Child Health – Application Narrative (FY 2019-20)

Priority 3: Improve the cognitive, physical and emotional development of all children.

Surveillance: CDPH/MCAH will review the national performance and national outcome data included in the Federally Available Data report prepared by MCHB and made available to states by May 2019. Meanwhile, throughout FY 2019-20, CDPH/MCAH will monitor select quantifiable characteristics to track the health of California children as part of its routine health surveillance efforts. The following select indicators and measures listed in the table below are continuously and systematically collected, analyzed and interpreted to guide program planning, implementation, and evaluation of interventions. These indicators will be analyzed at the state and sub-state levels to identify specific improvement opportunities.

Objective 1:

By June 30, 2020, increase the rate of children ages 9 months through 35 months screened for being at risk for developmental, behavioral and social delay, using a parent-completed standardized developmental behavioral screening tool during a healthcare visit from 22.4 % (2016-2017 National Survey of Children’s Health (NSCH) to 26.9 %.

Objective 1: Strategy 1:

Collaborate with relevant partners to strengthen systems to improve rates of behavioral, social, and developmental screening of children ages 9 months through 35 months.

• CDPH/MCAH will support the work of DHCS MCMC to assess and encourage local MCMC health plans to work with health care providers to improve reporting of developmental screening to the health plans and potentially reimburse health care providers using CPT 96110 for developmental screening using a standardized tool.
• CDPH/MCAH will begin to explore with DHCS MCMC the possible incorporation of an additional child health-related quality measure (e.g., developmental screening, school readiness) with the Medi-Cal managed care health plans.
• CDPH/MCAH will continue to participate in and fund (along with the Department of Developmental Services [DDS]) the California Statewide Screening Collaborative (SSC) and will work with members of the SSC to improve developmental screening in California and further disseminate the health care provider developmental and behavioral screening toolkit.
• CDPH/MCAH will fund the SSC and partner with its members to assess current needs and how family engagement can be incorporated within the SSC.
• CDPH/MCAH will partner with DDS to promote DDS resources and other identified resource tools to improve the social-emotional development of young children with its local programs.
• CDPH/MCAH will continue to coordinate and collaborate with the UC Davis Medical Investigation of Neurodevelopmental Disorders (MIND) Institute on its annual meeting and other technical assistance and outreach related to developmental screening and neurodevelopmental disorders.
• CDPH/MCAH will continue to support the CDPH California Health Interview Survey (CHIS) by participating in the CDPH CHIS Workgroup to assess whether additional questions related to developmental screening can potentially be added or modified to be consistent with the National Survey of Children’s Health (NSCH).  
• CDPH/MCAH will continue partner with the UCLA CHIS Child Development Technical Workgroup committee along with the State First 5 staff to assess the methodological issues surrounding questions related to developmental screening and referrals within the systems of care, specifically after identification of children who might be at high-risk of developmental delay.
• CDPH/MCAH will analyze and review the updated CHIS and NCHS data regarding developmental screening using the new objective (NPM 6). The age range was changed from 10 months-5 years to 9-35 months per HRSA guidance to align with the AAP/Bright Futures screening recommendations.
• CDPH/MCAH will support the efforts by the CDPH Safe and Active Communities Branch to fund the five-year NSCH oversampling for California, an option that will begin with the 2020 NSCH, to help to  support the analyses of smaller populations, rare outcomes or ability to produce county-level estimates with the goal of informing policy and programmatic efforts at the county level.
• CHVP will continue to partner with early childhood partners through co-leadership of the Home Visiting State Interagency Team (SIT) workgroup to help identify opportunities to overcome systems barriers, with the goal of helping home visiting families receive needed services.
• CHVP will continue to provide guidance to local CHVP sites on the development and maintenance of a Community Advisory Board (CAB) that promotes a community support system for home visiting programs and the local early childhood system of services. Local CHVP sites will continue to convene a CAB that serves in a consultative and/or governing capacity in the planning and implementation of program-related and systems-integration activities. This will include collaboration with their Regional Centers, schools, hospitals or any local agency that provides services to children with behavioral, social, and developmental needs.
• The DHCS/IHP will fund home visitation activities to improve developmental screening and infant mental health, including providing health education by American Indian paraprofessionals to pregnant American Indian women to improve maternal-child health outcomes.
• The DHCS/IHP case management program will seek to promote healthy child growth and development by supporting maternal mental health, educating on the importance of bonding/attachment, and promoting maternal-child bonding.
• Through local community developed projects, Indian health programs will conduct needs assessments to identify gaps in services for American Indian women and infants and implement interventions that address identified needs of American Indian women and infants.

Objective 1: Strategy 2:

Collaborate with relevant partners to strengthen systems to improve referrals and linkage to needed services for all children and youth, especially children birth through five years and at-risk populations.

