case Coordinator.
• NBS education updates, and bloodspot collection review was/is available anytime and quarterly for low performing hospitals by regional Nurse Coordinators.

 

A bi-annual (September 2022, April 2023) Genetics Advisory Committee meeting made of Genetic Physicians, Genetic Counselors, Genetics Lab, Parent(s) of children with genetic conditions, MSHA, and meeting is open to the public and health network to provide genetic condition education, MS birth conditions screening status, and genetic adoption updates, recommendations, and cost analysis. Bi-annual meeting will continue.

 

Due to COVID restrictions, low performing hospitals were visited virtually, to provide NBS screening training, as well as a comprehensive improvement plan. Contact with birthing hospitals are scheduled quarterly for hospitals that need improvement in one of the following areas:

• Unacceptable Specimens
• Missing information
• Screening conducted < 24 hours after birth (unacceptable)
• Collection to receipt timelines
• Birth to collection timelines.

 

Revvity Omics website data was used to assess improvement or assistance needs for each hospital to prepare for targeted outreach. During hospital visits for low hospital performance the following forms are used during the visit: Hospital Quarterly Visit Checklist, Genetics Quarterly Hospital Reporting Form (GQHR), Corrective Action Plan Template, MSDH Sign-in Sheet, MSDH Agenda, Sample of Completed Hospital Visit Information. Education and expectations were provided during the visit and follow-up visits were scheduled as required to ensure performance improved.

 

In Summer 2023, EHDI and NBS partnered to review screening expectations and answer questions and concerns for NBS and Point-of-Care services.

 

The Genetics/NBS Bureau actively monitoring to identify bottle necks that prevent timely screening of newborns within 24-48 hours. Daily, NBS data is analyzed to ensure that all screened newborns receive timely screening and timely follow-up. These data are closely audited, disaggregated, and disseminated in efforts to promote quality improvement, to identify missing data, to observe for bottleneck(s) that prevent timely screening, and to clean data for providing accurate and valid real-time status of newborn screening data.

 

In March 2023, the Genetics/NBS Bureau worked with EPI/EPIC there on data conversion issues with ICD9 and ICD10 conversions of hemoglobin. We continue to work with EPI/EPIC and Perkin Elmer Labs to identify areas of strengths to build on and weaker areas to strengthen data reliability.

 

Strategy: Increase timely screening and referral to tertiary centers for newborns and infants diagnosed with a genetic or metabolic condition

 

Completed Activities:

The Genetics/NBS Bureau received an internal audit of NBS screenings, follow-ups, and referrals for over 2000 cases for purpose of quality improvement and quality assurance. The Genetics/NBS Bureau created, analyzed, and compared quarterly hospital performance, visiting hospitals virtually with low performance to discuss and develop corrective action plan and improvements.

 

Reports were extracted from EPIC for infants receiving NBS screenings prior to the 24 hour or after 48 hour recommended timeframe. Hospitals in question were contacted virtually to review protocols and expectations to ensure babies are screened timely. During the meeting, hospitals provided feedback regarding barriers that caused early or late screening reporting due to staff turnover, staff duties increase, staff shortages due to COVID reassignments, and new staff training needs. In addition, the hospital report card is updated to include a ranking report for newborn screening, critical congenital heart defect, and early hearing screenings performance and posted online.

 

The Genetics/NBS Bureau monitored and identified bottle necks that prevented timely transit of specimens to laboratory within 1 day after collection. Reports were pulled from the database and reviewed to advise several hospitals that did not meet the 1-day transit timeline to laboratory. The hospitals were alerted, and a virtual meeting ensued. Per hospital, the specimens were lost in transit. As a result, infants were rescreened; however, received a delayed diagnosis report.

 

The Genetics/NBS Bureau monitored and identified bottle necks that also prevented timely screening to report time with 7 days. Reports from the database reveal hospital met the metric timeline.

 

As a result of these reviews, the Genetics/NBS Bureau developed a Quality Improvement program using the PSDA Cycle and framework to manage and monitor all aspects of the Newborn Screening Program. Develop weekly, monthly, and quarterly status reports. Continued QI surveillance is conducted to review screening timeliness and referrals to tertiary centers. Currently weekly reports are provided to monitor program activities and progress, and provide report indicators on active case episodes, regional caseloads, and resolved cases.

