Massachusetts has two priorities for Child Health for 2020-2025:
- Foster healthy nutrition and physical activity through equitable system and policy improvements.
- Strengthen the capacity of the health system to promote mental health and emotional well-being.
Priority: Foster healthy nutrition and physical activity through equitable system and policy improvements.
Objective 1. By 2025, increase the percent of families who can always afford to eat good nutritious meals from 73.2% (2017-2018 NSCH) to 81%.
Over the next five years, key strategies to address this objective will focus on maximizing the access that families with young children have to food resources for which they are eligible, increasing the availability of and access to fruits and vegetables, and identifying and implementing more upstream approaches to promoting food access and physical activity.
WIC
Data sharing activities with MassHealth, SNAP and Head Start will continue in FY22. Through a data match with MassHealth and SNAP, WIC identifies individuals who are likely eligible but not participating in WIC, contacts those households via text message, and includes a link to the online WIC application. WIC provides data back to SNAP to allow outreach to WIC participants that are likely eligible for but not participating in SNAP. Strengthened relationships between WIC and SNAP during the pandemic will result in improved coordination between programs related to outreach and messaging. With Head Start, data sharing activities aim to streamline and minimize program reporting burden and are specific to health data that are required by both programs (i.e. height, weight, hemoglobin) as well as nutrition care plans.
In FY22, the WIC Marketing Manager will work in partnership with WIC Nutrition, Operations, and IT teams to continue to increase awareness of the program through social media, connecting families to the WIC online application, and maximizing use of online application data in the WIC Management Information System. Ongoing use of the Loving Support breastfeeding outreach materials and creation of new WIC outreach videos will further enhance this effort.
To ensure equitable access to WIC retailers across the state, WIC will continue to actively monitor vendor coverage and reach out to potential vendors in communities in need of additional retail locations. Members of the WIC vendor unit will continue to provide leadership in national and state efforts to determine stepwise processes to modernize WIC retail transactions and eventually facilitate online ordering for WIC families. The WIC program will continue to facilitate the Vendor Advisory Group to seek advice from and provide guidance to MA WIC retailers in maximizing the WIC shopping experience. WIC will also continue ongoing enhancements of the WICShopper app.
In FY22, WIC will replicate the implementation of the summer 2020 WIC Farmers’ Market Nutrition Program in partnership with the MA Department of Agricultural Resources to continue safe distribution of Farmers’ Market coupons during the pandemic. Instead of local program distribution events that were held pre-COVID-19, the state office will manage mass distribution of coupons to eligible participants via email. Through this email, eligible participants statewide will be invited to sign up via text message and be directed to the MA WIC Farmers’ Market website. The website includes information on locations where coupons are accepted, instructions for their use, nutrition education resources, and information about the Healthy Incentives Program, which is a dollar-for-dollar incentive that SNAP participants can earn when they buy fresh produce at participating Farmers’ Markets, farm stands, and community-supported agriculture plans.
In FY22 the value of Farmers’ Market Nutrition Program coupons will be raised from $25 to $30 per participant due to an award increase resulting from 2020 unspent funds caused by COVID-19-related challenges. This will coincide with a short-term increase in the MA WIC cash value benefit for fruits and vegetables supported through the American Rescue Plan. WIC plans to collaborate with the Healthy Incentives Program on a summer fruits and vegetables marketing campaign to promote both programs and the increased cash value benefit for fruits and vegetables.
WIC and Mass in Motion will continue to explore collaboration opportunities to support healthy food access and reduce food insecurity among families with young children, with a focus on ongoing impacts of the COVID-19 pandemic.
Metabolic Food and Formula Program
The Metabolic Food and Formula Program provides medically prescribed formulas and special low-protein foods for children and adults with a diagnosis of phenylketonuria (PKU) or other related metabolic disorders who lack insurance coverage for these items or are MassHealth recipients. In FY22, the program will continue to directly provide medically appropriate food and formula to low-income and/or underinsured children with metabolic disorders.
School Health Services
The Comprehensive School Health Services (CSHS) program expects to be able to refocus on existing school health needs in FY22 along with the continued pandemic response. Per federal and state legislation, each school district must have a Wellness Committee (also known as a Health Advisory Committee) at the district and individual school levels to monitor data and work with community partners, including local Mass in Motion groups, on strategies to promote healthy eating and active living. School food service departments work closely with the Department of Transitional Assistance to identify families who might qualify for free and reduced meals who do not self-identify through the application process. In FY22, these programs will work to address food insecurity that predates and was exacerbated by the pandemic, with the support of school nurses.
Objective 2. By 2025, increase from 103 to 150 the number of injury-related data, technical assistance, and press requests that are completed by Injury Prevention and Control Program staff annually.
