III.E.2.c. Child Health: Annual Report (10/1/2020-9/30/2021)

 

State Priority Need:

Reduce preventable deaths in the MCH population with a focus on reduction and elimination of inequities in mortality rates

 

National Performance Measure (2020 - 2025):

NPM7.1- Rate of hospitalization for non-fatal injury per 100,000 children, ages 0 through 9

 

Evidence Based/Informed Strategy Measure (2020 - 2025): 

ESM 7.1.1: Percent of sites operating mobile fitting and car seat inspection stations to make sure car seats are properly installed.

ESM 7.1.2: Percent of child deaths reviewed by Child Fatality Review Teams.

 

General Information:

Injuries are a major public health issue in Indiana, especially for young children. Motor vehicle-related injuries are the leading cause of death and IDOH continued to ensure families are properly using child restraints and car seats through access and education. Now that IDOH’s Division of Trauma and Injury Prevention (DTIP) division can train child passenger safety technicians through their scholarship program and external partnerships, it is imperative to expand permanent fitting stations around the state. By partnering with the Indiana Criminal Justice Institute (ICJI) to provide continued support to existing fitting stations, DTIP engaged and encouraged local police and fire stations to join the effort and prevent further motor vehicle-related injuries for youth. Due to COVID-19, most of these efforts had been reduced and the focus of the injury prevention program coordinator had been diverted towards COVID-19 related activities.

 

Car Seat Safety

In the meantime, DTIP continued to support ICJI’s efforts to expand fitting stations across Indiana. ICJI put funding towards those fitting stations that resumed their activities and services to the public. During this time period, these were the tasks accomplished under ICJI:

• Car Seats Inspected: 6,136
• Car Seat Distributed by IDOH funding: 1,092
• Car Seats Distributed by IDOH and ICJI funding: 2,184

 

Child Fatality Review

Fatality review is a critical public health process to examine the circumstances and risk factors associated with unexpected child deaths. This process ultimately leads to recommendations on how to best prevent future deaths from occurring. Beginning in 2013, Indiana legislation moved the Indiana Statewide Child Fatality Review Committee (State Team) and local teams from the Indiana Department of Child Services (DCS) to IDOH. This new law, IC 16-49, also required multidisciplinary child fatality review (CFR) teams to be implemented at the local level, with coordination and support for local teams as well as coordination and support for the statewide committee to be provided by IDOH. Teams are required to review all deaths of children under the age of 18 that are sudden, unexpected, or unexplained; all deaths that are assessed by DCS; and all deaths that are determined to be the result of homicide, suicide, accident, or are undetermined. Teams are required to submit an annual report to the IDOH CFR Coordinator summarizing the child fatality reviews completed, identified needs, risk factors, and prevention action or recommendations made. The information from the local reports is included in a mandated annual report to policymakers.   

 

Ongoing support and training to CFR teams increases the accuracy and classification of child injuries and fatalities. As an unfunded mandate in Indiana, local communities are often challenged by the tasks associated with CFR. Providing guidance, training, and technical support to this network of volunteers is the role of the Fatality Review and Prevention (FRP) Division. The top request by local CFR teams is for more training opportunities from IDOH. To date, there are 60 local CFR teams covering 83 of the state’s 92 counties. FRP staff work closely with CFR teams and often attend review meetings to ensure the team is completing effective reviews and identifying and understanding risk factors and disparities in their communities. At these meetings, FRP staff also provide support and technical assistance to clarify standard classification of each child fatality and help ensure recommendations made by the CFR team are communicated to the local Community Action Teams (CATs) for recommended preventive actions. 

During this reporting period, FRP continued to contact and support existing local CFR teams and make efforts to engage counties that have not yet established teams. Outreach was conducted via email, virtual site visits, virtual meetings, and in-person site visits to provide data, case identification, and other necessary training and information regarding the fatality review process. This guidance helped local CFR teams improve processes and the prevention work that is implemented in their communities.

FRP has partnered with DCS to receive immediate notification of all fatalities and near fatalities reported. FRP continues to notify local CFR teams to ensure that child fatalities are reviewed in a timely, complete, and accurate manner. FRP staff also continued providing notifications via email of child fatalities from vital records or from the DCS notification as it is received.

CFR teams across the state have recognized and focused on ways to implement prevention activities to reduce child injury and death in their communities. Work continued with teams to focus on completing effective reviews to identify risk factors relating to child injury and death, including those caused by unsafe sleep environments, motor vehicle collisions, ATVs, drowning, and firearms.