 

During the project period, the Genetics/NBS Bureau worked with EPI/EPIC to create reports that allow for better monitoring. In September 2023, a report was developed on newborn screening caseloads by county and region, along with a detailed status report for follow-up actions. This allowed the department director to monitor timeliness of case closures, as well as identify variables preventing timely case closures. The report was reviewed weekly.

 

In addition, a status report was developed that outlines whether the program is operating at maximum aptitude and meeting outlined goals and objectives of the program. Weekly NBS staff meets to discuss, and report duties completed. In addition, EPIC provides a real-time review of active episodes. A summary report is provided to the Deputy Director regarding staff and department operations.

 

As a result, the program determined additional staff were needed and four additional Nurse Case Manager (NCM) PINS were requested to hire nurses in Districts 2,4,6, and 8. A position was also placed to fill NBS/Birth Defects Registry position. Unfortunately, in July 2023, the Genetics/NBS Bureau lost the Epidemiologist who had supported the program by preparing the Annual NBS report and National Birth Defects reports, which were unfinished at the time.

 

Strategy: Develop and implement plans to increase coordination and integration with early childhood programs to improve timely identification

 

Completed Activities:

The CYSCHN Program partnered with the MS Parent Training Institute and MS Families for Kids to provide training to Parents, LEAs and childcare providers and healthcare professionals on the importance of referring children to the CYSHCN program and providing developmental screenings at health fairs to identify children who may be eligible for programs that support children with special healthcare needs.

 

The MSFSEIP Service Coordinators conduct monthly child find activities to childcare and Head Start facilities by providing developmental screenings and providing educational materials.

 

The EHDI Program developed plans led by the EHDI Advisory Committee Systems Building Work Group to extend screening between 6-36 months of age in partnership with Early Intervention, Early Care and Education Centers, EPSDT Providers, and Primary Care Providers. During the project period, the EHDI program partnered with the EI Program to purchase screening devices and provided training to Service Coordinators. The hearing screening was implemented after the project period; details will be provided in the FY24 report.

 

Strategy: Expand infrastructure to conduct hearing screenings of children up to 36 months of age to identify late onset hearing loss, and to promote project sustainability

 

Completed Activities:

EHDI-MS continued to work on expanding infrastructure to screen children up to 36 months for late-onset hearing loss and to ensure the project's sustainability. Because of the need for training in hospitals and diagnostic clinics, EHDI-MS could not implement the expanded screening plan during this time frame. EHDI-MS has arranged contracts with two Audiologists to train staff in selected Mississippi Head Start programs for CORTI OAE Screenings to identify children with late onset hearing loss. Early Intervention conducts CORTI OAE screenings during evaluations for all infants and toddlers without confirmed hearing loss. Lastly, it has been recommended that EPSDT start using CORTI OAEs as the hearing screening for babies from birth to three years old in the Mississippi State Department of Health clinics. We will continue to work toward meeting this goal

 

Strategy: Work with Medicaid to identify rate of screenings and identify low-resource areas with gaps to be addressed through collectively through program improvement or development

 

Completed Activities:

Through a partnership and MOU with the MS Division of Medicaid, the program receives quarterly data detailing the number of children enrolled in Medicaid and the number of children who received a lead test. Using this data for 2022, the program was able to develop draft provider report cards at the state and county level that detail the following: percentage of children 72 months or younger in each public health district enrolled in Medicaid, the percentage of children 72 months or younger in each county who received a blood lead level screening that was reported back to the health department, and the percentage of homes in each county that were built prior to 1978.

 

Strategy: Increase knowledge and awareness among the public, public health professionals, childhood lead prevention workforce members, and other partners about childhood lead poisoning, new threshold blood lead levels, prevention, and intervention through tailored education and outreach

 

Completed Activities:

HM/HB and the Lead and Healthy Homes program have partnered to educate HM/HB staff about childhood lead poisoning, new threshold blood lead levels, prevention, and intervention through formal presentation as well as health education.

 

During the reporting period, the Lead program through a partnership with the MSDH Pharmacy Program and the resident interns, contacted 81 provider clinics across the state to schedule one-on-one education regarding lead poisoning screening, testing, reporting and follow-up. Outreach with each provider was attempted 3 times each. Through this, 23 provider visits were scheduled with 20 visits completed (10 in-person, 5 virtually, 5 telephone). Three of the scheduled visits were no-shows.

