Priority: Promote safe, stable, nurturing environments to reduce violence and the risk of injury

 

NPM 7: Rate of injury-related hospital admissions per population ages 0-9 years

Injury Prevention and Control Program

Poisoning/Overdoses:

In FY20, MDPH will focus its collaborative work with Massachusetts child-serving agencies to increase their promotion of injury prevention strategies in homes, communities, and childcare settings, in alignment with an updated ESM for this measure. Previously, in FY18, the ESM was the number of educational sessions held for child-serving organizations. This was determined to not be the best ESM because some education sessions might have only a few attendees while a single education session might have a couple hundred attendees. Therefore, the number of education sessions did not accurately reflect the direct outreach. To more accurately determine the outreach achieved, the new ESM that will be tracked in FY20 is the number of providers and caregivers who attend these educational sessions. Caregivers are defined as anyone who cares for a child, including but not limited to parents, guardians, grandparents, daycare providers, teachers, and after school providers. MDPH will provide education and outreach to parents and caregivers specific to poison prevention, with a focus on collaborating agencies with the goal of increasing attendees of training sessions each year, based on staff capacity estimates. MDPH expects to provide training to 300 child caregivers in FY19, and increase to 400 caregivers annually in FY20. One focus area within these sessions will be educating Massachusetts families whose first language is not English. The Regional Center for Poison Control is investing in educational materials in a variety of languages and providing electronic copies of materials in many languages to key agency staff if hard copies are not available.

 

Child Fatality Review:

The Local Teams will continue to 1) collect information on individual child deaths, 2) discuss case information in team meetings and develop an understanding of the incidence and preventable causes of child deaths, 3) promote collaboration among the agencies that respond to child deaths and provide services to family members, and 4) advise the State Team by making recommendations for changes in law, policy, and practice that will prevent child deaths.

 

In FY20, the Injury Prevention and Control Program (IPCP) team will continue to work with the Office of the Chief Medical Examiner (OCME) to support the ongoing child fatality case reviews and recommendation response. In FY20, the team will have addressed a substanial portion of the backlogged recommendations by either identifying that they are already in place, determining that they face considerable barriers, taking agency-based actions, or pushing them forward to the legislature and governor as official recommendations of the state team. The team will continue to participate in all local team meetings as feasible, collect the case review and recommendation data from local teams, coordinate and faciltiate every-other-month state team meetings, and assure consistent and timely communication between local and state teams. That will include keeping guidelines updated, creating toolkits and educational materials as necessary, and if possible, establishing a webpage or repository of available CFR materials.

 

WIC

The WIC Coordination Unit will continue collaboration with the IPCP to share timely child safety messages and product recalls with local WIC programs and to include child safety messages in WIC’s social media efforts. As in past years, the Coordination Unit will focus on topics such as car seat installation, installing and checking smoke alarms, bicycle helmet safety, water safety, window safety, winter heating safety, holiday toy safety, and prevention of poisoning from household products.

 

Early Intervention Parenting Partnerships Program

EIPP sites will continue to work with health plans and community-based agencies (i.e., Safe Kids) to offer free or low-cost new car seats to EIPP participants. In addition, home visitors will continue to provide educational materials and instructional aids to EIPP participants in accordance with recommendations by the National Highway Traffic Safety Administration and the Community Preventive Services Task Force.

 

MA MIECHV

To maintain or decrease the already low rate of ED visits resulting from injury, MA MIECHV will continue to encourage discussion of safety topics between the home visitor and participant, including through MA MIECHV’s injury prevention and safe sleep training for home visitors. MA MIECHV will also work to improve the accuracy and completeness of data collected on this MIECHV performance measure.

