Children are always learning, growing, and developing. Every child should reach certain milestones in learning, language, motor skills, even in playing. A child’s environment, genetics, and daily interactions with adults and other children can have a great impact on a child’s development. Developmental screens are a critical component to determining if a child is experiencing a delay in any of these areas. Early identification of developmental delays and subsequent early intervention is critical to giving the child the best possible outcome and potentially reducing costly treatment over time.

Parenting education and support was the chosen priority to focus on in the child domain from the 2020 Needs Assessment. Parents and caregivers should be aware of the developmental milestones every child should reach and the importance of screening. In addition, there are many things parents and caregivers can do to ensure optimal development and help their child grow. Families with a child with a developmental delay should also be given adequate support to help address the delay and improve the outcomes for the child.

The MCH Program carries out Ages and Stages Questionnaires (ASQ) and ASQ Social Emotional (SE) developmental screens through 72 of the 74 Community Health Offices. Families who visit a community health office are offered a developmental screen when they come to the clinic for WIC services as well as other services. Families are given education from the ASQ screening kits and laminated posters are displayed in the offices promoting developmental screening. In the event of an abnormal screen, additional education is provided, and a family may be referred to Birth to 3 or their local school district for follow up. During this reporting period, the community health staff facilitated the completion of 1981 ASQs and ASQ SEs.  

The MCH Program also carries out developmental screens through the Bright Start Home Visiting Program. This program utilizes the evidence-based Nurse Family Partnership (NFP) model and offers services to at-risk pregnant women and parents with young children by partnering families with a registered nurse. The program also offers an adapted curriculum for clients who don’t meet the NFP requirements but are still in need. The majority of program services are offered during home visits, but families and nurses also meet in other locations if the family prefers. Bright Start is funded in part through the Maternal, Infant, and Early Childhood Home Visiting Program (MIECHV) federal grant, as well as through a contract with the South Dakota Department of Social Services using Medicaid and TANF Block Grant funding. In 2022, the state legislature approved allocating additional Medicaid funds toward expanding Bright Start Home Visiting statewide. The program has since added a dedicated epidemiologist, regional team leads, and has been actively recruiting nursing and support staff. In 2022, the MCH Program contributed funding for new Bright Start promotional materials including brochures, posters, and media. The Bright Start Home Visiting Manager sits on MCH workgroups, leads a child health interagency meeting, and is supervised by the MCH Director.

During this reporting period, 65% of children enrolled in the Bright Start program had a completed ASQ-3 at 18 months. This number is significantly lower than previous years, however, with the addition of a program epidemiologist and improved data collection and reporting methods, this percentage is likely more accurate than previous years as we are able to better tease out the specific data we are measuring.

National Performance Measure 6:  Percent of children, ages 9 through 35 months, receiving a developmental screening using a parent-completed screening tool

Data Statement: 

South Dakota did not reach the 2021 annual target of 37.3%, with 32.9% of children ages 9-35 months receiving a developmental screening using a parent-completed screening tool in 2020-2021. This is a decrease from 36.5% in 2019-2020. The new annual target for 2022 is 35.8%. In 2020-2021, South Dakota was ranked 36th in the nation in percent of children receiving a developmental screening tool with a national percentage of 36.9%. The change from the base year (2016) to the current year is not significant.

State Objective: 

Increase the percent of children from non-metropolitan areas 9 through 35 months who received a developmental screening using a parent completed screening tool in the past year from 22.3% (2019-20) to 29.4% by 2025 (NSCH).   

State Objective Data Statement: 

The 2020-2021 South Dakota percentage of 25.6% exceeded the 2021 annual target of 23.7%. However, this percent among children from non-metropolitan areas was lower than the overall South Dakota percentage of 32.9%. The new annual target for 2022 is 26.6%. There is a data note for this indicator that the percentage should be interpreted with caution because the confidence interval width is greater than 20% points. 

