MCH Block Grant FY20 Application & FY18 Report

Child Health Domain Annual Report

NPM-06: Developmental Screening: Percent of children, ages 9 through 35 months, receiving a developmental screening using a parent-completed screening tool

FY20 Annual Report

Program Activities:

The Performance Measure for NPM-06 was not quite achieved. The Performance Objective was 33.3% and the Annual Indicator was 32.6% of Utah's infants and children (ages nine months through 35 months) received an age-specific developmental screening annually, according to Federally Available Data. The new Performance Objective for NPM-06 is to increase the percent of infants and children (ages 9 months through 35 months) receiving age-specific developmental screening to 33.1%.

The lead agency's programmatic efforts to address this priority need are routinely performed by the UDOH, Bureau of Maternal and Child Health's (MCH) program named, Early Childhood Utah (ECU). ECU is comprised of two distinct teams. One team consists of three UDOH staff members, known as the ECU State Team. The ECU State Team coordinates various activities aimed at improving Utah's early childhood system. The ECU State Team also engages in activities designed to promote early childhood developmental health.

The other team, named the Early Childhood Utah Advisory Council, is the Governor's Early Childhood Advisory Council which has been formed according to the rules and regulations found within the Head Start Act pertaining to each state’s Early Childhood Advisory Council. Utah participates in the Federal ECCS grant. ECCS grant activities also focus upon improving the developmental health of children, ages 0-3, which reside in communities that are wrestling with significant social and health disparities. The composition and activities of this team are also guided by the requirements of the HRSA/MCH Early Childhood Comprehensive Systems Grant (H25MC00268-"ECCS"). The ECU State Team is comprised of a Program Manager, a Promoting Developmental Health Program Coordinator, and an Early Childhood Integrated Data System Program Coordinator. The activities assigned to all three of these roles contribute toward Utah’s efforts at meeting the objective of NPM-06.

During this reporting timeframe, the ECU Program Manager (ECU PM) actively engaged in efforts to improve the overall coordination of the early childhood service delivery system in Utah. The logic is, if early childhood systems are effectively coordinated, universal best practices will dictate regardless of where a family with young children may live, they will have the opportunity to learn how important it is for infants, toddlers, and preschoolers to achieve age-specific developmental milestones. The family, child, and caregivers will also have consistent access to developmental screening opportunities to guide and monitor their child's progress.

One strategy for improving the early childhood service delivery system in Utah is the effective orchestration of the ECU Advisory Council. The PM assures that the ECU Advisory Council is consistently staffed with representation from over thirty different early childhood agencies and/or programs. The ECU PM provides oversight for the work of six ECU Advisory Council Subcommittees. The ECU PM also assists with developing strategic work plans and timelines for the advisory and subcommittees and for tracking and reporting upon ECU’s progress toward achieving our co-created objectives, thereby creating a continuous quality improvement (CQI) feedback loop.

The ECU Advisory Council’s articulated mission is “to promote broad statewide coordination and collaboration among a wide range of early childhood programs and services in the state to ensure that Utah children enter school healthy and ready to learn.” Representatives from the agencies and programs that participate in the ECU Advisory Committee concur that one of the most effective strategies to ensure Utah children enter school healthy and ready to learn is to support frequent developmental screening for infants, toddlers, and preschoolers and to ensure that any family with children that may be in need of supportive social and/or health services, receives it.

One of the tangible steps the ECU Advisory Council agencies takes to support frequent developmental screening and referral to any needed services is to support, market, and fund the mission and activities of Utah’s Help Me Grow program. The Department of Workforce Services/Office of Child Care, the Department of Human Services/Division of Child and Family Services, and the UDOH’s MCH Bureau all fund and support Help Me Grow Utah (HMG) activities.

HMG’s informed practices help identify families with young children that may need assistance with accessing a developmental screening opportunity and if challenges are discovered, and if the family is willing, HMG assigns a care coordinator to help families navigate the complex landscape of applicable programs and services. HMG provides resources and referrals to families that have the potential of improving a child’s developmental health and trajectory.

HMG collects comprehensive data regarding the families they assist. The data includes the number of families who contacted HMG for assistance related to a developmental concern and the disposition of the intake (i.e., the parent/caregiver received helpful information and/or was connected to related services). HMG also provides valuable demographic data such as 1) the age of the child/children the concern was regarding, 2) who called, 3) how the caller discovered HMG resources, 4) the reason/issue for the parent’s request for services, 5) how many referrals HMG provided for residents of the PBC, 6) data disaggregated for the number of referrals per issue, 7) barriers related to receiving information and/or services, and 8) race/ethnicity data.

The ability for HMG and an additional forty (actively screening) early care/education and health providers to offer development screening opportunities for children across the state is made possible through the Child Care Development Block Grant through the Department of Workforce Services/Office of Child Care and through the HRSA/MCH ECCS funds granted to the UDOH.

The opportunity for early care and education providers to facilitate age appropriate development screening opportunities is powered through the lead agency’s Ages and Stages Questionnaire (ASQ) database/online enterprise account (via Brookes Publishing). Since 2011, UDOH has enrolled over 160 early care and education providers, at no cost to their agency/program, in our Promoting Developmental Health Program. Enrolled early care and education providers include pediatricians, federally qualified pediatric community health centers, hospitals, MIECHV home visitors, Medicaid-targeted case management, county health departments, child care and head start providers, school districts, and beyond.

While the lead agency may not have fully met the performance objective for NPM-06, developmental screenings (ASQ-3), captured by the UDOH ASQ account, for 0-3 year olds, has steadily increased. According to the UDOH ASQ database, in 2016, 5,992 0-3 year olds, across the state, received an ASQ-3 screen. In 2017, 7,777 0-3 year olds received an ASQ-3 screen. In 2018, 8,892 received an ASQ-3 screen. This statewide ASQ-3 data represents a 48% increase in 0-3 year olds receiving an age appropriate developmental screen between 2016 and 2018.

