Arkansas Title V Maternal and Child Health Services Block Grant

2022 Report and 2024 Application

III.E.2.c.  State Action Plan Narrative by Domain

Child Health 2022 Annual Report

Title V activities targeting children under age 11 continued to address priority needs: developmental screening, injury hospitalization, and overweight/obesity. These needs were addressed by Title V staff (i.e., Child Health, School Health Services, MIECHV) working with stakeholders to reach children and their parents by increasing awareness of best practices and providing access to resources to support improvement in performance measures. During 2022, Title V staff worked with state physician associations to support the Learn the Signs Act Early (LTSAE) activities promoting developmental milestone education; WIC and MIECHV to deliver parenting education to families in rural areas of the state and local education agencies (LEA) to increase awareness of physical activity best practices amongst individuals with access to children.

The Arkansas Chapter of the American Academy of Pediatrics facilitates the state team’s LTSAE efforts through the Arkansas Act Early Ambassador. LTSAE is a nationwide initiative to engage parents and other care providers in ongoing developmental monitoring and early action to reduce developmental delays. LTSAE aims to improve the early identification of children with developmental delays and disabilities. Developmental Milestone Checklists, based on the child’s age, are provided to caregivers to complete. Referrals for developmental screening are completed based off the results of the developmental milestone checklist.

The Arkansas MIECHV program supports the delivery of early childhood home visiting services to families who live in at-risk communities in selected counties throughout the state through four evidence-based home visiting models (Healthy Families America, Parents as Teachers, Nurse Family Partnership, and Home Instruction for Parents of Preschool Youngsters) and Arkansas’s promising approach (Following Baby Back Home). Arkansas currently has 30 MIECHV-funded Local Implementing Agencies (LIAs) providing home visiting services in 57 counties. 

Priority Need:  Developmental Behavioral and Mental Health of Children

NPM 6:  Percent of children, ages 9 – 35 months, who received a developmental screening using a parent-completed screening tool in the past year.

The 2020-2021 National Survey of Children’s Health indicated that 34.8% of parents of children, ages 9-35 months, nationwide completed a developmental screening tool in the last year. The state improved performance for this measure by reporting that 28.4% of parents of children, ages 9-35 months, completed a developmental screening tool in the last year; up from 25.9% in 2021 and exceeding the annual objective of 26%. Child Health, WIC and MIECHV staff continued efforts to raise awareness of the importance of developmental screening throughout the year by implementing the following strategies:

Strategy 6.1:  Percent of WIC enrolled children ages 2 through 59 months at Learn the Signs Act Early sites who received developmental monitoring.

LTSAE is closely aligned with WIC’s mission to assist in the healthy development of young children and to provide referrals for other needed services. WIC initiated a pilot developmental monitoring project at three sites (Faulkner, Bradley, and Pulaski-North Little Rock local health units) using the CDC’s Learn the Signs Act Early checklist in 2019, with plans to expand the program statewide. Due to continued COVID-19 pandemic barriers, the LTSAE expansion was not rolled out and prevented children and their families from being served in 2022. WIC continued operating under a disaster waiver throughout most of the year. As a result, the in-person requirement for WIC services was waived. WIC staff were able to discuss developmental monitoring with participants and refer families to the CDC developmental milestones website when warranted, but there was not a system in place to monitor such referrals. Additionally, 2,355 families with children between ages 2-59 months were documented as completing a WIC program that included the CDC developmental monitoring tool; 1,311 of these families were indicated as already screened by PCP or early interventionist or already receiving therapy. Thirty-Four people completed the "Milestones Matter: Understanding Your Child's Development" module currently available on AR WIC Online.

Strategy 6.2:  Percent of children, ages 2 through 59 months, in home-visiting programs who were referred for therapy due to the results of a developmental screening using a validated parent-completed tool.

In 2022, the MIECHV program reported 1,907 clients (i.e., parents/caregivers) with 2,005 children between the ages of 0-59 months. Per program guidance, children in home visiting programs should receive a developmental screening if they are between the ages of 9 months and 30 months. This strategy supports early identification to promote optimal development for children. Program reports indicate approximately 85-90% of the participants between the ages of 0-59 months received a developmental screening. Some participants are inadvertently missed when there is a new enrollment and the screening has not occurred at the time of reporting, if the family relocates, or if there is transition within MIECHV staff. All Arkansas home visiting models use the Ages and Stages Questionnaire-Third Edition (ASQ-3) to track developmental milestones. The tool is not difficult to use, but it requires training that can present challenges for the programs.

