Child Health, Annual Report FY 22

 

Priority: Improve nutrition, physical activity, and overall wellness of children 

 

Measures: 

To address the priority of improving overall child health, efforts must address a broad range of issues impacting children. Pediatric primary care visits represent a key opportunity for monitoring and addressing the comprehensive needs of children’s health. The selected NPM relates to the critical role of developmental screening in monitoring and supporting child development. The SOM was established to measure the efforts to address child lead exposure in Ohio, which also relates to the Cross-Cutting domain and is aligned with the measure in the State Health Improvement Plan. Home visiting services also play an important role in monitoring and supporting child development. The ESM will measure the impact of efforts to improve rates of developmental screening for the child population served by Home Visiting. 

 

•       NOM 14: Percent of children (1-17) with tooth decay or cavities within the past year 

•      According to the National Survey of Children’s Health via the Federally Available Data (FAD), 10.7% of Ohio children from 2020-2021 had decayed teeth or cavities in the past year. This has remained stable since 2016. 

•       NOM 19: Percent of children (0-17) in excellent or very good health 

•      According to the National Survey of Children’s Health via the Federally Available Data (FAD), 92.4% of Ohio children were excellent or very good health during 2020-2021. This has remained stable since 2016. 

•       NOM 20: Percent of children (2-4) and adolescents (10-17) are obese 

•      According to the WIC Participant and Program Characteristics file via the FAD, 12.5% of children ages 2-4 were obese in 2020. This has not changed substantially since 2008. 
•      According to the National Survey of Children’s Health via the FAD, 15.8% of adolescents aged 10-17 were obese during 2020-2021. This has remained relatively stable since 2016. 

•       NOM 25: Percent of children (0-17) who were not able to obtain needed health care in the last year 

•      According to the National Survey of Children’s Health via the FAD, 2.8% of children were not able to obtain needed healthcare during 2020-2021. This is a small decrease from 2019-2020 (4.1%). 

•       SOM: Percent of children, ages 0-5, with elevated blood lead levels (BLL ≥5 ug/dl) (confirmed only) 

•      According to Ohio’s data on lead screening in children, 2.0% of children who were tested for lead in 2021 had confirmed elevated blood lead levels (≥5 ug/dL). This remained stable from 2020 (2.0%) after a steady decline from 2017.
  • ODH is updating its guidance to align with CDC’s new blood lead level of ≥3.5 ug/dL beginning July 1, 2023, so data in future reports will reflect that change.

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

•      According to the National Survey of Children’s Health via the FAD, 37.0% of children ages 9-35 months received a parent-completed developmental screening in 2020-2021. This is a continued year-over-year increase from 2017-2018 when 28.5% of children ages 9-35 months received a parent-completed developmental screening. 

•       ESM: Percent of children, ages 1 through 66 months, receiving home visiting services who have received a developmental screening 

•      Developmental screenings are required to be completed during the identified intervals within the Ohio Home Visiting Program. Screening data is recorded for each child enrolled within the data system and referral and follow-up are monitored by the home visitors. In FY 22, 64.2% of children ages 1-66 months had a developmental screening. In FY 21, 65.1% of enrolled children received a developmental screen. Children are included in the denominator if the family had at least 1 home visit during the period (making them “enrolled”) and if they were 30 days or older during the period (making them “due” for a screen). Children meeting those criteria were also included in the numerator if they had 1 or more developmental screens during the period (ASQ3 or ASQE2).  

 

Objective 1: By 2025, coordinate across programs to implement a plan to increase rates of primary care providers conducting quality comprehensive well child visits that include developmental and other screenings.  

Strategies: 

1. Increasing provider education/training for comprehensive well visits (Bright Futures screenings and referrals to include developmental screenings, lead, hearing vision, oral health, immunizations, BMI, social determinants of health, and ACEs). 

2. Partnership between programs that can mutually promote comprehensive well visit (e.g., state immunization). 

3. Explore opportunities to support/implement evidence-based models for pediatric primary care. 

4. Increase the awareness of the need for developmental screenings and other screenings amongst parents and caregivers. 

5. Educate primary care providers on billings for provision of services (expand QI initiative for vision screening billing and use results to inform efforts on other billing codes). 

