NPM #8 Physical Activity – Reduce obesity among children and adolescents.

 

Please note that some of the strategies and activities listed below impact both the Child and Adolescent Health domains. To avoid duplication, the information will only be listed in this domain, for which it is anticipated to have a larger impact.

 

Policy and Environmental Changes

Developing a healthier community involves creating a culture that promotes the benefits of physical activity and allows access to safe places to be active. Public policy is essential in supporting opportunities for children, youth, and families to develop healthy physical activity practices. Strategies include collaboration with internal partners, local public health agencies (LPHAs), youth, and statewide and community organizations with similar goals. In FY 21 Community Health and Wellness (CHW) will continue to contract with LPHAs to implement policy and environmental changes that increase opportunities for children to engage in physical activity (PA) across multiple settings.

 

Child Care Wellness contracts will support up to 20 LPHAs in providing training and technical assistance to child care providers in improving child care physical activity and nutrition policies and practices. LPHAs will use the University of North Carolina’s Go NAPSACC online system to assist and track child care providers’ progress.

 

The Department of Health and Senior Services (DHSS), through CHW, the Child Care Health Consultation (CCHC) program, and the Community Food and Nutrition Assistance program, will continue to support childcare providers to implement policies and practices supportive of physical activity. This is to occur by providing training, resources and technical assistance related to PA policies and practices to child care providers in their efforts to become a Missouri MOve Smart Child Care. 

 

CHW will contract with Missourian’s for Responsible Transportation to lead and conduct the Missouri Livable Streets Advisory Group. This group consists of active transportation experts and advocates that collaborate to assist communities with improving the accessibility of non-motorized transportation for all users throughout the state.

 

Professional Development, Training, and Resources

CHW staff are also available to provide training and technical assistance on obesity prevention strategies for local communities. To ensure staff are well-informed and can provide quality assistance, they plan to participate in professional development opportunities such as annual conferences of professional associations, the Southern Obesity Summit, and other evidence-based training.

 

CHW will continue to support Missouri communities in their obesity prevention efforts by providing professional development and training opportunities for key stakeholders. Additionally, technical assistance and resources are available to assist efforts in increasing regular physical activity and healthful eating. CHW will also assist communities in assuring interventions are inclusive of individuals of all abilities.

 

The School Health Program (SHP) will support school nurses to engage with students and families in addressing overweight/obesity in children. SHP will sponsor education and professional development in best-practices (for example Lead Nurse Collaborative Meeting and ECHO webinar series for school nurses), collaborating with stakeholders and organizational partners to make tools and resources available to school nurses, and facilitating connections between students and families, schools, and communities.

 

Partnerships

CHW staff participate in a number of coalitions and partnerships that help to advance progress towards the state’s goals and objectives. Examples of groups in which staff are involved include: Missouri Council for Activity and Nutrition, Missouri Convergence Partnership, Missouri Coordinated School Health Coalition, Department of Elementary and Secondary Education Wellness Workgroup, and the Missouri Livable Streets Advisory Council. Staff have opportunity to network and identify collaborative opportunities with other organizations working on similar goals, share DHSS resources available and leverage funding to increase reach of work.    

 

The Maternal Child Health Services Program will continue to contract with a total of 19 LPHAs that selected to address physical activity/obesity as their Priority Health Issue. The Program will support LPHA efforts to prevent and reduce overweight/obesity and increase physical activity among children and adolescents.

• Bates County Health Department will continue change organizational practices by increasing the number of schools, childcare facilities, preschools, summer camps, and after school programs who promote the inclusion of physical activity to achieve 60 minutes per day.
• Columbia/Boone County Department of Public Health and Human Services will continue to influence policy and legislation by increasing beyond 40% the number of 12345 Fit-Tastic!, Move Smart, or Eat Smart policies adopted by child care centers, schools, and out-of-school organizations to promote physical activity.
• Jefferson County Health Department, as part of ongoing efforts to increase knowledge about obesity reduction skills by utilizing and participating in after-school activities, parenting skills courses, and multi-session family programs will develop an evidence-based, interactive, family-oriented healthy lifestyle educational program for Jefferson County families with 6-11 year old children, provided weekly for 6-12 weeks. The program will have aspects for both parents and children, including: educational presentations, exercise activities, and goal tracking components.
• Clay County Public Health Center (CCPHC) will continue efforts to foster coalitions and networks by increasing the number of individuals/organizations working to decrease childhood and adolescent obesity in Clay County and will work with community partners to expand the CCPHC 12345 Fit-Tastic! Family Fun Day to other Clay County municipalities.
• In an effort to educate providers and influential organizations and leaders who will transmit skills and knowledge to others, Taney County Health Department will utilize current practices, trends, and social norms to share with organizations, leaders and health providers about the positive impact related to youth and physical activity and will make available e-learning web based links to community presentations to share needs and purpose of physical activity for youth.
• Pulaski County Health Department will continue efforts to educate the community on the importance of increasing physical activity and limiting screen time of children and adolescents.