Injury Prevention and Control Program
Injury prevention initiatives are important for increasing safe physical activity for children and youth. The Injury Prevention and Control Program (IPCP) provides information about injury prevention through trainings, policy analysis, and communications activities to state and community partners. IPCP conducts an annual review of technical assistance requests to which it has responded and uses that information to guide program activities, including updating and improving accessibility of IPCP webpages and identifying unmet community needs. In FY22, under the leadership of a new Training and Coalition Coordinator, IPCP will identify training needs and then develop trainings or form new partnerships to meet those needs. IPCP will also continue to track relevant bills filed by the legislature and signed into law to understand the policy implications, especially related to equity. Results of the analysis will be shared with MDPH leadership.
Several subprograms within IPCP expand the reach and specificity of IPCP technical assistance requests, including the following:
Traffic Safety
In FY22, the IPCP director will continue to serve as a tri-chair for the MA Traffic Safety Coalition. This multi-sectorial coalition explores evidence-based strategies to reduce and mitigate traffic and pedestrian crashes, including through environmental design, communications campaigns, and surveillance. In FY22, guided by technical assistance requests, IPCP staff will recruit presenters for quarterly coalition meetings, and assist with the dissemination of timely information. The IPCP team will also host at least one training on child passenger safety for home visitors and will identify and respond to additional training needs. IPCP will work closely with Injury Surveillance colleagues to identify trends in transportation-related injuries and disseminate data briefs.
Sports concussion
In FY22, the Sport Concussion program will continue to enforce the MA Sports Concussion Regulations by collecting year-end reports and letters of affirmation that schools have sports concussion policies in place. The program will also provide technical assistance and support to schools who receive a complaint about how they have handled concussions that occur during extracurricular athletic activities. IPCP will explore the evolving concussion science, especially repetitive concussions, as well as potential racial inequities in the implementation of post-concussion return-to-learn and return-to-play protocols with the aim of providing specialized support to under-resourced schools. MDPH will continue to collaborate with schools to adapt to the ever-changing education landscape due to the COVID-19 pandemic.
MassPINN
The MA Prevent Injuries Now! Network (MassPINN) is a broad-based coalition of injury prevention practitioners across the state. In FY22 they will continue broadening their membership, focusing specifically on MCH stakeholders. MassPINN disseminates a bi-monthly newsletter with key information about events, opportunities, research, and more about injury in MA. In FY22 they will explore new venues to disseminate information, attract new members, and provide technical assistance. At least one of the quarterly meetings will focus on racial equity and injury.
Healthy aging
IPCP coordinates activities related to older adult falls prevention, which is closely aligned with the Healthy Aging activities in the state. IPCP will share information about the healthy aging collaborative and affiliate programs with MCH staff so they are aware of opportunities for engagement and how the healthy aging movement can positively benefit MCH populations, especially accessibility for children and youth with special heath needs.
Priority: Strengthen the capacity of the health system to promote mental health and emotional well-being.
Objective 1 (NPM 6). By 2025, increase to 40% from baseline (37.3%, 2017-2018 NSCH) the percent of children, ages 9 through 35 months, who received a developmental screening using a parent-completed screening tool in the past year.
WIC
MA MIECHV
In FY22, MA MIECHV home visitors will continue to screen children with the Ages and Stages Questionnaire (ASQ) at the AAP-recommended intervals of 9, 18, 24 and 30 months and make referrals as needed. MA MIECHV home visitors will also continue to assess parent-child interaction using the PICCOLO or CHEERS Check-In screening tools, in adherence to the MIECHV performance measure on parent-child interaction. In addition, home visitors will continue to assess and report on the extent to which parents engage in activities to promote early childhood literacy.
Project LAUNCH/Early Childhood Mental Health Integration
Building on the success of MA LAUNCH and LAUNCH Expansion, for which funding ended in FY20, MDPH staff will continue to promote this model of integration of early childhood social and emotional health in pediatric primary care. In FY22, MDPH staff will provide technical assistance to MassHealth and other key stakeholders to implement MassHealth’s 1115 Waiver, which includes a pediatrics value-based payment model, to allow for team-based care to promote the integration of behavioral health, similar to LAUNCH. MDPH staff will also continue to promote early childhood mental health in the rollout of the state’s Behavioral Health Roadmap, which seeks to promote access to community-based care, including through behavioral health integration in primary care. In FY22, staff will further disseminate resources on the model including the LAUNCH/MYCHILD Practice Manual, the AMCHP Best Practice documentation, and a 4-part podcast series being developed by the Boston Public Health Commission. Staff will also disseminate a recent paper co-authored with the LAUNCH evaluators, Engaging and Supporting Young Children and their Families in Early Childhood Mental Health Services: The Role of the Family Partner.
