Child Health, Application Year FY 24 

The needs assessment process identified the priority for the child population: improve nutrition, physical activity, and overall wellness of children. Ohio has a lower rate of obesity among 2-4-year-olds than the U.S., but a higher rate among ages 10-17. Children in Ohio are also more likely to experience adverse childhood experiences (ACEs). While more children in Ohio receive developmental screenings compared to the U.S., this only represents one-third of children and early data indicates that the COVID-19 pandemic has decreased screening due to the suspension of face-to-face visits in health and home settings. 

Emerging Issues 

Because of the temporary closure of facilities and discontinued face-to-face trainings, there was an increase in online offerings for Early Care and Education (ECE) trainings for professionals around nutrition and health along with other COVID-19 related topics. There was also an increase in telehealth visits, which created a need to share more information virtually for parents and caregivers around nutrition, physical activity, and overall health issues. Over the last year, in person trainings and offerings have increased, however, the demand for virtual platforms continue to dominate the preferred method of delivery. 

The COVID-19 pandemic also highlighted the importance of the Cross-Cutting equity and ACEs priorities. In FY 24 the Child Action Group will continue to explore the integration of these priorities within the Child Action Plan. 

Priority: Improve nutrition, physical activity, and overall wellness of children 

Measures: 

•       NOM 19: Percent of children (0-17) in excellent or very good health 
•       NOM 20: Percent of children (2-4) and adolescents (10-17) are obese 

•       NOM 25: Percent of children (0-17) who were not able to obtain needed health care in the last year 
•       SOM: Percent of children, ages 0-5, with elevated blood lead levels (BLL ≥5 ug/dl) (confirmed only) 
•       NOM 14: Percent of children (1-17) who have decayed teeth or cavities in the past year 
•       NPM 6: Percent of children, ages 9 through 35 months, who received a developmental screening using a parent-completed screening tool in the past year 
•       ESM: Percent of children, ages 1 through 66 months, receiving home visiting services who have received a developmental screenings 

To address the priority of improving overall child health efforts must address a broad range of issues impacting children. Pediatric primary care visits represent a key opportunity for monitoring and addressing the comprehensive needs of children’s health. The selected NPM relates to the critical role of developmental screening in monitoring and supporting child development. The SOM was established to measure the efforts to address child lead exposure in Ohio, which also relates to the Cross-Cutting domain and is aligned with the measure in the State Health Improvement Plan. Home visiting services also play an important role in monitoring and supporting child development. The ESM will measure the impact of efforts to improve rates of developmental screening for the child population served by Home Visiting. 

Objective 1: By 2025, coordinate across programs to implement a plan to increase rates of primary care providers conducting quality comprehensive well child visits that include developmental and other screenings. 

Strategies: 

1. Increasing provider education/training for comprehensive well visits (Bright Futures, screenings and referrals to include: developmental screenings, lead, hearing vision, oral health, immunizations, BMI, social determinants of health, and ACEs). 

2. Partnership between programs that can mutually promote comprehensive well visit (e.g., state immunization). 

3. Explore opportunities to support/implement evidence-based models for pediatric primary care 

4. Increase the awareness of the need for developmental screenings and other screenings amongst parents and caregivers. 

5. Educate primary care providers on billings for provision of services (expand QI initiative for vision screening billing and use results to inform efforts on other billing codes). 

Ohio collected public comments on the objectives and strategies for the child population and this will serve as a guide for FY 24 and beyond. We will continue to implement and adjust plans through ODH programs and with state partners to help meet the needs of the community. Over the next year, ODH will partner with Ohio Chapter of the American Academy of Pediatrics (Ohio AAP) to develop and provide trainings and resources to medical and allied professionals around key topics appropriate for children and their caregivers. The Ohio AAP trainings will also help to lay the groundwork for Quality Improvement projects during FY 24 During FY 24, ODH will also explore partnerships to promote comprehensive well visits along with vaccination education and increase developmental screenings by reaching out to other populations such as public health nurses and the foster care community. The ODH Lead program is also working on creating a targeted testing model in high-risk areas by zip codes and working on billing coding for professionals around assessments. Educating primary care providers on billing for the provision of services will continue to be provided under the Save Our Sight Vision Screening Training and Equipment grant component in SFY23; however, it will not be a separate QI with Ohio AAP. Statewide vision screening training for primary care providers will continue to incorporate billing education for the provision of vision screenings in the primary care setting during SFY23.  

