ANNUAL REPORT: Child Health 

The health of children in RI remains an important issue to the MCH Program.  Poor oral, physical, mental, and behavioral health status can have long term health consequences later in life.  With the increase in childhood obesity in the United States, RI has focused on physical activity and nutrition and childhood obesity as priority issues.  Childhood overweight and obesity is a major concern in RI.  Not only does RI have worse rates than the national average and other New England, there are significant disparities by geography, insurance status, and race and ethnicity.  The loss of over one million dollars of CDC funding for the Physical Activity and Nutrition Program has been challenging for RIDOH, as it has resulted in the loss of FTEs and a number of planned program activities.   Despite these challenges, RIDOH has been able to use existing relationships with other state agencies and community organizations to continue to advocate for physical activity, nutrition, and obesity prevention. 

 

   

Supporting the growth of the local food sector through meaningful regulatory and policy initiatives is critical to increasing the number of jobs, growing the local economy, and ensuring positive health outcomes. Under Rhode Island General Laws 21-36-3, the Interagency Food and Nutrition Policy Advisory Council (IFNPAC) membership is made up of the Directors of the Department of Health (RIDOH), Department of Environmental Management (DEM), and Department of Administration (DOA). Administrators and Directors from other State agencies often participate, including representation from the Department of Human Services (DHS), Office on Healthy Aging (OHA), Department of Education (RIDE), Department of Corrections (DOC), Rhode Island Commerce Corporation (CommerceRI, and the leadership of the Rhode Island Food Policy Council (RIFPC). IFNPAC was created to find ways to overcome regulatory and policy barriers to developing a strong, sustainable food economy and healthful nutrition practices. IFNPAC submits an annual activity report to the General Assembly. This report has been drafted in accordance with the requirements set forth in Chapter 36, Section 21-36-5 of the Rhode Island Local Agriculture and Seafood Act.   

The Council met four times in 2019: on March 21, July 25, October 2, and December 18.  IFNPAC members listened to and discussed presentations by public and private partners with a stake in the Rhode Island food system. IFNPAC is focused on implementing the Governor’s Food Strategy, Relish Rhody. Agendas for meetings were set according to the Integrated Focus Areas of Relish Rhody.  See Appendix A for meeting minutes. 

The Council engaged in the five Integrated Focus Areas of Relish Rhody, including: 

•     Preserve and grow agriculture and fisheries industries in Rhode Island; 
•     Sustain and create markets for Rhode Island food and beverage products; 

•     Enhance the climate for food and beverage businesses; 
•     Ensure food security for all Rhode Islanders; and 
•     Minimize food waste and divert it from the waste stream. 

Based on these focus areas, IFNPAC and the Director of Food Strategy had several major priorities in 2019. Inter-agency progress was made under each of these focus areas in 2019, with highlights of the priorities of IFNPAC detailed below.  

 

1.              Preserve and Grow Agriculture and Fisheries Industries 

The integrated focus area to preserve and grow agriculture and fisheries industries in Rhode Island is a cornerstone of the Relish Rhody food strategy.  DEM and partner organizations led many of the efforts supporting our local agriculture and seafood industries. Some of the initiatives included: 

•       Offering technical support for compliance with the federal Food Safety Modernization Act to farmers across the state – in partnership with RIDOH and the University f Rhode Island (URI).  
•       Several IFNPAC agencies and partners worked with dairy farmers to help ensure they could continue to operate within Rhode Island and find markets for their products.  
•       The Local Agriculture and Seafood Act (LASA) committee awarded $100,000 to 12 Rhode Island small businesses. This funding helped farmers and aquaculturists expand within the state by providing small grants for specific infrastructure needs. Private foundation funding for the program ended prior to grant round and resulted in a 50% reduction of available funding for regranting for fiscal year 2019. This funding loss occurred even though the Rhode Island Food Policy Council found that between 2014-2016, inclusion of just 27 recipients created 84 new jobs, increased sales by more than $5 million, and leveraged $2.5 million in additional funding. (This does not include the recent funding secured by the Rhode Island Mushroom Company, an early LASA recipient and Innovation Bond participant, that is bringing an estimated $100 million of additional investment to Rhode Island.) 

•       IFNPAC partnered with Polaris and Polaris provided low-cost technical assistance and LEAN training specific to food businesses. Several farmers took advantage of the program and used LEAN principles to increase efficiency and profits.   
•       In April, Governor Raimondo announced 12 new Real Jobs Rhode Island partnerships. This included a new food business sector partnership based at the Rhode Island Food Policy Council. The Food Policy Council, the Director of Food Strategy, and staff from the Department of Labor and Training worked with the Rhode Island Nursery and Landscape Association and consultants at KK&P to learn from their successful apprenticeship Real Jobs program to build a model for food sector jobs training and skill building. The Food Policy Council will hire a Director of Workforce Initiatives to lead this work in early 2020. 
•       The Food Policy Council partnered with DEM, CommerceRI, and the Commercial Fisheries Research Foundation to evaluate approaches to eliminating wastewater processing constraints that are inhibiting the growth of seafood processing in the state.  The project team also looked at successful models from other parts of the country that could possibly increase wholesale/retail distribution and sales of locally processed seafood in Rhode Island.  This project will be continued in 2020 and will coordinate with the efforts of DEM’s Seafood Marketing Collaborative.  

