CHILD HEALTH DOMAIN

Nebraska Application for the 2019-2020 Year

 

In this section, Nebraska MCH Title V describes activities of the upcoming year, October 1, 2019 to September 30, 2020 for the Child Health Domain.  Also discussed is the relevance of the activities and ESMs to priorities, as well as any updates in the priorities, evidence-based or evidence informed strategies, and performance measures. The numerical sequence of headings used below references the new narrative format found on pages 35-36 of the Title V MCH Services Block Grant to States Program: Guidance and Forms for the Title V Application/Annual Report, Eighth Edition.

The Nebraska Priorities in the Child Health Domain are:

• Unintentional injury among children and youth, including motor vehicle crashes.

NPM: Rate of hospitalization for non-fatal injury per 100,000 children ages 0-9 years.

ESM: The percentage of school districts participating in a child safety seat awareness campaign.

• Access to preventive and early intervention mental health services for children.

SPM: Percent of children, ages 9 – 35 months, who received a developmental screening using a parent-completed screening tool in the past year.

ESM: none

• Obesity/overweight among women, youth, and children, including food insecurity and physical inactivity.

NPM: Percent of children, ages 6 to 12 years, who are physically active at least 60 min. per day.

ESM: Continuation of the “School Health Data Project” plan to collect BMI and other school health data.

 

For the Child Health Domain in 2019-2020, there are no changes in the population priority statements, or the selected NPMs and SPM respectively, compared to the previous program year.  Nebraska does propose removing an ESM in the unintentional injury priority, to increase the percentage of schools participating in a child safety seat campaign.  The school health data project provides a more intentional area for measurement.  2019-2020 marks the second program year the priority of overweight and obesity among children is stated in this population domain.  As a result, until that time, the priority was not assigned an NPM, SPM, or ESM in the Child Health Domain. 

 

1. Description of Planned Activities

Working in the child health population domain, Title V has an exceptionally strong asset in the School Health Program, and the state school nurse consultant.  Funded for many years with Title V funds, the School Health Program and the series of school nurse experts staffing the program, have established Title V as a credible, reliable, expert presence in school and child health in Nebraska.  The strategies of the 2019-2020 action plan leverage this asset more strongly than ever before.  In the priority of injury prevention, a strong partnership between the Title V School Health Program and the Nebraska Injury Prevention Program enhances the flow of information for parent audiences about correct child safety seat use.  In the priority of access to preventive and early intervention mental health services for children, the strategies proposed build on a school survey of 2018-2019 regarding referrals for students with mental and behavioral health services, with the School Health Program leading an effort to convene a collaborative and diverse workgroup to develop and deliver education for school nurses and other school personnel on considerations for students identified at school as having possible mental and behavioral health issues.  This activity is intended to deepen understanding about the extent schools consider or advise parents on:

• whether there may be unmet physical, dental, or vision needs resulting in undesired behaviors;
• whether the child is covered by health insurance;
• by what method has the child been screened, if at all, using a reliable instrument appropriate for age, language, and culture; and
• whether the child is referred by the school to a medical home or behavioral health provider.  

 

As discussed elsewhere in this Application/Annual Report, Nebraska has faced challenges in devising effective approaches to address a very large “meta” priority:  “Reducing overweight and obesity among women of childbearing age, children and youth, including food insecurity and physical activity.”  Fortunately, one of the most solid and available arenas Title V has access to when it comes to physical activity and nutrition environments of children is in schools, and the federally-mandated School Wellness Policies.  In addition, Title V has established a unique and important contribution to understanding of child obesity and overweight in Nebraska through the School Health Data Project.  In 2019-2020, Nebraska will conduct the fourth iteration of the BMI data project on students in grades 1, 4, 7, and 10 in public schools, which has occurred every three years since 2010, providing a basis for evaluating the School Health Data Project overall.  Using the BMI data reports since 2010, Title V will be seeking to describe impact or meaningful use of the data among partners and stakeholders, thereby informing implementation of strategies or activities that will lead to meaningful change in the indicator.

