Massachusetts has two Child Health priorities for 2020-2025:
- Strengthen the capacity of the health system to promote mental health and emotional well-being.
- Foster healthy nutrition and physical activity through equitable system and policy improvements.
Priority: Strengthen the capacity of the health system to promote mental health and emotional well-being.
Objective 1 (NPM 6). By 2025, increase to 60% from baseline (37.3%, 2017-2018 NSCH) the percent of children, ages 9 through 35 months, who received a developmental screening using a parent-completed screening tool in the past year.
Title V is committed to increasing the capacity of a cross-disciplinary workforce to screen for and promote social-emotional health in early childhood to raise awareness of the connection between physical and emotional health. Many children with developmental delays or behavioral concerns are not identified as early as possible and miss critical opportunities for intervention and treatment. The performance measure for this priority, NPM 6, reflects efforts to increase developmental screening among young children. According to the 2020-2021 NSCH, 44.7% of children ages 9 through 35 months received a developmental screening using a parent-completed screening tool in the past year, higher than the national screening rate of 34.8% in 2020-2021, but lower than the Massachusetts screening rate in 2019-2020 (52.3%).
WIC
Children from low-income groups, such as those served by WIC, may experience delays in access to screening and diagnostic services and miss the opportunity to benefit from Early Intervention (EI) services. The WIC Developmental Milestones Program was developed in Missouri to integrate CDC’s “Learn the Signs. Act Early.” (LTSAE) campaign into WIC clinics, promote referral for early identification and encourage children’s healthy growth and development. Because of its initial success, the program was replicated and refined in four Missouri counties, then expanded statewide and nationally through support from CDC and the Association of Public Health Nutritionists.[1],[2]
MDPH received the WIC Developmental Monitoring Program grant from CDC’s National Center on Birth Defects and Developmental Disabilities and the Association of State Public Health Nutritionists. The purpose of this grant is to integrate LTSAE into MA WIC to strengthen opportunities for developmental monitoring and connection to screening, services and supports for participating children and families. The evidence-based strategy measure for NPM 6 is the percent of infants and children enrolled in WIC who are monitored using the LTSAE checklist. In FY22, 8.4% of children (11,245 out of 133,258 infants and children) were monitored, while 23% of caregivers of WIC infants and children (30,951 out of 133,258 infants and children) were provided with education on development during appointments with WIC nutrition staff. In FY22, over 2,200 WICSmart online nutrition education modules on topics related to the 9- and 12-month developmental milestones were completed by parents and caregivers for their children’s follow-up appointments. Due to a larger eligible caseload of infants and children in FY22 (133,358) compared to FY21 (43,087) and similar monitoring efforts between both fiscal years, the 2025 statewide goal for monitoring using the LTSAE checklist has been lowered, with an anticipated reach of 15% by 2025.
In early FY22, after the successful pilot of the LTSAE Developmental Monitoring Program by seven local WIC programs, staff from all 31 local programs were trained to work with parents and caregivers to complete age-appropriate developmental milestone checklists during their infant and/or child’s WIC certification (initial), mid-certification (if enrolled longer than 6 months), and individual follow-up appointments. The training ran through July 2021, and all programs were actively implementing the program by August 2021. Four bulletins were sent to local program staff in FY22 providing reminders and updates about the program and continuing education opportunities. In late winter 2022, CDC revised the milestone checklists to better reflect what milestones most (75% or more) children are meeting, to eliminate repeated milestones between checklists, and add two new checklist ages (15 months and 30 months) to match AAP’s recommended ages for well-visits. As a result, the WIC state office offered a virtual training in Spring 2022 providing more information about the milestone revisions and offering a refresher on developmental monitoring for new and previously trained staff. Over 40 WIC local program staff attended the live training, which was also recorded for viewing at a later date. In May 2022, the WIC Act Early webpage on mass.gov went live providing information on and access to milestone checklists, and local and national resources for both families and providers. MDPH worked closely with the MA CDC Act Early Ambassador to create online checklists on the MA Act Early website, providing yet another means for developmental monitoring. In addition, the MA Act Early online checklists provide information on local resources and services and are available in English, Spanish, and Chinese with plans to include other languages in the future, furthering equitable access to monitoring tools.
