Due to the outbreak of coronavirus 2019 (COVID-19), all plans are subject to change based on the needs of the population. MCH will assess all in-person meetings and events for the need to move to a virtual format. MCH will continue to monitor the pandemic and adjust plans accordingly.
NPM 6: Percent of children, ages 9 through 35 months, who received a developmental screening using a parent-completed screening tool in the past year.
The American Academy of Pediatrics recommends all infants and children between 9 to 35 months of age receive screenings for developmental delays during well-checks using standardized screening tools. These screenings involve a questionnaire administered by the doctor to the parent and include age-appropriate questions for parents about the child’s development, including communication and social development. The National Survey of Children’s Health includes a question about screening for developmental delays, and their 2016-2018 data supports the participant’s perceptions regarding a need for developmental screenings. In the United States and Texas, most parents (68 percent and 63 percent, respectively) reported that they did not complete a developmental screening with their doctor for their child.
The FY20 Title V Needs Assessment identified the need for increased developmental screenings in children in Texas. The finding came up in focus group discussions among parents and providers of children. Some parents spoke from personal experience, explaining that it was difficult to get their child developmental screenings. Other focus group participants explained that these screenings need to be more widely available. An education component was also a topic of discussion, as participants explained that both providers and families should be educated on milestones and developmental screening.
MCH leads several efforts throughout Texas aimed to improve the state’s developmental screening capacity, including facilitating the Developmental Screening Workgroup, serving as the Help Me Grow Texas organizing entity, and creating and updating content for the child health webpage.
To sustain the work of the Texas LAUNCH Expansion Grant, the LAUNCH developmental screening workgroup transferred to MCH at the close of the expansion grant in FY19. In FY21, the workgroup will continue to identify and connect similar initiatives, create collective goals, and participate in collaborative efforts to increase screenings and quality service referrals statewide. The workgroup will continue to meet every other month instead of monthly to allow time for concentrated efforts to occur.
To expand on the momentum created during the LAUNCH grant, MCH started leading efforts in creating and implementing a coordinated early childhood system in FY20. The system is modeled after the Help Me Grow (HMG) framework. Texas will incorporate community engagement, family voice, health and care provider outreach and education, health equity, and sustainable quality improvement systems. While the focus of HMG Texas in FY21 will be to increase developmental screening and supports, there is potential for this system to expand to include a variety of other child health factors.
In FY20, DSHS was identified to coordinate HMG National Center support for six communities in the state. In consultation with HMG National Center, DSHS plans to divide the six communities into two cohorts through FY22. The communities will receive technical assistance and guidance from HMG National Center and support from MCH as they incorporate the HMG framework in their local area. During FY21, MCH will support one to four communities in assessing community readiness, community needs and assets, potential for success, and the feasibility of their proposal. HMG National Center will train communities on best practices, fidelity, evaluation, and quality improvement. Continuing in FY21, MCH will receive technical assistance from HMG National Center regarding effective and efficient organization and leadership of a statewide early childhood system. MCH’s work as the HMG organizing entity in Texas will be incorporated into other efforts and initiatives such as the state strategic plan for early childhood, the State Developmental Screening Workgroup, and the Pritzker grant awarded to the Texas Prenatal-to-Three (PN-3) Collaborative. Alignment between initiatives were identified in FY20 and plans for collective impact will be identified in FY21.
The State Child Health Coordinator will collaborate with the MCH Communications Specialist to maintain a webpage devoted to child health in Texas. The webpage will feature content about MCH’s programs, stakeholder resources, and current health information for children. The content will provide information relevant to each NPM. In response to COVID-19, information will include violence prevention for parents while kids are home, safe mask usage for young children, and starting handwashing early in life.
MCH funds several efforts throughout Texas aimed to improve the state’s developmental screening capacity, including projects expanding on the HMG framework, a Child Care Health Consultant grant, the Pediatric Brain Health Summit, and A Parent’s Guide to Healthy, Happy Children design and distribution.