 

Consumer Engagement in this domain:

Opportunities for consumer engagement in this domain area an area for improvement. Consumers in this domain include not only families, but the school nurses that are key to communicating with families, and the organizations and partners that together make up comprehensive and integrated systems of care to serve families.  Work continues to identify opportunities for active engagement of school nurses in program activities, from the stage of development to evaluation.

 

Striking success in engagement also is occurring.  Under the leadership of the N-MIECHV program manager, who has taken responsibility on behalf of Title V for convening the state-level cross-systems advisory committee for the Pediatric Mental Health Care Access program, engagement has taken a new form.  Rising to the challenge and the commitment to include families at every level of project work, the advisory committee lead, Jennifer Auman, has created a setting where meetings begin with the reading of short family case study, and discussion from the group on understanding the gaps between family needs and system solutions, conducted with respect and compassion.

 

The Power of Collaborative Partnerships:

Nebraska Title V MCH staff sustain participation in numerous relationships and collaborations significant to this population domain and related priorities.  In 2018-2019, Nebraska was awarded a Childhood Lead Poisoning Prevention Program grant from the Centers of Disease Control and Prevention, and Title V has participated in a state-level advisory committee as well as informal consultation with epidemiology staff responsible for grant activities statewide.

 

Title V are involved in many collaborative efforts around early childhood outcomes.  This includes participating in on-going state-level partnerships including an Early Childhood Workforce Development group sponsored by the Buffett Institute, a Preschool Development Grant Learning Begins at Birth group and planning committee, the cross-sector, comprehensive and coordinated early childhood mental health group, Rooted in Relationships, sponsored by the Nebraska Children and Families Foundation, and the Early Childhood Integrated Data System workgroup seeking to create a longitudinal data set describing children and their health and education outcomes in Nebraska. Title V participates in the Behavioral Health System of Care effort in Nebraska as well, as a presence and voice for including prevention, early identification, and early intervention activities in the tapestry of services for families with children with serious emotional disturbances.

 

In 2018-2019, many of these relationships came together in support of Nebraska Title V’s lead role in a successful application for the Pediatric Mental Health Care Access (PMHCA) program.  Not only has Nebraska taken a significantly inclusive and cross-systems approach to developing the grant, but Nebraska’s project is characterized by a very engaged project advisory committee that includes strong family voices.

 

Priority: Reduce Unintentional Injury among Children and Youth

 

Objective C7a: Increase by 10% booster seat use by parents for children aged 5-12 years.

Summary of Proposed Strategies:  Title V will collaborate with the Injury Prevention Program and N-MIECHV to monitor activities of qualified child safety seat technicians in N-MIECHV local implementing agencies on a quarterly basis.

 

Objective C7b: Increase by 10% the percentage of NE elementary schools participating in safe motor vehicle education for parents.

Summary of Proposed Strategies: The School Health Program will partner with the NE Injury Prevention/Safe Kids program to disseminate education to school personnel for parents about safe motor vehicle and safety seat practices, using channels such as newsletters, outreach activities, and wellness plans; and follow up to measure utilization of those materials by schools. 

 

Discussion of Activities for this Priority

Injury prevention activities have grown a stronger partnership between the Title V MCH program and the Nebraska Injury Prevention program, with the Injury Prevention Program providing leadership and the School Health Program providing the communication channel to reach school nurses and amplify the efforts of the Injury Prevention Program.  In 2018-2019, efforts to grow this relationship into more active engagement of school nurses in injury prevention activities in their local schools and communities did not come to fruition.  In 2019-2020, the School Health Program will continue to provide the communication channel for the Injury Prevention Program to reach school nurses, AND conduct a sample audit of school nurses to determine the extent to which school nurses state they use or share the injury prevention information received.  Obtaining this data will assist Title V staff in determining the best method of providing information to school nurses that will yield results.

 

Results-based Accountability (RBA) for this Priority

With the exception of contributing literacy review and assisting with translations of existing materials, the RBA measures proposed for 2018-2019 have not been well-aligned with activities. In 2019-2020, more accurate RBA measures are needed, while still capturing innovation (N-MIECHV home visitors as car safety seat technicians in their communities; use of the Nebraska School Nurse listserv); the commitment to more routinely look for, promote, and provide translated materials; and the responsibility to measure impact or at least uptake and utilization.  The School Health Program enhances the capacity of injury prevention by using effective communication channels with school nurses statewide.  In 2019-2020 it is feasible to follow up with the school nurse audience on uptake and utilization of the materials as a small-scale evaluation activity. 

