Children are always learning, growing, and developing. Every child should reach certain milestones in learning, language, motor skills, even in playing. A child’s environment, genetics, and daily interactions with adults and other children can have a great impact on a child’s development. Developmental screens are a critical component to determining if a child is experiencing a delay in any of these areas. Early identification of developmental delays and subsequent early intervention is critical to giving the child the best possible outcome and potentially reducing costly treatment over time.

Parenting education and support was the chosen priority to focus on in the child domain from the 2020 Needs Assessment. Parents and caregivers should be aware of the developmental milestones every child should reach and the importance of screening. In addition, there are many things parents and caregivers can do to ensure optimal development and help their child grow. Families with a child with a developmental delay should also be given adequate support to help address the delay and improve the outcomes for the child.

The MCH Program carries out ASQ and ASQ SE developmental screens through the DOH Community Health Offices (including contracted Public Health Alliance sites). Families who visit a community health office are offered a developmental screen when they come to the clinic for WIC services as well as other services. Families are given education from the ASQ screening kits and laminated posters are displayed in the offices promoting developmental screening. In the event of an abnormal screen, additional education is provided, and a family may be referred to their primary care doctor for follow up.

During this reporting period, the community health staff faced the ongoing challenge of carrying out ASQ screens during the Covid 19 pandemic. Developmental screens are typically given when families come into the office for WIC assessments. However, with the federal waiver allowing WIC certifications to be done over the phone, less families were seen in the office and developmental screen rates dropped by approximately 60%. Some offices, particularly those housed in Court Houses, were affected if the courthouse was closed to public traffic. However, community health staff were allowed to meet clients outside and escort them directly to and from the Community Health Office to receive services, but many families opted not to receive in-person services. Some services such as immunizations were offered to families in the parking lot while the child was in their car seat. While other offices did not close to the public, many families chose not to come in due to the risk of contracting illness. In these situations, staff were still able to offer some services virtually and developmental screens were carried out over the phone. Through these efforts, OCFS staff facilitated the completion of 1413 ASQs and ASQ SEs, and completed interventions with 172 infants and children who needed further evaluation for potential developmental delays. The number of infants and children receiving interventions is much higher than last year’s reported number due to our contracted Public Health Alliance sites now being included in that count.

The MCH Program also carries out developmental screens through the Bright Start Home Visiting Program. This program utilizes the evidence-based Nurse Family Partnership model and offers services to at-risk pregnant women and parents with young children by partnering families with a registered nurse. The majority of program services are offered during home visits, but families and nurses also meet in other locations if the family prefers. Bright Start is funded in part through the Maternal, Infant, and Early Childhood Home Visiting Program (MIECHV) federal grant, as well as through a contract with the South Dakota Department of Social Services using Medicaid and TANF Block Grant funding. The Bright Start Home Visiting Manager serves on multiple Title V workgroups and is supervised by the MCH Director.

During this reporting period, 92% of children enrolled in the Bright Start program had a completed ASQ-3 at 18 months.

National Performance Measure 6:  Percent of children, ages 9 through 35 months, receiving a developmental screening using a parent-completed screening tool

Data Statement: 

South Dakota did not reach the 2020 target of 39.9%, with 36.5% of children ages 9-35 months receiving a developmental screening using a parent-completed screening tool in 2019-2020. This is a decrease from 39.4% in 2017-18. In 2019-2020, South Dakota was ranked 26th in the nation in percent of children receiving a developmental screening tool with a national rate of 36.9%. 

The full-length South Dakota MCH Annual Data Summary can be found here:  

https://doh.sd.gov/documents/MCH/2022_SDMCH_DataSummary.pdf 

State Objective: 

Increase the percent of children from non-metropolitan areas 9 through 35 months who received a developmental screening using a parent completed screening tool in the past year from 22.3% (2019-20) to 29.4% by 2025 (NSCH).   

State Objective Data Statement: 

The 2019-20 South Dakota rate of 22.3% did not meet the 2020 target of 27.3%. This rate among children from non-metropolitan areas was lower than the overall South Dakota rate of 36.5%. There is a data note for this indicator that the rate should be interpreted with caution because the confidence interval width is greater than 20% points. 

The MCH Program has established strategies aimed at improving developmental screening rates through clear and consistent messaging, well-trained staff that provide screenings and education, and identification and remedy of gaps in parenting education and support.

Strategies:

6.1.  Develop and equitably disseminate a clear and consistent message to communicate the importance of developmental screening to families and community health providers

• Disseminated a trifold developmental screening tracking card that can be ordered through the DOH central ordering system. Cards are similar to immunization tracking cards and are given to parents for their records.

