Child Health

Application Narrative (FY 2020-21)

 

CHILD Priority Need 1: Optimize the healthy development of all children so they can flourish and reach their full potential. (2020-25 plan)

 

Surveillance: Throughout FY 2020-21, CDPH/MCAH will monitor quantifiable characteristics to track the health of California children as part of routine health surveillance efforts. Because of the significant impact of childhood poverty, including measures of the social determinants of health, on child health and health equity, this list includes key indicators. The following indicators and measures listed in the table below are continuously and systematically collected, analyzed, and interpreted to guide program planning, implementation, and evaluation of interventions. These indicators will be analyzed at the state and sub-state (where sample-size allowed) levels to identify specific improvement opportunities.

 

Select Child Health Indicators and Measures	Data Source
Developmental screening	National Survey of Children’s Health (NSCH); California Health Interview Survey (CHIS)
Family Resilience	NSCH
Preventive Dental Visit	NSCH
Childhood overweight and obesity (5th grade students)	CA Department of Education, Physical Fitness Testing Research Files (FitnessGram)
Childhood flourishing	NSCH
Preventive Medical visit	Local MCAH program data
Insurance Status and adequacy	American Community Survey (ACS); NSCH
Family and childhood Poverty	ACS; Public Policy Institute of CA Poverty Measure
Adverse childhood experiences	NSCH; Maternal and Infant Heath Assessment (MIHA) Survey
Food insecurity	MIHA; KidsData; CHIS; NSCH
Housing and income inequality	County Health Rankings
Reading daily to child (0-5 years)	CHIS
Economic stability	California Employment Development Department

 

 

Child Focus Area 1: Expand and support developmental screening. (Note: All activities related to referrals for a positive result on a development screen are included in the CYSHCN domain plan.)

 

Child Objective 1:

By 2025, increase the percentage of children, ages 9 through 35 months, who received a developmental screening from a health care provider using a parent-completed screening tool in the past year from 25.9% (NSCH 2017-18) to 32.4%.

 

Child Objective 1: Strategy 1:

Partner to build data capacity for public health surveillance and program monitoring and evaluation related to developmental screening in California.

 

Activities:

• CDPH/MCAH will partner with the CDPH Center for Healthy Communities and others to assess subpopulation data to identify disparities in developmental screening through an oversample of the National Survey of Children’s Health (NSCH).
• CDPH/MCAH will review current data collected related to developmental screening and monitoring.
• CDPH/MCAH will support DHCS Medi-Cal Managed Care Quality and Monitoring Division to share information on Medi-Cal-related developmental screening data, when available, and other related data with local MCAH programs and other stakeholders.
• CDPH/MCAH will assess additional opportunities for additional data collection related to developmental screening and monitoring.

 

Child Objective 1: Strategy 2:

Partner to improve early childhood systems to support early developmental health and family well-being.

 

Due to uncertainty around the future of this statewide initiative due to the COVID-19 pandemic, some of the following activities may be paused. We anticipate continued partnership in this area once the demands of the COVID-19 response have subsided. Our planned partnership activities from 20-21 are included and have been updated where possible.

 

Activities:

• CDPH/MCAH will partner with MCAH/CHVP and CDPH/MCAH CYSHCN Domain to identify areas of opportunity to improve early childhood systems coordination and collaboration.
• CDPH/MCAH will co-fund the Statewide Screening Collaborative to improve collaboration with other state programs to align system priorities and strengthen connections between systems to increase developmental screening.
• CDPH/MCAH will support First 5 Association and local First 5 programs and partner with local MCAH programs on their Help Me Grow and related efforts.
• CDPH/MCAH will partner with DHCS Indian Health Program’s American Indian Maternal Support Services and other programs to promote developmental screening, positive and responsive parenting, reading infant cues, calming/soothing, reading, singing, and playing with their infant.
• CDPH/CFH will serve on the California Secretary of Health Early Childhood Development Initiative and look for additional opportunities to support regular developmental screening and intervention when needed.

 

Child Objective 1: Strategy 3:

Partner to educate and build capacity among providers and families to understand developmental milestones and implement best practices in developmental screening and monitoring within MCAH programs.