In FY22, programs completed 11,245 developmental milestone checklists. If completed checklists indicated a potential developmental concern, staff provided a referral for developmental screening and further assessment. During FY22, all WIC programs statewide provided 954 referrals to EI, 193 referrals to Family TIES, 67 referrals to the local public school’s special education department, and 9,307 referrals to CDC’s Milestone Tracker App for continuous monitoring. Staff followed up on these referrals at subsequent WIC appointments to ensure families received services. The local programs reported that 3,254 infants and children received EI services and 331 received services from their local public school’s special education department. In addition, there were over 98,000 hits to the Developmental Monitoring button in the WICShopper App in FY22, providing families with additional information and resources on early childhood development, including a link to download CDC’s Milestone Tracker App.
MA MIECHV
During federal FY22, 6.2% of households enrolled in MA MIECHV home visiting services reported having a child with developmental delays or disabilities. MA MIECHV home visitors conduct developmental screenings (using the Ages and Stages Questionnaire-3 [ASQ-3] and ASQ-SE:2) on enrolled children to identify developmental concerns as early as possible. Home visitors plan activities to strengthen development in areas of concern and refer to EI and other appropriate community resources to ensure that children thrive in social and educational settings.
Young Children’s Council (YCC)
In FY22, the YCC, chaired by the State Title V Director, continued to meet quarterly. The YCC aligns MDPH and community-based work related to infant and early childhood mental health and advises programs that focus on early childhood systems building. Council membership includes state and community agency representatives as well as increasing family representation, including male caregivers and families with a diversity of life experiences. MDPH staff continue to improve meeting practices and structure to ensure families are equitably involved.
In FY22, the YCC maintained its commitment to centering racial equity in meeting operations, presentations, and discussions. A continued theme from FY21 into FY22 was the impact of COVID-19 on young children and their families and opportunities for a more coordinated and equitable response. The YCC served as a resource for the MDPH Vaccine Equity Initiative to inform vaccine rollout to children aged less than 5 years, including a focus on equity driven outreach and engagement strategies. Other meetings featured discussions to ensure the MDPH Pediatric Mental Health Care Access project centers families and racial equity in its implementation. The YCC brought on a new cohort of nine family leaders of diverse backgrounds, who are taking on increasing levels of leadership, including co-designing meeting agendas and facilitating breakout discussions. To ensure the YCC effectively captures and takes action to address feedback and ideas shared by the family leaders, MDPH developed a tracker tool with plans to pilot the tool in FY22.
Early Childhood Mental Health Integration
Title V staff support integration of early childhood social emotional health into pediatric primary care, aiming to carry forward the success of the SAMHSA-funded Project LAUNCH (Linking Actions for Unmet Needs in Children’s Health) and Project LAUNCH Expansion, which ended in 2020. The LAUNCH team (an early childhood mental health clinician and family partner) engaged families in behavioral/developmental screening in pediatric primary care prior to developing a care plan with the family. Following a screening conducted by the pediatrician, the LAUNCH team followed up with more in-depth screening, including family risk screening. In FY22, Title V staff promoted models similar to LAUNCH, in particular focusing on the value of the Family Partner in supporting families and their young children’s social emotional wellness.
MDPH was awarded the HRSA American Rescue Plan-Pediatric Mental Health Care Access cooperative agreement in August 2021. Because Massachusetts had an existing program to support pediatricians in getting consultation on children’s mental health, Title V staff partnered with that entity, the Massachusetts Child Psychiatry Access Program (MCPAP), to
enhance their early childhood mental health (ECMH) capacity, centering family engagement and equity. Title V partners with the MCPAP team at UMass Chan Medical Center, the Department of Mental Health, MassHealth, and the YCC to: establish and train an Early Childhood MCPAP team, including a part time psychiatrist and full time ECMH clinician, to provide telehealth consultation to primary care practices; provide training and case consultation using the ECHO model to enable primary care provider teams to support the behavioral health needs and wellness of children aged less than 6 years (including the evidence-based Pyramid Model and DC:0-5); and provide enhanced ECMH tools and resources and linkages to the early childhood and family support system.
MDPH staff advised the second iteration of an Infant and Early Childhood Mental Health Primary Care Integration Workgroup (formerly co-led by MDPH, and now co-led by the Department of Mental Health and the Children’s Mental Health Campaign), which developed recommendations to transform pediatric primary care practices to include infant and early childhood mental health, considering how this approach might be reflected in MassHealth’s 1115 Waiver.