A comprehensive fatality review process includes data entry into the National Center for Fatality Review and Prevention Case Reporting System (CRS). In 2013, Indiana Code mandated that the CFR team chair/members enter all fatality review data into the CRS. Local CFR teams continue to ask for assistance with data entry. Fatality review data entry is time consuming and unfunded at the local level, making the work challenging for many communities. FRP continued to support CFR teams in data collection and entry into the CRS as necessary to capture needed information and communicate recommendations to their associated CAT teams.

DCS and IDOH entered similar types of information for each child decedent into their respective data systems, which created an opportunity for an integrated data repository. A new, comprehensive data integration system project eliminated mistakes, duplication/redundancies, provided accuracy in reporting information, and saved valuable staff time. FRP helped develop and test, in conjunction with DCS, a new comprehensive web-based data system to track infant and child deaths with greater accuracy. The data integration system project matches child welfare records, vital records, and other records/information from the local CFR teams. The goal of the data integration system project was to provide a comprehensive set of data for each infant/child decedent that is easily accessible to all FRP and DCS staff in real time. Data from all sources described risk and/or protective factors as well as circumstantial information involved in infant/child deaths that is not compiled elsewhere. FRP and DCS were then able create a comprehensive joint report to help guide a public health, data-informed approach to infant/child death prevention. FRP collaborated with the Michigan Public Health Institute (MPHI) and the National Center for Fatality Review and Prevention (NCFRP) to ensure that the FRP/DCS data integration system project provided seamless, automated data integration with the CRS so Indiana’s data can be included with the national fatality data repository. The first phase of this roll out was scheduled for July 1, 2021, with the full integration scheduled for January 2022.

FRP continued working with the Centers for Disease Control and Prevention (CDC) to participate in the Sudden Unexplained Infant Death (SUID) and Sudden Death in the Young (SDY) Case Registry grant. The program ensured all necessary records are collected, entered the CRS in a timely manner, and checked for accuracy by the end of 2021. FRP staff continued to on-board coroners to the project to ensure tissue and blood samples can be saved at autopsy and that all child deaths eligible for the project are captured and analyzed. This project will continue to grow through 2022 and 2023 as FRP engages all Indiana counties for participation at CFR team and coroner levels.

FRP Title V-funded staff were able to expand their work by applying for additional funding opportunities. This resulted in three awards funded through the U.S. Department of Justice Office of Justice Programs, Office for Victims of Crime (OVC) and Children’s Justice Act.

The first opportunity, Child Safety Forward, was part of a demonstration initiative to develop multidisciplinary strategies and responses to address serious or near-death injuries because of child abuse or neglect and to reduce the number of child fatalities. Retrospective reviews of child fatalities were conducted during 2020 in four target counties identified by their high rates of externally caused deaths. These counties included Clark, Delaware, Grant, and Madison. The retrospective review and data collected by the local CFR teams helped identify family and systemic circumstances for the deaths. Based on the research conducted, unsafe sleep was identified as the leading cause of death due to external causes for children ages 0 - 18 years old, when excluding medically expected fatalities. Other causes of death that were noted included homicides, drownings, motor vehicle accidents, and suicide. Data were gathered and evaluated using the CRS, which allowed for all data points to be collected, including race/ethnicity. Based on the data, along with qualitative research conducted by the Indiana University School of Social Work, CFR teams and community stakeholders received opportunities to engage in training for trauma-informed care, social determinants of health, inter-state record sharing, and death investigation. They also focused efforts on a one-year research plan to increase knowledge around the cultural factors that influence unsafe infant sleep behaviors in Indiana. 

IDOH was one of five demonstration sites chosen nationally for this work. Each of the implementation strategies identified by the sites is unique and specific to their communities, honoring the data they collected over the past year to identify community-led solutions that support resilient families and keep children safe in their homes. All strategies were predicated on demonstrating a public health approach to child and family wellbeing called for by the federal Commission to Eliminate Child Abuse and Neglect Fatalities. With a focus on increasing equity in systems that serve families, elevating families into relationships of equal power, building protective factors, and supporting families who are having trouble weathering one or more of the storms impacting our country right now, each of the demonstration sites were hoping to create a body of knowledge about what works to reduce child fatalities.

The second funding opportunity awarded from OVC was to increase direct services support for the youngest victims of crime related to the opioid epidemic in two counties in Indiana. This project focused on decreasing secondary trauma after a child has experienced a potentially traumatic event where first responders are called to the scene. First responders provided a Handle with Care (HWC) notification to the child’s school that simply includes the child’s name and the words “Handle with Care.” This notification was distributed to staff that may encounter the student to ensure that they can watch for atypical behavior and use a trauma-informed response. The notification system was designed to be discrete, and the information provided does not indicate what type of event the child may have experienced. School staff were trained to provide additional support as needed. They were also trained not to ask questions or try to gather information about the event. If the child requires additional, formal supports, the school then helped connect the student to mental health services. Throughout 2021, the HWC program, which was originally implemented in one county within one school district, spread to three other school districts, leaving one school district left without the program. Plans to implement the program within the last school district will occur in 2022.

