In addition to population domain specific activities and programs, Arizona's Title V program addressed cross-cutting issues affecting women, infants, children (including children with special health care needs) and adolescents through programs that cross the lifespan (oral health) and programs that strengthen health systems and improve access to care (workforce development program and site development for safety net clinics).

Oral Health

Arizona has continued and enhanced several strategies to improve the oral health of Arizona's women and children. The Bureau of Women’s and Children’s Health (BWCH), Office of Oral Health (OOH), initiated the evidence-based Arizona School-based Sealant Program in 1987, with a grant received from the Flinn Foundation, to serve school-aged children on their school campus using portable dental equipment. Additional funding that same year from the Ronald McDonald Children's Charities allowed OOH to continue the program. In July of 1989, the Sealant Program was incorporated into the OOH State Budget. Maternal and Child Health Block Grant dollars were used for supplies, equipment, and contracting personnel for the Arizona School-based Sealant Program. Since that time, legislative changes have enabled the program to become sustainable through the ability to receive Medicaid reimbursement for oral health services.

The Cavity Free AZ Program includes the School-based Sealant Program and was implemented with the goal of decreasing tooth decay in the pits and fissures of teeth where topical fluorides are less effective. OOH has also been involved in collaborative efforts with other health agencies to promote the use of dental sealants and to provide technical and educational assistance in the development of additional resources for dental disease prevention.

The program has been very effective at reaching children who need services the most; Arizona's most vulnerable children. Both public and charter schools with 50% or higher free and reduced school meal program participation may apply and are eligible to participate in the program. Dental screenings and sealants are provided to children in 2nd and 6th grade with parental consent. Sealants are provided to uninsured children, Medicaid and State Children's Health Insurance Program (SCHIP) beneficiaries, and those covered by Indian Health Services who have erupted, non-restored, non-decayed first and/or second permanent molars. These two age groups are targeted because they have newly erupted permanent first or second molars. The sealant program provides services to children in 10 of the 15 Arizona counties. Services are provided by trained and calibrated dental providers. OOH trains providers to ensure successful sealant retention and makes every effort to connect participating children with a dental home in or near their community.

Program Impacts Related to the COVID Pandemic

In March 2020, the Governor issued an executive order to close schools to in-person learning, which greatly impacted the delivery of preventive oral health services for children.  These closures remained in effect throughout the end of 2020. A New York Times article, published in September 2020 and quoted by the DentaQuest Partnership for Oral Health Advancement and Catalyst Institute, states that: “The disproportionate effect of school closures on low-income children, who are less likely to have access to computers, home internet connections and direct instruction from teachers, has been well documented. Less recognized are the effects of school closures on children’s oral health.”

School closures in Arizona have suspended regular dental health visits in schools across the state. These school-based oral health (SBOH) programs included services such as: screenings and referrals, sealant applications, fluoride treatments, oral hygiene instruction as well as oral hygiene supplies. For many children, these services were their first encounter with a dental provider. For some, it was their only source of oral health care and only access point for health care in general.

A hygienist at the Pima County Health Department in Southern Arizona has seen the benefits of this care for elementary school children: “We see children who don’t go to the dentist, sometimes at all. We’ve had countless children come in with abscesses and decay. They are in pain and they don’t know what’s happening.”

In addition to school closures, elective dental services were limited due to the Governor’s executive order as well as the limited supply of personal protective equipment (PPE) throughout much of the pandemic.  As a result, many parents/caregivers did not take their children for routine preventive healthcare visits, including dental visits, for fear of exposure to the COVID-19 virus (see Santoli et. al, 2020).

School-based dental care is a crucial way to reach low-income children who may otherwise have little to no access to care. Nationally, children in low-income families are at higher risk of caries are less likely to receive sealants than children in higher-income families, at 39% and 46%, respectively. (Griffin et al., 2016) A 2020 report, cited in this CDC Commentary on Oral Health and COVID-19: Increasing the Need for Prevention and Access, asserts that: “The oral health care safety net is expected to cover . . . one-third of the US population, notably those who are low-income, uninsured, and/or members of racial/ethnic minority, immigrant, rural, and other underserved groups.” (Northridge, Kumar, Kaur, 2020).