 

MSDH Pharmacy residents attended a baby shower in Canton, MS sponsored by Magnolia Healthcare to distribute lead educational packets to new and expectant mothers. In partnership with Molina Healthcare, the residents attended two events at elementary schools reaching over 200 people in the Mississippi Delta with lead educational materials.

 

During the reporting period, meetings were held in-person and virtually with the Director of Lead Poisoning Prevention and Health Homes and the Director of the Office of Oral Health to discuss efforts to provide oral health education to the Healthy Home program. Twice per year, mass mailouts are sent to MS residents on information about reducing health hazards in the home and free mold and radon testing. The partnership resulted in one hundred packets on oral health educational consisting of information in both English and Spanish accompanying these mail outs. The program was careful to ensure the information covered a lifespan by including flyers on oral health needs for children, dry mouth symptoms, and solutions for older adults. In return, folders on lead poisoning and health homes were given to Regional Oral Health Consultants to give to residents during their participation in health screenings, school visits, and career fairs.

 

Strategy: Increase identification of children exposed to lead

 

Completed Activities:

HMHB and the Lead and Healthy Homes program have a Data Use Agreement (DUA) to where HM/HB shares their list of enrolled infants and Lead compares that list for those infants who may have been exposed to lead or who have already screened.  Lead and Healthy Homes program makes referrals to HM/HB as needed as well as when HM/HB has identified an infant or family member that has been exposed to lead, they are referred to the Lead and Healthy Homes Program.  HMHB nurse case managers ask about lead exposure to HM/HB new enrollees during the enrolment process. After a positive screening has been made, nurse case managers refer to Lead and Healthy Homes Program.

 

The Lead program identified 332 children less than 72 months of age with a venous blood lead level of 3.5 or higher qualifying the family for services such as care coordination services to include telephonic counselling, home visits, environmental assessments, referrals and education. Of this number, 173 families received telephonic counselling and the remaining 159 received educational materials through the mail. Six families of children accepted a home visit and environmental assessment.

 

Through a partnership with the Mississippi State Department of Health’s Supplemental Nutrition Program for Women, Infants and Children’s Nutrition (WIC), the program has incorporated lead-related questions on the WIC nutritional assessments for infants, children, pregnant women, and breastfeeding and non-breastfeeding women. The questions asked are listed below and vary slightly, based on the intended audience:

• Does your baby put objects in their mouth, such as keys, electrical cords, jewelry, vinyl (plastic) mini-blinds or bare soil outside near the home?
• Does your tap water come from a well?
• Do you or your baby live in an old house or attend daycare at an old building (built before 1978)?  Have you noticed the paint chipping? 
• Does your baby live in a household with someone who works with lead?  Examples include construction, painting, welding, or bullet manufacturing? 
• Does your baby have a family member or friend who has or did have an elevated blood lead level?

 

Standard lead educational materials are provided to each family enrolled in WIC to increase awareness about lead and the importance of testing. On February 1, 2023, the program started receiving referrals from WIC via REDCap for any family who answers yes to any of the lead questions. Once a referral is received, program staff contact the family to educate them about lead and to recommend that the child be tested for lead according to the American Academy of Pediatrics Bright Future Guidelines.

 

 

PRIORITY: Increase Breastfeeding, Healthy Nutrition, and Healthy Weight

 

NPMs, NOMs, SPM, and ESMs:

• SPM 11: Percent of children, ages 2-5 years, who have a BMI at or above the 85th percentile

 

Objective:

• By September 30, 2025, decrease the percentage of children, ages 2-5 years, who receive WIC services and have a BMI at or above the 85th percentile

 

Strategy: Increase breastfeeding initiation and duration rates through prenatal breastfeeding education and post discharge support to reduce childhood obesity

 

Completed Activities:

WIC Peer Counselors continue to provide prenatal education and breastfeeding support to WIC participants. From October 2022 to September 2023, peer counsellors provided support via 64,435 telephone calls, 26,170 office visits, 284 hospital visits, and 1,228 home visits. WIC staff completed 4 levels of breastfeeding curriculum training based on their role within the WIC Program. Approximately 275 WIC staff members statewide received Level 1 training regarding the basics of breastfeeding and ways to support pregnant and breastfeeding families. WIC breastfeeding staff provide breastfeeding support group meeting facilitation for the MS MILC Leagues. Families receive peer support and have access to an IBCLC to address any complex breastfeeding issues during group meetings. The WIC Program continues to provide WIC participants with free access to the Pacify tele-lactation mobile app for after hours and weekend support of breastfeeding. In September 2023, 61 new WIC participants were enrolled for Pacify services and 27 calls were made to an IBCLC with 44% of those calls made after regular clinic working hours.

