Priority:  Reduce Overweight and Obesity Among Children

 

MCH/Title V Funding: The TDH Overweight and Obesity Among Children priority team is administratively led by the Chronic Disease Prevention and Health Promotion section within the Division of Family Health and Wellness of TDH. The Chronic Disease Prevention and Health Promotion section includes Chronic Disease and School Health, Tobacco Prevention and Control, Diabetes Prevention, the Preventive Health Block Grant, Poison Control, and Gold Sneaker. The childhood overweight and obesity reduction efforts are mostly funded by state and other federal funds; however, MCH/Title funds are used to cover state school health nurse consultant services. Additionally, the Deputy Medical Director who provides leadership to this section is fully funded by MCH/Title V.

 

Interpretation of Performance Data on selected NPMs, SPMs, and SOMs:

 

SPM 6: Percent of schools with at least 50% physical education class time spent in moderate to vigorous physical activity

This is the first year of data collection and monitoring for this performance measure, as the question was only added to the annual Quality Physical Education (QPE) survey for the 2022 administration.  The actual value of 90.2% far exceeded the target of 20.0%, which was based on expert estimation but no actual baseline data until now.  The priority team has adjusted target values for 2023-2025 accordingly.  The Tennessee Department of Education (TDOE) has focused much attention on this issue over the past two years, which is showing an impact.

 

The strong partnership with TDOE contributed to the improvement of SPM 6.  The TDH Overweight and Obesity Among Children priority team facilitated several meetings with the TDOE Physical Activity/Physical Education State Coordinator and the Wellness Resource Coordinator to discuss program activities, collaborative efforts, professional development opportunities, performance measures, data collection, and survey revisions to support the MCHBG strategies and activities.  The ability to incorporate relevant questions into the QPE related to the work being conducted in the school was instrumental in measuring and reporting progress.

 

SPM 24: Rate of Double Up Food Bucks purchases per SNAP recipient

This is the first year of data collection and monitoring for this performance measure, as no previous baseline data existed, and therefore, there was no 2022 target value. The actual 2022 value of .01803 reflects the high number of SNAP recipients (80,636) in the six priority counties compared to the relatively low, but growing, number of Double Up Food Bucks (DUFB) transactions (1,454).  The program is sponsored and promoted by Nourish Knoxville, which has been expanding the reach of the initiative over the past few years.  Based on the expected rate of expansion, the team has set modest target values for 2023-2025.

 

Nourish Knoxville has made a conscious effort to expand its reach through communication and marketing. A new flyer was development in English and Spanish for the first time. The flyer was distributed to local social services such as Second Harvest for regional distribution, Interfaith Health Clinic, and Centro Hispano. A press release was released to announce that all Knoxville farmers' markets now accept SNAP and offer DUFB to SNAP users. The story was picked up by the local NBC affiliate WBIR. In addition, WBIR, WATE, and WVLT all conducted live spots at New Harvest Farmers' Market and the Program Coordinator spoke on all offered programs including DUFB. 

 

SOM 3: Percent of public school 6th graders who are overweight or obese

The data source for this outcome measure is the TODE Coordinated School Health Weight Status (BMI) report. The report highlights data from annual direct measurement of height and weight among public school students statewide.  However, staff could not obtain these measurements for the 2020-2021 academic year due to widespread school closings from COVID.  The 2021-2022 Weight Status (BMI) report had not been released at the time this update was completed. Therefore, data from the 2019-2020 academic year remains the most recent data available. The overweight/obesity team reported the risk of overweight or obesity actually increased to 45.0% in 2021, from the baseline of 43.64% in 2017-18, which is a statistically significant difference.

 

The team will be able to determine the outcome of this measure when data is available in 2023.

 

SOM 4: Percent of WIC recipients aged 2-4 years who are overweight or obese

The source for this outcome measure is the TN WIC program database.  There is usually a lag time of one year between the MCH fiscal year and the most recent, complete WIC data.  Therefore, data from CY2021 remain the most recent, as the WIC program has not yet completed data collection for height and weight in CY2022. 

