For the 2020 application year, the Bureau of Women's and Children's Health's (BWCH) priorities for children will continue to focus on decreasing the rate of injuries, both intentional and unintentional for children ages 0-19 and improving access to quality preventive health services, specifically developmental screening. Programs will support NPM 7 related to the rate of hospitalization for non-fatal injury per 100,000 children ages 0 through 9 and adolescents 10 through 19. The strategies to decrease the incidence of childhood injury will include continued analysis of child death data to support and train law enforcement agencies, medical examiners, and first responders on death scene investigation and primary prevention efforts in the recognition of unsafe sleeping environments.  Technical assistance for emergency departments and support of local Safe Kids coalitions are strategies that will continue in 2020.  BWCH home visiting programs will continue to support NPM 6, percent of children, ages 10 through 71 months receiving a developmental screening using a parent- completed screening tool.  Oral health prevention efforts will also be a key strategy. The following discussion details these strategies that will be either continued or strengthened in 2020.

 

BWCH through the Emergency Medical Services for Children (EMSC) Program will continue to provide technical assistance to the hospital community to achieve a higher level of preparedness in caring for children. In 2020, BWCH will leverage partnership with the Arizona Academy of Pediatrics to provide training to rural and Critical Access Hospital staff to be pediatric prepared. Goals have been identified on the EMSC Action plan. Goals include: increase the portion of EMS agencies that collect and submit uniform data to the national EMS Information System (NEMIS); support EMS agencies to identify a Pediatric Emergency Care Coordinator (PECC); evaluate pediatric skills among EMS agencies; support Arizona emergency departments to help stabilize and manage pediatric trauma; create inter-facility transfer guidelines and agreements for pediatric patients; and support the integration of EMSC priorities into hospitals and EMS systems into statues and regulations.  Additionally, the OCSHCN Family Advisor will participate in the planning and represent families in activities related to this grant.  This project is supported with Title V funds.

 

Arizona's Child Fatality Review (CFR) Program contracts with 11 local review teams to provide in depth analysis of all child fatalities occurring within the state. CFR reviews are conducted by a multi-disciplinary group of dedicated professionals including: medical professionals, law enforcement, public health professionals, child safety specialists, behavioral specialists, and representatives from Arizona's tribal nations. Teams have been instrumental in the identification of preventable child deaths occurring throughout the state. Collected review data enables the development of prevention strategies and promoting increased public awareness. Arizona will continue analyzing child death data while providing support and training for law enforcement agencies, medical examiners, and first responders on death scene investigation and primary prevention efforts in the recognition of unsafe sleeping environments for infants.

 

In 2020, BWCH through the Office of Injury Prevention (OIP) will provide support to the five local Safe Kids coalitions that are located around the state, additionally OIP serves as the liaison between the Safe Kids Worldwide and the local coalitions.  Each coalition works to help families and communities keep kids safe from unintentional injuries, including but not limited to reduce traffic injuries, drownings, falls, burns, poisoning and more.  OIP will provide Child Passenger Safety trainings to certify people to become car seat technicians around the state with a focus on rural and tribal communities.  A component of this includes identifying participants during the training to build local child passenger safety instructor capacity. In 2020 BWCH, OIP will request funds to purchase educational material for child passenger safety, i.e. car seats to be distributed through our partners at the local health departments and/or safe kid’s coalitions.

 

Arizona's early childhood home visiting programs provide support for new families to promote positive parenting and child development.  MIECHV, Health Start and HRPP/NICP home visiting programs, will continue to support and inform the Title V state priority need to increase early identification and treatment of developmental delays and NPM 6: percent of children, ages 10-17 months, receiving a developmental screening using a parent completed screening tool by implementing the following measures.  BWCH home visiting programs will continue to measure the proportion of new home visitors trained to provide ASQ within 6 months of hire. Home visiting programs will monitor and track new home visitors trained to provide ASQ from a ‘certified ToT.’ BWCH home visiting programs will also measure the percentage of children receiving an ASQ within 1 year of enrollment. By 2020, 85% of children enrolled will receive at least 1 ASQ within 1 year of enrollment. Furthermore, the internal home visiting workgroup will continue to meet to coordinate the shared vision for home visitation within the bureau, improve communication and coordination among bureau home visiting programs, and identify opportunities for collaboration.  The workgroup members include home visiting program managers, supervisors, contractors and representatives from each of the bureau offices as needed.

