Child Health

CT continues to support activities identified in the completed HRSA State Implementation Grant for Improving Services for Children and Youth with Autism Spectrum Disorders and other Developmental Disabilities to improve access to comprehensive, coordinated health and related services. The grant was a collaborative project between DPH – the state’s Title V agency and A.J. Pappanikou Center – the state’s University Center for Excellence on Developmental Disabilities (UCEDD). Proposed outcomes of the project included: (1) implementation of the CT State Autism Plan, with activities that strengthen stakeholders’ awareness of early signs of ASD; knowledge about and access to evidenced-based, individualized and timely screening; diagnostic assessment and interventions implemented by a competent workforce; (2) engage ASD specific family support and training organizations to provide information and education on ASD; (3) work with the AAP, pediatric primary and family care providers, and the CT Medical Home Initiative for CYSHCN (CMHI) providers to expand practices proving family-centered, comprehensive coordinated health care and related services including screening, linkage to diagnosis, and transition to evidence- based interventions.

Report numbers include the following: training on the importance of developmental screening and supporting materials were provided to 2,441 families and 2,105 professionals for a total of 4,456 trainings; Community outreach activities and distribution of developmental screening materials totaled 6,402; 14 “Learn the Signs.Act Early.” products were distributed 16,519 times during the project period; 7 products developed during the period were distributed 9,765 times and six products developed prior to the project were distributed 7,304 times during the project period.

Ann Gionet was selected as the Center for Disease Control and Prevention (CDC’s) “Learn the Signs. Act Early” Ambassador for Connecticut. The program aims to improve early identification of children with developmental disabilities including autism to raise awareness of the importance of screening and early identification through the distribution of materials for parents and professionals working with young children. ”Learn the Signs. Act Early.” trainings were provided to three hundred and seventy –nine individuals comprised of families, early care and education provides and state agency staff and community providers. The “Learn the Signs. Act Early” website tracked 31,099 unique visitors from Connecticut.    

The CT DPH Title V CYSHCN Director provided input to AMCHP's State Public Health Autism Resource Center (SPHARC) interactive, self-paced learning module called "Communicating the Value of Developmental Screening." This informational module aims to build capacity of Title V leaders, family members, health professionals and other key stakeholders in articulating the value of developmental screening by helping users: identify the purpose of developmental screening, understand the impact screening has on families and children, recognize the roadblocks and challenges of the screening process, understand the role of Title V in developmental screening and communicate its value, and identify additional resources.

Developmental screening is a priority area for the CT Department of Public Health State Health Improvement Plan Advisory Council and the Maternal, Infant and Child Health Workgroup. The Developmental Screening Workgroup includes a group of stakeholders committed to developmental screening made up of community providers, representatives from family organizations, state agency representatives, the group meets quarterly. The Developmental Screening Workgroup’s Action Agenda contains three strategies.

The first strategy is to conduct an education and awareness campaign that targets families and communities on the importance of developmental screening. The Developmental Screening Workgroup is supporting the Connecticut’s Project LAUNCH’s media campaign message which includes information on and the promotion of developmental screening, a focus on families & relationships, and the Strengthening Families’ Protective Factors. The success of the campaign will be monitored through the counting of several screening and referrals items available through Child Development Infoline during the timeframe July 1, 2015 through June 30, 2016 and tracking these data points overtime. Ages and Stages Questioner (ASQ) new enrollments 3,002; Ages and Stages Questioner (ASQ) Screenings Completed 3,068 Birth to Three referrals 9,704; Ages and Stages Questioner web hits 2,133; Ages and Stages Questioner enrollment from web hits 1,087. Promote awareness and use of Child Development Infoline. Total number of Child Development Infoline and Help Me Grow calls is 2,850, CDI/HMG cases related to monitoring a child’s development 714. Expand the number of “Learn The Signs. Act Early.” materials distributed statewide to families and community providers 356, “Learn The Signs. Act Early.” web hits at Child Development Infoline 157.

The second strategy is to train community and healthcare providers to improve screening rates and coordination of referrals and linkage to services within the state. Success will be tracked through a variety of Educating Practices in Communities (EPIC) including but not limited to Help Me Grow EPIC during July 1, 2017 to June 30, 2018 there was a presentation in Enfield with 3 staff of which 100% said they would use the information provided in the module and 100% said the information was helpful. Infant Mental Health EPIC had a presentation in West Hartford to 6 staff of which 100% said they would use the information provided in the module and 100% said they information is helpful. CT Association for Infant Mental Health (CT-AIMH) endorsement process had 7 Endorsed and 67 in progress; ECMH Pilot has 3 in progress. For all Infant Mental Health Training Series there were 2 DCF and community training series with 101 people attending; Childcare Training Series had one training and 25 attendees; the Home Visitor Training Series has 2 trainings and 41 attendees; the Child Parent Psychology 18-month training has 1 series with 5 attendees, and the Early Childhood Obesity Preventions Series has 1 training offered with 25 attendees.  The CT Association of Infant Mental Health offered two Infant Mental Health conferences, in total 300 people attended the two conferences. 

The third strategy is to engage in cross system planning and coordination of activities around developmental screening. Members of the Developmental Screening Workgroup will join state level groups in order to support communication among and coordination of statewide efforts around developmental screening and the promotion of healthy development including Connecticut Project LAUNCH’s State Level Young Child Wellness Council, the DPH State Level Care Coordination Collaborative, and the Help Me Grow Advisory Council.

CT Project LAUNCH success includes the co-creation of Developmental Screening marketing materials in partnership with the Department of Public Health, Child Development Infoline and Help Me Grow and streamlining family friendly language around developmental screening across agencies. These materials will be linked to a state level conference for the purpose of equipping families, family advocate, and providers to begin regional and community action plans. Communities will be provided Developmental Screening Community Action Planning Tool Kits.

