Based on the MCH Title V Block Grant guidance, the following annual report is based on activities during FY 2021 (October 01, 2020 through September 30, 2021). The CNMI MCH priorities for Children with Special Healthcare Needs (CSHCN) focus on providing support to parents and caregivers in navigating systems and supporting CSHCN and their families with transition into adult care.

 

Despite the program challenges caused by the COVID-19 pandemic, many of the programmatic activities that were significant aspects of the CSHCN program remain uninterrupted. Screenings and early identification activities were ongoing, service coordination for infants enrolled in EI continued, and all scheduled Shriner’s outreach clinics were conducted. Training for parents/caregivers of CSHCN and professionals were conducted virtually throughout the reporting year. Support groups for families with children who have been diagnosed with down-syndrome and autism were able to transition from a virtual meeting format back to a face to face setting in 2021.

 

Through Title V block grant funds, the program supports two full time Service Coordinators that provide service coordination for families of infants and toddlers who are enrolled in Early Intervention (EI) Services. The MICAH unit also works with the EHDI Program Coordinator who oversees CHCC population health efforts on newborn hearing screening and family support for children identified as deaf or hard of hearing, those diagnosed with a condition through metabolic screening, and families who are seen through the Shriner’s outreach clinic.

 

Priority: Helping parents/caregivers navigate the health care system for coordinated care

NPM 11: Percent of children with and without special health care needs, ages 0 through 17, who have a medical home

Strategy: Conduct outreach and provide peer support to families of children and youth with special healthcare needs.

The Family to Family (F2F) Health Information Center, under the MICAH unit leads MCH activities focused on outreach and peer support to families of children and youth with special healthcare needs. Families that are identified through screening programs, the hospital NICU, Pediatrics department, and partner agencies such as the Public School System refer families to the Family to Family (F2F) Health Information Center. Additionally, the F2F Support Specialist conducts outreach and organizes parent-led CSHCN focused community events such as CNMI Autism Awareness Month activities in April of 2021. The CNMI F2F focuses on building partnerships with parents to support parent leaders on Saipan, Tinian, and Rota. The F2F HIC faced some challenges during this project period with the departure of the program’s Family Support Specialist (FSS). However, through the partnership with the CNMI Office of Vocational Rehabilitation (OVR), the F2F HIC program had recruited a temporary intern to help with many of the program’s activities such as assisting with administrative duties, making reminder calls to families and assisting at outreach events. 

 

In 2021, the F2F conducted 10 virtual learning sessions attended by families and professionals. The F2F leverages partnerships throughout the health department and external agencies to coordinate virtual training events.

 

 

 

 

 

 

 

 

Figure 4: F2F Learning Sessions offered in 10/2020-09/2021

Month	Topic	Title	Trainer/Facilitator	Participants
October 20		SPIN Conference	Online	4
November 20	Oral Health for CSHCN	Healthy Teeth is the Gateway to a Healthy Child	Dr. Angelica Sabino, DDS, Chief Dentist, CHCC	29
December 20	Childhood Nutrition	Kids & Food	Hannah Shai, Diabetes Prevention Program Coordinator	37
January 21	Emergency Preparedness for Individuals with Disabilities	Emergency Preparedness	Monika Diaz, CNMI VOICES Self-Advocate in partnership with CNMI UCEDD	27
March 21	Developmental Disabilities Awareness	Promoting Health: Children and Youth with Developmental Disabilities	Rachel Haynes, CHCC Nurse Practitioner	62
May 21	Newborn Screenings	Newborn Screenings and Why they are Important	Shiella Marie Deray, EHDI Program Coordinator	16
June 21	Health Services for Teens in the CNMI	Chasing Wellness	Kagman High School Youth Leaders, Youth Advisory Panel (YAP)	39
July 21	How to get and keep your family healthy and whole to start the school year	Take Good Care	Dr. Sarah Lewis	29
August 21	Overview of support and services provided to students with disabilities	SPED Program	Donna Flores, PSS Dir. of Special Education	48
September 21	Understanding ABA Therapy	ABCs of ABA Therapy	Doemiko Flores, Behavior Analyst	39

 

Collaboration with the medical providers, early intervention services, and other partnering agencies were made to offer professional development and in-service trainings to help other agencies understand the connections between child health and CSHCN serving programs. Improvement in service coordination among programs and healthcare providers has produced a positive effect with family engagement.

