Child Health Annual Report
The Title V MCH Program is dedicated to improving child health outcomes by partnering with families and agencies to help children reach optimal growth, psychological development, and overall health. Child wellness is promoted through developmental screens, school-based health center activities, information sharing about the benefits of a medical home, the value of adequate insurance, and resources pertinent to immunization schedules, Bright Futures recommendations, oral health screenings, physical activity, and weight management. The population distribution by Census tract for children, ages zero to 21, is indicated in the map below.
Title V MCH Program selected NPM 6 and NPM 15 to improve child health outcomes. Program funded partners implement strategies to increase the percent of children, ages 9 through 35 months, who received a developmental screening using a parent-completed screening tool in the past year (NPM 6) and to increase the percent of children, ages zero-17 y.o. who are adequately insured (NPM 15). Health outcomes should improve when developmental screens are conducted and adequate insurance results in consistent medical visits. Additional efforts to improve child health include collection of survey data about five-year old’s for improving early childhood health planning, and referrals made through Nevada 211 call/chat lines and the Nevada Medical Home Portal (MHP). Specific program activities and successes related to these efforts are highlighted below.
Developmental Screening
The Title V MCH Program worked to increase the percent of children, ages 9 through 35 months, who received a developmental screening using a parent-completed screening tool in the past year (NPM 6). According to the National Survey of Children’s Health (NSCH) 2020-2021 report, 21.6% of Nevadan children ages 9 through 35 months received a developmental screening using a parent-completed screening tool in the past year compared to 34.8% nationwide.
To improve developmental screening, Title V MCH Program funded partners, provided over 500 community, parent, and provider education courses statewide concerning developmental milestones and the importance of screening using the Pyramid Model framework. The Pyramid Model is a tiered prevention and intervention framework to avert and address challenging behavior through evidence-based practices. The Pyramid Model consists of four layers:
- The foundation, where systems and policies are developed to ensure an effective workforce can adopt and sustain evidence-based practices
- Tier one, where universal supports for all children occur through nurturing and response relationships and high-quality supportive environments (behavioral needs of about 80% of children)
- Tier two, where prevention through targeted social-emotional strategies is used to prevent problem behaviors (behavioral needs of about 15% of children)
- Tier three, where individualized, intensive interventions comprise the top of the pyramid (required for about 5% of children)
The Title V MCH Program also participated in the WIC Developmental Monitoring Project, a joint project between U.S. Department of Health and Human Services, CDC, and the Association of State Public Health Nutritionists (ASPHN), which improves developmental screening in low-income families. The WIC Developmental Monitoring Project helps WIC respond to concerns from parents about their child’s development, provides an easy way to monitor a child’s early development using CDC Learn the Signs. Act Early (LTSAE) milestone checklists, help parents set goals related to their child’s growth and development, offer parent education about a child’s developmental milestones, and provide WIC with resources to refer a child when indicated. The Title V MCH Program partners with the Nevada Home Visiting (NHV) Program to help support two local implementing agencies. NHV provides Ages and Stages Questionnaire (ASQ) and ASQ-Social Emotional (ASQ:SE) screenings to the families they serve and facilitates resources and referrals to care related to developmental delays. NHV shares Milestone Moments and LTSAE resources with all families they serve in addition to the screenings home visitors provide.
Nevada Pyramid Model Partnership Report - The Children’s Cabinet
The Title V MCH Program provides funding to the Nevada Pyramid Model Partnership, in collaboration with The Children’s Cabinet. Nevada Pyramid Model Partnership is a statewide, collaborative initiative to enhance the ability of early care and education personnel and families to address the social, emotional, and behavioral needs of all young children birth to five years. Using the Pyramid Model, a tiered prevention and intervention framework to prevent and address challenging behavior through evidence-based practices, Nevada Pyramid Model Partnership provides training and technical assistance (TA) for supporting social emotional competence and addressing challenging behaviors in young children at-risk for or those with identified developmental delays.
The Title V MCH Program funds three Nevada Pyramid Model Partnership staff positions, including the Regional Coordinator (RC), Data and Evaluation Coordinator (D&EC), and Family Engagement Coordinator (FEC). The RC provides leadership, TA and training to local and regional Pyramid Model implementation sites and connects with diverse partners to expand potential sites. The D&EC handles data collection and summarization for the ASQ: SE-2 and Pyramid Model evaluation activities. The FEC is a contractual position in collaboration with the statewide non-profit organization Nevada Parents Encouraging Parents, Parents Educating Professionals, and Professionals Empowering Parents (Nevada PEP).
