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

Children’s health is the well-being of children from birth through adolescence, usually ages 1-11. Child health providers focus on the healthy growth and development of children to help ensure every child reaches their full potential. To support children’s health, it is important to prevent and treat illnesses and injuries that can affect a child’s development. It is also important to promote optimal oral health (teeth and gums) and healthy social and emotional development. The Rhode Island Department of Health (RIDOH) supports children to access healthy foods, be physically active, receive recommended immunizations, and receive timely, high-quality, culturally sensitive healthcare to help them stay healthy. RIDOH also works to foster strong family and community relationships and ensure children grow up in safe environments. This health domain section has taken into consideration that the care and outcomes of womxn, children, and families are impacted by the systemic racism, discrimination, unaddressed language barriers, and a lack of culturally responsive providers. The following quantitative, qualitative, and anecdotal information tries to tease out health disparities and the overarching healthcare needs of communities.

 

The following priority for child health emerged from Rhode Island’s 2019 Needs Assessment:

 

1. Improve school readiness

 

Priority: Improve School Readiness

The health of children in RI remains an important issue to the MCH Program. Poor oral, physical, mental, and behavioral health status can have long term health consequences later in life. It is pertinent to focus on early childhood development in order to improve the physical and psychosocial well-being of RI children. The MCH Program is prioritizing school readiness, which includes the ability of children in RI to exhibit their full potential of success and the support of families and communities to meet children’s needs of readiness.

 

Early literacy is an important precursor for developing a foundation to school readiness. The percentage of postpartum women reporting currently reading or looking at a book with their baby in the past week has significantly increased from 2019 (83.0%) to 2020 (88.7%). Statistically significant differences continue to exist among racial/ethnic groups in 2016-2020, where 74.1% of Hispanic postpartum women reported currently reading to their infant compared to 87.0% of Non-Hispanic White postpartum women. In 2019-20, 36.5% of family members were reading to their child ages 0-5 every day, a continued drop from 49.6% in 2017-18 and 40.8% in 2018-19. This outcome becomes more evident in the disparity between Hispanic family members reading to their child ages 0- 5 every day (19.4%) compared to Non-Hispanic White family members reading to their child (46.2%).

 

Needs assessment highlights from the community and professional surveys ranked the following as their top issue related to education that the RIDOH can focus on to better support families: 1) Schools that are safe, healthy, and high quality, and 2) Child care that is affordable and high quality. Similarly, a SISTA Fire survey found that 50% of the womxn of color surveyed thought screening for milestones and healthy development were important to improving health and wellbeing of young children (1-4 years old). Surveyed womxn of color also ranked the following as their top three important things to improving the health and wellbeing of children (5-12 years old): 1) Social & Emotional

Health (62%), 2) Bullying (43%), and 3) Nutrition & Physical Activity (37%).

 

These current survey findings are further supported by prior RIDOH community engagement completed for the Preschool Development Grant. Most of the surveyed caregivers reported access to affordable childcare as their priority (44%). Among families identified as experiencing significant stressors by the state, over 1/3 stressed a need for more “information about available programs for my family.” Families with young children and special needs and/or foster care indicated a particular need for “information about available programs for my family” and “childcare close to home”. Cumulatively, these surveys show that there is still a need for the state to support the overall development and social and emotional health of children, especially those at a particularly young age.

 

To respond to these issues and support this new priority, RIDOH will resume, continue, and add strategies as follows:

 

Improve early literacy through Reach Out and Read: Due to internal administrative issues Reach out and Read activities were delayed. Their contract activities have been moved to begin 9/2022.

 

Support Preschool Development Grant efforts in increasing equitable access to early childhood education: Over the past year the Rhode Island Preschool Development Grant projects continued to ensure that RI children prenatally to age five (P-5) families have equitable access to the high-quality services and supports they need for their children to enter kindergarten educationally and developmentally ready to succeed.  RIDOH continued to fund Parents as Teachers (PAT) Family Visiting slots to support families with young children to have the best outcomes possible. RIDOH also continued to support families participating in P-5 governance, through the family/caregiver advisory council. State agency staff continued to work on sustainability strategies to provide funding when PDG funding ends. In the 2023 state budget, RI pre-kindergarten received funding to sustain PDG slots for families.

