Application for FY21

For Child Health (CH), New York’s Title V program selected National Performance Measure (NPM) 8.1: Percent of children, ages 6 through 11, who are physically active at least 60 minutes per day. This NPM was selected because it is responsive to concerns voiced directly by families in NYS and reinforced by state-specific population health data.

Over 14% of NYS children age 10-17 are obese, and only 27% of NYS children age 6-11 years are physically active for at least 60 minutes daily. NYS families identified the availability and accessibility of amenities that support children’s safe, active play and access to healthy foods as top priority needs, alongside priorities for community and environmental safety for children and community transportation. Supporting healthy, active play and recreation for children and youth of all ages is critical to promoting healthy weight as well as general physical and mental health during childhood and throughout the life course. In addition, this measure provides opportunities to be responsive to the Title V priorities for health care access and quality, social support, and social cohesion. This NPM aligns directly with NYS Prevention Agenda goals for physical activity and chronic disease prevention. 

The NYS Title V program has important capacity to address these priorities through its School Based Health Center (SBHC) program and through collaboration with the NYSDOH Creating Healthy Schools and Communities program to enhance environmental infrastructure and supports, both in schools and in the community, to support physical activity. SBHCs serve NYS’s highest need communities and provide critical access to quality primary care for school-aged children.

Two specific objectives were established to align with this performance measure:

Objective CH-1: Increase the percent of NYS children age 6-11 who are physically active at least 60 minutes per day by 3.7%, from 27% in 2017-2018 to 28% in 2021-2022 (National Survey of Children’s Health, NSCH).

Objective CH-2: Decrease the percent of NYS children age 10-17 who are obese (BMI at or above the 95th percentile) by 2.8%, and from 14.4% of children age 10-17 in 2017-2018 to 14% in 2021-2022 (NSCH).

Four strategic public health approaches were identified to accomplish these objectives over the next five years. These are presented in the State Action Plan (SAP) Table, and each is described in more detail here, with specific program and policy activities that will be implemented to advance the broader strategic approach in the upcoming year. 

Strategy CH-1: Promote evidence-based and family-centered health care for children to promote healthy behaviors and to prevent, identify, and manage chronic health issues so that children can be healthy and active.  

To be physically active, children’s basic health needs for growth, development, and good nutrition must be met. Health care providers play an important role in promoting physical activity and other healthy behaviors, and in managing children’s health needs including mental health, obesity, asthma, and other special health care needs and challenges that may impinge on children’s ability to participate in active play and recreation. Health care providers should follow current evidence-based guidelines for anticipatory guidance, screening, counseling, and disease management, including guidelines specific to physical activity and healthy weight, and help guide children and their families in finding and using available community resources for active play and recreation.

School Based Health Centers (SBHCs) are an important source of primary and preventive care services for thousands of NYS children and have the opportunity and capacity to holistically address children’s needs. Title V staff will work with SBHCs statewide to ensure anticipatory guidance to promote proper nutrition and daily physical activity, weight status assessment, and attention to overall health promotion and chronic disease management, as part of routine primary and preventive care for children. In addition, the Title V program will continue to support an array of core public health programs that address children’s health and wellness and access to and primary and preventive health care services.

The Title V program will lead the following specific program and policy activities to advance this strategy over the upcoming 2020-21 year:

• Provide guidance and add quarterly reporting requirements for all funded School-Based Health Centers (SBHCs) to increase provision of 1) age-appropriate anticipatory guidance regarding physical activity and nutrition and 2) routine assessment for indicators of overall health, one of which will be weight status but it will not be the sole factor. Data from quarterly reports will be reviewed and reports will be generated for feedback to SBHCs to assess progress and drive improvements in these practices.  
• Promote the use of the American Academy of Pediatrics (AAP)’s Bright Futures model for anticipatory guidance in SBHCs and seek opportunities to engage AAP for assistance to promote this resource. 
• Incorporate guidance, reporting, and tracking to support SBHCs to engage their dental patients in conversations about physical activity and nutrition through the delivery of anticipatory guidance on nutrition including water and sugar-sweetened beverage consumption, and work with SBHCs to ensure that enrolled students have an established dental home to promote optimal oral and overall health.
• Explore opportunities to collaborate with New York School-Based Health Alliance (NYSBHA) to support SBHCs’ increased effort towards promoting physical activity such as hosting webinars with subject matter experts.
• Within the Title V program, strengthen collaboration between child- and adolescent- serving programs to enhance promotion of physical activity through established programs that focus on adult-led activities and social-emotional wellness. 
• Collaborate with the NYSDOH Division of Nutrition to incorporate public health nutrition messaging with physical activity guidance across child health programs, including SBHC and CYSHCN programs.  
• Continue to directly support a portfolio of Title V-funded programs and services that promote children’s wellness and enhance access to comprehensive primary and preventive care services for children, including:
  • School-based dental sealant and community water fluoridation programs to promote children’s oral health and reduce dental caries as key contributors to children’s overall health and well-being.
  • American Indian Health and Migrant and Seasonal Farmworker Programs to ensure access to primary and preventive care services for children and families in underserved populations. 
  • Comprehensive Services and Health Systems Approaches to Improve Asthma Control in New York State to improve the quality and availability of guidelines-based asthma care.
  • Local Health Department-based Lead Poisoning Prevention Programs and Regional Lead Resource Centers to promote risk-assessment, blood lead level testing, evaluation, and care management to reduce the prevalence and impact of elevated blood lead levels in children.

