In Fiscal Year 2020 (FY20), the Child workgroup members participated in the meetings and activities related to the MCH Needs Assessment process. Beginning in March, workgroup members, South Dakota WIC (SD WIC) and Office Child and Family Services (OCFS) staff became actively involved in the COVID-19 response. The COVID-19 pandemic created some challenges in carrying out some of the year’s planned activities, but progress was still able to be made in some areas.
During our 2015 MCH Needs Assessment two (2) state priority needs were identified that were inclusive of the child population:
- Improve early identification and referral for developmental delays; and
- Promote positive child and youth development to reduce morbidity and mortality (intentional/unintentional injuries, dietary habits, tobacco use, alcohol use, other drug utilization) and assure appropriate access to health services that are focused on families, women, infants, adolescents, and CYSHCN.
Under the National Performance/Domain framework, one (1) National Performance measure was chosen and one (1) State performance measure was identified and the objectives, strategies, and activities for each are identified within the State Action Plan framework. In addition to the performance measure activities there are other child health efforts that MCH team members support to assist in addressing child health priority needs. Efforts include:
- Promoting wellness visits with primary care providers
- Administering and promoting routine immunizations
- Educating families on the dangers of secondhand smoke
- Injury Prevention
- Suicide Prevention
At the end of this reporting period the MCH Impact Team workgroup members assigned to each national or state performance measure were asked to complete a data collection form. The data collection form was a checklist of the strategies that the program was to address during the grant year. The workgroup members rated the degree to which the strategies were implemented, and the percentage of completion is included as the ESM for each measure. In addition to this assessment for each measure, data was reported to provide a quantitative context for each strategy. This ESM process allowed us to better report progress to date on all strategies. Data collection forms can be found at the links below:
https://doh.sd.gov/documents/MCH/2020/DetailSheet_NPM6_FY20.pdf
https://doh.sd.gov/documents/MCH/2020/DetailSheet_SPM2_FY20.pdf
DOH Strategic Plan Goal 2: Support life-long health for all South Dakotans
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 41.4%, with 39.4% of children ages 9-35 months receiving a developmental screening using a parent-completed screening tool in 2017-18. This is a decrease from 42.4% in 2016-17. In 2018-2019, South Dakota was ranked 16th in the nation in percent of children receiving a developmental screening tool with a national rate of 36.4%.
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:
By June 30, 2020, increase the percent of children from non-metropolitan areas who have a developmental screening completed from 34.3% (2017-18) to 35.1%. (NSCH)
State Objective Data Statement:
The 2018-19 South Dakota rate of 26.4% did not meet the 2020 target of 35.1%. This rate among children from non-metropolitan areas is lower than the overall South Dakota rate of 39.4%. 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.
Strategies:
6.1. Partner with other entities (Medicaid, Child Care, Birth to 3, Head Start, Center for Disabilities, etc.) to pursue the development and dissemination of a standard and consistent message to communicate importance of developmental screening
- Incorporated training and reminders for Office of Child and Family Services (OCFS) staff to connect families to the CDC Milestone Tracker app.
- Continued to offer online resources including confidential ASQ screening tool at https://doh.sd.gov/family/childhood/child-development.aspx
- Released a Child Health data brief to the statewide Needs Assessment partners providing information on developmental screening rates in the state.
- Established a diverse workgroup to provide input and support in carrying out the strategies outlined in the Child action plan.
- CYSHCN Director/Child Coordinator met quarterly (as the COVID 19 pandemic allowed) with Medicaid, state Child Interagency Workgroup (including Birth to 3), Developmental Disabilities Council, and Community of Practice State Team to discuss current projects and opportunities for collaboration
6.2. Partner with “Learn the Signs, Act Early” (LtSAE) champion to promote developmental screening within the state of South Dakota.
- The MCH and CYSHCN Directors met with the Learn the Signs, Act Early champion at South Dakota Parent Connection to establish a new connection and discuss ideas for future collaboration. The MCH Program, on behalf of the Department of Health, supported the South Dakota LtSAE champion in applying for and obtaining an AUCD/CDC grant to support recovery and resilience of statewide early childhood systems from COVID 19 impacts as it relates to early identification and intervention. A letter of support was provided by the Secretary of Health. The CYSHCN Director serves on the advisory committee for this project.
