NPM 6 - Percent of children, ages 9 through 35 months, receiving a developmental screening using a parent-completed screening tool

For the Child Health domain, Hawaii selected NPM-6 Developmental Screening as a continuing priority, based on the 2020 five-year needs assessment. By July 2025, the state seeks to increase the percentage of children ages 9 through 35 months receiving a developmental screening to 45.0%.

Given changes brought on by COVID and the new ECCS grant and strategic plan under development, Hawaii is deleting two strategies, will retire ESM 6.2, and develop a new strategy measure in next year’s report.

Strategy 1: Systems Development

Hawaii will continue to work with partners to implement the statewide system for developmental screening, referral, and services. These efforts are part of the State Plan for Early Childhood that developed from the strategic plan for the federal Preschool Development Grant Birth through Five (PDG B-5).

New ECCS grant: Hawaii’s new ECCS grant is developing a strategic plan to focus on strengthening integration and promoting maternal, infant/child health, and family well-being. The plan will focus on addressing health disparities in this population. Developmental screening remains a part of the plan’s performance measures. Community-level initiatives piloted in Maui County and supported by the previous ECCS Impact grant will be used to inform statewide program efforts. Coordination will be maintained with other state early childhood entities. The ECCS activities assure family engagement (with parent leadership integrated into the Advisory Committee) and will help address other system issues, including policy development, agency coordination, standards setting, public awareness, and workforce training.

Medicaid partnership: With the inclusion of developmental screening as a priority into Hawaii Medicaid managed care contracts, Hawaii has a new data measure to assess screening efforts conducted by pediatric primary care providers serving Medicaid enrollees. For FY 2021, developmental screening rates in the first three years of life for Medicaid enrollees was 22.41%. Collaboration with Hawaii’s Medicaid and the five managed care plans will be explored. Progress on the new EPSDT client dataset will be monitored as an additional data source to track screenings and health status information collected during each pediatric visit. Race/ethnicity data shared by Medicaid on their enrollees confirms they represent populations that are underserved with health disparities and poor health outcomes.

Hi’ilei Developmental Screening program: The program services are underutilized. With staffing changes in FY 2021, CSHNB will use this opportunity to evaluate and re-envision the program scope to better address the statewide challenges and needs for developmental screening, especially in light of COVID changes in healthcare delivery. Purchase of an ASQ Enterprise license that can be used broadly will be explored. Results of the Enterprise license piloted in Maui County are being reviewed to assess the benefits to expand screening reach.

Strategy 2: Data Collection and Integration

Data from Hawaii’s Medicaid program for the developmental screening CMS quality measure will be monitored. A request for further disaggregation of the data will be requested. Medicaid progress on the EPSDT-related office visit data will also be followed, as the dataset is analyzed and findings generated.

Oversampling for the National Survey of Children’s Health (NSCH) will be sought, although funding and other administrative barriers exist.

Strategy 3: Social Determinants of Health and Vulnerable Populations

Media Campaign. A media campaign to promote child wellness visits and preventive screenings for development, vision, hearing, and behavioral health will continue through Fall 2022. Messaging will be translated into several languages and broadcast on radio. Screening information will be translated for viewing or downloading from the campaign website. Social media and community outreach activities are also planned.

The Hawaii CDC “Learn the Signs. Act Early” (LTSAE) team will continue to work with WIC to utilize the 2-year-old and 3-year-old developmental checklist to see if parents have any concerns about their child’s development. WIC staff will help with referral to Early Intervention if the child is younger than 3 or to Department of Education Preschool Special Education if the child is older than 3.

The translated milestones booklets based on the CDC LTSAE materials will be distributed to Chuukese, Marshallese, and Samoan speaking families in partnership with community-based organization.

The use of the Survey of Well-being of Young Children (SWYC) developmental screening tool that also examines family well-being will continue to be explored with partners to better address the social determinants of health and identify vulnerable at-risk families who may be in need of resources.

SPM 1 - Rate of confirmed child abuse and neglect cases per 1,000 children aged 0 to 5 years.

For the Child Health domain, Hawaii selected Child Abuse and Neglect (CAN) prevention as a continuing state priority based on the 2020 5-year needs assessment. By July 2025, the state seeks to reduce the rate of confirmed child abuse and neglect cases per 1,000 children aged 0 to 5 years, to 5.2. Plans to address this objective and SPM are discussed below.

For 2023, CAN strategies were revised/consolidated to reflect a broader public health systems approach:

• Support the collaboration and integration of family strengthening and child maltreatment prevention programs and activities across federal, state, local, and private programs, and organizations.
• Provide training and technical assistance to community-based, prevention-focused programs to strengthen families, prevent child abuse and neglect, and foster appreciation and knowledge of diverse populations.
• Promote health equity by addressing disparities in confirmed CAN cases.

Strategy 1: Support the collaboration and integration of family strengthening and child maltreatment prevention programs and activities across federal, state, and local and private programs and organizations.

Preventing CAN will be addressed through both established and new government and private organization collaboratives to address broad areas of workforce development, CANP activities, training, and health equity.

The Hawaii State Departments of Health, Education, Human Services (including Office of Youth Service), and Judiciary currently collaborate on several important child abuse and neglect prevention-related initiatives (see table below). The initiatives are a mix of primary, secondary, and tertiary prevention with the aim of building strong, nurturing, and resilient families and communities.

