The Florida Department of Health (Department) priorities during the reporting year included:

• Improve dental care access for children and pregnant women (State Performance Measure [SPM] 2: The percentage of low-income children under age 21 who access dental care).
• SPM 3: The percentage of parents who read to their young child age 0 through 5 years.
• Promote activities to improve the health of children and adolescents and promote participation in extracurricular and/or out-of-school activities in a safe and healthy environment (National Performance Measure 8.1: Percent of children, ages 6 through 11, who are physically active at least 60 minutes per day).

Oral health is essential to general health and well-being. Poor oral health status correlates with other systemic diseases, such as diabetes, heart disease, respiratory disease, stroke, and preterm and low-weight births. Tooth decay (cavities) is a transmissible, infectious oral disease resulting from an imbalance of multiple risk factors and protective factors over time. Though the prevalence and severity of tooth decay declined among school-aged children in recent years, it remains a significant problem in some populations, particularly among certain racial and ethnic groups and low-income children.

Dental caries (tooth decay) remains the most common preventable, chronic, infectious disease among young children and adolescents in the United States. Dental caries impact children five times more than asthma. According to the CDC, more than half of children ages six to eight have had a cavity in one of their baby teeth. More than half of adolescents ages 12 to 19 have had a cavity in a least one of their permanent teeth. Twenty – five percent of children ages five to 19 years from low-income families have cavities, whereas eleven percent of children from higher income households have cavities. Rates for Black and Hispanic children were higher than for White and Asian children. If tooth decay remains untreated, it can cause pain and infection leading to problems with chewing, swallowing, speaking, and learning. These problems jeopardize children’s physical growth, self-esteem, and capacity to socialize (CDC Children’s Oral Health Overview, April 6, 2023 Children's Oral Health | Basics | Children's Oral Health | Division of Oral Health | CDC).

Poor oral health is also associated with missing school and poor school performance Research estimated that U.S. children miss more than 34 million school hours annually due to dental problems (Naavaal, S., & Kelekar, U. [2018]. School hours lost due to acute/Unplanned dental care. Health Behavior and Policy Review, 5[2], 00-73). Children with poor oral health are three times more likely to miss school and four times more likely to perform poorly when compared to their healthy counterparts (Jackson SL, V. W. [2011]. Impact of poor oral health on children's school attendance and performance American Journal of Public Health, 101[10]: 1900-1906). Additionally, parents miss on average 2.5 days from work per year due to their children’s dental problems (Seirawan H, F. S. [2012]. The impact of oral health on the academic performance of disadvantaged children. American Journal of Public Health, 102[9]: 1729-34).

A cost-effective way of preventing tooth decay are dental sealants. Dental sealants are thin protective coatings that adhere to the chewing surfaces of the back teeth (molars) and prevent the acid of leftover food particles from creating holes, or cavities, in the teeth. Dental sealants can prevent up to 80 percent of cavities and protect teeth for several years. While children with dental sealants have increased over time, low-income children are 20 percent less likely to have them and are twice as likely to have untreated decay than high-income children. The objective is to increase children receiving dental health service to 50.9 percent by 2026. Barriers to receiving dental sealants or other dental care include the lack of access to dental services, dental care costs, and inadequate oral health literacy.

According to the Agency for Health Care Administration, during FY 21-22, the following oral health services were provided to children ages zero to 20 years with Medicaid:

• diagnostic and preventive (6,666,813)
• sealants (192,550)
• silver diamine fluoride (22,201)

Silver diamine fluoride is a topical liquid medication used to arrest tooth decay. According to the county health departments (CHDs), during FY 22-23, the following oral health services were provided to children ages zero to 20 years:

• diagnostic and preventive (648,624)
• sealants (39,353)
• silver diamine fluoride (2,198)

In addition, 704 periodontal treatments were provided to children during the same timeframe. As a quality improvement initiative, the Department implemented the collection of visit data to include services to maternity patients and CYSHCN. Training was provided and the data collection reporting is voluntary. During FY 22-23, the Department provided 367 oral health services were provided to 92 maternity patients and 12,969 services to 2,474 CYSHCN. The number of CYSHCN is expected to increase when the reporting data becomes required.