In addition to the implementation of HWC, FRP staff are working to implement trauma-informed practices throughout the funded counties. A multi-sectoral approach that includes hospitals, mental health providers, schools, law enforcement, courts, social services providers, United Way, community foundations, university partners, grassroots community organizations, faith-based communities, and local businesses were engaged to move forward with comprehensive trauma-informed practices that decrease secondary trauma, while also increasing positive childhood experiences that have been shown to mitigate adverse experiences.

The third funding opportunity through the Children’s Justice Act allowed for increased HWC support and additional FRP staff to help provide direct support and technical assistance to local partners and local CFR teams.

FRP and MCH were committed to increasing awareness of the impact of Adverse Childhood Experiences (ACEs). The ACEs Indiana Coalition formed in late 2019 and is dedicated to increasing awareness of adverse childhood experiences, building self-healing communities, and building a common language through statewide presentations. ACEs are potentially traumatic events in a child's life that could have negative and lasting effects on physical, mental, and emotional health. In addition, presenters promote self-healing communities focused on the implementation of trauma-informed interventions, local policy improvements and paradigm shifts in how we assist children and families. The ACEs Indiana Coalition is comprised of professionals from around the state with diverse backgrounds. Each coalition member brings a unique perspective to the initiative. The coalition currently has 100 active members, with plans to expand.

 

 

State Priority Need:

Promote Physical Activity through policy improvements and changes to the built environment

 

National Performance Measure (2020 - 2025):

NPM 8.1 - Percent of children, ages 6 through 11, who are physically active at least 60 minutes per day

 

Evidence Based/Informed Strategy Measure (2020 - 2025): 

ESM8.1 Number of schools participating in an activity (training, professional development, policy development, technical assistance, PA in-school programming, PA before and after school programming) to improve physical activity among children (6-11).

ESM8.1.2: Percent of children ages 6-11 impacted by improvements to the built environment.

 

General Information:

The IDOH MCH and CSHCN divisions partnered with the Division of Nutrition and Physical Activity (DNPA) to align efforts to increase the physical activity level of children ages 6-11. This included working with local organizations and schools to increase physical activity during the school day, raising awareness of child and adolescent obesity and low levels of physical activity as a public health issue, and promoting prevention strategies. In order to address child/adolescent obesity, DNPA trained a variety of professionals and community members to implement physical activity best practices across a wide-range of settings, including before and after school programs, in-classroom lessons, recess, and through other parental and teacher involvement.

 

The Division of Nutrition and Physical Activity (DNPA) holds an annual contract with Playworks to provide district-wide trainings on creating safe and healthy play in the recess environment. Playworks programs also decreased bullying and behavior problems, effective both at recess and in the classroom. Since physical education is often limited in the K-8 setting, Playworks encouraged an inclusive opportunity for all children to be active at recess, regardless of physical activity level or ability. DNPA continued this partnership throughout the 2020-21 year and expanded to school districts that have not yet been reached.

 

Physical Activity Minutes

DNPA supported Playworks in conducting two types of training opportunities:

• Recess Implementation (at three different school buildings): 2 days of recess instruction, 8 hours each, per training
• Team Up Program (at three different school buildings): 1 semester of on-site training

Each program listed produces at least 30 minutes of physical activity instruction, daily.

 

Program Attendance/Reach

Below lists the final student reach from the professionals who participated in the Playworks recess programs/trainings:

• Recess Implementation:1,135 students
• Team Up Program: 1,349 students
• Total: 2,484 students

 

GOAL University:

The DNPA also contracted with GOAL University to expand the after school, family-focused community program that encouraged healthy lifestyles for children and their families through nutrition, behavior and physical activity education. GOAL initially began in Bloomington and expanded to Lafayette, Indianapolis, and surrounding rural cities with multiple training sites in each city. The GOAL University program utilized nursing students from universities in each location to help carry out daily lessons and reinforce positive messaging. For the duration of the grant cycle, their programming was held virtually due to COVID-19.
 

