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

 

Annual Report FY22:

 

This Performance Measure was achieved. The Performance Objective was 34.2% and the Annual Indicator was 40.3%.

 

Program Activities:

NPM-6 objectives advance a common vision of improving early childhood developmental health outcomes and include the following activities in FY22: 1) increasing the level of ASQ Online participation by the local health departments (LHD), 2) offering ASQ training and technical assistance, 3) onboarding/enrolling programs in the DHHS ASQ Online Enterprise account, and 4) increasing the number of screens contributed to the enterprise system.

During the COVID-19 pandemic, the number of overall screenings initiated by DHHS ASQ Online providers decreased, leveled off, and then began to increase again in a positive direction in 2022. The two graphs below show these recovering trends. Graph 1 illustrates eight-year screening trends and totals for all DHHS screening programs. The second figure illustrates five-year trends and totals specific to those being completed by LHDs.

 

Graph 8. Trend in ASQ online screens pre and post COVID-19

 

 

 

 

 

 

 

 

 

Graph 9. Local Health Department ASQ screens pre and post COVID-19

In FY22, the Early Childhood Utah (ECU) Program Manager continued to offer monthly, quarterly, and “as needed” ASQ training. ECU provided 27 training courses attended by 129 participants. Targeted outreach and training efforts continued to focus on health care providers, pediatric providers, home visitors, and early intervention providers.

Once providers are trained in ASQ, their program's subaccount is established and they can enroll in their program’s ASQ Online subaccount. Throughout FY22, ECU on boarded and enrolled 11 new programs in the DHHS enterprise account. ECU also provides technical assistance to new (11) and currently enrolled programs (57). Newly enrolled programs included Baby Watch Early Intervention (IDEA Part C) community-based grantees, internal CSHCN programs, home visiting, LHDs, and childcare centers.

Federally Available Data from the National Survey of Children’s Health appear to align with the positive trends in Utah (graph 10). National screening trends are also included below for reference.

 

 

 

 

 

 

 

 

 

 

 

 

Graph 10. Historical developmental screening rates for Utah and the U.S. (average)

Prenatal to 3/early childhood system stakeholders have also been involved in advancing developmental health outcomes. The Institute for Disability Research, Policy, and Practice at Utah State University (USU) is part of the IDEA Part C and Part B section 619 Child Find network and administers Utah’s Learn the Signs Act Early program as funded by the Centers for Disease Control and Prevention. The Learn the Signs Act Early program provides developmental health resources to parents and caregivers and to programs/providers. Resources include developmental milestone checklists and free training. USU, ECU, and Help Me Grow Utah (HMGU) developmental screening resources are coordinated through staff collaboration and end-user websites.

Additional community-based partners, United Way of Northern Utah and Weber State University, have been integral partners with developmental screening promotion activities since 2016. The ECU program works closely with both stakeholders to generate, de-identify, and distribute ASQ Online data needed to guide their community objectives. The group’s overall aims are to increase family/child enrollment in local services while also increasing the number of young children that receive a developmental health screen for the first time.

 

Accomplishments / Successes:

 

In FY22 Utah began to successfully implement the statewide coordinated, “ASQ Project.”

Utah is investing in a developmental screening initiative to increase the number of developmental screenings. The ASQ Project was developed by the ECU Advisory Council’s Promoting Health and Access to Medical Homes subcommittee, and was endorsed by the Governor’s Early Childhood Commission. Implementation of the screening initiative is supported with American Rescue Plan Act funds, through the Department of Workforce Services Office of Child Care (DWS-OCC, Utah’s Child Care and Development Block Grant lead agency). The project aims to help early childhood programs and providers, in partnership with families across the state, work together to promote healthy child development through appropriate screening and referral to services. All professionals working with young children and their families are invited to participate by promoting developmental screening, helping parents screen their children, and using information gathered by screenings to connect families to needed services.

Throughout FY22, DHHS, DWS-OCC, HMGU, Brookes Publishing, and Multi-Dimensional Software Creations (MDSC) were actively involved in the day-to-day implementation of the statewide project. Implementation involved expanding from one statewide ASQ Online Enterprise Account, currently hosted by DHHS, to at least three additional statewide Enterprise accounts hosted by: 1) DWS-OCC for childcare providers, 2) the Head Start Association for Early Head Start and Head Start grantees, and 3) Help Me Grow Utah for any provider or family accessing HMGU services.

In addition to launching three additional enterprise accounts, screening data will be integrated to improve care coordination and to increase Utah’s data analytics and research capabilities.

As illustrated in the figure below, the Child Health Advanced Records Management Program (CHARM) will integrate ASQ data and share child-level results with approved providers. The Early Childhood Integrated Data System (ECIDS) will integrate ASQ data that will be included in cross-agency, dynamic, and aggregated reports.
 

Figure 8. Logic model of Early Childhood Integrated Data Systems (ECIDS) through multiple ASQ Online Enterprise Accounts


Project support includes funding for many of the resources needed for programs to facilitate completion of online screens, such as ASQ-3 and ASQ-SE:2 kits in English and Spanish, and the Family Access feature. APIs (data sharing portals) are also included with each enterprise subscription to help Utah reach its integrated data objectives.

