The CT Title V Program and our partners recognize the importance of access to a comprehensive health and mental health care system for all children, with a focus on underserved children and health equity. CT Title V works to advance improvements in collaboration with providers, policymakers, consumers, and state agencies with an emphasis placed on developmental promotion, developmental monitoring, early screening, evaluation, and intervention.

CT activities around developmental screening continue to address together shared strategies including: conducting an education and awareness campaign that targets families and communities on the importance of developmental screening; train community and healthcare providers to improve screening rates and coordination of referrals and linkage to services within the state; and engage in cross systems planning and coordination of activities around developmental screening.

Cross system planning and coordination of activities include a Title V staff member to continue to attend the Help Me Grow Advisory Council meeting that focused on developmental screening efforts including a focus on establishing a statewide learning collaborative to bring together developmental screening initiatives to increase understanding of screening practices and create an informed system of developmental promotion, developmental monitoring, early detection, linkage, and referral.

Screening to Succeed regional call to action efforts will continue through the increase of developmental awareness and promotion, developmental screening, and connecting to services by providing families and providers with the knowledge, resources, and tools for effective coordination and community wide implementation. Staff from Department of Public Health, University Center for Excellence in Developmental Disabilities, Child Development Infoline, Wheeler Clinic, Office of Early Childhood, Help Me Grow Advisory Committee and the Developmental Screening Workgroup of the State Health Improvement Plan will continue to support efforts to expand developmental screening through the implantation of community action plans.

DPH staff will work with CT Medical Home Initiative partners to distribute CT customized (LTSAE) materials in English and Spanish through trainings such as: the SIT for Autism training, which increases knowledge of the characteristics of autism and teaches participants up to five strategies that can be used while sitting for an individual with autism; and the Parent Advocacy Training, which trains parents, advocates, and guardians on advocating for children with ASD.

Child Development Infoline (CDI) has an updated family friendly web site that offers the Ages and Stages Questionnaires online along with developmental milestones. CDI has a supply of “Learn the Signs. Act Early.” Materials available on site for distribution for families and providers available in both English and Spanish. CT DPH has updated the Where is Bear? Book in English and Spanish to include CT referral information to United Way 2-1-1 Child Development Infoline.

CMHI will continue to work with staff from CT Children’s Medical Center Autism Spectrum Assessment Program (ASAP) as the program offers parents, families, and medical providers a direct line from the autism diagnosis to needed services and community supports.

School Based Health Centers actively ensure that immunizations are updated, and numerous SBHC have chosen immunizations as a Results Based Accountability outcome measure as well. Title V staff and our partners will work with the DPH Immunizations Program to disseminate information, including Advisory Committee on Immunization Practices (ACIP) guidelines and to promote the necessity of adhering to immunization schedules; and to advocate for the coverage of vaccines by all insurers. In addition, SBHCs perform oral health screenings and referral.

The Connecticut Department of Public Health Immunization Program provides all recommended childhood vaccines to over 680 providers statewide including private physician offices, community health centers, school-based health centers, and local health departments. In 2020, nearly 1,000,000 doses of vaccine were distributed and the Program universally expanded provision of Influenza vaccine for all children up through 18 years of age in Connecticut regardless of insurance status. Adult vaccines including HPV for uninsured patients 19-45 years of age are provided to local health departments, community health centers, and drug treatment facilities. Uninsured and Medicaid patients 9-18 years of age, as well as privately insured 11- and 12-year old’s, are also provided HPV vaccine.  All nationally recommended childhood vaccines are provided to School Based Health Centers for children up through 18 years of age free of charge. The Immunization Program also partners with the WIC program to promote timely immunizations and well childcare at WIC locations statewide. Nine local Immunization Action Plan (IAP) Contracts (Hispanic Health Council, Ledge Light Health District, Naugatuck Valley Health District, New Britain Heath Department, New Haven Health Department, Norwalk Health Department, Southwestern AHEC (Area Health Education Center), Torrington Area Health District, Waterbury Health Department) worked with providers, maternal and child health partners, and local WIC agencies to ensure that all children have a medical home and access to age appropriate vaccinations.

IAP Coordinators and state immunization program Epidemiologists conduct site visits called IQIP (Immunization Quality Improvement for Providers) with providers as a continuous quality improvement process developed by the Centers for Disease Control and Prevention (CDC) to raise immunization coverage rates, reduce missed opportunities to vaccinate, and improve standards of practice at the local level.

The Connecticut Immunization Information System (IIS) called CT WiZ tracks children statewide from birth up through age eighteen as reported from providers enrolled in the Connecticut Vaccine Program (CVP), as will be described below. CT WiZ can capture vaccines throughout the lifespan. All children born in Connecticut are automatically enrolled through State Vital Records and their provider offices, unless the parent opts out. CT WiZ enables providers to report electronically which reduces data entry and enables CT WiZ to capture timely data on children up through age eighteen and beyond.

The Connecticut Vaccine Program (CVP) is funded through a combination of state and federal monies. The state monies are from an assessment tax on all health insurers doing business in the state of Connecticut. This assessment allows the program to provide the majority of all nationally recommended vaccines for privately insured children up through 18 years of age free of charge.