In conjunction with the Help Me Grow Texas (HMGTX) initiative, MCH will fund two contracts for early childhood systems development in FY21. The first contract is with My Health, My Resources of Tarrant County (Tarrant County), the first implementer of the Help Me Grow model in Texas. With Title V funds, Tarrant County aims to stabilize their system through continuous quality improvement and replicate their systems development success in 12 surrounding counties. The second contract is with the Texas Institute for Excellence in Mental Health (TIEMH). TIEMH will provide technical assistance to communities to enhance readiness for developing effective, comprehensive early childhood systems. TIEMH will also develop a three-year strategic plan to support the expansion of these systems. In FY20, in response to increased calls to Care Navigators, Tarrant County was able to launch its centralized call center sooner. This launch allowed the Navigators to be a resource for families during the pandemic. In FY21, MCH will coordinate with Tarrant County to identify opportunities for replication in other communities.
Healthy Child Care Texas (HCCT) is a Child Care Health Consultant (CCHC) train-the-trainer program based on the Caring for Our Children National Health and Safety Performance Standard: Guidelines for Out-of-Home Child Care Programs. The curriculum addresses multiple aspects of health and safety as well as developmental milestones. FY21 will be the third year of the HCCT contract with the Texas Association for the Education of Young Children (TXAEYC). The focus will be to implement the HCCT-Social and Emotional Development (HCCT-SED) program. HCCT-SED assists childcare centers in improving early childhood developmental outcomes for the children in their care. The program will continue to:
- Train CCHCs to be train the trainers in the ASQ-3 and ASQ:SE-2 developmental screening tools;
- Provide a resource listing to locate CCHCs in each community;
- Provide a portal to collect data on assessed childcare centers;
- Provide scholarships to cover childcare centers’ assessment costs;
- Address any CCHC findings; and
- Train childcare staff on ASQ-3 and ASQ:SE-2 tools.
As a result of COVID-19, some delays in completing the HCCT-SED pilot in Harris County have occurred. Nearly half of all childcare centers in Texas closed in the spring of FY20 and most open centers were not accepting their usual capacity. During this time, TXAEYC transitioned some of their training efforts to a virtual format. Additionally, TXAEYC estimated fall enrollment to be the next best time to complete screenings. Several centers are not expected to complete these promised activities in time and plan to complete them in early FY21. No effects are yet seen for the Bexar County HCCT-SED pilot planned to begin in FY21. As needed in FY21, CCHCs will pivot some of their activities to ease burdens and alter technical assistance to address COVID-19.
The Pediatric Brain Health Summit (PBHS) is part of a multi-sector, multi-agency collaboration focused on the prenatal to three-year-old developmental window. The purpose of the PBHS is to bring together community-based organizations and health care professionals to discuss and learn about strategies for promoting pediatric brain health. The PBHS is a collaboration between the Texas Department of Family and Protective Services (DFPS), DSHS, Episcopal Health Foundation, the St. David’s Foundation, Casey Family Programs, The University of Texas System, and The University of Texas Health Science Center at Tyler (UTHSCT). The third PBHS will be held in FY21 and will continue the momentum from prior summits by building stronger connections between providers and community organizations.
In conjunction with the work of the PBHS, community partners and community health worker (CHW) resources and trainings will be adapted and promoted in FY21. For CHWs in Texas, there is not a CHW curriculum that is focused on child development in the birth to age three range. DSHS aims to provide high-quality training to utilize the strength of the state's CHW workforce to promote positive parenting and early brain development. The training will align with the framing of development work and with the core competencies of CHWs. Existing brain health materials will be translated into Spanish, including the Brain Architecture Game, early brain health infographics from UTHSCT and DFPS, executive functioning games for parents by the Harvard Center for the Developing Child, and select Core Brain Health Certification modules that will be useful for training and guiding language to be used with families. UTHSCT will work with The University of Houston Honor College for CHWs to take the information from the above resources to build a CHW curriculum focused on promoting early childhood brain development. This curriculum will aim to capture the core concepts of early brain development and provide CHWs with practical actions that they can take with families. UTHSCT will use components of the CHW curriculum for online videos and modules. These digital resources will be available for use by other community partners.