In addition to Title V MCH funding, The Children’s Cabinet worked to expand Pyramid Model implementation and training through new funding from the Child Care and Development Fund (CCDF). CCDF supports three statewide specialists to focus on Pyramid Model entry-level skills and training to reduce the number of children, particularly children on the childcare subsidy program, being asked to leave their programs either temporarily through suspension or permanently through expulsion. This additional funding has allowed Title V MCH funded coordinators to focus on implementation and demonstration sites as well as provide statewide coordination and consistency of training and outreach to sites. In addition, CCDF now funds a coach in northeastern Nevada (Wells Family Resource Center), and the statewide Nevada Pyramid Model Partnership Coordinator, Janice Lee (University of Nevada, Reno).
The Northern Nevada Coordinator revamped all data components used for Pyramid Model programs, and ensured all programs understand what data is required and how to collect it. Participating programs now have a standardized data collection protocol and are working towards data fidelity. All but two programs were able to receive one Teaching Pyramid Observation Tool (TPOT) for preschool assessment which will allow for better classroom level supports.
The Southern Nevada Coordinator onboarded two new implementation sites in October and is in the process of onboarding a site in Clark County as an exploration site.
Coordinators attended 60 site-level leadership team meetings and spent 130 hours of coaching time with implementation and demonstration sites. Coordinators provided most of their coaching focus to Tier 1 (universal) and Tier 2 (prevention) support. Coordinators spent their main coaching hours in these top five categories: leadership team meetings, data collection, problem-solving discussions, data review and TPOT and Teaching Pyramid Infant–Toddler Observation Scale (TPITOS) assessments. Coordinators spent their secondary coaching hours in these top five categories: data review, problem solving discussion, building rapport, goal setting and action planning and reflective conversation.
Nevada Pyramid Model Partnership sites administered 717 Ages & Stages Questionnaire: Social-Emotional, 2nd edition (ASQ:SE-2) screenings. Statewide, 236 participants attended 15 Pyramid Model trainings. For Implementation/Demonstration sites, 171 participants attended 17 trainings. For all participating school district classrooms, a set of materials was provided to support social and emotional skills using the Pyramid Model framework, with most materials provided in English and Spanish. Fact sheets were provided for each family, and some families received additional materials to support their abilities further to teach and support social and emotional skills at home.
Children’s Health and Wellness Outcomes
Through community events and clinic visits, staff distributed child health-related materials. These included, but were not limited to, Title V MCH Program provided resources on Nevada 211, MHP, health care transition, and child well visit promotion through the brochure Does Your Teen Need Health Coverage?.
CCHHS conducted several child health and wellness clinic activities. A CCHHS-created flyer was created promoting a medical home. The flyer was distributed to 725 people presenting for WIC services, allowing for discussion about the value of a medical home. CCHHS sent out 843 vaccination reminder cards for children aged four months through 35-months old. Childhood immunizations and the Medical Home Portal were endorsed through outreach events and health promotion marketing campaigns, including clinic digital signage. Child vaccination Facebook messages reached 1,806 people with 0.72% engaged users and Medical Home Portal social media was viewed by 6,557 individuals with 5% being engaged users.
CHS served children within clinic settings and through community immunization events, and 4,015 vaccines were administered to 1,883 children and youth ages 1-21 y.o. Adolescents and young adults, comprised 21% of the child immunization numbers with 28% of the children being between the ages of 15-21 y.o. During community point of dispensing sites Title V MCH Program funded education, resources, and referrals were provided.
Title V MCH Program disseminated child health topic content to be displayed on the MCH Coalition and Office of Primary Care e-newsletters. Child health items included COVID-19 vaccine information, Bright Futures Mini Training Modules, Minority Health Month resources, and social-emotional, behavioural, and mental health resources to enhance childhood resiliency, etc.
Numerous webinars and resources were created and shared statewide by the MCH-Immunizations CDC Foundations Assignee which were very well attended and received.
Continuous and Adequate Health Insurance
NPM 15 efforts were conducted to increase the percent of children ages zero-17 y.o. who were continuously and adequately insured. The NSCH 2020-2021 report, showed 63.9% of Nevadan children ages zero-17 y.o. to be consistently insured throughout the report year, compared to 68.2% nationwide. Title V MCH Program and funded partners promoted the value of continuous and adequate insurance through listservs, brochures, e-newsletters, and social media.