As stated earlier in this section, the UDOH also participates in the HRSA/MCH-ECCS grant. Through the ECCS grant, UDOH and our designated early childhood partners target developmental screening efforts in three marginalized communities. From 2015 to 2018, ASQ-3 screens for 0-3 year olds residing in these communities grew by 402% (from 49 to 246). One community, also a recipient of the Federal Rural Impact Grant (San Juan County), went from one ASQ-3 screen captured by the UDOH ASQ account in 2016, to 100 ASQ-3 screens entered into the UDOH ASQ account in 2018.

The activities and improvements presented above can be attributed to the investments the UDOH (and our partner agencies) are making to promote developmental health for Utah’s infants, toddlers, and preschoolers. These investments are not only financial, the UDOH and our early childhood stakeholders spend a considerable amount of time analyzing developmental screening data and engaging in the CQI process. Promoting the developmental health of children in Utah goes well beyond NPM-06. Yes, the lead agency intends to increase the number of children receiving age appropriate developmental health screens, but equally as important, UDOH aims to improve the percentage of children scoring above the cutoff mark. The path to accomplish this aim will be described in the UDOH annual plan for July 2019-June 2020.

Accomplishments / Successes:

From July 2017 - June 2018 The Early Childhood Utah (ECU) program at the Utah Department of Health (UDOH) continued to offer financial support and technical assistance to Help Me Grow Utah and to MIECHV Home Visiting caregivers. ECU engaged in ASQ online onboarding activities and provided additional training and to a variety of early care and education providers such as Federally Qualified Community Health Centers, school districts, childcare providers, Head Start, hospitals, pediatricians, etc.

One can attribute the positive trending data listed in the previous section and just below to the developmental health promoting activities of ECU and our many early childhood partners and stakeholders.

Between July 1, 2017 and June 30, 2018; 6,649 nine-month through thirty-five month olds received a developmental screen (ASQ-3 and/or ASQ-Social Emotional) as per the statewide UDOH-ASQ online account. Just as important to focus upon, 66.3% (4,414) of those children had scores in the developing age appropriately range, 19.2% (1,283) of those children were in the monitoring range and, corresponding with national data, there were significant developmental concerns for 14.3% (952) of the children that received an age aligned development screening through UDOH-ASQ early care and education providers.

As described in the previous section, ECU works directly with Help Me Grow (HMG) to increase the number of families and children that have an opportunity to receive age aligned development screening opportunities, growing and learning resources and if needed, care coordination such as helping families connect to early intervention providers. Preliminary data analysis reveals that ECU’s ongoing working relationship with HMG may lead to an increase in the number of young children receiving age aligned developmental screens and connections to the most applicable resources.

Between July 1, 2017 and June 30, 2018, HMG facilitated 2,964 age aligned developmental screens. Over the course of FY 2015-2018 HMG facilitated 10,509 age aligned developmental screens in Utah and all of those families/children received access to developmental health resources and care coordination.

The synergistic, positive effects of funding and co-training a part time WIC intake employee with a part time HMG care coordinator is becoming evident in one of Utah’s ECCS collective impact communities, San Juan County. In this frontier, poverty stricken, low resourced yet beautiful, and grand community, in 2016, 0 children were referred to HMG. However, after our collective ‘intervention’ throughout 2017, 43 (0-3) children were referred to HMG, and in 2018, 48 (0-3) children were referred to HMG (923, 0-3 year olds reside in San Juan County). All of these families/children were connected to no-cost, development health promoting activities, screening services, and care coordination.

Working effectively with our MIECHV and other early childhood partners throughout the state is also paying dividends. In another ECCS targeted-impact urban community (Ogden, UT - 84401; with 1,722 0-3 year olds) age aligned development screens increased from a total of 83 in 2015 and 2016 combined to 228 in 2017 and 2018 combined, a 175% growth rate (for 0-3 year olds, ASQ-3). Our MIECHV partners in this community, Prevent Child Abuse Utah (PCAU), contributed 0 screens to the UDOH ASQ online account in 2015, 8 in 2016, 37 in 2017, and 59 in 2018, displaying much improved participation and investment in the UDOH ASQ online database and Utah’s early childhood system of care (the PCAU data is for 0-3 year olds, ASQ-3).

One additional example of a blooming early childhood developmental screening relationship is portrayed by ASQ data received from our county health department partners in Davis County, Utah. From 2015 to 2018, Davis County Health Department completed 4,680 age aligned screens, 84% (3,929) of those screens were completed in 2018 alone. UDOH and ECU believe this data demonstrates the forward momentum that Utah is achieving with regards to increasing the number and percentage of screens 9 month through 35 month year olds receive.

Summary of successes and accomplishments on “Moving the Needle” in relation to NPM-06:

• Throughout FY18, 6,649 nine-month through thirty-five months old received an age aligned developmental health screen through the UDOH ASQ online account (ASQ-3 and ASQ SE).
• 85.5% of the 6,649 screens were above cutoff or in the monitoring zone.
• From 2015 to 2018, Help Me Grow Utah facilitated 10,509 age aligned developmental screens (ASQ-3 and ASQ-SE; all intervals/all ages).

Challenges / Gaps / Disparities:

 Challenges

Challenges that temporarily impeded developmental screening progress in Utah are related to the lead agency's ambition to “clean up” the UDOH ASQ online account’s privacy policy and parental disclosure/consent documentation. Prior to this process, issues of data ownership and data use may have been unclear to caregivers and parents. In order to mitigate this circumstance, UDOH’s legal counsel and our privacy and security team spent a considerable amount of time reviewing three Brooke’s Publishing documents: 1) the Family Access End User License Agreement, 2) Terms of Use, and 3) Privacy Policy.

After this thorough legal review, UDOH decided the best path forward would be to create our own ASQ Privacy Policy and Consent to Use of Data documentation and to create multiple and very apparent links on each enrolled program’s ASQ online landing page that families access to complete age aligned developmental screening. The link to the UDOH ASQ disclosure, consent, and terms of use document will be available alongside the link to the “hard-coded” Brooke’s disclosure and data use document.

