NPM #8 Physical Activity – Reduce obesity among children and adolescents

 

Please note that some of the strategies and activities listed below impact both the Child and Adolescent Health domains. To avoid duplication, the information will only be listed in this domain, for which it is anticipated to have a larger impact, but it should be noted that some strategies and activities may address a wider age range.

 

According to the 2020-2021 National Survey of Children’s Health (NSCH) data, 34.3% of Missouri children ages 6-11 years were physically active for at least 60 minutes every day, compared to their national counterparts (26.3%). Girls (29.2%) less likely met the physical activity benchmark than boys (38.9%). Survey findings suggest lower physical activity levels for children from college graduate or higher households (Figure 4). Children with public insurance only (39.6%*) were more frequently physically active for an hour daily than their national counterparts (28.1%).

 

 

Obesity is complex, and environmental and behavioral factors play a critical role. Healthy eating and regular physical activity are critical to achieving and maintaining good health. Missouri works to implement best practices to ensure all Missourians live in communities that support these healthy habits. The 2021 Behavioral Risk Factor Surveillance System (BRFSS) reports more than two of every three adults are overweight (32.0%) or obese (37.2%). Some degree of adult obesity is likely reflective of poor dietary habits and sedentary behaviors formed in childhood that persist into adulthood. With that in mind, it is critical to support healthy habits early. About 80% of Missouri school districts provided data through the Department of Elementary and Secondary Education (DESE)/ Department of Health and Senior Services (DHSS) data system collaborative. Of those students represented, 63,100 (8.3%) had asthma and had medication at home or school for the 2021-2022 school year. Additionally, there was a 0.34% increase in the proportion of students with diabetes. Obesity and chronic condition prevalence rates are significantly higher among African American and Hispanic communities, which compounds the gap in health equity and educational attainment for children from these minority groups.

 

Addressing obesity requires collaboration from multiple organizations. One way Missouri brings these partners together is through the Missouri Council for Activity and Nutrition (MOCAN), the statewide obesity prevention council facilitated by University of Missouri Extension (UME). MOCAN’s member organizations are structured into workgroups specific to settings or topics: schools & child care, physical activity, worksites, food systems, and healthcare. DHSS staff supported through MCH funding participated in MOCAN workgroups to support statewide improvements in physical activity.

 

Policy and Environmental Changes

Developing a healthier community involves creating a culture that promotes the benefits of physical activity and allows access to safe places to be active. Public policy is essential in supporting opportunities for children, youth, and families to develop healthy physical activity practices. Strategies to promote policy and environmental changes that can foster healthier communities and safe places to be physically active include collaboration with internal partners, local public health agencies (LPHAs), youth, and statewide and community organizations with similar goals. In FFY22, program staff in the Bureau of Community Health and Wellness (BCHW) continued to contract with LPHAs to implement policy and environmental changes that increased opportunities for children to engage in physical activity across multiple settings.

 

Child Care Wellness contracts supported two LPHAs in providing training and technical assistance to child care providers in improving child care physical activity and nutrition policies and practices. LPHAs used the University of North Carolina’s
Nutrition and Physical Activity Self-Assessment for Child Care (Go NAPSACC) online system to assist child care providers to improve children’s health through 47 practices, policies, and environments that instill habits supporting lifelong health and well-being. The Child Care Health Consultation (CCHC) Program Manager supported LPHA staff that provide Go NAPSACC technical assistance and consultation to child care providers.

 

DHSS, through BCHW and the Community Food and Nutrition Assistance program, continued to support child care providers in implementing policies and practices that support physical activity. DHSS provided training, resources and technical assistance related to physical activity policies and practices to assist childcare providers in their efforts to become Missouri MOve Smart child care facilities. The DESE CCHC Program continued to provide training and consultation for child care providers and health promotion for children. Training focused on: reinforcing the importance of physical activity, incorporating physical activity into daily routines, and implementing evidence-based policies and procedures that support physical activity for staff and children. Consultations centered on: the recommended guidelines for physical activity and nutrition, addressing facilitators and barriers to indoor and outdoor physical activity, implementing screen time policies, and the Nemours Children’s Health Physical Activity Learning Sessions (PALS) training content. Additionally, the CCHC Program offered training on becoming a Missouri MOve Smart Child Care.