 

Results Based Accountability (RBA) measures Reduce Unintentional Injury Among Children
	2018-2019	Proposed for 2019-2020
How much did we do?	How many PDSA cycles (tests) were used to invite input in the injury prevention activities?	How many N-MIECHV home visitors were newly trained as car safety seat technicians.
How well did we do it?	How many partners participated in the injury prevention small group projects?     Among partners and participants in child injury prevention activities, how many (%) represented consumers, families, and/or minorities including persons with disabilities?    Number and % of materials on child injury prevention produced/disseminated meeting CLAS and literacy standards.	How many materials/messages on injury prevention circulated to school nurses by Title V School Health Program.    How many materials included non-English translations when distributed to school nurses.
Is anyone better off?	Number and % of school partners providing positive feedback about the quality and impact of the activity.	At six months into the school year, at least 50% school nurses responding state they shared the injury prevention materials in their schools in some form intended to reach parents.

 

Priority: Access to preventive and early intervention mental health services for children.

 

Objective C8a: By 2020 increase by 10% the utilization of behavioral health services using tele-behavioral health by Medicaid-enrolled children.

Summary of Proposed Strategies: Title V and N-MIECHV collaborate with the Pediatric Mental Health Care Access project to expand the availability and utilization of tele-behavioral health services serving children and youth.

 

Objective C8b: By 2020, increase by 10% the percentage of children ages 0-5 years screened in a medical home practice.

Summary of Proposed Strategies: Title V and N-MIECHV continue participation in the Behavioral Health System of Care to promote inclusion of preventive and early intervention early childhood mental health services. Title V, N-MIECHV, and the Pediatric Medical Health Care Access project advisory committee collaborate to enhance the frequency that children with and without special health care needs are screened appropriately and regularly in clinic and community settings, using valid and appropriate instruments. Using data gathered from the CMS Affinity Group school survey conducted in 2018, the School Health Program will target areas in the state where respondents indicated a low rate of working with community partners to facilitate mental and behavioral health referrals for students.  Education for school nurses will include the need to make community linkages as well as identify appropriate resources within a 25 mile range of the school service area.  Additionally, education will include the need to enquire about whether students have health insurance and whether all vision, dental, and other medical needs have been met.  The School Health Data Project will include a survey of school nurses and special education directors on the extent to which students are screened for mental/behavioral health concerns in grades 1, 4, 7 and 10 using any of a selection of validated and appropriate screening tools as identified by the Pediatric Mental Health Care Access project, as well as the extent to which school staff make referrals to local clinics for additional screening.

 

Discussion of Activities for this Priority

Title V is committed to ongoing participation in Nebraska’s Behavioral Health System of Care, in an effort to include prevention, early identification, and early intervention activities in the tapestry of services and systems for families with children who have behavioral health needs, whether the child is diagnosed with serious emotional disturbance or not.

 

The remainder of strategies in this priority focus more specifically on screening and referrals for children with mental and behavioral health issues.  The School Health Program conducted a survey of schools in 2018-2019 on approaches for making referrals for children with mental or behavioral health issues.  The survey results yielded great insights into some of the processes in schools. The strategies proposed for 2019-2020 are intended to provide education to schools and school nurses on considerations in making effective referrals.  Another action area is to repeat the school survey with specific inquiries about methods of identifying students who are in need of screening and referrals.  Are schools using accurate and valid screening tools, appropriate for each student’s age, language, and culture, or are schools making referrals on the basis of observed behavior alone? Are schools communicating the need for screening or for treatment when referrals are made to community providers?  The School Health Program will collaborate with the Pediatric Mental Health Care Access project to conduct the strategies in 2019-2020, with the intent that results will be broadly significant to a mix of stakeholders and partners.  The report of the first school survey on referrals for mental and behavioral health services is available here: http://dhhs.ne.gov/Documents/Nebraska%20CMS%20School%20Health%20Affinity%20Group%20Report%20of%20School%20Survey.pdf.

