III.E.2.c. Child Health: Application Year (10/1/2023-9/30/2024)

State Priority Need:

Reduce preventable deaths in the MCH population with a focus on reduction and elimination of inequities in mortality rates.

National Performance Measure (2020 - 2025):

NPM7.1: Rate of hospitalization for non-fatal injury per 100,000 children, ages 0 through 9 and adolescents ages 10 through 19.

Evidence-Based/Informed Strategy Measure (2020 - 2025):   

ESM 7.1.1: Percent of sites operating mobile fitting and car seat inspection stations to make sure car seats are properly installed.

ESM 7.1.2: Percent of child deaths reviewed by Child Fatality Review Teams.

MCH plans to continue partnership with the division of Trauma and Injury Prevention (TIP) and Fatality Review and Prevention (FRP) to implement programming, reviews, and education to decreasing the rate of hospitalization for non –fatal injury in children and youth.

Car Seat Safety

In the first half of life, more Americans die from injuries and violence than from any other cause. Injuries are the leading cause of death among children. In the most recent data aggregated by TIP, traumatic brain injury and struck-by incidents are the top reasons for emergency department visits in Indiana.  Motor vehicle crashes continue to be one of the leading causes of death and The Indiana Department of Health’s Division of Trauma and Injury Prevention continues to lead efforts throughout the state promoting car seat use via access and education.

Title V funds have historically supported car seat allocation for car seat safety stations, where they are distributed to families receiving financial assistance. TIP plans to shift the focus from car seat safety stations to hospitals due to the growing need for car seats during hospital discharge. Several hospitals have requested car seats for mothers and newborns without the means or access to a car seat upon departure. Increased number of inpatients, especially immigrants who need access to car seats and cribs, have placed a significant strain on the inpatient newborn team to sustain the needs of their patients. Furthermore, barriers to attending car seat safety stations, such as lack of car seat availability and having to be on a waitlist to make appointments, pose ongoing challenges for all parties involved. To streamline the processes that connect caregivers to car seats and alleviate the burden of car seat provision on hospital staff, TIP will collaborate with Indiana Criminal Justice Institute (ICJI) to establish grants which initiate hospital car seat appropriations under the following conditions:

• Hospitals must at least have 1 Child Passenger Seat Technician (CPST) on staff to install and educate patients on distributed restraints.
• The child must be present at the time of car seat distribution.
• All inspections and seats distributed must be entered into the National Digital Car Seat Form and listing Title V as the funding source.
• Hospitals must be operational at least 10 hours/month offering appointments to caregivers and the community.
• Hospitals will be listed on National Highway Traffic Safety Administration, ICJI and Automotive Safety Program Websites.

TIP will continue the CPST reimbursement program to increase the number of technicians around the state. This program reduces the financial burden placed on partner agencies to maintain certifications among their staff. Participating individuals will be reimbursed $200, which funds course, travel, and lodging expenses. In addition to hospital and car seat technician support, TIP will continue the Booster Bash program. TIP will supply booster seats to local distribution events, where certified technicians will educate families on proper installation. This program is crucial because there has been a steady decline in families obtaining booster seats over the last few years. Notably, it has been shown that parents tend to graduate children to seat belts prematurely emphasizing the importance of booster seats of promoting and providing booster seats.

The Injury Prevention Program Coordinator plans to continue a constant network of communication and engagement with other stakeholders in the local community such as Healthy Families Indiana, Head Start Indiana and Indiana Department of Child services that directly work with families with young children. TIP plans to officially collaborate with Healthy Families Marion County to pilot a partnership where TIP will begin shipping car restraints to their staff to be distributed to their clients. As home visitation services close the gap between busy families and preventative information and resources, this initiative will serve families who may not have the capacity or transportation means to attend a traditional car seat safety station. Home visitation staff are trusted messengers for their clients and already provide extensive information to promote supportive environments for families. Thus, plans are underway to support Healthy Families sites by waiving the cost of training staff to become technicians through CPST reimbursement program and child passenger liaisons for families.

Additional activities of the TIP coordinator will continue to include working with local injury prevention coordinators around the state, providing them with technical assistance on their various projects, events, and activities, participating in coalitions and work groups, attending local and national conferences as a representative of Indiana, and promoting social media material; and sharing information with partners and Centers for Disease Control and Prevention.