 

SPM #1 Oral Health – Percent of children, ages 1 to 17 years, who had a preventive dental visit in the last year.

 

Ordering information for oral health resources from the Office of Dental Health (ODH) and the Missouri Primary Care Association (MPCA) will be provided to Genetics and Healthy Childhood (GHC) home visitors to promote National Children’s Dental Health Month, which is observed annually in February. National Children’s Dental Health Month will also be highlighted in the GHC Home Visiting Program’s continuous quality improvement newsletter, Quality Outlook, to provide home visitors with links and other resources that highlight the importance of preventive annual dental care in children. The Missouri WIC Program will collaborate with ODH to procure infant and toddler toothbrushes to have them available in their local WIC clinics. 

 

Additionally, literature is available to LPHAs, dental offices, and community outreach events like health fairs. The importance of regular dental care is also stated within the context of the ODH’s promotion of the use of dental sealants. Referrals and care coordination components of the Preventive Services Program (PSP), described more below, also encourage regular dental visits for children, particularly those who have been identified as having evidence of a dental need.

 

The ODH enjoys continued success with the PSP, which is an evidence-based fluoride varnish and oral health education program. PSP serves about 90,000 children each year. Each child receives an oral health screening by a dental professional, two doses of fluoride varnish, oral health literature and supplies, and oral health education. The oral health education is either provided by school staff or the dental professionals that volunteer to operate PSP. Educational materials are provided by the ODH (for each grade, K-12), but some schools choose to use their own materials. Due to the Coronavirus pandemic, many schools will not allow visitors to enter their school building. For those schools, PSP has adapted to provide a grade-specific and narrated educational video for teachers to show their classes, or a Zoom call can be scheduled with the school’s ODH Oral Health Consultant if they do not have their own educational materials or training. Oral health supplies and literature will still be given, and fluoride varnish will either be applied by a trained school staff member or sent home for parents or guardians to apply to their child’s teeth. ODH’s Oral Health Consultants will also be available to school nurses to advise on possible dental health needs their children have. School nurses can take pictures of a child’s teeth if there is a questionable issue, and an Oral Health Consultant can help in determining the need for dental care. 

 

Much of Missouri is a dental health provider shortage area, meaning many Missourians are not located close to a dentist nor do they have a dental home. COMTREA (a Federally Qualified Health Center) assists parents in understanding the importance of oral health and linking children with dental care to address barriers to dental services such as transportation, ability of parents to miss work, ability to pay, and knowledge of services available. ODH will work with COMTREA to provide assistance and support as needed in the form of educational materials and handouts.

 

SHP will coordinate with ODH and other programs to provide evidence-based information, resources, and professional development to school nurses supporting them with best practices to educate children and parents about oral health concerns as well as promote the need for annual dental visits and regular preventative practices in oral health.

 

The ODH will continue to promote the use of dental sealants as an effective means to prevent decay on newly erupted molars and is actively seeking new partnerships to provide dental sealants in school-based clinics. ODH continues to work with the Missouri WIC program to apply sealants in select local WIC agencies. Through a grant not funded by Title V, ODH is also working with five LPHAs to apply fluoride varnish to the teeth of their high-risk children, mainly through their WIC programs.

 

The TEL-LINK Program will refer callers to dental clinics to increase awareness of community resources to access needed dental health services. The program will continue to provide outreach to the underserved population through social media.

 

The CCHC Program will continue to provide education and consultation to child care providers and health promotions to children on the importance of dental health and the related implications for overall health.

 

The MCH Services Program will support LPHA efforts to:

• provide education on the importance of adequate dental care and overall oral health;
• collaborate with partners to provide screening, referral and direct provision of preventive dental services for oral health needs; and
• increase the number of children, ages 1 to 17 years of age, receiving a preventive dental visit in the last year.

 

Other strategies for the year include providing education to the public, city officials, dental and medical professionals, and public health authorities about the safety and effectiveness of community water fluoridation for the prevention of dental caries. The ODH also continues to improve the Missouri Oral Health Surveillance System to include updated fact sheets on topics of interest and regional reports compiling oral health statistics and related information.

 

Through a grant not funded by Title V, ODH is contracting with a dentist and dental hygienist to provide teledentistry services to schools, targeting the counties with very few or no dentists. This will provide dental services to children who may not have access to those services due to a lack of dental providers in their area. Through yet another funding opportunity, ODH is contracting with a dentist and dental hygienist to promote dental sealants and place those sealants through teledentistry services.