 

The Rhode Island Preschool Development Grant continued funding the Health Equity Zones (HEZs) to implement school readiness and family support activities.  HEZ funded activities such as parent education and support groups, supporting music education for young children, supporting early literacy for multi-lingual learners, the Incredible Years parent education, and other activities that were tailored to each individual community. PDG funding also continued to support “family navigators” in communities to help support families accessing any needed services. In the first quarter of 2022 family navigators addressed the needs of 193 families, which included 229 children. Family Navigators made 153 referrals to services including- basic needs assistance, child care, SNAP, WIC, housing support, legal assistance and more.

 

Child Health and Health Equity Zones

Administer Health Equity Zone school readiness and family support projects: The Rhode Island Health Equity Zones have continued to apply for public and private funding (ex. Preschool Development Grant) in order to implementing school readiness and family support projects. Family navigation services provided with the support of PDG funding have continued supporting families through June 2022. For instance, HEZs that received funding to support Family Navigators include Pawtucket and Central Falls, West Elmwood 02907, Newport, OneCranston, Central Providence Opportunities, West Warwick, and East Providence HEZs. PDG funds for HEZ Family Navigators resulted in over 880 families being supported over the course of State Fiscal Year 2022. Please see below for a further exploration of the various school readiness and family support initiatives HEZs have implemented this year.

 

Central Providence HEZ: Central Providence Opportunities HEZ, whose entire cohort of Family Navigators, supported in part by PDG funds, expanded the reach of the HEZ across the neighborhoods of Central Providence. The CP HEZ trained and employed 5 CHWs in CP as well as additional slots in other HEZs. This resulted in 14 CHWs who have received their CHW certification. 7 have completed apprenticeship RI credentials. 6 CHWs have received job promotions. CPHEZ also supported the trainings of 37 CHWs working with HEZs throughout Rhode Island from April 7th - end of May 2021.

 

In 2020, the Central Providence HEZ, specifically its collaborative member organizations Federal Hill House and The Autism Project, carried out programming to support children and their families. Federal Hill House developed playground extension projects, supported a First Providence Talks Extension (PTE) group that was designed to build parental behaviors that promote early childhood language and literacy, and promoted the Olneyville community’s Multi-Cultural Festival, which saw over 500 attendees. The Autism Project consulted local agencies to support children and families, as well as offered 10 hours of Conscious Discipline training for parents and caregivers, presented in both English and Spanish.

 

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

 

West Warwick: West Warwick has the highest rate of foster and kinship care in the state, which led a West Warwick resident and HEZ ambassador to establish the Grands Flourish program to support the experience of grandparents raising grandchildren due to the opioid epidemic and other trauma. Grands Flourish piloted a peer-to-peer grandparent support and resource group at the West Warwick HEZ Hub, and West Bay CAP implemented a part-time case manager solely dedicated to supporting grandparents raising grandchildren in West Warwick. Throughout the reporting year, the West Warwick HEZ continued to support these efforts and others to support families with children impacted by substance use.

 

West Warwick HEZ resumed efforts related to food insecurity and nutrition in summer of 2021. In partnership with the local library the free summer meal program provided children ages 0-18 with consistent meals during the summer. They are positioned to continue implementing their “pop up” farmers market for WIC and SNAP voucher recipients. In addition, West Warwick was funded by the Preschool Development Grant to have a family navigator support families and connect them to resources.

 

East Providence HEZ: The work at the East Providence HEZ, including family navigators, safe sleep, Incredible Years, and Parents as Teachers, continued through June 2022 with additional PDG funding, enabling the programming to positively impact the lives of children and families across the HEZ community.  EP HEZ continues the implementation of the evidence-based Parents as Teachers (PAT) model. They were successful in their second year partnering with the RI Philharmonic & Music School to implement music programming that supports early language acquisition for young children. “Family Music Time with the Phil,” a free 18 week program that combines music education for infants, toddlers and Pre-K students with the evidence-based PAT curriculum for parents, was offered to families across the city. The program was virtual due to COVID-19 but was still able to retain the majority of the families enrolled throughout the program. An average of 6 families and 7 children attended the infant/toddler classes. An average of 4 families and 5 children attended each Preschool class. Families receive free books and musical instruments to continue their education at home, and are able to make a connection with both the EBCAP family visiting team and EP HEZ Family Navigator. Families have already initiated contact regarding next year's programming and EP HEZ plans to continue their relationship with the RI Philharmonic.