 

Summary of successes and accomplishments on “Moving the Needle” in relation to NPM-6:

• The number of developmental screenings completed for young children, which trended downward during COVID-19, are now trending in a positive direction. The number of developmental screenings dropped from 15,283 in 2019 to 11,039 and 10,866 in 2020 and 2021, respectively. However, the number of screenings increased to 15,345 in 2022.
• In FY22, the ECU Program Manager facilitated 27 ASQ training courses attended by 129 participants.
• Throughout calendar year 2022, 11 new programs enrolled and on boarded into the DHHS ASQ Online Enterprise Account. These programs provide pediatric, early health-care, and/or early intervention services to young children.
• According to the National Survey of Children's Health, Utah has steadily increased its annual developmental screening rate for children ages 9 to 35 months from 29.1% in 2018-2019 to 40.3% in 2020-2021.
• DHHS is the coordinating agency engaged in the implementation of a new statewide ASQ Project.
• The enhancements that accompany the ASQ Project have the potential to increase the number of developmental health screens for children ages 9 to 35 months.

 

Challenges / Gaps / Disparities Report:

 

There were no challenges that interfered with Utah’s ability to complete planned activities. Challenges revolve around growing pains that are naturally associated with significant changes, such as preparation for the July 2022 merger between the Utah Department of Health and the Utah Department of Human Services. Additional changes included the restructuring of agency divisions, offices, and programs. Personnel changes, including new and departing staff, typically create transitional periods and gaps in programmatic expertise. Fortunately, DHHS provides the support needed to work through these types of challenges, including thoughtful and hands-on leadership as well as encouragement to maintain work-life balance.

There are emerging opportunities associated with the new statewide coordinated ASQ Project. In order to increase the number of programs and providers actively promoting developmental screening opportunities, multiple ASQ Online Enterprise Accounts are in the process of being established. Once the various accounts are launched, historical child profiles and screening data will need to be transferred to the respective accounts, training courses and records will need to be centralized, technical assistance networks will need to be implemented, and ultimately cross-agency and cross-program screening data will need to be integrated and utilized. All of these steps represent emerging opportunities that influence program activities related to this NPM.

 

Based on Federally Available Data (FAD), children born outside of the U.S. are less likely (38.3%) than those born in the U.S. (56.7%) to receive a development screening. Forty percent (40.3%) of parents reported completing a developmental screening for their child, which places Utah as 18th in the country for developmental screening. This represents an increase of 25 ranked points using NSCH 2020-2021 data compared to 2018-2019 data.

 

Agency Capacity/Family Partnerships/Collaboration:

The ECU Program also coordinates ECU Advisory Council and Subcommittee activities. The ECU Advisory Council, the ECU Executive Committee, and five ECU Subcommittees help to develop, orchestrate, and often assist in the implementation of Prenatal to 3/early childhood initiatives, such as the promotion of early childhood developmental health.

The ECU Advisory Council also serves as the State Advisory Council and as such, all of the entities required by the Improving Head Start for School Readiness Act of 2007, along with other stakeholders, are engaged in the Council as voting members. There are 29 ECU Advisory voting members and up to 90 ECU Advisory Subcommittee members (inclusive of the 29 voting members). Partners include the Governor's Office, Title V MCH, CSHCN, MIECHV, IDEA Parts B and C, and childcare leadership. Additional collaborators include private sector pediatricians, health department and WIC directors, higher education and head start representatives, early education professionals, human services and mental health administrators, and families.

ECU Advisory and Subcommittee activities are informed by Birth to Five needs assessments, strategic plans, and deliberative parent and family qualitative sessions. Some engaged parent-representatives receive a stipend for their time and participation.

A critical Prenatal to 3/early childhood partner and stakeholder, which connects families to a continuum of services, is Help Me Grow Utah (HMGU). HMGU is hosted by United Way of Utah County and provides a free information and referral helpline for parents, physicians, and community partners with resources for children under 8 years old. In FY22, HMGU worked with 1,565 new families, facilitated 3,160 developmental screening questionnaires, and made 5,599 care coordination referrals.

 

Report of ESMs related to NPM-6

 

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

 

Goal/Objective:

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

 

Significance of ESM 6.1:

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

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

 

ESM 6.1 Progress Summary:

We are deactivating ESM 6.1 because ASQ training modules are now continuously available online through a recorded webinar. A new ESM (6.3), outlined below, will replace this ESM. Live/in-person training is also available. The state's ASQ training resources and attendance records have been centralized. The previous measure tracked the number of trainings offered, and now that training is continuously available, a measurement change is taking place to track and increase the number of participants trained annually.

 

In FY22, the Early Childhood Utah Program Manager continued to offer monthly, quarterly and “as needed” ASQ training. ECU provided 27 training courses attended by 129 participants. DHHS’ targeted outreach and training efforts continued to focus on health department care providers, pediatric providers, home visitors, and early intervention providers.

