NPM #8 Physical Activity – Reduce obesity among children and adolescents.

 

Please note that some of the strategies and activities listed below impact both the Child and Adolescent Health domains. To avoid duplication, the information will only be listed in this domain, for which it is anticipated to have a larger impact.

 

Policy and Environmental Changes

Developing a healthier community involves creating a culture that promotes the benefits of physical activity and allows access to safe places to be active. Public policy is essential in supporting opportunities for children, youth, and families to develop healthy physical activity practices. Strategies to promote policy and environmental changes that can foster healthier communities in which opportunities and safe places to be physically active abound include collaboration with internal partners, local public health agencies (LPHAs), youth, and statewide and community organizations with similar goals. In FFY 22, program staff in the Bureau of Community Health and Wellness (BCHW) will continue to contract with LPHAs to implement policy and environmental changes that increase opportunities for children to engage in physical activity (PA) across multiple settings.

 

Child Care Wellness contracts will support up to 20 LPHAs in providing training and technical assistance to child care providers in improving child care physical activity and nutrition policies and practices. LPHAs will use the University of North Carolina’s
Nutrition and Physical Activity Self-Assessment for Child Care (Go NAPSACC) online system to assist child care providers to improve the health of young children through practices, policies, and environments that instill habits supporting lifelong health and well-being and track child care providers’ progress.

 

The Department of Health and Senior Services (DHSS), through BCHW, the Child Care Health Consultation (CCHC) program, and the Community Food and Nutrition Assistance program, will continue to support childcare providers to implement policies and practices supportive of physical activity. This is to occur by providing training, resources and technical assistance related to PA policies and practices to child care providers in their efforts to become a Missouri MOve Smart Child Care.

 

BCHW will contract with Missourian’s for Responsible Transportation to lead and conduct the Missouri Livable Streets Advisory Group. This group consists of active transportation experts and advocates that collaborate to assist communities with improving the accessibility of non-motorized transportation for all users throughout the state.

 

Professional Development, Training, and Resources

BCHW staff are also available to provide training and technical assistance on obesity prevention strategies for local communities. To ensure staff are well-informed and can provide quality assistance, they plan to participate in professional development opportunities such as annual conferences of professional associations, the Southern Obesity Summit, and other evidence-based training.

 

BCHW will continue to support Missouri communities in their obesity prevention efforts by providing professional development and training opportunities for key stakeholders. Additionally, technical assistance and resources are available to assist efforts in increasing regular physical activity and healthful eating. BCHW will also assist communities in assuring interventions are inclusive of individuals of all abilities.

 

The School Health Program (SHP) will support school nurses to engage with students and families in addressing overweight/obesity in children. SHP will sponsor education and professional development in best-practices (e.g., Lead Nurse Collaborative Meeting and ECHO webinar series for school nurses), collaborating with stakeholders and organizational partners to make tools and resources available to school nurses, and facilitating connections between students and families, schools, and communities.

 

Partnerships

CHW staff participate in a number of coalitions and partnerships that help to advance progress towards the state’s goals and objectives. Examples of groups in which staff are involved include: Missouri Council for Activity and Nutrition, Missouri Convergence Partnership, Missouri Coordinated School Health Coalition, Department of Elementary and Secondary Education Wellness Workgroup, and the Missouri Livable Streets Advisory Council. Staff have the opportunity to network and identify collaborative opportunities with other organizations working on similar goals, share available DHSS resources and leverage funding to increase the reach of their work.  

 

The MCH Services Program will continue to contract with a total of 22 LPHAs that selected promoting physical activity and reducing and preventing overweight/obesity as the Priority Health Issue to be addressed in their FFY 2022-2026 MCH Services contract work plan. LPHA efforts to prevent and reduce overweight/obesity and increase physical activity among children and adolescents will include:

• Knox County Health Department plans to work with their County Ball Association and school districts to implement healthy food options in their concession stands. They also plan to develop a walking trail for their communities and host walking events for children and adolescents along these trails.
• Mercer County Health Department plans to use the Water Access in Schools Toolkit from CDC to implement a water access plan within schools to make available free, safe drinking water in gym and other physical activity areas for students. They also plan to work with the Russ Derry Sports Complex to update playground equipment so that it is not only safe but inclusive to all children.
• Scotland County Health Department plans to work with the City of Memphis and implement safe drinking water filling stations in parks and recreational sites to encourage children and adolescents to drink more water when being active. They also will educate providers (childcare, medical, grocers, library, etc.) on 12345 Fit-Tastic! messaging and provide messaging as requested.
• Cooper County Health Department plans to work with at least two schools in Cooper County that have before or after school programs and incorporate physical activity opportunities for children by using GoNoodle, Brain Gym, 12345 Fit-Tastic! messaging). They also plan to host a Walk to School Day in October of each year and will collaborate with school health staff/PE teacher.
• Benton County Health Department plans to develop a community resource guide that identifies walking trails, parks, swimming pools/public beaches, bowling alley, skate park, YMCA, and other opportunities for physical activity in children and adolescents. They also plan to provide nutritional education classes to children and families, teaching them how to read nutrition labels, wash produce, and prepare a healthy recipe.

 

SPM #1 Oral Health – Percent of children, ages 1 to 17 years, who had a preventive dental visit in the last year.

 

Ordering information for oral health resources from the Office of Dental Health (ODH) and the Missouri Primary Care Association (MPCA) will be provided to all MCH funded home visitors to promote National Children’s Dental Health Month, which is observed annually in February. National Children’s Dental Health Month will also be highlighted in the Home Visiting Program’s continuous quality improvement newsletter, Quality Outlook, and in the Weekly Update emailed to all MCH funded home visitors and supervisors to provide links to materials, webinars, and other resources that highlight the importance of preventive annual dental care in children. The Missouri WIC Program will collaborate with ODH to procure infant and toddler toothbrushes to have them available in their local WIC clinics.

 

Additionally, literature is available to LPHAs, dental offices, and community outreach events such as health fairs. The importance of regular dental care is also stated within the context of the ODH’s promotion of the use of dental sealants. Referrals and care coordination components of the Preventive Services Program (PSP), described in more detail below, also encourage regular dental visits for children, particularly those who have been identified as having evidence of a dental need.

 

The ODH enjoys continued success with the PSP, which is an evidence-based fluoride varnish and oral health education program. PSP serves about 90,000 children each year. Each child receives an oral health screening by a dental professional, two doses of fluoride varnish, oral health literature and supplies, and oral health education. The oral health education is either provided by school staff or the dental professionals that volunteer to operate PSP. Educational materials are provided by the ODH (for each grade, K-12), but some schools choose to use their own materials. Due to the Coronavirus pandemic, many schools will not allow visitors to enter their school building. For those schools, PSP has adapted to provide a grade-specific and narrated educational video for teachers to show their classes, or a Zoom call can be scheduled with the school’s ODH Oral Health Consultant if they do not have their own educational materials or training. Oral health supplies and literature will still be given, and fluoride varnish will either be applied by a trained school staff member or sent home for parents or guardians to apply to their child’s teeth. ODH’s Oral Health Consultants will also be available to school nurses to advise on possible dental health needs their children have. School nurses can take pictures of a child’s teeth if there is a questionable issue, and an Oral Health Consultant can help in determining the need for dental care.

 

Much of Missouri is a dental health provider shortage area, meaning many Missourians are not located close to a dentist nor do they have a dental home. COMTREA (a Federally Qualified Health Center) assists parents in understanding the importance of oral health and linking children with dental care to address barriers to dental services such as transportation, ability of parents to miss work, ability to pay, and knowledge of services available. ODH will work with COMTREA to provide assistance and support as needed in the form of educational materials and handouts.

 

SHP will coordinate with ODH and other programs to provide evidence-based information, resources, and professional development to school nurses supporting them with best practices to educate children and parents about oral health concerns as well as promote the need for annual dental visits and regular preventative practices in oral health.

 

The ODH will continue to promote the use of dental sealants as an effective means to prevent decay on newly erupted molars and is actively seeking new partnerships to provide dental sealants in school-based clinics. ODH continues to work with two LPHAs and a dental health clinic to apply sealants in their clinics and at local schools. Through a grant not funded by Title V, ODH is also working with eleven LPHAs to apply fluoride varnish to the teeth of their high-risk children, mainly through their WIC programs.