 

To increase education and training on comprehensive well visits, in FY 22, Title V contracted with the Ohio Chapter of the American Academy of Pediatrics (Ohio AAP) to create and implement trainings and resources for medical and allied professionals around key topics appropriate for children and their caregivers. The Preventive Health Program (PHP) trainings were delivered in FY 22. Trainings focused on developmental screening; breastfeeding; promoting  immunizations, including COVID vaccines to teens and families; trauma-informed care and ACEs; adolescent behavioral health (suicide prevention, anxiety, and depression); child and adolescent well care and bright futures; adolescent vaping prevention; healthy night routines for infants including oral health; early literacy; safe sleep; how to connect with families about child health topics through technology; and top five screening tools used in pediatric practice. The Ohio AAP trainings will help to lay the groundwork for Quality Improvement projects during FY 23.  

 

Ohio Title V coordinates with the Bureau of Infectious Diseases (BID) to promote immunizations.  The Title V director meets with the Vaccines for Children (VFC) Program Administrator at least quarterly, and the school nursing administrator meets with BID more frequently.  The Ohio Title V Program collaborated with BID on a media campaign that concluded in FY 22.  

 

The ODH School Nursing program provides school nurses, schools personnel and school communities with resources to support the health and academic achievement of students. The program provides technical assistance, creates resources, manages the School Nurse Bulletin Board communication system, collects data regarding school health needs and services, and provides extensive professional development for licensed nurses working in the school setting. American Rescue Plan Workforce Development funding was used to create five Regional School Nurse Consultant and one State School Nurse Consultant position. The regional consultants provide additional support and knowledge of local resources to nurses working in the school setting. 

 

The professional development offered by the School Nursing program includes a library of more than 40 online independent study courses housed in OhioTRAIN. The program typically hosts three live Regional School Nurse Conferences, one summer conference, and one three-day New School Nurse Orientation each year. With the onset of COVID-19, the program has pivoted to offer these as live, virtual events. Continuing Nursing Education contact hours are offered for many of the courses. The program also develops and disseminates resources, such as handouts and resources for school nurses to use to teach school staff how to administer medications to students. These resources are heavily used by school nurses, with more than 750 nurses attending the live conferences and more than 1,000 participating in the online independent study courses annually. In 2023 the program will offer a combination of live, in person conferences and virtual conferences. Revisions are being made to all online independent study courses to keep their content current and provide updated continuing education credits to the nurses. 

 

In addition, training and resources related to ACEs, risk and resiliency, and other mental health topics addressing children over the age of 10 are included in the adolescent section of the report. School nurse trainings and other school-based trainings and programs cover both the child and adolescent population, as school staff can work with preschool-aged children up to twelfth grade. There is ongoing collaboration between child and adolescent workgroups to coordinate strategies included in each action plan, including co-leading of the two workgroups by three MCH staff (Adolescent Health Coordinator, Early Childhood Health staff, and Parent Consultant).  The groups each meet bi-monthly, as there are many MCH staff who sit on both workgroups.  The workgroups meet as a large group to share updates and discuss coordination twice a year. 

 

The Parenting at Mealtime and Playtime (PMP) program provides primary care office staff with strategies to enhance counseling during well-child visits for children.  The goal of PMP is to promote a shift toward earlier intervention in children at risk and a shift from unhealthy to healthy habits through physician discussions with families. PMP has shifted from a quality improvement (QI) project to an education-based model. In addition to the resources already created, PMP will be offering new handouts expanding beyond the age of 10. This will provide education to caregivers and youth of those in the 11- 14 year and 15-18 year age groups. There will also be trainings available to educate on topics related to these age groups. The toolkit that was created in SFY 20 will be updated and promoted throughout this year. In 2022, there were over 100 registrants with 25 new primary care providers such as physicians and nurse practitioners added through September 30, 2022.  This new educational model has allowed for dissemination of the PMP resources and new educational topics for primary care providers and staff. In addition to the toolkit, educational trainings are offered for MOC credits.  The topics are determined by the PMP Advisory Group and feedback from surveys distributed to past participants. In 2022, some topics included Body Image and Motivational Intervening, Female Health Triad, and a focus on eating disorders in collaboration with the Emily Project. In addition to the live and recorded trainings, OAAP updates and creates handouts about relevant topics for families and children such as healthy snacks, monitoring screentime, and outdoor play.  OAAP also developed and shared TikToks geared towards families and children in connection with the handouts and relevant topics. In FY 23, OAAP will be using other social media platforms to reach adolescents and their families. Also, ODH offers recorded webinars on PMP topics for community health workers, home visitors, allied medical professionals, and any professional that might work with families in the community that are currently being updated to allow for Social Work and Nursing professional development hours.   

