CHILD HEALTH DOMAIN

Nebraska Annual Report for the 2017-2018 Year

 

In this section, Nebraska MCH Title V reports on the accomplishments and activities in the Child Health Domain for the period October 1, 2017 to September 30, 2018. The numerical sequence of headings used below to organize the narrative references the narrative format found on page 35 of the Title V MCH Services Block Grant to States Program: Guidance and Forms for the Title V Application/Annual Report, Eighth Edition.

 

The Nebraska Priorities in the Child Health Domain with 2017-2018 NPM, SPM, and ESM statements are as follows:

• Priority: Unintentional injury among children, including Motor Vehicle Crashes.

NPM: Rate of hospitalization for non-fatal injury per 100,000 children ages 0-9 years.

ESM: The percentage of schools participating in a child safety seat campaign.

• Priority: Access to preventive and early intervention mental health services for children.

SPM: The percentage of children age 4 months to 5 years who have low or not risk for development, behavioral, or social delays.

• Obesity and overweight among women, youth, and children, including food insecurity and physical inactivity.

 

1. Context: the State of this Population Domain

With regard to child health broadly, a very significant change in Nebraska Medicaid occured when the state plan amendment (SPA) passed by the legislature in 2014 was approved by the federal Centers for Medicare and Medicaid.  Administratively, Nebraska Medicaid was ready to implement the changes in the SPA with an effective date of September 1, 2017.   This implemented a system for schools to access reimbursement for a significantly broader range of health services provided to students with Individualized Education Plans during the school day. Where schools historically could only be paid for physical therapy, occupational therapy, and speech therapy services provided to students, effective September 1, 2017 schools could also be reimbursed for: vision, mental health, nursing, personal care, and transportation services.  This change brought about new interest between public health, Medicaid, and school health to make schools, and school nurses, aware of the new opportunity.   

 

Nebraska Medicaid desired to join the national CMS School Health Affinity Group, and Title V was invited by Medicaid to be a partner in the activity.  The purpose of the Affinity Group was, in light of state changes to Medicaid opening reimbursement to schools, to explore how schools, public health, and Medicaid might be intentional and productive partners in advancing child health outcomes in each state.  The Nebraska team chose to focus on a topic of particular interest and alignment with Title V priorities: access to mental health services to children at school, including tele-behavioral health.  The cross-sector team grew to include the NDHHS Division of Behavioral Health and the Nebraska Department of Education. Several work products were produced, including results of a survey of school staff regarding practices when working with families to make referrals on behavioral health and mental issues of students; a project to use mapping methods to demonstrate a baseline level of tele-behavioral health utilization statewide; and a messaging project entitled “Why Health Insurance is Important for Your Child.”  The collaborative work also set the stage for Nebraska Title V stepping into a leadership role as an applicant, then recipient, of an award from the HRSA MCHB Pediatric Mental Health Care Access Program in the summer of 2018. The Nebraska Medicaid in Public Schools website hosts the materials: http://dhhs.ne.gov/Pages/Medicaid-Provider-School-Based-Services.aspx

 

In the mental and behavioral health arena, Nebraska Title V recognizes, convenes, networks, and connects the many systems-level and statewide partners and stakeholders who are deeply engaged in improving early childhood mental health, adolescent and child well-being, school readiness, and improving systems of care to address child and youth mental and behavioral health issues, and help families.  As a result, many relationships have formed that continue to bear fruit as opportunities arise.  One of these opportunities came about as a result of the Nebraska Governor’s response to school violence, in convening three collaborative and cross-systems workgroups to identify proactive, preventive, and responsive approaches.  Kathy Karsting of the Title V staff was asked to join the workgroup and represent public health approaches.  A final report of the workgroup was released on May 18, 2018.

 

In the injury prevention arena, Nebraska Title V plays more of a supportive and collaborative role, in partnership with the Nebraska Injury Prevention program. The Title V School Health Program helps provide access to a school-based audience statewide for the dissemination of prevention materials on motor vehicle safety topics including use of child safety seats and teen driver safety. Thus Title V plays a connecting role between the resources of the Injury Prevention Program and schools and school nurses statewide.

 

In the priority area of reducing overweight and obesity, including physical inactivity and food insecurity among children, youth and women of child-bearing age, a change aspect in the child health domain in 2017-2018 has been to add the population priority of “reduce overweight and obesity among women, youth, and children, including food security and physical inactivity.”  This extraordinarily broad priority statement was woven from many threads of interest from stakeholders, but it has been a challenge to settle into focus and effectiveness in terms of actions. 

