NPM-6: Percent of children, ages 9 through 35 months, who received a developmental screening using a parent-completed screening tool in the past year.

Annual Report FY21:

This Performance Measure was achieved. The Performance Objective was 31.3% and the Annual Indicator was 34.2%.

Program Activities:

The 2020 Utah Maternal and Child Health and Children with Special Healthcare Needs, Statewide Needs Assessment identified key needs and top concerns. Among the top concerns identified were Access to Care/Health Insurance and Access to Care/Limited Care. Parents of CSHCN described very long wait times to be determined eligible for services that could help improve their children’s ability to reach developmental milestones. Developmental screening opportunities were also described as not comprehensive and/or not readily available, especially in rural areas. Out of the “Top-10” ranked issues for parents of children with special health care needs, access to comprehensive and routine developmental screening opportunities was ranked #7 in the MCH/CSHCN Needs Assessment.

We developed two related strategies to improve outcomes for NPM-6

1. Increase the number of parent-completed developmental health screens received by children ages 9 months - 35 months by training additional Early Care & Education and Health programs in ASQ Online.
2. Increase the number of parent-completed developmental health screens received by children ages 9 months - 35 months contributed to the UDOH ASQ Online Enterprise Account Activities and Effectiveness

Increase ASQ Training

The Early Childhood Utah (ECU) program manager participated in quarterly meetings with the Local Health Departments in order to engage the nursing directors in ASQ training, to share information on the importance of developmental screening and to make developmental health promotion resources available to help them achieve their agency’s NPM-6 objectives.

The ECU program worked with each LHD on tiered developmental screening goals and objectives.

Tier 1: Increase ASQ Online Training and Promotion

• Promote ASQ Online training and the use of ASQ Online screening with community-based organizations. Attend ECU Advisory Council meetings.

 

Tier 2: ASQ Trained and Ready to Use ASQ

• Conduct ASQ Online screens with clients through the WIC, Home Visiting, Early Intervention and/or other LHD programs.

 

Tier 3: Advanced ASQ Utilization

• Establish and implement a schedule to complete screens at 6, 12, 18, and 25 months; along with 3, 4, and 5 years of age.
• Integrate billing Medicaid into the service delivery system, i.e. determine if codes 96110 and 96127 can be utilized by the LHD to bill for developmental screens.

 

Currently, the 13 LHDs are at various levels within the established tiers; three are at Tier 1, eight are at Tier 2, and two are at Tier 3.

 

According to the UDOH Early Childhood Integrated Data System (ECIDS) between July 1, 2020 and June 30, 2021 the LHDs collectively facilitated:

• 1,769 ASQ-3 screens to 1,137 distinct-children for children ages five and under.
  • 1,226 (69%) of the screens were Above Cutoff (no developmental concerns), 321 (18%) of the screens were in the Monitoring Zone (implement developmental practices and retest later), 182 (10%) of the screens were Below Cutoff (implement developmental practices and make appropriate referrals for the developmental areas in need of further assistance).
  • 927 (52%) of the ASQ-3 screens listed above, were for 680 distinct-children; ages 9-36 months.
  • 642 (69%) of the screens were Above Cutoff, 183 (20%) of the screens were in the Monitoring Zone, 102 (11%) of the screens were Below Cutoff.
• 525 ASQ Social Emotional screens to 385 distinct-children, ages five and under.

• 431 (82%) of the screens were Above Cutoff, 56 (11%) of the screens were in the Monitoring Zone, 38 (7%) screens were Below Cutoff.
• 316 (60%) of the ASQ Social Emotional screens listed above, were for 231 distinct-children; ages 9-36 months.
• 273 (86%) of the screens were Above Cutoff, 24 (8%) of the screens were in the Monitoring Zone, 19 (6%) were Below Cutoff.

 

ECU considers the data displayed above to be quite an accomplishment given that during the COVID-19 pandemic of 2020/21, LHDs were tasked with managing immunization clinics, as well as coordinating the regional pandemic response. During this timeframe, some departments/programs had to pull back on facilitating developmental screening opportunities for parents/children while they prioritized addressing the pandemic related needs of their community. For example, one LHD submitted 3,476 screens in 2019; in 2020 they submitted 970 screens and in 2021, only 316 screens. Through April 2022, this LHD had already submitted 780 screens, hopefully an indication of a positive trend. ECU consistently distributes information regarding the importance of screening along with training opportunities offered through the Brookes Publishing company to the LHD directors.

ASQ training for new providers continues to be offered through the ECU program on a quarterly basis or by request. It is important to note, any provider who contacts ECU can participate in this community-based ASQ training opportunity; training information is shared regularly during the LHD quarterly meetings.

The ECU program manager trained 69 providers/caregivers between July 1, 2020 and June 30, 2021. These providers/caregivers represented the UDOH Office of Home Visiting and IDEA Part C Early Intervention grantees, Head Start and childcare providers, LHDs, along with other early childhood service providers.

Additionally, the ECU program manager continued to invite LHD representatives to attend meetings of the Early Childhood Utah Advisory Council. Once an LHD provider has successfully completed ECU’s ASQ training course, congratulation emails are distributed and participants are encouraged to enroll in their agency’s UDOH ASQ Online Enterprise subaccount. The ECU program supports the enrolled LHDs with technical assistance (TA) and encourages LHDs to reach out for any additional assistance they may need. One example of TA provided, includes a collaboration between ECU and the LHDs to create and share a screening link which can be distributed as a text to parents/caregivers to streamline completing a screen on a parent’s/caregiver’s cell phone and/or through an email account. The objective of creating and sharing this resource is to help improve access to completing developmental screens for many parents/caregivers.