Effective interventions and initiatives are in place to promote child passenger safety, but increased funding and staff capacity are necessary to expand efforts to additional injury prevention areas. TIP is hoping to secure additional funding to expand staff and programming capacity as there is currently one program coordinator dedicated to injury prevention. There have been several recognized high priority areas such as traumatic brain injury, firearm violence prevention, water safety, and poisoning prevention. The need to strengthen existing evaluation and tracking efforts reinforces the need for additional support.

Child Fatality Review

Fatality review is a critical public health process to examine the circumstances and risk factors associated with unexpected child deaths and ultimately leads to recommendations on how to best prevent future deaths from occurring. Legislation enacted in 2013, IC 16-49, required multidisciplinary child fatality review (CFR) teams to be implemented at the local level, with coordination and support to be provided by IDOH. These teams are required to review all deaths of children under the age of 18 years that are sudden, unexpected, or unexplained. All deaths are assessed by the Indiana Department of Child Services (DCS), in addition all deaths that are determined to be the result of homicide, suicide, accident, or are undetermined. The teams are required to submit an annual report to the IDOH Division of Fatality Review and Prevention (FRP) summarizing the child fatality reviews completed, identified needs, risk factors and prevention action recommendations made. Information from the local reports is included in a mandated annual report to the Indiana legislature. 

Fatality Review and Prevention (FRP) staff will continue to provide ongoing guidance, training, and technical assistance to Child Fatality Review (CFR) Teams across Indiana. There are currently 67 local CFR teams covering all 92 counties across Indiana. In the next reporting period, FRP has the goal of completing 90% of reviews for deaths that meet the inclusion criteria. As an unfunded mandate in Indiana, local communities remain challenged by the tasks associated with CFR and the requisite data entry. This network of volunteers contributes their time to gathering records, preparing cases for review, facilitating meetings, and completing data entry of cases. The overwhelming request for FRP by local CFR teams is increased training opportunities. FRP works closely with CFR teams and attends all review meetings throughout the state, providing guidance to ensure teams are completing effective reviews, identifying, risk factors and disparities in their communities, providing support and technical assistance to accurately classify child fatality, and ensuring recommendations made by the CFR team are being communicated to the local Community Action Team (CAT) or prevention coalition for prevention actions to be taken. In communities where a local CAT or a prevention group is not present, FRP staff will continue to work closely with the members of the CFR team and community members to help identify child fatality trends. FRP will continue to introduce prevention initiatives in local communities and assist in providing resources for child injury and prevention action.

FRP will continue to contact and offer support to CFR teams via phone calls, emails, virtual visits, virtual meetings and in-person meetings. FRP staff will also maintain efforts to assist teams with identifying cases, providing data, providing effective review training to teams and support throughout the state. FRP also plans to upkeep engagement efforts with teams to complete timely, effective, and accurate reviews, along with improving recommendations and prevention actions in their communities. FRP will also continue to train CFR team members on the data entry process and the importance of the accuracy of records gathered and information entered.

FRP will maintain partnerships with DCS to ensure all local CFR teams have timely notifications of child fatalities occurring in their jurisdictions. In doing so, CFR teams will be able to strive for timely reviews with complete and accurate data collection and entry.  FRP will also follow up with local teams to offer support, resources, and technical assistance, as needed. CFR teams across the state continue to recognize and focus on ways to provide prevention action to reduce infant, child, and adolescent mortality in their communities.

FRP plans to provide technical assistance to existing CATs while forming new CATs in counties ready to implement prevention. CATs will continue to engage with a variety of stakeholders in the community to eliminate system gaps and barriers. CATs will continue to use data from FRP epidemiologists to inform prevention efforts, while utilizing recommendations from local fatality reviews. Prevention efforts will include but not be limited to drowning, substance use, and fire safety. FRP community coordinators will continue to foster a network with first responders statewide, providing trainings when necessary.

Sudden Unexpected Infant Death (SUID)/Sudden Death in the Young (SDY)

The Sudden Unexpected Infant Death (SUID)/Sudden Death in the Young (SDY) Case Registry is also a program of FRP. This program addresses adolescent health by conducting in-depth reviews of children who die suddenly and unexpectedly, often as a result of undiagnosed genetic conditions. The SUID/SDY Case Registry plans to review deaths of adolescents and offer no-cost genetic testing to the families and living siblings. In 2024, this program will begin implementing primary and secondary prevention strategies throughout the state by providing Automatic External Defibrillators (AEDs) to schools. In addition, thorough training will be administered to school staff on how to use and maintain this equipment. The SUID/SDY Case Registry will also partner with local foundations to provide low-cost heart screenings to children and young adults in Indiana.

