NPM 6 - Percent of children, ages 9 through 35 months, receiving a developmental screening using a parent-completed screening tool.

For the Child Health domain, Hawaii selected NPM-6 Developmental Screening as a continuing priority, based on the Title V 2020 five-year needs assessment. By July 2025, the state seeks to increase the percentage of children ages 9 through 35 months receiving a developmental screening to 45.0%.

Given changes brought on by COVID and new staffing resources, Hawaii is deleting two strategies, will retire ESM 6.2, and will develop a new strategy measure in next year’s report.

Strategy 1: Systems Development

Hawaii will continue to work with partners to implement the statewide system for developmental screening, referral, and services. These efforts are part of the State Plan for Early Childhood that developed from the strategic plan for the federal Preschool Development Grant Birth through Five (PDG B-5).

ECCS Health Integration Prenatal-to-three Program (ECCS HIPP) grant: The new Hawaii ECCS grant is developing a strategic plan to strengthen integration and promote maternal, infant/child health, and family well-being. The plan will focus on addressing health disparities in this population. Developmental screening remains a part of the plan’s performance measures. Community-level initiatives piloted in Maui County and supported by the previous ECCS Impact grant will be used to inform statewide program efforts. Coordination will be maintained with other state early childhood entities. The ECCS activities ensure family engagement (with parent leadership integrated into the Advisory Committee) and will help address other system issues, including policy development, agency coordination, standards setting, public awareness, and workforce training. Hawaii was one of three states to receive additional $750,000 for Early Childhood Developmental Health Systems funding which will help support screening, especially mental health and developmental screening and supports. 

Medicaid partnership: With the inclusion of developmental screening as a priority in Hawaii Medicaid managed care contracts, Hawaii has a new data measure to assess screening efforts conducted by pediatric primary care providers serving Medicaid enrollees. For FY 2021, developmental screening rates for Medicaid enrollees in the first three years of life was 22.41%. Collaboration with the Hawaii Medicaid program and the five managed care plans will be explored. Progress on the new EPSDT client dataset will be monitored as an additional data source to track screenings and health status information collected during each pediatric visit. Race/ethnicity data shared by Medicaid on their enrollees confirms they represent underserved populations with health disparities and poor health outcomes.

Hiʻilei Developmental Screening program: The program services are underutilized. With staffing changes in FY 2021, CSHNB will use this opportunity to evaluate and re-envision the program scope to better address the statewide challenges and needs for developmental screening, especially considering COVID changes in healthcare delivery. Purchase of an ASQ Enterprise license that can be used broadly will be explored. Results of the Enterprise license piloted in Maui County are being reviewed to assess the benefits of expanding screening reach.

Project LAUNCH grant:  CSHNB will work on implementation of the Substance Abuse and Mental Health Services Administration Project Linking Actions for Unmet Needs in Children’s Health (Project LAUNCH) grant to promote developmental screening and other screens to identify children who might have developmental or behavioral concerns and refer them to services to mitigate severe emotional disturbances (SED). 

Strategy 2: Data Collection and Integration

The Hawaii Medicaid program data for the developmental screening CMS quality measure will be monitored. A request for further disaggregation of the data will be requested. Medicaid progress on the EPSDT-related office visit data will also be followed as the dataset is analyzed and findings generated.

Oversampling for the National Survey of Children’s Health (NSCH) will be sought, although funding and other administrative barriers exist.

Strategy 3: Social Determinants of Health and Vulnerable Populations

Media Campaign: A media campaign to promote child wellness visits and preventive screenings for development, vision, hearing, and behavioral health will be relaunched to help promote expansion of the Hiʻilei program family and provider screening resources. If possible, messaging may be translated into several languages.

The Hawaii CDC “Learn the Signs. Act Early” (LTSAE) team will continue to work with WIC to utilize the 2-year-old and 3-year-old developmental checklist to see if parents have any concerns about their child’s development. WIC staff will help with referral to Early Intervention if the child is younger than 3 or to Department of Education Preschool Special Education if the child is older than 3.

The translated milestones booklets based on the CDC LTSAE materials will be distributed to Chuukese, Marshallese, and Samoan-speaking families in partnership with a community-based organization.

Using the Survey of Well-being of Young Children (SWYC) developmental screening tool that also examines family well-being and social determinants of health will continue to be promoted with partners to better address the social determinants of health and identify vulnerable at-risk families who may need resources.

SPM 1 - Rate of confirmed child abuse and neglect cases per 1,000 children aged 0 to 5 years.

For the Child Health domain, Hawaii selected Child Abuse and Neglect (CAN) prevention as a continuing state priority based on the 2020 Title V 5-year needs assessment. By July 2025, the state seeks to reduce the rate of confirmed child abuse and neglect cases per 1,000 children aged 0 to 5 years from 5.9 to 5.2. Plans to address this objective and SPM are discussed below.

