Child Health Annual Report (October 1, 2020-September 30, 2021)

The 2020 comprehensive Title V needs assessment process led to the development of the

Priority Need: To increase developmental screenings and referral to early intervention services for children. Several strategies were identified and incorporated into the state action plan to impact the following performance measures:

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.

According to NSCH data, only 37.9% of SC children, ages 9 through 35 months, received a developmental screening using a parent-completed screening tool, which falls well below SC’s Title V objective of 50% by 2025. Developmental screenings are essential for all children, and early intervention is the key to improved outcomes for those children with an identified need. The Title V/MCH program has prioritized NPM 6 collaborating with numerous partners to increase access to care and resources for early intervention services for children, working towards addressing barriers and gaps in services.

In September of 2021, Title V/MCH convened a strategic planning retreat with the Child Well-Being Coalition (CWBC) Core Team to plan for action around developmental screenings, one of the 3 newly identified priority areas (other areas include childhood injury and childhood obesity). The CWBC, under the direction of Title V/MCH, continued to promote the use of the CDC's Milestone Tracker App, a user-friendly means to monitor developmental progress in children, by widely disseminating information to providers and community partners. The CWBC has also established a developmental screening advisory group to engage developmental screening leaders in the state, as plans are underway for development and implementation of a statewide registry.

Help Me Grow SC, another key Title V partner for developmental screening as well as child development and early intervention services, completed 291 developmental screenings during this period, with 195 children and their families receiving referrals. Of those referrals, 29% were for mental health/behavioral health/counseling services and 15% were for communication, speech & language services. Approximately 9% of referrals were made to IDEA Part C (BabyNet) and another 9% were made to IDEA Part B (School Districts’ Child Find). Help Me Grow SC coordinates with families to ensure connection to services, and during this period, 88% of referral report connection to at least one service to which a referral was made.

The SC Title V program as well as the CWBC continued to foster a strong partnership with BabyNet, SC’s interagency early intervention system for children under the age of 3. The BabyNet program provides critical services for this population, with the goal of increasing early intervention services for children across the state. BabyNet staff participate in public awareness activities on an annual basis, and present at various early childhood conferences at the state and national level. The BabyNet program also has a contract with Family Connection of South Carolina, Title V’s Family Voices partner organization, to develop and disseminate materials, with the sole purpose of increasing the number of referrals to the program.

The MCH Bureau’s Birth Defects Program continued to make referrals of all infants with birth defects to BabyNet in South Carolina despite the pandemic. In fall 2020-2021, the program did audits of cases referred and found that many cases referred by the MCH Bureau's Birth Defects Program were eligible for early intervention (EI) services for the first time because of the DHEC referral made by SCBDP. This included children born with conditions not considered to be automatically eligible for BabyNet. The program began assessing ways to make more timely referrals and worked to complete a backlog of referrals of older infants. The program also continued to refer all pregnancies impacted by a neural tube defect to Greenwood Genetic Center.

The MCH Bureau’s First Sound program continued ongoing training to new staff and current staff at hospitals to improve screening outcomes and reporting compliance. Collaborated with family support and early intervention partners to provide training and education to staff at pediatric physician practices and community events. Continued internal partnerships with CYSHCN and SCBDP for data sharing and consultation.
The program also purchased an otoacoustic emissions hearing screener to place in a large free-standing birthing center to enable hearing screenings on site at birth instead of being referred to an audiologist.  

Priority Need: Improve coordinated and comprehensive health promotion efforts among the child and adolescent populations. 

The work in SC surrounding improvements to coordinated and comprehensive health efforts among the child population is extensive in hopes to address complex issues (e.g., build resiliency by providing support services at the community level, address mental/behavioral health issues in a variety of settings).  The CWBC continued to host several webinars as part of its How are the Children Series.  Topics covered as part of this series included child and adolescent outcomes including injury, behavioral health, and COVID-19. 