Objective 2: By 2025, increase the percent of children, ages 9-35 months, that receive developmental screens via home visiting programs. 

Strategies: 

1. Support MIECHV and other home visiting programs to provide developmental screening using Ages and States Developmental Screening tool. 

2. Educate parents about developmental screening tools. 

Following the return of face-to-face visits as restrictions due to the COVID-19 pandemic were lifted, home visiting providers were able to increase the rate of completion of developmental screenings in 2021 and 2022. In addition to the Home Visiting protocols requirement that developmental and social emotional screenings are completed, programs are also required to complete screenings that cover some of the social determinants of health (housing, employment, insurance, food insecurity, etc.). A tools completion report has been created that allows providers and ODH to track screening completion rates to address gaps and missing data. As part of their MIECHV Continuous Quality Improvement work, several providers have implemented projects focused on increasing the rates of required screening tools and potential subsequent referrals.  

ODH’s central intake and referral vendor now offers the Ages and Stages Questionnaire (ASQ) Online screening tool to Ohio families with children under the age of three to help them better understand how their child is developing and if there are any concerns. The website where the online tool is housed offers educational information for families on how developmental screening helps children. After completing the ASQ screening, a Help Me Grow specialist shares and discusses the results with the family, making referrals as necessary. 

Other Efforts Supported by Title V MCH 

Many of the programs presented in the Perinatal/Infant Application section also serve children and adolescents. Several program summaries are included below to highlight additional relevant programs. Please see the Program Map (Section V. Supporting Documents) for the full list of programs. 

School Hearing and Vision Programs 

The Ohio Department of Health (ODH) Children's Hearing and Vision Programs set the screening requirements and guidelines for school-based preschool and K-12 schools. ODH is given the authority by the Ohio Revised Code (ORC) to set the hearing and vision screening requirements for school-aged children and to track the data (ORC Sections 3313.50 and 3313.69). ODH works in partnership with ad hoc committees to develop the requirements. These requirements determine the grade levels routinely screened each year, approved screening tests and equipment and referral criteria. In addition to establishing school screening requirements, the program conducts annual statewide surveys of school hearing and vision screening to monitor compliance with screening requirements. 

ODH Vision program worked in collaboration with the Early Childhood Health (ECH) team to develop, record, and offer a three-part training called Vision Eye Health and Developmental Milestones for birth to 24 months, ages 3-5 years, and school age.  The trainings will be available for professional development credit for ECE professionals as well as home visitors, community health workers, and other professionals working with families of young children. 

Oral Health 

A continuing education module for early childhood educators, nurses, and nutritionists titled, Help Me Smile – Ensuring the Oral Health of Young Children, was developed on oral health of young children and oral health and pregnancy. This training focuses on supporting the oral health of young children. Participants learn about good oral health practices for young children, how to manage oral injury first aid and dental emergencies, how to identify and respond to signs and symptoms of possible child abuse in the mouth and dental neglect and be provided with the tools and resources to engage families in oral disease prevention. In addition, participants learn and understand how a pregnant mom’s oral health changes during pregnancy. 

The training was made available on August 24, 2022.  The training is approved for 1.5 Ohio Approved hours by the Ohio Child Care Resource and Referral Association, 1.6 Continuing Nursing Education contact hours, and is pending approval for registered dietitian continuing education units. The training will continue to be offered in FY24. 

ODH’s Early Childhood Obesity Prevention Program (ECOPP)  

The Early Childhood Obesity Prevention Program (ECOPP) is a coordinated and comprehensive approach involving families, early childhood education professionals, health professionals, and community organizations working together with consistent messaging and strategies to ensure a sound foundation for health in the future. ECOPP is a program within the Early Childhood Health Program. 

The Early Childhood Obesity Prevention Program (ECOPP) encompasses the Ohio Healthy Programs, Parenting at Mealtime and Playtime program, Health and Safety Trainings, and Farm to ECE. 