 

Additionally, the CNMI Public School System SPED department serves as a significant partner in reaching children with special health needs and their families. In 2021, the MICAH unit partnered with the CNMI SPED program to distribute 175 headphones to children enrolled in SPED as part of efforts to support access to telehealth services, virtual learning sessions offered by MICAH, and virtual classes provided by PSS.  

 

MCH Title V funding was used to support the salary of the Child Health Coordinator, who oversees the development and implementation of activities under this strategy.

 

Partnership with the CHCC Children’s Clinic providers and nurses were strengthened in 2021. Ad-hoc meetings and monthly high-risk perinatal case conferences have helped to improve collaboration and awareness of emerging issues and to address gaps in services for women and children. CHCC pediatric clinical staff have been instrumental in ensuring that children receive developmental and other health screenings, diagnostic services, and referrals to the CSHCN program for evaluation into Early Intervention, peer support, transportation vouchers, and other assistance that may be needed.

 

MCH Title V funds are used to support the salaries of 3 Service Coordinators who receive referrals and provide families of CSHCN with support to navigate the healthcare system and other programs available to CSHCN.

 

Data gathered from the CNMI MCH Jurisdictional Survey indicated that only 14.1 percent of CSHCN, ages 0 through 17 in 2021 reported having a medical home. Data on the CNMI CSHCN population continues to be a challenge to report on and there have been shifts in the years’ prior in identifying a data source to most accurately capture the percentage of children who identified as CSHCN and the percentage of CSHCN who reported having a medical home. In 2018, the program had partnered with the Public School System to survey the entire CNMI SPED population but unfortunately the disastrous super typhoon Yutu had caused major barriers in being able to return to the PSS SPED program to conduct the survey. In 2020, with the implementation of the MCH Jurisdictional Survey, the program transitioned to utilizing the information collected from the jurisdictional survey to inform the performance measure on medical home for CSHCN.

 

In 2021, as part of evaluation efforts, the F2F conducted a phone survey of families enrolled with the F2F to identify challenges families may have been facing due to the COVID-19 pandemic. Additionally, the survey collected information on families who reported that they had a medical home.

 

 

 

 

 

 

 

 

 

 

 

 

Figure 3: CNMI Medical Home Survey

Question	Yes	No	Unsure
1. During the past 12 months, has your child had a preventive care visit or WCC?	96.8%	3.2%	0
2. Where does your child receive health care services?	CHCC 77.8%	Private  3.2%	Both 19%
3. Does your child’s health care provider make you feel like a partner with your child’s care?	95.2%	0	4.8%
4. Does your CSHCN have multiple people from different disciplines working together to provide care for your child?	92.1%	4.8%	3.2%
5. Do you believe your CSHCN receives care in a well-functioning system?	81%	7.9%	11.1%

Source: CNMI F2F HIC Medical Home Survey   

 

A total of 63 surveys were completed out of 88 households that were contacted. Overall, a majority of families enrolled surveyed responded to having a Medical Home and receiving coordinated services, figure 3.

 

Priority: Support individuals, families and communities to make changes that will make it more likely for youth to be healthy and successful

NPM 12: Percent of adolescents with and without special health care needs, ages 12 through 17, who received services necessary to make transitions to adult health care

Strategy: Provide education, presentations, and support to high school students with special healthcare needs in making transition into adult healthcare.

Plans to conduct outreach and presentations in FY2021 at local high schools were impacted due to the COVID-19 pandemic. Schools had to make periodic shifts from face to face learning to virtual learning and temporary school closures due to COVID-19 infections. Schools also prioritized efforts to minimize COVID-19 school transmissions and vaccination among its student population. As an alternative, the MICAH unit, as a member of the Disability Network Partners (DNP) coordinated Youth Transition Conferences held on Saipan, Tinian, and Rota. The conferences were attended by high school teens identified with disabilities, their parents, community members, and professionals within the community that provided services to individuals with disabilities. The Family Support Specialist and Child Health Coordinator conducted presentations at these conferences regarding healthcare and related services available for children and teens who have special healthcare needs and their families through the MICAH unit, including information on accessing support for healthcare transition.

Other CSHCN Activities

MCH Title V funds are used to support developmental screening activities in the CNMI as part of efforts to identify CSHCN.

