NPM #8 Physical Activity – Reduce obesity among children and adolescents

 

Please note that some of the strategies and activities listed below impact both the Child and Adolescent Health domains. To avoid duplication, the information will only be listed in this domain, for which it is anticipated to have a larger impact, but it should be noted that some strategies and activities may address a wider age range.

 

Policy and Environmental Changes

Developing a healthier community involves creating a culture that promotes the benefits of physical activity and allows access to safe places to be active. Public policy is essential in supporting opportunities for children, youth, and families to develop healthy physical activity practices. Strategies to promote policy and environmental changes that can foster healthier communities in which opportunities and safe places to be physically active abound include collaboration with internal partners, local public health agencies (LPHAs), youth, and statewide and community organizations with similar goals. Program staff in the Bureau of Community Health and Wellness (BCHW) will continue to contract with LPHAs to implement policy and environmental changes that increase opportunities for children to engage in physical activity in early care and education settings.

 

The LPHAs will use the University of North Carolina’s Nutrition and Physical Activity Self-Assessment for Child Care (Go NAPSACC) online system to assist child care providers to improve the health of young children through practices, policies, and environments that instill habits supporting lifelong health and well-being. The system also tracks child care providers’ progress. The Child Care Health Consultation (CCHC) Program Specialist will continue to assist LPHA staff that provide Go NAPSACC technical assistance and consultation to child care providers as part of the program’s nutrition and physical activity consultations.

 

Through BCHW, the Department of Health and Senior Services (DHSS) will continue supporting child care providers to implement policies and practices supportive of physical activity. DHSS will provide training, resources and technical assistance related to physical activity policies and practices to providers aiming to become a Missouri MOve Smart Child Care Provider.

 

The CCHC Program at the Department of Elementary and Secondary Education (DESE) will provide consultation hours for child care providers to support the implementation of policies and procedures that support physical activity and nutrition. These consultation hours may include recommended guidelines for physical activity and nutrition, policies and procedures that promote indoor and outdoor physical activity, addressing barriers to indoor and outdoor activity, implementing screen time policies, and consultation and training on becoming a Missouri MOve Smart Child Care designated facility. With DESE’s change of clock hour provider, it is planned that CCHC clock hours will also be made available to child care providers who complete GoNAPSACC training modules.

 

Professional Development, Training, and Resources

BCHW staff are also available to provide training and technical assistance on obesity prevention strategies for local communities. To ensure staff are well informed and can provide quality assistance, they plan to participate in professional development opportunities such as annual conferences of professional associations and other evidence-based training.

 

BCHW will continue to support Missouri communities in their obesity prevention efforts by providing professional development and training opportunities for key stakeholders. Additionally, technical assistance and resources are available to assist efforts in increasing regular physical activity and healthful eating. BCHW will also assist communities in assuring interventions are inclusive of individuals of all abilities.

 

The School Health Program (SHP) will continue to encourage school nurses to engage with students and families in addressing overweight/obesity in children. The SHP will sponsor education and professional development in best practices (e.g., Lead Nurse Collaborative Meeting, weekly office hours, sessions at the Coordinated School Health State conference, and ECHO (Extension for Community Healthcare Outcome) webinar series for school nurses). The SHP will also collaborate with stakeholders and organizational partners to make tools and resources available to school nurses, and facilitate connections between students and their families, schools, and communities. The SHP is partnering with Washington University on a study Harnessing State-Wide Partnerships and Technology to Expand Access to Care for Eating Disorders in Adolescent Girls in the COVID-19 Pandemic and beyond. The study is funded by the U.S. Department of Health and Human Services and is being piloted in three school districts.

 

