Child Health
Annual Report (FY 2019-20)
CHILD Priority Need: Improve the cognitive, physical and emotional development of all children (from 2015-20 plan)
Early identification of developmental, behavioral, and social delays in young children can increase the numbers of children receiving timely early intervention services, so they may develop to their fullest potential.
Child Objective 1:
The American Academy of Pediatrics recommends that all children should be screened for developmental delays during their regular well-check visits at 9, 18, and 24 or 30 months. This measure uses age-appropriate questions to verify whether young children received standardized developmental, behavioral and social screening using a parent-reported, standardized screening tool. Three years (2016-2018) of data from the National Survey of Children’s Health (NSCH) were aggregated to obtain a more robust estimate for this indicator as the more recent two-year (2018-2019) aggregated data showed that the California estimate may not be reliable due to small sample size. According to NSCH 2016-2018, 24.9% (95% CI: 16.9 – 32.9) of children ages 9 through 35 months received a developmental screening using a parent-completed screening tool.
Child Objective 1: Strategy 1:
Collaborate with relevant partners to strengthen systems to improve rates of behavioral, social, and developmental screening of children ages 9 months through 35 months
California Statewide Screening Collaborative (SSC): CDPH/MCAH, including the Title V Children and Youth with Special Health Care Needs Director, actively participated in the SSC. CDPH/MCAH contributed Title V funding to the collaborative and both Title V and Maternal, Infant, and Early Childhood Home Visiting (MIECHV) funding to MCAH state level staff support for the SSC. The Department of Developmental Services (DDS) also contributed funding to the SSC. SSC participants included representatives from CDPH/MCAH, DDS, Department of Health Care Services (DHCS), First 5 Association of California, First 5 California, California Department of Education (CDE), California Department of Social Services (CDSS), American Academy of Pediatrics-California, DHCS’s Indian Health Program, developmental-behavioral pediatricians, and child-focused non-profit organizations.
The SCC and the Interagency Coordinating Council continued to promote the Provider Developmental Screening Toolkit website (http://www.cascreenbto5.org/), developed by a subcommittee of the SSC. The Toolkit includes developmental and behavioral screening tools, sample workflow, billing and referral information, and national, state, and local resources.
During 2020, work slowed due to the COVID-19 pandemic and the MCAH Division’s Pediatric Medical Officer, who leads MCAH’s collaboration with the SSC, being on extended leave and then retiring. However, planning continued among the SSC leadership team and the MCAH Title V Children and Youth with Special Health Care Needs Director/Acting Title V Director. Additionally, MCAH collaborated with DDS regarding strategies to increase Early Start referral rates and address other emerging needs related to the pandemic.
Women, Infant, and Children (WIC) Division: CDPH/MCAH began work with WIC to include more education and policies on developmental screening. CDPH/MCAH and WIC explored the use of evidence-based models for developmental monitoring, including Learn the Signs, Act Early. Due to impacts on MCAH workforce capacity during the COVID-19 pandemic, primarily the extended leave of the Division Pediatric Medical Officer (who was the Child Health lead), and priorities around the roll-out of e-WIC in California, collaboration activities slowed. The WIC Division remains a critical partner and as a sister Division under the Center for Family Health, both MCAH and WIC benefit from shared leadership, coordination and collaboration.
The California Health Interview Survey (CHIS): CHIS is the nation’s largest state health survey and a critical source of health data on Californians. CDPH/MCAH had representation in the CHIS Children’s Technical Advisory Workgroup and the CDPH CHIS Users’ workgroup to recommend subject matter content for the child questionnaire, which covers developmental screening.
California Home Visiting Program (CHVP): The CDPH/MCAH CHVP provided three evidence-based home visitation models: Healthy Families America (HFA), Nurse Family Partnership (NFP) and most recently, Parents as Teachers (PAT). Each of the models followed a different curriculum, however all include developmental screening as a component of the curriculum. CDPH/MCAH CHVP is not funded by Title V but receives federal MIECHV funding and State General Funds.
