III.E.2.c Annual Report: Child Health

The health of children in RI remains an important issue to the MCH Program. Poor oral, physical, mental, and behavioral health status can have long term health consequences later in life. With the increase in childhood obesity in the United States, RI has focused on physical activity and nutrition and childhood obesity as priority issues. Childhood overweight and obesity is a major concern in RI. Not only does RI have worse rates than the national average and other New England states, there are significant disparities by geography, insurance status, race and ethnicity. The loss of over one million dollars of CDC funding for the Physical Activity and Nutrition Program has been challenging for RIDOH, as it has resulted in the loss of FTEs and a number of planned program activities. Despite these challenges, RIDOH has been able to use existing relationships with other state agencies and community organizations to continue to advocate for physical activity, nutrition, and obesity prevention. In addition, RIDOH staff have continued to piece together support for the PAN program in the absence of funding. For example, previous PAN staff who moved to other RIDOH programmatic work have continued to support state and CBO initiatives with technical assistance and subject matter expertise.

Rhode Island had the following priority for child health from October 1, 2019 to September 30 2020:

1. Address obesity, nutrition and physical education for children

Priority: Address Obesity, Nutrition and Physical Education for Children

Supporting the growth of the local food sector through meaningful regulatory and policy initiatives is critical to increasing the number of jobs, growing the local economy, and ensuring positive health outcomes. To serve in this capacity, the Interagency Food and Nutrition Policy Advisory Council (IFNPAC) was created under Rhode Island General Laws 21-36-3 in 2013. The IFNPAC supports the growth of the local food sector by addressing regulatory and policy barriers to developing a strong, sustainable food economy and healthful nutrition practices. Membership is made up of the directors of the Department of Health (RIDOH), Department of Environmental Management (DEM), and Department of Administration (DOA). Administrators and directors from other State agencies often participate, including representation from the Department of Human Services (DHS), Office on Healthy Aging (OHA), Rhode Island Department of Education (RIDE), Department of Corrections (DOC), Rhode Island Commerce Corporation (RI Commerce), and the leadership of the Rhode Island Food Policy Council (RIFPC). IFNPAC submits an annual activity report to the General Assembly. This report has been drafted in accordance with the requirements set forth in Chapter 36, Section 21-36-5 of the Rhode Island Local Agriculture and Seafood Act.  

 

In 2017, IFNPAC created the Hunger Elimination Task Force (HETF). In October 2018, this task force released a set of recommendations to IFNPAC and Governor Raimondo, called Relish Rhody.

During the reporting year the program planned to focus on implementing initiatives that support Relish Rhody across five integrated focus areas:

1. Preserve and grow agriculture and fisheries industries in Rhode Island;
2. Sustain and create markets for Rhode Island food and beverage products;
3. Enhance the climate for food and beverage businesses;
4. Ensure food security for all Rhode Islanders; and
5. Minimize food waste and divert it from the waste stream.

 

Based on these focus areas, IFNPAC had several major priorities in 2019. Inter-agency progress was made under each of these focus areas in 2019, with highlights of the priorities of IFNPAC detailed below:

 

Preserve and Grow Agriculture and Fisheries Industries

The integrated focus area to preserve and grow agriculture and fisheries industries in Rhode Island is a cornerstone of the Relish Rhody food strategy.  DEM and partner organizations led many of the efforts supporting our local agriculture and seafood industries. Some of the initiatives included:

• Offering technical support for compliance with the federal Food Safety Modernization Act to farmers across the state – in partnership with RIDOH and the University of Rhode Island (URI). 
• Several IFNPAC agencies and partners worked with dairy farmers to help ensure they could continue to operate within Rhode Island and find markets for their products. 
• The Local Agriculture and Seafood Act (LASA) committee awarded $100,000 to 12 Rhode Island small businesses. This funding helped farmers and aquaculturists expand within the state by providing small grants for specific infrastructure needs. Private foundation funding for the program ended prior to grant round and resulted in a 50% reduction of available funding for regranting for fiscal year 2019. This funding loss occurred even though the Rhode Island Food Policy Council found that between 2014-2016, inclusion of just 27 recipients created 84 new jobs, increased sales by more than $5 million, and leveraged $2.5 million in additional funding. (This does not include the recent funding secured by the Rhode Island Mushroom Company, an early LASA recipient and Innovation Bond participant, that is bringing an estimated $100 million of additional investment to Rhode Island.)
• IFNPAC partnered with Polaris and Polaris provided low-cost technical assistance and LEAN training specific to food businesses. Several farmers took advantage of the program and used LEAN principles to increase efficiency and profits.  
• In April, Governor Raimondo announced 12 new Real Jobs Rhode Island partnerships. This included a new food business sector partnership based at the Rhode Island Food Policy Council. The Food Policy Council, the Director of Food Strategy at CommerceRI, and staff from the Department of Labor and Training worked with the Rhode Island Nursery and Landscape Association and consultants at KK&P to learn from their successful apprenticeship Real Jobs program to build a model for food sector jobs training and skill building. The Food Policy Council will hire a Director of Workforce Initiatives to lead this work in early 2020.
• The Food Policy Council partnered with DEM, CommerceRI, and the Commercial Fisheries Research Foundation to evaluate approaches to eliminating wastewater processing constraints that are inhibiting the growth of seafood processing in the state.  The project team also looked at successful models from other parts of the country that could possibly increase wholesale/retail distribution and sales of locally processed seafood in Rhode Island.  This project will be continued in 2020 and will coordinate with the efforts of DEM’s Seafood Marketing Collaborative. 

 

Sustain and Create Markets for Rhode Island Food and Beverage Products

Relish Rhody’s Integrated focus area to sustain and create markets for Rhode Island food and beverage products recognizes that Rhode Island growers, harvesters, and makers are businesses that need access to appropriate markets to thrive.  In this realm, IFNPAC supported four initiatives in 2019:

• Supply RI and anchor institution engagement: Agencies involved in IFNPAC have continued to work to advance its goals around institutional procurement of Rhode Island food products.  IFNPAC worked on a pilot project during the summer with Sodexo, with a goal that 10% of the produce procurement in three Lifespan facilities would be from local vendors. Sodexo officially launched the program in early June 2019 and purchased their produce and Rhode Island-made products from Farm Fresh RI’s Market Mobile Program.  Hospitals are also hosting on-site farmers markets twice a month, are labeling any Rhode-Island-grown ingredients that are available in the dining facility, and are creating locally-focused “action station” meals each week.  Early numbers show that the hospitals are exceeding their goals and more than $40,000 was spent during the summer in support of local farms. 
• Partnership with the Good Food Foundation: Relish Rhody was a host of the 2019 Good Food Mercantile in Brooklyn. As part of its sponsorship Rhode Island food businesses received discounted rates to showcase their products at the show. Participating businesses included Granny Squib, Beth Bakes, Dave’s Coffee, and Sanobe Superfoods. There was also a Relish Rhody table that featured food products from across the State.  In June 2019, the Director of Food Strategy led a group of the Good Food Foundation Merchants’ Collaborative on a tour of food producers in the state. Independent markets from across the country (Washington, DC, Colorado, and California) and representatives from the Good Food Foundation met with Rhode Island makers, tasted their products, shared advice, and developed relationships. The Collaborative spent two days in Rhode Island. Rhode Island also had a 2019 Winner of a Good Food Award: Sacred Cow Granola. Sacred Cow is a product of Munroe Dairy and a graduate of Hope & Main. They are also a participant in the Supply RI program and are currently building out a new kitchen facility in East Providence to expand their operations. 
• Wholesale readiness training for local agricultural and food processing businesses: The Food Policy Council worked closely with DEM and local organizations that serve farmers and small food processors on the development of a wholesale readiness workshop that provided technical assistance for businesses interested in selling to institutional or other wholesale buyers.  The first workshop attracted about 40 attendees and content was well received.  A second workshop took place on February 25 and there were more than 40 attendees.
• Increasing local food purchases by Rhode Island public schools:  The Food Policy Council worked closely with the Director of Food Strategy, DEM, RIDE, and other partners to identify ways to increase purchases of local food by public schools.  This year, a workplan that detailed ways to improve RIDE’s ability to accurately track local food purchases and identified ways to increase interest in purchasing local food at the district level was developed. The work plan is expected to be implemented in 2020. 