 

EBCAP’s Family Visiting program, and the East Providence school system offered two play-and-learn classes in the spring of 2022 where families with young children explored fun ways to support their child’s growth and development. EP HEZ was able to offer free classes to over 20 families. The EP HEZ Family Navigator also instructed a Jazz/dance movement class at the local library. 13 children participated and one family connected with EP HEZ and followed up for more resources. The Family Navigator also connects families to WIC, assists with SNAP applications, and provides educational programming.

 

As EP HEZ looks forward into year 4, they focus on the intersection different barriers to health equity; one of which is access to healthy food. Recognizing that healthy eating habits start young, their Family Navigator has created and interactive activity. Children choose and decorate their vegetable pot, fill it with soil and vegetable seed of their choice and receive a book on eating fruits and vegetables.

 

In partnership with RIDOH and EBCAP’s Head start program, EP HEZ presented a culturally sensitive safe sleep workshop, which will be continued in the coming year, and was attended by 13 participants, one of which won a free pack-and-play.

For the second year in a row, EP HEZ implemented the evidence-based “Incredible Years” program; a 12-week series of classes that help to treat and prevent behavioral health challenges among children, and to promote social, emotional, and academic competence. The sessions ran from February to April with 6 families participating in both sessions. The EP HEZ plans to continue the Incredible Years program in the coming year.

 

In efforts to support oral health EP HEZ collaborated with EBCAP Head Start and UnitedHealth care to offer a Head Start talk “ Why are Baby Teeth Important?” It occurred in February of 2022 and discussed the importance of healthy teeth and smiles. Families that attended previous “Head Start talks” were polled in areas of interest and  10 families attended this virtual conversation. Two water- flossers were raffled to participants and every family at the EBCAP Head Start location received a free dental kit. This collaboration is expected to continue in the coming application year.  

 

Pawtucket and Central Falls HEZ: Through June 2022, the Pawtucket and Central Falls HEZ has continued to expand on the CLR Project and support a Family Navigator to provide essential systems navigation services to families, connecting them to vital supports. Additionally, PCF HEZ supported Children’s Friend in purchasing multicultural classroom materials for Pawtucket and Central Falls classrooms. Classroom materials included items such as bilingual books, CDs, and dolls and clothing representing diverse nations around the world. Backpacks were filled with multicultural learning materials (similar to the classroom materials) and were also purchased to foster the home-school connection. 60 hours of mentor coaching was provided to teaching teams. It is approximated that 109 children and their families were impacted by this program.

 

PCF also houses the Childhood Lead Action Project (CLAP), an initiative that continues to provide lead poisoning prevention and education to the Pawtucket and Central Falls communities. CLAP facilitated lead poisoning prevention workshops at a high school for students studying environmental justice. The HEZ’s partnership with CLAP has contributed to achieving a decrease in childhood lead poisoning in Pawtucket, and the HEZ continued to support work to decrease childhood lead poisoning throughout the community. Over 50 individuals were engaged in receiving education regarding lead hazards.

 

Washington County HEZ: Maternal and child health was a primary focus of South County Healthy Bodies Healthy Minds (HBHM), which served as the backbone for the Washington County Health Equity Zone. HBHM implemented 5-2-1-0 to prevent childhood obesity and promote healthy habits, by encouraging families to be more physically active and eat healthier, while engaging community partners to create healthier environments for children. The 5-2-1-0 program promotes eating 5 fruits and vegetables, engaging in no more than 2 hours of recreational screen time, getting 1 hour of exercise, and drinking 0 sugary drinks per day. The Washington County HEZ reached over 19,000 children and adolescents with their 5-2-1-0 programming. Forty-six 5-2-1-0-related strategies were implemented in schools, child care centers, and other organizations. In total, 94 organizations partnered to increase awareness about healthy behaviors and/or created environments that provide opportunities for youth & families to engage in these behaviors.  Examples of policy/environmental changes: eliminating chocolate milk, implementing grab-n-go breakfast, and installing water refilling stations.