Oral health data is needed for ongoing monitoring, establishing the burden of oral health disease, and informing statewide programmatic planning efforts. To address the need for state level oral health surveillance data, the Department’s Public Health Dental Program (PHDP) has established a surveillance system for monitoring oral health status, risk factors, and access to dental services among various populations using the Basic Screening Survey Methodology developed by the Association of State and Territorial Dental Directors. The PHDP conducted its FY 21-22 third grade surveillance project ending December 2022. Fifty-five elementary schools participated in the project and licensed dental hygienists from the Florida Dental Hygienists’ Association screened 1,343 children from these schools. As of April 2023, 21 out of 55 high schools have agreed to participate in the FY 22-23 nineth grade surveillance project and 542 screenings have been completed.

The Title V MCH Block Grant supported the continued development and enhancement of the PHDP’s Florida’s Linked Oral Status System (FLOSS) Database which includes a School-Based Sealant Program (S-BSP) Module, an Oral Health Surveillance Module, and the Community Water Fluoridation Module. The S-BSP Module is used by all agencies and programs providing services at schools in Florida to enter aggregate data and information regarding their local S-BSPs annually. The PHDP has collected data on the number of children served, schools visited, services provided, and other programmatic information from FY 16-17 through FY 22-23 school years. The system is accessible by both the Department and external partners and serves as the true statewide data warehouse for public health dental measures for children. The PHDP used the Oral Health Surveillance Module to collect and validate data for the ongoing FY 21-22 third grade oral screening project and the FY 22-23 Ninth Grade Oral Screening Project. Using the FLOSS database for this data collection and validation has reduced data entry errors and improved overall data quality. Water operators of water treatment plants that add fluoride to adjust the fluoride levels to the optimal level to prevent tooth decay, must submit monthly operating reports (MORs) each month into the Community Water Fluoridation module of FLOSS. The PHDP fluoridation staff use the reports in FLOSS to determine if the MORs were submitted on time and to monitor the daily and monthly data to determine if the water was optimally fluoridated. The reports provide a rationale to research and discuss any maintenance issues that may have developed causing non-optimal fluoride levels. During FY 22-23, Title V MCH Block Grant funding has continued to support the development of the FLOSS database to improve functionality, enhance data quality and accuracy, and meet the dynamic business needs of the PHDP and FLOSS users.

The Department makes continued progress to improve access to preventive dental care for children in Florida. During FY 20-21, the PHDP used grant funding for the expansion of eight S-BSPs in counties with high unmet needs due to a lack of dental providers, transportation barriers, and low social economic factors influencing access to care. These expansion programs were in the following counties: Baker, Broward, Columbia, Leon, Okeechobee, Palm Beach, Pinellas, and Putnam. These S-BSPs provided preventive services to school-aged children and children in Early Head Start; Head Start; Special Supplemental Nutrition Program for Women, Infants, and Children (WIC); and Early Learning Coalitions. For FY 22-23, the PHDP used grant funding for the expansion of seven S-BSPs. The counties that received this funding were Broward, Clay-Baker, Columbia, Lake, Levy, Okaloosa, and Orange. These S-BSPs provided preventive services to school-aged children and children in Early Head Start; Head Start; Special Supplemental Nutrition Program for Women, Infants, and Children (WIC); and Early Learning Coalitions. Within the service period:

• 218,986 services were provided to 46,896 children, including 46,715 exams/screenings/assessments
• 28,629 dental sealants
• 46,652 fluoride varnish applications
• 46,410 oral health instructions

The PHDP will continue its collaborative partnerships with S-BSPs to share information on evidence-based prevention and early intervention practices and facilitate the promotion of oral disease prevention efforts with expanded focus to include pregnant mothers, at risk women and teens, and young children.