 

 

ESM 6.2: The number of ASQ screenings, for 0-3 year olds, contributed to the DHHS ASQ Online Enterprise Account by participating partners and enrolled programs.

 

Goal/Objective:

Increase the number of ASQ screens for children 0-3 years old contributed to the Utah DHHS ASQ Online Enterprise Account by participating partners and enrolled programs.

 

Significance of ESM 6.2:

This measure is significant because it demonstrates the culmination of Utah's ASQ training, enrollment, and implementation efforts. Tracking this data will show if Utah is increasing the number of developmental screenings received by children ages 9 to 35 months.

 

ESM 6.2 Progress Summary:

This ESM is being deactivated and will be replaced with ESM 6.4 (outlined below). Due to work being done by the Early Childhood Utah Advisory Council, many subaccounts are being transferred out of the current DHHS ASQ Online Enterprise Account into their own accounts. This measure tracked the number of screenings contributed to the DHHS ASQ Online account for children ages 0-3 and the new ESM 6.4 will track screenings for those ages 0-5. The DHHS account will host pediatric and early care providers such as health departments, home visitors, and early interventionists.

 

 

ESM 6.3: Number of pediatric, early health, early care, and early education providers that participate in the state's ASQ new provider training process annually.

 

Goal/Objective:

By tracking this measure, the Office of Early Childhood can better engage in the continuous improvement process, such as increasing the number of participants that complete ASQ training annually.

 

Significance of ESM 6.3:

Facilitating developmental screening, with a parent-completed screening tool, is a critical part of early childhood care and a great opportunity to engage families in the promotion of their child's developmental health. Developmental screening is used to determine if a child is reaching age-related milestones as anticipated or if there is a reason to coordinate additional assessment/intervention.

This ESM is significant to increasing the number of developmental screens received by children ages 9 to 35 months. In order to increase the number of screens received by infants/toddlers we need to increase the number of programs/providers that are appropriately trained to offer developmental screening opportunities to parents with young children.

 

ESM 6.3 Progress Summary:

This is a new strategy and measure replacing the former ESM 6.1. It is important to track and continually increase the number of new programs that are enrolled in the DHHS ASQ Online account. Increasing the number of enrolled programs increases the likelihood that additional children between ages 9 to 35 months will be afforded the opportunity to participate in developmental health screening opportunities.

 

ESM 6.4: The number of ASQ screenings, for children ages 0-5, contributed to the DHHS ASQ Online Enterprise Account annually.

 

Goal/Objective:

Increase the number of ASQ screens (for children ages 0-5) contributed to the Utah DHHS Online Enterprise Account annually.

 

Significance of ESM 6.4:

This measure is significant because it demonstrates the culmination of Utah’s ASQ training, enrollment, and implementation efforts. Tracking this data will show if Utah is increasing the number of developmental screenings received by children 9 months to 5 years. A new baseline is being established for ESM 6.4 due to many subaccounts being transferred out of the current DHHS ASQ Online Enterprise Account into their own Enterprise Accounts in 2023. Care types being transferred include Help Me Grow Utah, Head Start grantees, and childcare providers.

 

ESM 6.4 Progress Summary:

This is a new strategy and measure replacing the former ESM 6.2. FY2024 will serve as a new baseline for the expanded child population this ESM is targeting. ESM 6.2 targeted children aged 0-3 years and this ESM will target children between the ages of 0-5 years.

 

ESM 6.5: The number of new programs enrolled in the DHHS ASQ Online Enterprise Account annually.

 

Goal/Objective:

By tracking this measure, the effectiveness of Utah's training and program recruitment practices can be evaluated and improved upon.

 

Significance of ESM 6.5:

Enrolling new programs in the DHHS ASQ Online Enterprise Account increases the chances that developmental screening practices will be implemented into additional programs' early care/early education routines. Increasing the number of enrolled programs increases the likelihood that additional children between ages 9 to 35 months will be afforded the opportunity to participate in developmental health screening opportunities.

 

ESM 6.5 Progress Summary:

This is a new strategy and measure. The structure and composition of the statewide ASQ Program is changing and it is important to track and continually increase the number of new programs that enroll in the DHHS ASQ Online account. These changes are described in the Annual Report for NPM 6. Because of these changes, it will be imperative for DHHS to monitor and increase the number of new pediatric, health, and early care providers that enroll and participate in the DHHS ASQ Online Enterprise Account.

 

Local Health Department Successes and Challenges related to this performance measure:

 

Successes:
 

LHDs offer ASQs through mail or email in an effort to make screening as convenient as possible for the families. One district provides parents with a postage-paid envelope in an effort to ease the burden of sending the questionnaire back with the goal of improving follow-up.

 

During visits with families, nurses work with parents and caregivers to encourage age-appropriate activities to encourage development in categories where the child may have scored in the 'monitor' range. Nurses also encouraged parents to work on all areas to promote activities to help keep their children on pace with their milestones.

 

LHDs identified and worked with community partners and State partners to ensure staff were refreshed and trained on ASQs and the importance of administering the questionnaires. They are also working to train CHWs on ASQ screenings. One district is working to collaborate with Head Start, has created a local ASQ campaign, and added information to their website to promote ASQs.

