Child Health Annual Report (October 1, 2018-September 30, 2019)

Child Well-Being Coalition:  The Child Well-Being Coalition (CWBC) is a group of volunteer professionals working to alleviate the effects of poverty and improve outcomes and opportunity for all children in South Carolina. The work of the coalition is structured through three workgroups (Health, Education, and Community-Economy), led by a Core Team, and driven by national (KIDS COUNT) and local data (discussed below). The CWBC is coordinated by Children’s Trust of South Carolina, with funding (Title V) and partnership by the South Carolina Department of Health and Environmental Control (DHEC). DHEC and Title V funding have been instrumental to the operation of the CWBC. DHEC leadership has provided guidance and actively participated on the Core Team. Additionally, over the course of the 2018-19 year, DHEC staff assisted the workgroups with solidifying their individual goals and beginning their projects.

Health (KIDS COUNT ranking 38)

Program activities for the Health Workgroup over the 2018-19 year included finalizing their focus area (i.e., working to coordinate and improve access to comprehensive health care for children), supporting the National Children’s Mental Health Awareness Week, and beginning the process of designing a poster that will inform parents about the importance and components of a quality child well-care visit. A key partner in the success of this workgroup has been the Department of Health and Human Services and their relationships with pediatric practices. This workgroup has used vaccination data and began the process of obtaining Medicaid data. The Health Workgroup’s ties to Title V specifically addresses increasing the number of health screenings.

Education (KIDS COUNT ranking 42)

Over the course of the 2018-19 year, the Education Workgroup selected their target demographic (grades 4k-3), a cultural competency training, and identified schools to deliver an implicit bias training for its focus areas (i.e., working to reduce missed school days due to suspension and expulsion). Key partners include the Department of Education, the University of South Carolina, and the participating school districts. This group has used school district data as a benchmark for its progress. The Education Workgroup ties back into Title V through its focus on race equity and inclusion.

Community-Economy (KIDS COUNT ranking 38 and 37)

The Community-Economy Workgroup’s 2018-19 activities are based on addressing food insecurity by increasing participation rates within the Woman Infant and Children (WIC) nutrition program (overall focus area is to work to increase the utilization of nutrition programs by eligible families in poverty). Over the course of the year two separate workgroups (i.e., (Community and Economy) joined forces to examine WIC participation data at the county level, design an intervention to increase participation, and monitor the intervention for success. A key partner for this workgroup has been DHEC who assisted with access to WIC data and materials for the designed intervention, United Way of Oconee for piloting the intervention, and the National Dairy Council for donating materials for the project. The Community-Economy Workgroup supports Title V by promoting and improving access to healthy nutrition services.

State Child Fatality Advisory Committee (SCFAC): The MCH Bureau, as a member of the inter-agency SCFAC, consistently attended committee meeting and participated in review of 234 deaths during this time. Through work in this committee, the bureau continued to be advised on educational efforts needed to address the leading causes of child fatality. The MCH Bureau continued to be an active partner in the delivery of materials related to the South Carolina (SC) legislation which mandated Safe Sleep education to parents of newborns in hospitals, to adoptive and foster parents trained by South Carolina Department of Social Services (SC DSS) and to childcare centers licensed by SC DSS.

Additionally, the SCFAC Coordinator’s position joined the MCH Bureau and continued to help coordinate committee efforts and report development while also advocating for local child fatality review or children’s health and safety councils, teams, and their enhanced coordination and communication with the SCFAC. The SCFAC Program Coordinator maintained the SCFAC web page, Facebook page and Twitter accounts to help facilitate future SCFAC statewide health communication messaging. The committee’s 2019 annual report to the SC Legislature can be found here: https://scfacsc.files.wordpress.com/2020/02/2019-scfac-annual-report-final.pdf

MD STARnet: The specific aims for the South Carolina Muscular Dystrophy Surveillance Tracking and Research Network (SC MD STARnet) are unchanged from the previous year. Each specific aim is listed below.

The SC Muscular Dystrophy Surveillance, Tracking, and Research Network (SC MD STARnet) is a collaboration between the South Carolina Department of Health and Environmental Control (SC DHEC), the University of South Carolina (UofSC), and the state data repository in the Health and Demographics Section of the South Carolina Revenue and Fiscal Affairs Office (RFA). This collaboration supports each institution’s mission to assure and improve the health of South Carolinians. This collaboration has a two-fold purpose: (1) to maintain a dynamic surveillance system for muscular dystrophy that capitalizes on the strengths of the medical record and administrative data available in South Carolina, and (2) to develop and manage a data system that allows us to conduct ongoing analyses of health care utilization, costs, and community participation of people with these conditions.

South Carolina's first 5-year grant cycle funded by the Centers for Disease Control and Prevention (CDC) ended on August 31, 2019. In May of 2019 the SC MD STARnet program was granted a one-year no cost extension, which began on September 1, 2019, to complete activities not completed in year 5 of the current funding cycle. In August 2019 the SC MD STARnet program was refunded by the CDC for an additional 5 years (2019-2024). Year 1 of the new funding cycle began on September 1, 2019.

