For the 2022 application year, the Bureau of Women's and Children's Health (BWCH) priorities for children’s health will focus on strengthening emotional, physical, and social services to achieve equitable and optimal development for children in Arizona. Key activities will include the early identification and treatment of developmental delays and improving access to high-quality preventive health services, including oral health services.  BWCH home visiting programs will continue to support NPM 6: Developmental Screening (percent of children, ages 9 through 35 months, who received a developmental screening using a parent-completed screening tool in the past year).  The strategies implemented will provide support and ongoing professional development of Ages & Stages Questionnaire (ASQ) trainers to ensure a trained workforce and support families involved in the home visiting program to complete a developmental screening. Additionally, BWCH home visitation program will expand strategy to build awareness of the ASQ with medical providers including FQHCs and other professionals working with children.  In an effort to coordinate and align public health with early learning systems, BWCH will continue to participate in the state-wide, inter-agency efforts to leverage all existing efforts around screening and follow up.  The purpose of this work is to align systems to ensure that each child’s needs are identified; referrals to needed services are made and completed; services are not duplicated; and the messages that families hear are clear, aligned, and consistently reinforced to ensure that children and their families thrive.

The Arizona Dental Sealant Program will continue to provide school-based dental sealant programs to high-risk children in eligible public and charter schools throughout Arizona supporting NPM 13.2: Preventive Dental Visit - Child/Adolescent. The strategies to decrease the incidence of childhood injury will include continued analysis of child death data to carry out safe sleep initiatives, child passenger safety training, and community partnerships to support Arizona’s efforts to address NPM 7.1: Injury Hospitalization - Ages 0 through 9. Planned activities for 2022 focused on Children and Youth with Special Healthcare Needs (CYSHCN) can be found in the Children with Special Health Care Needs 2022 Action Plan.

The following narrative details the strategies that will either be continued or strengthened in 2022.

Arizona's Child Fatality Review (CFR) Program contracts with 10 local review teams to provide in-depth analysis of all child fatalities occurring within the state. State appropriated funds support these contracts along with partial full-time equivalencies (FTEs) for the program manager and an administrative assistant.  CFR reviews are conducted by a multi-disciplinary group of dedicated professionals including: medical professionals, law enforcement, public health professionals, child safety specialists, behavioral specialists, and representatives from Arizona's tribal nations. Teams have been instrumental in the identification of preventable child deaths occurring throughout the state. Collected review data enables the development of prevention strategies and promotes increased public awareness. In 2022, Arizona will continue analyzing child death data while providing support and training for law enforcement agencies, medical examiners, and first responders on death scene investigation and primary prevention efforts in the recognition of unsafe sleeping environments for infants. More information on deaths due to unsafe sleep environments is covered in the Perinatal/Infant Annual Report and Application.

Arizona's early childhood home visiting programs provide support for new families to promote positive parenting and child development.  In 2022, home visiting programs will continue to implement strategies that support services for mothers, infants, and families.  In addition, continued professional development for home visitors and home visiting supervisors will be a priority.  Details for planned activities are included below.

Arizona’s Maternal, Infant, and Early Childhood Home Visiting (MIECHV), funded by HRSA, is requesting funds for federal FY 2021/2023. BWCH is requesting the ceiling award amount of $10.9 million to leverage its resources in supporting voluntary, evidence-based home visiting programs in at-risk communities and coordinating services across the early childhood system.  In addition, MIECHV will continue to carry out work under the American Rescue Plan funding allocated for home visiting programs in Arizona.  Overall, ADHS, through MIECHV formula funding, will continue to fund evidence-based home visiting programs and continue to fund a state-funded home visiting program, Health Start, as a promising approach. 

MIECHV funds will support evidence-based home visiting programs with fidelity for a caseload capacity of 1,228 families.  MIECHV funds will continue to strengthen home visiting services by using the integrated home visiting data management system (Efforts-to-Outcomes) to provide data for home visitors and home visiting programs and to aggregate statewide data to make data driven decisions. MIECHV will continue to implement evaluation and continuous quality improvement requirements and home visiting services will continue to be augmented by professional development provided through training and education, online courses, regular informative e-newsletters, and an annual conference.

MIECHV will continue to support Title V National Performance measures and state priorities including:  

• Title V priority need to reduce infant mortality and morbidity and NPM 4: Breastfeeding (A. percent of infants who are ever breastfeed and B. percent of infant’s breastfeed exclusively through 6 months) through ongoing training and support for home visitors to become IBCLC certified or receive in-depth breastfeeding education and training.
• Title V state priority need to increase early identification and treatment of developmental delays and NPM 6: Developmental Screening (percent of children, ages 9 through 35 months, who received a developmental screening by using a parent-completed screening tool in the past year) through ongoing professional development of Ages & Stages Questionnaire trainers to ensure a trained workforce and support home visiting families to complete a developmental screening.