 

In 2021, the risk of overweight or obesity in TN WIC recipients ages 2-4 increased slightly to 32.0% from 31.2 in 2020, but the rate was substantially higher compared to pre-COVID levels (i.e., 25.5% in 2019). However, during the pandemic, the WIC program waived the requirement for in-person height and weight measurements, which could have greatly biased the results. Other aspects of the pandemic that limited opportunities for physical activity outside the home could have been a factor as well. 

 

NPM 8.1: Percent of children, ages 6 through 11, who are physically active at least 60 minutes per day

The combined 2020-2021 National Survey of Children’s Health (NSCH) percentage of TN children ages 6-11 who are physically active at least 60 minutes every day was 27.7%. This rate represented almost a three-point decline (i.e., higher risk) compared to the 2019-2020 value of 30.6% and was short of the Year 2 target by almost four points.  Although the decline was not statistically significant, there appears to be a less healthy trend developing for this measure, as the baseline value was 31.5%. Despite the NSCH being the definitive source for MCH national performance and outcome measures, the state sample size is small even after combining years of data. Therefore, the confidence interval around percentages is fairly broad and the sensitivity for determining statistical

 

Although the data does not show an improvement in the NPM, the partnership between TDH and TDOE has been integral in providing professional development opportunities for school staff and public health educators.  Trainings focused on Focused Fitness, Out of School Time and incorporating physical activities during class time.

 

Accomplishments and Challenges (based on FY2022 Action Plan):

 

Accomplishments include expanding programs to reach unserved and/or underserved populations, increasing collaborative efforts with internal and external partners, providing professional development opportunities addressing physical activity, nutrition, and youth mental health, and addressing way to improve data collection for reporting.

 

Challenges include postponing programs due to lack of staffing and restructuring, lack of data available for reporting, and finding ways to accurately track programs and/or participants.

 

Strategy 1: Support school-based efforts to promote physical activity and good nutrition

 

Supporting Evidence for Strategy 1: Physical Activity: Enhanced School-Based Physical Education: Enhanced school-based physical education (PE) involves changing the curriculum and course work for K-12 students to increase the amount of time they spend engaged in moderate- or vigorous-intensity physical activity during PE classes. https://www.thecommunityguide.org/findings /physical-activity-enhanced-school-based-physical-education

 

Activity 1a: Collaborate with DOE to develop and implement strategies to provide professional development to physical education teachers pertaining to engaging students in moderate-to-vigorous physical activity 50% or more of physical education class time.

 

Report 1a: The 2022 TDE Quality Physical Education Survey was not able to collect information on professional development for ESM 8.1.1 (percent of physical education teachers receiving professional development related to 50% of PE class time spent in moderate to vigorous physical activity) as originally expected. Therefore, no baseline or actual data currently exist for this measure despite concerted TDOE efforts in this area. A question on the subject will be added to the 2023 TDE District Survey alongside existing items on other types of professional development. The team will consider modifying this ESM to reflect the change in the data source. Values for the measure will be updated as data become available.

 

During the reporting period the TDH School Health and Wellness Program Director provided a professional development workshop at the TDOE Physical Activity for Educators Conference in June 2022.  The workshop consisted of the Physical Activity Learning Sessions (PALS) curriculum and resources for approximately 200 physical education and health teachers and public health educators. PALS combines content learning with facility-level self-assessments, policy development opportunities, resources and materials, aimed at supporting practice change in early childhood education programs.  TDOE facilitated the Coordinated School Health (CSH) Institute for approximately 150 CSH Coordinators and support staff focusing on physical activity, nutrition, and youth mental health.

 

Activity 1b: Collaborate with DOE to provide professional learning opportunities that connect mental health and physical health for PHEs and Health Councils, and youth (ie trauma-informed care, Youth Mental Health 1st Aid training, Movement as Medicine).