In FY22, MDPH staff will continue to participate in the Infant and Early Childhood Mental Health Primary Care Integration Workgroup (formerly co-led by MDPH, and now co-led by the Department of Mental Health and the Children’s Mental Health Campaign).
MA Early Childhood Comprehensive Systems (MECCS)
Funding for the 5-year MECCS Impact project ended in July 2021. Unfortunately, MDPH was not awarded the ECCS Health Integration Prenatal to Three funding to continue its activities to promote child developmental health through strengthening early childhood systems. MDPH is exploring ways to sustain collaborative activities and partnerships beyond the grant funding.
In FY22, MECCS and Title V staff will continue their leadership roles in the cross-secretariat early childhood efforts initiated through the Preschool Development Grant B-5 (PDG B-5). While funding for the grant ended in December 2020, MDPH staff will support implementation of the post-PDG Memorandum of Understanding (MOU), “Establish Shared Performance Indicators and Related Activities to Support Early Childhood Development and Education,” to promote coordination and collaboration in providing and supporting early childhood development programs and services. The post-PDG MOU is an agreement to ongoing collaboration across state agency partners who participated in the PDG, including: Executive Office of Education, Executive Office of Health and Human Services, MDPH, Department of Early Education and Care, Department of Elementary and Secondary Education, and the Children’s Trust. The MOU builds on three key strategic focus areas developed through the PDG, including: 1) family outreach and engagement, 2) provider supports and professional development related to B-5 developmental screening and assessment, and 3) state agency coordination, especially in establishing performance indicators and continuing to share data.
Using information from the new Early Childhood Integrated Data System (ECIDS), as well as other available data and research, the leadership group will determine a specific set of activities that they will pursue together to make progress on one or more of the key performance indicators. These activities will focus on three strategic areas: meeting the needs of young children and their families; supporting providers and educators across the Mixed Delivery System; and building coordinated processes and data systems. MDPH staff will also support further use and dissemination of the products developed with PDG funding, including research on best practices to communicate with families about developmental milestones and strategies to promote uniform developmental screening as well as enhanced use of screening data across state agency programs. Title V staff serve on the board of the ECIDS and will help explore further iterations beyond initial elements, which include child participation, enrollment and transitions, longer term outcomes, and demographics such as race and ethnicity.
Young Children’s Council
The MDPH Young Children’s Council (YCC) will continue to hold quarterly virtual meetings in FY22. Council goals include: 1) alignment of MDPH and partners’ work related to infant and early childhood social emotional wellness and family well-being, 2) advising programs in the Division of Pregnancy, Infancy, and Early Childhood that focus on systems building, and 3) leading with the voices of families of young children from communities across MA to ensure these programs are designed and delivered fairly, equitably, and effectively. FY22 YCC meetings will focus on the continued impact of the pandemic on young children’s development and family well-being and raise up resources and recommendations for state agencies and their partners to effectively respond to ongoing and emerging needs.
In FY22, YCC membership will continue to include state and community agency representatives as well as growing family and community representation, including male caregivers and families with a diversity of life experiences. Compensated family leaders will take on increasing levels of leadership, including co-designing agendas, providing presentations, and leading discussion groups.
Additional activities to strengthen the capacity of the health system to promote mental health and emotional well-being
Essentials for Childhood
The goal of Essentials for Childhood (EfC) is to prevent child abuse and neglect by promoting safe, stable, nurturing relationships and environments. In FY22, EfC will continue its focus on promoting social connectedness in ways that allow power and resources to be shared equitably.
The initiative’s Community Connection team will lead an effort to co-create and pilot resources for a Community Social Connectedness Toolkit in partnership with families and community members across the state. This toolkit will include families’ preferred approaches to accessing supports and services to promote their young children’s development. Due to COVID-19, the methods for creating this toolkit will include virtual focus groups and stakeholder interviews. EfC will also track the process of working with and for the community, as this may be an important tool for other programs seeking to be responsive to community needs.
To ensure that community voices guide the initiative, the EfC Racial Equity team will support a newly forming community governance body. EfC will continue to pay Family Leaders to facilitate this group, and the Racial Equity team will support other capacity building as needed during the group’s start-up period. EfC will also identify accountability structures between the current Leadership Team and the new community governance body and will document these processes to serve as a resource to others.
The cross-sector EfC Leadership Team and Collective Impact Team members will continue to participate in the Racial Equity Institute 2-day trainings, which are now being offered virtually. The learning from these trainings directly informs the work of EfC and has further impact for the state agencies and community organizations represented on these teams.
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