Arizona MIECHV will coordinate the use of the American Rescue Plan award to provide resources and supplies for families funded through MIECHV as outlined by HRSA, including: 1) Home Visiting service delivery, 2) Hazard pay or other staff costs, 3) Home visitor training, 4) Technology, 5) Emergency supplies (i.e., food and infant formula), 6) Diaper bank coordination, and 7) Prepaid grocery cards.

The Health Start Program will continue to support ESMs within this domain (e.g., percentage of children receiving an ASQ within 1 year of program enrollment; proportion of new home visitors trained to provide ASQ within 6 months of hire).  Health Start will continue to provide developmental screening for children ages 10-17 months to increase early identification and treatment of developmental delays.  In 2022, Health Start will continue to evaluate the Health Start Promising Approach program in accordance with the Office of Planning, Research and Evaluation (OPRE)- and HRSA-approved evaluation plan.  MIECHV will continue to fund five promising approach home visiting program sites that will support Health Start becoming an evidence-based model. In FY 2022, Health Start will continue to provide home visitation services and provide enhanced education, brief intervention, and referrals to treatment for mothers and families who use alcohol, tobacco, and/or other drugs to assist with decreasing the substance use crisis. Full details and planned activities for the Health Start program can be found in the Women’s Health 2022 Application.

High Risk Perinatal Program (HRPP) planned activities for 2022 can be found in the Perinatal/Infant Health 2022 Application.

MIECHV, Health Start, and HRPP home visiting programs will continue to offer virtual and in-person home visitation.  Programs will use the guidance released by ADHS Home Visiting Workgroup in 2021, COVID-19 CONSIDERATIONS: CHECKLIST AND GUIDELINES FOR RETURNING TO IN-PERSON HOME VISITS (see Appendix L). The guidance recommends that contractors continue to implement home visiting programs as outlined in program guidelines, following model developer guidance, with fidelity.  Furthermore, the guidance provides information and a checklist to assist home visiting programs in making decisions regarding resuming in-person home visits during the COVID-19 pandemic.  Each of the home visiting models successfully adjusted home visits to continue reaching families via alternative methods, such as telehealth visits or phone calls, to ensure that families continue to receive the services they need at the same high-quality level that they would receive in home. In 2022, MIECHV, Health Start, and HRPP home visiting programs will continue to monitor the impacts of COVID-19 and work collaboratively with federal and state partners, contractors and subcontractors to support telehealth home visits and monitor emerging trends to provide quality home visiting services.

Additionally, MIECHV, Health Start, and HRPP home visiting programs will continue to provide home visits to those communities that experience the highest-level of disparities.  The BWCH Home Visiting workgroup will continue to meet to ensure communities of highest need, including rural and tribal communities, have access to home visiting services through BWCH home visiting.  Lastly, ADHS home visiting programs will provide ongoing opportunities to support home visitors in the area of developmental screening through training and capacity building.

In 2022, the Office of Injury and Violence Prevention (OIP), in ADHS’s Bureau of Chronic Disease and Health Promotion, will continue to provide support to the five local Safe Kids coalitions that are located around the state. Additionally, OIP serves as the liaison between the Safe Kid Worldwide and the local coalitions.  Each coalition works to help families and communities keep kids safe from unintentional injuries, including but not limited to reducing traffic injuries, drownings, falls, burns, poisoning and more.  OIP will provide Child Passenger Safety training to certify people to become car seat technicians around the state, with a focus on rural and tribal communities. The program is exploring ways to develop this training virtually.  A component of this includes identifying participants during the training to build local child passenger safety instructor capacity. In 2022, BWCH and OIP will utilize Title V MCH Block Grant funding to purchase educational materials for child passenger safety as well as car seats to be distributed through our partners at the local health departments, community partners, Indian Health Services, tribal community partners, home visitors, Health Start and/or Safe Kids coalitions. In 2022, OIP will continue to support safe sleep by providing access to resources and educational materials to families (i.e., Pack ‘n Play bassinet/playpen) to be distributed through our partners. Additionally, OIP continues to chair the Safe Sleep Task force, with quarterly meetings being held.  Our partners again include the local health departments, community partners, Indian Health Services, tribal community partners, home visitors, Health Start, birthing hospitals and/or Safe Kids coalitions. Injury prevention efforts will also include updating home-safety and environmental checklists to address falls, drowning, sun safety, and accidental injury.  Arizona will explore the opportunity to create kits to be provided to families through the home visitation programs and other community partners working with children.  Overall, strategies will align with data and prevention recommendations as outlined in the Arizona Child Fatality Review Program annual report. 

