The MCAH Program has identified improving preventive health in children as a top priority, for which it will continue to focus its efforts on promoting; preventive dental and pediatric visits, healthy lifestyles to reduce the risk for childhood obesity, increased on-schedule immunization, decreased non-intentional injury, prevention of child abuse and neglect, increased early childhood developmental screening and early developmental stimulation, quality child care, and child emotional wellbeing. PR MCAH will also continue to collaborate in the development of recommendations to improve preparedness and recovery plans of the DOH and other emergency response agencies with emphasis in advocating for the needs of children.
Challenges to the Pediatric Population in 2020
The 2019-2020 season has been challenging in Puerto Rico with the emergent needs of the population created by the earthquakes and COVID-19, over imposed on the slow recovery from the effects of the 2017 hurricane disasters.
Earthquakes
Efforts in the development of strategies for the mitigation of the emotional distress caused by the recurring earthquakes which began in December 2019 and is expected to continue throughout 2020 at a lower magnitude and frequency, were implemented in collaboration with MCAH stakeholders. Displaced families in the south region of the island due to the damage to their homes and structures caused by the earthquakes have stronger emotional trauma but the general population has also been affected with the uncertainty and fear of a stronger quake affecting the whole island due to its geographical localization in a highly seismic area.
The effect of the quake on children displaced from their homes is emotional instability due to improvised dwellings, interruption in their schedules, loss of contact with playmates due to the need to relocate, the interruption in school semester, and emotional devastated parents and caretakers among other causes. The recovery from this event, amid a slow recovery from the damage caused by the 2017 hurricanes, is anticipated will be a prolonged process. The MCAHD promptly responded identifying the needs of families with children in government and community shelters and referred the families for services in the community. The MCAHD Pediatric Consultant also had multiple visits in collaboration with MCAH stakeholders, visiting families in shelters and providing orientation on preventive measures for families living in overcrowded conditions due to their displacement among other topics.
On February 14, 2020 an activity was delivered outside a damaged Head Start (HS) facility with the participation of more than 30 families and over 40 HS and Early Head Start staff of the surrounding towns of Guánica. Most of the HS and EHS of the south region are nonoperational due to damage to structures by the earthquakes. This activity was done in collaboration with the PR AAP Chapter, United Way of Puerto Rico, ASSMCA (PR Mental Health Services Agency, Adolescent and Children Division), Puerto Rico Family Department mobile library and VOCES (mobile immunization clinic) delivering basic hygiene kits, mosquito repellents, and sunscreen protection cream. It also provided an opportunity to educate on the correct use of mosquito repellents on children, the use of sunscreen protection in children, safe sleep and oral care in dislocated families. Vaccination against the flu was also provided. The coloring book Trinka y Juan, cuando la tierra se movió (Trinka and Sam, when the earth moved), as an instrument to help families mitigate the stress caused by the earthquakes in their children was distributed. Gratitude for the support was expressed by all the participants. Other counties visited were Ponce and Yauco, providing similar initiatives of support.
COVID19
The earthquake challenge was further complicated with the emergence of COVID-19. The pediatric consultant organized and moderated a virtual meeting on March 4, were a compilation of information and recommendations from CDC, AAP and the PR DOH were presented to pediatric leaders from all over the island followed by a discussion and proposals on how to contribute in the preparedness and management of COVID-19 in the community. From this collaboration materials for patient education and protocols for office staff in Spanish were developed and shared. Primary care doctors are the first line of contact for most patients and adequate protection of staff and physicians is vital importance. Strategies to implement telephone triage were also developed by this group.
On March 16 the PR government declared a state of emergency and ordered a shutdown to deter the spread of COVID-19, after cases were identified in the community. Working from home to comply with the governor’s order, the pediatric consultant continued in communication and collaboration with pediatric organization identifying the gaps for the identification and management of this new challenge and as a member of a Pediatrician Task Force to develop a toolkit with guidelines for the diagnosis and management of COVID-19 in the pediatric population. Due to the emerging concerns of how to implement protective protocols in the day care and HS and EHS settings the Pediatric Consultant in collaboration with the PR AAP Chapter developed and delivered a virtual meeting on March 16 on the spread of COVID-19 and infection control measures in public settings promoting the adoption of personal protective behaviors. The virtual conference had a total of 170 participants: day care and HS/EHS staff and community leaders. The content was based on the most recent recommendations by the CDC, AAP and the PR DOH. During the continued shutdown multiple webinars were coordinated and delivered by the Pediatric consultant with the collaboration of Pediatric colleagues and other stakeholders. These webinars had participants from all over the island; families and staff of HS, EHS and day care centers. Pre and post-test were administered with the purpose to evaluate participant’s beliefs and knowledge, and topics for future educational webinars.