 

In 2020, home visiting programs will continue to implement strategies that support services for mothers, infants, and families.  In addition, continued professional development for home visitors and home visiting supervisors implementing programs will be a priority.  Details for planned activities are included below.

 

Maternal, Infant, and Early Childhood Home Visiting (MIECHV) is requesting funds for the 2020/2021 FY.   BWCH is requesting the ceiling award amount of $11,204,224 to leverage its resources in supporting voluntary; evidence based home visiting programs in at-risk communities and coordinate services across the early childhood system.   The MIECHV program is working with the Office of Assessment of Evaluation to complete the update to the needs assessment and plans to have a contract with ASU Morrison Institute to complete the needs assessment update.  Overall, ADHS through MIECHV funding will continue to fund evidence-based home visiting programs including Healthy Families (through Arizona Department of Child Safety), Nurse-Family Partnership (through Maricopa County Department of Public Health, Pima County Health Department, and First Things First), Family Spirit (through Coconino County and San Carlos Apache Tribe) and Parents as Teachers provided by four Native American Tribes (Cocopah, Gila River, Hualapai, and Navajo Nation).  MIECHV will continue to fund state funded home visiting program, Health Start as a promising approach.  

 

The MIECHV grant is proposing to serve and estimated 1,624 families.  MIECHV will continue to implement evaluation and continuous quality improvement requirements and home visiting services will continue to be augmented by professional development provided through training and education, online courses, regular informative e-newsletters, and an annual conference.

MIECHV will continue to support Title V National Performance measures and state priorities including:  

•  Title V priority need to reduce infant mortality and morbidity and NPM 4: a) percent of infants who are ever breastfeed and b) percent of infant’s breastfeed exclusively through 6 months through the ongoing implementation of an IBCLC mentoring program.

 

•  Title V state priority need to increase early identification and treatment of developmental delays and NPM 6: percent of children, ages 10-17 months, receiving a developmental screening using a parent completed screening tool through implementation of revised measures monitoring new home visitor ASQ training and percent of children enrolled that receive at least 1 ASQ within 1 year of enrollment.

 

•  Title V state priority need to reduce the use of tobacco and other substances across the lifespan and NPM 14: a) percent of women who smoke during pregnancy and b) percent of children who live in households where someone smokes. MIECHV funded home visiting programs will participate in a coordinated project with Bureau of Tobacco and Chronic disease to improve the number of caregivers who engage in cessation services via ASHLine.

 

•  Title V state priority need to strengthen the ability of Arizona families to raise emotionally and physically active children. MIECHV will continue to support the implementation of evidence-based home visiting services.

 

MIECHV will continue to coordinate efforts to establish a coordinated data management system for home visiting programs in Arizona.  Additional activities include continuing to support the newly added non-MIECHV funded Healthy Families Arizona (HFA) programs, alignment with Nurse Family Partnership (NFP) data system, and state funded Health Start and HRPP/NICP into the Efforts-To-Outcomes (ETO).

 

The Health Start Program will continue to provide education and services to pregnant and parenting mothers and families with infants from birth to age two.  This will include immunization education and checks for immunization records and developmental screenings.   Health Start will continue to support ESM 6.1 – Number of home visitors trained to – provide ASQ3 and SE2 assessments to children over the next five years by meeting the annual objective of 10 home visitors trained in 2020. Health Start will continue to provide developmental screening for children ages 10-17 months to increase early identification and treatment of developmental delays.  Additional planned activities can be found in the Women’s Health HRSA domain segment of the report. In 2020, Health Start will continue with the final steps of the evaluation of the program through the submission of studies to be published in peer reviewed journals to  support Health Start becoming an evidence-based program. Health Start will integrate the Arizona Survey on Children’s Health Tool to assess twelve month old infants for special health care needs. In 2020, Health Start will focus on providing women in the program with additional sexually transmitted disease education to encourage testing and treatment to prevent congenital syphilis. In addition, Health Start will promote and provide community education on substance exposed newborns and neonatal abstinence syndrome in an effort to raise awareness and reduce stigma associated with women with substance use disorders.