 

Results-based Accountability (RBA) for this Priority

Reflecting a trend in the team use of RBA measures in Title V, in 2019-2020 the RBA measures for this priority reduce from five to four.  Title V leadership in Nebraska’s Pediatric Mental Health Care Access Program means the significance of convening cross-sector advisory committees and technical workgroups is powerful.  The remainder of the RBA measures reflect ongoing work in Nebraska Title V to be more inclusive of stakeholders and partners; and assure strategies that include working with school nurses also include measurement of impact or at least uptake and utilization.

 

Results Based Accountability (RBA) measures Access to preventive and early intervention mental health services for children
	2018-2019	Proposed for 2019-2020
How much did we do?	How many Early Childhood systems building activities attended by JA (ECICC, RinR, Sixpence, Buffett, BH SOC, CMS Affinity group)   How many entities represented on map of tele-BH services.	How many PMHCA cross-sector advisory committees convened.    How many schools were represented in survey on screening methods and referrals.
How well did we do it?	Number of consumers and partners providing input on the tele-behavioral health mapping project.   Number and % of materials related to telehealth meeting CLAS and literacy standards.	How many school nurses participated in planning education on mental/behavioral health referrals for students.
Is anyone better off?	Number and % of consumers and partners providing positive feedback from map project dissemination.	80% or more school nurses participating in education on mental and behavioral health screening and referral give an example of how practice will change in program evaluations.

 

Priority: Obesity/overweight among children, including food insecurity and physical inactivity

 

Objective C9a: By 2020, increase community engagement on built environments and school-based physical activity opportunities to support healthy and active living for adolescents.

Summary of Proposed Strategies: The School Health Program will collaborate with the Nebraska Department of Education and other cross-sector partners to enhance implementation and effectiveness of School Wellness Plans. The School Health Program will update and implement a strategic plan for the School Health Data Project, which includes gathering statewide data on student height and weight in grades 1, 4, 7, and 10 every three years.

 

Discussion of Activities for this Priority

As noted, this very broad priority statement has been difficult to translate into focused, sustained impact.  What originally seemed destined to be a community-level, “place matters” project on healthy environments has diverted (through community input) to become a lead poisoning prevention project.  The participation of the School Health Program staff in collaborative efforts to improve implementation of federally-mandated School Wellness Policies seems to be the most solid effort yet, complemented by the unique contribution of the School Health Data Project to measurement of child height and weight at school, with resulting statewide reports produced every three years.  The period 2019-2020 will mark the fourth iteration of the BMI report.

 

Results-based Accountability (RBA) for this Priority

In 2019-2020 a small set of RBAs for this priority in child health domain focuses on state-level activities coordinated by the Nebraska Department of Education to increase implementation of School Wellness Policies in Nebraska.  The Title V State School Nurse Consultant provides valued credibility as well as communication integrity to the cross-sector collaborative project.  An annual School Health Data Project in the Title V School Health program surveys schools for measures on child health conditions and screening.  In the 2019-2020, the School Health Data Project will repeat an every three year cycle to collect BMI data on Nebraska students in grades 1-4-7-10.

 

Results Based Accountability (RBA) measures Obesity/overweight among children, including food insecurity and physical inactivity
	2018-2019	Proposed for 2019-2020
How much did we do?	How many School Wellness Policies activities attended by CT.	How many School Wellness Policy activities attended.
How well did we do it?	The School Health Data Project strategic plan is completed. How many cross-sector partners were involved in the development of the School Health Data Project strategic plan.	How many students participated in the 2019-2020 data project on BMI.    Race/ethnicity data in the school health data project is presented as required data.
Is anyone better off?	The School Health Data Project strategic plan is disseminated.	The School Health Data Project is evaluated for impact and meaningful use of data.