The ECU program worked closely with the state WIC administrator to inform community-based WIC programs about this ASQ texting capability. The Utah WIC program administers a texting platform that can share messages with WIC enrollees. WIC distributes the ASQ screening link along with other informative messages and resources to the families they are working with.

The Salt Lake County and Southeast LHD directors examined ways to use Medicaid developmental screening billing codes, 96110 and 96127 in order to receive reimbursement for their screening efforts. The ECU program manager worked closely with both of these LHD directors to discover how to implement billing Medicaid into their regular screening practices. Meetings were also held with Utah Medicaid administrators regarding the utilization of these two billing codes. Issues around the billing codes not being open/available in Utah for Medicaid providers to use were explored. This collaborative process and problem-solving meetings led to the billing codes being opened by Medicaid.

The ECU program manager also attended the United Way of Salt Lake’s, prenatal-five workgroup. The focus of this workgroup is on Medicaid and Medicaid billing for a wide variety of providers. United Way facilitates this monthly meeting. This workgroup explores, through collaborations with state Medicaid staff and other stakeholders, ways to enhance and share information on using Medicaid developmental screening billing codes in order to receive reimbursement.

In addition to ECU’s comprehensive work with Local Health Departments, ECU enrolled several pediatric providers in the UDOH ASQ Online Enterprise Account. This included three large networks of pediatric providers: 1) Utah Valley Pediatrics, 2) Wasatch Pediatrics, and 3) the People’s Health Clinic. A large public mental health agency that serves many young children, Wasatch Behavioral Health, was also enrolled in the UDOH account.

The Early Childhood Utah Advisory Council's, Promoting Health and Access to Medical Homes subcommittee, had a Statewide Coordinated Developmental Screening initiative approved by the Governor’s Early Childhood Commission. The ASQ-3 and ASQ SE:2 were also adopted as the recommended statewide screening tools by the ECU Advisory Council and the Governor’s Commission. This multi-agency developmental screening initiative lays the foundation for large networks of medical providers and hospitals to establish their own enterprise accounts and, once the appropriate parental disclosure/consents and data sharing agreements are in place, to be able to share/access child level and aggregated screening results through common data repositories. American Rescue Plan Act funds, distributed through Utah’s Child Care and Development Block Grant lead agency, are supporting this initiative.

The ECU program assures ASQ materials are available in Spanish for any community-based screening program. The ASQ is also available in other languages as needed/as requested.
 

Accomplishments / Successes:

According to Federally Available Data (FAD) from the National Survey of Children’s Health (NSCH) Utah is trending in a positive direction with regards to improving the state’s developmental screening rates.

Throughout calendar year 2021, the UDOH ASQ Online Enterprise Account received the following screens from all enrolled community-based screening programs, for all ages (0-5) (Data sources: The Brookes Publishing-UDOH ASQ Online Enterprise Account and the UDOH Early Childhood Integrated Data System):

• ASQ-3: 4,738 distinct children received 7,249 ASQ-3 screens
  • 3,988 (55%) of the screens were Above Cutoff
  • 1,713 (24%) of the screens were in the Monitoring Zone
  • 1,524 (21%) screens were Below Cutoff
• ASQ-Social Emotional: 2,872 distinct children received 3,557 screens
  • ASQ SE:2 screens 2,571 (72%) of these screens were Above Cutoff (converted to the same cutoff language used for ASQ-3)
  • 492 (14%) of these screens were in the Monitoring Zone.
  • 494 (14%) of these screens were Below Cutoff

Fourteen new community-based programs enrolled in the UDOH ASQ Online Enterprise Account between July 1, 2020 and June 30, 2021. Forty-six different community-based early care, early health and pediatric providers contributed 10,506 developmental health screens to the UDOH ASQ Online Account.

In September 2020, the Governor's Early Childhood Utah (ECU) Commission voted to coordinate developmental screenings by asking all early care and education providers to use the same common developmental screening tools, specifically the Ages and Stages Questionnaire ASQ-3 and ASQ-Social and Emotional (SE) tools. Using the same screening tools allows early care and education providers, clinicians and health providers to align efforts by sharing screening data across systems to prevent children from falling through the cracks.

In 2021, the CHARM system was selected by the ECU Health Subcommittee and approved by the Executive Committee of the Governor’s ECU Commission to: 1) integrate identifiable child ASQ-3 and ASQ-SE developmental screening results collected by various agencies such as the Department of Health and Human Services, Department of Workforce Services, Help Me Grow, and Head Start, and 2) share the ASQ screening results with USIIS Immunize, the CHARM Web Portal, and up to three integrated EMR systems. Authorized users of these latter systems will use the ASQ data for operational, childcare, intervention, or case management. The overall purpose of the data project is to make identifiable child ASQ-3 and ASQ SE screening data available statewide to early care, development, health care, and education providers, as well as clinicians, for coordination and improving care to individual children and families.

This project builds upon the accomplishments of the CHARM data integration system to integrate developmental screening ASQ results so that better and more consistent referrals, services, treatments, and interventions are provided to children with potential developmental delays. The project will also ensure that Utah’s early childhood stakeholders are all working together across the state to identify and close learning gaps early so children and their families are prepared when they enter kindergarten.