 

The ODH’s Five-Year State Oral Health Plan was finalized and disseminated and is still a subject of ongoing communication with its partners.

 

ODH will continue its efforts to:

• Increase access to dental care by providing education about the importance of maintaining the adult dental benefit among MO HealthNet recipients. Information is distributed to policymakers, dental providers, leaders, and oral health stakeholders via the DHSS website and partners like the Missouri Coalition for Oral Health and Missouri Dental Association;
• Contract with the MPCA to provide education and technical assistance to State Dental Directors from all FQHCs in Missouri. The MPCA also assists ODH with distributing educational materials regarding the importance of a Dental Health Home for everyone, particularly for pregnant women and children;
• Support the development of the oral health workforce in Missouri through collaborations with the DHSS Office of Rural Health and Primary Care on incentive programs for dental professionals’; and
• Implement the “referrals” portion of the Preventive Services Program (PSP), which links children with an identified dental need to local dental providers. This is coordinated through school nurses and other local champions.

 

Other Title V Program Activities Related to the Child Health Domain

 

Developmental Screening

The CCHC Program will continue to provide training and consultation to child care providers around health and safety topics, including social/emotional/physical development.

 

Inclusion specialists will provide parents with listings of child care providers, based on the geographical location requested by the parent, so that parents can choose child care that will meet the needs of their child. Enrolling a child in a program that is prepared to meet the needs of that child will increase the likelihood of maintaining placement, which will support the educational needs of the child. Inclusion specialists provide onsite consultation to assist child care providers and develop adaptations and strategies to include the child with special needs in everyday classroom activities. They will assist in setting achievable goals for the child’s ongoing development. In addition, specialist’s deliver group training to better increase the knowledge base of child care providers in Missouri on how to include children with special needs.

 

Vision for Children at Risk (VCR), a non-profit organization in St. Louis City, has brought together a wide group of stakeholders in the early childhood realm in St. Louis who are committed to early childhood development and early interventions. Through this work, LEAP (Learning Everything at Pace) Ahead St. Louis provides families access to early developmental screening and treatment for delays for their children. LEAP Ahead St. Louis is focused on the importance of early identification of developmental delays through increased screening, with particular focus on the social and emotional development of the most at risk, underserved children and families in the region. The long term goal is to create a regional data hub that allows for sharing and tracking of screening data, and create a system for coordinated resource referrals between agencies. The Early Childhood Program Coordinator continues to maintain communication and work with VCR to support this work.

 

The Boone County Early Childhood Coalition is using the Survey of Wellbeing of Young Children (SWYC) and an online screening hub to increase social and emotional screening in Boone County. The tool is available for free online to parents and child care providers. The screening hub is accessible to the parents and providers and will track the child’s development. Children who are found to need additional screening or assessment will be referred to partner organizations. The Early Childhood Program Coordinator will continue to monitor their progress and watch for opportunities for impact at the state level.

 

The Early Childhood Program Coordinator will maintain communication with multiple early childhood collaboratives across the state. Each of these groups is working to support early childhood development and education. As opportunities are shared, information will be reviewed for statewide impact.

 

The Home Visiting Program’s contracted home visitors will use the Ages and Stages Questionnaire®- 3 (ASQ-3) screen tool to identify children’s developmental needs. Home visitors will provide referrals for children who score below the cut-off points indicating a need for additional developmental information and activities, community supports, or early intervention services through Missouri First Steps or Early Childhood Special Education to contribute to improved school readiness. Annual performance measure data will be collected on the percentage of ASQ-3 developmental screenings conducted at the specified time points of 9, 18, and 30 months of age. Annual performance measure data will also be collected on the percentage of completed referrals for children who score below the cut-off points of the ASQ-3.  

 

Additionally, the Home Visiting Program’s contracted home visitors will continue its best practice to screen all children of enrolled participants, birth to kindergarten entry, for social- emotional development using the Ages and Stages Questionnaire®: Social Emotional (ASQ:SE-2). Home Visitors will provide developmental activities for parents/children who score in the “monitoring” range and will assist families in accessing services as appropriate. These screenings will continue in FY21.

 

The Home Visiting Program will provide all contracted home visitors with education on childhood mental health conditions and warning signs through a variety of communications including: email; postings on the Missouri Home Visiting Gateway Website (https://health.mo.gov/living/families/hvcqigateway/) under resources and weekly updates; during the annual Home Visiting Summit conference; and through the continuous quality improvement home visiting newsletter, Quality Outlook (https://health.mo.gov/living/families/homevisiting/cqinewsletters.php).

 

The Newborn Health Program will partner with a wide variety of community health providers to distribute Pregnancy and Beyond as well as other educational materials that provide information on developmental screening. The program will track the distribution of these materials and obtain feedback from its partners on how the materials were used and ways to improve the materials.