 

ODH funded and provided guidance for the practices that were selected, although Title V funding was not utilized for this project. Funds were leveraged from CDC’s Preventive Health and Health Services Block Grant and state funding to implement the 4th wave of the Safe Environment for Every Kid (SEEK)+Injury QI screening tool project. SEEK is an evidence-based, practical model for improving primary healthcare for children and their families. SEEK helps primary healthcare professionals (PCPs) address common psychosocial problems, such as parental depression and substance use, etc.  This project combines the SEEK tool with select injury related questions. This project is also listed in ODH’s CDC Core State Injury Prevention Program grant as a main activity, although no funding came from this grant. VIPS partnered with Ohio Chapter, American Academy of Pediatrics (AAP) for this project. Participating practices incorporated the SEEK+Injury screening age-appropriate screening tools at well-child visits for children birth to 5 years of age to identify unsafe or risky behaviors and discuss or provide resources/referrals for all identified needs. Wave #4 began June 30, 2022, and will end February 28, 2023. Recruitment for this project was done with priority given to rural counties which were not connected to a pediatric hospital system.  

 

Wave #4 resulted in 20 new providers across 9 counties. Due to project dates, data metrics for this reporting period only cover two months of screening implementation. This wave is anticipated to end 2/28/2023. For the first two months, the providers screened 95 families and provided resources to 83. The resources address social determinants of health and injury topics scored as high risk on the assessment tool. All participating practices were provided training to begin the project and completed PDSA cycles, Practice Coaching Calls, and Action Period Calls. Families had the choice to complete the screening virtually, on a tablet in the office, or paper. Over 140 lock boxes have been provided to the pediatric providers to distribute. 

 

In FY 20, Ohio Title V joined a state team supporting the Early Childhood State Systems Through the Act Early Network. The proposal for the grant was led by the current Act Early Ambassador to Ohio who works at Cincinnati Children’s Hospital Medical Center’s Leadership Education in Neurodevelopmental and Related Disabilities (LEND) Program and the University of Cincinnati Center for Excellence in Developmental Disabilities (UCCEDD). The grant project goals were to increase awareness about the importance of developmental screening in early childhood and tracking of developmental milestones with the support of the evidence-informed “Learn the Signs. Act Early.” materials developed by the CDC. Title V staff joined others on the state team including the Part C/Early Intervention, WIC, Ohio AAP, Ohio F2F, and Head Start/Early Start. UCCEDD was successfully awarded the funds in September 2020, and funds were awarded for a second year in September 2021. In FY 21, success from year one was continued and expanded to reach an even greater number of families, professionals, and communities throughout Ohio. By the end of the project period, over 8,200 children’s books and app flyers in English were shared across 66 of 88 Ohio counties. In Spanish, 2,000 children’s books and over 1,500 app flyers were distributed across 14 Ohio counties. Additionally, over 5,500 Milestone Moments booklets were shared in both languages. The physician toolkit strategy, outreach to Hispanic/Latinx community organizations, and the Act Early ECHO educational sessions were the primary methods of reaching various audiences across the state Dr. Weber and her team also presented on family-engaged developmental monitoring and the “Learn the Signs. Act Early.” (LTSAE) program to Ohio AAP. The social media influencers, recruited and trained by the Act Early team have reached thousands of Ohio caregivers through Facebook, Instagram, and YouTube, using creative ways of showing milestones in real-time with their children. Act Early ECHO has been an effective cross-state collaboration with Massachusetts, Wyoming, and Virginia, reaching early childhood professionals and caregivers with topics on building resiliency and cultural responsiveness. The outreach to the Hispanic and Latinx communities has resulted in a variety of outreach including through the state-level Commission on Hispanic and Latino Affairs social media and statewide newsletters.  

  

Act Early Ohio engaged with several other communities. The team connected with more than half of the library systems across Ohio to circulate three children’s books as well as display LTSAE brochures. Dr. Weber has also connected with hospital-based Child Find Specialists to build in LTSAE materials especially in the process of follow up with families not yet enrolled in Part C. She provided ongoing consultation and collaboration through the Cincinnati Children’s Hospital Medical Center Physician Liaison program as well as their counterparts at Nationwide Children’s Hospital, which connects community providers to updated information and resources. Dr. Weber has presented numerous times on the Act Early work to audiences such as Part C home visiting, Ohio Commission on Fatherhood, Ohio Hispanic/Latin Affairs Commission, and interdisciplinary medical and allied healthcare teams.  