Dr. Chandra Ghosh Ippen, Associate Director and Dissemination Director at them Child Trauma Research Program at the University of California, San Francisco and author of the Trinka and Juan series collaborated as a presenter in the May 19 webinar teaching participants how to use the new publication, Trinka y Juan luchando contra el gran virus, to help families and children deal with the stress caused by the COVID19 crisis.
A chat with the participation of pediatricians from all over the island was created and moderated by Dr. Calderon with the purpose to serve as a forum to share updated information on the diagnosis and management of Pediatric COVID19, implementation of changes in practices to continue pediatric preventive services during the crisis while protecting their staff and themselves.
Another chat with the participation of multiple MCAH stakeholders was created with a similar purpose, to share updated information on COVID19 and initiatives to support the MCAH population. Among participants in this chat are representatives of United Way of PR, ACOG, Breastfeeding support groups, psychologist, pediatricians, MCAH advocates, Voces (vaccine advocate NPO), PR AAP leaders, presidents of all the Pediatric Organization on the Island and the pediatric representative of the PR COVID Task Force.
Webinars relevant to pediatric care during the COVID crisis have also been coordinated by Dr. Calderon, with participation of pediatricians from all over the island, United States and Latin America.
Multiple short video clips were produced by Dr. Cindy Calderon with collaboration of colleagues and published in the PR AAP you tube channel with orientation messages for parents promoting to continue preventive pediatric care, immunization, and breastfeeding during the crisis and protective measures to prevent contagion and transmission of COVID19. All the webinars and videos are published in the PR AAP you tube channel, accessible to the public, and have been shared through social media (www.youtube.com/channel/UCy8fBS9CNsgjXdIHW5TJRdw).
During COVID19 crisis the HVP implemented changes and continued to provide support for participants, establishing a protocol for weekly or biweekly telephone evaluations and orientations, including how to access services and information virtually.
The PR MCAH staff will continue working in close collaboration with all MCAH stakeholders that share similar aims. All the proposed initiatives will be continued to be implemented after the threat of COVID-19 is under control and quarantine measures are lifted.
During July 2020, Dr. Calderón led a Pediatric Task Force that developed Recommendations for a Safe Back to School Preparation during the COVID Crisis based on the actualized recommendations by the CDC and AAP.
Promoting Preventive Dental Visits
Oral health contributes to overall health and wellbeing, yet cavities remain the most prevalent chronic disease of childhood, with an impact on oral health throughout life. Therefore, promoting oral health from infancy contributes to the individual’s well-being and development in subsequent years and life stages (school years, adolescence, early adulthood, adulthood and older adulthood). The MCAHD will continue collaborating with MCAH stakeholders to advocate for dental services provided at very early ages, since eruption of first tooth and continued dental coverage in the PR GHP. The MCAHD will strengthen work in the area of oral health with existing partners to better coordinate educational and oral care services and referrals.
The Pediatric Consultant is a collaborator with the PR Territorial Dental Officer from the Health Promotion Division and other oral care stakeholders in a group working on improving oral health outcomes. In 2017 Law 63 was approved, stating the requirement of an oral exam certificate for minors prior to being enrolled or admitted in private or public school to kinder garden, second, fourth, sixth, eight or tenth grade. The group will continue to promote its implementation and monitor the response. Another collaborative group lead by the Pediatric Consultant was formed with the purpose to identify and implement strategies to prevent early childhood caries (ECC), with the participation of the PR AAP Chapter, The Puertorrican Pediatric Society, Materr (Progyn, PR ACOG District), and PR Pediatric Dentist Society.
From this initiative, Materr collaborated with AAP to create a holiday card emphasizing oral care promotion for pregnant women and early childhood caries prevention in infants as part of the New Year’s Resolution.
The collaboration also generated a newspaper article emphasizing the importance of preventing ECC including oral care during pregnancy, early establishment of dental home for infants at higher risk for caries, and recommendations for families to adopt habits that prevent ECC, February 14, 2020.