• For several years, Nebraska placed the priority statement in the adolescent health domain, and in the state plan Nebraska described (what was then) early work in addressing place-based public health and social determinants of health topics.  Authentic community engagement in testing the “Place Matters” materials resulted in application of the tool on issues of lead exposure, not physical inactivity or obesity, however. 
• In 2018, Nebraska Title V staff joined the national Children’s Healthy Weight CoIIN, sponsored by the Association of State Public Health Nutritionists, seeking new intervention ideas.  Nebraska joined the CoIIN as a technical assistance member (meaning, travel and participation in data reporting not required). The Nebraska team continued to meet and continue to use the tools of the CoIIN through the end of the reporting period.

 

Other important new developments in the child health domain in Nebraska occurred with the award of a multi-year grant in the Childhood Lead Poisoning Prevention Program (CLPPP), and continuing work to develop an Early Childhood Integrated Data System (ECIDS).  Title V staff are part of both projects in leadership and technical assistance roles. For the CLPP project, there are additional opportunities for delivering technical assistance to the grant in school and child health, collaborative partnerships, culturally- and linguistically-appropriate and health-literate services, and stakeholder engagement. In terms of the ECIDS, Title V staff are uniquely positioned to broker relationships and assist in bringing cross-system stakeholders together to overcome barriers and challenges in creating a sustainable, integrated data system.

 

2. Summary of programmatic efforts and use of EBP to address each priority need 

 

Priority: Reduce Unintentional Injury

2017-2018 Objectives and Strategies

 

• C7a.  Increase by 10% booster seat use by parents for children aged 5-12 years.

 

Summary of programmatic efforts:

The Title V school health program collaborated with the Nebraska Injury Prevention program to promote information statewide to school health professionals and school administrators to increase appropriate child safety seat use by parents.  During this period, Title V collaborated with the Injury Prevention Program on health-literate and translated information materials for parents to improve readability by diverse audiences.  The school health program made use of the statewide school nurse listserv, a Title V project hosted by University of Nebraska-Lincoln Center for Children, Family and the Law, called Answers4Families.  A related strategy in this objective area prompted collaboration between the Injury Prevention Program and N-MIECHV, assuring that all N-MIECHV sites include at least one home visitor certified as a child safety seat technician. 

 

• C7b. Increase by 10% the percentage of Nebraska Schools participating in safe motor vehicle education for parents.

 

Summary of programmatic efforts: 

The Title V School Health program initiated collaborations with several schools to conduct on-site child safety seat checks for parents. While 5-10 school nurses were originally sought for participation in the project, fewer actually did so, and later than anticipated, with implementation delayed to the 2018-2019 school year.  Information about the new Nebraska child passenger safety laws as disseminated to school administrators and nurses.  More child safety seat information was disseminated to school nurses via the school nurse listserv.

 

Evidence-based practice in this priority area:

Beginning with this 2017-2018 report, Nebraska Title V will reference the growing MCH Evidence data base as found: https://www.mchevidence.org/   Information is organized by NPM, in this case child injury prevention.  While the evidence-base is reported as “under development” at this time and consisting of promising practices, it is clear from states’ ESM examples that collaborations with schools and increasing awareness of child safety seat use among parents are strong approaches.

 

According to an on-line report January 5, 2018, Booster seats, car seats and seat belts are equally effective at saving the lives of children, while booster seats top the others at reducing minor injuries specifically among children ages 8-12, according to Montana State University economist D. Mark Anderson in two published studies.  (Source: https://www.sciencedaily.com/releases/2018/01/180105124030.htm, retrieved 5/20/2019.)

 

Priority: Improve access to preventive and early intervention mental health services for children.

2017-2018 Objectives and Strategies

 

• C8a. By 2020, increase by 10% the utilization of behavioral health services using telehealth by Medicaid-enrolled children.

 

Summary of programmatic efforts:

The initial strategy envisioned for this period was the N-MIECHV program manager leading a cross-sector group to consider innovations in improving access for children to mental and behavioral health care.  This did in fact occur, with an initial cross-sector gathering to discuss systems of care for children with mental and behavioral health needs.  Then, in a convergence of events and interest, the CMS School Health Affinity group convened under Medicaid leadership, and the Affinity group determined the focus for one year would be mental and behavioral health services for school-aged children and youth utilizing telehealth.  By spring 2018, the CMS Affinity group and the Behavioral Health System of Care both offered opportunities for Title V contributions without Title V convening a separate, yet similar group. In mid-2018, Nebraska Title V took the lead as the state awardee for the national Pediatric Mental Health Care Access program.

