MCH Block Grant FY21 Application & FY19 Report
Child Health Domain
NPM-06: Developmental Screening: Percent of children, ages 9 through 35 months, receiving a developmental screening using a parent-completed screening tool in the past year
FY19 Annual Report
Program Activities:
The Performance Measure was not achieved. The Performance Objective was 32.2% and the Annual Indicator was 31.1%. This data was obtained from the National Survey of Children’s Health (NSCH), combined 2017-2018 data. However, due to a high percentage of missing values, NSCH specified that data for NPM-06 might not be reliable.
Activity #1: Improve the developmental screening rates of programs that are currently enrolled in the UDOH Ages and Stages Questionnaire (ASQ) online account.
In order to discover an accurate screening rate baseline for programs enrolled in our Brookes Publishing/UDOH ASQ Online Enterprise Account our program, Early Childhood Utah (ECU), inventoried all of our ASQ online accounts. We discovered 175 accounts had been created since UDOH began our Developmental Health Promotion Program in 2010.
Within Utah’s 2019/2020 ESMs for NPM-06, ECU defined active accounts as programs that completed an online screen within the previous twelve months. According to this definition, there were eighty-six inactive Early Care and Education (ECE) provider accounts/programs. Inactive ECE providers included Early Head Start/Head Start programs and licensed childcare programs. Seventeen of these inactive accounts were subaccounts originally created for Local Health Departments (LHD). Six inactive accounts were for child care resource and referral agencies who establish accounts in order to facilitate family child care providers’ access to ASQ training and materials. Three inactive accounts were UDOH test/mock accounts created for training purposes. There were also nine miscellaneous inactive accounts created for home visiting, early intervention, tribal, and other early childhood health programs. After an appropriate level of outreach and continued tracking of screening activity, all ASQ online accounts deemed inactive have been disabled. Disabled accounts are easy to activate should an early childhood program decide to participate in the UDOH Developmental Health Promotion Program again.
In an effort to continuously improve screening rates, between 12/7/18 and 3/3/20, ECU enrolled fifteen new programs and re-enrolled thirty-one programs in our ASQ online Enterprise account.
Care types that currently participate in the UDOH ASQ online account include licensed child care programs, Early Head Start/Head Start grantees, Early Intervention IDEA Part C programs, LHDs, MIECHV local implementation sites, State Education Agency funded programs, community health centers, universities, and one of our most active screening programs, Help Me Grow Utah.
With regards to increasing developmental health screening rates, forty-nine active programs completed 15,339 screens in 2019. In 2018, forty-one programs completed 13,120 screens.
Below is a list of currently enrolled screening programs, by care type and by service delivery area. Two of the programs, Help Me Grow Utah and Davis County Health Department, completed 6,972 or 45% of our screens. Over time, we hope to duplicate Davis County’s screening accomplishments with several of the State’s LHDs.
Activity #2: In order to promote the importance of infant/toddler and preschooler developmental health, ECU will continue to work closely with our many early childhood stakeholders, partners, and with the larger ECE community. Emphasis will be placed on the importance for ECE providers to integrate the use of reliable and valid screening tools, such as the ASQ, into their curriculum and/or practice.
ECU is currently collaborating with many partners including licensed and regulated childcare and Head Start programs, MIECHV home visitors, Office of Home Visiting (OHV), community health and mental health practitioners, and with state and/or federally funded preschool programs to provide critical recommendations and information to the newly formed Utah Governor’s Commission on Early Childhood. We strive to strengthen these partnerships in order to promote the importance of infant/toddler developmental health and integrating reliable screening tools, like the ASQ, into their ongoing practice and curriculum.
ECU is implementing ASQ Developmental Screening training for the Early Childhood Comprehensive Systems’ (ECCS) three place-based communities (PBC), OHV, Office of Child Care, Statewide LHDs, and anyone in the community who is interested. This is a training program created to increase overall knowledge and use of the ASQ developmental screener and access the UDOH ASQ Database, expanding the current number of screens statewide. All LHDs are directly involved with outreach to and services with pregnant women and parents/caregivers of young children. Our collaboration with the Office of Home Visiting, to improve healthy development of children, through contracts with three home visitors, one in each PBC area, increases caregiver well-being and understanding of the importance of early childhood development. We have established community resources and coordinated strategies that are currently strengthening our PBC areas but are also establishing community partners whose systems’ work is invested in the use of the ASQ developmental screening as a vital tool in their individual practices strengthening the families and children they work with.
Activity #3: ECU will utilize ASQ data to track children whose screening scores fall within the monitoring zone and/or below cutoff. Not only is it essential for as many 9-35 month olds to receive age aligned developmental screening as possible, but it is equally important for families to receive access to the resources and/or services they may need to best improve the developmental trajectory of their child/children.
ECU utilized a variety of methodologies, metrics, and data to measure and monitor ASQ online screening results. Our team has a laser focus on the developmental health of the state’s infants and toddlers, otherwise known as Zero-Three.
Activities included (all data shared/reviewed is aggregated data):
- Track the number of ASQ screens children receive across the state with additional focus upon our PBCs and 0-3 year olds.
- Track the number and proportion of screens that are above cutoff, in the monitoring zone, and/or below cutoff.
- Track the number of ECE and health programs that are actively participating in the UDOH ASQ Online Enterprise Account.
- Track the number of family/child “intake calls” that are made to Help Me Grow from residents of our PBCs.
- Track the number of Help Me Grow intakes and screens that result in referrals for additional assessment/intervention (for residents of our PBCs).
Recently we added below cutoff by program and below cutoff by domain reports to our mix of data to review, analyze, and present to our Early Childhood Stakeholders as applicable.
We monitor the progress of our screening program by, 1) generating the aforementioned data out of the ASQ Online account; 2) analyzing the screening data for trends; 3) transforming the data into visuals that are easy for targeted teams to understand and discuss; and 4) meeting together monthly with targeted community leads to review monthly dashboard data, and biannual Help Me Grow intake/referral reports, along with comprehensive annual reports.
Another method employed for tracking our program’s progress is the reporting out of grant objectives, ASQ and Help Me Grow metrics, and narrative reports with Utah’s State Advisory Council, otherwise known as the Early Childhood Utah Advisory Council. ECU members offer critique on the data and on the interventions underway, and suggest ways to improve service delivery and avenues to involve additional partners. The ECU Advisory Council is also poised to make broad and specific recommendations to the newly legislated and formed Early Childhood Governor’s Commission.
Accomplishments / Successes:
In 2019, forty-nine programs completed 15,339 developmental health using the UDOH ASQ Online Enterprise Account. In 2018, forty-one programs completed 13,120 screens. This represents a one-year increase of 17%. This data is for all ages, both ASQ-3 and ASQ-SE, during the 2019 calendar year.
In 2019, Early Childhood Utah staff conducted an inventory and “cleansing” of the programs enrolled in our ASQ Online Enterprise Account. This inventory resulted in the disabling of eighty-six inactive accounts, re-enrolling thirty-one active programs, and enrolling fifteen new providers. Conducting this inventory and the enrollment/re-enrollment process provides ECU with enough detailed information to establish a clear line of communication with every active program. Future communication highlights may include information on 1) ASQ training opportunities, 2) ASQ tips/tricks for generating useful screening reports, and 3) an emphasis on the importance of referrals to additional services and/or activities to improve developmental health outcomes.
Our ASQ Online provider inventory and “clean-up” also affords ECU the improved ability to track ASQ screening data on a more granular and detailed level, such as by the program’s service delivery area and/or by care types. Additionally, ASQ data can now be more easily monitored for below cutoff percentages in conjunction with program outreach as needed and as applicable.
