III.E.2.c. Child Health: Application Year (10/1/2022-9/30/2023)

 

State Priority Need:

Reduce preventable deaths in the MCH population with a focus on reduction and elimination of inequities in mortality rates

 

National Performance Measure (2020 - 2025):

NPM7.1- Rate of hospitalization for non-fatal injury per 100,000 children, ages 0 through 9 and adolescents ages 10 through 19.

 

Evidence Based/Informed Strategy Measure (2020 - 2025): 

Increase the number of technicians and car seat inspection stations, to ensure car seats are properly installed and education is being provided to the targeted population.

Injury is the leading cause among child mortalities. For children who suffer non-fatal severe injuries, many develop special health care needs. Effective interventions to reduce injury exist but are not fully implemented in systems of care that serve children and their families. Reducing the burden of nonfatal injury can greatly improve the life course trajectory of infants, children, and adolescents resulting in an improved quality of life. In 2020, 769 children ages 0-9 were hospitalized for a non-fatal injury in Indiana, with a rate of 90 cases per 100,000 children. Of these cases, 54 children ages 0-9 had motor vehicle-related injuries. Motor vehicle-related injuries are one of the leading causes of death, and Indiana Department of Health’s Division of Trauma and Injury Prevention (DTIP) continues to ensure families are properly using child restraints and car seats through access and education.

In an effort to prevent child injuries, DTIP will increase the number of technicians and fitting stations and resume all child car passenger seat safety-related operations that were put on pause due to the COVID-19 pandemic. Most of these efforts had been reduced, and the focus of the injury prevention program coordinator had been diverted towards COVID-19 related activities. Thus, increasing car seat inspection stations and technicians in the Indiana counties will be one of the priorities for the upcoming fiscal year. Additionally, DTIP will work on partnering and facilitating a constant network with communications among its stakeholders. By elevating and expanding community collaborations and partnerships with existing home visitation family programs such as Healthy Families Indiana, Head Start Indiana and Indiana Department of Child Services that also directly work with families with young children, DTIP will expand the capacity and infrastructure of existing programming. As home visitation services close the gap between busy families and preventative information and resources, this initiative will serve families who may not have the capacity or transportation means to attend a traditional car fitting clinic. Home visitation staff are trusted messengers for their clients and already provide extensive information to promote supportive environments for families. Thus, plans are underway to support Healthy Families sites by reimbursing the cost of training staff to become technicians, child passenger liaisons for families, as well as distributing car seats directly through home visitation staff. This initiative will expand the reach of DTIP’s existing Title V child passenger safety programming beyond static fitting stations. Further work to finalize this initiative will continue into the later months of 2022.

Internally, DTIP will collaboratively partner with the Division of Maternal and Child Health to align efforts and raise awareness of child and adolescent injuries as a public health issue, support Child Fatality Review teams and their development of strategies to reduce infant and child mortality in their communities, promote prevention strategies and identify gaps in services and community-level needs related to child passenger seat safety.

DTIP will continue to implement and expand its Child Passenger Seat Technician Reimbursement Scholarship Program through public dissemination and utilization of networks of existing partners. Through DTIP, the injury prevention program coordinator will process reimbursement up to $250 to each participant upon the completion of the course to cover the $95 course fee, travel and lodging. This minimizes the burden placed on agencies’ funding constraints and incentivizes them to sustain certifications among their staff.

The Indiana Department of Health executes an annual contractual agreement with Indiana Criminal Justice Institute (ICJI) to manage a network of child safety seat inspection stations and the provision of car seats throughout the state of Indiana. Within those child safety seat inspection stations, the certified child passenger safety technician evaluates the way that the child is currently traveling, check the child’s current restraint for recalls, proper fit and installation of the distributed car seats. The parent or caregiver is instructed on how to properly install and use the child restraint. ICJI sponsors and collaborates with Automotive Safety Program (ASP) for certification and recertification of prospects and current technicians respectively. ASP conducts free car seat mobile fitting stations where certified technicians ensure car seats are properly installed during the one-day events. Funding will support the maintenance of foregoing car seat clinic events. The incumbent will support these efforts through referrals, technician training/recertification assistance, and technical services. The coordinator will also support existing car seat inspection activities in conferences, such as the annual Car Seat Clinic at the Indianapolis Injury Prevention Conference held by the Safe Kids Indiana and ASP. In 2022, the funding allowed for the purchase of child safety seats, resulting in 162 families serviced and over 200 distributed car seats and inspections. In 2023, aside from funding the acquisition of car seats, the coordinator will employ funding to assist with miscellaneous and organization components through purchase of volunteer shirts, signages, handouts regarding car seat safety and safe sleep to parents and other miscellaneous items to support this yearly event.