 

• C8b.  By 2020, increase by 10% the percentage of children aged 0-5 served in a medical home practice.

 

Summary of programmatic efforts:

Early in 2017, Title V participated in a small group quality improvement project to examine variations in referrals to Nebraska’s Early Development Network (EDN), by county, gender, race/ethnicity, and Medicaid status.  Though the work was preliminary and unrefined, the aggregate data effort by county level seemed interesting and promising. Members of the Title V team had by that time been developing mapping projects to demonstrate concentrated disadvantage and the distribution of social determinants of health and protective factors.  Proposed in 2017-2018 was a collaborative project to repeat and refine the methodology, and interpret the results and limitations, of the EDN referral mapping project.  As Nebraska has entered the era of the Pediatric Mental Health Care Access Program, with a large and buoyant cross-sector advisory group, the prospects of a technical workgroup carrying out this project in relation to access to early and preventive mental health services seems more feasible than ever.

 

Related strategies and activities in this area also include N-MIECHV promoting accurate and valid, regular screening for young children to improve early identification of social and emotional or developmental issues among young children.  This occurs largely through on-going collaborations with and within Nebraska’s early childhood mental health system of community, professional, and statewide partnerships.  N-MIECHV is prominent in this this systems work, as well as other well-established systems partners including Nebraska Sixpence, Head Start, First Five Nebraska, and Rooted in Relationships.

 

Nebraska Title V has long held and advanced a place for children’s and family needs in patient-centered medical home practice, including children with and without special health care needs.  Family-centered medical home practice was at one point (2003-2016) a signature initiative of the Nebraska early childhood comprehensive systems work and Title V.  Unique to Nebraska’s approach to family-centered medical home was inclusion of family-centered dental home.  In 2017-2018, the Nebraska Office of Oral Health and Dentistry, a key collaborator with Title V in developing a medical/dental home informational brochure for families, was responsible for disseminating several thousand copies of the brochure, largely through Nebraska’s network of public health dental clinics.  Patient-centered medical home approaches have been institutionalized as an expectation for Nebraska’s Medicaid Managed Care Organizations. 

 

Evidence-based practice in this priority area:

Beginning with this 2017-2018 report, Nebraska Title V will reference the growing MCH Evidence data base as found: https://www.mchevidence.org/   Information is organized by NPM, in this case increasing use of the medical home.  While the evidence-base is reported as “under development” at this time and consisting of promising practices, it appears from states’ ESM examples that conducting outreach to families on the benefits of medical home is a reasonable approach. 

 

As Nebraska’s Title V agency, staff are well-aware of the conditions and environments that promote well-being and resilience among children, and thus improve early mental and behavioral health.  Improving access to mental and behavioral health care services for children is a moving target, so to speak, including changes in technology, systems, and providers. During the period of 2017-2018, the CMS Affinity Group recognized the importance of health insurance enrollment as a gateway to access, and successful communication with the hardest to reach families a gateway to equity. While there is evidence that tele-behavioral health is well-accepted among users, there is little evidence to understand whether all racial/ethnic, and gender groups benefit equally.  

 

Priority: Decrease overweight and obesity among women, youth, and children, including food insecurity and physical inactivity.

2017-2018 Objectives and Strategies

 

• C9a. By 2020, increase community engagement on built environments and school-based physical activity opportunity to support healthy and active living for children and adolescents.

 

Summary of programmatic efforts:

The strategy Nebraska undertook in this priority in 2017-2018 was to join the national Children’s Healthy Weight CoIIN, with the intention that participation would lead to more innovative and integrated solutions to advance the priority in ways not yet discovered.  A small team formed, yet stumbled in early stages due to scheduling conflicts and retirement of a key collaborator.  Regrouping in early 2018, a small team agreed to continue working on the project.  Using the tools provided in the CoIIN, the team reached the conclusion that the opportunity for improvement that was of interest would be physical activity for special education students in transition programs, aged 16-21 years. The group considered various models for physical activity for children and youth with special needs, including adapted physical education, and unified physical education.