 

Enhance the Climate for Food and Beverage Businesses

In alignment with the integrated focus area to enhance the climate for food and beverage businesses in Rhode Island, IFNPAC tracked and supported other agencies’ initiatives in an effort to streamline regulations and update rules for food businesses.  Work in this focus area included: 

• The Director of Food Strategy worked with a student from Harvard to explore specific aspects of the climate for food businesses in Rhode Island. The student’s work finished in April, and the findings were presented to a cross-agency team in May. The report will be distributed to all IFNPAC members and stakeholders. 
• The Director of Food Strategy regularly met with businesses to provide technical assistance and guidance about troubleshooting administrative issues. 

 

Minimize Food Waste and Divert it from the Waste Stream

Momentum continues to grow surrounding food waste reduction and diversion within Rhode Island, and IFNPAC spent the third-quarter meeting focused on how to best support this work. This work has included:

• The Rhode to End Hunger continues to expand, with more than 20,000 pounds of food saved from the waste stream. 
• The Center for Ecotechnology (CET) is working with DEM to conduct outreach to businesses who are not in compliance with the tonnage threshold for the state’s food waste recycling law.  CET offers businesses technical assistance. 
• CET, with support from the Environmental Protection Agency (EPA) and the US Department of Agriculture (USDA), offers free technical assistance to Rhode Island businesses and institutions.  Since 2017, CET helped Rhode Island businesses donate three tons of edible food and divert more than 1,200 tons of food waste per year. 
• CET provided compost site technical assistance to two facilities in Rhode Island. CET offered guidance and recommendations for site expansion and recipe development.  This assistance supports the growth of processing capacity in the state. 
• The Director of Food Strategy and representatives from DEM toured the newly constructed anaerobic digester in Johnston. The facility is currently only in its pilot phase but plans to be more fully operational in the future after testing is completed. 
• DEM held a half-day information session for breweries on waste and wastewater processing and resources available to the industry from the State.  
• The RIFPC created a ‘Wasted Food Solutions’ work group that has four major initiatives.  First, it is supporting a new organization (Hope’s Harvest) that is recovering grade B produce from farms around Rhode Island and delivering it to the Rhode Island Food Bank and other emergency food organizations.  Around 50,000 pounds of fresh food was recovered by this effort in 2019.  Second, it is supporting the work of Foodscape RI, an organization that is working in public schools to educate students and set up diversion tables that recover excess food and send it to the Food Bank. Third, it is supporting the work of composters (Earth Care Farm, The Compost Plan, and smaller urban composting organizations) to remove obstacles to increasing composting activity.  Fourth, it is advocating for policies and legislation that could increase food donations, food recovery, and better organic waste management by businesses in Rhode Island.

 

Ensure Food Security for All Rhode Islanders

In 2017, IFNPAC created the Hunger Elimination Task Force (HEF). In October 2018, the Task Force released a set of recommendations to IFNPAC and Governor Raimondo. In 2019, the Task Force broke off into sub-groups to address specific sections of the recommendations.  The work of the sub-groups included:

• The USDA released their annual Food Insecurity Report, showing that Rhode Island’s food insecurity rate is down to 11%, from 12.4% in 2018. The Task Force aims to lower food insecurity rates to less than 10%, and with a more coordinated effort, it is expected that the goal will be attained. 
• The Task Force was focused on increasing school meal participation as part of its recommendation to ensure that Rhode Island is taking full advantage of federal funds.  As part of this effort, the State received grant support from Share our Strength’s No Kid Hungry program.  A cross-agency team, including RIDE, the Governor’s Office, the Director of Food Strategy, the Food Policy Council, and the Rhode Island Healthy Schools Coalition (who is the fiscal sponsor of the grant) was selected to participate in a multi-state meeting in New Orleans and is implementing an 18-month work plan to expand innovative breakfast models for K-12 schools. 
• This Working Group will also be exploring potential policy guidance on lunch shaming and school meal balances across the state.  This working group received community feedback at the July Health Equity Zone (HEZ) Learning community meeting. 
• The Task Force also moved forward on implementing other areas of its recommendations through working groups. 

However, as the COVID-19 pandemic worsened in 2020, it quickly became evident that more Rhode Islanders than ever needed emergency and supplemental food and focused action was required. Specifically, the Rhode Island Community Food Bank’s (RICFB) 2020 Status Report on Hunger in Rhode Island found that:

• One in four households in Rhode Island lacks adequate food.
• Underlying medical conditions that increase the risk of severe illness from COVID-19 are prevalent among Rhode Islanders experiencing food insecurity.
• Demand for food assistance at member agencies of the RICFB increased by 26% during the pandemic.
• Government aid is critical to protecting vulnerable families from hunger.

To address these needs, the IFNPAC shifted all of its efforts to addressing food security. Council members listened to and discussed topics presented by public and private partners with a stake in the Rhode Island food system. The IFNPAC was a part of a statewide network of community organizations, statewide non-profits, and municipal and state governments that came together to coordinate a response to food insecurity and disruption of local food supply chains during the COVID-19 pandemic. A description of these efforts is below.

COVID-19 Food Access Working Group

The IFNPAC Council members stepped up in the absence of a State Director of Food Strategy (a state position that has been vacant since 2019 and only recently filled in the first quarter of 2021) to understand and address exacerbated food access concerns arising from the impacts of the COVID-19 pandemic. Council members formed a COVID-19 Food Strategy Task Force (later renamed the Food Access Working Group) to address food access needs and opportunities. The group temporarily replaced the HETF and provided real-time coordination and collaboration on immediate needs arising from the pandemic. The work group included many of the members of HETF and was made up of representation from State agencies, Congressional delegation, municipalities, HEZs, and community-based organizations. The community organizations that were taking the lead to get food to those who needed it, shared what they were doing, identified gaps, and discussed how to leverage resources.  This group initially met three times a week, moved to weekly meetings, and continues to engage on a biweekly basis.  This coordination resulted in action at the federal, local, and community levels throughout 2020 to reach people in need of adequate food including:

1. State agencies, including RIDOH, RIDE, and DHS successfully obtained federal nutrition program waivers to increase food access flexibility and benefits and collaborated on communication efforts to increase outreach and program participation.
2. OHA and other council members and organizations facilitated the distribution of meals to the older adult population.
3. State agencies helped to facilitate and promote food and meal donation events across the state by utilizing Health Equity Zone (HEZ) partnerships.
4. IFNPAC members assisted in the planning of the URI Food System Summit, which focused on the impact of COVID-19 on food security in Rhode Island and across the US, as well as steps that can be taken to address food insecurity. This event took place on January 20, 2021. Follow-up sessions are scheduled to occur throughout the winter and spring 2021.