Physical Activity Minutes

While the time varied slightly each week due to the unique lesson plans, students typically spend about 30 minutes (of the 60-minute program) being physically active. The breakdown of a weekly program is below:

• Goal Setting and Checking: 10 minutes (sedentary)
• Nutrition Lesson: 25 minutes (15 minutes sedentary, 10 minutes active)
• Physical Activity Lesson: 25 minutes (5 minutes sedentary, 20 minutes active)

 

Program Attendance/Reach

Below were the total numbers of nursing student leaders and youth that participated in the GOAL University program in fall 2020 and spring 2021:

• 194 nursing college student leaders
• 1,190 students (school aged youth)

 

Community Mini Grants:

The DNPA is currently supporting seven community mini grants. The programs that these community mini-grants support, range from classroom specific to community wide initiatives and provide schools, educators, and students the resources to be physically active both in and out of school. The DNPA plans to provide the opportunity for each entity to continue their program throughout the 2020-2021 year. If a grantee does not wish to continue with funding, new grantees will be solicited.

 

Below is the final reach of each grantee’s program.
 

• Bloomington Parks and Recreation
  • Reach: 1,000 passports and 875 individuals interacted (numbers fluctuated due to COVID-19) with kids and their families throughout the summer. This could be amplified by how kids and parents shared the program with their friends as well.
  • Program: provide Passport to Play in Summer 2021 (program was originally supposed to be All Kids Swim but has been canceled due to COVID).
• Boys & Girls Clubs of Wayne County
  • Reach: 1,070 (6-17 years of age) enrolled in program
  • Program: Expanded ClubFit afterschool program in two additional sites (for a total of five sites) Further clubs’ details are as follows:
    • Jeffers Club: 410 total participants (two gyms with 70.3 average per day)
    • Central Club: 95 participants (2.5 average per day)
    • First Bank Club: 136 participants (35.1 average per day) 
    • Hagerstown Elementary School Club: 178 participants ((34.4 average per day)
    • McDaniel Club: 251 participants (47.8 average per day)

• Tindley Summit Academy
  • Reach: 50-60 students
  • Program: Expanded on afterschool programming (K-6th): basketball and cheerleading; start a boxing program, flower yoga; GoNoodle Plus.
• Embracing Together
  • Reach: 110 youth and adolescents
  • Program: Updated therapy and physical activity spaces, and playground with new adapted and handicap accessible equipment for youth and adolescents, 6-17 years of age who displayed developmental and intellectual disabilities with limited functioning the opportunity to engage in safe and inclusive play with their peers and within their current programming.
• Center for Homeless
  • Reach: 40 youth and adolescents
  • Program: Expanded the Youth Development Program to offer new physical activity equipment to youth and adolescents 6-17 years of age living at the facility. Offered new equipment that encouraged youth and adolescents to participate and improve their overall mental, physical, social, and emotional health.
• Christel House Academy
  • Reach:1,100 students
  • Program: Provided the following professional development trainings/modules: Mindfulness and Breathing, Cultivating Compassion and Kindness in the Classroom, Adventures in Mindfulness- Helping children navigate difficult emotions (elementary educators).
• Holy Angels Catholic School
  • Reach:135 students
  • Program: Purchased new physical education equipment for Pre K-6th grade students; equipment was utilized during physical education classes and as a part of the afterschool programming offered.

 

Professional Development Trainings:

Due to COVID-19, DNPA did not provide Professional Development trainings in 2020 - 2021. Trainings typically focus on K-12 PA/PE curriculum and integrating evidence-based practices to increase physical activity levels. Previous years and future years will include a focus on middle school and high school aged adolescents in addition to a focus on adapted PE and inclusion.

 

Comprehensive School Physical Activity Program Training:

The DNPA facilitated Comprehensive School Physical Activity Program (CSPAP) trainings that help school professionals form action plans on increasing access to physical activity in a multitude of school settings including before/after school, physical education, in-classroom, community events, and staff wellness. Due to COVID-19, DNPA staff members planned and organized an introductory virtual training in the fall of 2020 and then recorded additional segments of the training in the summer of 2021 with a plan to release these virtual trainings in the fall of 2021. Part two of these trainings was not completed by the end of the grant year but were very close to being completed. These trainings will give middle and high schools a framework for increasing physical activity for their students, ages 6-11. Options include before- and after-school options (not just athletics) in addition to the Physical Education class.

 

Built environment strategies

 

Temporary changes to the built environment: Tactical Urbanism Grant Program

IDOH continued to grant funds to organizations implementing pedestrian safety measures demonstrating the ability to create safer, healthier neighborhoods by promoting active lifestyles and active transportation for children and adults. Grantees were selected by a competitive application process and grant amounts ranged from $4,000 – $10,000. Grant projects included new pedestrian crosswalks, pop-up bike lanes, traffic calming installations, traffic speed reduction improvements, walking programs for schools, and pedestrian wayfinding improvements that increase safe access to everyday destinations for children and adults. The following grantees were awarded Tactical Urbanism Demonstration Grants in 2021 spanning from March – September.