The CHARM Program is partnering and currently working with representatives of the Governor’s Commission ECU Health Subcommittee and the Department of Workforce Services, Office of Child Care on this effort.

 

Summary of successes and accomplishments on “Moving the Needle” in relation to NPM-6 (July 1st, 2020 - June 30th, 2021):

• Utah's Local Health Departments facilitated 2,294 developmental and social-emotional screens to 1,237 distinct children.
• Forty-six different community-based early care, early health and pediatric providers contributed 10,506 developmental health screens to the UDOH ASQ Online Account.
• The ECU program manager trained 69 providers/caregivers.
• Fourteen new programs enrolled in the UDOH ASQ Online Account
• The ECU Advisory, ECU Subcommittees, and many other early childhood leaders and programs aligned their work with Utah's Birth-Five Strategic Plan.
• The Governor's Early Childhood Commission endorsed ASQ as Utah's preferred early childhood developmental screening tool; the Commission also endorsed proposals related to promoting universal and coordinated developmental screening.
• The ECU Advisory and ECU Subcommittees submitted a comprehensive annual report with early childhood system recommendations to the Governor's Early Childhood Commission for consideration.
   

Challenges / Gaps / Disparities Report:

Challenges:

Challenges that impeded progress in FY21 revolve around agency/program response to COVID-19. Local Health Departments had to establish and prioritize services directly related to the pandemic response, such as managing mass immunization clinics. Additional early childhood service providers such as early head start grantees, preschools, and home visitors temporarily paused direct services as they transitioned to virtual services. Challenges of this nature contributed to an overall decline in screens contributed to the UDOH ASQ Online Account.

Emerging opportunities:

In July 2022, the Utah Department of Health and the Utah Department of Human Services were consolidated into one agency. This multi-agency merger creates potential opportunities to address early childhood system gaps and to strengthen relationships between traditional perinatal-maternal-child health programs like WIC, Welcome Baby, home visiting and other systems of care like Child Protective Services, foster care, and mental health. Welcome Baby is a free community service offered by United Way in partnership with the Utah County LHD. Welcome Baby provides resources for parents from experienced nurses or trained parent educators to increase family stability.

Agency Capacity/Family Partnerships/Collaboration:

A companion document to Utah’s Birth-Five Strategic Plan is the Birth-Five Deliberative Sessions for Parents Summary. The Birth-Five Deliberative Sessions confirmed the following findings:

1. There are many unknowns for parents: a lack of knowledge of developmental milestones that might indicate the need for early childhood services, a lack of awareness of existing programs, and eligibility misconceptions that discourage service application.
2. Variable income poses challenges to maintaining service eligibility. Temporary extra income from seasonal work or year-end bonuses can disqualify families from services.
3. Participants learn about services through family, friends, or acquaintances. Stigma affects parents’ willingness to seek government services. For those who do seek services, negative interactions, particularly towards non-English-speakers applying for services and parents making WIC purchases, can deter them from further service use.
4. Barriers varied by community and parent background. Transportation difficulties are felt in most rural communities and language barriers by migrant workers and refugees.

The ECU Parent Engagement, Support, and Education Subcommittee’s goals have been developed to address the disparities/barriers listed above. The goals are to:

1. Ensure families are aware of and have access to high-quality programs and services needed to support the healthy development of their children, and
2. Actively engage families to inform improvements to service delivery systems to improve the overall health, well-being, and early learning outcomes of children.

Program managers from the UDOH and the Department of Human Services actively participate in the ECU Parent Engagement Support and Education subcommittee. The managers have been assigned as Parent Mentors within the group to guide/support parents who are interested in becoming a regular part of the subcommittee. Due to the COVID-19 pandemic, the subcommittee meetings have been virtual. During the reporting timeframe, the number of parents participating in the meetings climbed from zero to nine. Four of these parents are interested in becoming regularly participating members and some may participate in the larger ECU Advisory Council. This subcommittee created a common definition of parent engagement that can be shared through all the entities that serve parents and families. ECU Advisory Council recognizes the definition of family engagement as a collaboration between families, communities, and service providers equally invested in positive outcomes for children and families.

Report of ESMs related to NPM-6

ESM 6.1 - The number of annual ASQ trainings offered by the Early Childhood Utah Program.

 

Goal/Objective:

Ensure ASQ training opportunities are reasonably available and accessible to community-based providers/caregivers. By tracking this measure, ECU can help to ensure ASQ training opportunities are offered frequently and routinely by ECU and/or in collaboration with other state/community partners.

 

Significance of ESM 6.1:

Developmental screening is a critical element of well-child care and an important opportunity to engage families in the process of developmental health promotion. The screening process is used to determine if development skills are progressing as expected or if there is cause for concern and further evaluation is necessary.

This ESM is significant to increasing the number of developmental screens received by children ages 9 months - 35 months. In order to increase the number of screens received by infants/toddlers we need to increase the number of Early Care & Education and Health programs that offer developmental screening services to families with young children. ECE and Health programs cannot provide ASQ online services without first being trained in ASQ online.

ESM 6.1 Progress Summary:

ECU’s Developmental Screening program increases the capacity of early care, early health, and pediatric providers to effectively promote early childhood developmental health. ECU does this by educating, training and enrolling programs/caregivers in the Brookes-UDOH ASQ Online Enterprise Account.

