Child Health Domain

FY20 Application

 

 

The FY20 workplan for the Child Health Domain includes the following performance measures:

 

1. Oral Health
2. Injury Hospitalization
3. Early and Continuous Screening - Developmental Screening

 

Bethany Geldmaker, PhD (Early Child Health Consultant) currently serves as the Title V Child Health Domain Lead.

 

Leadership of Title V-funded efforts for child health is shared by the Division of Prevention and Health Promotion’s Dental Health Program and Injury and Violence Prevention Program and the Division of Child and Family Health’s Early Childhood Health Unit. These entities and their proposed activities for the upcoming grant period are detailed below.

 

 

 

Program Overview

 

The Division of Prevention and Health Promotion (DPHP)’s Dental Health Program is led by Tonya McRae Adiches, RDH (Dental Health Programs Manager).

 

A detailed overview is provided within the Women’s Health Domain application.

 

 

FY20 Action Plan Overview

 

Strategy: Continue to provide up to five health districts with direct service provider oral health trainings and dental provider trainings regarding ISHCN and very young children (a total of 10 trainings) and update the VDH online provider directory for dentists willing to treat ISHCN.

Domain: Child

 

 

With support for trainings from other federal sources, the MCH funded Individuals with Special Healthcare Needs (ISHCN) Oral Health Coordinator continues to provide trainings statewide to educate dental providers and care givers on oral care and treatment for ISHCN and very young children.  The overall goal of the program is to increase awareness and education regarding the oral health of ISHCN for a wide variety of stakeholders and providers that have the potential to make a difference in access to oral health care in this population. In FY20, the program will involve two approaches including providing oral health in-service trainings to direct service providers (DSPs) working in DBHDS licensed group homes for ISHCN and providing continuing education (CE) courses to dental providers regarding oral care of ISHCN. Both parts of the program will be completed in up to five separate health districts in the Commonwealth of Virginia.  Additionally, the online dentist directory for Commonwealth of Virginia dentists willing to see ISHCN and very young children (< 3 years) will continue to be maintained and updated on a monthly basis as new dentists are educated and added to the directory or contact information changes are requested by individual dentists.

 

 

Strategy: Integrate targeted adolescent oral health messaging into existing MCH-focused dental education programs to improve oral health for individuals across the lifespan.

Domain: Women/Maternal, Child, Adolescent

 

 

During FY19, VDH worked to increase access to care for pregnant women and young children through the Federal Perinatal and Infant Oral Health Quality Improvement Grant.  While this work was impactful, there remains a need to continue successful activities related to perinatal oral health and to integrate educational initiatives into the program that also target adolescents.  During FY20, through the work of a dedicated MCH-funded Maternal, Infant, and Adolescent Oral Health Consultant, VDH will continue to rely on a proven remote supervision dental hygienist model to integrate dental services and education into primary care settings; to support home visitors, community health workers and other client support workers in educating their clients on the benefits of oral health and to coordinate oral care; to collaborate with key partners and local stakeholders to maximize reach and effectiveness of oral health messaging; and to training dental and non-dental professionals on the importance of oral health care for overall wellness with the goal of improving access to oral health care for pregnant women and infants who are most at risk for dental disease.  In addition, VDH will develop new programming specifically aimed at advancing the oral health of adolescents.  This will include updating the 2009 School-aged Oral Health Curriculum to include emerging topics for adolescents including vaping, and HPV exposure and vaccination. 

 

 

Strategy: Continue to foster a network of 6 regional Oral Health Alliances to conduct regional needs assessments and implement systems change and data-sharing initiatives to improve the oral health of all Virginians, with emphasis on pregnant women, and children and adolescents aged 1-17.

Domain: Women/Maternal, Child, Adolescent

 

 

VDH will partner with the VaOHC to provide backbone support and facilitative leadership training to 6 Regional Alliances (South Hampton Roads, Northern Virginia, Richmond/Petersburg, Southside, Central Virginia, and Southwest Virginia) to conduct regional oral health needs assessments, develop and implement regional project work plans, and share region-specific data among state and local partners. Staffs will also work together to develop and disseminate communications, to include white papers addressing MCH populations.

 

 

Strategy: Convene statewide groups focused on targeted oral health issues and facilitate collaboration and work plan development, and provide leadership and oversight to guide initiatives.

Domain: Women/Maternal, Child, Adolescent

 

 

VDH will also partner with the VAOHC to convene a state-wide group focused on enhancing water equity in Virginia, continue convening the Early Dental Home (EDH) workgroup, collaborate with existing groups working on HPV to ensure oral health is integrated into their approach and goals.  Additionally, the VaOHC will expand community engagement and provide trauma-informed care, oral health and systemic health, and health equity education to providers at the Virginia Oral Health Summit.  Annually, the Summit reaches over 200 caregivers, who attend to learn skills to improve the health and wellbeing of the individuals they serve.  In 2020, the summit seeks to highlight best practices and the expertise of state and national experts so that attendees can work collectively to increase equitable access to quality health care, with a focus on oral health.