 

Food access and family health has been the primary focus of the “Healthy Bodies” portion of Washington County’s Healthy Bodies Healthy Minds (HBHM). 5-2-1-0 has been pre-established and implemented within almost all school districts across Washington County (with the exception of Exeter). These materials, teachings, and workbooks remain within the schools, classrooms, and have been verified to be a continuous resource for educators in their classrooms. While existing efforts remained continuous, the new Healthy Bodies Outreach Coordinator established existing and new relationships within the schools via their wellness committees, nutrition and physical activity sub-committees, and 3rd party food service providers to ensure that messaging remains consistent and opportunities to collaborate and improve existing policies continue. Currently, the Chariho district is working to offer the Farm to School program in more locations, long term, all schools within the district, short term, capturing grades youngest to oldest, new implementation will begin for the 22/23 school year. Chariho will also offer alternative (non-sugary) beverage options, based on post-covid restrictions and supply chain availability. These PSEs will impact ~1,129 students.

 

From an organizational standpoint, HBHM has made substantial progress in impacting their community, engaging 71 organizational partners, including 18 schools (K-12), 23 preschools, 8 health service organizations, and 22 afterschool programs, and provided 145 hours of technical assistance to organizations in their efforts to support healthy eating and physical activity. This included: 1) connecting community partners with Rhode Island Department of Health (RIDOH) to assist with needed COVID-related resources; 2) supporting Community Health Workers (CHWs) and the community members they serve to address food insecurity needs; 3) providing school staff—nurses and health and physical education teachers—physical activity resources to engage children and families remotely; 4) assisting 10 child care organizations fulfill a total of 17 NAPSACC^ goals; and 5) disseminating 1,522 5-2-1-0 materials, including frisbees, water bottles, jump ropes, toolkits, and pedometers to increase awareness of, and support for engaging in healthy behaviors. HBHM organized and conducted an online school garden conference with local school garden experts, now posted on HBHM’s YouTube channel; and partnered with Peace Dale Library to provide garden kits (accompanied by gently used books related to healthy habits) to children in the Champaign Heights neighborhood as well as South County YMCA and South Kingstown Parks & Recreation programs.

 

By the end of PDG activities funded through June 30, 2021, HBHM’s Incredible Years parent group leader has contacted 36 families and recruited 18 of those families for the Incredible Years Parenting Groups as well as setting up a schedule for the group sessions. They completed 16 sessions with 9 parents completing the first group and completed 16 sessions with an average of 10 parents attending each session for the second group. They also completed recruitment for a third Incredible Years parenting group, which will start in the fall. HBHM’s behavior analyst has also completed 58 hours of weekly individual contacts with parents as well. The behavior analyst completed virtual coaching of 10 Head Start teachers including helping to write behavior plans and creating and delivering needed materials to carry out the plans. They spent 32 hours coaching virtually and 2 hours coaching in person as well.

 

Healthy Bodies of HBHM has impacted their community by following up with existing and engaging 14 new community partners including: 2 grocery stores/retailers, 5 libraries, 1 social services Director, 3 University of RI professionals (related to food access and recovery), 1 food rescue technology professional, and 1 patient experience and food access professional within South County Hospital. The principal focus of these relationships is to fully develop and implement a plan to increase culturally appropriate food access awareness, accessibility, and education. Existing partners will serve as communicators and potential site-locations for vending and new partners will aid in plan development and implementation to meet community needs. A newly establish pilot exists in Exeter which will serve as a test “pop-up” Farmer’s Market/Pantry.

 

In relation to 5-2-1-0 physical material distribution, much came to a halt due to existing availability and no-awarded grant funding between the months of October and June. 5-2-1-0 buttons, water bottles, and play-produce picnic baskets were distributed at pre-schools and events as a reward for participating in activities related to healthy eating. 5-2-1-0 lesson plans, worksheets, and other promotional materials were distributed to new and existing partners via PDFs, these were more widely provided to libraries and daycare centers/pre-schools. The remaining PDG funds will serve as an incentive to increase zero sugary beverage consumption and healthy snacking promotion. 210 high-quality water bottles will be distributed to 10+ pre-schools containing the 5-2-1-0 logo. The water bottle will be accompanied by an age-appropriate lesson discussing the cost of health by regularly consuming sugary beverages. Following bottle distribution to students, HBHM Coordinator or the preschool’s educator will conduct follow-up sessions with “healthy fruit” stickers to add to the water bottle. Students will be encouraged to try the snack prior to receiving the sticker and learning more about each snack. These activities will begin in mid-summer through school year 2022-23.

