NPM 6: Percent of children, ages 9 through 71 months, receiving a developmental screening using a parent-completed screening tool

Title V Child and Adolescent Health (CAH) agencies continued to reinforce the importance of developmental screening through the informing process for newly enrolled Medicaid families. Bureau of Family Health (BFH) provided Title V CAH agencies with needed information and resources.  Title V CAH agencies also continued to offer gap-filling developmental screenings (Ages and Stages Questionnaire (ASQ)) and emotional-behavioral screenings (Ages and Stages Questionnaire: Social-Emotional (ASQ:SE)).

 In the Title V MCAH RFA application process and resulting contract, the Bureau of Family Health continued the requirement for provision of developmental screening services, including maintaining the working relationship with the Area Education Agencies (AEAs) regarding developmental screening and developmental monitoring under Early ACCESS. 

BFH staff maintained the strong working relationship between Title V MCAH and Iowa Medicaid Enterprise (IME).  BFH staff worked with Medicaid’s project manager to continue payable developmental screening services under the Screening Center provider status within the Iowa Medicaid and Medicaid Managed Care Organization (MCO) payment structure.  

As part of the federal-state partnership, Iowa’s state funded 1st Five program engages health care providers in supporting the use of developmental surveillance and screening tools.  The 1st Five program continued to support primary care providers in administering standardized developmental screening utilizing a validated instrument.  The partnership between providers and 1st Five staff was established for care coordination through developmental support, referral, and follow up services.

Local 1st Five site coordinators (currently engaged with 88 Iowa counties) worked on outreach to medical front desk office staff.  Outreach included screening information displayed in newsletters, trainings, and guide books.  Incentives promoting the 1st Five logo were provided in some locations as well.

Local 1st Five site coordinators will work with 1st Five Medical Consultants on providing developmental screening trainings to office staff and engaged healthcare partners. 

BFH continued to enhance collaboration between Title V CAH programs and 1st Five, Early ACCESS, early care and education, home visiting providers, and CHSC to encourage developmental screening.  BFH staff continued to share aggregated developmental screening data with the Children’s Justice Leadership Team related to its work regarding the health and well being of pregnant women, infants, and children.

NPM 13: B) Percent of infants and children, ages 1 through 17 years, who had a preventive dental visit in the last year

In 2019, OHC maintained the successful oversight and technical assistance for I-Smile™ and the MCAH contractors. OHC also addressed challenges, such as access to dentists for the MCAH population. Although OHC has limited impact regarding dental offices that accept Medicaid, we required I-Smile coordinators to make outreach visits to all general and pediatric dental offices within each service area. Developing and improving relationships with the offices is important to build stronger referral networks. In addition, the dental director continued communicating with the dental association’s new director, identifying areas of common ground and methods to improve the public-private link. The dental director also continued discussions with the Iowa Dental Board regarding services provided by I-Smile dental hygienists within hospital systems/medical offices. OHC staff expanded partnerships with state stakeholders who have investments in oral health for underserved Iowans, including Iowa Medicaid and Delta Dental of Iowa Foundation.

OHC staff led the Cavity Free Iowa initiative, monitoring activities with the Mercy Des Moines health system and providing technical assistance to I-Smile coordinators around the state to implement similar projects in their areas. Coordinators oversaw the school dental screening requirement and were required to make outreach visits to all pediatric medical offices in their service areas to continue to build awareness about gaps in dental care for at-risk children. Additional outreach occurred with child care providers, using oral health training and setting up toothbrushing protocols to assist centers with Quality Rating System requirements. Oral health promotion continued through updates to the I-Smile website (ismile.idph.iowa.gov) and sharing education through the I-Smile Facebook page, targeting parents. (https://www.facebook.com/ISmileDentalHomeInitiative/?ref=bookmarks).

OHC received approval by the Iowa Dental Board for use of silver diamine fluoride (SDF) by dental hygienists using public health supervision. This secondary preventive measure can arrest some tooth decay, potentially reducing pain and costs for restorative care. OHC incorporated use of SDF within I-Smile, to include education for hygienists, recommended outreach to dentists, assurance of available training, and development of materials such as consents with photographs of teeth treated with SDF. SDF was offered and used, when appropriate, for MCAH participants receiving gap-filling preventive services through I-Smile.

SPM 2: A) Percent of children 0-21 served by Title V who report a medical home

BFH staff continued to monitor data for the percent of children and adolescents served with a medical home.  This was accomplished through reports from the signifycommunity - CAH module.  Local CAH contract agencies continued to assess a child’s medical home status regularly when providing presumptive eligibility, informing for new Medicaid eligibles, care coordination, and gap-filling direct care health services  through completion of the Intake  Assessment. A medical home was identified for those children with a ‘yes’ response to three questions:  

1. Does the client have a usual source of medical care?  
2. Is the usual source of medical care available 24/7? 
3. Does the source of medical care maintain the child’s record?  