Parenting at Mealtime and Playtime (PMP) 

PMP is a professional development initiative for a variety of health care providers to optimize obesity risk assessment, prevention counseling, and family support for children 0-5 years of age and their families. PMP curriculum offers providers developmentally appropriate guidelines on nutrition, healthy activity, and sleep to share with families within the context of building resilient family-child interactions that support healthy habits. ODH’s ECOPP partners with the Ohio Chapter, Ohio AAP, to deliver PMP physician training that grants Maintenance of Certification (MOC) Part-IV professional development credit. Visit Ohio AAP’s PMP site for more information and to sign up for the PMP Resource Toolkit. 

PMP training and resources are also available for healthcare workers and providers such as home visitors, community health workers, and WIC professionals. These include a series of one-hour independent study courses for health care providers working with families in the early childhood population. The purpose of the trainings are to increase understanding of developmentally appropriate guidelines on nutrition, healthy activity, and sleep, all within the context of building resilient family-child interactions that support healthy habits. In these courses, local experts address the latest information about PMP to prevent obesity and improve the health of children 0-18 years of age.  In FY 24, Ohio AAP plans to upgrade and enhance the PMP materials and applications on the mobile app as well as their online Toolkit and resources. The redesign and alignment will be more user friendly and more appropriate and engaging to the user. Ohio AAP will continue to work with medical professionals but also increase their reach of PMP by engaging more community health workers, home visitors, and other professionals who are working with families in a home or other setting outside of an early childhood classroom setting.  

Ohio Healthy Program (OHP) 

The OHP provides technical assistance for Family Care, Child Care Centers, and Public Preschools by providing the training they need to make policy and environmental changes that will lead to OHP designation through Step Up to Quality and that ultimately will improve the health and wellbeing of children and families they serve. The OHP is part of a larger effort within the ECOPP, which is a coordinated and comprehensive approach involving families, early childhood education professionals, health professionals, and community organizations working together with consistent messaging and strategies to ensure a sound foundation for health in the future. OHP materials will be updated to reflect the current Early Learning and Development Standards (ELDS) for early care programs. Additional marketing materials will be developed to promote OHP throughout the state which local grantees can use to recruit programs. The training management system utilized by OHP will be streamlined to better serve teachers and early care administrators. 

Health and Safety  

The Early Childhood Health and Safety program works collaboratively with other state agencies to identify the learning needs of early childhood educators in diverse settings such as public preschools, childcare centers, and family childcare. Based on the assessments, the professional development program for health and safety designs and implements quality, relevant, accessible, and cost-effective opportunities for professional development related to the provision of safe and healthy environments for children in their care. Such topics include diabetes care, how the referral process in Ohio works for children birth to age 5, seizure first aid, vision development and milestones, and other pertinent health topics. 

Farm to ECE Implementation Grant (FIG) 

FIG offers increased access to the three core elements of local food sourcing, school gardens, and food and agriculture education to enhance the quality of the educational experience in all types of ECE settings (e.g., preschools, childcare centers, family childcare homes, Head Start/Early Head Start, programs in K – 12 school districts). FIG offers benefits that parallel the goals and priorities of the early care and education community including emphasis on experiential learning opportunities, parent and community engagement, and life-long health and wellness for children, families, and caregivers. 

Ohio’s Farm to ECE team will continue to implement a key system change by expanding and strengthening our state-level coalition to include diverse representation from affected communities and establishing sustainable and equitable coalition recruitment and governance.   

The coalition focuses our scalable strategies and intended impacts on children, families and caregivers who lack access to healthy food in care settings and at home, farmers, and food distributors.  Through a very deliberate process, a diverse, cross-sector coalition with partners who would bring new perspectives, resources, and skills was created. The number of members tripled in year one, however, there are many more layers of the community we must seek out and engage. This will be guided by our Equity Consultant. 

The expanded coalition of diverse early childhood educators, young families, farmers, distributors, educators, and others affected by food procurement at ECE sites is accomplishing most of the work through three subgroups: Coalition Expansion/Development, Policy Guidance, and Procurement Innovation.  The Coalition Development group will continue to conduct assessments, monitor needs, and recommend and guide practices for sustaining the coalition. 