In May 2023, Senate Bill 369 was passed in Indiana. This legislation requires AEDs to be present and accessible within three minutes of any school activity. Schools are also required to create action plans with training and drills so that individuals are aware of an AEDs location and how to use them properly. This legislation, which takes effect on July 1, 2023, was a grassroots effort led by families of children who died suddenly and unexpectedly during athletics on school grounds. However, the legislation does not provide funding for schools to put these life-saving prevention measures into place. FRP will provide support to the implementation of this new legislation that will benefit adolescents living with potentially undiagnosed congenital heart defects and children and young adults who may be affected by sudden cardiac arrest.

Suicide and Overdose Fatality Review

The Suicide and Overdose Fatality Review Program (SOFR) within FRP leads two state-level pediatric suicide fatality review teams. Currently, one team is reviewing all deaths among youth ages 18 years and younger that occurred in Indiana in 2021. The second team is reviewing all youth suicide deaths that occurred in 2020. By September 30, 2024, all 2021 and 2020 cases will have been reviewed. Information gathered will be translated into formats (presentations, factsheets, etc.) that are appropriate for various internal and external stakeholders. Recommendations from the pediatric suicide review teams are shared with internal partners at the IDOH as well as local fatality review teams.

Once 2021 and 2020 reviews are complete, SOFR will restructure the pediatric suicide review team. One team will work to review any cases not already covered by local CFR teams. The other team will serve as a working group, inclusive of local and state representatives from education, mental health treatment, public health, suicide prevention coalitions, government, law enforcement, child welfare, medicine, and pathology backgrounds, to advise and support the implementation of youth suicide prevention recommendations.

Currently, FRP and MCH staff are collaborating to develop a comprehensive youth suicide report, which will contain findings from local SOFR teams, Youth Behavior Risk Survey results, and hospital-based suicide attempt data. Additional pediatric suicide fatality review findings will be added to future reports.

SOFR also plans to continue to expand throughout the state, with the goal of coverage in all 92 Indiana counties. There are currently 31 local SOFR teams covering 32 counties in Indiana.

Handle with Care

FRP continues to identify opportunities to increase collaboration among communities to enhance capacities for resilience and protective factors, mitigating potential outcomes associated with adverse childhood experiences (ACEs). FRP leads the Handle with Care (HWC) initiative, continuing to expand programming to communities across the state. HWC is a collaborative approach identifying at-risk children at the scene of potentially traumatic incidences, providing a “heads up” to the child’s school to better support the child through a trauma-sensitive environment. Law enforcement and other first responders are trained to provide trauma-informed support on scene where EMS, fire, or law enforcement respond when a child is present. When present, a confidential notification including the child’s name, age, and the words, “Handle with Care” is sent to the child’s school to provide a “heads up” that they may need additional supports during school and to provide trauma-sensitive support, as needed. This notification is distributed to staff who may encounter the child the next day to ensure they are watching for atypical behavior from the student and can respond appropriately. The notification system is designed to be discrete and does not include incident-level information to reduce any bias in potential responses provided due to knowledge of an incident. School staff are trained to provide trauma-informed support as needed and to not ask questions or try to gather information about the event. If school-based interventions are not enough, the school will connect the student and their family to mental health services.

 

In 2021, FRP received a federal grant through the Office of Victims of Crime (OVC) to support the program’s implementation within two Indiana counties. Since the adoption of the program in Indiana in 2021, HWC has spread to nine counties including 27 school districts. Current efforts to expand HWC are occurring in an additional 19 counties with two counties expected to begin receiving notifications by the start of the 2023-2024 school year. FPR continues to support each county through technical assistance and training, ensuring each school district implementing the program is adequately positioned to begin receiving HWC notifications and responding appropriately without causing further harm for children exposed to trauma. Funding through the OVC solicitation will expire in September 2023. FRP continues to identify additional funding opportunities to support the program’s implementation, as well as to build a trauma-informed framework for the state to further support children and their families. FRP and MCH collectively applied for a CDC ACE’s and Resilience grant to continue this work and build trauma-informed communities.

