Maternal and Child Health Services Title V Block Grant – State Action Plan and Strategies

Child Health, Plan for FY 2018

 

Ohio Department of Health Priorities:

         Increase prevalence of children receiving integrated physical, behavioral, mental, and developmental services

         Reduce the rate of childhood obesity

Increase prevalence of children receiving integrated physical, behavioral, mental, and developmental services

According to the 2011/2012 National Survey of Children’s Health, 93.9% of Ohio children aged 0-5 received one or more preventive medical care visit. Eight-six percent of Ohio children aged 6-11 received one or more preventive medical care visit. Screening and well-child visits provide an opportunity for periodic assessment of core health status components including behavioral and mental health, developmental, dental, hearing or visual impairment and to identify and prevent elevated blood lead levels. Early detection and referral leads to earlier treatment & promotes proper management of the conditions. A systematic approach to quality improvement science should result in increasing the percent of children receiving timely, age-appropriate screening & improving the system overall to ensure children receive the care that they need. Comprehensive well child visits is a child health benefit for children under the age of 21. Services are intended to screen, diagnose, and treat children to avoid or minimize childhood illness. A 2010 Office of Inspector General’s report found that children were not receiving all of the required EPSDT screening. (Office of Inspector General Report, November 2014). It is estimated that 1 out of 5 children in Ohio under the age of six are at moderate or high risk for developmental, behavior or social delays. Through EPSDT, a child is identified early through the screening process and is more likely to find appropriate treatment so children are school ready (EPSDT & Developmental Screening, Voices for Ohio’s Children). According to the Resources for Title V Action Planning, Developmental Screening Strategies and Measures, screening for healthy development can reduce the likelihood of a child developing other delays if provided the appropriate screening, referral and follow up treatment. Strategies and activities target increasing the quality of care provided during a well child visit to decrease duplication of efforts while increasing the collaboration and efficiency of stakeholders.

Strategies:

1.       Implement a quality improvement learning collaborative to improve comprehensive screening practices (e.g. tools, documentation, referrals, follow-up)

2.       Establish an on-going, state led EPSDT Improvement advisory committee or taskforce that includes representatives from multiple state agencies as well as family an organizational stakeholders

3.       Develop a shared data system to share and track information on screening and follow-up to decrease duplication of services

4.       Modernize polices for billing, explore reimbursement and data reporting

Activities/Objectives:

         Implement a best-practice training for healthcare providers serving the identified population utilizing quality improvement methods.

o        Years 3-5: Implementation of trainings for healthcare providers that incorporate best-practice/evidenced based approaches for components of the comprehensive well child visit.

         Identify screening barriers and resources to overcome barriers.

o        Years 3-5: Barriers to conducting appropriate screening and follow up will be identified as a result of quality improvement methods.

o        Years 3-5: Resources to increase screening and follow up will be identified and provided as a result of quality improvement methods.

         Recruit and train at least ten new healthcare providers serving the identified population per year regarding standardized recommendations.

o        Year 3: At least ten new healthcare providers will be recruited to participate in quality improvement collaborative on a yearly basis.

o        Years 3-5: Healthcare providers will be trained on the best-practice/evidenced based approaches for components of the comprehensive well child visit.

o        Years 3-5: Healthcare providers will be trained on standard data reporting.

         Years 1-5: Monitor screening rates and compliance with standardized recommendations.

         Years 1-5: Partner with diverse stakeholder group to promote well care.

         Implement evidenced-based education for families and children.

o        Years 1-5: Access to follow up treatment and family support is available.

o        Years 1-5: Engage families in importance of screening, follow up and treatment.

o        Years 1-5: Explore evidenced based prevention activities for children.

         Implement evidenced-based education providers.

o        Years 1-5: Access to follow up treatment and provider support is available.

o        Years 1-5: Engage providers in importance of screening, follow up and treatment.

         Explore HL7 messaging for data reporting.

o        Year 3: Plan for implementation of linkage/integration recommendations.  A) Develop PCP for IT Governance approval; B) Implement IT project.

         Explore identification and tracking of trained providers.

o        Years 3-5: Healthcare providers who have received appropriate training are identified and monitored utilizing a unique identifier.

o        Years 3-5: Provide targeted technical assistance to identified providers.

         Create stratified system of care coordination.

o        Years 3-5: System of care coordination is developed and utilized.

o        Years 3-5: Gaps in system of care coordination are identified and corrected.

         Explore the modernization of payment models for comprehensive health services to ensure that children's insurance routinely covers appropriate evidence based treatments.

o        Years 2-5: Explore payment models for comprehensive health services and implement where appropriate.