Moreover, funding will be utilized to encourage and support child passenger safety certification training among law enforcement, fire department, healthcare and public health professionals. DTIP will encourage and engage local police and fire stations to join the combined efforts in a cross functional approach. Organizations can host and hold their own booster bash events at their selected location, wherein vendors contracted with Indiana Department of Health ship booster seats to the events’ physical address. The incumbent will provide technical assistance on site and document data during the event. The booster bash event program is crucial because there has been a steady decline in families obtaining booster seats over the last few years. Notably, it has been shown that parents tend to graduate their children prematurely and forgo booster seats, thus emphasizing the critical importance of booster seats education and distribution during this time.

Additional activities of the coordinator will include working with the injury prevention coordinators around Indiana by providing technical assistance on their various projects, events, and activities, participating in coalitions and work groups, attending conferences such as Safe States and Lifesavers as a representative of Indiana, increasing social media activities surrounding pediatric injuries, and participating communication outreach through updating the Division of Trauma and Injury Prevention website and distributing and sharing information with partners, grantees, and the CDC.

 

ESM 7.1.1: Percent of sites operating mobile fitting and car seat inspection stations to make sure car seats are properly installed.

Currently, ICJI oversees a network of 132 permanent fitting stations, 66 Child Passenger Safety Instructors, and 1204 technicians. During the 2021 reporting period, ICJI accomplished the following outcomes:

• Car Seats Inspected: 6136 
• Car Seats Distributed by ICJI and IDOH funding: 2184 
• Car Seat Distributed by IDOH funding: 1092 

In the 2022-2023 year, DTIP plans to work with partners to strive for:

• A goal of establishing a coverage of car seat safety inspections stations in each of Indiana’s counties
• An increase of 26 operating fitting stations in counties that currently do not have one
• An increase of number of technicians to 12100
• An increase in number of booster bash events held by agencies

 

ESM 7.1.2: Percent of child deaths reviewed by Child Fatality Review Teams.

Child Fatality Review

Fatality review is a critical public health process to examine the circumstances and risk factors associated with unexpected child deaths, and the process ultimately leads to recommendations on how to best prevent them. Beginning in 2013, Indiana legislation moved both the Indiana State Child Fatality Review Committee (State Team) and local teams from the Indiana Department of Child Services (DCS) under the auspices of IDOH. This new law, IC 16-49, also required multidisciplinary child fatality review (CFR) teams to be implemented at the local level, with coordination and support for the local teams and statewide committee to be provided by IDOH. Teams are required to review all deaths of children under the age of 18 that are sudden, unexpected, or unexplained; all deaths that are assessed by DCS; and all deaths that are determined to be the result of homicide, suicide, accident, or are undetermined. The teams are required to submit an annual report to the IDOH CFR Coordinator summarizing the child fatality reviews completed, identified needs, risk factors, and prevention action or recommendations made. The information from the local reports is included in a mandated annual report to policymakers.     

 

Ongoing support and training to CFR teams will increase the accuracy and classification of child injuries and fatalities. As an unfunded mandate in Indiana, local communities are often challenged by the tasks associated with CFR and the taxing data entry. Providing guidance, training, and technical support to this network of volunteers is one of the roles of the IDOH Fatality Review and Prevention (FRP) division. The most requested need by local CFR teams is for more training opportunities. To date, there are 67 local CFR teams covering 92 counties. FRP staff work closely with CFR teams and attend review meetings to ensure the team is completing effective reviews. Local fatality review teams continue to work toward completing effective reviews within the community by collecting complete records, having an in-depth discussion during the review, identifying and assessing the risks and needs of the child/family, and developing recommendations for preventative action in the community. FRP staff will continue to provide support to teams in providing guidance, assistance gathering complete and accurate records, facilitating team meetings as needed, technical assistance to identify standard classification of child fatalities and gathering information for data entry into the National Center for Fatality Review and Prevention-Case Reporting System (CRS). FRP will continue to work with teams to identify service gaps and to help address mental health challenges among children – an issue which continues to grow and one that is concerning statewide. Staff will guide teams to identify disparities in the communities and will provide support on developing recommendations for improvement to services for disparate populations. They will also continue to help ensure recommendations made by the CFR team are being communicated to the local Community Action Teams (CATs) for preventive actions to be taken.   