In order to adequately support HWC implementation, a trauma-informed framework is necessary for a community-wide approach to supporting children exposed to trauma. FRP has begun to explore opportunities for collaboration both at the state and local levels to implement a trauma-informed framework. In addition to these efforts, FRP has recognized the need for trauma-informed law enforcement training, as well as establishing equitable pathways for children and their families who have been exposed to trauma. Securing additional funding will be necessary to continue to provide state-level support in building a trauma-informed framework to address individual community capacity to support children exposed to trauma.

 

State Priority Need:

Promote Physical Activity through policy improvements and changes to the built environment.

National Performance Measure (2020 - 2025):

NPM 8.1: Percent of children, ages 6 through 11, who are physically active at least 60 minutes per day.

Evidence Based/Informed Strategy Measure (2020 - 2025): 

ESM8.1: Number of schools participating in an activity (training, professional development, policy development, technical assistance, PA in-school programming, PA before and after school programming) to improve physical activity among children (6-11).

ESM8.1.2: Percent of children ages 6-11 impacted by improvements to the built environment.

 

Physical Activity is still a main concern identified in Teens in Indiana. To make the biggest impact, MCH plans to continue to partner with the Division of Nutrition and Physical Activity (DNPA) who has been primarily responsible for implementing strategies to increase physical activity in youth, ages 6 - 11.

 

Physical Activity Minutes

DNPA plans to support Playworks in conducting at least two types of training opportunities:

• Two trainings (TBD) at Vigo County School Corporation
• Team Up Program (at five elementary schools: Crooked Creek, Winchester Village, Abraham Lincoln, Clinton Young, and Brookview)
• Recess Reboot (Northhaven Elementary School): four-day on-site training
• Trainings (TBD and number of training(s) TBD) at Boys and Girls Club of Morgan County

Each program listed produces at least 30 minutes of physical activity instruction daily.

GOAL University

The DNPA will contract with GOAL University to continue offering healthy lifestyles afterschool programming (physical activity and nutrition education) in southern Indiana rural counties. The tentative plan is to partner with school corporations in Monroe County (Monroe County Community School Corporation and Richland Bean Blossom School Corporation), Owen (Spencer-Owen School Corporation), Greene (Bloomfield School District), and Lawrence (North Lawrence Community Schools) Counties, with a goal to expand to Morgan and Brown Counties. Developing new and sustaining partnerships with school corporations, healthcare providers and youth-serving agencies will become a responsibility of the GOAL University Program. Another goal is to partner with Vincennes University instructors and students so GOAL University can be implemented in Dubois and/or Orange Counties.

 

Physical Activity Minutes

While the time varied slightly each week due to the unique lesson plans, students typically spend about 30 minutes (of the 60-minute program) being physically active. The breakdown of a weekly program is below:

• Goal Setting and Checking: 10 minutes (sedentary)
• Nutrition Lesson: 25 minutes (15 minutes sedentary, 10 minutes active)
• Physical Activity Lesson: 25 minutes (5 minutes sedentary, 20 minutes active)

Community Mini-Grants

The DNPA will support four community mini grants serving youth and adolescents, ages 6-11. The programs that these community mini grants supported, ranged from classroom specific to community wide initiatives and provide schools, educators, and students the resources to be physically active both in and out of school. The DNPA will provide the opportunity for each entity to continue their program throughout the 2023-2024 year.

 

Below is the potential reach of each program serving ages 6-11.

• Judah Ministries:
  • Potential Reach: 120 youth and adolescents; ages 6-12 years of age
  • Program: Provide 8-10 swimming lessons through Summer Enrichment Program (classes will be 45-60 minutes in duration) at local YMCA and Indy Parks and Recreation pools.

 

• Garrett Keyser-Butler Schools:
  • Potential Reach: 10-15 (Girls on the Run); 80 for yoga and mindfulness; 20-30 for skate and bike club; grades 1st-8th
  • Program: Provide Girls on the Run Program; yoga and mindfulness programming, and afterschool skate and bike club
     
• YMCA of Portage Township:
  • Potential Reach: 500 youth and adolescents; ages 6-17
  • Program: Provide swim lessons, basketball, kickball, SEL activities, and sensory camps for youth and adolescents with autism.
     
• North Side Elementary School:
  • Potential Reach: 60 students in grades Kindergarten-1st
  • Program: Provide 12-week All Kids Bike program (four sessions with roughly 18-20 students in each session).
     
• Firefly Children and Family Alliance:
  • Potential Reach: 325 youth and adolescents; ages 6-17
    Program: Expand 3BFit yoga programming and provide new boxing program for the youth and adolescents residing in two Firefly Children and Family Alliance shelters located in Marion County.