Another accomplishment in 2019 was the realignment and rejuvenation of the ECU Advisory Council. Through quarterly ECU Advisory meetings and through bi-monthly ECU subcommittee meetings, we promote the importance of integrating developmental health screenings into practices across the state. A big win for Utah in 2019 was the onboarding of an Early Childhood Governor’s Commission. This recently legislated body is another avenue ECU can utilize to promote age aligned and parent completed developmental screening opportunities across the state.
In 2019, through one-time Preschool Developmental Block grant funds, Utah developed and published an Early Childhood (ages 0-5) Statewide Needs Assessment, along with a 0-5 Early Childhood Systems Strategic Plan. The importance of promoting developmental health screening for young children was included in both of these comprehensive reports. Utah’s legislators, the Early Childhood Governor’s Commission, and Early Childhood Utah will utilize both of these reports to inform our path forward.
Finally, another significant accomplishment for Utah in 2019 was the integration of the UDOH ASQ Online database with our Early Childhood Integrated Data System (ECIDS). Through this data integration, UDOH is poised to examine how many distinct children receive ASQ screens and services by one or more programs. ECIDS>ASQ reports are able to display screening results alone or in combination by time frame, zip code, interval, and program. Programs that participate in the UDOH ASQ Online Enterprise Account will be given access rights to ECIDS>ASQ reports so they can easily generate ASQ data and visualizations specific to their program.
Summary of successes and accomplishments on “Moving the Needle” in relation to NPM-06:
- There were 15,339 ASQ screens contributed to the UDOH ASQ online account (all ages, both tools, all programs).
- Using the UDOH ASQ online account, 6,730 children ages 9 - 36 months old, received an ASQ-3 screen.
- Using the UDOH ASQ online account, 1,427 children ages 12 - 36 months old, received an ASQ-SE2 screen.
- Fifteen new screening programs were enrolled/on boarded in the UDOH ASQ online account.
- Thirty-one UDOH ASQ online programs were re-enrolled.
- An ASQ training curriculum and training schedule, sponsored by UDOH, was established for 2020.
- Utah's State Advisory Council for Early Childhood was rejuvenated and realigned as the Early Childhood Utah Advisory Council.
- An Early Childhood Governor's Commission was sworn in and orientated.
- ECU Rules and Regulations were submitted to the state rules division.
- ASQ data integration with the UDOH Early Childhood Integrated Data System.
Challenges / Gaps / Disparities:
In FY19, challenges included, maintaining sustained efforts to inventory and “clean-up” our ASQ Online account through various modalities of outreach to both active and inactive screening programs. At times, it was challenging to achieve contact with programs and then ascertain their commitment to continuing in our ASQ online initiative.
Developing a training schedule and curriculum that worked for screening programs that provide services across the state like LHDS, licensed childcare programs, MIECHV, and state funded home visitors was challenging.
Related challenges included working with the vendor, Help Me Grow Utah (HMG), to ensure they had a qualified/certified ASQ trainer in place so that both our program, Early Childhood Utah, and HMG could provide training across the state.
Another significant challenge for our team has been the need to adjust to the steady turnover of key contacts and leads within our PBCs. Our program expends a considerable amount of effort focused upon increasing developmental screening opportunities and appropriate referrals/follow ups within our PBCs. When we lose key contacts or leads to agency turnover, we take the time to build new relationships and assist with bringing new contacts/leads up to speed with this important program.
Since 2010, UDOH has distributed over 400 ASQ-3 and ASQ SE/SE2 kits in English and Spanish. Each kit costs $300, resulting in a $119,700 expenditure in just over 10 years, or
approximately $12,000 per year.
Further ASQ expenditures include our ASQ Online Enterprise Account with the Family Access feature, along with additional charges per screen completed; these costs average well over $10,000 annually.
The HRSA/ECCS CoIIN grant has helped to fund the ASQ online program costs listed above, as well as supporting developmental health promotion program staff and our data integration efforts. The HRSA/ECCS grant expires in July 2021; as such, an emerging issue is how will this invaluable program be funded in the future?
Another emerging issue is the overarching need for a widely accessible, “real-time” ASQ and follow up database. Our many early childhood stakeholders consistently express a desire for early care and education, and health providers to have access to real time ASQ data that would reveal whether a child has had a previous screen or not. Stakeholders also express the need for dynamic database information that pertains to the disposition of the child/family, concerning any follow-up referrals and/or additional assessments that may be indicated.
Obviously, a significant emerging circumstance revolves around myriad issues the Coronavirus 19 Pandemic will leave in its wake. Specially for NPM-06, will infants/toddlers and families continue to receive direct, face/face services that promote early developmental health, services such as high quality child care, Early Head Start/Head Start, Home Visiting, Early Intervention Parts B and C, state funded Pre-K, etc.? One also has to wonder if the need for developmental health screening will increase exponentially after this crisis subsides, and if so, will there be an increase in funding to support wide-scale efforts?
Agency Capacity / Collaboration:
Early Childhood Utah (ECU) is the program at UDOH that orchestrates the lead agency’s developmental health promotion program. ECU is also the program designated by the Governor’s office to function as the State Advisory Council on Early Childhood; otherwise known as the Early Childhood Utah Advisory Council. Due to our unique position as the body responsible for improving early childhood systems, we work closely with dozens of agencies and programs that provide direct services to families with young children. Promoting healthy development and ensuring all children have consistent access to age aligned developmental screening is a high priority for this legislated collaboration.
ECU works strategically with the agencies and programs listed below, most of these agencies/programs also report back to their own advisory councils and subcommittees, which includes teams of parents, families, and/or service consumers:
The Utah Office of Child Care, Weber State University-Early Learning Program, UDOH Maternal Infant Early Childhood Home Visiting, Medicaid Targeted Case Managers, the Utah Chapter of the American Academy of Pediatrics, the Governor's Office and Legislators, United Way, Help Me Grow Utah, Child Care Resource & Referral Agencies, the City of South Salt Lake, the Ogden United Promise Neighborhood Prenatal to Three Committee, the San Juan County Early Childhood Commission, the Head Start Association and Collaboration Office, Intermountain Health Care, Midtown Community Health Clinics, Voices for Utah Children, Utah Navajo Health System, School Districts, Division of Human Services, and Early Intervention Part C IDEA, Utah State Board of Education, and County Public Health Departments.
Summary Progress Report (2020) of ESMs related to NPM-06
The following four ESMs (6.1 – 6.4) have been deactivated*.
ESM 6.1 - Early Childhood Utah (ECU) effort to increase ASQ screenings: Number of ASQ screenings conducted by early care and education providers
ESM 6.2 - Early Childhood Utah (ECU) effort to increase ASQ screenings: Number of ASQ screenings conducted by early care and education providers
ESM 6.3 - Help Me Grow Utah (HMGU) ASQ screenings: Number of ASQ screenings conducted by Help Me Grow Utah (HMGU) staff
ESM 6.4 - Healthcare provider well-child checks: Number of ASQ online screenings done during well-child checks
*These measures were deactivated and replaced as the data were too difficult to extract from the database. New measures have been developed that more accurately reflect current activities.
