Illinois’ priority for the Child Health Domain is:

• Support expanded access to and integration of early childhood services and systems (Priority # 3)

While not specifically designated as a priority, the areas of asthma and oral health are of particular focus for Illinois’ Title V Program and have strategies identified within the state action plan.

Illinois’ has many successes in their child health performance measures.  Illinois’ children have relatively good access to preventive healthcare services. Compared to many other states, Illinois’ children are more likely to receive a parent-completed developmental screening. Illinois ranks 13th in the country on this measure (NPM #6), however, still less than 40% of children receive this screening. In Illinois, more than 80% of children had a preventive dental visit in the last 12 months (NPM #13.2), and children of all racial groups were similarly likely to receive this service.  Compared to other states, Illinois’ children are likely to receive preventative dental visits; Illinois had the eighth highest rate for this measure in the country.  Illinois has also steadily improved access to health insurance; in 2016, only 2.5% of children were uninsured (NOM #21), representing a 2.6% average annual improvement over the last five years and the 11th lowest rate in the country. 

There are some outcomes, however, that are more troubling. Less than 90% of Illinois’ children are in excellent or very good health (NOM #19), the ninth lowest rate in the country.  Additionally, Illinois has the second highest rate of autism spectrum disorder diagnosis in the country, and non-Hispanic black children are 80% more likely and non-Hispanic white children are 30% more likely to receive an autism spectrum disorder diagnosis than Hispanic children.

The selected NPMs, SPMs and ESMs are still relevant to the priorities of the Illinois Title V program and only one change is being made this year. ESM 6.3, a yes/no indicator related to the “development of a diagram to describe referrals of children with social, emotional, and developmental concerns” will be discontinued. While this project was initially envisioned as part of the multi-sector work being led by IDPH on social-emotional screening, it is no longer being planned as an activity of that workgroup. After collaboration with multiple state agencies to develop the SEL screening rules, it was determined that this activity is best delegated to local schools and social service providers who can specifically map the resources within their own communities.

During FY18, the Illinois Title V Program utilized the following strategies, as listed in the State Action Plan, to address the Child Health Domain priority related to early childhood systems:

A. Work with the Governor’s Office of Early Childhood Development and the Illinois Early Learning Council to develop an environmental scan of developmental screening, including social and emotional screens, including options for data collection, places of screening, and validated screening tools (completed in FY18).

IDPH OWHFS leadership was heavily involved in this process which included routine meetings to operationalize the findings of the environmental scan completed in FY17 into a roadmap/diagram. There were four main areas that the workgroup wanted to better understand: statewide data collection procedures (or lack thereof), types of settings where development screenings occur, screening tools used and options for referrals after a positive screen. The determination of the environmental scan and subsequent diagramming was that the state of Illinois does not have the resources to create an integrated system at this time. A final report was created and shared with stakeholders. 

B. Collaborate with the UIC Leadership and Education on Neurodevelopment and other Disabilities (LEND) program to train early childhood providers to conduct autism screening while conducting developmental and social-emotional screens.

Through their Title V mini-grant, CDPH consulted with UIC LEND to adopt the M-CHAT developmental screening tool for autism spectrum disorders for use in family case management services. During FY18, CDPH MCH nurses were trained on M-CHAT and are implementing it at their home visits. CDPH is also collaborating with A Place for Children with Autism to expand resources for referrals.

C. Participate on the Governor’s Children’s Cabinet and Illinois Early Learning Council to facilitate coordination between early childhood systems and assure that health is recognized as an integral component of improving children’s educational outcomes.  

During FY18, the Title V Director served all on three entities, ensuring that health had a voice at the table to influence priority setting and leveraging Title V resources as needed.  The Title V Director also participated in the BUILD Initiative for several years, which is a subset of the Executive Committee of the Illinois Early Learning Council. The BUILD initiative supports state leaders’ efforts to develop a comprehensive early childhood system tailored to the needs of the state’s unique young child population. The Title V Director was also involved in the planning for the state’s first Risk and Reach report which provides county-level data on the well-being of children in the areas of Family Stability, Health, and Early Care & Education to inform policies and programs. The state’s MCH Epidemiology Assignee also provided data for several of the indicators. The report was published in April 2019.

D. Collaborate with home visiting programs, including the Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program and early childhood providers to encourage alignment of activities.

IDPH Title V Program collaborates with various early childhood systems and programs in a variety of ways.  During 2018, the Title V director participated routinely in statewide committees such as the Early Learning Council and the Home Visiting Task Force where she served as chair. IDPH Title V Program also continues to connect MIECHV and home visiting programs to our other partners for collaboration and support.