The CCHC Program will continue to provide trainings for child care providers and health promotion presentations for children on the importance of nutrition and physical activity. Child care provider trainings will focus on physical activity and its positive effects on weight, physical and mental health, and the development of motor, social/emotional, and cognitive skills. Trainings will also address how to incorporate structured and free active play into daily routines, address AAP guidelines for screen time, and provide examples of age appropriate activities and games to promote physical activity. In June 2022, 25 CCHC Program trainers completed Nemours Physical Activity Learning Session (PALS) ‘train the trainer’ sessions, and are now equipped to provide physical activity trainings for child care providers in their respective counties. In January 2023, 43 CCHC Program trainers completed the Nemours Nourishing Healthy Eaters (NHE) in Early Care and Education settings ‘train the trainer’ sessions. They can provide trainings on best nutrition practices for children and adults, the role of nutrition in child growth and development, how child care providers can have a positive impact on a child’s developing nutrition habits, and specific nutritional considerations and challenges for infants, toddlers, and preschoolers. Considerations for infants and toddlers include responsive feeding, establishing breastfeeding-friendly environments, and adult practices that best support a child’s relationship with food. Considerations for preschoolers include developmental stages and common challenges in preschool aged children, mealtime practices, and engaging with families around food and child nutrition. Training and health promotion will also incorporate the 12345 Fit-Tastic! Healthy Lifestyles Initiative messaging and guidelines, which incorporate nutrition and physical activity guidelines for children in easy to utilize resources. The initiative is developed by the Kansas City Healthy Lifestyles Collaborative and funded by Children’s Mercy Hospital. Health promotion for children will also: provide fun and developmentally appropriate opportunities for physical activity and nutritional experiences, increase children’s knowledge on how physical activity and proper nutrition keeps their minds and heart healthy, and enable children’s involvement in fun activities through songs, books, structured and unstructured play that promote nutrition and physical activity. CCHC Program services will continue to provide evidence-based resources and educational materials for child care providers and the parents/guardians of children, provide resources and opportunities for collaboration with community-based organizations that promote physical activity and nutrition for children, and encourage family participation in all program services.

 

Partnerships

BCHW staff participate in coalitions and partnerships that help to advance progress towards the state’s goals and objectives to improve levels of nutrition and physical activity and to reduce obesity. Examples of groups in which staff are involved include: MOCAN, Missouri Convergence Partnership, Missouri Coordinated School Health Coalition, DESE Healthy Schools Project, and the Missouri Complete Streets Advisory Council. Staff have the opportunity to network and identify collaborative opportunities with other organizations working towards similar goals, share available DHSS resources, and leverage funding to increase the reach of their work. Through the MOCAN Schools Workgroup, BCHW staff are working to promote use of the Whole School Whole Community Whole Child framework in Missouri schools. The workgroup will share resources to assist schools in this effort. Another goal is to strengthen district wellness policies and practices that promote healthier school environments.

 

Through the Missouri Healthy Weight Advisory Committee, BCHW staff support work to increase the capacity of the health care workforce to provide evidence-based family-based treatment programs for children that are overweight and obese. Health care providers (registered dieticians/licensed clinical social workers/etc.) will be surveyed to identify existing capacity to provide family based obesity therapy. In 2022, the state’s Medicaid program made it possible for providers to bill for obesity treatment for pediatric patients. The surveys will also identify where additional resources are needed to increase health care provider capacity to provide these services. The ultimate goal will be to establish a training and certification program to increase the providers that can provide these services.

 

The CCHC Program Specialist participates in coalitions and partnerships that support physical activity and nutrition in early childhood and increase collaboration of nutrition and physical activity initiatives across the state. These include the Missouri Council for Activity and Nutrition (MOCAN) Child Care Work Group, the Kansas City Healthy Lifestyles Collaborative Early Childhood sector, and the Missouri Breastfeeding Coalition.

 

The MCH Services Program will continue to contract with the 23 LPHAs that selected promoting physical activity and reducing and preventing obesity as a Priority Health Issue in their FFY2022-2026 MCH Services contract work plan. LPHA efforts to prevent and reduce obesity and increase physical activity among children and adolescents include:

• Knox County Health Department is working with their County Ball Association and various community event organizers such as the Bright Futures Fishing Derby and Family Prom to implement healthy food options in their concession stands and serving areas using the Eat Smart in Parks toolkit. The nutrition guidelines in the toolkit help set a standard for the foods and drinks offered in parks and contain measures that can boost the availability of healthy food choices. The health department has replaced sugary beverages with options with less sugar and some food items with “healthier” options. For example, they introduced whole-grain items and fruit to replace chips, toaster pastries, and cookies. Some health department staff volunteer in the concession stands and provide nutrition education to various leaders and patrons. In addition, the health department’s Environmental Specialist is collaborating with the Farmer’s Market vendors to provide education on storage, handling and preparation of produce being sold and how to choose fresh fruit and vegetable items as a consumer. The market is held every Friday through the Summer and Fall months.
• Mercer County Health Department is using the Water Access in Schools Toolkit from the Centers for Disease Control and Prevention (CDC) to implement a water access plan within schools to increase availability of free safe drinking water in gyms and other physical activity areas. They are also working with the Russ Derry Sports Complex to incorporate a playground that it is safe and inclusive for all children.
• Scotland County Health Department is working with the City of Memphis to implement safe drinking water filling stations in parks and recreational sites to encourage children and adolescents to drink more water when being active. They are also educating providers (schools, Head Start, and childcare providers) on the 12345 Fit-Tastic! Healthy Lifestyles Initiative and providing messaging materials as requested (bookmarks, handouts, and posters).
• Benton County Health Department has developed a community resource guide that identifies walking trails, parks, swimming pools/public beaches, bowling alley, skate park, YMCA, and other opportunities for physical activity among children and adolescents and is updated as needed and annually. The map includes images of these areas to make locating them easy. In addition, the health department has collaborated with Parents as Teachers and the local library to provide nutrition education classes for children and families on how to read nutrition labels, wash produce, and prepare a healthy meal.