ESM 6.5 – Active participation of enrolled programs: Increase the percentage of enrolled programs that actively participate in the UDOH ASQ online account.*
Goal/Objective:
Increase the participation of enrolled programs in the UDOH ASQ online account by 10%. It is hoped that by tracking this measure and by increasing the number of ASQ online training sessions Early Care & Education and Health programs have access to, ASQ online enrollment and participation will increase. Ideally, this will lead to an increase
Significance of ESM 6.5:
Developmental screening is a critical element of well-child care and an important opportunity to engage families in the process of developmental health promotion. The screening process is used to determine if development skills are progressing as expected or if there is cause of concern and further evaluation is necessary. This ESM is significant to increasing the number of developmental screens received by children ages 9 - 35 months. In order to increase the number of screens received by infants/toddlers we need to increase the number of Early Care & Education and Health programs that offer developmental screening services to families with young children. ECE and Health programs cannot provide ASQ online services without first being trained in ASQ online. If UDOH can sponsor an increased number of ASQ online training opportunities, additional ECE and Health providers will enroll in the UDOH ASQ online account, and hopefully, actively participate. Ideally, increased ASQ online training opportunities will lead to an increase in the number of developmental health screening opportunities for 9 - 35 month year old children.
ESM 6.5 Progress Report:
The only way to increase the percent of children, ages 9 months through 35 months, who receive a parent-completed developmental screening, is to increase the actual number of screening opportunities that are given to families with newborns, infants, and toddlers. Correspondingly, one of the methods for discovering if Utah is increasing the number of screens received by the target age group is to increase the level of participation in our ASQ Online Enterprise Account. Finally, training, enrolling, "activating," and then facilitating ongoing/sustained screening practices is the critical foundation for increasing the percent of screens received by 0-3 year olds.
It is interesting to note that the NPM-06 Federally Available Data on the prevalence of 9 months to 35 months receiving developmental screening in Utah is derived by polling 100 parents of the targeted age group, and asking them if they completed a screen with language or social development questions. For this particular NPM measure, the Child and Adolescent Health Survey website cites that the Confidence Interval Width exceeds 20 percentage points and the data is missing values more than 2% and as such, this FAD may be deemed unreliable; 2017-2018 combined data sets.
According to actual screening data from the UDOH ASQ Online Enterprise Account, Utah has steadily increased the number of screens, received by all ages and received by 0-3 year olds. Over the last five years, Developmental Health Screens for all ages increased by 122%, and screens for 0-3 year olds increased by 58% as evidenced by the screening data displayed below:
Statewide usage reports for all participating programs, by calendar year
|
|||||||
|
2015 |
2016 |
2017 |
2018 |
2019 |
Total |
Increase rate |
ASQ-3 and ASQ SE, all ages |
6,901 |
7,673 |
10,436 |
13,120 |
15,339 |
53,469 |
122% |
ASQ-3 only, ages 0-3 |
6,208 |
5,992 |
7,777 |
8,892 |
9,785 |
38,654 |
58% |
ESM 6.6 - New program enrollment: Increase the number of programs enrolled in the UDOH ASQ online account by 10%.
Goal/Objective:
Increase the number of programs enrolled in the UDOH ASQ online account by 10%. One aspect of an essential method for increasing the number of parent-completed developmental screens received by 9 month - 35 month year old children is to track/monitor the number of screens that are contributed to our ASQ online Enterprise account.
Significance of ESM 6.6:
Early identification of developmental disorders is critical to the well-being of children and their families. Nationally, the percent of children with a developmental disorder has been increasing, yet overall, screening rates have remained low. The American Academy of Pediatrics recommends screening tests begin at the nine-month visit. This measure is significant because only by monitoring and increasing the number of programs participating and the number of screens contributed to our ASQ online Enterprise account will we be able to increase the percentage of 9 month - 35 month year old children that receive parent-completed developmental health screening opportunities.
ESM 6.6 Progress Report:
The only way to increase the percent of children, ages 9 months through 35 months that receive a parent-completed developmental screening is to increase the actual number of screening opportunities that are given to families with newborns, infants, and toddlers. Correspondingly, one of the methods for discovering if Utah is increasing the number of screens received by the target age group is to increase the level of participation in our ASQ Online Enterprise Account. Lastly - training, enrolling, "activating," and then facilitating ongoing/sustained screening practices is the critical foundation for increasing the percent of screens received by 0-3 year olds.
It is interesting to note that the NPM-06 Federally Available Data on the prevalence of 9 months to 35 months receiving developmental screening in Utah is derived by polling 100 parents of the targeted age group and asking them if they completed a screen with language or social development questions. For this particular NPM measure, the Child and Adolescent Health Survey website cites that the Confidence Interval Width exceeds 20 percentage points and the data is missing values more than 2% and as such, this FAD may be deemed unreliable (2017-18 combined data sets).
According to actual screening data from the UDOH ASQ Online Enterprise Account, Utah has steadily increased the number of screens, received by all ages and received by 0-3 year olds. Over the last five years, Developmental Health Screens for all ages increased by 122%, and screens for 0-3 year olds increased by 58% as evidenced by the screening data displayed below:
Statewide usage reports for all participating programs, by calendar year
|
|||||||
|
2015 |
2016 |
2017 |
2018 |
2019 |
Total |
Increase rate |
ASQ-3 and ASQ SE, all ages |
6,901 |
7,673 |
10,436 |
13,120 |
15,339 |
53,469 |
122% |
ASQ-3 only, ages 0-3 |
6,208 |
5,992 |
7,777 |
8,892 |
9,785 |
38,654 |
58% |
For 9 mo - 36 mo ASQ-3 = 6730 (out of 11,389 - all ages)
For 12 mo - 36 mo ASQ SE-2 = 1427 (out of 2641 - all ages)
*Following the 2020 MCH Needs Assessment, ESM 6.5 and 6.6 have been deactivated.
MCH Block Grant FY21 Application & FY19 Report
Child Health Domain
NPM-13B: Percent of children, ages 1 through 17, who had a preventive dental visit in the past year
FY19 Annual Report
Program Activities:
The Performance Measure was not achieved. The Performance Objective was 84.8% and the Annual Indicator was 81.4%
In October 2018, some changes were made in the Oral Health Program (OHP) structure. The OHP was a program directly under the MCH Bureau, but now it is a program in the Family and Youth Outreach Program. The State Dental Director (SDD) is not in this new program, but is directly under the MCH Bureau Director. His time was also changed from 0.5 FTE to 0.25 FTE in this position. The OHS and the OHE continued to be full-time.
The SDD started working 0.75 FTE for the Family Dental Plan Clinics operated by the Utah Department of Health instead of 0.5 FTE. He continued to serve as the Assistant Clinical Director and the State Occupation Health Officer for the program. He also provided treatment twice a month, for a half day each, at three juvenile justice system youth centers in their onsite dental clinics for incarcerated children.
In June 2019, at the Utah Dental Association annual leadership conference, the SDD presented information on Utah Medicaid updates. There were two Utah managed care dental care plans operating statewide for children. These plans provided basic dental benefits such as diagnostic, preventive, restorative (fillings), endodontists (root canals), and oral surgery. There was also one managed care CHIP plan. On July 1, 2019, fee reimbursements to dentists went up 21%.
The SDD provided general supervision in accordance with Utah laws, for the Oral Health Program’s two public health dental hygienists. These hygienists operate in various public health settings. His time permitted him to visit a few events during the year.
The SDD collaborated with Medicaid in efforts to increase the percentage of children who receive preventive dental visits.
The OHP OHS, organized volunteers for dental screenings at the Special Olympics Healthy Athletes Dental Clinic in the fall and spring, and helped coordinate charity care for the athletes at the Salt Lake Donated Dental Services (SLDD) dental clinic, as well as other locations statewide. The OHS and Oral Health Educator (OHE), along with dental and dental hygiene students, provided screenings and fluoride varnish. These athletes are children and adults with intellectual disabilities.
The OHS spoke to eighty dental students at Roseman Dental School in the fall of 2018 regarding Motivational Interviewing, as they see children and families. This information was originally created and presented at the National Oral Health Conference in 2017.