Current Activities

Through staff time funded by Title V, the DNPA has created the Project AWARE Goes to the Park Grant. This state-level grant is funded by the federal Project AWARE Grant awarded to the Indiana Department of Education by the Substance Abuse and Mental Health Services Administration (SAMHSA). The Project AWARE Goes to the Park Grant offers funding and technical assistance to community organizations to promote youth mental health in natural environments, such as parks. Four grantees will be conducting unique youth summer programs that incorporate both mental health programming and opportunities for physical activity in outdoor settings. Four other grantees will provide professional development opportunities to their staff related to mental health that will help incorporate mental health programming into their regular interactions with school-aged youth. Three grantees will provide both youth programs and staff professional development.

 

Wellness Policies

The DNPA will offer a free opportunity for school corporations and charter schools to submit their school wellness policy for DNPA’s Child Wellness Coordinator and Youth Physical Activity Coordinator for review. They will utilize the WellSAT 3.0 Quantitative Assessment Tool to score and provide an in-depth feedback letter including strengths and suggested ways to improve their wellness policy language.

 

Schools Mini Grants

The DNPA will support 4 school mini grants through the Healthy Schools Grant Program, a three-year grant that will fund programs that improve student physical activity minutes and nutrition.

• Circle City Prep (charter school)
  • Maximum reach: 262 students in grades 1-6
  • Program: Will be improving physical activity during recess and physical education classes by purchasing supplies and a PE curriculum. Will also be assessing school meal participation to both improve participation and reduce food waste.
• Culver Community School Corporation
  • Maximum reach: 342 students in grades 1-6
  • Program: Will expand their current district garden and incorporate produce into the cafeteria and backpack program for underserved students. Will also create a Minds in Motion space where elementary students can participate in physical activity breaks during the school day.
• Metropolitan School District of Pike Township
  • Maximum reach: 4,637 students in grades 1-6
  • Program: Will implement a running club at each elementary school in the district and an end-of-year walk/run celebration event for students, families, and staff.
• Vigo County School Corporation
  • Maximum reach: 6,316 students in grades 1-6
  • Program: Will expand the current after-school physical activity club (Move Crew) to three new elementary schools and will host a district-wide Fun Run festival for elementary students, their families, and community partners.
• Western Wayne Schools
  • Maximum reach: 295 students in grades 1-6
  • Program: Will implement an online ordering system where a healthy snack and physical activity can be ordered for classroom celebrations.

Professional Development Trainings
The DNPA provides professional development (PD) trainings to all K-12 physical education (PE) teachers and before and after school professionals in the state of Indiana. For 2023 PD trainings, the DNPA will contract with PL3Y, Inc to offer four one-day PD trainings in Terre Haute, Indianapolis, Fort Wayne, and South Bend in September. Each PL3Y, Inc. training will focus exploring new games that develop fundamental movement skills and learn about Teaching Games for Understanding (TGfU), a student-centered approach that develops decision-making and skill acquisition through game-based activities. Participants will discover the benefits of mindfulness and learn practical strategies to promote focus and well-being through dance, brain breaks, indoor recess activities, and more. The goal of each training is to leave participants empowered with practical ideas to improve physical activity and physical literacy in the youth and adolescents they serve.

 

Built environment strategies.

Changes to the Built Environment: The Tactical Urbanism Grant Program

IDOH will continue to grant funds to organizations implementing pedestrian safety measures demonstrating the ability to create safer, healthier neighborhoods by promoting activity-friendly routes for biking and walking to everyday destinations for children and adults. Grantees are selected by a competitive application process with grant amounts up to $10,000. Grant projects include new pedestrian crosswalks, traffic calming installations, traffic speed reduction improvements, and a tactical urbanism guidebook for Indiana communities. The following grantees were awarded Tactical Urbanism Demonstration Grants in 2023 spanning from May – September. Additional communities will be funded from May – September 2024.

Current Activities for Tactical Urbanism:

Nora Neighborhood Alliance: City of Indianapolis, MSD Washington Township

This tactical urbanism demonstration project will improve safe walking and bicycling for children and adults accessing nearby schools, shopping, and other destinations crossing 86th Street on the Monon Trail in the Nora neighborhood in Indianapolis. The project will include traffic calming and pedestrian safety countermeasure demonstration projects at the existing Monon Trail crossing to slow traffic and increase safety. Two fatalities of trail users crossing 86th Street have occurred at this location in the last year, creating a clear need for demonstrating safety measures at this intersection.