 

State of Rhode Island Food Access Workstream

In addition, a State of Rhode Island Food Access Workstream was established by the Governor’s Office to assess the landscape of the State’s immediate food access needs during the public health emergency and economic insecurity crisis and make recommendations for how new federal funding streams could be directed to address the needs and gaps. This group helped connect all of the efforts to address the food access crisis exacerbated by the pandemic. State and community-level stakeholders were interviewed and informed the team’s understanding of the drivers of food insecurity, ongoing challenges, and recommendations. The workstream team consisted of State agency representation from the Governor’s Office, RIDOH, DEM, OHA, RIDE, and DHS. The Governor’s policy advisor brought key issues from the Food Access Working Group and the stakeholder interviews to government leadership and also passed information from the state leadership to the group.

 

Ensure State Leadership of Food Strategy

The State Director of Food Strategy position was filled in the first quarter of 2021. The Director will play a lead role in planning IFNPAC and work group meetings.  In addition, the Director is responsible for advocating for a Food Access Manager Position with the RI state government, as well as for federal funding to reconvene the RIDOH Physical Activity and Nutrition program staff, implement strategies and make community investments.

All other activities such as the Supplemental Nutrition Assistance Program (SNAP) Incentive Expansion Working Group, and efforts to influence transportation to help residents more easily connect to food resources were suspended to focus on the COVID-19 response.

Child Health and Health Equity Zones

During the reporting period, the Health Equity Zones worked with their communities around a several initiatives related to child health including:

 

• Improving the Built Environment
• Reducing Lead Poisoning
• Expanding Programming for Children and Families

 

Improving the Built Environment

RIDOH continued to partner with Grow Smart RI to provide technical assistance and training to Health Equity Zones around improving the built environment to address child health, especially regarding increasing walkability and bikeability. This included training offered June through September 2020 through the virtual Power of Place Summit (which was extended to accommodate an online format). During this time period, Grow Smart also delivered onsite and virtual technical assistance and training to HEZs and municipalities (city/town councils and municipal planners) around the integration of Complete Streets principles (walkability/bike ability) into comprehensive transportation policy, plans, and communications efforts.

 

HEZ community-level efforts during the 10/1/19-9/30/20 timeframe included the following:

 

Central Providence (CP) HEZ: One Neighborhood Builders (ONB), the Central Providence HEZ backbone organization, increased their target area beyond Olneyville to include (8) nearby neighborhoods with similar characteristics and fewer community-based organizations to serve residents. These include Hartford, Valley, and Federal Hill, Elmhurst, Mt. Pleasant, Silver Lake, Smith Hill, and Manton. Socioeconomic and health data revealed that life expectancy is as much as nine (9) years less in the CP HEZ neighborhoods compared to more socioeconomically advantaged neighborhoods in the city of Providence.

Based on the results of a community needs assessment performed during the reporting period, the CP HEZ targeted specific areas and implemented activities designed, in part, to address nutrition and physical activity, including:

• Several playground extension projects
• Free quality after school and out-of-school programming for 70 youth and provided stipend leadership opportunities for youth 14 and older.
• A multi-layered technical assistance program designed to improve existing family childcare centers and to offer training for community members to open new, high-quality centers. This included no-cost technical assistance and business improvement partnerships with a recognized leader in providing families and children of all abilities the opportunity to thrive by fostering the development of the whole child, including TA relating to nutrition and physical activity.
• Statewide CHW Training - provided CHW training for 37 CHWs.
• Developed the first multi-employer CHW Apprentice Cohort, 16 CHWs were placed in 6 HEZ partner agencies.
• Developed and launched a Social Determinants of Health (SDoH) screening tool utilized by CHWs to assist families and individuals to identify needs and access services and supports, including those related to nutrition and physical activity.
• Lastly, in the spring and summer of 2020, during the pandemic, CHWs identified that many residents lacked stable secure internet access (lowest of any neighborhood in RI), which was critical to accessing online employment, school, medical needs, or grocery and basic needs shopping. The CP HEZ was able to secure free internet access to over 6,900 individuals.

In addition, the Central Providence HEZ enrolled an additional 150 children into the William D’Abate Elementary School Walking School Bus Program during this time period. The Walking School Bus program was suspended when schools closed in March 2020 due to COVID-19.

 

OneCranston HEZ: OneCranston HEZ worked with partners to develop specific programs to address child health. The OneCranston HEZ developed a proposal for the installation of a splash pad to provide safe outdoor recreational space to families and children in the community. OneCranston HEZ also began work to increase recycling around the city, held community activities in existing green spaces, organized neighborhood cleanups, and advocated for better bike systems.

 

Newport HEZ: The Newport HEZ’s Greening Urban Spaces Working Group developed a Zoning 101 resident education and training opportunity. In addition, the Newport HEZ provided input on the Newport-Pell Bridge realignment planning process, focusing on engaging North End residents. Their Transportation Working Group conducted focus groups with community members and other stakeholders to determine how transportation can become more accessible to Newport residents. A representative from Newport HEZ continues to serve on the City Planning & Zoning board.

In addition, Grow Smart RI facilitated technical assistance to the Newport Health Equity Zone (HEZ) regarding Community Benefits Agreements (CBA’s). The Newport HEZ is now exploring opportunities to advocate for a Community Benefit Agreement with any master developers within the North End redevelopment district.

West Elmwood Health Equity Zone (WE HEZ): With the West Elmwood Housing Development Corporation as the backbone organization, together with partner organizations, the WE HEZ serves the 02907 zip code of Providence to address the root causes of that lead to poor health outcomes. The WE HEZ partners, leaders in the community from the City of Providence, housing and homelessness, AE, neighborhood associations, youth leadership, refugee and immigrant community, environmental, harm reduction and recovery, and food systems come together with a shared commitment to the following principles: equity, anti-racism action, a whole-family lens, acknowledging humility, and fostering collaboration through a fully transparent process. During the reporting period the WE HEZ engaged in an extensive community assessment process that resulted in a focus on four primary areas of impact on child health: community health-housing, food access, environmental conditions, and education. In addition, during the reporting year, the establishment of the WE HEZ served as a community hub for COVID-response efforts, expanding their reach to serve communities in 02905 and 02906.