 

 

 

 

Program Overview

 

DPHP’s Injury and Violence Prevention (IVP) Program is led by Lisa Wooten, MPH, BSN, RN (Injury and Violence Prevention Program Supervisor). The IVP Program supports promising and best practice activities at the local level that address leading or emerging injury issues. Unintentional injuries continue to be a leading cause of death in the US and Virginia. Although death is the most severe result of injury, it represents only part of the problem. The majority of those who incur injuries survive, and often endure life-long mental, physical, and financial problems as a result of prolonged rehabilitation, hospitalization, loss of productivity, or stress to victim, family, and other caregivers. Despite its immense burden, injuries are largely preventable. Per the socioecological model, the IVP will aim to implement multi-level interventions (e.g. individual, relationship, community, societal) in order to effectively move the needle.

IVP works to incorporate activities for addressing health equity by Identifying injury and violence prevention strategies and supporting policies and legislation to improve access to a trained workforce and removal of barriers to safety devices.

IVPP staff continue to utilize data on deaths and hospitalizations attributable to injury to inform programmatic activities.  The Injury and Violence Epidemiologist, partially funded by MCH Title V, maintains the Virginia Online Injury Reporting System (VOIRS), which provides the public with data on deaths and hospitalizations attributable to injury. VOIRS allows quick and easy access to basic injury data and enables users to customize data reports on various types of injury hospitalizations and deaths. Data are available for both intentional and unintentional injuries, and some demographic and geographic information is included to allow for more detailed analysis. The Injury and Violence Epidemiologist routinely responds to data requests from constituents that could not be addressed through the VOIRS system.

 

IVPP provides an opportunity for family and consumer input into LISSDEP. Staff continue to work with the Division of Population Health to construct an exit survey to evaluate programmatic education and technical support efforts. In the upcoming FY, the VDH Injury and Violence Prevention Program will continue family and consumer input expansion through its Project Patience and Youth Suicide Prevention initiatives. 

 

 

Snapshot of Program Accomplishments

 

• IVPP supports the Low-Income Safety Seat Distribution and Education Program (LISSDEP) statewide network of 154 dissemination sites. IVPP leverages MCH funds with additional state and federal streams to disseminate approximately 2,200 child safety seats annually.

 

 

FY20 Action Plan Overview

 

Strategy: Provide an injury prevention curriculum to maternity hospitals.

Domain: Child

 

 

IVPP will continue the dissemination of Project Patience, an initiative supporting statewide delivery of prenatal and postpartum education on child maltreatment and infant injury prevention. Project Patience is based upon the American Academy of Pediatrics and Bright Futures benchmarks. The toolkit focuses on providing technical assistance to maternity hospitals and community comprehensive maternity case management programs. Priority populations include mothers of NAS infants and pregnant women at risk for or with a history of addiction. The goals are to engage, inform, and educate key stakeholders and to leverage infrastructure partnerships to address child maltreatment and injury prevention among substance-exposed infants.

 

 

Strategy: Eliminate financial barriers to safety devices by equipping income-eligible families with child safety seats through the Low Income Safety Seat Distribution and Education Program.

Domain: Child

 

 

 

The proper use of child safety seats and booster seats is required for all children under the age of eight by Virginia Code 46.2-1095. Pursuant to VA code 46.2-1098, VDH coordinates the Low-Income Safety Seat Distribution and Education Program (LISSDEP) to provide safety seats through a network of 154 dissemination sites statewide to indigent families through revenue derived from fines collected from violations of the CPS law. LISSDEP helps to remove financial barriers and increase access to safety devices and proper education for reducing motor vehicle related injuries. Local health departments operating as LISSDEP distribution sites support program coordination and Child Passenger Safety education for indigent families that addressed the proper usage and installation of safety seats. IVPP will continue dissemination of child safety seats through the LISSDEP network in support of income eligible families. Families are provided a no cost safety seat after receiving education and training in proper installation and usage.  Families must demonstrate proficiency in skills mastered. 

 

 

Strategy: Equip healthcare providers with primary prevention skills for reducing Neonatal Abstinence Syndrome through the evidence-based model Project ECHO®.

Domain: Child

 

 

IVPP will continue to facilitate the NAS Project ECHO® project. Based on a hub and spoke model, Project ECHO® is free to health care providers, and delivered right to their clinic through a virtual platform.  Providers are exposed to a community of learners, and are offered continuing medical education units, opportunity to present de-identified cases, and access to a virtual community of tools and resources.  In addition to Title V investments in program costs, partially MCH-funded staff provides technical assistance to the University of Virginia in curriculum development and delivery of the Project ECHO® model with fidelity and integrity.

 

About Project ECHO

 

Opioid overdose prevention efforts by the Injury and Violence Prevention Program  (IVPP) have included support for provider education. However, long-term sustainability for continuing opioid case management medical provider education is limited due to cost and staffing capacity. As part of the solution, the IVPP has begun implementing a sustainable model for delivering ongoing education to the primary and specialty prescribers using the Project ECHO© model. Using simple videoconferencing technology, providers connect to a community of learners with free continuing education credit and the opportunity to present actual present actual patient cases, in a de-identified format, and receive specialty input from a panel of experts. Research conducted by the University of New Mexico has shown that access to care has improved in primary health settings for patients with prescribers participating in the Project ECHO model.

