Child Health

The CNMI continues to focus on developmental screening as a strategy for improving child health. Parent administered screening instruments not only help healthcare workers identify potential developmental delays, but engages parents and caregivers in actively assessing developmental milestones their child may or may not be reaching. Families are increasingly engaged in conversations regarding the development of their children and becoming more aware of available community supports and specialized services available to them.

Another priority under the child health domain for the CNMI is Oral Health. A healthy mouth and teeth are an important part of child wellness and according to the American Academy of Pediatrics, tooth decay is the most common chronic children’s disease in the US. In the CNMI, 58 percent of 2nd and 6th grade public school students seen during the 2018 school year under the dental sealant program had untreated dental caries.

Priority Need: Improve child health through providing vaccinations and screening for developmental delays.

National Performance Measure 6: Percent of children, ages 9 through 35 months, who received a developmental screening using a parent completed screening tool.

Objective: By 2020, increase the percentage of children who are screened for a developmental delay by 11%.

Strategy: Implement a data system to able to capture developmental screening results, monitor screening rates, and manage referrals to needed services.

The MCH program was working in partnership with the CHCC IT Director towards implementing the Well Child Module of the CHCC Electronic Health Record as the central data system for capturing developmental screening information for children in the CNMI. However, recent developments towards a transition into a new electronic health record system has resulted in the MCH and IT department’s decision to develop a standalone system to serve as the centralized developmental screening database. Activities to support the implementation of a data system to capture developmental screening results, monitor screening rates, and manage referrals will include:

• Finalizing the scope of work and securing a contract with a vendor to develop the system
• Developing standard operating procedures and training MCH staff and partners on the use of the system

Strategy: Increase the number of clinics and early care and education settings that utilize the ASQs.

Increasing the number of sites that utilize the Ages and Stages Questionnaire developmental screening tool will improve the number of infants and young children who complete a developmental screening. The MCH program will conduct the following:

• Provide training to clinic and early care and education personnel
• Assist clinics and early care and education settings identify developmental screening workflow and standard operating procedures to support implementation
• Promote awareness of developmental screening among families and the CNMI community

 Strategy: Promote awareness of the importance of developmental screening and monitoring.

The program will utilize the Centers for Disease Control and Prevention’s (CDC) Learn the Signs. Act Early. Campaign to bring awareness to community members regarding the importance of developmental monitoring and screening. Additionally, activities for reaching developmental milestones and steps to take when there are concerns regarding development will be shared via social media, television commercials, and radio ads.

State Performance Measure 3: Percent of Children receiving routine vaccines.

Objective: By 2020, increase the percent of children ages 9 months through 35 months who received recommended vaccines by 9%.

Strategy: Increase community awareness regarding vaccines.

The MCH program will focus on promoting childhood immunizations and recommended vaccines by conducting the following awareness activities:

• Developing a commercial to be utilized on television, at the local movie theater, and on radio.
• Integrating reminders regarding vaccine schedules during the post-partum visit and WIC appointments

Priority Need: Improve Oral Health of Children and Pregnant Mothers.

National Performance Measure 13.2: Percent of children, ages 1 through 17, who had a preventive dental visit in the past year.

Objective: By 2020, increase the percentage of children ages 1 through 17 years who had a preventive dental visit by 10%.

Strategy: Increase access to preventive oral healthcare.

The MCH program will continue to work collaboratively with the CHCC Dental Clinic for improving the rates of individuals who access preventive oral healthcare. The child population ages 1 through 17 years and prenatal populations are groups of particular priority. To increase the access to preventive oral healthcare, the following activities will be conducted:

• Expand the School Dental Sealant Program to include 1st grade public school classes
• Provide oral health program outreach events on middle school and high school campuses
• Assist uninsured families with accessing Medicaid or CHCC Sliding Fee for dental care
• Partner with the Public School System to increase awareness regarding the importance and how to access preventive oral healthcare
• Educate prenatal and post-partum patients regarding the importance of preventive oral healthcare for their babies

Priority Need: Improve Insurance Status of Children and Pregnant Mothers

State Performance Measure 6: Percent of resident children, ages 0 thru 17 years, seen at any CHCC site with continuous health insurance.

Objective: By 2020, decrease the number of uninsured children by 8%.

Strategy: Increase access to Medicaid and CHCC Sliding Fee Program application assistance.

The MCH Program will continue to work with community agency partners, such as the Public School System, child care centers, and other partners to provide assistance with Medicaid or CHCC Sliding Fee Program application assistance. The CHCC Sliding Fee Program was recently revised to expand coverage to undocumented residents in the CNMI. We anticipate this recent policy change will result in positive health outcomes and support increased access to preventive healthcare. Activities related to this strategy will include:

• Provide brochures and applications for the CHCC Sliding Fee Program to Public School System and other partner agencies who serve children.
• Provide application assistance to uninsured families to the Medicaid Program or the CHCC Sliding Fee Program.

Emerging Need: Childhood Obesity

As mentioned in the Annual Needs Assessment Update section of this report, review of available data on overweight and obesity rates in the CNMI illustrates a steady increase in the number of young children and teens who are reported to be overweight or obese.

In 2018, 395 (22.89 percent) of young children ages 2 to 5 years old enrolled in the CNMI WIC program out of a total of 1,726 were reported to have Body Mass Index (BMI) levels between the 84.9 and 94.9 percentiles. This number of children enrolled in WIC identified as overweight has gradually increased since 2016, where a little over 18 percent (329 out of 1,764 children) were reported to be overweight.

In 2018, 10.25 percent (122) of a total of 1,726 children ages 2 to 5 years enrolled in WIC were reported to be obese with BMI levels at the 95th percentile or higher. The number of children enrolled in WIC identified as obese has also gradually increased since 2016 (8.45 percent).

The CNMI has also seen a steady increase in the number of teens reporting to be overweight or obese on the Youth Risk Behavior Survey (YRBS). A review of the 10-year trends on data available through the CNMI YRBS, both the number of middle school and high school students who reported to be overweight or obese had increased by almost 10 percent since 2007.

The burden of non-communicable diseases in the Northern Mariana Islands and its impact on the overall quality of life of many families in our communities in the addition to the continued rise in overweight and obesity among children demonstrates the significance for interventions and programs to address this need/issue.

To address this, programs within the Division of Public Health Services, led by the Medical Director of Public Health/MCH Epidemiologist, has initiated a partnership with the CNMI Public School System and the CNMI State Medicaid office to conduct data collection on the BMI status of elementary aged children and work on policy changes within our local food stamp program (Nutrition Assistance Program) to restrict the purchase of sugar sweetened beverages from being allowed to be purchased under food stamp benefits.

Additionally, the Title V MCH Program will work towards engaging families and parents in trainings and workshops to increase their knowledge and build capacity among families to make healthy choices around nutrition and physical activity as a strategy towards preventing and addressing obesity among children in the CNMI.