The OHP’s adolescent oral health campaign educational intervention is in its third year and continuing. The OHE managed interns who implemented this intervention in middle schools along the Wasatch Front, building sustainability. Anonymous pre- and post-tests continued to be administered to all students before and after the educational intervention, and used as an evaluation measure. In addition to the educational presentation brochures with local safety net, dental clinics were made available to all students. The OHE and OHP interns provided 126 presentations to 2,938 students. The OHE and OHP interns gave modified educational presentations to pre-K, Elementary, Middle, and High School age students at the Utah School for the Deaf and the Blind at the Ogden, Salt Lake, and Orem campuses. Nineteen presentations were given to 159 pre-K and elementary age students, and 67 middle school and 27 high school age students. Modifications to these educational presentations include several hands-on activities, such as practicing brushing and flossing time, instructional brushing music, nutritional activities, visual aids, and one- on-one time with each student.
The OHE went to Duchesne High School in Roosevelt, UT and Uintah River High School, a public charter school on the Ute Tribe Uintah Ouray reservation, and met with the health specialist and school administrators to provide toothbrushes, toothpaste, and educational materials for their students.
The OHE collaborated with Salt Lake Community College (SLCC) dental hygiene students and Oquirrh Mountain fitness center, for a lunch in the park program. This program provides free and reduced lunch program at school, and student can get a free lunch during the summer. The OHE and OHS presented to thirty-six elementary age children and seven adults through this program. After the presentation, the children were split into four groups that rotated between stations on brushing, flossing, nutrition, and going to the dentist. This allowed all of the children to participate in hands-on activities and have one-on- one instruction. The OHE also coordinated with SLCC dental hygiene students and Midvale Middle School to provide an oral health education booth, and local dental resources to sixty-five families. An education and resource booth was also provided at Granite Park Junior High reaching an additional 100 families. Granite Park serves a diverse population of students from over forty countries.
The OHP partnered with The Office of Health Disparities (OHD), who has had a five-year grant "State Partnership Initiative to Address Health Disparities" to fund events to increase access to medical and dental care. The OHD created strong partnerships in the community. This pilot project targeted two geographic areas (Glendale and South Salt Lake) based on a poverty map formula. The OHS and OHE provide dental screenings that were conducted through partnerships with local community organizations. After screenings were performed, prevention and restorative care was provided at Family Dental Plan (FDP), one of the partners in the project. Approximately 377 children and adults received either screening, preventive, and/or restorative care in FY19. A dental school and three hygiene schools were involved with this project. The OHP continued to work with Medicaid, using the CMS 416 report that shows annual EPSDT participation for dental visits. Additionally, as Medicaid was constantly changing in the state, we worked together with Medicaid to help providers, families, and other partners we worked with, to understand these Medicaid changes.
As part of the Oral Health Programs collaboration with Family Dental Plan, OHP interns provided thirteen presentations, to approximately 5,000 students, at school based sealant assemblies. These educational presentations were given in the weeks before the preventive sealant clinic came to the school. This program was run in the 12 title one schools in Salt Lake School District.
In February 2019, the OHS oversaw working with an OHP intern to send out over 1028+ emails to all elementary and middle schools in Utah for National Children’s Dental Health Month. Information included the prevention of cavities, nutrition, reducing soda consumption, and other oral health information. We continued to work with other school-based programs and tried to strategically collaborate and create access with sustainability. We shared information regarding HRSA and primary care grants to these organizations.
The OHS collects information from all school programs involved in SWISH (school based fluoride swish program), and is available for questions regarding topics such as benefits.
As the State Dental Hygiene Liaison, the OHS spoke in November of 2018 at a Regional Head Start conference in Salt Lake City to 25+ staff and parent advocates. She presented Smiles for Life! Preventive Strategies for Promoting Oral Health for Pregnant Women, Infants, and Children. She also spoke at several other parent events and staff trainings. She works closely with the State Head Start Collaborator to review the Periodic Information Report (PIR) and discuss barriers, challenges, and resources to help expand access to care and create sustainability with connections to creating dental homes for each child and family.
The OHS sits on the statewide Early Childhood Utah Board and works with the medical/dental home committee.
In January 2019, the OHS wrote an article for UAEYC (Utah Association for the Education of Young Children), on the American Academy of Pediatricians (AAP) oral health program: Brush, Book, Bed. This publication reaches about 400 educators, clinicians, and other staff that work with early childhood education. This article was also included in the WIC Wire for February.
The OHP continues their collaboration with the Physician Assistant (PA) Program’s interprofessional training of providing oral health risk assessments (OHRA) on children and applying fluoride varnish. The OHP, along with the PA program, provided OHRA, fluoride varnish and well child visits to 127 Ute tribe Head Start children in September of 2018. Two children were found with abscesses and appointments were made that day for the children to be seen by a dentist in the local area.
In addition, in September 2018, the OHP’s OHS and OHE provided education and oversight to twenty PA students, providing screenings and fluoride varnish to upwards of seventy migrant farm workers in Santaquin, UT. Many of these migrant farm workers are the parents of the migrant Head Start children we provide services to every June.
OHS and OHE provided dental screenings and fluoride varnish to Rural Head Starts in three cities in Utah, Wendover, Tooele, and Grantsville. Additional oral health education and training has been provided statewide by the OHS and OHE to Head Starts, Home Visiting, Fostering Healthy Utah Children, and WIC clinics staff and clients. The OHS and OHE are now writing bi-annually oral health articles for the Utah Chapter of the American Academy of Pediatrics. The OHP published and disseminated two Bi-Annual Oral Health Outreach Reports to stakeholders and other partners.
The OHS and OHE presented to statewide WIC directors and other WIC staff multiple times in the state, using the Smiles for Life! Preventive Strategies for Promoting Oral Health for Pregnant Women, Infants, and Children curriculum. This curriculum was created by the National Center of Early Childhood Health & Wellness.
Accomplishments / Successes:
In efforts to increase interprofessional workforce training and created sustained access to care, in March 2019, the OHS strategically connected the Dixie Dental Hygiene School Director, University of Utah PA Program faculty, and Head Start and Parent as Teachers Root for Kids in St. George, Utah. We are piloting the best practice model of Migrant Head Start interprofessional collaboration. Both schools provided oral health care to children and pregnant women for Root for Kids. The dental hygiene students during this outreach clinic taught the PA students how to do oral cancer screenings, and they saw seventeen children and their families.
Summary of successes and accomplishments on “Moving the Needle” in relation to NPM-13B:
- The OHS also serves as the State Dental Hygiene Liaison for Head Start (HS). She uses the Program Information Report (PIR) from HS to strategically target what programs she can help increase dental home access and education. She will continue these efforts with partnerships from the University of Utah PA program, and now Dixie Dental Hygiene School to see children in more rural areas, where access is more of a challenge. She will also try to extend this collaboration to the Hildale community where they are expanding Head Start and Home Visiting.
- The OHE managed interns who implemented an educational intervention in schools along the Wasatch Front, building sustainability. Brochures with local safety net dental clinics were made available to all students. The OHE and OHP interns provided 126 presentations to 2,938 students.
- In collaboration with Family Dental Plan, thirteen presentations, to approximately 5,000 students, were given at school based sealant assemblies. This program was run in the twelve title one schools in Salt Lake School District.
- In collaboration with the Office of Health Disparities (OHD), the OHS and OHE provided dental screenings, which were conducted in partnerships with local community organizations. After screenings were performed, prevention and restorative care was provided at Family Dental Plan (FDP). Approximately 377 children and adults received either screening, preventive, and or restorative care in FY19. There were many partners involved in this project, including one dental school and three dental hygiene schools.