Award funded public health nurses from CCHHS and DPBH CHS Program provided insurance resources and referrals to uninsured people in Nevada's rural and frontier regions through Nevada Medicaid, Nevada Check Up, and Nevada Health Link. Undocumented residents and those not eligible for Medicaid or other insurance were referred to the AHN Medical Discount Plan.
To increase access to care, the Title V MCH Program disseminated 34,000 (19,000 English/15,000 Spanish) of the brochure Does Your Teen Need Health Coverage? informing how to apply for health insurance. Primary distribution partners included DWSS, DCFS, Nevada Health Link, Title V MCH funded partners, and community agencies working to enhance the uptake of yearly adolescent well-visits. Prior to the pandemic, closer to 50,000 were disseminated; however, agencies not handing out print materials received electronic links to the documents for dissemination. The bulk supplied was disseminated within eight weeks of the insurance open enrollment period for 2023 coverage.
Maternal, Infant, and Early Childhood Home Visiting, partly funded by Title V MCH works directly with families of young children to facilitate completion of insurance enrollment referrals with the aim of increasing adequate insurance coverage.
Washoe County Fetal Infant Mortality Review (FIMR) uses Title V funding to study a variety of factors affecting the health of the mother, fetus, and infant to understand how to reduce fetal and infant mortality. To identify insurer-specific opportunities to reduce infant mortality gaps and look for opportunities to expand care, FIMR tracks the mother's insurance type during pregnancy and separates categories based on private, Medicaid, and no insurance.
The Division of Health Care Financing and Policy (DHCFP)/NV Medicaid works in partnership with the U.S. Centers for Medicare & Medicaid Services (CMS) to provide quality medical care for eligible individuals and families with low incomes and limited resources. Services are provided through a combination of traditional FFS provider networks and four large contracted managed care organizations. Medicaid partners with Title V MCH for informational and referral resources on the Katie Beckett waiver program, development of the one-sheet on Medicaid coverage for legally present children, and many other NPM 15-related efforts. Efforts between DHCFP/NV Medicaid, DHHS, and Title V MCH staff focused on increasing adequate prenatal care.
Nevada Institute for Children’s Research and Policy Kindergarten (NICRP) Heath Survey
Title V MCH Program funded the Nevada Institute for Children’s Research and Policy (NICRP) to conduct an annual health survey of children entering kindergarten in partnership with all school districts. Survey data provides estimates for monitoring MCH indicators and reporting to local, state, and federal entities. Desired outcomes are to inform efforts on how to improve future programming for child health.
The Health Status of Children Entering Kindergarten in Nevada (2021-2022 results) was posted on NICRP’s website and the agency distributed the report statewide to partners. Title V MCH Program shared the reports with awarded partners, the MCH Coalition and PCO e-newsletters for mass distribution.
NICRP circulated questionnaires to all public elementary schools statewide (paper and electric). NICRP received 7,058 surveys (23.3% response rate) from parents in 16 of the 17 school districts. All data was weighted (n = 30,198) to derive comparisons on issues representing Clark. Washoe, and Rural counties combined.
Children’s Behavioral Health
Title V MCH Program attended child focused social-emotional, behavioral, and mental health meetings through the Nevada Children’s Behavioral Health Consortium, Nevada Department of Education (NDE) and Division of Child and Family Services (DCFS). Topics of interest included Medicaid billing updates and policy changes, services assisting CYSHCN, activities conducted through the DCFS Systems of Care Grant, and School-Based Mental Health Services. NDE and DCFS Collaboration Meetings involved active sessions to build the Interconnected Systems Framework for state agencies working on childhood resiliency. Discussions and workgroups focused on compiling a comprehensive document of state programs assisting children in crisis. In the next report period, action plans will be discussed how to disseminate the information, allowing state and private agencies to learn what is available for those in crisis.