A press conference was held on February 15 with the participation of all the stakeholders. Another achievement of the group was the inclusion of the topic Identifying Infants at High Risk for Caries and Preventive Dental Care Options in the PR Dental Annual CME Congress in February 2020. The topic on Oral Care in Pregnant women was also included.
Another achievement was the promotion on using the infant at risk for caries screening tool to members of the pediatric organizations through e mail blast of the screening tool, February 2020. The Screening tool was mandated as a public policy by the Secretary of Health in November 2019, and has been disseminated to the providers of the GHIP. The MCAH staff will continue to promote its implementation by primary care providers.
During 2018 the PR Pediatric Preventive Health Care Services Guidelines (PR PPHCG) were updated, adding the most recent Bright Future recommendations of Early Childhood Caries Risk Screening of infants at 6 and 9 months and early referral. Therefore, the MCAH Program will continue disseminating the PR PPHCG, and preventive dental visits twice a year (after the eruption of the first tooth) for infants, children and adolescents. The Program will advocate for the adoption of fluoride varnish as a preventive strategy for infants and young children at high risk for caries. This is a cost effective strategy recommended by the AAP Bright Futures, reaffirmed in 2017.
The MCAH pediatric consultant will also continue promoting and collaborating with EHS and HS in the implementation of the infant at high risk for caries screening tool and referral for the early establishment of a dental home. A workshop on how to adopt the infant ECC risk screening was delivered by the pediatric consultant on January 15 to nurses, health technicians and staff of HS and EHS of 11 counties. The MCAH regional staff will also continue to deliver educational activities in the community promoting prevention of ECC and the establishment of a dental home for all the pediatric population.
The MCAH staff will continue to implement multiple strategies to promote good oral hygiene and regular preventive dental check-ups. The Program will continue to deliver orientation on dental decay and oral disease to families, children, adolescents, pregnant women and the general public in an effort to increase awareness of the risks to overall health and wellbeing and how preventive oral hygiene, healthy oral habits, and preventive dental visits contribute to a better overall health.
All educational activities will continue to be delivered through workshops, presentations, work groups, and one-on one education. Dental visits during pregnancy are extremely important, as oral health status is linked to birth outcomes such as low birth weight and prematurity, and the oral health status of mothers is a determinant for early childhood caries in their offspring. The Prenatal courses will continue to include education on oral care and to encourage a dental visit during pregnancy as part of every woman’s prenatal care plan. The HVNs will continue to educate pregnant participants about the importance of dental care and will continue to refer pregnant participants to visit the dentist as part of their prenatal care. The HVP will continue to administer the caries risk assessment to infants and refer participants to preventive dental visits. Because 44% of the participants of the HVP are adolescents (<20 years old) and all are referred to the dentist, they also contribute to improve the outcomes of oral health in the adolescent population. They will continue to provide orientation to families to decrease risk of caries by adopting good oral hygiene practices and modifying high risk behaviors.
The Positive Parenting Courses (for parents of children 0 to 5 years old and 6 to 11 years old) will also continue to include education on the risk for dental caries. Participating parents will receive strong advice to instill healthy oral habits in their children from early childhood, as well as information regarding GHP coverage for dental visits for their children, and how to request this service. More importantly, it will encourage the involvement of families in promoting healthy oral habits, establishing a dental home, and oral health literacy in communities. The Metropolitan Region MCAH Regional Board will continue to focus their collaborative efforts on promoting strategies for oral health in infants, children, adolescents, pregnant women and women in reproductive age.
The HVP, HCW and HE staff will continue to receive training to update knowledge on oral care in pregnant women, WRA, infants and children to increase their skill in delivering information and evaluating risks.
Promoting Preventive Pediatric Health Visits
During 2018, the updated PR Pediatric Preventive Health Care Services Guidelines (PR PPHCSG) were approved as a DOH Public Policy. The promotion of the PR PPHCSG in pediatric health services will continue to be advocated by the MCAHD at all levels: providers, providers training programs, providers associations, community, families and parents. Disseminating the PPHCSG to the general public empowers parents on what to expect in preventive visits.
The content of the guides also needs to be known by academia, health care professionals, and the insurance companies, so each can do their part to support their implementation and improve the quality of preventive services. The MCAH staff will continue to encourage including the use of the PR PPHCSG in the continuing medical education of providers, especially by pediatricians’ professional associations in PR.
In their interventions, the HVNs, CHWs, PNs and HEs will continue to educate parents and promote scheduled preventive visits and screenings as recommended in the guides. The importance of preventive health care services for the wellbeing of children will continue to be emphasized in the Positive Parenting Courses (0 to 5 years old and 6 to 11 years old).