 

Report 1b: This is the first year of data collection and monitoring for ESM 8.1.2 (percentage of TN counties in which trainings related to mental health and physical health have occurred). The team and partners only launched these programs within the past year. The actual value of 5.3% was about half of the target of 10.0%, which was based on an estimation of training activity but no actual baseline data. The priority team has adjusted target values for 2023-2025 accordingly. The TN Department of Education has begun to focus much attention on this issue through their Movement as Medicine and related programs, which they administered in Cannon, Hawkins, Sumner, Carroll, and Wilson counties during Year 2.

 

The TDH School Health and Wellness Program Director offered 67 virtual Focused Fitness trainings reaching over 600 local public health educators. The program is designed for activity leaders and teachers to deliver fitness, nutrition, and health concepts in a fun and motivating environment. Focused Fitness includes resources and materials for the After School Program, Physical Activity Program, Early Learner Fitness, Classroom Activity Breaks, and the PEACE Program.

The Program Director also leads the School Health Action Coalition’s (SHAC) Health Education Sub-Committee which focuses on physical, social, and emotional health.

 

Challenges Related to Implementation of Strategy 1: It has been challenging to track trainings that have been conducted with the number of attendees.

 

Strategy 2: Promote Gold Sneaker voluntary recognition program for licensed childcare centers

 

Supporting Evidence:  Center-based early childhood education programs (ECE) aim to improve educational outcomes that are associated with long-term health as well as social- and health-related outcomes. Economic evidence indicates there is a positive return on investment in early childhood education. The benefits from students' future earnings gains alone exceed program costs.  If targeted to low-income or racial and ethnic minority communities, ECE programs are likely to reduce educational achievement gaps, improve the health of these student populations, and promote health equity. https://www.thecommunityguide.org/findings/promoting-health-equity-through-education-programs-and-policies-center-based-early-childhood

 

ESM 8.1.3 Percentage of certified Gold Sneaker childcare facilities among all DHS licensed facilities

The Year 2 ESM was a modified version of the Year 1 measure related to the number of Gold Sneaker (GS) certified childcare facilities. The percentage of all childcare centers that are GS certified is a more accurate measure of program impact and reach. Year 2 data established a baseline value of 27.6% of the 2328 DHS licensed facilities being certified Gold Sneaker childcare facilities. The priority team established 2023-2025 targets accordingly. The overall number of GS certified facilities did not change in Year 2 from the 643 reported in Year 1. The lack of expansion was due to unfilled GS staff positions, a restructuring of the program, and changes in the DHS TrainTN System as reported under Activity 2a and 2b below.

 

Activity 2a: Host 1-2 technical assistance training for health promotion staff statewide in using the TrainTN system for Gold Sneaker certification training for licensed daycares.

 

Report 2a: This activity did not occur during this reporting period. Due to unfilled Gold Sneaker positions and restructuring of the program there were no trainings provided for health promotion staff. Additionally, the TN Department of Human Service (DHS) restructured the organization so the TrainTN System was not promoted or utilized for statewide trainings.

 

Activity 2b: Provide a minimum of 1-2 trainings that address implementation  practices of Gold Sneaker policies for public health educators, daycare staff, TN Department of Human Services staff, and Child Care Resource & Referral Center staff, and other partners statewide.

 

Report 2b: This activity did not occur during this reporting period. Due to unfilled Gold Sneaker positions and restructuring of the program there were no trainings provided for internal or external partners.

 

Challenges Related to Implementation of Strategy 2: The overall challenges included unfilled Gold Sneaker positions, program restructure, and childcare center closures.

 

Strategy 3:  Partner with healthcare providers to promote physical activity counseling during well-child visits

 

Supporting Evidence: Physical Activity: Family-Based Interventions.  Family-based interventions combine activities to build family support with health education to increase physical activity among children. https://www.thecommunityguide.org/findings/physical-activity-family-based-interventions 

 

TDH will focus on increasing provider referrals from TDH clinics in the West region, as electronic health records show referrals from the West region are low as compared to other TDH regions, and app usage in the West is less when compared to other regions of the state.  This approach will also address health equity, as the West region of the state has a higher percentage of African Americans, as compared to other regions (not including Metro Health Departments). 

