Child Health

Application Year

In 2016, the vast majority (91%) of children in the District reported to be in “very good” or “excellent” health, and DC boasts one of the highest rates of insured children in the nation, with over 98% covered. Despite this, only 24% of children under 6 years of age are reported as receiving a developmental screen. Additionally, more than one-third of District children are considered overweight or obese. Initiatives to reduce childhood obesity and increase developmental screening will help reduce the burden of preventable chronic disease among children. Improved rates of developmental screening in early childhood will enable early identification of and interventions to positively impact long-term developmental outcomes. Additionally, increasing the number of children and adolescents engaging in recommended daily physical activity will contribute to decreased rates of obesity and associated morbidities, such as diabetes and hypertension. This is important as cardiovascular disease is the leading cause of death among District residents. Mitigating long-term negative effects of developmental delays and disabilities and adopting healthy behaviors early in life will assist District children with growing into healthy adults.

Plan for the Application Year

To increase physical activity among children ages 6 through 11 years old, and adolescents 12 through 17, Title V will provide primary support for the following programs and strategies:

• Out of School Time Physical Activity – Although students in DC receive physical education and activity through the public and public charter school systems, students are still not meeting the Center for Disease Control and Prevention’s (CDC) recommended 60 minutes (1 hour) or more of moderate-to-vigorous daily physical activity and are falling short by nearly 225 minutes per week. In FY20, Title V plans to continue to collaborate with DC Public Schools Out of School Time Partnerships to provide support for the implementation of a physical activity program that helps children between the ages of 6 – 11 (or grades Kindergarten through 5th) build functional fitness as a way to prevent childhood obesity and meet CDC physical activity recommendations across the DC. More specifically, to increase physical activity in DC among children between the ages of 6 – 11 (or grades Kindergarten through 5th) during summer school. The lessons will be held five times per week using an evidence-based or evidence-informed curriculum approved by DC Health. The curriculum will be adapted to help children in grades Kindergarten through fifth practice aerobic exercise, muscle strengthening, and bone strengthening exercises. The outcome objectives will be to: 1) increase the number of students between the ages of 6 – 11 participating in at least 60 minutes of daily physical activity per school week during summer school; and 2) increase the knowledge and skill practice for physical activity to encourage building confidence and development of lifelong healthy habits.

To increase the percent of children, ages 10 months through 71 months, receiving a developmental screening using a parent tool, Title V will provide primary support for the following programs and strategies:

• Part C/Early Intervention Care Coordination – Title V will continue to fund the Office of the State Superintendent (OSSE), Division of Early Learning (DEL) to support the hiring of four Strong Start DC Early Intervention Program (DCEIP) evaluators (physical therapist, occupational therapist, speech therapist, and developmental therapist) to provide developmental evaluation services to CSHCN families. Additionally, Title V will support a developmental screening partnership that will provide a District-wide system of coordinated screening for children from 2 months to 60 months through Ages and Stages Questionnaires (ASQ) Enterprise and Hub Accounts. Through this partnership, in FY20 Title V will help:
  • Maximize the use of federal and local resources and reduce duplication in providing appropriate interventions and services to the District’s children ages birth to three years and their families.
  • Improve coordination of services for:
    • Title V
    • DC Newborn Screening
    • Help Me Grow DC
    • Home Visiting
    • Strong Start
  • Ensure that children and their families who are referred to early intervention services through health and developmental screening will receive appropriate and timely services.

The program goal for FY20 will focus on the implementation and testing of the online ASQ to selected child development providers. It is anticipated that OSSE will train the points of contact (POCs) for each pilot site who will manage the online ASQ. OSSE will conduct the pilot of the online ASQ for six months (October 2019 to March 2020), provide technical support, and document inquiries/concerns from the pilot sites. OSSE will also continue to meet with DEL managers and Quality Improvement Network (QIN) hubs to provide updates and solicit feedback on how to improve the online ASQ implementation. (Early Learning Quality Improvement Network (QIN) is the first step toward a multi-year effort to build a neighborhood- based quality improvement system for early childhood development providers in the District of Columbia). Upon conclusion of the pilot phase, OSSE plans to meet with DC Health to provide updates, lessons learned and plans for the next phase of online ASQ implementation (April 2020). OSSE DEL will identify the milestones and key activities after the pilot phase and plan on targeting the remaining providers participating in the QIN, Head Start and subsidy providers. Anticipated partnerships in FY20 include QIN hubs, selected child development providers, DC Office of Contracting and Procurement (OCP), Child Find vendors and Brookes Publishing.