The MCAH Program will continue to evaluate the use of clinical preventive services by the population in an effort to identify gaps and strategies to overcome them in collaboration with other stakeholders: agencies and professional organizations.
Promoting Physical Activity and Reducing the Risk for Childhood Obesity
MCAH staff will continue to encourage the inclusion of strategies that help improve nutritional habits and increase the time dedicated to physical activity of children according to ages, in an effort to reduce the risk of obesity. The MCAH staff will continue to educate participants regarding physical activity, breastfeeding, healthy nutrition and compliance with the recommendations of My Plate (culturally and linguistically adapted) during their home visits and in community based educational activities.
The Positive Parenting Course for ages 0 to 5 and 6 to 11 years old will continue to stress healthy nutritional choices and daily physical activity for children and their families. The Positive Parenting Courses include AAP recommendations for children ages 6 and older, to place consistent limits on the time spent using media, the types of media, and to make sure media use does not take the place of adequate sleep time, physical activity and other behaviors essential to health. Parents will also receive orientation on the obesogenic effect of consuming high calorie snacks with low nutritional value and the AAP’s recommendation to limit juice intake to less than 4 ounces a day in toddlers, 6 to 8 ounces a day in children, and no juice before 1 year old. The MCAH staff will also continue to promote the exchange of water instead of high-calorie sweetened beverages in purchased meals as mandated by Law 256 of 2015. Brochures developed with culturally adapted simple language will reinforce the messages delivered during orientations to families in the community, in the Positive Parenting courses, the prenatal courses, and in the Home Visiting Program.
The Secretary of Health approved the final recommendations developed for Infant and Young Child Nutrition (0 to 24 months), and they have been adopted as public policy by the DOH. In 2020-21 these recommendations will continued to be disseminated among health care providers for use in anticipatory guidance to families with infants. These recommendations will also be used to stimulate families to adopt better eating habits, develop skills in perceiving infant satiety and hunger cues, and learn the proper introduction of solid foods in infancy. MCAHD will collaborate in the development of educational materials at an appropriate literary level and culturally sensitive for the population served and in the dissemination of the material.
Promoting On-Schedule Immunization
In the visits to displaced families living in shelters the PR MCAH continued promoting the basic hygiene habits that deter the spread of viral infections, an increased risk when living in crowded conditions. With the emergence of COVID-19 as a public health emergency basic hygiene habits that deter the spread of respiratory viral infections was reinforced by all MCAH staff in their interventions in the communities.
The PR MCAHD will continue to provide accurate and reliable information to families on contagious diseases and promoting immunization as recommended in the CDC itinerary through educational initiatives in the community. The staff is vigilant for the identification of any cases of measles, influenza or corona virus in the population they serve, and informed on what actions to implement in order to protect themselves and the health of the most vulnerable and recommend strategies to deter further spread of the disease prior to government shutdown.
The Title V Program Staff assumes its role as part of the DOH, alert and actively collaborating, in the prevention of the spread of COVID-19, as an outbreak of a contagious disease with public health consequences. MCAH also has a collaborating partnership with the Immunization Division of the DOH and will provide support in promoting vaccination campaigns.
During 2020-2021 HVNs, HEs, PNs and CHWs will continue to promote immunization on schedule, with emphasis on updated schedules for children under 24 months of age. The HVN’s have continuous access to vulnerable families and are able to identify barriers to immunization, such as those related to the vaccination system in the health care centers. This information will continue to be shared with the Puerto Rico Immunization Program (PRIP), enabling them to propose strategies to overcome them. The topic of immunization is also included in the Positive Parenting Course. VOCES is a nonprofit organization that offers education about immunizations to health care workers and the general population. The MCAH staff will continue to collaborate with them in their annual conference, and providing advice for the development of strategies to promote immunization and educational interventions.
Preventing Unintentional Injury
The HVNs will continue with one on one education and provide written materials to participants directed at reducing unintentional injuries. The HEs will continue to deliver a course on unintentional injury focused on promoting prevention of in-home injuries, firearm safety, car seat placement and use, safe sleep, protective play gear, safe toys, prevention of forgotten baby syndrome, and drowning prevention, among others.