 

SPM #1 Oral Health – Percent of children, ages 1 to 17 years, who had a preventive dental visit in the last year

 

Ordering information for oral health resources from the Office of Dental Health (ODH) and the Missouri Primary Care Association (MPCA) will be provided to all MCH funded home visitors to promote National Children’s Dental Health Month, which is observed annually in February. National Children’s Dental Health Month will also be highlighted in the Home Visiting Program’s continuous quality improvement newsletter, Quality Outlook, and the Weekly Update emailed to all MCH funded home visitors and supervisors to provide links to materials, webinars, and other resources that highlight the importance of preventive annual dental care in children. The Missouri WIC Program will collaborate with ODH to procure infant and toddler toothbrushes to have them available in their local WIC clinics.

 

Additionally, literature is available to LPHAs, dental offices, and community outreach events such as health fairs. The importance of regular dental care is also stated within the context of the ODH’s promotion of the use of dental sealants. The referrals and care coordination components of the Preventive Services Program (PSP), described in more detail below, also encourage regular dental visits for children, particularly those who have been identified as having an oral health need.

 

The ODH enjoys continued success with the PSP, which is an evidence-based fluoride varnish and oral health education program. PSP serves about 90,000 children each year. Each child receives an oral health screening by a dental professional, two doses of fluoride varnish, oral health literature and supplies, and oral health education. The oral health education is either provided by school staff or the dental professionals that volunteer to operate PSP. Educational materials are provided by the ODH (for each grade, K-12), but some schools choose to use their own materials. Due the Coronavirus pandemic, many schools were not allowing visitors to enter their school building. During that time, fluoride varnish was either applied by a trained school staff member or parents/guardians. Those restrictions have been lifted for most schools and PSP will continue regular operations. When PSP was developed over 16 years ago, only licensed dentists or hygienists could conduct the PSP oral health screening. Due to the workforce shortage and as an outcome of the Coronavirus pandemic, many dental professionals are not able to volunteer for PSP as they did before 2020 because they are still trying to catch up with providing services to their patients, most of whom were not able to visit them during COVID. Additionally, the dental health workforce has seen a 5-10% decline; dentists and hygienists are now working in other fields and thus are not able to volunteer for PSP because they have either not renewed their license or have other work commitments. The ODH’s Oral Health Consultants will also be available to school nurses to advise on possible dental health needs. School nurses can take pictures of a child’s teeth if there is a questionable issue, and an Oral Health Consultant will help determine the need for further dental care. During the Coronavirus pandemic, the ODH created narrated videos, specific to grade levels from Kindergarten to 12th grade that are available on the DHSS website and can be accessed by any Missourian.

 

Due to the workforce shortage among dental professionals as mentioned above, the ODH is currently working with the Association of State and Territorial Dental Directors (ASTDD), Kansas City University (KCU) and the Dunklin County Health Department to pilot a program to train the public health nurses on basic oral health screenings. ODH has received input from ASTDD to ensure this is allowed and moved forward with training. A dentist from KCU and ODH’s Oral Health Consultant in that region provided the training to the nurses. LPHA nurses will visit local schools and conduct a basic oral health screening, offer oral health education, provide oral care supplies, and help with referrals and fluoride varnish applications. The LPHA will purchase fluoride varnish and since fluoride varnish application is reimbursed through Medicaid, the LPHA will be reimbursed and this helps sustain the program. The ODH will evaluate project outcomes and determine the feasibility of expanding to other areas suffering from workforce shortages.