Strategy CH-2: Promote home, school, and community environments that support developmentally appropriate active play, recreation, and active transportation for children of all ages and abilities. 

To achieve state goals related to increasing physical activity among children, children and their families need safe, appealing, and accessible places to play and be active – at home, in school, and in their neighborhoods and communities. Across the community listening forums, families and children voiced a desire for amenities in their neighborhoods that provide opportunities for active play and daily physical activity, such as playgrounds, athletic facilities, greenspace, and community centers. They want streets, sidewalks, and trails that are accessible and safe for walking and biking, both for transportation and recreation. They want these areas to be clean, appealing, and safe for children and families. They want to know what is available, have a way to get there, and feel welcome and included. These concepts are central to the mission of the NYSDOH Creating Healthy Schools and Communities program. Title V staff will develop strong relationships with this program and integrate SBHC staff into the program’s local efforts to enhance outcomes for the communities served. 

The Title V program will lead the following specific program and policy activities to advance this strategy over the upcoming 2020-21 year: 

• Collaborate with the NYSDOH Division of Chronic Disease Prevention (DCDP) to implement multi-pronged strategies to enhance the work of Creating Healthy Schools and Communities grantees, and other initiatives aimed at increasing children’s physical activity.
• Facilitate partnerships between local Creating Healthy Schools and Communities grantees and SBHCs to engage and educate community partners, families and community residents on the benefits of physical activity through Complete Streets implementation, including Safe Routes to School programs.    
• Actively participate in DCDP’s Pediatric Obesity Prevention Work Group, contribute to the direction of the group, and establish mutually beneficial priorities.

Strategy CH-3: Apply public health surveillance and data analysis findings to improve services and systems related to children's health and health care. 

Data-driven, evidence-based practice is essential to achieving public health goals for the Title V program. Across all Title V programs, continuous effort is needed to enhance the collection, analysis, and sharing of data to inform the planning and implementation of Title V-funded programs and policy work. Sharing data with stakeholders, including providers and community members, is critical to raise awareness, empower community action, and facilitate quality improvement efforts at all levels.    

The Title V program will lead the following specific program and policy activities to advance this strategy over the upcoming 2020-21 year:  

• Collaborate with the U.S. Census Bureau to conduct an over-sample of NYS 2021 National Survey of Children’s Health for NYS to allow for enhanced sampling of Black/African-American, Hispanic, and CYSHCN.
• Design and implement a SBHC data collection system that allows SBHCs to identify, track, and address disparities within the SBHC.
• Engage and survey stakeholders to identify, track, and address disparities within the SBHC. 
• Explore collaborative opportunities with DCDP’s Bureau of Chronic Disease Evaluation and Research to review and share information on student weight status assessments to inform SBHC work in this area.

Strategy CH-4: Apply a health equity lens to Title V activities to address social determinants of health and reduce disparities that impact children’s health and well-being.

Child health outcomes are impacted by social determinants of health (SDOH), or the conditions in which people are born, live, work, play, learn, and age. SDOH include factors like socioeconomic status, education, community environment, employment, social supports, and access to health care services. Systematic differences in the distribution of power and resources due to racism and other biases are root causes of inequities in access, availability, and quality of SDOH. All ten priorities that emerged from community members' input during the needs assessment revolve around SDOH and inequities. These factors and inequities impact the health outcomes of both individuals and entire communities.

SBHCs are located in the highest needs areas of NYS. The school communities served are disadvantaged economically and disproportionately impacted by key social determinants of health such as housing, transportation, employment, access to health care, and sources of healthy food. Families facing day-to-day challenges of poverty and racism, may be less able to prioritize or take advantage of opportunities for recreational physical activity. 

Development of community resources, public health programs, and other opportunities to promote physical activity need to be viewed through an equity lens. SBHC staff can have a direct effect on their school communities by assessing the physical activity needs and weight status of the students, helping to identify barriers to exercise and healthy food, and partnering with key stakeholders to take action to create a more equitable distribution of resources. These steps can contribute to environmental improvements that lead to increased physical activity and reduce health disparities attributed to lack of exercise and unhealthy lifestyle. 

The Title V Program will lead the following specific program and policy activities to advance this strategy over the upcoming 2020-21 year:

• Design the new SBHC data collection system with a racial justice and health equity lens, building a reporting tool that allows SBHCs to identify, track, and address disparities within the SBHC (site or provider level)
• Partner with key stakeholders such as the Community Health Care Association of New York State (CHCANYS) and NYSBHA to identify and share best practices for SBHCs to address racial justice and health equity.

The NYS Title V program established one Evidence-Based Strategy Measure (ESM) to track the programmatic investments and inputs designed to impact NPM 8.1:

ESM CH-1: Percent of children and youth enrolled in SBHCs who have documentation of counseling or anticipatory guidance on physical activity and nutrition during a visit to a SBHC within the past year.

Data for this measure will come from the SBHC quarterly reporting system. As this is a new measure, the baseline value will be established in FFY 2020-21, with improvement targets for subsequent years set once the baseline is available.