 

Water bottle filling stations were installed in Narragansett schools, the HEZ provided support for the state passage of sweetened beverage tax, supported the Bradford-on-the-lane food pantry, and the Davisville hangouts, which provided an online middle school community to support youth connections during the COVID-19 lockdown. The Washington County HEZ published Healthy habits and recipes book, and distributed hard copies and electronic versions throughout the county, and created the Feeding Toddlers Info Sheet for local pediatricians/Primary Care Providers (PCPs) to use with families in their practices.

 

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

 

Woonsocket HEZ: The Woonsocket HEZ was able to expand on this work after receiving additional PDG funding, to include programming and training taking place at both The Autism Project and Woonsocket Head Start. Woonsocket HEZ partnered with The Autism Project to offer a series of workshops for parents/caregivers, educators, and childcare providers of children between birth to age 5. These workshops trained participants to recognize potential indicators of autism or other developmental disabilities, provided best practices for caring for children with disabilities, and connected children to appropriate resources to support their development. These trainings allow for the early screening and diagnosis for developmental disabilities, and early connection to services, thus reducing delayed care for children with special healthcare needs.

 

Woonsocket HEZ continued to identify child development as a priority area. Their goal is that all children will be safe from harm and live-in families and neighborhoods that help them to thrive. In pursuit of this goal, they hope to decrease rates of child maltreatment in Woonsocket by 10%. Woonsocket HEZ partners began developing a comprehensive data dashboard that will allow them to track key indicators that measure child wellbeing and ACEs (adverse childhood experiences). They are also developing a strengths-based strategic plan that engages families in implementing culturally relevant and evidence-based best practices to increase the protective factors that minimize the impact of ACEs and that nurture the safe development of Woonsocket’s children.

 

Bristol HEZ:  Bristol HEZ continued supporting the Parents as Teachers program, which offers free family visiting to any family with a child between prenatal and kindergarten entry. This program provided knowledge for parents regarding age-appropriate skills and activities to promote school readiness, and increased families’ connections to various education, employment, family, and physical and mental health resources in the community. Last year, they conducted 387 personal visits with 49 group connections totaling 52 families and 59 children served. A total of 33 families were referred to the program with 28 joining. Most of new referrals came from the Rogers Free Library, Facebook, and First Connections.

 

Additionally, BHEZ continues to be a part of coordinating the Bristol-Warren Thrive by Five and Beyond. Their primary mission was, and is, to maintain a coordinated network of collaborating partners to support families’ access to health, educational and social services. This year and into next year, BHEZ has partnered with this group and the new Warren HEZ to bring a Kids Count Data Event to Bristol/Warren to bring the data to the community. This data and the conversation with the community will help promote the services that are needed most for local families. Community leaders, educators, and social service providers gathered in May of 2022 to hear a distillation of the community-level child wellbeing data from the Rhode Island Kids Count Factbook, with a specific focus on the children of Bristol and Warren. The event was sponsored by Rhode Island Kids Count, Bristol Warren Thrive by Five and Beyond, East Bay Community Action Program, Bristol Health Equity Zone, and Warren Health Equity Zone. The “Kids Count: Data in Your Backyard ” was a historic event for Bristol with over 70 registrants. With the support of Town Managers, school superintendent and state representatives the community began solution-oriented discussions on the needs of children and families.

 

Unlike the previous year, Bristol Health Equity Zone (BHEZ) Engagement Navigator was unable to offer one-on-one counseling to students at Mt. Hope High. However, the Engagement Navigator was able to provide services and supports to families across the Bristol and Warren community. BHEZ continues to partner with prevention coalitions to support the collective mental health of the community, and identify new partners to collaborate on combating social isolation.

 

Newport HEZ: With the expansion of HEZ PDG funding to additional HEZs during State FY22, the Newport HEZ provided vital systems navigation support to families in the North End of Newport with the addition of a full time Family Navigator. Newport HEZ also focused intensively on racial equity and racial justice. One of the Newport HEZ’s leading priorities was to eliminate disparities in Black maternal and child health outcomes. In efforts to improve racial equity, the HEZ participated in and hosted several racial equity trainings throughout the reporting year, reaching hundreds of attendees in the Newport community and beyond. The Newport HEZ conducted all their work through a resident-centered, racial justice lens.

 

The Newport HEZ partner Conexion Latina provided rent relief and gift-cards to support families in accessing basic necessities. Conexion Latina supported 27 families who were ineligible for state assistance with $500 in rental assistance. Conexion Latina also distributed gift cards of $50 each to families who expressed needing support in terms of basic necessities, hygiene items, and food.