 

High Risk Perinatal Program/Newborn Intensive Care Program (HRPP/NICP) 2020 planned activities can be found in the Perinatal/Infant Health HRSA domain segment of the report.

 

The Office of Oral Health (OOH) will continue to implement programs to address primary prevention strategies for children.  The 2020 planned activities can be found in the Cross-cutting HRSA domain segment of the report.

 

In 2020, BWCH will continue to partner with the Bureau of Nutrition and Physical Health (BNPA) initiatives that support nutrition, health and wellness for children and families. BNPA participates in the annual Strong Families conference, providing educational information through exhibiting and assisting with presentations.  In 2020, BNPA will continue to support the MIECHV program by providing information to home visitors about physical activity and nutrition for mothers and young children. In addition, BWCH will continue their participation on the Empower Advisory Committee (EAC) and the State Nutrition Action Committee (SNAC).

 

The Empower program outlines 10 nutrition and health standards for Arizona’s child care facilities to support children living healthy lives. Currently, almost 3,000 Arizona child care facilities, including approximately 2,400 ADHS licensed centers and 300 child care group homes, as well as 600 Department of Economic Security (DES) family child care homes participate in Empower.  All programs enrolled in Empower assess their own practice implementation and written policy adherence annually, with data uploaded to an ADHS database.

 

The Empower Advisory Committee was established to leverage and align multidisciplinary stakeholders work activities throughout the early care and education (ECE) statewide systems work around health, nutrition and wellness.  The EAC provides guidance and support for implementing healthy standards in Arizona’s child care community.  Aligning common and consistent messaging among various state agencies and programs helps providers better understand preventive health and their role with children and families.  Statewide systems coordination is an emphasis with the CDC (Centers for Disease Control and Prevention) and using the CDC Spectrum of Opportunities helps to ensure broad collaboration. In 2020, the EAC will begin review of a five year work plan, examining each content area for continued best practice, effective messaging and supportive resources.      

 

The EAC is a collaborative effort of partners throughout the state and includes representation from the following:   

• Arizona Department of Education –

o Child and Adult Care Food Program (CACFP)

o Farm to ECE (Early Care and Education) 

o Early Childhood Education (ECE)/Special Education (ECSE) 

o HSSCO (Head Start State Collaboration Office)

• Department of Economic Security - 

o Child Care Administration (CCA) 

o AzEIP (Arizona Early Intervention Program) 

• First Things First - 

o Quality First 

o Child Care Health Consultation (CCHC) 

• Arizona Department of Health Services -

o Bureau of Child Care Licensing (BCCL)

o Bureau of Nutrition and Physical Activity (BNPA) 

• WIC (Women, Infants, & Children) 
• SNAP-Ed (Supplemental Nutrition Assistance Program Education)

o Bureau of Tobacco and Chronic Disease (BTCD)

• ASHLine (Arizona’s Smoker’s Helpline)

o Bureau of Women’s and Children’s Health (BWCH) 

• OCSHCN (Office of Children with Special Health Care Needs)
• Oral Health
• MIECHV

o Office of Environmental Health

• SunWise
• Smoke-Free Arizona  

 

Empower currently has 10 online Learning Management Systems (LMS) courses addressing the following topics and completion data-to-date: 

 

Family Style Meals (1947)

Fruit Juice (1493)

Physical Activity for 0-12 (1668)

Sedentary and Screen Time (1623)

Sun Safety (1294)

Tobacco (875)

Tooth Brushing (979)

Inclusion (282 - since January 2019)

Breastfeeding (394 – since October 2018)

Overview of Empower (669 – since July 2018)

 

In just over two years, these courses have been accessed over 11,000 times.  This year, five of the courses will be translated into Spanish and include:  Inclusion, Breastfeeding, Overview of Empower, Family Style Meals and Physical Activity 0-12. These LMS courses are available to anyone, free of charge, via the Empower website as well as the Arizona Early Childhood Workforce Registry.  

