CHILD HEALTH

The MCH program continued its focus on improving the rate of children that are completing developmental screening. Developmental screening is part of well child visits offered through the CHCC Children’s Clinic and also is administered in Home Visiting, Head Start, child care centers, and the Early Intervention Program. Priorities for 2020 also included increase the number of children accessing preventive oral health care and routine vaccinations.

On-time vaccination helps provide immunity before children are exposed to potentially life-threatening diseases. As one of the greatest achievements in public health, vaccinations has had the greatest impact on the reduction of the burden from infectious diseases and associated mortality, especially in children. It is estimated that, each year worldwide, vaccines prevent up to 3 million deaths.

Child health activities were impacted by the COVID-19 pandemic. Outreach, trainings, and other events were put on hold as the CHCC initiated an organizational response to focus on addressing COVID-19 in the CNMI.

National Performance Measure 6: Percent of children ages 9 months through 35 months who received a developmental screening using a parent completed screening tool in the past year.

The percent of children, ages 9 through 35 months who received a developmental screening using a parent-completed screening tool in 2020 was 20 percent (n=489).   Out of 2,441 children ages 9 through 35 months in the CNMI, 489 were reported to have been screened through the Ages and Stages Questionnaire: 3rd edition.  The denominator value of 2,441 is based on population estimates in the CNMI provided by the US Census Bureau.  Change in both numerator and denominator value is seen for 2020.  The denominator value for 2020 has increased from 2,077, while the numerator value has decreased from 694 both compared to the previous year.  The number of children screened is based on the unduplicated number of children screened through the CHCC Children’s Clinic, with data maintained through the MCH program. 

There are other programs in the CNMI that utilize the ASQ screening tool such as the Early Head Start and Head Start programs and daycare centers that receive Child Care Development Fund (CCDF) subsidies.  Obtaining screening data has been a continuous challenge due to lack of a central data collection mechanism.  Therefore, there is a great probability that the number of children being screened Is underreported in this measure as children screened outside of the CHCC Children’s Clinic are not represented in this figure.

Strategy: Implement a data system to able to capture developmental screening results, monitor screening rates, and manage referrals to needed services.

The MCH program had anticipated to work on the development of a data system to serve as a central repository for developmental screening data as the CHCC’s current electronic health record system but was not capable of supporting the needs. However, in 2019 the CHCC began the process of a transition from its current electronic health records system to the Carevue EHR, supported through an agency named Medsphere. The initial stages of the transition included completing an assessment to support the development of specific modules needed to address the CHCC’s needs, including a central repository for developmental screening data. The estimated “go live” date for the Carevue EHR is January 2021.  This activity has been delayed due to the COVID-19.  New projected date is October 2021.

Strategy: Increase the number of clinics and early care and education settings that utilize the ASQs.

The MCH program has collaborated with the Child Care Development Fund to provide the Ages and Stages Questionnaire: 3rd edition training to CCDF subsidized daycare providers and staffs.  A total of 51 participants received training to be able to conduct ASQ developmental screening at their daycare centers.  In addition, program was successful with discussing opportunities in expanding developmental screening efforts with one of the private clinics.  However, implementation was postponed due to priorities focusing on the COVID-19 public health emergency for both program and the clinic.   

Strategy: Promote awareness of the importance of developmental screening and monitoring.

MCH program continues to promote awareness of developmental screening and monitoring by making the CDC Milestone Moments Booklets available in Newborn Packets that are distributed to all women prior to discharge from delivery.  Educational handouts have been developed to educate parents of the importance of screening and to help parent’s understanding on completing the parent-completed questionnaires.  Monitoring cards have also been developed for and are provided to parents to record their children’s screening results and to help parents keep track of when the next screening should be conducted.  In addition, the MCH program coordinated with one of the Children’s Clinic providers who conducted a presentation on Well Child Visit including the importance of developmental screening and monitoring through the Family-to-Family Health Information Center.  After the presentation, families had chance to ask questions and discuss concerns with the provider.  There was a total of 42 participants.

Evidence Based Strategy Measure 6: Percent of children that completed an ASQ screening at the CHCC Children’s Clinic during a well-child visit.

Data gathered in 2020 shows that 960 children ages 6 months thru 36 months were seen at the Children’s Clinic for a Well Child visit, and of those 798 children completed an ASQ developmental screening.  A 2.6 percent increase is illustrated compared to the previous year despite the restrictions and families having fear of visiting the clinic due to COVID-19. 

Title V funds are used to support the purchase of ASQ screening materials, resources, and toolkits.  Resources such as activity sheets are printed out and provided to families to help guide parents in providing support to their children.  In addition, age-appropriate books are provided at the Children’s Clinic for children completing developmental screening during a well child visit. The MCH Program also provides technical assistance to the Clinic, monitoring developmental screenings and communicating areas that may need improvement.

Additionally, the MICAH unit has stationed a Program Assistant at the Children’s Clinic who provides one on one assistance to parents who may need support in completing the ASQ tool. Primarily, the Program Assistant sees a majority of parents who bring their children in for the 6-month well-child check as this is the age in which the ASQs are initiated for children seen at CHCC.

National Performance Measure 13.2: Percent of children ages 1 through 17 years who had a preventive dental visit in the past year.