The FIG Coalition is working to become a sustainable group working towards advancing FIG in Ohio that is integrated into the Ohio Farm to School Network at the state and regional levels.  

Ohio Healthy Homes and Lead Poisoning Prevention Program (OHHLPPP) 

Lead can damage nearly every system in the human body and has harmful effects on both adults and children. It is a serious environmental public health threat to children in Ohio. The OHHLPPP addresses the needs of lead-poisoned children from birth through 5 years (up to 72 months) of age. The program assists family members, medical care providers, and other community members to reduce and prevent lead poisoning. OHHLPPP recognizes that children under the age of 3 years (36 months) are at greatest risk for lead poisoning. The program receives funding from the Centers for Disease Control and Prevention (CDC), Maternal and Child Health Block Grant, and the Ohio Department of Medicaid (ODM) for childhood lead poisoning prevention efforts in Ohio. OHHLPPP receives all blood lead testing results on Ohio resident children and performs inspections of homes, childcare facilities, and schools to determine the source of a child’s elevated blood lead level. The program coordinates funding to complete lead hazard abatement for qualified families. 

Asthma Program  

The ODH Asthma Program (ODH AP) works within the BCFH to improve outcomes related to asthma and improve health equity and has relationships with Title V funded programs. In Ohio children, there are racial, educational, and economic disparities in asthma prevalence. Non-Hispanic Black children in Ohio visit the emergency room for asthma at a rate more than 4 times that of non-Hispanic white children. Hispanic children visit the emergency room for asthma at a rate nearly double that of non-Hispanic white children. Non-Hispanic Black children are hospitalized for asthma at a rate more than 6 times that of white children. Hispanic children are hospitalized for asthma at a rate double that of non-Hispanic white children. Children under the age of five had the highest rates of emergency department visits due to asthma and asthma-related hospitalizations. To address these disparities, the ODH AP has a significant focus on equity and addressing systemic factors that contribute to poor health outcomes for children with asthma. The ODH AP mission is to is to engage individuals and entities intentionally and consistently across sectors and disciplines to build capacity and promote health equity to eliminate disparities, improve quality of life, and achieve optimal health outcomes for people with asthma in Ohio. ODH AP strategies focus on promoting inter- and intra-agency collaboration and strategic partnerships to address factors associated with asthma-related disparities; fostering opportunities for healthcare providers and stakeholders to learn about health equity, cultural competence, implicit bias, and structural racialization; and enabling stakeholder engagement to promote community-level approaches to reducing asthma disparities. The ODH AP will continue to work with schools to build and enhance policies and work to incorporate Community Engagement across Ohio. The Asthma Program will also continue to develop and offer asthma education and parent videos for families of young children in collaboration with Ohio Child Care Resource and Referral Agency (OCCRRA). 

Tobacco Use Prevention and Cessation Program (TUPCP)  

Housed with the ODH Bureau of Health Improvement and Wellness, the TUPCP is engaged in several activities that impact the burden of tobacco on children under 10 years of age.  Globally, the TUPCP works to prevent initiation of tobacco use, to increase quitting, prevent exposure to secondhand smoke, and to eliminate health inequities that result in disparate burden of tobacco on specific Ohio subpopulations.  At the state level, we work to enforce state level policies such as the Smoke Free Workplace Law as well as to promote voluntary adoption of smoke-free and tobacco-free comprehensive policies.  Evidence shows us that successful policy work not only protects children from second-hand smoke where they live, learn, and play but it increases quitting of adults in children’s lives and decreases initiation of smoking by youth.  Regarding quitting, TUPCP collaborates with the Bureau of Child and Family Health (BCFH) on various programs including asthma. TUPCP also aids and supports the Baby and Me Tobacco Free program that incentivizes pregnant mothers to quit smoking and stay quit after their baby is delivered.  The Ohio Tobacco Quit Line also offers a special protocol for pregnant women to quit and stay quit following delivery which includes incentives to increase and maintain participant engagement.