UDOH is currently in the process of assessing each enrolled programs intention of remaining enrolled and active in the UDOH Developmental Health Promotion Program (ASQ program) and updating each program’s landing page with the new UDOH disclosure, consent, and terms of use document.

The document review and development process described above took 4 months (April-July) to accomplish and enrollment of new programs into the UDOH ASQ online account was paused during this time.

Another advantage to engaging in this “clean up” process revolves around the lead agencies desire to produce enhanced ASQ reports and to engage in outcome research related to our developmental health promotion program.

With the permissions that were already in place via the Brooke’s publishing documents, the lead agency is currently in the process of integrating ASQ data with our Early Childhood Integrated Data System. These integrated data reports will give the lead agency increased insights into the distinct number of children that receive ASQ screens, what type of early care, education and referral services these same children receive, and in which order or sequence the services are received in. Phase I participating agencies include Head Start, WIC, Home Visiting, Help Me Grow, and Child Care.

In addition to the integrated data reports described above, the lead agency is investing in the development of enhanced ASQ reporting functionality. These enhanced ASQ data reports will give the lead agency a much easier way to assess which programs are actively screening children, determine where these programs are located, as well as much improved methods for discovering the results of screening activities i.e., above cutoff, monitoring zone, below cutoff.

Finally, in the near future, meeting the challenge of “cleaning up” our ASQ disclosure, consent and terms of use documents will better position the lead agency to engage in outcome research related to the efficacy of promoting developmental health and screening services. For example, were children that received developmental screening and any applicable follow up services able to avoid remedial and/or special education services in the K-3 environment.

Emerging issues

Utah’s population base is rapidly shifting from a predominantly white to a more racially diverse population. Utah is also welcoming and accommodating to refugee resettlement efforts. As such, the lead agency and our partners often encounter language barriers when it comes to facilitating a parent involved screening tool such as the ASQ. ASQ materials are readily available in Spanish, but our refugee population represents dozens of languages ranging from Somali and Sundanese to Arabic. At times, our ASQ providers have access to interpreters that can assist with translation, but much of the language and tasks involved in completing a developmental screening are not easy to translate across languages nor cultures. This emerging issue has been quite apparent in one of our ECCS collective impact communities, South Salt Lake, a new home for many refugees.

Additional emerging issues relate to concerns about data security. Our ASQ providers share families’ concerns with us. Families are worried about data breaches and the potential exploitation of their personal data. Families are also fearful of the “government” using their data to identify and deport them.

The lead agency has created a method for parents to opt out of completing developmental screens for their children online, instead parents can complete age aligned screens via paper forms. The downside to this approach is that UDOH is unable to capture this informative screening data. The upside is additional children receive the opportunity to participate in developmental screening and referral to any services that may be applicable.

Agency Capacity / Collaboration:

Early Childhood Utah (ECU) is the program at UDOH that orchestrates the lead agency’s developmental health promotion program. ECU is also the program designated by the Governor’s office to function as the State Advisory Council on Early Childhood, otherwise known as the Early Childhood Utah Advisory Council. Due to our unique position as the body responsible for improving early childhood systems, we work closely with dozens of agencies and programs that provide myriad services to families with young children. Promoting healthy development and ensuring all children have consistent access to age aligned developmental screening is a high priority for this collaboration.

ECU works strategically with the agencies and programs listed below, most of these agencies/programs also report back to their own advisory and subcommittees which include teams of parents, families, and/or service consumers:

The Utah Office of Child Care, Weber State University, Maternal Infant Early Childhood Home Visiting, Medicaid Targeted Case Managers, the Utah Chapter of the American Academy of Pediatrics, the Governor's Office and Legislators, United Way, Help Me Grow Utah, Child Care Resource & Referral Agencies, the City of South Salt Lake, the Ogden United Promise Neighborhood Prenatal to Three Committee, the San Juan County Early Childhood Commission, the Head Start Association and Collaboration Office, Intermountain Health Care, Midtown Community Health Clinics, Voices for Utah Children, Utah Navajo Health System, School Districts, Division of Human Services, and Early Intervention Part C IDEA, Utah State Board of Education, and County Public Health Departments.
 

Summary Progress Report (2019) of ESMs related to NPM6

 

The following four ESMs have been deactivated.

 

ESM 6.1 - Early Childhood Utah (ECU) effort to increase ASQ screenings: Number of ASQ screenings conducted by early care and education providers

 

ESM 6.1 - Early Childhood Utah (ECU) effort to increase ASQ screenings: Number of ASQ screenings conducted by early care and education providers

 

ESM 6.3 - Help Me Grow Utah (HMGU) ASQ screenings: Number of ASQ screenings conducted by Help Me Grow Utah (HMGU) staff

 

ESM 6.4 - Healthcare provider well-child checks: Number of ASQ online screenings done during well-child checks

 

*These measures were deactivated and replaced as the data was too difficult to extract from the database. New measures have been developed that more accurately reflect current activities.

 

Two new ESMs have been created this year:

 

ESM 6.5 – Active participation of enrolled programs: Increase the percentage of enrolled programs that actively participate in the UDOH ASQ online account by 10%.

 

Goal/Objective:

Increase the participation of enrolled programs in the UDOH ASQ online account by 10%.

 

Significance of ESM 6.5:

By increasing the percentage of enrolled programs that actively participate in the UDOH ASQ online account, UDOH will gain an improved ability to track and increase the number of age aligned developmental screens that 9 month-35 month olds receive. The percent of enrolled programs that contributed any screening data to the UDOH ASQ online account in calendar year 2018 was 25%, which is 41 out of 163 enrolled programs.

ESM 6.5 Progress Report:

This ESM has been revised to include the objective of increasing the percentage of enrolled programs that are actively contributing screening data to the UDOH ASQ account.

Help Me Grow is already the second highest active contributor to the UDOH ASQ online account, they contributed 2,879 screens in 2018.

UDOH can more effectively increase the number and percentage of screening data received by the UDOH ASQ account by targeting efforts toward increasing the screening activity of inactive, yet enrolled programs. In calendar year 2018, 163 programs were enrolled, but only 41 (25%) programs contributed any screening data to the UDOH ASQ online account. Active will be defined as a program contributing any ASQ-3 and/or ASQ-SE data to the UDOH ASQ online account within a 12-month period.

