For the 2024 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.

In 2024, all activities under each priority will be assessed annually and categorized using Levels of Public Participation (Inform, Consult, Involve, Collaborate, Empower) to identify the appropriate level of public participation and engagement for each activity, as found in Appendix H. Levels of Public Participation. The Children’s health population domain will continue implementing Health Equity and Family Engagement activities. The Health Equity activities are identified in italics throughout the report and the Family Engagement 2024 activities for each population domain are highlighted in the CYSHCN 2024 Action Plan narrative.

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, the BWCH home visitation program will expand this 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 2024 focused on Children and Youth with Special Healthcare Needs (CYSHCN) can be found in the Children with Special Health Care Needs 2024 Action Plan.

The following narrative details the strategies that will either be continued or strengthened in 2024.

Arizona's Child Fatality Review (CFR) Program contracts with 10 local review teams to provide an 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. Child Fatality Reviews are conducted by a multidisciplinary 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 2024, 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 Health 2022 Annual Report and 2024 Application.

Arizona's early childhood home visiting programs provide support for new families to promote positive parenting and child development. In 2024, 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 2023 (2023-2025). BWCH is requesting the ceiling award amount of $12.6 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 to finalize 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 2,074 (1,341 evidence-based models and 733 for the promising approach) between September 30, 2023-September 29, 2024, and 2,224 (1,491 evidence-based models and 733 promising approaches) between September 2024-September 29, 2025). 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:

• AZ Title V state priority need to reduce infant mortality and morbidity and NPM 4: Breastfeeding (A. percent of infants who are ever breastfed and B. percent of infants breastfed exclusively through 6 months) through ongoing training and support for home visitors to become IBCLC certified or receive in-depth breastfeeding education and training.
• AZ 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.

The Health Start Program will continue to support ESMs within this domain (e.g., the percentage of children receiving an ASQ within 1 year of program enrollment; the 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 2024, 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 2024, 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 2024 Application.

High-Risk Perinatal Program (HRPP) planned activities for 2024 can be found in the Perinatal/Infant Health 2024 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 the ADHS Home Visiting Workgroup in 2022, COVID-19 CONSIDERATIONS: CHECKLIST AND GUIDELINES FOR RETURNING TO IN-PERSON HOME VISITS (see Appendix K). 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. 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 the home. In 2024, MIECHV, Health Start, and HRPP home visiting programs will continue to 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 the 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 2024, the Office of Injury and Violence Prevention (OIVP), 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, OIVP serves as the liaison between Safe Kids 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. OIVP 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. A component of this includes identifying participants during the training to build local child passenger safety instructor capacity. In 2024, BWCH and OIVP 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 2024, OIVP 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, OIVP continues to chair the Safe Sleep Task Force, with quarterly meetings being held. Our partners include the Department of Child Safety, Arizona Chapter of the American Academy of Pediatrics (AzAAP), March of Dimes, Arizona Perinatal Trust, First Things First, local county health departments, community partners, Indian Health Services, tribal community partners, home visitors, Health Start, birthing hospitals and/or Safe Kids coalitions. 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 2024, local county health departments will continue to receive Title V funding through the Maternal Child Health (MCH) Healthy Arizona Families (HAF) Intergovernmental Agreement (IGA) to work on several strategies and activities to improve children’s health and wellbeing, including but not limited to promotion of safe sleep environments, conducting well-woman visits, school-based bullying prevention programs, interventions aimed at reducing motor vehicle and common household injuries, etc. The ADHS Block Grants Program Manager, who manages this IGA, will participate in the Safe Sleep Task Force, the BWCH Home Visiting Work Group, the Injury Prevention Advisory Council (IPAC), and other groups as required to ensure that there is coordination between Title V-funded activities implemented by local county health departments through the MCH HAF IGA and other Title V-funded or MCH-serving work occurring at the state level.

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 2024 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.

The Adverse Childhood Experiences (ACEs) workgroup comprises the Bureau of Assessment and Evaluation and other agencies within ADHS. The workgroup will continue to carry out the agency ACEs action plans with state funding through the Smart and Safe Arizona Act (Proposition 207). The three plans are as follows: Enhance surveillance and data visualization on ACEs/PCEs; Enhance provider awareness of ACEs and PCEs; and Make ADHS a trauma-informed care agency. The workgroup will continue to collaborate with the Arizona State University Morrison Institute to conduct policy analysis with experts in ACEs in Arizona to explore policy initiatives to mitigate the effects of ACEs and inform future policies.