FRP staff will continue to contact and support existing local CFR teams. The staff will offer technical assistance and support to team chairs and facilitators. Outreach will be done via email, virtual visits, virtual meetings, and in-person site visits. FRP staff offers training for effective reviews to all team members along with assistance identifying and notifying the team chair of a child fatality in the area. The staff will also continue to train CFR team members on the data entry process and the importance of the accuracy of records gathered and information entered. This guidance will help local CFR teams improve the review process, improve timeliness of reviews, improve consistency and accuracy of data, and ultimately determine the trajectory of prevention work in their communities through recommendations which can be placed into action. 

FRP staff will continue to provide Sudden Unexpected Infant Death Investigation (SUIDI) training across Indiana to help investigative members and CFR teams to better enhance their investigative abilities and to help team members better identify causes of death for child fatalities by using the Centers for Disease Control and Prevention (CDC) algorithm to promote accurate child death classification. FRP staff will continue to hold Community of Practice (COP) calls for FRP teams to promote learning, leadership, prevention recommendations/actions and networking between community members and colleagues. 

 CFR teams across the state are recognizing and focusing on ways to provide prevention action to reduce child injury and death in their communities. Work will continue with teams to focus on completing effective reviews to identify risk factors relating to child maltreatment injury and death, and other preventable injuries, such as those caused by motor vehicle collisions, ATVs, drowning, and firearms.  

Because DCS and IDOH were duplicating efforts by entering similar types of information for each child decedent into their respective data systems, on January 31st, 2022, Department of Child Service (DCS) data entry system integrated with the National Center for Fatality Review and Prevention Case Reporting System (CRS). Now, DCS enters the data for all child fatalities reviewed by the CFR team. This continues to be a fluid process. FRP staff will continue to provide technical assistance to DCS workers who are responsible for data entry. CFR team chairs/facilitators are encouraged to identify a point person within the local DCS office for the secure transfer of CFR records. With accurate and comprehensive fatality review processes, including data entry into the CRS, local communities can be assisted in their prevention work even more. FRP will continue to support CFR/DCS teams in data collection and entry into the CRS as necessary to capture the needed data. They will continue to disseminate the data to local communities and guide local CFR teams to analyze available data to communicate the trends and recommendations to their associated CATs. Through integration of the two systems FRP and DCS will be able create a comprehensive joint report to help guide a public health, data-informed approach to infant/child death prevention.  

 FRP will continue collaboration with the Michigan Public Health Institute (MPHI) and the National Center for Fatality Review and Prevention (NCFRP) to ensure that the FRP/DCS data integration system project will provide seamless, automated data integration with the CRS so Indiana’s data can be included with the national fatality data repository.   

 Work will continue with the CDC to participate in the Sudden Unexpected Infant Death (SUID) and Sudden Death in the Young (SDY) Case Registry grant. The program will ensure all necessary records are collected and entered into CRS in a timely manner and checked for accuracy by the end of 2022. FRP staff will continue to on-board coroners to the project to ensure tissue and blood samples can be saved at autopsy and that all child deaths that are eligible for the project are captured and analyzed. FRP will work in collaboration with DCS, coroners and Forensic Pathologists to continue to highlight the consent process for families once samples are collected to enhance knowledge about the fatality incident. This would allow for families to connect with genetic counseling or allow the family to have the sample used in future research which effects future preventative efforts. This project will continue to grow through 2024 as FRP reaches to all counties for participation at the CFR and coroner level.  

 

Handle with Care and Trauma-Informed Communities

FRP Title V-funded staff were able to expand their work by applying for additional funding opportunities. This resulted in two awards funded through the U.S. Department of Justice, Office of Justice Programs, Office for Victims of Crime (OVC). First, the Child Safety Forward award will include future work with local Family Resource Centers in three counties with high rates of SUIDs to develop safe sleep materials with local Black and Hispanic families. Family Resource Centers are located in places where families already frequently go (e.g., libraries, recreation centers, schools, etc.) and are staffed by members of the community. These centers are designed to provide easy access to a range of services and supports.

The second funding opportunity awarded from OVC is to increase direct services for children and youth victims of crime related to the opioid epidemic in two counties in Indiana. Through this funding opportunity, FRP works to address Adverse Childhood Experiences (ACEs) through decreasing secondary trauma after a child has experienced a potentially traumatic event where first responders are called to the scene. The program, Handle with Care (HWC), enables first responders to provide a heads up to the child’s school through a notification that includes only the child’s name and the words, “Handle with Care.” This notification is distributed to staff who may encounter the student to ensure they are watching for atypical behavior from the identified student and can use a trauma-informed response, if intervention is necessary. The notification system is designed to be discrete, and the information provided does not indicate what type of event the child may have experienced. School staff are trained to provide trauma-sensitive support as needed and to not ask questions or try to gather information regarding the event.