Title V staff co-led the Internal MDPH 1115 Waiver Workgroup, a cross bureau group whose goals were to: stay informed, analyze new information, and surface opportunities to support and influence, raise concerns/risks, and determine/catalogue possible actions related to the MassHealth 115 waiver; anticipate interests of other MDPH entities; bring the lenses of our partners/collaborators and anticipate needs, interests, and possible unintended impacts; and share learnings with MDPH Leadership and other relevant partners to connect the pieces and ensure the right voices are at the table. Title V Staff provided a briefing on the 1115 waiver, including opportunities and risks for MDPH, to the Commissioner and Bureau Directors in March 2022. Title V staff also met directly with MassHealth and other state agency leaders to surface policy and programmatic opportunities and concerns. A Title V staff was assigned to be MDPH observer of MassHealth Technical Advisory on Primary Care to promote information sharing.
In FY22, Title V staff continued to work with MassHealth, the Department of Mental Health, and the Massachusetts Association for Infant Mental Health to promote use of the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood (DC:0-5). Title V’s leadership in this cross-agency collaborative training implementation was highlighted by Zero to Three in an article entitled Integrating DC:0–5 Into State Policy and Systems: 5 Years of Progress. Title V also collaborated with MassHealth and other partners to explore how to encourage use of the tool and appropriate billing practices, including through developing a crosswalk between the DC:0-5 and the DSM-V/ICD-10 codes, published in June 2022.
Interagency Early Childhood Work Group
In FY22 Title V staff served in leadership roles in the Interagency Early Childhood Workgroup (IECW), co-led by the Executive Offices of Education (EOE) and Health and Human Services (EOHHS). Title V staff will continue to support implementation of the workgroup’s Memorandum of Understanding (MOU), “Establish Shared Performance Indicators and Related Activities to Support Early Childhood Development and Education,” to promote coordination and collaboration in providing and supporting early childhood development programs and services. The MOU builds on three key strategic focus areas developed by the Workgroup, including: 1) family outreach and engagement, 2) provider supports and professional development related to birth-to-5 developmental screening and assessment, and 3) state agency coordination, especially in establishing performance indicators and continuing to share data.
As part of this initiative, Title V staff led a task group, which developed recommendations, informed by family voice, to support enhanced communication with families concerning their young children’s development, including how to access developmental screening and relevant services and supports. Based on these recommendations, in FY22 the task group created a new state website for pregnant people and caregivers of children birth through age five that centralizes and facilitates easy access to information about state-funded early childhood and family health/well-being services available in their communities. The site also includes information about child growth and development, parenting support, and MA 211 (a call-line that connects people to information about critical health and human services available in their community) to further assist families in accessing local resources. The workgroup partnered with families to design the website to ensure it is family-friendly and accessible. The workgroup is monitoring traffic to the site and plans to make enhancements after the initial web analytics are discussed.
In FY22, Title V staff served on an IECW subgroup overseeing the operations of the newly formed Early Childhood Integrated Data System (ECIDS). The ECIDS includes data from the state’s major programs serving young children, all of which offer developmental health supports such as developmental monitoring, screening, or assessments. Within MDPH, these programs include WIC, MIECHV, and EI. Other programs include the Department of Early Education and Care (Child Care Financial Assistance and Preschool Expansion programs), the Department of Elementary and Secondary Education (Public Pre-K, for children with and without an Individualized Education Plan) and the Children’s Trust. ECIDS provides valuable insights to inform and improve the administration and impact of programs serving young children and their families, through aggregated, de-duplicated, de-identified and analyzed data about program participation and academic outcomes.
After a pilot of the system in FY21, the subgroup identified limitations in the breadth and depth of the current data sets. In FY22, the group identified resources to test a differential privacy strategy to address these limitations and allow for cross-filtering of the data and examination of smaller geographic units to provide more meaningful analysis. While this strategy does enable ECIDS data to be viewed at the municipal level, additional limitations were discovered in the accuracy of the data for programs that have small participant numbers. The subgroup continued to explore strategies to address these challenges as well as began to develop standard operating procedures and decision-making structure for the ECIDS Governance Board, which includes DPH/Title V staff.
Priority: Foster healthy nutrition and physical activity through equitable system and policy improvements.