 

Activity 3a: Provide training for 5 health provider champions on how to incorporate the use of the Healthy Parks Healthy Person park prescription portal to increase family-based physical activity. 

 

Report 3a: In 2022, medical providers at TDH local health departments wrote 289 prescriptions for the HPHP program (ESM 8.1.5). Prescriptions were provided by APRNs, RNs, LPNs, and MDs to patients ranging from approximately one (1) to sixty-four (64) years of age. This number far surpassed the 195 written in 2021 but fell short of the target of 400.  

 

As HPHP prescriptions have only been in existence for 2 years, the priority team is still gaining the necessary experience to estimate program uptake more accurately. Lingering effects of the COVID pandemic may also have limited patient contact The team has adjusted 2023-2025 targets accordingly for this very popular program. 

 

The success of this activity can be attributed to promoting the health benefits of outdoor recreation and physical activity at the local level, increasing participation of providers in the MCHBG partner meetings, and finding and partnering with champions at the LHDs to promote and encourage providing prescriptions.  

 

Activity 3b: Promote the use of the Healthy Parks Healthy Person park prescription program and app by PHNs, WIC staff, and other health providers in 10 additional local health departments with an emphasis in West Tennessee. 

 

Report 3b: ESM 8.1.4. (percent of LHD primary care clinics writing HPHP prescriptions annually) is a new ESM for Year 2, which provides a more accurate indicator of program reach among LHDs statewide. In the past year, 57.1% (i.e., 32 out of 56) of all LHD primary care clinics produced HPHP prescriptions. This value far surpassed the target of 25%. It is a testament to the effectiveness of promotional efforts that over half of the health departments participated in this relatively young program. The priority team revised the 2023-2025 targets accordingly. 

 

During the reporting period, HPHP increased promotion of the Healthy Parks Healthy Person reward program to increase outdoor physical activities. The HPHP Program Director presented about the prescription program and app at the Health Promotion Quarterly Call.  Participants included health promotion staff and public health educators from local, regional, state, and metro health departments. The HPHP App had over 10,700 app users. The new app provided participants their activity history, user notifications, reward refunds, and a healthy provider portal. In 2021 over 1,630 Rewards were sent to participants an increase from 479 in 2020.  The new app was promoted through the TDH website, promotion to internal and external partners, presentations to local Public Health Educators, and development of two PBS television spots. 

 

Challenges Related to Implementation of Strategy 3: The overall challenge was finding ways to promote HPHP to PHNs, WIC staff, and other health providers in LHDs.  

 

Strategy 4: Promote policy, systems, and environmental change (PSE) strategies to increase physical activity and promote access to healthy food and beverages

 

Supporting Evidence: Physical Activity: Creating or Improving Places for Physical Activity. In these types of interventions, worksites, coalitions, agencies, and communities work together to change local environments to create opportunities for physical activity. Changes can include creating or improving walking trails, building exercise facilities, or providing access to existing facilities. https://www.thecommunity guide.org/findings/physical-activity-creating-or-improving-places-physical-activity 

 

Activity 4a: Support and provide technical assistance to at least 5 local communities who set a goal to increase physical activity through the construction of walking and nature trails.

 

Report 4a: ESM 8.1.6: (percentage of TN counties with completed built environment projects) is new for Year 2, which provides a more accurate indicator of program reach across counties statewide. Since the beginning of the current MCH cycle in 2020, 95.8% (i.e., 91 out of 95) of all TN counties have seen at least one completed built environment project sponsored by either the TDH Office of Primary Prevention (OPP) or Project Diabetes. This value far surpassed the target of 30%.  During the last two years, OPP and Project Diabetes sponsored 95 and 28 completed projects, respectively. This achievement underscores the effectiveness of both programs. The priority team revised the 2023-2025 targets accordingly.