Due to additional communities interested in HWC, this program has spread across Indiana, with two additional counties implementing the program and an additional 15 in the planning stages for implementation. FRP intends to continue to spread awareness of HWC and will support community efforts by providing technical assistance and guidance to those interested in bringing HWC to their school systems.

In addition to the implementation of HWC, FRP staff are continuing to work to promote trauma-informed practices countywide in funded areas. FRP will continue to enhance community responses to ACEs through the promotion of trauma-informed practices that decrease secondary trauma, while also increasing positive childhood experiences that have been shown to mitigate adverse experiences through a multi-sectoral approach that engages hospitals, mental health, schools, law enforcement, courts, social services, faith-based communities, and local businesses.

FRP and MCH are committed to increasing awareness of the impact of ACEs. ACEs education should be incorporated into all direct services to children and youth including schools, medical facilities, mental health facilities, and first responders. IDOH will provide education about the effects of trauma, particularly among children who are victims of crime and intentional injury. This will be done through activities that provide information about services for young victims; promotion of referrals to specialized, evidence-based, trauma-informed victim services for children and youth; advocacy; and training communities and first responders to provide emotional support on-scene of an event where EMS, fire, or law enforcement respond, and a young victim is present. Partnership with the Indiana ACEs Coalition and mental health professionals at both the state and local levels will increase the ability of communities to address the needs of at-risk children and families.

 

State Priority Need:

Promote Physical Activity through policy improvements and changes to the built environment

National Performance Measure (2020 - 2025):

NPM 8.1 - Percent of children, ages 6 through 11, who are physically active at least 60 minutes per day

Evidence Based/Informed Strategy Measure (2020 - 2025): 

ESM8.1 Number of schools participating in an activity (training, professional development, policy development, technical assistance, PA in-school programming, PA before and after school programming) to improve physical activity among children (6-11).

ESM8.1.2: Percent of children ages 6-11 impacted by improvements to the built environment.

Current Activities and Plans for Coming Year:

IDOH MCH and CSHCN divisions will continue to partner with the Division of Nutrition and Physical Activity (DNPA) to align efforts to increase the physical activity level of children ages 6-11. This includes working with local schools and organizations to increase physical activity during the school day, in addition to before and after school, raising awareness of child and adolescent obesity and low levels of physical activity as a public health issue, and promoting prevention strategies. In order to address child/adolescent obesity, DNPA plans provide grants to schools and organizations, and to train a variety of professionals and community members to implement physical activity best practices across a wide-range of settings including before and after school programs, in-classroom lessons, recess, and through parental and teacher involvement.

Playworks:

DNPA holds an annual contract with Playworks to provide district-wide trainings on creating safe and healthy play in the recess environment. Playworks programs also decrease bullying and behavior problems, effective both at recess and in the classroom, especially for indoor recess. Since physical education is often limited mostly in the K-8 setting, Playworks encourages an inclusive opportunity for all children to be active at recess, regardless of physical activity level or ability. The DNPA currently has a partnership and plans to continue it throughout the 2022 – 2023 year and expand to school districts that have not yet been reached.

The DNPA supports Playworks in conducting two types of training opportunities:

• Recess Implementation (at three different school buildings): 2 days of recess instruction, 8 hours each, per training
• Team Up Program (at three different school buildings): 1 semester of on-site training

Each program listed produces at least 30 minutes of physical activity instruction, daily.

Below are the numbers of potential students reach from the professionals who participated in the Playworks recess programs/trainings:

• Recess Implementation: 2,090 students
• Team Up Program: 515 students
• Total: 2,605 students

GOAL (Get Onboard Active Living) University:

DNPA also holds an annual contract with GOAL University to expand after school, family-focused community programming that encourages healthy lifestyles for children and their families through education regarding nutrition, behavior and physical activity. GOAL initially began in Bloomington and has expanded to Lafayette, Indianapolis, and surrounds rural cities with multiple training sites in each city. The GOAL University program utilizes nursing students from the universities in the corresponding locations, to help carry out daily lessons and reinforce positive messaging. DNPA plans to provide the opportunity for GOAL to continue their program throughout the 2022 – 2023 year in multiple locations.

While the time varies slightly each week due to the unique lesson plans, students typically spend about 30 minutes (of the 60-minute program) being physically active. The breakdown of a weekly program is below:

• Goal Setting and Checking: 10 minutes (sedentary)
• Nutrition Lesson: 25 minutes (15 minutes sedentary, 10 minutes active)
• Physical Activity Lesson: 25 minutes (5 minutes sedentary, 20 minutes active)

Below is the planned reach for the GOAL University program in fall 2021 and spring 2022:

• Eight elementary schools in the Indianapolis and Lafayette communities. Between these eight sites, the planned reach is 200 elementary age students ages 6 – 11 participating.