 

Strategy: Implement evidence-based practices to decrease obesity in early childhood

 

Completed Activities:

The WIC Program continues to provide nutrition assessment, goal-centered nutrition education, breastfeeding promotion and support, and referrals to other healthcare services. These activities are an integral part of the WIC mission and are used to prevent and reduce childhood obesity.

 

The CYSHCN Program, in collaboration with trusted partners, provides CYSHCN and their families with information regarding the benefits of healthy eating and exercise. Healthcare professionals also work closely with CYSHCN who have identified concerns related to obesity.

 

HM/HB staff, including perinatal nurses and registered dietitians, provide health education, modeling, and direct instruction for healthy family nutrition and infant feeding practices, which are staged according to the approaching developmental stages of infants. In the prenatal and throughout post-partum period, the HM/HB staff assess each family for food security, making referrals to the appropriate resources, including WIC as needed. Also, during this period, maternity patients are provided education and support aimed at increasing water consumption and increasing healthy food and nutrient consumption to prepare for breastfeeding and optimizing post-partum recovery. In the post-partum period, for breastfeeding infants, education and support is focused on the breastfeeding mother’s nutrition and overall wellness, infant positioning, latch, and suck, number and length of feedings, infant signs of hunger and fullness, mother’s breast health, and pumping/expression and breast milk storage. For formula-fed infants, education and support is focused on formula access and supply, preparation, and storage. Staff counsel families on the need to avoid a too soon introduction of water, juice, and other non-breast milk or non-formula items to the infant without a medical professional’s recommendation, as well as bottle-propping, as this is a risk for choking/aspiration, dental caries, and excessive weight gain in infants. For all infants, HM/HB staff check their weight at each in-person interaction, monitoring it closely to assure steady and appropriate weight gain. When anomalies in the infant’s weight (either too little weight gain or too much weight gain) are suspected, the staff work with the caregiver to engage the infant’s medical home for further assessment.  As infants progress through developmental stages, weaning from the breast or bottle and teething is addressed, as well as the introduction of solids (i.e., cereal, pureed baby foods, etc.). The addition of finger-foods, self-feeding/drinking tools, and transition to cow’s milk follows as the infant approaches her first birthday. There is also support and education for the mother provided around returning to a healthy weight, including consumption of macro nutrients, avoidance of excess fast food and empty calories, and engaging in tolerable physical activity throughout the 12 months post-partum. Educational materials used include those from WIC and the Partners for A Healthy Baby Home Visiting Curriculum (Florida State University).

 

PRIORITY: Improve Access to Family-Centered Care

 

NPMs, NOMs, SPM, and ESMs:

• SPM 21: Percent of children with and without special healthcare needs who have a medical home

 

Objectives:

• By September 30, 2025, increase the number of infants and toddlers enrolled into family-centered services in a medical home to 2.15%
• By September 30, 2025, increase the percentage of the children who exit early intervention at or near age expectations: (1) in cognitive and language/ communication skills to 52.5% (2) in social-emotional development to 64.5% (3) in motor and adaptive skills to 58%
• By September 30, 2025, increase the percentage of families who report child health programs help them help their children by 5%
• By September 30, 2025, increase the number of families of children who have access to peer-to-peer support and role models by 5%

 

Strategy: Improve hospital and primary care provider family-centered care practices

 

Completed Activities:

The CYSHCN Program has a long-standing partnership with community health care clinics and tertiary clinics that provide services to the CYSCHN population. As a result of these partnerships, quarterly meetings are held to identify ways to increase enrollment through identification and referrals to the CYSHCN programs, as well as supporting, via funding the roles of Care Coordinator and Parent Consultants with those strategic partners. Supporting opportunities for other training opportunities to meet the specific needs of the particular groups and connecting them to other external groups that can help them develop skills to serve CYSCHN.