 

2.              Sustain and Create Markets for Rhode Island Food and Beverage Products 

 Relish Rhody’s Integrated focus area to sustain and create markets for Rhode Island food and beverage products recognizes that Rhode Island growers, harvesters, and makers are businesses that need access to appropriate markets to thrive.  In this realm, IFNPAC supported four initiatives in 2019  

1.   Supply RI and Anchor Institution Engagement: Agencies involved in IFNPAC have continued to work to advance its goals around institutional procurement of Rhode Island food products.  

1.   IFNPAC worked on a pilot project during the summer with Sodexo, with a goal that 10% of the produce procurement in three Lifespan facilities would be from local vendors. Sodexo officially launched the program in early June 2019 and purchased their produce and Rhode Island-made products from Farm Fresh RI’s Market Mobile Program.  Hospitals are also hosting on-site farmers markets twice a month, are labeling any Rhode-Island-grown ingredients that are available in the dining facility, and are creating locally-focused “action station” meals each week.  

1. Early numbers show that the hospitals are exceeding their goals and more than $40,000 was spent during the summer in support of local farms.  

2.   Partnership with the Good Food Foundation: 

1.   Relish Rhody was a host of the 2019 Good Food Mercantile in Brooklyn. As part of its sponsorship Rhode Island food businesses received discounted rates to showcase their products at the show. Participating businesses included Granny Squib, Beth Bakes, Dave’s Coffee, and Sanobe Superfoods. There was also a Relish Rhody table that featured food products from across the State.  

2.   In June 2019, the Director of Food Strategy led a group of the Good Food Foundation Merchants’ Collaborative on a tour of food producers in the state. Independent markets from across the country (Washington, DC, Colorado, and California) and representatives from the Good Food Foundation met with Rhode Island makers, tasted their products, shared advice, and developed relationships. The Collaborative spent two days in Rhode Island.  

3.    Rhode Island also had a 2019 Winner of a Good Food Award: Sacred Cow Granola. Sacred Cow is a product of Munroe Dairy and a graduate of Hope & Main. They are also a participant in the Supply RI program and are currently building out a new kitchen facility in East Providence to expand their operations.  

3.    Wholesale readiness training for local agricultural and food processing businesses:  The Food Policy Council worked closely with DEM and local organizations that serve farmers and small food processors on the development of a wholesale readiness workshop that provided technical assistance for businesses interested in selling to institutional or other wholesale buyers.  The first workshop attracted about 40 attendees and content was well received.  A second workshop took place in February 25 and there were more than 40 attendees. 

4.   Increasing local food purchases by Rhode Island public schools:  The Food Policy Council worked closely with the Director of Food Strategy, DEM, RIDE, and other partners to identify ways to increase purchases of local food by public schools.  This year, a workplan that detailed ways to improve RIDE’s ability to accurately track local food purchases and identified ways to increase interest in purchasing local food at the district level was developed. The work plan is expected to be implemented in 2020.  

 

3.              Enhance the Climate for food and beverage Businesses 

In alignment with the integrated focus area to enhance the climate for food and beverage businesses in Rhode Island, IFNPAC tracked and supported other agencies’ initiatives in an effort to streamline regulations and update rules for food businesses.  Work in this focus area included:  

•       The Director of Food Strategy worked with a student from Harvard to explore specific aspects of the climate for food businesses in Rhode Island. The student’s work finished in April, and the findings were presented to a cross-agency team in May. The report will be distributed to all IFNPAC members and stakeholders.  
•       The Director of Food Strategy regularly met with businesses to provide technical assistance and guidance about troubleshooting administrative issues.  

 

4.              Minimize Food Waste and Divert it from the Waste Stream 

Momentum continues to grow to surrounding food waste reduction and diversion within Rhode Island, and IFNPAC spent the third-quarter meeting focused on how to best support this work. This work has included: 

• The Rhode to End Hunger continues to expand, with more than 20,000 pounds of food saved from the waste stream.  
• The Center for Ecotechnology (CET) is working with DEM to conduct outreach to businesses who are not in compliance with the tonnage threshold for the state’s food waste recycling law.  CET offers businesses with technical assistance.  
• CET, with support from the Environmental Protection Agency (EPA) and the US Department of Agriculture (USDA), offers free technical assistance to Rhode Island businesses and institutions.  Since 2017, CET helped Rhode Island businesses donate three tons of edible food and divert more than 1,200 tons of food waste per year.  
• CET provided compost site technical assistance to two facilities in Rhode Island. CET offered guidance and recommendations for site expansion and recipe development.  This assistance supports the growth of processing capacity in the state.  
• The Director of Food Strategy and representatives from DEM toured the newly constructed anaerobic digester in Johnston. The facility is currently only in its pilot phase but plans to be more fully operational in the future after testing is completed.  
• DEM held a half-day information session for breweries on waste and wastewater processing and resources available to the industry from the State.   
• The RIFPC created a ‘Wasted Food Solutions’ work group that has four major initiatives.  First, it is supporting a new organization (Hope’s Harvest) that is recovering grade B produce from farms around Rhode Island and delivering it to the Rhode Island Food Bank and other emergency food organizations.  Around 50,000 pounds of fresh food was recovered by this effort in 2019.  Second, it is supporting the work of Foodscape RI, an organization that is working in public schools to educate students and set up diversion tables that recover excess food and send it to the Food Bank. Third, it is supporting the work of composters (Earth Care Farm, The Compost Plan, and smaller urban composting organizations) to remove obstacles to increasing composting activity.  Fourth, it is advocating for policies and legislation that could increase food donations, food recovery, and better organic waste management by businesses in Rhode Island. 

