Objective 1: Increase the number of delivering hospitals participating in the Period of PURPLE Crying Abusive Head Trauma curriculum from 39 in 2015 to 42 by 2020.

 

Data:

The number of participating hospitals was 39 as of September 30, 2020; the program lost one participating hospital because it stopped delivering infants.

 

Successes:

The Injury Prevention Work Group of Preparing for a Lifetime continued to meet quarterly, albeit virtually, to discuss projects, including the Period of PURPLE Crying. PURPLE provides evidence-based information via a booklet, DVD or app, and nurse education to inform new parents and caregivers about the patterns of infant crying in an effort to reduce abusive head trauma. Hospitals had the option to request the PURPLE application (or app) for families, in addition to the DVD in English or Spanish. For those needing additional languages, Arabic, Vietnamese, Chinese, French or Burmese, only DVDs were available.

 

Presentations were given by staff and partners during this time on the Period of PURPLE Crying, abusive head trauma (AHT) and the crying curve, as well as the barbershop project to state social workers, the state’s Head Start Health Managers and at the International Conference on Shaken Baby Syndrome/Abusive Head Trauma.

 

COVID put a hard stop on any in-person trainings or presentations. The barbershop project in Tulsa had to pause due to COVID protocols. Where possible virtually, community groups in the Tulsa area were provided information via The Parent Child Center, a member of the Injury Prevention Work Group and partner in the PURPLE program.

 

Injury Prevention workgroup members worked with the National Center to Prevent Shaken Baby Syndrome to plan data-driven training and distribution based on app use by delivery hospitals. MOUs with participating facilities were updated to include data tracking and were sent and signed by most delivery hospitals.

 

Challenges:

Program participation looked a little different for most of 2020 due to COVID-19. Most mothers were allowed only one or, at times during the pandemic, zero support persons in the delivery room, so often the mother was the only recipient of the information. In some hospitals, due to COVID rules, education was provided in take-home packets and not face-to-face, which for PURPLE is not best practice.

 

Objective 2. Continue CLICK for Babies outreach activities, and expand project to 2 new community partners by 2020.

 

Data:

CLICK provided handmade, purple knit hats to participating PURPLE hospitals in an effort to provide parents and caregivers with a visual reminder of the PURPLE crying techniques. The hats were given out during November, December, and January. This year’s CLICK Campaign in Oklahoma netted over 1,000 knitted caps sent to MCH to add to the approximately 20,000 remaining from a previous year’s campaign. Due to COVID, caps were not tagged prior to being sent to hospitals in September, so that they could be washed at the facility.

 

Successes:

The small number of cap donations for the year was due to limited marketing and outreach for CLICK efforts. Most caps came from knitting groups and individuals who had participated in the past and reached out to MCH staff. Because MCH stored a large number of caps from a previous year’s success, there was limited need for additional caps to meet all of the hospitals’ needs.

 

MCH and Injury Prevention Work Group members responded to a few email requests, providing information about CLICK, knitting patterns, crying patterns for infants, abusive head trauma, and ways to support new parents. Staff also created washing and drying guidelines for caps to provide to volunteers to assure that hats sent to birthing facilities were sanitized appropriately.

 

Challenges:

None to report, although it is unknown how many hospitals were able to wash, tag and distribute caps due to the pandemic.

 

Objective 3. Provide, via Adolescent Health Specialists, a total of 3 trainings in communities on adolescent distracted driving and graduated drivers licensing each year.

 

Data:

OSDH Child and Adolescent Health (CAH) and Injury Prevention Service (IPS) staff partnered to hold a training over concussion prevention and a teen distracted driving program, Countdown2Drive, in January 2020 for nurses, health educators (HEs), and Adolescent Health Specialists (AHS).

 

IPS staff provided the existing Graduated Driver Licensing (GDL) brochures to CAH staff for distribution to AHS in the rural counties.

 

Successes:

A total of five AHS were hired for the state-level teen pregnancy prevention project, Oklahoma Healthy YOUth (OHY), between October 2019 and June 2020 for Pittsburg County, Jackson County, Carter County, and Ottawa County. MCH continued to rebuild the project and plans were made to train new staff on responsibilities related to distracted driving and graduated drivers licensing.