6.3. Provide ASQ and ASQ SE screenings at OCFS offices as per DOH policy.
- Provided training on administering ASQ and ASQ SE screenings to all new staff as part of their orientation. Encouraged staff to use the Brookes Publishing ASQ/ASQ-SE newsletters for continuing education.
- Collaborated with Bright Start Home Visiting to reduce duplication of or gaps in developmental screenings and referrals for evaluation.
- 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.
- During this reporting period OCFS staff facilitated the completion of 1,393 ASQs; 1,320 ASQ SEs; and completed interventions with 29 infants and children who needed further evaluation for potential developmental delays.
- Between October 2019 and September 2020, 94% of children enrolled in DOH’s MIECHV program had a completed ASQ-3 at 18 months, an increase of 4% from the last reporting period.
Challenge: The Coronavirus pandemic created a substantial challenge for Community Health Offices to complete ASQs and ASQ SEs. The offices were unable to screen families in person for half of the grant year and had to create new methods of reaching families, including completing screenings over the phone and through the mail. The new methods also came with challenges, including a lack of response and interest from families. A third option of putting the screenings online was discussed but never came to fruition.
ESMs
The degree to which the South Dakota Title V program has implemented evidence-based or informed strategies to improve early identification and referral of developmental delays.
78% completion of identified strategies.
DOH Strategic Plan Goal 2: Support life-long health for all South Dakotans
State Performance Measure 2: Percentage of children, ages 2 to 5 years, receiving WIC services with a BMI at or above the 85th percentile (overweight or obese)
Data Statement:
South Dakota did not reach the 2020 target of 32.0%, with 34.3% of children ages 2 to 5 years receiving WIC services with a BMI at or above the 85th percentile of children in 2020. This is an increase from the 2019 rate of 33.8% and a rate of 33.1% in 2017. It is important to note the number of children whose data was reported for this indicator in 2020 dropped to 2354 from 6797 in 2019. The cause of this discrepancy is still under review, but it may have something to do with WIC services switching to the phone during the COVID-19 pandemic and staff not able to obtain this information
State Objective1:
By June 30, 2020, decrease the percentage of students 5-6 years old with a BMI at or above the 85th percentile from 26.7% (2017) to 25.8% (School height/weight data)
State Objective 1 Data Statement:
In 2019, the percentage of students 5-6 years of age with a BMI at or above the 85th percentile was 34.9% However, this data is not comparable to other years. Due to COVID-19 and schools being closed, only 12200 were included in the total sample, compared to around 43000 in previous years. In 2018, the percentage of students 5-6 years of age with a BMI at or above the 85th percentile was 27.6% and this has not changed between 2015 and 2018. The 2017 rate was 26.7%.
State Objective 2:
By June 30, 2020 decrease the percentage of American Indian children ages 2 through 4 years receiving WIC services with a BMI at or above the 85th percentile (overweight or obese) from 42.5% (2017) to 41.0% (PedNSS)
State Objective 2 Data Statement:
In 2020, 45.9% of American Indian children ages 2 through 4 years receiving WIC services had a BMI at or above the 85th percentile. South Dakota did not reach the 2020 target of 41.0% and there has been a significant increasing trend between 2016 and 2020 in the percent of American Indian children ages 2 through 4 receiving WIC with a BMI at or above the 85th percentile. The 2020 rate of 45.9% is greater than the statewide rate for all races of 34.3%. It is worth noting that the number of children whose data was reported for this indicator in 2020 dropped to 2354 from 6797 in 2019. The cause of this discrepancy is still under review, but it may have something to do with WIC services switching to the phone during the COVID-19 pandemic and staff not able to obtain this information.
Strategies:
S2.1. Engage and support collaboration among state agencies and community partners around nutrition and physical activity.
- Previous reporting period WIC and Head Start established a MOU to collaborate to reduce barriers for participants in both programs – such as providing services in a shared location, utilizing a common referral/release of Information form, and sharing of assessment data. During this reporting period this work has slow down due to staff utilizing their time on COVID-19 response and will start back up as soon as it is safe for both participants and staff.