CHVP shared leadership of the Home Visiting State Interagency Team (HV-SIT) with the CDSS California Work Opportunity and Responsibility to Kids (CalWORKs) Home Visiting Program. Title V staff participate in the quarterly HV-SIT meetings, which often include partner presentations and discussion relevant to early childhood developmental screening. HV-SIT participants included representatives from the following: First 5 Los Angeles, First 5 California, First 5 Association, Women, Infant & Children (WIC)/CDPH, WIC Association, CA MIECHV Tribal Home Visiting programs, Alameda County Public Health Department, Family Resource Centers Network of California, West Ed Center for Prevention and Early Intervention, California Department of Community Services & Development, CalFresh Healthy Living Program/CDSS, California Department of Developmental Services, CHVP graduates from Alameda and Nevada counties, California Partnership to End Domestic Violence, American Indian Infant Health Initiative (AIIHI)/DHCS, Child Welfare Division, Outcomes & Accountability Bureau/CDSS, Head Start Collaboration Office/CDE, Office of Child Abuse Prevention/DSS; Early Start Project Directors-Family Resource Centers Network of California, Children Now, Family Resource Centers Network of CA, Special Education Divison/CDE, Child Care Programs Bureau/DSS.
In 2019-20, the Nurse-Family Partnership home visiting program served 1,702 index children. Of the 689 eligible children aged 11-25.5 months, 619 (89.8%) completed at least one Ages and Stages Questionnaire-3 (ASQ-3) developmental screen.
In 2019-20, the Healthy Families America home visiting program served 566 index children. Of the 229 eligible children aged 11-25.5 months, 217 (94.8%) completed at least one ASQ-3 developmental screen.
American Indian Maternal Support Services (AIMSS): CDPH/MCAH funds the DHCS Indian Health Program (IHP) through Title V to implement AIMSS in four clinics in California. AIMSS grantees conduct developmental screening and promote health until one year of age through developmentally appropriate play, reading, singing, and positive parenting. Lessons regarding learning to read infant behavioral cues and the need to respond promptly assure the infant receives needed referrals and interventions. AIMSS programs use Ages and Stages questionnaires for infant screening at 9 months of age and provide parental education from the Family Spirit curriculum. Family Spirit is an evidence-based, culturally tailored home visiting program of the Johns Hopkins Center for American Indian Health to promote optimal health and well-being for parents and their children. Family Spirit curriculum encourages the use of Ages and Stages for assessment and provides the parent(s) with education on childhood development, milestones, what to expect and what they should see in both physical and social development of their infant. Their lessons build upon repetition to reinforce ideas and strengthen parent knowledge. Training for Family Spirit is provided in an ongoing way as new employees join the health care team. Ages and Stages training for staff is encouraged as well.
DHCS Medi-Cal Managed Care: CDPH/MCAH supported the DHCS/Medi-Cal Managed Care Quality and Monitoring Division by sharing information about their developmental screening and child health quality initiatives, including implementation of all the CMS Core Child Measures (e.g., developmental screening and well-child visits) as well as 2020 reimbursements to Medi-Cal health care providers for developmental screening and trauma screening. Information about the new DHCS initiatives was shared at Statewide Screening Collaborative meetings as well as with Local MCAH programs, which include MCAH Directors and Coordinators in the 61 local health jurisdictions. Collaboration slowed due to the pandemic, however, CDPH/MCAH will continue to explore opportunities to partner on quality improvement projects and information dissemination.
Evidence-based and evidence-informed practices utilized for this strategy:
Programs (NFP, HFA, PAT and AIMSS) use validated developmental screening tools recommended by AAP’s Bright Futures (e.g., ASQ-3) to assess children in the areas of communication, gross motor skills, fine motor skills, problem solving, and personal-social skills to identify children that would benefit from further evaluation for developmental delays.