 

The AHS worked towards developing partnerships with local schools and community organizations in hopes of re-establishing and/or building Public Health Youth Councils (PHYCs) in their district. The Jackson County AHS partnered with a local public library that had an existing youth group to hold a Countdown2Drive event, unfortunately it was postponed indefinitely due to the COVID-19 pandemic.

 

MCH, Injury Prevention Service, and the Oklahoma Child Death Review Board, continued to participate in the Child Safety Learning Collaborative to focus on reducing motor vehicle injuries and fatalities among children and adolescents in Oklahoma until it ended in April 2020. Teen driving safety was still the top priority to address this issue. Five counties in Oklahoma previously identified for having the highest teen crash rates were still used to focus efforts of the collaborative.

 

Challenges:

The OHY project was still in the process of rebuilding after the 2018 Reduction in Force (RIF) and experienced turnover among the AHS throughout this grant year. Three AHS resigned, greatly impacting adolescent health activities in three districts. Additionally, the COVID-19 pandemic caused a statewide shut down in March, lasting through June 2020. This reduced ability to conduct trainings, develop PHYCs, deliver presentations, and host events. During the pandemic, all AHS and many MCH staff were re-assigned to the pandemic response and assisted with COVID-19 testing, employee screening, and case management. AHS had limited time for planning and participation in adolescent health activities.

 

Objective 4. Reduce nonfatal motor vehicle injuries in children ages 0 to 19 from 394 in 2013 to 366 by 2020.

 

Data:

Due to the availability of data as reported by OSDH Injury Prevention, the data for this Objective is described in rates instead of by number. The rate of hospitalizations for nonfatal motor vehicle injuries for children ages 0-14 years in 2018 of 13.0 hospitalizations per 100,000 population was a decrease from 19.8 in 2010. Similarly, the rate of hospitalizations for nonfatal motor vehicle injuries for children ages 15-19 years in 2018 of 56.8 hospitalizations per 100,000 population was a decrease from 105.9 in 2010. Although the change over time for both age groups appears statistically significant, due to coding changes from the ICD-9-CM to the ICD-10-C, changes in rates should be interpreted with caution.

 

Successes:

The Early Childhood Coordinator, in the Child and Adolescent Health (CAH) Division of MCH, continued to provide support as a Certified Child Passenger Safety (CPS) Technician and Instructor. The Early Childhood Coordinator accepted appointments two to three days per week to check car seats, provide car seats for low-income families that did not have a safe seat, and educate the parent or caregiver about proper use and installation of the seats.

 

From October 1, 2019 through mid-March 2020, the Early Childhood Coordinator educated caregivers on the installation and appropriate use of approximately 64 child safety seats through individual appointments. On February 19, 2020 the Early Childhood Coordinator taught a one-day Child Passenger Safety course for home visitors. The Early Childhood Coordinator also participated in four community car seat events. On March 23, 2020 the Governor issued Statewide stay-at-home orders for all non-essential businesses and restricted public gatherings due to the rapidly spreading COVID-19 virus. Individual appointments and car seat events were suspended.

 

Individual car seat appointments resumed in June 2020, with the CPS technician wearing a gown and mask, and careful screening and instructions for the families. The Early Childhood Coordinator completed approximately 30 individual appointments from June 11, 2020 through September 30, 2020. In addition, MCH and Injury Prevention Service teamed up with OU Children’s Hospital to hold twice per month car seat check events for families. All CPS technicians and families wore masks and the families learned how to install their car seats outside in a practice seat. The family members then installed the car seats into their own vehicles with supervision from the CPS technicians.

 

The MCH Early Childhood Coordinator maintained the Certified CPS Technician Instructor status and assisted in one National CPS Certification Technician Training Class with the newly revised curriculum September 28 – 30, 2020.

 

Challenges:

There continued to be a higher need by families than there were services available with trained CPS technicians across the state. The outbreak of the COVID-19 virus reduced the number of qualified families who received car seats and the number of families who received assistance in proper installation by a CPS Technician.

 

Objective 5. Maintain an average minimum of 3,300 calls per month to the Poison Control Hotline through December 2020.

 

Data:

For the calendar year 2020, the Poison Control Hotline received an average of 3,196 calls per month, a decrease from the 3,300 minimum calls per month. The calls included both confirmed exposures and confirmed non-exposures to humans and animals along with informational calls requesting identifications of medications and risk of exposure to the medication. 