 

City of Columbus:  Bartholomew Consolidated School Corporation

• Reach: 5,100 children ages 6 - 11
• Program: The grantee implemented a tactical urbanism demonstration project to test several design elements of a proposed bicycle boulevard on 17th Street between Noblitt Park and Donner Park, increasing safe access to these two destinations for children and adults. This demonstration project included a traffic diverter to limit vehicle access on part of the corridor, pavement markings to guide bicyclists through the corridor, a mini traffic circle to calm traffic, and new 4-way stop intersections. The grantee conducted promotional and evaluation activities including vehicular traffic measurements (speed and volume) before and during the project; measures of bicycle & pedestrian comfort at this location through a community survey; project signage at the site and digital promotion that included a link to an online survey, and bicycle and pedestrian counts before and during project.

 

City of Gary: Gary Community School Corporation

• Reach: 872 children ages 6 - 11
• Program: The first phase of the project included the design of high visibility crosswalks with artistic treatments in highly visible locations including the 900 block of Broadway (downtown's southern entrance) and the Adam Benjamin Metro Center, an intermodal transportation facility on the north end of downtown Gary. The second phase of the project in 2022 will include the installation of artistic crosswalks, wheelchair ramps and path-of-travel improvements at locations lacking any marked paths or ramps across a state highway, helping to create safe access to public transportation and destinations for children and adults.

 

Indianapolis Windsor Park Neighborhood: Indianapolis Public Schools School District

• Reach: 11,346 children ages 6 – 11
• Program: In 2021 the project included the design of various traffic calming elements and crosswalks. In 2022 the project will be implemented including the planning, promotion, and implementation of new pedestrian crosswalk connecting Spades Park, Pogue’s Run Trail, Spades Park Library, and the Kan-Kan Community Theater in the Windsor Park neighborhood on the near east side of Indianapolis. Traffic calming elements will also be installed to slow traffic near the crosswalks. All these locations are destinations for children that currently lack safe, visible street crossings. The grantee will also conduct promotional and evaluation activities for the project in 2022.

 

Town of Middlebury: Middlebury Community Schools

• Reach: 1,968 children ages 6 – 11
• Program: The grantee implemented a tactical urbanism demonstration project to safely define the sharing of two neighborhood street for motorists, pedestrians, and bicyclists to access an adjacent local park and a regional trail. The project helped define the Pumpkinvine Nature Trail where it crosses town streets; and installed flexible delineators and barricades to temporarily separate motorized vehicle traffic from the adjacent trail to make the trail and the street safer and more comfortable for all users, including children and adults. The project included an Education and Action program, offering trail safety education while providing an opportunity to measure the number of users of the project improvements.

 

Richland-Bean Blossom: Richland-Bean Blossom Community School Corporation

• Reach:  1,143 children ages 6 – 11
• Program: The project provided funding to help install approximately 1500 feet of new asphalt sidewalk adjacent to a long entrance drive connecting the Edgewood High School main building in Ellettsville to an existing sidewalk along the school property frontage that provides a safe route for children to walk to school. The new sidewalk supports an ongoing safe route to school program at the school. Parents and school age children are part of a student-led, project-based learning group that engages residents within the community through the planning and implementation of the new sidewalk and the overall safe routes to school project.

 

City of South Bend: South Bend Community School Corporation

• Reach: 7,103 children ages 6 – 11
• Program: This project included planning, promotion, implementation, and evaluation of a temporary pedestrian crosswalk and traffic calming measures on Thomas Street, adjacent to the El Campito Child Development Center and new community garden, connecting the Child Development Center and the garden to the adjacent neighborhood.  The Center and the garden are destinations for children that currently lack a safe, visible street crossing.  The project included a temporary pedestrian refuge island and other traffic calming elements that created a safe crossing for pedestrians and calm the traffic through the area. The grantee conducted promotional and evaluation activities for the project.

 

Terre Haute: Vigo County School Corporation

• Reach: 6,333 children ages 6 – 11
• Program: The grantee implemented a tactical urbanism demonstration project to support a walk-to-school program for Fuqua Elementary School in Terre Haute and encouraged the use of a regional trail by students to walk to the school. School logo artwork was applied to the pavement at an existing cross walk to the school to draw attention to the walk-to-school program and increase visibility of the crosswalk.  Additional temporary stencils and temporary signs created by students were deployed along walk-to-school routes as part of the project. The stencils and signs drew attention to existing bicycle parking at the school as well. The grantee conducted evaluation activities including a parent survey at the school before and after the walk-to-school program using a template based on the National Center for Safe Routes to School.  The grantee also worked with the Terre Haute Police Department to monitor vehicular speeds in the school zone adjacent to the walk-to-school routes before, during and after the deployment of the tactical urbanism grant elements.