ESM 6.6 - New program enrollment: Increase the number of programs enrolled in the UDOH ASQ online account by 10%.

Goal/Objective:

Increase the number of new programs enrolled in the UDOH ASQ online account by 10%.

 

Significance of ESM:

If additional programs are enrolled and actively participate in the UDOH ASQ online account, UDOH may increase the number of 9 month through 35 month olds receiving an age aligned developmental screening. The effectiveness of this strategy will be measured by the increase in the number of new programs enrolled in the UDOH ASQ online over a 12-month time frame. At the end of calendar year 2018, 163 programs were enrolled in the UDOH ASQ online account.

ESM 6.6 Progress Report:

Connecting with childcare providers, after they have participated in a developmental screening class, to offer ASQ materials, training, and technical assistance is a good strategy. However, it is difficult to measure and may not help us achieve the end objective. At this time, developmental screening classes are not widely nor frequently available.

UDOH will continue to outreach to childcare providers that participate in developmental screening classes. UDOH will also outreach to early care and education providers such as targeted case management providers, pediatricians, community health clinics, school districts, etc. in order to increase the number of programs that are participating in the UDOH ASQ online account.

Progress toward meeting this goal will be measured by the number of new programs that enroll in the UDOH ASQ online account. If additional programs are enrolled and actively participate in the UDOH ASQ online account, UDOH may increase the number of 9 month through 35 month olds receiving an age aligned developmental screening.

MCH Block Grant FY20 Application & FY18 Report

 

SPM-03: Child Injury Deaths: The rate (per 100,000) of injury deaths among children aged 1-19

FY18 Annual Report

Program Activities:

Strategy 1. Provide education, awareness, and prevention activities to children 1-19 and their parents.

In addition to strategies that the Violence and Injury Prevention Program (VIPP) directly implements, VIPP also contracts with 13 local health departments (LHD) and several community based organizations (CBO) to provide education, awareness, and prevention activities to children ages 1 to 19 years and their parents.

During the reporting period, LHD’s provided several suicide prevention training sessions as part of their suicide prevention activities targeting children and their parents. These included 110 Question, Persuade, and Refer sessions with 3,039 reached, two SafeTALK sessions with 55 reached, and three Mental Health First Aide trainings with 56 reached. Furthermore, LHDs collaborated with school districts to support and coordinate activities with local hope squads reaching 3,695 children. Finally, LHDS distributed 810 gun locks to residents in their communities. Several CBOs implement primary prevention programs that include bystander intervention and healthy relationship education. More than 943 unique cycles of healthy relationships education were implemented during the reporting period.  

Safe Kids Utah (SKU) is a non-profit organization that strives to reduce unintentional injuries in children and teens. SKU has been serving the kids of Utah for over twenty years and has been dedicated to finding innovative ways to educate Utahns on how to keep kids safe from unintentional injuries. SKU is the leading non-profit organization in the state when it comes to car seat and active transportation safety. SKU works to educate parents about child passenger safety and in order to do this successfully, they work with 13 local Safe Kids coalitions throughout Utah. These coalitions work hard to provide accurate information to their communities. During the reporting period, SKU and the VIPP engaged in the following media and public awareness efforts: 1) Avoid a Deadly Summer – Tips to prevent injuries during the summer months, 2) Fireworks are Exciting but Injure More than 3,500 Children Each Summer –
Safe Kids Utah reminds parents to be prepared and follow top safety tips, and 3) Safe Infant Sleep – Tips for parents on the safest ways to put their baby to sleep.

To promote Child Passenger Safety Week, several activities were conducted throughout the state to support car seat checkpoints and help local health department staff with training and certification. These included community free events such as, “Ask the Car Seat Expert”, Car Seat Checkpoints, Car Seat Education, and Car Seat Classes, sponsored by SKU. A total of 333 car seats were disseminated to low-income families. In addition, three Child Passenger Safety Course trainings were held to certify advocates to train caregivers on how to properly install car seats (65 individuals trained). Child Passenger Safety Technicians trained came from hospitals, health departments, local fire and police, retail, health plans, head starts, and unaffiliated advocates.

In addition to child passenger safety activities, parent night programs are conducted as part of the driver’s education curriculum to bring awareness and educate parents and students on deadly driving behaviors and Utah Graduate Driver’s Licensing laws. To complement efforts related to motor vehicle crashes, LHDs conducted seatbelt observation studies that helps leverage funds from the Highway Safety Office to conduct additional seatbelt studies throughout Utah.

Other efforts to provide awareness and education in Utah include pre-conference and conference planning for Zero Fatalities and Four Corners without Borders. Pre-conferences provide an opportunity to help keep Child Passenger Safety Technicians, particularly in rural areas, keep up-to-date on their skills, and obtain CEUs for recertification.

Strategy 2. Provide funding to thirteen local health departments to conduct local prevention activities.

VIPP partners with thirteen LHDs to establish injury prevention priorities, strengthen local injury prevention program capacity, develop community-based injury prevention projects, and implement evidence-based programs. The current VIPP Strategic Plan addresses priority areas across the MCH service areas and include: child maltreatment, infant sleep, school-related injuries, motor vehicle crashes, suicides, teen dating violence, prescription drug overdoses, sexual assault and family violence, traumatic brain injuries, and youth sports concussion.

MCH funding enables local health departments to maintain a basic level of violence and injury prevention programmatic efforts by supporting a portion of an FTE for an injury prevention coordinator across all thirteen local health departments. MCH funding supports eight local health departments to serve as the lead agency and coordinator of local Safe Kids coalitions. Funding was allocated based on the approved funding formula for local health departments. All thirteen local health departments were required to conduct activities and implement evidence-based programs in the areas of child passenger safety, teen driver safety, suicide prevention, and distribute child injury messages through traditional and social media platforms.  