Objective 1. By 2025, increase the percent of families with children aged 0-5 years who can always afford to eat good nutritious meals from 77.9% (2017-2018 NSCH) to 87%.
The COVID-19 Community Impact Survey (CCIS), conducted in fall 2020, indicated that economic hardship brought on or exacerbated by the pandemic resulted in people being unable to afford enough food or healthy food for themselves and their family. The pandemic also made accessing groceries more challenging than before, especially among those without safe transportation and those more vulnerable to COVID-19. More than 1 in 4 (28%) CCIS respondents worried about getting food or groceries in the coming weeks. According to the 2020-2021 NSCH, 81.5% of families with children aged 0-5 years could always afford to eat good nutritious meals, a slight decrease from 84.3% in 2019-2020. Key strategies to reach this objective focus on building partnerships to maximize the access that families with young children have to food resources for which they are eligible, increasing the availability of and access to fruits and vegetables, and identifying and implementing more upstream approaches to promoting food access and physical activity.
WIC
WIC maintains a Memorandum of Agreement with Head Start to facilitate data sharing and support coordinated nutrition care of shared clients. WIC also has longstanding data sharing agreements with MassHealth and SNAP to identify and outreach to likely eligible but non-participating families. Following quarterly data exchanges and matching, text messages are sent to direct families to the WIC online application, routinely leading to spikes in the volume of online applications.
Massachusetts WIC, together with Washington State WIC, made progress on a USDA grant from the Gretchen Swanson Center for Nutrition to pilot an online ordering system for WIC participants, which will begin in the summer of 2024. The WIC state agencies are working with Walmart and EBT processor FIS to develop and implement a platform that will allow WIC participants to shop online at WIC-authorized Walmart stores and pick up their foods curbside or have them delivered.
The goals of the WIC Farmers’ Market Nutrition Program are to provide fresh, locally grown fruits and vegetables to WIC participants and to expand awareness of WIC participation and WIC-supported sales at farmers’ markets. Local WIC programs distribute farmers’ market coupons in their communities during distribution events that feature nutrition education, other agency outreach, and often the farmers themselves. Eligible participants receive $30 to spend at participating farmers’ markets, farm stands, and community-supported agriculture plans. In FY22, the Farmers’ Market Program served 22,522 participants with an overall coupon redemption rate of 65%, reflecting a substantial increase from 33% the prior year. This increase is most likely due to a return to in-person coupon distribution (for the first time since the COVID-19 pandemic) and more local WIC programs hosting distribution events at farmers’ markets, thereby making it easier for participants to use their coupons right away.
In FY22, WIC and Mass in Motion, an MDPH grant program and statewide movement that promotes opportunities for healthy eating and active living in the places people live, learn, work and play, worked together to represent MDPH on the state’s internal food security work group and collaborated to address food access concerns associated with the pandemic and its aftermath. WIC and Mass in Motion ensured there was a public health lens on food insecurity discussions (such as social determinants of health and upstream causes/solutions). The programs also continued to promote the COVID-19 Community Impact Survey and discuss opportunities to update the survey for future assessment needs.
Metabolic Food and Formula Program
State law mandates that private insurers cover medically prescribed formulas and up to $5,000 annually for special low-protein modified foods for people with phenylketonuria (PKU) and other metabolic disorders. The MDPH Metabolic Food and Formula Program fills the gap by providing coverage for special foods and formula to uninsured or underinsured individuals, and for MassHealth enrollees. In FY22, the program served 45 children aged birth to18 years. This likely reflects a large proportion of children who need MDPH services, although the denominator is unknown. Metabolic clinics are effective at enrolling new and existing patients eligible for the program. Throughout the year, some participants do not order special food and formula through MDPH because they switch to insurance plans that make them ineligible, become enrolled in clinical trials for non-dietary therapies, have fewer dietary restrictions over time, are no longer following the diet, or have moved out of state. MDPH works with participants and metabolic dietitians to follow up as needed.
Growth and Nutrition Program
The Growth and Nutrition Program (GNP) is a network of MDPH-funded clinics that use a multidisciplinary approach to providing comprehensive, coordinated, family-centered assessment and treatment to infants and children from birth through six years who have been diagnosed with Growth Faltering or Failure to Thrive (FTT). The program aims to address the many causes of delayed growth or growth deceleration, including medical, nutritional, and psychosocial determinants. The multidisciplinary team includes a physician, dietitian, nurse, social worker, and other disciplines based on support needs. Some clinics may offer additional services such as feeding groups and home visiting services.
