Child Health Plan, 2023

Priority: Support capacity of the early childhood workforce to incorporate trauma-informed practice in all program areas.

 SPM. Number of state and community programs with capacity for trauma-informed screening and care of families impacted by Adverse Child Experiences (ACE)

Objective 1. Increase the number of families screened for ACEs or alternative tools in supportive programs

Increase the number of programs with staff trained in trauma-informed skills

Strategy: Partner with the Early Childhood Education and Care Department to institute trauma-informed training for early childhood staff

ESM. Number of planning meetings coordinated between Title V and the Early Childhood Education and Care Department

The Early Child Education and Care Department (ECECD) received an Early Childhood Comprehensive Systems grant in 2021, which is focused on integration the health and early childhood systems in a way that centers equity and is driven by the voices of families and communities. As part of this grant, an Equity Council was formed, along with a Family Advisory Council and an overall ECCS Advisory Committee. 

One way we are connecting early childhood programming with the healthcare sector is by holding presentations at ongoing ECHO meetings that are attended by healthcare providers.  ECECD is presenting at the Reproductive Health ECHO to increase awareness of our early childhood services, and the CARA navigators are presenting at the Perinatal ECHO hosted by the NM Perinatal Collaborative to discuss how we can increase the percentage of care plans developed during the prenatal period for pregnant people using substances. 

The Family Infant Toddler program (FIT), which is New Mexico’s Early Intervention/Part C program, is working to increase equity in our Early Intervention system.  The program surveyed FIT providers in 2021 to assess their needs and interest around equity training.  The results showed all the respondents were interested in this type of training to some extent. They did have some reservations about facilitation and asked that it be facilitated by an expert, not by program staff. The Title V CSHCN program is also hosting a PHAP from the CDC who is working on increasing equity in early intervention services in tribal communities, in partnership with ECECD’s Chief Health Officer and the ECECD Assistant Secretary of Native American Education and Care. The FIT program is hoping to allocate funding for this training in the FY23 budget. Additionally, ECECD requested funding for trauma-informed training of early childhood providers in its FY23 budget as well as funding for a CARA early childhood navigator to better connect CARA families with ECECD services and ensure early childhood providers have knowledge of how best to work with these families.

Objective 2. Increase ability to analyze and improve early childhood services, including mental health and substance use referrals, through inter-agency coordination

Strategy- Improve data sharing and data linkages to improve mental health access and referrals

Strategy- Execute MOA between NMDOH Family Health Bureau and ECECD to optimize collaboration and increase ability to perform data linkages with DOH and ECECD data.

NMDOH Title V and ECECD programs intersect around nutrition and food security support, perinatal services, early intervention/Children’s Medical services, safe sleep, and home visiting. Data linkages to identify families with current trauma or a history of traumatic experiences is an important step in improving coordinated care.  With improved data linkages, the two departments may identify families in need of support. As an example, families with a plan of safe care for a substance-exposed infant require a variety and different levels of care. For some families, connections and navigated referrals to home visiting are sufficient. For others, more intensive counseling and behavioral health access, even in-patient care may be indicated. Working together to identify these needs by program area is crucial.

In the legislative session of 2021, $150,000 was allocated to DOH for an inter-agency data linkage effort called the Family Success Lab.  After a pilot of linking PRAMS, longitudinal follow-up survey and home visiting program data, the legislature pushed for more funding to support CARA evaluation and other priority work in the Department of Health and in the NM Children’s Cabinet. These data linkages and analyses will be collaboratively defined among ECECD and DOH Title V staff with input from other state agencies and community partners. The preliminary planned linkages are as follows but subject to change:

• CARA plans of care and Medicaid claims linkage and cost analysis
• PRAMS and hospital inpatient data assessing clinical outcomes in the perinatal period
• DOH datasets including CARA, CMS, PRAMS and HUGS toddler survey information linked to the early childhood outcomes data in Part C FIT, Early Head Start and home visiting
• An oversample of the National Survey of Children’s Health and comparisons to the NM HUGS survey (possible identified linkage, but likely not)
• CARA plans of care and SUID registry data linked to infant death records.