The majority of these funds are used to implement evidence-based programs or promising practices for teen driving, child passenger safety, Safe Kids focus areas for unintentional injuries (water safety, sports safety, school related-injuries, etc.), teen suicide prevention, traumatic brain injury and youth sports concussions, firearm safety, suffocation, etc. Much of the partnerships and implementation of these activities are done by Safe Kids Utah and the local Safe Kids coalitions throughout the state.

Strategy 3. Conduct media campaigns targeting parents of 15-17 year olds to encourage parents to be more involved in driver education training and to better understand Utah's graduated drivers licensing law.

For the past 11 years, VIPP, the Utah Department of Transportation Zero Fatalities Program, and Utah Teen Driving Task Force have worked closely with parents and families who have lost a teenager in a motor vehicle crash to tell their stories in a memoriam book, in addition to prevention messages. This culminates in a Teen Memoriam lunch with current and previous families who are provided information about grief support and available services. Grief counselors present on the stages of grief and families are provided an opportunity to share their story. This event creates an informal space for the families to connect and receive support. The families become a support network for each other and have expressed their appreciation and comfort in being able to share their story with others.

The goal of the effort is to personally meet with the participating families, provide grief resources, and help support their prevention messages to other families and young drivers. We held the event in November 2018 to share stories of families who lost a child in a motor vehicle crash in 2017. Additionally, we work closely with the media contractor to evaluate the parent seminars in Utah high schools and the parent night programs as part of the driver’s education curriculum to bring awareness and educate parents and students on deadly driving behaviors and Utah Graduate Driver’s Licensing laws.

Strategy 4. Provide surveillance data and information on childhood injuries and deaths to partners, policy makers and media.

VIPP identifies school injuries through the Student Injury Reporting System (SIRS). The SIRS is an online database that helps to identify where, when, how, and why students get hurt at school. The SIRS database identifies reportable school injuries as an injury that caused the loss of at least one-half day of school and/or warranted medical attention and treatment from a school nurse, physician, or other health care provider. VIPP has provided this database as a free resource for schools to house their injury data. An online system (https://sir.health.utah.gov) contains data starting on September 1, 2011. Users of the SIRS include Risk Managers at each of Utah’s 41 school districts, school staff (such as principals, secretaries, coaches) at more than 800 Utah public schools. Data collected includes school district and number, date and time of injury, sex, aid that was given to the student, contributing factors of the injury, and activity during which the injury occurred.

While the SIRS holds a large amount of data regarding student injuries at school, data users and school districts had no way to easily explore, analyze, or display their data to better understand what it means. To increase availability of the data, the VIPP and the Office of Public Health Assessment launched a queryable system on the Indicator Based Information System for Public Health (IBIS) for school districts to use to look at their own student injury data since 2012. School district data is queryable at the school level, and users can look at variables such as grade, student sex, injury type, contributing factors, period, surface type, activity, number of days absent and actions taken. Additionally, the system allows school districts to populate graphs for better data use.

The VIPP is developing a user-friendly guidance on how to run various data queries using IBIS. The VIPP hopes this new data query system allows school districts to better use and understand their student injury data, ultimately making better, data-informed decisions on how to keep Utah students safe.

In addition to student injuries, VIPP took the lead in developing the 2017 Utah Adolescent Health Report using data from the Prevention Needs Assessment (PNA), a survey administered in Utah public schools in grades 6, 8, 10, and 12 on substance abuse, violence, injury, and chronic conditions. The data included in the report shows adolescent rates for important health indicators by local health district, grade, and sex. Results on selected indicators from violence and injury-related categories included: mental health (feeling sad or hopeless, psychological distress, suicide ideation, suicide plan, and suicide attempt), substance abuse (binge drinking, marijuana use, and prescription drug abuse), and violence and injuries (driver talking on cell phone, driver texting, seat belt use, bullied at school electronic bullying, and dating violence). The data presented in this report are expected the help school administrators, teachers, and public health practitioners identify health and safety needs of Utah students and take steps towards protecting and improving student health.

VIPP staff participated in developing the 2017 Youth Risk Behavior Survey (YRBS) report which includes key finding and recommendations for creating healthy, safe, and supportive environments where students can focus on learning. Similar to the PNA, the YRBS is administered in Utah public schools in grades 9-12. The data included in the report show high school rates for suicide ideation and attempts, motor vehicle crashes, technology, sports concussions, alcohol, school safety, dating violence, and sexual violence.

Strategy 5. Use social and traditional media platforms to educate Utahns about child injury prevention laws and strategies to prevent injury death.

VIPP’s media specialist created social media content, scheduled the content on a regular basis and disseminated content to local health departments for use in promoting the prevention of child injury, teen driving safety, teen dating violence prevention, teen suicide prevention, Safe Kids coalition activities, bullying prevention, summer safety, injury prevention laws (e.g., GDL and concussion), and drowning prevention. VIPP social media posts are reaching over 80,000 each month with more than 1,000 monthly engagements and an estimated reach through LHD efforts to promote child injury prevention messages continues to exceed 150,000 people.

News releases and advisories were distributed to local media promoting the prevention of youth injury and violence prevention (e.g., news releases and advisories for the Utah Safe Kids Summer Safety Tips, Firearm Safety, Teen Memoriam, Utah Adolescent Health Report, YRBS Report, and Infant Safe Sleep).

VIPP manages a teen dating violence prevention Facebook page, the Use Only As Directed website and Facebook page, and contributes to the Suicide Prevention website and Facebook page.

Strategy 6. Continue to co-chair and provide technical assistance to the Utah Teen Driving Task Force.

VIPP staff participate on the monthly Utah Teen Driver Task Force to discuss efforts to address traffic safety among teen drivers. Members of the Task Force represent a variety of local, state, and private agencies concerned about coordinating activities to improve the safety of teen drivers, passengers, and pedestrians. The Task Force goals are to: 1) reduce the rate of motor vehicle crashes and deaths in Utah among teens ages 13-19, 2) bring together stakeholders with an interest in teen driving to ensure activities are coordinated throughout the state, 3) create an effective marketing campaign designed to reduce risky behaviors among teen drivers and passengers, 4) use storytelling to encourage safe driving behaviors, 5) develop, support, and advocate for effective teen driving policies, and 6) support continued innovation in driver education materials.