 

Changes in the built environment

Title V funding was used to promote increased levels of physical activity at the community level through changes to the built environment. Technical assistance was provided to stakeholders and Purdue Extension Community Wellness Coordinators at the local, regional, and state level to identify opportunities to make changes to the built environment supporting physical activity. Technical assistance activities included providing guidance to stakeholders for the planning and installation of multi-use trails, safe pedestrian crossings, bikeways, safe routes to schools and parks, and complete streets. Children ages 6-11 could walk and bicycle to a part-time job, to middle or high school, to the library, to their friends’ houses, to extracurricular activities and these types of built environment changes can help them get to places safely, while also getting in their physical activity to help set them up for lifelong health and wellness.

 

Active Living Workshops

Pandemic restrictions in 2021 caused a delay in this activity during the reporting period. Virtual and in-person active living workshops are planned for the 2022 reporting period. Title V funding will build support within the communities across Indiana to host a series of regional Active Living Workshops. These workshops will enable residents to create action plans that lead to changes in the built environment supporting higher levels of physical activity in their communities. The workshops will help children, ages 6 – 11, travel safely within their communities with their families. This process would also allow for safer walking and bicycling to school access, as well.  

 

Children’s Healthy Weight COIIN

DNPA was also involved in a project for a COIIN that included conducting a needs assessment to determine the nutrition work needed to address health inequities and identify gaps in nutrition messaging within perinatal home visiting programs to improve health outcomes. With this, DNPA compiled a database of home visiting services and nutrition curricula being used to create print and electronic bilingual nutritional materials for home visitors to provide consistent messaging.

 

Workplace Wellness

DNPA provided technical assistance to workplaces throughout Indiana on how to establish successful wellness programs. The “Work@Health” training gives workplaces the tools to start a program, conduct a needs assessment, compile data, and survey employees. DNPA also provided mini grants to workplaces on a variety of nutrition, physical activity, stress management, and lactation support activities. This work has a trickledown effect to children ages 6 – 11, as trained adults brought home information gained from wellness programs and integrate it into the family structure.  

 

State Priority Need:

Access to High-quality, family-centered, trusted care is available to all Hoosiers.

 

State Performance Measure (2020 - 2025):

SPM 5: Promotion of optimal health, development, and well-being

 

 

General Information:

Indiana’s Title V Needs Assessment data revealed that there is a significant need to address the health, development, and well-being for all children, including children with special health care needs. We understand that this cannot be achieved without also engaging and meeting the needs of their caregivers. For Indiana, this extends beyond NPM 6 (developmental screening). The goal behind this measure was to enhance and expand the promotion of optimal health, development, and well-being of children and their caregivers through education, awareness, and the development of common language across multiple sectors and platforms. These areas include, but is not limited to oral health, newborn screening, nutrition and physical activity, early intervention, social and emotional development and well-being, developmental screening, and ACEs awareness. IDOH acknowledges that this cannot be achieved without utilizing a system- building approach focused on intentional collaborations and partnerships with both family serving agencies and families themselves. This multi-pronged approach aims to create a cohesive and comprehensive system that is responsive to holistically meeting the families’ needs with the no wrong door approach to services offered.

 

MCH/CSHCS began gathering the total number of trainings and materials offered to children, youth, and families who were striving for optimal health. Reaching families was a collaborative effort measured through the work of our MCH systems building, genomics and newborn screening, and Early Hearing Detection and Intervention teams, as well as a close collaboration with the CSHCS division.

 

MCH's Community Outreach Team tracked the number of resources shared, what resources were shared, how they were shared, and to whom they were shared to ensure families are getting the information on optimal health. Over the past year, we tracked the following:

• Learn the Signs Act Early (LTSAE): materials include the milestone tracker booklet, growth charts, children’s books, and development checklists for providers and families. These materials are shared community events, with Home Visitors, First Steps, WIC providers, physicians, and families. All LTSAE materials have specific Indiana resources listed on them.
• Adverse Childhood Experience Trainings: presentations discussed the neurobiology of trauma, the original ACEs study, findings from this study, and how it is attributable to community. Community and state-wide based resources are provided.
• Developmental Screening: MCH also tracked materials distributed around developmental screening. With Help Me Grow Indiana, MCH can also report the number of screens completed. Indiana uses the Ages and Stages Questionnaire (ASQ) and can track information on referrals to care and referrals completed. 
• My Healthy Baby: With the rapid growth and expansion of MHB, materials and resources are provided to connecting pregnant woman to home visiting services. We will measure our reach as this happens.