CDPH/MCAH programs used evidence-based models of home visiting (NFP, HFA, PAT).
AIMSS used Family Spirit, which is the first and only evidence-based early childhood home-visiting program designed for and by American Indian communities, the first to demonstrate efficacy of paraprofessionals, and is uniquely tailored to address the behavioral health disparities that pose the greatest challenges to Native communities.
Challenges for this strategy:
In 2020, work was slowed due to the COVID-19 pandemic and the MCAH Division’s Pediatric Medical Officer, who leads MCAH’s Title V Child Health work, being on extended leave and then retiring. Challenges within AIMSS in attaining this strategy during this funding period included lack of access to face-to-face trainings and postponement of scheduled trainings due to the COVID-19 public health emergency. Although planned face-to face training could not occur, webinar trainings were scheduled at later dates. In addition, wildfires caused evacuations and clinic staff had to shift duties and help families in need. The COVID-19 public health emergency impacted all AIMSS participants and the Tribal clinics made necessary adjustments to be able to continue services to their population.
During this year, CHVP home visiting also transitioned from in-person home visits to virtual visits due to COVID-19 public health emergency. Many home visitors, particularly health care professionals, were redirected to respond to COVID-19. Additionally, some local agencies were directly and severely impacted by the wildfires. There was an impact in service delivery mostly due to redirection of staff and resources. CHVP agencies implemented a wide range of successful strategies to maintain family engagement and conduct screenings. However, the timely completion of developmental screenings decreased.
Child Objective 1: Strategy 2:
Collaborate with relevant partners to develop goals, objectives, and activities to strengthen systems to improve referrals and linkage to needed services for all children and youth, especially children birth through five years and at-risk populations.
California Home Visiting Program: Local CHVP sites are well connected within their local early childhood systems. CHVP has a System Integration Policy to provide guidance to local CHVP sites on the development and maintenance of a Community Advisory Board (CAB) that promotes a community support system for home visiting programs and the local early childhood system of services. Each local CHVP site convened a CAB that served in a consultative and/or governing capacity in the planning and implementation of program-related and systems-integration activities. This included collaboration with Regional Centers, schools, hospitals or any local agency that provided services to children with behavioral, social, and developmental needs.
During the past two fiscal years (2018-2020), CHVP has focused on improving the referral process at the local agency sites and integrated the topic of screening and referrals into quarterly CHVP Technical Assistance (TA) calls with Local Health Jurisdictions (LHJs) to continue to improve developmental screening rates and referrals. Through these, CHVP learned site-level processes and system challenges that affected developmental screening and referral completion rates. CHVP used the tools developed the previous year - Decision Trees and the Referrals-to-Services Tracking Report - and provided guidance through TA calls and webinars. The tools used are the following:
- Decision Trees: Provide instructions to home visitors for completing the required forms. They help home visitors understand how to report their referral efforts accurately in the data management system.
- Referrals-to-Services Tracking Report: Developed so local teams could use their data to identify opportunities to improve their referral process and follow-up on outstanding referral.
The supervisors reinforced that home visitors use the Decision Trees and used the Referrals-to-Services Tracking Report to monitor positive screens.
California Statewide Screening CollaborativE: SSC work related to referrals and linkage to needed services is summarized below.
During this year, the in-person SSC Spring meeting scheduled for March 20 was changed to a virtual format due to the COVID pandemic. During the rescheduled Spring (virtual) meeting on March 30, representatives from the Department of Health Care Services Behavioral Health Division and the Medi-Cal Benefits Division shared information about their efforts on screening and referral of very young children.
The Statewide Screening Collaborative continues to coordinate with Screening Collaborative stakeholders to support and collaborate with the Interagency Coordinating Council on Early Intervention (ICC)’s Family Workgroup on efforts to educate families about screening and referral of young children.
