Priority: Optimize Children’s Physical and Oral Health

Performance Measure (NPM): Percent of children, ages 6 through 11, who are physically active at least 60 minutes per day.

Current Efforts

Strategy: Increase the number of schools and early care and education sites that receive support and targeted outreach to improve policies and meet best practices for increasing physical activity opportunities for youth they serve

During FY22, the Maine CDC worked with Maine Roads to Quality (MRTQ), Maine Department of Education (Maine DOE), Maine Afterschool Network (MASN) and Let’s Go! to identify new or existing sites (schools, early childhood education (ECE), and out of school (OOS) programs) with policies that do not meet national standards for providing adequate and appropriate physical activity (lacking recess, physical education periods). Targeted professional development is based on needs of sites, including addressing limited time, space, and remote access. Ongoing constraints created by the pandemic resulted in many partners using online virtual platforms to provide technical assistance, resources, support, and trainings. The types of technical assistance offered include but are not limited to policy review, environmental strategy implementation support, general education, and online training.

The following activities occurred:

During the first quarter of FY22, Let’s Go! analyzed FY21 annual survey data to identify sites to target and engage with. Of all Let’s Go! registered sites (1124), the following were identified as needing further work and support, specific to improving outcomes for physical activity:

• Schools: 215 of the 317 (68%) registered were identified as needing training and technical assistance support for implementation of best practice and higher standards.
• OOS: 124 of 125 (99%) sites were identified as needing training and technical assistance support for implementation of best practice and higher standards.
• ECE: 462 of 472 (98%) registered were identified as needing training and technical assistance support for implementation of best practice and higher standards.

Over the second and third quarters, Let’s Go! reviewed and is updating the “Let’s Go! Guide to Success” environmental assessments for Schools, ECE and OOS programs and aligned with national recommendations to make it a more comprehensive assessment of physical activity (and our other strategies).

Let’s Go! held an annual virtual School Symposium October 29, 2021. The Symposium focus was “Physical Activity Stigma and Bias: Connections to Education, Health and a Positive School Culture”. 103 individuals representing 30 School Administrations attended the Conference. Other training and technical assistance offered included: Online ECE training - Moving Children to Good Health: Physical Activity for Young Children. To date 52 ECE’s received this training. A February 2022 online training for ECE’s and OOS focused on Supporting Policy Change to address sustainable healthy eating and physical activity. 20 ECE’s were represented at this event.

The Maine Association for the Education of Young Children fall conference, originally scheduled for in person was held remotely. The event was an overwhelming success with over 600 ECE sites and related personnel in attendance over the 2-day event. Maine CDC and partners attended the event and co facilitated two trainings: Physical Activity Learning Session (PALS) a training curriculum for early childhood providers aimed at supporting practice change in ECE programs leading to healthier, more active children; the curriculum is being launched in Maine. This session highlighted the importance of physical activity in child development including cognitive, social-emotional, and motor. Exploring the eight best practice areas of physical activity; ECE trainers and coaches that viewed or attended the session received information on PALS. 41 ECE’s attended or viewed the training. The second training was specific to an evidence-based self-assessment tool for ECE’s called Go NAPSACC (Nutrition and Physical Activity Self-Assessment for Child Care). This online tool is used to assist ECE’s in making quality improvements in many areas of health and wellness. 12 ECE’s attended or viewed the training.

Maine CDC partnered with Medical Care Development (MCD) to contract with Playworks to offer ongoing education, training, and access to resources for schools and afterschool programs. During FY22 trainings were held on November 18 and December 2, 2021 (29 participated in the workshop). Six participated in the March 22, 2022 action planning session. Recruitment activities for the November training included a Newsletter/Digest and communication with Let’s Go! Coordinators in late September; emails to all Maine Principals on October 18th; an announcement at Let's Go! Conference on October 29th and a posting in the Maine DOE Newsroom in early November. A Facebook Group was formed in November; three follow-up emails were sent to participants in December/January to encourage PlayworksU subscription activation; an invitation was sent in January to sign up for access to recordings and resources on the Maine DOE Newsroom; an invitation was sent to the Maine Afterschool Network in January to sign up for access to workshop recordings and additional resources. Other metrics such as Facebook and resource hits; 14 of the original 29 trained staff are engaged in the Active and Engaging Recess across Maine Facebook Group; 32 additional participants signed up for resources after the initial workshops for a total 72 school and out of school teachers; and there have been 31 views of workshop recordings on YouTube. 15 PlayworksU subscriptions were activated (online resources).

Over the past year the Maine CDC lead met with the MASN Director to identify areas that can support communication, education, training, and technical assistance for the OOS sites connected to the MASN. This relationship resulted in Playworks being featured on a bi-monthly educational meeting for OOS sites, offering those sites online resources that are offered to all schools.

The Maine CDC lead and Maine DOE continue to coordinate efforts and meet monthly. Promotion of trainings are shared with Maine school staff through multiple communication efforts, including the Maine DOE’s newsletter. The relationship with Maine DOE assists in planning, logistics, implementation, and promotion of all relevant training opportunities.