 

Strategy: Develop and distribute resources among early childhood partners and families regarding early identification of infants and toddlers who may be eligible for services

 

Completed Activities:

HM/HB Central Office team has participated in over 15 Community outreach events between October 2022 and September 2023 this does not include the numerous events that the HM/HB field staff attend to promote the program to the public as well as community agencies and early childhood partners.  HM/HB is also apart of the Early Childhood Development Coalition and had established relationships with MS Department of Human Services (Healthy Families of MS) at the time.

 

The CYSCHN Program participated in multiple health fairs and community events to provide knowledge of the CYSHN program and the support that it offers to families. The CYSHCN Program revised and improved informational materials that promote the CYSHCN program and how it can assist families in identifying and/or obtaining resources to better support their needs. CYSHCN partnered with the MS Parent Training Institute and MS Families for Kids to provide training to Parents, LEAs and childcare providers and healthcare professionals on the importance of referring children to the CYSHCN program and providing developmental screenings at health fairs to identify children who may be eligible for programs that support children with special healthcare needs.

 

First Steps Early Intervention contracted with Maris, West & Baker (MWB) to develop and co-brand educational material for the program. The program adopted the CDC’s Learn the Signs. Act Early. for its public awareness campaigns to educate early childhood partners and families on signs of developmental delay and how to refer children for evaluation. Resources are currently being printed and will be sent to referral sources. MWB developed both a 15- and a 30-second commercial for the program that ran on local TV stations for 3 months and was placed on YouTube (https://youtu.be/6P9dZnxghxc) and other social media sites in order for the program to be able to continue using them. CDC’s Learn the Signs. Act Early. brochures were edited to include the contact phone numbers for First Steps and the website of the Mississippi Department of Education Office of Special Education to contact local school districts. As a result of this media campaign, the program received 9,642,239 impressions across all media outlets in which 23,217 individuals clicked on the ad to learn more. 

 

Strategy: Collaborate with the Mississippi Department of Education to implement a statewide Child Find public awareness campaign

 

Completed Activities:

In Spring 2023, the Child & Adolescent Health Director/Part C Coordinator partnered with the State 619 Early Childhood Special Education Director to lead nine trainings across the state reaching more 350 educators about transition from early intervention (Part C) to special education (Part B) IDEA services. During the training, materials were shared and guidance was provided about joint public awareness campaigns between local education agencies/school districts and local early intervention programs.

 

The materials prepared by the First Steps Early Intervention, including brochures and social media, were shared with the MDE Office of Special Education to share broadly with all partners, including families who may have multiple children of various ages.

 

The CYSHCN Director collaborated with the MDE Office of Special Education and Office of Early Childhood to provide inservice training to teachers, paraprofessional, and parents on the supports available for CYSHCN, process for identification and referral, resources regarding symptoms of diagnosed conditions not readily identified, and the interaction of health on student performance.

 

The CYSHCN Director also engaged with the Special Education Advisory Panel (SEAP) to discuss effective transition of CYSHCN from Part C to Part B for those who are eligible. Topics included:

• For those who decided not to receive school-based services, what community supports are available and what are the rights of the parents/caregivers to later access school-based services.
• What are the supports provided to educators, especially new educators to aid them in working with children/families who are eligible for special education services and for those who have 504 and/or Health Plans.
• How are they monitored for effectiveness, when and what tools.

 

Strategy: Implement family-centered early intervention practices to improve development outcomes, including school readiness

 

Completed Activities:

The MSFSEIP restarted the coaches training of the Routine-Based Model. The Routines-Based Model for Early Intervention developed by Robin McWilliam is a comprehensive model for the delivery of early intervention services that is family-focused, routines-based, and uses transdisciplinary approaches. The model consists of six key practices: assessing family systems using Ecomaps, gathering individual family information through the Routines-Based Interview (RBI), development of participation-based functional child and family goals, use of transdisciplinary practices for service delivery, procedures for conducting supportive home visits, and use of collaborative consultation in childcare settings. During this time frame 15 coaches are going through the training.

 

Strategy: Implement interventions with families to reduce children’s exposure to lead and other environmental hazards

 

Completed Activities:

HMHB and the Lead and Healthy Homes program have a Data Use Agreement (DUA) to where HM/HB shares their list of enrolled infants and Lead compares that list for those infants who may have been exposed to lead or who have already screened.  Lead and Healthy Homes program makes referrals to HM/HB as needed as well as when HM/HB has identified an infant or family member that has been exposed to lead, they are referred to the Lead and Healthy Homes Program.  HMHB nurse case managers ask about lead exposure to HM/HB new enrolees during the enrolment process. After a positive screening has been made, nurse case managers refer to Lead and Healthy Homes Program. During the reporting timeframe, HM/HB staff issued 3 referrals to the HHLPPS.