Challenges / Gaps / Disparities:
Teledentistry - is a new emerging issue for our state. We have a few partners expanding and using teledentistry in school based programs. Senate bill 135 was passed, which promotes and supports teledentistry in Utah by defining key terms, establishing standards of care, enhancing the informed consent, strengthening the patient’s ability to file a complaint, and directing the Department of Professional Licensing (DOPL) to establish rules.
Agency Capacity / Collaboration:
Annually, the OHS collaborates with the PA Program from the University of Utah and the Migrant Head Start (MHS). In June, the OHS and OHE attended each of the MHS locations (Honeyville, Genola, and Providence), and provided physical assessments, oral health risk assessments applied fluoride varnish. Over 400 children are seen at the (MHS). With this interprofessional collaboration, in the fall, they visit the Ute Tribe Head Start (UTHS) to provide the same care, along with referrals. Approximately 120 children are seen at (UTHS). The OHS will follow-up on urgent needs found. We try to establish dental homes in the prospective areas. Additionally, in the fall of 2019, we then went and saw the parents of the Migrant Farm HS children and provided screenings and fluoride varnish to approximately eighty migrant farm workers.
The OHS collaborates with the Fostering Healthy Children Program. This program consists of nurses that help foster children with their medical and dental homes and care. The OHS provided education to over fifty-four staff statewide on oral health and dental resources.
The OHS also wrote an article for the Utah Association for Education of Young Children (UAEYC), on the AAP oral health program: Brush, Book, Bed. This is distributed to 400+ educators, clinicians, and other staff that work with early childhood education. This article was also shared with WIC staff statewide. The Brush, Book, Bed has been shared with all early intervention programs that the OHP partners with.
The OHE will continue to collaborate with local dental hygiene programs to provide education resource booths at back to school nights and at summer lunch programs in high need areas.
In efforts to improve dental care for children in Utah, the OHP will continue good partnerships and collaborations with Head Start, WIC, Fostering Healthy Children, the Office of Home Visiting, the Utah Oral Health Coalition, the OHD, Utah Medicaid, the Utah Dental Hygienist Association, the Utah Dental Association, and others.
Summary Progress Report (2020) of ESMs related to NPM-13B
ESM 13.2 - Collaborate with Medicaid: Percent of Medicaid children who had a preventive dental visit*
Goal/Objective:
Increase the percent of Medicaid children ages 1 - 18 who had a preventive dental visit.
Significance of ESM 13.2:
Measures the number of Medicaid children who have a preventive dental visit.
ESM 13.2 Progress Report:
This ESM is expected to increase the number of Medicaid children, ages 1 through 18 years, who have preventive dental visit in the past year. This includes an additional year of age 18 years, but it is close to the age range for NPM 13B. The Medicaid population is a group that has higher dental needs that those of higher economic status. They are part of the population in Utah that is important to concentrate on in improving this measure.
*Utah will continue with ESM 13.2.
MCH Block Grant FY21 Application & FY19 Report
Child Health Domain
SPM-03: Child Injury Deaths: The rate (per 100,000) of injury deaths among children aged 1-19
FY19 Annual Report
Program Activities:
The Performance Measure was not achieved. The Performance Objective was 14.9 and the Annual Indicator was 15.0.
Strategy 1: Identify risk and protective factors shared by at least two of the following top causes of child (ages 1-19) injury deaths: suicide, motor vehicle crashes, drug poisoning, falls, drowning, and/or homicides. Prevention activities will be built around these shared factors.
VIPP has begun focusing on shared risk and protective factors to address many violence and injury prevention topics in the state. By focusing on shared risk and protective factors for topic causes of child injury deaths, VIPP has developed prevention activities, strengthened non-traditional partners, and worked to streamline resources.
Risk and protective factors were identified for suicide and were included in the suicide fact sheet (https://health.utah.gov/vipp/pdf/Suicide/overall-suicide-factsheet-12-14.pdf). Some risk factors were alcohol or drug abuse, diagnosable mental health disorder, easy access to lethal methods, such as firearms or pills, family history of suicide or violence, lack of social support, loss of a family member or friend, especially if by suicide, physical health problems, relationship or school problems, family conflict, and stressful life event or loss. Some protective factors were receiving effective mental health care or substance abuse treatment, positive connections to family, peers, community, and social institutions that foster resilience, restricted access to highly lethal means of suicide, such as firearms or pills, skills in problem solving, conflict resolution, and nonviolent handling of disputes, and cultural and religious beliefs that discourage suicide and support self-preservation.
Strategy 2: Finalize and implement a strategic plan around shared risk and protective factors.
We have been working through the lens of Shared Risk and Protective Factors (SRPF) in order to maximize the effects of our prevention efforts. This type of approach requires both an understanding of the theoretical framework behind these efforts, as well as a practical understanding of how to align current and future efforts in this regard. To better understand our readiness to transition into using this type of approach across efforts, we partnered with Safe States to conduct an evaluation of both internal and external partners. We plan to use these result to help inform our strategic planning process. In addition, to develop tools, related to our approach to SRPFs, that states can use to help develop the capacity in working towards a similar approach, we participated in an expert convening with ASTHO, Safe States, CDC, and the Colorado Department of Public Health and Environment.
As mentioned above, in an effort to work on shared risk and protection across injury and violence topics, we have developed a strategic plan focusing on this shared lens and have engaged LHDs and VIPP staff in this effort. Identified overarching themes for VIPP’s state strategic plan include encouraging social norms that promote safety and health, improving access and utilization to physical and behavioral health care, enhancing the physical environment to improve safe and healthy living, improving the socioeconomic conditions for Utahns, and promoting individual, family, and community connectedness.
This strategic plan helps to break down silos in VIPP, working to reduce multiple forms of injury and violence among Utah children. The VIPP is working with traditional and non-traditional partners to develop common language, align prevention strategies, and optimize resource utilization across these areas of risk and protection.
Strategy 3: Provide education, awareness, and prevention activities to children 1-19 and their parents.
In addition to strategies that the Violence and Injury Prevention Program (VIPP) directly implements, VIPP also contracts with the thirteen local health departments (LHD) and several community based organizations (CBO) to provide education, awareness, and prevention activities to children ages 1 to 19 years and their parents.
During the reporting period, LHDs provided several suicide prevention training sessions as part of their suicide prevention activities targeting children and their parents. These evidence based suicide prevention programs included ninety-eight community sessions, with 2,527 reached. Local health departments distributed 2,413 gunlocks to community members throughout Utah. Gunlocks can be obtained free of charge from any health department, mental health authority, local police station, or by contacting the VIPP. The most recent brochure that is disseminated to communities can be found here: http://www.health.utah.gov/vipp/pdf/UTVDRS/gun-safety.pdf.
Safe Kids Utah (SKU) is a non-profit organization that strives to reduce unintentional injuries in children and teens. SKU has been serving the kids of Utah for over twenty years and has been dedicated to finding innovative ways to educate Utahns on how to keep kids safe from unintentional injuries. SKU is the leading non-profit organization in the state when it comes to car seat and active transportation safety. SKU works to educate parents about child passenger safety and in order to do this successfully, they work with thirteen local Safe Kids coalitions throughout Utah. These coalitions work hard to provide accurate information to their communities. During the reporting period, SKU and the VIPP engaged in the following media and public awareness efforts: 1) Avoid a Deadly Summer – Tips to prevent injuries during the summer months, 2) Fireworks are Exciting but Injure More than 3,500 Children Each Summer –
Safe Kids Utah reminds parents to be prepared and follow top safety tips, and 3) Safe Infant Sleep – Tips for parents on the safest ways to put their baby to sleep.