 

With these plans in mind, we are working through the ECCS advisory committee to consider the value of each proposed linkage and analysis for completion in FY23 and the following two years.

ORAL HEALTH

Priority  Expand access to preventive oral health care for children and adolescents including those with special health care needs by the end of 2023.

 

NPM (SPN) 13.2 Preventive dental visits for children and adolescents, ages 1 to 17.

 

Objective 1: By the end of 2023, decrease in 10% the incidence of untreated dental caries among school aged children and children with special needs.

 

Objective 2: By the end of 2023 increase in 10% the number of children aged 2 to 17 who participated in the Early and Periodic Screening, Diagnostic treatment program (EPSDT).

 

Objective 3:  By the end of 2023, increase in 10% the number of children who received a dental sealant or fluoride varnish application through the Office of Oral Health.

 

Objective  4: By the end of 2023, increase in 10% the number of preventive dental visits among children with special needs who do not have a dental home.

 

Tooth decay is the most common disease in the United States, and it is the primary cause of tooth loss through young adulthood.  According to CDC: “Children with poor oral health status are nearly 3 times more likely to miss school because of dental pain.”  Tooth decay is preventable. The Office of Oral Health (OOH) has implemented best practices to reduce the incidence of tooth decay; the application of fluoride varnish, dental sealants and oral health education (improving oral health literacy).

Dental caries is the most common chronic disease of childhood in the United States, The CDC reports that 1 of 5 (20%0 of children 5 to 11 years old and 1 of 7 (13%) of adolescents 12 – 19 years old have at least one untreated decayed tooth. Additionally, children 5 to 19 years old from low-income families are 25% more likely to have dental caries compared to the 11 % of children from higher income families. Best practices to prevent dental caries include dental sealants and fluoride varnish application. Fluoride varnish can prevent 33% of dental caries in the primary teeth and, dental sealants, if properly applied, can prevent up to 80% of dental caries on the chewing surfaces of molars for two years and continue to protect against 50% of dental caries for up to four years. The benefits of dental sealants begin immediately after application and are effective as long as the sealants are retained. Children 6 to 11 years old without sealants have almost three times more fist molar dental caries than children with sealants. Research has documented the effectiveness of dental sealants in reducing dental caries even when the dental sealants are partially retained. Several studies have shown the combination of fluorides and dental sealants can reduce the incidence of dental caries by up to 85%.

 

The NM 2006 Oral Health Surveillance Survey reports that 23% of the state’s children in 3rd grade have experienced dental caries. Many of NM children from low-income families, minority racial/ethnic group or immigrant populations, have limited or no access to preventive dental care. Usually, they lack dental insurance or live-in dental provider shortage area or isolated rural areas, which result in a higher risk to dental caries and serious infections that can result from untreated dental caries. NM is classified as a health care professional shortage state with 32 out of 33 counties designated as such. NM also ranks 37th of 50 states in per capita dentists. In NM, urban and rural communities struggle to recruit and retain an adequately number of dental providers, and three NM counties do not have a dentist. Studies have shown that school-based programs are successful in reaching the low-income children and underserved rural areas.

 

Gum disease, also called periodontal disease, varies with age and oral hygiene.  The gum inflammation, also called gingivitis, on children ages 6-11 is mostly associated with tooth eruption.  However, oral hygiene can impact gum health and gum inflammation can be present at short age.

 

The data clearly shows that the incidence of tooth decay among children has not improved years.

 

Preventing tooth decay and increasing access to our preventive services remains our primary goals among New Mexicans.

 

OOH provides preventive care to early head start, head start, preschool and school-aged children throughout New Mexico in urban/rural schools. Preventive care includes oral health promotion and education, dental screenings, sealants, fluoride varnish and dental health case management, securing a dental home and a treatment for uninsured and low-income children.  OOH also provides funding to the University of New Mexico, and private oral health providers to deliver dental treatments and prevention at no cost to low income and uninsured children and pregnant women. OOH is improving overall health and oral health literacy for New Mexicans through social media campaigns in TV, radio and internet.  Additionally, the OOH is working to promote fluoridated water consumption among Albuquerque and Santa Fe residents.