 

Pawtucket/Central Falls HEZ: The Pawtucket and Central Falls HEZ (PCF HEZ) worked with collaborators to develop, provide, and promote the following activities to support child health:

• Worked closely with PCFD to make changes in their program in response to COVID and to meet the needs of their residents. Staff conducted outreach to over 250 tenants ensuring they had information regarding COVID, rental and other available assistance.
• The PCF HEZ worked with GroundWorks RI to build community resilience to climate change. The partnership included GroundWorks RI, Blackstone Valley Community Action Program, Broad Street Regeneration Committee, Childhood Lead Action Project, Progreso Latino, and Southside Community Land Trust. A total of 24 youth were employed and trained on how to grow their own food at SCLT’s Galego Court farm in Pawtucket, how to process and cook their food at Harvest Kitchen and how to engage residents and gather data regarding climate resilient mitigation strategies with GroundWorks RI. Through the project 178 surveys were collected to understand residents’ concerns regarding climate issues. The most common concern among surveyed residents was the lack of trees (81% of the 178 respondents indicated somewhat to extreme concern). Other concerns included limited access to healthy food, lack of parks and open spaces, and flooding. Residents responded that they would like to see increased strategies around growing or buying local food, planting trees, and lastly reducing waste/preventing litter/recycling. GroundWorks RI engaged Pawtucket and Central Falls youth on home inspection for improved green infrastructure. The youth completed 25 home assessments, installed 9 raised garden beds, 7 rain barrels, conducted clean-up days, conducted tree surveys, and planted 6 trees.
• Conducted 5 lead poisoning prevention workshops at Calcutt Middle School and at Captain Hunt's Preschool, for a total of 12 families attending. Also, 41 additional individuals were educated at the CF High School Health Fair or the Cape Verdean American Community Development Health Fair. Information, provided in English and Spanish, included: lead/tenant's rights; lead abatement resources for homeowners; lead hazards found in paint, soil, dust and drinking water; lead safe cleaning methods and other interim controls; led safety for workers; lead testing for children and financial assistance for lead abatement for homeowners.
• Held financial training and healthy home education and support. Classes incorporated information regarding asthma risks and prevention.

Washington County: Maternal and child health was a primary focus of South County Health Bodies Healthy Minds (HBHM), which served as the backbone for the Washington County Health Equity Zone. HBHM implemented 5-2-1-0 to prevent childhood obesity and promote healthy habits, by encouraging families to be more physically active and eat healthier, while engaging community partners to create healthier environments for children. The 5-2-1-0 program promotes eating 5 fruits and vegetables, engaging in no more than 2 hours of recreational screen time, getting 1 hour of exercise, and drinking 0 sugary drinks per day. The Washington County HEZ reached over 19,000 children and adolescents with their 5-2-1-0 programming. Forty-six 5-2-1-0-related strategies were implemented in schools, child care centers, and other organizations. Five summer camps incorporated 5-2-1-0 materials and/or activities into their curriculum. An estimated 16,986 youth and adults have been indirectly impacted by 5-2-1-0 this reporting year through the efforts made at the organizational and county-levels .Ten K-12 schools implemented policy, systems, or environmental changes including offering a new grab-n-go breakfast option, eliminating chocolate milk for breakfast, and starting advisory committees for students to work with food service providers to give input on school nutrition. Three Washington County schools have established student committees. Policy, systems, and environmental (PSEs) made impacted an estimated 1,439 children.

From an organizational standpoint, HBHM has made substantial progress in impacting their community, engaging 71 organizational partners, including 18 schools (K-12), 23 preschools, 8 health service organizations, and 22 afterschool programs, and provided 145 hours of technical assistance to organizations in their efforts to support healthy eating and physical activity. This included: Connected community partners with Rhode Island Department of Health (RIDOH) to assist with needed COVID-related resources; supported Community Health Workers (CHWs) and the community members they serve to address food insecurity needs; provided school staff—nurses and health and physical education teachers—physical activity resources to engage children and families remotely; assisted 10 child care organizations fulfill a total of 17 NAPSACC^ goals; and disseminated 1,522 5-2-1-0 materials, including frisbees, water bottles, jump ropes, toolkits, and pedometers to increase awareness of, and support for engaging in healthy behaviors. HBHM organized and conducted an online school garden conference with local school garden experts, now posted on HBHM’s YouTube channel; and partnered with Peace Dale Library to provide garden kits (accompanied by gently used books related to healthy habits) to children in the Champaign Heights neighborhood as well as South County YMCA and South Kingstown Parks & Recreation programs.

West Warwick HEZ: Based on results of a recent community assessment, the West Warwick Health Equity Zone (WW HEZ) collaborated with municipal officials to integrate walkability/bikeability recommendations into the Town’s comprehensive plan. In addition, the WW HEZ coordinated the “Transportation that Works” program to promote improved bus service to jobs, substance abuse recovery services, health care, farmer’s markets, and senior services, as well as to promote physical activity. Signage was installed on the local bike path and fitness equipment in the parks and playgrounds.

 In addition, WW HEZ engaged in the following activities to promote child health:

• Local families were assisted in filling out applications for a variety of health-related programs, including the Supplemental Nutrition Assistance Program (SNAP) and Women, Infants and Child (WIC). As a result, the local WIC caseload increased by 37 participants and the summer meals program served 126 more lunches than the previous year.
• Over 600 residents were served through programs in conjunction with PDG grant funding, including West Warwick School Department’s "Play and Thrive" program, which provides opportunities for 0-5 year old children to safely interact with each other in a monitored and facilitated setting at the YMCA. The program is designed in partnership with the Family Navigator to mitigate the effects of trauma resulting from a lack of interaction necessary for early development. The play experience is provided by qualified licensed mental health professionals and is coupled with observations and feedback to families.

RIDOH will continue to offer learning community sessions related to the built environment to HEZs through the HEZ Learning Community and other avenues where appropriate. HEZs will continue to implement activities that focus on reducing obesity, including built environment strategies through support from PDG and other funding sources.

Partnering to reduce childhood lead poisoning in Pawtucket

By working with the Childhood Lead Action Project, the City of Pawtucket, and community partners to implement policies to improve the enforcement of lead safety laws in Pawtucket, the Pawtucket-Central Falls Health Equity Zone (PCF HEZ) contributed to a 44% decrease in childhood lead poisoning and the certification of approximately 200 lead safe rental units in Pawtucket. The groups mobilized their efforts in response to data showing high levels of childhood lead poisoning in Pawtucket. For years, Pawtucket residents had struggled with insufficient local compliance with lead safety requirements for rental housing, insufficient local enforcement of lead safety laws, and unsafe housing conditions. The local Health Equity Zone infrastructure helped the diverse partners working on these issues to come together to address shared goals and helped direct flexible funding to local priorities. Working together, the partners successfully trained local officials on the enforcement of lead safety laws, implemented a City policy to require proof of compliance before issuing a building permit, and conducted community outreach and training focused on tenants’ rights and lead-safe work practices. (As a result of this work, initially, the incidence of lead poisoning dropped from 4.9 percent in 2015 to 2.99 percent in 2017.)