  

5.              Ensure Food Security for All Rhode Islanders 

In 2017, IFNPAC created the Hunger Elimination Task Force. In October 2018, the Task Force released a set of recommendations to IFNPAC and Governor Raimondo. In 2019, the Task Force broke off into sub-groups to address specific sections of the recommendations.  The work of the sub-groups included: 

• The USDA released their annual Food Insecurity Report, showing that Rhode Island’s food insecurity rate is down to 11%, from 12.4% in 2018. The Task Force aims to lower food insecurity rates to less than 10%, and with a more coordinated effort, it is expected that the goal will be attained.  
• The Task Force was focused on increasing school meal participation as part of its recommendation to ensure that Rhode Island is taking full advantage of federal funds.  As part of this effort, the State received grant support from Share our Strength’s No Kid Hungry program.  A cross-agency team, including RIDE, the Governor’s Office, the Director of Food Strategy, the Food Policy Council, and the Rhode Island Healthy Schools Coalition (who is the fiscal sponsor of the grant) was selected to participate in a multi-state meeting in New Orleans and is implementing an 18-month workplan to expand innovative breakfast models for K-12 schools.  
  • This Working Group will also be exploring potential policy guidance on lunch shaming and school meal balances across the state.  This working group received community feedback at the July Health Equity Zone (HEZ) Learning community meeting.  
  • The Task Force is moving forward on implementing other areas of its recommendations through working groups.   

 

Supplemental Nutrition Assistance Program (SNAP) Incentive Expansion Working Group:  The Rhode Island Public Health Institute (RIPHI) hired a consulting team to facilitate a stakeholder engagement and implementation process for the SNAP Incentive Expansion Project.  The first phase of that work is near completion, and the next phase will be focused on advocacy and fundraising.  RIPHI is partnering with DHS, and DHS Director Courtney Hawkins has agreed that DHS will become the long-term permanent administrator for this program.  There is active collaboration with DHS to secure funding for 2020 through a USDA GunsNIP grant to begin a pilot program in 2022 with approximately 2,500 SNAP participants.  

 

Transportation:  The transportation subcommittee explored work to map the ways that members of the task force and the HEZ community can impact and influence transportation planning in their communities to better reflect their mobility needs to connect to food resources. The Transportation sub-committee presented at the May Hunger Elimination Taskforce (HETF) meeting and two Health Equity Zone (HEZ) Learning Community meetings.  

 

Data:  In response to the requests DHS released a SNAP client data snapshot with demographic data about how Rhode Islanders utilize SNAP programs. Understanding the demographics of who is using the programs can help partners better tailor their services and programs.  

•                      Jay Metzger, a RIDOH GIS Specialist, presented to the Task Force about the planned updates to the food insecurity mapping tool on RelishRhody.com.  RIDOH will be updating the map based on publicly available data.  Any requests for changes to the map can be shared directly with the Director of Food Strategy. 

 

Economic Development:  A cross-agency partnership of RIDOH, DHS, and DLT released shared communications materials in the fall. The Task Force identified that Rhode Islanders in need of good-paying, high-quality jobs were not getting information about programs like Real Jobs RI.  This new partnership will promote awareness of these programs across agencies and to Rhode Islanders who need the information.   

•       Overarching: 

•      For Fiscal Year 2019, the Center for Disease Control (CDC) severely restricted funding for state-level work for Physical Activity and Nutrition (PAN). CDC approved RIDOH’s grant application but did not provide funding. RIDOH Associate Director Carol Hall-Walker and Director of Food Strategy Sue AnderBois attended CDC’s annual meeting for all grantees as ambassadors from programs that were approved/unfunded to learn from, and connect with, PAN programs in other states. IFNPAC continues to advocate at the federal level for the reinstatement of funds for these vital programs.  
•      In partnership with the Rhode Island Food Dealers Association, Governor Raimondo released a proclamation declaring September as Family Meals Month, and encouraged all families to eat at least one additional meal at home with their families each week.  Family meals have been shown to improve the emotional and physical well-being of individuals. 

 

Emergency Preparedness and Response Action Learning Collaborative - In 2019, RI also joined the AMCHP Emergency Preparedness and Response Action Learning Collaborative as a collaborative effort between Title V and the Center for Emergency Preparedness and Response.  Activities include:  

• Integrating MCH into state EPR Plan Reviewing sections of the state plan that pertain to MCH 
• Developing strategies to gather epidemiologic/surveillance data on womxn of reproductive age and infants:  
  • Describing demographic characteristics and locations of high risk MCH populations who may be particularly vulnerable to effects of an emergency 
  • Assessing emergency preparedness among postpartum womxn  
  • Assessing possible use of the DRH Post-Disaster Health Indicators in emergency data collection 
• Establishing and promoting EPR communication about target population with clinical partners, public health and governmental partners, and with the general public. 
• Identifying public health programs, interventions, and policy to protect and promote MCH health and prevent disease and injury in emergencies.   