The ECU program manager trained 69 providers/caregivers during the reporting period. These providers/caregivers represented the UDOH Office of Home Visiting and IDEA Part C Early Intervention grantees, Head Start and childcare providers, LHDs, along with other early childhood service providers.

The ECU program manager participated in the LHDs’ quarterly meetings in order to engage the nursing directors in ASQ training, to share information on the importance of developmental screening, and to make developmental health promotion resources available to nursing directors to help them achieve their agency’s NPM-6 objectives.

ESM 6.2: The number of ASQ screens contributed to the UDOH ASQ Online Enterprise Account by participating partners and enrolled programs

Goal/Objective:

By analyzing screening data quarterly and outreaching/supporting inactive programs and/or programs whose screening rates are decreasing, developmental screening rates may be increased.

Significance of ESM 6.2:

Early identification of developmental disorders is critical to the well-being of children and their families. Nationally, the percentage of children with a developmental disorder has been increasing, yet overall screening rates have remained low. The American Academy of Pediatrics recommends screening tests begin at the nine month visit. This measure is significant; by increasing the number of programs actively participating in the UDOH ASQ Online Enterprise Account the percentage of 9 month - 35 month old children that receive parent-completed developmental health screening opportunities will increase.

ESM 6.2 Progress Summary:

Between July 1, 2020 and June 30, 2021 forty-six different community-based early care, early health, and pediatric providers contributed 10,506 developmental and/or social-emotional health screens to the UDOH ASQ Online Account. Utah’s LHDs facilitated 2,294 developmental and/or social-emotional screens to 1,237 distinct children.

According to Federally Available Data (FAD) from the National Survey of Children’s Health (NSCH) Utah is trending in a positive direction with regards to improving the state’s developmental screening rates.

The Governor’s Early Childhood Commission endorsed ASQ as Utah’s preferred early childhood developmental screening tool; the Commission also endorsed proposals related to promoting universal and coordinated developmental screening.

Local Health Department Activities related to NPM-6:

As noted above, all 13 LHDs work on activities for NPM-6. As expected COVID slowed progress in this area for most of them. The overall screening numbers did not meet goals set at the beginning of the year for the majority. All LHDs strive to ensure that infants and children served by their departments are provided an opportunity to be assessed for delays and if delays are noted, referred to appropriate agencies for care.

LHDs use the Brookes Online Tool for ASQ screenings. Most children with “positive” screens are referred to Parents as Teachers (home visiting), Early Head Start, or early intervention programs, depending on the need and the child’s age. LHDs work to build relationships with outside agencies because many times they give clients the best resource to support children. Many conducted screenings with WIC clients and home visiting families, wherever there are “touch points'' with children and families. During visits with families, nurses work with parents in identifying upcoming expected milestones as well as assessing the status of the infant/child. Education materials were provided to the families to help them better prepare and understand the age-appropriate milestones and supporting activities that will benefit their infant/child. Nurses also spent time on educating the parents on the importance of the developmental milestones and how the referral programs can help increase better outcomes for their infant/child.

The pandemic affected LHDs ability to conduct ASQ screenings. Many LHDs limited in person visits and home visitation programs which severely limited the number of screenings they completed. LHDs tried to utilize the online ASQ referral link, but many times did not have a great response in getting the caregivers to complete the survey. As time permitted, follow-up contact would be made to help identify barriers to the family not seeking assistance from the referral services. A challenge is parents not completing the screening tool or not having adequate time during other program visits such as WIC, Medicaid Targeted Case Management (TCM), Parents as Teachers (home visiting) to complete the screening with the parents. Text, phone calls, and mailing reminders were sent by WIC and TCM staff to contact and encourage parents to continue with their child's ASQ scheduled screenings. Some families who had infants/children with identified delays would sometimes not follow-through with the nurse referrals.

Many nurses who would normally be performing the developmental milestone assessments (ASQs) were reassigned to COVID response efforts. As a safety precaution, no home visits (or ASQ screenings) were conducted from October 2020 - September 2021. Many LHDs saw over 50% staff turnover last year. Frequently after training a new employee they left before we could get to MCH training.

With all the challenges of the past 12 to 18 months, many visits are still by phone or virtual. Home visitors closely monitored when screenings were due and initiated appointments in advance to assure deadlines were met. COVID-19 quarantine prevented in-person contact with parents of children who participated in WIC and TCM visits, which limited the assistance and encouragement to participate in ASQ screenings. With the return to regular operations, MCH nurses will resume the ASQ assessments and work towards reaching their established goals.

NPM-13.2: Percent of children, ages 1 through 17, who had a preventive dental visit in the past year

Annual Report FY21:

This Performance Measure was achieved. The Performance Objective was 82.8% and the Annual Indicator was 84.3%.

Program Activities:

The Utah Medicaid Office provided regular updates at the quarterly meetings of the Utah Oral Health Coalition. These updates include information on those who are Medicaid eligible, what services are covered including updated services, how to become a provider, and updating contact information and resource lists. From June - September of 2021 Silver Diamine Fluoride (SDF) underwent a full review and cost analysis and by December of 2021 it had been evaluated and approved as a covered service effective January 1, 2022 for primary teeth only.

The State Dental Director (SDD) continued to attend the Utah Dental Association board meeting and the state dental licensing board meetings to represent the UDOH. The Oral Health Specialist (OHS) and Oral Health Educator (OHE) presented to 62 Utah Dental Association dental hygiene members on Public Health Dentistry at their annual meeting.