 

With the support of the State Physical Activity and Nutrition Grant, the BCHW contracted with Missourians for Responsible Transportation to lead the Missouri Complete Streets Advisory Committee. This committee consists of active transportation experts and advocates that collaborate to assist communities with improving the accessibility of non-motorized transportation throughout the state. To date, 190 linear miles connecting everyday destinations are planned through the Complete Streets polices and active transportation plans. The plans are expected to reach over 58,649 Missouri citizens.

 

Professional Development, Training, and Resources

BCHW staff were also available to provide training and technical assistance on obesity prevention strategies for local communities. To ensure staff are well-informed and can provide quality assistance, they participated in professional development opportunities, such as the Academy of Nutrition and Dietetics Food and Nutrition Conference and Expo, the Southern Obesity Summit, and other evidence-based training (i.e. Physical Activity and Public Health Practitioner’s Course on Community Interventions).

 

BCHW continued to support Missouri communities in their obesity prevention efforts by providing professional development and training opportunities for key stakeholders. Additionally, technical assistance and resources were available to assist efforts in increasing regular physical activity and healthful eating. BCHW also assisted communities in assuring interventions are inclusive of individuals of all abilities.

 

The School Health Program (SHP) supported school nurses to engage with students and families in addressing overweight/obesity in children. School nurses and school mental health staff (social workers and counselors) requested help in having difficult conversations related to eating disorders, being overweight and behavioral health issues with parents. SHP sponsored education and professional development in best-practices through collaboration with stakeholders and organizational partners to make tools and resources available to school nurses. These activities have facilitated connections between students and families, schools, and communities as evidenced by the number of sessions offered for school staff and the response from participants related to increased comfort level in having difficult conversations with parents.

 

The CCHC Program provided 155.5 hours of training and consultation for child care providers on best practices for physical activity and nutrition, implications of healthy weight on overall health, and the role of breastfeeding in child nutrition and obesity prevention. Sessions also focused on physical activity and its positive effects on weight, physical and mental health, and the development of motor, social/emotional, and cognitive skills. Trainings also addressed how to incorporate structured and free active play into daily routines, AAP guidelines for limiting screen time, and age appropriate activities to promote physical activity. In June 2022, 25 CCHC Program trainers completed Nemours PALS ‘train the trainer’ sessions, and are now equipped to provide physical activity trainings to child care providers.

The CCHC Program provided 278.75 hours of health promotion for children on the topics of physical activity and nutrition. Topics were delivered in fun, developmentally appropriate, and engaging ways. Health promotion increased children’s knowledge on the importance of physical activity and enabled children’s participation in fun activities through songs, books, and games that promote structured and unstructured play. Health promotion also provided visual and hands on demonstrations of healthy snacks and drinks, and resources to share with families about physical activity and nutrition. CCHC Program services continued to use the ‘12345 Fit-Tastic! Healthy Lifestyles Initiative messaging and guidelines, which incorporate nutrition and physical activity guidelines into resources for child care providers and children. The initiative is developed by the Kansas City Healthy Lifestyles Collaborative and funded by Children’s Mercy Hospital. CCHC Program services increased access to information about physical activity and nutrition guidelines for children and families, continued to be inclusive of adults and children of all abilities, and encouraged family participation in program services. CCHC Program services continued to provide evidence-based resources and educational materials for child care providers and the parents/guardians of children in child care. The capacity for LPHAs to deliver CCHC Program services was severely impacted by the COVID-19 pandemic.