 

2. Alignment of Planned Activities with priority needs

 

Priority: Reduce Unintentional Injury among Children and Youth

Key activities planned for this priority seek to leverage opportunities Title V has to access two significant populations in Nebraska: through the Title V School Health Program reach to all schools in the state, and through the close relationship between Title V and N-MIECHV.  Activities are aligned with the priority need to reduce unintentional injury among children, and are led by the DHHS Injury Prevention Program, with Title V as amplifier and collaborator.  An improvement in activities for 2019-2020 is an effort to evaluate the collaboration for impact and meaningful use of the resources and materials channeled to partners.

 

Priority: Access to preventive and early intervention mental health services for children.

Activities in this priority area are aligned with the priority need of improving access to preventive and early intervention mental health services, and represent the nuanced and finely-tuned perspective Title V brings to the Pediatric Mental Health Care Access program in Nebraska.  The activities build on previous, significant work in Nebraska, by relating to the Behavioral Health System of Care, and Nebraska’s participation in 2017-2018 in the CMS School Health Affinity Group, a cross-sector collaboration initiated by DHHS Medicaid. In the course of this collaboration, Title V was positioned to consider access from the viewpoint of screening and referrals that originate with schools, when behavior or mental health issues of students become apparent and cause concern. This work led to enlightening findings about the extent to which schools work with community behavioral health resources, and also the extent to which school personnel inquire whether, when behavior is an issue, the child has been recently evaluated for medical, dental, and/or vision issues, and whether the child is covered by health insurance.  In addition to the need for education for school personnel on making referrals for behavior and mental health issues, the initial study has raised questions about when schools refer, has the child actually been screened, or is evaluation still needed.  What understanding do parents have as to whether the child is recommended to be seen by a primary care, or behavioral health, provider? 

 

The strategies proposed in this priority area for 2019-2020 are strongly aligned with the priority and take a strong systems approach to problem-solving access issues.

 

Priority: Obesity/overweight among children, including food insecurity and physical inactivity

The proposed strategies in this population domain for 2019-2020 reflect the capacity of Nebraska Title V to work collaboratively with partners, and to bring data to collaborations in support of data-driven decision-making.  The School Health Program Manager participates in cross-systems work led by the Nebraska Department of Education to advance implementation of School Wellness Plans in Nebraska Schools.  The combination of federal mandate (for schools participating in the school breakfast and lunch program to have School Wellness Programs); and the Title V School Health Data Project and production of reports on BMI among Nebraska school students in grades 1, 4, 7, and 10 have produced an effective role for Title V to address childhood obesity. 

 

3. Emerging, or Influential New Priorities

 

The newly passed Families First Prevention Services Act (FFPSA) has presented an opportunity for Title V to enhance the existing partnership with colleagues in the child welfare area within the Division of Children and Family Services; as well as to implement new modifications to the Home Visiting model used by the Maternal, Infant, Early Childhood Home Visiting (MIECHV) program in Nebraska.  FFPSA allows certain services related to prevention of child abuse and neglect to be reimbursed by federal funds, which has led to a pilot project for Nebraska to implement the Child Welfare Adaptation of Health Families America in two communities across the state, one rural and one urban.  The rural site, Panhandle Public Health Department (PPHD) is at time of this writing moving ahead with increasing staff, facilitating training, entering into agreements, and solidifying relationships with the local child welfare agency to begin receiving referrals of appropriate families.  The urban site, Lincoln Lancaster County Health Department (LLCHD) has invested time and energy into preparations for the pilot project, but at time of this writing has been put on hold as other uncertainties unrelated to the project are navigated through (including, but not limited to a new mayor and a new health department Director).  Title V is excited and passionate about the opportunity to move further into the prevention space around child neglect and abuse, and to assist state and local partners with the resources needed to assist families at risk.

 

New in 2018 in Nebraska is a CDC grant (CDC-RFA-DP18-1801), for Improving Student Health and Academic Achievement through Nutrition, Physical Activity and the Management of Chronic Conditions in Schools. The Title V School Health Program is a collaborative partner, however, DHHS is not the grant awardee.  The Nebraska Department of Education was the successful applicant and, upon award, entered into a subaward relationship with the new Center for Child and Community that is part of Children’s Hospital in Omaha.  Based in Lincoln, the Center for Child and Community has hired a school health coordinator, a Registered Nurse formerly with Nebraska Medicaid.  Eight schools have been recruited to participate in multi-year grant activities to improve implementation of School Wellness Policies and implement case management activities for children with chronic health conditions in school.