 

Other Programs/Initiatives Related to Child Health

Developmental Screening: As part of the 2012-2016 Race to the Top Early Learning Challenge grant, RIDOH assisted over 35 primary care practices in implementing standardized developmental screening to align with the Early Periodic Screening, Diagnosis, and Treatment (EPSDT) Schedule and the American Academy of Pediatrics recommendations. RIDOH continues to work with Medicaid and insurers to support providers screening children at 9, 18, and 30 months using a standardized tool. RIDOH is currently participating in the state’s First 1,000 Days initiative, which recognizes the importance of the first three years of life. The initiative is designed to increase Medicaid’s role in supporting well-child care, including using developmental screenings to identify issues early, which helps to increase the odds that children are able to reach their potential. In addition, RIDOH participated on the PCMH-Kids planning team and supported Developmental Screening as one of the PCMH kids quality measures; in 2020 the 19 PCMH kids sites all exceeded or met the targets for Developmental Screening in RI (78% overall and 70% for Medicaid population).

 

PediPRN Program: Like MomsPRN, PediPRN serves providers treating children and adolescents in partnership with Bradley Hospital. The project’s mission is to improve access to behavioral health care for Rhode Island children and adolescents by integrating psychiatry into the state’s pediatric primary care practices. PediPRN uses a telephonic integrated care model to improve access to quality behavioral health expertise to achieve its mission. This service, funded by a 5-year HRSA grant, is free and provides all Rhode Island pediatric primary care providers assistance with their patients' mild to moderate mental health care needs. PediPRN focuses on creating a culture of empowerment for pediatric primary care providers. The clinical team works closely with providers offering CME opportunities, educational e-blasts, an updated website with assessment and educational resources on pediatric behavioral health topics, and ongoing support during telephonic consultations.
 

PediPRN continued to implement training, mentoring, and education for Pediatric Primary Care Providers (PPCPs) in the PediPRN Intensive Program. The second (2020) cohort launched in Sept 2020 (delayed from the planned start of March 2020) and ended in May 2021. Specific topics included Attention Deficit Disorder Assessment and Treatment in Pediatric Primary Care; Depression and Non-Suicidal Self Injury; Teen Substance Use: Screening and Treatment; Evidence-Based Practices in Autism; Eating Disorders in Primary Care; and Obsessive-Compulsive and Anxiety Disorders in Pediatric Primary Care. Out of 10 enrolled participants, ten graduated. CME evaluation forms reflected positive feedback from the participants. PIP graduates continued to meet for regular consultation sessions (as requested by the 1st cohort graduates) virtually (via Zoom) until funding was no longer available to support this program component. We have applied for additional funding from local funding sources to continue this component from PIP.

 

PediPRN Program Utilization, Enrollment, and Outreach: In 2020, PediPRN fielded 437 teleconsultation calls from 358 providers at 68 practices, directly helping 242 unique pediatric patients. In addition, during the reporting period, 27 providers have graduated from the PediPRN Intensive program (PIP). Preliminary evaluation of both PIP graduates and highly engaged providers show that these providers have:

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

This data reflects a decrease in utilization during the height of the COVID pandemic when practices were adjusting to telehealth visits and workflow changes. Since offices resumed in-person visits and practices have adapted to workflow changes, utilization has increased and stabilized at volumes similar to previous years.

 

However, enrollment continues to be slow as we have already captured many practitioners in the State. We have made efforts to access working lists of pediatric practitioners in the State to establish estimates of eligibility and enrollment and target enrollment efforts to those eligible but not enrolled. Final numbers should be available soon.

 

Outreach visits were stopped due to COVID restrictions and added burden (time and work) for PCPs related to the pandemic. We are now resuming outreach visits, starting with practices that have not utilized the program recently, via teleconference or in-person (based on practice preference). The goals of these visits are to review current PediPRN services, assess mental health needs and services of the specific practices, and solicit feedback regarding future programming endeavors.

 

PediPRN Electronic Education: Electronic education via e-blasts and newsletters provides up-to-date information regarding mental health resources, mental health screening and treatment training, and PediPRN services.