 

Partnerships

BCHW staff participated in a number of coalitions and partnerships that help to advance progress towards the state’s goals of improving access to nutritious foods and physical activity throughout Missouri. Examples of groups in which staff were involved with include: MOCAN, Missouri Convergence Partnership, Missouri Coordinated School Health Coalition, DESE Wellness Workgroup, and the Missouri Complete Streets Advisory Committee. Staff have the opportunity to network and identify collaborative opportunities with other organizations working on similar goals, share resources and leverage funding to expand the reach of their work.

 

The MCH Services Program continued to contract with the 22 LPHAs that selected promoting physical activity and reducing and preventing overweight/obesity as the Priority Health Issue to be addressed in their FFY 2022-2026 MCH Services contract work plan. LPHA efforts to prevent and reduce overweight/obesity and increase physical activity among children and adolescents included:

 

• Pulaski County Health Department has increased the number of children and adolescents engaged in physical activity for at least 60 minutes/day. The Adolescents Committed to Improvement via Exercise (A.C.T.I.V.E.) Program, which has been implemented by four after school programs, has collectively impacted over 100 children and adolescents who were trained to complete a 5K. In addition, the health department facilitates an AquaCize class in the summer months for women of childbearing age and children. The class is held at a local pool and encourages children and families to be active (Pictures below.)

 

 

 

 

• Randolph County Health Department staff increased community knowledge regarding physical activity and nutrition by appearing at several community events with a smoothie bike. The bike grabs attention and is a fun tool to teach attendees about making healthy food and physical activity choices. Children and adolescents at the events made fruit smoothies and discussed what makes a smoothie “healthy”. They added ingredients to the blender and pedaled for 30 seconds. (Picture of Smoothie Bike below.)

 

 

• Clay County Public Health Center increased community knowledge by hosting a Family Fun Day in North Kansas City where over 500 women, children, and their families attended. They had several fun activities focused on reducing obesity among children and adolescents. Tony Temple, founder of Temple Made Fitness (TMF), authored the book Animal Movement, which inspires children to play, move and use mindful journaling to spark imagination and physical activity. Tony led a session for children from his book. There were also several partners who brought interactive games for children. To further engage young children, there were face painters who painted sports themes, like soccer balls and basketballs, as well as images of fruits and vegetables.

 

SPM #1 Oral Health – Percent of children, ages 1 to 17 years, who had a preventive dental visit in the last year

 

According to NSCH 2020-2021 data, nationally 75.1% of children ages 1-17 years old had a preventive dental visit in the past year. This was a greater percentage than in Missouri (69.8%). A lower percentage of Missouri children ages 1-5 years old (48.2%) had a preventive dental visit than their national counterparts (54.7%). This age group also had a lower percentage than Missouri children ages 6-11 years old (76.5%) and 12-17 years old (80.7%). Children who most frequently had a preventive dental visit in the past year lived in college educated households (76.9%) followed by some college or technical school (69.4%), and high school graduate or GED (36.0%) households. Children with private insurance only (76.8%) more frequently had a preventive dental visit than publicly insured only (64.3%) and uninsured (40.1%) children. Children in two-parent, married households (72.4%) reported having more frequent preventive dental visit in the past year than single parent households (67.8%).

 

Ordering information for oral health resources from the Office of Dental Health (ODH) and the Missouri Primary Care Association (MPCA) was provided to all MCH funded home visitors to promote National Children’s Dental Health Month, which is observed in February. National Children’s Dental Health Month was also highlighted in the Home Visiting Program’s newsletter, Quality Outlook, and in the Weekly Update emailed to all MCH funded home visitors and supervisors. The weekly update provided links to materials, webinars, and other resources that highlight the importance of preventive annual dental care in children. The Missouri WIC Program collaborated with the ODH to procure infant and toddler toothbrushes to have them available in local WIC agencies.

 

Additionally, literature is available to LPHAs, dental offices, and community outreach events such as health fairs. The importance of regular dental care is also stated within the context of the ODH’s promotion of the use of dental sealants. Referrals and care coordination components of the Preventive Services Program (PSP), described in more detail below, also encourage regular dental visits for children, particularly those identified as having a dental need.

