Priority: Support capacity of the early childhood workforce to incorporate trauma-informed practice in all program areas.

 SPM. Number of state and community programs with capacity for trauma-informed screening and care of families impacted by Adverse Child Experiences (ACE)

Objective 1. Increase the number of families screened for ACEs or alternative tools in supportive programs

Increase the number of programs with staff trained in trauma-informed skills

Strategy- Partner with the Early Childhood Education and Care Department to institute trauma-informed training for early childhood staff

ESM- Number of planning meetings coordinated between Title V and the Early Childhood Education and Care Department

Analysis by the UNM Center for Development and Disability during the 2020 needs assessment https://www.cdd.unm.edu/pdfs/health-equity-cyshcn-policy-brief-10-23-19.pdf revealed the disproportionate burden of ACE among families with children and youth with special healthcare needs. These findings reinforce the importance of medical home and primary care, coordinated specialty care, as well as behavioral and developmental services. The linkage between the two departments is crucial to addressing this disparity and helping link families with supportive activities and resources.

Screening with an ACE-specific tool has some drawbacks. A standard short ACE tool is used in many clinical and childcare or parent support settings; however, some families may be re-traumatized by this kind of screening, and carefully considered alternatives are required. Furthermore, it is not always necessary to know someone’s history if their current situation reveals traumatic experiences. Our ultimate goal is to ensure that all early childhood program staff are trained to provide services in a way that centers equity, reduces bias, and recognizes the impact of trauma without retraumatizing the child or family. ECECD has started laying the groundwork for this training by providing Embracing Equity training for all ECECD employees. This is an intensive, multi-session training that encompasses structural racism, bias, and equity conversations that facilitate deeper awareness in the participants.  This training was completed by all ECECD staff in 2021 over the course of several months.

The work of ECECD has also been informed by changes in the understanding of child development.  According to the Center on the Developing Child at Harvard University, the previous framework for early childhood policies and programs has been guided by three core concepts that they call ECD 1.0: (1) the impact of early experiences on brain architecture; (2) the importance of responsive, “serve and return” interactions for healthy development; and (3) the disruptive effects of toxic stress on the developing brain and early learning. With advancing science, three additional concepts have been added to create ECD 2.0.(below). Our trainings will emphasize not only the effects of toxic stress on the brain, but also on the lifelong effects on physical and mental health, and an expanded focus on structural inequity and systemic racism.

The ECECD received an Early Childhood Comprehensive Systems grant in 2021, which is focused on integration the health and early childhood systems in a way that centers equity and is driven by the voices of families and communities. As part of this grant, an Equity Council is being formed, along with a Family Advisory Council and an overall ECCS Advisory Committee.  One way we are connecting early childhood programming with the healthcare sector is by holding presentations at ongoing ECHO meetings that are attended by healthcare providers.  ECECD is presenting at the Reproductive Health ECHO to increase awareness of our early childhood services, and the CARA navigators are presenting at the Perinatal ECHO hosted by the NM Perinatal Collaborative to discuss how we can increase the percentage of care plans developed during the prenatal period for pregnant people using substances.  The NM Perinatal Collaborative, of which the ECECD Chief Health Officer is the immediate past president, is also very focused on equity training for healthcare providers and for its own Board.

The Family Infant Toddler program (FIT), which is New Mexico’s Early Intervention/Part C program, is working to increase equity in our Early Intervention system.  The program surveyed FIT providers in 2021 to assess their needs and interest around equity training.  The results showed all the respondents were interested in this type of training to some extent. They did have some reservations about facilitation and asked that it be facilitated by an expert, not by program staff. The Title V CSHCN program is also hosting a PHAP from the CDC who is working on increasing equity in early intervention services in tribal communities, in partnership with ECECD’s Chief Health Officer and the ECECD Assistant Secretary of Native American Education and Care. The FIT program is hoping to allocate funding for this training in the FY23 budget. Additionally, ECECD requested funding for trauma-informed training of early childhood providers in its FY23 budget as well as funding for a CARA early childhood navigator to better connect CARA families with ECECD services and ensure early childhood providers have knowledge of how best to work with these families.

Objective 2. Increase ability to analyze and improve early childhood services, including mental health and substance use referrals, through inter-agency coordination

Strategy- Improve data sharing and data linkages to improve mental health access and referrals

Strategy- Execute MOA between NMDOH Family Health Bureau and ECECD to optimize collaboration and increase ability to perform data linkages with DOH and ECECD data.

NMDOH Title V and ECECD programs intersect around nutrition and food security support, perinatal services, early intervention/Children’s Medical services, safe sleep, and home visiting. Data linkages to identify families with current trauma or a history of traumatic experiences is an important step in improving coordinated care.  With improved data linkages, the two departments may identify families in need of support. As an example, families with a plan of safe care for a substance-exposed infant require a variety and different levels of care. For some families, connections and navigated referrals to home visiting are sufficient. For others, more intensive counseling and behavioral health access, even in-patient care may be indicated. Working together to identify these needs by program area is crucial.

The NM Human Services Department is leading a cross-agency, multi-million dollar effort (HHS2020, also called MMISR or Medicaid Management Information System Replacement,) that will ultimately involve data sharing across multiple state agencies.  The project has been delayed by COVID; however, in 2021 IBM held a series of Design Thinking Meetings with Cabinet Secretaries and their delegates to develop and finalize the design of this project.  This work of developing and executing HHS 2020 will continue over the next few years. The goal is to provide a single point of application for consumers, to reduce administrative burden and duplication of effort with applications, and to improve the data reporting that agencies can use for evidence-based decision making.