Reach: 4,604 Children ages 6-11

Michiana Area Council of Governments: South Bend Community School Corporation

The project will include the preparation of an Indiana tactical urbanism project guidebook that addresses best practices for implementing demonstration projects in urban and rural areas. The guidebook will help to further reduce barriers to implementing tactical urbanism projects, particularly in underserved rural communities, creating safe access for walking and bicycling to everyday destinations for children and adults. It is anticipated that the grantee will utilize the completed guidebook to implement at least six tactical urbanism projects in the summer of 2024 within the north-central Indiana region.

Reach: 6,540 children ages 6-11

Changes in the Built Environment to Promote Physical Activity

Title V funding will be used to promote increased levels of physical activity at the community level through changes to the built environment. IDOH will provide funding to communities to hire consultants to prepare community-wide bicycle and pedestrian master plans to help create safe routes to everyday destinations for walking and bicycling. Technical assistance will also be provided to stakeholders and Purdue Extension Community Wellness Coordinators at the local, regional, and state level to identify opportunities to make changes to the built environment supporting physical activity. Technical assistance activities include providing guidance to stakeholders for the planning and installation of multi-use trails, safe pedestrian crossings, bikeways, safe routes to schools and parks, and complete streets. This work will enable children ages 6-11 to walk and bicycle to school or the library safely while also getting in their recommended amount of physical activity.

Current Activities for Bike/Pedestrian Planning:

City of La Porte: La Porte Community School Corporation

The grantee will hire a consultant to help the city to prepare a Trails, Greenways, and Blueways Master Plan that will contribute to achieving the community's vision by identifying specific streetscape enhancements that prioritize safety and ease of non-motorized transportation. The Plan will also identify opportunities to enhance the Blueways network connections between each public waterbody and the trails network. The plan will identify opportunities for walking and bicycling connectivity to everyday destinations for children and adults to entertainment, retail, public institutions, recreational areas, and downtown. The main goal of the Plan is to allow safe movement and access to healthy transportation options throughout the city.

Reach: 2,639 Children ages 6-11

 

Eskenazi Health Indianapolis: Indianapolis Public School Corporation

The grantee will prepare a “small area or neighborhood plan" in Indianapolis that promotes walking and bicycling for children and adults to everyday destinations such as schools, parks, and shopping to include a focus on Creating Safe Routes in three neighborhoods that contain Eskenazi Health Centers. The proposed project and planning effort will highlight opportunities to connect safe routes and trails more directly to health center sites. This planning effort will enhance both safe access to healthcare and facilitate programming opportunities such as Eskenazi Health Wellness Walks that encourage physical exercise. The planning effort is part of the Health Equity Zone initiative, in which Eskenazi Health will conduct in depth community engagement, facilitating focus groups with staff, patients, and neighborhood resident leaders. This outreach will be complemented by Eskenazi Health’s Community Health Workers and Community Weavers, a newly created role that connects community partners to each health center location.

Reach:  10,737 children ages 6-11

 

State Priority Need:

Access to High-quality, family-centered, trusted care is available to all Hoosiers.

State Performance Measure (2020 - 2025):

SPM 5: Promotion of optimal health, development, and well-being.

The creation of this State Performance Measures was a response to the needs identified in the 2020 needs assessment. While developmental screening (NPM6) is important to Indiana, the MCH team wanted to broaden the scope of the work to really include all the teams that are working with and alongside families to support their development in children with and without special healthcare needs. The work is done collaboratively among Help Me Grow Indiana, Early Hearing Detection and Intervention, Lead and Healthy Homes, Childrens Health, Genomics and Newborn Screening, and Children with Special Health Care Services teams. The work plan for this SPM is spread across this Children’s section and the CYSHCN section.

Project LAUNCH

In March of 2023, the Children’s Health program within MCH applied for the Linking Actions for Unmet Needs in Children’s Health (LAUNCH) grant through the Substance Abuse and Mental Health Services Administration (SAMHSA). MCH has received LAUNCH funding in the past, but through COVID-19 and staffing changes the funding was not continued. The purpose of LAUNCH is to promote the wellness of young children, from birth to 8 years of age, by addressing the social, emotional, cognitive, physical, and behavioral aspects of their development, as well as prepare them to thrive in school and beyond. In order to achieve this, MCH partnered with Marion County Commission on Youth (MCCOY), Indianapolis Public Schools (IPS), and IU Health Physicians (IUHP) to formulate multiple programs to reach children in the given age group.