 

Health Equity Zones and the Built Environment 

Through a contract with Grow Smart RI, RIDOH provided several HEZ Learning Community workshops on improving the built environment, especially with regard to increasing walkability and bikeability.  Grow Smart also delivered on-site technical assistance and training to HEZs and municipalities (city/town councils and municipal planners) around integrating Complete Streets principles (walkability/bike ability) into comprehensive transportation policy, plans, and communications.  HEZ community-level efforts include:    

Cranston HEZ:  

Worked with partners to develop a proposal for installation of a splash pad to provide a safe outdoor recreational space to families and children in the community  

 

Newport HEZ:  

-Greening Urban Spaces Working Group developed resident education opportunity on Zoning 101.

-Has provided input on the Newport-Pell Bridge realignment planning process, focusing on  engaging North End residents. 

-Transportation Working Group conducted focus groups with community members and other stakeholders.  

-Has representative present on City planning/zoning board.  

 

Central Providence HEZ:  

-ONE Neighborhood builders aims to develop 150 affordable homes in Providence and surrounding areas between 2020 and 2023 .

-Supported a walking school bus programs at William D’Abate Elementary school  

 

Pawtucket/Central Falls HEZ:  

-Held a number of financial training and home education opportunities and supports. 12 participated in a Tenant/Landlord class. 37 individuals participated in Spanish Homebuyer class and 12 in the English equivalent. PCFD also partnered with Bank of America for a Homeowner class and that had 18 participants. Classes incorporated information regarding asthma risks and preventions.  

 

 -Worked closely with PCFD to make changes in their program in response to COVID and to meet the needs of their residents. Staff did outreach to their over 250 tenants ensuring they had information regarding COVID, rental and other available assistance. 

 

 -The PCF Health Equity Zone worked with GroundWorks RI to build community resilience to climate change. The partnership included GroundWorks RI, Blackstone Valley Community Action Program, Broad Street Regeneration Committee, Childhood Lead Action Project, Progreso Latino, and Southside Community Land Trust. 24 youth were employed and trained on how to grow their own food at SCLT’s Galego Court farm in Pawtucket, how to process and cook their food at Harvest Kitchen and how to engage residents and gather data regarding climate resilient mitigation strategies with GroundWorks RI. Through the project 178 surveys were collected to understand residents’ concerns regarding climate issues. The most common concern among surveyed residents was lack of trees (81% of the 178 respondents indicated somewhat to extreme concern). Other concerns included limited access to healthy food, lack of parks and open spaces, and flooding. Residents responded that they would like to see increased strategies around growing or buying local food, planting trees, and lastly reducing waste/preventing litter/recycling. GroundWorks RI engaged Pawtucket and Central Falls youth on home inspection for improved green infrastructure. The youth completed 25 home assessments, installed 9 raised garden beds, 7 rain barrels, conducted clean-up days, conducted tree surveys, and planted 6 trees.  

 

 -Conducted 5 lead poisoning prevention workshops at Calcutt Middle School and at Captain Hunt's Preschool, for a total of 12 families attending. 41 additional individuals were educated at the CF High School Health Fair or the Cape Verdean American Community Development Health Fair. Information, provided in English and Spanish, includes: lead/tenant's rights; lead abatement resources for homeowners; lead hazards found in paint, soil, dust and drinking water; lead safe cleaning methods and other interim controls; led safety for workers; lead testing for children and financial assistance for lead abatement for homeowners.  

 

West Warwick HEZ:  

-Collaborating with municipal officials to integrate walkability/bikeability recommendations resulting from a built environment assessment into town comprehensive plan  

 

-Coordinating “Transportation that Works” to promote improved bus service to jobs, substance abuse recovery services, physical activity, health care, and senior services   

 

-Installing signage on local bike path and fitness equipment in parks and playgrounds  

 

 