 

In 2020, Empower will continue to publish monthly newsletters to over 6,300 subscribers representing child care providers and various stakeholders.  Information routinely consists of nutrition, physical activity, breastfeeding, and other wellness topics for child care settings, covering the span of infants, toddlers, preschool, and school age children and their families. 

 

Arizona’s State Nutrition Action Committee (SNAC), was developed in 2017 to coordinate efforts for a healthy, active Arizona.  They aim to strategically align nutrition and physical activity efforts across programs to ensure that all Arizonans have equal access to knowledge, as well as the ability to make choices to live a healthy lifestyle.  The SNAC Steering Committee represents several state agencies and programs including ADHS, ADE, DES, and the Dairy Council.  The Steering Committee provides strategic direction for the work groups.   

 

In 2020, the current SNAC work groups will continue to focus on the following goal areas:

• Breastfeeding

• Common/Consistent Messaging

• Healthy Eating

• Maximizing Reach

• Physical Activity

 

Through their representation and active involvement, BWCH has the opportunity to collaborate and provide input into all five of these work groups as they move forward into 2020 and beyond. 

 

According to the most recent CDC breastfeeding report card data (2015), the rate of initiation was at 82.7 percent, and exclusivity of breastfeeding at 6 months was 26.3 percent. Utilizing both the CDC and NIS as the national data reporting agencies BNPA was able to identify these percentages provide justification that breastfeeding support continues to be a necessary program objective for public health professionals.

 

According to the National Immunization data, Arizona is increasing the duration of breastfeeding rates even when the initiation percentage has declined in recent years’ surveys.

 

In 2019, the Arizona Department of Health Services launched an initiative to provide no-cost evidence based education for all maternity and infant care hospitals as an intervention for the declination of breastfeeding initiation statewide. Another aspect of this breastfeeding project is a collaborative promotion between maternity and infant facilities and the Arizona WIC Program to create a continuum of care for families and consistency in breastfeeding support and messaging.  It is expected that the breastfeeding initiation rates will rise in future years due to these hospital training courses, education and community support.

 

 

The Arizona Partnership for Immunization (TAPI) will continue to promote immunizations statewide in partnership with BWCH. Using their 400 members representing over 200 organizations, TAPI will distribute educational pieces to schools, child care facilities, private providers, county health departments, community health centers, managed care organizations and WIC sites.

 

TAPI will further promote usage by parents and professionals of the TAPI home web page, www.whyimmunize.org. TAPI Facebook page has become a resource for hundreds of Arizonans and TAPI will continue to expand the information shared and the number of times information is read. TAPI's tweets on Twitter will be viewed 6,000- 12,000 times. Content will include education to minimize exemptions, parent and doctor relationships, CDC updates, back to school information about vaccinations, Tdap, the pneumococcal vaccine recommendations, and flu season vaccinations. TAPI will provide information to the media routinely on vaccine funding and appropriate referrals as well as in depth stories.  TAPI will use appropriate subject matter experts and conduct media training through a speaker's bureau.

 

TAPI will continue to conduct provider education through annual best practice trainings, sharing relevant outbreak and vaccine news through medical associations. TAPI will work with Healthcare Associated Infection (HAI) and provide support with vaccine education and with the International Infection Prevention Week (IIPW) to raise awareness of the role infection prevention plays.  Continuation of HPV vaccine education is planned through both the dental partnerships and collaborations of HPV related research and educational grant agencies.

 

TAPI will continue to develop materials and programs for pregnant moms questioning vaccine safety that highlight healthy pregnancy and early childhood and lists recommended vaccines at every stage of development to providers statewide. Emphasis will continue for the appropriate coverage of infant and children with continued expansion in young adults “Off to College”, receiving oral cancer screenings and systemic support for increased pregnant women and adult immunization.

 

In 2019 the Governor’s Goal Council requested that ADHS establish action plans to address Immunizations and ACE’s and Trauma Informed Care. In 2020, BWCH will be an active participant on both of these workgroups and provide input and feedback in the areas of perinatal/infant and children's health. The Arizona Department of Health Services’ goals to address ACEs in Arizona: GOAL 1: Reduce the number of ACEs that Arizona children are exposed to; GOAL 2: Characterize the data that leads to Arizona having the highest percentage of children exposed to ACEs; and GOAL 3: Mitigate the number of adverse health outcomes that are associated with ACE exposure.