Strategies:

6.1.  Develop and equitably disseminate a clear and consistent message to communicate the importance of developmental screening to families and community health providers

• Communicating a clear and consistent message starts from within. All staff administering ASQ and ASQ SE screenings in Department of Health (DOH) Community Health offices and the Bright Start Home Visiting Program are provided with ASQ training on administering the screens as well as education from the ASQ kits to provide to families. In addition, the MCH program consistently promotes CDC Learn the Signs Act Early materials to Community Health, WIC, and Bright Start staff as a resource to provide to families and maintains a strong partnership with the state’s LTSAE ambassador to stay current on information and materials.
• For continuing education, staff are encouraged to use the Brookes Publishing ASQ/ASQ-SE newsletters.
• The MCH program works closely with other state agencies including the Department of Social Services and the Department of Education to increase awareness of what we are working on and the messages we are communicating to families and the public.

6.2.  Create new and support existing parenting resources to support healthy children and families

• The MCH program provided funding for increased printing of Learn the Signs Act Early developmental materials including books and developmental checklists.  Community Health, WIC, and Bright Start Home Visiting staff were given ordering information and encouraged to utilize these items when working with families.

• Community health staff utilize posters promoting the CDC Milestone Tracker App and assist families with downloading the app and going through the app’s instructions. Staff also assist families with signing up for Bright by Text and Text4Baby.
• Trifold developmental screening tracking cards are available to be ordered through the DOH central ordering system. Cards are similar to immunization tracking cards and are given to parents for their records.
• Continued to offer online confidential ASQ screening tool at  https://doh.sd.gov/family/childhood/child-development.aspx. This tool can be accessed by anyone with an internet connection. This tool may not be available at the time of writing as the DOH website is being rebuilt, however, the tool will become available again when the site is up and running.
• In 2022, the MCH program partnered with the Department of Health Office of Disease Prevention and Health Promotion to create the Move Your Way Playbook, a useful resource across many of our Department of Health programs when promoting physical activity. The Playbook is completed and includes content for physical activity during pregnancy and the postpartum period, preschool-aged audiences, youth 6-17 years and families. The Playbook can be found at the following link: https://healthysd.gov/move-your-way-south-dakota-playbook/.  Next steps are to identify 1-3 communities who will implement the Playbook.   

• The MCH Program also partnered with the Department of Health, Nutrition & Physical Activity Program to release the Harvest of the Month funding opportunity to support youth programs in South Dakota to actively engage children in learning about and exposing them to fruits and vegetables utilizing Harvest of the Month educational lesson plans, recipes and supporting materials. Thirty-two applications were received from various childcare/daycare and other youth programs (i.e. Boys & Girls Club, YMCAs) with 18 applicants being awarded funds up to $1,500 to support implementation of twelve Harvest of the Month lessons including purchase of produce for sampling and preparation of recipes, small equipment/utensils, and print materials.  The project period for these funds is September 15, 2022- September 15, 2023. Additional information will be gathered (successes, challenges, overall project outcomes) upon grantee submission of a final report due no later than September 15, 2023.

• The MCH Program contributed funding for statewide promotion of life.sd.gov and also promotes the resource on the DOH website. The site was created by the South Dakota governor’s office and provides education and resources to parents and expecting parents, including information on well child checks, safety, and parent trainings.  Many resources for parents are available on this page.

• SD WIC began an initiative to prioritize and increase the number of face to face visits, regardless of whether they are in-person or virtual and limit phone calls to be only used when other options are not possible.  In order to accomplish this, the program began to develop and implement a new telehealth system on the doxy.me platform. MCH contributed funding to the purchase and development of this new system to be used by WIC and Community Health nurses to reach families and provide face to face interaction.