In 2022, local county health departments will continue to receive Title V funding through the MCH Healthy Arizona Families IGA (MCH HAF IGA) to work on a number of strategies and activities to improve children’s health and wellbeing, including but not limited to: promotion of safe sleep environments, interventions aimed at reducing motor vehicle and common household injuries, promotion of physical activity, etc. The MCH HAF IGA Program Manager will participate in the Safe Sleep Task Force, the BWCH Home Visiting Work Group, and other groups as required to ensure that there is coordination between MCH HAF IGA activities and other Title V-funded activities implemented through the local county health departments. More information on the MCH HAF IGA can be found in the Cross-Cutting domain of this application.

The Office of Oral Health (OOH) will continue to implement programs to address primary prevention strategies to address NPM 13.2: Preventive Dental Visit - Child/Adolescent.  Planned activities for 2022 can be found in the Cross-Cutting domain of the report.

Adverse childhood experiences (ACEs), stressful or traumatic events that occur during a child’s key development stages, may have long-lasting and negative impacts on a person’s health and well-being. Unfortunately, data shows that children in Arizona experience a higher frequency and number of ACEs compared to children in other states. For this reason, in 2022 ADHS will work to increase surveillance and understanding of ACEs in Arizona and expand programming to prevent ACEs and support individual and family resilience in the face of adverse events.

BWCH will continue to co-sponsoring questions related to ACEs in the Behavioral Risk Factor Surveillance Survey (BRFSS), as we have done since 2012, to support internal and external stakeholders working on children's health initiatives. Additionally, BWCH will continue to participate in the Governor’s Goal Council, ACEs Action Plan, to support the following goals: 1) Reduce the number of ACEs that Arizona children are exposed to; 2) Characterize the data that leads to Arizona having the highest percentage of children exposed to ACEs; and 3) Mitigate the number of adverse health outcomes that are associated with ACE exposure. In addition, BWCH will continue participating in the state-wide Arizona ACE Consortium; dedicated to promoting ideas, policies, and practices that reduce and prevent childhood adversity and build resilience in individuals, families, and communities.

BWCH will ensure ongoing partnership and participation on the Arizona Collective Impact for Child Safety and Well Being workgroup.  This group represents a collective of key decision makers representing key organizations spanning Arizona’s child well-being and family health services network. The Collective Impact group meets regularly to discuss ongoing initiatives and programs dedicated to advancing the surveillance and prevention of ACEs in Arizona, and has representation from several of Arizona’s most active ACEs prevention groups. The group is made up of a core team and two priority Action Teams. The Core team includes: Governor’s Office for Youth, Faith and Families, Department of Child Safety, Department of Economic Security, Casey Family Programs, Prevent Child Abuse AZ,  ASU Morrison Insititute of Public Policy, Piper Family Trust, First Things First, Jewish Family Community Services, and Pima County Court. The two priority Action Teams focus on Family Navigation and Home Visitation.  Each group is composed of organizations and state agency program staff.  The Inter Agency Leadership Team, under MIECHV funding, serves as the Home Visitation Action Team.

In 2022, BWCH will continue to partner with First Things First (FTF)—Arizona’s critical partner in creating a family-centered, comprehensive, collaborative, and high-quality early childhood system that supports the development, health, and early education of all Arizona's children from birth through age five—on state-wide initiatives including the Zero-To-Three Building Strong Families Initiative. 

In 2022, BWCH will continue to partner with the Bureau of Nutrition and Physical Activity (BNPA) on initiatives that support the health and wellness of children. BNPA participates as an exhibitor and presenter at the annual Strong Families Home Visiting Conference, as well as many other early childhood events and conferences.  In addition, BWCH will continue its participation with the Empower Advisory Committee (EAC) and the State Nutrition Action Committee (SNAC).

Empower is a set of 10 standards designed to promote nutrition, health, and wellness in Arizona child care facilities. ADHS-licensed facilities participating in the Empower Program pledge to adopt 10 standards that support healthy eating, breastfeeding, encouraging active play, preventing exposure to second-and third-hand smoke, practicing sun safety, and promoting good oral health habits in exchange for a 50% reduction in licensing fees.