School-based dental sealants are one of only two evidence-based methods for the prevention of tooth decay and are crucial to reducing decay in children. Untreated tooth decay can cause pain and infection and can affect overall health. Dental screenings help identify serious oral health issues and dental sealants prevent the development of future health-related issues that can require more invasive treatments.

Because COVID-19 created a significant interruption in the delivery of on-site dental services in schools, Arizona’s sealant program responded by revising its policies and procedures so that once schools reopen, these vital services can continue to be provided safely.

This new Arizona School-Based Sealant Program Provisional Policies and Procedures Manual aligns with the most current guidelines and recommendations from the Centers for Disease Control and Prevention (CDC), Organization for Safety Asepsis and Prevention (OSAP), Environmental Protection Agency (EPA), Arizona Department of Education (ADE), and Arizona Department of Health Services (ADHS). As new information is released on this rapidly evolving health challenge, this document will be updated. It is of utmost importance to keep abreast of new information.

Results and Accomplishments

School closures resulted in a significant decrease in the number of children that were served by the program. During the 2019-2020 school year, the Arizona School-based Sealant Program provided dental screenings and referrals to 7,634 children, which is 67% less than the number of students screened the previous school year. Of the 7,634 students that received screenings, 5,230 received dental sealants.  Additionally, of the children who participated in the program, approximately 19% (1,450 children) were identified as children with special health care or educational needs. The program bills Medicaid for its eligible children and Title V funds are used for services to the uninsured. Partnerships with federally qualified health centers (FQHC) and county cooperative extensions have provided outreach to additional counties. When schools reopen, OOH will continue working toward reaching the goal of increasing the number of school-based sealant programs and individuals served in rural communities. During the 2019-2020 school year, Arizona School-based Sealant Program reached 36 rural schools. A rural community was categorized as having a population of 50,000 residents or less.

The Cavity Free AZ Program also includes the Kindergarten Fluoride Varnish Program as part of the same eligibility and infrastructure as the School-based Sealant Program. During the 2019-2020 school year, 81 schools participated from six counties: 1,656 kindergarteners received screenings and 1,359 fluoride varnish treatments were provided.

Continued efforts under the HRSA-funded Oral Health Workforce Grant included implementing the Silver Diamine Fluoride (SDF) Program, a prevention intervention for high-risk children. The SDF Program partnered with existing dental programs, including the Cavity Free AZ school-based programs and First Things First preschool fluoride varnish programs. All participating contractors participated in SDF Program trainings in July and August 2019. The same program training was conducted at three locations and also included a one-hour introductory webinar.  During the 2019-2020 school year, 30 schools in 4 counties received SDF services: 188 total children received SDF treatments, which included 83 kindergarteners, 86 second graders, and 19 sixth graders.

The goal of the Arizona school-based Fluoride Mouth Rinse (FMR) Program is to reduce tooth decay in children. Children in grades 1-6 who live in communities with sub-optimal fluoride in the community water supply and attend schools with 50% of students qualifying for the federal free and reduced lunch program are eligible to participate in the program.  Unlike other school dental programs, neither a dentist nor a dental hygienist is required to conduct the Fluoride Mouth Rinse Program. The classroom teacher, school nurse, or a volunteer parent can supervise the weekly rinsing procedure. The program operates at least 32 weeks of the school year. To be eligible for the program, schools must have at least three sequential grades participating with at least 80% of the children in the participating grades enrolled in the Fluoride Mouth Rinse Program. Also, schools have to agree to participate the entire school year, obtain parental consent, and consent to participate continuously for at least 3 years. The program has been very effective in reaching children in rural communities who would not otherwise have access to fluoridated water.

During the 2019-2020 school year, the Arizona School-based Fluoride Mouth Rinse Program distributed fluoride mouth rinse materials to 10,320 children attending eligible public schools; this included 70 schools in over 11 school districts across the state. Due to the COVID-19 pandemic, the total number of students participating in this program decreased as most Arizona schools closed to in-person instruction. OOH will continue to work with the schools and the program administrators to ensure that students in rural communities continue to benefit from this program.