• During this reporting year, MCH funding supported the purchase of Injoy video clips for the Community Health Offices on a variety of pregnancy, postpartum and newborn care topics. The nurses watch a short educational clip with the client and then they discuss it. The most viewed clips are on labor and delivery, newborn care, and postpartum care. Clips are also available on parenting, hunger cues, breastfeeding (to supplement WIC information), developmental milestones, and health and safety. Many times, families come in with multiple children and it can be challenging to sit through a 30 minute educational video with little ones. The video clips are meant to be short discussions on pertinent information they want and need and are available in English and Spanish.

6.3.  Collaborate with partners to identify gaps in parenting education and support and reduce duplication of efforts

• The MCH Child domain maintains a strong partnership with SD Parent Connection and the state’s Learn the Signs Act Early (LTSAE) ambassador (employed within SD Parent Connection). The MCH child domain lead sits on the LTSAE advisory committee and promotes LTSAE materials to community health, Bright Start, and WIC staff. The LTSAE advisory committee has membership with organizations all over the state including both state government and non-state government organizations.

• The SD DOH facilitates a child interagency workgroup, led by the Bright Start Home Visiting manager. The workgroup meets quarterly and is attended by leadership from the MCH Program, WIC, Community Health, Bright Start Home Visiting, Department of Social Services including Medicaid, Behavioral Health, and Child Protective Services, and the Department of Education including Birth to 3. The agencies and programs report on current projects, goals, and activities, and opportunities for collaboration are discussed.
• The child domain coordinator participates on a Medicaid well-child affinity group focused on improving well-child visit rates amongst the American Indian/Alaskan Native populations in our state.  
• The CYSHCN Director, who works closely with the child domain coordinator and oversees the child domain when the coordinator position is vacant, is a member of the South Dakota Developmental Disabilities Council, the state Community of Practice team for Intellectual Disabilities, and attends the Department of Human Services Division of Developmental Disabilities stakeholder collective. These groups are well attended by partners both in and out of state government as well as family and self-advocates. Identifying and addressing the gaps in support, resources, and education for caregivers and families is a frequent topic of these meetings as well as discussion of current efforts to address these gaps.

Child Death Review

In addition to developmental screening efforts, South Dakota has reviewed post hospitalization infant deaths statewide since 2012. In October of 2020 the SD Department of Health expanded death review to include all child deaths up to age 13.  The process includes two review teams, East River and West River. The East River team reviews infant/child deaths (post hospitalization through age 12) that occur in the 44 counties east of the Missouri River. The West River team reviews deaths that occur in the 22 counties west of the Missouri River. The teams are multidisciplinary and are comprised of volunteers from law enforcement, Child Protection Services, hospital staff, fire departments, emergency medical services, public health, behavioral health, forensic pathology, the Bureau of Indian Affairs, Indian Health Services, the Great Plains Tribal Leader's Health Board, and the States Attorney’s and U.S. Attorney’s offices.


Data from death review is shared with the public via published infographics, presentations, and an Infant Mortality Report, developed every 5 years. A data dashboard also displays information from death review and vital statistics on the Department of Health’s website under Infant Mortality.

With the expansion of death review to include all child deaths up to age 13, discussions began within the MCH child domain around how we can use the data collected to provide parenting education around injury and death prevention. South Dakota has the 5th highest crude death rate in the nation for child mortality (2010-2019, CDC WONDER). Creating educational materials around injury and death prevention was discussed by the Child workgroup as well as the broader MCH team. Following these discussions, the decision was made during the previous reporting year to bring the DOH Injury Prevention Coordinator in to co-lead the child domain and eventually take over leadership duties.

The decision to bring the DOH Injury Prevention Coordinator in to eventually lead the child domain was met with some challenges in 2022. The position was designed to be shared with the Office of Disease Prevention and Health Promotion, which created some complications for the injury prevention coordinator when reporting to two different lines of leadership, working with multiple grants, and only being able to allocate half their time to MCH. In addition, the Child Death Review data had not been collected long enough to really look at trends and determine leading causes of child injury and death over time. The position turned over and a new Injury Prevention Coordinator came on board at the end of this reporting period. In the absence of a child domain lead, the CYSHCN director stepped in to lead the domain.