In FY22, there were five MDPH-funded contracts supporting eight GNPs across the state. These programs, located in Berkshire, Worcester, Middlesex, Essex, Norfolk, Suffolk, and Plymouth Counties, served 1,068 children, including 186 infants.
In the latter half of FY22, the Nutrition Division released a Request for Response (RFR) that sought to increase access to GNP services in areas that did not have funded clinics, in particular Hampden County, serving the greater Springfield area, and Bristol County, serving Fall River and New Bedford. Data from the 2018 All-Payor Claims Database indicated that the cities within these counties have some of the highest documented diagnoses of FTT. At the conclusion of FY22, six contract packages were finalized, providing funding to 10 GNPs starting July 1, 2022. These are three-year contracts offering two options to renew up to seven years. As a result of this RFR, funding is being increased to clinics that have seen a rise in caseload, and services will be provided to families in Hampden and Bristol Counties. Funding is expected to support 1,195 children annually.
School Health Services
The Comprehensive School Health Services (CSHS) program provides additional support to existing, required school health services through a multi-disciplinary approach that supports the delivery of quality, comprehensive health services. In FY22, funding was provided to 135 public school districts, charter schools, and educational collaboratives, and 27 private schools, which are responsible for reporting performance measures on an annual basis. These performance measures track activities intended to reduce the percentage of students who are overweight or obese by 1% each school year, including creating education programs and case management services. One of the performance measures required school districts to compare their FY22 BMI data to the average from the prior 3 years. Since BMI screenings were not conducted for two of the prior three years due to the COVID-19 pandemic, the performance measure could not be operationalized in FY22. It will not be possible to operationalize this measure until FY25 or FY26, as some school districts were unable to resume BMI screening in FY22.
Per federal and state legislation, each school district must have a Wellness Committee at the district and individual school levels to monitor data and work with community partners, including local Mass in Motion groups, on strategies to promote healthy eating and active living. School nurses typically engage with these Wellness Committees and work to identify families that qualify for take home food programs supported by community gardens, farm shares, and food pantries. School food service departments also work closely with the Department of Transitional Assistance to identify families who may qualify for free and reduced meals who do not self-identify through the application process.
Injury Prevention and Control Program (IPCP, also includes activities of the Injury Surveillance Program)
Injury prevention initiatives are important for increasing safe physical activity for children and youth. The IPCP provides information about injury prevention through trainings, policy analysis, and communications activities to state and community partners, and through the dissemination of injury data prepared by the program’s epidemiologists. IPCP conducts an annual review of technical assistance (TA) requests (from both internal and external partners) to which the team has responded. Information from that review is used to update and improve accessibility of the IPCP webpages and identify unmet community needs. In FY22, IPCP received 55 injury-related TA requests (29 data-related and 26 program-related). This represents an increase from 10 in FY21, but still lower than previous years. This is attributed to many service providers continued focus on supporting communities in COVID-19 mitigation more than injury prevention.
Several subprograms/activities within IPCP expand the unit’s reach and specificity of TA requests, including the following:
Traffic safety
In FY22, IPCP staff participated in the development of the Strategic Highway Safety Plan, a multidisciplinary effort to improve road safety in Massachusetts through engineering, enforcement, education, emergency response, awareness, and policy strategies. IPCP staff participated in two plenary planning sessions and 12 subcommittees focusing on emphasis areas. The IPCP director led the subcommittee examining issues around young drivers and identifying strategic priorities and action steps to reduce injuries.
In FY22, the IPCP director also acted as tri-chair for the MA Traffic Safety Coalition. This multi-sectorial coalition meets quarterly to explore evidence-based strategies to reduce and mitigate traffic and pedestrian crashes through environmental design, communications campaigns, and surveillance. FY22 topics included seatbelt use and equity, the Strategic Highway Safety Plan (SHSP), and the MA Long-Range Safety Plan: Beyond Mobility, the SHSP’s Youth Emphasis Group and Kids Speaking Up for Distracted Driving.
IPCP staff continued work on Promoting Child Passenger Safety: A Toolkit for Pre-Hospital Providers, which aims to provide resources and information about how pre-hospital providers can set up and sustain a child passenger seat inspection and education program. IPCP staff completed development of the toolkit in May 2022 and began to disseminate the product to hospital providers and EMS personnel.