The OOH implements a Fluoride Varnish Program for pregnant women and children ages birth through five. This is in partnership with another state agency, First Things First (FTF), through the Arizona Early Childhood Development and Health Board. The Arizona Fluoride Varnish Program began as a pilot with the FTF South Phoenix Regional Partnership Council and Maricopa County. The program is offered at Women, Infants and Children (WIC) Program offices, immunization clinics, and child care centers throughout the county. The application of fluoride varnish, an extremely effective cavity-prevention agent, in combination with dental screenings, referrals, and other educational services, are the core of the primary prevention program. The role of OOH is to provide a sustainable billing system with partner counties. During the 2020 state fiscal year (July 1, 2019–June 30, 2020), the Fluoride Varnish Program served 17,959 children, ages birth through five, in six counties including screenings, oral hygiene education, referrals, and case management as needed. It also included fluoride varnishes for 11,072 children. Activities after March 2020 were paused due to COVID-19.

The Office of Oral Health began implementing the Healthy Smiles Healthy Bodies (HSHB) Survey during the 2019-2020 school year. This survey is conducted by OOH every five years. The goal of the HSHB Survey is to collect oral health and body mass index (BMI) status of population groups (kindergarten and 3rd grade) in Arizona. This surveillance data informs public health programs, monitors progress toward reaching state/national benchmarks, including Healthy People 2020 (and going forward, Healthy People 2030), and contributes to the CDC National Oral Health Surveillance System. Survey calibration trainings were held for survey teams at three locations (Flagstaff, Maricopa, and Tucson) early in the school year.  Survey teams completed 33 schools, including all schools in Cochise and Graham Counties. When the pandemic hit, there were 26 schools that had already received the HSHB consent forms and were scheduled to participate and another 51 schools that were scheduled and the HSHB coordinator was in the process of distributing paperwork for participation.  When COVID-19 closed schools and impacted infection prevention recommendations, OOH convened a workgroup of experts to develop policies and procedures for re-entry into schools.  As a result, providers were trained again in September 2020 on the new procedures. In addition to a change in implementation procedures, OOH developed communication materials for parents and schools on the safety and need for oral health screenings. OOH plans to resume the survey when schools reopen.

The Office of Oral Health continued working in partnership with the Arizona Health Care Cost Containment System (AHCCCS; Arizona's Medicaid program) by collaborating on reimbursement of oral health services for AHCCCS-enrolled children. Reimbursement of program services has built sustainability in the program and increased AHCCCS' preventive services initiatives. One major achievement and outcome of this collaboration was the institution of a policy within the AHCCCS Medicaid Early and Periodic Screening, Diagnostic and Treatment (EPSDT) requirements for health plans to participate with the Cavity Free AZ prevention programs. Collaboration between the two state agencies also included referrals and identifying opportunities to link Medicaid-eligible children to dental homes.

The Surgeon General’s Report on Oral Health in 2000 recognized the importance of good oral health during pregnancy. The report concluded that oral diseases can be associated with systemic conditions, including adverse pregnancy outcomes. The results of this report spearheaded Arizona’s movement towards improving the oral health of pregnant women and infants. The Office of Oral Health (OOH) developed training materials and resources for multiple audiences, including home visitors, childcare providers, health providers, pregnant women and new mothers, to enhance their knowledge and skills on improving oral health for women and young children.  These resources include e-learning modules on oral best practices as well as motivational interviewing, a client-centered counseling style for eliciting behavior change by helping clients explore and resolve ambivalence.  The oral health training resources reside on the home visitor portal, Strong Families AZ (strongfamiliesaz.com), and are available to home visitors and partners statewide. As part of the training, OOH distributed nearly 2000 oral hygiene kits to participating home visitors to provide to their clients during oral health conversations.

In addition to the e-learning modules, OOH developed three in-person training sessions to train oral health providers on oral health best practices for pregnant women, infants and toddlers.  In partnership with First Things First, Arizona’s early childhood agency, OOH trained nearly 100 oral health providers across Arizona. Trainings were provided throughout the calendar year and located geographically to accommodate wide participation from all counties. From July 2019 to March 2020, these providers screened, triaged and provided preventive oral health services to over 16,000 women and children. In March 2020, training and delivery of these services were halted due to the pandemic and remain in a paused state.