Dr. Karen Finello (part of the Screening Collaborative Leadership Team from WestEd) participates in meetings and activities of the California Essentials for Childhood Initiative where she is able to share information from the Screening Collaborative and reach out to other leaders in the state working on screening issues. Issues relevant to the SSC are also brought to State ICC meetings where Dr. Finello reports as a community representative on the SSC’s activities.
Medical Investigation of Neurodevelopmental Disorders (MIND) Institute: CDPH/MCAH participated in the UC Davis, University Center for Excellence in Developmental Disabilities (UCEDD), MIND Institute’s Consumer Advisory Committee during fall and early winter of FY 19-20. Participation has been paused since March due to the COVID-19 pandemic, but MCAH remains available as needed to MIND Institute partners.
Evidence-based and evidence-informed practices utilized for this strategy:
See Objective 1: Strategy 1
Challenges for this strategy:
There were reports that children who were noted to be at risk for developmental delays did not always receive a timely initial evaluation through the Regional Centers. Health care providers reported long waits after referral to early intervention and lack of feedback regarding their referral.
Child Objective 1: Strategy 3:
Provide technical assistance to MCAH programs to implement their SOW, promote the use of Birth to 5: Watch Me Thrive! or other appropriate materials, develop protocols to screen and refer, all children in MCAH home visiting or case management programs to early intervention services and develop quality improvement plans to ensure CYSHCN are identified early and connected to needed and ongoing services.
Adolescent Family Life Program (AFLP): Case managers worked with youth and their children to complete child developmental screening by:
- Providing child development and parenting education, including the use of validated early childhood developmental screening tools (e.g. ASQ, ASQ SE), education on positive parenting, linkage to preventive and primary care for the young parent and their child(ren), and linkage to early intervention support services when indicated.
- Providing anticipatory guidance and education regarding child development and well child visits.
- Modeling positive parenting skills and strategies for scaffolding child development, providing related educational materials and resources, and referring youth to parenting classes.
AFLP utilized evidence-based and evidence-informed materials and practices when possible in supporting youth and their children in the program. Some AFLP sites utilized Triple P Positive Parenting Program, the ASQ and the ASQ SE. Some AFLP sites participated in and collaborated with locally organized Birth to 5: Watch Me Thrive! and First 5 efforts.
Black Infant Health (BIH): Pregnant and postpartum BIH participants received information on child development in session 12 of the BIH curriculum. The curriculum provided an overview of brain development, the role that parents play in infant brain development, discussion of developmental milestones with CDC’s “Learn the Signs. Act Early” handout, and discussion of developmental screening with a standardized tool with their doctor during well-child visits. In session 13, effective parenting skills within the African American culture were covered. Participants also worked with their Family Health Advocate to cope with stressors, discuss concerns with their health care provider, and help them navigate through systems to receive the resources that they needed. BIH has added language to its SOW to promote “Birth to 5: Watch Me Thrive!” BIH is engaged in a program evaluation that will guide model revisions in the future. During 2018-19, 302 participants attended session 12, and 143 participants received referrals for child development/early intervention.
California Home Visiting Program: CHVP home visitors conducted developmental screenings using the ASQ-3 and ASQ-SE at regular intervals per model guidelines. Home visitors are trained in providing guidance to parents and facilitate parent-child activities to determine whether a child is developing appropriately utilizing the ASQ screenings. If it was determined that the child needs further assessment, the home visitor referred the child to the local early intervention program. The home visitor is required to follow up to verify that the child was evaluated by the referral program within 45 days.
CHVP collaborated and coordinated with Sacramento Help Me Grow to provide training to staff. CHVP State staff received a high-level training and CHVP was able to invite staff from MCAH and Title V to participate in the training. CHVP also coordinated a training on ASQ-3 and ASQ-SE and invited all local agency staff that provide direct services to participate in the free training. Home visitors and supervisors from many counties attended the training. Additionally, local CHVP agencies reported working closely with their local Help Me Grow program.