 

PediPRN Office Hours: Practice-based office hours have been a successful strategy to provide training, consultation, and support to specific practices. Office hours have also been an excellent opportunity to learn more about the mental health needs of particular practices across the State and establish program champions to support programming and sustainability efforts. The modality for practice-based office hours is Zoom and the frequency is monthly for one hour for each practice. During this time, PPCPs ask for support with specific cases and general mental health questions, share mental health-related challenges within their practices, and provide feedback regarding service needs in these discussions. We have also shared PediPRN sustainability efforts and inquired about PPCP's comfort with supporting these efforts via advocacy. Practitioners have utilized general/open “drop-in” office hours less frequently, so we have decided to pause on continuing these open office hours and are considering alternative strategies.

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

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

 

Home Asthma Response Program (HARP): HARP is an evidence based in-home asthma intervention that uses certified asthma educators (AE-Cs) and community health workers (CHWs) to conduct up to three intensive in-home sessions that: (1) assess a patient’s asthma knowledge and environmental trigger exposure, (2) provide intensive asthma self-management education, (#) deliver cost effective supplies to reduce home asthma triggers, and (4) improve the quality and experience of care. HARP eligibility is based on the child’s  age, city of residence, level of asthma control and health care use. An extensive environmental assessment is provided and involves an in-depth inspection of the family’s home to identify various environmental triggers that may be exacerbating the child’s asthma. Linkage to care is a component of HARP, in which children without current primary care providers at the time of the first home visit are referred to a primary care provider.

 

All children participating in HARP are required to receive an Asthma Action Plan (AAP) from their primary care providers. The AAP ensures that all individuals caring for the child, including school nurse teachers, daycares, parents/guardians, and other caregivers understand how to recognize when the child is having asthma symptoms, environmental triggers that may exacerbate the child’s asthma, how to safely administer medication, and ways to avoid asthma attacks. In 2017, RIACP submitted a proposal to the RI Attorney General’s Office to request a $300,000 allocation from the Volkswagen (VW) Clean Air Act Civil Settlement to improve asthma outcomes for high risk pediatric asthma patients in Rhode Island. Exposure to elevated levels of nitrous oxide (NOx) emissions have pervasive negative health impacts for people with impaired respiratory systems, and especially for children with severe asthma. RIDOH is using settlement funds to provide HARP to 200 severely asthmatic children in Central Falls, Pawtucket, Providence and Woonsocket.

 

RIACP led the effort to conduct a pilot study to provide HARP to children with poorly controlled asthma who are enrolled in a United Medicaid Plan. The pilot is now launched with Hasbro Children’s Hospital. In March of 2021, the RI Attorney General’s Office approved RIACP to provide HARP to a small pilot of adult patients with an asthma diagnosis. Having the opportunity to provide critical home-based asthma services to adult asthmatic patients is something that RIACP has been striving to accomplish for several years. The expansion of HARP to include both children and adults with poorly controlled asthma provides a unique opportunity to bring a lifespan approach to understanding the burden of asthma in children, adults, and to society. This advancement in comprehensive asthma care services also helps to move RIDOH closer to achieving health equity by addressing the needs of all low-income Rhode Islanders who have asthma.

 

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

 

RIACP continues to work with RIPTA, the statewide public transit agency, and shared GIS maps of asthma hotspots so that RIPTA could prioritize deployment of new zero emission electric buses in areas with a high asthma burden. The first zero emission buses were launched publicly with a well-attended press event and tour in October 2018. RIPTA is planning to use its VW Clean Air Act Settlement funding to purchase additional 16-20 electric busses for its permanent fleet. RIACP has also continued to collaborate with the RIDOH Lab and RI Department of Environmental Management on an EPA funded air quality study, called the Near Road Study, examining the air quality impact of I-95 highway on near-road communities with elevated asthma burdens. The study results were completed by the end of 2018 with RIACP playing a lead role in engaging communities on the results and recommendations.

 

The Information based on the study was disseminated to the public in order to take actions especially for the communities affected by the emissions by I-95; recommendations were developed regarding procedures to mitigate emissions and monitoring of air quality for communities residing near I-95. See link for more info: http://www.dem.ri.gov/programs/air/documents/air-mobile95-report.pdf. RIACP is also engaged in ongoing close partnerships with the City of Providence on the city's Climate Justice Plan, which includes prioritizing community health, environmental justice, and resilience in environmental justice communities that are disproportionately impacted by asthma and air pollution. RIACP is updating the 2014 Asthma Claims Databook to provide the City of Providence and its community partners with asthma data and maps to support the development of the city's climate justice policy plan.  The new Asthma Claims Databook is planned for release in 2022.