 

The ODH experienced continued success with the PSP, an evidence-based fluoride varnish and oral health education program. Each child receives an oral health screening by a dental professional, two applications of fluoride varnish, oral health literature and supplies, and oral health education. The oral health education is either provided by school staff or the dental professionals that volunteer to operate PSP. Educational materials are provided by the ODH (for grades K-12), but some schools choose to use their own materials. Prior to COVID-19, PSP served about 90,000 children each year; in FY22 PSP served 42,500 children. Due to the Coronavirus pandemic, many schools did not allow visitors for the 2020-2021 and 2021-2022 schools years. For those schools, PSP adapted to provide grade-specific, narrated educational videos for teachers to show their classes. Additionally, for schools that did not have their own educational materials or training, a Zoom call could be scheduled with the school’s Oral Health Consultant. Oral health supplies and literature were still distributed, and fluoride varnish was either applied by a trained school staff member or a parent/caregiver. The ODH’s Oral Health Consultants were available to school nurses to advise them on possible dental health needs. School nurses could take pictures of a child’s teeth if there was a questionable issue and an Oral Health Consultant helped to determine if there was a need for dental care. Only a few school nurses had questions about oral care during these school years. Starting in the 2021-2022 school year, PSP went back into the schools and participation has steadily increased. Since 2014, there has been a 5.3% decrease in the decay rate among PSP participants. Unfortunately, there has been an increase in PSP children who have an unmet dental need. A survey conducted by Lincoln County Health Department found nearly 61% of PSP participants needed early dental care in 2023 as opposed to 2020, when about 39.5% of children needed early dental care. This could be due to the oral health workforce shortage. The Elsberry school district, located in Lincoln County, recently told us how grateful they were for the PSP program. The statistics at their school district indicate a great need for PSP.

 

Through a HRSA grant, the ODH supported 22 LPHAs providing fluoride varnish services to WIC participants, most of whom are also Medicaid eligible. LPHA staff provided fluoride varnish services twice a year and received Medicaid reimbursement. The first few years of this program, the Medicaid reimbursement rate was about $13.50, however, with the Medicaid remuneration rate nearly doubling for some procedures, the fluoride varnish reimbursement rate (by a medical practitioner) is nearly $22. Additionally, the fluoride varnish costs less than a dollar per application and this makes the program very sustainable. Fifteen of these LPHAs are continuing this fluoride varnish program because it is sustainable, but most importantly, it provides the children with fluoride varnish, something that may not otherwise be available in their area.

 

Much of Missouri is a dental health provider shortage area, meaning many Missourians are not located close to a dentist nor do they have a dental home. COMTREA (a Federally Qualified Health Center (FQHC)) assists parents in understanding the importance of oral health and linking children with dental care to address barriers to dental services such as transportation, ability of parents to miss work or pay for services, and knowledge of available services. The ODH worked with COMTREA to provide assistance and support as needed in the form of educational materials and handouts.

 

The SHP coordinated with the ODH and other programs to provide evidence-based information, resources, and professional development to school nurses. This enabled them to utilize best practices when educating children and parents about oral health, including promoting the need for annual dental visits and regular preventive practices.

 

The ODH continued to promote the use of dental sealants as an effective means of preventing decay on newly erupted molars and is actively seeking new partnerships to provide dental sealants in school-based clinics. Through grants not funded by the Title V MCH Block Grant, the ODH continues to work with two LPHAs and two dental health clinics to apply sealants in their clinics and at local schools. ODH is hoping to contract with two other dental hygiene schools to bring this program to more schools. During the 2021-2022 school year, were 503 children received dental sealants. Over the past five years, 6,737 sealants were placed on 1,997 children.

 

The TEL-LINK Program referred 204 callers to dental clinics to increase awareness of community resources to access dental health services. The program continued to provide targeted outreach campaigns through online search engines to the underserved population through effective marketing strategies. The campaign reached over 175,000 Missourians resulting in 7,491 individuals taking action to find out more.