 

Successes:

The Oklahoma Center for Poison and Drug Information continued to provide clinical training opportunities for physician, pharmacy and nursing students, including pivoting to Zoom trainings after March 2020. Educational trainings for elementary schools, child care providers and the children in their programs were also provided virtually. Staff provided radio and television interviews on topics related to prevention of poisonings as requested. They also provided educational opportunities to parent groups, senior citizen clubs and community-based organizations. Technical assistance was given to emergency response personnel on potential poisoning episodes and to hospital emergency rooms treating patients with possible poisonings.

 

The services provided by the Oklahoma Center for Poison and Drug information continued to be invaluable during the COVID-19 pandemic as evidenced by the slight increase of calls after March 2020, compared to the previous year. The services provided were vital in keeping Oklahoma children safe, providing education and technical support.

 

COVID-19 highlighted the need for necessary changes to serve the citizens of Oklahoma. Staff transitioned to working from home using the Virtual Desk Interface which included web-based information, resources, links, and the capability to communicate via a video window with a toxicologist and other staff. The 2-day HAZMAT Life Support Course was held via Zoom during this time and participants and facilitators stated it was as successful as an in-person training without a drop in attendance.

 

Challenges:

The COVID-19 pandemic created challenges for the Center in that the back-up plan had to be reconfigured from the previous pattern of utilizing other states in an emergency, as all Poison Centers nationwide were in the same situation. Since March 2020, there has not been a need for many in-person educational presentations, as schools were either out or virtual. Not being in-person also drastically reduced the number of pamphlets and other items distributed with the Hotline number. Some presentations and trainings continued to be held virtually, but the request for educational programs dropped significantly during this time to almost zero.

 

Staff time and funding continued to limit the number of presentations and outreach that could be accomplished for prevention and educational activities.

 

Although there has been a decrease in the number of calls from the public, the Center continued to experience an increase in the number of calls from medical professionals, including emergency room providers and other medical clinics. This was similar to trends across the country. Calls from medical entities were more labor-intensive; therefore, the staff spent additional time taking care of more complex patient situations.

 

Objective 6. Reduce the percentage of children 0-17 years experiencing two or more adverse family experiences from 26.6% in 2016 to 23.9% by 2020.

 

Data:

According to 2018 and 2019 National Survey of Children’s Health, among children ages 0-17 years in Oklahoma, 49.8% had no adverse childhood experiences, 25.1% had one adverse childhood experience, and 25.1% had two or more adverse childhood experiences.

 

Successes:

Adverse Childhood Experiences (ACEs) occurred frequently among Oklahomans and accumulated over time, contributing to short- and long-term personal, familial, and societal outcomes, including early death. ACEs continued to include such things as family and neighborhood violence, mental illness and substance abuse in the family, divorce, incarceration of a family member, death of a parent/guardian, poverty, and being the victim of abuse. Such experiences caused stress responses in a child’s developing brain, including extreme fear and helplessness. Continued stress responses over a prolonged period created a buildup of high levels of stress hormones in the body, interrupting normal physical and mental development – even changing the brain’s architecture.

 

The Oklahoma Partnership for School Readiness (OPSR) held the OKFutures Moving Forward Professional Development Conference on November 2, 2019 in nine locations across the state. There was a total of 837 participants and one of the topics to choose from was Trauma-Informed Care: How to Support Children and Families Who Come from Hard Places. MCH staff, partners, and contractors assisted in the planning process for these events.

 

On January 30 & 31, 2020, the OPSR offered Conscious Discipline training to almost 200 early childhood professionals. The training took place in Midwest City, Oklahoma. This training was funded by the Preschool Development Grant Birth through Five from the U.S. Departments of Health and Human Services & Education. It featured Mara Spencer who has over 20 years of experience in early childhood. Each attendee received copies of the book “Conscious Discipline: Building Resilient Classrooms,” Conscious Discipline is a comprehensive, evidence-based self-regulation program that integrates social-emotional learning, classroom management, and discipline. Conscious Discipline helps build resilient classrooms by giving educators seven powers to see conflict differently. These powers include: perception, attention, unity, free will, love, acceptance and intention. Each of these powers encourages a positive response from children and promotes skills like composure, encouragement and empathy.