The Department provides funding to all 67 CHDs for the Florida Healthy Babies program. The purpose of the program is to improve one of six MCH outcomes by addressing broad social, economic, cultural, and environmental factors that impact access to care. The six priority areas were identified based on the Statewide Needs Assessment, State Health Improvement Plan, Agency Strategic Plan, MCH Program National Performance Measures, and Healthy People 2030. The goals are:

• Infant Mortality
• Maternal Mortality 
• Dental and Oral Health 
• Prevention of Unexpected Pregnancy   
• Well Women Care 
• Access to Care

The CHDs implement the Florida Healthy Babies program by providing evidence-based services resulting from a local needs assessment, ongoing quality improvement processes, and collaboration with community partners. An example of a Florida Healthy Babies service is the Reach Out and Read (ROR) program. The ROR program is an evidence-based early intervention model that encourages literacy and school readiness. ROR gives young children a foundation for success by incorporating books into pediatric care and encourages families to read aloud together. ROR medical providers encourage families to read aloud and engage with their infants, toddlers, and preschoolers every day. This program focuses on creating a reading rich environment in waiting room areas such as a child’s reading table and chairs, a bookshelf, children’s books, etc. Additionally, medical providers give books to children at more than 10 well-child visits from infancy until they start school. Participating families of the ROR program indicate:

• Parents are 2.5 times more like to read with their infants, toddlers, and preschoolers;
• Parents are 2 times more likely to read with their children three or more times per week;
• Parents are 2.5 times more likely to read with their infants, toddlers and preschoolers;
• Families are 2.5 times more likely to enjoy reading together or to have books in the home;
• Children’s language development is improved by 3-6 months; and
• Children’s language ability improves with increased exposure to ROR.

Healthy People 2030 includes objectives on school readiness and literacy in the child and adolescent domains. In 2021, 26.4 percent of parents read to their young children every day. The Department aims to increase the percentage of parents who read to their children to 38.7 percent by 2026.

In FY 21-22, Florida’s pre-kindergarten through 12th grade student population was over 2.7 million students, residing in 67 counties that are geographically, socioeconomically, and culturally diverse. Among this student population, there were 817,555 reported student health conditions, which included life-threatening allergies (30,245), asthma (108,012), cardiac conditions (11,029), diabetes (7,011), mental health conditions (31,112) and seizure disorders (16,081). Body mass index (BMI) screening results indicated that 282,749 (58.57 percent) of students were at a healthy weight, whereas 181,403 (37.57 percent) had results at or above the 85th percentile (overweight and obese categories).

The Department’s School Health Services Program continued its statewide leadership to ensure the provision of health services and health appraisal of student populations in Florida’s public and participating non-public schools. The program provided oversight and technical assistance to all 67 county School Health Services Programs, including CHDs, local education agencies, and their community partners, pursuant to Florida Statutes and Administrative Code.

Local CHDs, in collaboration with local schools and community partners, worked to ensure Florida’s pre-kindergarten through 12th grade students had access to health services that assess, protect, and promote their health and ability to achieve their individual educational potential. During FY 22-23, the School Health Services Program performed 16 on- site programmatic monitoring visits, two contract monitoring visits and conducted two statewide programmatic conference calls. In addition, the State Health Office program was provided funding from the Centers for Disease Control and Prevention (CDC) Crisis Response Cooperative Agreement (CoAG) grant. The funding supports nursing and mental health professional staff for use in school systems across the state. The program office developed and deployed a strategy for this project using incident command structure and was able to deploy staffing resources within three months. The grant was extended into next school year and the program will continue to maintain and develop the strategy it is using to implement this project statewide.

During the FY 22-23 school year, the Okaloosa CHD sustained its expanded services for the school health program in schools with vulnerable and underserved populations, using additional funding provided to full-service schools. Full-service schools provide additional services to students from schools that have specific student populations that are considered at high-risk of needing medical and social services. These additional services can include nutritional services, medical services, aid to dependent children, parenting skills, counseling for abused children, and education for the students’ parents or guardians. These services were supported by Title V Block Grant funds. In addition, the School Health Program continued to sustain partnerships with the Florida School Health Association and the Florida Association of School Nurses.