 

In addition to the built environment projects supported by the OPP and Project Diabetes, the TDH Regional Healthy Development Coordinators (HDCs) conducted 4 regional workshops addressing built environment, safe walking spaces, and community walkability. There was a total of 56 participants including but not limited to community leaders, local government, transportation, and law enforcement. The training used the Health by Design’s workshops model. Additionally, to expand reach and engage additional community members the HDCs made this a “train the trainer” model for interested community leaders.

 

There were also active living workshops conducted at the TN Bike Walk Summit as well as the TN Department of Transportation.

 

Activity 4b: Collaborate with non-profits in east Tennessee to increase access to fresh fruit and vegetables for SNAP recipients through the Double Up Food Bucks program.

 

Report 4b: ESM 8.1.7 (percent of eligible venues offering the Double Up Food Bucks Program) is new ESM for Year 2, which provides a more accurate indicator of program reach across eligible venues in priority counties. In the past year, 76.2% (i.e., 16 out of 21) of farmers markets and farmers stores in the designated area participated in the Double Up Food Bucks (DUFB) program sponsored by Nourish Knoxville. This value far surpassed the target of 45%, which was based on a best estimate in the absence of actual program data. The priority team revised the 2023-2025 targets accordingly.

 

Nourish Knoxville’s promotional efforts have been very effective in reaching their priority audience. For the reporting period, Nourish Knoxville conducted marketing and outreach for the Double Up Food Bucks (DUFB) program through diverse channels of communication. A new flyer was developed in English and Spanish for the first time. The flyer was distributed to local social services such as Second Harvest for regional distribution, Interfaith Health Clinic, and Centro Hispano. A press release was released to announce that all Knoxville farmers' markets now accept SNAP and offer DUFB to SNAP users. The story was picked up by the local NBC affiliate WBIR. In addition, WBIR, WATE, and WVLT all conducted live spots at New Harvest Farmers' Market and the Program Coordinator spoke on all offered programs including DUFB. Plans are already underway to expand the program to venues in additional counties.

 

Challenges Related to Implementation of Strategy 4: No challenges were reported during this time.

 

Update on Other Child Health Programs Supported by MCH/Title V:

 

Childhood Lead Poisoning Prevention: Under a contract with the UT Extension, the LeadTRK Database Management System maintains, updates and revises blood lead test results received for the Tennessee Department of Health to monitor and track children with elevated blood lead levels. During the period of this report (October 1, 2021 – September 30, 2022), there were 81,226 screenings of children aged 0 to 192 months of age and 379 children with confirmed, elevated blood lead levels. Training, support, maintenance and updates on LeadTRK usage was also provided. LeadTRK assistance was provided 411 times during the 2021-2022 fiscal year. A contract with Shelby County is provided for case management, outreach, education, and referrals to community services to families of children with elevated blood lead levels. A contract with Hamilton County is also provided for outreach, education regarding the importance of blood lead poisoning prevention and case management services.

Poison Control Center: During the reporting period, the Tennessee Poison Center (TPC) provided program materials, as requested, and distributed over 151,071 pieces of literature statewide, including brochures, fact sheets and stickers. The "Poison Help" brochure was available through download in 13 languages: Spanish, Russian, Korean, Vietnamese, Chinese, Arabic, Polish, Thai, Haitian, Creole, Portuguese, French and Hmong. The TPC staff gave presentations and lectures virtually to 3,417 first responders, pharmacy students TPC staff, community members and residents, and healthcare professionals. Additionally, the TPC “Question of the Week” newsletter reached 12,591 staff. TPC received 50,841 calls to the Tennessee Poison Center Hotline by individuals that have been exposed to poison agents. TPC staff provided appropriate medical follow-up to 100% individuals calling the Tennessee Poison Hotline who have been exposed to poison agents.

 

Priority:  Increase Prevention and Mitigation of Adverse Childhood Experiences (ACEs)

 

MCH/Title V Funding: The Prevention and Mitigation of ACEs priority team is administratively led by the Early Childhood Initiatives section within the Division of Family Health and Wellness of TDH. The Early Childhood Initiatives section includes Evidence-Based Home Visiting, ACEs Reduction, and Early Childhood Comprehensive systems. ACEs prevention efforts are funded by state and other federal funds. While MCH/Title V does not directly fund the activities highlighted in the annual report, it does fully fund the Deputy Director of Child Health who provides leadership to this section.

