Efforts continue, this application year, to enhance the tracking of Intake and referrals for children at higher risk for developmental delays. Increased developmental screening and linkages to services through building partnerships with child-serving providers will increase their awareness of screening and referral services in the state. We will continue to keep the pulse on families referred for early intervention to prevent such families from falling between the cracks. The ECCS program collaborated with early intervention programs to ensure children less than 3 years identified at risk for developmental delays are referred to appropriate services before age 3 to promote early detection and intervention. The partnership between the Birth to Three program and Help Me Grow /2-1-1 staff for follow-up with Ages and Stages screens remain even more established with the hiring of 2 more staff to assist with the uptake of screens. This effort is funded by the Birth to Three program.
The ECCS program in partnership with the American Academy of Pediatrics, will improve previous efforts to streamline and track referrals with the recent collaboration with Total Child Health to introduce the CHADIS pilot project. CHADIS is a web-based platform which enables health providers to access over 400 screeners and also track activities in real time. This approach will enable physicians to screen families during well-child visits and track any referrals to early intervention or other community resources, through a feedback loop. All these efforts will strengthen follow-up services to ensure children identified at risk for delays are referred to and receive early intervention services.
We will also continue to provide technical assistance and training to pediatricians and family practices that are using the PEDS instrument, as well as potential recruits. The training will be in the form of a webinar series, an online education course titled “Developmental & Autism-Specific Screening.” The training provides an overview of developmental screening best practices, Delaware’s developmental screening initiative, PEDS Online instrument, early intervention, referral and community resources, among others. The webinar will be posted on the AAP website including DEThrives as well as other partner sites.
Partnerships with the Office of Early Learning will continue to improve the delivery of developmental screening services within Delaware’s school districts. In 2019-2020, the ECCS teams partnered with the Office of Early Learning, which is housed within the Delaware Department of Education, to get 17 out of the 19 schools districts to post a link to the Ages and Stages developmental screening tool on the school district websites - opening up access for early care and education centers in each school district and their enrolled parents to utilize the platform and the subsequent referral and early intervention processes. This led to a spike in the number of children birth to 5 years receiving developmental screens. In May of 2021, Delaware legislature passed the developmental screening bill requiring all child care centers to administer developmental screens. The ECCS and Help Me Grow programs will work collectively with the early learning community to anticipate and address any opportunities and challenges that would surface as a result of this expansion.
The ECCS program will continue with outreach efforts to promote developmental screenings and milestones thereby increasing awareness and promoting and parental involvement. Outreach efforts such as Books, Balls, and Blocks (BBB) will continue in collaboration with multiple community stakeholders such as United Way of Delaware, Division of Libraries, Help Me Grow/2-1-1, Wilmington Head Start, Project LAUNCH and the Readiness teams. During the 2019-2020 grant period, the ECCS Impact team and its partners held five BBB events within a variety of settings. These settings included Head Start and other childcare centers, community centers and libraries. These events brought in approximately 120 families with about 60 children (birth through 5) receiving ASQ screens. Evaluations turned in after the event indicated that the families found the BBB event very beneficial in increasing their knowledge regarding the expectations for their children’s growth based on their ages. The success of the BBB events is due to its alignment to the goal of systems development and improvement through reaching out to a cross-sector of stakeholders who can garner and leverage their resources to benefit the whole. Plans to organize more BBB events in the southern part of the state at the beginning of 2020 were thwarted due to the Covid-19 pandemic. Despite such challenges, the ECCS teams were successful in organizing BBB online using zoom. For this application, we will continue to organize BBB online. Since its inception, we have held about 12 BBB online events.
We will continue to strengthen collaboration with the WIC Program. Through the University of DE Center for Disabilities and Learn the Signs Act Early Ambassador, the ECCS collaborated on a project involving the Special Supplemental Nutrition Program for Women, Infant and Children (WIC). The project introduced a CDC developmental screening checklist at all WIC locations in DE (with RWJF funding). WIC programs added the checklist to their intake system. Clients visiting WIC were asked questions based on the checklist. Families falling below the identified threshold were encouraged to call Help Me Grow/2-1-1 for an actual developmental screening to be administered. The data indicated that, of the approximately 4,000 checklists completed, 758 referrals were made to Help Me Grow, while only six of the referred families called the call center. Though this project has ended, ECCS program will find ways to engage its WIC partners as it serves as a great avenue to reach families enrolled in the program, who are often at-risk. Delaware will continue to implement these activities to achieve its stated goal of increasing screening through the implementation of the following strategies:
- Promoting early detection by encouraging physician practices to increase developmental screens and link families to community resources and services;
- Training and education targeting early childcare and education providers to increase the number of children who have developmental screens;
- Collaborating with early intervention programs to improve referrals following high risk developmental screens to ensure families are connected to treatment services;
- Launch the CHADIS pilot with 4 pediatric practices to improve the coordination of care and systems improvement;
- Building parent/family leadership and capacity to advocate for themselves and their communities; and
- Continue organizing community events such as Books, Balls and Blocks events and determine its sustainability beyond the ECCS grant.