In addition CT Project LAUNCH continued with their program success by strengthening resources at 2-1-1 Infoline that allows for phone and digital access to educational information, screening resources and connectivity to support services; expansion of parent participation at the state level young child wellness council and linkage to national parenting activities; and partnering with local schools around initiatives that support family strengthening.

The Screening to Succeed Conference An Early Childhood Call to Action for Communities to Promote Developmental Awareness and the Power of Community Connection was held in June of 2018 in Rocky Hill with 130 attendees. The call to action was designed to excite conference participants to take the next steps, get inspired and bring back messages and tools shared during the conference to the community. Attendees included parents, family advocates, and care coordinators, along with providers of health care and early care & education programs. Conference presenters worked to help equip communities to increase developmental awareness and promotion, developmental screening, and connecting to services by providing families and providers with the knowledge, resources, and tools for effective coordination and community wide implementation. The conference highlighted that developmental screening is part of a continuum, overview of various screening tools, examples of best practice, and linkages to resources.

Kate Taft, MPH, Associate Director Child and Adolescent Health at Association of Maternal and Child Health Programs and Adriane Griffen, DrPH, MPH, MCHES, Senior Director of Public Health and Leadership at the Association of University Center on Disabilities provided the Key note address, Strategies and Tools to Support Developmental Monitoring and Screening: Building My Leadership Toolbox. The afternoon provided panel overviews for expansion of developmental screening on both the macro and systems level as well as micro or community level. The event was sponsored by University Center for Excellence in Developmental Disabilities, Department of Public Health and Project LAUNCH in collaboration with the Child Development Infoline, Wheeler Clinic, Office of Early Childhood, the Help Me Grow Advisory Committee and the Developmental Screening Workgroup of the State Health Improvement Plan.

The Help Me Grow Advisory Council requested DPH staff join the Council whose mission includes to ensure screening and follow-up services are accessible and fully integrated and to build capacity of the system to respond to increased need for referrals and services. The Help Me Grow Advisory Council developed out of the Early Childhood Comprehensive Systems grant that had an Action Plan that utilized national materials shared at the CT Act Early meeting including the adoption of objectives including establishing a statewide learning collaborative and creating a marketing message to emphases the promotion of good health/development.

The MAVEN online reporting system is available to care coordinators within the CT Medical Home Initiative for Children and Youth with Special Health Care Needs (CMHI) with enhanced fields specifically related to developmental screening. Fields include whether the child received a developmental screening, screening results, confirmation of screening results and referrals made. This mandatory data entry gathered information from parents on developmental screening of CYSHCN under the age of four who are currently served by CMHI contractors.

Title V staff worked with Dr. Thyde Dumont-Mathieu, MD, MPH on the Connecticut study to identify and disseminate systems of care factors and culture of care factors that promote a higher level of screening and referral within patient centered medical homes and assess the impact of cultural and linguistic competency/effectiveness as a barrier or facilitator across the continuum of care. Dr. Dumont-Mathieu will continue to convene a workgroup of stakeholders, including DPH staff, to review and recommend tools, office practices, and levels of family involvement that may reduce the cultural and linguistic barriers to higher screening and referral. Trainings will be matched to providers’ needs and will address barriers such as; insufficient office time, better screening policies and practices, prolonged wait time for evaluation, language and reading level barriers.

Title V continues to partner with Child Health and Development Institute (CHDI) and CT Children’s Medical Center (CCMC) to conduct ASD training including two Educating Practices In the Community (EPIC) training modules that build upon the American Academy of Pediatrics (AAP) recommendation of formal screening at 9, 18 and 24 (30) months of age.

Title V and community partners disseminated CT Guidelines for a Clinical Diagnosis of Autism Spectrum Disorders, complete with the DSM-5 definitions, to practices in each of the five CMHI network regions. The clinical guidelines were created as part of the CT State ASD Plan. All 10,000 hard copies of the Guidelines have been distributed. The Guidelines are posted on several website including the University Center for Excellence in Developmental Disabilities website and the CT Department of Public Health.

A comprehensive service resource guide was placed on line as part of the CT legislature’s study of individuals with ASD. The guide is a user-friendly clearinghouse to facilitate access to services, catalog resources currently available (federal, state, private), catalog qualified professionals/facilities based on Qualified Credentialing Application; and catalog existing training opportunities for parents and professionals. DPH staff serve as the liaison for the comprehensive resource guide initiative and the training initiative. The Autism Services and Resources Connecticut houses the user-friendly clearing house on their website at ct-asrc.org/professional-resources-guide/

Oral Health

The Water First for Your Thirst! (WFFYT) initiative for early care and education (ECEs) providers was created in 2017 by the DPH OOH and the Nutrition, Physical Activity, and Obesity Prevention Program to increase the availability of fluoridated drinking water in ECE sites and promote fluoridated drinking water as the primary beverage for young children (birth to 5 years old).  The message “Water First for Your Thirst!” and the logo were developed by the staff at the University of Connecticut Health (UCONN Health), a DPH partner.

WFFYT focuses on providing training and support to ECE providers. The initiative includes a self-assessment for ECE providers to identify gaps in achieving best practices, a toolkit for education and guidance on ECE nutrition and oral health best practices, training for ECE site staff, and WFFYT implementation resources, such as drinking cups with the logo and website address for the children to take home with them, books to read to the children in the classroom, water pitchers and insulated water jugs to make water available at the site, and more.  The WFFYT website is hosted by UCONN Health and updated throughout the year.  The WFFYT website provides consumer information and resources on the value of drinking and cooking with fluoridated water and healthy food choices.  Since 2017, WFFYT has been successfully implemented in 11 center-based and 66 home-based ECE programs serving 1,014 children.