 

Massachusetts Pregnant and Parenting Teen Initiative

MPPTI will continue to serve expectant and parenting adolescents ages 14-24 and provide education, counseling and referrals for child health and safety issues, including infant and child car seats, smoke/carbon monoxide alarms, safe infant sleep, supervising young children in and around water, Poison Control Center, and other environmental health and safety topics. In FY20 MPPTI will continue to track ED visits by asking participants to report monthly whether their child has had to visit an emergency room for an accidental injury or ingestion and will work with funded programs to decrease the percentage of children who experience an accidental injury or ingestion warranting an ED visit.

 

School Health Services

School Health Services will continue to collect monthly data on the rate of injury-related hospital admissions in the school populations as a surveillance activity. School nurses are the first responders to any injuries or illnesses in schools. Through their assessment and interventions, the calls to 911 for these incidents can be reduced, and students remain in school, ready to learn. In the coming years, these interventions will be collected by injury and/or illness in order to determine trends specifically related to injury-related hospital admissions.

 

Additional activities to promote safe, stable, nurturing environments to reduce violence and the risk of injury

Essentials for Childhood

FY20 will be the second year of phase 2 of the Massachusetts EfC initiative funded by the CDC. MA EfC will continue to bring together public and private stakeholders across multiple sectors to address child maltreatment through the promotion of safe, stable, and nurturing relationships and environments. In FY20, activities will be underway in two strategy areas: 1) Strengthening economic supports to families - activities will include working toward equitable implementation of legislation on paid family and medical leave; and facilitating Voluntary Income Tax Assistance (VITA) sites in health care settings to increase the number of families filing for Earned Income Tax Credits (EITC). 2) Promoting positive parenting by supporting the social norm of community social connectedness will be advanced in FY20 by working with at least two communities in MA to pilot and refine a community social connectedness toolkit. Efforts will also be underway to ensure that racial equity is central to all EfC efforts, and to develop community level strategies to address risk and protective factors for preventing opioid misuse and its relationship to Adverse Childhood Experiences (ACEs).  

 

Priority: Promote equitable access to dental care and preventive measures for pregnant women and children. 

 

NPM 13 B: Percent of infants and children, ages 1 through 17, who had a preventive dental visit in the last year

Office of Oral Health

OOH has formed an alliance with portable dental programs statewide to better ensure all schools have access to school preventive oral health services. In FY19, through a mapping exercise with alliance members, we identified schools that currently do not engage with a school-based dental program. In FY20, the schools identified will be strategically connected with the portable dental programs in their area. The OOH will continue to operate the SEAL school based dental program in FY20 and will maintain the same number of schools and children who participate through continued education and outreach. As part of both the alliance initiative and the SEAL program, the number of schools that participate in a school-based dental program will increase in FY20.

 

Through collaborations with the Oral Health Equity Project, OOH has built relationships with EI programs in Holyoke and Worcester to pilot the integration of oral health screening forms into EI staff workflows, with the goal of expanding to EI programs statewide. In FY20, OOH will develop an online training module to spread the use of this oral health screening form to at least two additional EI programs.

 

Oral Health Equity Project

In FY20, OHEP will be in year five of this grant, and will continue implementing the interventions described in the FY18 Annual Report and collecting data to inform needed improvements. The goal of these interventions is to increase the number of children of color aged 0-14 years who are on Medicaid who have seen a dentist in the past 12 months. In FY20 OHEP will also disseminate lessons learned through publications and presentations at conferences.

 

Early Intervention:

In FY20, EI will continue supporting the OHEP. In FY20, the OHEP team will work with the EI pilot programs in Worcester and Holyoke to sustain the processes that they developed during the project. In addition, an online module training for EI staff is in development and will be embedded in the EI training system called “Training On Demand.” The training will be used for both new and existing staff to promote oral health during early childhood. In addition, the OHEP team will seek opportunities to disseminate findings so that other EI programs may use the model developed.