To promote Child Passenger Safety Week, several activities were conducted throughout the state to support car seat checkpoints and help local health department staff with training and certification. These included community free events such as, “Ask the Car Seat Expert,” car seat checkpoints, car seat education, and car seat classes, sponsored by SKU. In total, 540 car seats were disseminated to low-income families. In addition, forty-one car seat checkpoints and 889 car seat checks were conducted. Child Passenger Safety Course trainings were held to certify advocates to train caregivers on how to properly install car seats. Child Passenger Safety Technicians trained came from hospitals, health departments, local fire and police, retail, health plans, head starts, and unaffiliated advocates.
In addition to child passenger safety activities, parent night programs are conducted as part of the driver’s education curriculum to bring awareness and educate parents and students on deadly driving behaviors and Utah Graduate Driver’s Licensing laws. To complement efforts related to motor vehicle crashes, LHDs conducted seatbelt observation studies that helps leverage funds from the Highway Safety Office to conduct additional seatbelt studies throughout Utah.
Other efforts to provide awareness and education in Utah include pre-conference and conference planning for Zero Fatalities and Four Corners without Borders. Pre-conferences provide an opportunity to help keep Child Passenger Safety Technicians, particularly in rural areas, keep up-to-date on their skills and obtain CEUs for recertification.
The bystander intervention programming has steadily grown over the reporting period. Utah has six community organizations and four higher education organizations who have incorporated bystander intervention training and education into their existing curriculums, or as a part of their ongoing healthy relationships programming. These organizations serve over 2/3 of our state’s population. We have also updated the training curriculum to meet broader community needs and have begun to train and support teachers in five school district on bystander intervention approach and programming to move this approach into schools in Utah. This training has reached thousands of community members and students around the state
Strategy 4: Continue funding all 13 local health departments to implement evidence-based injury prevention programs within their communities.
VIPP partners with thirteen LHDs to establish injury prevention priorities, strengthen local injury prevention program capacity, develop community-based injury prevention projects, and implement evidence-based programs. The current VIPP Strategic Plan addresses priority areas across the MCH service areas includings child maltreatment, infant sleep, school-related injuries, motor vehicle crashes, suicides, teen dating violence, prescription drug overdoses, sexual assault and family violence, traumatic brain injuries and youth sports concussion.
MCH funding enables local health departments to maintain a basic level of violence and injury prevention programmatic efforts by supporting a portion of an FTE for an injury prevention coordinator across all thirteen local health departments. MCH funding supports eight local health departments to serve as the lead agency and coordinator of local Safe Kids coalitions. Funding was allocated based on the approved funding formula for local health departments. All thirteen local health departments were required to conduct activities and implement evidence-based programs in the areas of child passenger safety, teen driver safety, and suicide prevention, and distribute child injury messages through traditional and social media platforms.
The majority of these funds are used to implement evidence-based programs or promising practices for teen driving, child passenger safety, Safe Kids focus areas for unintentional injuries (water safety, sports safety, school related-injuries, etc.), teen suicide prevention, traumatic brain injury and youth sports concussions, firearm safety, suffocation, etc. Much of the partnerships and implementation of these activities are done by Safe Kids Utah and the local Safe Kids coalitions throughout the state.
Strategy 5: Conduct media campaigns targeting parents of 15-17 year olds to encourage parents to be more involved in driver education training and to better understand Utah's graduated drivers licensing law.
Since the year 2007, VIPP, the Utah Department of Transportation Zero Fatalities Program, and Utah Teen Driving Task Force have worked closely with parents and families who have lost a teenager in a motor vehicle crash to tell their stories in a memoriam book, in addition to prevention messages. This culminates in a Teen Memoriam lunch with current and previous families who are provided information about grief support and available services. Grief counselors present on the stages of grief and families are provided an opportunity to share their story. This event creates an informal space for the families to connect and receive support. The families become a support network for each other and have expressed their appreciation and comfort in being able to share their story with others.
The goal of the effort is to personally meet with the participating families, provide grief resources, and help support their prevention messages to other families and young drivers. We held the event in November 2018 to share stories of families who lost a child in a motor vehicle crash in 2017. Additionally, to bring awareness and educate parents and students on deadly driving behaviors and Utah Graduate Driver’s Licensing laws, we work closely with the media contractor to evaluate the parent seminars in Utah high schools and the parent night programs as part of the driver’s education curriculum.
Strategy 6: Provide surveillance data and information on childhood injuries and deaths to partners, policy makers, and media through fact sheets, reports, quarterly newsletter, and social media posts.
VIPP identifies school injuries through the Student Injury Reporting System (SIRS). The SIRS is an online database that helps to identify where, when, how, and why students get hurt at school or during school sponsored activities. The SIRS database identifies reportable school injuries as an injury that caused the loss of at least one-half day of school and/or warranted medical attention and treatment from a school nurse, physician, or other health care provider. VIPP has provided this database as a free resource for schools to house their injury data. An online system (https://sir.health.utah.gov/) contains data starting on September 1, 2011. Users of the SIRS include risk managers at each of Utah’s forty-one school districts and school staff (such as principals, secretaries, coaches) at more than 800 Utah public schools. Data collected includes school district and number, date and time of injury, sex, aid that was given to the student, contributing factors of the injury, and activity during which the injury occurred.
While the SIRS holds a large amount of data regarding student injuries at school, data users and school districts had no way to easily explore, analyze, or display their data to better understand what it means. To increase availability of the data, the VIPP and the Office of Public Health Assessment launched a queryable system on the Indicator Based Information System for Public Health (IBIS) for school districts to use to look at their own student injury data dating back to 2012 (https://ibis.health.utah.gov/ibisph-view/query/selection/studentinj/StudentInjSelection.html). School district data is queryable at the school level, and users can look at variables such as grade, student sex, injury type, contributing factors, period at which injury occurred (e.g., before school, athletic event, lunch, and fieldtrip), surface type, activity, number of days absent, and actions taken. Additionally, the system allows school districts to populate graphs for better data use.
The VIPP developed user-friendly guidance on how to run various data queries using IBIS. The VIPP hopes this new data query system allows school districts to better use and understand their student injury data, ultimately making better, data-informed decisions on how to keep Utah students safe. A student concussion fact sheet was released in 2019 student data came from the SIRS (https://health.utah.gov/vipp/pdf/TBI/ConcussionsInSchoolsFactsheet.pdf).
Additionally, the School Health Profiles survey provides a snapshot of health-related education policies, and programs in Utah schools. The Centers for Disease Control and Prevention in collaboration with the Utah Department of Health developed a questionnaire and conducts a survey of secondary schools every other year. The profiles help state and local education and health agencies monitor and assess characteristics of school health programs. They include information on policies related to physical education, tobacco-use prevention, nutrition, asthma management, health services, and violence and injury prevention. Recommendations for violence and injury related efforts include efforts to align school policies with the best available evidence.
Strategy 7: Use social and traditional media platforms to educate Utahns about child injury prevention laws and strategies to prevent injury death.
VIPP’s media specialist created social media content, scheduled the content on a regular basis, and disseminated content to local health departments for use in promoting the prevention of child injury, teen driving safety, teen dating violence prevention, teen suicide prevention, Safe Kids coalition activities, bullying prevention, summer safety, injury prevention laws (e.g., GDL and concussion), and drowning prevention. VIPP staff published 114 social media posts reaching 54,674 people. The average post reach was 480 per post, and 4,556 per month. Total engagement was 2,757 with the average of 24 engagements per post and 230 per month. There were 715 reactions to the posts, with an average of 6 reactions per post and 60 per month. There was a total of 311 shares, with the average share per post being 3 and per month 26.