 

In 2019/2020 The Arizona Immunization Program Office (AIPO) will work on the Immunizations action plan with stakeholders to improve vaccination coverage rates and reduce the utilization of personal beliefs exemptions forms (PBE).  PBE usage has continued to rise in Arizona over the past several years.  This puts children, families and communities at risk for an outbreak of a vaccine preventable disease. The action plan will engage stakeholders in a wide array of activities designed to educate, inform and promote a strong vaccination message.

 

In 2020, BWCH will continue to support internal and external stakeholders working on Children's Health initiatives by co-sponsoring questions related to Adverse Childhood Experiences (ACEs) in the 2018 Behavioral Risk Factor Surveillance Survey (BRFSS). BWCH acknowledges that ACEs can last a lifetime despite the availability of preventive social and public health programming. Early exposure to family violence, abusive treatment, neglect, alcohol and drug abuse, or separated/divorced parents can lead to health and social problems, risk-taking behaviors and a shortened lifespan. Safe, stable and nurturing relationships and communities can break the cycle of abuse and maltreatment. Since 2012, BWCH has sponsored the set of 11 core ACE questions.

 

The Office for Children with Special Healthcare Needs (OCSHCN) manages and administers the state hearing and vision screening program for early childhood education, school-age children, and other key projects that impact children’s health.  Additional information on planned activities can be found in the Children with Special Healthcare Needs domain section of the report.

 

Inter-agency collaborations with First Things First (FTF), Arizona’s critical partner in creating a family-centered, comprehensive, collaborative and high-quality early childhood system that supports the development, health and early education of all Arizona's children birth through age 5.  In 2020 the Bureau of Women’s and Children’s Health will continue to partner with FTF on state-wide initiatives including participating on the Childhood Screening and Early Intervention Stakeholder workgroup. In addition, the bureau will continue participating on the Arizona ACE Consortium, dedicated to promoting ideas, policies and practices that reduce and prevent childhood adversity and build resilience in individuals, families and communities.

BWCH will continue to partner with Bureau of Tobacco and Chronic Disease on reduction and prevention efforts as well as with the Empower Advisory committee on tobacco prevention, education and cessation efforts. 

 

The Office of Oral Health (OOH) provides population-based oral health prevention efforts and effective utilization of the dental workforce in implementing and improving oral health access. With the increased awareness of the impact of oral health to overall health, the OOH has increased its collaborations with community partners to improve oral health through prevention activities and direct access programs. In the original Title V Guidance (2015), this two-part NPM was in the Cross-cutting/Life Course population domain. With the separation of the measure between the Women/Maternal Health and the Child Health population domains in 2018, NPM 13.2 (focused on children) is discussed here for FY 2020.

 

In Arizona, all 15 counties have a full, partial or facility Dental Health Provider Shortage Area (DHPSA) designations. Only 47% of Medicaid-eligible children in Arizona received any dental service and only 44% receive preventive dental services. Children under the age of five are the least likely to have visited a dentist with only 35% receiving a preventive dental service. The Healthy People 2020 goal is to have 28.1% of children ages 6-9 with one or more dental sealants in place. Between 2010 and 2015 there has been a slight decrease in the percent of third grade students with at least one dental sealant. In 2010, 47% of third grade students had one or more dental sealants; in 2015 it was 44%.

 

Objective A:  Increase the number of school-based dental sealant programs in rural communities across Arizona.

 

This objective aligns with the Oral Health NPM: Percent of children, ages 1-17, who had a preventive dental visit in the past year. Implementing a school-based dental sealant program will support progress toward an increased number of children with a preventive dental visit. The Arizona school-based prevention program, Cavity Free AZ is focused on providing preventive oral health care to students through assessment, education, dental sealants, and fluoride varnish application. To best align preventive efforts to highest areas of need, Cavity Free AZ programs targets schools that have 50% or more students enrolled in the Free and Reduced Lunch Program (FRLP).