Oral Health is one of the priorities identified in the Arizona Health Improvement Plan (AzHIP).  AzHIP was designed with the participation and commitment from many stakeholders allowing for strategies to be more far reaching than those of the OOH alone. The oral health strategies include: expand access to childhood oral disease prevention programs; increase utilization of the oral health care system; integrate oral health into whole person health; and expand and maintain community water fluoridation systems. OOH continued partnering with stakeholders to implement and update the AzHIP priorities.  The majority of this work was completed through quarterly scheduled virtual meetings during 2020.

During 2020, OOH worked with a broad array of national, state, and local public and private partners to educate decision-makers on dental public health issues and concerns of state oral health programs. One such partnership included statewide and regional oral health coalitions that were instrumental in addressing access to care issues for our most vulnerable populations.  In 2020, Arizona worked on providing technical assistance to partners regarding the recently signed Dental Therapy bill, which created a new class of dental care providers in Arizona who will be able to provide primary dental care for children and underserved individuals. While employment of this provider type is still in the rules stage of development, partners are eager to move forward with implementation.  

Arizona also looks at ways to reach and serve the oral health needs of the disenfranchised, which started the Arizona Mission of Mercy. This event provides free dental care to those who most need it and is made possible through the work of hundreds of volunteers. A startling 42% of Arizona adults over 65 years have lost six or more teeth due to decay or gum disease. We know that nationally about half of people do not have dental insurance and pay for dental care out-of-pocket. Because of COVID-19 restrictions, the 2020 Mission of Mercy event at the Arizona Fairgrounds was redesigned as a drive-thru dental event. Volunteers gave out nearly 40,000 oral health kits and food boxes to emphasize the importance of good oral hygiene and provided community resources at several locations around the state.

ADHS implements the Empower Program to support Arizona’s early care and education (ECE) facilities in their endeavors to encourage young children to grow up strong and healthy. By enrolling in the Empower Program, licensed child care facilities voluntarily agree to implement all standards and develop a written policy for each standard that meets the needs of all children served. In turn, the child care facility is provided a fifty percent reduction in licensing fees, partially funded through Title V. Additionally, ECE programs contracted with the Arizona Department of Economic Security (DES) are required to enroll and participate in Empower. The Empower Program requires providers to adopt 10 health standards, two of which impact children's oral health: 'Fruit Juice' and 'Oral Health'. These efforts are welcomed by oral health stakeholders that recognize the link between fruit juice and the oral health of young children. In 2020, the OOH continued support of online e-learning courses on implementing tooth-brushing programs in child care and serving fruit juice. ‘Empower Training: Fruit Juice in Child Care Settings’ averages about 700 users per year and ‘Empower Training: Tooth Brushing in Child Care Settings’ averages about 500 users per year.  These training resources are available to all child care staff in Arizona.

In 2020, a work group of the Empower Advisory Committee (EAC) began a review of all the standards.  Under review are Empower Standard # 7 (Provide monthly oral health education or implement a toothbrushing program) and its components:

• Provides monthly oral health education and/or implements a daily tooth brushing program
• Does not allow children to carry a bottle or sippy cup during the day unless it is water
• Educates parent(s) on the importance of a dental visit by their child’s first birthday
• Does not put children to sleep with a bottle
• Limits serving of meals and snacks to scheduled times
• Educates parents about cleaning teeth and oral hygiene at home
• Provides information on tooth decay to families at least annually

Also, under review is Empower Standard # 5 (Limit serving fruit juice to no more than two times per week) and its components:

• Provides water throughout the day both inside and outside
• Offers water as the first choice for thirst
• Does not serve fruit juice more than twice per week for children 1 year and older
• Limits serving more than 4-6 ounces of fruit juice at one time
• Serves only 100% fruit juice with no added sugar
• Serves fruit juice only at meal or snack times
• Provides information about limiting fruit juice to families at least annually

Work groups will review existing standards and components, compare to best practices, and recommend changes for consideration.  The EAC and ADHS leadership anticipates a final report in 2022. 