 

The TEL-LINK Program will refer callers to dental clinics to increase awareness of community resources to access needed dental health services. The program will continue to provide outreach to the underserved population through effective marketing strategies.

 

The CCHC Program will continue to provide education and consultation to child care providers and health promotions to children on the importance of dental health and the related implications for overall health.

 

The MCH Services Program will support LPHA efforts to:

• provide education on the importance of adequate dental care and overall oral health;
• collaborate with partners to provide screening, referral and direct provision of preventive dental services for oral health needs; and
• increase the number of children, ages 1 to 17 years of age, receiving a preventive dental visit in the last year.

 

• The MCH Services Program will continue to contract with a total of eight LPHAs that selected enhancing access to oral health care services for children as the Priority Health Issue for their FFY 2022-2026 MCH Services contract work plan. Planned contract work plan activities include: Iron and Ripley County Health Department plan to partner with the Missouri Oral Health Preventative Services Program to provide fluoride varnish treatments to children.
• Audrain County Health Department plans to make dental services available to children within the health department collaborating with local dentists.

 

Other strategies for the year include providing education to the public, city officials, dental and medical professionals, and public health authorities about the safety and effectiveness of community water fluoridation for the prevention of dental caries. The ODH also continues to improve the Missouri Oral Health Surveillance System to include updated fact sheets on topics of interest and regional reports compiling oral health statistics and related information.

 

Through a grant not funded by Title V, ODH is contracting with two dental clinics and one dental hygiene school to bring a dentist and dental hygienists to provide teledentistry services to schools, targeting the counties with very few or no dentists. This will provide dental services to children who may not have access to those services due to a lack of dental providers in their area.

 

The ODH’s Five-Year State Oral Health Plan was finalized and disseminated and is still a subject of ongoing communication with its partners.

 

ODH will continue its efforts to:

• Increase access to dental care by providing education about the importance of maintaining the adult dental benefit among MO HealthNet recipients. Information is distributed to policymakers, dental providers, leaders, and oral health stakeholders via the DHSS website and partners like the Missouri Coalition for Oral Health and Missouri Dental Association;
• Contract with the MPCA to provide education and technical assistance to State Dental Directors from all FQHCs in Missouri. The MPCA also assists ODH with distributing educational materials regarding the importance of a Dental Health Home for everyone, particularly for pregnant women and children;
• Support the development of the oral health workforce in Missouri through collaborations with the DHSS Office of Rural Health and Primary Care on incentive programs for dental professionals’; and
• Implement the “referrals” portion of the Preventive Services Program (PSP), which links children with an identified dental need to local dental providers. This is coordinated through school nurses and other local champions.

 

Other Title V Program Activities Related to the Child Health Domain

 

Developmental Screening

The CCHC Program will continue to provide training and consultation to child care providers around health and safety topics, including social/emotional/physical development.

 

Inclusion Specialists will provide parents with listings of child care providers, based on the geographical location requested by the parent, so that parents can choose child care that will meet the needs of their child. Enrolling a child in a program that is prepared to meet the needs of that child will increase the likelihood of maintaining placement, which will support the educational needs of the child. Inclusion Specialists provide onsite consultation to assist child care providers and develop adaptations and strategies to include the child with special needs in everyday classroom activities. They will assist in setting achievable goals for the child’s ongoing development. Inclusion Specialists deliver group training to better increase the knowledge base of child care providers in Missouri on how to include children with special needs. Lastly, through the addition of a social-emotional learning project, specialists also deliver research-based training to child care professionals to help them understand how children develop socially and emotionally, as well as research-based intervention strategies on how they can foster social-emotional development in real, practical ways.