- The SD DOH, Department of Game, Fish, and Parks, and South Dakota State University (SDSU) Extension continued the Park Rx program across the state. Currently 141 Healthcare Providers and every OCFS Community Health Office (total of 77) are participating in the Park RX program. A complete survey assessment or previous Park Prescription participants can be found here: https://healthysd.gov/park-rx-prescribe-a-day-in-the-park/
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DOH’s Healthy SD Munch Code program developed a Vending and Snack Bar Munch Code toolkit and vending calculator. The Munch Code is a color coded labeling program designed to make it easier for people of all ages to choose healthier snacks on-the-go. GREEN foods and beverages are the healthiest options. You can eat a bunch! YELLOW foods and beverages have added sugar, fat, and calories. Be cautious and have just a little! RED foods and beverages are the highest in sugar, fat, and calories and the least healthy. Eat these occasionally but remember – not so much! There are 2 types of snacking environments where the Munch Code color system can be used:
- Concession Stands – The Munch Code Healthy Concessions Toolkit provides a number of resources including a model policy for schools and community organizations. Toolkits were sent to eight organizations in 2019/2020.
Vending Machines and Snack Bars – The SD Healthier Vending and Snack Bar (HVSB) program has worked with a total of 66 worksites since its start in 2013. The program is based on the SD HVSB standards which use the Munch Code color-coding system to categorize snack foods and drinks available for purchase in worksites. (The Munch Code standards are different for concession stands versus vending machines/snack bars.) The program is guided by the HVSB Toolkit which includes a model policy, policy implementation guide, project checklist, and ten additional appendices providing various tools and resources.
https://healthysd.gov/category/munch-code+workplace/
- SDSU Extension (which provides nutrition education to 7 Native American communities in SD) and the SD WIC Program have begun discussions on possible areas of collaboration in serving these communities. Due to COVID all in-person cooking classes have stopped. Both SDSU Extension and SD WIC have worked together to allow virtual cooking classes as an option for nutrition education.
S2.2. Integrate nutrition and physical activity educational messages into health promotion efforts including social media and other communications.
- A program brochure which explains the WIC program, program eligibility, program benefits, and what to expect at your WIC appointment is in the process of being made available via a mobile application. WIC worked with a local marketing company to update sdwic.org library and it now includes information on physical activity for anyone accessing the website. Topics include limiting screen time, active play for kids & teens and physical activity guidelines.
- In previous reporting WIC has begun utilizing tele nutrition for follow up nutrition counseling appointments in 7 counties. The tele nutrition committee recently met and is considering expansion to other counties/offices and other types of WIC appointments. There has been discussion in regard to developing lesson plans specific for use with tele nutrition. The attempted pilots in previous reporting period unfortunately did not work out but SD WIC is currently look at a web-based tele-nutrition platform that will be rolled out within the next 6 months.
https://healthysd.gov/category/breastfeeding+workplace/
- Partnered with DSS Medicaid to begin updating well-child letters. Medicaid well-child letters are sent out to participants annually to encourage participation and educate on annual well visits requirements. Medicaid Letter were broken down by the follow age groups, 0 to 3 years old, 4 to 9 years old, 10 to 12 years old and 13 + years old. Annual well-child letter for 4 to 5 years old encouraged participants to talk with their primary care provider about any questions regarding healthy eating and physical activity.
- 4 to 9 year old - https://doh.sd.gov/documents/Family/Medicaid_WellVisit_Letter_4-9.pdf
S2.3. Facilitate the provision of technical assistance to childcare centers on the importance of increasing physical activity opportunities within their center.
- Through a partnership with Sanford Health’s CHILD Services, 62 childcare programs received physical activity technical assistance (PATA) influencing over 5,318 children.
- The Department. of Social Services (DSS), Division of Child Care Services provided training to childcare centers on physical activity policy development and evidence-based strategies to create and environment supportive of increased physical activity.
S2.4. Provide Office of Child and Family Services (OFCS) staff with tips/strategies to approach the sensitive subject of weight with parents of overweight and obese children.
- Nutrition staff were provided training at the bi-annual nutrition training in Pierre by Sanford Fit that helped them learn to focus less on the topic of weight and more on keeping kids active and healthy.
Challenges: Limited time available for OFCS and SD WIC staff time to be focus on training outside of the COVID response responsibilities.
ESM: The degree to which the South Dakota Title V program has implemented evidence-based or informed strategies to increase nutrition and physical activity education.
73% completion of identified strategies.
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