 

The Ohio Department of Health (ODH) Children’s Hearing and Vision Program sets the screening requirements and guidelines for school-based preschool and K-12 schools. These requirements include grades that are routinely screened each year; equipment that is acceptable to use; specific hearing and vision tests that are needed to perform the screenings; and the referral criteria. Schools providing medical services are required to screen school-aged students for vision screenings. Regular school hearing and vision screenings are essential to identifying children at risk for hearing or vision loss. In addition to establishing school screening requirements, the program conducts annual reporting of hearing and vision screening data to determine compliance with screening requirements, plan statewide vision and hearing screening training, establish and revise Ohio hearing and vision screening guidelines, and provide resources for Ohio’s schools.   

According to the preliminary data from the 2021-2022 Annual Hearing Screening Report, the highest percentage of students who were screened in a required grade was kindergarten (77%) followed by first grade (77.0%), preschool (69.00%), third grade (76.0%), fifth grade (75%), ninth grade (62%), and eleventh grade (58%). The 2021-2022 Annual Hearing Screening Report also identified the highest percentage of a required grade to complete follow-up after a referral was followed by first grade (18 percent), kindergarten (13 percent) followed by third grade (13 percent), preschool (13 percent), followed by fifth grade (14 percent), then ninth grade (9 percent) and eleventh grade (8 percent). 

 

According to the preliminary data from the 2021-2022 Annual Vision Screening Report, the highest percentage of students who were screened in a required grade was preschool (88%), followed by first grade (81%), kindergarten (80%), third grade (80%), fifth grade (78%), seventh grade (74%), ninth grade (66%), and eleventh grade (58%). The 2020-2021 Annual Vision Screening Report also identified the highest percentage of a required grade to complete follow-up after a referral was third grade (39%), followed by kindergarten (32%), first grade (31%), fifth grade (30%), seventh grade (24%), ninth grade (21%), preschool (19%), and eleventh grade (8%).  

 

Objective 2: By 2025, increase the percent of children, ages 9-35 months, that receive developmental screens via home visiting programs.  

Strategies: 

1. Support MIECHV and other home visiting programs to provide developmental screening using Ages and States Developmental Screening tool. 

2. Implement Medicaid/CHIP reimbursement claim code for developmental screening activities at provider level. 

3. Educate parents about developmental screening tools. 

 

During FY 22 ODH continued to see a slight decrease in the number of children receiving at least one developmental screening through Help Me Grow Home Visiting, 65.1% in FY 21, and 64.2% in FY22. Most families received a combination of virtual and in-person visits during FY22, with an increasing majority of visits being conducted in person. The average length of home visits has not yet reached pre-pandemic levels. 

 

The national evidence-based home visiting models continue to support virtual home visits as a method of delivering quality home visits, and promote the use of a hybrid approach, acknowledging that this flexibility allows families to stay engaged that otherwise might not. While in FY 20 and FY 21 home visitors and families adjusted to virtual visits and generally felt they were able to stay connected, virtual visits presented unique challenges for home visitors when attempting to conduct screenings, assessments, and observations. ODH expected the decrease in completion of developmental screenings and other screenings and assessments to persist during the pandemic due to the challenges facing both home visiting providers and participating families. This hybrid approach seems to present similar challenges to completing assessments, screenings, and observations. 

 

During FY 22 ODH continued to share guidance and resources on virtual home visits from the national evidence-based home visiting models; provided resources to help families with emergency needs due to COVID; and, worked with other state partners to update safety guidelines for conducting in-person visits.  

 

Through continued enhancements to the Ohio Comprehensive Home Visiting Integrated Data System, and the rollout of now 95 unique home visiting data reports in DataOhio, including completion rates of screenings and assessments, home visiting providers can now use data to inform daily practice and focus efforts on quality improvement. 