Dental Visit (Child/Adolescent)
Delaware is tracking along with the national average of children, ages 1 through 17, who had a preventive dental visit in the past year. According to the 2018/2019 National Survey of Children’s Health, 79.7% of Delaware children had one or more dental visit, which resembles the national average of 79.6% of children. Unfortunately, this equals to 20.3% of Delaware’s children have not had a preventive dental visit in the past year.
MCH feels it is critical to collaborate with the Bureau of Oral Health and Dental Services (BOHDS) while they develop new approaches and integrated new technology into schools and other programs to continue to provide education, dental screenings, and case management to the most vulnerable populations during the COVID-19 pandemic.
Title V MCH feels it is crucial to support BOHDS with completing a statewide oral health survey of children in kindergarten and 3rd grade across the state. The oral health survey was last completed in 2013 and will measure the burden of oral disease including prevalence of dental caries, untreated dental decay, urgent dental needs, dental sealants, and access to care. The survey is part of the oral health surveillance system used by BOHDS to measure, monitor and report on the burden of oral disease in Delaware. The survey was delayed in 2020 due to the complexities of the COVID-19 pandemic. The BOHDS Dental Director has been working with the school nurses and superintendents to garner support for moving forward in 2022 with the survey. Data collected from the survey will be used by BOHDS to develop preventive oral health and nutrition programs targeted for kindergarten and third grade children at the start of the 2022 school year.
BOHDS has been collaborating with the Delaware Department of Education (DOE) to make oral health part of overall health. MCH supports BOHDS in its efforts to include oral health as part of total health through the schools and see it as a critical piece of medical and dental integration. The DOE is working on developing a standard student enrollment form to be used by all schools across the state. BOHDS continues to work with DOE to include valuable dental information on school enrollment forms that have been overlooked in the past. Parents and guardians will be asked if they have dental insurance, date of last visit to a dentist, and the name of their dental home.
BOHDS will continue working on completing oral health educational videos, resources, and online enrollment for oral health programs and education. MCH will be supporting BOHDS with sharing the information that will be posted on each school’s websites for teachers, nurses, athletic directors, parents/guardians and children to improve oral health literacy about preventive dental care, fluoride, nutrition, dental sealants, dental decay, oral health, systemic health, dental emergencies, mouth protection, vaccinations, oral cancer (HPV), mental health, oral health, and access to care (find a dentist and enrolling in dental insurance). MCH feels it is extremely important to assist BOHDS with this information campaign. MCH will be utilizing DEThrives to support BOHDS with these educational videos, resources, and online enrollment education.
As explained in the Child Health Annual Report, MCH and the BOHDS dental team collaborated this past year to find a solution to continue the Delaware Smile Check Program (DSCHP), through the COVID-19 pandemic. MCH and the BOHDS dental team have worked to add online enrollment, consent, and screening forms in addition to flyers and a satisfaction survey to our DEThrives website for portable dental operations. The portable program includes dental screenings and prevention programs onsite that include fluoride application, oral health education, and case management.
Although this project was not completed during the Annual Reporting time, MCH will continue to work with the BOHDS dental team and our DEThrives vendor, AB&C, to facilitate the creation of these 12 fillable Virtual forms in English and Spanish in addition to the eight On-Site fillable forms in English and Spanish on our DEThrives website. These forms target the populations: Birth to age 1, Age 1 to 5, Age 6 to 12, Age 13-18, Age 19 or older as well as Pregnant mothers. We are currently in the phase where we are reviewing each form for accuracy and hope to have it live shortly. Once complete, it will allow schools, organizations and parent/guardians to complete consent forms and other required documents online and eliminate complications for distributing paper documents to these locations and sending them home to students to return.
School personnel and parents will be able to complete through the school’s website enrollment in the Delaware Smile Check Program (DSCP). The DSCP is a portable and virtual preventive program that provides dental screenings, fluoride varnish application, customized oral health education and case management to remove barriers to obtaining oral health care for students and their families. BOHDS is targeting the release of a video demonstration of the DSCP requested by the school district. The video will be shared to show students and parents what to expect prior to receiving services.