The Oral Health Program (OHP) has several ‘Baby Your Baby’ and ‘Check Your Health’ segments on TV each year. They write talking points for local dentists and dental hygienists in leadership to give. Topics include: The importance of baby teeth, setting a good bedtime routine with the American Academy of Pediatrics’ (AAP) “Brush, Book, Bed” program, and our OHE gave a segment on choosing healthy beverages and avoiding sugar for children under the age of two. In addition, the oral health specialist partnered with the Maternal and Infant Health Program to provide a Power Your Life segment on pregnancy and the importance of baby teeth. It had approximately 300 views.

The OHS continued to sit on the Early Childhood Utah (ECU) Health subcommittee and share great oral health resources. The OHS also collaborated with Help Me Grow, another ECU partner, to write a blog posting for their website on a structured healthy bedtime routine program set out by the “Brush, Book, Bed” program. 

The OHP continues to support the Head Start and Early Head Start (EHS) programs throughout the state by sitting on the health advisory committees, providing staff training, parent educational presentations and screenings, and fluoride varnish to some sites. In January of 2021 the OHS presented Empowering Parents (From the National Center of Early Childhood Health and Wellness presentations) to Kids on the Move EHS Staff, reaching 36 staff members. In May and June the OHS and volunteer dental hygienist screened and provided fluoride varnish to 51 Head Start children in Tooele and Grantsville and an additional 26 children in Wendover.

The OHE continued to work with the Office of Home Visiting (OHV) to provide oral health education and training to families with children (ages 0-5) and staff. The OHE sent quarterly educational and dental resource emails to each site. All educational materials shared are evidence-based and include national materials on COVID-19, oral health care considerations and going to the dentist. The OHE supplied 160 donated toothbrushes and toothpaste to the Salt Lake City OHV Site. Additionally, donated toothpaste was mailed to all rural OHV sites ensuring that each location gets donated toothpaste and oral health educational supplies. In addition, a dental hygiene student provided education at a parents' night for the Southeast local health department, reaching five families. In addition, the OHE updated the 12 oral health messages, magnets, and modules. Updated magnets were delivered to four local health departments.

Recorded presentations including Empowering Parents and Oral Health and Pregnancy; (From the National Center of Early Childhood Health and Wellness presentations) in English, Spanish, Nepali, and Arabic continued to be shared with several Early Head Starts in Utah, WIC, OHV sites, Bountiful Food Pantry, and early intervention programs.

In September the OHS shared two Spanish language educational videos for Hispanic Heritage Month at a virtual health event. The presentations were “Smiles for Life” (https://byu.zoom.us/rec/share/ufZrH4Hw6khLRrfW5FDcAp8YRpnaX6a80XIW-KENzU8rwOVHCWmbwEghaMcUDNk0?startTime=1596635478000) and
“Empowering Parents”  (https://byu.zoom.us/rec/share/6uFEFI3iyCBIBbPx5V6OY5YBN8fBX6a8hyMZ-fVcnTSvBw3oFNRwJGLLviRuKVA?startTime=1591336032000).

The OHP, OHS, and OHE continued to share the opioid toolkit for dental professionals. The OHP disseminated the toolkit through the Utah Dental Association, Utah Dental Hygiene Association, safety net clinics, and dental and hygiene schools. In the fall of 2020, in-person trips were made to disseminate this toolkit in Davis, Tooele, Salt Lake, Utah, Wasatch, Duchesne, Sevier, Weber, and Washington Counties. This toolkit includes specific guidelines on opioid prescribing for pregnant women, children, and adolescents from the National Maternal and Child Oral Health Resource Center.

Working with The Association for Utah Community Health (AUCH) and their Community Health Workers (CHWs), the OHS and OHE gave a virtual oral health presentation to 29 CHWs. Dental educational materials for families and safety net clinic information were provided.

The Adolescent Oral Health Campaign (AOHC) is an intervention designed to educate middle school aged students about oral health care. In the 2020-2021 school year, all presentations were given virtually or viewed by a recording. A total of 89 in-person presentations were given to 1,758 students and an additional 383 students viewed the recorded presentation. The OHE managed OHP interns who implemented the program and gave presentations on building program sustainability. To measure the effectiveness of the intervention, the students complete anonymous pre- and post-tests. One page fact sheets were created for each school based on the data collected. Brochures with local safety net dental clinics were provided to all students and teachers physically and electronically.

For the Utah Schools for the Deaf and the Blind one email was sent in the fall and another in the spring. These emails included oral health coloring pages, two educational videos, and dental resources for families. These emails were sent by the teachers to over 140 families.

For children’s Dental Health Month in February, the OHP sent electronic newsletters to all public elementary school, middle school, and high school administrators. Over 1,000 schools were contacted. The OHP interns and OHP Specialists gave virtual and in-person presentations to 562 students in 12 elementary schools across seven different counties. These presentations were given to each individual class as assemblies were still not permitted due to COVID-19.

The OHP, OHS, and OHE continued to be active members of the Professional Advisory Committees for the different dental hygiene schools. The OHP continues to do presentations at the dental hygiene schools on cultural respect and public health dentistry. In the 2020-2021 school year, the OHS and OHE presented to all six of the dental hygiene schools. In September 2020, the OHS also presented to 3rd year dental students at Roseman University on motivational interviewing. She also shared materials from the National Maternal and Child Oral Health Resource Center.