 

  Figure 6: Number of children screened with ASQ and identified as needing monitoring or below          

  developmental cut-off, 2019 – 2021.

 

Year	Total Number Screened	Number Identified for monitoring or at below cut-off
2019	914	334
2020	1,256	389
2021	1,031	372

                     Source: MCH Program

 

In 2021, a total of 1,031 screenings were conducted at the Children’s Clinic during Well Child Care. Children who are identified with developmental risk and who need further assessment are referred to the Early Intervention Program or to the Special Education Program. 372 children identified as requiring additional monitoring or referral to Early Intervention services.

 

Early Intervention referral data reports a decrease in both the number of referrals to EI and the number of families served compared to the previous year. Due to the COVID-19 pandemic, EI services in the CNMI were temporarily suspended and eventually transitioned to virtual. During the mid-year, EI began providing face-to-face services to infants and toddlers who were enrolled into daycare settings.

 

Figure 7: Total Referrals to Early Intervention Services, 2019- 2021

Source: CNMI Early Intervention Program

 

A total of 127 families were served through the Early Intervention Program in during the school year 2020-2021. Of those families, 54 children were with established condition and 73 were identified as developmental delay. In 2021, 66% of infants and toddlers referred to EI were from the CHCC.

 

As in the previous year, 2021 data illustrates that 99% of babies born in the CNMI received a newborn hearing screening before one month of age. Of the babies screened, only one was diagnosed with hearing loss and was referred to the Early Intervention Program by 6 months of age. The CHCC-Early Hearing Detection & Intervention (EHDI) Program continues to meet the JCIH national benchmarks. Of the 5 babies that received a diagnostic audiological evaluation, 1 infant was diagnosed with hearing loss, 1 infant was lost to relocation and 3 infants had normal hearing, figure 8.

 

 

 

 

 

 

 

 

 

 

 

 

Figure 8: CNMI Newborn Hearing Screening, 2018- 2020

	2019	2020	2021
Births	909	654	575
Screened	903	648	569
Inpatient Pass	652	505	567
Inpatient Refer	247	138	100
Outpatient Pass	215	133	90
Outpatient LTFU	22	5	5
Outpatient Refer to DAE	11	5	5
DAE Pass	3	3	4
DAE Hearing Loss	10	1	1
EI Referral	9	1	1

Source: CNMI EHDI-IS

 

The MICAH unit works closely with the pediatrics and CHCC laboratory to ensure that newborn bloodspot services remain uninterrupted, identifying children who are identified as needing a secondary screening or diagnostic testing, and assist in contacting families to prevent lost to follow up.

Figure 9. Newborn Bloodspot Screening, 2019 - 2021

Data Source: CNMI Newborn Bloodspot Data

 

Of the 575 live births in 2021, 99% completed a newborn bloodspot screening. This is a significant increase compared to the prior year’s rate and the year prior to that. Through the work of the CHCC chairwoman of pediatrics, Dr. Sadie LaPonsie, and Laboratory Director, Dr. Philip Dauterman, CHCC was able to modify its newborn bloodspot screening policy to enable daily shipment of bloodspot samples to the Oregon Public Health laboratory, causing decreases in lost to follow up among infants whose parents are asked to return for samples to be collected. When an NBS sample is detected to have an abnormal value, Oregon Public Health Laboratory alerts the Pediatrician and Program Coordinator to inform them to either have the infant get a second screen or for confirmatory testing. Of 28 infants that were presumed positive, 11 infants received a confirmed diagnosis and are being followed-up by a primary care provider.  MCH Title V funds are used to support shipping costs for shipping newborn bloodspot samples. Samples are required to be sent via expedited courier (FedEx) to Oregon Department of Health laboratory to ensure viability of samples.

 

The Shriner’s Hospital Honolulu was able to continue their outreach services in the CNMI in the first quarter of 2021. In May 2021, a total of 83 children from ages 0 to 18 years of age were seen. Additionally, orthotic services were reinstated as the last orthotic visit to the CNMI was in 2019. Children who needed orthotics such as knee, foot and back braces were assessed and repairs and moldings were conducted. In addition to the outreach clinics, Shriners continued to provide telehealth services. Additionally, between October 2020 - September 2021, the MICAH CYSHCN unit worked collaboratively with the CNMI Medical Referral Program to send 9 patients to Honolulu despite COVID restrictions, so that the patients were able to complete the medical intervention needed.