To promote the need for developmental screenings and monitoring, MCH will continue to fund updates and dissemination of A Parent’s Guide to Raising Healthy, Happy Children, a legislatively mandated guide provided by physicians to pregnant women and new parents who receive Medicaid. In FY20, a new vendor was identified to design, update, and distribute the guide. The new vendor has prior experience in assisting MCH’s former vendor in these tasks. This comprehensive guide is in print and online and includes information on:
- Developmental milestones, screening tools, and timelines;
- Safety measures such as safe sleep practices, child car seat safety, and safe sibling interactions;
- Promotion of smoke free environments for babies and young children; and
- Nutritional milestones and feeding best practices
In addition, MCH will coordinate with the state Learn the Signs. Act Early. (LTSAE) ambassador to promote and distribute the Center for Disease Control and Prevention’s LTSAE materials. These materials encourage tracking children’s development and addressing concerns early.
MCH will also continue to partner with other organizations and agencies to address NPM 6, including participating in the Inter-Agency Workgroup, Early Childhood Systems Integration Group, and the Texas Early Learning Council.
The Inter-Agency Workgroup (IAW) is a collaboration of early childhood state agencies that are coordinating initiatives to have a more significant collective impact in the child wellness sector. The IAW will continue to meet monthly in FY21 to discuss ongoing activities and align agency work with other statewide efforts, such as the Pritzker grant and the Texas Early Learning Strategic Plan. In response to COVID-19, the IAW took on support of the Child Care Taskforce to assist in providing health and safety information. If needed, support of the Taskforce will continue in FY21.
In FY21, MCH will continue to actively participate in the Early Childhood Systems Integration Group (ECSIG). In FY19, the ECSIG became the data-focused subgroup of the IAW that combines efforts to track trends via results-based accountability measures by standardizing data collection and sharing practices across state agencies. The main product of the ECSIG in FY20 was the State of Texas Dashboard for Early Childhood Outcomes (DECO). The DECO’s purpose is to provide visualization and understanding regarding the collective impact of the ECSIG partner’s aligned contributions and impact for children. The three goals of the combined efforts are: children in Texas are healthy, children in Texas are safe, and children in Texas are on track to be school ready. DSHS-owned data are used to represent several key indicators for these goals. MCH will continue to provide epidemiological and subject matter expertise during DECO reviews in FY21. MCH will also promote the DECO to relevant stakeholders.
The Texas Early Learning Council (TELC) serves as the state’s advisory council, as required by the federal Improving Head Start for School Readiness Act of 2007, to improve the quality of and access to early childhood services across Texas. The TELC is comprised of cross-sector stakeholders who work to increase coordination and collaboration across state agencies and local entities. During FY21, the Title V Children with Special Health Care Needs Director/Child and Adolescent Health Branch Manager will represent DSHS on the council. In the absence of the Preschool Development Grant Birth through Five Implementation Grant award, the TELC is tasked to identify existing strategies within the state’s Early Learning Strategic Plan that aid accomplishing the goal of all Texas children are ready for school and ready to learn. MCH’s work as the Help Me Grow Texas hub will serve as a catalyst to accomplish several strategic plan activities.
MCH supports multiple initiatives aimed to improve the state’s developmental screening capacity, including the Texas Prenatal-to-Three Collaborative, the Children and Youth Behavioral Health Subcommittee, the Early Childhood Intervention Advisory Committee, and the Texas Health Steps’ Online Provider Education program.
Texas Prenatal-to-Three (PN-3) Collaborative became a Pritzker grantee in FY20. The PN-3 Collaborative is led by three Texas child advocacy organizations that are working with advocacy allies, policymakers, philanthropists, and state and community leaders to develop and implement a policy agenda that supports families and children during the first three years of life. A key goal of the PN-3 Collaborative is the expansion of a “universal connection” system to assess, screen, and refer families to support services in the postpartum period and early childhood years. Collaborative work will occur in FY21 on these shared visions. MCH will lead the efforts to generate and manage a plan for a coordinated system of early childhood services.