 

To combat the workforce shortage and grow PSP, the ODH is working with the University of Missouri–Kansas City and Score One for Health. The group is discussing the possibility of medical students performing PSP screenings. This project will not only address the dental workforce shortage and how it relates to PSP but also provide a learning tool for medical students. The objective is these students will be accustomed to performing a quick visual oral health assessment when they become practicing physicians, , thereby bringing possible issues to light before they require more intense treatment.

 

The ODH will continue distribution of Dental First Aid Kits. These kits include the newly updated Oral Health Guide for Caregivers of School-Aged Children and items to help school nurses in the event of a dental trauma. The ODH will purchase, assemble and distribute kits to the approximately 3,000 schools throughout Missouri.

 

The SHP will continue to coordinate with the ODH and other programs to provide evidence-based information, resources, and professional development to school nurses. These efforts will equip nurses with best practices to educate children and parents about oral health concerns as well as promote the need for annual dental visits and regular preventive practices. The SHP will continue to host the ODH during the statewide meeting of lead school nurses in an effort to recruit additional schools to offer school-based oral health programs. The SHP will offer a 60-minute orientation for all new school nurses on oral health programs and the role of the oral health consultant.

 

The ODH will continue to promote the use of dental sealants as an effective means of preventing decay on newly erupted molars. The ODH is actively seeking new partnerships to provide dental sealants in school-based clinics. In addition, the ODH is leveraging a CDC grant to work with two LPHAs and two dental health clinics to apply sealants in their clinics and at local schools. The ODH will also continue working with WIC Programs at LPHAs to support fluoride varnish application for high-risk children. The ODH will leverage another grant to contract with two dental clinics and two dental hygiene schools to provide teledentistry services to schools. These services will target counties with very few or no dentists and provide dental services to children who may not otherwise have access.

 

Through an agreement with DESE, the ODH will continue to provide free oral health screenings, fluoride varnish and oral care supplies to children at the Missouri Schools for the Severely Disabled. Registered Dental Hygienists will provide screenings, alert the school nurses when the child has an issue that needs immediate attention, and provide fluoride varnish, which has been shown to decrease dental decay with two or more annual applications. The ODH piloted an online screening form to be used to record and gather results of the screenings. This form will be used to create a report that will be available at the conclusion of FFY 2023.

 

The TEL-LINK Program will refer callers to community-based dental clinics to increase awareness of community resources to increase access to needed dental health services. The program will continue to provide outreach to the underserved population through effective marketing strategies.

 

The Child Care Health Consultation (CCHC) Program at DESE will continue to provide consultation and training for child care providers and health promotion for children in child care on the impact of oral health on physical health. Consultations will increase awareness of evidence-based policies and procedures that promote optimal oral health for children. Consultants will provide technical assistance during the implementation process. Trainings will increase the child care provider’s knowledge on oral health guidelines and promotion strategies, abnormal oral conditions among infants and young children, and specific implications for oral care for children with special health care needs. Health promotion for children in child care will provide developmentally appropriate and fun oral health education and help children understand why it is important to take care of their teeth, identify unhealthy snacks and beverages that could harm their teeth, and participate in hands on demonstrations of proper tooth brushing and flossing techniques. CCHC Program services will continue to provide child care providers and children in child care and their families with educational materials, toothbrushes, toothpaste, and floss to enhance their excitement around oral care and ability to participate in oral care at home. These educational materials will also increase parent/guardian awareness on the importance and recommended frequency of preventive dental checkups and other ways to promote oral health at home. CCHC services will continue to be inclusive of adults and children of all abilities, encourage family involvement in program services, and provide referrals to outside community resources for children’s oral health services.

 

The MCH Services Program will support LPHA efforts to:

• Provide education on the importance of adequate dental care on overall physical health;
• Collaborate with partners to provide screening, referral and direct provision of preventive dental services; and
• Increase the number of children, ages 1 to 17 years of age, receiving a preventive dental visit in the last year.

 

The MCH Services Program will continue to contract with the seven LPHAs that selected enhancing access to oral health care services for children as the Priority Health Issue for their FY 2022-2026 MCH Services contract work plan.