 

Vision for Children at Risk (VCR), a non-profit organization in St. Louis City, has brought together a wide group of stakeholders in the early childhood realm in St. Louis who are committed to early childhood development and early interventions. Through this work, LEAP (Learning Everything at Pace) Ahead St. Louis provides families access to early developmental screening and treatment for delays for their children. LEAP Ahead St. Louis is focused on the importance of early identification of developmental delays through increased screening, with particular focus on the social and emotional development of the most at risk, underserved children and families in the region. The long term goal is to create a regional data hub that allows for sharing and tracking of screening data, and create a system for coordinated resource referrals between agencies. The Early Childhood Program Coordinator continues to maintain communication and work with VCR to support this work.

 

The Boone County Early Childhood Coalition is using the Survey of Wellbeing of Young Children (SWYC) and an online screening hub to increase social and emotional screening in Boone County. The tool is available for free online to parents and child care providers. The screening hub is accessible to the parents and providers and will track the child’s development. Children who are found to need additional screening or assessment will be referred to partner organizations. The Early Childhood Program Coordinator will continue to monitor their progress and watch for opportunities for impact at the state level.

 

The Early Childhood Program Coordinator will maintain communication with multiple early childhood collaboratives across the state. Each of these groups is working to support early childhood development and education. As opportunities are shared, information will be reviewed for statewide impact.

 

The Home Visiting Program’s contracted home visitors will use the Ages and Stages Questionnaire®- 3 (ASQ-3) screen tool to identify children’s developmental needs. Home visitors will provide referrals for children who score below the cut-off points indicating a need for additional developmental information and activities, community supports, or early intervention services through Missouri First Steps or Early Childhood Special Education to contribute to improved school readiness. Annual performance measure data will be collected on the percentage of ASQ-3 developmental screenings conducted at the specified time points of 9, 18, and 30 months of age. Annual performance measure data will also be collected on the percentage of completed referrals for children who score below the cut-off points of the ASQ-3.

 

Additionally, the Home Visiting Program’s contracted home visitors will continue its best practice to screen all children of enrolled participants, birth to kindergarten entry, for social-emotional development using the Ages and Stages Questionnaire®: Social Emotional (ASQ:SE-2). Home Visitors will provide developmental activities for parents/children who score in the “monitoring” range and will assist families in accessing services as appropriate. These screenings will continue in FY22.

 

The Home Visiting Program will provide all contracted home visitors with education on childhood mental health conditions and warning signs through a variety of communications including postings within the Missouri Home Visiting Gateway resources and weekly updates, located on the Home Visiting Program’s web-based data collection system platform, and during annual professional development events.

 

The Newborn Health Program will partner with a wide variety of community health providers to distribute Pregnancy and Beyond as well as other educational materials that provide information on developmental screening. The program will track the distribution of these materials and obtain feedback from its partners on how the materials were used and ways to improve the materials.

 

The Missouri WIC Program is implementing the public awareness campaign “Talking is Teaching: Talk, Read, Sing” to help parents recognize their ability to improve their children’s early brain and vocabulary development. Training was provided statewide to WIC agencies, home visitors, Head Start, Parents as Teachers, health care providers, libraries, and other community partners. Handouts were created to give caregivers tips on fun and easy ways to improve their child’s learning. Books developed by the Centers for Disease Control and Prevention (CDC) as part of the “Learn the Signs. Act Early.” (LTSAE) public health campaign were printed and the WIC program will continue to distribute materials to stakeholders to share with their families as part of their educational efforts.

 

The Missouri WIC program will continue to offer training and support to local agencies and community partners interested in implementing the WIC Developmental Milestones Program.

 

Participating agencies will use a set of age-appropriate developmental checklists, based on the Centers for Disease Control and Prevention (CDC) “Learn the Signs. Act Early.” (LTSAE) public health campaign, to increase parents’ awareness of developmental milestones and to promote the early identification of potential developmental delay. Local agencies will refer participants for screening and early intervention services to primary care physicians or IDEA diagnostics programs, known in Missouri as First Steps (0-3 years of age) and Early Childhood Special Education (3-5 years). Local agencies may also refer their participants to ParentLink, an affiliate of Help Me Grow National Center, for validated screening and connection to intervention programs. Data reports from the Missouri WIC MIS system on referrals and follow-ups will be available for the first time in FY 2022. These reports will be used to assess the program’s effectiveness in providing referrals and access to early intervention programs. Technical assistance from DHSS will be available to all current participating agencies to improve program effectiveness.