Lastly, continued co-sponsoring of questions related to ACEs in the Behavioral Risk Factor Surveillance Survey (BRFSS) will be a priority as it has been since 2012. The data collected is used to support internal and external stakeholders working on children's health initiatives. BWCH will continue participating in ADHS efforts and 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 in 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 the Governor’s Office for Youth, Faith, and Families; the 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 (IALT), under MIECHV funding, serves as the Home Visitation Action Team.

In 2024, 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 frequently 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 childcare facilities. ADHS-licensed facilities participating in the Empower Program pledge to adopt ten (10) standards that support healthy eating, nutrition security, breastfeeding, encouraging active play, preventing exposure to tobacco and nicotine, promoting social and emotional development, professional development of staff, practicing sun safety, and promoting good oral health habits in exchange for a 50% reduction in licensing fees. In addition, the Department of Economic Security (DES) requires Empower participation for all of their contractors. In 2024, Arizona’s Title V Program will continue to provide funding to BNPA to support child care quality improvements through the Empower program.

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, and Oral Health), the Bureau of Nutrition and Physical Activity (i.e., WIC Program, Early Care and Education, andAZ Health Zone), Bureau of Chronic Disease and Health Promotion (Tobacco), Bureau of Child Care Licensing, Bureau of Environmental Health (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 the Arizona Department of Education (Child and Adult Care Food Program [CACFP], Early Childhood Education, Early Childhood Special Education), Department of Economic Security (Arizona Early Intervention Program [AzEIP], Division of Child Care) and First Things First.

In 2023, the Empower standards and components revisions were finalized and implemented statewide, effective July 1, 2023. In 2024, Arizona’s Title V Program will continue to provide partial funding to support the work of the EAC and workgroups with building out additional resources on the Empower website to match the revised standards. Resources will include updated training courses, also offered in the Arizona Early Childhood Workforce Registry, as well as updated materials and other helpful tools to improve health practices in childcare facilities.

The mission of the Arizona State Nutrition Action Committee (SNAC) is to strategically align nutrition and physical activity efforts across programs statewide to ensure that Arizonans have access to resources that support increased knowledge and cultivate the environment to live a healthy lifestyle. The SNAC engages multisector partners in improving health outcomes by forming workgroups to increase nutrition security, improve redemption, provide consistency, and support policy, system, and environmental changes within federal and state nutrition and physical activity programs across Arizona.

The Arizona Partnership for Immunization (TAPI) will continue to promote immunizations statewide in partnership with ADHS. Using their 500 members representing over 400 organizations, TAPI will distribute educational pieces to schools, childcare facilities, private providers, county health departments, community health centers, managed care organizations, and WIC sites.

TAPI will further promote usage by parents and professionals of the TAPI website (www.whyimmunize.org), which has been redesigned to better meet the needs of the community. TAPI’s 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 interest in the COVID-19 vaccine to include education to minimize exemptions, strengthen parent and doctor relationships, and share 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. TAPI will work with agencies on vaccine equity and provide support with vaccine education through nationally recognized immunization awareness days, weeks, and months. The continuation of HPV vaccine education is planned through both dental partnerships and collaborations of HPV-related research and educational grant agencies. BWCH will continue to partner with TAPI to support oral health providers in promoting the HPV vaccine for adolescents and women.

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

As a result of the COVID-19 vaccine changes, 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 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.

OCH will continue to monitor the Children’s Information Helpline, one of the three areas covered by the Arizona Title V toll-free helplines for pregnant women, infants, and children. The Strong Families AZ Helpline will continue to provide information and assistance to pregnant women and children in addition to serving as the state’s home visiting referral line. 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 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 (WIC) Program Helplines.

The ADHS Sensory Screening Program, funded through Title V, 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 to facilitate 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 screeners, and revision and issuance of hearing and vision rules and program guidelines. Areas of focus will include; updates to the hearing and vision screening rules, creation of web-based training, revision of hearing screening training and the sensory screening training process, increasing the number of trainers and screeners throughout the State, and continued support of statewide access to hearing and vision screening equipment for Arizona trainers and screeners.