The WinterKids online training module was made available to over 150 ECE’s through a collaboration with Maine CDC. To date the following outcomes have been achieved: 159 ECE providers enrolled in the online platform; 106 ECE providers (as of 3.18.22) completed the training and received supporting credits, resources, and materials.

FY23 Plan

Strategy: Increase the number of schools and early care and education sites that receive support and targeted outreach to improve policies and meet best practices for increasing physical activity opportunities for youth they serve

During FY23 the Maine CDC lead will continue to track progress on the ESM to identify the number of school administrative units, ECE, and after school/out of school programs that meet best practices and highest standards for physical activity. Ongoing work with partners for data collection will include reviewing Let’s Go! annual survey data, childcare licensing lists and GO NAPSACC registration and activity data. We will continue to partner with Maine DOE to coordinate available and relevant data.

Maine CDC and partners plan to undertake the following in support of the strategy:

Let’s Go! will utilize the updated “Let’s Go! Guide to Success” environmental assessment tool with all registered school, OOS, and ECE programs to better assess the success and opportunities of registered sites in increasing healthy eating and physical activity. The updated Guide to Success aligns with national recommendations of best practice and is a more comprehensive assessment that is both age and setting specific. To support new recommendations Let’s Go! will create and/or curate new tools, resources and trainings that align with the updated Let’s Go! Guide to Success. These resources will allow for comprehensive technical assistance to registered sites based on their environmental assessments and healthy eating and physical activity goals. As an ongoing support and practice, Let’s Go! plans to disseminate new tools, resources, and trainings to Let’s Go! registered sites based on site’s environmental assessment responses.

Maine CDC will partner with agencies including Maine Roads to Quality, WinterKids, and Let’s Go! to provide training and access to resources for ECE providers in support of newly developed online curricula and training. Maine CDC and partners anticipate developing and supporting peer to peer communities of practice, learning collaboratives and a statewide training focusing on a national PALs curriculum and resources. To strengthen technical assistance networks in Maine and sustain a competent qualified workforce, we anticipate offering opportunities to partners, including ECE providers, to become trained in PALs and be part of a sustainable peer led learning network. Other opportunities for training and learning collaboratives include Farm to ECE, Go NAPSACC, and Outdoor Learning Environments.

Working with the Maine DOE we will support additional training from Playworks to schools in support of enhancing skills, resources, and strategies to increase physical activity.

Performance Measure: Percent of children, ages 1 through 17, who had a preventive dental visit in the past year.

Dental decay and oral health literacy continue to burden the children in Maine. According to the 2019 Maine Integrated Youth Health Survey (the last year data was collected), nearly half (45%) of third graders had experienced tooth decay. One objective of the Maine School Oral Health Program (SOHP) is to reduce tooth decay among Maine children and adolescents grades Pre-K through six.

Current Efforts

The Maine CDC utilizes an approach that combines increased oral health literacy, providing classroom oral health resources for school nurses and collaboration with other dental stakeholders on oral health messaging.

Strategy: Maintain support for the School Oral Health Program consultants and administrators

During FY22 the SOHP disseminated educational materials to schools enrolled in the SOHP. The SOHP provided school nurses and teachers materials to assist in meeting the Maine Department of Education curricula requirements for teaching oral health lessons and to increase oral health education. During Children’s Dental Health Awareness Month (February) all schools (192) were emailed a Google Drive link which houses all oral health classroom resources. The Children’s Oral Health e-Learning Platform (COHELP) launched its first module in 2022. The module can be found at: COHELP (mcd.org).This on-line educational program, will be shared with all enrolled SOHP schools and other dental stakeholders. Additional educational modules will be created as funding is secured.

The SOPH provided outreach and technical assistance to schools interested in enrolling in the SOHP. Unfortunately, due to a workforce shortage, the SOHP was unable to open enrollment for FY22 and the goal to increase by 5% the number of new school enrollments and children who receive SOHP services was not met.

The school-based dental hygienists and school oral health Program Manager provided oral health educational resources to school nurses through trainings and technical assistance. Engaging Maine children with oral health literacy promotes good oral health habits resulting in less tooth decay. Educational resources were emailed to all willing and receptive school nurses.

The SOHP collaborated with other dental stakeholders and partners on shared children’s oral health messaging and resources. The SOHP Utilized COHELP to assist with increasing oral health literacy.

Strategy: Provide support and supplies for updated PPE requirements post COVID-19

The SOPH collaborated with SOHP hygienists and volunteers by providing dental public health training, outreach, technical assistance (data collection) and appropriate use of personal protective equipment (PPE) post COVID-19. The SOHP manual was provided to all SOHP hygienists and administrators.

FY23 Plan

Strategy: Maintain support for the School Oral Health Program consultants and administrators

The SOHP is collaborating with Medical Care Development to develop an on-line/virtual (hybrid) training for non-dental paraprofessionals. The goal is to offer an 8-hour training to interested nurses and other medical staff as well as community health workers. The training includes such topics as infection control, dental anatomy and tooth recognition. With an expanded workforce we can offer SOHP services to more schools resulting in a greater impact on decreasing childhood caries. The SOHP Program Manager will continue to provide support to existing consultants and program administrators.