VIPP ran a Positive Teen Behavior campaign during October 2019. Creative ads included messaging for opioids misuse, safe driving, TBI prevention, healthy relationships, and suicide prevention. Snapchat received 1,621,258 impressions with 18,947 Swipe Ups (clicks). Instagram received 3,900,567 impressions and 3,339 link clicks. Overall the campaign reached 566,521 people aged 13-18.
Six news releases and advisories were distributed to local media promoting the prevention of youth injury and violence prevention (e.g. “Drowning Danger Still High”, “Health Officials Urge Water Safety”, “New Report Highlights Trends in Utah Adolescent Health: Mental health identified as a key concern”, “Top Tips to Keep Teens Safe Behind the Wheel”, “Families Honor the Lives of Teen Crash Victims”, “Utah Teens Continue to Grapple with Unhealthy Dating Relationships”, and “Officials Warn of Deadly Temperatures: 11 children have died this summer after being left alone in a vehicle”).
Seven pieces of educational material were produced and published by VIPP staff. Material included, “Suicide Report”, “Sports Concussion”, “School Concussion Factsheet”, “Essentials for Childhood” brochure, “Drowning Factsheet”, “Swimming Safety” promotional video, and “Student Head injuries” promotional video.
Strategy 8: Continue to support and provide technical assistance to the Utah Teen Driving Task Force.
VIPP staff participate on the monthly Utah Teen Driver Task Force to discuss efforts to address traffic safety among teen drivers. Members of the Task Force represent a variety of local, state, and private agencies concerned about coordinating activities to improve the safety of teen drivers, passengers, and pedestrians. The Task Force goals are to: 1) reduce the rate of motor vehicle crashes and deaths in Utah among teens ages 13-19, 2) bring together stakeholders with an interest in teen driving to ensure activities are coordinated throughout the state, 3) create an effective marketing campaign designed to reduce risky behaviors among teen drivers and passengers, 4) use storytelling to encourage safe driving behaviors, 5) develop, support, and advocate for effective teen driving policies, and 6) support continued innovation in driver education materials.
Strategy 9: Review 100% of all child deaths in Utah. Enter data gleaned from these reviews in the national child death review database.
Since 1992, the Child Fatality Review Committee (CFRC) has been charged with the review of the circumstances and causes of all childhood deaths in Utah. The purpose of the CFRC is to develop a better understanding of child deaths in order to reduce the number of these tragedies. The goals of the CFRC are to: 1) identify and describe risk factors by studying and reporting trends and patterns of child deaths in Utah, 2) maximize resources through interagency collaboration to identify and describe the delivery of services by the involved systems (medical, human services, and law enforcement) to high-risk children, and make policy recommendations to improve the service systems to better meet the needs of families involved with these systems, 3) promote effective prevention strategies to reduce the number of child deaths, and 4) refer issues and propose strategies to appropriate organizations and agencies to promote education and prevention.
The CFRC meets once a month to review deaths of all Utah Children (ages 0-18) who died within the three months prior, as well as any more recent suspicious cases. The cases reviewed by the CFRC include any death that falls under OME jurisdiction. These include homicides, suicides, suspicious or undetermined deaths, as well as any sudden and unexpected deaths. This death review process provides a detailed understanding of how and why child deaths occur in Utah. CFRC data is entered into a national database. Recommendations are compiled after each review and shared with key stakeholders to implement for systems change.
Strategy 10: Evaluate the effectiveness of the motor vehicle, parent night program being offered at various schools in Utah.
VIPP is works with the media contractor who conducts the parent night programs throughout Utah to evaluate the parent night program in addition to the curriculum being used in driver’s education programs. Evaluation technical assistance has been provided by the CDC, who is also interested in this strategy. An average of fifteen parent night programs are conducted per month during the school year.
Strategy 11: Provide at least five evidence-based suicide prevention programs to youth ages 12-19.
Local health departments distributed 2,413 gunlocks to community members throughout Utah. Gunlocks can be obtained free of charge from any health department, mental health authority, local police station, or by contacting the VIPP. The most recent brochure that is disseminated to communities can be found here: http://www.health.utah.gov/vipp/pdf/UTVDRS/gun-safety.pdf
LHDs provided several suicide prevention training sessions as part of their suicide prevention activities targeting children and their parents. These evidence based suicide prevention programs included ninety-eight community sessions with 2,527 reached.
As a result of data and evaluation efforts, the following implications for prevention have been determined: with parents/guardians having legal authority over nearly 9 out of 10 of the firearms used in suicides of youth under 18, parents are key to prevention; urging parents to lock their guns may not entirely address the youth firearm suicide issue if their teenagers know where the keys are or indeed own a gun and control the keys; a more useful message may be to lock all guns and ensure children and teens don’t have access to the keys or combination; when a youth is struggling with a mental health or substance abuse problem or life crisis, storing guns away from home may be prudent; parents may be unaware that youth can use long guns to take their lives; some parents who do lock their guns may be unaware their child can defeat the lock; and clinicians, gun owners, and others could work together to develop messaging and storage
options that are sensitive to local values and realities.
Strategy 12: Publish the 2018 Teen Memoriam book.
Since the year 2007, the VIPP, Utah Department of Transportation Zero Fatalities Program, and Utah Teen Driving Task Force have worked closely with parents and families who have lost a teenager in a motor vehicle crash to tell their stories in a memoriam book.
We meet personally with the participating families, provide grief resources, and help spread their prevention messages to other families and young drivers. The families become a support network for each other, and have expressed their appreciation and comfort in being able to share their story with others. We held the family event in November to share stories of families who lost a child in a motor vehicle crash in 2018.
Accomplishments / Successes:
The rate of child injury deaths among children ages 1-19 years of age has remained stable with an overall downward trend indicating a 17.4% decrease in child injury deaths since 1999. Males have had a consistently higher child injury death rate compared to females, and children ages 15 to 19 years have had consistently higher child injury death rates compared to ages 1 to 14 years of age.
With the increase in suicide prevention efforts at the LHD level, VIPP feels confident that the rate of suicide deaths will start to decrease over time. In addition, VIPP has a full time suicide prevention coordinator that has provided technical assistance to the LHDs and is assisting with resource coordination with school districts. An emphasis on suicide prevention efforts have been placed on VIPP’s priorities and VIPP has become involved in participating more broadly in state and local efforts for suicide prevention. As part of this effort, the VIPP is collaborating with multiple state partners to develop a community “postvention” toolkit to provide guidance to LHDs and their local communities on writing a “postvention” response plan.
VIPP has begun focusing on shared risk and protective factors to address many violence and injury prevention topics in the state. We have begun developing a strategic plan focusing on this shared lens and have engaged LHDs in this effort. Identified overarching themes for VIPP’s state strategic plan include: encourage social norms that promote safety and health; improve access and utilization to physical and behavioral health care; enhance the physical environment to improve safe and healthy living; improve the socioeconomic conditions for Utahns; and promote individual, family, and community connectedness.
As a result of this work, VIPP has been able to engage non-traditional partners, has been instrumental in informing state level work on shared risk and protective factors, has implemented primary prevention trainings to local communities in Utah, has presented on national webinars, has had several abstracts accepted to present on this topic, and provided technical assistance and guidance on this approach to reducing child injury deaths in the state.