In 2024, BWCH will continue to use Title V funds to 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 2024, AzAAP will continue to certify and recertify PPEC hospitals and provide a publicly available, up-to-date register of hospital emergency departments that are certified: https://azaap.org/ppec. AzAAP will also 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 2024, 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 within 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.

The Office of Children’s Health through the CYSHCN Program will continue to support the Bureau-wide implementation of the Family and Young Adult Engagement contract awarded to Diverse Ability Inc. and Raising Special Kids. For Children’s Health, similar to Perinatal/Infant Health, the goal is to connect the CYSHCN Family advisors to more opportunities that impact the population served within this priority by connecting to programs like the High-Risk Perinatal Program, Safe Sleep, and Home Visiting. Through that initial intentional review of the program, we will be able to develop a family engagement role that will be able to continue to collaborate with initiatives within the Child Health domain. Due to current exploratory conversations and leading the efforts in bureau-wide implementation, the CYSHCN Program Family Advisor Dawn Bailey, along with Diverse Ability Inc. will share information on family engagement best practices at a learning festival taking place in 2024 for the Home Visiting Program.

Alongside the Children’s Health activities and work that will be led by the Office of Children’s Health team and collaborators, the Office of Oral Health (OOH) and Primary Care Office (PCO), housed within BWCH, will continue their cross-cutting activities relating to Children’s Health.

In 2024 the ADHS Office of Oral Health (OOH), within the Bureau of Women’s and Children’s Health, will continue to work toward reducing disparities in oral health by focusing on fundamental principles and strategies that are: equity-focused, evidence-empowered, data-driven, integration-centered, stakeholder engagement and innovation focused. Arizona will continue to focus on increasing the percentage of children who have a preventive dental visit (NPM 13.2). The percentage of Arizona children ages 1-17 who received preventive dental care in the previous two years dropped slightly from 77.5% in 2019-2020 to 75.16% in 2020-2021 (National Survey of Children’s Health). A key objective in Arizona’s Title V plan is to increase the number of students who receive preventive dental screenings, referrals, and the establishment of a dental home. Key programs and initiatives to meet this objective for the new year include the School-based Dental Sealant Program, the Silver Diamine Fluoride (SDF) Program, Fluoride Varnish Program, the Healthy Smiles Healthy Bodies Survey, Oral Health Workforce Development Program and the Arizona Mission of Mercy. Except for the Workforce Development Program, which is funded through a separate grant from HRSA, each of these programs receives partial funding from Title V through annual grants. The Title V funding administered through these programs helps to ensure the delivery of equity-focused, evidence-based core MCH services aligned with state-identified priorities as well as locally identified needs.

To help achieve the overarching goal of reducing health disparities across all population domains, OOH will continue to educate communities and individuals on the benefits of Community Water Fluoridation. OOH will provide technical assistance to communities, water systems, and other organizations that are sustaining existing fluoridation efforts or are looking to implement new water systems. OOH will continue to partner with tribal and minority grassroots organizations and the statewide oral health coalition to increase outreach, identify resources, and implement programs aimed at reducing oral health disparities through community water fluoridation efforts.

HRSA initially awarded ADHS the Oral Health Workforce grant to implement a silver diamine fluoride (SDF) program. While the grant ended in 2023, the program will continue into 2024 in collaboration with the Dental Sealant Program and Fluoride Varnish Program. The SDF Program pilot projects began in 2019 in Cochise, Pima, Pinal, and Santa Cruz counties. In 2024, the SDF program will expand services to more counties by adding silver diamine fluoride services for those children who are also eligible for the partner programs.

OOH will continue to collaborate with the Arizona Health Care Cost Containment System (AHCCCS; Arizona’s Medicaid agency) to identify opportunities to link Medicaid-eligible children to dental homes. As a result, referral connections will continue to be made with AHCCCS-contracted health plans to help establish follow-up care for children in need.