 

Interpretation of Performance Data on selected NPMs, SPMs, and SOMs:

 

SPM 8: Percent of children with two or more ACEs.

The data for FY2021/2022 from NSCH showed that 21.5% of Tennessee’s children experienced 2 or mores ACEs.

 

During the FY 2019/2020 20.6% of TN children were reported as having 2 or more ACEs. Thus, there was a slight increase by 0.9% points in the number of children that experienced 2 or more ACEs. The stress of the COVID-19 pandemic, including a loss of resources, school and childcare closures, and loss of connection to supports may have contributed to the slight increase in children with two or more ACEs.

 

SPM 9: Percent of substantiated child maltreatment cases among families served by home visiting programs

Of the 385 child maltreatment cases reported to DCS by home visiting programs, 3.2% (49) were substantiated. There was an increase in the number of cases that were investigated during this reporting period. This could partly be a result of staff turnover at the state agency (DCS) that deals with child maltreatment case investigation(s) and a backlog of cases resulting from the impact of the COVID19 pandemic

 

SPM 10: Percent of caregivers who experience intimate partner violence and do not receive professional support services among families served by home visiting.

During FY2022, any caregiver participant in the TN EBHV program, who experienced intimate partner violence were referred to, and received professional support services. Thanks to the tireless efforts from the TN EBHV local implementing agencies’ staff.

 

SOM 3: Percent of adults reporting chronic obstructive pulmonary disease (COPD)

The percentage of adult Tennesseans with COPD rose between FFY2021 (9.5%) and FFY2022 (10.4%). This increase, however, is not statistically significant.

 

This stagnation is likely because of a relatively slow decline in Tennessee’s adult smoking rate due to a myriad of factors including inadequate tobacco control policies, increases in stress during the COVID-19 pandemic, and aggressive marketing tactics by the tobacco industry.

 

Accomplishments and Challenges (based on FY2022 Action Plan):

Strategy 1: Increase knowledge and practice of ACE and Trauma Informed Care (TIC).

 

Supporting Evidence for Strategy 1:  The variety of sectors can make a difference in preventing ACEs by impacting the various contexts and underlying risks that contribute to violence and adversity and by supporting safe, stable, nurturing relationships and environments for all children while taking a trauma informed approach to prevent ACEs.

 

Centers for Disease Control and Prevention (2019). Preventing Adverse Childhood Experiences: Leveraging the Best Available Evidence. Atlanta, GA: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention. https://www.cdc.gov/violenceprevention/pdf/preventingACES.pdf

 

Activity 1a: Develop and implement online TIC training for TDH staff, including those in the CHANT and EBHV programs. Through this training TDH staff and CHANT and EBHV programs will be able to integrate trauma informed practices into their work with families, mitigating the impact of ACEs.

 

Report 1a: Trauma Informed Care (TIC) and ACEs trainings were created in video format and are now available to existing and new state employees. During FFY2022, 18 TDH staff were enrolled in the online ACEs training; 9 of those enrolled completed the training.

 

TDH continues to partner with the Tennessee Commission on Children and Youth (TCCY). This partnership included support of Building Strong Brains, an initiative to provide ACEs training across the state to sectors beyond early childhood. This work continues as Resilient Tennessee, the next step after ACEs education on how to increase protective factors, positive childhood experiences (PCEs), and build resilience.

 

Activity 1b: Provide ACE and TIC refresher training for child fatality teams as part of their ongoing training.  This training will provide information and insight to teams on the impact of ACEs and trauma and assist in understanding the impact on social determinants of health.

 

Report 1b: The annual child fatality review training was held on May 31, 2022.  The training included a session titled “Life Stressors and COVID-19”. This presentation highlighted changes to the life stressors and COVID-19 section of the child death database. These variables and the importance of collecting this information was discussed with the team. The National Center also gave guidance to the teams on “best practices” for determining the presence of life stressors. This training was held virtually with representation from all the child fatality review teams.