One of the OHPs greatest strengths is working with many strong partnerships/collaborations. The OHP began its 11th year collaborating with the University of Utah Physician Assistant (PA) Program. In the fall of 2020 the OHS and OHE trained 70 University of Utah PA students from the Salt Lake Campus and St. George Campus to perform oral health risk assessments and apply fluoride varnish. In August both the PA program and the OHP provided screenings and fluoride varnish applications to 120 migrant head start children and over 50 Migrant Farm Workers (parents of the MHS).

Again, the OHP partners with Head Starts, Office of Home Visiting, WIC, and other early intervention programs to share educational resources, as well as, help these populations find dental homes.

The OHS worked with individual Early Head Start/Head Start (EHS/HS) to help them get dental homes and address questions during shut down and pandemics. Because tooth brushing was halted in EHS/HS, educational videos and materials were created and given to address these barriers and concerns. During the pandemic, in spring of 2020, the OHP presented and shared virtually two presentations Empowering Parents and Oral Health and Pregnancy (from the National Center of Early Childhood Health and Wellness presentations) to several EHS/HS in Utah and also had local dental hygienists that speak Nepali and Arabic share with vulnerable populations with EHS. These were recorded in English, Spanish, Nepali, and Arabic for refugees and other families in EHS/HS. These presentations were also shared with Home Visiting, WIC, and other early intervention programs. The OHS and OHE worked creatively to conduct outreach to families during the pandemic.

Accomplishments / Successes:

A notable accomplishment of the OHP is its 10 year collaboration with the University of Utah Physician Assistant (PA) Program where direct services are not only provided to head start children but also oral health training of PA students occurred. In addition, the oral health program worked with different HS sites to screen and apply fluoride varnish to an additional 77 children. In addition the 12 oral health messages materials were updated and shared with the Office of Home Visiting Sites.

Summary of successes and accomplishments on “Moving the Needle” in relation to NPM-13.2 (June 1st, 2021 - September 1st, 2021):

• SDF underwent a full review and cost analysis and by December 2021 it had been evaluated and approved as a covered service, effective January 1, 2022, for primary teeth only.
• The OHP updated the 12 oral health messages, modules, and magnets, which were disseminated to all OHV sites. Quarterly educational and resource emails were sent to each site including information on drinking water instead of sugary beverages, regular snack times, what to expect from a dental visit during COVID-19, and the importance of brushing teeth.
• The OHS gave a round table discussion at the National Oral Health Conference. The OHS spoke on the 2007-2019 Non-traumatic Dental Report. From that round table the OHS was invited to present to the American Dental Association Emergency Department National Committee on her report in June of 2021.
• The OHE also had a roundtable discussion at the National Oral Health Conference on the Adolescent Oral Health Educational Campaign conducted along the Wasatch Front. Materials including the factsheets, end of year reports, and pre/posttest data were shared with attendants. The OHE was contacted by two other states after the roundtable to share additional information.
• The OHE shared vaping and cigarette oral health related educational flyers with adolescents, school teachers and nurses. The OHS shared information with the CSHCN birth defects program on oral health considerations for children with Autism, Down syndrome and children using feeding tubes
• The OHP received 1,500 full tubes of toothpaste. The toothpaste was taken or shipped to every office of home visiting site, some Head Starts, Granite Peak Jr. High and other community organizations including the Road Home (homeless shelter), Bountiful Food Pantry, 4th Street Clinic, Utah School for the Deaf and the Blind, Somali Self-Management Agency, Utah Navajo Health System, and Confederated Tribes of the Goshute in Ibapah.

 

Challenges / Gaps / Disparities Report:

One of the biggest ongoing challenges of providing access to dental care has been the pandemic. Many safety net clinics did not have the personal protective equipment (PPE) or were very delayed in opening back up. Several of the safety net dental clinics also didn’t offer preventive care, only exams and restorative care upon initial opening. This was a nationwide problem. The OHS worked with both dental schools and hygiene schools to see if screenings or other care could be provided. Several live online meetings were done to address this challenge. When the clinics finally opened many families were very hesitant to go to the dentist, let alone take their child. Another challenge for the OHP included reduction in staff. The OHS chose to reduce her hours from a full-time 1FTE to .5 FTE in July of 2020 and resigned from the position in May of 2021. Because of the COVID-19 pandemic and funding concerns, the Oral Health Survey of Utah’s school children which was planned for the 2020-21 school year was canceled. During FY20, planning was underway and IRB approval had been obtained, so it was unfortunate to need to cancel the survey. Previously, the survey was done every five years.

Emerging Issues:

The increase in PPE and protocols needed to treat patients from the pandemic have remained intact. This increased level of PPE adds patient time and cost to dental providers. Aerosolizing procedures in dentistry are common and many modifications have been and are being made to limit the amount of aerosols produced. Providers have found that preventive products such as Glass Ionomer sealants, Silver Diamine Fluoride (SDF) need to be utilized more as they do not produce aerosols. SDF became a covered service by Medicaid for primary teeth in January of 2021.

Agency Capacity/Family Partnerships/Collaboration:

Due to organizational changes and the loss of the OHS and SDD, capacity is limited at this time with only 1.0 FTE (OHE) working in the Oral Health Program. The Oral Health Program has also moved from the Office of Maternal and Child Health to the Office of Primary Care and Rural Health, which is under the direction of the Executive Director's Office (EDO). Once a new SDD is hired, the EDO has committed to increasing the SDD from 0.2 FTE to 0.5 FTE. Having more time from the SDD and the OHP in the Office of Primary Care and Rural Health will increase capacity for collaborating with private sector entities; federal, state, and local governments; tribal organizations, etc. to meet the oral health needs of Utah's children.