 

Other Title V Supported Programs 

Early Childhood Health (ECH) Health and Safety Professional Development 

The Early Childhood Health (ECH) program offered 19 recorded Health and Safety trainings that were approved for professional development credit for Early Childhood Professionals.  In FY 22, there were six new trainings developed on the following topics: Diabetes in the Early Care Setting; Seizure First Aid and Epilepsy in Early Care Settings; Preschool Special Education Referral; Making Referrals in Early Childhood Settings; Learn Through Play with PALS (Physical Activity Learning Session) with Focus on Infants and Toddlers; and an updated series on vision development focusing on Infants and Toddlers, Preschoolers, and School-age that incorporates the new CDC milestone updates and connections to physical activity and healthy nutrition. Each recorded webinar was produced in partnership with other ODH programs, community entities, and state partners such as Ohio Department of Education, Akron Children’s, Nemours’s PALS curriculum, and Epilepsy Alliance Ohio. In addition to the online option, a session on Learn Through Play with PALS (Physical Activity Learning Session) with Focus on Infants and Toddlers was presented at the Ohio Association of Young Children (OAEYC) annual conference to over 100 ECE professionals virtually.  In 2022, over 30,000 pro professionals completed the course for Ohio Approved credit.  Each year, the ECH program invites early childhood professionals from around the state to a virtual discussion group to share current trainings and gather information on training needs for the next year.  After the community discussion, the ECH program invites other state agencies to discuss current trainings, and results of the community session, and brainstorm about future trainings.  This collaboration has encouraged partnerships between agencies to reduce redundancy and expand the offerings to early childhood professionals in the state. 

 

Early Childhood Obesity Prevention Program (ECOPP) 

The Early Childhood Obesity Prevention Program (ECOPP) is a coordinated and comprehensive approach involving families, early childhood education professionals, health professionals, and community organizations working together with consistent messaging and strategies to ensure a sound foundation for health in the future. ECOPP is a program within the Early Childhood Health Program. The Early Childhood Obesity Prevention Program (ECOPP) encompasses the Ohio Healthy Programs and the Parenting at Mealtime and Playtime program.  

 

Ohio Healthy Program (OHP) 

Ohio Healthy Programs (OHP) is a designation for Early Childhood Education (ECE) programs that aims to increase the adoption of healthy eating, activity, and screen time behaviors among children aged 0-5 years. OHP is based on a curriculum called Healthy Children, Healthy Weights, which has received various recognitions including the National Association of County and City Health Officials (NACCHO) Model Practice Award. To apply, ECE programs must (1) have staff complete trainings on healthy eating and physical activity topics, (2) complete the OH PANA (see below for more information), (3) submit new sample menus and policy statements, and (4) documentation of parent engagement activities. The designation lasts for two years, at which time programs must go through a re-designation process. Technical assistance providers from local public health departments and community organizations help ECE professionals implement practice changes and complete the application. ODH coordinates and funds this work in collaboration with key organizations across the state, including Ohio Child Care Resource and Referral Association (OCCRRA), Columbus Public Health (CPH), and Children’s Hunger Alliance (CHA).  In 2022, there are over 270 OHP designated programs across the state and over 6,000 professionals in all 88 counties who completed the OHP curriculum that is required for OHP designation. 

For the Ohio Healthy Programs (OHP) Technical Assistance for Child Care Centers and Public Preschools grant, the population of focus was children and families of different racial, ethnic, and geographical areas that are disproportionately affected by poor health outcomes, highest need, that seek childcare services at an ODJFS center or ODE public preschool. The state was divided into 12 regions with funding for four regions available for the new sub-grants. 

  

ECH worked with external evaluators to create a self-assessment tool for early care and education (ECE) and school-age childcare programs.  This Ohio-specific assessment measures nutrition, physical activity, and related environments, practices, and policies in these settings.  It provides the programs with the opportunity to identify changes they want to make in these areas in the next year.  It is designed to be completed by family childcare professionals and administrators of ECE centers and school-age childcare programs (such as before/after school programs) across the state. Any ECE or other childcare professional in the state may choose to complete the assessment, however, it is a requirement as part of the OHP application.  This also allows ODH to collect data on the practices of ECE programs to identify future activity needs. A study conducted from 6/1/2020-6/30/2021 where 257 ECE programs included in the total sample, about half of which (132) were ready to submit their initial application, and half (125) were already OHP designated. Most ECE programs met two-thirds of nutrition and physical activity practices, while less than half met all the practices measured. Programs that were ready to submit their initial application for OHP (post-intervention) were less likely to meet all nutrition and physical activity best practices than OHP-designated programs (follow-up); they were also less likely to meet at least two-thirds of physical activity best practices and less likely to have policies that address child nutrition, physical activity, or screen time. 