 

Challenges:

 

A primary difficulty is the lingering COVID fears, as clients have said they are more comfortable with phone call visits. Home visits are now being offered but many parents still prefer telehealth.

 

Other challenges noted include:

• Getting parents to follow through with filling out the ASQ paper/computer work and returning it to the nurse.
• Screening can be overwhelming to some families.
• Some families state that it is too time consuming.
• Parents are leery of home visiting due to an increase of cellular scams.
• Staff turnover in several districts was noted. This creates a need to hire and train new staff on ASQ processes.
• Inability to meet in homes and actually see the children that were being screened.

 

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

 

Annual Report FY22:

 

This Performance Measure was NOT achieved. The Performance Objective was 84.7% and the Annual Indicator was 80.0%.

 

Program Activities:

 

The State Dental Director (SDD) regularly attended the Utah Medicaid Medical Care advisory committee and CHIP advisory council meetings and communicated with the Office of Medicaid for the Oral Health Program (OHP) team. In March of 2022, the previous SDD stepped down from the position. DHHS hired a new SDD in August of 2022. She has connected with the Medicaid office and is attending Utah Dental Association (UDA) board meetings.
 

The Utah Medicaid Office Director or a representative has been giving regular updates at the Utah Oral Health Coalition quarterly meetings including eligibility requirements for Medicaid members, covered services and updates to coverage, how to become a Medicaid provider, contact information, and resource lists.

The Oral Health Educator (OHEd) has continued to collaborate with the UDA on the opioid toolkit for dental providers, which includes prescribing guidelines for children, adolescents, and pregnant women from the National Oral Health Resource Center. Copies of an educational trifold with QR codes to the toolkit were provided to each dentist who attended the UDA regional Continuous Quality Improvement (CQI) meetings, reaching approximately 1,000 dentists. Additionally, mailed toolkits were sent to 1,300 Utah-licensed dentists with the help of our office support specialist and four volunteer dental hygiene students. All active licensed dentists will receive a mailed toolkit by the end of FY23.

 

In October 2021, the OHEd and a volunteer hygienist provided an educational booth at the Utah Dental Hygienists' Association (UDHA) annual conference including information on the opioid toolkit, naloxone, and encouraging providers to educate their patients on the safety of dental care during pregnancy and to establish a dental home by age one. This same educational booth was provided by the oral health educator and oral health specialist interns in March of 2022 at the Utah Dental Association annual conference. The OHEd also presented to 26 individuals at the Utah Public Health Association annual conference on the opioid toolkit for dental providers.

The OHEd wrote an article for the UDA Action magazine, which goes to UDA member dentists state wide, on the importance of age one dental visits. The OHEd also collaborated with the diabetes prevention program to write and submit a screening for prediabetes in dental offices to the Action magazine.

OHP provides two ‘Baby Your Baby’ or ‘Check Your Health’ segments on KUTV each year. OHP staff provide the segments or write talking points and coordinate with local dentists or dental hygienists to provide segments. Topics include: The importance of baby teeth, strategies to prevent tooth decay, how to get safe dental care during pregnancy, and the importance of age one dental visits.

In FY22, the OHEd started attending the Early Childhood Utah (ECU) Advisory Council meetings and participating in the Promoting Health and Access to Medical Homes subcommittee. The OHEd provides educational resources and updated dental resource lists to ECU members. The OHEd created a poster for October dental hygiene month with 10 simple messages discussing positive oral health behaviors in English and Spanish. This was disseminated through ECU, WIC, Head Start Programs, LHDs, and the teen success program.

 
OHP continues to support the Head Start and Early Head Start programs throughout the state by sitting on health advisory committees, providing staff training, parent educational presentations and screenings, and fluoride varnish to some sites. A local dentist and dental hygienist have been providing services within the DDI Vantage headstart programs in Salt Lake and Tooele. Utilizing teledentistry, they provide exams, prophylaxis, sealants, fluoride varnish, and appropriate referrals. The OHEd provided 12 oral health messaging educational materials for DDI vantage families and coordinated with these local providers.

 

In March of 2022, the OHEd, along with two OHP intern hygienists, provided dental screenings, fluoride varnish, referrals, and toothbrushes to 125 Head Start children within the Salt Lake Community Action Program.

The OHEd continues to work with the Office of Home Visiting to provide oral health education and training to families with children (ages 0-5) and staff. The OHEd sends quarterly educational and dental resource emails to each site. All educational material shared is current and evidence-based. The OHEd and OHP dental hygienist intern created a Care About Your Child's Teeth presentation for parents and staff in English and Spanish. This presentation was given at the Salt Lake City Parents as Teachers Home Visiting Site to 11 families and six staff members. OHP later recorded and shared the presentation with all OHV sites, migrant Head Start sites, Head Start sites, and WIC sites. National materials were also shared with OHV sites including; the National Oral Health Resource Center, Early Childhood Learning and Knowledge Center, and the National Institute of Dental and Craniofacial Research. In May of 2022, the OHEd presented at the first-ever peer dialogue session with 20 OHV site managers statewide.