 

During the period, progress continued on a work product of Title V entitled, Place Matters, which provides a framework for community-level work to improve environments to improve health.  The Place Matters Learning Collaborative developed the Place Matters toolkit and used a variety of data sources to identify five communities to test the toolkit in a pilot study.  Of the five identified communities, three engaged in communication regarding the project and ultimately one agreed to test the toolkit in 2017-2018 – Panhandle Public Health Department (PPHD). The toolkit essentially describes a locally-driven, collaborative process to engage stakeholders around a particular issue.  Through using the toolkit PPHD and partners determined in 2018 that childhood lead exposure was the main issue for their community.  While work continued, testing the toolkit in order to revise and refine it based on feedback, the work no longer reflected the population priority of Overweight and Obesity for this population and so was not continued as a strategy in 2018-2019.

 

Also during this period, an opportunity opened for Title V to become more engaged with School Wellness Plans, required nationwide of schools participating in the federal school lunch program. Sponsored by the Nebraska Department of Education, the Whole Child Whole Community Think Tank convened in April 2018, to identify barriers/gaps and successes related to school wellness policy implementation in Nebraska.  The Title V School Health Program has been an active participant in this activity, which in turn contributed to Nebraska being named as recipient for a CDC award to improve school health. 

 

New in 2018 in Nebraska is a CDC grant (CDC-RFA-DP18-1801), for Improving Student Health and Academic Achievement through Nutrition, Physical Activity and the Management of Chronic Conditions in Schools. The Nebraska Department of Education was the successful applicant and, upon award, entered into a subaward relationship with the new Center for Child and Community that is part of Children’s Hospital in Omaha.  Based in Lincoln, the Center for Child and Community has hired a school health coordinator, a Registered Nurse formerly with Nebraska Medicaid.  The Title V School Health Program is a collaborative partner in the project.  Eight schools have been recruited to participate in multi-year grant activities to improve implementation of School Wellness Policies and implement case management activities for children with chronic health conditions in school.

 

In Sept. 2018, the Title V School Health Program released the 2016-2017 School Health Data Project report, on BMI findings among Nebraska students in grades 1, 4, 7, and 10. See the report:  http://dhhs.ne.gov/MCAH/SchoolR-2016-2017StudentBMISurveillanceReport.pdf

 

Evidence-based practice in this priority area:

Beginning with this 2017-2018 report, Nebraska Title V will reference the growing MCH Evidence data base as found: https://www.mchevidence.org/   Information is organized by NPM, in this increasing physical activity.  While the evidence-base is reported as “under development” at this time and consisting of promising practices, it appears from states’ ESM examples that interventions are widely dispersed across data, community, and provider approaches, no more focused than Nebraska’s approaches.

 

Use of Evidence-based Practice in this Priority Area: Alignment with evidence-based practice in this priority area for children rests on an emerging body of literature pointing to the significance of “place” in health.  On the website https://www.mchevidence.org/   the evidence base for increasing physical activity is “under development” at this time.  It appears from states’ ESM examples on the site that interventions are widely dispersed across data, community, and provider approaches, no more focused than Nebraska’s approaches. The Children’s Healthy Weight CoIIN is anchored in evidence-based practice (breastfeeding for early nutrition and physical activity throughout childhood to reduce risks of health problems of obesity), along with theoretically-sound approaches to innovation practice, and data-driven project development. 

 

3. Alignment of NPMs, ESMs, SPMs, SOMS with priority needs

 

Priority: Unintentional injury among children, including Motor Vehicle Crashes.

NPM: Rate of hospitalization for non-fatal injury per 100,000 children ages 0-9 years.

ESM: The percentage of schools participating in a child safety seat campaign.

 

The ESM selected for this NPM is aligned with the priority.  However, in practical use, the ESM measure is very specific to an activity of collaboration, with unclear numerator and denominator from year to year.

 

Priority: Access to preventive and early intervention mental health services for children.

SPM: The percentage of children age 4 mos. to 5 years who have low or not risk for development, behavioral, or social delays.

 

This SPM is strongly aligned with the concerns and goals of the stakeholders who prioritized this need in 2015. However, the SPM is interesting in that it describes a condition of the population in terms of risk for delays.  In fact, the focus of activities is to increase the percentage of children who are screened at an appropriate frequency using appropriate and validated tools. The concern as expressed originally by stakeholders in identifying the priority was that children should have greater access to prevention and early intervention services to meet identified needs. 

 

Priority: Overweight and obesity among women, youth and children, including food insecurity and physical inactivity.