The Prenatal Course and the Positive Parenting Course will continue to educate on the topics of unintentional injury prevention and safety, including preventing shaken baby syndrome, safe sleep, safe toys and the proper use of car seats, among others. The MCAH personnel will continue providing and disseminating the latest NHSTA and AAP revised car seat guidelines and recommendations for adequate protective car seat selection and use according to the age and weight of the child through educational activities for parents and communities. In addition, staff will continue to promote compliance with local laws that require children be restrained while riding in a car and the use of safety approved helmets when riding a bicycle, motorcycle or any other moving vehicle. These efforts will be directed at decreasing the rate of deaths to children caused by motor vehicle crashes.
The MCAH staff will continue to collaborate with the Emergency Medical Services for Children (EMSC) Project in advocating for an improved emergency response infrastructure and a well-coordinated, well equipped and up-to date Emergency Response System in Puerto Rico that complies with the latest recommendations of the National Pediatric Readiness Project (NPRP). MCAH staff will also advocate that the PR DOH Hospital regulations and requirements incorporate the AAP guidelines for hospitals that provide pediatric emergency care.
The MCAH staff, in collaboration with the Hospital Association and the EMSC Project, will continue to promote that hospitals comply with Administrative Order 357 (November 2016) which requires all hospitals to change their measurements for pediatric patients to the metric system and to change their weighing equipment to measure only grams and kilograms. In 2020-21, strategies to encourage pre-hospital management of pediatric emergencies and preparedness to manage mass casualties in case of a disaster will continue to be emphasized, promoting the use of the Broselow System to deliver pediatric care in emergency situations, the use of proper pediatric equipment in rescue and emergency interventions, improved patient transfer for critical care, and hospital preparedness to manage pediatric cases after a disaster or a mayor emergency.
Child Abuse and Neglect
Child abuse and neglect is a priority identified. The rate of child maltreatment in Puerto Rico is 7.4 /1000 for 2018 (birth to 17 y/o) a decrease compared to 8.8 in 2017 and lower than the national average of 9.2/1000(data source Child Maltreatment 2018 Report of the US Department of Human Health Services Administration for Children and families https://www.acf.hhs.gov/cb/resource/child-maltreatment-2018).
The HVP, the Positive Parenting Course, and the Interactive Intervention on Management of Crying Babies are strategies in the MCAHD aimed at teaching parents skills that contribute to decreasing child abuse and neglect. The Pediatric Consultant has been appointed to the PR Children’s Justice Act (CJA) Committee. In this capacity, she contributes to attain the goal to improve the system that provides the investigative, administrative, and judicial handling of cases of child abuse and neglect in a manner which reduces the additional trauma to the child victim and the victim's family, which also ensures procedural fairness to the accused, and in compliance with the recently enacted Federal Family First Act. The HEs and MCAH staff will continue to deliver the interactive intervention on the management of crying babies to teach parents and caretakers skills to prevent Shaken Baby Syndrome (SBS). The SBS simulation doll will be used to help convey the message. The recommendations for Safe Sleep are included in this course, which will continue to be offered to caretakers and families in the community. The HEs delivered the Parenting Courses in April 2019 to caretakers of abused children, participants in the Biopsychosocial Program that provides treatment and support to these children. The Program will continue to collaborate with this initiative.
Promoting Developmental Screening and Early Developmental Stimulation
The HVP provides the opportunity to have an impact on the health and wellbeing of young children and their families. The HVN’s deliver relevant topics to educate and council families in the different stages from prenatal until child reaches 2 years, therefore contribute to the health and well-being of infants and young children. The HVP staff will continue to receive updated training on all topics pertaining to the Title V objectives chosen in Puerto Rico to strengthen their skills for working with families.
A parenting best practice is for parents and caregivers to learn the typical and atypical patterns of development so they can help identify at-risk children who can benefit from early intervention. To follow this recommendation, HVNs will continue administering the Ages and Stages Questionnaires (ASQ-2) and ASQ: Social Emotional (ASQ:SE-2) in the home setting in an effort to identify delays, teach parents how to stimulate maximum development, and refer for further evaluation and early intervention, if needed. HVNs have the opportunity to teach parents the importance of early stimulation and strategies to apply in their day-to-day interactions. The HVNs will also use the Justo a Tiempo educational materials to guide them in teaching parenting skills. HVNs and other MCAH staff will continue to offer educational activities and distribute educational materials on socio-emotional development, parenting skills, and related topics. The Positive Parenting course will continue to deliver and disseminate nurturing and positive parenting skills, including how to identify typical developmental milestones.