Community Mini-Grants:

DNPA is currently supporting five community mini grants. The programs that these community grants support range from classroom specific to community-wide initiatives and provide schools, educators, and students the resources to be physically active both in and out of school. DNPA plans to open a request for proposals for the 2022 – 2023 year. New grantees are often selected each year, but there are instances that we may continue a program’s funding for a second year.

Below is the planned reach of each grantee’s program.

• Bloomington Parks & Recreation:
  • Planned Reach: 50 youth K-3rd
  • Program: All Kids Swim Class summer 2022 - This swim class will specifically be offered to the Banneker youth, where many of their kids have experienced childhood trauma, have high ACE scores, and are ethnically and racially diverse.
     
• Evansville Trails Coalition:
  • Planned Reach: Community-based
  • Program: Provide Story Trail signage for new story trail in a highly vulnerable area in a local park; featured stories are from local authors; partners include YMCA and local library; all volunteer-based; The story trail consists of children's books featured on permanent and durable signs, with the ability to replace stories over time. Signs will also include inclusive and adaptable physical activities for youth and families to engage in along the trail. This will engage youth and families of all abilities, and youth serving organizations to become physically active, increase park usage, offer physical activity programming, and increase literacy. 
     
• Oak Park Church & Early Learning Academy:
  • Planned Reach: 50-100 youth and adolescents (K-12)
  • Program: Enhance playground environment for the church/early learning academy outdoor health and fitness park - designed for youth and adolescents 6-12 years of age. This project is and will provide youth and adolescents opportunities for outdoor learning and physical education, expand self-awareness, teach mindfulness, and will benefit their mental health by being outside in nature. Next to the playground, an already existing vegetable garden has been planted to teach youth and adolescents of all ages about healthy eating and gardening.

 

• Orleans Elementary School:
  • Planned Reach: 470 youth K-2nd
  • Program: Expand Mindfulness Movement Program; sensory pathways inside the building and outside on the playground in the elementary school. The program will include the following activities: yoga poses & exercises along with breath awareness that focus on balance, coordination, strength, and flexibility. The school will also transform their hallways into sensory hallways and outside on the playground.
     
• Springs Valley Community Schools Corporation:
  • Planned Reach: 380 elementary school students
  • Program: Provide training to teachers to implement Mindfulness in Motion program and sensory hallways in elementary schools; the school corporation is also purchasing new physical education equipment for their Jr./Sr. high school general PE classes and advanced PE classes which will include yoga mats, jump ropes, and resistance bands. The corporation will also partner with a locally certified strength and conditioning coach to teach students how to properly utilize equipment, ways to prevent injuries, and set S.M.A.R.T. goals.

Professional Development Trainings:
DNPA plans to provide three Professional Development trainings in fall 2022. The plan is for 35 professionals to attend each training for a total of 105 professionals which will have a wide geographic reach. Trainings will focus on grades K-5 and 6-8 PA/PE curriculum, as well as a component on Social Emotional Learning (SEL). These trainings will integrate evidence-based practices to increase physical activity levels and help students better understand and identify their emotions; learning the importance of SEL will help them develop empathy, increase self-control and manage stress. It will also help them build better relationships and interpersonal skills that will serve them in school and beyond, helping them succeed as adults.

Built environment strategies

Changes to the built environment: Physical Activity through Tactical Urbanism

IDOH will continue to grant funds to organizations implementing pedestrian safety measures demonstrating the ability to create safer, healthier neighborhoods by promoting active lifestyles and active transportation for children and adults. Grantees were selected by a competitive application process and grant amounts up to $10,000. Grant projects included new pedestrian crosswalks, pop-up bike lanes, traffic calming installations, traffic speed reduction improvements, and pedestrian wayfinding improvements that increase safe access to everyday destinations for children and adults. The following grantees were awarded Tactical Urbanism Demonstration Grants in 2022 spanning from May – September. We will fund additional communities the following May – September 2023.

 

City of Fort Wayne:  Fort Wayne Consolidated School Corporation

The grantee will implement low-cost demonstration improvements in highly visible locations along the Pontiac Street Corridor between Hanna St and S. Anthony Blvd. The project will be used to temporarily reconfigure the street to slow traffic and create placemaking opportunities that interact with the surrounding community. The implementation of the project will also be used to showcase additional pedestrian and bicycle projects along the corridor. Additionally, this project will allow the City’s newly created Neighborhood Planning and Activation workgroup to engage with the local community in a more personable and hands on capacity, helping to create safe access to destinations for children and adults along the corridor.