 

Strategy: Link children exposed to lead to recommended family-centered services

 

Completed Activities:

HMHB and the Lead and Healthy Homes program have a Data Use Agreement (DUA) to where HM/HB shares their list of enrolled infants and Lead compares that list for those infants who may have been exposed to lead or who have already screened.  Lead and Healthy Homes program makes referrals to HM/HB as needed as well as when HM/HB has identified an infant or family member that has been exposed to lead, they are referred to the Lead and Healthy Homes Program.  HMHB nurse case managers ask about lead exposure to HM/HB new enrollees during the enrolment process. After a positive screening has been made, nurse case managers refer to Lead and Healthy Homes Program.

During the reporting timeframe, HM/HB staff issued 3 referrals to the HHLPPS.

 

During the time frame the Lead and Healthy Homes Program referred 38 families to the early intervention program.

 

Strategy: Recruit a diverse team of family advisors located in each of the three regions of the state to provide assistance and support to families

 

Completed Activities:

The CYSHCN Program has partnered with community health clinics across the state to fund parent Consultants, to support the needs of CHYSCHN families, as well as a Parent Engagement Coordinator at the State level.

 

Strategy: Expand the EHDI family peer support program with Family Advisors and Deaf/Hard of Hearing Role Models

 

Completed Activities:

The EHDI-MS Program houses a Family Support Program (FSP) comprised of Family Advisors, who are parents of children who are Deaf/Hard of Hearing (D/HH), as well as D/HH Role Models, who can provide parents information about their lived experiences navigating the world with hearing loss. The EHDI-MS Program receives confirmed hearing loss diagnoses and sends the referral directly to MS First Steps EI Program, as well as the EHDI-MS Program Family Support Program. A family advisor is then assigned to the incoming family to begin making contact a guiding the family in making decisions for their child. During the project period, the EHDI Program recruited additional Family Advisors, bringing the total to four, and recruited a D/HH Role Models, to onboard after the project period, to support additional families. These FSP personnel participated in training and supervision to enhance their ability to meet the informational and emotional needs of families of children who were recently diagnosed with permanent hearing loss.

 

 

PRIORITY: Improve Oral Health

 

NPMs, NOMs, SPM, and ESMs:

• NPM 13.2: Percent of children, ages 1 through 17, who had a preventive dental visit in the past year
• NOM 14: Percent of children, ages 1 through 17, who have decayed teeth or cavities in the past year
• NOM 17.2: Percent of children with special health care needs (CSHCN), ages 0 through 17, who receive care in a well-functioning system
• NOM 19: Percent of children, ages 0 through 17, in excellent or very good health
• ESM 13.2.1: Number of children 0-3 years who had a preventive dental visit with referred dentist
• ESM 13.2.2: Number of referrals of children 0-3 years for a preventive dental visit by MSDH nurses
• ESM 13.2.3: Number of trainings completed by medical providers on use of fluoride varnish in the primary care setting

 

Objective:

• By September 30, 2023, increase the percent of children with a preventive dental visit by 1%

 

Strategy: Promote the delivery of preventive oral health care for children and adolescents enrolled in Medicaid by oral health professionals

 

Strategy: Support trainings on use of fluoride varnish in the primary care setting

 

Completed Activities:

A total of six Cavity Free in MS trainings occurred during the period between November 2022 and September 2023. In November, one training was held in Simpson County with seven medical staff members trained. In January 2023, Eupora Pediatric Clinic in Smith County received training for two Family Nurse Practitioners (FNP) and one Licensed Practical Nurse (LPN). Mississippi Medical in Webster County also received training in January 2023 for two Registered Nurses (RN). In March 2023, two medical staff members received training in Scott County. In August 2023, Lucedale Pediatrics received training for one RN, one Nurse Practitioner, Certified (NP-C), one Nurse Practitioner (NP), and one Medical Assistant (MA). In September 2023, Hattiesburg Children’s Clinic received training for nine Doctors, one RN, two FNP, one Certified Pediatric Nurse Practitioner-Primary Care (CPNP-PC), two FNPs, and one additional staff member.