Partnering to reduce childhood lead poisoning in Pawtucket 

By working with the Childhood Lead Action Project, City of Pawtucket, and community partners to implement policies to improve the enforcement of lead safety laws in Pawtucket, the Pawtucket-Central Falls Health Equity Zone contributed to a 44 percent decrease in childhood lead poisoning and the certification of approximately 200 lead-safe rental units in Pawtucket. The groups mobilized their efforts in response to data showing high levels of childhood lead poisoning in Pawtucket. For years, Pawtucket residents had struggled with insufficient local compliance with lead safety requirements for rental housing, insufficient local enforcement of lead safety laws, and unsafe housing conditions. The local Health Equity Zones infrastructure helped the diverse partners working on these issues to come together to address shared goals and helped direct flexible funding to local priorities. Working together, the partners successfully trained local officials on the enforcement of lead safety laws, implemented a City policy to require proof of compliance before issuing a building permit, and conducted community outreach and training focused on tenants’ rights and lead-safe work practices. As a result, the incidence of lead poisoning dropped from 4.9 percent (104 children) in 2015 to 2.99 percent (58 children) in 2017. Continuation of this work over the last several years had contributed to further reductions in new lead poisoning cases in Pawtucket (46 children in 2019). This year, Childhood Lead Action Project conducted 5 lead poisoning prevention workshops at Calcutt Middle School and at Captain Hunt's Preschool, for a total of 12 families attending. 41 additional individuals were educated at the CF High School Health Fair or the Cape Verdean American Community Development Health Fair. Information, provided in English and Spanish, includes: lead/tenant's rights; lead abatement resources for homeowners; lead hazards found in paint, soil, dust and drinking water; lead safe cleaning methods and other interim controls; lead safety for workers; lead testing for children and financial assistance for lead abatement for homeowners.  

 

Expansion of child health programming, and adapting to change 

Several RI Health Equity Zones have implemented “Walking School Bus” programs that are improving rates of attendance and chronic absenteeism in schools – and increasing physical activity and community connectedness in the process. In 2019 to early 2020, the Central Providence HEZ enrolled an additional 150 children into the William D’Abate Elementary School Walking School Bus Program. The Walking School Bus program was suspended when schools closed in March 2020 due to COVID-19. The onset of COVID-19 in Rhode Island also led to many new needs for children and families who had to adapt to distance learning. The HEZs worked with community partners and residents to quickly identify and address urgent needs. The Woonsocket HEZ distributed over 5,000 meals to families in need. The Pawtucket Central Falls HEZ collaborated with 35 organizations in their communities to distribute over 90,000 masks to residents, and they hosted a drive-up meal distribution event that was visited by over 1,000 cars. The PCF HEZ also partnered with the Boys and Girls Club to provide groceries and youth activities to 60 families.  

 

Developmental screening 

As part of the 2012-2016 Race to the Top Early Learning Challenge grant, RIDOH  assisted over 35 primary care practices in implementing standardized developmental screening to align with the Early Periodic Screening, Diagnosis, and Treatment (EPSDT) Schedule and the American Academy of Pediatrics recommendations.    

 

RIDOH continues to work with Medicaid and insurers to support providers to screen children at 9, 18, and 30 months using a standardized tool. RIDOH is currently participating in the state’s First 1,000 days initiative, which recognizes the importance of the first three ears of life and  initiative which is designed to increase Medicaid’s role in things like developmental screening which can identify issues early and help increase the odds the children are able to reach their potential. In addition RIDOH participates on the PCMH-Kids planning team and supported Developmental Screening as one of the PCMH kids quality measures; in 2019 the 19,  PCMH kids sites all exceeded or met the targets for Developmental Screening in RI (78% overall and 70% for Medicaid population).  

 

Mental Health Consultation within early care and education-Through a partnership with DHS, child focused mental health consultation is available statewide. RIDOH is currently working with DHS to sustain its program focused mental health consultation to childcare as well. In 2020, several mental health professionals from Bradley Early Childhood Research Center, who are also early childhood mental health consultants, developed and delivered a training on how to become a child care mental health consultant with the goal of expanding the capacity of the system overall.  

 

Parent education and support for children and their families: Three communities were supported to implement Incredible Years groups for families in the communities. Anticipated outcomes include, improved parenting, increased social emotional competence, and decreased behavior problems. In the longer term, RI expects to see improved school readiness, improved social-emotional functioning, and healthier families. 

 

Immunization Program- Universal Vaccine Purchasing Policy - The mission of the Immunization Program is to prevent and control vaccine preventable diseases in RI by increasing immunization rates among children, adolescents and adults.  This is achieved by implementing systems for efficient vaccine purchase and distribution, increasing vaccine access, decreasing cost as a barrier, quality assurance, quality improvement, public and provider education, information dissemination, surveillance, and community collaboration.  Rhode Island is a universal vaccine state in which all routinely recommended vaccines are provided to healthcare providers at no cost for children, adolescents, young adults (through 26 years of age), and select vaccines for high risk adults. Influenza vaccine is provided at no cost for all Rhode Islanders aged 6 months and older. 

 

Immunization Walk-In Clinic - The Immunization program supports a walk-in immunization clinic at St. Joseph’s Health Services offering no cost vaccination for children who are uninsured/under-insured or those who are new to the country and do not yet have a doctor or are delayed in getting an appointment, and also for uninsured adults. 

 

School Located Influenza Vaccination Clinics - The goal of the school located vaccination program is to reduce the burden of influenza in RI communities and to develop a sustainable vaccination model based on partnership among RI Department of Health (RIDOH), Department of Education (RIDE),  & The Wellness Company (TWC).  Vaccines are offered to all students, faculty, and staff at no cost.  High school and some middle school clinics are held during the school day and elementary school clinics are held afterschool and are open to the public.  Parents must provide consent for immunization and insurance information is collected for billing purposes, when available. 