 

There was no ESM, SPM, or NPM expressed for this priority in this population domain for 2017-2018.  However, section 2 notes that the NPM of increasing physical activity is aligned this priority.

 

4. Progress in achieving established performance measure targets along with other programmatic impact

 

Nebraska Title V is implementing a results based accountability framework for selected objectives and strategies of the Title V action plan.  The RBA table for Unintentional Injury Prevention captures the involvement of schools and school nurses and partnership with the Injury Prevention Program, as well as the quality improvement effort to include CLAS and literacy in materials development. Thirteen measures were initially identified, and six produced measures or statements of progress for the period.

 

2017-2018 Results Based Accountability (RBA) measures Unintentional injury among Children, including Motor Vehicle Crashes
	Planned for 2017-2018	Achieved 2017-2018
How much did we do?	# school nurses and schools participating in project to increase booster seat use;   # elementary students in participating schools eligible for car booster seats in preschool through third grade (ages 3 – 8 years);   measures of use in a voluntary sample of parents;    # parents participating in materials review and development prior to dissemination;   # special education students assessed for car seat safety	3     460         0     3     Not included in survey
How well did we do it?	% and # of schools represented in the project;   # and % parents receiving education;   # and % parents providing input on new or revised materials who are of minority groups;   # and % of students from non-majority culture in participating schools;   # of children with special health care needs participating in project; # of materials translated into languages and adjusted literacy level	3/250 School Districts     Not measured   Not measured       Not measured     Not measured   6
Is anyone better off?	# and % of parents of elementary students using appropriate safety seat correctly for their child.   # and % special education students receiving corrective intervention	100% of 37 participating parents were using car seats correctly.     Not measured

 

The RBA table for improving access to preventive and early intervention mental health services was initially constructed in relation to a cross-sector collaborative activity that did not proceed as planned.  While partners came together for insightful discussion, it was not at the time clear what focus the group would bring to comprehensive systems work, until the emergence of the Pediatric Mental Health Care Access program opportunity in the summer of 2018.  For the greater part of the program year, 2017-2018, there was little activity in this area.  Distribution of the Medical/Dental Home brochure continued, via the Office of Oral Health and Dentistry, which disseminates the brochure through an extensive network of partners working in public health dentistry and oral health of children.  One innovative twist occurred when an opportunity opened with the DHHS Office of Rural Health to advance adoption of maternal medical home approaches in Nebraska.  In large measure, the opportunity was possible due to the credibility Title V brings to the patient-centered medical home movement through the earlier work on medical and dental home for children with and without special health care needs. In all, in 2017 -2018, twelve measures were proposed and five were measured.

 

 

2017-2018 Results Based Accountability (RBA) measures Access to preventive and early intervention mental health services for children.
	Planned for 2017-2018	Achieved 2017-2018
How much did we do?	# partners convened by N-MIECHV in ad hoc group for innovation thinking on increasing access to EMCH services.    # and % participants from rural underserved counties;   # and % family and consumer participants as distinguished from provider and systems partners;   # of providers receiving revised brochure and # brochures distributed.	Group convened 11/16/2017 by N-MIECHV program manager. 14 persons present   3       0     Not measured
How well did we do it?	# and % of participants returning to meetings and participating throughout process;   # and % family participants reporting they felt their opinions were valued and respected;   # Innovative solutions considered viable. # and % of participants from non-majority culture;   # and % providers and consumers returning evaluation feedback on the medical home brochure.   # of additional revisions and translations of medical home brochure.	N/A – activity did not proceed as planned     N/A           N/A       N/A       1
Is anyone better off?	# new initiatives undertaken and measures of impact;   # hits on website to download MH brochure;   # requests for Spanish-language version.	Maternal Medical Home     Not measured     Not measured

 

No RBA measures were set for the 2017-2018 program year in the priority area of overweight and obesity including food insecurity and physical inactivity in the Child Health domain.

 

Learning from RBAs

Overall, the RBA framework provides a constructive way for staff to set and deliver achievement goals in priority areas of the Title V block grant, and feel the satisfaction of a results-based framework for success.  In the Child Health domain, a total of twenty-five RBA measurements were planned for the period 2017-2018, and eleven (44%) yielded some statements of results.  The team is learning that many RBA measures are not needed to reflect and measure significant performance, but a few key RBA measures are useful for keeping focus on the intent of the strategy.  (For example, paying attention to participation by consumers including race/ethnicity or preferred language of message testers is an easy course correction.)  RBA measures stated in a meaningful way are needed so designated reporters readily understand, remember, count, and record results. 