 

Transformation in the Title V School Health Program:  The Nebraska School Health Program has been supported for many years by Title V, in the position of the School Health Program Manager who is also designated Nebraska’s State School Nurse Consultant.  This programmatic asset and source of professional expertise has benefitted Nebraska schools and child health considerably over the years, translating into significant credibility and access to schools and school health professionals for Title V.  To ensure that the program remains responsive to changing child health needs in the population, Title V is launching a process to evaluate the role and effectiveness of the program, and identify opportunities to extend the reach and impact on child and adolescent health through systems-level innovations impacting child health and well-being at school.  The individual role of the State School Nurse Consultant represents critical expertise, often sought by individual school nurses for one-on-one consultation.  Title V is seeking strategies to grow capacity for school and child health statewide, in addition to individual school nurse practice, and enhance system-level approaches for child wellbeing.  It is becoming increasingly important that the School Health Program contributes to increasing the effectiveness of schools and school nurses systemically to meet increasing and complex needs in the population. 

 

Among numerous areas of potential interest, the School Health Program is positioned to participate with other cross-sector partners in Nebraska to help grow capacity to address mental and behavioral health needs of children and youth; decrease absenteeism and improve health management of children with asthma; enhance screening practices to more accurately inform referrals; grow consultation practice skills among all school nurses, and more.  During 2019-2020, the internal challenge to the School Health Program will be to grow the reach, scope, and effectiveness of Title V impact on child population health for children with special health needs not typically covered by an IEP (Individualized Education Plan) or served by programs such as Nebraska’s medically handicapped children’s program.  The population of children specifically of interest to the School Health Program includes those with asthma, diabetes, seizure conditions, and/or mental and behavioral health care needs including Attention Deficit Disorder/Attention Deficit Hyperactivity Disorder.

 

SNAPSHOT: PUBLIC INPUT

In June 2019, Title V conducted a public input activity for stakeholders on the proposed 2019-2020 action plan. There were 32 unique respondents.  Comments were contributed as Concerns, Needs, and Suggestions.

In the sections “Concerns” and “Needs” combined for the child population, a total of forty-eight comments were recorded. Twenty-six (54%) comments on need for high quality early social and emotional experiences for all children, whether through parenting or child care Six (12.5%) named access to health care.  Strong support was expressed for home visiting. The Department of Education was recommended as a critical partner for Title V. (Abstracted 7/10/2019 KKRN)

 

4. Relevance of current ESMs for a selected NPM and determine if new ESM needs to be established.

 

Priority: Unintentional injury among children and youth, including motor vehicle crashes.

NPM: Rate of hospitalization for non-fatal injury per 100,000 children ages 0-9 years.

ESM: The percentage of school districts participating in a child safety seat awareness campaign.

 

The 2019-2020 ESM is cumbersome however is retained for some consistency in measurement.  An early attempt to engage a small group of school nurses and community safety seat technicians in shared activities met with only slight success.  The Injury Prevention Program largely leads the child safety seat efforts in Nebraska in community and early childhood settings, more so than with schools.  Strategies within this priority have shifted to utilize the strong communication channels and relationships existing within the School Health and N-MIECHV programs, rather than to recruit schools to participate in safety campaigns.  Continuing to provide education to school nurses and adding the evaluation component to inform future work highlights Title V’s roles as a trusted source of information.  

 

Priority: Access to preventive and early intervention mental health services for children.

SPM: Percent of children, ages 9 – 35 months, who received a developmental screening using a parent-completed screening tool in the past year.

ESM: None

 

 

Priority:  Obesity/overweight among women, youth, and children, including food insecurity and physical inactivity.

NPM: Percent of children, ages 6 to 12 years, who are physically active at least 60 min. per day.

ESM: Continuation of the “School Health Data Project” plan to collect BMI and other school health data.