Strategy: Provide support and supplies for updated PPE requirements post COVID-19

The need for PPE is decreasing as the pandemic becomes manageable. Level 1 surgical masks, gloves and eye protection will be offered to all consultants. With the beginning of a new school year, the SOHP will continue to follow the federal CDC guidance, Occupational Safety and Health Administration, Organization for Safety, Asepsis and Prevention and the Maine DOE for PPE protocol.

Priority: Ensure early detection and intervention for developmental delay

Performance Measure: 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.

Current Efforts

Strategy: Work with community partners to collaborate and increase referrals for developmental screenings

During FY22, The Maine WIC program screened participants using the federal CDC’s Learn the Signs Act Early (LTSAE) tool. An annual review of these materials also occurred with WIC, Public Health Nursing and Head Start staff. Referrals to health care providers and Child Development Services (CDS) also continued. Data is shared with the WIC Nutritionists, enabling them to see the impact of their referrals and help in encouraging referrals to developmental screening, CDS and health care providers.

The Developmental Milestones were added to the WIC Shopper application so that participants can monitor their child’s development and reach out to their health care provider should they have any concerns with their child’s status. The LTSAE Ambassador, CDS Part C and WIC staff developed a poster with quick response (QR) barcodes for WIC, CDS Part B and Part C resources as COVID-19 has necessitated the destruction of regular paper resource materials.

FY23 Plan

Strategy: Work with community partners to collaborate and increase referrals for developmental screenings

During FY23, The Maine WIC program will continue to collaborate with community partners to increase referrals for children to health care providers and CDS for developmental screening. Maine WIC will host the annual lunch and learn to review developmental screening tools use and function for WIC, Public Health Nursing, and Head Start staff. In conjunction with the Learn the Signs Act Early tool, staff will begin to use the Ages and Stages Questionnaire (ASQ).

State Performance Measure: Percent of children, ages 19-35 months, who have completed the combined 7-vaccine series (4:3:1:3*:3:1:4)

Current Efforts

Strategy: Ensure children have access to the required immunizations according to the schedule

The Maine CDC continued to collaborate with the Maine Chapter of the American Academy of Pediatrics (Maine AAP) to promote routine childhood vaccinations. Maine physicians receive best practice communications through the Maine AAP listserv and social media platforms. Information was targeted to help increase children 24-35 months, students 4-6 years, and adolescents receive their routine immunizations.

The Maine CDC promoted and recruited provider sites to enroll in the Maine Immunization Program (MIP), with a focus on ensuring that children in rural areas have access to vaccine. During FY22, the MIP enrolled over 50 new provider sites for COVID-19 vaccination efforts. Many of these additional sites will also be able to carry and offer routine recommended childhood vaccines.

The MIP continued to partner with the Public Health Nursing (PHN) Program to offer catch-up immunization visits to all Maine children. These visits are offered in six Public Health Nursing offices located throughout the state. Public Health Nursing utilized the State of Maine immunization information system, ImmPact, to record these immunizations.

Other Efforts

Immunization rates and provider participation will be calculated quarterly using the Maine immunization information system, ImmPact. Students in grades K, 7, and 12 will be measured using the annual School Immunization Assessment Survey conducted in December of each year. The annual survey results can be viewed on our website at www.ImmunizeMe.org

FY23 Plan

Strategy: Ensure children have access to the required immunizations according to the schedule

During FY23 the MIP will continue collaborating with both the Maine AAP to promote childhood/adolescent vaccines and the Maine DOE to ensure superintendents, school nurses, and parents are informed of changes related to PL 154 and the importance of immunization.

MIP will continue to target and enroll new providers, work with these providers to educate on the importance of all vaccines and encourage them to become vaccines for children (VFC) providers.

MIP will continue its partnership with PHN to offer childhood vaccines at all DHHS offices across the state. There are currently six (6) of eight sites offering all Advisory Committee on Immunization Practices recommended immunizations. In addition, PHN will continue to offer both influenza and COVID-19 vaccine clinics.

The MIP will educate hospital organizations, clinics, and private practices enrolled in the VFC program to conduct reminder/recall to bring their children up to date on their vaccinations. The MIP will educate during VFC site visits of this important Maine Immunization Information System functionality and ensure an article is written in one of our monthly newsletters.

MIP will continue to provide all immunization rate information to the general public and constituents through our website. Immunization rates posted will include: quarterly rates for 24-35 month old children and 13 year old adolescents at both the county and statewide levels; annual school assessment rates for both required vaccines and exemption rates at the individual school, county, and statewide levels; annual healthcare worker assessment of required vaccines at the facility, county, and statewide levels; annual childcare facility rates at the county and statewide levels; and annual college assessment at the facility, county, and statewide levels. This information provides both transparency and the opportunity for individuals to make informed decisions about where to seek services.