 

MCAH has been unable to complete planning for this strategy because of the COVID-19 pandemic response since April 2020. MCAH is committed to continuing to monitor needs in this area and will resume planning and activities when needed staff are available. We are including our description of planned activities as developed for 20-21, but may need to defer action on these activities.

 

Activities:

• CDPH/MCAH will assess current program policies on developmental screening and monitoring developmental milestones.
• CDPH/MCAH will assess current education regarding child development, monitoring of developmental milestones, and developmental screening within MCAH programs.
• CDPH/MCAH will partner with local MCAH programs to assess specific educational and resource needs regarding developmental screening and monitoring of developmental milestones.
• CDPH/MCAH will partner to educate MCAH service providers and families about developmental screening recommendations and tools (e.g., ASQ and ASQ-SE) and developmental milestones (e.g., Learn the Signs. Act Early.)
• CDPH/MCAH will partner with WIC and other stakeholders to disseminate developmental milestone information, resources, and tools (e.g., Learn the Signs. Act Early, resources and mobile app) to families.

 

Child Objective 1: Strategy 4:

Support implementation of Department of Health Care Services (DHCS) policies regarding child health and wellbeing, including developmental screening.

 

While this strategy continues to be a priority for MCAH, planning has been paused due to COVID-19 redirections and other staff vacancies.

 

Activities:

• CDPH/MCAH will disseminate information regarding the new DHCS’ developmental screening-related policies.
• CDPH/MCAH will work with health care provider organizations to prioritize early childhood well-child visits during the COVID-19 emergency and later bring children back into well-child care to assure children receive appropriate developmental screenings.
• CDPH/MCAH will build capacity of local public health professionals to educate local providers about the new Medi-Cal developmental screening reimbursement and quality measure.

 

Child Focus Area 2: Raise awareness of adverse childhood experiences and prevent toxic stress through building resilience.

 

Child Objective 2:

By 2025, increase the percentage of children, ages 0 through17 years, who live in a home where the family demonstrated qualities of resilience (i.e. met all four resilience items as identified in the NSCH survey) during difficult times from 82.0% (95% CI: 78.2-85.3%) to 84.5%.

 

Child Objective 2: Strategy 1:

Partner with CDPH Essentials for Childhood and other stakeholders to build data capacity to track and understand experiences of adversity and resilience among children and families.

 

While this strategy continues to be a priority for MCAH, some of the planning and collaboration activities may be paused due to COVID-19 redirections and other staff vacancies.

 

Activities:

• CDPH/MCAH will partner with stakeholders to have a California oversample of the National Survey of Children’s Health to better understand key child health related measures (e.g., ACEs, family resiliency, child flourishing, neighborhood measures).
• CDPH/MCAH will partner with CDPH Essentials for Childhood, Lucille Packard Foundation, CHIS, and other stakeholders to explore options for measuring family resilience and positive childhood experiences in CHIS or other surveys.
• CDPH/MCAH will assess and review other child health-related data, including childhood poverty and social determinants of health, as well as maternal mental health and substance use.
• CDPH/MCAH will assess and explore feasibility of adding additional data measures related to child adversity and family resilience in MCAH programs.

 

Child Objective 2: Strategy 2:

Partner to build capacity and expand programs and practices to build family resiliency by optimizing the parent-child relationship, enhancing parenting skills, and addressing child poverty through increasing access to safety net programs within MCAH-funded programs.

 

While this strategy continues to be a priority for MCAH, some planning and collaboration activities may be paused due to COVID-19 redirections and other staff vacancies.

 

Activities:

• CDPH/MCAH will lead within CHVP by improving family resilience through support and education of families on positive parenting and linkage of families to needed services in the community.
• CDPH/MCAH will assess current practices to promote healthy, safe, stable, nurturing parent-child relationships within its funded programs, including activities and policies that promote positive parent-child interactions, parent-child play activities, co-regulation strategies, and positive parenting practices within MCAH programs.
• CDPH/MCAH will identify key statewide initiatives and programs that address social determinants of health.
• CDPH/MCAH will assess current capacity of MCAH programs to strengthen economic supports for families, including access to safety net programs (e.g., WIC, CalFresh, school meals, Earned Income Tax Credit, Child Tax Credit, housing subsidies, COVID-related assistance, unemployment) for families.
• CDPH/MCAH will partner and support CDPH Essentials for Childhood Program to develop a plan to enhance parenting knowledge/skills and strengthen economic supports for families.
• CDPH/MCAH will support and communicate with All Children Thrive leaders to strengthen economic supports for families.