The DEThrives website houses information that provides resources that benefits any type of person and any type of family situation. The DEThrives site is undergoing a website revamp and it is being reworked to organize and present content in a way where it would be more user-friendly for consumers to easily navigate throughout the site. The goal is to inform and educate the consumer with evidence-based content that is helpful and relatable based on the life stage a consumer would classify themselves in. The website will be set up in a way where the consumer could classify themselves in a category that resonates the best with them in describing their current life situation or life stage they are in. Once the consumer identifies themselves based on the provided options the site offers, relatable content such as the programs or services that DEThrives offers will populate into small groups of info all placed on one webpage. This presentation will help allow the consumer to see a layout of the type of info that may best suit their current life stage with helpful and credible resources. Content for providers and partners will be presented in a short and concise way so they may easily and efficiently refer to the site.
Part of the overhaul of the DEThrives website, will be to incorporate the Bureau of Oral Health and Dental Services information on our site. Our goal will be to add the existing Healthy Smiles dental program to the revamped DEThrives site. The Healthy Smiles landing page will consist of details regarding the BOHDS Delaware Smile Check Program. The Delaware Smile Check Program offers in-person school and organization visits along with virtual options where on-site and virtual forms are available in both English and Espanol. These services are for children as young as 1 year old, adults, and pregnant women and will be provided dental assistance, which includes patient education, regardless of if the consumer has insurance or not.
BOHDS will begin working with the DOE and collaborative partners to develop an effective plan to incorporate oral health into wellness centers in the Colonial School District. This school district is a priority since they have a significant percentage of students with disabilities and unmet dental needs.
Over the past five years Delaware has struggled to maintain the Delaware’s Oral Health Coalition. Changes in Directors, lack of resources, funding, and COVID have prevented BOHDS from moving forward with an agenda and partners. Relationships have been built, however, with many community partners during this time that work toward improving the health of the residents in Delaware. BOHDS Dental Director is making it a priority to reestablish The Delaware Oral Health Coalition over the next year to address oral health access issues and work on improving oral health for all residents statewide. MCH will be supporting the reestablishment of the Coalition to continue the progress made advancing oral health care for children.
MCH will also continue to support Delaware’s goal to expand their dental early intervention programs for pregnant women and infants. Through this program pregnant women are empowered and inspired to self-advocate for the oral health of their children as well as themselves through receiving preventive dental treatment during pregnancy, assuring their children receive routine preventive dental care and have a dental home by age one. This program has proven to be successful for both the women, infants, and other children in the family.
Delaware’s dental team will continue develop collaborations and conversations with the National Federation for the Blind, Autism Delaware, Family Shade, CYSHCN, DOE, Child Development Watch, and families that have a child with a disability. Through these collaborations, BOHDS has purchased assistive devices aimed at helping children and parents/guardians with brushing and flossing to maintain good oral health and overall health. Feedback from these discussions has encouraged the development of educational materials and presentations to begin next year that include for nutrition and medications, brushing, flossing and fluoride supplementation, positions for assisting with home dental care, and devices to assist with maintaining good oral health. MCH will support BOHDS as they collaborate with schools, organizations and families to provide training and education for teachers, staff and families in assistive devices available such as raised dots, putty, wrist straps, electric toothbrushes, flossers, tennis balls, etc., that assist with daily oral health routines and improve oral health literacy.
BOHDS has begun reimplementing training for physicians, physician assistances and nurse for fluoride varnish application, caries risk assessment and referrals for age one visits. During the past year there has been a dramatic decline in the number of pediatricians that continued with oral health activities. MCH supports the continuation of this training and its expansion to nurses for children under age 5.
This is a critical step in addressing the total health of a child and bridging the silos between medical and dental. MCH sees the value in supporting this collaboration between the early literacy program through the Delaware Medical Society and BOHDS to distribute Brush, Brush, Brush books, oral health supplies, and resources to pediatricians. Through this relationship the dental hygienist is building a relationship with the medical teams and serves as point of contact for dental questions, children with urgent dental needs and training for fluoride application, caries risk assessment, dental emergencies, age-appropriate oral health supplies and more. In addition, the dental hygienist has gained knowledge about medical information that they continue to reinforce with their patients (Medical homes, vaccinations, etc.) and assist families with connecting to other social services that are needed. A dental help line was created to assist families with finding a dental provider and business cards distributed to the medical providers. A child who needs a dentist is given the card to contact a dental provider that meets their needs. This was developed to remove the burden of assisting with finding a dentist through the pediatrician’s office. Currently the program targets age one and discussions have started to include more books and ages in the upcoming year.
Both BOHDS and MCH expect challenges due to COVID with pursuing oral health activities for the upcoming year. BOHDS has been preparing to provide virtual solutions and implement outreach for families to garner support for school surveys, DSCP and preventive treatments. MCH will support their efforts by continuing to market for their program, fairs, Storytime, and newsletters through DEThrives, Facebook and Twitter and over 200 Community Partners.
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