 

 

Newborn Screening Family Education: A newborn screening educational video was developed and uploaded to the department of health’s YouTube channel and website. The development of the video was part of an internship project which provided outreach to an additional partner, adoption agencies. The GNBS program had not previously included adoption agencies in educational outreach. Adoption families are often uninformed about newborn screening processes and the importance of follow-up and confirmatory testing. The GNBS program wanted to improve the follow-up of newborns who are adopted, and this outreach provided a new opportunity for the GNBS program. The video and handouts were disseminated to six adoption agencies. Additional efforts to reach prenatal educators, childbirth educators, primary care providers, OBGYNs, and other healthcare professionals continued. During this report period, the GNBS program distributed 970 dried blood spot and critical congenital screening handouts in English along with 110 dried blood spot and critical congenital heart disease screening handouts in Spanish. The newborn screening video has been viewed 290 times.

 

Newborn Screening Provider Education: The GNBS program developed six online training modules for hospital staff, health care providers, pediatricians, midwives, and other professionals that work with pregnant people and newborns. These trainings provided on-demand access to the latest newborn screening guidelines and protocols. The GNBS program is tracking the number of providers that completed these trainings through the online platform. Throughout this report period, the six trainings were completed by 696 individuals.

 

Home Visiting Provider Education: The goals of training home visiting professionals were to ensure community health workers understood the importance of newborn screening, educate families about the newborn screening process, and ensure that families received newborn screening results and any confirmatory testing or follow up after newborn screening is completed. The GNBS program completed one training to home visitors during this report period. Resources and educational materials were distributed to all attendees after the conclusion of the training. Training to home visitors will continue either through webinars or on-demand training.

 

Folic Acid Education: The GNBS program developed folic acid education materials to educate families and providers. The folic acid education materials consist of a Common Household Food Items list, an infographic, and a short video. St. Joseph county in northern Indiana volunteered to distribute these materials first. However, due to the need to respond to COVID-19 variants, St. Joseph County Department of Health had to shift their priorities and were unable to launch the pilot of these materials throughout the county. The IBDPR is planning to launch a folic acid campaign to correspond with National Folic Acid Awareness week in September 2022.

 

 

Genetic Counseling Student Education: Genetic counselors play a large role throughout the newborn screening system. They often play the role of consultant to providers for abnormal newborn screen result reporting, recommended genetic testing, and the interpretation of that testing. Additionally, genetic counselors will educate families about inheritance, prevention, and resources to promote informed decision-making for family planning. Genetic counselors also advise the GNBS program through participation on the Indiana Perinatal Quality Improvement Collaborative (IPQIC) Perinatal Genetics & Genomics task force. The GNBS program recognized the need for additional genetic counselors familiar with newborn screening across Indiana. There are two universities with genetic counseling programs in Indiana. One program through Indiana University and the other at Indiana State University. The partnership with the Indiana University Medical and Molecular Genetics Department provided an easy connection to the Indiana University genetic counseling students. The GNBS program presented to the genetic counseling students at Indiana University on September 28, 2021.

 

Early Hearing and Detection and Intervention Program (EHDI)

Indiana’s EHDI team provided technical assistance and training to birthing hospitals, healthcare providers, and parents to meet the federal and state mandated goals of “1-3-6.” The EHDI “1-3-6” goals were mandated in 2000 by the Joint Commission on Infant Hearing and American Academy of Pediatrics and ensure the following: all babies born in Indiana receive a newborn hearing screening by “1” month of age, if they do not pass newborn hearing screening, they receive a diagnostic audiology exam by “3” months of age, and if identified as deaf or hard of hearing, are enrolled in early intervention by “6” months of age.

 

In order to comply with these requirements, Indiana EHDI was responsible for collecting hearing screening results on approximately 80,000 children born annually in Indiana. This included providing onsite monitoring and training to all 85 birthing hospitals by our regional audiology staff. In addition, when a new birthing hospital staff member was identified for reporting newborn hearing screening results, Indiana EHDI trained them: approximately 40 staff members annually. Technical support included staff working on 14,000 child files per year through phone calls and emails providing guidance to healthcare providers, parents and other programs and entities to ensure “1-3-6” goals.

 

If a baby does not pass newborn hearing screening (3600 babies annually), IDOH staff was responsible for ensuring that those babies receive diagnostic audiology testing by three months of age. The follow up procedures for children who do not pass newborn hearing screening for those 3600 children included phone calls to parents and sending letters to parents and physicians with several resources: including information on Help me Grow, MOMS Help Line, Safe Sleep, and developmental milestones. These efforts continued several times through a child’s first year of life or until diagnostic audiology results are entered in our system.