 

The Oklahoma Professional Development Registry through the Center for Early Childhood Professional Development continued to offer formal training for early childhood professionals online and in the classroom on these ACEs topics from October 2019 through September 2020:

• Responding to Young Children Who Have Been Through Adverse Childhood Experiences
• Adverse Childhood Experiences: Building Resilience
• Addressing ACEs with Brain-based Approaches in Trauma-Informed Care
• Self-Care for ECE Professionals Who Care for Children Impacted by ACEs
• Foster and Adoptive Families: Supportive Strategies
• Understanding Adverse Childhood Experiences
• Promoting Equity Through Early Childhood Interventions  

 

In the summer of 2020 approximately 150 professionals participated in a pilot group that received training in the Pyramid Model. The Pyramid Model is a research-based framework for promoting healthy social and emotional development in children. The model provides education, guidance, and coaching for early childhood professionals and families to promote the best practices in social and emotional engagement that support positive behavioral outcomes in children.

 

The OSDH Child Guidance program remained uniquely positioned in public health settings to provide evidence-based programs that enhance protective factors and reduce risk factors for families. Child Guidance teams located in county health departments consist of master’s degree level clinicians in child development, behavioral health and speech/language pathology. Through a multidisciplinary approach, the Child Guidance Program continued to provide a continuum of services that supports development and parenting of children from birth to age 13 years. MCH and OSDH staff referred families to Child Guidance professionals for services in the county health departments.

 

MCH continued to work collaboratively with the Oklahoma Family Network. Oklahoma Family Network focused on supporting families of children and youth with special needs via emotional support, resource navigation, and ensuring quality health care for all children and families through strong and effective family/professional partnerships.

 

During the MCH Title X Comprehensive Site Review visits to county health departments, MCH staff members checked for community involvement in child abuse prevention efforts, health education provided in the schools and at community events, and appropriate resources and referrals for those dealing with mental health issues, needing treatment for substance abuse, and help for those experiencing homelessness, hunger, poverty and domestic violence. Due to COVID-19, only a few site visits were conducted prior to lockdown in March 2020.

 

The MCH Early Childhood Coordinator continued to serve on the Oklahoma Head Start Early Childhood Collaboration Advisory Board and attended the meetings. The Advisory Board was established to provide input to and receive updates on the strategic plan of work and activities of the Oklahoma Head Start State Collaboration Office (HSSCO).

 

The Board met according to schedule, three times per year, with ongoing communication between meetings, pivoting to virtual after March 2020. The membership of the advisory board continued to be composed of representatives of these priority areas: Health and Mental Health Care; Child Care; Education; Professional Development/Higher Education; Welfare (TANF); Child Welfare; Community Services; Family and Financial Literacy Services and Reading Readiness Programs; Activities related to Children with Limited English Proficiency; Activities related to Children with Disabilities; and Services to Children who are Homeless.

 

OPSR did not receive a second year of funding for OKFutures, the federal Preschool Development Grant Birth through Five by the U.S. Department of Health and Human Services, Administration for Children and Families, but they finalized the Oklahoma Early Childhood Strategic Plan. OPSR, as the State Early Childhood Advisory Council continued to lead efforts in collaborative, diversely representative decision-making through strategic plan implementation and continuous review processes. OKFutures stakeholders established a common agenda and developed shared measures for the OKFutures vision and desired outcomes and the MCH Early Childhood Coordinator served on the Family and Community Workforce Team.

 

The MCH Early Childhood Coordinator continued participating in the Oklahoma Tribal Child Care Association (OTCCA) meetings. The OTCCA remained a representative of American Indian and Alaska Native organization serving the 36 tribal Child Care Development Fund (CCDF) grantees that represent Tribal communities across Oklahoma. At the December 2019 meeting and the March 2020 meetings, the MCH Early Childhood Coordinator provided information and resources on safety, health, and nutrition for the tribal child care entities to share with the child care programs and families they serve. Due to COVID-19 restrictions the June and September 2020 meetings were cancelled.

 

Challenges:

Due to the COVID-19 pandemic, there was increased concern and challenges for all families and children in tolerating the increased adverse experiences created by the COVID-19 pandemic and sheltering at home.

 

There remained an identified need for more training on adverse family experiences for all who work with children and families, and for the families themselves.

 

Objective 7. Develop guidelines, with the assistance of the MCH-funded school nurses, and provide in-services for school staff on the importance of students having an evaluation by the school nurse prior to being sent home related to illness or behavior issues. 