In June of 2022, the OHEd provided a presentation to the Association for Utah Community Health (AUCH) leadership team with 14 in attendance. This presentation included information on the relocation of the Oral Health Program from the Office of Maternal and Child Health to the Office of Primary Care and Rural Health (OPCRH), introducing the program, and sharing educational materials for dissemination to families. These materials included healthy oral hygiene habits, healthy food choices, and encouraging regular dental visits during pregnancy and by age one.
 

The Adolescent Oral Health Campaign (AOHC) is an intervention designed to educate middle school aged students about oral health care. In the 2021-2022 school year, all presentations moved back to in-classroom presentations. A total of 140 presentations were given to over 3,723 students in 19 different schools. The OHEd managed OHP interns who implemented the program and gave presentations, building sustainability into the program. To measure the effectiveness of the intervention, the students completed anonymous pre- and post-tests. OHP created one-page fact sheets for each school based on the data collected. Brochures with local safety net dental clinics were provided to all students and teachers physically and electronically.
 

For children’s dental health month in February, the OHP sent electronic newsletters to all public elementary school, middle school, and high school administrators. Over 1,000 schools were contacted. The OHP interns and OHEd gave virtual and in-person presentations to over 1,016 students in 11 elementary schools. These presentations were given to each individual class as assemblies were still not permitted due to COVID-19.
 

In the Spring of 2022, an OHP intern and two volunteer dental hygiene students provided an education and dental resource booth at Harry S. Truman Elementary School. They provided interactive brushing, flossing, and nutrition activities for families along with a list of safety net clinics in English and Spanish. They were able to talk to 100 students and parents at the event. The OHEd also collaborated with and provided educational materials to four dental hygiene students who presented on the oral health effects of vaping to 27 middle school students in Salt Lake.
 

In April of 2022, the OHEd visited Westmore Elementary school to support the fluoride varnish program and meet with stakeholders. More than 80 children received services that day. Additionally, Community Health Connect, in partnership with Mountainlands Technical College, provides basic oral health risk assessments and fluoride varnish in all Utah County Title 1 schools. It is a fantastic partnership the OHP and SDD has supported for many years.

The OHEd continues to be an active member of the Professional Advisory Committees for the different dental hygiene schools within Utah. OHP continues to do presentations at the dental hygiene schools on cultural empathy, and public health dentistry. In the 2021-2022 school year, the OHEd presented at three dental hygiene schools. In September of 2021, the OHP intern and Dental Hygiene Liaison for Utah presented to 80 third-year dental students at Roseman University on motivational interviewing. They shared materials from the National Maternal and Child Oral Health Resource Center.

 
OHP coordinates with local dental hygiene programs to create outreach events for students. In February 2022, the OHP intern and four dental hygiene students from Salt Lake Community College presented to over 60 refugees at the Latter-day Saint Humanitarian Center. The presentations were focused on preventive oral health strategies including hygiene habits, nutrition, not letting babies sleep with a bottle, and dental safety during pregnancy. Six dental hygiene students from Fortis College were able to give this same presentation to 60 refugees at the Granite Peaks Adult Learning Center.

 
An event was held at the Utah College of Dental Hygiene for Utah County Give Kids a Smile, where volunteer dentists and dental hygiene students provided preventive and restorative care to 56 children. The OHEd contacted local Head Starts, WIC, and Home Visiting programs to promote the event to participant families.

 

In April 2022, Fortis College Dental Hygiene School, Roseman School of Dentistry, and the University of Utah School of Dentistry all participated in a Team Smiles event providing preventive and restorative dental services to 300 children. The OHEd promoted this event with local WIC, Head Starts, and Office of Home Visiting staff to share with participant families.

One of OHP’s greatest strengths is working with many strong partnerships and collaborations. OHP continues its now 12-year collaboration with the University of Utah Physician Assistant Program. In the fall of 2021, the OHEd and Dental Hygiene Liaison (DHL) for Utah trained 70 University of Utah PA students from the Salt Lake and St. George campuses on performing oral health risk assessments and applying fluoride varnish. In September, the PA students with faculty, DHL, and, OHEd provided oral health risk assessments and fluoride varnish applications to 280 migrant Head Start children. Migrant Head Start locations include Providence, Genola, Honeyville and a new participating program in Holden, UT. These same partners provided oral health assessments, blood glucose, cholesterol screenings, and flu shots to over 40 migrant farm workers (parents of the migrant Head Start children) in September of 2022.

 

Accomplishments / Successes:

 

OHP’s successes lie in working with partners to provide educational resources, focusing on prevention, and connecting families and staff to dental services. OHP works closely with Head Start, Office of Home Visiting, WIC, and other early intervention programs.

In January 2021, OHP submitted a workforce grant to HRSA to create an emergency department diversion program for non-traumatic oral health concerns in three rural hospitals. With this grant, OHP was able to hire a 1.0 FTE dental hygienist program coordinator and increase the position of the new SDD from .25 FTE to .5 FTE.