Report of ESMs related to NPM-13.2

ESM 13.2.1 - Collaborate with Medicaid. Percent of Medicaid children who had a preventive dental visit.

 

Goal/Objective:

Increase the percent of Medicaid children ages 1 - 18 who had a preventive dental visit.

Significance of ESM 13.2.1:

Measures the number of Medicaid children ages 1 - 18 years who have a preventive dental visit.

Notes & Comments:

The ESM Performance Measure was not achieved. The Performance Objective was 52.1% and the Annual Indicator was 47.8%. The most recently available data for reporting is from 2020. The 5-Year Annual Projected Performance Objectives have been updated.

ESM 13.2.1 Progress Summary:

This ESM is expected to increase the number of Medicaid children ages 1 through 18 years who have preventive dental visits in the past year. This includes an additional year of age 18 years, but it is close to the age range for NPM-13b. The Medicaid population is a group that has higher dental needs than those of higher economic status. They are part of the population in Utah that is important to concentrate on in improving this measure.

 

Local Health Department Activities related to NPM-13.2:

Three of thirteen Local Health Departments (LHDs) implement activities for this objective. As expected, COVID slowed down the implementation of planned activities during the year, however, some progress still occurred. Oral health education and materials were given to all parents who had a home visit (COVID restrictions permitting), including telehealth visits. One LHD offered 72 fluoride varnishes and 20 fluoride treatments, while for another 250 children received dental education and/or supplies or referrals. In the third LHD, 843 children received dental education and or dental hygiene supplies and provider referral, which more than tripled their goal for the year.

LHDs barriers for this objective included staffing issues, COVID restrictions, and connecting with parents and getting them to bring their children in for screening. During the first part of the year not many children received education and/or supplies, but during the last few months of the year more children received services.

 

State Priority Area: Family Connectedness

SPM-2: Percent of family members who live in the household that ate a meal together 4 or more days per week

Annual Report FY21:

Program Activities:

The Performance Measure was achieved. The Performance Objective was 78.8% and the Annual Indicator was 81.1%.

In this case, Utah has used the measure of family meals as a proxy indicator for connectedness. Family meals are also an opportunity to cultivate communication skills, improve family relationships, bolster self-esteem, decrease obesity rates, and develop life-long healthy eating and lifestyle habits.

Accomplishments / Successes:

Utah's five year goal was to increase the percentage of families who ate a meal together four or more days per week from 76.7% to 81.7% (2017-2018 National Survey of Children's Health). The 2019-2020 data from the National Survey of Children's Health show that 81.1% of Utah families ate a meal together four or more times per week. This nearly achieves the five year goal that Utah set and demonstrates a nearly 4% increase from the 2018-2019 data of 78.1%.

Summary of successes and accomplishments on “Moving the Needle” in relation to SPM-2.0 (July 1st, 2020 - June 30th, 2021)

• The Family & Youth Outreach Program (FYOP) distributed conversation cards to 45 Utah families. "Conversation Cards" are a deck of cards with pre-printed questions or conversation starters for parents to utilize with their teens or preteens. The cards can be used to promote healthy, relationship-building conversations during family meals. The Conversation Card resource was developed in collaboration with the Missouri Department of Health & Senior Services.
• FYOP, in collaboration with local partners, implemented the Families Talking Together intervention with 98 parents. This evidence-based program increases the ability of parents to communicate about sexual decision making, set boundaries, and engage more positively with their teen(s). Ultimately, increased conversations and stronger relationships with parents decreases the initiation of risky behaviors, such as sexual activity. Local partners are trained in the intervention and assist FYOP in reaching parents more broadly in communities across the state.
• The FYOP team held 24 virtual Teen Speak classes, with 160 parents and youth-serving professionals attending. FYOP also produced one Fostering Communications podcast (https://utahfostercare.org/feed/podcast) to promote the program, in collaboration with Utah Foster Care. The podcast episode reached approximately 150 foster parents. This evidence-based program utilizes motivational interviewing principles to support parents and trusted adults in improving communication skills and strengthening youth-adult relationships. Data suggests that teens who can identify a strong relationship with at least one trusted adult are less likely to use drugs or alcohol, engage in sexual activity, or attempt suicide.
• The Healthy Environments Active Living (HEAL) program (formerly known as EPICC), worked with Utah's governor to proclaim September 2021 as Healthy Meals Month.
• The HEAL program, produced and promoted 30 “A Way to HEAL, Utah” podcasts (https://podcasts.apple.com/us/podcast/a-way-to-heal-utah/id1497138073?ign-mpt=uo%3D4).

 

Challenges / Gaps / Disparities Report:

The COVID-19 pandemic has continued to present challenges to reaching parents and youth-serving professionals through education and other resources. However, virtual classes are proving to be successful in some aspects and even present an opportunity to reach more rural, underserved populations in the long-term, potentially addressing equity concerns.

Agency Capacity / Collaboration Report:

Partnerships include Utah Foster Care, Local Health Departments, the Utah State Board of Education, Local Education Authorities, home visitors, and other youth-serving organizations. The Family & Youth Outreach Program is striving to build and maintain more partnerships that can reach diverse populations and improve program equity, such as Centro Hispano, refugee resettlement agencies, Sacred Circle Health Care (serving the Confederated Tribe of the Goshute), and more.