 

Child Objective 2: Strategy 3:

Support the California Office of the Surgeon General and DHCS’ ACEs Aware initiative to build capacity among communities, providers, and families to understand the impact of childhood adversity and the importance of trauma-informed care.

 

While this strategy continues to be a priority for MCAH, planning has been paused due to COVID-19 redirections and other staff vacancies.

 

Activities:

• CDPH/CFH will continue to participate on Surgeon General’s Advisory Committees related to increased training and screening of ACEs by California healthcare providers.
• CDPH/MCAH will support the Surgeon General and DHCS’s efforts on trauma screening and training for Medi-Cal providers by disseminating information to local MCAH programs and other partners.
• CDPH/MCAH will partner to identify and disseminate resources and training opportunities to raise awareness of ACEs and the impact on health outcomes and importance of trauma-informed care across family-serving organizations in California communities.
• CDPH/MCAH will identify training opportunities on ACEs and trauma-informed care and disseminate to local MCAH programs, including new ACEs training that allows MediCal healthcare providers to be reimbursed for ACEs screening of pediatric, adolescent or pregnant patients.

 

Child Focus Area 3: Support and build partnerships to improve the physical health of all children.

 

Child Objective 3:

By 2025, increase the percentage of children, ages 1 through 17 years, who had a preventive dental visit in the past year from 80.2% (95% CI: 76.0- 83.9) [NSCH 2017-18] to 82.6%.  

 

Child Objective 3: Strategy 1:

Support the CDPH Office of Oral Health in their efforts to increase access to regular preventive dental visits for children by sharing information with MCAH programs.

 

Activities:

• CDPH/MCAH will support the efforts of the CDPH/OOH to improve access to pediatric preventive dental care, including establishment of a dental home by age one year.
• Based on the CDPH, Oral Health Advisory Partnership’s recommendations and strategic plan for oral health, CDPH/MCAH will support CDPH/OOH by sharing information and resources with local MCAH programs.

 

Child Objective 4:

By 2025, decrease the percent of 5th grade students who are overweight or obese from 40.5% (2018) to 39.3%.

 

Child Objective 4: Strategy 1:

Partner to enable the reporting of data on childhood overweight and obesity in California.

 

Activities:

• Review and use, as appropriate, child-overweight-and-obesity-related data collected via surveys (e.g., the National Survey of Children’s Health.)
• Identify opportunities with other California State governmental offices (e.g., CDPH’s NEOP Branch, CDE) to collect and report additional data related to child overweight and obesity.

 

Child Objective 4: Strategy 2:

Partner with WIC and others to provide technical assistance to local MCAH programs to support healthy eating and physically active lifestyles for families.

 

Activities:

• CDPH/MCAH will partner with WIC and support local MCAH programs to identify resources on healthy eating to disseminate to local programs.
• CDPH/MCAH will partner with WIC and local MCAH programs to identify best practices and tools to refer and link eligible clients to the WIC program.
• CDPH/MCAH will maintain and implement the Policies, Systems, and Environmental Change Toolkit on MCAH web page with focus on nutrition, physical activity and breastfeeding, limiting sedentary activity, and safe communities as a resource.
• CDPH/MCAH will offer resources (such as a new webinar posted from January 6, 2021 on nutrition related policy, systems and environmental changes) for MCH Directors’ consideration. Those who attend the webinar are offered technical assistance by professors at UCLA and Colorado State University.
• CDPH/MCAH will partner with CDPH Center for Healthy Communities, WIC, California WIC Association, the California Department of Social Services, and others to develop a collective impact by addressing (via nutrition and physical activity) and monitoring child overweight/obesity as well as family food insecurity. Continue collaboration on ECE nutrition and physical activity with Centers for Healthy Communities.
• CDPH/MCAH will lead efforts to develop a new child MyPlates (for ages 2-5 and for ages 6-12 years) to promote healthy eating in children. Collaborate with WIC and Center for Healthy Community to disseminate.