Continuation of this work from 10/1/2019 to 9/30/2020 has contributed to further reductions in new lead poisoning cases in Pawtucket. During this time period, Childhood Lead Action Project conducted lead poisoning prevention workshops with community members, including parents of preschoolers and elementary school students. Information, provided in English and Spanish, includes: lead/tenant's rights; lead abatement resources for homeowners; lead hazards found in paint, soil, dust and drinking water; lead safe cleaning methods and other interim controls; lead safety for workers; lead testing for children and financial assistance for lead abatement for homeowners.

Expanding Programming for Children and Families

With the support of Preschool Development Grant (PDG) funding over the last three fiscal years, the number of HEZs offering programming and support to children and their families has increased from five HEZs in 2019 to a total of 10 HEZs with the current PDG funding, which will end in June 2022.

The onset of COVID-19 in Rhode Island has also led to a number of urgent needs for children and families; HEZs provided a ready-made platform to work with community partners and residents to quickly identify and prioritize these needs and rapidly deploy resources and support.

Central Providence HEZ: Central Providence HEZ, through collaborative member organizations Federal Hill House and The Autism Project, carried out extensive programming to support children and their families. Federal Hill House developed playground extension projects, supported a First Providence Talks Extension (PTE) group that was designed to build parental behaviors that promote early childhood language and literacy, and promoted the Olneyville community’s Multicultural Festival, which saw over 500 attendees. The Autism Project consulted with local agencies supporting children and families, and offered 10 hours of Conscious Discipline training for parents and caregivers, presented in both English and Spanish. In early 2020, the Central Providence HEZ was awarded funding to support a Family Navigator to provide navigation services to parents and families in the HEZ community, working with a total of 161 families. In addition, the Central Providence HEZ enrolled an additional 150 children into the William D’Abate Elementary School Walking School Bus Program during this time period. The Walking School Bus program was suspended when schools closed in March 2020 due to COVID-19.

 

Cranston HEZ: The One Cranston HEZ received PDG funding in July 2020 to support a fourteen-week Incredible Years program in partnership with Head Start, with a focus on parents with young children, specifically those among the local Cambodian population. Funding also supported a Family Navigator that would fully participate in the HEZ. Through the completion of the funded period, the FN worked with over 100 unique families to connect them with local supports and programming.

 

East Providence HEZ: East Providence HEZ has provided effective engagement of children ages birth through five years and their families through two evidenced-based interventions including, Incredible Years (IY) and Parents as Teachers (PAT). PAT has partnered with the RI Philharmonic & Music School to enhance PAT group sessions with the school’s virtual early childhood music education program. Incredible Years is a program for parents, teachers and children that helps reduce challenging behaviors in children and increase their social emotional learning and self-control skills. Another component of the PDG associated work at the East Providence HEZ is Safe Sleep, a program with the aim of educating parents and caregivers of the importance of safe sleep practices. East Providence HEZ also supported a Family Navigator through PDG funds to support children and families and connect them to programming and supports within the community.

 

Newport and Bristol HEZs: During the reporting timeframe, HEZ PDG-funded activities to support programming and Family Navigators in an additional two HEZs. In the Newport HEZ PDG funding supported a full-time Family Navigator to connect community residents to local resources and services. The Bristol HEZ utilized this additional funding to enhance already successful programming taking place in the community. This includes programming provided through The Autism Project.  During the COVID-19 pandemic, efforts shifted to response activities. The Newport and Bristol HEZs served the community by providing outreach education, food assistance and personal needs, as well as face masks and personal protective equipment (PPE). 

 

Pawtucket-Central Falls HEZ: The Pawtucket Central Falls HEZ collaborated with 35 organizations in their communities to distribute over 90,000 masks to residents and hosted a drive-up meal distribution event that was visited by over 1,000 cars. The PCF HEZ also partnered with the Boys and Girls Club (BGC) to provide groceries, gift cards, educational materials, and youth activities (art supplies to local families several times a week. Teen members have been engaged online through fitness, live events, and meeting discussions. P/CF HEZ also supported Community Health Workers and a local COVID-19 response call center which linked families to local services and information, including testing and quarantine/isolation resources.

During the 2019-2020 State fiscal year, the Pawtucket and Central Falls HEZ launched PDG programming in their HEZ community, purchasing multicultural classroom materials for classrooms across the two cities, as well as providing over 60 backpacks with culturally competent materials to caregivers. This programming impacted approximately 216 children and their families in total. In July 2020, the Culturally and Linguistically Responsive (CLR) Project was expanded. Following evaluation of family tracking forms collected each month from teachers, students showed an improvement across all domains:

• Social Emotional domain, 29% more children met or exceeded expectations compared to the winter.
•  Physical domain, 81% more children met or exceeded expectations.
•  Language domain, 53% more children met or exceeded expectations.
•  Cognitive domain, 46% percent more children met or exceeded expectations
• Literacy and Mathematics domains, 50% more children met or exceeded expectations. 

Washington County/South County HEZ: During the reporting year (beginning July 2019), the Washington County HEZ supported over 36 hours of Incredible Years/Incredible Beginnings professional development training for teachers. Over 260 preschool children were impacted by their activities. During the following State fiscal year, Washington County expanded on this work and enhanced local playgrounds and distributed a healthy eating recipe book. During the following State fiscal year, Washington County’s programming would be expanded impacting a total of 869 children.

 

West Elmwood HEZ: In July 2020 the West Elmwood 02907 HEZ received PDG funds to provide Families Thrive programming through the Genesis Center and Providence Community Library. They also were able to support a Family Navigator, who would eventually assist 26 people by providing systems navigation support, including support in applying to the COVID-19 Relief Fund.

 

West Warwick HEZ: In July 2019, the West Warwick HEZ received PDG funding to support children and families in their community to access programming and resource, including Low-income Heating Assistance Program (LIHEAP), Supplemental Nutrition Assistance Program (SNAP) applications, Weatherization, library cards at the West Warwick Public Library, and Women Infants and Children (WIC). As a result, he WIC caseload increased by 37 participants and the summer meals program served 126 more lunches than the previous year, serving over 600 community members. More recently, the West Warwick HEZ received PDG funding to support a Family Navigator and provide learning and support events as well as opportunities for West Warwick families of children aged 0-5. These events and opportunities include Trauma Informed support and other topics identified by families.

 

Woonsocket HEZ: Woonsocket HEZ collaborative organizations were awarded PDG funding to facilitate Circle of Security training as well as Parents as Teachers (PAT) programming. The Woonsocket HEZ also used their PDG award to administer Conscious Discipline in Head Start classrooms and coach local teachers and administrators.

With the onset of COVID-19, Woonsocket HEZ partners rapidly pivoted to leverage resources such as funding, staff, and vans to create an emergency food response plan. Hundreds of children and their families received deliveries of milk, meals, and food supplies from local farmers and food producers. Woonsocket HEZ distributed over 5,000 meals to families in need.

Other Programs/Initiatives Related Child Health

Developmental screening

As part of the 2012-2016 Race to the Top Early Learning Challenge grant, RIDOH assisted over 35 primary care practices in implementing standardized developmental screening to align with the Early Periodic Screening, Diagnosis, and Treatment (EPSDT) Schedule and the American Academy of Pediatrics recommendations.