The MCH program collects data from the CHCC Oral Health Program to report on NPM 13.2: Percent of children ages 1 through 17 years who had a preventive dental visit in the past year. In 2020, 6.2 (n= 937) percent of children ages 1 through 17 years accessed preventive oral health care through the CHCC dental clinic. It is important to note that the data is limited to children seen at the CHCC Oral Health Clinic and does not include information on children who accessed preventive dental care through private dental clinics on the island of Saipan. The COVID-19 pandemic and the declaration of the Public Health Emergency in the CNMI significantly impacted dental services offered via the CHCC Oral Health Clinic as well as services provided by the program via outreach (Head Start Fluoride Varnish and School Sealant programs).

Strategy: Increase access to preventive oral healthcare.

Prior to the declaration of public health emergency in the CNMI, the MCH program worked with the CHCC Oral Health Clinic to develop awareness videos that were aired at the local movie theaters during national pediatric dental month in February of 2020. The video promoted preventive oral health care including brushing, avoiding sugar sweetened beverages, and routine preventive dental visits.

The CHCC Oral Health Clinic works closely with the Public School System to provide school-based preventive dental services, namely the School Sealant Program. However, due to the COVID-19 pandemic, dental services were temporarily suspended and schools transitioned to online learning, resulting in school based oral health services being suspended.  School sealants are typically provided to public school system students enrolled in the 2nd and 5th grades on the islands of Saipan, Tinian, and Rota.

The CHCC Oral Health program did resume operations after the temporary closure, prioritizing emergency dental needs and then opening up to routine services.

Evidence Based Strategy Measure 13.2.1: Percent of 2nd and 6th grade students from public schools who receive dental sealants.

In 2020, there were a total of 1,399 2nd and 6th grade students enrolled in the Public School System.  Of the total, 355 students received dental sealants through the CHCC Dental Clinic School Sealant Program.  The data illustrates a 64 percent percent decrease and largely a result of the COVID-19 pandemic.

State Performance Measure 3: Percent of children receiving routine vaccines

There were a total of 1,146 (71.5%) children ages 19 through 35 months who completed the combined 7-vaccine series services out of a total population of 1,603 children. In 2020, the Immunization focused on data quality of the CNMI’s Immunization registry to identify children who are no longer in the CNMI, including those born to tourist mothers who returned to China after birth. Quality improvement efforts, in addition to vaccination strategies enabled the CNMI Immunization program to maintain a high rate of vaccinations during the pandemic.

Through the Immunization Program, the CHCC as a health department, recruits and provides training to Vaccines for Children sites to ensure vaccine handling and safety, proper storage equipment, documentation, and access to the CNMI’s Immunization Registry. Currently, there are seven (7) VFC sites. In addition, the Immunization program conducts monthly assessments of childhood vaccination rates and coordinates reminder calls to parents and caregivers and facilitates school based vaccinations to provide expanded access to vaccinations for families throughout the CNMI.

In 2020, together with the MCH, the Immunization program focused its efforts towards supporting clinical integration of services into the CHCC Children’s Clinic. In March of 2020, at the same time that the CNMI had declared a state of emergency due to the COVID-19 pandemic, the Immunization program worked to implement childhood vaccination during well-child visits at the Children’s Clinic. To support this effort, the program partnered with the providers of the CHCC Children’s Clinic to develop a standing order policy for the administration of routine childhood vaccinations (CHCC Operating Policy: 9154) and provided training to clinical staff.

Cognizant of the potential threat of other infectious diseases to the CNMI population, and most especially to the vulnerable members in the community, the MCH program worked with the Immunization program to conduct thorough data reviews and identify children who needed to catchup on routine vaccinations. Utilizing the information, staff were assigned to conduct outreach telephone calls to families and the programs initiated a monthlong vaccination campaign allowing families to drive up to the CHCC parking lot and receive vaccinations. Over 800 patients received vaccinations during the drive thru campaign.

The CNMI has also been able to maintain coverage rates among adolescent receiving vaccinations. Illustrated in the graph below, in 2020, 95.6% (n= 5,517) of teen ages 13 through 17 years had received at least one dose of the HPV vaccine.

Percentage of 13 – 17-year-old in the CNMI with at least one dose of the HPV vaccine

Data Source: CNMI IIS, WebIz

Strategy: Increase community awareness regarding vaccines.

The MCH program utilized social media and print advertisements on local newspapers to promote awareness of the importance of vaccines for children and teens.  In addition, educational flyers regarding recommended vaccine schedules were provided to all women prior to discharge after a live birth.  In previous years, educational handouts were also shared with community members during community outreach events; however, in 2020, outreach activities were canceled due to the COVID-19 pandemic.

State Performance Measure 6: Percent of resident children, ages 0 thru 17 years, seen at any CHCC site with health insurance coverage.

In 2020, a total of 10,268 children ages 0 through 17 years were seen at CHCC.  Of these children, 5,745 (56%)  children had continuous health insurance coverage

Strategy: Increase access to Medicaid and CHCC Sliding Fee Program application assistance.

The MCH program continues to offer expedited Medicaid application processing for women and children referred to the program, at times facilitating home visits to complete Medicaid application requirements. In May of 2020, the CNMI Medicaid agency submitted a State Plan Amendment which allowed Medicaid application processing under Presumptive Eligibility. This change allowed representatives from the CHCC, such as the MCH Services Coordinator, to make presumptive eligibility (PE) decisions and allowed for 12 months’ continuous eligibility for children under age 19. Coverage under Medicaid increased from 14,189 enrollees in FY2019 to 36,637 at the end of FY2020.