• Continued to offer online confidential ASQ screening tool at  https://doh.sd.gov/family/childhood/child-development.aspx
• Provided Learn the Signs Act Early resources to Community Health staff. Staff were given ordering information and encouraged to order resources including books, checklists, and posters as needed.
• The child domain workgroup continues to meet to provide input and support in carrying out the strategies outlined in the Child action plan. This workgroup has representation from Bright Start Home Visiting, SD Parent Connection, the Department of Education, Sanford Health, Avera Health, and the Department of Social Services (Medicaid). The workgroup is always growing and evolving in membership.
• The Child domain coordinator and MCH Director met with the SD WIC Director and staff to discuss how we can better utilize Learn the Signs Act Early materials in the community health offices. Currently, community health staff utilize posters promoting the CDC Milestone Tracker App and also assist families with downloading the app and going through the app’s instructions. Staff are encouraged to utilize other resources including children’s books for families of children 1-3 years, developmental checklists, and tip sheets. Discussion was had about increasing the use of the developmental checklists to augment the ASQ and ASQ-SE education currently provided to families who undergo screening in the community health offices. 
• The Office of child and Family Services has been working on creating an Electronic Health Record (EHR) to be utilized across programs and within the community health system. The EHR will allow for more seamless tracking of developmental screens and referrals.

6.2.  Implement staff training that emphasizes health equity for community health offices that provide ASQ and ASQ SE screenings

• Provided training on administering ASQ and ASQ SE screenings to all new community health and Bright Start Home Visiting staff as part of their orientation. Encouraged staff to use the Brookes Publishing ASQ/ASQ-SE newsletters for continuing education.
• Incorporated training and reminders for Office of Child and Family Services (OCFS) staff to connect families to the CDC Milestone Tracker app. Staff in the community health offices have assisted families in person to download the app and go through instructions for usage, however, the COVID 19 pandemic greatly reduced in person visits in the community health offices for most of this reporting year. Staff were still encouraged to find ways to assist families over the phone with downloading and using the app.

6.3.  Identify and address gaps in parenting education through health equity lens and provide parenting support to South Dakota parents

• In 2021, the Bright Start Home Visiting Program restructured and added a Home Visiting Program Manager. The Home Visiting Program Manager supervises the home visiting nurses and reports to the MCH Director, which created a more seamless line of communication between Bright Start Home Visiting and the MCH Program. The MCH and Bright Start Teams met for a two-day meeting in Summer 2021 to discuss our programs, priorities, and collaboration opportunities. This collaboration is important to reduce duplication of or gaps in developmental screenings and referrals for evaluation. The Bright Start nurses work directly with families and bring a family perspective to the work being done in MCH.
• The MCH Program continues to strengthen its partnership with SD Parent Connection. Parent Connection is a strong resource for gaining insight and guidance on current and up and coming needs faced by the families they serve. They are a member of the child domain workgroup and the child domain coordinator often refers families to parent connection for resources.
• The SD DOH facilitates a child interagency workgroup. The workgroup meets quarterly and is attended by leadership from the MCH Program, WIC, Community Health, Bright Start Home Visiting, Department of Social Services including Medicaid, Behavioral Health, and Child Protective Services, and the Department of Education including Birth to 3. The agencies and programs report on current projects, goals, and activities, and opportunities for collaboration are discussed.
• The MCH Program began promoting strongfamiles.sd.gov on the DOH website as a resource for parents. This site was created by the South Dakota Governor’s Office and provides information on many local resources for parents, including local parenting education classes. In addition, the MCH Program continues to provide connections to SD Birth to 3, CDC Learn the Signs Act Early, Head Start, and SD Parent Connection on its website.
• The child domain coordinator joined a Medicaid well-child affinity group toward the end of this reporting period. The group will meet for two years and focus on improving well-child visit rates amongst the American Indian/Alaskan Native populations in our state. The child domain coordinator will work with the DSS and DOH communication teams to develop printable materials and social media posts promoting well-child visits to pregnant and postpartum American Indian/Alaskan Native women.

Child Death Review

In addition to developmental screening efforts, South Dakota has reviewed post hospitalization infant deaths statewide since 2012. In October of 2020 the SD Department of Health expanded death review to include all child deaths up to age 13.  The process includes two review teams, East River and West River. The East River team reviews infant/child deaths (post hospitalization through age 12) that occur in the 44 counties east of the Missouri River. The West River team reviews deaths that occur in the 22 counties west of the Missouri River. The teams are multidisciplinary and are comprised of volunteers from law enforcement, Child Protection Services, hospital staff, fire departments, emergency medical services, public health, behavioral health, forensic pathology, the Bureau of Indian Affairs, Indian Health Services, the Great Plains Tribal Leader's Health Board, and the States Attorney’s and U.S. Attorney’s offices.

The teams use a common data collection tool (Child Death Review Case Reporting System) so that findings can be reviewed by a state-level advisory group for prevention efforts.  The state-wide Preventable Death committee meets bi-annually to review data and make recommendations to help turn tragedies into lessons that can prevent other deaths.

Data from death review is shared with the public via published infographics and an Infant Mortality Report, developed every 5 years.  A data dashboard also displays information from death review on the Department of Health’s website under Infant Mortality.

With the expansion of death review to include all child deaths up to age 13, discussions began within the MCH child domain around how we can use the data collected to provide parenting education around injury and death prevention. South Dakota has the 5th highest crude death rate in the nation for child mortality (2010-2019, CDC WONDER). Creating educational materials around injury and death prevention was discussed by the Child workgroup as well as the broader MCH team. Following these discussions, the decision was made during this reporting year to bring the DOH Injury Prevention Coordinator in during the following year to co-lead the child domain and eventually take over leadership duties. This will create an opportunity to focus on injury prevention as well as improving developmental screening rates.