RIDOH continues to work with Medicaid and insurers to support providers screening children at 9, 18, and 30 months using a standardized tool. RIDOH is currently participating in the state’s First 1,000 Days initiative, which recognizes the importance of the first three years of life.  The initiative is designed to increase Medicaid’s role in supporting well-child care, including using developmental screenings to identify issues early, which helps to increase the odds that children are able to reach their potential. In addition, RIDOH participated on the PCMH-Kids planning team and supported Developmental Screening as one of the PCMH kids quality measures; in 2020 the 19 PCMH kids sites all exceeded or met the targets for Developmental Screening in RI (78% overall and 70% for Medicaid population).

Mental Health Consultation within early care and education

Through a partnership with DHS, child focused mental health consultation is available statewide. RIDOH is currently working with DHS to sustain its program focused mental health consultation to childcare as well. In 2020, several mental health professionals from Bradley Early Childhood Research Center, who are also early childhood mental health consultants, developed and delivered training on how to become a child care mental health consultant with the goal of expanding the capacity of the system overall.

 

PediPRN

At the end of 2018, the Rhode Island Department of Health (RIDOH)  was awarded a 5-year Health Resources and Services Administration (HRSA) grant that seeks to help healthcare providers treating children and adolescents patients to screen and manage behavioral health disorders. The program is implemented by Bradley Hospital with a mission to improve access to behavioral health care for Rhode Island children and adolescents by integrating psychiatry into the state’s pediatric primary care practices. To achieve its mission, PediPRN uses a telephonic integrated care model to improve access to quality behavioral health expertise. This service is free and provides all Rhode Island pediatric primary care providers assistance with the mild to moderate mental health care needs of their patients. PediPRN focusses on creating a culture of empowerment for pediatric primary care providers. The clinical team works closely with providers offering CME opportunities, educational e-blasts, an updated website with assessment and educational resources on pediatric behavioral health topics, and ongoing support during telephonic consultations.

In addition, PediPRN implemented the delivery of training, mentoring and education to PPCPs in the PediPRN Intensive Program (PIP) with the goal of creating a group of practitioners embedded in each of their home practices who will serve as local experts on various behavioral health topics. The PIP program has completed its first year in the spring of 2020 and a second cohort of physicians launched 2021 after a 6 month delay due to COVID. Additionally, PediPRN has expanded its capacity as a resource to providers during COVID-19 an has started hosting “office hours” to physicians via zoom. Providers can speak with a staff psychiatrist, or with each other, about topics to support behavioral health treatment in their practices. This additional resource is meant to provide additional support to providers during these unprecedented times. 

During 2019, PediPRN fielded 842 teleconsultation calls from 349 providers at 66 practices directly helping 570 unique pediatric patients. In addition, 27 providers have graduated from the PediPRN Intensive program (PIP). Preliminary evaluation of both PIP graduates and highly engaged providers show that these providers have:

• Higher rates of mental health focused visits
• Fewer psychiatric hospitalizations per year
• Report increased knowledge and comfort with assessing safety, evaluating and managing non-suicidal self-injury, and awareness of available mental health care

 

Immunization Program

The mission of the Immunization Program is to prevent and control vaccine preventable diseases in RI by increasing immunization rates among children, adolescents and adults. This is achieved by implementing systems for efficient vaccine purchase and distribution, increasing vaccine access, decreasing cost as a barrier, quality assurance, improving quality, offering public and provider education, disseminating information, providing surveillance, and collaborating with the community. The following policies and initiatives support this mission:

 

Universal Vaccine Purchasing Policy: Rhode Island is a universal vaccine state in which all routinely recommended vaccines are provided to healthcare providers at no cost for children, adolescents, young adults (through 26 years of age), and select vaccines for high risk adults. Influenza vaccine is provided at no cost for all Rhode Islanders aged 6 months and older.

 

Immunization Walk-In Clinic: The Immunization program supports a walk-in immunization clinic at St. Joseph’s Health Services offering no cost vaccination for children who are uninsured/underinsured, those who are new to the country and do not yet have a doctor or are delayed in getting an appointment, and also for uninsured adults. St. Joseph’s experienced a staffing shortage due to departures and LOA’s. In the interest of patient safety, they closed the clinic from October 2020 – February 2021 and reopened in March 2021. While they were closed, they diverted patients to Providence Community Health Centers. Due to COVID-19, St. Joseph’s is no longer accepting walk-ins at this time. Patients must make appointments.

 

School Located Influenza Vaccination Clinics: The goal of the school located vaccination program is to reduce the burden of influenza in RI communities and to develop a sustainable vaccination model based on partnership among RI Department of Health (RIDOH), Department of Education (RIDE), & The Wellness Company (TWC). Vaccines are offered to all students, faculty, and staff at no cost. High school and some middle school clinics are held during the school day and elementary school clinics are held after school and are open to the public. Parents must provide consent for immunization and insurance information is collected for billing purposes, when available. For the 2019-2020 school year, clinics were held from October 1 – December 10, 2019 and 385 schools participated. There were 249 individual and host clinics held throughout the state, with 28,784 children and adults vaccinated in the program.

 

School Immunization Reporting: The Immunization Program continues to collect web-based reporting data to monitor school immunization coverage rates. All schools with grades kindergarten, 7th, 8th, 9th and 12th are required to report to the RIDOH annually the number of children who are fully immunized as well as those who have exemptions. All students are required to provide documentation that they are up-to-date on certain vaccines for school entry to Kindergarten, 7th, 8th, 9th, and 12th grade or provide a signed state exemption. Data include the number of students assessed, fully immunized, without an immunization record, and with an exemption certificate on file. In August 2015 additional school immunization requirements were added to the school immunization regulations under all levels pre-k through College to improve vaccination coverage with the goal of reducing the incidence of vaccine preventable disease. Data collection was from September – December 2019. Overall, the Kindergarten completion rate was 95.9%, 7th grade completion rate was 80.1%, and 84.1% of 12th graders had at least one dose of MCV4 on or after their 16th birthday.

 

Immunization Quality Improvement for Providers (IQIP): Primary care practices enrolled in the state supplied vaccine program that see children and adolescents receive IQIP site visits from immunization program staff assessing vaccination coverage rates among children and adolescents in their practice with guidance on how to increase coverage rates and resources to help achieve that goal. IQIP is an evidence-based quality improvement tool employed by the Centers for Disease Control and Prevention to improve vaccination coverage rates. One resource that was developed is a KIDSNET tool allowing practices the access to run their own coverage rate reports on demand. In the summer/fall 2020, because of COVID-19, CDC granted permission to conduct IQIP visits virtually. Due to COVID-19, one Immunization Rep was re-assigned to the COVID-19 unit and did not come back to the Immunization Program until December 2020. Staff time and effort has mostly been diverted to the COVID-19 vaccine roll-out and catching up on the visit backlog.