 

The CCHC Program provided 32.75 hours of trainings and consultations for child care providers on the implications of oral health on overall health, and evidence-based guidelines, policies and procedures that promote optimal oral health among children. As a result of CCHC consultations and trainings, child care providers had increased knowledge of the link between a child’s oral health and their overall health and well-being. Providers also reported increased awareness of oral health promotion strategies they can implement at their facility. CCHC trainings also increased child care provider knowledge regarding identifying abnormal oral conditions in infants and young children. Trainings also focused on oral care implications for children with special healthcare needs (CSHCN), and overcoming challenges and barriers to providing oral care among the CSHCN population. The CCHC Program also provided 105.5 hours of health promotion on oral health topics to children in child care. Sessions were delivered in fun, developmentally appropriate, and engaging presentations. As a result, children could verbalize why their teeth are important, what could happen if they don’t care for their teeth, and how to identify unhealthy snacks and beverages that can harm their teeth. These children also participated in fun hands on demonstrations of proper brushing and flossing techniques and were provided with educational materials, toothbrushes, and toothpaste to enhance their excitement around oral care and their ability to participate in oral care at home. The educational materials also increased parental awareness of the importance and recommended frequency of preventive dental checkups. CCHC services continued to: 1) be inclusive of adults and children of all abilities, 2) encourage family involvement in program services, 3) provide children’s oral health service referrals to outside community resources, and 4) optimize the overall health of children in child care. The capacity for LPHAs to deliver CCHC Program services was severely impacted by the COVID-19 pandemic.

 

The MCH Services Program supported LPHA efforts to:

• provide education on the importance of adequate dental care and overall oral health;
• collaborate with partners to provide screening, referral and direct provision of preventive dental services for oral health needs; and
• increase the number of children, ages 1 to 17 years, receiving a preventive dental visit in the last year.

 

Additionally, the MCH Services Program continued to contract with the eight LPHAs that selected enhancing access to oral health care services for children as the Priority Health Issue for their FFY 2022-2026 MCH Services contract work plan.

• Wright County Health Department increased oral health knowledge among internal staff by training three nurses, one nutritionist and three clerks using the Varnish Volunteer Training for Preventative Services. A dental varnish program has been implemented at the health department and staff can provide oral assessment, education, referrals and applications of fluoride varnish to pregnant women, and children up to age 18 years. This service increased the number of children and pregnant women that receive an oral health screening and fluoride varnish application. 135 children received an oral health screening and education; and 56 children received fluoride varnish application. In addition, the health department developed oral health kits, which included a toothbrush, toothpaste, floss, and educational materials. The kits were distributed to all children ages 1-17 who visited the health department for any service. About 135 children received the kit. This increased the number of children that have access to oral health supplies and could participate in oral hygiene (see picture of kits below).
• Audrain County Health Department increased knowledge regarding oral health. The health department also increased access to oral hygiene products (toothbrushes, toothpaste and floss) by providing oral health programs and education to schools, daycare centers and at community events.In total, 833 students and 139 children in daycare benefited from this initiative. (Picture below.)

 

Other strategies included providing education to the public, city officials, dental and medical professionals, and public health authorities about the safety and effectiveness of community water fluoridation in preventing dental caries. The ODH also continued efforts to improve the Missouri Oral Health Surveillance System through updating oral health fact sheets and compiling regional reports that provide oral health statistics and related information.

 

Through a grant not funded by Title V MCH, the ODH is contracting with two dental clinics and two dental hygiene schools to provide teledentistry services to schools, targeting the counties with very few or no dentists. This will provide dental services to children who may not have access to those services.

 

The ODH’s Five-Year State Oral Health Plan was finalized and disseminated and is still a subject of ongoing communication with its partners.