 

Challenges Issues Related to Implementation of Strategy 1:

Challenges for implementation of this strategy include impacts of the COVID-19 Pandemic and staffing shortages - both on the State level and local implementing agency level.

 

Strategy 2: Ensure a strong start for children by promoting a healthy parent-child attachment through implementation of home visiting programs throughout the 95 counties of Tennessee.

 

Supporting Evidence for Strategy 2:  Effective home visiting models have demonstrated many benefits for children and parents. Early childhood home visitation can prevent ACEs by providing information, caregiver support, and training about child health, development, and care to families in their homes to build a safe, stable, nurturing and supportive home environment. Children participating in a home visiting program have better cognitive and language development, better academic achievement, fewer behavioral problems, lower rates of substance use, and fewer arrests, convictions, and parole violations by age 19. Home visiting is associated with better pregnancy outcomes, improved parenting practices, reductions in the use of welfare and other government assistance, greater employment, lower rates of substance use, and reduced exposure to intimate partner violence.

Centers for Disease Control and Prevention (2019). Preventing Adverse Childhood Experiences: Leveraging the Best Available Evidence. Atlanta, GA: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention. https://www.cdc.gov/violenceprevention/pdf/preventingACES.pdf

 

Activity 2a: Teach positive parenting skills through home visitation in partnership with local EBHV implementing agencies. This will include encouraging social-emotional learning and parent-child relationship whose instability has been exacerbated by the COVID-19 global pandemic.

 

Report 2a: TDH continues to provide EBHV services in all 95 counties in Tennessee. EBHV is a proven intervention to mitigate ACEs. Services were continued throughout the pandemic. EBHV programs continue to use a virtual home visiting format when necessary; otherwise have resumed in-person home visits.

 

Activity 2b: Provide health education through EBHV home visiting programs in counties throughout Tennessee.  Communicating the importance of children having a medical home to parents promotes high quality and culturally effective integrated care.

 

Report 2b:   TDH continues to provide EBHV services in all 95 counties in Tennessee. Home visitors discuss medical home, immunization schedules, and complete ASQ (Ages and Stages Questionnaires) with enrolled families.

 

Activity 2c: Provide supportive care and additional services to families and children through EBHV home visitation.  By connecting families with concrete services and knowledge of parenting and child development improve protective factors which mitigate or prevent ACEs.

 

Report 2c: The percent of families with an improved protective factors score (ESM 8.1.9.) remained unchanged, at 50% from last year (FY21). The plateau might be explained by differences in the different aspects of the protective factor measures; a higher percentage of families show improved resilience at 70.38% while a small percent show improvement in nurturing and attachment (at 21%).

 

TDH continues to partner with the Tennessee Commission on Children and Youth (TCCY) to expand knowledge across the state on building resilience in families through the Resilient Tennessee initiative, a new iteration of the Building Strong Brains ACEs education work. Further, the TDH ACEs Goal Team is working to identify strategies to increase Positive Childhood Experiences (PCEs). Also, EBHV programs continue to work with families through service delivery to increase protective factors.

 

Challenges Issues Related to Implementation of Strategy 2: Challenges during Year 2 include the aftereffects of the COVID-19 pandemic. Home visiting programs continued to provide services virtually during the pandemic. EBHV local implementing agencies (LIAs) have resumed in-home visits rather than virtual home visits when safe to do so and when both family and home visitor were comfortable. A related challenge is that families who enrolled in the program during the pandemic had not experienced in-home visits. Further challenges may include limited resources available during the pandemic.

 

Strategy 3: Intervene to lessen immediate and long-term harms by linking families to health and social services.

 

Supporting Evidence for Strategy 3:  Traumatic events in childhood can be emotionally painful or distressing and can have effects that persist for years. Factors such as the nature, frequency and seriousness of the traumatic event, prior history of trauma, and available family and community supports can shape a child’s response to trauma. Creating and sustaining safe, stable, nurturing relationships and environments for all children and families can prevent ACEs and help all children reach their full health and life potential.