OOH has a robust and long history of implementing children’s evidence-based preventive dental programs. The premier oral health program is the School-based Dental Sealant Program, which includes dental sealants for 2nd and 6th graders, fluoride varnish for kindergarten children, and silver diamine fluoride for all participating grades. The Program will be conducted in school-based settings using a public health dental hygienist and assistant team. OOH will partner with Pima, Gila, and Maricopa County Health Departments as well as the Sun Life Family Health Center which receives partial funding from Title V through annual grants. In addition, OOH will look to expand services to Mohave and La Paz counties through a partnership with River Cities United Way.

In addition to collaborating with county health departments, OOH will continue its partnership with AT Still University, School of Dentistry and Oral Health and Tooth BUDDS to implement the sealant program in underserved schools. Through this program, dental screenings, sealants, and referral services will be provided to children at eligible schools by licensed dental faculty and dental students, and dental hygienists. Through this program, a partnership with federally qualified health centers (FQHCs) and local community dental clinics in Pinal, Graham, and Greenlee Counties was established and will continue to be utilized for children needing additional dental services. In FY24, the goal is to continue to serve the 25 eligible schools that participated in the school-based sealant program through this partnership.

The Fluoride Varnish Program will continue to provide services for children at schools where there is a high majority of children receiving free and reduced lunch. In Arizona, 52% of children have experienced tooth decay by the time they reach kindergarten. With several frontier and rural counties in Arizona considered dental deserts, options for oral healthcare are limited. The Fluoride Varnish Program works to improve access to preventive oral health for kindergarten children by targeting children at high-risk schools and providing screenings, referrals, and fluoride varnish services. Kindergarten is age appropriate for screening, fluoride varnish, and dental referrals so children will be healthy, school-ready, and able to learn.

In addition, OOH will analyze and disseminate data from the statewide oral health survey, Healthy Smiles, Healthy Bodies, which was completed during the 2022-2023 school year. The survey includes a stratified random selection of schools to provide county-level point estimates and identify disparities in oral health. Through a partnership with First Things First, Arizona’s early childhood agency, children in kindergarten and 3rd grade will be screened. Data from the survey will be disseminated and shared with partners, stakeholders, and the CDC’s National Oral Health Surveillance System to help monitor the health status of children and improve oral health programs. In addition, a partnership with the ADHS Bureau of Nutrition and Physical Activity (BNPA) allows for the collection of children’s BMI status.

OOH will continue its partnerships with the Arizona Alliance for Community Health Centers, the Inter Tribal Council of Arizona, and the Greater Valley Area Health Education Center to provide professional development opportunities for dental providers and program administrators on dental public health and workforce development priorities targeted to underserved child populations. The OOH will continue to provide oral health anticipatory guidance for preschool and school-aged children, oral health surveillance, and motivational interviewing training across the state for home visitors with a focus on reaching rural home visitors. Evaluation will continue to measure provider confidence in speaking to families about oral health.

The OOH will continue to partner with the BNPA to support and promote the Empower Program. Early Care and Education (ECE) Providers are in a special position to empower young children to learn habits that can keep them healthy for life. The Empower Program is a voluntary program to support licensed ECE facilities' efforts to empower young children to grow up healthy. Today, the Empower Program reaches more than 200,000 children in state-licensed and certified early care and education facilities throughout Arizona. Materials designed to promote oral health literacy have been developed to assist childcare facilities in implementing toothbrushing programs and oral health education activities. Materials include the ‘Arizona Tooth Brushing Manual: Fostering Healthy Smiles in the Child Care Setting for Ages 3 and Older’ and an online course, ‘Toothbrushing in Child Care Settings.’ More than 550 providers have completed this online course since its launch in September 2017. Lastly, oral health education materials are regularly included in the monthly Empower Newsletter, reaching over 4,500 subscribers.

The Primary Care Office (PCO) will continue to lead efforts to improve access to care to all health services in Arizona’s rural and underserved communities through the Arizona State Loan Repayment Program (SLRP), the Behavioral Health Loan Repayment Program, the National Health Service Corps Loan Repayment Program (NHSC), the Nurse Corps, the Accelerated Nursing Programs, the Nursing Education Investment Pilot Program, the Preceptor Grant program, the Conrad 30 Waiver Program, and the National Interest Waiver Program.

Additional information about the Primary Care Office and Access to Care activities can be found in the Perinatal/Infant Health 2024 Action Plan.