 

Summary of successes and accomplishments on “Moving the Needle” in relation to NPM-13.2:

 

• In January 2022 OHP, SDD, Office of Home Visiting program manager and staff, MCH Office Director, MCH data program manager and partners submitted a HRSA workforce grant for an emergency department diversion program for non-traumatic oral health concerns in three rural Utah Hospitals. This grant was awarded and the first cycle of funding started September 1, 2022. With this grant award, the OHP hired a program coordinator at 1.0 FTE to manage the grant and the SDD position increased from .25 FTE to .5 FTE. The SDD position is funded at .25 FTE through the MCH block grant and .25 FTE through the HRSA workforce grant.
• From June - September 2021 Silver Diamine Fluoride (SDF) underwent a full review and cost analysis under Medicaid. By December 2021, SDF had been evaluated and approved as a covered service effective January 1, 2022 for primary teeth only.
• Teledentisty dental codes that opened in April 2020 will remain open post-pandemic.
• OHP updated the 12 oral health messages modules and magnets, which were disseminated to all of the OHV sites. Quarterly educational and resource emails were sent to each site including information on drinking water instead of sugary beverages, regular snack times, what to expect from a dental visit during COVID-19, and the importance of brushing teeth.
• Primary Children's Hospital and the Utah Tobacco Free Alliance created a Spot the Vape Campaign. The OHEd disseminated this campaign material to school nurses, middle school health teachers in the AOHC, and to every dental hygiene school to promote to their students and patients.
• The OHEd presented at the Diabetes and Education Specialist Annual Conference to medical providers and diabetes specialists on the bi-directional relationship of diabetes and periodontal disease reaching 10 providers.

 

Challenges / Gaps / Disparities Report:

 

One of the biggest ongoing challenges has been the reduction in staff. The former State Dental Director continued to work at .2 FTE during 2021 and resigned in March of 2022. The State Dental Director position was then filled in August 2022 at .2 FTE and moved to .5 FTE in September 2022 with the award of a Health Resource and Services Administration (HRSA) workforce grant. OHP was staffed at 1.0 FTE during the six-month span between dental directors, and staffed at only 1.5 FTE for the remainder of 2022. In addition, during 2021-2022 the OHEd was on full and intermittent FMLA working 20 to 40 hours a week due to personal circumstances.

In April 2022, in preparation for DHHS (Department of Health and Human Services) merger, the oral health program was moved from the Maternal and Child Health Bureau to the Office of Primary Care and Rural Health (OPCRH). OPCRH is one of six programs in the clinical service section of the department directly under the Executive Medical Director. This has been a good transition for OHP, but it has come with a new learning curve as OHP adapts to OPCRH and integrates its work.

Funding concerns and staff capacity have all played a role in the continued delay of the oral health survey of Utah’s schoolchildren. With additional staff and support, OHP is optimistic that planning and implementation of the oral health survey can take place in FY24. Historically the survey had been done every five years.

Effective January 1, 2021 Silver Diamine Fluoride (SDF) became a covered service by Medicaid for primary teeth only and remains a covered service. Integration of this and other preventive services such as oral health risk assessments, topical fluoride varnish, and establishing dental homes are still central to medical-dental integration.

Based on FAD, several subgroups within Utah face significant disparities for children receiving a preventative dental visit, including homes where the highest education level attained is high school (66.5%) compared to a college degree (83.9%). Children of mothers born outside the U.S. have a lower proportion of children receiving a preventative dental visit (70.7%) compared to children of mothers born in the U.S. (82.4%). Central city metropolitan statistical areas (70.9%) appear to be underserved in this area relative to non-central city metropolitan statistical areas (82.4%). Proportionally fewer Hispanic children receive preventive dental services (72.2%) compared to non-Hispanic White children (82.8%). Finally, dental visits are more common for children aged 6-11 years (93.3%) and 12-17 years (92.2%) compared to 1-5 years (75.8%).

 

Effective January 1, 2021 members who are age 21 or older and are eligible for Medicaid due to disability or blindness will transition and receive services through the University of Utah School of Dentistry network.

During the 2022 general session, the legislature appropriated funding for better dental restoration materials for crowns and fillings. Effective July 2022, composite fillings became available for all populations eligible for full dental services, meaning that members are no longer required to do ‘spend-ups’ from amalgam fillings to composite fillings. Effective July 2022, porcelain crowns also became covered for Early and Periodic Screening, Diagnostic, and Treatment and pregnant Medicaid members.

The legislature passed Senate Bill 103 Dental Hygienist Amendments during the 2021 general legislative session. This bill enacts provisions related to Medicaid reimbursement for billable services provided by a dental hygienist. In the new Medicaid PRISM system, hygienists will be billable providers for services they provide. This will add sustainability to programs and incentivize hygienists to work in public health settings.

OHP will conduct a needs assessment and create a state oral health improvement plan. Available data, stakeholders, and community members will be gathered to discuss the needs in Utah and help in the development of this plan.