Reach: 12,928 children ages 6 – 11

 

City of Gary: Gary Community School Corporation

The grantee will implement the second phase of previously designed, low-cost pedestrian improvements in highly visible locations including the 900 block of Broadway (downtown's southern entrance) and the Adam Benjamin Metro Center, an intermodal transportation facility on the north end of downtown Gary. The project features installation of artistic crosswalks, wheelchair ramps and path-of-travel improvements at locations lacking any marked paths or ramps across a state highway, helping to create safe access to public transportation and destinations for children and adults.

Reach: 2,003 children ages 6 – 11

 

City of Goshen: Goshen Community Schools

The grantee will install a temporary road diet and pop-up bikeway along approximately one-half mile of Lincoln Avenue in Goshen. The project will be part of Goshen's Bike to Work week activities and will include a kickoff event with a bike ride that includes the project area. Project evaluation activities will include vehicular speed and volume measurements before and during the project; measures of bicycle and pedestrian comfort; and bicycle and pedestrian counts. The city plans to engage local students in the project through field trips and discussions, helping to create safe access to destinations for children and adults along the corridor.

Reach: 2,761 children ages 6 – 11

 

Indianapolis Community Heights Neighborhood Association: Indianapolis Public               School Corporation

The grantee will improve safe walking and bicycling connections for students traveling to Indianapolis Public School 88 and the Irvington branch of the Indianapolis Public Library, Ellenberger Park and other amenities around the Community Heights neighborhood and Irvington in Indianapolis. The installation will calm traffic and create safer walking and bicycling environments for children and adults in the neighborhood.

Reach: 10,610 children ages 6 – 11

 

Changes in the built environment to promote Physical Activity

Title V funding will be used to promote increased levels of physical activity at the community level through changes to the built environment. IDOH will provide funding to communities to hire consultants to prepare community-wide bicycle and pedestrian master plans to help create safe routes to everyday destinations for walking and bicycling. Technical assistance will also be provided to stakeholders and Purdue Extension Community Wellness Coordinators at the local, regional and state level to identify opportunities to make changes to the built environment supporting physical activity. Technical assistance activities include providing guidance to stakeholders for the planning and installation of multi-use trails, safe pedestrian crossings, bikeways, safe routes to schools and parks, and complete streets. Children ages 6-11 can walk and spend time outdoors while also getting physical activity.

City of La Porte: La Porte Community Schools

The grantee will hire a consultant to help the city to prepare a Trails, Greenways, and Blueways Master Plan that will contribute to achieving the community's vision by identifying specific streetscape enhancements that prioritize safety and ease of non-motorized transportation. The Plan will also identify opportunities to enhance the Blueways network connections between each public waterbody and the trails network. The plan will identify opportunities for walking and bicycling connectivity to everyday destinations for children and adults to entertainment, retail, public institutions, recreational areas, and the downtown. The main goal of the Plan is to allow safe movement and access to healthy transportation options throughout the city.

Reach: 2,682 children ages 6 – 11

 

Eskenazi Health Indianapolis: Indianapolis Public School Corporation

The grantee will prepare a “small area or neighborhood plan" in Indianapolis that promotes walking and bicycling for children and adults to everyday destinations such as schools, parks, and shopping to include a focus on Creating Safe Routes in three neighborhoods that contain Eskenazi Health Centers. The proposed project and planning effort will highlight opportunities to connect safe routes and trails more directly to health center sites. This planning effort will enhance both safe access to healthcare and facilitate programming opportunities such as Eskenazi Health Wellness Walks that encourage physical exercise. The planning effort is part of the Health Equity Zone initiative, in which Eskenazi Health will conduct in depth community engagement, facilitating focus groups with staff, patients, and neighborhood resident leaders. This outreach will be complemented by Eskenazi Health’s Community Health Workers and Community Weavers, a newly created role that connects community partners to each health center location.

Reach: 10,610 children ages 6 – 11

 

Active Living Workshops

Title V funding will build support within the communities across Indiana to host a series of regional Active Living Workshops that will enable local residents to create actions plans that lead to changes in the built environment supporting higher levels of physical activity in their communities. The workshops will help children, ages 6 – 11 be able to travel safely within their communities with their families, whether it be for leisure, to a sporting activity or to the grocery store. This process would also allow for safer walking and bicycling to school access, as well.