 

KIDSNET (Includes the state Immunization Registry)

Concern over increasing rates of overweight and obese children created a desire for more data related to childhood obesity. RI does not have a statewide population-based registry with height, weight and body mass index (BMI) data for children. There are several related surveys and data-sets but each has limitations. The SSDI Director coordinates an annual statewide effort to combine BMI related data from multiple sources to monitor rates of overweight and obesity.  Child records from KIDSNET, RIDOH’s integrated child health information system, provided BMI data from Women, Infants and Children (WIC) and individual population level demographic data, allowing analysis by race, ethnicity, age, gender and residence in a core city.  These data were combined with similar BMI data from health plans and the state health information exchange (CurrentCare), analyzed by partners at Brown University, and communicated in policy briefs prepared by Rhode Island Kids Count, a child advocacy organization.

KIDSNET links data from birth certificates, newborn screening (developmental risk, bloodspot, CCHD, hearing), immunization, lead screening, home visiting, Child Outreach, WIC, Early Intervention, Early Childhood Developmental Screening, Foster Care, and Head Start.  KIDSNET continued to facilitate web-based access to these public health records by authorized users for care coordination.  New development and enhancements related to child health during the reporting period include: updating the hearing assessment page based on feedback from audiologists and other KIDSNET partners; adding the address from lead tests to the database to improve capacity to analyze lead screening data by city/town; linking newborns to primary care providers reports based on reported intended provider so they appear on reports immediately after birth; enhanced search capacity to allow searching based on all parents/guardians associated with a child, instead of just the mother; preventing address updates if a child is in foster care; collecting email addresses to facilitate communication with parents; data support to primary care practices as they work to remediate the decline in routine immunizations and lead screening that occurred during the COVID-19 pandemic; and the establishment of linkages with multiple state and federal information systems to allow provider participation in the COVID-19 response. Messages about the importance of immunizations were included in cards and brochures mailed to families of newborns.

The Rhode Island Asthma Control Program (RIACP)

RIACP has a strong public health foundation. It is built around home-based, school-based and health systems strategies that focus on children with asthma in Rhode Island’s (RI) four high poverty “core” cities: Central Falls, Pawtucket, Providence and Woonsocket. In these four cities more than one in four children live in poverty. The Comprehensive Integrated Asthma Care System (CIACS) is the framework for aligning these strategies. The CIACS model is built upon contracts with key partners in the core cities. Three programs form the foundation of the RIACP’s community-based services. These are:

1. Breathe Easy at Home (BEAH), an electronic-based referral system utilizing RIDOH’s KIDSNET program that allows medical providers to make referrals to municipal housing code offices for asthma triggers that are code violations,
2. Home Asthma Response Program (HARP), a pediatric asthma home visiting intervention that utilizes a certified Asthma Educator (AE-C) and Community Health Worker (CHW) to provide asthma self-management education (SME), and in-home environmental trigger reduction to reduce asthma ED visits and inpatient admissions for children with poorly controlled asthma, and
3. Draw a Breath (DAB), an  evidence-based asthma education program at Hasbro Children’s Hospital that provides group asthma education classes at the hospital and at schools.

Home Asthma Response Program (HARP): HARP is an evidence based in-home asthma intervention that uses certified asthma educators (AE-Cs) and community health workers (CHWs) to conduct up to three intensive in-home sessions that: (1) assess a patient’s asthma knowledge and environmental trigger exposure, (2) provide intensive asthma self-management education, (#) deliver cost effective supplies to reduce home asthma triggers, and (4) improve the quality and experience of care. HARP eligibility is based on the child’s  age, city of residence, level of asthma control and health care use. An extensive environmental assessment is provided and involves an in-depth inspection of the family’s home to identify various environmental triggers that may be exacerbating the child’s asthma. Linkage to care is a component of HARP, in which children without current primary care providers at the time of the first home visit are referred to a primary care provider. All children participating in HARP are required to receive an Asthma Action Plan (AAP) from their primary care providers. The AAP ensures that all individuals caring for the child, including school nurse teachers, daycares, parents/guardians, and other caregivers understand how to recognize when the child is having asthma symptoms, environmental triggers that may exacerbate the child’s asthma, how to safely administer medication, and ways to avoid asthma attacks.

In 2017, RIACP submitted a proposal to the RI Attorney General’s Office to request a $300,000 allocation from the Volkswagen (VW) Clean Air Act Civil Settlement to improve asthma outcomes for high risk pediatric asthma patients in Rhode Island. Exposure to elevated levels of nitrous oxide (NOx) emissions have pervasive negative health impacts for people with impaired respiratory systems, and especially for children with severe asthma. RIDOH is using settlement funds to provide HARP to 200 severely asthmatic children in Central Falls, Pawtucket, Providence and Woonsocket. RIACP led the effort to conduct a pilot study to provide HARP to children with poorly controlled asthma who are enrolled in a United Medicaid Plan. The pilot is now launched with Hasbro Children’s Hospital. In March of 2021, the RI Attorney General’s Office approved RIACP to provide HARP to a small pilot of adult patients with an asthma diagnosis. Having the opportunity to provide critical home-based asthma services to adult asthmatic patients is something that RIACP has been striving to accomplish for several years. The expansion of HARP to include both children and adults with poorly controlled asthma provides a unique opportunity to bring a lifespan approach to understanding the burden of asthma in children, adults, and to society. This advancement in comprehensive asthma care services also helps to move RIDOH closer to achieving health equity by addressing the needs of all low-income Rhode Islanders who have asthma.

Outdoor Air Quality Policies: RIACP participates in numerous initiatives that are working on policies relevant to childhood asthma. The RIDOH Environmental Health Risk Review group supports RIDOH's Director in reviewing environmental health concerns including ambient air quality and sources of air pollution that disproportionately impact people with asthma and other respiratory diseases. Projects reviewed include a large proposed power plant, a highway, and cumulative impacts in an industrial waterfront port. RIACP provided a Health Impact Assessment (HIA) training with key stakeholders in Providence to begin the planning process for assessing health impacts of the Port of Providence related to air pollution and toxicants from both stationary and mobile sources. Stakeholders include community residents and organizations, Rhode Island College School of Nursing, Brown University, Johnson and Wales University, Johns Hopkins University Bloomberg School of Public Health, Kresge Foundation, the City of Providence, RI Department of Environmental Management, RI Division of Statewide Planning, RIDOH Air Quality Laboratory, and the US Environmental Protection Agency.

RIACP continues to work with RIPTA, the statewide public transit agency, and shared GIS maps of asthma hotspots so that RIPTA could prioritize deployment of new zero emission electric buses in areas with a high asthma burden. The first zero emission buses were launched publicly with a well-attended press event and tour in October 2018. RIPTA is planning to use its VW Clean Air Act Settlement funding to purchase additional 16-20 electric busses for its permanent fleet. RIACP has also continued to collaborate with the RIDOH Lab and RI Department of Environmental Management on an EPA funded air quality study, called the Near Road Study, examining the air quality impact of I-95 highway on near-road communities with elevated asthma burdens. The study results were completed by the end of 2018 with RIACP playing a lead role in engaging communities on the results and recommendations.  The Information based on the study was disseminated to the public in order to take actions especially for the communities affected by the emissions by I-95; recommendations were developed regarding procedures to mitigate emissions and monitoring of air quality for communities residing near I-95. See link for more info: http://www.dem.ri.gov/programs/air/documents/air-mobile95-report.pdf. RIACP is also engaged in ongoing close partnerships with the City of Providence on the city's Climate Justice Plan, which includes prioritizing community health, environmental justice, and resilience in environmental justice communities that are disproportionately impacted by asthma and air pollution. RIACP is updating the 2014 Asthma Claims Databook to provide the City of Providence and its community partners with asthma data and maps to support the development of the city's climate justice policy plan.  The new Asthma Claims Databook is planned for release in 2022.