 

School Immunization Reporting - The Immunization Program continues to collect web-based reporting data to monitor school immunization coverage rates. All schools with grades kindergarten, 7th, 8th, 9th and 12th are required to report to the RIDOH annually the number of children who are fully immunized as well as those who have exemptions. All students are required to provide documentation that they are up-to-date on certain vaccines for school entry to Kindergarten, 7th, 8th, 9th, and 12th grade or provide a signed state exemption. Data include the number of students assessed, fully immunized, without an immunization record, and with an exemption certificate on file. In August 2015 additional school immunization requirements were added to the school immunization regulations under all levels pre-k through College to improve vaccination coverage with the goal of reducing the incidence of vaccine preventable disease.  

 

Immunization Quality Improvement for Providers  (IQIP) - Primary care practices enrolled in the state supplied vaccine program that see children and adolescents receive IQIP site visits from immunization program staff assessing vaccination coverage rates among children and adolescents in their practice with guidance on how to increase coverage rates and resources to help achieve that goal.  IQIP is an evidence-based quality improvement tool employed by the Centers for Disease Control and Prevention to improve vaccination coverage rates. One  resource that was developed is a KIDSNET tool allowing practices the access to run their own coverage rate reports on demand.   

 

KIDSNET (Includes the state Immunization Registry) - School Nurse Immunization Reports have been developed in KIDSNET that make it easier for school nurses to use KIDSNET to evaluate the immunization status of students. These reports identify students who have met, or not met, school requirements, as well as those who have no available information in KIDSNET. The reports can be run by school, by grade, and by school district. In the event of a disease outbreak, the reports can be narrowed to look at one vaccine, identifying those who are past-due for the vaccine that prevents the outbreak disease. Contact information for the last known primary care provider appears on the reports to facilitate care coordination.  Early Intervention sites have been connected to KIDSNET. First Connections, MIECHV programs, and WIC sites view KIDSNET to access children's immunization status and if a child is behind on immunizations, they link them to follow-up care.  Messages about the importance of immunizations will continue to be included in KIDSNET- generated cards mailed to families of newborns as part of the State Systems Development Initiative.   

 

The Rhode Island Asthma Control Program (RIACP) - has a strong public health foundation. It is built around home-based, school-based and health systems strategies that focus on children with asthma in Rhode Island’s (RI) four high poverty “core” cities: Central Falls, Pawtucket, Providence and Woonsocket. In these four cities more than one in four children live in poverty. The Comprehensive Integrated Asthma Care System (CIACS) is the framework for aligning these strategies. The CIACS model is built upon contracts with key partners in the core cities.  Three programs form the foundation of the RIACP’s community-based services.  These are:  1) Breathe Easy at Home (BEAH), an electronic-based -based referral system utilizing RIDOH’s KIDSNET program that allows medical providers to make referrals to municipal housing code offices for asthma triggers that are code violations; 2) Home Asthma Response Program (HARP), a pediatric asthma home visiting intervention that utilizes a certified Asthma Educator (AE-C) and Community Health Worker (CHW) to provide asthma self-management education (S-ME), and in-home environmental trigger reduction to reduce asthma ED visits and inpatient admissions for children with poorly controlled asthma, and  3) Draw a Breath (DAB), an evidence-based asthma education program at Hasbro Children’s Hospital that provides group asthma education classes at the hospital and at schools   

 

Home Asthma Response Program (HARP) - In 2018, Title V contributed $55,000 to HARP.  HARP is an evidence-based in-home asthma intervention that uses certified asthma educators (AE-Cs) and community health workers (CHWs) to conduct up to three intensive in-home sessions that: Assess a patient’s asthma knowledge and environmental trigger exposure, provide intensive asthma self-management education, deliver cost effective supplies to reduce home asthma triggers, and improve the quality and experience of care. HARP eligibility is based on the child’s age, city of residence, level of asthma control and health care use. An extensive environmental assessment is provided and involves an in-depth inspection of the family’s home to identify various environmental triggers that may be exacerbating the child’s asthma.  Linkage to care is a component of HARP, in which children without current primary care providers at the time of the first home visit are referred to a primary care provider.  All children participating in HARP are required to receive an Asthma Action Plan (AAP) from their primary care providers. The AAP ensures that all individuals caring for the child, including school nurse teachers, daycares, parents/guardians, and other caregivers understand how to recognize when the child is having asthma symptoms, environmental triggers that may exacerbate the child’s asthma, how to safely administer medication, and ways to avoid asthma attacks.  

In 2017, RIACP submitted a proposal to the RI Attorney General’s Office to request a $300,000 allocation from the Volkswagen (VW) Clean Air Act Civil Settlement to improve asthma outcomes for high risk pediatric asthma patients in Rhode Island.  Exposure to elevated levels of nitrous oxide (NOx) emissions have pervasive negative health impacts for people with impaired respiratory systems, and especially for children with severe asthma.  RIDOH is using settlement funds over the next 12-18 months to provide HARP to 200 severely asthmatic children in Central Falls, Pawtucket, Providence and Woonsocket. RIACP led the effort to conduct a pilot study to provide HARP to children with poorly controlled asthma who are enrolled in a United Medicaid Plan. The pilot is now launched with Hasbro Children’s Hospital. 