As examples of attempts to collaborate and align priorities, a member of the UIC MCH Epidemiology team (contracted for technical assistance to Title V) presented data on breastfeeding trends and disparities at the Illinois Home Visiting Task Force during 2018 and the former Title V director presented on severe maternal morbidity and maternal and infant mortality in April 2018.

E. Convene partners to develop administrative rules and coordinate implementation of a new state law requiring social/emotional screening during school physicals.

During FY18, OWFHS leadership, the Title V director and the School Health Program led an ad hoc workgroup to develop a draft rule and solicit feedback from other offices within IDPH as well as outside partners. In Spring 2019, the rule language was submitted through the formal processes for review and eventually adoption. 

Through their mini-Title V Block Grant, CDPH continued to work with Chicago Public Schools’ Office of Student Health and Wellness to ensure high consent levels for school related services.  For the 2017-2018 School Year, CPS continued to have a strong focus on Medicaid enrollment including a travelling enrollment team that conducts outreach to schools.

During FY18, the Illinois Title V Program utilized the following strategies to support ongoing efforts to improve asthma management in the school and community setting:

A. Improve asthma identification and support services, including education of families, referral of children with asthma to appropriate health care and social services, and care coordination through community-based partnerships (completed in FY18).

The Children’s Asthma Initiative provided technical assistance and support to health care providers and families with asthma in three communities within the City of Chicago at the school level. The program also supports a mobile van which provides on‐site services within the community. This was a Title V funded program through the University of Illinois at Chicago. 

In summary, the intervention at the school level involved screening children within the school for asthma diagnosis and symptoms, training of school staff and interested parents in basic asthma control methods and identifying parents to be further trained as parent peer educators. Asthma educators played crucial role in this initiative by scheduling appointments, following patients to ensure they are receiving care according to the National Guidelines, and reaching out to patients after an emergency room visit to schedule follow up care.  During FY18, this program reached over 5,800 people, with asthma education and/or care coordination.

B. Provide training, support, and technical assistance to school nurses in Illinois.

IDPH School Health Program hosts School Health Days every fall in five locations statewide. During Fall 2017 (FY18) there was an asthma-focused session called “Asthma Management for School Staff” which was provided by the Respiratory Health Association. Other trainings included understanding the opioid epidemic; immunization guidance; communicable disease outbreak-prevention and control in school settings; and school nurse’s health in wellness provided by the state board of education. Nearly 1,000 school nurses across the state attended the sessions.

Every spring, Critical Issue Trainings are provided to school nurses in two locations. During spring 2018, the topics included: self-management of diabetes; school safety prevention provided by the state police; school emergency and crisis management; and youth mental health first aid. Approximately 350 school nurses were trained at these events.

During FY18, the Illinois Title V Program utilized the following strategies to increase access to preventive oral health services:

A. Financially support IDPH Division of Oral Health to provide dental sealants to children, particularly those with Medicaid or without dental insurance.

Current estimates are that 80,000 children are eligible for Medicaid but remain uninsured, leaving them without access to medical and dental care. In FY18, 31 agencies received funding from IDPH to provide sealants to selected permanent molars for eligible children through the Illinois Dental Sealant Program, administered by IDPH Division of Oral Health. This Title V funded program is designed to assist school personnel and families by assuring access to:  oral health education, fluoride varnish, Illinois All Kids (Medicaid) enrollment, and referral to a dental home.  The program also helps families comply with Illinois’ mandatory school dental examinations for children in kindergarten, second and sixth grades.  During FY18, nearly 40,000 sealants were placed on approximately 32,100 children, the majority of whom are not eligible or not enrolled in Medicaid. 

Overall, IDPH Division of Oral Health assists Illinois school children who are most at risk for dental caries by granting funds, providing technical assistance, and training to public health departments and to other public not-for profit service providers to develop and to implement community-based oral health programs. Grantees of this program are required to have a specific process for referral and case management to the oral health care delivery system for children found to need treatment services, however, accessing follow up dental care to complete treatment plan for uninsured children continues to be a barrier.

B. Collaborate with IDPH Division of Oral Health to convene stakeholders and develop a statewide report and resource manual on oral health during pregnancy and early childhood (same as strategy #1-F).

See Women’s/Maternal Health domain strategy 1-F narrative for details.

C. Participate in Implementation of Quality Indicators to Improve the Oral Health of the Maternal and Child Health Population Pilot Project with IDPH Division of Oral Health to pilot a series of measures for children and pregnant women to inform the creation of a national set of indicators.

Strategy began in FY19 – no activities to report for FY18.