 

DHSS will support participating entities by providing education and promotional items, including printed materials such as the developmental checklists and the Amazing Me books developed by the CDC. For FY 2022, the Missouri WIC program will consider promotional materials that will assist parents in assessing their child’s development such as feeding utensils. These resources will be available for WIC agencies as well as internal and external stakeholders as part of providing educational support and promotion of early identification of potential developmental delays. Monthly updates on various child development topics will be posted on the Missouri WIC webpage to provide education and support to local agencies.

 

Efforts by the Missouri WIC program to recruit non-participating local agencies and external partners to implement the WIC Developmental Milestones Program will continue in FY 2022. Training and support will be provided to local agencies interested in implementing the program, including the language component, Talking is Teaching: Talk, Read, Sing. Implementation training developed by the CDC will be used to onboard new local agencies enrolling in the program. Agencies will also be required to complete the Association of Public Health Nutritionist (ASPHN) “Introduction to Child Development” training for WIC staff. The Missouri WIC Facebook page will host monthly posts to promote the program to local agencies and the public. Results from a FY 2021 local agency survey will be used to determine current program participation rates, clinic activities, and training needs from participating agencies, as well as gather data on program interest from agencies not currently enrolled. Feedback from agencies not currently enrolled in the program will be used to design future promotional activities.

DHSS will continue to collaborate with local and nationwide partners in the promotion of developmental milestones and identification of educational resources for parents and health care providers. Collaborations with CDC, ASPHN, ParentLink, and Wichealth will continue in FY 2022.

 

The Department of Elementary and Secondary Education, through its newly created Office of Early Childhood, is developing an early childhood system that is family friendly and ensures every young child receives services needed. The work undertaken by this new Office includes the development of an Early Childhood Integrated Data System, the development of a virtual hub for all families with children ages 0-5, and the development of regional hubs across the state. This work builds off work of the Early Childhood Comprehensive System (ECCS) that was led by DHSS for several years. A new grant, “ECCS Health Integration: Prenatal to 3 Program,” in the amount of $255,600 per year for each of the next 5 years, will be awarded to Missouri in August 2021. This funding will support the ECCS Program in leading the first integration of health needs, resources, and systems into the existing Statewide Early Care and Education (ECE) Strategic Plan and will build on current collaborative efforts to increase the impact for the prenatal to three population.

 

The MCH Services Program will support LPHA efforts to:

• provide infant and early childhood developmental and social-emotional screening services;
• provide developmental screening for children one to three years of age enrolled in LPHA home visiting programs;
• participate in preschool and pre-Kindergarten screening;
• provide direct school-health services, including developmental screening; and
• refer infants and children with potential developmental delay or failure to meet expected developmental milestones.

 

The Childhood Lead Poisoning Prevention Program (CLPPP) will support Title V strategies by actively providing information about the potential harmful cognitive and developmental effects that may occur following a child’s blood lead level elevations. Information will be provided to:

• the general public;
• health care providers, such as obstetricians;
• LPHA and health plan lead clinical case managers;
• WIC staff;
• Foster Care placement families;
• Asthma Program participants;
• Newborn Home Visiting Program families;
• Department of Elementary and Secondary Education (DESE) staff, including school nurses, Parents As Teachers (PAT), Head Start, and Early Intervention/First Steps staff and
• parents of children with elevated blood lead levels.

 

CLPPP will provide information about:

• what substances and environments are likely to be lead exposure sources;
• the need for and ways to avoid/remove/prevent a child’s exposure to environments or substances with lead in them;
• the need for blood lead testing of children under the age of 6 years per current Centers for Disease Control and American Academy of Pediatricians recommendations;
• Medicaid testing requirements;
• the recommended environmental and clinical follow up of children with elevated blood lead levels; and
• the recommended tracking of blood lead testing; and
• extended developmental monitoring of children with elevated blood lead levels.

 

Missouri will continue to support and improve coordinated systems of care to address the needs of maternal, infant, and child populations that are at risk for or experience exposure to lead. There is a strong partnership between Missouri’s Title V Program and the CLPPP activities, which enhances the impact that the programs can make.