  

School Indoor Air Quality Policies: RIACP has been engaging around school indoor air quality policy issues through conducting ongoing inspections in numerous schools across the state.  RIACP participated with the Fix Our Schools Now (FOS) Coalition by providing asthma data and by framing language for the policy platform around repairing school facilities. The platform supported the Governor’s Executive Order and Rhode Island School Building Task Force plan to repair or replace aging school facilities across the state.  In November 2018, Rhode Island voters approved a $250 million school repair bond. This is a tremendous investment that will improve indoor air quality in schools across the state.   

 

Outdoor Air Quality Policies: RIACP participates in numerous initiatives that are working on policies relevant to childhood asthma.  The RIDOH Environmental Health Risk Review group supports RIDOH's Director in reviewing environmental health concerns including ambient air quality and sources of air pollution that disproportionately impact people with asthma and other respiratory diseases.  Projects reviewed include a large proposed power plant, a highway, and cumulative impacts in an industrial waterfront port.  RIACP provided a Health Impact Assessment (HIA) training on May 21 and 22, 2018 with key stakeholders in Providence to begin the planning process for assessing health impacts of the Port of Providence related to air pollution and toxicants from both stationary and mobile sources. Stakeholders include community residents and organizations, Rhode Island College School of Nursing, Brown University, Johnson and Wales University,  Johns Hopkins University Bloomberg School of Public Health, Kresge Foundation, the City of Providence, RI Department of Environmental Management, RI Division of Statewide Planning, RIDOH Air Quality Laboratory, and the US Environmental Protection Agency.  RIACP continues to work with RIPTA, the statewide public transit agency, and shared GIS maps of asthma hot spots so that RIPTA could prioritize deployment of new zero emission electric buses in areas with a high asthma burden.  The first zero emission buses were launched publicly with a well-attended press event and tour in October 2018.  RIACP has also continued to collaborate with the RIDOH Lab and RI Department of Environmental Management on an EPA-funded air quality study examining the air quality impact of I-95 highway on near-road communities with elevated asthma burdens.  The study results were completed by the end of 2018 with RIACP playing a lead role in engaging communities on the results and recommendations.  RIACP is also engaged in ongoing close partnerships with the City of Providence on the city's Climate Justice Plan, which includes prioritizing community health, environmental justice, and resilience in environmental justice communities that are disproportionately impacted by asthma and air pollution.  RIACP is updating the 2014 Asthma Claims Databook to provide the City of Providence and its community partners with asthma data and maps to supporting the development of the city's climate justice policy plan.  

 

Oral Health Program- The OHP is located within RIDOH, Division of Community Health and Equity, Center for Preventive Services. The mission of the OHP is to achieve optimal oral health for all by eliminating oral health disparities in RI while also integrating oral health with overall health. To achieve this mission, the OHP focuses on prevention of oral disease through assurance of state-level oral health and public health leadership, documentation of the burden of oral disease in RI, and collaboration with statewide partners and the Rhode Island Oral Health Commission. In association with these partnerships, the OHP implements goals and objectives identified in the Rhode Island Oral Health Plan to improve access to oral healthcare services, integrate the dental and medical care systems, increase oral health literacy among RI residents, sustain the oral health workforce, and inform and support productive oral health policy decisions. 

 

Oral Health Academic Detailing – The Oral Health Program’s PIOHQI Project conducted outreach to 22 sites through academic detailing about the age one dental visit and fluoride varnish application. This work resulted in 105 health care providers being trained (this includes pediatricians, medical assistants, nurses, front desk staff, office managers, and preschool staff). The RIDOH PIOHQI Project also established 5 learning lab sites that either increased the percentage of pregnant women receiving dental referrals (Thundermist, WellOne, and St. Joseph Health Center) or successfully incorporated preventive oral health services at pediatric medical practices (Costal Medial and Dr. Richard Ohmmacht). Additionally, the Age One Champion Directory continues to grow, as 6 providers were added to the list since January 2019.  

The RIDOH PIOHQI Project also continued to develop and distribute an Age One Champion Directory to medical providers, community organizations, and families. This Directory is comprised of dental providers who have agreed to see very young children and is listed on the TeethFirst! website. The practices are sorted by location and include information about their hours of operation, insurances accepted, and contact information. Modifications to the RIDOH licensing system have been made so that dental providers renewing their license can indicate if they would like to be included in the Age One Champion Directory. 

 

Oral Health & Third Grade Reading Plan - The OHP successfully incorporated an oral health measurement into the Governor’s Third Grade Reading Action Plan. The number of children under two years of age with RIte Care/Medicaid coverage who have had a dental visit is now tracked quarterly within the school readiness domain of the plan and has been identified as one of the many strategies to improve reading readiness.  

 

This past year, a dental hygienist focus group was convened to assess the knowledge and willingness of dental hygienists to promote good oral health for pregnant womxn and young children. A report was released to the RI Perinatal and Infant Oral Health Quality Improvement Project Advisory Board and representatives of the Rhode Island Dental Association, Rhode Island Dental Hygienist Association, the Rhode Island Dental Assistant Association, and the Community College of RI Dental Health Department. In total, 17 RI dental hygienists who were employed at either a general practice or at a federally qualified health center were surveyed in early June. Responses were gathered through an online survey over the course of a three-day period and respondents answering all questions received a $100 gift card for their time.  