 

ODH continued its efforts to:

• Increase access dental care by providing education about the importance of maintaining the adult dental benefit among MO HealthNet recipients. Information is distributed to policymakers, dental providers, leaders, and oral health stakeholders via the DHSS website and partners like the Missouri Coalition for Oral Health and Missouri Dental Association;
• Contract with the MPCA to provide education and technical assistance to State Dental Directors from all FQHCs in Missouri. The MPCA also assisted the ODH with distributing educational materials regarding the importance of a dental health home for everyone, particularly for pregnant women, and children;
• Support the development of the oral health workforce in Missouri through collaborations with the DHSS Office of Rural Health and Primary Care on incentive programs for dental professionals; and
• Implement the referral portion of PSP, which links children with an identified dental need to local dental providers. This is coordinated through school nurses and other local champions.

 

Other Title V MCH Activities Related to the Child Health Domain

 

Developmental Screening

The CCHC Program continued to provide consultations and trainings for child care providers around health and safety topics, including social-emotional learning, language/communication, cognitive, and movement/physical development in children. The CCHC Program provided 139.75 hours of training and consultation for child care providers regarding developmental screenings and child growth and development.

The CCHC Program also targeted children by providing 189.25 hours of education on multiple areas of child development, including physical growth and development. Information and resources provided were developed in accordance with the Centers for Disease Control and Prevention (CDC) “Learn the Signs. Act Early.” (LTSAE) Program. Through CCHC Program services, child care providers and parents/guardians of children in child care have increased knowledge about the importance of developmental milestones. Child care providers also reported increased confidence in communication strategies to approach challenging discussions such as when they suspect a child is not meeting developmental milestones.

 

Inclusion Specialists provided parents with a listing of child care providers based on their location. Parents could choose child care that meets the needs of their child and this increases the likelihood of maintaining placement, which will support the educational needs of the child. Inclusion Specialists provided 316 onsite consultations to assist child care providers in developing adaptations and strategies to include CSHCN in everyday classroom activities. They also assisted in setting achievable goals for the child’s ongoing development. Inclusion Specialists delivered group training to increase the knowledge base of 1,904 child care providers in Missouri on how to include CSHCN. Through the social-emotional learning (SEL) project, specialists also delivered evidence-based training to child care professionals to help them understand how children develop socially and emotionally The training also included intervention strategies to foster social-emotional development in practical ways. 44 children were screened as part of the inclusion SEL project, 7 of the 44 scored “at-risk” or above the cut-off for the Ages and Stages Questionnaire®-Social Emotional (2nd Edition). This score indicates a potential for delays or disabilities in social-emotional development and further evaluation or assessment is recommended. Depending on a child’s age, families were either referred to First Steps or the local school district.

 

The Home Visiting Program’s contracted home visitors used the Ages and Stages Questionnaire®- 3 (ASQ-3), a validated screening tool through Maternal, Infant and Early Childhood Home Visiting (MIECHV), Building Blocks (BB), and Healthy Families Missouri Home Visiting (HFMoHV) programs. The ASQ-3 consists of 21 questionnaires that can be used to identify a child’s developmental needs. Home visitors provided referrals for children who scored below the cut-off points indicating a need for additional developmental information and activities, community support, or early intervention services through Missouri First Steps or Early Childhood Special Education to contribute to improved school readiness. Annual performance measure data was collected on the percentage of ASQ-3 developmental screenings conducted at the specified time points of 9, 18, and 30 months of age. In FY22, 89.2% (379/425) of enrolled children ages 9, 18, and 30 months received a developmental screening using the ASQ-3. 59.4% (19/32) of children who scored below the cut-off points were referred for further support. A nurse from a LPHA in St. Louis shared that during the 18 month visit she used the ASQ-3 and identified a child who lacked verbal communication. At 21 months, the child was referred to First Steps and is now receiving speech therapy to further his language skills.

 

Additionally, home visitors continued best practices to screen all children, birth to age three, using the ASQ:SE-2. Home Visitors also provided developmental activities for parents/children who scored in the “monitoring” range and assisted families in accessing services as appropriate. The Home Visiting Program provided all contracted home visitors with education on childhood mental health conditions and warning signs.