 

The Missouri WIC Program is implementing the public awareness campaign “Talking is Teaching: Talk, Read, Sing” to help parents recognize their ability to improve their children’s early brain and vocabulary development. Training was provided statewide to WIC agencies, home visiting nurses, Head Start, Parents as Teachers, health care providers, libraries, and other community partners. Handouts were created to give caregivers tips on fun and easy ways to improve their child’s learning. Books developed by the Centers for Disease Control and Prevention (CDC) as part of the “Learn the Signs. Act Early.” (LTSAE) public health campaign were printed and the WIC program will continue to distribute materials to stakeholders to share with their families as part of their educational efforts.

 

The Missouri WIC Developmental Milestones Program will continue to be offered at WIC local agencies statewide. This program assists with monitoring children’s developmental milestones and knowing when and how to refer families for follow-up if there are concerns and is based on the CDC LTSAE public health campaign. The WIC Developmental Milestones Program uses a set of checklists and family-friendly wall and floor graphics to increase parents’ awareness of developmental milestones and to promote the early identification of potential developmental delay.

 

Missouri Milestones Matter (MMM) is a project with the goal of embedding developmental monitoring into the Missouri child care system using the CDC LTSAE public health campaign. The materials include parent-friendly checklists to be used by teachers and parents to assist in monitoring the development of children up to the age of five. Children that are missing milestones will be referred to receive a screening using a validated developmental screening tool by one of our partners. The leadership team for this project includes the Early Childhood Program Coordinator, the Missouri Ambassador for the LTSAE program, the Section for Child Care Regulation, the Department of Social Services, and United 4 Children. The leadership team has brought together a larger stakeholder group that includes child care programs, parents, the Department of Elementary and Secondary Education, the Head Start State Collaboration Office, Title V Program staff and others. First Steps is the Part C of the Individuals with Disabilities Education Act (IDEA) program in Missouri and has been involved on the team developing the referral process to ensure that appropriate referrals are made and that children who should be in the early intervention system are included. The MMM program was piloted in 18 child care facilities from October 2019 through May 2020 and submitted monthly data. This project is being funded by the Department of Elementary and Secondary Education (DESE) Preschool Development Grant: Birth to Five (PDG). As regional hubs are established through the PDG across Missouri, MMM will be marketed and implemented in child care programs in those regions. This work is transitioning to be led by the University of Missouri, Center for Excellence in CHILD WELL-BEING. The leadership team and larger stakeholder group will remain engaged in this work to ensure a smooth transition through fiscal year 2021.

 

The Early Childhood Program Coordinator, Home Visiting Program Coordinator, MCH Epidemiologist, and Title V Director are working closely with the DESE PDG leadership team and other stakeholders on the development of an early childhood system that is family friendly and ensures every young child receives services needed. This work includes participating in activity teams working on a variety of priority areas. These include the development of an Early Childhood Integrated Data System, the development of a virtual hub for all families with children ages 0-5, and the development of regional hubs across the state. This work includes building off of the work of the Early Childhood Comprehensive System (ECCS) that has been led by DHSS for several years.

 

The MCH Services Program will support LPHA efforts to:

• provide infant and early childhood developmental and social-emotional screening services;
• provide developmental screening for children one to three years of age enrolled in LPHA home visiting programs;
• participate in preschool and pre-Kindergarten screening;
• provide direct school-health services, including developmental screening; and
• refer infants and children with potential developmental delay or failure to meet expected developmental milestones.

 

The Childhood Lead Poisoning Prevention Program (CLPPP) will support Title V strategies by actively providing information about the potential harmful cognitive and developmental effects that may occur following a child’s blood lead level elevations to:

• the general public,
• health care providers,
• LPHA and health plan lead clinical case managers,
• WIC staff,
• DESE staff, including school nurses, Parents As Teachers (PAT), Head Start, and Early Intervention/First Steps staff, and
• parents of children with elevated blood lead levels.

 

CLPPP will provide information about:

• what substances and environments are likely to be lead exposure sources,
• the need for and ways to avoid/remove/prevent a child’s exposure to  environments or substances with lead in them,
• the need for blood lead testing of children under the age of 6 years per current Centers for Disease Control and American Academy of Pediatricians recommendations,
• the recommended environmental and clinical follow up of children with elevated blood lead levels, and
• the recommended tracking of blood lead testing and extended developmental monitoring of children with elevated blood lead levels.

 

Missouri will continue to support and improve coordinated systems of care to address the needs of maternal, infant, and child populations that are at risk for or experience exposure to lead. There is a strong partnership between Missouri’s Title V Program and the CLPPP activities, which enhances the impact that the programs can make.