 
Most dental hygienists reported being comfortable providing preventive care to pregnant women, and only some expressed concerns with providing scaling and root planning with local anesthesia in the first and third trimester or taking x-rays. While most dental hygienists are comfortable treating children under age two, many reported not regularly seeing those patients as dental home establishment regularly occurs at age three. All dental hygienists reported being interested in receiving professional education about care for pregnant women and children under age two despite being well-aware of the clinical recommendations to provide such care. They also recommended more education for OB/GYNs and pediatricians on this topic and that barriers such as cost and patient education need to be addressed to improve dental utilization and outcomes. Survey respondents also expressed interest in learning more about the Age One Champion Directory and expressed that more could be done to promote its existence among dental professionals. They also noted that the decision to join such a directory would most likely be up to the dentist. For a complete overview of all focus group findings provided by Market Street Research, please click here. 

 

Fluoride Quality Measure – Over the past year, the OHP, with the assistance of the RIDOH Medical Director, were successful in having the OHIC Developmental Measure Workgroup agree to include a fluoride varnish application clinical quality measure for commercial medical plans about fluoride varnish application among children under age three. The OHP staff were also able to coordinate the reporting of fluoride varnish data of Rhode Island children age three and under administered by medical providers from the State’s All Payer Claims Database. This data was used by the RI SOHP and RIDOH’s medical director in their advocacy to gain approval from the Office of the Health Insurance Commissioner and SIM Steering Committee for the adoption of a fluoride varnish clinical quality measure for commercial medical plans. 
 

SEAL RI!  - SEAL RI! is a school-based dental program that provides exams and dental sealants to help prevent tooth decay for children ages 5-10. Currently, SEAL RI! Funds work in 11 of 39 RI communities and provide services in 56% of the schools targeted by the SEAL RI! program. Targeted schools are defined by those schools with 50% or more of the students eligible for the FRSM program. This target was designed to maximize effectiveness by targeting high-risk children living in the core cities. The primary advantage of the school-based model is a major increase in access and decrease in oral health disparities. This model is a less expensive way of providing dental care to Medicaid-eligible children than the traditional private practice dental care system. During the 2018-2019 school year, 5,757 children were screened and 1,792 of those were found to need sealants. Of those, 548 received at least one sealant.  To further improve SEAL RI! impacts, OHP staff has completed research on practices to improve consent form returns. SEAL RI! data also continues to be published in a joint school report card with the Immunization and Lead Programs. Dental sealant brochures have also been distributed to elementary schools, health fairs, and lead centers throughout the state and OHP staff were successful in advocating for the inclusion of sealant benefits in state employee dental befits. OHP staff continued to host quarterly meeting with all SEAL RI! sites to discuss improvement strategies about program delivery. 

 

Rhode Island EMS for Children Program - The purpose of RI EMSC activities is to coordinate, extend and improve upon the integration and focus of pediatric needs within the state EMS system. This involves building upon and strengthening relationships between mutually supportive pediatric-oriented programs and activities, such as those found in maternal and child health, trauma system development, disaster preparedness, and highway safety. EMSC also looks to support continued pediatric education for EMT's, paramedics and both school and emergency department nurses. EMSC will also partner with local chapters of AAP and ACEP and other professional organizations, to seek support and advice for the continued improvement of EMS care for children in Rhode Island.  

  

In the 2018 – 2019 grant year the program recognizes that improving pediatric outcomes is not solely based on addressing pediatric issues but developing systems that include pediatric patient care as a priority. The program is focused on making gains in three areas.  In the prehospital setting, the program will focus on ensuring that RI EMS agencies are submitting compliant data to the RI Center for EMS, identifying pediatric champions within EMS agencies and increasing the proportion of EMS agencies that evaluate EMS practitioner’s pediatric skills at least once per year. In the hospital setting, the goal is to develop a pediatric medical recognition system that ensures that hospital facilities are prepared to care for children in medical emergencies, develop a recognition system for pediatric trauma and ensure that hospitals have compliant interfacility transfer guidelines and agreements. In the community setting, the goal is to fortify family partnerships and to increase the presence of the EMSC state partnership program within the state of Rhode Island’s EMS system.  

 

As a result of the 2020 Needs Assessment, RI’s MCH has selected a different priority.  Several of the programs and projects will be continued within RI’s MCH programs or continued within the new 2020-2025 Priorities.  The following programs/projects will be sustained in the following manner:

• Continue to monitor and enhance data related to BMI to better access rates of childhood overweight and obesity.   
• Sponsor the Health Schools Collation breakfast.  This event always includes topics related to physical activity and nutrition. 
• Utilize the HEZ infrastructure to promote activities and share information and resources about physical activity and nutrition, food policy, and the built environment.  HEZ collaboratives have been able to make significant gains at the local level.  Title V will continue to provide technical assistance and training to the HEZ collaboratives individually and during bi-monthly Learning Network meetings.  

The Title V Program will also support the following RIDOH MCH Programs related to child health: the Immunization Program, the Oral Health Program, the Early Childhood Program, the EMS for KIDS, and the Asthma Program.