Child Health – Plan for the Application Year, FFY 2020

This narrative contains current activities and upcoming plans NPM 7, for ages 0 through 9.

NPM 7 – Child Injuries: Rate of hospitalization for non-fatal injury per 100,000 children ages 0 through 9, and adolescents 10 through 19.

Teaching parents and caregivers the proper installation of infant/child car seats is an on-going priority for most CPHDs, and eight currently have specific MCHBG activities in this area. This includes inspecting all infant and child car seats and, if incorrectly installed, demonstrating the proper method.  If possible, they have the parents or caregivers install the car seat themselves before leaving.

Some CPHDs struggle with attracting parents and caregivers to take advantage of the service. They have held stand-alone check station events in high traffic areas, some coupled with flu shot clinics and tied in with a kindergarten screening at an elementary school, but the numbers are low. Carter County took a different approach after these experiences:

“Lesson learned: I found that trying to bring my audience to me for educational purposes does not work in our area. So, I sought audiences that would benefit from this education and went to them. I secured an invite to a child development family consumer science class.

I brought a variety of car seats and instructed the class how to properly put a child in a car seat, how to properly install the seat and where to look for safety information such as expiration dates, weight/height requirements, and serial number in case of recalls. All five students in the class trained on each car seat.” Shannon Volmer, RN, Carter County (2017 MCHBG population = 426)

Silver Bow County has an easier time attracting people to participate in car seat check services, due to a much larger population (2017 MCHBG population = 13,168). Additionally, Silver Bow CPHD partners with the full-time, professional fire department in town.  This further expands their outreach to families. Carter County, like most frontier counties in the state, has volunteer fire stations that can only focus on fire operations.

The Silver Bow Fire Department offers a permanent child car seat station in-house. Once a month, the CPHD and Fire Department offer a car seat clinic together. Certified technicians inspect for proper installation, recalls, and correct make/size for the child. From October 2018 through March 2019, forty car seats have been donated to families who received the education, and 82 car seats inspected. The CPHD also has an in-house certified car seat technician who assists families as needed. 

Additionally, the six other CPHDs have inspected, educated and/or donated infant and child car seats to 56 families.  One is currently planning a seat-check in conjunction with the town library story time for kids.

Multiple CPHDs are bringing suicide prevention training to their communities before the end of FFY 19.  Lincoln County has provided two Mental Health First Aid training sessions to 31 community members including 3 school faculty.  Stillwater County recently had 18 participants attend a 2-day community Mental Health First Aid Training (16 certified). The training drew an impressive array of county leaders:

• Assistant County Attorney; 
• CEO of Stillwater Billings Clinic;
• Deputy Sheriff;
• Alternatives Director of a probational group that serves children;
• Elementary School, principal and a teacher;
• Director of Education for the Stillwater Sweet-Grass Cooperative;
• County-wide school psychiatrist and a school counselor;
• Two private-practice Licensed Clinical Professional Counselors; and,
• Two county advocates for Domestic Violence. 

One CPHD brought the Signs of Suicide (SOS) Prevention Program to the high school, for the first time. They had 106 students, ages 16-18, participate in this evidence-based prevention initiative. The remaining CPHDs addressing suicide will implement SOS or Question, Persuade, Refer (QPR) late this spring.

Five CPHDs recently collaborated with an adolescent mental health expert, who presented a research-based program on the importance of good decision making. This training helps with  development of healthy relationships and addresses issues such as bullying prevention and risky behaviors prevention. A total of 650 students attended from Sixth Grade up through High School, and were given four proven tools to work with:

•  Leaders choose to believe in themselves;
•  Leaders choose to outsmart the bullies;
•  Leaders choose to set healthy boundaries; and,
•  Leaders choose to forgive and move forward.

Cascade County is providing an interactive, childhood poison prevention activity in a number of settings: a pre-school fair, Boys & Girls Clubs, at the Cascade County Child Bridge/Foster Parent Support Program, a Young Parent’s Education Center, and more. They engaged children early with helping to build the props. Their visual consists of small, color-filled medicine bottle examples attached to large poster boards.  These can easily be mistaken as candy. Some bottles have a drinkable juice, while other bottles hold cough syrup, multipurpose cleaner or dish soap. Side by side, parents and kids cannot visually tell the difference. The samples teach children and adults how to compare poisonous items from non-poisonous. The preschool fair targeted children ages 2-4 and drew in over 200 families.

Two CPHDs are providing Safe Sitter education to youngsters in their communities. Patricia Keener M.D. developed the program after her child died in the care of a babysitter. Keener recognized the vulnerability of young children when cared for by unprepared caregivers. The program provides youth with the skills they need to be safe while home alone, watching younger siblings, or babysitting. For more than 35 years, Safe Sitter® has been a leader in providing life skills, safety skills, and childcare training for youth. Safe Sitter is a national nonprofit organization with over 900 registered providers in all 50 states. Class ratio is 8 students per instructor. Thus far, the two counties have certified 22 youth in three classes.

Big Horn County is working to develop a new approach in teen motor vehicle (MV) safety. The Crow Reservation occupies a large portion of the county with over two million acres.  Approximately 7,900 residents live on this largest reservation in Montana. Total county population is 13,300 (2017). The challenges are monumental: a driver’s license is not required to operate a vehicle on the Crow Reservation, no seatbelt laws exist, and many vehicles are old with broken seat belts or none at all.

There have been many MV safety initiatives implemented in Big Horn County over the years, but not one that is student-driven at the high-school level. The program is Teens in the Driver’s Seat, an evidence-based, MV safety program that is student-centered. The underlying concept is to form, engage and empower a student organization.  This group plans and delivers safety programming and messages to influence behavior change in their peers. The CPHD continues to meet with area high schools to secure buy-in from school administration.

Between October 1, 2018 through April 30, 2019, a variety of injury-prevention training opportunities were sent to the CPHDs. Thirty emails were sent offering webinar opportunities, articles, website resources, tip sheets, and more.

State-level staff disburse injury-prevention information on an ongoing basis.  So far in FFY 19 the range of topics includes:

• Teen driving
• Motor vehicle injuries
• Suicide
• Lead testing
• Carbon monoxide poisoning
• Firearm deaths
• All-terrain vehicle resources (ATV)
• Drowning
• Bullying
• Infant and Toddler choking hazards

For FFY 2019, there are six CPHDs working on two extra injury-prevention activities, in addition to the required one that all of them implement as a part of their FICMMR team duties.  These are Beaverhead, Custer, Deer Lodge, Fallon, Lake, and Ravalli.  The purpose of the Evidence-Based Strategy Measure (ESM) for NPM 7, for both FFY 2019 and 2020, is to provide state-level support and expertise to help CPHDs with their injury-prevention efforts.  The ESM evaluation is the percentage that meet their goals.