The Title V program supports the efforts of DHEC’s Immunization Program through promoting resources and outreach and awareness. The Division of Immunization at DHEC plays an important role in improving coordinated and comprehensive health promotion efforts among the child and adolescent populations in South Carolina, per statutory authority, allowing DHEC to have general direction and supervision of vaccination, screening, and immunization in this state. The Federal Vaccines for Children (VFC) Program in South Carolina is administered by the DHEC Division of Immunization and covers vaccines for children 18 and under. According to national immunization survey data from 2019, 68.3% of 24-month-olds in South Carolina were fully up to date for the vaccines recommended by this age.

The DHEC regional immunization programs coordinate school-located influenza vaccine clinics with school nurses and other partners to provide a safe, convenient opportunity for school-aged children to obtain the seasonal influenza vaccine with parent/guardian permission. As a result of parent and school engagement activities, a total of 380 schools participated across the state in the 2021-22 flu season, resulting in 11,246 children receiving at least one dose of the flu vaccine. 

NPM 8.1: Percent of children, ages 6 through 11, who are physically active at least 60 minutes per day.

Title V continued to support the work surrounding NPM 8.1 by working with internal partners and school districts. Through strategic coordination and collaboration between MCH and DHEC’s Division of Nutrition, Physical Activity, and Obesity Prevention (DNPAO), school environment improvements were made to support active living and to improve student health through the implementation of a statewide, web based FitnessGram system.  

DHEC’s DNPAO continued to work with the SC Department of Education (SCDE), the Alliance for a Healthier Generation (Healthier Generation), the MUSC Boeing Center for Children’s Wellness (BCCW), the SC Alliance for Health, Physical Education, Recreation, and Dance (SCAHPERD), BlueCross® BlueShield® of South Carolina Foundation, and the University of South Carolina (USC) to increase physical activity rates of children and adolescents in SC public schools before, during, and after school hours. 

As of September 30, 2021, 19 school districts had adopted the SC School Boards Association’s (SCSBA) Open Community Use of School Recreational Areas model policy. Twelve trainings were provided by DNPAO and partners including virtual statewide conferences, workshops, and webinars. These trainings were offered to statewide and local public health and education stakeholders, including school district administrators and PE teachers, on proven practices and policies to enhance physical activity opportunities for students, including the use of SC FitnessGram data. To date, all 79 public school districts have received professional development on evidence-based practices for providing a school environment supportive of active living, potentially impacting over 750,000 students (ESM 8.1.1).

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

The Title V Program collaborates with DHEC’s Division of Oral Health (DOH) to ensure that the oral health needs of infants and children are addressed within the medical and dental setting. Medical and dental providers can play an important role in improving the oral health of young children and their families by providing risk assessments, preventive care and patient education. The Division of Oral Health has focused on establishing interagency partnerships to improve coordination between oral health services and well child visits.

The DOH developed an online training for medical providers and their staff titled, Improving Health through Oral Health Integration. This oral health integration training is an expansion of the Connecting Smiles Initiative and is a collaborative project with the SC Department of Health and Human Services and other partners, including the SC Chapter of the American Academy of Pediatrics, the SC Primary Health Care Association and the SC Oral Health Coalition. The goal of the Connecting Smiles initiative is to promote and support a collaborative relationship that reaches the citizens of South Carolina, particularly families with young children. Completion of the online training specifically trains staff about fluoride varnish and enables the participants who complete the training to bill Medicaid and be reimbursed for fluoride varnish application. In addition to equipping medical teams with the skills needed to apply fluoride varnish, the online training also provides information about early care of the mouth even before teeth erupt; good feeding habits; the importance of the age 1 dental visit; how to reinforce good nutritional habits for the body and the mouth and how to determine a child’s level of risk for tooth decay. Healthcare providers and staff members also have access to resources that support oral health education for parents and children that can be given to families during well child visits.  

The Division of Oral Health, in collaboration with AHEC, reaches school nurses through an online training that supports the utilization of a basic screening survey to assess a student’s oral health status and support school-based efforts to reach families with preventive oral health messaging.

Table 3. Significance Testing for Child Health Measures