The goal is to develop an integrated prevention continuum of services, policies, and practices across the state and county government offices and programs. This will include strengthening the current collaborations and establishing new partnerships with state offices and programs that address CANP, specifically the Hawaii State Departments of the Attorney General and Public Safety, the Fatherhood Commission, and the Executive Office of Early Learning.

Expanding the collaboration will support policies, practices and services that support children and families and mitigate risks for CANP, such as housing, financial assistance, parent education, substance use and abuse treatment, and domestic violence. The outcomes of this collaboration could include blending or braiding of funding streams; defined policies that align with a shared vision; shared community collaboratives addressing common goals and outcomes; and shared tracking and accountability for outcomes.

The CANP Program will continue to work in collaboration and coordination with the Early Childhood Action Strategy to expand the outreach and offerings of the Aloha at Home initiative, and the Hawaii Children's Trust Fund (HCTF) with its grant-making efforts and the HCTF Coalition to ensure community-level needs, concerns, and solutions are in the forefront in planning and execution of statewide CANP training and activities.

Supporting the public and private collaboration and integration will be carried out in part through statewide CANP activities and training/workforce opportunities. The HCTF Coalition and the individual neighbor island coalitions represent diverse and broad membership involved in the execution of CANP activities. Their work will be supported by the CANP program funds. CANP supported trainings will be made available to these partners.

Strategy 2: Provide training and technical assistance to community-based, prevention-focused programs to strengthening families and prevent child abuse and neglect, and foster appreciation and knowledge of diverse populations.

CANP Program will continue to support learning opportunities addressing historical and cultural trauma experienced by Native Hawaiians and Pacific Islanders as well as the effects of trauma on special populations (military, children with disabilities, children and families experiencing incarceration or homelessness), building individual and community resilience, trauma-informed and trauma-responsive systems of care, protective factors, and Standards of Quality for Family Strengthening and Support. Opportunities will be implemented using a range of modes from virtual, on-demand/online, and in-person.

The CANP Program will partner with internal and external partners on other training topics as safe sleep, safe and effective discipline, and domestic violence. The Hawaii Home Visiting Program will continue to provide quarterly trainings to their contracted statewide service providers.

Strategy 3: Promoting Health Equity by addressing disparities in confirmed CAN cases.

The data from DHS CWS point to significant disparities among CAN confirmed cases, specifically by race, age, and geography (rural). These variables are not necessarily mutually exclusive. As previously noted, Native Hawaiians are overrepresented in confirmed CAN cases for all age groups.

CANP will expand its collaboration with community organizations such as Papa Ola Lokahi and Native Hawaiian Health Centers that provide medical and enabling services to Native Hawaiians in largely rural areas of the state to better understand the needs and gaps in CANP services and identify actions going forward to address these inequities.

The CBCAP American Rescue Plan funds may be used in part to address disparities associated with geography/rural and race/ethnicity linked to contract community organizations to promote evidence-based prevention strategies that focus on disparity populations.

SPM 5 - The percentage of Medicaid children receiving six or more well-child visits in the first 15 months of life

For the Child Health domain, Hawaii added this new state priority to promote child wellness visits and routine immunizations, especially for young children. The priority is a result of ongoing needs assessment and concerns raised during COVID that many well-child visits and immunizations were postponed or delayed due to healthcare office closures and COVID safety concerns.

By July 2025, the objective is to increase the percentage of Medicaid children receiving six or more well-child visits in the first 15 months of life. The measure is a Medicaid Core Child quality performance measure, which Hawaii is currently reporting and reflects Medicaid’s partnership in this project. Data for FFY 2021 was not available at the time of this report but will be reported next year.

Strategy 1: Collaboration with Pediatric Providers

Once the 2021 campaign was launched, the workgroup did not meet as many providers became busy with the Omicron surge and COVID vaccinations for older children. However, partners were pleased with the success of the campaign and continued collaboration occurred around other child health issues. By working with both the AAP Hawaii Chapter and the Medicaid Medical Director, Title V is using these networks to help promote other maternal and child health issues such as focusing on transition to adult health care for youth, safe sleep, developmental screening, and lead poisoning prevention.

When time and staffing permit, Title V will explore a more comprehensive partnership with Medicaid to collaborate on Title V priorities and other service program concerns.

Strategy 2: Conduct Public Awareness Campaign

Hawaii will continue to work on the second public awareness campaign, focusing on well-child visits and screenings (developmental, behavioral, vision, hearing). The original planning committee was reconvened and agreed to continue to work on the second campaign, using the similar framework and structure as the first campaign.  Following the MCH Evidence Center recommendations, more effort will be made to develop concurrent community outreach efforts to reinforce the media messages. Initiatives being discussed include: strengthening the digital/social media outreach via TikTok, using social influencers, sharing digital messaging with service/agency providers to disseminate to their clients, and meeting with community partners to better reach underserved populations.

Greater attention will also be placed on developing qualitative and quantitative metrics for the messaging ‘reach,’ to determine how well CWV reached the target population, increasing visit numbers.

Strategy 3: Build Capacity for Pediatric Champions

Title V continues to work with the AAP Hawaii Chapter and HCAN to help educate and inform the public and policymakers on important child health issues. More pediatric champions are needed to help provide a stronger voice and promote legislation to improve children’s health. Hawaii looks forward to continuing to further build capacity for pediatric champions to help advocate on behalf of children and families.