Boards

The DNPA Division Director will continue to serve on the executive team for Top 10 - a coalition in Indianapolis that focuses on making policy, systems, and environmental changes related to nutrition, physical activity and tobacco prevention and cessation in Indianapolis. Lindsey Bouza will continue work with the Kinesiology, Health and Sports Sciences Advisory Board for the University of Indianapolis and provides feedback to how the Public Health program can best prepare students for the public health workforce. Lastly, the DNPA team will continue being an active member of the Healthy Schools Action Team (HSAT): a subset of the Hoosier Health and Wellness Alliance (a coalition focused on statewide change related to food access and food insecurity, physical activity, and health equity). of both groups. HSAT is directly related to working with schools and collecting and disseminating best practices.

 

State Priority Need:

Access to High-quality, family-centered, trusted care is available to all Hoosiers.

 

State Performance Measure (2020 - 2025):

SPM 5: Promotion of optimal health, development, and well-being

The creation of this State Performance Measures was a response to the needs identified in the 2020 needs assessment. While developmental screening (NPM6) is important to Indiana, the IDOH team wanted to broaden the scope of the work to really include all of the teams that are working with and alongside families to support their development in children with and without special healthcare needs. The work is done collaboratively among Help Me Grow Indiana, Early Hearing Detection and Interview, Lead and Healthy Homes, Genomics and Newborn Screening, and Children with Special Health Care Services teams. The work plan for this SPM is spread across this Children’s section and the CYSHCN section.

Help Me Grow

Help Me Grow Indiana (HMG IN) will continue to promote healthy childhood development, with early childhood agency partnership, continued staff training, and promotional items, while using the MCH Helpline as it’s centralized access point.

Working in collaboration with both Spark Early Learning and CDC: Learn the Signs Act Early (LTSAE), HMG IN will provide statewide presentations to early childhood education (ECE’s) providers. These presentations offer an extensive explanation of the importance of understanding healthy milestone development in children and using the CDC LTSAE materials. This will also include a presentation from HMG IN, that covers the process of getting a free ASQ-3 developmental screening with an HMG Care Coordinator. HMG IN maintains a subscription to Brooks Publishing that contains the online ASQ-3 developmental screening. The online portal is accessed by HMG Care Coordinators to provide developmental screenings and reference materials for parents/guardians. The ASQ-3 is scored and a consultation with the parent/guardian and HMG Care Coordinator, results in developmental activity suggestions, explanation of developmental domains and possibly a referral to a child development provider, if needed. This Spark Early Learning, CDC, and HMG collaboration also provides ASQ-3 training for new staff. This training and the statewide presentation should lead to more area for HMG IN to expand to within the state. Indiana is looking forward to this strong partnership as HMG IN has experienced low call volume due to the COVID-19 pandemic.

HMG Indiana also has promotional materials and that aid community outreach specialists at conferences, expos, health fairs and community events. Hand sanitizers, magnets, notepads, and brochures contain the HMG logo and tagline and provide awareness to the HMG IN child development system. These materials, along with the CDC: LTSAE milestone materials are available at in person public health events and are also available to be ordered by providers at any time through an online order form. These materials are mailed out to requestors through Title V, as well. All promotional materials are available to both external requestors and internal MCH and CSHCS staff to disseminate at events.

HMG Indiana’s centralized access point is the MCH Helpline. The helpline provides a space for HMG Care Coordinator’s to connect with its families and providers by way of a shared toll-free number and online referral form. Moving forward, the MCH Helpline will continue to provide a centralized point for promotion of healthy child development (HMG), prenatal care (My Healthy Baby), and basic need resources for families (MOMS Helpline) while working in collaboration with Children Special Health Care Services.

The MCH Helpline continued to work in collaboration with Children Special Health Care Services (CSHCS) though client connection to specialized services to long term care for their children. Working with the MCH Helpline, Help Me Grow Indiana will continue to provide developmental screenings for Indiana families. Through those developmental screenings, developmental delays or concerns can be detected. Resources will continue to be provided through the Help Me Grow Care Coordinator. The current conversation workflow for HMG, provides an opportunity to recognize specialized needs for families that have children that possibly have serious, chronic medical conditions. This recognition will continue to be a determining factor for HMG Care Coordinators to elevate families in need of CSHCS to those care coordinators.

For the first time in 2022, IDOH applied for and received oral health educational materials and items (such as toothbrushes and floss) from the Delta Dental Foundation. The MCH Helpline put these items to good use: incorporating them into events to provide awareness of health oral hygiene for both parents and their children. These include adult and child toothbrushes, board books, oral health handouts and booklets. Receiving these items lends to the goal of the MCH Helpline providing a platform for Title V programming to be promoted through cohesive MCH outreach. The MCH Helpline can promote optimal health spanning from prenatal care to child development, through continued collaborations and partnerships.