Upon the receival of LAUNCH, IUHP will implement the Child-Adult Relationship Enhancement (CARE) model in clinical settings. CARE is a tiered approach to sustainably increase access to culturally and developmentally informed behavioral health interventions and resources. The CARE program is designed to provide immediate benefits and reduction in challenging behaviors and this shorter, easily accessible intervention will decrease wait times for families. Children spanning from birth to the age of five will benefit most from this program being implemented in clinical settings.

MCH also partnered with MCCOY and IPS to further expand a school-based community health worker (CHW) program that was previously piloted by MCCOY via Title V subgrantee funding. The CHW program has been extremely successful in serving school-aged children and their families in one IPS school in Marion County. The goal is to expand this program to more IPS schools across Marion County. The CHW program is used to target families that need additional support by providing community navigation, basic needs, healthcare resources, social emotional learning activities and educational events to build social capital across the school community.

In the next year, MCH hopes to continue to grow the Children’s Health program within MCH by receiving grant funding like project LAUNCH, collaborating with partners across the state, understanding early childhood development and the child welfare systems in Indiana, growing trauma-informed care systems amongst our schools and communities, and expanding access to and knowledge of resources for parents of children.

Genetic and Newborn Screening (GNBS)

Indiana’s GNBS program plans to update our patient status forms to improve data collection for short-term follow-up, referrals to services, and lost to follow-up. The newborn screening program wants to understand the barriers to follow-up. In order to better understand those barriers, we plan to add data fields to the current patient status forms. These forms are required to be submitted to the newborn screening program by our funded care coordination partners for any newborn referred to their clinic. The newborn screening program will analyze this data and make program improvements to better support families throughout the short-term follow-up process from abnormal screening results through confirmatory testing. The funded care coordination partners are also required to refer newborns diagnosed with a newborn screening condition to First Steps, Indiana’s early intervention services.

 

Early Hearing Detection and Intervention (EHDI)

In the next year, Indiana EHDI is coordinating with state stakeholders and organizations that serve DHH children to improve provider collaboration and communication between physicians, audiologists, early intervention specialists and school- based personnel. The goal is to develop a standard care coordination model for deaf and hard of hearing children in order to maximize outcomes.

EHDI also plans to  collaborate directly with Indiana First Steps to develop care coordination models for children with normal hearing, but speech and language delays to include hearing tests and for different types of permanent hearing loss. The goal is to improve First Steps service coordinators in best practice procedures for these children.

Help Me Grow - Indiana

Help Me Grow Indiana (HMG) has successfully provided Indiana families with free developmental screenings and resources for children ages 0-5 years, since its implementation in 2018. In the next reporting period, Help Me Grow Indiana (HMG) will move into the direction of expansion and increased access to developmental screenings for Indiana children. HMG Indiana will continue to work to improve the awareness and importance of early developmental screening, to improve developmental outcomes for Indiana children.

 

Indiana is currently recognized as a single-system state in reference to its Help Me Grow system, according to the Help Me Grow National Center. The one centralized access point (CAP), located in the Maternal & Child Health Division, at the Indiana Department of Health, is the hub of communication to HMG families. CAP provides confidential over the phone care coordination, online referral access, and resource/referral information to HMG families. The CAP is also the referral location for medical providers that refer their patients for additional care coordination.

Help Me Grow Indiana currently serves 9 pilot counties in Indiana, (Lake, LaPorte, St. Joseph, Elkhart, Delaware, Grant, Madison, Marion, & Scott counties). In 2023, HMG Indiana will expand its service counties by at least 50% of the current counties served. This measure has been suggested by Help Me Grow Nationals, 2022 Help Me Grow Annual Fidelity/Sustainability Assessment Summary, for HMG Indiana. An internal cohort within the Indiana Department of Health, will determine the counties that HMG Indiana will expand to, with the indication that an Early Childhood representative from each of those counties will collaborate with the internal cohort, to establish their respective county as a HMG partner. They will refer children and families needing developmental screenings, resources, referrals and providers to the CAP for HMG Indiana.