In FY22, IPCP also developed a presentation titled “Drowsy Driving in Massachusetts Teens, Key Findings from the 2017 and 2019 MA Youth Health Surveys” to share with traffic safety advocates and partners in FY23. The presentation highlighted the following results: of MA high school students who drove, 12.3% reported falling asleep at the wheel in the past 30 days; students who reported sleeping 6 hours or less on an average school night were more than twice as likely to report falling asleep at the wheel as students who slept 7 hours or more; and groups disproportionately likely to experience falling asleep at the wheel included LGBTQIA students, students of color, and students with physical or learning disabilities, or long-term physical or emotional health problems.
Injury Prevention Training Series
In fall of 2021, IPCP hosted a four-part training series delivered to 73 infant and early childhood home visitors, providing information and resources on injury prevention strategies to share with the families they serve. Topics included general injury prevention and water safety, poison prevention, child passenger safety, and infant safe sleep. A post-survey of the trainings showed a 9.3/10 satisfaction rate regarding the knowledge learned, usefulness, and training content.
Starting in January 2022, IPCP expanded the curriculum to a 12-part series and began developing materials for the trainings. A total of 123 participants attended the trainings that took place in FY22 (General Injury Prevention and Home Safety and Water Safety trainings). Comparing the pre and post survey, participants knowledge for general injury prevention and home safety and water safety prevention strategies increased after taking the training. Given this success, additional trainings were planned for FY23, including Child Passenger Safety, Poison Prevention, Infant Safe sleep, Abusive Head Trauma, Paid Family Medical Leave and Reproductive Healthcare Resources, Question, Persuade, and Refer (QPR) (a suicide prevention 101 training), Self-care and Secondary Trauma, Young and Novice Driver Transportation, Pedestrian, Bike and Concussion Management, Falls Across the Lifespan, and Introduction to Health Outcomes and Positive Experiences (HOPE).
Sports concussion and general traumatic brain injury
MDPH sports concussion regulations provide standardized procedures and guidance to schools with children in grades 6-12 in the prevention and management of sports-related head injuries in all public schools and other schools that are members of the MA Interscholastic Athletic Association. The IPCP monitors school compliance with these regulations by collecting, analyzing and reporting submission of “Year End Reports” on concussions by schools subject to these policies. The number of Year End Reports received from schools increased from 385 schools in school year 2020-2021 to 461 in school year 2021-2022, similar to pre-pandemic reporting levels.
Also in FY2022, the IPCP collaborated with Massachusetts Rehabilitation Commission (MRC) and the Massachusetts Brain Injury Association (MA BIA) to develop a data template to understand the epidemiology of traumatic brain injury (TBI) in Massachusetts. This involved generating preliminary data on TBI by age groups (including children aged 0-2, 3-5, 6-18, and 19-20 years), race/ethnicity, county, and geographic subregions. IPCP provided TA to these collaborators in the interpretation of the data findings. Other TBI programming involved reviewing and editing the Sports Concussion content in the Boston University’s SHIELD (School Health Institute for Education and Leadership Development) Training to identify areas of improvement and to ensure content was up to date.
MassPINN
IPCP co-chairs the Massachusetts Prevent Injuries Now! Network (MassPINN), a broad-based coalition of injury prevention practitioners across the state. During each meeting, the group receives a presentation and discusses programmatic and policy updates. FY22 topics included discussion of the intersection between racial equity and injury burden, community-based injury prevention collaborations with EMS agencies, connections between injuries and adverse childhood experiences, and Massachusetts’ long-term strategic plan for transportation infrastructure. IPCP sent monthly updates to MassPINN members with relevant articles, opportunities, and events.
Water Safety
In response to a cluster of drownings at the end of FY21, IPCP developed a water safety communications campaign that was disseminated from July to September in FY22 through social media. The campaign targeted teenagers and highlighted warning signs of drowning and action steps teenagers can take to keep themselves and others safe. IPCP also provided TA to the Commonwealth’s Executive Office of Environmental Affairs in developing a pilot program to provide free and low-cost swimming lessons. In August 2021, IPCP hosted a Water Safety training for 37 social workers from the MA Department of Children and Families. The training was well received and included local and national data on drownings, water safety strategies, and resources available to the foster and adoptive parents to reduce the risk of drownings.
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