  

Farm to Early Care and Education  

Farm to early care and education (farm to ECE) offers increased access to the three core elements of local food sourcing, school gardens, and food and agriculture education to enhance the quality of the educational experience in all types of ECE settings (e.g., preschools, childcare centers, family childcare homes, Head Start/Early Head Start, programs in K – 12 school districts). Farm to ECE offers benefits that parallel the goals and priorities of the early care and education community including an emphasis on experiential learning opportunities, parent and community engagement, and life-long health and wellness for children, families, and caregivers. 

 

Ohio has been accepted to participate in the 2022-23 ASPHN (Year 3) Farm to ECE Implementation Grant (FIG). The Year 3 FIG will fund and provide TA to advance farm to ECE initiatives at the state level.  In addition to funding, FIG teams will receive technical assistance to achieve the farm to ECE state-level policy, systems, and environmental changes described in each state’s FIG application update.  Year 3 FIG project period is November 1, 2022, through June 30, 2023.  

 

The Ohio Farm to Early Care and Education Coalition looks forward to building further capacity to increase the quality of ECE settings and access to healthy environments for all young children through the ASPHN 2022-23 Year 3 Farm to ECE Implementation Grant (FIG). Ohio’s Farm to ECE team will continue to implement a key system change by expanding and strengthening our state-level coalition to include diverse representation from affected communities and sustaining equitable coalition recruitment and governance.   

 

Our coalition focuses on our scalable strategies and intended impacts on children, families, and caregivers who lack access to healthy food in care settings and at home, farmers, and food distributors. Through work sponsored in Years 1 and 2 of FIG, we identified diverse, cross-sector coalition partners who would bring new perspectives, resources, and skills, triple the number of members, and expanded the range of voices. 

 

The expanded coalition of diverse early childhood educators, young families, farmers, distributors, educators, and others affected by food procurement at ECE sites accomplished most of our work through three subgroups: Coalition Expansion/Development, Policy Education, and Procurement Innovation. The Coalition Development group will continue to monitor and guide practices for sustaining the coalition. They will explore funding opportunities, as appropriate. 

In Year 3 we will continue to build Farm to ECE capacity at the regional level by working with regional Farm to ECE teams to gather data from both producers and ECE providers. 

 

In Years 1 and 2, the Policy Education and Guidance subgroup took on the ambitious task of developing information sheets and videos to demonstrate how foods grown in school gardens or purchased from local farmers or markets can indeed be used for educational activities and served to children in meals and snacks. This involved conducting listening sessions with stakeholder groups, reviewing existing resources, creating video scripts, identifying sites and experts for video recording, hiring a videographer, filming the videos, drafting, and designing aligned information sheets, and working on an equitable dissemination plan for these resources. These resources have been created and are in the state approval process for dissemination. 

  

Based on the needs assessments conducted in 2019, the FIG coalition began developing tools for scaling up the provision of local procurement and garden education (LP/GE) technical assistance (TA).  

 

After extensive discussions about addressing equity, input from Head Start providers, review of site applications and adjustments for seasonal programming, we piloted local procurement TA in 2 Head Start sites. This allowed us to establish initial TA approaches and to develop needed partnerships with local food hubs and other distributors. 

Using lessons learned, we applied for and were awarded internal OSU funding (~$35K) to pilot the proposed procedures at 4 additional Head Starts (beginning in Jan. 2022) through the Technical Assistance and Gardens or “TAG” project. As part of the TAG project, we implemented a Farm to ECE school garden and physical activity curriculum at these sites.  

 

In Year 2, we engaged 9 additional home and center based (mainly non-Head Start) sites to identify needs specific to other types of ECE providers. We enlisted 12 regional Farm to ECE coordinators to make contacts with and collect data from local producers and ECE providers. This work will continue through year 3. 

Resource development for FIG has been finalized this year, and the ODH ECOPP will use those resources to develop a Farm-to ECE training for the Ohio Healthy Programs and other ECE professionals. 