The Children and Youth Behavioral Health Subcommittee (CYBHS) is a subgroup of the Behavioral Health Advisory Committee (BHAC). The BHAC serves as the primary advisory voice to the Texas Health and Human Services Commission for issues related to mental health and substance use. The CYBHS provides recommendations on children and youth behavioral health topics and serves as the advisory body for the Texas System of Care, a framework to provide a spectrum of accessible, responsive, and effective services and supports. The State Child Health Coordinator will represent DSHS on the CYBHS during FY21. In this role, the State Child Health Coordinator will provide subject matter expertise and collaborate on cross-sector initiatives.
The Early Childhood Intervention (ECI) Advisory Committee advises the HHSC Division for Early Childhood Intervention Services on development and implementation of policies that constitute the sate ECI system. The Maternal and Child Health Section Director represents DSHS on the advisory council.
Education will continue to be provided through the Texas Health Steps’ Online Provider Education modules related to developmental screening to providers, teachers, regional staff, and other key stakeholders. Title V staff will continue to provide subject matter expertise for module reviews in FY21.
MCH staff have identified the need to incorporate health equity strategically throughout the Child, Adolescent, and Children with Special Healthcare Needs (CSHCN) domains. In FY21, MCH plans to dedicate one hour a month to racial health equity staff development. The team will use that time to identify personal bias and program areas where a health equity framework should be incorporated. This effort will address all NPMs.
NPM 7: Rate of hospitalization for non-fatal injury per 100,000 children, ages 0 through 9.
Various types of child abuse and neglect are categorized as ACEs. Data from Child Protective Services indicates that neglect is the most prevalent type of child maltreatment in Texas. In 2017, 83 percent of confirmed cases of child maltreatment were cases of neglect. Physical and sexual abuse cases were 14 percent and 10 percent, respectively. Cases of neglect have been consistently higher for the past three years among all types of child maltreatment.
Another focus of injury prevention among parents and providers of children in Texas include bullying and its relation to child mental health. Focus group participants noted that bullying could lead to outcomes like school shootings and suicide. Mental health for children was also identified as one of the major needs in Texas through key informant interviews and focus groups. Participants expressed concern over the lack of mental health resources and addressed the need for mental health resources geared specifically towards children.
There is also a racial health disparity among child injury and fatalities. Black children are disproportionately affected by ACEs, experience more injuries and greater fatalities, and are at a greater risk for long-term complications as a result of injury or violence.
MCH funds several initiatives aimed to reduce the rate of hospitalization for non-fatal injuries in children aged 0-9, including the Medical Child Abuse Resources and Education System, Parent’s Guide for Happy, Healthy Children design and distribution, the Healthy Child Care Texas grant, and Help and Hope videos.
MCH will continue to implement the legislatively mandated Medical Child Abuse Resources and Education System (MEDCARES) grant program to develop and support regional initiatives providing a comprehensive approach to preventing, assessing, diagnosing, and treating child abuse and neglect. An additional goal of the program is to build infrastructure that increases access to medical child abuse experts and improves timely and accurate child abuse diagnoses. There are 11 MEDCARES programs around the state located in hospitals and academic health centers with expertise in pediatric health care. In FY21, MEDCARES programs will continue to expand prevention programs like the Period of Purple Crying and education activities to Children’s Advocacy Centers, schools, community partners, and law enforcement on recognizing and reporting child abuse. In response to concerns about increased cases of child abuse and neglect due to COVID-19, MCH hosted voluntary collaborative meetings twice monthly in FY20. These meetings allowed MEDCARES contractors an opportunity to discuss emerging trends, share resources and ideas, and identify best practices. If needed, these meetings will continue in FY21.
MCH will continue to fund the design and distribution of A Parent’s Guide to Raising Healthy, Happy Children. Further information about the Guide can be found in NPM 6. In response to the COVID-19 pandemic, the FY21 revision will include hand washing and proper hygiene for young children.