 

5. Challenges and Emerging Issues

 

Specifically related to the Title V priority of overweight and obesity among children and youth are a couple of systems-level developments that hold promise for impact.  Nebraska’s Children’s Hospital, based in Omaha, has renewed their vision for statewide and community-level impact, with the founding of the Children’s Center for the Child and Community. One of the first programmatic activities of the Center for the Child and Community was launch of TeleECHO Clinics on Childhood Obesity.  Nebraska, as with other states, has been lacking in clinic-based intervention services for children currently morbidly obese, and the TeleECHO model seeks to fill that need.  The second, significant, undertaking of the Center was to collaborate with the Nebraska Department of Education to apply for funding from the Centers for Disease Control National Center for Chronic Disease Prevention and Health Program for “Improving Student Health and Academic Achievement through Nutrition, Physical Activity, and the Management of Chronic Conditions in Schools.”  More succinctly referred to locally as the “1801 Program”, Title V is a collaborator in several of the activities unfolding with schools driven by this project, including the Whole School, Whole Community Child Health Think Tank, convened by collaborative partners to increase support for child wellbeing.

 

The use of telehealth and tele-behavioral health to better meet the needs of children and youth in Nebraska living in underserved areas is very dynamic, exciting, and actively under development.  Title V is engaged in this work in significant ways, through identified priorities, the Pediatric Mental Health Access Program, the Behavioral Health System of Care, partnership with N-MIECHV and related systems work, and activities with many coordinated and collaborative partnerships.

 

Also highly pertinent to child health outcomes in the population are changes in Medicaid in Nebraska.  Already discussed have been the changes to expand the services eligible for Medicaid reimbursement to schools.  In 2018, Nebraska voters voted to expand Medicaid to include some 80,000 uninsured adults.  Children whose parents have health insurance can be said to be advantaged compared to those children whose parents do not have health insurance.  As a result, the prospect may emerge for equity impacts of the Medicaid expansion, when it occurs. 

 

Increasing collaborations between Title V and child welfare services are emerging in Nebraska, with the Division of Children and Family Services.  The CFS Division is the home of the Title V CYSHCN Director, and Title V funding goes to CFS for the Medically Handicapped Children’s program and related services.  In 2018, Title V and N-MIECHV staff, Sara Morgan and Jennifer Auman, began a collaboration with child welfare in the initiation Families First legislation and are engaged in a collaboration to launch a pilot project testing child welfare adaptation of the Healthy Families America home visiting model (https://www.healthyfamiliesamerica.org/hfa-blog/2018/11/8/introducing-the-healthy-families-child-welfare-adaptation.)

 

While there is broad support for an Early Childhood Integrated Data Systems (ECIDS) among Nebraska stakeholders, there are many challenges to merging large data sets owned by various governmental agencies and governed by respective state and federal laws.  Despite the challenges, key partners remain committed to the effort, as shown by the Nebraska Department of Education hiring a project officer to continue working through data governance and sharing policies and practices.  Title V continues to be available for technical assistance and support as this project moves forward.

 

6. Overall Effectiveness of Strategies and Approaches: Addressing Needs and Promoting CQI

 

Overall, developments in the Child Health domain during the 2017-2018 reporting period reflect significant leadership by Title V in Nebraska in serving as a convener, collaborator and partner. In the area of injury prevention for children, Title V has been effective in facilitating the use of culturally- and linguistically-appropriate and health literacy and readability standards, working with the Injury Prevention Program.  Title V has stepped up to be an effective partner in promoting motor vehicle safety, following the lead of the Nebraska Injury Prevention Program.  This has been positively reinforcing for Title V’s visibility and credibility as a constructive collaborator for cross-divisional work. 

 

Addressing improved access to preventive and early intervention mental health services, the significance of Title V leadership in the early childhood mental health arena is in advocating for systems approaches to create and grow a sustainable, comprehensive, early childhood system that has as its center at-risk families and children. To this work, Nebraska Title V uniquely contributes by calling for accurate assessment data, cross-sector and cross-divisional engagement, and an equity-focus on measurable outcomes, including implementation of culturally- and linguistically-appropriate services. Progress in early childhood mental health during the reporting period came in the form of recognizing opportunities to scale emerging project work to statewide, systems-level impact.