Strategy 7. Continue to review 100% of all child injury deaths to improve response and develop recommendations for prevention and system change.

Since 1992, the Child Fatality Review Committee (CFRC) has been charged with the review of the circumstances and causes of all childhood deaths in Utah. The purpose of the CFRC is to develop a better understanding of child deaths in order to reduce the number of these tragedies. The goals of the CFRC are to: 1) identify and describe risk factors by studying and reporting trends and patterns of child deaths in Utah, 2) maximize resources through interagency collaboration to identify and describe the delivery of services by the involved systems (medical, human services, and law enforcement) to high-risk children, and make policy recommendations to improve the service systems to better meet the needs of families involved with these systems, 3) promote effective prevention strategies to reduce the number of child deaths, and 4) refer issues and propose strategies to appropriate organizations and agencies to promote education and prevention.

The CFRC meets once a month to review deaths of all Utah children (ages 0-18) who died within the three months prior, as well as any more recent suspicious cases. The cases reviewed by the CFRC include any death that falls under OME jurisdiction. These include homicides, suicides, suspicious, or undetermined deaths, as well as any sudden and unexpected deaths. This death review process provides a detailed understanding of how and why child deaths occur in Utah. CFRC data is entered into a national database. Recommendations are compiled after each review and shared with key stakeholders to implement for systems change.

Strategy 8. Evaluate the effectiveness of the motor vehicle parent night program being offered at various schools in Utah.

VIPP is working with the media contractor who conducts the parent night programs throughout Utah to develop an evaluation plan of the parent night program in addition to the curriculum being used in driver’s education programs. Evaluation technical assistance has been provided by the CDC, who is also interested in this strategy. An average of fifteen parent night programs are conducted per month during the school year.

Strategy 9. Provide evidence-based suicide prevention programs to youth ages 12-19.

During the reporting period, LHDs provided several suicide prevention training sessions as part of their suicide prevention activities targeting children and their parents. These included 110 Question, Persuade, and Refer sessions with 3,039 reached, two SafeTALK sessions with 55 reached, and three Mental Health First Aide trainings with 56 reached. Furthermore, LHDs collaborated with school districts to support and coordinate activities with local hope squads reaching 3,695 children. Finally, LHDs distributed 810 gun locks to residents in their communities.

Strategy 10. Publish the 2017 Teen Memoriam book.

For the past 11 years, the VIPP, Utah Department of Transportation Zero Fatalities Program, and Utah Teen Driving Task Force have worked closely with parents and families who have lost a teenager in a motor vehicle crash to tell their stories in a memoriam book.

We meet personally with the participating families, provide grief resources, and help spread their prevention messages to other families and young drivers. The families become a support network for each other and have expressed their appreciation and comfort in being able to share their story with others. We held the family event in November to share stories of families who lost a child in a motor vehicle crash in 2017. The memoriam books were provided to each high school in Utah.

Accomplishments / Successes:

The rate of child injury deaths among children ages 1-19 years of age has remained stable with an overall downward trend indicating a 17.4% decrease in child injury deaths since 1999. Males have had a consistently higher child injury death rate compared to females, and children ages 15 to 19 years have had consistently higher child injury death rates compared to ages 1 to 14 years of age.

With the increase in suicide prevention efforts at the local health district (LHD) level, VIPP feels confident that the rate of suicide deaths will start to decrease over time. In addition, VIPP just hired a full time suicide prevention coordinator that has provided technical assistance to the LHDs and is assisting with resource coordination with school districts. An emphasis on suicide prevention efforts have been placed on VIPPs priorities, and VIPP has become involved in participating more broadly in state and local efforts for suicide prevention.

VIPP has begun focusing on shared risk and protective factors to address many violence and injury prevention topics in the state. We have begun developing a strategic plan focusing on this shared lens and have engaged LHDs in this effort. Identified overarching themes for VIPP’s state strategic plan include: 1) Laws and Policies – Promote laws and policies that support safe communities, 2) Cultural – Encourage social norms that promote safety and health, 3) Health Access – Improve access and utilization to physical and behavioral health care, 4) Physical Environment – Enhance the physical environment to improve safe and healthy living, 5) Economic Development – Improve the socioeconomic conditions for Utahns, and 6) Connectedness – Promote individual, family, and community connectedness.

As a result of this work, VIPP has been able to engage non-traditional partners, has been instrumental in informing state level work on shared risk and protective factors, has implemented primary prevention trainings to local communities in Utah, has presented on national webinars, and has had several abstracts accepted to present on this topic and provide technical assistance and guidance on this approach to reducing child injury deaths in the state.

 

Summary of successes and accomplishments on “Moving the Needle” in relation to SPM-03:

• Suicide prevention activities were emphasized in local health department contracts. As a result, there was an increase in individuals reached through suicide prevention activities in local communities. These included 110 Question, Persuade, and Refer sessions with 3,039 reached, two SafeTALK sessions with 55 reached, and three Mental Health First Aide trainings with 56 reached. Furthermore, LHDs collaborated with school districts to support and coordinate activities with local hope squads reaching 3,695 children. Finally, LHDs distributed 810 gun locks to residents in their communities. (July 3rd, 2017 - June 29th, 2018)
• VIPP has begun focusing on shared risk and protective factors to address many violence and injury prevention topics in the state. We have begun developing a strategic plan focusing on this shared lens and have engaged LHDs in this effort. Identified overarching themes for VIPP’s state strategic plan include: 1) Laws and Policies – Promote laws and policies that support safe communities, 2) Cultural – Encourage social norms that promote safety and health, 3) Health Access – Improve access and utilization to physical and behavioral health care, 4) Physical Environment – Enhance the physical environment to improve safe and healthy living, 5) Economic Development – Improve the socioeconomic conditions for Utahns, and 6) Connectedness – Promote individual, family, and community connectedness.
  