 

If a child was identified as deaf or hard of hearing, we provided education (230 children per year identified as deaf or hard of hearing) to the child’s parents and physician through a tool kit that included state and local resources and guidance for best practice services for deaf and hard of hearing children. In order to provide support to all entities involved in newborn hearing screening and best practice follow up efforts to maximize outcomes for deaf and hard of hearing children, Indiana EHDI provided ongoing annual training to several stakeholders throughout the state.

 

Specific training sessions done in the past year by the EHDI team include:

• Pediatric Audiology Best Practices: 80 pediatric audiologists
• Medical conferences: 105 physicians
• Home Visiting nursing agencies: 40 participants
• Annual First Steps (Part C Early Intervention) training: 7 county agencies
• Training manuals for school nurses: For all Department of Education nurses for hearing screening procedures on school age children.
• Video trainings: for birthing hospitals on best practices for newborn hearing screening procedures for birthing hospitals for them to use for new staff.

 

Adverse Childhood Experiences (ACEs)

CSHCS, in partnership with Indiana Youth Services Association, created a position and hired the first program director for The ACEs Indiana Coalition. The goal of the coalition reamins to create a team of individuals who have the capacity to train on the ACEs master training modules, create a common language among community members, and enhance and encourage resilient communities. The ACEs Indiana Coalition is dedicated to growing awareness on Adverse Childhood Experiences and building self-healing communities. All members of the ACEs Indiana Coalition have been trained as master trainers and have committed to training organizations in their sphere of influence. CSHCS collected data through the ACEs coalition which provided data on individuals/organizations trained, potential individuals impacted, and state-wide reach of trainings.

 

Lead and Healthy Homes

The primary goals of IDOH Lead and Healthy Homes Division is to track the prevalence of lead exposure in children throughout Indiana and to support local health departments and community partners in taking the necessary steps to promote primary prevention efforts to minimize that exposure and the resulting health risks. One way this is done is through performing risk assessments to identify lead hazards.

Through the support from Maternal & Child Health, Lead & Healthy Homes was able to license thirteen new risk assessor and renew the licenses of nine existing risk assessors. As a result of these risk assessors being licensed, Indiana was able to perform 342 risk assessment identifying lead hazards in homes were children have elevated blood levels

 

 

Oral Health

To help promote children’s oral health, MCH allocated funding in the 2021 Title V funding proposal specifically to fund oral health initiatives throughout Indiana. On October 1, 2021, two organizations will be funded: Community Dental Clinic and Dunebrook.

• Community Dental Clinic aims to enhance access and promote optimal pediatric oral health through prevention, intervention and education by bringing high-quality, compassionate dental care to Amish, Mennonite, and other under-served communities of rural northern Indiana. Community Dental Clinic served families in LaGrange, Elkhart and surrounding counties.
• Dunebrook aims to promote and deliver oral health education to low-income Healthy Families participants and deliver parenting education to expectant/new parents and families with children to improve family functioning and harmony to optimize children's mental, social and emotional health. Dunebrook served families in LaPorte and Porter Counties.

 

The Oral Health Program (OHP) at IDOH also has plans for a pilot project that embeds dental hygienists into physician offices to meet families where they are – through a pediatrician or OB/GYN. OHP ideally liked the hygienist to practice under an Access Practice Agreement (APA), which would allow the hygienist to practice at an APA location other than a dentist’s office and provide preventive dental hygiene services at that location without the supervision by a dentist. The OHP also liked the APA location to utilize telehealth so that the hygienist can remotely obtain any needed examination of a patient by a dentist, and subsequent prescription, which would allow the hygienist to provide certain therapeutic procedures at the APA location. This arrangement allowed a patient to receive significant preventive oral health services and procedures at an APA location, without the patient having to travel to a dentist’s office.  

 

Help Me Grow Annual Forum

Help Me Grow Indiana (HMG) successfully hosted the 12th Annual Help Me Grow National Forum in September 2021. HMG has continued to serve Indiana families in nine pilot counties (Lake, LaPorte, St. Joseph, Elkhart, Grant, Madison, Delaware, Marion, and Scott counties). HMG provided developmental screenings, resources and has continued quality assurance through HMG Indiana’s, unique feedback loop. HMG has continued the vision of statewide expansion, through its partnership with the John Boner Neighborhood Center and the CDC Learn the Signs Act Early initiative. Both partnerships promoted additional developmental screening opportunities for Indiana families and ASQ-3 training for early childhood providers.