Evidence-based and evidence-informed practices utilized for this strategy:
Birth to 5: Watch me Thrive
AFLP utilized evidence-based and evidence-informed materials and practices in supporting youth and their children in the program. Some AFLP sites utilized Triple P Positive Parenting Program, the ASQ and the ASQ (SE).
Challenges for this strategy:
Understanding appropriate developmental milestones for their baby can be a challenge for families. Some BIH participants stated that they did not feel as though they were being listened to by doctors and aren’t receiving comprehensive information about their child’s development. BIH plans to address this by assisting moms to advocate for themselves at doctor appointments. BIH also assisted mothers to overcome this challenge by providing families with information and bringing in guest speakers on challenging topics.
Child Objective 1: Strategy 4:
Assist MCAH LHJs to implement developmental screening, referral and appropriate linkages for all children using a parent-completed validated screening tool; provide technical assistance to improve provider, family and community outreach, and develop centralized telephone access and data collection processes.
LHJs were required to follow AAP guidelines for developmental screening, promote AAP-recommended preventive visits, and to adopt protocols/policies to screen, refer, and link all children in MCAH home visiting and case management programs. LHJs were encouraged to collaborate with partners that have an interest in this work in order to leverage resources and create systemic, collective impact changes. LHJs conducted activities to improve rates of developmental screening and improve timely early intervention for children with developmental delays. Examples included:
Amador County conducts Baby Welcome Wagon (BWW) home visits. Each visit includes a parent kit and information promoting preventive visits. The BWW home visitor asks families if they would like to participate in a Developmental Screening (ASQ), if they have a child in the home ages 9, 16, or 30 months. All families who receive a home visit are educated on the benefits of screening their child early to obtain needed services for any developmental delays or disorders. Families who choose to participate complete both an ASQ-3 and an ASQ-SE screening questionnaire. The questionnaires are completed by the parents and/or the caregiver. The BWW home visitor scores the questionnaires and schedules a visit with the families to discuss the results. Families are always encouraged to share the results with the child's medical provider. Resources are provided and/or referrals are made if delays are determined through the screening process. Families are also provided with age-appropriate activities and encouraged to rescreen their child if a screening indicates a need.
Fresno County utilizes the MyAvatar electronic medical record that requires home visitors to collect the presence of insurance and a medical home as a part of routine assessments for infants, toddlers, and children. All medical appointments are tracked and followed up on at subsequent home visits.
Orange County children are screened using ASQ-3 at 4 months, 8 months and 12 months of age and ASQ-SE at 6 months of age. The ages for screening were selected due to the high risk for developmental concerns and the high turn-over of clients. Children in AFLP are screened using PEDS at intake, 9 months, 18 months and 24 months to coincide with the yearly pediatric visit. Children at risk for developmental delay are referred to Help-Me-Grow, CCS, and Regional Centers and closely monitored by the program staff.
Ventura County has a policy for all the Community Health Nurses to administer approved, standardized, valid, and reliable developmental screening tools to children birth to six years of age. The approved screening tool is the ASQ and ASQ-SE. To promote early intervention strategies and resources for children, PHNs attend a refresher course for ASQ and ASQ-SE every three years. Also, PHNs screen children 13 years and older for depression with the f PHQ-9 and EPDS pregnant and post-partum women, including any pregnant teen, with the EPDS. PHNs started to screen children 6 years and older for emotional and physical health with the Pediatric Symptom Checklist which includes pictorial graphics.
Based on a 2018-19 survey of LHJs (with 60 of 61 LHJs responding), adoption of the core components of Help Me Grow by 61 LHJs was reported as follows:
- 53 LHJs had an updated resource directory for families with children at risk for developmental or behavioral health concerns
- 46 LHJs had educational or informational materials targeting medical providers to conduct developmental screening
- 42 LHJs maintained a designated phone number, warm line or hotline for parents/guardians, pediatricians, social service agencies or organizations to call
- 38 LHJs collected information on the number of children that have been screened for behavioral or developmental concerns and linked to services
- 52 LHJs have adopted at least two of the components of the developmental screening protocol
In the 2018-19 Year End survey, CDPH/MCAH assessed the types of resources and services available in local communities to screen children for developmental and behavioral health concerns. Forty MCAH LHJs reported that 4,214 children who screened positive for developmental or behavioral concerns were linked or referred to services.