Funding will continue for the Healthy Child Care Texas grant for training Child Care Health Consultants (CCHCs). The CCHC curriculum addresses multiple aspects of injury prevention in a childcare setting, including drowning, poisoning, falls, recognizing abuse, and how to provide an environment free of toxins and chemicals. MCH provides the CCHC certification and training requirements, which ensures that qualified health and childcare professionals are available to provide health and safety assessment and guidance to out-of-home childcare centers and family childcare homes in Texas. MCH will work to expand the program to increase the number of trainers available to provide health and safety guidance and resources to childcare facilities. As a result of COVID-19, CCHCs will pivot some of their FY21 activities to ease burdens and alter technical assistance to address infectious disease transmission and other relevant health and safety factors.
In partnership with the Prevention and Early Intervention (PEI) Division of the Texas Department of Family Protective Services, MCH will fund the creation of another Help and Hope parenting video. The video will focus on minimizing stressors during the transition from childhood to adolescence. During this vulnerable time, youth often face difficulties with assimilating in new schools, changing relationship dynamics, and increased autonomy. The video will encourage caring adult relationships to decrease the chances of mental health complications and self-inflicted harm. PEI will produce the video with input from the State Child Health Coordinator and the State Adolescent Health Coordinator.
MCH will continue to work with and provide injury prevention resources and trainings to stakeholders through MCH regional staff meetings, Friday Beat school health newsletter dissemination, Texas Health Steps Online Provider Education modules, and trainings. Additionally, MCH joined the Violence Prevention Advisory Panel hosted by PEI. The panel was created in response to COVID-19 and will continue in FY21 if needed.
MCH will continue to support and collaborate with the DSHS School Health program in the creation and distribution of the Friday Beat, an e-newsletter that is sent to over 6,700 school health stakeholders every Friday. The Friday Beat features articles and resources related to injury prevention in each edition.
MCH will continue to provide technical assistance to local child fatality review teams (CFRTs) to increase quality and quantity of reviewed deaths and increase the number of counties covered by CFRTs. The State CFRT will continue to focus on ensuring all of Texas’ 254 counties are covered by review teams and increasing the percentage of deaths reviewed. Continuing education opportunities for local CFRTs will focus on improving the review process in communities and address preventable deaths in Texas.
Education will continue to be provided through the Texas Health Steps’ Online Provider Education modules related to pediatric injury prevention to providers, teachers, regional staff, and other key stakeholders. Title V staff will continue to provide subject matter expertise for module reviews in FY21.
The Children and Youth Behavioral Health Subcommittee (CYBHS) provides recommendations on children and youth behavioral health topics as it relates to injury prevention. The group addresses topics such as trauma-informed care, statewide systems of care, and suicide and self-harm prevention. Further information about the CYBHS can be found under NPM 6.
NPM 14.2: Percent of children, ages 0 through 17, who live in household where someone smokes.
The Texas Asthma Control Program (TACP) began in FY20 as part of a competitive grant award from the Center for Disease Control and Prevention. The TACP is developing a statewide strategic plan which includes addressing asthma triggers like secondhand smoke. The goal of this component of the strategic plan is to reduce tobacco smoking among adults and child exposure to secondhand smoke. The State Child Health Coordinator will participate in the Texas Asthma Control Collaborative (TACC) in FY21. The TACC serves as guidance to the TACP and will form workgroups to implement strategies identified in the strategic plan.
Education will continue to be available through the Texas Health Steps’ Online Provider Education modules related to secondhand smoke to providers, teachers, regional staff, and other key stakeholders. Title V staff will continue to provide subject matter expertise for module reviews in FY21.
SPM 2: To reduce the prevalence of overweight and obesity in Texas children ages 2-21.
Based on body mass index calculations for second and fourth graders from the 2015-2016 Texas School Physical Activity and Nutrition (SPAN) data, DSHS estimates that about 40 percent of students are over the normal weight range for their height and about one out of four students are obese.
Child nutrition emerged as a theme in both the key informant interviews and focus group conversations. Discussions on this topic included what children were eating at school and home, nutrition education for children, food security concerns, and nutritional resources available to children. When looking at child nutrition as a need, the focus was mostly on addressing food insecurity and increasing education and awareness about nutrition.