 

Use of the School Health Data Project as an ESM relates to the function of the Data Project in collecting and analyzing height and weight data for students in grades 1, 4, 7, and 10 in public schools in Nebraska in three-year cycles.  As the only organized effort to obtain height and weight data about the pediatric population in Nebraska, the School Health Data Project is important.  Quality improvement considerations also are part of the Title V effort.  In the past, race/ethnicity data has been made optional on the part of the schools submitting data, weakening the meaning and significance of the analysis and understanding of disparities.  The methodology of the School Health Data Project is currently receiving an overhaul as the original strategic plan for the project is re-evaluated and updated in 2019-2020.

 

5. Are Changes needed in established SPMs and SOMs?

 

SPM changes in the priority area of “Access to preventive and early intervention mental health services for children” occurred in the 2018-2019 program year.  The previous SPM in 2017-2018 program year was: Percent of children age 4 months to 5 years who have low or no risk for developmental, behavioral, or social delays.  In 2018-2019 the SPM was revised to: Percent of children, ages 9 – 35 months, who received a developmental screening using a parent-completed screening tool in the past year.  No further changes in the SPM in this population domain are planned.

 

6. Updates to the five year action plan table that reflect new or revised priority needs, evidence-based or evidence-informed strategies or performance measures for driving improved performance.  

 

Priority: Unintentional injury among children and youth, including motor vehicle crashes.

Changes in the action plan for this priority include a narrowed focus on N-MIECHV as a partner in local capacity for child safety seat technicians, and channeling information for parents through schools via the School Health Program.  New to the action plan this year is the intention to evaluate the impact of channeling information for parents through schools via the School Health Program.  Dropped is an activity from the previous year to involve a handful of school nurses in a quality improvement project activity in their schools to improve child passenger safety. 

 

At the website, www.mchevidence.org, the evidence analysis for injury prevention is under development.  Because young children are subject to parental and caregiver practices when it comes to being equipped with properly installed and fitting safety seats, it is a logical approach to seek to influence parents.  However, as suggested by strategies, Nebraska has yet to actually test the hypothesis that information channeled to parents via the school nurse at the local school actually reaches and influences parent behavior in this area.

 

Priority: Access to preventive and early intervention mental health services for children.

The action plan for this priority for 2019-2020 sustains Title V participation in the Behavioral Health System of Care, but shifts spread of tele-behavioral health from the Behavioral Health System of Care to the Pediatric Mental Health Care Access Program as lead.  The former medical home dimension has been removed from this priority in the action plan, and instead the strategies are very specific to action steps building off of findings of the CMS Affinity Group, strengthening knowledge and practice among school personnel about valid and accurate screening, and effective referrals for children and youth with behavior and mental health issues.

 

The website, www.mchevidence.org summaries evidence with regard to improving developmental screening of children as follows (retrieved 5/29/2019):

• Quality improvement in health care settings appears to be effective.
• Systems-level approaches with quality improvement interventions appears to be effective.
• Health care provider training and home visiting programs may be effective; however, further evidence is needed to fully assess.

 

The www.mchevidence.org site also promises future evidence summaries on improving health insurance coverage, presently under development.

 

Title V is taking a hearty systems-level approach to improving access to mental and behavioral health services for children and youth, by engaging schools, primary care, community partners, and networks of stakeholders and advocates for improved outcomes for children. It would appear that the systems-level approach is at least sound for this priority area.

 

Priority:  Obesity/overweight among women, youth, and children, including food insecurity and physical inactivity.

There are no changes in the action plan for this priority for 2019-2020.  It has been a challenge for Title V to find the right, and effective, strategies to address such a broad priority statement that is suggestive not only of the condition of overweight but specific root causes or determinants of interest to Nebraska stakeholders that in turn speak to significant inequities and uneven distribution of opportunities to be healthy in the population.  For all of that, Nebraska has locked into understanding School Wellness Policies and the contribution of accurate, valid data about the distribution of overweight and obesity in the school-attending population as two significant and sustainable strategies.

 

At www.mechevidence.org, the evidence summary for improving physical activity is under development.  Nevertheless, “data-driven” is a step toward “evidence-based,” and Title V is committed to sustaining a high-quality School Health Data Project with meaningful use of accurate, valid data by stakeholders and partners.