• Audrain County Health Department is collaborating with the WIC program to provide oral health screening and referral for WIC participants interested in the Fluoride Varnish program. A LPHA nurse provides an oral screening, applies fluoride varnish and oral health education as well as a warm handoff to Arthur Center Community Health for follow-up dental care. The Arthur Center is a Federally Qualified Health Center (FQHC) that provides high quality preventative and restorative oral health services on a sliding scale fee for children, youth and adults covered by MO HealthNet and/or under 200% of the federal poverty level. From October 1, 2022- June 12, 2023, the Health Department has screened 182 children and applied varnish to 83 children. In addition, the health department is working to increase the number of children in early childhood education settings that receive oral health education. Oral health education and oral hygiene supplies have been provided to 244 children in FFY2023 and these numbers will continue to increase.
• Wright County Health Department is collaborating with the WIC program as well as using the Immunization Service Visit at both office locations to provide oral health screening, apply fluoride varnish, and provide oral health education for children. In FFY2023, as of current, 195 children received an oral health screening and education and 102 received a fluoride varnish application. The health department has created oral health kits that include a toothbrush, floss and toothpaste and are providing these kits to all children ages 1-17 who visit the health department for services. 195 children received an oral health kit. In addition, the health department is networking with Head Start and Parents as Teachers, providing oral health education and oral health kits that can be provided to their clients.

 

Additional strategies will include providing education to the public, city officials, dental and medical professionals, and public health authorities about the safety and effectiveness of community water fluoridation for the prevention of dental caries. The ODH will also continue to improve the Missouri Oral Health Surveillance System to include updated fact sheets on topics of interest and regional reports compiling oral health statistics and related information.

 

The ODH will continue to create Social Media posts for DHSS programs and the LPHAs to use throughout the year. These Social Media postings are available on the Oral Health webpage and readily accessible by LPHAs. The ODH was selected by the ASTDD to receive technical assistance in order to increase our social media presence and to develop these social media postings.

 

The ODH will continue to disseminate and engage partners in ongoing discussion related to the Five-Year State Oral Health Plan and continue its efforts to:

• Increase access to dental care by providing education about the importance of maintaining the adult dental benefit among MO HealthNet recipients. Information is distributed to policymakers, dental providers, leaders, and oral health stakeholders via the DHSS website and partners like the Missouri Coalition for Oral Health and Missouri Dental Association;
• Contract with the MPCA to provide education and technical assistance to State Dental Directors from all FQHCs in Missouri. The MPCA assists the ODH with distributing educational materials regarding the importance of a dental health home, particularly for pregnant women and children;
• Support the development of the oral health workforce in Missouri through collaborations with the DHSS Office of Rural Health and Primary Care on incentive programs for dental professionals;
• Implement the “referrals” portion of PSP, linking children with an identified dental need to local dental providers. This will be coordinated through school nurses and other local champions; and
• Promote and educate dental providers on the importance of HPV vaccine in order to increase the HPV vaccination rate.

 

Other Title V MCH Activities Related to the Child Health Domain

 

Developmental Screening

The CCHC Program will continue to provide consultations and trainings for child care providers around health and safety topics, including social-emotional learning, language/communication, cognitive, and movement/physical development in children. Consultations and trainings for child care providers will focus on incorporating the use of: developmental monitoring tools and checklists, strategies that positively affect child development, and individualized health plans (IHPs) for children with developmental delays. Trainings for child care providers will include the CDC “Learn the Signs. Act Early.” (LTSAE) campaign materials with the updated developmental milestones checklists. Trainings will stress the importance of monitoring developmental milestones, and provide communication strategies that child care providers can use when communicating with parents/guardians regarding concerns with a child’s development. Health promotion lesson plans for children in child care will continue to support all domains of child development. CCHC Program services will continue to provide resources about child development and developmental monitoring and screening for child care providers and parents/guardians of children in child care. Parent/guardian participation in all program services will continue to be encouraged.

 

Inclusion Specialists will provide parents with a listing of child care providers, based on the geographical location requested by the parent, so that parents can choose child care that will meet the needs of their child. Enrolling a child in a program that meets the needs of that child will increase the likelihood of maintaining placement, which will support the educational needs of the child. Inclusion Specialists provide onsite consultation to assist child care providers and develop adaptations and strategies to include the child with special needs in everyday classroom activities. They will assist in setting achievable goals for the child’s ongoing development. Inclusion Specialists deliver group training to better increase the knowledge base of child care providers in Missouri on how to include children with special needs. Lastly, through the addition of a social-emotional learning project, specialists also deliver evidence-based training to child care professionals to help them understand how children develop socially and emotionally. Sessions also emphasize real and practical strategies to foster social-emotional development.