 

WIC:

In FY20, the OHEP team will work with the CHW hired within Family Health Center of Worcester to sustain the process developed with WIC. Currently the CHW spends time in the WIC waiting room weekly to discuss oral health with families and make referrals to the community health center dental department. At that time, she focuses on providing oral health counselling, discusses any barriers that they may be facing, and gathers contact information so that she can follow up with them to make an appointment. In addition, the OHEP team will look for opportunities to disseminate findings so that other WIC programs may use the model developed. 

 

MA MIECHV

MA MIECHV home visitors will continue to assess whether children have a usual source of dental care and promote connection to oral health services.

 

Priority: Reduce the impact and burden of environmental contaminants on children and their families.

 

SPM 2: Percent of children aged 9-47 months with blood lead level screenings

The Title V objective for FY20 is to increase blood lead level screening rate for children aged 9-47 months by 1.0% over the previous year. In CY2018, 72.1% of children aged 9-47 months were screened, a slight decrease from 72.6% in CY2017.

 

Childhood Lead Poisoning Prevention Program

In FY20, CLPPP will continue to work with clinicians and other health care providers in high-risk communities to promote blood lead level screening, emphasize the revised regulatory requirement for venous re-screening, and provide culturally appropriate education about lead hazards. Using data demonstrating the correlation between childhood lead poisoning prevalence and racial inequities, CLPPP will continue to direct resources for pediatric in-service and other trainings to communities most significantly affected. CLPPP will continue to work with the Department of Early Education and Care, EI, Head Start and other programs to provide information related to Massachusetts lead screening requirements and CDC guidance on reference values. CLPPP will also begin a mutual data sharing agreement with the WIC program in CY19 to identify potential gaps in screening compliance and possible trends among populations living in high risk communities.

 

CLPPP’s primary focus remains case management of children at the newly re-defined lead poisoning threshold. In FY19 and in FY20, CHWs will fulfill a critical role to reach families to provide inspections. CHWs conduct home visits and assess temporary hazard reduction in the homes of families awaiting inspection. CHWs also provide child and site specific feedback to senior case managers, allowing us to more effectively triage cases and identify children at highest risk for additional exposure.

 

In FY19 CHWs developed and piloted a new lead exposure assessment tool to collect home visiting information. The new case management and surveillance database is expected to be online in the beginning of FY20. Using this new tool, CHWs will collect data electronically to better identify family needs, risk factors, and likely exposure sources, especially non-paint exposures. CLPPP will use this data to inform and update case management protocols.

 

Occupational Health Surveillance Program

OHSP will continue to enhance collaborative efforts with the BEH around lead poisoning and act as a liaison between CLPPP and the DLS Occupational Lead Poisoning Registry Program in FY20. OHSP will continue to collaborate with DLS, BEH, and BCHAP to incorporate information about elevated blood lead levels among adults into EPHT and PHIT. In addition, OHSP will conduct enhanced outreach among individuals with high blood lead levels. OHSP will conduct interviews to find out more about potential workplace factors associated with having a high blood lead level.

 

Additional activities to reduce the impact and burden of environmental contaminants on children and their families

Asthma Prevention and Control Program

On June 11, 2019, the APCP applied for a competitive re-application to the CDC to fund the core functions of the program for the next five years. The APCP tailored specific programmatic work consistent with the goals of the MCH Block Grant. Current funding for the APCP ends in August 2019.

 

Through August 2019, APCP will continue to support the provision of guideline-based primary care to all Massachusetts children with asthma. This will include dissemination of the Physician Asthma Care Education training and provision of technical assistance and support to members of the Asthma Learning Collaborative as they implement asthma self-management education and high-risk case management in clinic settings.

 

APCP will also continue to partner with MDPH’s Essential School Health Services program, using evidence-based practices, to support three school districts to improve the quality of care delivered to, and health outcomes of, children with moderate to high risk asthma in the school settings. Those three selected school districts will implement school interventions that fall into the following categories: evidence-based asthma self-management education, care management, and environmental and indoor air quality.