Adverse Childhood Experiences (ACE) studies have demonstrated the relationship between having been exposed to adverse events in childhood, such as physical or psychological abuse, neglect, witnessing violence, and the development of chronic health conditions in adulthood. In contrast, resilience has been proven to have a protective effect on ACE. The ACE questionnaire has been included in the revised Home Visiting Program Manual.
The HVN’s are trained on mental health and emotional wellbeing, on how to administer and interpret several related scales, including the ACE, the Cambridge Worry Scale, the Edinburgh Postnatal Depression Scale and other screening instruments. The HVNs acquired skills on Psychological First Aid tools to provide support to individuals and families after a traumatic event, will continued to be used as the population recovers from the recent earthquakes. Additional training will reinforce the negative effects of ACEs on health, and offer strategies to promote resilience among participants and their families.
MCAH staff will continue to endorse the use of screening tests by primary care physicians and as recommended in the PR PPHCSG guidelines. The Survey of Wellbeing in Young Children is an alternative test for screening different aspects of child development and wellbeing that has been adopted by many states. This test is among those recommended by the AAP, does not require a license for use, and is available in Spanish. In an effort to increase primary care physician screening for developmental delays, the SWYC has been added as alternative screening test in the PR PPHCSG update.
In 2020-21 the MCAHD will collaborate with the AAP and United Way of PR promoting the development of a reach out and read initiative in pediatric offices and day care centers. The goal is to identify funds that enable donations for baby books that cover topics such as oral health and safe sleep to parents with infants, at the earliest age possible, with the purpose to promote parent infant interaction and reading. Possible venues to donate the books could be in pediatric offices and day care centers.
Promoting Quality Child Care
Quality child care also has an impact in the wellbeing of young children. The MCAH staff will continue to collaborate and advocate for the development of public policies and regulations that call for the improvement of child care services, such as: supportive settings for breastfeeding mothers, adequate physical activity according to age, optimal nutritional selection, activities that stimulate development, and safety, among others.
During 2020-2021 the MCAH staff will continue to work in partnership with United Way, Association of Child Care Centers and Head Start/Early Head Start on strategies that empower community leaders and child care center staff to deal with the effects of natural disasters on the population. This includes preparedness for disasters, developing plans for an adequate response during a disaster, and mitigating the effects of trauma after a disaster strikes.
During 2019-2020 the MCAH staff has taken part in another collaborative project to address poverty in children due to its implication for the wellbeing of the pediatric population. This collaboration is led by the Instituto de la Juventud and Save the Children. The main goal is to improve the economic situation of youth between the ages of 16 to 21, especially those with young children. MCAH staff will continue collaborating in this project for 2020-2021, developing and implementing strategies to improve access and quality of early childhood day care centers for these young parents.
The United Way of PR has instituted the Children Friendly Cities Award in 2019, were 3 top municipalities in PR were selected after evaluating over 25 that participated submitting an application to compete. The competition is based on services and investments that the municipality directs to early childhood. The MCAHD supported the initiative by participating in the awards ceremony in 2019 and will participate in the evaluation process for 2020.
Child Emotional Wellbeing
Due to the impact on emotional wellbeing on children and families by the earthquakes the MCAH program will collaborate in the dissemination of the coloring book Trinka y Juan el día que la tierra se movió as an instrument to help families understand behavioral responses and strategies to mitigate it. The recently published coloring book Trinka y Juan luchando contra el gran virus will be adopted as a similar instrument to help families with young children deal with the uncertainty and stress of COVID19.
MCAH staff and the HVN will continue to foster the development of resilience in the participant families, awareness of the effects of adverse childhood events and how to prevent them in their children. The HVN will also continue to administer the Ages and Stages Questionnaires: Social Emotional (ASQ:SE-2) at to participating children of the HVP at scheduled intervals, teach parents how to promote healthy emotional development, and refer children that require further interventions based on the results of the screenings.
Emergency Preparedness and Response
With each emerging disaster, the importance of advocating for children’s need has been identified as a priority. Therefore the MCAH staff will continue to collaborate to develop an Emergency Preparedness and Response guide that takes into account the needs of children to incorporate in the state EPR plans.
Education to childcare and HS/EHS staff will continue to be offered via virtual presentations during the quarantine on topics of safe sleep, ECC prevention, immunization myths, breastfeeding, child development, disaster preparedness, oral care, and unintentional injury prevention.
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