 

Lead Prevention Program 

Ohio has made significant strides toward the elimination of childhood lead exposure, but the work is not done. There is no safe level of lead in the body. The primary source of lead exposure in children with elevated lead levels is deteriorated lead-based paint (dust). Other potential lead exposure sources include soil, water, and consumer products. ODH has administered a comprehensive statewide lead poisoning prevention program since 1991. The Ohio Lead Advisory Council (OLAC) provides the Director of Health with advice regarding the policies the childhood lead poisoning prevention program should emphasize, preferred methods of financing the program, and any other matter relevant to the program’s operation. ODH’s lead program provides guidelines on lead testing and medical management, educates healthcare providers, conducts surveillance and case management, conducts public health lead investigations (either directly or through local delegated boards of health), licenses the professional workforce, approves lead laboratories, and provides compliance assistance and monitoring. In addition to Title V funds, the ODH receives funding for lead poisoning prevention from the U.S. Centers for Disease Control and Prevention, U.S. Department of Housing and Urban Development, U.S. Environmental Protection Agency, Ohio Development Services Agency, Ohio Housing Finance Agency, and General Revenue Funds. 

  

When a child under six years of age is identified with an elevated blood lead level (lead poisoning), ODH or its delegated authority conducts a public health lead investigation to determine the probable source of lead exposure. If an investigation identifies an existing lead hazard, a Lead Hazard Control Order is issued ordering the property owner to control the lead hazard. If a property owner refuses to control an identified lead hazard, an order to vacate the property is issued, declaring it unsafe for human occupation, especially for children younger than 6 years of age and pregnant women. The ODH Director of Health can delegate the authority to conduct public health lead investigations to local health jurisdictions in accordance with Ohio Revised Code 3472.34. 

  

In the reporting period of 10/1/2021 to 9/30/2022, 151,033 Ohio children under age 6 received a blood lead screening test. The Census estimates Ohio’s population of children under age six is 826,951 (2021 ACS 5-Year Estimates, United States Census Bureau), which equates to 18.26% of children under age six tested for lead exposure in this time frame. Source: Ohio Healthy Homes and Lead Poisoning Surveillance System  

 

Ohio’s definition of an elevated blood lead level was updated in November 2014 from 10 micrograms per deciliter (μg/dL) to 5 μg/dL based on new guidance from the Centers for Disease Control and Prevention Advisory Council on Lead Poisoning Prevention. All blood lead levels at or above this threshold are now considered to be elevated blood lead levels. In 2021, there were 840 Ohio children with confirmed blood lead levels of 10 μg/dL or greater (0.56% of the total tested population) and 2,955 children with confirmed blood lead levels of 5 μg/dL or greater (1.97% of the total tested population).  

Source: Ohio Healthy Homes and Lead Poisoning Surveillance System  

  

Ohio law requires primary care providers to order a blood lead screening test for any child under six years old who is determined to be at risk of lead exposure based on their zip code. High-risk zip codes were determined through modeling of lead testing, housing, and socioeconomic data. The law also requires that a blood lead screening test be performed on all Medicaid-enrolled children at ages 1 and 2, and up to age 6 if a child is found not to have received a previous test. 

  

The Ohio Healthy Homes and Lead Poisoning Prevention Program is working with the Ohio Chapter of the American Academy of Pediatrics to improve blood lead testing rates. The responsibility of testing children for lead is on primary care providers, but it is well understood that about 40% or more of children that should be tested for lead never receive a lead test. This project will focus on developing a training plan and new training materials. The training will incorporate quality improvement initiatives so that blood lead testing rates improve in the practices touched by this training. 

  

Children with confirmed elevated blood lead levels are now automatically eligible for Early Intervention services from DODD. Early Intervention, known as EI, provides coordinated services to parents of eligible children under the age of 3 with developmental delays or disabilities. A child's team works with the family in their home or other places they spend time to develop a coordinated plan called an Individualized Family Service Plan. The team will work through the plan building upon existing supports and resources while discovering ways to enhance the child’s learning and development. 

  

Healthy Homes Awareness Month (HHAM) activities were conducted across the state in April 2022. The purpose of HHAM is to provide local health jurisdictions the opportunity to educate and raise awareness in their communities about the benefits of having a lead safe home. During HHAM 2022, ODH awarded 8 local health jurisdictions and 1 nonprofit organization up to $15,000 each to increase public awareness about lead poisoning prevention. The majority of HHAM activities focused on public outreach through billboards, banners, radio, television, digital advertising, social media, and local public transportation advertising to disseminate educational messages about lead poisoning prevention. Local health jurisdictions also pursued virtual outreach, which included hosting virtual trainings and community meetings and providing digital materials to daycare centers and WIC clinics. Some local health jurisdictions visited physicians’ offices and provided staff with materials focused on increasing awareness and knowledge about childhood lead poisoning and increasing blood lead testing of at-risk children. 