HHS 2020 is not limited to technology; it encompasses a re-evaluation of processes and organization structures used to manage and deliver program services, efforts to work across organizational boundaries to manage and deliver all HHS programs in the state and transition from current operating models to more effectively outcomes-based focus for our work. Fundamentally, HHS 2020 is about moving from a program-centric structure to a Stakeholder-centric structure. This involves moving away from program and technology silos into an integrated, flexible framework that supports service provision and Stakeholder interaction across HHS programs and organizations.

Title V and ECECD have met several times to discuss how to implement data linkages, and we have also had meetings with our General Counsels of each Department about creating an MOU for data sharing and other Title V activities. The MOU is currently in final review (March 2022). Coincidentally, we are also involved in an ASTHO project to link PRAMS data (from DOH/Title V) and home visiting data (from ECECD). In the legislative session of 2021, $150,000 was allocated to DOH for this data linkage project, also called the Family Success Lab.

Children’s Oral Health FY21

Priority: Expand access to preventive oral health care for children and adolescents including those with special health care needs by the end of 2023.

NPM (SPN) 13.2 Preventive dental visits for children and adolescents, ages 1 to 17.

The activities of the New Mexico Department of Health (DOH), Office of Oral Health (OOH) are aimed to reduce oral health disparities and achieve oral health equity among underserved communities in New Mexico (NM). The OOH administers a school-based dental sealant program for elementary school children, that provides oral health education, dental screenings, dental sealant applications on first and second molars, and dental case management. In rural areas, all elementary school children are eligible to participate in the dental sealant program. In urban areas, the services are limited to the first, second and third grade students. Program services are offered at no cost to parents or guardians of children enrolled in the participating schools. Elementary schools qualify for the program if they have at least 50% or more of its student population on the free and reduced school lunch program. An estimated 84% of elementary schools qualify for the free and reduced lunch program for the 2020 -2021 school year 671 students participated in the program with a total of 2,013 molars being sealed. The number of children participating in the program during this period are low due to the COVIC 19 Pandemic closing schools.

In addition to the sealant program, the OOH conducts a fluoride varnish program for head start and early head start centers. This program provides dental screening, three fluoride varnish applications per year, oral health education, dental case management and home dental hygiene supplies (toothbrush and toothpaste). For the FY 2020-2021 school year 145 children participated in the fluoride varnish program, and 290 fluoride varnish applications were given.

The dental sealant program and fluoride varnish programs were developed to provide preventive services for school children to reduce dental caries, since many low-income children have limited or no access to preventive dental care. The two programs are supported by state staff and contracted private dental providers. Dental case management is provided to children (served by state staff), who have dental caries and/or any other oral disease, to ensure they receive the dental care they need, especially among uninsured children.

 The application of dental sealants is a best practice shown to prevent dental caries up to 80% on the chewing surfaces of the teeth. Due to COVID-19 pandemic, participation in the sealant program has decreased during the last 2 years. However, OOH staff continue working to provide services and outreach to schools and parents to encourage participation in the program. Fluoride varnish can prevent up to 33% of dental caries in the primary teeth. Most of the parents of children enrolled in head and early head schools recognize the benefits of fluoride varnish application and participation in this program has been maintained and is increasing with lessening COVID-19 concerns. Oral health education and dental case management have been tools used to maintain parents and guardians engaged with the oral health of their children during this challenging time. It is important to have the support of parents to reinforce proper oral health hygiene habits at home since children spend most of their time at school, where the usual practice of daily classroom toothbrushing practices has been suspended due to the pandemic.

 Oral health education is at the center of improving the oral health literacy of New Mexicans.  Throughout the years state and contract staff have provided oral health education to countless children and adults at community events, health fairs, chair education, the media, and various social media platforms.  Improved oral health literacy contributes to good oral health practices, healthy eating, less sugar consumption, consumption of fluoridated water; all contributing to a healthy individual. 

 The COVID-19 pandemic required us to temporarily suspend clinical prevention and treatment services. OOH staff recognized that promoting the importance of good oral health during the pandemic was crucial and became very creative in the avenues used to reach the public. OOH took to the airways, newspaper advertisements, and virtual and in-person education throughout the course of the pandemic.  Within the past two years, OOH partnered with NM Delta Dental, the Native American Parental Professional Resource (NAPPR), the Hearst Corporation (KOAT and Estrella TV), and KRQE TV to promote oral health.  Public service announcements were created, and television spots were held during Children’s Oral Health Month” February 2020 and 2021. Guest speakers in the PSA’s were local dentists: Dr. Jeremey Dye (English), Dr. Charles Tatlock (Spanish), and Dr. Lisa Begay, who is one of New Mexico’s Native American Dentists. The PSA’s were in English and Spanish.  Target populations were children, adults, and the Native American population. We also partnered with NAPPR to hold a poster contest with the tribal Head Start centers to promote oral health in Head Start and Early Head Start families. The pandemic created an increased need to promote the importance of good oral health habits since daily toothbrushing that used to occur in the classrooms has still not resumed since being suspended at the beginning of the pandemic.