Many children in the United States live in food-insecure households. Of all 50 states, Texas ranks fifth for child food insecurity, with over 22.5 percent (over 1.6 million children) living in food insecurity. This percent exceeds the national average of 17 percent. Living in food insecure areas with little to no access to nutritious foods can impact the overall health of children and act as a risk factor for obesity and other conditions.
The U.S. Department of Health and Human Services set national guidelines for physical activity for children and adolescents with the recommendation of participating in 60 minutes or more of physical activity daily. For youth, physical activity is associated with stronger bones, lower body fat and thus reduced risk of obesity, reduced risk of chronic health conditions, improved cognitive function, and enhanced mental health. Based on 2015-2016 Texas SPAN data, it is estimated that only 22 percent of second grade students, and only 9 percent of fourth grade students are meeting this recommendation.
To address the prevalence of overweight and obese children in Texas, MCH leads an innovative nutrition initiative. In FY21, MCH will continue the work from the Children’s Healthy Weight Collaborative Improvement and Innovation Network (CHW CoIIN) by participating in the Maternal and Child Health Workforce Development Center’s (MCH WDC’s) 2020 Cohort program. The State Child Health Coordinator co-leads the Texas 2020 Cohort team. In FY20, the Texas team participated in technical assistance with the goal to break down structural silos within MCH via a nutrition program.
MCH funds multiple initiatives to address SPM 2, including the Healthy Child Care Texas Grant, the Texas School Physical Activity and Nutrition project, and, the A Parent’s Guide to Raising Healthy, Happy Children design and distribution.
To address obesity in early childcare, MCH will continue to fund the Healthy Child Care Texas (HCCT) grant in partnership with DSHS’ Obesity Prevention Program and Texas A&M AgriLife Extension. Part of the grant will be used to create obesity prevention online training modules for childcare staff, parents, Child Care Health Consultants (CCHCs), and trainers on the Texas Trainer Registry. The trainers will educate childcare professionals on the Texas Rising Star childcare quality rating system standards regarding healthy eating and active living. Technical assistance will be provided to help create better childcare environments that support healthy habits.
Two programs focused on obesity are incorporated into the HCCT grant. First, the Outdoor Learning Environment (OLE!) initiative improves outdoor spaces at childcare centers by adding design elements that encourage children to be active, learn in nature, and develop motor skills. Next, Nutrition and Physical Activity Self-Assessment for Child Care (Go NAPSACC) provides an avenue for childcare centers to assess their facility and identify topics of technical assistance need. MCH will continue to fund statewide access to Go NAPSACC.
In FY21, the fifth cycle of data collection for the Texas School Physical Activity and Nutrition (TXSPAN) project was planned to conclude. TXSPAN is a statewide surveillance system which monitors trends in body mass index and health behaviors of children in 2nd, 4th, 8th, and 11th grades. In conjunction with MCH Epidemiology, The University of Texas Health Science Center planned to clean, analyze, and publish data collected during the 2019-2020 school year. The data will be used in updating and creating additional Child Health Status Reports, which are one-pagers used to educate policymakers on the importance of child health in Texas. As a result of COVID-19, TXSPAN cancelled all further data collection efforts for FY20. The majority of the measurements occur in late spring and only half of the data was collected by mid-March 2020. By the time schools in Texas closed, TXSPAN’s data sample did not meet requirements to be representative of the state and health service regions. MCH identified alternative options for the contract and pursued a contract extension. TXSPAN plans to complete data collection during the 2020-2021 school year.
MCH supports several initiatives to address SPM 2, including the Early Childhood Obesity Prevention Committee and the Texas Health Steps Online Provider Education program.
The Early Childhood Obesity Prevention Committee is a multi-sector collaboration to improve the weight status of our children in Texas. The committee is divided into four subgroups that follow the socio-ecological model: policy, community, facility, and professional. Each subgroup convenes to identify goals, define activities, and develop steps to achieve each activity. The State Child Health Coordinator will participate in the community- and facility-level subgroups.
Education will continue to be provided through the Texas Health Steps Online Provider Education modules related to obesity prevention to providers, teachers, social workers, regional staff, and other key stakeholders. Title V staff will continue to provide subject matter expertise for module reviews in FY21.
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