 

OOH will continue to conduct the mobile prevention program by providing oral health education and preventive services such as dental sealant and fluoride varnish through school liked program throughout the state.  Also, OOH will renew oral health contract with providers to provide oral health preventive and treatment services to uninsured school aged children, pregnant women and children with disabilities.

 

2021-2022 Data Summary

OOH program activities included a sealant program, fluoride varnish program, dental screening program and case management provided by DOH staff. Data collected by the OOH for the FT 2021-2022 shows that oral health disparities persist among school aged children enrolled in Head Start Schools and in elementary public schools of Santa Fe, after the COVID-19 pandemic.

Data was collected from consent forms and student’s charts. From a sample of 4406 children eligible to participate in programs, 1,601 children (36.34%) returned consents to participate in the programs and 1590 received services.

862 children were screened with the dental sealant program, and from those, 336 ((38.9%) had untreated dental caries. From those 632 children 163 children were screened with the PK dental screening program, and from those 38 (23.3%) had untreated dental caries.

For the FV program the OOH provides 3 screenings and 3 FV applications per child per year. For the FV Head Start Program, there were 319 children eligible to participate. From those 251 (78.68%) signed consent to participate. A total of 505 screenings and 487 FV application were done during the year. For the FY 2021-2022. 89 (17.62%) children had untreated dental caries. It is important to note that school population is not stable since there are late enrollments and drops.  For the FV Early Head Start Program, there were 169 children eligible to participate. From those 157 (92.90%) signed consent to participate. A total of 279 screenings and 269 FV application were done during the year. For the FY 2021-2022. 10 (3.6%) children had untreated dental caries.

 

Demographics 9.56 of the population served were White, 26% were African Americans, 80.44% Hispanics, 1% Asian, 5.5% were Native American, 0.2 % Pacific Islander and 1.57% consider as other ethnicity. Also, 50.31% of children attended were males and 49.49 females.

In addition, 86.8% had dental insurance, with 16.57% enrolled in a private insurance and 70.21% enrolled in Medicaid and 13.1% with no dental insurance. Finally, 79.11 of children reported to have dental home and 20.8% did not have dental home. 

 

Strategies:

 

1. Expand access to oral health care for children and youth including those with special health care needs.

 

ESM: # of children who had at least a dental screening within the last year.

 

ESM:  # of children who received at least one dental sealant in a permanent tooth in the last year.

 

ESM:  # of children who received an application of fluoride varnish three times a

year.

 

ESM:  # of special needs children who had at least one dental visit during the last year.

ESM:  # of special needs children who received at least one sealant in permanent teeth during the last year.

ESM:  # of children with special needs who received topical fluoride at least one time in the last year.

 

2. Implement mandatory preventive dental visits for school aged children.

 

ESM:  # of children participating in a dental screening in the last year.

 

3. Partner with the Human Services Department to promote oral heath among EPSDT population and providers.

 

ESM: # of children who participated in the EPSDT program/total # of children 1 to 17 years of age who received a dental screening within the past year.

 

4. Conduct oral health education and preventive services to Head Start, other pre-school aged children, elementary school aged children and adolescents thereby increasing oral health literacy.

 

ESM:  # of children who received oral health education in the past year

 

ESM:  # of families who received oral health education in the last year.

 

5. Convene a Special Needs Task Force to assess current referral services available to the targeted population. 

 

ESM: # of Special Needs Task Force meetings in the last year

 

ESM: # of referrals to oral health services given to children with special needs. 

 

6. Conduct Public Service Announcements (PSA’s) throughout the state promoting the importance of oral health and preventive services.

 

ESM:  # of PSA produced and released promoting oral health among children and those with special needs per year.

 

7. ESM: # of PSA’s promoting oral health, oral hygiene, healthy eating, and consumption of tap drinking fluoridated water.