 

As part of the opioid epidemic, the IVPP recognizes that newborns born to substance-abusing caregivers are at particular risk not only for the effects of neonatal abstinence syndrome but also unintentional and intentional injury following discharge from the hospital. Therefore, supported by Title V funds, the IVPP has partnered with the University of Virginia to develop and launch a Project ECHO© Neonatal Abstinence Syndrome Case Management Learning Lab series which will also include injury prevention modules to reduce injury-related hospitalizations among this population of children. Outcomes that demonstrate how the practice, program, or activity addressed the problem will reflect policy and practice changes, reduced gaps in care, and reduction of the impact of Neonatal Abstinence Syndrome.

 

Investing in Project ECHO was a new Title V strategy for the FY19 application.

 

 

Budget Update

 

IVPP leverages Title V funds, along with state revenue funds and other federal funds, to oversee the development, implementation, and evaluation of various statewide injury prevention programs. Efforts focused on capacity-building (particularly regarding staffing), sustaining and expanding service delivery, and policy.

 

 

Consumer/Family Engagement & Partnership

 

IVPP provides an opportunity for family and consumer input into LISSDEP. Staff continue to work with the Division of Population Health to construct an exit survey to evaluate programmatic education and technical support efforts. In the upcoming FY, the VDH Injury and Violence Prevention Program will continue family and consumer input expansion through its Project Patience and Youth Suicide Prevention initiatives. 

 

 

Emerging Issues

 

Prevention of opioid poisonings as a result of misuse, overuse, and abuse continues to be a growing focus throughout Virginia. There are several drivers to this public health issue which continue to escalate this epidemic, including the problematic practice of opioid case management, prescribing, and dispensing among healthcare providers. Women are at particular risk during child bearing age, as women often are prescribed opioids longer than men, often seek healthcare from multiple providers, and have differing metabolism than men. The impact often extends past the woman, as newborns are at particular risk not only for the effects of Neonatal Abstinence Syndrome, but continuing unintentional and intentional injury post discharge from the hospital. 

 

 

 

 

 

Program Overview

 

The Division of Child and Family Health’s Early Childhood Health (ECH) Unit administers the agency’s home visiting programs. A detailed overview is provided within the Perinatal/Infant Health Domain application.

 

Developmental screening initiatives fall within this unit, led by Bethany Geldmaker, PhD, PNP (ECH Consultant).

 

Developmental screening represents an emerging priority for the state Title V program. These efforts are jointly expected to support implementation of the Bright Futures guidelines and to encourage a more comprehensive, coordinated approach to providing child health care at the community level.

 

Virginia ranks 37th in the country for developmental screening care for children under age 5. The state has no centralized manner for collecting data, relying on parent report.

 

 

FY20 Action Plan Overview

 

Key accomplishments to date and planned FY20 activities are summarized below:

• Three planning meetings with facilitators from NC Work force Development and AMCHP. The meetings included over 40 stakeholders from key state agencies and organizations;
• Working on the web site updates/revisions for developmental screening, Bright Futures and medical home;
• Talking with other Title V states about their NPM 6 measures and activities;
• Distributed Spanish ASQ3 and ASQSE2 starter kits for 6 LHDs and to uploaded to the VDH nursing resource page;
• Working with Resource Mothers to determine the need for kits as they transition into their new data base- how to capture screenings and referrals;
• Planning meetings being scheduled with MIECHV to discuss screening rates;
• Talking with Head Start regarding developmental screening data and their PIR report;
• Working with CSHCN and VA-AAP to discuss DS and partnership opportunities;
• Working with regional Smart Beginnings Coalitions to develop a hub and spoke model for regional work. Coalitions have submitted letters of interest. Six sites have been selected and are submitting work plans and budgets to begin developing developmental screening action plans; and
• Demonstrating inclusion of family voices and address health equity, including racial and geographic disparities.

 

Strategy: Through early childhood partnerships, support ongoing work force development through training, technical assistance, professional development and education with evidence-based tools for LHDs and their community partners.

 

 

 

Strategy: Provide messages for families and the community about the importance of ongoing screening, monitoring, referral and follow-up of child development using social media.

 

 

Strategy: Strengthen the continuum of child health care infrastructure for screening, assessment, referral, and follow-up for developmental screening.

 

 

 

Strategy: Develop a strategic developmental screening work plan with community stakeholders, in each of the six hubs, to build a continuum of developmental and behavioral care to reduce barriers and gaps and promote equity for all young children and their families.

 

 

 

Budget Update

 

Title V funding, to date, has been used primarily for planning purposes. Two stakeholder meetings were held (September 2018 and April 2019). The purpose of the meetings was to support Title V efforts to work with partners to develop statewide and regional strategies to increase universal developmental screening by aligning critical stakeholders around a common vision informed by their current practice and experience.

 

Regional strategies include developing a hub and spoke model. Smart Beginnings coalitions submitted letters of interest outlining their goals and objectives in building out their hubs. Six sites were selected to develop action plans in their regions to improve screening and referrals.