Help Me Grow Indiana, currently offers the Ages and Stages-3 Questionnaire (ASQ-3). The ASQ-3 is a cognitive screening, that provides a summary of a child’s development. The results are provided by a series of age-driven developmental questions, answered by the child’s guardian that focus on 5 developmental areas (communication, problem solving, personal-social, fine motor and gross motor skills). This is the only developmental screening provided by HMG Indiana and the one preferred by HMG National. To support the goal to increase developmental screenings for Indiana children, HMG Indiana will train HMG Care Coordinators and implement the Ages & Stages -Social Emotional Questionnaire (ASQ-SE), to its set of screenings provided. This will provide an additional aid for parents and guardians to advocate for the mental and developmental wellness of their young child. Both screenings will be provided confidentially over the phone, in-person at any of the Help Me Grow: Books, Balls and Blocks events, and soon through the Help Me Grow website and screening portal.

Help Me Grow Indiana, will continue to have a presence at annual community and school-based events throughout Indiana. This is also including two of the largest events in Indiana, the Indiana Black Expo &Indiana Minority Health Fair, and the Latino Expo. HMG Indiana’s ongoing partnership CDC’s Learn the Signs Act Early (LTSAE) initiative will continue to provide virtual trainings to Indiana early childhood providers, on the importance of milestone development, early developmental screening and referring to Help Me Grow Indiana.

Help Me Grow Indiana’s early childhood partnerships, expansion goals, and increased ability to provide screenings in 2023 and 2024, will provide the opportunity to improve the developmental outcomes and services for Indiana children.

Lead and Healthy Homes

The primary goals of IDOH Lead and Healthy Homes Division (LHH) is to track the prevalence of lead exposure in children throughout Indiana and to support local health departments and community partners in taking the necessary steps to promote primary prevention efforts to minimize that exposure and the resulting health risks. One way this is done is through performing risk assessments to identify lead hazards.

As LHH looks toward the future, 2023-2024 brings a new and increased focus on lead. This includes the potential to move forward on two key initiatives that will dramatically increase Indiana’s identification of and service to children with elevated blood lead levels (EBLL): lowering the EBLL threshold and requiring testing for all children, regardless of insurance type. Lowering the EBLL threshold will significantly increase the number of children eligible for holistic, local case management support and will provide families access to nursing and home inspection expertise at half the BLL required today. Standardizing blood lead testing for all children at an early age will provide parents and physicians with a more complete picture of a child’s health and ensure that we, as a state, are not missing or misdiagnosing a child affected by lead exposure. Both initiatives will require MCH, LHH, Local health departments, and healthcare providers to increase capacity and stretch in new, challenging, positive ways.

Oral Health

MCH plans to continue partnership with the two Title V funded organizations: Community Dental Clinic and Dunebrook. The programs will continue to increase and promote access to pediatric dentistry in their communities. MCH and CSHCS are also looking at how to better partner with the IDOH Oral Health Division as a new Division Director was appointed and looking to expand programming.

 

Commission on Improving the Status of Children

The Indiana Commission on Improving the Status of Children (CISC) sits under the Indiana Supreme Court and aims to study issues concerning vulnerable youth, review and make recommendations concerning legislation, and promote information sharing and best practices. Its mission is to improve the status of children in Indiana through systemic collaboration. Its vision is that every child in Indiana will have a safe and nurturing environment and be afforded opportunities to reach their full potential and live a healthy and productive life.

Kate Schedel, the MCH Programs Director was appointed as the Co-Chair of the Children’s Health and Safety Task Force in October 2021 and will continue to serve alongside her co-chair from the Department of Child Services for the upcoming year. The children’s commission works across state agencies on four strategic goals: health and safety, mental health and addiction services, educational outcomes, and justice-involved youth outcomes. The Commission adopted a new strategic plan that will be in place from 2023 – 2025. Of note and alignment with Title V are goals related to increasing support for families with children, increasing housing stability for families, increasing access to early intervention, and promoting healthy teen relationships preventing unplanned pregnancies and reducing sexual victimization. The Commission and its partners will continue to work on these issues over the next year with partners statewide.

New Children’s Health Lead

In October 2022, IDOH’s Title V Coordinator transitioned into the Children’s Health Administrator. Olivia Clark, MPH, brings a wealth of experience from her studies at IUPUI and her work as a home visitor through Healthy Families Indiana. Olivia is tasked with the overall strategy for children’s health. She is currently leading the Children and Adolescent Health Innovation Team. Since the role was vacant in the middle of the pandemic, Olivia will be tasked with finding what exists and where there are gaps in children’s health needs alongside our many state agencies and external partners in the field.