 

The Newborn Health Program partnered with a variety of community health providers to distribute the Pregnancy and Beyond booklet, as well as other educational materials that provide information on developmental screening. The program tracked the distribution of these materials and obtained feedback on ways to improve the materials.

Based on the feedback, we are planning to have the booklet translated into Bosnian, Russian and Ukrainian. We are also adding information related to Marijuana use during the prenatal and postnatal period.

 

The Missouri WIC Program implemented the public awareness campaign “Talking is Teaching: Talk, Read, Sing” to help parents recognize their ability to improve their children’s early brain and vocabulary development. Training was provided statewide to WIC agencies, home visitors, Head Start, Parents as Teachers, health care providers, libraries, and other community partners. Handouts were created to give caregivers tips on fun and easy ways to improve their child’s learning. The WIC program also distributed books developed as part of the CDCs LTSAE public health campaign.

 

The Missouri WIC program continued to offer training and support to local agencies and community partners interested in implementing the WIC Developmental Milestones Program (DMP). A total of 60 local WIC agencies implemented the DMP with two new agencies joining in FFY223. Participating agencies use a set of age-appropriate developmental checklists, based on the LTSAE public health campaign, to increase parents’ awareness of developmental milestones and to promote the early identification of potential developmental delays. Local agencies refer participants for screening and early intervention services to primary care physicians or Individuals with Disabilities Education Act diagnostics programs, such as First Steps (0-3 years of age) and Early Childhood Special Education (3-5 years). Local agencies may also refer their participants to ParentLink, an affiliate of the Help Me Grow National Center, for validated screening and connection to intervention programs. The local agency added ParentLink to their referral form. This includes the name of the facility, address, and phone number. The parent has a choice to reach out to ParentLink. ParentLink staff then utilize the ASQ-3 and ASQ: SE to assess the child’s overall development (such as communication, gross motor, fine motor, problem solving, and social skills) and social-emotional challenges (such as ability to calm down, take direction and follow rules, communicate, perform daily activities, act independently, demonstrate feelings, and interact with others). The WIC Program further collaborated through ParentLink, Help Me Grow Missouri’s ambassador, to integrate supportive services that help children thrive Help Me Grow helps to ensure families can access needed services. Data reports from the Missouri WIC Management and Information System (MIS) on referrals and follow-ups will be available for the first time in FFFY24. These reports will be used to assess the program’s effectiveness in providing referrals and access to early intervention programs.

 

To improve the program’s effectiveness, DHSS provided technical assistance to all participating WIC agencies. DHSS provided education and promotional items, including printed materials such as the developmental checklists and the Amazing Me books developed by the CDC. Information on various child development topics was shared through monthly updates on the Missouri WIC webpage. For FY23, the Missouri WIC program considered promotional materials to assist parents in assessing their child’s development, such as feeding utensils. These resources were also available to other internal and external stakeholders to promote early identification of developmental delays.

 

This is the fourth year the Missouri WIC program has collaborated with the Association of State Public Health Nutritionist (ASPHN). The program worked with the ASPHN to update the “Milestones Matter” Nutrition Education modules. There were 43,810 “Milestones Matter” nutrition education modules completed by WIC participants in all states from June 2021-July 2022. Missouri uses WIChealth.org platform, the Introduction to Child Development for WIC Staff training module, and other child development content on the WICShopper app to include CDC’s revised milestones. The ASHPN committee worked with National WIC Association (NWA) to add the Introduction to Child Development module to the WIChealth platform. This allows other states to access this resource. WIC Agencies were required to complete the training module. The Missouri WIC Facebook page posted monthly to promote the program to local agencies and the public. Results from a FY21 survey were used to determine current program participation rates, clinic activities, and training needs of participating agencies. The survey also gathered data on program interest from agencies not currently enrolled. The feedback is being used to design future promotional activities.