State School Nurse Program:  The School Nurse Consultant (SNC) continued to connect internal DHEC partners, Oral Health, Immunizations, Acute Disease and Epidemiology, Tobacco, Health Regulations, Children and Youth with Special Health Care Needs, the Bureau of Population Health Data Analytics and Informatics (PHDAI), and Obesity and Nutrition with school nurse initiatives during 2018-2019. The SNC helped to facilitate the collection of oral health data, the improvement of immunization rates, including flu vaccines, in the school aged population, the education of school nurses on the dangers of vaping, understanding sickle cell disease, and recognizing medication diversion in the school setting.

The SNC collaborated with the South Carolina School Nurses Association and Lowcountry AHEC to provide multiple educational opportunities for school nurses. The New Nurse Orientation curriculum was completely revised and added sickle cell education, medication diversion education, oral health screening, and understanding the Individual Healthcare Plan (IHP) to the training curriculum. The two annual conferences included training on the recognition and reporting of medication diversion which is so important during an opioid crisis, and brought together a panel of diabetes stakeholders including, parent, school nurse, student, diabetic educators and an endocrinologist to discuss the evolution of diabetes technology and the benefits and challenges of this in the school setting.

The SNC facilitated triannual meetings with lead nurses called the School Nurse Program Advisory Committee (SNPAC). A variety of educational topics were provided to lead school nurses, new school nurses and nurse attendees at the 38th Annual School Nurse Conference and the 19th Annual SCASN Summer Nurse Conference to enable better care for students with chronic and acute disease and mental illness. Over 500 nurses received professional development during this period.

In 2018-19, the SNC formed two new SNPAC quality improvement focused workgroups in September 2019: Chronic Disease Management and Suicide Prevention. Chronic Disease started by developing a sickle cell IHP which will be shared with lead nurses, charter and private school nurses as a template to individualize for their students.

The Suicide Prevention workgroup started to create a brief survey which will assess the suicide program status in the South Carolina school settings. The workgroups have reached out to non-profit B-Strong to gain input for the IHP and the suicide survey will include input from University of SC, the Department of Mental Health, and the PHDAI Bureau. The SNC is the lead on a Child Safety Learning Collaborative team focused on Suicide and Self Harm Prevention and the team's focus will be to start with the school nurse survey and use it to identify gaps and needs in the school districts of SC related to suicide prevention, intervention and postvention.

Lead Screening: During this reporting period, DHEC’s Childhood Lead Poisoning Prevention Program (CLPPP) maintained our core strategies of surveillance, case identification, environmental assessment and guidance for remediation, and nursing case management. Environmental, epidemiological, nursing, and programmatic positions were fully staffed for most of the 2019.

Staff in the Bureau of Population Health Data Analytics and Informatics (PHDAI) developed and disseminated provider score cards for clinical practices reporting lead tests to DHEC. The score cards provided data on frequency, timeliness, and completeness of reporting, in addition to requirements and strategies for reporting. Data collected through an online survey, and through calls to PHDAI staff indicated that the score cards were well received.

DHEC staff developed a media campaign to address the hazards of “take home lead” among workers in high-risk occupations. Radio and television stations across the state aired 30 second “spots” showing the risks of lead and directing viewers to DHEC’s website and Lead Line (hotline). DHEC selected radio and TV stations based on viewership characteristics and coverage areas where lead-producing industries are known to be located. Web traffic increased during the 2-month period in the fall when the television spots aired. DHEC did not observe a corresponding increase in calls to the Lead Line.

DHEC continued our close collaboration with the Catawba Indian Nation for surveillance, investigation, and remediation services. DHEC continued work with federal, state, regional, and municipal housing providers for remediation of lead hazards for children living in subsidized properties. DHEC continued collaboration with Head Start on referrals and follow-up. Work continues with SC’s Individuals with Disabilities Education Act (IDEA) lead agency to address eligibility requirements for early intervention for EBLL children without diagnosed delays. Work will continue into FFY 2021 to facilitate data-sharing with OSHA to link EBLL children with parents’ occupational lead exposures.

State lead and CDC grant monies fund the work of core CLPPP staff. Regional nursing staff activities are partially funded through state lead dollars; most of their work is funded through Title V MCH Block Grant monies.

Data showed 52,878 SC children under six years of age were reported to DHEC with at least one least blood lead screen in SFY 2019. This was 111.8% over the number of children reported to DHEC in SFY 2018. 909 children under age six (1.72% of children tested) had at least one presumptive positive screen, that being a single capillary or venous result of 5 micrograms per deciliter (mcg/dL) or greater. These children were tracked by DHEC and their healthcare providers with additional testing and lead education. 263 of these children (0.50% of tested children) had at least one venous blood lead test meeting the CDC’s case definition for confirmed elevated blood lead level, 5 mcg/dL. 69 children under six years of age (0.13% of children tested) met DHEC’s 10 mcg/dL threshold for nursing case management and environmental assessments in SFY 2018. 

Table 3. Significance Testing for Child Health Measures

*p<0.05,   **p<0.001; NS=not statistically significant