 

Agency Capacity/Family Partnerships/Collaboration:

In the fall of 2021, the oral health educator presented at the diabetes and education specialist annual conference on the correlation between oral health and diabetes. Ten healthcare providers attended the presentation.

Spot the Vape campaign was a direct collaboration between Primary Children's Hospital, UTFA, and the tobacco prevention and control program. The OHEd disseminated campaign materials to the Utah Oral Health Coalition, Dental Schools, Dental Hygiene Schools, and AOHC participating middle schools for dissemination to families.

The OHEd continues to work with staff in the Home Visiting Program and WIC providing professional development around oral hygiene, nutrition recommendations, educational materials, and local dental resources.

OHP and the MCH team applied for, and were awarded, a HRSA workforce grant with a four-year performance period September 1, 2022 through August 31, 2026. Partners on this project will include three rural emergency departments (Ashley Regional Medical Center and Uintah Basin Medical Center), two Federally Qualified Health Centers (FQHCs) (Mountainlands Community Health Center Dental Clinic and IHS Fort Duchesne Health Center), and the University of Utah School of Dentistry. Activities during this grant period include creating a CME education curriculum for ED personnel to appropriately assess and address oral health concerns, Hospital and FQHC staff being available to help eligible individuals enroll in Medicaid, the creation of a statewide public resource and referral map, and increasing the local capacity within the FQHC to see ED patients in a timely manner.

 

Report of ESM related to NPM-13.2

 

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

 

Goal/Objective:

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

 

Significance of ESM 13.2.1:

The Medicaid population is a group that has higher dental needs than those with higher economic status. They are part of the population of Utah that is important to concentrate on in improving this measure.

 

ESM 13.2.1 Progress Summary:

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

 

Local Health Department Successes related to this performance measure:

 

One health district is providing dental vouchers for uninsured children. This district provided 265 dental services through their dental providers. Their staff called and met with dental providers to promote their program.

State Priority Area: Family Connectedness

 

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

 

Annual Report FY22:

This Performance Measure was NOT achieved. The Performance Objective was 81.0% and the Annual Indicator was 80.6%.

 

Program Activities:

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

 

The state and local health departments have been working to promote family mealtime to Utah residents. More specifically, they have worked with schools and childcare centers and used social media to provide families with materials and resources to apply for programs such as the Supplemental Nutrition Assistance Program (SNAP), WIC, and the National School Breakfast and Lunch Programs.

 

Accomplishments / Successes:

 

Utah’s five-year goal was to increase the percentage of families who ate a meal together four or more days per week from 76.7% (2017-2018 National Survey of Children’s Health) to 84%. The 2020-2021 data from the National Survey of Children’s Health show that 80.6% of Utah families ate a meal together four or more times per week. This comes close to achieving the five-year goal that Utah set and demonstrates nearly a 4% increase from the baseline data.

 

Summary of successes and accomplishments on “Moving the Needle” in relation to SPM-2

• Members of the Healthy Environments Active Living (HEAL) team have been meeting monthly with other health educators from LHDs who work directly with schools. Ideas were discussed and the group brainstormed ways to better collaborate.
• LHDs have attended conferences related to school health and have found ways to promote SNAP at local events in their communities.
• LHDs have expanded the reach of SNAP and WIC and have invited school district representatives to be stakeholders in those discussions.

 

Challenges / Gaps / Report:

 

LHDs and the state have encountered significant staff turnover, which has created a knowledge gap between new staff and remaining staff. Vital institutional knowledge is less available as staff members have left the program for new positions.

Agency Capacity / Collaboration Report:

 

Funding from the State Physical Activity and Nutrition and Prevention (SPAN) program and Title V Block Grant provides funding to LHDs to improve physical activity and nutrition among children ages 0-18. The state of Utah has an early childcare center program called TOP Star, which stands for Teaching Obesity Prevention in Early Child Care Settings. TOP Star is a free Utah-based program that helps early childcare facilities improve their nutrition, physical activity, and breastfeeding policies. TOP Star also offers free technical assistance and resources to participants. Utah funds childcare facilities with incentives to improve physical activity and nutrition services for families. By providing educational services to young families, nutrition improves in homes. School health is also a priority. School wellness policies are created to guide schools efforts in creating supportive school nutrition and physical activity environments, which includes foods on school campuses, rules on snacking in classrooms, and special occasion snack protocols. Utah recognizes and partners with schools because they play an important role in helping children make healthy eating choices and establish physical activity habits while they are young.

 

 

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

 

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

 

National Outcome Measures (NOM):

 

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

 

In 2022, CSHCN contracted with Help Me Grow Utah (HMGUT) to screen children using the Modified Checklist for Autism in Toddlers-Revised (M-CHAT R/F) and make referrals as appropriate. HMGUT screened 176 children for autism spectrum disorder and referred 233 children to appropriate services. The M-CHAT R/F is designed for children 16 to 30 months of age. If an M-CHAT R/F is properly administered, these children can get appropriate Part-C and Part-B services. If this screener leads to appropriate testing and diagnosis, these children can enter school with an appropriate classification (General Education, 503 or Special Education).