Some LHJs lacked the resources and capacity to fully implement these policies.
Staff turnover and limited local Title V staffing to address child health made it difficult to implement child health-related SOW activities fully or in a comprehensive way. LHJs continued to hear that providers were reluctant to screen for developmental delays due to barriers to referrals for additional evaluation, including lack of local resources, long waiting time for services, or limited knowledge of where to refer a child who screened positive.
Child Priority Need: Increase access and utilization of health and social services (from 2015-20 plan)
Child Objective 2:
By June 30, 2020, increase the rate of children ages 1-17 years who received a dental visit in the last year from 75.4% (2016/17 NSCH) to 79.1%.
Based on NSCH 2016-18 data, the percent of California children ages 1 through 17 years who received any type of dental care in the past year was 80%, of which 77.7% (95% CI: 74.6 – 80.8) saw a dentist, and 2.3% (95% CI: 1.1 – 3.4) saw another oral health care provider. Data by race/ethnicity showed that 74.7% (95% CI: 69.6-79.7) of Hispanic and 84.2% of White (95% CI: 80.6-87.7) children ages 1-17 years saw a dentist during the past 12 months. Data for other race/ethnic groups (e.g., Black) are not shown because the 95% confidence interval width exceeded 20 percentage points and may not be reliable.
Child Objective 2: Strategy 1:
Under the guidance of the CDPH State Dental Director, MCAH and the Office of Oral Health (OOH) will collaborate to implement the State’s Oral Health Plan to identify priorities, goals, objectives and key strategies.
CDPH/MCAH has supported the CDPH/OOH by participating on their Oral Health Advisory Committee, convening bimonthly meeting with OOH State staff to support State and local activities addressing MCAH population domains, and sharing resources to local MCAH programs. Due to limited staffing and redirection due to the COVID-19 public health emergency, participation in Advisory Meetings was limited.
Evidence-based and evidence-informed practices utilized for this strategy:
Several evidence-based or informed practices will be used within the Local Oral Health Programs, including: community water fluoridation, school-based/school-linked programs, promotion of dental sealants, promotion of first dental visit by age 1, and increasing access to fluoride varnish application by non-dental providers.
Challenges for this strategy:
CDPH/MCAH’s limited staffing and redirection of staff to COVID-19 efforts was a challenge to its participation at the OOH Advisory Committee meeting during this report period. MCAH intends to support the OOH by participating in future OOH planning meetings and partnership activities when staffing allows.
Child Objective 2: Strategy 2:
LHJ staff informs all eligible and enrolled clients of currently available dental benefits offered by Medi-Cal to promote the dental home and Medi-Cal warm transfer service through 1-800 customer service phone number or other referral services.
CDPH/MCAH supported OOH efforts to promote the dental home and access to Medi-Cal dental services. DHCS Medi-Cal’s Dental Program’s “Smile, California” representatives have provided information and resources to promote Medi-Cal Dental services and finding a dental home to the Local Oral Health Programs (LOHPs). LOHPs have implemented activities such as providing training for community partners to ensure robust knowledge of transportation options to access oral health services. In addition, a majority of LOHPs will address the following activities: establishing care coordination, referral, and navigation support, single-point-of entry to dental homes, and working with oral health providers to accept a certain number or percent of Medi-Cal dental service patients annually.