Access to Care

In addition, the Primary Care Office (PCO) within BWCH leads statewide efforts to improve access to care to all health services in Arizona’s rural and underserved communities. The PCO continues to assist with designating areas for Health Professional Shortage (HPSA) or Medically Underserved Areas or Populations (MUA/P) to inform where resources can be leveraged to create the greatest impact for improving access to health care. As of May 2021, Arizona had 587 HPSAs: 220 primary care, 211 dental, and 213 mental health. These include facility HPSAs for Federally Qualified Health Centers and Indian Health Service sites. Arizona needed 558 primary care physicians, 381 dentists, and 178 psychiatrists to eliminate these HPSA-designated areas, which is a lower need when compared to 2019. There were also 37 MUAs and 10 MUPs in the State. Residents residing in these underserved areas are less likely to receive preventative health services.

The State Loan Repayment Program (SLRP) and the National Health Service Corps Loan Repayment Program (NHSC) help recruit and retain health care professionals into HPSAs by providing loan repayment incentives to providers in exchange for an initial two-year commitment to practice medicine in the HPSAs. In 2020, 137 providers were obligated through SLRP and 503 through NHSC.

The PCO partnered with the Arizona Alliance for Community Health Centers, Arizona’s Primary Care Association (PCA), to implement activities that educate communities about programs and resources that can help recruit healthcare professionals in areas with significant challenges with recruitment. Those activities also aim to build partnerships with academic training programs, employers, local and state partners, tribal entities, and providers to collectively address workforce shortages in Arizona.  Examples of activities implemented this year include: education and technical assistance to students and residents attending medical, dental, or behavioral health training; local and national presentations; partnering with the PCA to help students receive rotation placements in community health centers; assisting providers with finding job placements; and working on improving the coordination efforts between the PCO, PCA, and the State Office of Rural Health to recruit providers in underserved rural areas of the state. 

In terms of expanding access to care via telemedicine, the PCO launched the Rural Prenatal Telemedicine Program (RPTP) in State Fiscal Year (FY) 2020 (July 2019 – June 2020) through a Request for Proposal (RFP) process. The RPTP aims to improve the health outcomes of women in rural areas before, during, and after pregnancy by improving access to prenatal care services through telemedicine. Through legislation, the RPTP is required to contract with rural hospitals in federally designated HPSAs to create or expand telemedicine infrastructure for the provision of prenatal care. The RFP was released three times to solicit contractors to operate the RPTP.  Unfortunately, no qualifying organization responded to the RFP and no awards were made. 

The PCO received a one-time state funding for State FY 2020 in the amount of $700,000 to implement the Community-Based Primary Care Program.  This funding is intended to support the provision of primary health care services in geographically isolated areas of the State.  Required services include primary and preventative medical, dental, behavioral health, pharmacy, labs, referral, transportation, 24-hour triage, and other medically necessary services provided on-site or through a referral process to an outside entity.  Through an RFP process, the PCO awarded the funds to a new HRSA-designated federally qualified health center, Creek Valley Clinic, serving Colorado City, a geographically isolated area in Mohave County, Arizona. Colorado City is on the border of Utah and Arizona and residents in this community frequently travel into Utah to access needed health care.  The community experienced historical trauma related to family separation, restricted child play and toys for appropriate social development, child labor, child abuse as well as issues of malnutrition, lack of primary education, and low literacy levels.  Other cultural barriers include fear of asking for assistance from people outside the community and an aversion to evidence-based public health practices, such as immunizations and fluoride treatment. Creek Valley Clinic was able to leverage these state funds to provide services while applying for and successfully obtaining HRSA federally qualified health center funding and status. 

Supporting the COVID-19 Response

This section describes the ways in which Arizona’s Title V Program supported the state’s COVID-19 response in 2020.