• CDPH/MCAH will partner with DDS to fund and actively participate in the SSC and will work with members of the SSC to identify barriers and identify opportunities to improve timely referrals and linkage to early intervention services after a positive developmental screen.
• CDPH/MCAH will fund the SSC who will assess current data on referrals to early intervention and local models and processes from local Regional Centers in California to identify areas for improvement. 
• CDPH/MCAH will fund the SSC to assess available county pediatric behavioral/mental health resources.

• CHVP will continue to use the ASQ-3 to screen for developmental delays in their clients and refer them to external agencies for evaluation and services if the screen is positive.
• CHVP will lead efforts to improve the referral process (started in October 2017) to early intervention with local programs through technical assistance and use of newly developed tools. CHVP will continue to collect information about children who were read to, told stories to, and/or sang songs with every day during a typical week. This information will be obtained by interviewing the parent and recording the response on a form.
• The DHCS/IHP will fund home visitation activities, such as facilitating prompt referrals for needed follow-up and assisting with referrals for infant mental health.
• Local Indian health programs will conduct needs assessments to identify gaps in services for American Indian women and infants, including improvement of clinic referrals.

Objective 1: Strategy 3:

Provide technical assistance to MCAH programs to implement their SOW, promote the use of Birth to 5: Watch Me Thrive! or other appropriate materials, develop protocols to screen and refer all children in MCAH home visiting or case management programs to early intervention services and develop quality improvement plans to ensure CYSHCN are identified early and connected to needed and ongoing services.

• CDPH/MCAH will continue to provide education and technical assistance related to developmental screening, referral and linkage to services for our state CDPH/MCAH programs (e.g., BIH, AFLP, CHVP), as needed.
• CDPH/MCAH will work with its programs to review current data on developmental screening and referrals as well as review current program efforts to promote healthy brain development and attachment in the infants/young toddlers within the programs.
• CDPH/MCAH will update its website to include up-to-date information on developmental screening and resources to promote positive social-emotional development.
• AFLP case managers will continue to provide child development and parenting education, which includes use of validated early childhood developmental screening tools (e.g. ASQ, ASQ SE), education on positive parenting, and identification of a source of preventive and primary care for the client and his/her child.
• The Black Infant Health (BIH) Program will continue to implement information related to child development during session 12 of the BIH Group Curriculum. BIH will also encourage participants to have the discussion around the ASQ with their pediatrician during well-child visits. “Learn the Signs” handouts will continue to be available during well-child visits as well as looking at the possibility of recommending other handouts that can be part of session 12 in the Group Curriculum.

Objective 1: Strategy 4:

Assist MCAH LHJs to implement developmental screening, referral and appropriate linkages for all children using a parent-completed validated screening tool; provide technical assistance to improve provider, family and community outreach, and develop centralized telephone access and data collection processes.

• CDPH/MCAH will continue to fund and support LHJs regarding local implementation of Help Me Grow or programs that promote the core components of Help Me Grow (pediatric health care provider outreach, family/community outreach, central access point/call center, and data collection/analysis).
• CDPH/MCAH will continue to support LHJ efforts to collaborate with partners, such as First 5, local CCS programs, local children’s programs or organizations, Regional Centers, Family Resource Centers, and families to leverage resources, understand systems and gaps, and create systemic collective impact changes.
• CDPH/MCAH will lead efforts to provide technical assistance, best practices, and/or evidence-informed resources and tools to LHJs individually, via conference calls and/or webinars to help LHJs implement their SOW requirements on developmental screening and linking clients to services, health insurance, and preventive health care visits.

Priority 7: Increase access and utilization of health and social services.

Surveillance: Throughout FY 2019-20, CDPH/MCAH will monitor select quantifiable characteristics to track social determinants of health (SDOH) as part of health surveillance efforts. Monitoring these indicators help to engage diverse partners and stakeholders to work together and shape policies that address social, economic and environmental factors that promote health, health equity and sustainability.

Select SDOH indicators as listed in the table below will be continuously and systematically collected, analyzed and interpreted to guide program planning and implementation.

To provide a greater depth in understanding the how SDOH correlate to health disparities, analysis of these key indicators and measures will include stratification by state and sub-state level, given the specific measure and the data constraints.

Objective 2:

By June 30, 2020, increase the rate of children ages 1-17 years who received a dental visit in the last year from 75.3 % (2011/12 NSCH) to 79.1 %.

Objective 2: Strategy 1:

Under the guidance of the CDPH State Dental Director, MCAH and the Office of Oral Health (OOH) will collaborate to implement the State's Oral Health Plan to identify priorities, goals, objectives and key strategies.