         Years 2-5: Explore reimbursement models that have led to quality outcomes and assess implementation feasibility.

Reduce the rate of childhood obesity

Obesity has reached epidemic levels in Ohio; 15.7% of low income preschool-aged (2 to 5 years) children are overweight and 12.8% are obese and Ohio is not seeing a decrease in obesity among this age group.  Since the Early Childhood Obesity Prevention Program started in 2013, several initiatives now address this epidemic.  This program is working with healthcare practitioners in clinical settings, early childcare education providers in centers and family homes, and is planning additional work in home visiting programs and WIC clinics.  Ohio’s Child and Family Health Services (CFHS) program funds local health departments to conduct needs assessments and if communities choose to address childhood obesity they are funded to work in childcare or school settings.  The strategies and activities described below encompass these multiple venues as well as BMI surveillance for preschool children (coordinated with oral health screenings).  Preventing childhood obesity is an objective in the Ohio Chronic Disease Plan, the CDC Chronic Disease Cooperative Agreements, the HPIO Report on Population Health, and the SIM grant.

 

Strategies

1.      Increase the number of at-risk children and youth, birth – 5 years, receiving interventions to prevent and manage obesity through health practitioners

2.      Increase the number of licensed early child and school-aged child care providers that have adopted organizational healthy eating/ active living (HEAL) policies

3.      Through MCH grants, support local communities to identify nutrition/physical activity needs and gaps, create an action plan, and work with facilities (including schools) to increase nutrition education, access to healthy food choices, and/or physical activity

4.      Through collaboration with the Oral Health Program, conduct BMI surveillance within child care centers in the Southwest and Northeast Ohio (n=83)

 

Activities/Objectives

         Years 1-5: Implement Parenting at Mealtime and Playtime (PMP) Quality Improvement opportunities or learning collaborative(s) with healthcare practitioners in Ohio, e.g. dietitians, physicians, home visitors and nurses

o        Annually (on state fiscal year) set up learning collaborative(s) or QI opportunities

o        Annually recruit practitioners, estimate market to 100 to 200 practitioners annually

o        Annually train practitioners, estimate train 60-80 practitioners

         Years 1-5: Maintain and disseminate current guidelines for the use of evidence-based interventions to prevent and manage obesity

o        Annually review and update guidelines based on current research

o        Annually disseminate guidelines

         Years 1-5: Promote use of interventions to healthcare practitioners through partnerships with hospitals, foundations and other stakeholders.

o        Convene the Ohio Early Childhood Health Network healthcare subcommittee quarterly

o        Quarterly, build partnerships with hospitals, foundations and other stakeholders through participation in the subcommittee meetings or strategies

o        Annually promote use of interventions

         Years 1-5: Facilitate operation of OECHN so that it aligns activities Statewide to support and improve early childhood health outcomes throughout the state.

o        Convene quarterly OECHN meetings

o        Quarterly update and maintain membership lists, website and materials

o        Support OECHN subcommittees with related communication or facilitation needs

         Years 1-5: Through CFHS grantees, train and provide technical assistance to licensed early child and school-aged child care providers to become Ohio Healthy Program (OHP) Designated.

o        CFHS grants developed by ODH and awarded

o        ODH will administer the grant to assure the following occurs:

         Train child care staff –track the number of staff attending each session

         Track the number of technical assistance calls/visits provided to each participating center

         Track the number of policies and menus changed and number of family engagement activities provided

         Track the number of child care facilities designated “Ohio Healthy Program”

         Years 2-5: Funded communities conduct a needs assessment, form a local coalition, and submit an action plan.

o        ODH will administer grant to assure that CFHS subgrantee agencies:

         Attend training

         Conduct a comprehensive Nutrition and Physical Activity Community Needs Assessment

         form a local coalition

         submit an action plan

         Years 2-5: Implement (through school/ facility personnel) evidence-based and/or best practice nutrition education program in schools to increase nutrition education, access to healthy food choices, and/or physical activity

o        ODH will administer grant to assure that CFHS subgrantee agencies:

         Track the number of facility personnel implementing a nutrition education/physical activity program

         Track the number of kids served (by grade)

         Track the number of classrooms served (by grade)

         Track the number of facilities served

         Track the number of family engagement activities provided

o        Measure the changes in student knowledge based on the nutrition education/physical activity education program selected

         Year 2-3: Interpret findings, develop report, print, and distribute findings from BMI survey of 2- 5 year olds.