The Chief for the Office of Women’s Health provided support in the Schools Reopening Task Force. She was brought in to assist with a Schools Support pilot project that was being implemented with 14 school districts across the state and included a myriad of options schools could select from to help support them during COVID. The main component offered was saliva-based testing and surveillance for school teachers and staff to help schools identify their infection rates within the school staffing community.  Aside from the pilot project, her role included participation in weekly check-in meetings with the Arizona Department of Education and the local county health departments to ensure all agencies were kept informed of the work being conducted with schools around COVID.

On March 25, 2020, Governor Ducey issued Executive Order 2020-15, which expanded telemedicine statewide to address the COVID-19 crisis.  A short summary of the Executive Order can be found here. In light of this, a Telemedicine Task Force was created within the HEOC structure to assist with efforts in the statewide telemedicine expansion and help identify barriers and resolutions to implement the Executive Order. Within the Arizona Department of Health Services (ADHS), the work of the Telemedicine Task Force was led by the Bureau Chief/Title V MCH Director and other staff from the Bureau of Women’s and Children’s Health.

Provider and Pediatric Telehealth Readiness surveys were conducted to support the implementation of the Governor's Executive Order by quickly assessing capacity, readiness, and barriers to providing telehealth/telemedicine services across Arizona’s providers. The data was collected between May 27 and June 10, 2020. The survey was disseminated via an email announcement in partnership with the Arizona Medical Association, the Alliance for Community Health Centers, Arizona Telemedicine Program (University of Arizona), Arizona Council of Human Service Providers, Primary Care Office, the Advisory Council on Indian Health Care and the Arizona Chapter of the American Academy of Pediatrics.

There were a total of 698 practice responses; the breakdown by specialty was: unspecified providers (90%) and pediatricians (10%). A majority of respondents (86%) do provide telehealth/telemedicine services. The most common service provided via telemedicine among respondents was behavioral health services (36%) followed by primary care (34%) and support for Substance Use Disorder (12%). Behavioral health services (36%) was also the most common service provided via telephonic care, followed by pharmacy services (33%). A majority of respondents (84%) provide training material for providers. A majority of respondents (60%) provide training material for patients. A majority of respondents (72%) use Zoom for telehealth/telemedicine services.

The Telehealth Task Force identified an immediate need to disseminate the Executive Order to statewide partners and to provide additional resources that may help address concerns in delivering services via telemedicine, including telephonic visits. For example, the team worked to enhance the interactive map for Sliding Fee Schedules to include a phone icon indicating where telehealth services were available at the different locations throughout Arizona. This provided a quick resource to those who were interested in receiving telehealth services.  The Telehealth Task Force also identified a number of clinician- and patient-related barriers to implementing or using telemedicine services, including an overall lack or limited knowledge of telemedicine technology, limited understanding of telehealth requirements and regulations (i.e., reimbursements, coding, HIPAA regulations, etc.), lack of awareness of where telemedicine services could be accessed in Arizona, and broadband and connectivity issues.

To address these barriers, ADHS provided funding through Title V to the University of Arizona’s Arizona Telemedicine Program to provide training, technical assistance and resources related to telemedicine and telehealth to facilitate increased adoption and use of telemedicine services among providers, employers and patients. Through this partnership with Title V, they have provided education and information on the regulatory changes, broadband programs, information for providers on how to implement telemedicine/telehealth services in practice (i.e., staff required, changes to clinical flow, type of technology available and/or required), information on how to bill for telehealth, and other topics.

MCH Healthy Arizona Families IGA

From January 1, 2020, to June 30, 2020, local county health departments received Title V funding through the Healthy People Healthy Communities IGA, which allowed them to use Title V funding for provision of family planning and reproductive health services or to address the following NPMs (1, 4, 6, 7, 9, 10, 14).