Additionally, all MIECHV models use the Family Map to promote family engagement while assisting families in navigating their child’s early years. This tool is built to meet all requirements from each model to collect information from clients, the tool is not distributed to clients for completion. Seventy Home Visitors were trained to use this tool, and the Family Map was used with 1,604 families. Using these tools, the program identified 65.4% of the children in home visiting programs, between the ages of 2-59 months, were referred for therapy after receiving a developmental screening. While the 2022 performance is a slight decrease from the previous year, the program continues to perform higher than the national average. Additionally, children who screen positive but have not had a completed referral will stay flagged in the database as needing a referral for as long as they remain enrolled in the program. This allows the child to still have an opportunity to obtain a referral during the following year. MIECHV does not have any specific partnerships in place at this time to prioritize developmental screenings and referrals, but current activities support improvement in outcome measures such as school readiness and overall health status for children.

Child Health staff continued providing support to new parents through education on early support and developmental milestones via the agency website and a developmental milestone letter. Parents who request a birth certificate for a child under three years of age receive a developmental milestone letter from the Child and Adolescent Health Medical Director with information about the CDC Milestone Tracker app, locating a primary care physician, toxic stress, breastfeeding, and safe sleep. In 2022, 11,762 developmental milestone letters were distributed with birth certificates requested for children ages 0-3. Additionally, the agency continued to promote the use of the CDC’s Milestone Tracker app  and additional parent support educational material on the Child Health website. During 2022, the Parent Support webpage received 450 views from 361 first time visitors.

Other Activities: 

The WIC Baby & Me program helped ensure families received the latest information on parenting practices that help children grow up healthy and bright. This program is for WIC participants who are either pregnant or have an infant less than 1 month old. Parent Support Mentors meet with participants for seven, 20–30-minute monthly sessions. Sessions cover topics such as developmental milestones, crying, routines, stress, home safety and safe sleep. The WIC Baby & Me program was delivered in 17 counties and served 750 participants. The WIC Baby & Me program does not have any specific partnerships in place at this time to prioritize and/or implement strategies to address disparities as this time. Additionally, the program experienced challenges in effective scheduling to offer in-person services as a result in turnover amongst Parent Support Mentors. However, the program reported increased interest in participating in the program, program completions, and consideration for expanding the program as successes for the year.

Priority Need:  Injury Hospitalization

NPM 7:  Rate of Hospitalization for non-fatal injury per 100,000 children ages 0-9.

According to the State Inpatient Database, 117.8 per 100,000 children ages 0-9 were hospitalized for non-fatal injuries in 2020. The state did not improve performance for this measure, and performance identified an increase in the rate of hospitalization when compared to the previous period. The Child Health Section has limited staff to conduct activities supporting reductions in hospitalization. However, available staff promote injury prevention by participating in infant child death reviews to provide prevention recommendations and by distributing shaken baby syndrome brochures to educate parents on the dangers of abusive head trauma. Brochures are distributed annually to each birthing hospital for inclusion in the discharge packet each family receives prior to discharge. These brochures are also available on the agency’s website and distributed by early childhood centers, through a partnership with the Division of Human Service’s Program and Professional Development Administrator’s Child Care Aware Resource and Referral Agencies as a result of Arkansas Code § 20-9-1401. Lastly, local health unit’s Parent Support Mentors use the brochures during education with new parents on the dangers of abusive head trauma. In 2022, 1,150 brochures were distributed by Child Health in efforts to reduce infant injury.

Strategy 7.1.1:  Percent of families served in home-visiting program who have reports of child maltreatment.

Each MIECHV model promotes positive parenting skills, assists parents in becoming self-sufficient and addresses maternal and child health issues that may create significant cost savings for the state. These activities promote reductions in intentional injury seen in children ages 0-9. The MIECHV national average for reports of child maltreatment was 6.0-7.4% over the last four years, but Arkansas continues to report performance exceeding the national average in this area. During 2022, 5.2% of families in home visiting programs reported child maltreatment. This performance indicates a reduction in the number of families reporting child maltreatment when compared to the previous year, 5.9%. The 2022 reporting year is the second year this measure included all models for MIECHV in Arkansas data, and this is the first year there is no missing data. Having complete data depends on timely and accurate data entry after collecting information from a home visit, which can be a challenge; but the program is seeing improvement in collecting complete data.

Priority Need:  Overweight/Obesity

NPM 8:  Percent of children ages 6-11, who are physically active at least 60 minutes per day.

The 2020-2021 National Survey of Children’s Health indicated that 26.3% of children nationwide were physically active at least 60 minutes every day. Arkansas exceeded nationwide performance by demonstrating 28.8% of children engaged in physical activity each day, and thus almost meeting the 2022 annual objective of 30%. The School Health Services (SHS) programs at ADH and the Division of Elementary and Secondary Education (DESE) continued efforts to create healthier environments for children to support increases in physical activity through the delivery of the Act 1220 and Coordinated School Health (CSH) programs.