School-Based Health Services
Title V MCH Program provided guidance to agencies interested in setting up school-based health centers (SBHC) through sharing contacts and resources for successful SBHC outcomes. Staff referred SBHC sponsoring agencies setting up facilities with Medicaid billing questions to Nevada’s DHCFP
Title V MCH Program enhanced their partnership with DCHFP through several meetings resulting in collaborative efforts. Key conversations focused on learning the differences between SBHC and School Health Services (SHS) operations and Medicaid billing systems. SHS, a program within DPCFP was created with the implementation of a recent state plan amendment expanding allowable billables under Provider Type (PT) 60 to increase sustainability. The PT 60 billing code benefits are now contained inside the Nevada SBHC Toolkit. Title V MCH Program joined the SBHC special interest group organized by the State Adolescent Health Resource Center (SAHRC), funded by HRSA. A small group of state adolescent health coordinators and SAHRC leadership, convened to share efforts conducted and planned to enhance uptake of SBHC visits, standards of care, and quality improvement measures.
The Joint Interim Standing Committee on Health and Human Services voted to present a bill draft review to the 82nd (2023) Session of the Nevada Legislature pertaining to SBHCs. Title V MCH Program provided input for the study to review Medicaid reimbursement rates to create parity among different provider types. Additionally, DPBH contributed to the portion for the study to consider opportunities to incentivize SBHCs through the promotion of well visits, value-based payments, etc.
Vaccinations for COVID-19 and Influenza
Through partnership with the Immunization Program, Title V MCH funding enabled a mobile vaccine vendor, OptimuMedicine, to administer COVID-19 and flu vaccinations to children statewide from June to September 2022. OptimuMedicine provided 2,749 COVID-19 vaccinations and 523 flu vaccinations to children 18 y.o. and younger.
Child Health Domain Accomplishments
Title V MCH Program focused on improving the health status of children to reduce negative long-term implications for health, productivity, and longevity. Funded partners dedicated efforts to help children reach optimal physical growth, psychological development, and overall health. Parents/caregivers, providers, and partners received best practice information about developmental screens, benefits of a medical home, value of being adequately insured, immunization schedules, oral health screenings, and physical activity and weight management. For this reporting period, Title V MCH extended funding in collaboration with the state Immunization Program to administer vaccinations for COVID-19 and influenza to children through a mobile vaccination vendor.
The Health Status of Children Entering Kindergarten in Nevada (2021-2022 results) report showed behaviors in the health status category remaining relatively steady with only slight fluctuations from last year. This was the sixth consecutive year rates improved for infants being exclusively breastfed for each age category.
Title V MCH Program enhanced their partnership with DCHFP through several information sharing meetings and collaborative efforts. Discussions resulted in DHCFP contributing to Medicaid revisions in the Nevada SBHC Toolkit, exploring parity in reimbursement rates for state certified SBHCs, consideration of incentives to SBHCs promoting well visits, and value-based payments.
MCAH created new partnerships with state agencies to build childhood resiliency due to gaps identified in the Title V Five-Year Needs Assessment.
Child Health Data
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 the 2020-2021 NSCH, 21.6% of Nevadan children ages 9 through 35 months received a developmental screening, which is down from 30.6% in 2018-2019. Nevada is below the 2020-2021 national average of 34.8%, and ranks near the bottom at 47th out of the 50 states and D.C.
NPM 14.2- Percent of children, ages 0 through 17, who live in households where someone smokes
The 2020-2021 NSCH found 14.2% of Nevada children ages 0 through 17 live in households where someone smokes, a percentage which has been fluctuating but overall declining from a high of 17.7% from 2016-2017. Nevada is slightly higher than the national average of 13.8% from 2020-2021. Nevada ranks below the median, at 26th out of 50 states and D.C. When stratifying Nevada data by health insurance, households with Medicaid insurance have the highest percentage for someone who smokes at 17.5%, followed by uninsured households (17.3%), and private insurance (12%).
NPM 15- Percent of children, ages 0 through 17, who are continuously and adequately insured
According to data from the NSCH the percent of children who are continuously and adequately insured has remained relatively stable from 62.2% in 2016 to 63.9% from 2020-2021. This is lower than the 2020-2021 national average of 68.2%, and Nevada ranks near the bottom at 44th out of the 50 states and D.C. Disparities exist in Nevada for this measure, but improvement was seen for Non-Hispanic Black children over the past year, as the percentage insured increased from 52.7% in 2019-2020 to 73.9% in 2020-2021. This is the highest insured percentage among all racial and ethnic groups. Non-Hispanic Asian children have the lowest percentage at 53.3%, followed by Hispanic children at 58.9%. Non-Hispanic White and Non-Hispanic Multiple Race are above the Nevada average, at 66.1% and 71.8%, respectively.
To Top
Narrative Search