Statewide medical home percentages were tracked on the Child Health Program Profile and the IDPH Executive Scorecard. 

Medical homes were established for uninsured or underinsured children as well as those on Medicaid.  Presumptive eligibility services for children continued to be provided, offering a window of Medicaid coverage while a full determination of eligibility for Medicaid or Hawki is made.  Local Title V CAH agencies continued to assist families with understanding their Medicaid or Hawki coverage.  For Medicaid enrolled children, they assisted families to connect with primary care providers within their child’s Medicaid status.  Local CAH agency staff promoted health literacy by striving to assure that families understood their health insurance coverage, knew how to use it to access health care, and assisted with needed transitions to new providers or alternate types of health care coverage.

Local CAH agencies advanced public-private partnerships with local medical providers of preventive health care services, including educating practitioners on the CAH agency’s role in assuring medical homes and serving children in the EPSDT program.  This work was especially strong among CAH agencies that also held a contract for Iowa’s 1st Five Healthy Mental Development Initiative.  

Local CAH contract agencies with a FFY 2019 RFA adolescent well visit plan worked with primary care practitioners in the area of adolescent health, with a goal to increase the number of adolescents served and enhance the quality of the well visit.  These agencies partnered with school districts and other adolescent serving organizations to promote adolescent well visits in an established medical home.  Addressing annual adolescent well visits per Iowa’s revised EPSDT Periodicity Schedule remained a priority.

At the state level, BFH staff worked with Iowa Medicaid and MCOs to address challenges regarding provision and payment of services for the EPSDT population provided by Title V CAH agencies (Medicaid Screening Centers). Monthly Medicaid Team meetings continued to be held.  Local CAH agencies continued to strive to work effectively with the MCOs to maintain access to care that meets the needs of the families they serve.

BFH staff will work with Child Health Specialty Clinics regarding efforts to promote medical homes for children with special health care needs to support NPM #11 and assure appropriate resources for referral from CAH agencies.

SPM 3: Percent of children with a payment source for dental care

OHC continued to monitor the climate in Iowa for a possible transition to managed care for dental services for children through regular communication and face-to-face meetings with Iowa Medicaid Enterprise, Delta Dental of Iowa and Managed Care of North America (MCNA), a carrier for Medicaid’s adult dental services. The dental director continued his role as a leader in the state through his work on the Hawki board, with stakeholder groups, and with national organizations with insight to other state’s policies. 

I-Smile coordinators were required to make outreach visits to all pediatric medical offices as well as general and pediatric dental offices, intended to build the referral network for I-Smile and in the end increase not only access to dental care but also assistance for families to receive care. Coordinators provided oral health training and implemented tooth brushing protocols for child care centers to help meet child care Quality Rating System requirements. Enrollment information about Medicaid and Hawki were shared with child care providers through this outreach. In addition, through the regular contacts with families via the services provided by I-Smile at WIC, Head Start, schools, and other public health sites, children found to have no payment source for dental care were screened for presumptive eligibility.

SPM 4: Percent of early care and education programs that receive Child Care Nurse Consultant Services

Iowa’s Healthy Child Care Iowa Coordinator was involved in the development of Iowa’s Quality Rating System (IQ4K). In the new system there are new requirements that programs must utilize CCNC services: 

• Professional Development Category - Medication Administration Skills Competency training and skills “test-out” requirement for all home providers and center director/staff who administer medications.
• Environment Category - Onsite assessment using the Health and Safety Checklist a nationally recognized research based assessment tool developed by the California Childcare Health Program, UCSF School of Nursing. This tool is being used by nurse (health) consultants in 4 states to evaluate health and safety in early care and education environments.  Iowa will be the 5th state to utilize this tool.

Additional areas that Child Care Nurse Consultants help support providers in quality:

• Nutrition and Physical Activity Category – Providers will complete a self- assessment and develop a quality action plan in both nutrition and physical activity.  NAP SACC and Let’s Move Child Care are two resources that CCNCs currently utilize in training/consultation and will be helpful to providers in this category.
• Teaching and Learning Category- This category promotes developmental screening and inclusive environments. CCNCs can assist providers with developmental screening resources and are knowledgeable in policies/procedures for inclusive care.
• Health Policies: Safe sleep; playground equipment stability, fall surfacing, and inspection; strangulation prevention; Tobacco Free/Nicotine Free environment (aligning with IDPH policy guidelines); oral health.
• Positive Behavioral Interventions and Supports (PBIS) training/coaching

While the IQ4K framework and criteria are finalized, the Iowa Department of Human Services has not implemented the updated QRS. 

Title V staff and HCCI staff continued researching potential partnerships to increase funding for gap filling services throughout the state.  Through the MCAH RFA, Title V was able to support each child health agency with funding to ensure a minimum level of service was available in all areas.