• CDPH/MCAH will partner with the OOH who will continue to support LHJs with funding from Proposition 56, the California Healthcare, Research and Prevention Tobacco Tax Act of 2016 (Prop 56), to plan and implement oral health efforts within their jurisdictions.
• Local MCAH will receive technical assistance on implementation of key dental health access objectives such as establishing school-based and school-linked oral health programs and exploring the virtual dental home model as a possible strategy to increase access to services where children live, work, play, and go to school. Technical assistance will be provided by the OOH-funded California Oral Health Technical Assistance Center (COHTAC) at UCSF.
• The State Dental Director will continue to partner with DHCS in the implementation of the four Domains of the Dental Transformation Initiative (DTI), which aims to reach children and other MCAH priority populations. The DTI efforts include preventive dental services, caries risk assessment, continuity of care, and ensuring a dental home is established. The objectives for the DTI align with the Title V plan and the COHP.

Objective 2: Strategy 2:

LHJ staff informs all eligible and enrolled clients of currently available dental benefits offered by Medi-Cal to promote the dental home and Medi-Cal warm transfer service through 1-800 customer service phone number or other referral services.

• Local health jurisdictions will implement their OOH local action plan to build capacity and recruit non-traditional partners and maintain a local advisory committee to identify strategies to identify successful strategies and address barriers and gaps for eligible and enrolled clients.
• OOH-funded COHTAC will assess training needs to assist LHJs in their outreach efforts and implementation of evidence-based or evidence informed interventions.
• CDPH/MCAH will partner with the OOH to share information with local MCAH program’s on Medi-Cal Dental Services’ new campaign, Smile, California, to increase member’s use of Medi-Cal’s dental benefit. Smile, California is an integrated member and provider outreach plan developed by the Department of Health Care Services and Delta Dental, Medi-Cal Dental's administrative services contractor, to improve overall performance of the program.
• CDPH/MCAH will partner with OOH to ensure that oral health activities align with the Title V Action Plan and the COHP and that efforts are complementary and not duplicative.
• AFLP case managers will continue to work with youth in the program to assess needs and provide linkage and ongoing case management support for indicated dental services.

Objective 2: Strategy 3:

Under the guidance of the CDPH State Dental Director, MCAH and the Office of Oral Health (OOH) will collaborate to implement the newly funded Local Oral Health Programs and pursue a coordinated system involving various State Programs that serve children’s dental needs.

• The LHJs will continue to determine if identified strategies address vulnerable children.
• OOH will continue to fund and support local MCAH programs to provide information and education regarding best or promising practices, establishing communities of practice, and identify opportunities for collaboration.

Priority 8: Increase the proportion of children, adolescents and women of reproductive age who maintain a healthy diet and lead a physically active lifestyle.

Objective 3:

By June 30, 2020, reduce the proportion of WIC children aged 2-4 years who are overweight or obese from 34.5% (WIC PC 2012) to 33.5%.

Objective 3: Strategy 1:

Improve capacity for nutrition and physical activity for children through collaboration and technical assistance, especially by sharing science-based resources such as new nationally recognized guidelines and initiatives as well as trainings and funding opportunities with LHJ MCAH directors and MCAH funded program contacts.

• CDPH/MCAH will partner with CDPH nutrition partners to update links and resources on the MCAH/NUPA Initiative page, including the Systems and Environmental Changes toolkit to support optimal nutrition, physical activity, and breastfeeding through fostering partnerships between LHJ MCAH programs and existing organizations to promote healthy environmental changes.
• CDPH/MCAH will partner with UCLA through their MCHB funded technical assistance to promote Policy, Systems and Environmental change for nutrition and physical activity.
• California will promote the EMSA Childcare Nutrition web page that CDPH/MCAH was a partner in developing in a CoIIN process.
• CDPH/MCAH will continue to maintain relationship with the ASPHN, including their MCAH nutrition and their obesity councils.
• CDPH/MCAH will identify or develop and disseminate information and tools through key partners (CDPH/Nutrition Education and Obesity Prevention Branch [NEOPB], WIC CDE, Systems of Care, EMSA) to help low-income children meet the dietary guidelines for Americans. CDPH/MCAH will continue to promote national guidelines on weight, nutrition and physical activity for young children by collaborating with CDPH/NEOPB.
• CDPH/MCAH will promote a two question validated screening tool for food security as recommended by AAP.

• CDPH/MCAH partners with the national and California Association of State Public Health Nutritionists (ASPHN), especially their MCAH nutrition and their obesity councils.
• CDPH/MCAH will partner with CDPH/NEOPB, WIC, CDE, DHCS Integrated Systems of Care, EMSA to identify or develop and disseminate information and tools to help low-income children meet the USDA dietary guidelines.
•  MCAH will partner with CDPH/NEOPB to promote national guidelines on weight, nutrition and physical activity for young children, including “Rethink Your Drink” and “Healthy Snack.”
• CDPH/MCAH staff will attend and network at the 2020 state WIC Conference.

• The AFLP state team will support local AFLP programs by providing education, resources for case management, and technical assistance related to nutrition and physical activity for children and youth, including sharing science-based resources.