The Empower Advisory Committee includes both internal and external partners from state agencies that are aligned with the work of Empower.  Its purpose is to advise the program and to help develop common and consistent messaging to early care and education (ECE) providers.  The Empower Advisory Committee uses a systems-building approach and is a collaborative effort with partners and supporters throughout the state.  Internal partners include staff from ADHS’ Bureau of Women’s and Children’s Health (i.e., Sensory Screening Program, Home Visiting Programs, CYSHCN Program, Oral Health), the Bureau of Nutrition and Physical Activity (i.e., WIC Program, Early Care and Education, AZ Health Zone), Bureau of Chronic Disease and Health Promotion (Tobacco), Division of Licensing (Child Care Licensing), Office of Epidemiology & Disease Control (SunWise Skin Cancer Prevention, Smoke-free AZ) and others. External partners are drawn from other state agencies that are aligned with the work of Empower, such as: Arizona Department of Education (Child and Adult Care Food Program [CACFP], Early Care and Education), Department of Economic Security (Arizona Early Intervention Program [AzEIP], Child Care Administration) and First Things First.

In 2022, EAC activities will continue to focus on reviewing Empower standards and components, comparing them to licensing rules and best practices, and developing and finalizing recommendations for updating them.

The mission of the Arizona State Nutrition Action Committee (SNAC) is to strategically align nutrition and physical activity efforts across programs to ensure that Arizonans have access to resources that support increased knowledge and cultivate the environment to live a healthy lifestyle.  This will be done by forming workgroups around increased access to food and nutrition, providing nutrition education to support increased knowledge in the community, and implementing policy, systems, and environmental (PSE) changes to support health promoting behaviors.

The Arizona Partnership for Immunization (TAPI) will continue to promote immunizations statewide in partnership with BWCH. Using their 400 members representing over 200 organizations, TAPI will distribute educational pieces to schools, child care facilities, private providers, county health departments, community health centers, managed care organizations and Women, Infants, and Children (WIC) Program sites.

TAPI will further promote usage by parents and professionals of the TAPI website: www.whyimmunize.org. The TAPI Facebook page has become a resource for hundreds of Arizonans and TAPI will continue to expand the information shared and the number of times information is read. TAPI's tweets on Twitter will be viewed 12,000-15,000 times. Content will leverage public interest in the COVID-19 vaccine to include education to minimize exemptions, parent and doctor relationships, CDC updates, back-to-school information about vaccinations, Tdap, the pneumococcal vaccine recommendations, and flu season vaccinations. TAPI will provide information to the media routinely on vaccine funding and appropriate referrals as well as in-depth stories.  TAPI will use appropriate subject matter experts and conduct media training through a speaker's bureau. TAPI will continue to provide provider education through annual best practice training and the AzAAP weekly emailed update. TAPI will work with agencies on vaccine equity and provide support with vaccine education and with the International Infection Prevention Week (IIPW) to raise awareness of the role infection prevention plays.  Continuation of human papillomavirus (HPV) vaccine education is planned through both the dental partnerships and collaborations of HPV-related research and educational grant agencies.

TAPI will continue to develop materials and programs for pregnant moms who are questioning vaccine safety that highlight healthy pregnancy and early childhood and lists recommended vaccines at every stage of development to providers statewide. Emphasis will continue for the appropriate coverage of infants and children with continued expansion in young adults “Off to College,” receiving oral cancer screenings and systemic support for increased pregnant women and adult immunization.

As a result of the COVID-19 outbreak, TAPI will help get public health outbreak guidance to primary care offices, including health alerts and how to manage immunizations for infants and vaccine inventory.  TAPI will be ready to assist offices with best practices to host nurse-only immunization clinics, use of catch-up schedules, and how to prevent vaccine preventable disease outbreaks after system disruption.

The Office of Children’s Health (OCH) will promote the importance of childhood immunizations by using Health and Human Services (HHS) social media messages and graphics from the “Catch-up to Get Ahead” Toolkit. Information will be shared with BWCH home visiting programs.  The “Catch-up to Get Ahead” messages and toolkits will be posted on the OCH web pages. Messages and resources shared will focus on the vaccine schedule for children (ages 0-12), while the Adolescent Health program will focus on the vaccine schedule for teens. Furthermore, OCH will continue to promote the American Academy of Pediatrics campaign to help get patients and families Back to the Office during the pandemic. Resources aim to reach parents with reminders that going to the pediatrician, even during COVID-19, is important and safe.