The Act 1220 program is facilitated in accordance with Arkansas Code § 20-7-135, which enables the State School Health and Wellness Coordinators and Community Health Promotion Specialist to work with 1,102 schools in the 262 districts statewide to promote physical activity and nutrition while ensuring state and federal school health mandates are met. The SHS program worked to promote reductions in obesity rates by providing education and resources highlighting best practices in food services, nutrition, physical and health education. Lastly, SHS staff worked with school and district wellness committees to complete the annual School Health Index assessment using the Centers for Disease Control and Prevention's (CDC) School Health Index to complete modules 1-4, 10, and 1. The results of the School Health Index are used to create an improvement plan, which is required for accreditation.

The CSH program delivers professional development and resources based on the components of the national Whole School, Whole Community, Whole Child Model (WSCC). Arkansas has emerged as a leader in CSH with LEAs across the state strengthening districts and building-level wellness teams. Any school or district in the state may participate in the CSH program by accessing resources or attending quarterly meetings. However, a school/district must attend at least three quarterly meetings each year to be recognized as a CSH school. Typically, participating CSH schools have highly effective wellness committees with a dedicated chairperson that consistently attends quarterly state-level CSH meetings. In 2022, at least 276 school health coordinators from 59 districts participated in the state CSH program, representing 23% of the state’s total school districts.

SHS staff continued supporting schools in implementing health and wellness activities to create a safe environment to promote learning using the following strategies:

Strategy 8.1:  Percent of children attending public schools, grades K-5, who are in the normal or healthy weight zone for Body Mass Index (BMI).

Pursuant to Arkansas Code § 6-20-702, all children in grades K-5 must receive at least 40 minutes of instructional time each day for recess. During recess, students are supervised and must have access to opportunities for vigorous activity and free play whether recess occurs inside or outside. As a result of this standard, Arkansas children can have greater access to physical activity each day, promote opportunities for achieving a BMI in a normal or healthy weight zone and reduce the number of children identified as obese. Through the partnership between ADH SHS and the Arkansas Center for Health Improvement (ACHI), a statewide BMI report is created annually. The report identifies the student’s BMI and includes information to discuss the results with the child’s primary care physician. The 2022 BMI report states that 58.2% of students, grades K-5, were in the normal or healthy weight zone for Body Mass Index. The state saw an increase in performance for this measure and the annual objective of 57% was met.

The State School Health and Wellness Coordinators worked to provide technical assistance for school staff and resources to promote physical activity as well as striving to increase partnerships between communities and their schools. However, CSH participants’ surveys indicated there are barriers to increasing physical activity for students such as superintendents and principals, lack of facilities for hosting indoor recess during adverse weather, and inadequate infrastructure in communities to promote activity. In previous years, the program encountered success in promoting physical activity using the Joint Use Agreement (JUA) funding opportunity. This process, supported by the Arkansas Tobacco Excise Tax, provided funding to assist schools in implementing community partnerships to maximize resources to increase opportunities for physical activity. For example, funding could be obtained to complete structural changes to school facilities/spaces to allow community members to have a safe environment to engage in physical activity outside of school operating hours. Due to continued COVID-19 pandemic barriers, the DESE was unable to fund any JUA projects in 2022.

Lastly, the CSH program continued promoting the use of playground stencil sets housed at the 15 educational cooperatives (co-ops) in the state. Schools within the co-ops’ service area were allowed to check out the stencil sets to enhance play areas, walkways, or gyms to enhance the space and help increase opportunities to engage in physical activity The stencils were used in at least four districts serving more than five schools. Due to staff transitions, the number of students reached was not documented during the current project period. The playground stencils continue to serve as an opportunity to increase children’s access to safely participate in physical activity.

Strategy 8.2:  Increase the percentage of school personnel who participated in CSH training with increased knowledge of evidenced-based physical activity practices and curriculum and physical activity services provided by SHS.

School staff attending CSH professional development trainings reported improved skills to implement strategies as a result of attending the training. SHS staff worked to promote access to quality physical activity by providing technical assistance to assist school staff. The CSH program provided quarterly training opportunities for all school personnel highlighting the components of the WSC model using funding from a CDC grant. Additionally, the CSH program designated six priority districts to receive targeted technical assistance and funding to improve nutrition, physical activity, and the management of chronic conditions to improve the health of the students and staff. During the reporting period, 1,716 school personnel participated in CSH training and SHS conducting 10 trainings regarding physical activity. Ninety-six percent of the school personnel who participated in CSH training had post-test results that demonstrated an increase in knowledge of evidenced-based physical activity practices and curriculum and SHS physical activity services.

The Child Health Section faced challenges in delivering more services/activities to address priority needs as a result of the lack of additional staff. As a result, direct partnerships with pediatricians have not been established at this time, but the staff regularly communicated with the Arkansas Academy of Pediatricians and Arkansas Academy of Family Physicians to share resources. Additionally, Child Health staff continued identifying opportunities to support efforts to address priority needs by partnering with other collaborators through participation in workgroups such as Excel by 8, Arkansas Natural Wonders and the Statewide School Health Coalition. Staff collaborate with these organizations to educate partners on available resources and to support their action plan strategies to promote child health.