On July 1, 2020, ADHS entered into a new five-year intergovernmental agreement with local county health departments to leverage the partnerships between state and local health departments in Arizona by providing Title V funding to counties to promote and implement evidence-based or evidence-informed strategies that will improve the health and wellbeing of Title V populations in their communities. Through the MCH Healthy Arizona Families IGA (MCH HAF IGA), counties are encouraged to address needs identified through the 2020 Title V Needs Assessment and the 2019 State Health Assessment (SHA) and to align their efforts with the 2021-2025 MCH health priorities and Arizona Health Improvement Plan (AzHIP) strategies; however, they are provided with the flexibility to design their strategies and activities in a way that meets the needs of their local context. Fourteen out of Arizona’s fifteen counties have elected to participate in the MCH HAF IGA; only Santa Cruz County does not because its health department is too small to conduct prevention and health promotion work. Through this mechanism, $2,017,415.00 is invested each fiscal year to serve Title V populations across Arizona. In 2020, local county health departments directly served 34,128 clients through their MCH Programs and 2,084 through their Family Planning Programs (see the Women’s Health narrative for more information).

Local health departments (LHDs) develop Action Plans for each state fiscal year, which runs July to June. Between July 1, 2020, and December 31, 2020, LHDs worked on a diverse set of strategies and activities to serve MCH populations. Ten (10) counties used funds for family planning and reproductive health services, including cancer screenings (pap, mammograms) and STD/STI screening and treatment (see the Women’s Health 2020 Annual Report for more information on the Title V-funded Family Planning Program). Two counties promoted breastfeeding with their Title V funds, six worked on safe sleep education and support (i.e., provision of pack n’ plays), six worked on injury prevention strategies (including car seats, safe teen driving, etc.), five worked on bullying prevention, and four worked on transition. Please see Appendix R for a full crosswalk of the county strategies across the 15 NPMs.

Unfortunately, the COVID-19 pandemic, and the response it required from local county health departments, slowed the progress of many of these identified strategies in 2020. In the fall of 2020, many staff at the local level were pulled into the COVID response to assist with contract tracing and resource coordination/navigation support for community members affected by COVID or quarantine measures. In addition, many local county health department staff contracted COVID-19 in the course of their duties, and several local health departments were closed at different periods during fall 2020 to mitigate the spread of COVID-19 among their staff. Additionally, school closures disrupted school-based programs like Battle of the Belts, an initiative to encourage teen seat belt use. County MCH colleagues reached out and collaborated across counties to brainstorm ways to adapt programming, but still found that most schools were unwilling to participate in public health “extracurricular” programming during the 2020-2021 school year.

Investment of MCH Funds

MCH 2020 Expenditures for Oral Health - Total Expended = $ 119,630.72

During FY 2020, the Office of Oral Health expended $27,054 on Personnel Services. These funds supported personnel who oversaw policy development, needs assessment and quality assurance for oral health in Arizona.  Another primary function of these positions was to oversee and administer the implementation of prevention programs, including the school-based sealant and fluoride varnish program. $80,381 was awarded to sub-contractors, including five county health departments and one federally qualified health center (FQHC). Sub-contractors provided local and community preventive dental services to eligible children. In addition, a portion of the funding was used to implement the Healthy Smiles Healthy Bodies Survey.  $3,835.05 was expended toward the purchase of equipment and supplies needed to carry out the program activities, including office dental and office related supplies. Dental supplies included the purchase of toothbrushes, toothpaste, and CDC-recommended enhanced Personal Protective Equipment (PPEs) such as gowns, face shields, hand sanitizers, gloves, and surface disinfectants capable of killing the coronavirus (COVID-19). Indirect cost is set at 26.7% of personnel expenditures for the agency. The total indirect costs for FY20 was $8,332.63.

MCH 2020 Expenditures for Primary Care Office - Total Expended = $ 76,618.14

In FY2020, the Primary Care Office was supported by the MCH Title V grant to expand maternal and child access to care activities. One of the main initiatives supported was a partnership with the Arizona Alliance for Community Health Centers (AACHC); approximately $59,000 was used to expand recruitment for providers in the underserved areas of Arizona. AACHC hosted two conferences: 1) National Health Service Corps Scholars Conference and 2) Arizona Student/Resident Experiences and Rotations in Community Health Partners Meeting (AZ SEARCH) to support recruitment and retention of providers for rural and underserved communities. Approximately $11,000 was used to support the monitoring MCH shortage designations, to provide assistance with maintaining the Sliding Fee Scale, and to review and assess MCH data and trends for access to care in Arizona.