Summary of successes and accomplishments on “Moving the Needle” in relation to SPM-03:
- The Utah Coalition for Protecting Childhood (UCPC) focused its efforts on upstream approaches to child maltreatment prevention. Research has shown that economic instability and intergenerational poverty are risk factors for child maltreatment. Economic instability underlies all social determinants of health, which negatively impact long term health outcomes and opportunity equity.
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We collaborated with community partners in the planning, implementation, and
evaluation of two youth mental health screening nights in a local health district, one for junior high and high school students and the other for pre-kindergarten and elementary students. These events were attended by 145 youth and their families. The events were held to provide access to mental health screening for youth, to link them with appropriate service providers and treatment, and to serve as an early intervention for those in need. Screenings were provided at no cost. Following the event, twenty-one follow-up appointments were made and forty-three referrals were given. Every family was given a Youth Services Directory, which contained nearly 150 local services such as medical treatment, counseling, self-care, support groups, classes, and crisis lines. - Suicide prevention activities were emphasized in local health department contracts. During the reporting period, LHDs provided several suicide prevention-training sessions as part of their suicide prevention activities targeting children and their parents. These evidence based suicide prevention programs included ninety-eight community sessions, with 2,527 reached. Finally, LHDs distributed 2,413 gunlocks to residents in their communities.
- VIPP has focused on shared risk and protective factors to address many violence and injury prevention topics in the state. We have developed a strategic plan focusing on this shared lens, and have engaged LHDs in this effort. Identified overarching themes for VIPP’s state strategic plan include encourage social norms that promote safety and health, improving access and utilization to physical and behavioral health care, enhance the physical environment to improve safe and healthy living, improving the socioeconomic conditions for Utahns, and promoting individual, family, and community connectedness.
- As a result of this work, VIPP has continued to be able to engage non-traditional partners, informing state level work on shared risk and protective factors, implemented primary prevention trainings to local communities in Utah, presented on national webinars, had several abstracts accepted to present on this topic, and provided technical assistance and guidance on this approach to reducing child injury deaths in the state.
Challenges / Gaps / Disparities:
Funding sources are often very siloed, making it difficult to focus on comprehensive, primary prevention efforts where impact can be leveraged by having shared prevention vision to reduce risk factors and promote protective factors.
Over the last few years, the rate in youth of suicide by firearm has been increasing. In 2018, Utah saw the highest rate recorded for firearm suicide deaths (13.25 deaths per 100,000 youth ages 15-19). Efforts to promote means restriction and firearm safety among adults who own firearms is of paramount importance, in addition to promoting protective factors such as connectedness among youth. In addition, technology as a risk factor for suicide needs to be explored.
Agency Capacity / Collaboration:
VIPP partnered with multiple agencies and entities to address the child injury performance measure. VIPP continues to contract with all thirteen local health departments to implement evidence-based injury and violence prevention programs to reduce risk factors and promote protective factors associated with injury and violence. Local health departments were also contracted to collaborate with local entities to enhance injury and violence efforts in their health district. Collaborations included Safe Kids coalitions, law enforcement agencies, hospital systems, parent-teacher associations, school districts, firearm retailers, fire departments, EMS, and others. Staff at the local and state level are supported in maintaining certifications in various disciplines that may impact moving the needle for child injury mortality. These disciplines include maintaining certifications as child passenger safety technicians, QPR instructors, SafeTALK instructors, Mental Health First Aid instructors, and other injury-related trainings.
National experts conducted a technical assessment of VIPP's injury infrastructure, policy, and programs in the summer of 2018 through the Safe States Alliance State Technical Assessment Team (STAT) program. The STAT assesses injury and violence prevention within the state health agency, focusing on specific roles, relationships, and performance of the designated injury and violence prevention program. The goal is to support the development, implementation and evaluation of injury and violence prevention efforts at the state health department level by conducting an on-site, point-in-time assessment of the injury and violence prevention program, and providing recommendations for improvement.
The assessment focuses on core components of a successful state health department injury and violence prevention program, including infrastructure, data, and policy and program strategies. For each core component, Safe States Alliance has developed standards and indicators that describe the conditions that should exist within an ideal, comprehensive state health department injury and violence prevention program. The assessment often serves to refocus a participating state by requiring it to reflect on its strengths, weaknesses, opportunities, and barriers to success. The STAT process also serves to bring together different members of the injury and violence prevention community and allows individuals to share ideas for program development.
VIPP STAT recommendations encouraged VIPP to finalize the strategic plan focusing on shared risk and protective factors, prioritize staff activities to meet grant deliverables, prioritize hiring a Suicide Prevention Coordinator, develop a publications protocol, publish timelier reports, and modify LHD contracts to focus on high-impact actions.
*SPM-03 has been dropped following the 2020 MCH Needs Assessment.
Other activities in the Child Health domain that contribute to improvement in the National Outcome Measures
Utah works to adhere to the three-tier framework outlined in the MCH Block Grant guidance. While the focus of most activities is the ESM →NPM→ NOM framework, activities on improving NOMs outside of the NPMs transpires in parallel. The following programmatic activities also work to improve outcomes in this domain.
National Outcome Measures (NOM)
NOM 13: Percent of children meeting the criteria developed for school readiness
The CHARM system integrates data between the Early Hearing Detection and Intervention (EHDI) and Baby Watch Early Intervention (BWEI) Programs. This linkage enables the EHDI program to know that a child with hearing loss has been referred to early intervention by six months of age for follow-up care. Receiving timely treatment and intervention for children that are Deaf and Hard of Hearing maximizes their developmental and communication potential so they can be ready for school entry. Likewise, the BWEI program receives hearing screening results in its BTOTS system through CHARM from the EHDI program. This has enabled the BWEI staff to know if a child has received a hearing screening, or still needs one, thereby providing timelier follow-up care and comprehensive service/treatment plans for a child. In addition, when a child transitions from part C to part B, the health information provided through CHARM is documented in the child’s record when the child moves from infant/toddler services to preschool, which provides continuity of care.
UDOH-MCH is developing an Early Childhood Integrated Data System (ECIDS) with participants like WIC, IDEA Part C, MIECHV, Head Start, Child Care, UDOH-ASQ screening programs and Help Me Grow. UDOH-MCH will be able to match data with Utah's State Education Agency (SEA) to better assess if children that received early childhood services enter school better prepared to learn. The SEA has developed a Kindergarten Entry/Exit Readiness Profile (KEEP). Data matching, analysis and research will be facilitated by the Utah Data Research Center created by state legislation in 2017.
NOM : a) Percent of children, ages 19 through 35 months, who have completed the combined 7-vaccine series b) Percent of children, ages 6 months through 17 years, who are vaccinated annually against seasonal influenza c) Percent of adolescents, ages 13 through 17 years, who have received at least one dose of the HPV vaccine d) Percent of adolescents, ages 13 through 17 years, who have received at least one dose of the Tdap vaccine e) Percent of adolescents, ages 13 through 17 years, who have received at least one dose of the meningococcal conjugate vaccine
The CHARM system links immunization histories of children, ages 0-18, from the Utah Statewide Immunization Information System (USIIS) and provides it electronically to the Baby Watch/Early Intervention Program, the Early Hearing Detection and Intervention Program, the Fostering Health Children Program, the WIC Program, Newborn Screening Heel-stick Program, and private provider clinics. These programs that have obtained immunization information through the CHARM system have continued to identify children in need of immunizations, and follow-up with parents to get their child vaccinated and up-to-date. As stated in NOM 19, CHARM collaborated with the Utah Birth Defects and USIIS Programs during the past grant year and linked the Critical Congenital Heart Defect (CCHD) results to USIIS through the CHARM system. Public and private providers can now obtain the CCHD results, in addition to the hearing screening results, in USIIS.
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