EHDI

The Early Hearing Detection and Intervention Program (EHDI) serves 3500 families and caregivers each year of those who do not pass newborn hearing screenings. EDHI begins this process by sending several letters to parents to inform them of the results of the screen. The goal of these handouts was to help improve parent education and compliance with follow up testing. The first letter is sent to parents when a newborn did not pass their newborn hearing screening. It now includes a “Frequently Asked Questions” handout regarding newborn hearing screening and follow up. It also includes questions that our parent consultants reported were the most common questions regarding hearing screening results and the importance of follow up testing.  If IDOH does not receive diagnostic testing results by the child’s first birthday, EHDI will send a final letter to the parents that includes a handout with developmental milestones. IDOH wants to provide resources directly to the parents/caregivers to empower them if they see delays in their child to follow up with either their physician or with a hearing test. 

In each of our parent letters, EHDI also include handouts and resources from Help me Grow and Mom’s Helpline, plus includes contact information for those call centers in each letter. The goal is to provide families with resources for insurance, transportation, and other need that may arise.

Annually, the EHDI program sends over 10,000 letters to parents and their physicians that include those educational and resource materials mentioned above. EHDI is tasked with state side data surveillance for newborn hearing screening results, follow up diagnostic testing and support for families with deaf and hard of hearing children. Our staff contacts (via phone, text or fax) physicians, audiologists and parents to obtain diagnostic audiology testing, information on early intervention services or medical information on over 14,000 children per year.

The EHDI program has also presented at several conferences for organizations and agencies that serve young children (ie: Indiana First Steps, Early Childhood Center, Head Start, School Nurses Conference, and the School Health Network Conference) with presentations focusing on teaching families the importance of their role in improving their child’s brain, overall cognitive development, and language skill development. EHDI is providing practical resources and activities directly to families and providers on how to empower parents to understand the importance of their role in their child’s development, regardless of economic or social barriers. EHDI has provided trainings and technical assistance to over 800 participants, including birthing hospital staff, physicians, audiologists and other healthcare providers through virtual and onsite conferences or seminars. IDOH’s Guide by Your Side parent-to-parent support program through regional family events, direct parent to parent support, and annual EHDI conference reaches over 350 families annually.

The EHDI program is being tasked by our federal partners at HRSA and the CDC to expand our education and data collection for hearing screening efforts through age three. It is well known that 50% of deaf and hard of hearing children are diagnosed after or outside of newborn hearing screening efforts. Currently and historically, EHDI’s focus has been centered on newborn hearing screening and follow up through the first year of life. IDOH has started building relationships through its EHDI Advisory Committee, MCH partners, as well as other stakeholders to identify education opportunities regarding hearing screening efforts and reporting for organizations and agencies serving preschool children through school entrance. A formal plan outlined by June 2023.

In 2019, Indiana EHDI started the ASTra (Educational Advocacy Program) with the use of Title V funding. ASTra is a Deaf and Hard of Hearing Educational Advocacy Program that embodies the mission and vision of Hands & Voices. They aim to provide support to families with children who are deaf or hard of hearing (D/HH) without a bias around communication mode, method, and educational setting so that every D/HH child has the opportunity to achieve their full potential. ASTra content is derived from years of direct advocacy experience working with families in schools, attending advocacy trainings from legal experts, providing trainings, and the Hands & Voices Educational Advocacy Guidebook. Indiana is the 12th state to attain the ASTra Program Certification. This program provides parent training to all families twice a year. In addition, certified ASTra parent advocates are available to assist parents of deaf and hard of hearing children with the process of developing appropriate individualized education plans for their children. This support can start with transition from early intervention to school services or at any time in a child’s educational journey through school exit. The ASTra program services are free to families. From 2019 to 2020, the program served 47 families. From 2020 to 2021, they served 78 families. As of May 31, 2022, the program has already served 73 families. EHDI will continue this work into the next year and reach as many families as possible.

Lead and Healthy Homes

The IDOH Title V team will also continue to partner with the Lead and Healthy Homes Division. The primary goals of this team are to 1) track the prevalence of lead exposure in children throughout Indiana and 2) support local health departments and community partners in taking the necessary steps to promote primary prevention efforts to minimize that exposure and the resulting health risks. One way this is done is through performing risk assessments to identify lead hazards. Through support from Maternal & Child Health division, Lead & Healthy Homes was able to license twelve new risk assessors and renew the licenses of seven existing risk assessors. As a result of these risk assessors being licensed, Indiana was able to perform 151 risk assessments identifying lead hazards in homes where children have elevated blood levels. Due to the lead threshold lowering, we expect an increase of financial support needed for licensing more risk assessors. The team will be continuing this important work over the upcoming year.