For 2023, CAN strategies were revised/consolidated to reflect a broader public health systems approach:

• Support the collaboration and integration of family strengthening and child maltreatment prevention programs and activities across federal, state, local, and private programs, and organizations.
• Provide training and technical assistance to community-based, prevention-focused programs to strengthen families, prevent child abuse and neglect, and foster appreciation and knowledge of diverse populations.
• Promote health equity, by addressing disparities in confirmed CAN cases.

The strategies may be reassessed and revised with staffing changes and system innovations.

Strategy 1: Support the collaboration and integration of family strengthening and child maltreatment prevention programs and activities across federal, state, local, and private programs and organizations.

Preventing CAN will be addressed through established and new government and private organization collaboratives addressing broad areas of workforce development, CANP activities, training, and health equity.

The Hawaii State Departments of Health, Education, Human Services (including Office of Youth Service), and Judiciary currently collaborate on several important child abuse and neglect prevention-related initiatives (see table below). The initiatives are a mix of primary, secondary, and tertiary prevention to build strong, nurturing, and resilient families and communities.

The goal is to develop an integrated CAN prevention continuum of services, policies, and practices across the state and county government offices and programs. This will include strengthening the current collaborations and establishing new partnerships with state offices and programs that address CANP, including the Hawaii State Departments of the Attorney General and Public Safety, the Fatherhood Commission, and the Executive Office on Early Learning. This includes new collaborations around Family Resource Centers and the Office of Wellness and Resiliency to further support the child welfare system.

Expanding the collaboration will support policies, practices, and services that help children and families mitigate risks for CANP, such as lack of housing, need for financial assistance, more parent education, expanded access to substance use and abuse treatment, and prevention of domestic violence. The outcomes of this collaboration are envisioned to include: combined funding streams; defined policies that align with a common vision; diverse community collaboratives addressing common CAN goals and outcomes; and universal tracking and accountability for outcomes.

The CANP Program will continue to collaborate and coordinate with the Early Childhood Action Strategy to expand the outreach and offerings of the Aloha at Home initiative and the Hawaii Children's Trust Fund (HCTF) with its grant-making efforts. The HCTF Coalition will address community-level needs, concerns, and solutions to ensure systemic planning and execution of statewide CANP training and activities.

Public and private collaboration and integration will be supported through statewide CANP activities and training/workforce opportunities. The HCTF Coalition and the individual neighbor island coalitions represent diverse and broad membership involved in the execution of CANP activities to be supported by the CANP program funds.

Strategy 2: Provide training and technical assistance to community-based, prevention-focused programs to strengthen families, prevent child abuse and neglect, and foster appreciation and knowledge of diverse populations.

CANP Program will continue to support training that focuses on historical and cultural trauma experienced by Native Hawaiians and Pacific Islanders, as well as the effects of trauma on special populations (military, children with disabilities, children, and families experiencing incarceration or homelessness). Content will include; building individual and community resilience, trauma-informed and trauma-responsive systems of care, protective factors, and Standards of Quality for Family Strengthening and Support. Trainings offered will use a range of modalities: virtual, on-demand/online, and in-person.

The CANP Program will also partner with internal and external partners on other CAN training topics: safe sleep, safe and effective discipline, and domestic violence. The Hawaii Home Visiting Program will continue to provide quarterly trainings to all CAN- contracted service providers statewide.

Strategy 3: Promoting Health Equity by addressing disparities in confirmed CAN cases.

The data from DHS CWS points to significant disparities among CAN-confirmed cases, specifically by ethnicity, child’s age, family income, and geography (rural). These variables are not necessarily mutually exclusive.

CANP will expand its collaboration with Native Hawaiian community organizations by participating in the new Office of Wellness and Resiliency‘s Mālama ‘Ohana Working Group, which has been meeting to address the over-representation of Native Hawaiians in foster care by transforming the existing CWS program. The partnership seeks to transform the existing CWS program by helping identify culture-specific needs and gaps in CAN prevention services and identify recommended programmatic strategies to address these disparities.

Many of the service contracts supported by CBCAP funds were disbursed to community-based organizations addressing disparities associated with rural areas and race/ethnicity. The CANP will monitor implementation of these contracts to ensure identified projected outcomes. Based on program evaluations, these efforts are expected to develop into emerging evidence-based interventions and practices.

SPM 5: The percentage of Medicaid children receiving six or more well-child visits in the first 15 months of life

While the workgroup will continue to meet, Hawaii plans to end this SPM as the public awareness campaign was the major activity. Hawaii will continue to monitor well-child visits and EPSDT screenings.