DC Health has made significant programmatic investments in supporting early childhood health. DC Health is particularly interested in furthering its work in strengthening early childhood systems of care. While programs and services that address early care and education, health, mental health, and family support services are critical, they are only as strong as the infrastructure that supports them. To be effective, programs must be organized within cohesive systems that coordinate and align a broad array of services. To support the healthy development of all children, the District must provide comprehensive, coordinated, well-funded systems of high-quality, prenatal-to-age-8 services that foster success in school and life.

• Help Me Grow DC (HMG) – In FY20, Title V staff will continue to provide oversight for the implementation of the HMG program in DC. HMG recognizes the value of healthy child development and early prenatal care and understands that community partnerships and focusing on improving outcomes for children, will ultimately lead to positive outcomes for early childhood education services, families, school and the community as children experience better support through their early years. During FY20, HMG will continue to target pregnant women and children 0-5 and will continue to use a variety of data to make programmatic decisions. The program will focus to: create a clear HMG DC mission, goals and vision; refine HMG key performance indicators; work with DC Mental Health Access in Pediatrics (MAP) AND DC Social, Emotional and Early Development (DC SEED) providers to identify early childhood mental health services in the District; host first annual Books and Blocks Developmental Screening Event; launch a HMG DC website; pilot a centralized or coordinated intake referral process; continue to develop requirements for the new HMG DC database system; and launch the HMG DC newsletter for internal and external partners.

• Maternal, Infant, and Early Childhood Home Visiting Program (MIECHV) – As a federally funded program, MIECHV intends to improve maternal and child health, prevent child abuse and neglect, encourage positive parenting and promoting child development and school readiness. In FY20, Title V will provide oversight of MIECHV to: 1) shift in recruiting and serving families by using cluster neighborhood levels, versus ward levels, to determine at-risk communities; 2) expand the LIA’s capacity to implement targeted recruitment of families from highest risk neighborhood clusters in the District; and, 3) increase both the programs’ family retention and home visitor staff retention rates. Additionally, MIECHV and Title V will collaborate on the design and implementation of a perinatal and early childhood needs assessment, with some focus on assessing consumer demand for home visiting and exploration of additional evidence-based home visiting models that may better address the needs of District’s maternal and child health population.

To decrease the percent of District children who are food insecure, Title V will provide support to the following programs and strategies:

• Joyful Food Markets (JFM) – JFM, a partnership between Martha’s Table, the Capital Area Food Bank, and DC Health, are run in all elementary schools in Wards 7 and 8 (areas of the city with disproportionate poverty and hunger). In FY20, Title V will continue to provide oversight of Joyful Food Markets. Additionally, Title V will continue to provide technical assistance to improve data collection methods, such as measurement of overall participation over longer periods, as well as providing better opportunities for cross-tabulation with grade-level, home address, commuting distance and other variables to inform program implementation and evaluation. JFM plans to explore opportunities to improve their evaluation process, such as identifying types of foods selected by participants instead of determining the overall weight to provide specific data on food distribution.

• Healthy Corners Stores Partnership (HCSP) – In FY20, Title V will continue to provide oversight of the Healthy Corners Stores Partnership. The program will continue with its core program goals of distribution of healthy food to low-income neighborhoods, technical assistance and equipment support for stores, and education for customers. In FY19, DCCK received a Food Insecurity Nutrition Incentive (FINI) grant from USDA, the first in the country dedicated to corner stores. Through the incentive, HCSP plans to continue to provide matching funds for SNAP customers to use on healthy foods based on their use of SNAP in the Healthy Corner Stores. Partners include the DC Department of Human Services, which administers SNAP, and Community Foodworks, which has a FINI grant to provide similar incentives at farmers’ markets. Title V staff will also continue to work with Healthy Corners and the DC Department of Small and Local Business Development to explore sustainability strategies, such as cooperative produce purchases among Healthy Corners vendors.

• Produce Plus Program (PPP) – Title V will continue to provide oversight of PPP in FY20 to increase access to fruits and vegetables for low-income DC residents, improve the viability of farmers’ markets operating in communities with high poverty rates, and improve attitudes and understanding of healthy eating through education. In FY20, PPP will examine pilot programs to replace paper vouchers with branded debit cards. The advantages of this shift would be to allow customers more flexibility in where they spend their benefits, lessen the time spent waiting in line, allow for consistent availability of benefits, and encourage more participation among individuals with time constraints, notably parents of small children.

• Mobile Farmer’s Markets – Mobile Farmer’s Markets will continue setting up farmers’ markets in low-income neighborhoods of Washington, for up to 10 regularly scheduled weekly market stops per week. Through its partnership with Arcadia Center for Sustainable Food & Agriculture, the program will continue to partner with the SNAP-Ed program to assure that a significant number of markets include nutrition education and healthy food demonstrations. Mobile Markets will also work with the Produce Plus Program to establish one-time Market Day events with an emphasis on child-friendly activities.