 

Tooth decay is the leading chronic childhood disease and nationally leads to more than 51 million missed school hours per year. Dental sealants are an evidence-based strategy to prevent tooth decay. Cavity Free AZ is a school-based prevention program that provides dental screening and places dental sealants for students at no cost to families. In addition to dental sealants, students receive a dental screening, oral health education and fluoride varnish.

 

Cavity Free AZ began in 1987 with a single pilot program serving a handful of schools. Through increased awareness and advocacy, the program has seen consistent growth by adding more programs and with each individual program expanding into more schools annually. Currently the program has 10 grantees across the state. Although the program experienced significant growth into approximately 430 schools in FY 2018, the majority of schools in Arizona do not offer a dental sealant program to students. Dental sealants ultimately decrease dental disease in youth as they are nearly 100% effective in preventing dental decay when they are retained on the tooth. Therefore, reaching children through school-based services is ideal and is a recognized best practice approach by the CDC and the Association of State and Territorial Dental Directors.

The first strategy under this objective is to utilize the Cavity Free AZ database to track the number of students receiving an annual preventive dental screening. Program management and growth significantly rely on data collection. Cavity Free AZ has made ongoing improvement modifications to its data collection efforts. Annual reports are written in a timely manner and released for each local program as well as aggregated into a statewide report. Data can illustrate program success through annual increases in number of schools and students served and through number of sealants placed. Ultimately, the data will be captured by the Arizona Healthy Smiles Healthy Bodies Basic Screening Survey of third grade and kindergarten students (completed every five years), to demonstrate the prevalence of oral disease and access to preventive services in children across the state.

 

Continual updating of the database allows for tracking the number of unique students who receive one or more dental sealants through the program. The second strategy is to promote dental sealant programs through school health professionals. The growth of the program relies on continual expansion into new schools. OOH will continue to a) promote dental sealant programs through school nurses and other school health professionals and b) encourage participation with Cavity Free AZ or other school-based dental sealant programs. This strategy will be accomplished through collaboration with internal partners, as well as embracing external partnership opportunities via professional organizations, conferences and educational venues.

Cavity Free AZ attempts to reach the target population through family and consumer outreach and engagement. The program’s focus is on schools with a high number of children enrolled in the FRLP. The program relies on parent and guardian awareness of the program; thus, parents’ consent for their children to receive the preventive oral health services is a key component of the program. To reach families and consumers, staff from the funded programs attend back-to-school nights and Parent Teacher Organization (PTO) meetings. All student consent forms are delivered home with an informational brochure on the program and the benefits of dental sealants. Program materials were developed by professional health literacy specialists and written at a third-grade reading level to accommodate varying literacy levels.

 

The Arizona Dental Sealant Program will continue to provide school-based dental sealant programs to high risk children in eligible public and charter schools throughout Arizona. The Office of Oral Health (OOH) will maintain Intergovernmental Agreements with county health departments, FQHCs, and the University of Arizona to provide school-based oral screenings, referrals and sealants to children in eligible schools. Collaborations and outreach to expand the program to rural areas will continue. The HRSA Oral Health Workforce grant which allowed for the expansion of the sealant program to the border counties of Arizona ended in 2018 and through sustained partnership with the University of Arizona Cooperative Extension the program will continued to provide services in the border counties which include some of the most rural counties in Arizona. The Cavity Free AZ program will continue to collaborate with the Arizona Medicaid program to identify opportunities to link Medicaid eligible children to dental homes.

 

In addition to collaborating with county health departments, OOH will continue its partnership with AT Still University, School of Dentistry and Oral Health to implement the sealant program in underserved schools.  Through this program dental screenings, sealants, fluoride varnish and referral services will be provided to children at eligible schools by licensed dental faculty and dental students. Through this program a partnership with local community dental clinics in Pinal County was established and will continue to be utilized for children needing additional dental services. For 2020 the goal is to continue to serve 15 eligible schools.