 

School Health Services

School Health Services will continue to prioritize chronic disease and asthma prevention and management. School Health Services activities will continue to solicit district programming directed at asthma, which includes continuing education for nurses, collaboration and coordination with families, medical specialists, and school personnel. School Health Services will continue to monitor asthma medication management and medical treatment plans.

 

Priority: Promote emotional wellness and social connectedness across the lifespan.

Division of Pregnancy, Infancy, and Early Childhood

The state-level Young Children’s Council will continue to meet in FY20. The goal of this Council is to align MDPH and our partners’ work related to infant and early childhood social emotional wellness and to advise DPIE programs that focus on systems building (e.g. Project LAUNCH, MECCS, MA MIECHV). The council will continue its focus begun in FY18 on racial equity together with efforts beginning in FY19 to more substantially engage families in YCC planning and decision making. The council will also continue to consider sustainability of early childhood prevention programs. The Integration of Social Emotional Health Workgroup of the YCC will promote strategies to integrate early childhood mental health into primary health care, which has been the focus of MDPH’s Project LAUNCH Expansion grant, ending in FY19. Council membership will continue to include state and community agency and family/consumer representation.

 

MA Early Childhood Comprehensive Systems

In FY20 MECCS will further implement activities identified through its racial equity strategic plan. Through convening public and private-sector partners, MECCS will facilitate the creation of a roadmap for connecting and strengthening existing racial justice work within early childhood initiatives across the state. MECCS will continue to provide training and coaching to its community partners on how to incorporate a racial equity lens into their work, including support for their family leadership activities. MECCS will refine the GIS maps with partners to develop a compelling tool to highlight inequities and inform conversations with community leaders about opportunities to promote racial justice within early childhood systems of care.

 

MECCS community teams in Chelsea and Springfield will continue to engage new partners and expand their cross-systems early childhood networks. Outreach efforts will focus on fathers, the business community, and public safety officials. Community activities will include piloting a closed loop referral system with early childhood network partners, promoting the Boston Basics child development framework community-wide, identifying resources to sustain the family leadership positions, and scaling the DRIVE universal screening model.

 

MECCS is also an active partner in the efforts of MA Essentials for Childhood to develop a toolkit for municipal leaders that includes strategies for promoting social connectedness for families with young children. MECCS will facilitate pilot testing of this tool in Chelsea and Springfield in FY20.

 

Early Intervention

EI will continue to implement its State Systemic Improvement Plan to ensure that children enrolled in EI demonstrate improved social-emotional outcomes before exiting services. A key strategy is implementing the evidence-based practice Parents Interacting with Infants (PIWI) during home visits to support families in achieving their IFSP outcomes. The goal is for clinical interventions to support the relationships between the parent and child by increasing confidence, competence and mutual enjoyment. EI specialists are working to move to less directive strategies (e.g., Establishing Dyadic Context, Affirming Parenting Competence) to support the parent/child relationship. The expected outcome is that children and families will experience higher quality services based on research-based best practices with consistency across local programs. This would result in improved child outcomes, particularly in positive social-emotional skills development.

 

Massachusetts EI will continue to collect and monitor evaluation data and refine implementation activities as necessary. In FY20 the MDPH EI Training Center (EITC) and UMass Boston are offering a four-day training institute for PIWI champions and supervisors. The Institute will provide an overview of the PIWI model, the “why” behind PIWI, strategies for successful implementation, and opportunities to problem-solve challenging situations.

 

MA MIECHV

In FY20, MA MIECHV home visitors will continue to screen children with ASQs at the AAP-recommended intervals of 9, 18, 24 and 30 months and make referrals as needed in adherence to the MIECHV performance measures. MA MIECHV home visitors will also continue to assess parent-child interaction using the PICCOLO or CHEERS Check-In screening tools, in adherence to the MIECHV performance measure. In addition, MA MIECHV home visitors will continue to assess the extent to which parents engage in activities to promote early childhood literacy.