Title V will continue to be engaged as an integral participant in other key District initiatives supporting quality early childhood systems.

• State Early Childhood Development and Coordinating Council is a multi-sector body with the mission of supporting and advocating for policies and practices and improving collaboration and coordination among agencies and community partners to ensure a comprehensive early childhood education and development system. DC Health will remain a key partner for this effort, providing leadership for the overall body, as well as the Health and Wellness Subcommittee.

• Early Learning Quality Improvement Network (QIN) – DC Health, Title V staff, serves as a member of the QIN Interagency Coordinating Council, which supports the District’s efforts to implement the QIN, a coordinated, community-based quality improvement system aligned to the comprehensive, quality standards of Early Head Start. The Interagency Council brings together leaders from the District’s child and family-serving agencies, including the Child and Family Services Administration, Department of Human Services, Department of Health Care Finance, Department of Behavior Health, and the Department of Health. The Interagency Council has supported enhanced collaboration across agencies in several ways, including joint professional development, expansion of mental health consultation, and developing streamlined policies and procedures that ensure our city’s most vulnerable families benefit from the Early Head Start model. In FY20, the QIN will revise their existing programmatic goals to better capture the progress that has been made since its inception in 2016. The revised goals will allow the QIN to incorporate feedback from the Spring 2019 provider and family QIN self-assessment. The purpose of the self-assessment was to examine the degree to which the QIN had improved the quality and accessibility to high-quality childcare to children and families in the District. Additionally, the Office of the State Superintendent of Education (OSSE) will be re-structuring the QIN Child Care Partnership (CCP) agreement to: enable greater flexibility for providers to opt out; and to improve OSSE’s ability to terminate CCPs based on violations of health and safety standards and/or insufficient evidence of quality improvements, as determined by evidence-based tools used in the Capital Quality QRIS system, Family Child Care Environment Rating Scale-Revised and the Classroom Assessment Scoring System.

Through place-based initiatives, DC Health strives to help create neighborhoods that are places where children and families can succeed and thrive. Place-based initiatives intend to achieve improved health, education and economic outcomes through effective and sustainable neighborhood transformation. In FY20, Title V staff will provide oversight of locally funded place based early childhood initiatives in five District communities. Projects for FY20 include:

• Smart from The Start (Smart) is a family support and community engagement organization promoting the healthy development of children located in the Woodland Terrace community (Ward 8). Smart engages, educates, and empowers parents to step confidently into their role as their child's first teacher and to achieve goals to increase their self-sufficiency. Smart’s core activities will remain relatively the same in FY20. Key programmatic changes include a service area expansion to include a two-mile radius beyond Woodland Terrace that started in in FY19. FY20 will likely include a more defined expansion coverage area and pipelines for receiving new families. Smart plans to coordinate with the Metropolitan Police Department to address residents’ safety concerns. The program is also exploring a partnership with the DC’s Cure the Streets initiative. The program is based on the Cure Violence public-health model, which has been successful in reducing shootings and killings by 20 to 60 percent in more than 100 cities nationwide and globally. This program employs local, credible individuals with deep ties to the neighborhood called “violence interrupters” who de-escalate situations and avert potentially fatal incidents. In addition, Smart has developed programming to extend their workforce readiness component to include mothers.

• The Early Childhood Innovation Network Place-Based Project (ECIN) provides a holistic health strategy in Historic Anacostia, Barry Farm, Sheridan, and the Buena Vista communities (Ward 8) through the development and implementation of Neighborhood Family Champions (NFCs). ECIN collaborates with Far Southeast Family Strengthening Collaborative, Parent Watch, Total Family Care Coalition and Health Alliance Network to recruit and train NFCs from each neighborhood to reach families where they live. Two NFCs serve as social capital builders, making important contact and connecting with families with children ages zero through five. The NFCs will utilize the ECIN mobile app to connect families to physical and mental health supports that reduce the duration and severity of maternal depression, food insecurity, and other family stressors that perpetuate poor health outcomes. In FY20, Neighborhood Family Champions (NFCs) will continue to connect families with children 0-5 in target neighborhoods Cluster 38 (Douglass, Shipley Terrace) and cluster 39 (Congress Heights, Bellevue, Washington Highlands) in Ward 8 to resources and provide peer-to-peer support as necessary. NFCs will also continue bridging the CHC-Anacostia clinic with the community and will work with the HealthySteps team at the clinic to facilitate external behavioral health referrals. ECIN plans to maintain partnerships with Total Family Care Coalition, Parent Watch, Health Alliance Network, Far Southeast Family Strengthening Collaborative to continue developing and modifying the NFC Model. ECIN will also begin analyzing results from NFC time studies to understand the model’s nuances and to increase the likelihood of replication in other communities.