Oral Health Program

The OHP is located within RIDOH, Division of Community Health and Equity, Center for Preventive Services. The mission of the OHP is to achieve optimal oral health for all by eliminating oral health disparities in RI while also integrating oral health with overall health. To achieve this mission, the OHP focuses on prevention of oral disease through assurance of state-level oral health and public health leadership, documentation of the burden of oral disease in RI, and collaboration with statewide partners and the Rhode Island Oral Health Commission. In association with these partnerships, the OHP implements goals and objectives identified in the Rhode Island Oral Health Plan to improve access to oral healthcare services, integrate the dental and medical care systems, increase oral health literacy among RI residents, sustain the oral health workforce, and inform and support productive oral health policy decisions. During the reporting year, the Oral Health program focused on the following strategies:

 

Nutrition Training for Dental Hygienists: The Oral Health Program recognized that there was a need for further education around the connection of nutrition and oral health for young children. Dental hygienists are often the trusted sources in the dental office and they also see the patient (and their families) for a longer period than the dentist during a visit.

The Oral Health Program partnered with two nutrition experts from the University of Rhode Island and SNAP-Ed to develop an in-person training for dental hygienists. It included background on nutrition, the oral health connection, an introduction to motivational interviewing, and multiple breakout sessions to practice. The first in person training was completed in early 2020 with 30 dental hygienists (they received CE credits). Due to COVID-19 the Oral Health Program Is currently developing an online training.

Oral Health & Third Grade Reading Plan: The OHP successfully incorporated an oral health measurement into the Governor’s Third Grade Reading Action Plan.  The number of children under two years of age with RIte Care/Medicaid coverage who have had a dental visit is now tracked quarterly within the school readiness domain of the plan and has been identified as one of the many strategies to improve reading readiness.

 

Fluoride Varnish Quality Measure: This is the second year that the fluoride varnish quality measure was included as a clinical quality measure for commercial medical plans about fluoride varnish application among children under age three. The OHP staff were also able to coordinate the reporting of fluoride varnish data of Rhode Island children aged three and under administered by medical providers from the State’s All Payer Claims Database. This data was used by the RI SOHP and RIDOH’s medical director in their advocacy to allow for the measure to remain for the second year so that it may have the opportunity to gain traction with medical providers.

SEAL RI!: SEAL RI! is a school-based dental program that provides exams and dental sealants to help prevent tooth decay for children ages 5-10. Currently, SEAL RI! funds work in 10 of 39 RI communities and provides services in 56% of the schools targeted by the SEAL RI! program. Targeted schools are defined by those schools with 50% or more of the students eligible for the FRSM program. This target was designed to maximize effectiveness by targeting high-risk children living in the core cities. The primary advantage of the school-based model is a major increase in access and decrease in oral health disparities. This model is a less expensive way of providing dental care to Medicaid-eligible children than the traditional private practice dental care system.

To further improve SEAL RI! impacts, OHP staff has completed research on practices to improve consent form returns. Dental sealant brochures have also been distributed to elementary schools, health fairs, and lead centers throughout the state and OHP staff were successful in advocating for the inclusion of sealant benefits in state employee dental benefits. OHP staff continued to host quarterly meetings with all SEAL RI! sites to discuss improvement strategies about program delivery.

The COVID-19 Pandemic put a halt to the SEAL RI! program as schools shut down for the remaining 2019-2020 school year and the beginning of the 2020-2021 school year as well. One program was successful in screening students and recommending sealants by operating in conjunction with the COVID-19 testing hub at the school.

Rhode Island EMS for Children Program

The purpose of the Rhode Island Emergency Management System for Children (EMSC) program is to coordinate, extend, and improve upon the integration and focus of pediatric needs within the state EMS system. This involves building upon and strengthening relationships between mutually supportive pediatric-oriented programs and activities, such as those found in Maternal and Child Care, trauma system development, disaster preparedness, and highway safety. EMSC also looks to support continued pediatric education for EMTs, paramedics, and school and emergency department nurses. EMSC also partners with local chapters of the American Academy of Pediatrics (AAP) and the American College of Emergency Physicians (ACEP), Family Voices, and other professional organizations to seek support and advice for the continued improvement of EMS care for children in Rhode Island.

In 2020, the EMSC program awarded 16 EMS agencies with a Pediatric Skills Mini award to support projects that promote a process that requires EMS providers to physically demonstrate the correct use of pediatric specific equipment and pediatric education. The maximum award was $4950.

Awarded Agencies

1. Brown Emergency Medical Services awarded $2465.85 to purchase pediatric training equipment and build an EMS pediatric curriculum titled Three Sepsis Scenarios in Pediatric Care. There were 10 EMS practitioners trained.
2. Charlestown Fire Department awarded $4720.29 to purchase pediatric equipment and train three instructors utilizing the HandTevy system training. Subsequently, will train 30 EMS practitioners.
3. Cumberland Emergency Medical Services awarded $4898.50 to purchase pediatric equipment to train 24 EMS practitioners.
4. East Providence Fire Department awarded $4950 to purchase training materials and fund 4 instructors to participate in HandTevy system training.
5. Harmony Fire Department awarded $4945 to purchase pediatric equipment and train 67 EMS practitioners to utilize the HandTevy system and other pediatric simulation training.
6. Harrisville Fire Department awarded $4950 to purchase pediatric equipment and train 22 EMS practitioners to utilize the HandTevy system and other pediatric simulation training.
7. Hianloland Fire Department awarded $4950 to purchase pediatric equipment and train 17 EMS practitioners.
8. Kingston Fire District awarded $4950 to develop curriculum and encourage EMS practitioners to enhance pediatric simulation skills. There were 72 participants trained.
9. Lincoln Fire Department awarded $4832 to train 18 EMS practitioners to utilize the HandTevy system.
10. Narragansett Fire Department awarded $4903.56 to purchase pediatric equipment for pediatric simulation training. There were 32 EMS practitioners trained.
11. Providence Fire Department awarded $4950 to provide simulation training to Providence EMS practitioners.
12. Smithfield Fire Department awarded $3,974.53 to purchase pediatric equipment for pediatric simulation training.
13. South Kingstown Emergency Medical Services awarded $4574.76 to purchase pediatric equipment and train 20 EMS practitioners to utilize the HandTevy system and other pediatric simulation training.
14. Warwick Fire Department awarded $4950 but did not complete grant requirements.
15. Warren Fire Department awarded $3347.51 to purchase pediatric equipment and train 20 EMS practitioners.
16. Western Coventry Fire Department awarded $4325.03 to purchase pediatric equipment and train 21 EMS practitioners to utilize the HandTevy system and other pediatric simulation training.