CDPH/OOH supported oral health and primary care integration and the Medical Dental Services Program Dental Transformation Initiative to increase access to care, identify and treat dental disease and incentivize continuity of care for the approximately 5 million children enrolled in the Denti-Cal program. Local Dental pilot programs initiated a Virtual Dental Home (VDH) an innovative teledentistry model to increase access, improve health outcomes and cut costs. In order to leverage efforts, CDPH/OOH collaborated with CDPH/MCAH to identify priorities, leverage resources at the local level, and defined state roles and limitations of local resources.
Adolescent Family Life Program: AFLP case managers continued to work with youth in the program to assess needs, provide education, and link the youth and their children to medical and oral health services as needed. Some AFLP agencies provided dental screenings for AFLP participants and their child(ren) at their clinics or onsite events.
Evidence-based and evidence-informed practices utilized for this strategy:
These oral health strategies are recommended by the American Academy of Pediatric Dentistry, Bright Futures in Practice: Oral Health, and the Centers for Medicare & Medicaid Services (CMS).
State funding for CDPH/OOH was approved in August 2019. The CDPH/OOH had limited staff during 2018-19 and has been working to fill the new positions to build capacity.
AFLP agencies had to pause dental screenings at their clinics and cancel screening events due to the COVID-19 public health emergency.
Child Objective 2: Strategy 3:
Under the guidance of the CDPH State Dental Director, MCAH and OOH will collaborate to implement the newly funded Local Oral Health Programs and pursue a coordinated system involving various State Programs that serve children’s dental needs.
CDPH/MCAH met every two months with CDPH/OOH to coordinate and collaborate efforts, including providing updates on program progress to identify areas for program planning and future activities. CDPH/OOH worked with partners to promote oral health by developing and implementing prevention and healthcare policies and guidelines for programs, health care providers, and institutional settings (e.g., schools) including integration of oral health care and overall health care. Collaboration meetings have been paused due to staffing and COVID-19 reprioritization; however, MCAH intends to reconvene meetings and support OOH since perinatal and child oral health continue to be needs of the MCAH population.
CDPH/OOH provided funding for CDPH/MCAH’s Maternal Infant Health Assessment (MIHA) survey to fund questions that will help to determine progress in priority oral health areas. MIHA will be used for ongoing state and local surveillance of oral health services for pregnant women in California.
Evidence-based and evidence-informed practices utilized for this strategy:
To accomplish this Objective, LOHPs can choose the following evidence-based or best practice strategies: convene partners (e.g., First 5, Early Head Start/Head Start, Maternal Child and Adolescent Health (MCAH), Child Health and Disability Prevention (CHDP), Black Infant Health, Denti-Cal, Women, Infant and Children (WIC), home visiting, schools, community-based organizations, etc.) to improve the oral health of 0-6 year old children by identifying facilitators for care, barriers to care, and gaps to be addressed; and/or increase the number of schools implementing the kindergarten oral health assessment by assessing the number of schools currently not reporting the assessments to the System for California Oral Health Reporting (SCOHR), identifying target schools for intervention, providing guidance to schools, and assessing progress.
Challenges for this strategy:
COVID-19 presented a significant problem to local programs to address this strategy. Dental offices had to close in the initial stage of COVID-19 until dental guidelines were developed regarding aerosol generating procedures. These guidelines limit the number of patients dental providers can see at a time. Other impacts included limited operatory space and continuing challenges in obtaining PPE. While schools closed initially, most now operate via distance learning. As a result, local programs’ ability to implement evidence-based programs was limited due to the inability to access to pre-school and school age children. COVID-19 will have an ongoing impact for public health programs as dental preventive procedures are more restrictive due to COVID-19. However, local programs initiated innovative programs such as drive-through screenings and the distribution of oral health kits at schools, which include toothbrushing supplies, preventive dental education, nutrition information, and referral resources. Local oral health programs have been coordinating efforts with other local programs such as First 5, Nutrition/Obesity Prevention programs, Children’s Health and Disability Prevention and Maternal and Child Health programs.