  As a result of this work, VIPP has been able to engage non-traditional partners, has been instrumental in informing state level work on shared risk and protective factors, has implemented primary prevention trainings to local communities in Utah, has presented on national webinars, and has had several abstracts accepted to present on this topic and provide technical assistance and guidance on this approach to reducing child injury deaths in the state. (January 1st, 2018 - June 29th, 2018)
• To increase awareness of violence and injury impacting youth, VIPP took the lead in developing the 2017 Utah Adolescent Health Report using data from the Prevention Needs Assessment (PNA). The data included in the report showed that 27.3% of students reported feeling sad or hopeless, 20.6% of students reported psychological distress, 18.1% of students seriously considered suicide, 14.3% of students made a suicide plan, and 7.7% of students made one or more suicide attempts. Percentages for all of these indicators are highest among females, and 10th and 12th grade students were significantly more likely to have reported feeling sad or hopeless, to have reported psychological distress, and seriously considered suicide. In addition, 8.1% of students reported recently using marijuana and 5.5% of students reported binge drinking. Marijuana use and binge drinking increased with increasing grade. Further, 2.7% of students reported recently using prescription medications without a prescription.
  
  Additional data showed that 48.8% of students reported talking on a cell phone while driving, and 37.6% reported texting while driving, both of which are forms of distracted driving. Students in 12th grade reported significantly more distracted driving than students in 8th and 10th grade. Majority of students reported frequently wearing a seatbelt (95.5%). Females and students in lower grades were significantly more likely to be bullied than males and students in higher grades. Overall, 27.9% of students reported being bullied at school and 27.2% of students reported being bullied over the Internet, by email, or by someone with a cell phone. Students in 8th grade were significantly more likely to be electronically bullied than 12th grade students. Females reported more than 50% more electronic bullying than males. Overall, 10.7% of students reported experiencing dating violence in the past year. Females had significantly higher percentages of dating violence than males.
  
  VIPP staff participated in developing the 2017 Youth Risk Behavior Survey (YRBS) report which includes key finding and recommendations for creating healthy, safe, and supportive environments where students can focus on learning. Recommendations for violence and injury included efforts to: utilize evidence-based materials to educate students about dating violence and how to build healthy relationships; increase protective factors and decrease risk factors for various forms of violence; adopt a concussion policy in accordance with Utah law; require coaches, trainers, student athletes, parents, and school nurses to take their respective CDC Heads Up online training; replace damaged equipment promptly, especially helmets and other protective head gear; participate in the Student Injury Reporting System (SIRS); implement an evidence-based or best practices suicide prevention program; train staff to recognize the signs and symptoms of depression and suicide; inform parents and student about the consequences of underage drinking; and implement evidence-based programs aimed at preventing underage drinking.

Challenges / Gaps / Disparities:

Challenges

VIPP has been conducting strategic planning to focus on shared risk and protective factors, and meetings and primary prevention trainings have been held with the Injury Community Implementation Board, local health departments, and staff to gear up for this approach. It has been challenging to finalize the strategic plan due to competing priorities and less familiarity to this new approach and way of addressing violence and injury in the state. In addition, many funding sources are very siloed, making it difficult to focus on a comprehensive, primary prevention efforts, where impact can be leveraged by having shared prevention vision to reduce risk factors and promote protective factors.

Emerging Issues

Over the last few years, suicide by firearm in youth have been increasing. Efforts to promote means restriction and firearm safety among adults who own firearms is of paramount importance, in addition to promoting protective factors such as connectedness among youth.

Agency Capacity / Collaboration:

VIPP partnered with multiple agencies and entities to address the child injury performance measure. VIPP continues to contract with all thirteen local health departments to implement evidence-based injury and violence prevention programs to reduce risk factors and promote protective factors associated with injury and violence. Local health departments were also contracted to collaborate with local entities to enhance injury and violence efforts in their health district. Collaborations included Safe Kids coalitions, law enforcement agencies, hospital systems, parent-teacher associations, school districts, firearm retailers, fire departments, EMS, and others. Staff at the local and state level is supported to maintain certifications in various disciplines that may impact moving the needle for child injury mortality. These disciplines include maintaining certifications as child passenger safety technicians, QPR instructors, SafeTALK instructors, Mental Health First Aid instructors, and other injury-related trainings.

National experts conducted a technical assessment of VIPP's injury infrastructure, policy, and programs in the summer of 2018 through the Safe States Alliance State Technical Assessment Team (STAT) program. The STAT assesses injury and violence prevention within the state health agency, focusing on specific roles, relationships, and performance of the designated injury and violence prevention program. The goal is to support the development, implementation, and evaluation of injury and violence prevention efforts at the state health department level by conducting an on-site, point-in-time assessment of the injury and violence prevention program, and providing recommendations for improvement.

The assessment focuses on core components of a successful state health department injury and violence prevention program, including infrastructure, data, policy, and program strategies. For each core component, Safe States Alliance has developed standards and indicators that describe the conditions that should exist within an ideal, comprehensive, state health department injury and violence prevention program. The assessment often serves to refocus a participating state by requiring it to reflect on its strengths, weaknesses, opportunities, and barriers to success. The STAT process also serves to bring together different members of the injury and violence prevention community, and allows individuals to share ideas for program development.

VIPP STAT recommendations encouraged VIPP to finalize the strategic plan focusing on shared risk and protective factors, prioritize staff activities to meet grant deliverables, prioritize hiring a Suicide Prevention Coordinator, develop a publications protocol, publish timelier reports, and modify LHD contracts to focus on high-impact actions.

Other activities in the Child Health domain that contribute to improvement in the National Outcome Measures

 

Utah works to adhere to the three-tier framework outlined in the MCH Block Grant guidance. While the focus of most activities is the ESM →NPM→ NOM framework, activities on improving NOMs outside of the NPMs transpires in parallel. The following programmatic activities also work to improve outcomes in this domain.