Pediatric outpatient visits and routine childhood vaccination have declined during the COVID-19 pandemic, leaving children and communities at risk for outbreaks of vaccine-preventable diseases. In response, the CT DPH Immunization Program has supported providers to remind parents that vaccinations are safe and important through activities including: Surveying providers on their ability to provide catch-up and coordinating with the State Department of Education on recommendations for health assessment records; Sending memos and resources to pediatric providers via Everbridge mass communication system and posting on: https://portal.ct.gov/DPH/Immunizations/CVP---Information-for-Providers; Posting on CTDPH social media sites to promote vaccine catch up; Sharing resources and social media toolkits with providers and local Immunization Action Plan (IAP) Contractors conducting outreach and education to raise immunization rates; Preparing and posting a letter encouraging providers to onboard with CT WiZ as a strategy for real-time reporting and utilizing reminder recall reports; Continuing to onboard providers with CT WiZ; Promoting and posting the updated reminder recall reports training on the CT WiZ Training website: https://portal.ct.gov/DPH/Immunizations/CT-WiZ-Patient-Management; Sharing AAP and CDC messaging/webinars/resources on routine catch up reminding parents to take kids to their pediatrician.

The Connecticut Department of Public Health Office of Oral Health tracks the number of children who receive a dental visit annually through the CT Behavioral Risk Factor Surveillance Survey. The most recent data available is from 2019 and it shows 86.2% of Connecticut children between the ages of 0 and 17 receive a dental visit. Other data captured includes “dental visit among children aged 1-17 years with special health care needs” from National Survey of Children’s Health and it shows that Connecticut has 93.1% which is above the national percentage of 85.4% in 2019. Connecticut can also capture “preventive dental visit among children aged 1-17 years enrolled in Medicaid/SCHIP” via CMS-416 and Connecticut’s percentage is 82.8% in 2019.

The Office of Oral Health (OOH) continues to promote the benefits of sealants through its school-based sealant programs, other community partners, and other health promotion channels. In the last year the Office of Oral Health created a Communications Plan for school-based dental sealant programs which included strategies to foster community awareness, develop bilingual resources, and promote them via the website and social media. The OOH continues to facilitate the CT Dental Sealant Advisory, a statewide stakeholder group that meets quarterly to provide guidance and technical assistance to the SEAL CT! program. Despite covid, the group maintained strong attendance and participation, meeting virtually.  Resources to promote sealants and the safety of preventative visits during covid were created in English and Spanish and shared with partners for broad utilization. A 30 second public service announcement (PSA) was created to promote sealants.

The OOH will support the Dental Sealant Advisory in hosting the annual workshop in the Fall of 2021 which bring together sealant partners to discuss the benefits, challenges, and best practices. This year’s workshops will be focused on re-engagement of families to further promote sealants. Due to covid, there is general hesitancy about resuming preventative dental services. This workshop will best around be sharing best practices and lessons learned. The OOH is also planning to conduct the oral health surveillance of kindergarten and 3rd grade students in CT as part of a long-term surveillance strategy. Randomly selected school are chosen by the CDC and in partnership with the CT State Department of Education. The survey will be conducted in the 2021-2022 school year. Active planning with partners was conducted in 2020-2021.

The survey is conducted every 4 years to provide an update of the oral health status of children in CT so that the OOH, along with partners can make appropriate recommendations of intervention, health education and policy recommendations. Through a HRSA grant the OOH is working with the Community Health Center, Inc (CHCI) to implement a medical dental integration pilot that addresses common risk factors for child obesity. Referrals between dental and medical providers within the CHCI system is aimed to address risk factors, provide nutritional counseling, and access to other resources. A CDC grant will address the adult component for those at risk for diabetes. CHCI staff received comprehensive training including Motivational Interviewing and a Provider Toolkit to assist the pilot implementation at five sites in May 2021.

The Nutrition, Physical Activity, and Obesity (NPAO) Program will continue to expand the existing Early Care and Education (ECE) site initiatives by working with new and existing partner organizations.

Go NAPSACC: The NPAO Program plans to recruit a minimum of 60 ECE sites for participation in the Go NAPSACC initiative from October 1, 2021 to September 30, 2022.  Recruitment will be supported by state and local partners, including the partnering organizations that provide training and technical assistance to most of the participating ECE sites: the Regional Education Service Centers (RESC) Alliance; All Our Kin, a family child care home network; and the City of Hartford Department of Children, Families, and Recreation. As ECE sites recover from the COVID-19 pandemic, the NPAO Program plans to work with ECE sites and their TAs to promote full completion of the Go NAPSACC process with a goal of at least 50% of enrolled sites completing both the pre and post assessment to measure best practice attainment.

Early Childhood (CEC): The NPAO Program plans to implement CEC in at least 15 ECE classrooms from October 1, 2021-September 30, 2022. Because of COVID-19, NPAO Program and University of St. Joseph (USJ) staff will need to be recertified to conduct training on CEC, which requires the three-day Training Academy with the CATCH master trainer.   Each of the selected ECE classrooms will identify a two-person CEC team, consisting of one administrator and one lead or senior teacher, who will coordinate CEC implementation for a total of 60 staff trained.

Nutrition and Physical Activity Education: The NPAO Program, with USJ, plans to conduct at least 105 sessions and workshops from October 1, 2021-September 30, 2022 for a total of 788 participants. The NPAO Program plans to finalize the handout for School Based Health Center staff which will outline reliable nutrition education information for students and their families on reducing sugary drink consumption.  The information included is sourced from nationally recognized websites (National Institutes of Health, American Academy of Pediatrics, CDC, USDA, and so forth) and includes content in English, Spanish, and other available languages.