 

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

 

Nutrition Training for Dental Hygienists: The Oral Health Program recognized that there was a need for further education around the connection of nutrition and oral health for young children. Dental hygienists are often the trusted sources in the dental office and they also see the patient (and their families) for a longer period than the dentist during a visit. The Oral Health Program partnered with two nutrition experts from the University of Rhode Island and SNAP-Ed to develop an in-person training for dental hygienists. It included background on nutrition, the oral health connection, an introduction to motivational interviewing, and multiple breakout sessions to practice. The first in person training was completed in early 2020 with 30 dental hygienists (they received CE credits). Due to COVID-19 the Oral Health Program Is currently developing an online training.

 

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

 

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

 

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

 

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

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

 

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

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

Awarded Agencies

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

 

Preserve and Grow Agriculture and Fisheries Industries

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

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

 

Sustain and Create Markets for Rhode Island Food and Beverage Products

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

 

Supply RI and anchor institution engagement: Agencies involved in IFNPAC have continued to work to advance its goals around institutional procurement of Rhode Island food products.  IFNPAC worked on a pilot project during the summer with Sodexo, with a goal that 10% of the produce procurement in three Lifespan facilities would be from local vendors. Sodexo officially launched the program in early June 2019 and purchased their produce and Rhode Island-made products from Farm Fresh RI’s Market Mobile Program.  Hospitals are also hosting on-site farmers markets twice a month, are labeling any Rhode-Island-grown ingredients that are available in the dining facility, and are creating locally-focused “action station” meals each week.  Early numbers show that the hospitals are exceeding their goals and more than $40,000 was spent during the summer in support of local farms.

 

Partnership with the Good Food Foundation: Relish Rhody was a host of the 2019 Good Food Mercantile in Brooklyn. As part of its sponsorship Rhode Island food businesses received discounted rates to showcase their products at the show. Participating businesses included Granny Squib, Beth Bakes, Dave’s Coffee, and Sanobe Superfoods. There was also a Relish Rhody table that featured food products from across the State.  In June 2019, the Director of Food Strategy led a group of the Good Food Foundation Merchants’ Collaborative on a tour of food producers in the state. Independent markets from across the country (Washington, DC, Colorado, and California) and representatives from the Good Food Foundation met with Rhode Island makers, tasted their products, shared advice, and developed relationships. The Collaborative spent two days in Rhode Island. Rhode Island also had a 2019 Winner of a Good Food Award: Sacred Cow Granola. Sacred Cow is a product of Munroe Dairy and a graduate of Hope & Main. They are also a participant in the Supply RI program and are currently building out a new kitchen facility in East Providence to expand their operations. 

 

Wholesale readiness training for local agricultural and food processing businesses: The Food Policy Council worked closely with DEM and local organizations that serve farmers and small food processors on the development of a wholesale readiness workshop that provided technical assistance for businesses interested in selling to institutional or other wholesale buyers.  The first workshop attracted about 40 attendees and content was well received.  A second workshop took place on February 25 and there were more than 40 attendees.

 

Increasing local food purchases by Rhode Island public schools: The Food Policy Council worked closely with the Director of Food Strategy, DEM, RIDE, and other partners to identify ways to increase purchases of local food by public schools.  This year, a workplan that detailed ways to improve RIDE’s ability to accurately track local food purchases and identified ways to increase interest in purchasing local food at the district level was developed. The work plan is expected to be implemented in 2020. 

 

Enhance the Climate for Food and Beverage Businesses

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

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

 

Minimize Food Waste and Divert it from the Waste Stream

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

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

 

Ensure Food Security for All Rhode Islanders

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

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

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

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

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

 

COVID-19 Food Access Working Group

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

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

 

State of Rhode Island Food Access Workstream

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

 

Ensure State Leadership of Food Strategy

The State Director of Food Strategy position was filled in the first quarter of 2021. The Director will play a lead role in planning IFNPAC and work group meetings.  In addition, the Director is responsible for advocating for a Food Access Manager Position with the RI state government, as well as for federal funding to reconvene the RIDOH Physical Activity and Nutrition program staff, implement strategies and make community investments. All other activities such as the Supplemental Nutrition Assistance Program (SNAP) Incentive Expansion Working Group, and efforts to influence transportation to help residents more easily connect to food resources were suspended to focus on the COVID-19 response.