 

Other activities in the Child Health domain that contribute to improvement in the National Outcome Measures

Utah works to adhere to the three-tier framework outlined in the MCH Block Grant guidance. While the focus of most activities is the ESM →NPM→ NOM framework, activities on improving NOMs outside of the NPMs transpires in parallel. The following programmatic activities also work to improve outcomes in this domain.

National Outcome Measures (NOM):

NOM 13: Percent of children meeting the criteria developed for school readiness

The CHARM system continued to integrate data between the Early Hearing Detection and Intervention (EHDI) and Baby Watch Early Intervention (BWEI) Programs. This linkage enables the EHDI program to know that a child with hearing loss has been referred to early intervention by six months of age for follow-up care. Receiving timely treatment and intervention for children that are Deaf and Hard of Hearing maximizes their developmental and communication potential so they can be ready for school entry. Similarly, the BWEI program receives hearing screening results in its Baby Toddler Online Tracking System (BTOTS) system through CHARM from the EHDI program. This has enabled the BWEI staff to know if a child has received a hearing screening, or still needs one, thereby providing timelier follow-up care and comprehensive service/treatment plans for a child. In addition, when a child transitioned from part C to part B, the health information provided through CHARM continued to be documented in the child’s record when the child moved from infant/toddler services to preschool, which provided continuity of care.

NOM 14 - Percent of children, ages 1 through 17, who have decayed teeth or cavities in the past year. (Reduce the percent of children and adolescents who have dental caries or decayed teeth)

The UDOH Oral Health program partnered with the University of Utah Physician’s Assistant (PA) Program to see 120 children in the migrant head start program. PA students performed an assessment to identify dental needs and applied fluoride varnish to prevent dental decay.

The UDOH Oral Health Adolescent Educational Campaign ran over the 2020 school year and reached 2,141 students. Educational presentations and local dental resource lists are made available to all middle school students who received the intervention.

In March of 2021 the Oral Health Specialist presented to 36 Early Head Start Staff at Kids on the Move EHS emphasis was placed on tooth brushing in the home since it was not being done in the center due to COVID. In May, the Oral Health Specialist along with volunteer dental hygienists provided screenings and fluoride varnish to 77 children at the Tooele, Grantsville, and Wendover Head Starts.

The Baby Your Baby Outreach Program included several news interviews on the importance of taking care of your children's teeth.

NOM 19 - Percent of children, ages 0 through 17, in excellent or very good health. (Improve the health status of children) and NOM 20 - Percent of children, ages 2 through 4, and adolescents, ages 10 through 17, who are obese (BMI at or above the 95th percentile). (Reduce the percent of children and adolescents who are considered obese)

Teaching Obesity Prevention in Early Childcare and Education Settings, TOP Star for short, is a program created by the DHHS Healthy Environments Active Living (HEAL) program to improve the health of children who are cared for in early childcare and education settings. The program supports childcare providers by improving their nutrition, physical activity and breastfeeding environments and policies to help promote health and prevent obesity in children. Local health department consultants provide individual guidance, support, resources, and tools.

The HEAL program also works with the Utah State Board of Education and other partners and organizations to ensure that school health is a priority within the school setting. Best practices to guide schools to develop policies and healthy environmental settings can follow the CDC's framework known as the Whole School, Whole Community, Whole Child, or WSCC model. The WSCC model is student-centered and emphasizes the role of the community in supporting the school, the connections between health and academic achievement and the importance of evidence-based school policies and practices.

The model provides 10 component areas to help address a well-rounded school health environment:

• Physical education and physical activity
• Nutrition environment and services
• Health education
• Social and emotional climate
• Physical environment
• Health services (School Nursing and other services)
• Counseling, psychological, and social services
• Employee wellness
• Community involvement
• Family engagement

NOM 21 - Percent of children, ages 0 through 17, without health insurance. (To ensure access to needed health care services for children)

Baby Your Baby included an interview with the CHIP and Medicaid director encouraging those who are without insurance to apply. The same staff that answer the MCH phone line also answer the phone line for CHIP. Staff are easily able to provide information on CHIP and Medicaid to those who call about their child through MCH.

NOM 22: a) Percent of children, ages 19 through 35 months, who have completed the combined 7-vaccine series b) Percent of children, ages 6 months through 17 years, who are vaccinated annually against seasonal influenza c) Percent of adolescents, ages 13 through 17 years, who have received at least one dose of the HPV vaccine d) Percent of adolescents, ages 13 through 17 years, who have received at least one dose of the Tdap vaccine e) Percent of adolescents, ages 13 through 17 years, who have received at least one dose of the meningococcal conjugate vaccine

The CHARM system continues to link immunization histories of children, ages 0-18, from the Utah Statewide Immunization Information System (USIIS) and provides it electronically to the Baby Watch/Early Intervention Program, the Early Hearing Detection and Intervention Program, the Fostering Health Children Program, the WIC Program, Newborn Screening Heel-stick Program, and private provider clinics. These programs and clinics, that obtain immunization information on the combined 7- vaccine series, seasonal influenza, and adolescent HPV, Tdap, and meningococcal vaccine through the CHARM system, have continued to identify children in need of immunizations, and have followed-up with parents/foster parents to get their child vaccinated and up-to-date. In addition, health care providers that use USIIS can access and view newborn hearing screening and Critical Congenital Heart Defect (CCHD) through CHARM links that query this information.