Child Priority Need: Increase the proportion of children, adolescents and women of reproductive age who maintain a healthy diet and lead a physically active lifestyle (from 2015-20 plan)
Child Objective 3:
By June 30, 2020, reduce the proportion of WIC children aged 2-4 years who are overweight or obese from 34.5% (WIC PC 2012) to 33.5%.
In 2018, 31.0% of children two through four years of age enrolled in WIC were overweight or obese.
Child Objective 3: Strategy 1:
Improve capacity for nutrition and physical activity for children through collaboration and technical assistance, especially by sharing science-based resources such as new nationally recognized guidelines and initiatives as well as trainings and funding opportunities with LHJ MCAH directors and MCAH funded program contacts.
CDPH/MCAH partnered with UCLA through their MCHB funded technical assistance to promote Policy, Systems and Environmental change for nutrition and physical activity. CDPH/MCAH provided links to training to WIC, LHJs, AIMSS, and CDPH Nutrition Education and Obesity Prevention Branch (NEOPB). AIMSS continued to provide education on obesity and WIC services are available to American Indian families for infants to age 1 year.
In 2019-2020, MCAH led an expert advisory group to develop two new educational handouts/web postings entitled MyPlate for Children (2-5 years of age) and MyPlate for Children (6-12 years of age). The material is drafted but has paused pending decisions to adapt multiple MyPlate handouts in a new format. The handouts focus on the MyPlate graphic and theme, healthy beverages, reduction of added fats, sodium and sugar, and increased physical activity. To compliment this new material, a new webpage was posted on prevention of choking for children. The webpage was shared with the Center for Healthy Communities, CDPH.
In 2019-2020, the MCAH Nutrition and Physical Activity Coordinator and the MCAH Pediatric Medical Officer provided input into a CDPH and CDSS produced handout entitled “Trauma-Informed Nutrition.” The handout focuses on recognizing the relationship between adversity, chronic disease, and nutritional health.
CDPH/MCAH partnered with CDPH/NEOPB, WIC, DHCS Integrated Systems of Care, and Emergency Medical Services Authority (EMSA) to promote national guidelines on weight, nutrition, and physical activity for young children. CDPH/MCAH disseminated information and tools through key partners to help low-income children meet the Dietary Guidelines for Americans. California promoted and provided updates to the EMSA Childcare Nutrition web page that CDPH/MCAH was a partner in developing through a CoIIN process. CDPH/MCAH partnered with other CDPH programs to update links and resources, including new data links on the MCAH/Nutrition and Physical Activity (NUPA) initiative page, including the Systems and Environmental Changes toolkit to support optimal nutrition, physical activity, and breastfeeding through fostering partnerships between LHJ MCAH programs and existing organizations to promote healthy environmental changes. In 2019-2020, all MCAH nutrition and physical activity web links were reviewed and updated.
CDPH/MCAH programs and WIC screen for food security regularly, and CPSP, AFLP and WIC use a two-question validated food security screening tool as recommended by AAP.
Adolescent Family Life PrograM: AFLP case managers continued to support expecting and parenting youth with leading physically active lifestyles through education, referrals and goal setting regarding nutrition, physical activity and breastfeeding. Through one-on-one education, referrals and goal setting, case managers provided evidence-informed and medically-accurate materials to raise awareness and support youth with promoting their health and wellbeing. AFLP case managers continued to make referrals to WIC as needed to support healthy nutrition for themselves and for their child(ren). In 2019-2020, AFLP participated in the MCAH effort to update the State Adolescent Nutrition and Physical Activity Guidelines, which are currently under review.
Evidence-based and evidence-informed practices utilized for this strategy:
Challenges for this strategy:
Nutrition is an important component of the CDPH/MCAH Division, yet there is only one registered dietitian/public health nutritionist to work across domains. To build capacity and consider succession planning, the MCAH nutritionist offered nutrition related educational opportunities to MCAH staff and MCAH increased staff representation in the Association of State Public Health Nutritionists.
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