The OCH will continue to explore the opportunity to revise and enhance the Children’s Information Helpline, which is one of the three areas covered by the Arizona Title V toll-free helplines for pregnant women, infants, and children. The goal is to continue to partner with MIECHV to enhance the line to include a state-wide referral for home visitation programs. The line will be renamed to Strong Families AZ Helpline and will continue to provide information and assistance to pregnant women and children. The helpline will continue to provide families with  information and resources about immunizations, car seats, health information, and other health services available for women and children, including youth under the age of 21 with special health care needs. In addition, the Strong Families AZ Helpline will provide home visiting referrals to families and professionals seeking services for families. The customer service representative will provide a warm hand-off, connecting the family directly to the home visiting program and/or the already established coordinated referral center in the desired service area.  BWCH will continue to partner with the Bureau of Nutrition and Physical Activity to operate the Breastfeeding and Women, Infant, and Children Helplines. 

The ADHS Sensory Screening Program will continue to manage and oversee the hearing and vision screening for children in the State of Arizona. Hearing and vision screening statutes legislatively mandate the administration of screenings and referrals to children enrolled in educational programs. The mandates require that a systematic program for hearing and vision screenings be made available to children in order to allow early identification and appropriate intervention. The program will continue to implement the mandates for hearing and vision screening for preschool through high school-aged children by providing hearing and vision loaner equipment, training of hearing and vision trainers and screenings, and revision and issuance of hearing and vision rules and program guidelines. Areas of focus will include; creation of program policy and procedures, curriculum updates and training guides, selection of a statewide training vendor through an RFGA process and continued support of statewide access to hearing and vision screening equipment for Arizona screeners.

In 2022, BWCH will continue to fund and contract with the Arizona Chapter of the Academy of Pediatrics (AzAAP) to support Pediatric Prepared Emergency Care (PPEC) services. The objective of this work is to support and expand a well-established pediatric emergency preparedness certification system to effectively deliver pediatric emergency care across the state. In 2022, AzAAP will continue to certify and recertify PPEC hospitals and provide a publicly available, up-to-date register of hospital emergency departments who are certified: https://azaap.org/ppec. They will provide support and coordination to tribal and critical access hospitals (CAHs) seeking membership and certification in the program.

AzAAP will also provide continuing medical education opportunities for physicians, nurses, and other health care professionals in Pediatric Prepared Emergency Care (e.g., Certified Emergency Nurse [CEN] Course, Certified Pediatric Emergency Nurse [CPEN] Course, Emergency Nursing Pediatric Course [ENPC]). In 2022, AzAAP will complete a needs assessment of Continuing Medical Education (CME) needs for physicians and mid-level providers. The program will continue to use virtual platforms to advance its aims as the needs of member hospitals require.

BWCH will continue to partner with the Emergency Medical Services for Children (EMSC) Program, housed in the Bureau of Emergency Medical Services & Trauma System with ADHS’s Division of Preparedness. The Title V Block Grant Coordinator and Family Engagement Specialist will continue to participate in the Pediatric Advisory Council for Emergency Services (PACES) meetings. The EMSC Program Manager will continue to provide a technical review of AzAAP reporting.

In 2022, COVID-19 pandemic recovery efforts will focus on improved child health and well-being.  The Office of Children’s Health (OCH) will continue to monitor the impacts on children as a result of the interruption and return to schooling, social and emotional well-being, well-child visits, family functioning, and overall  social determinants of health. Areas of focus will include: Leverage existing partnerships and resources to support child/family care for communities in need; Create and provide resources that improve awareness of, and address, the impact of social isolation and loneliness on family health and building social connections; Support the Arizona Department of Education "ready for school" campaign to get students excited and welcome them back to in-person instruction; Share statewide AZ TAPI Immunization efforts with providers and partners; Support coordinated efforts of child safety and well-being highlighting protective factors and promote the Lean on Me AZ report and toolkit; Continued efforts to promote Strong Families AZ, Arizona’s home visiting alliance supporting home visiting as a key link to early childhood intervention, community supports such as health care, mental health, early care and education and services that promote child development and healthy child-parent interaction; and Increase community awareness on available tax resources (i.e. tax credits such as the Child Care Credit, Child Tax Credit) and other resources established to address poverty and social inequity.  The OCH will work to incorporate these strategies within all population health domains that focus on children of all ages, including, perinatal/infant, adolescent, and children and youth with special healthcare needs.  The OCH will work with family advisors to create, review, and provide feedback on information and resources that are developed.  All information will be accessible online and translated as needed.