 

The third strategy is to monitor evaluations to determine best practices in school-based  programs with high participation. Ongoing evaluation of sealant programs is imperative to overall growth. Learning from all partners involved (students and parents, school administrators, teachers, school nurses, health professionals, social workers) through evaluation will assist in directing the Cavity Free AZ program toward continued success. In FY 2018, a full Cavity Free program evaluation was conducted by OOH, and the final evaluation was reviewed for program improvement strategies that could be implemented by individual programs.

A fourth strategy to implement in FY 2020 is to examine ongoing health trends to identify geographic areas experiencing a high burden of disease, and then use this information to identify populations that will benefit from an increase in dental sealant placement in proportion to disease and population. This strategy will help assess whether oral health programs are funded in areas of high need and to maximize access and preventive potential to the populations with the highest need.

 

Objective B:  Increase the number of preschool children who have a preventive dental visit.

 

OOH has been addressing access to oral health care for preschool children by implementing oral health promotion and education opportunities through Strong Families AZ and the Arizona Empower Program.  The first and second strategy under this objective will be to continue online trainings and provide educational materials through Empower and Strong Families AZ.  Materials have been developed to assist child care facilities in implementing toothbrushing programs and oral health education activities. Materials include the ‘Arizona Tooth Brushing Manual:  Fostering Healthy Smiles in the Child Care Setting for Ages 3 and Older’ and an online course, ‘Toothbrushing in Child Care Settings’.  More than 350 providers have completed this online course since its launch in 2017.  In addition, oral health education materials are regularly included in the monthly Empower Newsletter, reaching over 4,500 subscribers.  In 2020, OOH intends to continue to partner with Strong Families AZ to provide motivational interviewing trainings across the state for home visitors with a focus on reaching rural home visitors. Evaluation will continue to measure home visitor confidence in speaking to families about oral health and also measuring oral health knowledge gained from trainings.

 

Objective C: Maintain and promote community water fluoridation.

 

Only 57% of Arizonans have access to optimally fluoridated water.  As well know, community water fluoridation is one of the greatest achievements in public health of the  20th century.  Community water fluoridation (CWF) continues to be a challenge for Arizona with one community choosing to stop fluoridating in 2018.  OOH will continue to assist communities in maintaining CWF systems and also help new communities promote CWF to demonstrate its benefits.  The Arizona School-based Fluoride Mouthrinse program will continue to provide services to high risk children in eligible public and charter schools throughout Arizona. Schools are eligible if they have 50% or greater children on Free and/or Reduced Lunch and are located in a community with sub-optimal levels of fluoride.  The OOH will continue to maintain partnerships with participating schools and school districts throughout the state to increase access for children in high risk schools.

 

Other areas of focus:

 

OOH received a HRSA Oral Health Workforce Grant to develop and implement a Silver Diamine Fluoride program. Silver Diamine Fluoride (SDF) is a low-cost colorless liquid that arrests tooth decay when applied to a cavity. It requires no drills, no anesthetic and a simple application of the liquid which stops current tooth decay from progressing. SDF has consistently demonstrated very high rates of stopping tooth decay. The program will use the existing framework of its Cavity Free AZ programs and other established community prevention programs across the state to implement the new SDF Program. The focus will be to identify those children who are at highest risk of decay and increase the number and proportion of children served. Collaborations and outreach to expand the program to new service areas will continue. The program will continue to seek to increase expansion in some of the most rural counties in Arizona by partnering with more schools in rural communities throughout the state.

 

The Healthy Smiles Healthy Bodies survey, a statewide oral health survey of children in kindergarten and 3rd grade will be conducted during the 2019-2020 school year.  Partnerships for this project include the Arizona Department of Health and First Things First.  Oral Health screenings and data collection will be performed on over 6000 children in elementary schools across Arizona.  Data and reports from this survey will help to identify oral health needs and disparities across the state.   

 

OOH will continue its partnerships with the Arizona Alliance for Community Health Centers, the Inter Tribal Council of Arizona, and the Greater Valley Area Health Education Center to provide professional development opportunities for dental providers and program administrators on dental public health issues.  Topics to be included for next year include, infection prevention in the dental setting, implementing school-based sealant programs, implementing preschool prevention programs, motivational interviewing, risk assessment and anticipatory guidance.