  

Title V Maternal Child Health Block Grant (MCH BG) funds are vital to the Ohio Healthy Homes and Lead Poisoning Prevention Program. Over 1.6 million dollars of MCH BG funds are used to leverage a 12-million-dollar lead poisoning prevention program. Most of these funds are utilized to pay the salaries of the lead staff who perform the state mandated surveillance activities, implement lead hazard control home repair programs, and provide hundreds of public health lead investigations for affected families each year. 

  

The lead measure within the MCH BG is the percent of children, ages 0-5, with elevated blood lead levels (BLL ≥5 ug/dl) (confirmed only). Baseline 2.8% 2017, Short term outcome 1.5% (2022), Intermediate outcome 1.0% (2025), Long-term outcome .7% (2028). 

  

Childhood lead levels are most often tracked using the percent of children tested for lead, less than six years of age, who had a confirmed elevated blood lead level of 5 micrograms of lead per deciliter of blood (µg/dL). This figure is usually calculated, published, and tracked by calendar year, but can be calculated for other time ranges where needed. So that the measure shows the number of children tested and with elevated blood lead levels, when a child is tested more than once in the calendar year, only one test for that child is counted. The chosen test to represent their blood lead level in that year is their highest confirmed test, if they had a confirmed test in that year, or their highest overall test, otherwise. We call this their “best test.” A confirmed test is one that uses a venous sample (blood was drawn from the vein) and where the sample was not analyzed on a point-of-care device. 

 

Oral Health Program 

A continuing education module for early childhood educators, nurses, and nutritionists titled, Help Me Smile – Ensuring the Oral Health of Young Children, was developed on oral health of young children and oral health and pregnancy. This training focuses on supporting the oral health of young children. Participants learn about good oral health practices for young children, how to manage oral injury first aid and dental emergencies, how to identify and respond to signs and symptoms of possible child abuse in the mouth and dental neglect and be provided with the tools and resources to engage families in oral disease prevention. In addition, participants learn and understand how a pregnant mom’s oral health changes during pregnancy. 

 

The training was made available on August 24, 2022. During FY22, the course was completed by 152 participants. The training is approved for 1.5 Ohio Approved hours by the Ohio Child Care Resource and Referral Association, 1.6 Continuing Nursing Education contact hours, and is pending approval for registered dietitian continuing education units.  

 

In addition to reaching the ECE community, Oral Health also provides the School-based Dental Sealant Program with a target audience in 2nd, 3rd, 6th, and 7th grades. This is an opportunity to create a partnership and bridge between child and adolescent. 

 

Tobacco Use Prevention and Cessation Program (TUPCP) 

The Tobacco Use Prevention and Cessation Program (TUPCP) is engaged in several activities that impact the burden of tobacco on children under 10 years of age.  Globally, the TUPCP works to prevent initiation of tobacco use, to increase quitting, to prevent exposure to secondhand smoke and to eliminate health inequities that result in disparate burden of tobacco on specific Ohio subpopulations.  At the state level, we work to enforce state level policies such as the Smoke Free Workplace Law as well as to promote voluntary adoption of smoke-free and tobacco-free comprehensive policies.  Evidence shows us that successful policy work not only protects children from SHS where they live, learn, and play but it increases the quitting of adults in children’s lives and decreases initiation of smoking by youth.  The TUPCP collaborates with (BCFH) Asthma Program, and this past year funded a campaign focused on reducing home exposure to secondhand smoke for children with asthma. TUPCP also aids and supports the BCFH Baby and Me Tobacco Free program that incentivizes pregnant mothers to quit smoking and stay quit after their baby is delivered.  The Ohio Tobacco Quit Line also offers a special protocol for pregnant women to quit and stay tobacco free following delivery which includes incentives to increase and maintain participant engagement.  Additionally, TUPCP is collaborating with Partners for Kids (PFK) which is the oldest and largest pediatric accountable care organization in the United States responsible for the care of more than 400,000 children covered by Medicaid Managed Care across 47 counties in Ohio. The program has collaborated with the BCFH Asthma Program at ODH to offer a presentation to their family practice QI projects in October 2021 and is continuing to work with PFK to reach additional providers and coordinate strategies to further engage providers in reaching families and youth about tobacco cessation options for parents and youth. 

 

Many of the programs presented in the Perinatal/Infant Application section also serve children and adolescents.