National Outcome Measures (NOM)

 

NOM 13 - Percent of children meeting the criteria developed for school readiness

 

Violence during childhood can have lasting impacts throughout the lifespan affecting school readiness for children. There are several risk and protective factors that contribute to and protect from child abuse and neglect in Utah. As a result, the Violence and Injury Prevention Program is strategicly planning around shared risk and protective factors to increase child health and school readiness. This will incorporate strategies to build and improve upon a sustainable, multi-sectoral program to promote safe, stable, nurturing relationships and environments for children and families by implementing best practice strategies.

 

The mission of Safe Kids Utah is to prevent childhood injuries in kids and teens ages 0-19 in the state of Utah by working with schools to increase awareness around bicycle and pedestrian safety to and from school, sports injury awareness and teen driving safety. The Student Injury Reporting System (SIRS) is an invaluable data collection tool that tracks injuries that occur while traveling to and from school and during school time or school-related activities. The SIRS helps to identify where, when, how, and why students get hurt at school. By using this information, education officials can pinpoint risk factors at individual schools and develop safety guidelines and prevention programs which can minimize the physical and financial impact of injury on the individual, family, school, and community. Since 1983, the Utah Department of Health, Utah State Office of Education, and local school districts have collected data on student injuries in Utah public schools. All 41 Utah school districts and over 800 public schools have participated and data collection has remained fairly consistent over the past 30 years. Injuries that meet the following criteria are entered into the SIRS database:

1. Injury caused the loss of at least one-half day of school and/or
2. Injury required medical attention and treatment from a school nurse, physician, or other health care provider.

 

NOM 15 - Child mortality rate, ages 1 through 9, per 100,000

 

In 1992, the Utah Child Fatality Review Committee (CFRC) was established. The CFRC was charged with the review of the circumstances and cause of all childhood deaths in the state. The purpose of the CFRC is to develop a better understanding of child deaths in order to reduce the number of intentional and unintentional deaths of Utah children. Often, this involves improving the response of various agencies involved in the investigation of child deaths to prevent future deaths. In order to improve and standardize data collection of SUID cases, the Violence and Injury Prevention Program (VIPP) conducts statewide SUID surveillance, Sudden Death in Young (SDY) surveillance, and advanced fatality review. The Advanced Child Death Review Team is charged with reviewing and categorizing all SUID and SDY cases in Utah. Additionally, advanced autopsy guidance will be utilized by the Utah Office of the Medical Examiner (OME) and VIPP will work closely with the OME to ensure completion of the SUIDI form or SDY Field Investigation Guide. This will be provided to the VIPP will build on the current work to conduct violence and injury surveillance throughout Utah, disseminate the data to partners, and increase timeliness and quality of data, and greater utilization of data for prevention efforts. The overall goals of this project are to:

1. Increase data completeness, timeliness and case ascertainment resulting in a robust SUID and SDY surveillance system in Utah
2. Increase policies and practices that are informed by SUID and SDY Case Registry data among partner agencies serving families and working to prevent sudden and unexpected infant and child deaths
3. Reduce the incidence of SUID and SDY in Utah.

The mission of Safe Kids Utah is to prevent childhood injuries in kids and teens ages 0-19 in the state of Utah by working with schools to increase awareness around bicycle and pedestrian safety to and from school, sports injury awareness and teen driving safety. Knowing which car seat or booster seat is right for your child - based on their age, height, and weight - and type of vehicle is critical in decreasing the child mortality rate. Trained child passenger safety technicians are available throughout Utah to help install child safety seats the right way.

NOM 23 - Percent of children, ages 3 through 17, with a mental/behavioral condition who receive treatment or counseling

The leading causes of traumatic brain injuries among youth ages 5 to 19 are from motor vehicle traffic crashes, bicycle crashes, recreational activities, falls, and pedestrian crashes. The Violence and Injury Prevention program has developed the infrastructure within the local public health system to facilitate success of concussion education and implementation of concussion management programs, including linking individuals to resource facilitation services. Efforts to strengthen the capacity of local public health systems to implement suicide and opioid overdose prevention strategies have increased over the last few years. Local staff are trained to implement the evidence based Question, Persuade, and Refer (QPR) trainings in their communities and local health departments are gearing up for a community crisis response training and development and community guides for suicide and opioid post-vention responses. This includes linking individuals to mental health and substance abuse treatment.

 

NOM 27-   a) Percent of children, ages 19 through 35 months, who have completed the combined 7-vaccine series

b) Percent of children, ages 6 months through 17 years, who are vaccinated annually against seasonal influenza

c) Percent of adolescents, ages 13 through 17 years, who have received at least one dose of the HPV vaccine

d) Percent of adolescents, ages 13 through 17 years, who have received at least one dose of the Tdap vaccine

e) Percent of adolescents, ages 13 through 17 years, who have received at least one dose of the meningococcal conjugate vaccine

The CHARM system continues to integrate immunization histories of children from the Utah Statewide Immunization Information System (USIIS) and provides them electronically to the Baby Watch/Early Intervention Program, the Early Hearing Detection and Intervention Program, the Fostering Health Children Program, the WIC Program, Newborn Screening Heel-stick Program, and private provider clinics. These programs that have obtained immunization information through the CHARM system have been able to identify children in need of immunizations, and follow-up with parents to get their children vaccinated and up-to-date.

Other activities of note:

The Healthy Living Through Environment, Policy and Improved Clinical Care Program (EPICC) works with the State Board of Education (USBE) Child Nutrition Program to provide professional development opportunities to School Food Authorities on the following areas: Smarter Lunchroom, Smart Snacks, Local Wellness Policies, School Lunch and Breakfast Programs,, Farm to Fork, Non-Food Rewards, Recess Before Lunch, and other nutrition related opportunities. EPICC and USBE also provide professional development opportunities to school health and PE teachers, specialists and paraprofessionals K-12. Topics include physical activity, quality PE, mental health, and health standards. There were 550 attendees across the state who attended this conference.

EPICC also works closely with Utah Department of Transportation in promoting Safe Routes to School. Activities would include in working with Local Education Agencies and schools to strengthen Safe Routes to School plans and maps, promoting walking and biking to school, promoting walking school buses and bicycle trains, Bike Utah’s BEST program, Safe Routes Assembly, and other activities that promote healthy, active lifestyles.