 

The DHHS Office of Early Childhood, the Department of Workforce Services-Office of Child Care, the Utah State Board of Education-Early Childhood Department, Early Childhood Utah, and dozens of community based programs such as: Help Me Grow Utah, Local Health Departments, Head Starts, Child Care Providers, Home Visitors, Early Interventionists, and Pediatric Providers are engaged in statewide efforts to facilitate early and routine developmental health screening. The tools for this project used are Brookes Publishing ASQ-3 and ASQ Social-Emotional. Children that need further assessment and/or services are connected to additional resources. When developmental delays are discovered and treated early, children have increased opportunities to arrive at school healthy and ready to learn.

 

The CHARM system continued to integrate data between the Early Hearing Detection and Intervention (EHDI) and Baby Watch Early Intervention (BWEI) Programs. This linkage enables the EHDI program to know that a child with hearing loss has been referred to early intervention by six months of age for follow-up care. Receiving timely treatment and intervention for children that are deaf and hard of hearing maximizes their developmental and communication potential so they can be ready for school entry. Similarly, the BWEI program receives hearing screening results in its BTOTS system through CHARM from the EHDI program. This has enabled the BWEI staff to know if a child has received a hearing screening or still needs one, thereby providing timelier follow-up care and comprehensive service/treatment plans for a child. The CHARM program also began work on a project to integrate the Ages and Stages Questionnaire (ASQ-3) and ASQ Social and Emotional-2 (ASQ SE-2) developmental screening results from various State of Utah agencies through the CHARM system and share those results with DHHS health program database systems and Electronic Medical Record (EMR) systems. The overall purpose of the data project is to make ASQ-3 and ASQ SE-2 screening data available statewide to early care, development, health care, and education providers, as well as clinicians, for coordination and improving care to individual children and families.

 

The project builds upon the accomplishments of the CHARM data integration system to integrate developmental screening ASQ results so that better and more consistent referrals, services, treatments, and interventions are provided to children with potential developmental delays. This project will also ensure that Utah’s early childhood stakeholders are all working together across the state to identify and close learning gaps early so children and their families are prepared when they enter kindergarten. This ASQ developmental screening project is detailed more in NOM 17.3.

 

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

 

OHP continues to support the Head Start and Early Head Start programs throughout the state by sitting on the health advisory committees, providing staff training, parent educational presentations and screenings, and providing fluoride varnish to some sites. A local dentist and dental hygienist have been providing services within the DDI Vantage headstart programs in Salt Lake and Tooele. Utilizing teledentistry, they provide exams, prophylaxis, sealants, fluoride varnish, and appropriate referrals. The OHEd provided 12 oral health messaging educational materials for DDI vantage families and coordinated with these local providers. In March 2022, the OHEd along with two OHP intern hygienists provided dental screenings, fluoride varnish, referrals, and toothbrushes to 125 Head Start children within the Salt Lake Community Action Program.

 

The OHEd continues to work with the Home Visiting program to provide oral health education and training to staff and families with children (0-5). The OHEd sends quarterly educational and dental resource emails to each site. All educational material shared is current and evidence-based. The OHEd and OHP dental hygienist intern created a Care About Your Child's Teeth presentation for parents and staff in English and Spanish. This presentation was given at the Salt Lake City Parents as Teachers Home Visiting Site to 11 families and 6 staff members. It was then later recorded and shared with all OHV sites, migrant Head Start sites, Head Start sites, and WIC sites. National materials were also shared with OHV sites including; the National Oral Health Resource Center, Early Childhood Learning and Knowledge Center, and the National Institute of Dental and Craniofacial Research educational materials. In May of 2022, the OHEd presented at the first-ever peer dialogue session with 20 OHV site managers statewide.

 

NOM 19 - Percent of children, ages 0 through 17, in excellent or very good health. (Improve the health status of children)

 

The Department of Health and Human Services-Office of Early Childhood, the Department of Workforce Services-Office of Child Care, the Utah State Board of Education-Early Childhood Department, Early Childhood Utah and dozens of community based programs such as Help Me Grow Utah, Local Health Departments, Head Starts, Child Care Providers, Home Visitors, Early Interventionists, and Pediatric Providers are engaged in statewide efforts to facilitate early and routine developmental health screening. The tools used for this project are Brookes Publishing ASQ-3 and ASQ Social-Emotional. Children that need further assessment and/or services are connected to additional resources. When developmental delays are discovered and treated early, children have increased opportunities to arrive at school healthy and ready to learn.

 

NOM 22.2-22.5 - a) Percent of children, ages 19 through 35 months, who have completed the combined 7-vaccine series; b) Percent of children, ages 6 months through 17 years, who are vaccinated annually against seasonal influenza; c) Percent of adolescents, ages 13 through 17 years, who have received at least one dose of the HPV vaccine; d) Percent of adolescents, ages 13 through 17 years, who have received at least one dose of the Tdap vaccine; e) Percent of adolescents, ages 13 through 17 years, who have received at least one dose of the meningococcal conjugate vaccine

 

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