Child Health - Annual Report

Illinois’ priority for the Child Health Domain is:

• Support expanded access to and integration of early childhood services and systems (Priority #3)

Many measures of child health in Illinois have demonstrated little change over the last several years.  Child mortality (NOM #15) and overall health status (NOM #19) rates have remained relatively level. While 89% of Illinois children are reported to be in excellent or very good health (NOM #19), this is the ninth lowest rate in the county, demonstrating that Illinois Title V has ample opportunity to improve overall child health. Racism impacts child health in Illinois.  Only 77% of Hispanic children are reported to be in excellent or very good health, compared to 94% of non-Hispanic White children. Similarly, the overall child mortality rate among non-Hispanic Black children is more than twice the rate among non-Hispanic White children.

Early childhood is a place to focus on cross-disciplinary collaborations to improve child health trajectories and school readiness. Currently, less than 40% of Illinois’ young children receive a parent-completed developmental screening (NPM #6).

Illinois has traditionally been a national leader in childhood insurance coverage but has lost ground in recent years.  In 2019, 4% of Illinois children were uninsured (NOM #21). Illinois is ranked 17th out of the 50 states on this measure, and the rate of uninsured children has increased significantly since 2015. Access to services is a challenge among both insured and uninsured children. Nearly half of children in 2018-2019 with a diagnosed mental or behavioral health condition did not receive any treatment for their condition (NOM #18). In 2018-2019, only 3 in 4 children received a preventative dental visit in the last 12 months (NPM #13.2), and among children without insurance, less than half received a preventive dental visit in the last year.  Illinois must continue to address other barriers, such as health insurance access, health care provider shortage areas, community safety, and transportation to enable children to receive the health services they need.

During FY20,  IL Title V utilized the following strategies, as listed in the State Action Plan to address Priority #3 - Support expanded access to and integration of early childhood services and systems:

1. Work with the Governor’s Office of Early Childhood Development and the Illinois Early Learning Council to develop an environmental scan of developmental screening, including social and emotional screens, that contains options for data collection, places of screening, and validated screening tools.

This strategy was completed in FY17 – there are no activities to report for FY20.

2. Collaborate with the UIC Leadership and Education on Neurodevelopment and other Disabilities (LEND) program to train early childhood providers to conduct autism screening while conducting developmental and social/emotional screens.

This strategy was completed in FY17 – there are no activities to report for FY20.

3. Participate on the Governor’s Children’s Cabinet and Illinois Early Learning Council to facilitate coordination between early childhood systems and assure that health is recognized as an integral component of improving children’s educational outcomes.

During FY20, the Title V director served on all three entities, ensuring that public health had a voice at the table to influence priority setting and to leverage Title V resources as needed. The Title V director also participates in the BUILD Initiative which works closely with the executive committee of the Illinois Early Learning Council. BUILD had spent much of FY20 exploring opportunities to address racial equity in Illinois’ early childhood system.

4. Collaborate with home visiting programs, including the Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program and early childhood providers to encourage alignment of activities.

IL Title V collaborates with various early childhood systems and programs in a variety of ways. During 2020, the Title V director participated routinely in statewide committees, such as the Early Learning Council and the Home Visiting Task Force. Title V also continues to connect MIECHV and home visiting programs to other partners for collaboration and support (e.g., Task Force on Infant and Maternal Mortality Among African Americans).

While the CDPH Nursing and Support Services under the mini-Title V grant are largely focused on maternal and infant health, CDPH’s home visiting nurses provide support, guidance, and referrals for families who need assistance and services for older children. Examples include referrals for day care and pre-K programs, pediatricians, early intervention, and benefit programs like WIC and SNAP.

5. Convene partners to develop administrative rules and to coordinate implementation of a new state law requiring social/emotional screening during school physicals.

During FY18, OWFHS leadership, the Title V director, and the School Health Program led an ad hoc workgroup to develop a draft rule and solicit feedback from other offices within IDPH and outside partners. In FY19, the rule language was submitted through the formal processes, and as of FY20, is still in review.

The IL Title V utilized the following strategies to support ongoing efforts to improve asthma management in the school and community setting:

1. Improve asthma identification and support services, including education of families, referral of children with asthma to appropriate health care and social services, and care coordination through community-based partnerships.

This strategy was completed in FY18 – there are no activities to report for FY20.

2. Provide training, support, and technical assistance to school nurses in Illinois.

During CY20, the IDPH School Health Program hosted two statewide virtual School Health Days. The trainings included child/adolescent mental health, immunization, vision/hearing and dental, ISBE requirements, and COVID-19 issues in school nursing and adolescent health. Nearly 1,400 school nurses across the state attended the sessions.

In FY20, IL Title V staff concluded its participation in the School Health Services National Quality Initiative Collaborative Improvement and Innovation Network (NQI CoIIN) for School-Based Health Centers.

Due to COVID-19, the School Health Program did not host its traditional annual critical issues training sessions. It is expected that critical issues will resume in FY22.

During FY20,  IL Title V utilized the following strategies to increase access to preventive oral health services:

1. Financially support IDPH Division of Oral Health to provide dental sealants to children, particularly those with Medicaid or without dental insurance.

IDPH Division of Oral Health (DOH) assists Illinois school children who are most at risk for dental caries by granting funds, providing technical assistance, and providing training to local health departments and to other public not-for profit service providers to develop and to implement community-based oral health programs. In FY20, with the support of IL Title V, DOH funded 30 agencies to provide sealants to selected permanent molars for eligible children through the Illinois Dental Sealant Program. This program is designed to assist school personnel and families by assuring access to oral health education, fluoride varnish, Illinois All Kids (Medicaid) enrollment, and referral to a dental home. The program also helps families comply with Illinois’ mandatory school dental examinations for children in kindergarten, second, and sixth grades.  During FY20, approximately 171,244 sealants were placed on nearly 99,807 children.

Grantees were required to have a specific process for referral and case management to the oral health care delivery system for children found to need treatment services. Two grantees used mobile restorative equipment and scheduled visits to establish a continuation of care and case management as a mobile dental home. Nine grantees referred the children back to the school-based provider’s office to provide necessary follow-up care and establish a dental home. The remaining grantees provided follow-up care through either a dental provider willing to accept the child into their practice or a health department clinic or FQHC. It is acknowledged, however, that accessing follow-up dental care to complete a treatment plan for uninsured children continues to be a barrier.

2. Collaborate with IDPH Division of Oral Health to convene stakeholders and develop a statewide report and resource manual on oral health during pregnancy and early childhood.

See Women’s/Maternal Health Domain strategy 1-F narrative for details.

3. Participate in Implementation of Quality Indicators to Improve the Oral Health of the Maternal and Child Health Population Pilot Project with IDPH Division of Oral Health (DOH) to pilot a series of measures for children and pregnant women to inform the creation of a national set of indicators.

In FY2019, in addition to continuing the Illinois Dental Sealant Program, DOH embarked on a new initiative focused on enhancing oral health surveillance. DOH continued to work with HFS to promote and understand the reach of preventive and periodontal care received by women during pregnancy. Once the Oral Health During Pregnancy and Early Childhood in Illinois Resource Manual is published, IL Title V will support the dissemination and uptake of these resources.

The Title V data manager/epidemiologist provided support in the Implementation of Quality Indicators to Improve the Oral Health of the Maternal and Child Health Population Pilot Project through data analysis and reporting as well as technical advising. In addition to Title V funds, this pilot received support from the Center for Oral Health Systems Integration and Improvement (COHSII) consortium as well.