 

Data: 

During the 2019-2020 school year, MCH continued to assist the Oklahoma State Department of Education with funding for eleven school nurses in nine rural school districts. The school nurses returned 6,528 students back to class to finish the day following an evaluation by the school nurse, up from 4,253 students the previous year. The school nurses sent 1,052 students home following the school nurse evaluation, which was up from 601 sent home the previous year. The 9 school districts had attendance rate of 93% or greater with total absences of 6,906 with 6,429 students enrolled (or an average of 1.1 absences per student). Compared with 2018-2019 numbers, Coronavirus-19 (COVID-19) appeared to have increased the number of students’ visits with the school nurse as well as a slight increase in the number of students sent home due to caution and mitigation practices. The nurses were following the CDC guidelines for signs and symptoms of COVID-19 until school ceased to meet in person in mid-March 2020.

 

Successes:

The MCH-funded school nurses (in 9 districts) continued to educate staff on the guidelines for their school districts to ensure that students were evaluated by the school nurse prior to being sent home for self-reports of illness or injury. Having guidelines in place to have each student evaluated by the school nurse prior to being sent home for illness reduced unnecessary absences and assisted in maintaining attendance rate for the school district. The school nurse followed evidence-based nursing principles and communicable disease guidelines, including the new COVID-19 guidelines, to determine if the student’s signs and symptoms warranted being sent home related to illness or injury. If deemed unnecessary, the students were returned to class to continue learning and limit the number of absences in the district as well as increased the student’s learning time at school. The districts’ access to a school nurse continued to keep the unnecessary absences to a minimum, even during a pandemic.

 

The School Health Coordinator worked with all state school nurses in creating and disseminating COVID-19 mitigation efforts, policies, procedures and guidance. Most Oklahoma schools did not return in-person following Spring Break March 2020. School guidance regarding picking up medication and other important items from school were created and sent out to Oklahoma school nurses and districts in April 2020. Algorithms and easy to follow flow sheets were developed for staff to discern the need for evaluation by the nurse versus the need to manage care in the classroom.

 

Once schools began returning in person, school nurses worked with their local county health department offices for contract tracing to reduce the spread of illness. The nurses also continued to provide necessary health education in a variety of ways including videos and working with the students virtually. Guidance and protocols were sent out to school nurses and other school staff as it was written and vetted through the OSDH process. Work on the Emergency Guide for School Nurses was written with the assistance of School Nurse Leaders around the state. This was accomplished while the School Health Coordinator also worked several shifts per week on the statewide COVID-19 Hotline. The crafting of the various COVID-19 related policies, procedures, and guidelines created the need for several meetings each week with school nurses, OSDE, and OSDH, which strengthened the working relationship with OSDE, MCH, and school districts around the state.

 

Successful creation of the mandated Diabetes Management Training for School Staff in a virtual setting was accomplished during this time by the School Health Coordinator in collaboration with OSDE. The trainings were held in the fall of 2020. School nurses around the state volunteered to assist with the completion of the training by providing needle skill trainings for other districts in their areas without a school nurse. This, in turn, created a stronger network of school nurses for the School Health Coordinator.

 

School nurses were able to complete their mandatory vision screenings, health education, social emotional learning, and nursing duties using COVID-19 mitigation strategies to keep their schools as healthy and safe as possible.

 

Challenges: 

COVID-19 created many challenges including not being in-person at school, schools working on a hybrid schedule of both in-person and virtual learning. The nurses were stretched to manage typical chronic illness, acute illness or injury, in addition to COVID-19 mitigation, contact tracing, testing, etc. Sometimes the school nurse was the only person in their district directly responsible for pandemic mitigation and there were many associated stressors.

 

Due to the Pandemic, the MCH-funded nurses halted data collection in March 2020. A system for each district had to be developed to count students as absent and the differences may skew the data numbers as each district’s policy was slightly different. The pandemic created the need for most of the original guidelines, policies, and programs to be placed on hold through the period of March 2020-October 2020. During this time, the school nurse’s focus was turned to contact tracing, mitigation, and development of new procedures and policies. Changes also occurred to policies regarding sending students to school nurse, and new guidance was developed to assist staff on when to send to the nurse and when to manage in the classroom. Some districts created a small kit for each classroom that contained items such as bandages and nail clippers to keep the student in the classroom, reducing time in the hall, office, or nurse’s office. The nurses had to adapt, lead, and support their district, community, and surrounding school districts during this challenging time.