Centers for Disease Control and Prevention (2019). Preventing Adverse Childhood Experiences: Leveraging the Best Available Evidence. Atlanta, GA: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention. https://www.cdc.gov/violenceprevention/pdf/preventingACES.pdf

 

Activity 3a: Screen and assess families for enrollment in CHANT to identify health and social needs that have long term impact on families and children.  By identifying the needs of families immediate, priority services can be provided to families.

 

 Report 3a: CHANT continues to receive referrals and conduct the Screening and Assessment through telephonic intervention within 2 weeks of birth using data from the health department’s birth files.  This screening usually occurs within the TDH call center.  Local health departments continue to receive referrals “in-house” from internal and external partners. Care Coordinators then contact these families directly to complete the screening and assessment which identifies the needs of the family.  Care Coordinators provide referrals and link families to resources and services within their communities. During this time frame 12,145 families participated in the Screening and Assessment.

 

Activity 3b: Provide referrals to families for identified health care and social service needs.  Identifying which of the sixteen pathways of care families have identified as needs increase the protective factors within a family by providing concrete services at the time identified.

 

Report 3b: During this time frame CHANT has assisted 8189 families (over 10,000 individuals) on pathway progression. Families continue to identify their needs through the screening and assessment. Once these needs have been identified the Care Coordinator works with the family to develop a plan of care and works to complete the action steps of that pathway. A critical review of all pathways was conducted.  Based on that review Priority Pathways (Dental home, Developmental Screening, Health Insurance, Immunization, Medical home, Prenatal/Postnatal and Social Services) were developed. These pathways allow the Care Coordinator to focus on the most critical needs of the family. Emergent needs are also able to be identified at any time during a family’s involvement with CHANT and can create a new pathway of care- this allows for service delivery to be fluid and based on the family’s needs. Red flag health and safety concerns are prioritized by the Call Center and sent to the county Team Lead for immediate follow up. CHANT staff worked to provide concrete services when issues were identified as can be evidenced by the number of individuals CHANT was able to serve even with restrictions on community resource delivery.

 

Activity 3c: Assist families in navigating the healthcare and social services system through the CHANT care-coordination model.  Aiding in navigating any of the sixteen pathways, including obtaining a medical home or an EPSDT, is solution focused as barriers and other obstacles are addressed.  Through this family resiliency is increased as a strategy to eliminate and mitigate ACEs the family might have experienced.

 

Report 3c: The data shows an increase in the percent of families who partially or fully completed pathways from 42.6% in FY2021 to 45.2% in FY2022, which is above the goal of 42.0% for FY2022.

 

This increase can be attributed to CHANT staff have received training on accessing the social service systems and how to assist families in obtaining an EPSDT, immunizations, and/or obtaining a primary care physician. LHD are no longer providing EPSDT services which increased the need for CHANT staff to assist families who identify they need a PCP/Medical home to find those resources within their community. Families who are contacted by the TDH Call Center who are not interested in CHANT services are assisted with obtaining a PCP/medical home by Call Center staff telephonically; to close the gap and provide more families with needed medical care. Restrictions from the pandemic remained active during this time period but starting to show a decline, as such community resources were more available which may also contribute to the reason the program was able to see an increase in pathways partially or fully completed.

  

Challenges Issues Related to Implementation of Strategy 3: During and following the height of the pandemic, resources were often more difficult to obtain due to decline in overall resource availability, decreased community partners office hours, and the ability to see patients in person etc.  Restrictions from the pandemic impacted service delivery across all levels of care during this time frame.  As those restrictions are lifted. Resources and services continue to increase for families. Community resources often had to alter their service delivery which affected referral and resource linkage. CHANT staff were able to work around these restrictions and able to serve 8189 families during this time period. CHANT was able to provide/assist with finding a medical home/PCP for 727 individuals during this time frame, increasing preventive medical care and therefore increasing family resiliency.