 

The Home Visiting programs’ contracted home visitors will use the Ages and Stages Questionnaire®- 3 (ASQ-3) screening tool to identify children’s developmental needs. Home visitors will provide referrals for children who score below the cut-off points indicating a need for: additional developmental assessment, information and activities, community support, or early intervention services through Missouri First Steps or Early Childhood Special Education to contribute to improved school readiness. Annual performance measure data will be collected on the percentage of ASQ-3 developmental screenings conducted at the specified time points of 9, 18, and 30 months of age. Annual performance measure data will also be collected on the percentage of completed referrals for children who score below the cut-off points on the ASQ-3.

 

Additionally, the Home Visiting Program’s contracted home visitors will continue best practices to screen all children, birth to kindergarten entry, for social-emotional development using the Ages and Stages Questionnaire®: Social Emotional (ASQ:SE-2). Home Visitors will provide developmental activities for parents/children who score in the “monitoring” range and will assist families in accessing services as appropriate. The Home Visiting Program will provide all contracted home visitors with education on childhood mental health conditions and warning signs through a variety of communications including the Office of Childhood and the Home Visiting Program Weekly Updates as well as during annual professional development events.

 

The Newborn Health Program will partner with a wide variety of community health providers to distribute the Pregnancy and Beyond booklet as well as other educational materials that provide information on developmental screening. The program will track the distribution of these materials and obtain feedback from its partners on how the materials are being used and ways to improve them.

 

The Missouri WIC Program will continue to promote the public awareness campaign “Talking is Teaching: Talk, Read, Sing” to help parents recognize their ability to improve their children’s early brain and vocabulary development. Training will be provided statewide to WIC agencies, home visitors, Head Start, Parents as Teachers, health care providers, library staff, and other community partners. The Program will create handouts that provide tips on fun and easy ways to improve a child’s learning. Additionally, books developed as part of the LTSAE public health campaign will be distributed to stakeholders.

 

The Missouri WIC program will also continue to offer training and support to local agencies and community partners interested in implementing the WIC Developmental Milestones Program. (See NPM #11 - Medical Home application narrative for additional details.)

 

In August 2021, the DESE Office of Childhood was awarded a new grant, “ECCS Health Integration: Prenatal to 3 Program”, in the amount of $255,600 per year for each of the next 5 years. This funding will support an integrated maternal and early childhood system of care that is equitable, sustainable, comprehensive, and inclusive of the health system. The system will also promote early developmental health and family well-being and increase access to family-centered care and engagement of the prenatal-to-3 year old population.

 

The MCH Services Program will support LPHA efforts to:

• Provide infant and early childhood developmental and social-emotional screening services;
• Provide developmental screening for children one to three years of age enrolled in LPHA home visiting programs;
• Participate in preschool and pre-Kindergarten screening;
• Provide direct school-health services, including developmental screening; and
• Refer infants and children with potential developmental delay or failure to meet expected developmental milestones.

 

The Childhood Lead Poisoning Prevention Program (CLPPP) will support Title V MCH strategies by actively providing information about the potential harmful cognitive and developmental effects that may occur following a child’s blood lead level elevation. Information will be provided to:

• The general public;
• Health care providers, such as pediatricians;
• LPHA and health plan lead clinical case managers;
• WIC staff;
• Newborn Home Visiting Program families;
• DESE staff, including school nurses, Parents As Teachers (PAT), Head Start, and Early Intervention/First Steps staff and
• Parents of children with elevated blood lead levels.

 

CLPPP will work to address social determinants of health by providing health literate and linguistically appropriate materials to diverse populations. CLPPP intends to conduct a health literacy review of three publications and translate at least three documents into languages based on identified population needs. CLPPP hopes to increase compliance with directions on harm reduction activities related to lead poisoning. 

 

CLPPP will provide information about:

• Substances and environments that are likely to be lead exposure sources;
• The need for and ways to avoid/remove/prevent a child’s exposure to environments or substances with lead;
• The need for blood lead testing for children under the age of 6 years per current CDC and American Academy of Pediatricians recommendations;
• Medicaid testing requirements;
• The recommended environmental and clinical follow up of children with elevated blood lead levels; and
• The recommended tracking of blood lead testing; and
• Extended developmental monitoring of children with elevated blood lead levels.

 

Missouri will continue to support and improve coordinated systems of care to address the needs of maternal, infant, and child populations that are at risk for or experience exposure to lead. The strong partnership between Title V MCH and the CLPPP enhances program activities and impact.